Bleeding: symptoms and classification, first aid, treatment. First aid for all types of bleeding First aid for bleeding and blood loss

Bleeding- outflow of blood from blood vessels in case of violation of the integrity or permeability of their walls. There are traumatic bleeding caused by mechanical damage vascular wall(cut, tear, blow, compression, crush), and non-traumatic, caused pathological changes vessels or surrounding tissues (arrosia, wall delamination) in atherosclerosis, syphilis, malignant tumors, purulent inflammation. The cause of non-traumatic bleeding can be such diseases and pathological conditions in which blood clotting is impaired (jaundice, blood diseases, poisoning, sepsis, beriberi).

For arterial bleeding(Fig. 4, c) blood is bright red, pours out in a pulsating stream. Bleeding out large vessels(aorta, carotid, femoral, brachial arteries) can lead to cardiac arrest within a few minutes or even seconds.

For venous bleeding(Fig. 4, b) the blood is dark red, flows out in a slow stream, since the pressure in the veins is much lower than in the arteries. Bleeding from large veins (femoral, subclavian) poses a danger to the life of the victim, both as a result of rapid blood loss and in connection with a possible air embolism.

capillary bleeding(Fig. 4, a) occurs when the destruction (trauma) of capillaries, arterioles. As a rule, it stops on its own, but in patients with impaired blood clotting (hemophilia), it can lead to significant blood loss.

Rice. 4. Types of bleeding: a) capillary bleeding; b) venous bleeding; c) arterial bleeding

Parenchymal (internal) bleeding occurs when the tissue of the liver, kidneys, spleen and other parenchymal organs is damaged; almost always leads to large blood loss and rarely stops on its own, since the walls of blood vessels in these organs are fixed and do not collapse.

Bleeding can be external or internal. External bleeding is characterized by the outflow of blood into external environment through broken skin or mucous membranes. With internal bleeding, blood enters the body cavity (pleural, abdominal, cranial cavity) or through the lumen of a hollow organ - into the stomach, intestines, bladder, uterus, bronchi, trachea. Internal bleeding includes hemorrhages in subcutaneous tissue, between muscles, sheets of aponeuroses. resulting in the formation of hematomas.

Unlike external bleeding, internal bleeding is not always easy to diagnose. Signs of internal bleeding are:

Pale skin and mucous membranes;

Cold sweat;

Growing anxiety;

Dizziness;

Drowsiness;

Loss of consciousness.

There is a collapse (increase and weakening of the pulse, sharp drop pressure) and decrease in hemoglobin.

internal bleeding can be the cause of death even with a relatively small blood loss, when the outflowing blood compresses vital organs (heart or brain).

There are also primary and secondary bleeding. Primary is called bleeding that occurs at the time of injury. Secondary bleeding develops as a result of suppuration of the wound, the presence of foreign body(drainage, fragment), bleeding disorders and other complications.

At the first sign of bleeding, measures should be taken to stop it. There are temporary (preliminary) and permanent (final) stops of bleeding. Temporary stop of bleeding prevents dangerous blood loss and allows you to buy time for the final stop of blood.

To stop bleeding, you must:

Raise the injured limb up; close the bleeding wound with dressing material (from the bag), folded into a ball, and press down from above, without touching the wound itself with your fingers; in this position, without releasing your finger, hold for 4-5 minutes; if the bleeding does not stop, then, without removing the applied material, put another pad from another bag or a piece of cotton on top of it and bandage the wounded area (with some pressure);

With severe bleeding, if it does not stop with a bandage, squeezing the blood vessels that feed the wounded area is used by bending the limb in the joints, as well as with fingers, tourniquet or twist; in all cases of large bleeding, it is necessary to urgently call a doctor without suspending first aid.

Stop bleeding with fingers. You can quickly stop the bleeding by pressing the bleeding vessel with your fingers to the underlying bone above the wound (closer to the body). On human body there are a number of places where you can squeeze blood vessels. The most convenient places and ways of pressing blood vessels are shown in Fig.5.

Rice. 5. Points of digital pressure of the arteries

1 - temporal; 2 - jaw; 3 - sleepy; 4 - subclavian; 5 - axillary; 6 - shoulder; 7 - radial; 8, 9 - femoral; 10 - tibial

Bleeding from the vessels of the lower part of the face is stopped by pressing the jaw artery to the edge mandible, and bleeding from the temple and forehead - by pressing temporal artery ahead of the ear. Bleeding from large head and neck wounds can be stopped by applying pressure carotid artery to the cervical vertebrae.

Bleeding from wounds of the armpit and shoulder is stopped by pressing the subclavian artery against the bone in the supraclavicular fossa. When bleeding from the forearm, the brachial artery is pressed in the middle of the shoulder. When bleeding from the hand and fingers, two arteries are pressed in the lower third of the forearm near the hand. Bleeding out lower extremities stop by pressing down femoral artery to the pelvic bones. 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 strongly enough.

