Rules for the provision of first aid for arterial bleeding. Correct application of a tourniquet for arterial bleeding

Severe arterial bleeding requires immediate action. The blood from the damaged artery spurts with a jet - and a fatal outcome can occur in a matter of minutes. Correct application of a tourniquet to the injured area will help stop blood loss. After that, you need to urgently call ambulance and take the victim to the hospital.

Blood is a fluid liquid connective tissue, which is responsible for providing nutrition and metabolism in all cells of the body. It consists of the following elements:

plasma - a liquid that contains nutrients, proteins, enzymes, waste products of the body, etc.;
blood cells - erythrocytes, leukocytes, platelets.

Liquid tissue moves through a closed system, which consists of large arteries and veins, as well as smaller arterioles, venules, and capillaries. In less than thirty seconds, the blood has time to make a full circle, give useful elements to the cells, take harmful products and attributed to the authorities that are responsible for their output to the outside.

Arteries carry blood rich in nutrients and oxygen, which gives blood its bright red color. The speed of liquid tissue through these vessels is as fast as possible, since it is set in motion by the heart, pushing it outward with a strong push. Metabolic products move through the veins, which must be removed from the body. Among them is carbon dioxide, which was taken by red blood cells from cells after they transferred oxygen to tissues. Carbon dioxide gives the dark red color to the plasma circulating through the veins. Venous tissue moves much more slowly than arterial tissue.

If vascular rupture occurs, the liquid tissue, together with useful substances leaves the body. Because of this, cells are deprived of nutrition, decay products are retained in them, which in serious cases leads to tissue necrosis. There are two types of bleeding:

internal, when liquid tissue flows into the body cavity, which leads to hematomas and other problems;
external, when plasma, due to damage to the skin, comes out, leaving the body.

If internal bleeding occurred deep in the body, they can only be detected with the help of special equipment. External damage are determined instantly, since the blood leaves the body through the damaged skin, which is visible to the naked eye. In this case, blood loss is accompanied by pain in the affected area. It is customary to allocate the following types external bleeding:

Arterial. It is characterized by a bright scarlet stream of blood, beating with a fountain. This variety is the most dangerous: plasma moves through the arteries to top speed, because of which the blood leaves the body extremely quickly. The person turns pale, the pulse weakens, the pressure drops, dizziness, nausea, and vomiting begin. If blood loss is not stopped in time, death is possible. It should be noted that the arteries are not easy to damage, since they are located deep in the body. The cause of such injuries are serious injuries that put life at risk.
Venous. Cherry-colored blood flows evenly, at the same speed, sometimes it can pulsate a little. If a large vessel is damaged, negative pressure appears, which can provoke the appearance of an air embolism (air bubbles) in the vessels. In case of serious damage, a fatal outcome is also possible, but this requires more time. Since some veins are located along the skin, the likelihood of such damage is much higher than arterial.
Capillary. Least dangerous damage. Capillaries are the smallest vessels in the human body, through which blood transfers nutrients to cells and takes away decay products. Plasma from a damaged vessel oozes slowly, and the body is able to stop blood loss by itself, blocking the site of damage with a thrombus. Capillary bleeding is dangerous only with reduced blood clotting.

Help with arterial bleeding

The loss of blood due to a ruptured artery is so rapid that the victim must be treated within the first two minutes. Otherwise, the person will quickly lose consciousness, fall into a coma and die. It is necessary to immediately squeeze the place of the rupture with your fingers, and even better - with your fist to stop the flow of arterial blood. If the limb is damaged, it must be fixed with a splint or scarf. Then you need to proceed as follows:

Disinfect the damaged area by wiping with alcohol.
Cover the wound with a sterile dressing to prevent infection.
At pain shock to make anesthesia, why give Analgin, Tramadol or another analgesic. In extreme cases, ice will do.
In case of minor damage, a sterile bandage or a tight roller is wrapped around the injured area.
In case of injury to a large vessel, a rubber tourniquet is quickly applied to stop bleeding.
Call an ambulance or take the victim to the hospital as soon as possible.

How to pinch a vessel during arterial bleeding depends on the damaged area. It is necessary to proceed from the following rules:

	Where to press
femoral	To pelvic bones
temporal artery	to the bone between the ear and the eye, or to a cartilaginous protrusion
around the hands and fingers	press on the elbow, shoulder or radial artery
external maxillary artery	To masseter muscle
brachial artery	press in the middle of the shoulder from the inside
subclavian artery in the region of the armpit and shoulder	to the bone in the recess under the collarbone
popliteal	press down with a fist in the center of the popliteal cavity
	to the vertebra

There are several types of tourniquet, each of which has its own characteristics when applied and fixed. Among them, it is worth highlighting the following options:

Esmarch's tourniquet is a thick rubber tube with a chain attached on one side and a hook on the other.
Tape tourniquet - a rubber strip 3-5 cm wide. After the end of the dressing, a knot is tied.
Twist - a strip of durable material 1 m long, 3 cm wide with a loop. To fix the tape, insert a stick into the loop and begin to wrap the tape around the arm. After the end of the dressing, the stick must be fixed with a bandage.

A tourniquet is used to stop the fountain of blood that spurts from an injured artery. Applied only with severe damage to a large vessel, when other measures to stop arterial bleeding were ineffective. This is explained by the fact that the tourniquet not only strongly compresses the vessels, but also the surrounding tissues, which disrupts the supply nutrients to the damaged area.

In case of arterial bleeding, the application of a tourniquet should be done above the damaged area: if the leg is injured - on the thigh, the arm - on the upper third of the shoulder (it cannot be applied in the middle, since the radial nerve can be damaged). In case of severe damage, it may be necessary to apply two rubbers. The tourniquet in the head area should not be tightened too much, as it can provoke suffocation or violation cerebral circulation.

