Signs of stomach bleeding in a child. Bleeding in a newborn: concept and treatment tactics
Internal bleeding is an acute life-threatening condition in which, through a rupture in the vessel wall, blood flows from the bloodstream either into the lumen of a hollow organ (uterus, stomach, lungs) or into a cavity artificially created by the volume of leaked blood (for example, intermuscular space). Such bleeding is never isolated independent disease– but only either a sign or a consequence of the underlying pathological condition.
This pathology often develops as a result of injury or chronic illness. Severe types of such bleeding with large blood loss (more than 1.5 liters) are very dangerous and can be fatal. Bleeding with less blood loss (less than 1.5 liters) is still very serious. Spilled blood can compress nearby vessels, disrupting the function of internal organs, come out through the mouth, for example, with gastric bleeding, and are accompanied by other serious manifestations.
Internal bleeding is called because the spilled blood does not flow outside the body. Therefore, uterine, gastric or intestinal bleeding is not always interpreted as internal; although, given that blood sometimes does not immediately exit through physiological openings - mouth, anus, vagina - it is advisable to classify them as internal.
The general causes, symptoms and treatment of internal bleeding are the same in men and women.
Uterine bleeding is eliminated by a gynecologist, intestinal bleeding by a proctologist, pulmonary bleeding by a thoracic surgeon, post-traumatic bleeding by a traumatologist, and intracranial bleeding by a neurosurgeon.
Late provision of medical care when a person contacts doctors late or has difficulties with differential diagnosis increase the risk to his health, and even life.
Types of internal bleeding
Internal bleeding is classified into many types based on location, cause, time of occurrence, amount of blood loss, etc.
Gastric - into the lumen of the stomach
Gastrointestinal – blood loss into the cavity of the esophagus or other hollow organ
Hemopericardium - filling the pericardial sac with blood
Hemothorax - between the layers of the pleura, i.e. in the slit-like space between the special membranes surrounding each lung
Hemarthrosis – in the joint
Abdominal - into the cavity of the peritoneum, pleura
Explicit – easily determined by visual inspection
Arrosive - when the vascular wall is damaged due to the germination or disintegration of a neoplasm, a destructive or necrotic process (with tissue death)
Diapedetic - with blood leaking through vascular wall for scurvy, scarlet fever, malaria
Severe – blood loss is no more than one and a half liters of blood
Massive – up to 2.5 l
Lethal - from 2.5 to 3 l
Absolutely lethal - over 3–3.5 l
Venous – when the vein wall ruptures
Arterial - from an artery
Mixed - from different vessels
Parenchymal - blood pours out of the vessels parenchymal organ(these are the spleen, liver, lungs, pancreas, kidneys and others - these are internal organs built from solid tissue)
Secondary – some time after the injury. In the first 1–5 days it is considered early, after 10–15 days – late
Causes of internal bleeding
Each type of bleeding has its own causes, the most common of which are injuries and illnesses in acute or chronic form.
- Open and closed injuries of the abdomen and lumbar region with damage or rupture of internal organs, most often the spleen or liver, less often the intestines and pancreas. Massive bleeding in abdominal cavity cause a blow during a fight or during a car accident, compression– when pressed with a heavy object, etc.
- A rib fracture leads to bleeding into the pleural cavity.
- Traumatic brain injury. Bleeding inside the skull is life-threatening because the volume of the skull is limited. Any hematoma leads to compression of brain structures and serious consequences. It can develop not only immediately after an injury, but also several hours or days after it.
- Chronic diseases digestive tract. Bleeding into the cavity of the corresponding organ occurs with varicose veins of the esophagus, erosive gastritis, cirrhosis of the liver, peptic ulcer, malignant tumor process, the formation of a through hole in an ulcer of the duodenum or stomach.
- Gynecological diseases and pathological conditions– apoplexy (rupture) of the ovary, ectopic pregnancy, malignant neoplasm, rupture of an ovarian cyst. In obstetrics and gynecology, uterine bleeding can provoke abortion, previa or premature placental abruption. It can begin after childbirth due to rupture of the birth canal or uterus, late release of the placenta.
- Ruptured aortic aneurysm.
- Hemophilia – hereditary disease men with a malfunction of the blood clotting process.
Symptoms
Symptoms depend on the amount of blood loss and its location. There are general signs and those characteristic of a specific species.
General symptoms of blood loss
General – the appearance of weakness, darkening or clouding of the eyes, drowsiness, dizziness, cold sweat, thirst. Loss of consciousness is possible. The intensity of blood loss is determined by pulse rate, blood pressure and characteristic complaints patient.
- Minor blood loss often does not manifest itself in any way, but for some, the pulse increases slightly and blood pressure (BP) decreases slightly.
- Manifestations of moderate bleeding: heart rate up to 100 beats per minute, decrease in systolic pressure to 80 mmHg. Art., moderate shortness of breath, dry mouth, cold hands and feet, cold sweat, dizziness, severe weakness, slower reactions, fainting.
- With severe blood loss, symptoms are more pronounced. A drop in blood pressure of more than 80 mmHg is noted. Art., tachycardia more than 110 beats per minute, shortness of breath, hand tremors, excruciating thirst against the background of a decrease in the volume of urine excreted, apathy. There may also be a sharp pallor of the mucous membranes and skin, cyanosis of the limbs and the area around the lips, clouding or loss of consciousness.
- Among clinical manifestations massive hemorrhage, blueness of the skin and mucous membranes, confusion, and delirium are observed. The eyeballs sink inward, facial features become sharper, the pulse reaches 160 beats per minute, blood pressure drops to 60 mm Hg. Art.
- With fatal and absolutely fatal blood loss, we are talking about a threat to life. The pupils dilate, convulsions appear, the number of heart beats (bradycardia) sharply decreases to 2–10 beats per minute, breathing becomes agonal, urine and feces are spontaneously released. The patient falls into a coma, his skin is dry, pale with a marbled pattern. The result is agony, death.
Signs of hemothorax
Hemothorax is the entry of blood into the pleural cavity. In addition to general symptoms, it manifests itself as sharp pain in the problem area, difficulty in breathing, cough with foamy bloody sputum. X-ray shows the mediastinum (the space in the middle part chest cavity) is shifted towards the healthy lung.
Signs of uterine bleeding
Symptoms of internal bleeding in women can be pulling, bursting or sharp pains lower abdomen with irradiation to the lower back and anus, the urge to defecate, a feeling of swelling of the mucous membranes.
Signs of hemorrhage in the urinary and digestive organs
- Tar-colored, foul-smelling stool—melena—indicates bleeding from the upper intestine or other digestive organs.
- When there is a hemorrhage in the stomach, a person begins to vomit with bloody clots; into the lumen of the duodenum, it becomes the color of coffee grounds.
- Bleeding from hemorrhoids manifests itself as bright bloody discharge from the anus.
- Blood that gets into the renal area, urinary tract, comes out with urine - hematuria.
For any type of internal blood loss, you should immediately call an ambulance. Although with mild blood loss a person himself can reach medical institution and get help, but it’s better not to risk it, because it’s unknown whether the bleeding has stopped or whether it will get worse general state further or not.
From the correctness of rendering first aid often a person's life depends. Before the doctors arrive, the patient must be laid down; further actions must be carried out only after he has assumed a horizontal position, and in case of hemothorax, a semi-sitting position. Apply ice to the area of the suspected source of the problem, focusing on the complaints. Then, as quickly as possible, transport the victim in this position to the nearest medical facility. institutions or wait for the ambulance to arrive.
It is strictly forbidden to: heat the bleeding area, apply a pressure bandage, insert suppositories, use laxatives, do an enema (for intestinal bleeding), offer painkillers and medications that stimulate the heart.
Neglecting the above steps can lead to increased blood loss and death.
Inpatient medical care
Based on symptoms and primary medical examination, presumably they find out which organ was damaged, and the patient is hospitalized in the appropriate department. If there are objective symptoms of large blood loss, go to intensive care.
Main goals of treatment:
- Stopping bleeding.
- Restoring the lost volume of blood constantly circulating in the body (BCV).
- Normalization of microcirculation.
Often massive blood loss can be stopped by performing emergency surgery:
- in case of a stomach ulcer, its resection is carried out - part of it is removed along with the ulcer;
- for pneumothorax, a thoracotomy is performed - opened chest, find and eliminate the cause of bleeding;
- in case of a hematoma in the cranial cavity, trepanation is performed: through holes made in the bones of the skull, the neurosurgeon gains access to the structures of the brain and the resulting hematoma, from which the blood is sucked out;
- in some cases, internal bleeding can be stopped by performing a tamponade: for example, to tamponade a bronchial tube, a sterile gauze swab or a foam sponge.
To replenish the blood volume, infusion solutions, blood substitutes, and blood products are administered intravenously. The remaining funds are used for their intended purpose.
The prognosis depends on the competent provision of pre-medical and timely medical care.
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What are the symptoms of internal bleeding?
Internal bleeding is a situation in which heme is poured into the body cavities, as well as into the spaces between organs and tissues. Most diseases manifest themselves as pain. With internal bleeding, this symptom is absent, and other signs do not appear immediately. This makes timely diagnosis difficult.
Symptoms of internal bleeding become noticeable only when significant damage has already been caused to the health, posing a great threat to the life of the patient.
Provoking factors
Internal hemorrhage occurs either due to trauma or as a result of a chronic process.
Deadly post-traumatic internal bleeding of the abdomen develops when a blunt injury occurs when the liver or spleen, intestines or omentum are damaged.
In case of rib fractures with injury to the pleura and blood vessels, pleural blood loss occurs.
Craniocerebral injuries make internal bleeding of the skull likely.
