Bleeding in trauma: application of a tourniquet. How to properly apply a tourniquet

When you need to provide emergency medical care, unfortunately, anyone can be. That is why everyone must know the rules for applying a tourniquet, the life of the victim completely depends on this. There are few nuances in saving lives, but they affect the favorable outcome of the situation.

Treatment Options for Bleeding

A short-term stop of external bleeding helps to gain time before the intervention of doctors and the provision of professional medical care. Temporary stopping techniques include: applying a tourniquet, pressing an artery with a finger, applying pressure bandages. A tourniquet is the most reliable way to stop bleeding limbs. The rules for applying an arterial tourniquet imply a serious attitude to the procedure.

In case of arterial bleeding, a tourniquet is needed only in case of damage to a large artery, in all other cases this emergency measure is not necessary (bandaging or dressing of the wound can be dispensed with).

Tourniquet application steps

When providing first aid for major arterial bleeding on the limbs, it is necessary to strictly follow the rules for applying a tourniquet. In the absence of a specialized device (self-tightening strip with holes for fixation), improvised means can be used (a belt, a bandage folded in several layers, a rubber tube or a rope).

The rules for applying a tourniquet are an algorithm of sequential actions:

On a bare limb (from 5 to 7 cm above the upper edge of the wound), apply a bandage from a bandage or wrap it with a terry towel, eliminating bumps or bumps.
Above the bleeding place, wrap the limb with a tourniquet several times and secure (if the tourniquet is applied tight enough, the bleeding stops).
The tourniquet application time is determined by the season: in winter it should not exceed 90 minutes, in summer - two hours.

In cold weather, the injured limb should, if possible, be isolated from low temperatures. After helping, the tourniquet should be loosened for 5-10 minutes, and the wound should be firmly pressed with a hand through the bandage. It is necessary to loosen the tourniquet one hour after its application, and then - also every hour.

Errors when applying a tourniquet

When applying a tourniquet, it is necessary to avoid common mistakes:

The tourniquet is not tightened tightly enough, while the victim continues to lose blood, a symptom of a weak tourniquet is a cyanotic color of the skin.
The tourniquet is applied too tightly, which can lead to paralysis of the limbs and damage to the nerve trunks.
The imposition of a tourniquet on bare skin leads to injury to the latter, without stopping the bleeding.
Overlapping time exceeded.

Prohibited zones when applying a tourniquet:

lower third of the thigh;
middle third of the shoulder;
upper third of the leg.

Features of applying a tourniquet, control

The rules for applying a tourniquet for bleeding imply constant monitoring of the pulse and attaching a mandatory note under it with the data of the person who provided assistance and information about the time and date of applying the tourniquet. Such information is needed in order to know the time when it is necessary to loosen the tourniquet in order to provide nutrition to the tissues that are located below. In the absence of oxygen, tissues gradually begin to die, so it is important not to miss the time after which weakening is simply necessary. The tourniquet cannot be bandaged or covered with clothing; it must be conspicuous.
It is worth using a tourniquet only in extreme cases, when large main vessels are damaged.

Important points when applying a tourniquet:

in case of bleeding from the arm, it is advisable to apply a tourniquet in the upper third of the shoulder;
if the leg is damaged, the tourniquet is applied in the middle of the limb.

A tourniquet is also provided for amputation of limbs. In this case, for the outflow of blood, the limb is raised for a while, and a tourniquet is applied over the operation site.

Rules for applying a hemostatic tourniquet for venous bleeding

For this procedure, you will need three tourniquets.

First you need to seat the victim for 10-15 minutes, which will reduce blood flow to the heart, most of the blood remains in the lower extremities.
Apply tourniquets (if possible simultaneously) on three limbs: on the thigh, on the arm (on the middle third) and 15 cm below the inguinal fold. Under the harnesses you need to put napkins.
Inject the drug solution into the free hand (intravenously).
Measure the arterial pulse below the application of the tourniquet.
Pay special attention to the color of the skin below the places where the tourniquets are applied (the skin should not be pale).
After the end of the procedure, remove the tourniquets one by one in the absence of the necessary drugs to reduce the volume of circulating blood.

It is very important to establish a trusting contact with the victim before the procedure. His panic state can affect the consequences. The victim must understand that he will be given the right help, any of his opposition can seriously interfere.

Signs of arterial bleeding: blood of scarlet color is emitted from the wound in a stream in time with the heartbeat.

As a tourniquet, usually a standard Esmarch rubber tape tourniquet or a cloth tourniquet in the form of a braid with a twist is used. Do not use wire or rope.

