Haemorhage surgical diesease in depth detail

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1. VITEBSK STATE MEDICAL UNIVERCITY GENERAL SURGERY DEPARTMENT

2. Haemorrhage ACUTE BLOOD LOSS LECTURE № 3

3. Haemorrhage - is blood escape from blood vessels as a result of its damage or alteration of vessel wall transmissivity . Haemorrhage

4. External hemorrage Extravasation Petechia Purpura Ecchymosis Hematoma Types of hemorrage

5. Petechia - is a small (1-2mm) red or purple spot on the body, caused by a minor hemorrhage (broken capillary blood vessels)

6. Purpura is the appearance of red or purple discolorations on the skin that do not blanch on applying pressure. They are caused by bleeding underneath the skin. Purpura measure 0.3–1 cm (3–10 mm), whereas petechiae measure less than 3 mm

7. Ecchymosis is the medical term for a subcutaneous purpura larger than 1 centimeter or a hematoma, commonly called a bruise. It can be located in the skin or in a mucous membrane.

8. Hematoma – is a boardered amount of blood in tissues as a result of their dissection with blood pressure .

9. Physiological ( menses ) Pathological Classification

10. By mechanism As a result of mechanical damage of vessels ( haemorrhagia per rhe х in ) Arrosive ( haemorrhagia per diabrosin ) – for example in case of stomach ulcer Diapedesic ( haemorrhagia per diapedesin ) Classification

11. Mechanical damage of vessels ( haemorrhagia per rhe х in )

12. Arrosive hemorrage ( haemorrhagia per diabrosin )-

13. Diapedesic hemorrage ( haemorrhagia per diapedesin ) in case of increased vessel transmissivity, changes of blood chemistry or coagulation/antycoagulation system

14. Clinical Acute Chronic Classification

15. Anatomical arterial ; venous ; capillary ; parenchimatous ; mixed . Classification

16. Capillary bleeding

17. external internal occult Classification

18. According to the time primary ; secondary - early - late Classification

19. Accordin to severity Mild ; Medium ; Severe . For clinical aims hemarrage may be classified as: Stopped hemorrage ; On going hemorrage . Classification

20. Main risk of any hemorrage is the acute bloodloss Second risk factor is an internal organs compromise Third risk factor is infection. COMPLICATIONS AND OUTCOMES

21. Main risk of any hemorrage is the acute bloodloss Causes of death: Acute circulatory collaps Functional blood compromise Acute bloodloss of 30% of circulating blood extremly lifethreating condition. Acute loss of 40% of circulating blood is fatal )

22. Hemorrage rate ; Vessel type and diameter ; Coagulation state Outcomes offering factors

23. Age Sex Preexisting conditions ( shock , anemia , chronic disease ) Environment ( hypothermia , hyperthermia ). Outcomes offering factors

24. Second risk factor is internal organs compromise

25. Third risk factor is infection: blood an excellent substrate for bacterial growth .

26. In acute hemorrage love organism mobilize all systems to maintain own vitality. Organism reaction on acute hemorrage

27. Vessel wall contraction ; Activation of coagulative system ; Cardiovascular response . Hemorrhage arrest offering factors

28. 80% of blood circulate in vessels, whereas other 20 % contained in the parenchymatous organs . Veins contains 70-80% of circulating blood , arteries contains about 15-20% and only 5-7,5% lodged in capillary . Blood cells compose about 40-45% of circulating blood and the serum is all the rest Circulating blood

29. Immidiate circulating blood restoration Blood quality correction mechanism Compensatory reactions

30. Hypovolemic vicious circle

31. Tissue hypoxia . Anaerobic metabolism . Metabolic acidosis Multiple organ failure Hypovolemic dearangement

32. 1 stage – compensated reversible shock 2 stage – decompensated reversible shock 3 stage – shock. Hemorrhagic shock

33. 1.     Is there are any ongoing hemorrhage ? 2.     If there are no ongoing bleeding, does it happened at last ? 3.     Does hemorrhage stopped or still goin? 4.     Where is the source ? 5.     If you are dealing with arrested hemorrahage? Do you have safe hemostasis? 6 .     Assess the volume of the hemorrhage. 7 .     Which disorders appeared as a result of bloodloss ? Diagnostic aims

