Finger pressed arteries algorithm. Conducting the finger pressed arteries during bleeding to what the carotid artery is pressed during bleeding

Depending on the type of bleeding (arterial, venous, capillary) and the funds available during the provision of first medical assistance, they carry out a temporary or final stop.

A temporary stop of the most dangerous to life of outdoor arterial bleeding is achieved by the imposition of a harness or twist, fixing the limb in the position of maximum bending, pressing the artery above its place damage to the fingers. Sleepy artery is pressed below the wound. Fingerproof arteries - the most affordable and fast way to temporarily stop arterial bleeding. The arteries are pressed in places where they pass near the bone or above it (Table II color plint).

The temporal artery (1) is pressed with a thumb to the temporal bone ahead of the ear shell during bleeding from wound heads.

The mandibular artery (2) is pressed with a thumb to the corner of the lower jaw when bleeding from wounds located on the face.

The total carotid artery (3) is pressed against the vertebrae on the front surface of the neck on the side of the larynx. Then impose a gulling bandage, which is put on the damaged artery with a dense roller from the bandage, napkins or wool.

The subclavian artery (4) is pressed to the 1st edge in the hole above the clavicle when the wound is bleeding in the area of \u200b\u200bthe shoulder joint, the upper third of the shoulder or in the axillary depression.

When the wound is located in the region of the medium or lower third, the shoulder shoulder artery (5) to the head of the shoulder bone, for which, leaning with a thumb on the top surface of the shoulder joint, squeeze the artery.

The shoulder artery (6) is pressed against the shoulder bone from the inner side of the shoulder on the side of the double-headed muscles.

The radiation artery (7) is pressed to the dice in the wrist area in the thumb with damage to the arteries of the brush.

The femoral artery (8) is pressed in the groin area to the pubic dice by pressing with a compressed fist (this is done during damage to the femoral artery in the middle and lower third). In the arterial bleeding from the wound, located in the field of the lower leg or foot, press the popliteal artery (9) in the field of the popliteal fossa, for which the thumbs are put on the front surface of the knee joint, and the rest pressed the artery to the bone.

At the foot, it is possible to press the filtering bones of the Foot rear (10), then impose a gulling bandage on the foot, and with strong arterial bleeding - harness to the lower leg.

After taking a finger pressed vessel, you need to quickly impose, where it is possible, harness or a twist and sterile bandage on the wound.

The imposition of the harness (twist) is the main way to stop bleeding during damage to large arterial limb vessels. The harness is imposed on the thigh, the shin, shoulder and forearm above the place of bleeding, closer to the wound, on clothes or a soft lining from the bandage so as not to pinch the skin. Harness impose with such force to stop bleeding. With too much squeezing the tissues are more traumatized by the nerve trunks of the limbs. If the harness is not imposed enough, arterial bleeding is enhanced, since only veins are squeezed, according to which blood outflows are carried out from the limb. The correctness of the imposition of the harness is controlled by the absence of a pulse on the peripheral vessel.

The attachment time of the harness indicating the date, an hour and minutes are noted in the note, which is put under the course of the harness so that it is clearly visible. The limb, pulled by the harness, is covered warm, especially in winter, but not laid by the heating. The anti-observative means of a syringe tube is affected.

Syringe Tubik (Fig. 15) consists of a polyethylene case, an injection needle and a protective cap; Designed for disposable drug administration intramuscularly or subcutaneously.

For the introduction of an anti-oblamic agent, the syringe tube is taken for the housing, the left behind the ribbed bezel cannula, the housing turns until it stops. Remove the cap, protecting the needle. Without touching the needle with his hands, put it into the soft tissues of the upper third of the outer surface of the thigh, the top third of the shoulder is behind, in the outer upper quadrant of the buttocks. Highly squeezing the housing of the syringe tube, squeeze the contents and, without squeezing the fingers, remove the needle. The used syringe tube rises to clothes affected by the breast, which at the subsequent stages of evacuation indicates the introduction of an anti-tax agent.

Harness on the limbs should be kept no more than 1.5-2 hours to avoid finite grounds below the place of imposing a harness. In cases where, from the moment of its imposition, 2 hours passed, it is necessary to perform the finger pressed artery, slowly under the control of the pulse, weaken the harness for 5-10 minutes and then apply it a little higher than the previous place again. Such temporary removal of the harness is repeated after every hour until surgical assistance is affected, while each time they make a mark in the note. If the pipe is a tubular, without a chain and hook at the ends, its ends are tied to the knot.

In the absence of harness, arterial bleeding can be stopped by the imposition of the twist (Fig. 16) or by maximizing limb flexion and its fixation in this position.

To stop bleeding using a twist, a rope, twisted handkerchief, fabric strips are used. The improvised harness can serve as a trouser belt, which is folded in the form of a double loop, put on the limb and tighten.

The temporary stop of the outer venous and capillary bleeding is carried out by applying a quenching sterile bandage onto the wound (close it with sterile napkins or a bandage of 3-4 layers, the hygroscopic wool is placed on top) and make the damaged part of the elevated position with respect to the body. In some cases, the temporary stop of venous and capillary bleeding can be final. The final stop of the arterial, and in some cases and venous bleeding is carried out in surgical processing of the Russian Academy of Sciences.

With internal bleeding on an estimated region of bleeding, a bubble with ice is put, affected immediately deliver to the medical institution.

