Rules for applying a hemostatic tourniquet. How to apply a tourniquet for arterial and venous bleeding

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Arterial hemorrhage is a dangerous injury that can lead to profuse blood loss in a short time. After damage, bright scarlet blood flows in a gushing stream from the vessel. The degree of hemorrhage depends on the diameter of the artery.

Most often, it is quite difficult to stop, which is why the condition of the victim quickly worsens. Injury can lead to serious complications or even death. To prevent this from happening, it is necessary to correctly determine the signs of arterial bleeding and provide first aid to a person (PMP). This information is important for everyone!

Stop arterial bleeding

With arterial bleeding, first aid should be provided as soon as possible. First of all, you need to call an ambulance and stop the bleeding within 3 minutes.

An arterial hemorrhage can be identified by the following signs:

• A wound or fracture in the area of ​​​​the location of large arteries (the inner surface of the shoulder, forearm, thigh, etc.);
• A stream of bright scarlet blood, which pulsates in accordance with the beats of the heart;
• The pulsation of the vessels that are under the wounded area and the bleeding artery is disturbed;
• The victim is losing a lot of blood, feels weak, dizzy, turns pale, heart rhythm is disturbed, pressure decreases;
• The injured limb becomes cold.

It is important to correctly determine the type of bleeding, so as not to worsen the condition of the victim.

After an injury, a person loses a lot of blood, and the larger the artery, the higher the likelihood of coma and even death. Therefore, you should immediately begin to stop the hemorrhage.

First aid for arterial bleeding point by point:

• Stop the bleeding by clamping the artery over the injury site and call an ambulance. If the wound is on the neck and head, then pressing is carried out under the wound;
• Disinfect the wound and hands to prevent infection. To do this, the edges of the wound surface are wiped with alcohol, before bandaging the wound is covered with a sterile material;
• The injured limb is fixed with a scarf or splint;
• In case of pain shock, the patient is given an analgesic (for example, analgin, tramadol).

After providing first aid for arterial bleeding, the victim is transported to a medical facility or waiting for an ambulance.

Detailed first aid instructions

How to stop arterial bleeding? To stop the flow of blood, you need to pinch the artery with your fingers or fist.

Ways to stop arterial bleeding, depending on the location of the wound:

• If blood flows from the temple, then press the temporal artery to the bone between the eye and ear;
• If the wound is on the cheek, then press the lower jaw artery against the masticatory muscle;
• Bleeding on the face or near the mouth is stopped by pressing the carotid artery on the damaged side. The vessel is pressed with the thumb, and the remaining fingers clasp the muscles at the back of the neck. It is strictly forbidden to squeeze two carotid arteries at the same time, as the victim may lose consciousness;
• Bleeding in the shoulder girdle is stopped by pressing the subclavian artery. The vessel is pressed with the thumb, and the rest grasp the muscles above the collarbone and shoulder blade;

• If blood flows from the shoulder, then the injured limb is raised and the axillary artery is pressed against the head of the shoulder;
• Blood on the forearm is stopped by squeezing the brachial artery from the inside of the shoulder;
• To stop bleeding in the hand, press on the radial, ulnar, or brachial artery;
• When bleeding on the thigh, press on a thick artery in the groin area. To do this, they press the vessel with their thumbs, and the remaining fingers wrap around the leg from the side and back;
• The popliteal artery is squeezed with a fist in the popliteal cavity.

The artery is pressed with ten fingers to the bone for 10 minutes to stop mild bleeding.

Abundant bleeding from large vessels is stopped by bending the limbs. If the wound is located in the area of ​​the wrist or forearm, then a roller is inserted into the armpit, the arm is bent as much as possible and fixed in this position.

If the wound is above the shoulder, then both limbs are brought behind the back, pressed against each other in the area of ​​the humerus and fixed with a bandage. This compresses the artery between the clavicle and the right rib.

To stop the hemorrhage from the lower part of the legs (shin, foot), the roller is placed in the popliteal cavity, the limb is bent as much as possible and fixed. In addition, bleeding can be stopped by bending the leg at the hip joint. In this case, the roller is inserted into the inguinal fold.

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If the blood has stopped, then the victim is transported to a medical facility. But if there is a fracture, then the bending method is not suitable, in which case the damaged vessel is pressed with fingers and a tourniquet is applied.

Tourniquet technique

Already during the squeezing of the vessel, the assistant must provide improvised materials for. To do this, you need cotton wool, a bandage and cotton napkins. A bandage or tissue is applied to the damaged area over the bleeding site (at a distance of 3-10 cm). Before this, the injured limb must be lifted and wrapped with a rubber band 2 or 3 times.

The bandage must be tight to stop bleeding, but excessive pressure is dangerous to the limb. The ends of the tourniquet are tied and secured with a hook or chain.

Applying a tourniquet for arterial bleeding, depending on the site of injury:

• In case of injury to the upper limbs the tourniquet is applied to the upper third of the shoulder. It is strictly forbidden to apply a tight bandage in the middle of the shoulder, as this can damage the radial nerve;
• With severe bleeding from the femoral artery impose 2 tourniquets. In this case, the second bandage is placed slightly above the first;
• If the carotid artery is damaged or other arterial vessels on the face and head, then a soft bandage is placed under the tourniquet, which will protect against additional injury. The tourniquet must not be strongly tightened, as the likelihood of cerebrovascular accident and suffocation increases.