34. Subjective ( weakness, blinking, buzzing in the ears, nausea) Objective ( conciousness , pallor , heart rate , respiration rate, BP , CVP ). General symptoms of hemorrhage

35. Bleeding Altered blood discharge Symptoms and signs of organ dysfunction Symptoms of blood accumulation . Local symptoms of hemorrhage

36. Bronchoscopy

37. Nasogastric tubing and oesophagogastroscopy

38. Flexible colonoscopy

39. Red cells count Hb Ht Lab tests

40. Способ определения Мужчина Женщина Volume to the 1 m 2 of body surface 2, 8 2, 4 l % of body weight 7, 5 % 6,5 % ml/kg of body weight 70 ml/kg 65 ml/kg Calculation method Male Female 2, 8 l 2, 4 7, 5 % 70 65 Calculation of circulating blood volume

41. Direct assessment Indirect assessment Assessement of hemorrhage volume

42. Algover ratio is a ratio of heart rate to systolic BP Algover ratio Volume of hemorrhage as % of circulating blood 0, 8 and less 10 0, 9-1, 2 20 1, 3-1, 4 30 1, 5 and more 40 and more Algover ratio

43. Severity of blood loss Clinical sings Volume of blood loss Mild In general patient seems to be stable: his alert, slightly pale. Heart rate less then 100 per min. < 20 % of circulating blood Medium Patient is apparent pale, there are sings of hemorrhagic collaps with single loss of consciousness. Heart rate more then 100 per min. Systolic BP decreased to 90 mm. Hg. 25-30 % of circulating blood Severe Patient is critically ill, unconscious, weak, pallor, cold sweat, thirst, Heart rate 130-140 per min. Pulse weak or not found, systolic BP less then 70 mm. Hg. > 30 % of circulating blood Assessment of hemorrhage volume

44. Primary care for bleeding patient 1. Hemostasis . 2. Fluid resuscistation / blood replacement .

45. Methods of temporary hemostasis ; Methods of permanent hemostasis . Methods of hemostasis

46. Finger compression of artery ; Flexion or lifting of the limb ; Applying of compressive bandage ; Wound tamponade ; Applying of tourniquet ; Applying of stump on the bleeding vessel ; Temporary bypass . Methods of temporary hemostasis

47. Finger compression of artery

48. Flexion or lifting of the limb

49. Applying of compressive bandage

50. Applying of tourniquet

51. Arrest of the hemorrhage . Absence of arterial pulse distally from the tourniquet . Pale skin distally from the tourniquet . Assesment of effectivness

52. Twisting and squeezing of the vessel . Ligation og the vessel . 1.     ligation in the wound ; 2.     ligation in proximal region . Stiching the vessel . Vascular suture and vessel reconstruction . Tamponade . Vessel embolisation . Organ resection or removing . Usage of obturator-devices . Mechanical methods of permanent haemostasis

53. Mechanical methods

54. Usage of obturator-devices in esophageal varicosity bleeding

55. Low temperature applying . High temperature applying (electric or laser coatermy) . Ultrasaund coagaltion (Ligasure) Physical methods

56. Localy active medicine 1. H 2 O 2 . 2. Aminocapronic acid 3. Medicines of gelatin 4. Soluble hemostatic materials 5. Epinephrin 6. wax . Chemical methods

57. 1. Aminocapronic acid . 2. CaCl 2 . 3. Ethamsilat (этамзилат ). 4. Vicasol (Soluble Vit K) . Resorbtive active medicines

58. Own patients tissues . Biological medicines . 1. Thrombin 2. Hemostatic sponge 3. Biological antiseptic plug ( BAP ). 4. Fibrinogen medicines . Biological methods Localy active medicine

59. 1. Blood and its components . 2. Antienzymes ( trasilolum , contrical ) 3. Hormonal ( pituitrin , oxitocin ) Biological methods Generaly active medicine

60. Fluid resuscitation

61. Any qustions ?