Patients may find bleeding visible and disturbing, or it may have significant effects on their quality of life. The rapidity of control of bleeding should be considered, but so too should the comfort of the patient during the treatment process.
For example, radiation therapy can usually control bleeding within 24—48 hours, but patients have to be comfortable lying on the treatment table for the planning and treatment process. For patients who suffer a major episode of bleeding but are not at the end of life, establishment of intravenous access, stabilization with fluids, and hemodynamic monitoring may allow investigation into the cause of bleeding.
Analysis should include a complete blood count, coagulation profile, and a complete metabolic panel with assessment of liver enzymes and function. Possible contributing factors including comorbidities, medications, and recent therapeutic interventions should be examined. In particular, if the patient is on anticoagulation therapy, the risks of further bleeding versus those of clotting should be examined and discussed. Use of oral anticoagulants has been associated with genitourinary cancer in atrial fibrillation patients with hematuria, so it is important to consider stopping it, and to carefully evaluate these patients for the cause of hematuria 9.
For patients at risk of catastrophic bleeding, patients and their families should be prepared for the visually and mentally disturbing effects of such an episode. Encourage the use of dark sheets, towels, blankets, and clothing to reduce the visual shock of seeing a massive bleed. Fast acting sedatives such as intravenous or subcutaneous midazolam should be available, and families should be instructed on their use if the patient is at home.
Although terminal sedation may be appropriate for bleeding at the end of life, a catastrophic bleed may cause death rapidly and there may not be time for sedation. One of the most critical components of the assessment of patients with bleeding is a thorough assessment of potential causative or exacerbating agents. Obviously, the medications that fall into this category cannot be fully discussed in this manuscript, but the most common medications for advanced cancer patients include NSAIDs and anticoagulants.
Anti-inflammatories are often used to treat pain for patients with advanced cancer, but it is important to consider their anti-platelet and anti-coagulant properties that may exacerbate bleeding. Similarly, patients with advanced cancer are often on anticoagulants such as warfarin or enoxaparin, which necessitates the considerations of the risks of further bleeding against the risks of deep venous or pulmonary thromboembolism. Among patients on anticoagulation, patients with cancer develop bleeding complications at a higher rate than those without cancer INR control is difficult in the setting of cancer treatments, so use of oral anticoagulation during the first year after cancer diagnosis can increase bleeding and other major cardiac adverse events The effect of chemotherapy agents and radiation therapy on thrombocytopenia should also be considered, as this may increase the risk of bleeding.
If considered a critical contributor, these agents may be held to allow bone marrow recovery and resolution of thrombocytopenia. Transfusions of whole blood or blood products can be given to resuscitate patients who are hemodynamically unstable and actively bleeding. The AABB formerly the American Association of Blood Banks has evidence-based guidelines for the transfusion of red blood cells, platelets, and plasma 12 - It is less clear how to use transfusions for the palliative treatment of patients with advanced malignancy, although symptomatic improvement has been seen in these patients Vitamin K can be given orally, subcutaneously, or intravenously.
Mike, if the finished size if the document is 8. As a printing company owner this is a good guide to use on bleed. You mentioned books and maybe needing more bleed. That is very true. That would be to primarily accomodate creep and would be more prevalent in saddle stitching but can also apply to perfect binding.
Thanks for helping us printers and designers come together! Any prepress person not using PitStop along with Acrobat is causing a lot of trouble for themselves. Your email address will not be published.
Save my name, email, and website in this browser for the next time I comment. Skip to content Bleed refers to objects that extend beyond the edge of the printed page.
Thanks for the post, It cleared a few things for me regarding the bleed marks. This is a brilliant article!! Good Article! Still learning InDesign. Just what I needed to make my file ready for print. Leave a Reply Cancel reply Your email address will not be published. A cookie is used to collect visitor statistics. The adverts also use one. It is usually not necessary to dilate the cervix before insertion.
Ultrasonography can be used to confirm placement. The balloon can be kept in place for up to 24 hours. Continued bleeding will drain through the catheter, so the balloon can be gradually deflated after drainage stops. A combination of hormonal and nonhormonal therapies may be necessary to control heavy menstrual bleeding in adolescent girls with bleeding disorders. Effective options include combined oral contraceptives with higher estrogen levels, the transdermal contraceptive patch, the vaginal contraceptive ring, and the levonorgestrel-releasing intrauterine device Mirena , all of which can be used continuously with minimal or no withdrawal periods.
