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Latest revision as of 17:51, 22 April 2014

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Synonyms and keywords: Desagnuination; bleeding out; hemorrhagic shock; bleeding to death; massive blood loss; fatal bleed; fatal bleeding; fatal blood loss; severe hemorrhage; massive bleeding; massive bleed; massive hemorrhage

Overview

Exsanguination is the fatal process of total hypovolemia (blood loss). It is most commonly known as "bleeding to death."

Historical Perspective

The term was widely used by Hippocrates in traditional medicine practiced in the Greco-Roman civilization and in Europe during the Middle Age. The word was possibly used to describe the lack of personality (by death or by weakness) that often occurred once a person suffered hemorrhage or massive blood loss.

The exact ideology of the term, as it is commonly used, is not clearly understood. Medical literature suggests that a person who suffered massive blood loss as being alive, but some authors may be convinced the person is not living. This ambiguity is likely the cause of its infrequent use in the medical profession today.

The word itself originated from Latin: 'ex' (out of) and 'sanguis' (blood). Therefore the word literally means 'out of blood'.

Epidemiology and Demographics

Exsanguination is a relatively uncommon cause of death in humans.

Causes

It might be more precise to say that exsanguination is a mode of death rather than a cause, since exsanguination itself will have an underlying cause which is listed here:

Common causes

Hematemesis - vomiting fresh blood.
Hemoptysis - coughing up blood from the lungs.
Hematochezia - rectal blood.
Hematuria - blood in the urine from urinary bleeding.
Intracranial hemorrhage - bleeding in the skull.
Cerebral hemorrhage - a type of intracranial hemorrhage, bleeding within the brain tissue itself.
Intracerebral hemorrhage - bleeding in the brain caused by the rupture of a blood vessel within the head. See also hemorrhagic stroke.
Subarachnoid hemorrhage (SAH) implies the presence of blood within the subarachnoid space from some pathologic process. The common medical use of the term SAH refers to the nontraumatic types of hemorrhages, usually from rupture of a berry aneurysm or arteriovenous malformation(AVM). The scope of this article is limited to these nontraumatic hemorrhages.
Pulmonary hemorrhage
Vaginal bleeding
Postpartum hemorrhage
Breakthrough bleeding
Ovarian bleeding. This is a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome undergoing transvaginal oocyte retrieval.^[1]
Upper gastrointestinal bleed
Suicide: Exsanguination is a suicide method caused by cutting of arteries, notably: carotid, radial, ulnar, and femoral arteries.
Trauma: Injury or trauma can cause exsanguination if bleeding is not stymied. It is the most common cause of deaths on the battlefield (though the most common cause of death from battle is infection). Non-battlefield causes can include partial or complete amputation from use of circular saws (e.g., hand-held circular saw, radial arm saw, table saw).
Internal hemorrhage: Patients can develop catastrophic internal hemorrhages, such as from a bleeding peptic ulcer or splenic hemorrhage, which can cause exsanguination even without any external bleeding. It is a relatively common cause of unexpected, sudden death in patients who seemed previously well.
Alcoholism: Alcoholics can also suffer from exsanguination. Thin-walled dilated veins just below the lower esophageal mucosa, called esophageal varices, may ulcerate or be torn ("Mallory-Weiss syndrome") during the violent retching of the alcoholic leading to massive bleeding and sometimes exsanguination.
Retroperitoneal hematoma
Ruptured aortic aneurysm
Ruptured abdominal aortic aneurysm

