Talk:Internal bleeding

message: Internal bleeding is an important subject and deserves a better article  —Preceding unsigned comment added by 70.54.112.35 (talk) 01:01, 30 November 2009 (UTC)
thread_title:  This is an important article 

message: Hi all, 
I'd like to make some updates to this page, as it's very vague, has outdated citations, and is missing many sections according to the MoS for medicine-related articles. I appreciate any input for these proposed changes:
- Add Classification: differentiate internal bleeding from external bleeding and arterial bleeding from venous bleeding. Goal: complete by 3/11
        Update 3/20: elected not to include as there is no true classification system. Defined in lede
- Add Signs & Symptoms with Complications sub-section: 
Initially no pain → pain, swelling, bruising, hemorrhagic shock, etc.  Should link to hemorrhagic shock page, may include hemorrhagic shock classification 1-4. Link out to pages for specific sources of bleeding by body part (ex. Intracranial → subarachnoid, subdural, epidural bleed): Goal: complete between 3/13 - 3/16
        Update 3/20: S&S completed, still need to complete complications
- Updates Causes: change "trauma" vs. "pathologic disease" vs. "health care caused" to "traumatic" vs. "non-traumatic" vs. "other.  Traumatic should list blunt vs. penetrating. Link out to types. Non-traumatic causes will link out to types. List medical error/iatrogenic under other. Goal: complete 3/22 - 3/24
        Update 3/20: removed incorrect info and reorganized
- Will not add Mechanism as it is dependent on the mechanism of injury.  
- Add Diagnosis: discuss general assessment (physical exam including vitals --> imaging). Goal: complete 3/13 - 3/16
        Update 3/20: completed, kept intentionally non-specific to avoid providing medical advice
- Add Treatment: discuss and link to fluid resuscitation,  medical management, "watch and wait", surgical intervention. Goal: complete 3/22 - 3/24
        Update 3/20: in progress, need to complete non-medical internvention, kept intentionally non-specific to avoid providing medical advice
- Update Prognosis to Outcomes: currently poorly cited, will update to add most common outcomes. Goal: complete 3/22 - 3/24
I hope to update the lede after these sections are completed. 
-- Julia Sobel 02:27, 6 March 2019 (UTC)
thread_title:  Proposed updates (March 2019) 

