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L.N. Belikov

One of the most important compensatory and adaptive reactions of the human body is the ability to independently stop bleeding by activating the blood coagulation system. Unfortunately, this is not always possible, since bleeding from large vessels can stop on its own quite rarely. Continued external bleeding is an indication for the use of temporary bleeding control, the timeliness and correctness of which often determines the life of the victim.

Quite a lot of methods for stopping external bleeding are known and, in principle, if we look at the history of surgery, its development is primarily the development of methods to combat blood loss.

A general practitioner should know the following simplest and most effective methods of temporarily stopping bleeding: finger pressure on the vessel, flexion of the limb in the joint, application of a pressure bandage, tourniquet, hemostatic clamps; be able to perform wound tamponade and use local hemostatic agents.

At the same time, you need to have a clear understanding that the above methods of stopping bleeding are far from equivalent and have certain disadvantages and advantages, so there are corresponding indications for each. These indications are determined by the nature of the clinical situation, and, above all, by the type of external bleeding and its intensity. External bleeding can be arterial, venous, capillary and mixed. Its intensity depends on the type and caliber of the damaged vessel.

Arterial bleeding recognized by the scarlet color of blood and its pulsating fountain-like stream. This kind of bleeding is the most dangerous.

Venous bleeding as a rule, not so intense; the jet can be quite powerful, but does not pulsate, but flows continuously. Although when bleeding from the subclavian or jugular veins, blood may flow out in an intermittent stream, synchronously with breathing.

The color of the blood is dark cherry.

At capillary bleeding the blood is dark red, flowing from the entire surface of the wound, individual bleeding vessels are not visible. Such bleeding is observed with shallow skin cuts and abrasions.

Mixed bleeding As a rule, it combines one or another number of the above characteristics.

7.1. FINGER PRESSION OF A VESSEL

The method is used to temporarily stop arterial bleeding on the limbs, neck, head. The pressure is applied above the bleeding area, where there is no large muscle mass, where the artery does not lie very deep and can be pressed against the bone. The artery is compressed with a finger, palm, or fist at certain points. The most important of them are shown in Fig. 7-1.

Rice. 7-1. Temporarily stop bleeding with finger pressure. 1 - temporal; 2 - occipital; 3 - jaw; 4 - sleepy; 5 - subclavian; 6 - axillary; 7 - shoulder; 8 - radial; 9 - ulnar; 10, 11 - femoral; 12, 13 - tibial artery

The supraclavicular region is the place of compression of the subclavian artery, where it is pressed against the first rib at a point located above the collarbone, immediately outward from the place of attachment of the sternocleidomastoid muscle to the manubrium of the sternum; in the axillary fossa where the axillary artery can be compressed by pressing it against the head of the humerus; inguinal fold - area for pressing the common femoral artery to the pubic bone; the inner surface of the biceps muscle - for the arm artery; the neck at the inner edge of the sternoclavicular muscle, near its middle, the area where the carotid artery presses against the transverse process of the VI cervical vertebra; along the inner surface of the thigh in the upper and middle third, you can try to press the femoral artery to the femur; the popliteal artery is compressed in the popliteal fossa, towards the distal part of the femur with the knee joint slightly bent; The posterior tibial artery can be compressed just behind the medial malleolus; the dorsal artery of the foot is pressed on the front surface of the foot outward from the extensor tendon of the big toe; on the face you can easily find the superficial temporal artery lying directly

but on the bone at a point anterior to the ear canal; bleeding from the cheek is easily stopped by pressing the facial artery to the horizontal part of the lower jaw.

Indications: first steps to stop arterial bleeding; first before applying other methods. Advantages:

Quick (almost instant) application;

Possibility of use in anatomically complex areas (head, neck, axillary, subclavian, groin areas);

The most gentle way to stop bleeding. Flaws:

When the vessel is pressed with fingers, the nearby nerve trunks and the very sensitive periosteum are compressed, which is quite painful;

Long-term stopping of bleeding with this method is impossible due to rapid fatigue of the helping hand;

The use of this method significantly reduces the intensity of bleeding, but does not stop it completely due to collateral blood flow;

Due to the anatomical features of the location of the arteries (carotid subclavian, axillary, popliteal) or the complex nature of their damage, finger pressure is sometimes ineffective.

In some cases (the presence of sterile gloves, good visualization of the source of bleeding), digital compression of the vessel can be performed directly in the wound (Fig. 7-2).

For vein injuries, you can also use finger pressure, which is performed distal to the wound.

Rice. 7-2. Stopping bleeding by digital compression of blood vessels in the wound

7.2. TEMPORARY STOP OF BLEEDING BY MAXIMUM FLEXION OF THE LIMB IN THE JOINT

Stopping bleeding with maximum flexion in the joint is possible: in case of damage to the subclavian and axillary arteries, by moving the arm back as far as possible and pressing it to the back. Thus, the artery is compressed between the clavicle and the first rib (Fig. 7-3 a); in case of injury to the arteries of the upper third of the thigh and groin area - by flexion in the hip joint (b); in case of damage to the popliteal artery - by flexing the knee joint (c); in the elbow joint - if the brachial artery is damaged in the elbow bend (d). Using this method to stop bleeding from the distal parts of the limb is possible, but not advisable, since there are other optimal methods for such injuries.

Rice. 7-3. Stopping bleeding by bending the limb at the joint

Indications:

Stopping all types of bleeding from the groin, popliteal and elbow areas;

The first stage before applying other methods. Advantages:

Speed ​​of application;

Possibility of use in areas where the location of the vessels is deep and difficult to access (inguinal and subclavian region, popliteal and axillary fossa);

Possibility of use with a minimum of dressings and available materials.

Flaws:

Bending the limb at the joint may not be effective, especially if the subclavian vein is damaged;

Sometimes this method can be painful or uncomfortable.

