Ways to stop bleeding. Ways to stop arterial bleeding Reducing bleeding by giving an elevated position to the damaged

1. Temporary stop of bleeding can be done in several ways. Choose from the given answers the correct ones:

a) finger pressing of the arterial vessel below the injury site;

b) applying an aseptic bandage to the site of bleeding;

c) applying a tourniquet 3-5 cm above the wound;

d) finger pressure of the arterial vessel above the wound;

e) maximum extension of the limb;

e) applying a pressure bandage to the site of bleeding;

g) applying a tourniquet 3-5 cm below the wound;

h) maximum limb flexion;

i) elevated (slightly higher than the chest cavity) position of the injured limb;

j) minimal limb flexion.

(c; d; f; h; i)

2. The most reliable way to stop bleeding in case of damage to large arterial vessels of the arms and legs is:

a) applying a pressure bandage;

b) finger pressing;

c) application of a tourniquet;

d) maximum limb flexion.

3. From the given answers, select those that determine the maximum time for applying a tourniquet in summer and winter:

a) no more than 30 minutes;

b) no more than 60 minutes;

c) no more than 90 minutes;

d) no more than 120 minutes;

e) no more than 150 minutes.

(in summer - d, in winter - b)

4. What information should be indicated in the note attached to the tourniquet:

a) surname, name, patronymic of the victim;

b) the date and time of the injury;

c) the place where the victim was injured;

d) date and exact time (hours and minutes) of application of the tourniquet;

e) tourniquet application time (hours, minutes and seconds);

f) the surname, name and patronymic of the person who applied the tourniquet.

5. Pressure bandage - a simple and reliable way:

a) stop bleeding;

b) pain reduction;

c) lowering the temperature;

d) creating rest for the damaged part of the body.

There is a mistake in the above answers, please find it.

6. What method can be used to stop bleeding from the vessels of the hand or forearm. Choose the correct answer:

a) take the victim's shoulders as far back as possible and fix them behind the back with a wide bandage;

b) place a roller of rolled-up fabric in the elbow joint, bend the arm at the elbow joint and fix the forearm to the shoulder.

7. What should be done to the wound before applying the pressure bandage? Choose the correct answer:

a) wash the wound with water and treat it with brilliant green;

b) treat the wound with iodine;

c) treat the wound with hydrogen peroxide or a weak solution of potassium permanganate.

8. The method of stopping bleeding by giving an elevated position to the injured limb is mainly used:

a) for any injuries of the limb;

b) with mixed bleeding;

c) with superficial wounds in case of venous bleeding.

9. The victim must be sent to a medical facility if the nosebleed cannot be stopped within:

b) 20-30 minutes;

Any mechanical damage to blood vessels is accompanied by blood loss. A small loss of it is not dangerous to humans. However, the loss of more than 1 liter of blood leads to serious consequences for his body, because a person has only about 5 liters of blood. Therefore, for all wounds, first aid should be aimed primarily at stopping bleeding. This must be done quickly, without delay, as blood loss can disrupt the heart and breathing. Help in this case should be provided right on the spot.

Ways to temporarily stop bleeding:

Press the arterial vessel slightly above the bleeding wound with your fingers;
apply a tourniquet 3-5 cm above the wound;
apply a pressure bandage to the bleeding site;
bend the limb as much as possible;
give the injured limb an elevated (slightly higher than the chest) position.

Pressing the fingers of an arterial vessel above the wound is a simple and affordable way to temporarily stop bleeding. However, its reliability is low, since it is impossible to press the artery with fingers for a long time with sufficient force. The proposed figure shows the points of the superficial location of the arteries. They are located directly under the skin. In this place, they can be easily pressed to stop the bleeding.

Tourniquet application- the main and reliable way to stop bleeding in case of damage to large arterial vessels in case of injury to the legs or arms. Any suitable object can be used as a tourniquet - a rubber band or a sufficiently strong tourniquet, a fabric twisted into a tube. Of course, it is best to use a factory-made rubber tourniquet for this purpose, which is part of any first aid kit.

The cessation of bleeding indicates the correct application of the tourniquet.

It is very important to remember that it is impossible to apply a tourniquet for more than 2 hours in summer and 1 hour in winter, as tissue necrosis may occur. After 1-2 hours, it must be removed and applied in another place, after pinching the artery with a finger. Therefore, a note is necessarily attached to the tourniquet (pinned with a safety pin, sewn with thread or tied) with the date and exact time (hours and minutes) of the tourniquet being applied.

The victim with a tourniquet applied must be delivered to a doctor for qualified assistance within 1-2 hours. If during the specified time the victim could not be delivered to the doctor, then the tourniquet must be rearranged to another place, but also above the bleeding site.

Applying a pressure bandage- another simple and reliable way to stop bleeding, reduce pain and create rest for the damaged part of the body. At the same time, such a bandage protects the wound from contamination.

