By Dr Prins fefar

1. .
Acute Hemorrhage

2. Introduction
 Haemorrhage is the loss of blood escaping 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
mouth,nose,ear,urethra,vagina or anus or through a
break in the skin.
 Uncontrolled bleeding can lead to shock & death.

3. Types of Blood loss
 American college of surgeons identifies 4 categories
of blood loss based on percent of loss of blood
volume.
 CLASS I: Loss of 15% or less of total blood vol.
 CLASS II: Loss of 15-30% of blood vol.
 CLASS III: Loss of 30-40% of blood vol.
 CLASS IV: Loss of more than 40%.

4. Sign & Symptoms
 Mild To Moderate :
 Dizziness or light headedness
 Headache
 Diarrhea
 Weakness
 Low bp
 Muscle fatigue
 Shortness of breath

5. Mild to Moderate Severe
 Light headedness
/dizziness
 Headache
 Diarrhoea
 General weakness
 Muscle pain
 Disorientation
 Blurred vision
 Low BP
 Very low BP
 Rapid heart rate
 Sweaty wet skin often
cool to touch
 Little or no urine
 Loss of consciousness
 Organ failure
 Seizure
 coma
Signs & Symptoms

6. Causes
 Internal bleeding:
 Minor injury
 Chronic high bp
 Blood thining medications
 Genetic clotting conditions
 Steroids
 Anti clotting medicines
 DVT
 GI conditions( Crohns Disease, IBS, Ulcerative
colitis)

7. Causes
 Severe or sudden haemorrhaging:
 Traumatic injury: accidents, bullet wounds, falls,
explosion,crush injuries
 Embolism
 Broken bones
 Aneurysm ( bulges in blood vessels)
 Ectopic Pregnancy

8. Investigations
 CBC
 BT
 CT
 PROTHROMBIN TIME
 PERIPHERAL BLOOD SMEAR
 Ct brain for intracranial bleed
 X ray, usg for bleeds in thorax,abdomen

9. MANAGEMENT
 Management of haemorrhage will vary based on:
 Anatomical location
 Extent of the injury
 Patient presentation
 Resources available

10. BASIC TREATMENT
 Basic fluid resuscitation with NS and RL by placing
two large bore Iv’s
 Blood products administration ( whole blood, PCV,
FFP , PLATELETS)
 For traumatic external wounds – direct pressure,
placements of tourniquets proximal to source of the
haemorrhage.
 GOALS OF TREATMENT ARE TO RESTORE
INTRAVASCULAR VOLUME AND MAINTAIN
OXYGEN DELIVERY UNTIL THE SOURCE OF
BLEEDING CAN BE RESOLVED.

11. DIFFERENTIAL DIAGNOSIS
 MIGRANE HEADACHES
 MENINGITIS/ENCEPHALITIS
 TUMOUR
 ELECTROLYTE ABNORMALITIES
 STROKE
 MI
 INTOXICATION/POISONING

12. Complications
 Occur due to decreased blood flow to organs and
ultimately tissue hypoxia leading to
 Organ failure
 Seizures
 Coma
 Eventually death.

13. Team Work
 Acute haemorrhage management requires an
interprofessional team approach, including
physicians, specialists,trained nurses and
pharmacists all collaborating across disciplines to
achieve optimal patient results.
 A TEAM APPROACH WILL PROVIDE THE BEST
OUTCOMES.

14. THANK YOU.