Table 1

Critical Site Bleeds

Type of BleedInitial Signs and SymptomsPotential Consequences of Bleed
Intracranial hemorrhage: Includes intraparenchymal, subdural, epidural, and subarachnoid hemorrhagesUnusually intense headache, emesis
Neurological signs: e.g., reduced LOC, vision changes, numbness, weakness, aphasia, ataxia, vertigo, seizures
Stupor or coma
Permanent neurological deficit
Other central nervous system hemorrhage: Includes Intraocular, intra- or extra-axial spinal hemorrhagesIntraocular: monocular eye pain, vision changes, blindness
Spinal: back pain, bilateral extremity weakness or numbness, bowel or bladder dysfunction, respiratory failure
Intraocular: permanent vision loss
Spinal: permanent disability, paraplegia, quadriplegia, death
Pericardial tamponadeShortness of breath, tachypnea
Hypotension, jugular venous distension
Tachycardia, muffled heart sounds, rub
Cardiogenic shock
Airway, including posterior epistaxisAirway: hemoptysis, shortness of breath, hypoxia
Posterior epistaxis: profuse epistaxis, hemoptysis, hypoxia, shortness of breath
Hypoxemic respiratory failure, Death
Hemothorax, intra-abdominal bleeding, and RPHHemothorax: tachypnea, tachycardia, hypotension
Intra-abdominal (nongastrointestinal): abdominal pain, distension, hypotension, tachycardia
RPH: Back/flank/hip pain, tachycardia, hypotension
Hemothorax: respiratory failure
RPH: femoral neuropathy
All: hypovolemic shock, death
Extremity bleeds: includes intramuscular and intra-articular bleedingIntramuscular: pain, swelling, pallor, paresthesia, weakness, diminished pulse
Intra-articular: joint pain, swelling, decreased range of motion
Intramuscular: compartment syndrome, paralysis, limb loss
Intra-articular: irreversible joint damage

LOC = loss of consciousness; RPH = retroperitoneal hematoma.