bleeding

1. BLEEDING

2. BLEEDING (HAEMORRHAGIA)
- blood escape from blood vessels as a
result of vascular injury or vascular
hyperpermeability.

3. ANATOMICAL BLEEDING CLASSIFICATION:
 arterial bleeding;
 venous bleeding;
 capillary bleeding;
 parenchymatous bleeding.

4. BLEEDING CLASSIFICATION BASED ON
THE COURSE
Acute;
Chronic.

5. CLASSIFICATION BASED ON GENESIS
MECHANISM:
 Haemorrhagia per rhexin – bleeding due to
mechanical injury (rupture) of blood vessel;
 Haemorrhagia per diabrosin – bleeding in
case of arrosion of blood vessel due to any
pathologic process;
 Haemorrhagia per diapedesin – bleeding in
case of vascular hyperpermeability due to
some diseases (sepsis).

6. BLEEDING CLASSIFICATION IN RELATION TO
EXTERNAL ENVIRONMENT:
 External bleeding (blood escapes outside the
body through a break in the skin).
 Internal bleeding (blood escapes inside the
body): - visible (open);
- invisible (closed).

7. INTERNAL BLEEDING

8. BLEEDING INTO CAVITIES:
 haemoperitoneum;
 haemothorax;
 haemopericardium;
 haemartrosis.

9. CLASSIFICATION BASED ON BEGINNING TIME:
 Primary bleeding (manifests immediately or in
the first few hours after injury).
 Secondary bleeding:
- early (usually from a few hours to 4-5 days
after injury);
- late (more than 4-5 days after injury).

10. CLASSIFICATION BASED ON SEVERITY DEGREE
OF BLOOD LOSS:
 mild degree – blood loss under 10% of blood
circulation volume ( up to 500 ml);
 moderately severe degree - blood loss 10-20%
of blood circulation volume (500-1000 ml);
 severe degree - blood loss 21-30% of blood
circulation volume (1000-1500 ml);
 massive blood loss - blood loss more than 30%
of blood circulation volume (>1500 ml).

11. CLASSIFICATION OF BLOOD LOSS SEVERITY
(GOSTISHCHEV V.K., EVSEEV M.A., 2005)
 I degree (mild blood loss) – orthostatic
tachycardia, Hb>100g/l, hematocrit
(PCV)≥40%, blood loss under 15%;
 II degree (moderately severe blood loss) -
orthostatic hypotension with ↓ AP>15mmHg,
orthostatic tachycardia with ↑ heart rate>20
per minute, Hb=80-100g/l, PCV=30-40%,
blood loss 15-25%;

12.  III degree (severe blood loss) – signs of
peripheral discirculation, hypotension (systolic
pressure=80-100mmHg), tachycardia (heart
rate>100 per minute), tachypnea (respiratory
rate>25 per minute), orthostatic collapse, ↓
diuresis (<20ml/h), Hb=60-80g/l, PCV=20-30%,
blood loss 25-35%;
 IV degree (very severe blood loss) –impairment of
consciousness, hypotension (systolic
pressure<80 mmHg), tachycardia (heart
rate>120 per minute), tachypnea (respiratory
rate>30 per minute), signs of peripheral
discirculation, anuria, Hb<60g/l, PCV<20%, blood
loss >35%.

13. COMPENSATORY-ADAPTIVE MECHANISMS IN
ACUTE BLEEDING
 venospasm;
 inflow of tissue fluid
 tachycardia;
 oliguria;
 hyperventilation;
 peripheral arteriolospazm.

14. CLASSICAL SIGNS OF BLEEDING:
 pale and clammy skin;
 tachycardia;
 hypotension;
 weak pulse.

15. COMPLAINS OF THE PATIENT:
 weakness;
 vertigo (dizziness);
 “darkness in the eyes”, “flies” before the
eyes;
 feeling of air shortage;
 anxiety;
 nausea.

16. FINDINGS ON EXAMINATION:
 pale skin, cold sweat, acrocyanosis;
 hypodynamia;
 lethargy and other disorders of consciousness;
 tachycardia, thready pulse;
 decrease in blood pressure;
 dyspnea;
 decreased urine output.