Questions and tasks. 1. What are the ways to temporarily stop arterial bleeding? 2. What are the arteries and where are pressed to stop bleeding? 3. What are the rules for imposing a hemostatic harness and spin? 4. Enter the harness on the thigh, shoulder, shin, forearm. 5. Verify the trouser belt on the shoulder in the form of a double loop. Enter the twig on the shoulder. 6. How do venous and capillary bleeding stop? 7. How is the syringe tube and what are the rules for use?

The method of finger pressed arterial stem over the distance is based on squeezing the wall of the main vessel between the finger and the bone in certain anatomical points.

This manipulation is indispensable when it is impossible to immediately have more radical assistance.

Patient position:

Technique manipulation:

• On the limbs, the finger pressing of the arterial trunk is proximal to the place of its damage, on the neck and head - distal.
• The compression of the vessels is produced by several fingers, but most efficiently - two first fingers of both hands.
• The temporal artery is pressed above and the kleon from the ear shell.
• Sleepy artery - among the middle of the head-and-ended edge of the breast-curable-bed-like muscle to the transverse process of the VI vertebra.
• The outer jaw artery is to the lower edge of the lower jaw on the border of the rear and medium third.
• The temporal artery is pressed against the temporal bone in the area of \u200b\u200bthe temple, ahead and above the ear goat.
• The plug-in artery is higher than the clavicle to 1 edge (it is better to apply a sharp assignment of the hands of the back and the book, while the artery hurts to 1 edge by the clavicle).
• The axillary artery is pressed in the axillary depression to the head of the shoulder bone.
• The shoulder artery is to the shoulder bone along the inside edge of the double-headed muscle.
• The elbow artery is pressed to the elbow bone in the upper third of the inner surface of the forearm.
• Bleeding from the arteries of the brush is stopped by simultaneously pressing the elbow and radial artery to the same bones along the palm surface of the lower third of the forearm.
• The abdominal aorta is pressed with a fist, having it to the left of the navel to the spinal column.
• The femoral artery is to the horizontal branch of the pubic bone below the tippack bundle in its middle.
• The popliteal artery is in the middle of the poned fossa during a semi-bounted knee joint to the rear surface of the femoral or large bone sumpers.
• At the foot at the same time (both hands) pressed the back of the foot on the middle of the distance between the outer and the inner ankles, below the ankle joint to 1 tie and rear tibia - behind the inner ankle.

Technique imposing Zhguta

Equipment:

• Zhgut Esmark.

Patient position:

• The patient lies on his back or sits.

Tactics manipulation:

• The limb before applying a harness, if there is no fracture, lifted.
• Climbing the harness is needed at 8-10 cm. It is proximal than the injury of the blood vessel (the unreasonable turning off of the blood supply of the large segment of the limb contributes to the appropriate extent to the development of tissue hypoxia, impaired trophic processes, the accumulation of toxic decay products of non-expendable tissues, creating favorable conditions for the development of anaerobic infection; after the harness is removed; The flow of a significant amount of toxic substances in the blood circuit causes or exacerbates the shock state of the victim).
• Harness should be put on clothes or the place of overlay to overtake exactly a towel, a diaper. It is necessary to impose a harness with a metered effort, seeking only stopping bleeding. An indicator of sufficient compression is the disappearance of the pulse on the arterial vessels of the peripheral limb.
• The harness is put, making a complete turn and dosed by stretching the part of it that has come around the limb. Subsequent tours lay from above, completely or two-thirds overlapping the previous one.
• The limb with superimposed harness must be immobilized.
• If there is a bone fracture except bleeding, then harness is appropriate to the limb, as far as possible outside the fracture.
• The harness can be kept no more than 1.5 hours on the top and 2 hours on the lower limb. If the delivery of the victim cannot be provided within the specified time, the harness should weaken every hour to weaken or shoot, and with renewed bleeding, it is re-imposed again, but somewhat above the place of the first overlay.
• The time of the imposition of a harness must be mentioned in the accompanying note.
• At the very first opportunity, harness must relax or remove, replacing it with a gulling bandage.

Stopping bleeding with a harness when the carotid and the axillary artery wound has certain features, due to the anatomical features of the neck and the axillary region.

When the carotid artery is injected, the harness is superimposed using the neck of the corler's tire, the screwdrivers in the form of a piece of blackboard or a stick, raised arm (shoulder) of the victim from the opposite healthy side of the neck. Under the fingers, squeezing the carotid artery, should be put longitudinally (artery) lifelong roller, rolled bandage, etc. Then, without releasing the fingers, the harness is superimposed according to the general rules, while with a healthy side it passes through the tire that protects against the compression is not a wounded carotid artery.

When the axillary artery (distal part) is injected in the area of \u200b\u200bthe brachial bone head, the harness is applied as eight. Do not stop the finger pressed, under the finger spend the middle of the harness. Then, stretching strongly, harness in the middle part it is crossed over the clavicle. Its ends are connected in a healthy axillary area. It is desirable for the harness on the wounded artery to pre-lay a march roller, rolled bandage, etc.

Errors and complications when attaching a harness:

• The imposition of a harness without sufficient readings.
• The imposition of a harness on nude skin can cause it to ischemia or tissue necrosis.
• Incorrect selection of a place to impose a harness (a gross error when the harness is applied on the thigh or shoulder when the blood vessels of the foot or brushes is injured).
• Weak tightening of the harness leads to compression only veins, which leads to congestive hyperemia in limb and enhancing bleeding.
• A long stay of the harness on the limb may result in damage to the nerves (paresa, paralysis), ischemic contractures and even gangrene of the part or the entire limb and creates favorable conditions for the development of anaerobic infection.
• The patient with superimposed harness should be sent in an emergency order to the medical institution for the final stop of bleeding.