The bandage can be applied to any part of the body: on the head, on the eyes, on the chest and abdomen, on the arm or leg. How to do it? Before applying a bandage, the wound must be treated with hydrogen peroxide. After that, a sterile napkin or a small piece of bandage should be applied to the wound. And only then bandage.

When a person receives a through wound that has an inlet and outlet, it is better to use an individual dressing bag to stop the bleeding. This package consists of a bandage and two cotton-gauze pads enclosed in a sheath made of rubberized or other waterproof fabric. One pad is sewn at the beginning of the bandage, the other can be moved along the bandage.

Individual dressing package

When helping the wounded, one pad is applied with a sterile inner side to the inlet of the wound, and the other closes the outlet. Both pads are bandaged and the bandage is fixed by making a knot or stabs with a safety pin below the injury site.

In some cases, when bleeding from an arm or leg, their maximum flexion is used to stop the blood. To stop bleeding from the vessels of the hand, the forearm, a small roll of tightly rolled tissue is placed on the flexor surface of the elbow joint, and then the arm is bent as much as possible in the elbow joint. The forearm is fixed to the shoulder or torso using a bandage or any other suitable fabric.

Bleeding from the subclavian artery can be stopped by the maximum retraction of the left and right shoulder. They are carefully fixed behind the back using a wide bandage or any fabric.

With bleeding from the lower limb (shin, foot), maximum flexion used in two cases.

Stop bleeding by bending the limbs

The victim is placed on his back. In one case, a roll of tightly rolled tissue is placed in the popliteal fossa, and in the other, in the inguinal fold. Then the limb is compressed as much as possible either in the knee or in the hip joint. And after that, the lower leg is fixed to the thigh.

A way to stop bleeding by giving the injured limb an elevated position used mainly for superficial wounds, when there is venous bleeding.

In all cases of superficial wounds of the upper or lower extremities, one of the possible ways to stop venous bleeding is an elevated position of the limb. This is done very simply: the injured arm must be raised up, slightly above the head, and a small roller of some kind of fabric must be placed under the injured leg (you can use a bag, backpack, blanket, pillow, armful of hay). The leg should be slightly higher than the chest. Of course, in this case, the person should lie on his back.

Bleeding from the nose occurs as a result of trauma, with an increase or decrease in blood pressure, with diseases of the liver and bone marrow. Therefore, in case of recurring bleeding, it is necessary to consult a general practitioner.

First aid for nosebleeds:

Have the patient sit down and ask him to slightly tilt his torso forward;
put a bubble with ice, cold water or ice wrapped in a plastic bag on the bridge of his nose;
if after this the bleeding does not stop, it is necessary to firmly press the wings of the nose to the septum for 5-10 minutes;
if even after this the bleeding does not stop, insert into the nasal passages to a depth of 3-4 cm a piece of cotton wool or gauze, moistened with a solution of common salt (1 teaspoon per glass of water), tightly closing the nasal passages;
if the nosebleed does not stop within 30-40 minutes, the victim must be transported to the doctor in a sitting position

QUESTIONS AND TASKS

1. The loss of how much blood can lead to serious consequences for the human body?
2. Name the methods of temporary stopping of bleeding known to you.
3. Why is stopping bleeding by finger pressure on an artery not reliable enough?
4. Tell me how to properly apply a tourniquet.
5. What is a pressure bandage? How to apply it correctly?
6. How to properly use an individual dressing bag?
7. For what kind of injuries and to stop what bleeding is it used to give the injured part of the body an elevated position?

PROBLEM 33. How to help a friend (girlfriend) with a nosebleed? Choose from the proposed options for further actions and determine their order.

1. Tell a friend to stand with his head thrown back and not move.
2. Sit a friend down by tilting his torso forward.
3. Take the temperature and give pain medication.
4. Moisten pieces of cotton wool with a solution of table salt and insert them into the nasal passages.
5. Put cold on the back of the nose.
6. Tightly press the wings of the nose to the septum for 5-10 minutes.

Temporary ways to stop bleeding are mechanical in nature.

Temporary stop of external bleeding is carried out in the provision of out-of-hospital (first medical, feldsher, first medical) care.

The main objective of these types of assistance is temporary stop of external bleeding. Correct and timely execution of this task can be decisive for saving the life of the victim.

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

First of all, it is necessary to determine the presence of external bleeding and its source. Every minute of delay, especially with massive bleeding, can be fatal. It is possible to transport a victim with external bleeding only after a temporary stop of bleeding at the scene.

Ways to temporarily stop bleeding:

pressing the artery with fingers proximal to the wound;

maximum flexion of the limb in the joint;

elevated position of the limb;

applying a pressure bandage;

tight tamponade of the wound;

pressing the bleeding vessel in the wound;

applying a clamp to a bleeding vessel in the wound;

application of an arterial tourniquet.

PRESSING THE ARTERY WITH THE FINGERS PROXIMAL TO THE WOUND

The greatest danger to the life of the victim is arterial external bleeding. In such cases, immediate action must be taken pressing the artery with fingers to the bone proximal to the wound (closer to the heart from the wound): on the limbs - above the wound, on the neck and head - below the wound, and only after that prepare and perform a temporary stop of bleeding in other ways.

