Bleeding Expulsive

Expulsion bleeding is an extreme case of bleeding, when blood flows out of a wound in excess of normal and far exceeds the body’s ability to absorb it. Such bleeding can occur in children, people of both sexes, and even in the elderly in cases that would seem favorable for compensation of blood loss. The most common cause of extravasation is damage to the large main vessels of the neck or femoral artery due to trauma, cirrhosis of the liver with portal hypertension with concomitant encephalopathy, eclampsia in a precomatous state, or rupture of an aneurysm of the internal carotid arteries. In such cases, the volume of blood loss may be more than half the volume of circulating blood.\n\nExpulsive bleeding develops suddenly. The spilled blood fills the parapharyngeal space. General and local vascular-platelet reactions occur, spasms of both the system of superficial and deep veins of the legs occur, which promotes the movement of blood in the proximal direction. Blood flow to the periphery increases due to increased cardiac output, but this fluid also moves to the veins of the legs. At the same time, the venous return of blood to the heart decreases due to insufficiency of the vein valves and compression of the sternocleidomastoid muscle. These factors exacerbate the inability of the cardiovascular system to compensate for the rejected blood. After some time, the tension of the vein wall in the zone of the first pulse increases sharply, the vein is cut by an arterial jet. The counterflow of blood flow leads to equalization of pressure in the container and vein. The deeper the vein wall is cut, the larger volumes of blood pass per unit time, and the more it flows out. There is a rapid decrease in the total volume of blood circulating at that time, as a result of which the general condition of the victim significantly worsens. The BCC deficit can reach 50–60% of the calculated value. Blood pressure approaches zero, cardiac output is reduced to the minimum pumping ability of the heart, and peripheral circulation ceases. Central hemodynamics is restored on its own as soon as the tension in the walls of the main veins subsides. After 7–10 days, threatening complications often occur due to the coagulation of bleeding tissue, which is accompanied by the formation of blood clots in the area of ​​the ulcer (the so-called thrombi in