Bleeding is the most dangerous post-traumatic complications that threaten the life of the injured person. The degree of possible risk depends on the specific characteristics and location of the damaged vessels.

There is the following classification of types of bleeding:

• Capillary bleeding. This type of bleeding occurs when the smallest vessels located in the mucous membranes, muscle tissue, and skin are injured. Signs of bleeding from the capillaries are: dark red color of the blood, bleeding in a small stream (for superficial cuts) or even bleeding over the entire surface of the wound (for abrasions). Capillary bleeding extremely rarely threatens the life and health of the affected person (if there is no hemophilia and problems with blood clotting) and, as a rule, stops on its own.
• Venous bleeding. The main sign of bleeding from the veins is the slow but continuous flow of blood from the wound. The blood is dark red. In case of venous bleeding of significant force, in order to prevent the loss of a large amount of blood, it is necessary to urgently clamp the damaged vessel using any available means (you can even use your finger).
• Parenchymal bleeding. Refers to internal bleeding. It is typical for wounds and injuries of the lungs, liver, spleen and other internal organs. With this type, it is possible to bleed blood of different colors (depending on which internal organ is damaged) - dark red and bright scarlet. When blood comes out, it appears evenly over the entire wound surface. The greatest danger is when parenchymal bleeding occurs hidden. The patient risks losing a lot of blood without waiting for first aid, because... Diagnosis of internal bleeding is extremely difficult.
• Arterial bleeding. A characteristic sign of bleeding from the arteries is a pulsating stream of blood from the wound; the color of the blood is bright scarlet. This species poses a particular danger to the life of the victim, because rapidly leads to the onset of complete bleeding of the body. The development of acute anemia during arterial bleeding is accompanied by the following, most obvious, signs: a drop in pulse and blood pressure, progressive pallor of the skin and mucous membranes, nausea, vomiting, darkening of the eyes, dizziness, loss of consciousness.
• Mixed (combined) bleeding - occurs with extensive injuries and combines various types of bleeding described in the previous paragraphs.

Treatment of bleeding

First aid measures for bleeding should be started as soon as possible after injury. They consist primarily of stopping bleeding and preventing significant blood loss. If we are talking about arterial bleeding, the necessary measures to stop the bleeding must be taken immediately, since with this type of bleeding, a significant amount of blood flows from the wound damage over a short period of time. A rapid and sudden loss of blood (more than two liters) can lead to death, especially if the bleeding is combined with combined traumatic injuries.

For obvious reasons, first aid for bleeding is usually performed outside the walls of a medical institution. Therefore, this procedure is temporary and consists of stopping the bleeding in order to quickly transport the injured person to a medical hospital.

Ways to temporarily stop bleeding:

Video from YouTube on the topic of the article:

– leakage of blood from damaged vessels of the skin, mucous membranes, muscles and subcutaneous tissue into the external environment. Usually occurs as a result of injury, although other causes are also possible (for example, failure of the sutures when suturing a vessel or melting of the vessel wall due to phlegmon). Depending on the type of damaged vessel (or vessels), it may either not require specialized care or pose an immediate danger to the patient’s life. Diagnosis of external bleeding is usually not difficult. Treatment is surgical. Ligation of the damaged vessel, vascular suture, tamponade, etc. can be performed. Simultaneously with surgical treatment, general measures are taken to compensate for blood loss and prevent the development of complications.

To stop external bleeding, suturing of blood vessels is used, and less commonly, wound tamponade. If large arterial trunks are damaged, a vascular suture may be applied. An operation to stop bleeding is carried out as an emergency and is accompanied by general measures aimed at compensating for blood loss and preventing the development of complications.

Bleeding is a process formed as a result of a traumatic effect on human tissue, as a result of which it is damaged. This statement is partially true. However, upon closer examination, it turns out that this definition is only the tip, a kind of snow cap, under the more massive concept and structure of which is meant such a difficult term as bleeding. Let us consider sequentially all the processes and their signs that occur during certain types of bleeding, and try to understand all the subtleties and intricacies of this specific issue.

What could be simpler than to describe the types of bleeding? However, in reality everything is not so simple, since there are many varieties, categories and subgroups into which it is divided.

Main types of bleeding

Why is there blood flowing? Let's start delving into the abyss of medical knowledge by defining the main categories of bleeding. In fact, there are many more of them than the three species that we studied at school. All these varieties are characterized by a huge list of parameters. So, bleeding in adolescents, like other people, regardless of their age, is of the following types, which differ in their characteristics and methods of manifestation:

• in the direction of blood flow;
• along a damaged vessel;
• by origin;
• by severity;
• according to the reaction time.

In addition to this entire list, each of these items contains its own subcategories, characteristic only for a certain type of bleeding. Based on this, it is clear that bleeding is not a simple release of blood from a wound, but a much more complex process than it seemed at first glance.

Bleeding in the direction of blood flow

Why is there blood? The first definition characterizing the concept of bleeding is the direction of blood flow. In most cases, it is formed as a result of injury to one or another part of the tissue and, depending on this, it happens:

• external;
• internal.

From the terms themselves, it becomes clear that external bleeding occurs as a result of injury to the outer layers of the skin. In this case, damaged vessels release blood into the external environment. In simple words, an external wound is formed from which blood flows. This appearance is usually what first comes to mind when the term bleeding is mentioned. This is due to the fact that in the course of human life we ​​often encounter precisely similar lesions, which form a similar reaction to this term in our perception.

The latter categories are practically incompatible with life, since with such blood loss the functioning of the body cannot be restored. Blood leaves the tissues and devastates the organs, the heart stops working and the brain dies. Resumption of life activity with such a percentage of losses is practically impossible.

Bleeding according to the time of the process

There are often cases when internal or external bleeding is stopped, but other complications arise. This led to the emergence of another branch of structuring, which looks like this:

• primary;
• secondary.

Primary involves direct damage to blood vessels, resulting in the release of blood. In such conditions, the causes of bleeding play absolutely no role; the most important factor here is the consequences that require immediate elimination. Any cut or wound is an example of primary blood loss that must be eliminated in order to avoid more severe consequences and stages of injury.

Secondary bleeding occurs after the primary consequences have been neutralized and the wound has completely stopped. It is formed as a result of disruption of the regenerating layer or as a result of postoperative complications. Such secondary problems can arise either in the form of hidden or form new open bleeding. Treatment of such consequences, as a rule, is significantly difficult and is an extremely long-term and complex process.

Conclusion on the topic

Bleeding is a rather complex concept, since it includes many categories and a fairly deep structure that characterizes almost all known factors that influence such consequences. It would not be out of place to say that each individual lesion of tissues or organs does not form a separate type, but mixed bleeding, which implies the use of several categories. Also, any of the listed types of bleeding can occur as a result of medical intervention or improperly organized treatment. Such injuries have their own separate name - iatrogenic blood loss.

Any such damage requires immediate response and first aid. Whether it is bleeding from the genitals or capillary discharge, all lesions require consultation with a doctor. More severe consequences of each type separately should be treated under the clear guidance of a specialist who will prescribe the necessary medicine and draw up a list of preventive agents.

– shedding of blood into the external environment, natural body cavities, organs and tissues. May occur when the integrity of the vessel is disrupted or the permeability of the vascular wall increases; develop as a result of injury or disease; be arterial, venous, capillary, parenchymal or mixed. The clinical significance of bleeding depends on the magnitude and rate of blood loss. Symptoms: weakness, dizziness, pallor, tachycardia, decreased blood pressure, fainting. Detection of external bleeding is not difficult, since the source is visible to the naked eye. To diagnose internal bleeding, depending on the location, various instrumental techniques can be used: puncture, laparoscopy, X-ray contrast study, endoscopy, etc. Treatment is usually surgical.

First aid consists of anesthesia and immobilization with a splint. For open fractures, apply a sterile bandage to the wound. The patient is taken to the emergency room or trauma department. To clarify the diagnosis, radiography of the damaged segment is prescribed. For open fractures, PSO is performed; otherwise, treatment tactics depend on the type and location of the injury. For intra-articular fractures accompanied by hemarthrosis, a joint puncture is performed. In case of traumatic shock, appropriate anti-shock measures are taken.

Bleeding from other injuries

TBI can be complicated by hidden bleeding and hematoma formation in the cranial cavity. At the same time, a fracture of the skull bones is not always observed, and patients in the first hours after the injury may feel satisfactory, which complicates the diagnosis. With closed rib fractures, damage to the pleura is sometimes observed, accompanied by internal bleeding and the formation of hemothorax. With blunt trauma to the abdominal cavity, bleeding from the damaged liver, spleen or hollow organs (stomach, intestines) is possible. Bleeding from parenchymal organs is especially dangerous due to the massive blood loss. Such injuries are characterized by the rapid development of shock; without immediate qualified assistance, death usually occurs.

In case of injuries to the lumbar region, a bruise or rupture of the kidney is possible. In the first case, the blood loss is insignificant; bleeding is evidenced by the appearance of blood in the urine; in the second case, there is a picture of rapidly increasing blood loss, accompanied by pain in the lumbar region. With bruises in the lower abdomen, rupture of the urethra and bladder may occur.