Pressing the artery with a finger proximal to the wound is a fairly simple method that does not require any auxiliary items. Its main advantage is the ability to perform as quickly as possible. The disadvantage is that it can be effectively applied only for 10-15 minutes, that is, it is short-term, as the hands get tired and the pressure weakens. In this regard, already at the stage of first aid, there is a need to use other methods of temporarily stopping arterial bleeding.

It is especially important to press the artery with a finger proximal to the wound in preparation for the application of an arterial tourniquet, as well as when changing it. The time spent preparing a tourniquet or pressure bandage for uncontrolled bleeding can cost the life of the victim!

There are standard points in the projection of large arteries, in which it is convenient to press the vessels to the underlying bone protrusions. It is important not only to know these points, but also to be able to quickly and effectively press the artery in the indicated places without wasting time searching for it (Table 4, Fig. 3.).

Table the names of the main arteries, the points of their pressing and external landmarks, as well as the bone formations to which the arteries are pressed are presented.

These places were not chosen by chance. Here the arteries lie most superficially, and under them there is a bone, which makes it quite easy to close the lumen of the vessel with precise pressure with the fingers. At these points, you can almost always feel the pulsation of the arteries.

Rice. Finger pressure on the carotid (a), facial (b), temporal (c), subclavian (d), brachial (e), axillary (f), femoral (g) arteries to temporarily stop bleeding.

Table 4

Points for finger pressure of arterial trunks in case of external bleeding

Pressing and especially holding the main arterial trunk present certain difficulties and require knowledge of special techniques. The arteries are quite mobile, so when you try to press them with one finger, they “slip out” from under it. To avoid loss of time, pressing should be done either with several tightly clenched fingers of one hand, or with the first two fingers of both hands (which is less convenient, since both hands are busy) (Fig. 4 a, b). If you need a sufficiently long pressure that requires physical effort (especially when pressing the femoral artery and abdominal aorta), you should use your own body weight. (Fig. 4c).

It should be remembered that properly performed finger pressing should lead to an immediate stop of arterial bleeding, i.e., to the disappearance of a pulsating stream of blood coming from the wound. With arteriovenous bleeding, venous and especially capillary bleeding may, although decrease, but persist for some time.

After arterial bleeding is stopped by pressing with fingers, it is necessary to prepare and implement a temporary stop of bleeding in another way, most often by applying an arterial tourniquet.

The abdominal aorta can be pressed against the spine through the anterior abdominal wall. To do this, lay the victim on a hard surface and press with your fist, using the entire weight of your body, on the navel or slightly to the left. This technique is effective only in thin people. It is used for profuse bleeding with injuries of the iliac arteries (above the inguinal ligament).

Pressing, as a rule, does not completely clamp the aorta, and therefore the bleeding does not completely stop, but only becomes weaker. This technique may be accompanied by trauma to the anterior abdominal wall and even the abdominal organs. It is not recommended to perform it for educational purposes, it is enough to learn how to determine the pulsation of the abdominal abortion in the umbilical region.

Rice. 3. Points for digital pressure of the arteries (explanation in the text)

Rice. 4. Temporary stop of bleeding by the method of digital pressure of the arteries

a - pressing with the fingers of one hand; b - pressing with the first two fingers; c - pressing the femoral artery with a fist.

MAXIMUM LIMB FLEXION IN THE JOINT

To stop arterial bleeding (for injuries of the femoral, popliteal, axillary, brachial, ulnar, radial and other arteries) from the distal extremities, you can resort to maximum limb flexion. In the place of flexion (elbow bend, popliteal fossa, inguinal fold), a bandage roll or a dense cotton-gauze roller with a diameter of about 5 cm is placed, after which the limb is rigidly fixed in the position of maximum flexion in the elbow (in case of injury to the arteries of the forearm or hand), knee (in case of injury of the arteries of the lower leg or foot) or hip (in case of injury to the femoral artery) joints (Fig. 5). Bleeding is stopped by kinking of the arteries.

This method is effective for arterial bleeding from the thigh (maximum flexion at the hip joint), from the lower leg and foot (maximum flexion at the knee joint), hand and forearm (maximum flexion at the elbow joint) .

Rice. 5. Temporarystop bleeding by maximum flexion of the limb.

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

Indications for maximum flexion of the limb in the joint are generally the same as for the application of an arterial tourniquet. The method is less reliable, but at the same time less traumatic. Stopping bleeding with the help of maximum flexion of the limb leads to the same as when applying a tourniquet, ischemia of the distal sections, therefore, the duration of the limb in the maximum flexed position corresponds to the duration of the tourniquet on the limb.

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

When bleeding from the axillary artery or peripheral parts of the subclavian artery both shoulders are retracted posteriorly as much as possible (almost to the point of contact of the shoulder blades) and fixed one to the other at the level of the elbow joints. This causes compression of the subclavian artery between the clavicle and the first rib.