Rules for applying a hemostatic tourniquet

The tourniquet is used only for damage to the arteries of the extremities. In case of damage to the carotid artery on the opposite side of the neck, an impromptu splint or Kramer splint is applied with emphasis on the head and shoulder joint (Mikulich's method). In the absence of tires, you can use the hand on the healthy side, which is placed on the head and bandaged. The splint (arm) should prevent compression of the carotid artery from the opposite side. A roller is placed on the damaged carotid artery below the damage and a tourniquet is pulled through the splint (arm).
Do not apply a tourniquet to a bare wound. The lining should not have any wrinkles. The tourniquet is applied over clothing or some kind of soft padding (bandage, gauze, scarf, etc., folded in several layers and wrapped around the limb).
The injured limb is given an elevated position and the artery is pressed with fingers above the wound (subclavian artery to the first rib, femoral artery to the pubic bone).
The tourniquet is applied 5-7 cm above the upper edge of the wound. The optimal localization of the tourniquet on the upper limb is the upper third of the shoulder (the tourniquet cannot be applied in the middle of the shoulder to avoid damage to the radial nerve). On the lower limb - the upper third of the thigh.
The first round should be tight, the next - fixing.
The tourniquet is applied in a tiled manner, without infringing the skin.
The tourniquet should not be crushing. The approximate force of applying the tourniquet is until the disappearance of the pulse in the artery below the tourniquet.
With a properly applied tourniquet, bleeding should stop, and the pulse on the artery below the tourniquet should not be determined, the skin becomes pale.
Under the last tour of the tourniquet, a note is attached indicating the date and time of its application.
Be sure to carry out transport immobilization of the injured limb and anesthesia.
The tourniquet must always be visible.
In cold weather, the limb must be insulated to prevent frostbite.
The duration of the application of the tourniquet in the summer is no more than 1 hour, in the winter - no more than half an hour. (In children, a shorter time of 40-20 minutes is desirable).
If the time has expired, but the tourniquet cannot be removed:

The damaged artery is pressed with fingers above the tourniquet;

Carefully loosen the tourniquet for 20-30 minutes to restore blood circulation in the injured limb;

The tourniquet is reapplied, but above or below the previous location and the new time is indicated;

If necessary, the procedure is repeated after half an hour or an hour.

Mistakes

The tourniquet was not applied according to indications.
Weak tourniquet application.
Excessive stretching of the tourniquet, which leads to trauma to the nerve trunks and muscles.
Missing note with time and date.
Masking the tourniquet under clothing or bandages.
Applying a tourniquet on the naked body and away from the wound.
Overlay in the middle third of the shoulder.
Delivery of the victim to the hospital with a tourniquet without immobilization of the limb and warming.

A tourniquet is a device for stopping blood. It is a rubber band 125 cm long. Its width is 2.5 cm, thickness - 3 - 4 cm. One end of the tape is equipped with a hook, the other - with a metal chain. This simple device is in the first aid kit of every car for a reason. Sometimes his absence can be fatal. As a result, a large person can die without waiting

How to properly apply a tourniquet?

When applying a tourniquet, rubber gloves are first put on the hands. Then the limb affected by the injury is lifted and examined. The tourniquet is applied not on the naked body, but on top of the fabric lining. It can be a person's clothes, a towel, a bandage, cotton wool. A medical tourniquet applied in this way will not cross and will not injure the skin.

Its end must be taken in one hand, and the middle in the other. Then stretch harder, and only after that circle around the arms or legs. With each subsequent turn of the winding, the bundle stretches less. The loose ends are knotted or secured with a hook and chain. Under any one turn of the tape, a note is necessarily enclosed, which indicates the time of its imposition.

A tourniquet should not be left on for more than two hours, otherwise paralysis or necrosis of the arm or leg may occur. Every hour in the warm season and half an hour in winter, the tourniquet relaxes for several minutes (at this time, the vessel is pressed with fingers), the application of the tourniquet for bleeding is done in the same way as for the first time, only a little higher.

If the harness is applied incorrectly. Their veins could have been accidentally pulled. This will lead to the fact that the pressure in the vessels will begin to rise and bleeding will increase. With an excessively tightened tourniquet, muscles, nerves, and tissues can be damaged, which leads to paralysis of the limbs. The victim with a tourniquet applied is transported to a medical facility in the first place.

The tourniquet can be applied using a plywood tire. It is placed on the opposite side of the damaged vessel. This method has a beneficial effect. If the upper third of the thigh or shoulder is injured, a medical tourniquet is applied as a figure eight during bleeding.

