What are hemorrhages? Hemorrhage is the more or less copious release of blood from a vein or artery due to accidental or spontaneous rupture of the same.
HOW HEMORRHAGE IS CLASSIFIED
There are many classifications that can be made of hemorrhages, since each one addresses a different aspect. However, the most common classification of hemorrhages are:
Hemorrhages according to their cause
Hemorrhages can be divided into traumatic and pathological hemorrhages according to their cause.
- Traumatic hemorrhages: these are those produced by an external agent that, acting suddenly on the tissues, cuts or tears blood vessels.
- Pathological hemorrhages: these are hemorrhages produced by a disease, either local to the bleeding vessel, such as an aneurysm, or general, such as scurvy, hemorrhagic purpura, etc.
Hemorrhages according to their type
Bleeding can be divided into arterial, venous and capillary types, depending on whether the bleeding vessel is an artery, a vein or a capillary. Bleeding of two or three of these types often occurs simultaneously in the same wound.
Arterial hemorrhage
Arterial hemorrhage is usually the most dangerous type of bleeding. Arterial bleeding can usually be recognized by the following characteristics: (a) The blood is bright red, clear and shiny.
(b) It comes out in a strong jet, animated by intermittent increases that occur with each heartbeat. However, when arterial bleeding occurs deep in a wound, the intermittent jet may not be visible on the outside, because it hits the injured deep tissues. However, its arterial origin can still be recognized by its light red color and its abundance.
(c) The blood comes quickly. It may happen that the wound has cut an artery and a vein simultaneously; in this case the blood will be darker in color. The quantity of blood will, in this case, be even more abundant.
Venous hemorrhage
When the injury is to a vein, the blood is a very dark reddish colour and usually comes out continuously, without force due to the low pressure of the blood in the veins.
If the injured vein is large, the blood comes out in a large and continuous jet, and can become dangerous. In the case of injuries to the large venous trunks at the base of the neck, there is a risk of air penetration, which will go to the heart where it can cause a life-threatening gas embolism.
Capillary hemorrhage
In capillary bleeding, the blood, which is between the bright red of arterial blood and the dark red of venous blood, comes out in the form of small drops. In general, the amount that comes out is not abundant or very persistent, unless the person suffers from purpura, hemophilia, or some disease that modifies blood coagulation or the behavior of the vessels.
Hemorrhages according to the site where they occur
Depending on where it occurs, the bleeding will be external or internal.
- External bleeding: external bleeding is that which has a visible origin, usually caused by a wound on the surface of the body, in which case the blood spills out.
- Internal bleeding: internal bleeding is that which occurs in a closed cavity, for example, that produced in the peritoneum by a rupture of the spleen or liver. These are the internal bleedings per se. When they occur in a hollow organ that communicates by nature with the outside, such as the stomach or the lung, in which, after being produced, the blood is generally expelled to the outside, they really constitute a mixed type of bleeding: internal at the time of its occurrence, and external when the blood is expelled to the outside.
Hemorrhages according to the time at which they occur
Taking into account the time or moment in which they occur, hemorrhages can be divided into immediate, late and secondary.
- Immediate hemorrhages: this type of hemorrhage is very common. In these cases, the injury to the vessel is immediately followed by the spilling of blood.
- Late hemorrhages: late hemorrhage occurs minutes or hours after the injury. A serious example of this type of hemorrhage is the case of the main artery of a limb that has been torn off, which sometimes does not bleed for a while, due to the plug formed by the inward coiling of the inner layer of the vessel and the drop in blood pressure caused by the loss of consciousness caused by such a serious trauma.
- Secondary hemorrhages: secondary hemorrhage is the type of hemorrhage that occurs days after a surgical intervention or trauma. It is due either to the shedding of dead tissue, commonly called bedsores, or to an infection.
WHAT ARE THE SYMPTOMS OF A HEMORRHAGE
Generally, one of the most common symptoms of hemorrhage is fainting, which is caused by the sight of blood. In many cases, this is favorable, since the drop in blood pressure caused by fainting tends to stop the hemorrhage.
If the hemorrhage had stopped or decreased, it may reappear when the victim regains consciousness. If the loss of blood is abundant, the symptoms that have been collectively called acute anemia appear in rapid succession or almost simultaneously.
Other symptoms of hemorrhage are increasing weakness, shortness of breath, dizziness, ringing in the ears, and thirst. Blood pressure drops, and the pulse becomes rapid and weak. There is restlessness, nervousness, and even nervous excitement in the injured person.
The skin becomes pale and cold, the lips and nails colorless and sometimes slightly blue. Breathing, at first rapid and deep, ends up becoming slow and shallow. Nausea and vomiting may also occur, as well as symptoms of shock, such as cold sweats, etc.
The pupils also dilate, the tongue becomes dry and the voice becomes very weak. If the mucous membranes are observed, they are seen to be extremely pale. Finally, syncope occurs, with irregular and spaced pulses, and if no intervention is made, death occurs.
If the bleeding is not stopped and cardiac and respiratory stimulants are given instead, blood loss continues or increases, which worsens the patient's condition even more.
WHAT IS FIRST AID FOR HEMORRHAGE
In general, first aid measures for hemorrhage are:
- Lay the injured person down. If the bleeding is severe, place the head lower than the feet. The stillness of the injured part helps the formation of a clot.
- If the wound is covered by clothing, uncover it. Avoid any compression of the body, loosening the collar, belt, and any bandages. Avoid cooling the injured person.
- If the wound is on a limb, elevate that limb.
- Stop the bleeding by one of the temporary or provisional methods mentioned below:
If the hemorrhage is small
- It is almost always sufficient to apply direct pressure to the wound with a pad made of sterile gauze, or failing that, with clean handkerchiefs or another piece of clean, recently ironed clothing.
