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03.03.2022

Types of bleeding and ways to stop them presentation. Presentation on life support "bleeding and stopping bleeding"

Municipal educational institution secondary school No. 4 Presentation on life safety on the topic: “Bleeding. First aid for bleeding” Health and safety teachers Sulaymanov Zh.D. Plakhin S.V. Vsevolozhsk 2011 In many cases, when soft tissue is injured, it is enough to apply a bandage and not disturb the wound. But there are cases when more qualified help is required. To do this, you need to know how to recognize and how to treat the most common injuries - bleeding and wounds. Blood has three main functions: Supplying oxygen and nutrients to the body's tissues and removing waste products Protecting the body from disease by producing antibodies and protecting against infection Maintaining a constant body temperature by circulating blood throughout the body Bleeding causes several reactions in the body. The brain, heart and kidneys try to immediately compensate for blood loss to maintain the flow of oxygenated blood to vital organs. The blood in the wound area begins to clot. The body also begins to produce more red blood cells (RBCs), which helps increase the supply of oxygen to the cells. Red blood cells Soft tissues Include skin layers, adipose tissue and muscles that protect the deeper parts. The dermis contains nerves, sweat and fat glands, and blood vessels. Most soft tissue injuries are painful and often result in bleeding. With a strong external impact, damage to all layers of soft tissue is possible. BLEEDING External bleeding - a sharp object, Internal bleeding - an organ or part, such as a knife, pierces the skin and damages other organs of the body receives a blow, for example, when you hit your foot on a table. Severe internal bleeding - a strong blow to a blunt object, for example, when falling from a great height. External bleeding Causes damage to blood vessels with blood leaking to the surface of the skin. Minor bleeding stops on its own after about 10 minutes as the blood clots. But when large vessels are damaged, blood flows out too quickly, without having time to clot, the bleeding can be life-threatening, especially for children and infants. Signs and symptoms of severe external bleeding Arterial(a): 1. Weakness 2. Rapid and heavy bleeding 3. Severe pain in the injured part of the body 4. Bright red color of the blood 5. Blood usually spurts out of the wound Venous(b): 1. Blood flows smoothly from the wound, does not gush out like a fountain 2. Blood is dark red or burgundy First aid for external bleeding First aid is aimed at stopping the bleeding and protecting the wound from infection. Apply pressure to the wound 1. Apply a sterile bandage or clean cloth to the wound 2. Ask the victim to press the cloth firmly against the wound with his hand. If this is not possible, then do it yourself 3. Do not waste time trying to wash the wound Elevate the injured limb The injured part should, if possible, be above the level of the heart Lay the victim on his back Apply a pressure bandage 1. Completely bandage the injured area, applying the bandage in a spiral 2. Tie or secure bandage with a bandage or pin 3. If blood seeps through the bandage, apply additional napkins and wrap them with a bandage over the old bandage. Do not remove tissues that are already soaked in blood. Apply a pressure bandage When applying a bandage to an arm or leg, leave the fingers exposed unless bandaging is necessary. You can use your fingers to determine whether the bandage is too tight. Remember that if used incorrectly, elastic bandages can block blood flow to the limb. Take anti-shock measures 1. Elevate the victim's legs 2. Maintain a constant temperature in the victim. Cover him with a blanket 3. Reassure him 4. Monitor his signs of life 5. Wash your hands immediately after completing the manipulations 6. Even if the bleeding has stopped, the victim should consult a doctor for qualified help Points of finger pressure on the arteries The method of finger pressure on the arteries is another way to stop the arterial bleeding. It is used in combination with direct pressure on the wound. This method involves the person providing first aid using their hand to compress the artery above the site of injury. There are many pressure points on the arteries, but there are two main ones to remember: the brachial and femoral. This manipulation must be carried out for at least 10 minutes. Its main disadvantage is that the person providing assistance is not able to carry out other actions at this time. Finger pressure of the arteries Applying a tourniquet Applying a tourniquet is an effective way to completely stop arterial bleeding in case of uncontrolled bleeding in the extremities. Good example applying a tourniquet - when amputating a limb, since almost always applying a tight bandage and digital pressure on the arteries is sufficient to stop severe bleeding. The first aider should be aware that application to a non-amputee limb cuts off blood flow to areas below the tourniquet, which can result in damage to nerves, blood vessels and ultimately loss of the limb. Rules for applying a tourniquet 1. 