Hemorrhage: Types and Classifications

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Questions and Answers

What is the primary goal of managing hemorrhage?

Maintaining a stable heart rate

Arresting the bleeding source (correct)

Blood transfusions to replace lost blood

Fluid resuscitation to restore blood volume

Which of the following are clinical signs of hemorrhage?

Rapid heart rate and low blood pressure (correct)

Warm, flushed skin

Slow, deep breathing

Increased blood pressure

What is the estimated blood volume in an adult?

50 ml/kg

90 ml/kg

70 ml/kg (correct)

110 ml/kg

Which of the following treatments would NOT be considered a direct attempt to stop bleeding?

Administering intravenous fluids (D) Signup and view all the answers

Which of these is a potential complication of aggressive fluid resuscitation in a patient with ongoing hemorrhage?

Coagulopathy, acidosis, and hypothermia (D) Signup and view all the answers

What is oliguria a sign of in a patient with hemorrhage?

Decreased blood flow to the kidneys (D) Signup and view all the answers

What vital sign is most often associated with the initial stages of hemorrhage?

Increased heart rate (C) Signup and view all the answers

Which of the following is NOT a recommended method to stop bleeding?

Administering antibiotics (B) Signup and view all the answers

Which type of hemorrhage is considered more serious and requires active investigation and control?

Internal Hemorrhage (C) Signup and view all the answers

What is the characteristic color of blood in a venous hemorrhage?

Dark red (A) Signup and view all the answers

What is a secondary hemorrhage?

Hemorrhage occurring 1-2 weeks after trauma. (B) Signup and view all the answers

What is the most likely cause of reactionary hemorrhage?

Sudden rise in blood pressure. (C) Signup and view all the answers

Which of the following is NOT a cause of pathological hemorrhage?

Hemophilia. (A) Signup and view all the answers

What type of vessel is most likely involved in a hemorrhage that presents with pulsatile jets of bright red blood?

Artery (C) Signup and view all the answers

What is the significance of sudden cessation of oozing during a surgical operation?

The patient may be experiencing cardiac arrest. (D) Signup and view all the answers

Which of the following is a feature of spontaneous hemorrhage?

Can happen with minimal or no trauma. (C) Signup and view all the answers

Study Notes

Hemorrhage

Hemorrhage is the escape of blood outside the circulatory system.
Classification by bleeding site:
- External: Bleeding visible through the skin (wounds) or body orifices (epistaxis, hematemesis, hematuria).
- Internal (concealed): More serious, requires investigation and control. Examples include hemoperitoneum, retroperitoneal hemorrhage, and hemothorax.
Classification by type of disrupted vessel:
- Arterial: Bright red blood in pulsatile jets, bleeding more from the proximal end.
- Venous: Dark red blood in a steady flow, bleeding more from the distal end, can be alarming if a large vein is injured.
- Capillary: Diffuse oozing, bright red blood. Sudden cessation of oozing can indicate cardiac arrest.
Classification by timing in relation to trauma:
- Primary: Occurs at the time of trauma.
- Reactionary: Occurs within 24 hours after trauma, often due to blood pressure changes after treatment or postoperative pain.
- Secondary: Occurs 1-2 weeks after trauma, precipitated by factors like infection or necrosis of vessel walls, or malignancy.
Classification by etiology:
- Traumatic: Accidental or surgical, includes interventional procedures like biopsies.
- Pathological: Atherosclerotic (e.g., ruptured aortic aneurysm), inflammatory (e.g., bleeding peptic ulcer), or neoplastic (e.g., hematuria in renal cancer).
- Spontaneous: Bleeding diathesis like hemophilia, increasing traumatic and pathological bleeding; cannot be controlled by surgical means (except packing), requires correcting coagulation abnormalities.
Physiological response to hemorrhage:
- Stopping bleeding: Vasoconstriction and subsequent clotting of injured blood vessels.
- Maintaining circulating volume: Prioritizing vital organs (heart, brain) over less critical regions (skin, skeletal muscle).
Summary: Integrated mechanisms stop hemorrhage and maintain critical organ perfusion. They permit survival without treatment for losses up to 15% of blood volume.
Clinical picture:
- Symptoms: Weakness, fainting (especially when standing), feeling cold and thirsty.
- Signs: Tiredness, pale skin, anxiety/drowsiness, tachycardia progressing to hypotension, tachypnea, hypothermia, coagulopathy, pale, cold, clammy skin, oliguria.
Management:
- Arresting bleeding: packing, pressure, limb elevation, pressure on feeding vessel (e.g., brachial artery).
- Definitive treatment: Identifying the cause of bleeding.
- IV line: Two short peripheral cannulas.
- Blood sample: Blood group, cross-matching, CBC, hematocrit, coagulation profile.
- IV fluids or blood: Based on severity of bleeding.
- Other: Oxygen mask, keep the patient warm, urinary catheter, analgesics, bed rest, elevate legs.
Monitoring:
- Frequent monitoring: every 15 minutes initially, then hourly or semi-hourly for 2 hours and later four hourly, until stabilized.
- Monitor: Pulse, blood pressure, respiratory rate, urine output, skin, temperature, mental status, and central venous pressure.
Reference: SRB's Manual of Surgery 3rd ed.

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Description

Explore the different types and classifications of hemorrhage in this quiz. Learn about external and internal bleeding, as well as classifications based on vessel type and timing in relation to trauma. Test your understanding of these critical concepts in medical science.