Home Tooth pain Effective ways to stop bleeding from a wound. Bleeding In arterial bleeding, blood leaks from the wound.

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Effective ways to stop bleeding from a wound. Bleeding In arterial bleeding, blood leaks from the wound.

A) ANATOMICAL CLASSIFICATION

Based on the type of bleeding vessel, bleeding is divided into arterial, venous, arteriovenous, capillary and parenchymal.

Arterial bleeding . Bleeding from a damaged artery. Blood flows out quickly, under pressure, often in a pulsating stream, sometimes gushing out. The blood is bright scarlet. The rate of blood loss is quite high. The volume of blood loss is determined by the diameter of the vessel and the nature of the injury (lateral, complete, etc.).

With profuse (heavy) arterial bleeding, the wound is in the projection of a large artery; the gushing blood is bright red (scarlet), beating in a strong pulsating stream. Due to high blood pressure, bleeding usually does not stop on its own. Damage to the main artery is dangerous, both due to rapidly progressing blood loss and ischemia of the tissues to which it must supply blood. The rate of blood loss is high, which often does not allow the development of compensatory mechanisms and can quickly lead to death.

Venous bleeding. Bleeding from a damaged vein. Uniform flow of dark cherry-colored blood. The rate of blood loss is less than with arterial bleeding, but with a large diameter of the damaged vein it can be very significant. Only when the damaged vein is located next to a large artery can a pulsating jet be observed due to transmission pulsation. When bleeding from the veins of the neck, you need to remember the danger of air embolism. If large veins of the upper half of the body are damaged, blood can flow out in an intermittent stream, synchronously with breathing (due to the suction action chest), and not the pulse.

There are significant clinical differences in bleeding when the deep (large, main) and superficial (subcutaneous) veins are damaged. Bleeding due to damage to the main veins is no less, and sometimes even more dangerous, than arterial bleeding, since it quickly leads to a drop in pressure at the mouth of the vena cava, which is accompanied by a decrease in the strength of heart contractions. Such bleeding can lead to air embolism, which especially often develops with damage to the veins of the neck or intraoperative damage to the vena cava. Veins, unlike arteries, have an underdeveloped muscular layer, and the rate of blood loss is almost not reduced due to vessel spasm.

Bleeding from damaged saphenous veins is usually less dangerous, since the rate of blood loss is much lower and there is virtually no risk of air embolism.

Capillary bleeding. Bleeding from capillaries, in which blood oozes evenly from the entire surface of damaged tissue. This bleeding is caused by damage to capillaries and other microvessels. In this case, as a rule, the entire wound surface bleeds, which, after drying, becomes covered with blood again. 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 well-supplied tissues.

Arteriovenous bleeding. In the presence of simultaneous arterial and venous bleeding. Particularly common is combined damage to an artery and vein located nearby, as part of one neurovascular bundle. 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.

Parenchymal bleeding. Bleeding from the parenchyma of any internal organ. It is observed when parenchymal organs are damaged: liver, spleen, kidneys, lungs, pancreas. Such bleeding usually does not stop on its own. Since the listed organs mainly consist of parenchyma, they are called parenchymatous. Bleeding when damaged is called parenchymal .

B) ACCORDING TO THE MECHANISM OF APPEARANCE

Depending on the reason that led to the release of blood from the vascular bed, two types of bleeding are distinguished:

Physiological bleeding among women.

Pathological bleeding- other.

According to their origin, pathological bleeding is divided into

- traumatic caused by mechanical damage to the vascular wall (including during surgery), and

- non-traumatic, Related pathological changes vascular (with neoplasm, inflammatory process, increased permeability of the vascular wall, damage by ionizing radiation, etc.).

Causes of bleeding may be different:

mechanical damage to the vessel wall : injury to a vessel with an open injury or rupture of a vessel with a closed injury;

destruction (destruction) of the vessel wall during a pathological process : ulceration of atherosclerotic plaque, destructive process in tissues (focus purulent inflammation, stomach ulcer, decaying tumor);

increased permeability of the vascular wall (for intoxication of the body, sepsis, vitamin deficiency C), leading to blood leaking through the walls of blood vessels.

Blood clotting disorder ( with hemophilia, thrombocytopenia, disseminated intravascular coagulation, overdose of anticoagulants, cholemia) in itself is not the cause of bleeding. But, it prevents the bleeding from stopping and contributes to the development of prolonged bleeding and massive blood loss.

Read more about the causes of bleeding

Traumatic bleeding - bleeding caused by a violation of the integrity of blood vessels due to injury (wound, rupture of the vessel wall or heart), includingsurgical bleeding (during surgery).

These lesions (injuries) may be open, in which blood flows out through the wound channel, or closed. For example, with closed fractures, blood vessels may be ruptured by bone fragments. Also, to the development of internal bleeding during closed injuries, lead to traumatic ruptures of internal organs, muscles and other anatomical formations.

Closed vascular injuries represent great danger, since difficulties in recognizing them often lead to diagnostic errors and untimely provision of assistance. In this case, hemorrhages in the body cavity, as well as retroperitoneal and intermuscular hematomas can be very significant in terms of blood loss, leading to severe acute hypovolemia and hemorrhagic shock.

Non-traumatic bleeding – these are bleedings caused by pathological changes in the walls of blood vessels or the heart.

According to the mechanism of occurrence, they distinguish

- bleeding from rupture(haemorrhagia per rhexin),

- bleeding from corrosion(haemorrhagia per diabrosin - arrosive bleeding,

- bleeding from leakage(haemorrhagia per diapedesin) with increased permeability of the vascular wall.

Rupture of a pathologically altered wall of a vessel or heart.

With an aneurysm of a vessel or heart, hemorrhoids, varicose veins, myocardial infarction, sclerotic changes in the arteries, tubal ectopic pregnancy, etc. Rupture of the wall of a vessel or heart is promoted by an increase in blood pressure.