2. 3. 4. 5. The tourniquet should be applied above the injury at a distance of approximately 5 cm. Place a napkin or clean cloth between the damaged limb and the tourniquet. A wide strip of cloth can be used as a tourniquet. Do not use rope or twine, as they can damage the underlying tissue. Tie a tourniquet with 1 knot, place an object on top (pen, scissors, piece of wood), secure it with another knot and begin twisting until the bleeding stops. Never loosen the tourniquet; remember the time when it was imposed; do not cover the tourniquet with clothing or a blanket. Applying a twist: It can be made from available materials (scarves, pieces of cloth, gauze, etc.). We wrap the limb, tie the ends tightly, insert a piece of a strong stick between the rings, rotate it in a circle, squeeze the limb segment and blood vessels (arteries) until bleeding from the wound stops. We fix the stick with an additional bandage. In the following, the actions are similar to those for applying a tourniquet. Infection The first signs and symptoms of infection, which can occur in the next two days after the injury: the area around the wound becomes swollen, red and warm to the touch. The victim may experience throbbing pain in this area. A serious infection leads to an increase in temperature and deterioration of the patient's condition. Sometimes red stripes are observed on the skin, radiating from the wound. In this case, you need to consult a doctor. Keep the wound clean by covering it with a bandage. Minor wounds Signs and symptoms: With capillary bleeding, blood appears to ooze from the wound; Blood flows out under low pressure; Blood from capillaries is usually not as bright as arterial blood; Blood clotting occurs quickly. First aid for minor wounds Wash the wound with an antiseptic solution or soap and water; To clean contaminated wounds, use a clean cloth or sterile swab: always start in the middle of the wound, working towards the edges. Change the napkin with each subsequent action; Apply a small bandage; Doctor's help is needed only if there is a risk of wound infection; Do not use alcohol to clean the wound. Internal bleeding Internal bleeding is much more difficult to detect than external bleeding, since its signs and symptoms are not so pronounced and may only become apparent after some time: Blue skin (bruising in the area of ​​injury) Soft tissues are painful, swollen or hard to the touch Feeling of agitation or anxiety in the victim Rapid weak pulse, rapid breathing, nausea or vomiting, decreased level of consciousness Pale skin, cool or moist to the touch Feeling of unquenchable thirst Bleeding from natural openings of the body (nose, mouth, etc.) First aid for internal bleeding: Provide help with shock or to prevent its development A cold compress relieves pain and reduces swelling. Apply cold for 15 minutes every hour Immediately call "03" Carefully examine the victim, find out if he has serious injuries to internal organs Shock Shock usually occurs as a result of extensive internal or external bleeding, as this leads to a decrease in the volume of circulating blood, which reduces the flow of oxygen to vital organs. Shock is a life-threatening condition and can lead to death. Signs and symptoms of shock Pale, cold, and clammy skin; Weakness, anxiety, dry mouth; Weak rapid pulse, rapid breathing; Confusion or unconsciousness. Remember that to provide first aid to the victim, it is not necessary to know the cause of shock or see bleeding First aid for shock Maintain normal body temperature, cover him with a blanket Ask him to take a lying position Raise his legs 30 cm above body level to improve blood flow to the vitals important organs. You should not raise your legs if there is a possible injury to the head, neck, spine, hip or leg, there is a suspicion of a stroke, heart attack or you are not sure about the condition of the victim Try to eliminate the cause of shock, for example, external bleeding Reassure the victim Do not give the victim anything to drink (wet the victim’s lips with water if he is thirsty) List of websites and literature used: http://www.itmed.ru/library/k/krovotecheniy_1.htm Life Safety Textbook – First Medical Aid. Atlas of volunteer rescuers.


