Bleeding is the leakage of blood from vessels that are damaged due to injury. In some cases, bleeding is not of a traumatic nature, but of corroding blood vessels at the site of an existing painful focus (ulcer, cancer, tuberculosis).

Stopping any bleeding should occur thanks to an important natural property of blood, which is the main way to stop it - its coagulability, which makes it possible to clog the hole in the vessel formed as a result of a wound with the help of a blood clot.

With poor coagulability, even after a minor injury, blood loss may be incompatible with human life. Stopping blood loss in different ways should be used depending on the severity and nature of the hemorrhage.

For this reason, it is important for everyone to remember the basic rules on how to stop venous bleeding, as well as arterial bleeding if it occurs, as well as what types of blood loss exist and ways to stop bleeding.

Types of bleeding

The danger of an open wound appearing on the human body, leading to blood loss, exists both at work and at home. If the threat is ignored, infection of the vascular bed and subsequent infection of the body may occur. There are several types of bleeding, to stop which different methods are used:

1. Capillary. It is distinguished by a slow and uniform release of scarlet-colored blood. With normal clotting, the blood stops on its own.
2. Venous. It is distinguished by the uniformity of the outpouring of a continuous flow of dark-colored blood.
3. Arterial. The flowing stream pulsates in jerks. It has a scarlet color. The volume of blood loss can be very large. The danger of arterial bleeding is death in cases of damage to large arteries.
4. Mixed type, which occurs with extensive damage. Accompanied by heavy blood loss.

In practice, several types of vessels are often injured at once because they are located very close. For this reason, bleeding is divided into types according to the strength of the jet.:

1. Weak. The final stop of which occurs during wound treatment.
2. Strong. Blood flows out of the wound very quickly, so first they try to stop it completely, and only then treat the wound. Long duration of blood loss can cause death.

Temporary and permanent methods of stopping bleeding

Temporary methods are used in the first minutes of wound formation before the arrival of specialists, as well as during transportation of the victim. Temporary methods include:

• Applying a pressure bandage;
• Giving a body part an elevated position;
• Maximum bending of the joint to compress the blood vessels;
• Pressing blood vessels with fingers;
• Applying a tourniquet;
• Applying clamps to a bleeding vessel.

Ways to stop bleeding temporarily

In order to correctly provide assistance to a victim in case of blood loss in an emergency situation, you need to firmly remember the algorithm of necessary actions and methods for its implementation, given in the Table below.

Types of external bleeding and first aid methods

View	Signs	Method for stopping blood loss
Capillary	Blood flows out of superficial vessels in slow drops	To stop it is necessary to treat the wound with hydrogen peroxide. A quick way is to apply a bandage using any available means - a handkerchief, bandage or gauze, maintaining moderate compression of the damaged area. When processing, you can use cotton wool, but do not leave it inside the bandage.
Venous	A deep wound is formed as a result of injury from a piercing or cutting object. The volume of blood flowing out is large, the color is dark red, while the victim has pale skin	Stopping venous bleeding in case of limb injury is achieved by giving an elevated position. When using this method, the wound is treated with peroxide and a napkin is applied, which is tightly bandaged. If the bleeding is severe, someone will need help to apply pressure on the wound or just below it (in case of a limb injury).
Arterial	A deep wound occurs when exposed to piercing or cutting objects. Can be chopped. The flowing stream often pulsates and has a scarlet color. The victim turns pale and may lose consciousness.	You can stop arterial bleeding with the help of a bandage, during the preparation of which the bleeding vessel is pressed with your fingers or palm slightly above the wound. To prepare the bundles, use various materials available at hand. This method requires precision, so be sure to place a note under the tourniquet with a note about the time of application. The bandage is applied in several layers, allowing the vessels to be tamponed. For wounds in the neck and groin area, the temporary bandage can become very wet, so keep your fingers on the damaged vessels until the doctors arrive.
Mixed	It is the result of extensive external damage, accompanied by heavy blood loss.	A temporary stop can be attempted in several ways, which were listed above.

For temporary dressing, the use of cold in the form of a heating pad with ice or another object is effective.. The victim is soldered with water to partially compensate for fluid loss. A tourniquet is used as the main method to temporarily stop bleeding.

Photos of stopping different types of bleeding

When applying it, you must follow a number of rules:

1. More often, a tourniquet is used for arterial bleeding.
2. Tourniquets are most effective when applied to a limb b, having only one bone (shoulder or thigh). When applied to the forearm or lower leg, only the veins are compressed.
3. A support is required for the harness to avoid pinching the skin.
4. The tourniquet can only be applied to the upper or middle third of the thigh or shoulder to prevent pinching of nerves (sciatic or ulnar).
5. The maximum period for applying a tourniquet is 2 hours. In winter, the limb should be additionally insulated to prevent frostbite.
6. The tourniquet needs to be loosened from time to time, pressing the vessels with your fingers at this moment. In summer, this should be done every hour, in winter - twice as often.
7. When the tourniquet is applied correctly, the skin turns pale. The tourniquet stops the pulsation of the arteries in the area below.
8. Use a clamp to stop bleeding, requiring mandatory transport immobilization followed by final blood stop in the hospital.

Can a twist be used instead of a hemostatic tourniquet? The answer to this is positive. In most cases, only a high-quality bandage is required, while a tourniquet should only be used for arterial bleeding.

Methods to finally stop bleeding

Methods to definitively stop bleeding include:

1. Mechanical.
2. Thermal.
3. Chemical.
4. Biological.

The characteristics of each of them are presented below. Types of bleeding and ways to stop them completely

View	Actions	Indications for use
Mechanical	Ligation of blood vessels, application of vascular sutures, pressure bandages, tamponing, use of vascular prostheses (shunts)	Vessel ligation is used for injuries of small and medium vessels, excluding main ones.
Chemical	The use of agents that constrict blood vessels and increase blood clotting (adrenaline, ergot preparations, calcium chloride, etc.)	The method is used for internal bleeding that excludes other measures. Used as a necessary aid for uterine bleeding, as well as loss of blood from the lung and stomach
Biological	1. Tampons made from animal tissues rich in thrombokinase (omentum, adipose tissue, etc.).	The method is used in various situations with varying degrees of bleeding severity
	2. Local use of blood products (thrombin, hemostatic sponge, etc.).
	3. Blood transfusion with the use of drugs that increase blood clotting (plasma, fibrinogen, platelet mass, etc.) depending on the degree of blood loss.
	4.Introduction of vitamins (C, K in the form of vikasol), which increase blood clotting.
	5. Intramuscular injection of human or animal blood serum for a hemostatic effect.

Stopping bleeding from a small wound in the face or head

When a wound forms on the skin of the face or head, blood appears on the forehead or from the nose, it can cause quite severe bleeding due to the fact that this is where many blood vessels are located close to the surface.

In most cases, such bleeding can be easily eliminated at home, even if it seems very dangerous.

To do this, you need to have a good understanding of the difference between wounds that are subject to self-treatment, know how to stop them, and those whose treatment requires emergency medical care. Cases requiring emergency assistance include:

• Deformations of the skull, the appearance of sunken areas, visible bone fragments or exposure of the brain;
• Eye injuries;
• The appearance of clear fluid flowing from the nose or ears.

If it is necessary to stop bleeding from a small wound The following rules must be observed:

• Wash your hands thoroughly with soap and water before handling;
• Help another person put on latex gloves. If they are unavailable, you can use a plastic bag or a clean cloth folded in several layers;
• Place the victim on his back;
• Remove any visible objects from the wound, but do not attempt to clean it;
• Apply firm pressure to the wound with gauze, a clean cloth, or other clean material. If there is an object remaining in the wound that cannot be removed, try not to touch it;
• Apply pressure to the wound for a quarter of an hour, checking the time on the clock, without lifting the tissue during this period. If blood has soaked the material, apply a new one;
• If after 15 minutes of continuous pressure blood continues to flow, you need to apply pressure to the wound for another 15 minutes. This method can be repeated up to 3 times;
• If bleeding continues, continue to apply pressure and call an ambulance;
• The appearance of anxiety, confusion, signs of fear, shallow and rapid breathing in the victim should be remembered that all of them may indicate the onset of a state of shock, which is also life-threatening and requires emergency medical care.

Video

Briefly about other types of bleeding and ways to stop it

Pleural bleeding

Occurs with rib fractures and chest injuries. You can assume the presence of bleeding based on the following signs:

• Increasing pallor;
• Acute pain in the chest;
• Difficulty breathing.

Methods to stop bleeding are only possible with hospital treatment.

Pulmonary hemorrhage

Blood coming from the pulmonary vessels begins to accumulate in the bronchi, causing a reflex cough. It can be distinguished by the foamy nature of the sputum coughed up. Elimination of such bleeding at home is impossible. The main method is hospitalization. Before the doctor arrives, you should:

• Leave the patient in a sitting position;
• Give a Codterpine tablet to relieve cough;
• Place a cold compress on your chest;
• If the patient is sick with tuberculosis, provide drinking a saturated saline solution (a spoonful of salt per glass of water);
• Mandatory transportation to a medical facility.

Bleeding from the stomach or intestines

Acute bleeding of internal organs can be caused by a stomach or intestinal ulcer, in which the disintegration of the tumor damages the blood vessels.

The effusion may occur in the form of dark-colored vomit or appear as loose stools. The patient should not be given food or drink. A cold compress should be applied to the upper abdomen.

Methods to stop bleeding are available only to specialists, so transportation to a hospital must be ensured.

It poses a greater danger to the life of the victim than the injury itself.