In this regard, we can separately highlight vicarious hemorrhage– bleeding from small vessels of the mucous membrane of the nasal walls, caused by excess blood pressure, for example during a hypertensive crisis. Or bleeding from secondary hemorrhoids caused by increased pressure in the portal vein (portal hypertension), most often with cirrhosis of the liver.

Corrosion (arrosion) of the vessel wall .

- bleeding through a defect in the vascular wall formed as a result of a pathological process (purulent-necrotic, tumor, etc.).

Arrosive (arrosive) bleeding arises

When the vascular wall is corroded (destructed) (when the vascular wall grows with a malignant tumor and disintegrates - destruction of the tumor;

With necrosis, including ulcerative process;

With caseous necrosis in the wall of the tuberculous cavity;

In case of destructive inflammation, including purulent inflammation, when melting of the vessel wall at the source of inflammation may occur;

With enzymatic melting of the vascular wall with pancreatic juice containing proteases, lipases, amylases in pancreatic necrosis, etc.).

Increased permeability of microvascular walls.

Diapedetic hemorrhage ( due to increased permeability of vessel walls) occurs due to blood leakage from microvessels (arterioles, capillaries and venules). An increase in the permeability of the vascular wall is observed with hemorrhagic diathesis, including systemic vasculitis, avitaminosis (especially vitamin deficiency C), uremia, sepsis, scarlet fever, other infectious and infectious-allergic diseases, as well as benzene and phosphorus poisoning.

The state of the blood coagulation system plays a certain role in the development of bleeding. Violation of the thrombus formation process in itself does not lead to bleeding and is not its cause, but it significantly aggravates the situation. Damage to a small vein, for example, usually does not lead to visible bleeding, since the system of spontaneous hemostasis is triggered, but if the state of the coagulation system is impaired, then any, even the most minor injury can lead to fatal bleeding. The most well-known diseases affecting the blood clotting process are hemophilia and Werlhof's disease. Disseminated intravascular coagulation syndrome and cholemia also lead to decreased blood clotting. Often there are decreases in blood coagulation of medicinal origin, which occur when using indirect anticoagulants that disrupt the synthesis of blood coagulation factors VII, IX, X in the liver; direct anticoagulants (for example, heparin); thrombolytic drugs (for example, streptase, streptokinase, urokinase, streptolyase, etc.), as well as non-steroidal anti-inflammatory drugs (for example, acetylsalicylic acid, butadione, etc.), which disrupt platelet function.

BleedingAndness- tendency to prolonged, low-intensity bleeding; observed when there is a violation of the blood coagulation mechanism and (or) an increase in the permeability of the vascular wall.

Hemorrhagic diathesis is a condition characterized by increased bleeding, a tendency to prolonged bleeding, which is observed with blood clotting disorders and (or) increased permeability of the vascular wall.

The Greek word diathesis means a tendency or predisposition to something, such as certain diseases or inappropriate reactions to ordinary stimuli.

C) IN RELATION TO THE EXTERNAL ENVIRONMENT

All bleeding is divided into three main types: external, internal and mixed. There are also various combinations of these types of bleeding in one patient.

I. External bleeding occurs from a wound (or from a trophic skin ulcer) directly into the external environment, outward, onto the surface of the body.

IIMixed bleeding e – this is bleeding into the lumen of a hollow organ communicating with external environment through the natural openings of the body. In mixed bleeding, blood first accumulates in cavities that communicate (normally) with the external environment, and then, through the natural openings of the body, is released out, unchanged or altered. A typical example is bleeding into the lumen of the gastrointestinal tract: with gastric bleeding, blood first accumulates in the stomach and is then released in the form of bloody vomiting; vomiting of “coffee grounds” is possible (hemoglobin under the influence of hydrochloric acid turns into black hydrochloric acid hematin) and ( or) bloody stools, often black (melena). In addition to bleeding into the lumen of the gastrointestinal tract, bleeding into the lumen of the tracheobronchial tree and into the urinary tract - hematuria - can be considered mixed.

1. Esophageal, gastric, intestinal bleeding (into the lumen of the esophagus, gastrointestinal tract);

2. Pulmonary hemorrhage (V Airways);

3. Bleeding in the urinary tract (hematuria); urethral bleeding (into the lumen of the urethra, which is manifested by urethrorrhagia - the release of blood from the urethra outside the act of urination); hemospermia (presence of blood in seminal fluid).

4. Uterine bleeding (metrorrhagia).

5. Nosebleeds (epistaxis).

6. Bleeding into the bile ducts (hemobilia).

Gastrointestinal, pulmonary bleeding, bleeding in the urinary tract, etc. occur obvious And hidden.

Overt bleeding manifests itself with obvious clinical signs.

Hidden (occult) bleeding determined only by special research methods.

Obvious bleeding- these are bleedings in which blood, even in a changed form, appears outside after a certain period of time, which is visible to the naked eye. For example, bloody vomiting unchanged blood or coffee grounds; bloody stools that are red, dark, or even black (melena); hematuria in the form of bloody urine; hemoptysis or discharge of scarlet foamy blood during coughing.

Hidden bleeding - These are such small bleedings in which the naked eye (macroscopically) cannot see the blood coming out from the natural orifices of the body, since there is only a small amount of blood in the test material (feces, urine) (occult blood). It is detected only by special laboratory tests (for hidden gastrointestinal bleeding and microhematuria) and (or) instrumental (endoscopic) research methods.

III. Internal bleeding occurs inside the body:

In body cavities that do not normally communicate with the external environment,

In tissues, organs.