Remember!!!

  • Complications occur when 1/3 of blood volume is lost
  • With a loss of 50%, death occurs

PMP

  • Necessary

to everyone

learn


Bleeding -

  • loss of blood resulting from damage to blood vessels.


  • Capillary – damage to small vessels
  • Characteristic : the entire wound surface bleeds
  • PMP :

Rinse

Treat the wound with hydrogen peroxide, edges– brilliant green or iodine

Apply pressing gauze bandage


  • Nasal bleeding
  • PMP :

Cold on the bridge of the nose

In the nostrils - a piece of cotton wool with hydrogen peroxide


  • Venous
  • Characteristic : dark red blood flows out of the wound slowly, in a continuous stream in large quantities
  • PMP :

Do not remove the traumatic object, secure it with a cotton-gauze bandage

Apply a pressure bandage to the wound

You can apply a tourniquet below wounds

Take him to the doctor immediately


  • Arterial

It's hard to stop

Most dangerous

  • Characteristic : pulsating bright red stream flowing out at high speed

  • Arterial

PMP: 1.Stop the bleeding!

  • Methods: finger

pressing the vessel

higher places of damage.

Pressure points


  • Arterial
  • Methods : temporary stop of bleeding by flexing a limb

Place the roller in the joint area, bend it as much as possible and fix it in the given position. (P.97)


  • Arterial

Methods : tourniquet application

  • A tourniquet should be applied only in cases of massive arterial bleeding.
  • His misuse can lead to necrosis and gangrene of the limb.

  • Arterial

Rules for applying a tourniquet

  • a tourniquet from a first aid kit, a rubber hose, a belt.
  • The tourniquet is placed approximately 7 cm above the wound site.
  • The tourniquet should be applied over clothing
  • Apply the first round of the tourniquet and secure it. We stretch the tourniquet and apply another 3-4 turns.
  • The main criterion for successful application is the absence of a pulse below the application site and stopping bleeding

  • Arterial
  • A note should be made about the time the tourniquet was applied.
  • In the warm season, the tourniquet should be no more than 2 hours, in the cold season - no more than an hour, for children 40-60 minutes.
  • Treat the wound and apply a bandage
  • Delivery of the victim to a medical facility.

  • Arterial
  • If it was not possible to deliver to the hospital during this time, remove the tourniquet for 5-10 minutes, while stopping the bleeding with finger pressure, then reapply it slightly above the previous place of application.

  • Arterial

Way to stop bleeding:

- twist


  • External
  • Hematoma- bleeding into tissue
  • Internal- bleeding occurs in the body cavity (cranial, abdominal, thoracic, pleural, ...)

  • Internal bleeding!!!

PMP :

peace, coldness to the supposed

place of rupture. See a doctor urgently!




Homework

  • Repeat § 14-21
  • Questions on page 99 “Test yourself”
  • Prepare for a test on the topic “Blood. Circulation"

  • How to properly help with a nosebleed?

Select your next steps from the options offered and determine their order:

  • A) Tell your friend to stand with his head thrown back and not move;
  • B) Make your friend sit down, tilting his torso forward.
  • C) Take the temperature and give pain relief.
  • D) Moisten pieces of cotton wool with a solution of table salt and insert them into the nasal passages.
  • D) Place cold on the back of the nose.
  • E) Press the wings of the nose tightly against the septum

5 - 10 minutes.

  • Answer:
  • b, d, f, d

Think!!

  • When are these actions necessary?

Description of the presentation by individual slides:

1 slide

Slide description:

2 slide

Slide description:

Bleeding. Bleeding is the outpouring of blood from blood vessels when the integrity of their walls is violated. The danger with bleeding is that it can lead to significant blood loss. Loss of 40-50% of blood leads to human death. Therefore, it is very important to know how to stop bleeding.

3 slide

Slide description:

Types of bleeding. Venous bleeding Bleeding Capillary bleeding Arterial bleeding

4 slide

Slide description:

Capillary bleeding The bleeding is superficial, the blood looks like a deep red liquid. Blood flows out in a small volume. The so-called “blood dew” symptom, blood appears slowly on the affected surface in the form of small, slowly growing drops. Stopping bleeding is done with tight bandaging. With adequate blood clotting ability, it resolves on its own without medical assistance.

5 slide

Slide description:

First aid for capillary bleeding. To stop capillary bleeding, a method of applying a pressure bandage is used. First, the wound should be cleaned of dirt, washed with clean water, then lubricate the skin around the wound with tincture of iodine, and rinse the wound with 3% hydrogen peroxide. Then close the wound with several layers of sterile gauze or bandage. If these are not available, you can use improvised means, for example, a clean handkerchief, a clean sheet torn into wide strips, etc. Next, place a tightly rolled ball of cotton wool on the napkins, and then bandage tightly. If cotton wool is not available, you can use a rolled-up sterile bandage. If blood comes from the nose, then you need to: 1. Make the patient sit comfortably so that the head is higher than the body; 2.Tilt the patient’s head slightly forward so that blood does not enter the nasopharynx and mouth; 3.If you have a nosebleed, you should not blow your nose, because... this may increase bleeding! 4.Press the wing of the nose to the septum. Before this, you can insert cotton swabs, dry or moistened with a 3% solution of hydrogen peroxide, into the nasal passages; 5.Put cold on the back of the head and bridge of the nose (ice pack) for 20 minutes.

6 slide

Slide description:

Arterial bleeding When an artery is damaged, the blood is bright scarlet in color and flows like a fountain from the wound. Arterial bleeding is life-threatening, especially if a large artery is damaged, since the wounded person can lose large number blood.

7 slide

Slide description:

If a person has arterial bleeding, then it is necessary to clamp the vessel above the wound site in those places where the pulse is palpable. 1 - temporal; 2 - occipital; 3 - mandibular; 4 - right common carotid; 5 - left common carotid; 6 - subclavian; 7 - axillary; 8 - shoulder; 9 - radial; 10 - ulna; 11 - femoral; 12 - posterior tibial; 13 - artery of the dorsum of the foot.

