Haemorrhage

1. Haemorrhage

2. • Definition Haemorrhage is the escape of
blood from vessel, which may be due to
trauma injury or some disease.

3. Haemorrhage classification.
:-
• According to blood vessel :
• (i) Arterial bleeding - is bright red in
colour and spurts out of the vessel. The
blood escapes from the proximal end of
the artery.
• (ii) Venous bleeding - is dark purplish in
colour, flows out in an even stream. The
blood escapes from the distal end of the
vein. (iii) Capillary bleeding - The
bleeding is from a low surface.

4. According to the time :-
• Primary Haemorrhage - Which occurs at
the time of injury.
• (ii) Reactionary haemorrhage - Which
occurs with in few hours after injury or
operation usually 12-24 hours.
• (iii)Secondary hemorrhage - Occurs within
10 days of injury or operation due to
sepsis.

5. c) According to visibility
• (i) External or revealed - Bleeding from
wound or surface in which case blood is
visible
• (ii) Internal or concealed -
Bleeding from an internal cavity which is
not visible.

6. Signs and symptoms
Early symptoms :-
• Restlessness and anxiety
• Coldness – temp-<98o F
• Slightly increased pulse rate
• Low BP
• Pallor
• Patient feels thirsty

7. In severe haemorrhage
• Extreme pallor – the face may be ashen
white, cold clammy, sweating.
• Subnormal temp - < 97o F
• Air hunger
• Rapid and thready pulse
• Extremely low BP
• Extreme thirst
• Oliguria or anuria
• Low CVP
• Blindness , tinnitus and coma may occur.

8. Management
AIMS
• Arrest of haemorrhage
• Restoration of blood volume
• Prevention of shock
a) FIRST AID AND EMERGENCY
MANAGEMENT
External haemorrhage
• Apply a direct pressure to the bleeding wound
with a pad and bandage.
• Digital pressure (applied over the pressure
points of the artery)

9. • Elevation of limb.
• Application of tourniquet
• Surgical ligation if the bleeding is
persistent.
• Coagulation – of bleeding point with
electrocautery or diathermy.
• A pack will temporarily control severe
haemorrhage.
• Adrenalin 1: 1000 may be used locally in
certain cases.

10. Internal or concealed hge
• Empty the blood clot if possible from the
organ.
• Increase the coagulability of the blood by
inj. Vit K.
• Packing with gauze soaked in Adrenalin in
certain cases.
• Surgical ligature.
• Antibiotics
• Internal pressure by the balloon for
example in prostatectomy.

11. NURSING MANAGEMENT
1. Remove the patients clothing and quickly
carry out physical examination.
2. Observe the vitals.
3. Apply firm pressure over the bleeding
area or at pressure points.
4. Apply a firm dressing.
5. Elevate the injured part and immobilize
to control bleeding.
6. Insert two wide bore canulas and replace
fluid volume. Solutions to be used- R/L,
N/S, HAEMACCEL

12. Nursing management
7.Withdraw blood samples for investigations
including grouping and cross matching.
 Replace IV fluids till blood is available.
 Transfuse fresh blood to prevent loss of
platelets and coagulation factors.
 Additional platelets and clotting factors
(FFP) may be given when large amount of
blood are needed.

13. Nursing management
8.Keep the patient warm.
9.Observe TPR, BP, colour to assess response to
therapy.
10.Catheterize the patient and measure urine out
put hrly in severe hge.
11.Reassure the patient through out.
12.Relieve pain and anxiety.
13.Give appropriate therapy as per instructions.
14.Prepare the patient for ligation of blood
vessels.
15.Maintain intake out put chart.