For how long can a hemostatic tourniquet be applied. Harness rules

Topic#5 . First aid for bleeding.

Pe list of issues to be worked out:

1. Classification of traumatic bleeding.

2. Clinical signs and complications of bleeding. PP for arterial, venous, capillary, mixed, internal, nasal bleeding.

3. Signs of blood loss. Ways to temporarily stop bleeding: finger pressure, elastic tourniquet, twist tourniquet, improvised tourniquet from improvised materials, belt, maximum flexion of the limb, pressure bandage on the wound. Mikulich method.

4. Rules, indications and contraindications for the imposition of a hemostatic tourniquet, possible complications and their prevention. Management of patients with suspected internal bleeding.

Blood It is the life support system of the body. It is involved in all types of metabolism, transportation of O 2 and CO 2, distribution of water, removal of waste products.

Bleeding- this is damage to the walls of the vessel due to any injury and outflow of blood into the external environment or into the internal environment of the body.

If bleeding rate:

30 ml / min - death without assistance can occur after 2 hours;

30-150 ml / min - death occurs within 1 hour;

More than 150 ml / min - death in 15-20 minutes.

Causes bleeding can be wounds, closed injuries, complications of certain diseases.

Complications bleeding - compression of vital organs (compression in the cavities of the skull, chest of large volumes of blood leads to compression of the brain, lungs, heart), air embolism (air ingress into a large-diameter vessel gaping in the wound), hemorrhagic shock (associated with blood loss) .

Bleeding is arterial, venous and capillary.

If the outflowing blood beats with a pulsating stream (gushing) synchronously with the pulse and has a bright red (scarlet) color, then you have arterial bleeding. This is very life-threatening, since a simultaneous blood loss of 1.5-2.0 liters of blood can be fatal. On average, in the body of an adult, about 10% of its weight is blood (about 6 liters).

If the blood flowing outward is dark red in color, and it flows out in a continuous stream, then you have venous bleeding in front of you. If the large veins of the upper half of the body are damaged, blood can flow out in an intermittent stream, but not synchronously with the pulse, as with arterial bleeding, but with breathing. Such bleeding is dangerous for the development of an air embolism with a rapid lethal outcome.

Damage to small superficial vessels (capillaries) causes capillary bleeding. This happens with abrasions, shallow wounds, scratches. If different vessels are damaged, bleeding may be mixed in nature.

Bleeding can be divided into external, when blood flows out from damaged vessels, and internal, when blood enters and accumulates inside the body - in cavities, in tissues. Allocate internal hidden bleeding into the lumen of the gastrointestinal tract and tracheobronchial tree. If internal organs (liver, spleen, kidneys) are damaged, there may be parenchymal bleeding. Their feature is the impossibility of spontaneous stopping of bleeding, since blood vessels are organically included in the tissues of these organs. A significant reduction in the lumen of the vessels does not occur, therefore, for the final stop of bleeding for health reasons, urgent surgical interventions are required. Internal bleeding is usually profuse and difficult to recognize.

It is also customary to distinguish between primary and secondary bleeding. The primary occurs immediately after injury. Secondary bleeding begins a certain time after it due to the expulsion of a blood clot that clogged the vessel, or as a result of wounding the vessel with sharp fragments or foreign bodies. The cause of secondary bleeding may be careless first aid, poor immobilization of the limb, shaking of the victim during transportation, development of suppuration in the wound.

Any bleeding is dangerous because with a decrease in the volume of circulating blood (BCC), blood supply and heart activity worsen, oxygen supply to vital organs - the brain, kidneys, liver, is disrupted, which ultimately leads to a sharp disruption of all metabolic processes in the body. This condition occurs already with the loss of 1-1.5 liters of blood and is called acute anemia . Its symptoms do not depend on what type of bleeding (external or internal) they are caused by. The victim complains of weakness, tinnitus, dizziness, darkening and flickering of "flies" in the eyes, thirst, nausea, vomiting is possible. The victim may be excited or inhibited, the blood pressure is low. Possible loss of consciousness, convulsions, involuntary urination. The victim is very pale, covered with cold sweat, yawns; his pulse is frequent and weak (sometimes completely disappears), his breathing is shallow, rapid. If you do not take urgent measures, then a fatal outcome is not ruled out.

Acute blood loss - loss of a large amount of blood in a short period of time.

For any type of bleeding, direct pressure on the wound gives time:

Assess the type and risk of bleeding;

Choose another method to stop bleeding;

Cannot be used for open fractures.

What should be done to quickly and effectively stop the bleeding?

