First aid at bleeding and blood-waste on the pre-

hospital stage.

Reasons of originReasons of origin of of hemorrhagehemorrhage are are traumatic damages of fabrics of traumatic damages of fabrics of

organism and bleedingorganism and bleeding, , which cause which cause traumatic and traumatic and hemorrhagehemorrhage shocksshocks, , in in basis of which there is basis of which there is hypovolemiahypovolemia. .

That is why they in obedience to That is why they in obedience to modern classification are connected modern classification are connected

in in hypovolemiahypovolemia shockshock..

SSymptom group ymptom group of shock mis of shock mis determined the type of traumadetermined the type of trauma, , volume of mechanical damage of volume of mechanical damage of fabrics and organs, size of fabrics and organs, size of hemorrhage hemorrhage andand hypovolemia, hypovolemia, by by intensity of pain and reaction – intensity of pain and reaction – answer of organism on aggression, answer of organism on aggression, by duration of the pathological state.by duration of the pathological state.

At considerable At considerable hemorrhage ( hemorrhage (more then more then 30 30 % % CB)CB) a skin is palea skin is pale,, moisture moisture. . As the result As the result of the broken of the broken microcirculation microcirculation the the peripheral temperature of body falls down peripheral temperature of body falls down for patientsfor patients. . A difference between a rectal A difference between a rectal temperature and temperature of skin makes temperature and temperature of skin makes more more 3-3-th degrees on Celsius.th degrees on Celsius. There is a There is a symptom of symptom of ““white spotwhite spot” (” (at pressure a at pressure a white sot which in a norm disappears white sot which in a norm disappears through through 3 3 secs). The considerable secs). The considerable lengthening of time of existence of spot lengthening of time of existence of spot testifies to testifies to microcirculationmicrocirculation disoders.disoders.

The loss of blood and tissue liquid results in The loss of blood and tissue liquid results in lowering oflowering of turgor turgor of hypodermic cellulose, of hypodermic cellulose, tone of eyeballstone of eyeballs, fill blood, fill blood of hypodermic of hypodermic viensviens. . The pulsation of peripheral arteries is The pulsation of peripheral arteries is weakweak; ; a pulse becomes frequent, soft, a pulse becomes frequent, soft, threadlike.threadlike. Arterial pressure, central venous Arterial pressure, central venous pressure goes downpressure goes down. . A kidney blood A kidney blood streams goes down as a result ofstreams goes down as a result of hypotension hypotension and compensate spasm of and compensate spasm of kidney arterieskidney arteries(perfusion (perfusion of budsof buds). ). Oliguria Oliguria develops.develops.

BleedingBleeding•Haemorrhage, or bleeding, is the Haemorrhage, or bleeding, is the

escape of blood from the blood escape of blood from the blood vessels into the tissues and vessels into the tissues and cavities of human body or cavities of human body or outside, as the result of an injury outside, as the result of an injury or defect in the permeability of or defect in the permeability of the blood vessel wall.the blood vessel wall.

Anatomical classification Anatomical classification (according to kind of bleeding (according to kind of bleeding

vessel)vessel) • Arterial hemorrhage;Arterial hemorrhage;• Venous hemorrhage;Venous hemorrhage;• Capillary hemorrhage;Capillary hemorrhage;• Parenchymatous hemorrhage.Parenchymatous hemorrhage.

Classification according to Classification according to mechanism of beginningmechanism of beginning

• Mechanical failure, vessel rupture (haemorrhagia per rhexin);Mechanical failure, vessel rupture (haemorrhagia per rhexin);• Arrosive hemorrhage (haemorrhagia per diabrosin). This Arrosive hemorrhage (haemorrhagia per diabrosin). This

types of bleeding takes place during suppurative melting of types of bleeding takes place during suppurative melting of wessel wall;wessel wall;

• Diapedetic hemorrhage (haemorrhagia per diapedesin);Diapedetic hemorrhage (haemorrhagia per diapedesin);• The violation of chemical composition of blood. The The violation of chemical composition of blood. The

hemophilia, scarlet fever, sepsis, scurvy and others are hemophilia, scarlet fever, sepsis, scurvy and others are causing bleeding sometimes. Toxins or beriberi to produce causing bleeding sometimes. Toxins or beriberi to produce defect in the permeability of the vascular walls and caused of defect in the permeability of the vascular walls and caused of hemorrhage;hemorrhage;

• Increased of arterial and venous blood pressure. The Increased of arterial and venous blood pressure. The diseases, such as essential hypertension, atherosclerosis diseases, such as essential hypertension, atherosclerosis sometimes coursed of an injury of the vascular wall and sometimes coursed of an injury of the vascular wall and bleeding (stroke, hemorrhoidal bleeding, etc.);bleeding (stroke, hemorrhoidal bleeding, etc.);

• Violation of fibrillation (haemophilia, Werlgof’s disease, Violation of fibrillation (haemophilia, Werlgof’s disease, cholemic hemorrhage in patients with jaundice)cholemic hemorrhage in patients with jaundice)

Symptoms of acute anemiaSymptoms of acute anemia • persisting paleness;persisting paleness;• trembling and small pulse;trembling and small pulse;• progressing decrease of blood pressure;progressing decrease of blood pressure;• dizziness;dizziness;• nausea;nausea;• vomiting;vomiting;• syncope.syncope.

