Clot or Bleed

Post on 03-Jun-2018

225 views 0 download

Transcript of Clot or Bleed

  • 8/12/2019 Clot or Bleed

    1/52

  • 8/12/2019 Clot or Bleed

    2/52

    "#$%& &'() *%(+,"#$%&'(&)& )& %*# %+ ',% -(.'& %+ -(',%/%01 ',(' /%'& %+ &'23#*'& +)*3 %4#.5,#/$)*06 7,#.#8& &%$29, 0%)*0 %* )* ',# 9%(02/(')%* 9(&9(3# (/%*# : &% $(*1 ;%$(* *2$#.(/&< &% $(*1 (..%5& '%3)++#.#*' $%/#92/#&< &% $(*1 &)$)/(.:&%2*3)*0 (==.#4)(')%*&666)'8& #*%20, '% $(># ( -#.&%* ',.%5',# =%%> (' ',# 5(// (*3 0% '(># ( *(-6 ?& %*# &'23#*' -2' )'@ AB 3%*C' >*%5 (*1%*# 5,% 3%#&*C',('# 9%(06D

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

    -.&/0 ',12B+ 1%2 (.# &'29>< %. +.2&'.('#3< %. )+ &%$#',)*0 J2&' 3%#&*8' $(># *< +##/ +.## '% *3 $# (*#$()/ (' -(',%/%01K-(',%/%01&'23#*'69%$6 B8// 3% $1 =#&' '% 0#' 1%2 2*&'29> (*3 =(9> %* '.(9>6

    "345$61,+*,7,5&)? =)0 ',(*>& '% L#++.#1 M29(> +%. ,)& $#')92/%2& #3)')*06

    N OPQQ R(',%/%01 S'23#*'

  • 8/12/2019 Clot or Bleed

    3/52

    R(0# T %+ UO

    8'02&,/ 9: ;$6

  • 8/12/2019 Clot or Bleed

    4/52

    R(0# [ %+ UO

    M#'8& '(># ( G2)9> /%%> (' 5,('8& 0%)*0 %* )* #(9, &'#- V5#8// 0#' )*'% $%.# 3#'()/ )* ( $)*2'#W6

    9>?1$$+ @,)),1) 3$5)&/(3& 7,)& )& ( 0%%3 5(1 '% G2)9>/1 92' 3%5* %* =/%%3 /%&&\ 4#&/ 9%*&'.)9')%* /#(3& '% 3#9.#(

    =/%%3 +/%5< .#329)*0 ',# ($%2*' %+ =/%%3 /%&'6 B' (/&% ,#/-& -/('#/#'& (*3 9%(02/(')%* +(9'%.& 9%$# )*'% 9%*'(9' 5)', #(9, %',#. (*3 &')9>

    '%0#',#. 5,#* ',#1 =2$- )*'% #(9, %',#. V5,)9, )& *#9#&&(.1 +%. ',# 5,%/# -.%9#&& '%-.%9##3W6 ]%.$(//1< ',# &-##3 (*3 &,#(. &'.#&& %+ =/%%3 +/%5 A=.#(>&D ',)& =)*3)*0 (++)*)'16

    ]%=%31 '(/>& $29, (=%2' ',)& -(.' %+ 9/%'')*0 V(*3 *#)',#. 5)// 5#W : -.%=(=/1 =#9(2 )'5%.>& -.#''1 5#// $%&' %+ ',# ')$#< (*3 ',#.# (.#*8' $(*1 3)(& )*4%/4)*0 ',)& &'#- %+9/%'')*06

    A>B10&,1,&)C$/7 0 21%* B* ',)& &'#-< ',# -/('#/#'& 9/2$- '%0#',#. (*3 +%.$ ( /)''/# $2&,1 -/20 ',(' 9%4#.& ',# ,%/#

    )* ',# 4#&/6 B'8& 0.#(' : =2' 5)',%2' ',# +)*(/ &'#- V+)=.)* +%.$(')%*W< )' 5%2/3 +(// (-(.' (*3=# 2/#&&6

    7,)& &'#- )& %+'#* 9(//#3 A-.)$(.1 ,#$%&'(&)&D V)* &-)'# %+ ',# +(9' ',(' )'8& *%' .#(//1 ',#+).&' ',)*0 ',(' ,(--#*& )* 9/%'')*0W6

    D>E(#/(5 ),01) &', 21%* B* ',)& +)*(/ &'#-< +)=.)*%0#* '2.*& )*'% +)=.)*< ( /%*0 $%/#92/# ',(' =)*3& '% (*3 &%/)3)+)#& ',#

    -/('#/#' -/206 7,#.# (.# ( =2*9, %+ $%/#92/#& )*4%/4#3 )* ',# -.%9#&&< #(9, (9')4(')*0 ',# *#F' )* (

    9(&9(3# +(&,)%* V,#*9# ',# *($# A9%(02/(')%* 9(&9(3#DW6 7,)& &'#- )& %+'#* 9(//#3 A%*3(.1 ,#$%&'(&)&D V#4#* ',%20, '#9,*)9(//1 )'8& ',# ',).3 &'#-

    )* ',# -.%9#&&W6 7,#.# (.# #.(/ &'#-& '% +)=.)* +%.$(')%*@

    Q6 7,# )*)')('%. %+ ',# 5,%/# -.%9#&& )& ( $%/#92/# 9(//#3 ')&&2# +(9'%. V7^W6O6 7,# 9%(02/(')%* 9(&9(3# -.%9##3&< %*# $%/#92/# (9')4(')*0 ',# *#F'< (// ',# 5(1 3%5*

    '% ',# /(&' &'#- V5,)9, )& ',# 9%*4#.&)%* %+ +)=.)*%0#* '% +)=.)*W6T6 ^)=.)* &2-#.0/2#& ',# -/('#/#'& '% #(9, %',#.< (/)*0 (*3 (*9,%.)*0 ',# -/206

  • 8/12/2019 Clot or Bleed

    5/52

    R(0# U %+ UO

    R.)$(.1 ,#$%&'(&)&R.)$(.1 ,#$%&'(&)& )& ',(' -(.' %+ 9/%'')*0 )* 5,)9, 1%2 +%.$ ( -/('#/#' -/206 M#'8& '(># ( /%%> ('-/('#/#'&< (*3 ',#* 5#8// /%%> (' ,%5 ',#1 )*'#.(9' '% +%.$ ',# -/206

    B10&,1,& 7$/2'$1$*FR/('#/#'& (.# *%' .#(//1 9#//& V',#1 3%*8' ,(4# ( *29/#2&W6 7,#18.# +.(0$#*'& %+ 91'%-/(&$ &,#3 =10)0(*')9 -.#92.&%. 9#//& 9(//#3 $#0(>(.1%91'#& ',(' /)4# )* ',# =%*# $(..%56 R/('#/#'& /%%> /)>#',)&@

    G$/701 210&,1,& (5 #1$$+ )7,0/

    7,#1 (.# 92'# /)''/# )..#02/(./1:&,(-#3 +.(0$#*'& %+ 91'%-/(&$ 5)', ( 9#*'.(/ .#0)%* %+ -2.-/)&,0.(*2/#& V',# A0.(*2/%$#.#DW (*3 ( -#.)-,#.(/ .#0)%* ',(' )& 0.(*2/#:+.## V',# A,1(/%$#.#DW6 _%&'%+ ',# -/('#/#'& /)4# )* ',# =/%%3 V(*3 =%*# $(..%5W\ (=%2' ( ',).3 (.# G2#&'#.#3 )* ',# &-/##*6

    7,#). &)$-/# (--#(.(*9# =#/)#& (* ($(E)*0/1 9%$-/#F &'.29'2.#6 H%', ',# $#$=.(*# (*3 ',#0.(*2/#& ,(4# ( '%* %+ )$-%.'(*' +#('2.#&6

    B10&,1,& 7,7#/05,7,# -/('#/#' $#$=.(*# )& 9.)')9(/ '% ',# 5,%/# -.%9#&& %+ 9/%' +%.$(')%*@

    B' -.%4)3#& ( &-#9)(/ -,%&-,%/)-)3 &2.+(9# V,)&'%.)9(//1 .#+#..#3 '% (& -/('#/#' +(9'%. T< %.R^TW +%. 9%(02/(')%* +(9'%.& '% =)*3 '%6 X%(02/(')%* +(9'%.& *##3 ',)& 2*)G2# -,%&-,%/)-)3&2.+(9# )* %.3#. '% +2*9')%* -.%-#./1< (*3 5,(' =#''#. -/(9# ',(* ',# &2.+(9# %+ ',#-/('#/#'& ',#$/4#&Z

    B' 3)&-/(1& ( =2*9, %+ .#9#-'%.& ',(' =)*3 )$-%.'(*' $%/#92/#&6 75% )$-%.'(*' %*#& (.#

    0/19%-.%'#)* V`RW B=< 5,)9, =)*3& 4%* a)//#=.(*3 +(9'%. V4a^W< (*3 `R BB=:BBB(< 5,)9, =)*3&+)=.)*%0#*6

    B10&,1,& 3$5&,5&)7,#.# (.# /%'& %+ ',)*0& )*&)3# -/('#/#'& ',(' ,#/- 5)', ',# -.%9#&& %+ 9/%'')*0@

    b 0.(*2/#& Vc&-#9)+)9 0.(*2/#&cW 9%*'()* +)=.)*%0#*< 4%* a)//#=.(*3 +(9'%. V4a^W< -/('#/#':3#.)4#3 0.%5', +(9'%. (*3 R:/#9')*6

    d 0.(*2/#& Vc3#* 0.(*2/#&cW 9%*'()* .%'%*)*< ?7R< ?eR< (*39(/9)2$ V5,)9, )& *#9#&&(.1+%. ',# 4)'($)* Y 3#-#*3#*' 9%(02/(')%* +(9'%.&W6

    X%*'.(9')/# -.%'#)*& V/)># (9')*W ',(' ,#/- ',# -/('#/#' 9,(*0# &,(-# 32.)*0 (3,#&)%* V( &'#-

    ',(' )& #&*')(/ +%. ',# .#/#( %+ 0.(*2/#&W6

  • 8/12/2019 Clot or Bleed

    6/52

    R(0# f %+ UO

    ;$6 +$ 210&,1,&) C$/7 0 21%*HQ6 g*3%',#/)(/ 3($(0# #F-%& &2=#*3%',#/)(/ -.%'#)*& V/)># 9%//(0#*W< 5,)9, (''.(9' -/('#/#'&6O6 R/('#/#'& &')9> '% ',# &2=#*3%',#/)2$ V4%* a)//#=.(*3 +(9'%. )& ',# 0/2#W< ( -.%9#&& 9(//#3

    (3,#&)%*6T6 7,#1 9,(*0# &,(-# (*3 .#/#( ',#). 0.(*2/# 9%*'#*'&< 5,)9, (''.(9' $%.# -/('#/#'&6[6 7,#1 &')9> '% #(9, %',#. (*3 +%.$ ( '#$-%.(.1 -/20 V+)=.)*%0#* )& ',# 0/2#W< ( -.%9#&&

    9(//#3 (00.#0(')%*6U6 ?+'#. ( 5,)/#< ',# -/('#/#'& 9%*'.(9'< 5,)9, ,#/-& .#'.(9' ',# 9/%' (*3 (/ ',# 4#&/ 5(//6

    S#9%*3(.1 ,#$%&'(&)&S#9%*3(.1 ,#$%&'(&)& )& ',(' -(.' %+ 9/%'')*0 )* 5,)9, 1%2 $(># +)=.)*< 5,)9, (/& 2- ',# -/('#/#'-/206 M#'8& '(># ( /%%> (' ,%5 +)=.)* )& $(3#< 5,)9, )*4%/4#& ( -.%9#&& 9(//#3 ',# 9%(02/(')%*9(&9(3# V%.< (& %*# &'23#*' -2' )'< A',# ;%$(* *2$#.(/ 9(&9(3# %+ $#$%.)E(')%* ,#//DW6

    7,# 9%(02/(')%* 9(&9(3# )& ( .)#& %+ #*E1$#& VD+(9'%.&DW 5,)9, (9')4('# #(9, %',#. )* ( 9(&9(3#+(&,)%* V,#*9# ',# =.)//)(*'/1 3#&9.)-')4# *($#W6 7,# 5,%/# -%)*' %+ ',# 9(&9(3# )& '% '2.*+)=.)*%0#* V( =)0 /%*0 -.#92.&%. $%/#92/# 5,)9, )& 2 (& ( 0/2# )* #(./1 -/('#/#' -/20 +%.$(')%* &%/)3 =/%%3 /%&& =(..)#.W6