Venous bleeding and bleeding from small arterial vessels can be stopped with a pressure bandage. To do this, press the afferent artery above the wound with your finger. On the wound, place a sterile gauze napkin, folded in several layers, and put a tight twist of clean material on top of the napkin. (Remember that without a gauze pad, you can’t put cotton on the wound!) Then bandage everything tightly. With these actions you squeeze the bleeding vessels and stop the bleeding. The imposition of a pressure (tight) bandage for open fractures is prohibited. The injured limb must be raised (20-30 cm above the level of the heart), placing a pillow or a roll of clothing under it. This position reduces blood flow and helps stop bleeding from the artery. The same method of stopping bleeding is indicated for bleeding on the torso. Recommended cold on the area of injury.

Wounds of large venous trunks can lead to significant blood loss and possible air embolism. In this regard, damage to the veins of the neck and chest is especially dangerous. Air locks disrupt the blood supply to the organs and lead to the loss of their functions, which can lead to death.

When bleeding from large veins of the extremities, finger pressure should be performed below the wound site, and in the neck area - above. (Venous blood flows from the periphery to the heart.)

When damaged major arteries, a person can quickly die due to large blood loss, so first aid should be provided immediately. In this case, it is better to provide assistance with 2 rescuers (one presses the artery, the other applies a tourniquet, twist or pressure bandage). To do this, you need to know the pressure points of the arteries (temporal, carotid, subclavian, axillary, brachial, femoral) and remember that arterial blood flows from the heart to the periphery. If there is only one rescuer, the bleeding is stopped in two stages: the first is the application of a tourniquet, the second is a bandage.

In case of severe bleeding from wounds of the face, it is necessary to press the carotid, temporal or mandibular artery on the side of bleeding. When squeezing the temporal artery, one must be aware of a possible fracture of the temporal bone. The edge of its inner cortical plate is very sharp and traumatic for the brain and its vessels. The carotid artery is pressed on the side of the larynx with the thumb to the spine, and the remaining fingers are placed behind the neck. Due to the connection of the damaged carotid artery with the opposite through the willisian arterial circle, bleeding can be from the distal and proximal ends. In this regard, a large area of pressure bandage is needed.

When bleeding from the upper part of the shoulder, the subclavian or axillary artery is pressed. The right subclavian artery is pressed with the left hand, the left - with the right. They put their hand so that the thumb lies in the supraclavicular fossa along the upper edge of the clavicle, and the remaining fingers are behind, on the wounded man's back. To press the artery, it is enough to turn the thumb with an edge, at the same time slightly pressing down so that it is behind the wounded collarbone. The subclavian artery is pressed against the first rib. The axillary artery is pressed against the head of the humerus with the right fist inserted into the corresponding axillary cavity. Pressure is exerted from the bottom up. At the same time, the shoulder joint of the wounded is firmly held with the left hand.

In case of bleeding from the lower part of the shoulder and from the forearm, it is necessary to press the brachial artery, it is pressed with one or four fingers to the humerus at the inner edge of the biceps muscle.

Bleeding from the thigh is stopped by pressing the femoral artery: with both hands they cover the upper part of the thigh at the inguinal fold so that the thumbs, placed one on top of the other, converge at the middle of the thigh and press the artery to the bone.

In case of failure, and also if the arterial blood spurts out (continuous and strong jet), immediately proceed to the application of a hemostatic tourniquet. Currently, the Esmarch tourniquet is most often used, which is a thick rubber belt with clasps at the ends. It is applied:

With severe arterial bleeding;

Traumatic amputations;

Syndrome of prolonged compression.

Rules for applying a hemostatic tourniquet

1. A tourniquet is applied in case of damage major arterial vessels.

2. In case of bleeding from the arteries of the upper limb, place the tourniquet on the upper third of the shoulder; with bleeding from the artery of the lower limb - on the middle third of the thigh.

3. The tourniquet is applied to the raised limb. A soft pad is laid under the tourniquet: bandage, clothes, etc.

4. The tourniquet is applied tightly, but not unnecessarily. Be sure to attach paper indicating the time of its application.

5. The tourniquet cannot be kept for more than 1 hour, if the time of evacuation of the affected person to the medical institution is delayed, it is necessary to loosen the tourniquet for 10-15 minutes every 20 minutes.

6. If the rescuer does not have a special tourniquet at hand, improvised means can be used: a scarf, tie, suspender, belt, etc.

7. When a part of a limb is torn off, a tourniquet is necessarily applied, even in the absence of bleeding.

If possible, the tourniquet is applied as close to the wound as possible, but not closer than 4-5 cm, in order to reduce the ischemia zone between the tourniquet and the wound. Do not apply cold to a limb with a tourniquet.

1 - from the arteries of the lower third of the leg; 2 - femoral artery; 3 - arteries of the forearm; 4 - brachial artery; 5 - axillary artery; 6 - external iliac artery.

