Stop bleeding from parenchymal organs. Bleeding: symptoms and classification, first aid, treatment

It occurs as a result of a violation of the integrity of the vessel with injuries, purulent fusion, an increase in arterial, atmospheric pressure. Changes in the vitamin balance in the body, the action of toxins can also lead to vascular permeability. A number of diseases cause bleeding due to changes in the chemical composition of the blood: hemophilia, jaundice, scarlet fever, sepsis, scurvy, etc. Bleeding can be either internal - in one or another body cavity (pleural, abdominal, etc.); in tissue (hematoma); hidden - not having pronounced external manifestations is determined by special research methods. Hemorrhage is the diffuse soaking of blood in any tissue (subcutaneous tissue, brain tissue, etc.).

Taking into account the time, there are: a) primary bleeding, starting immediately after injury, trauma; b) early secondary bleeding that occurs in the first hours and days after injury (before the development of infection in the wound). More often they occur from the expulsion of a blood clot by blood flow with an increase in intravascular pressure or when a vessel spasm is relieved; c) late secondary bleeding, which can begin at any time after the development of infection in the wound. They are associated with purulent fusion of a thrombus in a damaged vessel or its walls and are dangerous: it is necessary to carefully monitor a patient with damaged large vessels, always have tourniquets at his bedside!

According to the severity and resulting blood loss (acute anemia), there are four degrees of blood loss. Grade 1 - the general condition of the patient is satisfactory, the pulse is somewhat quickened, sufficient filling, blood pressure (BP) is normal, hemoglobin content is above 8 g%, the deficit in circulating blood volume (BCC) is not more than 5%. II degree - a state of moderate severity, the pulse is frequent, blood pressure is reduced to 80 mm Hg. Art., hemoglobin content - up to 8 g%, BCC deficiency reaches 15%. Grade III - severe condition, pulse - filiform, blood pressure - up to 60 mm Hg. Art., hemoglobin content - up to 5 g%, BCC deficiency - 30%. IV degree - the state borders on agonal, pulse and blood pressure are not determined, hemoglobin content is less than 5 g%, BCC deficiency exceeds 30%.

Symptoms and course

arterial bleeding.

Blood is ejected in a jet, often jerky (pulsating), its color is bright red. Arterial external bleeding is the most significant and quickly leads to acute anemia: increasing pallor, frequent and small pulse, progressive decrease in blood pressure, dizziness, darkening of the eyes, nausea, vomiting, fainting. Such bleeding of the brain causes death due to oxygen starvation, impaired brain function and the cardiovascular system.

Venous bleeding.

Blood has a dark color, pours continuously and evenly. With external venous bleeding, a slow outflow of blood is characteristic. When large veins are injured with increased intravenous pressure, often due to obstruction of outflow, blood may flow out in a jet, but it usually does not pulsate. In rare cases, a slight pulsation is possible due to the transmission of a pulse wave from an artery passing next to the damaged vein. Injury to large veins is dangerous by the development of air embolism of cerebral vessels or heart vessels: at the moment of inspiration, negative pressure arises in these veins.

capillary bleeding.

Separate bleeding vessels are not visible, blood oozes like a sponge. On coloring stands on the verge between arterial and venous. Capillary bleeding quickly stops on its own and matters only with reduced blood clotting (hemophilia, liver disease, sepsis).

Parenchymal bleeding.

Especially dangerous, it can be very difficult to stop. The entire wound surface bleeds due to the abundance of blood vessels in the internal organs. Bleeding with a mixed wound of small arteries, veins, capillaries of internal parenchymal organs (liver, spleen, lungs, kidneys) can be very profuse and prolonged.

General symptoms

are the same for all types of bleeding, including internal ones. Manifested with significant blood loss, acute anemia.

Local signs are different.

With bleeding into the cranial cavity, symptoms of brain compression develop. Bleeding into the pleural cavity (hemothorax) is accompanied by compression of the lung of the affected side, which causes shortness of breath; there is also a limitation of respiratory excursions of the chest, weakening of trembling and respiratory noises on the side of blood accumulation. Diagnostic thoracic puncture detects the presence of blood in the pleural cavity.

Accumulation of blood in the abdomen (hemoperitoneum)

occurs with subcutaneous ruptures of parenchymal organs (spleen, liver, etc.), rupture of the tube during tubal pregnancy, injuries of the abdominal organs, etc. and is manifested by symptoms of peritoneal irritation (pain, abdominal muscle tension, nausea, vomiting, etc.

