Pathology - haemorrhage

Introduction • Hemorrhage is extravasation of blood outside the blood vessel. • Hematoma-Hemorrhage enclosed within a tissue or a cavity • Exsanguination- total loss of blood • Desanguination- major loss • Hemorrhage is one of the basic problems and considerations in surgery • From trivial trauma or major abdominal organ injuries- congenital and acquired coagulation disorders • A wide spectrum of problems involves hemorrhage Classification of hemorrhage  According to the American College of Surgeons' ATLS • Class I Hemorrhage involves up to 15% of blood volume. • There is typically no change in vital signs and fluid resuscitation is not usually necessary. • Class II Hemorrhage -15-30% of total blood volume. Tachycardia is a narrow difference between the systolic and diastolic bp. –Body attempts to compensate with peripheral vasoconstriction. –Skin is pale and cold to the touch. The patient may exhibit slight changes in behavior. Volume resuscitation is required • Class III Hemorrhage -loss of 30-40% of circulating blood volume – Bp drops, the heart rate increases, peripheral hypoperfusion (shock), such as worsening of capillary refill and mental status