Chronic diseases consequences of acute blood loss. Changes in the body during acute blood loss. Acute blood loss: treatment

Internal.

Bleeding occurs during internal cavities or fabric.

Hidden.

Dont Have characteristic manifestations... Usually occurs in the cavity organs (eg, gastrointestinal).

By volume

• Small (0.5 - 10% BCC, on average - 0.5 l);
• Medium (11 - 20% BCC, on average 0.5 - 1 l);
• Large (21 - 40% BCC, on average 1–2 liters);
• Massive (41 - 70% BCC, about 2-3.5 liters);
• Lethal (more than 70% of the BCC, usually over 3.5 liters).

By the speed of development

• Acute (more than 7% of the BCC within an hour);
• Subacute (5-7% BCC within an hour);
• Chronic (less than 5% of the BCC within an hour).

Causes

1. Injuries, injuries, fractures;
2. Operations;
3. Pathological changes in blood vessels (ruptured aneurysm);
4. Violation of menstruation uterine bleeding, ectopic pregnancy;
5. Childbirth;
6. Gastrointestinal bleeding due to ulcerative processes;
7. Violation of the permeability of the vascular wall in the microvasculature with radiation injuries, oncological processes, some infections;
8. Decreased blood clotting ability, which can lead to profuse blood loss even with minor injuries.

Symptoms

1. Pallor of the skin;
2. Sweating;
3. Decrease in blood pressure;
4. Tachycardia (increased heart rate, while the pulse is weak, poorly palpable, small filling);
5. Decreased urine output (urine output), oliguria and anuria;
6. Weakness, lethargy, darkening of the eyes, tinnitus, depression of consciousness up to its loss.

Diagnosis degree

• With external or surgical bleeding, the amount of blood loss can be assessed visually.
• There are also average values ​​of blood loss at various injuries or surgical manipulations (example: fracture of the pelvic bones - 2-4 liters, C-section- 0.5-0.6 l).
• In cases where the above methods are not applicable, it is very convenient to determine the severity of the condition by the Algover index, which is calculated as the ratio of the pulse rate to the systolic (upper indicator) blood pressure. Thus, the higher the pulse and the lower the pressure, the more pronounced the deficiency of the BCC.

The materials are published for information purposes only, and are not a prescription for treatment! We recommend that you consult a hematologist at your hospital!

Every person is sometimes faced with such a problem as blood loss. In an insignificant amount, it does not pose a threat, but if the permissible limit is exceeded, appropriate measures must be taken urgently to eliminate the consequences of the injury.

Every person from time to time is faced with the problem of bleeding of varying complexity. The amount of blood loss may be insignificant and not pose any threat to health. With massive bleeding, minutes count, so you need to know how to deal with them.

In general, each person knows the external signs of blood loss. But a wound on the body and traces of blood are not all. Sometimes bleeding is hidden or not taken seriously enough. You should pay attention to general signs:

• pallor;
• cold sweat;
• cardiopalmus;
• nausea;
• flies before eyes;
• tinnitus;
• thirst;
• clouding of consciousness.

These symptoms can be harbingers of hemorrhagic shock, which develops with profuse bleeding.

Let's take a closer look at the features different categories blood loss and how dangerous each of them is.

Types of blood loss

V medical practice there are several criteria for the classification of blood loss. Let's consider their main types. First of all, such bleeding is distinguished:

• capillary;
• venous;
• arterial;
• parenchymal.

Important: the most dangerous are arterial and parenchymal (internal) types.

Also, the classification implies division into such groups:

• Acute blood loss ... A one-time loss of blood in a significant amount.
• Chronic... Minor bleeding, often hidden, lasting for a long time.
• Massive... Loss of large blood volume, drop in blood pressure.

It will be useful for you to find out also on our website.

Allocate certain types, depending on what caused the bleeding:

• Traumatic - with damage to tissues and blood vessels.
• Pathological - pathology circulatory system, internal organs, diseases and tumors.

