Injuries that are accompanied by extensive damage to the blood vessels are quite dangerous. Sometimes the life of the victim depends on how quickly and skillfully first aid is provided. Bleeding is arterial, venous and capillary, and each type requires a special approach in providing first aid.
Ways to stop bleeding from an artery
Arterial bleeding is the most dangerous. In this case, the blood acquires a bright red (scarlet) color and is poured out in time with the contractions of the heart in a pulsating stream. The rate of blood loss in case of damage to a large arterial vessel (aorta, femoral, brachial, carotid artery) is such that a person can die in a matter of minutes.
You can stop bleeding from an artery in one of the following ways:
- apply a hemostatic tourniquet;
- give the wounded limb or body part an elevated position;
- press the artery with your fingers.
Applying a hemostatic tourniquet... When there is no tourniquet at hand, you can use the means at hand for this purpose - a rubber tube, a piece of thick cloth, a waist belt, a strong rope. The tourniquet is applied to the forearm, shoulder, thigh or lower leg (always above the site of blood loss). To prevent it from injuring the skin, apply a tourniquet on top of the clothes, first straightening its folds, or put some kind of material under the device. Make 2-3 turns of the tourniquet around the limb, then tighten it so that the bleeding stops. If you did everything correctly, then the pulsation of the artery below the damaged area will not be detected.
However, be careful - if the tourniquet is tightened too tightly, you can pinch the nerves, damage the muscle, and this is fraught with paralysis of the limb (in some cases, even necrosis). Also remember: the tourniquet is allowed to be applied for no more than 30 minutes in the cold season and for 1.5-2 hours in the warm season. For a longer period, there is a risk of tissue necrosis. If you need to hold the tourniquet for longer than the prescribed time, press the artery above the damaged area with your finger, then remove the tourniquet for 10-15 minutes, then reapply it just below or above the previous place.
Giving a limb an elevated position... You can also temporarily stop bleeding from the artery by holding the injured limb in a certain position. So, for example, by bending the leg or arm as much as possible in the knee or elbow joint, it is possible to press the femoral, popliteal, ulnar and brachial arteries. At the same time, the pressure in the vessels decreases sharply, the blood flow to the damaged area decreases, and a blood clot quickly forms, which prevents blood loss. After stopping the bleeding from the artery, you need to take the victim to the nearest hospital as soon as possible.
Finger pressure of the artery. This method is one of the most effective for emergency control of bleeding. Its essence lies in the fact that the torn artery is pressed with a finger to the bone formations. This method can only be used for a short period of time, since it requires great physical strength from the person providing assistance. Nevertheless, there are certain advantages - you have a few minutes to prepare the necessary funds (twist, tourniquet) to provide better quality care. You can press the artery with your palm, fist, thumb.
Methods for stopping venous and capillary bleeding
Venous bleeding not as intense as arterial. Dark, cherry-colored blood flows out of the injured veins in a uniform, continuous stream. Stopping venous bleeding is carried out using a pressure bandage. A sterile gauze or bandage is applied to the bleeding area. If you cannot use a special dressing, take a clean cloth and put some iodine on it. On top of the fabric, place a thick roller made of handkerchief, cotton wool or bandage. Then wrap it tightly and, if necessary, continue to lightly press on the roller with your hand. When the pressure bandage is applied correctly, blood loss will stop and the bandage will not get wet. It is also advisable to raise the bleeding limb above the level of the body in order to reduce blood flow.
Capillary bleeding appears as a result of damage to capillaries (the smallest blood vessels) - with superficial wounds, extensive abrasions. Blood flows out slowly and if the victim has normal clotting, the bleeding stops on its own. If it continues, a regular sterile dressing can be applied to the wound.
In all cases described above, it is recommended to apply an ice pack (over the bandage) to the injured area.
First aid rules
If you had to provide first aid to the victim, be sure to follow these rules:
- it is forbidden to cover the wound with powder or lubricate with ointments - this prevents healing;
- it is possible to wash the damaged area only if poisonous or corrosive substances enter it;
- if the wound becomes dirty, it is necessary to carefully remove the dirt from the skin around it (in the direction from the edges of the wound outward);
- if rust, sand or other elements have got into the wound, you cannot rinse it with drug solutions or water;
- only a specialist should remove small fragments of glass from an injured limb or part of the body;
- it is forbidden to remove blood clots from the wound, as this can provoke severe bleeding;
- you can not touch the bleeding wound with your hands, even with thoroughly washed ones;
- before applying the dressing, the edges of the wound are treated with tincture of iodine, while it should not be allowed to enter the wound;
- if the blood loss turned out to be significant, after providing first aid, the patient must be immediately sent to a hospital.
First aid for arterial, venous and capillary bleeding, first of all, is to stop it. The main thing in this situation is not to panic and carefully think over each action. Remember that the life of another person depends on how you do everything right.
Temporary bleeding controls are mechanical in nature.
Temporary stopping of external bleeding is carried out when providing out-of-hospital (first medical, paramedic, first medical) aid.
The main task of these types of assistance is temporary stop of external bleeding. Correct and timely completion of this task can be critical in saving the life of the victim.
Methods for temporarily stopping bleeding make it possible to save the victim from acute blood loss and imply immediate stopping the bleeding at the scene of the incident and transporting the wounded to a hospital, 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 of the accident.
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;
the imposition of a pressure bandage;
tight wound tamponade;
pressing the bleeding vessel in the wound;
placing a clamp on a bleeding vessel in the wound;
the imposition of an arterial tourniquet.
PRESSURE OF THE ARTERY WITH THE FINGERS PROXIMUM WOUND
The greatest danger to the life of the victim is arterial external bleeding. In such cases, you must immediately implement pressing the artery with your 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 then prepare and temporarily stop 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. Disadvantage - it can be effectively applied only for 10 - 15 minutes, that is, it is short-term, since the hands get tired and the pressure weakens. In this regard, already at the stage of first aid, it becomes necessary 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 taken to prepare a tourniquet or pressure bandage for unstoppable bleeding can cost the victim a life!
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 looking for it (Table 4, Fig. 3.).
In the table the names of the main arteries, their points of pressure and external landmarks, as well as 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 is the bone, which makes it easy enough 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 pressing of 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 with external bleeding
|
Localization of severe arterial bleeding |
Artery name |
Placement of finger pressure points |
|
Wounds to the upper and middle parts of the neck, submandibular region and face |
1. Common carotid artery |
At the middle of the medial edge of the sternocleidomastoid muscle (at the level of the upper edge of the thyroid cartilage). Pressurize with large or II-IV fingers towards the spine. The artery is pressed against the carotid tubercle of the transverse process of the VI cervical vertebra. |
|
Cheek wounds |
2. Facial artery |
To the lower edge of the lower jaw at the border of the posterior and middle thirds (2 cm anterior to the angle of the lower jaw, i.e. at the anterior edge of the masseter muscle) |
|
Wounds to the temporal region or above the ear |
3. Superficial temporal artery |
To the temporal bone in front and above the ear tragus (2 cm up and anterior to the opening of the external auditory canal) |
|
Wounds of the shoulder joint, subclavian and axillary regions, upper third of the shoulder |
4. Subclavian artery |
To the I rib in the supraclavicular region, behind the middle third of the clavicle, outward from the attachment point of the sternocleidomastoid muscle. Pressure is produced with large or II-IV fingers in the supraclavicular fossa from top to bottom, while the artery is pressed against the I rib. |
|
Upper limb wounds |
5. Axillary artery |
To the head of the humerus in the axillary fossa along the anterior border of hair growth, while the hand should be turned outward |
|
6. Brachial artery |
To the humerus in the upper or middle third of the shoulder, on its inner surface, at the medial edge of the biceps muscle, in the groove, between the biceps and triceps |
|
|
To the ulna in the upper third of the inner surface of the forearm, at the point where, when measuring blood pressure, a systolic murmur is heard with a phonendoscope |
||
|
8. Radial artery |
To the radius at the point of determining the pulse, in the distal forearm |
|
|
Lower limb wounds |
9. Femoral artery |
Below the inguinal ligament (somewhat medial to its middle) to the horizontal branch of the pubic bone, squeeze the artery with thumbs or a fist |
|
10. Popliteal artery |
In the center of the popliteal fossa to the posterior surface of the femur or tibia, from back to front with a slightly bent knee joint |
|
|
11. Posterior tibial artery |
To the posterior surface of the medial malleolus |
|
|
12. Artery of the dorsum of the foot |
Below the ankle, on the front surface of the foot, outward from the extensor tendon of the big toe, i.e. approximately midway between the outer and inner ankles |
|
|
Pelvic wounds injuries of the iliac arteries |
13. The abdominal part of the aorta |
Fist to the spine in the navel, slightly to the left of it |
Pressing and especially holding the main arterial trunk presents certain difficulties and requires 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 must be carried out 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 occupied in this case) (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. 4 c).