8 slide

Slide description:

Techniques for stopping bleeding in the arteries using maximum flexion of the limb. To temporarily stop bleeding at the scene of the incident, you can successfully resort to maximum flexion of the limb at the joint, followed by fixing it in this position. This method is effective when the wound is located below the joints - elbow, hip, knee or in the articular fossa. A tight cotton-gauze roll should be placed in the joint area. So, for example, if there is bleeding from the forearm and hand, you need to put a cotton-gauze roller into the ulnar fossa, bend the arm as much as possible at the elbow joint and fix the forearm to the shoulder in the position of maximum flexion. If the femoral artery is damaged, the limb is bent as much as possible at the hip and knee joints, the thigh and lower leg are bandaged to the body. When bleeding from the lower leg and foot, a thick pad must be placed in the popliteal fossa, the leg is fixed in the position of maximum flexion in the knee joint.

Slide 9

Slide description:

Applying a tourniquet (twisting) After applying the tourniquet, the wound is treated and a pressure bandage is applied. But after this, the patient must be taken to the doctor. You can keep the tourniquet in the summer for up to 1 hour. In winter – up to 30 minutes. Then the tourniquet is loosened for 2 - 3 minutes. If the tourniquet is overexposed, tissue necrosis may occur. Therefore, you need to remember to put a note under the tourniquet with time.

10 slide

Slide description:

Venous bleeding. Unlike arterial bleeding, venous bleeding is characterized by a weak pulsation in time with the heartbeat and dark red blood, sometimes almost black in appearance. Occurs with shallow cuts, cuts in the joint area. But it can be no less safe than arterial bleeding if there is a rupture of large veins, such as the femoral one.

11 slide

Slide description:

Help with venous bleeding If blood is simply flowing from a vein, then such bleeding can be stopped with the help of a pressure bandage. Applying a pressure bandage. Apply a sterile bandage, gauze or clean cloth directly to the bleeding wound. If you use a non-sterile dressing, it is recommended to drip a little tincture and iodine onto the fabric to create a spot larger than the wound. A thick roll of bandage, cotton wool or a clean handkerchief is placed on top of the fabric. The roller is tightly bandaged and, if necessary, continue to press on it with your hand. If possible, the bleeding limb should be raised higher than the body. At correct position With a pressure bandage, bleeding stops and the bandage does not get wet. If there is an object in the wound, then it cannot be pulled out, since when it is removed, severe bleeding will begin. Only a specialized surgeon can remove a foreign body.

12 slide

Slide description:

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Bleeding
Completed 311 medical procedures.
L/O/G/O
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Haemorrhagia

- leakage of blood from the lumen of a blood vessel due to its
damage or disruption of the permeability of its wall.
The surgeon’s ability to cope with bleeding is an indicator of his professionalism
Bleeding is a complication of many diseases and
damage, as well as the consequence of the action
surgeon
Continued bleeding is an immediate threat to the patient's life
In case of bleeding, speed of administration is extremely important.
solutions and assistance
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Classification of bleeding

Depending on the anatomical type
damaged vessels:
arterial, venous, capillary,
parenchymal and mixed.
In relation to the external environment:
indoor, outdoor and mixed.
Internal bleeding can be:
- intracavitary
- explicit
- interstitial
- hidden
- mixed
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According to the mechanism of occurrence:
1. Bleeding of mechanical origin
(Hemorrhagia per rhexin)
2. Arrosive bleeding (Hemorrhagia per
diabrosin) – ulcers, tumors, TBC, abscesses,
purulent wounds
3. Acute bleeding developing
due to vascular disorders
permeability (Hemorrha-gia per diapedesin) –
scurvy, hemorrhagic vasculitis, scarlet fever,
smallpox, leukemia, uremia, sepsis.
4. Bleeding in case of violation
blood clotting – hemophilia, disease
Verlhof, cholemia, DIC
5. Bleeding due to specific
inflammation of the intestinal wall - syphilis, TVS,
dysentery, typhoid fever, actinomycosis
6. Artificial bleeding - bloodletting
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Downstream:
- Acute - bleeding is observed in a short period
time.
- Chronic - bleeding occurs gradually, in small quantities
in portions. Sometimes it lasts for many days
slight, sometimes periodic bleeding.
By volume of blood loss:
- mild degree – loss of up to 10% of bcc (up to 0.5 l);
- average degree - loss of 10-20% of bcc (0.5-1.0 l.);
- severe degree – loss of 21-30% of bcc (1.0-1.5 l.);
- massive blood loss - over 30% of the volume of blood volume (over 1.5 l.)
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According to the time of appearance they distinguish:
a) primary bleeding - occurs after a vessel injury;
b) secondary bleeding - some time after
stopping primary bleeding.
Secondary bleeding is divided into:
a) early - occur in the first hours or days (up to 3) after
injuries and are associated with the release of a fresh blood clot as a result
increased pressure in the circulatory system;
b) late - with the development of suppuration and arrosion of the vessel in the wound.
By source localization:
1) from the top respiratory tract and lungs
2) in case of damage to the organs of the thoracic cavity
3) for injuries and diseases of the esophagus
4) from the organs of the upper floor of the abdominal cavity (stomach, liver,
duodenum, spleen)
5) from the organs of the lower floor of the abdominal cavity (intestinal,
uterine)
6) organs of the retroperitoneal space.
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Pathophysiology of acute blood loss

