Haemorrhage.pptx

HAEMORRHAGE 1  LEARNING OUTCOMES Students should be able to; Discuss first aid and managing a bleeding victim Discuss how to manage hemorrhage and shock 2  Definition Of Bleeding It is leakage of blood out side the blood vessels A hemorrhage may be...

HAEMORRHAGE 1  LEARNING OUTCOMES Students should be able to; Discuss first aid and managing a bleeding victim Discuss how to manage hemorrhage and shock 2  Definition Of Bleeding It is leakage of blood out side the 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. 3  Clinical Situations Trauma /accidents General operative interventions Gynecological procedures Congenital coagulation disorders Acquired coagulation disorders DIC Anticoagulants MOF Common surgical conditions 4  TYPES OF BLEEDING Depending on the source of bleeding 1- Arterial– bright red and comes in jets with the pulse of the patient 2- Venous – dark red blood , steady and copious 3- Capillary– bright red rapid ooze ( abrasions ) 5  Depending on the time of occurrence 1- Primary bleeding – occurs at the time of injury or operation 2- Reactionary bleeding – usually occurs in 4-6 hours or with in the 24 hours that follow the primary bleeding, due to either slipping of ligature , dislodgement of a clot or cessation of the reflex vasospasm. 6  3- Secondary bleeding – occur within 7-14 days after the primary trauma or operation 7  Depending on the Visibility a- External ( revealed ) bleeding b- Internal ( concealed ) bleeding like intra-abdominal or intracranial bleeding the internal bleeding may become external as in hematemesis due to a bleeding peptic ulcer or hematuria after renal injury or an intrauterine bleeding turns into bleeding per vagina 8  HOW TO MEASURE ACUTE BLOOD LOSS ? A normal blood volume is 80-85 ml / kg in infants and about 65-75 ml / kg in adults 1- Blood clot size – a clenched fist size clot roughly equals 500 ml 2 - Site of a closed # swelling -- a moderate swelling in a # tibia equals to 500- 1500 ml of blood, while a moderate swelling in a # femur equals to 500-2000 ml of blood loss 3- Swab weighing – by subtracting the weight of soaked swabs from their weight when they were dry and the blood loss is 1 ml for every 1 gm difference 4- Hemoglobin level estimation – there is no immediate decrease in Hg level after bleeding but after 8 hours it will drop because of the influx of the interstitial fluid into the vascular compartment ( dilution ) 9  FIRST AID FOR BLEEDING IS INTENDED TO: *Stop the bleeding *Prevent infection *Prevent shock Precaution Before providing care, put on protective gloves or use a barrier between you and the victim, to reduce the chance of disease transmission while assisting the injured person. Cleanse your hands thoroughly with soap and water when finished. BASIC FIRST AID TREATMENT 10  How to control bleeding ? Apply DIRECT PRESSURE on the wound. use a dressing, if available. if a dressing is not available, use a rag, towel, piece of clothing or your hand alone. 11  IMPORTANT: ONCE PRESSURE IS APPLIED, KEEP IT IN PLACE. IF DRESSINGS BECOME SOAKED WITH BLOOD, APPLY NEW DRESSINGS OVER THE OLD DRESSINGS. THE LESS A BLEEDING WOUND IS DISTURBED, THE EASIER IT WILL BE TO STOP THE BLEEDING! 12  If bleeding continues, and you do not suspect a fracture, ELEVATE the wound above the level of the heart and continue to apply direct pressure 13  If the bleeding still cannot be controlled, the next step is to apply PRESSURE AT A PRESSURE POINT For wounds of the arms or hands, pressure points are located on the inside of the wrist ( radial artery-where a pulse is checked) or on the inside of the upper arm (brachial artery) For wounds of the legs, the pressure point is at the crease in the groin (femoral artery) 14 15   THE FINAL STEP TO CONTROL BLEEDING IS TO APPLY A PRESSURE BANDAGE OVER THE WOUND. A BANDAGE, SUCH AS ROLL GAUZE, IS USED TO HOLD A DRESSING IN PLACE AFTER THE BANDAGE IS IN PLACE, IT IS IMPORTANT TO CHECK THE PULSE TO MAKE SURE CIRCULATION IS NOT INTERRUPTED A SLOW PULSE RATE, OR BLUISH FINGERTIPS OR TOES, SIGNAL A BANDAGE MAY BE IMPEDING CIRCULATION. 