Sharp blood loss – irrevocable loss of blood within a short period of time. Arises owing to bleeding from the damaged vessels. Influences a condition of all bodies and systems. Loss of considerable volume of blood is followed by development of the hemorrhagic shock posing a threat for the patient's life. The trauma and some diseases can become the reason of sharp blood loss. HELL, short wind, euphoria or oppression of consciousness is shown by pallor, tachycardia, decrease. Treatment – elimination of a source of bleeding, infusion of blood and blood substitutes.
Sharp blood loss
Sharp blood loss – a state at which the organism quickly and forever loses a certain volume of blood as a result of bleeding. Is the most widespread injury of a human body during all history. Arises at injuries (both opened, and closed) and destruction of a wall of a vessel at some diseases (for example, ulcer processes in digestive tract). Loss of large volume of blood poses hazard to life owing to sharp reduction of OTsK and the subsequent development of a hypoxia, a gipoksemiya, hypotonia, insufficiency of blood supply of internals and metabolic acidosis. In hard cases also development of the DVS-syndrome is possible.
Than the volume of blood loss is more and than quicker blood streams, that serious condition of the patient and is worse the forecast. Besides, reaction of an organism is influenced by such factors as age, the general condition of an organism, intoxication, chronic diseases and even season (loss of blood is transferred to warm season heavier). Loss of 500 ml (10% of OTsK) at the adult healthy person does not lead to essential violations of haemo dynamics and does not need special correction. At loss of similar volume by the patient having a chronic disease completion of OTsK with blood use, a shelter - and plasma substitutes is necessary. Most heavier this state is transferred by the elderly people, children and pregnant women having toxicosis.
Most often injuries become the reason: wounds of soft fabrics and internals, multiple fractures or injuries of large bones (for example, heavy change of a basin). Besides, sharp blood loss can result from a stupid trauma with a rupture of this or that body. Wounds with damage of large vessels, and also wounds and ruptures of parenchymatous bodies are especially dangerous. Among diseases which can cause blood loss – stomach ulcer and a duodenum, Mallori-Weiss's syndrome, the cirrhosis which is followed by a gullet varicosity, malignant tumors of a GIT and bodies of a thorax, lung gangrene, a heart attack of a lung and other diseases at which destruction of a wall of a vessel is possible.
There are several sistematization of sharp blood loss. Most widely in clinical practice the following classification is used:
- Easy degree – loss to 1 liter (10-20% of OTsK).
- Average degree – loss to 1,5 liters (20-30% of OTsK).
- Heavy degree – loss to 2 liters (40% of OTsK).
- Massive blood loss – loss more than 2 liters (more than 40% of OTsK).
Besides, allocate supermassive or deadly blood loss at which the patient loses over 50% of OTsK. At such sharp blood loss even in case of immediate completion of volume in absolute majority of cases irreversible changes of a homeostasis develop.
At sharp blood loss of easy degree receptors of veins therefore there is a resistant and total venous spasm are irritated. Considerable haemo dynamic violations are absent. Completion of OTsK at healthy people happens within 2-3 days due to activization of a hematopoiesis. At loss over 1 liter not only venous receptors, but also alpha receptors of arteries are irritated. It causes excitement of sympathetic nervous system and stimulates neurohumoral reaction – emission by bark of adrenal glands of a large number of catecholamines. At the same time the amount of adrenaline exceeds norm by 50-100 times, quantity of noradrenaline – at 5-10 times.
Under the influence of catecholamines capillaries, and then and larger vessels spazmirutsya at first. Sokratitelny function of a myocardium is stimulated, there is tachycardia. The liver and a spleen are reduced, throwing out to the vascular course blood from depot. In lungs arteriovenozny shunts reveal. Everything listed allows to provide within 2-3 hours with necessary amount of blood vitals, to support HELL and level of hemoglobin. In the subsequent neuroreflex mechanisms are exhausted, the angiospazm is succeeded by a vazodilatation. The blood-groove in all vessels decreases, arises erythrocytes. Exchange processes in fabrics are even more broken, metabolic acidosis develops. Everything listed forms a picture of a gipovolemiya and hemorrhagic shock.
