Bleeding - a blood output from the damaged or diseased vessel. Depending on the degree of loss, the total blood volume (CBV) and trauma place the victim may experience symptoms of acute or chronic reduction of hemoglobin (anemia).
In medical practice, identify different types of bleeding, which determine the degree of risk events for the patient and CPR and first aid.
Why is the blood
Depending on the etiology of the phenomenon causes of bleeding are classified into mechanical and pathological. Mechanical bleeding occurs at damage arteries, veins or capillaries with normal wall, and pathological - at rupture of the vessel with a modified structure or a damage in disorders of the coagulation blood system. When pathological bleeding traumatic impact may be minimal or absent on the vascular system.
The main causes of bleeding include the following events:
- Injury. Traumatic vascular lesions arise at high temperatures (burns) and mechanical damages of tissues. Vascular wall may be destroyed as a foreign object (vehicle paneling elements, piercing and cutting arms, instruments, etc..) and own tissues (fragments edges femurs and et al.). The highest risk of bleeding occurs with household and industrial tools with a cutting edge, falls from height, road accidents, and other armed conflicts.
- Neoplastic processes and other vascular pathology. Inflammation of the vessel walls and congenital dysplasia, connective tissue and vascular endothelium lead to a thinning of the vascular wall and the appearance of tears in it. The rapid development of pathological changes in vascular structure occurs in cancer lesions (e.g., hemangiosarcoma) and purulent inflammatory processes.
- Pathology of blood coagulation. Bleeding disorders provoke frequent bleeding. Cause deterioration clotting may be hemophilia, Cancer bone marrow disease, liver disease (cirrhosis, chronic hepatitis), acute deficiency of vitamin C and K. Pathogenesis phenomena may be based on clotting factors deficiency (hemophilia), low activity of the glycoprotein, which provides attachment of platelets to damaged tissues (for vWD), a lack of fibrinogen inferiority platelet al.
- Systemic diseases. Endocrine diseases (eg, diabetes), cause a reduction in blood clotting and disorders Hemostasis, which show the appearance of hematomas, severe bleeding in trauma and prolonged wound healing. Cause spontaneous bleeding can become infectious and systemic diseases (viral infections, sepsis), which dramatically increases the permeability of the vessel walls.
- Neoplasms and ulceration of the internal organs. Bleeding from the internal organs may occur as in the open or closed trauma and with lesions of the walls which touch the vascular net. pneumorrhagia It provoked predominantly foci of tuberculosis or aggressive cancer, gastric - ulceration walls uterine - endometriosis, polyposis, inflammatory processes and cancer, and intestinal - presence of anal fissures, neoplasms (tumors, polyps, hemorrhoids) and anomalies structure.
Before therapy is necessary to determine why the blood flows with a reduced rate of BCC and the form in which bleeding occurs (expiration outer, hematoma, bleeding in tissue).
The causes of bleeding determines the algorithm of first aid, the choice of the pathology treatment (medication, surgical) and a list of recommended drugs.
signs of bleeding
Bleeding accompanied by local and general signs. The intensity of the symptoms depend on the presence of external damage, size and localization of the damaged vessel, the total BCC and other factors.
The emergence of general and local bleeding symptoms caused by different mechanisms. Pathogenesis manifestations of disease is shown in Table.
| The nature of the symptoms | Pathogenesis |
| General | Reduction in the total blood volume. Hypoxia brain tissue due to blood supply insufficiency. A compensatory increase in heart rate. |
| local | Direct foreign object damage to the vessel or bone fragment. Lack of blood coagulation, is too extensive nature of the injury to the bleeding has stopped spontaneously, or lack of time to stop it without first aid (with capillary, at least - with venous damage). |
| Local (internal bleeding) | The accumulation of blood in the internal organs (hematoma) and within the parenchyma (hemorrhage) or blending it with natural and pathological secretions (vomiting, feces, cervical mucus). Squeezing functional tissue and organs stretching rich nerve endings mesenteric blood accumulation. Damage to the walls of organs and intoxication of an organism. |
General
To the list of common signs of bleeding include the following events:
- drowsiness;
- decreased performance (in massive after - sudden severe weakness);
- muscle weakness;
- sweating (cold sweats);
- tachycardia (heart rate greater than 90 beats per minute), palpitations;
- hypotension (decrease in blood pressure);
- shortness of breath, panic, feelings of lack of oxygen;
- thirst, volume reduction detachable kidney urine until dysuria;
- blanching patient, pathologically lighter shade of mucous and skin;
- dizziness, impairment of consciousness.
