Providing first aid for bleeding. Types of bleeding and first aid. First aid for external bleeding First aid for vascular bleeding

Bleeding is divided into traumatic and non-traumatic. The cause of traumatic bleeding is mechanical damage to the vessel, accompanied by a rupture of its wall.
Non-traumatic bleeding is not preceded by mechanical trauma to the vessel. This type of bleeding develops as a result of various diseases and pathological conditions (such as tumor processes, chronic and acute inflammatory diseases, blood diseases, beriberi, atherosclerosis, etc.). The blood volume of an adult is 5 liters. Loss of 2 liters of blood is almost always fatal.

Clinical manifestations of massive blood loss

With blood loss of more than 200 ml, the general well-being of the victim is almost always disturbed. The following clinical manifestations are noted: a drop in blood pressure, increased heart rate, general weakness, fainting. Maybe thirst.
Thus, almost all bleeding creates a potential danger to the life of the patient.

First aid

It is necessary, if possible, to stop the bleeding, and then urgently hospitalize the victim in a hospital on a stretcher. Their head end descends, the foot end rises. To stop bleeding, tourniquets, pressure bandages, and cold are used. An urgent replacement of the volume of lost blood is needed.

Nosebleeds

Nosebleeds are also divided into traumatic and non-traumatic. The causes of traumatic nosebleeds can be a blow to the nose, damage to its mucous membrane when picking the nose.
Non-traumatic bleeding is a consequence of the following pathological conditions: diseases accompanied by an increase in blood pressure (hypertension, pathologies of the kidneys, heart, atherosclerosis); diseases accompanied by a violation of the structure of the vascular wall (hemorrhagic diathesis, atherosclerosis, connective tissue diseases); liver pathologies; viral diseases (ARI, influenza); malignant and benign tumors in the nasal cavity.

Clinical manifestations
Blood during nosebleeds can be released out through the nasal openings or drain down the back of the throat and enter the digestive tract (the so-called hidden bleeding). When blood is released to the outside, this is the main symptom of nosebleeds. The blood is bright, the intensity of bleeding is different - from insignificant (a few drops) to abundant. Prolonged ingestion of blood can lead to hematemesis. With prolonged bleeding that does not stop, leading to large blood loss and a drop in blood pressure, fainting may develop.

First aid
The victim must be seated, his head thrown back, in the nasal passage from the side of the injury, place a cotton turunda soaked in a 3% hydrogen peroxide solution, and pinch the nostrils; apply cold to the bridge of the nose and the back of the head for 20-30 minutes (until the bleeding stops completely).

To stop prolonged massive bleeding from the nose in otorhinolaryngology, anterior or posterior tamponade of its cavity is performed.

With high blood pressure, measures are taken to normalize it (the use of antihypertensive drugs). Non-abundant nosebleeds after these events completely stop. If the bleeding is heavy, the measures taken did not give results within 30 minutes, the victim must be urgently hospitalized in a hospital. Also, hospitalization is necessary if the bleeding is caused by the presence of a serious illness in the victim (blood diseases, neoplasms, hemorrhagic diathesis, liver pathologies, severe infectious diseases).

Bleeding from the mouth

The causes of bleeding from the oral cavity may be the following: traumatization of the soft tissues of the oral cavity (tongue, palate, gums, cheeks) with sharp objects; removal of a tooth; malignant or benign tumors; the presence of diseases accompanied by a violation of blood coagulation.

Clinical manifestations
The intensity of bleeding and the appearance of blood depend on the type (artery, vein or capillary) and caliber (small or large) of the damaged vessel. With massive bleeding, blood can enter the respiratory tract with respiratory arrest, as well as the development of a shock state as a result of blood loss.

First aid
The patient must be laid on his side or seated on a chair, lower his head, remove liquid blood and its clots from his mouth. In case of bleeding after tooth extraction, the tooth socket is tamponade with cotton wool soaked in a 3% hydrogen peroxide solution. If, after the extraction of a tooth, the blood cannot be stopped within an hour, you should be examined for the presence of diseases of the blood coagulation system. When bleeding from the cheek or gums, a cotton swab dipped in a 3% hydrogen peroxide solution is placed between the cheek and teeth. If the bleeding is profuse and does not stop after applying the described methods, the patient must be hospitalized in a hospital. Also, hospitalization is needed for persons whose bleeding is caused by diseases accompanied by a violation of blood clotting, tumors.

Pulmonary bleeding

Depending on the amount of blood lost, pulmonary hemorrhages are divided into proper pulmonary hemorrhages and hemoptysis.
Hemoptysis is the appearance in the sputum of a small amount of blood in the form of streaks or its uniform bright red staining. Isolation with sputum of a large amount of blood and the presence of sputum in each portion indicate the presence of pulmonary hemorrhage.