Bleeding into the pericardial cavity (hemopericardium)

the phenomena of cardiac tamponade increase (fall in cardiac activity, cyanosis, increased venous pressure, etc.).

Intra-articular bleeding gives:

an increase in the volume of the joint, a sharp pain during movements and palpation, limitation of mobility, a symptom of fluctuation, determined in joints that are not covered with muscles. For hemorrhage in the knee joint, balloting of the patella is characteristic. The diagnosis is confirmed by puncture of the joint cavity and obtaining blood from it.

The symptomatology of an interstitial hematoma depends on its location, size, and the state of the blood that has poured into the tissue (liquid, clots). Usually there is an increasing swelling, the disappearance of the pulse on the vessels, peripheral hematoma, cyanosis or a sharp pallor of the skin, which becomes cold, i.e. ischemia events. Patients complain of severe pain. On palpation, there is a symptom of unsteadiness, if the blood in the hematoma is liquid, and a pulsation of swelling, if its cavity communicates with the lumen of a large artery. More often, interstitial hematomas occur when the main vessels of the extremities are damaged. The resulting hematoma compresses the veins and intact arterial trunks, which sometimes leads to the development of ischemic gangrene of the limb, if surgical care is not provided in a timely manner.

Recognition. With small bleeding (internal or hidden), they resort to puncture (of the joint, pleural cavity, pericardium). Endoscopic and X-ray examinations are of great help in the diagnosis. Bronchoscopy, thoracoscopy, esophagoscopy, gastroscopy, duodenoscopy, sigmoidoscopy, colonoscopy, laparoscopy, cystoscopy are widely used.

To study internal bleeding, a radioisotope method can be used. The radionuclide is administered intravenously and normally accumulates in the liver, where it is absorbed by reticuloendothelial cells and disappears from the bloodstream in 15-20 minutes. In pathology, together with the outflowing blood, it is found in the tissues or in the cavity.

With hidden bleeding in the gastrointestinal tract, a benzidine test is used.

Bleeding outcomes:

bleeding, leading to a rapid decrease in maximum blood pressure to 80 mm Hg. Art. or a drop in the percentage of hemoglobin by 1/3 of the initial values is extremely dangerous, since bleeding of the brain can develop. During a slow, over several weeks, blood loss, the body adapts to chronic anemia and can exist for a long time with a very low hemoglobin content.

Blood poured into a closed cavity can compress the brain, heart, lung, etc., disrupt their activity and create a direct threat to life. Hemorrhages, compressing the vessels that feed the tissues, sometimes lead to necrosis of the limb.

The blood circulating in the vessel is largely bactericidal, while the blood poured into the tissues and cavities becomes a good breeding ground for microbes. Therefore, with internal or interstitial accumulations of blood, there is always the possibility of infection. So, the development of pyogenic microflora with hemothorax causes purulent pleurisy, with hemarthrosis - purulent arthritis.

Without medical attention, bleeding can end up spontaneously stopping or bleeding and death from anemia of the brain and impaired cardiovascular activity.

Spontaneous stop of bleeding. It occurs as a result of a spasm of a blood vessel and the formation of a thrombus in its lumen, which is facilitated by a decrease in blood pressure during bleeding.

If then a purulent infection does not develop in the cavity (pleural, abdominal, etc.), then the blood undergoes destruction and absorption. With an interstitial hematoma on the extremities, as a result of the closure of the damaged vessel by a thrombus, blood circulation is usually restored through the collateral vessels, and the hematoma may gradually resolve. Due to reactive inflammation around the accumulation of blood, a connective tissue capsule is often formed, i.e. a blood cyst appears. Usually, scars and adhesions appear around it, and calcium salts are deposited in the capsule itself.

Mechanisms to compensate for blood loss: for the outcome of bleeding, the magnitude and speed of blood loss, the age of the patient, the general condition of the body and the cardiovascular system are of great importance.

To maintain the required level of blood supply to vital organs in the body, a complex adaptation mechanism develops, including: 1) vasospasm; 2) increased cardiac activity and respiration; 3) an increase in the volume of circulating blood by attracting it from the depot and tissue fluid.

