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Surgery M4 part 1 > Hemorrhage > Flashcards

Hemorrhage Flashcards

1
Q

What are the 2 types of bleeding?

A

external (revealed)
- hematemesis, epistaxis, hematuria
internal (concealed)
- hemoperitoneum, retroperitoneal hemorrhage, hemothorax

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2
Q

What should be suspected in a trauma patient with a systolic blood pressure of less than 90?

A

bleeding until proven otherwise

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3
Q

Pulsatile jets occur in?

A

arterial bleeding

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4
Q

How to know which disrupted vessel is affected?

A

ARTERIAL VEIN CAPILLARY

  • bright red - dark red - bright red
  • pulsatile jets - steady flow - diffuse oozing
  • bleeding proximal - more from distal - sudden cessation of bleeding during
    - terrifying if large vein is injured surgery means cardiac arrest
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5
Q

When does reactionary hemorrhage occur?

A
  • within 24 hours after trauma
  • when pressure rises due to correct of hypovolemia or secondary to post-op pain
  • insecure slipped ligation or dislodged clot
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6
Q

when does secondary hemorrhage occur?

A

1 -2 weeks after trauma

precipitated by factors like infection eroding blood vessels
Pressure necrosis
Malignancy

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7
Q

What are the etiologies for bleeding?

A 
traumatic 
- accidental 
- surgical
- interventional procedures 
pathological
- atherosclerotic 
- inflammatory 
- neoplastic  
spontaneous
- bleeding diathesis (hemophilia)
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8
Q

What are the physiological responses to hemorrhage?

A
  • stopping the bleeding

- maintaining effective circulating volume

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9
Q

What are the factors affecting the physiological response?

A

neural

endocrine

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10
Q

What neural factors effect the physiological response to bleeding?

A

Sympathetic discharge causing:

  • constriction of veins to restore functional blood volume
  • constriction of arterioles to raise peripheral resistance
  • increase rate and strength of cardiac contraction
  • transcapillary refill improves overall circulatory volume
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11
Q

Sympathetic discharge increases in proportion to what?

A

A drop is

  • arterial pressure
  • venous return & atrial filling pressure
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12
Q

What are the endocrine factors affecting the physiological response to bleeding?

A
  • catecholamines from adrenal medulla
  • ACTH, cortisol, & growth hormone
  • renin-angiotensin aldosterone system
  • vasopressin (ADH)

Augment vasoconstriction & contribute to transcapillary refill

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13
Q

The factors affecting the physiological response to hemorrhage can withstand how much of the loss of blood?

A

15% (less than 750ml)

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14
Q

What lowers the patients physiological tolerance to hemorrhage?

A

Greater losses

Poor cardiovascular reserve (severe anemia)

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15
Q

What are the symptoms that a hemorrhagic patient presents with?

A
  • Weakness & fainting (esp when standing)

- Cold & thirsty (put a thin blanket)

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16
Q

What are the signs of hemorrhage?

A
  • tired & pale patient
  • anxious or drowsy
  • tachycardia & then progressive hypotension
  • tachypnea
  • hypothermia coagulopathy
  • cold & clammy
  • Oliguria (normal 1mL/kg/hr)
17
Q

What’s the cause of tachycardia in a hemorrhagic patient?

A

Hypotension

Pain

18
Q

What is the normal blood volume?

A

70mL/kg in ADULTS

80mL/kg in CHILDREN

19
Q

What are the signs of a patient presenting with stage I bleeding?

A
  • <15% (750-999mL) loss of blood
  • heart rate is normal
  • blood pressure is normal
  • breathing is normal
  • capillary refill in normal
  • bowel sounds are present
  • urinary output is >30ml/hr
  • metal state is normal or slightly anxious
20
Q

What are the signs of Stage II bleeding?

A
  • 15 - <30% (1000-1499mL)
  • tachycardia >100bpm
  • orthostatic changes in BP (increase in vasoconstriction intensifies in non-critical organs)
  • RR mildly increases
  • > 2 seconds capillary refill: clammy skin
  • hypoactive bowel sounds
  • 20 - 30ml/hr
  • mildly anxious or agitated
21
Q

What are the signs of Stage III bleeding?

A
  • 30% - <40% (1,500 - 1999)
  • tachycardia >120bpm
  • markedly decreased BP (<90mmHg SBP)
  • moderate tachypnea
  • > 3 seconds capillary refill, pale skin
  • paralytic ileus
  • <20 ml/hr urinary output
  • confused, agitated
22
Q

What are the signs of stage IV bleeding?

A
  • > 40% (2000 - or more)
  • tachycardia >140bpm
  • profoundly decreased <80mmHg SBP
  • marked tachypnea, respiratory collapse
  • > 3 seconds, cold mottled skin
  • paralytic ileus, mucosal necrosis
  • anuria
  • obtunded
23
Q

What is the first line of treatment in hemorrhage?

A

Arresting the bleeding

24
Q

What are the method used to stop the hemorrhage?

A

1- packing, pressure
2- position (limb elevation)
3- pressure on feeding artery
4- treat the cause

25
Q

What are the steps of management of hemorrhage?

A 
1- stop bleeding 
2- IV line
3- blood sample 
4- give IV fluids or blood 
5- oxygen mask 
6- keep patient warm 
7- insert urinary catheter 
8- general care 
9- monitor treatment
26
Q

When should the IV line be inserted?

A

2 short peripheral canulas inserted ASAP after stopping hemorrhage to avoid venous collapse

27
Q

How frequently should a hemorrhagic patient be monitored?

A
  • every 15 minutes until patient is resuscitated
  • half - hourly for 2 hours
  • four hourly
28
Q

What are the most important things to be monitored?

A
  • pulse & pressure
  • RR
  • urine output (0.5-1mL/kg/hr)
  • skin & temperature
  • mental state
  • central venous pressure
29
Q

What are the indications of fluid therapy?

A
  • rapid restoration of fluid & electrolytes in dehydration due to vomiting, diarrhea, shock (due to hemorrhage, sepsis, or burn)
  • total parenternal nutrition
  • anaphylaxis, cardiac arrest, hypoxia
  • post gastrointestinal surgeries
  • for maintenance or replacement of loss
30
Q

What are the problems that could occur in fluid therapy?

A
  • needs hospitalization
  • fluid overload
  • thrombophlebitis
  • pyrogenic reaction
  • discomfort
31
Q

How much sodium is present in one liter of normal isotonic saline?

A

154 mEq

32
Q

What is Ringer’s lactate?

A 
Most physiological fluid 
Crystalloid containing: 
130 mEq of sodium 
4 mEq/It of potassium
109 mEq/It of chloride 
28 mEq/It of lactate (bicarbonate)
3 mEq of calcium

Surgery M4 part 1 (47 decks)

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