HAEMORRHAGE

Dr.Syed Alam Zeb

Ortho B HMC

TYPES OF HAEMORRHAGE

• Arterial

• Venous

• Capillary

TYPES OF HAEMORRHAGE

• Primary

• Reactionary

• Secondary

TYPES OF HAEMORRAGE

• External ( revealed hemorrhage )

• Internal ( concealed )

ARTERIAL HAEMORRHAGE

• Bright red

• Emitted as spurting jet

• Can lead to severe blood loss

• Blood becomes watery if too much fluids given in protracted bleed.

VENOUS HAEMORRHAGE

• Darker red

• Steady and copious flow

• Color becomes further darker with oxygen desaturation

• Bleed from jugular, femoral, portal veins and esophageal varices is fatal if not controlled.

CAPILARY HAEMORRHAGE

• Bright red

• Rapid and oozing

• Blood loss becomes serious if continues for hours

• Common in haemophiliacs.

PRIMARY HAEMORRHAGE

• Occurs at the time of surgery

• Cause is injury to vessels

• May be arterial, venous or capillary

• More common in surgery on malignancies.

REACTIONARY HAEMORRHAGE

• Bleeding within 24 hours ( usually 4-6 hrs ) of surgery

• Cause is slipping of ligature, dislodgement of clot or cessation of reflex vasospasm

• Bleed starts when there is a rise in the arterial or venous pressure.

SECONDARY HAEMORRHAGE

• Occurs after 7-14 days of surgery

• Cause is sloughing of vessel due to infection

• 1st a warning stain followed by a sudden severe bleed

• Common after hemorrhoids surgery, GI surgery & amputations.

REVEALED HAEMORRHAGE

• External or visible bleed

• Bleeding from the limb vessels

CONCEALED HAEMORRHAGE

Internal or invisible bleed

May remain concealed as in ruptured spleen or liver

Concealed hemorrhage may become revealed as in haemetemesis or melaena in peptic ulcer bleed

MEASUREMENT OF ACUTE BLOOD LOSS

• Assessment & measurement of loss depends on pre-existing circulatory volume

• Blood clot

• Swelling in closed fractures

• Swab weighing

• Hb level

• CVP

TREATMENT OF HAEMORRHAGE

• Pay attention to airway & breathing.

• Pressure & packing.

• Position & rest.

• Operative techniques.

PRESSURE & PACKING

• Apply tight pressure from any thing .

• Digital pressure

• Use of balloons in variceal bleed

• Use of gauze packs in surgery.

POSITION & REST

• Elevate the limb---gravity, vasoconstriction.

• Trendelenburg position.

• Anti-trendelenburg position.

• Head down position in shock.

OPERATIVE TECHNIQUES

• Use of artery forceps.

• Sutures.

• Clips.

• Diathermy.

• Lasers.

• Gelatin sponges.

• Removing the bleeding organ.

SUMMARY

H A E M O R R H A G E

P R IM A R YR E A C T IO N A R Y

S E C O N D A R Y

R E M E M B E RA B C

If p a tie n t is in sh o ck

H A E M O S T A S ISP o s itio n & re st

P re ssu re & p ack ingS u rg ica l m e a ns

A R T E R IA LV E N O U S

C A P IL L A R Y

C O N C E L E A DR E V E A L E D

C L A S S IFY

THANKS