HEMORRHAGE

Hemorrhage is a process of bleeding from the system of blood vessels that caused by accidental injury ( open or closed ) or wound surgery.

Hemorrhage can be cause anoxia on tissue due to reduced oxygen transported by the blood, this condition can be continue to shock irreversible until death if the volume of blood incirculation declined sharply. Hemorrhage can prolong the process healing of wound because the blood clot that forms will inhibit attachment both of edge surface of wound and can become a medium for growth of microorganisms. Hemorrhage can inhibit procedure of surgery because complicates the identification of tissue and anatomical structures.

The process of hemorrhage can occur by :

1. Diapedesis ( radiation ).In the case of hemorrage effect of injuries, disorders of blood clotting time,and occurred spontaneously due to abnormalities around of blood vessels, neoplasm, infection and increased blood pressure suddenly.

2. Reksis ( seeps ).The type of hemorrhage according to place of origin occurred hemorrhage (arterial, venous, capillary ), and based on the time of occur hemorrhage (primary, intermedier, secondary ).

The type of hemorrhage are :

A. The type of hemorrhage according to place of origin occurred hemorrhage.

1. Arterial hemorrhage.

Blood came out by radiation and bright red because it has levels of oxygen high.

2. Vein hemorrhage .

Blood came out seeped and the dark red because they have the levels of oxygen low.

3. Capillaries hemorrhage.

Blood came out seeped and blood dark that come from small blood vessels.

B. The type of hemorrhage based on the time of occur hemorrhage.

1. Primary hemorrhage.

Hemorrhage which occur coincided with the formation of the wound, type of the subcutaneous bleeding and cause contusion on the skin.

2. Intermedier hemorrhage.

Hemorrhage which occurred within 24 hours the formation of the wound, type ofthe bleeding in cases of shock or conditions with low blood pressure.

3. Secondary hemorrhage.

Hemorrhage that happened more than 24 hours after the formation of the wound.type of the bleeding due to release of ligation, nekrose or vessel ulsera inligation, low blood pressure during surgery.

The cause of hemorrhage are :

1. Vulnus.

The type of accidental injury or surgery injury which is marked by the existence of incontinuitas tissue by cellular or anatomical, effect of contactwith sharp objects or blunt object. For example: penetration wound, incisionwounds, lacerations and contusions.

2. In certain circumstances with disorder of blood-clotting that manifestation of blood clotting time that increase. For example: liver disease, warfarinintoxication, radiation repeatedly, cases of haemophilia and anaphylactic shock.

3. Occurred spontaneously.

Abnormalities can occur in around blood vessels, neoplasm, infection and increased blood pressure spontaneously.

Procedures termination of hemorrhage :

1. Tamponade.

In mild cases hemorrhage can be done emphasis with tampon for certain period in the region of hemorrhage until occur process of blood clotting. This action give process of wound healing is the best, because not found there are corporaaliena such thread, knot or necrotic tissue, but can occur secondary bleeding that caused by the release of thrombus.

2. Strangulation and torsio.

This action require instrumen of hemostatik forceps, vascular forceps and onlycan be done at hemorrhage that come from the small blood vessels ( capillaries).

3. Blood vessels ligation.

Action hemostasis with suture the blood vessels only, or include some tissue around blood vessels that damage. This action give good results for hemorrhage that come from large blood vessels ( veins, arteries ), but must be observedmaking node can cause disruption on process of healing wound.

4. Suture.

This action aims to overcome hemoragi and relates both sides of the wound surface.

5. Tourniquette.

In hemorragi come from blood vessels adjacent with bone can be done ligati on outside of leather with the aim of pressing the blood vessels to bone. Use of this tourniquette should not be too long because it can cause nerve damage, necrotic tissue, trauma of subcutaneous tissue and cutaneous, tourniquette thus should be removed every 20 minutes for reoxygenasi tissue. This action is only temporary, so to perfect haemostasis can be performed ligation on blood vessel.

6. Giving local medicamenta ( EDSA ).

Use of this medicamenta have task for adstringensia of blood vessels and surrounding tissue. Can be applied to superficial wounds and abrasion woundswith to paste medicamenta materials ( silver nitrate, sulfate ferry, ferrychloride, glacial acetic acid, a solution of povidone iodine ) for certain period in the region of hemorrhage until occur blood clotting.

7. Electricity.

This procedure requires cauter electricity and forceps diathermy low voltage with task of the resulting of heat that searing tissue and forming necrotic tissue with task as inhibitor on the blood vessels. If use small objects withlow voltage of electricity can use tissue incision ( electro surgery ). The weakness of this action can form secondary hemorrhage that caused by the loss of necrotic tissue that is formed.

8. Giving systemic haemostatica.

Giving hemostatica can contribute to the process of blood clotting or can giving other material that can help the process of blood clotting. For example: vitamin K, vitamin C, calcium, full blood transfusions ( WBC ) to add thereduced blood components, ergometrin to reduce hemorrhage post partum witheffect vasoconstriction extra vascular uterus.

9. Specific coagulants.

Giving by intra-venous with blood components that act directly on the blood clotting process. For example: fibrin, thrombin.

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