There are many reasons for its occurrence:

• lung diseases: malignant and some benign tumors, tuberculosis, connective tissue pathologies, abscess, cysts, pneumonia;
• diseases of the cardiovascular system: aneurysms of the vessels of the lungs and aorta, myocardial infarction, heart defects;
• chest and lung injuries;
• common infectious diseases, accompanied by increased fragility of blood vessels (flu, etc.).

Clinical manifestations
The appearance of a cough with bright red sputum, foamy. The blood in the sputum does not clot. Sometimes with rapidly developing pulmonary bleeding, cough may be absent. Massive pulmonary bleeding quickly leads to the development of respiratory failure in the patient due to the filling of the respiratory tract with blood, which causes loss of consciousness, and then death. With gradually developed and not very abundant pulmonary bleeding, the most common complication is pneumonia (pneumonia).

First aid
The patient must be seated, given to drink cold water in small sips and swallow pieces of ice. With a strong cough, it is recommended to give him any antitussive drug containing codeine, and try to take the patient to the hospital as soon as possible.

Bleeding from the digestive tract

Causes of bleeding from the gastrointestinal tract:

• diseases of the esophagus: cancer, injury by sharp foreign bodies, rupture of varicose veins;
• diseases of the stomach: ulcer, erosive gastritis, cancer, rupture of the mucous membrane;
• bowel diseases: duodenal ulcer, cancer, ulcerative colitis, dysentery;
• diseases of the rectum: hemorrhoids, cancer.

Clinical manifestations
Bleeding from the gastrointestinal tract has 2 main manifestations: hematemesis and tarry stools. The vomit may be bright red or dark brown in color. Bright red vomit indicates an acute onset of heavy bleeding; while the blood quickly accumulates in the stomach, stretches it and causes vomiting. Dark brown vomit appears when the bleeding is not very profuse and the blood has been in the stomach for some time, where it was exposed to gastric juice before vomiting began. Blood that is not removed from the digestive tract with vomit enters the intestine and after 15-20 hours is excreted with feces, giving it a black color (tarry stool) and a specific smell of decomposed blood. In addition to these manifestations, bleeding from the digestive tract is accompanied by general weakness, a drop in blood pressure, increased heart rate, and the occurrence of fainting. The onset of bleeding from a stomach or duodenal ulcer, bleeding from a rupture of the gastric mucosa is often accompanied by pain in the abdomen of varying severity.

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First aid
A patient with suspected gastrointestinal bleeding must be urgently delivered to the hospital. Hospitalization should be carried out on a stretcher, the patient is laid on his back, with his head lowered below the body, a heating pad with cold water or an ice pack is placed on his stomach, he is given to drink cold water in small portions or swallow pieces of ice.
With continued bloody vomiting, the patient's head must be turned to the side so that the vomit does not enter the respiratory tract and does not lead to respiratory arrest and, subsequently, to the development of severe pneumonia.

External bleeding

Bleeding can occur from arteries, veins and small vessels - capillaries. Bleeding from the capillaries, as a rule, is not life-threatening and soon stops on its own.
An exception is capillary bleeding if the victim has diseases accompanied by a violation of blood clotting. These include hemophilia, thrombocytopenia, thrombocytopathies. In this case, damage to even a very small vessel can lead to large blood loss, since the bleeding is almost impossible to stop.

Clinical manifestations
When bleeding from an artery, the blood has a scarlet color, pours out under high pressure, abundantly, in jolts. With arterial bleeding from large vessels (aorta and arteries extending from it), there is a rapid loss of a large volume of blood, which leads to the death of the patient. When the carotid artery ruptures, blood loss becomes fatal after 1 minute. When bleeding from venous vessels, dark blood flows slowly, in a trickle. When small veins are damaged, blood loss usually does not reach large volumes.

First aid
At the prehospital stage, the main thing in providing first aid to a patient with external bleeding is his temporary stop.
It is performed in 2 stages. First, the damaged vessel is pressed against the underlying bone, then a tourniquet is applied to the affected limb. With bleeding from a vein, the vessel is clamped below the injury site, with bleeding from an artery - above.

Danger to the life of the patient can occur if the large veins of the neck, subclavian veins are damaged, since as a result of the suction action of the chest, negative pressure is created in them. This leads to the suction of air through the damaged wall of the vein and the development of a deadly complication - an air embolism.