Consider the algorithm of actions for applying an arterial tourniquet. If you put on the bandage correctly, the bleeding stops. A note is placed under the tourniquet, which indicates information about the injury and the time the tourniquet was applied in case of arterial bleeding. The area with the tourniquet must be open so that the medical staff can immediately identify it.

After applying a pressure bandage, the patient is immediately taken to the hospital. If you are transporting a person with damage to a large artery, immobilize him first.

The tourniquet is left on the body for no longer than 1 hour 30 minutes. Otherwise, the likelihood of tissue malnutrition, necrosis and paralysis due to nerve compression increases.

If the bandage cannot be removed from the limb, then it is loosened for a while, and then tightened again. If you apply a tourniquet in the cold season, then do not forget to wrap the damaged area well. It is necessary to know and follow the rules for applying an arterial tourniquet, since the further condition of the patient as a whole depends on this.

Qualified medical assistance

The victim is taken to a medical facility and handed over to the surgeon. The plan of further actions depends on the diameter of the damaged vessel, the general condition of the patient and the nature of the injury.

Options for stopping hemorrhage from an artery todepending on the nature of the injury

• The surgeon sutures the wound in the vessel;
• The doctor bandages the damaged artery. This method is used if the diameter of the vessel is small and there are other sources of blood supply to the damaged area;
• Physicians partially or completely prosthetize the affected area of ​​the artery. The section of the vessel is replaced with a segment from one's own vein or artificial material.

After surgery, the wound is sutured and a drainage system is installed.. To make sure that arterial bleeding has stopped, infusion and restorative treatment is carried out for the "reperfusion syndrome" (resumption of blood flow in the ischemic area).

Danger of arterial hemorrhage

If a person who has bleeding from the arteries is not helped during the first minutes after it starts, then he will die from profuse blood loss. Due to the rapid loss of blood, the body does not have time to include defense mechanisms. The heart feels a lack of blood, as a result, blood circulation stops completely.

Pressing the arteries in the first minutes of injury is quite difficult, because these vessels are thicker than the veins and the blood pressure in them is much stronger. Bleeding is dangerous because even after medical intervention, serious complications can occur.

During treatment, the surgeon ligates the artery in the wound surface, if necessary, applies a vascular suture. Due to changes in the structure of tissues in the damaged area and heavy bleeding, it is not so easy to find a vessel and apply ligatures.

With internal hemorrhage, an urgent operation is performed, since a compressive bandage in this case will be ineffective.

If the victim was not provided with assistance after applying a pressure bandage, then the blood flow is disturbed and the tissues of the limb die off. The lack of blood circulation in the tissues within 8 hours after damage to the vessel becomes critical. As a result, gangrene develops. In this case, the injured limb is amputated.

Arterial hemorrhage is a dangerous injury that requires urgent and qualified assistance.

It is important in the first minutes of a hemorrhage to stop the blood by finger pressing or bending and correctly apply a tourniquet to the damaged area in case of arterial bleeding, and in the absence of first aid, a person may lose a limb or die from blood loss. It is for this reason that everyone should know the basic rules for stopping arterial hemorrhage.

- This is a very serious injury, which in case of untimely medical care can lead to death. It is considered the most dangerous of all types of bleeding. When arteries are damaged, blood flows out of them in a gushing stream.

Arterial blood is distinguished by its bright scarlet color. It flows out of the vessel in accordance with the beats of the heart. Such an injury can cause death not only immediately after it is received, but even when qualified medical care is provided. Arterial bleeding can lead to the loss of an injured limb and other complications.

Rules for stopping arterial bleeding

Blood loss during arterial bleeding occurs so rapidly that it is necessary to provide emergency assistance from the very first 2-3 minutes after its formation. When large arteries are injured, the time to provide emergency care is reduced to 1-2 minutes. Otherwise, with every second, the blood pressure will fall, as a result of which the victim will lose consciousness, fall into a coma, or die immediately.

In case of arterial bleeding, first of all, pinch (squeeze) the injury site with your fingers or fist, trying to stop the gushing flow of blood.

In this case, certain rules should be observed in pressing and squeezing certain blood vessels:

The common carotid artery is pressed with fingers to the spine, namely: to the transverse processes of the cervical vertebrae. In this case, one should press on the inner edge of the sternocleidomastoid muscle approximately in its middle part.

The external maxillary artery is pressed against the anterior edge of the masticatory muscle with fingers.

The temporal artery is compressed with fingers slightly forward from the upper edge of the ear.

The subclavian artery is pressed with fingers or a fist behind the outer edge of the clavicular part of the sternocleidomastoid muscle against the first rib.

The brachial artery is compressed by fingers along the inner edge of the biceps muscle to the bone.

The femoral artery is pressed with a fist against the pubic bone under the pupart ligament. In thin people, this vessel can be easily pressed against the thigh.

The popliteal artery is pressed down with a fist in the middle of the popliteal cavity.

After providing emergency assistance in pressing the vessel in case of damage to large arteries, it is necessary to immediately apply a rubber tourniquet to them. In case of minor bleeding, a tight roller or a single sterile bandage is bandaged to the damage. In extreme conditions, instead of a tourniquet, you can use a belt, scarf, thick rope and other improvised means with which to make a pressure bandage. A sterile bandage is applied to the wound itself to prevent infection from entering the body.

In some cases, when there is no bone fracture, forced flexion of the injured limb can be used instead of a tourniquet. With this method of stopping arterial bleeding, the injured limb is bent and fixed in a bent position with a bandage or other improvised means.