Internal bleeding may cause bleeding in body cavities that do not (normally) communicate with the external environment: cranial cavity, joint cavity (hemarthrosis), pleural cavity (hemothorax), abdominal cavity (hemoperitoneum), into the pericardial cavity (hemopericardium), and blood can also pour out from the vessels in the tissue, in the form of a hematoma(formed as a result of tissue separation, with the formation of a cavity filled with liquid or coagulated blood), or ashemorrhages with tissue soaking in blood (the appearance of petechiae, ecchymoses). With interstitial bleeding (hemorrhage), blood flowing from the vessels can saturate the tissues surrounding the damaged vessel. Hemorrhages into the integument of the body (skin, mucous membranes), with their soaking in blood (which leads to the formation of petechiae and ecchymoses), are also a type of internal bleeding. There are petechiae - pinpoint hemorrhages; ecchymosis (bruising, bruising) - hemorrhages into these tissues larger than petechiae. Petechiae- pinpoint, small spotty hemorrhages in the skin, as well as in the mucous or serous membranes, the size of which, on average, is from the head of a pin to the size of a pea. Ecchymoses(ancient Greek ἐκχύμωσις - “outpouring” from ἐκ- “from-” and χέω- “pour”) - more extensive hemorrhages into the skin or mucous membrane, the diameter of which usually exceeds 2 cm. Ecchymosis is also called a bruise (in everyday life), hemorrhage (in medicine) - a section of surface tissue (skin, mucous membrane) soaked in blood flowing from a damaged vessel (damaged vessels).

Hematomas usually form in denser tissues (brain tissue, liver) or are delimited by fascia (on the limbs). More loose fabrics(fatty tissue, muscles), more often than not, are simply 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 characteristic of subcapsular ruptures of the parenchyma of the liver and spleen (two-stage ruptures of the organ with the development of intra-abdominal bleeding).

Small hematomas may resolve over time.

Hematomas, bigger size, are usually organized, i.e. are replaced by fibrous connective tissue and turn into scar.

If a large hematoma exists long enough, the surrounding tissue turns into a scar, and the hematoma becomes surrounded by a fibrous connective tissue capsule. This is how a pseudocyst is formed. In addition, hematomas can fester, turning into phlegmon, and, if there is a strong capsule, into abscesses.

Read more about internal bleeding.

1. Intracavitary (cavitary) bleeding , when blood flows into any large serous cavity of the body that does not normally communicate with the external environment:

A) hemorrhage with accumulation of blood in the abdominal cavity– hemoperitoneum (in case of injury or rupture of blood vessels, abdominal organs or abdominal wall);

b) hemorrhage with accumulation of blood in pleural cavity – hemothorax;

V) hemorrhage with accumulation of blood in the pericardial cavity– hemopericardium.

G) hemorrhage with accumulation of blood in the joint cavity - hemarthrosis.

Open cavitary (intra-abdominal, intrapleural) bleeding observed when hemoperitoneum, hemothorax with bleeding from the cavity to the outside, through a penetrating wound or through drains. At the same time, the intensity of blood flow outward often does not correspond to the intensity of internal bleeding.

2. Interstitial bleeding (hemorrhage) - This is the flow of blood into the thickness of the tissue.

Interstitial (interstitial) are bleeding in which blood or saturates fabrics or accumulates in the interstitial spaces, forming a hematoma.

A) INintratissue hemorrhage with tissue penetration (hemorrhagic infiltration, hemorrhagic tissue imbibition):

Small pinpoint (petechial) hemorrhages caused by capillary hemorrhage into the thickness of the skin, mucous membrane and serous membranes - hemorrhagic petechiae;

Multiple spontaneous hemorrhages in the skin, mucous membranes of a purplish color (red color with a purple tint) - thrombocytopenic purpura;

- spotted planar hemorrhage into the thickness of the skin or mucous membrane – bruise(bruise, suffusio, ecchymosis);

Hemorrhage into the brain substance in the form of a focus of hemorrhagic softening - intracerebral hemorrhage;

Hemorrhage into the subarachnoid space of the brain or spinal cord - subarachnoid hemorrhage;

Outcome of hemorrhage may be different:

Blood resorption

Formation of a cyst at the site of hemorrhage,

Encapsulation and germination by connective tissue,

Infection and suppuration.

b) Hemat O ma (haematoma; hemato- + -oma; blood tumor) - occurs during interstitial bleeding with tissue dissection and the formation of a cavity containing liquid or coagulated blood accumulated in it.

Types of hematomas according to their localization (by location):

subcutaneous hematoma,

intermuscular hematoma,

subperiosteal hematoma,

retroperitoneal (in the retroperitoneal tissue) hematoma,

perirenal (in the perinephric tissue) hematoma,

extrapleural hematoma (between soft tissues chest wall and parietal pleura),

paraurethral hematoma (in paraurethral tissue),

mediastinal hematoma (mediastinal hematoma),

intrawound hematoma (with intrawound bleeding, a hematoma in the wound canal formed as a result of hemorrhage into the cavity of a gunshot or stab wound, without significant external bleeding from the wound),

subcapsular (subcapsular) hematoma of any parenchymal organ (spleen, kidney, liver),

intracranial hematoma (with hemorrhage into the cranial cavity),

suprathecal (epidural) hematoma (with hemorrhage between the hard meninges and bones of the skull or spine),

intrathecal (subdural) hematoma (with hemorrhage under the dura mater),

intracerebral (intracerebral) hematoma (with hemorrhage into the substance of the brain),

intraventricular hematoma (with hemorrhage into a ventricle of the brain),

hematocele (hemorrhage with accumulation of blood between the membranes of the testicle, in the tissues of the scrotum).

Blood poured into tissues and cavities provided a good breeding ground for microorganisms. Thus, any hematoma, any accumulation of blood due to internal bleeding. are predisposing factors for the development of suppuration.

Outcomes of hematomas:

Suppuration of a hematoma (formation of an abscess) during infection

Resorption of hematoma;

Organization of a hematoma (germination of the hematoma by connective tissue) with the formation of a scar;

Encapsulation of a hematoma with the formation of a pseudocyst;

Pulsatinghematoma is a hematoma formed as a result of interstitial arterial bleeding and maintaining communication with the lumen of the damaged artery.

