Home Wisdom teeth How to identify arterial bleeding and provide first aid. Effective ways to stop bleeding from a wound How to stop blood flowing like a fountain

Wisdom teeth

How to identify arterial bleeding and provide first aid. Effective ways to stop bleeding from a wound How to stop blood flowing like a fountain

- This is the outpouring of blood into the external environment, natural body cavities, organs and tissues. The clinical significance of the pathology 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.

ICD-10

R58 Bleeding not elsewhere classified

General information

Bleeding – pathological condition, in which blood from the vessels is poured into the external environment or into internal organs, tissues and natural body cavities. Is a condition that requires emergency health care. The loss of a significant volume of blood, especially within a short time, poses an immediate threat to the patient's life and can cause death. Treatment of bleeding, depending on the cause of its occurrence, can be carried out by orthopedic traumatologists, abdominal surgeons, thoracic surgeons, neurosurgeons, urologists, hematologists and some other specialists.

Classification

Taking into account the place into which the blood flows, the following types of bleeding are distinguished:

External bleeding - into the external environment. There is a visible source in the form of a wound, open fracture or crushed soft tissue.
Internal bleeding - into one of the natural body cavities communicating with external environment: bladder, lung, stomach, intestines.
Hidden bleeding– in tissues or body cavities that do not communicate with the external environment: in the interfascial space, ventricles of the brain, joint cavity, abdominal, pericardial or pleural cavities.

As a rule, in clinical practice hidden bleeding is also called internal, however, taking into account the characteristics of pathogenesis, symptoms, diagnosis and treatment, they are separated into a separate subgroup.

Depending on the type of damaged vessel, the following types of bleeding are distinguished:

Arterial bleeding. Occurs when the artery wall is damaged. Is different high speed blood loss poses a danger to life. The blood is bright scarlet and flows out in a tense, pulsating stream.
Venous bleeding. Develops when the vein wall is damaged. The rate of blood loss is lower than when an artery of similar diameter is damaged. The blood is dark, with a cherry tint, flows in an even stream, and there is usually no pulsation. If large venous trunks are damaged, pulsation in the rhythm of breathing may be observed.
Capillary bleeding. Occurs when capillaries are damaged. Blood is released in separate drops resembling dew or condensation (symptom of “blood dew”).
Parenchymal bleeding. Develops when parenchymal organs (spleen, liver, kidneys, lungs, pancreas), cavernous tissue and cancellous bone are damaged. Due to the structural features of these organs and tissues, damaged vessels are not compressed by the surrounding tissue and do not contract, which causes significant difficulties in stopping bleeding.
Mixed bleeding. Occurs when veins and arteries are simultaneously damaged. The cause, as a rule, is injury to parenchymal organs that have a developed arterial-venous network.

Depending on the severity, bleeding can be:

Lungs (loss of no more than 500 ml of blood or 10-15% of blood volume).
Average (loss of 500-1000 ml or 16-20% of bcc).
Severe (loss of 1-1.5 liters or 21-30% of bcc).
Massive (loss of more than 1.5 liters or more than 30% of the bcc).
Fatal (loss of 2.5-3 liters or 50-60% of blood volume).
Absolutely fatal (loss of 3-3.5 liters or more than 60% of the blood volume).

Taking into account the origin, traumatic bleeding is distinguished, which develops as a result of injury to unchanged organs and tissues, and pathological bleeding, which occurs as a result pathological process in any organ or are a consequence of increased permeability of the vascular wall.

Depending on the time of occurrence, specialists in the field of traumatology and orthopedics distinguish between primary, early secondary and late secondary bleeding. Primary bleeding develops immediately after injury, early secondary bleeding occurs during or after surgery (for example, as a result of a ligature slipping from the wall of a vessel), and late secondary bleeding occurs after several days or weeks. The cause of late secondary bleeding is suppuration followed by melting of the vessel wall.