Applying a tourniquet for arterial bleeding

Already during the provision of first aid to the victim for squeezing blood vessels, one of the people around should prepare a tourniquet or improvised means, cotton wool, gauze or cotton napkins. On the damaged areas of the body, gauze or tissue is applied, not reaching the site of bleeding. Injured limbs should be in an elevated position. The rubber tourniquet is slightly stretched and wrapped around the limb in 2-3 turns. The tourniquet should be applied tight enough to stop bleeding from the artery, but it is unacceptable to strongly squeeze the limb. Its ends are tied, fastened with a hook or chain. As a rule, a tourniquet or pressure bandage is applied 2-3 cm above.

Features of applying a tourniquet for various types of damage to the arteries:

If the hands are damaged, it is applied to the upper third of the shoulder.

The optimal localization of the tourniquet on the upper limb is the upper or lower third of the shoulder (the tourniquet cannot be applied in the middle of the shoulder to avoid damage to the radial nerve).

In case of severe damage to the femoral artery, another tourniquet may be needed, which is applied a little higher than the first.

In case of ruptures of the carotid artery and other injuries of the face and head, a soft bandage is placed under the tourniquet so as not to cause additional injuries. At the same time, the tourniquet is not tightened too tightly to prevent suffocation of a person and insufficient blood circulation to the brain.

If the tourniquet is applied correctly, then the flow of blood stops completely. A note is placed under the tourniquet, which indicates the data on the damage and the time of application of the pressure bandage. The area on the body where the tourniquet is applied should not be completely covered by clothing so that the medical staff in the hospital immediately finds the injury site.

After applying the tourniquet, the victim is immediately sent to a medical facility, where he will receive the necessary assistance. When transporting a patient with wounds on large arteries, he must be immobilized (immobilized).

To prevent serious consequences from insufficient nutrition of tissues, their necrosis and paralysis due to compression of nerve fibers, the tourniquet should not be left on the body for more than 90 minutes. If there is a situation where the tourniquet should still remain on the damaged artery, it is slightly loosened for a few minutes and then tightened again tightly. When using a tourniquet in the cold season, it is necessary to wrap the victim warmly, especially the injured limb.

Danger of arterial bleeding

If the victim with arterial bleeding is not provided with emergency assistance in the first minutes after injury, he will simply bleed out and die. Very rapid blood loss does not allow the body to turn on the defense mechanisms. In this case, the heart does not have enough normal volume of blood, as a result of which blood circulation stops completely.

Even pressing arteries in the first minutes after injury is often difficult, because they have thicker and more stubborn walls than veins, and the blood pressure in them is much greater. Even with the final stop of such bleeding in a medical institution, various complications may arise. When treating a wound, the doctor bandages the vessel in the wound. In some cases, a vascular suture may be needed. Changes in tissue ratios in anatomical terms, their crushing and severe bleeding make the process of finding a vessel and applying a ligature in the wound very problematic. With internal bleeding, the victim needs urgent surgical intervention, since in this case a compressive bandage cannot be applied.

The lack of assistance after applying a tourniquet often leads to the death of the limb, due to impaired blood flow. The lack of blood in the tissues becomes critical 8–10 hours after injury to the artery. This begins the development of gangrene, which is an irreversible necrosis of the tissues of the limb. After this, the patient can still be saved only by amputation of the injured limb. Moreover, it is amputated much higher than the place where it began.

With significant blood loss, the victim is transfused with donor blood after stopping the bleeding. Its volume can be up to 1000 cc. With such injuries, rapidly growing pulsating hematomas often occur. They also need to be operated on. For bleeding in people with reduced blood clotting and pathological changes in the walls of blood vessels, a 10% solution of calcium chloride is used. It is prescribed in the amount of 10-20 cubic meters. see intravenously. The best result in the treatment of arterial bleeding is given by repeated blood transfusions in small (homeostatic) doses (100-150 cc). The patient needs complete rest after the operation. A cold compress is applied locally to the wound.

Based on the foregoing, it becomes clear that without the provision of emergency and professional medical care, damage to the arteries, leading to bleeding, can cost a person life. That is why it is so important to be able to provide first aid to the victim and quickly deliver him to the hospital. The prognosis for recovery after such an injury depends on the size of the injury, its location on the body, and a number of other reasons that led to this injury.

About the doctor: From 2010 to 2016 practicing physician of the therapeutic hospital of the central medical unit No. 21, the city of Elektrostal. Since 2016, she has been working at the diagnostic center No. 3.

The tourniquet is applied above the wound, as close as possible to it, but not closer than 4-5 cm, so that it does not interfere with the dissection and revision of the wound during the primary surgical treatment. The tourniquet is not applied in the areas of the joints, on the hand and foot. At the beginning of the 20th century, there was an idea that a tourniquet can only be applied to segments of limbs that have one bone (shoulder and thigh), since segments that have two bones (forearm and lower leg) may not occlude the interosseous artery. It has now been established that this is not the case; the interosseous artery is reliably compressed by the surrounding tissues.

The limbs are elevated.

The tourniquet is not applied to bare skin - a lining is required - a towel, a napkin, a shirt sleeve.

Esmarch's rubber tourniquet is stretched, applied to the limb from the side of the projection of the vessels and wrapped around it 2-3 times, then secured with a hook. The first round is done with great tension, the subsequent rounds are fixing, with weakening. The criterion for the correct application of the tourniquet is the complete cessation of bleeding. If the tourniquet is applied weakly, the artery is not completely clamped, and bleeding continues. In this case, the veins are pinched with a tourniquet, the limb overflows with blood, and bleeding may even increase.

