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First aid at bleeding and blood-waste on the pre- hospital stage.

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Presentation on theme: "First aid at bleeding and blood-waste on the pre- hospital stage."— Presentation transcript:

1 First aid at bleeding and blood-waste on the pre- hospital stage.

2 Reasons of origin of hemorrhage are traumatic damages of fabrics of organism and bleeding, which cause traumatic and hemorrhage shocks, in basis of which there is hypovolemia. That is why they in obedience to modern classification are connected in hypovolemia shock.

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

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

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

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

7 Anatomical classification (according to kind of bleeding vessel) Arterial hemorrhage; Arterial hemorrhage; Venous hemorrhage; Venous hemorrhage; Capillary hemorrhage; Capillary hemorrhage; Parenchymatous hemorrhage. Parenchymatous hemorrhage.

8 Classification according to mechanism of beginning Mechanical failure, vessel rupture (haemorrhagia per rhexin); Mechanical failure, vessel rupture (haemorrhagia per rhexin); Arrosive hemorrhage (haemorrhagia per diabrosin). This types of bleeding takes place during suppurative melting of wessel wall; Arrosive hemorrhage (haemorrhagia per diabrosin). This types of bleeding takes place during suppurative melting of wessel wall; Diapedetic hemorrhage (haemorrhagia per diapedesin); Diapedetic hemorrhage (haemorrhagia per diapedesin); The violation of chemical composition of blood. The hemophilia, scarlet fever, sepsis, scurvy and others are causing bleeding sometimes. Toxins or beriberi to produce defect in the permeability of the vascular walls and caused of hemorrhage; The violation of chemical composition of blood. The hemophilia, scarlet fever, sepsis, scurvy and others are causing bleeding sometimes. Toxins or beriberi to produce defect in the permeability of the vascular walls and caused of hemorrhage; Increased of arterial and venous blood pressure. The diseases, such as essential hypertension, atherosclerosis sometimes coursed of an injury of the vascular wall and bleeding (stroke, hemorrhoidal bleeding, etc.); Increased of arterial and venous blood pressure. The diseases, such as essential hypertension, atherosclerosis sometimes coursed of an injury of the vascular wall and bleeding (stroke, hemorrhoidal bleeding, etc.); Violation of fibrillation (haemophilia, Werlgof’s disease, cholemic hemorrhage in patients with jaundice) Violation of fibrillation (haemophilia, Werlgof’s disease, cholemic hemorrhage in patients with jaundice)

9 Symptoms 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.

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

11 Some kinds of internal bleeding have specific name Haemobilia – haemorrhage from diliary ducts; Haemobilia – haemorrhage from diliary ducts; Haematuria - haemorrhage from kidneys and urinary system; Haematuria - haemorrhage from kidneys and urinary 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 cavity; Haemopericardium - haemorrhage in pericardial 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.

12 Classification according to time of beginning primary; primary; secondary (early and late). secondary (early and late).

13 Classification according to clinical course acute; acute; chronic. chronic.

14 Classification according to degree of severity (V.I.Struchkov and E.W.Lutzevich ) I level – easy degree – blood loss is even to 10 – 12% of blood circulating volume (500 – 700 ml). Haemorrhage is causing little changes to hemodynamic. The general condition of patient is satisfactory. Pulse is slightly quickened, arterial pressure is normal (standart). Blood hemoglobin is rised above 100 g/l (10 g %). During capillaroscopy: background is rosy, 3 – 4 capillary loops with quick gomogenous bloodstream are determined. I level – easy degree – blood loss is even to 10 – 12% of blood circulating volume (500 – 700 ml). Haemorrhage is causing little changes to hemodynamic. The general condition of patient is satisfactory. Pulse is slightly quickened, arterial pressure is normal (standart). Blood hemoglobin is rised above 100 g/l (10 g %). During capillaroscopy: background is rosy, 3 – 4 capillary loops with quick gomogenous bloodstream are determined.

