Anyone may be in an abnormal situation at which large artery is damaged. If you do not provide a timely artery, the fatal outcome is not excluded. The loss of more than 50% of blood is considered incompatible with life. In most cases, materials are not provided for hand. In such a situation, the life can be saved with the finger pressed arteries during bleeding. This is the only solution to wait for the arrival of ambulance.

The urgent transmission of the vessel of the artery, from which blood hits, also appeal in accidents, and during surgical operations, if large artery is damaged.

The surgeon transfers the place of the gap, and the assistant imposes the clamp above the damage.

Pour the vessel of the artery, placing it between the fingers can not, because it is impossible to see it in the wound, which bleed blood. The area of \u200b\u200bthe lesion can close the dirty shreds of clothing and bone fragments. In this regard, it is followed by a large artery for the above injury.

Among the nonspecialists, the likelihood of meeting a person who knows an anatomy is fadingly. Therefore, a potential rescuer needs to know the location and point finger pressed In order to make a temporary stop of bleeding.

They are chosen in accordance with the direction of blood flow in large arteries and neighboring bone formations. For effective pressed artery fingers, it is necessary to surpassed the artery on both sides.

A table has been developed to the finger pressure of the arteries during bleeding, according to which it is possible to navigate which vessel in what place to shift to stop any bleeding.

The way it is impossible to apply if the bone is broken at the point where there is blood From the artery of the recommended squeezing.

Arterial hemorrhage requires immediate assistance. Developed an algorithm for finger pressed arteries during bleeding.

Instructions How to stop the finger pressed artery:

• Conduct an assessment of the condition of the victim. characterized by the expiration of pulsating blood;
• It is necessary to release the place of injury from under clothes;
• The recommended methods for squeezing the arteries with a thumb or cover with hand, after a while lead to cramps and pains, therefore, you need to be able to adapt to squeezing the artery by pressing the fist;
• When it is not clear, in what place happened, putting palms on the wound to identify the area of \u200b\u200bdamage;
• It is necessary to hold the press before it is supplied with a squeezing bandage.

The diagram of the finger pressed arteries during bleeding includes:

• Establishment;
• Stop bleeding;
• Pain relief and anti-shock actions;
• Preventing infection of the wound.

Human arterial bleeding is diagnosed with the humiliation of pulsating blood. Hemorrhage stops produce finger pressed artery. Pain relief consists in grinding painkillers and placing powder under the tongue. The victims are protected from overcooling overcooling, heated by hot tea or coffee waiting for the arrival. Infection prevents skin treatment around the wound with antiseptic and the imposition of a sterile dressing.

Points of finger pressed arteries at bleeding are depicted in the photo:

Points of finger pressed

Artery Shoulder

The nearest point of the finger pressed when bleeding is located between the shoulder muscles. When pulsating bleeding in the shoulder is detected, for, the hand is injured or laid out. The rescuer will be more convenient when the victim is located behind the victim. It is necessary to forgive the intertpete recess, which is located approximately, at a distance of one third of the length shoulder bone From the joint shoulder. Press the vessel by four fingers, or clasping the hand, giving it to the bone in the specified place.

The shoulder pulsating in the dorsal part is due to the impaired integrity of the axillary artery. The finger press of the axillary artery is made so, pressing is carried out from the inside of the shoulder to the epiphysis of the shoulder bone. Cook shoulder with both hands and are strongly pressed in the area of \u200b\u200bthe armp.

The place of the finger pressing of the femoral artery is in groin, approximately in the middle of the inguinal fold (see Figure). In this place the artery is pressed against the bone of the thigh. The rescuer falls on his knees, turning facing to the place of damage. Two thumb presses the point of pressed, the remaining fingers cover the surface of the hip.

Carotid artery

Bloodflowing is in demand if the pulsating occurs from the arteries of the head, the dorsal part of the neck and submandibular. The difficulty of manipulation lies in the absence of the opportunity to impose a gulling bandage on the neck without the risk of overlapping respiratory tract. Therefore, the carotid artery is pressed below the bleeding place with a thumb.

The alternative of the finger press of the carotid artery is implemented using four fingers, being behind the injured. The required point of the finger pressing of the carotid artery in humans is located in the central part of the dorsal surface of the cervical muscle. The artery is pressed against the spinish crest of the vertebra.

Artery connectible

The finger pressing of the subclavian artery is carried out with traumatic damage to the head, neck and shoulder joint. The thumb is strongly pressed on top into the executioner. The artery is pressed to the edge.

Jewish artery

When bleeding occurs in the lower half of the face, block the jaw artery, pressing it to the lower jaw with his finger.

When bleeding occurs in the upper half of the person, press the temporal artery, pressing it with her finger to the vest of pulsation in front of the ears.

Bleeding out of the limbs

The hand is lifted and squeezed in the forearm of the hands. The arteries of the foot are pressed from above. Pressing the arteries of the limbs requires considerable effort. Therefore, it is necessary, neglecting the rules of aseptic, using the emerging surroundings, accelerate the arrival of ambulance.

Rescuer is obliged to protect himself infection through contact with the blood of the victim. Therefore, it should work in gloves and undergo the required laboratory tests.

Blood is a rapid flow of the injured organism, and there is nothing at hand, which could help in the provision emergency, and hope for salvation melts with every second.

Never eyewitness incidents inclined above the victim, with anxiety in the eyes trying to estimate the degree of hanging threat. But dirty scraps of clothing, a mixture with bone fragments, blocked access to a mortal wound and do not make it possible to see something under them. Finally, a person trying to assist the victim, assessed the degree of a dangerous situation.

Open bleeding from the wound requires instant help, because the delay threatens human life. He strongly cleans the wound and squeezes the damaged artery with his fingers.

Blood continues to flow, and the vessel between the fingers eludes and it is impossible to effectively compress it. Saving struggling to the artery with big fingers of both hands. Over time, from incredible efforts, his fingers are eager. There is a need to change the way to relieve and apply coverage by hand, presses with a thumb torn artery. There is no help, but the hand, compressing the wound, begins to experience pain. For minutes after ten convulsions, the limb will reduce, forcing the way to change again. He will have a fist of the second hand to put on a finger, pressing the artery. As long as the exact source of bleeding is unknown, the decision is made to weaken the clamp and put on the wound to the wound both palms and wait for the possibility of putting a tight bandage on the wound. But even if after that, the bleeding does not stop, and the more enhanced, then again it is necessary to put on the wound.

Wounded unusually lucky if his lifeguard is familiar with anatomical structure The human body knows the points of influence on the injured vessel in an alternative place.

How to choose the point

For sure, knowing the main locations of the clamp, you can transmit a trunk arterial vessel, not in the wound, and slightly above it. This will significantly reduce the influx of blood and will be able to protect the injured organism for a while. Points choose not at random. It is necessary to take into account the direction of blood current by vessels, clamping the damaged artery on both sides. Only in this case is a positive effect. But if there is a bone of fracture at the injury, then the compression of the intended point is unacceptable!

It is necessary to designate the accurate places of pressed artery. I would like to note that the arteries are divided into such as:

If there is a shoulder artery, then the closest point of pressed is between the muscles located on the shoulder. In this case, it is necessary to lay the hand of the head victim to him and take a place behind the victim, accepting a convenient position. Press the artery is needed by four fingers outside, fastening the deepening between the shoulder muscles and pressed strongly, pressing this place to the bone. There are cases when bleeding with the upper part of the shoulder is resigned by pressing with your fingers, pressing the vessel to the head of the shoulder bone in the armpit area.

In case of damage to the femoral artery, the point in the groin zone in the middle of the skin folds is pushed. In this place, the artery is pressed against the femoral bone. Standing on his knees from the injured leg, pressing with all their weight on the arms elongated for the stop, while with all the fingers wrapped the thigh of the victim and only then indexed pressure on the point in the groin.

Stop bleeding of vessels from the head or when damaged the vessel of the top of the neck is possible:

1. Impacting a carotid artery, while eliminating the use of a tight, gulling dressing, because there will be nothing to breathe the victim.
2. Palm is put on the head of the victim, and the press makes a thumb or are located behind and clamp the wound with four fingers.
3. Given the direction of blood flow through the carotid artery, they pin down the point below the injury.
4. The location of this point is the middle of the front surface of the cervical muscle.
5. The head of the wounded turn so that it was clearly visible. The artery is pressed against the masculous process of vertebrae.

If the head is injured, the shoulder joint or neck, then instead of a carotid artery, the connective artery is pressed by the index finger and press on the vestment on the wedge.

Jewish and temporal artery are located in the area of \u200b\u200bactive invention of facial. The stopping of heavy bleeding of the jaw artery is achieved by her pressed to the lower jaw.

Stopping bleeding from the temporal artery occurs after pressing the point in front of the ear shell.