7.3. COMPRESSION BANDAGE

The application of a pressure bandage to the area of ​​a bleeding wound causes an increase in interstitial pressure and compression of the lumen of damaged vessels, which contributes to the formation of an intraluminal thrombus. Skilled application of a pressure bandage can stop bleeding even from a large arterial vessel and in anatomically complex areas.

Technique for applying a pressure bandage: first check whether the wound contains foreign objects (shards of glass, pieces of wood or metal), clear the wound site of clothing and elevate the injured limb above the level of the heart, with the patient lying down. After this, several layers of sterile gauze are placed on the wound, and if it is not available, a pad made of clean fabric (a handkerchief, a piece of sheet, etc.) is placed and the edges of the wound are pressed tightly, at the same time bringing them together as close as possible. On top of the gauze, to increase compression, be sure to place a pad made of a dense ball of cotton wool or rolled up fabric and bandage it tightly. The situation is simplified if official means are available, in particular an individual dressing package (Fig. 7-4 a, b).

Rice. 7-4. Applying a pressure bandage using an individual dressing package (IPP) (a, b)

Indication: any injury, mainly to the extremities.

Advantage: the most gentle and fairly effective way to stop any bleeding. Flaws:

Does not in all cases provide stopping bleeding when large arteries are injured;

Tissue compression causes circulatory problems in the peripheral parts of the extremities.

7.4. APPLYING A Tourniquet

Among the various methods of temporarily stopping bleeding, applying a tourniquet is the most reliable and fairly quick. By applying a tourniquet, the soft tissues of the limb are compressed in a circular manner along with the blood vessels and pressed against the bone. Application of a tourniquet is indicated only in case of severe arterial bleeding from the artery of the limb, in all other cases, using this method is not recommended.

The Esmarch elastic tourniquet is the most widely used. It is a strong elastic rubber tube or strip up to 1.5 m long, to the ends of which are attached a chain and hook used to secure it, or other devices (Fig. 7-5).

In the absence of a standard tourniquet, it is possible to use various improvised devices (a twist, a tourniquet with a pelot, any strong rubber tube with a diameter of 1-1.5 cm, a rubber bandage, a belt, a scarf, a piece of cloth, etc.) (Fig. 7-6), pneumatic cuffs from the tonometer (Fig. 7-7).

Rice. 7-5. Hemostatic rubber tourniquet, Esmarch type (TU 38.106002-95)

Rice. 7-6. Stop bleeding using improvised means. a - spin with pilot; b - twist with a soft cloth without a pad

Rice. 7-7. Stopping bleeding using a pneumatic cuff from a tonometer

It is only necessary to remember that it is not recommended to use coarse, hard objects such as wire or rope due to the risk of nerve damage.

Technique for applying a rubber band: To prevent pinching of the skin, place a towel, the wounded person’s clothing, etc. under the tourniquet. The limb is lifted up slightly, the tourniquet is brought under the limb, stretched (Fig. 7-8) and wrapped around the limb several times without loosening the tension (Fig. 7-9) until the bleeding stops. The tourniquets should lie next to each other without pinching the skin (Fig. 7-10). The ends of the tourniquet are fixed with a chain and a hook on top of all the rounds. The tissues should be tightened only until the bleeding stops.

Rice. 7-8. Technique for applying a rubber band, stretching the band

Rice. 7-9. Technique for applying a rubber band. Application of a tourniquet with constant stretching

With a correctly applied tourniquet, arterial bleeding immediately stops, the limb turns pale, and the pulsation of the vessels below the applied tourniquet stops. Excessive tightening of the tourniquet can cause crushing of soft tissues (muscles, nerves, blood vessels) and cause the development of paralysis of the limbs. A loose tourniquet does not stop bleeding, but on the contrary, creates venous stagnation (the limb does not turn pale, but becomes bluish) and increases venous bleeding. The tourniquet should be positioned so that it is conspicuous. After applying a tourniquet, the limb should be immobilized. Due to the complete cessation of blood circulation in the limb, when applying a hemostatic tourniquet, a direct threat of necrosis is created, therefore

Rice. 7-10. Technique for applying a rubber tourniquet: the turns of the tourniquet are placed one next to the other

Rice. 7-11. Technique for applying a rubber band: a note indicating the time of application

the tourniquet should not compress the limb more than 2 hours However, if possible, the tourniquet should be removed every hour and checked to see if the bleeding has stopped and whether it is time to replace the tourniquet with a pressure bandage. If it continues, the bleeding artery must be pressed along its length, and the tourniquet must be reapplied after 15 minutes, slightly higher or lower. And again for no more than an hour. In the accompanying document of the wounded person or on a piece of white oilcloth attached to the tourniquet (Fig. 7-11), it is necessary to indicate the exact time (hours, minutes) of application of the tourniquet and the signature of the person providing assistance. Typical places for applying an Esmarch tourniquet to stop bleeding are shown in Fig. 7-12. However, there is an opinion that applying a tourniquet to the forearm is considered by some to be of little effectiveness due to the deep location of the vessels between the two bones of the forearm. Besides,

Rice. 7-12. Typical sites for applying an Esmarch tourniquet to stop bleeding.

1 - on the lower leg; 2 - on the thigh; 3 - shoulder; 4 - shoulder (high) with fixation to the body;

5 - on the thigh (high) with fixation to the body

It should be remembered that application of a tourniquet in the middle of the shoulder is contraindicated due to the possibility of compression of the radial nerve. Indications:

Traumatic amputation of a limb;

Inability to stop bleeding with other known means. Advantages:

A fairly quick and most effective way to stop bleeding from the arteries of the limb.

Flaws:

The use of a tourniquet leads to complete bleeding of the distal limbs due to compression of not only damaged great vessels, but also collaterals, which can lead to gangrene for more than 2 hours;

Nerve trunks are compressed, which causes post-traumatic plexitis with subsequent pain and orthopedic syndrome;

Stopping blood circulation in the limb reduces tissue resistance to infection and reduces their regenerative abilities;

The use of a tourniquet can cause severe vasospasm and lead to thrombosis of the operated artery;

Restoring blood circulation after using a tourniquet contributes to the development of tourniquet shock and acute renal failure;

The use of a tourniquet is not possible on the torso or is limited in anatomically difficult areas.