Stop bleeding by bending the limbs. More quickly and reliably than pressing with a finger, you can stop bleeding by bending the limb in the joints (Fig. 6).

Rice. 6. Flexion of the overlying joint during bleeding: a - from the forearm, b - from the shoulder, c - from the lower leg, d - from the thigh

If the victim quickly roll up his sleeve or trousers and, having made a lump (pelot) of any matter, put it into 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, it will be squeezed artery passing in the fold, supplying blood to the wound. In this position, the leg or arm must be tied or tied to the body of the victim.

Stop bleeding with a tourniquet or twist. When flexion in the joint cannot be used (for example, in the case of a simultaneous fracture of the bone of the same limb), then in case of severe bleeding, the entire limb should be tightened by applying a tourniquet (Fig. 7). As a tourniquet, it is best to use some kind of elastic, stretchable fabric - a rubber tube, garters, suspenders. Before applying the tourniquet, the limb (arm or leg) must be raised up. If the assisting person does not have an assistant, then the preliminary pressing of the artery with the fingers can be entrusted to the victim himself.

Figure 7. Applying a tourniquet

The tourniquet is applied to the part of the shoulder or thigh closest to the body. The place on which the tourniquet is applied is wrapped with something soft: a bandage, gauze, a piece of cloth. You can also apply a tourniquet over a sleeve or trousers. Before applying the tourniquet, it must be stretched, and then tightly applied to the limb, leaving no uncovered skin areas between turns of the tourniquet. Pulling the tourniquet of the limb should not be excessive, otherwise the nerves may be squeezed and damaged. It is necessary to tighten the tourniquet until the bleeding stops. If it is found that the bleeding has not completely stopped, then additionally (more tightly) apply several turns of the tourniquet.

The applied tourniquet is held for no more than 1.5 - 2 hours (a note is attached indicating the time the tourniquet was located), otherwise it will lead to necrosis of the bloodless limb. The pain caused by the applied tourniquet can be very strong, so sometimes you have to loosen it for a while. In these cases, before loosening the tourniquet, it is necessary to press the artery along which there is blood to the wound, and allow the victim to rest from the pain, and the limbs to receive some blood flow. Dissolve the tourniquet should be gradual and slow.

If there is no stretchable rubber band at hand, you can tighten the limb with the so-called twist, made of non-stretch material: a tie, belt, twisted scarf or towel, rope, belt (Fig. 8.8). The material from which the twist is made is circled around the limb raised up, previously wrapped in some soft cloth, and tie a fracture on the outer side of the limb. Some solid object (in the form of a shelf) is passed into or under this knot, which is twisted until the bleeding stops.

Rice. 8. Overlay spin

You can not tighten the twist too much. Having twisted to the required degree, the stick is tied so that the twist cannot spontaneously unwind.

In case of bleeding from the nose, the victim should be laid or seated, slightly tilting his head back, unfasten the collar, put a cold lotion on the bridge of the nose and on the nose, squeeze the soft parts (wings) of the wearer with your fingers, insert a piece of sterile cotton wool or gauze soaked in hydrogen peroxide into the nose.

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If large vessels are damaged, a person can lose more than 500 ml of blood per a short time, this poses a threat to him and his life and requires immediate medical care. There are several:, venous and, as well as mixed.

In order to successfully provide primary care for venous bleeding (first aid), first of all, it is necessary to establish which vessels are damaged.

How to stop bleeding

First aid for venous bleeding should be carried out strictly according to the points:

Pinch the bleeding vessel above and below the wound with your fingers;
Apply a pressure bandage to the wound, it can be made from a bandage, gauze or improvised materials. This will make it possible to avoid air embolism;
Apply ice to bleeding site;
If the vein is damaged, below the movable joint, and there are no improvised means to create a pressure bandage, then the blood can be stopped by bending the limb as much as possible, while there is a natural clamping of the vessels;
Also, to stop the blood, you can apply a tourniquet to the limb;
The patient is immediately taken to the hospital for suturing the damaged vessel.

Signs of bleeding from the veins

Each type of bleeding has its own characteristic symptoms defining it. To provide first aid for venous bleeding, as with any other, you need to know the appropriate signs. Table No. 1 presents the symptoms of types of external hemorrhage.

