Download Expulsive haemorrahge

Expulsive Haemorrhage
Sr.Shanthi, OT
ARAVIND EYE CARE SYSTEM
Definition
• Expulsive Supra Choroidal Haemorrhage
is a sudden rise in Intra Ocular Pressure,
resulting in expulsion of intra ocular
contents
Supra choroidal
Haemorrhage
• It may occur any time during surgery
ARAVIND EYE CARE SYSTEM
Occurrence
• Uncontrolled Hyper Tensive
Systolic
(more than 200mm/Hg)
Dyastolic
(more than 100mm/Hg)
• Cardiac with Hyper Tensive (Uncontrolled)
• High Intra Ocular Tension
• Increased Intra Ocular Orbital Pressure (more
quantity of Xylocaine i.e. Repeated Block
• Retro bulbar Haemorrhage
ARAVIND EYE CARE SYSTEM
Occurrence – Contd…
• Secondary Glaucoma – Phacomorphic
• Malignant Choroidal Melanoma
• Not Good Massaging
• Advanced Age
Malignant
choroidal
melanoma
• Increased Axial length
• During surgery, PCR with vitreous loss
• Short Neck & Obese Patient
• Very Poor Patient cooperation
ARAVIND EYE CARE SYSTEM
Symptoms
After entering anterior chamber,
suddenly Iris will come out
Anterior chamber becomes flat
Excessive bleeding from supra
choroidal space from post
ciliary vessels
Benign choroidal
nevus
Fundus glow becomes dull
Lens, Vitreous, Retina, Choroid,
also tend to come out
immediately
ARAVIND EYE CARE SYSTEM
To the Attention of Scrub Nurse
• Knowledge and identification of Expulsive Haemorrhage
• While putting Superior Rectus Suture the hardness of the
eye ball could be seen.
• In ocular emergency condition call Senior surgeon &
Senior scrub nurse because, only they can manage
• Inform OT supervisor & Authority person
• Running nurse also is to be always alert
ARAVIND EYE CARE SYSTEM
Things to be ready in OT
• 15 degree knife, with holder for sclerotomy, to reduce
the sub retinal fluid pressure
• Cylodyalisis Spatula for reposite the Iris
• Need more dressing eye pads & cotton wiper
• 8.0 silk suture
• IV Mannitol 20% with IV set
• IV / IM sedation
• Pain killer to be given after surgery
ARAVIND EYE CARE SYSTEM
Managing the Surgery in Ocular Emergency
• Sclerotomy with 15 degree knife reduce the intra ocular pressure
• Surgeon will put suturing with 8.0 silk and close the wound
immediately otherwise, the eye ball will emerge out
• Clean the wound very quickly
• 5 to 8 sutures should be applied with 8.0 silk suture
• 9.0 or 10.0 should be avoided because of the thinness. It may
break in the hurry burry work.
ARAVIND EYE CARE SYSTEM
Managing the Surgery in Ocular Emergency
Contd…
• Start IV mannitol 20% during surgery (100 ml or 200 ml) as per
the surgeon’s advise.
• In cardiac patient if necessary get IV Mannitol on the advise
of the physician
• Check the BP
• In case there is no chance of preserving vision
“Evisceration can be done in some cases”
ARAVIND EYE CARE SYSTEM
Managing the Surgery in Ocular Emergency
• Tight pad and bandage
• After surgery Tab Diamox, oral Glycerol is to be
given
• Post operative – topical steroids
• After 1 week if the blood clot gets liquefied,
surgery (PPV) can be tried in some cases
** Avoid Diamox for patient with renal failure
** Avoid oral Glycerol for Diabetic patient. If necessary
give Mannitol with physician advise
ARAVIND EYE CARE SYSTEM
Shifting
• Patient is to be shifted by stretcher trolley to ICU for
observation
• Every 1 hour check BP
• Check the Bleeding from the Eye. If the eye is still bleeding
change the pad and bandage.
• Inform ward Doctor, Ward In-charge
• Opinion from Glaucoma clinic and Retina clinic for USG
• Medical Officer will counseling to the patient attender
regarding visual prognosis
• Avoid unnecessary talking about Expulsive Haemorrhage in
front of the patient or attender
ARAVIND EYE CARE SYSTEM
Precautions
• BP is to be checked by the Doctor for all Hypertensive
patient before surgery
• Check intra ocular tension for all glaucoma cases
• If the Ocular tension is high give Mannitol on the advise of
the physician
• Check the eye movement after giving local anesthesia
• Good massage is to be given
• Check the tension digitally
• Check whether there is sub conjunctival Haemorrhage or
Retro Bulbar Haemorrhage
ARAVIND EYE CARE SYSTEM