Hemostasis

This article describes medical measures to stop bleeding. For the body's own mechanisms of primary hemostasis, also referred to as hemostasis, see there.

As hemostasis those measures are referred to a bleeding stop or bring to a standstill. In addition to the body's own hemostasis mechanisms ( hemostasis ), there are various medical practices that lead to sealing of opened blood vessels mechanically, thermally or by means of high voltage. Drugs and medical aids to stop bleeding are called hemostatics , hemostyptics or antihemorrhagics.

Emergency medical measures

In emergency medicine , elevating injured parts of the body can reduce the blood pressure at the bleeding site. A pressure bandage is usually applied to the wound, which is usually sufficient. Gauze pads can be placed under a tight wrap to increase the pressure. A proximal compression of the artery, a squeezing of the artery close to the body from the bleeding, is also possible. Certain anatomical points where there is a bony abutment ( arteria subclavia , arteria brachialis , arteria temporalis superficialis , arteria femoralis and arteria poplitea ) are useful for this . The setting is used when no adequate hemostasis can be achieved by pressure. Clamping off vessels is usually not indicated in emergency medicine.

surgery

Surgical sutures can be avoided by using fibrin glue or tissue glue, as the substance sticks the wound edges together and is detached by the physiological wound healing process without the wound reopening. This means that sensitive tissues can be spared. In dentistry, the fibrin glue is sometimes combined with a collagen fleece. Oxidized cellulose can also initiate hemostasis.

In surgery, vessels can be tied off ( ligature ) or closed by means of "piercing" (Z-shaped suture around the blood vessel), larger vessels can also be sutured. Smaller diffuse hemorrhages are tamponized locally, and mucosal hemorrhages are burned. Swabs soaked with adrenaline are also used for tamponade , which causes the blood vessels to contract ( vasoconstriction ). Hollow organs and deep wounds can all be tamponized .

Physical methods ( cauterization ) are also used to stop bleeding . In monopolar HF surgery (high-frequency surgery ), high-frequency alternating current is applied to the instruments (e.g. the electric scalpel, cautery), and coagulation begins immediately on the surface of the cut tissue, i.e. the bleeding is stopped. To remove larger amounts of tissue, deep coagulation is used, in which the tissue is heated over a large area in the depth, which is determined by the strength of the current, and can be removed later. In bipolar HF surgery, a high-frequency voltage is applied between two electrodes, and the thermal energy generated due to the electrical resistance leads to a thermal seal of the tissue or blood vessel. In some cases, direct thermal cautery methods are also used by placing a hot filament (thermocautery) at the location of the bleeding.

With an argon beamer , hemostasis can be brought about endoscopically. In the case of very heavy bleeding, liquid plastics, plastic balls or fibrin sponges can be brought to the bleeding site via a catheter, which is known as embolization .

Bone wax , often a mixture of sterilized beeswax and petroleum jelly, is used for mechanical hemostasis in the case of bone damage , with which the fine pores of the spongy bone substance ( cancellous bone ) are closed.

Systemic hemostasis

For systemic hemostasis, lysine analogs, e.g. B. tranexamic acid and aprotinin , both inhibitors of fibrinolysis, are related.

In coagulation disorders due to lack of blood clotting factors or platelets are blood plasma , genetically produced clotting factors or platelet concentrates used. Corresponding antidotes are used in cases of poisoning with substances that inhibit blood clotting , for example vitamin K in coumarin poisoning.

Individual evidence

1. ↑ S3- guideline for multiple trauma / treatment of seriously injured persons of the DGU . In: AWMF online (as of 07/2011)

literature

• Walter von Brunn : On the history of hemostasis , The medical world 9 (1935), p. 107f.
• EF Heeger: On the history of hemostasis in antiquity and the Middle Ages , Wiener Klinische Wochenschrift (1910), pp. 1006–1008 and 1079–1080.

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !