Question

Hemorrhage due to trauma: Identify relevant data including pathophysiology, causative agent, levels of reactions as appropriate (mild, mod, level 1 – 4, etc.) What would they look like? What would vital signs look like? Mentation?

Answer 1

Haemorrhage due to trauma :

Haemorrhage refers to the heavy release of blood within or from the body or bleeding. Trauma refers to any serious injury to the body often resulting from violence or an accident.

Causative agents / causes :

Events that causes traumatic brain injury are ;

* Vehicle related collisions or accidents

* Sports injuries

* Violence

* bomb balsts or other explosive blasts, gun shots

* Falls  

* Blows to head or penetrating wound, stabs.

Pathophysiology:

Traumatic injury may results in incisions, lacerations, abrasions, hematoma, contusion, puncture wound, crushing injuries etc.

Due to traumatic injury,Haemorrhage / mild , moderate or extensive bleeding may occur . Mild bleeding or moderate bleeding may stop due to coagulation mechanism. In case of severe wound and extensive bleeding , there is will be huge blood loss , that may leads to hypovolemia in the body . Decreased circulatory volume results in hypovolemic shock, as the heart is unable to pump adequate amount of blood to the vital organs and to other tissues.    Consequently renal failure also happens due to decreased circulatory volume.  

Level of reactions: ( vital signs , mentation/mental status)

* Class 1 haemorrhage:

There is a loss of blood volume upto 15% ( 750 mL) and there will not be much changes in the body system and Vital signs. Fluid resuscitation also not indicated in this condition.  

* Class 2 :

Bleeding occurs and there will be 15 - 30 % ( 750 - 1500 mL)of total blood loss.

- Person may experience a rapid heart beat, and a reduction in pulse pressure.

- Skin looks pale and cool fue to peripheral vasoconstriction, as a compensatory mechanism.

- Slight behavioural changes may occur

- Fluid resuscitation is required with Normal saline and lactated ringer's solution.  

* Class 3 :

- 30 to 40 % ( 1500 - 2000 mL) blood loss occurs in patient

- Tachycardia and a drop in blood pressure occurs and increased respiratory rate occurs.

- Extremities become   cool to touch, diminished capillary refill due to decreased blood supply and shock.

- Altered consciousness or Mental status becomes worsens

- Both fluid resuscitation and blood transfusion is required.

Class 4: There will be a blood loss of more than 40% ( > 2000 mL)and body is no longer able compensate with the loss. The individual experience loss of consciousness , Significant tachycardia, narrow pulse pressure   or no diastolic pressure , cold and pale skin. Immediate Resuscitation and and blood transfusion is required to prevent death and disability.