The tourniquet is applied for no more than 2 hours in summer, and in winter - no more than 1-1.5 hours. A tag (sheet of cardboard) is attached to the tourniquet indicating the time of application or a similar record is made directly on the tourniquet.

If after the specified time the victim is not delivered to a medical institution, then it is necessary:

carry out finger pressing of the artery above the tourniquet;

loosen or remove the tourniquet for 10-15 minutes;

re-tighten the tourniquet or shift it slightly higher;

release finger pressure, make sure there is no bleeding.

With profuse postpartum uterine bleeding, detachments of the lower extremities, injuries of the iliac arteries, a Momburg tourniquet can be used. It is a tape of tarpaulin about 3 meters long. The patient is placed on the table, on his back. On the stomach, to the left of the navel, a dense roller with a diameter of 8-10 cm is applied, then at the level of the navel, the stomach is wrapped around with two tours of the tourniquet, which is tightened with great force: two people, resting one foot on the table, pull the tourniquet in different directions. This compresses the abdominal aorta. The tourniquet can be kept for 15-20 minutes. during which preparations are being made for emergency surgery. Currently, due to advances in the development of obstetrics, the Momburg tourniquet is almost completely out of use.

Complications of tourniquet application.

The use of a hemostatic tourniquet is a simple and reliable way to temporarily stop bleeding, however, along with its undoubted advantages, it is not without its drawbacks.

Turnstile shock (crash syndrome). Unlike all other methods of temporarily stopping bleeding, the tourniquet stops the blood flow not only through the damaged main vessel, but also through all its collaterals, veins, and lymphatic vessels. This leads to sharp violations of the trophism of the limb below the application of the tourniquet. In the absence of an influx of oxygenated blood, metabolism is anaerobic. When the permissible time for applying a tourniquet is exceeded, underoxidized metabolic products accumulate in the limb, which cause myolysis (disintegration of skeletal muscle fibers). After removing the tourniquet, underoxidized products enter the general circulation, causing a sharp shift in the acid-base state to the acid side (acidosis). Myolysis products cause generalized vasoplegia (decrease in vascular tone), and myoglobin released from muscle fibers is filtered into the urine and, under conditions of acidosis, precipitates in the renal tubules, causing acute renal failure. The combination of the described damaging factors causes acute cardiovascular, and then multiple organ failure, referred to as tourniquet shock or crash syndrome. The pathogenesis of tourniquet shock is almost identical to the pathogenesis of long-term compression syndrome and positional compression syndrome.

When the tourniquet stays on the limb for more than two hours, the actions revealed during transportation are similar to those described above (the tourniquet loosens for 10-15 minutes with finger pressure above the tourniquet). When transporting such a victim to a medical institution, the following actions are necessary:

The patient is placed in the intensive care unit or ward, the parameters of central hemodynamics, hourly diuresis are monitored.

Large volumes of plasma substitutes are administered intravenously, followed by forced diuresis to prevent the development of acute renal failure.

Above the tourniquet, a case novocaine blockade is performed, the limb below the tourniquet is lined with ice packs. These measures can slow down the flow of unoxidized products and myoglobin from the affected limb to the general bloodstream. After that, the tourniquet is removed, the primary surgical treatment of the wound is carried out, the final stop of bleeding.

There is a HBO session.

In the future, the condition of the affected limb is carefully monitored. With the development of reperfusion edema, fasciotomy is performed. With thrombosis of the main arteries - thrombectomy. In cases of irreversible ischemia and the development of gangrene, as well as with the development of acute renal failure, amputation of the limb.

During the Great Patriotic War, the technique of slow, fractional dissolving of the tourniquet was used, and a rubber tourniquet of a tubular shape was applied to the limb above the applied tourniquet to slow down the venous outflow. Currently, these measures are recognized as ineffective and are not applied.

Wound anaerobic infection. In the absence of an inflow of oxygenated blood into the limb on which the tourniquet is applied, ideal conditions are created for the development of an anaerobic infection (the presence of an entrance gate - a wound, a nutrient medium - damaged tissues and the temperature necessary for incubation of microbes). The risk of developing anaerobic infection is especially high when the wound is contaminated with earth, manure, and feces.

Neuralgia, paresis and paralysis develop with excessively strong compression of the limb with a tourniquet, which leads to injury and ischemic damage to the nerves.

Thrombosis and embolism . Excessive compression can lead to damage to blood vessels with the development of thrombosis of the veins and arteries. The risk of arterial thrombosis against the background of atherosclerosis is especially high.

Frostbite of limbs under the tourniquet often develop in the cold season. This explains the limitation of 1-1.5 hours of tourniquet application time under these conditions.

In view of the dangers described above associated with the application of a tourniquet, indications for its use should be strictly limited: it should be used only in cases of injury to the main vessels, when it is impossible to stop the bleeding in other ways.

An alternative to applying a tourniquet is the relatively recent methods of temporarily stopping bleeding: the imposition of a hemostatic clamp in the wound, a blind suture of the wound over the damaged vessel, and temporary prosthetics of the vessel.

Applying a hemostat in a wound at the stage of first aid it is possible when:

There is a sterile hemostatic clamp with a cremalier (Billroth, Kocher or any other) - they are included in the "Ambulance" package;

The bleeding vessel in the wound is clearly visible.

