Exsanguination - Northern Health

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Exsanguination
A topic we don’t want to talk about...but one we need to know about...
Diseases with Massive Bleeding Risk:
ENT Tumor
Carotid artery erosion from
 neck metastases
 mouth/nose tumor
Gastrointestinal
hemorrhage
Ulceration or tumor erosion
 chronic stomach ulcers that bleed
 significant blood in stool from
small or large bowel
Bladder
Blood in urine due to
 tumor
 blood disorder
Leukemia or blood Possible multiple sites of bleeding
dyscrasia
 external mouth or nasal bleeding
is obviously distressing
 extensive bruising is also visually
difficult for many family
Disseminated
Intravascular
Coagulation (DIC)
Other
Bleeding disorder due to
 profound infection
 various causes
 Ruptured aortic aneurysm
 Tumor lymph node erosion into
adjacent vessels
(Gallagher, 2006) Medical Care of the Dying
Clinically significant bleeding occurs in 6-10% of pts. with ad­
vanced cancer. 3% of patients with lung cancer has terminal
massive hemoptysis (Prommer, 2005).
Rapid exsanguination occurs when a tumor erodes an artery in
the upper chest or neck.
Patients at risk of a major bleed include those with:
 Large ulcerating mass in the neck or in close proximity to
the large arteries in the neck; risk increases if mass becomes pulsatile.
 Recurrent episodes of bleeding; e.g., hemoptysis, hematemesis, hematuria, rectal bleeding.
 Underlying anticoagulation problems, including thrombocytopenia, in above patients increases the risk.
Balance the need to prepare a family for this possibility
against the anxiety of alerting and preparing them.
Keep dark towels/face cloths available to cover the site and
surrounding area. This will reduce the shock of witnessing
copious amounts of blood.
Have family prepared to comfort, touch, hold and support
patient during crisis. Do not leave patient alone.
Provide sedation to have at hand for caregivers in case of a
massive bleed. (Midazolam 5-10 mg SC/IM).
Pallium Canada, 1st ed, 2013
More information on the NH PC Program and registration forms can be
found at www.northernhealth.ca,
or contact your local Palliative Care Nurse Consultant.