Rice. 6. Temporary stop of bleeding from the axillary or subclavian artery

Maximum elbow flexion is often used to stop bleeding. after puncture of the cubital vein.

GIVING THE DAMAGED LIMB TO AN HIGH POSITION

Raising the injured limb (giving the limb an elevated position) reduces blood supply to blood vessels and promotes more rapid formation of a blood clot.

Indications for its use - venous or capillary bleeding in case of injury to the distal extremities.

PRESSURE BANDAGE

Applying a pressure bandage. Bleeding from veins and small arteries, as well as from capillaries, can be stopped by applying a pressure bandage. It is desirable to combine the application of a pressure bandage with other methods of temporarily stopping bleeding: with raising the limb and (or) with wound tamponade.

After treating the skin around the wound with a skin antiseptic, sterile gauze wipes are applied to the wound, and a layer of cotton wool or a cotton-gauze roller is applied on top, which are tightly bandaged for local compression of bleeding tissues.

Before applying the bandage, it is necessary to give the limb an elevated position. The bandage should be applied from the periphery to the center. At the same time, in order to achieve the necessary pressure of the roller on soft tissues during its fixation, the “cross-bandage” technique is used, as shown in Fig. 7.

Rice. 7. Receiving a "cross bandage" when applying a pressure bandage

An individual dressing bag is convenient for these purposes (Fig. 8).

Rice. 8. Individual dressing package

A pressure bandage can be applied when bleeding from varicose veins of the lower extremities, as well as after many operations, for example, after phlebectomy, after resection of the mammary gland, after mastectomy. However, a pressure bandage is not effective for massive arterial bleeding.

TIGHT WOUND PACKING

In cases where raising the limb and applying a pressure bandage fails to stop the bleeding, tamponade of the wound is used, followed by the application of a pressure bandage, which, provided the limb is elevated, is a good method of temporarily stopping bleeding from large veins and small (and sometimes large) arteries. It is used for deep injuries and wounds of blood vessels. Wound tamponade also stops capillary bleeding. Tight wound tamponade is often used for venous and arterial bleeding in the scalp, neck, trunk, gluteal region and other areas of the body.

The method consists in tightly filling the wound cavity with gauze, turundas or special tampons. Gauze swabs or napkins are introduced into the wound, which tightly fill the entire wound cavity. In this case, it is necessary to ensure that the tip of each napkin is on the surface of the wound. In some cases, the skin edges of the wound are stitched and pulled together with sutures over a swab. Gauze, saturated with blood, becomes the basis for the falling out fibrin and the formation of a blood clot. Wound tamponade can be used as a method of temporary or permanent hemostasis. Tamponade is often combined with topical hemostatic agents such as hydrogen peroxide to enhance the effect. The use of wound hypothermia enhances the hemostatic effect due to vasospasm and increased adhesion of platelets to the endothelium.

It is far from always possible to perform a full-fledged tamponade at the prehospital stage of medical care, in the absence of aseptic conditions and anesthesia.

You should be very careful about tamponing if you suspect a penetrating wound (thoracic, abdominal cavity), since tampons can be inserted through a wound into the body cavity. It is also necessary to be careful with tight tamponade of wounds in the popliteal region, since in this case limb ischemia and its gangrene may develop.

In addition, wound tamponade creates conditions for the development of anaerobic infection. Therefore, where possible, packing the wound should be avoided.

PRESSING A BLEEDING VESSEL IN THE WOUND

Pressing the bleeding vessel in the wound carried out, if necessary, in urgent cases (this technique is sometimes used by surgeons for bleeding during surgery). For this purpose, the doctor (paramedic) quickly puts on a sterile glove or treats the worn gloves with alcohol. The site of damage to the vessel is pressed in the wound with fingers or a tupfer (a gauze ball or a small napkin in a Mikulich or Kocher clamp, or in a forceps). Bleeding is stopped, the wound is drained and the most appropriate method for stopping bleeding is selected.

CLAMPING THE BLEEDING VESSEL IN THE WOUND

At the prehospital stage, when providing assistance, hemostatic clamps can be applied in the wound if sterile hemostatic clamps (Billroth, Kocher or others) are available and the bleeding vessel in the wound is clearly visible. The vessel is grasped with a clamp, the clamp is fastened, and an aseptic dressing is applied to the wound. The clamps are placed in a bandage applied to the wound, and a provisional tourniquet is left on the limbs. When transporting the victim to a medical facility, immobilization of the injured limb is necessary. The advantages of this method are simplicity and preservation of collateral circulation. The disadvantages include low reliability (the clamp may unfasten during transportation, break off the vessel or come off together with a part of the vessel), the possibility of damage to the veins and nerves located near the damaged artery by the clamp, crushing the edge of the damaged vessel, which subsequently makes it difficult to apply a vascular suture for final stop of bleeding.

