Wounds of main vessels. Bleedings and loss of blood Distinguish the open and closed wounds of vessels.

Open - damages of vessels concern which are accompanied by infringement of integrity of skin covers. The majority of fire damages of vessels concern to open. losed damages - which are not accompanied by infringement of integrity of skin covers. .

The special kind of the closed damages of vessels are the concussions or !contusions! of vessels arising in reply to a trauma. "n these cases arises e#pressed spasm of the damaged vessel and there can be a break of an internal environment of a vessel with possible it turn in a gleam and fast formation of a blood clot. This kind of damages is especially characteristic for wounds by bullets or splinters with high speed of flight$ thus the damages of vessels can arise on significant distance from the wound channel. By the form damages of a vessel should be distinguished% wounds of arteries$ veins$ capillaries. On character of damages of vessels distinguish:

omplete cross wounds "ncomplete cross wounds &ateral wounds Through wounds Tangential wound On character of a clinical picture distinguish: Without e#terior bleeding and pulsing hematoma With a primary bleeding With formation of pulsing heamatoma Arising at wounds of vessels of a bleeding divide on: arterial venous mi#ed parenchymatous Outside "nternal "ntratissular "ntracavitary "ntracavitary The bleedings can be

The bleedings arising at once after a wound name primary.

The bleedings arising as a result of complications of wounds name secondary. The secondary bleedings can be repeated. The secondary bleedings arise after a stop primary. Dangers of secondary bleedings: bleedings:

B(

'rise always suddenly 're be plentiful Occur at amnesia of the patients Weakened of the patient Early secondary bleedings: (ushing out of a blood clot after an e#it from a shock and restoration "mperfect immobili)ation *ough transportation Displacement of bone fragments Displacement of alien bodies Late secondary bleedings:

"nfection in a wound 'rrosion of a wall of vessel Decubitus of a wall of a vessel from pressure by bone$ splinter$ drainage$ tampon +aving dug pulsations - hematoma or aneurysm Harbingers of a close bleeding are: ,udden increase of temperature without attributes of a delay of pus Occurrence of a pulsation in places where there were only !noise! Harbingers of a close bleeding are:
onnection of noise to available infringement of pulse Occurrence of fine clots of blood in wound effluent

The beginning bleeding must be stopped fast. The urgent radical operation is shown. Degrees of ischemia at damages of vessels -. ompensated ischemia$ described by absence of frustration of sensitivity and impellent function Degrees of ischemia at damages of vessels : b. /ot compensated ischemia$ which is subdivided into the first stage 0there are frustration of sensitivity and impellent function. and second stage at development ischemic contracture.

"n the first stage not compensated ischemia by the bleeding is necessary for restoring not later than in 1-2 hours$ and at the second stage the restoration of a bleeding is contra-indicated linical picture

-. 3eneral b. &ocal !eneral symptoms

 "schemia of all conducting organs and systems is characteristic and first of all /,. 4or amnesic of a head brain the headaches are characteristic vertigo$ confusion of consciousness down to its loss$ noise in ears$ flashed midges before eyes$ cold sweat$ fear. The reduction of volume circulating erythrocytes results in increase of breath. !eneral symptoms ompensatory number of heartbeats is increased and B( falls. Decreases central venous pressure. omes hypo#ia of hepatic crates with infringement of its function. Decreases diuresis$ there comes centrali)ation of blood circulation. The local clinic depends on a degree of indemnification ischemia .
Temporary stop of a bleeding:

On a place of incident% tourni5uet. +ard tamponade of a wound pressing bandage$ forced bending e#tremity$ pressing of a bleeding vessel. "roblems of wounds of main vessels 4eatures of fire wounds ,everity of a condition +emorrhage Time it is a lot of on operation omple#ity of diagnostics 6 damage of bones 6 e#tensive damage of soft tissues Treatment of wounds of vessels (lastics of veins ,ynthetic artificial vessels ,hunting Temporary shunting

Hemorrhage +emorrhage is the most often symptom of a sharp trauma main of blood vessels$ is especial at wounds of subclavicular$ iliac$ femoral and popliteal arteries. #everity of hemorrhage: hemorrhage: (re-clinic stage 7 899 ml$ the volume of central blood circulation 0: B . is restored due to transport of the e#tracell fluid into vessels. ;iddle stage 7 <999 ml$ <9-=9> of : B $ blood circulation is centrali)ed$ compensation of hemorrhagic shock 'verage stage 7 <899 ml$ up to ?9> of : B $ stage of decompensation ,evere stage - =999 ml and more 't hemorrhage of an average and severe degree the reali)ation of transfusion therapy$ including transfusion of large molecular de#tran$ of hormonal preparation

and transfusion of blood is necessary. Than$ you for attention %