Severity

The greater the severity of blood loss, the more serious its consequences. There are such degrees:

• Easy... Lost less than a quarter of the total circulating blood volume, the condition is stable.
• Average. Profuse blood loss, on average 30-40%, hospitalization is required.
• Severe degree... From 40%, it carries a serious threat to life.

The degree of acute blood loss is also characterized by the severity of hemorrhagic shock:

1. 1 - lost about 500 ml of blood;
2. 2 - about 1000 ml;
3. 3 - 2 liters or more.

Table: Classification by severity

According to the criterion of reversibility, the following phases of the shock state are distinguished:

• compensated reversible;
• decompensated irreversible;
• irreversible.

But how do you determine the amount of blood lost? There are such ways of determining:

• on general symptoms and the type of bleeding;
• weighing blood dressings;
• weighing the patient;
• laboratory tests.

What to do in case of severe blood loss?

To prevent hemorrhagic shock syndrome and other complications, it is important to provide proper and timely assistance to the victim. With blood loss, the consequences can range from temporary weakness and anemia to organ failure and death. Death occurs with blood loss over 70% of the BCC.

First aid

First aid for bleeding is to reduce the intensity of blood loss and its complete cessation. For minor injuries, a sterile bandage is sufficient.

If we are talking about profuse venous bleeding, you will need a tight bandage and further help from doctors. At arterial bleeding you cannot do without a tourniquet with which the artery is pinched.

In case of internal bleeding, a person should be provided with complete rest, you can apply cold to the damaged area. You need to immediately call " ambulance", And before their arrival provide a person abundant drink and keep him awake.

Table: First aid for different types bleeding

In the hospital, the amount of blood loss is determined, and on the basis of the data, a further treatment... With significant risks, infusion therapy is used, that is, transfusion of blood or its individual components.

Arterial bleeding is deadly if first aid is not provided in a timely manner. Many, finding themselves in such a situation, simply do not know how to help. Consider the intricacies of first aid, the imposition of a tourniquet for arterial bleeding.

In total, the body of the average person contains about 5 liters of blood. At the same time, he can lose some of it practically without any harm to himself: for example, the volume of blood taken from a donor at a time is 450 milliliters. This amount is considered perfectly safe for. A more or less serious problem may be the loss of 20% of the total blood volume or more.

The volume and nature of blood loss

With a loss of about one liter of blood, or about 20% of the total blood volume circulating in the body, the heart ceases to receive sufficient blood volume for circulation, a person experiences interruptions heart rate, the level of blood pressure and pulse rate are sharply reduced. Nevertheless, if blood loss can be stopped at this stage, it, as a rule, does not pose a significant threat to human life, and with sufficient nutrition and rest, the body is able to restore the lost volume on its own.

In the case of a loss of 20% to 30% of blood in a relatively short time, which is equivalent to a volume of 1-1.5 liters of blood for an adult, there is excessive sweating and thirst, nausea, vomiting is possible. A person does not have enough air, he becomes apathetic, his hands, and his vision becomes blurry. In this case, even if the bleeding stops, self-restoration of the lost volume is usually difficult, and the person needs a transfusion.

With a rapid loss of 2-3 liters of blood, that is, 30% or more of the total present in the body, the surface of the human skin becomes cold, he himself becomes noticeably pale, and the face and limbs acquire a bluish tint. In most cases, such blood loss is accompanied by loss of consciousness, and often - falling into a coma. In this case, only immediate blood transfusion can save a person's life. Quick loss 50% or more of the total amount of blood in the body is considered fatal.

If the blood loss is gradual, for example, with internal bleeding, the body has time to adapt to the situation and is able to withstand significantly large volumes of blood loss. For example, medicine is known for cases of survival with the loss of 60% of blood after timely intervention.

