Symptoms and treatment of parenchymal bleeding. Types of bleeding and first aid Organ damage occurs parenchymal bleeding

a) pressure bandage;

*b) tamponade;

c) vascular suture;

d) ligation of bleeding vessels;

e) clamping.

The most effective way to stop nosebleeds is:

*a) tight tamponade;

c) pressure bandage;

d) plasma transfusion;

e) blood transfusion.

a way to temporarily stop bleeding from the carotid artery pool:

a) apply a pressure bandage;

b) apply a ligature;

d) bend your head

*e) make finger pressing to the carotid tubercle.

indication for twisting:

a) bleeding from the muscles of the back;

b) bleeding from the veins of the leg;

c) bleeding from the external carotid artery;

*d) bleeding from the popliteal artery;

e) bleeding from the large veins of the neck.

a way to temporarily stop bleeding WHEN THE FEMORAL ARTERY IS WOUNDED:

a) apply a pressure bandage;

b) apply a ligature;

c) give the limb an elevated position;

*d) apply an elastic tourniquet;

e) pack the wound.

first-priority measure in a patient with an open fracture and bleeding from a damaged large artery:

a) limb immobilization;

b) the introduction of cardiac and vasoconstrictor agents;

c) the introduction of drugs for pain relief;

*d) application of a tourniquet on a limb;

e) applying a bandage to the wound of the limb.

a sign of the correct application of Esmarch's tourniquet:

a) hyperemia distal to the application of the tourniquet;

b) impossibility of limb movement;

c) severe pain at the fracture site;

*d) the disappearance of the pulse on the periphery of the limb;

e) absence of tendon and muscle reflexes.

The maximum time the tourniquet is on the limb in summer:

a) 30 minutes;

b) 40 minutes;

c) 60 minutes;

*d) 90 minutes;

e) two hours.

The maximum time the tourniquet is on the limb in winter:

a) 30 minutes;

c) 1.5 hours;

e) 2.5 hours.

disadvantage of using a tourniquet:

a) complexity of use;

b) venous stasis;

c) lack of sensitivity below the tourniquet;

*d) compression of soft tissues and nerve trunks;

e) difficulty in moving the joint above the tourniquet.

HAZARDS WHEN THE BLEEDING IS STOP BY PLACEMENT OF A HARNESS:

a) thromboembolism;

*c) irreversible limb ischemia;

d) thrombophlebitis;

e) lymphostasis.

1. The most effective way to permanently stop bleeding from an artery is:

a) applying a tourniquet;

b) pressure bandage;

*c) ligation of the vessel in the wound;

d) introduction of fibrinogen;

e) administration of vikasol.

way to finally stop arterial bleeding:

a) maximum limb flexion;

b) application of a tourniquet;

*c) the imposition of a ligature;

d) pressure bandage;

e) elevated position of the limb.

INDICATION FOR VASCULAR SUTURE:

a) damage to the saphenous vein of the thigh;

*b) injury to the main artery;

c) profuse bleeding from the wound;

d) the presence of a previously applied tourniquet;

d) gunshot wound.

a way to temporarily stop VENOUS bleeding WHEN THE HIPS IS WOUNDED:

*a) apply a pressure bandage;

b) apply a ligature;

c) apply a biological swab;

d) apply an elastic tourniquet;

e) apply a clamp on the bleeding vessel.

danger of injury to the veins of the neck:

a) thrombosis;

b) thromboembolism;

c) respiratory distress;

*d) air embolism;

e) inflammation of the cavernous sinus.

type of bleeding in which there is a real risk of air embolism:

a) arterial from the femoral artery;

b) arterial from the brachial artery;

c) capillary;

d) venous from the veins of the leg;

*e) venous in case of injury of the veins of the neck.

First aid for bleeding from a varicose vein on the lower leg:

a) press the femoral vein in the groin;

b) press the femoral artery;

c) lower your leg

* d) lay the patient on his back and raise his leg;

e) put a tourniquet on the thigh.

physical method to stop bleeding:

a) plugging;

b) vascular suture;

*c) exposure to cold;

d) ligation of the vessel;

e) blood transfusion.

Parenchymal bleeding: why it occurs

Since this type of blood loss is quite serious and dangerous, many people have a natural question: under what injuries can it appear? Consider the main reasons for this trouble:

If you suffer from any of the above, you need to be especially careful about your body, as cases of sudden bleeding are possible.

The mechanism of blood loss and the main signs

Parenchymal bleeding is the release of vital fluid from the vessel into the external environment or internal cavities. Particularly copious discharge
occur as a result of trauma or injury. There is no way to stop this process on your own, so you should immediately consult a doctor. But this immediately raises the question: how to detect blood loss? There are several symptoms of this trouble:

• sudden loss of consciousness;
• dizziness;
• severe weakness;
• pallor;
• cardiopalmus.

Of course, according to these indicators, it is difficult to recognize exactly parenchymal bleeding, since they are quite extensive. Therefore, it is important to know other, more characteristic signs:

1. No pulse in forearm.
2. Severely low blood pressure.
3. Pain in the organ that provokes trouble.
4. The appearance of red tints in the urine.
5. Hard breath.
6. Cold sweat.

With these symptoms, you should immediately call an ambulance, because the faster qualified assistance is provided, the less time the treatment will take and there will be more chances for a successful cure. In addition, the reasons for emergency care are severe hematomas on the body and bruising. After receiving an injury of any degree, it is necessary to go to the doctor, since the absence of pain and noticeable external damage may indicate internal bleeding.

First aid for parenchymal bleeding

First aid in this case consists in promptly calling an ambulance or delivering the victim to the nearest medical facility. However, while waiting for doctors, you should also not waste time in vain, since performing certain actions can alleviate the patient's condition. So, if you are next to a person who is suspected to have internal bleeding, in particular parenchymal, you should:

1. First, calm down the victim and calm down himself, so that there is no panic, hysteria and unnecessary worries.
2. Next, it should be, if possible, laid in a horizontal position, placing 1-2 pillows under your feet.
3. If you roughly know which organ caused the trouble, apply cold to it.
4. Never shake a person or give him medicines.

Upon arrival, the ambulance must necessarily take the victim to the hospital, where he will be treated in a stationary mode. He will be injected with special drugs that will reduce the loss of vital fluid. Of course, they will not completely stop it, but they will significantly reduce the outflow. Next, an infusion of saline into a vein will begin to maintain blood pressure. Until the patient completely stops parenchymal bleeding, he will not be able to leave the medical facility.

Bleeding(haemorragia: synonym for hemorrhage) - intravital outflow of blood from a blood vessel in case of damage or violation of the permeability of its wall.

