| First aid for bleeding

Basics of life safety
Grade 11

Lesson 5
First aid for bleeding

Fundamentals of medical knowledge and rules of first aid

Every citizen should know the rules of first aid, which are studied in the course “Fundamentals of Life Safety.” In this chapter, we will look at the rules for providing first aid for wounds and bleeding, some types of injuries, as well as for traumatic shock, acute heart failure, stroke and cardiac arrest.

Bleeding

Bleeding - bleeding from blood vessels when the integrity of their walls is violated.

Types of bleeding and their characteristics are given in scheme 3.

Types of bleeding and their characteristics

Causes, causing bleeding one type or another are different. External bleeding occurs when a sharp object, such as a knife or a piece of glass, damages blood vessels in the skin and deep-lying organs. Internal bleeding occurs with a closed injury, with a sharp blunt impact, for example, in the case of a car accident, when the driver is thrown against the steering wheel, or when a person falls to the ground after tripping over an object. Internal bleeding may be caused by lung diseases (pulmonary tuberculosis) or peptic ulcer stomach (when a bleeding ulcer forms in the stomach wall), damage internal organs- liver, kidney, rupture of the spleen. In this case, an internal parenchymal bleeding. It is extremely difficult to stop him. Surgeon intervention is required.

External bleeding

External bleeding is caused by damage to a blood vessel and is manifested by the leakage of blood onto the surface of the skin.

Signs of external arterial bleeding X:

Rapid and pulsating bleeding;
severe pain in the injured part of the body;
blood is bright red;
blood gushes from the wound;
weakness.

Signs of superficial venous bleeding:

The blood flows calmly from the wound, and does not flow like a fountain;
blood is dark red or burgundy. First aid for bleeding depends on its nature and consists of temporarily stopping the bleeding and transporting the victim to the nearest medical institution. This must be done quickly: the loss of even a small amount of blood disrupts the functioning of the heart and breathing. Help must begin to be provided right on the spot.

There are several ways to temporarily stop bleeding:

Finger pressing of superficially located arterial vessel slightly above the bleeding wound;
applying a tourniquet 3-5 cm above the wound;
applying a pressure bandage to the bleeding site;
maximum limb flexion;
giving the injured limb a sublime (slightly higher chest) positions.

Arterial bleeding from the vessels of the upper and lower extremities is stopped in two stages: first, the artery above the site of injury is pressed against the bone to stop the flow of blood to the site of injury, and then a standard or improvised tourniquet is applied.

It is best to press the arteries to the bony protrusions at certain, most convenient points for this (Fig. 1), where the pulse can be easily felt.

Temporal artery press with your thumb on the temple in front and just above the auricle.

Carotid artery pressed to the left or right (one side only!) on the side of the neck. This must be done as quickly as possible: even a second’s delay is dangerous for the life of the victim. Pressure with the fingers should be applied towards the spine, while the carotid artery is pressed against it.

Subclavian artery pressed in the hole above the collarbone to the first rib.

Axillary artery (if there is bleeding from a wound in the area shoulder joint and shoulder girdle) are pressed to the head humerus along the anterior edge of hair growth in the armpit.

Brachial artery (for bleeding from wounds of the middle and lower third of the shoulder, forearm and hand) pressed against the humerus on the inside of the biceps muscle.

Radial artery (in case of bleeding from wounds of the hand) pressed against the underlying bone in the wrist area thumb.

Femoral artery (when bleeding from wounds in the thigh area) is pressed in the area of ​​the inguinal fold, in its middle part. Pressing is done in groin area halfway between the pubis and the protuberance of the ilium.

Anterior tibial artery (for bleeding from wounds of the leg and foot) press in the area of ​​the popliteal fossa.

Arteries of the dorsum of the foot (when bleeding from a wound on the foot) is pressed against the underlying bone.

Finger pressure makes it possible to stop bleeding almost instantly. But even the most strong man cannot continue it for more than 3-5 minutes, as his hands become tired and the pressure weakens. Nevertheless, this technique is important: it allows you to gain some time to use other methods of stopping bleeding.