The imposition of a clamp on a bleeding vessel in a wound is used if it is impossible to temporarily stop bleeding in other ways, in particular, when bleeding from damaged vessels in case of injuries to the proximal limbs, as well as injuries to the chest or abdominal wall. When applying clamps, it must be remembered that this must be done very carefully, always under visual control, in order to avoid damage to nearby nerves, blood vessels and other anatomical structures.

First, they try to stop the bleeding by pressing the bleeding vessels with their fingers (throughout, in the wound) or with a tupfer in the wound, drain the wound from the blood, and then apply hemostatic clamps in the wound either directly on the bleeding vessel, or (if it is difficult to identify) on the thickness of the soft tissues in which the damaged vessel is located. There may be several such clamps. Since the victim is to be transported further, in order to prevent early secondary bleeding, measures must be taken to prevent the clamps from slipping, tearing or unfastening.

APPLICATION OF ARTERIAL TOURNEY

If it is impossible to temporarily stop external arterial or arteriovenous bleeding in other ways, apply hemostatic tourniquet.

Rice. 9. Arterial tourniquet

Happlication of an arterial tourniquet is the most reliable way to temporarily stop bleeding. Currently, a rubber tourniquet and a twist tourniquet are used. Rubber band equipped with special fasteners designed to secure the superimposed tourniquet. It can be a metal chain with a hook or plastic "buttons" with holes in the rubber band. The classic tubular rubber tourniquet proposed by Esmarch is inferior to the tape tourniquet in terms of efficiency and safety and is practically no longer used. Temporary stopping of external arterial or arteriovenous bleeding with a tourniquet consists in tightly pulling the limb above the injury site. It is unacceptable to use an arterial tourniquet for venous or capillary bleeding.

Rice. 10. Places of application of a hemostatic tourniquet in case of bleeding from arteries: a - feet; b - lower leg and knee joint; in - brushes; g - forearm and elbow joint; d - shoulder; e - hips

The negative side of the imposition of an arterial tourniquet is that the tourniquet compresses not only damaged vessels, but all vessels, including intact ones, and also compresses all soft tissues, including nerves. There is a complete cessation of blood flow distal to the tourniquet. This ensures the reliability of stopping bleeding, but at the same time causes significant tissue ischemia, in addition, a mechanical tourniquet can compress nerves, muscles and other formations.

In the absence of an influx of oxygenated blood, the metabolism in the limbs proceeds according to the anoxic type. After removing the tourniquet, underoxidized products enter the general circulation, causing a sharp shift in the acid-base state to the acid side (acidosis), vascular tone decreases, and acute renal failure may develop.

Intoxication causes acute cardiovascular, and then multiple organ failure, referred to as tourniquet shock. The lack of oxygen in the tissues located distally to the applied tourniquet creates favorable conditions for the development of gaseous anaerobic infection, i.e. for the growth of bacteria that grow without oxygen.

Considering the dangers associated with the application of a tourniquet, the indications for its use are strictly limited: it should be used only in cases of injury to the main (main) arteries, when it is impossible to stop the bleeding in other ways.

It must be remembered that, along with high efficiency, this method in itself can lead to serious consequences: tourniquet shock and damage to the nerve trunks, followed by the development of paresis or paralysis. Clinical experience shows that 75% of victims apply a tourniquet without proper indications, so its use as a method of temporarily stopping bleeding should be limited. For wounds accompanied by profuse bleeding, a tourniquet should be applied immediately at the scene. After stopping the bleeding, it is necessary to tamponade the wound and apply a pressure bandage to the wound, after which the tourniquet can be dissolved. As a rule, this ensures stable hemostasis during the transportation of the victim to a medical institution, where the final stop of bleeding will be made.

It is necessary to know a number of general rules for applying an arterial tourniquet, the implementation of which will achieve a reliable stop of bleeding; at least in part, to prevent the harmful effect of the tourniquet and reduce the possibility of complications:

1) A tourniquet is mainly used with injury to the main arteries. It can be difficult to distinguish venous from arterial bleeding in the complex anatomy of the wound channel and venous-arterial bleeding. Therefore, if the blood from the wound flows powerful, especially. in varying degrees, a pulsating jet, should act as in arterial bleeding, i.e. to resort to the imposition of a hemostatic arterial tourniquet, which is always carried out uniformly, as in arterial bleeding - proximal to the wound. It should be considered a gross mistake to apply a tourniquet distal to the wound.

2) The tourniquet is applied proximal to the wound and as close as possible to the site of injury. ,but not closer than 4 - 5 cm. If for various reasons, during the evacuation process, it is not possible to remove the tourniquet in time, ischemic gangrene develops. Compliance with this rule allows the maximum preservation of viable tissues located proximal to the site of damage.

3) Before applying the tourniquet, press the artery with your fingers to the bone .

4) Then, the injured limb should be elevated to drain the blood from the veins. This will allow, after applying the tourniquet, to avoid the outflow of venous blood from the wound, which has filled the vessels of the distal parts of the limb.

5) You can not apply a tourniquet in the middle third of the shoulder and in the upper quarter of the lower leg so as not to damage, respectively, the radial and peroneal nerves. Also, the tourniquet is not applied in the area of ​​​​the joints, on the hand, foot.