Classification of bleeding

Depending on the sign underlying the classification, the following types of bleeding are distinguished:

I. Due to occurrence:

one). Mechanical bleeding(h. per rhexin) - bleeding caused by a violation of the integrity of blood vessels in trauma, including combat damage or surgery.

2). Arrosive bleeding(h. per diabrosin) - bleeding that occurs when the integrity of the vessel wall is violated due to the germination of the tumor and its decay, when the vessel is destroyed by continued ulceration during necrosis, a destructive process.

3). Diapedetic bleeding(h. per diapedesin) - bleeding that occurs without violating the integrity of the vascular wall, due to an increase in the permeability of small vessels due to molecular and physico-chemical changes in their wall, in a number of diseases (sepsis, scarlet fever, scurvy, hemorrhagic vasculitis, phosphorus poisoning and etc.).

The possibility of bleeding is determined by the state of the blood coagulation system. In this connection, they distinguish:

- fibrinolytic bleeding(h. fibrinolytica) - due to a violation of blood clotting due to an increase in its fibrinolytic activity;

- cholemic bleeding(h. cholaemica) - due to a decrease in blood clotting in cholemia.

II. By type of bleeding vessel (anatomical classification):

one). arterial bleeding(h. arterialis)- Bleeding from a damaged artery.

2). Venous bleeding(h. venosa)- bleeding from an injured vein.

3). Capillary bleeding(h.capillaris) - bleeding from capillaries, in which blood oozes evenly over the entire surface of damaged tissues.

four). Parenchymal bleeding(h. parenchymatosa) - capillary bleeding from the parenchyma of any internal organ.

5). Mixed bleeding(h. mixta) - bleeding occurring simultaneously from arteries, veins and capillaries.

III. In relation to the external environment and taking into account clinical manifestations:

one). External bleeding(h. extema) - bleeding from a wound or ulcer directly to the surface of the body.

2). Internal bleeding(h.intema) - bleeding into tissues, organs or body cavities.

3). Hidden bleeding(h. occuta) - bleeding that does not have pronounced clinical manifestations.

In turn, internal bleeding can be divided into:

a) Internal bleeding(h. cavalis) - bleeding into the abdominal, pleural or pericardial cavity, as well as into the joint cavity.

b) Interstitial bleeding(h. interstitialis) - bleeding into the thickness of the tissues with their diffuse imbibition, stratification and hematoma formation.

The accumulation of blood from a vessel in the tissues or cavities of the body is called hemorrhage(haemorrhagia).

ecchymosis(ecchymosis) - extensive hemorrhage into the skin or mucous membrane.

Petechia(petechia, syn. point hemorrhage) - a spot on the skin or mucous membrane with a diameter of 1-2 mm, caused by capillary bleeding.

Vibices(vibices, syn. purple linear spots) - hemorrhagic spots in the form of stripes.

Bruise(suffusio, bruise) - hemorrhage into the thickness of the skin or mucous membrane.

Hematoma(haematoma, synonymous with bloody tumor) - a limited accumulation of blood in tissues with the formation of a cavity in them containing liquid or clotted blood.

IV. By time of occurrence:

one). Primary bleeding(h. primaria) - traumatic bleeding that occurs immediately after damage to the vessel.

2). Secondary bleeding(h. secundaria) - traumatic bleeding that occurs after any period of time after injury.

In turn, secondary bleeding is divided into:

2.1. Secondary early bleeding(h. secundaria praecox) - secondary bleeding that occurs in the first 3 days after injury due to the expulsion of a blood clot from the damaged vessel as a result of an increase in blood pressure or during the elimination of vessel spasm, as a result of slipping of the ligature in violation of the rules for the final stop of bleeding, with insufficient control hemostasis during surgery.

2.2. Secondary late bleeding(h. secundaria tarda) - secondary bleeding that occurs after a longer period of time (from 3 days and later) as a result of the development of purulent-inflammatory complications in the wound, caused by a purulent straightened thrombus covering the lumen of the vessel, suppuration of a pulsating hematoma, necrosis and sequestration of the vascular wall .

Factors that determine the volume of blood loss and the outcome of bleeding

1. Volume and rate of blood loss - play a decisive role in the outcome of bleeding, depend on the nature and type of the damaged vessel. The main pathogenetic factor of blood loss is a decrease in the volume of circulating blood (BCC). Thus, a rapid loss of 30% of the BCC causes (ceteris paribus) more pronounced disturbances in the body's vital functions than a slow outflow of the same volume of blood.

2. General condition of the body- Healthy people tolerate blood loss more easily, the body's resistance to blood loss is reduced by trauma, anemia, starvation, mental and physical overload, long-term operations, heart failure, and a violation of the blood coagulation system.

3. Efficiency of adaptation mechanisms to blood loss- women and donors quickly adapt to blood loss, since blood loss during menstruation or constant donation creates favorable conditions for the development of compensatory reactions necessary for the body to adapt to acute anemia.

4. Gender and age - play a significant role in the outcome of blood loss. Women tolerate blood loss more easily than men. Due to the anatomical and physiological characteristics of the body, as well as the functional state of the cardiovascular system, children and the elderly have a hard time enduring blood loss.

5. The role of the organ in which the hemorrhage occurred - a slight hemorrhage into the substance of the brain, into the spaces of the skull, into the heart sac leads to compression of a vital organ (brain, heart, lung, etc.) and disruption of its function, which creates a direct threat to the life of the patient.

6. Unfavorable environmental factors - hypothermia and overheating adversely affect the body's adaptability to blood loss.

Acute blood loss

Acute blood loss is a rapid irretrievable loss of blood by the body as a result of bleeding through the walls of damaged vessels.

Homeostasis disorders resulting from acute blood loss are the result of a sharp deterioration in the function of central hemodynamics, subsequent disorders of the peripheral circulation and transcapillary metabolism.

Acute blood loss causes a sudden decrease in BCC, which entails a loss of the vital correspondence between BCC and vascular capacity, i.e. factor that determines the value of the total peripheral resistance (OPS). A sharp decrease in OPS causes a deterioration in heart function - the stroke volume of the heart (SV) and the minute volume of blood circulation (MOC) decrease. Without sufficient OPS, it is impossible to maintain intravascular blood (arterial) pressure at the proper level. Thus, hypovolemia caused by acute blood loss is the primary cause of a decrease in TPS, and then in blood pressure, the progressive fall of which characterizes the development of the clinical picture of hemorrhagic shock. The degree of blood pressure reduction in acute blood loss is directly dependent on the BCC deficiency. Acute posthemorrhagic anemia serves as a trigger mechanism for disorders of central hemodynamics, and then for all other body systems that are functionally associated with it. Prolonged physical inactivity leads to the development of severe microcirculation disorders.

