Haemorrhage Flashcards
What procedures can post-op haemorrhage occur after?
Any
What are the classifications of post-op haemorrhage?
- Primary bleeding
- Reactive bleeding
- Secondary bleeding
What is primary bleeding?
Bleeding that occurs within the intra-operative period
How should primary bleeding be managed?
Should be resolving during the operation, with any major haemorrhages recorded in the operative notes and the patient monitored closely post-op
What is reactive bleeding?
Bleeding that occurs within 24 hours of the operation
What are most cases of reactive bleeding cause by?
A ligature that slips, or a missed vessel
Why might a vessel be missed during the operation (causing reactive bleeding)?
Due to intraoperative hypotension and vasoconstriction, meaning only once the blood pressure normalises post-op will this bleeding occur
When does secondary bleeding occur?
7-10 days post-op
What is secondary bleeding often caused by?
Erosion of a vessel from spreading infection
When is secondary haemorrhage most often seen?
When a heavily contaminated wound is closed primarily
What are the clinical features of haemorrhagic shock?
- Tachycardia
- Dizziness
- Agitation
- Visible bleeding
- Decreased urine output
What is one of the most sensitive signs of haemorrhagic shock?
Raised respiratory rate
What should be considered when thinking about hypotension as a sign of haemorrhagic shock?
It is often a late sign, and you should not assume a patient is stable or not bleeding just because their BP is normal
What should examination include in suspected haemorrhagic shock?
- Thorough exposure for bleeding
- Systematic palpation of the surgical Rea looking for swelling, discolouration, disproportionate tenderness, and any peritonitis
What is important when there is clinical suspicion of post-operative bleeding?
Fast and efficient initial management