Bleeding- outpouring of blood from blood vessels in violation of the integrity of their walls. Depending on the type of damaged blood vessels, bleeding can be arterial, venous, capillary and mixed. Of particular danger to life are arterial bleeding, when under high pressure the blood is poured either outward or into the body cavity during internal bleeding. A decrease in the volume of circulating blood (normally about 5 liters in a person) leads to a deterioration in the supply of oxygen to the heart, lungs, liver, kidneys, and brain. Bleeding is the most dangerous complication of wounds, directly threatening life. Bleeding refers to the release of blood from damaged blood vessels. It can be primary when it occurs immediately after vascular damage, and secondary if it appears after some time.

Depending on the nature of the damaged vessels, arterial, venous, capillary and parenchymal bleeding is distinguished.

Most dangerous arterial bleeding, in which a significant amount of blood can flow out of the body in a short time. Signs of arterial bleeding are the scarlet color of the blood, its outflow in a pulsating stream. Venous bleeding, unlike arterial bleeding, is characterized by a continuous outflow of blood, which has a darker color, while there is no obvious jet. capillary bleeding occurs when small vessels of the skin, subcutaneous tissue and muscles are damaged. With capillary bleeding, the entire surface of the wound bleeds. Parenchymal bleeding occurs when internal organs are damaged: the liver, spleen, kidneys, lungs (it is always life-threatening).

Bleeding can be external and internal. At outsidenom bleeding, blood flows out through the wound of the skin and visible mucous membranes or from the cavities.

At domestic bleeding blood pours into the tissue, organ or cavity, which is called hemorrhage. When tissue bleeds, blood soaks it, forming a swelling called an infiltrate or bruise. If the blood impregnates the tissues unevenly and, as a result of their expansion, a limited cavity filled with blood is formed, it is called a hematoma. Acute loss of 1-2 liters of blood, especially in severe combined lesions, can lead to death.

Signs of external bleeding: - arterial: blood is bright red, pours out in a pulsating stream; - venous: blood is dark red, flows out in a uniform stream; - capillary: blood is released over the entire surface of the wound.

First aid for bleeding

Depending on the type of bleeding (arterial, venous, capillary) and the means available in the provision of first aid, it is temporarily or permanently stopped.

A temporary stop of the most life-threatening external arterial bleeding is achieved by applying a tourniquet or twist, fixing the limb in the position of maximum flexion, pressing the artery above the site of its injury with the fingers. The carotid artery is pressed below the wound. Finger pressing of the arteries is the most affordable and fastest way to temporarily stop arterial bleeding. The arteries are compressed where they pass near or over the bone.

The temporal artery is pressed with the thumb against the temporal bone in front of the auricle when bleeding from head wounds.

Mandibular artery pressed with the thumb to the angle of the lower jaw when bleeding from wounds located on the face.

common carotid artery pressed against the vertebrae on the front surface of the neck on the side of the larynx. Then a pressure bandage is applied, under which a dense roller of bandage, napkins or cotton wool is placed on the damaged artery.

subclavian artery pressed against the 1st rib in the fossa above the clavicle with a bleeding wound in the shoulder joint, upper third of the shoulder or in the armpit.

When the wound is located in the region of the middle or lower third of the shoulder, the axillary artery is pressed against the head of the humerus, for which, leaning with the thumb on the upper surface of the shoulder joint, the rest squeeze the artery.

The brachial artery is pressed against the humerus from the inside of the shoulder to the side of the biceps muscle.

The radial artery is pressed against the underlying bone in the wrist at the thumb in case of damage to the arteries of the hand.

The femoral artery is pressed in the groin against the pubic bone by pressing with a clenched fist (this is done when the femoral artery is damaged in the middle and lower thirds). In case of arterial bleeding from a wound located in the region of the leg or foot, the popliteal artery is pressed in the region of the popliteal fossa, for which the thumbs are placed on the anterior surface of the knee joint, and the rest are pressed against the artery to the bone.

On the foot, the arteries of the rear of the foot can be pressed against the underlying bones , then apply a pressure bandage on the foot, and in case of severe arterial bleeding - a tourniquet on the shin area.