First aid for bleeding from the arteries of the upper and lower extremities

Wound of the arteries of the shoulder. To press the vessel into the armpit, a hand clenched into a fist is placed (a towel folded several times, several folded packs of bandages, etc.), the hand on the side of the lesion is straightened and pressed to the body.
Injury to the arteries of the hand. A rolled bandage is applied to the bleeding vessel and it is tightly bandaged with another bandage, after which the hand is given an elevated position. As a rule, this event is sufficient to stop bleeding from the arteries of the hand.
Injury to the femoral arteries. A hand clenched into a fist is pressed on the surface of the thigh from the side of the lesion so that the fist is located immediately under the inguinal fold, perpendicular to it.
Wound of vessels of a shin. A towel folded with a roller or 2 folded packs of bandages is placed under the knee, after which the leg is bent as much as possible at the knee joint.
Injury to the arteries of the foot. The same manipulations are performed as for wounding the vessels of the lower leg. Another way to stop bleeding from the arteries of the foot is to tightly bandage a rolled bandage or a roll of sterile wipes to the wound site, after which the leg is given an elevated position. As a rule, after these measures, the bleeding stops, the application of a tourniquet is not required.
After stopping the bleeding by pressing the vessel to the bone protrusion, a tourniquet is applied. You can use a standard rubber tourniquet, in its absence, you can use a bandage, a cuff from a tonometer, a scarf, a towel. A tourniquet (standard or impromptu) is stretched, brought under the injured limb and tightly tightened around the arm or leg. With a properly applied tourniquet, bleeding from the wound stops, the pulse on the wrist (when the tourniquet is applied to the arm) or foot (when the tourniquet is applied to the leg) disappears, skin blanching is noted. In order not to injure the skin under the tourniquet, it is recommended to place a double-folded towel (or napkin) between it and the skin of the limb. Since prolonged compression of the limb with a tourniquet (more than 1.5 hours in summer and 30-60 minutes in winter) can lead to irreversible circulatory disorders in the affected limb, it is very important to remove the tourniquet in time. After its imposition, the patient must be urgently delivered to a surgical hospital, where the final stop of bleeding (suturing of the vessel) will be performed. If 1.5 hours after applying the tourniquet, the patient is not taken to the hospital, it is necessary to loosen the tourniquet for 15 minutes every 30 minutes to restore blood circulation in the constricted limb, after first pressing the injured artery above the tourniquet with a finger. After that, the tourniquet is applied again, but each time it is slightly higher than the previous level.

First aid for bleeding from the arteries of the head, neck and trunk

If the arteries on these parts of the body are damaged, the bleeding is temporarily stopped as follows: a large number of sterile napkins are placed on the wound, an unfolded sterile bandage is placed on top, and the whole structure is tightly bandaged to the head, neck or torso. A tourniquet is not applied if the victim cannot be quickly taken to the hospital and the bleeding can be completely stopped. As the tampons get wet, they are not removed from the wound, additional gauze pads and a folded sterile bandage are applied on top, and everything is tightly bandaged again. With heavy bleeding and the absence of dressing material at hand, it is possible to use finger pressure of a large vessel supplying the affected area.
When bleeding from wounds of the face and upper neck, the carotid artery is pressed. Finger pressure on the carotid artery instantly stops bleeding from it for 10-15 minutes (more than 15 minutes, this method cannot be used, since the arm gets tired and the pressure exerted is insufficient to stop the bleeding). Pressing the vessel is made with the thumb or 3 fingers (index, middle and ring), folded together. It is carried out towards the spine. After finger pressing the artery, it is necessary to quickly apply a pressure bandage, then urgently hospitalize the victim.

With stab wounds, the outflow of blood from the wound may be small. At the same time, a deep wound channel is able to penetrate into body cavities, causing damage to internal organs and large vessels. Therefore, only by the volume of blood loss it is impossible to judge the severity of the condition of the wounded.

With heavy bleeding due to injury to the axillary, subclavian areas of the body, shoulder joint, with a high detachment of the arm, a temporary stop of bleeding is performed by digital pressing of the subclavian artery. Pressing this vessel is carried out with the thumb or 3 fingers folded together. The artery is pressed over the clavicle, the direction of pressure is from top to bottom. To further stop the bleeding, the following method is used: the arm from the side of the lesion is brought as far as possible behind the back, bent at the elbow joint and, in this form, is wrapped with a bandage to the body.

First aid for bleeding from small veins

With these types of bleeding, a tourniquet is not required. Several sterile gauze pads are applied to the wound, after which everything is tightly fixed with a sterile bandage. Sometimes it is required to give the wounded limb a somewhat elevated position.

First aid for bleeding from large (main) veins

The main veins include the neck, subclavian and femoral veins. When they are injured, either a hemostatic tourniquet is applied (according to the same rules as for arterial bleeding), or the wound is plugged. For this purpose, a large number of sterile wipes are placed in it, a folded sterile bandage is placed on top and all this is tightly wrapped with another sterile bandage.

First aid for capillary bleeding

All types of capillary bleeding are stopped by applying a tight pressure bandage to the wound using a sterile bandage.