Fully moments so that the person faces the high probability of danger to his life. Qualified medical care is only on the approach, and the blood loss from the wound from the rupture of the artery threatens with a fatal outcome. Blood with a rapid flow leaves the injured organism, and there is nothing at hand, which could help in providing emergency care, and hope for salvation melts with every second.

Never eyewitness incidents inclined above the victim, with anxiety in the eyes trying to estimate the degree of hanging threat. But dirty scraps of clothing, a mixture with bone fragments, blocked access to a mortal wound and do not make it possible to see something under them. Finally, a person trying to assist the victim, assessed the degree of a dangerous situation.

Open bleeding from the wound requires instant help, because the delay threatens human life. He strongly cleans the wound and squeezes the damaged artery with his fingers.

Blood continues to flow, and the vessel between the fingers eludes and it is impossible to effectively compress it. Saving struggling to the artery with big fingers of both hands. Over time, from incredible efforts, his fingers are eager. There is a need to change the way to relieve and apply coverage by hand, presses with a thumb torn artery. There is no help, but the hand, compressing the wound, begins to experience pain. For minutes after ten convulsions, the limb will reduce, forcing the way to change again. He will have a fist of the second hand to put on a finger, pressing the artery. As long as the exact source of bleeding is unknown, the decision is made to weaken the clamp and put on the wound to the wound both palms and wait for the possibility of putting a tight bandage on the wound. But even if after that, the bleeding does not stop, and the more enhanced, then again it is necessary to put on the wound.

What is the shining of sleepy arteries

The wounded is unusually lucky if his lifeguard is familiar with the anatomical structure of the human body and knows the points of influence on the injured vessel in an alternative place.

How to choose the point

For sure, knowing the main locations of the clamp, you can transmit a trunk arterial vessel, not in the wound, and slightly above it. This will significantly reduce the influx of blood and will be able to protect the injured organism for a while. Points choose not at random. It is necessary to take into account the direction of blood current by vessels, clamping the damaged artery on both sides. Only in this case is a positive effect. But if there is a bone of fracture at the injury, then the compression of the intended point is unacceptable!

It is necessary to designate the accurate places of pressed artery. I would like to note that the arteries are divided into such as:

• shoulder;
• femoral;
• sleepy;
• jewish;
• temporal;
• connect.

If there is a shoulder artery, then the closest point of pressed is between the muscles located on the shoulder. In this case, it is necessary to lay the hand of the head victim to him and take a place behind the victim, accepting a convenient position. Press the artery is needed by four fingers outside, fastening the deepening between the shoulder muscles and pressed strongly, pressing this place to the bone. There are cases when bleeding with the upper part of the shoulder is resigned by pressing with your fingers, pressing the vessel to the head of the shoulder bone in the armpit area.

In case of damage to the femoral artery, the point in the groin zone in the middle of the skin folds is pushed. In this place, the artery is pressed against the femoral bone. Standing on his knees from the injured leg, pressing with all their weight on the arms elongated for the stop, while with all the fingers wrapped the thigh of the victim and only then indexed pressure on the point in the groin.

Stop bleeding of vessels from the head or when damaged the vessel of the top of the neck is possible:

1. Impacting a carotid artery, while eliminating the use of a tight, gulling dressing, because there will be nothing to breathe the victim.
2. Palm is put on the head of the victim, and the press makes a thumb or are located behind and clamp the wound with four fingers.
3. Given the direction of blood flow through the carotid artery, they pin down the point below the injury.
4. The location of this point is the middle of the front surface of the cervical muscle.
5. The head of the wounded turn so that it was clearly visible. The artery is pressed against the masculous process of vertebrae.

If the head is injured, the shoulder joint or neck, then instead of a carotid artery, the connective artery is pressed by the index finger and press on the vestment on the wedge.

Jewish and temporal artery are located in the area of \u200b\u200bactive invention of facial. The stopping of heavy bleeding of the jaw artery is achieved by her pressed to the lower jaw.

Stopping bleeding from the temporal artery occurs after pressing the point in front of the ear shell.

In case of injuries, the blood bleeding of vessels does not cause mortal danger. Nevertheless, to reduce blood loss, at the moment when a tight bandage is preparing, a finger pressing is applied. Raising the finiteness with a circular grip, squeeze the point located in the middle third of the forearm.

Bleeding of vessels stops stopping her back side.

The finger pressed artery during bleeding is temporary and is made in the case of emergency assistance to the victim to the arrival of qualified specialists.

How to diagnose inner bleeding

If, with outdoor bleeding, it is not so difficult to determine the diagnosis, then with internal - it is not possible. It will require certain knowledge, because the blood does not fall at once, but after some time.

So, pulmonary bleeding is accompanied by a hemoplange, the progress of the foaming blood from the nose / mouth. Esophageal or gastric bleeding is accompanied by vomiting with blood (sometimes "coffee grounding"). If bleeding occurs in the stomach, duodenalist, biliary tract, it entails a manifestation of a tin-shaped chair.

If bleeding was formed in a straight / colon, it is accompanied by the appearance of the blood of raspberry, cherry, scarlet color in feces. Renal bleeding colors urine victim in scarlet color.

It is worth noting that with visible internal bleeding, the discharge of blood can not be manifested immediately, but after some time. Accordingly, the use of general symptoms and certain diagnostic methods with internal bleeding is extremely necessary.

