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[Audio] In this lecture we will discuss about Hemorrhage

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[Audio] Outline Introduction Definition Natural arrest of hemorrhage Factors affecting hemorrhage Types & causes Signs & symptoms Effects of hemorrhage Control of external hemorrhage First aid treatment of external hemorrhage Control of internal hemorrhage First aid treatment of internal hemorrhage Special sites of hemorrhage

Introduction Definition Natural arrest of hemorrhage Factors affecting hemorrhage Types & causes Signs & symptoms Effects of hemorrhage Control of external hemorrhage First aid treatment of external hemorrhage Control of internal hemorrhage First aid treatment of internal hemorrhage Special sites of hemorrhage

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[Audio] Hemorrhage Hemorrhage is the loss of blood vessel.The blood loss is described as extra vasculated(outside the vessel).it may lie on the surface of body, on patients clothing or on the floor. Blood may be lost from all three types of vesseles, the arteries , the vein or capillaries

 Hemorrhage is the loss of blood vessel.The blood loss is described as extra vasculated(outside the vessel).it may lie on the surface of body, on patients clothing or on the floor. Blood may be lost from all three types of vesseles, the arteries , the vein or capillaries

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[Audio] Hemmorrhage can also be define as : The term hemorrhage refers to excess loss of blood due to rupture of blood vessel. Or Lose blood from the body as a result of injury or illness Or Hemorrhage means the loss of blood from the vascular system associated with an absolute reduction in the circulating blood volume

The term hemorrhage refers to excess loss of blood due to rupture of blood vessel. Or Lose blood from the body as a result of injury or illness Or Hemorrhage means the loss of blood from the vascular system associated with an absolute reduction in the circulating blood volume

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[Audio] Natural arrest of hemorrhage : Adequate amount of calcium is required & all the clotting factors are essential for the natural arrest of hemorrhage. The blood in the circulation is kept fluid by a fine balance between clotting & fibrinolysis. 1st of all When a tissue is damaged Then Prothrombin is converted in to its active from thrombin(in to presence of calcium) In next step Fibrinogen then transformed by thrombin to fibrin finally Mesh is formed by platelets & other blood to form clot

Adequate amount of calcium is required & all the clotting factors are essential for the natural arrest of hemorrhage. The blood in the circulation is kept fluid by a fine balance between clotting & fibrinolysis. When a tissue is damaged Prothrombin is converted in to its active from thrombin(in to presence of calcium) Fibrinogen then transformed by thrombin to fibrin Mesh is formed by platelets & other blood to form clot

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[Audio] Platelets contribute via adhesion, activation and aggregation, which are triggered upon tissue injury, and these actions stimulate the coagulation factors and other mediators to achieve hemostasis. Fibrin threads wind around the platelet plug at the damaged area of the blood vessel, forming an interlocking network of fibers and a framework for the clot. This net of fibers traps and helps hold platelets, blood cells, and other molecules tight to the site of injury, functioning as the initial clot.

Calcium Prothro m bi n Fibrinogen

Stage I Injured vessel Stage II stage Ill Fibrin fibers 2 a Prothrombin Fibrinogen Prothrombin activator (PTA) Thrombin Trapped red blood cells (ABCs) Blood clot

Red blood cell O Platelet Fibrin Activated platelet Blood vessel wall

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[Audio] Causes of hemorrhage :  There are many causes of bleeding but few of the most commonest are discussed here in this presentation and they are as follows: 1. WOUNDS A break in the continuity of skin, is termed as wound. Various types of wounds are as follows:- Incised wound laceration Abrasion Contusion Punctured wound Gunshot Wound

 There are many causes of bleeding but few of the most commonest are discussed here in this presentation and they are as follows: 1.WOUNDS A break in the continuity of skin, is termed as wound. Various types of wounds are as follows:- Incised wound laceration Abrasion Contusion Punctured wound Gunshot Wound

