Post Operative Bleeding.pptx

8/10/2019 Post Operative Bleeding.pptx

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MANAGEMENT OF POST-OPBLEEDING

Presented bySidra Tul MuntahaDemonstrator OMFS.


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Case Report

Name: M.Ubaid

Age: 6 years

Gender: Male

Address: Islamabad

P/C: pain in upper right andlower left side of the face

Diagnosis: Rampant cariesTreatment: extractions

under GA.


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Pressure with oral packs


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Electrocautery


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Suturing/ligation


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Hemostat.


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Hemostatic agents

They are used for bleeding control and for

wound protection. Gel foam.

Surgicel.

Bone wax. Collagen.

Thrombin.


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Gelfoam

A sterile, pliable, surgical spongeprepared from purified gelatinsolution.

When implanted in tissues, thesponge is completely absorbed within

four to six weeks without inducingexcessive scar tissue.

Provide scaffold for the formation ofblood clot.


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Surgicel(resorbable oxidized regenerated cellulosematerial).

It is prepared as a sterile fabricmeshwork.

Its mechanism of action is notcompletely known, but appears to bephysical rather than involve an alterationof the clotting mechanism.

After it is fully absorbed with blood, itswells into a brownish/black gelatinousmass that aids in clotting. Surgicelisbacteriostatic and absorbs in 12 weeks.


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Bone wax

Bone Wax is a sterile mixture ofbeeswax, paraffin, and isopropylpalmitate.

It is useful when bleeding is from avisualized local vascular channel withinbone.

The wax is pliable enough to be placedwithin a vascular channel, immediatelytamponading the vascular source.

Bone Wax is absorbable in 30 days.


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Collagen

These products (eg, CollaPlug, CollaTape,and Helistat) are soft, white sponge-likestructures.

They are fabricated from bovine collagenand are nontoxic and nonpyrogenic.

Causes platelet aggregation andaccelerate clotting mechanism.

These products should be held in placefor approximately 2 to 5 minutes toachieve hemostasis and then may beremoved, replaced, or left in situ.

All of these collagen materials arecompletely resorbed within 14 to 56 days.


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Systemic measures to control

bleedingSystemic drugs work by inhibiting fibrinolysisor

promoting coagulation

Tranexamic acid.

Vitamin K.
http://en.wikipedia.org/wiki/Fibrinolysishttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Coagulationhttp://en.wikipedia.org/wiki/Fibrinolysis


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Tranexamic acid

Tranexamic acid is asynthetic derivative of theamino acid lysine that exerts itsantifibrinolytic effect throughthe reversible blockade of lysine

binding sites on plasminogenmolecules.

Intravenously administeredtranexamic acid (mostcommonly 10 mg/kg followed

by infusion of 1 mg/kg/hour)


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The competitive inhibition produced as tranexamic acid binds toplasminogen makes it impossible for plasminogen to bind withfibrin.


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Vitamin K

Vitamin k is required for synthesis of clottingfactor II, VII, IX, X.


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Vitamin K

Factor II

(prothrombin) is

converted into

thrombin duringclotting and results

in clot formation.


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Vitamin K


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If bleeding still persist then you should ruleout for systemic causes.


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Systemic causes

Hemophilia

Von Willebrands disease

Thrombocytopenia Vitamin K deficiency

Disseminated intravascular coagulation


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References

Contemporary oral and maxillofacial surgery.

Medical problems in dentistry by Scully.

Textbook of medical physiology by Guyton & Hall

Tranexamic acid: a review of its uses in surgery &other indications Dunn CJ, Goa KL.

Etiology, Prevention and Management of PostExtraction ComplicationsContinuing Dental Education Course - 4 CEUs

Author Michael Florman, DDS Review of Hemostatic agents in dentistry

Written by William L. McBee, DDS, and Karl R. Koerner, DDS, MSTuesday, 01 March 2005 00:00
http://www.dentistrytoday.com/oral-medicine/oral-surgery/1538http://www.dentistrytoday.com/oral-medicine/oral-surgery/1538


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Acknowledgement

Dr. Mamoona Ahmed


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THANK YOU

Documents

Post Operative Bleeding.pptx