The improvised means used should be at least 2–3 cm wide. Very thin cords, strings, wires (everything that has a circular cross section in diameter) can cut through the skin along with vessels that have not yet been damaged. The use of rubber tubes leads to damage (necrosis) of the skin. A tourniquet is the last resort. To prevent damage to blood vessels and nerves, the width of the tourniquet should be at least 5 cm. You can apply a cuff from the pressure measuring device above the bleeding site (without applying it to the joint) and inflate it to a level of 300 mm Hg. The overlay time is recorded. Vessel clamping is performed only if life-threatening bleeding continues.

Remember that a tourniquet for arterial bleeding must be applied above the site of bleeding (closer to the heart) and closer to the site of injury in order to bleed as little of the limb as possible. You must first raise this limb. In the area of \u200b\u200bthe wrist and ankles, it is useless to apply a tourniquet.

A rubber tourniquet is applied in a “male” or “female” way. The first requires a lot of physical effort. The tourniquet is applied to the limb with its middle from the side of the projection of the vessel; its two halves are immediately pulled, quickly wrapped once around the limb and fixed with a knot or hook with a chain. With the “female” method, the rubber band is applied to the body with one end with a slight indent (you need to leave the tourniquet area free for subsequent fixation). Then they make several turns around the limb, while one round of the rubber band is placed on the previous one or next to it with moderate tension. The ends of the tourniquet are brought together and fixed. With a weak application of the tourniquet, the arteries are not completely clamped, and bleeding continues. Due to the fact that the veins are clamped with a tourniquet, the limb becomes filled with blood, its skin becomes cyanotic, bleeding may increase. In case of severe compression of the limb with a tourniquet, the nerves are injured, which can lead to paralysis of the limb. Proper application of the tourniquet leads to stopping the bleeding and blanching of the skin of the limb. The degree of compression of the limb with a tourniquet is determined by the pulse on the artery below the place of its application. If the pulse disappeared, then the artery was squeezed by the tourniquet.

Having applied a tourniquet or twist to the limb, the wound is covered with a primary bandage. If the wounded was not taken to the medical center within 1 hour, it is necessary to press the corresponding artery with your fingers and then loosen the tourniquet. When the limb turns pink and warm, again apply a tourniquet above or below the previous place and stop pressing the vessel with your fingers. When removing the tourniquet, it must be loosened gradually. In the cold season, when applying a tourniquet or pressure bandage, the limb must be insulated. The tourniquet must always be visible.

A contraindication to the imposition of a tourniquet or twist is an inflammatory process.

Recently, the atraumatic ribbed hemostatic tourniquet of Dr. V.G. Bubnov has become famous. This tourniquet does not infringe the skin when applied and can be used on a bare limb; the tourniquet does not injure blood vessels and nerves, so it is tightened when applied with maximum effort; the tourniquet can remain on the body for 8-10 hours, since the ribbing of the tourniquet helps to maintain blood circulation in the skin and subcutaneous vessels, which is the prevention of necrotic processes in the distal limbs.

A tourniquet is not a perfect solution to the problem of stopping bleeding. It is believed that the applied tourniquet inevitably leads to rough compression of large nerve trunks and the development of severe neuropathy in the later stages, i.e. damage to the nerves with a sharp violation of the functions of the limb. After 7-10 min. after applying a tourniquet, the victim has a feeling of unbearable tingling and a feeling of fullness, very severe pain. The tourniquet stops the blood flow through the main and collateral vessels below the applied tourniquet. In the absence of an influx of oxygenated blood, metabolism proceeds according to the anoxic type. After removing the tourniquet, underoxidized products enter the general circulation, causing a sharp shift in the acid-base state to the acid side (acidosis), vascular tone decreases, and acute renal failure develops. The combination of the described damaging factors causes acute cardiovascular, and then multiple organ failure, referred to as tourniquet shock or crash syndrome. This creates ideal conditions for the development of anaerobic infection, especially when the wound becomes infected. The application of a tourniquet, at best, is an opportunity to win some time for the first aid provider (with very severe arterial bleeding). In the absence of a tourniquet, you can apply a twist, which is made of soft but durable material (fragments of clothing, a piece of cloth, a soft trouser belt). At the same time, a strip of material is brought above the wound and closer to it and its ends are tied. Then insert a wooden stick and rotate it, while slowly tightening the twist until the bleeding stops. The free end of the stick is fixed with a bandage.

You can stop arterial bleeding by applying a pressure bandage to the wound, clamping the artery throughout and giving the damaged limb an elevated position. Sometimes only the imposition of a pressure bandage is sufficient.

Other Ways to Stop Bleeding

In cases where there are no fractures of the limb, methods can be applied to stop bleeding by flexing the limb as much as possible.