Profuse (massive) arterial bleeding leads to acute anemia so quickly that the mechanisms for compensating for blood loss do not have time to develop. And even unsharply expressed exsanguination is the cause of death of the patient. The main work to restore blood loss falls on the cardiovascular system. Therefore, in old age, when the heart and blood vessels no longer have sufficient reserves, worse outcomes are observed. Sclerosis, organic defects and functional disorders of cardiac activity are very unfavorable moments. Young children do not tolerate blood loss well, since they have not yet had time to form all the compensation mechanisms. An important role is played by the biochemical properties of blood, in particular, the state of the coagulation system. If it is violated, for example, streets suffering from hemophilia, even a small wound can lead to acute anemia and death of the victim.

Methods for temporarily stopping bleeding:

elevate a limb

bend as much as possible in the joint and squeeze the vessels passing in this area (finger pressure, pressure bandage, application of a tourniquet, as well as clamps on a bleeding vessel in the wound). Existing methods have advantages and disadvantages and are used alone or in combination (eg pressure bandage and limb elevation). Any injury to a limb without clear signs of damage to a large artery is an indication for the imposition of a pressure bandage. Its disadvantage is that it does not stop bleeding from large arteries and, by squeezing tissues, leads to impaired blood circulation in the peripheral parts of the limbs. By raising the limb high, you can stop bleeding if the veins are damaged. This method is often used in combination with a pressure bandage.

Compression of the artery.

It is used to temporarily stop arterial bleeding on the limbs, neck, head. Pressing is made above the bleeding place, where there are no large muscle masses, where the artery does not lie very deep and can be pressed against the bone. Pressing is carried out at certain points. The most important of them: the inguinal fold - for the artery of the thigh, the popliteal region - for the artery of the lower leg, the elbow joint - for the brachial artery in the elbow bend, the axillary region and the inner surface of the biceps muscle - for the artery of the hand; on the neck at the inner edge of the sternocleidomastoid muscle, near its middle - for the carotid artery, pressing it with a finger against the transverse process of the VI cervical vertebra. The subclavian artery is squeezed, pressing it against the 1st rib at a point located above the clavicle, immediately outward from the place of attachment of the sternocleidomastoid muscle to the handle of the sternum. The axillary (axillary) artery can be compressed by pressing against the head of the humerus in the armpit. The brachial artery is pressed against the inner surface of the humerus at the inner edge of the biceps muscle. The femoral artery is most easily compressed by pressing it against the horizontal branch of the pubic bone at a point immediately below the pupartite ligament (in the inguinal region) midway between the anterior superior iliac axis and the symphysis (interdulum bones).

Compression of the vessel with a finger

sometimes it is possible to temporarily stop the bleeding and deliver the victim to the surgical department. Often, when the vessel is pressed with a finger, the large nerve trunks located nearby are also squeezed, which causes severe pain. Prolonged stopping of bleeding by this method is impossible.

The imposition of a tourniquet.

Circular pulling of the soft tissues of the limb together with the blood vessels is carried out with a tourniquet. There are various modifications (harness with a harness, elastic, etc.). Esmarch's tourniquet is a strong rubber tube up to 1.5 m long, at one end of which a metal chain is fixed, and at the other - a hook. A rubber bandage injures tissue less than a rubber tube.

The raised limb is surrounded by a strongly stretched tourniquet 2-3 times above the injury site, after which it is tied or crocheted to a chain. In order not to infringe the skin, a towel is placed under the tourniquet. With the correct application of the tourniquet, arterial bleeding stops immediately, the pulse disappears and the limb turns pale (waxy appearance). Excessively tight pulling can cause paralysis and necrosis of the limb. A loosely applied tourniquet compresses only the veins, which leads to stagnation of blood in the limb and increased bleeding. If only the veins are injured, a tourniquet is usually not required, as bleeding can be controlled by applying a pressure bandage, elevating the limb, and improving drainage.

Disadvantages of applying a tourniquet: 1. Compression not only of the arteries, but also of the nerve trunks, which can lead to paresis. 2. The cessation of blood circulation in the tissues reduces their resistance to infection and creates fertile ground for the development of anaerobic gangrene, 3. You can not leave a tourniquet on the limbs for more than 2 hours due to the danger of necrosis. Therefore, the accompanying patient should be informed of the time of application of the tourniquet.

To reduce the adverse effect, it is recommended to dissolve the tourniquet after one hour for a few minutes (if the bleeding does not resume) and then tighten it again. This improves tissue nutrition and increases their resistance, which is especially important when transporting victims in the cold season (especially in winter).

