massive hemorrhage.pptx

7/28/2019 MASSIVE HEMORRHAGE.pptx

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Massive bleeding

It is a rapid anduncontrollable loss oroutflow of blood from aruptured vessel; Bleeding

can occur internally, whereblood leaks from bloodvessels inside the body orexternally, either through anatural opening such as the

vagina, mouth, nose, ear oranus, or through a break inthe skin.


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Blood from an

artery is bright red in

color and comes inspurts; that from a

vein is dark red and

comes in a steady

flow.


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CAUSES

Bleeding arises due to either traumatic injury,underlying medical condition, or a combination.

Traumatic Injury:

Laceration: Irregular wound caused by blunt

impact to soft tissue overlying hard tissue or

tearing such as in childbirth. In some instances,this can also be used to describe an incision.


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Incision :A cut into a body tissue or organ,such as by a scalpel, made during surgery.

Punctured Wound: Caused by an object thatpenetrated the skin.

Crushing Injuries: Caused by a great or

extreme amount of force applied over a period oftime. The extent of a crushing injury may notimmediately present itself.

Ballistic Trauma: Caused by a projectile

weapon, this may include two external wounds(entry and exit) and a contiguous wound betweenthe two


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Medical Condition

causes of bleeding not directly due to trauma

Intravascular changes : changes of the bloodwithin vessels (e.g. blood pressure, clottingfactors)

Intramural changes: changes arising withinthe walls of blood vessels (e.g. aneurysms,dissections, AVMs, vasculitides)

Extravascular changes: changes arisingoutside blood vessels (e.g. H pyloriinfection,brain abscess, brain tumor)


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Classification

Class I Hemorrhage involves up to 15% of blood

volume.

Class II Hemorrhage involves 15-30% of total

blood volume.

Class III Hemorrhage involves loss of 30-40% of

circulating blood volume.

Class IV Hemorrhage involves loss of >40% of

circulating blood volume.


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PATHOPHYSIOLOGY

lack of adequate

circulating blood volume

causing decreased tissue

perfusion and metabolism

hypoxia, vasoconstriction

and shunting of the

available circulating blood

volume to the vital

organs(heart and brain);

Sympathetic nervous

system stimulation

hormonal release of

antidiuretic hormone

and the angiotensin-

renin mechanisms

neural responses attempt

to compensate for the lossof circulating volume

metabolic acidosis

MULTI

ORGAN

SYSTEM

FAILURE

OCCURS


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Clinical Manifestations

cool, clammy, pale skin (esp. distal extremities) delayed capillary refill (>3 seconds) weak, rapid pulses

decreased blood pressure (systolic pressure28/ min) restless, anxious, decreased LOC

cardiac dysrhythmias (abnormalities of cardiacrhythm)

decreased urinary output


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DIAGNOSTICS

o Evidence of bleeding from thoracotomy thatindicates bleeding from chest area

o Abdominal or pelvic CT scan, abdominal

ultrasound or peritoneal lavage indicate intra-abdominal bleeding

o Endoscopy indicates upper or lower GI bleeding

o Angiography procedures diagnose severe vascular

damageo Extremity radiographs show long bone fractures


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o Haemoglobin and haematocrit from the CBC are

decreased due to blood loss

o Elevated serum lactate if bleeding continues and

client becomes acidotic

o ABGs show metabolic acidosis as blood loss

continues

o Baseline coagulation studies should be reviewed;

initial PT/PTT and platelet counts will be within

normal limits but as coagulation factors becomedepleted, clotting times will increase and platelet

counts will decrease

o Serum electrolytes to assess renal function


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Pharmacotherapy

Crystalloids and bloodproducts tomaintainadequate

circulating volumestatus

Sodium Bicarbonate tocorrect acidosis state

Vasopressor such asDopamine


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Control of internal Bleeding

o Packed red blood cells (O-negative) are

administered at a rapid rate

o Surgery

o Pharmacologic therapy

o Arterial blood specimens obtained

o Px maintained in supine


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Control of external

Bleedingo rapid physical assessment

o firm pressure is applied over the bleeding

area or the involved arteryo The injured part is elevated

o immobilize extremity

o apply torniquet as a last resort when externalhemorrhage cannot be controlled in anyother way


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Nursing management

o Establish an adequate airway, breathing

pattern, and applying supplemental oxygen

o Give priority interventions to control bleedingsuch as direct pressure to wound site, or

assisting with surgical interventions

o Establish IV access and begin with fluid

replacement


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o Draw blood specimens as ordered to assist in

evaluation of haemoglobin, haematocrit,electrolyte, oxygenation and hydration status

o Insert an indwelling catheter and NG tube to

assist in accurate recording of fluid balance status

o Perform and document continuous serial

assessments of hemodynamic parameters such as

VS, capillary refill, CVP, cardiac rhythm, LOC,

urinary output and laboratory findings


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thank you.

massive hemorrhage.pptx

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