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Haemorrhage

• Definition: Blood escaping from the circulatory system due to vascular wall breakage.
• Classification of Bleeding:
  • Visibility:
    • Revealed Hemorrhage: Visible bleeding (e.g., skin, oral cavity, nose, ears, anus).
    • Concealed Hemorrhage: Hidden bleeding (e.g., cranial, thoracic, abdominal cavities).
  • Type of Vessel Injured:
    • Arterial Bleeding: Bright red, pulsatile jet.
    • Venous Bleeding: Dark red, non-pulsatile.
    • Capillary Bleeding: Oozing blood.
  • Timing After Trauma/Surgery:
    • Primary Bleeding: Occurs immediately after trauma/surgery.
    • Reactionary Bleeding: Occurs within the first 24 hours.
    • Secondary Bleeding: Occurs 7-14 days after trauma/surgery.
• Etiology:
  • Surgical or Traumatic: Related to injury or surgery.
  • Non-Surgical (Medical): Coagulation disorders (e.g., haemophilia).
• Blood Volume:
  • Adults: Approximately 5 liters.
  • Neonates/Children: 80 cc/kg; Adults: 70 cc/kg.
• Importance of Stopping Bleeding: Prevents hypovolemic shock, acidosis, coagulopathy, hypothermia, and organ failure.

Wound Healing

• Definition: Breakage in body tissue integrity (e.g., skin, mucosa, bone).
• Types of Wounds:
  • Open Wounds: Punctures, incisions, burns, bites, gunshot wounds.
  • Closed Wounds: Contusions, abrasions, lacerations.
• Acute vs. Chronic Wounds:
  • Acute Wounds: Heal within 3 weeks.
  • Chronic Wounds: Persist beyond 3 weeks.
• Phases of Healing:
  • Inflammatory Phase: Day 1-2.
  • Proliferative Phase: Day 3-Week 3.
  • Maturation (Remodeling) Phase: Week 3-months/years.
• Factors Affecting Healing:
  • Local Factors: Skin tension, hypoxia, contamination, infection, radiotherapy.
  • Systemic Factors: Age, obesity, malnutrition, smoking, diabetes, medications (e.g., steroids).

Surgical Wound Classification

• Class I (Clean): No inflammation; sterile.
• Class II (Clean-Contaminated): Controlled entry into respiratory, alimentary, or genitourinary tracts.
• Class III (Contaminated): Open wounds or significant sterile breaks.
• Class IV (Dirty): Infected wounds.

Managing Bleeding in Emergency Room

• Steps:
  • Secure the airway, breathing, and circulation.
  • Apply direct pressure to visible bleeding.
  • Insert IV cannulas and prepare fluids/blood for transfusion.
  • Keep the patient warm and assess for other injuries.
• Control Techniques: Direct pressure, surgical clamps for visible bleeders, positioning (e.g., elevate limb, Trendelenburg position if necessary).
• Hemostasis in Operating Room: Surgical suturing, angioembolization, endoscopic control.

Other Topics

• Haemorrhage control in emergency room: Identify bleeding site, apply direct pressure with gloved fingers or clean packs. Use surgical clamps for temporary cessation if bleeder is clearly visible. Change body position as needed (e.g., reversed Trendelenburg for neck bleeding, elevate limb for limb bleeding).
• Methods to stop bleeding in operation room: Surgical suturing, angioembolisation technique, endoscopic control.
• What to do after successful cessation of bleeding: Resuscitation, coagulopathy correction, continuous close follow-up of vital signs, urine output, and operation site.
• How to differentiate between acute and chronic wounds: Acute wounds heal within 3 weeks; chronic wounds persist beyond 3 weeks.
• How wounds normally heal: Inflammatory phase (Day 1-2), Proliferative phase (Day 3-Week 3), Maturation (Remodeling) phase (Week 3-months/years).
• Factors affecting abnormal acute wound healing: Local factors (skin tension, hypoxia, contamination, infection, radiotherapy) and systemic factors (age, obesity, malnutrition, smoking, diabetes, medications).