Attachment 1
Finger pressing of the arteries.
Arterial external bleeding poses the greatest danger to the life of the victim. In this case, immediate digital pressure of the artery is necessary, and only after that it is possible to prepare and carry out a temporary stop of bleeding in another way.
It is necessary to clearly know the pressure points of the arteries and be able to quickly and effectively press the artery in the right place without wasting time looking for it. Since the artery is mobile, the finger seems to slide off it, so it is more effective to press the artery with several fingers of one hand, tightly pressed against each other, or with two fingers of both hands. When it is necessary to press a large artery, they use pressing it with a fist, and the pressure is produced using the weight of one's own body.
Finger pressing of the arteries throughout is carried out at the points where the artery is closest to the bone, therefore, it is easier to press it.
Fig.1.
Arterial compression points
with bleeding:
1.temporal;
2. mandibular;
3. sleepy;
4. subclavian;
5. axillary;
6. shoulder;
8. radial;
9. femoral;
10. posterior tibial;
11. artery of the dorsal foot.
Table 1.
Points of digital pressure of the arteries
| artery name | Pressing technique | Place of pressing |
| temporal artery | thumb | To the temporal bone 1 - 1.5 cm in front of the auricle |
| Mandibular artery | thumb | To the lower edge of the lower jaw, on the border of its posterior and middle third |
| Carotid artery | four fingers | To the transverse process of the 6th cervical vertebra along the inner edge of the sternocleidomastoid muscle in the middle of its length |
| subclavian artery | one or four | In the supraclavicular fossa to the 1st rib, outward from the place of attachment of the sternocleidomastoid muscle to the sternum |
| axillary artery | fist | In the armpit to the head of the humerus |
| Brachial artery | four fingers | To the humerus along the inner edge of the biceps muscle |
| Ulnar artery | two fingers | To the ulna in the lower third |
| radial artery | two fingers | To the head of the radius |
| Abdominal aorta | Fist in the navel | Lumbar spine |
| femoral artery | With two thumbs of both hands, clasping the thigh with the rest of the fingers. fist | To the femur at the border of the inner and middle third of the inguinal fold |
| Middle tibial artery | two fingers | To the outer ankle |
| Posterior tibial artery | two fingers | To inner ankle |
| Dorsal foot artery | two fingers | To the talus |
Rice. 2.
Points of digital pressure of arteries.
Carotid Mandibular Temporal
Subclavian Shoulder Axillary
Annex 2
Maximum flexion of the limb at the joint.
Maximum flexion of the limb can be used to stop bleeding from the distal extremities. The maximum flexion of the limb is carried out in the elbow, hip and knee joints. A cotton-gauze roller is placed in the fold of the joint for better compression of the vessel in this area. The bent limb is fixed. extension is carried out in the region of the shoulder joints when bleeding from the subclavian arteries is stopped. This method is not used for concomitant bone fractures. The duration of the stay of the limbs in the maximum bent position corresponds to the timing of the application of the tourniquet on the limbs.
Appendix 3
Applying a pressure bandage
Rice. 3.
Applying a pressure bandage
Indications: small venous and capillary bleeding.
Equipment:
1. Individual dressing package
2. Cotton ball wrapped in gauze
3. Cloth pad.
Sequencing:
Ø The skin around the wound is treated with 5% alcohol tincture of iodine;
Ø A pad of an individual dressing bag, a ball of cotton in gauze or a cloth pad is applied to the bleeding wound;
Ø After that, tight bandaging is carried out. For the need for pressure on soft tissues during bandaging, you can use the bending of the bandage.
Ø The victim is transported to the hospital, accompanied by a medical worker.
Appendix 4
Application of an arterial tourniquet.
The imposition of an arterial tourniquet on a limb is the most reliable method of temporarily stopping bleeding.
There are three types of harnesses:
Ø fabric with a twist;
Ø wide band rubber;
Ø tubular Esmarch.
The tourniquet injures the tissue least of all, so it is most often used to stop arterial bleeding.
When applying a tourniquet, it is necessary to follow a number of rules, which allows to ensure maximum efficiency of hemostasis and avoid complications.
Finger pressure on the artery is performed in all cases of head and neck injuries if the bleeding cannot be stopped with a pressure bandage. The convenience of digital pressure on the arteries lies in the speed of this method of temporarily stopping bleeding. The main disadvantage of this method is the fact that the person providing assistance cannot move away from the victim to provide assistance to other wounded.