Definitely complex is the diagnosis of hidden internal bleeding. In this situation, local symptoms are divided into two main groups:

1. Identifying spectacular blood.
2. Some changes in the functions of those or other bodies that were damaged.

To reveal the spilled blood, you should pay attention to some signs:

1. Bleeding in pleural cavity:
   • percussion sound is dulled over a certain surface of the chest;
   • breathing weakens;
   • mediastum shifts;
   • there is a breathing failure.
2. Bleeding in the abdominal cavity:
   • stomach swells;
   • peristalistics weakens;
   • the percussion sound is dulled in the detached places of the abdomen;
   • sometimes symptoms of peritonean irritation are observed.
3. Bleeding in a cavity of a joint:
   • the joint increases in volume;
   • the appearance of sharp pain;
   • violation of the direct function of the joint.
4. Hemorrhage / Hematomas:
   • you can determine swelling;
   • pain symptom in acute form.

What is blood pressure and in which units is measured

Finally, it is worth noting that the blood loss is not so terrible and is dangerous with bleeding, as a significant change in the functions of certain organs. As an example, it is possible to bring bleeding into the pericardial cavity, which entails the pericardium tamponade (while there is a sharp decline in cardiac output, stop the heart), although the volume of blood loss is completely small.

Temporary methods of stopping bleeding are mechanical in nature.

Temporary stopping of outdoor bleeding is carried out when providing community (first medical, paramedic, first medical) help.

The main task of these types of assistance is temporary stop of outdoor bleeding. The correct and timely execution of this task may be decisive to save the life of the victim.

Methods of temporary stopping of bleeding make it possible to save the victim from acute blood loss and suggest an immediate stopping of bleeding at the scene and delivery of the wounded to the medical institution where the final stop will be made.

First of all, it is necessary to determine the presence of outer bleeding and its source. Each minute of delay, especially with massive bleeding, may be fatal. You can transport the victim with outer bleeding only after a time stop of bleeding at the scene.

Ways to temporarily stop bleeding:

pressing the artery fingers proximal than the wound;

maximum flexion of limb in the joint;

raised limb position;

imposition of the gag

tight tamponade wounds;

pressing a bleeding vessel in the wound;

overlay clamp on a bleeding vessel in the wound;

the imposition of arterial harness.

Pressing the artery fingers proximal than the wound

The greatest danger to the life of the victim is arterial outdoor bleeding. In such cases, it is necessary to immediately implement pressing the artery fingers to the bone is proximal than the wound (closer to the heart from the wound): on the limbs - above the wounds, on the neck and head - below the wound, and only after that prepare and perform a temporary stopping of bleeding in other ways.

Pressing the artery finger is proximal than wounds. This is a fairly simple method that does not require any auxiliary items. Its main advantage is the possibility of as quickly as possible. The disadvantage - can be effectively used only for 10 - 15 minutes, that is, it is short-term, since the hands are tired and the pressure weakens. In this regard, at the first stage, there is a need to apply other methods of temporary stopping of arterial bleeding.

It is especially important to press the artery finger to be proximal than the wound when preparing for the imposition of arterial harness, as well as with its change. The time spent for the preparation of a harness or a gulling bandage with unexpected bleeding may cost the life of the victim!

There are standard points in the projection of large arteries, in which it is convenient to press the vessels to those subject to bone protrusions. These points are important not easy to know, but also to be able to quickly and effectively press the artery in the specified places, without spending time on its search (Table 4, Fig.3.).

Table the names of the main arteries, points of their pressed and external benchmarks, as well as bone emphasis, to which arteries are pressed.

These places are not chosen by chance. Here arteries are the most superficially, and the bone is under them, which allows with the exact pressed fingers it is quite easy to overlap the clearance of the vessel. At these points, it is almost always forgiving the pulsation of the arteries.

Fig. Fingerproof Sleepy (a), facial (b), temporal (B), connectible (g), shoulder (D), axillary (E), femoral (g) arteries for temporary bleeding stop.

Table 4.

Points for finger pressed arterial stems with exterior bleeding

Pressing and especially retention of the trunk arterial trunk represent certain difficulties and require knowledge of special techniques. The arteries are quite mobile, so when trying to add their pressed, one finger "slip" from under it. In order to avoid loss of time, pressed is necessary to carry out or several tightly compressed fingers of one hand, or two first fingers of both hands (which is less convenient, since both hands are engaged in this) (Fig. 4 A, b). If necessary, a sufficiently long pressing, requiring physical effort (especially when pressed the femoral artery and the abdominal aorta), should be used by a mass of its own body. (Fig. 4 V).

It should be remembered that the correctly produced finger pressing should lead to an immediate stop of arterial bleeding, i.e., to the disappearance of the pulsating jet of blood coming from the wound. In arteriovenous bleeding, venous and especially capillary bleeding can, although to decrease, but some time is maintained.

After arterial bleeding is stopped by pressing fingers, you need to prepare and carry out a temporary stopping of bleeding in another way, most often by the imposition of arterial harness.

The abdominal aorta can be squeezed to the spine through the front abdominal wall. To do this, put the victim for a rigid surface and put on a fist, using the whole severity of your body, to the area of \u200b\u200bthe navel or a little left. This reception is effective only at thin people. It is used in profuse bleeding in the wounds of the iliac arteries (above the groove bundle).

Pressing, as a rule, does not give a complete movement of the aorta, in connection with which the bleeding does not stop completely, but only becomes weaker. This technique may be accompanied by an injury of anterior abdominal wall and even the abdominal organs. It is not recommended to perform it with an academic goal, it is enough to learn how to determine the pulsation of the abdominal abortion in the aircraft region.