Before proceeding with the application of the tourniquet, it must be borne in mind that the damaged area must be in an elevated position. This means that if the leg is injured, it is lifted and fixed above the level of the body. Next, you need to apply a tourniquet for arterial bleeding according to the following scheme:

Pinch the damaged artery with your finger or fist.
Disinfect the area.
Apply tissue or gauze to the injured area, not reaching the wound, in order to protect damaged tissues from infection and additional trauma that may occur when rubber is applied.
Bring the tourniquet to the injured area, apply 2-5 cm above the wound. If it is missing, a belt, a thick rope, a scarf will do.
Tighten the rubber a little and wrap around the limb 2-3 times. It is necessary to tighten the tape with arterial bleeding tightly so that the bleeding stops, but do not squeeze the tissues strongly. The first turn should be the tightest, the others weaker, while making sure that the skin is not infringed during winding.
After applying the tape, you need to tie the ends, secure with a hook or chain.
Ensure that the patient does not move the injured limb until he is taken to the hospital.
The area on which the bandage is applied should not be completely covered with clothes, so that after the patient is in the hospital, the medical staff immediately finds the wound. However, in the cold season, the victim must be wrapped warmly, especially the injured area.
If the rubber is applied correctly during arterial bleeding, the pulse on the damaged vessel disappears, the area below the ligation site turns pale, and the flow of arterial blood stops.

Features of use

After bandaging, a piece of paper is placed under the tourniquet indicating the time when it was applied. This information is necessary for doctors in order to prevent tissue necrosis, which can develop in the bandaged area due to the lack of nutrient supply to it. The imposition of a tourniquet in the summer and winter time differs, since cold stimulates tissue necrosis. For this reason, the maximum time for applying a tourniquet in summer is two hours, in winter - sixty minutes.

If this time needs to be extended (for example, there is no way to deliver the patient to the hospital on time), the rubber should be loosened for 15-60 seconds so that arterial blood flows to the bled tissues. In this case, press the broken vessel with your finger. Then tie the rubber tight again. If arterial blood begins to ooze, another tourniquet is applied.

After applying the rubber, it is imperative to take the victim to the hospital, where the doctor will stitch and take other measures aimed at healing the vessel. With severe blood loss, a blood transfusion is necessary. If the patient is not provided with a tourniquet after applying a tourniquet medical care cells begin to die. After 8-10 hours, a critical situation occurs when irreversible tissue necrosis begins, which leads to gangrene. In this case, in order to save a human life, it is necessary to amputate the leg or arm much higher than the injury site.

Hard to reach places

With bleeding from the femoral, carotid or muscular artery, the patient can die in two minutes, so you need to act as quickly as possible. The difficulty is also that it is much harder to apply rubber to these areas than to an injured limb. The rules for applying a tourniquet for arterial bleeding, provoked by damage to the neck, are as follows:

The artery is pressed with a fist.
A cotton-gauze pad is applied to the wound.
Fix the neck, head and shoulder with a Cramer splint or other device that is used to immobilize a limb in case of fractures.
If there is no tire, it is necessary to take the victim's hand, put her forearm on the head so that the shoulder begins to act as a counter-stop. In addition, you can use a board, the length of which is 60 cm, the width is 8-10 cm, attaching it to the shoulder and head.
The roller is pressed from the side of the wound, after which a tourniquet is applied in one or two turns.

If the artery is damaged, the patient's thighs are immobilized. The femoral artery is pressed with a fist against the pubic bone under the inguinal ligament. If a person is thin, the vessel can simply be pressed against the thigh. Further, the tourniquet is applied according to the following scheme.

Depending on the type of damaged vessel:
View	What does it look like?	Characteristic
arterial bleeding		The color is bright scarlet. Blood flows out in a pulsating stream, quickly, under pressure. High rate of blood loss.
Venous bleeding		Cherry blood. Constant, uniform flow of blood without pulsations. The rate of bleeding is less than with arterial.
capillary bleeding		It occurs as a result of damage to capillaries, small veins and arteries. The wound surface bleeds. Bleeding is not as severe as with arterial or venous bleeding.
Parenchymal bleeding		Occurs due to injury internal organs such as: liver, spleen, lungs, kidneys. Similar to capillary bleeding, but poses a greater health risk.
Depending on the cause that led to the release of blood from the vascular bed:
1. Haemorrhagia per rhexin		Bleeding as a result mechanical damage vessel walls. The most frequent.
2. Haemorrhagia per diabrosin		Bleeding due to ulceration or destruction of the vascular wall in pathological processes (inflammatory processes, tumor decay, peritonitis, etc.).
3. Haemorrhagiaperdiapedesin		Bleeding as a result of a violation of the permeability of the vascular wall. An increase in wall permeability is more common in the following conditions: a decrease in vitamin C in the body, hemorrhagic vasculitis, scarlet fever, uremia, sepsis, etc.
Towards external environment
external bleeding		Blood flows out of the wound into the external environment.
internal bleeding		Blood is poured into the internal cavities of the body, into the lumen of hollow organs, and tissues. Such bleeding is divided into obvious and hidden. Explicit: blood, even if in an altered form, but after a certain time appears outside Example: stomach bleeding- Vomiting or bloody stools (melena) Hidden: blood is poured into various cavities and is not visible to the eye (into the chest cavity, into the joint cavity, etc.).
By time of occurrence
Primary bleeding		Bleeding occurs immediately at the time of injury when the vessel is damaged.
Secondary bleeding		Allocate: early and late bleeding. Early arising from several hours to 4-5 days after damage. Causes: slippage of the thread from the vessel imposed during the primary operation, washing out of the thrombus from the vessel with an increase in pressure, acceleration of blood flow or a decrease in vessel tone. Late ones occur 4-5 days or more after the injury. This is usually associated with the destruction of the vascular wall as a result of the development of infection in the wound.
With the flow
Acute bleeding		The outflow of blood occurs in a short period of time.
Chronic bleeding		The outflow of blood occurs gradually, in small portions.
By severity
Light		The volume of blood loss is 500-700 ml;
Medium		Loss of 1000-1400 ml;
heavy		Loss of 1.5-2 liters;
Massive blood loss		Loss of more than 2000 ml; A one-time blood loss of about 3-4 liters is regarded as incompatible with life.