Symptoms of bleeding

To the number common features pathologies include dizziness, weakness, shortness of breath, extreme thirst, pallor of the skin and mucous membranes, decreased blood pressure, increased heart rate (tachycardia), pre-syncope and fainting. The severity and rate of development of these symptoms is determined by the rate of bleeding. Acute blood loss is more difficult to tolerate than chronic blood loss, since in the latter case the body has time to partially “adapt” to the changes taking place.

Local changes depend on the characteristics of the injury or pathological process and the type of bleeding. With external bleeding, there is a violation of the integrity of the skin. When bleeding from the stomach occurs, melena (tarry black loose stool) and vomiting changes dark blood. Esophageal bleeding is also possible bloody vomiting, but the blood is brighter, red, rather than dark. Bleeding from the intestines is accompanied by melena, but the characteristic dark vomiting is absent. If the lung is damaged, bright scarlet, light foaming blood is coughed up. For bleeding from renal pelvis or Bladder Hematuria is typical.

Hidden bleeding is the most dangerous and most difficult to diagnose; they can only be identified by indirect signs. At the same time, the blood accumulating in the cavities compresses the internal organs, disrupting their functioning, which in some cases can cause the development of dangerous complications and death of the patient. Hemothorax is accompanied by difficulty breathing, shortness of breath and weakening of percussion sound in the lower parts chest(with adhesions in pleural cavity possible dullness in the upper or middle sections). With hemopericardium, due to compression of the myocardium, cardiac activity is disrupted, and cardiac arrest is possible. Bleeding into the abdominal cavity is manifested by bloating of the abdomen and dullness of percussion sound in its sloping sections. When bleeding into the cranial cavity, neurological disorders occur.

Bleeding out of bounds vascular bed has a pronounced Negative influence for the whole body. Due to bleeding, the blood volume decreases. As a result, cardiac activity deteriorates, organs and tissues receive less oxygen. With prolonged or extensive blood loss, anemia develops. The loss of a significant volume of bcc over a short period of time causes traumatic and hypovolemic shock. Shock lung develops, volume decreases renal filtration, oliguria or anuria occurs. Foci of necrosis form in the liver, and parenchymal jaundice is possible.

Types of bleeding

Bleeding from wounds

First aid consists of anesthesia and immobilization with a splint. At open fractures A sterile bandage is applied 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. For blunt trauma abdominal cavity possible bleeding from a damaged liver, spleen or hollow organs (stomach, intestines). Bleeding from parenchymal organs is especially dangerous due to the massive blood loss. Such injuries are characterized by rapid development of shock, without immediate qualified assistance usually death 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 horizontal position with raised legs. Apply cold (blister or heating pad with ice or cold water). If esophageal or gastric bleeding is suspected, the patient is not allowed to eat or drink.

On prehospital stage If possible, carry out anti-shock measures and replenish the blood volume. Upon admission to medical school. establishment continues infusion therapy. Scroll 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

In case of damage to blood vessels of various types, it is necessary to stop the bleeding in time. This is especially true for heavy bleeding, which can lead to fatal outcome. To avoid large blood loss, it is important to be able to determine the nature of the wound and provide first aid correctly.

Photo 1. Even a small wound needs treatment. Source: Flickr (Kenga86)

Types of bleeding

Vascular injury causing bleeding may be associated with trauma as a result of external influence(traumatic bleeding), or with destruction of blood vessels from the inside (for example, tumor growth into the vessel wall).

Bleeding occurs depending on the direction of blood flow external And internal.

Based on the type of damaged vessel, they are divided into three groups:

Arterial;
Venous;
Capillary.

A clear separation of types is of great practical importance, since for each of them it is necessary different approaches to provide assistance.

How to stop bleeding

Damage at home skin very easy, considering the arsenal of cutting and piercing objects in the kitchen (knives, graters, processor attachments, hatchets for cutting meat). If such a nuisance occurs, the first thing to do is to assess the depth of tissue damage.

