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Hemorrhage in children


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Hemorrhage is a process of lose of blood either through a wound or because of any medical condition. Children are very prone to injuries as they are in the stage of attaining their motor developments.

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Hemorrhage in children

  2. 2. INTRODUCTION Hemorrhage is a process of lose of blood either through a wound or because of any medical condition. Children are very prone to injuries as they are in the stage of attaining their motor developments. A complex system of clotting, anti-clotting mechanics exists to ensure clot formation only in the presence of blood vessel injury and to limit clotting process. Dysfunction of these system leads to bleeding.
  3. 3. DEFINITION Hemorrhage is the loss of blood or blood escape 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 the mouth, nose, ear, vagina or anus, or through a break in the skin.
  4. 4. TYPES Hemorrhage is classified into four classes by the American College of Surgeons' Advanced Trauma Life Support(ATLS). • Class i • Class ii • Class iii • Class iv
  5. 5. CLASS I HEMORRHAGE It involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary.
  6. 6. CLASS II HEMORRHAGE • It involves 15-30% of total blood volume. • A patient is often tachycardia (rapid heart beat) with a narrowing of the difference between the systolic and diastolic blood pressures. • The body attempts to compensate with peripheral vasoconstriction. • Skin may start to look pale and be cool to the touch.
  7. 7. • Child may exhibit slight changes in behaviour • Volume resuscitation with crystalloids (Saline solution or Lactated Ringer's solution) is all that is typically required. • Blood transfusion is not typically required.
  8. 8. CLASS III HEMORRHAGE • It involves loss of 30-40% of circulating blood volume. • The patient's blood pressure drops, the heart rate increases, peripheral hypo perfusion (shock), such as capillary refill worsens • The mental status worsens. • Fluid resuscitation with crystalloid and blood transfusion are usually
  9. 9. CLASS IV HEMORRHAGE • It involves loss of >40% of circulating blood volume. • The limit of the body's compensation is reached and aggressive resuscitation is required to prevent death.
  10. 10. CAUSES Bleeding arises due to either traumatic injury, underlying medical condition, or a combination of injury and medical condition. • Traumatic Injury • Medical condition
  11. 11. TRAUMATIC BLEEDING It is caused by some type of injury. There are different types of wounds which may cause traumatic bleeding. These include: • Abrasion • Excoriation • Hematoma • Laceration • Incision • Puncture Wound • Contusion • Crushing Injuries • Ballistic Trauma
  12. 12. • Abrasion - Also called a graze, this is caused by transverse action of a foreign object against the skin, and usually does not penetrate below the epidermis • Excoriation - In common with Abrasion, this is caused by mechanical destruction of the skin, although it usually has an underlying medical cause • Hematoma - Caused by damage to a blood vessel that in turn causes blood to collect under the skin.
  13. 13. • Laceration - Irregular wound caused by blunt impact to soft tissue overlying hard tissue or tearing such as in childbirth. In some instances, this can also be used to describe an incision. • Incision - A cut into a body tissue or organ, such as by a scalpel, made during surgery. • Puncture Wound - Caused by an object that penetrated the skin and underlying layers, such as a nail, needle or knife
  14. 14. • Contusion - Also known as a bruise, this is a blunt trauma damaging tissue under the surface of the skin • Crushing Injuries - Caused by a great or extreme amount of force applied over a period of time. The extent of a crushing injury may not immediately present itself. • Ballistic Trauma - Caused by a projectile weapon such as a firearm. This include two external wounds (entry and exit) & a contiguous wound between the two
  15. 15. MEDICAL CONDITION 'Medical bleeding' denotes hemorrhage as a result of an underlying medical condition (i.e. causes of bleeding that are not directly due to trauma). Blood can escape from blood vessels as a result of 3 basic patterns of injury: • Intravascular changes • Intramural changes • Extra vascular changes
  16. 16. • Intravascular changes - changes of the blood within vessels (e.g. ↑ blood pressure, ↓ clotting factors) • Intramural changes - changes arising within the walls of blood vessels (e.g. aneurysms, dissections, AVMs, vascul atures) • Extra vascular changes - changes arising outside blood vessels (e.g. H pylori infection, brain abscess, brain tumour)
  17. 17. CAUSES There are certain medications which causes increased bleeding risk. 1. NSAIDs exposure to non steroidal anti inflammatory drugs, inhibit the activation of platelets and increase risk of bleeding. The effect of aspirin is irreversible, so it will be present until the replacement of platelets.
  18. 18. 2. WARFARIN ( Coumadin) it acts by inhibiting the production of vitamin K in the gut. It is required for the production of the clotting factors ii, vii, ix and x in liver. Therefore it affects production of clotting factors.