It is not recommended to apply a tourniquet to limbs with acute surgical infection, or in case of vascular damage (arteriosclerosis, thrombophlebitis, etc.), as this may contribute to the spread of the process or the development of embolism.

In addition to the arterial tourniquet, sometimes a so-called venous tourniquet is applied for bleeding from large subcutaneous veins. It is applied below the site of damage to the vessel with a force that causes compression of only superficial veins, and for up to 6 hours.

Such a tourniquet is also used for other purposes (depositing blood in the extremities during bloodletting, etc.)

Twisting (constriction). In the absence of a specialized tourniquet, you can use improvised material, for example, a scarf.

It is tied at first completely freely, then some kind of stick or plank is inserted into the loop and the scarf is twisted to the required degree.

Methods for the final stop of bleeding are divided into four groups: 1) mechanical, 2) thermal, 3) chemical and 4) biological. With extensive wounds and severe bleeding, it may be necessary to apply several methods simultaneously or sequentially in various combinations. Along with this, measures are taken to combat acute anemia (blood transfusion or blood-substituting solutions, intravenous administration of glucose solutions, isotonic sodium chloride solution, etc.). Often, to stop internal bleeding, they resort to surgery (abdominal surgery, thoracotomy, craniotomy, etc.).

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What types of bleeding are there and why do they occur?

There are many classifications of this pathological condition and experts teach them all. However, we are interested in dividing bleeding into varieties, first of all, from a practical point of view. For the successful provision of first aid, the following classification is important. It shows the types of bleeding depending on the nature of the damaged vessel.

arterial bleeding

It comes from the arteries, which contain oxygenated blood flowing from the lungs to all organs and tissues. It poses a serious problem, since these vessels are usually located deep in the tissues, close to the bones, and situations where they are injured are the result of very strong impacts. Sometimes this type of bleeding stops on its own, because the arteries have a pronounced muscular membrane. When such a vessel is injured, the latter spasms.

Venous bleeding

Signs and consequences of bleeding

Common signs of bleeding include dizziness , weakness, shortness of breath, severe thirst, pallor of the skin and mucous membranes, decreased pressure, increased heart rate ( tachycardia ), pre-syncope states and fainting. The severity and rate of development of these symptoms is determined by the rate of blood flow. Acute blood loss it is more difficult to tolerate than chronic, since in the latter case the body has time to partially "adapt" to the changes taking place.

Are common

Patient complaints:

Weakness, unmotivated drowsiness;
Dizziness;
Thirst;
Feeling of palpitations and shortness of breath.

The external symptoms of blood loss that are observed with any type of bleeding are as follows:

Pale skin and mucous membranes;
Cold sweat;
Increased heart rate;
Dyspnea;
Disorders of urination up to the complete absence of urine;
drop in blood pressure;
Frequent weak pulse;
Violations of consciousness up to its loss.

Local

External effusion of blood

The main local symptom is the presence of a wound on the surface of the skin or mucous membrane and a visible outflow of blood from it. However, the nature of bleeding is different and is directly dependent on the type of vessel.

Capillary is manifested by that the blood is collected in large drops, oozing from the entire surface of the wound. Its loss per unit of time is usually small. Its color is red.
Signs of venous bleeding: blood can flow out fairly quickly when a large vein is injured or several at once, it drains from the wound in strips. Its color is dark red, sometimes burgundy. If the large veins of the upper body are injured, there may be intermittent discharge of blood from the wound (however the rhythm is synchronized not with the pulse, but with the breath).
Signs of arterial bleeding: blood pours out of the injury site in pulsating shocks - “fountains” (their frequency and rhythm coincide with heartbeats and pulse), its color is bright scarlet, red. The loss of blood per unit of time is usually rapid and significant.

Manifestations of occult bleeding

General symptoms of bleeding

Symptoms of bleeding depend on its type and the type of damaged vessels.

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.

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The human and mammalian organism is permeated with thousands of small, medium and large vessels, which contain a valuable fluid that performs a huge number of functions - blood. Throughout life, a person experiences the influence of a considerable number of harmful factors, among them, such traumatic effects as mechanical damage to tissues are most common. As a result, bleeding occurs.

