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Y5 ED > Haemorrhage > Flashcards

Haemorrhage Flashcards

1
Q

What is the definition of a massive haemorrhage ?

A

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

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2
Q

What are some complications of a massive haemorrhage ?

A

Hypothermia
Hypocalcaemia
Hyperkalaemia
Transfusion related reactions

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3
Q

What is the acute treatment of a variceal haemorrhage ?

A

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

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4
Q

What is the prophylaxis of a variceal haemorrhage ?

A

Propranolol
Endoscopic variceal band ligation - primary prevention in patients with liver cirrhosis

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5
Q

What is a sub dural haemorrhage ?

A

A collection of blood deep to the dural layer of the meninges

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6
Q

What are the classifications of sub dural haemorrhages ?

A

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

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7
Q

What are the hallmark features of a sub dural haemorrhage ?

A

Patients have a head trauma followed by a lucid period then a gradual decline of consciousness
Headache
Confusion
Lethargy

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8
Q

What is the first line investigation in sub dural haemorrhage and what does it show ?

A

CT head - crescentic collection not limited by suture lines - hyper dense

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9
Q

What are the management options for sub dural haemorrhage ?

A

Small or incidental can be observed conservatively
Surgical options - monitoring ICP and decompressive craniectomy

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10
Q

Who is at risk of developing a sub dural haemorrhage ?

A

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

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11
Q

What is the difference between acute and chronic sub dural haemorrhage on CT ?

A

Acute - hyper dense
Chronic - hypodense

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12
Q

How is a chronic sub dural haemorrhage managed ?

A

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

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13
Q

What is the definition of PPH ?

A

Blood loss of more than 500 ml after vaginal delivery

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14
Q

What are the causes of PPH?

A

Uterine atony
Perineal tear
Retained placenta
Clotting disorder

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15
Q

What are the risk factors for primary PPH ?

A

Previous PPH
Prolonged labour
Pre-eclampsia
Increased maternal age
Emergency c section
Placenta praevia

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16
Q

What is the management of PPH ?

A

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

17
Q

What is secondary PPH ?

A

Occurs 24 hours to 12 weeks and is typically due to retained placental tissue or Endometritis

18
Q

What is APH ?

A

Defined as bleeding from the genital tract after 24 weeks pregnancy prior to delivery of foetus

19
Q

What is a subarachnoid haemorrhage ?

A

An intracranial haemorrhage that is defined as the presence of blood within the subarachnoid space.

20
Q

What are some causes of SAH ?

A

Trauma
Intracranial aneurysm - berry
Arteriovenous malformation
Pituitary apoplexy

21
Q

What are the classical presenting features of SAH ?

A

Thunderclap headache usually occipital
N&V
Photophobia and neck stiffness
Coma
Seizures

22
Q

What is the first line investigation for SAH ?

A

Non-contrast CT head

23
Q

When should an LP be performed in SAH ?

A

If the CT head isn’t performed within 6 hours and is normal

24
Q

What are some clinical features of an acute upper GI bleed ?

A

Haematemesis
Melaena
Raised urea

25
Q

What are some oesophageal causes of an upper GI bleed ?

A

Oesophageal varices
Oesophagitis
Cancer
Mallory Weiss tear

26
Q

What are some gastric causes of an upper GI bleed ?

A

Gastric ulcer
Gastric cancer
Gastritis

27
Q

What are some duodenal causes of an upper GI bleed ?

A

Duodenal ulcer
Aorto-enteric fistula

28
Q

What is the Glasgow-Blatchford score ?

A

Helps clinicians decide whether patients can be managed as outpatients or not

29
Q

What is the ROCKALL score and when is it used ?

A

Provides a percentage risk of re bleeding and mortality post endscopy
After an endoscopy

30
Q

In patients suffering from trauma what is the most likely causes of shock >

A

Haemorrhagic

31
Q

What are some causes of haemorrhagic shock ?

A

Trauma
Tension pneumothorax
Spinal cord injury
Cardiac tamponade

32
Q

What causes neurogenic shock ?

A

Spinal cord transection at a high level

33
Q

What are some causes of cardiogenic shock ?

A

Ischaemic heart disease
Mycocardial trauma or contusion

34
Q

What are the main groups of shock ?

A

Septic
Haemorrhagic
Neurogenic
Cardiogenic
Anaphylactic

35
Q

What is shock ?

A

It occurs when there is insufficient tissue perfusion

36
Q

What is the cause of death if it occurs immediately after trauma ?

A

Brain or high spinal injuries, cardiac or great vessel damage

37
Q

What is the cause of death if it occurs in early hours after trauma ?

A

Splenic rupture
Subdural haematomas
Haemopneumothoraces

38
Q

What is the cause of death if it occurs in the days after trauma ?

A

Sepsis
Multi-organ failure

Y5 ED (5 decks)

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