First aid for all internal bleeding of a traumatic nature consists of pain relief, ensuring rest and immediate delivery of the patient to a specialized medical facility. institution. The patient is placed in a horizontal position with legs elevated. Apply cold (a bubble or heating pad with ice or cold water) to the area of ​​suspected bleeding. If esophageal or gastric bleeding is suspected, the patient is not allowed to eat or drink.

At the prehospital stage, if possible, anti-shock measures are carried out and blood volume is replenished. Upon admission to medical school. the institution continues infusion therapy. The list of diagnostic measures depends on the nature of the injury. In case of TBI, a consultation with a neurosurgeon, skull X-ray and EchoEG are prescribed, in case of hemothorax - chest X-ray, in case of

BLEEDING- outpouring (leakage) of blood from blood vessels when the integrity of their walls is violated.

By origin, bleeding can be traumatic, caused by damage to blood vessels, or non-traumatic, associated with the destruction of a vessel by some painful process or with increased permeability of the vascular wall in certain diseases. In addition, bleeding accompanies physiological processes such as menstruation and childbirth. Traumatic bleeding that occurs immediately after injury is called primary, and bleeding that appears or resumes a few days after the injury is called secondary. The cause of secondary bleeding is most often purulent processes in the wound, which lead to the melting of blood clots that closed the lumen of the damaged vessel. The appearance of bleeding, its duration and intensity is facilitated by reduced blood clotting.

The danger of bleeding primarily lies in the fact that with a decrease in the amount of circulating blood, the activity of the heart worsens, and the supply of oxygen to vital organs - the brain, liver, and kidneys - is disrupted. This leads to a sharp disruption of metabolic processes in the body, and in case of severe blood loss, to the death of the patient. The severity of blood loss is determined by the speed and duration of bleeding. The activation of the body's defenses (narrowing of the lumen of a bleeding vessel, the formation of a blood clot) ensures that bleeding from small vessels, as a rule, stops on its own. Bleeding from large blood vessels, especially arterial vessels, can lead to fatal blood loss within minutes. Therefore, any bleeding must be stopped quickly. Blood loss is especially dangerous in children and the elderly. In some diseases accompanied by reduced blood clotting (hemophilia, radiation sickness), any, even minor bleeding can become life-threatening due to its duration.

Bleeding may be external, in which blood through a wound to the skin or mucous membrane of the mouth or nose directly enters the environment; internal explicit, in which blood is poured into hollow organs (stomach, intestines, bronchi, bladder) and, as it accumulates, is released out through natural openings; internal hidden when blood enters a closed body cavity (abdominal, thoracic, cranial cavity), and interstitial(otherwise - hemorrhage), in which the blood pushes the soft tissues apart, forming an accumulation in them - a hematoma, or saturates them (see Bruise). Depending on the type of bleeding vessel, bleeding is divided into arterial, venous, arteriovenous (mixed), and capillary.

For external arterial bleeding the flowing blood has a bright red color, flows in a strong intermittent stream, and is ejected in jerks in accordance with the pulse.

For venous bleeding the blood is dark cherry, flows out in a uniform stream; when large veins are injured, a pulsating stream of blood may be observed, but this corresponds not to the pulse, but to breathing.

Mixed external bleeding characterized by signs of both arterial and venous bleeding.

For capillary bleeding blood is released evenly over the entire surface of the wound (like from a sponge).

Bleeding through the mouth may be associated with bleeding from the lungs, upper respiratory tract, pharynx, esophagus and stomach. The discharge of foamy scarlet blood from the mouth is characteristic of pulmonary hemorrhage, which arose, for example, with pulmonary tuberculosis. “Bloody vomiting” often occurs due to peptic ulcer of the stomach and duodenum, if the ulcerative process destroys a blood vessel; stomach bleeding sometimes it is the first manifestation of a peptic ulcer, which until then had been asymptomatic.

Sometimes gastric bleeding can complicate the course of acute gastritis and stomach tumors. A common cause of gastric bleeding is cirrhosis of the liver, which leads to dilation and rupture of the venous vessels of the esophagus and stomach. A completely reliable sign of bleeding from the stomach and duodenum is vomiting with contents resembling coffee grounds (blood poured into the stomach, under the influence of hydrochloric acid of gastric juice, acquires a dark brown color); with rapid gastric bleeding, vomiting of fresh and coagulated dark red blood is possible, with only a small admixture of “coffee grounds”. After some time (1-2 days), tar-like feces (melena) with a fetid odor (due to the admixture of digested blood) appear. Blood in the stool appears when bleeding from any part of the gastrointestinal tract, and a tarry appearance of stool indicates bleeding from the upper parts of the gastrointestinal tract, dark red blood, evenly mixed with stool, indicates bleeding from the lower intestines, unchanged blood, not mixed with feces is a sign of bleeding from the lowermost parts of the colon. The presence of blood in the urine indicates bleeding from the kidneys, ureters, and bladder. However, these signs do not always allow one to determine the source and cause of bleeding, and therefore complex diagnostic studies are resorted to. A small amount of blood in urine, feces, etc. can only be detected under a microscope or using special reactions.

Internal hidden bleeding, i.e. bleeding into closed body cavities, occurs mainly as a result of damage to internal organs (liver, lung, etc.), and blood is not released outside. Such bleeding can be recognized only by changes in the general condition caused by blood loss, and by symptoms of fluid accumulation in a particular cavity. Bleeding into the abdominal cavity is manifested mainly by signs of acute anemia - pallor, weak rapid pulse, thirst, drowsiness, darkening of the eyes, fainting. When bleeding into the chest cavity, the symptoms of anemia are combined with shortness of breath (difficulty and rapid breathing). When bleeding into the cranial cavity, the signs that come to the fore are not blood loss, but compression of the brain, manifested by headache, impaired consciousness, breathing disorders, paralysis and other neurological symptoms.

At the first signs of bleeding, measures should be taken to stop it. Various physical, biological and medicinal means are used. In case of external bleeding, a distinction is made between temporary (preliminary) and permanent (final) stopping of bleeding. Temporarily stopping the bleeding prevents dangerous blood loss and allows you to buy time to finally stop the bleeding. Methods to temporarily stop external bleeding include: applying a pressure bandage; finger pressure of the artery; application of a hemostatic tourniquet; forced flexion of the limb.

A pressure bandage to temporarily stop external bleeding is applied mainly for minor bleeding - venous, capillary and for bleeding from small arteries. They do it this way: apply a sterile gauze napkin to the wound, a tightly rolled ball of cotton wool on top of it, and then bandage it tightly in a circular motion with the bandage. Instead of cotton wool, you can use an unwound sterile bandage. Applying a pressure bandage is the only method of temporarily stopping bleeding from wounds located on the torso (for example, in the gluteal region), on the scalp.

Pressing the artery along its length, i.e. not in the wound area, but higher (closer to the heart along the blood flow), is the most accessible way in any situation to temporarily stop large arterial bleeding. To use it, you need to know the place (point) where this artery lies closest to the surface and can be pressed against the bone; at these points you can almost always feel the pulsation of the artery (Fig. 1). Finger pressure makes it possible to stop the bleeding almost instantly. But even a strong person cannot continue pressing for more than 10-15 minutes, because his hands get tired and the pressure weakens. In this regard, this technique is important mainly insofar as it allows you to gain time for other methods of temporarily stopping bleeding, most often for applying a tourniquet.

Pressure of the common carotid artery is performed in case of severe bleeding from wounds of the upper and middle part of the neck, submandibular region and face. The person providing assistance presses the carotid artery on the side of the wound with the thumb or fingers II-IV of the same hand. The pressing fingers should be positioned as shown in Fig. 2, and apply pressure towards the spine, while the carotid artery is pressed against the transverse process of the VI cervical vertebra.

Pressure of the subclavian artery is performed in case of severe bleeding from wounds in the shoulder joint, subclavian and axillary regions and the upper third of the shoulder. It is performed with the thumb or fingers II-IV in the supraclavicular fossa. To increase pressure on the pressing finger, you can press with the thumb of your other hand. Pressure is applied above the clavicle in a direction from top to bottom, while the subclavian artery is pressed against the first rib (Fig. 3).

Pressure of the brachial artery is used for bleeding from wounds of the middle and lower third of the shoulder, forearm and hand. It is done with fingers II-IV, which are placed on the inner surface of the shoulder at the inner edge of the biceps muscle. The brachial artery is pressed against the humerus.

Compression of the femoral artery is performed in case of severe bleeding from wounds of the lower extremities. It is carried out with the thumb or fist. In both cases, pressure is applied to the groin area midway between the pubis and the protuberance of the ilium. When pressing with the thumb, to increase the pressure, apply pressure on top of it with the thumb of the other hand. Pressing with a fist is carried out so that the line of folds in the interphalangeal joints is located across the inguinal fold. To increase pressure, you can use your other hand (Fig. 5).

Application of a hemostatic tourniquet is the main method of temporarily stopping bleeding when large arterial vessels of the extremities are damaged. A rubber band consists of a thick rubber tube or tape 1-1.5 liters long, with a hook attached to one end and a metal chain to the other. In order not to damage the skin, the tourniquet is applied over clothing or the place where the tourniquet is applied is wrapped several times with a bandage, towel, etc. The rubber tourniquet is stretched, applied in this form to the limb and, without weakening the tension, wrapped around it several times so that the turns lie close to one another and so that no folds of skin get between them. The ends of the harness are fastened with a chain and hook. In the absence of a rubber band, improvised materials are used, for example, a rubber tube, a waist belt, a tie, a bandage, or a handkerchief (Fig. 6). In this case, the limb is pulled like a tourniquet, or a twist is made using a stick. The use of thin or hard objects (rope, wire) can damage tissue, especially nerves, so their use is not recommended.