6) The tourniquet must not be applied to bare skin - a lining under the tourniquet is required. The pre-intended area of ​​application of the tourniquet is wrapped with a soft material. (towel, scarf, cotton-gauze lining, bandage, etc.), avoiding the formation of wrinkles on it. You can apply a tourniquet directly to the clothes of the victim without removing it.

7) Good place a piece of thick cardboard under the tourniquet from the side opposite to the vascular bundle which partially preserves collateral blood flow.

Rice. 6.Stages of imposing a standard hemostatic tourniquet:

a - wrapping the limb with a towel;b- tourniquet brought under the thigh and stretched; in - the first turn of the tourniquet;G- fixing the harness

Fig. 11 Applying an arterial tourniquet:

a - preparation for the application of a tourniquet

b - the beginning of the overlay

c - fixing the first round

g - tourniquet applied

8) A stretched tourniquet is applied to the limb from the side of the projection of the vessels. The tourniquet is grasped with the left hand at the edge with the clasp, and with the right hand - 30-40 cm closer to the middle, no further (Fig. 11 a). Then the tourniquet is stretched with both hands and the first turn of the tourniquet is applied in such a way that the initial section of the tourniquet overlaps with the next turn. Thus, the first turn of the tourniquet is crossed to prevent its weakening (Fig. 11 b). Moreover, the long end of the tourniquet is applied to the short one. A tourniquet compresses the limb until the arterial bleeding from the wound stops and the pulse disappears in the peripheral arteries.Compression should be sufficient, but not excessive . Already the first tightened turn (coil) of the tourniquet should pinch the artery and stop the bleeding. Upon reaching the stop of bleeding, further tightening of the tourniquet is unacceptable!

The next turns of the tourniquet are applied with a slight tension, only in order to maintain the tension of the first turn (Fig. 11 c). These fixing turns of the tourniquet are applied in a spiral with an "overlap" on each other, and each subsequent turn should partially (by 2/3), overlap the previous one, and not lie down separately to avoid infringement of the skin (Fig. 11 d). Then the hook is attached to the chain.

To prevent loosening of the tourniquet tension, it must be securely fastened after application.

Given the risk of developing severe complications, instead of a tourniquet, you can use a cuff from the device for measuring blood pressure. The pressure in the cuff should exceed the systolic blood pressure (in the cuff application area) by no more than 10 - 15 mm Hg.

Tourniquet application for bleeding from the femoral and axillary arteries is shown in Fig. 31.

9) Both insufficient and excessive tightening of the tourniquet are equally unacceptable. .

Overtightening the tourniquet (especially tourniquet-twisting) can lead to crushing of soft tissues (muscles, blood vessels, nerves). Perhaps the occurrence of hematomas, the development of tissue necrosis, traumatic and ischemic neuritis, which are manifested by paresis, paralysis and sensitivity disorders. Excessive compression can lead to damage to blood vessels with the development of thrombosis of the veins and arteries. Therefore, do not over-tighten the tourniquet. It must be tightened with such force that allows you to stop bleeding.

In the same time, insufficient tightening tourniquet does not provide a sufficiently complete compression of the main artery, in connection with this, arterial blood flow to the limb is maintained. In this case, only the veins are compressed, so the outflow of blood from the distal parts of the limb stops. With insufficient tightening of the tourniquet, bleeding from the wound does not stop, but, on the contrary, may increase, as the limb overflows with blood.

1 . H violation of the anatomical integrity of the integumentary or internal tissues throughout their entire thickness, and sometimes also of internal organs, caused by mechanical action - this is

a) wound;

b) fracture ;

c) bleeding;

d) trauma.

2. Bleeding, characterized by the outflow of blood in a pulsating stream, which has a scarlet color:

a) arterial;

b) venous;

c) parenchymal;

d) capillary.

3. The outflow of blood from damaged blood vessels is:

a) hemorrhage;

b) bleeding;

c) trauma;

d) wound.

4. Bleeding, characterized by continuous outflow of blood that has a dark color:

a) arterial:

b) venous;

c) capillary;

d) parenchymal.

5. How to stop venous bleeding?

a) apply a pressure bandage;

b) apply a tourniquet;

c) treat the wound with alcohol and cover with a sterile napkin;

d) disinfect with alcohol and treat with iodine;

6. If the carotid artery is injured, it is urgent to:

a) apply a tight bandage;

b) apply a tourniquet;

c) pinch the artery below the wound with a finger;

d) pinch the artery above the wound with a finger.

7. Arterial bleeding occurs when:

a) damage to any artery with a deep wound;

b) superficial injury;

c) a shallow wound in case of damage to any of the vessels;

d) damage to the vein.

8. Reducing bleeding by giving an elevated position to the injured limb is mainly used for:

a) internal bleeding;

b) superficial wounds;

c) any injuries of the limb;

d) deep wounds.