Fig. 3. Points for finger pressed arteries (explanation in the text)

Fig. 4. Temporary cessation of bleeding by the method of finger pressed arteries

a - pressed with fingers of one hand; b - pressed two first fingers; In - Pressing the femoral artery fist.

Maximum flexion of limbs in the joint

To stop arterial bleeding (with injuries of femoral, poning, axillary, shoulder, elbow, radiation and other arteries) from distal limbs can be resorted to maximum flexion limb.In the place of flexion (elbow fold, a patellied fossa, a groin fold) put the rollers of the bandage or a dense-gauze roller with a diameter of about 5 cm, after which the limb is rigidly fixed in the position of maximum bending in the elbow (when the arteries of the forearm or brush), knee (when The origin of the arteries of the leg or foot) or the hip (with the injury of the femoral artery) joints (Fig. 5). Bleeding stops due to the inflection of the arteries.

This method is effective in arterial bleeding from the hip (maximum bending in the hip joint), from the leg and foot (maximum bending in the knee joint), brushes and forearms (maximum bending in the elbow joint) .

Fig. 5. Temporarystop bleeding by maximum flexion bending.

a - in the elbow joint; b - in the knee joint; in the hip joint.

Indications for the maximum flexion of limb in the joint as a whole are the same as when the arterial harness is applied. The method is less reliable, but at the same time less trauma. Stopping bleeding with the help of maximum flexion of the limb leads to the same as when the harness is superimposed, ischemic distal departments, therefore the period of stay of the limb in the maximum bent position correspond to the deadlines for the limbs of the harness.

This method does not always lead to the goal. The described method of stopping bleeding is not applicable with accompanying bone injury (fractures or bone dislocations).

When bleeding from the axillary artery or peripheral sections of the subclavian arteryboth shoulders maximize the kice (almost to contact the blades) and fix one to another at the level of the elbow joints. At the same time there comes compression of a subclavian artery between the collar and the first edge.

Fig. 6. Temporary stop of bleeding from the axillary or plug-in artery

Maximum flexion in the elbow joint is often used to stop bleeding. after puncture of cubital veins.

Giving a damaged limb of an elevated position

Raising the damaged limb (making the limb of the sublime position)reduces blood blood flow and contributes to a faster thrombus formation.

Indications for its use - venous or capillary bleeding when the distal limbs are injured.

Overlaying grapple dressing

Overlaying the gag.Bleeding from veins and small arteries, as well as from capillaries, it is possible to stop by imposing a gulling bandage. The imposition of the gulling dressing is desirable to combine with other methods of temporary stopping of bleeding: with a raising limb and (or) with a wound tamponade.

After processing the skin around the wound by the skin antiseptic, sterile gauze wipes are applied to the wound, and on top of a wool layer or a cottage-gauze roller, which for the local grinding of bleeding tissues are tightly recorded.

Before overlaying the dressing, it is necessary to give the limbs an elevated position. The bandage should be applied from the periphery to the center. At the same time, in order to achieve the required pressure of the roller on soft tissues, with its fixation, the reception of the "Bandage crossing" is used, as shown in Fig. 7.

Fig. 7. Reception of "Bandage CrossTow" when applying a gulling bandage

It is convenient for these purposes an individual dressing package (Fig. 8).

Fig. 8. Individual dressing package

The gulling bandage can be imposed when bleeding from varicose-wide extended veins of the lower extremities, as well as after many operations, for example, after phlebectomy, after resection of the breast, after a mastectomy. However, the gulling bandage is not effective in massive arterial bleeding.

Tight tamponade wounds

In cases where the raising of the limb and the imposition of the gulling dressing is not possible to stop the bleeding, the wound tampony is used, followed by the applied of the gulling bandage, which, provided the sublime limb position, is a good method of temporary stopping of bleeding from large veins and small (and sometimes, and large) arteries. It is used with deep damage and vascular injuries. The wound tamponade also stops capillary bleeding. A tight tamponade wounds are often used in venous and arterial bleeding in the area of \u200b\u200bthe scalp, on the neck, torso, in the jagged area and other areas of the body.

The method is tight filling the wound cavity with gauze napkins, turgunds or special tampons. Gauze tampons or wipes are introduced into the wipes, which are tightly filled with the whole wound cavity. At the same time, it is necessary to ensure that the tip of each napkin is on the surface of the wound. In some cases, the skin edges of the wounds are flashing and tightened with seams over a tampon. Marley, soaking with blood, becomes the basis for the drop-down fibrin and the formation of the thrombus. Tamponade wounds can be used as a method of temporary or permanent hemostasis. To enhance the action, tamponade is often combined with the use of local hemostatic agents, such as hydrogen peroxide. The use of wound hypothermia enhances the hemostatic effect due to the spasm of the vessels and an increase in platelet adhesion to the endothelium.

Perform a full-fledged tamponade at the prehospital stage of medical care, in the absence of aseptic conditions and pain relief, it is not always possible.

It should be very careful about tampony in suspected penetrating injuries (thoracic, abdominal cavity), since the tampons can be introduced through the wound in the body cavity. It is also necessary to treat tight Tamponade wounds in the populated area, since in this case the limb ischemia and its gangrene can develop.

In addition, the wound tamponade creates conditions for the development of anaerobic infection. Therefore, where possible, from wound tamponation should be refrained.