It should be remembered that a properly performed digital pressure should lead to an immediate stop of arterial bleeding, i.e., to the disappearance of the pulsating stream of blood coming from the wound. With arteriovenous bleeding, venous and especially capillary bleeding may decrease, but persist for some time.
After arterial bleeding is stopped by pressing with fingers, it is necessary to prepare and temporarily stop bleeding in another way, most often by imposing 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 push with your fist, using the entire weight of your body, on the navel area or slightly to the left. This technique is only effective for thin people. It is used for profuse bleeding with injuries of the iliac arteries (above the inguinal ligament).
Compression, as a rule, does not completely clamp the aorta, and therefore the bleeding does not stop completely, but only becomes weaker. This technique can be accompanied by trauma to the anterior abdominal wall and even to the abdominal organs. It is not recommended to perform it for educational purposes, it is enough to learn how to determine the pulsation of abdominal abortion in the umbilical region.
Rice. 3. Points for finger pressure of the arteries (explained in the text)
Rice. 4. Temporary stopping of bleeding by finger pressure of the arteries
a - pressing one hand with the fingers; b - pressing with the first two fingers; c - pressing the femoral artery with a fist.
MAXIMUM EXTENSION OF THE LIMB 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 flexion of the limb. In the place of flexion (elbow bend, popliteal fossa, inguinal fold), a roll of bandage 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 (if the arteries of the forearm or hand are injured), knee (with injury to the arteries of the leg or foot) or hip (in case of injury to the femoral artery) joints (Fig. 5). Bleeding is stopped by kinking the arteries.
This method is effective for arterial bleeding from the thigh (maximum flexion in the hip joint), from the lower leg and foot (maximum flexion in the knee joint), hand and forearm (maximum flexion in the elbow joint) .
Rice. 5. Temporarystopping bleeding by the method of maximum flexion of the limb.
a - in the elbow joint; b - in the knee joint; in the hip joint.
The 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 with the application of a tourniquet, ischemia of the distal sections, therefore, the duration of the limb stay in the maximally bent position corresponds to the time spent on the limb of the tourniquet.
This method does not always lead to the goal. The described method of stopping bleeding is not applicable in case of concomitant bone trauma (fractures or dislocations of bones).
For bleeding from the axillary artery or peripheral subclavian artery both shoulders are maximally retracted posteriorly (almost to the contact of the shoulder blades) and fixed one to the other at the level of the elbow joints. In this case, the subclavian artery is compressed between the clavicle and the first rib.
Rice. 6. Temporary stop of bleeding from the axillary or subclavian artery
Maximum flexion at the elbow is often used to stop bleeding. after puncture of the cubital vein.
GIVING AN INJURED LIMB TO THE EXTENDED POSITION
Raising the injured limb (giving the limb an elevated position) reduces blood circulation in blood vessels and promotes faster thrombus formation.
Indications for its use are venous or capillary bleeding in case of injury to the distal extremities.
SUPPRESSIVE BANDING
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 advisable 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 napkins are applied to the wound, and on top is a layer of cotton wool or a cotton-gauze roller, which are tightly bandaged for local compression of the 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 required pressure of the roller on the soft tissues during its fixation, the "bandage cross" technique is used, as shown in Fig. 7.
Rice. 7. Reception of "cross bandage" when applying a pressure bandage
An individual dressing package is convenient for these purposes (Fig. 8).
Rice. 8. Individual dressing package
A pressure bandage can be applied for bleeding from varicose veins of the lower extremities, as well as after many operations, for example, after phlebectomy, after breast resection, after mastectomy. However, a pressure bandage is not effective for massive arterial bleeding.
TIGHT WOUND TAMPONADE
In cases where raising the limb and applying a pressure bandage fails to stop the bleeding, wound tamponing is used, followed by the application of a pressure bandage, which, given the elevated position of the limb, is a good method of temporarily stopping bleeding from large veins and small (and sometimes large) arteries. It is used for deep damage 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 tight filling of the wound cavity with gauze napkins, turundas or special tampons. Gauze tampons or napkins are introduced into the wound, with which the entire wound cavity is tightly filled. 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 cutaneous edges of the wound are stitched and closed with sutures over the tampon. Gauze, soaked in blood, becomes the basis for the prolapsed fibrin and the formation of a blood clot. Wound tamponade can be used as a method of temporary or permanent hemostasis. To enhance the effect, tamponade is often combined with the use of local hemostatic agents such as hydrogen peroxide. The use of wound hypothermia enhances the hemostatic effect due to vasospasm and an increase in platelet adhesion to the endothelium.
It is not 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 penetrating wounds (chest, abdominal cavity), since the tampons can be inserted through the wound in the body cavity. You also need to be careful about tight tamponade of wounds in the popliteal region, since in this case ischemia of the limb and its gangrene may develop.
In addition, wound tamponade creates conditions for the development of anaerobic infection. Therefore, where possible, you should refrain from packing the wound.
PRESSURE OF THE BLOOD VESSEL IN THE WOUND
Pressing a bleeding vessel in a 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 place of damage to the vessel is pressed in the wound with fingers or a swab (gauze ball or small napkin in the Mikulich or Kocher clamp, or in the forceps). The bleeding is stopped, the wound is drained and the most appropriate method of stopping the bleeding is selected.
CLAMPING THE BLOOD VESSEL IN THE WOUND
At the prehospital stage, when providing assistance, hemostatic clamps can be applied in the wound, if sterile hemostatic clamps are available (Billroth, Kocher or others) and the bleeding vessel in the wound is clearly visible. The vessel is grasped with a clamp, the clamp is fastened, an aseptic bandage 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 a victim to a hospital, 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 during transportation can unfasten, break off the vessel or come off along with a part of the vessel), the possibility of damage by the clamp to the veins and nerves located next to the damaged artery, crushing of the edge of the damaged vessel, which subsequently makes it difficult to apply a vascular suture for the final stop of bleeding.
Applying a clamp on a bleeding vessel in the early stages is used if it is impossible to temporarily stop bleeding by other methods, in particular, when bleeding from damaged vessels with injuries to the proximal extremities, as well as injuries to the chest or abdominal wall. When applying clamps, it must be remembered that this must be done with extreme caution, 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 fingers (throughout, in the wound) or with a swab in the wound, drain the wound from the blood, and then apply hemostatic clamps in the wound or directly to a bleeding vessel, or (if it is difficult to identify it) to the thickness of soft tissues in which the damaged vessel is located. Several such clamps can be applied. Since the victim is to be transported further, in order to prevent early secondary bleeding, it is necessary to take measures to prevent the clamps from slipping, tearing or unbuttoning.
APPLICATION OF ARTERIAL PLAIR
If it is impossible to temporarily stop external arterial or arteriovenous bleeding by other methods, apply hemostatic tourniquet.
Rice. 9. Arterial tourniquet
Narterial tourniquet alopecia is the most reliable way to temporarily stop bleeding.Currently, a tape rubber tourniquet and a twist tourniquet are used. Rubber band harness equipped with special fasteners designed to secure the applied 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 for bleeding from arteries: a - feet; b - lower leg and knee joint; c - brushes; d - forearm and elbow joint; d - shoulder; e - hips
The negative side of applying an arterial tourniquet is that the tourniquet squeezes not only damaged vessels, but all vessels, including intact ones, and also squeezes 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 inflow of oxygenated blood, the metabolism in the limb proceeds according to the oxygen-free type. After removing the tourniquet, the under-oxidized products enter the general bloodstream, causing a sharp shift in the acid-base state to the acidic side (acidosis), the 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 distal to the imposed tourniquet creates a fertile ground for the development of anaerobic gas infection, i.e. for the growth of bacteria that multiply without oxygen.
Given 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 by other means.
It must be remembered that, along with high efficiency, this method itself can lead to serious consequences: tourniquet shock and damage to the nerve trunks with the subsequent development of paresis or paralysis. Clinical experience shows that 75% of injured tourniquets are applied without proper indications, therefore, its use as a method of temporarily stopping bleeding should be limited. For injuries accompanied by profuse bleeding, the 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 provides stable hemostasis during transportation of the victim to a hospital, where the final stop of bleeding will be made.
You need to know a number of general rules for applying an arterial tourniquet., the implementation of which will allow to 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) Hemostatic tourniquet is used mainly when the main arteries are injured. It can be difficult to distinguish venous from arterial bleeding with complex wound canal anatomy and venous-arterial bleeding. Therefore, if the blood flows from the wound is powerful, especially. to one degree or another, with a pulsating stream, one should act as in arterial bleeding, i.e. 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 error to apply a tourniquet distal to the wound.