The tourniquet is applied above the wound and as close to it as possible (Fig. 8). If the tourniquet is applied loosely, the artery becomes bluish in color. If the limb is compressed too much by a tourniquet, the underlying tissues, including nerves, are damaged, and paralysis of the limb can occur. The tourniquet should be tightened only until the bleeding stops, but no more. When applied correctly, bleeding immediately stops, and the skin of the limb turns pale. The degree of compression of the limb can be determined by the pulse in any artery below the applied tourniquet: the disappearance of the pulse indicates that the artery is compressed. The applied tourniquet can remain on the limb for no more than two hours (and in winter outside the room - 1-1.5 hours), because with prolonged compression, necrosis of the limb below the tourniquet can occur. A sheet of paper (cardboard) is attached to the tourniquet indicating the time of its application. In cases where more than two hours have passed and the victim for some reason has not yet been taken to a medical facility, the tourniquet is removed for a short time. They do this together: one applies finger pressure to the artery above the tourniquet, the other slowly, so that the blood flow does not push out the blood clot formed in the artery, releases the tourniquet for 3-5 minutes. and places it again, but slightly higher than the previous place. Victims who have a tourniquet applied should be monitored as the tourniquet may loosen and bleeding will resume.

Forced flexion of the limb as a way to temporarily stop bleeding is applicable for the upper and to a lesser extent for the lower limb. With forced flexion of the limb, the bleeding stops due to the bending of the arteries. When bleeding from wounds of the forearm and hand, stopping the bleeding is achieved by bending the elbow joint to full capacity and fixing the bent forearm with a bandage that pulls it to the shoulder. When there is bleeding from wounds of the upper shoulder and subclavian region, the upper limb is forced behind the back with flexion at the elbow joint; the limb is fixed with a bandage. Another way is to bring both arms back with the elbows bent and pull them together with a bandage. In this case, the arteries on both sides are compressed. If there is bleeding from the arteries of the lower extremities, you should bend your leg at the knee and hip joints until failure and fix it in this position. All these methods do not always lead to the goal and are impossible if there is a fracture of the bones of the limb.

In case of any bleeding, especially when a limb is wounded, it is necessary to give it an elevated position and ensure the rest of the injured part of the body. The final stop of external bleeding, which requires the use of special measures to stop it, is carried out by a surgeon, to whom the victim must be immediately delivered.

In case of internal bleeding, any reliable temporary stop of bleeding during first aid is impossible; When they appear, you should call an ambulance doctor or immediately take the patient to the hospital. In case of severe bruises and wounds of the abdomen, you should seek medical help, without waiting for signs of internal bleeding, which may not appear immediately, especially if the spleen is damaged, since its tissue sometimes begins to bleed violently only a few hours after the injury.

If you have a head injury, you should also not hesitate to see a doctor (see Traumatic brain injury).

Pulmonary or gastrointestinal bleeding indicates a serious illness that usually requires hospital treatment. In case of gastrointestinal bleeding, until the doctor arrives, provide the patient with strict rest; place a bubble with ice or cold water on the upper abdomen; The patient should not be given any food or drink. In case of hemorrhoidal bleeding, the patient should consult a doctor for treatment of hemorrhoids. Heavy bleeding from the rectum requires calling an ambulance. See also Nosebleed.

Bleeding is the leakage of blood from blood vessels when the integrity of their walls is violated in the tissue, body cavity, or into the external environment. 1. Anatomical and physiological classification - according to the source of bleeding: arterial, venous, capillary (parenchymal) mixed.

In a typical case of arterial bleeding, the wound is located in the projection of a large neurovascular bundle; the gushing blood is bright red (scarlet color) and flows in a strong pulsating stream. Due to high blood pressure, bleeding does not stop on its own. The rate of blood loss is high, which does not allow compensatory mechanisms to be realized and quickly leads to death. However, all of the above signs of arterial bleeding are not always observed: for example, with deep wounds with a narrow, tortuous wound channel, the pulsation of the blood stream may be absent; in case of severe hypoxia (for example, as a result of asphyxia), blood containing little oxygen will not be scarlet, but dark cherry, like venous blood.

In the presence of lacerated, crushed wounds, or avulsions of limbs, arterial bleeding can stop on its own due to spasm of the muscular lining of the vessel, screwing into the intima of the vessel, and the release of a large amount of tissue thromboplastin.

With venous bleeding, the blood is dark cherry red and flows out in an even stream. Only sometimes there is a weak pulsation of the blood stream as a result of the proximity of the damaged vessel to the pulsating arterial trunk or in time with breathing, due to the suction action of the chest. There are significant clinical differences between bleeding due to damage to the deep (large, main) and superficial (subcutaneous) veins.

Bleedings caused by damage to the main veins are no less, and sometimes even more dangerous, than arterial ones, because: they quickly lead to a drop in pressure at the mouths of the vena cava, which is accompanied by a decrease in the strength of heart contractions (Bain-Bridge reflex); can lead to air embolism, which especially often develops with damage to the veins of the neck, intraoperative damage to the vena cava; veins, unlike arteries, have a poorly developed muscular layer, and the rate of blood loss is almost not reduced due to vessel spasm.

Bleeding from damaged saphenous veins, as a rule, is less dangerous, since the rate of blood loss is much lower, there is practically no danger of air embolism, when the vessel wall is damaged and blood pressure decreases, the saphenous veins collapse, and the bleeding tends to stop on its own.

With capillary bleeding, blood is released evenly over the entire surface of the wound. Such bleeding is observed when any vascularized tissue is damaged (only a few tissues do not have their own vessels: cartilage, cornea, dura mater). Capillary bleeding usually stops on its own. Capillary bleeding is of clinical significance when there is a large area of ​​the wound surface, disorders of the blood coagulation system and damage to richly vascularized internal organs and tissues (liver, spleen, pancreas, kidneys, lungs).

Such bleeding usually does not stop on its own. Since these organs mainly consist of parenchyma, they are called parenchymatous. Bleeding when damaged is also called parenchymal. Massive capillary bleeding is accompanied by bone fractures, especially spongy bones. Most of the intraosseous vessels are veins, so bleeding when the bone is damaged takes an intermediate position between capillary and venous. The walls of blood vessels in bone tissue are fixed in the Haversian tubules, and the vessels do not collapse when damaged. Bleeding stops only when a hematoma forms around the damaged bone, the blood pressure in which is equal to the capillary pressure.

Mixed bleeding is called bleeding in the presence of several sources at the same time: injury to an artery and vein, a large vessel and a parenchymal organ. Particularly common is combined damage to an artery and vein running side by side as part of one neurovascular bundle. The clinical picture consists of a combination of symptoms of various types of bleeding, and at the first aid stage it is not always possible to reliably determine the source and nature of the bleeding. In such cases, you should act on the principle of “greatest danger” - see the section “Temporary stop of external bleeding”.

2. Classification according to the nature of damage to the vessel wall.

As a result of vessel injury - hemorrhagia per rexin (bleeding through a rupture). As a result of increased permeability of the vascular wall in the absence of macroscopic changes - hemorrhagia per diapedesin (bleeding through sweating). As a result of the destruction of a vessel by a pathological process in the vascular wall itself (ulceration of an atherosclerotic plaque) or an inflammatory process next to the vessel (purulent wound, stomach ulcer, lung abscess, pancreatic necrosis, disintegrating tumor) - hemorrhagia per diabrosin (bleeding through corrosion). As a rule, the presence of a destructive process near a vessel makes it possible to predict the development of bleeding and take timely measures to prevent it or prepare for its emergency stop. For example, if there is a purulent wound on a limb next to a large vessel, it is recommended to apply 1-2 rounds of a hemostatic tourniquet above the wound without tightening it. If bleeding develops, it can be quickly stopped by tightening the tourniquet. Sometimes bleeding per diabrosin develops unexpectedly. The authors observed two cases of bleeding from the aortic arch when a tracheal ulcer penetrated into it in a young patient with destructive pneumonia and when an ulceration of an atherosclerotic aortic plaque penetrated into the esophagus in an elderly patient. Both of these patients died within minutes of treatment within minutes of bleeding. Diagnoses were made only at autopsy.

3.Depending on the location of the bleeding, bleeding is divided into: external, internal hidden.

External bleeding - blood is released through a wound of the skin or external mucous membranes into the external environment. Bleeding from the nose (epitaxis), uterine cyclic (menorragia, mensis) and acyclic (metrorragia) bleeding, hemorrhoidal bleeding (haemorrhoe) are also usually classified as external.

With hidden external bleeding, blood first accumulates in cavities communicating with the external environment, and then is released out, often in an altered form. A typical example is bleeding into the lumen of the gastrointestinal tract: with gastric bleeding, blood first accumulates in the lumen of the stomach, and then is released out in the form of bloody vomiting (haematomesis) or in the form of “coffee grounds” vomiting (hemoglobin under the influence of hydrochloric acid is converted into hydrochloric acid). hematin), or in the form of tarry stools (melena). At a low rate of blood loss, blood released to the outside can only be detected using special laboratory (Gregersen reaction to “occult” blood) or instrumental (endoscopic) methods. In addition to bleeding into the lumen of the gastrointestinal tract, hidden external bleeding can be considered bleeding into the lumen of the tracheobronchial tree and into the urinary tract (haematuria).

