Medicine of Urgent Situation 3

Tasks and organization of Tasks and organization of urgent medical care for victims urgent medical care for victims

of the emergency situations. of the emergency situations. First aid in case of bleeding.First aid in case of bleeding.

Intensive therapy of hemorrhagic Intensive therapy of hemorrhagic shock. shock.

Yuri ShkatulaYuri Shkatula

Every year from 44 to 70 thousand people suffer from traumas, Every year from 44 to 70 thousand people suffer from traumas, poisonings and accidents. This is a reproductive part of our population poisonings and accidents. This is a reproductive part of our population which is able to work. In case of undue first medical aid 20% of victims which is able to work. In case of undue first medical aid 20% of victims

die.die.

The main reason of death is massive bleeding and as the The main reason of death is massive bleeding and as the result of disfunction of vitally important inner organs.result of disfunction of vitally important inner organs.

BleedingBleeding, is the loss of blood out the circulatory , is the loss of blood out the circulatory system. Bleeding can occur internally, where blood system. Bleeding can occur internally, where blood

leaks from blood vessels inside the body or leaks from blood vessels inside the body or externally, either through a natural opening such as externally, either through a natural opening such as the vagina, mouth or anus, or through a break in the the vagina, mouth or anus, or through a break in the skin. The complete loss of blood is referred to as skin. The complete loss of blood is referred to as exsanguination, and , and desanguination is a massive is a massive

blood loss. Loss of 10-15% of total blood volume can blood loss. Loss of 10-15% of total blood volume can be endured without clinical manifestation in a healthy be endured without clinical manifestation in a healthy

person.person.

Traumatic bleeding is caused by some type of injury. There are different Traumatic bleeding is caused by some type of injury. There are different types of types of wounds which may cause traumatic bleeding. which may cause traumatic bleeding. These include:These include:

Abrasion - Also called a graze, this is caused by transverse action of a foreign object against - Also called a graze, this is caused by transverse action of a foreign object against the skin, and usually does not penetrate below the the skin, and usually does not penetrate below the epidermis

Excoriation - In common with Abrasion, this is caused by mechanical destruction of the skin, - In common with Abrasion, this is caused by mechanical destruction of the skin, although it usually has an underlying medical cause although it usually has an underlying medical cause

Hematoma - (Also called a blood tumor) - Caused by damage to a blood vessel that in turn - (Also called a blood tumor) - Caused by damage to a blood vessel that in turn causes blood to collect under the skin. causes blood to collect under the skin.

Laceration - Irregular wound caused by blunt impact to soft tissue overlying hard tissue or - Irregular wound caused by blunt impact to soft tissue overlying hard tissue or tearing such as in childbirth. In some instances, this can also be used to describe an incision. tearing such as in childbirth. In some instances, this can also be used to describe an incision.

Incision - A cut into a body tissue or organ, such as by a - A cut into a body tissue or organ, such as by a scalpel, made during surgery. , made during surgery.

Puncture WoundPuncture Wound - Caused by an object that penetrated the skin and underlying layers, such as - Caused by an object that penetrated the skin and underlying layers, such as a nail, needle or knife a nail, needle or knife

Contusion - Also known as a bruise, this is a blunt trauma damaging tissue under the surface of - Also known as a bruise, this is a blunt trauma damaging tissue under the surface of the skin the skin

Crushing Injuries - Caused by a great or extreme amount of force applied over a period of - Caused by a great or extreme amount of force applied over a period of time. The extent of a crushing injury may not immediately present itself. time. The extent of a crushing injury may not immediately present itself.

Ballistic Trauma - Caused by a projectile weapon, this may include two external wounds (entry - Caused by a projectile weapon, this may include two external wounds (entry and exit) and a contiguous wound between the two and exit) and a contiguous wound between the two

Hemorrhaging is broken down into 4 classes by Hemorrhaging is broken down into 4 classes by the American College of Surgeonsthe American College of Surgeons

Class IClass I Hemorrhage involves up to 15% of blood volume. There is typically no Hemorrhage involves up to 15% of blood volume. There is typically no change in vital signs and fluid resuscitation is not usually necessary. change in vital signs and fluid resuscitation is not usually necessary.