A tourniquet is applied to the damaged vessels of the neck using a plank of wood or a tire in the form of a ladder. These devices are placed on the opposite side of the wound. Due to the tire, the trachea will not be squeezed and In the absence of a tire at hand, you need to put your hand on your head from behind, it will play its role. A tourniquet can be replaced with a twist, using improvised material for this: handkerchiefs, scarves, belts, ties.

Application

A hemostatic tourniquet, if necessary, is applied to the thigh, lower leg, shoulder, forearm and other parts of the body. If the place of its application is the limbs, choose a place so that it is higher than the wound, but closer to it. This is necessary so that the portion of the limb remaining without blood circulation is as short as possible.

When applying a tourniquet, remember that it must not be applied:

On the area of the upper third of the shoulder (it is possible to injure the radial nerve) and the lower third of the thigh (tissue is injured when the femoral artery is clamped).
There are no muscles in the lower third of the forearm and lower leg, and if a tourniquet is applied to these places, skin necrosis may begin to develop. These areas of the body are shaped like cones, so the tourniquet can slip off when the victim is moved. It is easier, more convenient and more reliable to put the tape on the shoulder or thigh.

arterial bleeding. First aid before the doctor arrives

Loss of blood through an artery is often the cause of death of the victim, so it must be stopped quickly. In the body of an adult, the volume of blood is 4-5 liters. If the victim loses one-third of this volume, he may die.

The first thing to do when treating arterial bleeding is to compress the artery so that blood does not enter the wounded area and does not flow out. To determine the place where it is located, you need to feel the pulse. Where he is, there is an artery. Confidently press this place with your fingers, but 2-3 centimeters above the wound.

If the victim needs to be transported, the application of a tourniquet for arterial bleeding is mandatory. Only this must be done correctly, as described above in the article. But if, as a result of a traffic accident, a person has lost his leg, and blood flows from the wound, the application of an arterial tourniquet must be done so that it is 5 centimeters higher than the damaged area, and not 2-3. Under no circumstances should it be weakened. Not everyone has a tourniquet handy. It can be replaced with a twist. But in no case should you use narrow ropes, cords made of inelastic material.

When the victim is the first, you need to remember that when a tourniquet is applied, the blood supply to all departments that are below it stops. It is necessary to know that the movement of blood through the arteries is carried out from the heart to all peripheral parts.

Internal bleeding

The loss of blood as a result of damage to the internal organs of a person is very dangerous for life, since its determination is often delayed for some time.

Bleeding occurs when a strong blow has been dealt, as a result of which the spleen and liver are torn. In this case, the victim experiences severe pain in the abdomen, shock and may lose consciousness.
Esophageal bleeding occurs as a result of rupture of the veins, as some liver diseases lead to their expansion.
Gastric bleeding occurs due to an ulcer, tumor, or injury to the stomach. The defining feature is the vomit of dark red or clotted blood. In this case, the victim must be provided with peace and a semi-sitting position with legs bent at the knees. A compress should be placed on the peritoneal area and not allowed to eat or drink. The victim urgently needs to be hospitalized, where he will undergo surgery.
Bleeding in the chest cavity is due to a strong blow or trauma to the chest. The accumulated blood begins to put pressure on the lungs, as a result of which their normal functioning is disrupted. Breathing becomes difficult, choking may occur. The victim urgently needs to be transported to the hospital, and before the doctor arrives, put an ice compress on his chest, provide him with a half-sitting position with bent legs.

Venous bleeding. First aid

If, upon examination of the victim, it turned out that the damage to the vein is insignificant, it is enough to press the vessel with your finger below the damaged area, since this blood moves from bottom to top, and not vice versa. If this is not enough, a pressure bandage should be applied to the site of injury to stop the blood flowing from the vein. This is the first aid.

But first, the skin around the injury site is treated with iodine, the wound is closed with a sterile bandage, and a sealing roller is applied from above, along the location of the bones. Now the site of the injury must be tightly bandaged, and the injured limb should be given an elevated position. The pressure bandage is applied correctly if the bleeding stops and there are no blood stains on it.

In the case when such assistance is not enough to stop the bleeding, venous tourniquets are applied, only below, and not above, the site of the vessel lesion. You just need to know that the flow of venous blood occurs in the opposite direction, that is, towards the heart.

Bleeding

When the integrity of the walls of blood vessels is violated, blood flows out of them. This is called bleeding. Its danger lies in the fact that the amount of blood that circulates in the vessels decreases. This leads to deterioration of cardiac activity and insufficient supply of human organs with oxygen.

