L.N. Belikov

One of the most important compensatory-adaptive reactions of the human body is the ability to self-stop bleeding by activating the blood coagulation system. Unfortunately, this is not always possible, since bleeding from large vessels to stop independently quite rare. The continued outdoor bleeding is an indication for the application of a temporary stopping of bleeding, the life of the victim often depends on the timeliness and correctness.

The methods of stopping outdoor bleeding are known to be quite a lot and, in principle, if you turn to the history of surgery, its development is primarily the development of methods of combating blood loss.

The general practitioner must own the following most simple and effective ways to temporarily stop bleeding: finger presses of the vessel flexing the limb in the joint, the imposition of the gulling bandage, the harness, the hemostatic clamps; be able to produce a wound tamponade and use hemostatic local action.

At the same time, it is necessary to have a clear idea that the above methods for stopping bleeding are far away are not equivalent and have certain disadvantages and advantages, therefore there are corresponding indications for each. These indications are determined by the nature of the clinical situation, and, above all, the type of outer bleeding and its intensity. Outdoor bleeding can be arterial, venous, capillary and mixed. Its intensity depends on the type and caliber of the damaged vessel.

Arterial bleedingrecognize the scarlet color of blood and its pulsating fountain-shaped jet. Such bleeding is most dangerous.

Venous bleedingas a rule, not so intense, the jet can be quite powerful, but does not pulsate, but flows continuously. Although, with bleeding from a subclavian or jugular vein, the blood can flow in an intermittent jet, synchronously breathing.

Blood color dark cherry.

For capillary bleedingblood is dark red, flowing from the entire surface of the wound, separate bleeding vessels are not visible. Such bleeding is observed with shallow cuts of the skin, abrasions.

Mixed bleedingas a rule, combines the number of above-mentioned signs.

7.1. Finger pressed vessel

The method is applied to temporary stop arterialbleeding on the limbs, neck, head. Pressing is made above the bleeding place, where there is no large muscular massif, where the arterie is not very deep and can be attached to the bone. The artery is squeezed with a finger, palm, fist at certain points. The most important of them are indicated in Fig. 7-1.

Fig. 7-1.Temporary shovel bleeding with finger pressed. 1 - temporal; 2 - occipital; 3 - maxillary; 4 - Sleepy; 5 - connectible; 6 - axillary; 7 - shoulder; 8 - radiation; 9 - elbow; 10, 11 - femoral; 12, 13 - Targertic artery

The test area is the place of comprehension of the subclavian artery, where it is pressed to the I edge at the point, located above the clavicle, immediately the duck from the place of attachment of the breast-curable-bed-like muscle to the sternum handle; In the axillary yam where the cerval artery can be survived by pressing the head shoulder bone; Pakhovy fold - the area for pressing the common femoral artery to the LONA bone; The inner surface of the double muscle - for the artery of the hand; Neck at the inner edge of the sternum-clavish muscle, near its middle, zone, where the carotid artery is pressed against the transverse process of the Vi cervical vertebra; On the inner surface of the hip in the upper and middle third, you can try to press the femoral artery to the femoral bone; The popliteal artery is squeezed in a ponated jam, to the distal part of the femoral dice with a slightly bent knee joint; The rear tibia artery can be survived immediately behind the inner ankle; The back artery of the foot is pressed on the front surface of the foot of the extensor tendon thumb; On the face you can easily find a surface temporal artery lying directly

but on the bone at the point located in front of the auditory pass; Bleeding from the cheek easily stops pressing the face artery to the horizontal part of the lower jaw.

Indications:first actions to stop arterial bleeding; The first before applying other methods. Benefits:

Speed \u200b\u200b(almost instant) application;

The possibility of using in anatomically complex areas (head, neck, axillary, subclavian, groove area);

The most gentle method of stopping bleeding. Disadvantages:

At the finger, the vessel is squeezed by nearby nerve trunks and a very sensitive periosteum, which is quite painful;

Long-term cessation of bleeding this method is impossible due to the rapid fatigue of the hand, assisting;

The use of this method significantly reduces the intensity of bleeding, but does not stop it completely due to collateral blood flow;

because of anatomical features The arrangement of the arteries (sleepy connectible, tunched, poning) or complex nature of their damage to the finger pressed is sometimes inefficient.

