Haemorrhage Flashcards

1
Q

What procedures can post-op haemorrhage occur after?

A

Any

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2
Q

What are the classifications of post-op haemorrhage?

A
  • Primary bleeding
  • Reactive bleeding
  • Secondary bleeding
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3
Q

What is primary bleeding?

A

Bleeding that occurs within the intra-operative period

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4
Q

How should primary bleeding be managed?

A

Should be resolving during the operation, with any major haemorrhages recorded in the operative notes and the patient monitored closely post-op

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5
Q

What is reactive bleeding?

A

Bleeding that occurs within 24 hours of the operation

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6
Q

What are most cases of reactive bleeding cause by?

A

A ligature that slips, or a missed vessel

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7
Q

Why might a vessel be missed during the operation (causing reactive bleeding)?

A

Due to intraoperative hypotension and vasoconstriction, meaning only once the blood pressure normalises post-op will this bleeding occur

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8
Q

When does secondary bleeding occur?

A

7-10 days post-op

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9
Q

What is secondary bleeding often caused by?

A

Erosion of a vessel from spreading infection

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10
Q

When is secondary haemorrhage most often seen?

A

When a heavily contaminated wound is closed primarily

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11
Q

What are the clinical features of haemorrhagic shock?

A
  • Tachycardia
  • Dizziness
  • Agitation
  • Visible bleeding
  • Decreased urine output
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12
Q

What is one of the most sensitive signs of haemorrhagic shock?

A

Raised respiratory rate

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13
Q

What should be considered when thinking about hypotension as a sign of haemorrhagic shock?

A

It is often a late sign, and you should not assume a patient is stable or not bleeding just because their BP is normal

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14
Q

What should examination include in suspected haemorrhagic shock?

A
  • Thorough exposure for bleeding
  • Systematic palpation of the surgical Rea looking for swelling, discolouration, disproportionate tenderness, and any peritonitis
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15
Q

What is important when there is clinical suspicion of post-operative bleeding?

A

Fast and efficient initial management

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16
Q

What are the initial steps in monitoring post-op haemorrhage?

A

A-E approach, taking particular care to ensure IV access (18G cannula as minimum) and rapid fluid resuscitation

17
Q

What is involved in the management of post-op haemorrhage?

A
  • Direct pressure applied to bleeding site
  • Urgent senior surgical review
  • Appropriate imaging to ascertain level of bleeding
  • Urgent blood transfusion
  • Read op notes
18
Q

When should urgent blood transfusion be considered in post-op haemorrhage?

A

In case of moderate to severe post-op haemorrhage

19
Q

What blood products may be used in post-op haemorrhage?

A
  • RBC
  • Platelets
  • FFP
    Major haemorrhage protocol activated as necessary
20
Q

What should be looked for in the op notes in post-op haemorrhage?

A
  • Type of surgery

- Location of wounds, drains, or areas of importance

21
Q

What may be required after senior review in post-op haemorrhage?

A

May be appropriate to re-operate on the patient for further haemostasis

22
Q

After what surgeries might haemorrhage have catastrophic consequences?

A

Post thyroidectomy or parathyroidectomy

23
Q

What is the result of the potential for bleeding post thyroidectomy or parathyroidectomy having catastrophic consequences?

A

Surgeon must take great care to ligate any vessels and coagulate any bleeding points

24
Q

What is the primary sign of post-op haemorrhage after thyroidectomy or parathyroidectomy?

A

Airway obstruction

25
Q

Why is the primary sign of post-op haemorrhage after thyroidectomy or parathyroidectomy likely to be airway obstruction?

A

Because the paratracheal fascia of the neck will only distend so far, so when bleeding occurs into this space, compression on the venous return results in venous congestion, with subsequent laryngeal oedema leading to eventual asphyxiation

26
Q

What should be done if there is any evidence of respiratory distress or airway compromise in patients post thyroidectomy or parathyroidectomy?

A

Emergency protocol for airway rescue, involving removing skin clips and deep layer sutures and suction of haematoma beneath, done at bedside as no time to get patient to theatre
Urgent senior surgical opinion and anaesthetic review should be organised

27
Q

What artery is vulnerable to injury from laparoscopic ports?

A

Inferior epigastric artery

28
Q

Why is the inferior epigastric artery vulnerable to injury from laparoscopic ports?

A

Because of its course

29
Q

What is the course of the inferior epigastric artery?

A

Arises from external iliac artery and runs up abdominal wall below recus muscle vertically in approx mid-clavicular line

30
Q

Why might injury to the inferior epigastric artery not be noticed at the time of surgery?

A

Due to gas insufflation

31
Q

Where is the entry site for angiography?

A

External iliac artery in groin, above inguinal ligament

32
Q

Where will bleeding from the external iliac artery caused by angiography go?

A

Any bleeding from this artery will go into the retroperitoneum

33
Q

Why can bleeding from external iliac artery after angiography be difficult to detect?

A

Because the actual arterial puncture site is hidden by the inguinal ligament

34
Q

Why do patients with bleeding from the external iliac artery after angiography often bleed profusely?

A

Because tamponading the area is difficult

35
Q

What should be done in any suspected occult retroperitoneal haemorrhage cause by angiography?

A

Apply pressure to puncture site, resuscitate the patient, ensure blood products are made immediately available, and call for senior support