Table No. 1:

Venous	Arterial	capillary
The blood is dark in color, flows out slowly and evenly, with a very weak pulsation	Bright scarlet blood is ejected in a pulsing jet	The color of the blood is lighter than with venous bleeding, but darker than with arterial bleeding.
Blood pressure is stronger at the bottom of the injury	The patient's condition is rapidly deteriorating, pallor of the skin appears, the pulse quickens	Blood oozes over the entire surface of the wound, but individual vessels are difficult to distinguish
In rare cases, there are signs of a strong pulsation, which are directly related to pulse wave arteries	The patient has a sharp drop in blood pressure	Capillary bleeding is dangerous only if the patient has diseases that affect blood clotting. In all other cases, it is not dangerous.
The patient turns pale, has a rapid heartbeat and dizziness	There is nausea, vomiting, darkening in the eyes, loss of consciousness
If large veins are damaged, they may become blocked with air bubbles, which can lead to death.	If help is not provided in a timely manner, the patient dies.
If damaged superficial veins feet and hands, there is a slight bleeding that stops on its own after a few minutes. Without proper assistance, it can resume

How to stop venous bleeding

First aid for venous bleeding includes the following actions:

Elevate the limb to reduce blood flow to the injured area;
Wash the wound with a solution of hydrogen peroxide;

Apply a napkin soaked in this solution to the wound, cover it with a tight lump of cotton wool. You can also use a dressing bag for this purpose;
Then the limb is wrapped with a bandage, and covered with a scarf on top. A tight bandage should be applied below the injury site;
If the bleeding does not stop, a tourniquet must be applied.

Damaged small superficial veins can thrombose on their own, leading to spontaneous bleeding.

When deep veins are injured, bleeding is more intense, and in a short period the patient may lose a large number of blood, therefore it is necessary to stop it as soon as possible.

First of all, it is included in the ways to stop venous bleeding. Then apply ice or a heating pad to the damaged area. cold water and take the patient to the doctor. Every half an hour, the cold must be removed for 10 minutes.

When bleeding in the area of the main saphenous veins of the shoulder or thigh, medical assistance is necessary, since the blood stops flowing on its own in very rare cases. Diseases (leukemia, hemophilia, thrombocytopenia) lead to increased blood loss, alcohol intoxication or the use of blood thinners (Aspirin, Cardiomagnyl).

Stopping bleeding - this is what instructors first of all talk about when teaching rendering first aid with injuries and accidents. What types of bleeding are and first aid for them - that's what will be discussed below.

Types of bleeding

First, let's look at how dangerous it is. In medicine, there are several classifications. At the same time, bleeding from an injured arm or leg, familiar to everyone, is just a special case.

Types of bleeding. First aid for bleeding depends on what kind of vessel was damaged, in what place and how intense the bleeding.

Separation according to the place of blood flow:

external;
internal.

Separation according to the type of damaged vessels:

venous;
arterial;
capillary;
parenchymal;
mixed.

By the nature of the process that caused bleeding:

traumatic;
pathological.

By severity:

lung - up to 500 ml;
average - up to 1 l;
heavy - up to 1.5 l;
massive - up to 2.5 l;
lethal - up to 3 liters (which is 50-60% of the total blood volume);
absolutely lethal: from 3 to 3.5 liters (more than 60% of the total volume).

For young children, blood loss of about 250 ml is considered dangerous.

Common signs of bleeding

In the case, common symptoms appear:

weak pulse;
cardiopalmus;
dizziness;
lowering blood pressure;
fainting.

In severe cases it develops hypovolemic shock caused by a decrease in the amount of blood in the vascular bed and insufficient blood supply to vital organs with oxygen.

How to help with external bleeding

When providing first aid, so-called temporary stopping methods are used. Depending on what types of bleeding, first aid for bleeding may include the following techniques.

If serious types of bleeding are observed, it should be provided as soon as possible. Sometimes minutes count. How to understand how dangerous the situation is? To do this, it is necessary to distinguish one type of bleeding from another.

Arterial

Damage to the arteries causes dangerous types of bleeding. First aid for bleeding from main vessel consists in pressing the artery with a finger, bending the limb or applying a tourniquet. If the relief measures are performed correctly, then the bleeding stops immediately, when a tourniquet is applied, the limb below the site turns pale, becomes cold.

If an artery is damaged, death from blood loss can occur within 10 to 15 minutes. With damage to the carotid and femoral arteries, this time is reduced. How to distinguish arterial bleeding? The blood is bright scarlet, flows out in a strong pulsating stream.

Venous

Venous bleeding: first aid, types and signs, ways to stop differ from arterial bleeding in the following points.

capillary

Capillary bleeding, first aid for bleeding, types of first aid are similar to those for venous.

Such vascular damage is dangerous only with internal bleeding or poor blood clotting.

Bleeding from the nose

Such a pathology occurs with various systemic diseases, trauma, fever, sunstroke, overvoltage, circulatory disorders, diseases and defects of the nasal cavity. Perhaps with excitement and stress. It often occurs in young children and adolescents during the period of hormonal changes in the body.

If someone has first aid for bleeding, the types and ways to stop it are as follows.

When applying a cold compress, tampons, keep your head in a slightly tilted state. In other cases, tilt slightly so that the blood flows out of the nose and not into the throat.