    "#.#8& &%$#',)*0 ',(' 1%2 &,%2/3 '(''%% %* 1%2. ',)0, V%>(1< $(1=# J2&' 5.)'# )' %* 1%2. ,(*3W@7,# a,%/# R%)*' %+ ',# X%(02/(')%* X(&9(3# )& '% 72.* ^)=.)*%0#* )*'% ^)=.)*6

    a,1 5%2/3 1%2 5.)'# ',(' %* 1%2. =%31Z

    H#9(2 )'8& 5(1 '%% #(&1 '% 0#' &% 9(20,' 2- )* $#$%.)E)*0 ',# *($#& %+ ',# #*E1$#& V-/2& (//',#). ;%$(* *2$#.(/ 3#&)0*(')%*&< -/2& 5,)9, %*# (9')4('#& 5,)9,W ',(' 1%2 +%.0#' ',# #$)*0/1%=4)%2& 0%(/ %+ ',# 5,%/# -.%9#&&< 5,)9, )& J2&' ',# +%.$(')%* %+ +)=.)*6 B'8& ',# %/3 9(*8':#:',#:+%.#&':+%.:',#:'.##& ',)*06 B'8& (/&% #(&1 '% +%.0#' ',(' +)=.)* +%.$(')%* )& %*/1 %*# -(.' %+ 9/%'+%.$(')%*h B' 5%2/3*8' $#(* (*1',)*0 )+ 1%2 3)3*8' (/.#(31 ,(4# ( 5()')*0 -/('#/#' -/206 7.1 '%>##- ',)& )* $)*3 (& 5# '(/> (=%2' ',# 3#'()/& %+ ',# 9%(02/(')%* 9(&9(3#6

    8$0*%10&($5 C03&$/)?// ',# 9%(02/(')%* +(9'%.& #F9#-' +)=.)*%0#* (.# #)',#. #*E1$#& %. 9%+(9'%.&6

    -5IF7,) 7,# 021& (9')4('# %',#. 9%(02/(')%* +(9'%.&6 7,#1 9).92/('# (& )*(9')4# #*E1$# -.#92.&%.&6 a,#* ',# 9(&9(3# )& )*)')('#3< ',#1 (.#

    ,13.%/1E#3 =1 ',# -.#9#3)*0 9%(02/(')%* +(9'%. V',%20, *%' (/5(1& )* *2$#.)9(/ %.3#.W ',# 2- )* ',# .#+#.#*9# ')%* )+ 1%28.# )*'% ',(' >)*3 %+ ',)*0W)9>& %++ ',# 9%(02/(')%* 9(&9(3#4)( ',# #F'.)*&)9 -(',5(16

    ?+'#. ( /)''/# i( )& +%.$#3< 7^RB V')&&2# +(9'%. -(',5(1 )*,)=)'%.W '2.*& %++ 7^< (*3 ',##F'.)*&)9 -(',5(1 )& &,2' 3%5*< -.#4#*')*0 %4#.:9/%'')*0 (*3 ',.%$=%&)&6

  • 8/12/2019 Clot or Bleed

    8/52

    R(0# n %+ UO

    (//)>.#)*< iBBW (.# -.#''1 $29, (=*'

    +.%$ $29, %+ %2. 3)&92&&)%*6 7,('8& =#9(2 (/',%20, '#9,*)9(//1 ',#1 (.# (=/# '% (9')4('#',# )*'.)*&)9 -(',5(1< ',#1 3%*8' -/(1 $29, %+ ( .%/# !" *!*+6 iBB< )* -(.')92/(.< )& %*/1)$-%.'(*' )* +%.$)*0 9/%'& )* '#&' '2=#&6 R#%-/# 5)', 9%*'(9' +(9'%. 3#+)9)#*9)#& 3%*8' ,(4#=/##3)*0 3)&%.3#.&h 7,# +(9'%.& (.# *%' 9.29)(/ +%. (9')4(')%* %+ ',# )*'.)*&)9 -(',5(1 !"*!*+6

  • 8/12/2019 Clot or Bleed

    9/52

    R(0# o %+ UO

    I%28// *##3 '% 9%$# 2- 5)', &%$# 5(1 '% $(># ',)& 3)(0.($ $#$%.)E(=/#6 B ,(4# ( /)''/#$*#$%*)9 ',(' B 2 +%. $1 &'23#*'& ',(' '#*3& '% 5%.>6 B'8& &)//1< =2' ,#1< (.#*8' $%&'$*#$%*)9&Z 7,)& %*# .#G2).#& ( &,%.' 3)0.#&&)%* )*'% ',# '%-)9 %+ 5%$#*8& &,%#&6

    N'$,)HI#&< &,%#&6 ^%. ',# -2.-%& %+ ',)& 3)&92&&)%*< 5#8// &(1 ',(' ',#.# (.# '5% >)*3& %+ &,%#& )* ',#5%./3@ 0%%3 %*#& (*3 =(3 %*#&6 ?*3 5#8.# J2&' '(/>)*0 ,)0, ,##/& ,#.# : +%.0#' +/('& (*3 =%%'& (*3',% 3)&02&')*0 $)3:,#)0,' ,##/&6

    ? 0%%3 &,%# )& #/#0(*'6 B' )& &)$-/#< ')$#/#&&< (*3 9/#(* )* 3#&)0*6 B' 3.(5& (''#*')%* *%' '% )'/+=2' '% ',# 0%.0#%2& /#0 )' (3%.*&6 M)># ',)&@

  • 8/12/2019 Clot or Bleed

    10/52

    R(0# QP %+ UO

    ? =(3 &,%#< %* ',# %',#. ,(*3< )& '(9>16 B' )& 9%$-/)9('#3 V',)*> =%5&< E)--#.&< +)&,)*0 /2.#&< %. : )+1%28.# M(31 `(0( : +/(*> &'#(>W< +.)4%/%2&< (*3 =2&16 B' )& &% 3)&'.(9')*0 ',(' )' $(>#& )' )$-%&&)=/# '%3)&9#.* ',# =#(2'1 %+ ',# 5%$(*\ %*# )& '%% 9(20,' 2- )* '.1)*0 '% 4)&2(//1 3#9%*&'.29' ',#%=*%F)%2& &,%#6 M)># ',)&@

    S% )' )& 5)', ',# 9%(02/(')%* 9(&9(3#6 7,#.# )& ',# )*'.)*&)9 (.$ %+ ',# 9(&9(3#< 5,)9, )&2*(-%/%0#')9(//1 9/2''#.#3 5)', &% $(*1 ;%$(* *2$#.(/& (*3 (..%5& ',(' %*# 9(**%' +)02.# %2'V/#' (/%*# .#$#$=#.W 5,(' )& 0%)*0 %*6 ?*3 ',#.# )& ',# #F'.)*&)9 (.$< 5,)9, )& &)$-/#< 2*+#''#.#3 ',)& )& )$-%.'(*' *%5< =2' 5,#*1%2. (''#*3)*0 (&>& 1%2 (' ',.## )* ',# $%.*)*0 5,)9, -(',5(1 ',# -.%',.%$=)* ')$# $#(&2.# 1%2 /%%> &$(.'?''#*3)*0@ Aa,)9, -(',5(1 9%*'()*& +(9'%. kBBZDS'23#*' V',)*>)*0 G2)#'/1@ /#'8& #666',('8& ',# &)$-/#< #/#0(*' -(',5(1 5)', J2&' ')&&2# +(9'%. (*3kBB< ',# %*# 5)', ',# 0%%3 &,%#666W@ A7,# F'.)*&)9 -(',5(16D?''#*3)*0 V#1#& %-#*#3 5)3#W@ Aa,('ZDS'23#*' V.#9%4#.)*0 G2)9>/1W@ AgF'.)*&)96 7,# #F'.)*&)9 -(',5(16D?''#*3)*0 V9%*&)3#.)*0 ( ,#(.)*0 ()3W@ AgF(9'/16D

  • 8/12/2019 Clot or Bleed

    11/52

    R(0# QQ %+ UO

  • 8/12/2019 Clot or Bleed

    12/52

    R(0# QO %+ UO

    8'02&,/ A: ;$6 &$ N&$2 81$&&(5*

    7,#.# (.# '5% $()* 5(1& %+ >##-)*0 9/%'')*0 2*3#. 9%*'.%/@Q6 I%2 9(* )*,)=)' ',# 9%(02/(')%* 9(&9(3# V*2$=#. Q )* ',# +(*91 3)(0.($ =#/%5WO6 I%2 9(* /1 -%.')%*& %+ ',# 9/%' '% >##- )' 3%5* '% ( .#(&%*(=/# &)E# V*2$=#. O )* ',# +(*913)(0.($W< ( -.%9#&& 5,)9, +%.$& /)''/# +)=.)* +.(0$#*'& 9(//#3 +)=.)* 3#0.(3(')%* -.%329'&< %. ^eR&6

    M#'8& '(># ( /%%> (' #(9, %+ ',# -.%9#&& )* ( /)''/# 3#-',6

    X%(02/(')%* 9(&9(3# )*,)=)')%*S#4#.(/ -.%'#)*& >##- ',# 9%(02/(')%* 9(&9(3# m (*3 ',2&< +)=.)* +%.$(')%* m 2*3#. 9%*'.%/6 7,#*('2.(/ (*')9%(02/(*'& )*9/23# 7^RB V')&&2# +(9'%. -(',5(1 )*,)=)'%.W< ?7BBB V(*')',.%$=)* BBBW# 1%2 /%%> &$(.'l6 S% 5,(' '2.*& %* -.%'#)* XZ?6 R.%'#)* X )& '2.*#3 %* =1 ',.%$=)*6 ?9'2(//1< ',.%$=)* =)*3& '% ',.%$=%$%32/)* V( .#9#-'%. %*#*3%',#/)(/ 9#//& ',(' (/'#.& ',# ',.%$=)* $%/#92/#W< (*3 ',# .#&2/')*0 ',.%$=)*:',.%$=%$%32/)*9%$-/#F (9')4('#& R.%'#)* X6 7,('8& -.#''1 9%%/@ ',.%$=)* .#02/('#& )'/+ =1 '2.*)*0 %* ',# ',)*0',(' >##-& )' )* 9,#9>6

    H1 ',# 5(1< -.%'#)* X 3%#& ( 9%2-/# %',#. )$-%.'(*' ',)*0&6 B' -.%$%'#& +)=.)*%/1&)& =1 ,#/-)*0 %2'')&&2# -/(&$)*%0#* (9')4('%. V':R?W V# =#/%5W6 B' (/&% ,#/-& >##- )*+/($$(')%* )* 9,#9> =1)*,)=)')*0 91'%>)*# -.%329')%*6 H#9(2 %+ )'& #++#9'& %* 9/%'')*0 (*3 )*+/($$(')%*< 0)4)*0 (9'2(/

    -.%'#)* X 9(* =# 2+2/ )* 9(& %+ .#(//1 .#(//1 =(3 eBX V3)&$)*('#3 )*'.(4(&92/(. 9%(02/(')%*W6

  • 8/12/2019 Clot or Bleed

    14/52

    R(0# Q[ %+ UO

    X/%' /1&)&a,#* ',# 9/%' ,(& 3%*# )'& J%= (*3 =/##3)*0 ,(& &'%--#3< ',#.# (.# #.(/ -.%'#)*& ',(' ,#/-A.#$%3#/D ',# 9/%' =1 =.#(>)*0 3%5* +)=.)* )*'% /)''/# 9,2*>& 9(//#3 +)=.)* 3#0.(3(')%* -.%329'&V^eR&W6 7,# 9/%':=2&')*0 -.%'#)*& )*9/23# ':R? V')&&2# -/(&$)*%0#* (9')4('%.W (*3 -/(&$)*6 ':R? )&(9'2(//1 2 (& ( 3.20 +%. '.#('$#*' %+ 4#.1 .#9#*' )&9,#$)9 &'.%>#& V=2' *%' ,#$%..,(0)9 %*##-& )'& (9')%* /%9(/)E#3 '% ',# 9/%'hW (*3

    9%*4#.'& -/(&$)*%0#* '% -/(&$)*6 R/(&$)*%0#* )& 9%*4#.'#3 '% -/(&$)*< 5,)9, =.#(>& 3%5* +)=.)* )*'% +)=.)* 3#0.(3(')%*

    -.%329'& V^eR&W< (/&% 9(//#3 &-/)' -.%329'&< 5,)9, ',#$/4#& )*,)=)' ',.%$=)* (*3 +)=.)*+%.$(')%* V,%5 ,(*31W6

    H/%%3 9%*'()*& )*,)=)'%.& %+ ':R? V-/(&$)*%0#* (9')4('%. )*,)=)'%.< %. R?BW (*3 -/(&$)* VbO:(*')-/(&$)*W &% +)=.)*%/1&)& 3%#&*8' 0#' %2' %+ ,(*36

  • 8/12/2019 Clot or Bleed

    15/52

    R(0# QU %+ UO

    8'02&,/ D: O0#$/0&$/F (' ( =/%%3 &$#(. 2*3#. ( $)9.%&9%-# (*3 # )+ ',# -/('#/#'& /%%> *%.$(/6

    G$/701 210&,1,& (5 #1$$+ )7,0/

    7,#1 (/$%&' (/5(1& /%%> /)># ',)& V#4#* 5,#* ',#1 3%*8' 5%.> -.%-#./1W : =2' %* %99(&)%*< ',#1 5)//=# =)00#. ',(* 2&2(/< %. /(9> 0.(*2/#&< %. =%',6 a#8// /%%> (' &%$# -/('#/#' 3)&%.3#.& ',(' ,(4#+2**1 $%.-,%/%01 /('#.6

    ?1,,+(5*

  • 8/12/2019 Clot or Bleed

    16/52

    R(0# Qf %+ UO

    ;$6 +$ F$% +$ 0 #1,,+(5* &(7,H R2' ( =/%%3 -.#&&2.# 92++ %* ',# -(')#*'8& (.$ (*3 )*+/('# )' '% [P $$ "06 _(># ( /)''/# )*9)&)%* V2&)*0 ( 3)&-%&(=/# &-.)*0:/%(3#3 /(*9#'W %* ',# )**#. &2.+(9# %+ ',#

    -(')#*'8& /%5#. (.$< *%')*0 ',# ')$#6 H/%' 3.%-& %+ =/%%3 (& ',#1 (--#(. (' ',# )*9)&)%* &)'#6 a()' V'#3)%2&hW6 a,#* ',# )*9)&)%* &'%-& =/##3)*0< *%'# ',# ')$#6 7,# '%'(/ ')$# #/(- =#'5##* )*9)&)%* (*3 =/##3)*0 9#&&(')%* )& 9(//#3 ',# =/##3)*0 ')$#6 7,# .#+#.#*9# .(*0# )& O '% o $)*2'#& )* (32/'& V/%*0#. )* 9,)/3.#*W6

    R'0& 4(5+) $C &'(5*) 30%), 0 2/$1$5*,+ #1,,+(5* &(7,H R/('#/#' 3)&%.3#.&< &29, (& 4%* a)//#=.(*3 3)( S#4#.# ',.%$=%91'%-#*)(6

    R',5 )'$%1+ F$% $/+,/ 0 #1,,+(5* &(7,H S%$# #F-#.'& %.3#. )' '% &9.##* &1$-'%$(')9 V=/##3)*0W -(')#*'& +%. )*,#.)'#3 -/('#/#'

    3)&%.3#.&6 r',#. #F-#.'& 9%*&)3#. )' &% 2*.#/)(=/# ',(' ',#1 3%*8' 2 )' (' (//< (*3 0% &'.()0,' '% ',#

    +(*91< &-#9)+)9 '#&'& +%. 4%* a)//#=.(*3 3)( (*3 %',#. -/('#/#' 3)&%.3#.&6 I%2 9(* (/5(1& 9(// 1%2. +.)#*3/1 ,%&-)'(/ -(',%/%0)&' (*3 (&> ,#. 5,(' &,# 5%2/3

    .#9%$$#*36

    B10&,1,& 0**/,*0&($5 )&%+(,)R'0& +$ 210&,1,& 0**/,*0&($5 )&%+(,) 7,0)%/,H

    "%5 5#// ',# -/('#/#'& (.# (=/# '% (00.#0('# V&')9> '% #(9, %',#.W6

    ;$6 +$ F$% +$ 0 210&,1,& 0**/,*0&($5 )&%+FH ?33 4(.)%2& (00.#0(')*0 (0#*'& V/)># ?eR< 9%//(0#*< .)&'%9#')*< (.(9,)3%*)9 (9)39:( $!?:# *!-1 &+"#-!"% 1!##1( &1;5,% +4 ,1-#(1(#% .#:(< 1++7 1!7( 1!##1( 41-7(%@A:!&: 4+$5(8 !" $(%,+"%( #+ #:( -88!#!+" +4 B/C> D+#( #:-# #:( $!?:# *!-1 !%1(%% #;$=!8E #:!% 8(&$(-%( !" #;$=!8!#< !% A:-# !% 5(-%;$(8 !" #:( ,1-#(1(#-??$(?-#!+" -%%- F+#: *!-1% :-*(

  • 8/12/2019 Clot or Bleed

    18/52

    R(0# Qn %+ UO

    X%(02/(')%* +(9'%. '#&'&7,# '#&'& $#(&2.# ,%5 /%*0 )' '(>#& '% $(># +)=.)*6 7,#.# (.# #.(/ '#&'&< #(9, %+ 5,)9, &'(.'(' ( 3)++#.#*' -%)*' )* ',# 9%(02/(')%* 9(&9(3# V&% 1%2 9(* '#// 5,#.# ',# -.%=/#$ )&W6 I%28// 2

    ',# '#&'& ( /%' 5,#* 1%28.# %* ',# 5(.3& V(*3 )* 9/)*)9W6 I%28// 2 ',# R77 (*3 B]; &% +.#G2#*'/1',(' 1%28// '(/> (=%2' ',#$ )* 1%2. &/##-6

    =$)& 3$0*%10&($5 &,)&) 0/, +$5, 1(4, &'(): e.(5 ',# -(')#*'8& =/%%3 )*'% ( &-#9)(/ '2=# V9%*'()*)*0 9)'.('#< 5,)9, =)*3& ',# 9(/9)2$ )*

    ',# =/%%3 &($-/# '% -.#4#*' ',# =/%%3 +.%$ 9/%'')*0W6 H(9> )* ',# /(=< &-)* ',# '2=# )* ( 9#*'.)+20#< (*3 3#9(*' ',# -/(&$( V5,)9, )& J2&' .2$

    -/2& 9%(02/(')%* +(9'%.&W6 R2' ',# -(')#*'8& -/(&$( )* ( '#&' '2=# (*3 (33 .#(0#*'6 _#(&2.# ,%5 /%*0 )' '(>#& ',# -(')#*'8& =/%%3 '% +%.$ +)=.)*6

    B/$&'/$7#(5 &(7, P$/ 2/$&(7,Q PB# &2=&'(*9#W '% ',# '#&' '2=#'% 0#' ',# '#&' '% 0%6

    R'0&V) &', +,01 6(&' C03&$/ WJJH B'8& $(3# =1 ',# /)4#. B' *##3& 4)'($)* Y +%. (9')4(')%* B'& &1*',#&)& )& )*,)=)'#3 =1 9%2$(3)* V5(.+(.)*W B' ,(& ( %:+$# ,(/+:/)+# V)' 3%#&*8' '(># /%*0 '% 3#-/#'# 1%2. +(9'%. kBB &'%.#&hW

    R'0& 704,) &', B< *$ %2 P$/ 2%& 05$&',/ 60FK 6'0& X2/$1$5*)Y &', B

  • 8/12/2019 Clot or Bleed

    19/52

    R(0# Qo %+ UO

    R',5 )'$%1+ F$% $/+,/ 0 B (' ',# B]; -(.' V# *#F'W6

    J5&,/50&($501 5$/701(I,+ /0&($ PJGTQL40FK )$ 6'0&V) 05 JGTH

    B'8& J2&' ( R7 ',('8& =##* $(',#$(')9(//1 9%..#9'#3 '% (99%2*' +%. 3)++#.#*9#& =#'5##*/(=%.('%.)#&6

    7,# R7 )& ( -.#''1 (**%1)*0 '#&'< =#9(2 ( -(')#*' 9%2/3 0#' ( R7 )* %*# ,%&-)'(/< (*3 ',#*0% '% (*%',#. ,%&-)'(/ 3%5* ',# &'.##'< (*3 ',# R7 5%2/3 =# '%'(//1 3)++#.#*' V=#9(2 ',#&'2-)3 ',.%$=%-/(&')* 4(.)#& &% $29, =#'5##* $(*2+(9'2.#.&W6 S% ',# .#&2/'& %+ ',# R75#.# .#(//1 %*/1 2+2/ 5)',)* #(9, -(.')92/(. ,%&-)'(/6

    7% +)*3 %2' 5,(' ',# B]; )&< 1%2 3% ( R7 V(33 ',.%$=%-/(&')* (*3 9(/9)2$ '% ',# -(')#*'8&=/%%3W< (*3 ',#* 1%2 -/20 ',# .#&2/' )*'% ( +%.$2/(< 5,)9, &-)'& %2' ',# B];6

    7,('8& 9%%/< =#9(2 *%5 #4#.1%*# )& 2&)*0 ',# &($# &9(/# %+ $#(&2.#$#*'6 _1 B]; (' S'6_(.18&< +%. #F($-/#< 5%2/3 =# ',# &($# (& $1 B]; 3%*# (' S'6 M2>#8&6

    ]%5 5# 9(* 2 &'(*3(.3& ',(' (--/1 '% #4#.1%*#< *% $(''#. 5,#.# ',#1 0%' ',#). '#&'3%*#h a,#* &%$#%*# ,(& ( ',.%$=%')9 '#*3#*91< +%. #F($-/#< ',# &'(*3(.3 %+ 9(.# )& '%>##- ',#). B]; V5,#.#4#. )'8& -#.+%.$#3W =#'5##* O (*3 T6

    R',5 )'$%1+ F$% $/+,/ 05 JGTH 7% (&&& ( -(')#*'8& 9%(02/(')%* &'('2& V#606< )* 2*#F-/()*#3 =/##3)*0< )* eBX< %. (+'#. /%'&

    %+ '.(*&+2&)%*&W 7% $%*)'%. 9%2$(3)* ',#.(-16 7,# B]; )& ',# =#&' '#&' +%. $%*)'%.)*0 9%2$(3)* V=#''#.

    ',(* ',# R77< 5,)9, 5#8// '(/> (=%2' *#F'W6 7,('8& =#9(2 ',# +).&' +(9'%. '% =#9%$#3#-/#'#3 (+'#. 9%2$(3)* (3$)*)&'.(')%* )& +(9'%. kBB6 S% 1%2 5(*' ( '#&' ',(' $#(&2.#&+(9'%. kBB< =#9(2 ',(' '#&' 5)// =# ',# $%&' *&)')4#6 ? '#&' ',(' %*/1 $#(&2.#3 ',# %',#.V/%*0#.:,(/+:/)+#W 4)'($)* Y 3#-#*3#*' 9%(02/(')%* +(9'%.& 5%2/3*8' =# (& 2+2/ : =#9(2=1 ',# ')$# #:-# '#&' =#9($# (=*%.$(/< ',# -(')#*' 5%2/3 =# (' 0.#(' .)&> %+ =/##3)*0h

    a,#* 1%2 (.# (&&&)*0 /)4#. +2*9')%*p3($(0# V(92'# ,#-(')')&< (9#'($)*%-,#* %4#.3%W _(1=# (& (* ,%&-)'(/ (3$)&&)%* %. -.#:%-#.(')4# &9.##* V#&-#9)(//1 )+ -(')#*' )& %*

    9%2$(3)* %. ,(& ( =/##3)*0 ,)&'%.1W

    B0/&(01 &'/$7#$210)&(5 &(7, PB

  • 8/12/2019 Clot or Bleed

    20/52

  • 8/12/2019 Clot or Bleed

    21/52

    R(0# OQ %+ UO

    B*%5 ',#-%%/#3 ,2$(* -/(&$( $2&' ,(4# &2--/)#3 &%$#',)*0 '% ',# -(')#*'8& -/(&$( '% $(># )'9/%' *%.$(//16 V7,# A&%$#',)*0D )& 2&2(//1 ( 9%(02/(')%* +(9'%. ',(' ',# -(')#*' )& $)&&)*06W

    B+ ',# *#5 R77 4(/2# )& &')// (=*%.$(/ V)+ ',# R77 )& &')// -.%/%*0#3< (*3 3%#&*8' A9%..#9'DW)*3 %+ (=*%.$(/ ',.%$=%')9 &'('#< /)># 3)&$)*('#3 )*'.(4(&92/(. 9%(02/(')%* VeBXW# ( -2/$%*(.1 #$=%/2& %. ( 3##- 4#*%2&',.%$=%&)&W6 B+ ',# '#&' )& -%&)')4#< 1%2 9(*8' =# &2.# ',(' ',# -(')#*' ,(& ( 9/%' V=#9(2#4#* *%.$(/< -,1&)%/%0)9 9/%'')*0 9(* $(># 1%2. ^eR& 0% 2-W6

    H2'< &)*9# ',)& '#&' )& &%%%%% *&)')4#< )'8& ( 0.#(' '#&' +%. -.%4)*0 ',(' ( -(')#*' ergS ]r7

    ,(4# (* (=*%.$(/ 9/%'h B+ ',# '#&' )& *#0(')4#< 1%2 9(* =# -.#''1 &2.# ',# -(')#*' 3%#& *%',(4# ( 9/%'6 B'8& 2 G2)'# ( =)' )* g;& '% .2/# %2' -2/$%*(.1 #$=%/)&$6

    E(#/(5$*,5 "))0FR'0&V) C(#/(5$*,5 0*0(5H

    ^)=.)*%0#* )& ',# +)*(/ 9%(02/(')%* +(9'%. 5(1 (' ',# =%''%$ %+ ',# 9(&9(3#6 B'8& ',#-.#92.&%. '% +)=.)*6

    B'8& $(3# =1 ',# /)4#.< (*3 )& .(-)3/1 3#-/#'#3 32.)*0 9/%'')*06

    R'0& 30%),) &', C(#/(5$*,5 1,@,1 &$ *$ +$65H

    B* .)-:.%(.)*0 eBX V3)&$)*('#3 )*'.(4(&92/(. 9%(02/(')%*W< ',# +)=.)*%0#* /#4#/ %+'#* 0%#&3%5* V+)=.)*%0#* 0#'& 2 2- $(>)*0 (// ',% 9/%'&W6

    "%5#4#.< &)*9# +)=.)*%0#* )& (* (92'# -,( .#(9'(*'< ( -(')#*' 9(* =# )* +/%.)3 eBX (*3 &')//,(4# ( *%.$(/ +)=.)*%0#* /#4#/6

  • 8/12/2019 Clot or Bleed

    23/52

    R(0# OT %+ UO

    R',5 )'$%1+ F$% $/+,/ 0 C(#/(5$*,5 0))0FH a,#* 1%28.# #4(/2(')*0 ( -(')#*' +%. eBX V5,)/# .#(/)E)*0 ',(' ( *%.$(/ +)=.)*%0#* /#4#/

    3%#& *%' .2/# %2' eBXW6 a,#* 1%28.# $(&&)4#/1 '.(*&+2&)*0 ( -(')#*' V=#9(2 5,#* &%$#%*# 9%$#& )* 5)', (