There are several ways to stop bleeding, each of which is used in a specific situation. A tourniquet is used in exceptional cases when a large artery is damaged or other methods to stop blood loss were not effective.

With severe blood loss, there is no time to think, so it is important to clearly know how to apply a tourniquet correctly, because the slightest mistake will threaten the victim with amputation due to tissue death.

Considering that, depending on the type of bleeding, there are 2 methods of using a tourniquet, it is necessary to clearly distinguish between the types of blood loss.

Features of using a tourniquet

Capillary blood loss does not pose a threat to human life and is characterized by minor and slow bleeding. To stop the bleeding, it is enough to treat with antiseptic agents.

With venous bleeding, the blood is dark in color and flows out of the wound in a continuous stream. Most often, a compressive bandage or tampon is used to stop blood loss. A tourniquet is applied only as a last resort.

When bleeding from damaged arteries, the blood flows out in spurts and has a bright scarlet color. Such blood loss poses a serious danger to the life of the victim. With it, a tourniquet is almost always applied.

We list the moments when a tourniquet should be applied to stop blood loss:

• When the bleeding is so severe that stopping it by other methods is not possible;
• When a rupture of an arm or leg is recorded;
• If there is a foreign object in the wound that does not allow the blood to stop;
• If a large amount of blood loss has already been recorded, and there is little time to save the person.

In what situations is it strictly prohibited to use a tourniquet:

• Bleeding from capillaries;
• Obvious inflammatory processes in the wound;
• or joints;
• It is forbidden to use a tourniquet on the lower part or shoulder, as this damages a large number of nerve endings.

It is also important to know a few rules on how to apply a tourniquet so that the tissue does not become dead:

1. If there is no medical device at hand, you can use any wide fabric instead of a tourniquet. The main condition for this is that it should not be narrower than 4 cm. This means that objects such as wires or ropes cannot be used instead of a tourniquet: they will cut into the skin.
2. The bandage is not applied to the damaged area of ​​the body, but to a place located 5 cm above it.
3. Only a medical professional can remove the device, otherwise there is a high risk of complications.
4. After applying the tourniquet, attach a note to it indicating the exact time. The patient’s condition after its removal depends on how long the hemostatic bandage is applied.

Tactics for arterial bleeding

Injuries in which blood spurts out of the arteries are dangerous due to large and rapid blood loss, so it is important to know how to apply a tourniquet in case of arterial bleeding.

Before applying the device, you need to prepare all the materials needed for this:

• A harness or material replacing it;
• A small, strong tube or stick;
• Bandage or any clean cloth;
• A roller made from or made independently.

When all the necessary devices are at hand, the artery from which the blood comes is firmly clamped with a finger or fist.

We list the methods for applying a tourniquet for arterial bleeding, depending on the location of the wound.

If the carotid artery is damaged, the person providing treatment needs to apply a tourniquet to the neck. This procedure is as scary as it is necessary, since blood leaves the artery very quickly, which without urgent measures will lead to the death of a person.

Considering that there will be a lot of blood, it will not be possible to pinch the artery with your finger: it will slide. Therefore, in this case, you need to squeeze it with a piece of cloth, and if it is missing, you can use part of the victim’s clothing.

1. A cloth or gauze roller is placed on the material with which the artery is being compressed;
2. A tourniquet is applied to it so that on the opposite side of the wound it is pulled over the victim’s arm, which is raised up and thrown behind his head.

If the hip is injured, a tourniquet is applied as follows:

1. Raise the affected limb higher;
2. Clamp the artery;
3. Make a tourniquet from two scarf-type bandages;
4. Wrap the bandage around your thigh and tie a strong knot;
5. Be sure to place a fabric roller or a small gauze bandage under it;
6. Carefully pass a stick or tube under the knot;
7. Lift the device and slowly rotate until it touches the damaged area;
8. After the blood loss has stopped, press the stick, securing the tourniquet with its second part.

For injuries of the upper extremities, use a tourniquet applied to the shoulder.

The algorithm of actions in this case should be as follows:

1. Raise your injured arm up;
2. Apply pressure to the pulsating artery;
3. Fold the tourniquet like a loop (in half);
4. Throw the loop over your shoulder;
5. After the tourniquet is thrown over the shoulder, pull on its ends until the blood stops flowing;
6. Tie the ends of the tourniquet in a knot.

Tactics for venous bleeding

With venous bleeding, blood loss occurs a little more slowly, but there is a high risk of air getting into large veins. When a vein is damaged, the air that has entered it is converted into small bubbles that quickly move towards the heart or brain. If they reach one of these organs, an embolism (blockage of blood vessels) will occur, which in most cases leads to the death of the patient.

If blood loss from a vein is detected, you need to proceed according to the following scheme:

1. Treat the wound with disinfectants;
2. Shape the gauze or bandage into a tampon by rolling it in several layers;
3. Place a clean cloth on top of the tampon, securing it with a wide bandage so that it is not on the damaged area, but around it;
4. Make sure the bandage is applied tightly enough. Then it will help connect the torn edges of the vein.

• Most often, such methods are effective and quickly eliminate bleeding. However, if a deep vein is ruptured, the above measures do not produce results: rapid blood loss continues. Only in this case, in case of venous bleeding, use a tourniquet!
• If during arterial bleeding a tourniquet is used above the site of injury, then venous injuries require the opposite location: under the wound. This feature is associated with the functional responsibilities of the veins, because the blood in them moves from bottom to top, that is, directly to the muscles of the heart, and not from them.
• When using this device, it is important to remember that applying it to unprotected skin is unacceptable! Any material can be used. If there is not a single piece of clean fabric, you can use elements of the victim’s clothing for these purposes.

Algorithm for using a tourniquet for bleeding from a vein:

1. Without pulling, bandage the limb loosely with the device;
2. Slide a tube or stick under it;
3. Taking both ends of the tube, begin to twist the tourniquet until you achieve optimal compression.

Important information

We have already mentioned that a tourniquet is used only in exceptional cases, since its incorrect use will cause irreparable harm to the patient. Therefore, it is important to be able to determine that the hemostatic tourniquet is applied correctly.

If the device is applied correctly, the following factors are noted:

1. Blood loss stops;
2. The skin becomes pale in the place where the tourniquet is located and above;
3. There is a clear pulsation in the area below the blocked artery.

• If there is no pulsation, this indicates excessive compression of the artery. In this case, the device should be relaxed.
• No less important is the factor for how long the tourniquet is applied: prolonged occlusion of arteries or veins leads to complete tissue necrosis. That is why an important condition after the event is to write a note indicating the time when the device was secured. In the event that there is no paper and pen to make the necessary notes, the time is written in the patient's blood on his face or limb. This indication will be the deciding factor for medical personnel for further emergency action.

During natural disasters, industrial accidents, road accidents and catastrophes, and accidents at home, situations sometimes arise in which first aid supplies are not enough or are not at hand.

Then, to save the life and health of the victims, you have to use available means. A very important point in such conditions is their selection and preparation. Any objects can be useful for this - pieces of clean cloth, straight tree branches, boards, metal plates, skis, ropes, soft wire, etc. How to use them correctly! This will be discussed in the published article.

One of the common types of injuries is open injuries, in which the integrity of the skin, mucous membranes, and sometimes the underlying tissues is damaged. The wound is usually accompanied by bleeding. It may be minor and stop on its own. Sometimes it is so abundant that blood loss leads to death in a matter of minutes. More often, such massive bleeding occurs when large vessels of the extremities are injured. In this case, emergency measures are required.

Stopping bleeding is done in various ways.

For moderate bleeding, it is enough to apply a pressure bandage. Sometimes it is so strong that there is no time to use a tourniquet and you have to resort to pressing the vessel - with your fingers or fist. This does not provide a long and effective stop, so another person immediately begins to prepare a twist tourniquet.

Any material is suitable for twisting - a belt, a belt, a rope, a strip of dense material, a rubber tube, a tie, a soft wire. The length of the twist should be such that you can make two rounds around the limb, twist the material with a stick and secure the ends so that the created compression remains constant.

The technique of applying it is somewhat different from applying a standard rubber tourniquet. As a rule, the twist material is less elastic than a tourniquet, and therefore, if it is tightly tightened, necrosis of the pressed tissues and damage to the nerve trunks is possible, which leads to paralysis of the limb. To prevent complications, several layers of dense material are placed under the twist, like a rubber band. The wounded vessel is compressed under the control of the pulse in the peripheral arteries. To do this, before tightening the tourniquet, find the pulsation of the artery below the level of bleeding. When the upper limb is injured, it is determined on the radial artery, and the lower - on the posterior tibial artery (behind the inner malleolus).

The fact that the twist is applied correctly is judged by the disappearance of the pulse in the peripheral arteries and by a sharp decrease in the blood coming out of the wound. But the bleeding does not stop completely, since some of the blood is in the veins and small vessels. It flows lightly from the wound. We need to remember this. Some people make this mistake: they tighten the tourniquet or improvised remedy indefinitely and wait until the bleeding stops completely.

After applying the twist, an accompanying note is left indicating the time for stopping the bleeding. This is done in order to weaken it in time: cessation of blood flow for more than one hour can cause necrosis of the limb.

A tourniquet-twist reliably stops bleeding, but for wounds of the back, neck, or gluteal region it cannot be applied. Then you have to squeeze the vessel in the wound. They do it this way: if there is a piece of clean material at hand, then it is rolled up to a size corresponding to or slightly larger than the wound, and with fingers or a fist, forcefully press it into the wound so that it fills the entire cavity. If there is no tampon, simply press on the vessel with your fist. The effectiveness of first aid is judged by a significant reduction in bleeding.