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

16 Classification according to degree of severity (V.I.Struchkov and E.W.Lutzevich ) III level – heavy degree – blood loss is 20 – 30 % of blood circulating volume (1500 – 2000 ml). The general condition of patient is bad (grave condition). Paleness of skin, cold sweat is observed. Rapid vomiting and melena are determined. The bleeding is accompanied by syncope. Visible mucous membranes are colourless. The patient yawns, feels thirst. Pulse is rapid and thready. Arterial pressure is decreased to 60 mm Hg. Hematocrit is 0,30 – 0,32, hemoglobin is 50 – 80 g/l (5 – 8 g %). Oliguria is observed. III level – heavy degree – blood loss is 20 – 30 % of blood circulating volume (1500 – 2000 ml). The general condition of patient is bad (grave condition). Paleness of skin, cold sweat is observed. Rapid vomiting and melena are determined. The bleeding is accompanied by syncope. Visible mucous membranes are colourless. The patient yawns, feels thirst. Pulse is rapid and thready. Arterial pressure is decreased to 60 mm Hg. Hematocrit is 0,30 – 0,32, hemoglobin is 50 – 80 g/l (5 – 8 g %). Oliguria is observed.

17 Classification according to degree of severity (V.I.Struchkov and E.W.Lutzevich ) IV level – massive blood loss – loss of blood is more then 30 % of blood circulating volume (more than 2000 ml). Plentiful bleeding with prolonged loss of consciousness may be observed. The general condition of patient is very grave, preagony. Pulse and arterial pressure are not fixed. Hematocrit is 0,23 and lower, hemoglobin is 50 g/l and lower. Anuria is observed. IV level – massive blood loss – loss of blood is more then 30 % of blood circulating volume (more than 2000 ml). Plentiful bleeding with prolonged loss of consciousness may be observed. The general condition of patient is very grave, preagony. Pulse and arterial pressure are not fixed. Hematocrit is 0,23 and lower, hemoglobin is 50 g/l and lower. Anuria is observed.

18 The compensatory-adaptive mechanisms during acute blood loss 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 haemopoiesis stimulation. Activation of fibrillation system and haemopoiesis stimulation.

19 Relative simplicity of research enables quickly to set the degree of shock and volume of loss of blood for adequate renewal of deficit of BC. Utilize next calculations. For example, mass of body of a victim is 80 kg, indexes of hemodynamics : BP - 80 to 50, Puls - 120 per/min. the proper volume of circulatory blood for him makes 70 ml/kg the masses of body, that 70 · 80 = 5600 ml. Relative simplicity of research enables quickly to set the degree of shock and volume of loss of blood for adequate renewal of deficit of BC. Utilize next calculations. For example, mass of body of a victim is 80 kg, indexes of hemodynamics : BP - 80 to 50, Puls - 120 per/min. the proper volume of circulatory blood for him makes 70 ml/kg the masses of body, that 70 · 80 = 5600 ml. Degree of depth of shock Degree of depth of shock

20 At such value of shock index bleeding will be about 30 % from BC. Consequently, a patient lost 30% from 5600ml, or 5600 · 0,3 = 1680 ml of blood. At such value of shock index bleeding will be about 30 % from BC. Consequently, a patient lost 30% from 5600ml, or 5600 · 0,3 = 1680 ml of blood. On the measure of duration of shock,even at the stopped bleeding, BC continues to go downso called relative bleeding, predefined stasis RBC in vessels of microcirculation, their aggressive, sequestration and exception from general circulation of blood). On the measure of duration of shock,even at the stopped bleeding, BC continues to go downso called relative bleeding, predefined stasis RBC in vessels of microcirculation, their aggressive, sequestration and exception from general circulation of blood).

21 Exigent measures Exigent measures First of all its necessary to stop arterial bleeding holding the artery to the bone in the higher place of trauma, by imposition of arterial plait or twirling in higher place of wound. During this time when a plait was imposed should be fixed. Examination condition vital activity of organism. To estimate the state of viability of organism(to define a presence and character of pulse above peripheral and central arteries, degree of oppression of consciousness,, efficiency of function of the external breathing). First of all its necessary to stop arterial bleeding holding the artery to the bone in the higher place of trauma, by imposition of arterial plait or twirling in higher place of wound. During this time when a plait was imposed should be fixed. Examination condition vital activity of organism. To estimate the state of viability of organism(to define a presence and character of pulse above peripheral and central arteries, degree of oppression of consciousness,, efficiency of function of the external breathing). To provide correct position of body of a victim. In the swoon state it follows to turn him on a side. But its contra- indicated to fill up a head of a patients with the trauma of neck department of spine! To provide correct position of body of a victim. In the swoon state it follows to turn him on a side. But its contra- indicated to fill up a head of a patients with the trauma of neck department of spine!

22 THANK YOU FOR ATTENTION !!!


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