Blood loss - a pathological process arising from bleeding and characterized by a complex complex of pathological disorders and compensatory reactions to a decrease in the volume of circulating blood and hypoxia due to a decrease in the respiratory function of the blood.

Etiological factors of blood loss:

Violation of the integrity of blood vessels (injury, damage to the pathological process).

Increased vascular wall permeability (ARS).

Decreased blood clotting (hemorrhagic syndrome).

In the pathogenesis of blood loss, there are 3 stages: initial, compensatory, terminal.

Initial. BCC decreases - simple hypovolemia, cardiac output decreases, blood pressure falls, circulatory type hypoxia develops.

Compensatory. A complex of protective and adaptive reactions aimed at restoring the BCC, normalizing hemodynamics, and oxygen supply of the body is turned on.

Terminal stage blood loss can occur with insufficient adaptive reactions associated with severe diseases, under the influence of unfavorable exogenous and endogenous factors, extensive trauma, acute massive blood loss exceeding 50-60% of the BCC and the absence of therapeutic measures.

In the compensatory stage, the following phases are distinguished: vascular reflex, hydraemic, protein, bone marrow.

Vascular reflex phase lasts 8-12 hours from the onset of blood loss and is characterized by spasm of peripheral vessels due to the release of catecholamines by the adrenal glands, which leads to a decrease in the volume of the vascular bed ("centralization" of blood circulation) and contributes to the maintenance of blood flow in vital organs. Due to the activation of the renin-angiotensin-aldosterone system, the processes of sodium and water reabsorption in the proximal renal tubules are activated, which is accompanied by a decrease in urine output and water retention in the body. During this period, as a result of an equivalent loss of blood plasma and corpuscles, compensatory flow of deposited blood into the vascular bed, the content of erythrocytes and hemoglobin per unit of blood volume and the hematocrit value remain close to the initial value ("latent" anemia). Early signs acute blood loss are leukopenia and thrombocytopenia. In some cases, an increase in the total number of leukocytes is possible.

Hydraemic phase develops on the 1st or 2nd day after blood loss. It is manifested by the mobilization of tissue fluid and its entry into the bloodstream, which leads to the restoration of plasma volume. "Dilution" of blood is accompanied by a progressive decrease in the number of erythrocytes and hemoglobin per unit volume of blood. Anemia is normochromic, normocytic in nature.

Bone marrow phase develops on the 4-5th day after blood loss. It is determined by the intensification of the processes of erythropoiesis in the bone marrow as a result of the overproduction of the cells of the juxtaglomerular apparatus of the kidneys, in response to hypoxia, of erythropoietin, which stimulates the activity of the committed (unipotent) erythropoietic progenitor cell - CFU-E. The criterion for sufficient regenerative capacity bone marrow(regenerative anemia) is an increase in the blood content of young forms of erythrocytes (reticulocytes, polychromatophiles), which is accompanied by a change in the size of erythrocytes (macrocytosis) and the shape of cells (poikilocytosis). Perhaps the appearance of erythrocytes with basophilic granularity, sometimes - single normoblasts in the blood. Due to the increased hematopoietic function of the bone marrow, moderate leukocytosis (up to 12 × 10 9 / L) develops with a shift to the left to metamyelocytes (less often to myelocytes), the number of platelets increases (up to 500 × 10 9 / L and more).

Protein compensation is realized due to the activation of proteosynthesis in the liver and is detected within a few hours after bleeding. Subsequently, signs of increased protein synthesis are recorded within 1.5-3 weeks.

Types of blood loss:

By the type of damaged vessel or heart chamber:

arterial, venous, mixed.

By the volume of blood lost (from the BCC):

light (up to 20-25%), medium (25-35%), severe (more than 35-40%).

By the time of the onset of bleeding after trauma to the heart or vessel:

Primary - bleeding begins immediately after injury.

Secondary - bleeding is delayed in time from the moment of injury.

At the site of the outpouring of blood:

External - hemorrhage into the external environment.