The vessel is captured by the clamp, the clamp is fastened, and an aseptic dressing is applied to the wound together with the clamp. When transporting the victim to a medical facility, immobilization of the injured limb is necessary. The advantages of this method are simplicity and preservation of collateral circulation. The disadvantages include low reliability (the clamp can unfasten during transportation, break off the vessel or come off along with a part of the vessel); the possibility of damage to the clamp located next to the damaged artery veins and nerves; crushing the edge of the damaged vessel, which subsequently makes it difficult to apply a vascular suture for the final stop of bleeding.

Temporary prosthetics of the vessel and blind suture of the wound over the damaged vessel . These methods of temporarily stopping arterial bleeding, unlike those discussed above, are not used in first aid, but during the operation of primary surgical treatment of the wound, when a wound is found in the main artery, and there are currently no conditions for restoring its integrity (the surgeon does not own the technique operations on vessels, there are no necessary tools and materials).

In the event that the ends of the damaged vessel in the wound are clearly visible, it is possible to carry out its temporary prosthetics with a plastic tube (special or from a blood transfusion system) fixed in the lumen of the vessel at the site of its injury with twisting ligatures. In more detail the technique of this rather difficult operation is considered in special manuals.

Subject to the appointment of anticoagulants (heparin), antibiotics, replenishment of blood loss and provision of the necessary rheological properties of blood, a temporary prosthesis can function up to several days, although the risk of thrombosis of the prosthesis or damaged vessel, thromboembolism of the distal end of the vessel, slipping of ligatures and relapse is constantly maintained and over time increases. bleeding.

If the ends of the damaged vessel cannot be found in the wound, sealed sutures can be applied to the wound over the damaged vessel. A closed cavity is formed around the site of injury to the vessel. Blood, pouring out from the proximal end of the damaged vessel into this cavity, finds no other way out, except to the distal end of the vessel. The so-called "pulsating hematoma" is formed. Thus, the blood flow through the damaged vessel is restored and can last up to a day or more. There is a great danger that instead of a small pulsating cavity, a large interstitial hematoma will form (see above). No less high is the risk of vascular thrombosis at the site of injury, the development of insolvency of the wound sutures and recurrence of external bleeding. In some cases, a false (traumatic) aneurysm may form at the site of the "pulsating hematoma" (see below).

As in the case of temporary prosthetics of the vessel, and when applying sealed sutures, the victim should be re-operated as soon as possible in order to restore the integrity of the vessel. In military field conditions, he must be evacuated by ambulance to the stage of specialized medical care. During transportation, reliable transport immobilization of the affected limb is of particular importance. In a civilian environment, it is necessary to call a team of vascular surgeons "on one's own".

As a temporary way to stop external bleeding can be used wound tamponade . Tamponade can be used both at the stage of first aid and during the primary surgical treatment of the wound. Gauze swabs, tightly filling the wound, serve as a scaffold for the deposition of fibrin and the formation of a clot. It should be noted the unreliability of such hemostasis, and therefore tamponade can be supplemented by suturing the wound to fix the tampons in its depth.

Maximum flexion and extension at the joints are also ways to temporarily stop arterial bleeding. To stop bleeding from the arteries of the forearm or lower leg, you can use the maximum flexion in the elbow or knee joints. A roller with a diameter of 5-7 cm is placed on the flexion surface of the joint, then maximum flexion is performed in the joint, and the limb is fixed in this position with a bandage.

To stop bleeding from the arteries of the upper limb, you can use the maximum extension in the shoulder joint: if you bring the affected limb behind the head of the victim, the brachial artery will bend over the head of the shoulder, and blood flow through it will stop. For transportation, the limb must be fixed in this position with a bandage.

Both of these methods do not have sufficient reliability, stopping bleeding when using them is accompanied by compression of the nerve bundles. They are rarely used in practical healthcare, they are mainly of theoretical importance.

Temporary arrest of bleeding in case of damage to the saphenous veins is discussed above (see temporary arrest of capillary bleeding).

In case of damage to the main veins of the extremities a temporary stop of bleeding can usually be achieved by tamponade of the wound. It is possible to suture the wound over tampons. At the same time, the implementation of a full-fledged tamponade at the stage of first medical aid, in the absence of aseptic conditions, anesthesia, is not always possible. In addition, it can be difficult to differentiate venous bleeding from arterial bleeding with complex anatomy of the wound channel (see above) and mixed venous-arterial bleeding. That's why, if blood flows out of the wound in a powerful, especially to some extent pulsating stream, one should act as in arterial bleeding, that is, resort to applying a hemostatic tourniquet, which is always applied in the same way, as in arterial bleeding - above the wound. It should be considered a gross mistake to apply a tourniquet below the wound, as recommended by some textbooks and manuals.

When applying a tourniquet below the wound, only the distal end of the damaged vein is clamped, while:

retrograde bleeding continues from its proximal end;

an air embolism may occur in the proximal end of the damaged vein;

with concomitant even minor damage to the artery, bleeding will not only not stop, but will intensify.

When a tourniquet is applied above the wound, as mentioned earlier, the limb will be completely turned off from the blood and lymph circulation, thus:

the proximal end of the damaged vein is clamped with a tourniquet;

the artery above the wound is also clamped with a tourniquet, thus stopping the blood flow to the limb, and bleeding from the distal end of the damaged vein stops.

