16-Hemorrhage
Petechia (pxx021)
(pxxo55)
(pxx231) (pxx233) (pxx257) (pxx258), epistaxis, bloody wounds, bloody gums (bxx046),
bloody sputum (scx006) (scx007), bloody stools (sfx015) (sfx014) (sfx008) (sfx026),
sub corneal hemorrhage (yxx005),
hematoma/ echymosis (pxx232) (pxx247) or hemorrhage anywhere else can be connected with hemostatic
problems. We do not have many ways to treat because of lack of lab tests and
suitable drugs.
Drugs we have access to:
- Vit K 1amp IV or IM 1 amp
1x/day for 3days
- Transamine 1tab 3x/day for
many days (often useless)
- Adrenaline mixed with sterile
water used topically for epistaxis, wounds…
Curative:
- Stop diclofenac, aspirin,
other NSAIDs… Reduce corticoids…
- Check if cause of hemorrhage could be one of the following
drugs: Bactrim, chloramphenicol, sulfa.
Difficult to know, of course, but for security, often we stop these drugs
if it is possible. (bxx050)
(pxx258)
See "Allergy"
- If patient takes TB drugs or TOXO
drugs, check if receiving also folic acid...
If not, you must give it!
- If patient has red blood mixed with feces, give metronidazole
400mg 3x/day (scx006) (scx015)
- If gastric origin is possible (epigastric pain,stomach ache,
melena (scx008)(sfx026)),
give cimetidine 400mg 2-3x/day
- If bloody sputum, think about TB.
- Finally, think about idiopathic thrombocytopenic purpura (petechia...but
no echymosis!), which is not rare in AIDS. Treat with prednisolone (2 tabs 3x/day)... or dexa
(4tabs in the morning + 1 tab at noon) as a last chance test if the hemorrhagic
problem is more and more severe (connection possible with autoimmune problem)
NB "vascular hernia syndrome"
is a strange bloody disease that we observe sometimes in our ward. A few
vascular hernias, full of blood, disseminated on the body, but especially on
lips and border of former wounds. On the lips, it can become a spectacular
tumor... For us, it seems that sulfa is the main cause. See comments
under photos:(bxx050) (pxx259) (pxx260)...//
(bxx031)
(bxx032)//See
"protocol
allergy"
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