Pressing a bleeding vessel in the wound

Pressing a bleeding vessel in the woundexercise, if necessary, in urgent cases (this technique sometimes use surgeons when bleeding during surgery). For this purpose, the doctor (Feldsher) quickly puts on a sterile glove or processes their alcohol gloves. The place of damage to the vessel is pressed in the wound with your fingers or a tipper (gauze ball or a small napkin in a Mikulich or Kohler cliement, or in Corncange). Bleeding is suspended, the wound drained and choose the most appropriate way to stop bleeding.

Overlaying clamping on a bleeding vessel in the wound

At the cooking stage, when assisting, it is possible to impose hemostatic clamps in the wound, if there are sterile hemostatic clamps (bilro, cross or others) and the bleeding vessel in the wound is clearly visible. The vessel is captured by the clamp, the clamp is fastened, a aseptic bandage is superimposed on the wound. The clamps are placed in a bandage imposed on the wound, and the limbs leave a provisional harness. When transporting the victim in the medical institution, immobilization of the damaged limb is necessary. The advantages of this method are simplicity and preservation of collateral blood circulation. The disadvantages include low reliability (the clamp in the process of transportation may unbavailable, break from the vessel or tear together with a part of the vessel), the ability to damage the clamp spaced next to the damaged artery of the veins and nerves, crushing the edge of the damaged vessel that later makes it difficult for the exhibition of vascular seam for Final bleeding stop.

The imposition of the clamp on the bleeding vessel in the wound apart in case of the impossibility of the time stop of the bleeding in other ways, in particular, when bleeding from damaged vessels in the injuries of the proximal sections of the limb, as well as injuries of the chest or abdominal wall. When you lay the clamps, it is necessary to remember what to do this is extremely careful, necessarily under the control of the view to avoid damage to the nearby nerves, vessels and other anatomical formations.

At first trying to stop the bleeding, pressing the bleeding vessels with your fingers (throughout, in the wound) or a bottle in the wound, drained the wound from the blood, and then impose hemostatic clamps in the wound or directly to the bleeding vessel, or (with the difficulties of identifying it) on the thickness of the soft tissues in which the damaged vessel is located. There may be several such clamps. Since the victim is to be further transported, with the aim of preventing early secondary bleeding, it is necessary to take measures to prevent scalp, breaking or unbounding the clamps.

Outping arterial zhguta

In case of impossibility of temporary stopping of outdoor arterial or arteriovenous bleeding in other ways impose hemitting harness.

Fig. 9. Arterial Zhgut

N.actuction of arterial zhgutait is the most reliable way to temporarily stop bleeding. The ribbon rubber harness and harness-spin are used. Rubber belt harnessequipped with special clasps designed to fasten the imposed harness. It can be a metal chain with a crochet or plastic "buttons" with holes in the rubber ribbon. A classic tubular rubber harness proposed by Esmark is inferior to a tape harness on efficiency and safety and is practically no longer applied. The temporary stop of the external arterial or arteriovenous bleeding of the harness is the tight of the limb to the limb above the location of the damage. Unacceptable application of arterial harness in venous or capillary bleeding.

Fig. 10. Places of imposing a hemostatic harness when bleeding from the arteries: a - feet; b - shin and knee joint; in - brushes; g - forearm and elbow joint; d - shoulder; E - hips

Negative side of the imposition of arterial harness it is that the harness squeezes not only damaged vessels, and all the vessels, including intact, and also squeezes all the soft tissues, including nerves. There comes a complete cessation of blood flow distal than the harness. This ensures the reliability of stopping bleeding, but at the same time causes a significant ischemia of tissues, in addition, mechanically harness can squeeze the nerves, muscles and other education.

In the absence of influx of oxygenated blood, the metabolism in the limbs passes through oxygen-free type. After removing the harness, unsafeed foods come to the overall bloodstream, causing a sharp shear of the acid-alkaline state into the acidic side (acidosis), the vascular tone decreases, the development of acute renal failure is possible.

Inxication causes acute cardiovascular, and then polyorgan deficiency denoted as a turnstip shock. The lack of oxygen in the tissues located distal than imposed harness creates a favorable soil for the development of gas anaerobic infection, i.e. For the growth of bacteria breeding without oxygen.

Considering the dangers associated with the imposition of a harness, the testimony for its use is strictly limited: it should be applied only in cases of injury of the main (main) arteries, when it is impossible to stop bleeding in other ways.

It must be remembered that along with high efficiency, this method itself can lead to severe consequences: turnstile shock and damage to the nerve trunks with the subsequent development of the paresium or paralysis. Clinical experience shows that 75% of victims harness are imposed without proper testimony, so the use of it as a method of temporary stopping bleeding should be limited. When wounds accompanied by profuse bleeding, the harness must be imposed immediately at the scene. After stopping bleeding, it is necessary to produce a wound tamponade and impose a gulling bandage on the wound, after which the harness can be dissolved. As a rule, it provides persistent hemostasis during the transportation of the victim to the medical institution, where the final stop of the bleeding will be made.

You need to know a number of general rules for imposing arterial harness, the execution of which will allow to achieve reliable stopping of bleeding; Although in part, to prevent the harmful action of the harness and reduce the possibility of complications:

1) The hemostatic harness is used mainly when the main arteries are injured. It is difficult to distinguish venous bleeding from the arterial with a complex anatomy of the wound canal and venous-arterial bleeding. Therefore, if the blood from the wound follows powerful, especially. To one degree or another pulsating jet, should act as in arterial bleeding, i.e. resort to the imposition of a hemostatic arterial harness, which is always uniformly, as in arterial bleeding - is proximal than the wound. It should be considered a rough error overlaying the harness distal than wounds.