    $(&&)4# =/%%3 /%&& : &(1< +.%$ ( =(3 9(. (99)3#*' : 1%2 0#*#.(//1 3%*8' 2 5,%/# =/%%3\ 1%22 ( 9%$=)*(')%* %+ =/%%3 -.%329'&< &'(.')*0 5)', .#3 9#//&< (*3 (33)*0 +.#&, +.%E#*-/(&$( (& *#9#&&(.16

    B+ 1%28.# *%' 9(.#+2/ 5)', 1%2. 9%$=)*(')%* %+ .#-/(9#$#*' -.%329'&< 1%2 $)0,' 2-' ',#9%(02/(')%*p(*'):9%(02/(')%* =(/(*9#< (*3 ',# -(')#*'8& +)=.)*%0#* 9%2/3 0#' 3)/2'#3 [%)& *(@, 7, 0 \%(34 )%770/F>

    R77 t )*'.)*&)9 -(',5(1 R7pB]; t #F'.)*&)9 -(',5(1 R77 $)F)*0 '#&' t R77 5)', -(')#*' =/%%3 -/2& -%%/#3 -/(&$( 77 t +)=.)*%0#* '% +)=.)* ^eRpe:3)$#. t $#(&2.#& ^eR&pe:3)$#.& ^)=.)*%0#* t $#(&2.#& +)=.)*%0#*

    JV7 ,@,5 7$/, ,.'0%)&,+ 5$6> T,7(5+ 7, 6'F J 6$%1+ $/+,/ &',), &,)&)> R77@ 7% $#(&2.# ( -(')#*'8& 0#*#.(/ 9%(02/(')%* &'('2&\ '% 9,#9> ',# )*'.)*&)9 -(',5(1 )*

    -(.')92/(.\ '% $%*)'%. /)4#. +2*9')%*\ '% $%*)'%. ,#-(.)*6 R7pB];@ 7% $#(&2.# ( -(')#*'8& 0#*#.(/ 9%(02/(')%* &'('2&\ '% 9,#9> ',# #F'.)*&)9 -(',5(1

    )* -(.')92/(.\ '% $%*)'%. /)4#. +2*9')%*\ '% $%*)'%. X%2$(3)*6 R77 $)F)*0 '#&'@ B* ( -(')#*' 5)', ( -.%/%*0#3 R77 V=2' ( *%.$(/ 77W< '% +)02.# %2' 5,#',#.

    ',# -.%=/#$ )& ( +(9'%. 3#+)9)#*91 %. (* )*,)=)'%.6 77@ 7% /%%> +%. ( +)=.)*%0#* -.%=/#$\ '% $%*)'%. ,#-(.)*6 ^eRpe:3)$#.@ 7% .2/# %2' ( ',.%$=2&6 ^)=.)*%0#*@ 7% $%*)'%. +)=.)*%0#* /#4#/& 32.)*0 $(&&)4# '.(*&+2&)%*6

  • 8/12/2019 Clot or Bleed

    24/52

    R(0# O[ %+ UO

    8'02&,/ ]: ?1,,+(5* +()$/+,/)

    `#*#.(/?,C$/, 6, *,& (5&$ #1,,+(5* +()$/+,/)7,#.# (.# /%'& %+ ',)*0& ',(' 9(* $(># 1%2 =/##3@ 4(&92/(. 3)&%.3#.&< ',.%$=%91'%-#*)(< (*3-.%=/#$& 5)', ',# 9/%'')*0 &1&'#$6 r2. 3)&92&&)%* 5)// =# /)$)'#3 '% ',% =/##3)*0 3)&%.3#.&)*4%/4)*0 ',.%$=%91'%-#*)( (*3 ',# 9/%'')*0 &1&'#$6 e)&%.3#.& .#&2/')*0 +.%$ ',.%$=%91'%-#*)()*9/23# )3)%-(',)9 ',.%$=%91'%-#*)9 -2.-2.( VB7RW (*3 ',# ',.%$=%')9 $)9.%(*0)%-(',)#&6e)&%.3#.& )*4%/4)*0 ',# 9/%'')*0 &1&'#$ 9(* .#&2/' +.%$ 9%(02/(')%* (=*%.$(/)')#& V#606# +)=.)* 5#//< &% ',#-/('#/#' -/20 )&*8' (/#3 2-< (*3 )' J2&' 5(&,#& (5(1 (+'#. &%$# ')$#6 R(')#*'& 5)', #.# +(9'%.3#+)9)#*9)#& V/)># #.# ,#$%-,)/)(W =/##3 )*'% J%)*'& (*3 &%+' ')&&2# V',#1 0#' /(.0# )*'.($2&92/(.=/##3&W6

    ^)*(//1< -(')#*'& 5)', -/('#/#' 3)&%.3#.& '#*3 '% =/##3 +.%$ $29%2& $#$=.(*#& (*3 &>)* V',#1 0#'*%=/##3&< `B =/##3&< (*3 $#*%..,(0)(W 5)', /)''/# %. *% (--(.#*' -.#9#3)*0 '.(2$(6

    7,% (.# 0#*#.(/)E(')%*&< ,%5#4#. : ',#.#8& &%$# 9.%&&%4#. %+ &1$-'%$&< &% )'8& *%' #*').#/1=/(9> (*3 5,)'#6 7,# 9/)*)9(/ -)9'2.# J2&' -%)*'& 1%2 )* ( 0#*#.(/ 3).#9')%* V-/('#/#'& 4&69%(02/(')%*W &% 1%2 >*%5 ,%5 '% &'(.' ',# 5%.>2- %+ 1%2. -(')#*'6

  • 8/12/2019 Clot or Bleed

    25/52

    R(0# OU %+ UO

    ?1,,+(5* +()$/+,/)a#8.# 0%)*0 '% 3)4)3# ',# =/##3)*0 3)&%.3#.& )*'% '5% =)0 0.%2-&@ ',% ',(' (.# ,#.#3)'(.1< (*3',% ',(' (.# (9G2).#36 S%$# %+ ',# (.# -.#''1 .(.# V/)># ',# ,#$%-,)/)(&W =2' 1%2 %=4)%2&/1 &')//

    *##3 '% >*%5 ( =)' (=%2' ',#$6 "#.#8& ',# %2'/)*# 5#8// =# +%//%5)*0@9> ;,/,+(&0/F #1,,+(5* +()$/+,/)

    4%* a)//#=.(*3 3)( V( 3)&%.3#. %+ =%', -/('#/#'& (*3 9%(02/(')%*W "#$%-,)/)( ? V9%(02/(')%*W "#$%-,)/)( H V9%(02/(')%*W r',#. +(9'%. 3#+)9)#*9)#& V9%(02/(')%*W "#.#3)'(.1 -/('#/#' 3)&%.3#.& V-/('#/#'&W

    A> "3\%(/,+ #1,,+(5* +()$/+,/) e)&$)*('#3 )*'.(4(&92/(. 9%(02/(')%* VeBXW V-/('#/#'& (*3 9%(02/(')%*W

    B3)%-(',)9 ',.%$%=%91'%-#*)9 -2.-2.( VB7RW V',.%$=%91'%-#*)(W 7,.%$=%')9 $)9.%(*0)%-(',)#&@ ',.%$=%')9 ',.%$=%91'%-#*)9 -2.-2.( V77RW (*3

    ,#$%/1')9:2.#$)9 &1*3.%$# V"qSW V',.%$=%91'%-#*)(W H/##3)*0 9(2 =1 3#+)9)#*91 %+ 4)'($)* Y 3#-#*3#*' +(9'%.& V9%(02/(')%*W H/##3)*0 (&&%9)('#3 5)', /)4#. +()/2.# V-/('#/#'& (*3 9%(02/(')%*W

  • 8/12/2019 Clot or Bleed

    26/52

    R(0# Of %+ UO

    "#.#3)'(.1 =/##3)*0 3)&%.3#.&"#.#3)'(.1 =/##3)*0 3)&%.3#.& )*9/23# 9%(02/(')%* +(9'%. 3#+)9)#*9)#& (*3 -/('#/#' (=*%.$(/)')#&6 B*0#*#.(/< ',#1 (.# /#&& 9%$$%* ',(* (9G2).#3 =/##3)*0 3)&%.3#.& V(/',%20, (& 5#8// # *#F'< 4%*

    a)//#=.(*3 3)( )& -.#''1 3(*0 9%$$%*W6

    r+'#* ( 0%%3 ,)&'%.1 5)// #/)9)' &%$# 9%$$#*'& +.%$ ',# -(')#*' 5)', ( ,#.#3)'(.1 =/##3)*03)&%.3#.@ AI#(,< *%5 ',(' 1%2 $#*')%* )'< $1 &)&'#. 0#'& ',# &($# *%=/##3& B 3%D %. A5#//< $1$%$ &(1& ',(' $1 0.(*3+(',#. 3)#3 5,#* ,# 5(& .#(//1 1%2*0 +.%$ &%$# >)*3 %+ =/%%3 -.%=/#$6DS%$#')$#&< %+ 9%2.< ',#.# )& *% ,)&'%.1 ',(' ',# -(')#*' >*%5& (=%2' m %. ',# -(')#*' )&2*9%*&9)%2& m &% )'8& &%$#',)*0 1%2 5)// 5(*' '% 9%*&)3#. 5,#* 5%.>)*0 2- (*1 -(')#*' 5)',(=*%.$(/ =/##3)*06

    @$5 R(11,#/05+ U(),0), P@RUQ

    ^,5,/01 7,# $%&' 9%$$%* ,#.#3)'(.1 =/##3)*0 3)&%.3#. VQ )* QPP -#%-/#< =1 &%$# #&')$('#&W6 ?2'%&%$(/ 3%$)*(*' )*,#.)'(*9#< 2&2(//16 I%2 *##3 '% =# (5(.# %+ ',)& 3)( =#9(2 )' )& &% 9%$$%*h I%2 $(1 *#4#. #

    &%$#%*# 5)', ,#$%-,)/)( V5,)9, ,(--#*& )* Q )* QP#,1&'#.#9'%$)#& +%. ,#(41 $#*&'.2(/ +/%5W (*3 /#&* .)&>& V/)># #F9#&&)4# =/##3)*0 (+'#.'%%', #F'.(9')%*&W6

  • 8/12/2019 Clot or Bleed

    27/52

    R(0# Oj %+ UO

    O0#$/0&$/F &,)&) 7,# =/##3)*0 ')$# )& -.%/%*0#3 V',('8& ',# 5,%/# -%)*'@ 1%2 *##3 4a^ '% =)*3 -/('#/#'& '%

    #*3%',#/)(/ 9#//&W6 7,# B]; )& *%.$(/ V=#9(2 ',# #F'.)*&)9 &1&'#$ )& 5%.>)*0 +)*#W 7,# R77 )& 2&2(//1 -.%/%*0#3 V=#9(2 %+ ',# 5,%/# +(9'%. kBBB ',)*0W< (*3 )' A9%..#9'&D 5,#*

    1%2 3% ( R77 $)F)*0 &'231 V=#9(2 ',# -%%/#3 -/(&$( &,%2/3 ,(4# ( *%.$(/ ($%2*' %++(9'%. kBBB )* )'W6

    7% 9%*+).$ 1%2. 3)(0*%&)&< 1%2 9(* %.3#. &%$# +(*91 '#&'& /)>#@! ( 4a^ /#4#/ V/%5 )* '1-# Q< (=*' )* '1-# T< *%.$(/ )* '1-# OW! -/('#/#' (00.#0(')%* &'23)#& V(=*%.$(/W

    V.)%2&/1W6

    ^(9'%. kBBB 9%*9#*'.('# m ',)& 9(* =# .#(/ +(9'%. kBBB +.%$ -%%/#3 ,2$(* -/(&$( V*%' &%0%%3< =#9(2 1%2 5%..1 (=%2' )*+#9')%2& 3)(&W %. +(># +(9'%. kBBB +.%$ ( 3.20 9%$-(*1V( =#''#. )3#(\ $(3# 2&)*0 $%*%9/%*(/ (*')=%3)#& (*3 &-#9)(/ e]? '#9,*)G2#&W6

    ;,7$2'(1(0 "^,5,/01

    7,# $%&' 9%$$%* 9%(02/(')%* +(9'%. 3#+)9)#*916 i:/)*>#3 .#9#&&)4# )*,#.)'(*9#< 2&2(//1 V(=%2' TPu %+ -(')#*'& ,(4# ( &-%*'(*#%2&$2'(')%*W6

    l2##* k)9'%.)( VH.)')&, &%4#.#)0* +.%$ QnTj 2*')/ ,#. 3#(', )* QoPQW ,(3 ,#$%-,)/)( (*3-(& )' %* '% ',.## %+ ,#. 9,)/3.#*@ %*# (++#9'#3 &%* VM#%-%/3W (*3 '5% 9(..)#. 3(20,'#.&V?/)9# (*3 H#('.)9#W6 ?/)9# (*3 H#('.)9# )* '2.* -(& ',# 0#*# %* '% ',#). 9,)/3.#*< (*3',.%20, ',# 3#&9#*3(*'&< ',# 3)( -.%4#3 3)&(&'.%2& +%. #.(/ %+ ',# .%1(/ ,%2& %+g2.%-#6 X,#9> %2' ',# &'%.1 %+ ',# A$(3 $%*>D ;(&-2')*< 5,% 5(& 9%*&2/'#3 =1 ?/)F< 5)+#%+ ',# ;2&&)(* XE(. ])9,%/(& BB< +%. '.#('$#*' %+ ',#). (++#9'#3 &%*< ?/#F)&6 X#.'()* -#%-/#3)3*8' /)># ',# $%*>C& )*+/2#*9# %* ',# ;%1(/ +($)/1< (*3 ',)& $(1 ,(4# 9%*'.)=2'#3 '% ',#