Errors:

Using it without indications i.e. with venous and capillary bleeding;

Naked body application;

Far from the wound;

Weak or excessive tightening;

Poor fastening of the ends of the harness;

Lack of accompanying note;

Use more than 2 hours;

Cover the tourniquet with a bandage or clothing.

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

Technique of circular tugging of a limb by twisting auxiliary means: The object used for twisting is loosely tied at the desired level. A stick or plank is inserted into the formed loop and, rotating it, the loop is twisted until the bleeding stops completely, after which the stick is fixed to the limb. Applying a twist is a rather painful procedure, so it is necessary to place something under the twist, especially under the knot. All errors, dangers and complications observed when applying a tourniquet, and the scope of application, fully apply to twisting.

I would like to once again emphasize that, according to the experience of vascular surgery, the unjustified use of a tourniquet occurs in 70-80% of cases. This occurs in cases of damaged veins, crushed limbs, bruised and lacerated wounds, when a properly applied pressure bandage is quite effective.

7.5. WOUND TAMPONADE

An effective way to stop bleeding in anatomically complex areas of the pelvis, neck, abdomen, chest, buttocks, i.e. where the main arteries are located quite deep behind the muscle layer and the use of a tourniquet and a pressure bandage is problematic. This is especially advisable in the presence of narrow wound channels in a large muscle mass (wound of the subclavian, axillary artery).

To tamponade a wound, a gauze swab is inserted with an instrument, tightly filling the wounds with the force necessary to stop bleeding. Indications: bleeding from wounds on the torso and neck.

Advantages: possibility of effective and safe use in anatomically complex areas. Flaws:

Difficulties of use at the prehospital stage;

Availability of practical skills;

Possibility of wound infection and continued thrombosis.

7.6. LOCAL APPLICATION OF HEMOSTATIC AGENTS

To stop capillary and parenchymal bleeding or bleeding from small vessels of muscles and bones, especially in patients with a tendency to hypocoagulation, the hemostatic effect is enhanced by using a hemostatic sponge. Using a sponge ineffective for bleeding from large vessels.

Hemostatic sponge (hemostatic sponge with Ambien, collagen hemostatic sponge, “Tachocomb”): externally it looks like a plate of dried foam and is native plasma with the addition of thromboplastin and calcium chloride. Its modern modification (Fig. 7-13) is made from animal collagen with associated blood clotting factors: thrombin, fibrinogen and fibrinolysis inhibitors. After contact with a bleeding wound or other fluids, blood clotting factors dissolve and create bonds between the carrier - collagen and the wound surface. By cleaving peptides, thrombin converts fibrinogen into fibrin. Like a two-part adhesive, the wound surface and collagen are bonded together during polymerization. Fibrinolysis inhibitors prevent premature dissolution of fibrin by plasmin. The components of the sponge degrade in the body under the action of enzymes within 3-6 weeks.

Method of application: maintaining sterility, open the package with scissors and take out a plate with a sponge. The dosage depends on the size of the wound that needs to be closed. The hemostatic plate should cover an area 1-2 cm larger than the immediate surface of the wound. If several plates are required for this, they must overlap each other at their edges. If the wound is small, then the drug can be cut with sterile scissors to the required size (Fig. 7-14). Before applying to the surface of the wound, blood should be removed as much as possible, which is achieved by quickly drying with gauze.

Rice. 7-13. Local hemostatic agent: collagen hemostatic sponge

Rice. 7-14. Stopping bleeding using a hemostatic sponge

napkins. After that, pieces of the sponge are pressed with a gauze ball onto the bleeding surface for 3-5 minutes. The sponge can be placed in a gauze pad to loosely pack the cavity. The tampon is removed after 24 hours. If necessary, cover the entire wound surface with a crushed sponge; it is also permissible to spray with a syringe or spray. Indications:

Capillary and parenchymal bleeding, bleeding from bones, muscles, nasal, gingival and other external bleeding;

The same types of bleeding in patients with bleeding disorders (thrombocytopenic purpura, leukemia, hemorrhagic thrombocytopathies, Randu-Osler disease, liver cirrhosis, local increase in fibrinolytic activity of the blood and general fibrinolysis, etc.);

Continued bleeding when using a pressure bandage and packing the wound.

Advantages: high efficiency and safety. Flaws: allergic reactions are possible.

7.7. APPLICATION OF A HEMOSTATING CLAMP

As a way to temporarily stop bleeding in first aid settings, this method is used in exceptional cases for bleeding from deep-lying vessels of the pelvis and abdominal cavity. Applying a hemostatic clamp to a damaged vessel and leaving it in the wound is one of the most reliable ways to stop bleeding.

Technique of application: if the source of bleeding is not clearly visualized, the edges of the wound are pulled apart with hooks. It is advisable to apply a sterile hemostatic clamp carefully, in a “dry” wound, as close as possible and perpendicular to the site of damage to the vessel (Fig. 7-15). This is necessary in order not to turn off the collaterals and not to cause additional trauma to the artery, which can complicate the performance of reconstructive surgery on the vessels. The clamps are left in the wound and covered with an aseptic dressing.

Indications: gaping wounds with clear visualization of the source of bleeding in complex anatomical areas when other methods are impossible and ineffective.

Advantages:

High efficiency;

Preservation of collateral circulation. Flaws:

Risk of damage to nearby nerves;

The likelihood of crushing blood vessels over a long distance;

The need for surgical skills.

Rice. 7-15. Application of hemostatic clamps to a vessel in a wound

The application of hemostatic clamps in a wound as a way to temporarily stop bleeding on non-main arterial vessels can also be a way to finally stop bleeding. To do this, the damaged vessel under the clamp must be bandaged with a sterile thin thread. When bleeding, in order for the bleeding from small vessels to finally stop, sometimes it is enough to apply a clamp and hold it for 10-15 minutes, and then, after twisting it several times along the axis, remove it.

