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Haemorrhage (Bleeding)

Mohd Nidzammuddin Mohd Azhar

Bachelor of Nursing (Hons) Kulliyyah of Nursing, IIUM, Kuantan Campus

1) 2) 3) 4) 5) 6) Definition of Bleeding Types of Bleeding Cause of Bleeding Symptom of Bleeding Kadar Pendarahan Treatment of Bleeding

1. Definition
Bleeding refers to the loss of blood. Bleeding can happen inside the body (internally) or outside the body (externally). It may occur:
Inside the body when blood leaks from blood vessels or organs Outside the body when blood flows through a natural opening (such as the vagina, mouth, or rectum) Outside the body when blood moves through a break in the skin

2. Types of Bleeding
Postoperative hemorrhage - after surgery Postpartum hemorrhage - from childbirth Arterial hemorrhage - from an artery Venous hemorrhage - from a vein Capillary hemorrhage - from a capillary Primary hemorrhage - if bleeding immediately follows an injury Reactionary hemorrhage - delayed bleeding after injury Secondary hemorrhage - delayed bleeding from sepsis Hematuria - blood in the urine from urinary bleeding Hemoptysis - coughing up blood from the lungs Hematemesis - bleeding in the stomach

Internal bleeding
Def: bleeding that can't be seen on the outside of the body The internal bleeding may occur within tissues, organs, or in cavities of the body including the head, chest, and abdomen Internal bleeding occurs when damage to an artery or vein allows blood to escape the circulatory system and collect inside the body.

Cause internal bleeding

1. Blunt trauma Most people understand that falling from a height or being involved in a car accident can inflict great force and trauma upon the body. 2. Deceleration trauma Deceleration may cause organs in the body to be shifted inside the body. This may shear blood vessels away from the organ and cause bleeding to occur. This is often the mechanism for intracranial bleeding such as epidural or subdural hematomas.

3. Fractures Bleeding may occur with broken bones. Bones contain the bone marrow in which blood production occurs. They have rich blood supplies, and significant amounts of blood can be lost with fractures. The break of a long bone such as the femur (thigh bone) can result in the loss of one unit (350-500cc) of blood. Flat bones such as the pelvis require much more force to cause a fracture, and many blood vessels that surround the structure can be torn by the trauma and cause massive bleeding.

4. Pregnancy Bleeding in pregnancy is never normal, though not uncommon in the first trimester, and is a sign of a potential miscarriage. Early on, the concern is a potential ectopic or tubal pregnancy, in which the placenta and the fetus implant in the Fallopian tube or another location outside of the uterine cavity. As the placenta grows, it erodes through the tube or other involved organs and may cause fatal bleeding.

Bleeding after 20 weeks of pregnancy may be due to placenta previa or placental abruption, and urgent medical care should be accessed. Placenta previa describes the situation in which the placenta attaches to the uterus close to the opening of the cervix and may cause painless vaginal bleeding. Abruption occurs when the placenta partially separates from the uterine wall and causes significant pain with or without bleeding from the vagina.

5. Spontaneous bleeding Internal bleeding may occur spontaneously, especially in those people who take anticoagulation medications or who have inherited bleeding disorders. Routine bumps that occur in daily life may cause significant bleeding issues. 6. Medication Internal bleeding may be caused as a side effect of medications (most often from nonsteroidal antiinflammatory drugs such as ibuprofen and aspirin) and alcohol. These substances can cause inflammation and bleeding of the esophagus, stomach, and duodenum, the first part of the small intestine as it leaves the stomach. 7. Alcohol abuse Long-term alcohol abuse can also cause liver damage, which can cause bleeding problems through a variety of mechanisms.