Internal - hemorrhage in the body cavity or organs.

The outcome of bleeding is also determined by the state of the body's reactivity - the perfection of adaptation systems, gender, age, concomitant diseases, etc. Children, especially newborns and infants, tolerate blood loss much more heavily than adults.

A sudden loss of 50% of the BCC is fatal. Slow (over several days) blood loss of the same blood volume is less life threatening, since it is compensated by adaptation mechanisms. Acute blood loss up to 25-50% of the BCC is considered life-threatening due to the possibility of developing hemorrhagic shock. In this case, bleeding from the arteries is especially dangerous.

Recovery of erythrocyte mass occurs within 1–2 months, depending on the volume of blood loss. In this case, the reserve fund of iron in the body is consumed, which can cause iron deficiency. Anemia in this case becomes hypochromic, microcytic in nature.

The main dysfunctions of organs and systems in acute blood loss are shown in Fig. one

Figure 1.– The main dysfunctions of organs and systems in acute blood loss (according to V.N. Shabalin, N.I. Kochetygov)

Continued bleeding leads to depletion of the body's adaptive systems involved in the fight against hypovolemia - develops hemorrhagic shock. In this case, the protective reflexes of the macrocirculation system are already insufficient to ensure adequate cardiac output, as a result of which the systolic pressure quickly drops to critical figures (50-40 mm Hg). The blood supply to the organs and systems of the body is disrupted, oxygen starvation develops and death occurs due to paralysis of the respiratory center and cardiac arrest.

The main link in the pathogenesis of the irreversible stage of hemorrhagic shock is the decompensation of blood circulation in the microvasculature. Violation of the microcirculation system takes place already at early stages the development of hypovolemia. Prolonged spasm of capacitive and arterial vessels, aggravated by a progressive decrease in blood pressure with persistent bleeding, sooner or later leads to a complete cessation of microcirculation. Stasis sets in, aggregates of erythrocytes are formed in the spasmodic capillaries. The decrease and slowdown of blood flow arising in the dynamics of blood loss are accompanied by an increase in the concentration of fibrinogen and blood plasma globulins, which increases its viscosity and promotes the aggregation of erythrocytes. As a result, the level of toxic metabolic products rapidly increases and becomes anaerobic. Metabolic acidosis is compensated to a certain extent by respiratory alkalosis, which develops as a result of reflexive hyperventilation. Gross violations of vascular microcirculation and the entry into the blood of under-oxidized metabolic products can lead to irreversible changes in the liver and kidneys, and also adversely affect the functioning of the heart muscle even during the period of compensated hypovolemia.

Blood loss measures

Treatment for blood loss is based on etiotropic, pathogenetic and symptomatic principles.

Anemias

Anemia(literally - bloodlessness, or general anemia) is a clinical and hematological syndrome characterized by a decrease in the hemoglobin content and / or the number of erythrocytes per unit of blood volume. Normally, the content of erythrocytes in the peripheral blood in men averages 4.0-5.0 × 10 12 / l, in women - 3.7-4.7 × 10 12 / l; the level of hemoglobin, respectively, 130-160 g / l and 120-140 g / l.

Etiology: acute and chronic bleeding, infections, inflammation, intoxication (with salts of heavy metals), helminthic invasions, malignant neoplasms, vitamin deficiencies, diseases of the endocrine system, kidneys, liver, stomach, pancreas. Anemias often develop with leukemia, especially in their acute forms, with radiation sickness. In addition, pathological heredity and disorders of the body's immunological reactivity play a role.

General symptoms: pallor of the skin and mucous membranes, shortness of breath, palpitations, as well as complaints of dizziness, headaches, tinnitus, discomfort in the heart, severe general weakness and rapid fatigability... In mild cases of anemia, general symptoms may be absent, since compensatory mechanisms (increased erythropoiesis, activation of cardiovascular and respiratory systems) provide the physiological need for oxygen in tissues.

