Ways of penetration of infectious agents into the wound. Measures for the prevention of surgical infections
Among the complications in surgery, the most common infectious.They can be fatal despite a brilliantly performed operation. The prevention of such complications is the main principle of surgery, which is based on asepsis and antiseptics.
Asepsis - a set of measures aimed at preventing the entry of infectious agents into the wound or the human body.
Antiseptic - a set of measures aimed at combating infection in the human body, preventing or eliminating an infectious inflammatory process.
Both methods represent a coherent whole in the prevention of surgical infection. They should be considered from the point of view of the relationship between the source of infection, the ways of its transmission and the body's susceptibility.
Any science goes through certain stages of development. In surgery, a radical revolution came with the introduction of antiseptics and asepsis, which defined the line between the pre-antiseptic and antiseptic periods. And this is not accidental, since the mortality rate in the pre-antiseptic period, even after small incisions or punctures, reached more than 80%. In the 19th century, even for a surgeon like Billroth, the mortality rate after mastectomy and strumectomy was 50%. Patients died from suppuration of wounds, erysipelas, gangrene, sepsis. The priority in the development of the antiseptic method belongs to the English surgeon Joseph Lister (1829-1912). His work revolutionized surgery and marked the beginning of a new stage in its development.
Surgeons of the 18th century identified purulent complications of wounds (phlegmon, erysipelas, tetanus, etc.) with rotting, caused, in their opinion, by the effect of air on the wound, which cools and dries the wound. Therefore, they recommended applying occlusive, airtight dressings, and the English surgeon Benjamin Bell advised dressing as quickly as possible in order to limit the time the wound is exposed to air (especially "impure"). His compatriot Praingle believed that in order to purify the air, it was necessary to better ventilate the hospital premises.
The French surgeon Puteaux (XVIII century) established an important fact that was important for the subsequent formation of the basic provisions of contact infection of wounds: purulent wound discharge from one patient, when it enters the wound of another, causes purulent inflammation in the latter. So, when using already used dressing material or material that is contaminated with hands "contaminated with the bad air of patients", wounds become infected.
Other surgeons also suggested the role of microbes in the development of purulent complications of wounds. N.I. Pirogov during the Crimean War (1853-1856) wrote: “... it can be safely asserted that most of the wounded die not so much from the injuries themselves, but from hospital infection ... We are not far from the time when a thorough study of traumatic and hospital the miasm will give surgeons a different direction. " N.I. Pirogov believed that the infection ("miasms") is transmitted through hands, linen, mattresses, dressings, and recommended hygienic measures in this regard. He used alcohol, iodine, silver nitrate to heal wounds, capable of destroying the "miasms".
The priority in the systemic use of antiseptics belongs to the Hungarian obstetrician I. Semmelweis, who in 1847 used a solution of bleach for disinfecting the birth canal of puerperas, hands, instruments and all other items in contact with the birth canal. It was not by chance that I. Semmelweis approached this method: he experimentally proved the presence of a contaminated beginning in the secretions from the uterus of women with maternity fever (sepsis): rabbits, into whose blood secretions were injected, died. Proceeding from this, I. Semmelweis believed that the transfer of an infectious principle from a sick postpartum woman to a healthy one, its penetration through the vast wound surface, which is the uterus after childbirth, lead to the development of sepsis. The use of the treatment method proposed by I. Semmelweis led to a decrease in mortality in his clinic by a third. However, the method did not become widespread, since most surgeons believed that airborne infection was the cause of wound infection.
An immediate prerequisite for the development of the antiseptic method in surgery by J. Lister was the discovery in 1863 of the cause of fermentation and decay by Louis Pasteur, who established that they were based on the penetration and vital activity of specific microorganisms. L. Pasteur also developed methods of preventing these processes. The undoubted merit of J. Lister is that he transferred the discovery of L. Pasteur to surgery, drew parallels between decay and suppuration of wounds, considering the cause of suppuration to be penetration from the outside of some disease-causing principles. Based on this, he suggested covering the wound with a special bandage that does not allow air to pass through, and using phenol to prevent decay in the wound. The choice of phenol was not accidental - it is an integral part of the tar, and at that time the cesspits were poured with tar to prevent rotting in them. Several years earlier, Lehmer had established the disinfecting effect of phenol. Using phenol to treat open fractures, J. Lister obtained excellent results. After two years of research, he created a system for the prevention of purulent complications of wounds and in 1867 published a work entitled "On a new method of treating fractures and abscesses with comments on the causes of suppuration." The essence of prevention was to combat airborne and contact infections and was reduced to the destruction of bacteria with the help of phenol in the air, on hands, tools and other objects in contact with the wound. The effectiveness of the system for the prevention of infectious complications using the Lister method was convincingly confirmed by a several times decrease in the frequency of deaths from purulent complications.