Blood in the pleural cavity
Important! Blood entering the joint cavity, which may be caused by a fracture or bruise, does not pose a clear threat to life, but causes significant harm to health.
The causes of chronic internal bleeding are erosion of the walls of blood vessels as a result of the development of neoplasms, chronic diseases such as ulcerative perforations of the intestines, gastra, dilation of the gulam veins, gynecological diseases: ovarium ruptures, ectopic pregnancy, graviditate and genus pathologies.
Symptoms and signs
Common symptoms of intraorgan hemorrhage include:
- weakness and malaise,
- fainting, dizziness,
- excessive paleness of the skin,
- apathy,
- lowering blood pressure,
- tachycardia.
Important! Internal bleeding threatens the possibility of developing a pre-shock state. His harbingers are considered extreme thirst, weakness, state of anxiety. The skin turns pale and cold, the pulse becomes rapid and thready, breathing becomes shallow and uneven.
Specific symptoms arise in connection with the place of bleeding and shedding of blood: into the chambers or into the tissues.
Signs of internal bleeding in the abdominal cavity:
- bloating. It becomes painful, hard;
- blood in feces.
Internal hemorrhage in the urinary organs is detected by the appearance of blood in the urine. When blood accumulates in the heart sac, symptoms of cardiac tamponade, cyanosis, and an increase in venous pressure appear.
The outpouring of blood into the pleural cavity produces compression of the lung, which is detected by shortness of breath and confirmed by the absence of respiratory sounds during auscultation.
The release of scarlet heme from the anus indicates hemorrhoidal inflammation.
Possible bloating with abdominal bleeding
The types and signs of internal bleeding are presented in the table:
Bleeding into the abdominal cavity caused by organ ruptures
2. Specific: “Vanka-Vstanka” sign. If a person lies down, pain in the shoulder appears; if he gets up, the pain disappears. On palpation, abdominal pain is felt.
Bleeding in the pelvis. Ruptures of the uterus and ovarium
1. General: pain, discomfort lower abdomen.
2. Specific: pain on palpation in the area of the pubic bones, with in serious condition"Vanka-Vstanka" sign
Bleeding into the retroperitoneal space,
with kidney ruptures and abdominal region aorta
1. General: dizzy, weakness, low blood pressure, tachycardia, pale, cold skin.
2. Specific: lumbar pain. When you knock on the lower back, the pain intensifies.
Bleeding in the gastric and duodenum
1. General: dizzy, weakness, low blood pressure, tachycardia, pale, cold skin.
2. Specific: vomiting with heme or “coffee sediment”, Brown; bloody diarrhea, feces color black or dark cherry; no pain.
Diagnostic tests
If internal bleeding is suspected, the following general measures are taken:
- Detailed inspection. They check the pulse, blood pressure, listen to the chest, palpate and tap the abdominal cavity.
- Hematological studies.
Specific diagnostic methods are carried out taking into account the preliminary diagnosis:
- rectal examination;
- esophagogastroduodenoscopy;
- colonoscopy;
- bronchoscopy;
- cystoscopy;
- sigmoidoscopy.
In case of hidden hemorrhages, pay attention to general syndrome internal bleeding: dizziness, weakness, hypotension, tachycardia, coldness and pale skin.
Important! An objective sign of blood entering the lung is the disappearance of the lower border of the organ on an x-ray.
When diagnosing bleeding in the abdominal cavity, laparoscopy is used, and intracranial hematoma is identified by echoencephalography.
Echoencephalography of the brain can detect hematomas
Primary care
Important! The main thing is to get the patient to the clinic as quickly as possible. First aid is to ensure peace.
If pulmonary hemorrhage is suspected, the patient is placed in a semi-sitting position. When internal bleeding occurs in other places, before emergency assistance arrives, the patient should be placed on a level surface and cold should be applied to the site of possible bleeding. Do not apply heat or give medications to support the heart.
Methods to stop bleeding
Patients are hospitalized in a hospital. Select a department based on the source of bleeding: traumatology, thoracic, neurosurgical, gynecological or general surgery. The first concern at the first stage is how to stop the bleeding.
The video shows how to provide first aid
In some cases, tamponade helps. In others - cauterization of the bleeding area. However, most often it is required surgery under anesthesia.
If shock from blood loss is observed or the possibility of its occurrence, blood transfusion is performed. If blood flows into the lung area, bronchial tamponade is performed. If hemothorax is observed, a pleural puncture is performed. If bleeding occurs in the abdominal cavity, laparatomy is performed and the liver defect or other damaged organ is sutured.
Intracranial hematoma is cured with craniotomy. If the cause of bleeding is a gastric or duodenal ulcer, gastric resection or vessel suturing and vagotomy are performed.
In case of successful stopping of bleeding, before determining a rehabilitation scheme after blood loss, it is necessary to restore the mass of circulating fluid. This is achieved by administering glucose by stream, saline solution and blood substitutes.
It will also be useful for you to learn about gastrointestinal bleeding on our website.
Prevention of complications
To prevent complications, infusion therapy is used. It is carried out with strict control of blood pressure, cardiac output, and hourly diuresis. The amount of infusion drugs administered is determined based on the volume of blood loss.
- Blood substitutes with hemodynamic properties are used: rheopolyglucin, stabizol or infuctol.
- Saline preparations: saline solution, Ringer's solution.
- Heme preparations: frozen blood serum, erythrocyte biomass, albumin, glucose and other sugars.
To normalize blood pressure in emergency situations, adrenaline and its analogues are used. If necessary, apply antishock therapy. After the threat to life has passed, the balance of basic and acidic elements in the blood is adjusted.
Signs of internal bleeding: symptoms of the condition and treatment
Medical emergencies require special medical supervision. In many critical situations, minutes count, and the patient’s life depends on the qualifications of a medical specialist.
Sometimes the patient himself needs to recognize the signs of a dangerous condition and immediately consult a doctor. A common critical condition after injury is blood loss. Signs of internal bleeding may not be as obvious.
What is internal bleeding?
Internal bleeding is not visible from the outside
From point of view ordinary person internal bleeding describes an outwardly invisible loss of blood. Medical specialists tend to clarify such a term as the source of blood loss and the place of blood accumulation in the body.
Internal bleeding can occur in tissues, organs, or body cavities, including the brain, spinal canal, abdomen, and chest cavity.
Blood loss may be so unnoticed and insignificant that the patient will quickly notice anemia resulting from a constant decrease in the number shaped elements blood.
Open bleeding is quite easy to recognize and stop. An injury or cut is immediately followed by bleeding on the surface of the skin, allowing a person to assess the severity of the injury.
Internal bleeding is much more dangerous, since the victim cannot appreciate the severity of his condition. That is why, after accidents, ambulances take even apparently unharmed people to the hospital for diagnosis.
Internal bleeding itself is associated with damage to an artery or vein. Blood from the vessels forms accumulations in tissues, organs or body cavities. The amount of blood loss depends on the degree of damage and the size of the affected vessels.
The most important and functionally active organs form the most acute bleeding if damaged. These organs include the brain, heart, liver, spleen and kidneys.
Internal bleeding can be associated not only with injury, but also with a chronic disease. Most often, this type of blood loss occurs in the gastrointestinal tract. A person may gradually and continuously lose blood due to a chronic stomach or intestinal ulcer, polyps, or inflammatory pathologies of the large intestine.
Patients taking blood thinners or anti-clotting medications are more likely to experience internal bleeding. The same applies to patients suffering from pathologies of the blood coagulation system.
Main causes of the condition
Signs of internal bleeding
Sometimes it is easy to determine the cause and source of bleeding. Damage from an accident or any other trauma suffered may have characteristic signs indicating the nature of internal bleeding.
Also, diagnosing blood loss is not difficult if the doctor is aware of various pathologies organs that can cause internal bleeding. However, not all cases of internal blood loss are so obvious.
The main cause of bleeding is always the same - damage to the vessel and tissue depositing blood. Vessels can be of different sizes, which affects the severity of bleeding.
Damage main arteries leads to the death of a person in the shortest possible time, and rupture of capillaries can lead to the loss of a small volume of blood.
Basic non-traumatic causes bleeding:
- Inflammation of the vessel walls can lead to minor bleeding. Dissection of large arteries, on the contrary, leads to massive blood loss.
- Insufficiency of blood clotting factors. The human body produces special substances that block bleeding. The lack of these substances leads to frequent bleeding.
- Taking certain medications. Bleeding may occur due to anti-clotting drugs prescribed to fight blood clots.
- Chronically high blood pressure. High pressure weakens the walls of blood vessels and leads to the formation of aneurysms.
- Inherited bleeding disorders. Hemophilia is a genetic pathology in which blood clotting is impaired. Even a minor injury can cause severe bleeding in a patient with this condition.
- Gastrointestinal diseases. Most often, blood loss in the digestive organs occurs due to inflammation and erosion. Typical diseases include colon polyps, colitis, Crohn's disease, gastroenteritis, esophagitis and ulcers.
- Lifestyle factors. Alcohol, drug use and smoking may be associated with chronic blood loss in the stomach.
Causes associated with critical blood loss:
- Injury. Car accidents, falls from heights, fights and other situations can damage organs and associated blood vessels.
- Bone fracture. A closed fracture of large bones can damage the arteries.
- Ectopic pregnancy. This condition can cause massive blood loss.
- Surgical intervention. Massive bleeding is often a consequence of the surgeon’s actions.
There are also private causes of internal bleeding.
Signs of internal bleeding
Cold is indicated for bleeding
Symptoms and manifestations of internal bleeding depend on the source and duration of blood loss. Also an important factor determining the signs of the condition is the area of damage.
When damaged, some organs lose a small amount of blood (thick skin), while others cause massive bleeding (kidneys, liver).
