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Hemoragia

Hemoragia. Definitie: scurgerea singelui in afara sistemului vascular cu consecinte hematologice si hemodinamice . Clasificare: dupa tipul vasului: - hemoragii arteriale h. venoase h. capilare h. mixte dupa cauza hemoragiei:- traumatica medicala

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Hemoragia

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  1. Hemoragia

  2. Definitie: scurgerea singelui in afara sistemului vascular cu consecinte hematologice si hemodinamice

  3. Clasificare: • dupa tipul vasului: - hemoragii arteriale • h. venoase • h. capilare • h. mixte • dupa cauza hemoragiei:- traumatica • medicala • dupa momentul aparitiei: h. primitiva sau secundara • dupa locul unde se varsa singele: - h. externa • - h. interna: neexteriorizata (cavitati)sau exteriorizata (epistaxis, hematemeza, melena, hemoptizie, etc) • - h. interstitiala( hematomul circumscris sau difuz) • - notiunea de sevrare a focarului hemoragic • - necesitatea corelarii semenlor generale cu cele locale • - notiunea de sesizare a originii singerarii pe criterii clinice • dupa cantitate: mica <500ml; • mijlocie 500-1500 ml • mare peste 2500 ml • dupa durata si ritmul hemoragiei: acute si cronice

  4. Fiziopatologie: • Hemoragia (cantitate, viteza) • I I • elemente figutare, o2 plasma, factori coagulare • I I I • hipovolemie, tulburari coagulare • tulb. Hemodinamice • I • hipoxie, acidoza • I • raspuns compensator • (efectul depinde de intensitae si durata) • cardiovascular- adrenergic • respirator > • renal : decompensare sau compensare • hemoragie - coagulopatie ( hipotensiune, dilutie, acidoza) • hipotensiune(+pierderi; - producere; transfuzii singe) • acidoza ( soc traumatic, clampare aorta, vasopresoare, transfuzie masiva, < performantei cardiace.

  5. Traumatism vascular • I I I • expunere colagen subendotelial aderere plachete, agregare eliberare factori tisulari • I I • vasoconstrictie coagulare • I • hemostaza • I • fibrinoliza

  6. Semne clinice: coroborare semne clinice cu cele generale • Locale: h, externa: arteriala, venoasa, capilara, mixta • h. interna – semen clinice functie de locul hemoragiei: hemotorax, hemoperitoneu, hemopericard, hematemeza • h. interna exteriorizata – semen clinice: epistaxis, hemoptizia, hematemeza, melena, metroragia, hematuira, hemobilia • h. interstitiala: hematom circumscris, pulsatil • Generale: • explicatie fiziopatologica • monitorizare • sesizarea urgentei majore • paloare, transpiratii, tegumente reci, tahipnee, tahicardie, puls mic, filiform, hipotensiune arteriala, tandinta la lipotimie, sete, oligurie • Sdr. Umoral: • scadere hemoglobina, hematocrit • scadere volum sangvin circulant • scadere proteinemie • scadere na, k, cl • crestere co2 • acidoza • creste azotul neproteic si amoniemia

  7. Tratament • hemostaza( spontana, provizorie, definitiva) • compensarea pierderilor ( hemodinamice, hamatologice) • tratamentul anemiei • compensarea hipoproteinemiei • refacerea axului vascular

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