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Haemorrhage _VERIFIED_

Intracerebral haemorrhage is an important public health problem leading to high rates of death and disability in adults. Although the number of hospital admissions for intracerebral haemorrhage has increased worldwide in the past 10 years, mortality has not fallen. Results of clinical trials and observational studies suggest that coordinated primary and specialty care is associated with lower mortality than is typical community practice. Development of treatment goals for critical care, and new sequences of care and specialty practice can improve outcome after intracerebral haemorrhage. Specific treatment approaches include early diagnosis and haemostasis, aggressive management of blood pressure, open surgical and minimally invasive surgical techniques to remove clot, techniques to remove intraventricular blood, and management of intracranial pressure. These approaches improve clinical management of patients with intracerebral haemorrhage and promise to reduce mortality and increase functional survival.


The aim of this study was to establish the relative importance of risk factors for mortality after acute upper gastrointestinal haemorrhage, and to formulate a simple numerical scoring system that categorizes patients by risk. A prospective, unselected, multicentre, population based study was undertaken using standardised questionnaires in two phases one year apart. A total of 4185 cases of acute upper gastrointestinal haemorrhage over the age of 16 identified over a four month period in 1993 and 1625 cases identified subsequently over a three month period in 1994 were included in the study. It was found that age, shock, comorbidity, diagnosis, major stigmata of recent haemorrhage, and rebleeding are all independent predictors of mortality when assessed using multiple logistic regression. A numerical score using these parameters has been developed that closely follows the predictions generated by logistical regression equations. Haemoglobin, sex, presentation (other than shock), and drug therapy (non-steroidal anti-inflammatory drugs and anticoagulants) are not represented in the final model. When tested for general applicability in a second population, the scoring system was found to reproducibly predict mortality in each risk category. In conclusion, a simple numerical score can be used to categorize patients presenting with acute upper gastrointestinal haemorrhage by risk of death. This score can be used to determine case mix when comparing outcomes in audit and research and to calculate risk standardised mortality. In addition, this risk score can identify 15% of all cases with acute upper gastrointestinal haemorrhage at the time of presentation and 26% of cases after endoscopy who are at low risk of rebleeding and negligible risk of death and who might therefore be considered for early discharge or outpatient treatment with consequent resource savings.

A subconjunctival haemorrhage is one common cause of a red eye. It is caused by a small bleed behind the covering of the eye. It can look alarming but it usually causes no symptoms and is usually harmless. The redness usually clears within two weeks.

Occasionally, a subconjunctival haemorrhage can be caused by an injury to the eye or a head injury. Sometimes they occur after a bout of coughing or being sick (vomiting). They are associated with other medical conditions such as high blood pressure (hypertension), diabetes mellitus and coronary heart disease. If you have a bleeding disorder, such as haemophilia, or if you take anticoagulant medication (blood thinners such as warfarin), you may be more prone to getting a subconjunctival haemorrhage (or other bleeding such as nosebleeds or easy bruising).

Usually none. You often do not notice it until someone points it out to you, or you see it in a mirror. It can be alarming, as sometimes a large part of the white of the eye (sclera) appears bright red. This is because the tiny bleed (haemorrhage) spreads between the thin 'skin' on the front of the eyeball (the conjunctiva) and the sclera in a thin film. It looks a lot worse than it really is! Your eye might feel mildly irritated but your vision should be entirely normal. It is not uncommon for it to happen again at a later date.

The most common types of brain haemorrhage that can happen in full term babies are called subarachnoid haemorrhage and subdural haemorrhage. Other types of brain haemorrhage, including an IVH, are less common in babies born at term.

Having a baby who is unwell with a brain haemorrhage in intensive or special care can be a stressful experience. You may feel out of control of your situation. Feeling this way is very common. How you feel and process what has happened to you might be different to others who face these challenges. We have some information about how you might be feeling and the different types of support available.

WGH/RIE: Attending clinicians should telephone switchboard on the emergency number (2222), informing them that there is major haemorrhage, the name and location of the patient and a contact telephone number (and individual where possible).

Urgent blood transfusion should be considered in the case of moderate to severe post-operative haemorrhage. If severe bleeding, this should be in the form of red blood cells, platelets, and fresh frozen plasma, with a major haemorrhage protocol activated as necessary

Upon review with a senior, it may be appropriate to re-operate on the patient for further haemostasis. Conservative management may be indicated in smaller haemorrhages, but close monitoring should always be undertaken.

Post-operative thyroidectomy or parathyroidectomy haemorrhage can have catastrophic consequences and the operating surgeon must take great care to ligate any vessels and coagulate bleeding points.

The primary sign of post-operative haemorrhage is likely to be airway obstruction. This is because the pretracheal fascia of the neck will only distend so far; when bleeding occurs into this space, compression on the venous return results in venous congestion, with subsequent laryngeal oedema leading to eventual asphyxiation.

For any suspected occult retroperitoneal haemorrhage, apply pressure to the puncture site, resuscitate the patient, ensure blood products are made immediately available, and call for senior support. Cross-sectional imaging to confirm the diagnosis is often required.

A subarachnoid haemorrhage (SAH) is an uncommon type of stroke caused by bleeding on the surface of the brain. It is a very serious condition and can be fatal (NHS 2019). SAH after the rupture of a cerebral aneurysm is the cause of approx. 6% - 8% of all cerebrovascular accidents, affecting approx.10 per 100,000 people each year (Castanares-Zapatero et al 2011). Due to the bleeds nature, symptoms that could relate to a SAH diagnosis should be treated with urgency and warrant a 999 call.

A weak or thin spot in the wall of an artery that balloons out is called an aneurysm. The aneurysm gets weaker as it gets bigger, and there is a risk it will burst and leak blood. Aneurysms often cause a subarachnoid haemorrhage.

Major haemorrhage is a clinical emergency that results in morbidity and mortality: practice guidance is important to reduce these risks. Delayed recognition of bleeding continues to be one factor for adverse outcomes in the management of major haemorrhage, as described in a recent SHOT report.5

This 2015 BSG Guideline was recently reviewed by the BSG Liver Section Committee (March 2022). The Guideline covers primary prophylaxis of bleeding, management of acute haemorrhage, and secondary prophylaxis following a variceal bleed. Much of the guidance remains valid, specifically the sections on acute bleeding and secondary prophylaxis, which are in line with current practice and continue to be appropriate. Therefore, the BSG recommend the Guidelines should still be followed in these areas.

These updated guidelines on the management of variceal haemorrhage have been commissioned by the Clinical Services and Standards Committee (CSSC) of the British Society of Gastroenterology (BSG) under the auspices of the liver section of the BSG. The original guidelines which this document supersedes were written in 2000 and have undergone extensive revision by 13 members of the Guidelines Development Group (GDG). The GDG comprises elected members of the BSG liver section, representation from British Association for the Study of the Liver (BASL) and Liver QuEST, a nursing representative and a patient representative. The quality of evidence and grading of recommendations was appraised using the AGREE II tool. 041b061a72


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