With prolonged blood loss, anemia begins to develop. This is especially dangerous for children and the elderly. Their bodies can't handle the rapidly declining blood volume. So there are three types of bleeding. It depends on which vessel they are localized in.

Arterial. It can be easily identified: scarlet blood fountains from an artery.
Venous. Dark-colored blood flows from the injured vessel.
Capillary. This is a mild form of bleeding, in which small blood vessels are damaged.
Parenchytamous. It occurs when non-hollow internal organs of a person, such as the spleen, liver, kidneys, are damaged. Such bleeding is mixed. It is associated with a rupture of some organ. Without surgery, it is impossible to completely stop parenchytamous bleeding. But, when providing first aid to the victim, ice should be put on the site of the alleged damage.

Bleeding happens:

External.
Internal. In this case, the blood from the affected vessel is poured into the tissue of some organ.

Signs by which bleeding can be determined

The most important sign is the blood flowing from the vessel. But with internal bleeding, you can not notice it. Therefore, there are other signs:

The skin and mucous membranes become pale.
There is dizziness, thirst.
The blood pressure drops.
The pulse is weakly felt and tachycardia appears.
The person loses consciousness. This happens when there is a rapid and severe loss of blood.

Arterial and venous bleeding in wounds. First aid

A wound is an injury in which the integrity of the skin, tissues, membranes is violated, and which is accompanied by pain and blood loss. When injured, pain is caused by damaged receptors and nerve trunks, and bleeding is directly related to the nature and number of damaged vessels. That is why, first of all, the depth of the wound is established and it is determined from which vessel the blood flows: veins or arteries. It is especially necessary to act quickly if the wounds are very deep and punctured, and large blood vessels are affected when injured.

Rendering before the arrival of the ambulance team is usually done by people nearby. A tourniquet is applied to the site of injury to stop bleeding.

In a hospital, first aid for arterial and venous bleeding is carried out surgically. At the site of damage to the vessel, its walls are sutured.

First aid for injuries to the head, chest, neck, abdomen and other areas of the body is carried out by applying a pressure bandage. Sterile gauze is placed on the wound and bandaged.

It should be noted: it is not necessary to apply cold when bleeding from a vein or artery, since this makes no sense. These large vessels do not narrow from exposure to low temperatures.

Natural openings on the human body. Bleeding out of them

There is a loss of blood when it flows out of the nose. This can be with a strong blow or as a result of a traumatic brain injury. To stop the bleeding of the victim, you need to lay on his back, slightly raise his head. Ice should be put on the bridge of the nose, neck, heart area. Do not blow your nose or blow your nose during this time.

If a person has an injury to the ear canal or a skull fracture, the ear may bleed. In this case, a sterile gauze bandage is applied to him, and the victim is laid on the opposite side and his head is raised. It is strictly forbidden to wash the ear.

How to stop bleeding with bent limbs?

If a wound has formed in the area of \u200b\u200bthe hand or forearm and blood flows out of it, you need to put a roller of gauze, bandage or soft tissue in the elbow bend and bend your arm. To fix it in this position, the forearm should be tied to the shoulder. The bleeding will stop.
To stop it from the artery of the forearm, the roller is placed under the armpit, the arm is bent at the elbow, placed on the chest and bandaged.
With axillary bleeding, the arms are bent, pulled back and the elbows are tied. This position allows the subclavian artery to press the clavicle against the rib. This technique cannot be used if a person has a fracture of the bone tissue of the limbs.

Car first aid kit. Her equipment

Many people believe that this kit is only needed to pass the inspection. But this is far from true. No one knows what the situation may be along the route of the car. Perhaps your humane attitude towards another person, knowledge of the rules for providing first aid to the victim and necessary for someone will save a life.

Currently, the first-aid kit of the automobile is produced according to new standards. It consists of: an apparatus with which you can make artificial ventilation of the lungs, bandages, hemostatic gloves and scissors. Disinfectants and all medicines are excluded from the first-aid kit. It does not contain analgin, aspirin, activated charcoal, validol, nitroglycerin, and even iodine with brilliant green.

The complete set of the first-aid kit automobile became much poorer. What caused it to change? First of all, the European practice of providing first aid before the arrival of doctors. They believe that most drivers in Russia do not know how to use the necessary drugs. Therefore, for them, calling a doctor and stopping the blood loss of the victims will be the main task.

