Mechanical methods for the final stop of bleeding. Classification of bleeding

Rules for the final stop of bleeding

Methods

• ligation of bleeding vessels
• ligation of vessels throughout
• stitching of the damaged vessel
• wound tamponade

Physical methods for the final stop of bleeding

• application of high and low temperature and high frequency currents
• irrigation of the bleeding tissue area with hot (45-500 C) isotonic sodium chloride solution
• cold (ice pack, cold water in the form of compresses)
• electrocoagulation (the device is based on the action of high frequency currents)
• electroknife during operations on parenchymal organs

Medications to stop bleeding

Chemical-pharmaceutical means of stopping bleeding are used to increase blood clotting and vasoconstriction. These hemostatic substances are divided into internal and external, or local. For this, various medications are used. local action. Vasoconstrictors: adrenalin and ephedrine. Hemostatic agents (hemostatics): 3% hydrogen peroxide solution. Hemostatic agents of general action: 5% aminocaproic acid intravenously, 10% calcium chloride intravenously, 1% solution of vikasol (vitamin K) intramuscularly

Biological methods to stop bleeding

• tissue tamponade
• vitamin K(vikasol)
• hemostatic sponge, gauze
• transfusion of a small amount of blood (50-100 ml)
• serum administration

Transportation of a bleeding victim

• put the victim on a stretcher, on his back
• lower the head end of the stretcher
• put a cushion under your feet
• control blood pressure, pulse rate, consciousness and other vital functions
• control the condition of the bandage
• prepare everything necessary for the internal administration of drugs as prescribed by the doctor (correction of BCC)

Methods for the final stop of bleeding, depending on the nature of the methods used, are divided into mechanical, physical (thermal), chemical and biological.

Mechanical Methods

Mechanical methods of stopping bleeding are the most reliable. In case of damage to large vessels, vessels of medium caliber, arteries, only the use of mechanical methods leads to reliable hemostasis.

Vessel ligation

Ligation (ligation) of a vessel is a very ancient method. For the first time, Cornelius Celsus proposed to bandage a vessel during bleeding at the dawn of our era (I century). In the 16th century, the method was revived by Ambroise Pare and since then has been the main method of stopping bleeding. Vessels are bandaged during PST of wounds, during any surgical operations. For one intervention many times it is necessary to impose ligatures on the vessels.

There are two types of ligation of vessels:

Ligation of a vessel in a wound

Ligation of the vessel throughout.

a) Ligation of the vessel in the wound

Bandaging the vessel in the wound, directly at the site of injury, is certainly preferable. This method of stopping bleeding disrupts the blood supply to a minimum amount of tissue.

Most often, during operations, the surgeon applies a hemostatic clamp to the vessel, and then a ligature (the temporary method is replaced by the final one). In some cases, when the vessel is visible before damage, the surgeon crosses it between two previously applied lines.

Rice. 5. Vessel ligation technique

A. Vessel ligation after applying a hemostatic clamp

B. intersection of the vessel after its preliminary ligation.

gaturami (Fig. 5.). An alternative to such ligation is vessel clipping - application of metal clips to the vessel using a special clipper. This method is widely used in endoscopic surgery.

b. Vessel ligation throughout

The ligation of the vessel throughout is fundamentally different from the ligation in the wound. Here we are talking about the ligation of a rather large, often main trunk proximal to the injury site. In this case, the ligature very reliably blocks the blood flow through the main vessel, but bleeding, although less serious, can continue due to collaterals and reverse blood flow.

The main disadvantage of ligation of the vessel throughout is that much more tissues are deprived of blood supply than with ligation in the wound. This method is fundamentally worse and is used as a forced measure.

There are two indications for ligation of the vessel throughout:

The ends of the vessel cannot be found, which happens when bleeding from a large muscle mass (massive bleeding from the tongue - they tie up the lingual artery on the neck in the Pirogov triangle, from the muscles of the buttocks - they tie up the internal iliac artery, etc.).

Secondary arrosive bleeding from a purulent or putrefactive wound (bandaging in the wound is unreliable, since arrosion of the vessel stump and recurrence of bleeding are possible, in addition, manipulations in the purulent wound will contribute to the progression of the inflammatory process).

In these cases, in accordance with the topographic and anatomical data, the vessel is exposed and tied up along the length proximal to the zone of its damage.

