The document discusses hemostasis and mechanisms of bleeding control. It describes how hemostasis involves vascular constriction, platelet plug formation, and blood clotting in response to vascular injury. Multiple mechanisms are involved in clot formation, including platelet adhesion and aggregation, thrombin conversion of fibrinogen to fibrin, and fibrin mesh contraction. A variety of techniques can be used to achieve hemostasis, including direct pressure, gauze packing, sutures, staples, cautery, and pharmacological agents.

1. Dr. Imran Aslam
Assistant Professor
North Surgical Ward

2.  Hemostasis is the process of forming clots in
the walls of damaged blood vessels and
preventing blood loss while maintaining blood
in the fluid state within the
vascular system.

3.  Coagulation is combination of
1. Stasis of blood
2. Endothelial injury
3. Hypercoagulability

4.  Hemostasis means prevention of ‘Blood Loss’. Hemostasis is achieved by several
mechanism:-
 Vascular constriction
 Formation of platelet plug
 Formation of blood clot
 Growth of fibrous tissue into the clot.

5.  The contraction results from:-
 Local myogenic spasms
 Local autacoid factors
 Nervous reflexes
 Platelets release, Thromboxane-A2
which is responsible for vasoconstriction of
smaller vessels.
 The more severely a vessel is
traumatized, the greater the degree of
vascular spasm.

6.  MECHANISM OF PLATELET
PLUG
 Platelet adhesion
 Platelet activation
 Platelet aggregation
 Formation of temporary
hemostatic plug

7.  Third mechanism for hemostasis is formation of blood clot
 Clot begins to develop-
 severe trauma-15 to 20 sec
 minor trauma-1 to 2 min

8.  These mechanisms are set into play by:-
 Trauma to the vascular wall and the adjacent tissues
 Contact of the blood with damaged endothelial cells
 a) Extrinsic pathway for initiating blood clotting
 b) Intrinsic pathway for initiating blood clotting

11. In response to rupture of the vessel or damage to the blood
itself-formation of prothrombin activator
Prothrombin activator catalyzes conversion of prothrombin to
thrombin
Thrombin catalyzes fibrinogen into fibrin fibers.

13.  The clot is a meshwork
 Fibrin fibers also adhere to damaged surfaces of blood vessels.
 As the clot contracts, the edges are further pulled together, contributing ultimate
state of Hemostasis.

14. FIBRINOGEN
ACTION OF THROMBIN ON FIBRINOGEN TO FORM FIBRIN
BLOOD CLOT
CLOT RETRACTION-SERUM

18. Direct pressure
Gauze pack
Suture and ligation
Staples

19.  First choice to control bleeding
 Fast and simplest
 Small Arterial bleeding
 Venous bleeding
 15-20 sec
 Not recommended in major artery and veins.

20.  Used with direct pressure
 It is used in
 - only pressure is not an
option
 -systemic bleeding due to
infection, trauma, massive blood loss,
and platelet dysfunction.


21.  Suture – used in major arteries and veins
 Ligation of facial artery, lingual artery, and external carotid artery

22. Stick Tie:
 Also called as transfixation.
 Used for High Blood pressure
 Proximal part of the vessels
Regular Tie
 Used for Distal part of the vessels
 Also used for tubectomy .

23. Staples- sterile and disposable
 titanium staples
Ligating clips-
 quick and easy
 decrease foreign body reaction
 various size

24.  Hemostats (Mosquito and Artery) are designed to catch bleeders.
 Can be straight or curved.

25.  Is a mixture of Beeswax (70%) and Vaseline (30%).
 It is a non-absorbable material , becoming soft and malleable in the hand when
warmed
 Its Hemostatic effect is based on physical rather than biochemical properties.
 It has been used in bone surgeries

26.  -Restricts tumors blood supply .
 -Arterial embolization preferentially interrupts tumors blood supply and stalls
growth until neovascularization
 - Used to control bleeding in Hemangiomas

28.  Heat (Cautery)
 Electro cautery: it is the use of high frequency alternating current for cutting,
coagulating, dessication or fulgurating tissue in both open and laparoscopic
procedure
 monopolar electro surgery
 bipolar electro surgery
 bipolar electrosurgery vessel sealing technology
 argon enhanced coagulation technology
 Ultrasonic device
 Lasers

29.  Most frequently used
 Two electodes- active (the pencil)
 - dispersive
 Modes - coagulation mode
 - cutting mode
 - blend mode
 Current flows through the patient from electrode (active) to electrode (dispersive)

30.  Current does not flow through the patient’s body
 Lower voltage
 Indicated in limited thermal spread
 Delicate tissue, small anatomical tissue
 Safe for implanted medical devices such as pacemaker, internal cardioconverter
fibrillator etc.

32.  Pharmacological agents
 Topical haemostatic agent
 Passive
 active

33.  Sterile haemocoagulase solution
 Epinephrine
 Vitamin k
 Protamine
 Desmopressin
 Lysin analogs
 Etamsylate

34.  Causes direct vasoconstriction
 Can be applied topically and can be injected with LA
 Prolong analgesic effect
 Reduces bleeding during surgery
 Topical - The drug is applied with the help of gauze pack in concentration of
1:1000 over a oozing
 It is also injected along with local anesthetics in concentration of 1:80,000 and
1:2,00,000.

35.  Plays important role in coagulation process
 Helps in production of fibrinogen and prothrombin in liver
 Route- orally and IV(slow)
 IM and subcutaneous is not recommended because irratic absorption
 Dose- Males: 120 mcg/day PO
 Females: 90 mcg/day PO
 5-10 mg IV (dilute in 50 mL IV fluid and infuse over 20 min

36.  Reverse heparin anticoagulation activity
 Adverse effect- anaphylaxis, acute pulmonary vasoconstriction, right ventricular
failure
 Contraindication
 -diabetic
 -pt undergone vasectomy
 -drug allergy
 -previous protamine exposure
 Dose -1.0 -to- 1.5 mg protamine sulfate IV for every 100 IU of active heparin

37. Tranexamic acid- loading dose 2-7gm
 Follwed by 20-250 mg hourly
 Total dose of 3-10gm
 Oral dose; 500 mg 6-8 hrly
 Children; 1.25g/5 ml of syrup
 Inj- 0.5-1g slow i.v infusion TID

38.  Passive- collagen based product
 - oxidised regenerated cellulose
 - gelatine

 Active haemostat
 - thrombin product
 - pooled human plasma thrombin
 - recombinant thrombin