Expanding hematoma– this is a pulsating hematoma associated with a damaged large main artery, rapidly increasing in volume and compressing surrounding tissues; in the event of compression of the collateral vessels passing through them, ischemic gangrene of the limb may occur. A false arterial aneurysm (post-traumatic or arrosive) can form from a pulsating hematoma.

Aneurysm(from the Greek aneuryno - expand) is a local (local) expansion of the lumen of a blood vessel or heart cavity due to a pathological change in their walls (usually atherosclerotic) or developmental anomalies.

True aneurysm - This is an aneurysm, the walls of which have layers inherent to this blood vessel.

Congenital aneurysm– an aneurysm resulting from an abnormal development of the vascular wall:

Arterial aneurysm,

Venous aneurysm,

Arteriovenous aneurysm, characterized by the presence of a communication between the artery and the accompanying vein.

Dissecting aneurysm(usually the aorta) is an aneurysm (of the aorta) in the form of an intrawall canal formed as a result of a tear in the inner lining of the vessel and dissection of the vessel wall with blood entering through the tear.

False aneurysm is a pathological cavity communicating with the lumen of the vessel. It is formed by the formation of a connective tissue capsule around a pulsating hematoma formed as a result of injury to the vascular wall (post-traumatic aneurysm); less often when the vessel wall is destroyed by a pathological (inflammatory or tumor) process that has spread to the vessel wall (arrosive aneurysm).

IVVarious combinations of the main types of bleeding in one patient. For example: with a chest injury, a combination of intrapleural bleeding (hemothorax) and bleeding into the respiratory tract (pulmonary hemorrhage) is possible, and if there is a chest injury, external bleeding from damaged vessels of the chest wall wound is also possible. The intensity of each of these bleedings may vary.

D) BY TIME OF APPEARANCE

According to the time of occurrence of bleeding, there are primary and secondary.

Primary bleeding caused by damage to the vessel at the time of injury. It appears immediately after damage to the vessel and continues after the damage.

Secondary bleeding They can be early (usually from several hours to 4-5 days after damage) and late (more than 4-5 days after damage).

Early secondary bleeding develop in the first hours or days after injury due to the expulsion of a blood clot from a vessel or the slipping of a ligature from a vessel (with an increase in blood pressure), as well as due to the end of a vessel spasm. Early secondary bleeding may be caused by damage to blood vessels from a bone fragment or detachment of a blood clot, due to poor transport immobilization, careless repositioning of the victim, etc. It is very important to remember the possibility of secondary early bleeding during anti-shock therapy, when the resulting increase in blood pressure can contribute to the expulsion of the blood clot by current blood.

Late secondary (or arrosive) bleeding develop several days after the injury due to the melting of the blood clot by a purulent process, arrosion (destruction) of the vessel wall in the focus of purulent inflammation. Often, late secondary bleeding is a consequence of destruction of the vessel wall as a result of prolonged pressure from a bone fragment or foreign body (bedsore), purulent melting of a blood clot, erosion of the vessel wall, or rupture of an aneurysm.

D) WITH THE CURRENT

All bleeding can be acute or chronic.

Acute bleeding the most dangerous, bleeding is observed in a short period of time. Quick loss 30% of the circulating blood volume (CBV) leads to acute anemia, cerebral hypoxia and can result in the death of the patient.

Chronic bleeding. With chronic bleeding, blood loss occurs slowly and gradually, in small portions, and therefore the body has time to adapt to a slight decrease in blood volume. Sometimes for many days there is a slight, sometimes periodic, bleeding. Chronic bleeding may occur with stomach ulcers and duodenum, malignant tumors, hemorrhoids, uterine fibroids, etc.

According to the frequency of bleeding there are:

■ one-time;

repeated;

multiple.

The body of humans and mammals is penetrated by thousands of small, medium and large vessels, which contain a valuable liquid that performs a huge number of functions - blood. Throughout life, a person is influenced by a considerable amount of harmful factors, among them the most common traumatic effects are mechanical damage to tissue. As a result, bleeding occurs.

What it is? Medical Science " pathological physiology" gives this definition this state: “This is the release of blood from a damaged vessel.” At the same time, it pours out or into the body cavity (abdominal, thoracic or pelvic) or organ. If it remains in the tissue, saturating it, it is called hemorrhage; if it freely accumulates in it, it is called a hematoma. A condition in which blood vessels are damaged, most often occurring suddenly, and if there is a strong rapid leakage of vital fluid, a person can die. That is why first aid for bleeding often saves his life, and it would be nice for everyone to know the basics. After all, such situations do not always occur when there are medical workers nearby or even just specially trained people.

What types of bleeding are there and why do they occur?

There are many classifications of this pathological condition and specialists teach them all. However, we are interested in dividing bleeding into types, first of all, from a practical point of view. The following classification is important for successful first aid. It shows the types of bleeding depending on the nature of the damaged vessel.

Arterial bleeding

It comes from the arteries containing oxygenated blood flowing from the lungs to all organs and tissues. Makes up serious problem, since these vessels are usually located deep in the tissues, close to the bones, and situations where they are injured are the result of very strong impacts. Sometimes this type of bleeding stops on its own, since the arteries have a pronounced muscular layer. When such a vessel is injured, the latter goes into spasm.

Venous bleeding

Its source is venous vessels. Through them, blood containing metabolic products and carbon dioxide flows from cells and tissues to the heart and further to the lungs. Veins are located more superficially than arteries, so they are damaged more often. These vessels do not contract during injury, but they can stick together because their walls are thinner and their diameter is larger than that of arteries.

Capillary bleeding

Blood bleeds from small vessels, most often the skin and mucous membranes; usually such bleeding is insignificant. Although it can be frighteningly abundant with a wide wound, since the number of capillaries in the tissues of the body is very large.

