Arterial bleeding

Because arterial bleeding often becomes a threat not only to health, but also to a person's life, very much depends on how timely and competently the help was provided to the injured or patient with heavy bleeding.

Arterial bleeding from small arteries, as well as arteries located on the body, can be stopped using the same pressing dressing( it is the only way to pre-stop bleeding on the trunk), while several layers of gauze or gauze napkins should be applied to the wound, then tighttwisted cotton wool or bandage, and then tightly pribintovyvat them several rounds of bandage or use other improvised means, carrying out stopping bleeding according to the principle described above. In the presence of an extensive wound surface with gaping vessels, hemostatic clamps should be applied to the vessels in the wound.

One of the best and available in any situation ways to temporarily stop arterial bleeding is the clamping of the vessel over - above the wound, closer to the heart by the blood flow. But for this it is necessary to know where the damaged artery lies as close to the surface as possible to press it against the bone. To find this place, you can focus on the presence of pulsation of the artery. When it is found, it should be pressed to the bone with more than one finger, and several, you can do it with your palm or your fist. With the correct location of the pulsation of the artery and good pressure, the bleeding stops almost immediately. But since it is difficult to press the artery to the bone for 15 minutes, and when it is transported, it causes certain difficulties, then this method of stopping bleeding is used to prepare the material for treating the wound and stopping bleeding in other ways that do not require prolonged application of the forcefrom the person who provides assistance.

The following arteries are the typical arterial clamping points for the purpose of temporary hemorrhage stopping: carotid, subclavian, humeral, axillary, radial, abdominal aorta, total femoral, superficial femoral, rear of the foot.

Let's consider several ways of pressing the arteries throughout.

For the fastest finding of a suitable bleeding point for pressing, one should know that the most important points for pressing are:

• for the hip artery - inguinal fold;

• for the leg artery - popliteal region;

• for the arm artery - the axillary region and the inner surface of the biceps muscle;

• for the carotid artery - on the neck near the inner edge of the sternoclavicular muscle, near its middle;

• for subclavian artery - supraclavicular area.

1. Severe bleeding when injuring the upper and middle part of the neck, as well as the submaxillary region and face should be stopped, pressing the common carotid artery. To do this, on the side of the wound, one large or grouped the fingers of the same hand in the same line II, III and IV, placed along the carotid artery and pressed them towards the spine, the carotid artery will be pressed against the transverse process of the sixth cervical vertebra.

The temporal artery, located in front of the auricle, should be pressed with the thumb to the temporal bone.

The mandibular artery should be pressed with the thumb to the angle of the lower jaw.

2. Severe bleeding from injuries to the shoulder, subclavian and axillary area, as well as the upper third of the shoulder should be stopped by pressing the subclavian artery. To do this, on the side of the wound, one large or grouping the second, third and fourth fingers of the same hand into one line, place it in the supraclavicular fossa and press on the artery. To increase pressure, you can press on the fingers from above with the fingers of the other hand. The pressure should be made above the clavicle directing the force from the top down, the subclavian artery will be pressed against the first rib.

3. Severe bleeding from injuries of the middle and lower third of the shoulder, forearm, or hand should be stopped by pressing the humerus artery. Stop bleeding by pressing the IV-IV fingers to the inner surface of the shoulder at the inner edge of the biceps muscle, while the brachial artery will be pressed against the humerus.

You can stop bleeding from the damaged artery of the hand by pressing the radial artery to the radius in the wrist area of ​​the thumb.

4. Severe bleeding from injuries of the lower limbs should be stopped by pressing the femoral artery. To do this, with your thumb or fist, you should press the artery in the inguinal area at a point located on an equal length between the pubis and the ileal prominence. If the caretaker presses the artery with one thumb, then the pressure can be increased by helping the thumb of the other hand.

Clenching of the artery by the fist should be done so that the line of folds in the interphalangeal joints is located across the inguinal fold, again, to strengthen the pressure it is possible to help squeeze the other arm.

Severe arterial bleeding from the artery of the lower leg or the foot should be stopped by pressing the popliteal artery in the popliteal fossa. In order to stop bleeding from the ankle artery, the thumb of the hand should be placed on the front surface of the knee joint, and the other fingers of the hand should press the artery to the bone. To stop bleeding from the artery of the foot, it should be pressed against the bones of the rear of the foot, and then apply a pressure bandage on the foot or burn to the shin area with heavy bleeding.

As mentioned above, the compression of the artery throughout the application is short-lived, therefore, for a temporary stop of severe arterial bleeding, a method of circular tugging with a rubber strand above the bleeding point can be used. It is one of the main and most effective ways to stop massive bleeding that occurs when large arterial vessels of the extremities are damaged, since all the vessels above the wound site are pinched.

The harness is a thick rubber or cloth tape or a 1-1.5 m long tube. A hook is attached to one end of the harness, and to the other - a metal chain.

