HOSPITAL

After identifying the type of hemorrhage, arterial, venous, capillary, a position is ensured that increases the amount of blood, and implicitly of oxygen, to vital organs, brain, kidneys, liver, etc.

For conscious patients, supine position without a pillow is indicated, with the lower limbs elevated at 30-400, with the head below the body level. Patients with brain trauma are an exception.

The unconscious patient is placed in a lateral decubitus position with the lower limbs elevated at 30-400 with the head below the body level.

The application of temporary hemostasis depends on the size of the hemorrhage and its location.

If the bleeding is very strong or if the patient has a severed limb, a tourniquet is applied. The tourniquet can be improvised from an elastic rubber tube (preferable) or any flexible, but non-elastic material: tie, scarf, handkerchief rolled diagonally, socks, etc.

Temporary artificial hemostasis

·       Application of tourniquet;

·       Digital compression;

·       Maximum flexion in the joint;

·       Elevated position of the member;

·       Compression bandage;

·       Padding the wound;

·       Applying hemostatic forceps to the vessel;

·       Temporary bypass.

The tourniquet is applied to the proximal part of the arms (on four sides of the finger under the armpit), for bleeding of the upper limb, and to the proximal part of the thighs for bleeding of the lower limb.

The tourniquet is applied by fixing a roll of gauze or textile material in the area of ​​the main artery, noting on a ticket the date and time when it was applied.

 In venous hemorrhages, the tourniquet is applied below the wound.

The tourniquet is tightened in such a way as to stop the circulation, but to maintain the color of the integuments close to the normal one.

The tourniquet is maintained for a maximum of 2 hours, loosening it for 1-2 minutes every 20 minutes - an interval to allow tissue irrigation, during which hemostasis is ensured by remote digital compression.

Warm up the patient progressively, giving him warm drinks and warming his extremities with bottles or bags of warm water. Depending on the severity of the hemorrhage, macromolecular solutions will be used to compensate the hemorrhage - Dextran 70 (Macrodex), Dextran 70 (Rheomacrodex), amino acid solutions - Aminofusin pediatric, Aminoplasmol Lx-10, Aminosteril KE800, Aminosteril L400. Gelatin solutions can also be administered - Haemacel, Plasmogel, Marisang or human Albumin type products

If possible, oxygen is administered by nasal probe or mask, so that the red blood cells, which are reduced in number and circulate faster than usual through the lungs, have a greater amount of oxygen available.

The removal of the tourniquet is done by a doctor, because all the necessary measures must be taken to intervene promptly at the first manifestations of the shock produced by lifting the tourniquet,

In parallel with performing hemostasis, in cases where the hemorrhage has exceeded 700-1000 l in an adult person or much smaller amounts in adolescents and children, the circulating mass will be restored by transfusion.

Clinical and paraclinical supervision takes into account the pulse, breathing, BP, with the aim of immediately intervening in case of cardiorespiratory arrest.

To make breathing easier, remove or loosen the clothing parts that press the neck, chest or abdomen.

Blood is collected to determine the blood group, hematocrit, hemoglobin, blood count.

Definitive hemostasis is performed in the hospital in the surgical services and consists of:

·       cauterization of the sectioned vascular ends;

·       tamponade of wounds;

·       ligation of vessels;

·       clamping with permanent hemostatic forceps.