Thus, the algorithm for stopping external bleeding is as follows: first of all, determine the type of bleeding, which can be arterial (main, non-main), venous, capillary and mixed.

Capillary bleeding is stopped by applying a regular bandage. The hemostatic effect is enhanced by loosely packing the wound surface with sterile napkins with 3% hydrogen peroxide or by applying a hemostatic sponge to the wound.

Venous bleeding - a pressure bandage for injury to the extremities, on the torso and neck - wound tamponade. While preparing the dressing material, bleeding can be reduced by lifting the limb upward, pressing the damaged vessel (distal) of the wound with a finger, or, as a last resort, placing a “venous tourniquet” distal to the wound, squeezing only the veins and not disrupting arterial circulation. The effectiveness of the “venous” tourniquet is judged by the cessation of bleeding with a distinct pulsation of the arteries below the wound.

Arterial bleeding from a non-main vessel is stopped, like venous bleeding, by a pressure bandage or tamponade. To prepare for applying a bandage, the bleeding vessel is compressed above (proximal) the wound (Fig. 7-16).

Rice. 7-16. Stages of stopping arterial bleeding from a non-main vessel. a - arterial bleeding; b - temporary stop of bleeding by pressing the artery along the proximal extent of the wound; c - applying a pressure bandage

In case of arterial bleeding from a great vessel, the first measure should be digital compression or maximum flexion in the joint, and then apply a pressure bandage. If the bandage gets wet with blood (“drips”), a tourniquet should be applied above the wound and again try to achieve hemostasis with a pressure bandage, increasing local compression of the damaged area or fixing the limb in the position of maximum flexion. Only the ineffectiveness of these measures dictates the need to use a tourniquet. Bleeding from anatomical areas inaccessible to a pressure bandage and tourniquet is stopped with tamponade, and if it is ineffective, with a hemostatic clamp.

In all cases, after temporarily stopping the bleeding, it is necessary to raise the injured limb above the body, which reduces the flow of blood and improves the possibility of blood clot formation.

To summarize the above, I would like to emphasize that the fate of a victim with external bleeding depends primarily on the quick and correct actions of those providing first aid, and it is provided not by vascular surgeons, but by general practitioners.

How is digital pressure applied to arteries during bleeding? If arterial bleeding occurs, you should act immediately and decisively, since in this situation minutes count. It is important not to get confused and not waste precious time; for this, a person needs to familiarize himself with the rules of first aid in the event of such a situation. In most cases, people do not have items at hand to stop bleeding from a wound; in such a situation, it is necessary to use finger pressure.

How to determine the pressure point

Finger pressure of the arteries should be performed in case of damage to the arterial artery, but you should be aware that this measure has only a temporary effect.

This technique is used not only in the event of an emergency or other incident, but also during surgery.

It is important to know that it is impossible to stop bleeding by squeezing the vessel between the fingers, because:

1. The vessel is not noticeable in a bleeding wound.
2. The site of the lesion is often surrounded or contaminated by bone fragments or clothing.

But this does not apply to the situation when a bone fracture occurred at the site of intentional compression; here, finger pressure of the vessels is simply impossible.

Doctors have a special scheme that can be used to determine where the points of finger pressure on the arteries are:

• the underlying bone is temporal, and the artery is located a centimeter up and forward from the opening of the ear;
• lower jaw, the artery is located two centimeters forward from the angle of the jaw;
• the bone in this case is the carotid tubercle of the transverse process of the sixth vertebra of the neck, and the artery can be found in the middle of the inner edge of the sternocleidomastoid muscle;
• the bone is the first rib, and the artery is behind the clavicle in the middle third;
• in this case the bone is the head of the humerus, and the artery is located on the border of the hair in front of the armpit;
• the bone is here on the inner surface of the shoulder, and the artery is on the medial edge of the biceps muscle;
• horizontal branch of the pubic bone, where the artery is located in the middle of the Pupart fold;
• the back of the tibia, where the artery is at the top of the popliteal fossa;
• the bone is here in the lumbar spine, and the artery is in the navel area, which can be pressed with a fist.

Knowing their locations, even an untrained person can determine the location of the arteries and clamp them at the right time.

Procedure

The condition itself, arterial hemorrhage, requires emergency care; specialists for this case have developed a special algorithm for how to apply finger pressure during bleeding:

• First of all, you should objectively assess the general condition of the patient. You can check the intensity of blood flow by paying attention to the places where blood leaves the artery with pulsation.
• Clothes should be removed from the damaged area.
• Some doctors say that the artery needs to be pinched with your thumb or by grasping the site of injury with your hand. But such actions can lead to pain and cramps, which is why you only need to squeeze the artery with your fist.

• If it is impossible to understand exactly where the artery is torn, it is necessary to compress the wound with your palms.
• Compression of the artery with a fist must be carried out until a compressive bandage is applied.

The artery is compressed towards the heart from the site of injury, but it should be remembered that this is only a temporary stop of bleeding by finger pressure and its maximum effect is possible only for the first ten minutes, then the fingers of the person providing assistance weaken.

Painkillers, which should be crushed and placed under the tongue, will help relieve pain. Next, you need to warm the victim by covering him with warm clothes or a blanket, you need to give him hot coffee or tea.

Treatment with antiseptic agents, as well as applying a bandage, which must be sterile, will help to avoid infection.

Clamping of arteries

Since the arteries themselves are quite mobile, clamping should be done with tightly clenched fingers or thumbs, which is not very convenient, since this will require the help of at least one more person.

In order to begin providing first aid before the ambulance arrives, it is necessary to determine the location of the bleeding and its source, that is, whether it is an artery or a vein. As for the first option, the situation is much more dangerous.

