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Immediate stabilization
Unstable bleeding framework
Airway and breathing threat screen
Altered mental status
Active emesis or aspiration risk
Circulation threat screen
Shock index
Ongoing heavy bleeding
If shock physiology, resuscitation bay
Two large-bore IV lines
Cardiac monitor
If hypotension or poor perfusion, activate massive hemorrhage protocol per site
RBC transfusion trigger by instability
Early gynecology involvement
Hemodynamic targets and monitoring
Perfusion targets
MAP at least 65 mmHg
Urine output at least 0.5 mL/kg/hour
Mental status normalization
Lactate trend to normal if obtained
Monitoring
Serial vital signs
Orthostatic vitals only if stable
Strict pad counts if admitted
Repeat hemoglobin timing based on trajectory
Immediate bedside decisions
Bleeding source localization
Vaginal versus cervical versus uterine versus non-gynecologic source
External genital trauma
Rectal bleeding mimic
Pregnancy exclusion despite history
Urine or serum beta hCG early
If positive, switch pathway to pregnancy bleeding
Time-critical consultation triggers
Hemodynamic instability
Suspected cervical or uterine malignancy with heavy bleeding
Suspected retained foreign body
Suspected sexual assault or significant genital trauma
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.