General symptoms of bleeding

Classic signs:

The skin is pale, moist;
fast heartbeat (tachycardia);
Decreased blood pressure.

Patient's complaints:

general weakness and malaise, anxiety,
dizziness, especially when lifting the head,
"flies" before the eyes, "darkening" in the eyes,
nausea,
feeling short of breath.

Local symptoms of bleeding
For external bleeding:

direct outflow of blood from a damaged vessel.

For internal bleeding:

Gastrointestinal bleeding: vomiting of blood that is not altered or altered (" coffee grounds); discoloration of feces, black stools (melena).
Pulmonary haemorrhage: hemoptysis or foaming blood from the mouth and nose.
Bleeding from kidneys: scarlet color of urine.
Accumulation of blood in cavities (thoracic, abdominal, joint cavity, etc.). With bleeding into the abdominal cavity, the abdomen is swollen, physical activity digestive tract reduced, possible pain syndrome. With the accumulation of blood in the chest cavity, breathing weakens, motor activity chest reduced. When bleeding into the joint cavity, there is an increase in its volume, severe pain, dysfunction.

First aid for bleeding

Waystemporary stop of bleeding

Pressing the artery
Fixing a limb in a certain position
Elevated position of the limb
pressure bandage
Tamponade of the wound
Clamp on the vessel

A tourniquet for bleeding

Harness rules
A tourniquet is a very reliable way to stop bleeding, however, if used ineptly, it can lead to very severe complications.
Standard tourniquet (Esmarch's tourniquet) - a rubber band 1500 cm long, with special fasteners at the ends. Improvised means (belt, rope, etc.) can be used as a tourniquet. Modern harnesses have the ability to self-tighten.

Harness types:

Harness name	What does it look like?
Bandage tape rubber (langenbeck's tourniquet)
Esmarch's tourniquet
Dosed compression tourniquet
Harness NIISI RKKA
Atraumatic tourniquet "Alpha"

When to apply?

arterial bleeding,
Any massive bleeding in limbs.

The setting of a tourniquet in the axillary and inguinal region and also on the neck

Harness rules:

Before applying the tourniquet, it is necessary to elevate the limb;
It is impossible to apply a tourniquet on a bare limb, it is necessary to substitute a cloth (towel, clothes).
If possible, a tourniquet should be applied as close as possible to the wound, from the side of the blood flow;
When setting the tourniquet, 2-3 tours are performed, evenly stretching the tourniquet, so that the tours do not lie one on top of the other, the tourniquet should press the vessel to the bone protrusion;
In case of bleeding from the wrist area, a tourniquet is applied to the shoulder;
After setting the tourniquet, be sure to indicate the exact time of its setting (hour and minutes);
The part of the body where the tourniquet is placed must be accessible for inspection. This is necessary to observe the changes that can occur in the absence of blood supply;
The victim, to whom a tourniquet has been applied, must be transported to a medical facility and treated there in the first place;
The tourniquet should be removed gradually, gradually loosening it, after performing anesthesia;
The tourniquet should be held for no more than 2 hours on the lower extremities and no more than 1.5 hours on the upper ones, with the condition that every 30-40 minutes the tourniquet will be loosened for 20-30 seconds. In the cold season, the tourniquet holding time is reduced to 40-60 minutes on the lower extremities and 30-40 minutes on the upper ones. Low temperatures impair circulation in tissues, especially in the limbs, this is due to reflex vasoconstriction under the influence of cold. During long-term transportation of the victim, they burn every 30-40 minutes, regardless of the external temperature, should be removed for 20-30 seconds until the skin below the tourniquet turns pink. This can be done for several hours, the time originally recorded in the note should not be changed. This technique avoids irreversible processes in limb tissues. Temporary delivery of blood to tissues will help maintain their viability.
If, after applying the tourniquet, the limb abruptly begins to swell and turn blue, the tourniquet should be immediately removed and reapplied. At the same time, controlling the disappearance of the pulse below the application of the tourniquet.

Method of applying a tourniquet to a limb

The upper third of the shoulder is the place of application of the tourniquet in case of bleeding from the vessels of the upper limb, the tourniquet is applied. In case of bleeding from the vessels of the lower limb, a tourniquet is applied in the middle third of the thigh.
A towel or clothing of the victim should be placed under the tourniquet so as not to pinch the skin and the pressure on the vessels was uniform.
The limb is lifted, a tourniquet is brought under it, stretching it as much as possible. Then wrap around the limb several times. Tours should lie next to each other while not infringing on the skin. The first round is the tightest, the second is applied with less tension, the next with a minimum. The ends of the tourniquet are fixed on top of all tours. The tissues should be compressed until the bleeding stops, no more, no less. It is important to make sure that there is no pulse in the arteries below the applied tourniquet. If the disappearance of the pulse is incomplete, after 10-15 minutes the limb will swell and turn blue.
Apply a sterile dressing to the wound.
Attach a piece of paper with the exact time of applying the tourniquet (hour and minute).
Fix the limb using a transport splint, bandage, scarf or other available means.