After performing finger pressing of the vessel, it is necessary to quickly apply, where possible, a tourniquet or twist and a sterile dressing on the wound.

The imposition of a tourniquet (twisting) is the main way to temporarily stop bleeding in case of damage to large arterial vessels of the extremities. The tourniquet is applied to the thigh, lower leg, shoulder and forearm above the site of bleeding, closer to the wound, on clothing or a soft bandage lining so as not to pinch the skin. It is applied with such force to stop the bleeding. With too much compression of the tissues, the nerve trunks of the limb are injured to a greater extent. If the tourniquet is not applied tightly enough, arterial bleeding increases, since only the veins are compressed, through which the outflow of blood from the limb is carried out. The correct application of the tourniquet is controlled by the absence of a pulse in the peripheral vessel.

The time of application of the tourniquet with the date, hour and minute is noted v a note that is placed under the tourniquet so that it is clearly visible. The limb, tied with a tourniquet, is warmly covered, especially in winter, but not covered with heating pads. The affected person is injected with an analgesic from a syringe tube.

The syringe-tube (Fig. 8) consists of a polyethylene body, an injection needle and a protective cap; It is intended for single administration of drugs intramuscularly or subcutaneously.

To administer an analgesic, the syringe tube is taken by the body with the right hand, the ribbed rim of the cannula is taken with the left hand, the body is turned until it stops. Remove the cap protecting the needle. Without touching the needle with your hands, it is injected into the soft tissues of the upper third of the outer surface of the thigh, the upper third of the shoulder from behind, into the outer upper quadrant of the buttocks. Strongly squeezing the body of the syringe tube with your fingers, squeeze out the contents and, without opening your fingers, remove the needle. The used syringe-tube is pinned to the clothes of the affected person on the chest, which at the subsequent stages of evacuation indicates the introduction of an analgesic to him.

The tourniquet on the limb should be kept for no more than 1.5-2 hours in order to avoid its necrosis below the place where the tourniquet was applied. In cases where 2 hours have passed since its application, it is necessary to press the artery with a finger, slowly, under pulse control, loosen the tourniquet for 5-10 minutes and then apply it again a little higher than the previous place. This temporary removal of the tourniquet is repeated every hour until the affected person is provided with surgical assistance, while each time a note is made. If the tourniquet is tubular, without a chain and a hook at the ends, its ends are tied into a knot.

The main task with bleeding is to stop it as soon as possible. To do this, it is necessary: ​​- to press the artery above the level of damage (Fig. 9 c). The location of the arteries and the places of their pressing in case of bleeding are shown in Fig. 9 b, c. - apply a pressure bandage to temporarily stop bleeding (venous, capillary, as well as from small arteries). Considering that in children the arteries are more elastic, and blood pressure is lower than in adults, even arterial bleeding can be stopped with a pressure bandage!

Rice. 9. Scheme of the human arterial network and points of digital pressure of the arteries to stop bleeding.

Technics applying a pressure bandage: a clean, preferably sterile, gauze napkin is applied to the wound, a tightly folded lump of cotton wool is placed on top of it, after which it is tightly bandaged with circular bandages. The use of a hemostatic tourniquet is indicated for damage to large arteries of the extremities.

1. A tourniquet is applied in case of damage major arterial vessels.

2. In case of bleeding from the arteries of the upper limb, place the tourniquet on the upper third of the shoulder; with bleeding from the artery of the lower limb - on the middle third of the thigh.

3. The tourniquet is applied to the raised limb. A soft pad is laid under the tourniquet: bandage, clothes, etc.

4. The tourniquet is applied tightly, but not unnecessarily. Be sure to attach paper indicating the time of its application.

5. The tourniquet cannot be kept for more than 1 hour, if the time of evacuation of the affected person to the medical institution is delayed, it is necessary to loosen the tourniquet for 10-15 minutes every 20 minutes.

6. If the rescuer does not have a special tourniquet at hand, improvised means can be used: a scarf, tie, suspender, belt, etc.