Weight of hemorrhagic shock is defined with pulse, the arterial pressure, a diuresis and laboratory indicators (a gematokrit and the content of hemoglobin in blood). Under the influence of an aldosteron in kidneys arteriovenozny shunts open, as a result blood "is dumped", without passing through the yukstaglomerulyarny device that leads to sharp decrease in a diuresis up to an anury. Because of hormonal changes plasma does not come out vessels in interstitsialny fabrics that, along with deterioration in microcirculation, aggravates violations of fabric exchange even more, makes heavier acidosis and provokes development of polyorgan insufficiency.
The listed violations completely do not manage to be stopped even at immediate completion of blood loss. After restoration of OTsK the lowering of arterial pressure remains within 3-6 hours, violation of a blood-groove in lungs – within 1-2 hours, violation of a blood-groove in kidneys – within 3-9 hours. Microcirculation in fabrics is restored only for 4-7 day, and complete elimination of consequences takes many weeks.
Symptoms and diagnostics
Symptoms of sharp blood loss sudden weakness, increase of pulse, decrease HELL, pallor, thirst are among, dizziness, preunconscious states and faints. In hard cases short wind, periodic breath, cold sweat, loss of consciousness and marble coloring of integuments is possible. Along with clinical signs there are laboratory indicators allowing to estimate blood loss volume. The quantity of erythrocytes decreases lower than 310 ¹ ²/l, gematokrit – lower than 0,35. However the transferred figures only indirectly testify to degree of sharp blood loss as results of analyses reflect the real course of events with some "lag", that is, at massive blood loss during the first hours analyses can remain normal. Especially often it is observed at children.
Considering the aforesaid, and also not specificity of signs of sharp blood loss (especially easy or moderate), it is necessary to pay special attention to external signs. At external bleeding establishment of the fact of loss of blood does not represent difficulties. At internal bleeding consider indirect signs: a blood spitting at pulmonary bleeding, vomiting "a coffee thick" and/or to a melen at pathology of a gullet, stomach and intestines, tension of a forward belly wall and obtusion at percussion in sloping departments of a stomach at damage of parenchymatous bodies etc. Data of survey and the anamnesis supplement with results of tool researches. If necessary carry out a X-ray analysis, MRT, ultrasonography, a laparoscopy and other researches, appoint consultations of the vascular surgeon, the abdominal surgeon, the thoracic surgeon and other experts.
treatment should be carried out only under the supervision of a doctor. Self-treatment is unacceptable!!!
Tactics of treatment depends on the volume of sharp blood loss and a condition of the patient. At loss to 500 ml special events are not required, restoration of OTsK happens independently. At loss to 1 liter the issue of completion of volume is resolved differentially. At tachycardia no more than 100 beats/min, normal HELL and a diuresis of infusion are not shown, in case of violation of these indicators pour plasma substitutes: physical solution, glucose and dextran. Decrease HELL is lower than 90 mm of mercury is the indication for drop infusion of colloidal solutions. At decrease HELL is lower than 70 mm of mercury. make jet transfusions.
At average degree (to 1,5l) transfusion of plasma substitutes in the volume which by 2-3 times exceeds the size of loss of OTsK is required. Along with it transfusion of 500-1000 ml of blood is recommended. At heavy degree blood transfusion and plasma substitutes in the volume which by 3-4 times exceeds the size of loss of OTsK is necessary. At massive blood loss it is required to pour 2-3 volumes of blood and several volumes of plasma substitutes.
Criteria of adequate restoration of OTsK: pulse no more than 90 beats/min, stable HELL of 100/70 mm of mercury., hemoglobin of 110 g/l, TsVD of 4-6 cm of water column and diuresis more than 60 ml/h. At the same time one of the major indicators is the diuresis. Restoration of a mocheotdeleniye within 12 hours from the beginning of blood loss is one of paramount tasks as otherwise kidney tubules nekrotizirutsya, and the irreversible renal failure develops. For normalization of a diuresis use infusional therapy in a combination to stimulation by furosemide and eufilliny.