Sunday, February 23, 2014

Post-Operative Hemorrhage

by Janet King, RN, BSN, CCRN.

Doctors classified major bleeding after the surgical procedure as "primary", "secondary" or "intermediary."

Primary hemorrhage was defined as a major escape of blood occurring from a ruptured blood vessel(s) within 24 hours of receipt of a wound. Intermediary hemorrhage was defined as occurring "from 24 hours until the establishment of suppuration on the fifth or sixth day" from receipt of wound. Secondary hemorrhage was described as occurring from the sixth day to even months after the injury or surgery.

Secondary hemorrhage was usually caused by an infection which had disintegrated the blood vessel�s wall, usually an artery, which then resulted in massive and irreversible blood loss and death.

As has been noted in the description of an amputation, the surgeon would "tie off" the bleeding blood vessels with a ligature (suture) of non-sterile silk, linen or cotton thread. One end would be left hanging out of the wound. On daily rounds, the surgeon would tug on this ligature to see if the loop on the blood vessel had rotted loose. When this suture came away, the surgeon hoped a blood clot had formed thus preventing the vessel from bleeding. If this was not the case, then a secondary and frequently fatal hemorrhage would occur. Unfortunately this happened with "dreadful frequency." Sometimes the patient would be almost to the point of discharge from the hospital and ready to return home, when suddenly - due to the disintegration of the arterial wall - the vessel would bleed profusely. The surgeon would try to stop this, first by manual compression of the artery, and perhaps an attempt to re-tie the vessel. In most cases it was a lost battle, while the soldier bled to death in front of his doctors, nurses and comrades.

The surgeons tried various styptics (blood clotting agents) such as astringents i.e. alum, tannic acid and persulphate of iron, perchloride of iron and silver nitrate - but these did little good. This deadly post-operative complication held a 62% mortality rate.



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