In case of injuries, the blood bleeding of vessels does not cause mortal danger. Nevertheless, to reduce blood loss, at the moment when a tight bandage is preparing, a finger pressing is applied. Raising the finiteness with a circular grip, squeeze the point located in the middle third of the forearm.

Bleeding of vessels stops stopping her back side.

The finger pressed artery during bleeding is temporary and is made in the case of emergency assistance to the victim to the arrival of qualified specialists.

How to diagnose inner bleeding

If, with outdoor bleeding, it is not so difficult to determine the diagnosis, then with internal - it is not possible. It will require certain knowledge, because the blood does not fall at once, but after some time.

So, pulmonary bleeding is accompanied by a hemoplange, the progress of the foaming blood from the nose / mouth. Esophageal or gastric bleeding is accompanied by vomiting with blood (sometimes "coffee grounding"). If bleeding occurs in the stomach, duodenalistician, biliary tract, it entails a manifestation of a tar-shaped chair.

If bleeding was formed in a straight / colon, it is accompanied by the appearance of the blood of raspberry, cherry, scarlet color in feces. Renal bleeding colors urine victim in scarlet color.

It is worth noting that when visible internal bleeding Blood isolated can not be displayed immediately, but some time. Accordingly, application general symptomatics And certain methods of diagnosis with internal bleeding are extremely necessary.

Definitely complex is the diagnosis of hidden internal bleeding. In this situation, local symptoms are divided into two main groups:

1. Identifying spectacular blood.
2. Some changes in the functions of those or other bodies that were damaged.

To reveal the spilled blood, you should pay attention to some signs:

1. Bleeding in pleural cavity:
   • percussion sound dulled over a specific surface chest;
   • breathing weakens;
   • mediastum shifts;
   • there is a breathing failure.
2. Bleeding in the abdominal cavity:
   • stomach swells;
   • peristalistics weakens;
   • the percussion sound is dulled in the detached places of the abdomen;
   • sometimes symptoms of peritonean irritation are observed.
3. Bleeding in a cavity of a joint:
   • the joint increases in volume;
   • the appearance of sharp pain;
   • violation of the direct function of the joint.
4. Hemorrhage / Hematomas:
   • you can determine swelling;
   • pain symptom in acute form.

Finally, it is worth noting that the blood loss is not so terrible and is dangerous with bleeding, as a significant change in the functions of certain organs. As an example, bleeding into the pericardial cavity, which entails the pericardium tamponade (while there is a sharp decline heart Emission, Stopping a heart), although the volume of blood loss at the same time is completely small.

The necessary materials may not always be at hand to stop bleeding. If a large arterial vessel is damaged, the union of the help threatens the victim of large blood loss, even a deadly outcome.

Therefore, the finger pressed arteries can be temporary, but single way out In a situation, until he emerges medical care.

The immediate compression of a bleeding vessel is resorted not only at the scene, but also during operational intervention during damage to the arterial barrel. One surgeon presses the estimated breakdown, the other makes the artery dressing above or imposes a clamp.

Main Arteries Pressing Places

What you need to know for pressed

Surprise the vessel between the fingers is impossible, because:

• it is not visible at all in a bleeding wound;
• simultaneously surround the place of lesion can contaminated scraps of clothing, bone fragments.

Therefore, with arterial bleeding, the main leading (mainstural) vessel is not in the wound, and above it is "over". This allows you to reduce blood inflow to the place of injury. Not everyone knows the anatomy well. The assistance must be familiar only with the location of the main points of pressed.

They are not chosen arbitrarily, but in accordance with the direction of blood vessels and the nearest anatomical bone formations. So that the attachment was effective, the artery should be clamped from both sides.

The method is absolutely not applicable at the bone fracture at the point of the alleged compression.

Since bleeding requires emergency careThe rules should be followed:

1. the delay is dangerous for the life of the victim, therefore the assessment of the state is performed instantly (the type of pulsating wound);
2. if necessary, you can break or cut part of the affected clothing, it will still have to do for inspection of the wound;
3. methods of compression are recommended either with both thumbs or hand coverage to thumb Posted at the desired point, but after 10 minutes the rescuer is possible convulsions and pain in their hands, so in practice it is necessary to adapt and press the fist;
4. if it is unclear the origin of bleeding, it is allowed to put pressure on the wound to the wound itself, until the location of damage is clarified (so they are injured in the stomach);
5. keep pressing is necessary until the imposition of the gulling bandage, if after this bleeding is enhanced, the pressure will have to be repeated.

Consider specific points of pressed.

Shoulder artery

The nearest point lies between the shoulder muscles.

1. The hand of the victim should be raised or lay behind the head.
2. It is more convenient to be behind the patient.
3. The compression of the vessel is carried out by four fingers outside or when ticking from the inside.
4. The deepening between the muscles below the shoulder joint is on 1/3 shoulder and is very attached to the bone.

Pressing the shoulder artery from the position of the front (A) and the back (b)

Migratic artery

Bleeding in the top of the shoulder area can be associated with damage to the axillary artery. Pressing is carried out from the inside to the head of the shoulder bone using the circular coverage of the shoulder with two hands and pressure in the axillary region.

Femoral artery

Press point is located in the groin zone, approximately in the midst of the fold. Here, the artery is pressed against the femoral bone.

1. The help supplied should be kneeling from the damaged leg.
2. The first fingers of the hands should be pressed to the point in the groin, while the other fingers covered the thigh.
3. It is necessary to put it all weighing, overlooking the straight hands.

Carotid artery

Pressing the carotid artery is required when bleeding from the vessels of the head, the submandibular region, the top of the neck. The situation is complicated by the impossibility of imposing a circular grapple dressing on the neck, because the victim suffocates.

Therefore, pressing is conducted on the side of the wound by the thumb, when the rest are located on the head of the victim, or four fingers when approaching the back. It is important to take into account the direction of blood in the carotid artery: it is shifted below the location of damage.

In such ways, the carotid artery is pressed

The desired point is in the middle of the front surface of the cervical muscle. Turn the head of the wounded in the opposite direction and it will be clearly visible. The artery is attached to the masculous process of vertebrae.

Subclavian artery

With the wounds of the head, the shoulder joint and neck, besides the carotid, you can press the subclavian artery. To do this, the first finger from above is hard to press in the pumpe of the collar.

Behind the clavicle is the first edge, the vessel is pressed against it.

Jewish and temporal artery

Injury and damage to individuals are accompanied by strong bleeding due to the massive blood supply to this zone.

At the bottom of the person requires a stopping of bleeding maxillary artery. It is pressed with a finger to the lower jaw.

The temporal artery is pressed ahead of the ear shell.

Bleeding of a brush or foot

Usually bleeding from the vessels of the brush and foot are not life-threatening. But to reduce blood loss and during the preparation of the gulling dressing, you can apply a finger press. The limb should be lifted. The hand is squeezed by a circular capture in the area of \u200b\u200bthe middle third of the forearm. On the foot it is necessary to press the vessels from the back.

Pressing the artery requires strength on behalf of the first help, so you need to try to attract the attention of others and cause an ambulance. It does not need to think about compliance with the rules of asepsum and antiseptics, washing the hands, skin disinfection. Time loss is driving the condition of the victim.

Rescuer, providing help without gloves, exposes itself to the risk of infection from affected infections transmitted through blood (viral hepatitis, AIDS). You need to be considered and go through the necessary laboratory tests in the clinic.

Temporary cessation of bleeding (finger press) when the common carotid artery is injected

With strong arterial bleeding from the upper half of the neck, the shocking artery is pressed. For this, a person presses the side of his hand on the front surface of her hand on the side of his hand from his larynx, clasping the late fingers the side and rear surface of his neck.

If a person is behind the wounded, the depression of the carotid artery is made by pressing on the front surface of the neck on the side of the larynx by four fingers, while the thumb wraps the back surface of the neck neck.

Sleepy artery-transverse process VI cervical vertebrae,

Carotid artery pressed on the inner surface of the mouse muscle in the middle third to the transverse process of the cervical vertebra.

Temporary bleeding stop (finger pressed) when the plug-in artery is injected

The plug-in artery is attached to the I edge behind the clavical leg of the breast-clarity-nose muscle.

The right-hand plug-in artery is pressed with her left hand, left-right. To do this, while on the side of the affected, put your hand so that the thumb is in the pressure hole along the top edge of the clavicle, and the remaining fingers are behind, on the back of the affected. To press the artery, it is enough to turn the thumb finger, at the same time slightly pressed down, so that it turns out to be behind the clavicle of the affected.

The subclavian artery is pressed with fingers to the I edge in the middle department of the percussion.