Strong flexion at the knee stops bleeding from the arteries of the foot and lower leg. To increase pressure on the vessel, a roller made of a bandage or other material is used. Strong flexion and bringing the knee to the stomach compresses the femoral artery. When the axillary artery is injured, compression is carried out by taking it - the hand is laid behind the back and strongly pulled to the healthy side, or both arms, bent at the elbow, are strongly retracted, and the elbow joints are tied behind the back. This stopping method is used very rarely.

Temporary stop of bleeding by maximum limb flexion:

A - from the axillary and subclavian arteries; B-femoral artery; In-from the artery of the forearm; D - leg arteries.

The duration of the stay of the limbs in the maximum bent state, causing ischemia of their distal sections, corresponds to the duration of the tourniquet on the limb.

What to do with external bleeding?

Don't get lost, do the following:

Pinch the wound with your fingers to stop the bleeding;

Lay the affected person horizontally;

Urgently send someone for an "ambulance";

If you start to get tired, let someone from those present press your fingers from above (it is necessary to hold the vessel pressed down for at least 20 minutes, during this time, as a rule, thrombosis of the damaged vessel occurs and the bleeding intensity will decrease.

When bleeding from the cervical (carotid) artery, immediately squeeze the wound with your fingers or fist, and after that the wound can be stuffed with a large amount of clean tissue. This method is called plugging. It can be used in cases where it is impossible to apply a tourniquet. Tamponade is carried out for at least 20 minutes. The victim must be taken to the hospital as soon as possible for specialized care. After ligation of bleeding vessels, the victim should be given a soft drink to drink.

What to do if you suspect internal bleeding?

Such bleeding can occur from a blow to the stomach, a fall from a height, etc. due to rupture of the liver or spleen. In the event that the affected person complains of severe pain in the abdomen after a blow has taken place, or he has lost consciousness after a blow to the stomach, one should think about the possibility of internal bleeding (into the abdominal cavity). Move the affected person to a semi-sitting position with legs bent at the knees, and put a cold compress on the abdomen. A cold compress or ice pack is applied for 30 minutes, then the cold is removed, a break is taken for 30 minutes and the cold is applied again for 30 minutes. This alternation is carried out until hospitalization. You can not give him to drink or eat. It is urgent to organize the transfer of the victim to the hospital.

With a strong blow to the chest, bleeding into the pleural cavity may occur. If there was such a blow and the affected person breathes with difficulty and begins to choke, you should give him a semi-sitting position with bent lower limbs and put a cold compress on the chest.

Place the victim in an anti-shock position. Place the unconscious victim in a stable lateral position.

How to support the life of a person who has lost a lot of blood?

As a result of blood loss in the human body, changes occur that can become irreversible and lead to death. After you have stopped the bleeding (or it stopped spontaneously), a pressure bandage must be applied to the wound. Then release the affected person from squeezing clothing to facilitate breathing (unfasten, remove). If a person is conscious, and he has no wounds in the abdomen, you should give him sweet tea to drink. It is necessary to lay the victim on his back so that the legs are raised and the head is lowered. This posture contributes to the redistribution and temporary increase in the amount of blood in the heart, lungs, brain and other vital organs (the brain is most sensitive to its lack). It is necessary to organize the evacuation of the affected person to the hospital as soon as possible. The final stop of bleeding and complete surgical treatment of wounds is carried out in medical institutions, and we must not forget that stopping bleeding is the prevention of shock.

A tourniquet is a high-strength elastic product in the form of a strip used in medicine for squeezing blood vessels and temporarily stopping blood flow.

Types of harnesses

Currently, there are several varieties of medical tourniquets, they are distinguished by the material of the product and the principle of operation:

Esmarch's rubber band is a simple and cheap option, easy to process, does not change its shape over time. At the same time, the tourniquet has many disadvantages: it cracks and tears in the region of the holes, loses elasticity at low temperatures, can only be used over clothing, and is not very convenient to use.
Polymer-latex medical tourniquet is a rubber-fabric long strip with a plastic clasp. Easy to use - the compression force is easily adjusted, by pressing the button the tourniquet is easily unfastened. It is not expensive, long service life.
An electronic-pneumatic tourniquet is an electronic tourniquet that compresses blood vessels using a pneumatic chamber. Air injection is controlled by a sensor. The indicator shows the amount of squeezing pressure and the application time.
The tourniquet tourniquet is a high-strength product, but absolutely not elastic. It is tightened by twisting the lever.

For children, latex harnesses are used. They may differ in color and length - less than 50 millimeters.

