Documente Academic
Documente Profesional
Documente Cultură
HEMOSTASIS
HEMORRHAGE AND BLEEDING
The escape of blood from the vessels
Petechial lesion
Ecchymosis
Hematoma
Internal bleeding
External bleeding
PETECHIAL LESIONS,
PURPURIC LESIONS SMALLER
THAN 3 MM.
PLANTAR MIDFOOT
ECCHYMOSIS
TMT JOINT TRAUMA LESIONS
BLACK EYE,
PERIORBITAL ECCHYMOSIS,
EXTRAVASATION OF RBC INTO
THE SURROUNDING TISSUE,
PATCHES GREATER THAN 3MM
HAMSTRING BRUISING
ANKLE SPRAIN
CHRONIC VENOUS ULCER
EXTERNAL BLEEDING
Epistaxis
Hemoptysis
Hematemesis
Melena
Hematochezia
Hematuria
POSTTRAUMA HEMORRHAGE
HEAD INJURY
NECK INJURY
HEAD INJURY
INTRACRANIAL BLEEDING
EXTRADURAL BLEEDING
SUBDURAL BLEEDING
INTRACEREBRAL BLEEDING
SKULL FRACTURES
SCALP ECCHYMOSIS
PERIORBITAL HEMATOMA
SUBCONJUNCTIVAL HEMORRHAGE
MASTOID BRUISING
PHARYNGEAL BRUISING
EXTRADURAL HEMATOMA
SUBDURAL HEMATOMA
1/3 OF PTS. HAVE A LUCID PERIOD,
MAJORITY ARE DROWSY,
UNILATERAL HEADACHE,
BRAIN DAMAGE MORE SEVERE,
PROGNOSIS WORSE - EDH
INTRACRANIAL HEMATOMA
INTRACRANIAL HEMATOMA
GCS
Less than or equal to 8 at 6 h.- 50% die
Severe head injury 3 – 8
NECK WOUNDS
Mr. Ty Royd
A) Careful intubation
B) Go directly to the OR
C) Take a fiber optic look for airway injury
D) CT neck
E) Angiography with possible embolisation
F) Cross your fingers and pull the knife
CHEST INJURY
HEMOTHORAX
HEMOPERICARDIUM
CARDIAC INJURY
ABDOMINAL INJURY
Mental state
Color, temperature, moisture of the skin
BP and PR
RR
Complete exam. to head to toes
HEMORRHAGIC SHOCK
BP< 90 mm.Hg.
Tachycardia with weak, thready pulse,
Polypnea
Cold, clammy, pale skin
Urinary output< 30 ml/h or none
SHOCK INDEX
SHOCK INDEX = PR/SBP
NORMAL= 70/140= 0,5
PLATELET DISORDERS
thrombocytopenia
hyperkalaemia
hypothermia
METHODS TO REDUCE THE NEED
FOR BLOOD TRANSFUSION
ACUTE VOLUME REPLACEMENT
HYDROXYETHYL STARCH (HES)
DEXTRAN 70
DEXTRAN40
UREA-BRIDGED GELATIN (HAEMACCEL
MECHANISM FOR REDUCED
BLOOD USE IN SURGERY
PREOPERATIVE
* Surgery elective – Correct the Haemoglobin level.
Stop drugs that interfere Haemostasis
INTRAOPERATIVE
Posture
Use of Vasoconstrictors
Use of tourniquets
POST OPERATIVELY
Blood can be salvaged from drains into collection devices that permit
reinfusion
Decision to transfuse post operatively should depend