You must also understand that the blood released from the vessel irritates the tissues and causes inflammation and painful sensations.
The main signs of intracranial bleeding:
- Dizziness and weakness.
- Loss of consciousness.
- Paralysis of individual muscles or sides of the body.
- Tingling in arms and legs.
- Expressed sudden headache.
- Difficulty swallowing and chewing.
- Deterioration of vision and hearing.
- Loss of coordination and balance.
- Confused speech.
Internal bleeding resulting from injury or a ruptured aneurysm will primarily manifest itself as an acute pain symptom.
In second place will be psychological and neurological manifestations associated with shock. Subarachnoid bleeding often causes headache and dizziness.
Neurological examination of a patient with such bleeding may reveal conditions ranging from mild confusion to coma. A stroke involving blood leaking into the brain will present with more severe mental and neurological symptoms.
Intra-abdominal bleeding is often almost asymptomatic. Pain in this condition may not be expressed. Patients with this type of internal bleeding often complain of weakness, confusion, difficulty breathing, and dizziness.
Signs of bleeding in the chest or abdominal cavity:
Pain in joints and muscles, difficulty in motor functions may indicate bleeding in the musculoskeletal system.
Other symptoms
Paleness and shock are signs of internal bleeding
Often internal bleeding associated with damage to internal organs causes shock. Shock is a critical state of the body caused by acute disorder functions of the cardiovascular system.
Shock can cause conditions of varying severity - from short-term loss of consciousness to coma. Symptoms of shock include:
- Accelerated heartbeat.
- Low blood pressure.
- Paleness of the skin.
- Neurological disorders: headache, drowsiness, lethargy, stupor.
- General weakness.
The presence of other manifestations will help the doctor determine the source of the bleeding. For example, anemia is usually associated with slow, chronic bleeding in the digestive organs. This condition can cause constant weakness, fatigue and shortness of breath.
Diagnosis and treatment of internal bleeding
Internal bleeding is not always accompanied by pain
Detection of internal bleeding usually requires certain diagnostic procedures, including physical examination, laboratory tests and instrumental methods.
Diagnosis may vary depending on the suspected causes of blood loss. Signs of gastrointestinal bleeding require examination of the digestive organs.
Intracranial bleeding can be confirmed by various types of scans. Basic instrumental diagnostic methods:
The cause of blood loss may not be so obvious. Doctors often need to prescribe several diagnostic procedures to exclude various pathological conditions. Laboratory confirmation, including stool, urine, and blood tests, is often required.
If symptoms indicate critical blood loss, the doctor may have little time to make an accurate diagnosis. In this case, surgical intervention is often necessary, during which the cause of blood loss is determined and its source is discovered.
Treatment of blood loss also depends on its nature. Most often, surgery is required. Unlike open bleeding, internal bleeding is much more difficult to stop without special skills.
This video will familiarize you with the symptoms and signs of stomach bleeding:
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Internal hidden bleeding, i.e. bleeding into closed body cavities, occurs mainly as a result of damage to internal organs (liver, lung, etc.), and blood is not released outside.
There are specific symptoms of internal bleeding, knowledge of which can help timely diagnosis this complex problem.
Such bleeding can be suspected only by changes in the general condition of the victim and by symptoms of fluid accumulation in a particular cavity.
Bleeding into the abdominal cavity is manifested by pallor, weak rapid pulse, thirst, drowsiness, darkening of the eyes, fainting. When bleeding into the chest cavity, these symptoms are combined with shortness of breath.
When bleeding into the cranial cavity, signs of compression of the brain come to the fore - headache, impaired consciousness, breathing difficulties, paralysis, etc.
In modern surgery Special attention given to internal bleeding. This is due to the fact that internal bleeding is much more difficult to diagnose compared to open bleeding. This means that the medical assistance provided may be delayed. Internal bleeding is characterized by the outpouring of blood into the natural cavities of the body or artificially created spaces.
Depending on the amount of blood shed, there are three degrees of bleeding: moderate, moderate and severe.
The main reasons include: rib fractures with rupture of intercostal vessels and damage lung tissue, malignant neoplasms of internal organs, closed damage liver, spleen, intestines, complications of diseases of organs such as the esophagus (with varicose veins), stomach and duodenum, liver, female genitals.
Main signs of internal bleeding:
- Sticky cold sweat
- Pallor
- Shallow breathing
- Pulse is frequent and weak
Signs and symptoms that are not so pronounced and may only become apparent after some time:
- Blue skin discoloration (hematoma formation in the area of injury)
- Soft tissues that are tender, swollen, or hard to the touch
- The victim feels nervous or restless
- Rapid weak pulse rapid breathing, nausea or vomiting, decreased level of consciousness
- Pale skin that feels cool or damp to the touch
- Feeling of unquenchable thirst
- Bleeding from natural orifices of the body (nose, mouth, etc.)
First aid for internal bleeding:
- Provide complete rest
- Place the victim in a semi-sitting position
- Apply ice or cold water
- Urgently transport the victim to a surgical hospital
Frequency of internal bleeding
Most often, bleeding occurs when the gastrointestinal tract is affected. Therefore, it is worth getting acquainted with emergency treatment methods for gastrointestinal bleeding. In total, there are about 20 diseases, the most significant and common among which are: acute erosive gastritis and stomach cancer, varicose veins of the esophagus, cirrhotic liver disease. In the case of stomach cancer, the danger is a disintegrating tumor. The only sign that allows the patient to suspect something is wrong is the darkening of the stool, which occurs due to the coagulated blood contained in it. If vomiting occurs, the vomited masses, again due to coagulated blood, have the color of coffee grounds.
Symptoms of internal bleeding depend on its location and the degree of blood loss. In some cases, it is necessary to distinguish bleeding from the esophagus or stomach from bleeding from a damaged lung. In case of lung pathology, foamy, unchanged scarlet blood is released.
Diseases of the female reproductive system can also cause internal bleeding. The most common cause is tubal abortion. When a fallopian tube ruptures, blood accumulates in the abdominal cavity, creating a feeling of tension and some pressure in the pelvis, especially on the rectum. By the way, bleeding from the anus is also quite common. Subsequently, irritation of the peritoneum occurs with blood, which leads to the development of a state of shock, loss of consciousness, and fainting. The pulse in this case becomes frequent and thread-like. Upon examination, abdominal bloating, stool and gas retention are revealed. The patient becomes pale and covered in cold sweat.
Symptoms of hemothorax (blood in the chest)
How to identify and recognize internal bleeding in the chest? If blood accumulates in the pleural cavity, the so-called hemothorax develops. The pleural cavity is a small space that separates the lungs from the chest. The reasons leading to the development of hemothorax include the following: falls from a height, injuries with damage to the ribs and intercostal vessels, knife wounds, lung cancer, lung abscesses (that is, the formation of abscesses in the lung tissue).
When blood accumulates in the pleural cavity, there is difficulty breathing when inhaling and when coughing, sharp pain in the chest, a disturbance in the general condition - dizziness, weakness, fainting, pallor of the skin, increased heart rate and breathing, sweating. Percussion of the patient's chest reveals a shortening of the percussion sound over the affected half, weakening or complete absence of breathing. On an x-ray, it is possible to determine signs of mediastinal displacement towards the healthy lung.
Hemarthrosis (blood in the joint cavity)
A common joint lesion is the development of hemarthrosis, which means the accumulation of blood in the joint cavity. A similar condition occurs as a result of injury, less often with hemophilia, scurvy. The anemic symptom is expressed insignificantly, in contrast to the local symptoms. The clinic distinguishes three degrees. With grade 1 hemarthrosis, mild pain is noted, the contours of the joint are slightly smoothed, and the range of motion is not changed. In general, the volume of blood in the joint is up to 15 ml. Grade 2 is characterized by severe pain, which intensifies with exercise, and smoothness of the joint is noted. There is an increase in the circumference of the affected joint by 1.5–3 cm compared to a healthy one. In case of hemarthrosis knee joint Balloting of the patella is observed. The blood content in the cavity is up to 100 ml. At grade 3, the pain syndrome is acute, the outlines of the joint are completely changed. The joint's circumference increases to 5 cm, and mobility is severely limited. Blood volume is more than 100 ml.
General symptoms
Thus, there are signs of bleeding that occur in any case, regardless of the source of the bleeding. Early signs include: pallor of the skin and visible mucous membranes, cold sweat, general weakness, dizziness, darkening of the eyes, if the lungs are affected - cough with streaks of blood, if organs are involved in the process digestive system– bloody vomiting or bloody diarrhea, symptoms of peritoneal irritation, which occurs when internal organs (spleen, liver, kidney) rupture. With moderate bleeding, a number of symptoms may be either mild or not appear at all
In other words, bleeding leads to the development of anemia. In addition to the above symptoms, anemia is manifested by increased heart rate and hypotension, that is, a decrease in blood pressure. The changed parameters directly depend on the degree of blood loss: with moderate - pulse no more than 75 beats per minute, systolic pressure drops to 100 mm Hg. Art.; with average - the pulse rises to 100 beats per minute, blood pressure decreases to 100 mHg. Art.; in severe cases, the pulse increases to beats per minute, systolic blood pressure drops below 80 mmHg. Art.
Diagnostics
In case of combined trauma, laparocentesis is performed; it is a simple, fast, affordable and gentle method for diagnosing injuries to the abdominal organs and internal bleeding. An ultrasound of the abdominal organs is also sometimes performed.
An important point in confirming the diagnosis is laboratory research blood. The analysis reveals a decrease in the number of red blood cells, the amount of hemoglobin and a drop in hematocrit.