It is easier and less traumatic to stop bleeding from head wounds: a thick tampon is applied to the entire surface of the wound so that the bleeding surface is securely pressed against the bones of the skull. The tampon is secured with a tight bandage.

One of the significant drawbacks of improvised means used in dressing wounds is their unsterility. This means that by using them, you can further infect the wound area. In order to avoid this, the following rules must be observed:

When providing first aid to treat a wound, you need to limit yourself to the minimum amount of manipulation.

Before dressing, you must wash your hands and free the skin surrounding the wound from contamination. It is best to use antiseptic solutions for this purpose. But, as a rule, in case of sudden disasters such means are not available. Then use regular soap. Hands are washed with soap for at least 1-2 minutes, contaminated areas of healthy skin are cleaned by wiping with tampons moistened with soap suds or antiseptic solutions - from the wound to the periphery; in extreme cases, just clean water can be useful for this purpose. The washed surface is dried with cotton wool, gauze or a clean piece of cloth. If possible, you should treat your hands and skin surrounding the wound with tincture of iodine, alcohol, cologne, BF glue or other antiseptics.

It is strictly forbidden to wash the wound during treatment. This contributes to the additional introduction of infections into the underlying tissues and increases the possibility of complications.

Only extremely careful removal of foreign objects lying freely on the surface of the wound that interfere with the application of a bandage is allowed. You should not remove shards of glass, metal, or wood from the injured area. Such an intervention can lead to severe bleeding, increase pain, and even lead to shock.

In case of penetrating wounds into the abdominal cavity with the omentum or intestinal loops coming out of the wound, under no circumstances should they be put back. The contents of the abdominal cavity are covered with clean cloth or plastic wrap so as to limit contact with surrounding tissues.

To reduce inflammatory complications, the wound is covered with the cleanest material available. If there are sterile bandages or individual bags, they cover only the wound surface. The rest of the bandage is applied from improvised means.

When preparing dressing material from available materials, you must clearly understand the purpose of the dressing. Depending on the purpose, dressings are divided into retaining or strengthening, immobilizing - creating immobility of the affected organ; occlusive - hermetically closing the wound for penetrating wounds of the chest.

The most common dressing material is bandages. But they can be made in limited quantities from available materials, since this requires long strips of material. The bandage performs its functions only if, during dressing, it is possible to make at least two and a half rounds. And to secure it, you have to apply other types of bandages on top.

More economical are kerchief, sling-shaped, T-shaped bandages, Mashtafarov bandages.

As a rule, the following material is prepared for dressing using improvised means: a napkin is cut out from a clean piece of cloth. Folded in four, it should completely cover the wound surface. If possible, such a napkin should be ironed with a hot iron for partial disinfection. Then a strip of fabric is prepared in the form of a bandage to secure the napkin applied to the wound.

The end of the bandage, so that the bandage does not loosen, can be hemmed to the previous round or secured with a pin pierced in the transverse direction, a hairpin, or a wire bent in the shape of a hairpin.

You can securely secure the bandage with one of the following types of bandages.

Test: “Basics of first aid”
1. How to stop heavy venous bleeding?
A- apply a pressure bandage;
B- apply a tourniquet;
B- treat the wound with alcohol and cover with a sterile cloth;
D- disinfect with alcohol and treat with iodine;
D- sprinkle with salt.
2. When wounded, blood flows in a continuous stream. It's bleeding

A- Parenchymatous
B-Venous.
B- Capillary.
G- Arterial..
3. Arterial bleeding occurs when:
A- damage to any artery due to deep injury;
B- superficial wound;
B- shallow wound in case of damage to any of the vessels.
4. How to choose the right place to apply a hemostatic tourniquet for venous bleeding?
A- apply a tourniquet to the treated wound;
B- 10- above the wound 15 cm;
B- below the wound on 30 cm;
G- by 20- 25 cm below the wound;
D- by 10- 15 cm below the wound;
5. How long is the tourniquet applied in winter?
A- For an hour
B- At 1 hour 30 minutes
B- For 2 hours
G- For 2 hours 30 minutes
D-For 3 hours
6. Instead of a tourniquet, you can use:
A - Pressure bandage.
B- Spin.
B- Cold to the wound.
G-Compress
7. How to properly treat a wound?
A- disinfect the wound with alcohol and tie it tightly;
B- moisten gauze with iodine and apply to the wound;
B- treat the wound with hydrogen peroxide;
G- lubricate the wound itself with iodine;
D- sprinkle with salt

8. In case of frostbite on a skin area, you must:

A- Grind with snow.
B- Warm up and give warm drink.
B- Rub with a mitten.
9. Pneumothorax is:
A- Open abdominal wound
B- Difficulty breathing
B- Type of lung disease
G- Open wound of the chest.
10. This is a fracture
A - destruction of soft tissue of bones;
B- cracks, chips, fractures of keratinized parts of the body;
B - cracks, chips, crushing of bones.
11. In case of an open fracture with bone displacement, it is necessary:
A- Correct the displacement and apply a splint
B- Correct the displacement and bandage it
B- Apply a splint to return the bones to their original position
G- Bandage the wound without disturbing the fracture, and apply a splint.
12. In case of an open fracture, first of all it is necessary:
A- give a pain reliever;
B- immobilize the limb in the position in which it was at the time of injury;
IN- Apply a sterile bandage to the wound in the area of ​​the fracture;
G- stop the bleeding.
13. A splint made of hard material is applied
A - on a naked body
B- on a twisted scarf
B - on cotton wool, a towel or other soft fabric without folds
14. When is resuscitation performed?
A - with a fracture;
B- for bleeding;
B - when there is no breathing and cardiac activity;
G - with a dislocated leg;
D - no correct answer
15. When should chest compressions be used?
A- after the victim is released from the dangerous factor;
B- with increased blood pressure;
B- when there is no pulse;
G- when using artificial respiration;
D - for bleeding
16. "Cat's eye" sign
A - clinical death;
B- agony;
B- fainting, traumatic shock;
G-biological death.
17. In case of a third degree burn, immediately call an ambulance and:
A – Pour water over the bubbles;
B – Give the victim plenty of fluid;
B – Treat the skin with fat or brilliant green;
18. During heavy physical work in a room with high air temperature and humidity, it is possible
A - sunstroke;
B- traumatic shock;
B - traumatic toxicosis;
G - heatstroke
19. Sudden loss of consciousness is:
A – Shock;
B – Fainting;
B – Migraine;
G – Collapse.
20. In case of a bullet wound to the soft tissues of the leg, it is necessary
A - strengthening bandage;
B - pressure bandage;
B - immobilizing bandage;
G - thick bandage.
Table of answers to tests

Test No.	answer	Test No.	answer
1	B	11	G
2	B	12	G
3	A	13	IN
4	D	14	B
5	A	15	IN
6	B	16	G
7	IN	17	B
8	B	18	G
9	G	19	B
10	IN	20	B

Topic No. 5 . First aid for bleeding.

List of questions to be worked on:

1. Classification of traumatic bleeding.

2. Clinical signs and complications of bleeding. PP for arterial, venous, capillary, mixed, internal, nasal bleeding.

3. Signs of blood loss. Methods for temporarily stopping bleeding: with finger pressure, an elastic tourniquet, a twist tourniquet, an improvised tourniquet made from scrap materials, a belt, maximum flexion of the limb, a pressure bandage on the wound. Mikulicz method.

4. Rules, indications and contraindications for applying a hemostatic tourniquet, possible complications and their prevention. Tactics for managing victims with suspected internal bleeding.

Blood is the life-supporting system of the body. It is involved in all types of metabolism, transportation of O 2 and CO 2, water distribution, and removal of waste products.

Bleeding is damage to the walls of a vessel due to any injury and leakage of blood into the external environment or into the internal environment of the body.

If the bleeding rate:

30 ml/min – death without assistance may occur within 2 hours;

ml/min – death occurs within 1 hour;

More than 150 ml/min – death in minutes.

Reasons bleeding can occur from wounds, closed injuries, complications of certain diseases.

Complications bleeding - compression of vital organs (compression of large volumes of blood in the cavities of the skull and chest leads to compression of the brain, lungs, heart), air embolism (entry of air into a large diameter vessel gaping in the wound), hemorrhagic shock (associated with blood loss) .

Bleeding can be arterial, venous and capillary.

If the blood flowing outward beats in a pulsating stream (gushing) synchronously with the pulse and has a bright red (scarlet) color, then you have arterial bleeding. This is very life-threatening, since a single blood loss of 1.5-2.0 liters of blood can be fatal. On average, about 10% of an adult's body weight is blood (about 6 liters).

If the blood flowing out is dark red in color, and it flows out in a continuous stream, then you have venous bleeding. If large veins of the upper half of the body are damaged, blood may flow out in an intermittent stream, but not synchronously with the pulse, as with arterial bleeding, but with breathing. Such bleeding is dangerous due to the development of air embolism with a rapid fatal outcome.

Damage to small superficial vessels (capillaries) causes capillary bleeding. This happens with abrasions, shallow wounds, and scratches. If different vessels are damaged, bleeding may be mixed in nature.

Bleeding can be divided into external, when blood flows out from damaged vessels, and internal, when blood enters and accumulates inside the body - in cavities, in tissues. Internal hidden bleeding is identified into the lumen of the gastrointestinal tract and tracheobronchial tree. If internal organs are damaged (liver, spleen, kidneys), parenchymal bleeding may occur. Their peculiarity is the impossibility of spontaneous stopping of bleeding, since the blood vessels are organically included in the tissues of these organs. There is no significant reduction in the lumen of the vessels, therefore, to finally stop the bleeding for life-saving reasons, urgent surgical interventions are required. Internal bleeding is usually profuse and difficult to recognize.