If the bleeding does not stop within 15 minutes, an ambulance must be called.

internal bleeding

Types of bleeding, first aid for bleeding during internal cavities bodies, their signs.

Blood enters the lungs - causes pulmonary edema, When bleeding into the pleural cavity - difficulty breathing due to compression of the lung. The victim is given a semi-sitting position, the legs are bent, a roller is placed under the knees.
When blood enters, there are general signs of bleeding, abdominal pain. The position of the victim - lying on his back, legs half-bent.
In both cases, put ice on the site of the alleged bleeding, provide a sufficient amount of fresh air. Keep the victim immobile.
When blood flows into the muscles, swelling and hematoma form.

All cases of internal bleeding require immediate hospitalization.

Uterine bleeding

Various types of bleeding and first aid for violations in reproductive system female body require skilled medical care. The uterus is abundantly supplied with blood vessels, and it is not so easy to stop the bleeding. This requires the introduction medicines and often surgery.

Uterine bleeding is possible with inflammatory and degenerative processes in the uterus, hormonal disorders, pregnancy.

First aid measures:

Take a lying position, raise your legs, placing a pillow under them.
Place an ice pack or cold water bottle on the lower abdomen through a cloth. Keep ice for 10-15 minutes, then take a break for 5 minutes. Total keep cold for about 1-2 hours.
Drinking plenty of water is recommended to replenish blood loss.

In field conditions, first aid for bleeding is very important. Emergency medicine involves the provision of competent assistance in conditions where it is impossible to quickly consult a doctor. When planning hiking trips, practicing various sports, hunting, fishing, you should have at your disposal a minimum set of medical preparations- a first aid kit. To stop bleeding, a tourniquet, bandage, and disinfectants are needed. A 3% solution of hydrogen peroxide will not only disinfect the wound, but will also help stop bleeding. To compress the vessels of the limbs, you can use improvised means: clean cotton cloth, handkerchiefs, scarf, belt, clothes. Instead of a tourniquet, you can apply a twist using a strip of fabric and a stick.

In any case, if bleeding occurs, its type and degree of danger should be determined, if necessary, pinch the vessel with a finger and prepare means to stop the bleeding. In case of serious injuries, the victim should be taken to the first-aid post and then to the hospital. Counting on qualified medical care, you must have a sufficient level of knowledge to help yourself and your loved ones if necessary. Indeed, in some cases, an ambulance can arrive only after a few hours, and sometimes you have to deliver the victim to the nearest settlement on your own.

Blood provides organs and tissues with the necessary nutrients, protects them from foreign agents, removes the end products of metabolism. The stability of its transport activity contributes to well-coordinated work all body systems. If the integrity of the vascular bed is violated and bleeding occurs, malfunctions in the functioning of organs appear. Massive blood loss (more than 50% of blood volume) poses a serious danger to human life and health, so you need to know the basics of first aid in this situation.

Blood loss occurs as a result of a damaging effect on vascular system various factors: injuries, diseases internal organs, violations of coagulation processes. The result is bleeding varying degrees gravity. The choice of method of assistance directly depends on the type of blood loss.

Depending on the area of bleeding, it can be:

outdoor- blood flows from the vascular bed into the external environment. Its outpouring occurs on the surface of the skin from wounds, which are of various types, based on the damaging factor: cut, torn, stabbed, bruised, chopped, gunshot, bitten, crushed;
internal- when blood flows into the body. The causes of its appearance are strokes, diseases of internal organs ( parenchymal bleeding), stab and gunshot wounds, fractures, falls. It can be overt and covert.

The first variant is characterized by bloody discharge from natural openings: ears, nose, vagina, anus, oral cavity, urethra. With a latent form, blood accumulates in a certain cavity (abdominal, pelvic, pleural).

Depending on the type of damaged vessel, bleeding is classified:

capillary- appears as a result of a superficial wound, deep tissues are not affected, the blood is bright red in color. Blood loss in this case is small, there is a danger of infection entering the affected area;
venous- Occurs when more deep damage. Blood loss is quite abundant, especially with trauma large vein. This condition can be fatal. The outpouring of blood occurs at a measured pace, continuously, without gushing;
arterial- most dangerous view bleeding, especially when large arteries are injured. Blood loss develops at a rapid pace, often massive, which is a mortal danger. The ejection of blood of a scarlet color occurs in pulsating shocks (gushing), since it is under great pressure in the vessel, moving in the direction from the heart;
mixed- characteristic of deep wound, appears when blood loss of various types is combined.

Symptoms

To determine the necessary assistance to the victim, sometimes you need to know clinical manifestations with blood loss. At outdoor the form of bleeding diagnosis of difficulties does not cause. There are pallor, dizziness, fainting, a feeling of thirst and dryness in the oral cavity, blood pressure drops, the pulse quickens, but its filling is weak, there may be difficulty in breathing, a state of shock.