If such symptoms and diagnostic data are detected, it is necessary to immediately identify the cause of the underlying disease and begin treatment. It should be remembered that the earlier the cause of internal bleeding is identified, the more effective and rapid the recovery process will be.
Internal bleeding is one of the most dangerous types of bleeding, requiring immediate hospitalization.
How to spot internal bleeding
Detecting internal bleeding is very difficult. At the initial stage, its symptoms are very vague and similar to the signs of other diseases. Something is wrong can be suspected when there are severe external injuries, but some chronic diseases also cause a similar condition. The danger is that a person does not always experience pain. However, if urgent measures are not taken, the life of the sufferer will be at risk. How to recognize signs of internal bleeding and how to help before doctors arrive? Read about this later in the article.
Types of internal bleeding and their manifestations
Significant internal blood loss occurs for two reasons:
- mechanical damage to internal organs due to impact, fall from height, work injury or even after a showdown with fists;
- chronic diseases that lead to thinning of the walls of blood vessels and their rupture. In this case, blood fills either a natural cavity (stomach, uterus in women, lungs) or a cavity created by it.
No matter how much blood is poured out, the body strives to push it out. It comes out along with feces, stomach contents, from the internal genital organs in women, and is expectorated with sputum from the bronchi and lungs. However, you should not think that the bleeding will stop on its own; the wound will heal on its own. At the first manifestations of internal blood loss, you should consult a doctor as soon as possible.
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Gastrointestinal
According to doctors, cirrhosis of the liver, ulcers, varicose veins of the stomach or duodenum provoke every third internal bleeding. In this case, you can recognize the problem by vomiting mixed with bloody clots of a dark, almost black color. Another characteristic feature internal bleeding into the digestive organs - stool that resembles tar in color and consistency. It can appear 1–2 or even 9–10 hours after the onset of blood loss.
Cranial
Otherwise, this type of internal bleeding is called a stroke. In this situation, the fluid does not find a way out and accumulates in the skull. Blood clots can only be removed surgically. The danger of blood clots in the brain cannot be underestimated: they can cause complete or partial paralysis, disruption of the functioning of those organs for which the affected area is responsible, and even fatal outcome. In addition to severe head injury, stroke often results from:
- high blood pressure;
- diabetes;
- brain tumors;
- vascular aneurysm;
- encephalitis.
Small pelvis
We are talking about uterine bleeding. It can occur in women for various reasons. Changes in hormonal levels, tumors, ectopic pregnancy, miscarriage, placental abruption during pregnancy, rupture of the uterus or ovaries - all these factors hidden from human eyes provoke internal bleeding. They may open after or during your period. One of the signs of internal bleeding is blood coming out profusely in the form of large dark clots. Accompanied by the process aching pain in the lower abdomen.
In the abdominal cavity
Severe internal bleeding in this area is possible for various reasons:
- ectopic pregnancy;
- tumors;
- low blood clotting.
What makes this type of bleeding special is the fact that a person, experiencing acute pain in the peritoneum, is forced to sit with his knees pulled up to his chest in order to relieve it at least a little. Most often, doctors encounter external mechanical damage:
- abdominal injuries;
- chest injuries;
- ruptures of internal organs: liver, ovaries, spleen.
In the respiratory system
The accumulation of blood in the lungs and its release is associated with complications after certain diseases (tumors in the chest, tuberculosis), with injuries to the ribs, heart and respiratory organs themselves. At the same time, along with typical characteristics, there are also some specific signs:
- The pulse rate decreases noticeably with heart injuries and increases if the lungs are damaged;
- difficulty breathing, lack of oxygen if blood fills the pleural cavity;
- there are chest pains of varying strength;
- characterized by restless behavior, distortion of facial features;
- cough is accompanied by the release of scarlet blood mixed with foam.
Main signs and symptoms
Along with specific ones, experts note numerous general symptoms of internal bleeding, regardless of which specific organ or part of the body is affected. These signs include:
- severe dizziness;
- inability to do daily activities, weakness;
- unnatural pallor of the skin and whites of the eyes;
- apathy, drowsiness, inability to concentrate;
- nausea, vomiting;
- fainting;
- especially severe cases are marked by confusion, inability to adequately perceive and respond to what is happening;
- with injuries incompatible with life, the person falls into a coma.
By some signs you can judge which vessels are damaged. Capillary bleeding is very weak and does not pose any particular danger to life. Parenchymal, in which all channels are involved, is very long-lasting and abundant. Arterial is characterized by the release of bright red blood, and it flows jerkily. The main signs of venous bleeding are the slow, uniform flow of dark-colored blood.
First aid for internal bleeding
It is difficult to determine the source of internal bleeding without examining a doctor. However, if the sufferer is left without help at all, the situation can significantly worsen. A few simple steps will alleviate the victim’s condition and give him a chance for a successful outcome:
- try to provide the victim with peace and maximum possible comfort;
- if, based on some signs, you can assume that internal hemorrhage has occurred in the upper part of the body, make the person recline. Otherwise, lay on your back;
- make sure that the victim moves as little as possible;
- put something cold (a bag of frozen food, cold water, ice cubes) to the area where you think internal bleeding is occurring;
- You should not give the sufferer any medications, drinks other than water, or carry out any procedures. What is necessary in each specific case can only be determined by a specialist;
- do everything so that the doctor arrives as soon as possible.
By watching the video below, you will learn how to properly assist a person suffering from internal bleeding on the street. A professional doctor tells how to competently, armed with the familiar items at hand, relieve a patient’s suffering before the emergency doctor appears. You will learn about the first symptoms of internal bleeding, which will give you a signal to act, because such a problem should never be left to chance.
The information presented in the article is for informational purposes only. The materials of the article do not call for self-treatment. Only a qualified doctor can make a diagnosis and make recommendations for treatment based on the individual characteristics of a particular patient.
is a condition in which blood flows either into a natural cavity of the body (stomach, bladder, uterus, lungs, joint cavity, etc.), or into the space artificially formed by the shed blood (retroperitoneal, intermuscular). Symptoms of internal bleeding depend on its location and the degree of blood loss, usually including dizziness, weakness, drowsiness, and loss of consciousness. Pathology is diagnosed based on external examination data, X-ray results, CT, MRI and endoscopic studies. Treatment - infusion therapy, prompt elimination of the source of bleeding.
ICD-10
K92.2 S27.1 S06.4 O08.1
General information
Internal bleeding is a loss of blood in which the blood flows not outward, but into one of the cavities human body. The cause may be injury or chronic disease. The massive nature of blood loss, late seeking of help by patients and diagnostic difficulties in identifying this pathology increase the seriousness of the problem and turn internal bleeding into serious threat for the lives of patients. Treatment is carried out by specialists in the field of clinical traumatology, abdominal and thoracic surgery, neurosurgery, vascular surgery.
Causes
The cause of internal bleeding can be either injury or some chronic diseases. Massive, life-threatening post-traumatic bleeding into the abdominal cavity can develop as a result of blunt trauma to the abdomen with damage to the spleen and liver, less commonly the pancreas, intestines or mesentery (due to an impact, a fall from a height, a car accident, etc.). Bleeding into the pleural cavity usually occurs with multiple rib fractures with damage to the intercostal vessels and pleura. In isolated cases, it is caused by fractures of 1-2 ribs.
Bleeding into the cranial cavity is one of the dangerous complications of traumatic brain injury. Since the skull, unlike other natural cavities, has a strictly fixed volume, not even a large number of spilled blood causes compression of the brain structures and poses a threat to the patient’s life. It should be borne in mind that intracranial bleeding can develop not only immediately after injury, but also several hours or even days later, sometimes against the background of complete well-being.
Bleeding into the joint cavity can be caused by both an intra-articular fracture and a bruise. It does not pose an immediate threat to life, but if left untreated it can lead to serious complications.
A significant proportion of the total amount of internal bleeding consists of bleeding into the cavity of an organ that develops as a result of chronic diseases gastrointestinal tract: malignant tumors, peptic ulcers of the stomach and intestines, erosive gastritis, varicose veins of the esophagus with cirrhosis of the liver, etc. In surgical practice, Mallory-Weiss syndrome is also often encountered - cracks in the esophagus due to alcohol abuse or a single large meal.
Another fairly common cause of internal bleeding is gynecological diseases: ovarian ruptures, ectopic pregnancy, etc. In gynecological practice, internal bleeding occurs after abortion. Internal bleeding is also possible with placenta previa or premature abruption, postpartum bleeding with retained placenta, rupture of the uterus and birth canal.
Classification
There are several classifications of internal bleeding:
- Taking into account the cause of occurrence: mechanical (due to damage to blood vessels during trauma) and arrosive (due to damage to the vascular wall during necrosis, germination and disintegration of a tumor or destructive process). In addition, there are diapedetic bleedings that occur due to increased permeability of the walls of small vessels (for example, with scurvy or sepsis).
- Taking into account the volume of blood loss: light (up to 500 ml or 10-15% of the circulating blood volume), moderate (500-1000 ml or 16-20% of the bcc), severe (1000-1500 ml or 21-30% of the bcc), massive (more than 1500 ml or more than 30% of the bcc), fatal (more than 2500-3000 ml or more than 50-60% of the bcc), absolutely fatal (more than 3000-3500 ml or more than 60% of the bcc).
- Taking into account the nature of the damaged vessel: arterial, venous, capillary and mixed (for example, from an artery and vein or from a vein and capillaries). If blood flows from the capillaries of any parenchymal organ (liver, spleen, etc.), such bleeding is called parenchymal.
- Taking into account localization: gastrointestinal (into the cavity of the esophagus, stomach or intestines), into the pleural cavity (hemothorax), into the pericardial sac (hemopericardium), into the joint cavity, etc.