Causes by Organ System

Cardiovascular	Ruptured aortic aneurysm, Aorticoduodenal fistula
Chemical / poisoning	No underlying causes
Dermatologic	No underlying causes
Drug Side Effect	Breakthrough bleeding
Ear Nose Throat	No underlying causes
Endocrine	No underlying causes
Environmental	No underlying causes
Gastroenterologic	Dieulafoy's lesion, Esophageal variceal bleeding, Hematemesis, Hematochezia, Liver rupture, Mallory-Weiss syndrome, Oropharyngeal tumour erosion in mouth, Upper gastrointestinal bleed
Genetic	No underlying causes
Hematologic	Disseminated intravascular coagulation
Iatrogenic	No underlying causes
Infectious Disease	No underlying causes
Musculoskeletal / Ortho	No underlying causes
Neurologic	Cerebral hemorrhage, Intracranial hemorrhage, Subarachnoid hemorrhage
Nutritional / Metabolic	No underlying causes
Obstetric/Gynecologic	Breakthrough bleeding, Ovarian bleeding, Postpartum hemorrhage, Vaginal bleeding
Oncologic	Carotid artery erosion from neck metastases, Tumour lymph node erosion into adjacent vessels, Oropharyngeal tumour erosion in mouth
Opthalmologic	No underlying causes
Overdose / Toxicity	No underlying causes
Psychiatric	Suicide
Pulmonary	Hemoptysis, Pulmonary artery rupture, Pulmonary hemorrhage, Pulmonary vein rupture
Renal / Electrolyte	No underlying causes
Rheum / Immune / Allergy	No underlying causes
Sexual	No underlying causes
Trauma	Trauma, Liver rupture, Pulmonary artery rupture, Pulmonary vein rupture
Urologic	Hematuria
Dental	No underlying causes
Miscellaneous	Aorticoduodenal fistula, Internal hemorrhage, Retroperitoneal hematoma

Causes in Alphabetical Order

Treatment

Medical Therapy

Compression at the bleeding site.
Resuscitation with fluid.
Transfusion of red blood cells.
Reversal of anticoagulation or antiplatelet agents with fresh frozen plasma (FFP) or platelet transfusion.

Surgery

Surgical repair of a lacerated artery or vein.

Related Chapters

Hypovolemia

References

↑ Liberty G, Hyman JH, Eldar-Geva T, Latinsky B, Gal M, Margalioth EJ (2008). "Ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration: a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome". Fertil. Steril. 93 (3): 874–879. doi:10.1016/j.fertnstert.2008.10.028. PMID 19064264. Unknown parameter |month= ignored (help)

Template:WH Template:WS

[Liberty-1] Liberty G, Hyman JH, Eldar-Geva T, Latinsky B, Gal M, Margalioth EJ (2008). "Ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration: a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome". Fertil. Steril. 93 (3): 874–879. doi:10.1016/j.fertnstert.2008.10.028. PMID 19064264. Unknown parameter |month= ignored (help)

[1]