7. When a part of a limb is torn off, a tourniquet is necessarily applied, even in the absence of bleeding.

If possible, the tourniquet is applied as close to the wound as possible, but not closer than 4-5 cm, in order to reduce the ischemia zone between the tourniquet and the wound. Do not apply cold to a limb with a tourniquet.

1 - from the arteries of the lower third of the leg; 2 - femoral artery; 3 - arteries of the forearm; 4 - brachial artery; 5 - axillary artery; 6 - external iliac artery.

The improvised means used should be at least 2-3 cm wide. Very thin cords, strings, wires (everything that has a circular cross section in diameter) can cut through the skin along with vessels that have not yet been damaged. The use of rubber tubes leads to damage (necrosis) of the skin. A tourniquet is the last resort.

To prevent damage to blood vessels and nerves, the width of the tourniquet should be at least 5 cm. You can apply a cuff from the pressure measuring device above the bleeding site (without applying it to the joint) and inflate it to a level of 300 mm Hg. The overlay time is recorded. Vessel clamping is performed only if life-threatening bleeding continues.

Remember that a tourniquet for arterial bleeding must be applied above the site of bleeding (closer to the heart) and closer to the site of injury in order to bleed as little of the limb as possible. You must first raise this limb. In the area of ​​​​the wrist and ankles, it is useless to apply a tourniquet.

A rubber tourniquet is applied in a “male” or “female” way. The first requires a lot of physical effort. The tourniquet is applied to the limb with its middle from the side of the projection of the vessel; its two halves are immediately pulled, quickly wrapped once around the limb and fixed with a knot or hook with a chain. With the “female” method, the rubber band is applied to the body with one end with a slight indent (you need to leave the tourniquet section free for subsequent fixation). Then they make several turns around the limb, while one round of the rubber band is placed on the previous one or next to it with moderate tension.

The ends of the tourniquet are brought together and fixed. With a weak application of the tourniquet, the arteries are not completely clamped, and bleeding continues. Due to the fact that the veins are clamped with a tourniquet, the limb becomes filled with blood, its skin becomes cyanotic, bleeding may increase. In case of severe compression of the limb with a tourniquet, the nerves are injured, which can lead to paralysis of the limb. Proper application of the tourniquet leads to stopping the bleeding and blanching of the skin of the limb. The degree of compression of the limb with a tourniquet is determined by the pulse on the artery below the place of its application. If the pulse disappeared, then the artery was squeezed by the tourniquet.

Having applied a tourniquet or twist to the limb, the wound is covered with a primary bandage. If the wounded was not taken to the medical center within 1 hour, it is necessary to press the corresponding artery with your fingers and then loosen the tourniquet. When the limb turns pink and warm, again apply a tourniquet above or below the previous place and stop pressing the vessel with your fingers. When removing the tourniquet, it must be loosened gradually. In the cold season, when applying a tourniquet or pressure bandage, the limb must be insulated. The tourniquet must always be visible.

A contraindication to the imposition of a tourniquet or twist is an inflammatory process.

Recently, the atraumatic ribbed hemostatic tourniquet of Dr. V.G. Bubnov. This tourniquet does not infringe the skin when applied and can be used on a bare limb; the tourniquet does not injure blood vessels and nerves, so it is tightened when applied with maximum effort; the tourniquet can remain on the body for 8-10 hours, since the ribbing of the tourniquet helps to maintain blood circulation in the skin and subcutaneous vessels, which is the prevention of necrotic processes in the distal limbs.

A tourniquet is a far from ideal solution to the problem of stopping bleeding. It is believed that the applied tourniquet inevitably leads to rough compression of large nerve trunks and the development of severe neuropathy in the later stages, i.e. damage to the nerves with a sharp violation of the functions of the limb. After 7-10 min. after applying a tourniquet, the victim has a feeling of unbearable tingling and a feeling of fullness, very severe pain. The tourniquet stops the blood flow through the main and collateral vessels below the applied tourniquet.

In the absence of an influx of oxygenated blood, metabolism proceeds according to the anoxic type. After removing the tourniquet, underoxidized products enter the general circulation, causing a sharp shift in the acid-base state to the acid side (acidosis), vascular tone decreases, and acute renal failure develops. The combination of the described damaging factors causes acute cardiovascular, and then multiple organ failure, referred to as tourniquet shock or crash syndrome.

