Haemorrhage

Hemorrhage is the loss of blood escaping from the circulatory system.
Bleeding can occur internally, where blood leaks from blood vessels inside the body, or externally either through a natural opening such as mouth, nose, ear, urethra or anus or through a break in the skin.
Uncontrolled bleeding can rapidly lead to shock and death.
Excessive or uncontrollable bleeding, often caused by trauma, surgical or obstetrical complications, or the advanced stages of certain illnesses such as cirrhosis and peptic ulcer disease.

1. Hemorrhage PREPARED BY: RN Arpana Bhusal BNS

2. CONTENTS INTRODUCTION DEFINITION TYPES CLINICAL FEATURES EMERGENCY MANAGEMENT

3. Introduction Hemorrhage is the loss of blood escaping from the circulatory system. Bleeding can occur internally, where blood leaks from blood vessels inside the body, or externally either through a natural opening such as mouth, nose, ear, urethra or anus or through a break in the skin. Uncontrolled bleeding can rapidly lead to shock and death. Excessive or uncontrollable bleeding, often caused by trauma, surgical or obstetrical complications, or the advanced stages of certain illnesses such as cirrhosis and peptic ulcer disease.

4. Definition A hemorrhage is a loss of blood from blood vessels. A hemorrhage may be “external” and visible on the outside of the body or “internal”, where there is no sign of bleeding outside the body. Bleeding from a cut on the face is an external hemorrhage. Bleeding into the spleen or liver are examples of internal hemorrhage.

5. Types Depending on the type of blood vessel involved: Arterial: bright red and sudden jets of blood venous: dark red and continuous flow of blood capillary: bright red and slow oozing of blood Depending on the source of bleeding: External hemorrhage: when bleeding is revealed and seen outside, e.g epistaxis Internal hemorrhage : bleeding is concealed and not seen outside, e.g intracranial hematoma

6. Contd.. Depending on the time period after surgery: Primary hemorrhage : A t the time of injury/surgery or continuously afterwards. Reactionary hemorrhage: restarts after period of 3 hours post-operatively. Secondary hemorrhage : R estarts few days later after surgery

7. Contd .. Depending upon volume of blood loss: Mild hemorrhage: Blood loss <500ml Moderate hemorrhage: Blood loss 500-1000ml Severe hemorrhage: Blood loss >1L

8. clinical Features Early features: Restlessness Anxiety Coldness Pulse rate slightly increased Increased thirst pallor

9. Contd .. Features after severe hemorrhage: Dilated pupil Coldness is profound Air hunger Rapid pulse rate Respiration is rapid Extremely low blood pressure oliguria

10. Contd .. Some features of internal bleeding: tachycardia Falling blood pressure Change in vision or hearing Severe, sudden headache Abdominal pain and swelling Blood in urine and stool Severe weakness and dizziness

11. Emergency management

12. Control of External H emorrhage A. Pad and bandage: This is the simple method of applying direct pressure to a bleeding wound and is applicable to vast majority of cases. It is effective and causes no damage.

13. Contd .. C. Digital pressure : It is the pressure applied on the point of artery supplying blood to the area of wound. This will control hemorrhage temporally and is called indirect pressure.

14. D. Application of tourniquet: A tourniquet can be applied to an extremity only when hemorrhage cannot be controlled by other ways. It is applied just proximal to the wound and tied tightly enough to control arterial blood flow. The great danger of tourniquet is that if it is continued for more than 30min then gangrene of the limb may occur.

15. E. Surgical ligation: It is necessary if the bleeding is persistent. F. Pack : It will temporarily control severe hemorrhage. This a method is used in operation theatre to control temporary or sudden hemorrhage.

16. First Aid Treatment I n C ase O f Severe Bleeding Bring the sides of wound together and press firmly. Press on the pressure point for 10-15min. Place the causality in comfortable position and raise the injured part and reassure him. Apply clean pad larger than the wound and press it firmly with the palm until bleeding becomes less. If bleeding continues do not take off original dressing but add more pads. Bandage, it but not too tightly.

17. Control Of Internal Hemorrhage The following methods can be used to control bleeding : The organ is emptied of blood clots. if possible in case of severe bleeding from bladder, a catheter is passed and bladder is emptied. It involves the administration of intravenous vitamin K, fresh frozen plasma, blood and platelets. The use of ergometrine after the birth of placenta is an example of stimulating the vessel to contract. Pitocin IV may be effective in control of bleeding from esophageal varies.

18. Contd.. Packing can be done with gauze soaked in adrenaline is effective. Surgical ligature can be done in case of ruptured spleen.

19. First Aid T reatment I n C ase Of Severe I nternal B leeding Lay the causality down with head low; rise his legs by use of pillow. Keep him calm, relaxed and reassure him. Do not allow him to move. Keep up the body heat with thin blankets or coat. Do not give anything to eat or drink aspiration occurs. Do not apply ice bag or hot water bag to chest and abdomen. Take him to hospital as early as possible. Transport gently.

20. References Brunner and Siddhartha's (2004), ‘medical and surgical nursing,” 7 th edition, J.B Lippincott co, Philadelphia, page no:301-332 July 4, 2017. hemorrhage. https//www.slideshare.net/raisaira@2021/07/07 at 1pm 2019.mayo foundation of medical foundation and research. Hemorrhage . http//www.mayoclinic.org@2021/07/07 at 2pm