- Taking into account the location of the accumulation of spilled blood: abdominal (into the pleural, abdominal and other cavities) and interstitial (into the thickness of tissues with their impregnation).
- Taking into account the presence or absence of obvious signs of bleeding: obvious, in which the blood, even after some time and in a changed form, “comes out” through natural openings (for example, turning the stool black), and hidden, in which it remains in the body cavity.
- Taking into account the time of occurrence: primary, occurring immediately after traumatic damage to the vascular wall, and secondary, developing some time after the injury. In turn, secondary bleeding is divided into early (develops on days 1-5 due to the slipping of the ligature or pushing out of a blood clot) and late (usually occurs on days 10-15 due to purulent melting of the blood clot, necrosis of the vessel wall, etc.) .
Symptoms of internal bleeding
General early signs This pathology includes general weakness, drowsiness, pale skin and mucous membranes, dizziness, cold sweat, thirst, darkening of the eyes. Fainting is possible. The intensity of blood loss can be judged both by changes in pulse and blood pressure, and by other clinical signs. With low blood loss, there is a slight increase in heart rate (up to 80 beats/min) and a slight decrease in blood pressure, in some cases clinical symptoms may be missing.
Moderate internal bleeding is indicated by a drop in systolic pressure to 90-80 mm. rt. Art. and increased heart rate (tachycardia) up to 90-100 beats/min. The skin is pale, there is coldness in the extremities and a slight increase in breathing. Possible dry mouth, fainting, dizziness, nausea, adynamia, severe weakness, slow reaction.
In severe cases, a decrease in systolic pressure to 80 mm is observed. rt. Art. and lower, increased heart rate to 110 or higher beats/min. There is a strong increase and disturbance in the rhythm of breathing, sticky cold sweat, yawning, pathological drowsiness, tremors of the hands, darkening of the eyes, indifference, apathy, nausea and vomiting, a decrease in the amount of urine excreted, excruciating thirst, blackouts, severe pallor of the skin and mucous membranes, cyanosis limbs, lips and nasolabial triangle.
With massive internal bleeding, the pressure drops to 60 mm Hg. Art., there is an increase in heart rate to 140-160 beats/min. Characteristic periodic breathing(Cheyne-Stokes), absence or confusion of consciousness, delirium, severe pallor, sometimes with a bluish-gray tint, cold sweat. The look is indifferent, the eyes are sunken, the facial features are pointed.
With fatal blood loss, coma develops. Systolic pressure drops to 60 mmHg. Art. or not determined. Agonal breathing, sharp bradycardia with a heart rate of 2-10 beats/min, convulsions, dilated pupils, involuntary release of feces and urine. The skin is cold, dry, “marbled”. Then comes agony and death.
Treatment of internal bleeding
It is necessary to ensure that the patient is transported to a specialized care unit as quickly as possible. The patient needs to be kept at rest. If hemothorax is suspected or pulmonary hemorrhage the patient is given a semi-sitting position; in case of blood loss in other areas, the patient is placed on a flat surface. Apply cold (such as an ice pack) to the area of suspected bleeding. It is strictly forbidden to heat the painful area, give enemas, give laxatives or introduce drugs into the body that stimulate cardiac activity.
Patients are hospitalized in a hospital. The choice of department is made taking into account the source of internal bleeding. Treatment of traumatic hemothorax is carried out by traumatologists, non-traumatic hemothorax and pulmonary hemorrhages are carried out by thoracic surgeons, intracranial hematomas– neurosurgeons, uterine bleeding – gynecologists. In case of blunt abdominal trauma and gastrointestinal bleeding, hospitalization is carried out in the general surgery department.
The main tasks in this case are to urgently stop internal bleeding, compensate for blood loss and improve microcirculation. From the very beginning of treatment, to prevent empty heart syndrome (reflex cardiac arrest due to a decrease in the volume of bcc), restore the volume of circulating fluid and prevent hypovolemic shock, a jet transfusion of a 5% glucose solution, saline solution, blood, plasma and blood substitutes is performed.
Sometimes internal bleeding is stopped by tamponade or cauterization of the bleeding area. However, in most cases, emergency surgery under anesthesia is required. If there are signs of hemorrhagic shock or the threat of its occurrence at all stages (preparation for surgery, surgery, the period after surgery), transfusion measures are carried out.
Internal bleeding due to ectopic pregnancy is an indication for emergency surgical intervention. In case of dysfunctional uterine bleeding, tamponade of the uterine cavity is performed; in case of massive bleeding due to abortion, birth trauma, and after childbirth, surgical intervention is performed.
Infusion therapy is carried out under the control of blood pressure, cardiac output, central venous pressure and hourly diuresis. The volume of infusion is determined taking into account the severity of blood loss. Blood substitutes with hemodynamic action are used: dextran, rheopolyglucin, solutions of salts and sugars, as well as blood products (albumin, fresh frozen plasma, red blood cells).
Causes of gastrointestinal bleeding in children
Hemorrhagic disease of the newborn characterized by spontaneous prolonged bleeding from the gastrointestinal tract, which appears between 2-5 days after birth. The disease is associated with prothrombin deficiency due to insufficiency or absence of vitamin K, which is formed in the intestine in the presence of a stabilized bacterial flora. The most common clinical manifestation of the disease is neonatal melena. The cause of these bleedings is most often erosion of the mucous membrane of the stomach and duodenum. The clinical picture is characterized by large amounts of bloody bowel movements 3-4 times a day.
Esophagitis. The most common cause of esophagitis in newborns and infants Reflux esophagitis occurs due to regurgitation of gastric contents. It is observed in children with achalasia, shortening of the esophagus, and hiatal hernia. The initial symptom is vomiting, often mixed with blood. Frequent entry of gastric juice into the esophagus causes the development of ulcers in it, which are a source of bleeding.
Gastritis- inflammation of the gastric mucosa. Idiopathic ulcerative gastritis has been described in newborns, which progresses rapidly and can result in perforation of the stomach wall. The most likely causes of ulcerative gastritis are stress lesions of the digestive tract due to asphyxial or hypoxic conditions in the newborn. There are three mechanisms for the occurrence of stress stomach ulcers and gastrointestinal bleeding in children.
Firstly, any hypoxic condition of the newborn leads to an increase in the level of catecholamines, which cause vascular spasm and ischemia of the gastric mucosa. Insufficient blood supply to the gastric mucosa is especially dangerous because it is exposed to digestive juices.
Secondly, glucocorticoids, prostaglandins and serotonin play an important role in stress gastric ulceration; their levels increase under stress.
Thirdly, coagulopathy, which develops especially often in toxic conditions, is of great importance in the occurrence of stress ulcer bleeding.
In the neonatal period, in 50% of cases, ulcers are localized in the stomach, in 20% - in the duodenum, and in 30% - combined damage to the duodenum and stomach. At the age of 2 weeks to 1 year of life, gastric ulcers account for 15%, duodenal ulcers - 56 %.
Duplication of the stomach may be in the form of a cyst or be tubular in shape. These formations are lined with gastric or intestinal epithelium, are rarely represented by pancreatic tissue and are prone to ulceration and bleeding. Another cause of bleeding may be retention of gastric contents with the development of an inflammatory process and ulceration.
Incomplete intestinal rotation with obstruction. The combination of compression of the duodenum by the cecum or cords coming from it with volvulus of the midgut is called Ladd syndrome. The cause of bleeding in this pathology is intestinal infarction due to impaired blood supply during midgut volvulus.
Necrotizing ulcerative enterocolitis of newborns. Under stressful conditions, a redistribution of blood occurs, an increase in its volume in vital organs and a decrease in other organs, in particular the intestines.
Macroscopically, intestinal bloating is noted, the mucous membrane in the early period of the lesion looks sharply thickened, dark red in color in more late stages the mucous membrane becomes gray-dirty with single and multiple ulcerations."
Clinically, newborns exhibit flatulence, regurgitation, vomiting, watery stool mixed with mucus, greenery and blood.
Doubling small intestine occurs more often than duplication of other parts of the digestive tube. Duplications are located on the mesenteric edge or lateral wall of the intestine
Clinical symptoms with duplication of the small intestine are caused by compression of the lumen of the main tube, disruption of its blood supply and pathological changes in the wall of the adjacent intestine or duplication, and inflammation of the peritoneum. One of the most common complications of small intestinal duplication is bleeding, which can be massive.
Mallory-Weiss syndrome- this is damage to the mucous membrane of the gastroesophageal junction due to increased vomiting or blunt trauma. This disease is rare in children but can develop at any age. Repeated severe vomiting leads to ruptures of the gastric mucosa and subsequent release of blood in the vomit.
Hiatal hernia There are two types: esophageal, in which the esophagus moves upward along with the cardiac part of the stomach, and paraesophageal, when the stomach moves upward, but the esophagus remains fixed. In this case, the clinical picture of vice hernias is dominated by signs caused by deformation and trauma of the stomach in the hernial orifice. One of the leading symptoms include vomiting blood. Hemorrhagic syndrome is characterized as “esophageal ring syndrome.” The origin of bleeding and anemia is associated with the reflux of acidic gastric contents into the esophagus and the bending of the stomach in the esophageal ring. As a rule, chemical and mechanical influences are combined with injury to the nerve trunks, which leads to degenerative processes not only in the mucous membrane, but also in the deeper tissues of the esophagus and stomach.
In the group from 1 to 3 years old, the most common causes of gastrointestinal bleeding in children from the upper gastrointestinal tract are peptic ulcers of the stomach and duodenum.
