1. Hemorrhage is defined as blood escaping from the circulatory system. It can be classified by the type of vessel (arterial, venous, capillary), timing (primary, reactionary, secondary), duration (acute, chronic), and nature (external, internal). 2. Hemorrhagic shock occurs when blood loss exceeds 30-40% of total blood volume, leading to falling blood pressure and tissue hypoperfusion. It is classified into four stages based on symptoms. 3. Homeopathic medicines like Carbo veg, Aconite, Ferrum, Bovista, Crot. H, and Secale cor are used to manage hemorrhage based on

1. HAEMORRHAGE
DR.PRAFULLA PATIL
LECTURER,S.C.H.M.C,JALGAON.

2. DEFINITION
 Blood escaping from the circulatory system.

3. Types
 1) Depending on nature of vessels:-
A) Arterial:-
Bright Red , jets Out Easily ,Its Can Be Easily Controlled And Visible
B) Venous:-
dark red , oozes out never jets out , difficult to control because
veins retracted.
c) Capillary:-
red in colour ,never jets out , slowly oozes out.

4.  Depending on timing:-
a) Primary :-
Occurs At The Time Of Surgery.
b) Reactionary:-
6-12 hours after surgery , hypertension , violent
sneezing , coughing or retching.
c) Secondary :-
occurs after 5-7 day due to infection.

5.  3) Depending on duration of Hemorrhage:-
a) Acute:-
occurs suddenly
b) Chronic :-
occurs over a period of times
hemorrhoids and piles

6.  4) Depending on the Nature Of Bleeding :-
a) External :- epistaxis , haematemesis
b) Internal :- Internal Injury.

7. PATHOPHYSIOLOGY OF
HAEMORRHAGIC SHOCK
 A loss of more than 30-40% blood volume result in fall of blood pressure and gross
hypoperfusion of the tissues leading to hemorrhagic shock.

8. Evolution of Haemorrhagic shock classified
in four stages:-
 Class 1:-
Blood Loss Less Than 750 Ml(<15 % Of Blood Volume)is
Called Mild Hemorrhage.
Peripheral Venoconstriction Takes Place
Mild Tachycardia And Thirst,vital Signs Normal-BP
Urine Output

9.  Class 2 :-
800-1500 ml (15 to 30 % of blood volume) moderate haemorrhage
Peripheral venoconstriction may not be sufficient to maintain the circulation.
Hence, adrenaline and noradrenaline released from the sympathoadrenal system cause
powerful vasoconstriction of both arteries and veins.
Increased secretion of ADH causes retention of water and salt. Thirst increases.
the patient shows a heart rate of 100-120 beats/ minute and an elevated diastolic
pressure. The systolic pressure may remain normal. Urine output is reduced to about 0.5
ml/kg/h. Extremities may look pale and the patient is confused and thirsty.

10.  Class 3:-
1500-2000 ml (30-40%blood volume)
symptoms worse
BP falls
HR Increases
RR increase
Urine Output Decrease
Patient Is Pale , aggressive ,Drowsy

11.  CLASS 4:-
More Than 2000 Ml(>40% OF BLOOD VOLUME)
Peripherals Are Cold
Pulse Thready More Than 120/Minute
BP:- Unrecordable

12. Management of Haemorrhagic shock:-
 I. Treatment-general measures
 • Hospitalisation
 • Care of all critically ill patients begins with A, B and C.
 A: Airway, B: Breathing, and C: Circulation.
 • Oxygen should be administered by face mask to all patients who are in shock but are
conscious and are able to maintain their airway.
 • If unconscious, endotracheal intubation and ventilation with oxygen may be
necessary.

13.  • Haemorrhage control
• Intravenous access: Urgent intravenous administration of Ringer lactate to restore blood
volume to normal. If there has been massive blood loss as in Class IV shock or the patient is
anaemic, blood transfusion is indicated. Colloids such as gelofusine or 5% albumin may also
be used. The use of hetastarch may be associated with increased rate of acute kidney injury and
mortality, and hence better avoided.
• Investigations: Blood is collected at the earliest opportunity for routine investigations as well
as for blood grouping and cross-matching.

14. • Cross-matched blood is usually given: lfthe haemorrhage is life-threatening, uncross-
matched, 0 -ve packed cells may be transfused into the patient.
• Use of inotropes and vasoconstrictors is not indicated as they may harm tissue perfusion.
• However, if inotropes have been started as a life-saving measure, an attempt should be made
to wean them as soon as the volume status is corrected and the patient is stable.

15. HOMOEOPATHIC MANAGEMENT:-
 Carbo veg – continuous passive hemorrhage, patient wants to be fanned; skin cool and
bluish, pulse rapid and weak’ hemorrhages of a low type, blood changed in its composition,
dark and rather fluid; lack of animal heat; anguish of heart.
 Aconite – Acute haemorrhages call for Aconite when there is anxiety and fever, and a
profuse bright red flow. Millefolium has the same bright red flow, but no anxiety or fever,
and this remedy is most useful in active hemorrhages from the nose, lungs, or bowels of
mechanical origin; epistaxis. It is a more active haemorrhage than that requiring
Hamamelis. It also corresponds to haemorrhages in typhoid fever with tympanitis.

16.  Ferrum – homeopathic medicine for haemorrhage of bright red blood, associated with a
great deal of flushing, rapid and a little labored breathing, pulse increased in frequency and
strength. After severe loss of blood; pale, bloated appearance, skin cool and pitting on
pressure, particularly about joints.
 Bovista – Bovista produces a relaxation of the entire capillary system which, of course,
favors haemorrhage. It is, therefore, useful in epistaxis, and in uterine haemorrhage when
the uterus is engorged ; it flows between the menstrual periods from any little over-
exertion. Farrington gives as characteristic that the flow occurs chiefly or only at night or
early in the morning. The surface of the body is puffy

17.  Crot. H. – haemorrhagic diathesis, hemorrhage from every orifice, from nose, mouth, ears,
anus, vagina, uterus, bowels, lungs, and from all mucus membranes. Intraocular
hemorrhage; all discharges are bloody, even sweat and saliva are, from all orifices, skin,
nails and gums. Blood is dark, fluid and non coaguable;
 Secale cor – This remedy corresponds to passive, painless, dark, offensive haemorrhages in
thin scrawny women with formication and tingling in the limbs , surface of body cold and
desire to be uncovered. It is characterized by slow oozing, dark, thin and persistent and
worse from motion.