The method of applying a tourniquet on the neck
In emergency situations, the application of a tourniquet to the vessels of the neck is vital and can save a life. However, the setting of the tourniquet on the vessels of the neck has some features.
The tourniquet is applied in such a way as to press the vessels only on one side of the neck and not press on the other. To do this, on the opposite side of the bleeding, use Kramer's wire splint or other improvised means, or use the victim's hand wound behind the head. This keeps blood flow to and from the brain.

Setting technique: a tissue roller is applied to the bleeding wound (a sterile bandage is better, if not, improvised means can be used). The roller is pressed with a tourniquet, then wrapped around the arm or the tire. Pulse stop monitoring is not required. You can keep the tourniquet around your neck for as long as you need.

Criteria for a correctly applied tourniquet:

Bleeding from the damaged vessel has stopped;
The pulse on the limb below the tourniquet is not palpable;
The limb is pale and cold.

Errors when applying a tourniquet:

Do not apply a tourniquet to the upper third of the thigh and the middle third of the shoulder, this can lead to serious damage nerve trunks and be ineffective in stopping bleeding.
The wrong type of bleeding is determined, and setting a tourniquet only increases it (for example: venous bleeding);
The tourniquet is not tightened enough or large vessels are not pressed against the bone protrusions;
Excessive tightening of the tourniquet can cause severe damage to soft tissues (muscles, blood vessels, nerves), which can lead to paralysis of the limb.
Exceeding the time limit for applying a tourniquet can subsequently lead to the loss of a limb;
Putting a tourniquet on a bare leg. There is no sufficient pressing of the vessels, the skin under the tourniquet is injured.
Apply a tourniquet away from the wound. However, with an unspecified source of bleeding in emergency, applying a tourniquet as high as possible from the wound is vital necessary action. Since bleeding from the femoral artery within 2-3 minutes leads to death, therefore there is no time for long discussions and the application of a tourniquet at the base of the leg, just below the inguinal ligament, will be the best option.

Finger artery pressure

A simple method that does not require aids. Advantage - the ability to perform as quickly as possible. The disadvantage is that it is applied for a short time, within 10-15 minutes. The method is especially important in emergency situations, when it gives time to prepare for another method of stopping bleeding (application of a tourniquet). Arteries are pressed at certain points. At these points, the arteries lie most superficially and can be easily pressed against bone structures.

Indications:

arterial bleeding

The main pressure points of the arteries

Pressing the temporal artery, 2 cm up and anterior to ear canal.
Pressing of the maxillary artery, 2 cm anterior to the angle of the mandible.
Pressing the carotid artery, the middle of the edge of the sternocleidomastoid muscle (upper edge of the thyroid cartilage).
Pressing the brachial artery, the inner edge of the biceps.
pressing axillary artery, anterior border of hair growth in armpit.
Compression of the femoral artery, middle of the inguinal ligament.
Pressing the popliteal artery, the top of the popliteal fossa.
Pressing the abdominal aorta, the umbilical region (pressing is done with a fist).

Fixation of a limb in a certain position

This method stop bleeding will be used when transporting the victim to the hospital. Reception is more effective if a gauze or cotton roll is placed in the flexion area. Indications are generally the same as when applying a tourniquet. The method is less reliable, but also less traumatic.

When bleeding from subclavian artery, bent arms at the elbows are retracted as much as possible and tightly fixed at the level of the elbow joints (Fig. b).
In case of bleeding from the popliteal artery, the leg is fixed with maximum flexion in the knee joint (Figure E).
When bleeding from the femoral artery, the thigh is brought to the abdomen as much as possible (Fig. e).
When bleeding from the brachial artery, the arm is bent as much as possible in elbow joint(Figure D).

Elevated position of the limb

The method is simple, but quite effective in case of venous or capillary bleeding. When a limb is raised, the flow to the vessels decreases, the pressure in them decreases, which creates favorable conditions for the formation of a blood clot and stop bleeding. The method is especially effective for bleeding from the lower extremities.

pressure bandage

Necessary materials: bandage and dressing material.
Indications:

Moderate venous or capillary bleeding
Bleeding from varicose veins of the lower extremities

Technics:
Several sterile napkins are applied to the wound, sometimes a special roller is applied on top, then bandaged tightly. Before applying the bandage, give the limb an elevated position. The bandage is applied from the periphery to the center.

Tamponade of the wound

Indications:

capillary and venous bleeding small vessels in the presence of a wound cavity.
Often used in surgeries.

Technics:
The wound cavity is filled tightly with a swab, which is left for a while. The method allows you to buy time and prepare for a more adequate method of stopping bleeding.

Circular tug of limb

For twisting, use a special tourniquet or rubber tube, belt, piece of cloth, scarf. The object used for twisting is loosely tied at the desired level. A plank, stick, etc. is inserted into the formed loop. Then, by rotating the inserted object, the loop is twisted until the bleeding stops completely. After that, a plank or stick is fixed to the limb. The procedure is painful, so it is better to put something under the spin knot. When twisting the dangers, the procedures and complications are similar to those when applying a tourniquet.

Clamping on a vessel

The method is indicated to stop bleeding during surgery. The Billroth clamp is used as a hemostatic forceps. Vessel clamp is used briefly to prepare for the final method of stopping bleeding, more often ligation of the vessel.

How to stop arterial, venous bleeding?