2) Harness impose a proximal wound and as close as possible to the place of injury ,but no closer 4 - 5 cm. If for various reasons, in the evacuation process, it is not possible to remove the harness on time, ischemic gangrene develops. Compliance with this rule allows you to maximize the viable tissues that are proximal to the place of damage.

3) Before applying the harness pressed the artery fingers to the bone .

4) Then, wounded limb should be lifted So that the blood is retended from the veins. This will allow after the imposition of a harness to avoid the expiration from the wounds of venous blood filled the vessels of the distal limbs.

5) It is impossible to impose harness in the middle third of the shoulder and in the upper quarter of the leg In order not to damage, respectively, the radiation and mulberry nerves. Also, harness is not superimposed in the joints of the joints, on the brush, stop.

6) The harness cannot be applied to nude skin - a lining under the harness is necessary. Pre-alleged area of \u200b\u200bimposition of harness wrapped with soft material (Towel, Kosyanka, Valito-gauze lining, bandage, etc.), avoiding education on it folds. You can put the harness straight on the clothes of the victim without removing it.

7) Okay planted under the harness a piece of dense cardboard from the opposite vascular beam that partially retains collateral blood flow.

Fig. 6.Stages of the imposition of a standard hemostatic harness:

a - wrapping of the limb towel;b.- harness is supplied under the thigh and stretched; in - the first turnover of the harness;g.- Fastening Zhguta

Fig.11 The imposition of arterial harness:

a - Preparation for the imposition of a harness

b - the beginning of the imposition

b - fixation of the first round

g - harness is imposed

8) Stretched harness is applied to the limb from the projection of the vessels. The harness is captured by the left hand at the edge with a fastener, and right - by 30-40 cm closer to the middle, not further (Fig. 11 a). Then the harness is stretched by two hands and the first turnover of the harness so that the initial section of the harness overlapped with the next twist. Thus, the first round of the harness is made by crossing to prevent its weakening (Fig. 11 b). And the long end of the harness is superimposed on short. The harness squeeze the limb to the cessation of arterial bleeding from the wound and the disappearance of the pulse on the peripheral arteries.Compression should be sufficient but not excessive . Already the first tightened turnover (round) of the harness should cause the artery and stop the bleeding. Upon reaching a stop of bleeding Further tightening of the harness is unacceptable!

The following turns of the harness are superimposed with a small tension, only in order to maintain the tension of the first turn (Fig. 11 c). These fixing turns of the harness are superimposed on a spiral with the "adhesive" on each other, and each subsequent round must be partially (on 2/3), overlap the previous one, and not separately fall into order to avoid infringement of the skin (Fig. 11 g). Then the hook is attached to the chain.

To prevent the weakening of the tension of the harness, after the overlay it must be securely secured.

Given the danger of the development of heavy complications, instead of the harness, you can use the cuff from the unit to measure blood pressure. The pressure in the cuff must exceed systolic blood pressure (in the field of cuffs) not more than 10 - 15 mm.rt.st.

The imposition of a harness during bleeding from the femoral and the axillary arteries is represented in Fig. 31.

9) Equally unacceptable both insufficient and excessive tightening of the harness .

Excessive tightening of the harness (especially the buzz) can lead to crushing of soft tissues (muscles, vessels, nerves). Perhaps the occurrence of the hematoma, the development of tissue neurosis, traumatic and ischemic neurites, which are manifested by paresis, paralysis and sensitivity disorders. Overly, severe compression may damage the vessels with the development of vessel thrombosis and arteries. Therefore, it should not be overly tightening the harness. It must be tightened with such a force that allows you to stop bleeding.

In the same time, insufficient tightening the harness does not provide a sufficiently complete compression of the main artery, in this connection the inflow of arterial blood to the limb remains. In this case, only veins are siled, therefore it stops the outflow of blood from the distal limbs. With insufficient tightening of the harness, the bleeding from the wound does not stop, but, on the contrary, it may increase, as the limb is overwhelmed with blood.

Arterial bleeding is open damage, which, with a non-time-rendered assistance rendered, can lead to human death. It is precisely it is considered the most dangerous of all possible varieties of blood loss.

Before providing medical care, you should make sure that it is it. A distinctive feature of such a wound will be the fact that blood from it will splash in literally fountain, due to the jolts of the heart and pressure. Blood itself will have a pronounced red color. In such a state, the victim will be very pale and weak. His face will cover very quickly later. There may be dizziness, drowsiness, panic attack and fainting. Also, people in such a state may feel thirst and dry mouth. Pulse is weakened.

Before considering first assistance in arterial bleeding, you need to say about such existing blood loss varieties:

1. Bleeding from the affected veins is accompanied by commemorating the blood of dark red.
2. Capillary bleeding is accompanied by a slight discharge of scarlet blood.
3. Mixed bleeding is characterized by simultaneous damage to veins, capillaries and vessels.
4. Arterial bleeding is characterized by a complete or partial rupture of the artery vessel.

In the event that first aid for arterial bleeding will not be provided in the next few minutes after the moment of damage, then the patient will die from blood loss and there will be a fatal outcome. In such a state, an instant blood loss is observed, because of which the body simply does not have time to connect protective functions. This leads to a shortage of blood for the work of the heart, the deficiency of oxygen and the myocardial stop.

If the femoral artery of the limb was damaged, then the patient may have a variety of consequences - from gangrene and infection, until the need for leg amputation.