And despite the fact that earlier assumptions were made about the role of some external factors in the development of septic complications and certain means were proposed to prevent complications, the merit of J. Lister is that he created a system of prevention - an antiseptic method. The main components of this system were a multilayer Lister dressing, treatment of hands, instruments, and air sterilization in the operating room. The dressing consisted of the following layers: a silk dressing soaked in 5% phenol solution was attached to the wound, 8 layers of gauze soaked in the same solution with the addition of rosin were applied over it, covered with a rubberized cloth or oilcloth and fixed with gauze bandages soaked in phenol. The surgeon's hands, instruments, dressing and suture material were washed with 2-3% phenol solution. The operating field was treated with the same solution. In the operating room, a phenol solution was sprayed with a spray bottle before and during the intervention to sterilize the air.
The use of the Lister method led to a decrease in the frequency of purulent complications of wounds, but also revealed disadvantages. The use of phenol solutions, in addition to a positive one, also had a negative effect, causing general intoxication of patients, burns of tissues in the wound area, kidney damage, and diseases of surgeons (dermatitis, burns, hand eczema). Attempts were made to replace phenol with other substances: a solution of mercury dichloride (mercuric chloride), boric or salicylic acid, potassium permanganate, etc. However, the stronger the antimicrobial effect of the agents used, the more pronounced their toxic effect on the body.
There are also dramatic moments in the history of antiseptics. Thus, the idea expressed by L. Pasteur in 1880 that all purulent inflammations have one pathogen, E. Bergman questioned as unproven and therefore doubtful. The Swiss surgeon C. Garre (1857-1928), to prove the correctness of L. Pasteur, rubbed into the skin of his left forearm a microbial culture of staphylococcus from colonies obtained by sowing pus from a patient with osteomyelitis. At the site of infection, a large carbuncle has developed, surrounded by multiple small boils. Staphylococcus was isolated when pus was inoculated. The doctor recovered. Having conducted an experiment on himself, he empirically proved that staphylococci cause various purulent diseases: abscess, boil, carbuncle, osteomyelitis.
Gradually, interest in the Lister method and its modifications was lost, and after 25 years it was replaced by the aseptic method, which consisted of sterilizing all objects in contact with the wound. The founder of asepsis was the German surgeon E. Bergman, who had previously worked in Russia. At the congress of surgeons in Berlin in 1890, he reported on a new method of fighting wound infection and demonstrated patients who were successfully operated on under aseptic conditions. The chairman of the congress J. Lister congratulated E. Bergman on his success, calling the aseptic method a brilliant conquest of surgery.
The proposed aseptic method is based on the principle of destruction of the microbial flora on all objects in contact with the wound, exposure to high temperature (boiling, hot steam, etc.). Since 1892, the asepsis method has been used in many clinics around the world. The results were so striking that there were calls to completely abandon the antiseptic method (fighting infection in the human body) and even exclude antiseptics from surgical practice. However, it turned out to be impossible to do without them in surgery: the treatment of the surgeon's hands and the operating field, the sanitation of purulent cavities and many other measures are impracticable without antibacterial drugs, especially since over time new low-toxic antiseptic agents appeared, and antiseptic methods were replenished not only by chemical, but also by physical means (laser, ultrasound, etc.).
The main requirements for antiseptic agents are as follows: bactericidal or bacteriostatic action on a microorganism; lack of irritating toxic effect on tissues when local application; preservation of properties in contact with biological fluids (blood, exudate, pus) and air (they should not be volatile); besides, their production should be cheap.
