In the article, we will consider how to determine internal bleeding. This is a pathological condition in which blood is poured 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, results of CT, MRI, radiography and some endoscopic studies. In this case, infusion therapy, surgical relief of the source of bleeding is carried out.
Description
Many are interested in how to determine internal bleeding. This condition is characterized by loss of blood when it does not flow out, but into any cavity of the human body. The occurrence of this condition may be a chronic disease or trauma. The massive nature of the blood loss, diagnostic difficulties in determining the causes and characteristics of the pathology, the late treatment of patients for help reinforce the severity of this problem and turn bleeding into a threat to life. Treatment is carried out by specialists in the field of neurosurgery, clinical traumatology, thoracic, vascular and abdominal surgery.
The causes of the disease
The cause of internal bleeding can be both an injury and various chronic diseases. Life-threatening massive bleeding after an injury, the abdominal cavity can occur as a result of blunt abdominal injuries with damage to the liver and spleen, less often the intestines, pancreas or mesentery (when falling from a height, shock, 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, the cause of such pathologies are fractures of 1-2 ribs.
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 spilled blood provokes compression of the brain structures and poses a threat to the patient's life. It must be borne in mind that intracranial bleeding can occur not only immediately after an injury, but also after some time, sometimes even against the background of absolute well-being.
Bleeding into the joint cavity can be triggered by fractures and bruises of the joints. Such conditions do not represent an immediate danger, however, in the absence of therapy, they can entail many complications.
Intracavitary
A significant proportion of the total number of internal bleeding is made up of those that occur inside the cavity of any organ and arise as a result of chronic pathologies of the gastrointestinal tract: peptic ulcer of the intestine and stomach, malignant tumors, varicose vessels of the esophagus with cirrhosis, erosive gastritis, etc. e. Gastrointestinal bleeding according to the ICD-10 code has K92.2.
In addition, Mellory-Weiss syndrome is often encountered in surgical practice, when a patient has esophageal cracks as a result of alcohol abuse or a single meal in a large volume.
Gynecological pathologies are another common cause of bleeding in the abdominal cavity: ectopic pregnancy, rupture of the ovaries, etc. In gynecological practice, bleeding after abortion is often observed. The occurrence of this pathology is also possible with premature detachment of the placenta or presentation, rupture of the birth canal and uterus during the birth process.
Below we consider the types of bleeding and how to stop them. This information is useful for everyone to possess.
Types of bleeding
In medicine, there are several classifications of this pathology:
- In connection with the cause: arrozive internal bleeding (as a result of damage to the vessel wall in case of necrosis, decay of the tumor and its germination or in the presence of a destructive process) and mechanical (as a result of traumatic damage to the vessels). In addition, diapedetic bleeding is distinguished, which occurs due to the high permeability of the walls of small vessels (with sepsis or scurvy).
- Given the volume of blood loss: lung (10-15% of the total blood volume), moderate (16-20%), heavy (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 flows from the capillary vessel of a specific parenchymal organ (spleen, liver, etc.), such bleeding is called parenchymal.
- Depending on the 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 (in the thickness of tissues) and abdominal (in the abdominal, pleural and other cavities)
- Depending on the presence or absence of signs of bleeding: obvious when blood comes out through natural openings, and hidden when it remains inside the body.
- Depending on the time of occurrence: primary bleeding that occurs immediately after an injury to the vascular wall, and secondary, which develop after a certain time. Secondary bleeding, in turn, is divided into early (occur on 1-5 days) and late (on 10-15 days).
Symptomatology
So how to determine internal bleeding? The early signs of this pathological phenomenon are weakness, pallor of the mucous membranes and skin, drowsiness, severe dizziness, thirst, cold sweat, darkening in the eyes. Fainting conditions may occur. Doctors can judge the degree of blood loss both by the change in the patient’s blood pressure and pulse and by some other clinical symptoms. With minor blood loss, a slight increase in heart rate is observed, a decrease in pressure, but clinical signs may be absent.
What are the signs of internal bleeding? Its moderate form is evidenced by a decrease in systolic pressure to 90-80 mm. Hg. Art. and tachycardia up to 90-100 beats / min. The skin of the patient is pale, cooling of the extremities and rapid breathing are noted. Fainting, dry mouth, dizziness, nausea, severe weakness, adynamia, and slow reaction are possible.