The following arteries should be clamped if arterial bleeding occurs:

1. Shoulder. If the blood comes from the shoulder, then you need to raise your hand and place it behind your head. It is necessary to pinch the artery with four fingers in the intermuscular cavity, which can be found at a distance of 1/3 of the length of the humerus from the joint.
2. Axillary. In this case, you need to press on the inside of the shoulder, clasp the shoulder with both hands and press in the armpit area.
3. Femoral. Clamping is done in the middle of the inguinal fold using two thumbs.
4. Sleepy. If there is bleeding from the head due to a wound in the upper part of the neck, it is necessary to clamp this particular artery, but, unfortunately, it will not be possible to apply a bandage in this place.
5. Subclavian. When the injury is located on the shoulder joint, armpit or upper third of the shoulder. Use your thumb to press into the clavicular fossa.
6. Temporal. If blood from the injury comes from the upper half of the face, then you need to take your thumb and press it in front of your ear at the place of pulsation.

In cases of damage to the arteries, it is necessary to bend the limb as much as possible, in the place where the blood is coming from, lift it and tie a pressure bandage to the required place.

It is important to carry out digital pressure correctly, since the right actions will help not only stop pulsating bleeding, but also save the life of the victim.

Arterial bleeding is damage to a vessel, which, if assistance is not provided in a timely manner, can lead to death. Before the ambulance arrives, it is necessary to provide the victim with first aid, namely, apply finger pressure to the arteries or apply a tourniquet. In the latter case, materials that can help stop bleeding are not always at hand. In such situations, it is necessary to apply finger pressure to the vessel.

How to recognize arterial bleeding

Before performing digital pressure on the artery, you should make sure that the blood is flowing from this particular type of vessel. A feature of the wound will be bright scarlet blood, which splashes out like a fountain (with each contraction of the heart, the blood literally comes out in pulsating streams). The victim will be pale and sweating will increase. When dizziness occurs, drowsiness increases, and a panic attack occurs. If there is a lot of blood loss, it will cause fainting.

With blood loss, severe thirst occurs, dry mouth appears, and the pulse weakens.

Venous bleeding has a dark red tint. When this type of vessel is damaged, blood simply flows out, as with cuts, without the “gushing” effect.

Providing first aid

In case of arterial bleeding, before providing first aid you should know the general rules:

1. You can't hesitate. Every second of delay can cost the patient's life.
2. In some cases, you can use improvised means to stop bleeding. This could be a scarf, belt, long piece of fabric, towel, etc.
3. If the wound is located in a place where it is not possible to apply a tourniquet or there is no suitable object at hand, then finger pressure on the artery should be immediately performed.

Damage to each type of vessel requires certain tactics to stop bleeding.

The artery is pressed above the wound, which helps reduce blood flow to the site of injury, i.e. the vessel is closed before the injury. This method is associated with the peculiarity of blood flow - from the heart, blood flows through the arteries to the organs and tissues.

There are specific points that allow effective compression of the arteries, but to achieve the best results, it is necessary to clamp the artery on both sides.

The finger pressure method is not used for bone fractures at the point of intended compression.

The places where the arteries are pressed are presented in the table below.

Brachial artery

When pressing arteries with fingers, you need to know the specific places to which the vessel is pressed.

If the brachial artery is damaged, it is necessary to raise the victim’s hand and place it behind the head. Then the vessel is clamped: this is done with four fingers. The point of finger pressure on the artery is located between the mice below the shoulder joint in the third part of the shoulder. In this place, the vessel is strongly pressed against the bone, thus ensuring impact on the artery from both sides.

Axillary artery

If bleeding occurs in the upper part of the shoulder, the axillary artery is compressed. It is pressed against the head of the humerus: the procedure is performed from the inside, using the method of full (circular) grip of the shoulder with the hand and finger pressure in the axillary region. You can press in another way, as shown in the figure below.

Femoral artery

During bleeding, finger pressure on the artery is carried out at a point located in the groin area, approximately in the middle of the fold. In this part the artery is pressed against the thigh.

To provide assistance, it is recommended to kneel on the side of the uninjured leg. Then the thumbs press on a point in the groin, and the other fingers seem to cover the thigh. When performing this procedure, you should press with all your weight, leaning on your hands.

Carotid artery

In cases where the vessels of the head, submandibular region, or upper part of the neck are damaged, finger pressure is performed. It is difficult for a person without medical education to apply a tourniquet to the neck so that the victim does not suffocate (the tourniquet is applied by pulling it through the hand raised behind the head). Therefore, only finger pressure is applied to the neck. It is performed with the thumbs: they are positioned so that the remaining fingers are on the back of the head. If the carotid artery is damaged, it should be taken into account that blood flows upward through it (from the body towards the head). To eliminate bleeding, the vessel is clamped below the wound site.

The pressure point of the carotid vessel is located in the middle of the anterior surface of the cervical muscle. When the manipulation is performed correctly, the artery is pressed against the vertebrae.

Subclavian artery

If the wound is located above the point of pressure of the carotid artery or at the shoulder joint, then you can press. To do this, you need to press on the hole behind the collarbone: pressure is applied with your thumb, and the rest are located behind.

Temporal and maxillary arteries

In case of damage and wounds to the face, accompanied by arterial bleeding, immediate compression of the temporal or jaw vessels is required. The latter is pressed with a finger to the lower jaw. And the temporal artery is pressed in front of the auricle.

Arteries of the limbs

Arterial bleeding of the feet and hands is rarely life-threatening. However, even these types of injuries should not lead to serious blood loss. To reduce it, you need to lift the limb, then use your hands to squeeze the middle third of the forearm using a circular grip. The artery of the foot is pressed using the same principle: it is pinched on the third part of the lower leg.

While pressing, do not release the pressure so as not to provoke further bleeding. It is necessary to keep your hands on the vessel until the ambulance arrives. When performing the technique of finger pressing of arteries, you do not need to think about the rules of asepsis and antisepsis, or wash your hands - in such situations, seconds count, because each of them could be the last for the victim. In some situations, you can apply a tourniquet or use improvised means to compress the artery. In any case, it is necessary to monitor the patient’s condition, and you also need to note the time when the tourniquet was applied or finger pressure began. This is necessary so that emergency doctors can assess the severity of the patient’s condition.

