Haemorrhage by Dr.Syed Alam Zeb

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Haemorrhage by Dr.Syed Alam Zeb

  1. 1. HAEMORRHAGE Dr.Syed Alam Zeb Ortho B HMC
  2. 2. TYPES OF HAEMORRHAGE <ul><li>Arterial </li></ul><ul><li>Venous </li></ul><ul><li>Capillary </li></ul>
  3. 3. TYPES OF HAEMORRHAGE <ul><li>Primary </li></ul><ul><li>Reactionary </li></ul><ul><li>Secondary </li></ul>
  4. 4. TYPES OF HAEMORRAGE <ul><li>External ( revealed hemorrhage ) </li></ul><ul><li>Internal ( concealed ) </li></ul>
  5. 5. ARTERIAL HAEMORRHAGE <ul><li>Bright red </li></ul><ul><li>Emitted as spurting jet </li></ul><ul><li>Can lead to severe blood loss </li></ul><ul><li>Blood becomes watery if too much fluids given in protracted bleed. </li></ul>
  6. 6. VENOUS HAEMORRHAGE <ul><li>Darker red </li></ul><ul><li>Steady and copious flow </li></ul><ul><li>Color becomes further darker with oxygen desaturation </li></ul><ul><li>Bleed from jugular, femoral, portal veins and esophageal varices is fatal if not controlled. </li></ul>
  7. 7. CAPILARY HAEMORRHAGE <ul><li>Bright red </li></ul><ul><li>Rapid and oozing </li></ul><ul><li>Blood loss becomes serious if continues for hours </li></ul><ul><li>Common in haemophiliacs. </li></ul>
  8. 8. PRIMARY HAEMORRHAGE <ul><li>Occurs at the time of surgery </li></ul><ul><li>Cause is injury to vessels </li></ul><ul><li>May be arterial, venous or capillary </li></ul><ul><li>More common in surgery on malignancies. </li></ul>
  9. 9. REACTIONARY HAEMORRHAGE <ul><li>Bleeding within 24 hours ( usually 4-6 hrs ) of surgery </li></ul><ul><li>Cause is slipping of ligature, dislodgement of clot or cessation of reflex vasospasm </li></ul><ul><li>Bleed starts when there is a rise in the arterial or venous pressure. </li></ul>
  10. 10. SECONDARY HAEMORRHAGE <ul><li>Occurs after 7-14 days of surgery </li></ul><ul><li>Cause is sloughing of vessel due to infection </li></ul><ul><li>1 st a warning stain followed by a sudden severe bleed </li></ul><ul><li>Common after hemorrhoids surgery, GI surgery & amputations. </li></ul>
  11. 11. REVEALED HAEMORRHAGE <ul><li>External or visible bleed </li></ul><ul><li>Bleeding from the limb vessels </li></ul>
  12. 12. CONCEALED HAEMORRHAGE <ul><li>Internal or invisible bleed </li></ul><ul><li>May remain concealed as in ruptured spleen or liver </li></ul><ul><li>Concealed hemorrhage may become revealed as in haemetemesis or melaena in peptic ulcer bleed </li></ul>
  13. 13. MEASUREMENT OF ACUTE BLOOD LOSS <ul><li>Assessment & measurement of loss depends on pre-existing circulatory volume </li></ul><ul><li>Blood clot </li></ul><ul><li>Swelling in closed fractures </li></ul><ul><li>Swab weighing </li></ul><ul><li>Hb level </li></ul><ul><li>CVP </li></ul>
  14. 14. TREATMENT OF HAEMORRHAGE <ul><li>Pay attention to airway & breathing. </li></ul><ul><li>Pressure & packing. </li></ul><ul><li>Position & rest. </li></ul><ul><li>Operative techniques. </li></ul>
  15. 15. PRESSURE & PACKING <ul><li>Apply tight pressure from any thing . </li></ul><ul><li>Digital pressure </li></ul><ul><li>Use of balloons in variceal bleed </li></ul><ul><li>Use of gauze packs in surgery. </li></ul>
  16. 16. POSITION & REST <ul><li>Elevate the limb---gravity, vasoconstriction. </li></ul><ul><li>Trendelenburg position. </li></ul><ul><li>Anti-trendelenburg position. </li></ul><ul><li>Head down position in shock. </li></ul>
  17. 17. OPERATIVE TECHNIQUES <ul><li>Use of artery forceps. </li></ul><ul><li>Sutures. </li></ul><ul><li>Clips. </li></ul><ul><li>Diathermy. </li></ul><ul><li>Lasers. </li></ul><ul><li>Gelatin sponges. </li></ul><ul><li>Removing the bleeding organ. </li></ul>
  18. 18. SUMMARY
  19. 19. THANKS

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