Class II Class II Hemorrhage involves 15-30% of total blood volume. A patient is often Hemorrhage involves 15-30% of total blood volume. A patient is often tachycardic (rapid heart beat) with a narrowing of the difference between the tachycardic (rapid heart beat) with a narrowing of the difference between the systolic and diastolic blood pressures. The body attempts to compensate with systolic and diastolic blood pressures. The body attempts to compensate with peripheral vasoconstriction. Skin may start to look pale and be cool to the touch. peripheral vasoconstriction. Skin may start to look pale and be cool to the touch. The patient might start acting differently. Volume resuscitation with crystalloids (The patient might start acting differently. Volume resuscitation with crystalloids (Saline solution or or Lactated Ringer's solution) is all that is typically required. ) is all that is typically required. Blood transfusion is not typically required. Blood transfusion is not typically required.

Class III Class III Hemorrhage involves loss of 30-40% of circulating blood volume. The Hemorrhage involves loss of 30-40% of circulating blood volume. The patient's patient's blood pressure drops, the heart rate increases, peripheral perfusion, such drops, the heart rate increases, peripheral perfusion, such as capillary refill worsens, and the mental status worsens. Fluid resuscitation with as capillary refill worsens, and the mental status worsens. Fluid resuscitation with crystalloid and crystalloid and blood transfusion are usually necessary. are usually necessary.

Class IV Class IV Hemorrhage involves loss of >40% of circulating blood volume. The Hemorrhage involves loss of >40% of circulating blood volume. The limit of the body's compensation is reached and aggressive resuscitation is limit of the body's compensation is reached and aggressive resuscitation is required to prevent death. required to prevent death.

Types of bleedingsTypes of bleedings

Bleedings can be traumatic, operating and Bleedings can be traumatic, operating and spontaneousspontaneous..

Bleedings can be internal and externalBleedings can be internal and external..

Bleedings can be arterialBleedings can be arterial, venous, venous and capilyar and capilyar..

Bleedings can be primaryBleedings can be primary oror secondarysecondary..

Bleedings can be one-shotBleedings can be one-shot and repeatedand repeated..

SymptomsSymptoms Blood coming Blood coming out ofout of an an open wound Bruising Shock, which may cause any of the following Shock, which may cause any of the following

symptoms: symptoms: Confusion or decreasing alertness or decreasing alertness Clammy skin Dizziness or light-headedness after an injury Dizziness or light-headedness after an injury Low blood pressure Low blood pressure Paleness Paleness Rapid pulse, increased heart rate Rapid pulse, increased heart rate Shortness of breath Shortness of breath Weakness Weakness

Classification of bleedingsClassification of bleedings((A.GA.G..BrussovBrussov,1998).,1998).

TypeType TraumaticTraumatic

PathologicPathologic

ArtificialArtificial

InjuryInjury

Tumor and other diseasesTumor and other diseases

Medical exfusionMedical exfusion

The speed of The speed of developmentdevelopment

OccureOccure

SuboccureSuboccure

ChronicChronic

More than More than 7% 7% VCBVCB per hourper hour

5-7% 5-7% VCBVCB per hourper hour

Less thanLess than 5% 5% VCB per hourVCB per hour

VolumeVolume SmallSmall

MediumMedium

LargeLarge

MassiveMassive

LethalLethal

0,5-10% 0,5-10% VCBVCB (0,5 (0,5 ll))

10-20% 10-20% VCBVCB(0,5 – 1,0 (0,5 – 1,0 ll))

21 – 40 21 – 40 VCBVCB(1,0 – 2,0 (1,0 – 2,0 ll))

41 – 70% 41 – 70% VCBVCB (2,0 – 3,5 (2,0 – 3,5 ll))

More thanMore than 70% 70% VCB VCB

Classification of bleedings Classification of bleedings ((A.GA.G..BrussovBrussov,1998).,1998).

