REACTIONARY HEMORRHAGE -ETIOLOGY ,CLASSIFICATION,PATHOPHYSIOLOGY, PRECIPITATING FACTORS ,CLINICAL FEATURES,TREATMENT

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     REACTIONARY HEMORRHAGE 

INTRODUCTION:

  • The term hemorrhage refers to excess loss of blood due to rupture of blood vessel


STUDENTS CORNER :
Start your answer by giving a short introduction to the topic followed by table of contents ,it can be visa versa to ,under the table of content mention etiology ,precipitating factors, pathophysiology ,clinical features and end it with treatment plan . Now let me give you a mnemonic that I used while preparing in order to remember etiology remember HTC MTC where:
H-HYDROCELE SURGERY 
 T-THYROID SURGERY 
 C-CHOLECYSTECTOMY 
M-MAJOR ABDOMINAL SURGERIES
T-TONSILLECTOMY 
C-CIRCUMSICION .
 To remember precipitating factors the mnemonic as:
 PBS ,CVS
P(SILENT )
 B- BLOOD PRESSURE
 S-STRAING 
 C-CLOT DISLODGEMENT 
 V- VOMITING
 S - SLIPPING OF LIGATURE .
Clinical feature CDC TROPHY 
C-CYANOSIS
 D-DRY FACE,DRY MOUTH 
 C-COLD CLAMMY SKIN 
 T- TACHYPNEA,TACHYCARDIA 
R- RAPID THREADY PULSE
 O-OLIGURIA
 P-PALLOR 
H- HYPOTENSION 
Y (SILENT ) 
Hope these mnemonic might have been useful if it helped you learn then do let me know in the comment section below as this would motivate me to post more such content .


CLASSIFICATION 1 (ACCORDING TO SITUATION ):

  • ARTERIAL -
Bright red 

Pulsating flow 

Spurting blood

VENOUS- 

  • Dark red colour ,steady slow flow

CAPILLARY - 

Bright red ,slow even flow 

CLASSIFICATION2 (ACCORDING TO TIME OF WOUND)

  • PRIMARY HEMORRHAGE-occur immediately 
  • REACTIONARY HEMORRHAGE-occurs in first 24 hours after operation
  • SECONDARY HEMORRHAGE- infection present ,blood vessel wall erode and burst 


CLASSIFICATION 3

  • REVELAED
  • CONCEALED
  • INTITIALLY CONCEALED BUT LATER REVEALED 

CLASSIFICATION 4 

  • ACUTE
  • CHRONIC
  • ACUTE ON CHRONIC HEMORRHAGE 

Classification by American college of surgeons "ADVANCED TRAUMA LIFE SUPPORT ".







ETIOLOGY :

  • Thyroid surgery
  • Cholecystectomy
  • Major abdominal surgeries
  • Circumcision
  • Hydrocele surgery
  • Tonsillectomy











PRECIPITATING FACTORS:

  • Coughing
  • Vomiting
  • Increased blood pressure
  • Clot dislodgement
  • Straining
  • Venous refilling during recovery from anesthesia
  • Slipping of ligature








PATHOPHYSIOLOGY:

  • Reactionary hemorrhage occur within 24 hours after surgery or after injury
  • Commonly in 4-6 hours 
  • Bleeding causes hypovolemia that lowers the cardiac output ,tachycardia resulting in hypoxia
  • Bleed starts when there is a rise in arterial or venous pressure






CLINICAL FEATURE:

  • Pallor
  • Cyanosis
  • Tachycardia
  • Cold clammy skin
  • Dry face
  • Dry mouth
  • Rapid thready pulse
  • Hypotension
  • Oliguria







TREATMENT :

  • IMMEDIATE RESUSCIATATION:

Airway 

breathing

circulation

  • Normal saline /ringer lactate infusion is started

control of hemorrhage:

  • Restoration of blood loss : by blood transfusion ,plasma infusion
  • Catheterization
  • Leg end elevation
  • CVP monitoring
  • Antibiotic
  • Pressure and packing
  • Absolute rest 








CONCLUSION:

HI! vanakam stencildent family members hope you all are doing good ,the aim of this post is purely educational moto only kindly do not practice self medication always do consult a doctor and dont assume  your prescription as it differs from person to person ,this post is just to share notes on reactionary hemorrhage so that it would be useful for last minute revision .

Thank you 

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