Already upon examination of the wound it becomes clear: it is superficial or deep wound. Each requires different measures to stop bleeding.

Superficial cut

This means damage in which The integrity of only the skin and the underlying fatty tissue is compromised. There is no injury to large vessels, blood flows out evenly, in small volumes.

Often, such bleeding can be stopped on your own without going to the hospital.

First of all, the wound needs to be carefully rinse with cold running water. This is done to remove both possible tissue contamination and to reflexively narrow small vessels. Even these manipulations help reduce blood loss. The next step is to treat the wound with special solutions that prevent tissue infection.
Wound edges expedient handle .
Next is superimposed pressure bandage on the wound. To do this, it is better to use a gauze bandage or special sterile bags (usually found in first aid kits). If you don’t have any of this at hand, any clean cloth (scarf, towel) will do.

Note! If after all the actions the bleeding does not stop within 15 minutes, then the person should be taken to a specialized hospital for assistance.

Deep cut

With such damage there is a high probability of destruction of large vessels, nerves, tendons, since the wound is much deeper. If help is not provided in time, death is possible.

The algorithm of actions is as follows:

Determine the type of bleeding. Venous - blood flows smoothly, its color is dark burgundy. When bleeding from the arteries, the color of the blood is deep red, it flows out under high pressure (gushing).
To reduce blood loss, you should clamp the vessels in the right place. This should be done immediately, especially with large cuts. For venous bleeding, a tourniquet from available means is applied below the wound (farther from the heart), for arterial bleeding - above the site of injury (closer to the heart). A belt, a towel, and a piece of sheet are suitable for these purposes. The tourniquet should be tightened until the bleeding stops completely.
Cover the wound with a bandage, if possible sterile.
In parallel follows call an ambulance.

It is important! Note the time when the tourniquet is applied and inform your healthcare provider later. It’s even better to write down the time on a piece of paper and attach it in a visible place on the patient’s body.

For cuts in children First of all, don't panic. Since the volume of circulating blood in a child is less than in an adult, in case of a serious wound you should act as quickly as possible.

Children react much more strongly to acute blood loss. It should be remembered that a child may be frightened by the sight of his own blood, to the point of losing consciousness. That's why distract the baby something interesting, try to keep the wound out of his field of vision. If the victim loses consciousness, then you should do the following:

lay down horizontally.
If possible, carry the baby out on Fresh air or open a window.
Energetic helps trituration ears, cheeks.

Good for bringing awareness tampon with ammonia, brought to the nose.

What not to do

Under no circumstances is it worth it fill the wound with iodine tincture. This will lead to chemical burn in the wound, and it will be difficult to heal. This rule also applies to a solution of brilliant green, hydrogen peroxide, if we are talking about deep damage.
It is forbidden touch wound edges with dirty hands.
If there are any left in the wound cutting objects(a piece of glass is stuck, for example), then in no case don't take it out them yourself. This leads to repeated tissue injury and increased blood loss.
Do not remove the bandage soaked in blood, but apply a new layer of dressing material on top.
There should be no delay in transporting the victim to the hospital.

It is important! There is no need to give water or food to the victim, even if there is minimal risk of internal bleeding!

What medications help stop bleeding?

To stop bleeding, hemostatic drugs, antiseptics or folk remedies are used.

Hemostatic drugs

Most of the hemostatic agents have a narrow scope of application and are not prescribed for small cuts.

Examples of drugs include:

tranexamic acid(prescribed only in the postoperative period),
aminocaproic acid(with a lack of coagulation factors in the body),
vagotil(mainly used in gynecology).

It is not advisable to use these medications at home; they have a lot of contraindications.

Note! The most affordable and safe remedy– hydrogen peroxide solution. When applied to the edges of a wound, in addition to its antiseptic effect, it also stops bleeding. Particularly effective for shallow damage to the skin.