It is also customary to distinguish between primary and secondary bleeding. Primary occurs immediately after injury. Secondary bleeding begins a certain time after it due to the expulsion of a blood clot that has blocked the vessel, or as a result of injury to the vessel by sharp fragments or foreign bodies. The cause of secondary bleeding may be careless provision of first aid, poor immobilization of the limb, shaking of the victim during transportation, or the development of suppuration in the wound.

Any bleeding is dangerous because with a decrease in circulating blood volume (CBV), the blood supply and activity of the heart deteriorate, the supply of oxygen to vital organs - the brain, kidneys, liver - is disrupted, which ultimately leads to a sharp disruption of all metabolic processes in the body. This condition occurs already with the loss of 1-1.5 liters of blood and is called acute anemia . Its symptoms do not depend on what type of bleeding (external or internal) they are caused by. The victim complains of weakness, tinnitus, dizziness, darkening and flickering of “spots” in the eyes, thirst, nausea, and possible vomiting. The victim may be agitated or inhibited, and blood pressure is low. Loss of consciousness, convulsions, and involuntary urination are possible. The victim is very pale, covered in cold sweat, yawning; His pulse is frequent and weak (sometimes completely disappears), his breathing is shallow and rapid. If urgent measures are not taken, death cannot be ruled out.

Acute blood loss – loss of a large amount of blood in a short period of time.

For any type of bleeding, direct pressure on the wound gives time:

Assess the type and danger of bleeding;

Choose another method to stop bleeding;

Cannot be used for open fractures.

How should you act to quickly and effectively stop bleeding?

Venous bleeding and bleeding from small arterial vessels can be stopped using a pressure bandage. To do this, press the adductor artery above the wound with your finger. Place a sterile gauze napkin, folded in several layers, on the wound, and place a tight twist of clean material on top of the napkin. (Remember that you cannot put cotton wool on the wound without a gauze pad!) Then bandage everything tightly. With these actions you compress the bleeding vessels and stop the bleeding. The application of a pressure (tight) bandage for open fractures is prohibited. The affected limb must be raised (20-30 cm above the level of the heart), placing a pillow or a roll of clothing under it. This position reduces blood flow and helps stop bleeding from the artery. The same method of stopping bleeding is indicated for bleeding on the torso. Cold application to the injured area is recommended.

Injuries to large venous trunks can lead to significant blood loss and possible air embolism. In this regard, injuries to the veins of the neck and chest are especially dangerous. Air locks disrupt the blood supply to organs and lead to loss of function, which can be fatal.

When bleeding from large veins of the extremities, finger pressure should be applied below the wound site, and in the neck area - above. (Venous blood flows from the periphery to the heart.)

If damaged large artery, a person can quickly die due to large blood loss, so first aid should be provided immediately. In this case, it is better to provide assistance by 2 rescuers (one presses the artery, the other applies a tourniquet, twist or pressure bandage). To do this, you need to know the pressure points of the arteries (temporal, carotid, subclavian, axillary, brachial, femoral) and remember that arterial blood flows from the heart to the periphery. If there is only one rescuer, stopping the bleeding is carried out in two stages: the first is applying a tourniquet, the second is applying a bandage.

In case of severe bleeding from facial wounds, it is necessary to press the carotid, temporal or mandibular artery on the bleeding side. When squeezing the temporal artery, you need to remember about a possible fracture of the temporal bone. The edge of its inner cortical plate is very sharp and dangerous for the brain and its vessels. The carotid artery is pressed from the side of the larynx with the thumb to the spine, and the remaining fingers are placed on the back of the neck. Due to the connection of the damaged carotid artery with the opposite one through the circle of Willis, bleeding can occur from the distal and proximal ends. In this regard, a large area of ​​pressure bandage is required.

For bleeding from the upper arm, the subclavian or axillary artery is pressed. The right subclavian artery is pressed with the left hand, the left one with the right. Place the hand so that the thumb lies in the supraclavicular fossa along the upper edge of the collarbone, and the remaining fingers are placed behind, on the wounded person’s back. To press the artery, it is enough to turn the thumb with its edge, at the same time lightly pressing down so that it is behind the wounded man's collarbone. The subclavian artery is pressed against the first rib. The axillary artery is pressed against the head of the humerus with the right fist inserted into the corresponding axillary cavity. Pressure is applied from bottom to top. At the same time, the left hand firmly holds the shoulder joint of the wounded person.

When bleeding from the lower part of the shoulder and from the forearm, the brachial artery must be pressed; it is pressed with one or four fingers to the humerus at the inner edge of the biceps muscle.

Bleeding from the thigh is stopped by pressing the femoral artery: with both hands, cover the upper part of the thigh at the groin fold so that the thumbs, placed one on top of the other, meet at the middle of the thigh and press the artery to the bone.

In case of failure, and also if arterial blood flows like a fountain (a continuous and strong stream), immediately proceed to apply a hemostatic tourniquet. Currently, the Esmarch tourniquet, which is a thick rubber belt with fasteners at the ends, is most often used. It is superimposed:

With severe arterial bleeding;

Long-term compartment syndrome.

Rules for applying a hemostatic tourniquet

1. A hemostatic tourniquet is applied in case of injury large arterial vessels.

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

3. A tourniquet is applied to the elevated limb. A soft pad is placed under the tourniquet: bandage, clothing, etc.

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

5. The tourniquet cannot be held for more than 1 hour; if the time for evacuation of the affected person to a medical facility is delayed, it is necessary to loosen the tourniquet for a minute every 20 minutes.

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

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

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

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

The available means used must be at least 2–3 cm wide. Very thin cords, strings, wires (anything that has a round cross-section in diameter) can cut through the skin along with intact vessels. The use of rubber tubes leads to damage (necrosis) of the skin. Applying a tourniquet is the last resort. To prevent damage to blood vessels and nerves, the width of the tourniquet should be at least 5 cm. You can apply a cuff from a pressure measuring device above the bleeding site (without placing it on the joint) and inflate it to a level of 300 mm Hg. The overlay time is recorded. Applying a clamp to the vessel is performed only if life-threatening bleeding continues.

Remember that a tourniquet for arterial bleeding must be applied above the site of bleeding (closer to the heart) and closer to the site of injury in order to bleed as little of the limb as possible. It is necessary to first elevate this limb. It is useless to apply a tourniquet around the wrist and ankles.

The rubber tourniquet is applied in a “male” or “female” way. The first requires a lot of physical effort. The tourniquet is applied to the limb with its middle from the side of the vessel projection; its two halves are immediately pulled on, quickly wrapped once around the limb and secured with a knot or hook with a chain. With the “female” method, a rubber band is applied to the body at one end with a slight indentation (you need to leave a section of the tourniquet free for subsequent fixation). Then they make several turns around the limb, with one round of the rubber band placed on or next to the previous one with moderate tension. The ends of the tourniquet are brought together and fixed. If the tourniquet is applied weakly, the arteries are not completely clamped, and bleeding continues. Due to the fact that the veins are pinched with a tourniquet, the limb becomes engorged with blood, its skin becomes bluish, the bleeding may intensify. If the limb is severely compressed by the tourniquet, the nerves are injured, which can lead to paralysis of the limb. Correct application of a tourniquet stops bleeding and makes the skin of the extremity pale. The degree of compression of the limb by the tourniquet is determined by the pulse in the artery below the place where it is applied. If the pulse disappears, it means that the artery is compressed by the tourniquet.

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

A contraindication to applying a tourniquet or twisting is an inflammatory process.

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

A tourniquet is far from an ideal solution to the problem of stopping bleeding. It is believed that an applied tourniquet inevitably leads to severe compression of large nerve trunks and the development of severe neuropathy in the later stages, i.e. nerve damage with severe impairment of limb functions. After 7-10 minutes. after applying a tourniquet, the victim experiences an unbearable tingling sensation, a feeling of fullness, and very severe pain. The tourniquet stops blood flow through the main and collateral vessels below the applied tourniquet. In the absence of an influx of oxygenated blood, metabolism proceeds according to an oxygen-free type. After removing the tourniquet, under-oxidized products enter the general bloodstream, causing a sharp shift in the acid-base state to the acidic side (acidosis), vascular tone decreases, and acute renal failure develops. The combination of the described damaging factors causes acute cardiovascular and then multiple organ failure, referred to as tourniquet shock or crash syndrome. This creates ideal conditions for the development of anaerobic infection, especially when a wound becomes infected. Applying a tourniquet, at best, is an opportunity to gain some time for the first aid provider (in case of very severe arterial bleeding). If there is no tourniquet, you can apply a twist, which is made from a soft but durable material (fragments of clothing, a piece of cloth, a soft trouser belt). In this case, a strip of material is brought above the wound and closer to it and its ends are tied. Then insert a wooden stick and rotate it, while slowly tightening the twist until the bleeding stops. The free end of the stick is secured with a bandage.

Arterial bleeding can be stopped by applying a pressure bandage to the wound, clamping the artery along its length and placing the injured limb in an elevated position. Sometimes only applying a pressure bandage is sufficient.

Other ways to stop bleeding

In cases where there are no limb fractures, methods can be used to stop bleeding by bending the limb as much as possible.