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[Audio] FRACTURE OF LARGE BONES INTRAOPERATIVE PERIOD ROAD TRAFFIC ACCIDENT BLUNT TRAUMATIC INJURY INVASSIVE DIAGNOSTIC PROCEDURES is, percutaneous surgery which involves needle puncture of the skin, laparoscopic surgery commonly called keyhole surgery, a coronary catheter, angioplasty and stereotactic surgery. ANATOMICAL DEFECTS CANINE BITE is also called as dog bite CRUSH INJURY VARICOSE BLEEDING

FRACTURE OF LARGE BONES INTRAOPERATIVE PERIOD ROAD TRAFFIC ACCIDENT BLUNT TRAUMATIC INJURY INVASSIVE DIAGNOSTIC PROCEDURES ANATOMICAL DEFECTS CANINE BITE CRUSH INJURY VARICOSE BLEEDING

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[Audio] incised wound is a wound or cut caused by a clean, sharp object. Examples of these types of wounds include surgical incisions and cutting the skin with a knife, razor, or broken glass.

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[Audio] Incised wound on hand

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[Audio] Gunshot wound

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[Audio] Road traffic accident

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[Audio] Laceration – A messy looking wound caused by a tearing or crushing force.Unlike an abrasion, none of the skin is missing. A cut is typically thought of as a wound caused by a sharp object, like a shard of glass. Lacerations tend to be caused by blunt trauma.

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[Audio] Contusion is the medical term for a bruise. It is the result of a direct blow or an impact, such as a fall. Contusions are common sports injuries. A contusion is an injury that causes bleeding and tissue damage underneath the skin, usually without breaking the skin. Any injury that puts pressure on an area repetitively can cause a contusion. A contusion happens when an injured capillary or blood vessel leaks blood into the surrounding area. Contusions are a type of hematoma, which refers to any collection of blood outside of a blood vessel

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[Audio] When an abrasion is caused by the skin sliding across hard ground, it may be called road rash. abrasions ( scrapes) that don't penetrate too far below the skin.

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[Audio] According to World health organization classification of wound are divided into 5 grades : Grade0-no bleeding Grade1-petechial bleeding Grade2-mild blood loss(clinically significant) Grade3-gross blood loss, requires transfusion Grade4-debilitating blood loss, retinal or cerebral associated with fatality.

Classification-

World health organization Grade0-no bleeding Grade1-petechial bleeding Grade2-mild blood loss(clinically significant) Grade3-gross blood loss, requires transfusion Grade4-debilitating blood loss, retinal or cerebral associated with fatality.

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[Audio] Hemorrhaging is broken down into four classes by the American College of Surgeons' advanced trauma life support ( 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 2 Hemorrhage : involves 15- 30% of total blood volume. A patient is often tachycardic reduction in blood pressures. The body attempts to compensate with peripheral vasoconstriction. Skin may start to look pale and be cool to the touch. The patient may exhibit slight changes in behavior. Volume resuscitation with crystalloids ( Saline solution or Lactated Ringer's solution) is all that is typically required. Blood transfusion is not usually required. Class 3 Hemorrhage : involves loss of 30- 40% of circulating blood volume.The patient's blood pressure drops, the heart rate increases, peripheral hypoperfusion ( shock) with diminished capillary refill occurs, and the mental status worsens. Fluid resuscitation with crystalloid and blood transfusion are usually necessary. Class 4 Hemorrhage : involves loss of > 40% of circulating blood volume.The limit of the body's compensation is reached and aggressive resuscitation is required to prevent death.

Hemorrhaging is broken down into four classes by the American College of Surgeons' advanced trauma life support (ATLS).

Hemorrhaging is broken down into four classes by the American College of Surgeons' advanced trauma life support (ATLS).

Class I Hemorrhage involves up to 15% of blood volume.. Class II Hemorrhage involves 15-30% of total blood volume. Class III Hemorrhage involves loss of 30-40% of circulating blood volume. Class IV Hemorrhage involves loss of >40% of circulating blood volume.

