bleeding control mit
TRANSCRIPT
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BLEEDING CONTROL
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SEQUENCE
IMPORTANCE Physiology/homeostasis Integrity of circulatory systemTYPES/CAUSESCONTROL METHODSBLOOD TRANSFUSION
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Subject’s importance
Hemorrhage is one of the basic problems and considerations in surgery.
From-trivial trauma or major abdominal organ injuries-to- congenital and acquired coagulation disorders.
A wide spectrum of problems involves hemorrhage.
Transfusion of blood is the main remedy
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Clinical Situation-Bleeding
Trauma /accidents General operative interventions Gynecological procedures Common surgical conditions that presents with bleeding- Intracranial hemorrhages/CVA Upper GIT bleed/ hematemesis and melena Bleeding hemorrhoids Chronic wounds Aneurysms Coagulation disorders
Congenital- Hemophil ia, vWF deficiency Acquired
DIC Anticoagulants Fulminant sepsis
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What Prevents Hemorrhage
NATURAL BARRIERS AGAINST HAEMORRHAGE
Integrity of vascular wall Coagulation system
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Body’s response to hemorrhage/injury
Attempts to repair the loss & restore normality
There are several interrelated stages
Local response / Generalized response
Aims at: Wall repair Restoration of volume loss Correction of coagulation abnormalit ies
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Signs of the bleeding
Local
Hematoma, suffusion, ecchymosis
Compression in the pleural cavity, in pericardium, in the skull
Functional disturbancies – e.g. hyperperistalsis
General Pale skin, Cyanosis, Decreased BP, Tachycardia, Difficulty in breathing,
sweating, decreased body
temperature, unconsciousness, cardiac standstill
Signs of shock
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Body’s response to hemorrhage/injury
Local Vasoconstriction Platelet aggregation and plug formation Coagulation leading to Fibrin formation –Intrinsic
& Extrinsic Pathways
General Cardiac stimulation Compartmental Volume movement
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TYPES OF HAEMORRHAGE
AMOUNT OF LOSS -MINOR/MAJOR
ACUTE/CHRONIC
ARTERIAL/VENOUS/CAPILLARY/MIXED
LOCALIZED/DIFFUSE
EXTERNAL/ INTERNAL
OVERT/OCCULT
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TYPES OF HAEMORRHAGE
ARTERIAL BLEEDING is of a bright red colour, and escapes from the end of the vessel in jets, synchronous with the heart's beat
VENOUS BLEEDING is of a darker colour; the flow is steady, the bleeding is from the distal end of the vessel .
CAPILLARY BLEEDING is a general oozing from a raw surface .
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Hemorrhage and ShockWhat happens when you start to
bleed? – it depends on how much blood you lose
Normal Adult Blood Volume is about 5 Litres
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Severity of Hemorrhage
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The Direction Of Hemorrage
External
Internal In a luminar organ (hematuria, hemoptysis, melena)
In body cavities (intracranial, hemothorax, hemoperitoneum, hemopericardium, hemarthros)
Among the tissues (hematoma, suffusion)
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Internal Hemorrhage
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INTERNAL HAEMORRHAGE /WOUNDS
Causes Penetrating wounds –o chest, abdomen, neck, limbs Upper GI haemorrhage-o Bleeding Ulcers Lower GI haemorrhage
o Diverticulosiso Haemorrhoidso Carcinomas
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External Hemorrhage
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BleedingPREOPERATIVE HEMORRHAGE
Prehospital care! – maintenance of the airways, ventillation and circulation
bandages, direct pressure, torniquets
INTRAOPERATIVE HEMORRHAGEanatomical and/or diffuse
depending on the surgeon, the surgery, position,
the size of the vessel, pressure in the vessel
(ANESTHESIA)
POSTOPERATIVE BLEEDINGineffective local hemostasis, undetected hemostatic defect, consumptive coagulopathy or fibrinolysis
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CLASSIFICATION OF SURGICAL HAEMORRHAGE
Primary Hemorrhage occurring at the time of the injury or surgery
Reactionary Hemorrhage within twenty-four hours of the accident/surgery, due to
slippage of ligature, hypertension post op
Secondary Hemorrhage occurring at a later period (48-72hrs) and caused by
septic condition of the wound (infection).
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EFFECTS OF HAEMORRHAGE
Depend upon following: Acute loss vs Chronic loss The amount of loss The compensatory mechanisms General state of health
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SURGICAL HEMOSTASIS
Aim – to prevent the flow of blood from the incised or transected vessels
Mechanical methods
Thermal methods
Chemical and biological methods
Radiological/Interventional methods
Adequate blood/blood products transfusion
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SURGICAL HAEMOSTASIS
Natural CONTROL/arrest of hemorrhage arises from-
(1) changes taking place in the cut vessel causing its retraction and contraction
(2) the coagulation mechanism of the blood
(3) temporary-platelet plug Permanent-fibrin clot.
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SURGICAL HEMOSTASISMECHANICAL METHODS
Digital pressure – direct pressure,
e.g. Pringle maneuver
Tourniquet
Ligation
Suturing
Preventive hemostasis
Clips
Bone wax
other
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SURGICAL TREATMENT OF HAEMORRHAGE
First Aid Management DIRECT PRESSURE In small blood-vessels
pressure will be sufficient to arrest, hemorrhage permanently
LIMB ELEVATION TOURNIQUET
APPLICATION
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CLIPS FOR CONTROLLING BLEEDING
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LIGATURE In large vessels with a reef-knot main artery of the limb exposed
by dissection at the most accessible point .
SUTURING & LIGATURE
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THERMAL METHODS Low temperature
Hypothermia – eg. stomach bleeding
Cryosurgery
Dehydratation and denaturation of fatty tissue
Decreases the cell metabolism
Vasoconstriction
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THERMAL METHODS High temperature
Electrosurgery – electrocauterization
Monopolar diathermy
Bipolar diathermy
Harmonic devices
Laser surgery
coagulation and vaporization
for fine tissues
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Diathermy
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Thermal methods High temperature
Electrocoagulation
Electrofulguration (A)
Electrodessication
Electrosection
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Hemostasis with chemical and biological methodsVASOCONSTRICTION COAGULATION HYGROSCOPIC EFFECT
Absorbable collagen
Absorbable gelatin
Microfibrillar collagen
Oxidized cellulose
Oxytocin
Epinephrine
Thrombin
QuikClot
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Hemostasis with chemical and biological methods
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HemCon
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Bleeding Control by Interventional Radiology
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Interventional Radiology
Post trauma-intra abdominal bleeding
Gastro intestinal bleeding control- Upper
Lower
Uterine atony causing Postpartum hemorrhage
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Embolisation particles
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Post trauma
Vascular and solid organ trauma. Celiac angiogram showing 3 foci of extravasation in spleen, 2 in the upper pole (arrow) and 1 in the lateral aspect of the mid spleen
Post—super-selective embolization splenic angiogram demonstrating microcoils in good position and no evidence of further extravasation
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Gastrointestinal Bleeding
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