1. put the victim
2. unbutton trouser strap and squeezing clothes
3. clear the oral cavity
4. eliminate the spares of language: to break your head as much as possible, spread the lower jaw
5. if one person conducts resuscitation, then make 4 respiratory movements for lung ventilation, then alternate artificial respiration and a heart massage in the ratio of 2 breaths of 15 chest compresses; If the resuscitation is carried out together, then alternate artificial respiration and heart massage in the ratio of 1 breathing 4-5 of the compressions of the chest

Resuscitation activities are not held in the following cases:

• card-brain injury with brain damage (injury incompatible with life)
• fracture of the sternum (in this case, when conducting a heart massage, heart will be injured with sternum sternum); Therefore, before resuscitation, it should be carefully forgiven the sternum

8. Temporary stop of outdoor bleeding

Clinic. External bleeding of difficulties for diagnosis and determination of treatment tactics are not available. Difficulties arise, as a rule, when habering variants of chronic or sharp internal bleeding. It should be remembered that with blood loss up to 10-15% of the BCC clinical symptoms are quite scanty and manifests itself moderate tachycardia and shortness of breath; The occurrence of a fainting state is possible. With blood loss, more than 15% of the BCC occurs centralization of blood circulation and the typical picture of the hypovolemic (hemorrhagic) shock is developing.

General principles of therapy of outer sharp blood loss

General principles of therapy acute blood loss fold from the following components:

Immediate temporary stopping of outdoor bleeding, elimination of the BCC deficiency,

Control of the effectiveness of therapy.

Any injury is accompanied by bleeding due to damage to the walls of blood vessels. Blood bleeding arterial, venous, mixed (arteriovenous) and capillary

Types of bleeding: A - arterial; b - venous; in - capillary

In arterial bleeding, blood flows out of the wound a strong pulsating jet of bright red. In case of damage to the artery, death from bleeding may occur within 3-5 minutes from the moment of injury. Therefore, with arterial bleeding, first aid must be rendered immediately. To stop the bleeding, the artery is pressed with fingers to the dice above the place of injury. To do this, you need to know exactly the place of pressed arteries. The artery is pressed with the fingers for a short time, only before overlaying the twist or harness. Finger pressed with a thumb, ends of four fingers, and sometimes fist

Fingerproof arteries

General rules - need one or more fingers (and large vessels, such as aorta and femoral - fist) press the artery to the toed bone with an effort slightly exceeding arterial pressure blood. If the pressed is performed briefly, the position of the fingers is not important, but if it is necessary to hold the artery for a long time, then you should "fix" your hand on the victim. The artery is pressed above the place of damage to arterial bleeding, below the place of damage during venous bleeding, or in the wound.

When bleeding from wounds of dark and the temporal area, pressing the temporal artery to temporal bone In the area of \u200b\u200bthe temple in front and above the ear goat (point 1). The artery is pressed or located in one plane 2, 3 and 4 with fingers, or a palm surface of the finger, and the remaining fingers wrap the head in front of the forehead, thus fixing the hand for a long retention. On the affected pressed, the pressed is performed either in a similar way, or 1 finger, but withering the head of the back.

When bleeding from wounds of persons (nose, lips, chin) perform the pressing of the outer vertex artery to the lower edge of the lower jaw on the boundary of its rear and middle third to the corner of the lower jaw (point 2) 2, 3 and 4 fingers, and 3 finger is located directly on The edge of the jaw, and 2 and 4 are higher and below 3, as if covering the jaw.

When bleeding from wounds of heads, pressing the total carotid artery to the sleepy tubercarc of the transverse step 6 - 7 of the cervical vertebrae at the inner edge of the breast-curable-bed-like muscle (point 3) is pressed by an artery or located in one plane 2, 3 and 4 fingers in front. Or the palm surface of the finger 1, and the remaining fingers wrap the neck from behind, fixing the hand to the long-term retention. On the affected, the pressed is performed located in the same plane 2, 3 and 4 fingers, and the neck and 1 finger are wrapped in the back.

When bleeding from wounds of shoulder joint and the upper limb, fingers should press a subclavian artery to 1 edge in the test area (point 4) of the duck from the place of attachment of the breast-curable-bed-like muscle behind the average third of the clavicle 2, 3 and 4 fingers.

When bleeding from wounds of the upper limb on themselves, the axillary artery is pressed to the head of the shoulder bone in the axillary yam (point 5) of the palm surface of the first finger, pressing as if from the bottom-up from the inside the duck, and the remaining fingers and palm wrap the shoulder joint in front and, if possible, from above. On the affected, pressing is performed either by the first fingers of both hands in the same way as on themselves, but wrap the joint in front and rear. If the victim has well-developed muscles, and the help providing - on the contrary, the artery is pressed by two hands - the fist of one of them presses on the artery and the head of the shoulder bone in the axillary yam, as if from the inside of the duck, and the other hand performs the oppression to meet the first, camping Outside and top of the shoulder joint.

When bleeding from wounds of the lower third of the shoulder, the forearls and brushes press the shoulder artery to the shoulder bone in the upper third of the inner shoulder surface (point 6) at the edge of the two-headed muscles on itself the palm surface of the finger 1, and the brush wars the shoulder on the front and outside by fixing the hand in this way For long retention. On the affected, pressing is done on the contrary, 2 - 4 fingers, located from the inside, and the palm and 1 finger clamp the shoulder behind the back

When bleeding from wounds brushes press:

radiation artery to radial bone at the point of determination of the pulse;

the elbow artery to the elbow bone in the lower third of the inner surface of the forearm (point 7).

When bleeding from Ran Crotch, the area of \u200b\u200bthe hip joint, the abdominal aorta organs can be carried out. For this injured laid on a rigid base (floor, couch, ground). One hand is compressed in the fist and have along the body between the swords and the sternum and the navel. Another hand brush wars the first with a palm surface for the area of \u200b\u200bthe ray-taking joint. With the maximum effort, the pressure is carried out with both hands on the front abdominal wall to sell all the fabrics and press the abdominal aort to the spine.

When bleeding from wounds of the lower limb, the femoral artery is pressed below the middle of the tippack ligament to the horizontal branch of the LONA bone (point 8) with a fist or 2 - 4 fingers. If the bleeding wound is located at the level of the middle third of the thigh or below, you can overpace the femoral artery at the boundary of the upper and middle third of the thigh on the front surface to the femoral bone. For this, as far as possible, the thigh is wrapped up with both hands, and the pressure is carried out superimposed one on the other thumbs.

When bleeding from Rounds of the shin and the foot, the poplite artery (point 9) is pressed to the articular end of the femoral bone in the center of the poplilated pits large or 3 and 4 fingers, carrying out pressure in the back, and crumbbed the knee joint.

When bleeding from wounds of the foot on the back surface, the assembly of the stop rear is pressed in the middle of the distance between the outer and the inner ankles below the ankle joint (point 10) first or 2 and 3 fingers. When bleeding from the plantar and inner surfaces, the rear bertovy artery to the rear surface of the inner ankle is pressed.

In the presence of bleeding from the Russian Academy of Sciences, it is necessary to press the sleepy, temporal or mightylace artery on the side of bleeding. The carotid artery is pressed with a thumb to the spine, on the side of the larynx, and the remaining fingers are put back on the neck. When bleeding from the top of the shoulder, a subclavian or axillary artery is pressed. The right-hand plug-in artery is pressed with her left hand, left-right. Lying on the side of the wounded, face to him, put your hand so that the thumb lay down in an inscluster jam along the top edge of the clavicle, and the remaining fingers are behind, on the back of the wounded. To press the artery, it is enough to turn the thumb finger, at the same time slightly pressed down so that it turns out to be behind the wounded clavicle. The subclavian artery is pressed to the head of the shoulder bone with the right fist entered into the corresponding subclavian depression. Pressure is rendered upwards. At the same time, the shoulder joint of the wounded shoulder hold the shoulder joint. When bleeding from the lower arm of the shoulder and from the forearm, you need to press the shoulder artery, it is pressed by one or four fingers to the shoulder bone from the inner edge of the double-headed muscle. Bleeding from the hips stop, pressing the femoral artery: with both hands cover the upper part of the thigh in the inguinal bend so that the thumbs put on one on the other come together in the middle of the hips and pressed the artery to the bone.

To continue download, you must collect a picture:

Holding the finger pressed arteries during bleeding

Anyone may be in an abnormal situation at which large artery is damaged. If you do not provide timely first aid when bleeding the artery, the fatal outcome is not excluded. The loss of more than 50% of blood is considered incompatible with life. In most cases, materials for stopping blood at hand does not turn out. In such a situation, the life can be saved with the finger pressed arteries during bleeding. This is the only solution to wait for the arrival of ambulance.

The urgent transmission of the vessel of the artery, from which blood hits, also appeal in accidents, and during surgical operations, if large artery is damaged.

The surgeon transfers the place of the gap, and the assistant imposes the clamp above the damage.

How to hold pressed

Pour the vessel of the artery, placing it between the fingers can not, because it is impossible to see it in the wound, which bleed blood. The area of \u200b\u200bthe lesion can close the dirty shreds of clothing and bone fragments. In this regard, it is followed by a large artery to stop bleeding above the place of injury.