SOURCES AND WAYS OF DISTRIBUTION OF INFECTION IN SURGERY
Under sourceinfections understand the habitat, development, reproduction of microorganisms. In relation to the patient's (wounded) body, exogenous (outside the body) and endogenous (inside it) sources of surgical infection are possible.
main sources exogenous infection- patients with purulent-inflammatory diseases, bacilli carriers, less often - animals (Scheme 1). From patients with purulent-inflammatory diseases, microorganisms enter the external environment (air, surrounding objects, hands of medical personnel) with pus, mucus, sputum and other secretions. If certain rules of behavior, operating mode, special methods of processing objects, tools, hands, dressing material are not observed, microorganisms can enter the wound and cause purulent inflammatory process... Microorganisms enter the wound from the external environment in various ways: contact -in contact with the wound of infected objects, tools, dressings, surgical linen; air- from the ambient air in which microorganisms are located; implantation- infection when left in the wound for long time or constantly certain objects (suture material, bone fixators and other implants), infected during the operation or as a result of violation of the rules of sterilization.
Scheme 1. Exogenous infection.
Animals play a lesser role as a source of surgical infection. When processing carcasses of sick animals, anthrax infection is possible. The causative agents of tetanus and gas gangrene can get into the environment with the faeces of animals. On the surrounding objects, in the ground, these microorganisms are in the form of spores for a long time. In case of accidental injury, they can penetrate the wound with soil, scraps of clothing and other objects and cause specific inflammation.
The source endogenous infectionare chronic inflammatory processes in the body, both outside the operation zone (diseases of the skin, teeth, tonsils, etc.), and in the organs on which the intervention is performed (appendicitis, cholecystitis, osteomyelitis, etc.), as well as the microflora of the oral cavity, intestines , respiratory, urinary tract, etc. Ways of infection with endogenous infection - contact, hematogenous, lymphogenous (Scheme 2).
Scheme 2. Endogenous infection.
Contactwound infection is possible if the operation technique is violated, when exudate, pus, intestinal contents can get into the wound, or when microflora is transferred on instruments, tampons, gloves due to non-compliance with precautions. From the focus of inflammation located outside the operation zone, microorganisms can be brought in with lymph (lymphogenousroute of infection) or with blood flow (hematogenouspath of infection).
Using aseptic methods, they fight against exogenous infection, using antiseptic methods - against endogenous infections, including those that have entered the body from the external environment, as is the case with accidental wounds. For successful prevention of infection, it is necessary that the fight be carried out at all stages (source of infection - pathways of infection - body) by a combination of aseptic and antiseptic methods.
To prevent infection of the environment in the presence of a source of infection - a patient with a pyoinflammatory disease - first of all, organizational measures are necessary: \u200b\u200btreatment of such patients in special departments of surgical infection, performing operations and dressings in separate operating rooms and dressing rooms, the presence of special personnel to treat patients and care for them. The same rule exists for surgery on an outpatient basis: patients are admitted, treated, bandaged and operated in special rooms.
Bacillary carriers (they include people who are practically healthy, but emit pathogenic microflora into the environment, most often from the nose, pharynx) must be removed from work in surgical institutions and appropriate treatment, they are allowed to return to work only after bacteriological control.
Conditions for the development of infection in the body.
1. Decrease in the body's defenses (during cooling, blood loss, severe infectious diseases, starvation, hypovitaminosis).
2. High virulence of the microorganism.
3. Large dose of infection.
In a special place is the "dormant infection", which manifests itself clinically with a decrease in protective forces.
"Entrance gate" - the way by which a microorganism enters the human body, not necessarily through a wound (food, water, contact, wound).
It gets into the wound in two main ways:
1. Exogenous pathway - from the external environment:
a) air
b) pin
c) drip
d) implantation
Contact way has the greatest practical value, because in most cases, wounds are contaminated by contact. A typical example of a contact infection is a wound in the street or in the field. In these cases, the object with the wound (a car wheel, shovel, stone, etc.) is covered with dust or earth and contains a significant amount of microorganisms, including such formidable ones as tetanus stick or gas gangrene bacteria. Microbes that have penetrated into the wound get into the deepest parts of it and cause the wounds to fester. In surgical wounds, germs can get from the hands of the surgeon, instruments and dressings, if they were not sterile. Prevention of contact infection is the main task of operating nurses and surgeons.
