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HAEMORRHAGE AND HAEMOSTASIS (Haemorrhage (escape of blood from a vessel…
HAEMORRHAGE AND HAEMOSTASIS
Haemorrhage
escape of blood from a vessel following vascular injury
Arterial
Venous
Capillary
Mixed
external (obvious) or internal (concelaed)
may not be what we expect
Classification
Type
Primary
Immediately after vessel disrupted
Surgery
Trauma
Primary haemostasis disorders
Platelet response
Secondary
Erosion of vessel
drain
implant
bacterial infection
Delayed
Intermediate
Within 24 hours
examples
Ligature slip
Inappropriate electrocautery
Dislodgement of blood clot
Return to normal blood pressure
pop the clot
Secondary haemostasis disorders
Problems with coagulation cascade
PT
APTT
Volume
Owner advice
Clean compressive dressing
Safely transport
Manual pressure over area or main artery supplying area
What to do
ABC
A: Airway
B: Breathing
C: Circulation
DEF in anaesthesia CPR
Stabilisation
Control haemorrhage
Restore blood volume
Investigation of cause
Transfixing ligatures
Simple ligature
Halsted transfixing
Modified transfixation
Tissue ligature
Stick tie
Haemostasis
Spontaneous physiological response to haemorrhage designed to control loss of blood
Why?
Improve morbidity
Infection
Delayed wound healing
Haematoma formation
Shock
Halstead Principles
Methods
Mechanical
Tourniquets
Distal extremeties
Eshmark's bandage
Latex secured haemostat
Pneumatic
Care with length applied
DO NOT use if vascular compromise
risk of thrombosis
Digital pressure
Soaked saline swabs
prevent sticking and dislodging blood clot
reduced absorbance of blood
DAB
Dressing
Haemostatic clamps
Kelly
Crile/ Halstead Mosquito
Curved forceps improve visibility
Ligatures
Square knot
even
4 throws
Double ligature
Circumferential/ Transifixing
#
Bone wax
Thermal
Hypothermia
Vasocontriction
Laser
Argon beam coagulation
Diathermy
Electrocautery
Heat applied directly
Electrocoagulation
Heat generated within tissue by current
High frequency alternating current
Converts to heat on contact with vessel
vessel shrinks and occludes lumen
Advantages
Reduced surgical time
Blood free field
Disadvantages
Security not as good as ligature
May get delayed healing
Types
Monopolar
Current flows from hand piece
through patient
1 more item...
Bipolar
Current flows between 2 electrodes
Advantages
4 more items...
Chemical
Vasocontrictors
NA
Silver nitrate crystals
For small vessels
Collagen
Cellulose
Matrix
Swell
direct pressure effect
Gelatin