MEDICAL BIOLOGY, HUMAN ANATOMY, PHYSIOLOGY AND PATHOLOGY - Y.I. Fedoniuk 2010

ANATOMY, PHYSIOLOGY, PATHOLOGY

CHAPTER 5. BLOOD AND LYMPH CIRCULATION PROCESSES AND THEIR PATHOLOGY

METHODS OF BLEEDING ARREST

Temporary cessation of bleeding is achieved by digital pressure of major Blood Vessels against the bones, specifically the carotid, subclavian, brachial, femoral, and others. The carotid artery is compressed with a finger against the transverse process of the sixth cervical vertebra, which corresponds to the midpoint of the sternocleidomastoid Muscle on its medial side. The Subclavian Artery is compressed against the first rib in the area above the clavicle, lateral to the attachment point of the sternocleidomastoid muscle to the manubrium of the Sternum. The axillary artery can be compressed against the HEAD of the humerus within the axillary fossa. The brachial artery is compressed against the Medial surface of the humerus near the medial border of the biceps brachii muscle. The femoral artery is most easily compressed against the superior horizontal ramus of the pubic bone below the inguinal (Poupart's) ligament, midway between the anterior superior iliac spine and the Pubic Symphysis.

Digital pressure for temporary Hemorrhage control is rarely used. It is applied during emergency care or amputations when applying a tourniquet is contraindicated or undesirable (e.g., atherosclerosis, gas gangrene). Subsequently, at the earliest opportunity, digital pressure is replaced by a tourniquet application or definitive surgical hemostasis.

Applying a tourniquet compresses the soft Tissues of the limb along with the blood vessels against the bone. There are numerous modifications of tourniquets (windlass, pneumatic tourniquet, elastic band, etc.). Esmarch's tourniquet is the most commonly used—a thick rubber tube 1.5 meters long, equipped with a metal chain at one end and a hook at the other. It is utilized exclusively to stop bleeding from extremity vessels.

The technique of tourniquet application is as follows. A heavily stretched tourniquet is wrapped around the proximal end of an elevated limb 2-3 times, after which it is tied or secured by fastening the hook into the chain. To prevent Skin pinching, a soft cloth or towel is placed underneath the tourniquet, accompanied by a note indicating the exact date and time (hours and minutes) of application. For arterial injuries, the tourniquet is applied proximal to the wound site to completely occlude the vessel. When correctly applied, the pulse in the peripheral Arteries distal to the tourniquet is absent. A tourniquet should not be left in place for more than 2 hours; during this period, it must be temporarily released for a few minutes every 30-60 minutes while maintaining hemostasis via digital pressure.