Prev. 100Hemiptera2 Hemlock1 Hemlock Tree1 Hemophelia1 Hemorhage1 Hemorrhage2Hemorrhoids1 Hemostatic1 Hemp3 Hempen cravat1 Hempen Fever1 Hempen Widow1 Hem-self1 Hen1 Hen and Chickens1 Hen House1 Henbane2 Hence1 Hende2 Hendeliche1 Hendi1 Hendred1 Heng1 Henge1 Hengist and Horsa1 Hen-hearted1 Henne1 Hennes1 Hennes-forth1 Hen-party1 Hen-pecked1 Henpecked1 Henrietta Keddie1 Henrietta Maria of France1 Henriette Sontag2 Henri-Frédéric Amiel2 Henry1 Henry Alford1 Henry Andrews (mathematician)1 Henry Blackburn1 Henry Brooke1 Henry Brougham, 1st Baron Brougham ...1 Henry Carey1 Henry Cecil, 1st Marquess of Exeter1 Henry Charlton Bastian1 Henry Chettle1 Henry Cholmondeley Pennell1 Henry Christmas1 Henry Cockburn, Lord Cockburn1 Henry Crabb Robinson1 Henry David Inglis1 Henry Edward Manning1 Henry Edward Napier1 Henry Ellis (librarian)1 Henry Esmond1 Henry Fawcett1 Henry Fielding2 Henry Fothergill Chorley1 Henry Francis Carey1 Henry Francis Lyte1 Henry George Liddell1 Henry Hallam1 Henry Hart Milman1 Henry Home, Lord Kames1 Henry Howard, Earl of Surrey1 Henry I of England4 Henry II of England7 Henry III of England1 Henry IV of England13 Henry James Byron1 Henry James Pye1 Henry James Sumner Maine1 Henry John Temple, 3rd Viscount Pal...1 Henry John Todd1 Henry King1 Henry Kingsley1 Henry Kirk White1 Henry Kirke White1 Henry Liddon1 Henry Longueville Mansel1 Henry Mackarness1 Henry Mackenzie1 Henry Mayhew1 Henry More1 Henry Morley1 Henry Nelson Coleridge1 Henry Neville1 Henry Nicol1 Henry Noel-Fearn1 Henry Rogers1 Henry Roscoe1 Henry Rose (priest)1 Henry Savile (Bible translator)1 Henry Scott Riddell1 Henry Sidgewick1 Henry Spelman1 Henry St John, 1st Viscount Bolingb...1 Henry Taylor (dramatist)1 Henry Thomas Buckle1 Henry V of England2 Prev. 100

Hemorrhage

 Hæmorrhage

Hæmorrhage, when caused by an artery being divided or torn, may be known by the blood issuing out of the wound in leaps or jerks, and being of a bright scarlet colour. If a vein is injured, the blood is darker and flows continuously. To arrest the latter, apply pressure by means of a compress and bandage. To arrest arterial bleeding, get a piece of wood (part of a mop handle will do), and tie a piece of tape to one end of it; then tie a piece of tape loosely over the arm, and pass the other end of the wood under it; twist the stick round and round until the tape compresses the arm sufficiently to arrest the bleeding, and then confine the other end by tying the string round the arm. A compress made by enfolding a penny piece in several folds of lint or linen, should, however, be first placed under the tape and over the artery.

If the bleeding is very obstinate, and it occurs in the arm , place a cork underneath the string, on the inside of the fleshy part, where the artery may be felt beating by any one; if in the leg , place a cork in the direction of a line drawn from the inner part of the knee towards the outer part of the groin. It is an excellent thing to accustom yourself to find out the position of these arteries, or, indeed, any that are superficial, and to explain to every person in your house where they are, and how to stop bleeding.

If a stick cannot be got, take a handkerchief, make a cord bandage of it, and tie a knot in the middle; the knot acts as a compress, and should be placed over the artery, while the two ends are to be tied around the thumb. Observe always to place the ligature between the wound and the heart . Putting your finger into a bleeding wound, and making pressure until a surgeon arrives, will generally stop violent bleeding. 


Hemorrhage

Definition. The escape of blood from the blood vessels in great or small quantities, is called hemorrhage, and may occur either spontaneously or because of injury.

Spontaneous hemorrhage  occurs in the organs and cavities of the body as a result of constitutional diseases, such as tuberculosis, syphilis, cancer, etc., in which erosion of tissue extends into vessels. It is also a result of a constitutional tendency. Persons with this, so called hemorrhagic diathesis, are known as hemophiliacs.

In hemophilia, uncontrollable bleeding may occur from trifling injuries.

Hemorrhage due to Injury  may be classified as follows:

a—arterial
b—venous
c—capillary

(a ) Arterial hemorrhage may be recognized by rapid, spurting jets of red blood, occurring synchronous with the heart beat.

(b ) Venous bleeding (from a vein) occurs as a steady even stream of dark blood, not affected by the heart beat.

(c ) Capillary hemorrhage is in the form of a steady stream oozing from the raw surface of a tissue. The color is intermediary, as both arterial and venous capillaries contribute to it.

Nature's Efforts to Control Hemorrhage. When an artery is severed, the inner and middle coats immediately retract and curl up within the lumen, partially closing up the cut end.

Blood has the property of clotting, if it comes in contact with anything but the natural endothelial lining of the vessels.

The curling in of the inner and middle coats retards the escaping stream and facilitates coagulation within the cut end of the vessel now formed by the outer coat alone. When the hemorrhage is severe, these processes are reinforced by an increased tendency to coagulate, and by a weakened heart action.

The Control of Hemorrhage. The object of treatment in every case is to check the flow of blood, and, though death from ordinary wounds is rare, yet the loss of much blood is weakening for a long time.