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[Audio] 1.arterial bleeding, the blood comes from the artery and pumps out with each heart beat blood is typically bright red to yellowish in colour, due to the high degree of oxygenation. 2.Venous bleeding flow may appear fast at first, blood loss is usually slight and is easily controlled. venous bleeding, the blood runs out at a steady rate. The color of the blood dark red to purplish in color. 3.Bleeding from a capillary could be described as a ' trickle' of blood. Which means blood flow slowly.

According to situation-

Arterial hemorrhage (Blood jet) Capillary hemorrhage Venous hemorrhage

ARTERIES • Spurting blood • Pulsating flow • Bright red color VEINS • Steady. slow flow • Dark red color CAPILLARIES • Slow, even flow

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[Audio] According to the time of wound; Primary hemorrhage(occurs within the intra-operative period) Reactionary or intermediate hemorrhage(occurs within 24 hours of operation) 3.Secondary hemorrhage(occurs 7- 10 days post-operatively) Clinical classification of the hemorrhage; Revealed or External Concealed or Internal 3.Accidental hemorrhage –

According to the time of wound ; Primary hemorrhage ( occurs within the intra-operative period) Reactionary or intermediate hemorrhage ( occurs within 24 hours of operation) 3.Secondary hemorrhage ( occurs 7-10 days post-operatively) Clinical classification of the hemorrhage; Revealed or External Concealed or Internal 3 .Accidental hemorrhage –

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[Audio] Accidental hemorrhage is of two types; A. Primary hemorrhage : is often due to some common causes B. Secondary hemorrhage :  is often due to erosion of a vessel from a spreading infection. Post-partum hemorrhage-excess bleeding that occurs immediately after labor( delivery of baby) is called post partum hemorrhage. Hemorrhage due to premature detachment of placenta -in some cases the placenta is detached from the uterus of mother before the due to date of delivery causing severe hemorrhage.

Accidental hemorrhage is of two types; A . Primary hemorrhage B. Secondary hemorrhage Post-partum hemorrhage - excess bleeding that occurs immediately after labor( delivery of baby) is called post partum hemorrhage. Hemorrhage due to premature detachment of placenta - in some cases the placenta is detached from the uterus of mother before the due to date of delivery causing severe hemorrhage.

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[Audio] Sign And symptoms of hemorrhage include ; Early signs & symptoms- Restlessness & anxiety Feeling faint Coldness( temp.slightly subnormal) Pallor Patient feels thirsty Signs & symptoms after severe hemorrhage- Extreme pallor Child sensation Air hunger Rapid thredy pulse Extremely low blood pressure Extreme thirst

Early signs & symptoms- Restlessness & anxiety Feeling faint Coldness( temp.slightly subnormal) Pallor Patient feels thirsty Signs & symptoms after severe hemorrhage- Extreme pallor Child sensation Air hunger Rapid thredy pulse Extremely low blood pressure Extreme thirst

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[Audio] Dminished urine output If it's left untreated, it's possible that decreased urine output can cause medical complications, such as: hypertension. heart failure. anemia Blindness tinnitus & coma occur prior death Tinnitus is when you experience ringing or other noises in one or both of your ears

Dminished urine output Blindness tinnitus & coma occur prior death

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[Audio] fainting

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[Audio] conjunctiva of eye look paler on examination

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[Audio] Restlessness and anxiety also occur during this

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[Audio] Patient also feel thirsty during hemorrhage

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[Audio] Following are the effects of hemorrhage : On cardiovascular system- It Reduced blood after hemorrhage decreases venous return, ventricular filling & cardiac output. During mild hemorrhage- during slow or mild hemorrhage when there is loss of a small amount of blood up to 350- 500 ml the blood pressure decreases slightly & soon it returns back to normal. During severe hemorrhage- when hemorrhge is severe with lost of about 1500 to 2000 ml of blood , the arterial blood pressure falls to a great extend.