3. Cause
bleeding disorder (e.g. hemophilia) a low platelet count anticoagulant medications a broken or ruptured blood vessel and severe trauma. that could possibly cause Hemorrhage includes:
Injury Bleeding disorders Hemophilia Leukemia

4. Symptoms of Bleeding
Pale, cool, clammy skin Fast heart rate Low blood pressure Light-headedness Unconsciousness Death within seconds to minutes (in severe cases) Blood coming from an open wound Bruising Shock, which may cause any of the following symptoms:
Confusion or decreasing alertness Clammy skin Dizziness or light-headedness after an injury Low blood pressure Paleness (pallor) Rapid pulse, increased heart rate Shortness of breath Weakness

Symptoms of Internal Bleeding may also include: Abdominal pain and swelling Chest pain External Bleeding through a natural opening
Blood in the stool (appears black, maroon, or bright red) Blood in the urine (appears red, pink, or tea-colored) Blood in the vomit (looks bright red, or brown like coffee-grounds) Vaginal bleeding (heavier than usual or after menopause)

Skin color changes that occur several days after an injury (skin may black, blue, purple, yellowish green

5. Kadar Pendarahan
Perdarahan terbahagi kepada beberapa kelas menurut jumlah Cavity/ volume darah yang keluar: - Perdarahan kelas I : Darah yang keluar melibatkan sehingga 15% isi padu darah. Lazimnya tiada perubahan vital sign dan dalam pemulihan pemberian bendalir / cairan biasanya tidak perlu. - Perdarahan kelas II : Darah yang keluar melibatkan 15-30% jumlah isi padu darah. Lazimnya tidak perlu pemindaan darah.

- Perdarahan kelas III : Darah yang keluar melibatkan kehilangan isi padu darah sehingga 30-40% pemindaan darah perlu. - Perdarahan kelas IV : Melibatkan kehilangan darah sehingga > 40% dari jumlah isi padu dalam peredaran darah.
Tindakan segera sangat diperlukan bagi mencegah kematian.

6. Treatment of Bleeding
For severe bleeding, apply immediate, direct pressure to the wound with any available, clean material. Continue pressure until the bleeding is controlled. Elevate the wound above the heart. The person should be lying down with the legs elevated. Apply a tourniquet only if other means to control life-threatening bleeding do not work. Tighten the tourniquet only enough to stop the bleeding. Note the time the tourniquet was applied and remove as soon as possible.

How to treat different types of bleeding

1. Capillary bleeding: this occurs with a minor cut or scrape. Bleeding is light, and usually stops itself as the blood clots. Applying gentle pressure can help to stop the bleeding, but it will usually stop itself fairly quickly. Wash the wound with water, and use an alcohol wipe if you can.

2. Venous bleeding: This is heavier than capillary bleeding, and occurs in deep cuts that have reached a vein. It results in a steady but slow flow of dark red blood. This type of bleeding can be treated by applying firm, direct pressure to the wound. Once the bleeding has stopped, wash the wound and cover it with a sterile dressing. If the blood does not stop after a few minutes, seek medical assistance.

3. Arterial bleeding: This is the most serious type of bleeding, and occurs with very deep wounds. Bright red blood spurts out of the wound, and can be fatal if not treated quickly. This type of bleeding requires more complex treatment. The victim should lie down, with their head lower than their trunk and their feet elevated. This reduces the risk of fainting.

Elevation of the bleeding body part is also helpful, as it can slow down the rate at which the blood escapes from the wound. Large chunks of debris should be removed from the wound. However, any impaled objects should not be touched. Apply extremely firm pressure to the wound, preferably using a sterile bandage or cloth If the blood begins to seep through this, apply something else over the top of it (do not remove it). Apply firm pressure until medical help arrives.


Cover any exposed wounds with a dressing Do not touch infected wounds or potentially infected material (eg. Dressings) with bare hands After administering First Aid - soak clothes in cold water for at least 60 minutes then machine wash using hot water and detergent Clean contaminated surfaces with strong bleach solution. Treat all people equally-assume all are infectious

Wash hands thoroughly with soap & water and dry Wash hands after dressing an open wound Wear disposable gloves whenever possible Change gloves for each casualty Change gloves if torn during treatment Avoid touching an open wound

Make a Nursing Process

By referring to our lecture today, makes 1 Nursing Process (1 Actual & 1 Potential) (15 min)

*buat yek, jgn tiru2x..

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http://www.medicinenet.com/internal_bleedi ng/page2.htm