The Detailing Heamorrhage

 

Heamorrage may be defined as escape of blood from the vascular system.

·        Classification of heamorrhage:

·        According to vessel involved/source:

1.Arterial:Bright Red.Spurting due to increased pressure.

2.Venous:Dark red.welling up due to low pressure.

3.Capillary:Generalized oozing.

·        Clinical /According to duration:

1.primary:Heamorrage occurring immediately  due to injure or surgery.

2.Reactionarywithin 24 hours of (usually 6 hours),due to clot dislodgement,sliping of ligature,release of vasospasm ,rise of BP,straining ar extubation,coughing.Examples:after thyroiectomy,tonsillectomy,prostatectomy, heamorroidectomy.

3.Secondary :Within 7-14days after primary heamorrhage ,cause -infection ,pressure necrosis ,malignancy.

·        According to exposure:

1.External:Bleeding that occurs during incision,massive heamatemeais from a duodenal ulcer.

2.Internal/concealed hge:E.g:Ruptured ectopic pregnancy, ruptured spleen ,intracranial, heamathorax.

·        According to duration:

1.Acute:Stab injury.

2.Chronic:Hookworm infestation,hemorrhoids,menorrhagia,bleeding peptic ulcer.

Principles of treatment of heamorrhage:

Control of Bleeding:

1.       Pack and pressure

2.       Elevation

3.       Clamp and cattery

4.       Clamp and ligature.

5.       Repair of blood vessel

6.       Application of pharmaceutical agents. Such as adrenaline.Tranexamic acid.

7.       Surgical /spongostan-helps in clotting

8.       Bone wax:to stop bleeding from bones.

9.       Tourniquet:to apply pressure proximal to the injury.