Target:

Indications: arterial bleeding.

Equipment:

I. Preparatory stage

the victim.

Get consent.

II. Main stage

Arteries along:

Common carotid artery

External maxillary artery

Temporal artery

Subclavian artery

Brachial artery

Radial artery

Axillary artery

Ulnar artery

Femoral artery

popliteal artery

Posterior tibial artery

Dorsal artery of the foot

Abdominal aorta

III. The final stage

antiseptic.

Target:

Indications:

Contraindications:

Equipment:

Preparatory stage

1. Wear personal protective equipment in the ambulance.

2. Ensure personal safety and security

the victim.

3. Conduct an initial examination of the victim to determine the type of injury.

Main stage.

5. Sit or lay the victim down.

7. Stop bleeding with finger pressure

arteries throughout.

to failure.

12. Fasten the buckle.

will stop.

twists.

The final stage:

TOOL SET FOR

Indications: the need for transfusion of large quantities of solutions due to severe intoxication, disorders of the acid-base state and water-electrolyte balance, and the need for parenteral nutrition.

Set of tools:

Kornzang;

Surgical tweezers;

Scalpel;

Needle holder;

Cutting needle with thread;

Scissors;

Sterile beads;

Sterile wipes;

Sterile gloves;

Antiseptic;

Anesthetic;

Syringe (2-5 ml) for skin anesthesia;

Syringe 10.0 (20.0) ml;

Patch;

Standard catheterization kit;

System filled with saline solution.

Patient preparation:

1. Explain to the patient the need and principle of puncture, obtain consent:

2. Place the patient on his back.

3. Place a cushion under your shoulders.

4. Place the hand on the puncture side along the body.

5. Lower the shoulder girdle on the side of the puncture slightly.

STANDARD SET FOR

CATHETERIZATION OF THE SUBCLAVIA VEIN

1. Needle for vein puncture. The needle cannula has depressions for easy grip with fingers and is transparent, so the filling of the chamber with blood is clearly visible when the needle enters the lumen of the vein.

2. A flexible conductor tucked into a special case to prevent spontaneous unwinding. The tip of the conductor is bent, which prevents perforation of the wall when it moves into the lumen of the vein.

COVERING THE STERILE TABLE

IN THE DRESSING ROOM

Indications: dressing postoperative patients in the surgical department of the hospital, performing minor operations (PHO, punctures, etc.)

Material equipment:

1. Equipment for routine cleaning of the dressing room (see instructions).

2. Equipment for surgical treatment of hands (see instructions).

3. Equipment for putting on sterile clothing (see instructions).

4. Cuvette with kidney-shaped trays and instruments in a dry-heat oven. On average, for 15 dressings you need:

Kidney-shaped trays (8 pcs.);

Surgical tweezers (12 pcs.);

Anatomical tweezers (12 pcs.);

Hemostatic clamps (8 pcs.)

Scalpels (3 pcs.);

Scissors (10 pcs.)

Probes (4 pcs.);

Plate hooks (1 pair);

- containers for solutions, etc.;

Paper and pen.

Preparatory stage of the manipulation:

1. Remove all objects from your hands before starting work, cut your nails short.

2. Put on a cotton suit, a clean hat, and an apron.

3. Check the timing of sterilization of the biks, tightness, external indicator, indicate the date and time of opening of the biks on the tag. Check the tightness and sterilization date of Kraft packaging.

4. Carry out routine cleaning of the dressing room (see instructions). When disinfecting the working and auxiliary tables of the dressing room, first treat the surface of the table, then its legs.

5. Remove and disinfect apron and gloves.

6. Treat your hands surgically (see instructions).

7. Put on sterile clothing (see instructions).

The main stage of the manipulation:

8. Open the lid of the box with sterile oilcloth by pressing

foot on the pedal.

9. After making sure that the installation is sterile, fold back the edges of the diaper lining the bix so that it covers the edges of the bix.

10. Take out the oilcloth, unfold it and lay it on the table in one layer in the direction away from you.

11. Open the cover of the universal stacking box,

pressing your foot on the pedal.

12. After making sure that the installation is sterile, take out the first sheet and unfold it so that it does not touch adjacent objects and your clothes.

13. Lay down the first sheet, folded in half so that it hangs 25 cm from the edge of the table.

14. Lay the second sheet in the same way as the first.

15. The third sheet is 10-15 cm higher than the previous ones.

16. The fourth - similar to the third.

17. Place a sterile diaper folded in four on a nearby table and cover your hands with another one.

18. Ask the nurse to open the dry-heat cabinet.

19. Remove the tray with tools from it and place it on the prepared diaper.

20. Using working tweezers, lift 4 pins and tweezers from the tray. Hold them in your left hand.

21. Use the first tack to secure all the layers at the top right.

22. Using tweezers, take a note from the nurse indicating the date, time of setting the sterile table, and the nurse’s signature.

23. Using the second clip, secure the note and all layers at the top left. Discard the tweezers.

24. Using the remaining two pins, secure the front edges of the two top sheets and open the table with an accordion.

25. Using working tweezers, transfer the kidney-shaped trays and instruments to the left edge of the table, laying it out from top to bottom. Take additional tweezers to lay out the dressing material.

26. After making sure that the dressing material is sterile, put it out of the box on the table, untie the stacks of napkins and bundles of brushes, and open the bags.

27. Place a diaper on the right edge of the table, and another one on it

working tweezers.

28. Close the table.

Note:

1. The shelf life of the sterile dressing table is a work shift (6 hours).

2. There are different ways to cover a sterile table, but the principle is the same: the instruments are placed between eight layers of sheets (4 before and 4 after).

3. In the dressing room of the clinic, instead of a sterile dressing table, it is more advisable to use individual craft packaging with instruments and dressings for performing various types of dressings. This method of dressing can also be used in a hospital.