    #4#*'2(/ $2.3#. %+ ',# #*').# +($)/1 )* QoQj6 ?*15(16 r*# $%.# )*'#.#&')*0 +(9'< (*3 ',#* 5# $%4# %* '% ',# 3)( l2##* k)9'%.)(,(3 *% >*%5* +($)/1 ,)&'%.1 %+ ',# 3)( m &% &,# $(1 ,(4# =##* %*# %+ ',# TPu %+-(')#*'& )* 5,)9, ( &-%*'(*#%2& $2'(')%* )& ',# 9(2 %+ ',# 3)(

  • 8/12/2019 Clot or Bleed

    28/52

    R(0# On %+ UO

    _%,,5 W(3&$/(0K B/(53, "1#,/& 05+ &',(/ 3'(1+/,5C+$#$-!# =< G$-"0 H-*($ 6!"#($:-1#($ !" IJK2>

    81(5(301 C(5+(5*) e)( #.)'1 3#-#*3& %* ,%5 $29, +(9'%. kBBB ',# -(')#*' 9(* $(>#6 71-)9(/ =/##3)*0 )* ,#$%-,)/)( )*9/23#& .#92..#*'< -()*+2/ =/##3)*0 )*'% J%)*'& +%//%5)*0

    &%$# &%.' %+ '.(2$(< -.%/%*0#3 =/##3)*0 (+'#. 3#*'(/ #F'.(9')%*&< (*3 &-%*'(*#%2&$29%&(/ ,#$%..,(0#6

    B+ 3)( )& #.# %. 2*'.#('#3< J%)*' 3#+%.$)'1 %. 3)&(=)/)'1 9(* .#&2/'6

    O0#$/0&$/F &,)&) 7,# R77 )& -.%/%*0#3< (*3 )' A9%..#9'&D 5,#* 1%2 3% ( R77 $)F)*0 &'231 Va,1Z B+ 1%2 *##3

    '%< 0% =(9> (*3 .#(3 (=%2' ',# R77 $)F)*0 &'231W6 7,# B];< 77< -/('#/#' 9%2*'< (*3 =/##3)*0 ')$# (.# *%.$(/6 "#1 5()'< ',# =/##3)*0 ')$# )& *%.$(/Z I#&h 7,# =/##3)*0 ')$# )& *%.$(/6 7,('8& =#9(2 ',# =/##3)*0 ')$# r]MI $#(&2.#& ',#

    -/('#/#' .#&-%* '% )*J2.1< *%' ',# 9%(02/(')%* 9(&9(3#6 S##$& 5#).3< =2' )'8& '.2#6 7,)& )&/)>#/1 =#9(2 -(')#*'& 5)', ,#$%-,)/)( 9(* $(># ( -/('#/#' -/20 J2&' +)*# V&% ',#1 &'%-

    =/##3)*0 *%.$(//1 (+'#. ',# =/##3)*0 ')$# )*9)&)%*W : =2' ',#1 9(*8' $(># +)=.)* '% (/ 2-',(' -/20 V&% ',#1 5)// /)>#/1 =/##3 (' &%$# -%)*' /('#. %*< (+'#. ',#184# /#+' ',# /(=%.('%.1W6S($# -.)*9)-/# (& /('# =/##3)*0 +%//%5)*0 '.(2$( %. &2.0)9(/ -.%9#32.#&6

    7% 9%*+).$ 1%2. 3)(0*%&)&< %.3#. G2(*')'(')4# (*3 G2(/)'(')4# +(9'%. kBBB (&&(1&6 e)(0*% ',# 9(..)#. &'('# 2&)*0 e]? '#&')*06

    # (*1 +(9'%. kBBB (' (//W *##3 +(9'%. kBBB.#-/(9#$#*'6 I%2 5(*' '% 0)4# (& /)''/# %+ ',)& (& 1%2 9(*< =#9(2 &%$# -(')#*'& 5)// &'(.'$(>)*0 (*')=%3)#& '% +(9'%. kBBB V(*3 ',#* 1%2 ,(4# '% 0)4# ( '%* %+ +(9'%. kBBB '% 0#' (*1.#&-%*W6

  • 8/12/2019 Clot or Bleed

    29/52

    R(0# Oo %+ UO

    ;,7$2'(1(0 ?^,5,/01

    B*,#.)'(*9# -(''#.* )& ',# &($# (& ',(' %+ ,#$%-,)/)( ?6

    _29, /#&& 9%$$%* ',(* ,#$%-,)/)( ?6

    )*3 %+ *)9# ',(' ',#1 *($#3 ',#$ ',)& 5(1@ ,#$%-,)/)( ? )& +(9'%. kBBB< (*3 ,#$%-,)/)(

    H )& +(9'%. Bi6 7,# +(9'%. Bi 0#*# V/%9('#3 *#F' '% ',# +(9'%. kBBB 0#*#W )& $2'('#36

    R'0&V) C03&$/ J` *$$+ C$/H B'8& %*# %+ ',# )$-%.'(*' 9%(02/(')%* +(9'%.& )* ',# )*'.)*&)9 9%(02/(')%* -(',5(1 V%* ',#

    /#+':,(*3 &)3# %+ ',# /)''/# 9%(02/(')%* 9(&9(3# )$-.)*'#3 %* 1%2. =.()*W6

    81(5(301 C(5+(5*) S($# (& ',% %+ ,#$%-,)/)( ?6

    O0#$/0&$/F &,)&) S($# B];< R77< 77 (*3 =/##3)*0 ')$# .#&2/'& (& )* ,#$%-,)/)( ?6 7,# %*/1 5(1 '% '#// ,#$%-,)/)( ? (*3 H (-(.' )& =1 3%)*0 +(9'%. kBBB (*3 Bi (&&(1& V(*3

    0#*#')9 '#&'&W6

    #*(E) L#5&< (*3 2&2(//1 9(2& #F9#&& =/##3)*0

    %*/1 (+'#. '.(2$( V&29, (& &2.0#.1W6 E03&$/ `JJJ 3#+)9)#*91 9(2& ( #.# =/##3)*0 '#*3#*91 V2&2(//1 -.#*')*0 5)', 2$=)/)9(/

    &'2$- =/##3)*0W6 B' ,(& ( *%.$(/ R77h 7,('8& =#9(2 +(9'%. iBBB 9.%&&/)*>& +)=.)* $%/#92/#&5)',)* ',# 9/%'\ )' .#(//1 ,(& *%',)*0 '% 3% 5)', +)=.)* +%.$(')%*6 S% )'8& *%' $#(&2.#3 =1 ',#R77 %. ',# B];6

  • 8/12/2019 Clot or Bleed

    30/52

    R(0# TP %+ UO

    ;,/,+(&0/F 210&,1,& +()$/+,/)7,# (.# 3(*0 .(.#6 S% 5,1 (.# 5# 9%4#.)*0 ',#$Z 75% .#(&%*&@

    Q6 7,#1 ,(4# &,%5* 2- %* ]H_g -(.' Q6 B >*%5< .)0,'Z ;)3)92/%2&6

    O6

    S#4#.(/ ')$#& (+'#. /#9'2.)*0 %* ',)&< &%$#%*# ,(& &()3< AB J2&' ,(3 ( -(')#*' 5)', H#.*(.3:S%2/)#.hD %. %*# %+ ',# %',#.&6 S%6665,#',#. &%$#',)*0 )& .(.# %. *%'< )' ,(--#*& V(*3 '% ',#-(')#*' 5,% ,(& )'< )' 3%#&*8' $(''#. ,%5 .(.# )' )&W6

    ?,/50/+SN$%1(,/ )F5+/$7, ?2'%&%$(/ .#9#&&)4# )*,#.)'(*9# R(')#*'& ,(4# (* (=*%.$(/)'1 %+ 0/19%-.%'#)* B= V5,)9, =)*3& 4%* a)//#=.(*3 +(9'%.W< &%

    ',#). -/('#/#'& 9(*8' =)*3 '% ',# &2=#*3%',#/)2$ `)(*' -/('#/#'& S#4#.# =/##3)*0

    ^105I7055 &'/$7#0)&',5(0 ?2'%&%$(/ .#9#&&)4# )*,#.)'(*9# R(')#*'& ,(4# (* (=*%.$(/)'1 %. (=*9# %+ 0/19%-.%'#)* BBH:BBB( V5,)9, =)*3& +)=.)*%0#*W< &%

    ',#). -/('#/#'& 3%*8' (00.#0('# S#4#.# =/##3)*0

    ^/0F 210&,1,& )F5+/$7, R/('#/#'& ,(4# +#5 %. *% b 0.(*2/#& V,#*9# ',#1 /%%> #$-'1< %. 0.(1W `)(*' -/('#/#'& _)/3 =/##3)*0

    a */05%1, +,C(3(,53F R/('#/#'& ,(4# +#5 %. *% d 0.(*2/#& V',# (.#*8' .#(//1 4)&)=/# =1 /)0,' $)9.%&9%-1 (*15(1W B&%/('#3< %. -(.' %+ ( &1*3.%$# V/)># X,#3)(>:")0(&,)W

  • 8/12/2019 Clot or Bleed

    31/52

    R(0# TQ %+ UO

    ?9G2).#3 =/##3)*0 3)&%.3#.&?9G2).#3 =/##3)*0 3)&%.3#.& (.# $%.# 9%$$%* ',(* ,#.#3)'(.1 =/##3)*0 3)&%.3#.&6 q*/)>#,#.#3)'(.1 =/##3)*0 3)&%.3#.&< ',#1 )*4%/4# $2/')-/# +(9'%. 3#+)9)#*9)#&6

    U()),7(50&,+ (5&/0@0)3%10/ 3$0*%10&($5 PUJ8Q^,5,/01

    eBX )& ( ',.%$=%:,#$%..,(0)9 V9/%'')*0 (*3 =/##3)*0W 3)&%.3#. ',(' %992.& (& (9%$-/)9(')%* %+ /%'& %+ 3)++#.#*' 9%*3)')%*&6

    S%$#',)*0 V# =#/%5W '.)00#.& ',# 9%(02/(')%* &1&'#$< .#&2/')*0 )* /%'& %+ /)''/# +)=.)* 9/%'&V5,)9, #*'.(- -/('#/#'&W ',.%20,%2' ',# =%316

    7,# /)''/# 9/%'& V%. $)9.%',.%$=)W 3% =(3 ',)*0&@ ',#1 &*(0 (*3 3#&'.%1 .#3 =/%%3 9#//&V9(2&)*0 ( ,#$%/1')9 (*#$)(W (*3 %99/23# &$(// 4#&/& V9(2&)*0 ')&&2# ,1-%F)( (*3)*+(.9')%*W6

    ?// ',)& .($-(*' 9/%'')*0 2& 2- ',# -/('#/#'& (*3 9%(02/(')%* +(9'%.&< 9(2&)*0 =/##3)*06 7% $(># $(''#.& 5%.< (& ',# =%31 '.)#& '% /1 ',# 9/%'&< +)=.)* )& =.%>#* 3%5* )*'% +)=.)*

    3#0.(3(')%* -.%329'& V5,)9, ',#$/4#& )*,)=)' 9/%'')*0 (*3 (00.(4('# ',# =/##3)*0-.%=/#$W6

    R'0& 4(5+) $C &'(5*) 704, 0 2,/)$5 *$ (5&$ UJ8HQ6 7,)*0& ',(' 32$- -.%9%(02/(*' &2=&'(*9#& )*'% ',# =/%%3

    %=&'#'.)9 9%$-/)9(')%*& V(=.2-')%*< ($*)%')9 +/2)3 #$=%/)&$W (3#*%9(.9)*%$( V#&-#9)(//1 .#(//1 $29)*%2& %*#&< /)># -(*9.#(')9 (3#*%9(.9)*%$(W 4#*%$%2& &*(># =)'#& (92'# -.%$1#/%91')9 /#2>#$)(

    O6 7,)*0& ',(' 3($(0# #*3%',#/)2$ %. ')&&2# #.#< 0.($:*#0(')4#< '%F)*:-.%329)*0 =(9'#.)(/ )*+#9')%* '.(2$( %. ',#.$(/ =2.*& 4(&92/)')& V/)># &1&'#$)9 /2-2& #.1',#$('%&2&W

    ;$6 07 J )%22$),+ &$ /,7,7#,/ 011 &'$), &'(5*)HI%2C// 3% 5#// )+ 1%2 .#$#$=#. ',# +%2. ',)*0& ',(' 9(2 $%&' 9(& %+ eBX V;#(//1h M)&'#3 ',)&5(1< ',#1 &-#// A$%&'hDW@

    $(/)0*(*91 %=&'#'.)9 9%$-/)9(')%*& -&)& '.(2$(

    7,)*0& '% $(># 1%2 /%%> &$(.'?''#*3)*0@ A7#// $# ',# +%2. $%&' 9%$$%* 9(2& %+ eBX6DS'23#*' V/#'8& #666_6r6S67666_6r6S67666W@ A_(/)0*(*91< rH 9%$-/)9(')%*&< -&)&< (*3 '.(2$(6D?''#*3)*0@ AB8$ &% )$-.#&$ ])9# J%=6 g4#.1 &'23#*' &,%2/3 =# (& &$(.' (& 1%26D