The harness can be attached as follows. First of all, a towel or gauze should be applied to the place of application of the tourniquet, it is possible to wrap the place several times with a bandage in order not to injure the skin with a tourniquet and not to cause the victim thereby additional suffering. After this, the limb should be raised and the tourniquet fed to it. Then it should be stretched and in this form attached to the limb and, without weakening the tension to wrap around it several times, the following rounds should be weaker, while trying to ensure that the bundles of the bundle lie close to each other, without infringing the skin. Finish the application of the bundle by fixing the ends of the bundle, fastening them with a hook and chain.

In the absence of a rubber harness, it can be replaced with a rubber tube, belt or tie, bandage, eventually with a handkerchief, pulling a limb with them, as well as a tourniquet. To do this, you first need to put a cloth on the intended site for the tow, and then use a shawl or other material used as a tourniquet to tie loosely on the limbs, making a strong loop so that it is more than 1.5-2 times the circumference of the wounded limb. The loop is to be put on the limb with the knot up, making 2-3 turns with an improvised tourniquet around the limb, then insert a strong stick or plank under the knot and twist the tourniquet until the bleeding stops completely. It should be remembered that tight tug-of-war and rough cutting constrictions can cause undesirable complications in the form of damage to the nerves of the limbs;In addition, the use as twists or tows of thin or hard objects such as rope or wire can lead to damage to tissues and nerves. To end the spinning overlap, you should stick the stick to the limb, so that the twist does not spin.

A tourniquet or twist should be applied above the wound, but as close as possible to it. Evidence of the appropriate overlapping of the tourniquet or twist is considered unheard-of pulsation of the vessels below the tourniquet, stopping the bleeding, the skin at the same pale.

If the bleeding does not stop, then the tourniquet or twist was incorrectly applied, weakly, while the damaged artery was not completely squeezed;In addition, the veins tightened by the tourniquet contribute to the accumulation of blood in the limb, with the pressure in the vessels increasing, resulting in bleeding can only increase, and the skin, due to the overflow of veins with blood, becomes bluish. A tightly tight tourniquet compresses the underlying tissues, including the nerves, very much, this can lead to crushing of tissues, including muscles, nerves and vessels, and this can lead to limb paralysis.

This method of stopping bleeding is one of the most reliable, but the technique of imposing a tourniquet on the limb does not end there. Since the superposition of the blood supply not only of the wound region, but of the whole limb below the level of the tourniquet, results in the necrosis of the limb, with the passage of time. Therefore, the tourniquet should be applied to the limb for no more than 2 hours in the warm season and 1-1.5 hours for the cold season. To properly control the time of application of the bundle under it, it is customary to put a note indicating the time of its imposition. If, at the end of this time, the victim or the patient is not taken to the medical center for any reason, the tourniquet should be removed and it should be done better together: one rescuer should hold the finger pressure along the damaged artery above the harness, and the other in the meantime, without hurrying,so that the liberated blood stream does not push out the formed thrombus, dissolve the tourniquet for 3-5 minutes, then again puts it on the limb, but slightly higher than the previous application, not forgetting the time of removal and the next application of the tourniquet. The victim with the bundle attached to the limb should be constantly under the care of the rescuer, who must monitor the skin condition, the correctness of the application of the tourniquet or the newly discovered bleeding, in order to provide the necessary assistance.

Carry out this method of stopping bleeding only with severe arterial bleeding;Any kind of material should always be placed under the plait or twist;tightly tighten the tourniquet or twist it is impossible.

The usual places of application of the harness are the forearm, shoulder, hip, shin.

There is another method of temporary bleeding stopping - forced flexion, which does not require special training of the rescuer, special knowledge and auxiliary tools. But this method of stopping bleeding is advisable to carry out only if the upper limbs are injured and to a lesser extent for the lower limbs, provided that there is no fracture of the bones of the bleeding limb. The forced flexion of the limb allows to stop the bleeding due to the inflexion of the artery.

When injuring the forearm and hand, stop arterial bleeding by bending the elbow joint to the point of failure and fixing the bent forearm, pulling it to the shoulder with a bandage, fabric tape or other improvised material.

When injuring the upper part of the shoulder and the subclavian area, accompanied by arterial hemorrhage, it is necessary to make a forced institution of the upper limb behind the back, while bending the arm in the elbow joint. The extremity must be fixed with a bandage or an improvised material.

In case of damage to the brachial and subclavian arteries, another way of forced flexion can be done, and the arteries on both sides will be squeezed. For this it is necessary to have both hands of the victim back, while they will be bent in the elbow joints;then they need to be pulled to each other and fixed in this position.

If the arteries of the lower limb are damaged, the leg in the knee and hip joints should be bent as much as possible and fixed in this position with a bandage or an improvised material.

Whenever a bleeding stop is performed in any way, its effectiveness will be increased if the damaged area is raised and the rest of the affected body is completely at rest.