9. The most reliable way to stop bleeding in case of damage to large arterial vessels of the arms and legs is:

a) applying a pressure bandage;

b) finger pressing;

c) maximum limb flexion;

d) application of a tourniquet.

10. In case of an open fracture of a limb with severe bleeding of the wound, it is necessary first of all:

a) treat the edge of the wound with iodine;

b) immobilize the limb;

c) wash the wound with hydrogen peroxide;

d) stop bleeding.

Answers:

Methods for temporarily stopping external bleeding are used in first aid at the site of injury. They involve the rapid delivery of the victim to the hospital, where the final stop of bleeding will be performed. There are the following methods of temporary hemostasis: -

1) digital pressure of the artery to the bone above the wound, and on the neck and head below the wound;

2) giving the injured limb an elevated position;

3) application of a hemostatic tourniquet for arterial bleeding

4) maximum flexion of the limb in the joint during arterial bleeding;

5) the imposition of a pressure bandage for venous, capillary and minor arterial bleeding;

6) tight tamponade of the wound;

7)
pressing the bleeding vessel in the wound with the fingers;

8) the imposition of a hemostatic clamp on a bleeding vessel in a wound when providing first aid in the conditions of a FAP, a health center, a surgical room in a polyclinic;

9) local application of cold.

Finger pressing of the arteries. Pressing the arteries with fingers at certain anatomical points allows you to immediately stop the bleeding and prepare for more reliable hemostasis (Fig. 2.2-2.6).

The point of digital pressure of the temporal artery is 1 cm anteriorly and above the tragus of the ear. The external maxillary artery is pressed against the lower edge of the lower jaw at the border of its posterior and middle thirds. The point of digital pressure of the carotid artery is located at the level of the thyroid cartilage along the anterior inner edge of the sternocleidomastoid muscle. The artery is pressed against the carotid tubercle of the transverse process of the VI cervical vertebra. The point of digital pressure of the subclavian artery is located in the middle of the supraclavicular region. The artery is pressed from above to the first rib. The axillary artery in the armpit is pressed against the head of the humerus. The brachial artery is pressed against the humerus at the inner edge of the biceps muscle. The radial artery is pressed against the radius in the place where the pulse is usually determined. The ulnar artery is pressed against the ulna opposite the point of pressure of the radial artery. The femoral artery is pressed in the inguinal region to the tubercle of the pubic bone. The popliteal artery is pressed in the middle of the popliteal fossa to the tibia. The point of digital pressure of the posterior tibial artery is located behind the medial malleolus. Rear pressure point Noah foot artery is located between the first and second metatarsal bones.

The abdominal aorta is pressed with a fist to the spine to the left of the navel.

The artery is pressed throughout the skin to the bone II-IV with fingers, palm or fist. This method makes it possible to stop bleeding when some large arteries are injured: carotid, subclavian, temporal, brachial, femoral, etc. Unfortunately, the fingers of the person providing assistance quickly get tired, bleeding resumes.

Giving the injured limb an elevated position.

This method helps to empty the veins and reduce blood flow to the wound.

Application of an arterial tourniquet. Currently, for the purpose of temporary hemostasis in arterial bleeding, a standard Esmarch rubber band tourniquet is used. In its absence, you can use a cloth tourniquet in the form of a braid with a twist and other means, but not wire, rope, etc.

A twist-twist is a strip of durable fabric 1 m long and 3 cm wide with a twist and a clasp at one end. The twist - a loop of braid with a stick in the middle and fabric rings for fixing its ends - is connected to the strip of the tourniquet by two rectangular buckles located not far from the clasp.

Rules for applying a hemostatic tourniquet (Fig. 2.7).

1. The tourniquet is used only for damage to the arteries of the limbs. In case of damage to the carotid artery on the opposite side of the neck, an impromptu splint or Kramer splint is applied with emphasis on the head and shoulder joint (Mikulich's method - Fig. 2.8). In the absence of tires, you can use the hand on the healthy side, which is placed on the head and bandaged. The splint (arm) should prevent compression of the carotid artery from the opposite side. In this case, the tourniquet is applied below the wound. A roller is applied to the damaged carotid artery. After that, a tourniquet is pulled through the tire (arm) and the roller.

2. Do not apply a tourniquet on a bare wound. The lining should not have any wrinkles.

3. The damaged limb is given an elevated position and the artery is pressed with fingers above the wound.

4. The tourniquet is applied above the wound and as close to it as possible. The optimal localization of the tourniquet on the upper limb is the upper and lower third of the shoulder, on the lower limb - the thigh area. A tourniquet cannot be applied to the middle third of the shoulder, since the radial nerve lies on the bone here. From crushing this nerve, paralysis of the muscles of the forearm and hand will develop.

5.
The first round should be tight, the rest should be fixing.

6. The tourniquet is applied in a tiled manner, without infringing on the skin.

7. The tourniquet should not be crushing.

8. When the tourniquet is correctly applied, the bleeding stops, the pulse on the artery below the tourniquet is not detected, the skin becomes pale.