Depending on the type of damaged vessel:
View	What does it look like?	Characteristic
arterial bleeding		The color is bright scarlet. Blood flows out in a pulsating stream, quickly, under pressure. High rate of blood loss.
Venous bleeding		Cherry blood. Constant, uniform flow of blood without pulsations. The rate of bleeding is less than with arterial.
capillary bleeding		It occurs as a result of damage to capillaries, small veins and arteries. The wound surface bleeds. Bleeding is not as severe as with arterial or venous bleeding.
Parenchymal bleeding		Occurs due to damage to internal organs, such as: liver, spleen, lungs, kidneys. Similar to capillary bleeding, but poses a greater health risk.
Depending on the cause that led to the release of blood from the vascular bed:
1. Haemorrhagia per rhexin		Bleeding as a result of mechanical damage to the vessel wall. The most frequent.
2. Haemorrhagia per diabrosin		Bleeding due to ulceration or destruction of the vascular wall in pathological processes (inflammatory processes, tumor decay, peritonitis, etc.).
3. Haemorrhagiaperdiapedesin		Bleeding as a result of a violation of the permeability of the vascular wall. An increase in wall permeability is more common in the following conditions: a decrease in vitamin C in the body, hemorrhagic vasculitis, scarlet fever, uremia, sepsis, etc.
In relation to the external environment
external bleeding		Blood flows out of the wound into the external environment.
internal bleeding		Blood is poured into the internal cavities of the body, into the lumen of hollow organs, and tissues. Such bleeding is divided into obvious and hidden. Explicit: blood, even in an altered form, but after a certain time appears outside Example: stomach bleeding - vomiting or feces with blood (melena); Hidden: blood is poured into various cavities and is not visible to the eye (into the chest cavity, into the joint cavity, etc.).
By time of occurrence
Primary bleeding		Bleeding occurs immediately at the time of injury when the vessel is damaged.
Secondary bleeding		Allocate: early and late bleeding. Early arising from several hours to 4-5 days after damage. Causes: slippage of the thread from the vessel applied during the primary operation, washing out of the thrombus from the vessel with an increase in pressure, acceleration of blood flow or a decrease in vessel tone. Late ones occur 4-5 days or more after the injury. This is usually associated with the destruction of the vascular wall as a result of the development of infection in the wound.
With the flow
Acute bleeding		The outflow of blood occurs in a short period of time.
Chronic bleeding		The outflow of blood occurs gradually, in small portions.
By severity
Light		The volume of blood loss is 500-700 ml;
Medium		Loss of 1000-1400 ml;
heavy		Loss of 1.5-2 liters;
Massive blood loss		Loss of more than 2000 ml; A one-time blood loss of about 3-4 liters is regarded as incompatible with life.

General symptoms of bleeding

Classic signs:

The skin is pale, moist;
fast heartbeat (tachycardia);
Decreased blood pressure.

Patient's complaints:

general weakness and malaise, anxiety,
dizziness, especially when lifting the head,
"flies" before the eyes, "darkening" in the eyes,
nausea,
feeling short of breath.

Local symptoms of bleeding
For external bleeding:

direct outflow of blood from a damaged vessel.

For internal bleeding:

Gastrointestinal bleeding: vomiting of blood that has not been altered or altered ("coffee grounds"); discoloration of feces, black stools (melena).
Pulmonary haemorrhage: hemoptysis or foaming blood from the mouth and nose.
Bleeding from kidneys: scarlet color of urine.
Accumulation of blood in cavities (thoracic, abdominal, joint cavity, etc.). With bleeding into the abdominal cavity, the stomach is swollen, the motor activity of the digestive tract is reduced, pain is possible. With the accumulation of blood in the chest cavity, breathing weakens, the motor activity of the chest is reduced. When bleeding into the joint cavity, there is an increase in its volume, severe pain, dysfunction.

First aid for bleeding

Waystemporary stop of bleeding

Pressing the artery
Fixing a limb in a certain position
Elevated position of the limb
pressure bandage
Tamponade of the wound
Clamp on the vessel

A tourniquet for bleeding

Harness rules
A tourniquet is a very reliable way to stop bleeding, however, if it is used ineptly, it can lead to very serious complications.
Standard tourniquet (Esmarch's tourniquet) - a rubber band 1500 cm long, with special fasteners at the ends. Improvised means (belt, rope, etc.) can be used as a tourniquet. Modern harnesses have the ability to self-tighten.

Harness types:

Harness name	What does it look like?
Bandage tape rubber (langenbeck's tourniquet)
Esmarch's tourniquet
Dosed compression tourniquet
Harness NIISI RKKA
Atraumatic tourniquet "Alpha"

When to apply?

arterial bleeding,
Any massive bleeding in limbs.

