Gerome Isaiah P.

Rabang
BSN-IV

Massive Bleeding/Major Hemorrhage

 Definition
-Massive hemorrhage can be defined as follows: (i) blood loss exceeding circulating
blood volume within a 24-hour period, (ii) blood loss of 50% of circulating blood volume
within a 3-hour period, (iii) blood loss exceeding 150 ml/min, or (iv) blood loss that
necessitates plasma and platelet transfusion, although there is no universal definition.

 Type of c bleeding and its treatment

 Arterial Bleeding
The function of the arteries is to carry oxygenated blood away from the heart and
toward your internal organ. The oxygen is then absorbed by the organs and the veins
carry oxygen-depleted blood back to the heart.

Because the blood pressure inside the arteries tends to be much higher than that in the
veins, a major arterial rupture can result in some fairly obvious and dramatic bleeding.
Arterial bleeding is characterized by rapid pulsing spurts, sometimes several meters
high, and has been recorded as reaching as much as 18-feet away from the body.

It is heavily oxygenated, arterial blood is said to be bright red. However, the best way to
identify aerial bleeding is normally through the location of the wound and the pressure of
the spurt, as the color of the blood can sometimes be difficult to discern.
 Treatment

Because of the high pressure and therefore rapid loss of blood, arterial bleeding is the
most dangerous and often the most difficult to control.
To treat arterial bleeding, apply direct pressure. If the patient is able, ask them to hold a
thick pad or dressing in place while you secure it with roller gauze. Do not lift the
dressing to see if the bleeding has stopped. If you want to see if it has stopped, lift your
hand away from the dressing to see if blood is seeping through.

 Venous Bleeding
The job of the veins is to carry deoxygenated blood back to the heart. The blood
pressure in your veins is lower than that in your arteries so an injury a major vein may
cause blood to ooze out rather than spurting out in dramatic fashion.
 Treatment

While venous bleeding is not as quick and dramatic as arterial bleeding, it is just as
serious. As with arterial bleeding, the best way to treat it is to apply direct pressure with
a clean pad or dressing.

 Capillary Bleeding
The tiny capillaries are the smallest blood vessels in the body and are only 5 to 10
micrometers in diameter. They exist close to the surface of the skin, as well as inside
organs such as your eyes and your lungs.

Bleeding from the capillaries is usually superficial. When you are first injured, you may
see a rapid flow of blood at first, but it will quickly slow to a trickle and is normally easily
managed.

Most of the time, capillary bleeding will simply stop on its own. However, you can apply
a pad or clean bandage to help stop the flow of blood
 Treatment

Capillary bleeding might not seem like a big deal, but it is worth taking seriously. If the
blood flow does not stop and the wound continues to bleed even when under pressure,
or the patient feels dizzy, nauseous, or is having trouble standing, you should always
call emergency services as this might be a sign of a more serious issue.

 Risk Factors
This have all been described as risk factors for bleeding:

 High blood pressure

 cerebrovascular disease
  recent surgery or trauma
 neoplasia
 heart disease
 diabetes mellitus
 kidney failure
 liver failure
 history of gastrointestinal bleedin
 chronic alcoholism

Potential causes and risk factors for minor to moderate internal bleeding include:

 minor injury
 chronic or long-term high blood pressure
 blood-thinning medications
 genetic clotting conditions
 corticosteroids
 antibiotics
 antidepressants
 diabetes or uncontrolled blood sugar levels
 long-term dehydration
 smoking
 excessive or chronic alcohol use
 use of illegal drugs
 stimulant medications, such as diet pills
 anti-clotting medications
 stroke or heart attack
 liver, kidney, or spleen conditions
 cancer
 deep vein thrombosis (DVT)
 gastrointestinal conditions

 Complications
Internal bleeding is considered a leading cause of trauma-associated mortality globally.

If untreated, severe or chronic hemorrhaging might lead to organ failure, seizures,

coma, external bleeding, and eventually death. Even with treatment, severe internal
bleeding is often fatal.

Early identification and treatment of internal bleeding can reduce the risk of
complications and help a person make a full recovery.

How much blood can you lose?

If you lose too much blood, your brain doesn’t get enough oxygen to support life. People
who experience major injury and trauma, such as a car accident, may lose blood very
quickly. Losing an excessive amount of blood is known as hemorrhagic shock. Doctors
categorize hemorrhagic shock into four classes based on how much blood is lost. In
class IV, the amount of blood loss can be fatal.

 Diagnostic tests/procedures and laboratory data

Prothrombin Time (PT) and Partial Thromboplastin Time (PTT), which evaluate
various components of the plasma protein clotting process (hemostasis)

Complete blood count(CBC) to evaluate the number of platelets present and to

determine if bleeding has led to anemia.

Factor Inhibitors it detects antibodies directed against individual coagulation

factors.Reason for this test is to see if coagulation factor activity test is abnormaI and if
present, may cause specific factor deficiencies and excessive bleeding

*If the PT and/or the PTT are prolonged, for example, further testing may be done to
identify problems with coagulation factors and to see whether or not there may be factor
specific inhibitor.
 Treatments
 Treatment for a bleeding disorder depends on the cause, whether it is an
acquired or inherited condition, as well as on the duration and severity of signs
and symptoms. Typically, bleeding disorders are identified, monitored, and
controlled both to prevent excessive blood loss and to prevent complications that
may arise. The degree and frequency of treatment needed will depend on the
severity of the deficiency or condition, whether or not there is a stimulus for
bleeding such as surgery or trauma, and whether or not the condition progresses
or worsens over time.

 Sometimes simply avoiding injury, limiting physical contact sports for instance,
may be enough to minimize bleeding episodes in those with mild conditions, and
under most circumstances, in those with moderate bleeding tendencies.

 If a bleeding disorder is due to an acquired condition, it may improve or worsen

as the underlying condition is resolved or progresses. If, for instance, factor
deficiencies are due to a lack of vitamin K, they may return to normal with vitamin
supplementation. If they are due to liver disease or to a cancer, they will likely
follow the course of the disease.

 Use simple dressings with direct pressure to control external hemorrhage. In

patients with major limb trauma use a tourniquet if direct pressure has failed to
control life- threatening hemorrhage.

 Physical therapy and lifestyle changes, such as quitting smoking or drinking

alcohol, may also be recommended to reduce the chances of further injury and
bleeding.

 Management
 Algorithm for the management of major hemorrhage (adapted from the BCSH
Practical Guideline for the Management of Those With, or At Risk of Major
Hemorrhage (2014)