Dr. Bassim Rassam
Lec. 1
HAEMORRHAGE
Tues. 18 / 11 / 2014
Published by : Ali Kareem
مكتب اشور لالستنساخ
5102
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5102
Haemorrhage Dr. Bassim Rassam
18-11-2014
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Haemorrhage
Types of haemorrhages :
- Regarding the source of bleeding
Arterial bleeding : Is recognized as bright red blood spurting
as a jet which rises and falls in time with the pulse. In
protracted bleeding and when quantities of intravenous
fluids other than blood are given it can become watery in
appearance.
Venous haemorrhage : Is a darked red steady and copious
flow. The color darkens still further from excessive oxygen
desaturation when blood loss is severe or in respiratory
depression and obstruction. Blood loss is particularly rapid
when large veins are opened as a common femoral or
jugular veins.
Capillary haemorrhage: Is bright red often rapid ooze. If
continuing for many hours blood loss can become serious as
in haemophillia.
- Regarding the time of injury
Primary haemorrhage : Occurs at time of injury or
operation.
Reactionary haemorrhage : May follow haemorrhage
with in 24hours (usually 4-6hours) and is mainly due to
Haemorrhage Dr. Bassim Rassam
18-11-2014
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rolling (slipping) of a ligature, dislodgement of a clot or
cessation of reflex vasoconstriction. The precipitating
circumstances are the rise of blood pressure and refilling
of the venous system or recovery from shock and
restlessness, coughing and vomiting which raise the
venous pressure.
Secondary haemorrhage : Occurs after 7-14 days and is
due to infection and sloughing of part of the wall of an
artery, predisposing factors are pressure of the drainage
tube, a fragment of bone, a ligature in infected area or
cancer.
It is also a complication of arterial disease or amputation .
Haemorrhage can be fatal as in haematemesis may occur in peptic
ulcer. In advanced cancer the erosion of a main vessel as carotid
or uterine artery by a locally ulcerative growth becomes the cause
of death of patient. Secondary haemorrhage can also occur with
anorectal wounds after haemorrhoidectomy.
External haemorrhage : Is visible bleeding usually from opened
wound called revealed haemorrhage.
Internal haemorrhage : Called concealed haemorrhage as in
ruptured spleen or liver, fracture femur, ruptured ectopic
pregnancy or in cerebral haemorrhage. Concealed haemorrhage
can become revealed haemorrhage as in haematemesis or malaena
from bleeding peptic ulcer or as in haematuria from ruptured
kidney or via the vagina in accidental uterine haemorrhage of
pregnancy.
Haemorrhage Dr. Bassim Rassam
18-11-2014
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( Types of Bleeding
ـهم يعتبر من ضمن ال
External & Internal Bleeding
ـال
)
Measurement of acute blood loss :
Assessment and management of blood loss must be related to pre-
existing circulating blood volume which can be derived from the
patient's weight as in infant 80-85ml\kg and in adult is 65-75
ml\kg.
The measurement of blood loss is done by :
1- Blood clot : The size of clenched fist if roughly equal to 500ml.
2- Swelling in closed fracture : Moderate swelling in closed fracture
of the tibia equals 500-1500ml\kg blood loss. Moderate swelling in
fractured shaft of the femur equals 500-2000ml\kg.
3- Swab weighing : In operating theater, blood loss can be measured
by weighing the swabs after use and subtracting the dry weight.
The resulting total obtained as 1g=1ml is added to the volume of
blood collected in suction or drainage bottles .
- In extensive wound and operations, the blood loss is grossly
under estimated due to evaporation of water from swabs before
weighing each batch. Blood, plasma and water also lost from
vascular system because of evaporation from opened wounds, in
to the tissue, sweating and expired water via the lung .
- In deed, for operations such as radical mastectomy or partial
gastrectomy it may necessary to multiply the swab weighing
total by factor 1 1\2. For prolonged surgery via a large wound
as abdominothoracic or abdominoperineal operation the total
measured may need to be multiply by factor 2.
Haemorrhage Dr. Bassim Rassam
18-11-2014
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4- Haemoglobin level : Normal value being 12-16g\dl there is no
immediate change in Haemoglobin but after some hours the level
falls by influx of interstitial fluid in to vascular compartment to
restore the blood volume.
Treatment :
Minimize further blood loss by :
1- Pressure and packing : The first aid treatment of haemorrhage
from a wound is a pressure dressing made from any thing handy
which is soft and clean. The dressing or pack should be bound on
tightly.
The other type of pressure is digital pressure as for episaxis.
Packing by means of rolls of wide gauze is important standby in
operative surgery. If several rolls are used the ends must be tied
together to ensure complete removal later.
2- Position and rest : Elevation of limbs as in rupture of varicose
veins employs gravity to reduce bleeding. Elevation also causes
vasoconstriction. A bed elevator is often used to raise the foot of
the bed thus increasing venous return to the heart and maintain
cardiac out put.
Gravity is also used in certain operations as in thyroidectomy
when the patient is tilted feet down ward called reverse
trendelenburg position, or as in stripping of varicose vein when a
head down tilt is used called trendelenburg position.
3- Operative procedures techniques : Artery forceps (haemostat) and
clips are mechanical means of controlling bleeding by pressure.
Haemorrhage Dr. Bassim Rassam
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The clamped vessel can be ligated or can be coagulated by
diathermy.
Suturing of vessel can be done, transfixation by needle or using
vascular repair defect done by vein patch or Dacron mesh. Topical
application for oozing areas includes gauze or sponge as gelatin
sponge or oxycel.
Excision of bleeding organ used to stop bleeding as ruptured
spleen treated by splenectomy, ruptured liver can treated by
removal of bleeding segment called partial hepatectomy, bleeding
of ruptured kidney excision done to it and this is called
nephrectomy to stop bleeding.
بالمد او
Essay
األشياء اللي
الدكتور
گ
ال
سؤالـك يجتو ةرضاحملاب ةمهم ههيلع
بالفاينال
Q/ What are the types of Haemorrhage ?
Q/ How would you manage bleeding ?
Q/ How would you measure blood loss ?
Management
[ From History to Time of Discharge ]
Done by
Ali Kareem