Insufficiency of central hemodynamics on the basis of acute hypovolemia is manifested by a decrease in the rate of blood flow in the capillary bed, an increase in the viscosity of circulating blood. In lung tissue, hemorrhages in the alveoli and small bronchi injure the alveolar epithelium, disrupt the synthesis of pulmonary surfactant, which prevents the collapse of the alveoli, and impede the diffusion of gases through the alveolar-capillary membrane. Prerequisites are created for the occurrence of pneumonia and atelectasis. Significant disturbances of microcirculation occur in the kidneys and liver. An inevitable consequence of the slowing of capillary blood flow is the development of hypercoagulation syndrome, which deepens the disorders of capillary circulation.

As a result of violations of the rheological properties of blood and microcirculation, the hydrodynamic and oncotic intracapillary pressure largely changes, which disrupts the processes of ultrafiltration in the arterial and reabsorption in the venous section of the capillary bed. A decrease in blood flow velocity and its shunting leads to a disruption in the supply of oxygen to tissues, prerequisites are created for serious violations of oxygen metabolism, and body tissues experience oxygen starvation.

Only the loss of not more than 25% of the BCC can be compensated by the body due to protective and adaptive mechanisms. First of all, the mechanisms of systemic vasoconstriction and shunting of blood flow play a leading role, contributing to the redistribution of blood (centralization of blood circulation), providing blood supply to the brain and heart in extreme conditions. In addition, the hydremia reaction plays an important role, i.e. autohemodilution, which contributes to the filling of vessels with interstitial fluid, reducing the deficiency of BCC (Albert S.H., 1963). Generalized vasoconstriction, which contributes to the centralization of blood circulation and an increase in OPS, provides an increase in the UOS and an increase in the IOC. As a result, despite posthemorrhagic hypovolemia, blood pressure rises, and central hemodynamics is restored. Restoration of normovolemia occurs at the next stage, in the process of developing protective reactions from the microcirculation and transcapillary metabolism, in particular, autohemodilution reactions. With an increase in blood pressure, the transcapillary exchange changes in favor of the vascular bed, which leads to a decrease in venous and hydrostatic pressure and the cessation of diffusion of the liquid part of the blood into the interstitial space. Increased hydrostatic pressure in the interstitial space promotes the transfer of excess fluid into the vascular space, thereby increasing the VCP and thinning the condensed blood in the capillary bed (pathological and physiological depots). The physiological depots of the body, which contain autoblood, include non-functioning capillaries (90% of their total number), which contain from 4 to 5 liters of blood with a hematocrit of 60-70. So, the liver contains 20% of the deposited blood (hematocrit 40), the spleen - 16% (hematocrit 60), etc. The main reserve of deposited blood is located in the capillary network of the muscle tissue of the skeletal muscles.

Clinical picture of bleeding

The clinical picture of bleeding is determined by the degree of blood loss, the characteristics of damage to organs and tissues, the nature and size of injuries, the type of damaged vessel, its caliber, and also where the blood is poured: into the external environment, into the body cavity, into the lumen of an organ or into body tissues.

Allocate general and local symptoms of bleeding.

General symptoms are the same for all types of bleeding, manifest with significant blood loss and are expressed in the appearance of signs of acute anemia: weakness, dizziness, noise in the head, ringing in the ears, headache. pain in the region of the heart, nausea, flies before the eyes, cold sticky sweat, increased respiration, rapid and small pulse, decreased arterial and central venous pressure, oliguria and anuria, loss of consciousness.

Local symptoms of bleeding are different. Damage to the main blood vessels are among the most dramatic in terms of intensity and speed of developing consequences. There is no other injury where emergency care would be so necessary and where it would not save a life with such obviousness as with arterial or venous bleeding. Local signs of damage to the main vessels include: a wound in the projection of a blood vessel; bleeding from a wound; decrease or absence of pulsation of the artery distal to the injury site; the presence of a pulsating hematoma in the wound area; pallor of the skin and coldness of the limb distal to the wound; development of paresthesia, paresis, ischemic contracture; an absolute sign of damage to the main artery is ischemic gangrene of the limb. With a long and narrow wound channel, even if the main vessels are damaged, bleeding can be minimal, and a hematoma forms along the wound channel, which, when connected with the artery, turns into a pulsating hematoma. Reaching large sizes in some cases, the hematoma compresses the muscles and nearby vessels and nerves, which can be accompanied by malnutrition and even necrosis of surrounding tissues. A few days later, a connective tissue capsule forms around the pulsating hematoma, blood clots partially dissolve and thicken, resulting in the formation of an arterial or arteriovenous false traumatic aneurysm - an expansion of a limited area of ​​the vessel wall. The victims show signs of deterioration of blood circulation in the distal parts of the limb (pallor and coldness, impaired sensitivity, weakening of the pulse in the periphery), with an arteriovenous shunt formed during auscultation, a symptom of "cat's purr" can be determined; arteriography plays a leading role in the diagnosis of damage to the main arteries. Damage to the aneurysm or its independent breakthrough leads to repeated heavy bleeding.

If bleeding occurs in lumen of hollow organs its source is rather difficult to determine. In the diagnosis of hemorrhage, the leading role, along with the general symptoms of blood loss, is given to the color and condition of the outflowing blood. Signs of pulmonary hemorrhage are haemoptoe- secretion of frothy red blood and haemoptysis- coughing up bloody sputum from the respiratory tract. With gastroduodenal bleeding, there are haematemesis- vomiting blood or blood mixed with vomit, as well as vomiting "coffee grounds" - hematemesis, in which the vomit is black-brown in color, due to the formation of hematin hydrochloride during the interaction of blood with hydrochloric acid of gastric juice. Melaena(melena, synonym: Hippocratic black disease, tarry stool) - black tarry stool is an important symptom of bleeding from the upper gastrointestinal tract, discharge of scarlet blood from the rectum is a sign of bleeding from the sigmoid and rectum. The leading symptom of bleeding from the kidney or urinary tract is hematuria- the presence of blood or red blood cells in the urine. epistaxis- bleeding into the nose. The leading role in the diagnosis and stopping of bleeding into the lumen of a hollow organ belongs to endoscopic research methods.