In case of arterial bleeding from the vessels of the upper and lower extremities, bleeding can be stopped using maximum flexion of the extremities. So, if there is bleeding from the artery of the forearm, you need to put a small roll of soft tissue, for example a pack of bandage, into the elbow bend, and bend your arm as much as possible. elbow joint. The same can be done in case of bleeding from the artery of the leg: place a soft tissue roller in the popliteal area and bend the leg at the joint as much as possible (Diagram 4).

After pressing the artery, they begin to apply a hemostatic tourniquet. The tourniquet is applied to clothing or to a fabric placed under it (towel, piece of gauze, scarf). Applying a tourniquet to bare skin is unacceptable. The tourniquet is placed on the limb above the bleeding site, approximately 3-5 cm from the wound, stretched strongly and, without reducing the tension, tightened around the limb and its ends are secured. When the tourniquet is applied correctly, bleeding from the wound stops, the limb below the site where the tourniquet is applied turns pale, and the pulse in the artery disappears. A note must be placed under the tourniquet indicating the date, hour and minutes of its application (Diagram 5).

The limb below the site of application of the tourniquet remains viable for 2 hours, and in winter outside the room for 1-1.5 hours, therefore, after the specified time, the tourniquet must be removed and after a few minutes applied in another place - a little higher. In this case, the victim will inevitably lose some blood. During this time, it is necessary to take measures to deliver the victim to the nearest medical facility, where he will receive qualified medical care.

Possible errors when applying a tourniquet:

Too little tightening causes compression of only the veins, resulting in increased arterial bleeding;
too much tightening, especially on the shoulder, leads to damage to the nerve trunks and paralysis of the limb;
Applying a tourniquet directly to the skin usually leads, after 40-60 minutes, to severe pain at the site of its application.

In the absence of a tourniquet, a belt, scarf, strip of durable fabric, i.e., any suitable material, is used to stop bleeding. The belt is folded into a double loop, put on the limb and tightened. A scarf or other fabric is used to apply a tourniquet (Fig. 2).

Applying a pressure bandage is another simple and reliable way to stop bleeding, reduce pain and create rest for the injured part of the body. At the same time, the bandage will protect the wound from secondary infection (Diagram 6).

In all cases of superficial wounds of the upper or lower extremities, one of the possible ways to stop venous bleeding is to elevate the extremity. This is quite easy to do. Damaged hand you need to raise it up, a little above your head. Under the injured leg you need to place a small cushion rolled up from some kind of fabric (you can also use a bag, backpack, blanket, pillow, or armful of hay). The leg should be slightly higher than the chest. Of course, the wounded person must lie on his back.

Capillary bleeding occurs when the smallest blood vessels are damaged. It is characterized by the fact that blood oozes from the entire surface of the wound, the color being average between venous and arterial. Most often, such bleeding stops voluntarily in a matter of minutes due to blood clotting. If this does not happen, it is stopped with a pressure bandage. A sterile napkin is applied to the bleeding area, which is then pressed to the injured surface with a bandage. If a limb is injured, then after applying a bandage it must be given an elevated position.

Internal bleeding

In case of internal bleeding, blood from a damaged artery, vein or capillary does not go beyond the skin. This is usually bleeding into the chest or abdominal cavity. A special type of internal bleeding - into the cavity cranium. In this case, an extensive hematoma is formed, which disrupts the activity of the brain and internal organs. Minor internal capillary bleeding causes bruising under the skin and is not dangerous. But deeper arterial or venous bleeding can lead to large blood loss and serious consequences.

Signs of internal bleeding:

Blue skin (bruising) in the area of ​​injury;
soft tissue that is tender, swollen, or hard to the touch;
the victim feels nervous or uneasy;
rapid weak pulse;
rapid breathing;
pale or gray skin that feels cool or damp to the touch;
nausea and vomiting;
feeling of unquenchable thirst;
decreased level of consciousness;
a fall blood pressure;
cough with bloody discharge.