Internal bleeding - blood pours out: 1.) into the body cavity: into the cranial cavity (haemorrhagia cerebri); into the joint cavity, the accumulation of blood in the joint cavity is called haemarthrosis; into the pleural cavity, the accumulation of blood in the pleural cavity is called hemothorax; into the abdominal cavity, the accumulation of blood in the abdominal cavity is called hemoperitoneum (haemoperitoneum); into the pericardial cavity, the accumulation of blood in the pericardial cavity is called hemopericardium (haemopericardium). 2.) in tissue: in the form of limited accumulations of blood - hematomas (haematoma); in the form of impregnation of fabric. Hematomas usually form in denser tissues (brain tissue, liver) or are delimited by fascial sheaths (on the extremities). More loose tissues (fatty tissue, muscles) are saturated with blood. As the pressure in the hematoma cavity increases, the bleeding stops, but in the future the tissue delimiting the hematoma may rupture, and the bleeding recurs. This mechanism of early secondary bleeding is typical for injuries of the liver and spleen (two-stage ruptures with the development of intra-abdominal bleeding). Since hematomas exist for quite a long time, the surrounding tissue turns into a scar, and the hematoma is surrounded by a connective tissue capsule. Over time, small hematomas can resolve almost completely. Larger hematomas are usually organized, i.e. are replaced by fibrous connective tissue and turn into a scar, which later sometimes becomes ossified. Cysts may form in place of large hematomas. This occurs if the central part of the hematoma undergoes autolysis and resolves, and the surrounding tissue, soaked in blood, turns into a scar. In addition, hematomas can fester. When suppuration occurs in the early stages, before the formation of a strong capsule, hematomas turn into phlegmons, and in the presence of a strong capsule - into abscesses. Loose tissues, saturated with blood, can accommodate significant volumes of it. Thus, retroperitoneal fatty tissue in case of kidney damage or fracture of the pelvic bones can accommodate up to 2.5 - 3 liters of blood; damaged muscles during a fracture of the femoral diaphysis absorb up to 1 liter of blood.

Hemorrhages into the integument of the body are also a variant of internal bleeding. The following names are used to designate them: petechiae - petechiae, pinpoint hemorrhages; ecchymoses - hemorrhages larger than petechiae; vibices - stripes of hemorrhages; suggilatio, suffusio - tissue hemorrhage, bruise. 4. Based on the time of occurrence of bleeding, they are divided into: 1.) primary bleeding - develops immediately after damage to the vessel; 2.) early secondary bleeding - develops in the first hours or days after injury due to squeezing out a blood clot or slipping of a ligature from a vessel when pressure increases, eliminating spasm; 3.) late secondary bleeding - develops no earlier than a few days after the injury due to melting of the blood clot by a purulent process or due to autolysis; erosion of the vessel wall in a purulent wound. Temporarily stopping external bleeding At the first signs of bleeding, measures should be taken to stop it.

In case of external bleeding, it is possible to temporarily stop it, which prevents further blood loss and allows the victim to be transported to a medical facility to completely stop the bleeding. For different sources of bleeding, different methods of temporary stopping are used.

In case of capillary bleeding and bleeding from the saphenous veins, you should: Give the injured limb an elevated position Apply a pressure (tight) bandage It must be remembered that the bandage should not be too tight so as not to compress the main arteries and veins. In case of arterial bleeding, you should: Perform finger pressure on the vessel to the underlying bone along its length (above the wound); Give the limb an elevated position; Apply a hemostatic tourniquet or use another reliable method of temporarily stopping arterial bleeding. The ability to perform digital pressure on various arteries is necessary for a doctor of any specialty, since delay even for a few seconds can cost the victim his life. At the points of pressure, pulsation of the arteries is palpated. You should learn (on yourself or your comrades) to instantly find the necessary points and clamp the arteries. The criterion for correct clamping of the artery during the training process is the disappearance of the pulse distal to the compression, and in a real situation - the cessation or significant weakening of bleeding. The carotid artery is pressed against the carotid tubercle (tuberculum caroticum) of the transverse process of the sixth cervical vertebra. To apply pressure, you need to find the middle of the inner edge of the sternocleidomastoid (sternocleidomastoid) muscle and press backwards and inwards, towards the midline of the back of the neck. The effectiveness of compression is checked on the temporal artery. For educational purposes, this technique should be performed carefully as it can be painful. It is quite obvious that simultaneous compression of the carotid arteries on both sides cannot be performed. The subclavian artery is pressed against the first rib in the area of ​​the Lisfranc tubercle. To apply pressure, you should find the outer edge of the sternocleidomastial muscle at the point of attachment to the collarbone. Pressing is carried out in the direction from top to bottom, immediately outward from the indicated point. The effectiveness is checked by the pulse on the radial artery. For educational purposes, this technique should also be performed carefully, since the branches of the brachial plexus are located immediately outside the artery. The axillary artery is pressed against the head of the humerus along the anterior edge of the hairy part of the axilla. Pressing is carried out at the pulsation point in an upward and inward direction. The effectiveness is checked by the pulse on the radial artery. The brachial artery presses against the inner surface of the humerus and the inner edge of the biceps muscle. The effectiveness of compression is checked on the radial artery. The femoral artery presses against the horizontal branch of the pubis under the Pupartian ligament. To apply pressure, you should find the middle of the projection of the Pupartian ligament (between the spina iliaca superior anterior and the pubic tubercle of the pubic bone). Pressure is carried out in the sagittal direction immediately below the projection of the ligament at the pulsation point of the artery. Efficacy is tested on the dorsalis pedis or posterior tibial artery. The abdominal aorta can be pressed against the spine through the anterior abdominal wall. To do this, lay the victim on a hard surface and press with your fist, using the full weight of your body, on the navel area or slightly to the left. This technique is effective only in thin and physically weak individuals. It is used for profuse postpartum uterine bleeding, for injuries of the iliac arteries above the inguinal ligament. Pressing, as a rule, does not completely compress the aorta, and therefore the bleeding does not stop completely, but only weakens. Performing this technique may be accompanied by injury to the anterior abdominal wall and even the abdominal organs. It is not recommended to perform it for educational purposes. It is enough to learn to determine the pulsation of the abdominal aorta in the peri-umbilical region with deep methodical palpation of the abdomen according to Obraztsov-Strazhesko. This gives an idea of ​​the pressure point. Finger pressure makes it possible to stop the bleeding almost instantly, but even a strong person cannot continue the pressure for more than 10-15 minutes, as his hands weaken. In this regard, already at the first aid stage there is a need to use other methods of temporarily stopping bleeding, the simplest and most reliable of which is the application of a hemostatic tourniquet.

The first mention of the use of a hemostatic tourniquet dates back to antiquity. In the 16th century, its use was revived by Ambroise Paré. Currently, the Esmarch tourniquet, which is a thick rubber belt with fasteners at the ends, is most often used. During the Great Patriotic War, the fabric tourniquet of the NIISI RKKA system was widely used. It consisted of a three-centimeter cloth tape with a buckle that automatically locked as the harness was pulled, and a loop of braid with a wooden twist and two bows for fixing the twist. An important feature of the tourniquet was the ability to adjust the tension and thereby prevent excessive compression or, conversely, apply the tourniquet to thick clothing. Technique for applying a hemostatic tourniquet: The tourniquet is applied above the wound, as close to it as possible, but not closer than 4-5 cm, so that it does not interfere with dissection and revision of the wound during primary surgical treatment. The tourniquet is not applied in the joint areas, on the hand and foot. At the beginning of the 20th century, there was an idea that a tourniquet could only be applied to limb segments that have one bone (shoulder and thigh), since on segments that have two bones (forearm and shin), compression of the interosseous artery may not occur. It has now been established that this is not the case; the interosseous artery is reliably compressed by the surrounding tissues. The limb is given an elevated position. The tourniquet is not applied to bare skin - a lining is required - a towel, napkin, shirt sleeve. The Esmarch rubber tourniquet is stretched, applied to the limb from the side of the projection of the vessels and wrapped around it 2-3 times, then secured with a hook. The first round is done with great tension, subsequent rounds are fixing, with weakening. The criterion for correct application of a tourniquet is the complete cessation of bleeding. If the tourniquet is applied loosely, the artery is not completely compressed, and bleeding continues. In this case, the veins are pinched with a tourniquet, the limb becomes overflowing with blood, and the bleeding may even intensify. The tourniquet is applied for no more than 2 hours in summer, and in winter - for no more than 1-1.5 hours. A tag (sheet of cardboard) is attached to the tourniquet indicating the time of application, or a similar record is made directly on the tourniquet. If after the specified time the victim is not delivered to a medical institution, then it is necessary to: apply finger pressure to the artery above the tourniquet; loosen or remove the tourniquet for 10-15 minutes; re-tighten the tourniquet or move it slightly higher; release the finger pressure and make sure there is no bleeding.