Most often, bleeding occurs as a result of damage to blood vessels. The most common cause is trauma (strike, injection, cut, crush, sprain). Vessels are much easier to damage and bleeding occurs in atherosclerosis, hypertension. Bleeding can also occur when the vessel is corroded by a painful focus (pathological process) - tuberculous, cancerous, ulcerative.

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

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

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

There are arterial, venous, capillary and parenchymal bleeding.

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

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

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

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

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

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

Stop venous bleeding done with a pressure bandage

(Fig. 69). To do this, several layers of gauze are applied over the wound, a tight ball of cotton wool and tightly bandaged. The blood vessels squeezed by the bandage quickly close with clotted blood, so this method of stopping bleeding can be final. With severe venous bleeding during the preparation of a pressure bandage, bleeding can be temporarily stopped by pressing the bleeding vessel with your fingers below the wound.

To stop arterial bleeding vigorous and swift action is needed. If the blood flows from a small artery, good effect Rice. 69. Applying a pressure bandage gives a pressure bandage.

Rice. 70. Places of clamping of the arteries: 1 - femoral, 2 - axillary, 3 - subclavian, 4 - sleepy 5 - shoulder

To stop bleeding from a large arterial vessel, the technique of pressing the artery above the injury site is used. This method is simple and based on the fact that a number of arteries can be completely blocked by pressing them to the underlying bone formations in typical places (Fig. 70, 71).

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

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

The tourniquet is applied over the sleeve or trousers, but not on the naked body: the skin can be damaged. Hold a tourniquet in an adult not more than 2 hours (in winter - no more than 1 hour), longer

Rice. 74. Twist overlay

Rice. 71. Finger clamping of the arteries Rice. 72. Correct tourniquet application

pressure on blood vessels can lead to necrosis of the limb. A note must be placed under the tourniquet with an exact (up to a minute) indication of the time of its application (Fig. 72).

If the tourniquet is applied correctly (Fig. 73), the bleeding stops immediately, the limb turns pale, and the pulsation of the vessels below the tourniquet disappears. Excessive tightening of the tourniquet can cause crushing of muscles, nerves, blood vessels and cause limb paralysis. With a loose tourniquet, conditions are created for venous stasis and increased bleeding.

If there is no special tourniquet, you can use improvised means: a belt, a scarf, a piece of cloth, a scarf, etc. A tourniquet made from auxiliary materials is called a twist. To apply a twist, it is necessary to freely tie the object used for this at the required level. A stick should be passed under the knot and, rotating it, twist until the bleeding stops completely, then fix the stick to the limb (Fig. 74). The application of the twist is painful, so it is necessary to put cotton wool, a towel or a piece of cloth folded 2-3 times under it. All errors, dangers and complications noted during the application of the tourniquet fully apply to twisting.

Rice. 73. Places for applying a tourniquet for bleeding from the arteries:

1 - shins, 2 - lower leg and knee joint, 3 - brushes, 4 - forearm and elbow joint, 5 - shoulder, 6 - hips

To stop bleeding during transportation, pressure on the arteries is used by fixing the limbs in a certain position. In case of injury to the subclavian ar-

Rice. 75. Fixation of limbs

terii, bleeding can be stopped by the maximum abduction of the arms back with their fixation at the level of the elbow joints (Fig. 75, a). Compression of the popliteal and femoral arteries is shown in Fig. 75, b, c.

Stopping bleeding from wounds on the forearm (shoulder, thigh or lower leg), in the elbow (armpit, inguinal fold or popliteal fossa) put a roller of cotton wool or tightly folded tissue, bend the arm to failure in the elbow joint (or, respectively, in the shoulder, pressing it to the body, and the leg - in the hip or knee joint) and fix it in this position with a bandage, scarf, belt, towel (Fig. 76). You can leave the limb in this position, like a tourniquet, for no more than 2 hours.

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

Rice. 76. Stop bleeding from a wound on the forearm

Bleeding from the nose. When the nose is bruised, and sometimes for no apparent reason, with certain infectious diseases, high blood pressure, anemia, etc., nosebleeds often occur.

First aid. First of all, it is necessary to stop washing the nose, blowing your nose, coughing up blood that enters the nasopharynx, sitting with your head down, etc., since these measures only increase the bleeding. The patient should be seated or laid down with his head raised, his neck and chest should be freed from restrictive clothing, and fresh air should be given access. sick Rice. 77. Stopping the nasal is recommended to breathe through an open mouth. Most but-

bleeding of owl bleeding when the patient is in a calm position

stops. You can put cold (blister or plastic bag with ice, cold lotions) on the bridge of the nose. Stopping bleeding in most cases is facilitated by compression of the nose for 15-20 minutes (Fig. 77), especially after a lump of cotton wool is introduced into the nostril (you can moisten it with a solution of hydrogen peroxide or a vasoconstrictor, for example, a solution of naphthyzinum). If the bleeding does not stop soon, it is necessary to call a doctor or refer the patient to a medical facility.

