Revision 3, Hemorrhages and hemostasis

Question 1

Types of hemorrhage

Answer 1

• Arterial hemorrhage
  1. Ruptured artery
  2. Bright red color
  3. Flows ordinally in waves of spurts
• May be steady if artery is deep
  4. Spontaneous hemostasis rare
  5. Life-threatening
  6. Hardest to control
• Venous hemorrhage
  1. Ruptured vein
  2. Rather dark red
  3. Steady, profuse bleeding
  4. Spontaneous hemostasis possible
  5. Level of danger dependent on the diameter of the vessel
  6. Potentially life-threatening
• Capillary hemorrhage
  1. Ruptured capillaries
  2. Most common
  3. Mix of arterial and venous blood (fairly bright)
  4. Trickle of blood (small drops at a time)
  5. Spontaneous hemostasis likely
  6. Usually not life-threatening
  7. Easiest to control
• Parenchymatous hemorrhage
  1. Injury to parenchymal organ (liver, spleen, pancreas), corpus
  cavernosum (penis, clitoris), cancellous bone
  2. Similar to capillary hemorrhage, bleeding more profuse
  3. Spontaneous hemostasis unlikely or time-consuming
  4. Potentially life-threatening

Question 2

Treatment of hemorrhage

Answer 2

Medical attention in case:
1. Bleeding does not stop
2. Class 2 (recommended)
3. Class 3 and 4 (necessary)

Question 3

Classification of hemorrhage (including symptoms)

Answer 3

• Blood volume 7-9% of body weight (cats 6,5%)

Class 1 (minimal blood loss) -15%
* HR, RR, BP normal, normal urine output; slightly anxious

Class 2 (mild blood loss) 15-30%
* HR^, RR^, BP normal, oliguria; confused, irritable; cool extremities

Class 3 (moderate blood loss) 30-40%
* HR^^, RR^, BP low, oliguria; lethargic; cool extremities

• Class 4 (severe blood loss) >40%
• HR^^^, RR^^, BP very low, anuria; lethargic, comatose; cold extremities, cyanosis

Question 4

Physiological hemostasis

Answer 4

Hemostasis = Process that cause blood from escaping the damaged blood vessel

1. Injury
2. Vasoconstrictors released from endothelium
3. Vasoconstriction at the site
4. Aggregation and adhesion of platelets (plug formation)
5. Thromboplastin catalyzes the conversion of prothrombin to
   thrombin
6. Thrombin causes fibrinogen to polymerize
7. Polymerized fibrin forms long strands of tough unsoluble protein
   that are bound to the platelets
8. Formation of hemostatic clot

Question 5

Artificial hemostasis

Answer 5

-Provisional / temporary
* Manual pressure
* Tamponade
* Pressure bandage
* Hemostats (forceps)
* Tourniquet

Definitive (permanent?):

MECHANICAL:

1. Tamponade
   - The closure/blockade of a wound as if/by a tampon to stop bleeding
   - Mild capillary/parenchymatous hemorrhage
2. Ligation
   - Placement of surgical suture around a vessel, arterial,
   venous hemorrhage
   - Transfixation ligature – larger arteries
   - Mass ligature - preferably not used

PHYSICAL:

1. Low local temperature
   - Vasoconstriction (minor bleeding)
2. High temperature, electrocautery
   - Monopolar
   - Bipolar

CHEMICAL:

1. Topical substances
   - Bone wax
   - Gelatin- and cellulose-based hemostatic products (clotting)
   - Adrenalin (vasoconstriction)
2. Systemic treatments (mostly preventative)
   - Ca
   - Vitamin K
   - Tranexamic acid (cyclokapron)

BIOLOGICAL:

1. Goal to promote coagulation
2. Localized use:
   - Cover the bleeding (not severe) with a part of the omentum
3. Systemic use:
   - Blood transfusion
   - Blood coagulation factor concentrates