Vessel sheathing

In cases where the bleeding vessel does not protrude above the surface of the wound and it is not possible to capture it with a clamp, a purse-string or Z-shaped suture is applied around the vessel through the surrounding tissues, followed by tightening the thread - the so-called sheathing of the vessel (Fig. 6.).

Rice. 6. Sheathing of a bleeding vessel.

Twisting, crushing blood vessels

The method is rarely used for bleeding from small veins. A clamp is applied to the vein, it is on the vessel for some time, and then it is removed, while it first rotates around its axis several times. In this case, the wall of the vessel is maximally injured and it is reliably thrombosed.

Wound tamponade, pressure bandage

Wound tamponade and pressure dressing are methods of temporarily stopping bleeding, but they can also become definitive. After removing the pressure bandage (usually 2-3 days) or removing tampons (usually 4-5 days), bleeding may stop due to thrombosis of damaged vessels.

Rice. 7. Method of posterior tamponade of the nasal cavity.

a. passing the catheter through the nose and mouth to the outside; b. attaching a silk thread to the catheter; in. reverse insertion of a catheter with a tampon.

Separately, it should be said about tamponade in abdominal surgery and in nosebleeds.

a) Tamponade in abdominal surgery

During operations on the abdominal organs, in cases where it is not possible to reliably stop the bleeding and “leave the abdomen” with a dry wound, a swab is brought to the place of blood leakage, which is brought out, sewing up the main wound. This happens extremely rarely with bleeding from the liver tissue, venous or capillary bleeding from the area of ​​​​inflammation, etc. Tampons are kept for 4-5 days and after their removal, bleeding usually does not resume.

b) Tamponade for nosebleeds. For epistaxis, tamponade is the method of choice. It is practically impossible to stop the bleeding here in any other mechanical way. There is anterior and posterior tamponade. The anterior one is carried out through the external nasal passages, the technique for performing the posterior one is shown in the diagram (Fig. 7.). The tampon is removed for 4-5 days. It is almost always possible to achieve stable hemostasis.

Vascular embolization

The method refers to endovascular surgery. It is used for bleeding from the branches of the pulmonary arteries and the terminal branches of the abdominal aorta. At the same time, according to the Seldinger method, the femoral artery is catheterized, the catheter is brought to the bleeding area, a contrast agent is injected, and, by performing x-rays, the injury site is identified (diagnostic stage). Then, an artificial embolus (spiral, chemical substance: alcohol, polystyrene) is brought along the catheter to the site of damage, covering the lumen of the vessel and causing its rapid thrombosis.

The method is low-traumatic, avoids major surgical intervention, but the indications for it are limited, in addition, special equipment and qualified personnel are needed.

Embolization is used both to stop bleeding and in the preoperative period to prevent complications (for example, embolization of the renal artery in case of a kidney tumor for subsequent nephrectomy on a "dry kidney").

Special methods for dealing with bleeding

Mechanical methods of stopping bleeding include certain types of operations: splenectomy for parenchymal bleeding from the spleen, gastric resection for bleeding from an ulcer or tumor, lobectomy for pulmonary bleeding, etc.

One of the special methods is the use of an obturator probe for bleeding from varicose veins of the esophagus - a fairly common complication of liver diseases accompanied by portal hypertension syndrome. Usually, a Blackmore probe is used, equipped with two cuffs, the lower of which is fixed in the cardia, and the upper one, when inflated, compresses the bleeding veins of the esophagus.

Vascular suture and vascular reconstruction

Vascular suture is a rather complicated method that requires special training of the surgeon and certain instruments. It is used in case of damage to large main vessels, the cessation of blood flow through which would lead to adverse consequences for the patient's life. Distinguish between manual and mechanical seam. Recently, hand stitching has been mainly used.

The method of applying a vascular suture according to Carrel is shown in fig. 8. When applying a manual suture, an atraumatic non-absorbable suture material is used (threads No. 4/0-7/0, depending on the caliber of the vessel).

Depending on the nature of the damage to the vascular wall, various options for intervention on the vessels are used: lateral suture, lateral patch, resection with end-to-end anastomosis, prosthetics (vessel replacement), shunting (creation of a bypass for blood).

Rice. 8. Technique of vascular suture according to Carrel.

When reconstructing blood vessels, auto-1 vein or synthetic material is usually used as prostheses and shunts. In such a vascular operation, the following requirements must be met:

High degree of tightness

Absence of blood flow disorders (constrictions and eddies),

As little suture as possible! in the lumen of the vessel

Precise comparison of the layers of the vascular wall.

