Hemorrhage: Types, Symptoms, Causes, Diagnosis
Describe different types of hemorrhage and management of hemorrhage.
Answer. Hemorrhage is the escape of blood from a blood vessel.
Types Of Hemorrhage
Depending upon the nature ofthe vessel involve:
Arterial hemorrhage:
- Bright red, jet out.
- Pulsation of the artery can be seen.
- It can be easily controlled as it is visible.
Venous hemorrhage:
- Dark red.
- It never gets out but oozes out.
- Difficult to control because the vein gets retracted, nonpulsatile.
Capillary hemorrhage:
- The red color, never jets out, slowly oozes out.
- It becomes significant, if there are bleeding tendencies.
Depending upon the timing of the hemorrhage:
- Primary hemorrhage: Occurs at the time of surgery.
- Reactionary hemorrhage: Occurs after 6 to 12 hours of surgery.
Hypertension in the postoperative period, and violent sneezing, coughing, or retching are the usual causes. - Secondary hemorrhage: Occurs after 5 to 7 days of surgery.
It is due to infection which eats away the suture material, causing sloughing of the vessel wall.
Depending upon the duration of the hemorrhage:
- Acute hemorrhage: Occurs suddenly, e.g. esophageal varices bleeding.
- Chronic hemorrhage: Occurs over some time, e.g. hemorrhoids/piles.
- Acute or chromic hemorrhage: It is more dangerous as bleeding occurs in individuals who are already hypoxic, which may get worsened faster.
Depending upon the nature of bleeding:
- External hemorrhage or reversal hemorrhage, e.g.epistaxis, haematemesis.
- Internal hemorrhage or concealed hemorrhage, e.g.splenic rupture following injury.
Based on the possible intervention
- Surgical hemorrhage: Can be corrected by surgical intervention
- Non-surgical hemorrhage: It is diffuse and oozes due to coagulation abnormalities and disseminated intravascular coagulation.
Management of Hemorrhage
Hemorrhage General management:
- Hospitalization
- Care of critically ill patients starts with A, B, and C (Airways, breathing, circulation).
- Oxygen should be administered.
- Intravenous line: Urgent intravenous administration of isotonic saline to restore the blood volume to normal.
- Colloids such as gelatins or hetastarch have also been used.
Hemorrhage Specific Measures
Hemorrhage Conservative
- By local pressure and packing:
- Pressure is applied with tight dressing, applying digital pressure, or cloth pegs for epistaxis.
Use of double-balloon in the esophagus and stomach to control the bleeding from esophageal varices. - Packing employing rolls of the wide gauge is an important stand-by in operative surgery.
Elevation of part: As in bleeding varicose ulcer.
- Rest: Absolute rest.
- Sedation: With diazepam.
- Treatment of shock: Treatment of hypovolemia by restoration of blood volume by blood transfusion and or saline, dextrose, etc.
Hemorrhage Operative
- Clamping the bleeding vessels with catgut, thread, or silk.
- Coagulation by thermocautery or diathermy.
- By local application of adrenaline swabs.
- Application of silver clips as in neurosurgery.
- Under running or transfusion of vessels by needle and suture.
- Application of crushed piece of muscle at the site of bleeding.
- Bone wax or bismuth iodoform paraffin paste (BIPP) is used for oozing from bone.
- Repair of a vascular defect by patches of vein or Dacron mash.
- Excision of the bleeding organ: Splenectomy.
- Restoration of blood volume after hemorrhage
- Resuscitation from hemorrhage includes restoration of the circulating volume.
So Ringer lactate is preferred over the normal saline. Isotonic crystalloid or colloid solutions can be used for volume replacement in hemorrhage. - Blood transfusion: For restoring the circulating volume and replacing coagulation factors and oxygen-carrying capacity many blood products are available.
- By crystalloid solution, hypovolemia is corrected.
- Packed RBCs restore intravascular volume and oxygen-carrying capacity.
- Platelet transfusions can be done for significant thrombocytopenia and continued hemorrhage
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