For profuse postpartum uterine bleeding, avulsions of the lower extremities, and injuries to the iliac arteries, a Momburg tourniquet can be used. It is a ribbon of tarpaulin about 3 meters long. The patient is placed on the table, on his back. A thick cushion with a diameter of 8-10 cm is placed on the stomach, to the left of the navel, then at the level of the navel, two rounds of a tourniquet are wrapped around the stomach, which is tightened with great force: two people, resting one leg on the table, pull the tourniquet in different directions. This compresses the abdominal aorta. The tourniquet can be held for 15-20 minutes. during which preparation for emergency surgery is carried out. Currently, due to advances in the development of obstetrics, the Momburg tourniquet has almost completely fallen out of use. Complications of applying a tourniquet. The use of a hemostatic tourniquet is a simple and reliable way to temporarily stop bleeding, however, along with its undoubted advantages, it is not without its disadvantages. Tourniquet shock (crash syndrome). Unlike all other methods of temporarily stopping bleeding, a tourniquet stops blood flow not only through the damaged main vessel, but also through all its collaterals, veins, and lymphatic vessels. This leads to severe disturbances in the trophism of the limb below the application of the tourniquet. In the absence of an influx of oxygenated blood, metabolism proceeds according to the anaerobic type. If the permissible time limit for applying a tourniquet is exceeded, under-oxidized metabolic products accumulate in the limbs, which cause myolysis (disintegration of skeletal muscle fibers). After removing the tourniquet, under-oxidized products enter the general bloodstream, causing a sharp shift in the acid-base state to the acidic side (acidosis). Myolysis products cause generalized vasoplegia (decreased vascular tone), and myoglobin released from muscle fibers is filtered into the urine and, under conditions of acidosis, precipitates in the renal tubules, causing acute renal failure. The combination of the described damaging factors causes acute cardiovascular and then multiple organ failure, referred to as tourniquet shock or crash syndrome. The pathogenesis of tourniquet shock is almost identical to the pathogenesis of prolonged compression syndrome and positional compression syndrome. If the tourniquet remains on the limb for more than two hours and is detected during transportation, the actions are similar to those described above (loosening the tourniquet for 10-15 minutes with finger pressure above the tourniquet). When delivering such a victim to a medical institution, the following actions are necessary: ​​The patient is placed in an intensive care unit or ward, the parameters of central hemodynamics and hourly diuresis are monitored. Large volumes of plasma substitutes are administered intravenously, followed by forced diuresis to prevent the development of acute renal failure. A novocaine case blockade is performed above the tourniquet; the limb below the tourniquet is covered with ice packs. These measures make it possible to slow down the flow of under-oxidized products and myoglobin from the affected limb into the general bloodstream. After which the tourniquet is removed, primary surgical treatment of the wound is carried out, and the bleeding is finally stopped. An HBO session is being conducted. In the future, the condition of the affected limb is carefully monitored. If reperfusion edema develops, fasciotomy is performed. For thrombosis of the main arteries - thrombectomy. In cases of irreversible ischemia and the development of gangrene, as well as in the development of acute renal failure, amputation of the limb. During the Great Patriotic War, the technique of slow, fractional release of the tourniquet was used, and to slow down the venous outflow, a tubular rubber tourniquet was applied to the limb above the applied tourniquet. Currently, these measures are considered ineffective and are not used. Wound anaerobic infection. In the absence of an influx of oxygenated blood into the limb on which a tourniquet is applied, ideal conditions are created for the development of an anaerobic infection (the presence of an entrance gate - a wound, a nutrient medium - damaged tissues and a temperature necessary for the incubation of microbes). The risk of developing an anaerobic infection is especially high when the wound is contaminated with soil, manure, or feces. Neuralgia, paresis and paralysis develop when the limb is compressed too much by a tourniquet, which leads to injury and ischemic damage to the nerves. Thrombosis and embolism. Excessive compression can lead to damage to blood vessels with the development of thrombosis of veins and arteries. The risk of arterial thrombosis is especially high against the background of atherosclerosis. Frostbite of the extremities under a tourniquet often develops in the cold season. This explains the 1-1.5 hour time limit for applying a tourniquet under these conditions. Taking into account the dangers associated with applying a tourniquet described above, the indications for its use should be strictly limited: it should be used only in cases of injury to the great vessels, when it is impossible to stop the bleeding by other means. An alternative to applying a tourniquet is the relatively recent methods of temporarily stopping bleeding: applying a hemostatic clamp in the wound, blind suture of the wound over the damaged vessel, temporary vessel prosthetics. Applying a hemostatic clamp in a wound at the first aid stage is possible when: A sterile hemostatic clamp with a ratchet (Billroth, Kocher or any other) is available - included in the ambulance kit; The bleeding vessel in the wound is clearly visible. The vessel is grasped with a clamp, the clamp is fastened, and an aseptic dressing is applied to the wound along with the clamp. When transporting the victim to a medical facility, immobilization of the injured limb is necessary. The advantages of this method are simplicity and preservation of collateral circulation. Disadvantages include low reliability (the clamp may become unfastened during transportation, break off the vessel, or come off along with part of the vessel); the possibility of damage by the clamp to the veins and nerves located next to the damaged artery; crushing the edge of the damaged vessel, which subsequently makes it difficult to apply a vascular suture to finally stop the bleeding. Temporary vessel prosthetics and closed wound suture over the damaged vessel. These methods of temporarily stopping arterial bleeding, in contrast to those discussed above, are used not in the provision of first aid, but during the operation of primary surgical treatment of a wound, when a wound to the main artery is detected, and there are currently no conditions for restoring its integrity (the surgeon does not own the technique operations on blood vessels, there are no necessary tools and materials). If the ends of the damaged vessel in the wound are clearly visible, it can be temporarily replaced with a plastic tube (special or from a blood transfusion system), fixed in the lumen of the vessel at the site of its injury with coiled ligatures. The technique of this rather complicated operation is discussed in more detail in special manuals. Subject to the prescription of anticoagulants (heparin), antibiotics, replenishment of blood loss and provision of the necessary rheological properties of blood, a temporary prosthesis can function for up to several days, although the danger of thrombosis of the prosthesis or damaged vessel, thromboembolism of the distal end of the vessel, slippage of ligatures and relapse increases constantly and over time. bleeding. If the ends of the damaged vessel cannot be found in the wound, then sealed sutures can be placed on the wound above the damaged vessel. A closed cavity is formed around the site of the vessel injury. Blood, pouring out from the proximal end of the damaged vessel into this cavity, finds no other exit except into the distal end of the vessel. A so-called “pulsating hematoma” is formed. Thus, blood flow through the damaged vessel is restored and can persist for up to a day or more. There is a great danger that instead of a small pulsating cavity, a large interstitial hematoma will form (see above). No less great is the risk of thrombosis of the vessel at the site of injury, the development of failure of the wound sutures and recurrence of external bleeding. In some cases, a false (traumatic) aneurysm may form at the site of a “pulsating hematoma” (see below). Both in the case of temporary vessel prosthetics and when sealed sutures are applied, the victim should be subjected to repeated surgery as quickly as possible in order to restore the integrity of the vessel. In military field conditions, he must be evacuated by ambulance to the stage of specialized medical care. During transportation, reliable transport immobilization of the affected limb is of particular importance. In a civilian situation, it is necessary to call a team of vascular surgeons “to take care of yourself.” Wound tamponade can be used as a temporary way to stop external bleeding. Tamponade can be used both at the first aid stage and during primary surgical treatment of the wound. Gauze swabs that tightly fill the wound serve as a framework for fibrin deposition and clot formation. It should be noted that such hemostasis is unreliable, and therefore tamponade can be supplemented by suturing the wound to fix tampons in its depth. Maximum flexion and extension of the joints are also ways to temporarily stop arterial bleeding. To stop bleeding from the arteries of the forearm or lower leg, you can use maximum flexion in the elbow or knee joints. A roller with a diameter of 5-7 cm is placed on the flexor surface of the joint, then maximum flexion is performed in the joint, and the limb is fixed in this position with a bandage. To stop bleeding from the arteries of the upper limb, you can use maximum extension in the shoulder joint: if you place the affected limb behind the victim’s head, the brachial artery will bend over the head of the humerus, and blood flow through it will stop. To carry out transportation, the limb must be fixed in this position with a bandage. Both of these methods do not have sufficient reliability; stopping bleeding when used is accompanied by compression of the nerve bundles. They are rarely used in practical healthcare and have mainly theoretical significance. Temporary stop of bleeding in case of damage to the saphenous veins is discussed above (see temporary stop of capillary bleeding). If the main veins of the extremities are damaged, temporary bleeding control can usually be achieved by wound tamponade. It is possible to apply sutures to the wound over tampons. At the same time, performing a full-fledged tamponade at the first aid stage, in the absence of aseptic conditions and anesthesia, is not always possible. In addition, it can be difficult to differentiate venous bleeding from arterial bleeding with the complex anatomy of the wound channel (see above) and mixed venous-arterial bleeding. Therefore, if blood flows from a wound in a powerful, especially more or less pulsating stream, you should act as in case of arterial bleeding, that is, resort to applying a hemostatic tourniquet, which is always applied uniformly, as in case of arterial bleeding - above the wound. It should be considered a gross mistake to apply a tourniquet below the wound, as is recommended in some textbooks and manuals. When a tourniquet is applied below the wound, only the distal end of the damaged vein is clamped, while: retrograde bleeding continues from its proximal end; an air embolism may occur in the proximal end of the damaged vein; with concomitant even minor damage to the artery, the bleeding will not only not stop, but will also intensify. When applying a tourniquet above the wound, as mentioned earlier, the limb will be completely excluded from blood and lymph circulation, thus: the proximal end of the damaged vein is clamped with a tourniquet; the artery above the wound is also compressed with a tourniquet, thus stopping the flow of blood into the limb, and bleeding from the distal end of the damaged vein stops.

