1. How this module fits in Consult Practice
This module constrains probability using terrain and tempo, without turning into a reversal protocol or a diagnostic list.
| Lens | What it contributes here |
|---|---|
| Orientation | Defines the clinical terrain and level of danger |
| Thinking | Guides how competing harms are weighted under uncertainty |
| Execution | Clarifies what must be prioritized, communicated, or revised in real time |
2. What this module is for
To answer: “In this anticoagulated patient with bleeding, which risk frame deserves the most weight right now, and what contextual features most strongly shape that weighting?”
3. How to use this module
Use at the moment of the consult page and again after initial stabilization. Start with terrain (bleeding tempo and thrombotic recency), then assign weight to a small set of functional frames. Re-weight daily.
4. Why this matters
This is not a unification problem. It is a competing-harms problem. Binary thinking creates preventable harm because the safest stance is usually adaptive, not absolute.
5. Core Content
A. Terrain-weighting table (functional frames, not diagnoses)
| Terrain cue | Frame that deserves more weight now | Frame held in parallel (not dismissed) |
|---|---|---|
| hemodynamic instability or rapidly falling hemoglobin | hemorrhage-dominant danger | thrombosis risk remains relevant, but usually deferred in the next hours |
| stable vitals but ongoing visible bleeding | evolving hemorrhage risk | thrombosis risk depends on recency and severity |
| bleeding seems contained, hemoglobin stable | rebalancing terrain | thrombosis frame gains relative weight, especially if recent event |
| recent high-risk thrombosis (recent PE, high clot burden, severe symptoms) | thrombotic vulnerability frame | hemorrhage still matters, but posture shifts once bleeding trajectory is controlled |
| remote or lower-risk thrombosis history | hemorrhage frame remains dominant longer | thrombotic frame often carries less immediate weight |
| additional hemostatic derangement (thrombocytopenia, coagulopathy, multi-lineage decline) | broader hematologic-system terrain | anticoagulant contribution is possible but should not dominate prematurely |
B. “Most likely” terrain buckets (what this usually is in hospital time)
| Common inpatient context | What deserves early weight | What commonly misleads teams |
|---|---|---|
| acute GI bleed on anticoagulation | competing-harms terrain with hemorrhage first, then rebalancing | assuming anticoagulant is the cause, or that resumption timing is obvious |
| postoperative bleeding with therapeutic anticoagulation | tempo and stability dominate; competing-harms often tight | forced closure into one frame (“surgical bleed only” or “PE risk only”) |
| bleeding plus systemic abnormalities | broader hematologic-system terrain | treating this as a simple anticoagulant problem |
C. One stance sentence to align the room
- “This is a competing-harms situation. We will weight bleeding and thrombosis asymmetrically based on tempo, visibility, reversibility, and trajectory, and we will revise that weight as the picture declares itself.”
6. Bottom line
Orientation defines the terrain. Thinking assigns posture. Execution makes posture visible. Use this module to weight danger by tempo and thrombotic context, and to avoid binary closure.