Also with a strong blood loss, be it shoulder, neck or limb, the patient often develops hematoma. It needs to be promptly eliminating.

As can be understood from the above, the first aid in arterial bleeding is the algorithm of medical actions, from the correctness of which the human life and further treatment depends.

You can learn about the rules for first aid during the blood loss on the learning video.

Stop arterial bleeding: rules and methods

The foundations of the PMP in arterial bleeding are studying even at school for obzh, however, in a critical situation, few people can truly unmistor to stop arterial bleeding.

The PMP with arterial bleeding depends largely on the particular location of the wound.

Due to the fact that this type of blood loss requires immediate assistance, a person who has it should be aware of such rules:

1. In this case, it is impossible to slow, so the evaluation of the patient's condition is carried out in seconds.
2. If necessary, you can tear or cut clothes, as it will still need to do to be able to conduct a normal injury inspection.
3. In the critical situation, the dressing and clamp of the wound can be made by a belt belt - a belt, a scarf and something like that.
4. With the uncertainty of the original source of bleeding, it is possible to put it with your hands on the wound itself until the point of finding the exact place of damage. Typically, this is done with the wounds of the abdomen.

Stop arterial bleeding on the forearm provides for the rise of the patient's hand and casting her head. Further, the person who assists, needs to be behind the victim, clamp the vessel with your fingers, find the deepening between the muscles and give the area to the bone tissue.

PMP with arterial bleeding of a carotid artery provides for the experience of the wound with a thumb, when the remaining fingers will be located on the patient's head. It should be remembered that it is always necessary to shift the carotid artery below the damage.

Temple artery You need to squeeze your fingers just above the upper edge from the ear.

Artery on the hip. The most sacrifted with hand and presses to the pubic bone. Slender victims of the victims, this vessel is very easy to press to the thigh.

Jewish artery Must be pressed by hand to the edge of the chewing muscle.

Stop arterial bleeding of the leg Must occur by pressing the patient's ponashed. Next should be bent foot in the knee.

For defeat of Vessels of the Upper Limbs In the armpit, you need to enter a fist and press the damaged hand to the body.

PMP in arterial bleeding provides patching, but not transferring the artery. At the same time, the correct relief requires a sufficiently important force, since it will have to hold the artery in this position a sufficiently long time.

It is also worth knowing that so far one person presses the artery, the other should find the harness and gauze during this time to go to the second stage to help.

Methods for stopping arterial bleeding are selected individually, depending on the nature and complexity of the wound. This may be the imposition of a harness or finger sample artery.

Ways to stop venous bleeding less complex. They provide for the imposition of a tight bandage bandage.

Selects such features of the imposition of the harness:

• In case of damage to the upper limbs, the harness is superimposed on the top of the shoulder.
• In the case of local damage to the artery on the lower limb, two harnesses can be applied. The second will be superimposed a little higher than the first.
• If the carotid artery is damaged under the harness you need to put the bandage so as not to apply a person even more injury and prevent the transfer of air flow.
• In winter, the harness must be applied for half an hour. In the summer, it can be held for no more than an hour, after which it is to relax that the blood is in a foot again.
• The harness is superimposed solely with the defeat of the large vessels of the body. With insignificant venous damage, the wound is only needed to conbay.
• After the harness was imposed, the damaged part of the body should not be covered with clothing so that the doctor can control the patient's wound state.

The technique of the imposition of the harness is simple. First, the damaged area needs to wrap gauze. Next, raise the limb and stretch the harness. Wrap it around the limb twice. At the same time, the harness should not be tightly overlap so that it is not too much to press the limb. At the end, the harness is fixed and the patient is delivered to the hospital.

In the event that the harness is correctly imposed, blood flow should be completely stopped. Under it, it is necessary to put a note with the last time of the bandage imposition.

Unfortunately, when you embed a harness, people often make mistakes. This may be the imposition of a harness without sufficient testimony to the procedure or overlay it on a naked skin, which will lead to a leaning of soft tissues.

An error is also considered to be the wrong localization of the imposition of the harness and its weakly tightening, which will only strengthen the bleeding.

Another error is the long stay of the harness in a prolonged state, which creates conditions for gangrene, infection and necrosis.

There is the following squeezing dry dressing technique:

1. To put on gloves and carefully inspect the wound.
2. Treat wound with antiseptic.
3. Sterile wipes are put on the wound and to rewind the bandage on top.
4. Secure the bandage bandage.
5. Deliver the patient to the doctor.

Finger pressed arteries and basic points to know

The finger pressing of the arteries is used for all cases of injury of the head (maxigous and temporal area including) and neck when bleeding cannot be left using a traditional experienced binting lining.

The finger pressed arteries are convenient because this is a quick method to stop bleeding without imposing bandages. The disadvantage of this practice is that a person who assists cannot move away from the patient to come to the rescue to other wounded patients.

The points of the finger pressed arteries differ in the anatomical location of the lesion. Thus, when bleeding in the temporal artery, it must be over with two fingers in the area of \u200b\u200bthe ears.

When bleeding, which is localized at the bottom of the front part, you need to use this technique in the area located in the zone between the jaw and the chin.

With damage to the carotid artery, you need to push the front of the neck with a big finger.

With a shoulder injection, you need to press the shoulder artery. To do this, you need to press the artery finger to the bone and bend your hand.

In case of damage to the femoral artery, a lot of power will be required. It is necessary to press it with your fingers folded together (right hand). Next to press the other hand.

Also, with strong bleeding, you can use the 3D method. It consists in a strong and constant pressure with his hands on a wound for ten minutes.