FIRST AID

FOR ACUTE URINARY RETENTION

Causes:

Early postoperative period;

Prostate adenoma (in older men);

Spinal cord injury.

Indications: lack of urination with a full bladder.

Equipment:

Urinal or bedpan;

A jug of warm water;

Bladder catheterization kit;

Set for suprapubic puncture.

Sequencing:

1. Separate the patient with a screen. Outsiders must leave.
2. Place the patient in a sitting or semi-sitting position.
3. Provide a urine bag and cover the patient with a sheet.
4. Try to induce voluntary urination using reflex actions:

The sound of a water jet (open a water tap or pour from a jug and basin);

A heating pad on the lower abdomen (if there are no contraindications);

Pour warm water over the genitals.

5. If the above measures are ineffective within 6 hours, catheterize the bladder with a soft catheter.

1. A paramedic or doctor may perform a suprapubic puncture.
2. If the above measures are unsuccessful, transport the patient to the urology department in a sitting or lying position on his back or side.

FIRST AID FOR FRACTURES

Indications: injury accompanied by bone fracture.

Complications:

Traumatic (painful) and hemorrhagic shock;

Damage to blood vessels and nerves;

Fat embolism;

Damage to the skin from bone fragments.

Material support:

1. Personal protective equipment (apron, sleeves, mask, goggles or protective screen, gloves).

2. Means for temporary hemostasis.

3. Tonometer and phonendoscope.

4. Narcotic analgesics (1 ml., 1% morphine solution or 1 ml. 2% promedol solution), non-narcotic (2 ml. 50% analgin solution) and local anesthetics (50-100 ml. 0.5% solution -ra novocaine).

5. Syringes and needles.

6. Set for toileting the wound and applying an aseptic dressing.

7. Means for transport immobilization (standard tires or improvised means).

8. Bandage, cotton wool.

9. Stretcher, blanket.

10. Drugs for the prevention of tetanus.

STOPING BLEEDING BY FINGER PRESSING AN ARTERY DISTINGUISHING A VESSEL

The method of stopping bleeding by digitally pressing the artery to the bone is the fastest and quite effective, however, it excludes the possibility of transporting the victim to a medical facility and therefore this method should be considered preparatory. It makes it possible to reduce blood loss and move on to another more reliable method that allows transporting the victim. The bleeding vessel is pressed in those places where the artery is located superficially near the bone to which it can be pressed. When the limbs are wounded, the vessels are pressed above the wound; when the neck is wounded, the vessels are pressed below the wound.

Target: temporary stop of bleeding

Indications: arterial bleeding.

Equipment:

1. Personal protective equipment (waterproof apron, mask, goggles or protective screen, gloves).

2. Containers with disinfectant solution.

I. Preparatory stage

1. Wear personal protective equipment in the ambulance.

2. Ensure personal safety and security

the victim.

3. Conduct an initial examination of the victim to determine the type of injury.

4. Inform the victim about the purpose and nature of first aid.

Get consent.

II. Main stage

5. Sit or lay the victim down.

6. Place the limb in an elevated position.

Common carotid artery press the middle of the inner edge of the sternocleidomastoid muscle against the carotid tubercle of the transverse process of the 6th cervical vertebra (with the first finger or the other four).

External maxillary artery press it to the lower edge of the lower jaw at the border of its posterior and middle thirds (with your first finger).

Temporal artery press in the temple area above the tragus of the ear to the temporal bone (with your first finger).

Subclavian artery press in the middle of the supraclavicular region against the tubercle of the first rib (with the first finger or the other four). Pressing this artery is also possible by pulling the arm down and back. In this case, the artery is compressed between the collarbone and the first rib.

Brachial artery press in the upper third of the inner surface of the shoulder at the edge of the biceps muscle to the humerus (with your first finger or the other four.

Radial artery presses against the radius in the area where the pulse is examined.

Axillary artery press in the middle of the armpit to the head of the humerus (with the first two fingers or the other four of both hands).

Ulnar artery press against the ulna in the upper third of the inner surface of the forearm (with the first finger or the other four).

Femoral artery press below the middle of the Pupart ligament to the horizontal rami of the pubic bone (with the first two fingers, fist, knee).

popliteal artery press in the middle of the popliteal fossa to the femur, while bending the lower limb at the knee joint (with the first two fingers or the remaining four of both hands).

Posterior tibial artery Press against the back of your inner ankle (with your first finger or the other four).

Dorsal artery of the foot press on its back surface in the middle between the outer and inner ankles, slightly below the ankle joint (with the first finger or the other four).

Abdominal aorta press with your fist or knee to the spine to the left of the navel (this can be done with a flaccid abdominal wall).

8. Apply the bleeding control method,

allowing the victim to be transported.

9. Diagnose shock and degree of blood loss.

10. Carry out pain relief (prevention of shock).

11. Clean the wound and apply an aseptic bandage.

12.Immobilize the limb.

13.Transport the victim to a medical facility.

III. The final stage

1. Disinfect personal protective equipment or place it in a sealed bag.

2. Wash your hands with soap and sanitize them

antiseptic.

STOPING BLEEDING BY APPLYING A FABRIC TURNINE-TWIST

Target: temporary stop of bleeding.

Indications: arterial bleeding of the shoulder and thigh, bleeding from the stump of a limb during traumatic amputation, damage to the carotid artery.

Contraindications: bleeding in children under three years of age.

Equipment:

1. See instructions “Applying a Tourniquet”.

2. Twist tourniquet or improvised twist tourniquet.

Preparatory stage

1. Wear personal protective equipment in the ambulance.

2. Ensure personal safety and security

the victim.

3. Conduct an initial examination of the victim to determine the type of injury.

4. Inform the victim about the purpose and nature of first aid. Get consent.

Main stage.

5. Sit or lay the victim down.

6. Elevate the limb.

7. Stop bleeding with finger pressure

arteries throughout.

