Эффективность различных способов временной остановки наружного кровотечения на догоспитальном этапе оказания помощи

Abstract

Objective. To estimate the efficiency of different methods of temporary external hemostasis at the pre-hospital stage of emergency medical care, taking into account the localization of injuries. Material and Methods. The cases (n=86) of prehospital emergency medical care for patients with external bleeding were studied. The data on the victims (age, gender), clinical status (type and location of injuries, type of bleeding), the volume of emergency care, the hemostasis methods used to control bleeding, their efficiency, side effects, difficulty of use were collected, and the duration of the pre-hospital stage were also taken into account. Results. The study found out that the most common cause of external bleeding is domestic accident (45.35%) of cases. By the nature of tissue damage, the cut wounds prevailed. Multiple or combined injuries occurred in 13.95% of cases. A tourniquet was the main method of hemostasis. Contact hemostatic agents were used only in 2.32% of cases at the pre-hospital stage. In some cases, when attempting to control the external bleeding, several hemostatic agents were sequentially used due to the lack of their efficacy. In 17.4% of cases, the victims with multiple or combined injuries received intravenous administrationof the systemichemostatic agents. In the complex of anti-shock measures in patients with severe trauma 77.91% of the prehospital patients underwent infusion therapy. Isotonic crystalloid solutions were used. A reliable increase in the duration of the prehospital stage of victims who underwent to a combination of hemostasis methods and intravenous infusion has been registered. The increase in the length of the prehospital stay occurs at the expense of the time required for creation of venous access and initiate infusion. The authors propose the algorithm for temporal control of external bleeding during emergency medical care at the pre-hospital stage. Conclusion. The main principles that need to be guided in the choice of any methods for stopping of bleeding are the speed and reliability of hemostasis for entire time of evacuation and the minimum damaging effect on the tissues. What this paper adds The effectiveness of various methods for temporal external hemostasis at the pre-hospital stage of emergency medical treatment taking into account the localization of injuries was estimated. It has been established that the main principles that must be followed in choosing any of the methods for stopping the bleeding are the speed and reliability of hemostasis for the entire duration of evacuation and the minimal tissue damage.