Haemorrhage

Question 1

Classification

Answer 1

• Primary - continuous bleeding starting during
surgery

• Reactive - occurs within 24 hours of operation
- secondary to ↑ CO and BP

• Secondary

• Bleeding >24h post-op
• occurs 7-10 days post-op
• Usually due to infection

Question 2

Clinical features of haemorrhagic shock

Answer 2

Tachycardia
Dizziness
Agitation
Visible bleeding
Decreased urine output

Question 3

most sensitive sign for haemorrhagic shock

Answer 3

Raised respiratory rate

Question 4

Late sign of haemorrhagic shock

Answer 4

Hypotension

Question 5

Examination

Answer 5

Thorough exposure looking for bleeding

Systematic palpation of the surgical area looking for swelling, discoloration, disproportionate tenderness, and any peritonism.

Review the observations and grade any degree of shock

Question 6

Mx

Answer 6

A-E

Clarify the type of surgery and the location of wounds, drains, or areas of importance

Direct pressure applied to the bleeding site (if visible)

Urgent senior surgical review

Appropriate imaging

Urgent blood transfusion - moderate to severe

Severe bleeding - major haemorrhage protocol activated as necessary

Question 7

Which artery is vulnerable to injury from insertion of laparoscopic ports

Answer 7

Inferior epigastric artery

Question 8

Retroperitoneal Bleeding Post-Angiography puncture site

Answer 8

external iliac artery