Step by step guide to bleeding

Take self-protection measures for people who care for a bleeding victim. It is necessary to wear rubber gloves, avoid getting blood on the mucous membranes and skin, especially if they are damaged. This is the prevention of various infectious diseases (viral hepatitis, HIV, etc.).
If the bleeding is massive, be sure to call an ambulance or take the victim to a medical facility on your own, after temporarily stopping the bleeding.
Stop bleeding using the methods listed above, depending on the type and location of the bleeding.
To prevent the development of acute anemia and to carry out the first medical measures when it occurs:

For this, the following is required. Give the victim a horizontal position. In case of massive blood loss, fainting of the victim should be laid so that the head is lower than the body. Raise the upper and lower limbs, thereby increasing the flow to vital organs (brain, lungs, kidneys, etc.). With preserved consciousness and no damage to organs abdominal cavity you can give the victim tea, mineral or ordinary water to drink, help replenish the loss of fluid from the body.

capillary bleeding

Plain bandage on the wound easily stops bleeding. It is enough just to raise the injured limb above the torso and the bleeding decreases. At the same time, blood flow to the wound decreases, pressure in the vessels decreases, which contributes to the rapid formation of a blood clot, closure of the vessel and cessation of bleeding.

Venous bleeding

To stop bleeding you need: pressure bandage. Apply several layers of gauze over the wound, a dense ball of cotton wool and tightly bandage. This leads to the fact that under the bandage in the vessels, the blood turns into blood clots, which reliably stop the bleeding. Of particular danger are bleeding from large veins of the neck and chest, in which negative pressure is normal. And if they are damaged, air can enter them, which can subsequently cause blockage of the vital vessels of the lungs, heart, brain and lead to death. Therefore, in case of bleeding from large venous vessels, a tight hermetic bandage should be applied. And if the bandage is completely saturated with blood, it should not be removed, another clean one should be applied over it.

arterial bleeding

If the bleeding is small, it is possible to stop it with a pressure bandage. When bleeding from a large artery, to immediately stop bleeding, apply finger pressure vessel in the wound for the period of tourniquet preparation. Bleeding is stopped by applying a clamp to the bleeding vessel and a tight tamponade of the wound is carried out with a sterile napkin. The clamp can only be used by a surgeon or an experienced paramedic. Also, for an emergency stop of bleeding, pressure is applied to the artery throughout. The arteries are pressed against the underlying bone formations. Stopping bleeding with finger pressure is only done as a short-term measure.

For a person providing assistance, this method requires great physical strength and patience. However, the method helps to gain time for setting up a more reliable method - tourniquet. The artery is usually pressed with the thumb, palm, fist. The femoral and brachial arteries are most easily pressed.

And so, the methods used to temporarily stop arterial bleeding are as follows:

1) finger pressing of the vessel in the wound;
2) pressing the artery throughout;
3) tight tamponade;
4) application of a tourniquet;
5) circular tug-of-war
6) hemostatic clamp.

How to stop bleeding from the femoral artery?

Simple steps that will save lives when bleeding from the femoral artery:

Signs of bleeding from the femoral artery: bleeding from a wound on the leg, in which a pool of blood increases to 1 m in a matter of seconds.
Immediately press the arteries below the inguinal ligament with a fist, then press with a hard object (for example: a roll of a bandage), through which a tourniquet is applied to the thigh. Attach a note with the time of setting the bandage. Do not remove the tourniquet before the arrival of medical workers, even if their arrival is delayed.
Bleeding from the femoral artery for more than 2-3 minutes leads to death.

How long is a tourniquet applied for arterial bleeding? This issue is considered even at school when studying the provision of first aid. But over time, this knowledge “leaves”. But with a similar situation, when you urgently need to apply a tourniquet to stop the bleeding, everyone can push. An accident or domestic injury - all this can end in failure if the bleeding is not stopped. Therefore, refreshing this knowledge is simply necessary.

How to determine the type of bleeding?

Almost every injury causes bleeding. This is due to vascular damage. In any case, the blood must be stopped, otherwise the body may be seriously damaged.

There are three types of bleeding:

Capillary.
Venous.
Arterial.

The first type is not particularly dangerous. In order to protect human health, it is enough just to treat the wound with an antiseptic. A completely different matter is venous and arterial bleeding. The second option is especially dangerous. There is a high probability of significant for the body (incompatible with life) blood loss. Therefore, assistance must be timely and effective.

How can you distinguish between arterial and venous bleeding? After all, the way of rendering assistance depends on the type of damaged vessels.

To accept the right decision, doctors recommend paying attention to the following factors:

arterial blood has a brighter scarlet color than from veins or capillaries;
attention must be paid to the character with which the blood comes to the surface. The artery is directly connected to the heart. Therefore, the blood from it will pulsate.

When bleeding from an artery, urgent measures should be taken immediately. Otherwise, irreparable harm may be done to the body.

How to stop the bleeding will be discussed in the next chapter.

First aid

Applying a tourniquet for arterial bleeding takes some time. But even a slight delay can lead to serious consequences. Therefore, while the tourniquet is applied, you need to block the artery with a fist or finger. How to choose the place of "application of force"? Where should you press?

Here, as well as when choosing the place for applying the tourniquet, you should use the following recommendations from doctors:

if the carotid artery is damaged, then efforts must be applied to the transverse processes of the cervical vertebrae;

when bleeding from the submandibular artery, it should be clamped just below the jaw joint;
if the femoral artery was damaged, then the pinch point is in the groin, on the frontal bone.

There are other points, each of which corresponds to a specific injury. But it is impossible to hold the artery with a finger or palm for a long time. Therefore, each person should know the rules for applying a tourniquet. In this case, he will be able to help in emergency situations.

We use a tourniquet

Stopping arterial bleeding is an important task. If this is not done in time, then there may be serious complications. As a rule, such an operation is carried out with a tourniquet. There are several types of them. The tourniquet is superimposed from both woven material and tape, and the so-called Esmarch tourniquet. The last option is used by doctors.