It should be noted that among all the methods of stopping bleeding, the imposition of a vascular suture (or the production of vessel reconstruction) is fundamentally the best - only with this method is the blood supply to the tissues fully preserved.

Physical Methods

Starting to present other, non-mechanical methods of stopping bleeding, it should be said that all of them are used only for bleeding from small vessels, parenchymal and capillary, since bleeding from a medium or large caliber vein, and even more so an artery, can only be stopped mechanically.

Physical methods are otherwise called thermal, as they are based on the use of low or high temperatures.

Cold exposure

The mechanism of the hemostatic effect of hypothermia is vasospasm, slowing of blood flow and vascular thrombosis.

a) Local hypothermia

To prevent bleeding and hematoma formation in the early postoperative period, an ice pack is placed on the wound for 1-2 hours. The same method can be used for nosebleeds (ice pack on the bridge of the nose), gastric bleeding (ice pack on the epigastric region).

With gastric bleeding, it is also possible to introduce cold (+4 ° C) solutions into the stomach through a tube (usually, chemical and biological hemostatic agents are used).

b) Cryosurgery

Cryosurgery is a special area of ​​surgery. Very low temperatures are used here. Local freezing is used in operations on the brain, liver, and in the treatment of vascular tumors.

Exposure to high temperature

The mechanism of the hemostatic effect of high temperature is the coagulation of the protein of the vascular wall, the acceleration of blood clotting.

a) Use of hot solutions

The method can be applied during the operation. For example, with diffuse bleeding from a wound, with parenchymal bleeding from the liver, gallbladder bed, etc., a napkin with hot saline is injected into the wound and held for 5-7 minutes, after removing the napkin, the reliability of hemostasis is controlled.

b) Diathermocoagulation

Diathermocoagulation is the most commonly used physical method for stopping bleeding. The method is based on the use of high-frequency currents, leading to coagulation and necrosis of the vascular wall at the point of contact with the tip of the device and the formation of a thrombus (Fig. 9.).

Rice. 9. Diathermocoagulation of the wound vessel.

Without diathermocoagulation, not a single serious operation is now conceivable. It allows you to quickly stop bleeding from small vessels without leaving ligatures (foreign body) and thus operate on a dry wound. Disadvantages of the electrocoagulation method: it is not applicable to large vessels; if excessive coagulation is incorrect, extensive necrosis occurs, which can impede subsequent wound healing.

The method can be used for bleeding from internal organs (coagulation of a bleeding vessel in the gastric mucosa through a fibrogastroscope), etc. Electrocoagulation can also be used to separate tissues with simultaneous coagulation of small vessels (the instrument is an electron), which greatly facilitates a number of operations, so how the incision is essentially not accompanied by bleeding.

Based on antiblastic considerations, the electroknife is widely used in oncological practice.

c) Laser photocoagulation, plasma scalpel.

Methods relate to new technologies in surgery. They are based on the same principles (creation of local coagulative necrosis) as diathermocoagulation, but they allow you to stop bleeding more metered and gently. This is especially important in parenchymal bleeding.

It is also possible to use the method for tissue separation (plasma scalpel). Laser photocoagulation and plasma scalpel are highly effective and increase the possibilities of conventional and endoscopic surgery.

d) Coagulation hemostasis.

Heat leads to hemostasis by denaturing proteins. How to supply thermal energy to cells? Most often, a high-frequency alternating electric current is used for this. Monopolars effectively coagulate vessels less than 1.5 mm in diameter. Bipolars - up to 2 mm in diameter. Vessels are larger, but there is more adhesion, soot, and heat distribution. The new technology applied by Wallilab (USA) allows for hemostasis of tissues with vessels up to 7 mm in diameter. This gives the surgeon an alternative to all existing standard ligation methods - ligatures, clips, staples, as well as electrosurgical instruments, ultrasound and other energy technologies. Moreover, the technology implies the rejection in many cases of the standard surgical technique of organ mobilization, which involves the isolation of a vessel of medium and large diameter from the surrounding tissues with its subsequent ligation. The technology is in many ways similar to bipolar: high-frequency alternating current (470 kHz) with a voltage of max 120 V, a power of 4A and a power of max. 150 W (Fig. 10).

