V. Reference basis of actions

Determination of size of blood loss. At the I degree of blood loss the expressed clinical signs are absent. At the II degree of blood loss are determined tachycardia to 100 in a minute, lowering arterial pressure to 90-100 mm of mercury column, skin covers are pale, extremities cold to the feel. At heavy blood loss (the III degree) the uneasy conduct of patient, cyanosis, pallor of skin covers and visible mucous membranes, rate gain of breathing, death-damp, are marked. Frequency of pulse arrives at 120 in a minute, arterial pressure is lowered up to 80-90 to mm of rt. item The quantity of the separated urine is diminished — oliguria. At massive blood loss (the IV degree) a patient is put on the brakes, is found in a state of stupor, are marked sharp pallor of skin covers, acrocyanosis, anuria (stopping of piss). A pulse on peripheral vessels is weak, threadlike or is not determined quite, tachycardia to 130-140 and more in a minute, arterial pressure is lowered up to 30 to mm of mercury column and below.

Determination of size of blood loss by the hematocrit method Moore, the size of blood loss is determined on a formula:

BL = CBV_D (HT_D – HT_A)/HT_D

where BL – size of blood loss; CBV_D – due circulatory blood volume; HT_D – due size of hematocrit (men – 45, women – 42); HT_A – actual size of haematocrit, definite after the stop of bleeding and stabilization of hemodinamics.

Methods of temporal stop of bleeding. Imposition of plait is the most reliable method, however he is used in area of extremities mainly.

A styptic plait is a rubber ribbon long 1,5 m, from one side ending with a metallic chainlet, with other – by a hook. At the set arterial or massive bleeding the plait of proximal site of damage is laid on.

The supposed region of imposition of plait is wrapped by soft material (towel, sheet and pr.), I.e. a soft gasket is created. A plait is stretched, lay on nearer to the chainlet or hook and do 2-3 rounds by a plait; subsequent coils are laid on, stretching a plait; then a hook is attached to the chainlet. Time of imposition of plait is necessarily indicated, as squeezing by him the arteries during more than 2 ch on lower extremity and 1,5 hours – on overhead fraught by development of numbness of extremity. Are the control of rightness of imposition of plait stopping of bleeding, disappearance of pulsation of the peripherally located arteries and easy "waxen pallor" of skin of extremity. If transporting of injured occupies more than 1,5-2 ch, follows periodically on 10-15 mines to take off plait for renewal of arterial current of blood. Pin the thus damaged vessel by swab in a wound or produce the finger pinning of artery. Then a plait is laid on again, some higher or below than that place, where he was found.

The finger pinning of artery on the extent is produced in those areas, where arteries are disposed superficially and near a bone: carotid – the transversal sprout С_IV, subclavian – the І rib, humeral – region of internal surface of humeral bone, femoral artery – share bone. Finger pinning it is especially important at preparation to imposition of plait or his change, and also how the reception is during amputation of extremity.

Bending of extremity in a joint effectively on condition of fixing of arcuated completely hand in an elbow joint at bleeding from the vessels of forearm or brush, and feet – in a knee-joint at bleeding from the vessels of shin or foot. At high, inaccessible to imposition of plait damages of femoral artery, it follows to fix a thigh to the stomach at the maximal bending of extremity in a knee and hip joint.

The tampon of wounds and imposition of pressing bandage with immobilisation on condition of the elevated position of extremity are the good method of temporal stop of bleeding from veins and small arteries, from soft fabrics, covering skull bones, elbow and knee joints. For tight a tampon gauze tampon is brought into a wound, tightly filling her, and then fix by a pressing bandage. The tight tamponada is contra-indicated at the wounds in area of popliteal pit, as in these case the gangrene of extremity develops often. Pressure by a load or in combination with cooling (ice-bag) use for the vnutritkanevih bleeding, and also often apply how the method of prophylaxis of posleoperatsionnih haematomas is.

Pinning of vessel in a wound by fingers carry out in urgent situations, sometimes during the operation. For this purpose a doctor quickly puts on a sterile glove or processes a hand by an alcohol, by an iodine and pins or squeezes a vessel in a wound, stopping bleeding.

At bleeding from the damaged deeply located vessels of proximal departments of extremity, abdominal region, thorax, when applying the listed above methods of temporal stop of bleeding is impossible, imposition is used on the bleeding vessel of styptic clamp in a wound. To evade injuring of the alongside located educations (nerves), it is needed in the beginning to make an effort stop bleeding, pinning a vessel by fingers, and then to impose a clamp directly on a bleeding vessel, preliminary drying a wound from a blood.

The temporal shunting of vessel is the method of renewal of circulation of blood at the damage of large arterial vessels. In both ends of the damaged artery enter a dense elastic tube and ends of vessel fix on pipes by ligatures. On a such temporal shunt arterial circulation of blood is restored. A shunt can function from a few o'clock of to a few days, while there will be no possibility of final stop of bleeding.