With proper pressure on the artery, bleeding from it should stop.
Rice. 1. Finger pressure of the artery during bleeding.
1 - pressing the radial and radial arteries when the palm is injured;
2 - pressing the temporal artery;
3 - pressing the external maxillary artery;
4 - pressing the carotid artery;
5 - pressing the brachial artery.
When bleeding from the temporal artery, the latter is pressed with two or three fingers at the level of the auricle, in front of it at a distance of 1-2 cm.
With arterial bleeding from the lower half of the face, the thumb of the external-maxillary artery is pressed at a point located between the chin and the angle of the lower jaw, somewhat closer to the latter.
With severe arterial bleeding from the upper half of the neck, the carotid artery is pressed. To do this, a person presses on the front surface of the wounded man's neck with his thumb on the side of his larynx, clasping the lateral and back surfaces of his neck with the rest of his fingers.
If the person is behind the wounded, then pressing the carotid artery is done by pressing on the front surface of the neck on the side of the larynx with four fingers, while the thumb wraps around the back of the victim's neck.
In order to stop arterial bleeding in high shoulder injuries, the axillary artery is pressed against the head of the humerus. To do this, put one hand on the shoulder joint of the victim and, holding the joint in a stationary state, with four fingers of the other hand, forcefully press on the armpit of the wounded along the line, closer to the front border of the cavity (the line of the front border of armpit hair growth, according to N. And Pirogov).
Rice. 2. Arteries and places of their pressing during bleeding.
1 - temporal artery;
2 - external maxillary artery;
3 - carotid artery;
4 - subclavian artery;
5 - axillary artery;
6 - brachial artery;
7 - radial artery;
8 - ulnar artery;
9 - palmar artery;
10 - iliac artery;
11 - femoral artery;
12 - popliteal artery;
13 - anterior tibial artery;
14 - posterior tibial artery;
15 - artery of the foot.
In case of injuries of the shoulder, forearm and hand, finger pressing of the brachial artery is performed to stop arterial bleeding. To do this, a person, standing facing the wounded man, clasps his shoulder with his hand so that the thumb is located at the inner edge of the biceps muscle of the shoulder. When pressed with the thumb in this position, the brachial artery will inevitably be pressed against the humerus. If the caregiver is behind the victim, then he puts four fingers on the inner edge of the biceps muscle of the shoulder, and with his thumb grabs the back and outer surface of the shoulder; while pressing the artery is produced by the pressure of four fingers.
Fig.3. Pressing points of the most important arteries.
1 - temporal;
2 - occipital;
3 - mandibular;
4 - right common carotid;
5 - left common carotid;
6 - subclavian;
7 - axillary;
8 - shoulder;
9 - radial;
10 - elbow;
11 - femoral;
12 - posterior tibial;
13 - artery of the rear of the foot.
With arterial bleeding from the vessels of the lower limb, digital pressing of the femoral artery is performed in the inguinal region to the pelvic bones. To this end, the nurse must press the thumbs of both hands on the inguinal region of the victim, somewhat closer to the inner edge, where the pulsation of the femoral artery is clearly felt.
Pressing the femoral artery requires considerable force, so it is also recommended to do it with four fingers of one hand folded together while pressing on them with the other hand.
Arterial bleeding is damage to the vessel, which, if not provided in time, can lead to the death of a person. Prior to the arrival of the ambulance, it is necessary to provide the victim with first aid, namely, to apply finger pressure to the arteries or to apply a tourniquet. In the latter case, materials that can help stop bleeding are not always at hand. In such situations, it is necessary to carry out finger pressing of the vessel.
How to recognize arterial bleeding
Before applying finger pressure to an artery, make sure that the blood is flowing from this particular type of vessel. A feature of the wound will be bright scarlet blood, which splashes out in a fountain (with each contraction of the heart, the blood literally comes out in pulsating streams). The victim will be pale, sweating will increase. When dizziness is observed, drowsiness increases, a panic attack occurs. If there is a lot of blood loss, it will cause fainting.
With blood loss, there is a strong thirst, dry mouth appears, the pulse weakens.
Venous bleeding has a dark red tint. If this type of vessel is damaged, the blood simply flows out, as with cuts, without the “gushing” effect.