Accumulation of blood in the abdominal cavity - haemoperitonaeum - is associated with open and closed trauma of parenchymal organs, retroperitoneal space, mesenteric vessels, ectopic pregnancy, ovarian rupture, etc., presents certain difficulties for diagnosis and a serious danger to the life of patients. In the abdominal cavity, the blood undergoes defibrinization, its coagulation activity decreases, and spontaneous bleeding does not occur. Pain in the abdomen is moderate, the abdomen is slightly swollen, soft, painful in all departments, positive symptoms of peritoneal irritation are mild. Percussion reveals dullness of percussion sound in the lateral sections (with blood accumulation of about 1000 ml), dullness disappears when the body position changes. A positive symptom of "roll-up" is determined - a forced half-sitting position, the patient cannot lie down due to the appearance of severe pain in the supraclavicular region, caused by irritation of the phrenic nerve. During vaginal examination in women, overhanging of the posterior fornix of the vagina is noted, with rectal examination - overhanging of the anterior wall of the rectum. To clarify the diagnosis, laparocentesis is of paramount importance - puncture of the abdominal cavity using a "groping" catheter and laparoscopy. When establishing the diagnosis of intra-abdominal bleeding, an emergency operation is indicated - laparotomy with revision of the abdominal organs and the final stop of bleeding.

Accumulation of blood in the pleural cavity - haemothorax- observed with open and closed chest trauma, including surgery, with a complication of a number of diseases of the lungs and pleura (tuberculosis, tumors, echinococcus, etc.). The source of bleeding into the pleural cavity during injuries and injuries may be large vessels of the chest wall (intercostal and internal mammary arteries and veins), internal organs and great vessels. There are the following types of hemothorax:

- h. minor(small hemothorax, less than 500 ml), in which the level of blood in the pleural cavity does not reach the angle of the scapula, blood usually fills only the sinuses;

- h. meclius(medium hemothorax, from 500 to 1000 ml), in which the blood level in the pleural cavity reaches the angle of the scapula;

- h. totalis(hemothorax large, total, more than 1000 ml), in which the blood occupies the entire or almost the entire pleural cavity.

Blood in the pleural cavity, with the exception of cases of profuse bleeding, does not coagulate, since, getting into the pleural cavity, it undergoes defibrinization. The clinical picture of hemothorax depends on the intensity of bleeding, compression and displacement of the lungs and mediastinum. The patient is restless, complains of chest pain, shortness of breath, cough with bloody sputum. There is a restriction of respiratory excursions of the chest, dullness of percussion sound, weakening of voice trembling, with auscultation, a sharp weakening or absence of respiratory noises on the side of blood accumulation. The diagnosis is established on the basis of the results of X-ray examination and data obtained during pleural puncture, which has a diagnostic and therapeutic value and determines the tactics of treatment. With a small hemothorax, conservative treatment is carried out using the method of daily pleural punctures. With an average hemothorax, drainage of the pleural cavity with active or passive aspiration, observation in dynamics, and hemostatic therapy are performed. With a large hemothorax, surgery is absolutely indicated. An absolute indication for thoracotomy and the final stop of bleeding is also ongoing or profuse bleeding into the pleural cavity, which is diagnosed on the basis of the following criteria:

1) after the installation of the drainage, more than 1500 ml of blood was simultaneously obtained;

2) for the first hour, more than 500 ml of blood was obtained from the pleural cavity through drainage;

3) blood separation through drainage in the following hours exceeds 150-200 ml/hour;

4) the blood obtained from the pleural cavity coagulates (positive Ruvelua-Gregoire test).

The accumulation of blood in the pericardial cavity - haemopericardium - is caused by bleeding with open and closed injury of the heart and pericardium, less often with a ruptured heart aneurysm, acute myocardial infarction, etc. When the heart is compressed, blood flow to the right atrium is disturbed, CVP increases, cyanosis is noted, swelling of the neck veins . Cardiac output sharply decreases, blood pressure falls, blood flow disturbances in the internal organs and tissue hypoxia develop. The patient's anxiety, shortness of breath, pain in the heart, tachycardia, hypotension are noted. The cardiac impulse shifts or disappears, with percussion, the expansion of the boundaries of relative and absolute dullness of the heart is determined, with auscultation - muffled heart tones. The accumulation of 400-500 ml of blood in the pericardial cavity threatens the patient's life and leads to cardiac tamponade, the patient loses consciousness, cardiac arrest (asystole) and breathing (apnea) occur. If hemopericardium is suspected, a diagnostic pericardial puncture is performed. Surgical intervention includes sternotomy or left-sided anterolateral thoracotomy in the fourth intercostal space, pericardiotomy, removal of cardiac compression and bleeding control.

Accumulation of blood in the joint cavity - haemartrosis- occurs with open and closed injuries of the joints, with a number of diseases (hemophilia, scurvy, etc.). Local symptoms include an increase in the volume of the joint, smoothness of its contours, limited mobility, severe pain on palpation and movement, a symptom of fluctuation. If the knee joint is damaged, the symptom of balloting of the patella is determined. To clarify the diagnosis, X-ray and endoscopic (arthroscopy) examinations are performed. Joint puncture is both diagnostic and therapeutic manipulation.

Accumulation of blood in the cranial cavity - haemocranion- observed most often in traumatic brain injury and leads to compression of the brain due to the formation of hematomas. There are the following locations of hematomas in relation to the brain and its membranes:

epidural hematoma - h. epidurale- accumulation of blood between the bones of the skull and the dura mater;

subdural hematoma - h. subdurale- accumulation of blood under the dura mater;

Intraventricular hematoma - h. intraventriculare- accumulation of blood in the ventricles of the brain;

intracerebral hematoma - h. intracerebral - accumulation of blood in the brain.

For the development of clinical symptoms of brain compression, 30-40 ml of blood is sufficient. The clinical picture with intracranial bleeding and compression of the brain does not occur immediately, but after some time, necessary for the accumulation of blood and compression of the brain tissue, the so-called lucid interval. A picture of a cerebral coma develops with severe disorders of the cardiovascular and respiratory activity, meningeal symptoms. On the side of the location of the hematoma, pupil dilation is noted, on the opposite side, focal neurological symptoms are determined. The patient's death occurs from compression, cerebral edema and paralysis of the respiratory and vasomotor centers. Localization of intracranial hematoma can be clarified by echoencephalography, computed tomography. With the development of symptoms of brain compression, trepanation of the skull, removal of the hematoma and the final stop of bleeding are indicated.

Methods for determining the volume of blood loss

The risk of blood loss is associated with the development of hemorrhagic shock, the severity of which is determined by the intensity, duration of bleeding and the amount of blood lost. That is why, along with finding out the cause and localization of the source of bleeding, one of the urgent tasks of emergency surgery in peacetime and wartime is to determine the volume of blood loss, including surgical and postoperative blood loss after traumatic surgical interventions.

Until now, surgeons determine the amount of blood loss and judge the severity of bleeding by clinical signs and objective data (color of the skin and mucous membranes, pulse and respiration rate, arterial and central venous pressure, hourly urine output) and hemogram indicators (the number of red blood cells, hemoglobin, hematocrit level), although there was a significant discrepancy between the amount of blood loss and the picture of peripheral blood, the amount of blood pressure and other relative indicators. On the basis of these data, it is possible to form the most approximate idea of ​​the volume of blood loss, which does not reflect the true condition of the patient (Gorbashko A.I., 1982).