  • 8/12/2019 Clot or Bleed

    32/52

    R(0# TO %+ UO

    81(5(301 C(5+(5*)Q6 r*' $(1 =# +2/$)*(*' V#606< -&)&W %. )*&)3)%2& V#606< (3#*%9(.9)*%$(WO6 S1$-'%$& (.# %+'#* )* $(*1 %.0(* &1&'#$&@

    .#&-).('%.1 &1&'#$ V31&-*#(< 91(*%&)&W *#.4%2& &1&'#$ V)E2.#&< 9%$(W .#*(/ &1&'#$ V%/)02.)(< (92'# .#*(/ +()/2.#W 4(&92/(. &1&'#$ V9).92/('%.1 +()/2.#< &,%9>W

    T6 S)0*& %+ =/##3)*0 (*3 ',.%$=%&)&@ =/##3)*0 +.%$ 4#*)-2*9'2.# &)'#& %. &2.0)9(/ 5%2*3& `B< /2*0< %. %=&'#'.)9(/ =/##3)*0 -#'#9,)(# 0(*0.#*#

    O0#$/0&$/F &,)&)Q6 X%(02/(')%* '#&'&

    7,# B];< R77< 77 (*3 +)=.)*%0#* /#4#/ (.# -.%/%*0#3 V=#9(2 (// +(9'%.& (.# 3#-/#'#3W ^)=.)* 3#0.(3(')%* -.%329'& (.# )*9.#( V=#9(2 %+ (// ',# 9/%'')*0 0%)*0 %*W

    O6 H/%%3 &$#(. 7,# -/('#/#' 9%2*' )& /%56 ^.(0$#*'#3 .#3 =/%%3 9#//& V&9,)&'%91'#&W (.# -.#*'\ ',)& )& 9(//#3 ( $)9.%(*0)%-(',)9

    ,#$%/1')9 (*#$)( V_?"?W =#9(2 ',# .#3 9#//& (.# 3#&'.%1#3 )* &$(// V$)9.%W 4#&/&6 7,# #.)'1 %+ eBX )& .#+/#9'#3 )* ',# =/%%3 &$#(.h X/)*)9)(*& %+'#* %.3#. 3()/1 =/%%3

    &$#(.& '% # )+ ',# *2$=#. %+ &9,)&'%91'#& )& '.#*3)*0 2- %. 3%5*6

    7,)*0& '% $(># 1%2 /%%> &$(.'?''#*3)*0@ AB+ _.6 L%*#& .#(//1 )& )* eBX< 5,(' &,%2/3 ,)& =/%%3 &$#(. /%%> /)>#ZDS'23#*'@ AB' 5)// &,%5 ( /%5 -/('#/#' 9%2*' (*3 (/&% &%$# +.(0$#*'#3 .#3 9#//&< %. &9,)&'%91'#&6 a#9(* %.3#. ( &$#(. #4#.1 3(1 (*3 # )+ ',# *2$=#. %+ &9,)&'%91'#& )& 0%)*0 2- %. 3%5*6D?''#*3)*0@ AI#&< ',('8& '.2#6 _(*< 5,#.# 3)3 1%2 '.()*Z I%28.# =.)//)(*'h 7,# .#&' %+ 1%2< '(>#*%'#6D

  • 8/12/2019 Clot or Bleed

    33/52

    R(0# TT %+ UO

    J+($20&'(3 &'/$7#$3F&$2,5(3 2%/2%/0 PJ#& (*')=%3)#& (0()*&' ,)&p,#. -/('#/#'&< 5,)9, ',#* 0#'#('#* 2- =1 $(9.%-,(0#&6 B' )& 3)4)3#3 )*'% 9,.%*)9 (*3 (92'# +%.$&< #(9, %+ 5,)9, ,(& )'& %5* 9/)*)9(/ +#('2.#&6

    81(5(301 C(5+(5*)Q6 X,.%*)9 B7R

    _%&' 9%$$%* )* (32/' 5%$#* w[P6 R.)$(.1 V2*.#/('#3 '% (*1 >*%5* .)&> +(9'%.&W %. %*3(.1 V%992..)*0 )* ',# '')*0 %+

    %',#. 9%*3)')%*&< &29, (& /2-2&< "Bk< %. 9,.%*)9 /1$-,%91')9 /#2>#$)(W6 r*' %+'#* )*&)3)%2&6 S1$-'%$& )*9/23# =/##3)*0 )*'% &>)* (*3 $29%&(/ &2.+(9#&

    V-#'#9,)(#W< *%=/##3&< #(&1 =.2)&)*0< $#/#*(< ,#$('2.)(< (*3 #F9#&&)4# $#*&'.2(/ +/%56 e(*0#.@ &2=(.(9,*%)3 ,#$%..,(0# (*3 )*'.(9#.#=.(/ ,#$%..,(0# V.(.# )* '.#('#3 -(')#*'&

    ',%20,W6O6 ?92'# B7R

    _%&' 9%$$%* )* 9,)/3.#*6 ?=.2-' %*'\ 2&2(//1 +%//%5& ( 4).(/ )//*#&&6 S#/+:/)$)')*0 )* $%&' 9(&6 B* (=%2' OPu %+ 9,)/3.#*< ',%20,< )' $(1 -#.&)&' (*3 .#$=/# 9,.%*)9 B7R6

    B0&'$*,5,)() ?2'%:(*')=%3)#& '% -/('#/#' $#$=.(*# 0/19%-.%'#)*& BB=:BBB(< %. B=:Bi6 7,# (*'):-/('#/#' (*')=%3)#& =)*3 '% -/('#/#'&< $(>)*0 ',# -/('#/#'& 12$$1 '% -,(0%91'#&6 _%&' %+ ',# #(')*0 ,(--#*& )* ',# &-/##* V)+ 1%2 '(># %2' ',# &-/##*< ',# &1$-'%$& 2&2(//1

    0% (5(1W6

    O0#$/0&$/F &,)&)Q6 ^)*3)*0& )*3)9(')*0 -/('#/#' 3#&'.29')%* )*9/23#@

    M%5 -/('#/#' 9%2*'6 ]%.$(/p)*9.#( $#0(>(.1%91'#& )* =%*# $(..%56 M(.0# -/('#/#'& )* =/%%3 V$#0(>(.1%91'#& (.# '.1)*0 &% ,(.3 '% $(># -/('#/#'& +(&' ',(' ',#1

    #*3 2- $(>)*0 =)0 %*#&W6

    O6 B];pR77 (.# *%.$(/h V=#9(2 ',)& )& J2&' ( -/('#/#' -.%=/#$WT6 7,#.# )& *% &-#9)+)9 /(= '#&' '% ,$+*( ',(' ',# -(')#*' ,(& B7R6 B' )& ( 3)(0*%&)& %+ #F9/2&)%*\ %*/19(// )' B7R (+'#. .2/)*0 %2' %',#. 9(2& %+ ',.%$=%91'%-#*)(< &29, (&@

    e.20 #++#9' ?-/(&')9 (*#$)( H%*# $(..%5 .#-/(9#$#*' V#606< =1 '2$%.W H)0 &-/##* ]%*:)$$2*#:.#/('#3 -/('#/#' 3#&'.29')%* V#606< eBX< 77R< "qSW

    # Bk B0 %. (*'):XeOPW6

  • 8/12/2019 Clot or Bleed

    34/52

    R(0# T[ %+ UO

    # 1%2 /%%> &$(.'?''#*3)*0@ AX(* (*1%*# '#// $# ,%5 1%2 5%2/3 2 ',# B]; (*3 R77 '% #4(/2('# -(')#*'& 5)', ($)9.%(*0)%-(',)9 ,#$%/1')9 (*#$)(ZDS'23#*'@ Aa#//< )* eBX< ',# -(')#*' )& 9%*&2$)*0 9%(02/(')%* +(9'%.&< &% ',# B]; (*3 R77 (.# =%',-.%/%*0#36 H2' ',#.# (.# (/&% %',#. 9(2& %+ $)9.%(*0)%-(',)9 ,#$%/1')9 (*#$)(6 B* 77R (*3 "qS (=%2' )'6 M#'8& +)*)&, .%2*3)*0 +).&'6D

  • 8/12/2019 Clot or Bleed

    35/52

    R(0# TU %+ UO

    #& ( *(&'1 '%F)* ',(' )& (=&%.=#3 +.%$ 02' )*'% =/%%36! 7%F)* )*J2.#& #*3%',#/)(/ 9#//& (*3 '.)00#.& -/('#/#' (9')4(')%*6

    ]%*:#-)3#$)9< A('1-)9(/D "qS! ?&&%9)('#3 5)', 3#+#9'& )* 9%$-/#$#*' +(9'%. "< $#$=.(*# 9%+(9'%. -.%'#)* VXe[fW %.

    +(9'%. B V-.%'#)*& ',(' *%.$(//1 >##- ',# (/'#.*(')4# 9%$-/#$#*' -(',5(1 )* 9,#9>W6! B*,#.)'#3 V4(.)%2& 3#+#9'&W %. (9G2).#3 V)*,)=)'%.1 (2'%(*')=%3)#&W6! q*9/#(. ,%5 ',# 3#+#9'& '.)00#. -/('#/#' (9')4(')%*6

    T>L>b>N C/$7 B/(53,)) ?/(+, B =!?L %&-$< #:!"? #+ =( -*+!8(8 -# -11 &+%#%>

  • 8/12/2019 Clot or Bleed

    36/52

    R(0# Tf %+ UO

    U$5V& ,0& &'()cM(=-"(%( %#(-7 #-$#-$( =< %#;N%,!*-&7L 4$+5 41!&7$

    81(5(301 C(5+(5*)Q6 77R

    7,# 9/(&&)9 -#*'(3 %+ +)*3)*0& )& /)&'#3 (=%4#6 "#.# (.# ',# &1$-'%$&@Q6 =/%%3 )* 2.)*#< J(2*3)9# V+.%$ ',# _?"?WO6 =/##3)*0< =.2)&)*0 V+.%$ #.# ',.%$=%91'%-#*)(WT6 +#4#. V"#.#8& ( /)''/# .#'@ 1%2 9(* (/5(1& &(1 A91'%>)*# .#/#(D %. A)*+/($$(')%*D

    5,#* 1%2 3%*8' >*%5 ',# #F(9' 9(2 %+ &%$#',)*0W[6 =)E(..# =#,(4)%.< (/'#.#3 $#*'(/ &'('2&< ,#(3(9,# V+.%$ $)9.%',.%$=) )* ',# X]SWU6 3#9.#( 2.)*# %2'-2' V+.%$ .#*(/ +()/2.#W

    R(')#*'& $(1 (/&% ,(4# %',#. &1$-'%$& V=#&)3#& ',% )* ',# X]S (*3 >)3*#1W .#/('#3 '%',# 3#-%&)')%* %+ $)9.%',.%$=)\ (*1 %.0(* V,#(.'< `B< %',#.&W 9(* =# (++#9'#36

    R(')#*'& 3% ]r7 ,(4# '% ,(4# ',# #*').# -#*'(3 '% =# 3)(0*% 5)', 77Rh B* +(9'< $%&'-(')#*'& (.# $)&&)*0 %*# %. $%.# %+ ',# +)*3)*0&6

    O6 "qS g-)3#$)9 "qS

    ! X,)/3.#* (*3 #/3#./1 (.# (' ,)0,#&' .)&>6! X%*'($)*('#3 +%%3 V.(5 ,($=2.0#.< &-)*(9,W )& 2&2(//1 ',# 92/-.)'6! X/(&&)9 &1$-'%$&@ =/%%31 3)(..,#(< +%//%5#3 ( +#5 3(1& /('#. =1 .#*(/ +()/2.#6 ]#2.%/%0)9

    &1$-'%$& (*3 +#4#. (.# .(.#6! R(')#*'& 9(* .#9%4#. 5)', &2--%.')4# 9(.#\ =2' )..#4#.&)=/# .#*(/ 3($(0# (*3 3#(',

    %992. )* $%.# #.# 9(&6

    +

    ]%*:#-)3#$)9 "qS!

    S1$-'%$& (.# ',# &($# (& )* #-)3#$)9 "qS< =2' 5)',%2' ',# 3)(..,#(6! 7,# 3)( 9%2. )& .#/(-&)*0:.#$)'')*06

    & '% .#-/(9# ',#).