Classification. The existing classifications of anemias are based on their pathogenetic signs, taking into account the peculiarities of etiology, data on the content of hemoglobin and erythrocytes in the blood, morphology of erythrocytes, the type of erythropoiesis and the ability of the bone marrow to regenerate.

Table 1... Classification of anemias

A pathological process caused by damage to blood vessels and loss of part of the blood and characterized by a number of pathological and adaptive reactions.

Overview of Major Blood Loss

Acute blood loss develops when a large vessel is damaged, when there is a very rapid drop in blood pressure to almost zero. This condition is noted with a complete transverse rupture of the aorta, superior or inferior veins, and pulmonary trunk. The volume of blood loss is insignificant (250-300 ml), but due to a sharp, almost instantaneous drop in blood pressure, anoxia of the brain and myocardium develops, which leads to death. Morphological picture consists of signs acute death, a small amount of blood in the body cavities, damage to a large vessel and specific feature- Minakov spots. With acute blood loss, exsanguination of internal organs is not observed. With massive blood loss, a relatively slow outflow of blood from the damaged vessels occurs. In this case, the body loses about 50-60% of the available blood. Within a few tens of minutes, a gradual drop in blood pressure occurs. At the same time, the morphological picture is quite specific. "Marble" skin, pale, limited, insular cadaveric spots that appear in more late dates than with other types of acute death. Internal organs pale, dull, dry. It is found in body cavities or at the scene of an accident a large number of spilled blood in the form of bundles (up to 1500-2500 ml). With internal bleeding, large enough blood volumes are needed to soak the soft tissue around the lesions.

Pathogenesis with large blood loss

The main link in the pathogenesis of blood loss is a decrease in the BCC. The primary reaction to blood loss is cramping small arteries and arterioles, which occurs reflexively in response to irritation of the receptive fields of the vessels (baroreceptors of the aortic arch, the carotid sinus zone and tissue chemoreceptors that are again involved in the process) and an increase in tone sympathetic division vegetative nervous system... Due to this, with a small degree of blood loss and even with a large one, if it proceeds slowly, it is possible to maintain a normal blood pressure value. The total peripheral vascular resistance increases in accordance with the severity of blood loss. The consequence of a decrease in the BCC is a decrease in venous flow to the heart and cardiac output. Increased heart rate in initial stages blood loss to some extent is supported by the IOC, and in the future it steadily decreases. In order to compensate, the force of contractions of the heart increases and the amount of residual blood in its ventricles decreases. In the terminal stage, the force of heart contractions decreases, residual blood in the ventricles is not used. Blood loss suffered changes functional state cardiac muscle - the maximum achievable contraction rate decreases while maintaining the contraction force. As blood pressure falls, the volume of blood flow decreases in coronary arteries to a lesser extent than in other organs. Appear ECG changes, characteristic of progressive myocardial hypoxia, conduction is disturbed, which is important for prognosis, since the degree of coordination of the heart's work depends on it. With blood loss, the arteriovenous shunts open, while some of the blood, bypassing the capillaries, passes through the anastomoses into the venules. As a result, the blood supply to the skin, kidneys, muscles deteriorates, but it becomes easier for blood to return to the heart and thus maintain cardiac output, blood supply to the brain and heart (centralization of blood circulation), blood pressure and tissue perfusion for some time can also be maintained due to the transfer of part of the blood from systems low pressure(veins, pulmonary circulation) into the system high pressure... Thus, a decrease of up to 10% of the BCC can be compensated without changes in blood pressure and heart function. This is the basis of the beneficial effect of bloodletting in venous stasis and edema, including pulmonary edema. Another mechanism aimed at preserving hemodynamics is that the fluid from the interstitial spaces and the proteins contained in it enter the bloodstream (natural hemodynamics), which contributes to the restoration of the original blood volume. It was found that the plasma volume is restored rather quickly (within the first day). The process as a whole is directed towards the transition of circulatory hypoxia to anemic, which is less dangerous and easier to compensate. Blood loss causes microcirculation disorder. When blood pressure falls below 50 mm Hg. Art. the movement of blood slows down, stasis is observed in individual capillaries, the number of functioning capillaries decreases. In the terminal stage, microthrombi are noted in individual capillaries, which can lead to irreversible changes in organs and secondary heart failure. With blood loss, spasm of interlobular arteries and afferent arterioles of the renal glomeruli occurs. When blood pressure drops to 60-50 mm Hg. Art. renal blood flow decreases by 30%, urine output decreases, at 40 mm Hg. Art. and below it ceases altogether. Slowing down of renal blood flow and impaired filtration are observed for several days after suffering blood loss. If a large blood loss was not completely replaced or with a delay, there is a risk of developing an acute renal failure... Hepatic blood flow as a result of blood loss decreases in parallel with the fall in cardiac output. Hypoxia with blood loss is mainly of a circulatory nature; the degree of its severity depends on hemodynamic disturbances.