message: Hi Drgoose89,
Overall, this is a great general article about internal bleeding. This is probably the landing article RE: bleeds for many readers before they are referred out to articles for specific bleeds; I would continue to tailoring the design/layout of the article toward 1. easy-to-read mapping/linking to more defined bleeds, and 2. what can laypersons/patients do urgently while EMT arrives. From a content standpoint, you certainly did a lot with the original skeleton article--bravo! If possible, I would find out more general themes about "internal bleeding" and elaborate on how it contrasts in terms of risks/prognosis/epidemiology/management of other types of bleeds. Overall, very easy to read and helpful resource to search different iterations of interal bleeing. Fantastic work!
Criteria                   	Comments
Summary/Lead               	Nice and easy to read. Great idea to have disclaimer statement RE: seeking emergent care at the end. Just to keep formatting consistent, normal text (no bold or italics) should be fine.
3/27 response: Thanks, removed bold but will italicize, as when emphasizing something, the MoS suggest italicizing.
Readability                	Overall very easy to understand from a flow standpoint. Not convoluted. Still lots of medical jargon, which is inexcapable sometimes; I suggest looking through and see which ones can be paraphrased further.
3/27 response: Took suggestion further down to use parenthesis to define medical terms on their first appearance, then use medical terminology later on.
Target Readership          	Currently grade 11 per Hemingway.app, so it's already good. Some medical jargons like "exsanguination" can be simplified into something like "loss of blood" then link out to the former as you did. Kind of hard with retroperitoneal space, haha.
Citation quality           	I don't know if citing UptoDate is better than a well-established systemic review (e.g. for signs and symptoms section).  You can try citing, instead,  the review articles used in the UptoDate article.
3/27 response:I'll look into this, though per MoS I think using UpToDate is fine.
Overall Organization       	Good framework. Excellent for the Causes section with the gradual progression from general to more specific ideas. For some paragraphs, I think having bulleted lists would be good since it allows you to group like-with-like, instead of having a block of blue links.
3/27 response: Working on formatting into bullet where appropriate. De-linked some of the more basic phrases, definitely appreciate the feedback on using linking for more advanced terms. Thanks!
Pictures and Media         	Good gross visuals. Since your article is a general one about bleeding (regardless of anatomic site), may I recommend a diagram showing possible sites for bleeding? Otherwise, I would do the same thing as you did with the brain aneurysm and peptic bleeding, but for more anatomic sites.
3/27 response: Working on this, I'm having a really hard time finding images without copyright that can be used here so they might need to stay as is. If I have time, I will work on creating a diagram with possible sites of bleeding because I think this is a really great idea.
Links                      	I wouldn't suggest repeating links like tachypnea, blood vessel, hemostasis, etc. hypovolemic shock, etc. Overall, I like the use to linking to complicated topics (things that may require more explanation/triggers more curiosity); I wouldn't recommend links to simple things like death, pulses, etc or else your article will look like a visual mess of black- and blue-colored text.  
3/27 response: See above response to Overall Organization
Avoiding doctor-speak      	For words that are very jargon-y, I would capture in laymen's words and link out form there (paresthesia>abnormal skin sensation, ecchymosis>bruising)--a.k.a. let your linked articles speak for themselves.
3/27 response: See above response to readability
Grammar/editing suggestions	Minor cleaning up of extra spaces before citation numbers, and keeping citations placing consistent (i.e. after punctuation). Suggestion for first sentence: "loss of blood occuring from a blood vessel that collects inside.."
3/27 response: Corrected
Content                    	CAUSES: I like the definitions of different categories; you can think about making a bulleted list for longer lists (e.g. non-traumatic causes) and categorizing them into whatever sub-groups is used in seminal papers (e.g. by system, by underlying pathophysiology, etc). "Other" subheading >> "Other causes" then group things together like "Medication," "Iatrogenic," etc. 
3/27 response: Will bullet point where appropriate, but there isn't really a standardized sub-grouping (or really any seminal papers actually) on this, as they are focused more on the general concept of hemorrhage or hemorrhagic shock. I don't think I'll expand out this section much more since the goal is to use it as a general overview with the ability to link out where appropriate. I'm concerned if I add too many specific examples it will become convoluted. 
SIGNS & SYMPTOMS: Perhaps link "low blood pressure" to the Hypotension article, since laypersons don't need to know what jargons use but rather what these things capture, etc. For the last section, some of them look like they belong better under Causes (e.g. the different ICH's, GI bleeding). Going back to Causes, you might explore combining it with a Definitions section; since a lot of the causes seem to be very specifically anatomically defined.  
3/27 response: I elected to just make a separate section cause "Types of Internal Bleeding (by location)", since these locations didn't quite fit into signs & symptoms or into causes. Hope this is ok. 
DIAGNOSIS: Great sub-sections based on different parts of a H&P. Perhaps define your column headers with units (e.g. RR = per min) 
3/27 response: Good catch, updated.
TREATMENT: I wouldn't re-cite the same things (hypotension, bleeding). Grammar in Fluid replacement first sentence. If you want to mention massive tranfusion protocol, I would make it more understandable to a lay audience (e.g. what are units, what's a 'protocol'). "(ex."-->>"(e.g." One way to use parathesis is if want to use the same term over and over again, then I would do as you did with the "...to stop bleeding (achieve hemostasis)" and then continue to use hemostasis again in the future without re-linking; another way is for a quite qualifying statement; otherwise, I wouldn't use paratheses as a one-time "a.k.a." kind of thing (e.g. direct pressure (compression)). For the "Stop (or slow) the bleed" subsection, I would space things out by where bleeding can occur, like what you already started to do with the bone fx vs thorax bleeding. This is actually a section where your article can offer a quick pointer on how to temporize different internal bleedings based on causes/site, hence save lives.
3/27 response: I have the same urge to provide basic bleeding control advice here. We discussed this extensively at the last WIP-WP and reviewed the medicine MoS which states this is not a medical advice page. I reviewed other pages with types of bleeding and most do not even have a treatment section, so I think I will keep it as is - educational re: how it is managed in the hospital without providing pre-hospital advice. I may include a sentence like: More information on stopping the bleed is available at (hyperlink to Stop the Bleed campaign) so people can link out to it. However, most internal bleeding is not actually controlled with direct pressure so this would only really apply to wound compression for a penetrating trauma that caused the internal bleeding. 
Thank you SO much for the detailed review and suggestions. I really appreciate it!
Julia Sobel 17:48, 27 March 2019 (UTC)
thread_title:  Peer Review 

message: I tried rephrasing some things but it is still quite confusing on the medical procedure required to stop the internal bleeding. An expert needs to review this article. Timato24 (talk) 00:09, 22 February 2020 (UTC)
thread_title:  What is happening with the "Stop the bleed" section? 

message: — Assignment last updated by Leximed (talk) 20:35, 2 October 2023 (UTC)
thread_title: Wiki Education assignment: BioC 7210 - Wikipedia Editing for Health Care Professionals

message: This article as of now has some vague areas that I think should be expanded upon, this page may be someone's first introduction to a critical situation. 
Additions: via Uptodate, will collect more research.
Links to ATLS- current trauma guidelines
Augment treatment section: Giving IV fluids in the setting of trauma is a controversial topic as of now. Should update with the current guidelines, IVF fluids should only be given if MAP <60, and should be given in the smallest volumes needed to avoid impaired clotting from diluted blood. 
Add-Blood thinners should be stopped to avoid worsening of bleeding
Expand on imaging section organized for area of bleed
e-FAST: abdomen, chest, lungs
CT head without contrast: intracranial hemorrage
CT Abd, pelvis
Add Possible outcomes of internal bleeding- general-ischemia, acidosis/ hypovolemic shock Jasperchico (talk) 15:58, 8 September 2023 (UTC)
thread_title:  Internal bleeding outline 

message: The sentence "Internal bleeding is a medical emergency and should be treated immediately by medical professionals." at the end of the first paragraph should be the first sentence of the page. If someone is coming to this page bc they have concerns that they, or someone they know, may be bleeding internally, they should stop reading and proceed to the nearest emergency room.  Leximed (talk) 16:19, 8 October 2023 (UTC)
thread_title:  Intro 

message: I am going to update the signs and symptoms section to be in layman's terms.  Jasperchico (talk) 16:43, 8 October 2023 (UTC)
thread_title:  Introduction