Parenchymal bleeding

Separately, so-called parenchymal bleeding is also distinguished. The organs of the body are hollow, essentially “bags” with multi-layered walls, and parenchymal, which consist of tissue. The latter include the liver, spleen, kidneys, lungs, and pancreas. Typically, this type of bleeding can only be seen by a surgeon during an operation, since all parenchymal organs are “hidden” deep in the body. It is impossible to determine such bleeding based on the type of damaged vessel, because the organ tissue contains all their varieties and all of them are injured at once. This is mixed bleeding. The latter is also observed with extensive wounds of the extremities, since the veins and arteries lie nearby.

Depending on whether the blood remains in the cavity of the body or organ or pours out of the body, bleeding is distinguished:

Internal. Blood does not come out, staying inside: in the abdominal, thoracic, pelvic cavities, joints, and ventricles of the brain. A dangerous type of blood loss that is difficult to diagnose and treat because external signs there is no bleeding. There are only general manifestations of its loss and symptoms of significant dysfunction of the organ(s).
External bleeding. Blood is poured into the external environment, most often the causes of this condition are injuries and various ailments that affect individual organs and systems. These bleedings can be from the skin and mucous membranes, gastric and intestinal, or from the urinary system. In this case, visible outpourings of blood are called obvious, and those that occur in a hollow organ communicating with the external environment are called hidden. The latter may not be detected immediately after bleeding begins, because it takes time for blood to come out, for example, from a long digestive tube.

Typically, bleeding with clots is external, hidden or internal, when the blood is retained inside the organ and partially coagulates.

Spicy. In this case, a large amount of blood is lost in a short period of time, usually occurring suddenly as a result of injury. As a result, a person develops an acute state (anemia).
Chronic. Long-term losses of small volumes of this biological fluid, the reason is usually chronic diseases organs with ulceration of the vessels of their walls. Causes a state of chronic anemia.

Video: bleeding in the “School of Doctor Komarovsky”

Main causes of bleeding

What can cause bleeding? It is appropriate to note here that there are also two fundamentally different types of them, based on the factor whether a normal vessel is damaged or pathological condition arose against the background of destruction of the altered vascular wall. In the first case, bleeding is called mechanical, in the second - pathological.

The following main causes of bleeding can be identified:

Traumatic injuries. They can be thermal (from exposure to critical temperatures), mechanical (from a bone fracture, wound, bruise). The latter occur at different extreme situations: road accidents, train and plane crashes, falls from heights, fights involving sharp objects, gunshot wounds. There are also industrial and domestic injuries.
Vascular diseases, including tumors (purulent tissue lesions involving blood vessels, atherosclerosis, hemangiosarcoma).
Diseases of the blood coagulation system and liver (fibrinogen deficiency, hypovitaminosis K, hepatitis, cirrhosis).
General diseases. For example, diabetes, infections (viral, sepsis), lack of vitamins, poisoning cause damage vascular walls throughout the body, resulting in plasma and blood cells leaking through them and causing bleeding.
Diseases that affect various organs. Bleeding from the lungs can cause tuberculosis, cancer; from the rectum - tumors, hemorrhoids, fissures; from the digestive tract - stomach and intestinal ulcers, polyps, diverticula, tumors; from the uterus - endometriosis, polyps, inflammation, neoplasms.

What is the risk of bleeding for a person?

One of the most important, but by no means the only function of blood is the transport of oxygen and nutrients. It delivers them to the tissues, and takes metabolic products and carbon dioxide from them. With significant bleeding, there is a significant loss of this necessary for the body substances. Very sensitive to oxygen deficiency nervous system and heart muscle. Brain death, when the flow of blood into it completely stops, occurs in humans and animals in just 5-6 minutes.

However, in addition to the immediate loss of precious oxygen-containing fluid, there is another problem. The fact is that it keeps the blood vessels in good shape and with a significant loss of blood vessels, they collapse. In this case, the oxygen-containing blood remaining in the human body becomes ineffective and can help little. This condition is very dangerous, it is called vascular shock or collapse. It occurs in acute severe cases.

Its consequences described above are life-threatening patient and develop very quickly after bleeding.

Blood performs great amount functions, among them very important are maintaining balance internal environment body, as well as ensuring the connection of organs and tissues with each other through the transfer of various biologically active substances. In this way, billions of cells in the body exchange information and, as a result, can work harmoniously. Bleeding, to one degree or another, disrupts the constancy of the internal environment of the body and the functions of all its organs.

Often, blood loss does not directly threaten the patient’s life; this is observed in many diseases. In such cases, blood loss is chronic and mild. Replacement of the outflowing blood occurs through the synthesis of plasma proteins by the liver and bone marrow- cellular elements. Bleeding becomes important diagnostic sign to recognize the disease.

Signs of bleeding

Are common

Patient complaints:

Weakness, unmotivated drowsiness;
Dizziness;
Thirst;
Feeling of palpitations and shortness of breath.

External symptoms of blood loss that are observed with any type of bleeding are as follows:

Paleness of the skin and mucous membranes;
Cold sweat;
Increased heart rate;
Dyspnea;
Urinary disorders up to complete absence urine;
Drop in blood pressure;
Frequent weak pulse;
Impaired consciousness up to and including loss of consciousness.

Local

External effusion of blood

Basic local symptom- this is the presence of a wound on the surface of the skin or mucous membrane and visible bleeding from it. However, the nature of bleeding varies and is directly dependent on the type of vessel.