By implantationthe infection is introduced deep into the tissues during injections or together with foreign bodies (fragments, chips, scraps of clothing). In peacetime, implantation infection is most often associated with the suture and implantation of prostheses, the prevention of implantation infection is extremely thorough sterilization of sutures for sutures, nylon nets and other items intended to be left in the tissues of the body. Implantable threads or prostheses are also impregnated with antiseptic substances. An implantation infection can appear after a long period of time after surgery or injury, proceeding as a "dormant" infection. In these cases, suppuration around the stitches, fragments or prostheses develops after the weakening of the body's defenses, due to any disease or damage. Implant infection is especially dangerous during tissue and organ transplant operations, when the body's defenses are specially suppressed by special drugs, immunosuppressants, which inhibit the body's response to foreign tissues, including the introduction of microbes. In these cases, some types of bacteria, which usually do not cause suppuration, become virulent.
Air way - contamination of the wound with microbes from the air of the operating room - is prevented by strict adherence to the operating unit regime.
Drip path arises from the ingress of small droplets of saliva into the wound, scattering through the air when talking.
2. Endogenous pathway:
a) hematogenous
b) lymphogenous
c) contact
Sources of endogenous infection are often carious teeth, inflammatory processes in the oropharynx and nasopharynx, pustular skin lesions, etc. In this case, the infection is brought into the wound from an internal focus with the flow of blood or lymph. By contact, the infection spreads to a neighboring organ.
The skin and mucous membranes isolate the internal environment from the external and reliably protect the body from the penetration of microbes. Any violation of their integrity is the entrance gate for infection. Therefore, all accidental wounds are knowingly infected and require mandatory surgical treatment. Infection can occur from the outside (exogenously) by airborne droplets (by coughing, talking), by contact (by touching the wound with clothes, hands) or from the inside (endogenously). Sources of endogenous infection are chronic inflammatory diseases skin, teeth, tonsils, ways of spreading infection - blood or lymph flow.
As a rule, wounds become infected with pyogenic microbes (streptococci, staphylococci), but infection with other microbes can occur. Infection of the wound with sticks of tetanus, tuberculosis, gas gangrene is very dangerous. The prevention of infectious complications in surgery is based on the strictest adherence to the rules of asepsis and antisepsis. Both methods represent a coherent whole in the prevention of surgical infection.
Antiseptic - a set of measures aimed at destroying microbes in the wound. Distinguish between mechanical, physical, biological and chemical methods of destruction.
Mechanical antiseptic includes carrying out the primary surgical treatment of the wound and its toilet, i.e., removal of blood clots, foreign objects, excision of non-viable tissues, and washing of the wound cavity.
Physical method based on the use of ultraviolet irradiation, which has a bactericidal effect, the imposition of gauze dressings that absorb wound discharge well, dry the wound and thereby contribute to the death of microbes. The same method involves the use of concentrated saline (osmosis law).
Biological method based on the use of serums, vaccines, antibiotics and sulfonamides (in the form of solutions, ointments, powders). Chemical method microbial control focuses on the use of various chemicals called antiseptics.
The drugs used against the causative agents of surgical infection can be divided into 3 groups: disinfectants, antiseptic and chemotherapy. Disinfectants the substances are intended mainly for the destruction of infectious agents in the external environment (chloramine, mercuric chloride, triple solution, formalin, carbolic acid). Antiseptic means are used to destroy microbes on the surface of the body or in serous cavities... These drugs should not be absorbed in significant quantities into the blood, as they can have a toxic effect on the patient's body (iodine, furacilin, rivanol, hydrogen peroxide, potassium permanganate, brilliant green, methylene blue).
Chemotherapyfunds are well absorbed into the blood when different ways introduction and destroy the microbes in the patient's body. This group includes antibiotics and sulfonamides.
Pathogens can enter the wound in two ways: exogenous and endogenous.
Exogenous pathway (penetration of infection from the external environment):
-- airborne infection (out of thin air)
- contact infection (objects in contact with the wound - 0.2 seconds is enough for the transmission of infection!).
- drip infection (with saliva, when coughing, etc.)
- implantation (transmitted with objects left in the tissues: suture material, endoprosthesis, tampon, drainage, etc.).
Endogenous pathwaywhen the infection is in the body (pustular skin lesions, carious teeth, purulent otitis media, inflammation of the tonsils, purulent - inflammatory lung diseases, etc.).