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

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

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

It is necessary to reassure the patient, pointing out the absence of danger to life. Then you should put him in bed with a raised upper body. To facilitate breathing, unfasten or remove squeezing clothing, open the window. The patient is forbidden to speak and drink hot, he should not cough, if possible, they are given cough-soothing medicines from the home medicine cabinet. Place on the patient's chest

an ice pack, to the feet - heating pads or mustard plasters. When thirsty, you should give small sips of cold water or a concentrated solution of table salt (1 tablespoon of salt per 1 glass of water).

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

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

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

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

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

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

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

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

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

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

21 Order No. 84

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

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

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

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

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

First aid for bleeding should be provided anywhere. Knowing and being able to perform the necessary activities is useful for everyone. Imagine that your loved ones may find themselves in the position of the victim. A person's life will depend on how quickly passers-by (not medical workers) orient themselves in the situation and the correctness of their assistance.

To understand the indications and various methods, let's remember what bleeding is.

Types of bleeding

When choosing urgent measures to stop blood loss, there is no time to think and look for information about the patient's illnesses. It should be clearly distinguished:

• external bleeding;
• internal.

According to the type of the affected vessel:

• capillary,
• venous,
• arterial,
• mixed.

Some classify "interstitial" hemorrhage (bruising) as bleeding. It is easier to characterize it as internal, since the damaged vessel is not visible.

What signs should you be aware of

Signs of defeat are needed to determine the volume and sequence of assistance. If the victim is not alone, it is necessary to decide who is more in need of participation.

From the cries, one cannot draw conclusions about the severity of the condition. Often in emergency situations, people do not behave quite adequately. Fainting happens simply from the sight of blood from a neighbor, and not from poor health.

1. Symptoms of external bleeding are difficult to confuse. This is an open wound (cut, fracture, wound) from which blood flows. The victim may be conscious, faint, or agitated. The face is pale.
2. The capillary network consists of very thin and small vessels. Even with a shallow wound, you can see how the blood gradually oozes from the wound. We often meet with such injuries in everyday life (hand cuts, abrasions and scratches on the skin).
3. Damage to the veins is characterized by the following: more abundant blood loss, the blood is dark, can coagulate into clots, the clothes of the wounded person get wet quickly. Bleeding from large veins in the neck can be life-threatening.
4. Damage to the artery is most severely tolerated by the victims. The bleeding is increasing rapidly. Red pulsating blood flows from the wound. The general condition is objectively rapidly deteriorating. The pallor of the face, cyanosis of the lips, sticky cold sweat on the forehead attracts attention.

A mixed appearance is characteristic of massive injuries. In such cases, all types of vessels are damaged. Large trunks of veins run next to the arteries, and therefore are damaged together.

Providing first aid

Any vessels contain clotting factors that independently produce blood clots to block the damage. This takes time and support. First aid for bleeding requires the ability to work quickly.

With mild capillary bleeding

If necessary, if possible, rinse the wound with clean water, lubricate with iodine and apply a pressure bandage of gauze, bandage or other clean material. If the leg or arm is injured, you need to give it an elevated position.

Do not forget that you can stop a passing car and use the driver's first aid kit to provide assistance on the street. At home, you should always have the necessary means for dressing and disinfection and duplicate the first-aid kit in the country.

If bleeding from the veins

External venous bleeding is more often observed with injuries of the arms, legs, head and neck. In cases of bleeding from the dilated veins of the esophagus, the blood enters the stomach, then is excreted with vomiting or feces. This view also applies to the outside.

A tight tight bandage is applied to the wound. This should be done with the arms or legs elevated.

A pressure bandage is applied

arterial bleeding

Stopping arterial bleeding from small and medium-sized arteries is also possible, as in the case of venous bleeding, with a pressure bandage.

When a large artery is damaged, various methods are used to press the vessel against the bone. By these methods, the cessation of blood flow to the damaged area is achieved, the measures taken are effective only for the time of compression.

Methods of pre-medical bleeding control

In addition to a pressure bandage, other methods are applicable for severe bleeding.

Tourniquet application

Improvised means are used as a "harness" (scarf, scarf, belt, belt, tie). A tourniquet is applied only for injuries to the arms and legs. The place of application should always be above the wound. An impromptu tool is tied with a strong knot, to increase pressure, a piece of a branch, a handle are slipped under a coil of fabric and twisted. As a result, the bleeding stops, the limb turns noticeably pale. Such a tourniquet can be kept on the limb for no more than two hours. When transferring the victim to the ambulance doctor, inform about the time of applying the tourniquet. Better yet slip a note into the bandage.

A tourniquet was applied for bleeding from the vessels of the forearm

Flexion of the limb at the joint

This measure allows you to reduce blood flow in case of injuries in the popliteal and elbow regions. The bent limb should be fixed with a belt, tie or rope. The femoral artery is occluded by the maximum pulling of the thigh to the abdomen.