This creates ideal conditions for the development of anaerobic infection, especially when the wound becomes infected. The application of a tourniquet, at best, is an opportunity to win some time for the first aid provider (with very severe arterial bleeding). In the absence of a tourniquet, a twist can be applied, which is made of soft but durable material (fragments of clothing, a piece of cloth, a soft trouser belt). At the same time, a strip of material is brought above the wound and closer to it and its ends are tied. Then insert a wooden stick and rotate it, while slowly tightening the twist until the bleeding stops. The free end of the stick is fixed with a bandage.

You can stop arterial bleeding by applying a pressure bandage to the wound, clamping the artery throughout and giving the injured limb an elevated position. Sometimes only the imposition of a pressure bandage is sufficient.

If a person, for one reason or another, has intense external bleeding, the slightest delay is dangerous to his health and life. That's why it's so important to know how to properly apply a tourniquet. It turns out that way.

Temporarily suspending the pathological process, we get a supply of precious time. Sometimes it is so necessary to wait for the doctors or bring the victim to the hospital.

The device we need is a tape or rubber tube 1.5 meters long with a fixing element on one side. Can be made from improvised means. Any person should know for how long a tourniquet can be applied.

All medical "devices" must be used strictly for their intended purpose. There are a number of cases when it is simply impossible to do without the use of a tourniquet:

Life-threatening bleeding on the injured limb, its severe crushing with numerous open wounds or complete separation. When normal airway patency is ensured, it is worth additionally considering the importance of using a tourniquet, which, if possible, is replaced by a more gentle hemostatic device.

1. Bleeding when other methods fail.
2. The area where bleeding is observed is not available for effective external pressure. In other words, there is no possibility of direct pressure on the affected focus.
3. Often a tourniquet is applied in situations where a large number of people with serious bleeding at the same time need emergency help (accidents, accidents, natural disasters).
4. The application of a tourniquet with damage or even subsequent loss of a limb is an alternative to death. The death of a person can occur from hypovolemic shock with unstoppable external bleeding.

Sequencing

It is important to know how to apply a tourniquet for arterial bleeding, as well as where to place it. As a standard, it is superimposed on the forearm or shoulder, lower leg, thigh.

Preliminarily, finger clamping of the damaged vessel is carried out with clean hands. The force on the wound should be such that the bleeding stops completely. In this case, a natural formation of a blood clot occurs, which prevents blood loss. Sequencing:

• Determine the severity of the bleeding.
• Choose the most correct place for fixing the pulling device.
• When asked whether it is possible to apply an arterial tourniquet directly to the skin, the unequivocal answer is no. A clean cloth is preliminarily underlain, excluding damage to the skin.
• It is necessary to stretch the tourniquet, place it just above the injured area. If there is a twisting mechanism, twist gently and in a spiral in several turns, and then fix it in any way provided. When using improvised means, a piece of rubber or a nylon stocking, for example, must be tied tightly, before wrapping several times around the limb.
• When applying a tourniquet on your own, be sure to fix a note in a convenient place indicating the date and exact time of first aid.
• An important step is to call an ambulance.

The sequence of actions when applying a tourniquet

How to determine that the hemostatic tourniquets are applied correctly.

First of all, the pulse disappears at the site of the affected vessel, the release of blood stops, blanching of the skin of the affected area is observed.

The victim must be warned that the described squeezing device is applied with a certain force to stop bleeding and causes pain. The person providing assistance is obliged to observe the exact time during which the tourniquet is used.

The complete absence of tissue blood supply leads to the development of necrosis, ischemia.

For how long can a hemostatic tourniquet be applied.

Any form of bleeding involves the imposition of the described products in the summer for no more than 2 hours, in the winter - up to 1.5 hours.

If it is necessary to hold bleeding for a long time, a tourniquet weakens briefly followed by finger pressing of the affected vessel, after which it is tightened again.

Fundamental rules

How to apply a tourniquet for arterial bleeding, so as not to harm the victim. The following recommendations should be followed:

1. The hemostatic device is placed as close as possible to the affected area, so injuries to healthy tissues are prevented.
2. The skin is protected by a soft cloth.
3. The fixed product is not covered with bandages, clothing, free access to it is required.