In some cases (the presence of sterile gloves, good visualization of the source of bleeding) the finger compression of the vessel can be produced directly in the wound (Fig. 7-2).

When wounds, it is also possible to use the finger pressed, which is performed distal than the wound.

Fig. 7-2.Stop bleeding to the finger squeezing of vessels in the wound

7.2. Temporary stop of bleeding with the maximum flexion of the limb in the joint

Stopping bleeding with maximum flexion in the joint is possible: with damage to the plug-in and axillary arteries by maximizing the arm of the hand back and pressing it to the back. Thus, the artery is squeezed between the collar and I edge (Fig. 7-3 A); When the arteries of the upper third of the thigh and the groin region - flexion in the hip joint (b); In case of damage to the patellied artery - the bending of the knee joint (B); in locks Susta - If there is damage to the shoulder artery in the elbow bending (g). Use of this method to stop bleeding from distal departments The limbs are possible, but not advisable, since there are other optimal methods for such damage.

Fig. 7-3.Stop bleeding bending flexion in the joint

Indications:

Stop all types of bleeding from the groove, poning and elbow area;

The first stage before applying other methods. Benefits:

Speed \u200b\u200bof use;

The possibility of using in areas where the location of the vessels is deeply and difficult to access (ink and subcircuit region, poning and axillary yam);

The possibility of applying at a minimum of dressing material and remedies.

Disadvantages:

Reflexing limbs in the joint may be inefficient, especially when the subclavian vein is damaged;

Sometimes this method may be painful or uncomfortable.

7.3. Rose bandage

The imposition of the gulfed bandage on the area of \u200b\u200bthe bleeding wound causes an increase in urban pressure and squeezing the lumen of damaged vessels, which contributes to the formation of an intra-road thrombus. A qualified imposition of the gulling bandage can stop bleeding even from a large arterial vessel and in anatomically complex areas.

The appliances imposition of the gulling bandage: first should be checked if the wound does not contain foreign objects (glass fragments, pieces of wood or metal), release the place of injury from clothes and lift the damaged limb above the level of the heart, while the patient is lying. After that, there are several layers of sterile gauze on the wound, and in its absence, the laying of pure fabric (nasal handkerchief, a piece of sheets, etc.) and the edges of the wound are tightly pressed, while bringing them to each other as close as possible. On top of gauze to enhance the compression, a pad of a tight lump of cotton wool or rolled fabric and tight bintuit are mounted. The situation is simplified if there are official funds in the presence, in particular the individual dressing package (Fig. 7-4 A, b).

Fig. 7-4.Overlaying the gulling bandage using an individual dressing package (IPP) (A, B)

Indication:any wound, mainly limbs.

Advantage:the most gentle and fairly effective way to stop any bleeding. Disadvantages:

Not in all cases ensures the stopping of bleeding when the wounded of large arteries;

Tissue compression causes a circulatory disruption in the peripheral limbs.

7.4. Overlay zhgut

Among the various ways to temporarily stop bleeding, the harness is the most reliable and fairly fast. The imposition of the harness is carried out circular squeezing of soft fabrics of the limb along with blood vessels and pressed them to the bone. The imposition of a harness is shown only with strong arterial bleeding from the artery of the limb,in all other cases, this method is not recommended.

The elastic harness of Esmark received the greatest spread. It is a strong elastic rubber tube or a strip of up to 1.5 m long, to the ends of which the chain and hook used to secure it or other devices (Fig. 7-5) are attached.

In the absence of a standard harness, it is possible to use different submitted devices (spin, harness with a pelot, any durable rubber tube with a diameter of 1-1.5 cm, rubber bandage, belt, handkerchief, a piece of matter, etc.) (Fig. 7-6), pneumomagets from a tonometer (Fig. 7-7).

Fig. 7-5.Harness hemostatic rubber type Esmark (TU 38.106002-95)

Fig. 7-6.Stop bleeding with remedies. a - twist with a pelot; B - spin soft cloth without pelota

Fig. 7-7.Stop bleeding with a tonometer pneumomage

At the same time, it only needs to be remembered that rude rigid items, type of wire or ropes are not recommended to be applied due to the danger of nerve damage.

