Post-op Bleeding

Localised Bleeding
That occuring early is often technical in origin
Is surgically correctable by early intervention

Primary Haemorrhage
Occurs during operation in sites that can be difficult to control
- eg pelvis or injured liver.
Need packing
--> remove at 72hrs to reduce risk of sepsis.

Reactive Haemorrhage
Usually reveals iself in recovery
- eg slipped ligature or aortic graft anastomotic leak.
- needs to return to theatre for control.
--> pts becoming overtly shocked almost always need surgery
--> as do pts suffering a recurrence of lesser degrees of cardiovascular compramise (eg fluid requirement) that cannot be explained

Secondary Haemorrhage
Occurs at day 7-8 post op.
Is infection-related.
- often unexpected so control may come late and become difficult.
- proximal vascular control may be needed to stop the bleeding.

Other Management Points
- pts with post-op bleeding usually end up with a sizeable transfusion
Hypotension, coagulopathy and hypothermia make ICU admission advisable in many cases.

Generalised Bleeding
Consider non-technical factors:
- anticoagulant therapy
- recent large transfusion
- sepsis and DIC
- unrecognised concomitant bleeding disorder (congenital or acquired)

Coagulopathy is common in the critically ill

- correction is advisable prior to operating
- take care in ascribing surgical bleeding to minor degrees of coagulopathy
- coagulation ratios >1.5  or so make surgery difficult.