Symptoms of bleeding to the Symptoms of bleeding to the stomachstomach

• At bleedings in empty space of a At bleedings in empty space of a gastrointestinal tract the blood in a gastrointestinal tract the blood in a stomach changes the color. In ample stomach changes the color. In ample quantityquantity of its accumulation a vomiting, of its accumulation a vomiting, like “ground coffe” (like “ground coffe” (hematemesishematemesis), is ), is originated.originated. Further or at a bleeding from Further or at a bleeding from underlaying departments of a underlaying departments of a gastrointestinal tract it is observed weak gastrointestinal tract it is observed weak tarry stool in large quantitytarry stool in large quantity ((melenamelena).).

Some kinds of internal bleeding Some kinds of internal bleeding have specific namehave specific name

• Haemobilia – haemorrhage from diliary ducts;Haemobilia – haemorrhage from diliary ducts;• Haematuria - haemorrhage from kidneys and urinary Haematuria - haemorrhage from kidneys and urinary

system;system;• Haemoperitoneum - haemorrhage in abdominal cavity;Haemoperitoneum - haemorrhage in abdominal cavity;• Haemothorax - haemorrhage in pleural cavity;Haemothorax - haemorrhage in pleural cavity;• Haemopericardium - haemorrhage in pericardial Haemopericardium - haemorrhage in pericardial

cavity;cavity;• Haemartrosis – haemorrhage in joint cavity;Haemartrosis – haemorrhage in joint cavity;• Metrorrhagia – uterine bleeding;Metrorrhagia – uterine bleeding;• Proctorrhagia – rectal bleeding;Proctorrhagia – rectal bleeding;• Hemorrhagic insult – cerebral hemorrhage.Hemorrhagic insult – cerebral hemorrhage.

Classification according to time of Classification according to time of beginningbeginning

• primary;primary;• secondary (early and late).secondary (early and late).

Classification according to Classification according to clinical courseclinical course

• acute;acute;• chronic.chronic.

Classification according to degree of Classification according to degree of severity (severity (V.I.Struchkov and V.I.Struchkov and E.W.Lutzevich E.W.Lutzevich ))• I levelI level – easy degree – blood loss is even – easy degree – blood loss is even

to 10 – 12% of blood circulating volume to 10 – 12% of blood circulating volume (500 – 700 ml). Haemorrhage is causing (500 – 700 ml). Haemorrhage is causing little changes to hemodynamic. The little changes to hemodynamic. The general condition of patient is general condition of patient is satisfactory. Pulse is slightly quickened, satisfactory. Pulse is slightly quickened, arterial pressure is normal (standart). arterial pressure is normal (standart). Blood hemoglobin is rised above 100 g/l Blood hemoglobin is rised above 100 g/l (10 g %). During capillaroscopy: (10 g %). During capillaroscopy: background is rosy, 3 – 4 capillary loops background is rosy, 3 – 4 capillary loops with quick gomogenous bloodstream are with quick gomogenous bloodstream are determined.determined.

Classification according to degree of Classification according to degree of severity (severity (V.I.Struchkov and V.I.Struchkov and E.W.Lutzevich E.W.Lutzevich ))• II levelII level – middle degree - blood loss is even to – middle degree - blood loss is even to

15 – 20 % of blood circulating volume (1000 – 15 – 20 % of blood circulating volume (1000 – 1400 ml). Apparent bleeding is distinguished. 1400 ml). Apparent bleeding is distinguished. The general condition is medium-scale The general condition is medium-scale difficalty. Limpness, dizziness, hyperhidrosis, difficalty. Limpness, dizziness, hyperhidrosis, syncope are observed. Coverlet is pale. syncope are observed. Coverlet is pale. Respiration is accelerated. Reflexes are Respiration is accelerated. Reflexes are decrease. Single vomiting or melena may be decrease. Single vomiting or melena may be observed. Pulse become noticeably more observed. Pulse become noticeably more rapid (90 – 100 per min.). Arterial pressure is rapid (90 – 100 per min.). Arterial pressure is decreased to 90 mm Hg. Leucocytosis, decreased to 90 mm Hg. Leucocytosis, deviation of the differential count to the left deviation of the differential count to the left are determined. Hematocrit is 0,38 – 0,32, are determined. Hematocrit is 0,38 – 0,32, hemoglobin is 80 – 100 g/l (8 – 10 g %). hemoglobin is 80 – 100 g/l (8 – 10 g %). Quantity of urination is decreased. Quantity of urination is decreased.