Capillary is manifested by that the blood collects in large drops and oozes from the entire surface of the wound. Its loss per unit of time is usually small. Its color is red.
Signs of venous bleeding: Blood can bleed quite quickly when wounded. large vein or several at once, it flows from the wound in strips. Its color is dark red, sometimes burgundy. If damaged large veins upper body, there may be intermittent bleeding from the wound (however the rhythm is synchronized not with the pulse, but with breathing).
Signs of arterial bleeding: blood pours out from the site of injury in pulsating tremors - “fountains” (their frequency and rhythm coincide with heartbeats and pulse), its color is bright scarlet, red. Blood loss per unit time is usually rapid and significant.

Manifestations of hidden bleeding

From the lungs - blood is released with a cough (a symptom of hemoptysis), it is foamy, the color is bright red.
From the stomach - brown color (hydrochloric acid gastric juice reacts with blood, the latter changes color). There may be clots.
From the intestines - feces acquire a dark brown or black color and a viscous, viscous consistency (tarry stool).
From the kidneys and urinary tract - urine becomes red (from a brick shade to brown with “rags” - clots and pieces of tissue).
From the uterus and genitals - blood is red, often there are pieces of mucous membrane in the discharge.
From the rectum - scarlet blood can be found in drops on the feces.

Signs of internal bleeding

No bleeding is observed in environment. Available general symptoms blood loss.
Local manifestations will depend on the location of the vessel damage and in which body cavity the blood accumulates.
- loss of consciousness or confusion, local impairment of motor functions and/or sensitivity, coma.
In the pleural cavity - chest pain, shortness of breath.
In the abdominal cavity - abdominal pain, vomiting and nausea, tension in the muscles of the abdominal wall.
In the joint cavity there is swelling, pain on palpation and active movements.

Can the body cope with bleeding?

Nature has provided for the possibility that fragile and delicate living tissues of the body will be injured over a long life. This means that a mechanism is needed to resist the flow of blood from damaged vessels. And people have it. The composition of blood plasma, that is, the liquid part that does not contain cells, contains biologically active substances- special proteins. Together they make up the blood coagulation system. It is assisted by special blood cells - platelets. The result of complex multi-stage blood clotting processes is the formation of a thrombus - a small clot that clogs the affected vessel.

In laboratory practice, there are special indicators that show the state of the blood coagulation system:

Duration of bleeding. An indicator of the duration of blood effusion from a small standard injury caused by a special stylet on a finger or earlobe.
Blood clotting time - shows how long it takes the blood to clot and form a blood clot. Conducted in test tubes.

The normal duration of bleeding is three minutes, time - 2-5 minutes (according to Sukharev), 8-12 minutes (according to Lee-White).

Often trauma or damage to a vessel pathological process sometimes the bleeding is too extensive and the natural mechanisms to stop the bleeding fail, or the person simply does not have time to wait due to the threat to life. Without being a specialist, it is difficult to assess the condition of the victim, and treatment tactics will vary depending on the cause.

Therefore, a patient who has severe bleeding from a vein or artery must be urgently transported to medical institution. Before this he must be provided urgent Care. To do this, you need to stop the bleeding. Usually this is a temporary cessation of blood flow from the vessel.

First aid

What methods are known to temporarily stop bleeding? Here they are:

Pressure (pressing a vessel in the wound, applying a pressure bandage).
Applying a hemostatic sponge, ice, irrigation with hydrogen peroxide (for capillary bleeding).
Very strong flexion of the limb.
Dense tamponade with bandage, gauze, cotton wool (for the nasal cavity, deep external wounds).
Application of a hemostatic tourniquet.

Methods to finally stop bleeding, which can only be performed by a doctor and in a hospital setting, are:

Mechanical: ligation of a vessel in a wound, performing vascular suture, stitching the fabric together with the vessel.
Chemical: anti-clotting and vasoconstrictor drugs (calcium chloride, epinephrine, aminocaproic acid)
Thermal: electrocoagulation.
Biological (to stop capillary and parenchymal bleeding during operations): fibrin films, hemostatic sponges, suturing of the body’s own tissues (omentum, muscle, fatty tissue).
Embolization of a vessel (introduction of small air bubbles into it).
Removal of the affected organ or part thereof.

It is very important to determine the type of damaged vessel, because this will determine how to stop the flow of blood from it.

First aid for arterial bleeding

Applying a tourniquet is very effective if a limb vessel is damaged. The method of pressure and tight wound tamponade is also used.

Rules for applying a tourniquet

While he is preparing, you need to press the artery with your fist or fingers to the bones above the wound, remember that when a large vessel is injured, minutes count. The brachial artery is pressed against the shoulder bone along its inner surface, the ulnar artery in the elbow bend, the femoral artery in the groin fold, the tibia in the popliteal fossa, the axillary artery in the cavity of the same name.

The injured leg or arm needs to be raised. Apply a tourniquet, tightening it tightly and placing a towel or rag between it and the skin. If there is no special rubber band, you can use a regular bandage, scarf, thin rubber hose, trouser belt, scarf or even rope. Then it is tied loosely around the limb, a stick is inserted into the loop and twisted until the desired compression is achieved. The criterion for correct application of a tourniquet is the cessation of bleeding. Time spent on the limb: no more than two hours in summer and half an hour in winter. To record the moment of vascular compression, the time is written on a piece of paper and secured to the affected limb.

Danger

The problem is that it is impossible to apply a tourniquet for more than the above-mentioned time interval due to poor circulation in the injured leg or arm; the tissues die. The function of the limb will then not be fully restored, and sometimes amputation becomes necessary. In addition, there is a danger of development in the area of damage (bacteria that live in the soil and multiply in living tissues in the absence of oxygen enter the wound). If the person has not yet been delivered to the hospital within the specified time, in any case the tourniquet should be loosened for a few minutes. The wound is then clamped using a clean cloth..

When wounded carotid artery and bleeding from it, it is necessary to pinch it with a finger and tamponade the wound with a sterile dressing. A tourniquet can be applied to the neck; a special technique is used for this to prevent suffocation of the victim. Raise the arm on the side opposite to the injury and tighten the neck with a tourniquet below places of injury along with the limb.