The technique of overlaying rubber harness:to prevent the skin infringement under the harness put the towel, wounded clothes, etc. The limb is somewhat up, the harness is fed under limb, stretch (Fig. 7-8) and are wrapped around the limb several times, without weakening the tension (Fig. 7-9), until cease-bleeding. Tours of the harness must lie next to each other without reducing the skin (Fig. 7-10). The ends of the harness are fixed using a chain and hook over all tours. Fabrics must be tightened only before stopping bleeding.

Fig. 7-8.The technique of overlaying the rubber harness, stretching the harness

Fig. 7-9.Technique overlay rubber harness. The imposition of a harness with its constant stretching

With correctly imposed harness, arterial bleeding immediately stops, the limb pale, the ripple of the vessels below the imposed harness stops. Excessive tightening of the harness can cause the scramble of soft tissues (muscles, nerves, vessels) and cause the development of paralysis of the limbs. Weakly tightened harness bleeding does not stop, but on the contrary, creates venous stagnation (The limb will not be pale, but acquires a blue color) and enhances venous bleeding. Harness must lie so that he rushes into the eyes. After applying the harness, immobilization of the limb should be made. In connection with the complete cessation of blood circulation in the limb when the hemostatic harness is applied, a direct threat of death is created, so

Fig. 7-10.The technique of overlaying a rubber harness: the coils of the harness fall one to another

Fig. 7-11.The technique of overlaying the rubber harness: note indicating the overlay time

harness should not compress the limb more than 2 hoursHowever, if there is an opportunity, then every hour you need to shoot and check whether the bleeding stopped and it is time to replace the harness by the gouring bandage. If it continues, the bleeding artery should be sealing over, and the harness is re-applied in 15 minutes somewhat higher or lower. And again no more than an hour. In the accompanying document of the wounded or on a piece of white oilcloth attached to the harness (Fig. 7-11), it is necessary to specify the exact time (hours, minutes) of the harness, the signature of the assistance. Typical places of imposition of Esmark harness to stop bleeding are shown in Fig. 7-12. However, it is believed that the imposition of a harness on the forearm of some is considered little effective due to the deep location of the vessels between the two bones of the forearm. Moreover,

Fig. 7-12.Typical places of imposition of Esmark harness to stop bleeding.

1 - on the shin; 2 - on the thigh; 3 - shoulder; 4 - shoulder (high) with fixation to the body;

5 - on the thigh (high) with fixation to the body

it should be remembered that the imposition of a harness in the middle of the shoulder is contraindicated due to the possibility of squeezing the radial nerve. Indications:

Traumatic amputation limbs;

The inability to stop the bleeding by other known means. Benefits:

Quite fast and most effective way to stop bleeding from the finiteness arteries.

Disadvantages:

The use of the harness leads to a complete bleeding of the distal sections of the extremities due to the compression of not only damaged main vessels, but also collaterals, which for more than 2 hours can lead to gangrene;

Nervous trunks are squeezed out, which is the cause of post-traumatic plexitis, followed by pain and orthopedic syndrome;

The cessation of blood circulation in the limb reduces the resistance of infection tissues and reduces their regenerative abilities;

The use of a harness can cause pronounced angiospasm and lead to thrombosis of the operated artery;

The reduction of blood circulation after applying the harness contributes to the development of turnstip shock and acute renal failure;

The use of the harness is impossible on the torso or limited in anatomically difficult regions.

Errors:

Use it without reading. with venous and capillary bleeding;

Overlay on a naked body;

Far from the wound;

Weak or excessive tightening;

Bad fixation of the ends of the harness;

Lack of accompanying note;

Use more than 2 hours;

Closing harness with bandage or clothing.

Contraindications:it is not recommended to apply the harness to the limbs affected by an acute surgical infection, or during the damage to the vessels (arteriosclerosis, thrombophlebitis, etc.), as this can contribute to the spread of the process or the development of embolism.

Technique of circular measurement of the limb to the twisting of the utility funds:used for spin item freely tie to the desired level. In the formed loop, a stick or a plate is carried out and, rotating it, spin the loop until the bleeding stops, after which the stick is fixed to the limbs. The imposition of the spin is a rather painful procedure, so it is necessary to twist, especially under the node, something to put. All errors, dangers and complications observed when the harness is applied, and the scope is fully related to the twist.