Profuse bleeding with loss of more than 30% of circulating blood can lead to coma and death even before the patient will have time to give first aid.
local
The main feature of the outer discharge is the presence of blood burn surface, a wound or other damage to the mucous membranes or skin. Blood can be collected drops on the wound surface to drain therefrom strips of different widths or spill a small fountain to the beat of the heart beats. Color selections may be red, cherry (dark red) or bright scarlet.
The intensity of the color of blood extraction and depend on the size of the lesion, the amount and type of damaged vessels.
When hidden, and internal bleeding visible blood separation does not occur, however, signs of anemia and the symptoms can be observed, is the cause of damage to the vessel. The internal flow of blood may be accompanied by the following symptoms:
- foam spotting a bright red color when coughing, shortness of breath, chest pain (with pulmonary disease);
- red or brown urine color, the presence in it of blood clots, increased frequency of urination, severe pain in the abdomen or in the lumbar region, swelling, fever (glomerulonephritis, kidney stones, kidney cancers and neoplasias hemorrhagic cystitis);
- pink, red or brown discharge (in some cases - with pieces of endometrium, blood clots, mucous inclusions), aching or sharp pain in the abdomen (with metrorrhagia, spontaneous abortion, and cervical tube pregnancy);
- vomiting syndrome "coffee grounds" - brown gastric allocation with clots that form in the blood and by contact with hydrochloric acid, strong aching pain in the upper stomach, heartburn (for ulcerous lesions, trauma and tumors of the upper digestive tract), the voltage of the anterior abdominal wall, sharp pain (surgical pathologies GIT);
- cal viscous dark brown or black - tarry stools (bleedings in the large intestine);
- blood in the stool, on toilet paper, underwear back (if anal fissures, hemorrhoids, bleeding and other injuries of the rectum).
Bleeding inside the body or joint provokes violation of its functions. When large amounts of hematoma or palpation affected zone occurs pain syndrome.
Types of bleeding and first aid are always interrelated phenomena, so it is important to pay attention to even the smallest signs that may indicate the etiology and localization of hearth defeat.
what are the
Abnormal flow of blood is classified by the nature of symptoms, mean vessel length, presence of mucosal lesions and skin.
The most common classification of bleeding - the distribution by type of diseased or injured vessel. In accordance with this classification of isolated major bleeding (blood), small (capillary) and outputting vessels that carry blood back to the heart (venous).
In arterial bleeding, there are species that indicate the location of injury. This criterion is important for the proper provision of primary health care (PHC).
Pathology is a separate species parenchymal hemorrhageWhich develops when damaged organs, which are not among the hollow.
arterial
Bleeding of this type occurs when rupture of the largest vessels (carotid, vertebral, axillary, femoral and other arteries). It is accompanied by the rapid development of anemia, severe nausea and a high risk of loss of consciousness.
The blood ejected by strong shocks to the beat of the heart muscle. Highlight color - bright red. The pressure drop and a compensatory increase in heart rate to critical values occurs within several tens of minutes.
The most common bleeding of this type come with extensive damage to the body during a crash and a deep penetration of a foreign object.
venous
When injuries and diseases of the veins that are accompanied by local symptoms, blood expires slow but continuous stream (frequently - multiple stripes). Discharge has cherry tint.
Medical classification of bleeding determines the flow of blood from the veins as the third degree of danger after arterial and parenchymal bleeding.
When a low pressure inside the vein, and normal coagulogram small area of damage at the fracture formed thrombus, and blood loss ceases.
