Hemorrhage Classification Quiz

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Questions and Answers

Which type of hemorrhage occurs within 24 hours after trauma?

Primary hemorrhage

Secondary hemorrhage

Reactionary hemorrhage (correct)

Spontaneous hemorrhage

What is the characteristic feature of arterial bleeding?

Dark red blood in a steady flow

Slow, even bleeding from the distal end

Diffuse ooze of bright red blood

Bright red blood in pulsatile jets (correct)

Which of these factors can precipitate secondary hemorrhage?

Hypovolemia

Postoperative pain

Infection (correct)

Insecure ligature

Which condition is NOT considered a pathological cause of hemorrhage?

Hemophilia (C) Signup and view all the answers

What is the most likely reason for sudden cessation of oozing during a surgical operation?

Cardiac arrest (B) Signup and view all the answers

Which type of hemorrhage is particularly dangerous due to being hidden and potentially overlooked?

Internal hemorrhage (C) Signup and view all the answers

What is the main characteristic of spontaneous hemorrhage associated with a bleeding diathesis?

Bleeding occurs independently of trauma (C) Signup and view all the answers

What is the principle behind managing hemorrhage related to bleeding diathesis?

Correction of coagulation abnormalities (D) Signup and view all the answers

What is the primary goal of managing hemorrhage, according to the provided text?

Arresting the bleeding source. (A) Signup and view all the answers

What is the approximate blood volume in a 70 kg adult?

4.9 liters (A) Signup and view all the answers

Which of the following is NOT a clinical sign of hemorrhage?

Bradycardia (B) Signup and view all the answers

What is the rationale behind the use of IV fluids in hemorrhage management?

To increase blood pressure and improve tissue perfusion. (A) Signup and view all the answers

What is the highest percentage of blood loss that a patient can tolerate without requiring therapy, according to the text?

15% (C) Signup and view all the answers

Which of the following methods is NOT mentioned in the text as a means of stopping hemorrhage?

Tourniquet application (C) Signup and view all the answers

What are the two main physiological responses to hemorrhage?

Vasoconstriction and maintenance of effective circulating volume. (C) Signup and view all the answers

What is the potential outcome of attempting to resuscitate patients with ongoing hemorrhage?

Physiological exhaustion leading to coagulopathy, acidosis, and hypothermia. (D) Signup and view all the answers

Study Notes

Hemorrhage

Hemorrhage is the escape of blood outside the circulatory system.
Hemorrhage classification is based on different criteria:

Classification by site of bleeding

External: Bleeding visible through the skin (e.g., wounds) or from body orifices (e.g., epistaxis, hematemesis, hematuria).
Internal (concealed): More serious, hidden bleeding, requiring active investigation and control (e.g., hemoperitoneum, retroperitoneal hemorrhage, hemothorax).

Classification by type of disrupted vessel

Arterial: Bright red blood, pulsatile jets, bleeding primarily from the proximal end.
Venous: Dark red blood, steady flow, bleeding primarily from the distal end, can be dangerous if large veins are injured.
Capillary: Bleeding as diffuse ooze, bright red blood. Sudden cessation of oozing during surgery may signify cardiac arrest.

Classification by timing in relation to trauma

Primary: Bleeding occurring at the time of trauma.
Reactionary: Bleeding occurring within 24 hours after trauma, sometimes due to blood pressure correction post-procedure or postoperative pain.
Secondary: Bleeding occurring 1-2 weeks after trauma, often due to factors like infection, necrosis, or malignancy, especially around surgical sites.

Classification according to etiology

Traumatic: Accidental or surgical, including interventional procedures, such as biopsies.
Pathological: Atherosclerotic (e.g., ruptured aortic aneurysm), inflammatory (e.g., bleeding peptic ulcer), or neoplastic (e.g., hematuria in kidney cancer).
Spontaneous: Bleeding diathesis (e.g., hemophilia), increased bleeding with little or no trauma, typically treated via correction of coagulation abnormalities.

Physiological Response to Hemorrhage

Stopping the bleeding: Vasoconstriction of injured blood vessels and subsequent clotting.
Maintaining effective circulating volume: Prioritizing blood flow to critical organs (heart and brain) at the cost of less critical tissues (skin and skeletal muscle) , which is achieved using various systems

Clinical Picture

Symptoms: Weakness, fainting (especially standing), feeling cold and thirsty.
Signs: Pale, tired appearance, anxious or drowsy, tachycardia (fast heart rate), progressive hypotension (low blood pressure), tachypnea (rapid breathing), hypothermia, pale, cold, and clammy skin, and oliguria (reduced urine output).

Management

Stop the bleeding: Packing, pressure, elevation (e.g., elevating the limb), direct pressure on the blood vessel source. Definitive treatment should also consider the underlying cause of bleeding.
IV line: Multiple short peripheral cannulas.
Blood sample: Blood type, cross-matching, complete blood count (CBC), hematocrit, coagulation profile.
IV fluids/Blood: Administered based on the severity of hemorrhage.
Other measures: Oxygen mask, maintaining patient warmth, urinary catheter insertion for urine output monitoring, analgesics, bed rest, and elevating the legs (for edema).

Monitoring of Treatment

Frequent monitoring (every 15 minutes initially, then hourly or half hourly until stable, then every 4 hours) for pulse, blood pressure, respiratory rate, urine output, skin temperature, level of consciousness, and central venous pressure (to assess blood return to heart).

Summary

Hemorrhage must be aggressively diagnosed and treated to prevent shock, multi-organ failure, and potential death. Treating the bleeding is more effective than just fluid or blood transfusions for most patients.
Supportive measures to keep organs perfused, such as resuscitaton, can be harmful if severe or uncontrolled hemorrhage continues as it leads to physiological exhaustion/failure.
Blood volume estimation (around 70 ml/kg in adults, 80 ml/kg in children) and classification is essential for appropriate management.

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Description

Test your knowledge on the various classifications of hemorrhage. This quiz covers the different types of bleeding based on site, vessel type, and timing related to trauma. Understand the critical differences that can affect treatment outcomes.