3. Subject’s importance
Hemorrhage is one of the basic problems and
considerations in surgery.
From-trivial trauma or major abdominal organ
injuries-to- congenital and acquired coagulation
disorders.
A wide spectrum of problems involves
hemorrhage.
Transfusion of blood is the main remedy
4. Clinical Situation-
Bleeding Trauma /accidents
General operative interventions
Gynecological procedures
Common surgical conditions that presents with bleeding-
Intracranial hemorrhages/CVA
Upper GIT bleed/ hematemesis and melena
Bleeding hemorrhoids
Chronic wounds
Aneurysms
Coagulation disorders
Congenital- Hemophilia, vWF deficiency
Acquired
DIC
Anticoagulants
Fulminant sepsis
6. Body’s response to
hemorrhage/injury
Attempts to repair the loss & restore normality
There are several interrelated stages
Local response / Generalized response
Aims at:
Wall repair
Restoration of volume loss
Correction of coagulation abnormalities
7. Signs of the bleeding
Local
Hematoma, suffusion,
ecchymosis
Compression in the pleural
cavity, in pericardium, in the
skull
Functional disturbancies –
e.g. hyperperistalsis
General
Pale skin,
Cyanosis,
Decreased BP,
Tachycardia,
Difficulty in breathing,
sweating,
decreased body
temperature,
unconsciousness, cardiac
standstill
Signs of shock
7
8. Body’s response to
hemorrhage/injury
Local
Vasoconstriction
Platelet aggregation and plug formation
Coagulation leading to Fibrin formation –Intrinsic
& Extrinsic Pathways
General
Cardiac stimulation
Compartmental Volume
movement
9. TYPES OF HAEMORRHAGE
AMOUNT OF LOSS -MINOR/MAJOR
ACUTE/CHRONIC
ARTERIAL/VENOUS/CAPILLARY/MIXED
LOCALIZED/DIFFUSE
EXTERNAL/ INTERNAL
OVERT/OCCULT
10. TYPES OF HAEMORRHAGE
ARTERIAL BLEEDING is of a bright red colour, and escapes
from the end of the vessel in jets, synchronous with the
heart's beat
VENOUS BLEEDING is of a darker colour; the flow is steady,
the bleeding is from the distal end of the vessel .
CAPILLARY BLEEDING is a general oozing from a raw surface .
11. Hemorrhage and Shock
What happens when you start to
bleed? – it depends on how much
blood you lose
Normal Adult Blood
Volume is about
5 Litres
13. The Direction Of
Hemorrage
External
Internal
In a luminar organ (hematuria, hemoptysis, melena)
In body cavities (intracranial, hemothorax, hemoperitoneum,
hemopericardium, hemarthros)
Among the tissues (hematoma, suffusion)
13
15. INTERNAL HAEMORRHAGE
/WOUNDS
Causes
Penetrating wounds –
o chest, abdomen, neck, limbs
Upper GI haemorrhage-
o Bleeding Ulcers
Lower GI haemorrhage
o Diverticulosis
o Haemorrhoids
o Carcinomas
17. Bleeding
PREOPERATIVE HEMORRHAGE
Prehospital care! – maintenance of the airways, ventillation and
circulation
bandages, direct pressure, torniquets
INTRAOPERATIVE HEMORRHAGE
anatomical and/or diffuse
depending on the surgeon, the surgery, position,
the size of the vessel, pressure in the vessel
(ANESTHESIA)
POSTOPERATIVE BLEEDING
ineffective local hemostasis, undetected hemostatic
defect, consumptive coagulopathy or fibrinolysis
17
18. CLASSIFICATION OF
SURGICAL HAEMORRHAGE
Primary Hemorrhage
occurring at the time of the injury or surgery
Reactionary Hemorrhage
within twenty-four hours of the accident/surgery, due to
slippage of ligature, hypertension post op
Secondary Hemorrhage
occurring at a later period (48-72hrs) and caused by
septic condition of the wound (infection).
19. EFFECTS OF
HAEMORRHAGE
Depend upon following:
Acute loss vs Chronic loss
The amount of loss
The compensatory mechanisms
General state of health
20. SURGICAL HEMOSTASIS
Aim – to prevent the flow of blood from the incised or transected
vessels
Mechanical methods
Thermal methods
Chemical and biological methods
Radiological/Interventional methods
Adequate blood/blood products transfusion
20
21. SURGICAL
HAEMOSTASIS
Natural CONTROL/arrest of
hemorrhage arises from-
(1) changes taking place in the
cut vessel causing its retraction
and contraction
(2) the coagulation mechanism
of the blood
(3) temporary-platelet plug
Permanent-fibrin clot.