I would like to once again focus on the fact that, according to the experience of vascular surgery, the unreasonable use of the harness takes place in 70-80% of cases. This occurs in cases of veins damage, the learn limbs, bruised and ribbon wounds, when a properly imposed applied gulling bandage is quite effective.

7.5. Tamponade wounds

Effective way to stop bleeding in anatomically complex areas of pelvis, neck, belly, chest, buttocks, i.e. Where the main arteries are located quite deeply behind the muscle layer and the use of harness and the gulling bandage is problematic. It is especially advisable in the presence of narrow wound channels in a large muscular array (wounded by a subclavian, cercel artery).

For the tamponade wounds, a gauze swab is introduced by a tool, filling the wounds with effort necessary to stop bleeding. Indications:bleeding from wounds on the torso and neck.

Benefits:the possibility of effective and safe use in anatomically complex zones. Disadvantages:

Difficulties of use in the prehospital stage;

The presence of practical skills;

The possibility of infecting the wound and distribution of continued thrombosis.

7.6. Local use of hemostatic agents

To stop the capillary and parenchymathic bleeding or bleeding from small vessels of muscles and bones, especially in patients with a tendency to hypocoagulation, the hemostatic effect is enhanced by the use of hemostatic sponge. Using sponge when bleeding from large vessels is inefficient.

Hemostatic sponge (hemostatic sponge with amben, hemostatic sponge collagen, "Takhokomb"): Externally, there is a type of plate of dried foam and is a native plasma with the addition of thromboplastin and calcium chloride. Its modern modification (Fig. 7-13) is made from the animal collagen with the blood coagulation factor associated with it: thrombin, fibrinogen and fibrinolysis inhibitors. After contact with a bleeding wound or other liquids, blood coagulation factors dissolve and create connections between the carrier - the collagen and the wound surface. Skipping peptides, thrombin converts fibrinogen to fibrin. Like two-component glue, the wound surface and collagen glued together during the polymerization. Fibrinolysis inhibitors prevent the premature dissolution of fibrin plasmin. Sponge components are degraded in the body under the action of enzymes within 3-6 weeks.

Application technique:by observing sterility, scissors reveal the package and get the plate with a sponge. The dosage depends on the size of the wound, which should be closed. The plate with the hemostatic should close the area, 1-2 cm greater than the immediate surface of the wound. If there are several plates for this, they must be superimposed by the edges. If the wound is small, then the preparation can be cut with sterile scissors to the required size (Fig. 7-14). Before imposing on the surface of the wound, the blood should be as much as possible, which is achieved by the rapid drainage of gauze

Fig. 7-13.Gematostatic tool of local action: hemostatic sponge collagen

Fig. 7-14.Stop bleeding with a hemostatic sponge

napkins. After that, pieces of sponge are pressed by a gauze ball to a bleeding surface for 3-5 minutes. A sponge can be placed in a gauze tampon for loose tamponads of the cavity. The tampon is removed after 24 hours. If necessary, the chopped sponge covers the entire wound surface, it is also permissible to spray with a syringe or sprayer. Indications:

Capillary and parenchymatous bleeding, bleeding from bones, muscles, nasal, gum and other outer bleeding;

The same types of bleeding in patients with blood clotting impaired (thrombocytopenic purpura, leukemia, hemorrhagic thrombocytopathy, radius-osaler disease, liver cirrhosis, local increasing fibrinolytic blood activity and general fibrinolysis, etc.);

Continuing bleeding when using the gulling bandage and wound tamponade.

Benefits:high efficiency and safety. Disadvantages:allergic reactions are possible.

7.7. The imposition of hemostatic clamping

As a method of temporary stopping bleeding in the conditions of the first medical care this method Used in exceptional cases when bleeding from deep pelvis and abdominal vessels. The imposition of the hemostatic clamp on the damaged vessel with leaving it in the wound is one of the most reliable ways to stop bleeding.

