Ques. 1 What is Haemorrhage? What are its types?
Ans. Extravasation of blood (or the escape of blood from the vessels).
Types of Haemorrhage :
(A) On types of vessel injured –
- Venous – Less severe, controlled by less pressure or by simply elevation of limb; bluish red (reduced Hb), continuous flow, non-spurting; more bleeding occurs from distal cut end.
- Capillary – here bleeding is in the form of oozing; the blood is a little bluish but gets red as soon as it comes out.
- Arterial – More forceful requires more pressure to be controlled ; bright red (oxy - Hb); occurs in jerks, synchronous with the heart beats (spurting); more bleeding occurs from proximal cut end.
(B) On times expired after the incidence –
- Primary – Occurring instantaneously with the injury to the vessels, be it arterial, venous or capillary (within 12 hours of injury).
- Secondary – It is the haemorrhage that occurs from a wound after a few days (usually after 7 to 10 days) of its occurrence (must be after 48 hours). Sepsis or infection is main operating factor is the genesis of secondary haemorrhage. As bleeding is secondary o infection, it is called ‘secondary’.
- Reactionary – Within 24 to 48 hours after the injury and is usually due to rise of blood pressure or due to the slipping of ligature.
(C) On site –
- External- It is visible, hence the diagnosis is easy.
- Internal – It is not seen and occurs from deep seated vessels of following rupture of internal organs, e.g. liver, kidney, mesentery, lung, etc. or peptic ulcer, haemorrhage from the malignant growths, strangulated gut etc. It is diagnosed from the following feature : - (i) restlessness, (ii) thirst, (iii) skin – cold, clammy, (iv) dry tongue, (v) sunken eyeballs, (vi) weak, quick, thread pulse, (vii) hurried and shallow respiration, (viii) B.P. – low, (ix) tenderness and swelling over the particular site, (x) shifting dullness in case of rupture of internal organs. (xi) history of injury at the particular site, (xii) pallor – which increase steadily,
(D) On acuteness – (a) Chronic – piles, hook worm, menorrhagia (with shock), etc. (b) Acute – traumatic (local).
Ques. 2 What are the clinical features and investigations of Haemorrhage?
Ans. Clinical Features : In internal haemorrhage, bleeding is concealed inside the body, e.g. intrapleural, intra or retroperitoneal, intra-cranial or intra-muscular etc. Internal haemorrhage may be revcaled later as haematemesis haemoptysis, haematuria. Haemorrhage may be external or internal. The external haemorrhage is an obvious one, from wound, external orifice or mucous surface.
- History of trauma of blood diseases (haemorrhagic diathesis).
- Toxaemia may be present.
- On examination – (i) anaemia – present, pallor, (ii) pulse – weak, quick, thread pulse, (iii) respiration – hurried, (iv) B.P. – low, (v) temperature – low, (vi) local – vary according to cause.
- Sex – females stand bleeding better.
- Complains – sign of shock, causative symptoms.
Investigations : Blood test – Blood grouping, R.B.C. count, Hb%, E.S.R., special deficiency of coagulation factors B.T. & C.T. etc.
(A) Prophylaxis –
- Never to operate on the unhealthy skin.
- Post – operative antibiotics in infected cases.
- Tourniquet must be kept by the side of the bed in anticipation.
- Strict aseptic measures during operation.
(B) General –
- Control of infection – antibiotics are administered, preferably an antibiotic to which the organisms, in the wound, are sensitive.
- Vit. C should be given in heavy doses, with other vitamins, esp. Vit. A. Vit. B-complex etc.
- Treatment of shock, e.g. absolute rest, sedation (i.e.Inj. morphine, pethidine), fluid transfusion in suitable dosage, blood transfusion may have to be started.
- At emergency – A.T.S./A.G.S. – if required.
(C) Local –
- If bleeding continues, the wound is opened up at the operation theatre and the clots carefully removed. The main bleeding points are gently picked up with haemostatic forceps and ligated.
- In uncontrolled cases proximal ligature of the main vessel of the limb has to be done.
- If gangrene sets in, or if bleeding continues even after proximal ligation, amputation of the limb has to be undertaken.
- Absolute rest to the limb, preferably in a splint or cast, and the limb is kept elevated.
- On spot – head low, pressure bandaging of the wound. In the majority of cases a pressure bandage arrests the haemorrhage.
Ques. 3 Which Homoeopathic medicines are useful for shock?
Ans. Homoeopathic Remedies :
- ARNICA – Bleeding is caused by injury, concussion, fatigue, patient feels a soreness as from a bruise in part when the blood issues, hot head and cool body, pain causes a rush of blood to head, which feels very hot to the patient, bleeding constant and bright red, sensitive headache.
- HAMAMELIS – Passive venous haemorrhages, esp. When the part from which the flow of blood proceeds, treat sore and bruised, patient exhibits no alarm or anxiety.
- IPECAC – Profuse and steady bright-red flow of blood, usually accompanied by nausea and sometimes by very hard, labored breathing, patient takes long breaths, as panting.
- CHINA – The blood is dark and clotted from any orifice of the body; profuse flow, patient wants to be fanned in order to get more oxygen; fainting spells; pulse irregular; skin cold and clammy.
- CARBO VEG – Continuous passive haemorrhage, the patient wants to be fanned, haemorrhages of a low type, blood changed in its composition, dark and rather fluid, lack of animal heat.
- PHOSPHORUS – Haemorrhage from any part of body, particularly from lungs and stomach, when associated with Bright’s disease.
Ques. 4 Which Biochemic Remedies are useful?
Ans. Biochemic Remedies
- KALI PHOS – Epistaxis in weak, delicate constitution from debility, weakness or old age, predisposition to bleeding of the gums, nose, etc. Septic haemorrhage.
- NATRUM MUR – Haemorrhage, blood pale, thin, red, watery, not coagulating. Epistaxis on stooping, when coughing, with soreness of limbs.
- FERRUM PHOS – Bleeding from wounds externally and internally, in conjunction with surgical aid. Epistaxis of bright red blood, whether from injury or otherwise; this generally suffices.