In this case, the path of spread of infection in the body can be:
Hematogenous (through blood vessels),
Lymphogenous (through the lymphatic vessels).
In surgery, a system of measures has been developed that makes it possible to reduce the danger of the introduction of microbes into the wound and into the body as a whole. This is achieved by aseptic and antiseptic methods, which are the basis of modern prophylaxis of nosocomial surgical infection.
All provisions for the fight against surgical infection are regulated (defined) in the order No. 720 M3 of the USSR dated 07.31.78, which is called "On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial
infection ".
"Antiseptic"
This is a set of measures aimed at destroying or reducing the number of microbes in the wound and in the body as a whole.
The founder of antiseptics is the English scientist J. Lister. J. Lister used carbolic acid as the first antiseptic.
Currently, the following antiseptic methods are used: mechanical, physical, chemical, biological and mixed.
Mechanical method - provides for the removal of microbes by a purely mechanical means through the following measures:
Toilet of the wound with all dressings and the provision of primary care;
Primary surgical debridement wounds (PCO) - excision of the edges, bottom of the wound, removal of foreign bodies, blood clots, etc.
Autopsy and puncture of abscesses;
Excision of dead tissue (necrectomy).
Physical method:this is the creation in the wound of unfavorable conditions for the vital activity of microbes and the maximum reduction in the absorption of decay products and toxins from the wound. To do this, use:
■ hygroscopic dressing (gauze, cotton wool, cotton-gauze tampons, i.e. wound tamponade):
hypertonic sodium chloride solution - 10% - high osmotic pressure of this solution promotes the flow of tissue fluids from the wound into the bandage;
■ drainage of wounds -distinguish between passive drainage - use ordinary graduates - a thin strip of glove rubber or PVC tubes (often perforated :;
active (vacuum) drainage (plastic bellows, cartridges or electric suction);
flow - washing drainage (continuous washing of the wound antiseptic solutions - rivanol, furacilin, antibiotics, etc.
- drying out warm air wounds are an open method for treating burns and wounds;
Ultrasound;
UFO - accelerates the regeneration of wounds: used for blood irradiation (apparatus "Isolde");
Chemical method - this is the use of various antiseptic agents that either kill bacteria in the wound, or slow down their multiplication, creating favorable conditions to fight the body against infection. Data chemical agents are widely used for asepsis: treatment of hands, surgical field, sterilization of instruments and various items required during the operation; besides cleaning floors, walls, etc.
Biological method: provides for the destruction of microorganisms using biological substances.
Three groups of biological substances are widely used in surgery. The first group of biological substances (BV) increases the protective (immunological) forces of the body: donated blood, blood components (erythrocyte, platelet, leukocyte mass, plasma) and its preparations (albumin, protein, fibrinogen, hemostatic sponge, etc.) Serums for passive immunization :
Anti-tetanus serum (PSS);
Human tetanus immunoglobulin (TITI);
Anti-gangrenous serum for the treatment and prevention of gas gangrene;
Antistaphylococcal gamma - globulin and antistaphylococcal hyperimmune plasma (native plasma of donors immunized with staphylococcal toxoid) are used for surgical infections (especially for sepsis and its threat);
Antipseudomonal hyperimmune plasma Toxoids for active immunization:
Tetanus toxoid (CA) - for the prevention and treatment of tetanus; staphylococcal toxoid for surgical staphylococcal infection.
The second group of biological substances:
- Proteolytic enzymes (melting proteins) action :
and) trypsin, chymotrypsin, chymopsin (of animal origin - from the pancreas of cattle);
b) streptokinase, asperase and others - drugs bacterial origin:
in) papain, bromelan - herbal preparations.
Enzymes lyse (melt) proteins of non-viable
(necrotic) tissues. This helps to cleanse purulent wounds, trophic ulcers without resorting to necrectomy, which naturally accelerates wound healing.
