Bleeding. Bleeding. Methods Of Methods Of HemostasisHemostasis

LectureLecture

BleedingBleeding

Haemorrhage, or bleeding, is the Haemorrhage, or bleeding, is the escape of blood from the blood escape of blood from the blood vessels into the tissues and vessels into the tissues and cavities of human body or cavities of human body or outside, as the result of an injury outside, as the result of an injury or defect in the permeability of or defect in the permeability of the blood vessel wall.the blood vessel wall.

HematomaHematoma

In other cases when the In other cases when the poured out blood causes poured out blood causes stratification of tissues, stratification of tissues, separation of organs and separation of organs and as a result the dimension as a result the dimension cavity arised, which is cavity arised, which is filled with a blood is filled with a blood is formed, - we speak about a formed, - we speak about a hematomahematoma

Anatomical classification Anatomical classification (according to kind of (according to kind of

bleeding vessel) bleeding vessel) Arterial hemorrhage;Arterial hemorrhage; Venous hemorrhage;Venous hemorrhage; Capillary hemorrhage;Capillary hemorrhage; Parenchymatous hemorrhage.Parenchymatous hemorrhage.

Types of bleedingTypes of bleeding

Classification according to Classification according to mechanism of beginning mechanism of beginning

Mechanical failure, vessel rupture (haemorrhagia per Mechanical failure, vessel rupture (haemorrhagia per rhexin);rhexin);

Arrosive hemorrhage (haemorrhagia per diabrosin). This Arrosive hemorrhage (haemorrhagia per diabrosin). This types of bleeding takes place during suppurative melting of types of bleeding takes place during suppurative melting of wessel wall;wessel wall;

Diapedetic hemorrhage (haemorrhagia per diapedesin);Diapedetic hemorrhage (haemorrhagia per diapedesin); The violation of chemical composition of blood. The The violation of chemical composition of blood. The

hemophilia, scarlet fever, sepsis, scurvy and others are hemophilia, scarlet fever, sepsis, scurvy and others are causing bleeding sometimes. Toxins or beriberi to produce causing bleeding sometimes. Toxins or beriberi to produce defect in the permeability of the vascular walls and caused of defect in the permeability of the vascular walls and caused of hemorrhage;hemorrhage;

Increased of arterial and venous blood pressure. The Increased of arterial and venous blood pressure. The diseases, such as essential hypertension, atherosclerosis diseases, such as essential hypertension, atherosclerosis sometimes coursed of an injury of the vascular wall and sometimes coursed of an injury of the vascular wall and bleeding (stroke, hemorrhoidal bleeding, etc.);bleeding (stroke, hemorrhoidal bleeding, etc.);

Violation of fibrillation (haemophilia, Werlgof’s disease, Violation of fibrillation (haemophilia, Werlgof’s disease, cholemic hemorrhage in patients with jaundice) cholemic hemorrhage in patients with jaundice)

Classification according to Classification according to environment the bleeding environment the bleeding

External bleeding;External bleeding; Internal bleeding.Internal bleeding.

Symptoms of acute Symptoms of acute anemia anemia

persisting paleness;persisting paleness; trembling and small pulse;trembling and small pulse; progressing decrease of blood progressing decrease of blood

pressure;pressure; dizziness;dizziness; nausea;nausea; vomiting;vomiting; syncope. syncope.

Symptoms of bleeding to the Symptoms of bleeding to the stomachstomach

At bleedings in empty space of a At bleedings in empty space of a gastrointestinal tract the blood in a gastrointestinal tract the blood in a stomach changes the color. In ample stomach changes the color. In ample quantityquantity of its accumulation a vomiting, of its accumulation a vomiting, like “ground coffe” (like “ground coffe” (hematemesishematemesis), is ), is originated.originated. Further or at a bleeding Further or at a bleeding from underlaying departments of a from underlaying departments of a gastrointestinal tract it is observed gastrointestinal tract it is observed weak tarry stool in large quantityweak tarry stool in large quantity ((melenamelena).).

Some kinds of internal Some kinds of internal bleeding have specific name bleeding have specific name

Haemobilia – haemorrhage from diliary ducts;Haemobilia – haemorrhage from diliary ducts; Haematuria - haemorrhage from kidneys and Haematuria - haemorrhage from kidneys and

urinary system;urinary system; Haemoperitoneum - haemorrhage in abdominal Haemoperitoneum - haemorrhage in abdominal

cavity;cavity; Haemothorax - haemorrhage in pleural cavity;Haemothorax - haemorrhage in pleural cavity; Haemopericardium - haemorrhage in pericardial Haemopericardium - haemorrhage in pericardial

cavity;cavity; Haemartrosis – haemorrhage in joint cavity;Haemartrosis – haemorrhage in joint cavity; Metrorrhagia – uterine bleeding;Metrorrhagia – uterine bleeding; Proctorrhagia – rectal bleeding;Proctorrhagia – rectal bleeding; Hemorrhagic insult – cerebral hemorrhage.Hemorrhagic insult – cerebral hemorrhage.

Classification according to Classification according to time of beginningtime of beginning

primary;primary; secondary (early and late).secondary (early and late).

Classification according to Classification according to clinical course clinical course

acute;acute; chronic.chronic.