Fig.10. Apparatus ligaSure

The current is supplied in cycles (packets), at the end of the cycle, energy is not supplied (the tissue is cooling down), but at the same time, the jaws of the instrument mechanically squeeze the tissues. Electric current supply cycles alternate with pauses until the moment of protein denaturation and collagenization, then the end signal is heard. The whole process, on average, takes 5 seconds. The tissues placed between the jaws of the instrument (up to 5 cm) are welded, then it remains only to cross them (Fig. 11, 12).

Fig.11. Scheme of hemostasis by LiShur device

Fig.12. View of the vessel before (a) and after (b) the use of the LigaSure device

Benefits of LigaSure technology:

Reliability, constancy, strength of sealing the walls of the vessel

Minimal heat spread

Reduced sticking and soot

The strength of the filling is higher than that of other energy methods

Sealing strength comparable to existing mechanical methods

There are 3 groups of causes that cause bleeding.

The 1st group includes mechanical damage to the vascular wall. These injuries can be open, when the wound channel penetrates the skin with the development of external bleeding, or closed (for example, as a result of injuries of blood vessels with bone fragments in closed fractures, traumatic ruptures of muscles and internal organs), leading to the development of internal bleeding.

The 2nd group of causes that cause bleeding include pathological conditions of the vascular wall. Such conditions can develop due to atherosclerosis, purulent fusion, necrosis, specific inflammation, tumor process. As a result, the vascular wall is gradually destroyed, which ultimately can lead to "suddenly" occurring arrosive bleeding.

In the 3rd group of reasons are combined violations of various parts of the blood coagulation system(coagulopathic bleeding). Such disorders can be caused not only by hereditary (hemophilia) or acquired (thrombocytopenic purpura, prolonged jaundice, etc.) diseases, but also by decompensated traumatic shock leading to the development of disseminated intravascular coagulation syndrome (consumption coagulopathy).

Depending on where the blood is poured, there are outdoor bleeding, in which blood is poured into the external environment (either directly or through the natural openings of the body), and internal, when blood accumulates in body cavities, interstitial spaces, imbibes tissues.

Depending on the time of occurrence, primary and secondary bleeding are distinguished.

Primary bleeding is due to damage to the vessel at the time of injury and occurs immediately after it.

Secondary-early bleeding (from several hours to 2-3 days after injury) can be caused by damage to blood vessels or separation of a blood clot due to inadequate immobilization during transportation, rough manipulations during reposition of bone fragments, etc.

Secondary-later bleeding (5-10 days or more after injury), as a rule, is a consequence of the destruction of the vessel wall as a result of prolonged pressure from a bone fragment or a foreign body (decubitus), purulent fusion of a thrombus, erosion, aneurysm rupture.

Depending on the anatomical structure of the damaged vessels, bleeding can be arterial, venous, capillary (parenchymal) and mixed.

Stop bleeding.

Allocate temporary (pursuing the goal of creating conditions for further transportation of the victim) and the final stop of bleeding.

Temporary stop of external bleeding

produced in the provision of first medical, pre-medical and first medical aid. The following methods are used for this:

Finger pressing of the artery;

Maximum limb flexion;

tourniquet;

The imposition of a pressure bandage;

Applying a clamp in the wound (first medical aid);

Packing the wound (first medical aid).

When providing qualified surgical care in case of damage to the main vessel, its temporary bypass is performed (restoration of blood flow through a temporary prosthesis) - the only method of temporary stop of bleeding inherent in this

kind of help.

Final stop bleeding

(external and internal) is the task of qualified and specialized surgical care. The following methods are used for this:

Applying a ligature to a bleeding vessel (ligation of a vessel in a wound);

Ligation of the vessel throughout;

The imposition of a lateral or circular vascular suture;

Vessel autoplasty (when specialized assistance is provided).

First aid:

Hemostasis control; tourniquet revision (relocation of the tourniquet, the residence time of which is approaching the maximum, finger pressure); imposition of hemostatic clamps, ligatures. With venous and capillary - apply a pressure bandage.

Qualified help:

Final stop of external bleeding is performed in the dressing room, where victims are sent with compensated shock or ongoing external bleeding, as well as with a tourniquet for the purpose of revision and removal. Victims with decompensated shock and a fully executed temporary stop of bleeding without the use of a tourniquet are sent to the anti-shock room; the final stop of bleeding in them is delayed until they are taken out of shock.

The final stop of bleeding is usually carried out in parallel with the primary surgical treatment of the wound and consists in the application of ligatures to damaged vessels.

