Bleeding control mit

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BLEEDING CONTROL

Transcript of Bleeding control mit

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BLEEDING CONTROL

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SEQUENCE

IMPORTANCE Physiology/homeostasis Integrity of circulatory systemTYPES/CAUSESCONTROL METHODSBLOOD TRANSFUSION

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Subject’s importance

Hemorrhage is one of the basic problems and considerations in surgery.

From-trivial trauma or major abdominal organ injuries-to- congenital and acquired coagulation disorders.

A wide spectrum of problems involves hemorrhage.

Transfusion of blood is the main remedy

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Clinical Situation-Bleeding

Trauma /accidents General operative interventions Gynecological procedures Common surgical conditions that presents with bleeding- Intracranial hemorrhages/CVA Upper GIT bleed/ hematemesis and melena Bleeding hemorrhoids Chronic wounds Aneurysms Coagulation disorders

Congenital- Hemophil ia, vWF deficiency Acquired

DIC Anticoagulants Fulminant sepsis

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What Prevents Hemorrhage

NATURAL BARRIERS AGAINST HAEMORRHAGE

Integrity of vascular wall Coagulation system

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Body’s response to hemorrhage/injury

Attempts to repair the loss & restore normality

There are several interrelated stages

Local response / Generalized response

Aims at: Wall repair Restoration of volume loss Correction of coagulation abnormalit ies

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Signs of the bleeding

Local

Hematoma, suffusion, ecchymosis

Compression in the pleural cavity, in pericardium, in the skull

Functional disturbancies – e.g. hyperperistalsis

General Pale skin, Cyanosis, Decreased BP, Tachycardia, Difficulty in breathing,

sweating, decreased body

temperature, unconsciousness, cardiac standstill

Signs of shock

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Body’s response to hemorrhage/injury

Local Vasoconstriction Platelet aggregation and plug formation Coagulation leading to Fibrin formation –Intrinsic

& Extrinsic Pathways

General Cardiac stimulation Compartmental Volume movement

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TYPES OF HAEMORRHAGE

AMOUNT OF LOSS -MINOR/MAJOR

ACUTE/CHRONIC

ARTERIAL/VENOUS/CAPILLARY/MIXED

LOCALIZED/DIFFUSE

EXTERNAL/ INTERNAL

OVERT/OCCULT

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TYPES OF HAEMORRHAGE

ARTERIAL BLEEDING is of a bright red colour, and escapes from the end of the vessel in jets, synchronous with the heart's beat

VENOUS BLEEDING is of a darker colour; the flow is steady, the bleeding is from the distal end of the vessel .

CAPILLARY BLEEDING is a general oozing from a raw surface .

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Hemorrhage and ShockWhat happens when you start to

bleed? – it depends on how much blood you lose

Normal Adult Blood Volume is about 5 Litres

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Severity of Hemorrhage

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The Direction Of Hemorrage

External

Internal In a luminar organ (hematuria, hemoptysis, melena)

In body cavities (intracranial, hemothorax, hemoperitoneum, hemopericardium, hemarthros)

Among the tissues (hematoma, suffusion)

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Internal Hemorrhage

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INTERNAL HAEMORRHAGE /WOUNDS

Causes Penetrating wounds –o chest, abdomen, neck, limbs Upper GI haemorrhage-o Bleeding Ulcers Lower GI haemorrhage

o Diverticulosiso Haemorrhoidso Carcinomas

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External Hemorrhage

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BleedingPREOPERATIVE HEMORRHAGE

Prehospital care! – maintenance of the airways, ventillation and circulation

bandages, direct pressure, torniquets

INTRAOPERATIVE HEMORRHAGEanatomical and/or diffuse

depending on the surgeon, the surgery, position,

the size of the vessel, pressure in the vessel

(ANESTHESIA)

POSTOPERATIVE BLEEDINGineffective local hemostasis, undetected hemostatic defect, consumptive coagulopathy or fibrinolysis

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CLASSIFICATION OF SURGICAL HAEMORRHAGE

Primary Hemorrhage occurring at the time of the injury or surgery

Reactionary Hemorrhage within twenty-four hours of the accident/surgery, due to

slippage of ligature, hypertension post op

Secondary Hemorrhage occurring at a later period (48-72hrs) and caused by

septic condition of the wound (infection).

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EFFECTS OF HAEMORRHAGE

Depend upon following: Acute loss vs Chronic loss The amount of loss The compensatory mechanisms General state of health

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SURGICAL HEMOSTASIS

Aim – to prevent the flow of blood from the incised or transected vessels

Mechanical methods

Thermal methods

Chemical and biological methods

Radiological/Interventional methods

Adequate blood/blood products transfusion

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SURGICAL HAEMOSTASIS

Natural CONTROL/arrest of hemorrhage arises from-

(1) changes taking place in the cut vessel causing its retraction and contraction

(2) the coagulation mechanism of the blood

(3) temporary-platelet plug Permanent-fibrin clot.

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SURGICAL HEMOSTASISMECHANICAL METHODS

Digital pressure – direct pressure,

e.g. Pringle maneuver

Tourniquet

Ligation

Suturing

Preventive hemostasis

Clips

Bone wax

other

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SURGICAL TREATMENT OF HAEMORRHAGE

First Aid Management DIRECT PRESSURE In small blood-vessels

pressure will be sufficient to arrest, hemorrhage permanently

LIMB ELEVATION TOURNIQUET

APPLICATION

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CLIPS FOR CONTROLLING BLEEDING

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LIGATURE In large vessels with a reef-knot main artery of the limb exposed

by dissection at the most accessible point .

SUTURING & LIGATURE

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THERMAL METHODS Low temperature

Hypothermia – eg. stomach bleeding

Cryosurgery

Dehydratation and denaturation of fatty tissue

Decreases the cell metabolism

Vasoconstriction

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THERMAL METHODS High temperature

Electrosurgery – electrocauterization

Monopolar diathermy

Bipolar diathermy

Harmonic devices

Laser surgery

coagulation and vaporization

for fine tissues

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Diathermy

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Thermal methods High temperature

Electrocoagulation

Electrofulguration (A)

Electrodessication

Electrosection

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Hemostasis with chemical and biological methodsVASOCONSTRICTION COAGULATION HYGROSCOPIC EFFECT

Absorbable collagen

Absorbable gelatin

Microfibrillar collagen

Oxidized cellulose

Oxytocin

Epinephrine

Thrombin

QuikClot

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Hemostasis with chemical and biological methods

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HemCon

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Bleeding Control by Interventional Radiology

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Interventional Radiology

Post trauma-intra abdominal bleeding

Gastro intestinal bleeding control- Upper

Lower

Uterine atony causing Postpartum hemorrhage

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Embolisation particles

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Post trauma

Vascular and solid organ trauma. Celiac angiogram showing 3 foci of extravasation in spleen, 2 in the upper pole (arrow) and 1 in the lateral aspect of the mid spleen

Post—super-selective embolization splenic angiogram demonstrating microcoils in good position and no evidence of further extravasation

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Gastrointestinal Bleeding

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