Providing first aid
In case of arterial bleeding, before providing first aid, you should know the general rules:
- You can't delay. Every second of delay can cost the life of the patient.
- In some cases, you can use improvised means to stop bleeding. It can be a scarf, a belt, a long piece of cloth, a towel, etc.
- If the wound is located in a place where it is not possible to apply a tourniquet, or there is no suitable object at hand, then digital pressure on the artery should be immediately performed.
Damage to each type of vessel provides for a specific tactic to stop bleeding.
Pressing the artery is carried out above the wound, which helps to reduce the flow of blood to the site of injury, i.e. the vessel is blocked before injury. This method is associated with the peculiarity of blood flow - from the heart, blood goes through the arteries to organs and tissues.
There are special points that allow effective pressure on the arteries, but to achieve the best results, it is necessary to clamp the artery from two sides.
The method of finger pressing is not used for fracture of bones at the point of intended compression.
Places of pressure of arteries are presented in the table below.
Brachial artery
With finger pressing of the arteries, it is necessary to know certain places to which the vessel is pressed.
If the brachial artery is damaged, it is necessary to raise the victim's hand and put it behind the head. Then the vessel is clamped: this is done with four fingers. The point of digital pressure of the artery is located between the mice below the shoulder joint in the third part of the shoulder. In this place, the vessel is strongly pressed against the bone, thus providing an impact on the artery from both sides.
axillary artery
When bleeding occurs in the upper part of the shoulder, the axillary artery is clamped. It is pressed against the head of the humerus: the procedure is performed from the inside, using the method of complete (circular) capture of the shoulder by the hand and pressure with a finger into the axillary region. You can press in another way, as shown in the figure below.
femoral artery
Finger pressing of the artery during bleeding is carried out at a point located in the inguinal region, approximately in the middle of the fold. In this part, the artery is pressed against the thigh.
To provide assistance, it is recommended to kneel on the side of the uninjured leg. Then, with the thumbs, they press on the point in the groin, and the other fingers, as it were, cover the thigh. When performing this procedure, you should press with all your weight, leaning on your hands.
Carotid artery
In cases where the vessels of the head, submandibular region, and upper part of the neck are damaged, finger pressure is performed. It is difficult for a person without medical education to apply a tourniquet on the neck so that the victim does not suffocate (the tourniquet is applied by pulling through the arm raised behind the head). Therefore, only finger pressing is carried out on the neck. It is performed with the thumbs: they are positioned in such a way that the remaining fingers are on the back of the head. If the carotid artery is damaged, it should be borne in mind that the blood flows upward through it (from the body towards the head). To eliminate bleeding, the vessel is clamped below the wound.
The pressure point of the carotid vessel is located in the middle of the anterior surface of the cervical muscle. With proper manipulation, the artery is pressed against the vertebrae.
subclavian artery
If the wound is located above the pressure point of the carotid artery or at the shoulder joint, then you can press it. To do this, you need to press on the hole behind the collarbone: pressure is exerted by the thumb, and the rest are located behind.
Temporal and maxillary arteries
In case of injuries and injuries of the face, accompanied by arterial bleeding, immediate pressing of the temporal or maxillary vessels is required. The latter is pressed with a finger to the lower jaw. And the temporal artery is pressed in front of the auricle.
Limb arteries
Arterial bleeding of the feet and hands is rarely life-threatening. However, even these types of injuries should not lead to serious blood loss. To reduce it, it is necessary to raise the limb, then the middle third of the forearm is squeezed with the hands using the circular grip method. By the same principle, the artery of the foot is pressed: it is clamped on the third part of the lower leg.
During pressing, the pressure must not be released so as not to provoke further bleeding. Keep your hands on the vessel until the ambulance arrives. When performing the technique of finger pressing the arteries, you do not need to think about the rules of asepsis and antisepsis, wash your hands - in such situations, seconds count, because each of them can be the last for the victim. In some situations, you can apply a tourniquet or use improvised means to squeeze the artery. In any case, it is necessary to monitor the patient's condition, and it is also necessary to note the time when a tourniquet was applied or finger pressure began. This is necessary so that emergency doctors can assess the severity of the patient's condition.
