Читать книгу Point-of-Care Ultrasound Techniques for the Small Animal Practitioner - Группа авторов - Страница 216

In general, postinterventional bleeding in noncoagulopathic patients will not stop without a surgical intervention, in other words, the ligation of the bleeder(s). Many “large‐volume bleeders” are not initially anemic in the acute setting because patients can compensate, especially dogs which have a unique large splenic blood reservoir.

 AFS 3 and 4 (modified AFS system ≥3) initially or on serial examinations are “large‐volume bleeders” and in general should be explored or have another appropriate intervention to stop the bleeding as soon as possible, with the caveat that the patient has an acceptable coagulation profile.

 The author follows the axiom “If it's an AFS of 3 or 4, you should explore (surgically intervene),” with the caveat that the patient has an acceptable coagulation profile.

Pearl: Waiting on a compensated postinterventional noncoagulopathic “large‐volume bleeder” (AFS ≥3) instead of surgically addressing the cause of bleeding often leads to increased morbidity and cost (e.g., transfusion products) and increased patient anesthetic risk, because “large‐volume bleeders” predictably become markedly to severely anemic and overtly decompensate in time. Thus, “If it's an AFS of 3 or 4, you should explore (surgically intervene),” with the caveat that the patient has an acceptable coagulation profile.