1. How this module fits in Consult Practice
| Lens | What it contributes here |
|---|---|
| Orientation | Identifies whether this is immediate hemorrhage, competing harms, or rebalancing |
| Thinking | Specifies what should change the weighting, not what “the answer” is |
| Execution | Translates those changes into explicit triggers and recalibration language |
2. What this module is for
To answer: “What new information would shift my stance toward continued interruption, cautious resumption, or heightened thrombotic vigilance?”
3. How to use this module
Use it as a reassessment tool during the first 6–12 hours, then daily. It is not a checklist. It is a set of posture-shifting signals.
4. Why this matters
Harms are asymmetric and evolve over time. The safest stance is the one that updates with trajectory, not the one that felt decisive at presentation.
5. Core Content
Posture-shifting table
| New information | How it shifts Thinking (weight) | What it demands in Execution (visible behavior and communication) |
|---|---|---|
| ongoing bleeding, worsening vitals, accelerating hemoglobin drop | shifts weight strongly toward hemorrhage | prioritize stabilization and alignment, make anticoag hold explicit, tighten reassessment tempo |
| bleeding stops and hemoglobin stabilizes | shifts toward rebalancing, thrombotic frame gains | communicate readiness to revisit anticoag, define what would reopen bleeding concern |
| very recent high-risk thrombosis becomes clearer | shifts toward thrombotic vulnerability | shorten the “uncertainty tolerance” for interruption, increase vigilance for thrombotic signs |
| bleeding source remains unclear but patient stable | supports continued vigilant uncertainty | avoid forced closure, communicate that timing depends on trajectory not labels |
| recurrent bleeding after initial control | shifts weight back toward hemorrhage | openly revise stance, explain that revision is expected not failure |
| no bleeding progression over time (release by non-progression) | allows demotion of hemorrhage-dominant frame | document and say out loud why earlier caution was correct and why posture can change now |
Language that prevents drift
When shifting toward thrombosis:
- “Now that bleeding trajectory is controlled, thrombotic vulnerability deserves more weight.”
When shifting back toward bleeding:
- “The biology changed. This is recalibration, not reversal.”
6. Bottom line
Use posture shifts, not certainty, to govern the consult. Trajectory changes weight. Make those changes explicit so the team’s vigilance matches reality.