In case of internal bleeding it is necessary:

Provide the victim with absolute rest;
examine the victim, trying to determine whether he has injuries to internal organs;
apply direct pressure to the area of ​​bleeding (this leads to its reduction or stopping);
apply cold to the bleeding area (this relieves pain and relieves swelling); When using ice, you need to wrap it in gauze, a towel or cloth, or even better, place it in plastic bag; apply cold for 15 minutes; then you need to remove the water and reapply ice to the damaged surface;
if the victim complains about severe pain or cannot move a limb, and if you think that the injury is very serious and can cause severe internal complications, you should immediately 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.

The oxygen-rich blood of the arteries has a scarlet-red hue, while the 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, 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 peculiarities of localization of organs, it represents great danger for 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, pulsating, but when the vessel is injured in lower arteries no pulsation is 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 V 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. Therefore, first aid can only consist of monitoring the condition and, if necessary, resolving the pressure.

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

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 zone muscle dense and available 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, you must follow the steps:

1. The damaged area is clamped with a bandage or cloth.
2. Next, the patient’s hand, located on the other side of the injury, is placed deep behind the head.
3. 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.

To provide assistance, it is important to know in which bleeding the blood coming from the wound flows like a fountain, and in which it flows out in a continuous stream.

The most dangerous bleeding occurs when arteries are injured. This is due to the fact that in these vessels blood flows with a certain pressure and if the wall is damaged, the bleeding takes the form of a gushing stream. Blood loss increases rapidly and, if first aid is not provided, the victim may develop hemorrhagic shock. Pre-medical measures to stop bleeding are very simple and no less effective. In order not to get confused in an emergency, the article presents first aid for arterial bleeding, broken down point by point to make it easier to remember.

Blood in arteries and blood in veins move in opposite directions. Arteries carry oxygen-rich blood from the heart to the periphery. The veins collect blood rich in carbon dioxide from the periphery and carry it back to the heart.

Stopping bleeding is achieved by pressing the damaged vessel in such a way as to block the flow of blood out. Therefore, before rendering emergency care should begin with an assessment of bleeding by appearance:

• If, when injured, blood flows in a continuous stream, this is venous bleeding. When a vein is damaged, the blood has a dark red appearance and flows out smoothly.
• If the blood flows in a pulsating stream and has a bright scarlet color, then this is arterial bleeding.

The blood does not always flow like a fountain, since a person may have low blood pressure, but the pulsation will be visible in any case.

After determining the type of damaged vessel, it becomes clear where to apply the tourniquet, above or below the site of injury.

In case of arterial bleeding, a tourniquet should be applied above the injury site to stop the flow of blood from the heart to the limb.

With venous, the direction of flow goes from the extremities to the heart, so it is necessary to compress the vessels below the wound site towards the limb, since it simply does not make sense to compress the vessels above the injury.

Important to remember! An error in diagnosing a damaged vessel can cost a life.

First aid

First aid can be provided by a person without medical education. Most bleeding develops as a result of household injuries, so it is important to know how to stop bleeding from an artery using improvised means.

Action	Description
	If there is bleeding, you should immediately call an ambulance. The dispatcher must be informed of the location of the injury and describe the severity of the bleeding. Be sure to focus on whether the victim is conscious or not.
	If the blood spurts out, then in parallel with calling an ambulance, you need to stop the bleeding with finger pressure. This method is quite simple if you know where to press the damaged artery. The disadvantage is that the bleeding may slow down but not stop. And it’s quite difficult to press the artery for a long time.
	After heavy bleeding has stopped, you can find improvised means to replace finger pressure with a more convenient way to temporarily stop the bleeding.

Finger pressure points

Emergency assistance in the form of finger pressure is provided for massive bleeding from one artery. In order to implement this type first aid you need to know which vessel goes where and what to press it against.

Points 1-7 for pressing the vessels in the upper body. To effectively stop bleeding, you need to make efforts to press the vessel to the bone.