Ways of infection in the wound:
Exogenous path (from the external environment): airborne (from the air); contact (from what is in contact with the work) implantation (through suture material, for example, catgut)
Endogenous pathway (the infection is in the patient), for example, infection of the skin, during internal organs: hematogenous (with blood), lymphogenous (with lymph)
Prevention measures
Airing
Application of germicidal lamps
Everything that comes into contact with the wound must be sterile
Thermal sterilization - firing
Boiling
Autoclaving
· Cold sterilization) chem. Substances)
Radiation (ray, alpha and beta rays)
3. Antiseptics: definition, types. Antiseptic agents used in first aid
Antiseptic- a set of measures aimed at combating microbes in the wound or in the human body as a whole
Kinds
1) Mechanical - removal of microorganisms using some mechanical methods (it is the main one in the work of a surgeon). It includes:
a. Wound toilet (removal of purulent exudate, blood clots, cleaning the surface of the wound)
b. Primary surgical treatment of the wound (it turns the infected wound into a sterile one by excising the edges of the wound, walls, bottom and zones of necrosis / dead tissue, tissue damage). This treatment includes: dissection (the wound is dissected), revision (a probe is launched), excision (the walls are excised), surface restoration, suture.
c. Secondary surgical treatment (the wound, unlike PCHOR, is not sutured, the wound is drained / drained for pus).
d. Other operations and manipulations
2) Physical - destruction of microorganisms due to physical phenomena, for example, hygroscopic dressing / gauze, cotton-gauze tampons; hypertonic solutions / due to the pressure difference (NaCl / furacilin); adsorbents, for example activated carbon or polyphepan; laser; Ultrasound.
3) Chemical- the following chemical antiseptic agents are used: iodine (1 – 5 – 10% alcohol solution, used to treat the skin around the wound); iodipal (1% solution for external use, for rinsing the throat); lugol's solution (I + KI, both aqueous and alcoholic solution is used, has disinfectant, antiseptic properties, heals patients with diseases thyroid gland); chloramine (for disinfection of dishes, washing floors, 1 - 3% water solution); alcohol(96%, 70% for sterilization, wound treatment, surgeon's hands); brilliant green (1 - 2% solution for the treatment of superficial abrasions, etc.); methylene blue (1 - 2% alcohol. / Aqueous solution, external use, for the treatment of mucous membranes, surface membranes, and 0.02% for washing wounds); boric acid (1 - 2% for external use, the main preparation for washing purulent wounds); hydrogen peroxide (3% for washing purulent wounds, has a hemastatic / hemostatic and deodorizing effect); potassium permanganate (2 - 3% for the treatment of burns and bedsores); furacilin (external use for the treatment of purulent wounds and gargling); ammonia (0.5% for the treatment of the surgeon's hands); tar, ichthyol ointment etc.
4) Biological
5) Mixed
Bactericidal action- killing germs
Bacteriostatic action- inhibits the growth and further spread of microbes
4. Wounds: classification, signs, complications. The first health care
Wound - trauma in which integrity is violated skin, or mucous membrane. Moreover, the damage is quite deep
Abrasion - superficial skin damage
Signs of a wound: pain, dehiscence (dehiscence), bleeding, dysfunction
Classification:
¨ Cut wound: The edges are even, the bleeding is quite profuse, usually clean, heals well
¨ Puncture wound (such as with a heel in the belly): Small inlet, deep, requires surgical intervention, the wound needs to be sutured
¨ Chopped wound: With the help of an object with a large mass, deep, bones stick out from the wound, profuse bleeding, blue around the site of injury, heals for a long time
¨ Contused wound: Massive hemorrhage, torn edges, contaminated, takes a long time to heal
¨ Laceration: Dirty wound, takes a long time to heal, painful
¨ Gunshot wound: Through and blind exits, the exit is larger than the entrance
¨ Wounds bitten: The human bite is the dirtiest
First aid
1) Examine the wound
2) Determine the nature of bleeding
3) You need to take a clean object (napkin), do not touch it with your bare hands
4) Rinse the wound
5) Delete foreign bodies
6) Lubricate the skin around the wound with a disinfectant
7) Apply a clean cloth to the damaged area
8) Bandage
9) Immobilization - not to move
10) Individual dressing package
Complication of wounds: suppuration (4-5 days after suturing), bleeding
5. Bleeding: classification, methods of temporary stopping, especially stopping in children
Bleeding - outflow / outflow of blood from the lumen of a blood vessel due to its damage or violation of the permeability of its wall.