Degree of Degree of hypovolemiahypovolemia

LightLight

MediumMedium

HardHard

Extremely hardExtremely hard

Deficit of VCB 10-20%Deficit of VCB 10-20%

No shockNo shock


Shock develops in case of long Shock develops in case of long hypovolemia hypovolemia


Shock is inevitableShock is inevitable

Deficit of VCB 40%Deficit of VCB 40%

Shock, terminal conditionShock, terminal condition

Empiric volume of traumatic bleeding:Empiric volume of traumatic bleeding:

HaemothoraxHaemothorax - - 1,5 – 21,5 – 2ll Fracture of Fracture of oneone rib - rib - 0,2 – 0,5 0,2 – 0,5ll Trauma of Trauma of the abdomenthe abdomen - to - to 2 2ll Fracture of Fracture of bones of the pelvicbones of the pelvic - - 3,0 – 5,03,0 – 5,0ll Fracture of the hipFracture of the hip -- 1,0 – 2,5 1,0 – 2,5ll Fracture of the shoulderFracture of the shoulder//shankshank - - 0,5 – 1,50,5 – 1,5ll Fracture of the forearmFracture of the forearm - - 0,2 – 0,50,2 – 0,5ll Fracture of the spine cord -Fracture of the spine cord - 0,5 – 1,5 0,5 – 1,5ll ScalpedScalped injuryinjury (palm size) - (palm size) - 0,5 0,5ll

Shock index of Algover (1967)Shock index of Algover (1967)

Pulse/Pulse/arterial pressurearterial pressure(60/120)=0,5(0,54)(60/120)=0,5(0,54)

If this index is 1 (100/100) than the volume of If this index is 1 (100/100) than the volume of bleeding is 20% of VCB;bleeding is 20% of VCB;

If this index is 1,5 (120/80) than the volume of If this index is 1,5 (120/80) than the volume of bleeding is 30 – 40% of VCB;bleeding is 30 – 40% of VCB;

If this index is 2 (120/60) than the volume of bleeding If this index is 2 (120/60) than the volume of bleeding is 50% of VCB.is 50% of VCB.

Symptoms of internal bleeding may also include:Symptoms of internal bleeding may also include:

Abdominal pain Abdominal pain Abdominal swelling Abdominal swelling Chest pain Chest pain External bleeding through a natural opening External bleeding through a natural opening

Blood in the stool (appears black, maroon, or bright red) Blood in the stool (appears black, maroon, or bright red) Blood in the urine (appears red, pink, or tea-colored) Blood in the urine (appears red, pink, or tea-colored) Blood in the vomit (looks bright red, or brown like coffee-Blood in the vomit (looks bright red, or brown like coffee-

grounds) grounds) Vaginal bleeding (heavier than usual or after menopause) Vaginal bleeding (heavier than usual or after menopause)

First aidFirst aid

Stopping of an external bleeding.Stopping of an external bleeding. Immobilisation.Immobilisation. AAneneaasthesthessationation

Infusion therapyInfusion therapy

Methods of stopping of bleedings.Methods of stopping of bleedings.







Headband of HyppocrateHeadband of Hyppocrate

Calculation of the infusion speedCalculation of the infusion speed

С= Δ • М • 20 : К, С= Δ • М • 20 : К,

wherewhere С – С – speedspeed, , dropsdrops//minmin.; .; Δ – Δ – the dose of medicinethe dose of medicine, , mkgmkg//kgkg//minmin.; .; М-М-weightweight,, kg kg;;20- 20- quantity of dropsquantity of drops in in 1м1мll;;К –К –concentration of medicine,concentration of medicine, мк мкgg/м/мll..

Documents

Medicine of Urgent Situation 3