post operative bleeding.pptx
TRANSCRIPT
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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