8. Select the correct location for applying the tourniquet:

proximal (above) the wound and as close to it as possible.

9. Twist the tourniquet around the limb once.

10.Pass the free end of the braid through the metal

ring and circle it 2-3 times around the limb.

11. Pass the free end of the harness through the buckle and tighten

to failure.

12. Fasten the buckle.

13. Twist until the bleeding stops

will stop.

14. Insert a stick into the fabric loop to hold the end

twists.

15. Check the correct application of the tourniquet by the cessation of bleeding, absence of pulse in the periphery and blanching of the distal limb.

16. Attach a note to the twist cord indicating the date, time, full name. the person who applied the tourniquet.

17. Measure BP and PS to diagnose shock and degree of blood loss. If there is shock, take anti-shock measures (see instructions).

18. Provide pain relief to prevent traumatic shock.

19. Clean the wound and apply an aseptic bandage.

20. Immobilize the limb. Suspend the upper limb on a scarf so that the tourniquet and bandage are visible to control them. If a lower limb is injured, place the victim on a stretcher.

The final stage:

21. Transport the victim to a surgical or trauma department to completely stop the bleeding. In winter, wrap your limb.

22. Disinfect instruments, dressings, and personal protective equipment.

23. Wash your hands with soap and treat them with an antiseptic.

In a situation where severe bleeding cannot be stopped with a pressure bandage, it is necessary to notice digital pressure on the arteries. This is one of the most effective methods of providing first aid, which in an emergency situation allows you to save the life of the victim.

What are the signs of arterial bleeding? There are several types of bleeding - arterial, venous and capillary. Arterial blood loss is damage to the artery through which blood flows from the heart to tissues and organs. The blood in the artery is enriched with oxygen, so it has a bright scarlet color. Unlike venous bleeding, when blood flows out of the wound very slowly, arterial blood loss occurs quickly, under high pressure, throwing out a pulsating stream of blood. Arterial bleeding is dangerous to human life. Finger pressure on the artery is used not only in cases of injuries and falls; surgeons often resort to this method if the arterial trunk is damaged during surgery.

How to stop bleeding?

Don't be afraid of this manipulation. The damaged vessel cannot be squeezed with fingers, since it is not visible in the bleeding lesion, scraps of clothing and bone fragments. In case of arterial bleeding, it is necessary to clamp the main vessel not in the wound itself, but slightly higher. As a result, blood flow to the injured area will decrease.

Not everyone knows the basic rules of anatomy, so the one who will carry out finger pressure must know where the main points of location of the vessels and arteries are located. They are placed exactly in the direction of the vessels and nearby bone formations. For the method of emergency stopping blood by pressing the vessels to be effective, the artery must be clamped on both sides.

This emergency method is strictly unacceptable if the bone is broken at the point of intended compression. This means that the artery must be compressed using both hands for 10 minutes. If this time is not enough to completely stop the bleeding, the procedure is repeated again.

Basic rules for providing emergency first aid for bleeding:

1. 1. You must not hesitate, every minute can cost the life of the victim. It is important to immediately assess the situation and take action.
2. 2. If necessary, you can cut or tear clothing if this is required for a good examination of the wound.
3. 3. The method of finger pressing of the artery is carried out with the thumbs. They are pressed at the desired point. If the victim begins to have convulsions and severe pain in the limbs, you can press on the point with your fist.
4. 4. In case of an unknown cause of blood loss, you can apply pressure to the wound with your palm. This is what you do for open wounds of the abdomen.
5. 5. You need to press the points on the arteries until pressure bandages are applied.

Finding the right points on the body

Let's take a closer look at the main places of finger pressure:

1. 1. To clamp the brachial artery, find the area located between the shoulder muscles. The upper limb of the injured person is raised and placed behind the head. The person providing assistance should be positioned behind the victim at this moment.
2. 2. If it is necessary to clamp the brachial vessel, then the pressure point is located between the shoulder muscles, just below the shoulder joint. Having found the required point, it should be pressed firmly against the bone.
3. 3. If blood loss is localized in the upper part of the shoulder, then this may be due to impaired functioning of the axillary artery. Clamping is done from the inside of the humerus, wrapping the shoulder in a circular manner with two thumbs in the armpit area.
4. 4. The clamping point of the femoral artery is located in the groin area, approximately on the middle fold. At this point, the artery is strongly pressed against the femur. It is important to consider some features of compression of the femoral artery:

• the person providing first aid should be positioned on the side of the injured hip, kneeling;
• the thumbs press the groin point, and the remaining fingers of the hand clasp the thigh;
• you need to press as hard as possible, pressing with the weight of your body, leaning on your hands.

Timely measures to compress the carotid artery are tantamount to a new birth, since a minute of delay can cost life. The carotid artery is clamped in case of injuries to the head, vessels of the submandibular region, and injuries to the upper part of the neck. Providing first aid is complicated by the fact that it is impossible to wrap a tight circular bandage around the neck, as the victim will simply suffocate.

Correct compression of the carotid artery should be done in the following way:

1. 1. The point is pressed with the thumb, at the same time the remaining fingers are located on the back of the wounded person.
2. 2. It is necessary to take into account the direction of blood flow in the carotid artery. The vessel is clamped just below the rupture point.
3. 3. The required point is located approximately in the middle of the neck muscle. To determine this location, it is necessary to turn the victim’s head to the opposite side.
4. 4. The carotid artery needs to be pressed against the processes of the cervical vertebrae.

How to clamp the subclavian and temporal vessels?

In a situation where the vessels of the head of the shoulder joint and neck are damaged, it is necessary to press the subclavian artery. To do this, use your thumb to press firmly on the point behind the collarbone, pressing it against the first rib. The complexity of another situation is that a large number of blood vessels are concentrated on the face. If the lower part of the face is damaged, then to urgently stop the bleeding it is necessary to clamp the jaw artery. The artery located in the temporal part is pressed with a finger at a point located just above the auricle.