Among the nonspecialists, the likelihood of meeting a person who knows an anatomy is fadingly. Therefore, a potential lifeguard needs to know the location and points of the finger pressed when arterial bleeding to make a temporary stopping of bleeding.

They are chosen in accordance with the direction of blood flow in large arteries and neighboring bone formations. For effective pressed artery fingers, it is necessary to surpassed the artery on both sides.

A table has been developed to the finger pressure of the arteries during bleeding, according to which it is possible to navigate which vessel in what place to shift to stop any bleeding.

Table of place of finger pressed arteries during bleeding

The way it is impossible to apply if the bone is broken at the point where blood comes from the artery of the recommended squeezing.

Rules for presses

Arterial hemorrhage requires immediate assistance. Developed an algorithm for finger pressed arteries during bleeding.

Instructions How to stop the finger pressed artery:

• Conduct an assessment of the condition of the victim. Bleeding from the wound is characterized by the expiration of pulsating blood;
• It is necessary to release the place of injury from under clothes;
• The recommended methods for squeezing the arteries with a thumb or cover with hand, after a while lead to cramps and pains, therefore, you need to be able to adapt to squeezing the artery by pressing the fist;
• When it is not clear where the aorta rupture occurred, put on the wound with his palms to identify the area of \u200b\u200bdamage;
• It is necessary to hold the press before it is supplied with a squeezing bandage.

The diagram of the finger pressed arteries during bleeding includes:

• Establishing a type of bleeding;
• Stop bleeding;
• Pain relief and anti-shock actions;
• Preventing infection of the wound.

Human arterial bleeding is diagnosed with the humiliation of pulsating blood. Hemorrhage stops produce finger pressed artery. Pain relief consists in grinding painkillers and placing powder under the tongue. The victims are protected from overcooling with wrapping, warm tea or coffee waiting for the arrival of emergency care. Infection prevents skin treatment around the wound with antiseptic and the imposition of a sterile dressing.

Points of finger pressed arteries at bleeding are depicted in the photo:

Stop bleeding from arteries, points of pressed

Points of finger pressed

Artery Shoulder

The nearest point of the finger pressed when bleeding is located between the shoulder muscles. When pulsating bleeding in the shoulder is detected, to provide a prefigure help, the hand is injured or laid down. The rescuer will be more convenient when the victim is located behind the victim. It is necessary to forgive the intertensive recess, which is located approximately, at a distance of one third of the length of the shoulder bone from the shoulder joint. Press the vessel by four fingers, or clasping the hand, giving it to the bone in the specified place.

Migratic artery

The pulsating heavy bleeding in the dorsal part of the shoulder is due to the impaired integrity of the axillary artery. The finger press of the axillary artery is made so, pressing is carried out from the inside of the shoulder to the epiphysis of the shoulder bone. Cook shoulder with both hands and are strongly pressed in the area of \u200b\u200bthe armp.

Migrating Artery Point

Femoral artery

The place of the finger pressing of the femoral artery is in groin, approximately in the middle of the inguinal fold (see Figure). In this place the artery is pressed against the bone of the thigh. The rescuer falls on his knees, turning facing to the place of damage. Two thumb presses the point of pressed, the remaining fingers cover the surface of the hip.

Point of pressed thigh artery

Carotid artery

Bloodflowing is in demand if the pulsating strong bleeding occurs from the arteries of the head, the dorsal part of the neck and submandibular. The difficulty of manipulation lies in the absence of the possibility of imposing a gulling bandage on the neck without the risk of overlapping the respiratory tract. Therefore, the carotid artery is pressed below the bleeding place with a thumb.

The alternative of the finger press of the carotid artery is implemented using four fingers, being behind the injured. The required point of the finger pressing of the carotid artery in humans is located in the central part of the dorsal surface of the cervical muscle. The artery is pressed against the spinish crest of the vertebra.

Artery connectible

The finger pressing of the subclavian artery is carried out with traumatic damage to the head, neck and shoulder joint. The thumb is strongly pressed on top into the executioner. The artery is pressed to the edge.

Jewish artery

When bleeding occurs in the lower half of the face, block the jaw artery, pressing it to the lower jaw with his finger.

Temporable artery

When bleeding occurs in the upper half of the person, press the temporal artery, pressing it with her finger to the vest of pulsation in front of the ears.

Temporal artery pressed in front of ear sink

Bleeding out of the limbs

The hand is lifted and squeezed in the forearm of the hands. The arteries of the foot are pressed from above. Pressing the arteries of the limbs requires considerable effort. Therefore, it is necessary, neglecting the rules of aseptic, using the emerging surroundings, accelerate the arrival of ambulance.

Rescuer is obliged to protect himself infection through contact with the blood of the victim. Therefore, it should work in gloves and undergo the required laboratory tests.

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Finger pressed arteries during bleeding

14. First medical care for bleeding

Depending on the type of bleeding (arterial, venous, capillary) and the funds available during the provision of first medical assistance, they carry out a temporary or final stop.

A temporary stop of the most dangerous to life of outdoor arterial bleeding is achieved by the imposition of a harness or twist, fixing the limb in the position of maximum bending, pressing the artery above its place damage to the fingers. Sleepy artery is pressed below the wound. Fingerproof arteries - the most affordable and fast way to temporarily stop arterial bleeding. The arteries are pressed in places where they pass near the bone or above it (Table II color plint).

Table II. Points of finger pressed arteries

The temporal artery (1) is pressed with a thumb to the temporal bone ahead of the ear shell during bleeding from wound heads.

The mandibular artery (2) is pressed with a thumb to the corner of the lower jaw when bleeding from wounds located on the face.

The total carotid artery (3) is pressed against the vertebrae on the front surface of the neck on the side of the larynx. Then impose a gulling bandage, which is put on the damaged artery with a dense roller from the bandage, napkins or wool.

The subclavian artery (4) is pressed to the 1st edge in the hole above the clavicle when the wound is bleeding in the area of \u200b\u200bthe shoulder joint, the upper third of the shoulder or in the axillary depression.

When the wound is located in the region of the medium or lower third, the shoulder shoulder artery (5) to the head of the shoulder bone, for which, leaning with a thumb on the top surface of the shoulder joint, squeeze the artery.

The shoulder artery (6) is pressed against the shoulder bone from the inner side of the shoulder on the side of the double-headed muscles.

The radiation artery (7) is pressed to the dice in the wrist area in the thumb with damage to the arteries of the brush.

The femoral artery (8) is pressed in the groin area to the pubic dice by pressing with a compressed fist (this is done during damage to the femoral artery in the middle and lower third). In case of arterial bleeding from the wound, located in the field of the lower leg or foot, press the popliteal artery (9) in the field of the patented fossa, for which the thumbs are put on the front surface knee SustavaAnd the rest pressed the artery to the bone.

At the foot, it is possible to press the filtering bones of the Foot rear (10), then impose a gulling bandage on the foot, and with strong arterial bleeding - harness to the lower leg.

After taking a finger pressed vessel, you need to quickly impose, where it is possible, harness or a twist and sterile bandage on the wound.

The imposition of the harness (twist) is the main way to stop bleeding during damage to large arterial limb vessels. The harness is imposed on the thigh, the shin, shoulder and forearm above the place of bleeding, closer to the wound, on clothes or a soft lining from the bandage so as not to pinch the skin. Harness impose with such force to stop bleeding. With too much squeezing the tissues are more traumatized by the nerve trunks of the limbs. If the harness is not imposed enough, arterial bleeding is enhanced, since only veins are squeezed, according to which blood outflows are carried out from the limb. The correctness of the imposition of the harness is controlled by the absence of a pulse on the peripheral vessel.

The attachment time of the harness indicating the date, an hour and minutes are noted in the note, which is put under the course of the harness so that it is clearly visible. The limb, pulled by the harness, is covered warm, especially in winter, but not laid by the heating. The anti-observative means of a syringe tube is affected.

Syringe Tubik (Fig. 15) consists of a polyethylene case, injection needle and protective cap; Designed for disposable drug administration intramuscularly or subcutaneously.

Fig. 15. Syringe Tube: A - general form: 1 - body, 2 - cannula with needle, 3 - protective cap, b - use: 1 - piercing membrane in the housing by rotation of the cannula until the stop, 2 - removal of the cap from the needle, 3 - position when the needle boils

For the introduction of an anti-oblamic agent, the syringe tube is taken for the housing, the left behind the ribbed bezel cannula, the housing turns until it stops. Remove the cap, protecting the needle. Without touching the needle with his hands, put it in soft fabrics The upper third of the outer surface of the hip, the upper third of the shoulder is behind, in the outer upper quadrant of the buttocks. Highly squeezing the housing of the syringe tube, squeeze the contents and, without squeezing the fingers, remove the needle. The used syringe tube rises to clothes affected by the breast, which at the subsequent stages of evacuation indicates the introduction of an anti-tax agent.