In this age group, ulcerative lesions of the stomach and duodenum differ in clinical course from ulcers in older children. They are usually sharp and very difficult. Their beginning is always acute. The ulcerative defect penetrates the muscle layer, affecting the integrity of the blood vessels, which leads to massive bleeding and perforation of the organ. Majority peptic ulcers in children are associated with stress, especially traumatic stress. The literature describes ulcers that occur in children as a result of burn injury(Curling's ulcers), traumatic brain injury (Cushing's ulcers).
The cause of gastrointestinal bleeding in children from lower sections The gastrointestinal tract at the age of 1 to 3 years serves intestinal polyps. More than 90% of all cases of colon polyps in children are juvenile (hamartoma) polyps. Hamartoma polyps are nodular formations that arise due to disruption of the embryonic development of colon tissue. The favorite localization of juvenile polyps is the rectum and sigmoid colon. The size of polyps ranges from a few millimeters to 3 cm. Their surface is covered with mucus and bleeds easily when injured by dense feces. Polyps can also ulcerate and lead to bleeding with the development of hypochromic anemia. A serious complication is twisting of the polyp stalk, followed by necrosis and bleeding. A generalized form of juvenile gastrointestinal polyps, characterized by diarrhea, bleeding, hypoproteinemia, swelling and ascites in children under 2 years of age, in 100% of cases it ends in death.
Meckel's diverticulum- protrusion of the wall of the lower third of the ileum, which is a remnant of the incompletely reduced vitelline duct. In 40% of all cases of complications of Meckel's diverticulum, heavy gastrointestinal bleeding is detected in children under 2 years of age. Up to 85% of the cause of bleeding is ectopia of the gastric mucosa and much less often - ectopia of the tissue of the pancreas and duodenum. Ulcers, as a rule, form at the border of the ectopic and normal mucosa. Meckel's diverticulum is characterized by repeated bleeding at regular intervals. Heavy repeated bleeding often leads to anemia in the child.
Dieulafoy's disease- a genetically determined anomaly in the development of submucosal vessels with the presence of erosion of an unusually large artery, the formation of an acute ulcer with massive gastrointestinal bleeding in children.
Among all bleedings in children from the upper gastrointestinal tract, Dieulafoy's disease is the rarest etiological factor, amounting to 0.3%. The most likely cause of the disease is a violation of angiogenesis with the formation of a pronounced vascular anomaly of the submucosal membrane of the stomach in the form of dilatation of the arteries.
At illnesses Dieulafoy is characterized by the localization of the pathological process in the proximal stomach, on back wall along the lesser curvature (80% of all cases).
Clinically, the disease is characterized by a sudden onset with no abdominal pain and massive gastric bleeding. Recurrent gastric bleeding is observed in 15-100% of patients, which is a distinctive feature of this pathological process.
In children over 3 years of age, the most likely cause of gastrointestinal bleeding from the upper GI tract is varicose veins of the esophagus. In 85% of children, bleeding from the veins of the esophagus occurs at the age of 5-10 years, and is one of the most common clinical manifestations portal hypertension syndrome.
The cause of bleeding from varicose veins of the esophagus is their rupture due to a hypertensive crisis in the portal system, pathological (erosive and ulcerative) changes in the mucous membrane of the stomach and esophagus, or a disorder of the blood coagulation system,
Clinical practice shows that the precursors of bleeding are signs of a sharp deterioration in the condition: weakness increases, pallor of the skin and mucous membranes becomes noticeable, thirst, dry mouth, and icterus of the sclera appear. Tachycardia increases, pulse filling decreases, and blood pressure drops. The absolute symptom of bleeding is vomiting of scarlet blood or “coffee grounds.” Vomiting of scarlet blood indicates massive bleeding from the veins of the cardiac region. The gag reflex is caused by rapid filling of the stomach. That is why vomit contains unchanged blood.
After a few hours, tarry stools appear. With profuse gastrointestinal bleeding in children, stool in the form of “raspberry jelly” may appear within the next few minutes. This depends on the severity of the gag reflex and the rate of blood flow into the intestines.
Eosinophilic gastroenteropathy- a chronic relapsing disease in which eosinophils form large cell inflammatory infiltrates in the gastrointestinal tract.
Clinical manifestations depend on the extent of eosinophilic infiltration (diffuse or local type) and the depth of organ damage (mucous, muscular or serous membranes). The entire digestive tract can be affected, but the stomach and small intestine are most often affected. Involving e pathological process the mucous membrane of the stomach or small intestine is accompanied by bleeding. Eosinophilic infiltration of the muscularis propria may cause strictures of the viscus. The allergic nature of the disease accounts for up to 70% of all cases; in particular, the role of food allergies is considered, as well as high sensitivity to immunoglobulin E).
Clinical symptoms of eosinophilic gastroenteropathy may include vomiting, pain in the abdomen, retardation in physical development, frequent loose stools mixed with blood, anemia and hypoproteinemia.
Gastrointestinal bleeding in children with Peutz-Jeghers syndrome occurs in 19% of patients aged 10-15 years. Peutz-Jeghers syndrome(intestinal polyposis) is a congenital hereditary disease that is characterized by multiple polyps in the small (sometimes large) intestine and finely spotted brown pigmentation of the mucous membrane of the mouth, skin, lips, and eyelids. Polyps are regarded as hamartomas of the intestinal wall, containing all elements of the intestinal mucosa. The cause of bleeding is torsion of polyps with the development of infarctions and ulceration of the intestinal mucosa.
Familial polyposis colon characterized by the proliferation of the mucous membrane of the colon with the formation of multiple adenomatous polyps with a stalk. Some patients have lymphoid hyperplasia of small intestinal follicles and lymphoid polyps of the colon. 5% of untreated children develop adenocarcinoma by age 5
Gardner's syndrome is a type of familial adenomatous polyposis of the colon in combination with subcutaneous tumors, epidermoid and sebaceous cysts, bone tumors of the jaws and skull bones.
The cause of bleeding in children from the lower digestive tract may be Tarcott syndrome - a variant of familial adenomatous polyposis of the colon and a malignant tumor of the central nervous system- medulloblastomas. This is a tumor of undifferentiated neuroectodermal embryonic stem cells that have a dual potential for differentiation towards neural and glial elements,
Non-specific ulcerative colitis- a disease of the colon, which is based on inflammation of the intestine with suppuration, ulceration and sclerotic scarring. Children make up about 10% of the total number of patients and 5% of patients under 10 years of age.
The clinical picture of ulcerative colitis is manifested by increased frequency of stools that are bloody and mucous in nature, cramping abdominal pain, periodic increases in body temperature, and decreased appetite. Characteristic signs are general weakness, anemia, exhaustion, and delayed physical development.
Macroscopically, the mucous membrane of the colon is full-blooded, edematous, with multiple superficial and deeper ulcers that merge with each other and form extensive ulcerative fields. Between the ulcers there are pseudopolyps - areas of preserved edematous mucous membrane.
Vascular malformations of the gastrointestinal tract are rare causes of gastrointestinal bleeding in children. However, they should be taken into account in the differential diagnosis of diseases that cause bleeding. In accordance with the existing classification, two groups of vascular pathologies of the gastrointestinal tract are considered: hemangiomas and vascular malformations.
Hemangiomas are vascular tumors characterized by rapid growth, endothelial hyperplasia, an increased number of mast cells, and are considered vascular malformations that do not undergo reverse development.
Vascular malformations usually appear from the moment the child is born and grow in proportion to his growth. Morphologically, they are characterized by the presence of embryonic rudiments of capillary, arterial, venous and lymphatic vessels. All congenital vascular malformations can be divided into venous, arteriovenous malformations, aneurysms and lymphatic malformations.
Venous malformations of the gastrointestinal tract can present in the form of phlebectasias. Clinically, they manifest as acute or chronic bleeding, most often from the small intestine. Venous malformations in the rectal area may be manifested by the leakage of fresh blood.
Arteriovenous malformations are pathological communications between arteries and veins and can be a source of acute or chronic bleeding from the intestine. Multiple intestinal lesions due to arteriovenous malformations are combined with Randu-Osler-Weber syndrome,
Gastrointestinal aneurysms usually occur with Menkes syndrome, which is characterized by weakness of the vascular wall due to impaired copper absorption. Up to 25% of vascular malformations of the gastrointestinal tract occur in children of the first year of life and manifest themselves as a clinical picture of acute or chronic gastrointestinal bleeding.
Emergency care for children with bleeding
Blood is a unique liquid tissue, the quantity of which is strictly limited. The blood volume of a newborn child is 500 ml, an adult’s is about 5 liters, and every drop of this volume is priceless. Any blood loss is not indifferent to a person: small bleeding is stress for the body, massive bleeding is a threat to life and health. Bleeding is especially difficult for children and adolescents - it is for them that even a relatively small loss of blood can turn into a big disaster. How not to miss bleeding in a child and stop it correctly? Let's find out...
The cause of bleeding is a violation of the integrity of a blood vessel - an artery, vein or capillary. Moreover, damage to the vessel does not necessarily result from injury or injury - the cause of bleeding can be the rupture of the vessel under the influence of high blood pressure(nosebleeds), damage to blood vessels by a growing tumor, exposure to medicines (gastrointestinal bleeding). The amount of blood loss depends on the type and caliber of the vessel (bleeding from arteries is more abundant than bleeding from veins and capillaries), as well as on the duration of blood loss. Sometimes damage to a relatively small vessel leads to the development of anemia and other severe complications due to late detection of bleeding. The nature of first aid for bleeding depends on the location of the bleeding vessel (external or internal bleeding), the type of vessel (artery, vein, capillary, vessels of internal organs) and the intensity of blood loss. It is always easier to recognize and stop external bleeding than internal bleeding, since with internal bleeding, blood is usually not visible, only symptoms of blood loss are visible.
