Bleeding

BleedingIt is advisable to distinguish between external bleeding, diagnostics available for inspection, and a variety of internal bleeding from the gastrointestinal tract, lung, abdominal cavity, soft tissue (intermuscular space, retroperitoneal tissue, etc). For all types of blood loss, the main threat to the life of the patient is not losing weight vector of the oxygen - hemoglobin, and hypovolemia - weight loss of circulating blood in General, but primarily its plasma, which leads to centralisation of blood circulation, zapustevanie small vessels parenchymatous organs, deep circulation, microtrombidiidae arterioles and venules. In turn, developing due to the fall in blood pressure and stasis in small vessels disseminated intravascular coagulation (DIC) leads to a further increase of macrothrombocytopenia. Especially often it occurs after the age of 50 years, when the depletion of the fibrinolysis system (opposing DIC-syndrome) is developing rapidly, and microtrombidiidae acquires the features of a vicious circle. One should not assume that the standard symptoms of bleeding in the gastrointestinal tract (vomiting coffee grounds, melena always helps the doctor in his diagnostic search. Often the other symptoms are either absent or found after many hours of bleeding. The most important symptoms of bleeding, developing acute: sudden dryness in the mouth, pallor, restlessness of the patient, zapustevanie peripheral veins are a symptom of "empty vessels". Usually observed tachycardia when bleeding in the gastrointestinal tract or in the abdominal cavity may be absent due to irritation of the vagus nerve (vagal reflex). The mere detection of the symptom of "empty vessels" on the background of dryness in the mouth and pallor is sufficient grounds for immediate on/in 1 l of fresh frozen plasma jet or a quick drops (about 100 in 1 min). The need for transfusion of erythrocyte mass in acute blood loss may not be objectivesyou the blood counts, and hemoglobin level and content of erythrocytes in the next hours after acute blood loss can be almost within the normal range in any degree the actual anemizatsii. Therefore, the indicator in determining the need for transfusion of erythrocyte mass, the amount is pronounced pallor of conjunctiva, mucous membranes, shortness of breath (part of the wings of the nose in the act of breath), persisting after transfusion of plasma anxiety or workload (more common in older people). Usually you need to pour the plasma is much larger than red blood cells. Except in cases of massive blood loss, transfusion therapy should begin not with red blood cells, and fresh frozen plasma. When a small blood loss is not accompanied by circulatory disorders (dyspnea, tachycardia, fall in blood pressure), transfusion therapy is either not needed, or can be limited to the transfusion of saline or colloid solutions, plasma substitutes. Transfusion of whole blood in all cases of bleeding contraindicated (except when the doctor has no components of the blood, fresh frozen plasma and erythrocyte mass), as agglomerates of erythrocytes in whole blood and largely inactivated in it the factors of fibrinolysis lead to the deepening of DIC in acute blood loss, which in turn triggers the resumption stopped bleeding. It should be borne in mind that the elderly often bleeding from acute gastric ulcers themselves are defined DIC-syndrome arising in connection with some other diseases (myocardial infarction, ischemic stroke, collapse in severe infections, etc). After repeated bleeding, even if still not showing signs of circulatory disorders, it is advisable to transfusion of fresh frozen plasma rapid drops in quantities of 500-1000 ml with hemostatic purpose..



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