Strong bending of the knee stops bleeding from the arteries of the foot and leg. To increase pressure on the vessel, a roller made of a bandage or other material is used. Strong bending and bringing the knee towards the abdomen compresses the femoral artery. When the axillary artery is injured, compression is performed by placing the arm behind the back and pulling it strongly to the healthy side, or both arms, bent at the elbow, are pulled back strongly and the elbow joints are tied behind the back. This stopping method is used very rarely.

Temporarily stopping bleeding by maximal flexion of the limb:

A-from the axillary and subclavian arteries; B-femoral artery; B-from the artery of the forearm; G – arteries of the leg.

The duration of the limbs being in a maximally bent state, causing ischemia of their distal parts, corresponds to the duration of the tourniquet being on the limb.

What to do if there is external bleeding?

Don't get lost, do the following:

Press the wound with your fingers to stop bleeding;

Place the affected person horizontally;

Urgently send someone for an ambulance;

If you start to get tired, have one of those present press your fingers from above (it is necessary to keep the vessel pressed without stopping for at least 20 minutes; during this time, thrombosis of the damaged vessel usually occurs and the intensity of bleeding will decrease.

If there is bleeding from the cervical (carotid) artery, you should immediately apply pressure to the wound with your fingers or fist, and then the wound can be stuffed with a large amount of clean tissue. This method is called tamponing. It can be used in cases where applying a tourniquet is not possible. Tamponade is carried out for at least 20 minutes. The injured person must be taken to the hospital as quickly as possible for specialized care. After ligating the bleeding vessels, the victim should be given a soft drink.

What to do if you suspect internal bleeding?

Such bleeding can occur when you are hit in the stomach, fall from a height, etc. due to rupture of the liver or spleen. In the event that the victim complains of severe abdominal pain after a blow, or he loses consciousness after a blow to the stomach, one should think about the possibility of internal bleeding (into the abdominal cavity). Place the affected person in a semi-sitting position with your knees bent, and place a cold compress on the abdominal area. A cold compress or ice pack is applied for 30 minutes, then the cold is removed, a break is taken for 30 minutes and the cold is applied again for 30 minutes. This alternation is carried out until hospitalization. You can't give him anything to drink or eat. It is necessary to urgently arrange for the victim to be transported to the hospital.

With a strong blow to the chest, bleeding into the pleural cavity may occur. If there was such a blow and the victim breathes with difficulty and begins to choke, you should give him a semi-sitting position with bent lower limbs and put a cold compress on his chest.

Place the victim in an anti-shock position. Place the unconscious victim in a stable lateral position.

How to support the life of a person who has lost a lot of blood?

As a result of blood loss, changes occur in the human body that can become irreversible and lead to death. After you have stopped the bleeding (or it has stopped spontaneously), you must apply a pressure bandage to the wound. Then release the affected person from constrictive clothing to facilitate breathing (unfasten, remove). If a person is conscious and has no wounds in the abdominal area, you should give him sweet tea. It is necessary to lay the victim on his back so that his legs are raised and his head is down. This position promotes the redistribution and temporary increase in the amount of blood in the heart, lungs, brain and other vital organs (the brain is most sensitive to its deficiency). It is necessary to organize the evacuation of the injured person to the hospital as quickly as possible. The final stop of bleeding and complete surgical treatment of wounds are carried out in medical institutions, and we must not forget that stopping bleeding is the prevention of shock.

Is it possible to use a twist instead of a hemostatic tourniquet?

Stopping bleeding by twisting involves tying the limb above the wound site with a scarf, rope, towel or other material twisted into a tourniquet, and then inserting a stick or other object into the resulting ring and rotating it to stop the bleeding. It is necessary to tighten the twist only until the peripheral pulse disappears and bleeding stops. After 2 hours, the twist should be loosened for a few minutes while simultaneously pressing the main vessel with your fingers, then it should be applied again.

The most reliable way to temporarily stop severe arterial bleeding is to apply a hemostatic tourniquet to the injured limb, i.e., circular compression. The Esmarch rubber tourniquet is most often used. If this is not available, you can use available material: a rubber pipe, a towel, a belt, a rope, a scarf, etc. There are special hemostatic tourniquets for children. The tourniquet can be applied to the shoulder, forearm, thigh and lower leg above the wound, but as close to it as possible (Fig. 144).

The tourniquet is applied as follows. Part of the limb is wrapped in a towel or several layers of bandage (lining). Then the injured limb is raised, the tourniquet is stretched, 2-3 turns are made around the limb in order to compress the soft tissues and the ends of the tourniquet are secured with a chain and a hook, and if they are absent, they are tied with a knot.

The correct application of the tourniquet is confirmed by the cessation of bleeding from the wound, the disappearance of the pulse in the periphery of the limb and the blanching of the skin.

Features of applying a tourniquet: 1) applying a tourniquet should be used in cases of severe arterial bleeding; 2) applying a tourniquet to bare skin can cause pinching and even death; 3) the tourniquet must be applied above the wound site; 4) weak tightening of the tourniquet increases bleeding, strong tightening compresses the nerve trunks.

In the cold season, the limb with a tourniquet applied must be wrapped to prevent frostbite.

The tourniquet can be kept on the limb for no more than 2 hours, m

Typical places and in persons exposed to ionizing radiation - no more than 1-1/2 hours (the tourniquet on the shoulder should be kept much shorter). A patient with a tourniquet applied during a tourniquet should be immediately sent to the emergency department for bleeding to finally stop the bleeding and remove the tourniquet artery (by gradually unraveling it).

If the tourniquet or twist needs to be held longer (1-2 hours), then the compression should be loosened until the limb turns pink and its sensitivity is restored. This is done carefully, slowly, so that the blood flow does not push out the blood clot that has formed in the wound.

To prevent bleeding from resuming, patients should be transported carefully, avoiding jolts and sudden movements.

Another reliable way to stop bleeding is to bend the limb at the joints to the maximum and fixate them in this position. It's done like this. Rolls of gauze or cotton are placed in the area of ​​​​the articular bends, the limb is bent as much as possible to compress the vascular bundle, and it is bandaged to the body.

If there is no external bleeding, but the victim feels it. weakness, dizziness, loss of consciousness, his skin turns pale, this indicates intracavitary bleeding. In this case, immediate medical attention is necessary. In order to prevent or reduce brain bleeding, it is recommended to lie the victim down and slightly raise the lower limbs. The head should be slightly lower than the body.

Methods to stop venous and capillary bleeding. To stop venous bleeding, it is enough to apply a pressure bandage and elevate the damaged part of the body. With capillary bleeding, blood oozes over the entire surface of the wound, sometimes it is profuse, so to stop it it is enough to apply a pressure or regular bandage.

The described methods of stopping bleeding are called temporary. The final stop of bleeding is carried out by a doctor when treating the wound.

First aid for internal bleeding. In addition to external bleeding, there are also internal ones. In this case, the blood flowing from the damaged vessel accumulates in some internal cavity, for example, the chest or abdominal cavity. Internal bleeding is recognized by sudden pallor of the face, paleness and coldness of the hands and feet, increased pulse rate, the filling of which becomes weaker and weaker. Dizziness, tinnitus, and cold sweat appear. Then fainting may occur. At the first signs of internal bleeding, the victim should be immediately sent to a medical facility.

The nurse must be fluent in the technique of applying various dressings and assist the doctor in applying more complex dressings (for example, plaster, etc.).

Types of dressings. The following types of dressings are distinguished: 1) soft - adhesive (cleol, colloid, adhesive plaster), bandage, scarf, etc.; 2) hard (transport, medicinal) and gypsum. Bandage bandages are used more often.

For bandage dressings, gauze bandages of different lengths and widths are used. Rules for applying a bandage: the victim must

be in a position that is comfortable for him, and the part of the body where the bandage is applied should be motionless (so that the paths of the bandage do not move). The limb is bandaged in the position in which it should be even after applying the bandage.

Bandage begins from the bottom (from the periphery) up (towards the center). Unwrap the head of the bandage with your right hand, hold the bandage with your left hand and straighten the passages of the bandage. Pull evenly and unroll the bandage in one direction, usually clockwise. Bandaging begins with a circular, securing movement of the bandage. Each subsequent turn of the bandage should cover the previous one by 1/2 or 2/3 of the width of the bandage.

Having finished bandaging, you need to check whether the bandage is applied correctly - whether it covers the diseased part of the body, whether it gets confused, does not press, or is applied too tightly. The end of the bandage is strengthened on the healthy side of the limb and in a place where the knot will not bother the patient. The end of the bandage, torn along the length, is tied around the bandaged part; it can be secured by hemming or pinning it to the bandage.

Main types of bandages.

1. Circular (circular) bandage - turns of the bandage lie one on top of the other, covering the entire wound. This bandage is convenient when applied to the wrist, lower third of the leg, forehead, neck and abdomen.

2. Spiral bandage - they begin to do it, like the previous one, i.e., with two or three circular moves, and then the moves of the bandage go in an oblique direction (spiral), only partially, by two-thirds, covering the previous move. Bandaging is done from the bottom up (ascending bandage) or from the top down (descending bandage). Bends are made every 1-2 turns. At the end, you can apply a simple spiral bandage or again resort to bends (for a fracture of the tibia, hip, forearm, shoulder).

3. Cross-shaped, or eight-shaped, bandage - in the shape or moves of the bandage, describing the figure eight; very convenient for bandaging the head and neck. The bandage is strengthened around the head in a circular motion, then above and behind the left ear it is lowered in an oblique direction down to the neck. Next, the bandage goes along the right side of the neck, goes around it in front and rises along the back of the neck to the head. Having circled the front of the head with a bandage, it is passed over the left ear and obliquely, then the moves of the bandage are repeated. Subsequently, the bandaging is continued, alternating the last two moves, and secured around the head (on the knee, elbow and ankle joints, as well as on the hand and chest).

