it includes steps of controlling bleeding, primary and secondary hemostasis etc...

1. Dr. Imran Aslam
Assistant Professor
North Surgical Ward

2.  Hemostasis is the process of forming clots in
the walls of damaged blood vessels and
preventing blood loss while maintaining blood
in the fluid state within the
vascular system.

3.  Coagulation is combination of
1. Stasis of blood
2. Endothelial injury
3. Hypercoagulability

4.  Hemostasis means prevention of ‘Blood Loss’. Hemostasis is achieved by several
mechanism:-
 Vascular constriction
 Formation of platelet plug
 Formation of blood clot
 Growth of fibrous tissue into the clot.

5.  The contraction results from:-
 Local myogenic spasms
 Local autacoid factors
 Nervous reflexes
 Platelets release, Thromboxane-A2
which is responsible for vasoconstriction of
smaller vessels.
 The more severely a vessel is
traumatized, the greater the degree of
vascular spasm.

6.  MECHANISM OF PLATELET
PLUG
 Platelet adhesion
 Platelet activation
 Platelet aggregation
 Formation of temporary
hemostatic plug

7.  Third mechanism for hemostasis is formation of blood clot
 Clot begins to develop-
 severe trauma-15 to 20 sec
 minor trauma-1 to 2 min

8.  These mechanisms are set into play by:-
 Trauma to the vascular wall and the adjacent tissues
 Contact of the blood with damaged endothelial cells
 a) Extrinsic pathway for initiating blood clotting
 b) Intrinsic pathway for initiating blood clotting

11. In response to rupture of the vessel or damage to the blood
itself-formation of prothrombin activator
Prothrombin activator catalyzes conversion of prothrombin to
thrombin
Thrombin catalyzes fibrinogen into fibrin fibers.

13.  The clot is a meshwork
 Fibrin fibers also adhere to damaged surfaces of blood vessels.
 As the clot contracts, the edges are further pulled together, contributing ultimate
state of Hemostasis.

14. FIBRINOGEN
ACTION OF THROMBIN ON FIBRINOGEN TO FORM FIBRIN
BLOOD CLOT
CLOT RETRACTION-SERUM

18. Direct pressure
Gauze pack
Suture and ligation
Staples

19.  First choice to control bleeding
 Fast and simplest
 Small Arterial bleeding
 Venous bleeding
 15-20 sec
 Not recommended in major artery and veins.

20.  Used with direct pressure
 It is used in
 - only pressure is not an
option
 -systemic bleeding due to
infection, trauma, massive blood loss,
and platelet dysfunction.


21.  Suture – used in major arteries and veins
 Ligation of facial artery, lingual artery, and external carotid artery

22. Stick Tie:
 Also called as transfixation.
 Used for High Blood pressure
 Proximal part of the vessels
Regular Tie
 Used for Distal part of the vessels
 Also used for tubectomy .

23. Staples- sterile and disposable
 titanium staples
Ligating clips-
 quick and easy
 decrease foreign body reaction
 various size

24.  Hemostats (Mosquito and Artery) are designed to catch bleeders.
 Can be straight or curved.

25.  Is a mixture of Beeswax (70%) and Vaseline (30%).
 It is a non-absorbable material , becoming soft and malleable in the hand when
warmed
 Its Hemostatic effect is based on physical rather than biochemical properties.
 It has been used in bone surgeries

26.  -Restricts tumors blood supply .
 -Arterial embolization preferentially interrupts tumors blood supply and stalls
growth until neovascularization
 - Used to control bleeding in Hemangiomas

28.  Heat (Cautery)
 Electro cautery: it is the use of high frequency alternating current for cutting,
coagulating, dessication or fulgurating tissue in both open and laparoscopic
procedure
 monopolar electro surgery
 bipolar electro surgery
 bipolar electrosurgery vessel sealing technology
 argon enhanced coagulation technology
 Ultrasonic device
 Lasers

29.  Most frequently used
 Two electodes- active (the pencil)
 - dispersive
 Modes - coagulation mode
 - cutting mode
 - blend mode
 Current flows through the patient from electrode (active) to electrode (dispersive)

30.  Current does not flow through the patient’s body
 Lower voltage
 Indicated in limited thermal spread
 Delicate tissue, small anatomical tissue
 Safe for implanted medical devices such as pacemaker, internal cardioconverter
fibrillator etc.

32.  Pharmacological agents
 Topical haemostatic agent
 Passive
 active

33.  Sterile haemocoagulase solution
 Epinephrine
 Vitamin k
 Protamine
 Desmopressin
 Lysin analogs
 Etamsylate

34.  Causes direct vasoconstriction
 Can be applied topically and can be injected with LA
 Prolong analgesic effect
 Reduces bleeding during surgery
 Topical - The drug is applied with the help of gauze pack in concentration of
1:1000 over a oozing
 It is also injected along with local anesthetics in concentration of 1:80,000 and
1:2,00,000.

35.  Plays important role in coagulation process
 Helps in production of fibrinogen and prothrombin in liver
 Route- orally and IV(slow)
 IM and subcutaneous is not recommended because irratic absorption
 Dose- Males: 120 mcg/day PO
 Females: 90 mcg/day PO
 5-10 mg IV (dilute in 50 mL IV fluid and infuse over 20 min

36.  Reverse heparin anticoagulation activity
 Adverse effect- anaphylaxis, acute pulmonary vasoconstriction, right ventricular
failure
 Contraindication
 -diabetic
 -pt undergone vasectomy
 -drug allergy
 -previous protamine exposure
 Dose -1.0 -to- 1.5 mg protamine sulfate IV for every 100 IU of active heparin

37. Tranexamic acid- loading dose 2-7gm
 Follwed by 20-250 mg hourly
 Total dose of 3-10gm
 Oral dose; 500 mg 6-8 hrly
 Children; 1.25g/5 ml of syrup
 Inj- 0.5-1g slow i.v infusion TID

38.  Passive- collagen based product
 - oxidised regenerated cellulose
 - gelatine

 Active haemostat
 - thrombin product
 - pooled human plasma thrombin
 - recombinant thrombin