But if there is no such “device” at hand, then you can pull the artery with the help of improvised means. Often a belt or belt is used for this. The main thing is to know how to apply a tourniquet for arterial bleeding.

Here you should use the following recommendations:

Regardless of the material used, the procedure and technique for applying the tourniquet should be the same. The main thing is to do everything quickly, but carefully and carefully.
The procedure for applying a hemostatic tourniquet is performed above the wound. As a rule, an indent of 1.5-2 centimeters is made.
Apply a tourniquet for arterial bleeding on a tissue or other soft material. At the same time, it must be carefully smoothed out. Any fold can harm the skin.
How to properly apply a tourniquet? The first round is very tight. Further, efforts are reduced so as not to harm the limb.
A tourniquet for arterial bleeding is done mainly when a vessel is damaged on the legs or arms. If the wound is on the neck (carotid artery), then a stopping tourniquet is applied to the tire or to the arm raised up. They are placed on the head, and with healthy side, and only after that tighten.

The most important thing is to know how long a tourniquet is applied for arterial bleeding. If you hold such a “clamp” for longer, then the limb or tissue area may atrophy.

In the warm season, the tourniquet can be kept for about an hour. If the temperature outside is below zero, then this time is halved, to half an hour. After the tourniquet is applied, the exact time of this operation is recorded on paper and attached to something on the injured limb. So the paramedics will be able to remove it in time.

Indications:

? arterial bleeding from main vessels upper and lower limbs, common carotid artery ( tourniquet);
? bleeding from large saphenous veins when they are injured or ruptured varicose veins (venous tourniquet) - fig. 4.10. For arterial bleeding, an elastic tourniquet is used.

Esmarch, tourniquet "Alpha" and improvised means (cloth tourniquet-twist or belt).

Esmarch's tourniquet is an elastic rubber band up to 1.5 m long, at one end of which there are plastic buttons, and at the other - according to their hole sizes (Fig. 4.11a).

Rice. 4.10.

Rice. 4.11.

The "Alpha" tourniquet is an elastic corrugated rubber band with a clasp in the form of a rubber loop (Fig. 4.116).

Rules for applying Esmarch's tourniquet for arterial bleeding:

? bleeding is temporarily stopped by finger pressure of the vessel throughout;
? over the wound at the site of the tourniquet, a pad of clothing or soft fabric (scarf, bandage, napkin) is applied without the formation of folds on it;
? for outflow venous blood the limb is raised by 20-30 cm;
? the tourniquet is grasped with the right hand at one of its edges, with the left - 30-40 cm distally;
? the tourniquet is stretched as much as possible by the hands (Fig. 4.12) and as close as possible to the wound, starting from the back surface of the limb, the first circular tour is applied so that the initial segment of the tourniquet overlaps with the next tour (lock); the criterion for the effectiveness of the imposition of the first round of the tourniquet is the cessation of bleeding from the wound and the disappearance of the pulse;

Rice. 4.12. Tourniquet application steps [B]

? after the first round is applied, in order to prevent excessive compression of the soft tissue tourniquet, it must be slightly loosened until capillary bleeding appears, and then tightened again until it stops;
? the second and third rounds of the tourniquet are applied when it is stretched;
? subsequent rounds are applied without stretching the tourniquet in a spiral so as to half close each previous round (soft tissues are not infringed), after which the buttons are fixed;
? impose an aseptic bandage on the wound;
? a limb with a tourniquet is immobilized using a transport tire or improvised means; the tourniquet is not bandaged, it should be clearly visible;
? a note is attached to the tourniquet or clothing of the victim indicating the date and time (hours and minutes) of the application of the tourniquet, or similar information is noted on the forearm (Fig. 4.13);

Rice. 4.13.

? the victim with a tourniquet is immediately evacuated to medical institution for final hemostasis; pre-administered analgesics;
? the patient is transported lying down with the head end down, accompanied by medical personnel;
? in the cold season, a limb with a tourniquet is covered so that frostbite does not occur;
? when transporting a patient with a tourniquet for more than 2 hours in summer and 1-1.5 hours in winter, it is necessary to change the place of application of the tourniquet. To do this, above the tourniquet, you should finger press the main artery throughout, remove the tourniquet and after 10-20 minutes (until the hands pressing the artery get tired) apply it to a new place slightly higher or lower than the previous one, but as close as possible to the wound. If necessary, the removal of the tourniquet is repeated, in winter - after 30 minutes, in summer - after 50-60 minutes.

Features of the technique of applying the tourniquet "Alpha" for arterial bleeding:

? impose a corrugated surface outwards, like Esmarch's tourniquet;
? after the imposition of all tours of the tourniquet, the fastener loop wraps around it, is pulled back and wound up under the free end of the tourniquet;
? a note is inserted under the elastic band of the loop indicating the time the tourniquet was applied.

Given the location of the artery and nerve trunks in relation to the adjacent bone, the tourniquet is applied in certain places (Table 4.1).

Typical places for applying a tourniquet for arterial bleeding

Table 4.1

In the middle and lower third of the shoulder, the tourniquet is not applied because of the risk of damage to the radial nerve with the subsequent development of paresis or paralysis of the arm (Fig. 4.14). A tourniquet is applied to the axillary fossa and the base of the lower limb (Fig. 4.15) in the form of a figure-eight with squeezing of the bleeding vessel through the pelota.

Rice. 4.14.

Rice. 4.15.

Stopping bleeding from the vessels of the neck (Fig. 4.16.):

? a cotton-gauze roller (pelot) is applied to the site of damage to the carotid artery;
? through a cotton-gauze roller, the carotid artery is squeezed with a stretched tourniquet;
? the tourniquet is fixed on the opposite side on a hand thrown over the head or a ladder splint, a wooden plank, which prevents squeezing of the trachea (asphyxia) and an intact carotid artery.

