Alya Putri Khairani | 13011010220 | D1
Bleeding
BLOOD VESSEL
The blood vessel, with its smooth and continuous
endothelial lining and fibrous coat, is designed to
facilitate blood flow as well as participate in the
process of Hemostasis. The structure of the vessel
wall, which is includes the outermost layer
(Adventitia), the middle layer (Media), and the inner
layer (Intima)
Involves 15-30% of total blood volume. A patient
is often tachycardic (rapid heartbeat) with a
narrowing of the difference between the systolic
and diastolic blood pressures
Type III Hemorrhage
Involves loss of 30-40% of circulating blood
volume. The patient's blood pressure drops,
the heart rate increases, peripheral
hypoperfusion (shock)
Type IV Hemorrhage
Involves loss of >40% of circulating blood
volume. The limit of the body's compensation is
reached and aggressive resuscitation is required
to prevent death
CAUSES
1.
2.
3.
Tunica Adventitia
Connective tissue cell support
Tunica Media
Elastic tissue and smooth muscle; controlling
vasoconstriction and sometimes vasodilatation
Tunica Intima
Broad flat endothelial cells with an underlying
basement membrane, supported by a few
connective tissue cells, providing a smooth
nonwettable surface but facilitating migration of
cells through the spaces as needed
BLEEDING
When the blood vessel is disrupted, it may cause
some bleeding. Bleeding or Hemorrhage is the loss
of blood or blood escaping from the circulatory
system. Bleeding can occur internally, where blood
leaks from blood vessels inside the body, or
externally, either through a natural opening such as
the mouth,
nose, ear, urethra, vagina or anus, or through a break
in the skin. Typically, a healthy person can endure a
loss of 1015% of the total blood volume without
serious medical difficulties, and blood
donation typically takes 810% of the donor's blood
volume.
CLASSIFICATION
Hemorrhaging is broken down into four classes by the
American College of Surgeons' advanced trauma life
support (ATLS)
Type I Hemorrhage
Involves up to 15% of blood volume. There is
typically no change in vital signs and fluid
resuscitation is not usually necessary
Type II Hemorrhage
Traumatic Injury
Traumatic bleeding is caused by some type of injury.
There are different types of wounds which may cause
traumatic bleeding. These include:
Abrasion - caused by transverse action of a
foreign object against the skin, and usually does
not penetrate below the Epidermis
Excoriation - In common with Abrasion
Hematoma - Caused by damage to a blood
vessel that in turn causes blood to collect under
the skin.
Laceration - Irregular wound caused by
blunt impact to soft tissue overlying hard tissue
or tearing such as in childbirth. In some
instances, this can also be used to describe an
incision.
Incision - A cut into a body tissue or organ,
such as by a scalpel, made during surgery.
Puncture Wound - Caused by an object that
penetrated the skin and underlying layers, such
as a nail, needle or knife
Contusion - Also known as a bruise, this is a
blunt trauma damaging tissue under the surface
of the skin
Crushing Injuries - Caused by a great or
extreme amount of force applied over a period of
time. The extent of a crushing injury may not
immediately present itself.
Ballistic Trauma - Caused by a projectile
weapon such as a firearm. This may include two
external wounds (entry and exit) and a
contiguous wound between the two
Medical Condition
'Medical bleeding' denotes hemorrhage as a result of
an underlying medical condition (i.e. causes of
bleeding that are not directly due to trauma). Blood
can escape from blood vessels as a result of 3 basic
patterns of injury:
Intravascular changes - changes of the
blood within vessels (e.g. blood pressure,
clotting factors)
Alya Putri Khairani | 13011010220 | D1
Intramural changes - changes arising
within the walls of blood vessels
(e.g. aneurysms, dissections, AVMs, vasculitides)
Extravascular changes - changes arising
outside blood vessels (e.g. H
pylori infection, brain abscess, brain tumor)
PROCESS
The endothelial surface of the blood vessel is usually
inert to platelets and coagulation factors. It is termed
a non-thrombogenic surface because the physical
and biochemical characteristics of the endothelium
render the cell surface thromboresistant, such as:
NO, PGI2, t-PA, Thrombin, Protein C, and ADP
Diphosphatase
However, the endothelial lining is disrupted, the
vascular system acts to prevent bleeding by
promoting rapid vasoconstriction of the injured vessel
as well as adjacent vessels. This process diverts
blood flow around the damaged vessel and enhances
contact activation of platelets and coagulation
factors. Actions of the vascular system to prevent
bleeding:
Contraction of vessels (vasoconstriction) and
reflex stimulation of adjacent vessel
Diversion of blood flow around damaged
vasculature
Initiation of contact activation of platelets with
subsequent adhesion, release reaction, and
aggregation
Contact activation of the coagulation system
(both extrinsic and intrinsic) leading to Fibrin
formation
All actions above are together sequenced into
Hemostasis. Hemostasis occurs when blood is
present outside of the body or blood vessels. It is the
instinctive response for the body to stop bleeding
and loss of blood. During Hemostasis three steps
occur in a rapid sequence. Vascular spasm is the
first response as the blood vessels constrict to allow
less blood to be lost. In the second step, platelet
plug formation, platelets stick together to form a
temporary seal to cover the break in the vessel wall.
The third and last step is called coagulation or
blood clotting. Coagulation reinforces the platelet
plug with fibrin threads that act as a molecular glue