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The imposition of a tourniquet for arterial bleeding. Algorithm of actions for the forearm, hip, shoulder

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Content

  1. Indications
  2. Contraindications
  3. Possible complications
  4. Training
  5. Procedure step by step
  6. From the upper limb
  7. From the lower limb
  8. From the femoral artery
  9. Care procedures after
  10. Advantages and disadvantages
  11. Video about the application of a tourniquet for bleeding

Algorithm of actions for the imposition of the Esmarch harness at arterial bleeding includes the rapid provision of first aid to a patient who shows signs of damage to the main vessel. This type of blood loss is considered the most dangerous for the human body, since the onset of a lethal outcome can occur within 5-8 minutes. from the moment of rupture of the walls of the arteries.

The application of a tourniquet on an upper or lower limb with signs of arterial bleeding is the most effective way to stop further blood outflow as quickly as possible. With the help of this method of providing first aid, before the arrival of doctors, it allows the victim to survive, to stabilize his condition, and also to prevent critical blood loss.

The imposition of a tourniquet for arterial bleeding is only the first stage in stopping further blood outflow. The main actions aimed at restoring the integrity of the blood vessel are carried out in the hospital of the surgical department of a medical institution. The algorithm of actions to stop arterial bleeding using a tourniquet provides for blocking the source of blood loss using two main methods.

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The most effective method of stopping further outflow of arterial blood is digital blockage of the damaged vessel with simultaneous flexion of the injured limb. Then a rubber band is applied to the arm or leg. In the absence of this type of medical device, a belt or piece of thick fabric is used.

Indications

The imposition of a tourniquet for arterial bleeding (the algorithm for the actions of the person providing first aid includes the fastest pulling of the torn artery) shown for execution in the following cases:

  • gushing bleeding from the upper or lower limb;
  • lacerated wounds of the arms and legs, as a result of which there was a rupture of the arterial vessel;
  • open fractures of the upper and lower extremities, at the time of occurrence of which the bone damaged the arterial vessel;
  • bullet, mine-explosive injuries, accompanied by single or multiple ruptures of the walls of the arteries;
  • traumatic amputations of the upper and lower extremities;
  • various damage to the pelvic bones, the result of which is a violation of the integrity of the femoral artery.

The main indication for the application of a tourniquet on the upper or lower limb is the presence of a rapid outflow of blood, which comes from an open wound surface. In conditions of damage to an arterial vessel, blood always gushes, pulsates, and also differs in the presence of a light scarlet hue.

The decision to apply a tourniquet on the injured limb should be made as soon as possible, and all actions to prevent further blood loss are carried out in compliance with all the rules for stopping arterial bleeding. Otherwise, a person with this kind of injury will face critical blood loss with further coma and death.

Contraindications

The imposition of a tourniquet for arterial bleeding (the algorithm of actions for the provision of emergency care includes a digital blockage of blood outflow) is contraindicated to be performed in the following clinical cases:

  • the victim is diagnosed with atherosclerosis of arterial vessels;
  • at the site of damage to the upper or lower limb, from which arterial blood gushes, a wound formation with signs of suppuration is observed;
  • the patient's age is less than 3 years (during the arrest of arterial bleeding in children, it is prohibited to use medical tourniquet, but only the use of stopping blood loss by compressing the injured vessel with fingers is shown arms);
  • the victim's wound is contaminated with infectious microorganisms of the anaerobic type.

In most cases, the above contraindications for using a medical tourniquet as the only way stopping arterial bleeding is difficult to diagnose in the field, when the victim needs urgent help. Before applying the tourniquet, you must make sure that the selected medical device is suitable for further use.

The shelf life of this device for stopping arterial bleeding is no more than 5 years. A tourniquet that is operated for a longer period of time is contraindicated for use, since it may not provide sufficient the level of therapeutic efficacy, and in some cases can harm a blood vessel with signs damage.

Possible complications

The imposition of Esmarch's hemostatic tourniquet inevitably causes the development of negative consequences, the severity of which is much less than the risk of death from rupture of an arterial vessel. The table below describes the main complications associated with pulling the injured area of ​​the body with a medical tourniquet.