4. Converging and diverging (“turtle”) bandage - for application to the joint area. In the area of ​​the knee joint, the divergent bandage begins with a circular move through the most protruding part of the patella, then similar moves are made below and above the previous one. The moves of the bandage cross at the popliteal

cavity, diverge in both directions from the first and, covering half of each other, cover the joint area more and more tightly. The bandage is secured around the thigh.

The converging bandage begins with circular moves, above and below the joint, crossing in the popliteal cavity. The following moves proceed like the previous ones, moving closer to each other and to the most convex part of the joint, until the entire area is covered.

1. A scarf bandage is most often used as a sling to create rest for the upper limb in case of injuries or diseases of the hand, forearm and shoulder. This is a triangular shaped piece of cotton fabric. To apply a bandage, the middle of the scarf is placed under the forearm (the arm is bent at the elbow at a right angle - the base of the scarf is located along the midline of the body, and the top is directed towards the elbow between the torso and the sore arm). The ends of the scarf are tied around the neck.

2. A sling bandage, or sling, is a piece of bandage or other material, both ends of which are cut in the longitudinal direction (the cuts do not reach the middle of the piece). This bandage is indispensable for dressing the nose and for injuries to the jaws. The uncut part of the sling is placed on the chin, the ends are crossed, and the end that was the bottom is led up and tied at the crown with the opposite end. The upper end is led to the back of the head, crossed with the end coming from the opposite side, and tied on the forehead.

3. A T-shaped bandage consists of a strip of material (bandage), to the middle of which the end of another strip is sewn, or of a strip, through the middle of which another strip is thrown. The horizontal part of the bandage goes around the waist in the form of a belt, while the vertical stripes run from the belt through the crotch and are attached to the belt on the other side of the body. They are used for various wounds, injuries and diseases of the perineum and anus.

4. Colloid and cleol dressings. Collodion and cleol adhesive solutions are used. Applying a colloid dressing: cover the wound area with several layers of gauze and apply a larger unfolded gauze pad to it. The free edges of the top napkin adjacent to the skin are moistened with collodion. Applying a bandage with cleol: the wound is covered with several layers of gauze, the skin around the wound is smeared with cleol and wait until it dries a little. Only after this, the surface, lubricated with cleol, is covered with a stretched gauze napkin and pressed tightly. The edges of the bandage that do not stick to the skin are trimmed with scissors.

Rules for applying a pressure bandage.

Pressure bandages are most often applied to wounds of the extremities accompanied by bleeding. To stop

For venous and capillary bleeding, applying a pressure bandage is sufficient. To do this, you can use individual dressing bags and aseptic dressings.

Minor arterial bleeding can often be stopped with a pressure bandage (Fig. 145, 146).

In cases where it is impossible to apply a tourniquet (for bleeding on the head, chest, abdomen), a tight pressure bandage is used. In most cases, to stop venous bleeding, it is enough to raise the limb and apply a pressure bandage to the wound.

Thus, to stop bleeding, the following are used: digital pressure on damaged vessels, flexion of the limb, application of a pressure bandage, application of a tourniquet. For bleeding from large veins, a tourniquet or twist is applied below the wound, and for arterial bleeding - above the wound site. As a material for circularly pulling the limb above the wound site, a rubber or fabric tourniquet, a twist and a tourniquet made from available material (kerchief, footcloth, shirt sleeve, belt, etc.) can be used.

In modern surgery, a variety of dressings are used that have good absorption capacity (hygroscopicity), dry quickly, do not degrade quality during sterilization, do not irritate tissue, are durable, elastic and cheap.

1. Gauze is densely looped (13-20 threads per 1 cm) and sparsely looped (10-12 threads per 1 cm), capable of absorbing moisture at different rates.

Standard gauze should get wet quickly: a piece measuring 5 x 5 cm, thrown into water, should sink in 10-15 seconds and absorb twice the amount of water by weight.

2. Bandages - long strips of gauze, rolled into a roll; bandages measuring 16 x 1000 cm, 14 x 700 cm are used,

10 x 500 cm, they are produced non-sterile and sterile (in parchment paper packaging).

3. Napkins are made in the form of quadrangular pieces in 3-4 layers of gauze; they come in small (10 x 15 cm), medium (10 x 70 cm) and large (50 x 70 cm). The edges of the napkins are wrapped so that they do not fray, and they are folded in packs of 10-20 pieces, tying them with narrow strips of gauze.

Rice. 146. Temporary stop of bleeding by fixing the limb in a certain position: a - in the subclavian; b - femoral; c - popliteal; d - shoulder and elbow areas

4. Headscarves - a triangular-shaped canvas made of khaki-colored fabric measuring 100 x 100 x 135 cm; the long side is called the base; the angle lying opposite the base is the apex, and the other two angles are the ends. They are produced ready-made and take up little space (5 x 3 x 3 cm), convenient for working in the field.

5. Dressing bags (individual and ordinary). IPPs consist of two cotton-gauze pads measuring 10 x 12 cm, attached to a bandage 7 cm wide, 5 m long. The bandage is packaged in a paper (waxed) shell, and on top of it in a waterproof rubberized or polyethylene shell. Enclosed in a paper shell and a separately wrapped safety pin. The bandage and pads are sterile. Application: 1) tear the rubberized shell along the cut and remove the bag with paper wrapper; 2) open the paper shell, unfold the pads with your left hand, taking the head of the bandage with your right hand (touch the side attached to the bandage and marked with a colored thread); 3) place the pads on the wound with the clean side and secure the bandage with a bandage. In case of a through wound, the pads can be placed on the areas of the entrance and exit holes. If there is only one wound, then both pads are placed side by side or one on top of the other.

6. Lignin is a wood processing product, hygroscopic, used in multi-layer dressings, and comes in the form of leaves measuring 60 x 80 cm and 1.5 x 2 m.

7. Tubular bandages "Retelast" made of elastic material - stretch to the desired width, put on the desired part of the body (over sterile material, if there is a wound). The "Ratelast" bandage is made from rubber and cotton threads in the form of a mesh tube (the net comes in different sizes: No. 1 - for the fingers of adults, hands and feet of children, for the hand, forearm, foot, elbow and ankle joints of adults, shoulder, shin and knee joint of children; No. 3 and 4 - for the forearm, shoulder, lower leg, knee joint of adults, hip, head of children; No. 4-5 - for the head and hip of adults, chest, abdomen, pelvis and perineum of children; No. 7 - for chest, abdomen, pelvis, perineum of adults.Bandages can be sterilized by boiling and in an autoclave.

8. Tubular knitted bandages - in the form of rolls, also of different sizes; put on top of the dressing applied to the wound, pre-fixed with cleol or 1-2 strokes of a regular bandage. You can put them on your foot or head.

9. Contour bandages made of calico or linen (according to Lukyanov and Mashtafarov) are applied to the lower leg and foot: shoe cover type bandages (“boot” made of fabric, ripped along the seam, with ties); such “boots” are used when a large number of patients are admitted with wounds in this area.

10. Gauze balls - from pieces of gauze measuring 6 x 7 cm (small), 8 x 9 cm (medium) and 11 x 12 cm (large).

11. Tampons - pieces of gauze (3-4 layers) of various widths and lengths; medium and large napkins with a width of 1 to 5 cm, narrow gauze strips 300-500 cm long are used. Narrow tampons (1-2 cm wide) are called turundas.

12. Vata. For dressings, only sterile absorbent cotton wool (white, purified cotton) is used. Gray, non-hygroscopic cotton wool is used mainly for lining under tires, sewing bolsters and mattresses, and sometimes for compresses.

13. Aseptic dressings - from two cotton-gauze pads and a bandage; The headbands come in large (23 x 33 cm pads) and small (14 x 16 cm pads) and are packaged in double waxed wrapping only. The package can be opened by pulling the thread, which cuts the paper.

14. Hemostatic gauze is treated with nitrogen and propane oxides, antiseptics; Available in the form of napkins measuring 13 x 13 cm in a parchment package of two pieces.

15. An adhesive plaster (adhesive plaster) consists of a strip of material wound on a round cardboard frame (width - 6 cm, length - 10 m) or cut into narrow strips (width - 1 cm, length - 10 cm) and sealed in a cellophane bag. The matter is covered with an adhesive mass (20 parts gelatin, 40 parts glycerin, 10 parts zinc oxide, 30 parts water). The plaster is used to close wounds and secure bandages without bandages. It sticks well only to dry skin. Disadvantages of the patch: skin irritation, does not adhere to the hairy parts of the body, stripes remain when they get wet.

Consequently, ready-made dressings include: gauze bandages, dressing bags, aseptic dressings, sterile gauze wipes, hemostatic gauze, scarf bandages, contour bandages, elastic mesh-tubular bandages (“Retelast”), adhesive plaster.

Questions and tasks:

1. What materials are used to apply a tourniquet?

2. What mistakes should not be made when applying a tourniquet?

3. Tell us about ways to stop venous and capillary bleeding.

4. What types of dressings are most often used?

5. Tell us about the rules for applying bandages.

6. Name the main types of bandages.

7. Tell us about strengthening dressings.

8. In what cases are pressure bandages applied?

9. What materials are used as dressings?

10. In your workbook, complete tasks No. 6-7.

CHAPTER 7 STOPING EXTERNAL BLEEDING

One of the most important compensatory and adaptive reactions of the human body is the ability to independently stop bleeding by activating the blood coagulation system. Unfortunately, this is not always possible, since bleeding from large vessels can stop on its own quite rarely. Continued external bleeding is an indication for the use of temporary bleeding control, the timeliness and correctness of which often determines the life of the victim.

