{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,22]],"date-time":"2026-10-22T16:58:10Z","timestamp":1792688290131,"version":"4.5.0"},"reference-count":170,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,1,25]],"date-time":"2025-01-25T00:00:00Z","timestamp":1737763200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Major bleeding is a life-threatening condition with high morbidity and mortality. Trauma, gastrointestinal bleeding, haemoptysis, intracranial haemorrhage or other causes of bleeding represent major concerns in the Emergency Department (ED), especially when complicated by haemodynamic instability. Severity and source of bleeding, comorbidities, and prior use of anticoagulants are pivotal factors affecting both the clinical status and the patients\u2019 differential response to haemorrhage. Thus, risk stratification is fundamental in the initial assessment of patients with bleeding. Aggressive resuscitation is the principal step for achieving haemodynamic stabilization of the patient, which will further allow appropriate interventions to be made for the definite control of bleeding. Overall management of major bleeding in the ED should follow a holistic individualized approach which includes haemodynamic stabilization, repletion of volume and blood loss, and reversal of coagulopathy and identification of the source of bleeding. The aim of the present practical guide is to provide an update on recent epidemiological data about the most common etiologies of bleeding and summarize the latest evidence regarding the bundles of care for the management of patients with major bleeding of traumatic or non-traumatic etiology in the ED.<\/jats:p>","DOI":"10.3390\/jcm14030784","type":"journal-article","created":{"date-parts":[[2025,1,28]],"date-time":"2025-01-28T07:54:08Z","timestamp":1738050848000},"page":"784","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Major Bleeding in the Emergency Department: A Practical Guide for Optimal Management"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2038-844X","authenticated-orcid":false,"given":"Sofia","family":"Bezati","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7572-4527","authenticated-orcid":false,"given":"Ioannis","family":"Ventoulis","sequence":"additional","affiliation":[{"name":"Department of Occupational Therapy, University of Western Macedonia, 50200 Ptolemaida, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3041-4787","authenticated-orcid":false,"given":"Christos","family":"Verras","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-4322-3266","authenticated-orcid":false,"given":"Antonios","family":"Boultadakis","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3734-5443","authenticated-orcid":false,"given":"Vasiliki","family":"Bistola","sequence":"additional","affiliation":[{"name":"Second Department of Cardiology, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Sbyrakis","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University Hospital of Heraklion, 71500 Crete, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7641-0482","authenticated-orcid":false,"given":"Othon","family":"Fraidakis","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Venizelion Hospital of Heraklion, 71409 Crete, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0501-4340","authenticated-orcid":false,"given":"Georgia","family":"Papadamou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, University Hospital of Larissa, 41334 Larissa, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0019-0134","authenticated-orcid":false,"given":"Barbara","family":"Fyntanidou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, AHEPA University Hospital, Aristotle University of Thessaloniki, 54636 Thessaloniki, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Parissis","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Effie","family":"Polyzogopoulou","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Attikon University Hospital, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,1,25]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"746","DOI":"10.1111\/vox.13244","article-title":"International Forum on the Management of Major Haemorrhage: Summary","volume":"117","author":"Green","year":"2022","journal-title":"Vox Sang."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1111\/j.1538-7836.2005.01204.x","article-title":"Definition of Major Bleeding in Clinical Investigations of Antihemostatic Medicinal Products in Non-surgical Patients","volume":"3","author":"Schulman","year":"2005","journal-title":"J. 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