All existing methods for determining the volume of blood loss, the study of operational and postoperative blood loss can be divided into indirect(by clinical signs, visually, calculation methods) and straight(weighing napkins, weighing the patient, colorimetric, method of electrical conductivity, blood density, etc.). At the same time, each of these methods cannot be accurate, since there is no strong relationship between the volume of blood loss and the degree of decrease in BCC, due to the fact that not only the blood that has spilled out of the vascular bed, but also the deposited blood leaves the circulation.

Acute blood loss is clinically manifested only after a decrease in the initial BCC by more than 25%. It is conditionally possible to distinguish three degrees of blood loss:

1) moderate, constituting no more than 25% of the original BCC;

2) large, equal to an average of 30-40% of the original BCC;

3) massive - more than 40% of the patient's initial BCC. With blood loss of 40% of the BCC or more, as a rule, hemorrhagic shock develops (Klimansky V.A., Rudaev Ya.A., 1984).

To determine the amount of blood loss, you can use indicator of the Algover-Burri shock index(1967), determined by the ratio of the pulse rate and the level of systolic blood pressure. With an index of 0.8 or less, the volume of blood loss is 10% of the BCC, with 0.9-1.2 - 20%, with 1.3-1.4 - 30%. at 1.5 and above - 40% of the BCC and more.

To visual methods determination of the volume of blood loss in victims with open and closed fractures of bones and wounded with gunshot injuries include methods proposed by Clark (1951) and Omar (1951).

Determination of blood loss in closed and open fractures. (FROMlark, 1951)

Lower leg - 0.5-1 liter;

Thigh - 0.5 - 2.5 liters;

Basin, rear half ring - up to 2-3 liters;

Basin, front half ring - up to 0.8 liters.

In wounded with gunshot injuries, to determine the volume of blood loss, it is proposed to take into account the size of the wound, measuring it with an open hand. It is believed that the area of ​​a wound the size of a brush corresponds to the loss of 500 ml of blood. The foot, knee joint and forearm are approximately equal in volume and represent 2-3 times the volume of the hand each, and the thigh is 10-12 times the size of the hand. This method is absolutely not suitable for injuries and wounds of the chest and abdomen.

Determination of blood loss by the size of the wound. (Grant, 1951)

One brush - 10% BCC;

two brushes - 20% bcc;

three brushes - 30% bcc;

four brushes - 40% bcc.

gravimetric method determination of blood loss is based on weighing the patient or surgical material before and after surgery.

The method of weighing the patient has a number of significant drawbacks and allows you to get results only after surgery.

The method of weighing the operating material is quite simple. The volume of blood loss is determined by the difference in the weight of dry and blood-soaked tampons, balls, sheets and gowns, taking into account that 1 ml of blood weighs about 1 g. However, it also has significant drawbacks (plasma evaporation at high temperature in the operating room, etc. is not taken into account). .), which forces surgeons to increase the resulting number by 25-30%.

Laboratory methods determining the volume of blood loss are most common in the surgical clinic. The generally accepted studies are the study of the composition of peripheral blood, the determination of the hematocrit number, the relative density of the blood, performed immediately upon admission of the patient or victim to the department. The data of each of these methods are more significant when applied in a complex manner. Evaluation of the content of erythrocytes, hemoglobin should be carried out taking into account the time elapsed from the onset of bleeding. In the first 3-5 hours, the content of erythrocytes and hemoglobin, the hematocrit almost do not differ from the normal level, which is due to the delay in the autohemodilution reaction. The hydremic reaction begins immediately after blood loss, but its results are revealed much later. In this connection, despite the stoppage of bleeding, the content of relative indicators continues to decrease, and anemia increases. In severe blood loss, only blood taken from the central vein should be examined. The staff of the department of faculty surgery of YSMA developed a four-degree classification for assessing the severity of blood loss depending on laboratory parameters (Khorev A.N. et al., 1990), presented in table 2.

Table 2. Classification of the severity of blood loss according to laboratory parameters.

To determine the volume of blood loss in the clinic, the method for determining the relative density of blood and plasma proposed by Phillips is used, using a copper sulfate solution with a relative density of 1.034 to 1.075. It is based on the ability of copper proteinate to form a shell around a drop of blood or plasma, which retains its relative density for 10-15 seconds. A drop of citrate blood taken from a vein is dipped from a height of 1 cm into a test tube into a solution of copper sulfate. If the density of the blood is lower than the density of the given solution, then the drop immediately floats up, and if it is higher, the drop sinks. The study is carried out until the drop remains suspended in the liquid for 3-4 seconds, which indicates the correspondence of their densities.

The use of the method for determining the relative density of blood in case of blood loss in the clinic and in the experiment makes it possible to obtain approximate data on the amount of blood loss (Barashkov A.G., 1956), presented in Table 3.

According to I.N. Kopustyanskaya (1973), with a relative blood density of 1.057-1.051, blood loss is 500 ml, with a relative density of 1.051-1.047 - from 600 to 1000 ml, with 1.046-1.041 - blood loss is 1500 ml or more (quoted by Gorbashko A.I. , 1982).

V.F. Pozharisky (1972) simplified the R.A. Phillips et al. (1946) determining the value of BCC by the degree of blood thinning in response to the introduction of a certain amount of fluid (plasma, polyglucin) into the vascular bed, where BCC is the volume of circulating blood, V is the volume of transfused plasma, polyglucin, Ht is the hematocrit value before plasma transfusion, polyglucin , Ht - hematocrit value 30 minutes after plasma transfusion, polyglucin.

In traumatology, the volume of blood loss is determined by hematocrit, taking into account the weight of the patient, using the Jenkins table.

The most accurate assessment of the amount of blood loss is currently considered to be the determination of the deficit in the volume of circulating blood. (VCC) and its components: circulating plasma volume (VCP) and volume of circulating erythrocytes (VCE).

Information about the BCC deficiency can be used only in the first hours from the onset of blood loss to the onset of the hydremia reaction. The most persistent component of the BCC, which determines the severity of bleeding, is the deficiency of the BCE, which is slowly restored and more objectively reflects the amount of blood loss (Gorbashko A.I., 1982).

Methods for determining the bcc and its components are divided into direct and indirect, which have been developed for more than 150 years.

Direct methods for measuring blood volume, based on bloodletting, washing vessels with water with recalculation of hemoglobin per blood volume, were performed in the distant past on decapitated criminals. The BCC of a person is from 5 to 6 liters or 1/13 of the body weight (Albert S., 1963) and is a variable value that depends on physiological and pathological changes and the method of determination. To determine normal mean BCC values, a calculation is performed using mass, body surface area, or height. The most acceptable is the calculation per 1 kg of body weight, taking into account fatty tissue, since it contains less blood than the tissue of parenchymal organs, muscles, etc.