Small vessels may be coagulated.

Mechanical methods to stop bleeding include ligation of the vessel in the wound or throughout, the imposition of a vascular suture, pressure bandage and tamponade.

dressingvesselinwound is the most common and most reliable method of stopping bleeding.

Technics dressings vessel inwound. The vessel is grasped with a hemostatic clamp, after which it is tied up with one or another thread. First, one knot is tied and tightened, and after the clamp is removed, the other. When large vessels are injured, there is a danger of the ligature slipping off the stump of the vessel (which is facilitated by pulsation). In these cases, the vessels are tied up after preliminary flashing of the tissues near the vessel, which prevents the ligature from slipping. Always bandage both ends of the wounded vessel.

dressingvesselon thethroughout used in cases where it is impossible to tie a bleeding vessel in a wound, for example, with secondary bleeding from an infected wound that has developed as a result of vessel erosion. This method is also used to prevent severe bleeding during surgery (for example, preliminary ligation of the external iliac artery before disarticulation of the thigh), as well as in cases where the vessel in the wound cannot be ligated due to technical circumstances.

The advantage of ligation of the vessel throughout is that this operation takes place away from the wound in intact tissues. However, in the presence of a large number of collaterals, bleeding can continue, and if they are poorly developed, necrosis of the limb often occurs. These complications led to the fact that the indications for ligation of vessels throughout were limited to those indicated earlier.

overlayvascularseamon thewoundedvessel or replacement of a section of a damaged artery with a preserved vessel or a plastic prosthesis is an ideal method of stopping bleeding, which allows not only to stop blood loss, but also to restore normal blood circulation along the damaged bed.

Prostheses to replace the area of ​​the damaged vessel are prepared by various methods:

from arteries taken from a corpse and subjected to special processing (freeze-drying) under conditions of low temperature and low pressure. Such ready-made prostheses are stored in ampoules with reduced pressure for a long time;

the vascular prosthesis is made of plastics (polyvinyl alcohol, etc.);

from fabrics (nylon, dacron, etc.). Considering that stopping bleeding is an emergency operation, everything necessary for a vascular suture and vessel plasty should be prepared in advance in the operating room.

The main rule of the vascular suture is the obligatory connection of the vessels with their inner membranes (intima).

There are lateral and circular vascular sutures. The lateral suture is used for parietal wounds of the vascular wall, and the circular suture is used for complete damage to the vessel.

When applying a circular vascular suture, tension should not be allowed between the peripheral and central ends of the vessel, which should not have bruises, ruptures that disrupt nutrition.

Measures are taken to prevent the formation of a thrombus (introduction of heparin, atraumatic operation, etc.). For the imposition of a vascular suture, atraumatic needles, thin silk, or synthetic threads, special instruments are used. Stitching of the vessels can be carried out with a vasoconstrictor apparatus. Good results are achieved by the method of connecting vessels with the ring of D. A. Donetsk.

With a manual suture, the central and peripheral ends of the damaged vessel, after applying elastic vascular clamps to them, approach each other. Then, three fixation nodal or U-shaped sutures are applied along the circumference of the vessel.

When the threads of the fixation sutures are pulled, the lumen of the damaged vessel acquires a triangular shape. The vessel wall between the fixation sutures is sutured with a continuous suture. Stitching of the vessel wall can also be done with continuous mattress or separate interrupted U-shaped sutures.

In case of damage to small vessels, arteries, as well as small venous trunks, bleeding can be finally stopped by applying a pressure bandage. Establishing a good outflow and reducing blood supply by elevating the limb can also lead to a permanent stop of bleeding, especially in combination with a pressure bandage.

In cases where it is impossible to apply any of the above methods, capillary and parenchymal bleeding can be stopped by introducing a gauze swab into the wound that compresses the damaged vessels. However, this method of stopping bleeding should be considered forced, since if the wound is contaminated, the tampon, making it difficult for the outflow of wound contents, can contribute to the development and spread of wound infection. Therefore, hemostatic tampons are recommended to be removed from the wound after 48 hours, when the damaged vessels are reliably blocked by a thrombus.

Removing the tampon, which usually causes severe pain, must be done with extreme caution after pre-irrigating the tampon with a 3% hydrogen peroxide solution.