At the first opportunity, it is necessary to replace the compressive product with a pressure bandage (from a bandage or gauze). If not only the vessel is damaged, the blood flow is stopped only by means of a tourniquet as the most effective device.

Drag locations

With a correctly applied arterial tourniquet, a cessation of blood flow is noted, but the damaged area is not strongly constricted. Usually a squeezing device is placed 2-3 cm above the affected area:

• If the arm is injured, the tourniquet is located on the upper or lower third of the shoulder; it is not recommended to fix it on the forearm, because. there is a high risk of damage to the neurovascular bundle.
• In case of damage to the vessel on the lower limb, the upper or middle third of the thigh is pulled to avoid injury to the lower leg. Vessels in such places pass between the bones, due to which the compression is significantly worsened.
• Injury to the carotid artery, other parts of the head or face involves pre-covering the skin with a soft cloth. At the same time, the tourniquet does not tighten much, it is important to prevent poor blood circulation in the brain or complete suffocation of a person when providing assistance.

Importance of emergency first aid and common mistakes

You can often hear the question of when to immediately apply a tourniquet.

Massive damage to large arterial trunks (brachial, femoral artery) requires immediate pulling of the damaged part of the body until the blood flow stops completely.

Otherwise, the person may die. In the body, defense mechanisms do not have time to “turn on”, the heart in this state of affairs experiences a sharp shortage of blood, and its oxygen capacity is significantly reduced.

If it is impossible to apply a tourniquet, then in the first minutes after injury, the arteries are pressed with a hand, a pressure bandage. However, in such vessels, the walls are unyielding and thickened in comparison with the veins, and the blood pressure in them is also noticeable. Therefore, it is impossible to do without the dragging devices described before the arrival of the ambulance.

Always want to warn against potential mistakes. What signs can be found in a person if the tourniquets are applied incorrectly:

1. Using a tourniquet without sufficient evidence.
2. Pulling this product on bare skin may result in soft tissue injury.
3. Incorrectly chosen place for fixing the tightening device, for example, if the foot is damaged, the upper part of the thigh is pulled.
4. If the fixation of the device is not strong enough, only the veins are compressed, while congestive hyperemia occurs, the bleeding only intensifies.
5. Prolonged use of the tourniquet causes ischemic contracture, nerve damage, gangrene.

How to apply a tourniquet, while helping, and not harming the victim. It is important to immediately respond to the situation, assess the severity of the injury. Next, in accordance with the established rules, apply a tourniquet, completely stopping the bleeding. Don't know what to do with nosebleeds - read on.

The main goals of first aid for cuts:
1. Stop bleeding
2. Prevention of infection

Classification of bleeding:

ARTERIAL
The most severe type of bleeding. It occurs with deep cuts and shallow wounds in the joints. Such bleeding requires an IMMEDIATE stop, and the victim - hospitalization in a hospital. Characteristic signs:
a. The blood is bright scarlet.
b. It flows out in a pulsating jet under pressure.
v. Bleeding does not stop with peroxide treatment and tamponade of the wound.

VENOUS
Slightly less "light" kind of bleeding. It occurs with shallow cuts, cuts in the area of ​​\u200b\u200bthe joints. Characteristic signs:
a. The blood is dark red.
b. It flows out in a slow stream.
v. Bleeding stops for a while when treated with peroxide and tamponade of the wound.

CAPILLARY
The most favorable type of bleeding. Occurs with abrasions, shallow cuts.
Characteristic signs:
a. Red blood.
b. The entire surface of the wound bleeds.
v. Bleeding is easily stopped by treatment with peroxide and tamponade of the wound.

MIXED
Occurs most often. There may be combinations of the above types.