@@ Line 1: / Line 1: @@
 __NOTOC__
 {{SI}}
 {{CMG}}
-{{SK}} Desagnuination; bleeding out; hemorrhagic shock; bleeding to death; massive blood loss
+{{SK}} Desagnuination; bleeding out; hemorrhagic shock; bleeding to death; massive blood loss; fatal bleed; fatal bleeding; fatal blood loss; severe hemorrhage; massive bleeding; massive bleed; massive hemorrhage
 ==Overview==
-'''Exsanguination''' (also known colloquially as '''bleeding out''') is the fatal process of total [[hypovolemia]] (blood loss). It is most commonly known as "[[bleeding]] to death."
+'''Exsanguination''' is the fatal process of total [[hypovolemia]] ([[blood loss]]). It is most commonly known as "[[bleeding]] to [[death]]."
 ==Historical Perspective==
-The term was widely used by the [[Hippocrates]] in traditional medicine practiced in the Greco-Roman civilization and in Europe during the Middle Ages. The word was possibly used to describe the lack of personality (by death or by weakness) that often occurred once a person suffered [[hemorrhage]] or massive blood loss.
+The term was widely used by [[Hippocrates]] in [[traditional medicine]] practiced in the Greco-Roman civilization and in Europe during the Middle Age. The word was possibly used to describe the lack of personality (by [[death]] or by [[weakness]]) that often occurred once a [[person]] suffered [[hemorrhage]] or massive [[blood loss]].
-The exact ideology of the term as it is commonly used is not clearly understood. Medical literature suggests that a person who suffered massive blood loss as being alive, but some authors may be convinced the person is not living. This ambiguity is likely the cause of its infrequent use in the medical profession today.
+The exact ideology of the term, as it is commonly used, is not clearly understood. [[Medical literature]] suggests that a [[person]] who suffered massive [[blood loss]] as being [[life|alive]], but some authors may be convinced the [[person]] is not living. This ambiguity is likely the cause of its infrequent use in the medical profession today.
-The word itself originated from Latin: 'ex' (out of) and 'sanguis' (blood). Therefore the word literally means 'out of blood'.
+The word itself originated from Latin: 'ex' (out of) and 'sanguis' ([[blood]]). Therefore the word literally means 'out of [[blood]]'.
 ==Epidemiology and Demographics==
-Exsanguination is a relatively uncommon cause of death in humans.
+[[Exsanguination]] is a relatively uncommon [[cause of death]] in [[humans]].
 == Causes ==
+It might be more precise to say that [[exsanguination]] is a ''mode'' of [[death]] rather than a cause, since [[exsanguination]] itself will have an underlying cause which is listed here:
-It might be more precise to say that exsanguination is a ''mode'' of death rather than a cause, since the fact of exsanguination will have some underlying cause. It is essentially bleeding to death.
+===Common causes===
+*'''[[Hematemesis]]''' - [[vomiting]] fresh [[blood]].
-=== Common Causes ===
+*'''[[Hemoptysis]]''' - [[coughing]] up [[blood]] from the [[lungs]].
+*'''[[Hematochezia]]''' - [[rectal bleeding|rectal blood]].
+*'''[[Hematuria]]''' - [[blood]] in the [[urine]] from [[hematuria|urinary bleeding]].
+*'''[[Intracranial hemorrhage]]''' - [[bleeding]] in the [[skull]].
+*'''[[Cerebral hemorrhage]]''' - a type of [[intracranial hemorrhage]], [[bleeding]] within the [[brain tissue]] itself.
+*'''[[Intracerebral hemorrhage]]''' - [[bleeding]] in the [[brain]] caused by the [[dissection|rupture]] of a [[blood vessel]] within the [[head]]. See also [[hemorrhagic stroke]].
