Bleeding. Blood loss. Bleeding compensation in eliminating the consequences of emergencies.

1. Bleeding. Blood loss. Bleeding compensation in
eliminating the consequences of emergencies.

2. Bleeding

3. During the Second World War on the battlefield were dying
up to 50% of the wounded from bleeding;
36.6% of them dying from limb vessels’ damage.

4. The arteries of the
lower limbs
– 61 %
The arteries of upper
limbs
– 31 %
The frequency of vascular injury during
conducting military operations.

5. Causes of bleeding
Open
Closed
1. Mechanical damage
of the vascular wall.
2. Pathological
condition
of the vascular wall.
3. Disorders of blood
coagulation system
(coagulopathy)
The gradual destruction
arrosive bleeding
Violation of permeability
diapedetic bleeding
hemophilia
thrombocytopenia
Disseminated intravascular
coagulopathy (DIC)
Atherosclerosis
Tumor.
Inflammation.
Necrosis.
Beriberi.
Intoxication.
septicemia
aneurysm

6. Mechanical damages of the vascular wall
Contusion
Повреждение
только
адвентиции
Regional
injury
Damage by
half diameter
Almost
complete
break
Exit
Wounds
complete
break
Compression of
bone fragments or
foreign bodies

7. Compression of the
brachial artery as a
result of dislocation of
the forearm.
Compression of the popliteal
artery by hematoma (tibia
fracture).
Mechanical damages of the vascular wall
hips fracture with
damage of the femoral
artery.
Regional injury of the
femoral artery
Humerus’ fracture with
compression of the
brachial artery.

8. Bleeding
InternalExternal
Hematoma
(intra-muscular,
interfascial,
subcutaneous ...)
haemoperitoneum
haemothorax
hemopericardium
hemarthrosis
intracranial
hematoma

9. Bleeding
deferred
bleeding
First time
bleeding
Earlier
(1-3 days
after injury)
Later
(3-10 days or more
from the injury time)
(immediately
after injury)
1.Thrombus’ eject out from the
vessel by the bloodstream.
2. Vessel’s damage
(lack of immobilization,
coarse manipulation)
3. Ligatures slipping.
1. Necrosis of the vessel wall
2. purulent fusion of the thrombus
or the vessel wall
3. aneurysm rupture.
4. ligaturesSlipping
5. Infringement blood clotting system

10. Bleeding
Venous
Arterial
Mixed
Capillary
Classification of
bleeding in case
of emergency
Medical
classification
small amount
of blood
Fountain of
blood
A lot of blood

11. Damages’ symptoms of great vessels of
limb
No or weakening of the pulse in the distal parts of limb
Pale skin
Lowering the skin temperature
Lowering the sensitivity
ischemic pain
Contractures (muscles rigidity)

12. 1. Stop the bleeding
Первая
Доврачебная
Первая врачебная
Квалифицированная
Специализированная
Temporarily
stopping of
external
bleeding
The final stop of
all kinds of
bleeding
prehospital
period
hospital
period
Виды медицинской
помощи

13. 1.1. Temporarily stopping of
external bleeding
Compression of the
vessel in the
wound
Stop by the
position
Pressing the vessel
proximally
Thermal
1.2. Final bleeding’s stopping
Biological
Chemical
Thermal
Mechanical
Temporary artery
bypass grafting

14. 1.1. Temporarily stopping
of external bleeding
A. Compression
of blood vessels
in the wound
Compressive
bandage
tamponing
Vessels’ clipping in
the wound
Москит Бильрот Кохер
Temporary
ligation the
vessel

15. Anterior nasal
packing
(including -
predoctor care)
Postnasal
packing
Stop nasalbleedings

16. 1.1. Temporarily
stopping of external
bleeding
B. Stop by the
position
Elevated limbs
position
Immobilisaition

17. 1.1. Temporarily
stopping of external
bleeding
C. Pressing the
vessel proximally
By the finger
By the roller with a
maximum limbs
bending
By the tourniquet

18. 1.1. Temporarily
stopping of external
bleeding
C. Pressing the
vessel proximally
By the finger
By the tourniquet
By the roller with a
maximum limbs
bending
An improvised
tourniquet (twisting)
Medical tourniquet
1
3
2

19. Regulations concerning tourniquet
1. Lift the limb before
applying
2. Put on the clothes
or on the gasket.
3. Proximally the
location of bleeding
4. As close as possible
to the wound.
6. Tighten until the bleeding
stops or the
disappearance of the
pulse.
5. Each subsequent round
covers the
previous for the half of width.
7. Clearly
visible
8. Reliably
fixed
9.Indicate the
date and time.
10.
anesth
etize
12. In the cold - wrap the
limb.
11. Immobilize
13. The maximum period of time
- 2 hours in warm weather,
and 1 hour in cold weather
PREPARATION
CHOOSING A SITE FOR
TOURNIQUET
TECHNIQUE OF
OVERLAY
CARE AND
CONTROL 14. Each subsequent
tourniquet - half time of the
previous.