1. The temporal artery passes through the temple area and descends in front of auricle. It is easy to press it to the bones of the skull anterior to the opening of the ear canal.
2. The maxillary artery runs along the edge lower jaw, you need to press it closer to the chin.
3. The external carotid artery is located on the side of the neck. The bleeding from it is very serious. You can press it below the site of injury to the 7th cervical vertebra.
4. The subclavian artery should be pressed above the collarbone, at the junction of the clavicle and sternum.
5. Axillary artery - passes in the axillary fossa, where it is pressed with a fist to the humerus and the arm is brought as close to the body as possible.
6. The brachial artery runs along the inner surface of the biceps; we press it to the humerus above the site of injury.
7. The radial artery runs along the forearm above radius- This is the bone on the side of the thumb. The artery should be pressed against the bone above the injury site.
8. The ulnar artery corresponds ulna- bone on the side of the little finger. We press the damaged vessel to the bone of the forearm.
9. The femoral artery is a large vessel. Damage to it is no less dangerous than injury to the carotid artery. In case of injury in the upper and lower part of the thigh, the vessel is pressed with a fist to femur slightly above the injury site.
10. The tibial artery is pressed behind the ankle on the inside.

Points 8 -10 for pressing large vessels in the lower part of the body require great strength

Temporarily stopping bleeding using improvised means

Ways to help with arterial bleeding include stopping the blood using household items - a belt, a cloth twist. The emergency care scheme is presented in the table.

Action	Description
	It is necessary to raise the injured limb to an elevated position. Lifting the limb leads to a physiological slowdown in blood flow. Also, in this position, venous blood flows away from the arm, which will reduce swelling of the limb from compression.
	Above the bleeding site, the limb should be wrapped in a clean cloth. When applying a tourniquet to bare skin, compression occurs superficial vessels and nerves, and the deep arteries, damage to which caused the bleeding, remain uncompressed. Therefore, the tourniquet must be applied to fabric or clothing.
	General rules applying a tourniquet from scrap materials: · apply higher at a distance of 2-3 cm from the wound if the shoulder or hip is injured. · If the injury is on the forearm or lower leg, then the tourniquet is applied higher to one joint, that is, on the shoulder or thigh, respectively. · The tourniquet is applied above or below the middle third of the shoulder, since this is where the nerve is compressed. · Do not use wire or cable as this may cause soft tissue rupture.
	Belt harness. If there is a belt, wrap it several times and tighten it tightly.
	We take a strip of fabric or bandage, tie it at the ends and put it on the injured limb. We insert a stick between the hand and the fabric ring and begin to twist the fabric into a rope. When the twist compresses the limb tightly enough, we secure the stick with a cloth or bandage.
	The medical tourniquet is applied in the form of several tours around the limb, which do not overlap each other.
	You need to place a note under the blood-stopping agents with the time of their application. As a last resort, you can write this time in a visible place on the victim, for example on the forehead.
	Treating the edges of the wound and applying a bandage. If there is an antiseptic - iodine or peroxide, then we treat the edges of the wound and put a bandage on top and fix it tightly.

Alternative methods

In some cases, you can use other options to stop arterial bleeding:

1. A pressure bandage is used for mild damage to the artery, when blood does not flow out like a fountain, but smoothly and in small quantities. In this case, several folded sterile bandage napkins are applied to the wound, which are tightly bandaged on top. In this condition, the patient can be taken to the emergency room independently.
2. Maximum flexion of the limb is performed with mild bleeding. It is carried out in the elbow, knee and hip joints. In this case, a thick roller is placed at the bend.

The bent limb must be fixed.

Important! If the victim laceration limbs, and profuse bleeding, then a tourniquet is applied above the injury site and pressure bandage to the site of damage itself.

The video in this article shows ways to help with bleeding.

What's next?

Medical care is provided by a paramedic, emergency physician or traumatologist in an emergency room. All patients with arterial bleeding undergo definitive bleeding control. Depending on what kind of assistance is provided to pre-medical stage If large arteries are damaged, further treatment tactics will be developed.

It is difficult to predict what the consequences of bleeding from a large artery will be, since it depends on the size of the damage, the degree of blood loss and the somatic status of the victim.

Arterial bleeding has fundamental characteristics and differences from venous bleeding. Everyone should know these features, since the rules for providing assistance with different types blood loss is diametrically opposed.

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 may flow out in an intermittent stream, synchronous with breathing (due to the suction action of the chest), and not with 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 these 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 pose a 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 bleeding 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.