Pressing the vessel with fingers to the bone base

In order to gain time to prepare another way to stop bleeding and transport, the vessel is pressed with force over the wound with a hand, fist or palm. It is impossible to use this method for a long time, but it has to be used when the femoral and brachial arteries are injured. Pressing the carotid artery against the spinous process of the spine is even more difficult.

internal bleeding

Bleeding into internal closed cavities occurs with a strong blow, fall, squeezing. There are no visible lesions on the skin. Blood pours into the cranial cavity, pleura, peritoneum, and can compress vital organs (brain, heart, lung tissue). It is not necessary to count on spontaneous vascular thrombosis. Such injuries can quickly lead to death.

For recognition, you need to consider the signs:

• significant pallor of the skin;
• blue lips;
• weak and frequent pulse;
• superficial rapid breathing;
• lethargy of the victim;
• complaints of dizziness, darkening in the eyes;
• fainting state.

At the pre-medical level, it is almost impossible to provide assistance to such victims. It is only necessary to ensure peace, if possible, apply cold to the head or stomach, if possible, determine the nature of the injury.

In case of any suspicion of bleeding, an ambulance should be called.

What can emergency services do?

First aid for bleeding begins at the "Ambulance" stage. Many substations have specialized trauma teams for this purpose. It is much easier for a doctor than for an uninitiated person to diagnose.

The algorithm of actions depends on the severity of the condition of the victim.

The provision of medical care is carried out in the cabin of the car while being transported to the surgical department

The doctor leaves the imposed primary means if everything is done correctly. To stop external bleeding, there are rubber bands, means of fixation. The "twist" on the limb can be removed after a higher tourniquet application.

As hemostatic agents, vikasol, calcium chloride are administered intravenously, a system with aminocaproic acid is placed.

If the bleeding continues, the doctor clamps the damaged vessels in the wound with a clamp.

Blood pressure is measured. Depending on the indicators, drugs are used that support the activity of the heart, normalize blood pressure, anti-shock therapy is carried out.

With extensive blood loss, normal saline is injected. The main thing is to ensure fluid replenishment.

Further activities will be carried out in the hospital.

The life of the victim depends on timely and correct assistance at the prehospital stage. Often, patients who have experienced trauma with bleeding seek out their rescuers specifically to give thanks.

Since trauma, and therefore bleeding due to it, can happen anywhere and anytime, every adult should know how to provide first aid for bleeding.

Types of bleeding and their features

Depending on the type of injured vessel, the following types of bleeding are distinguished:

• arterial;
• Venous;
• Capillary.

Also, bleeding is distinguished by location. The hands are most often injured - bleeding of the upper extremities is the most common type. In second place are leg injuries, and nosebleeds are in third place. The most dangerous type is bleeding of internal organs, since it is difficult to notice them in time, it is even more difficult to keep the situation under control. Below we will consider the principles of first aid for arterial, venous, nasal and internal bleeding.

First aid for arterial and venous bleeding

Many people vaguely remember that first aid for arterial bleeding consists in applying a tourniquet to the vessel, but few people know how to do it correctly. Doctors warn: the application of a tourniquet can be no less dangerous than the loss of blood, an ineptly applied tourniquet can lead to the need for amputation of a limb, and, alas, often leads. How to provide first aid for arterial bleeding without causing harm? Remember, with an injury to a large artery, there is not much time left, only 3-5 minutes. The algorithm of actions is as follows:

1. Do not wash or in any other way try to decontaminate the wound, do not remove small fragments that have got there;
2. Apply a pressure bandage as follows: directly on the wound, apply a sterile bandage or a clean cloth folded in several layers (it is desirable that the dressing be sterile, if there is none at hand, use any). Put another roller made of fabric on top. Then bandage everything tightly, after which the limb must be placed above the level of the body. If done correctly, the bleeding should stop;
3. If there was nothing at hand that could serve as a dressing, you can try to stop the bleeding by maximum flexion of the joint located above the wound;

First aid for bleeding and wounds with a tourniquet. This method is resorted to if it was not possible to stop the blood in another way. The rules are as follows:

• A tourniquet (or any long piece of rubber, such as a rubber hose) is applied 5-7 cm above the wound, but not on bare skin, but on the fabric that should be wrapped around the limb, it can be on a sleeve or trouser leg;
• After stretching the tourniquet, lay it in several turns without gaps between them, the first is not too tight, each subsequent turn is tighter. A sign of a correctly applied tourniquet is to stop bleeding;
• The tourniquet should not be applied too tightly so as not to injure the nerves. If severe pain occurs from the tourniquet, the injured vessel must be pressed with a finger, and the tourniquet removed, give the victim a break from the tourniquet, then apply again;
• Be sure to record the time of applying the tourniquet! This is an extremely important condition that can save a person from possible disability. It is advisable to write the time of applying the tourniquet with a pen directly on the skin or clothing of the victim. The maximum time for which a tourniquet can be applied is one and a half to two hours in summer and one hour in winter. During this time, the patient should be taken to the hospital, if this is not possible, and the time has elapsed, the tourniquet must be removed very carefully and slowly, if the bleeding has resumed, press the vessel with your finger above the wound.

