ICU Map

Bleeding

From assessing hemodynamic stability to correcting reversible contributors to coagulopathy.

RecognizeAssessDecideDifferentialInterveneReassess
Bleeding
Diagnosis / EtiologyAssess hemodynamic stability firstExplore Topic
Vital signs, mentation, and capillary refill determine whether this is major, life-threatening bleeding.
Assessment StepIdentify the source
Exam plus history — gastrointestinal, a surgical or procedural site, trauma, or an occult source (retroperitoneal, thoracic).
Diagnosis / EtiologySend type & screen/crossmatch and coagulation labsExplore Topic
CBC, coagulation panel, and fibrinogen; activate the massive transfusion protocol if bleeding is major.
Clinical ActionCorrect reversible contributors
Identify and address anything actively worsening the bleeding, in parallel with source control.
Differential Branches (3)
1Branch
Physiologic MechanismAnticoagulant-associated
Identify the specific agent and last dose; use targeted reversal where one exists rather than empiric plasma.
2Branch
Physiologic MechanismCoagulopathy of critical illnessExplore Topic
Correct with blood products guided by actual coagulation labs, not empirically.
3Branch
Physiologic MechanismThrombocytopenia
Assess platelet count and function; transfuse according to bleeding severity and the relevant threshold.

An educational representation of clinical reasoning, not a diagnostic algorithm or personalized medical advice — always apply clinical judgment and institutional protocols.

Caution

Escalate — Red Flags & Critical Warnings

  • Signs of hemorrhagic shock (tachycardia, hypotension, altered mentation) — activate the massive transfusion protocol and pursue source control in parallel with resuscitation, not after it.
  • Life-threatening hemorrhage on a direct oral anticoagulant — give targeted reversal (e.g. idarucizumab for dabigatran; for factor-Xa inhibitors use the locally recommended reversal strategy (commonly 4F-PCC in the U.S. in 2026)) rather than relying on plasma alone.

Related Bedside Clinical Problems (20)

Bedside Presentations
New or Massive Hemoptysis

Airway preservation and bleeding localization: non-massive vs massive hemoptysis (> 100–200 mL/hr), lateral decubitus positioning, isolation of the bleeding lung, and endovascular/bronchoscopic intervention.

View Bedside Problem →
Acute Hypotension & Undifferentiated Shock

Rapid bedside hemodynamic categorization: confirming MAP < 65 mmHg, assessing peripheral perfusion, POCUS cardiac/IVC profiling, and differentiating hypovolemic, distributive, cardiogenic, and obstructive etiologies.

View Bedside Problem →
Refractory Shock Despite High-Dose Vasopressors

Advanced multimodal hemodynamic rescue: second-line vasopressors (vasopressin, angiotensin II), inotropic augmentation, stress-dose steroids, metabolic correction, and mechanical circulatory support evaluation.

View Bedside Problem →

Linked Deep-Dive Topics (8)

Reference Knowledge
Major Bleeding, Hemorrhagic Shock, & Damage Control Resuscitationhematology

The trauma lethal diamond (hypothermia, acidosis, coagulopathy, hypocalcemia), 1:1:1 massive transfusion (PROPPR trial), early TXA (CRASH-2), and TEG/ROTEM algorithms.

Explore Topic →
Blood Product Transfusion in Critical Carehematology

Patient-specific RBC transfusion thresholds, current platelet/procedural thresholds, plasma/cryoprecipitate use, and the TRALI vs TACO diagnostic matrix.

Explore Topic →
Therapeutic Anticoagulation & Emergency Reversal in the ICUhematology

UFH vs LMWH vs DTIs (Argatroban/Bivalirudin), anti-Xa vs aPTT monitoring, and emergency reversal (Protamine, 4F-PCC, Idarucizumab; historical andexanet evidence with current availability caveats).

Explore Topic →
Upper Gastrointestinal Bleeding (UGIB)gi-hepatic

Risk-stratified non-variceal and variceal hemorrhage care: resuscitation, selective airway protection, individualized transfusion, PPI or portal-pressure therapy, endoscopic hemostasis, and escalation to IR/TIPS/surgery when indicated.

Explore Topic →
Lower Gastrointestinal Bleeding (LGIB)gi-hepatic

Risk stratification, selective assessment for an upper source, CTA localization of ongoing severe bleeding, endoscopic or catheter therapy, and individualized transfusion/resuscitation.

Explore Topic →
Disseminated Intravascular Coagulation (DIC) & Sepsis Coagulopathyhematology

Tissue-factor-driven coagulation activation, antithrombin/protein C depletion, PAI-1-associated fibrinolytic suppression, ISTH 2025 DIC assessment, comparison with TTP/HUS/HIT, and targeted replacement.

Explore Topic →
Shock: Foundational Critical Care Frameworkcardiovascular

Cellular dysoxia, DO2/VO2 physiology, the 4 shock phenotypes, dynamic fluid responsiveness (PLR/PPV) vs fluid tolerance (VExUS), and vasoactive pharmacology.

Explore Topic →
Heparin-Induced Thrombocytopenia (HIT)hematology

PF4-heparin antibody Fc-gamma-RIIa platelet activation, the 4Ts score, ELISA OD values vs Serotonin Release Assay (SRA), and direct thrombin inhibitor protocols.

Explore Topic →

Evidence status

Review metadata not yet recorded.

Status, review dates and guideline versions appear here once editorial metadata is authored for this content.