Mechanical methods also include stopping bleeding by twisting a vessel captured with a hemostatic clamp. This leads to crushing of the end of the vessel and twisting of its inner membrane, which closes the lumen of the vessel and facilitates the formation of a thrombus. This method of stopping bleeding is possible only if small vessels are damaged. In case of bleeding from large vessels in deep wounds, when it is impossible to apply a ligature after capturing the vessel with a hemostatic clamp, it is necessary to leave the clamp applied to the vessel in the wound. This method of stopping bleeding is rarely used and should be considered forced. It is unreliable, as bleeding may resume after the clamp is removed.

Methods for the final stop of bleeding are conventionally divided into:

· mechanical;

· physical (thermal);

· chemical;

· biological;

· combined.

They may be local, directed at the vessels and the bleeding wound surface, and general, affecting the hemostasis system. The choice of each method depends on the nature of the bleeding. For external bleeding, mainly mechanical methods are used, while for internal bleeding, all methods are used, including surgery using various methods to stop bleeding. The final stop of bleeding is carried out, as a rule, in a medical institution. .

Mechanical Methods most often used during operations and injuries. The most common and reliable method of stopping bleeding is ligation of a vessel in a wound . To do this, the vessel is captured with a hemostatic clamp, and then tied up (ligated) with silk, nylon or other thread. It is necessary to tie up both ends of the vessel, as there may be quite a strong retrograde bleeding. A variant of ligation of a vessel in a wound is its stitching together with the surrounding tissues, which are used when it is impossible to seize and isolate the vessel in isolation, as well as to prevent slipping of the ligatures.

Vessel ligation at a distance used when it is impossible to bandage the vessel in the wound (with secondary bleeding from an infected wound due to vessel erosion), as well as to prevent severe bleeding during surgery. The advantage of this method is that the operation is performed away from the wound on intact vessels.

Currently, it is widely used during operations clipping vessels - clamping them with stainless steel metal brackets using special tools.

Bleeding from small vessels can be stopped long pressing hemostatic clamps, which are applied to the vessels at the beginning of the operation after the incision of the skin and subcutaneous tissue, and removed at the end. It is even better to combine this method with torsion (twisting along the axis) of blood vessels, designed to crush them and glue the intima, which contributes to the formation of blood clots in them.

When it is not possible to apply other methods for the final stop of bleeding, apply tight tamponade gauze swab. This method should be considered forced, since with purulent complications, the tampon makes it difficult for the outflow of wound contents and can contribute to the development and spread of wound infection. In these cases, tampons are removed only after 3-7 days, so that bleeding does not resume. Remove them slowly and very carefully.

Methods final bleeding stops are also vascular suture and vascular prosthetics .

In recent years, methods of endovascular embolization of vessels have been developed and introduced. Under X-ray control, a catheter is inserted into a bleeding vessel and emboli (balls made of synthetic polymeric materials) are introduced through the catheter, closing the lumen of the vessel, thereby achieving a bleeding stop. Thrombus formation occurs at the site of embolization.

Physical (thermal) method stop bleeding is based on the use of both high and low temperatures.

Heat causes protein coagulation and accelerates thrombus formation. When bleeding from muscles, parenchymal organs, skull bones, tampons moistened with hot saline (45 - 50 ° C) are used. Widely used diathermocoagulation, based on the use of high-frequency currents, which is the main thermal method for stopping bleeding in case of damage to the vessels of the subcutaneous fatty tissue and muscles. However, its use requires some caution so as not to cause burns and skin necrosis. In this regard, an effective method for stopping bleeding, including from parenchymal organs, is laser photocoagulation , which has several advantages over electrocoagulation. It allows, for example, avoiding the passage of electric current through the tissues and mechanical contact between them and the electrode, dosing and evenly distributing energy within the light spot, and also performing constant visual control, since the bleeding area is not covered by the electrode.

Low temperature causes spasm of blood vessels, contraction of surrounding tissues, which contribute to the formation of clots and blood clots. Cold is used for subcutaneous hematomas, intra-abdominal bleeding, when, along with other methods of stopping bleeding, an ice pack is applied. Cold is used in operations (cryosurgery) on richly vascularized organs (brain, liver, kidneys), especially when removing tumors.

Chemical Methods stop bleeding based on the use of various medications that have a vasoconstrictor effect and increase blood clotting. Topical application of a number of drugs (hydrogen peroxide solution, potassium permangonate, silver nitrate) can help reduce bleeding, but is not sufficiently effective. To stop ulcerative bleeding of the stomach and duodenum 12, caprofer containing reduced iron Fe³ + and &- aminocaproic acid is successfully used.