2) The tourniquet is applied proximal to the wound and as close to the wound site as possible ,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 you to maximize the preservation of viable tissues located proximal to the site of injury.
3) Before applying the tourniquet, the artery is pressed against the bone with the fingers. .
4) Then, the injured limb should be raised to drain the blood from the veins. This will allow, after the application of the tourniquet, to avoid the outflow of venous blood from the wound, which filled the vessels of the distal parts of the limb.
5) A tourniquet cannot be applied 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, or on the foot.
6) The tourniquet should not be applied to naked skin - a tourniquet lining is required. The preliminary intended area of application of the tourniquet is wrapped in a soft material (towel, kerchief, cotton-gauze lining, bandage, etc.), avoiding the formation of folds on it. You can apply a tourniquet directly to the victim's clothing without removing it.
7) Good put 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 applying a standard hemostatic tourniquet:
a - wrapping a limb with a towel;b- the tourniquet is brought under the thigh and stretched; c - the first turn of the bundle;G- fixing the harness
Fig. 11 Arterial tourniquet application:
a - preparation for the imposition of a tourniquet
b - start of overlay
c - fixing the first round
g - the tourniquet is imposed
8) A stretched tourniquet is applied to the limb from the side of the vascular projection. The tourniquet is grasped with the left hand at the edge with the fastener, and with the right hand - 30-40 cm closer to the middle, not further (Fig. 11 a). Then the tourniquet is stretched with both hands and the first turn of the tourniquet is applied so that the initial section of the tourniquet overlaps with the next turn. Thus, the first turn of the bundle is made with a cross to prevent it from loosening (Fig. 11 b). Moreover, the long end of the tourniquet is applied to the short one. The limb is squeezed with a tourniquet until arterial bleeding from the wound stops and the pulse disappears from the peripheral arteries.Compression should be sufficient, but not excessive. ... Already the first tightened turn (turn) of the tourniquet should clamp the artery and stop the bleeding. After reaching the stop of bleeding, further tightening of the tourniquet is unacceptable!
The next turns of the bundle 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 pinching the skin (Figure 11 d). Then the hook is attached to the chain.
To prevent loosening of the harness tension, after application it must be securely fastened.
Considering the risk of developing serious complications, instead of a tourniquet, you can use a cuff from a device for measuring blood pressure. The pressure in the cuff should exceed the systolic blood pressure (in the area of overlapping of the cuff) by no more than 10-15 mm Hg.
The application of a tourniquet 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. .
Excessive tightening of the tourniquet (especially a twist-rope) 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 impaired sensitivity. Excessive compression can lead to vascular damage with the development of venous and arterial thrombosis. Therefore, do not overtighten the tourniquet. It must be tightened with enough force to stop the bleeding.
In the same time, insufficient tightening the tourniquet does not provide a sufficiently complete compression of the main artery; therefore, the flow of arterial blood 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, the bleeding from the wound does not stop, but, on the contrary, may intensify, since the limb is overflowing with blood.
MOU Klevantsovskaya secondary school of the Ostrovsky district of the Kostroma region
Related tests
"First aid"
Completed by: Abronov Alexander Nikolaevich, teacher of life safety, NVP
Kostroma-2010
Introduction.
The main function of testing is a controlling function, which consists in monitoring the knowledge and skills of students, determining the achievement of a basic level of training by students, mastering the mandatory minimum of the content of the discipline.
Distinguish between current, thematic and final testing of students' knowledge. All types of verification are carried out using different forms, methods and techniques.
Testing has a number of advantages over traditional forms and methods, it naturally fits into modern pedagogical concepts, allows more rational use of class time, cover a larger volume of content, quickly establish feedback with students and determine the results of mastering the material, focus on knowledge gaps and make adjustments to them. Test control provides simultaneous verification of the knowledge of the entire class and forms their motivation to prepare for each lesson, disciplines them.
^
Explanatory note for tests
General Provisions
It is possible to apply tests both directly for a specific section in the process of studying it (checking homework, reflection), and in a complex manner in several sections as a final certification. Also, the presented tests can be offered to students as a basic platform for creating their own tests.
The electronic version allows you to quickly, easily and with a minimum amount of time create test assignments of any size and complexity, while maintaining the sequential numbering of sections and tests in sections for consistency with the table of answers.
Test preparation.
The questions have 3 levels of difficulty:
1.Less complexity.
2. Medium difficulty.
3. Increased complexity.
The numbering of questions of least difficulty is not accompanied by anything.
Numbering of questions of medium difficulty - accompanied by the sign - *
Numbering of questions of increased complexity - accompanied by the sign - **
^ 2.2 Test control conditions:
Any outside help is prohibited during the test.
Test participants have only writing materials with them. (There shouldn't be any reference material).
before testing, students are familiar with the conditions for the test.
A specific time is allocated for the test.
Tasks can be completed in any order.
The correct answer is marked with any sign (cross, check mark, circle, etc.).
Testing starts simultaneously for all participants.
The final result.
^ 3. An approximate sample of the task card
| Surname, name of the student |
||||||
| Question number | Selected answer |
|||||
| A | B | V | G | D | Indicate the order of answers |
|
| 1.1 | ||||||
| 1.2 | ||||||
| 1.3 | ||||||
| 1.4 | ||||||
| 1.5 | ||||||
| 1.6 | ||||||
| 1.7 | ||||||
^ Test Answer Table
| № test | answer | № test | answer | № test | answer |
| 1.1 | A | 4.1 | V | 7.1 | C, B, D, A, D |
| 1.2 | G | 4.2 | B | 7.2 | C, A, B, D, D |
| 1.3 | B | 4.3 | G | 7.3 | A |
| 1.4 | V | 4.4 | B | 7.4 | B |
| 1.5 | B | 4.5 | A | 7.5 | D |
| 1.6 | B | 4.6 | V | 7.6 | A |
| 1.7 | A | 4.7 | G | 7.7 | B |
| 1.8 | V | 4.8 | B | 7.8 | V |
| 1.9 | G | 4.9 | G | 7.9 | A |
| 1.0 | G | 4.0 | B | 7.0 | G |
| 2.1 | B | 5.1 | V | 8.1 | C, D, A, B |
| 2.2 | V | 5.2 | G | 8.2 | A |
| 2.3 | D | 5.3 | A | 8.3 | V |
| 2.4 | V | 5.4 | B | 8.4 | V |
| 2.5 | A | 5.5 | B | 8.5 | B |
| 2.6 | B | 5.6 | V | 8.6 | A |
| 2.7 | V | 5.7 | V | 8.7 | A |
| 2.8 | G | 5.8 | B | 8.8 | B |
| 2.9 | B | 5.9 | B | 8.9 | |
| 2.0 | G | 5.0 | V | 8.0 | |
| 3.1 | V | 6.1 | V | 9.1 | V |
| 3.2 | A | 6.2 | V | 9.2 | V |
| 3.3 | B | 6.3 | A | 9.3 | G |
| 3.4 | A | 6.4 | B, F, I | 9.4 | A |
| 3.5 | G | 6.5 | B, A, D, C, D | 9.5 | A |
| 3.6 | V | 6.6 | B | 9.6 | B |
| 3.7 | B | 6.7 | V | 9.7 | V |
| 3.8 | V | 6.8 | V | 9.8 | A |
| 3.9 | A | 6.9 | A | 9.9 | B |
| 3.0 | V | 6.0 | G | 9.0 | B |
Tests
1. Bleeding1.1 What is hypoxia?
A - oxygen starvation;
B - dehydration of the body;
B - overheating of the body;
G - cooling of the body;
D - thermal irradiation.
^ 1.2 Bleeding is
A - poisoning with hazardous chemicals;
B - respiratory function;
B - high blood pressure;
D - bleeding from blood vessels in violation of the integrity of their walls;
D - bone fracture.
^ 1.3 How to stop heavy venous bleeding?
A - apply a pressure bandage;
B - apply a tourniquet;
B- treat the wound with alcohol and close with a sterile napkin;
D - disinfect with alcohol and treat with iodine;
D - sprinkle with salt.
^ 1.4 In case of injury to the carotid artery, it is urgent to:
A - apply a tight bandage.
B- apply a tourniquet.
B - pinch the artery below the wound with your finger.
1.5 When injured, blood flows in a continuous stream. This is bleeding
A- Parenchymal
B- Venous.
B- Capillary.
D- Arterial ..
^ 1.6 Characteristic signs of arterial bleeding:
A- Blood of a dark color, flows out in an even stream.
B- Blood of scarlet color, flows out in a pulsating stream.