In severe bleeding, a decrease in pressure to 80 mm is observed. Hg. Art. and more, the heart rate rises to 110 or more. Significant increase in breathing and violation of its rhythm, cold sweat, pathological drowsiness, darkening in the eyes, hand tremors, apathy, dyspepsia, decreased urine, intense thirst, altered consciousness, severe pale skin, cyanotic nasolabial triangle and limbs.
With massive internal bleeding, the pressure drops sharply, and the pulse reaches 140-160 beats / min. The patient has periodic breathing, confusion, sharp pallor, delirium. With fatal blood loss, a coma occurs.
With pulmonary hemorrhage, a cough with bright blood may occur, with the accumulation of which in the pleural cavity there is marked shortness of breath, lack of air.
First aid
What is the first aid for pulmonary hemorrhage or any other form of it? The victim with this pathology should as soon as possible to the medical facility. But he needs first aid before the ambulance arrives. To do this, it is recommended to follow a certain algorithm of actions:
- Create absolute peace for the patient - the person should be immobilized.
- Position the victim in a sitting position (if the symptoms indicate pulmonary or gastrointestinal bleeding). In other cases, the patient is placed on a horizontal surface.
- Apply cold to the area of possible damage.
If possible, it is recommended that you transport the patient to the hospital yourself.
Diagnostics
If internal bleeding of the intestinal tract or any other is suspected, a series of diagnostic procedures should be performed to confirm the diagnosis and determine the causes of blood loss. As a mandatory procedure, a detailed examination is carried out, which includes the measurement of pulse and pressure, percussion and palpation of the abdominal cavity, chest auscultation. To assess the severity of the condition, laboratory tests of hemoglobin and red blood cells are performed.
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 (code K92.2 is assigned in the ICD-10 pathology), probing, rectal examination, colonoscopy, esophagogastroduodenoscopy and sigmoidoscopy are performed, bronchoscopy for lung diseases, cystoscopy may be prescribed for bladder lesions. In addition, ultrasonic, radiological 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 with maximum speed. If pulmonary hemorrhage 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, put enemas, inject cardiac drugs into the body.
Assisting with internal bleeding should be timely. The treatment of hemothorax is carried out by trauma doctors, pulmonary bleeding - by thoracic surgeons, intracranial hematomas - by neurosurgeons, uterine bleeding - by gynecologists. With blunt injuries of the abdomen and gastrointestinal bleeding, the patient is hospitalized in the General Surgery Department.
What are the main challenges?
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 (preventing the development of empty heart syndrome), to restore the volume of circulating blood and prevent hypovolemic shock, jet transfusion of glucose, blood, saline, blood and plasma substitutes is carried out.
If pulmonary hemorrhage occurs, bronchial tamponade is performed. With small and medium hemothorax, pleural puncture is performed, with severe hemothorax, the patient is shown thoracotomy with suturing of lung damage or ligation of an injured vessel. With hemorrhage in the abdominal cavity, an emergency laparotomy is performed, suturing the wounds of the liver, spleen or other damaged organ. With the formation of intracranial hematoma, specialists perform trepanation of the skull.
With gastric ulcers, a resection of this organ is performed, the development of Mellory-Weiss syndrome - endoscopic stop of bleeding, application of cold, the appointment of aminocaproic acid, antacids and blood coagulation stimulants.
Infusion therapy is carried out under the control of cardiac output, blood pressure, central venous pressure and urine output. 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 salts, as well as blood products (freshly frozen plasma, albumin, erythrocyte mass).
If it is not possible to normalize blood pressure by means of infusion therapy, after stopping the bleeding, dopamine, adrenaline or norepinephrine are administered. For the treatment of hemorrhagic shock, Dipyridamole, Pentoxifylline, Heparin and hormonal drugs are used.
Surgical intervention
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. With dysfunctional bleeding from the uterus due to abortion or after childbirth, surgical treatment is also performed.
Vascular cauterization
Sometimes relief of internal bleeding is carried out by cauterizing 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 performed. We examined how to determine internal bleeding. The main thing is to do everything quickly and correctly, then a person’s life can be saved.