First aid for venous bleeding occurs according to a similar algorithm, the only difference is that the vessel should be pressed below the wound.

First aid for nosebleeds

As a rule, nosebleeds are not life-threatening, although they look frightening. However, blood loss can be significant. To prevent this, you must take the following actions:

1. In the nostril from which the blood comes, you need to insert a small swab of cotton, bandage, napkin or handkerchief. The tampon should not cause pain;
2. The person must be seated with his head slightly tilted down. A common mistake is made by people who, as first aid for nosebleeds, lay a person on his back or make him throw his head back. This can cause blood to drain down the back of the throat;
3. Put a cold compress or any cold object on the nose area;
4. Slightly squeeze the wings of the nose.

First aid for internal bleeding

Internal bleeding is difficult to recognize on its own. An indirect sign of it after an injury that has occurred is a deterioration in a person’s condition, blanching of the skin, cold sweat that has come through, darkening in the eyes. In this case, blood may be excreted with vomiting or with feces, but not necessarily. If you notice these signs, the following should be done as first aid for internal bleeding:

• In case of a chest injury, give the person a semi-sitting position, in case of an abdominal cavity injury - lying down;
• Provide fresh air supply;
• Apply cold to the abdomen or chest;
• Forbid the victim to eat, drink, move and talk;
• Take the person to the hospital immediately.

The last point is relevant not only for injuries of internal organs. In case of massive blood loss, the main point of first aid for bleeding of any kind will be the delivery of the victim to the clinic for the provision of qualified medical care.

When bleeding, the rate of blood loss can be dangerous, so in many cases you need to act quickly. First aid measures depend on the type of bleeding, its location, the nature of the injury, and some other factors. In the article we will talk about ways to deal with in different situations.

Types of bleeding

There is also parenchymal bleeding that cannot be seen. It occurs when the integrity of the liver, pancreas, kidneys is violated. The nature of parenchymal bleeding is similar to capillary, but is a great danger to life. With deep penetrating wounds or violation of the integrity of internal organs, bleeding can be mixed.

In the direction of the blood outlet, internal and external bleeding is also distinguished. In the first case, blood accumulates in the cavities of the body, in the second, it comes out through.

Harness rules

A tourniquet is applied only to stop arterial bleeding, and also if an arm or leg has been amputated as a result of an injury. In other cases, the use of a tourniquet is impractical due to the high degree of injury to the skin and soft tissues. To temporarily stop bleeding, you can use Esmarch's tourniquet or improvised rubber material.

Basic rules and sequence for applying a tourniquet:

1. If possible, raise the arm or leg for a few seconds and fix it in a comfortable position - this will lead to the outflow of venous blood.
2. The tourniquet is superimposed over clothing or a piece of fabric is placed under it. This is necessary to protect the skin.
3. The first two turns must be made as tight as possible, it is they who stop the blood, while the crosshair is superimposed on the back of the artery.
4. The maximum duration of applying a tourniquet in the warm season should not exceed 90 minutes, in the cold - 60 minutes. If during this time the victim cannot be taken to the hospital, the tourniquet must be loosened for 10-15 minutes, and the artery should be pinched with a finger. Then the tourniquet is applied again, 1-2 cm above or below the previous place. The duration of the tourniquet for children should not exceed an hour.
5. The time of application of the tourniquet must be recorded and attached to a conspicuous place. In reality, due to problems with compiling (search for paper and pens in field or combat conditions, while there are more urgent tasks to save the life of the victim) and preservation (paper soaks in blood and spreads or is simply lost) notes, in modern In practice, it is customary to write the time of applying the tourniquet with a marker directly in a prominent place on the body, for example, it can be the forehead, it is recommended to indicate the name of the rescuer or the person who made the tourniquet.

Indications:

• traumatic amputation of a limb;
• inability to stop bleeding by other known means.

Advantages:

• fast enough and the most effective way to stop bleeding from the arteries of the limb.

Flaws:

• the use of a tourniquet leads to complete bleeding of the distal extremities 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 is the cause of post-traumatic plexitis with subsequent pain and orthopedic syndrome;
• cessation of blood circulation in the limb reduces the resistance of infection tissues and reduces their regenerative abilities;
• the use of a tourniquet can cause severe angiospasm and lead to thrombosis of the operated artery;
• restoration of blood circulation after the application of the tourniquet contributes to the development of tourniquet shock and acute renal failure;
• the use of a tourniquet is not possible on the trunk or is limited in anatomically difficult areas.

