Massive Bleeding (Hemorrhage)
 Copious

discharge of blood from the blood vessels or a rapid and uncontrollable loss or outflow.

.is the loss of blood or blood escape from the circulatory system. nose. either through a natural opening such as the vagina. Bleeding can occur internally. mouth. ear or anus. where blood leaks from blood vessels inside the body or externally. or through a break in the skin.

underlying medical condition. or a combination. this can also be used to describe an incision. Traumatic Injury: >Laceration. .Causes: Bleeding arises due to either traumatic injury. In some instances.Irregular wound caused by blunt impact to soft tissue overlying hard tissue or tearing such as in childbirth.

Caused by a great or extreme amount of force applied over a period of time. The extent of a crushing injury may not immediately present itself. >Ballistic Trauma.Caused by an object that penetrated the skin. >Crushing Injuries.A cut into a body tissue or organ. this may include two external wounds (entry and exit) and a contiguous wound between the two .Caused by a projectile weapon.>Incision . such as by a scalpel. >Punctured Wound . made during surgery.

Medical Condition . H pylori infection.changes of the blood within vessels (e. brain abscess. vasculitides) >Extravascular changes . aneurysms. ↓ clotting factors) >Intramural changes.g. ↑ blood pressure. brain tumor) .g.g.changes arising within the walls of blood vessels (e.changes arising outside blood vessels (e.causes of bleeding not directly due to trauma >Intravascular changes . AVMs. dissections.

The patient may have an internal hemorrhage that is invisible or an external hemorrhage that is visible on the outside of the body. • Bleeding into the spleen or liver is internal hemorrhage. . • Bleeding from a cut on the face is an external hemorrhage.

• Class II Hemorrhage involves 15-30% of total blood volume.Classification • Class I Hemorrhage involves up to 15% of blood volume. • Class III Hemorrhage involves loss of 30-40% of circulating blood volume. . • Class IV Hemorrhage involves loss of >40% of circulating blood volume.

Assessment: The px is assessed for signs of shock: >cool moist skin >falling blood pressure >increased heart rate >delayed capillary refill >decreasing urine volume .

it is not a quantitative assessment indicating the amount of bleeding.Laboratory &Diagnostics • Radiology and initial treatment • X-ray • FAST (Focused Assessment with Sonography for Trauma) • DPL (Diagnostic Peritoneal Lavage) DPL has 97 % sensitivity for blood in the peritoneal cavity. . However.

but as a method to control the bleeding by embolisation.• CT (Computed Tomography) CT scanning with intravenous contrast is considered “the gold standard” of trauma imaging. . • Angiography and angioembolisation Angiography in the trauma patient should not be seen only as a diagnostic tool. placement of covered stent grafts or insertion of balloon catheters.

Since this is the hallmark of shock.Laboratory tests No laboratory tests are diagnostic of major bleeding. Frequent arterial blood gas (ABG) tests are useful in providing information on the presence of metabolic acidosis. the test can be used as an adjunct to determine when the patient is fully resuscitated. A full screen should be performed from venous blood drawn within the ED. . The only crucial blood sample is the one used for assessing the ABO-blood type and cross matching.

before you try to stop severe bleeding. Don't reposition displaced organs. wash your hands to avoid infection and put on synthetic gloves. If the wound is abdominal and organs have been displaced. .If possible. don't try to push them back into place — cover the wound with a dressing.

Management • Fluid Replacement is imperative to maintain circulation two large-bore intravenous cannulae are inserted may include isotonic solution. colloid and blood component therapy .

.O-negative blood for women of child bearing age and in emergent situation. Additional platelets and clotting factors are given.

• Control of external Hemorrhage rapid physical assessment  firm pressure is applied over the bleeding area or the involved artery The injured part is elevated immobilize extremity apply torniquet as a last resort when external hemorrhage cannot be controlled in any other way .

• Control of internal Bleeding Packed red blood cells (O-negative) are administered at a rapid rate Surgery Pharmacologic therapy Arterial blood specimens obtained Px maintained in supine .

Ineffective Tissue Perfusion Deficient Fluid Volume Decreased Cardiac Output .

Hemostatic resuscitation for massive bleeding: the paradigm of plasma and platelets--a review of the current literature. .

What appropriate IVF should he administer? a.)D50W c.)D5IMB .33% NaCl d. Nurse Fidz is going to administer an IVF to a patient experiencing hemorrhage.QUESTIONS 1.) 0.) Lactated Ringer’s solution b.

) Apply tourniquet proximal to the wound for 30 min. . Which of the following is not a management for patients with massive bleeding? a. c.2.) Apply pressure directly to the wound.) Have the injured lie down and cover the person. d. b.) Administer isotonic solution as prescribed.

) Insertion of balloon catheter for angiography c. Within the resuscitation area he is indicated for X-ray examination and revealed massive hemothorax.) Administer coagulants . What is the appropriate intervention? a. Patient is rushed to the Hospital because of trajectory gunshot wound.) Chest drain insertion b.3.

nlm.References Brunner and Suddarth’s Medical Surgical Nursing volume 2 Nurse’s Pocket Guide www.nih.ncbi.com .gov www.wikipedia.

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