The main points of digital pressure of the arteries
|
artery name |
External landmarks |
Underlying bone |
|
1 cm above and anterior to the opening of the external auditory canal |
Temporal bone |
|
|
2 cm anterior to the angle of the mandible |
Lower jaw |
|
|
A. carotis communis |
The middle of the inner edge of the sternocleidomastoid muscle (upper edge of the thyroid cartilage) |
Carotid tubercle of the transverse process of the VI cervical vertebra |
|
Behind the clavicle in the middle third | ||
|
Anterior border of hair growth in the armpit |
Humeral head |
|
|
Medial edge of the biceps muscle (sulcusbicipitalismed.) |
Inner surface of the shoulder |
|
|
The middle of the pupart fold (according to bone landmarks) |
Horizontal branch of the pubic bone |
|
|
Apex of the popliteal fossa |
Posterior surface of the tibia |
|
|
Aorta abdominalis |
Navel area (pressing with a fist) |
Lumbar spine |
Tourniquet application.
Indications
The main indications for the imposition of a tourniquet:
Arterial bleeding from wounds of the extremities;
Any massive bleeding from limb wounds.
The peculiarity of this method is the complete cessation of blood flow distal to the tourniquet. This provides reliable stopping of bleeding, but at the same time causes significant tissue ischemia. In addition, the tourniquet can compress nerves and other formations.
General rules for applying a tourniquet
Harness rules.
1. Before applying the tourniquet, elevate the limb.
2. The tourniquet is applied proximal to the wound and as close as possible to it.
3. Place a piece of cloth (clothing) under the tourniquet.
4. When applying a tourniquet, 2-3 rounds are made, evenly stretching it, and the tours do not need to be superimposed one on top of the other.
5. After applying the tourniquet, it is imperative to indicate the exact time of its application (usually a piece of paper with the corresponding entry is placed under the tourniquet).
6. The part of the body where the tourniquet is applied must be accessible for inspection.
7. Victims with a tourniquet are transported and served first.
Criteria for a correctly applied tourniquet:
Stop bleeding;
Termination of peripheral pulsation;
Pale and cold extremity.
It is extremely important that the tourniquet cannot be kept for more than 2 hours on the lower extremities and 1.5 hours on the upper ones. Otherwise, the development of necrosis of the limb due to its prolonged ischemia is possible. If it is necessary to transport the victim for a long time, the tourniquet is dissolved every hour for about 10-15 minutes, replacing this method with another temporary way to stop bleeding (finger pressure). It is necessary to remove the tourniquet gradually weakening it, with the preliminary introduction of painkillers.
Tamponade of the wound
The method is indicated for moderate bleeding from small vessels, capillary and venous bleeding in the presence of a wound cavity. This method is often used during surgery: the wound cavity is tightly filled with a swab and left for a while. In this case, the bleeding stops, then a more adequate method is used.
Clamping on a bleeding vessel
The method is indicated for stopping bleeding during surgery. The surgeon puts a special hemostatic clamp (Billroth clamp) on the bleeding vessel, the bleeding stops. Then apply the final method, most often - ligation of the vessel. The method is very simple, effective and reliable, and therefore it has become very widespread. When applying a clamp, it must be remembered that this must be done very carefully, otherwise, in addition to the damaged one, the main vessel or nerve may also get into the clamp.
Temporary bypass
The application of the method is necessary in case of damage to large main vessels, mainly arteries, the cessation of blood flow through which can lead to undesirable consequences and even threaten the life of the patient.
Methods for the final stop of bleeding: mechanical, physical, chemical and biological
Mechanical methods:
Vessel ligation
Bandaging of the vessel in the wound, Bandaging of the vessel throughout
Vessel sewing
Twisting, crushing blood vessels
The method is rarely used for bleeding from small veins. A clamp is applied to the vein, which is removed after a while. Additionally, it is possible to rotate the clamp several times around its axis, which results in maximum injury to the vessel wall and reliable thrombosis.
Wound tamponade, pressure bandage
Wound tamponade and pressure dressing are methods of temporarily stopping bleeding, but they can also become definitive. After removing the pressure bandage (usually on the 2-3rd day) or removing the tampons (usually on the 4-5th day), bleeding may stop due to thrombosis of damaged vessels.
Separately, tamponade in abdominal surgery and nosebleeds should be noted.
