The Varix That Ruptured at Dinner - Vascular Medicine clinical simulation case. A 74-year-old woman on chronic warfarin for atrial fibrillation presents...
A 74-year-old woman on chronic warfarin for atrial fibrillation presents with brisk, pulsatile hemorrhage from a ruptured medial calf varicose vein sustained while descending stairs to dinner. Soaked stockings, soaked wooden floorboards, ongoing profuse bleeding controlled en route by EMS with direct pressure. History of bilateral great saphenous vein insufficiency, chronic venous stasis dermatitis, and recent minor trauma from a wooden chair edge.
Acute Resuscitation Milestones & Priorities
Clinical phases and key interventions encountered in this emergency module:
Field Hemorrhage Control & Triage
Anticoagulation Reversal & Resuscitation
Definitive Bedside Hemostasis
Source Control, Skin Care & Disposition
High-Yield Clinical Pearls
Ruptured varix hemorrhage is a recognized cause of fatal exsanguination; direct pressure and elevation above the heart is the immediate control maneuver.
Patients on vitamin K antagonists with major bleeding require 4-factor PCC plus IV vitamin K for rapid, sustained reversal.
The bleeding varicosity is a sign of chronic superficial venous insufficiency; definitive care requires compression therapy and venous reflux assessment, not isolated wound care.
Friable stasis skin overlying varicosities is not suitable for cautery, foam sclerotherapy, or primary closure; gentle ligation with compression achieves durable hemostasis.
Test Your Clinical Reasoning in Real Time
Step into the active clinician role for this case. Order diagnostic tests, analyze live laboratory panels, and navigate branching clinical decisions with real-time feedback.