Activation of the sympathetic-adrenal
systems
Hemodilution
Microcirculation disorders
Breathing disorders
Renal dysfunction
Metabolic changes
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COMPENSATORY-ADAPTIVE MECHANISMS

Venospasm.
Influx of tissue fluid.
Tachycardia.
Oligouria.
Hyperventilation.
Peripheral arteriolospasm.
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Diagnosis of bleeding

For external bleeding: visually, palpation.
1) arterial, venous - by color, pulsation, intensity;
2) by localization - temporal, carotid, subclavian, brachial...
For internal bleeding:
1) clinical picture of bleeding;
2) diagnosis of diseases that cause bleeding
(or injuries).
Local signs of internal bleeding:
o Hemoptysis (pulmonary hemorrhage)
o Vomiting of blood or “coffee grounds” type (esophageal and
stomach bleeding)
o Blood in the stool or tarry stools - melena (bleeding
from the stomach, duodenum and biliary tract)
o Hematuria (bleeding from the kidneys)
Local signs of internal hidden bleeding:
o detection of spilled blood
o change in the function of damaged organs
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Diagnostic methods:

History, complaints, objective examination.
R-logical examination of the chest, esophagus,
stomach.
Angiography, computed tomography, NMR,
spiral tomography.
Ultrasound examination
Diagnostic punctures
Endoscopic examination: bronchoscopy,
thoracoscopy, esophagogastroduodenoscopy, colonoscopy,
laparoscopy, cystoscopy.
Laboratory tests: blood, urine, gastric
contents, feces.
Operative diagnostic methods: thoracotomy,
laparotomy.
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Common symptoms of bleeding

Signs of bleeding:
pale skin, cold sweat, acrocyanosis,
physical inactivity,
lethargy and other disturbances of consciousness,
tachycardia, thready pulse,
decrease in blood pressure,
dyspnea,
decreased diuresis
Complaints:
weakness,
dizziness, especially when raising the head,
“darkness in the eyes”, “spots” before the eyes,
feeling of lack of air,
anxiety,
nausea.
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Clinical symptoms with varying degrees of blood loss

Lightweight
Clinical
signs:
none.
Volume
blood loss:
up to 10% bcc
Average
Clinical
signs:
minimum
tachycardia, decreased
ie blood pressure, signs
peripheral
vasoconstriction
(pale cold
limbs)
Volume
blood loss:
10-20% bcc
Heavy
Massive
Clinical
signs:
tachycardia up to 120 V
min,BP lower
100mmHg, uneasy
property,cold
sweat, pallor, cyan
oz, shortness of breath, oligour
and I.
Volume
blood loss:
21-30% bcc
Clinical
signs:
tachycardia more
120 per minute, blood pressure 60
mmHg And
lower, often not
determined, step
r, sharp
pallor, anuria.
Volume
blood loss:
More than 30% bcc
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LABORATORY INDICATORS FOR BLEEDING

The number of red blood cells in the peripheral
blood. Normally 4.0-5.0 102 /g.
Hemoglobin content in peripheral
blood. Normally 125-160 g/l.
Hematocrit - the ratio of the volume of formed
elements to the volume of whole blood.
Normal is 44-47%.
Specific gravity of blood. In practical medicine
rarely determined. Normally 1057-1060 units.
In case of bleeding, the values ​​indicated
indicators are decreasing.
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METHODS FOR DETERMINING BLOOD LOSS

by direct quantity
poured out during external
blood bleeding,
by weight of dressing material
(for blood loss during
operations).
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Methods for determining blood loss Using the palm of your hand

Degree of blood loss Wound area
Lightweight
%
blood loss
1 palm
10%
Average
2-3 palms
20%
Big
3-5 palms
40%
Heavy
>5 palms
50%
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Determination of blood loss using the shock index.