On cardiovascular system- Reduced blood after hemorrhage decreases venous return, ventricular filling & cardiac output. During mild hemorrhage- during slow or mild hemorrhage when there is loss of a small amount of blood up to 350-500 ml the blood pressure decreases slightly & soon it returns back to normal. During severe hemorrhage- when hemorrhge is severe with lost of about 1500 to 2000 ml of blood , the arterial blood pressure falls to a great extend.

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[Audio] On skin- it produce Vasoconstriction It increases the deoxygenation of blood. It results pallor in color of skin. Sometimes cyanosis develops. On tissue fluid- arteriole constriction decreases the capillary pressure. It helps to compensates the blood loss. On kidney- constriction of afferent & efferent arterioles of kidney after hemorrhage decreases the GFR very much, Therefore, the urinary output decreases.

On skin- Vasoconstriction It increases the deoxygenation of blood. It results pallor in color of skin. Sometimes cyanosis develops. On tissue fluid- arteriole constriction decreases the capillary pressure. It helps to compensates the blood loss. On kidney- constriction of afferent & efferent arterioles of kidney after hemorrhage decreases the GFR very much, Therefore, the urinary output decreases.

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[Audio] On Renin secretion- hypoxia produced after blood loss increases secretion of Renin from kidney & the subsequent formation of Angiotensin 2. It also increases release of aldosterone from adrenal cortex. Aldosterone causes retention of sodium On secretion of antidiuretic hormone – ADH is released in large quantities immediately after the hemorrhage. It is probably due to increased osmolality of body fluid by aldosterone induced sodium retention

On Renin secretion- hypoxia produced after blood loss increases secretion of Renin from kidney & the subsequent formation of Angiotensin 2. It also increases release of aldosterone from adrenal cortex. Aldosterone causes retention of sodium On secretion of antidiuretic harmone – ADH is released in large quantities immediately after the hemorrhage. It is probably due to increased osmolality of body fluid by aldosterone induced sodium retention.

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On respiration- hemorrhage causes stagnant hypoxia because of decreases in venous return, cardiac output. On nervous system- on reticular formatio n- The catecholamine stimulates the reticular activating system. it causes restlessness, anxiety and increased motar actvity after hemorrhage.

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2. on brain-  Through hemorrhage causes vasoconstriction in many organ of the body, it causes vaso-dilation in brain. 3. Fainting -  when hemorrhage is severe, cardiac output decreases & blood pressure falls. So, the blood flow to brain decreases resulting in unconsciousness. 4. cerebral ischemia -  when the blood flow to brain is severely affected due to hypoxia , ischemia of the brain tissue develops within 5 minutes. It causes irreversible damage to brain tissues

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[Audio] 1. Pad & Bandage- This is the simple method of applying direct pressure to a bleeding wound & is applicable to vast majority of cases. It is effective & causes no damage. Digital pressure- It is the pressure applied on the point of artery supplying blood to the area of wound. This will control hemorrhage temporally & is called indirect pressure. Elevation of the limb- It will control venous hemorrhage. This is a classical method of dealing with a sudden hemorrhage from a ruptured varicose vein of leg

1.Pad & Bandage- This is the simple method of applying direct pressure to a bleeding wound & is applicable to vast majority of cases. It is effective & causes no damage. Digital pressure- It is the pressure applied on the point of artery supplying blood to the area of wound. This will control hemorrhage temporally & is called indirect pressure. Elevation of the limb- It will control venous hemorrhage. This is a classical method of dealing with a sudden hemorrhage from a ruptured varicose vein of leg

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[Audio] 4. Application of tourniquet- A temporary tourniquet may have to be devised in sudden emergency. It should be 3- 4 inches wide. The great danger of tourniquet is that if it is self on for more than 30 min then gangrene of the limb may occur. 5.Surgical ligation-  It is necessary if the bleeding is persistent.