+*'''[[Subarachnoid hemorrhage]]''' '''''(SAH)''''' implies the presence of [[blood]] within the [[subarachnoid space]] from some [[pathology|pathologic]] process. The common medical use of the term ''SAH'' refers to the nontraumatic types of [[hemorrhages]], usually from [[dissection|rupture]] of a [[berry aneurysm]] or [[arteriovenous malformation]]''(AVM)''. The scope of this article is limited to these nontraumatic [[hemorrhages]].
+*'''[[Pulmonary hemorrhage]]'''
+*'''[[Vaginal bleeding]]'''
+*'''[[Postpartum hemorrhage]]'''
+*'''[[Breakthrough bleeding]]'''
+*[[Ovarian]] bleeding'''. This is a potentially catastrophic and not so rare complication among lean [[patients]] with [[polycystic ovary syndrome]] undergoing [[transvaginal oocyte retrieval]].<ref name=Liberty>{{cite journal |author=Liberty G, Hyman JH, Eldar-Geva T, Latinsky B, Gal M, Margalioth EJ |title=Ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration: a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome |journal=Fertil. Steril. |volume= 93|issue= 3|pages= 874–879|year=2008 |month=December |pmid=19064264 |doi=10.1016/j.fertnstert.2008.10.028 |url=}}</ref>
+*'''[[Upper gastrointestinal bleed]]'''
+*'''[[Suicide]]''': Exsanguination is a [[suicide method]] caused by cutting of [[arteries]], notably: [[carotid artery|carotid]], [[radial artery|radial]], [[ulnar artery|ulnar]], and [[femoral artery|femoral]] [[arteries]].
+*'''[[Trauma]]''': [[Injury]] or [[trauma]] can cause exsanguination if [[bleeding]] is not stymied. It is the most common [[death|cause of deaths]] ''on'' the battlefield (though the most common cause of [[death]] ''from'' battle is [[infection]]).  Non-battlefield causes can include partial or complete [[amputation]] from use of circular saws (e.g., hand-held circular saw, radial arm saw, table saw).
+*'''Internal hemorrhage''': [[Patients]] can develop catastrophic [[internal bleeding|internal hemorrhages]], such as from a [[bleeding]] [[peptic ulcer]] or [[spleen|splenic]] [[hemorrhage]], which can cause exsanguination even without any external [[bleeding]]. It is a relatively common cause of unexpected, sudden [[death]] in [[patients]] who seemed previously well.
+*'''[[Alcoholism]]''': [[alcoholic|Alcoholics]] can also suffer from exsanguination.  Thin-walled dilated [[veins]] just below the lower [[esophageal]] [[mucosa]], called [[esophageal varices]], may ulcerate or be torn ("[[Mallory-Weiss syndrome]]") during the violent [[wikt:retch|retch]]ing of the [[alcoholic]] leading to massive [[bleeding]] and sometimes exsanguination.
+*'''[[Retroperitoneal hematoma]]'''
+*'''Ruptured [[aortic aneurysm]]'''
+*'''Ruptured [[abdominal aortic aneurysm]]'''
 === Causes by Organ System ===
 {|style="width:80%; height:100px" border="1"
 |style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
-|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Ruptured aortic aneurysm]], [[Aorticoduodenal fistula]]
+|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |  [[Dissection|Ruptured]] [[aortic aneurysm]], Aorticoduodenal [[fistula]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 57: / Line 75: @@
 |-bgcolor="LightSteelBlue"
 | '''Gastroenterologic'''
-|bgcolor="Beige"| [[Dieulafoy's lesion]], [[Esophageal variceal bleeding]], [[Hematemesis]], [[Hematochezia]], [[Liver rupture]], [[Mallory-Weiss syndrome]], [[Oropharyngeal tumour erosion in mouth]], [[Upper gastrointestinal bleed]]
+|bgcolor="Beige"| [[Dieulafoy's lesion]], [[Esophageal varices|Esophageal variceal]] [[bleeding]], [[Hematemesis]], [[Hematochezia]], [[Liver]] [[rupture]], [[Mallory-Weiss syndrome]], [[Oropharyngeal]] [[tumour]] erosion in [[mouth]], [[Upper gastrointestinal bleed]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 89: / Line 107: @@
