RaktaSrava, Haemorrhage, Bleeding disorder, Bleeding Controle

2. IMPORTANCE OF BLOOD
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3. • Carries O2 from lungs to all cells of body.
• Transport CO2 from body cells to lung.
• Transport nutrients from digestive organs to the cell.
• Transports waste product from cells to kidney, lungs,
& sweat glands.
• Transport hormones from endocrine glands to the
target cells.
• Transport enzymes to various cells.
• Regulates body pH, body temp. water & electrolyte
balance.
• Prevents body fluid loss through clotting mechanism.
• Protects against toxins and foreign microbes by WBC.
IMPORTANCE OF BLOOD

5. HAEMORRHAGE
Escape of blood from the vessel either
into the tissue, inside the cavity or on a
free surface due to the break in the wall
of the vessel either from trauma disease
or deficiency.

6. CLASSIFICATION
• Size / extent
– Petechial haemorrhage
– Purpura
– Echymosis
– haematoma
• Site / organ
– Epitaxis, Haematemesis, Malena, Haemoptysis, Menorrhogia,
Metrorrhegia, Cerebral Haemorrhage, APH, PPH,
Haematocele, Haematocolops, Haematometra etc.
• Severity
– Arterial Haemorrhage
– Venous Haemorrhage
– Capillary Haemorrhage
• Time
– Primary Haemorrhage
– Reactionary Haemorrhage
– Secondary Haemorrhage
• Chronicity
– Acure Haemorrhage
– Chronic Haemorrhage
HAEMORRHAGE
EXTERNAL INTERNAL

7. Arterial Hemorrhage
Venous Hemorrhage
Capillary Hemorrhage

8. CAUSES
• TRAUMA – injury to blood vessels by cut,
bruise, laceration , tear, accidental injury
• DISEASE – Hypertension, Peptic Ulcer,
Malignancy, Arterial Aneurism, Purpura,
Haemophilia etc.
• DEFICIENCY – Vit-C, Vit –K, Calcium

9. 1. Jwara
2. Raktapitta
3. Prameha
4. Rajayakshma
5. Kshatakshina
6. Udara
7. Arshas
8. Pandu
9. Kumbhakamala
10.Kasa
11.Atisara
12.Chardhi
13.Ashmari
14.Yonivyapath
DISEASE WITH FEATURE OF BLEEDING

10. CLINICAL FEATURE
• EXTERNAL HAEMORRHAGE
Bleeding seen from outside.
• INTERNAL HAEMORRHAGE
Bleeding is concealed.
Increased pulse rate, Low B.P, Increasing
pallor, Restlessness, Deep Respiration (Air
Hunger), Cold & Clammy Extremities, Empty
veins, Sunken Eyes, Low Urine Output, Dry
tongue, Skin elasticity Loosed

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13. External Hemorrhage
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1. Sirobhitapa (headache)
2. Andhyatwa(blurring of vision)
3. Adhimantha
4. Timira
5. Dhatukshaya
6. Akshepaka(convulsions)
7. Daha
8. Pakshaghata
9. Ekangavikara (monoplegia)
10.Hikka
11.Swasa
12.Pandu
13.Marana

14. Internal Hemorrhage
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1.Pandu
2.Sheetata of pada/kara/anana(face).
3.Sheeta uchswas
4.Raktanetrata
5.Badhakoshta

15. ASSESSMENT OF BLOOD LOSS
• WEIGHING THE SWAB
• MEASURING THE SWELLING IN CLOSED
FRACTURE
• MEASUREMENT OF BLOOD CLOT
• BLOOD VOLUME DETERMINATION
• HAEMOGLOBIN LEVEL
• MEASUREMENT OF CVP

16. MANAGEMENT OF HAEMORRHAGE
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17. Management
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 Sandhana
 Skandana
 Pachana
 Dahana

18. Sandhana
Local Hemostasis
• Rodra
• Madhuka
• Gairika
• Sarjarasa
• Shalmali pushpa
• Durva
• Priyangu
(For local application)
General Hemostasis
Internal administration
of kashaya rasa yukta drugs

19. Skandana
Sheeta achadana
Sheeta bhojana
Sheeta agara
Sheeta pradeha
Sheeta parisheka

20. Pachana
(Using of churna & bhasmas)
Kshouma Bhasma
Samudraphena
Laksha churna
Shanka bhasma
Shukti bhasma

21. Dahana
 Application of kshara & Agni

22. Homeostasis principles Acc. to
disease
Nasagata rakta srava
Avapedana nasya with vasa, durva.
Rakta arshas
Langhana
Tikta oushadha sevana
Pratisaraniya kshara
Rakta pana
Raktaja Mutrakrichra
Utpalanala + Sita + Madhu
Vidarikanda
Ikshu
Trapusa

23. 1. Emergency Treatment.
2. With Santarpana and Apatarpana
3. With madhura, sheeta, tikta, kashaya
pradhana bhojana
4. WithPradeha, parisheka
5. Pratimarga harana by vamanadi shodhana
chikista
6. Deciding about the raktasthambana
7. Administration of Kshara
RAKTA PITTA