What it is? The medical science "pathological physiology" gives such a definition to this condition: "this is the exit of blood from a damaged vessel." At the same time, it pours out or into the cavity of the body (abdominal, thoracic or pelvic) or the organ. If it remains in the tissue, impregnating it, it is called a hemorrhage, if it accumulates freely in it, it is called a hematoma. A condition in which blood vessels are damaged, most often occurring suddenly, and with a strong rapid outflow of vital fluid, a person may die. That is why first aid for bleeding often saves his life, and it would be nice for everyone to know the basics of it. After all, such situations do not always occur when there are health workers nearby, or even just specially trained people.

What types of bleeding are there and why do they occur?

There are many classifications of this pathological condition and experts teach them all. However, we are interested in dividing bleeding into varieties, first of all, from a practical point of view. For the successful provision of first aid, the following classification is important. It shows the types of bleeding depending on the nature of the damaged vessel.

arterial bleeding

It comes from the arteries, which contain oxygenated blood flowing from the lungs to all organs and tissues. It poses a serious problem, since these vessels are usually located deep in the tissues, close to the bones, and situations where they are injured are the result of very strong impacts. Sometimes this type of bleeding stops on its own, because the arteries have a pronounced muscular membrane. When such a vessel is injured, the latter spasms.

Venous bleeding

Its source is venous vessels. Through them, blood containing metabolic products and carbon dioxide flows from cells and tissues to the heart and further to the lungs. Veins are located more superficially than arteries, so they are damaged more often. These vessels do not contract during injury, but they can stick together because their walls are thinner and their diameter is larger than that of arteries.

capillary bleeding

Blood flows from small vessels, most often the skin and mucous membranes, usually such bleeding is insignificant. Although it can be frighteningly abundant in a wide wound, since the number of capillaries in the tissues of the body is very large.

Parenchymal bleeding

Separately, the so-called parenchymal bleeding is also distinguished. The organs of the body are hollow, in fact, - these are "bags" with multilayer walls - and parenchymal, which consist of tissue. The latter include the liver, spleen, kidneys, lungs, pancreas. Typically, this type of bleeding can only be seen by a surgeon during an operation, since all parenchymal organs are "hidden" deep in the body. It is impossible to determine such bleeding by the type of the damaged vessel, because in the tissue of the organ there are all their varieties and all of them are injured at once. This is mixed bleeding. The latter is also observed with extensive injuries of the limbs, since the veins and arteries lie side by side.

Depending on whether blood remains in the cavity of the body or organ or is poured out of the body, bleeding is distinguished:

Internal. The blood does not go outside, lingering inside: in the cavity of the abdominal, thoracic, pelvic, joint (s), ventricles of the brain. A dangerous type of blood loss that is difficult to diagnose and treat because there are no outward signs of bleeding. There are only general manifestations of its loss and symptoms of significant dysfunction of the organ(s).
External bleeding. Blood is poured into the external environment, most often the causes of this condition are injuries and various ailments that affect individual organs and systems. These bleedings can be from the skin and mucous membranes, gastric and intestinal, from the urinary system. At the same time, visible outpourings of blood are called explicit, and those that occur in a hollow organ that communicates with the external environment are called hidden. The latter may not be detected immediately after the onset of bleeding, because it takes time for blood to come out, for example, from a long digestive tube.

Usually bleeding with clots is external hidden or internal, when the blood lingers inside the organ and partially clots.

Acute. In this case, a large amount of blood is lost in a short period of time, usually it occurs suddenly as a result of an injury. As a result, a person develops a state of acute (anemia).
Chronic. Long-term loss of small volumes of this biological fluid is usually caused by chronic diseases of organs with ulceration of the vessels of their walls. Cause a state of chronic anemia.

Video: bleeding at the “School of Dr. Komarovsky”

The main causes of bleeding

What can cause bleeding? It is appropriate to note here that there are also two fundamentally different types of them, based on the factor whether the normal vessel is damaged or the pathological condition arose against the background of the destruction of the altered vascular wall. In the first case, bleeding is called mechanical, in the second - pathological.