 |-bgcolor="LightSteelBlue"
 | '''Obstetric/Gynecologic'''
-|bgcolor="Beige"| [[Breakthrough bleeding]], [[Ovarian bleeding]], [[Postpartum hemorrhage]], [[Vaginal bleeding]]
+|bgcolor="Beige"| [[Breakthrough bleeding]], [[Ovarian]] [[bleeding]], [[Postpartum hemorrhage]], [[Vaginal bleeding]]
 |-
 |-bgcolor="LightSteelBlue"
 | '''Oncologic'''
-|bgcolor="Beige"| [[Carotid artery erosion from neck metastases]], [[Tumour lymph node erosion into adjacent vessels]], [[Oropharyngeal tumour erosion in mouth]]
+|bgcolor="Beige"|  [[Carotid artery]] erosion from [[neck]] [[metastases]], [[Tumour]] [[lymph node]] erosion into adjacent [[vessels]], [[Oropharyngeal]] [[tumour]] erosion in [[mouth]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 109: / Line 127: @@
 |-bgcolor="LightSteelBlue"
 | '''Pulmonary'''
-|bgcolor="Beige"| [[Hemoptysis]], [[Pulmonary artery rupture]], [[Pulmonary hemorrhage]], [[Pulmonary vein rupture]]
+|bgcolor="Beige"| [[Hemoptysis]], [[Pulmonary artery]] [[dissection|rupture]], [[Pulmonary hemorrhage]], [[Pulmonary vein]] [[dissection|rupture]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 125: / Line 143: @@
 |-bgcolor="LightSteelBlue"
 | '''Trauma'''
-|bgcolor="Beige"| [[Trauma]],[[Liver rupture]], [[Pulmonary artery rupture]], [[Pulmonary vein rupture]]
+|bgcolor="Beige"| [[Trauma]], [[Liver]] [[rupture]], [[Pulmonary artery]] [[dissection|rupture]], [[Pulmonary vein]] [[dissection|rupture]]
 |-
 |-bgcolor="LightSteelBlue"
@@ Line 137: / Line 155: @@
 |-bgcolor="LightSteelBlue"
 | '''Miscellaneous'''
-|bgcolor="Beige"| [[Aorticoduodenal fistula]], [[Internal hemorrhage]], [[Retroperitoneal hematoma]]
+|bgcolor="Beige"|  Aorticoduodenal [[fistula]], [[Internal bleeding|Internal hemorrhage]], [[Retroperitoneal hematoma]]
 |-
 |}
 === Causes in Alphabetical Order ===
+{{col-begin|width=80%}}
-{{MultiCol}}
+{{col-break|width=33%}}
-*[[Aorticoduodenal fistula]]
+*Aorticoduodenal [[fistula]]
 *[[Breakthrough bleeding]]
-*[[Carotid artery erosion from neck metastases]]
+*[[Carotid artery]] erosion from [[neck]] [[metastases]]
 *[[Cerebral hemorrhage]]
 *[[Dieulafoy's lesion]]
 *[[Disseminated intravascular coagulation]]
-*[[Esophageal variceal bleeding]]
+*[[Esophageal varices|Esophageal variceal]] [[bleeding]]
 *[[Hematemesis]]
 *[[Hematochezia]]
 *[[Hematuria]]
 *[[Hemoptysis]]
-*[[Internal hemorrhage]]
+*[[Internal bleeding|Internal hemorrhage]]
 *[[Intracranial hemorrhage]]
-*[[Liver rupture]]
+*[[Liver]] [[rupture]]
 *[[Mallory-Weiss syndrome]]
-{{ColBreak}}
+{{col-break|width=33%}}
-*[[Oropharyngeal tumour erosion in mouth]]
+*[[Oropharyngeal]] [[tumour]] erosion in [[mouth]]
-*[[Ovarian bleeding]]
+*[[Ovarian]] [[bleeding]]
 *[[Postpartum hemorrhage]]
-*[[Pulmonary artery rupture]]
+*[[Pulmonary artery]] [[dissection|rupture]]
 *[[Pulmonary hemorrhage]]
-*[[Pulmonary vein rupture]]
+*[[Pulmonary vein]] [[dissection|rupture]]
 *[[Retroperitoneal hematoma]]
-*[[Ruptured aortic aneurysm]]
+*[[Dissection|Ruptured]] [[aortic aneurysm]]
 *[[Subarachnoid hemorrhage]]
 *[[Suicide]]
 *[[Trauma]]
-*[[Tumour lymph node erosion into adjacent vessels]]
+*[[Tumour]] [[lymph node]] erosion into adjacent [[vessels]]
 *[[Upper gastrointestinal bleed]]
 *[[Vaginal bleeding]]
-{{EndMultiCol}}
+{{col-end}}
-*[[Hematemesis]] - vomiting fresh blood
-*[[Hemoptysis]] - coughing up blood from the lungs
-*[[Hematochezia]] - rectal blood
-*[[Hematuria]] - blood in the urine from urinary bleeding