Indirect Methods BCC determinations are carried out using various indicators introduced into the patient's vascular bed. The principle of determining BCC is to dilute an indicator in the patient's blood, the volume of which is precisely known. Usually, substances are used that determine the volume of circulating plasma (VCP) or the volume of circulating erythrocytes (VCE), and then BCC is calculated through the hematocrit.

To determine the VCP, the blue azo dye T-1824 (Evans blue) can be used as an indicator, which comes into close contact with albumin and circulates in the blood with it for a long time. The concentration of the dye in the patient's blood is determined using spectrophotometry. Another indicator that easily enters into combination with plasma albumin and serves as an indicator of the magnitude of the VCP is the radioactive isotope of iodine 131 I. To determine the BCE, the chromium isotope Cr is used. The errors of these methods do not exceed 5-10% in relation to the actual BCC; at the same time, in everyday work, especially in the conditions of urgent surgery, the possibilities of these methods are limited, due to the duration of the study, the lack of necessary reagents, and equipment.

N.M. Shestakov (1977) proposed a method for determining the BCC by the integral resistance of the body using a rheograph. It was found that there is an inversely proportional relationship between the integral resistance of the body and the bcc. This method for determining BCC is simple, it does not take much time to carry it out, it can be used for continuous monitoring of the main indicators in dynamics.

Thus, the determination of the BCC and its components, primarily the BCE, makes it possible to reliably judge the volume and rate of blood loss, objectively assess the patient's condition, purposefully and fully determine the complex of therapeutic measures.

Methods for stopping bleeding

Timely stopping of bleeding is crucial for saving the life of the victim, while time becomes a prognostic factor. Distinguish spontaneous and artificial stop of bleeding.

Spontaneous stop of bleeding occurs as a result of spasm of the blood vessel and the formation of a thrombus in its lumen, which is facilitated by the hypotension that occurs. So, with a complete transverse rupture of the artery, the vessel contracts, the inner membrane is screwed inward, as a result of which the possibility of thrombus formation and the probability of spontaneous bleeding arrest are much higher than with marginal damage to the artery. Spontaneously, as a rule, bleeding from small arteries and veins, as well as from capillaries, stops.

Artificial stop of bleeding is temporary and final.

Methods for temporarily stopping bleeding

Methods for temporarily stopping bleeding include: tamponade of the wound and the application of a pressure bandage, maximum flexion of the limb in the joint, elevated position of the limb, finger pressure of the artery throughout and in the wound, clamping the bleeding vessel in the wound, applying a tourniquet, temporary vessel bypass.

Wound tamponade and pressure dressing are the simplest and most effective ways to temporarily stop bleeding from veins, small arteries and capillaries - pressing the vessel directly at the site of injury with a tightly applied bandage reduces the lumen of the vessel, contributes to its thrombosis and prevents the development of hematoma. This method of hemostasis must necessarily be combined with immobilization and an elevated position of the limb above the level of the body.

Maximum limb flexion in the joint is an effective and well-known method of temporarily stopping arterial bleeding, based on bending the limb to failure in the joint lying above the wound - the elbow, knee and hip, and fixing it with a bandage or improvised material.

Finger artery pressure throughout is used in cases where an immediate stop of arterial bleeding is necessary. This method is based on pressing a superficially located arterial vessel to the nearby bones of the skeleton above the site of bleeding in case of wounds of the vessels of the limb and below the wound in case of damage to the vessels of the neck. This technique is performed with considerable effort, finger pressure is carried out in such a way that the lumen of the vessel is completely blocked. The carotid artery can be pressed against the carotid tubercle of the transverse process of the VI cervical vertebra. The subclavian artery is squeezed, pressing it against the 1st rib at a point located above the clavicle, immediately outward from the place of attachment of the sternocleidomastoid muscle to the sternum handle, while the patient's hand is taken down and back. The axillary artery is easily pressed in the armpit against the head of the humerus. The brachial artery is pressed against the inner surface of the humerus at the inner edge of the biceps muscle. The femoral artery presses against the pubic bone at a point immediately below the pupartite ligament midway between the anterior superior iliac spine and the symphysis. When assisting a victim with a wound of a large vein, the damaged vessel should be pressed in the wound and above it. It is better to press the vessel with the thumbs of both hands, placing one finger on top of the other. This method is especially relevant during first aid, in preparation for applying a tourniquet or changing it.

Finger pressing of the vessel in the wound is used in emergency cases, sometimes during operations. An effective way to temporarily stop bleeding is to apply a hemostatic clamp to a bleeding vessel in the wound. The clamping of a bleeding vessel is carried out only in the operating room, and it is impossible to blindly clamp the vessel: firstly, it is ineffective, and secondly, nearby nerves and the artery itself can be damaged. To prevent complications, you must first try to stop the bleeding by pressing the vessel with your fingers in the wound, and then, after drying the wound, apply a clamp directly to the bleeding vessel.

Temporary vascular bypass (temporary intravascular prosthetics) is a method of temporary restoration of blood circulation in case of damage to large arterial vessels and prevents the further development of acute limb ischemia (Novikov Yu.V. et al., 1984). A tube-prosthesis is inserted into both ends of the damaged vessel, the ends of the vessel are fixed on the prosthesis with ligatures. With the help of shunts inserted into the lumen of damaged arteries and veins, it is possible to maintain temporary blood flow for 6-24 hours or more. Temporary prosthetics can be external (external), internal and lateral. Tubes of various materials are used as temporary prostheses, preference is given to prostheses made of silicone - a material that is chemically inert, durable, has water-repellent and athrombogenic properties, is easily sterilized, and is securely fixed in the lumen of a damaged vessel.

A tourniquet is the most reliable method of temporarily stopping bleeding. This method is not without a number of serious drawbacks, however, it has justified itself in the practice of providing emergency care to victims with bleeding in the extremities. Since the introduction of Esmarch's tourniquet in 1873, this method has become widespread due to the simplicity, speed and reliability of stopping bleeding in case of limb injury. Esmarch's hemostatic tourniquet is a rubber band 1.5 m long, ending with a metal chain on one side and a hook on the other. The principle of stopping bleeding is based on pressing the main arterial trunk together with soft tissues to the bone. In this regard, the tourniquet is applied only on the upper third of the shoulder and the middle third of the thigh. If the tourniquet is applied correctly, then the arterial bleeding will immediately stop, the pulse on the peripheral arteries will disappear, the limb will become pale and cold, and its sensitivity will decrease. It must be remembered that the tourniquet saves the life of the wounded, but not the limb. In this connection, in order to reduce the negative consequences, it is necessary to strictly observe the following harness handling rules :

Apply a tourniquet only on the shoulder and thigh and only on a soft lining;

Be sure to attach a note to the tourniquet indicating the date and time (hour and minute) of the tourniquet application;

The tourniquet should always be clearly visible, and therefore it is advisable to tie a piece of bandage or gauze to it and never put a bandage over it;

Using standard or improvised splints, ensure immobilization of the injured limb;

Evacuate the victim with a tourniquet first;

In the cold season, after applying a tourniquet, in order to prevent frostbite, warmly wrap the limb.