For internal and occult bleeding a temporary stop of bleeding, as a rule, is impossible. Exceptions are bleeding from esophageal varices in portal hypertension. In these cases, it is advisable to use the Blackmore probe, which is a gastric tube with two balloons inflating through separate channels, located at the end of the probe and covering the probe in the form of cuffs. The first (lower, gastric) balloon, located 5-6 cm from the end of the probe, inflated has the shape of a ball with a diameter of 7-8 cm, the second balloon, located immediately after the first one, has the shape of a cylinder with a diameter of 4-5 cm and a length of about 20 see. A probe with uninflated balloons is inserted into the stomach. Then the lower balloon is inflated and the probe is pulled up until the inflated balloon is wedged into the cardia of the stomach. After that, the upper balloon, located in the esophagus, is inflated. Thus, the veins of the cardial part of the stomach and the lower third of the esophagus are pressed by inflated balloons to the walls of the organs. The bleeding from them stops.

Severe arterial bleeding requires immediate action. The blood from the damaged artery spurts with a jet - and a fatal outcome can occur in a matter of minutes. Correct application of a tourniquet to the injured area will help stop blood loss. After that, it is necessary to urgently call an ambulance and deliver the victim to the hospital.

Blood is a fluid, mobile connective tissue that is responsible for providing nutrition and metabolism to all body cells. It consists of the following elements:

• plasma - a liquid that contains nutrients, proteins, enzymes, waste products of the body, etc.;
• blood cells - erythrocytes, leukocytes, platelets.

Liquid tissue moves through a closed system, which consists of large arteries and veins, as well as smaller arterioles, venules, and capillaries. In less than thirty seconds, the blood has time to make a full circle, give useful elements to the cells, pick up harmful products and carry them to the organs that are responsible for their removal to the outside.

Arteries carry blood rich in nutrients and oxygen, which gives blood its bright red color. The speed of liquid tissue through these vessels is as fast as possible, since it is set in motion by the heart, pushing it outward with a strong push. Metabolic products move through the veins, which must be removed from the body. Among them is carbon dioxide, which was taken by red blood cells from cells after they transferred oxygen to tissues. Carbon dioxide gives the dark red color to the plasma circulating through the veins. Venous tissue moves much more slowly than arterial tissue.

If there is a rupture of blood vessels, the liquid tissue, along with useful substances, leaves the body. Because of this, cells are deprived of nutrition, decay products are retained in them, which in serious cases leads to tissue necrosis. There are two types of bleeding:

• internal, when liquid tissue flows into the body cavity, which leads to hematomas and other problems;
• external, when plasma, due to damage to the skin, comes out, leaving the body.

If internal bleeding occurred deep in the body, they can only be detected with the help of special equipment. External damage is determined instantly, since blood exits the body through the damaged skin, which is visible to the naked eye. In this case, blood loss is accompanied by pain in the affected area. It is customary to distinguish the following types of external bleeding:

• Arterial. It is characterized by a bright scarlet stream of blood, beating with a fountain. This variety is the most dangerous: plasma moves through the arteries at maximum speed, which is why the blood leaves the body extremely quickly. The person turns pale, the pulse weakens, the pressure drops, dizziness, nausea, and vomiting begin. If blood loss is not stopped in time, death is possible. It should be noted that the arteries are not easy to damage, since they are located deep in the body. The cause of such injuries are serious injuries that put life at risk.
• Venous. Cherry-colored blood flows evenly, at the same speed, sometimes it can pulsate a little. If a large vessel is damaged, negative pressure appears, which can provoke the appearance of an air embolism (air bubbles) in the vessels. In case of serious damage, a fatal outcome is also possible, but this requires more time. Since some veins are located along the skin, the likelihood of such damage is much higher than arterial.
• Capillary. The least dangerous damage. Capillaries are the smallest vessels in the human body, through which blood transfers nutrients to cells and takes away decay products. Plasma from a damaged vessel oozes slowly, and the body is able to stop blood loss by itself, blocking the site of damage with a thrombus. Capillary bleeding is dangerous only with reduced blood clotting.

Help with arterial bleeding

The loss of blood due to a ruptured artery is so rapid that the victim must be treated within the first two minutes. Otherwise, the person will quickly lose consciousness, fall into a coma and die. It is necessary to immediately squeeze the place of the rupture with your fingers, and even better - with your fist to stop the flow of arterial blood. If the limb is damaged, it must be fixed with a splint or scarf. Then you need to proceed as follows:

• Disinfect the damaged area by wiping with alcohol.
• Cover the wound with a sterile dressing to prevent infection.
• In case of pain shock, make anesthesia, for which give Analgin, Tramadol or another analgesic. In extreme cases, ice will do.
• In case of minor damage, a sterile bandage or a tight roller is wrapped around the injured area.
• In case of injury to a large vessel, a rubber tourniquet is quickly applied to stop bleeding.
• Call an ambulance or take the victim to the hospital as soon as possible.

How to pinch a vessel during arterial bleeding depends on the damaged area. It is necessary to proceed from the following rules:

There are several types of tourniquet, each of which has its own characteristics when applied and fixed. Among them, it is worth highlighting the following options:

• Esmarch's tourniquet is a thick rubber tube with a chain attached on one side and a hook on the other.
• Tape tourniquet - a rubber strip 3-5 cm wide. After the end of the dressing, a knot is tied.
• Twist - a strip of durable material 1 m long, 3 cm wide with a loop. To fix the tape, insert a stick into the loop and begin to wrap the tape around the arm. After the end of the dressing, the stick must be fixed with a bandage.

A tourniquet is used to stop the fountain of blood that spurts from an injured artery. Applied only with severe damage to a large vessel, when other measures to stop arterial bleeding were ineffective. This is explained by the fact that the tourniquet not only strongly compresses the vessels, but also the surrounding tissues, which disrupts the supply of nutrients to the damaged area.

