Bleeding is one of the main complications that can occur following any type of surgery. In certain instances, the complication could well be enough to either re-do the surgery or else in leading to fatal consequences. Many parameters, both direct and indirect, are being used in assessing the risk of bleeding and its early identification is vital in the process of early recovery.
The amount of bleeding following a surgery can vary from surgery to surgery and the potential sites of bleeding would also differ accordingly. In certain instances, the bleeding can be visible to the outside, but in most instances, the bleeding would be within the body.
Following are some of the measures used in identifying such bleeding episodes after a surgical procedure.
Pulse
When there’s bleeding taking place, the heart tries to compensate for the lost volume in the circulation through pulsating rather quickly. This would give rise to a condition known as ‘tachycardia’ or rapid heart rate. In the wards, the medical staff would be looking at a progressive change in the pulse rate rather than a static reading, as all of us has different pulse rates from one to another.
Blood pressure
If there is a bleeding taking place, the intravascular volume will get depleted and thus the pressure within the vasculature will drop. Thus, it would be evident to see a progressive drop in the blood pressure in patients who are having a bleed. But, although in combination it provides much evidence for bleeding, its sensitivity in identifying a bleed early is questionable.
Malaena stools
The term is used to describe the black colored tarry stools which indicate an intestinal bleeding which is taking place in the proximal intestine. This can be normal in the first day or two following an intestinal procedure or surgery, but beyond, it may need further investigations.
Pallor and Hemoglobin levels
Pallor is the clinical sign which can be seen in a patient with low hemoglobin levels. Such patients will demonstrate an overly pale looking conjunctiva or a tongue. As this indicates either an anemic state present from the beginning or blood loss during or after surgery, it should be investigated by doing a blood hemoglobin level.
Abdominal distension
Measuring the increasing abdominal girth is one way of assessing massive bleeds that can take place following major abdominal surgeries and it should be distinguished between a distension occurring due to collection of air or any other fluid.
Continuously soaked dressing
A dressing that gets soaked each time it is changed can be a sign of localized bleeding and would need further investigations.
Cold peripheries
In instances where there is an internal bleeding, body tries to compensate by reducing the flow to the peripheries and channeling it to the vital organs. Thus, this kind of unusually cold and clammy peripheries needs further investigations.
Reduced urine output
It can be the result of renal insufficiency or else reduced blood volume, leading to a lesser urine output.
Pain
Due to the irritation, compression or distension of tissue structures, the patient can suffer from pain which can be progressive. Along with the other evidence, it can prompt towards a bleeding that would require further investigations.
Apart from these indications, there can be other such factors that can be associated with post op bleeding and it should always be investigated in order to prevent detrimental outcomes.