  19. 19. • deficiency of Factor VIII causes classic Haemophilia A • deficiencies of Factor IX cause "Christmas disease"(haemophilia B). • deficiency of or abnormal function of the "von Willebrand" factor, which is involved in platelet activation named von willebrand disease.
  20. 20. MANAGEMENT the factors which will have a major effect on the way a wound is managed are : • The type of wound (incision, laceration, puncture etc.) • area of the body affected • presence of any foreign objects in wound. The key principles of wound management are: • Elevation • Direct pressure • Pressure points
  21. 21. ELEVATION • Keeping the wound above the level of the heart will decrease the pressure at the point of injury. • It will reduce the bleeding. • This mainly applies to limbs and the head, as it is impractical (in some cases damaging) to attempt to move the torso around to achieve this. • Most emergency management protocols do not use elevation on limbs which are broken, as this may exacerbate the injury.
  22. 22. DIRECT PRESSURE • Placing pressure on the wound will constrict the blood vessels manually • Ideally a barrier, such as gauze should be used between the pressure supplier and the wound,to help reduce chances of infection and help the wound to seal. • Direct pressure can be used with some foreign objects protruding from a wound, and to achieve this, padding is applied from either side of the object to push in and seal the wound - objects are never removed.
  23. 23. PROCEDURE • put firm pressure on the wound with a clean cloth. • Continue to hold pressure for ten minutes or until the bleeding stops. • If the bleeding doesn't stop or if the wound seems very deep or penetrating, especially if the edges of the wound do not come together by themselves or the wound is more than 1/2 inch long, you should seek medical attention right away
  24. 24. For minor wounds that quickly stop bleeding • you can next gently wash the wound with warm, soapy water. • Cover the wound with an antibiotic cream or ointment and apply a sterile dressing. • You should wash the wound daily and reapply the antibiotic cream and dressing until healing is complete. • If the wound show signs of infection, becoming red, tender or draining pus, you should get medical
  25. 25. • Sometimes using icepacks will help stopping bleeding. • Fill a freezer bag with ice. • Bind the wound with tight bandage • Apply ice pack with direct pressure for 10 minutes.
  26. 26. PRESSURE POINTS In situations where direct pressure and elevation are either not possible or proving ineffective, it is advised to use pressure points to constrict the major artery which feeds the point of the bleed. • This is performed at a place where a pulse can be found, such as in the femoral artery. • it is used only when other methods have not worked. • It is a last resort because areas of the body that are not bleeding will also have their blood flow reduced.
  27. 27. • Each arm or leg has a major artery supplying it. • Apply direct pressure to the wound and elevation of the injured area • Use four fingers to feel for a pulse. • Once the pulse has been located, apply firm pressure with the heel of the hand or use four fingers along the path of the artery to compress the artery against the underlying bone.
  28. 28. Eg : When the bleeding is from the leg, the pressure point is over the femoral artery. • If there are no suspected injuries to the head, neck, or spine and the child can be moved, place her on her back. • When the bleeding is coming from the arm, the pressure point is over the brachial artery. This can be found at the middle of the inner aspect of the arm, just underneath the biceps muscle on the top of the arm.
  29. 29. EPISTAXIS Epistaxis or a nosebleed is a special case, where almost all first aid providers train the use of pressure points. The appropriate point here is on the soft fleshy part of the nose, which should constrict the capillaries sufficiently to stop bleeding, although obviously, this will not stop bleeding which originates in the nasopharynx or the tear ducts
  30. 30. • Make the child to sit or stand • Make him to lean forward • put firm pressure on nose by squeezing the lower half of his nose. • Keep firm pressure for ten full minutes and then release your hold and see if it is still bleeding. • If the bleeding hasn't stopped, apply pressure for another ten minutes. • Get medical help if doesn't stop.
  31. 31. TOURNIQUET Another method of achieving constriction of the supplying artery is via the use of a tourniquet - a tightly tied band which goes around a limb to restrict blood flow. Tourniquets are routinely used in order to bring veins to the surface for cannulation, although their use in emergency medicine is more limited.
  32. 32. INTERNAL BLEEDING • The treatment of internal bleeding is beyond simple first aid, and should be life threatening. • The definitive treatment for internal bleeding might be surgical treatment, or doctor may suggest vitamin K or plasma / blood transfusion. • Treatment should be for underlying cause.
  33. 33. CONCLUSION In pediatric trauma, we don’t just have an injured child, we have an injured family. Psychological support is very essential in emergency management. Reassure child, calm him and also support family.