In case of arterial bleeding, the application of a tourniquet should be done above the damaged area: if the leg is injured - on the thigh, the arm - on the upper third of the shoulder (it should not be applied in the middle, since the radial nerve can be damaged). In case of severe damage, it may be necessary to apply two rubbers. The tourniquet in the head area should not be tightened too much, as it can provoke suffocation or cerebrovascular accident.

Before proceeding with the application of the tourniquet, it must be borne in mind that the damaged area must be in an elevated position. This means that if the leg is injured, it is lifted and fixed above the level of the body. Next, you need to apply a tourniquet for arterial bleeding according to the following scheme:

• Pinch the damaged artery with your finger or fist.
• Disinfect the area.
• Apply tissue or gauze to the injured area, not reaching the wound, in order to protect damaged tissues from infection and additional trauma that may occur when rubber is applied.
• Bring the tourniquet to the injured area, apply 2-5 cm above the wound. If it is missing, a belt, a thick rope, a scarf will do.
• Tighten the rubber a little and wrap around the limb 2-3 times. It is necessary to tighten the tape with arterial bleeding tightly so that the bleeding stops, but do not squeeze the tissues strongly. The first turn should be the tightest, the others weaker, while making sure that the skin is not infringed during winding.
• After applying the tape, you need to tie the ends, secure with a hook or chain.
• Ensure that the patient does not move the injured limb until he is taken to the hospital.
• The area on which the bandage is applied should not be completely covered with clothes, so that after the patient is in the hospital, the medical staff immediately finds the wound. However, in the cold season, the victim must be wrapped warmly, especially the injured area.
• If the rubber is applied correctly during arterial bleeding, the pulse on the damaged vessel disappears, the area below the ligation site turns pale, and the flow of arterial blood stops.

Features of use

After bandaging, a piece of paper is placed under the tourniquet indicating the time when it was applied. This information is necessary for doctors in order to prevent tissue necrosis, which can develop in the bandaged area due to the lack of nutrient supply to it. The application of a tourniquet in summer and winter is different, since the cold stimulates tissue necrosis. For this reason, the maximum time for applying a tourniquet in summer is two hours, in winter - sixty minutes.

If this time needs to be extended (for example, there is no way to deliver the patient to the hospital on time), the rubber should be loosened for 15-60 seconds so that arterial blood flows to the bled tissues. In this case, press the broken vessel with your finger. Then tie the rubber tight again. If arterial blood begins to ooze, another tourniquet is applied.

After applying the rubber, it is imperative to take the victim to the hospital, where the doctor will suture and take other measures aimed at healing the vessel. With severe blood loss, a blood transfusion is necessary. If the patient is not provided with medical assistance after applying the tourniquet, the cells begin to die. After 8-10 hours, a critical situation occurs when irreversible tissue necrosis begins, which leads to gangrene. In this case, in order to save a human life, it is necessary to amputate a leg or arm much higher than the injury site.

Hard to reach places

With bleeding from the femoral, carotid or muscular artery, the patient can die in two minutes, so you need to act as quickly as possible. The difficulty is also that it is much harder to apply rubber to these areas than to an injured limb. The rules for applying a tourniquet for arterial bleeding, provoked by damage to the neck, are as follows:

• The artery is pressed with a fist.
• A cotton-gauze pad is applied to the wound.
• Fix the neck, head and shoulder with a Cramer splint or other device that is used to immobilize a limb in case of fractures.
• If there is no tire, it is necessary to take the victim's hand, put her forearm on the head so that the shoulder begins to act as a counter-stop. In addition, you can use a board, the length of which is 60 cm, the width is 8-10 cm, attaching it to the shoulder and head.
• The roller is pressed from the side of the wound, after which a tourniquet is applied in one or two turns.

If the artery is damaged, the patient's thighs are immobilized. The femoral artery is pressed with a fist against the pubic bone under the inguinal ligament. If a person is thin, the vessel can simply be pressed against the thigh. Further, the tourniquet is applied according to the following scheme.

There are situations in life when bleeding occurs. It can be caused by serious injuries, open fractures, etc. If you find yourself in this situation, it is worth applying a tourniquet. It is necessary to carry out the procedure exclusively according to the rules so as not to harm the victim. There are two options for applying a tourniquet: for arterial bleeding and for venous bleeding. It is worth distinguishing them and applying the tourniquet correctly.

What you need to know about arterial bleeding, applying a tourniquet

Applying a tourniquet is a way to stop blood, both venous and arterial. But it should be understood that the idea to apply a tourniquet comes only in extreme cases, when the previously applied measures did not give a positive result. This is due to the fact that during this operation, not only the artery is compressed, but also tissues, blood vessels, nerves, which leads to the fact that oxygen does not enter the limb. It is known that most often the tourniquet is applied to the upper and lower limbs of the human body. Although there are cases when it should be applied to the neck and thigh.

The application of a tourniquet for arterial bleeding is necessary in such situations:

• in cases where there is no way to stop serious bleeding of the artery with other options;
• in cases where there is a rupture of the limb;
• in situations where there is a foreign body in the wound, due to which the blood does not stop, when the blood vessel is pressed;
• when the bleeding is heavy enough and time is short.

Depending on which part of the body is affected, the hemostatic tourniquet can be applied in different ways.