At internal blood loss evaluation of symptoms is important to confirm the fact of bleeding. In this case, the same symptoms are present as in the external form. However, additional hemoptysis may be added, respiratory failure(with pulmonary hemorrhage), painful, hard stomach, coffee-colored vomiting, melena (with blood loss in the abdominal cavity). The patient's condition deteriorates sharply up to shock and cardiac arrest.

First aid for bleeding

When a situation arises, life threatening a person, in particular with blood loss, you need to know the basics and some of the nuances of first aid. This will save precious minutes before the arrival of doctors, help preserve the health and life of a person.

The table shows common methods stopping and reducing blood loss various types bleeding.

Type of bleeding	First aid
capillary	clamp the wound with the palm of your hand or cloth; elevate a limb wash, disinfect the wound area (excluding the wound itself); the use of a sterile bandage, possibly pressing (with oozing blood)
Venous	pressing the wound with fingers or palms; lifting up the affected limb; application of a pressure bandage
Arterial	finger pressure on the artery above the damaged area; the use of a tourniquet above the lesion; limb flexion
internal	to give a comfortable posture, based on the localization of blood loss; apply cold; cover the victim; not allowed to move, eat, drink

To put into practice these methods of stopping and reducing blood loss, you need to know their detailed technique, take into account some of the nuances and possible consequences.

With capillary bleeding

With minor damage, a regular sterile dressing made from a bandage or napkin is often sufficient. The wound must be washed, treated edges antiseptic(iodine, brilliant green, alcohol). A pressure bandage may be applied if blood continues to ooze. At the same time, a sterile napkin with an antiseptic is placed on the wound, tightly bandaged, a cotton roll is applied on top and again tightly fixed with a bandage.

For venous bleeding

With this type of blood loss, the use of a pressure bandage is most justified. Its purpose is to accelerate thrombosis of the vessel, often such a technique is enough to stop blood loss. If it is saturated with blood, it is not necessary to change it, it is necessary to bandage an additional one on top.

ATTENTION! In the absence of means for making a bandage, it is possible to press the wound with your fingers or palm.

Elevation of the limb helps to reduce or stop blood loss.

The mortal danger of such bleeding may lie in the possible occurrence of an air embolism, due to the absorption of air bubbles through damage in the venous bed and their entry into the heart.

ATTENTION! It is forbidden to remove blood clots from the wound, this can provoke massive blood loss!

For arterial bleeding

With this type of blood loss, every minute is valuable, so clamping an artery, usually the brachial or femoral, is a priority technique. This is done above the injury site with significant use of force. Pressing is carried out with a finger or palm, fist (in case of damage to large vessels). This method is designed for a short period of time, since it requires a lot of effort, but it makes it possible to prepare a tourniquet and seek medical help during this period.

ATTENTION! If blood loss does not stop when pressing the artery for ten minutes, you should take a break for a few seconds to avoid the formation of a blood clot in the vascular bed!

Flexion of the limbs can help stop bleeding. If the popliteal artery is damaged, it is necessary to bend the leg to the stop in knee joint, with damage to the femoral artery - bring the thigh to the stomach as much as possible. The subclavian artery is clamped with the help of arms bent at the elbows, wound behind the back and securely fixed. When the brachial artery is injured, the arm is bent to the stop in elbow joint.

The use of a tourniquet is advisable in extreme situations, with the failure of other methods, since its prolonged use leads to nerve atrophy and tissue necrosis. The tourniquet is stretched and the leg or arm is wrapped several times above the site of the lesion like a bandage, the first wrap (tour) is the tightest that needs to be fixed, the subsequent rounds (3-4) are weaker. It is superimposed exclusively on clothing or any material at hand in order to avoid infringement of tissues. You can make a tourniquet yourself from a rope, belt, twisted fabric (twist). In this case, the arm or leg is tightly bandaged, a stick or other similar objects (pen, spoon) are inserted into the knot, secured with an additional knot and wrapped several times until the blood loss stops. The correct use of the tourniquet is determined by the pronounced pallor of the limb and the absence of a pulse. Be sure to specify the time of application of the tourniquet.

IMPORTANT! Its exposure time should not exceed two hours in summer and half an hour in winter period(for children - no more than fifty minutes). With a delay, the tourniquet is loosened for a quarter of an hour, using the method of pressing the vessel, then again applied slightly above or below the original location.

For internal bleeding

The main thing in this state is to completely immobilize the patient, giving him a certain pose:

with blood loss in the chest, in the stomach, with a miscarriage, the patient takes a semi-sitting position;
with damage to the abdominal cavity, pelvic organs give the legs an elevated position;
in case of traumatic brain injury, a pose with a slightly raised head is used.

It is forbidden to feed, drink, anesthetize the patient, cold is applied to the affected area, the victim must be covered.