It is not excluded the setting of a tourniquet in the armpit and inguinal region, as well as on the neck

Harness rules:

Before applying the tourniquet, it is necessary to elevate the limb;
It is impossible to apply a tourniquet on a bare limb, it is necessary to substitute a cloth (towel, clothes).
If possible, a tourniquet should be applied as close as possible to the wound, from the side of the blood flow;
When setting the tourniquet, 2-3 tours are performed, evenly stretching the tourniquet, so that the tours do not lie one on top of the other, the tourniquet should press the vessel to the bone protrusion;
In case of bleeding from the wrist area, a tourniquet is applied to the shoulder;
After setting the tourniquet, be sure to indicate the exact time of its setting (hour and minutes);
The part of the body where the tourniquet is placed must be accessible for inspection. This is necessary to observe the changes that can occur in the absence of blood supply;
The victim, to whom a tourniquet has been applied, must be transported to a medical facility and treated there in the first place;
The tourniquet should be removed gradually, gradually loosening it, after performing anesthesia;
The tourniquet should be held for no more than 2 hours on the lower extremities and no more than 1.5 hours on the upper ones, with the condition that every 30-40 minutes the tourniquet will be loosened for 20-30 seconds. In the cold season, the tourniquet holding time is reduced to 40-60 minutes on the lower extremities and 30-40 minutes on the upper ones. Low temperatures impair circulation in tissues, especially in the extremities, this is due to reflex vasoconstriction under the influence of cold. During long-term transportation of the victim, they burn every 30-40 minutes, regardless of the external temperature, should be removed for 20-30 seconds until the skin below the tourniquet turns pink. This can be done for several hours, the time originally recorded in the note should not be changed. This technique allows you to avoid irreversible processes in the tissues of the limb. Temporary delivery of blood to tissues will help maintain their viability.
If, after applying the tourniquet, the limb abruptly begins to swell and turn blue, the tourniquet should be immediately removed and reapplied. At the same time, controlling the disappearance of the pulse below the application of the tourniquet.

Method of applying a tourniquet to a limb

The upper third of the shoulder is the place of application of the tourniquet in case of bleeding from the vessels of the upper limb, the tourniquet is applied. In case of bleeding from the vessels of the lower limb, a tourniquet is applied in the middle third of the thigh.
A towel or clothing of the victim should be placed under the tourniquet so as not to pinch the skin and the pressure on the vessels was uniform.
The limb is lifted, a tourniquet is brought under it, stretching it as much as possible. Then wrap around the limb several times. Tours should lie next to each other while not infringing on the skin. The first round is the tightest, the second is applied with less tension, the next with a minimum. The ends of the tourniquet are fixed on top of all tours. The tissues should be compressed until the bleeding stops, no more, no less. It is important to make sure that there is no pulse in the arteries below the applied tourniquet. If the disappearance of the pulse is incomplete, after 10-15 minutes the limb will swell and turn blue.
Apply a sterile dressing to the wound.
Attach a piece of paper with the exact time of applying the tourniquet (hour and minute).
Fix the limb using a transport splint, bandage, scarf or other available means.

The method of applying a tourniquet on the neck
In emergency situations, the application of a tourniquet to the vessels of the neck is vital and can save a life. However, the setting of the tourniquet on the vessels of the neck has some features.
The tourniquet is applied in such a way as to press the vessels only on one side of the neck and not press on the other. To do this, on the opposite side of the bleeding, use Kramer's wire splint or other improvised means, or use the victim's hand wound behind the head. This keeps blood flow to and from the brain.

Setting technique: a tissue roller is applied to the bleeding wound (a sterile bandage is better, if not, improvised means can be used). The roller is pressed with a tourniquet, then wrapped around the arm or the tire. Pulse stop monitoring is not required. You can keep the tourniquet around your neck for as long as you need.

Criteria for a correctly applied tourniquet:

Bleeding from the damaged vessel has stopped;
The pulse on the limb below the tourniquet is not palpable;
The limb is pale and cold.

Errors when applying a tourniquet:

A tourniquet should not be applied to the upper third of the thigh and the middle third of the shoulder, this can lead to serious damage to the nerve trunks and be ineffective in stopping bleeding.
The wrong type of bleeding is determined, and setting a tourniquet only increases it (for example: venous bleeding);
The tourniquet is not tightened enough or large vessels are not pressed against the bone protrusions;
Excessive tightening of the tourniquet can cause severe damage to soft tissues (muscles, blood vessels, nerves), which can lead to paralysis of the limb.
Exceeding the time limit for applying a tourniquet can subsequently lead to the loss of a limb;
Putting a tourniquet on a bare leg. There is no sufficient pressing of the vessels, the skin under the tourniquet is injured.
Apply a tourniquet away from the wound. However, with an unspecified source of bleeding in an emergency, applying a tourniquet as high as possible from the wound is a vital action. Since bleeding from the femoral artery within 2-3 minutes leads to death, therefore there is no time for long discussions and the application of a tourniquet at the base of the leg, just below the inguinal ligament, will be the best option.

