DIAGNOSIS AND MANAGEMENT OF HEMORRHAGE
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Transcript of DIAGNOSIS AND MANAGEMENT OF HEMORRHAGE
DIAGNOSIS AND MANAGEMENT OF HEMORRHAGE
Introduction Types of hemorrhage Mechanism of hemostasis Causes of
hemorrhage Evaluation of patient with hemorrhage Blood tests
Management of hemorrhage INTRODUCTION TO HEMORRHAGE
Means escape of blood from a blood vessel. Bleeding which is
prolonged & uncontrolled Blood loss can be less or more in
quantity. Abnormal internal or external loss of blood. TYPES OF
HEMORRHAGE DEPENDING ON THE TYPE OF BLOOD VESSEL INVOLVED
Arterial : Bright red and sudden jets of blood. Venous : Dark red
and continuous flow of blood. Capillary : Bright red and slow
oozing of blood. TYPES OF HEMORRHAGE DEPENDING ON THE TIME PERIOD
AFTER SURGERY
Primary hemorrhage : At the time of injury / surgery or
continuously afterwards. Reactionary hemorrhage :Restarts after
period of 3 hours post-operatively. Secondary hemorrhage : Restarts
few days later after surgery. MECHANISM OF HEMOSTASIS
Hemostasis means STOPPAGE OF BLEEDING. STEPS IN HEMOSTASIS (Normal
Mechanism) 1. Vasoconstriction. 2. Formation of platelet plug. 3.
Coagulation. 1. Vasoconstriction: When the blood vessel is damaged,
vasoconstriction occurs to reduce bleeding, as a normal mechanism.
2. Activation and aggregation of platelets causing formation of
platelet plug at the damaged surface of blood vessel. 3. Activation
of clotting mechanism, conversion of fibrinogen to fibrin.
Platelets bind with fibrin and form a blood clot. MAJOR REASONS
EFFECTING NORMAL HEMOSTASIS
VESSEL WALL Severe damage to the wall of blood vessel like in Major
Trauma. Laceration of any Major Blood Vessel. PLATELETS Less number
of platelets than normal PLATELET COUNT which has normal value 150,
,000 Platelets Per Microliter (mcL). Lower than normal platelet
count is called thrombocytopenia can be caused by certain specific
drugs like anticancer drugs, radiotherapy, autoimmune diseases.
Proper functioning of platelets. A higher-than-normal number of
platelets thrombocytosis. DEFECTIVE CLOTTING MECHANISM
Inadequate levels of clotting factors. NORMAL CLOTTING MECHANISM
CAUSES OF HEMORRHAGE In normal patients Local infection.
Tear of blood vessel. Punctured wound. Disturbance of blood clot.
Post-operative trauma to the operated site. In patients with
systemic diseases
Haemophilia. Hypertension. Anticoagulant therapy. Vitamin K
deficiency. Thrombocytopenia. Liver disorders. EVALUATION OF
PATIENT WITH HEMORRHAGE
History. Physical examination. Patients on medications like
anticoagulants etc. Screening for any relevant systemic diseases.
Investigations BLOOD TESTS Bleeding time. Clotting time.
Prothrombin time.
Partial thromboplastin time. Platelet count MANAGEMENT OF
HEMORRHAGE
Depends on patients hematological status. 1. Patient with normal
hematological status. 2. Patient with deficiency in any of the
factors promoting coagulation and healing. MANAGEMENT OF
HEMORRHAGE
Normal patients Digital pressure pack. Hemostatic agents like
Monsels solution, Tannic acid, Gelfoam, Oxycel, Surgicel, Thrombin,
Bone wax. Electrocautery. Ligation. Suturing the wound. Patients
with systemic diseases
Preoperative treatment for the underlying cause like hypertension
etc. Preoperative care for underlying deficiency of platelets or
clotting factors etc, and their proper replacement. BLOOD TESTS
NORMAL VALUES
Bleeding time = Minutes in adults, Minutes in children, Longer in
female than in male Clotting time (or) = / 14 Seconds Prothombin
time Partial thromboplastin time = 25 35 Seconds