Tamponade in abdominal surgery
During operations on the abdominal organs, in cases where it is impossible to reliably stop the bleeding and “leave the abdomen” with a dry wound, a swab is brought to the place of blood leakage, which is brought out, sewing up the main wound. This happens extremely rarely with bleeding from the liver tissue, venous or capillary bleeding from the area of inflammation, etc. Tampons are kept for 4-5 days, and after their removal, bleeding usually does not resume.
Tamponade for nosebleeds
For epistaxis, tamponade is the method of choice. It is practically impossible to stop the bleeding in any other mechanical way. There are anterior and posterior tamponade: the anterior is carried out through the external nasal passages. The tampon is removed on the 4-5th day. Almost always there is a stable hemostasis.
Vascular embolization
The method is referred to as endovascular surgery. It is used for bleeding from the branches of the pulmonary arteries, the terminal branches of the abdominal aorta, etc. In this case, according to the Seldinger method, the femoral artery is catheterized, the catheter is brought to the bleeding area, a contrast agent is injected and, performing x-rays, the injury site is identified (diagnostic stage). Then, an artificial embolus (spiral, chemical substance: alcohol, polystyrene) is brought along the catheter to the site of damage, covering the lumen of the vessel and causing its rapid thrombosis. The method is low-traumatic, avoids a major surgical intervention, but the indications for it are limited, in addition, special equipment and qualified specialists are needed.
Physical methods:
Cold exposure
The mechanism of the hemostatic effect of hypothermia is vasospasm, slowing of blood flow and vascular thrombosis.
local hypothermia
To prevent bleeding and the formation of hematomas in the early postoperative period, an ice pack is placed on the wound for 1-2 hours. The method can be used for nasal bleeding (ice pack on the bridge of the nose), gastric bleeding (ice pack on the epigastric region). With gastric bleeding, it is also possible to introduce cold (+4 ° C) solutions into the stomach through a tube (usually, chemical and biological hemostatic agents are used).
Cryosurgery
Cryosurgery is a special area of surgery based on the use of very low temperatures. Local freezing is used in operations on the brain, liver, and in the treatment of vascular tumors.
Exposure to high temperature
Use of hot solutions
The method can be applied during the operation. For example, with diffuse bleeding from a wound, parenchymal bleeding from the liver, gallbladder bed, etc. a napkin moistened with hot saline is introduced into the wound. After 5-7 minutes, wipes are removed and the reliability of hemostasis is monitored.
Diathermocoagulation
Diathermocoagulation is the most commonly used physical method to stop bleeding. The method is based on the use of high-frequency currents, leading to coagulation and necrosis of the vascular wall at the point of contact with the tip of the device and the formation of a thrombus.
Laser photocoagulation, plasma scalpel
The methods are classified as new technologies in surgery, are based on the same principle as diathermocoagulation (creation of local coagulation necrosis), but allow more dosed and gentle bleeding. This is especially important in parenchymal bleeding. This method is also used to separate tissues (plasma scalpel). Laser photocoagulation and plasma scalpel are highly effective and increase the possibilities of conventional and endoscopic surgery.
Chemical Methods
Local hemostatic agents
1. Hydrogen peroxide is used for bleeding from a wound. The drug causes an acceleration of thrombosis.
2. Vasoconstrictors (epinephrine) are used to prevent bleeding during tooth extraction, injected into the submucosal layer during gastric bleeding, etc.
3. Fibrinolysis inhibitors (aminocaproic acid) are injected into the stomach during gastric bleeding.
4. Gelatin preparations (gelaspon) are foamed gelatin sponges. Accelerate hemostasis, since platelets are damaged upon contact with gelatin and factors that accelerate the formation of a blood clot are released. In addition, they have a dampening effect. Used to stop bleeding in an operating room or accidental wound.
5. Wax has a plugging property. They are covered with damaged flat bones of the skull (in particular, during the operation of trepanation of the skull).
6. Carbazochrome is used for capillary and parenchymal bleeding. It reduces vascular permeability, normalizes microcirculation. Wipes moistened with a solution are applied to the wound surface.
7. Kaprofer is used for irrigation of the gastric mucosa during bleeding from erosions, acute ulcers (during endoscopy).
Hemostatic agents of resorptive action
Hemostatic substances of resorptive action are introduced into the patient's body, causing an acceleration of the process of thrombosis of damaged vessels. The main drugs are listed below.
1. Fibrinolysis inhibitors (aminocaproic acid). Currently, the effectiveness of this drug as a resorptive hemostatic agent is considered doubtful.