Finger artery pressure

A simple method that does not require auxiliary means. Advantage - the ability to perform as quickly as possible. The disadvantage is that it is applied for a short time, within 10-15 minutes. The method is especially important in emergency situations, when it gives time to prepare for another method of stopping bleeding (application of a tourniquet). Arteries are pressed at certain points. At these points, the arteries lie most superficially and can be easily pressed against bone structures.

Indications:

arterial bleeding

The main pressure points of the arteries

Pressing the temporal artery, 2 cm up and anterior to the ear canal.
Pressing of the maxillary artery, 2 cm anterior to the angle of the mandible.
Pressing the carotid artery, the middle of the edge of the sternocleidomastoid muscle (upper edge of the thyroid cartilage).
Pressing the brachial artery, the inner edge of the biceps.
Pressing the axillary artery, the anterior border of hair growth in the armpit.
Compression of the femoral artery, middle of the inguinal ligament.
Pressing the popliteal artery, the top of the popliteal fossa.
Pressing the abdominal aorta, the umbilical region (pressing is done with a fist).

Fixation of a limb in a certain position

This method of stopping bleeding will be used when transporting the victim to the hospital. Reception is more effective if a gauze or cotton roll is placed in the flexion area. Indications are generally the same as when applying a tourniquet. The method is less reliable, but also less traumatic.

In case of bleeding from the subclavian artery, the bent arms at the elbows are pulled back as much as possible and tightly fixed at the level of the elbow joints (Fig. b).
In case of bleeding from the popliteal artery, the leg is fixed with maximum flexion in the knee joint (Figure E).
When bleeding from the femoral artery, the thigh is brought to the abdomen as much as possible (Fig. e).
When bleeding from the brachial artery, the arm is maximally bent at the elbow joint (Fig. D).

Elevated position of the limb

The method is simple, but quite effective in case of venous or capillary bleeding. When a limb is raised, the flow to the vessels decreases, the pressure in them decreases, which creates favorable conditions for the formation of a blood clot and stop bleeding. The method is especially effective for bleeding from the lower extremities.

pressure bandage

Materials needed: bandage and bandage.
Indications:

Moderate venous or capillary bleeding
Bleeding from varicose veins of the lower extremities

Technique:
Several sterile napkins are applied to the wound, sometimes a special roller is applied on top, then bandaged tightly. Before applying the bandage, give the limb an elevated position. The bandage is applied from the periphery to the center.

Tamponade of the wound

Indications:

Capillary and venous bleeding from small vessels in the presence of a wound cavity.
Often used in surgeries.

Technique:
The wound cavity is filled tightly with a swab, which is left for a while. The method allows you to buy time and prepare for a more adequate method of stopping bleeding.

Circular tug of limb

For twisting, use a special tourniquet or rubber tube, belt, piece of cloth, scarf. The object used for twisting is loosely tied at the desired level. A plank, stick, etc. is inserted into the formed loop. Then, by rotating the inserted object, the loop is twisted until the bleeding stops completely. After that, a plank or stick is fixed to the limb. The procedure is painful, so it is better to put something under the spin knot. When twisting the dangers, the procedures and complications are similar to those when applying a tourniquet.

Clamping on a vessel

The method is indicated to stop bleeding during surgery. The Billroth clamp is used as a hemostatic forceps. Vessel clamp is used briefly to prepare for the final method of stopping bleeding, more often ligation of the vessel.

How to stop arterial, venous bleeding?

Step by step guide to bleeding

Take self-protection measures for people who care for a bleeding victim. It is necessary to wear rubber gloves, avoid getting blood on the mucous membranes and skin, especially if they are damaged. This is the prevention of various infectious diseases (viral hepatitis, HIV, etc.).
If the bleeding is massive, be sure to call an ambulance or take the victim to a medical facility on your own, after temporarily stopping the bleeding.
Stop bleeding using the methods listed above, depending on the type and location of the bleeding.
To prevent the development of acute anemia and to carry out the first therapeutic measures when it occurs:

For this, the following is required. Give the victim a horizontal position. In case of massive blood loss, fainting of the victim should be laid so that the head is lower than the body. Raise the upper and lower limbs, thereby increasing the flow to vital organs (brain, lungs, kidneys, etc.). With preserved consciousness and no damage to the abdominal organs, you can give the victim tea, mineral or ordinary water to drink, and help replenish fluid loss from the body.

capillary bleeding

Plain bandage on the wound easily stops bleeding. It is enough just to raise the injured limb above the torso and the bleeding decreases. At the same time, blood flow to the wound decreases, pressure in the vessels decreases, which contributes to the rapid formation of a blood clot, closure of the vessel and cessation of bleeding.

