In the Toradol protocol it simply uses term "current/active bleed" as a contraindication, the companion document provides little clarification as to how this applies to trauma pts as trauma was removed as a contraindication. Would trauma with high index of suspicion for internal bleeding (MVC, Motorcycle accident, fall from height) be a contraindication? Would multisystem trauma pts? Or would the better course of action be to treat their pain? Thanks!
You are correct that the OBHG Companion Document does not list all potential symptoms which could indicate a current/active bleed. A previous Ask MAC (5-Nov-2014) lists other examples of signs and symptoms of potential internal active bleeding, such as bruising and swelling in the setting of trauma. If you are concerned for internal bleeding due to mechanism of injury or signs and symptoms, withhold the NSAID and document your rationale on the ACR.