9. Under the last round of the tourniquet, a note is fixed indicating the date and time of its application.

10. Be sure to carry out transport immobilization
injured limb and pain relief.

11. The tourniquet must always be visible.

12. In the cold season, the limb must be insulated to prevent frostbite.

13. In summer, the tourniquet can be kept up to 2 hours, in winter - up to 1 hour. Exceeding the time is fraught with necrosis of the limb.

14. If the time has expired, but the tourniquet cannot be removed:

■ press the damaged artery above the tourniquet with fingers;

■ carefully loosen the tourniquet for 20-30 minutes to restore blood circulation in the injured limb;

■ re-apply tourniquet, but above or below the previous location and indicate the new time;

■
if necessary, the procedure is repeated after 0.5-1.0 hours. The technique of applying a tourniquet-twist (Fig. 2.9). Cloth tourniquet

impose on the limb, thread the free end through the buckle and tighten as much as possible. Next, the cloth tourniquet is tightened by rotating the stick, squeezing the limb until

the bleeding will stop. Then fasten the stick in one of the loops.

Similarly, you can apply an impromptu tourniquet from a trouser belt, scarf, scarf, etc. From the material at hand, you need to fold a tape 3 cm wide, wrap it around the limb, tie the ends and insert the stick into the loop formed. When the wand is rotated, the tourniquet is tightened. So that it does not unwind, it must be fixed with one or two rounds of a circular bandage.

Errors when applying a tourniquet. The following main errors are distinguished:

1) application of a tourniquet not according to indications;

2) weak application of a tourniquet - arterial bleeding continues;

3) excessive stretching of the tourniquet, which leads to trauma to the nerve trunks and muscles;

4) the absence of a date and time stamp for the application of the tourniquet;

5) masking the tourniquet under clothing or bandages;

6) application of a tourniquet on the naked body and away from the wound;

7) application of a tourniquet in the middle third of the shoulder;

8) delivery of the victim to the hospital with a tourniquet without immobilization of the limb and warming.

Maximum flexion of the limb at the joint. In the absence of a hemostatic tourniquet, the method of maximum flexion of the limb in the joint can be used to stop arterial bleeding (Fig. 2.10). When bleeding from the arteries of the forearm or hand, the maximum flexion of the arm in the elbow joint is effective, followed by fixation in this position. When bleeding from the arteries of the lower leg and foot, the maximum flexion of the leg in the knee joint is performed. When bleeding from the femoral artery - the maximum flexion of the leg in the hip joint. In case of bleeding from the subclavian, axillary or brachial arteries, it is recommended that both elbow joints with bent forearms be pulled back almost to their contact and fixed, for example, with a bandage. It is advisable to put a dense roller into the fold area.

The limb flexion method cannot be used in case of a fracture of one of the bones that form the joint in which maximum flexion is planned. The timing of maximum flexion of the limb in the joint corresponds to the timing of the tourniquet.

The imposition of a pressure bandage for venous, capillary and minor arterial bleeding. This method gives a good result, especially if the limb is given an elevated position (Fig. 2.11). Manipulation is performed as follows: several napkins are applied to the wound, a lump of cotton wool or a piece of bandage is placed on top of them and tightly bandaged. On top of the bandage, you can put an ice pack and a load in the form of a bag of sand.

Tight tamponade of the wound. When bleeding from a deep wound, when it is impossible to apply other methods of hemostasis, tight wound tamponade is used. With sterile tweezers or forceps, a sterile swab is inserted into the wound, filling it tightly. The outer end of the tampon must be visible so that it is not forgotten in the wound. Tight tamponade of the wound can be ended by applying a pressure bandage with local application of cold and weight.

Tight tamponade is contraindicated for injuries in the area of ​​the popliteal fossa, since compression of the great vessels may occur, followed by the development of gangrene of the limb. With a small nosebleed, a simple way to stop it is to press the wing of the nose against the nasal septum with your finger. It is also recommended to introduce a piece of cotton wool moistened with a 3% solution of hydrogen peroxide or petroleum jelly into the nose and press it through the wing of the nose to the septum. In the absence of effect, anterior tamponade of the nasal cavity is resorted to. An ice pack is placed on the back of the head, which in a reflex way helps to reduce bleeding.

Pressing the bleeding vessel in the wound with the fingers. In emergency situations, often during operations, pressing the bleeding vessel in the wound with the fingers is used. In other situations, if the situation allows, you must quickly put on a sterile glove or treat your hands with alcohol (other antiseptics), insert your fingers into the wound and stop the bleeding by pressing the bleeding vessel.

Applying a hemostatic clamp to a bleeding vessel. In cases where the vessel is visible, a clamp is applied across it, closer to the end, and firmly fixed with a bandage. It is necessary to perform transport immobilization of the limb and keep the immobility of the applied clamp.

Cold use. With local exposure to cold, a spasm of capillaries occurs, which helps to reduce or even stop bleeding. For this purpose, an ice pack is usually used. It is not recommended to keep cold for longer than 15 minutes, as capillary paralysis sets in and bleeding resumes.