Rice. 4.1

The use of a cloth tourniquet and a belt (improvised means) for arterial bleeding:

? from improvised means as a cloth bundle, you can use a scarf, towel, tie, sheet, handkerchief;
? a cloth tourniquet or belt is applied to clothing or a pad;
? a cloth tourniquet is tied around the limb above the damage (Fig. 4.17a);
? a stick is passed under the loop, with which a home-made tourniquet is twisted until the bleeding stops (squeezing of the vessel occurs gradually - Fig. 4.176);
? after stopping the bleeding, the twist is fixed to the bandage (Fig. 4.17c).

When using a belt, the end of it is threaded into the buckle so that it is inside the formed ring; then this end is again brought out through the buckle from the inside to the outside, as a result of which a double ring is formed, which is put on the limb; strongly pulling the end of the belt, tighten both loops (Fig. 4.18).

Rice. 4.17.

ATTENTION!

As a tourniquet, it is forbidden to use the material of rigid thin structures (wire, cord), since when squeezed, they cause deep tissue damage.

Possible complications of applying a tourniquet for arterial bleeding:

? gangrene of the limb when squeezing it with a tourniquet for more than two hours;
? paralysis and paresis, especially on the upper limb, due to excessive compression of the nerve trunks;
? development of thromboembolism when a tourniquet is applied to a limb with thrombophlebitis, both superficial and deep veins;

Rice. 4.18.

? generalization of infection when a tourniquet is applied to a limb with symptoms inflammatory process v lymphatic vessels(lymphangitis), soft tissues or bones, therefore, during operations on the affected limb, including amputation, in the patients indicated in the previous three positions, the tourniquet is not applied;
? creation of favorable conditions (tissue ischemia) for the development of anaerobic infection ( gas gangrene, tetanus) in wounds;
? increased bleeding with a weak tourniquet tension (due to the formation of venous stasis).

Features of imposing a venous tourniquet:

? the limb is raised for 10-15 minutes;
? finger pressing of the bleeding vessel in the wound or below the wound;
? applying a tourniquet with a force that causes compression of only superficial veins;
? tourniquet application time - up to 6 hours.

Fixation of the limb in the position of maximum flexion (hemostatic position of the limb) - table. 4.2.

Hemostatic position of the limb depending on the location of bleeding

Table 4.2

Flexion of the limb in the joint should be carried out to failure using a pellot and reliable fixation of the bent segment of the limb, which ensures compression of the main arterial trunk (Fig. 4.19). The technique of giving the limb a hemostatic position is shown in fig. 4.20-4.22.

Epistaxis - discharge of non-foaming blood from the nostrils or its flow down back wall throats. In 90-95%, the source of epistaxis is the anteroinferior section of the nasal septum, in other cases, it develops in the middle and posterior sections of the nasal cavity. Nosebleeds can be caused either by a sharp increase in blood pressure (then you should immediately take measures to reduce it), or by a pathology in the nasal cavity (most often, increased permeability of the walls blood vessels at the expense

Rice. 4.19.

Rice. 4.20.

Rice. 4.21.

popliteal artery to stop bleeding from the lower leg and foot

Rice. 4.22. Maximum flexion of the hip with pressure on the femoral artery with a pad to stop bleeding from it, acute or chronic inflammation), as well as traumatic injuries nose hypovitaminosis with a lack of vitamin C; heat due to its drying effect on the nasal mucosa, due to heat or sunstroke.

At hypertension the appearance of blood from the nose is a kind of compensatory process that prevents overload of the cerebral vessels, and is characterized by its duration. Profuse bleeding from the nose at high blood pressure can lead to its rapid fall, which can provoke acute heart failure (collapse).

Another cause of frequent spontaneous nosebleeds is atrophic rhinitis. With this disease, the nasal mucosa becomes thin and dry. This contributes to the violation of the integrity of blood vessels at the slightest touch.

Nosebleeds with heat or sunstroke are accompanied by headache, dizziness, nausea, fainting.

Classification of nosebleeds

1. According to the predominant discharge of blood from the anterior or posterior sections of the nasal cavity, nosebleeds are divided into anterior and posterior.
2. According to the nature of the damaged vessel, nosebleeds can be capillary, arterial and venous.
3. Basically causal factor allocate primary (due to local reasons) and secondary (at common diseases) nosebleeds.

First aid for nosebleeds:

? reassure the patient, since with excitement there is a rapid heartbeat, and this, in turn, increases nose bleed;
? unbutton the collar, loosen the tight parts of the clothing, ensure the flow fresh air(for example, open a window), make him breathe deeply, inhaling through his nose and exhaling through his mouth. Breathing through the nose helps to increase blood clotting and stop bleeding;
? seat the patient on a chair or on the floor, slightly tilt his head forward;
? do not tilt your head back. This makes it difficult for blood to flow through the veins of the neck, as a result of which nosebleeds can increase. In addition, in this position of the head, a false impression is created of reducing bleeding. In fact, blood usually flows into the pharynx, then enters the lower Airways, and if swallowed, hematemesis may occur;
? place a container in front of the face to collect blood flowing from the nose and spitting blood flowing into the throat;
? it is necessary to blow your nose to remove blood clots, the presence of which prevents the nasal mucosa from contracting;
? put cold on the bridge of the nose for 30 minutes (an ice pack or ice wrapped in a dense cloth, or a napkin moistened cold water), to the feet of a heating pad;
? if the application of cold is ineffective, drip vasoconstrictors into the nasal cavity: galazolin, naphthyzin, otrivin or press the wing of the nose against the nasal septum;
? if these measures do not help, then a ball of sterile cotton wool or gauze moistened with a 3% hydrogen peroxide solution should be inserted into the anterior part of the nasal cavity and held for 10-15 minutes, pressing it through the wing of the nose to the septum.

