L9: Hemorrhage Flashcards
etiology of Hemorrhage
Pathophysiology of Hemorrhage
Importance of local response in Hemorrhage
Stopping the bleeding.
what does local resonse in Hemorrhage include?
- Immediate VC.
- Retraction of intima of injured vessel.
- Subsequent blood clotting.
Importance of Systemic Response in Hemorrhage
- Maintaining effective circulatory volume & perfusion of critical tissues (Brain & Heart) at the expense of less critical tissues (skin, skeletal muscle & splanchnic area.
what does Systemic Response in Hemorrhage include?
- Neural factors (Rapid)
- Endocrinal Factors (Slow)
Neural factors Systemic Response to Hge
Endocrinal factors Systemic Response to Hge
- Catecholamines
- Anti-insulins
- RAAS system
- Vasopressin (ADH)
Catecholamines Systemic Response to Hge
Anti-insulins Systemic Response to Hge
RAAS System Systemic Response to Hge
Vasopessin (ADH) Systemic Response to Hge
Classification in Hemorrhage
According to:
- site
- Source
- Time of occurence
Classification in Hemorrhage according to site
Classification in Hemorrhage according to source
Classification in Hemorrhage acc to time of occurence
Clinical Features of Hemorrhage
Classes of Hemorrhage
Investigations in Hemorrhage
- Clinically
- Urinary Catheter
- CVP
- PAWP
- Arterial Canulation
- Blood Gases
- Blood Studies
- ECG
Clinical investigation in Hemorrhage
what is Normal urine output?
0.5 - 1 ml/kg/h
Def of Central Venous Pressure (CVP)
Venous pressure in right atrium
Importance of Central Venous Pressure (CVP)
As long as cardiac function is normal it reflects:
- Volume of blood returning to heart.
- The ability of heart to expel it.
Normal Range of Central Venous Pressure (CVP)
5-15 cm H2O (if zero is the mid axillary line)
what does Central Venous Pressure (CVP) indicate?
- High perfusion indicates over transfusion & possibility of pulmonary edema
- Low pressure indicates hypovolemia.
Pulmonary Artery Wedge Pressure (PAWP) is measured by ……
- Swan-Ganz catheter through Jugular or antecubital vein
Importance of Pulmonary Artery Wedge Pressure (PAWP)
Site of Arterial Canulation
Radial artery
Importance of Arterial Canulation
- Determination of blood pressure.
- Sampling of arterial blood.
Blood gases, normal value & effects of hge shock
ECG
to detect any arrythmia.
what do blood studies include?
Hb% - hematocrit - electrolytes - urea - creatinine.
TTT of Primary External Hemorrhage
TTT of Reactionary Hemorrhage
Re-explore the wound & control the bleeding.
what is
What is the Most serious complication of septic wounds?
Secondary Hemorrhage
Characters of Secondary Hemorrhage
Hemorrhage is usually arterial & often preceded by slight bleeding.
Needs urgent treatment:
* Fresh blood transfusion & other anti-shock measures.
* Umbrella of antibiotics.
* Explore bleeding vessel within the wound.
* Apply ligatures above & below the clot then resect the vessel in between.
If source of bleeding cannot be identified, wound is tightly packed with gauze over which a pressure bandage is applied for 48 hours
what should happen after TTT of Secondary Hemorrhage?
