Diagnosis & Assessment of Hemorrhage

Diagnosis & assessment of  hemorrhage

1. History-about predisposing factors, time & mode of onset.
2. General examination –Appearance, pulse, B.P.,respiration.
3. Local examination –Evidence of hemorrhage-concealed, revealed, associated injuries .
4. Investigation-

(a)For assessment of extent of bleeding-

1. Measurement of lost blood ,e.g., clot size of a clenched fist is roughly equal to 500ml.

2. Urinary output

3. CVP

4.Blood TC, DC,Hb% haematocrit , grouping &cross matching , blood urea

(b)For detection of sources of bleeding-

1.       BT,CT

2.       Radiology.

3.       Endoscopy

4.       Surgical exploration.

Treatment:

1. Stoppage (control) of blood loss by-

i.   Pressure & packing

ii.  Position (elevation)& rest with sedation

iii.Operation , lightion ,repair, excision, tourniqued , cauterization(electrical, chemical)

2. Restore blood volume by-

i.   Blood transfusion-

ii.  I/V fluid- 5%DNS ,saline

iii. Plasma, gelatin, dextrin.

Wounds : Decontamination of surface epithelium of skin is known as wound.

Types of wounds:

1. According to  infection-

1. Ascetic wound : One which is not infected by pathogen,
2. Septic wound : one that is infected with pathogen.

2. According to the type of injury-

1.Contused wound: A wound in which skin is unbroken.

2.Incised wound: One made by cutting instrument.

3.Lacerated wound: Where laceration with Massine tissue damage occurs.

4.Penetrating wound : Which pens through the skin into the underline structure usually caused by a sharp blander object.