In case of internal and hidden bleeding, temporary stopping of bleeding is usually impossible. Exceptions include bleeding from esophageal varices with portal hypertension. In these cases, it is advisable to use a Blackmore tube, which is a gastric tube with two balloons inflated through separate channels, located at the end of the tube and covering the tube in the form of cuffs. The first (lower, gastric) balloon, located 5-6 cm from the end of the probe, when inflated, has the shape of a ball with a diameter of 7-8 cm, the second balloon, located immediately after the first, has the shape of a cylinder with a diameter of 4-5 cm and a length of about 20 see. A probe with uninflated balloons is inserted into the stomach. Then the lower balloon is inflated and the probe is pulled up until the inflated balloon wedges into the cardiac part of the stomach. After this, the upper balloon located in the esophagus is inflated. Thus, the veins of the cardiac part of the stomach and the lower third of the esophagus are pressed by inflated balloons to the walls of the organs. The bleeding from them stops.

Submitting your good work to the knowledge base is easy. Use the form below

Students, graduate students, young scientists who use the knowledge base in their studies and work will be very grateful to you.

Posted on http://www.allbest.ru/

Ministry of Education and Science of the Russian Federation

FSBEI HPE “Chuvash State University named after I.N. Ulyanova »

Faculty of Medicine

Department of Traumatology, Orthopedics and Extreme Medicine

Abstract

On the topic: “Classification of bleeding”

Completed by: students gr. M-10-14

Musatkina Yu.Yu., Khaibullina I.A.

Checked by Doctor of Medical Sciences, Professor

Karalin Alexander Nikolaevich

Cheboksary, 2016

Introduction

1. Classification of bleeding

2. Bleeding clinic

3. Diagnosis of bleeding

4. Stop bleeding

5. Blood groups

6. Blood substitutes

7. Methods for restoring blood loss

8. Transfusion of pre-collected blood

Conclusion

References

Introduction

Bleeding is the outpouring of blood from the bloodstream into the tissues and cavities of the body or into the external environment.

Bleeding occurs with any injury.

Blood loss is one of the main causes of death in persons with traumatic injuries. Surgeons pay exceptionally great attention to the problem of bleeding, since it still often limits the capabilities of the surgical method and can cause the death of a patient from acute anemia during extensive and severe surgical interventions.

The cause of bleeding is a violation of the integrity of the vascular wall, caused by: trauma, vascular erosion due to various diseases and purulent processes, increased blood pressure in the vessel, a sharp decrease in atmospheric pressure.

1. Classification of shelterswelling

Each classification is based on a certain principle that characterizes the type of bleeding.

The anatomical classification distinguishes bleeding: arterial, venous, capillary and parenchymal, which differ from each other in clinical picture and features of stopping methods.

Depending on the reason, there are:

a) bleeding of a mechanical nature - damage to the vessel is caused by a mechanical reason;

b) bleeding of a neurotrophic nature - the permeability of the vessel is caused by trophic disorders of its wall (sepsis, scarlet fever, scurvy, etc.).

Taking into account the clinical manifestations, bleeding is distinguished:

a) external;

b) internal;

c) hidden.

With external bleeding, blood flows into the external environment or a hollow organ communicating with the external environment. Internal bleeding is called bleeding into one or another body cavity (pleural, abdominal).

Hidden bleeding does not have obvious external manifestations and is determined by special research methods. In this case, the bleeding vessel is accessible to normal visual observation. An example of such bleeding is bleeding from a stomach ulcer, which should be classified as external hidden. To determine the source of bleeding in diseases of the gastrointestinal tract, fibroendoscopy is of great importance.

Taking into account the time of appearance, the following are distinguished:

a) primary bleeding - begins immediately after damage or injury;

b) early secondary bleeding - in the first hours and days after injury (before the development of infection in the wound). Such bleeding often develops due to the expulsion of a thrombus from a wounded vessel by the blood flow when intravascular pressure increases or when a vessel spasm is eliminated; bleeding arterial hemostasis detoxification

c) late secondary bleeding, which can begin at any time after the development of infection in the wound. Such bleeding is caused by purulent melting of a blood clot in a damaged vessel, arrosion, melting of the vessel wall by the inflammatory process.

2. Bleeding clinic

The clinical picture of bleeding is determined by the degree of blood loss, the characteristics of tissue damage, the size of the injury, the type of damaged vessel, its caliber, as well as where the blood loss occurs: into the external environment, into the body cavity, the lumen of an organ or into the body tissue.

With arterial external bleeding, scarlet blood flows out in a pulsating stream. Such bleeding quickly leads to acute anemia. Acute anemia is characterized by the following symptoms: increasing pallor, rapid and small pulse, progressive decrease in blood pressure, dizziness, darkening of the eyes, nausea, vomiting, fainting. Arterial bleeding can quickly lead to death due to oxygen starvation, dysfunction of the cardiovascular system and brain.

External venous bleeding is characterized by the slow flow of dark blood. When large veins are injured with increased intravenous pressure, often due to obstruction of outflow, blood may flow out in a stream, but this stream usually does not pulsate. Rarely, a slight pulsation of the flowing blood is observed during venous bleeding. Injury to the large veins of the neck is dangerous due to the possibility of developing air embolism of the cerebral vessels or heart vessels due to the fact that at the moment of inhalation, negative pressure arises in these veins.

Capillary and parenchymal bleeding is characterized by the fact that the entire wound surface, small vessels and capillaries bleed. Parenchymal bleeding due to the fact that the bleeding vessels are fixed in the stroma and do not collapse, stops with difficulty and often leads to acute anemia.

The clinical picture of internal bleeding depends on the damaged organ and the cavity in which the blood accumulates. There are general and local symptoms of internal bleeding.

General symptoms are the same for all types of bleeding, including internal bleeding into various cavities. They are observed with significant blood loss and consist of the appearance of signs of acute anemia (pallor, dizziness, fainting, rapid small pulse, progressive decrease in blood pressure).

Local symptoms vary. When bleeding into the cranial cavity, symptoms of brain compression develop; bleeding into the pleural cavity is accompanied by compression of the lung on the affected side, which causes shortness of breath; Limitation of respiratory excursions of the chest, dullness during percussion, weakening of vocal tremors, and weakening of respiratory sounds on the side of blood accumulation are also noted.

Hemoperitoneum occurs with subcutaneous ruptures of parenchymal organs (spleen, liver, etc.), rupture of the fallopian tube during tubal pregnancy, injuries to the abdominal organs, etc. and is manifested by symptoms of peritoneal irritation (pain, tension in the abdominal muscles, nausea, vomiting, etc.) and dullness of percussion sound in the sloping parts of the abdominal cavity, determined by percussion. When the position of the body changes, the localization of dullness changes. Symptoms of acute anemia usually increase. Both with hemothorax and hemoperitoneum, in addition to local symptoms, as a rule, there are phenomena of acute anemia, the degree of which depends on the amount of blood loss.

3. Diagnosis of bleeding

Diagnosis of external bleeding and determination of its nature does not cause any difficulties. The color of the blood, the pulsating current, and the location of the inlet help to make an accurate diagnosis.

The diagnosis of internal bleeding may be difficult at first. Measuring blood pressure, monitoring the pulse rate and hemoglobin level and the number of red blood cells, the behavior and appearance of the patient allow one to suspect internal bleeding. The appearance of bloody vomiting, loose tarry stools, and hemoptysis makes the diagnosis of internal bleeding unconditional. It is more difficult to diagnose bleeding in the cavity. With intracranial hematomas, loss of consciousness, a decrease in pulse rate, and local symptoms appear.

Bleeding into the abdominal cavity is characterized by pallor of the skin, tachycardia, a drop in blood pressure and dullness of percussion sound in sloping areas of the abdomen, and symptoms of peritoneal irritation.

Bleeding into the pleural cavity, along with signs of hypovolemia and anemia, is accompanied by respiratory failure and a displacement of the heart in the opposite direction. Sometimes, to clarify the diagnosis, they resort to diagnostic punctures of the abdominal, thoracic cavities, and spinal canal.

If intra-abdominal bleeding is suspected, laparoscopy is performed.

The amount of blood loss is determined based on clinical data and instrumental methods. The degree of blood loss is important for determining the volume and method of transfusion therapy. Under-replenishment of blood loss, as well as transfusion of excess volume, leads to negative consequences for the patient.

4. Stop bleeding

Methods for stopping bleeding or hemostasis depend on the type and severity of the injury. There are two groups of such methods: temporary and final methods. Temporary hemostasis is carried out quickly to prevent large blood loss immediately after injury before the arrival of the medical team, and, as a rule, lasts 2-4 hours.

Methods for finally stopping bleeding are carried out by specialists and include the correct method of stopping, eliminating the open wound and completely restoring the integrity of the blood vessels. When the final stop is made, the bleeding is completely eliminated, including the elimination of relapses.