Negative consequences of the application of a tourniquet for stopping arterial bleeding Characteristics of the pathological process
Tug of nerve trunks Pathological compression of the largest nerves of the peripheral type, which eventually becomes the cause the occurrence of severe neuropathy, impaired sensitivity and functional activity of the skeletal muscles of the lower limbs. The severity of the nerve contusion depends on how long the lower or upper limb has been tied with a tourniquet.
Capillary damage and pain After 7-10 minutes. from the moment the tourniquet is applied, most of the victims complain of a feeling of unbearable pain, which is accompanied by a feeling of strong distention and tingling of the tissues. In this case, damage to smaller blood vessels occurs, which suffer from local circulatory disorders.
Cessation of blood flow to blocked tissue sites After the application of a medical tourniquet, the process of irrigation with blood of the main and smaller vessels located below the injured area of ​​the artery is stopped. This leads to the fact that metabolic processes occur in these tissues of the upper or lower limb without access to oxygen-enriched blood. After removing the tourniquet, the under-oxidized products of intracellular metabolism enter the general bloodstream, which leads to a sharp violation of the acid-base balance. The patient shows signs of acidosis, the development of an acute form of renal failure is possible.
Turnstile shock The imposition of a tourniquet for arterial bleeding. Algorithm of actions for the forearm, hip, shoulderThis complication of using a tourniquet as the primary means of stopping arterial bleeding is also known as crash syndrome. Against the background of a critical violation of the acid-base balance of the blood, progressive renal dysfunction, heart failure occurs. The prerequisites are created for the infection of the arterial blood flow with pathogens of anaerobic infection. Especially if at the time of violation of the integrity of the blood vessel, bacterial microorganisms in the general bloodstream and tissues located in the circumference of the wound surface of the hand or legs.
Amputation of the injured limb Esmarch's tourniquet, which has been applied to the upper or lower limb for too long, causes ischemia of the arterial vessel, necrosis of the tissues of the arm or leg that are left without blood supply. A similar complication can develop if the compressive bandage was on the limb for more than 2 hours in the summer and for more than 1 hour in winter. Tissues that have not received oxygenated blood for a long period of time change color, become cyanotic, and dark spots appear on the surface of the skin. In most cases, the doctor decides to amputate part of the limb.

The Bubnovsky tourniquet with a ribbed base causes fewer complications associated with the compression of blood vessels, tissues and peripheral nerves of the injured limb.

A medical device of this type is practically not represented in first-aid kits and points of emergency medical care. In order to minimize the risk of developing complications caused by stopping arterial bleeding, it is necessary to observe rules for applying a tourniquet, as well as follow all recommendations for caring for an injured limb after stopping blood loss.

Training

The imposition of a tourniquet for arterial bleeding (the algorithm of therapeutic manipulations is prescribed in medical protocols regulating first aid in conditions of profuse blood loss) requires a minimum number of organizational actions character.The imposition of a tourniquet for arterial bleeding. Algorithm of actions for the forearm, hip, shoulder

In this case, you will need to observe the following preparation rules:

  1. Help the victim to take a comfortable and at the same time the correct position of the body, taking into account the localization of the injury, due to which arterial bleeding opened.
  2. Remove the rubber band from the first aid kit.
  3. Make sure that this medical device is suitable for practical use in connection with the preservation of its service life.
  4. Free the patient's upper or lower limb from clothing.
  5. Prepare a piece of fabric that will act as a spacer between the rubber band and the surface of the injured arm or leg.

All preparatory actions are carried out quickly. Every second of hesitation and doubt increases the risk of the victim developing a shock state, provoked by the rapid loss of arterial blood.

Procedure step by step

The algorithm of actions for the imposition of a medical tourniquet in order to stop arterial bleeding depends on which part of the body was damaged as a result of its injury.

From the upper limb

The imposition of a tourniquet on the upper limb, inside which the main vessel was damaged, occurs in compliance with the following rules:

  1. Clamp the injured vessel with your fingers to slow down the outflow of arterial blood.
  2. Place soft tissue 10 cm higher from the damaged tissues of the limb, which will act as a pad.
  3. Raise your arm 20-30 cm upward to organize venous outflow.
  4. Fix the tourniquet in your hands while stretching its structure.
  5. Perform the first round of tug on the injured limb, applying a tourniquet over the soft tissue.
  6. Check the pulsation of the blood vessels below the area of ​​the tourniquet application, which, provided that the procedure is performed correctly, should be completely absent.
  7. Without preliminary stretching, subsequent tours are performed with a tourniquet, guiding it around the injured limb in a spiral.
  8. The edge of the tourniquet is fixed to maintain its rigidity and pressure on the pinched blood vessels.
  9. A squeezing bandage is applied on top of the wound.
    The imposition of a tourniquet for arterial bleeding. Algorithm of actions for the forearm, hip, shoulder
    The imposition of a tourniquet for arterial bleeding

In the winter season, the injured upper limb should be well insulated. In this case, the tourniquet must not be bandaged or hidden in any other way. A note is attached to the patient's clothes, which indicates the time of the application of the tourniquet. This information can also be indicated by making an appropriate inscription on the surface of the victim's forehead. For example, if there is a risk of losing paper records.

From the lower limb

The imposition of a tourniquet on the surface of the lower limb, the injury of which is accompanied by arterial bleeding, provides for the following algorithm of actions:

  1. Lay the victim on his back.
  2. Raise the injured leg to a height of 30-40 cm from the ground.
  3. Pinch the destroyed blood vessel with your fingers.
  4. Place a piece of soft tissue on top of the surface of the lower limb, on which the tourniquet will be applied.
  5. Take a medical tourniquet in your hands, straightening its edges.
  6. Perform the first turn with a tourniquet around the leg, placing it 10 cm higher from the wound surface.
  7. Make sure that there is no pulsation in the vessels below the zone of arterial damage.
  8. Draw another 2-3 turns with a tourniquet around the injured leg, and then secure its edge.
  9. Apply a compression bandage over the open wound.The imposition of a tourniquet for arterial bleeding. Algorithm of actions for the forearm, hip, shoulder

Information about the time of the application of the tourniquet on the lower limb is compiled exactly according to the same principle as in the case of stopping arterial bleeding from the tissues of the hand. It is forbidden to fix the tourniquet in the area of ​​the upper third of the lower leg.

