External bleeding is the outflow of blood from damaged vessels into the external environment. Depending on the type of damaged vessel (or vessels), it may be either not requiring specialized care or posing an immediate danger to the patient’s life. Diagnosis of external bleeding is usually not difficult. The treatment is surgical. Wound suturing, ligation of a damaged vessel, vascular suture, tamponade, etc. can be performed. At the same time with surgical treatment, general measures are taken to compensate for blood loss and prevent the development of complications.
ICD 10
R58 Bleeding, not classified elsewhere
Meaning
External bleeding in traumatology and orthopedics is called the outflow of blood into the external environment. The cause may be damage to the vessels of the muscles, subcutaneous tissue, skin or mucous membranes. External bleeding (with the exception of some small capillary bleeding) requires immediate specialized care. With significant blood loss, not only local (surgery), but also general medical and resuscitation measures are necessary.
The most dangerous bleeding is arterial. If large arteries are damaged, a person can bleed out in just a few minutes. The blood pouring into the external environment is visible to the naked eye, so the diagnosis of external bleeding is usually simple, but determining the degree of blood loss at the first aid stage can cause difficulties.
Causes
As a rule, external bleeding develops as a result of acute trauma – an impact that exceeds the strength characteristics of the vessel in its strength. Less often, other causes are identified, for example, the failure of the seams when suturing the vessel or the melting of the vessel wall with phlegmon.
Classification
Depending on the type of damaged vessel:
- Arterial. The blood is bright red, flows out in a pulsating stream, while the pulsation corresponds to the rhythm of heart contractions. If large arterial trunks are damaged, gushing is possible. Due to the high pressure of the fluid, blood clots do not have time to form, so there is no spontaneous stop. Damage to the arteries is most dangerous due to the high rate of blood loss. It is necessary to apply a tourniquet and immediately deliver the patient to a specialized medical institution.
- Venous. The blood is dark, with a cherry tint, flowing from the wound. In some cases (with damage to large venous trunks), pulsation of the jet in time with breathing is possible. Blood flows out more slowly when a vein is damaged, so clots are formed, however, in many cases they are washed away by blood flow, therefore spontaneous stop of external bleeding can occur with a significant delay and be accompanied by more or less significant blood loss. A patient with such bleeding should also be taken to the med immediately. institution.
- Capillary. The blood is saturated red, similar to arterial, but the bleeding in this case is superficial. There may be a symptom of “bloody dew”, in which slowly increasing drops of blood appear on the damaged area, similar to condensation or dew. The blood loss is insignificant. In the absence of pathology on the part of the coagulation system, such external bleeding stops on its own.
Taking into account the degree of blood loss:
- Easy. No more than 10-15% of the CBV (circulating blood volume) is lost. Blood loss is no more than 500 ml. Pulse and blood pressure are normal, the skin is of normal color, consciousness is clear.
- Average. 16-20% of CBV is lost, blood loss from 500 to 1000 ml. A slight decrease in blood pressure, moderate tachycardia, a slight increase in breathing. The skin is pale, the limbs are cold, dizziness, weakness, dry mouth, some inhibition. Fainting is possible.
- Heavy. 21-40% of CBV is lost, blood loss from 1000 to 2000 ml. The pulse is up to 120 beats faster . per minute, blood pressure is reduced to 90-100 mmHg, breathing is noticeably faster, breathing rhythm disturbances are possible. There is sticky cold sweat, cyanosis of the limbs, lips and nasolabial triangle, sharp pallor of the skin and mucous membranes, darkening of the eyes, trembling of the hands, darkening of consciousness, pronounced thirst, pathological drowsiness, indifference, yawning (a sign of oxygen starvation), nausea and vomiting.
- Massive. 41-70% of CBV is lost, blood loss from 2000 to 3500 ml. The pulse is thready, increased to 140-160 beats. in a minute, there is no peripheral arteries, the pressure is reduced to 60 mmHg. There are gross violations of the rhythm of breathing, delirium or confusion, cold sweat, deathly pallor. The skin has a bluish-gray tinge, the facial features are sharpened.
- Absolutely deadly. More than 70% of the CBV is lost, blood loss is more than 3000-3500 ml. Coma, agonal state. Sudden bradycardia or disappearance of the pulse, pressure drop below 60 mm Hg, shallow agonal breathing. The skin is “marble”, cold, dry, pupils are dilated. Involuntary excretion of feces and urine, convulsions. In the future – death.
Taking into account the time of occurrence:
- Primary. Develop immediately after injury.
- Early secondary. They occur some time after stopping, usually due to insufficient high-quality hemostasis of the wound, for example, when the ligature fails.
- Late secondary. They develop as a result of melting of the vessel wall during suppuration of the wound or during an independent purulent process.
Diagnostics
Diagnosis, as a rule, is not difficult, since the symptoms of external bleeding are obvious: there is a wound from which blood flows. However, it is not always possible to determine the severity of blood loss at the first aid stage, especially if the patient was moved or changed, so it is impossible to estimate the amount of blood that leaked.
It should also be taken into account that the patient may be in a state of excitement and deny or downplay the severity of his condition due to the initial stage of traumatic shock. In addition, in some cases, with severe injuries, bleeding stops due to intense vasospasm. Therefore, if there is even the slightest doubt about the degree of blood loss, any bleeding should be considered as a condition requiring immediate specialized medical care.
Treatment
At the first aid stage for capillary or small venous bleeding, it is enough to apply a pressure bandage. In case of arterial bleeding, forced limb flexion, finger pressing or tourniquet application is used. At first, in order to stop the blood immediately, the artery is pressed with fingers or a fist above the injury site, and then a tourniquet is applied. The best option is a factory harness in the form of a rubber band. If there is no such harness, you can use any improvised means: a bandage, a handkerchief, a belt, a belt or a tie. Do not use objects that can damage the fabric at the place of application (for example, wire). Under any tourniquet, if possible, a wide strip of fabric should be placed, rolled up in several layers – this will protect the underlying tissues from damage.
The tourniquet for arterial bleeding is applied above the injury site – to the middle third of the thigh or shoulder – the nerves in these places run deep enough, so there is no risk that the tourniquet will damage them. At the same time, a sufficient amount of soft tissue provides a soft, non-traumatic, but effective “squeezing” of the artery lumen and a quick stop of bleeding. Applying a tourniquet to the lower leg and forearm is irrational – due to the insufficient number of soft tissues and the location of the vessels, this method is usually not effective enough. In winter, for adults, the tourniquet is applied for a period of no more than an hour, for children – for 10-15 minutes. In summer, for adults – for 1.5-2 hours, for children – for 25-30 minutes.
The final stop of bleeding is performed in a specialized medical institution. Orthopedic traumatologists usually treat patients with capillary and venous bleeding. Traumatologists or vascular surgeons can help a patient with arterial bleeding. To stop external bleeding, vascular suturing is used, less often – tamponade of the wound. If large arterial trunks are damaged, a vascular suture may be applied. The operation to stop bleeding is carried out urgently and is accompanied by general measures aimed at compensating for blood loss and preventing the development of complications.