Classification according to degree of Classification according to degree of severity (severity (V.I.Struchkov and V.I.Struchkov and

E.W.Lutzevich E.W.Lutzevich ))• III levelIII level – heavy degree – blood loss is 20 – 30 – heavy degree – blood loss is 20 – 30

% of blood circulating volume (1500 – 2000 % of blood circulating volume (1500 – 2000 ml). The general condition of patient is bad ml). The general condition of patient is bad (grave condition). Paleness of skin, cold sweat (grave condition). Paleness of skin, cold sweat is observed. Rapid vomiting and melena are is observed. Rapid vomiting and melena are determined. The bleeding is accompanied by determined. The bleeding is accompanied by syncope. Visible mucous membranes are syncope. Visible mucous membranes are colourless. The patient yawns, feels thirst. colourless. The patient yawns, feels thirst. Pulse is rapid and thready. Arterial pressure is Pulse is rapid and thready. Arterial pressure is decreased to 60 mm Hg. Hematocrit is 0,30 – decreased to 60 mm Hg. Hematocrit is 0,30 – 0,32, hemoglobin is 50 – 80 g/l (5 – 8 g %). 0,32, hemoglobin is 50 – 80 g/l (5 – 8 g %). Oliguria is observed.Oliguria is observed.

Classification according to degree of Classification according to degree of severity (severity (V.I.Struchkov and V.I.Struchkov and

E.W.Lutzevich E.W.Lutzevich ))• IV level IV level – massive blood loss – loss of – massive blood loss – loss of

blood is more then 30 % of blood blood is more then 30 % of blood circulating volume (more than 2000 ml). circulating volume (more than 2000 ml). Plentiful bleeding with prolonged loss of Plentiful bleeding with prolonged loss of consciousness may be observed. The consciousness may be observed. The general condition of patient is very general condition of patient is very grave, preagony. Pulse and arterial grave, preagony. Pulse and arterial pressure are not fixed. Hematocrit is pressure are not fixed. Hematocrit is 0,23 and lower, hemoglobin is 50 g/l and 0,23 and lower, hemoglobin is 50 g/l and lower. Anuria is observed.lower. Anuria is observed.

The compensatory-adaptive The compensatory-adaptive mechanisms during acute blood mechanisms during acute blood

lossloss • Spasm of veins;Spasm of veins;• Interstitial fluid inflow;Interstitial fluid inflow;• Tachycardia;Tachycardia;• Oliguria;Oliguria;• Hyperventilation;Hyperventilation;• Peripheral arteriolespasm;Peripheral arteriolespasm;• Sympaticoadrenal system’ activation;Sympaticoadrenal system’ activation;• Activation of fibrillation system and Activation of fibrillation system and

haemopoiesis stimulation.haemopoiesis stimulation.

• Relative simplicity of researchRelative simplicity of research enables quickly enables quickly to set the degree of shock and volume of to set the degree of shock and volume of loss loss of bloodof blood for adequate renewal of deficit of for adequate renewal of deficit of BCBC. . Utilize next calculationsUtilize next calculations. . For example, For example, mass of body of a victim is 80 kg, indexes ofmass of body of a victim is 80 kg, indexes of hemodynamicshemodynamics: : BPBP - 80 - 80 toto 50, 50, PulsPuls - 120 - 120 perper//minmin. . the proper volume of circulatory the proper volume of circulatory blood for him makes blood for him makes 70 70 mlml//kgkg the masses of the masses of bodybody, , that that 70 70 · · 80 = 5600 80 = 5600 mlml..

• Degree of depth of shockDegree of depth of shock

• At such value of shock index At such value of shock index bleedingbleeding will be about will be about 30 % 30 % fromfrom BCBC. . ConsequentlyConsequently, , a patient lost a patient lost 30% 30% from from 56005600mlml, , or or 5600 5600 ·· 0,3 = 1680 0,3 = 1680 ml of bloodml of blood..

• On the measure of duration of shockOn the measure of duration of shock,,even even at the stopped bleeding at the stopped bleeding , , BCBC continues to continues to go downso called relativego downso called relative bleedingbleeding, , predefinedpredefined stasis stasis RBCRBC in vessels ofin vessels of microcirculation, microcirculation, their aggressivetheir aggressive, , sequestration sequestration and exception from general and exception from general circulation of bloodcirculation of blood).).

• Exigent measures Exigent measures • First of all its necessary to stopFirst of all its necessary to stop arterial arterial

bleeding holding the artery to the bone in bleeding holding the artery to the bone in the higher place of traumathe higher place of trauma, , by imposition of by imposition of arterial plait or twirling in higher place of arterial plait or twirling in higher place of woundwound. . During this time when a plait was During this time when a plait was imposed should be fixed. Examination imposed should be fixed. Examination condition vital activity of organism. To condition vital activity of organism. To estimate the state of viability of estimate the state of viability of organismorganism((to define a presence and to define a presence and character of pulse above peripheral and character of pulse above peripheral and central arteries, degree of oppression of central arteries, degree of oppression of consciousnessconsciousness ,, ,, efficiency of function of the efficiency of function of the external breathingexternal breathing).).

• To provide correct position of body of a To provide correct position of body of a victimvictim. . In the swoon state it follows to turn In the swoon state it follows to turn him on a sidehim on a side. . But its contra- indicated to But its contra- indicated to fill up a head of a patients with the trauma fill up a head of a patients with the trauma of neck department of spine!of neck department of spine!

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