2. Calcium chloride - used for hypocalcemia, since calcium ions are one of the factors in the blood coagulation system.
3. Substances that accelerate the formation of thromboplastin (for example, sodium etamsylate) also normalize the permeability of the vascular wall and microcirculation.
4. Substances of specific action. For example, the use of oxytocin for uterine bleeding: the drug causes contraction of the muscles of the uterus, which reduces the lumen of the vessels of the uterus and thus helps to stop bleeding.
5. Synthetic analogues of vitamin K (menadione sodium bisulfite) promote the synthesis of prothrombin. It is indicated for violation of liver functions (for example, with cholemic bleeding).
6. Substances that normalize the permeability of the vascular wall (ascorbic acid, rutoside, carbazohrom).
biological methods
Biological methods to stop bleeding can also be local and general.
Methods of local action
Local biological methods are divided into two types:
The use of the body's own tissues (The most commonly used fat (part of the omentum) and muscle tissue rich in thromboplastin. A free piece of these tissues or a strand (flap) on the vascular pedicle is fixed to the desired area. In this case, a certain plugging effect occurs.)
The use of agents of biological origin. (Homo- and heterogeneous components of blood plasma are used (primarily factors of the coagulation system), sometimes with the addition of collagen, which has its own hemostatic activity.)
Clinic of acute bleeding and blood loss. Hemorrhagic shock, Algover index.
General symptoms
Classic signs of bleeding:
Pale moist skin;
Tachycardia;
Decreased blood pressure.
Patient complaints:
Weakness;
Vertigo, especially when lifting the head;
"dark in the eyes", "flies" before the eyes;
Feeling short of breath;
Anxiety;
Nausea.
Objective research data:
Pale skin, cold sweat, acrocyanosis;
Hypodynamia;
Lethargy and other disturbances of consciousness;
Tachycardia, thready pulse;
Decreased blood pressure;
Decreased diuresis.
Signs of blood loss: pallor and moisture of the skin, a haggard face, frequent and small pulse, increased respiration, in severe cases, Cheyne-Stokes type breathing, lowering of CVP and blood pressure. Subjective symptoms: dizziness, dry mouth, thirst, nausea, darkening of the eyes, increasing weakness. However, with a slow flow of blood, the clinical manifestations may not correspond to the amount of blood lost.
Depending on the volume of outflowing blood and the level of decrease in BCC, four degrees of severity of blood loss:
I - mild degree: loss of 500-700 ml of blood (decrease in BCC by 10-15%);
II - medium degree: loss of 1000-1500 ml of blood (decrease in BCC
III - severe degree: loss of 1500-2000 ml of blood (decrease in BCC
IV degree - massive blood loss: loss of more than 2000 ml of blood (decrease in BCC by more than 30%).
The concept of hemorrhagic shock
Hemorrhagic shock is one type of hypovolemic shock (see Chapter 8). The clinical picture of shock can be with blood loss of 20-30% of the BCC and largely depends on the initial state of the patient.
There are three stages of hemorrhagic shock:
Stage I - compensated reversible shock;
Stage II - decompensated reversible shock;
III stage - irreversible shock.
Compensated reversible shock- the volume of blood loss, which is well replenished by the compensatory-adaptive capabilities of the patient's body.
Decompensated reversible shock occurs with deeper circulatory disorders, spasm of arterioles can no longer maintain central hemodynamics, normal blood pressure. In the future, due to the accumulation of metabolites in tissues, paresis of the capillary bed occurs, decentralization of blood flow develops.
Irreversible hemorrhagic shock characterized by prolonged (more than 12 hours) uncontrolled arterial hypotension, ineffectiveness of transfusion therapy, development of multiple organ failure .
An assessment of the severity of blood loss is used according to the Allgover shock index (the ratio of heart rate [HR] to the value of blood pressure), which is normally 0.5, and increases with blood loss.
Traumatology:
| " |
In all cases of severe bleeding, it is necessary to call a doctor, but do not suspend first aid.
There are arterial, venous and capillary bleeding. With arterial bleeding, the blood is bright red in color and is ejected in a strong pulsating jet. Bleeding can be pulsating, corresponding to the rhythm of the heart.