The principle on which we act in our efforts to permanently stop bleeding, depends on the power which the blood has of clotting, or as it is called, coagulating.

If by any means the blood can be made to “stand still” in a blood vessel at the point of injury, it will clot, thus forming a plug which prevents further escape.

In wounds involving only small veins or capillaries from which there is no distinct jet of blood (capillary hemorrhage), pressure of the thumb, a wad of sterile gauze intervening, will usually suffice in a few minutes. Gauze dipped in hot water applied to such wounds, also at times effects a stoppage of such bleeding. Often only tight bandaging is necessary.

Bleeding from large arteries or veins can be controlled temporarily by pressure directly over the wound.

Temporary control may also be obtained by digital pressure above or below the wound, if in a leg or arm, depending upon whether the escape is chiefly from a vein or an artery, for in any wound some of the bleeding will be capillary. This method, or the application of a tourniquet, will absolutely control bleeding in an extremity.

The pressure in arterial hemorrhage must be applied at a point nearer the heart and in venous hemorrhage at a point away from the heart.

A tourniquet may be devised from a handkerchief, a piece of rope or of rubber tubing wound around the limb and tightened just enough to arrest the main stream; in addition, pressure exerted over the wound will control whatever hemorrhage persists. Such a control can only be temporary, as the arrest of circulation in an extremity below the tourniquet for more than an hour or two might cause gangrene. However, there is no great fear of this occurring, as some blood reaches the parts through deep vessels.

Permanent control of such hemorrhages can only be effected by grasping the severed vessels in the open wound with artery clamps, and then ligating below the clamps with cat gut.

Deep-seated hemorrhages, in the abdomen or chest, can often be controlled by pressure directly over the wound until an open operation can be performed.

Deep pressure, with the fist upon the abdomen just to the left of the vertebral column, will compress the aorta and greatly reduce the escape of blood from any artery supplied by the descending aorta.

Hemorrhage in Chiropody. For the chiropodist, bleeding is an annoying and especially perplexing occurrence. The feet are the most bacteria-laden part of the body; here are warmth and moisture, congenial to bacteria, and a thick epidermis for their safe concealment. When hemorrhage occurs, therefore, its proper control along antiseptic lines is imperative.

The vessels severed are rarely of sufficient size to cause the escape of blood in an actual stream, but rather as a rapid oozing. It is, as a rule, capillary hemorrhage.

The methods for its control have already been described in this chapter, and will always stop such bleeding.

In chiropodial practice, however, the degree of bleeding determines the method of treatment, and, though the extreme may fall short of actual danger, it still behooves the operator to control it absolutely before dismissing his patient.

Easily Controlled Bleeding. The degree of bleeding or slight oozing, as it should be termed, incident to skiving a calloused surface, is well controlled with styptics.

In employing these substances it should be borne in mind that they are not usually antiseptic but, on the contrary, may harbor organisms which may be transferred to the wound and cause infection. The subsulphate of iron, commonly employed in the form of Monsel's solution, is usually employed because of its efficiency as a styptic, and because of the fact that it is less irritating than others. It, however, is not antiseptic and should be kept sterile and uncontaminated by dropping it upon the wound directly from the bottle, rather than by dipping the cotton-wound applicator into it, as is so frequently done. Even this does not prevent an originally sterile bottle of solution from becoming contaminated, exposure to the air, when the stopper is removed, admitting many bacteria each time.

A superior styptic has been supplied in the form of dry subsulphate of iron fused to small sticks of wood. These are efficient because of their cleanliness, each being used but once and at no appreciable expense.

It is needless to say that the dressing of even so slight a wound should prevent the admission of infection to the thousands of portals of infection which are present. A bandage is not indicated nor justifiable, and the cotton collodion cocoon suffices.

Persistent Bleeding. When bleeding occurs which does not yield to the effects of a styptic because of its constant washing away when applied, it becomes necessary to apply pressure to the wound. Frequently a wad of cotton or gauze, pressed firmly upon the bleeding area, will almost stop the bleeding in a few minutes, after which it becomes possible to apply the styptic. Should this, however, be found impossible and the bleeding resume when the pressure is released, clotting in the vessel can only be expected by the agency of either ligation of the tissue or any individual vessel or more commonly by tight bandaging. The latter procedure usually accomplishes the control of the hemorrhage incident to a deep dissection for papilloma or verucca.

A pad of several thicknesses of sterile gauze is placed upon the wound and held in place by a few turns of narrow bandage, applied quite tightly. Though blood may be seen to “spot” through this dressing, it should occasion no alarm unless the hemorrhage has been clearly either venous or arterial. Under such circumstances the spurting, either constant or intermittent, will give immediate evidence of its character. Active hemorrhage of this nature may yield to tight bandaging, but ligation of the vessel should be done.

Venous or Arterial Bleeding  requiring ligation may be easily dealt with, and every chiropodist should be equipped with a small artery clamp with which to grasp the tissues; he should also be provided with sterile catgut, sizes 0 or 00, with which to ligate a bleeding vessel.

Antiseptic Precautions. In dealing with hemorrhage of even the slightest degree, it should be remembered that portals of entrance for bacteria upon the feet require every antiseptic precaution, both as to the treatment of the wound, and as to the instruments and dressings which come in contact with it.

For open wounds the U. S. P. tincture of iodin, diluted in water to one-half strength, is antiseptic and not extremely irritating.

Instruments dipped in pure phenol and dried on sterile gauze are rendered sterile and may be safely employed.

Dry sterile gauze in the dressing of a clean surgical wound is all that is necessary. Healing in the absence of infection will be prompt. The habitual use of ointments and wet dressings should be discountenanced, except in the presence of a real indication.