FIRST AID
1. Stop the effect of the traumatic factor
2. Put on rubber gloves, treat their tips of the phalanges with a 5% alcohol solution of iodine or brilliant green.
3. Determine "by eye" the type of bleeding. If the bleeding is arterial or profuse venous, immediately press the affected vessel with your finger in the wound (1 cm above the wound), and then apply a tourniquet!
4. Carefully remove contaminated clothing (it is better to cut off). The fabric of clothing is removed from the wound area last!
5. Rinse the wound abundantly with 3% hydrogen peroxide solution at least three times!
6. Treat the wound with a sterile gauze swab (napkin, bandage) moistened with 3% hydrogen peroxide solution.
7. Remove large foreign objects (torn pieces of clothing, glass fragments, etc.). If a foreign object is difficult to get, it is better to leave this occupation for doctors.
8. Repeat point 6.
9. Treat the edges of the wound with a 5% alcohol solution of iodine or brilliant green.
10. Apply a sterile napkin moistened with 70% alcohol to the wound.
11. Bandage the wound with a non-sterile bandage (you can use an elastic bandage).
12. Put a cold and heavy object on the wound area - a bottle of cold water, ideally an ice pack.
13. Cover the affected limb to prevent hypothermia.

RULES FOR APPLICATION OF THE HARNESS
1. The harness must be of sufficient length and width.
2. The tourniquet is applied above the injury site.
3. In the immediate vicinity of the wound.
4. Place a soft pad under the tourniquet.
5. The tourniquet is applied with the limb elevated.
6. The tourniquet is applied with an overlap of the tour by half the width.
7. DO NOT apply a tourniquet on the middle third of the shoulder and on the upper third of the lower leg!
8. Under the last tour of the tourniquet, you must enclose a note with the exact date and time of its application.
9. The tourniquet should not be completely closed (i.e. it should be visible that it is applied).
10. It is necessary to limit the mobility of the limb on which the tourniquet is applied as much as possible (make a splint from improvised materials and a bandage, fix at least two joints in the area of ​​injury).
11. In the cold season, the affected limb must be covered to avoid frostbite.
12. The maximum time for the initial application of the tourniquet is 1.5 hours. After the expiration of this time, it is necessary to untie the tourniquet for 15 minutes. At this time, the bleeding vessel must be held with a finger in the wound. Subsequently, the tourniquet is applied 1-2 cm above / below the previous application site for 40 minutes with 10 minute breaks. All actions with the tourniquet, starting from the time of application, must be recorded in the marking sheet. The maximum period of use of the tourniquet is a day.
Use and take to heal cuts.

With arterial bleeding, not a minute should be lost, as it can be fatal. You need to apply a tourniquet as soon as possible. Learn how to do it right in this article.

The ability to apply a tourniquet helps save a life.

How to apply a tourniquet for arterial bleeding

First of all, you need to make sure that the bleeding is arterial. The blood from the artery is bright, scarlet, flows from the wound profusely, in jerks.

How to apply a tourniquet correctly? It should be higher than the wound and press the artery against the bony prominences.

An ordinary tourniquet looks like a long elastic band. At its ends you can see a hook and a chain. With their help, the tourniquet is fixed.

In order not to damage soft tissues, gauze, bandage or any piece of clean cloth is placed under the tourniquet.

They make several turns around the limb, the first one is as tight as possible, blocking the blood flow, the others are weaker. The tension of the harness must be loosened gradually.

How to determine that the tourniquet was applied correctly? The bleeding must stop. A correctly tightened limb should not have a pulse, the skin becomes very pale. But if it acquires a bluish tint, swelling appears - it means that the tourniquet is applied incorrectly. It is untied and re-imposed, otherwise it may result in the loss of a limb.

It is important to know how long a tourniquet can be applied. It is rather short, in summer time - two hours, in winter - one hour. After this time, the tissues begin to die. Necrotic changes are irreversible, there is a risk of amputation. To prevent this, the exact time of bandaging is recorded. When providing emergency assistance to victims in any accident, you need to write it down on paper and put it under the tourniquet, so that it would be easier for the arriving doctors to navigate.

How to put a tourniquet on the neck

What to do in case of injury to the artery passing through the neck? The matter folded several times is pressed against the wound, a tourniquet is placed on it. On the opposite side, the tourniquet goes through the hand wound behind the head. Since the other side of the neck is not clamped, the blood continues to circulate freely and enter the brain. A tourniquet can also be passed through the armpit.