IMPORTANT! It is necessary to monitor the condition of the person and be ready to carry out resuscitation measures! Transportation is carried out in a sitting position!

First aid in special cases

In some cases, bleeding is required special approach to provide first aid in accordance with certain rules.

It is forbidden to remove anything from the wound on your own, whether it be glass, sand, or a protruding object. This is done exclusively by a doctor. With a protruding object (or part of a bone), it is recommended to apply a bandage near it. Self-removal can provoke increased blood loss.
When bleeding from the nose, cold is applied to this area, the head is slightly forward. If after a quarter of an hour the blood loss has not stopped, this is a reason to apply for medical assistance.
With ear bleeding, an examination should be carried out for superficial wounds that can be treated with an antiseptic. If there are no injuries, it is necessary to urgently seek medical help, this may be a symptom of a fracture of the base of the skull.
In case of damage to the peritoneum (penetrating), assistance is provided in the same way as with internal blood loss. If there are internal organs that have fallen out, they are placed in a bag and bandaged or glued with a plaster. In this case, the intestines must be constantly moistened.
In case of traumatic amputation, together with measures to stop blood loss, the amputated limb should be placed in a bag, then in another one with cold water or ice. At the same time, you need to keep it on weight.

In the event of serious bleeding, you should immediately seek medical help. The danger of blood loss lies in the fact that the deterioration of the condition increases sharply and without the provision of high-quality first aid, the prognosis in most cases is disappointing. Proper and quick application of methods to stop bleeding can save the health and life of the injured person.

Bleeding - an outpouring of blood from blood vessels in violation of the integrity of their walls. Most common cause injuries (blow, injection, incision, crush, sprain).

Bleeding is of varying strength and depends on the type and caliber of the damaged vessel. Bleeding, in which blood flows out of a wound or natural openings, is called outdoor. Bleeding in which blood accumulates in body cavities is called internal. Especially dangerous are internal bleeding into closed cavities - into the pleural, abdominal, heart shirt, cranial cavity. These bleedings are imperceptible, their diagnosis is extremely difficult, and they can remain unrecognized.

Internal bleeding occurs with penetrating wounds, closed injuries (ruptures of internal organs without damage to the skin as a result of a strong blow, fall from a height, squeezing), as well as diseases of internal organs (ulcer, cancer, tuberculosis, blood vessel aneurysm).

With a decrease in the amount of circulating blood, the activity of the heart worsens, the supply of oxygen to vital organs - the brain, kidneys, liver - is disrupted. This causes a sharp violation of all metabolic processes in the body and can lead to death.

There are arterial, venous, capillary and parenchymal bleeding.

arterial bleeding the most dangerous: in a short time, a person loses a large amount of blood flowing out under high pressure. Blood of bright red (scarlet) color beats with a pulsating jet. This type of bleeding occurs with deep chopped, stab wounds. If large arteries, the aorta, are damaged, blood loss that is incompatible with life can occur within a few minutes.

Venous bleeding occurs when the veins are damaged, in which the blood pressure is much lower than in the arteries, and the blood (it is dark cherry in color) flows out more slowly, evenly and continuously. Venous bleeding is less intense than arterial bleeding and is therefore rarely life-threatening. However, when the veins of the neck and chest in the moment deep breath air can be drawn into the lumen of the veins. Air bubbles, penetrating with blood flow into the heart, can cause blockage of its vessels and cause lightning death.

capillary bleeding occurs when the smallest blood vessels (capillaries) are damaged. It happens, for example, with superficial wounds, shallow skin cuts, abrasions. Blood flows out of the wound slowly, drop by drop, and if the blood clotting is normal, the bleeding stops on its own.

Parenchymal bleeding associated with damage to internal organs that have a very developed network of blood vessels (liver, spleen, kidneys).

Stop bleeding. First aid for bleeding at the scene of the accident aims to temporarily stop the bleeding, then to deliver the victim to medical institution where the bleeding will stop completely. First aid for bleeding is carried out by applying a bandage or tourniquet, maximum flexion of the injured limb in the joints.

capillary bleeding easily stopped by applying a conventional bandage to the wound. To reduce bleeding during the preparation of the dressing, it is enough to raise the injured limb above the level of the body. After applying a bandage to the area of the injured surface, it is useful to put an ice pack.

Stop venous bleeding is carried out by applying a pressure bandage (Fig. 10 ). To do this, several layers of gauze are applied over the wound, a tight ball of cotton wool and tightly bandaged. The blood vessels squeezed by the bandage are quickly closed by clotted blood, therefore this way stop bleeding may be definitive. With severe venous bleeding during the preparation of a pressure bandage, bleeding can be temporarily stopped by pressing the bleeding vessel with your fingers below the wound.

To stop arterial bleeding vigorous and swift action is needed. If blood flows from a small artery, good effect gives a pressure bandage.

