Clinic of sharp blood loss

The clinical picture of bleeding is defined by extent of blood loss, features of damages of fabric, a look and caliber of the damaged vessels, and also is the basic – where there is a blood loss: in environment, in a body cavity, in a gleam of body or in organism fabric

A) Local symptoms at external bleeding.

At arterial external bleedings the streaming blood has bright red color, beats a strong stream, jumps out pushes according to pulse.

At venous bleeding blood dark and cherry, follows a uniform stream: at wound of large veins pulsing of a stream of blood, however according to not pulse, but breath can be observed. Wound of large veins in a neck dangerously by development of an air embolism of brain vessels or vessels of heart: at the time of a breath in these vessels there is negative pressure. At capillary bleeding of the separate bleeding vessels it isn't visible, blood exudes as from a sponge. On coloring costs on the verge between arterial and venous. Capillary bleeding quickly stops independently and matters only at the lowered coagulability of blood (hemophilia, a liver disease, sepsis).

Parenchymatous bleeding is observed at damage of parenchymatous bodies: liver, spleen, kidneys, lungs. All wound surface owing to abundance of blood vessels in internals bleeds.

At traumatic damage or development of pathological process in the field of a vessel internal bleeding is observed. Diagnosis of internal obvious bleedings is more difficult, than external as blood in this or that look gets to environment not at once, and through certain time. If bleeding occurs in a gleam of hollow bodies, blood streams through natural openings outside, it is difficult to define a source of such bleeding. So, release of blood through a mouth can be caused by bleeding from lungs, a trachea, a gullet, a stomach, a duodenum. Therefore color and a condition of the streaming blood matter: foamy, scarlet blood – a symptom of pulmonary bleeding, vomiting "a coffee thick" - gastric or duodenal. The black tar-like chair (melen) is a symptom of bleeding from the top departments of a digestive tract, allocation from a rectum of scarlet blood – bleedings from sigmovidny, obodochny or a rectum. Bleeding from kidneys is shown by scarlet coloring of urine – haematuria.

The clinic and diagnosis of the internal latent bleedings (in the closed body cavities is most difficult: skull cavity, spinal channel, chest and belly cavities, pericardium, joint cavity). At bleeding in a pleural cavity (haemothorax) obtusion of a perkutorny sound over the corresponding surface of a thorax, weakening of breath, shift of a sredosteniye, and also phenomenon of respiratory insufficiency is noted.

The blood congestion in an abdominal cavity (haemoperitoneum) is connected with wound and the closed stomach injury, damage of parenchymatous bodies, vessels of a bryzheyka, with the broken extra-uterine pregnancy, a rupture of an ovary, etc. Against blood loss local symptoms are defined: an abdominal distension, weakening of a vermicular movement, obtusion of a perkutorny sound in sloping places of a stomach, positive symptoms of irritation of a peritoneum. Bleeding in a cavity of a joint (haemartrosis) it is shown by increase in a joint in volume, sharp morbidity, malfunction.

Clinical manifestations of sharp blood loss irrespective of localization of a source of bleeding are characterized by the general objective symptoms: pallor and humidity of skin, the frequent small pulse which is speeded up by breath, decrease in venous and arterial pressure.

Subjective symptoms: dizziness, dryness in a mouth, nausea, "front sights" before eyes, the increasing weakness.

At an assessment and recognition of blood loss estimate also its weight. It is estimated, based on character (arterial, venous). Speed an izlitiya of blood depends on caliber of vessels. Weight of internal bleedings should be determined by expressiveness of symptoms of blood loss.

Distinguish 4 extents of blood loss: easy, average, heavy and massive.

1. Easy degree (to 500 ml) – quantity of erythrocytes over 3 million, level of hemoglobin is higher than 100 g/l, gematokrit higher than 30%, pulse rate to 100 уд. in a minute, the HELL is higher than 100 mm of mercury. Deficiency of OTsK to 10%, ChVD – 106 mm. водн. St.

2. Average degree – loss from 500 to 1000 ml. The quantity of erythrocytes within 2,5-3,5 million, hemoglobin level from 80 g/l to 100 g/l, gematokrit 25-30%, pulse rate – to 100 уд, in a minute, the HELL from 100 to 80 mm of mercury. deficiency of OTsK of 15-20%, TsVD – 72 mm водн. St.

3. Heavy extent of blood loss – quantity Ayr, is less than 2,5 million, pulse rate higher than 120 in min., systolic the HELL is lower than 80 mm Hg. Loss to 21-30% of OTsK (100-1500 ml) and more, TsVD – 46 mm водн. St.

4. Massive blood loss – loss more than 30% of OTsK (more than 1500 ml.).

Odnomomomentny blood loss more than 40% VCB (the volume of the circulating blood) is incompatible with life.

Hemorrhagic shock – one of types of gipovolemichesky shock, its clinic appears, since blood loss of 25-30% of OTsK). Allocate 3 stages of hemorrhagic shock:

The I stage – the compensated reversible hemorrhagic shock (a syndrome of small emission) is caused by blood loss which is well compensated by changes of cardiovascular activity. The consciousness is kept, the patient is pale, the cold snap of extremities, hypodermic veins zapustevat, pulse of weak filling, А/Д the normal. Oligouriya: diuresis is reduced half (norm of 30-40 ml/hour), TsVD is lowered or negative.

The II stage – dekompensirovanny reversible shock – a spasm артериол doesn't support normal haemo dynamics any more. Pulse rate to 120-140 beats per minute, the low pulse arterial pressure (the HELL of systolic lower than 100 mm Hg). Pallor of integuments, short wind, cyanosis against pallor, an oliguriya (less than 20 ml/h). At the patient hypotonia due to manifestations of violations of an organ blood-groove in a liver, kidneys, heart, a brain progresses; акроцианоз, short wind. Tones of heart deaf; "a shock lung".

The III stage – irreversible hemorrhagic shock. It is characterized long (more than 12 h.) uncontrollable hypotonia, inefficiency of transfusion therapy, development of polyorgan insufficiency.

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