B- The entire surface bleeds, flows out in the form of small drops.
^ 1.7 Arterial bleeding occurs when:
A - damage to any artery with deep injury;
B- superficial injury;
B - a shallow wound in case of damage to any of the vessels.
^ 1.8 Reducing bleeding by giving an elevated position of the injured limb is mainly used for:
A - internal bleeding;
B- superficial wounds;
B - any injuries to the limb.
^ 1.9 The most reliable way to stop bleeding in case of damage to large arterial vessels of the arms and legs is:
A - the imposition of a pressure bandage;
B - finger pressure;
B - maximum flexion of the limb;
G - the imposition of a tourniquet;
^ 1.0 For an open fracture of a limb with severe bleeding, the first step is to:
A - Treat the edge of the wound with iodine;
B - Carry out immobilization of the limb;
B - Rinse the wound with hydrogen peroxide;
D - Stop bleeding.
^ 2. Applying a tourniquet
2.1 The tourniquet is applied:
A- With capillary bleeding.
B. With arterial and venous bleeding.
B. With parenchymal bleeding.
^ 2.2 How to choose the right place of application of a hemostatic tourniquet for arterial bleeding?
B - 10-15 cm above the wound;
B - 15-20 cm below the wound;
G - 20-25 cm below the wound;
D - 30 cm below the wound.
^ 2.3 How to choose the right place of application of a hemostatic tourniquet for venous bleeding?
A - apply a tourniquet to the treated wound;
B - 10-15 cm above the wound;
B- 30 cm below the wound;
G - 20-25 cm below the wound;
D - 10-15 cm below the wound;
^ 2.4 How long is the tourniquet applied in the summer?
B- For 1 hour 30 minutes
B- For 2 hours
Y - For 2 h 30 min
D-At 3 o'clock
2.5 How long is the tourniquet applied in winter?
B- For 1 hour 30 minutes
B- For 2 hours
Y - For 2 h 30 min
D-At 3 o'clock
^ 2.6 Instead of a bundle, you can use:
A - Pressure bandage.
B- Twist.
B- Cold to the wound.
G- Compress
2.7 * What information should be included in the note attached to the harness:
A- surname, name, patronymic of the victim, time of injury;
B- date and exact time (hours and minutes) of the harness overlay;
В- the date, exact time (hours and minutes) of the harness application, as well as the surname, name, patronymic of the victim, surname, name of the fatherland of the person who applied the harness.
^ 2.8 In the field, if a shin is injured with severe pulsating bleeding, it is possible
A - apply a tight bandage made of clean cloth and cotton wool;
B - pull the femoral artery;
B - apply a tight sterile bandage;
D - pull the popliteal artery with a kerchief.
^ 2.9 How many minutes after the application of the tourniquet, it must be loosened for several minutes
A - 30-50 min;
B-30-40 min;
B - 20-30 min;
G - 20-25 min.
^ 2.0 What can lead to continuous long-term presence of a limb with an imposed tourniquet (more than 2 hours)
A - to an increase in the temperature of the limb, tingling pains, redness of the skin;
B - to the entry into the blood of a significant amount of toxins from the tissues above the tourniquet and the development of traumatic toxicosis;
G - to the entry into the blood of a significant amount of toxins from the tissues below the tourniquet and the development of traumatic toxicosis.
3. Wounds
3.1 How to properly treat a wound?
A - disinfect the wound with alcohol and tie tightly;
B - moisten gauze with iodine and apply to the wound;
B- treat the wound with hydrogen peroxide;
G - lubricate the wound itself with iodine;
D- sprinkle with salt
3.2 Closed damage includes:
A - dislocations, strains, bruises;
B - abrasions and wounds;
B- scratches and cuts.
^
3.3 In case of frostbite, a skin area must:
A- Rub with snow.
B- Warm up and give a warm drink.
B- Rub with a mitten.
3.4 ** What is the sequence of first aid for tick bites:
A - wash your hands with soap and water, drop a drop of oil, kerosene or petroleum jelly into the place where the tick has sucked, remove the tick with tweezers by swinging it from side to side, treat the bite site with alcohol and iodine, send the victim to a medical facility;
B - drop a drop of iodine on the place where the tick has sucked, remove the tick with tweezers by gently swaying from side to side, treat the bite site with alcohol and iodine;
B- wash your hands with soap and water, drop a drop of oil, kerosene or petroleum jelly on the place where the tick has sucked, and then treat with alcohol and iodine, send the victim to a medical facility
^ 3.5 Pneumothorax is:
A- Open wound of the abdomen
B- Shortness of breath
B- Type of lung disease
D- Open wound of the chest.
^ 3.6 ** Determine the correctness and sequence of first aid to the victim with closed pneumothorax:
A - if possible, give the victim oxygen, call an ambulance, keep the spine motionless, give the victim a sedative;
B - give the victim a sedative, maintain the required body temperature of the victim, put cold on the sternum, call an ambulance;
B - give the victim an anesthetic, give him an elevated position with a raised headboard, if possible, give oxygen, urgently call an ambulance.
3.7 * The victim has severe abdominal pain, dry tongue, nausea, vomiting, swollen abdomen, “the abdomen is like a board. The patient lies on his back or on his side with legs bent at the knee and hip joints. Our actions
A - warmth on the stomach and the fastest transportation to the surgical department of the hospital
B- cold on the stomach and the fastest transportation to the surgical department of the hospital
B - cold on the stomach, give a drink and the fastest transportation to the surgical department of the hospital
^ 3.8 * In case of an open injury to the abdomen, it is necessary
A- An aseptic bandage is applied to the wound. When intestinal or omentum loops fall out into the wound, the organs should be adjusted and pinched.
B- Give the patient a drink. An aseptic bandage is applied to the wound.
B- An aseptic dressing is applied to the wound. If the intestinal or omentum loops fall out into the wound, the organs are not adjusted; it is necessary to cover them with a sterile gauze napkin or ironed cotton cloth and bandage loosely.
^ 3.9 ** The victim fell from a height, paralysis of the legs, necessary
A- Complete rest. The victim is laid with his back on a shield placed on a stretcher. A small roller is placed under the lumbar region. If there is no shield, the victim can be transported on a stretcher in a prone position, with clothes or a rolled blanket under his chest and thighs. Urgent hospitalization
B- The victim is seated. A small roller is placed under the lumbar region. Urgent hospitalization
B- The victim is placed with his back on a soft stretcher. A small roller is placed under the lumbar region. If there is no stretcher, the victim can be transported by hand. Urgent hospitalization
^ 3.0 In case of a laceration of the soft tissues of the head, it is necessary
A - apply a bandage, anesthetize and deliver the victim to a hospital;
B - apply a bandage, anesthetize;
B - apply an aseptic bandage, anesthetize and deliver the victim to a hospital.
4. Fractures
4.1 The fracture is
A - destruction of the soft tissues of the bones;
B- cracks, chips, fractures of keratinized parts of the body;
B- cracks, chips, crushing of bones.
^ 4.2 * How to provide first aid for a fracture of the pelvic bones?
A - treat the fracture site with a disinfectant, apply a splint;
B- lay the victim on a flat hard surface, put a roller under the bent and parted knee joints (frog pose);
B - lay on a hard surface, apply two splints on the inside and outside of the thigh;
D-straighten your legs, lay motionless and call a doctor;
D - do not touch the victim.
^ 4.3 In case of an open fracture with displacement of the bones, it is necessary:
B- Correct displacement and bandage
D- Bandage the wound without disturbing the fracture, and apply a splint.
^ 4.4 In case of a closed fracture with displacement of the bones, it is necessary:
A- Correct the misalignment and apply a splint
B- Apply a splint
B- Apply a splint with the return of the bones to their original position
D- Bandage the wound without disturbing the fracture, and apply a splint
^ 4.5 When the spine and pelvic bones are fractured, paralysis occurs ...
A - parts of the body below the fracture site;
B- Lower limbs.
B- Upper limbs.
^ 4.6 * Determine the sequence of first aid for open fractures:
A - give the victim a comfortable position, carefully adjust the bone to its original position, apply a bandage and immobilize, deliver the victim to a hospital;
B- give an anesthetic, immobilize the limb, send the victim to a hospital;
B-stop bleeding, apply a sterile bandage, give an anesthetic, immobilize, deliver the victim to a hospital.
^ 4.7 In case of an open fracture, first of all, it is necessary:
B- to immobilize the limb in the position in which it is at the moment of injury;
B - apply a sterile bandage to the wound in the area of the fracture;
D- stop bleeding.
^ 4.8 When providing first aid in the event of a fracture, it is prohibited:
A - to carry out immobilization of injured limbs;
B- insert bone fragments into place and set the released bone in place;
B- stop bleeding.