Harness on the limbs should be kept no more than 1.5-2 hours to avoid finite grounds below the place of imposing a harness. In cases where, from the moment of its imposition, 2 hours passed, it is necessary to perform the finger pressed artery, slowly under the control of the pulse, weaken the harness for 5-10 minutes and then apply it a little higher than the previous place again. Such temporary removal of the harness is repeated after every hour until surgical assistance is affected, while each time they make a mark in the note. If the pipe is a tubular, without a chain and hook at the ends, its ends are tied to the node.

In the absence of harness, arterial bleeding can be stopped by the imposition of the twist (Fig. 16) or by maximizing limb flexion and its fixation in this position.

Fig. 16. Stop arterial bleeding twist: A - B - sequence of operations

To stop bleeding using a twist, a rope, twisted handkerchief, fabric strips are used. The improvised harness can serve as a trouser belt, which is folded in the form of a double loop, put on the limb and tighten.

The temporary stop of the outer venous and capillary bleeding is carried out by applying a quenching sterile bandage onto the wound (close it with sterile napkins or a bandage of 3-4 layers, the hygroscopic wool is placed on top) and make the damaged part of the elevated position with respect to the body. In some cases, the temporary stop of venous and capillary bleeding can be final. The final stop of the arterial, and in some cases and venous bleeding is carried out in surgical processing of the Russian Academy of Sciences.

With internal bleeding on an estimated region of bleeding, a bubble with ice is put, affected immediately deliver to the medical institution.

Questions and tasks. 1. What are the ways to temporarily stop arterial bleeding? 2. What are the arteries and where are pressed to stop bleeding? 3. What are the rules for imposing a hemostatic harness and spin? 4. Enter the harness on the thigh, shoulder, shin, forearm. 5. Verify the trouser belt on the shoulder in the form of a double loop. Enter the twig on the shoulder. 6. How do venous and capillary bleeding stop? 7. How is the syringe tube and what are the rules for use?

Arterial bleeding is open damage, which, with a non-time-rendered assistance rendered, can lead to human death. It is precisely it is considered the most dangerous of all possible varieties of blood loss.

Before rendering medical care, It is necessary to make sure that it is it. A distinctive feature Such a wound will be the fact that blood from it will splash in literally fountain, due to the jolts of the heart and pressure. Blood itself will have a pronounced red color. In such a state, the victim will be very pale and weak. His face will cover very quickly later. There may be dizziness, drowsiness, panic attack and fainting. Also, people in such a state may feel thirst and dry mouth. Pulse is weakened.

Before considering first assistance in arterial bleeding, you need to say about such existing blood loss varieties:

1. Bleeding from the affected veins is accompanied by commemorating the blood of dark red.
2. Capillary bleeding is accompanied by a slight discharge of scarlet blood.
3. Mixed bleeding is characterized by simultaneous damage to veins, capillaries and vessels.
4. Arterial bleeding is characterized by a complete or partial rupture of the artery vessel.

In the event that first aid for arterial bleeding will not be provided in the next few minutes after the moment of damage, then the patient will die from blood loss and there will be a fatal outcome. In such a state, an instant blood loss is observed, because of which the body simply does not have time to connect protective functions. This leads to a shortage of blood for the work of the heart, the deficiency of oxygen and the myocardial stop.

If the femoral artery of the limb was damaged, then the patient may have a variety of consequences - from gangrene and infection, until the need for leg amputation.

Also with a strong blood loss, be it shoulder, neck or limb, the patient often develops hematoma. It needs to be promptly eliminating.

As can be understood from the above, the first aid in arterial bleeding is the algorithm of medical actions, from the correctness of which the human life and further treatment depends.

You can learn about the rules for first aid during the blood loss on the learning video.

The foundations of the PMP in arterial bleeding are studying even at school for obzh, however, in a critical situation, few people can truly unmistor to stop arterial bleeding.

The PMP with arterial bleeding depends largely on the particular location of the wound.

Due to the fact that this type of blood loss requires immediate assistance, a person who has it should be aware of such rules:

1. In this case, it is impossible to slow, so the evaluation of the patient's condition is carried out in seconds.
2. If necessary, you can tear or cut clothes, as it will still need to do to be able to conduct a normal injury inspection.
3. In the critical situation, the dressing and clamp of the wound can be made by a belt belt - a belt, a scarf and something like that.
4. With the uncertainty of the original source of bleeding, it is possible to put it with your hands on the wound itself until the point of finding the exact place of damage. Typically, this is done with the wounds of the abdomen.

Stop arterial bleeding on the forearm provides for the rise of the patient's hand and casting her head. Further, the person who assists, needs to be behind the victim, clamp the vessel with your fingers, find the deepening between the muscles and give the area to the bone tissue.

PMP with arterial bleeding of a carotid artery provides for the experience of the wound with a thumb, when the remaining fingers will be located on the patient's head. It should be remembered that it is always necessary to shift the carotid artery below the damage.

The temporal artery must be squeezed with his fingers just above the top edge from the ear.

An artery on the hip is most sake as much as possible and pressed against the pubic bone. Slender victims of the victims, this vessel is very easy to press to the thigh.

Maxim artery should be pressed against the edge of the chewing muscle.

The stop of arterial bleeding of the lower leg should occur by pressing the patient's popliteal. Next should be bent foot in the knee.

With the damage to the vessels of the upper limbs in the armpit, you need to enter a fist and press the damaged hand to the body.

PMP in arterial bleeding provides patching, but not transferring the artery. At the same time, the correct relief requires a sufficiently important force, since it will have to hold the artery in this position a sufficiently long time.

It is also worth knowing that so far one person presses the artery, the other should find the harness and gauze during this time to go to the second stage to help.

Methods for stopping arterial bleeding are selected individually, depending on the nature and complexity of the wound. This may be the imposition of a harness or finger sample artery.

Ways to stop venous bleeding less complex. They provide for the imposition of a tight bandage bandage.

Selects such features of the imposition of the harness:

• In case of damage to the upper limbs, the harness is superimposed on the top of the shoulder.
• In the case of local damage to the artery on the lower limb, two harnesses can be applied. The second will be superimposed a little higher than the first.
• If the carotid artery is damaged under the harness you need to put the bandage so as not to apply a person even more injury and prevent the transfer of air flow.
• In winter, the harness must be applied for half an hour. In the summer, it can be held for no more than an hour, after which it is to relax that the blood is in a foot again.
• The harness is superimposed solely with the defeat of the large vessels of the body. With insignificant venous damage, the wound is only needed to conbay.
• After the harness was imposed, the damaged part of the body should not be covered with clothing so that the doctor can control the patient's wound state.

The technique of the imposition of the harness is simple. First, the damaged area needs to wrap gauze. Next, raise the limb and stretch the harness. Wrap it around the limb twice. At the same time, the harness should not be tightly overlap so that it is not too much to press the limb. At the end, the harness is fixed and the patient is delivered to the hospital.

In the event that the harness is correctly imposed, blood flow should be completely stopped. Under it, it is necessary to put a note with the last time of the bandage imposition.

Unfortunately, when you embed a harness, people often make mistakes. This may be the imposition of a harness without sufficient testimony to the procedure or overlay it on a naked skin, which will lead to a leaning of soft tissues.

An error is also considered to be the wrong localization of the imposition of the harness and its weakly tightening, which will only strengthen the bleeding.

Another error is the long stay of the harness in a prolonged state, which creates conditions for gangrene, infection and necrosis.

There is the following squeezing dry dressing technique:

1. To put on gloves and carefully inspect the wound.
2. Treat wound with antiseptic.
3. Sterile wipes are put on the wound and to rewind the bandage on top.
4. Secure the bandage bandage.
5. Deliver the patient to the doctor.

The finger pressing of the arteries is used for all cases of injury of the head (maxigous and temporal area including) and neck when bleeding cannot be left using a traditional experienced binting lining.

The finger pressed arteries are convenient because this is a quick method to stop bleeding without imposing bandages. The disadvantage of this practice is that a person who assists cannot move away from the patient to come to the rescue to other wounded patients.

The points of the finger pressed arteries differ in the anatomical location of the lesion. Thus, when bleeding in the temporal artery, it must be over with two fingers in the area of \u200b\u200bthe ears.

When bleeding, which is localized at the bottom of the front part, you need to use this technique in the area located in the zone between the jaw and the chin.

With damage to the carotid artery, you need to push the front of the neck with a big finger.

With a shoulder injection, you need to press the shoulder artery. To do this, you need to press the artery finger to the bone and bend your hand.

In case of damage to the femoral artery, a lot of power will be required. It is necessary to press it with your fingers folded together ( right hand). Next to press the other hand.

Also, with strong bleeding, you can use the 3D method. It consists in a strong and constant pressure with his hands on a wound for ten minutes.

Remember that self-treatment is dangerous for your health! Be sure to consult your attending physician! The information on the site is presented solely in popular-familiarization purposes and does not claim for reference and medical accuracy, is not a guide to action.

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Stop bleeding

All methods of stopping bleeding can be divided into two groups:

Temporary stop methods;

Methods of final stop.

Methods of temporary stopping bleeding

The simplest way is the finger pressed artery to the dice above the location of damage. This requires the following topographic and anatomical conditions:

1. Surface arming.

2. Slide the durable bone directly under the artery.

To reliably stop bleeding, a certain sequence of actions is important:

1. Determination of the point of the finger pressed (crossing the projection line of the artery with the dice to be dilated).

2. Rational labeling of fingers for effective pressed artery.

3. Application of finger pressure vector.

Finger pressed total carotid artery

1. The point of the finger pressing of the artery is at the intersection of the projection line (from the middle of the distance between the angle of the lower jaw and the top of the mastoid process to the sternum-key joint) with a sleepy tuberculk transverse process of the Vi cervical vertebra. This point usually corresponds to the middle of the length of the front edge of the breast-curable-cottage muscle.

2. The doctor is located face to the victim. A distal phalanx I finger places on the front surface of the neck at the point of pressed, the remaining fingers on the back surface of the neck.

3. To press the artery to the sleepy tuberculosis, you need to bring fingers into a strictly sagittal direction:

If the vector is deviated in the dodge, the total carotid artery will slip from the transverse process and an attempt to stop the bleeding will be ineffective;

With a pressure in the medial direction, you can surpassed the trachea and call asphyxia.

10.1.2. Finger Press Facial Artery

1. The projection line of the face artery takes place from the middle of the body length of the lower jaw to the medial corner of the eye;

The point of finger pressed is located in the middle of the lower edge of the body of the lower jaw at the very beginning of the projection line.

2. The doctor is located face to the victim;

Folded II-V fingers put on the body of the lower jaw the opposite side, and distal Falang. thumbs are placed in the point of pressed;

Running fingers, produce the compression of the facial artery.

Finger pressed surface temporal artery

1. The projection line of the surface temporal artery takes place from the middle of the zilly arc to the top of the top:

Point of finger pressed is 1-2 cm above the middle of the length of the zilly arc.

2. The doctor is located on the side of the victim.

Methods of the final stop of bleeding

The methods of the final stop of bleeding include:

1. Vascular ligation:

Directly in the wound;

Out of the wound within healthy fabrics throughout the artery.

2. Seam of vessels, which relative to the circumference length is divided into two types:

Side;

Circular.

To ligate small vessels (in subcutaneous tissue, muscles), the resinking material is mainly used (for example, ketgut). Silk or synthetic threads are used to dress the vessels of medium and large calibers.

Vascular ligation in the wound

The method of ligation of vessels in the wound is determined by their caliber:

1. Stop bleeding from fine caliber vessels along the edges of the wound.

2. Ligation of the main vessels in the wound.

Before leaging the vessels, a temporary stopping of bleeding in the wound is achieved with the help of hemostatic clamps.

Heal standing clamps

The hemostatic clamps can be divided into the following groups:

1. Clamps designed to relive the ends of the vessels before imposing ligatures or electrocoagulation (the actual hemostatic clamps).

2. Clamps intended for the temporary cessation of blood flow before the restoration of the vessel's intake using vascular seam (vascular clamps).

The shape of the branches (sponges) of the hemostatic clamp can be different:

1. Extra long triangular (Holvded clamps).

2. A pointed trapezium (bilro clamp).

3. Trapezoidal with teeth (Kohler clamp).

4. Oval (Pena clamp) (Fig. 51).

Fig. 51. Heal-standing clamps: A - Bilro Clamp; B - Kohler clamp.

Fig. 51 (end). Heal-standing clamps: B - Holvded Clamp; Mr. Pan's clamp (by: Medicon Instruments, 1986).

Branches of hemostatic clamps can be straight and curved.

Stop bleeding from small vessels on the edges of the wound

To dress the ends of small vessels in subcutaneous fatty tissue, the sequence of actions should be as follows:

1. The first assistant is two surgical tweezers imposed on the skin, turns the edge of the wound nearest to himself. At the same time, the plane of the edge of the wound becomes available for the review.

2. The second assistant is the edge of the gauze ball, clamped in a tweeze, removes blood from the wound plane, demonstrating bleeding transverse vessels.

To save material, you need to imagine a gauze ball in the form of a cube, the brink of which must be sequentially used to drain the edges of the wound.

3. The surgeon sequentially shifts the tips of the hemostatic clamp of the ends of the bleeding vessels. The knob of the hemostatic clamp after overlaying the vessel should be put on the appropriate edge of the wound (Fig. 52-1).

Fig. 52. Stop bleeding from small vessels along the edges of the wound (explanation in the text) (by: Lopukhin Yu. M., Molodrenkov M. N., 1968).

The end of the hemostatic clamp should be a continuation of the vessel.

The volume of fatty fiber and loose connective tissue, captured with the vessel, must be minimal.

With insignificant bleeding on the ends of very small vessels, it is better to impose hemostatic hemostatic clamps of Holvded.

The ends of the vessels of a small diameter can be shifted by the hemostatic clips of the bilror or kohker.

4. After a temporary stop of bleeding from one wound plane, similar actions are produced on the other side of the wound. At the same time, the first assistant works with the clips, and the surgeon pulls the edge of the wound with tweezers.

5. After the imposition of hemostatic clamps, it is necessary to visually check the carefulness of temporary hemostasis.

6. The final cessation of bleeding is made using ligatures:

From the "nearest side" of the wound, the first assistant establishes the hemostatic clamp vertically;

The surgeon comes over the clamp of the ligature;

The assistant tilts the hemostatic clamp to itself so that his tip is clearly visible. Curved clamp need to rotate along the longitudinal axis so that its end is clearly visible;

Under the tip of the clamp you should form a loop and gradually delay the first node;

The ends of the fingers in the formation of the loop and tighten the node should be in the immediate vicinity of the clips. This prevents the thread break (Fig. 52-2; 3);

As the node is tightened, the hemostatic clamp must be removed from the end of the vessel;

After removing the clips, the node must be tightened to the end, providing the imposition of ligature directly to the wall of the vessel. This simple reception requires care and pre-training. Asynchrony of actions will inevitably lead to a breakdown of the node from the end of the vessel.

7. After tightening the first node, you need to form and tighten the second node:

Both hinges must necessarily form a "marine" node.

The formation of the "female" node is a gross mistake due to the high probability of its unleashing;

The node must be orienting to the side opposite to the skin.

8. Similar actions are performed on other clamps.

As the ligators are imposed on the ends of the vessels, the second assistant must cut off the scissors of the coopers of ligatures. The following rules should be followed:

1. It is impossible to dramatically for the ends of ligatures. It is fraught with the danger of their breakdown from the end of the vessel.

2. Plane of the divorced blades of cooper scissors should be orient to the thread at an angle of 40-50 °.

3. Before the intersection of folded threads, the lower blade of scissors must persist in the node.

4. The length of the cut end of the ligature should not exceed 1-2 mm.

On the other side of the wound, all actions with the clips performs the surgeon, and the first assistant delays ligatures. Responsibilities of the second assistant former. After the imposition of hemostatic clamps, the final stop of bleeding can be made without imposing ligatures by the "twisting" method. To do this, the clamp imposed on the vessel of a small caliber must be turned several times along the axis. Due to the crushing of the wall at the end of the vessel, a thrombus is formed, stopping bleeding. It should be remembered that this method can be used only with a shortage of time on the blood vessels of small caliber, passing in subcutaneous fatty tissue. In the electrosurgical embodiment, the coagulation of the ends of the vessels is produced when the electrode is applied to the hemostatic clamp.

Stop bleeding in the width of the main vessels

In the overwhelming majority of cases, the final cessation of bleeding is possible to ensure the ligation of the ends of the damaged arteries of medium and large caliber directly in the wound when performing primary surgical treatment.

Usually, for each end, the vessel is superimposed on one ligature. However, when stopping bleeding from large arteries to the central end of the artery, two ligatures can be applied.

Stages of the operation

1. Dissection of wounds to expose the central and peripheral end of the artery.

2. The imposition on the ends of blood vessels of the hemostatic clamps.

3. Ligation of the ends of the arteries.

Rules for dissection of the wound before dressing artery

1. The incision must pass according to the course of the vascular-nerve beam. Conduct across the stroke of the vascular-nerve beam is extremely dangerous than the possibility of non-hydrogen damage to the rest of its elements.

2. The length of the cut should ensure comfortable conditions in the wound.

3. It is necessary to carefully select from the surrounding loose connective tissue and fatty tissue not only the central, but also the peripheral end of the artery.

