definitions classification of hemorrhage management of hemorrhage

1. G E N E R A L S U R G E R Y
Hemorrhage
Dr. Haydar Muneer Salih
B.D.S., F.I.B.M.S.

2. Haemorrhage
is an escape of blood from a ruptured blood vessel

3. • Haemorrhage is treated by arresting
the bleeding, and not by fluid
resuscitation or blood transfusion
• Although necessary as supportive
measures to maintain organ
perfusion, attempting to resuscitate
patients who have on-going
haemorrhage will lead to
physiological exhaustion

5. definit

6. Revealed haemorrhage

7. Revealed haemorrhage

8. Concealed haemorrhage

9. Concealed haemorrhage

10. • (immediately) as a result of an
injury (or surgery).
Primary hemorrhage

11. Reactionary hemorrhage
• (within 24 hours) usually caused by
dislodgement of clot by resuscitation,
normalization of blood pressure and
vasodilatation. Reactionary haemorrhage
may also result from technical failure such
as slippage of a ligature

12. Secondary hemorrhage
• (within 7–14 days) is caused by
sloughing of the wall of a vessel. It
usually occurs 7–14 days after injury
and is precipitated by factors such as
infection, pressure necrosis (such as
from a drain) or malignancy

13. The adult human has
approximately 5 liters of blood
(70 ml kg–1children and adults)
(80 ml kg–1 neonates).
.

14. Classification of haemorrhage
Class 1 : <15%
Class 2: 15-30%
Class 3: 30-40 %
Class 4: >40 %

15. Management of haemorrhage
1. Identify hemorrhage
External hemorrhage may be obvious but
the diagnosis of concealed hemorrhage
may be more difficult
• cavity hemorrhage must be excluded with
rapid investigations (chest and pelvic
radiography, abdominal ultrasound or
diagnostic peritoneal aspiration).

16. Control of haemorrhage
1. Pressure and packing
- Pressure dressing
- Digital pressure
- Balloon
- Tourniquet

23. Control of haemorrhage
2. Position and rest
Elevation (varicose veins,
thyroidectomy)

25. Control of haemorrhage
3. Operative technique
• By artery forceps
• Ligation
• Diathermy
• Clips
• Suturing
• Pressure by gauze
• Repair of large vessels
• Synthetic substances