Temporary hemostasis includes the following techniques:

1. Compression of the wound consists of applying a pressure bandage and tight packing. Tamponation is carried out by inserting a gauze swab into the wound. It can be dry or soaked in an antiseptic (for example, hydrogen peroxide). A gauze or bandage pressure bandage (without cotton wool) is applied for capillary or venous (moderate) damage.

2. Ensuring the desired position of the damaged area allows you to stabilize and reduce blood flow. Basic methods: ensuring an elevated position and immobilization. Immobilization of the damaged area is based on the application of various types of splints and is very important when bones or joints are damaged.

3. Extended compression is based on mechanical elimination of blood flow. The simplest technique is finger pressure. In case of arterial damage, a technique such as applying a tourniquet is used. It is applied above the wound site, but not on the forearm and lower leg. The tourniquet can be applied for no more than 2.5 hours, as negative changes may begin in the tissues due to the blocking of the blood supply. Pressure can be achieved by flexing the limbs: bleeding in the area of ​​the elbows or knees can be stopped by flexing the upper or lower limbs at these joints. To ensure maximum pressure, rollers are placed on the damaged area.

4. Thermal stop can be achieved by either low or high temperature. Cooling causes vascular spasm, which helps stop blood flow to the wound. Cold can be provided by ice applied through several layers of fabric. High-temperature exposure involves thermal cauterization of the wound.

Final stopping techniques:

1. Mechanical methods involve restoring the integrity of blood vessels and soft tissues by applying sutures and ligatures. Vascular suturing is carried out in stationary conditions with the installation of hemostatic clamps.

2. Thermal methods are based on coagulation methods, i.e. cauterization with electricity, laser or liquid nitrogen.

3. Chemical methods are hemostasis techniques when special chemicals are used to stop blood by increasing its coagulability. Such medications increase the rate of clotting and inhibit fibrinolysis.

4. Biological techniques are based on the introduction of biological tampons or grafts. This event is held in special clinics. The problem of how to stop severe bleeding with large blood loss is sometimes solved by blood transfusion. This operation involves the transfusion of whole donor blood, plasma, red blood cells or platelets.

5. Blood groups

In the human body there are many genetically determined, inherited blood factors that do not change throughout life, combined into antigen systems. There are erythrocyte, leukocyte, platelet and protein antigens. The membrane of human erythrocytes is a carrier of 250 antigens, which are combined into more than 15 systems: ABO, Rhesus, Kidd, etc.

In 1901, K. Landsteiner discovered that the membrane of human red blood cells can contain agglutinogens A and B, and in plasma - agglutininsbAndV. Agglutinogens are complex substances, glycolipoproteins (glycophorins), built into the cytoplasmic membranes of erythrocytes. The antigenic specificity of agglutinogens is determined primarily by the carbohydrate component of their outer segments. There are variants of antigen A (A 1 ,A 2 ,A 3 ) . Antigen B also has varieties B 1, B 2, B 3, almost identical in antigenic ability.

Antigens are detected on red blood cells already at 8-12 weeks of embryogenesis. After the birth of a person, the formation of the corresponding antibodies begins in his body - anti-A (denoted b) and anti B (denoted c) against antigens supplied with food (A and B). The maximum production of antibodies occurs at 8-10 years of age.

K. Landsteiner described three blood groups according to the ABO system. IV (AB) blood group was discovered by Jan Jansky. Depending on the presence or absence of agglutinogens and antibodies in the blood of a particular person, 4 blood groups are distinguished. This system is called AVO. Blood groups in it are designated by numbers and those agglutinogens that are contained on the red blood cells of this group. A person's blood type is constant. It does not change throughout life and is inherited. There are no antibodies to antigens A and B in the blood plasma of newborns. They are formed during the first year of a child’s life under the influence of substances supplied with food, as well as those produced by intestinal microflora, to those antigens that are not in his own red blood cells.

Group I (0) - there are no agglutinogens on the erythrocyte membrane, but the plasma contains agglutinins b and c.

Group II (A) - the membrane of erythrocytes contains agglutinogen A, the plasma contains agglutinin B.

Group III (B) - agglutinogen B is located on the erythrocyte membrane, agglutinin B is in the plasma.

Group IV (AB) - agglutinogens A and B are found on the erythrocyte membrane, but there are no antibodies in the plasma.

6. Blood substitutes

Blood substitutes are medicinal solutions intended to replace lost or normalize impaired blood functions. Blood substitutes are widely used in clinical medicine to maintain and correct the main indicators of homeostasis in various pathological conditions. They are highly effective, targeted, and their transfusions are performed without taking into account the recipient’s blood group.

Based on functional characteristics, the following types are distinguished:

1. Hemodynamic(anti-shock) blood substitutes. They are used for shock of various origins and restoration of hemodynamics (increased blood pressure, bcc, minute and systolic blood volume), including microcirculation. Such drugs include neorondox, rheopolyglucin, polyglucin, gelatinol and others that maintain colloid osmotic blood pressure. Hemodynamic blood substitutes are able to remain in the vascular bed for a long time and, due to the difference in colloid-osmotic pressure, create a gradient of transcapillary fluid exchange.

2. Detoxification blood substitutes. For the treatment of intoxications of various origins (including hemolytic disease of newborns, burns). This group of drugs includes hemodez, neohemodez, periton-N, polydes, neocompensan. These drugs do not circulate in the bloodstream for long. The mechanism of action of this group of drugs is based on their ability to dilute, bind due to high adsorbed capacity, neutralize and remove various toxic substances from the body.

3. Regulators of water-salt metabolism and acid-base status. Drugs in this group include saline solutions of various compositions, as well as osmotic diuretics. With their help, it is possible to replenish the deficiency of interstitial fluid, regulate the osmotic pressure of plasma, and correct the volume of intravascular fluid and its electrolyte composition. Solutions - correctors of the acid-base state of the blood - are used mainly for metabolic acidosis or alkalosis.

Water metabolism regulators are used to correct water-salt balance disorders of various origins. The main property of regulators of water-salt and acid-base status is osmolarity. During infusion of isosmolar solutions (Ringer's solution, Ringer-lactate, etc.), the liquid is distributed between the vascular and intravascular aqueous sectors in a ratio of 1:3.

4. Blood substitutes, gas carriers V. Modeling the respiratory function of blood (hemoglobin solutions and fluorocarbon emulsions). To this day they remain ineffective.

5. Complex multifunctional blood substitutes. This group includes drugs that have several effects on the body. Among them are mafusol, polyfer, reogluman, polyglusol.

6. Preparations for parenteral nutrition. This group includes nitrogenous(polyamine, hydrolysine, etc.), fatty, carbohydrate (5-40% glucose solutions) drugs that are included in metabolic processes and provide the body’s energy resources in severe pathological conditions.

Requirements for blood substitutes can be general for all groups and private, specific in accordance with their functional purpose.

General requirements for all blood substitute fluids:

a) sterility (preparations must withstand sterilization by autoclaving), non-toxic and non-pyrogenic;

b) stability (persistence) over a long shelf life (at least 2 years);

c) similarity in physical and chemical properties (viscosity, osmolarity, etc.) to blood plasma parameters;

d) non-anaphylactogenicity; they should not cause sensitization of the body upon repeated administration.

Blood substitutes must be completely eliminated from the body without damaging tissues or disrupting body functions, or be metabolized by enzymatic systems.

7. Methods for restoring blood loss

Methods of restoring blood loss include blood transfusion.

Based on the type of blood used, transfusion methods are divided into two groups:

transfusion of one's own blood (autohemotransfusion),

· donated blood transfusion.

Postmortem (fibrinolysis) blood is currently not transfused.

Depending on the method and preservation period, a distinction is made between transfusion of freshly collected and canned blood of different shelf life.

Based on the method of administering blood, blood transfusions are divided into intravenous, intraarterial, and intraosseous. The most commonly used is intravenous administration.

Infusion-- parenteral (intravenous, intraarterial, intralymphal) administration of various fluids into the body for therapeutic or diagnostic purposes (radiocontrasts, sonocontrasts, dyes, etc.). Infusion is a broader concept and includes transfusion procedures.

8. Transfusion of pre-stocked blood

This method of autohemotransfusion is used for planned operations with expected massive blood loss. It is advisable to collect blood before surgery if the expected operational blood loss is more than 10% of the blood volume. Either a one-time blood sampling method or a step-by-step method are used.

Autotransfusion of pre-collected blood involves exfusion and blood preservation.

For a single blood draw, the day before a blood draw is performed in a volume of 400 - 500 ml of blood, replacing it with a blood replacement solution. It is most advisable to carry out blood exfusion 4-6 days before surgery, since during this period the restoration of blood loss is achieved, and the taken blood retains its properties well. With this method of collecting blood, its volume does not exceed 500 ml. A single sampling is used for operations with relatively little blood loss.

Reinfusion- this is a type of autohemotransfusion in which a patient is transfused with his own blood, poured into closed body cavities (thoracic or abdominal), as well as into a surgical wound.

Blood reinfusion is used for bleeding caused by damage to the abdominal organs (rupture of the spleen, liver, mesenteric vessels), chest organs (intrapleural bleeding, rupture of intrathoracic vessels, lung), disrupted ectopic pregnancy, traumatic operations on the pelvic bones, femur, spine, accompanied by large intraoperative blood loss.