    ?e?_7SQT6O6 "qS

    R(')#*'& 5)', "qS (.# '.#('#3 &2--%.')4#/1 V3)(/1&)&< #'96W6 B+ 1%28.# *%' &2.# 5,#',#. )'8& "qS %. 77R V%+'#*< )'8& ,(.3 '% '#// ',# 3)++#.#*9#hW 1%2 9(* 3%

    -/(&$(-,#.#&)& +%. ( 5,)/# 2*')/ 1%2 +)02.# )' %2'6

  • 8/12/2019 Clot or Bleed

    37/52

  • 8/12/2019 Clot or Bleed

    38/52

    R(0# Tn %+ UO

    T%+$1C W(/3'$6/$-A!"? =< M(%1!( 6-$8 !" R-"!#< G-!$L IJST>

    8'02&,/ e: # ',# +%.$ %+ 3##-4#*%2& ',.%$=) V)* ',# 4#)*& %+ ',# /#0W %. -2/$%*(.1 #$=%/)6 7,# )*9)3#*9# %+ ',.%$=%&)& 0%#& 2-5)', (0#< (*3 5)', ',# -.#*9# %+ 9#.'()* .)&> +(9'%.& V5,)9, 5#8// '(/> (=%2'W6 r*# %+ ',% .)&>+(9'%.& )& ',# -.#*9# %+ ( ',.%$=%')9 3)&%.3#. V%+ 5,)9, ',#.# (.# #.(/ '1-#&< (& 1%28// # )* ($)*2'#W6

    L2&' '% 0)4# 1%2 &%$# -#.&-#9')4#@ $%&' -(')#*'& 5,% 3#4#/%- ',.%$=) 3% "+# ,(4# ( ',.%$=%')93)&%.3#.6 q&2(//1< ',# ',.%$=2& )& 32# '% ( 9%*&'#//(')%* %+ .)&> +(9'%.& V+%. #F($-/#< %=#&)'1 -/2&&$%>)*0 -/2& %.(/ 9%*'.(9#-')4# 2W6 S% 5,#* ( -(')#*' 9%$#& )* 5)', ( ',.%$=2&< 1%2 5%2/3*8'5(*' '% &'(.' 5%.>)*0 ',#$ 2- =1 /%%>)*0 +%. .(.# ',.%$=%')9 3)&%.3#.& .)0,' (5(1\ 1%283 &'(.' =1/%%>)*0 +%. 9%$$%* .)&> +(9'%.&6 B+ ',#.# (.#*8' (*1< ',%20,< %. )+ ',#.# (.# %',#. 5#).3 +)*3)*0&V# =#/%5W< ',('8& 5,#* 1%2 &,%2/3 &'(.' /%%>)*0 +%. ( ',.%$=%')9 3)&%.3#.6

    T%+$1C W(/3'$6B+ 1%2 ,(4#*8' (/.#(31 .#(3 (=%2' ;23%/+ k).9,%5< 1%2 &,%2/3 &'%- .#(3)*0 ',)& &'231 02)3#)$$#3)('#/1 (*3 0% /%%> ,)$ 2- )* a)>)-#3)(6 B8$ *%' >)33)*06 ;231 VB /)># '% 9(// ,)$ ;231W 5(&%*# %+ ',% -#%-/# )* ',# QnPP& ',(' #$#3 '% =# (=/# '% 3% #4#.1',)*0 : (*3 3% )' 5#//6 "# 5(&)*'% (*',.%-%/%01< ,)&'%.1< =)%/%01< -%/)')9&< (*3 %* '%- %+ )' (//< ,# 5(& ( -,1&)9)(*6 "# ,(& (

    &-#9)(/ -/(9# )* ',# ,#(.'& %+ -(',%/%0)&'& (& ,# )& 9%*&)3#.#3 A',# +(',#. %+ -(',%/%016D

  • 8/12/2019 Clot or Bleed

    39/52

    R(0# To %+ UO

    I%28// ,#(. ,)& *($# ( /%' (& 1%2 0% ',.%20, 1%2. '.()*)*0@ k).9,%58& (*0/#< k).9,%58& 9#// ',#%.1V5,)9, 3)&-.%4#3 &-%*'(*#%2& 0#*#.(')%*W< k).9,%58& *%3#< k).9,%58& (2'%-&1 $#',%3 V5,)9, )& (*)9# $#',%3< 5(1 =#''#. ',(* ',(' )3)%' ;%>)'(*&>18&W< k).9,%5:;%=)* &-(9#&< ',# /)&' 0%#& %* (*3%*6

    W(/3'$6V) ;F2,/3$0*%10#(1(&F 7,#.# (.# ( =2*9, %+ #$)*0/1 2*.#/('#3 .)&> +(9'%.& ',(' +(// )*'% ',)& 9('#0%.1< &29, (&

    &$%>)*0< %.(/ 9%*'.(9#-')4# 2 (*3 (3#*%9(.9)*%$( V=#9(2 ',# $29)* )* ',# '2$%. 9#//&)& ( -.%:9%(02/(*'W6

    7,.%$=%')9 3)&%.3#.& V/)># 5#8.# '(/>)*0 (=%2' )* ',)& 9,(-'#.W (/&% +(// )*'% ',)& -(.' %+k).9,%58& '.)(36

    7,# '.)(3 )& &')// ( 2+2/ (*3 9%..#9' 9%*9#-' '%3(16 )+ 1%2 /%%> (' (// ',# >*%5* .)&> +(9'%.& +%.',.%$=%&)& V# =#/%5W< ',#1 (// +(// )*'% %*# %+ ',# ',.## 9('#0%.)#&6 B+ 1%2 9(*8' .#$#$=#. (//',% .)&> +(9'%.&< 1%2 9(* -.%=(=/1 .#$#$=#. k).9,%58& '.)(3 : (*3 +.%$ ',#.#< 1%2 9(* /)&' %++ (=2*9, %+ ',)*0& ',(' 5%2/3 )*9.#( 1%2. .)&>6 7,(*>&< ;2316

  • 8/12/2019 Clot or Bleed

    40/52

    R(0# [P %+ UO

    T()4 C03&$/) C$/ &'/$7#$)()7,#.# (.# /%'& %+ .)&> +(9'%.& +%. ',.%$=%&)&6 _%&' %+ ',# )* (*3 %+ ',#$/4#& (.# *%' '%%3(*0#.%2&666=2' )+ 1%2 &'(.' '% 0#' '5% %. ',.## %. $%.#< 5('9, %2'@ ',# .)&> 0%#& 5(1 2-6

    (',#.%&9/#.%&)& '.(2$( %=#&)'1 -.%/%*0#3 )$$%=)/)E(')%* 4(.)9% 4#)*& -.#0*(*91 %.(/ 9%*'.(9#-')4# 2 $1%9(.3)(/ )*+(.9')%* ('.)(/ +)=.)//(')%* 9(.9)*%$( V#&-#9)(//1 (3#*%9(.9)*%$(W &$%>)*0

    R',5 )'$%1+ F$% )&0/& 6$//F(5* 0#$%& 0 &'/$7#$&(3 +()$/+,/H_%&' %+ ',# ')$#< ',.%$=%&)& )& 9(2 =1 ',# -.#*9# %+ '%% $(*1 .)&> +(9'%.&6 S%$#')$##- )'

    )* 9,#9>6 AM#)3#*D )& +%. ',# 9)'1 )* ',# ]#',#./(*3& 5,#.# ',# $2'(')%* 5(& +).&' 3)&9%4#.#36

    7,)*0& '% $(># 1%2 /%%> &$(.'l6 a,('8& (9')4('#3 -.%'#)* X .#&)&'(*9#Z?6 B'8& 5,#* -.%'#)* X V(+'#. =#)*0 (9')4('#3W )& 2*(=/# '% 9/#(4# +(9'%. k6 7,#.# (.# /%'& %+ 9(2&%+ (9')4('#3 -.%'#)* X .#&)&'(*9# : =2' ^(9'%. k M#)3#* )& =1 +(. ',# $%&' 9%$$%*6

  • 8/12/2019 Clot or Bleed

    42/52

    R(0# [O %+ UO

    ;$6 3$77$5 () &', C03&$/ W O,(+,5 7%&0&($5H ?=%2' ,(/+ %+ ',# -(')#*'& 5)', A2*#F-/()*#3D ',.%$=%&)& m ',(' )&< ',.%$=%&)& %992..)*0 )*

    ',# (=*9# %+ >*%5* .)&> +(9'%.& m '2.* %2' '% ,(4# +(9'%. k M#)3#*6 ?=%2' Uu %+ X(29(&)(*& 9(..1 ',# $2'(')%*6 ]%< ',('8& *%' ( '1-%@ )'8& .#(//1 Uu6 R#%-/# %+

    ?&)(*< ](')4# ?$#.)9(*< %. ?+.)9(* 3#&9#*' (.# 4#.1 2*/)>#/1 '% 9(..1 )'6

    R'0& () &', /()4 $C *,&&(5* 0 #0+ 31$& (C F$% '0@, &', 7%&0&($5H "#'#.%E10%'#& ,(4# ( ',.%$=%&)& .)&> ',(' )& j ')$#& *%.$(/6 "%$%E10%'#& ,(4# ( ',.%$=%&)& .)&> ',(' )& nP ')$#& *%.$(/6

    7,)*0& '% $(># 1%2 /%%> &$(.'7,# )*9)3#*9# %+ 3##- 4#*%2& ',.%$=%&)& )* ',# 0#*#.(/ -%-2/(')%* )& (9'2(//1 -.#''1 &$(//6 B+ 1%2(3J2&' +%. (0# (*3 F< ',# (**2(/ )*9)3#*9# )& &%$#5,#.# (.%2*3 QOP -#%-/# -#. QPP %+ ',.%$=%&)& ',('8& 3%2=/# ',# *%.$(/ .)&>< ',(' &%2*3&.#(//1 &9(.1 : =2' )* .#(/)'1< 1%2. .)&> )& &')// 4#.1 /%5< &)*9# ',# *%.$(/ .)&> )& 4#.1 4#.1 /%56

    ;$6 +$ F$% +(0*5$), C03&$/ W O,(+,5H 7,# B]; (*3 R77 (.# *%.$(/ )* ',# -(')#*'& VX(* 1%2 #F-/()* 5,1Z B+ *%'< 3.%- 2& (*

    #$()/ (' -(',%/%01KR(',%/%01S'23#*'69%$6W< &% ',# '#&'& 3%*8' ,#/- 1%26 I%2 *##3 '% %.3#. 0#*#')9 '#&')*0 V&%2*3& 9%$-/)9('#3< =2' )'8& *%'6 B'8& ( 9,#(- RX; '#&'

    ',('8& =#9%$)*0 $%.# (*3 $%.# 9%$$%* ',# 3(1&W6 7,)& 5)// '#// 1%2 )+ 1%2. -(')#*' ,(&',# +(9'%. k M#)3#* $2'(')%*< (*3 (& ( =%*2&< 1%28// +)*3 %2' 5,#',#. 1%2. -(')#*' )&,%$%E10%2& %. ,#'#.%E10%2&6

    ;$6 +$ F$% &/,0& 20&(,5&) 6(&' &', C03&$/ W O,(+,5 7%&0&($5H B* 0#*#.(/< -(')#*'& 5)', +(9'%. k M#)3#* V#4#* ,%$%E10%'#&hW &,%2/3 "+# =# '.#('#3 2*/#&&

    ',#1 ,(4# ,(3 ( ',.%$=%&)&6 X%2$(3)* )& ',# %*/1 ',)*0 1%2 9(* .#(//1 0)4# ',# -(')#*'&6 7,('< (*3 '#// ',#$ '% (4%)3

    (// ',# .)&> +(9'%.& ',#1 9(*6

    "5&(&'/$7#(5 JJJ +,C(3(,53FR'0& () 05&(&'/$7#(5 JJJ 0*0(5HB'8& ( *('2.(/ (*')9%(02/(*' ',(' )*,)=)'& ',# .)*# -.%'#(& VBB(< kBB(< Bi(< i(< iB(< iBB(W< ',2&

    )*,)=)')*0 (// ',.## -(',5(1&6 "#-(.)* -%'#*')('#& )'& (9')%*6

    R'0& () 6/$5* 6(&' &', 05&(&'/$7#(5 *,5, (5 &'() +()$/+,/HM%'& %+ 3)++#.#*' $2'(')%*& ,(4# =##* 3#&9.)=#3< #(9, 5)', )'& %5* .)&> %+ ',.%$=%&)& V9%$-(.#',)& '% +(9'%. k M#)3#*< )* 5,)9, 4).'2(//1 (// -(')#*'& ,(4# ',# #F(9' &($# $2'(')%*W6

    ;$6 3$77$5 () 05&(&'/$7#(5 JJJ +,C(3(,53FHB'8& ($-$- -*!%6 ?=%2' P6PUu %+ ',# 0#*#.(/ -%-2/(')%* ,(& (*')',.%$=)* BBB 3#+)9)#*916

  • 8/12/2019 Clot or Bleed

    43/52

  • 8/12/2019 Clot or Bleed

    44/52

    R(0# [[ %+ UO

    a,)9, $#(*& ',(' .)0,' (+'#. X%2$(3)* (3$)*)&'.(')%*< -(')#*'& (.# (9'2(//1 ( =)',1-#.9%(02/(=/#6

    a)',)* ( +#5 3(1&< ',# %',#. +(9'%.& (.# )*,)=)'#3< ')--)*0 ',# =(/(*9# )* +(4%. %+(*')9%(02/(')%*6

    ^%. $%&' -(')#*'&< ',# )*)')(/ ,1-#.9%(02/(=/# &'('# 3%#&*8' $(*)+#&' 9/)*)9(//1 V0)4)*0 ( /)''/#,#-(.)* )* ',# =#0)**)*0 )& *%' ( =(3 )3#(< ',%20,< =#9(2 ',(' &,%2/3 '(># 9(.# %+ (*1,1-#.9%(02/(=)/)'1 32.)*0 ',% +).&' +#5 3(1&W6