^ 4.9 What are the signs of a closed fracture
A - pain, swelling;
B - bleeding, pain, itching;
B - pain, swelling, bleeding;
^ 4.0 What are the signs of an open fracture
A - pain, swelling;
B- open wound, bone tissue is visible, pain, impaired motor function of the damaged organ
B- pain, swelling, bleeding
D - violation of the motor function of the damaged organ, pain, swelling, deformation at the site of injury.
^ 5. Sprains, dislocations
5.1 Dislocation of it
A - displacement of the limb with a sharp movement;
B - displacement of bones relative to each other;
B - persistent displacement of the articular ends of the bones;
D - persistent displacement of the joint.
^ 5.2 The main signs of traumatic dislocation
A - sharp pain;
B - sharp pain, increase in body temperature;
B - sharp pain, swelling;
D - severe pain, change in the shape of the joint, impossibility of movements in it or their limitation.
^ 5.3 ** First aid for rupture of ligaments and muscles is:
A - apply cold and a tight bandage to the damaged area, provide peace to the victim, give him an anesthetic and deliver the victim to a medical facility;
B - apply a tight bandage to the damaged area, provide peace to the victim, give him an anesthetic and deliver the victim to a medical facility;
B - urgently steam out the damaged area, and then apply a tight bandage, provide peace to the victim, give him an anesthetic, give the injured limb an elevated position and deliver the victim to a medical facility.
^ 5.4 * What is the first aid sequence for stretching:
A - apply a tight bandage to the damaged area, ensure the rest of the injured limb, lowering it as low as possible to the ground, and deliver the victim to a medical facility;
B- apply cold and apply a tight bandage to the damaged area, ensure peace of the injured limb, give it an elevated position and deliver the victim to a medical facility;
B- to ensure the rest of the injured limb, give it an elevated position and deliver the victim to a medical facility
5.5 * While playing football, one of the team's players fell onto his hand. He developed severe pain, deformity, and abnormal mobility in his forearm. What first aid should you provide:
A - give an anesthetic, apply a pressure bandage and deliver to a medical facility;
B- give an anesthetic, bend the arm at a right angle at the elbow joint and immobilize it with a splint or improvised means and deliver it to a medical institution;
B- lubricate the site of injury with iodine, give an anesthetic and deliver to a medical facility.
^ 5.6 Immobilization is
A - gathering of military personnel;
B- bringing body parts to a free state;
B - bringing a part of the body (limb, spine) to a stationary state.
^ 5.7 A splint of hard material is applied
A - on a naked body
B- on a twisted scarf
B- on cotton wool, towel or other soft cloth without folds
^ 5.8 When immobilized, fix
A- damaged joint
B- damaged and adjacent joint
B- all joints
5.9 As a bus, you can use
A - ski stick, board, towel;
B - a piece of board, a suitable branch of a tree, a ski;
B - a ski pole, a board, a towel, a flexible cable, a piece of board, a suitable branch of a tree, a ski.
^ 5.0 In the absence of a suitable splint for a fractured tibia, it is possible
A - to immobilize the limb with tape;
B- immobilize the limb with glue and tarpaulin;
B - bandage the affected leg to the healthy one.
^ 6. ERP
6.1 When to perform resuscitation
A - with a fracture;
B - with bleeding;
B - when there is no breathing and cardiac activity;
G - with dislocation of the leg;
Y- there is no correct answer
^ 6.2 When should chest compressions be used?
A - after the release of the victim from the dangerous factor;
B - with an increase in blood pressure;
B - in the absence of a pulse;
G - when using artificial respiration;
D - with bleeding
^ 6.3 In what sequence is it necessary to provide first aid to the victim in case of cessation of his cardiac activity and breathing?
A - to free the airways, perform artificial respiration and external heart massage;
B- perform a heart massage, empty the airways, and then administer artificial respiration;
B- to free the airways, perform artificial respiration and heart massage.
** Choose from the proposed answer options the correct actions to determine the signs of clinical death:
B – Ensure full respiratory activity;
V – Make sure there is no breathing;
G – Make sure there is no consciousness;
D – Make sure that the victim has no speech;
E – Make sure the pupils respond to light;
F – Make sure there is no reaction of the pupils to light;
Z – Make sure the victim has bruises, head or spine trauma;
AND – Make sure there is no pulse in the carotid artery;
TO – Determine the presence of hearing in the victim.
^ Determine the sequence of resuscitation assistance to the victim:
B - put the victim on his back on a hard surface;
B - carry out artificial ventilation of the lungs;
D - start an indirect heart massage;
D - call an ambulance or urgently deliver the victim to the hospital.
^ 6.6 ** When providing resuscitation care, it is necessary:
A - put the victim on his back on a soft surface, produce a precordial blow in the neck area, start chest compressions and artificial lung ventilation, urgently deliver the victim to the hospital;
B - put the victim on his back on a hard surface, perform a precordial blow in the sternum, start chest compressions and artificial lung ventilation, call an ambulance or urgently deliver the victim to the hospital;
B - to strike in the area of the xiphoid process, to proceed to indirect heart massage and artificial ventilation, call an ambulance or urgently deliver the victim to the hospital.
^ 6.7 ** The victim should be given an indirect cardiac massage. What is the sequence of your actions:
A - put the victim on a flat hard surface, kneel on the left side of the victim parallel to his longitudinal axis, put two palms on the heart area at once, while the fingers should be unclenched, alternately press on the sternum, first with the right, then with the left palm;
B - put the victim on a bed or on a sofa and stand from him on the left side, put your palms at the projection point of the heart on the sternum, press on the sternum with your hands with bent fingers alternately rhythmically every 2-3 seconds;
B - put the victim on a flat hard surface, kneel on the left side of the victim parallel to his longitudinal axis, put the palm of one hand on the lower third of the sternum (2-2.5 cm above the xiphoid process), cover the first with the palm of the other hand to strengthen pressure. The fingers of both hands should not touch the chest, the thumbs should look in different directions, press on the chest only with straight arms, using the weight of the body, the palms should not be torn from the victim's sternum, each subsequent movement should be made after the chest returns to its original position.
^ 6.8 ** What is the correct procedure for delivering a precordial blow to the sternum:
A - precordial blow, short and rather sharp, is applied to a point located on the sternum 2-3 cm above the xiphoid process, the elbow of the blowing hand should be directed along the victim's body, immediately after the blow, find out whether the heart has resumed
B - the precordial blow is applied with the palm of the hand to a point located on the sternum above the xiphoid process by 2-3 cm and 2 cm to the left of the center of the sternum, the elbow of the hand striking must be directed across the victim's body, the blow must be sliding;
a precordial blow is applied with the edge of a palm clenched into a fist to a point located on the sternum 2-3 cm above the xiphoid process, immediately after the blow, check the pulse.
^ 6.9 * In the text below, determine the correct procedure for gastric lavage:
A - give the victim to drink at least 2 glasses of boiled water or a weak solution of baking soda and, irritating the root of the tongue with your fingers, induce vomiting;
B - give the victim to drink at least 2 glasses of cold tap water, pressing on the abdomen, induce vomiting;
B - give the victim to drink 2 glasses of vinegar essence and, pressing on the neck area, induce vomiting.
^ 6.0 "Cat's eye" sign
A - clinical death;
B - agony;
B - fainting, traumatic shock;
G - biological death.
7. Burns
7.1 * Determine the sequence of first aid for a chemical burn with acid:
A - give an anesthetic;
B - rinse the skin with running water;
B - remove acid soaked clothing from a person;
D - rinse the damaged area with a weak solution of baking soda;
D - deliver the victim to a hospital.
^ 7.2 Determine the sequence of first aid for chemical burns with alkali:
A - rinse the skin with running water;
B - wash the damaged area with a weak solution (1-2%) of acetic acid;
B- remove clothes soaked in alkali;
D - deliver the victim to a medical facility;
D - give an anesthetic.
^ 7.3 * In case of a burn, you must:
A - remove a hot object from the surface of the body, cut off clothes with scissors, apply cold on the damaged surface for 5-10 minutes, disinfect healthy skin around the burn, apply a sterile bandage on the burned surface and send the victim to a medical institution;
B - remove a hot object from the surface of the body, cut off clothes with scissors, lubricate the damaged surface with iodine and then oil, apply a sterile bandage and send the victim to a medical facility;
B - remove a hot object from the surface of the body without cutting off the clothes with scissors, pour oil over the burned surface, apply a sterile bandage and send the victim to a medical facility.