The following main causes of bleeding can be distinguished:

Traumatic injuries. They can be thermal (from exposure to critical temperatures), mechanical (in case of a bone fracture, wound, bruise). The latter occur in various extreme situations: traffic accidents, railway and plane crashes, falls from a height, fights involving piercing objects, gunshot wounds. There are also industrial and domestic injuries.
Vascular diseases, including tumors (purulent tissue lesions with vascular involvement, atherosclerosis, hemangiosarcoma).
Diseases of the blood and liver coagulation system (fibrinogen deficiency, hypovitaminosis K, hepatitis, cirrhosis).
General diseases. For example, diabetes mellitus, infections (viral, sepsis), lack of vitamins, poisoning cause damage to the vascular walls throughout the body, as a result, plasma and blood cells seep through them and bleeding occurs.
Ailments that affect various organs. Expiration of blood from the lungs can cause tuberculosis, cancer; from the rectum - tumors, hemorrhoids, fissures; from the digestive tract - ulcers of the stomach and intestines, polyps, diverticula, tumors; from the uterus - endometriosis, polyps, inflammation, neoplasms.

What threatens a person with bleeding?

One of the most important, but by no means the only function of blood is the transport of oxygen and nutrients. It delivers them to the tissues, and takes away metabolic products and carbon dioxide from them. With significant bleeding, there is a significant loss of this substance necessary for the body. The nervous system and the heart muscle are very sensitive to oxygen deficiency. The death of the brain with a complete cessation of blood supply to it occurs in humans and animals in just 5-6 minutes.

However, in addition to the direct loss of the precious oxygen-containing liquid, there is another problem. The fact is that it keeps the vessels in good shape and, with a significant loss of it, the latter subside. In this case, the blood remaining in the human body, which contains oxygen, becomes ineffective and can do little to help. This condition is very dangerous, it is called vascular shock or collapse. It occurs with an acute strong.

The above-described consequences are life-threatening for the patient and develop very quickly after bleeding.

Blood performs a huge number of functions, among which the most important are maintaining the balance of the internal environment of the body, as well as ensuring the connection of organs and tissues with each other by transferring various biologically active substances. Thus, billions of body cells exchange information and, as a result, can work smoothly. Bleeding to some extent violates the constancy of the internal environment of the body and the functions of all its organs.

Often, blood loss does not directly threaten the patient's life; this is observed in many diseases. In such cases, blood loss is chronic and mild. The replacement of outflowing blood occurs by the synthesis of plasma proteins by the liver and cellular elements by the bone marrow. Bleeding becomes an important diagnostic sign for recognizing the disease.

Signs of bleeding

Are common

Patient complaints:

Weakness, unmotivated drowsiness;
Dizziness;
Thirst;
Feeling of palpitations and shortness of breath.

The external symptoms of blood loss that are observed with any type of bleeding are as follows:

Pale skin and mucous membranes;
Cold sweat;
Increased heart rate;
Dyspnea;
Disorders of urination up to the complete absence of urine;
drop in blood pressure;
Frequent weak pulse;
Violations of consciousness up to its loss.

Local

External effusion of blood

Capillary is manifested by that the blood is collected in large drops, oozing from the entire surface of the wound. Its loss per unit of time is usually small. Its color is red.
Signs of venous bleeding: blood can flow out fairly quickly when a large vein is injured or several at once, it drains from the wound in strips. Its color is dark red, sometimes burgundy. If the large veins of the upper body are injured, there may be intermittent discharge of blood from the wound (however the rhythm is synchronized not with the pulse, but with the breath).
Signs of arterial bleeding: blood pours out of the injury site in pulsating shocks - “fountains” (their frequency and rhythm coincide with heartbeats and pulse), its color is bright scarlet, red. The loss of blood per unit of time is usually rapid and significant.

Manifestations of occult bleeding

From the lungs - blood is excreted with a cough (a symptom of hemoptysis), it is frothy, the color is bright red.
From the stomach - brown color (hydrochloric acid of gastric juice reacts with blood, the latter changes color). There may be clots.
From the intestines - feces acquire a dark brown or black color and a viscous, viscous consistency (tar-like stools).
From the kidneys and urinary tract - urine becomes red (from a brick shade to brown with "rags" - clots and pieces of tissue).
From the uterus and genitals - red blood, often in the discharge there are pieces of the mucous membrane.
From the rectum - scarlet blood drops can be found on the feces.

Signs of internal bleeding

There is no outflow of blood into the environment. There are general symptoms of blood loss.
Local manifestations will depend on the site of damage to the vessel and in which body cavity the blood accumulates.
- loss of consciousness or its confusion, local disturbances of motor functions and / or sensitivity, coma.
In the pleural cavity - chest pain, shortness of breath.
In the abdominal cavity - abdominal pain, vomiting and nausea, tension in the muscles of the abdominal wall.
In the cavity of the joint - its swelling, pain on palpation and active movements.

Can the body deal with bleeding?

Nature has provided for such a possibility that the fragile and delicate living tissues of the body will be injured during a long life. This means that a mechanism is needed to resist the outflow of blood from damaged vessels. And people have it. As part of blood plasma, that is, the liquid part that does not contain cells, there are biologically active substances - special proteins. Together they make up the blood coagulation system. To help her are special blood cells - platelets. The result of complex multi-stage blood coagulation processes is the formation of a blood clot - a small clot that clogs the affected vessel.

In laboratory practice, there are special indicators that show the state of the blood coagulation system:

duration of bleeding. An indicator of the duration of blood outpouring from a small standard injury inflicted with a special stylet on a finger or earlobe.
Blood clotting time - shows how long it takes for blood to clot and form a clot. It is carried out in test tubes.

The norm of bleeding duration is three minutes, the time is 2-5 minutes (according to Sukharev), 8-12 minutes (according to Lee White).

Often, the injury or damage to the vessel by the pathological process is too extensive and the natural mechanisms for stopping bleeding cannot cope, or the person simply does not have time to wait due to the threat to life. Without being a specialist, it is difficult to assess the condition of the victim, and the treatment tactics will be different depending on the cause.

Therefore, a patient with severe bleeding from a vein or artery is subject to urgent delivery to a medical facility. Before that, he must be given emergency care. To do this, you need to stop the bleeding. Usually this is a temporary cessation of blood flow from the vessel.

First aid

What methods of temporary stop of bleeding are known? Here they are:

Pressure (pressing the vessel in the wound, applying a pressure bandage).
Applying a hemostatic sponge, ice, irrigation with hydrogen peroxide (for capillary bleeding).
Very strong flexion of the limb.
Dense tamponade with a bandage, gauze, cotton wool (for the nasal cavity, deep external wounds).
Applying a hemostatic tourniquet.

Ways to finally stop bleeding, which can only be performed by a doctor and in a medical institution, are:

Mechanical: ligation of the vessel in the wound, performing a vascular suture, stitching the tissue together with the vessel.
Chemical: anticoagulants and vasoconstrictors (calcium chloride, epinephrine, aminocaproic acid)
Thermal: electrocoagulation.
Biological (to stop capillary and parenchymal bleeding during operations): fibrin films, hemostatic sponges, hemming of the body's own tissues (omentum, muscle, fatty tissue).
Vessel embolization (introduction of small air bubbles into it).
Removal of the affected organ or part of it.

It is very important to determine the type of damaged vessel, because the ways to stop the outpouring of blood from it will depend on this.

First aid for arterial bleeding

A tourniquet is very effective if the vessel of the limb is damaged. The method of pressure and tight tamponade of the wound is also used.

Harness rules

While it is being prepared, it is necessary to press the artery to the bones above the wound with a fist or fingers, remember that with an injury to a large vessel, minutes count. The brachial artery is pressed against the bone of the shoulder along its inner surface, the ulnar artery - in the elbow bend, the femoral artery - in the inguinal bend, the lower leg - in the popliteal fossa, the axillary - in the hollow of the same name.

The injured leg or arm must be raised. A tourniquet is applied, tightly tightening and placing a towel or rag between it and the skin. If there is no special rubber band, you can use a regular bandage, scarf, thin rubber hose, trouser belt, scarf, or even a rope. Then it is tied loosely around the limb, a stick is inserted into the loop and twisted to the desired clamping. The criterion for the correct application of the tourniquet is the cessation of bleeding. The time of his stay on the limb: no more than two hours in summer and half an hour in winter. To fix the moment of clamping the vessels, the time is written on a piece of paper and fixed on the affected limb.

Danger

The problem is that it is impossible to apply a tourniquet for more than the above time interval due to circulatory disorders in the injured leg or arm, the tissues die off. The function of the limb then will not be fully restored, sometimes amputation becomes necessary. In addition, there is a danger of development in the area of damage (bacteria that live in the soil and multiply in living tissues in the absence of oxygen enter the wound). If the person has not yet been delivered to the hospital within the specified time, in any case, the tourniquet must be loosened for a few minutes. The wound during them is clamped using a clean cloth.