What can be used if there is no tourniquet at hand: cloth and stick (twist method), belt, tie, belt, tow rope, rubber tube

Indications for application

A medical tourniquet is used in the following situations:

first aid for severe venous or arterial bleeding;
intravenous injections;
venous blood sampling;
traumatic limb avulsion;
pulmonary edema;
snake bite;
compression compression of the limb for a long (or unknown) time.

Harness rules:

it should be applied exclusively to clothing, if it is not there, any fabric should be used
it is necessary to adjust the degree of compression carefully and slowly - tighten gradually until the bleeding stops;
under the tourniquet there must be a note about the time of application, if there is no paper, write on the skin of the victim;
maximum safe wearing time of the tourniquet:
- time in winter up to 30 minutes;
- in the warm season - up to 60 minutes.
loosen the tourniquet every 10-15 minutes, while at the same time pinching the vessel above the tourniquet with your finger, then tighten it again with a little more force.
do not apply to the wound.
The position of the tourniquet depends on the source of bleeding:
- if an artery is damaged (scarlet blood, pulsating jet) compression above the site of bleeding, close to the wound.
- with venous bleeding (dark blood, draining from the wound) - below the wound.
the squeezed limb should be wrapped up so as to avoid freezing.

The criteria for a correctly applied tourniquet is the cessation of pulsation below the wound (artery injury), bleeding stops, the skin of the extremity is marbled.

Applying a tourniquet, depending on the site of arterial bleeding

Damage to the large vessels of the lower extremities: press the femoral artery (inner surface, upper third of the thigh) with a fist, put a roller (any solid object) in this place and clamp it with a tourniquet from above.

Damage to the carotid artery: a cotton-gauze roller or tissue is applied to the gushing carotid artery, on the opposite side the patient raises his arm so that the tourniquet wraps around the wound with the roller and the shoulder, tightens until the bleeding stops.

Injury to the upper limb: the tourniquet compresses the brachial or axillary artery, located on the inner side of the upper third of the shoulder, under the tourniquet roller.

Damage to the hand: the radial artery is clamped, at the level of the lower third of the forearm from the inside.

A tourniquet is an extreme measure to stop bleeding. It is applied only if other methods are ineffective - finger pressure of the vessel, pressure bandage on the wound.

Don't Make These Mistakes When Applying a Tourniquet

When applying a tourniquet, the following mistakes should not be made, since their commission is dangerous for the health of the victim:

clothes over the tourniquet;
use without indications;
insufficient fixing;
applying a tourniquet to the skin will damage it;
a strongly tightened tourniquet threatens with necrosis of the limb;
a poorly tightened tourniquet is ineffective,
the bleeding will continue; there is no overlay time stamp.

How to remove the tourniquet

First you need to make sure that the compression time does not exceed the allowable values, otherwise it is life-threatening. It is necessary to remove it gradually, to ease the pressure slowly, it is impossible to remove it sharply. Prior to removal, it is desirable to conduct anesthesia.

Other uses

In addition to stopping bleeding, a latex tourniquet is widely used in medical institutions. It is applied to the shoulder during venous blood sampling, removed before pulling out the needle. It is also used for intravenous injections and droppers, in order to facilitate the entry of a needle into veins that are invisible and not palpable without compression.

A patient with chronic heart failure may develop a complication in the form of pulmonary edema. The first first aid is the imposition of venous tourniquets on the limbs to reduce the load on the heart and temporarily turn off a certain amount of blood from the bloodstream. To do this, the patient lies down, arms and legs should be lower than the body, venous tourniquets are applied to the hips and right shoulder. Arterial pulsation must be present.

A tourniquet from a snake bite is a controversial issue. In the case of venomous bites, a tourniquet can aggravate a person's condition. This is due to the fact that after removal, the poison rapidly enters the bloodstream. It is better to use standard first aid methods without applying compression. With non-poisonous bites, pressure is all the more unnecessary.

With prolonged compression syndrome, it is important to use the tourniquet correctly so as not to cause total harm to health. First, the tourniquet is applied until the person is released from under the squeezing object. Secondly, it is necessary to impose strictly above the compression zone. In the case of inoperable destruction of the limb or necrosis, the tourniquet remains for a long time. In this condition, the patient is taken to the hospital, where infusion therapy and surgical treatment are performed.

There is also a tourniquet symptom - a method for verifying dermatological diseases such as syphilis, vasculitis, eczema and other diseases. The bottom line is squeezing the veins for 5-10 minutes at shoulder level (the pulsation of the arteries should not disappear), the appearance of a rash is considered a positive symptom.