With extensive damage, the presence of abnormalities of the hematopoietic system or receiving anticoagulants (Acetylsalicylic acid, warfarin, etc.) Venous bleeding can lead to a substantial reduction BCC and the development of shock.
The risk of damage to the vein in the domestic environment is higher than the artery or internal organs, as the depth of their occurrence under the less skin.
capillary
Bleeding capillary type occurs when small traumas (cuts, pricks, abrasions, etc.)., Hemorrhagic syndromes and pathological closed soft tissue injuries and internal organs. It is characterized by the lowest risk of complications and self-arrest in the absence of abnormalities of the coagulation system.
Blood is red and oozing from the wound surface in small portions. The edges of the damaged vessels can not be visualized. Such bleeding is dangerous only with mixed character (more related injuries large vessels) and the presence of diseases that reduce the concentration of platelets or their ability to adhesion.
parenchymal
Bleeding of this type can occur in parenchymal (tissue) of the internal organs: spleen, liver, lungs, kidneys, endocrine glands, and others.
They are further classified by the nature of the expiration internal (hematoma, bleeding) and exterior. Open, visible bleeding from parenchyma called explicitly and flow of blood into the cavity, which communicates with the external environment - hidden. Recent manifested bloody vomiting or changes in color, texture and volume of normal secretions.
Pathology is a danger due to dysfunction of vital systems, high risk of massive blood loss and difficulty of diagnosis without surgical intervention.
Type damaged vessel at the expiration of the parenchymal blood is not determined, because It damaged the entire circulatory system at a single site or across the body volume.
Parenchymal bleeding may occur in different types of trauma (blunt force trauma, dropped from a height RTA), cancer and other pathologies.
How to stop the bleeding
Stopping the bleeding is a necessary measure for the preservation of life of the patient until the arrival of ambulances or delivery of the patient to a medical facility. Selecting the way to stop bleeding depends on the type and location of the damaged vessel rupture place.
People who do not have experience of providing medical care, often try to clean the wound and get out of her traumatic foreign body before you stop the bleeding. In case of damage of large vessels (veins and arteries) to clean the wound and remove from her own sharp objects is strictly prohibited.
When heavily soiled wounds can gently clean the edges (in the direction from damage and only with a sterile bandage soaked in antiseptic). The edges of the wound surface should also be lubricated with an antiseptic solution. When using iodine is impossible to put it inside the wound.
Wrong assist in bleeding can cause inflammation of the soft tissues, infection of the wound surface, necrosis of the extremities and increase blood loss.
when the capillary
First aid for bleeding from capillaries possible at home. If the damage larger blood vessels is practiced only temporary stop, followed by treatment in a medical institution.
Stop bleeding of capillary type, you can use the following:
- Raise your arm or leg with a wound above the heart to reduce the pressure in the vessels.
- Treat the area around the wound with antiseptic, if contaminated - wash.
- Close the injured area bactericidal plaster or sterile bandage.
- Apply compress ice (ice wrapped in a towel) to reduce blood separation, swelling and pain.
- If blood loss continues to apply a pressure bandage and seek medical advice.
Different type of capillary damage is a nasal flow of blood.
To stop a nosebleed, you must:
- Soothe affected (stress and panic help to increase blood loss).
- Slightly tilt your head forward and press human fingers wings of his nose. This will reduce the blood supply to the vessels and control the amount of discharge.
- Attach an ice compress to the nose.
- Writing affected Ascorutinum pill or other medication to strengthen the capillary walls.
- If the blood is not stopped in both nostrils pieces need to enter a sterile bandage or cotton turundy soaked in a solution of hydrogen peroxide (3%). The ends of the dressings should be left outside, fixing a top dressing. Turundy can remove a few hours after moistening them in order not to damage the formed crust.
If all the methods described do not help, as soon as possible address to the therapist or audiologist. During long-term and frequent flow of blood to patients are assigned haemostatics (Vikasol, Dicynonum).
venous
The most effective venous bleeding is a way to stop the imposition of a pressure bandage. Emergency aid is provided in the following order:
- Raise the injured limb. Injured leg or arm before bandaging should bend.