Video: emergency care for severe bleeding

Venous bleeding

For venous bleeding, tight bandaging or a tourniquet works well. The peculiarity of the latter’s technique is that its location is not above the site of injury, as with arterial injury, but, on the contrary, below.

With any method of stopping bleeding, the wound itself is covered with a sterile napkin or clean cloth. If pain medication is available, you can give the person an injection or a pill if they are conscious. A person lying on the ground should be covered to prevent hypothermia. The victim must not be moved or turned over.

If internal bleeding caused by injury is suspected, it is necessary to ensure the patient is completely rested and send him to the hospital as soon as possible.

Video: first aid for venous bleeding

Capillary bleeding

For capillary bleeding, a pressure method is used, including using the palm or fingers, applying a bandage, hemostatic sponges, and cold objects. With adequate functioning of the coagulation system, temporary cessation of bleeding becomes final.

Therapy after stopping bleeding in the hospital

The use of blood coagulation improving drugs, blood replacement drugs, whole blood/plasma/platelet suspension is mandatory. Intravenous fluid is also required infusion therapy to restore ion balance. Since bleeding is usually not the only problem after serious traumatic incidents, in parallel with the work to stop it, doctors carry out emergency diagnosis and treatment of concomitant disorders.

The main thing is not to lose your head if something bad happens to someone around you and the person is bleeding. In order to cope with it, you can use materials from your car first aid kit, items from your own bag, items of clothing or household items.

The task and duty of everyone normal person is providing first medical care to the victim, which consists in temporarily stopping his blood loss. And then you should immediately take the patient to a medical facility under your own power or urgently call an ambulance.

Arterial bleeding is characterized by a massive splash, a fountain of blood from the injured area. This condition is quite dangerous, since if first aid was not provided in a timely manner, the person may die from blood loss.

Features and Basics

When the integrity of the arteries is compromised, intense bleeding occurs. These are large vessels with strong walls; they carry oxygenated blood from the heart to all organs. human body. That is why their internal pulsation corresponds to the rhythm and frequency of heart contractions.

Oxygen-rich arterial blood has a scarlet-red hue, while venous blood is dark and burgundy. When bleeding begins, blood flows out in a pulsating fountain, which is caused by high blood pressure due to contraction of the left ventricle of the heart, which pumps blood.

Causes

Bleeding occurs under the influence of a number of factors:

Mechanical damage. The problem arises due to injury, trauma, rupture, burn or frostbite.
Erosive form - when the structure of the vessel wall is damaged. This may be preceded by destructive inflammatory processes, necrosis, tumor.
The diapedetic type is characteristic of people with increased permeability of small vessels. The condition can occur when taking certain medications or a number of pathologies, for example, vitamin deficiency, smallpox, scarlet fever, vasculitis, uremia.

In addition, arterial bleeding can occur due to diseases circulatory system when there is poor blood clotting. Less often, the causes lie in illnesses general, such as diabetes mellitus, infectious pathologies, liver dysfunction.

Classification

Based on the type of vascular damage, there are 5 types of bleeding in medicine:

Capillary. In this case, small vessels suffer. Bleeding is weak and short-lived. The color of blood is red.
Venous. The middle vessels are damaged. The blood is dark in color and flows out in a stream. The speed is directly related to the diameter of the vessel.
Arterial. Caused by a violation of the integrity of large vessels. The stream is liquefied, scarlet, pulsating. High rate of blood loss.
Parenchymal. Caused by damage to the lungs, liver, kidneys, and spleen. Due to the peculiarity of the localization of organs, it poses a great danger to the health of the victim.
Mixed. All types of vessels are involved.

Arterial bleeding is divided into 2 large groups:

External, when damage is visible and blood is emitted outside.
Internal. Characterized by the leakage of blood into tissues, cavities, and organ lumens. Internal type can be hidden or obvious. In the first case, the blood remains in the cavity. If it is obvious, the leaked mass eventually comes out through feces, urine, and vomit.

Depending on the period of occurrence, bleeding can be primary or secondary, that is, it appears immediately after injury or after a certain period of time.

Symptoms

Arterial bleeding is characterized by intensity, rate of blood loss and the bright shade of the latter.

Capillary appears as large red drops over the entire surface of the wound. The speed is low, the blood loss is small.

Venous is characterized by purple stripes. The speed is greater, blood loss depends on the diameter of the wound.

The arterial always flows and pulsates, but when a vessel is injured in the lower arteries, the pulsation is not felt.

In addition, you should pay attention to the following signs:

The blood is scarlet-red and liquid.
The bleeding does not decrease even when the wound is compressed.
The stream flows like a pulsating fountain.
The rate of blood loss is high.
The wound is located along the major arteries.
Body temperature and blood pressure decrease.
Worried about dizziness, weakness.

The victim may lose consciousness due to vascular spasm.

Internal bleeding is quite difficult to differentiate. The main symptoms are:

Drowsiness, increased weakness.
Unpleasant sensations in the abdominal cavity.
A sharp decrease in blood pressure.
Pallor of the integument.
Change the heart rate towards an increase.

For bleeding in the gastrointestinal tract characteristic features- vomiting blood, black stools.

Why is it important to quickly call an ambulance?

Arteries are large vessels, and damage to them can result in serious blood loss. If medical assistance is not provided in a timely manner, the person dies within 30-40 minutes.

If large arteries on the inside of the body or limbs in the flexion zone are damaged, then death occurs within a few minutes.

When an artery is completely ruptured, the entire volume of circulating blood flows out in one minute. This is why delay can cost lives.

Possible consequences

With severe blood loss, the heart does not receive enough circulating fluid and blood circulation stops. Vasospasm caused by trauma provokes loss of consciousness. The greatest danger is instant death.

