Slaid 20 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.

Slaid 21 At arterial external bleedings the streaming blood has bright red color, beats a strong stream, jumps out pushes according to pulse.

Slaid 22 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.

Slaid 23 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.

Slaid 24 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 sigmoid, colon or a rectum. Bleeding from kidneys is shown by scarlet coloring of urine – haematuria.

Slaid 25 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 percussion sound over the corresponding surface of a thorax, weakening of breath, shift of a mediastinum, 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 mesentery, 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 ventricular movement, obtusion of a percussion 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.

Slaid 26 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 outpouring of blood depends on caliber of vessels. Weight of internal bleedings should be determined by expressiveness of symptoms of blood loss.

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