Circulatory system Haemorrhage and Shock

 

Circulatory  system Haemorrhage and Shock

 

Classification of haemorrhage

Based on blood vessel	Arterial Venous Capillary
Based on time	Primary Reactionary
Based on site	Internal External Special sites.

 

 

Arterial haemorrhage

1.It occurs from arteries.

2.The blood is well oxygenated and hence appears bright red in colour.

3.The pressure of the blood is high and hence the blood loss is in the form of spurts.

4.The blood loss is excessive.

Venous blood

1.It occurs from veins.

2.The blood is not oxygenated and hence appears bluish in colour.

3.The pressure of the blood is low and hence the blood loss is in the form of a continuous ooze.

4.The blood loss than arterial blood loss.

5.The blood loss is slow.

Capillary bleeding

1.It occurs from capillaries.

2.The blood is partially oxygenated and hence appears like a mixture of red and bluish blood.

3.The pressure of the blood is low and hence the blood and hence the blood loss is in the form of an ooze.

4.The blood loss in mild.

 

Primary haemorrhage.

1.It is the haemorrhage,which occurred from the wound, when it is made,such as the following:-

                             .Haemorrhage from a cut inthhe finger.

                             .Haemorrhage from a surgical incision.

2.It may be arterial ,venous, or capillary type,depending on which vessels have  been cut.

 

Reactionary haemorrhage

1.It,usually occurs ,during the first 6to 12 hours after the injury.

2.It is the haemorrhage ,which occurs from injured blood vessels,after the patient’s blood from pressure improves, such as the following:-

              .There is no bleeding when the arteries are damage due to hypotension,as under spinal anaesthesia,and when the blood pressure improves with recovery of blood pressure,the collapsed vessels start bleeding.

               .There is no bleeding when the arteries are damaged due to hypotension, as in shock,and when the blood pressure improves with recovery of blood pressure,the collapsed vessels start bleeding.

3.It may be arterial or venous ,depending on which vessels have been cut.

 

Secondary haemorrhage

1.It usually ooccurs 6 to 10 days after the inujury.

2.It is caused by wound infection,which results in lysis of bloodclots within blood vessels,and destruction of the walls of blood vessels .

3.Initially it is of capillary type ,and then arterial or venous,depending on which type blood vessel is damaged.

External (revealed) haemorrhage

1.It is due to injury to superficial blood vessels.

2.It is seen from outside and hence it is easier to give treatment to these patients.

                                    Haemorrhage from special sites

Site	Features
Menorrhagia	Intermenstrual blood loss.
Menorrhagia	Excessive menstrual blood.
Melaena	Bleeding in the stools, in the form of black stools.
Haemothorax	Bleeding in the pleural cavity.
Haemoptysis	Bleeding in the sputum.
Haemoperitoneum	Bleeding in the  peritoneal cavity.
Haemopericardium	Bleeding in the pericardial cavity.
Haematuria	Bleeding from the urine.
Haematomyelia	Bleeding in the spinal cord.
Haematemesis	Bleeding in the vomitus.
Haemarthrosis	Bleeding in a joint.
Epistaxis	Bleeding from the nose.

 

First-aid

Type of haemorrhage	Treatment
Arterial	.Rest in a comfortable position. .Reassurance  to the patient and his relatives. .Avoid crowding aroun the patient,so that he gets sufficient oxygen. .Pressure on the bleeding site with a clean piece or cloth. .Application of a tourniquet over a limb ,over a single bone,i.e.in the arm or thigh,to control bleeding at a site distal to the site of the tourniquet. .If there is haemorrhage in the area of a joint, application of heavy dressing over it. .If the cut ends of the artery areseen ligature with a piece of thread.
Venous	.Rest in a comfortable position. .Reassurance to the patient and his relatives. .Avoid crowding around the patient,so that he gets sufficient oxygen. .Pressure on the bleeding site with thumb. .If that fails to achieve haemostasis,pressure bandage over the bleeding  site. .Appliction of ice packs around the wound to cause vasoconstriction and reduce bleeding.
Capillary	Pressure bandage.

 

 

General measures*

1.Head low position by half or full block.

2.Monitoring of the pulse,respiration and blood pressure periodically.

3.Warmth,Stimulant drink,e.g.coffee.

4.Transfer to a dispensary or hospital if the bleeding is serious.

(*Except in a case of head injury).

 

Effects of haemorrhage

1.If a healthy person loses one litre of blood in half an hour ,he can die .

2.However, if the same blood loss takes place over a day, and the same thing continues over anum ber of days, the person does not die immediately.his circulating blood volume does not decreases significantly because fluid is withdrawn  from tissues causing haemodilution. This results in a significant drop in the Hb level.

3.With low Hb level, the oxygen- carring capacity is reduced and the patient becomes breathlessness.

 

Clinical features

Stage	Features
Early	.External bleeding. .Restlessness. .Anxiety. .Giddiness. .Coldness of skin:Body temperature is <37 C. .Excessive thirst. .Pallor: conjunctiva, oral mucosa,tongue, and nails.
Late	.Severe pallor. .Skin is cold and clammy. .Respiration is rapid (air hunger). .The pulse is rapid and thread(low volume). .Blood pressure is very low. .Excessive thirst:Dry llips, dry tongue,and sunken eyes. .Vision is dim. .There is ringing in the ears. .Urine output is low. .Central venous pressure is low.

Treatment

 

External haemorrhage

 

1.pressure is applied over the bleeding site by placing sterile cotton or gauze on it, and applying pressure bandage over it.

2.Digital pressure is made over the feeding artery proximal to the site of bleeding.

3.The limb is elevated to reduce venous pressure and hence venous bleeding. This is especially important when there is venous bleeding from ruptured varicose veins.

4.A tourniquet is applied to a limb with the following precautions:

                           .It is applied over a single bone,e.g.over humerus in the arm and femur in the thigh.

                           .Cotton or gauze pad is placed at the site over which the tourniquet is to be tied.

                           .A large handkerchief,String, or rubber tube may be used instead of a tourniquet in an

                            Emergency.

                            .A wooden stick or spoon may be used t0 tighten the tourniquet.

                            .The tourniquet is loosened for 10 minutes every half an hour so as to prevent gangrene                                

                             Of the limb distal to the site of application of the tourniquet.

5.The bleeding vessel is ligated surgically if it is seen.

6.The bleeding vessel may be coagulated with diathermy if it is seen.

7.Ice packs are applied around the bleeding site to cause vasoconstriction and control the bleeding temporarily.

8.Any of the following styptic agents may be applied for local action to stop bleeding.

                                     .Adrenaline 1:1000.

                                      .Turpentine.

                                       .Thrombin:During surgery.

                                        .Gelfoam :During surgery.

 

Internal haemorrhage

Cause	Treatment
Traumatic haemorrhage	.Surgical exploration and appropriate treatment of the injury.
Secondary haemorrhage	Antibiotics and control of blood pressure.
Special sites      Urinary bladder	.Emptying the urinary bladder with a self retaining catheter.
Oesophageal varices	.Pressure with three balloon sengstaken Blakemore tube.
Epistaxis	.Adrenaline packs. .Pressure with balloon of foley’s catheter.
Bleeding into an organ	.Embolization of the bleeding vessel under fluoroscopic control by selective  catheterization of the vessel using seldinger technique.