- Cotton can be placed on top of the pad, maintaining the pressure, once it has been seen to be effective, with a bandage that provides moderate compression.
If the hemorrhage is of medium intensity
A) If there is a medium, intermittent stream of light red blood.
- Press between the heart and the wound with your fingers.
- If the bleeding stops, you are applying pressure in the right place. If you cannot find a place to apply pressure, apply pressure directly to the edge of the wound or to the wound itself with a sterile gauze pad or clean handkerchief. If the bleeding still does not stop, apply a temporary tourniquet.
If the hemorrhage is very heavy
A) If there is an intermittent thick stream.
- Apply a tourniquet as soon as possible as a temporary treatment between the heart and the wound. We will show you how to do this later in this article.
- If you do not know how to apply a tourniquet or know where to press on the artery, simply put your fingers in the wound and apply pressure where the stream is coming from.
- You will likely contaminate the wound by doing this, but the important thing is to save the life of the injured person.
- Apply a tourniquet between the limb and the wound, or apply pressure between the wound and the limb.
WHAT IS THE USE OF THE TOURNIQUET IN FIRST AID IN CASE OF HEMORRHAGE?
A tourniquet is a constriction band applied to a limb in such a way that it can be tightened to the point of stopping the flow of arterial blood. This tool is the most useful in first aid, its management and treatment of hemorrhages.
In first aid for hemorrhage, the tourniquet is used mostly to stop major arterial bleeding, and sometimes to a lesser extent to prevent poison injected into a wound by a snake or other poisonous animal from entering the general circulation.
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| A tourniquet, one of the most commonly used first aid tools to stop hemorrhage. |
A tourniquet can be saved many lives by correctly and timely application. However, there is a tendency for tourniquets to be abused by first aid providers, which has led to the loss of limbs due to improper application.
Any patient who has a tourniquet applied should be treated as soon as possible by a doctor so that definitive hemostasis can be achieved and the limb can be removed.
How to make a tourniquet
An ideal tourniquet is the pneumatic cuff of a blood pressure machine, into which air is blown until the bleeding stops. However, any material that is at least 2 1/2 cm wide or that can be folded into a band can be used to make a tourniquet, such as a necktie, a large handkerchief, a towel, a belt, etc.
All that needs to be done with this sufficiently long band is to wrap it around the affected limb twice.
A rubber tube, of the type used for an irrigator, is often used. It is quite satisfactory to use and has the advantage of being easily found. Better, however, would be to use the flat rubber band mentioned above, as the pressure is distributed over a wider area and thus less likely to injure soft tissue.
It is important to mention that string or wire should not be used to make a tourniquet, as they injure tissue.
Where to place a tourniquet
The preferred sites for placing a tourniquet on the upper and lower limbs are one hand width below the armpit and one hand width below the groin, respectively.
However, a tourniquet should not be placed where the limb has two bones (forearm and leg), as the arteries often cannot be satisfactorily compressed in that area because they are protected in the space between the bones.
A tourniquet should also not be placed on the lower third of the arm, as it can compress and injure important nerves.
How to apply a tourniquet
The immediate treatment and the first aid procedures are used to decrease hemorrhage is the use of the tourniquet
To apply a tourniquet in case of hemorrhage, the following procedure must be followed:
- Place a handkerchief or towel, or any cloth, under the tourniquet, around the limb in that place, to protect the soft tissues.
- If the location of the main artery is known, place a pad over it, which can be a roll of bandage or can be made by folding a handkerchief, towel or any cloth. In this way, the pressure exerted by the tourniquet will predominate on the main vessel.
- If the tourniquet is not made of elastic material and is long enough, you can wrap it tightly around the limb, and tie it in a second loop.
- Under this second loop, pass a twig, ruler, pencil, etc., which will be twisted so that the tourniquet encircles the bleeding limb.
- If the tourniquet is not long enough, wrap it around the limb only once, but leave it loose enough so that the twig or pencil can easily pass through the skin and the knot. Care should be taken in this case that the skin is not caught in the twisting.
- Another satisfactory way of applying the tourniquet is to tie a half-knot after encircling the limb with the tourniquet, place the pencil or stick on top of the half-knot and tie a full knot above it before beginning to twist.
- In the case of an elastic tourniquet, put it already taut and pass the end of the first turn across the rubber band about 10 to 15 cm from its end, in order to prevent it from slipping.
- Several turns can be made, increasing or decreasing the tension, until the bleeding is seen to cease. Join the two ends of the elastic tourniquet with a hemostatic forceps, a piece of string or a clothespin.
How much to compress a tourniquet
In the event of hemorrahage, the tourniquet should be compressed only as much as necessary to stop the flow of arterial blood and the pulse below the tourniquet. If it is compressed less, it will not prevent arterial bleeding, it will only stop venous blood. If it is compressed more, the skin, muscles and nerves may be injured.
Particular care must be taken not to leave the tourniquet in place for more than 20 minutes at a time. If it is necessary to do so, it should be loosened for a few moments every 15 or 20 minutes, to prevent gangrene from occurring in the limb where it is applied due to lack of nutrition.
Sometimes when you loosen it, you see that the bleeding does not return, or that it has greatly diminished, in which case it will be enough to apply a compressive dressing to the wound. When the patient has lost a lot of blood and when you loosen the tourniquet, the bleeding starts again, you should immediately compress it again.
If a tourniquet has to be applied to a casualty as first aid, a note should be clearly visible on the casualty's clothing stating that a tourniquet has been applied, to prevent the casualty from being left behind, which can sometimes cause injury.
Of course, it is extremely important that a tourniquet never be placed on the neck to stop bleeding, as the compression applied to stop bleeding will simultaneously crush the trachea, suffocating the casualty.