After the dissection of the wound and the detection of the ends of the damaged artery, hemostatic clamps impose on them:

The hemostatic clamp is imposed so that its working parts are a continuation of the axis of the vessel;

It is incorrectly applied to the hemostatic clamp across the vessel, since the adjacent fat and connecting tissues are captured together with its wall, which make it difficult to highlight the vessel ends.

After the imposition of the hemostatic clamp, the tweezers must carefully distinguish the end of the artery from the surrounding fat and connective tissue on a plot to 1-2 cm.

The criterion for the correctness of the selection of the artery is the appearance of the mattiness of its outer surface.

The importance of the release of the artery wall from the surrounding connecting tissue is due to two circumstances:

1. Biological property connective tissue is dissolved under pressure from ligature. The weakening of the pressure of the ligature on the vessel can lead to its scaling and the appearance of secondary bleeding.

2. The immobility of ligature fixed to the tissues located on top of the pulsating end of the vessel. As a result, the throbbing end of the artery can slip out from under the stationary ligature and secondary bleeding will begin.

The criterion for the correct imposition of the ligature is the pulsation of the end of the artery along with the ligature superimposed on it.

To reliably stop bleeding, ligature must be superimposed both on the central and peripheral end of the artery. Even the unburpose peripheral end of the artery needs to be found and tied up, since some time a while, bleeding from it can be resumed, especially when evacuating the victim.

However, in some cases, the vessel dressing in the wound is difficult.

1. It is impossible to bandage the vessels in the wound during its localization in topographic anatomical areas with particularly complex relationships of elements (for example, in a deep person).

2. Expectively tied up with a vessel when bleeding from purulent wound. Pump has a destructive effect on the wall of the vessel and blood clots. Bleeding will inevitably resume during the depreciation of ligatures and melting the thrombus.

3. It is irrational to try to ligate the vessels when bleeding from the swollen wound, as it is very difficult to find the ends of the vessels among the destroyed fabrics, and sometimes it is impossible.

4. It is difficult to impose a large number of clamps when bleeding from tissues with a scattering type of vessel branching (for example, when damaged language).

In the cases listed, for the final cessation of bleeding, it is not resorted to the dressing of the artery not in the wound, and outside it within the limits of healthy tissues. This method of stopping bleeding is called the dressing of the artery during. The drawing of the arteries during the distance can be used not only as a way of stopping bleeding from a damaged vessel, but also as a method of its warning before performing some complex operations - for example, before removing the tumor of the language, resection of the upper jaw.

Gleaning artery throughout

Stages of the operation

1. Marking of the projection line of the artery.

2. Access to the vascular-nerve beam.

3. Isolation of the artery from surrounding tissues.

4. The imposition of ligatures on the artery.

5. Crossing the artery between ligatures.

5. layering wounds.

Array exposure rules

1. To determine the projection line of the artery, the most simply detected and unstable bone protrusions should be used as guidelines. Conducting the projection line along the contours of soft tissues (muscles) may result in an error. In the edema of tissues, the development of hematoma, etc. The position of the muscles may change and the projection line will be incorrect.

2. To identify the artery during its dressing, it is necessary to clearly know the topographic anatomy of the appropriate area - the relationship between the artery with fascia, muscles, nerves and tendons.

3. Access to the artery strictly on the projection line is called direct. The use of direct access allows you to approach the artery to the shortest way, reducing the operational injury and the operation time. However, in some cases, the use of direct access may result in complications - damage alongside the underlying vein, nerve.

4. In order to avoid possible complications In some cases, it is used to expose the arteries of occupation, which is performed by several aside from the projection line. In this case, the artery is suitable from the safest side, for example, through the vagina of the adjacent muscle.

5. Operational reception lies in the selection of the artery from the vasculating of the vascular-nerve beam and its dressing.

In order to avoid damage to the elements of the vascular-nerve beam, novocaine is introduced in its vagina with the aim of the "hydraulic separation of tissues", and the opening of the vagina is produced through a grooved probe. Before the imposition of ligatures, the artery is thoroughly isolated from its surrounding connective tissue, after which the vessel dressing is tracked using a ligational needle (Fig. 53).

Fig. 53. Opening of the vascular vascular beam vascular beam (a) and the selection of the artery from the connective tissue (b): 1 - a connecting case of a vascular-nerve beam; 2 - artery; 3 - nerve (by: Lopukhin Yu. M., Moldenkov M. N., 1968).

Ligatural needles

Ligature needles can be pointed and stupid:

A pointed needle is used if you need to piercing fabrics and dressing artery together with the adjacent tissues with a single block;

Stupid needles are used to summarize ligatures for a vessel after performing operational access;

For the convenience of fixing in the palm of the handle of the ligature needle has a compiled shape;

The ligature needle is held in the hand in the position of the "bow" or "table knife";

Fixing the tool in the position of the "letter pen" will lead to the loss of movement accuracy;

Deshan's ligature needle is designed to ligate vessels located relatively superficially;

With the help of a ligar needle, Cooper tied deeply located blood vessels (Fig. 54);

Fig. 54. Ligature needles. 1 - Deshan's ligature needle: A - left; B - right; 2 - Ligatural Needle Cooper.

The length of the ligature charged to the needle must be 1.5 times higher than the tool length. At the same time, one end should be long, and the other is short;

The ligature needle should begin to bring under the vessel with the most "dangerous" side - from the side of the adjacent vein, nerve (Fig. 55).

Fig. 55. The initial phase of the ligational needle of the Deshan under the artery (2) on the side of the nerve (1) (by: Lopukhin Yu. M., Molodrenkov M. N., 1968).

Collateral blood circulation

"Collateral blood circulation" - blood flow into the peripheral departments of the side of the side branches and their anastomoses after closing the lumen of the main (main) trunk. Taking into account the temporary factor, collaterals are divided into two groups:

1. Essential (anatomical).

2. Newly formed (functional).

Anatomical or pre-consistent collaterals are the largest branches, immediately making them the function off immediately after ligation or blockage of the main artery (Fig. 56).

Fig. 56. Arterial channel of the head and neck (scheme) (by: Zolko Yu. L., 1964). 1 - a. Meningea Media; 2 - a. Temporaalis Superficialis (Ramus Frontalis); 3 - a. Ophthalmica; 4 - a. supraorbitalis; 5 - a. Supratrochlearis; 6 - a. Dorsalis NASI; 7 - connection between a. Ophthalmica and a. infraorbitalis; 8 - a. angularis; 9 - a. infraorbitalis; 10 - connection between a. InfraorBitalis and a. Tacialis; 11 - a. Maxillaris; 12 - connection between AA. TRANSVERSA FACIEI, BUCCALIS AND FACIALIS; 13 - a. TRANSVERSA FACIEI; 14 - a. Labalis Superior; 15 - a. Alveolaris Inferior; 16 - a. Labalis Inferior; 17 - connection between a. Mentalisia. Facialis; 18 - a. Facialis; 19 - a.submentalis; 20 - a. lingualis; 21 - a. Carotis Externa; 22 - a. Thyreoidea Superior; 23 - compounds between a. Thyreoidea Superior and a. thyreidea Inferior; 24 - a. thyreidea Inferior; 25 - truncus brachiocephalicicus; 26 - a. Thoracica Interna; 27 - a. vertebralis; 28 - truncus thyreocervicalis; 29 - TRUNCUS COSTOCERVICALIS; 30 - a. suprascapularis; 31 - a. TRANSVERSA Colli; 32 - a. INTERCOSTALIS SUPREMA; 33 - a. Cervicalis Superficialis; 34 - a. Cervicalis Ascendens; 35 - a. CERVICALIS PROFUNDA; 36 - a. CAROTIS INTERNA; 37 - Connections between a. CERVICALIS PROFUNDA and A. vertebralis; 38 - a. Occipitalis; 39 - Connections between a. vertebralis and a. Occipitalis; 40 - connections between a. CERVICALIS PROFUNDA and A. Occipitalis; 41 - a. vertebralis; 42 - a. Auricularis Posterior; 43 - a. Temporaalis superficialis; 44 - a. Temporaalis Superficialis (Ramus Parietalis).

On the localization of intersascular anastomoses, the anatomical collaterals can be divided into several groups.

1. Intrasthetic or short collaterals connecting the vessels within the pool of any single large artery (for example, outer sleepy).

2. InterSystem (long) collaterals connect with each other the pools of different vessels located in different areas (for example, the branches of sleepy and plug-in arteries).

3. Intorganized collaterals - compounds between vessels inside the organ (for example, anastomoses between the arterial branches in the thickness of the breast-curable and large-sized or chewing muscle).

4. Supplemental collaterals - compounds between vessels before their immersion in the organ (for example, in the two-dimensional muscle).