22. SURGICAL HEMOSTASIS
MECHANICAL METHODS
Digital pressure – direct pressure,
e.g. Pringle maneuver
Tourniquet
Ligation
Suturing
Preventive hemostasis
Clips
Bone wax
other
22
23. SURGICAL TREATMENT
OF HAEMORRHAGE
First Aid Management
DIRECT PRESSURE
In small blood-vessels
pressure will be sufficient to
arrest, hemorrhage
permanently
LIMB ELEVATION
TOURNIQUET
APPLICATION
25. LIGATURE
In large vessels with a reef-knot
main artery of the limb exposed
by dissection at the most
accessible point .
SUTURING & LIGATURE
26. THERMAL METHODS
Low temperature
Hypothermia – eg. stomach bleeding
Cryosurgery
Dehydratation and denaturation of fatty tissue
Decreases the cell metabolism
Vasoconstriction
26
27. THERMAL METHODS
High temperature
Electrosurgery – electrocauterization
Monopolar diathermy
Bipolar diathermy
Harmonic devices
Laser surgery
coagulation and vaporization
for fine tissues
27
35. Post trauma
Vascular and solid organ trauma.
Celiac angiogram showing 3 foci
of extravasation in spleen, 2 in the
upper pole (arrow) and 1 in the
lateral aspect of the mid spleen
Post—super-selective embolization splenic
angiogram demonstrating microcoils in good
position and no evidence of further extravasation
Conjunctival suffusion with subconjunctival hemorrhage (ou), which was suggestive of leptospirosis, developed on the second hospitalization day.
The Pringle maneuver. The portal triad is occluded by guiding the posterior blade of the clamp through the foramen of Winslow with the aid of the left index finger.
-6. kép: amennyiben vérnyomásmérő áll rendelkezésre, úgy pneumatikus vértelenség felhelyezése. 280 Hgmm-re felfújjuk a vérnyomásmérő mandzsettát, így a sebalapot megtekinthetjük. Betadines vagy Octeniseptes fedőkötés, steril pólya, korrekt nyomókötés
7-8.kép: a nyomókötés felhelyezése után a vértelenség felengedése. Amennyiben erős vérzést észlelünk, ismételten felfújjuk a mandzsettát és revideáljuk a kötést. (az erős vérzés forrása csak technikai hiba lehet az elsősegélynyújtó részéről).
Timed spot freeze technique used to treat a malignancy (possibly a small basal cell cancer), demonstrating freeze ball formation and the 5-mm treatment margins necessary to achieve a temperature of −50ºC (−58 ºF) and, thus, the required depth of 4 to 5 mm.
Cryosurgery is a method of superfreezing tissue in order to destroy it. The technique is used to treat tumors, control pain, and control bleeding.
Information
The cold is introduced through a probe which has liquid nitrogen circulating through it. To destroy diseased tissue, the tissue is cooled to below -20 degrees Celsius. Other procedures that control pain or bleeding are cooled to a lesser degree to prevent tissue damage.
Electrocoagulation: A fine wire probe or other delivery mechanism is used to transmit radio waves to tissues near the probe. Molecules within the tissue are caused to vibrate which lead to a rapid increase of the temperature, causing coagulation of the proteins within the tissue, effectively killing the tissue. At higher powered applications, full desiccation of tissue is possible.
Two forms of electrosurgery: (A) Electrodesiccation with an active electrode tip touching the skin and showing penetration of planned tissue damage. (B) Fulguration with sparking from electrode to tissue. Treatment area is more superficial than in desiccation.Added by BiomedGuy
AboutEdit
Fulguration, also called electrofulguration, is the destruction of tissue by means of a high-frequency electric current applied with a needlelike electrode. In fulguration, the electrode is held away from the skin to produce a sparking at the skin surface and more shallow tissue destruction Fulguration is especially useful in treating superficial epidermal lesions, such as a superficial basal cell carcinoma of the trunk.[1]
LinksEdit
ReferenceEdit
↑ http://www.aafp.org/afp/2002/1001/p1259.html | Electrosurgery for the Skin | BARRY L. HAINER, M.D.,RICHARD B. USATINE, M.D., | Am Fam
HemCon Medical Technologies, Inc. began with funding from the United States Army and access to research by Dr. Kenton Gregory, Dr. Bill Wiesmann, the Oregon Medical Laser Center, and Providence Health Systems. The result was the HemCon® Bandage, which was designed to control life threatening bleeding.
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The bandage was ushered through the FDA clearance process in a near-record 48 hours, and was soon deployed on the battlefield. Since then, the bandage has been used extensively and is credited with helping save over 100 lives with no adverse events reported. In 2005, the Army Surgeon General mandated that any soldier serving in Iraq or Afghanistan will carry at least one HemCon Bandage. This commitment by the U.S. Army is a testament to the efficacy and value of the HemCon Bandage. HemCon is rapidly changing from a military provider to a broad-based supplier of medical technology. With new products, strong partnerships in distribution, and a world class development team, we will continue to be unwavering in our commitment to innovate in all that we strive to achieve.