20. Tourniquet’s Re-imposition
Each subsequent
tourniquet - half time
of the previous.
Revision of tourniquet.
Finger pressing the artery proximal to the tourniquet
Loosen tourniquet
Wait until the blood filling the capillaries starts
under the nail plate
Overlay tourniquet from 4-5 cm proximal to the
previous level.
Remove the bandage
Finger pressing the artery proximal to the tourniqu
Loosen tourniquet
Loosen finger pressing and examining the
wound at the same time.
Trying to
temporarily stop the
bleeding without a
tourniquet.
Bleeding resumed Bleeding is not
resumed
Protective
bandage, and
the imposition
of a provisional
tourniquet.
(do not remove the bandage!)
Anywhere treatment room

21. Cloth tourniquet
➢ After removing the tourniquet the bleeding has stopped, but
the source of bleeding is not defined.
➢ Bleeding is stopped by a clipping or temporary ligatures.
Накладывание импровизированного
провизорного жгута Затягивание жгута

22. EVERYDAY LIFE:
Many people help to one victim
EMERGENCY
SITUATION:
one person is helping to
a large number of
victims.
Why tourniquet is
especially dangerous
in emergency
situations?

23. 1.1. Temporarily
stopping of external
bleeding
D. Thermal Local
hypothermia
E. Temporary
bypass
grafting (drop
counter tube)

24. 1.2. The final stop
of all kinds of bleeding
А. Mechanical
ligation of the
vessel in the
wound
Ligation of the
vessel proximal to
the wound
Angiorrhaphy
Plastic or
prosthesis of the
vessel
Elevated position
Tamponade of the wound
Сompressive bandage

25. 1.2. The final stop
of all kinds of bleeding
B. Thermal
Local
hypothermia
Applications
of hot
solutions
Electrocoagulation

26. 1.2. The final stop
of all kinds of bleeding
C. Chemical
D. Biological
Medicamentous
effects on the blood
coagulation system
Local impacts
Tamponade by own
tissues or biological
graft.

27. Prehospital period Hospital period
Compressive bandage
Tamponing the wound
Clip on a vessel in the
wound
Postnasal packing
Limbs elevated position
Finger pressing
Maximum bending of limbs
Сloth tourniquet
Standard tourniquet
Local hypothermia
Temporary
bypass grafting
Ligation of the vessel in a wound
Ligation of the vessel more proximally
Angiorrhaphy
Repair of the
vessel or the
vessel prosthesis
Electrocoagulation
Intervention on the blood coagulation system by medicines
Tamponade by own tissues
or biological graft
ПЕРВАЯ
ВРАЧЕБНАЯ
ПОМОЩЬ
КВАЛИФИЦИ-
РОВАННАЯ
ПОМОЩЬ
СПЕЦИАЛИЗИ-
РОВАННАЯ
ПОМОЩЬ
ДОВРА-
ЧЕБНАЯ
ПОМОЩЬ
Anterior nasal packing
Local application of hemostatic drugs
Возвышенное
положение
конечности
Локальная
гипотермия
Локальное
применение
гемостатических
препаратов
Давящая
повязка
Пальцевое
прижатие
Максимальное
сгибание
конечности
Импровизированный
жгут (закрутка)
Табельный
жгут
Наложение
зажима на
сосуд в ране
Тампонирование
раны
Медикаментозное
воздействие на
свертывающую
систему крови
Передняя
тампонада
носовых ходов
Задняя
тампонада
носовых ходов
Перевязка
сосуда на
протяжении
Лигирование
сосуда в ране
Временное
шунтированиеelectrocoagulation
Tamponade by
own tissues
or biological
graft
Angiorrhaph
y
Repair of the vessel
or the vessel
prosthesis

28. Compensation
of blood loss

29. General weakness
Pale skin
Вizziness
Noise in the ears.
Yawning.
Tachycardia
Excessive thirst.
Symptoms of acute
blood loss
Flashing "flies" in front of the eyes
Cold clammy sweat.
Frequent weak pulse.
Fast breathing.
Fall of blood pressure
Сlouding or loss of consciousness
Mydriasis.

30. SEVERITY OF BLOOD LOSS
Shock index of
about 0.8
Shock index of
about 1.5 and more
Shock index of
about 1,3-1,4
Shock index of
about: 0,9-1,2