Application technique: If the source of bleeding is not clearly visualized, the edges of the wound are pushing with hooks. It is desirable sterile, the hemostatic clamp should be carefully, in the "dry" wound, as close as possible and perpendicular to the place of damage to the vessel (Fig. 7-15). This is necessary in order not to turn off the collateral and do not apply additional artery injury, which may complicate the execution of the rehabilitation operation on the vessels. The clamps are left in the wound and close a aseptic bandage.

Indications:gaping wounds with a clear visualization of the source of bleeding in complex anatomical zones when it is impossible and ineffectiveness of other methods.

Benefits:

High efficiency;

Preservation collateral blood circulation. Disadvantages:

Danger of damage to nearby nerves;

The probability of crushing the vessels at a high outrest;

The need for surgical skills.

Fig. 7-15.The imposition of hemostatic clips on the vessel in the wound

The imposition of hemostatic clamps in the wound as a method of temporary stopping bleeding to arterial not trunk vessels can be the way the final stop of bleeding. To do this, a damaged vessel under the clip must be tied with a sterile fine thread. When bleeding, so that bleeding from small vessels is completely stopped, sometimes it is enough to impose clamp and hold for 10-15 minutes, and then spinning several times along the axis, remove.

Thus, the algorithm for stopping outdoor bleeding is as follows: first of all determine the type of bleeding, which may be arterial (main, not trunk) venous, capillary and mixed.

Capillary bleeding is stopped by applying a conventional bandage. The hemostatic effect is enhanced by loosely rubbing the wound surface with sterile wipes with 3% hydrogen peroxide or when the hemostatic sponge is applied.

Venous bleeding - a grazing bandage during the injury of limbs, on the body and neck - wound tamponade. At the time of preparing the dressing material, the bleeding can be reduced by raising the finiteness up by pressing the damaged vessel (distal) of the wound, or, in the extreme case, putting the distal wound "venous harness", squeezing only veins and non-body blood circulation. The effectiveness of the "venous" harness is judged by the cessation of bleeding in the distinct pulsation of the arteries below the wound.

Blood bleeding from a non-magic vessel stops, as well as venous, gulling bandage or tamponade. To prepare for the imposition of the dressing, the bleeding vessel is compressed above (proximal) wounds (Fig. 7-16).

Fig. 7-16.Stages of stopping arterial bleeding from a non-magbust vessel. A - arterial bleeding; b - temporary stopping of bleeding by pressing the artery for the proximal wound; B - the overlay of the gag

In the arterial bleeding from the main vessel, the first measure should produce a finger compression or maximum flexion in the joint, and then apply the gulling bandage. If the bandage rises with blood ("dripping"), above the wounds should be imposed harness and again try to carry out hemostasis of the gulling bandage, amplifying the local compression of the damaged area or fixing the limb in the maximum bending position. Only the ineffectiveness of these measures dictates the need to use the harness. Bleeding from the anatomical areas inaccessible to the gulling dressing and harness, stop the tamponade, and when it is ineffective, the hemostatic clamp.

In all cases, after a temporary stop of bleeding, it is necessary to lift the injured finiteness above the body, which reduces blood flow, improves the ability to form a thrombus.

Summing up the foregoing, I would like to emphasize that the fate of the victim with outer bleeding depends primarily from the rapid and correct actions of persons providing first medical care and have no vascular surgeons, but general practitioners.

Fully moments so that the person faces the high probability of danger to his life. Qualified medical care is only on the approach, and the blood loss from the wound from the rupture of the artery threatens with a fatal outcome. 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 reboot and apply coverage with hand, pressing big finger broken 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.

What is the shining of sleepy arteries

Wounded unusually lucky if his lifeguard is familiar with anatomical structure human organism And knows the points of exposure to 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:

• shoulder;
• femoral;
• sleepy;
• jewish;
• temporal;
• connect.

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 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.

Finger pressed The arteries during bleeding is temporary and is made in case of emergency assistance to the victim before 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 with visible internal bleeding, the discharge of blood can not be manifested immediately, but after 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 is dulled over a certain surface of the 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.

What arterial pressure and in which units is measured

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.

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 wall damage. 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) to press the artery to the toed bone with an effort, slightly exceeding blood pressure. 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 a dark and temporal area, pressing the temporal artery to the temporal bone in the temple area in front and above the ear of the ear (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 Ran of shin and foot the popliteal 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 from behind, and gripping the knee joint with the brushes.

