Definitions

Definitions

Revealed and concealed haemorrhage Haemorrhage may be revealed or concealed. Revealed haemorrhage is obvious external haemorrhage, such as exsanguination from an open arterial wound or from massive haematemesis from a duodenal ulcer. Concealed haemorrhage is contained within the body cav ity and must be suspected, actively investigated and controlled. In trauma, haemorrhage may be concealed within the chest, abdomen, pelvis, r etroperitoneum or in the limbs with con tained vascular injury or associated with long-bone fractures. Examples of non-traumatic concealed haemorrhage include occult gastrointestinal bleeding or ruptured aortic aneurysm. Primary, reactionary and secondary haemorrhage Primary haemorrhage is haemorrhage occurring immediately as a result of an injury (or surgery). Reactionary haemorrhage is delayed haemorrhage (within 24 hours) and is usually due to dislodgement of a clot by resus citation, normalisation of blood pressure and vasodilatation. Reactionary haemorrhage may also be due to technical failure, such as slippage of a ligature. Secondary haemorrhage is due to sloughing of the wall of a vessel. It usually occurs 7–14 days after injury and is precip itated by factors such as infection, pressure necrosis (such as from a drain) or malignancy . Surgical haemorrhage is due to a direct injury and is amenable to surgical control (e.g. suture ligation) or other techniques such as angioembolisation. Non-surgical haemorrhage is general bleeding from raw surfaces and mucous membranes due to coagulopathy and cannot be stopped by surgical means (except packing). Treat - ment requires correction of the coagula tion abnormalities. Diagnosis of active bleeding: response to fluid therapy The mode of resuscitation is determined by whether patients are actively bleeding, which requires a dynamic assessment of the blood pressure response to volume infusion. Patients who are ‘non-responders’ or ‘transient responders’ are still bleeding and must have the site of haemorrhage identified and controlled. Responder There is a good and sustained improvement in blood pressure in response to a bolus transfusion. Transient responder There is an improvement in the blood pressure but this is not sustained. The rate of haemorrhage is less than the rate of volume administration. Non-responder There is no improvement in the blood pressure to a bolus transfusion. The rate of haemorrhage is greater than the rate - of volume administration. -

TABLE 2.3 Traditional classi /f_i cation of haemorrhagic shock. 1 Blood volume lost as percentage of total <15%

Definitions

Revealed and concealed haemorrhage Haemorrhage may be revealed or concealed. Revealed haemorrhage is obvious external haemorrhage, such as exsanguination from an open arterial wound or from massive haematemesis from a duodenal ulcer. Concealed haemorrhage is contained within the body cav ity and must be suspected, actively investigated and controlled. In trauma, haemorrhage may be concealed within the chest, abdomen, pelvis, r etroperitoneum or in the limbs with con tained vascular injury or associated with long-bone fractures. Examples of non-traumatic concealed haemorrhage include occult gastrointestinal bleeding or ruptured aortic aneurysm. Primary, reactionary and secondary haemorrhage Primary haemorrhage is haemorrhage occurring immediately as a result of an injury (or surgery). Reactionary haemorrhage is delayed haemorrhage (within 24 hours) and is usually due to dislodgement of a clot by resus citation, normalisation of blood pressure and vasodilatation. Reactionary haemorrhage may also be due to technical failure, such as slippage of a ligature. Secondary haemorrhage is due to sloughing of the wall of a vessel. It usually occurs 7–14 days after injury and is precip itated by factors such as infection, pressure necrosis (such as from a drain) or malignancy . Surgical haemorrhage is due to a direct injury and is amenable to surgical control (e.g. suture ligation) or other techniques such as angioembolisation. Non-surgical haemorrhage is general bleeding from raw surfaces and mucous membranes due to coagulopathy and cannot be stopped by surgical means (except packing). Treat - ment requires correction of the coagula tion abnormalities. Diagnosis of active bleeding: response to fluid therapy The mode of resuscitation is determined by whether patients are actively bleeding, which requires a dynamic assessment of the blood pressure response to volume infusion. Patients who are ‘non-responders’ or ‘transient responders’ are still bleeding and must have the site of haemorrhage identified and controlled. Responder There is a good and sustained improvement in blood pressure in response to a bolus transfusion. Transient responder There is an improvement in the blood pressure but this is not sustained. The rate of haemorrhage is less than the rate of volume administration. Non-responder There is no improvement in the blood pressure to a bolus transfusion. The rate of haemorrhage is greater than the rate - of volume administration. -

TABLE 2.3 Traditional classi /f_i cation of haemorrhagic shock. 1 Blood volume lost as percentage of total <15%

Definitions

Revealed and concealed haemorrhage Haemorrhage may be revealed or concealed. Revealed haemorrhage is obvious external haemorrhage, such as exsanguination from an open arterial wound or from massive haematemesis from a duodenal ulcer. Concealed haemorrhage is contained within the body cav ity and must be suspected, actively investigated and controlled. In trauma, haemorrhage may be concealed within the chest, abdomen, pelvis, r etroperitoneum or in the limbs with con tained vascular injury or associated with long-bone fractures. Examples of non-traumatic concealed haemorrhage include occult gastrointestinal bleeding or ruptured aortic aneurysm. Primary, reactionary and secondary haemorrhage Primary haemorrhage is haemorrhage occurring immediately as a result of an injury (or surgery). Reactionary haemorrhage is delayed haemorrhage (within 24 hours) and is usually due to dislodgement of a clot by resus citation, normalisation of blood pressure and vasodilatation. Reactionary haemorrhage may also be due to technical failure, such as slippage of a ligature. Secondary haemorrhage is due to sloughing of the wall of a vessel. It usually occurs 7–14 days after injury and is precip itated by factors such as infection, pressure necrosis (such as from a drain) or malignancy . Surgical haemorrhage is due to a direct injury and is amenable to surgical control (e.g. suture ligation) or other techniques such as angioembolisation. Non-surgical haemorrhage is general bleeding from raw surfaces and mucous membranes due to coagulopathy and cannot be stopped by surgical means (except packing). Treat - ment requires correction of the coagula tion abnormalities. Diagnosis of active bleeding: response to fluid therapy The mode of resuscitation is determined by whether patients are actively bleeding, which requires a dynamic assessment of the blood pressure response to volume infusion. Patients who are ‘non-responders’ or ‘transient responders’ are still bleeding and must have the site of haemorrhage identified and controlled. Responder There is a good and sustained improvement in blood pressure in response to a bolus transfusion. Transient responder There is an improvement in the blood pressure but this is not sustained. The rate of haemorrhage is less than the rate of volume administration. Non-responder There is no improvement in the blood pressure to a bolus transfusion. The rate of haemorrhage is greater than the rate - of volume administration. -

TABLE 2.3 Traditional classi /f_i cation of haemorrhagic shock. 1 Blood volume lost as percentage of total <15%