4 .Application of tourniquet- A temporary tourniquet may have to be devised in sudden emergency. It should be 3-4 inches wide. The great danger of tourniquet is that if it is self on for more than 30 min then gangrene of the limb may occur. 5.Surgical ligation-  It is necessary if the bleeding is persistent.

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[Audio] 6. coagulation-. It can be used to coagulate the blood from small blood vessels 7.Pack- It will temporarily control severe hemorrhage. This method is used in operation theater to control temporary or sudden hemorrhage. 8. styptics-  These are also used to control bleeding & they act as astringents. Astringents such as snake venom or adrenaline may be used locally in certain cases.

6.coagulation- .

It can be used to coagulate the blood from small blood vessels 7 .Pack- It will temporarily control severe hemorrhage. This method is used in operation theater to control temporary or sudden hemorrhage . 8.styptics-  These are also used to control bleeding & they act as astringents. Astringents such as snake venom or adrenaline may be used locally in certain cases.

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[Audio] First aid treatment given to patient in case of severe external bleeding include : Brings the sides of wound together & press firmly. Press on the pressure point for 10- 15min. Place the causality in comfortable position & raise the injured part & reassure him. Apply clean pad larger than the wound & press it firmly with the palm until bleeding becomes less. If bleeding continues do not take off original dressing but add more pads. Bandage, it but not too tightly.

Brings the sides of wound together & press firmly. Press on the pressure point for 10-15min. Place the causality in comfortable position & raise the injured part & reassure him. Apply clean pad larger than the wound & press it firmly with the palm until bleeding becomes less. If bleeding continues do not take off original dressing but add more pads. Bandage, it but not too tightly.

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[Audio] The following methods can be used to control internal bleeding- The organ is emptied of blood clots if possible in case of severe bleeding from bladder, a catheter is passed & bladder is emptied. The vessels are encouraged to contact a lots of saline or sodium bicarbonate to which a few drops of adrenaline solution have been added, is of great value in washing the organ.This can be repeated every two hourly. The use of ergometrine after the birth of placenta is an example of stimulating the vessel to contact pitosin IV may effective in control of bleeding from esophageal varies. Packing it can be done with gauze soaked in adrenaline is effective. Surgical ligature can be done in case of ruptured spleen.

The following methods can be used to control bleeding- The organ is emptied of blood clots if possible in case of severe bleeding from bladder, a catheter is passed & bladder is emptied. The vessels are encouraged to contact a lots of saline or sodium bicarbonate to which a few drops of adrenaline solution have been added, is of great value in washing the organ.This can be repeated every two hourly. The use of ergometrine after the birth of placenta is an example of stimulating the vessel to contact pitosin IV may effective in control of bleeding from esophageal varies. Packing it can be done with gauze soaked in adrenaline is effective. Surgical ligature can be done in case of ruptured spleen.

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[Audio] First aid treatment given to patient in case of severe internal bleeding include : The following methods can be used to control bleeding- The organ is emptied of blood clots if possible in case of severe bleeding from bladder, a catheter is passed & bladder is emptied. The vessels are encouraged to contact a lots of saline or sodium bicarbonate to which a few drops of adrenaline solution have been added, is of great value in washing the organ . This can be repeated every two hourly. The use of ergometrine after the birth of placenta is an example of stimulating the vessel to contact pitosin IV may effective in control of bleeding from esophageal varies. Packing it can be done with gauze soaked in adrenaline is effective. Surgical ligature can be done in case of ruptured spleen.

The following methods can be used to control bleeding- The organ is emptied of blood clots if possible in case of severe bleeding from bladder, a catheter is passed & bladder is emptied. The vessels are encouraged to contact a lots of saline or sodium bicarbonate to which a few drops of adrenaline solution have been added, is of great value in washing the organ.This can be repeated every two hourly. The use of ergometrine after the birth of placenta is an example of stimulating the vessel to contact pitosin IV may effective in control of bleeding from esophageal varies. Packing it can be done with gauze soaked in adrenaline is effective. Surgical ligature can be done in case of ruptured spleen.

