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
What are the initial steps in monitoring post-op haemorrhage?
A-E approach, taking particular care to ensure IV access (18G cannula as minimum) and rapid fluid resuscitation
What is involved in the management of post-op haemorrhage?
- Direct pressure applied to bleeding site
- Urgent senior surgical review
- Appropriate imaging to ascertain level of bleeding
- Urgent blood transfusion
- Read op notes
When should urgent blood transfusion be considered in post-op haemorrhage?
In case of moderate to severe post-op haemorrhage
What blood products may be used in post-op haemorrhage?
- RBC
- Platelets
- FFP
Major haemorrhage protocol activated as necessary
What should be looked for in the op notes in post-op haemorrhage?
- Type of surgery
- Location of wounds, drains, or areas of importance
What may be required after senior review in post-op haemorrhage?
May be appropriate to re-operate on the patient for further haemostasis
After what surgeries might haemorrhage have catastrophic consequences?
Post thyroidectomy or parathyroidectomy
What is the result of the potential for bleeding post thyroidectomy or parathyroidectomy having catastrophic consequences?
Surgeon must take great care to ligate any vessels and coagulate any bleeding points
What is the primary sign of post-op haemorrhage after thyroidectomy or parathyroidectomy?
Airway obstruction
