5. Hemorrhage and hemostasis

Question 1

14. Types of hemorrhage

Answer 1

-Hemorrhage= abnormal bleeding from blood loss from blood vessel: artery vein, arteriole, venal, capillary network
-Types of hemorrhages:
>traumatic injury/medical condition
>external/internal
>primary-mostly in surgical patients: damage blood vessels-occurs soon after injury
>secondary hemorrhage-follows injury after considerable lapse of time

x arterial hemorrhage=rupture artery, bright red color (O2), flow ordinarily in waves of spurts, steady if artery is deep, spontaneous hemostasis rare, life-threatening, HARDEST TO CONTROL

(x) venous hemorrhage= rupture vein, dark red, steady or profuse bleeding, spontaneous hemostasis possible, level of danger dependent on diameter of vessel, potentially life-threatening

-capillary hemorrhage=ruptured capillaries, MOST COMMON, mix of arterial and venous blood (fairly bright), trickle of blood (small drops at time), spontaneous hemostasis likely, EASIEST CONTROL

x parenchymatous hemorrhage= injury to parenchymal organ (liver, spleen, pancreas etc.), corpus cavernous (penis, clitoris), cancellous bone, similar to capillary hemorrhage-bleeding more PROFUSE, spontaneous hemostasis unlikely or time-consuming, potentially life-threatening (x)

Question 2

15. Classification of hemorrhage

Answer 2

-Classes 1-4

1. class: minimal blood loss: -15% > HR, RR, BP normal, normal urine output, slightly anxious
2. class: mild blood loss: 15-30% > elevated HR, RR, BP normal, oliguria: confused, irritable; cool extremities
3. class: moderate blood loss: 30-40%> elevated HR, RR, decrease BP, oliguria; lethargic; cool extremities
4. class: severe blood loss: more than 40% > 3 arrows up increase HR and RR, 2 arrows down BP, anuria; lethargic; comatose; cold extremities; cyanosis

Question 3

14. Treatment of hemorrhage

Answer 3

-Hemostasis
-Physiological and artificial hemostasis
-3 steps: 1. vascular spasm 2. platelet plug formation 3. clot formation

Question 4

Physiological hemostasis

Answer 4

HEMOSTASIS=process that causes blood from escaping damaged blood vessel
-3 steps: platelet clot formation > temporary 1st minimize blood loss > blood clot more strong > blood coagulation comes stronger
1. vascular spasm
2. platelet plug formation
3. clot formation (coagulation)

> low local temperature - vasoconstriction (minor bleeding)
high temperature: electrocautery: monocular, bipolar

Question 5

17. Artificial hemostasis

Answer 5

1. Provisional artificial hemostasis= manual pressure, tamponade(MOST COMMON), pressure bandage, hemostats(forceps),tourniquet
2. Definitive artificial hemostasis= mechanical, physical, chemical, biological

Question 6

HEMOSTASIS

Answer 6

=blood clot formation
1. injury > vasoconstriction released from endothelium (endothelin)> vasoconstriction at the site > (aggregation and) adhesion of platelets (plug formation)
2. Thromboplastin (combination of phospholipids and tissue factor) catalyzes conversion of prothrombin (nonactive) to thrombin > thrombin causes fibrinogen to polymerize > polymerized fibrin forms long strands to tough insoluble protein that are bound to platelets > formation of hemostatic clot