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[Audio] IMPROVE OXYGENATION:- Reassure the patient and make him comfortable. Calm down the patient as anxiety may increase heart rate further causes complications. If patient is restless, irritable never give him opiods as it may further cause hpoxia. Clear the air way if it is obstructed with blood clots, blood or some dust particles. Turn head to one side Administer oxygen with the help of nasal canulla at the rate of 4 lit / minutes. During hypoxia patient is confused hence explain him the need of oxygenation and the purpose of nasal cannula.

IMPROVE OXYGENATION :- Reassure the patient and make him comfortable. Calm down the patient as anxiety may increase heart rate further causes complications. If patient is restless, irritable never give him opiods as it may further cause hpoxia. Clear the air way if it is obstructed with blood clots, blood or some dust particles. Turn head to one side Administer oxygen with the help of nasal canulla at the rate of 4 lit / minutes. During hypoxia patient is confused hence explain him the need of oxygenation and the purpose of nasal cannula.

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[Audio] RESTORE AND MAINTAIN ADEQUATE PERFUSION:- Assess the patient for the manifestation of hypoxia. Avoid hot application to treat hypothermia as it dilates peripheral blood vessels and pull away blood from vital organs. Use modified trend burg position for the patient to increase cardiac output. Provide blanket to the patient to prevent hypothermia. Check vital signs every 5 minutes specially blood pressure and pulse.

RESTORE AND MAINTAIN ADEQUATE PERFUSION:- Assess the patient for the manifestation of hypoxia. Avoid hot application to treat hypothermia as it dilates peripheral blood vessels and pull away blood from vital organs. Use modified trend burg position for the patient to increase cardiac output. Provide blanket to the patient to prevent hypothermia. Check vital signs every 5 minutes specially blood pressure and pulse.

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[Audio] TEMPERATURE MONITORING:- Temperature monitoring is very important in patient with shock. Check temperature by using rectal thermometer avoid axillary and oral temperature taking. CARDIAC MONITORING:- Monitor blood pressure of the patient every 5 minutes till patients systolic blood pressure comes to 100 mm of Hg. Check the pulse for the rate and rhythm. Monitor patients closely on cardiac monitors as patients with haemmorhagaic shock tend to have arrhythmias due to severe electrolytes imbalance. Measurement of CVP is important in hypovolemic shock as it helps us to prevent fluid overload.

TEMPERATURE MONITORING:- Temperature monitoring is very important in patient with shock. Check temperature by using rectal thermometer avoid axillary and oral temperature taking. CARDIAC MONITORING:- Monitor blood pressure of the patient every 5 minutes till patients systolic blood pressure comes to 100 mm of Hg. Check the pulse for the rate and rhythm. Monitor patients closely on cardiac monitors as patients with haemmorhagaic shock tend to have arrhythmias due to severe electrolytes imbalance. Measurement of CVP is important in hypovolemic shock as it helps us to prevent fluid overload.

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[Audio] BLEEDING CONTROL:- Assess the wound for the bleeding. Apply direct and firm pressure on the bleeding site. Inform the doctor immediately regarding bleeding. Prepare the patient for the surgery if required. Assist the doctor in ligation and closure of wound . Assure aseptic technique throughout the procedure , assess that wound is cleaned properly no foreign particles are left behind in the wound.

BLEEDING CONTROL:- Assess the wound for the bleeding. Apply direct and firm pressure on the bleeding site. Inform the doctor immediately regarding bleeding. Prepare the patient for the surgery if required. Assist the doctor in ligation and closure of wound . Assure aseptic technique throughout the procedure , assess that wound is cleaned properly no foreign particles are left behind in the wound.