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.

1. General Sleepy - the middle of the breast-culshigious-bed-like muscle to 6 cervical vertebra.
2. Outdoor jaws - Lower edge of the lower jaw on the border of the rear and middle third.
3. Temple - In the area of \u200b\u200bthe temple, above the goat.
4. Connectible - the middle of the screwdriver to the tubercle 1 ribs or pulling the hands down and back.

1. Migratic - In the axillary depression to the head of the shoulder bone.
2. Shoulder - To the shoulder bone at the inner edge of the double muscle.
3. Radius - To radial dice, where the pulse is determined.
4. Femoral - in the middle of the tipparent bundle to the horizontal branch of the Lonny bone.

1. Podconde - By the middle of the poplings.
2. Rear artery foot - In the middle between the outer and inner ankles.
3. Rear tibial - To the rear surface of the inner ankle.
4. Abdominal Aorta - fist to the left of the navel to the spine.

Fig. Arteries 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.

Figure. Supplements 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.

Wound - It is mechanical damage to the skin or mucous membranes with possible damage to the deep tissues.

The magnitude of the outer bleeding depends on the type of wound, as well as the place on the human body, where the intake of the intake or mucous membranes occurred.

Classification of the Russian Academy of Sciences:

1. By the nature of damage:

Ø Koloty - applied with a stitching weapon, awl, needle. Characteristic of a slight surface damage, mucous membrane, but deep wound channel. With them the bleeding is minimal, but there may be damage internal organs, nerves, strong internal bleedingDeep infection is often infected. Do not assign anesthetic!

Ø Rezany - applied with cutting tools. It is characteristic of the minimum damage to the tissues (only in the lines of the cut), are not infected, the wound zyns (the edges of the wound diverge), heals the primary tension. These wounds are most favorable in their clinical flow.

Ø Chilled - applied with a chopping subject (ax). Characteristically deep damage to fabrics, the gaping wound, surrounding fabrics - bruised and shocked, and this worsens healing, more often infected.

Ø Harrant and ribany - There are a stupid subject, falling. Characterized by a large number of bruised, sophisticated tissues, edges of ribbons, unnaviable, often infected.

Ø Branched - Extensive and deep, are richly infected, the presence of rabies virus - therefore vaccination against rabies is necessary.

Ø Poisoned - Applied by any instrument with the presence of poison, bites poisonous snakes and insects. The value is paid to the poison that has occurred to the body.

Ø Firearms – highlight 3 zones:

ü 1 zone - wound channel - complete death of all tissues;

ü 2 zone - traumatic necrosis - caused by the impact of the temperature factor - tissue burns;

ü 3 zone - molecular concussion - caused by a shock wave.

2. Taking into account the cause of damage:

Ø Operating (aseptic ) - are formed in surgical operations performed in aseptic conditions;

Ø Random - always infected;

Ø B. special group Highlight battle wounds.

3. Depending on the presence in the wound of the microbial flora:

Ø Aseptic - only operating;

Ø Infected - all random wounds;

Ø Purulent - These are wounds in which inflammation has already begun.

4. In relation to body cavities:

Ø Penetrating - in the cavity of the chest, abdomen, skull, joint, etc.;

Ø Impenetrable - Damage is limited to the wall of the cavities.

5. Depending on the affecting factors:

Ø Uncomplicated - damage is limited only to mechanical damage to the tissues;

Ø Complicated - In addition to mechanical, the action of other factors is joined: poison, poisoning, radioactive substances, infections, burns or frostbite.

Clinical picture Tied with general disorders and local symptoms is pain, bleeding, wound gaping.

In a situation where strong bleeding is impossible to stop the gulling bandage, you need to notify the finger pressed arteries. This is one of the most effective ways Providing first aid, which in an emergency allows you to preserve the life of the victim.

What features are arterial bleeding determine? There are several types of bleeding - it is arterial, venous and capillary. Arterial blood loss is damage to the artery, according to which the blood flows from the heart to the tissues and organs. Blood in artery is enriched with oxygen, so it has a bright scarlet color. In contrast to venous bleeding, when blood flows out of the wound very slowly, the blood loss flows quickly, under high pressure, throwing a pulsating stream of blood. Arterial bleeding is dangerous for human life. The finger pressed artery is used not only in case of injury and falls, to this method Surgeons are often resorted if the arterial barrel is damaged during the operation.