Quite a lot of methods for stopping external bleeding are known and, in principle, if we look at the history of surgery, its development is primarily the development of methods to combat blood loss.

A general practitioner should know the following simplest and most effective methods of temporarily stopping bleeding: finger pressure on the vessel, flexion of the limb in the joint, application of a pressure bandage, tourniquet, hemostatic clamps; be able to perform wound tamponade and use local hemostatic agents.

At the same time, you need to have a clear understanding that the above methods of stopping bleeding are far from equivalent and have certain disadvantages and advantages, so there are corresponding indications for each. These indications are determined by the nature of the clinical situation, and, above all, by the type of external bleeding and its intensity. External bleeding can be arterial, venous, capillary and mixed. Its intensity depends on the type and caliber of the damaged vessel.

Arterial bleeding is recognized by the scarlet color of the blood and its pulsating fountain-like stream. This kind of bleeding is the most dangerous.

Venous bleeding, as a rule, is not so intense; the stream can be quite powerful, but does not pulsate, but flows continuously. Although when bleeding from the subclavian or jugular veins, blood may flow out in an intermittent stream, synchronously with breathing.

The color of the blood is dark cherry.

With capillary bleeding, the blood is dark red, flowing from the entire surface of the wound, individual bleeding vessels are not visible. Such bleeding is observed with shallow skin cuts and abrasions.

Mixed bleeding, as a rule, combines one or another number of the above symptoms.

7.1. FINGER PRESSION OF A VESSEL

The method is used to temporarily stop arterial bleeding on the limbs, neck, and head. The pressure is applied above the bleeding area, where there is no large muscle mass, where the artery does not lie very deep and can be pressed against the bone. The artery is compressed with a finger, palm, or fist at certain points. The most important of them are shown in Fig. 7-1.

Rice. 7-1. Temporarily stop bleeding with finger pressure. 1 - temporal; 2 - occipital; 3 - jaw; 4 - sleepy; 5 - subclavian; 6 - axillary; 7 - shoulder; 8 - radial; 9 - ulnar; 10, 11 - femoral; 12, 13 - tibial artery

The supraclavicular region is the place of compression of the subclavian artery, where it is pressed against the first rib at a point located above the collarbone, immediately outward from the place of attachment of the sternocleidomastoid muscle to the manubrium of the sternum; in the axillary fossa where the axillary artery can be compressed by pressing it against the head of the humerus; inguinal fold - area for pressing the common femoral artery to the pubic bone; the inner surface of the biceps muscle - for the arm artery; the neck at the inner edge of the sternoclavicular muscle, near its middle, the area where the carotid artery presses against the transverse process of the VI cervical vertebra; along the inner surface of the thigh in the upper and middle third, you can try to press the femoral artery to the femur; the popliteal artery is compressed in the popliteal fossa, towards the distal part of the femur with the knee joint slightly bent; The posterior tibial artery can be compressed just behind the medial malleolus; the dorsal artery of the foot is pressed on the front surface of the foot outward from the extensor tendon of the big toe; on the face you can easily find the superficial temporal artery lying directly

but on the bone at a point anterior to the ear canal; bleeding from the cheek is easily stopped by pressing the facial artery to the horizontal part of the lower jaw.

Indications: first steps to stop arterial bleeding; first before applying other methods. Advantages:

Quick (almost instant) application;

Possibility of use in anatomically complex areas (head, neck, axillary, subclavian, groin areas);

The most gentle way to stop bleeding. Flaws:

When the vessel is pressed with fingers, the nearby nerve trunks and the very sensitive periosteum are compressed, which is quite painful;

Long-term stopping of bleeding with this method is impossible due to rapid fatigue of the helping hand;

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

Due to the anatomical features of the location of the arteries (carotid subclavian, axillary, popliteal) or the complex nature of their damage, finger pressure is sometimes ineffective.

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

For vein injuries, you can also use finger pressure, which is performed distal to the wound.

Rice. 7-2. Stopping bleeding by digital compression of blood vessels in the wound

7.2. TEMPORARY STOP OF BLEEDING BY MAXIMUM FLEXION OF THE LIMB IN THE JOINT

Stopping bleeding with maximum flexion in the joint is possible: in case of damage to the subclavian and axillary arteries, by moving the arm back as far as possible and pressing it to the back. Thus, the artery is compressed between the clavicle and the first rib (Fig. 7-3 a); in case of injury to the arteries of the upper third of the thigh and groin area - by flexion in the hip joint (b); in case of damage to the popliteal artery - by flexing the knee joint (c); in the elbow joint - if the brachial artery is damaged in the elbow bend (d). Using this method to stop bleeding from the distal parts of the limb is possible, but not advisable, since there are other optimal methods for such injuries.

Rice. 7-3. Stopping bleeding by bending the limb at the joint

Stopping all types of bleeding from the groin, popliteal and elbow areas;

The first stage before applying other methods. Advantages:

Possibility of use in areas where the location of the vessels is deep and difficult to access (inguinal and subclavian region, popliteal and axillary fossa);

Possibility of use with a minimum of dressings and available materials.

Bending the limb at the joint may not be effective, especially if the subclavian vein is damaged;

Sometimes this method can be painful or uncomfortable.

7.3. COMPRESSION BANDAGE

The application of a pressure bandage to the area of ​​a bleeding wound causes an increase in interstitial pressure and compression of the lumen of damaged vessels, which contributes to the formation of an intraluminal thrombus. Skilled application of a pressure bandage can stop bleeding even from a large arterial vessel and in anatomically complex areas.

Technique for applying a pressure bandage: first check whether the wound contains foreign objects (shards of glass, pieces of wood or metal), clear the wound site of clothing and elevate the injured limb above the level of the heart, with the patient lying down. After this, several layers of sterile gauze are placed on the wound, and if it is not available, a pad made of clean fabric (a handkerchief, a piece of sheet, etc.) is placed and the edges of the wound are pressed tightly, at the same time bringing them together as close as possible. On top of the gauze, to increase compression, be sure to place a pad made of a dense ball of cotton wool or rolled up fabric and bandage it tightly. The situation is simplified if official means are available, in particular an individual dressing package (Fig. 7-4 a, b).

Rice. 7-4. Applying a pressure bandage using an individual dressing package (IPP) (a, b)

Indication: any injury, mainly to the extremities.

Advantage: the most gentle and quite effective way to stop any bleeding. Flaws:

Does not in all cases provide stopping bleeding when large arteries are injured;

Tissue compression causes circulatory problems in the peripheral parts of the extremities.

7.4. APPLYING A Tourniquet

Among the various methods of temporarily stopping bleeding, applying a tourniquet is the most reliable and fairly quick. By applying a tourniquet, the soft tissues of the limb are compressed in a circular manner along with the blood vessels and pressed against the bone. Application of a tourniquet is indicated only in case of severe arterial bleeding from the artery of the limb; in all other cases, this method is not recommended.

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

In the absence of a standard tourniquet, it is possible to use various improvised devices (a twist, a tourniquet with a pelot, any strong rubber tube with a diameter of 1-1.5 cm, a rubber bandage, a belt, a scarf, a piece of cloth, etc.) (Fig. 7-6), pneumatic cuffs from the tonometer (Fig. 7-7).

Rice. 7-5. Hemostatic rubber tourniquet, Esmarch type (TU 38.)

Rice. 7-6. Stop bleeding using improvised means. a - spin with pilot; b - twist with a soft cloth without a pad

Rice. 7-7. Stopping bleeding using a pneumatic cuff from a tonometer

It is only necessary to remember that it is not recommended to use coarse, hard objects such as wire or rope due to the risk of nerve damage.

Technique for applying a rubber tourniquet: to prevent pinching of the skin, place a towel, clothing of the wounded person, etc. under the tourniquet. The limb is lifted up slightly, the tourniquet is brought under the limb, stretched (Fig. 7-8) and wrapped around the limb several times without loosening the tension (Fig. 7-9) until the bleeding stops. The tourniquets should lie next to each other without pinching the skin (Fig. 7-10). The ends of the tourniquet are fixed with a chain and a hook on top of all the rounds. The tissues should be tightened only until the bleeding stops.

Rice. 7-8. Technique for applying a rubber band, stretching the band

Rice. 7-9. Technique for applying a rubber band. Application of a tourniquet with constant stretching

With a correctly applied tourniquet, arterial bleeding immediately stops, the limb turns pale, and the pulsation of the vessels below the applied tourniquet stops. Excessive tightening of the tourniquet can cause crushing of soft tissues (muscles, nerves, blood vessels) and cause the development of paralysis of the limbs. A loose tourniquet does not stop bleeding, but on the contrary, creates venous stagnation (the limb does not turn pale, but becomes bluish) and increases venous bleeding. The tourniquet should be positioned so that it is conspicuous. After applying a tourniquet, the limb should be immobilized. Due to the complete cessation of blood circulation in the limb, when applying a hemostatic tourniquet, a direct threat of necrosis is created, therefore

Rice. 7-10. Technique for applying a rubber tourniquet: the turns of the tourniquet are placed one next to the other

Rice. 7-11. Technique for applying a rubber band: a note indicating the time of application

the tourniquet should not compress the limb for more than 2 hours. However, if possible, then every hour the tourniquet should be removed and checked to see if the bleeding has stopped and whether it is time to replace the tourniquet with a pressure bandage. If it continues, the bleeding artery must be pressed along its length, and the tourniquet must be reapplied after 15 minutes, slightly higher or lower. And again for no more than an hour. In the accompanying document of the wounded person or on a piece of white oilcloth attached to the tourniquet (Fig. 7-11), it is necessary to indicate the exact time (hours, minutes) of application of the tourniquet and the signature of the person providing assistance. Typical places for applying an Esmarch tourniquet to stop bleeding are shown in Fig. 7-12. However, there is an opinion that applying a tourniquet to the forearm is considered by some to be of little effectiveness due to the deep location of the vessels between the two bones of the forearm. Besides,

Rice. 7-12. Typical sites for applying an Esmarch tourniquet to stop bleeding.