24. • REST
• SEDATION
• POSITION
• PRESSURE & PACKING FROM OUTSIDE
• OPERATIVE MANAGEMENT ASSISTED BY
MEDICINE
• RESTORATION OF BLOOD VOLUME BY
TRANSFUSION OR INFUSION
MANAGEMENT OF HAEMORRHAGE

26. Initiation
• Quick review types of injuries
• Review tactical combat casualty care
• Evaluate and control bleeding
• Take home message:
HEMORRHAGE CONTROL SAVES LIVES

27. Facts and Tips
• Blood volume of the adult human body
– Approximately 5 to 6 liters
– Loss of as little as 2 pints may cause
shock
• Field blood pressures, when palpable pulse
is appreciated
– Carotid: SBP>60 mmHg
– Femoral: SBP>70 mmHg
– Radial: SBP>80 mmHg

28. Sources of Bleeding
• Arterial
- Rapid, profuse and pulsating
- Bright red in color
• Venous
- Steady flow, no pulsating
- Dark red or maroon in color
• Capillary
- Slow and oozing
- Often clots spontaneously, not dangerous

29. External Bleeding

30. Types of External Bleeding
• Lacerations
• Abrasions
• Puncture wounds
• Amputations
• Avulsions

31. Laceration

32. Abrasion

33. Puncture Wound

34. Core Skills Control Bleeding 34
Amputations

35. Avulsion

36. Internal Bleeding
• Can occur with blunt or penetrating
trauma
• Suspicion based on mechanism of injury
– Falls
– Blast injuries
– Penetrating trauma

37. Causes of Internal Bleeding
• Blunt Trauma
–Auto vs.
pedestrian
–Motor vehicle
accidents
–Falls
–Blast injuries
–Etc.
• Penetrating injuries
– Gunshot wounds
– Stab wounds
– Shrapnel wounds

38. Internal Bleeding
• Signs and Symptoms
–Pain, tenderness, swelling,
discoloration at injury site
–Bleeding from any body orifice
–Vomiting blood
–Tender, rigid, or distended abdomen

39. Internal Bleeding

40. Injured Internal Organs

41. Internal Bleeding
• Can result in rapid progression to
Hypovolemic shock and death
• IV fluids may buy time
• The scalpel is the cure: The rapidly
deteriorating patient requires
surgical intervention
• Immediate evacuation

42. STOP THE BLEEDING !
• Apply direct pressure with gauze or Israeli
dressing
• Elevate the extremity above the heart
• Apply additional dressings if wound
continues to bleed
• Apply pressure to appropriate pressure point
if continues to bleed
• Immobilize injured extremity with a splint
• Apply tourniquet if continues to bleed
• Initiate IV fluids and treatment for shock as
needed

43. Pressure Points
• May be helpful with severe bleeding
as an adjunct
• Apply when bleeding not controlled
by direct pressure and elevation
• Apply pressure to appropriate
pressure point
(

44. Important Pressure Points
(

45. Brachial Pressure Point
• Located in upper arm above the
elbow in the groove between muscles
• Apply pressure to the inside of the
arm over the bone using the fingers
or thumb

46. Brachial Pressure Point

47. Brachial Pressure Point

48. Femoral Pressure Point
• To control
severe bleeding
of thigh and
lower leg
• Located at front,
center part of
crease in the
groin

49. Splints
• Immobilization of the injured
extremity is one of the best ways to
stop bleeding
• Broken bone fragments may lacerate
blood vessels
• Muscular activity will increase rate of
blood flow

50. CARE UNDER FIRE
• Prompt use of tourniquets to stop
the bleeding may be life saving
• Various types of tourniquets exist
– Combat application tourniquet (CAT)
– Theraband
– Cloth and stick

51. Tourniquets
• Early use of a tourniquet in the setting of
forceful arterial bleeding, such as an
amputation, may be life-saving.
• Use a commercial tourniquet, such as the
Combat Application Tourniquet.
• If not available, then use..
– Cravat
– Belt
– Rope
– Any available material

52. Core Skills Control Bleeding 52
Combat Application
Tourniquet
WINDLASS
OMNI TAPE BAND
WINDLASS STRAP

53. Tourniquet Application
• Place tourniquet between the
heart and wound
• Wrap tourniquet around
extremity
• Tighten UNTIL BLEEDING
STOPS

54. Control Bleeding
Tourniquet Application

55. Control Bleeding
Tourniquet Self-Application

56. Tourniquet Etiquette
• Never cover a tourniquet with
another dressing, etc.
• Write “T” on the casualty's
forehead with pen or blood
• Never loosen or remove a
tourniquet once placed

57. Amputation
• First, STOP THE BLEEDING!
• Use direct pressure, Israeli dressing,
or tourniquet as necessary
• Apply dressing to cover end of the
stump
–Blood vessels may collapse,
retract or curl closed and limit
bleeding

58. CONCLUSION
• Hemorrhage is medical & surgical
emergencies
• Practical applicability of the principles
are very much needed
• Measurement of amount of blood loss is
often important & that amount should
always be replaced.
• The basic principle of treatment is bi-
folded
☻stop the bleeding
☻Restore the blood volume.