Contraindications to reinfusion are: 1) damage to the hollow organs of the chest (large bronchi, esophagus) and hollow organs of the abdominal cavity (stomach, intestines, gall bladder, extrahepatic bile ducts, bladder); 2) malignant neoplasms; 3) hemolysis of the shed blood and the presence of foreign impurities in it. It is not recommended to transfuse blood that has been in the abdominal cavity for more than 12 hours (possibility of defibration and infection),

During reinfusion, blood is taken with a metal scoop or a large spoon by scooping or using a special suction with a vacuum of at least 0.2 atm. Blood collected in vials with a stabilizer is filtered through 8 layers of gauze. For blood preservation, use either a solution of TsOLIPK No. 7b in a ratio of 1:4 with blood, or a solution of heparin - 10 mg in 50 ml of isotonic sodium chloride solution per 500 ml bottle. You can't store that kind of blood. Blood is infused intravenously through a transfusion system using standard filters. A type of reinfusion is the transfusion of blood poured into a wound during planned interventions; such reinfusion is carried out using special devices - reinfusers.

Conclusion

The danger of bleeding is that it can lead to significant blood loss. The severity of blood loss is determined by the rate of bleeding and the duration of bleeding, so any bleeding must be quickly stopped. The inclusion of the body's defenses helps to ensure that bleeding from small vessels often stops on its own.

In our work, we talked about bleeding that can occur as a result of an emergency, as well as types of bleeding, first aid for bleeding, etc.

References

1. “Surgical diseases”, ed. - B.C. Savelyeva, A.I. Kiriyenko

2. Surgery" - G.P. Rychagov, P.V. Garelik, V.E. Kremen et al.

3. “General surgery” - Rychagov G.P., Garelik P.V., Martov Yu.B. .

4. “General surgery” - P.N. Zubarev, M.I. Lytkina, M.V. Epifanova

5. Methodological developments of the Department of General Surgery of STGMA

Posted on Allbest.ru

Similar documents

Features of nursing care for bleeding. Maintaining homeostasis as a functional feature of blood. Anatomical classification of bleeding. Classification of internal bleeding. The main causes of primary and secondary bleeding.

presentation, added 02/17/2014


Classification of bleeding, its local and general symptoms. Methods for temporary and final stopping of bleeding. Application of a hemostatic tourniquet. Complications of bleeding and blood loss. Stages of hemorrhagic shock. Calculation of blood loss replacement.

presentation, added 12/25/2015


Nursing care for bleeding. Maintaining homeostasis as a functional feature of blood. Anatomical classification of bleeding according to vessel size and development, clinical manifestations, time of manifestation. Causes of primary bleeding.

presentation, added 10/25/2013


Bleeding is the outpouring of blood from the bloodstream into the tissues and cavities of the body or into the external environment. Classification of bleeding. Clinical nature of bleeding. Danger of bleeding. Methods and techniques for stopping bleeding. Application of a tourniquet.

abstract, added 12/02/2008


The concept of obstetric bleeding as a group of pathological bleeding from the uterus and other organs of the reproductive system. Bleeding in the first trimester of pregnancy, its second half and during childbirth. Bleeding during miscarriage. Main causes of bleeding.

presentation, added 12/18/2013


Causes, classification and risk factors for obstetric hemorrhage in the first half of pregnancy. Clinical picture, diagnosis, treatment of pathological conditions of pregnancy with bleeding. Study of obstetric hemorrhage in Valuysky district.

course work, added 06/09/2016


Hemoptysis: causes, diagnosis and treatment. Bleeding from the nose. Rules for applying a hemostatic tourniquet or twisting. Arterial, venous, capillary, parenchymal bleeding, their main causes and first aid for them.

abstract, added 02/12/2015


The concept of obstetric bleeding as a group of pathological bleeding from the uterus and other organs of the reproductive system. Classification of bleeding during pregnancy depending on the trimester. Indications for hospitalization, diagnostic criteria.

presentation, added 06/04/2015


Concept and clinical picture of bleeding; their classification according to origin, type of bleeding vessel and location of blood eruption. Rules for applying an arterial tourniquet. Causes of traumatic shock; principles of first aid.

presentation, added 10/21/2014


Diagnosis of gastrointestinal bleeding. Assessing the degree of blood loss. Symptoms of bleeding from different parts of the digestive tract. Endoscopic diagnosis, stage-by-stage tasks of an endoscopist for gastrointestinal bleeding, treatment methods.

Bleeding from traumatic injuries

Bleeding is a life-threatening consequence of road traffic injuries, being one of the main causes of death in prehospital victims.

Based on the source of bleeding, they are divided into the following types:

- Arterial bleeding is the most dangerous, since when large arteries are injured, a large loss of blood occurs in a short time. A sign of arterial bleeding is usually a scarlet pulsating stream (fountain).

- Venous bleeding characterized by a lower rate and volume of blood loss, the blood is dark cherry and flows out in a stream. It is less dangerous than arterial, but injury to the veins of the neck is life-threatening due to the possible absorption of air into them and the development of serious complications.

- Capillary bleeding observed with abrasions, cuts, scratches. Mild bleeding, as a rule, does not pose an immediate threat to life.

- Mixed bleeding – this bleeding, in which there is simultaneously arterial, venous and capillary, is called mixed. It is observed, for example, with traumatic amputation of a limb. Dangerous mainly due to the presence of an arterial component.

Based on clinical signs, bleeding is divided into the following types:

- External bleeding accompanied by damage to the skin, with blood pouring out. Signs of external bleeding are:

Bleeding from a wound (arterial, venous, capillary, mixed);

Soaking clothes (scarlet, dark cherry) in blood;

Blood near the victim;

Signs of blood loss (see "Signs of blood loss").

- External hidden bleeding. External hidden bleeding is called bleeding from internal organs that communicate with the external environment. For example: lungs, stomach, intestines, bladder. This type of bleeding appears after some time; at first there are no obvious signs, but there are indirect signs that allow one to suspect hidden bleeding (see “Signs of blood loss”).

- Internal bleeding occurs with blunt trauma to the chest and abdomen, accompanied by damage to internal organs - lungs, liver, spleen. The main sign of internal bleeding is a combination of pain at the site of injury and signs of blood loss (see "Signs of blood loss").

Signs of blood loss.

severe general weakness;

feeling of thirst;

dizziness;

flickering of flies before the eyes;

fainting, more often when trying to get up;

nausea and vomiting;

pale, damp and cold skin;

rapid weak pulse;

Acute blood loss- a syndrome that occurs in response to a primary decrease in circulating blood volume (CBV).

As a rule, there are no diagnostic problems with external bleeding. It is much more difficult to diagnose internal bleeding that is not accompanied by pain. If blood loss during internal bleeding does not exceed 10-15% of the bcc, then the clinical manifestations in this case are quite scanty and can manifest as moderate tachycardia and shortness of breath, and fainting. With more massive blood losses exceeding 15% of the bcc, centralization of blood circulation develops with a typical picture of hypovolemic shock.

Classification of bleeding by source

• Arterial bleeding is the most dangerous type of blood loss in which blood flows out of a damaged artery in a scarlet pulsating stream. If you do not take immediate action to stop the bleeding, the victim may quickly die due to massive blood loss.
• Venous bleeding - the blood is dark in color and flows out in a slow stream. If veins of small diameter are damaged, spontaneous cessation of bleeding is possible.
• Parenchymal or capillary bleeding - a feature of these bleeding is bleeding of the entire tissue surface, which is possible with damage to internal organs.
• Mixed bleeding.

Classification of bleeding according to clinical manifestations

• External bleeding is not difficult to diagnose and is observed when the integrity of the skin is damaged due to various types of injuries.
• Internal bleeding is the most difficult to diagnose, especially when it is painless. We must remember that with intracavitary bleeding, the blood does not clot for a long time. With interstitial bleeding, it is quite difficult to realistically estimate the amount of blood loss.
• Hidden bleeding is determined by special research methods, since it does not have obvious external manifestations.

Classification of bleeding by time of occurrence

• Primary bleeding occurs immediately after damage to a blood vessel.
• Secondary bleeding - occurs after a certain period of time after injury:
  • Early secondary bleeding - develops in the first hours or days after injury, the main reasons being relief of vascular spasm or rupture of a thrombolytic plaque due to increased blood pressure.
  • Late secondary bleeding is associated with suppuration of the wound, erosion of the vessel walls, and impaired blood clotting properties.

Classification of bleeding according to the rate of development

• Lightning blood loss occurs after damage to the heart or aorta and quickly ends in the death of the victim.
• Acute blood loss occurs after damage to large major vessels and requires emergency medical care.
• Chronic blood loss - accompanies diseases such as hemorrhoids, colon tumors, etc. Planned therapeutic measures are required.

Classification of bleeding by source location

• pulmonary;
• esophageal;
• gastric;
• intestinal;
• renal.

Classification of bleeding depending on the volume of blood volume loss

• 15-25% - mild blood loss;
• 25-35% - average blood loss;
• 35-50% - severe blood loss;
• more than 50% - massive blood loss.

ATTENTION! Information provided on the site website is for reference only. The site administration is not responsible for possible negative consequences if you take any medications or procedures without a doctor’s prescription!