31. Ориентировочный объем
кровопотери при переломах (мл)
Если кровопотеря не превышает 1/3 ОЦК,
самопроизвольное восполнение занимает:
Объем плазмы – 24-48 час
Концентрация белков плазмы – 72-94 час
Масса эритроцитов – 20-25 сут
ОТКРЫТЫЕ
ТРАВМЫ
ЗАКРЫТЫЕ
ТРАВМЫ
ТРАВМАТИ-
ЧЕСКИЕ
ОТРЫВЫ
(АМПУТАЦИИ)
ПЕРЕЛОМЫ
КОСТЕЙ
черепа –
до 0,5 л
таза (изолированные
переломы) – 0,5 -1,0 л
живота –
1,5-3,0 л
груди –
1,5-1,8 л
черепа –
1,5 л и более
груди –
2,0 л
и более
живота –
1,5-3,0 л
и более
разрушения таза
с повреждением
внутренностей –
3,5 л и более
ключицы –
0,1-0,3 л
ребер–
0,5-0,6 л
плеча –
0,3-0,5 л
таза (заднее
полукольцо) –
1,5-1,8 л
предплечья –
0,3 -0,4 л
таза (переднее
полукольцо) –
0,3-0,6 л
бедра–
0,5-1,2 л
голени –
0,3-0,75 л
голеностопного
сустава –
0,35-0,45 л
плеча –
1,5 л
предплечья –
1,0 л
кисти–
0,75 л
бедра –
2,0 л
голени –
1,8 л
стопы–
0,8 л

32. Decrease CBV
Decrease inflow of venous blood to the heart
Decrease in stroke volume and minute ejection.
Decrease in arterial pressure
Decrease in perfusion pressure in the vessels
Microcirculatory disorders
Tissue hypoperfusion
The capillary-trophic insufficiency
Hypoxia, toxemia, acidosis, dystonia
Multiorgan failure
Disorders of vital activity
The severity of
blood loss
Volume Speed
✓The spasm of small blood vessels and
increase the tone of the sympathetic part of the
autonomic nervous system
(maintaining blood pressure)
✓ Tachycardia
(maintenance of minute volume)
✓ Disclosure of arteriovenous shunts, it
facilitates the return blood to the heart
(CENTRALIZATION OF CIRCULATION)
–compensates up to 10% of the deficit CBV
✓ Interstitial fluid begins replenish the the
bloodstream
(Replenishing CBV)
tHE WHOLE PROCESS IS DIRECTED
TOWARDS THE TRANSITION INTO THE
CIRCULATORY HYPOXIA
TO ANEMIC HYPOXIA.
Compensatory mechanisms

33. Crystalloid
solutions
Infusion-transfusion fluids.
They remain in the
bloodstream for about
25 %
of the injected volume
Colloidal solutions
(blood substitutes)
They increase the CBV
1,2-1,3
times more self-
administered volume.
Blood and
blood products
If life-threatening conditions, we start with crystalloid
infusion solutions, then - blood substitutes
Blood - optimal fluid
transfusion
BUT:
compatibility problems
the risk of infection

34. приказ Минздрава РФ
от 25 ноября 2002 г. N 363
Transfusion of blood components is accompanied some consequences to the recipient,
both positive and negative:
1. Acute hemolysis.
2. Deferred hemolytic reactions.
3. Bacterial shock.
4. Responses resulting from the anti-leukocyte antibodies.
5. Anaphylaxis.
6. Acute volemic overload.
7. Transmissible Infection
Transmission of human immunodeficiency virus by transfusion is about 2% of all AIDS
cases.
A LONG PERIOD OF PRODUCTION OF SPECIFIC ANTIBODIES AFTER
INFECTION (6 - 12 WEEKS) MAKES COMPLETE ELIMINATION OF
RISK OF HIV TRANSMISSION ALMOST IMPOSSIBLE
INDICATIONS FOR TRANSFUSION OF WHOLE BLOOD CANNED DOES NOT EXIST.
except in cases of acute massive blood loss, when there is no blood substitutes or fresh frozen plasma,
packed red blood cells or a slurry.
The indications for transfusion of blood gas carriers in acute anemia due to massive blood loss is the loss of 25 - 30%
of circulating blood volume, accompanied by a decrease hemoglobin level below 70 - 80 g / l and a hematocrit below
25% and the occurrence of circulatory disorders.
The use of intraoperative blood reinfusion indications only in those circumstances where the anticipated blood loss
exceeds 20% of circulating blood volume.
Transfusions fresh frozen plasma to replenish blood volume is not recommended (we have a safer and more
economical medications)
BLOOD TRANSFUSIONS ARE USED ONLY FOR THE LIFE-SAVING

35. INTRAVENOUSLY:
Puncture a peripheral vein
Puncture
central vein
(subclavian)
Preparation a peripheral vein
INTRAARTERIALLY
INTRAOSSEOUS
The routes of entry of
infusion fluids.

36. Basic rules for
infusion therapy
in critical conditions
1. The main thing is not composition of the infusion solution, but
- the timeliness of infusion’s start,
- the volume;
- the rate of introduction
2. Are beginning to infusion with a quick introduction of crystalloid solution
3. The proportion of colloid and crystalloid solutions – 2:1
4. Volume infusion must be greater than deficit CBV by 1,5-2,0 times
5. Blood transfusions are used only for the life-saving.
6. Percentage of blood products should not exceed the volume of blood loss

37. Thank you for
attention!