Bleeding

Bleeding (synonym hemorrhage) - the blood of the circulatory system. Causes of bleeding variety.
The most common cause is trauma to the vessel - cut, break, blow, compression, crush. The cause may be disease that changes the structure of the vessel wall,atherosclerosis, syphilis, cancer and other such diseases may arise violation of the integrity of the vessel and bleeding from it due to a sudden sharp rise in blood pressure caused by the physical stress, anxiety, etc. Cause bleeding are also diseases that lead to the violation of the chemical composition of blood,jaundice, blood diseases, poisoning (gasoline, phosphorus), sepsis, beriberi and other Observed in these cases, the reduction in blood clotting , and increased permeability receptacles lead to a significant hemorrhage even without macroscopic damage the walls of blood vessels.
Bleeding may be life-threatening the patient, which depends on the number streamed blood (see Blood loss), the place of occurrence of bleeding, and on the type of the damaged vessel and how quickly poured out the blood. Accordingly, there are arterial, venous and capillary and parenchymatous bleeding.
Arterial bleeding from damaged arteries are the most dangerous. Flowing from the arteries, blood is bright red in color emitted strong pulsating stream. Bleeding from the large artery (aorta, the femoral artery) in several minutes can lead to the death of the patient. Rapid blood loss with arterial bleeding can be dangerous even in small quantities streamed blood.
Venous bleeding when damage to the veins less dangerous. Blood pressure in the veins is much lower than in the arteries, so venous bleeding is characterized by bleeding continuous stream; the blood is dark red. The damage to the veins of the neck, chest dangerous because when inhaling pressure decreases and becomes even negative. This can lead to air entrainment into the lumen of Vienna and the development of air embolism (see).
Capillary bleeding occurs if the damage is the smallest blood vessels - capillaries. If it bleeds all wound (small cuts, abrasions). The blood accumulates slowly and quickly folded. Usually capillary bleeding stops independently, but in patients with impaired blood clotting (hemophilia) it can lead to serious complications.
Parenchymatous bleeding occurs when tissue damage the liver, kidneys, spleen, pancreas, and other parenchymatous organs. Blood vessels in these organs are many and they are fixed in the tissues and not zadayutsya. So parenchymatous bleeding is always significant and stop yourself extremely rare.
There are also internal and external bleeding. They arise when the damage to arteries, veins, and capillaries. External bleeding is characterized by bleeding out through broken skin or mucous membranes. If internal bleeding blood enters into the body cavity: pleural, peritoneal, the cavity of the skull or in the lumen of hollow organ in the stomach, intestines, bladder. Internal bleeding include hemorrhage (see) in the interstitial spaces between the muscles and the leaves of the aponeurosis, in subcutaneous tissue), forming hematomas (see).

the bleeding
Fig. 4 - 6. Typical changes the color of blood internal bleeding, depending on the place of their origin (schematically). Fig. 4. Bleeding stomach. 5. Bleeding lung. Fig.6. Intestinal bleeding at different levels.

Signs of internal bleeding: paleness skin and mucous membranes, cold sweat, growing anxiety of the patient, dizziness, accompanied by loss of consciousness, drowsiness, yawning, longing. Notes collapse (frequency and the weakening of the voltage pulse, the sharp fall in blood pressure and decreased hemoglobin). It is very important to identify the presence of blunting of percussion sound in sloping areas of the abdomen (bleeding into the abdomen); if bleeding into the pleural cavity (see Hemothorax) - dulling pulmonary sound and decreased breath when listening, hydrothorax chest x-ray; when bleeding in the pericardial cavity (see Emaperiod) - percutere the expansion of the boundaries of the heart and weakening of the heart sounds.
The most dangerous is bleeding into the cavity of the body (stomach, intestines, lungs), as this bleeding hidden, it can be very significant and, in some cases, insufficient monitoring of a patient can be promptly detected. Stomach bleeding (Fig. 4) occurs due to tumors or ulcers stomach and duodenal ulcer, gastritis, veins of the esophagus with cirrhosis of the liver. It is manifested rich hematemesis (gematemezis) and bleeding in the intestine in the form of stinking rich liquid tarry stools (melena).
Intestinal bleeding (Fig. 6) occurs when the polyps, tumors and ulcers, colitis, hemorrhoids and fissures. It neobichno, faeces or painted unchanged blood, or the chair is bloody. When fissures - pain and is bright red blood. Lung haemorrhage (Fig. 5). There is true bleeding - from pulmonary tuberculosis and lung tumors, diseases of cardiovascular system (stenoses mitral, aortic aneurysm) and false bleeding from the upper respiratory tract (nose and throat, tonsils and others). The selection of red blood ranges from several millimeters to several glasses and more, which can lead to aspiration and asphyxia.
Sometimes internal bleeding can be fatal even in a relatively small blood loss: poured out the blood can lead to compression of the vital organs, and death of the patient (for example, compression of the heart, bleeding in the substance of the brain). Possible internal bleeding, which can themselves do not represent danger to the patient, but are symptomatic of a dangerous diseases (see Hematuria, Hemoptysis, Uterine bleeding).
There are also the primary and secondary bleeding. Bleeding from a blood vessel observed at the time of injury, called primary bleeding; bleeding that occurs during healing wounds, that is, after a certain period of time after the injury,is secondary. It usually develops as a result of wound infection, the presence of a foreign body (drainage, splinter), and other complications.
One of the types of secondary bleeding is postoperative bleeding. It can result from sliding off ligatures imposed during the operation on the vessel (see Ligation of the blood vessels), or in the more remote periods after operation complications in the wound suppuration, the bedsore blood vessel and other blood clotting Disorders due to illness or an overdose of anticoagulants may also become a cause of postoperative bleeding.
Bleeding may be temporary, or provisional and final.
Temporary stoppage of bleeding can be made by the medical assistant, the sick person or the surrounding persons.



temporary stop bleeding
The point of pressure vessels (1-4) and hemostatic the position of the limbs (5-7) temporary stop bleeding: 1 - pressing of the brachial artery; 2 - femoral; 3 - common carotid; 4 - subclavian; 5 - establishment hands back; 6 and 7 - the maximum flexion of the elbow and hip joints.

Measures of temporary stop bleeding: 1) an application form (see Harness hemostatic); instead of a tourniquet to stop the bleeding on a limb you can use a piece of cloth, rope or a belt (bandaged limb freely above bleeding place, and then, forming a loop, inserting a wand and tight spin to stop bleeding); 2) pressure artery hand above bleeding places (Fig., 1-4) or the imposition of a pressure aseptic bandage (visible bleeding from the vessel can be stopped, having imposed a styptic clip and leaving it in the wound); 3) changing the position of the limbs (Fig., 5-7). To stop mild bleeding on the limbs and head to give them an elevated position, tamponiruut the wound and apply a pressure bandage.
Internal haemorrhage in the abdominal or chest cavity, gastrointestinal tract requires immediate hospitalization of the patient. A physician should be in advance by telephone warned about delivery critically ill. Prior to admission, it is recommended cold (ice) at the area, where there were bleeding, intravenous administration of a 10-20ml 10% solution of chloride calcium, hemostatic. To stop bleeding appoint drugs that raise blood pressure, it is not necessary, as it can worsen the situation. Transporting patient with symptoms of heavy bleeding and anemia need on a stretcher with a lowered head end. At a bleeding from vessels in the limbs requires immobilization limbs bus. In the hospital urgently need to start a blood transfusion.
The final stop bleeding usually requires surgery and is performed by a doctor in the hospital.