^ 7.4 For a third-degree burn, call an ambulance immediately and:
A - Pour water over the bubbles;
B - Give the victim a large amount of liquid;
B - Treat the skin with fat or brilliant green;
7.5 * A person injured in a fire damaged tissues lying deep (subcutaneous tissue, muscles, tendons, nerves, blood vessels, bones), partially charred feet, what is his degree of burn
^ 7.6 * Signs of heatstroke
A - an increase in body temperature, chills, weakness, headache, dizziness, redness of the skin of the face, a sharp increase in heart rate and respiration, noticeable loss of appetite, nausea, profuse sweating;
B - a decrease in body temperature, chills, weakness, headache, dizziness, redness of the skin of the face, a sharp increase in heart rate and respiration, noticeable loss of appetite, nausea;
B - increased body temperature, headache, redness of the facial skin, profuse sweating.
^ 7.7 * Causes contributing to frostbite
A - low air humidity, hard physical work, warm clothes, forced long-term stay in the cold (skiers, climbers);
B- high humidity, strong wind, tight wet shoes, forced prolonged immobility, prolonged exposure to frost (skiers, climbers), alcoholic intoxication;
B - low ambient temperature, hard physical work, warm clothes, forced prolonged long stay in the cold (skiers, climbers).
^ 7.8 * With shallow frostbite of the auricles, nose, cheeks
A - they are rubbed with snow until reddening. Then rubbed with 70% ethyl alcohol and smeared with vaseline oil or some kind of fat.
B - rub them with a warm hand or a soft cloth until reddening. Then wipe with cold water and grease with vaseline oil or some kind of fat.
B - rub them with a warm hand or a soft cloth until reddening. Then rubbed with 70% ethyl alcohol and smeared with vaseline oil or some kind of fat.
^ 7.9 * In case of thermal shock, it is necessary to
A - undress the victim, lay him on his back with raised limbs and lowered head, put cold compresses on his head, neck, chest, give a copious cold drink;
B - put the victim to bed, give tea, coffee, in severe cases, the victim should be laid on his back with lowered limbs and raised head;
B - put the victim to bed, give cold drinks, in severe cases, the victim should be laid on his back with his limbs lowered and his head raised.
^ 7.0 During hard physical work in a room with high air temperature and humidity, it is possible
A - sunstroke;
B - traumatic shock;
B - traumatic toxicosis;
G - heatstroke.
^ 8 head contusions, concussions, traumatic shock, heart failure
8.1 Determine the sequence of first aid for fainting:
A - spray your face with cold water;
B- give the legs an elevated position;
B- lay the victim on his back with his head slightly thrown back;
D - open the collar and give fresh air access.
^ 8.2 * Determine the sequence of first aid for concussion:
A - urgently call a doctor, provide absolute peace to the victim, apply cold on his head;
B - put cold on the victim's head, give him strong tea or coffee, accompany him to a medical facility;
B - give the victim pain relievers and sedatives, take him to a medical facility.
8.3 * As a result of the fall, the teenager developed nausea and vomiting, and the coordination of movements was impaired. What is the sequence of actions for first aid:
A - give pain pills and take the teenager to the nearest clinic, hospital;
B- do a gastric lavage, put an enema, give a sedative;
B - to provide rest, apply a cold compress to the head, call an ambulance.
^ 8.4 In case of traumatic shock, first of all, it is necessary:
A - create a calm environment for the victim (exclude annoying noises), give an anesthetic;
B- to carry out temporary immobilization, to provide complete rest to the victim, to send the victim to a medical institution;
B- eliminate the effect of the traumatic factor, stop bleeding, give anesthetic, treat the wound, apply a pressure bandage.
^ 8.5 Sudden loss of consciousness is:
B - Fainting;
B - Migraine;
D - Collapse.
8.6 ** The causes of heart failure can be:
A - rheumatic lesions of the heart muscle, heart defects, myocardial infarction, physical stress, metabolic disorders and vitamin deficiencies;
B- internal and external bleeding, damage to the musculoskeletal system, fatigue, heat and sunstroke;
B - severe injuries accompanied by blood loss, crushing of soft tissues, crushing of bones, extensive thermal burns.
^ 8.7 ** Signs of a concussion
A - short-term loss of consciousness, vomiting, loss of memory for events preceding the injury (retrograde amnesia), headache, dizziness, tinnitus, unsteady gait, dilated pupils;
B - short-term loss of consciousness, headache, dizziness, sleep disturbance;
B - headache, vomiting, dizziness, sleep disturbance;
^ 8.8 * Main causes of traumatic shock
A - overwork, overload, blood loss;
B- pain, large blood loss, intoxication due to the absorption of decay products of dead and crushed tissues, damage to vital organs with a disorder of their functions
B- pain, blood loss, intoxication due to the absorption of alcohol decomposition products, damage to vital organs.
^ 8.9 Normal blood pressure is
A- 120/60 mm. rt. Art .;
B- 140/80 mm. rt. Art .;
В- 130-120 / 80 mm. rt. Art.
With an arterial pressure of 160/110, the patient is prohibited
B- lie on a soft bed;
B- drink cranberry juice.
9. Bandages
9.1 In case of injuries to the occiput, a bandage is applied:
A - Kosynochnaya
B - Spiral;
B - Cruciform.
^ 9.2 Any bandage begins with fixing moves. It means:
A - fixing the second round of the bandage to the third;
B- the second round of the bandage must be fixed to the first with a pin or hairpin;
B - the first round must be fixed by bending the tip of the bandage, and fix it with the second round.
^ 9.3 * Find the mistake in listing the purpose of the dressing:
A - the bandage protects the wound from exposure to air:
B- bandage protects the wound from contamination
B - the bandage covers the wound;
G-bandage reduces pain.
^ 9.4 When applying a bandage, it is prohibited
A - touch the sterile part of the bandage in contact with the wound with your hands;
B - touch the sterile part of the bandage with your hands, not in contact with the wound;
B- twist the bandage
^ 9.5 Bandaging is usually carried out
A - left to right, from the periphery to the center;
B- right to left, from the periphery to the center;
B- left to right, from center to periphery.
^ 9.6 For injuries to the cheeks and chin area, apply
A- bandage "cap"
B- bandage "bridle"
B - bandage - "Hippocratic hat".
^ 9.7 In case of damage to the scalp, apply
A - bandage - "Hippocratic hat".
B- bandage "bridle"
B- bandage "cap"
^ 9.8 * When applying a bandage with open pneumotrax, it is necessary to
A - apply a rubberized PPM sheath (medical dressing package) to the wound with the inner side without preliminary laying with a gauze napkin;
B- apply any airtight material directly to the wound
B- bandage the wound with a sterile bandage.
^ 9.9 * For first aid in case of open injuries (wounds, burns), it is most convenient to use as an aseptic dressing
A - sterile bandage;
B- medical dressing package (PPM)
B - sterile bandage, cotton wool.
9.0 In case of a bullet wound to the soft tissues of the lower leg, it is necessary
A - strengthening bandage;
B - pressure bandage;
B - immobilizing bandage;
D - thick bandage.
Bibliography
1. Zavyalov V.N., Gogolev M.I., Mordvinov V.S., ed. Kurtseva P.A. Medical and sanitary training of students: Textbook. for environments. study. Establishments. Moscow: Education 1988.2. M.P. Frolov, E.N. Litvinov, A.T. Smirnov and others; Ed. Yu.L. Vorobyova OBZH: 9, 10, 11th grade: Textbook for educational institutions ..- M .: OOO "AST Publishing House". 2003.
Bleeding is called the outflow of blood from the blood vessels, which occurs as a result of a violation of their integrity. The following classification of bleeding is generally accepted:Primary bleeding occur when various blood vessels are damaged immediately or shortly after injury or trauma. Depending on the source, where it came from, bleeding is divided into arterial - from the arteries; arteriovenous - from arteries and veins with simultaneous damage to them; venous - from venous vessels; capillary - from capillaries; parenchymal - from the parenchyma of various organs.
Signs of different types of bleeding
1. Arterial. Blood flows out in a stream, a fountain. The amount of ejected blood depends on the caliber of the vessel and the size of the vessel wound. The color of the blood is scarlet, bright. Arterial bleeding stops when the vessel is compressed between the wound and the heart.
2. Arterio-venous. Blood quickly fills the wound. The color of the blood is red. Pressing the vessel above the wound does not stop the bleeding, but the blood becomes dark. Pressing the vessel below the wound does not stop the bleeding, the blood turns red.
3. Venous. Blood flows in a steady, slow, non-pulsating stream. The spray color is dark. Pressing the vessel above the wound increases bleeding.
4. Capillary. Bleeding from tissues occurs as from a sponge, the bleeding vessels are not visible.
5. Parenchymal. The vessels of the parenchymal organs are closely connected with the connective tissue stroma of the organ, therefore, in the cut (when injured), they gap and do not collapse.