Shock index (Allgover) is the quotient of a number
pulse beats in peripheral arteries per minute
on systolic blood pressure. Normally, IS = 0.5.
Each increase of 0.1 corresponds to blood loss in
volume 0.2 l or 4% bcc.
- IS< 0,8 при кровопотере до 500 мл (10 % ОЦК);
- ISH = 0.9-1.2 with blood loss up to 1000 ml (20% of blood volume);
- ISH = 1.3-1.4 with blood loss up to 1500 ml (30% of blood volume);
- ISH = 1.5-2.0 with blood loss up to 2500-3000 ml (40-
50% bcc).
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By type, nature and location of bone fracture

Injuries
Fractures
Blood loss (l)
Forearms
0,3-0,6
Shoulder
0,6-0,64
pelvic bones
1,25-2,5
Hips
1,0-1,8
Shin
0,8-1,0
skull bones (open and closed)
0,5-1,2
Breasts
Abdomen with internal damage
organs
0,5-1,8
1,7
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Determination of blood loss during surgery

1. Gravimetric - weigh napkins and balls soaked
blood during surgery, subtract the weight of dry wipes and balls;
the difference in weight indicates the amount of blood lost.
2. Calorimetric - used and soaked in blood during
during the operation, dressing material (wipes, balls, tampons and
etc.) washed from blood in water (in a certain amount),
determine the hemoglobin content in water and calculate it using the formula
the amount of blood lost.
3. Weighing the patient before and after surgery - difference in weight
indicates the amount of blood lost during surgery.
4. Measurement of bcc by various methods (Evans paint,
radioactive albumin) before and after surgery.
5. By electrical conductivity - in a vessel with distilled water
place a dressing soaked in blood, wash it off
blood. The electrical conductivity of the bloody fluid is measured.
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Classification of the degree of blood loss

Blood loss rate
Degree of blood loss
light
average
heavy
Number of red blood cells,
in l.
>3,5*1012
3,5*1012-
2,5*1012
<2,5*1012
Hemoglobin level, g/l
>100
83-100
<83
Pulse rate per 1 min.
Up to 80
80-100
Above 100
Systolic blood pressure, mm.
rt. Art.
> 110
110-90
<90
>30
25-30
<25
Up to 20
From 20 to 30
30 and more
Hematocrit, %
Globular deficiency
volume, % of due
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THE CONCEPT OF HEMORRHAGIC SHOCK

Hemorrhagic shock is pathological
condition arising as a result of rapid and
massive blood loss causing sudden
decrease in blood volume, cardiac output and tissue
perfusion, and characterized by decompensation
defensive reactions and the increase in pathological
disorders in the body. Leading initial
a link in the pathogenesis of hemorrhagic shock
is a violation of biological balance
between vascular bed capacity and mass
circulating blood, which the body is not in
able to maintain at the proper level for
account of compensatory mechanisms during profuse
hemorrhages. Rapid loss of more than 30% of bcc
leads to acute circulatory failure
and the development of hemorrhagic shock.
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There are three stages
hemorrhagic shock:
Stage I - compensated
reversible shock (small syndrome)
ejection);
Stage II - decompensated
reversible shock;
Stage III - irreversible shock.
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Stage I. Compensated shock is caused by the loss of such
blood volume - up to 25% of the bcc, which is good
compensated by mechanisms of adaptation and self-regulation.
Stage II. Decompensated reversible shock develops
with a loss of 25-45% of the bcc (1300-1800 ml) is characterized
more profound circulatory disorders, with
which peripheral vasospasm is unable to
compensate for low cardiac output; arterial
pressure drops below 100 mm. rt. Art., pulse 130-140 V
min, arterial and venous pulse decreases
pressure.
Stage III. Irreversible hemorrhagic shock (loss of more than
50% bcc - 2000-2500 ml) is qualitatively less than
differs from decompensated shock and is a stage
even more profound circulatory disorders in all
organs and systems. The pulse reaches more than 140 beats per minute.
Blood pressure drops below 60 mm. rt. Art. Irreversible
hemorrhagic shock is associated with progressive organ failure
failure in which liver function is affected,
kidneys, lungs, heart.
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The first stage of the examination is intended for the wounded,
admitted in extremely serious condition with a well-defined
source of bleeding.
- A quick external examination of the wounded person, his skin and mucous membranes.
- Pulse detection and blood pressure measurement.
- Assessment of consciousness.
- Taking an electrocardiogram.
- Determination of the amount of blood loss using the “shock index”.
- Carrying out X-ray examination.
- Clinical assessment of the severity of hypovolemia using a capillary test.
- Inspection and auscultation of the chest, palpation of the abdomen.
- Place a catheter in the main vein and draw blood for
determination of hematocrit, hemoglobin, blood group, acid-base status (ABS) and blood gases; under appropriate conditions –
introduction of an indicator for assessing the BCC, beginning (or continuation)
infusion therapy.
- Making a decision on urgent surgery or further tactics
examinations and treatment. In cases where the wounded is transferred to
operating room, a catheter is being installed in the right side of the heart
by puncture of the subclavian vein with measurement of central venous pressure.
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The second stage of the examination is used in lighter and less
clear cases when it is necessary to clarify the location of the source
bleeding.
- Thorough examination of the affected area and identification of the source
bleeding that continues or has stopped. For this
the whole range of additional instrumental tools is used
research
- X-ray examination.
- Assessment of central venous pressure.
- Determination of the severity of hypovolemia and deficiency of main components
OCC.
- Repeated studies of hematocrit indicators in the peripheral
blood for dynamic assessment of the nature of changes occurring
red blood parameters.
- Study of biochemical parameters of blood, coagulation and
fibrinolytic systems.
- Conclusion about the severity of the wounded person’s condition, making a decision on
further treatment tactics - conservative or surgical, with
performing a delayed or early operation.
- Calculation of the required volume of blood substitutes for replenishment
blood loss.
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PRINCIPLES OF TREATMENT OF ACUTE BLOOD LOSS

1) performing final hemostasis using surgical
method and drugs of hypercoagulant action;
2) restoration of blood volume and elimination of hypovolemia;
3) ensuring central blood circulation as required
level;
4) elimination of microcirculation disorders and restoration
tissue perfusion;
5) correction of breathing disorders, increasing oxygen capacity
and transport function of blood and elimination of hypoxia;
6) normalization of transcapillary exchange;
7) improvement of the rheological properties of blood;
8) restoration of violations of CBS and water-electrolyte
balance;
9) normalization of blood coagulating properties;
10) maintaining the body’s energy balance in
posthemorrhagic period
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Methods to stop bleeding

Stop
bleeding
Spontaneous
a) spasm of a wounded vessel with
reducing it
lumen
Artificial
Temporary
stop
bleeding
Final
stop
bleeding
b) decreased blood pressure
c) screwing intima into
lumen of the vessel
d) development of the reaction
collapsing with
formation of a clot,
thrombus closing
lumen of the vessel.
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METHODS FOR TEMPORARILY STOPING BLEEDING

Pressure bandage
Elevated limb position
Maximum joint flexion
Finger pressure of large vessels
Application of a tourniquet
Tamponade of the wound with a sterile bandage,
napkin or improvised material.
Applying a clamp to a vessel in a wound.
Temporary bypass
main vessel.
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Sublime
limb position
Wound tamponade
Pressure bandage
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FINGER PRESS OF AN ARTERY

Artery name
External landmarks
Subjacent bone
A.temporalis
1cm above and anterior to the hole
external auditory canal
Temporal bone
A.facialis
2 cm anterior to the angle of the lower
jaws
Lower jaw
A.carotis communis
Center of the inner edge
sternocleidomastoid muscle (upper edge
thyroid cartilage)
Carotid tubercle transverse
process of the 7th cervical vertebra
A.subclavia
Behind the collarbone in the middle third
1st rib
A.axillaris
Anterior border of hair growth
armpit
Head of humerus
A. brachialis
Medial edge of the biceps
muscles (sulcus bicipitalis medialis)
Inner surface of the shoulder
A.femoralis
The middle of the poupart fold (according to
bony landmarks)
Horizontal branch of the pubis
bones
A.poplitea
Top of the popliteal fossa
Rear surface
tibia
Aorta abdominalis
Navel area (pressure with fist)
Lumbar
spine
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a - diagram of the location of the main arteries and
their pressure points (indicated by arrows); b, c -
compression of the common carotid artery; g - pressing
subclavian artery; d - pressing the outer
maxillary artery; e - compression of the temporal artery; and,
h - compression of the brachial artery; and - pressing
axillary artery.
Methods for stopping bleeding from the vessels of the extremities
by their forced bending: a - general mechanism
actions of forced flexion of the limb (1 -
blood vessel, 2 - cushion, 3 - limb); b - at
injury to the subclavian artery; c - when injured
axillary artery; d - in case of injury to the shoulder and elbow
arteries; d - when the popliteal artery is injured; e - at
injury to the femoral artery.
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Rules for applying a tourniquet

1. Raise the limb.
2. Apply more proximally
close
wounds for 1-1.5 hours.
3. Place fabric under the tourniquet.
4. Impose the first 2-3 rounds
separately.
5. Pin a card with the exact
indicating the application time.
6. The part of the body where the tourniquet is applied
must be available for inspection.
7.Transportation and maintenance
the wounded man with a tourniquet should
be carried out first.
8. You need to remove the tourniquet gradually
loosening it, with preliminary
anesthesia.
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METHODS FOR FINALLY STOPING BLEEDING

1. Mechanical methods
- Ligation of a vessel in the wound.
- Ligation of the vessel throughout.
- Twisting the vessel with a hemostatic clamp.
- Sheathing the vessel.
- Applying a vascular suture to a wounded vessel and prosthetics
vessel.
- Wound tamponade according to Mikulic
- Vascular embolization.
- Special methods to control bleeding: splenectomy,
gastric resection, lobectomy, etc.
- Blockage of bleeding intraosseous vessels with wax during
operations on the skull.
A
b
V
G
d
a) ligation, b) electrocautery, c) ligation and intersection
vessel at a distance, d) ligation of the vessel along its length, e) puncturing
vessel
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Physical methods

2. Physical
(thermal) methods
(during surgery for
stop bleeding
enjoy
electrocoagulation with
using diathermy,
radiofrequency
coagulation. Besides,
laser is used
photocoagulation,
plasma scalpel.
With parenchymal
bleeding - hot
saline solution)
electrocoagulator
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Physical methods

Exposure to low temperature
mechanism of hemostatic effect of low temperature spasm of blood vessels, slowing of blood flow and thrombosis
blood vessels (local hypothermia: with nosebleeds -
ice pack)
Exposure to high temperature
mechanism of the hemostatic effect of high temperature -
coagulation of vascular wall protein, acceleration of coagulation
blood (use of hot solutions: during operations on the wound
cloth moistened with hot saline solution)
Electrocoagulation is the effect on tissue of alternating
high frequency current (500 kHz - 2 MHz), which leads to
releases a large amount of heat, but does not
influence on endogenous human electrical potentials.
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LASER PHOTOCOAGULATION is a non-contact method of tissue coagulation by exposure to optical coherent radiation, characterizing

LASER PHOTOCOAGULATION
this is a non-contact method of tissue coagulation by exposure
optical coherent radiation, characterized
high directionality and high energy density.
Advantages:
Precise tissue dissection
Minimum
heat spread
Light wavelengths with
tissue selectivity
Non-contact method
LASER DEVICE
SURGICAL DIODE "
DIOLAS-810"
Flaws:
High cost
apparatus ($50-100,000)
and consumables
Need for training and
certification
Technical limitations
Smoke formation
limits visualization
in endosurgery
Risk of damage
distant tissues
Need for protection
eye
Decrease in coagulating
effect with abundant
bleeding
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Chemical methods

topically - 3% peroxide solution
hydrogen; aminocaproic
acid (proteolysis inhibitor)
- orally for gastrointestinal bleeding,
irrigation during endoscopy;
adrenaline solution -
mucosal lubrication
membranes during bleeding;
for gastric, pulmonary and
uterine bleeding -
use drugs
ergot inside; drugs
gelatin (telaspon);
carbazochrome.
Intravenously: chloride
calcium 10 ml 10% solution, 5%
NaCl or 40% glucose solution;
aminocaproic acid –
100ml; dicinone, ethamsylate,
pituitrin, Vit. S, routine,
synthetic vikasol.
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Biological methods

1) tamponade of a bleeding wound with one’s own
tissues of the patient (omentum, muscle, fat
fiber, fascia);
2) transfusion of small doses of blood, fresh plasma, serum,
platelet mass, fibrinogen, etc., introduction
prothrombin complex - clotting concentrate
factors II-VII-IX-X, antihemophilic globulin A;
3) administration of vitamins;
4) intramuscular injection of human serum
or animals;
5) local application of blood derivatives (thrombin,
hemostatic sponge, isogenic fibrin film,
biological antiseptic swab, etc.).
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Tactics for bleeding

1
2
3
Deciding on the indication for surgery and
ability to stop bleeding
mechanically.
Resolving the issue of the possibility of providing local
hemostatic effect (coagulation of the vessel at the bottom
ulcers, administration of cold hemostatic agents
solutions, the use of local biological factors
nature)
Complex conservative treatment
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Complex hemostatic therapy

2) Actually
hemostatic therapy
(usage
chemical and
biological methods
general action)
1) Substitute
therapy (replacement of blood volume
and erythrocyte mass).
When conducting
replacement therapy
first of all it should
take into account the volume
blood loss
3) Combating acidosis
(transfusion 150-300 ml
4% soda solution)
Bleeding
tion
4) Symptomatic therapy,
aimed at
maintenance of function
main organs and systems
body (primarily
cardiovascular, pulmonary
and kidneys).
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