The most common of the vasoconstrictor drugs apply adrenalin norepinephrine, mezaton, ephedrine. In gynecological practice, for bleeding from the uterus, pituitrin, oxytacin. Of the drugs that affect blood coagulation, apply etamsylate (dicynone). Its hemostatic effect is associated with an activating effect on the formation of thromboplastin. In addition, use the solution calcium chloride, vikasol . For the prevention of bleeding associated with fibrinolysis, can be used aminocaproic acid as a plasminogen activator inhibitor.

biological methods stop bleeding based on the use of biological agents general and local actions.

General action:

Fresh frozen plasma, cryoprecipitate (donor preparation containing protein coagulation factors), platelet preparation. Vitamin P (rutin) and C (ascorbic acid), which reduce the permeability of the vascular wall. Fibrinogen, which works well with hypo - and afibrinogenemia, inhibitors of proteolytic enzymes of animal origin (trasilol, pantrypin, etc.), used for bleeding associated with an increase in the activity of the fibrinolytic system. Dry antihemophilic plasma and antihemophilic globulin are used for bleeding against the background of hemophilia.

Local action:

They are used, as a rule, for capillary and parenchymal bleeding. These funds include: thrombin, which is a dry protein preparation from the blood plasma of a donor and promotes the rapid formation of a blood clot; fibrin sponge, which is made of fibrin and impregnated with thrombin, it fits snugly to the bleeding surface and creates good hemostasis; dry plasma (serum) has the form of a free-flowing powder and is sprinkled on a bleeding surface to achieve hemostasis; fibrin foam is prepared from fibrinogen and thrombin and is also applied to the bleeding surface, fibrin powder is prepared from livestock blood fibrin with the addition of antiseptics, it is mainly used for bleeding from infected wounds of soft tissues and bones Gelatin sponge causes hemostasis mainly mechanically, since, unlike the hemostatic sponge, it does not dissolve.

Biological antiseptic swab (BAP) prepared from blood plasma with the addition of gelatin, blood-clotting and antimicrobial agents, therefore it can be used to treat infected wounds.

To enhance the hemostatic effect, various methods of stopping bleeding are combined . Combined Methods very diverse and effective and in practice are used most often. Bleeding is an obligatory sign of any wound, any operation, possibly an injury. Bleeding is a condition, now at the present moment, threatening the life of the patient and requiring quick, professional action aimed at stopping it. Only after the bleeding has been stopped, one can think, reason, do an additional examination, etc. This is possible only with the absolute professionalism of the medical staff, based on good practical and theoretical knowledge.

Importance of Nurse Competence in Hemorrhage Care.

Stopping bleeding is an important element in the provision of both nursing (pre-medical) and qualified medical care. The professional competence of a nurse in this matter is a set of professional knowledge, skills, professional and personal qualities that determine the internal readiness of a nurse to carry out professional activities in emergency cases based on qualification requirements and moral and ethical standards.

Adequate cessation of blood loss will often save a person's life, preventing the development of shock, facilitating subsequent recovery.

LECTURE.

Topic: Fundamentals of transfusiology.

The role of knowledge about the basics of transfusiology in the work of a nurse.

The importance and role of knowledge about the basics of transfusiology in the work of a nurse is one of the important and relevant topics today. Transfusiology is a science, the knowledge of which is in demand today in all branches of professional activity, one way or another connected with people. This is especially true for professions of a surgical orientation, the object of which is a person. The uniqueness of the nurse's knowledge of the basics of transfusiology is to provide assistance not only to an individual, sick or healthy, but to all patients in need of blood transfusion, which helps to restore his health in the postoperative period or after traumatic blood loss, with which a person does not could cope without outside help, and this should be done in such a way as to help him regain independence as soon as possible. Obviously, without the knowledge of transfusiology, many of these problems would be impossible to solve.

