In the article, we will look at how to determine internal bleeding. This is a pathological condition in which there is an outpouring of blood either into the natural cavities of the body (bladder, stomach, lungs, uterus, joint cavity, etc.), or into the space artificially formed by this blood (intermuscular, retroperitoneal). Symptoms of internal bleeding depend on the degree of blood loss and its localization and usually include dizziness, drowsiness, weakness, loss of consciousness. This pathology is diagnosed on the basis of visual examination data, the results of CT, MRI, radiography and some endoscopic studies. In this case, infusion therapy is carried out, surgical relief of the source of bleeding.
Description
Many are wondering how to identify internal bleeding. This condition is characterizedloss of blood when it does not flow out, but into any cavity of the human body. This condition can be caused by a chronic illness or injury. The massive nature of blood loss, diagnostic difficulties in determining the causes and characteristics of the pathology, late patients seeking help increase the severity of this problem and turn bleeding into a threat to life. Treatment is provided by specialists in neurosurgery, clinical traumatology, thoracic, vascular and abdominal surgery.
Causes of illness
The cause of internal bleeding can be both trauma and various chronic diseases. Life-threatening massive bleeding after an injury to the abdominal cavity can occur due to blunt abdominal trauma with damage to the liver and spleen, less often to the intestines, pancreas or mesentery (when falling from a height, impact, traffic accident, etc.). Bleeding into the pleural cavity can occur with multiple fractures, accompanied by damage to the pleura and intercostal vessels. In isolated cases, fractures of 1-2 ribs are the cause of such pathologies.
After an injury, internal bleeding is the easiest to recognize.
Bleeding into the cranial cavity is one of the most dangerous complications of traumatic brain injury. Since the skull, unlike other natural cavities, has a rigidly fixed volume, even a small amount of outflowing blood provokes compression of the brain structures and poses a threat to the patient's life. Necessarytake into account that intracranial bleeding can occur not only immediately after an injury, but also after a while, sometimes even against the background of absolute well-being.
Bleeding into the joint cavity can be triggered by fractures and bruises of the joints. These conditions do not pose an immediate danger, but if left untreated, they can lead to many complications.
Intracavitary
erosive gastritis, etc. Gastrointestinal bleeding according to ICD-10 code is K92.2.
In addition, Mallory-Weiss syndrome is common in surgical practice, when a patient develops esophageal fissures as a result of alcohol abuse or a single large meal.
Another common cause of bleeding into the abdominal cavity is gynecological pathologies: ectopic pregnancy, ovarian ruptures, etc. In gynecological practice, bleeding after abortions is often observed. It is also possible the occurrence of this pathology with premature detachment of the placenta or presentation, ruptures of the birth canal and uterus during the birth process.
Below, consider the types of bleeding andways to stop them. It is useful for everyone to have this information.
Types of bleeding
In medicine, there are several classifications of this pathology:
- Due to the cause of occurrence: arrosive internal bleeding (as a result of damage to the vessel wall during necrosis, tumor decay and its germination, or in the presence of a destructive process) and mechanical (as a result of traumatic damage to blood vessels). In addition, diapedetic bleeding is distinguished, which occurs due to the high permeability of the walls of small vessels (with sepsis or scurvy).
- Taking into account the volume of blood loss: mild (10-15% of the total blood volume), moderate (16-20%), severe (21-30%), massive (more than 30%), fatal (50-60 %) and absolutely fatal (over 60%).
- Depending on the nature of the damaged vessel: venous, arterial, mixed and capillary. If blood is poured from a capillary vessel of a certain parenchymal organ (spleen, liver, etc.), such bleeding is called parenchymal bleeding.
- Depending on location: hemothorax (bleeding into the pleural cavity), gastrointestinal (into the cavity of the stomach, esophagus or intestines), into the hemopericardium (into the pericardial sac), into the joint cavity, etc.
- Depending on the place of blood accumulation: interstitial bleeding (into the thickness of tissues) and cavitary (into the abdominal, pleural and other cavities)
- Depending on the presence or absence of signs of bleeding: obvious, when the blood comes out throughnatural holes, and hidden when it stays inside the body.
- Depending on the time of occurrence: primary bleeding that occurs immediately after an injury to the vascular wall, and secondary bleeding that develops after a certain time. Secondary bleeding, in turn, is divided into early (occur on days 1-5) and late (on days 10-15).
Symptomatics
So how do you spot internal bleeding? Early signs of this pathological phenomenon are weakness, pallor of the mucous membranes and skin, drowsiness, severe dizziness, thirst, cold sweat, darkening of the eyes. Fainting may occur. Doctors can judge the degree of blood loss both by changes in the patient's blood pressure and pulse and by some other clinical symptoms. With slight blood loss, there is a slight increase in heart rate, a decrease in pressure, however, clinical signs may be absent.
What other signs are used to judge internal bleeding? Its moderate form is evidenced by a decrease in systolic pressure to 90-80 mm. rt. Art. and tachycardia up to 90-100 beats / min. The patient's skin is pale, there is a cooling of the extremities and increased respiration. Possible fainting, dry mouth, dizziness, nausea, severe weakness, weakness, slow reaction.
