Main methods of hemorrhage control
Under conditions where specialized surgical intervention is unavailable, the following methods for temporary blood loss cessation are used:
- Digital pressure of the artery. Performed at typical anatomical points proximal (above) to the bleeding site.
- Maximum limb flexion. The joint (hip, knee, or elbow) is flexed to the limit and securely fixed in this position.
- Application of a hemostatic tourniquet. A standard rubber tourniquet or an improvised tourniquet-windlass made from improvised materials using a lever is used.
- Pressure bandage. The optimal method for arresting venous or capillary bleeding, often supplemented with a cotton-gauze pad.
- Application of a clamp to the vessel. A hemostatic clamp is fixed directly to the stump of the damaged vessel right in the wound.
Rules for applying a hemostatic tourniquet
A tourniquet is an effective but traumatic tool. Its use requires strict adherence to technique:
- Before starting the manipulation, the injured limb must be elevated.
- The tourniquet is applied as close as possible to the level of the injury.
- To avoid pinching the skin, a soft fabric must be placed under the rubber.
- Rule of the first turn: bleeding must stop after the very first stretched turn.
- All subsequent turns are applied in a spiral in the proximal direction. They must overlap and serve only to secure the result, after which they are fixed with a clasp.
- The area with the applied tourniquet must not be covered — it must be clearly visible.
- A note indicating the exact time of its application must be attached under the tourniquet.
Typical errors and their consequences
Errors during tourniquet application can lead to fatal consequences or limb loss.
- Insufficient tightening: does not block arterial inflow, but blocks venous outflow. Paradoxically, this leads to increased venous bleeding from the wound.
- Excessive tightening: severely traumatizes soft tissues and nerve trunks, which can cause their subsequent necrosis.
Place of hemostasis in the anti-shock complex
Temporary cessation of hemorrhage is one of the main elements of the anti-shock management complex. These actions are strictly regulated and should begin as early as possible, even if there are no overt life-threatening disorders yet.
In addition to hemostasis, the algorithm includes:
- Elimination of the shockogenic factor (safe extrication from rubble or extinguishing flames without inflicting additional injuries).
- Pain relief (systemic analgesics or novocaine blockades, such as fascial compartment blockade of the limb or Shkolnikov intrapelvic blockade for pelvic fractures).
- Immobilization of injuries.
- Normalization of circulating blood volume (CBV) and correction of homeostasis.
- Maintenance of respiration and circulation (in case of clinical death, performing cardiopulmonary resuscitation according to the ABC rule: Airway — maintaining airway patency, Breathing — artificial ventilation, Circulation — closed-chest cardiac massage).
After rendering first aid, gentle and rapid transportation of the casualty to a hospital for definitive treatment is indicated.
Briefly: answers to topical questions
What are the indications for applying a vascular clamp?
The application of a vascular clamp is used for the temporary arrest of hemorrhage in a wound, starting from the stage of primary medical and emergency care. In surgical practice, this method is indicated in the following cases:
- Arrest of bleeding in the surgical wound — applying a clamp to a bleeding vessel or stump.
- Hemostasis of small vessels — a mosquito clamp is used.
- Temporary blood flow occlusion — a vascular clamp ("Bulldog") is used without injuring the vessel wall.
- Vessel transection — application of a clamp (e.g., Fedorov renal clamp) before dividing the artery and vein.
- Working in deep wounds — a curved hemostatic clamp is used.
What types of novocaine blockades are used for anesthesia in trauma?
For local anesthesia in trauma, standard and special types of novocaine blockades are used.
- Fracture site blockade — injection of an anesthetic directly into the hematoma surrounding the bone fragments.
- Circular limb blockade — creation of a transverse anesthetic "screen" proximal to the injury site.
- Shkolnikov-Selivanov intrapelvic blockade — injection of the drug into the fascial sheath of the iliac fossa (insertion at the spina iliaca anterior superior) in pelvic fractures.
- Intercostal nerve blockade — performed proximal to the site of rib fracture.
- Vagosympathetic blockade — used for chest injuries.
- Paranephric blockade — indicated for extensive burns or crush syndrome.
- Peripheral nerve blockades — regional nerve block anesthesia.
Rule of the first turn: remember that it is the very first stretched turn of the rubber tourniquet that must occlude the artery and stop the bleeding. The subsequent turns are needed only for fixation. Under-tightening increases bleeding, over-tightening causes necrosis.
Class and exam questions
Why is it impossible to permanently stop bleeding at the scene of an incident?
Definitive hemostasis requires full surgical exploration of the wound and reconstruction of injured vessels, which is technically feasible only in a specialized hospital setting.
What is a pressure bandage used for?
A pressure bandage is used primarily for the arrest of venous or capillary bleeding when applying an arterial tourniquet is inappropriate.
What will happen if the tourniquet is not tightened securely enough?
Insufficient tension of the tourniquet will compress only the veins while maintaining arterial inflow, leading to a sharp increase in venous bleeding from the wound.
What else to study on this topic
- Definitive hemostasis in a hospital setting
- Technique of local anesthesia and novocaine blockades
- Cardiopulmonary resuscitation according to the ABC rule
- Normalization of circulating blood volume (CBV) in traumatic shock
- Prevention of infectious complications in wounds
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