-*[[Intracranial hemorrhage]] - bleeding in the skull.
-*[[Cerebral hemorrhage]] - a type of intracranial hemorrhage, bleeding within the brain tissue itself.
-*[[Intracerebral hemorrhage]] - bleeding in the brain caused by the rupture of a blood vessel within the head. See also [[hemorrhagic stroke]].
-*[[Subarachnoid hemorrhage]] (SAH) implies the presence of blood within the [[subarachnoid space]] from some pathologic process. The common medical use of the term SAH refers to the nontraumatic types of hemorrhages, usually from rupture of a berry aneurysm or [[arteriovenous malformation]](AVM). The scope of this article is limited to these nontraumatic hemorrhages.
-*[[Pulmonary hemorrhage]]
-*[[Vaginal bleeding]]
-*[[Postpartum hemorrhage]]
-*[[Breakthrough bleeding]]
-*[[Ovarian]] bleeding. This is a potentially catastrophic and not so rare complication among lean patients with [[polycystic ovary syndrome]] undergoing [[transvaginal oocyte retrieval]].<ref name=Liberty>{{cite journal |author=Liberty G, Hyman JH, Eldar-Geva T, Latinsky B, Gal M, Margalioth EJ |title=Ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration: a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome |journal=Fertil. Steril. |volume= 93|issue= 3|pages= 874–879|year=2008 |month=December |pmid=19064264 |doi=10.1016/j.fertnstert.2008.10.028 |url=}}</ref>
-*[[Upper gastrointestinal bleed]]
-*[[Suicide]]: Exsanguination is a [[suicide method]] caused by cutting of arteries, notably: [[carotid artery|carotid]], [[radial artery|radial]], [[ulnar artery|ulnar]], and [[femoral artery|femoral]] arteries.
-*[[Trauma]]: Injury or trauma can cause exsanguination if bleeding is not stymied. It is the most common cause of deaths ''on'' the battlefield (though the most common cause of death ''from'' battle is infection).  Non-battlefield causes can include partial or complete [[amputation]] from use of circular saws (e.g., hand-held circular saw, radial arm saw, table saw).
-*Internal hemorrhage: Patients can develop catastrophic internal hemorrhages, such as from a bleeding [[peptic ulcer]] or [[spleen|splenic]] hemorrhage, which can cause exsanguination even without any external bleeding. It is a relatively common cause of unexpected, sudden death in patients who seemed previously well.
-*[[Alcoholism]]: Alcoholics can also suffer from exsanguination.  Thin-walled dilated veins just below the lower esophageal mucosa called [[esophageal varices]] may ulcerate or be torn ("[[Mallory-Weiss syndrome]]") during the violent [[wikt:retch|retch]]ing of the alcoholic leading to massive bleeding and sometimes exsanguination.
-*[[Retroperitoneal hematoma]]
-*Ruptured [[aortic aneurysm]]
-*Ruptured [[abdominal aortic aneurysm]]
 ==Treatment==
-*Compression at the bleeding site
+===Medical Therapy===
-*Resuscitation with fluid
+*Compression at the [[bleeding]] site.
-*[[Transfusion]] of red blood cells
+*[[Resuscitation]] with [[fluid]].
-*Reversal of [[anticoagulation]] or [[antiplatelet agents]] with [[fresh frozen plasma]] ([[FFP]]) or platelet transfusion.
+*[[Transfusion]] of [[red blood cells]].
-*Surgical repair of a lacerated artery or vein
+*Reversal of [[anticoagulation]] or [[antiplatelet agents]] with [[fresh frozen plasma]] ([[FFP]]) or [[platelet]] [[transfusion]].
-==References==
+===Surgery===
-{{Reflist|2}}
+*[[Surgery|Surgical repair]] of a [[dissection|lacerated]] [[artery]] or [[vein]].
-==See also==
+==Related Chapters==
 *[[Hypovolemia]]
@@ Line 216: / Line 211: @@
 [[Category:Intensive care medicine]]
 [[Category:Emergency medicine]]
+==References==
+{{reflist|2}}
+{{WH}}
+{{WS}}