Capillary bleeding . The most common cause of capillary bleeding is minor injuries - cuts, scratches and abrasions. For an adult, such an injury and the associated bleeding are insignificant, and they are not always paid attention to. But for a child’s body there are no insignificant injuries and bleeding - therefore, even in such a “frivolous situation”, first aid should be provided to the victim.
First aid.
Regardless of the location, the abrasion is washed with hydrogen peroxide, the skin around the wound is treated with an antiseptic (iodine, brilliant green) and a sterile napkin is pressed against the wound for a while to stop bleeding. If the abrasion is localized on the skin of the abdomen, chest or head, it is necessary to exclude internal bleeding, damage to the brain and internal organs - for this, the child must be shown to a specialist.
Venous bleeding . As the name suggests, this type of bleeding occurs when the veins are damaged. For those who don’t know: veins are vessels that carry blood from internal organs and different parts body to heart. Venous blood is poor in oxygen and rich in carbon dioxide, which is why its color is dark red. The blood pressure in a vein is relatively low (much less than the pressure in an artery), so deoxygenated blood relatively slowly flows out of the vessel, spreading over the skin. However, this does not mean that venous bleeding is harmless - if damaged large vein blood loss can reach life-threatening levels within a few minutes.
First aid.
The most in a simple way stopping venous bleeding is pressure on the damaged vessel - as a result, the vein is pinched, the bleeding decreases or stops. You need to apply pressure to the bleeding vein and, accordingly, the wound, with a sterile napkin or a roll of a sterile bandage; in the absence of which, you can use a clean handkerchief or any other piece of clean cloth. If there is no other way out, you can apply pressure to the wound with your palm or fingers. Pressing the vessel to stop bleeding can only be used as a temporary measure - a pressure bandage should be applied to the wound as soon as possible.
Starting to apply a pressure bandage, take several sterile napkins or a roll of sterile bandage, press them tightly to the wound and, without releasing the pressure, firmly bandage it to the body with several tight rounds of bandage. If the bandage is applied correctly, bleeding significantly decreases or stops.
As additional measures to stop venous bleeding from the vessels of the limb, temporary clamping of the vessel below (!) the wound and elevated position of the limb are used.
If the veins of the neck are damaged, applying a conventional pressure bandage is impossible, since such a measure threatens suffocation. In this situation, the child’s hand on the side opposite to the location of the wound is tilted upward, towards the head, and a pressure bandage is applied to the neck, grabbing the hand on the healthy side and using it as a support.
Even if actions to stop venous bleeding are completely successful, the child must be shown to a doctor. To prevent wound infection and recurrent bleeding, the doctor will clean the wound and apply stitches.
Arterial bleeding . Arterial bleeding is the most dangerous look bleeding. It is characterized by the bright scarlet color of the blood, the release of blood from the wound under pressure (a pulsating stream or fountain), rapid rates of blood loss and a high risk of developing shock. Most often, arterial bleeding accompanies injuries to the extremities, including limb avulsion.
First aid.
You need to act quickly and clearly - the rate of blood loss during arterial bleeding They don't give you time for a second try. The first step is to lift and strongly squeeze the limb above (!) the wound - you will have to press really hard, since the arteries are located deep in the tissues and are protected by muscles. If you are injured in the lower leg, foot, forearm or hand, maximum flexion of the leg or arm at the knee or elbow joint and fixing the limb in this position. While continuing to apply pressure on the artery, apply a pressure bandage according to the same rules as for venous bleeding(usually the second rescuer applies the bandage).
After the bandage is applied, we gradually reduce the pressure on the vessel and see what happens. If the bandage remains dry or the amount of blood on it does not increase, measures to stop the bleeding were successful; further actions are up to the doctor. If after applying a pressure bandage the bleeding does not stop, it is necessary to apply a hemostatic tourniquet. The purpose of applying a tourniquet is to press the affected vessel to the bone, so the tourniquet is applied to that part of the limb where there is one bone - the thigh, the shoulder. There is no point in applying a tourniquet to the lower leg or forearm - the vessel will not be crushed and bleeding will continue.
When an artery is injured, a tourniquet is always applied above the injury site. The pressure must be sufficient, but not excessive, otherwise traumatic damage to the nerves will occur, and as a result, dysfunction of the limb. The tourniquet on the limb is tightened until the pulse disappears in the wrist or foot (provided that you can determine the pulse) or until bleeding from the damaged vessel stops. Any long, strong and elastic object can act as a tourniquet - a wide rope, a trouser belt, a belt, a tie, a headscarf. It is not recommended to apply a tourniquet to a naked body - be sure to place any cloth, towel, or piece of clothing under it. After applying the tourniquet, record the time of application - the time factor in this case is very important. The tourniquet should not compress the limb for a long time, as this can lead to irreversible changes in the tissues of the limb. In winter, the safe period does not exceed 30 minutes, in summer – 1.5 hours. In this case, regardless of the time of year, every 15 minutes the pressure of the tourniquet must be slightly loosened until blood circulation is restored, and then tightened again.
Typically, the application of a hemostatic tourniquet is required in following situations: traumatic amputation (severance) of a limb; a large number of victims and there is no time to use other methods of stopping bleeding; the injury to the limb is so significant that it is impossible to determine the type of bleeding; other methods of stopping bleeding are ineffective.
After the bleeding has stopped, while waiting for the ambulance to arrive, the victim must be laid down, if he is conscious, calmed down, warmed up and given hot tea. To maintain normal blood supply to the brain and internal organs, it is recommended that victims with a large volume of blood loss be placed on their back, without a pillow, with their legs elevated 115-20 cm. If your arm is injured, make sure that the injured limb is also in an elevated position.
Let's say a few words about the features of providing assistance to a child with life-threatening traumatic amputation (severance) of a limb or some part of the body. First aid measures in such a situation boil down to stopping the bleeding using any available methods: compression of large vessels supplying blood to the affected area of the body, application of a pressure bandage or hemostatic tourniquet. A sterile bandage is applied to the wound, and the limb is fixed. After the patient’s condition ceases to cause concern, it is imperative to find the severed part of the body so that microsurgeons can subsequently sew it back (this is especially important for children and adolescents). The severed body part (amputate) must be cleaned of visible contaminants or washed, a sterile bandage must be applied to the tear site, and the amputate must be placed in a plastic bag, which must be placed in another bag filled with ice, snow, and cold water. Such measures will keep the tissue viable for approximately 18 hours. Be sure to include a note in the first bag indicating the exact time of injury and the start of cooling. Do not freeze the rejected part in the refrigerator or freezer.
Internal bleeding, bleeding from internal organs . Internal bleeding can be caused by damage to vessels located outside the organs or damage to the internal organs themselves. Most often, internal bleeding accompanies injuries to the abdomen, lower back, chest and head, but can also be a complication of certain diseases - erosive gastritis, peptic ulcer of the stomach and duodenum (gastrointestinal bleeding), pulmonary tuberculosis (pulmonary bleeding). Common symptoms of internal bleeding are weakness, rapid heartbeat, cold sticky sweat, impaired consciousness, pallor, pain at the site of the damaged vessel (not always). When bleeding into the abdominal cavity, the child takes a forced position - lying on his side with his knees bent and his legs pressed to his stomach. When bleeding into the lumen of the gastrointestinal tract, vomiting blood appears (vomit may be red or brown due to contact of blood with gastric juice) and bloody diarrhea (usually black). Bleeding into the pleural cavity is accompanied by compression of the lung, which is manifested by shortness of breath, blue lips, the child tries to take a sitting or semi-sitting position. A symptom suspicious for kidney damage is the appearance of blood in the urine.
First aid.
First of all, the child must be ensured peace - try not to move the victim unless absolutely necessary. If there is a chest injury, help the child take a semi-sitting position; if there is an abdominal injury and gastrointestinal bleeding is suspected, help the child take a supine position. Place cold on the site of injury - chest, abdomen or lower back - and do not give water or food to the child. Provide access fresh air and at the same time, keep the baby warm. Ambulance should be called immediately after injury - than more like a child receives qualified help, the greater his chances of recovery.
Nose bleed . The causes of nosebleeds are injuries, diseases of the nose (deviated nasal septum, polyps, tumors) and systemic diseases(arterial hypertension). Nosebleeds often occur suddenly and can vary in intensity and duration.
First aid.
The child must be seated, tilt his head forward, press his nostrils with his fingers, put cold on the bridge of his nose and leave in this position for 10 minutes. You cannot force a child to throw back his head - blood from the nose can get into the larynx and trachea, which is undesirable. If listed activities did not stop the nosebleed or after some time the bleeding recurred - immediately show the child to the doctor.
Hemoptysis . Hemoptysis is the release of blood with or without sputum during a cough. The most common causes of hemoptysis are pulmonary tuberculosis, bronchitis, pneumonia, tumors of the respiratory system, foreign bodies entered the respiratory system. The basis of hemoptysis is pulmonary hemorrhage, so hemoptysis is often accompanied by typical signs blood loss: weakness, drowsiness, pale skin, cold sweat, rapid heartbeat, shortness of breath.
First aid.
When helping a child with hemoptysis, it is necessary to sit him down, calm him down, and provide access to fresh air. A heating pad with ice should be placed on the chest, and at the same time, the child should be allowed to drink cold water in small sips or swallow very small pieces of ice. In this case, an early consultation with a doctor is vital.
Finally
Heavy bleeding is the most dangerous situation, which only a child can get into, and all hope in this case is on the adult closest to the place of injury. Massive external bleeding usually makes a strong impression on others, and despite this, it is necessary to act quickly and clearly. Do not panic under any circumstances and remember that the life of a wounded child depends on your actions in the next few minutes. Take care of your health!
