All Bleeding Stops, Eventually (But: The Sooner The Better!)


  • Curt Tribble Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
  • Lam Pham Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA
  • Nicholas Teman Division of Cardiac Surgery, University of Virginia, Charlottesville, VA, USA



All Bleeding Stops


It’s your first day as the surgery resident working in the cardiac surgery intensive care unit (ICU) and you are accepting the hand-off of a cardiac surgery patient that your senior resident has brought up from the operating room for admission to the ICU. During the handoff, your resident colleague tells you that the patient is ‘oozing a lot and that the operating team, after a diligent search for bleeding sites, does not believe that the oozing is ‘surgical.’ She announces that your job will, therefore, be to stop the ongoing oozing, while, of course, being alert to the possible development of tamponade physiology.


Tribble C, Merrill W. 2016. In Your Own Words: Towards a More Perfect Union of Patient Care and Education. Ann Thorac Surg 101: 837-40.

Tribble C. 2017. Grandmother Rules: Crucial Conversations with Patients and Families. Heart Surgery Forum 20(1): 1 – 5.

I Corinthians 13: 13. (Accessed 12-3-21)

von Hippel A. 1970. Chest Tubes and Chest Bottles. Charles C. Thomas Publisher. Springfield, IL.

Elefteriades J, Tribble C, Geha A, Siegal M, Cohen L. 2013. The House Officer’s Guide to ICU Care, Third Edition. Cardiotext Publishing, LLC, Minneapolis, MN.

Clark D, Tesseneer S, Tribble C. 2012. Nitroglycerin and Sodium Nitroprusside: Potential Contributors to Postoperative Bleeding? Heart Surgery Forum 15 (2): E92 – E96.

Cope J, Banks D, Mauney M, Lucktong A, Shockey K, Kron I, Tribble C. 1997. Intraoperative hetastarch infusion impairs hemostasis after cardiac operations. Ann Thorac Surg 63: 78-83.

Gersh K, Nagaswami C, Weisel J. 2009. Fibrin network structure and clot mechanism properties are altered by incorporation of erythrocytes. Thromb Haemost 102 (6): 1169-75.

Cines D, Lebedeva T, Nagaswami C, Hayes V, Massefski W, Litvinov R, Rauova L, Lowery T, Weisel J. 2014.Clot contraction: compression of erythrocytes into tightly packed polyhedra and redistribution of platelets and fibrin. Blood 123(10):1596-1603.

Tibi P, McClure R, Huang J, Baker R et al. 2021. STS/SCA/AmSECT/SABM Update to the Clinical Practice Guidelines on Patient Blood Management. Ann Thorac Surg 112 (3): 981-1004.

Holcomb J, Tilley B, Baraniuk S, et al. 2015. Transfusion of Plasma, Platelets, and Red Blood Cells in a 1:1:1 vs 1:1:2 Ratio and Morality in Patients with Severe Trauma. JAMA 313(5): 471-482.

Hess J. 2021. Massive Blood Transfusion. UpToDate. (Accessed 11-24-21)

Salzman E, Weinstein M, Weintraub R, Ware J, Thurer R, Robertson L, Donovan A, Gaffney T, Bertele V, Troll J, Smith M, Chute L. 1986. Treatment with Desmopressin Acetate to Reduce Blood Loss after Cardiac Surgery. N Engl J Med 314:1402-140

Calland J, Guerlain S, Adams R, Tribble C, Foley E, Chekan E. 2002. A systems approach to surgical safety. Surg Endosc 16 (6): 1005-14.

Fiser SM, Tribble CG, Kern JA, Long SM, Kaza AK, Kron IL. 2001. Cardiac reoperation in the intensive care unit. Ann Thorac Surg 71: 1888-93.

LaPar D, Isbell J, Mulloy D, Stone M, Kern J, Ailawadi G, Kron I. 2014. Ann Thorac Surg 98: 1645-51.

Led Zeppelin. 1969. Communication Breakdown. Genius Lyrics: (Accessed 11-24-21).



How to Cite

Tribble, C., Pham, L., & Teman, N. (2022). All Bleeding Stops, Eventually (But: The Sooner The Better!). The Heart Surgery Forum, 25(1), E079-E087.