Bleeding- outpouring of blood from blood vessels in violation of the integrity of their walls. Depending on the type of damaged blood vessels, bleeding can be arterial, venous, capillary and mixed. Of particular danger to life are arterial bleeding, when under high pressure the blood is poured either outward or into the body cavity during internal bleeding. A decrease in the volume of circulating blood (normally about 5 liters in a person) leads to a deterioration in the supply of oxygen to the heart, lungs, liver, kidneys, and brain. Bleeding is the most dangerous complication of wounds, directly threatening life. Bleeding refers to the release of blood from damaged blood vessels. It can be primary when it occurs immediately after vascular damage, and secondary if it appears after some time.

Depending on the nature of the damaged vessels, arterial, venous, capillary and parenchymal bleeding is distinguished.

Most dangerous arterial bleeding, in which a significant amount of blood can flow out of the body in a short time. Signs of arterial bleeding are the scarlet color of the blood, its outflow in a pulsating stream. Venous bleeding, unlike arterial bleeding, is characterized by a continuous outflow of blood, which has a darker color, while there is no obvious jet. capillary bleeding occurs when small vessels of the skin, subcutaneous tissue and muscles are damaged. With capillary bleeding, the entire surface of the wound bleeds. Parenchymal bleeding occurs when internal organs are damaged: the liver, spleen, kidneys, lungs (it is always life-threatening).

Bleeding can be external and internal. At outsidenom bleeding, blood flows out through the wound of the skin and visible mucous membranes or from the cavities.

At domestic bleeding blood pours into the tissue, organ or cavity, which is called hemorrhage. When tissue bleeds, blood soaks it, forming a swelling called an infiltrate or bruise. If the blood impregnates the tissues unevenly and, as a result of their expansion, a limited cavity filled with blood is formed, it is called a hematoma. Acute loss of 1-2 liters of blood, especially in severe combined lesions, can lead to death.

Signs of external bleeding: - arterial: blood is bright red, pours out in a pulsating stream; - venous: blood is dark red, flows out in a uniform stream; - capillary: blood is released over the entire surface of the wound.

First aid for bleeding

Depending on the type of bleeding (arterial, venous, capillary) and the means available in the provision of first aid, it is temporarily or permanently stopped.

A temporary stop of the most life-threatening external arterial bleeding is achieved by applying a tourniquet or twist, fixing the limb in the position of maximum flexion, pressing the artery above the site of its injury with the fingers. The carotid artery is pressed below the wound. Finger pressing of the arteries is the most affordable and fastest way to temporarily stop arterial bleeding. The arteries are compressed where they pass near or over the bone.

The temporal artery is pressed with the thumb against the temporal bone in front of the auricle when bleeding from head wounds.

Mandibular artery pressed with the thumb to the angle of the lower jaw when bleeding from wounds located on the face.

common carotid artery pressed against the vertebrae on the front surface of the neck on the side of the larynx. Then a pressure bandage is applied, under which a dense roller of bandage, napkins or cotton wool is placed on the damaged artery.

subclavian artery pressed against the 1st rib in the fossa above the clavicle with a bleeding wound in the shoulder joint, upper third of the shoulder or in the armpit.

When the wound is located in the region of the middle or lower third of the shoulder, the axillary artery is pressed against the head of the humerus, for which, leaning with the thumb on the upper surface of the shoulder joint, the rest squeeze the artery.

The brachial artery is pressed against the humerus from the inside of the shoulder to the side of the biceps muscle.

The radial artery is pressed against the underlying bone in the wrist at the thumb in case of damage to the arteries of the hand.

The femoral artery is pressed in the groin against the pubic bone by pressing with a clenched fist (this is done when the femoral artery is damaged in the middle and lower thirds). In case of arterial bleeding from a wound located in the region of the lower leg or foot, the popliteal "artery is pressed in the region of the popliteal fossa, for which the thumbs are placed on the front surface of the knee joint, and the rest are pressed against the artery to the bone.

On the foot, the arteries of the rear of the foot can be pressed against the underlying bones , then apply a pressure bandage on the foot, and in case of severe arterial bleeding - a tourniquet on the shin area.

After performing finger pressing of the vessel, it is necessary to quickly apply, where possible, a tourniquet or twist and a sterile dressing on the wound.

The imposition of a tourniquet (twisting) is the main way to temporarily stop bleeding in case of damage to large arterial vessels of the extremities. The tourniquet is applied to the thigh, lower leg, shoulder and forearm above the site of bleeding, closer to the wound, on clothing or a soft bandage lining so as not to pinch the skin. It is applied with such force to stop the bleeding. With too much compression of the tissues, the nerve trunks of the limb are injured to a greater extent. If the tourniquet is not applied tightly enough, arterial bleeding increases, since only the veins are compressed, through which the outflow of blood from the limb is carried out. The correct application of the tourniquet is controlled by the absence of a pulse in the peripheral vessel.

