Terminal Hemorrhage- Preparation & Management.pptx

Terminal hemorrhage is a rare but devastating terminal event in cancer patients that can lead to death in few minutes. It is very important to manage such events with total calm and no panic.

1. Terminal Hemorrhage- Preparation & Management Dr Naine Bhadrala Associate Professor GMC Jammu

2. Terminal bleeding A cute and severe hemorrhage that often occurs in terminally ill patients, particularly in palliative care settings . Terminal haemorrhage – bleed- ing which is considered to be “major, from an artery, which is likely to result in death within a period of time that may be as short as minutes” These events can be both physically and emotionally distressing for patients, families, and healthcare providers.

3. Causes of Terminal Bleeding 1.Cancer 2.Trauma or invasive procedures 4.Vascular malformations 3.Coagulopathies

4. Clinical Features of Terminal Bleeding Massive hemoptysis   Hematemesis Hematochezia or melena     Epistaxis   Visible external bleeding from wounds or lesions.

5. Risk Factors Advanced cancer . Radiation therapy Use of anticoagulants Liver or renal failure .

6. Goals of Management Maintain patient comfort Minimize patient and family distress Control bleeding where possible :

7. Guideline for the management of terminal haemorrhage in palliative care patients with advanced cancer discharged home for end-of-life care Edith Ubogagu,1 Dylan G Harris2

8. Algorithm for the management of terminal haemorrhage .

9. Preparation for Terminal Bleeding Anticipatory Planning Identify patients at risk : Discuss with the family : Advance directives : Prepare the care environment :

10. Supplies to Have Ready Absorbent materials Dark towels or sheets Dark towels or sheets Sedative or opioid medications Hemostatic agents Yellow bags Gloves

11. 2. Managing the event:   The “ABC” algorithm : A – Assurance ; B – Be There ; C – Comfort and Calm .

12. Immediate Management of Terminal Bleeding For Massive Bleeding: Sedation/Analgesia : In Case of Hemoptysis : Stay calm : Pressure or packing : Topical hemostatics :

13. Emotional and Psychological Support For patients : For families : For the healthcare team :

14. Preventive Interventions (if appropriate ) Radiation therapy Endovascular procedures Blood transfusions or clotting factors

15. Ethical Considerations Resuscitation efforts : Patient autonomy : Balancing comfort vs. intervention :

16. After the event:    Provide bereavement support to all involved, including family members who may be traumatized from witnessing the event and subsequently at risk for complicated grief and post-traumatic stress symptoms

17.   Conclusion Terminal bleeding is a medical emergency  that requires swift action, but in terminally ill patients, the focus must remain on comfort and dignity . Preparedness is key : Having an anticipatory plan, discussing it with the family, and equipping the team with both the tools and emotional support strategies are essential components of effective management.