There are two types of bleeding:

1. Arterial. Serious injury that can be fatal if not treated promptly. This is the most terrible type of bleeding, it is easy to recognize it, as the blood spurts from the site of the lesion. Her color is also not the same as the usual venous one, it is bright scarlet. And what is most interesting, it flows with the rhythm of the heart. The danger of such an injury is that a fatal outcome can occur even after quality assistance is provided by a professional. It is important to apply the tourniquet correctly so as not to aggravate the problem.
2. Venous bleeding. In this situation, the blood flows out on its own, and at the same time after a couple of minutes it can end. The color of the blood is dark brown. Despite the fact that the blood can stop flowing on its own, you need to be able to stop it with a bandage and a tourniquet.

The rules for applying a tourniquet for arterial bleeding, what you need to understand so as not to harm the patient:

1. Remember that you can not apply such a bandage to broken bones or joints, as this can harm the patient.
2. It is very important that the pressure bandage (tourniquet) is made of a wide fabric that will not cut the skin. So, for example, you can take a scarf. Remember, the rope can not be used, and also do not use a belt, wire. The main rule is the width of such a bandage, the tourniquet should be 4-5 cm.
3. The dressing itself is not applied to the wound itself, but above it, by 4-5 centimeters. It is important to note that the place where the bandage should be should be between the heart and the wound itself.
4. Despite the fact that anyone can apply a tourniquet, only a doctor should remove it. This is due to the fact that if the tourniquet is not removed correctly, microbes can enter the blood of the victim. The correct approach of a specialist is important here.
5. When you applied the tourniquet, be sure to remember the time it was done. This is due to the fact that the tourniquet should not be on the body for more than an hour and a half. Since the death of tissues, nerve endings and so on begins.

Stopping arterial bleeding with a tourniquet should be carried out according to such a simple scheme.

Consider applying such a bandage to the thigh:

• the first thing to do is to raise the affected limb up;
• then it is worth temporarily stopping the blood by pressing the artery;
• quickly fold the tourniquet from two small but wide scarf bandages;
• then you need to wrap the thigh itself with one scarf bandage and tie it in a knot;
• now you need to put a pillow under the knot. It is a simple gauze bandage;
• you need to put a stick under the knot, and lift it a little and start rotating it until it touches the very limb, in this text, the leg. When you saw that the blood stopped flowing, you need to press the stick and fix this design with the second part of the tourniquet, with a scarf bandage.

Tourniquet for arterial bleeding, applied to the shoulder:

• as in the first option, it is necessary to raise the injured limb up;
• according to the previous scheme, first of all, you need to press the artery;
• quickly need to fold the scarf bandage:
• it is important to fold the tourniquet in the form of a loop (fold in half);
• the loop should be applied to the shoulder;
• when the shoulder is in the loop, start pulling the tourniquet by the tails (in different directions), until the blood stops completely;
• when the loop has become tight, tie the tails into a knot, but at the same time everyone does not need to loosen the tension;
• then apply a sterile bandage;
• be sure to leave a note with the time the tourniquet was applied.

It should be understood that an incorrectly blocked artery with a tourniquet can lead to dire consequences. Therefore, before applying such a bandage, it is worth trying other methods to stop bleeding.
It is also worth understanding that you must definitely leave a note to the doctor, where the time will be written when you applied the tourniquet itself, and also write the name of the person who made it. This should make it easier for the doctor to determine the nature of the damage.

Venous bleeding

The venous type of bleeding is characterized by the fact that dark blood flows out of the injury site, which can stop on its own. But you should not count on this, as there are cases when the blood does not stop on its own, and here it is important to take drastic measures.

The application of a tourniquet for venous bleeding should be carried out correctly and carefully, taking into account all the rules and recommendations. It is from the correct application of such a tourniquet that further measures related to this problem depend. The doctor will be able to carry out the correct diagnosis and provide assistance. Such a tourniquet is applied for one and a half to two hours in summer, and in winter for a maximum of one and a half. It is very important to loosen the tourniquet for a while every half hour.

How to apply a tourniquet for venous bleeding:

1. In this case, the bandage should be applied below the injury itself.
2. When you begin to apply such a bandage to a wound, be sure to put some kind of cloth (gauze) on it so as not to damage the soft tissues.
3. Further, the main thing is to stretch the tourniquet very quickly and wrap it around the limb.
4. It should be noted that the turns of the bundle should be overlapped, but very small. The coils of the bandage should not pinch the skin of the affected part of the body.
5. The most important thing when applying a tourniquet in this case is that the first three turns should be quite tight, and the rest can be slightly loosened.
6. Be sure to write a note to the doctor, if there is no paper, leave a mark on the patient's hand. This is a very important element of the whole procedure, which plays an important role in further treatment.
7. Remember that the tourniquet should never be covered with clothing. It is important that it is conspicuous.

If there is deep vein bleeding, then it is important to remember that the limbs must be given an elevated position, after which the tourniquet itself should be applied. Doctors also advise applying ice to the affected area, or a bottle of cold water. Then quickly send the victim to the hospital.

It is logical that a correctly applied tourniquet stops the blood, but at the same time, the pulsation in the arteries is preserved for everyone. The most important thing when applying a bandage, whether to an artery or a vein, is not to get confused. For panic leads to the fact that a person begins to make many chaotic movements, which subsequently can affect the fact that the tourniquet itself will be made incorrectly, which will ultimately lead to terrible consequences.

It is important to remember that everyone should know the basics of first aid. And if you are afraid of blood, then it is better to have someone else apply the bandage, as you can only exacerbate the problem. The ability to stop bleeding plays an important role in a person's life, since no one is immune from accidents.