The time of application of the tourniquet with the date, hour and minute is noted V a note that is placed under the tourniquet so that it is clearly visible. The limb, tied with a tourniquet, is warmly covered, especially in winter, but not covered with heating pads. The affected person is injected with an analgesic from a syringe tube.

The syringe-tube (Fig. 8) consists of a polyethylene body, an injection needle and a protective cap; It is intended for single administration of drugs intramuscularly or subcutaneously.

To administer an analgesic, the syringe tube is taken by the body with the right hand, the ribbed rim of the cannula is taken with the left hand, the body is turned until it stops. Remove the cap protecting the needle. Without touching the needle with your hands, it is injected into the soft tissues of the upper third of the outer surface of the thigh, the upper third of the shoulder from behind, into the outer upper quadrant of the buttocks. Strongly squeezing the body of the syringe tube with your fingers, squeeze out the contents and, without opening your fingers, remove the needle. The used syringe-tube is pinned to the clothes of the affected person on the chest, which at the subsequent stages of evacuation indicates the introduction of an analgesic to him.

The tourniquet on the limb should be kept for no more than 1.5-2 hours in order to avoid its necrosis below the place where the tourniquet was applied. In cases where 2 hours have passed since its application, it is necessary to press the artery with a finger, slowly, under pulse control, loosen the tourniquet for 5-10 minutes and then apply it again a little higher than the previous place. This temporary removal of the tourniquet is repeated every hour until the affected person is provided with surgical assistance, while each time a note is made. If the tourniquet is tubular, without a chain and a hook at the ends, its ends are tied into a knot.

The main task with bleeding is to stop it as soon as possible. To do this, it is necessary: - to press the artery above the level of damage (Fig. 9 c). The location of the arteries and the places of their pressing in case of bleeding are shown in Fig. 9 b, c. - apply a pressure bandage to temporarily stop bleeding (venous, capillary, as well as from small arteries). Considering that in children the arteries are more elastic, and blood pressure is lower than in adults, even arterial bleeding can be stopped with a pressure bandage!

Rice. 9. Scheme of the human arterial network and points of digital pressure of the arteries to stop bleeding.

Technique applying a pressure bandage: a clean, preferably sterile, gauze napkin is applied to the wound, a tightly folded lump of cotton wool is placed on top of it, after which it is tightly bandaged with a circular bandage. The use of a hemostatic tourniquet is indicated for damage to large arteries of the extremities.

1. A tourniquet is applied in case of damage major arterial vessels.

3. The tourniquet is applied to the raised limb. A soft pad is laid under the tourniquet: bandage, clothes, etc.

4. The tourniquet is applied tightly, but not unnecessarily. Be sure to attach paper indicating the time of its application.

6. If the rescuer does not have a special tourniquet at hand, improvised means can be used: a scarf, tie, suspender, belt, etc.

7. When a part of a limb is torn off, a tourniquet is necessarily applied, even in the absence of bleeding.

1 - from the arteries of the lower third of the leg; 2 - femoral artery; 3 - arteries of the forearm; 4 - brachial artery; 5 - axillary artery; 6 - external iliac artery.

The improvised means used should be at least 2-3 cm wide. Very thin cords, strings, wires (everything that has a circular cross section in diameter) can cut through the skin along with vessels that have not yet been damaged. The use of rubber tubes leads to damage (necrosis) of the skin. A tourniquet is the last resort.

To prevent damage to blood vessels and nerves, the width of the tourniquet should be at least 5 cm. You can apply a cuff from the pressure measuring device above the bleeding site (without applying it to the joint) and inflate it to a level of 300 mm Hg. The overlay time is recorded. Vessel clamping is performed only if life-threatening bleeding continues.

Remember that a tourniquet for arterial bleeding must be applied above the site of bleeding (closer to the heart) and closer to the site of injury in order to bleed as little of the limb as possible. You must first raise this limb. In the area of the wrist and ankles, it is useless to apply a tourniquet.

The ends of the tourniquet are brought together and fixed. With a weak application of the tourniquet, the arteries are not completely clamped, and bleeding continues. Due to the fact that the veins are clamped with a tourniquet, the limb becomes filled with blood, its skin becomes cyanotic, bleeding may increase. In case of severe compression of the limb with a tourniquet, the nerves are injured, which can lead to paralysis of the limb. Proper application of the tourniquet leads to stopping the bleeding and blanching of the skin of the limb. The degree of compression of the limb with a tourniquet is determined by the pulse on the artery below the place of its application. If the pulse disappeared, then the artery was squeezed by the tourniquet.

A contraindication to the imposition of a tourniquet or twist is an inflammatory process.