Rice. 10. Applying a pressure bandage

Fig.11. Places of cross-clamping of arteries:

1 - femoral, 2 - axillary, 3 - subclavian,

4 - sleepy, 5 - shoulder.

To stop bleeding from a large arterial vessel, the technique of pressing the artery above the injury site is used. This method is simple and based on the fact that a number of arteries can be completely blocked by pressing them against the subject bone formations V typical places(Fig. 11, 12 ).

Prolonged stopping of bleeding with the help of finger pressing of the artery is impossible, since this requires great physical strength, is tiring and practically excludes the possibility of transportation.

Reliable way to stop heavy bleeding from the artery of the limb is the imposition of a hemostatic tourniquet (standard or impromptu).

The tourniquet is applied over the sleeve or trousers, but not on the naked body: the skin can be damaged. They hold the tourniquet of an adult for no more than 2 hours (in winter - no more than 1 hour), a longer squeezing of the vessels can lead to necrosis of the limb. A note must be placed under the tourniquet with an exact (up to a minute) indication of the time of its application (Fig. 13)

Rice. 12. Finger clamping of the arteries

Rice. 13. Proper tourniquet application

If the tourniquet is applied correctly (Fig. 14), the bleeding stops immediately, the limb turns pale, and the pulsation of the vessels below the tourniquet disappears. Excessive tightening of the tourniquet can cause crushing of muscles, nerves, blood vessels and cause limb paralysis. With a loose tourniquet, conditions are created for venous congestion and increased bleeding.

If there is no special tourniquet, you can use improvised means: a belt, a scarf, a piece of cloth, a scarf, etc. A tourniquet made from auxiliary materials is called a twist. To apply a twist, you must freely tie the object used for this at the required level. A stick should be passed under the knot and, rotating it, twist until the bleeding stops completely, then the stick should be fixed to the limb (Fig. 15 ). The application of the twist is painful, so it is necessary to put cotton wool, a towel or a piece of cloth folded 2-3 times under it. All errors, dangers and complications noted during the application of the tourniquet fully apply to twisting.

Rice. 14 . Places for applying a tourniquet for bleeding from the arteries:

1 - lower leg, 2 - lower leg and knee joint, 3 - hand, 4 - forearm and elbow joint, 5 - shoulder, 6 - thigh

To stop bleeding during transportation, pressure on the arteries is used by fixing the limbs in a certain position. When injured subclavian artery bleeding can be stopped by the maximum abduction of the arms back with their fixation at the level of the elbow joints (Fig. 16, a). pressing of a popliteal and femoral artery is shown in fig. 16, a, b, c.

Rice. 15. Overlay spin

Fig.16. Fixation of limbs

Stopping bleeding from wounds on the forearm (shoulder, thigh or lower leg), in the elbow bend ( armpit, inguinal fold or popliteal fossa) put a roller of cotton wool or tightly folded tissue, bend the arm to failure in the elbow joint (or, respectively, in the shoulder joint, pressing it to the body, and the leg in the hip or knee joint) and fix it in this position with the help of bandage, scarf, belt, towel ( rice. 17 ). You can leave the limb in this position, like a tourniquet, for no more than 2 hours.

This method is not suitable for broken bones or severe bruises.

Rice. 17. Stop bleeding from a wound on the forearm

First aid has to be provided not only for blood loss from wounds, but also for other types of bleeding.

Bleeding from the nose. With a bruised nose, and sometimes without apparent reason, in some infectious diseases, increased blood pressure, anemia, etc. d. nosebleeds often occur.

First aid. First of all, it is necessary to stop washing the nose, blowing your nose, coughing up blood that enters the nasopharynx, sitting with your head down, etc., since these measures only increase the bleeding. The patient should be seated or laid down with his head raised, his neck and chest should be freed from restrictive clothing, and fresh air should be allowed to enter. The patient is advised to breathe open mouth. Most nosebleeds stop when the patient is calm. You can put cold (blister or plastic bag with ice, cold lotions) on the bridge of the nose. Stopping bleeding in most cases contributes to the compression of the nose for 15-20 minutes, especially after the introduction of a lump of cotton wool into the nostril (you can moisten it with a solution of hydrogen peroxide or a vasoconstrictor, such as a solution of naphthyzinum). If the bleeding does not stop soon, it is necessary to call a doctor or refer the patient to a medical facility.

Bleeding after tooth extraction. After a tooth is removed or after it is damaged (knocked out teeth), bleeding from the dental bed (hole) is possible, especially when the victim sucks blood from the hole, rinses the mouth, and sometimes with insufficient blood clotting. If the bleeding that occurs during the extraction of a tooth does not stop, becomes more abundant or resumes, measures should be taken to stop it.