Errors:

• its use without indications, that is, with venous and capillary bleeding;
• overlay on the naked body;
• away from the wound;
• weak or excessive tightening;
• poor fixing of the ends of the tourniquet;
• absence of a cover note;
• use for more than 2 hours;
• closing the tourniquet with a bandage or clothing.

A tourniquet is applied in case of severe bleeding on the upper third of the shoulder or the middle third of the thigh. In these areas, the anatomical location of the humerus and femur allows you to stop the blood with maximum efficiency. Applying a tourniquet in other places will not give the desired result. If the limb is torn off, the application of a tourniquet is mandatory even in the absence of bleeding.

If the tourniquet is applied correctly, characteristic signs will appear after a while. The limb below the site of application will turn pale and become cold, bleeding will stop, and the peripheral pulse will not be palpable. The junction of the tourniquet should be located on the outside of the arm or leg, since the artery is located on the axillary side.

First aid

For arterial bleeding

When an artery is damaged, bleeding is rapid, so you can not hesitate. Having briefly assessed the condition of the victim, measures must be taken to temporarily stop the bleeding. First, the artery is pinched with a finger, for this, certain points are used:

1. For bleeding in the face area, press the corner of the lower jaw with your thumb.
2. In case of bleeding from the head, press on the area of ​​the temporal bone in front of the ear.
3. In case of arterial bleeding in the area of ​​the shoulder joint, press the subclavian artery against the rib.
4. If the hand is damaged, press the brachial artery against the bone from the side of the shoulder.
5. If the integrity of the femoral artery is broken, press the fist on the pubic bone in the groin area.

First aid for arterial bleeding

After finger pressing, a tourniquet is applied in compliance with the rules described above. If there is no tourniquet and similar material at hand, you can apply a twist. To do this, use a piece of twine or fabric. A loop is made of the material and applied to the desired area of ​​\u200b\u200bthe limb. A metal or wooden rod is inserted into the loop, with which the bandage is twisted. Further actions are the same as when stopping bleeding with a tourniquet.

For venous bleeding

In most cases, bleeding from a vein is easier to stop than from an artery, so neither a tourniquet nor a twist is practically used.

The algorithm for providing first aid is as follows:

1. The wound is closed with several layers of bandage, napkins or any clean piece of cloth.
2. Sterile cotton wool is placed on top.
3. Tightly fix everything with a bandage, scarf or piece of fabric of the desired width.

To consolidate the effect, the injured limb is raised so that it is higher than the body and fixed. If it is not possible to apply a bandage, the wound is tamponed with a tightly twisted bandage. Sometimes this is enough to stop the bleeding.

If the vein is bleeding heavily, a pressure bandage may be useless. In this case, you need to apply a tourniquet, and attach an ice pack to the wound. After that, the victim must be taken to the nearest hospital.

With capillary bleeding

In most cases, capillary bleeding does not pose a threat to the life of the victim and, if the first aid measures were correct, does not cause complications.

To stop bleeding with external bleeding, you must adhere to the following sequence:

1. Treat the area of ​​\u200b\u200bthe skin with any antiseptic.
2. Apply a napkin and fix it with a bandage;
3. If the limb is damaged, raise it relative to the body.

With various injuries or diseases, nosebleeds can begin. It occurs in case of damage to the blood vessels located in the mucous membrane, it can stop on its own, but in severe cases, first aid will be required.

First of all, you need to press the wing of the nose to the nasal septum. With minor damage to blood vessels, the blood should stop after 10 minutes. If this does not happen, a nasal tamponade is done. With nosebleeds, you need to monitor the well-being of the victim and warn him that you need to breathe through your mouth.

First aid for types of bleeding

For internal bleeding

It is quite difficult to detect internal bleeding. Symptoms largely depend on the type of damage and its location, most often there is a rapid pulse (up to 140 / min), a decrease in blood pressure and pallor of the skin.

First aid for internal bleeding is as follows:

1. Help the person lie down in a certain position.
2. Restrict movement.
3. Monitor physiological indicators - pulse, respiration, pressure.

If internal bleeding is suspected, the victim should be taken to a medical facility as soon as possible.

If there is a suspicion that the bleeding is localized in the chest or stomach, the victim should be provided with a “reclining” position, if localized in the abdominal or pelvic cavity, raise the legs up.

Sources:

• Zavyalov V.N., Gogolev M.I., Mordvinov V.S. "Health education of students" 1988.
• D. V. Marchenko - "First aid for injuries and accidents" 2009.
• General surgery: textbook / Petrov S.V. - 3rd ed., revised. and additional – 2010.