Arteries are blood vessels that carry blood from the heart to the organs. And since the heart acts as a pump, the pressure that it creates is enough to cause massive bleeding. Even when a small artery is injured, the blood from the wound can spurt out, leading to its rapid loss. Injuries to large arteries - femoral, brachial, carotid - pose a real threat to life. In a matter of minutes, blood loss can lead to death. A person's life depends entirely on whether help is provided in time. All first aid measures should be aimed at one thing - to stop the loss of blood.
Signs of arterial bleeding: the color of the blood is bright scarlet. The blood from the wound splashes out in a fountain.
To assist the victim, it is necessary to clamp the bleeding vessel above the bleeding site. This can be done in three ways:
Finger pressing;
Sharp bending of the limb;
Applying a tourniquet.
Finger pressing of the artery. The artery is pressed not in the wound area, but above it, closer to the heart along the blood flow (on the extremities, the vessels are pressed above the wound, on the neck and head - below the bleeding site). Squeezing of the vessels is carried out with several fingers of one or two hands at once. This is the most affordable way in any setting to temporarily stop severe arterial bleeding. To use it, you need to know the place (point) where this artery lies closest to the surface and can be pressed against the bone; at these points, you can almost always feel the pulsation of the artery. Finger pressure on the artery makes it possible to stop the bleeding almost instantly. But even a strong rescuer cannot press the artery for more than 10-15 minutes, as the hands get tired and the pressure weakens. This technique is very important, as it allows you to buy time for other methods of temporarily stopping bleeding, most often for applying a tourniquet.
The most convenient places (points) and ways of pressing the arteries are shown in Fig. 7.8-7.13.
Rice. 7.8. Location of pressure points for blood vessels
Pressing the common carotid artery is performed with severe bleeding from wounds of the upper and middle parts of the neck, submandibular region and face. The assisting person presses the carotid artery on the side of the wound with the thumb or second or fourth fingers of the same hand (Fig. 7.9). With pressing fingers, pressure should be applied towards the spine.
Rice. 7.9. Ways of pressing the carotid artery:
a - pressing with the thumb; b - pressing with the second-fourth fingers
Pressing the subclavian artery (Fig. 7.10) is performed with severe bleeding from wounds in the shoulder joint, subclavian and axillary regions and the upper third of the shoulder. Produce it with a large or second - fourth fingers in the supraclavicular fossa. To increase pressure on the pressing finger, you can press the thumb of the other hand. Pressure is applied above the clavicle from top to bottom, while the subclavian artery is pressed against the first rib.
Rice. 7.10. Compression of the subclavian artery
Pressing the brachial artery is used for bleeding from wounds of the middle and lower third of the shoulder, forearm and hand. It is made with the second or fourth fingers, which are placed on the inner surface of the shoulder at the inner edge of the biceps muscle. The brachial artery is pressed against the humerus.
Compression of the femoral artery is undertaken in case of severe bleeding from wounds of the lower extremities. It is carried out with the thumb or fist. In both cases, pressure is applied to the groin midway between the pubis and the iliac crest. When pressing with the thumb to increase pressure, pressure is applied over it with the thumb of the other hand. Pressing down with a fist is done so that the line of folds in the interphalangeal joints is located across the inguinal fold. To increase pressure, you can resort to using the other hand.
Rice. 7.11. Compression of the brachial artery
Bleeding from the vessels of the lower part of the face is stopped by pressing the jaw artery to the edge of the lower jaw (Fig. 7.12), and bleeding from the temple and forehead is stopped by pressing the temporal artery in front of the ear (Fig. 7.13).
Rice. 7.12. Pressing of the maxillary artery
Rice. 7.13. Compression of the temporal artery
To stop bleeding from the hand and fingers, two arteries are pressed in the lower third of the forearm, near the hand. Bleeding from the foot can be stopped by pressing on the artery that runs along the back of the foot.
Press the bleeding vessel with your fingers very quickly and strongly enough. It is unacceptable to waste time even on the release of limbs from clothing.
Stop bleeding by bending the limbs. In this way, more quickly and reliably than pressing with a finger, you can stop the bleeding. The limb should be bent as much as possible (Fig. 7.14). After that, the limb should be securely fixed in a bent position with a belt or any other means at hand.