Profuse bleeding, difficult to stop.
Secondary bleeding develops after the primary bleeding - from direct damage to a blood vessel - has stopped spontaneously or has been stopped with the help of some or other therapeutic techniques. Secondary bleeding is single, but may be repeated. Then they are called repeated, or recurrent.
Distinguish between early and late secondary bleeding.
Early secondary bleeding occurs in the next 2-3 days after injury due to discharge of a blood clot, slipping of the ligature, or when a foreign body clogs the defect from the vessel wall. Early secondary bleeding is rare and occurs most often during transportation of the wounded without sufficient immobilization of the injured limb.
Late bleeding usually appears 10-15 days, and sometimes several weeks after injury.
Causes of secondary bleeding. An increase in blood pressure with the use of drugs - promotes the expulsion of an unorganized blood clot from the vessel; pressure on the vessel of the inserted drainage, metal foreign body (bullet, splinter), displaced bone fragment - leads to the formation of a pressure ulcer of the vessel, which results in secondary bleeding; improper techniques when stopping bleeding - lead to slipping or untightening of the ligatures imposed on the vessel. Purulent-inflammatory processes in the wound often cause purulent softening and melting of the thrombus, which also leads to secondary bleeding.
The causes of secondary bleeding include sepsis, leading to melting of the thrombus, as well as conditions that disrupt reparative processes in general and blood vessels, in particular: blood loss, traumatic shock, protein deficiency, etc.
Clinic of acute blood loss
Symptoms of acute blood loss depend on the rate of flow and the amount of blood lost. The more rapidly the bleeding occurs, the more severe the clinical picture of acute blood loss is. Rapid blood loss; 1/3 of the blood volume is life threatening, the loss of half of the total blood volume is fatal. With a mass of 65 kg, the blood volume is approximately 5 liters. Thus, the loss of 1.5-1.7 liters of blood is dangerous, and 2.5 liters is fatal. However, the clinic noted deviations associated with individual sensitivity to blood loss. The following factors affect sensitivity to blood loss.Age - children and old people tolerate blood loss worse; women are more resistant to blood loss; rapid flow of blood - adaptive mechanisms do not have time to turn on, with prolonged, chronic bleeding, adaptive mechanisms compensate for blood loss; general condition of the body: people who are exhausted, weakened, physically overworked, exposed to hypothermia, who have undergone illness and surgery, are obese, and so on, tolerate blood loss worse.
Symptoms of acute blood loss. Pallor of the skin and visible mucous membranes, dry skin. Pointed facial features. Darkening in the eyes, tinnitus, dizziness, nausea, vomiting are explained by irritation of the cerebral cortex and the vomiting center due to hypoxia. The pulse is fast, weak, even threadlike. Decrease in arterial and central venous pressure. With a blood pressure of 60-50 mm Hg. Art. and below, there are increasing violations of higher nervous activity: first, anxiety appears, then fear, a feeling of impending catastrophe, panicky facial expression, screaming, disorientation, depression, confusion and, finally, loss of consciousness (N. Stone et al., 1965). Loss of consciousness is followed by convulsions, involuntary excretion of urine, feces, and death.
First aid for external bleeding consists in the fastest possible temporary stop of bleeding by any available means.
Ways to temporarily stop bleeding
First aid in case of bleeding on the battlefield, it always finds itself in difficult conditions and comes down to the use of the following temporarily stopping bleeding methods (depending on the damage to the artery or vein).Finger pressure of an artery above the site of injury on the battlefield is rarely used. In the BCH or in the MPP, the method is used as a preliminary method so that the wounded does not lose blood; when controlling or changing a previously applied tourniquet, they resort to stopping bleeding in another way, for example, by imposing a hemostatic clamp on a bleeding vessel.
Finger pinching of the arteries is applied at the points where the artery passes over the bone to which it is pressed. The temporal artery is pressed against the temporal bone, the external maxillary artery is pressed against the corner of the lower jaw. The carotid artery is pressed against the cervical vertebrae at the inner surface of the sternocleidomastoid muscle at the border of the middle and lower third of it.
The subclavian artery can be pressed with a finger to the I rib behind the middle third of the clavicle, and the axillary artery - to the proximal end of the humerus from the armpit. Finger pressing of the brachial artery to the humerus is carried out along the inner surface of the biceps brachii. The femoral artery is pressed against the proximal end of the femur under the inguinal ligament.
Finger pressing of the artery allows you to stop the blood loss for the period necessary to stop the bleeding in some way, for example, using a tourniquet. This is the main meaning of finger pressure in the provision of first medical, first aid and first medical aid.
Maximum flexion of the limb. To stop bleeding from the armpit, ulnar region, groin, popliteal fossa and from areas close to them, a ball of cotton wool, rolled clothes are placed on the flexor surface of the joint and the corresponding joint is bent over them to failure, then fixing the arm or leg in bent position with a bandage, scarf or belt. The method has not received wide distribution, however, with its help you can sometimes get out of a difficult situation. It is not applicable in the presence of gunshot fractures of the extremities. The removal and evacuation of the wounded with their limbs bandaged in this position is difficult.
Pressing bandage on the battlefield during the Great Patriotic War, it was used in 27.6% of the wounded with bleeding from arterial or venous vessels of small caliber, as well as with capillary bleeding from wounds. The contents of one or two individual dressing bags are usually used to apply a pressure dressing.
Harness application is the main way to temporarily stop bleeding on the battlefield and in the military area. During the Great Patriotic War, for this purpose, it was used in 65.7% of the wounded.
The tourniquet severely affects the fate of the limb, causing ischemia of the distal limb. The nerves are most severely injured when they are pressed against the bone base, where there are fewer muscles and nerve trunks are located near the bone tissue (the middle third of the shoulder is the radial nerve, the upper quarter of the leg is the peroneal nerve). A tourniquet imposed for a long time (2 hours or more) causes true ischemic gangrene of the limb, therefore, in a non-frosty period after 2 hours, and in a cold period after 1 hour, it is necessary to dissolve (loosen) the tourniquet to temporarily restore blood flow along collaterals in the distal section injured limb and reapply a tourniquet to transport the victim.
In this regard, there is the only indication for the imposition of tourniquets, arterial bleeding with injuries of the extremities. On the battlefield, hemostatic tourniquets are often applied without sufficient reason. M.A. Akhutin, P.A.Kupriyanov, T.I. Emenson et al. (1953) consider this to be inevitable: on the battlefield, under targeted enemy fire, at night or in the cold season, an orderly or sanitary instructor is often guided by indirect signs : blood soaking clothes and shoes, as well as the feelings of the wounded themselves. Nevertheless, the imposition of a tourniquet on the battlefield, even without sufficient reason, poses less danger to the life of the wounded than the refusal to apply it in the presence of bleeding. All military personnel must know the rules for applying the tourniquet and be able to apply it correctly. It is applied when large arteries are injured.
Harness imposition rules. In order not to squeeze the skin and cause necrosis, it must be protected with a soft pad made of a bandage or any other tissue (towel, torn shirt, etc.). The tourniquet can also be applied directly to clothing, after having straightened its folds. A tourniquet should not be applied in the middle third of the shoulder and in the upper third of the lower leg, so as not to injure the radial and peroneal nerves.
Before applying a tourniquet, the limb is raised to create an outflow of venous blood. The tourniquet is applied proximal to the wound, as close to it as possible, without excessive tightening - until the bleeding from the wound stops and the pulse disappears from the peripheral arteries. The pressure of the tourniquet should exceed the arterial pressure at the site of its application by no more than 15-20 mm Hg. Art. The tourniquet should be visible on the wounded. About the time of its imposition, they make a note on thick paper and put it under the tour of the tourniquet or put it in the victim's pocket. In the summer, the duration of the tourniquet on the limb should not exceed 2 hours, and in the winter - 1 hour.
The technique of applying a tourniquet. The person applying the tourniquet is located outside the limb. The tourniquet is placed under the limb above the wound. One hand of the person applying the tourniquet is on the outside, the other on the inside of the limb. The tourniquet is stretched and the stretched section is applied to the area of passage of the main vessel. The first round is done with a cross to prevent it from weakening. All the while pulling the tourniquet, they wrap it around the limb several times so that the tourniquets lie side by side, not on top of each other, and the area of contact of the tourniquet with the skin was as wide as possible.
Tight wound tamponade (WWT). If the pressure bandage is not effective, and the tourniquet cannot be applied due to the anatomical features of the damaged area (deep wounds in the gluteal region, upper third of the thigh), apply a tight wound tamponade with a long sterile napkin.