When applying a tourniquet, it is important that assistance is provided no later than 8 hours, otherwise the area will die and gangrene develops. In this case, only amputation of the damaged part of the body can save.
First aid

If there is external bleeding, you should immediately call an ambulance. While doctors are on the way, it is necessary to try to stop the bleeding and improve the condition of the victim.

To do this, you need to strictly follow the following algorithm of actions:

Wearing gloves or wrapping your hand in a bandage, you need to remove clothing at the site of injury and determine the location of the injury.
Cover the wound with a napkin or cloth and apply pressure with your hand for 5 minutes. With direct compression, most bleeding stops due to compression of the lumen of the vessels.
Do not remove the soaked napkin, but if necessary, place a clean one on top. Next, a compressive bandage is applied.
If a limb bleeds when pressed directly, it must be elevated above the level of the heart to reduce the amount of blood flow in that area.
If a large artery is damaged and bleeding continues after all manipulations, it is necessary to additionally clamp the artery at the point where it borders the bone and skin. If damaged lower limb, then it should be fixed femoral artery in the groin. When the lower arm area is damaged, the brachial artery is compressed along the inner surface of the biceps muscle.
For people who don't have medical education, the described method of stopping the blood can be complex, so it is easier for them to use the method of applying a tourniquet slightly above the damage itself. But this should be done carefully, as blood vessels or nerves can be damaged, causing a number of difficulties for the victim. The tourniquet should not be left in place for a long time; the dressing should be changed after 1-2 hours.

To disinfect the damage, you should not treat the entire surface, but only the edges of the wound. If the injury is serious, it is necessary to give the victim painkillers to prevent painful shock.

When providing assistance, it is important to follow the rules so as not to make mistakes:

The tourniquet should not be applied to bare skin.
If there is any object inside the wound, it must not be removed under any circumstances.
The area where the tourniquet is located must not be covered with clothing or other things.
If the area below the bandage swells or turns blue, the procedure must be repeated.

If there is internal bleeding, it is impossible to stop it without hospitalization. That's why first aid may consist only of monitoring the condition and, if necessary, adjusting the pressure.

It is necessary to control the victim's breathing.
If vomiting occurs, it is necessary to turn the person on his side to prevent the mass from flowing into the respiratory tract.

If blood pressure has dropped to the lower limits, then you should slightly raise the person’s legs and cover him with a blanket.

Ways to stop bleeding

Stop method heavy bleeding may be temporary or permanent. The first includes pre-medical manipulations. The final stop is made after hospitalization.

If the wound is small, then sometimes primary care is enough, the main methods are:

Finger pinch.
Application of a tourniquet.
Tamponade.
Use of improvised means.

Finger compression is most effective when minor bleeding. You cannot do without it in those places where it is not possible to apply a bandage:

In the temporal part.
On the face or neck.
In the armpit area.
In the area of the popliteal area, groin.

In case of extensive bleeding, a tourniquet must be applied. If you don’t have a special one, then you can take a belt or scarf.

It is important that the strip is wide, as thin ropes can cause necrosis. The tourniquet is placed on top of the fabric or clothing above the damage by 3-5 cm.

You can check the correctness of the action by checking the pulsation of the artery below the bandage; the pulsation should be weak or completely absent. The first turn is made tight, the subsequent ones a little weaker.

In order not to severely compress the artery, it is necessary to remove the tourniquet for 10 minutes or loosen it after a certain period of time. In summer, the bandage can last 1-2 hours, in winter - 30-50 minutes.

Tamponade is performed if emergency treatment with a tourniquet does not help. To do this, use a bandage or gauze, from which a tampon is formed to stop the bleeding. Fix it bandage . If it is not possible to use sterile materials, then it is necessary to disinfect a homemade tampon before clamping the artery.

Improvised means are used only as a last resort. To do this, take any clean clothing and tear it into strips suitable in width for the tourniquet. Alcohol, vodka, and tincture are used as a disinfectant.

Methods for stopping bleeding at different artery locations

Depending on which part of the body is affected, they may be used. different ways to stop bleeding.

It will be enough to apply a bandage for injury to small arteries. Several layers of gauze are placed on the affected area, then a cotton swab, and everything is secured on top with a bandage. In case of bleeding, the vessel above the damage is clamped, followed by the application of a tourniquet and tamponade.

Sometimes it is necessary to press the artery at certain points in the area of close contact between bone and skin, so it is important to remember where they are located:

If bleeding is from the thigh, then the groin fold is needed.
Lower leg injury - pinched in the popliteal area.
Wound upper limb - inner side biceps muscle.
Carotid artery injury - sternoclavicular muscle in the neck.
Bleeding in the subclavian zone - clamping of the supraclavicular area.

When bleeding from the hand or foot, a tourniquet is not needed; the limb is raised, a bandage is applied to the wound and wrapped tightly.

Bleeding from an artery in the neck, head, or torso requires wound tamponade. Usually the carotid, subclavian, iliac, and temporal arteries are affected.

Injuries in the femoral area are quite dangerous, as a person can bleed to death in a short period of time. To stop, 2 tourniquets are used, since in this area the muscle tissue is dense and there are significant areas fat deposits. First, the artery is clamped, then a tourniquet is applied. This method cannot be used on the lower third of the thigh and middle of the shoulder..

In case of injury to the carotid artery, it is necessary to follow the steps:

The damaged area is clamped with a bandage or cloth.
Next, the patient’s hand, located on the other side of the injury, is placed deep behind the head.
A tampon is placed on top of the tissue on the wound and a tourniquet is passed through the outer side of the victim’s arm so that the structure presses the roller tightly.

Arterial bleeding is very dangerous for human life. In this case, it is important to remember what to do depending on the location and size of the vessel.

The most difficult thing is to stop femoral and cervical bleeding. It may be necessary to clamp the artery, apply a bandage, tourniquet, or tamponade. The main thing is to concentrate and provide timely assistance to the victim.