Temporary stop of bleeding with internal bleeding can not be made, so the only effective help for the injured or sick will be urgent transportation to a medical institution.

Immediate hospitalization, without waiting for signs of internal bleeding, is subject to victims with severe bruises of the stomach. With a spleen injury, her tissue begins to bleed violently only a few hours after injury.

With a head injury, the victim needs specialized medical care.

Hemorrhages in hemophilia are stopped by the same methods used for traumatic bleeding: a pressure bandage is applied, tamponade, intravenous calcium chloride, vikasol( vitamin K) as a hemostatic. With significant blood loss - a blood transfusion.

In case of pulmonary hemorrhage, the patient should be ensured complete rest by placing him in bed with an elevated head end. Conversations and smoking are strictly forbidden, food and especially drinking are limited and served cold. In severe cases of stopping bleeding, you can put a bubble with ice on the chest, and at the feet - warmers. The patient should be given a half cup of salt solution, prepared from the calculation of 1-2 tsp for half a cup of water( this irritates the mucous membrane of the stomach and intestines, as a result of which the vessels of the gastrointestinal tract expand, fill with blood, thereby reducing blood supply to smallcircle of blood circulation), in hospital conditions, the introduction of calcium chloride, glucose;with a strong cough appoint codeine, dionine, less often - morphine;With bleeding due to stagnant phenomena in the lungs, cardiac remedies are shown.

Minor nasal bleeding in most cases stops with a tamponade in front of a piece of cotton or gauze, which was previously moistened with hydrogen peroxide. To do this, the tampon through the nose wing should be pressed to the nasal septum and stored for 15-20 minutes. In this case, the patient should be given a horizontal position or sitting with the head thrown back, to release from the restraining clothes. When nasal bleeding ceases, cold compresses, ice packs applied to the nose and the back of the neck can be used. When repeated bleeding is prescribed anesthesia, and then cauterization of the bleeding site with chromic or trichloroacetic acid. In severe nasal bleeding, anterior and posterior tamponade and drugs that increase blood coagulability, autohemotherapy, blood transfusion are prescribed.

Hygroma( hemorrhage in the mucous bag) is treated with warming compresses.

If hemorrhage in the joint - hemarthrosis - should apply a pressure bandage on the joint area, an ice pack, tire bandages. To accelerate the process of resorption from the 3-4th day, you should use warmers. Cautious movements are allowed from the 10th to the 12th day. In the absence of the effect, the patient is referred to a hospital where puncture, blood suction, accelerating recovery is used.

Prevention is the protection against repeated injuries. In case of acute course of the disease, you should immediately consult a doctor.

Bleeding due to rupture of an aneurysm( artery enlargement) alone or with someone's help can not be stopped, urgent hospitalization of the patient is needed for surgical treatment. Prior to the arrival of the "First Aid" it is possible to apply finger compression of the artery trunk. In order to prevent the rupture of the artery, finger compression is recommended to be performed daily for 1-2 hours. It is performed by pressing above the aneurysm in those places where the vessel is more superficially located, and in the depth can be pressed against the bone.

Parenchymal hemorrhages can be stopped by giving ergot preparations, hydrastis, drugs that increase blood coagulability. The patient should be immediately delivered to the hospital, where during surgery the parenchymal hemorrhage will be stopped definitively.

In case of gastrointestinal bleeding, the patient should be rushed to the medical center immediately, transportation is carried out only in a prone position. At the same time, measures should be taken to prevent the passage of vomit into the respiratory tract. The patient is given absolute rest, a bubble with ice is superimposed on the epigastric region;prescribes calcium chloride or sodium chloride intravenously;with significant bleeding, blood transfusion is indicated;the first two days the patient is not allowed to eat and drink, while doing enemas with glucose, or it is administered intravenously, a strong thirst is satisfied by rinsing the mouth. On the second or third day, if bleeding stops, food intake in cold form and in small portions is allowed, especially cold cream, butter, egg whites are shown.

In case of hematuria( discharge of blood with urine) before the arrival of the "First Aid" it is possible to put ice on the area of ​​the kidneys and bladder, to provide the patient with complete peace.

In case of uterine bleeding, urgent medical attention is required from a specialist. To before the doctor's arrival to ease the patient's condition, she should be laid on the bed without a pillow, put a bubble with ice or cold water on the bottom of the stomach.

As some women prefer to give birth at home and others have to give birth on the way, you should know that bleeding in this case can be stopped by pressing the aorta through the abdominal covering with a fist or a tight roller. In the absence of effect, a manual examination of the uterine cavity( under strict aseptic conditions) is performed followed by a massage through the abdominal covering;The second hand, compressed into a fist, must be in the uterus. This is how a "massage on the fist" is performed - one of the most effective ways to stop such bleeding, but he does not guarantee that there will be no bleeding again, so the patient should be immediately taken to a hospital facility.

Permanent, or definitive, bleeding is stopped in a medical hospital by a surgeon using special measures, instruments and medications.