We must not forget that the imposition of a tourniquet is far from an indifferent procedure. When a tourniquet is applied to a limb, complete bleeding of its distal sections occurs not only due to compression of the main vessels, but also collaterals and muscle branches. Intact nerve trunks are also subjected to compression, which can lead to impaired motor function of the limb up to paralysis, persistent angiospasm; tourniquet removal may be accompanied by tourniquet shock. In this regard, the tourniquet must be applied without excessive tightening and only with such force that allows you to stop the bleeding. The most formidable complication of pulling a limb with a tourniquet is tissue necrosis and the development of limb gangrene due to a prolonged cessation of blood flow. A similar complication develops, first of all, with the uncontrolled use of a tourniquet for a long time. That is why the tourniquet is applied for no more than 2 hours in the summer and for 1 hour in the winter. If it is necessary to transport the wounded for a longer period, in order to partially restore blood circulation in the constricted limb, the tourniquet should be relaxed for several minutes, after pinching the large artery above the site of the tourniquet with a finger, until the limb turns pink and warm, and then tighten and fix the tourniquet again. It must be remembered that the tourniquet should always be left in the shoulder area for a shorter time than in the thigh area, which is due to a less pronounced volume of muscles in the upper limb and, accordingly, limited resources of collateral circulation.

Methods for the final stop of bleeding

All methods for the final stop of bleeding can be divided into 4 groups: 1) mechanical, 2) physical, 3) chemical, 4) biological.

mechanical methods. These methods of stopping bleeding include ligation of the vessel in the wound and throughout, twisting of the vessel, wound tamponade, artificial vessel embolization, vascular suture, auto- and alloplasty of arteries and veins. With the final stop of intracavitary bleeding, a part of the organ is removed (for example, gastric resection for peptic ulcer complicated by gastroduodenal bleeding) or the entire organ (splenectomy for ruptured spleen).

Ligation of a vessel in a wound is the most reliable and common method of stopping bleeding. After highlighting the central and peripheral ends of the bleeding vessel, they are captured with hemostatic forceps and tied with a ligature. In order to prevent slippage of the ligature when a large vessel is injured, it is tied up after preliminary stitching of the tissues near the vessel.

Vessel ligation throughout it is used in cases where it is impossible to detect the ends of a bleeding vessel in a wound (for example, when the external and internal carotid arteries, the gluteus maximus artery are injured), when the dressing in the wound is unreliable (with secondary late bleeding, when the arrosed vessel is located in the thickness of the inflammatory infiltrate), as well as in conditions of significant tissue crushing. This method is also used to prevent bleeding during surgery. In such cases, taking into account the topographic and anatomical data, the vessel is exposed and ligated along the length outside the wound. The disadvantages of this method include ongoing bleeding in the presence of pronounced collateral circulation, as well as necrosis of the limb - with its poor development.

twisting of the vessel, captured by the hemostatic clamp leads to crushing of the end of the vessel and twisting of its intima, which ensures the closure of the vessel lumen and facilitates the formation of a thrombus. This method can be applied only in case of damage to small-caliber vessels.

Wound tamponade can be used to stop capillary and parenchymal bleeding. To do this, gauze swabs are introduced into the wound, which compress the damaged vessels.

In recent years, methods have been developed and implemented to stop pulmonary and gastroduodenal bleeding. artificial vascular embodization, when, under X-ray control, a catheter is inserted into a bleeding vessel and emboli are introduced through it, closing its lumen; thrombus formation occurs at the site of embolization.

vascular suture, as well as auto- and alloplasty of arteries and veins are the ideal methods of definitively stopping bleeding. allowing not only to stop bleeding, but also to restore normal blood circulation along the damaged bed. More than 70 modifications of the connections of blood vessels have been described, however, to obtain good results in reconstructive operations, the leading role is not so much the type of vascular suture. how much is the quality of its implementation (Novikov Yu.V. et al., 1984). The main principles of this method are: 1) strength, 2) tightness, 3) mandatory comparison of the intima of one part of the vessel with the intima of another part, 4) there should be no suture material in the lumen of the vessel, 5) the suture should minimally narrow the lumen of the vessel. There are circular and lateral vascular sutures. Atraumatic needles are used to apply a vascular suture manually: vascular stapling devices are currently used for circular suturing of blood vessels, while the mechanical suture is quite perfect and resistant to infection. With a significant diastasis between the ends of the vessel, a significant tension that occurs when trying to bring the ends of the damaged vessel together, with vascular defects, especially in areas of increased physiological stress (popliteal, inguinal, ulnar regions), it is more expedient to resort to plastic surgery of arteries and veins (Novikov Yu.V. et al., 1984). The best material for vascular reconstruction should be recognized as the victim's own vein (great saphenous vein of the thigh or saphenous veins of the shoulder). The veins of the injured limb should not be used to obtain a transplant due to the risk of developing possible venous insufficiency and an increased risk of deep vein thrombosis. A promising method for restoring the main blood flow is the use of autoarterial grafts. When using vascular prostheses made of synthetic materials, the risk of developing purulent complications increases. Reconstructive operations on blood vessels should be performed only by specially trained surgeons (angiosurgeons) with special instruments, optical devices, suture material.

Physical methods. Thermal methods of stopping bleeding were used by ancient doctors in Egypt, Greece, the Roman Empire, cauterizing a bleeding wound with a red-hot iron, boiling oil. These methods are based on the property of low temperatures to cause vasospasm, and high temperatures to coagulate proteins and accelerate blood clotting. For local hypothermia of tissues in the area of ​​a bleeding vessel, a medical bubble filled with ice, snow or cold water is usually used. Local hypothermia of the stomach with chilled water up to a temperature of +4°, +6°C is widely used in the complex of therapeutic measures for acute gastroduodenal bleeding. The main thermal way to stop bleeding is diathermocoagulation, based on the use of high frequency alternating currents. This method is widely used during surgery to stop bleeding from damaged vessels of subcutaneous adipose tissue and muscles, from small vessels of the brain, as well as for endoscopic arrest of gastroduodenal bleeding. To stop capillary or parenchymal bleeding, irrigation of the wound with a hot isotonic solution of sodium chloride is used.