If the carotid artery is injured and bleeding from it, it is necessary to pinch it with a finger and tamponade the wound with a sterile dressing material. A tourniquet can be applied to the neck, for this a special technique is used to prevent strangulation of the victim. Raise a hand on the opposite side of the injury, and tighten the neck with a tourniquet below injury site along with the limb.

Video: emergency care for severe bleeding

Venous bleeding

With venous bleeding, tight bandaging or a tourniquet works well. The peculiarity of the technique of the latter is that its location is not above the injury site, as in an arterial injury, but, on the contrary, below.

With any method of stopping bleeding, the wound itself is covered with a sterile napkin or clean cloth. If pain medication is available, the victim may be given an injection or a pill if the victim is conscious. A person lying on the ground must be covered to prevent hypothermia. Do not move or turn the victim.

If internal bleeding caused by trauma is suspected, the patient should be given complete rest and sent to the hospital as soon as possible.

Video: first aid for venous bleeding

capillary bleeding

For capillary bleeding, the pressure method is used, including with the palm or fingers, bandaging, hemostatic sponges, cold objects. With adequate work of the coagulation system, a temporary stop of bleeding becomes final.

Therapy after stopping bleeding in the hospital

The use of coagulation-improving, blood-substituting drugs, whole blood / plasma / platelet suspensions is mandatory. Intravenous infusion therapy is also needed to restore the balance of ions. Since bleeding is usually far from the only problem after serious traumatic incidents, in parallel with the work to stop it, doctors carry out emergency diagnosis and treatment of concomitant disorders.

The main thing is not to lose your head if trouble happened to one of the people around you, and the person has bleeding. In order to cope with it, you can use materials from the car first-aid kit, things from your own bag, items of clothing or household items.

The task and duty of every normal person is providing first aid to the victim, which consists in the temporary cessation of blood loss. And then you should immediately take the patient to a medical institution on your own or urgently call an ambulance.

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

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

This group includes:

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

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

What are dangerous

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

Reasons for development

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

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

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

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

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

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

Symptoms

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

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

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

When admitted to the hospital

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

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

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

Medical assistance in a hospital setting

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

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

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

When the internal organs are damaged, a mixed injury occurs to small arteries, veins, capillaries of the internal parenchymal organs (liver, spleen, lungs, kidneys) and is accompanied by abundant, rapidly giving acute anemia or prolonged bleeding that is difficult to stop.

First aid. Measures of temporary assistance before referring the victim to the hospital are the same as those used when there is no possibility for a radical stop of bleeding. The first thing that needs to be applied is measures that lower blood pressure, both general and in the diseased organ, that is, the patient's resting position with an elevated bleeding part of the body and local application of cold.

For some bleeding, internal hemostatic agents that cause vasoconstriction are also applicable: ergot preparations or adrenaline 1: 1000 - 0.5 g under the skin, although they cause an increase in blood pressure. To increase blood clotting, calcium preparations are also administered: inside a 10% solution of 1 tablespoon, preferably intravenously 5 ml of a 10-20% solution (you cannot use the solution under the skin, as it causes skin necrosis) and vikasol (vitamin K) inside at 0 01 g 2 times a day or intramuscularly 5 ml of a 0.3% solution.

The best results are obtained by the use of biological methods to stop bleeding. The most important agent from this group is normal horse serum, injected subcutaneously at 20-40 ml or intravenously at 10-20 ml. If there is no normal horse serum, then you can take one of the therapeutic sera (anti-diphtheria, anti-tetanus) in the same quantities; of course, sera are administered according to the method of A. M. Bezredki to prevent anaphylactic shock.

A very good means of increasing blood clotting is the transfusion of plasma, serum and small amounts of blood (50-250 ml) by the drip method.

Treatment. Measures to stop parenchymal bleeding are conservative only in milder cases, and operational in more severe cases: suturing a wounded organ, tamponade with an omentum, muscle, gauze swabs, etc. Blood plasma, a hemostatic sponge and freely transplanted tissues are used as local hemostatic agents for parenchymal bleeding (pieces of muscles, omentum, fascia) rich in thrombokinase.

Parenchymal bleeding requires such measures of assistance that are not always feasible in the conditions of the work of a paramedic. Therefore, all patients with such bleeding, as well as patients with suspected internal bleeding, should be referred to a surgical hospital as soon as possible.

Emergency surgical care, A.N. Velikoretsky, 1964.