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Massive Bleeding/Hemorrhage Also called hemorrhea. It is the escape of blood from a ruptured vessel; it can be either external or internal.

Blood from an artery is bright red in color and comes in spurts; that from a vein is dark red and comes in a steady flow. Aside from the obvious flow of blood from a wound or body orifice, massive hemorrhage can be detected by other signs, such as restlessness, cold and clammy skin, thirst, increased and thready pulse, rapid and shallow respirations, and a drop in blood pressure. If the hemorrhage continues unchecked, the patient may complain of visual disturbances, ringing in the ears, or extreme weakness. Nursing Management: Non Life threatening: Nursing staff must implement resuscitative techniques as so: Oxygen therapy should be started, and maintained at a prescribed rate. Vital signs checked regularly (Blood pressure, Pulse, Respirations) as signs of worsening haemorrhage. CVP (central venous pressure) monitoring may also be started Vomit should be assessed (if any), for signs of blood, and the type that there is (fresh or "coffee ground" appearance) If bleeding is severe and vomiting is continuous, an NG (nasogastric) tube may be inserted to determine the amount. Stools should be observed for melaena Pain usually requires opiate analgesic relief (such as morphine, fentanyl). - Response to the pain relief should be rechecked and monitored, for signs of respiratory depression, and effectiveness. Urine output must be monitored, as hypotension (low blood pressure) caused by the bleeding can impair renal output. Fluid should be topped up, either plasma protein substitutes or full blood products should be given to maintain a circulating volume. The patient should also be talked to and reassured, trying to keep the patient calm is important. When/If the patients situation has stabilised preparations can be made for surgery. If conservative treatment has worked however, there should be no need. Antihemorrhagic An antihemorrhagic (antihaemorrhagic) agent is a substance that promotes hemostasis (stops bleeding). It may also be known as a hemostatic (also spelled haemostatic) agent. Brand name: Hemostan, Fibrinon, Cyklokapron, Lysteda, Transamin Classification: Anti-fibrinolytic, antihemorrhagic Indications: Tranexamic acid is used for the prompt and effective control of hemorrhage in various surgical and clinical areas: 4. 5. 3. Contraceptives, estrogen-containing, oral or Estrogens. Concurrent use with tranexamic acid may increase the potential for thrombus formation. Renal function impairment (medication may accumulate; dosage adjustment based on the degree of impairment is recommended) Hematuria of upper urinary tract origin (risk of intrarenal obstruction secondary to clot retention in the renal pelvis and ureters if hematuria is massive; also, if hematuria is associated with a disease of the renal parenchyma, intravascular precipitation of fibrin may occur and exacerbate the disease) Nursing Responsibilities 1. 2. 3. Unusual change in bleeding pattern should be immediately reported to the physician. For women who are taking Tranexamic acid to control heavy bleeding, the medication should only be taken during the menstrual period. Tranexamic Acid should be used with extreme caution in CHILDREN younger than 18 years old; safety and effectiveness in these children have not been confirmed. 4. 5. 6. 7. The medication can be taken with or without meals. Swallow Tranexamic Acid whole with plenty of liquids. Do not break, crush, or chew before swallowing. If you miss a dose of Tranexamic Acid, take it when you remember, then take your next dose at least 6 hours later. Do not take 2 doses at once. Inform the client that he/she should inform the physician immediately if the following severe side effects occur: Severe allergic reactions such as rash, hives, itching, dyspnea, tightness in the chest, swelling of the mouth, face, lips or tongue Calf pain, swelling or tenderness Chest pain Confusion Coughing up blood Decreased urination Severe or persistent headache Severe or persistent body malaise Shortness of breath Slurred speech Slurred speech Vision changes

Treating heavy menstrual bleeding Hemorrhage following dental and/or oral surgery in patients with hemophilia Management of hemophilic patients (those having Factor VIII or Factor IX deficiency) who have oral mucosal bleeding, or are undergoing tooth extraction or other oral surgical procedures

Surgical: General surgical cases but most especially operative procedures on the prostate, uterus, thyroid, lungs, heart, ovaries, adrenals, kidneys, brain, tonsils, lymph nodes and soft tissues.

Obstetrical and gynecological: abortion, post-partum hemorrhage and menometrorrahgia Medical: epistaxis, hemoptysis, hematuria, peptic ulcer with hemorrhage and blood dyscrasias with hemorrhage Effective in promoting hemostasis in traumatic injuries. Preventing hemorrhage after orthopedic surgeries.

Mechanism of Action Tranexamic acid is a synthetic derivative of the amino acid lysine. It exerts its antifibrinolytic effect through the reversible blockade of lysine-binding sites on plasminogen molecules. Anti-fibrinolytic drug inhibits endometrial plasminogen activator and thus prevents fibrinolysis and the breakdown of blood clots. The plasminogen-plasmin enzyme system is known to cause coagulation defects through lytic activity on fibrinogen, fibrin and other clotting factors. By inhibiting the action of plasmin (finronolysin) the anti-fibrinolytic agents reduce excessive breakdown of fibrin and effect physiological hemostasis. Contraindications 1. 2. 3. Allergic reaction to the drug or hypersensitivity Presence of blood clots (eg, in the leg, lung, eye, brain), have a history of blood clots, or are at risk for blood clots Current administration of factor IX complex concentrates or anti-inhibitor coagulant concentrates Precautions 1. 2. Pregnancy. Tranexamic acid crosses the placenta. Lactation. Tranexamic acid is distributed into breast milk; concentrations reach approximately 1% of the maternal plasma concentration.

Trade Name(s): Obrochrome, Xychrome, Styptocid Forte, Capistat (10 ml), Styptocid (1mg), Styptochrome, Capistat, Styptochrome Inj, Swistat, Haemstat, Siochrome F, Clot, Klog, Styptindon, Pfichrome. Apricol Forte, Sigmachrome, Adrenostazin. Other Name : Adrenochrome Monosemicarbazone Why it is prescribed (Indications) : This medication is an antihemorrhagic agent, prescribed for bleeding disorders.

When it is not to be taken (Contraindications): Hypersensitivity. When it is to be taken : Adult- PO- The recommended dose is 10-30 mg three times per day. SC/IM- The recommended dose is 10 mg daily. How it should be taken : It comes as a capsule to take by mouth, with or without food. It comes as a solution for injection to be administered by a healthcare provider into the large muscle or under the skin. Warnings and Precautions : * Caution should be exercised in elderly people, children, pregnancy and breastfeeding women. Side Effects : Gastrointestinal disturbances, and hypersensitivity. Other Precautions : *Avoid excess dosage.

Ethamsylate is a drug, known to possess antihemorrhagic properties. It is said to correct abnormal platelet adhesion, thereby reducing capillary bleeding. The drug is used for preventing and treating capillary haemorrhages associated with menorrhagia, heamoptysis, haematuria etc. Dosage Adults: 250-500 mg thrice daily Neonates: 12.5mg/kg body weight every 6 hours Contra Indications: Hypersensitivity Side Effects The drug has certain side effects, that can affect individuals in different ways. The following are some of the side effects, that are often associated with the drug: Headache Rahs Nausea Transient hypotension with i.v. injection