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

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

It should be remembered that application of a tourniquet in the middle of the shoulder is contraindicated due to the possibility of compression of the radial nerve. Indications:

Traumatic amputation of a limb;

Inability to stop bleeding with other known means. Advantages:

A fairly quick and most effective way to stop bleeding from the arteries of the limb.

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

Nerve trunks are compressed, which causes post-traumatic plexitis with subsequent pain and orthopedic syndrome;

Stopping blood circulation in the limb reduces tissue resistance to infection and reduces their regenerative abilities;

The use of a tourniquet can cause severe vasospasm and lead to thrombosis of the operated artery;

Restoring blood circulation after using a tourniquet contributes to the development of tourniquet shock and acute renal failure;

The use of a tourniquet is not possible on the torso or is limited in anatomically difficult areas.

Using it without indications i.e. with venous and capillary bleeding;

Naked body application;

Weak or excessive tightening;

Poor fastening of the ends of the harness;

Lack of accompanying note;

Use more than 2 hours;

Cover the tourniquet with a bandage or clothing.

Contraindications: it is not recommended to apply a tourniquet to limbs affected by an acute surgical infection, or with vascular damage (arteriosclerosis, thrombophlebitis, etc.), as this may contribute to the spread of the process or the development of embolism.

The technique of circularly pulling a limb by twisting auxiliary means: the object used for twisting is loosely tied at the desired level. A stick or plank is inserted into the formed loop and, rotating it, the loop is twisted until the bleeding stops completely, after which the stick is fixed to the limb. Applying a twist is a rather painful procedure, so it is necessary to place something under the twist, especially under the knot. All errors, dangers and complications observed when applying a tourniquet, and the scope of application, fully apply to twisting.

I would like to once again emphasize that, according to the experience of vascular surgery, the unjustified use of a tourniquet occurs in 70-80% of cases. This occurs in cases of damaged veins, crushed limbs, bruised and lacerated wounds, when a properly applied pressure bandage is quite effective.

7.5. WOUND TAMPONADE

An effective way to stop bleeding in anatomically complex areas of the pelvis, neck, abdomen, chest, buttocks, i.e. where the main arteries are located quite deep behind the muscle layer and the use of a tourniquet and a pressure bandage is problematic. This is especially advisable in the presence of narrow wound channels in a large muscle mass (wound of the subclavian, axillary artery).

To tamponade a wound, a gauze swab is inserted with an instrument, tightly filling the wounds with the force necessary to stop bleeding. Indications: bleeding from wounds on the torso and neck.

Advantages: possibility of effective and safe use in anatomically complex areas. Flaws:

Difficulties of use at the prehospital stage;

Availability of practical skills;

Possibility of wound infection and continued thrombosis.

7.6. LOCAL APPLICATION OF HEMOSTATIC AGENTS

To stop capillary and parenchymal bleeding or bleeding from small vessels of muscles and bones, especially in patients with a tendency to hypocoagulation, the hemostatic effect is enhanced by using a hemostatic sponge. Using a sponge for bleeding from large vessels is ineffective.

Hemostatic sponge (hemostatic sponge with Ambien, collagen hemostatic sponge, “Tachocomb”): externally it looks like a plate of dried foam and is native plasma with the addition of thromboplastin and calcium chloride. Its modern modification (Fig. 7-13) is made from animal collagen with associated blood clotting factors: thrombin, fibrinogen and fibrinolysis inhibitors. After contact with a bleeding wound or other fluids, blood clotting factors dissolve and create bonds between the carrier - collagen and the wound surface. By cleaving peptides, thrombin converts fibrinogen into fibrin. Like a two-part adhesive, the wound surface and collagen are bonded together during polymerization. Fibrinolysis inhibitors prevent premature dissolution of fibrin by plasmin. The components of the sponge degrade in the body under the action of enzymes within 3-6 weeks.

Method of application: maintaining sterility, open the package with scissors and take out a plate with a sponge. The dosage depends on the size of the wound that needs to be closed. The hemostatic plate should cover an area 1-2 cm larger than the immediate surface of the wound. If several plates are required for this, they must overlap each other at their edges. If the wound is small, then the drug can be cut with sterile scissors to the required size (Fig. 7-14). Before applying to the surface of the wound, blood should be removed as much as possible, which is achieved by quickly drying with gauze.

Rice. 7-13. Local hemostatic agent: collagen hemostatic sponge

Rice. 7-14. Stopping bleeding using a hemostatic sponge

napkins. After that, pieces of the sponge are pressed with a gauze ball onto the bleeding surface for 3-5 minutes. The sponge can be placed in a gauze pad to loosely pack the cavity. The tampon is removed after 24 hours. If necessary, cover the entire wound surface with a crushed sponge; it is also permissible to spray with a syringe or spray. Indications:

Capillary and parenchymal bleeding, bleeding from bones, muscles, nasal, gingival and other external bleeding;

The same types of bleeding in patients with bleeding disorders (thrombocytopenic purpura, leukemia, hemorrhagic thrombocytopathies, Randu-Osler disease, liver cirrhosis, local increase in fibrinolytic activity of the blood and general fibrinolysis, etc.);

Continued bleeding when using a pressure bandage and packing the wound.

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

7.7. APPLICATION OF A HEMOSTATING CLAMP

As a way to temporarily stop bleeding in first aid settings, this method is used in exceptional cases for bleeding from deep-lying vessels of the pelvis and abdominal cavity. Applying a hemostatic clamp to a damaged vessel and leaving it in the wound is one of the most reliable ways to stop bleeding.

Technique of application: if the source of bleeding is not clearly visualized, the edges of the wound are pulled apart with hooks. It is advisable to apply a sterile hemostatic clamp carefully, in a “dry” wound, as close as possible and perpendicular to the site of damage to the vessel (Fig. 7-15). This is necessary in order not to turn off the collaterals and not to cause additional trauma to the artery, which can complicate the performance of reconstructive surgery on the vessels. The clamps are left in the wound and covered with an aseptic dressing.

Indications: gaping wounds with clear visualization of the source of bleeding in complex anatomical areas when other methods are impossible and ineffective.

Preservation of collateral circulation. Flaws:

Risk of damage to nearby nerves;

The likelihood of crushing vessels over a long distance;

The need for surgical skills.

Rice. 7-15. Application of hemostatic clamps to a vessel in a wound

The application of hemostatic clamps in a wound as a way to temporarily stop bleeding on non-main arterial vessels can also be a way to finally stop bleeding. To do this, the damaged vessel under the clamp must be bandaged with a sterile thin thread. When bleeding, in order for the bleeding from small vessels to finally stop, sometimes it is enough to apply a clamp and hold it for a minute, and then, after twisting it several times along the axis, remove it.

Thus, the algorithm for stopping external bleeding is as follows: first of all, determine the type of bleeding, which can be arterial (main, non-main), venous, capillary and mixed.

Capillary bleeding is stopped by applying a regular bandage. The hemostatic effect is enhanced by loosely packing the wound surface with sterile napkins with 3% hydrogen peroxide or by applying a hemostatic sponge to the wound.

Venous bleeding - a pressure bandage for injury to the extremities, on the torso and neck - wound tamponade. While preparing the dressing material, bleeding can be reduced by lifting the limb upward, pressing the damaged vessel (distal) of the wound with a finger, or, as a last resort, placing a “venous tourniquet” distal to the wound, squeezing only the veins and not disrupting arterial circulation. The effectiveness of the “venous” tourniquet is judged by the cessation of bleeding with a distinct pulsation of the arteries below the wound.

Arterial bleeding from a non-main vessel is stopped, like venous bleeding, by a pressure bandage or tamponade. To prepare for applying a bandage, the bleeding vessel is compressed above (proximal) the wound (Fig. 7-16).

Rice. 7-16. Stages of stopping arterial bleeding from a non-main vessel. a - arterial bleeding; b - temporary stop of bleeding by pressing the artery along the proximal extent of the wound; c - applying a pressure bandage

In case of arterial bleeding from a great vessel, the first measure should be digital compression or maximum flexion in the joint, and then apply a pressure bandage. If the bandage gets wet with blood (“drips”), a tourniquet should be applied above the wound and again try to achieve hemostasis with a pressure bandage, increasing local compression of the damaged area or fixing the limb in the position of maximum flexion. Only the ineffectiveness of these measures dictates the need to use a tourniquet. Bleeding from anatomical areas inaccessible to a pressure bandage and tourniquet is stopped with tamponade, and if it is ineffective, with a hemostatic clamp.

In all cases, after temporarily stopping the bleeding, it is necessary to raise the injured limb above the body, which reduces the flow of blood and improves the possibility of blood clot formation.

To summarize the above, I would like to emphasize that the fate of a victim with external bleeding depends primarily on the quick and correct actions of those providing first aid, and it is provided not by vascular surgeons, but by general practitioners.