Rice. 7.14. Flexion of the joint of the extremities to stop bleeding: a - from the forearm; b - from the shoulder; in - from the lower leg; g - from the thigh
For bending, the following operations are performed: the victim should quickly roll up the sleeve or trouser leg, make a lump of any matter, put it in the hole formed by bending the joint located above the wound, and then strongly, to the point of failure, bend the joint over this lump. In this way, the artery passing in the fold, supplying blood to the wound, will be squeezed by the lump. In a bent position, the leg or arm must be tied or tied to the body of the victim.
If this was not enough to stop the bleeding, a tourniquet should be applied to the limbs above the wound.
Applying a hemostatic tourniquet. This is the main way to temporarily stop bleeding in case of damage to large arterial vessels of the extremities. A rubber band consists of a thick rubber tube or tape 1–1.5 m long, with a hook attached to one end and a metal chain to the other. In order not to damage the skin, the tourniquet is applied over clothing or the tourniquet is wrapped several times with a bandage, towel or any other soft cloth. The rubber tourniquet is stretched and, in this form, applied to the limb, without loosening the tension, wrapped around it several times so that the coils lie close to one another and so that skin folds do not get between them. The ends of the bundle are fastened with a chain and a hook. In the absence of a rubber tourniquet, improvised materials are used, for example, a rubber tube, a waist belt, a tie, a bandage, a handkerchief, from which a twist is made using a wrench (sticks). The tourniquet is applied above the wound and as close to it as possible.
Twisting tourniquets must be tightened tight enough to occlude the damaged artery.
The material from which the twist is made is circled around the limb raised up, previously wrapped in some kind of soft cloth, and tied with a knot on the outside of the limb. A collar (a stick or some hard object) is threaded into this knot (or under it). The resulting loop is twisted until the bleeding stops. The position of the knob is fixed as shown in Fig. 7.15 and 7.16.
Rice. 7.15. The imposition of a tourniquet-twist on the shoulder: 1 - soft tissue; 2 - bandage fixing the stick; 3 - knob (stick); 4 - spin
Rice. 7.16. The imposition of a tourniquet-twist on the thigh
Pulling the tourniquet of the limb should not be excessive, otherwise the nerves may suffer. If it is found that the bleeding has not completely stopped, then additionally (more tightly) it is necessary to apply a few more turns of the tourniquet. A tourniquet is applied to the thigh through a smooth solid object.
The tourniquet is not bandaged, it should be clearly visible. Be sure to leave a note on it indicating the time the tourniquet was applied. The tourniquet can be on the limb for no more than one hour. Since the stoppage of bleeding is achieved by a complete cessation of the blood supply to the damaged area, all tissues are deprived of blood supply. If the specified time is exceeded, irreversible necrotic changes will begin. To avoid this, it is necessary to remove or loosen the tourniquet every hour for 3-5 minutes. The victim will be able to rest from the pain caused by the applied tourniquet, and the limb will receive some blood flow. This will ensure the viability of the tissues until qualified assistance is provided. During a respite, the main vessel is pressed with fingers, and the tourniquet is applied to a new place, higher.
Dissolve the tourniquet should be gradual and slow. In the winter season, a limb with an applied tourniquet is well insulated so that frostbite does not occur.
A tourniquet is applied to the neck without pulse control. Before applying the tourniquet, a pressing roll of dressing material is applied to the wound, formed from sterile napkins, the arm of the victim is thrown over the head from the side opposite to the wound. The tourniquet is stretched, wound behind the neck and through the armpit, as shown in Fig. 7.17.
Rice. 7.17. Putting a tourniquet on the neck
With venous bleeding, the blood pours out more slowly, it is dark cherry in color. With venous bleeding, the limb (arm or leg) should be raised so that the wound is above the level of the heart.
Capillary bleeding is the outflow of blood from damaged small arteries and veins when the skin, muscles, and other soft tissues are injured.
Slight bleeding (venous, capillary and from small arteries) is stopped with a pressure bandage. They do it this way: a sterile gauze napkin is applied to the wound, a tightly folded ball of cotton wool is placed on top of it, and then they are tightly bandaged with circular bandages. Instead of cotton wool, you can use an unwound sterile bandage. Before applying a pressure bandage, the skin around the injury at a distance of 3-4 cm from the edges of the wound should be treated with tincture of iodine or another antiseptic solution. The bandage applied in this way compresses the blood vessel, and the bleeding quickly stops.
The imposition of a pressure bandage is the only method of temporarily stopping bleeding from wounds located on the trunk (for example, in the gluteal region), on the scalp.