How to stop bleeding?

Do not be afraid of this manipulation. The damaged vessel is impossible to squeeze with fingers, because it is not visible in the bleeding defeat, scraps of clothing fabric and bone fragments. In case of arterial bleeding, it is necessary to overpace the main vessel not in the wound itself, but slightly higher. As a result, the inflow of blood to the area of \u200b\u200bdamage will decrease.

Not everyone knows the basic rules of anatomy, therefore the one who will carry a finger press, should know where the main points of the location of the vessels and arteries are located. They are placed exactly in the direction of vessels and the nearest bone formations. So that the method of emergency blood stop by pressing the vessels was effective, the artery must be clamped from both sides.

This method of emergency care is categorically unacceptable if the bone is broken at the point of intended compression. This means that the artery must be compressed with two hands for 10 minutes. If this time is not enough to complete bleeding, the procedure is repeated again.

Basic rules for the provision of emergency first aid for bleeding:

1. 1. It is impossible to slow, every minute can cost the life of the victim. It is important to make an instant assessment of the situation and start acting.
2. 2. If necessary, you can cut or tear clothes, if required for high-quality wound inspection.
3. 3. The method of finger pressed artery is carried out by thumbs. They are pressed at the desired point. If the victim has started convulsions and severe pains in the limbs, it is possible to press the point with a fist.
4. 4. In the event of an indefinite cause of blood loss on the wound, you can put the palm. So do when the abdomen's wounds are open.
5. 5. Press the point on the artery you need to the point until the gullings are applied.

Finding the desired points on the body

Consider in more detail the main places of finger pressed:

1. 1. To perform the clamp of the shoulder artery, find a zone located between the shoulder muscles. The upper limb of the injured person raise and lay down. The one who provides assistance should be located behind the victim.
2. 2. If you need to hold the shoulder vessel, the point of pressed is located between the shoulder muscles, just below the shoulder joint. Fasting the necessary point, it should be strongly pressed against the bone.
3. 3. If blood loss is localized at the top of the shoulder, this may be due to the impairment of the axillary artery. The roast is carried out from the inner part of the shoulder bone, the circular coverage of the shoulder with two thumbs in the area of \u200b\u200bthe axillary depression.
4. 4. The clamping point of the femoral artery is located in the groin area, approximately on the middle fold. At this point, the artery is strongly pressed against the femoral bone. It is important to take into account some of the features of the femoral artery:

• a person who has the first help must be located on the side of the damaged thigh, standing on his knees;
• the thumbnails pressed the inguinal point, and the remaining fingers of the brush worst the thigh;
• it is necessary to crush as stronger as possible, pressing the weight of your body, overlooking the hands.

On time, the combined artery compression measures are equivalent to a new birth, since a minute of delay can cost life. Sleepy artery is clamped with damage to the head, vessels of the submandibular region, injuries of the top of the neck. The provision of first aid is complicated by the fact that it is impossible to wind a tight circular bandage on the neck, since the victim just suffocates.

It is necessary to properly compress the carotid artery:

1. 1. The point is pressed with a thumb hand, while at the same time the remaining fingers are located on the occipital part of the wounded.
2. 2. It is necessary to take into account the direction of the flow of the blood flop in the carotid artery. The vessel is shifted just below the break point.
3. 3. The required point is located approximately in the middle of the cervical muscle. To determine this place, you need to turn the head of the victim to the opposite direction.
4. 4. Sleepy artery requires to press the copper vertebrals.

How to clamp connective and temporal vessels?

In a situation where the vessels of the head of the shoulder joint and neck are damaged, you must press the subclavian artery. For this, the thumbs need to press the point behind the clavicle, pressing it to the first edge. The complexity of another situation is that it is on the face that a large number of blood vessels are focused. If the lower part of the person is damaged, then for an emergency stop of blood, it is necessary to hold the jaw artery. The arterily located in the temporal part is pressed with a finger at a point located just above the ear shell.