Haemorrhage Flashcards
What is the definition of a massive haemorrhage ?
The loss of one blood volume in 24 hours
Or
The loss of 50% of the circulating blood volume in 3 hours
Or
A blood loss of 150ml/min
What are some complications of a massive haemorrhage ?
Hypothermia
Hypocalcaemia
Hyperkalaemia
Transfusion related reactions
What is the acute treatment of a variceal haemorrhage ?
ABC - resus, transfusion if required
Correct clotting - FFP, vitamin K
Terlipressin
Prophylactic IV abx
Endoscopic variceal band ligation
Transjugular intrahepatic portosystemic shunt if above fails
What is the prophylaxis of a variceal haemorrhage ?
Propranolol
Endoscopic variceal band ligation - primary prevention in patients with liver cirrhosis
What is a sub dural haemorrhage ?
A collection of blood deep to the dural layer of the meninges
What are the classifications of sub dural haemorrhages ?
Acute - symptoms develop within 48 hours and there is rapid neuro deterioration
Subacute - symptoms manifest within days to weeks post injury, gradual progression
Chronic - common in elderly, develop over weeks to months
What are the hallmark features of a sub dural haemorrhage ?
Patients have a head trauma followed by a lucid period then a gradual decline of consciousness
Headache
Confusion
Lethargy
What is the first line investigation in sub dural haemorrhage and what does it show ?
CT head - crescentic collection not limited by suture lines - hyper dense
What are the management options for sub dural haemorrhage ?
Small or incidental can be observed conservatively
Surgical options - monitoring ICP and decompressive craniectomy
Who is at risk of developing a sub dural haemorrhage ?
Elderly and alcoholics due to brain atrophy and therefore the bridging veins are more fragile and taut.
Infants also have more fragile bridging veins and can rupture in shaken baby syndrome
What is the difference between acute and chronic sub dural haemorrhage on CT ?
Acute - hyper dense
Chronic - hypodense
How is a chronic sub dural haemorrhage managed ?
If small or neuro intact then manage conservatively with hope it will dissolve with time.
If patient is confused, has associated neuro deficit or severe imaging then surgical decompression with burr holes
What is the definition of PPH ?
Blood loss of more than 500 ml after vaginal delivery
What are the causes of PPH?
Uterine atony
Perineal tear
Retained placenta
Clotting disorder
What are the risk factors for primary PPH ?
Previous PPH
Prolonged labour
Pre-eclampsia
Increased maternal age
Emergency c section
Placenta praevia
What is the management of PPH ?
ABC - 2 peripheral cannula, lie patient flat, fluid resus, bloods + group and save
Mechanical - palpate uterine fundus and rub it stimulate contraction
Medical - IV oxytocin, ergometrine slow IV or IM
Surgical - intrauterine balloon tamponade, b-lynch sutures, ligation of uterine arteries
Last resort hysterectomy
What is secondary PPH ?
Occurs 24 hours to 12 weeks and is typically due to retained placental tissue or Endometritis
What is APH ?
Defined as bleeding from the genital tract after 24 weeks pregnancy prior to delivery of foetus
What is a subarachnoid haemorrhage ?
An intracranial haemorrhage that is defined as the presence of blood within the subarachnoid space.
What are some causes of SAH ?
Trauma
Intracranial aneurysm - berry
Arteriovenous malformation
Pituitary apoplexy
What are the classical presenting features of SAH ?
Thunderclap headache usually occipital
N&V
Photophobia and neck stiffness
Coma
Seizures
What is the first line investigation for SAH ?
Non-contrast CT head
When should an LP be performed in SAH ?
If the CT head isn’t performed within 6 hours and is normal
What are some clinical features of an acute upper GI bleed ?
Haematemesis
Melaena
Raised urea