Chemical methods. These include the use of vasoconstrictors and blood clotting agents. Vasoconstrictor drugs include epinephrine (1:1000), used topically for bleeding from the mucous membranes, as well as ergot extract (uterine horns), used for uterine bleeding. Hydrogen peroxide, used in the form of a 3% solution, has a hemostatic effect. With the introduction of a swab soaked in a 3% solution, H,0 decomposes into atomic oxygen and water. As a result of oxidation, blood clotting increases and a convolution is formed. This group includes aluminum-potassium alum, which in the form of "hemostatic pencils" are used in the treatment of abrasions and minor wounds. Of the agents that increase blood clotting, calcium chloride is widely used, which is administered intravenously in 10 ml of a 10% solution. Its hemostatic effect consists not only in stimulating coagulation, but also in influencing the vascular component of hemostasis, by reducing the permeability of the vascular wall and increasing the tone of peripheral vessels.

Biological methods. Biological agents used to stop bleeding have a resorptive and local effect. Hemostatic substances of general resorptive action include freshly preserved blood and its preparations (plasma, cryoprecipitate, fibrinogen, etc.), biological (trasylol, contrykal) and synthetic (aminocaproic acid) antifibrinolytic drugs, vitamin K (vikasol) and vitamin C (ascorbic acid) . Topical hemostatic preparations are widely used, which have the ability to stop bleeding when applied topically to a wound. These include thrombin, hemostatic and gelatin sponge, fibrin film, biological antiseptic tampon, etc. Muscle tissue, the greater omentum in the form of a free flap or a pedunculated flap, fascia, rich in thrombokinase and used to stop bleeding from the parenchymal organ, are a kind of biological tampon.

To enhance the effect of hemostasis, various methods of stopping bleeding are often combined.

The abdomen in the human body is the most unprotected area, injuries and bumps are common here, especially in adolescence. Most of them are not dangerous and do not require emergency medical intervention, but some have quite serious consequences. Trauma to internal organs with damage to the blood vessels is one of the most common causes of hospitalization. If parenchymal bleeding occurs during injury, and was not noticed and stopped in time, it carries the threat of complications, up to death.

What are parenchymal organs? These are organs, most of which do not have a cavity, the main tissue of which is abundantly supplied with a mesh. Parenchymal organs in humans are involved in vital processes in the body: in providing respiration, nourishing tissues, cleaning.

This group includes:

• lungs- the main supplier of oxygen and a utilizer of carbon dioxide, lung tissue provides gas exchange through a network of small capillaries and alveoli;
• liver- "factory" of blood purification from toxins formed in the process of splitting substances, in addition, it is involved in the production of certain enzymes;
• spleen- an important organ of hematopoiesis, along with the bone marrow, is a place of storage of young maturing and a place of utilization of cells that have worked out their time;
• pancreas- the main organ that produces insulin;
• The kidneys regulate the excretion of fluid and the decay products dissolved in it.

The main tissue of the parenchymal organs has a rich blood supply, and even the slightest injury can cause a massive one.

What are dangerous

With internal bleeding, an outpouring of blood occurs: into the surrounding tissue, into the cavity of the organ, into the free cavity (pleural, abdominal, pelvic). According to the affected vessel, there are: arterial, venous, capillary bleeding. For example, venous bleeding can occur when the portal vein of the liver is injured, it is characterized by a rapid increase in symptoms, massive blood loss, and the likelihood of developing hemorrhagic shock.

Reasons for development

• According to statistics, the main cause of vascular damage is trauma.
• that cause a violation of the integrity of tissues, such as tuberculosis.
• Malignant neoplasms in the last stage cause bleeding during the decay of the tumor.
• Benign neoplasms, in case of their rupture.

Each parenchymal organ has its own most common causes, signs and features of the development of bleeding.

The lungs are often injured by the sharp edges of the ribs when they are fractured. Therefore, if a rib fracture is suspected, tight bandaging is strictly contraindicated. Also a common cause is bleeding in tuberculosis and oncological diseases. The main symptoms of bleeding are hemoptysis, shortness of breath, and tightness in the chest.

Spleen. Teenagers are more susceptible to injuries of this organ. Often primary bleeding occurs under the capsule. Only a few days later, from overstretching, the capsule breaks, pouring the accumulated fluid into the cavity.

Injury to the pancreas is a rare phenomenon, like bleeding itself, the main causes of damage to blood vessels are cysts and malignant tumors.

The kidneys are usually injured with a fairly strong blow or pressure, as well as when the cysts rupture. Bleeding of the kidneys is accompanied by a characteristic color of urine () and severe pain, it can occur both in the lumen of the organ and in the pelvic cavity.

Symptoms

The usual measures (pressing the vessel, applying a tourniquet) do not work in this case. The main task is to deliver the patient to the nearest medical facility as soon as possible.

Before the arrival of the ambulance, the person should be laid down, cold is applied to the alleged place of bleeding. To do this, you can use an ice pack, thermal packs, or a regular bottle of cold water. With a rapid decrease in blood pressure, the foot end is raised 30-40 centimeters above the level of the heart.

It is important to constantly control breathing and heart rate, if necessary, carry out resuscitation. It is contraindicated to give the victim any medicines, including painkillers, food and drink; if you are very thirsty, you can rinse your mouth with water.

When admitted to the hospital

In a hospital, the diagnosis consists of taking an anamnesis and an objective examination of the victim:

• an important point is the presence of a blunt trauma or penetrating wound of the chest, abdominal, pelvic cavities;
• probable infectious diseases or neoplasms;
• palpation and percussion examination;
• change in normative parameters - blood pressure, heart rate, body temperature.
• clinical examination reveals signs of acute blood loss.

If you suspect a lesion of the organs of the abdominal or pelvic cavity, ultrasound is of great help. If necessary, endoscopy is performed.

Medical assistance in a hospital setting

The final treatment, the fight against bleeding and the restoration of the lost blood volume, occurs in a hospital setting. Stopping parenchymal bleeding is not an easy task. Hemostatic drugs, such as vikasol and aminocaproic acid, do not have the desired effect. Usually it is necessary to resort to a surgical method of intervention, but even at the same time, the delicate tissue of the parenchyma often breaks through and bleeds.

As auxiliary methods, diathermocoagulation, the imposition of hemostatic sponges, transfusion of whole donor blood, plasma and platelet mass are used. If it is impossible to suture the organ, its resection or removal is performed. Subsequently, the main task is to prevent the development of shock from acute blood loss, to restore the necessary circulating blood volume.

It is important to remember that parenchymal bleeding during injury is not able to stop on its own, and every lost hour and day worsens the condition of the victim and increases the risk of complications. Mixed bleeding is especially dangerous, which, if medical care is not provided in time, leads to death.