Recently, the atraumatic ribbed hemostatic tourniquet of Dr. V.G. Bubnov. This tourniquet does not infringe the skin when applied and can be used on a bare limb; the tourniquet does not injure blood vessels and nerves, so it is tightened when applied with maximum effort; the tourniquet can remain on the body for 8-10 hours, since the ribbing of the tourniquet helps to maintain blood circulation in the skin and subcutaneous vessels, which is the prevention of necrotic processes in the distal limbs.

A tourniquet is a far from ideal solution to the problem of stopping bleeding. It is believed that the applied tourniquet inevitably leads to rough compression of large nerve trunks and the development of severe neuropathy in the later stages, i.e. damage to the nerves with a sharp violation of the functions of the limb. After 7-10 min. after applying a tourniquet, the victim has a feeling of unbearable tingling and a feeling of fullness, very severe pain. The tourniquet stops the blood flow through the main and collateral vessels below the applied tourniquet.

In the absence of an influx of oxygenated blood, metabolism proceeds according to the anoxic type. After removing the tourniquet, underoxidized products enter the general circulation, causing a sharp shift in the acid-base state to the acid side (acidosis), vascular tone decreases, and acute renal failure develops. The combination of the described damaging factors causes acute cardiovascular, and then multiple organ failure, referred to as tourniquet shock or crash syndrome.

This creates ideal conditions for the development of anaerobic infection, especially when the wound becomes infected. The application of a tourniquet, at best, is an opportunity to win some time for the first aid provider (with very severe arterial bleeding). In the absence of a tourniquet, you can apply a twist, which is made of soft but durable material (fragments of clothing, a piece of cloth, a soft trouser belt). At the same time, a strip of material is brought above the wound and closer to it and its ends are tied. Then insert a wooden stick and rotate it, while slowly tightening the twist until the bleeding stops. The free end of the stick is fixed with a bandage.

It could be everyone. No one is immune from all kinds of injuries and injuries, which is why it is so important and, sometimes even vital, to know some aspects of first aid. Among such especially important techniques, one can also find the rules for applying a tourniquet.

So what you need to know.

Firstly, a tourniquet is needed when a large artery is damaged (in such cases, ordinary dressing and bandaging of the wound will not help stop the bleeding).
It is important to correctly position the tourniquet - five centimeters above the upper wound edge.

So, in case of bleeding from the vessels of the upper limb, the optimal location of the tourniquet is at the level of the upper third of the shoulder, and in case of bleeding from the vessels of the lower limb, it is at the level of the middle third of the thigh.

As a tourniquet, you can use a belt, a bandage (folded in layers to increase strength), any fabric, and many other things at hand. The tourniquet must be applied to the raised limb.

The density of its imposition should be such that the bleeding stops. However, do not overdo it, otherwise the underlying tissues will remain completely bled. As a result, tissue necrosis (death) will occur. Do not forget to put some kind of dense tissue under the tourniquet to reduce local (local) compression in the overlay area. For this purpose, you can apply it directly to clothing.

The rules for applying a tourniquet include one very important point, which should not be forgotten in any case. Attach a sheet of paper or cardboard to it, on which write the time it was applied. This is necessary so that in the event of a tourniquet being applied for a long time, to know when it is necessary to loosen it and give the underlying tissues “nutrition”. Indeed, in oxygen-free conditions (without blood flow), tissues begin to die, which is why it is so important to loosen the tourniquet in time and partially restore blood flow, even for a short period of time.
Remember - you can not apply a tourniquet for more than one to two hours.

In the winter season, care must be taken not to get frostbite of a limb tied with a tourniquet, that is, it is necessary to thoroughly isolate it from the cold. In the cold, the maximum squeezing time is reduced to one and a half hours.

It is necessary to loosen the tourniquet for 10-15 minutes, while pressing the bandage on the wound with your hand. Frequency of weakening: first one and a half to two hours from the time of application, and then every half hour.

Venous or from the vessels of the extremities does not require a tourniquet. In such a case, it is enough to stop the bleeding with a tight one. Do not forget to give the limb an elevated position - this will ease the bleeding.

To stop severe bleeding, when a large vessel is damaged, and there is no option for applying a tourniquet, you can resort to an alternative method - finger pressure of the bleeding vessel. In order for it to stop, it is necessary to press the vessel above the wound to the bone, that is, you need to choose a place for finger pressing in which the vessel is located relatively superficially and passes near the bone.

One of the difficulties of digital pressing is the inability to squeeze the vessel for a long time due to hand fatigue.

Realizing that the rules of imposition are so important, and that it is often their knowledge that saves people's lives, you begin to treat the material you read with great respect, interest and awe.
Knowing the technique and rules for applying a tourniquet, you can help people in trouble.

Both the rules for applying a tourniquet and in an emergency will help save the life of your own or your loved ones, so do not neglect them, and, from time to time, return to re-reading this material.