WOUNDS AND BLEEDING

A. Wounds

The wound is the loss / partial damage of body tissues.

Various sores:

• Vulnus scissum (wound cut)

• Vulnus punctum (stab wound)

• Vulnus laseratum (tear wound)

• Excoriation (blisters / friction)

• Combostio (burns) Ethylogy:

• Sharp / dull object trauma

• Temperature changes

•             Chemicals

• Explosion

•             Electric shock

• Animal bites

The next phase is tissue damage, then healing. Phase of healing:

• Phase of Inflammation

It lasts from the wound until about the 5th day. PD that breaks in the wound will cause bleeding and the body will try to stop it with vasoconstriction, PD shrinking disconnected, and hemostatic reactions. Hemostatis occurs because the platelets that come out of the PD stick together and together fibrin net formed freeze blood coming out of the PD, while an inflammatory reaction occurs.

Mast cells in connective tissue produce serotonin and histamine which increase capillary permeability resulting in fluid exudation. Inflammation of the inflammatory cell with local vasodilation resulting in edema and swelling.

• Proliferative phase

It lasts from the end of the inflammatory phase until approximately the end of week 3. This phase of the fibers is formed and destroyed again for adjustment to the tension wound which tend to shrink. This property is along with the fibroblast's contractive properties. This phase of the wound is filled with inflammatory cells, fibroblasts, collagen forming a reddish tissue with a smooth surface called granulation tissue. The epithelial wound comprising a basal cell is detached from its base and displaces the surface of the wound. The place is then filled by new cells formed from the process of mitosis. The process of migration can only occur towards the lower / flat, because the epithelial can not migrate to the higher direction. This process only stops after epithelial cells touch each other and cover the entire surface of the wound. With the closed surface of the wound, the fibroplasia process with the formation of granulation tissue will also stop and begin the process of maturation in the phase of the end

• End of phase

There is a maturation process consisting of excessive tissue absorption, shrinkage in accordance with the force of gravity and ultimately resurfacing of newly formed tissue, this phase may last for months and is declared ended if all signs of inflammation have disappeared.

NO PHASE PROCESS SYMPTOMS AND SIGNS

1. Inflammation Reaction of Dolor, rubor, calor, tumor

2. Prolefiration Regeneration / fibroplasia Network granulation / bone callus. Epithelial closure / endotel / mesotel

3. termination Maturation and re-closure of scar tissue / fibrosis

Classification of healing:

• Secondary healing (sanatio persecundam intentioem) wound healing without external help

• Primary cure (sanatio perprimam intentioem) wounds are linked.

B. Bleeding

Bleeding is the discharge of blood from the blood vessels

Type of bleeding

1. Artery (blood looks out spray, fresh red)

2. Veins (blood flow out, blackish)

3. Capillaries (blood out seeps, fresh red)

Action on bleeding

Stop the bleeding

• Pressing on one point from 6 points on one side of the body

• Direct emphasis on wounds (with clean sterile fabrics)

• Coat press

• Torniquet only on amputation / as life saving

Replace the lost blood

Blood component

1. Complete Blood

2. Packed red blood cells

3. Washed red cells

4. Fresh plasma

5. Fresh frozen plasma

6. Platelet rich plasma

7. Platelet concentrat

8. Cryoprecipitate

Non Clotting Class

• Packed red blood cells (which contain red and 1/3 plasma blood grains, so they are not pure components).

• Washed red cells (which contain red blood grains and electrolytes) are cleaner than packed red cells.

• Frozen red cells (which are cleanest and can be stored long and also red blood remained like frozen time, should be worn within 24 hours after being heated, expensive).

• Plasma protein fraction (plasma reduced gamma globulin, with pasteurization hazard hepatitis absent).

• Albumin (this component is in isoosmotic and hypercotic forms). • leukocytes (only made at complete transfusion centers).

• Immunoglobulins (tetanus immunoglobulin germs) are known by the name of hypertet trade.

Clotting Group

• Fresh frozen plasma (contains all blood clotting factors, except thrombocyte).

• Cryoprecipitate (factor i and viii only)

• Platelet rich plasma (containing all clotting factors coupled with platelets).

• Platelet concentrate (containing platelets and factor ii, v, vii, ix, x).

C. Complications

• Overload volume

• Plebitis

• Air Emboli

• Disease transmission

• Bacterial contamination

• Allergy

• Hyperpyrexia

• Metabolic

Signs of Hemolytic Complications

• Incompatibility of class A, B, O from donors and recipients.

• Rapid reactions that should be watched first 30 minutes / 50cc first with signs: fever, pruritis, chills, headache, chest and hip pain, breathlessness, nausea, vomiting, diarrhea, hypotension, hemoglobinuri and diffuse bleeding.

• Slow reaction after several hours / weeks is anemia, jemas, jaudice

• Best prevention o Stop transfusion o Overcome hypotension o Overcome bleeding

o Prevent anuria

Causes of allergy

• Patients who have often received transfusions become allergic to serum proteins.

• Leucocytes and platelets of donors have other antigens from red blood.

• Maybe donor blood contains allergic antibodies.

Hyperpyrexis

The causes are not clear, can be by pyrogens, the reaction of some components of blood and leukocytes and platelets. Long lasting blood changes

• The affinity of hb to o2 increases. Because in the blood more 5 days occurred 2.2 dpg depletion.

• The presence of citric acid and the formation of lactic acid the blood becomes acidic.

• K concentration ranges from 30 mlgr / l more than normal, K out of red blood into plasma.

• Old blood transfusion can cause cardiac arrhythmias and arestia. Higher hb affinity and lower ph can damage the kidney causing hyper K to be great. The image in the blood of the donor will bind calcium recipients and this hypocalcemia state will intensify hyperkalemia against the heart.

• Old blood may appear bad ammonia if it is given to a circulatory patient.

• The platelet count after 1 day is zero and at week 3 the v and vi factor is only 10%.

The wrong habit

• Transfusion of 1 bottle to pursue anesthesia requirements with hb ≥ 10gr%.

• Fresh blood use in patients without hemostatic disturbance.

• High temperatures are not contra-indicative transfusions

• Blood need not be heated first, except on massive transfusion.