Classification K / T:
1) anatomical (depending on the damaged vessel)
· Arterial K / T: blood comes out of the vessel under pressure in a rapidly pulsating stream in the form of a fountain. The color of the blood is bright scarlet. A significant amount of blood loss. And it is determined by the caliber of the damaged vessel. If the artery leaves the aorta, the C / T is very strong. 15% of the population has theramediaritis extending from the aortic arch, the blood from it pulsates very strongly.
· Venous K / T: the volume of K / loss is less than with arterial, the blood flows out gradually. The color of the blood is dark cherry (enriched with carbon dioxide).
· Capillary K / T: in case of damage to small vessels (arteries, venules, capillaries). It is characterized: the entire surface is bleeding, small vessels are not visible, the volume of k / loss is much less than with venous.
· Perechimatous K / T: from perchymatous organs (liver, spleen, kidneys, lungs). Dangerous because it is associated with dysfunction of these organs
2) by the mechanism of occurrence:
K / T due mechanical damage vessels, for example with a knife
Due to a pathological process affecting the vessel wall, for example, an ulcer, malignant tumor, inflammatory process - the integrity of the vessel wall is disrupted
Violation of the integrity of the vessel at the microscopic level, for example, vitamin deficiency \u003d scurvy - gums bleed, etc. the vessel wall is intact inside
3) in relation to the external environment:
External - blood comes out
Internal - blood enters the body cavity / hollow organ
o explicit - after some time, in some altered version, the blood will appear outward, for example, internal gastric bleeding with an ulcer: when the blood accumulates, it changes and comes out in the form of vomiting)
hidden - can only be determined using special diagnostic methods
For example, a hematoma is an internal hidden C / T, because blood does not come out.
4) by the time of occurrence:
Primary - associated with direct damage to the vessel during injury, during injury (appears immediately / in the first hours after injury)
Secondary
o early - appear within 4-5 days (their cause may be a rastrombation of the vessel - a ligature was applied, the vessel was tied, and it jumps off)
o late - their cause may be a developed infectious process (appears after 4-5 days)
5) downstream
Acute - blood runs out in a short period of time
Chronic - bleeding occurs for a long time in small portions, this leads to anemia
6) by severity
· Mild severity - k / loss is 10-15% of the circulating blood volume (BCC) (\u003d 4.5-5 l)
· medium degree severity - to / loss of 15-20% BCC
Severe degree - 20-30% BCC
Massive k / loss - more than 30%
A person dies with a simultaneous loss of more than 40%.
Temporary stop methods K / T.
1) application of a tourniquet
2) raising the position of the limbs - only weakens the C / T, and does not stop, it makes it possible to prepare for the use of other methods.
3) maximum flexion of the limbs - if we have K / T, for example, from the hand and forearm, we put in a roller (1) and bandage the forearm to the shoulder (2). If K / T from the lower part to the shoulder, hand, forearm - from the upper part of the shoulder the same, only the arm behind the back. If the shin, foot, lower third of the thigh - the patient should lie on his back, the roller in the knee fossa, the shin should be bandaged to the thigh.
4) pressure bandage - to stop capillary K / T, small venous and arterial K / T.
5) wound tamponade - with small C / T and when there is a cavity, the cavity is filled with a sterile bandage.
Stopping K / T with a harness. It is used for external K / T. harness imposition rules:
a) before applying the tourniquet, give the limbs exalted position
b) the tourniquet is applied above the wound, but as close to it as possible
c) the tourniquet is not applied to the naked body (necessarily on the bandage, gauze, clothes)
d) we stretch the tourniquet, apply it so that the tours do not overlap to cover a large surface
e) indicate the exact time of the harness application
f) the part of the body where the tourniquet was applied must be accessible for inspection
g) transport the victim with a tourniquet first
h) the tourniquet must not be applied for more than 1.5 hours. If it takes longer, it is relaxed or removed for 10-15 minutes, and at this time other methods are used.
Criteria for the correct application of the harness:
Termination of C / T
Termination of ripple
The limb should be pale, but not blue
If there is no harness at hand, on belts, waistbands, etc.
Stopping K / T using a twist rope
Twist the stick to pinch, stop the bleeding
6) finger pressure of the artery - to press the artery against the underlying bone. Carotid artery - if it is transmitted, the person will die. K / T of carotid artery can be stopped - put 4 fingers under the pectoral cardio-key muscle and press against the 6th vertebra.