The second bleeding

The second bleeding can be early (in the first 3 days) and late - through the large interval of time after the wound (from 3 to a few days, weeks). The division on early and late is determined by the reasons of origin of the second bleeding (as a rule, they differentiate and at times displays). The reason of the early second bleeding is violation of rules of final stop of bleeding: insufficient control of hemostasis during the operation or surgical treatment of wound, the poorly strung ligatures on vessels. To bleeding can lead the rise arterial pressure after the operations (if patient or the injured is operated at decompressed), shock, hemorrhagic anaemia, guided hypotensia, when are possible extrusion of blood clots from large or shallow vessels, sliding of ligatures off.

The principal reasons of the second bleeding are festering-inflammatory complications in a wound, development of necrosis, that can result in melting of blood clots. The reason of the late bleeding can be also bedsores of vessels at pressure on them of bone or metallic fragments, drainages. Appearing necrosis of wall of vessel can result in his break and origin of bleeding.

The second bleeding, as well as primary, can be arterial, vein, capillary, parenchymatous, and also outward and internal.

Weight of the state of patient is determined of blood loss volume, relies on a caliber character of damage of vessel. The second bleeding on influence on an organism is more heavy, than primary, because arise up on a background before former blood loss because of the primary bleeding or operative interferences. Therefore at the second bleeding weight of the state of patients short of to the volume of blood loss.

The clinical picture of the second bleeding consists of general and local symptoms, as well as at the primary bleeding.

Principles of stop of the second bleeding are the same, as well as primary.

Next basic moments serve by the prophylaxis of the second bleeding.

Careful final stop of the primary bleeding at the damage of vessels and during any operative interference. Before taking of wound in the area of operative interference must be carefully examined (verification of haemostasis). The operation is concluded by taking of wound in at a confidence in the complete stop of bleeding.

Careful conducting of primary surgical treatment of wounds, deleting of foreign to the tel.

Warning of festering complications from the side of wound: observance of rules of asepsis and antisepsis during the operation, antibacterial therapy.

Setting of drainage (at a necessity drainage of wounds, cavities) taking into account the topography of vessels, to warn formation of bedsores of wall of vessel, his arrosion.

Research before every planned operation of the state of rolling up the anticoagulation systems of blood of patient. In the case of violations in a state of the system of blood rolling up the control after the state of haemocoagulation at these patients which are ramp in the plan of the second bleeding is carried out systematic in a postoperative period.

Careful supervision of patients carrying the operation, with the purpose of timely exposure of the second bleeding. A medical personnel must know the clinical signs of the second bleeding and his danger for the life of patient. A personnel taking the care of must own the methods of temporal stop of bleeding.