14. Types of hemorrhage and treatment

Question 1

14. Types of hemorrhage and treatment

Answer 1

Hemorrhage
-hemorrhage (bleeding)–an abnormal escape of blood from an artery,a vein,an arteriole,a venule or a capillary network
-caused by traumatic injury/medical condition
-external/internal
-primary hemorrhage occurs soon after an injury
-secondary hemorrhage follows an injury after a considerable lapse of time
-arterial/venous/capillary/parenchymatous

Arterial hemorrhage
*ruptured artery
*bright red colour(oxygen)
*flow ordinarily in waves of spurts
*may be steady if artery is deep
*spontaneous hemostasis rare
*life-threatening
*hardest to control

Venous hemorrhage
*ruptured vein
*rather dark red
*steady,profuse bleeding
*spontaneous hemostasis possible
*level of danger dependant on the diameter of the vessel
*potentially life-threatening

Capillary hemorrhage
*ruptured capillaries
*most common
*mix of arterial and venous blood(fairly bright)
*trickle of blood(small drops at a time)
*spontaneous hemostasis likely
*usually not life-threatening
*easiest to control

Parenchymatous hemorrhage
*injury to a parenchymal organ(liver,spleen,pancreas etc.),corpus
cavernosum(penis,clitoris), cancellous bone
*similar to capillary hemorrhage,bleeding more profuse
*spontaneous hemostasis unlikely or time-consuming
*potentially life-threatening

Blood loss
-prognosis dependant on many factors(severity,rate,concurrent
disorders)
-medical attention in case:
>bleeding does not stop
>class II (recommended), >class III or IV (necessary)
-blood loss→hypovolemic shock→death(1/2 - 2/3 of total blood volume lost)

Hemostasis(estää veren pääsyn vahingoittuneesta verisuonesta)
-complex process involving platelet activation and circulating clotting factors
-physiological hemostasis
-artificial hemostasis
>temporary (provisional)
>definitive

Hemostasis
-hemostasis–process that causes blood from escaping the damaged
blood vessel
-the balance of anti-and procoagulants keeps the blood in liquid form
1.vascular spasm
2.platelet plug formation(verihiutale tulppa)
3.clot formation(coagulation) (hyytymä)

Provisional(väliaikainen) artificial hemostasis
-manual pressure
-tamponade
-pressure bandage
-hemostats(forceps)
-tourniquet

Definitive(lopullinen) artificial hemostasis
* Mechanical
* Physical
* Chemical
* Biological

Mechanical hemostasis
-tamponade–the closure or a blockade of a wound as if or by a tampon to stop bleeding (absorbent material, pressure); mild
capillary or parenchymatous hemorrhage
-ligation–placement of a surgical suture (smallest material possible?)around a vessel; arterial, venous hemorrhage
-transfixation ligature (larger arteries)
-mass ligature– preferably not used

Physical hemostasis
-low local temperature– vasoconstriction (minor bleeding)
-high temperature: electrocautery
*monopolar(generator,active electrode, return electrode)
*bipolar(generator,2wires,patient’s body)

Chemical hemostasis
-topical(paikalliset) substances
-bone wax (tamponade)
-gelatin-and cellulose-based hemostatic products (clotting)
-adrenalin (vasoconstriction)
-systemic treatment(mostly preventive)
>Ca
>vitamin K
>tranexamic acid (Cyclokapron)

Biological hemostasis
-goal is to promote coagulation
-localized use:
>covering the bleeding(not severe)with a part of the omentum
-systemic use:
>blood transfusion(blood coagulation factor concentrates)