1. The concept of transfusiology.

The most important component of modern medical science and practice is transfusiologists I – a branch of clinical medicine that studies the issues of transfusion of blood and its preparations, as well as blood-substituting and plasma-substituting fluids. Transfusiology has passed a centuries-old path of development. Even in ancient times, it was noticed and it turned out to be obvious that with the loss of blood, a wounded person dies. Then it made me think about some kind of "vital force", to consider blood as "vital juice". Attempts have been made to somehow replace the loss of blood, and sometimes to use it to cure ailments and prolong life. Despite the fact that the doctrine of blood transfusion dates back centuries, this problem found its solution much later. The great work of many scientists of the world, including our compatriots, has brought rich results, contributed to the progress of surgery, therapy and other clinical sciences. The tasks of transfusiology are diverse. In clinical terms, they include the definition of indications and contraindications, the rationale for methods and tactics for the use of transfusion agents in various pathological conditions. Transfusion of blood, its components and blood products, as well as blood substitutes is the most effective means of replenishing blood loss, is included in the complex of measures for the treatment of shock, burn disease, anemia and other diseases.

2. History of the development of transfusiology.

The history of development can be divided into four periods.

I.Period. Ancient - was the longest and the poorest in terms of facts, covering the history of the use of blood for therapeutic purposes. Faith in blood transfusion was so great that in 1492 Pope Innocent VIII decided to transfuse himself with blood in order to prolong life, the experiment was unsuccessful, and the pope died. Hippocrates wrote about the usefulness of mixing the blood of sick people with the blood of healthy people. The first mention of the successful use of blood in the treatment of wounds was found in a handwritten medical book of the 11th century. in Georgian. The book of Libavius, published in 1615, describes for the first time the transfusion of blood from person to person by connecting their vessels with silver tubes.

II.Period. The beginning of the period is associated with the discovery by Harvey of the law of blood circulation in 1628. Since that time, thanks to a correct understanding of the principles of blood movement in a living organism, the infusion of therapeutic solutions and blood transfusion have received anatomical and physiological justifications. In 1666, the report of the eminent anatomist and physiologist Richard Lower was discussed at the Royal Society in London; he was the first to successfully transfuse blood from one dog to another. The first blood transfusion from an animal to a human was performed in 1667 in France by the court physician of Louis XIV Denis, a professor of philosophy and mathematics, who later became a professor of medicine. The first mention of blood transfusion for wounds belongs to I.V. Buyalsky (1846), surgeon and anatomist, professor at the Medico-Surgical Academy, one of the supporters of blood transfusion in Russia. In 1865 V.V. Sutugin, a Russian doctor and researcher, defended his doctoral dissertation “On blood transfusion”, he owns the idea of ​​blood preservation. Despite a number of convincing experimental and clinical studies of our compatriots, blood transfusion in clinical practice in the last quarter of the 19th century. was rarely used, and then was completely stopped.

III. Period. In 1901, the Viennese bacteriologist Karl Landsteiner established the division of people into groups according to the isoserological properties of their blood and described three types of human blood. The fourth author has been described as an exception.

In 1930 he was awarded the Nobel Prize. In 1940, Karl Landsteiner, together with the American transfusiologist and immunologist Wiener, discovered another important blood sign, called the Rh factor. A Czech doctor, professor of neurology and psychiatry at the University of Prague, Jan Jansky in 1907 identified four human blood groups, which confirmed Landsteiner's discovery. In 1921, at the congress of American bacteriologists, pathologists and immunologists, it was decided to use the nomenclature of blood groups proposed by Jansky. Another important discovery was made in 1914-1915, when almost simultaneously V.A. Yurevich (in Russia), Hustin (in Belgium), Agote (in Argentina), Lewison (in the USA) used sodium citrate to stabilize the blood.

In connection with the discovery of blood groups and the introduction of sodium citrate into practice, interest in blood transfusion in clinical practice has increased dramatically. The discoveries made made it possible to call this period in the history of blood transfusion scientific.

IV. Period. Even at the beginning of this period in 1924, S.S. Bryukhonenko was offered a heart-lung machine "autojector". For the first time in the world, such new methods of transfusion as transfusion of post-mortem (Shamov V.N., 1929; Yudin S.S., 1930), placental (Malinovsky S.S., 1934), waste blood (Spasokukotsky S.I., 1934) were developed. , 1935). Since the middle of the 20th century, research has begun on the creation of blood substitutes in different countries. At present, the doctrine of blood-substituting fluids is a separate problem, closely related to the problem of blood transfusion. At present, in all civilized countries of the world, there exists and is constantly improving the state system of blood service, an integral part of which is the blood service of the armed forces, designed to autonomously meet the needs of military medical institutions for blood in peacetime and wartime.

3. The concept of the antigenic structure, blood groups and Rh factor, as the main human antigen-antibody system.