In severe bleeding, there is a decrease in pressure up to 80 mm. rt. Art. and more, the pulse quickens to 110 or more. There is a significant increasebreathing and disturbance of its rhythm, cold sweat, pathological drowsiness, darkening of the eyes, hand tremor, apathy, dyspepsia, decrease in the amount of urine, severe thirst, change in consciousness, severe pallor of the skin, cyanosis of the nasolabial triangle and extremities.
With massive internal bleeding, the pressure drops sharply, and the pulse reaches 140-160 beats / min. The patient has periodic breathing, confusion, severe pallor, delirium. With fatal blood loss, a coma sets in.
With pulmonary bleeding, a cough with bright blood may occur, with the accumulation of which in the pleural cavity there is severe shortness of breath, lack of air.
First aid
What is the first aid for pulmonary bleeding or any other form of it? The victim with this pathology should go to a medical facility as soon as possible. But he needs first aid before the ambulance arrives. To do this, it is recommended to follow a certain algorithm of actions:
- Create absolute rest for the patient - the person must be immobilized.
- Position victim in a sitting position (if symptoms suggest pulmonary or gastrointestinal bleeding). In other cases, the patient is placed on a horizontal surface.
- Apply cold to the affected area.
If possible, it is recommended that you transport the patient to the hospital yourself.
Diagnosis
If internal bleeding is suspectedintestinal tract or any other, a series of diagnostic procedures should be carried out to confirm the diagnosis and determine the causes of blood loss. As a mandatory procedure, a detailed examination is carried out, which includes measuring the pulse and pressure, percussion and palpation of the abdominal cavity, and auscultation of the chest. To assess the severity of the condition, laboratory tests of the level of hemoglobin and erythrocytes are carried out.
The choice of research methods is carried out taking into account the alleged cause of the development of the pathological process.
If gastrointestinal bleeding is suspected (in ICD-10 pathology code K92.2) probing, examination of the rectum, colonoscopy, esophagogastroduodenoscopy and sigmoidoscopy are performed, in case of lung diseases - bronchoscopy, in case of bladder lesions it can be prescribed performing cystoscopy. In addition, ultrasonic, X-ray and radiological methods are used.
As already noted, it all depends on the type of bleeding.
Ways to stop them
With this pathological condition of a person, it is necessary to ensure his transportation to the hospital as quickly as possible. If pulmonary bleeding or hemothorax is suspected, the patient is given a sitting position, with bleeding in other areas, they are placed on a flat surface. It is strictly forbidden to apply heat to the affected area, give enemas, or inject heart preparations into the body.
Treatment for internal bleeding must be timely. Treatment of hemothorax is carried out by traumatologists, pulmonary bleeding - by thoracic surgeons, intracranial hematomas - by neurosurgeons, uterine bleeding - by gynecologists. In case of blunt abdominal trauma and gastrointestinal bleeding, the patient is hospitalized in the general surgery department.
What are the main tasks?
The main tasks in this situation are to urgently stop internal bleeding, compensate for blood loss and normalize blood microcirculation. From the very beginning of therapy for preventive purposes (prevention of the development of the empty heart syndrome), in order to restore the volume of circulating blood and prevent hypovolemic shock, jet transfusion of solutions of glucose, blood, saline, blood and plasma substitutes is carried out.
When pulmonary bleeding occurs, tamponade of the bronchus is performed. With small and medium hemothorax, a pleural puncture is performed; with severe hemothorax, the patient is shown a thoracotomy with suturing of the lung injury or ligation of the injured vessel. In case of hemorrhage into the abdominal cavity, an emergency laparotomy is performed, suturing the wounds of the liver, spleen or other damaged organ. With the formation of an intracranial hematoma, specialists perform a craniotomy.
For gastric ulcers, resection of this organ is performed, the development of Mallory-Weiss syndrome - endoscopic hemostasis, cold application, administration of aminocaproic acid, antacids and blood clotting stimulants.
Infusion therapy is carried out under the control of cardiac output, blood pressure, central venous pressure and diuresis. The volume of infusion is determined taking into account the degree of blood loss. Blood substitutes for hemodynamic effects are used: Reopoliglyukin, Dextran, solutions of sugars and s alts, as well as blood products (fresh frozen plasma, albumin, erythrocyte mass).
If through infusion therapy fails to normalize blood pressure, dopamine, epinephrine or norepinephrine is administered after stopping the bleeding. Dipyridamole, Pentoxifylline, Heparin and hormonal drugs are used to treat hemorrhagic shock.
Surgery
In cases where conservative treatment does not give the desired result, the patient is shown surgery.
Internal bleeding during ectopic pregnancy is considered an indication for emergency intervention. Dysfunctional bleeding from the uterus due to abortion or after childbirth is also treated surgically.
Cauterization of vessels
Sometimes the relief of internal bleeding is carried out by cauterization of a bleeding vessel or tamponade. But in most cases, the patient needs emergency surgery under general anesthesia. If there are signs of hemorrhagic shock or the threat of its occurrence at all stages (preparation, surgery, postoperative period), transfusion measures are carried out. WeConsidered how to determine internal bleeding. The main thing is to do everything quickly and correctly, then a person's life can be saved.