With severe blood loss, due to a strong decrease in IOC, the delivery and consumption of oxygen by tissues decreases, and severe oxygen starvation develops, in which the central nervous system suffers first of all. Tissue hypoxia leads to the accumulation of under-oxidized metabolic products in the body and to acidosis, which is compensated in the initial stages of blood loss. With deepening blood loss, uncompensated metabolic acidosis with a decrease in pH in venous blood to 7.0-7.05, in arterial - to 7.17-7.20 and a decrease in alkaline reserves. In the terminal stage of blood loss, venous blood acidosis is combined with alkalosis. Blood clotting during blood loss is accelerated, despite a decrease in platelet count and fibrinogen content. At the same time, fibrinolysis is activated. Great importance at the same time, they have changes in the components of the coagulation system: the adhesiveness of platelets and their aggregation function, the consumption of prothrombin, the concentration of thrombin, the content of factor VIII of blood coagulation increase, the content of antihemophilic globulin decreases. Tissue thromboplastin comes with interstitial fluid, and antiheparin factor from destroyed erythrocytes. Changes in the hemostatic system persist for several days, when total time blood clotting is already normalizing. With insufficient compensatory mechanisms and with a prolonged decrease in blood pressure, acute blood loss becomes irreversible (hemorrhagic shock), which lasts for hours. V severe cases blood loss may appear thrombohemorrhagic syndrome, caused by a combination of slow blood flow in the capillaries with an increased content of procoagulants in the blood. An irreversible condition as a result of prolonged blood loss in many respects differs from acute blood loss and approaches terminal stage traumatic shock.

Symptoms of large blood loss

The clinical picture of blood loss does not always correspond to the amount of blood lost. With a slow flow of blood, the clinical picture may be blurry, and some symptoms may be absent altogether. The severity of the condition is determined primarily on the basis of clinical picture... With very large blood loss, and especially with rapid blood flow, compensatory mechanisms may be insufficient or will not have time to turn on. In this case, hemodynamics progressively deteriorate as a result of a vicious circle. Blood loss reduces oxygen transport, which leads to a decrease in tissue oxygen consumption and an accumulation of oxygen debt, as a result oxygen starvation The central nervous system is weakened contractile function myocardium, the IOC falls, which, in turn, further impairs oxygen transport. If this vicious circle will not be severed, then the increasing disturbances lead to death. Increase the sensitivity to blood loss, overwork, hypothermia or overheating, the season (in the hot season, blood loss is worse tolerated), trauma, shock, ionizing radiation, concomitant diseases... Age and gender matter: women are more resistant to blood loss than men; newborns, infants and the elderly are very sensitive to blood loss.