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[Audio] ASSESS PATIENT FOR FLUID OVERLOAD:- While treating hypovolemia often rigorous fluid therapy is given which may cause complication such as pulmonary edema if not done carefully. Be alert for the signs and symptoms of pulmonary edema During fluid therapy assess cardiac as well as respiratory signs and symptoms which indicate pulmonary edema. Inform unfavorable changes immediately.

ASSESS PATIENT FOR FLUID OVERLOAD:- While treating hypovolemia often rigorous fluid therapy is given which may cause complication such as pulmonary edema if not done carefully. Be alert for the signs and symptoms of pulmonary edema During fluid therapy assess cardiac as well as respiratory signs and symptoms which indicate pulmonary edema. Inform unfavorable changes immediately.

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[Audio] PSYCHOLOGICAL SUPPORT TO THE PATIENT AND THE FAMILY:- Assure the patient and his family. As anxiety increases oxygen demand by increasing the heart rate hence calm down the patient. Keep family members informing about recent updates of patients condition and his progress. Explain use of various equipments to the client. Explain each and every procedure prior to doing it NUTRITION:- When patient is in hypovolemia , his BMR is increased hence there is more need of energy. Nutrition supplement is initiated as soon as possible.

PSYCHOLOGICAL SUPPORT TO THE PATIENT AND THE FAMILY:- Assure the patient and his family. As anxiety increases oxygen demand by increasing the heart rate hence calm down the patient. Keep family members informing about recent updates of patients condition and his progress. Explain use of various equipments to the client. Explain each and every procedure prior to doing it NUTRITION:- When patient is in hypovolemia , his BMR is increased hence there is more need of energy. Nutrition supplement is initiated as soon as possible.

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[Audio] BLOOD TRANSFUSION:- Check the blood bag for recipients details, group, expiry. Tally the name of patient with blood bag. Monitor the patient throughout for any reaction. Insure that informed written consent is obtained. Keep eye on vital signs to detect reaction at early stage. Use specially designed large bore transfusion set and set the rate as per order of physician. If reaction occurs stop the transfusion notify physician immediately. Do not live client alone during blood transfusion. Keep monitoring the patient for any life threatening reaction.

BLOOD TRANSFUSION:- Check the blood bag for recipients details, group, expiry. Tally the name of patient with blood bag. Monitor the patient throughout for any reaction. Insure that informed written consent is obtained. Keep eye on vital signs to detect reaction at early stage. Use specially designed large bore transfusion set and set the rate as per order of physician. If reaction occurs stop the transfusion notify physician immediately. Do not live client alone during blood transfusion. Keep monitoring the patient for any life threatening reaction.

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[Audio] The occurrence from special sites is designated by special term as : Epistaxis-It is bleeding from nose. Hemoptysis-It is expectation of bleed from lungs Haematemesis-It is the vomiting of bleed Malaena-It is the passage of dark blood per rectum from a site high in intestinal tract. Hematuria-It is the presence of blood in the urine. Haemothorax-It is the bleeding in to the chest Haemoperitonium-Bleeding in to the peritoneum.

The occurrence from special sites is designated by special term; Epistaxis- It is bleeding from nose. Hemoptysis -It is expectation of bleed from lungs Haematemesis -It is the vomiting of bleed Malaena -It is the passage of dark blood per rectum from a site high in intestinal tract. Hematuria -It is the presence of blood in the urine. Haemothorax -It is the bleeding in to the chest Haemoperitonium -Bleeding in to the peritoneum.

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[Audio] Menorrhagia-Excessive menstruation at normal interval. Haemopericardium—It is the bleeding in to the pericardium Hematomyalia-It is the bleeding in to the spinal cord.

Menorrhagia -Excessive menstruation at normal interval. Haemopericardium —It is the bleeding in to the pericardium Hematomyalia -It is the bleeding in to the spinal cord.