13.Haemorrhage,Classification,Diagnosis,Management,Blood Transfusion c

8/13/2019 13.Haemorrhage,Classification,Diagnosis,Management,Blood Transfusion c

1/38

Professor Panna Lal SahaProfessor of Surgery & Head

Department of SurgeryGC Trust Medical CollegeChittagong

Haemorrhage classificationdiagnosis management blood

transfusion


2/38

Definition

Escape of circulating blood from the

vascular system.

60-70 percent of the blood volume is

accommodated in low pressure

venules and veins and in the

sphlanchnic vessels, and a loss of upto 10% (500-600ml) is adequately

compensated for by the

venoconstriction and therefore the


3/38


4/38

Signs

External blood loss is

obvious, but a serious

internal hemorrhage must berecognized without delay by

the general signs of bloodloss:


5/38

Signs

Restlessness

Increasing

pulse rateDecreased

blood pressure

Increasing

pallor

Deep sighing

respiration

Cold and

clammy skin

Empty veins

Thirst, tinnitusand blindness


6/38

Effects

Blood loss threatens the oxygen supply to

tissue cells

Pending the arrest of hemorrhage and the

replacement of blood, the function of vital

structures such as the heart and brain stemis largely preserved by the increasing pulse

rate peripheral vasoconstriction

Unchecked and untreated blood loss resultsin failure of the heart and vasomotor centre

to maintain a sufficient perfusion of oxygen

for their own purposes and death follows.


7/38

Effects

Vasoconstriction fails to maintain theblood pressure when blood loss

increases beyond 20-30%

Hypotension becomes severe with a50% loss and the perfusion of

myocardium and brain stem is affected.

Thus the heart fails and vasoconstrictionof venous reservoir fails each affecting

the others in a vicious cycle which ends

in death


8/38

Natural blood volume and red cell

recovery

The recovery of blood volumesbegins immediately by thewithdrawal of fluid from the tissues

from the circulation. There ishemodilution. Plasma proteins arereplaced by the liver

Red cell recovery takes some fiveto six weeks


9/38

Chronic hemorrhage

Examples of causes in surgical practiceare bleeding hemorrhoids, fibroids,

carcinoma colon, peptic ulcer etc.

There is no diminution of blood volumeas there is time for plasma

replacements, but red cell replacement

lags behind resulting in a state ofanaemic hypoxia, requiring an increased

cardiac out put.


10/38

Chronic hemorrhage

These patients develop high outputcardiac failure

They must not be transfused with

normal blood, but require packed

cells instead.

Acute hemorrhage in such cases ispoorly compensated, as oxygen

carriage is already depleted.


11/38

Measurement of hemorrhage

Bed side observation

Record keeping

Hemoglobin level

The hematocrit Measuring blood loss

Blood clot

Swelling in closed fracture

Swab weighing Blood volume determination

Measurement of CVP


12/38


13/38

Pressure and packing

Pressure dressing to be applied inthe wound

Simple pressure over the bleeding

site by finger stop bleeding

Packing by roll gauge is an

important tool to control bleeding inspecial circumstance

Tourniquets applied in special place

and circumstance to stop bleeding


14/38

Position and rest

Elevation of limbs

Position of patient during

operationAbsolute rest

Sedation


15/38

Hemorrhage management during

operation

Artery forceps

Bleeding vessels are ligated with cat gut,

silk, vicryl, etc. or coagulated with

diathermy. Management of scalp hemorrhage during

operation by special technique

Pressure by gauze pack helps to stopoozing

Gel-foam or oxygel application stops

bleeding in special circumstance


16/38

Blood transfusion


17/38

Indication of blood transfusion in

surgical practice

Following traumatic incidentswhere there has been severe

blood loss, or hemorrhage frompathological lesion, e.g. from

gastrointestinal tract

During major operativeprocedures where a certain

amount of blood loss is inevitable,


18/38


19/38


20/38

Preparation of blood products

It is important that blood donors should befit and no history of serious diseases, in

particular hepatitis, AIDS, malaria which

are transmitted in donor blood Blood is collected into a sterile

commercially prepared plastic bag with

needle and plastic tube attached in a

complete, closed sterile unit

Usually 410 ml blood is collected from a

donor and mixed with 75 cc anticoagulant

(CPD).


21/38

Infectious Disease Testing of Blood Donations

1. Syphilis Testing - TPHA

2. Viral Serology Testing

- HBsAg, HCV Ab, HIV-1&2 Ab

3. NAT Testing

- HIV/HCV/HBV

4. Bacterialtesting forplatelets5. Malaria testing

for at-risk donors


22/38


23/38

BLOOD STORAGE

It is essential to store blood at 4 2 C

WBC- rapidly destroyed in stored

blood

Platelets at 4 C survival of platelets

considerably reduced

Clotting factors like platelets,

clotting factors VIII and V are labile

and their level falls quickly


24/38


25/38

Giving blood

Selection and preparation of the site

Careful checking of the donor blood. This

should bear a compatibility label stating the

patientsname, hospital reference no., wardand blood group.

Insertion of needle or canula. The latter may

be valuable if intravenous therapy is

required for any length of time

Giving detailed written instructions as to the

rate of flow, for example, 40 drops/min

allows one 540 ml unit of blood to be


26/38

Giving blood

Site

As routine measure, vein on the forearm,

or on the back of the hand is chosen. In

women, young children, and some men,especially when the venous pressure is

low, a visible or palpable vein may not be

found in the arm; consequently anothersite must be used.


27/38


28/38


29/38

Monitoring Procedure-

Two patients with same surname in the same ward

Both having a blood transfusion

Patient identification check not undertaken

Group O patient transfused with Group A RBCs

Patient complained of generalised pain

Transfusion continued

Patient became very ill and died 6 hours later


30/38

A m ild react ion may be the ear ly stages o f a severe react ion

- DONT IGNORE IT!

Signs & Symptoms of aTransfusion ReactionMild Reaction Severe Reaction

Fever Pyrexia, rigors

Urticaria HypotensionRash Loin/Back Pain

Pruritis Increasing anxiety

Pain at infusion site

Respiratory Distress

Dark urineSevere Tachycardia

Unexpected bleeding (DIC)


31/38

1. Stopthe transfusion

(check patient and component compatibility)

2. Seek medical advice

3. Assess patient

4. Commence appropriate treatment

If s igns & sym ptoms worsen wi th in 15 m inutes

treat as a severe react io n

Management of a Mild AcuteTransfusion Reaction


32/38

1. Stop the transfusion

Replace the administration setIV access should be maintained with normal saline

(check patient and component compatibility)

2. Call the doctor to see the patient urgently

3. Assess patient - resuscitate as required4. Inform the HTL and return the component

5. Document event in patient case notes

Management of a SevereTransfusion Reaction


33/38

Safer Practice Takes Seconds

A consistent, professional approach to safe transfusion

practice can save lives

Id like to know who I can blame I still feel hate.

I am furious and angry someone couldnt be bothered

to treat my chi ld in a pro fessional and safe manner.Mrs Green 15/12/98

C li ti f bl d


34/38

Complications of blood

transfusion

Congestive cardiac failure

Transfusion reactions

IncompatibilitySimple pyrexial reaction

Allergic reaction

Antibody reaction


35/38


36/38


37/38


38/38

13.Haemorrhage,Classification,Diagnosis,Management,Blood Transfusion c

Documents

Transcript of 13.Haemorrhage,Classification,Diagnosis,Management,Blood Transfusion c