When measures are ineffective first aid and continued bleeding, an ambulance should be called.

Correct application of a tourniquet for arterial bleeding will save the life of a person who has received serious injury. It will be useful for each person to know how to properly apply a tourniquet.

Arterial bleeding is one of the most dangerous species bleeding. Blood from the damaged artery flows in a fountain or strong stream, pulsing in the rhythm of the beating of the heart muscle. The blood flowing through the arteries is bright red. Arterial bleeding is extremely dangerous, so if the blood is not stopped quickly, the person will die. Arterial bleeding can cause complications and limb amputation if first aid is not provided correctly or too late.

Emergency help

With this type of bleeding, first aid should be provided quickly. It is important to remember that due to blood pressure, an injured person can lose consciousness or even fall into a coma.

There is no way to waste time, the people around the injured person have a couple of minutes to apply a tourniquet to the wound and begin to provide first aid. First of all, with the help of the fingers, try to close the place of the rupture of the artery, thereby temporarily stopping the fountain of blood. Experts recommend considering the following rules for each separate species arteries:

1. If the carotid artery is damaged, it is pressed against the transverse vertebral processes on the neck.
2. If the jaw artery is damaged, then it must be pressed against the jaw muscle.
3. The artery of the temporal region should be pressed slightly, in front of the edge auricle above.
4. Subclavian arterial blood loss is stopped by the pressing action of the fist on the outer edges of the clavicle from the back side towards the rib.
5. The brachial artery should be pressed against inside bone muscles.
6. The artery on the thigh must be pressed against the pubic bone.
7. Artery under knee joint should be pressed against the middle of the kneecap.

It is clear that remembering these rules is not so easy. In the event of an unforeseen emergency, few people will be able to apply them in practice. But even if you just read the rules, then there is already a high probability that they will pop up in your memory when a person in trouble needs help.

After pressing the artery, it is necessary to apply a rubber tourniquet. A medical tourniquet made of rubber can be replaced with a belt, rope, rag weave. To prevent infection from getting into the injured place, a sterile bandage should be applied to the wound. If there is no fracture of the limb, then fixation of the artery can be done by bending the injured arm or leg. The limb must be bent, in this state, bandaged with a bandage or other clean suitable material.

Action algorithm

It is important to work together when providing first aid. While one person is applying a tourniquet, the second should prepare cotton, gauze, bandage, clean synthetic fabric, roller. A tourniquet is applied only when the lower or upper limbs. When the wound is on the carotid artery, with reverse side neck should be splinted. If there is no tire, then you can put the hand of the injured person. Thanks to the tire or the hand of the victim, the carotid artery should be transferred directly to the site of injury.

Next, a roller must be applied to the place below the injury, and a tourniquet must be applied through the splint or arm. Do not apply a tourniquet to a bare wound. Be sure to put a gasket under the harness. It should not have a crease, should be soft, not synthetic, cotton is best.

The injured limb should be elevated. The tourniquet should be twisted as close as possible to the injured area. It is superimposed above the wound. If it is a hand, then it is necessary to impose in the shoulder area. In no case should a tourniquet be applied in the middle of the shoulder, since the radial nerve passes there.

If bleeding of the lower limb occurs, then it is better to apply the tourniquet on the upper third of the thigh. The very first turn of the tourniquet should be tightening, all the rest are done exclusively for fixation. It is impossible to prevent pinching of the skin. In order to choose what the tension of the tourniquet should be, it is necessary to feel the pulse below the wound, if it is absent, the tension is normal.

When the tourniquet has been properly applied, the affected person should receive pain medication. It can be analgin or other strong medicine. In the event that the artery is severely damaged, the person must be immobilized. The tourniquet should not be hidden under clothing, it should be visible. If a person was injured in autumn or winter, then the injury site must be insulated to avoid frostbite of the limb.

It is important to remember that in the cold season, the tourniquet can be on the limb for no more than half an hour. If it is warm outside, then the tourniquet should be removed no later than an hour later. A note can be inserted into the tourniquet, on which the time the tourniquet will be applied will be written. If the victim does not have time to be delivered to the hospital, and it is already dangerous to hold the tourniquet, then the following actions should be taken:

1. It is necessary to press the artery in the area above the applied tourniquet.
2. The tourniquet must be loosened for half an hour. This will restore blood circulation.
3. As soon as 30 minutes have passed, the tourniquet must be applied again, but the place should be slightly higher or lower than the previous one.

The procedure is repeated again, if necessary, the main thing is to perform all actions according to the rules. It is important to deliver the victim to the hospital as quickly as possible, not to miss time.

If blood loss occurs - what to do?

After the tourniquet is applied, the injured person must be transported as quickly as possible to the nearest medical facility. Only a professional team of doctors will be able to provide the injured person with qualified medical care. If the doctor's help is not provided within a maximum of 10 hours after the tourniquet is applied, then this can cause catastrophic consequences. Up to death.

Tragic consequences can be the most terrible, for example, tissue may die, which will lead to amputation of a limb. As a result of gangrene, the limb is removed slightly above the place it touched. If the victim has lost a lot of blood, then he must be given a blood transfusion and other medical measures to provide emergency medical care.

In addition to bleeding from an artery, there are cases of blood loss from a vein. Blood in this case flows out in a stream, has the color of ripe cherries.

It is important to know that if blood is lost from a vein, the bandage must be applied a few centimeters below the injury area.

Any bleeding poses a danger to human life, so the people around the victim must react quickly in an extraordinary situation for them. The main thing is not to panic, but responsibly perform the tourniquet in accordance with the rules.