In case of 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 for pancreatic necrosis, etc.).

Increased permeability of microvascular walls.

Diapedetic hemorrhage ( due to increased permeability of vessel walls) occurs as a result of 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 changed. 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 is converted 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 (into the respiratory tract);

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 of 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 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 material being examined (feces, urine) ( hidden 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 larger than petechiae into these tissues. 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 soaked in 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 liver and spleen parenchyma (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 outside 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 Bleeding is pathological condition , characterized by the flow of blood from the bloodstream into environment or in various cavities

bodies.

Massive blood loss is dangerous to human health and life, so everyone should be able to recognize the signs of bleeding in time and know how to act in such a situation.

Arterial bleeding is a type of bleeding that comes from damaged arteries. These vessels carry oxygenated blood to all corners of our body, so failure of large vessels of this type can be fatal.

It is worth acting immediately in case of such blood loss, because high pressure in the arteries causes blood to flow out at high speed. Often the count goes by minutes and even seconds.

What is characteristic of arterial bleeding?

The main sign of arterial bleeding is a rapid flow of scarlet blood from the wound. When bleeding from veins, the blood has more dark color and flows slowly, since the pressure in these vessels is much lower.

Arterial bleeding has characteristic signs by which it can be easily recognized:

• The leaking blood is bright scarlet in color and flows at considerable speed;
• The blood is quite thin, as opposed to thick venous;
• The blood stream “pulsates” in rhythm with the heartbeat;
• The pulse in the areas of the damaged artery located below the wound is weakly felt or absent;
• The victim’s well-being worsens before our eyes: the person feels dizzy, loses strength, and may lose consciousness;
• The skin quickly becomes pale and acquires a bluish tint.

What can cause bleeding?

In the clinic, there are two types of bleeding: from mechanical or pathological damage. The first indicates trauma to the vessel wall due to fractures of nearby bones or injury from any object.

Pathological ones occur when the arterial wall is destroyed due to its structural changes. This phenomenon may be the result tumor process in blood vessels, occur due to vasculitis and other systemic diseases.

TO common reasons bleeding from the arteries should be attributed to:

When a large artery is damaged, centralization of blood circulation occurs - a condition in which blood moves away from the extremities, concentrating in the area of ​​vital organs - lungs, brain, heart. This physiological phenomenon, aimed at emergency life support. It manifests itself as pallor and cyanosis of the extremities, which cease to be supplied with blood as usual.

Why is arterial bleeding most dangerous?

Arterial blood is the main supplier of oxygen to all organs.

Serious blood supply threatens ischemia, that is oxygen starvation, certain parts of the body. Organs like the intestines can go without air for tens of minutes, but irreversible changes occur in the brain and heart after just 6 minutes of fasting.

There is also such a thing as collapse - a condition in which hemorrhagic shock occurs due to a sharp drop in blood pressure and blood flow volume. It can lead to cardiac arrest.

How can you stop bleeding?

Several techniques are used to stop bleeding. It is worth choosing one of them depending on the location of the damaged vessel, its size, and the intensity of the hemorrhage.

These are the techniques:

• Finger compression of the vessel;
• Application of a tourniquet;
• Wound tamponade.

Pressure points of arteries

The first and last methods of stopping are suitable if the carotid, maxillary or temporal artery, that is, those vessels on which it is impossible to apply a tourniquet. Arterial bleeding from wounds of the extremities can most effectively be stopped using a tourniquet.

How to provide first aid correctly?

Timely provision of first aid for profuse arterial hypertension often determines whether the victim will remain alive. To quickly provide assistance, it is worth knowing what to do in this situation. First of all, call an ambulance, and then immediately begin following the recommended course of action.

Stop bleeding point by point

How should a vessel be clamped during arterial bleeding?

To provide assistance with blood loss as quickly as possible, you need to know what actions to perform during digital compression and in what order.

