HAEMORRHAGE

Bleeding, technically known as haemorrhaging is the loss of

blood or blood escape from the circulatory system. Bleeding can occur internally, where blood leaks from blood vessels inside the body or externally, either through a natural opening such as the vagina, mouth, nose, ear or anus, or through a break in the skin. The complete loss of blood is referred to as exsanguination Desanguination is a massive blood loss. Typically, a healthy person can endure a loss of 1015% of the total blood volume without serious medical difficulties,

Recognation of types of haemorrhage

Arterial haemorrhage recognised as bright red blood ,spurting as a jet which rises and falls in

time with the pulse Venous haemorrhage darker red, a steady and copious flow - Pulmonary artery haemorrhage is dark red (venous blood) whereas pulmonary vein is bright red (oxygenated) Capillary haemorrhage bright red, often rapid, ooze

 Primary haemorrhage occurs at the time of injury or operation Reactionary haemorrhage

- may follow primary haemorrhage within 24 hrs (usually 4-6hrs), mainly due to rolling( slipping)of a ligature, dislogement of a clot or cesation of reflax vasospasm

 Precipitating factors- rise in blood pressure

and refilling of the venous system on recovery from shock, restlessness, coughing, vomiting which raise the venous pressure

 Secondary haemorrhage

- occurs after 7-14 days, - due to infection and sloughing of part of the wall of an artery, - predisposing factors pressure of a drainage tube, a ligature in a infected area

 External haemorrhage visible, revealed

haemorrhage Internal haemorrhage invisible, concealed haemorrhage

American College of Surgeons' Advanced Trauma Life Support (ATLS).

Class I - Hemorrhage involves up to 15% of blood volume.

- typically no change in vital signs - fluid resuscitation is not usually necessary. Class II - Hemorrhage involves 15-30% of total blood volume. - A patient is often tachycardic (rapid heart beat) with a narrowing of the difference between the systolic and diastolic blood pressures. - The body attempts to compensate with peripheral vasoconstriction. - Skin may start to look pale and be cool to the touch. - The patient may exhibit slight changes in behavior. - resuscitation with crystalloids (Saline solution or Lactated Ringer's solution) is all that is typically required. - Blood transfusion is not typically required.

 Class III - Hemorrhage involves loss of 30-40% of circulating

blood volume. - blood pressure drops, the heart rate increases, peripheral hypoperfusion (shock), such as capillary refill worsens, and the mental status worsens. - Fluid resuscitation with crystalloid - blood transfusion are usually necessary.

Class IV - Hemorrhage involves loss of >40% of circulating blood

volume. - The limit of the body's compensation is reached - aggressive resuscitation is required to prevent death.

Measurement of acute blood loss

Measuring blood loss

- blood clot the size of a clenched fist is roughly equal to 500ml, - swelling in closed fracture moderate swelling in closed fracture of tibia ~ 500 1500ml blood loss, - moderate swelling in a fracture shaft of femur ~ 500 2000ml of blood loss, - swab weighing blood loss can be measured by weighing the swabs after use and subtracting the dry weight. 1gm =1ml

 Haemoglobin level normal value 12-16

g/100ml, - no immedate change in haemorrhage, after some hrs level falls by influx of interstitial fluid into vascular compartment in order to restore blood volume. Measurement of central venous pressure 58cm H20

Treatment of haemorrhage
Pressure packing Position and rest Operative procedure ligation,repair,excision Fluid resuscitation Restore blood volume by blood transfusion,

albumin 4.6%,saline,dextran,plasma infusion