Bleeding, Bruising - 15-1
Some bleeding or bruising, although common, is idiopathic and/or self-limiting (e.g., epistaxis, post-traumatic bruising). However, excessive or spontaneous bleeding/bruising may point to a serious underlying disease, in which case urgent management may be required. Note that bleeding related to major organ systems is covered under other objectives (e.g., , , , ).
- Localized bleeding (e.g., epistaxis, laceration)
- Hemostasis disorders
- Platelet or blood vessels disorders (e.g., von Willebrand disease, collagen disorder, medication-induced)
- Coagulation disorders (e.g., factor VIII or vitamin K deficiency, fibrinolysis)
Given a patient with a bleeding tendency or bruising, the candidate will diagnose the cause, severity, and complications, and will initiate an appropriate management plan, recognizing that some presentations are self-limited.
Given a patient with a localized or other bleeding/bruising, the candidate will
- list and interpret critical clinical findings, including results of an appropriate history and physical examination performed with a particular attention to
- airway and hemodynamic status;
- differentiation between various disorders of hemostasis and self-limited and/or idiopathic bleeding (e.g., epistaxis);
- list and interpret relevant investigations (e.g., complete blood count, coagulation studies);
- construct an effective initial management plan, including
- initiating immediate management of bleeding (e.g., nasal packing, IV resuscitaiton if hemodynamically unstable);
- providing counselling/education on how to prevent future episodes;
- making a determination as to whether specialized care is required.