Blood loss is a deficiency in the volume of circulating blood. There are only two types of blood loss - latent and massive. Latent blood loss is a deficiency of erythrocytes and hemoglobin, the deficiency of plasma is compensated by the body as a result of the phenomenon of hemodilution. Massive blood loss is a lack of circulating blood volume, leading to impaired function of cardio-vascular system... The terms "latent and massive blood loss" are not clinical (referring to the patient), they are academic (physiology and pathophysiology of blood circulation) educational terms. Clinical terms: (diagnosis) post-hemorrhagic Iron-deficiency anemia corresponds to latent blood loss, and the diagnosis of hemorrhagic shock corresponds to massive blood loss. As a result of chronic latent blood loss you can lose up to 70% of red blood cells and hemoglobin and save life. As a result of acute massive blood loss, you can die, losing only 10% (0.5 l) of the BCC. 20% (1L) often leads to death. 30% (1.5 L) BCC is absolutely fatal blood loss if not compensated (US military field surgery protocol). Massive blood loss is any blood loss in excess of 5% of the blood volume. The volume of blood taken from a donor is the boundary between latent and massive blood loss, that is, between that to which the body does not respond, and that which can cause collapse and shock. Forensic experts note the presence deaths with blood loss of 450 ml in military personnel (practically healthy ones), the mechanism of death is still unknown. Doctors, anesthesiologists and surgeons often ignore the favorable conditions of the operating room, therefore they assess the risk of blood loss differently, which unfortunately found its place in the medical literature.

Large (1.0-2.0 L) 21-40% BCC. Medium degree the severity of hypovolemia, blood pressure is reduced to 100-90 mm Hg. Art., severe tachycardia up to 120 beats / min, breathing is very rapid (tachypnea) with rhythm disturbances, a sharp progressive pallor of the skin and visible mucous membranes, lips and nasolabial triangle cyanotic, pointed nose, cold sticky sweat, acrocyanosis, oliguria, consciousness is darkened, excruciating thirst, nausea and vomiting, apathy, indifference, pathological drowsiness, yawning (a sign of oxygen starvation), pulse - frequent, low filling, weakening of vision, flashing of flies and darkening in the eyes, corneal opacity, hand tremors.

Treatment for large blood loss

The main task in the treatment of hemorrhagic shock is to eliminate hypovolemia and improve microcirculation. From the first stages of treatment, it is necessary to establish a jet transfusion of liquids ( saline, 5% glucose solution) for the prevention of reflex cardiac arrest - empty heart syndrome.

Immediate stopping of bleeding is possible only when the source of bleeding is available without anesthesia and everything that accompanies more or less extensive operation... In most cases, patients with hemorrhagic shock have to be prepared for surgery by injecting various plasma-substituting solutions and even blood transfusions into a vein and continue this treatment during and after surgery and stopping bleeding.

Infusion therapy aimed at eliminating hypovolemia is carried out under the control of central venous pressure, blood pressure, cardiac output, total peripheral resistance vessels and hourly urine output. For substitution therapy in the treatment of blood loss, combinations of plasma substitutes and canned blood preparations are used, based on the volume of blood loss.

For the correction of hypovolemia, blood substitutes of hemodynamic action are widely used: dextran preparations (reopolyglucin, polyglucin), gelatin solutions (gelatinol), hydroxyethyl starch (refortan, stabizol, infukol), saline solutions(saline solution, Ringer lactate, lactosol), sugar solutions (glucose, glucosteril). Of the blood products, erythrocyte mass, fresh frozen plasma, and albumin are most often used. In the absence of an increase in blood pressure, despite adequate infusion therapy within 1 hour, additional drugs such as adrenaline, norepinephrine, dopamine and other vasoconstrictor drugs are administered (after stopping bleeding). In the treatment of hemorrhagic shock, drugs are used that improve the rheological properties of blood: heparin, courantil, trental, and steroids. After removing the patient from the hemorrhagic shock and eliminating the immediate threat to life, violations of individual links of homeostasis (acid-base composition, hemostasis, and so on) are corrected.