SURGICAL DISEASES, TRAUMATOLOGY, ORTHOPEDICS, UROLOGY : BLEEDING (НАЕМ0RRHAGIA) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Bleeding mechanical (reg гhехin) is a primary violation of the integrity of the vascular wall at the wound, secondary, early - in the first two days and later (after three days) - slide ligatures, inadequate hemostasis, bounce when the pressure increases or purulent fusion of a clot rupture of the vessel wall with foreign body, bone fragments, fusion wall suppurative process. Bleeding give destruction of the vessel wall of the pathological process (reg diabrosin) ulcers, tumors, multiple sclerosis wall; violations of the permeability of the wall (reg diapedesin) with molecular physico-chemical changes in it: violations of the chemical properties of the blood (decrease bleeding), blood pressure changes, etc. May impact several reasons; one and the same cause (sepsis, cholemia) gives the change of the vascular wall and blood chemistry. When the modified wall negligible mechanical injury causes the gap.
The strength of bleeding depends on the type of vessel (artery, vein, capillary), nature of injury (cut wounds bleed stronger), blood pressure, degree of coagulation. The outpouring of blood may be outside (external bleeding) or in tissue, or in one of the cavities (internal hemorrhage), in a closed cavity (hidden) or in the cavity chamber connected with the outside world (stomach, intestines); it becomes after a while explicit.
Symptoms, course, treatment.
Blood: blood has a pulsating stream, the color of blood red, soaking bandages quick drop in blood pressure and rapid death if the wound is large vessel. Pressure artery centrally wound stops or reduces bleeding.
Temporary stop bleeding:
(a) elevation of the bleeding area.
b) Pressing the bleeding place a sterile dressing material with the imposition of a pressure bandage. When mortal danger (arterial bleeding from the root of the limbs) valid provided with a violation of asepsis,
C) Pressing the artery throughout. The pressing is done with your thumbs, four other fingers or thumbs, superimposed one upon the other, with his fist. Point of contact: the inguinal fold if bleeding from the arteries of the thigh, the popliteal region of the arteries of lower leg, armpit and the inner surface of the biceps muscle of the arteries of the hands on the neck of the inner edge groovecruise-liners muscles in her mid-stretch, is clamped to the transverse processes of the vertebrae - the carotid artery and in the supraclavicular region outward from the attachment of the sternoclavicular muscle to I edge for subclavian artery,
g) Maximum flexion in the joints. The maximum abstraction of both elbows bent backwards with arms and fixing them in such position when the bleeding of the subclavian and krylovii arteries, bringing the thigh to the abdomen and pribinova him when wounded artery in the groin area. The maximum flexion in the knee and elbow joints with premenovanie when the wound of lower leg arteries and arteries of the forearm,
d) Overlay harness (only when severe arterial bleeding). Overlay should be so tight to stop the bleeding. Limb pale (not bluish). The duration of abandonment harness - no more than 1 ½ - 2 hours with a temporary lifting and pressing artery for 10 minutes over one hour, and in the cold time of the year - in half an hour. Is applied as close as possible to the wound on the thigh, leg, shoulder (not in the middle third), and forearm. Don't forget to wrap the limb in the cold season and to note the time the tourniquet is applied. In the absence of a tourniquet applied fabric twist: the handkerchief tied around the limb freely in a loop insert the stick and twirl to the extent of pulling of the leg.
The final stop bleeding:
a) Tamponade with a pressure bandage with a small arterial bleeding on the trunk, neck and head,
b) Ligation of vessels in the wound without disclosure. Around, twisting. The remaining vessel clamps á demeure 4 - 7 days,
C) Ligation of vessels over
d) Vascular suture.
Venous: the blood flows continuously, filling the wound. When obstruction of the outflow (bleeding from varicose site when standing position of the patient, when the pressing of Vienna between the wound and the heart may bleed stream, increasing bleeding: the color of dark blood. Elevation of the bleeding area, compressive bandage, bandaging of the vessel, and when the wound of the largest vessels - vascular suture.
Capillary: blood is fine droplets across the surface of the wound, separate bleeding vessels are not visible. Stop yourself: is set at low clotting. Apply burns thermocautery, electrocoagulation, Packed with 3% hydrogen peroxide, adrenaline 1:1 000 and horse serum. Activities to increase blood coagulability see the parenchymal Bleeding.
Lung - injury of the internal organs. Due to the abundance of blood vessels (arteries, veins, capillaries) and the absence of their spadine after injury, bleeding profusely and long-lasting. When viewing the individual bleeding vessels are not visible, bleeds if the entire surface of the wound.
Applied physical, chemical and biological methods to stop parenchymal bleeding. Physical methods: cold, cauterization and electrocoagulation (especially if bleeding from the vessels of the brain and membranes), hot water and physiological solution (50 - 60º) (when bleeding from the cavity of the bladder and uterus). Chemical methods: vasoconstrictor is epinephrine 1 : 1 000 applied topically in urology and GRT-laryngological practice, under the skin of 0.5, inside 10 - 20 drops. Preparations of ergot, pituitrin and extract Goldenseal for bleeding from the uterus, stomach, lung. Increase the coagulability of blood: a 20% solution of gelatin (in the cavity 100 ml under the skin 20 ml), calcium chloride (10% 5 - 10 ml intravenously or orally for 1 tablespoon), a saturated solution of table salt (tablespoons). Biological methods: subcutaneous injection of horse serum (stored no more than 10 to 14 days) or any antitoxic (diphtheria and other) 20 - 40 ml or dry horse serum after breeding, the transfusion of hemostatic doses of blood (50 - 100 ml) or plasma, intravenous dry plasma or serum after breeding castilliano water, 5% glucose solution or saline solution, taken in quantities indicated on the label. Enter in the amount 50 - 60 ml
After stopping the bleeding blood transfusion (300 - 500 ml or more). The introduction of intravenous fluids (saline, 5% glucose solution), under the skin, in muscle or drip enema and out through the mouth. Salaperaisine blood (position with his head lowered, raised and bandaged elastic bandages limbs). Heart drugs. Camphor, caffeine, ephedrine. Warming of extremities. The inhalation of oxygen.