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Hemodynamics Hemodynamics HEMORRHAGE HEMORRHAGE Dr.CSBR.Prasad, M.D.

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HemodynamicsHemodynamicsHEMORRHAGEHEMORRHAGE

Dr.CSBR.Prasad, M.D.

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HEMORRHAGEHEMORRHAGE• Hemorrhage - extravasation of blood due to rupture of BV• Capillary bleeding: Chronic congestion Hemorrhagic diatheses • Rupture of a large artery or vein - due to: Vascular injury Trauma Atherosclerosis Inflammatory Neoplastic erosion of the vessel wall

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Manifestations – depends on size, Manifestations – depends on size, extent, and location of bleeding. extent, and location of bleeding.

• Hematoma (accumulation of blood within tissue )• Petechiae (1 - 2 mm hemorrhages into skin,

mucous membranes, or serosal surfaces )• Purpura (≥3 mm) • Ecchymoses (>1 - 2 cm) subcutaneous

hematomas • Large accumulations of blood in one or another of

the body cavities - hemothorax, hemopericardium, hemoperitoneum, or hemarthrosis

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A - Punctate petechial hemorrhages of the colonic mucosa

B - Intracerebral hemorrhage

Consequences of thrombocytopenia

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Petechial hemorrhages (pinpoint hemorrhages) seen on the epicardium

of the heart

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Hemopericardium – Hemopericardium –

Cardiac tamponadeCardiac tamponade

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Aortic tear with hemorrhages

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Lacerated Liver – [Peritoneal hemorrhages]

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Ecchymoses

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Hematoma

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Adrenal hemorrhageAdrenal hemorrhage

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Raccoon Raccoon eyeseyes

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HematomaHematoma

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HematomaHematoma

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Purpura - HSP

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Subconjunctival hemorrhage

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Subdural Subdural

hematomahematoma

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Subdural hematomaSubdural hematoma

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Subgaleal hemorrhageSubgaleal hemorrhage

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Subgaleal Subgaleal hemorrhagehemorrhage

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Clinical significance of hemorrhage Clinical significance of hemorrhage

Depends on the volume and rate of bleeding & blood loss: • Rapid loss of up to 20% of the blood volume or slow losses of even >20%

• Losses >20% may result in hemorrhagic (hypovolemic) shock

• The site of hemorrhage is also important: Trivial bleeding in the subcutaneous tissues – innocuous Trivial bleeding in the brain – may cause death

• External loss Vs Internal loss: Chronic or recurrent external blood loss – Loss of iron and IDA Hemorrhage into body cavities or tissues – No iron deficiency

No adverse effects

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E N DE N Dgoto goto Hemostasis & Thrombosis