Venous bleeding

To stop bleeding you need: pressure bandage. Apply several layers of gauze over the wound, a dense ball of cotton wool and tightly bandage. This leads to the fact that under the bandage in the vessels, the blood turns into blood clots, which reliably stop the bleeding. Of particular danger are bleeding from large veins of the neck and chest, in which negative pressure is normal. And if they are damaged, air can enter them, which can subsequently cause blockage of the vital vessels of the lungs, heart, brain and lead to death. Therefore, in case of bleeding from large venous vessels, a tight hermetic bandage should be applied. And if the bandage is completely saturated with blood, it should not be removed, another clean one should be applied over it.

arterial bleeding

If the bleeding is small, it is possible to stop it with a pressure bandage. When bleeding from a large artery, finger pressure of the vessel in the wound is used to immediately stop the bleeding for the period of tourniquet preparation. Bleeding is stopped by applying a clamp to the bleeding vessel and a tight tamponade of the wound is carried out with a sterile napkin. The clamp can only be used by a surgeon or an experienced paramedic. Also, for an emergency stop of bleeding, pressure is applied to the artery throughout. The arteries are pressed against the underlying bone formations. Stopping bleeding with finger pressure is only done as a short-term measure.

For a person providing assistance, this method requires great physical strength and patience. However, the method helps to gain time for setting up a more reliable method - tourniquet. The artery is usually pressed with the thumb, palm, fist. The femoral and brachial arteries are most easily pressed.

And so, the methods used to temporarily stop arterial bleeding are as follows:

1) finger pressing of the vessel in the wound;
2) pressing the artery throughout;
3) tight tamponade;
4) application of a tourniquet;
5) circular tug-of-war
6) hemostatic clamp.

How to stop bleeding from the femoral artery?

Simple steps that will save lives when bleeding from the femoral artery:

Signs of bleeding from the femoral artery: bleeding from a wound on the leg, in which a pool of blood increases to 1 m in a matter of seconds.
Immediately press the arteries below the inguinal ligament with a fist, then press with a hard object (for example: a roll of a bandage), through which a tourniquet is applied to the thigh. Attach a note with the time of setting the bandage. Do not remove the tourniquet before the arrival of medical workers, even if their arrival is delayed.
Bleeding from the femoral artery for more than 2-3 minutes leads to death.

With arterial bleeding, not a minute should be lost, as it can be fatal. You need to apply a tourniquet as soon as possible. Learn how to do it right in this article.

The ability to apply a tourniquet helps save a life.

How to apply a tourniquet for arterial bleeding

First of all, you need to make sure that the bleeding is arterial. The blood from the artery is bright, scarlet, flows from the wound profusely, in jerks.

How to apply a tourniquet correctly? It should be higher than the wound and press the artery against the bony prominences.

An ordinary tourniquet looks like a long elastic band. At its ends you can see a hook and a chain. With their help, the tourniquet is fixed.

In order not to damage soft tissues, gauze, bandage or any piece of clean cloth is placed under the tourniquet.

They make several turns around the limb, the first one is as tight as possible, blocking the blood flow, the others are weaker. The tension of the harness must be loosened gradually.

How to determine that the tourniquet was applied correctly? The bleeding must stop. A correctly tightened limb should not have a pulse, the skin becomes very pale. But if it acquires a bluish tint, swelling appears - it means that the tourniquet is applied incorrectly. It is untied and re-imposed, otherwise it may result in the loss of a limb.

It is important to know how long a tourniquet can be applied. It is rather short, in summer time - two hours, in winter - one hour. After this time, the tissues begin to die. Necrotic changes are irreversible, there is a risk of amputation. To prevent this, the exact time of bandaging is recorded. When providing emergency assistance to victims in any accident, you need to write it down on paper and put it under the tourniquet, so that it would be easier for the arriving doctors to navigate.

How to put a tourniquet on the neck

What to do in case of injury to the artery passing through the neck? The matter folded several times is pressed against the wound, a tourniquet is placed on it. On the opposite side, the tourniquet goes through the hand wound behind the head. Since the other side of the neck is not clamped, the blood continues to circulate freely and enter the brain. A tourniquet can also be passed through the armpit.