    ^%. -(')#*'& 5)', -.%'#)* X 3#+)9)#*91< ,%5#4#.< ',(' )*)')(/ -.%'#)* X )*,)=)')%* )&3(*0#.%2& V&)*9# ',#). -.%'#)* X /#4#/& (.# (/.#(31 .#(//1 /%5W6 B' 9(* $(*)+#&' (&5)3#&-.#(3 9/%'')*0 ',(' +%. &%$# .#(&%* &,%5& 2- $%&' )* ',# &>)* V5)', -2.-2.( (*3*#9.%&)&W6

    l6 a,('8& -2.-2.( +2/$)*(*&Z?6 B'8& ( &)$)/(. &)'2(')%* : 5)3#&-.#(3 9%(02/(')%* 5)', -2.-2.( (*3 &>)* *#9.%&)&6 B' )& $%&'

    9%$$%* )* =(=)#& (*3 &$(// 9,)/3.#*< (*3 )' )& 2&2(//1 (&&%9)('#3 5)', #.# )*+#9')%* V%+'#*5)', ( 0.($:*#0(')4# %.0(*)&$W6 B' )& (* (92'# (*3 /)+#:',.#('#*)*0 9%*3)')%* ',(' .#G2).#&(00.#&&)4# '.#('$#*'6

    ;$6 +$ F$% +(0*5$), 2/$&,(5 8 +,C(3(,53FH 7,# =#&' $#',%3 )& +2*9')%*(/ '#&')*0 m 5,)9, '#//& 1%2 )+ ',# -(')#*'C& -.%'#)* X )& 5%.>)*0

    V(*3 5,#',#. ',#.#C& #*%20, %+ )' (.%2*3W6 B'C& =#&' '% 3% ',)& '#&' 5,#* ',# -(')#*' )& *%' (9')4#/1 9/%'')*0 %. %* (*')9%(02/(*' ',#.(-1 +%. 0#'')*0 -2.-2.( +2/$)*(*&6

    ;$6 +$ F$% +(0*5$), 2/$&,(5 N +,C(3(,53FH S($# &'%.1 (& +%. (*')',.%$=)* BBB (*3 -.%'#)* X@ +2*9')%*(/ '#&')*06 S($# 9(4#('& (--/1@ 1%2 9(*C' =# &2.# %+ '#&' .#&2/'& 5,#* ',# -(')#*' )& (9')4#/1 9/%'')*0 %.

    %* (*')9%(02/(*' $#3&6

  • 8/12/2019 Clot or Bleed

    45/52

    R(0# [U %+ UO

    E03&$/ JJ P2/$&'/$7#(5Q *,5, 7%&0&($5R'0&f) 6/$5* 6(&' &', C03&$/ JJ *,5, (5 &'() +()$/+,/HB* ',)& 3)&%.3#.< ',#.# )& ( 0#*# $2'(')%* ',(' 9(2& ',# -.%329')%* %+ ()&(%%-.%',.%$=)*h 7,#

    -.%',.%$=)* )'/+ )& *%.$(/ )* &'.29'2.# (*3 +2*9')%*< ',%20,6 B'C& J2&' ',(' ',#.#C& '%% $29, %+ )'6;$6 3$77$5 () &', C03&$/ JJ 7%&0&($5H

    ?=%2' Uu %+ X(29(&)(*& 9(..1 ',# $2'(')%*6 R#%-/# %+ ?&)(*< ](')4# ?$#.)9(*< %. ?+.)9(* 3#&9#*' (.# 4#.1 2*/)>#/1 '% 9(..1 )'6

    R'0& () &', /()4 $C *,&&(5* 0 #0+ 31$& (C F$% '0@, &', 7%&0&($5H "#'#.%E10%'#& ,(4# ( ',.%$=%&)& .)&> ',(' )& O ')$#& *%.$(/6 "%$%E10%'#& ,(4# ( ',.%$=%&)& .)&> ',(' )& OP ')$#& *%.$(/6

    ;$6 +$ F$% +(0*5$), &', C03&$/ JJ *,5, 7%&0&($5H 7,#.# )& ( RX; '#&'< /)># )* +(9'%. k M#)3#*6

    ;F2,/'$7$3F)&,(5,7(0R'0&V) '$7$3F)&,(5, 0*0(5H"%$%91&'#)*# )& $(3# +.%$ 3)#'(.1 $#',)%*)*#6 B'8& )$-%.'(*' )* $()*'()*)*0 $1#/)*< (*3 )' )&*')(/ +%. ',# 9%*4#.&)%* %+ 3)#'(.1 +%/('# )*'% ',# +%.$ %+ +%/('# ',(' -(.')9)-('#& )* e]?&1*',#&)&6 X,#9> %2' ',# HQOp+%/('#p,%$%91&'#)*#p$#',)%*)*# 3)(0.($ =#/%56 I%284# #* =#+%.#)* =)%9,#$ V&,233#.W (*3 5)// *% 3%2=' # (0()*< )* 3)++#.#*' )'#.(')%*&< )* %',#. 9%2.&6 B' &,%5&,%5 $#',)%*)*# V5,)9, 9%$#& +.%$ 1%2. 3)#'W )& '2.*#3 )*'% ,%$%91&'#)*#< &%$# %+ 5,)9, 0#'&$#'(=%/)E#3 )*'% 91&'(',)%*)*# (*3 &%$# %+ 5,)9, 0#'& .#919/#3 )*'% $#',)%*)*# V5)', ',# ,#/- %+HQO (*3 +%/('#W6

  • 8/12/2019 Clot or Bleed

    46/52

    R(0# [f %+ UO

    N$ '$6 +$ F$% *,& 'F2,/'$7$3F)&,(5,7(0H X/(&&)9 ,%$%91&'#)*;$!- )& ( .(.# (2'%&%$(/ .#9#&&)4# 3)&%.3#. 9(2 =1 ( 3#+)9)#*91 )* ',#

    91&'(',)%*)*# =#'( &1*',( V&% ,%$%91&'#)*# 3%#&*8' 0#' =.%>#* 3%5* )*'%91&'(',)%*)*#W6 B' '2.*& %2' ',(' ',# -(')#*'& 0#' 4(&92/(. 3)( (*3 ',.%$=%&)& (' ($29, #(./)#. (0#< (*3 '% ( 0.#('#. #F'#*'< ',(* -(')#*'& 5)',%2' ,%$%91&'#)*2.)(6 B'C&',%20,' ',(' ',# 4(&92/(. 3)(p',.%$=%&)& )& 9(2 =1 ',# ,)0, ,%$%91&'#)*# /#4#/& m=2' )' ,(&*C' =##* 3#+)*)')4#/1 -.%4#*6

    H2' 1%2 9(* 0#' #/#4('#3 /#4#/& %+ ,%$%91&'#)*# =1 %',#. $#(*&@! S%$# -#%-/# ,(4# $2'('#3 $#',1/ '#'.(,13.%+%/('# .#329'( 0#*# V',# 0#*# ',('

    -.%329#& ',# #*E1$# 5)', ',# 2*+%.'2*('# (==.#4)(')%* _7"^;W6 g2.%-#(*&< _)33/#g(&'#.*#.&< (*3 L(-(*# -(')#*'& ,(4# ',# ,)0,#&' 9(..)#. .('#&6 7,)& $2'(')%* 9(*%=&'.29' ',# *%.$(/ +%/('# 919/#< /#(3)*0 '% $)/3 ,%$%91&'#)*#$)(6

    ! e)#'(.1 3#+)9)#*9)#& %+ +%/('#< HQO< (*3 Hf 9(* (/&% /#(3 '% $)/3 ,%$%91&'#)*#$)(6

    R'0&V) )$ #0+ 0#$%& '0@(5* 'F2,/'$7$3F)&,(5,7(0H "1-#.,%$%91&'#)*#$)( (--#(.& '% =# (&&%9)('#3 5)', ( 0.#('#. .)&> %+ ',.%$=%&)& (*3

    (',#.%&9/#.%&)& V/#(3)*0 '% (.'#.)(/ (*3 4#*%2& ',.%$=%&< $1%9(.3)(/ )*+(.9')%*< (*3&'.%>#W6

    gF(9' $#9,(*)&$& (.# *%' 9/#(.< =2' )' )& >*%5* ',(' '%% $29, ,%$%91&'#)*# 9(* ,(4# =(3#++#9'& %* ,#$%&'(&)& V=1 9(2&)*0 ')&&2# +(9'%. #F-.#&&)%*W (*3 4#&/ 5(//& V=1 9(2&)*0)*')$(/ ',)9>#*)*0W6

    R'0& () &', /()4 C$/ *,&&(5* 0 #0+ 31$& (C F$% '0@, (&H 7,# .)&> +%. 4#*%2& ',.%$=%&)& )& O6U ')$#& *%.$(/6 7,# .)&> +%. $1%9(.3)(/ )*+(.9')%* )& QP ')$#& *%.$(/6

    ;$6 +$ F$% +(0*5$), 'F2,/'$7$3F)&,(5,7(0H _#(&2.# ',# -/(&$( /#4#/ %+ ,%$%91&'#)*# V,%$%E10%'#& ,(4# 4#.1 ,)0, /#4#/&\ =2'

    ,#'#.%E10%'#& %. -(')#*'& 5)', 3)#'(.1 3#+)9)#*9)#& $(1 ,(4# %*/1 &/)0,'/1 #/#4('#3 %. #4#**%.$(/ /#4#/&W6

    7,#.# )& ( RX; '#&' +%. ',# _7"^; 0#*# $2'(')%* V#F-#*&)4#< =2' 3)(0*%&')9W6 I%2 $)0,' (/&% 5(*' '% /%%> +%. +%/('# 3#+)9)#*91 V2&)*0 .2$ (*3 .#3 9#// +%/('# /#4#/&W

    (*3 HQO 3#+)9)#*91 V2&)*0 $#',1/$(/%*)9 (9)3 /#4#/&W6

  • 8/12/2019 Clot or Bleed

    47/52

  • 8/12/2019 Clot or Bleed

    48/52

  • 8/12/2019 Clot or Bleed

    49/52

    R(0# [o %+ UO

    X%$$%* (==.#4)(')%*&

    S%2.9#&"#.# (.# &%$# 0%%3 .#+#.#*9# &%2.9#& +%. +2.',#. .#(3)*0 (*3 #F-/(*(')%*&6Q6 "%++=.(*3 ?6k6P%%("#!-1 X-(5-#+1+?< 6 ^)+', #3)')%* OPPf@ H/(9>5#// S9)#*9#< g*0/(*3O6 ;%==)*& -(0#& QQU m QOQ V*%.$(/ ,#$%&'(&)&WT6 ;%==)*& -(0#& QOQ m QOo V',.%$=%&)& (*3 9%*G2#*9#&W[6 ;%==)*& -(0# fff V/(= '#&'&WU6 ;%==)*& -(0#& ffj :fj[ V=/##3)*0 3)&%.3#.&W

    ^2* (9')4)')#&Q6 e.(5 %2' 1%2. %5* /)''/# $(- %+ ',# 9%(02/(')%* 9(&9(3#< )*9/23)*0 ',# *('2.(/ (*')9%(02/(*' R.%$-'/1 +%.0#' ',)& (+'#. =%(.3&6;#3.(5 )' (& (* )*'#.* (*3 -2' )' )* ',# /)''/# =%%> 1%2 9(..1 )* 1%2. 5,)'# 9%('6

  • 8/12/2019 Clot or Bleed

    50/52

    R(0# UP %+ UO

    O6 ^)// )* ',# +%//%5)*0 '(=/#&@

    T6 a.)'# 3%5* (& $(*1 .)&> +(9'%.& +%. ',.%$=%&)& (& 1%2 9(* ',)*> %+6 `% =(9> '% ;%==)*& -6 QOO)*0 &,#..1O '&-6 9%.*&'(.9, -/2& z 92- 5('#.< 9%$=)*#3 )* ( &$(// =%5/f 7=&-6 -#(*2' %)/Q { '&-6 ,%' -#--#. +/(>#& )* %)/Q 7=&-6 ,%' -#--#. -(&'#O 7=&-6 %1&'#. &(29# V%-')%*(/WQ '&-6 &20(.(*%',#. T 7=&-6 &%1 &(29#< -/2& QpT 92- 5('#.{ '&-6 0.%2*3< .%(&'#3 SE#9,5(* -#--#.9%.*&(*%',#. Q '&-6 &($# %)/Q '&-6 &(/'< %. '% '(&'#

    R2' ',# '.## #(.& )* ( &$(// =%5/ (*3 -%2. ',# =%)/)*0 5('#. %4#. ',#$6 M#' ',#$ &%(> +%. (=%2' QU$)*2'#&< 2*')/ ',#1 =#9%$# &%+' (*3 0#/(')*%2&6 R##/ ',# 0)*0#.< ',#* 9,%- )' )*'% ')*1 -)#9# /)''/# -)#9#& %+ 5%%3< ',(' $)0,' &')// =# #$=#33#3 )* ',#$6 7,#* $)*9# ',#$)*'% /)''/# -)#9#& ',# &)E# %+ ( $('9, ,#(36

    L2&' =#+%.# 1%2 (.# .#(31 '% =#0)* 9%%>)*0< (33 ',# 9%.*&'(.9, '% ',# $#(' $)F'2.# (*3 =/#*3',%.%20,/16 "#(' 1%2. 5%> %. -(* %4#. ( $%3#.('#/1 ,)0, +/($# +%. (=%2' QU %*3&< ',#* (33

  • 8/12/2019 Clot or Bleed

    52/52