Pediatric emergency medicine trisk 2183 2183

orthostasis, chest pain or dyspnea, decreased urine output, and any change in mental
status.

FIGURE 93.1 Causes of blood loss.

Assessment of hemodynamic parameters to identify signs of impending
cardiopulmonary collapse (e.g., severe tachycardia, hypotension, hypoxia) is critical,
remembering that hypotension is a late finding in shock in young children. Physical
examination should assess for location of blood loss and signs of systemic illness that
may cause anemia. Signs of end-organ dysfunction, such as change in mental status,
congestive heart failure, or renal insufficiency should be noted. In the trauma patient,
bleeding may be evident or occult, as in the case of femoral, pelvic, or abdominal
(including both intra- and retroperitoneal) hemorrhage. These may be hemodynamically
significant but not immediately obvious. The presence of trauma itself may be subtle in
nonaccidental injury. Consider gastrointestinal or gynecologic bleeding when the
etiology is unclear.
Diagnostic Testing
Laboratory testing for patients with suspected blood loss includes complete blood count
(CBC), reticulocyte count, coagulation studies, and a type and screen, or type and crossmatch if transfusion is anticipated. If the etiology of the anemia is unclear, obtain stool
guaiac for occult blood, hemolysis labs, and other studies as outlined below (see section
on Hemolytic Anemia). Send a pregnancy test if clinically indicated.
Management