First aid. It is necessary to make a small roller of sterile cotton wool or gauze, lay it between the top and lower teeth according to the place extracted tooth, after which the patient tightly compresses his teeth. The thickness of the roller should correspond to the gap between the teeth and, when the jaws are closed, will press on the place of bleeding.

Hemoptysis, or pulmonary hemorrhage. In patients with tuberculosis and some other lung diseases, as well as heart defects, sputum with streaks of blood (hemoptysis) is separated, blood is coughed up in a significant amount or profuse (pulmonary) bleeding occurs. Blood in the mouth may also be from the gums or mucous membranes, with vomiting due to gastric bleeding. Pulmonary bleeding is usually not life threatening, but makes a painful impression on the patient and others.

It is necessary to reassure the patient, pointing out the absence of danger to life. Then you should put him to bed with a raised top torso. To facilitate breathing, unfasten or remove squeezing clothing, open the window. The patient is forbidden to speak and drink hot, he should not cough, if possible, they are given cough-calming medicines from home first aid kit. An ice pack should be placed on the patient's chest, heating pads or mustard plasters should be placed at the feet. When thirsty, drink in small sips cold water or concentrated solution table salt(1 tbsp. salt per 1 glass of water).

A doctor is called for first aid. Only a doctor, having determined the severity of bleeding and the nature of the disease, can dictate further actions.

Hematemesis. With a stomach ulcer, duodenal ulcer and some other diseases of the stomach, as well as with varicose veins veins of the esophagus often occurs vomiting dark clots of color coffee grounds, and sometimes unclotting bright blood. Vomiting blood can be single, a small amount and repeated, abundant, life-threatening patient.

Symptoms. At stomach bleeding blood is excreted with vomit. In some cases, blood from the stomach and duodenum enters the intestine and is detected only by the presence of black stools. At heavy bleeding there are signs of acute anemia: dizziness, weakness, pallor, fainting, weakening and increased heart rate.

First aid. The patient is subject to immediate hospitalization (in the surgical department). Before transportation, the patient needs complete rest, giving a lying position, prohibition of any movements, placing an ice pack on the epigastric region. You should not feed the patient, but you can give teaspoons of cold jelly. Transportation is carried out in a supine position on a stretcher with great care, even if hematemesis has stopped; in case of collapse, measures are taken at the scene until the patient exits a serious condition.

Intestinal bleeding. With intestinal ulcers and some of its diseases, significant bleeding into the intestinal lumen may occur. It is accompanied common features loss of blood, and later - the appearance of black stools.

From the dilated veins of the area anus with hemorrhoids and other diseases of the rectum, it is possible with a bowel movement to excrete unchanged or mixed blood with feces. Such bleeding is usually mild, but often repeated many times.

First aid. With intestinal bleeding, complete rest, giving a lying position, placing ice on the stomach are necessary. You should not feed the patient, give him laxatives and put enemas.

With significant bleeding from the anus, it is recommended to put an ice pack on the sacral region.

Blood in the urine (hematuria). Damage to the kidney and urinary tract (ruptures), tuberculosis of the kidney and Bladder, stones in the urinary tract, tumors and a number of other diseases may be accompanied by the appearance of an admixture of blood in the urine or its release through urinary tract in significant quantities, sometimes in the form of clots or even pure blood.

First aid. Required bed rest, ice on the lower abdomen and lumbar region. In view of the fact that blood in the urine is often a sign of a serious illness, the patient is subject, even after the bleeding has stopped, to hospitalization for a special examination.

Uterine bleeding. Many diseases of the female genital organs (miscarriages, disorders menstrual cycle, inflammatory processes, uterine tumors) are accompanied by uterine bleeding during menstruation or in between.

First aid. The patient should be given horizontal position or, even better, raise the foot end of the bed, put an ice pack on the lower abdomen. On the bed you need to put an oilcloth and on top of it - to absorb blood - a towel folded several times. The patient should be given a cold drink. The question of admission to the hospital maternity hospital, gynecological department hospital) is decided by the doctor. With abundant and prolonged bleeding referral to hospital must be urgent.

Internal bleeding during ectopic pregnancy. Life-threatening internal (in abdominal cavity) bleeding occurs during pregnancy that has developed not in the uterus, but in fallopian tube what happens most often after inflammatory diseases tubes and abortions. An ectopic pregnancy is complicated by rupture of the tube and bleeding.

Symptoms. Internal bleeding occurs suddenly

2 - 3 months of pregnancy. It is accompanied by scarce spotting from the genital tract, cramping pains in the lower abdomen; dizziness occurs cold sweat, pallor, rapid breathing, weak pulse, sometimes vomiting and fainting. The presence of pregnancy is confirmed by a preliminary delay in menstruation, pigmentation of the nipples and swelling of the mammary glands.

First aid. The patient should lie with ice on the stomach. It is necessary to ensure the most urgent delivery in surgery department.