Blood loss estimation in epistaxis scenarios

Beer, Helen; Duvvi, S; Webb, Christopher; Tandon, S

doi:10.1258/0022215053222752

Cited by 28 publications

(23 citation statements)

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“…However, the diagnosis of hemorrhage is of primary concern and the importance of the accurate estimation of blood loss is paramount to allowing the appropriate intervention by warning of impending hemorrhagic shock. Estimates of blood loss by paramedics [64], surgeons [65] and obstetricians and midwives [66] are often inaccurate and vary widely. Studies following vaginal [67] and abdominal delivery [68] show visual estimation of blood loss to be of limited clinical use.…”

Section: Discussionmentioning

confidence: 99%

Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group

Knight

Callaghan

Berg

et al. 2009

BMC Pregnancy Childbirth

595

426

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BackgroundPostpartum hemorrhage (PPH) is a major cause of maternal mortality and morbidity worldwide. Several recent publications have noted an increasing trend in incidence over time. The international PPH collaboration was convened to explore the observed trends and to set out actions to address the factors identified.MethodsWe reviewed available data sources on the incidence of PPH over time in Australia, Belgium, Canada, France, the United Kingdom and the USA. Where information was available, the incidence of PPH was stratified by cause.ResultsWe observed an increasing trend in PPH, using heterogeneous definitions, in Australia, Canada, the UK and the USA. The observed increase in PPH in Australia, Canada and the USA was limited solely to immediate/atonic PPH. We noted increasing rates of severe adverse outcomes due to hemorrhage in Australia, Canada, the UK and the USA.ConclusionKey Recommendations1. Future revisions of the International Classification of Diseases should include separate codes for atonic PPH and PPH immediately following childbirth that is due to other causes. Also, additional codes are required for placenta accreta/percreta/increta.2. Definitions of PPH should be unified; further research is required to investigate how definitions are applied in practice to the coding of data.3. Additional improvement in the collection of data concerning PPH is required, specifically including a measure of severity.4. Further research is required to determine whether an increased rate of reported PPH is also observed in other countries, and to further investigate potential risk factors including increased duration of labor, obesity and changes in second and third stage management practice.5. Training should be provided to all staff involved in maternity care concerning assessment of blood loss and the monitoring of women after childbirth. This is key to reducing the severity of PPH and preventing any adverse outcomes.6. Clinicians should be more vigilant given the possibility that the frequency and severity of PPH has in fact increased. This applies particularly to small hospitals with relatively few deliveries where management protocols may not be defined adequately and drugs or equipment may not be on hand to deal with unexpected severe PPH.

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Section: Discussionmentioning

confidence: 99%

Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group

Knight

Callaghan

Berg

et al. 2009

BMC Pregnancy Childbirth

595

426

View full text Add to dashboard Cite

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“…9 Accurate visual estimation of cumulative blood loss forewarns of impending haemorrhagic shock. Estimates of blood loss by paramedics 10 and surgeons 11 are inaccurate, and studies following vaginal 12 and abdominal delivery 13 show visual estimation to be of limited clinical use. Menstrual pictograms to facilitate the assessment of menorrhagia in the field of gynaecology 14 have now been produced; however, little pictorial data yet exist to facilitate similar estimations of blood loss in obstetrics.…”

Section: Introductionmentioning

confidence: 99%

Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions

Bose¹,

Regan

Paterson‐Brown³

2006

BJOG

348

218

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Objectives Following the results of the Confidential Enquiries into Maternal Deaths report, which claims two maternal deaths annually in the UK from postpartum haemorrhage, our aim was to assess the accuracy of ‘visual estimation of blood loss’ and produce suitable pictorial and written algorithms to aid in the recognition and management of massive obstetric haemorrhage. Design Observational study to determine discrepancy between actual blood loss (ABL) and estimated blood loss (EBL). Setting Teaching hospital. Population Hundred and three obstetricians, anaesthetists, midwives, nurses and healthcare assistants. Methods Clinical scenarios were reproduced in the form of 12 Objective Structured Clinical Examination (OSCE) style stations augmented with known volumes of whole blood. Individual staff estimated the blood loss visually and recorded their results. Digital photographs were used to produce a pictorial ‘algorithm’ suitable for use as a teaching tool in labour ward. Main outcome measures Areas of greatest discrepancy between EBL and ABL. Results Significant underestimation of the ABL occurred in 5 of the 12 OSCE stations: 500‐ml (50‐cm diameter) floor spill, 1000‐ml (75‐cm diameter) floor spill, 1500‐ml (100‐cm diameter) floor spill, 350‐ml capacity of soaked 45‐ × 45‐cm large swab and the 2‐l vaginal postpartum haemorrhage on bed/floor. Conclusions Accurate visual estimation of blood loss is known to facilitate timely resuscitation, minimising the risk of disseminated intravascular coagulation and reducing the severity of haemorrhagic shock. Participation in clinical reconstructions may encourage early diagnosis and prompt treatment of postpartum haemorrhage. Written and pictorial guidelines may help all staff working in labour wards.

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“…Our case was unique in the sense that a haemangioma of the size smaller than a pea (5 mm 9 5 mm) could produce so much blood loss that the patient required transfusion [5]. Although the haemangiomatous mass was situated in the nasal cavity it hardly produced symptoms of frank epistaxis and the bleeding was mostly posterior producing symptoms of haemoptysis and haematemesis, and despite all investigations rigid endoscopy provided the relevant information and was helpful in treatment of the case [6].…”

Section: Discussionmentioning

confidence: 79%

Intractable Anemia: A Case of Bleeding Nasal Cavernous Hemangioma

Sarkar

Roychoudhury

Roychaudhuri

2011

Indian J Otolaryngol Head Neck Surg

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Cavernous haemangioma of the nose is rare, but when it occurs it usually presents with severe epistaxis. This nasal pathology is mostly seen in adult patient patients. Standard approach to dealing with such haemangiomas is surgical resection. A 30-year-old woman presented to General Physician with history of haemoptysis, haematemesis and weakness. She was admitted for investigation of her severe anaemia. On examination there was no obvious source of bleeding in the mouth or oropharynx, and Upper GI endoscopy did not reveal any pathology. She was referred to us after a trivial episode of epistaxis. Anterior and posterior rhinoscopy did not reveal any abnormality. Her extreme anxiety made indirect laryngoscopy and post-nasal space examination difficult but no obvious abnormality was seen. Diagnostic nasal endoscopy was done, and a small haemangiomatous mass was found in the postero superior part of inferior turbinate. Excision of the mass was done under local anaesthesia and sent for histopathological evaluation. The mass on histopathology came out to be Cavernous haemangioma.

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Blood loss estimation in epistaxis scenarios

Cited by 28 publications

References 0 publications

Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group

Trends in postpartum hemorrhage in high resource countries: a review and recommendations from the International Postpartum Hemorrhage Collaborative Group

Improving the accuracy of estimated blood loss at obstetric haemorrhage using clinical reconstructions

Intractable Anemia: A Case of Bleeding Nasal Cavernous Hemangioma

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