bleeding control mit
TRANSCRIPT
BLEEDING CONTROL
SEQUENCE
IMPORTANCE Physiology/homeostasis Integrity of circulatory systemTYPES/CAUSESCONTROL METHODSBLOOD TRANSFUSION
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
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
What Prevents Hemorrhage
NATURAL BARRIERS AGAINST HAEMORRHAGE
Integrity of vascular wall Coagulation system
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
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
TYPES OF HAEMORRHAGE
AMOUNT OF LOSS -MINOR/MAJOR
ACUTE/CHRONIC
ARTERIAL/VENOUS/CAPILLARY/MIXED
LOCALIZED/DIFFUSE
EXTERNAL/ INTERNAL
OVERT/OCCULT
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 .
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
Severity of Hemorrhage
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
INTERNAL HAEMORRHAGE /WOUNDS
Causes Penetrating wounds –o chest, abdomen, neck, limbs Upper GI haemorrhage-o Bleeding Ulcers Lower GI haemorrhage
o Diverticulosiso Haemorrhoidso Carcinomas
External Hemorrhage
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).
EFFECTS OF HAEMORRHAGE
Depend upon following: Acute loss vs Chronic loss The amount of loss The compensatory mechanisms General state of health
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.
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
CLIPS FOR CONTROLLING BLEEDING
LIGATURE In large vessels with a reef-knot main artery of the limb exposed
by dissection at the most accessible point .
SUTURING & LIGATURE
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
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
Bleeding Control by Interventional Radiology
Interventional Radiology
Post trauma-intra abdominal bleeding
Gastro intestinal bleeding control- Upper
Lower
Uterine atony causing Postpartum hemorrhage
Embolisation particles
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
Gastrointestinal Bleeding