Article publication date: 06/08/2017
Article updated date: 12/21/2018
From the article you will learn: what internal bleeding is, why it is dangerous and by what signs it is recognized. Types of internal bleeding and first aid algorithm.
Internal bleeding is an acute life-threatening condition in which, through a rupture in the vessel wall, blood flows from the bloodstream either into the lumen of a hollow organ (uterus, stomach, lungs) or into a cavity artificially created by the volume of leaked blood (for example, intermuscular space). Such bleeding is never an isolated independent disease - but only either a sign or a consequence of the underlying pathological condition.
This pathology often develops as a result of injury or chronic illness. Severe types of such bleeding with large blood loss (more than 1.5 liters) are very dangerous and can be fatal. Bleeding with less blood loss (less than 1.5 liters) is still very serious. Erupted blood can compress nearby vessels, disrupt the functioning of internal organs, escape through the mouth, for example, during stomach bleeding, and be accompanied by other serious manifestations.
Internal bleeding is called because the spilled blood does not flow outside the body. Therefore, uterine, gastric or are not always interpreted as internal; although, given that blood sometimes does not immediately exit through physiological openings - mouth, anus, vagina - it is advisable to classify them as internal.
The general causes, symptoms and treatment of internal bleeding are the same in men and women.
The elimination is carried out by a gynecologist, intestinal - by a proctologist, pulmonary - by a thoracic surgeon, post-traumatic - by a traumatologist, intracranial - by a neurosurgeon.
Untimely provision of medical care when a person contacts doctors late or difficulties with differential diagnosis increase the risk to his health, and even life.
Types of internal bleeding
Internal bleeding is classified into many types based on location, cause, time of occurrence, amount of blood loss, etc.
| Bleeding categories | Types, description |
|---|---|
| By location | Intestinal - blood comes from the intestinal vessels Gastric - into the lumen of the stomach Gastrointestinal – blood loss into the cavity of the esophagus or other hollow organ Hemopericardium - filling the pericardial sac with blood Hemothorax - between the layers of the pleura, i.e. in the slit-like space between the special membranes surrounding each lung Intracranial Hemarthrosis – in the joint |
| According to the area of blood accumulation | Interstitial - into tissues adjacent to the vessel Abdominal - into the cavity of the peritoneum, pleura |
| According to the signs and characteristics of detection | Hidden - hemorrhage into the cavitary organs and cavities that communicate with external environment, for example, the bladder or lungs. But there are no obvious symptoms of bleeding; it can only be detected with the help of special diagnostics Explicit – easily determined by visual inspection |
| By origin | Mechanical - with traumatic injury tissues and vessels of internal organs Arrosive - when the vascular wall is damaged due to the germination or disintegration of a neoplasm, a destructive or necrotic process (with tissue death) Diapedetic - with blood leaking through the vascular wall during scurvy, scarlet fever, malaria |
| By volume of leaked blood | Lung – blood loss no more than 500 ml Average – 0.5–1 l Severe – blood loss is no more than one and a half liters of blood Massive – up to 2.5 l Lethal - from 2.5 to 3 l Absolutely lethal - over 3–3.5 l |
| Taking into account the type of damaged vessel | Capillary - from capillaries Venous – when the vein wall ruptures Arterial - from an artery Mixed - from different vessels Parenchymal - blood pours out from the vessels of a parenchymal organ (these are the spleen, liver, lungs, pancreas, kidneys and others - these are internal organs built from solid tissue) |
| According to development period | Primary – immediately after injury Secondary – some time after the injury. In the first 1–5 days it is considered early, after 10–15 days – late |
Hemothorax Causes of internal bleeding
Each type of bleeding has its own causes, the most common of which are injuries and illnesses in acute or chronic form.
Hemorrhage is caused by:
- Open and closed injuries of the abdomen and lumbar region with damage or rupture of internal organs, most often the spleen or liver, less often the intestines and pancreas. Massive bleeding into the abdominal cavity is caused by a blow during a fight or during a car accident, compression - when pressed with a heavy object, etc.
- A rib fracture leads to bleeding into the pleural cavity.
- Traumatic brain injury. Bleeding inside the skull is life-threatening because the volume of the skull is limited. Any hematoma leads to compression of brain structures and serious consequences. It can develop not only immediately after an injury, but also several hours or days after it.
- Chronic diseases of the digestive tract. Bleeding into the cavity of the corresponding organ occurs with erosive gastritis, cirrhosis of the liver, peptic ulcer, malignant tumor process, the formation of a through hole in an ulcer of the duodenum or stomach.
- Gynecological diseases and pathological conditions - apoplexy (rupture) of the ovary, ectopic pregnancy, malignant neoplasm, rupture of an ovarian cyst. In obstetrics and gynecology, uterine bleeding can provoke abortion, previa or premature placental abruption. It can begin after childbirth due to rupture of the birth canal or uterus, late release of the placenta.
- Hemophilia is a hereditary disease in men with a malfunction of the blood clotting process.
Symptoms
Symptoms depend on the amount of blood loss and its location. There are general signs and those characteristic of a specific species.
General symptoms of blood loss
Common signs of internal bleeding are weakness, darkening or clouding of the eyes, drowsiness, dizziness, cold sweat, and thirst. Loss of consciousness is possible. The intensity of blood loss is determined by pulse rate, blood pressure and characteristic complaints of the patient.
- Minor blood loss often does not manifest itself in any way, but for some, the pulse increases slightly and blood pressure (BP) decreases slightly.
- Manifestations of moderate bleeding: heart rate up to 100 beats per minute, decrease in systolic pressure to 80 mmHg. Art., moderate shortness of breath, dry mouth, cold hands and feet, cold sweat, dizziness, severe weakness, slow reactions, fainting.
- With severe blood loss, symptoms are more pronounced. A drop in blood pressure of more than 80 mmHg is noted. Art., tachycardia more than 110 beats per minute, shortness of breath, hand tremors, excruciating thirst against the background of a decrease in the volume of urine excreted, apathy. There may also be a sharp pallor of the mucous membranes and skin, cyanosis of the limbs and the area around the lips, clouding or loss of consciousness.
- Clinical manifestations of massive hemorrhage include cyanosis of the skin and mucous membranes, confusion, and delirium. The eyeballs sink inward, facial features become sharper, the pulse reaches 160 beats per minute, blood pressure drops to 60 mm Hg. Art.
- With fatal and absolutely fatal blood loss, we are talking about a threat to life. The pupils dilate, convulsions appear, the number of heart beats (bradycardia) sharply decreases to 2–10 beats per minute, breathing becomes agonal, urine and feces are spontaneously released. The patient falls into a coma, his skin is dry, pale with a marbled pattern. The result is agony, death.
Signs of hemothorax
Hemothorax is the entry of blood into the pleural cavity. In addition to general symptoms, it manifests itself as sharp pain in the problem area, difficulty in breathing, cough with foamy bloody sputum. On x-ray, the mediastinum (the space in the middle of the chest cavity) is shifted towards the healthy lung.
Signs of uterine bleeding
Symptoms of internal bleeding in women can be pulling, bursting or sharp pain in the lower abdomen radiating to the lower back and anus, the urge to defecate, a feeling of swelling of the mucous membranes.
Signs of hemorrhage in the urinary and digestive organs
- Tar-colored, foul-smelling stool—melena—indicates bleeding from the upper intestine or other digestive organs.
- When there is a hemorrhage in the stomach, a person begins to vomit with bloody clots; into the lumen of the duodenum, it becomes the color of coffee grounds.
- Bleeding from hemorrhoids is manifested by bright bloody discharge from the anus.
- Blood that gets into the renal area, urinary tract, comes out with urine - hematuria.
First aid for internal bleeding
For any type of internal blood loss, you should immediately call an ambulance. Although with mild blood loss a person can go to a medical facility and get help, it is better not to risk it, because it is not known whether the bleeding has stopped, whether the general condition will worsen further or not.
A person’s life often depends on the correct provision of first aid. Before the doctors arrive, the patient must be laid down; further actions must be carried out only after he has assumed a horizontal position, and in case of hemothorax, a semi-sitting position. Apply ice to the area of the suspected source of the problem, focusing on the complaints. Then, as quickly as possible, transport the victim in this position to the nearest medical facility. institutions or wait for the ambulance to arrive.
It is strictly forbidden to: heat the bleeding area, apply a pressure bandage, insert suppositories, use laxatives, do an enema (for intestinal bleeding), offer painkillers and medications that stimulate the heart.
Neglecting the above steps can lead to increased blood loss and death.
Inpatient medical care
Based on the symptoms and initial medical examination, they presumably find out which organ was damaged, and the patient is hospitalized in the appropriate department. If there are objective symptoms of large blood loss, go to intensive care.
Main goals of treatment:
- Stopping bleeding.
- Restoring the lost volume of blood constantly circulating in the body (BCV).
- Normalization of microcirculation.
Often massive blood loss can be stopped by performing emergency surgery:
- in case of a stomach ulcer, its resection is carried out - part of it is removed along with the ulcer;
- for pneumothorax, a thoracotomy is performed - the chest is opened, the cause of bleeding is found and eliminated;
- in case of a hematoma in the cranial cavity, trepanation is performed: through holes made in the bones of the skull, the neurosurgeon gains access to the structures of the brain and the resulting hematoma, from which the blood is sucked out;
- in some cases, internal bleeding can be stopped by performing tamponade: for example, to tamponade the bronchus, a sterile gauze swab or foam sponge is inserted into it through a bronchoscope.
To replenish the blood volume, infusion solutions, blood substitutes, and blood products are administered intravenously. The remaining funds are used for their intended purpose.
The prognosis depends on the competent provision of pre-medical and timely medical care.