Along with the pre-seated collaterals, the so-called newly formed collaterals are of particular importance. After lining the main trunk, a complex restructuring and development in normal conditions not functioning intramuscular arterial branches, Vasa Vasorum, Vasa Nervorum occurs only by the end of the second month. Consequently, with the functional insufficiency of the pre-consuming collaterals, the arising ischemia of the peripheral region of the region is compensated by newly formed collateral vessels. The strengthening of the functioning of the pre-consuming collaterals until the full disclosure of the newly formed collateral can be avoided by sharply expressed peripheral arterial insufficiency.

The intensity of collateral blood circulation depends on anatomical features Essential side branches:

Diameter of arterial branches;

The level of death from the main vessel;

An angle of death from the main trunk;

The number of side branches;

Type of branching.

The intensity of collateral blood circulation depends also:

From the functional state of the vessels, primarily from the tone of their walls;

From severity exchange processes in the region.

Contribute to maintaining the necessary level of metabolic processes in one area or another can be either activating collateral blood circulationor reducing consumption by tissues of oxygen coming with blood.

Features of the imposition of ligatures, taking into account the anatomical factors

1. It is necessary to maximize the existing large side branches and impose ligators if possible below the level of their departing from the main barrel.

2. Better conditions For equilibrium blood flow, it is created when attaching ligatures on a vessel section with an acute angle of outrage of the side branches, while a stupid angle of extrusion of lateral vessels from the main trunk increases hemodynamic resistance.

3. In areas with rich vessel muscles, there are also the most favorable conditions for collateral blood flow and tormula collateral.

Features of operational action, taking into account the functional state of the vascular wall

When attaching ligats, it is necessary to take into account and functional state Vascular wall:

1. At contusion, the walls of the artery, as well as when imposing ligatures, irritation of sympathetic nerve fibers, which are vasoconstrictors occur. This leads to the reflex spasm of collaterals, and the most plastic arterioleary link of the vascular bed turns off from the blood flow.

2. Since the sympathetic nerve fibers go in the outer shell of the arteries, to eliminate the reflex spasm of collaterals and the maximum opening of the arteriole simple way It is the intersection of the artery wall along with the sympathetic nerve fibers between the two ligatures.

3. When crossing the artery between ligatures due to the discrepancy between its ends, the angle of dishevement of the lateral branches is occurring to a more acute, accompanied by a decrease in hemodynamic resistance and the improvement of collateral blood circulation.

After the imposition of ligatures and crossing the artery between them, the wound is in layers in layers. IN postoperative period Compliance with the following conditions:

Maintaining room temperature environment;

Providing peace condition for the operated area.

Access and features of the ligation of the outer sleepy and gear artery are described in a special section on the topographic anatomy of the neck and the methodology for performing some operational interventions.

Temporary prosthetics

To restore blood flow by artery with a diameter of at least 6 mm at a relatively short period of time, the method of temporary prosthetics tube from synthetic materials (polychlorvinyl, silicone, polyethylene, etc.) or special T-shaped cannula is used.

For this, the washed with a solution of heparin tube is injected into the distal and proximal ends of the damaged artery. The fastening of a temporary prosthesis in the boss of the ends of the arteries produce temporary ligatures.

Benefits of the temporary prosthetics method

A victim with a temporary prosthetic can be transported to a medical institution to provide him with specialized medical care.

The temporary prosthesis allows you to restore and for some time maintain blood flow in the relevant area.

Disadvantages of the temporary prosthetics

Limitability of time (as a rule, not more than 72 hours).

The possibility of intima damage when the ends of the prosthesis are introduced into the clearance of the vessel and thrombing it in the subsequent.

Concept of seam of blood vessels

To stop bleeding from large trunk arteries in appropriate conditions, you can use the restoration of the continuity of the damaged vessel with the help of special seams.

The seam of the vessel around the circle, superimposed with a complete break or disturbance of the circle by more than 2/3 of its length, is called circular. Vascular seam, superimposed on the edges of the wound of a vessel, not exceeding 1/3 of the circumference length, is called side.

Methods for overlaying the vascular seam are divided into two groups:

Manual seam vessel;

Mechanical seam vessel.

To impose seams on the vessels, a number of conditions must be observed.

1. The seam on the vessels should be applied only in aseptic conditions.

2. We need wide anatomical access to the vessel damage site.

3. The walls of the vessel must be viable, their blood supply and innervation should be saved.

5. The vessel must be well isolated from the perigrian tissues and shifted by vascular clips or turnstiles. Soft vascular clamps or rubber turnstiles should be used (for example, a cuff from a surgical glove).

6. To increase the diameter of the anastomosis, the ends of the vessel can be crossed at an angle.

7. The seam should be superimposed without significant tension, so the distance between the ends of the damaged vessel should not exceed 3-4 cm.

8. To overlay the seam use microsurgical needles and tweezers.

9. Atraumatic needles with unproductive threads 4/0 - 6/0 should be applied.

10. The suture material must have thromboroistant properties.

Requirements for seams on vessels:

1. Tightness.

2. Strength.

3. WARNING The narrowing of the lumen of the vessel.

4. Conduct the thread through all the shells of the vascular wall.

5. Ensuring good adaptation of the sex of the two ends of the vessel crosslinkable. The restoration of intima continuity is ensured by the eurmonation of the ends of the vessel.

6. The exclusion of Adventization and suture spectrum in the clearance of the vessel (Fig. 57).

Fig. 57. Circular seam of the vessel according to A. Karrel (by: Semenov G. M., Petrishin V. A., Kovshova M. V., 2002): a - imposition of seams-keys; B - the imposition of a charming continuous seam; B is the imposition of nodal seams on the vessel wall.

The finger pressed artery is made in all cases of heads of head and neck if bleeding cannot be stopped using a gulling bandage. The convenience of the finger pressed arteries is the speed of this method of temporary stopping bleeding. The main disadvantage of this method is the fact that the person providing assistance cannot move away from the victim to assist other wounded.

With proper pressed artery, bleeding from it should stop.

Fig. 1. Finger pressed artery during bleeding.
1 - pressed radiation and radial artery when hitting the palm;
2 - pressing the temporal artery;
3 - pressed outdoor jaw artery;
4 - Pressing the carotid artery;
5 - Pressing the shoulder artery.

When bleeding from the temporal artery, the latter pressed two-three fingers at the level of the ears, ahead from it at a distance of 1-2 cm.

With arterial bleeding from the bottom half of the person, pressing the thumb with a thumb of the outdoor-jaw artery at a point located between the chin and the angle of the lower jaw is somewhat closer to the latter.

With strong arterial bleeding from the upper half of the neck, the shocking artery is pressed. For this, a person presses the side of his hand on the front surface of her hand on the side of his hand from his larynx, clasping the late fingers the side and rear surface of his neck.

If a person is behind the wounded, the depression of the carotid artery is made by pressing on the front surface of the neck on the side of the larynx by four fingers, while the thumb wraps the back surface of the neck neck.

In order to stop arterial bleeding at high wounds of the shoulder, the axillary artery is pressed against the head of the shoulder bone. To do this, put one hand on the brachy joint of the victim and, holding the joint in a fixed state, the four fingers of another hand with a force to press on the axillary dam in the wounded line, closer to the front boundary of the depression (the line of the front border of the growth of the axillary depression, on N. and . Pogging).

Fig. 2. Artery and places of their pressed when bleeding.
1 - temporal artery;
2 - outdoor jaw artery;
3 - Sleepy artery;
4 - plug-in artery;
5 - axillary artery;
6 - shoulder artery;
7 - radiation artery;
8 - elbow artery;
9 - palm artery;
10 - iliac artery;
11 - femoral artery;
12 - popliteal artery;
13 - front tibial artery;
14 - rear tibial artery;
15 - Stop artery.

When the shoulder wounds, the forearm and brushes to stop arterial bleeding are made of the shoulder artery. For this, a person, getting face to the wounded, worst his shoulder in his hand so that the thumb is located at the inside edge of the shoulder double-headed muscle. When pressing a thumb in this position, the shoulder artery will inevitably turn out to be pressed against the shoulder bone. If the help provided is behind the victim, he puts four fingers to the inner edge of the shoulder two-headed muscles, and the back and outdoor surface of the shoulder worst with a large finger; At the same time, the pressing of the artery is produced by the pressure of four fingers.

Fig.3. Pressure points of the most important arteries.
1 - temporal;
2 - occipital;
3 - the municipal;
4 - right common sleepy;
5 - left overall sleepy;
6 - connectible;
7 - axillary;
8 - shoulder;
9 - radiation;
10 - elbow;
11 - femoral;
12 - rear tibia;
13 - Artery Tar Stop.

In case of arterial bleeding from the vessels of the lower limb, the finger press of the femoral artery is made in the groin area to the bones of the pelvis. To this end, the sandprint must put pressure on both hands on the inguinal area of \u200b\u200bthe victim, somewhat closer to the inner edge, where the pulsation of the femoral artery is clearly tested.