Ibuprofen in trauma

As per the Ontario Base Hospital Group (OBHG) Companion Document for the Advanced Life Support Patient Care Standards and active bleed is defined as:

• External trauma that has been dressed and controlled is not considered an active bleed.
• Occult bleeding should be considered active bleeding (hematuria/GI bleed).
• Trace blood in urine with suspected renal colic is not considered active bleed.

The wound in your scenario is still technically bleeding (active oozing is ongoing bleeding), but it would not typically be classified as an uncontrolled or clinically significant hemorrhage once hemostasis is achieved with a simple pressure dressing.

For NSAID administration, consider whether the patient has:

• Ongoing significant hemorrhage
• Incomplete hemostasis
• Suspected arterial bleeding
• Hemodynamic instability
• A bleeding disorder or anticoagulation
• An injury where even a small increase in bleeding could be clinically important

In your scenario:

• Approximately 100 mL of blood loss at the scene
• Bleeding reduced to minor oozing
• Easily controlled with a pressure dressing
• No tourniquet, hemostatic agent, or sustained manual pressure required
• No evidence of major ongoing blood loss

That would generally suggest hemostasis is largely achieved and the patient is not experiencing a clinically significant active hemorrhage.

This interpretation is also consistent with the literature showing that a single dose of ibuprofen or ketorolac has not been associated with increased major bleeding events, transfusion requirements, or return-to-OR rates across a wide variety of surgical settings.

In conclusion, this injury would be considered more as a controlled soft-tissue bleed rather than an active clinically significant bleed.