Internal bleeding syndrome

2021-01-26 12:00 AM

Bleeding in the natural compartments, but the blood does not flow out. In the case of pericardial effusion does not cause bleeding syndrome but acute compression of the heart

Define

There is blood in the abdomen.

There was no piercing wound.

There is blood in the pleural space.

There was no bleeding.

Bleeding in the cavities spontaneously, but the blood does not drain. Pericardial effusion does not cause bleeding syndrome but causes acute heart compression syndrome.

Reason

Bleeding in the abdomen

Due to rupture of a solid organ (s): Due to trauma or disease.

The organ in the peritoneum: Liver, spleen.

Outer peritoneum + tear peritoneum: Kidney.

Due to damage to blood vessels: Due to trauma or disease.

Abdominal wall (without damage to all layers of the abdominal wall).

Mesenteric vessels, conjunctiva (rupture of the uterus).

Bleeding in the pleural space

Due to damage to the intercostal vessels.

Due to damage to the lung parenchyma.

Due to damage to the mediastinum rupture into the pleura.

Symptom learning

Body sign

The shock of blood loss.

Mechanical signs

Functional paralysis (bloating) in abdominal bleeding.

Difficulty breathing in pleural cavity bleeding.

Entity markers

Bleeding in the abdomen:

There is fluid in the abdomen: The patient is lying on his back: knocking with low cloudiness, changing position in the side of the cloudy area also moved to a low place.

Visit rectum, vagina, pouch with Douglas bulging (especially in case of ectopic pregnancy).

Abdominal puncture:

The puncture is usually at 4 points where the lines dividing the abdomen or 2 points between the big straight outer edge.

If puncture often does not see blood, pump through the needle to leak 500ml of isotonic saline serum (abdominal lavage) and then suck out.

Care should be taken to avoid mistakes when poking into the abdominal wall blood vessels.

Peritoneum induction.

Bleeding in the pleural space:

Fluid in the pleural space (decreased syndrome 3: alveolar reduction, decreased vocal fibrillation, decreased percussion).

Pleural puncture with blood, not clotting

Haematological signs

HC, HST, Hematocrit.

Imaging signs (X-rays, ultrasound)

There is fluid in the abdomen.

There is fluid under the diaphragm (air sac, the stomach is pushed down, in splenic rupture).

There is gastric drainage in the abdominal wall.

Fluid in the pleura.

Clinical forms

Ultra-muscular form: Major vascular injury usually dies before admission.

Normal form.

Hidden form: Symptoms of mild anaemia, mild abdominal pain. Diagnosis is done by monitoring the clinical course, abdominal fistula, x-rays or ultrasound.

The second body is: Usually due to injury to rupture of the liver or spleen: the head has a hematoma under Gilson of the liver or splenic rupture without symptoms of blood in the abdominal cavity when the rupture of the capsule shows clearly.

The principles of treatment

At district level: Good recovery, only transfer to higher levels when the condition is stable, maximum blood pressure is over 90 mmHg, gently move with staff and resuscitation facilities.

If the situation does not allow inviting higher levels to operate.

At gland capable of surgery:

With abdominal bleeding, the principle of surgery must check all organs in the abdomen, even though there is damage.

With hemothorax, aspiration and follow-up, if better, continue. If severe, the blood is drawn out does not clot, surgery to treat the damage (lung stitching, lung resection, intercostal hemostasis, mediastinum ...).