IN extreme situation try to concentrate and follow this algorithm:

1. Find the wound. If it is not visible due to blood, you need to apply pressure with your palm. This way you can determine exactly where the “fountain” is coming from and better cover the wound.
2. Remove clothing from the injured area.
3. If the bleeding is coming from a vessel on your arm, press it against the nearest bone with your thumb, clasping and squeezing your hand with the rest.
4. Hold the wound for 10 minutes. This time is most often enough to stop mild to moderate bleeding.
5. Do not remove your fingers until the tourniquet is applied.

It is advisable to disinfect your hands with soap or antiseptic before performing clamping. This way you can avoid infection in the wound. However, in a situation where there is a serious threat to the life of the victim, this advice can be safely ignored.

Places of compression of the main arteries:

Artery name	How to find	Bone to press
Temporal	2 cm superior and anterior to the opening of the external auditory canal	Temporal
Facial	2 cm anterior to the angle of the mandible	Lower jaw
General sleepiness	Superior edge of the thyroid cartilage	Carotid tubercle of the transverse process of the 6th cervical vertebra
Subclavian	Behind the collarbone in the middle third	First rib
Axillary	Anterior border of hair growth in the armpit	Head of humerus
Shoulder	Medial border of the biceps muscle	Inner surface of the shoulder
Femoral	Middle of the inguinal fold	Horizontal ramus of the pubis
Popliteal	Top of the popliteal fossa	Posterior surface of the tibia
Abdominal aorta	Navel area (pressed with fist)	Lumbar spine

Actions when applying a tourniquet

Tourniquet – more reliable way stopping bleeding than clamping the artery. It is applied in cases of moderate and severe hemorrhages 2 cm above the damaged area.

The tourniquet can be medical, that is, pre-made. However, in emergency situations Most often, this device can be replaced with improvised means such as a belt, strips of strong fabric, or a tie.

When choosing an item to bandage, make sure it is as wide as possible. Thin ropes are not suitable for making a tourniquet, as they compress the tissue too much, promoting the development of necrosis.

The tourniquet is not applied to the skin. To avoid pinching too much, place a piece of fabric under it or simply fasten it to the patient’s clothing. The criterion for correct application of a tourniquet is the absence of a pulse in the compressed vessel below the point of application.

It is worth remembering that the tourniquet cannot be applied to long time. In summer, the vessel can be fixed for 60 minutes, in winter – 30 minutes. To help emergency doctors, write a note with exact time clamp the artery, secure it with a tourniquet or pin it to clothing. If paper is not available, write a note on the victim's skin.

Applying a tourniquet to carotid artery has a number of features. In order not to crush the vessel on the opposite side, it is necessary to raise the victim’s hand on the side opposite to the location of the wound.

You can also use any strong stick, after placing a cotton-gauze roll between it and the skin.

Secure the artery with a tourniquet, also wrapping it around the splint (stick or hand). Bleeding in the neck is very difficult to stop, so try to secure the tourniquet well.

Tamponade and tourniquets can stop serious bleeding, but they are only temporary measures. Only qualified health workers can finally cope with the situation.

How to stop bleeding if it is impossible to apply a tourniquet? In such cases, tamponade is necessary.

To do this, you will need a bandage or cotton wool; if they are unavailable, ordinary paper napkins will do.

Fold cotton wool or napkins in several layers, press them to the wound, wrapping them tightly with a bandage. A tampon of this type is used for hemorrhages from the arteries of the upper and lower extremities.

To make stopping the bleeding more effective, elevate the affected limb.

Actions in case of large blood loss

The most bloodthirsty artery is the carotid artery. It is vital and its damage very often ends fatal. If you manage to stop the bleeding from such main vessel, it is worth taking measures to prevent hypovolemic shock (hypovolemia is a condition in which the volume of blood flow sharply decreases).

The victim should be provided with access to air. Remove his excess clothing. Lay him on his back, try to put his legs on an elevation so that the blood is concentrated as much as possible in the central part of the body.

If the victim is conscious, give him some water or sweet tea. In case of loss of consciousness and absence breathing movements, swipe indirect massage hearts.

In cases of acute blood loss, try to calm the victim so that he does not make unnecessary movements. Wait for the ambulance to arrive, which you need to call before providing first aid. Tell the dispatcher the address of the incident and immediately begin to stop the bleeding.

Video: Methods to stop arterial bleeding