- Close open injury with a sterile swab and apply a pressure bandage just below the affected places. The dressing comes in individual dressing packets prepared or improvised: a clean cut of cloth or sterile wipes, which develops several times and pressed against the damage of the bandage that wrapped limb or body on top of the napkin and handkerchief over bandage. The bandage is applied in a circle tight and overlapped.
- In the absence of dressings must recompress place below the injury or strongly bend and press an arm or leg in the joint. If you stop the blood with the help of a pressure bandage did not work, you need to immediately apply a tourniquet to the same place as the bandage.
- To deliver a man with a wound to a medical facility or to call an ambulance.
Before you stop the bleeding, clean the edges are allowed to open the damage, but to get a traumatic object to touch and can not wash out the wound.
With the correct application of bandages or tourniquet stops the blood loss, and below the wound persists ripple.
when arterial
Effectively stop the heavy bleeding is possible only with the help of the harness, which is well above squeezes vessel injury.
Stop the bleeding at the expiration of the artery using the following method:
- Push the container located close to the bone. For the brachial artery is the humerus, to the subclavian - the first edge, underarm - bones hand (it requires strong pressing), for the knee - the knee fossa, for the femur - the thigh bone. If you press the artery is not possible, it is necessary to bend the limb, putting it into a joint roller or a roll of bandage. When carotid injury should press the palm of one hand to the back surface of the human neck, and the second finger - press below the injury.
- If the pause method does not work, you need to immediately apply a tourniquet above the wound site, previously lifted the limb, and putting it under the rubber band fabric.
- When wound in the carotid, subclavian, temporal and iliac artery wounds is sometimes required tamponade. Tourniquet on the carotid artery is pulled through the armpit.
- After providing first aid should be immediately taken to hospital.
Touch the wound before the blood can not be stopped.
when an internal
First aid for bleeding from internal organs is limited to the following:
- turn patient;
- attach to the proposed site expiration ice compress;
- if necessary, the presence of drugs - enter haemostatics (Vikasol et al.).
Stop the bleeding is possible only in conditions of medical institutions. Before the arrival of doctors should not be given to the affected food and water, wash the gastrointestinal tract. Homemade methods of blood stops can lead to death of the patient.
How to apply a tourniquet
Overlaying the harness is the most effective way of temporary stop bleeding. It can be made from scrap materials (towels, bandages, belt) or a special rubber tape and fabric. Thin cuts of fabrics, laces and other narrow bands are used to stop bleeding in the home can not.
Medical teams need to call as soon as possible, because tourniquet allowed to keep no more than 30 minutes in the cold time of the year and not more than 1 hour - a warm one. If you want to prolong the action of the dressing, remove the tourniquet to restore circulation and again to impose, but no more than 10-15 minutes.
This method of stopping the bleeding suggests a lack of pulsations in the damaged area and a complete cessation of blood loss.
If the wrong first aid with the use of the harness can lead to permanent impairment of blood circulation in the tissue below the injury.
How to Bleed
Provoke blood loss in several ways:
- traumatic (e.g., via cuts);
- surgical (during operation in the internal organs, the excision of soft tissue portion from suppurative inflammation, obstetrics, drainage);
- drug-induced.
Taking certain medications (anticoagulants, NSAIDs) reduces platelet aggregation and increases the risk of disease.
Blood loss is extremely distressing.
The use in the treatment of bleeding is outdated method of unproven efficacy.
The dangerous
Heavy bleeding can cause the following complications:
- DIC (a state of shock, which provokes extensive hemorrhage);
- occurrence of thrombi and emboli in small vessels;
- trauma (with loss of consciousness);
- multiple organ failure;
- coma;
- fatal outcome.
Bleeding in children can cause serious complications even when blood loss mild to moderate in severity.
Chronic vaginal bleeding provoking weakness, worsening of memory and performance, decreased muscle tone, frequent headaches and dizziness.