Placing a hemostat in this part of the leg increases the risk of severe damage to most peripheral nerves with further development of neuropathy. In the case of traumatic amputation of the lower limb, a tourniquet is applied to stop arterial bleeding with the simultaneous use of analgesics and anti-shock drugs.

From the femoral artery

To stop acute blood loss from the femoral artery, the following sequence of actions must be followed:

  1. Put the patient on his back.
  2. Place a small cloth roller or towel under the victim's buttocks.
  3. Squeeze the destroyed arterial vessel with your fingers.
  4. Close the wound surface with a dense tissue bandage.
  5. Bend the injured leg of the victim in the knee joint, pulling it as far as possible to the chest.
  6. Apply a fixation tourniquet so that its turns pass along the back of the thigh of the bent leg and the lower part of the victim's buttocks.
  7. Make sure to reduce the intensity of blood loss.
  8. The time of the tourniquet application is indicated in a note or on the victim's body.The imposition of a tourniquet for arterial bleeding. Algorithm of actions for the forearm, hip, shoulder

In the absence of a medical harness, a similar algorithm of actions can be carried out using a belt for pants or a belt from a dressing gown. In this situation, it will not be possible to achieve such a strong fixation of the tourniquet as in the case of overtightening of the arteries of the upper or lower limb. Therefore, the patient must be evacuated to a medical institution as soon as possible.

Care procedures after

The imposition of a tourniquet for arterial bleeding (algorithm of actions for the provision of the first emergency help has its own sequence) is not limited to stopping the pathological process of outflow blood.

Before the arrival of doctors, it is necessary to provide the patient with the following care aimed at preventing the development of irreversible changes in his body:

  1. On the wound, from which, after the application of the tourniquet, the outflow of arterial blood has significantly decreased, it is necessary to fix a compressive bandage.
  2. Free the patient's body from tight-fitting clothing.
  3. Open the vents and windows to supply additional oxygen to the room.
  4. Give the patient sweet tea, supporting the work of his heart muscle and tissues of other internal organs with glucose.
  5. In case of injury to the artery of the lower extremity, lay the victim in a vertical position on his back, lifting his legs up.
  6. The rupture of the arterial vessel of the upper limb requires raising the arm up immediately after the application of the tourniquet and squeezing bandage.
  7. The unconscious patient should be laid on his side.

Compliance with the above rules of caring for a person who has been applied a tourniquet to stop arterial bleeding, will support the stable work of his heart, lungs and brain tissues until the arrival of doctors Ambulance. The fastest possible evacuation of a patient to a hospital, performing surgical suturing of a torn artery minimizes the risk of developing shock against the background of profuse blood loss.

Advantages and disadvantages

Stopping arterial bleeding with a medical tourniquet has its pros and cons.The imposition of a tourniquet for arterial bleeding. Algorithm of actions for the forearm, hip, shoulder

The following advantages of this method of preventing acute blood loss are distinguished:

  • fast blockage of a blood vessel;
  • prevention of further outflow of blood;
  • ensuring stable functioning of the heart muscle and blood vessels, which do not show signs of traumatic injury;
  • prevention of the onset of shock caused by acute blood loss;
  • preservation of the victim's life until the arrival of ambulance doctors.

Timely application of a tourniquet on the tissue of the injured limb makes it possible to stabilize the patient's condition until the moment when he is in the hospital of a medical institution.

This method of providing emergency care has the following disadvantages:

  • during the pulling of the injured limb, pathological compression of the peripheral nerves occurs, which disrupts its functionality in the future;
  • there is a risk of ischemia of blood vessels that have been without oxygenated blood for a long period of time;
  • a lower or upper limb that has been tied with a tourniquet for too long can be amputated;
  • the likelihood of infection of the arterial blood flow with bacterial microorganisms of the anaerobic type increases;
  • acidosis, provoked by a sharp restoration of blood flow after removal of the tourniquet, can cause acute failure of the kidneys and heart muscle.

Pulling an injured limb using a tourniquet has a large number of disadvantages and complications. Despite this, this method of providing first aid remains the only one to save the life of a person with signs of acute arterial blood loss.

The algorithm for applying a tourniquet for arterial bleeding includes the mandatory preparation of the victim for pulling the tissues of his injured limb. All manipulations are carried out as quickly as possible, but at the same time in compliance with the rules for providing first aid. Before the start of the tug of the arterial vessel, its walls in the damaged area are clamped with the fingers of the hand.

Then a tourniquet is applied to the tissues of the upper or lower extremities 10-15 cm higher from the source of the blood outflow. The injured part of the body is lifted up to minimize blood loss. A note is attached to the victim's body indicating the time when the tourniquet was applied. The final phase of stopping arterial bleeding is carried out in a medical institution by stitching the walls of the damaged vessel.

Video about the application of a tourniquet for bleeding

The technique of applying a tourniquet for bleeding:

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