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- In Class-I Hemorrhage there is little tachycardia and usually there is no significant change in BP, Pulse pressure, respiratory rate.
- In Class-II hemorrhage, HR>100 beats per minute, tachypnea, decreased Systolic BP, oliguria.
- In Class-III hemorrhage Marked tachcardia and tachypnea, decreased systolic BP, oliguria.
- In Class-IV hemorrhage marked tachycardia and decreased systolic BP, narrowed pulse pressure, markedly decreased (or no) urinary output.
Causes and Types of Hemorrhage
A variety of incidents or conditions can cause bleeding. Possible causes include: Traumatic bleeding injury. It is an injury that can cause traumatic bleeding. Common types of traumatic injury include: abrasions, hematoma, lacerations, excoriation, puncture wounds, contusion. There are also some medical conditions that can cause bleeding such as Intravascular changes, Intramural changes, Extravascular changes, Bleeding diathesis. There are two types of hemorrhage, internal and external. Internal hemorrhage is the loss of blood that occurs from the vascular system into a body cavity or space. Internal bleeding that can cause hemodynamic instability usually occurs in one of four body cavities: Chest, Abdomen, pelvis, Retroperitoneum. Internal Hemorrhage is discoloured, tender, swollen or hard skin, with the rigid abdomen. Excess blood can compress organs and cause their dysfunction. If there is pressure, it may lead to death or a brain hemorrhage.
External Haemorrhage and Antepartum Hemorrhage
In External hemorrhage blood exits through a break in the skin such as mouth, vagina, rectum, nose. Capillary bleeding is slow, oozes out, and clots easily. Antepartum haemorrhage (APH) is defined as bleeding from or in to the genital tract, occurring from 24+0 weeks of pregnancy and prior to the birth of the baby. 70% of APH is caused by Placental Bleeding, 25% is unexplained and 5% is due to extra placental. In Accidental Hemorrhage there are two kinds of placenta abruption, relating to where the bleeding occurs. One type of placenta abruption is Concealed and the other is External. 30% of Accidental Hemorrhage produce no symptoms. If severe, symptoms may include: Vaginal Bleeding, Abdominal Pain, Fetal Distress. Placenta previa means that placenta is lying unusually low in uterus, next to or covering cervix.
Post Partum Hemorrhage
WHO define Post Partum Hemorrhage as Primary PPH and secondary PPH. Primary PPH is bleeding from the genital tract in excess to 500ml in the first 24 hours after delivery. Secondary PPH is bleeding from the genital tract in excess to 500ml in the after 24 hours after delivery till end of puerperium. Causes of PPH are Tone-uterine atony, Tissue-Products of conception, Placenta, Trauma: Planned-conception, Placenta. Anemia, Death, blood transfusion, fatigue, and myocardial ischemia are some of the complications of PPH.
Compensatory Effects of Hemorrhage
Body’s initial response is to stop bleeding by chemical means (Hemostasis). Tissue injury modifies heart rate and blood pressure responses to Hemorrhage. Compensation to Hemorrhage means the counteracting mechanisms by which the body tackles blood loss. Immediate Compensatory Reactions include the secretion of adrenaline and noradrenaline, Vasoconstriction of arterioles, Venoconstriction, increase in heart rate, and contraction pf spleen. Delayed Compensatory Reactions include mobilization of labile and reserve proteins and the secretion of ADH & aldosterone that leads to the retention of water and as a result plasma volume increases.