Breakthrough bleeding is best treated by doubling the dosage of the combined oral contraceptive. For adolescents unable to tolerate estrogen-containing therapy, progestin therapy such as norethindrone, 5 to 15 mg per day, can be used for menstrual suppression.
Long-acting reversible contraceptive methods, such as the levonorgestrel-releasing intrauterine device, are another choice for adolescents. Only the mg levonorgestrel-releasing intrauterine device has been studied in women with bleeding disorders, with limited data in adolescents.
Oral iron supplementation 60 to mg per day and dietary counseling are first-line therapies for treating iron deficiency anemia. Limited research supports higher effectiveness with dosing every other day due to improved absorption. Ovarian cysts are common in bleeding disorders. For adolescents who have recurrent hemorrhagic cysts, systemic hormones can suppress ovulation and cyst formation. Hormonal contraceptives can be combined with a levonorgestrel-releasing intrauterine device. An adolescent with a known bleeding disorder should be counseled before menarche and should have a plan in place for managing heavy menstrual bleeding.
Guideline developed by participants without relevant financial ties to industry? Not reported. September ; 3 :e71—e Already a member or subscriber? Log in. A deficiency can cause easy bleeding, and one study found that it may lead to gum bleeding.
Foods rich in vitamin K include:. The Office of Dietary Supplements recommends that adult men get micrograms and women get 90 micrograms of vitamin K daily. Shop for vitamin K online. Your gums may also bleed from trauma or an injury to the gum tissue. A cold compress applied to the gum line can reduce swelling and restrict blood flow to stop bleeding.
Apply an ice pack or a cold cloth to your gums several times a day, 20 minutes on and 20 minutes off. Shop for cold compresses online. Research has found that reducing your carbohydrate intake may also improve gum health and prevent gum disease. Carbohydrates and sugary foods encourage plaque and the growth of bacteria.
The more plaque accumulated on your gums, the more likely you are to have bleeding gums. Although brushing and flossing regularly can reduce this buildup, cutting back on carbs helps prevent plaque formation. Drinking green tea on a daily basis may also reverse periodontal disease and stop bleeding gums. One study of men analyzed the effectiveness of green tea on improving periodontal health. For the study, researchers examined the periodontal pocket depth of participants before and after drinking green tea, as well as any loss of gum tissue and incidences of gum bleeding by probing.
Based on the results, researchers concluded that the more green tea a person drinks, the better their periodontal health. The recommended daily intake of green tea is three to four cups, although some researchers believe that you need to drink up to 10 cups a day to notice any improvement in health.
Shop for green tea online. The diagnosis of upper gastrointestinal bleeding is assumed when hematemesis is documented. In the absence of these findings, consider a nasogastric aspirate to determine the source of bleeding.
If the aspirate is negative, the source of a gastrointestinal bleed is likely lower. The accuracy of the aspirate is improved by using the Gastroccult test. The nasogastric aspirate can help determine the location of bleeding and thus direct initial diagnostic and treatment plans. Determining whether blood is in gastric contents, either vomited or aspirated specimens, is difficult.
Slide tests are based on orthotolidine Hematest reagent tablets and Bili-Labstix or guaiac Hemoccult and Gastroccult. Rosenthal found orthotolidine-based tests more sensitive than specific; the Hemoccult test's sensitivity reduced by the acidic environment; and the Gastroccult test be the most accurate.
Holman used simulated gastric specimens and found the Hemoccult test to have significant problems with non-specificity and false-positive results, whereas the Gastroccult test was very accurate.
Among these people there were no deaths or interventions needed and they were able to be effectively treated in an outpatient setting. The predictive values cited are based on the prevalences of upper gastrointestinal bleeding in the corresponding studies.
A clinical calculator can be used to generate predictive values for other prevalences. The initial focus is on resuscitation beginning with airway management and fluid resuscitation using either intravenous fluids and or blood.
Those with a Glasgow Blatchford score less than 2 may not require admission to hospital.For decades, aircraft have used engine bleed air for everything from engine starting to cabin pressurization to anti-icing. Here’s how engine bleed air works.