16  SIGNS AND SYMPTOMS OF INTERNAL BLEEDING ARE: * BRUISED, SWOLLEN, TENDER OR RIGID ABDOMEN *BRUISES ON CHEST OR SIGNS OF FRACTURED RIBS *ABNORMAL PULSE AND DIFFICULTY BREATHING *COOL, MOIST SKIN FIRST AID OF INTERNAL BLEEDING 1- LAY THE VICTIM DOWN WITH HIS HEAD LOW AND TO ONE SIDE TO 17 ENSURE A GOOD BLOOD SUPPLY TO HIS  2-LOSSEN ANY CONSTRICTING CLOTHING AROUND HIS NECK, CHEST AND WAIST 3-REASSURE HIM AND EXPLAIN THE NECESSITY FOR HIM TO RELAX 4-CHECK BREATHING AND PULSE RATE AND LEVEL OF RESPONSIVENESS AT 10-MINUTES INTERVALS 5-EXAMINE THE VICTIM FOR OTHER INJURIES AND TREAT AS NECESSARY 18  6.IF HE BECOMES UNCONSCIOUS, KEEP HIS AIR WAY OPEN AND CHECK BREATHING AND COMPLETE THE ABC 7.KEEP THE VICTIM COVERED AND PLACE A BLANKET UNDERNEATH HIM 8.KEEP A RECORD OF ANY SPECIMEN PASSED OR VOMITED BY THE VICTIM Do not give the victim any thing by mouth 19  NOSEBLEED OCCUR WHEN TINY BLOOD VESSELS INSIDE THE NOSTRILS ARE RUPTURED ,EITHER BY A BLOW TO THE NOSE, OR A RESULT OF SNEEZING AND HIGH BLOOD PRESSURE. 20  First Aid of Nose bleed 1- Reassure the victim 2- Ask the victim to Sit down and advice her to tilt her head forwards 3- Ask the victim to breath from her mouth 4- Pinch the soft part of the nose 5-Tell the victim to keep pinching her nose ,and advice her not to speak , swallow ,cough 21  6- IF BLEEDING CONTINUES, HOLD THE POSITION FOR AN ADDITIONAL 10 MINUTES 7- APPLY ICE BAG TO NOSE AND CHEEKS TO CONSTRICT THE BLOOD VESSELS IN NOSE AND STOP THE BLEEDING 8-IF BLEEDING DOES NOT STOP IN SHORT TIME, VICTIM SHOULD BE TRANSFERRED TO THE HOSPITAL 22  Bleeding from the ear It is usually due to burst(perforated)eardrum Causes 1-Foreign object pushed in the ear 2-A blow to side of the head Symptoms * Sharp pain * Earache * Deafness * Dizziness * Watery blood * If skull fracture occur fluid is leaking from around the brain 23  FIRST AID OF EAR BLEEDING 1-HELP THE VICTIM INTO A HALF – SITTING POSITION, WITH HIS HEAD TILTED TO THE INJURED SIDE TO ALLOW TO DRAIN 2- PUT ON GLOVES IF AVAILABLE.HOLD A STERILE DRESSING OR A CLEAN PAD LIGHTLY IN PLACE ON THE EAR 24  BLEEDING FROM THE MOUTH CUTS TO THE TONGUE, LIPS, OR LINING OF THE MOUTH RANGE FROM TRIVIAL INJURIES TO MORE SERIOUS WOUNDS CAUSES THE CAUSE IS USUALLY THE VICTIM'S OWN TEETH OR DENTAL EXTRACTION FIRST AID OF BLEEDING FROM THE MOUTH 1. ASK THE VICTIM TO SIT DOWN, WITH HER HEAD FORWARDS AND TILTED SLIGHTLY TO THE INJURED SIDE TO ALLOW BLOOD TO DRAIN FROM THE MOUTH 25  2.PLACE GAUZE PAD OVER THE WOUND 3. ASK THE VICTIM TO SQUEEZE THE PAD BETWEEN FINGER AND THUMB AND PRESS ON THE WOUND FOR 10 MINUTES. 4.IF BLEEDING PERSISTS, REPLACE THE PAD 5.TELL VICTIM TO LET THE BLOOD DRIBBLE OUT; IF SWALLOWED, IT MAY INDUCE VOMITING Avoid drinking anything hot for 12 hours 26  BLEEDING VARICOSE VEIN VEINS CONTAIN ONE-WAY VALVES THAT KEEP BLOOD FLOWING TOWARDS THE HEART.IF THESE VALVES FAIL, BLOOD COLLECTS BEHIND THEM AND MAKE THE VEINS SWELL FIRST AID OF BLEEDING VARICOSE VEIN 1- HELP THE VICTIM TO LIE DOWN ON HER BACK, THEN RAISE AND SUPPORT THE INJURED LEG AS HIGH AS POSSIBLE 27  2- APPLY FIRM, DIRECT PRESSURE ON THE AREA USING STERILE DRESSING OR CLEAN PAD, UNTIL THE BLOOD LOSS IS UNDER CONTROL 3.REMOVE GARMENTS SUCH AS ELASTIC – BECAUSE THESE MAY CAUSE BLEEDING TO CONTINUE 28  4- PUT BANDAGE TO EXERT EVEN PRESSURE, BUT NOT SO TIGHTLY THAT THE CIRCULATION IS IMPAIRED 29  Hemorrhage -four classes American College of Surgeons' Advanced Trauma Life Support (ATLS) Class I Hemorrhage -involves up to 15% of blood volume, typically no change in vital signs and fluid resuscitation is not usually necessary Class II Hemorrhage -involves 15-30% of total blood volume, patient is often tachycardic (rapid heart beat) with a narrowing of the difference between the systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction. Skin may start to look pale and be cool to the touch. The patient may exhibit slight changes in behavior. Volume resuscitation with crystalloids (Saline solution or Lactated Ringer's solution) is all that is typically required. Blood transfusion is not typically required. 30  Class III Hemorrhage involves loss of 30-40% of circulating blood volume. blood pressure drops, the heart rate increases, peripheral perfusion (shock), such as capillary refill worsens, and the mental status worsens. Fluid resuscitation with crystalloid and blood transfusion are usually necessary. Class IV Hemorrhage involves loss of >40% of circulating blood volume. The limit of the body's compensation is reached and aggressive resuscitation is required to prevent death. 31  MANAGEMENT OF HAEMORRHAGE Prevention Precautions during surgery Operative method of control of haemorrhage Blood Transfusion 32  PRINCIPLES OF MANAGEMENT Teat the primary cause Avoid irreversible shock Fluid electrolytes Blood and blood products 33  THANK YOU 34