Classification according to degree Classification according to degree of severity (of severity (V.I.Struchkov and V.I.Struchkov and

E.W.Lutzevich E.W.Lutzevich )) I levelI level – easy degree – blood loss is even – easy degree – blood loss is even

to 10 – 12% of blood circulating volume to 10 – 12% of blood circulating volume (500 – 700 ml). Haemorrhage is causing (500 – 700 ml). Haemorrhage is causing little changes to hemodynamic. The little changes to hemodynamic. The general condition of patient is general condition of patient is satisfactory. Pulse is slightly quickened, satisfactory. Pulse is slightly quickened, arterial pressure is normal (standart). arterial pressure is normal (standart). Blood hemoglobin is rised above 100 g/l Blood hemoglobin is rised above 100 g/l (10 g %). During capillaroscopy: (10 g %). During capillaroscopy: background is rosy, 3 – 4 capillary loops background is rosy, 3 – 4 capillary loops with quick gomogenous bloodstream with quick gomogenous bloodstream are determined.are determined.

Classification according to degree Classification according to degree of severity (of severity (V.I.Struchkov and V.I.Struchkov and

E.W.Lutzevich E.W.Lutzevich )) II levelII level – middle degree - blood loss is even to – middle degree - blood loss is even to

15 – 20 % of blood circulating volume (1000 – 15 – 20 % of blood circulating volume (1000 – 1400 ml). Apparent bleeding is distinguished. 1400 ml). Apparent bleeding is distinguished. The general condition is medium-scale The general condition is medium-scale difficalty. Limpness, dizziness, hyperhidrosis, difficalty. Limpness, dizziness, hyperhidrosis, syncope are observed. Coverlet is pale. syncope are observed. Coverlet is pale. Respiration is accelerated. Reflexes are Respiration is accelerated. Reflexes are decrease. Single vomiting or melena may be decrease. Single vomiting or melena may be observed. Pulse become noticeably more observed. Pulse become noticeably more rapid (90 – 100 per min.). Arterial pressure is rapid (90 – 100 per min.). Arterial pressure is decreased to 90 mm Hg. Leucocytosis, decreased to 90 mm Hg. Leucocytosis, deviation of the differential count to the left deviation of the differential count to the left are determined. Hematocrit is 0,38 – 0,32, are determined. Hematocrit is 0,38 – 0,32, hemoglobin is 80 – 100 g/l (8 – 10 g %). hemoglobin is 80 – 100 g/l (8 – 10 g %). Quantity of urination is decreased. Quantity of urination is decreased.

Classification according to degree Classification according to degree of severity (of severity (V.I.Struchkov and V.I.Struchkov and

E.W.Lutzevich E.W.Lutzevich )) III levelIII level – heavy degree – blood loss is 20 – 30 – heavy degree – blood loss is 20 – 30

% of blood circulating volume (1500 – 2000 % of blood circulating volume (1500 – 2000 ml). The general condition of patient is bad ml). The general condition of patient is bad (grave condition). Paleness of skin, cold sweat (grave condition). Paleness of skin, cold sweat is observed. Rapid vomiting and melena are is observed. Rapid vomiting and melena are determined. The bleeding is accompanied by determined. The bleeding is accompanied by syncope. Visible mucous membranes are syncope. Visible mucous membranes are colourless. The patient yawns, feels thirst. colourless. The patient yawns, feels thirst. Pulse is rapid and thready. Arterial pressure Pulse is rapid and thready. Arterial pressure is decreased to 60 mm Hg. Hematocrit is 0,30 is decreased to 60 mm Hg. Hematocrit is 0,30 – 0,32, hemoglobin is 50 – 80 g/l (5 – 8 g %). – 0,32, hemoglobin is 50 – 80 g/l (5 – 8 g %). Oliguria is observed.Oliguria is observed.

Classification according to degree Classification according to degree of severity (of severity (V.I.Struchkov and V.I.Struchkov and

E.W.Lutzevich E.W.Lutzevich )) IV level IV level – massive blood loss – loss of – massive blood loss – loss of

blood is more then 30 % of blood blood is more then 30 % of blood circulating volume (more than 2000 circulating volume (more than 2000 ml). Plentiful bleeding with prolonged ml). Plentiful bleeding with prolonged loss of consciousness may be observed. loss of consciousness may be observed. The general condition of patient is very The general condition of patient is very grave, preagony. Pulse and arterial grave, preagony. Pulse and arterial pressure are not fixed. Hematocrit is pressure are not fixed. Hematocrit is 0,23 and lower, hemoglobin is 50 g/l 0,23 and lower, hemoglobin is 50 g/l and lower. Anuria is observed.and lower. Anuria is observed.

The compensatory-adaptive The compensatory-adaptive mechanisms during acute mechanisms during acute

blood loss blood loss Spasm of veins;Spasm of veins; Interstitial fluid inflow;Interstitial fluid inflow; Tachycardia;Tachycardia; Oliguria;Oliguria; Hyperventilation;Hyperventilation; Peripheral arteriolespasm;Peripheral arteriolespasm; Sympaticoadrenal system’ activation;Sympaticoadrenal system’ activation; Activation of fibrillation system and Activation of fibrillation system and

haemopoiesis stimulation.haemopoiesis stimulation.

Temporary control of Temporary control of bleedingbleeding

Temporary control of Temporary control of bleedingbleeding

Final hemostasisFinal hemostasis

Final hemostasisFinal hemostasis