First medical (on the battlefield) and first aid (BCH)
includes, in essence, all the techniques for temporarily stopping bleeding that are used on the battlefield as a first aid procedure. It is assumed, however, that the qualification of a nursing worker at the BCH will make it possible to temporarily stop bleeding more efficiently, and defects in previously applied dressings and tourniquets will be corrected.
First aid. At the MPP in the dressing room, all the wounded should be monitored previously applied tourniquets to determine whether it was applied according to indications or not.
Technique of control of a previously applied tourniquet. Remove the bandage from the wound. Remove the harness. Examine the wound.
Even large arterial vessels usually do not bleed after the tourniquet is removed. After 2-3 minutes, reactive hyperemia sets in. If arterial bleeding resumes, which is recognized by the scarlet color of blood and a (pulsating) jet that gushes in the form of a fountain, the damaged great vessel is pressed with a finger (such actions as insurance can be carried out before removing the tourniquet) and wait another 2-3 minutes to provide a temporary the flow of arterial blood into the distal parts of the limb through collateral arterial vessels.
If, after removing the tourniquet, arterial bleeding continues, you should:
a) during the tense periods of the MPP operation, with severe bleeding from a large vessel, reapply a tourniquet and, first of all, send the wounded to the medical center for the final stop of the bleeding;
b) pushing the wound apart with hooks, try to put a hemostatic clamp on the artery and bandage the vessel in the wound. In doubtful cases, do not remove the clamp with it; send the wounded to the OmedB;
c) sew the vessel in the wound;
d) in case of persistent bleeding from the depth of the wound, carry out a tight tamponade of the wound with sterile gauze and apply 2-Z deep sutures over the tampon, capturing the skin, subcutaneous tissue and muscles;
e) in the cases shown, tie (sew) the vessel above the place of its damage.
In these cases, an appropriate entry is made in the primary medical card, and the wounded person is first of all sent to the medical hospital.
If, after removing the tourniquet, arterial bleeding from the wound is not detected, the tourniquet was apparently applied without sufficient reason. A pressure bandage should be applied to stop bleeding.
After temporarily stopping bleeding by any of the above methods, an aseptic bandage is applied to the wound, transport immobilization of the limb is carried out (according to indications), and the limb is insulated in winter.
The wounded with tourniquets imposed on the battlefield as soon as possible (no later than 4 hours) should go to that stage (ОМедБ, ОМО) where the final stop of bleeding can be done. Since in practice these periods are much longer (12-24 hours), one should strive to stop bleeding at the MPP.
Methods of the final stopping of bleeding are considered in the 2nd lesson of the II theme "Injuries of large blood vessels of the extremities."
Methods for temporarily stopping external bleeding are used in the provision of first aid at the site of injury. They involve quick delivery of the victim to a medical facility, where the final stop of bleeding will be performed. There are the following methods of temporary hemostasis: -
1) finger pressing 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) the imposition 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 wound tamponade;
7) 
pressing the bleeding vessel in the wound with fingers;
8) the imposition of a hemostatic clamp on a bleeding vessel in a wound when providing first aid in a FAP, a health center, a surgical office of a polyclinic;
9) local application of cold.
Finger pressure of the arteries. Pressing the arteries with fingers at certain anatomical points allows you to immediately stop bleeding and prepare for more reliable hemostasis (Fig. 2.2-2.6).
The point of digital pressure of the temporal artery is located 1 cm anteriorly and above the ear tragus. The external jaw artery is pressed against the lower edge of the lower jaw at the border of its posterior and middle third. The point of digital pressure of the carotid artery is located at the level of the thyroid cartilage along the antero-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. The radial artery is pressed against the radius where the pulse is usually measured. The ulnar artery is pressed against the ulna opposite the radial artery pressure point. The femoral artery is pressed in the groin to the pubic tubercle. The popliteal artery is pressed in the middle of the popliteal fossa against the tibia. The digital pressure point of the posterior tibial artery is located behind the inner ankle. Pressure point rear Noah the artery of the foot 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 through the skin to the bone II-IV with fingers, palm or fist. This method manages 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, the bleeding resumes.
Giving the injured limb an elevated position.
This method helps to empty the veins and reduce blood flow to the wound.
Arterial tourniquet application. Currently, for the purpose of temporary hemostasis in arterial bleeding, a standard Esmarch rubber band is used. If it is absent, you can use a cloth rope in the form of a braid with a twist and other means, but not wire, rope, etc.
A twist rope is a strip of strong fabric 1 m long and 3 cm wide with a twist and a fastener at one end. The twist - a loop of braid with a stick in the middle and cloth rings to fix its ends - is connected to the cord strip by two rectangular buckles located not far from the fastener.
Rules for the imposition of a hemostatic tourniquet (Fig. 2.7).
1. The tourniquet is used only in case of damage to the arteries of the extremities. If the carotid artery is damaged, an impromptu splint or Kramer splint is applied on the opposite side of the neck with an emphasis on the head and shoulder joint (Mikulich's method - Fig. 2.8). If there are no splints, 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 (hand) and the roller.
2.Do not apply tourniquet on a bare wound. The lining should not be wrinkled.
3. The injured limb is given an elevated position and the artery is pressed with the 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 here the radial nerve lies on the bone. From the crushing of this nerve, paralysis of the muscles of the forearm and hand will develop.
5. 
The first round should be tight, the rest - fixing.
6. The tourniquet is applied in a tiled manner, without pinching the skin.
7. The tourniquet should not be crushing.
8.With a correctly applied tourniquet, 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 recorded indicating the date and time of its imposition.
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 avoid frostbite.
13.In the summer, the tourniquet can be kept up to 2 hours, in the 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 with the fingers above the tourniquet;
■ gently loosen the tourniquet for 20-30 minutes to restore blood circulation in the injured limb;
■ re-apply a tourniquet, but above or below the previous location and indicate a new time;
■ 
if necessary, the procedure is repeated after 0.5-1.0 hours. The technique of applying a twist rope (Fig. 2.9). Cloth tourniquet
put on the limb, pass 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 attach the stick in one of the loops.
In a similar way, you can apply an impromptu tourniquet from a trouser belt, scarf, headscarf, etc. From the material at hand, you need to fold a ribbon 3 cm wide, wrap it around the limb, tie the ends and insert a stick into the resulting loop. When the stick 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. There are the following main errors:
1) the imposition 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) absence of date and time stamp of the harness application;
5) masking the tourniquet under clothes or bandages;
6) the application of a tourniquet on the naked body and far from the wound;
7) the imposition of a tourniquet in the middle third of the shoulder;
8) delivery of the victim to a medical facility with a tourniquet without immobilization of the limb and insulation.
Maximum flexion of the limb in the joint. In the absence of a hemostatic tourniquet to stop arterial bleeding, you can apply the method of maximum flexion of the limb in the joint (Fig. 2.10). When bleeding from the arteries of the forearm or hand, maximum flexion of the arm in the elbow joint is effective, followed by fixation in this position. When bleeding from the arteries of the leg and foot, maximum flexion of the leg in the knee joint is performed. With bleeding from the femoral artery - 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 in 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.
Applying a pressure bandage for venous, capillary and minor arterial bleeding. This method gives good results, especially if the limb is given an elevated position (Fig. 2.11). The 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 bandaged tightly. You can place an ice pack and a sandbag weight on top of the bandage.
Tight wound tamponade. In case of bleeding from a deep wound, when it is impossible to apply other methods of hemostasis, a tight wound tamponade is used. With sterile forceps or forceps, a sterile swab is inserted into the wound, filling it tightly. The outer end of the tampon should be visible so that it is not forgotten in the wound. Tight wound tamponade can be completed by applying a pressure bandage with local application of cold and weight.
Tight tamponade is contraindicated for injuries in the popliteal fossa, as compression of the great vessels may occur with the subsequent development of limb gangrene. For mild nosebleeds, an easy way to stop is to press the wing of the nose against the nasal septum with your finger. It is also recommended to insert a piece of cotton wool moistened with 3% hydrogen peroxide solution or petroleum jelly into the nose and press it through the wing of the nose to the septum. In the absence of effect, resort to anterior tamponade of the nasal cavity. An ice pack is placed on the back of the head, which reflexively helps to reduce bleeding.
Pressing the bleeding vessel in the wound with fingers. In emergency situations, often during operations, pressing the bleeding vessel in the wound with fingers is used. In other situations, if the situation permits, 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 forceps 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 maintain the immobility of the applied clamp.
Using the cold. With local exposure to cold, a spasm of the capillaries occurs, which helps to reduce or even stop bleeding. An ice pack is usually used for this purpose. It is not recommended to keep the cold for longer than 15 minutes, as capillary paralysis sets in and bleeding resumes.
Loading ...