This document discusses hemorrhage and shock in oral surgery. It defines hemorrhage as bleeding from damaged blood vessels and describes different types including arterial, venous, capillary and bony bleeding. It also discusses classifications based on timing, duration and location. The document then covers hemostasis techniques including mechanical, thermal and chemical methods. It describes hereditary coagulopathies like hemophilia A and B. Finally, it defines and discusses different types of shock including hypovolemic, cardiogenic, septic, neurogenic and anaphylactic shock along with their signs, symptoms and treatments.
3. Types
A-depending upon the nature of the
vessel
Arterial hemorrhage
Bright red color
Pulsation of the artery can be seen
Venous hemorrhage
Dark red color,
Non-pulsating with steady flow(constant
flow)
Difficult to control because vein gets
retracted
3
4. Cont.
Capillary hemorrhage
Red colour
Slowly oozes out
It becomes significant if there is
bleeding tendencies
Bony bleeding
From nutrient vessels in bone
Usually follows removal of lower 3rd
molar
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5. Cont.
B. Depending upon timing of
hemorrhage
Primary hemorrhage -occurs at the time
of surgery
Reactionary or intermediate
hemorrhage -occurs after 24 hrs of
surgery(causes-hypertension in
postoperative period, sneezing,coughing)
Secondary hemorrhage -occurs after
48-72 hrs after surgery (infection)
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6. Cont.
C-depending upon the duration of
hemorrhage
Acute hemorrhage -occurs suddenly
(esophageal variceal bleeding due to
portal hypertension)
Chronic hemorrhage-(hemorrhoids or
piles or chronic duodenal ulcer
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7. Cont.
D-depending upon the nature of
bleeding
External hemorrhage - epistaxis
Internal hemorrhage - splenic rupture
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8. Laboratory tests for screening
Bleeding time (aspirin therapy)
Platelet count (liver disease, c/c leukemia)
Prothrombin time (heparin therapy, liver
disease)
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13. Chemical methods
Astringents (ferric sulfate in ethyl cellulose)
Styptics (epsilon amino caproic acid local &
systemic)
Bone wax (bees wax(7)+olive
oil(2)+phenol(1),helps in platelet aggregation)
Gelfoam (compressed sponge made up of porcine
skin & have physical action)
Adrenaline
Surgicel (knitted fabric, interaction with platelets)
Fibrin glue (thrombin+fibrinogen+factor8)
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14. Prevention of hemorrhage during &
after extraction
Primary hemorrhage – tender handling
of soft tissues & bone.
Reactionary hemorrhage – semi supine
or sitting posture, diazepam 5 mg at
bedtime or antihypertensive drugs after
consultation with the physician
Secondary hemorrhage - antibiotics
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15. Control of hemorrhage from major
arteries
Greater palatine artery
Pressure pack
A round bolus of gauze is made of
adequate size , so that it does not cause
gagging
It is kept in place by tie over sutures for
24 to 48 hours
Pressure pack can be safely removed
after 48 hours
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16. Cont.
Lingual artery
Local clamping of the artery & application
of electrocautery usually controls bleeding
Superficial temporal artery
Electrocautery
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18. Hemophilia -a
Caused by deficiency of factor 8
Sex-linked recessive inherited disorder
Seen in males
Hemophilia-a is graded as mild ,
moderate ,& severe
Mild - factor 8 level ranges from 6 to 30
percent
Moderate - factor 8 level ranges from 1
to 5 percent
18
19. Cont.
Severe - factor 8 level ranges from nil to
1 percent
Clinical features - prolonged bleeding
tendencies even after a mild trauma
Patients are higher risk for bleeding after
oral surgical procedures
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20. Hemophilia b
It is caused by deficiency of factor 9
It is congenital disorder& transmitted as
sex--linked recessive trait
Clinical manifestations of this disease
are similar to hemophilia a
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21. Shock
Shock is a pathophysiologic condition
clinically recognized as a state of
inadequate perfusion due to
inadequate blood flow,there is
inadequate delivery of nutrients to the
tissues & inadequate removal of
cellular waste products from tissue cells,
results in disruption of vital organ
functions.
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22. Clinical features
Mild - <20% blood loss
Cold, calmy,moist skin
↓ in BP
Rapid pulse
Collapsed neck veins
Concentrated urine
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25. Hypovolemic shock
Decrease in the circulating or effective
intravascular volume
Most common type of shock in
maxillofacial trauma
Hypovolemic shock is classified into
1.Haemorrhagic shock
2.Non- hemorrhagic shock
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26. Cont.
Hemorrhagic shock is due to loss of
blood from the body causing decreased
venous return & thus decreasing the
cardiac output
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27. Cont.
Non-hemorrhagic shock-there is
massive fluid shift from intravascular
compartment to extra vascular
compartment causing decreased blood
volume &thus decreasing tissue perfusion.
can result from burns, crush injuries,
pancreatitis, peritonitis & pleural effusion,
water loss due to severe diarrhea, vomiting,
hyperglycemia & nephritis
27
28. Cont.
Treatment
Control bleeding
Legs raised & body supine is preferred
posture as this increases venous return &
cardiac index
Fluid replacement; normal saline or ringer
lactate
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29. Cardiogenic shock
Inadequate cardiac output , impaired
oxygen delivery & reduced tissue
perfusion, caused by loss of effective
contractile function of myocardium
Treatment
Dopamine is the vasopressor of choice. It
is diluted in normal saline or 5%dextrose
drip
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30. Septic shock
Produced by microorganisms or toxins
May be produced by bacteria ,virus &
fungi
Inflammatory response causing
vasodilatation & hypovolemia
Clinically: fever, tachycardia&
respiratory alkalosis
30
31. Cont.
Treatment
Early & effective volume replacement
Restoration of tissue perfusion
Control of infection with antibiotic therapy
I.V betamethasone or dexamethasone
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32. Neurogenic shock
Vasovagal syncope or emotional fainting
Blockage of sympathetic nervous system
→dialatation of blood vessels →hypovolemia
→shock
Predisposing factors – fear, anxiety, painPredisposing factors – fear, anxiety, pain
- fatigue- fatigue
- fasting- fasting
- hot & humid weather- hot & humid weather
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33. Cont.
Signs & symptoms(Clinical feature):Signs & symptoms(Clinical feature):
Pale, cold & moist skinPale, cold & moist skin
Slow pulse initially followed by rapid pulseSlow pulse initially followed by rapid pulse
DizzinessDizziness
WeaknessWeakness
Nausea & sweatingNausea & sweating
Loss of consciousnessLoss of consciousness
Dilated pupilDilated pupil
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34. Cont.
Prevention
Reassurance
Achieve confidence of the patient
Anxiolytic medication prior to surgery
(diazepam 5 mg 1 tablet night before the
surgery & one 1/2hr before surgery)
patient should not come with empty stomach
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35. Cont.
ManagementManagement
Monitoring pulseMonitoring pulse
Lowering head to improve cerebellar circulationLowering head to improve cerebellar circulation
Loosening of tight cloths at neckLoosening of tight cloths at neck
Smelling of salt of aromatic ammoniaSmelling of salt of aromatic ammonia
Flashing the face with cold waterFlashing the face with cold water
Glucose drinksGlucose drinks
Inj.dexamethasoneInj.dexamethasone
Reassurance of patientReassurance of patient
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