Bloodletting

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The bloodless bloodletting is a method for relief of the pulmonary circulation. In contrast to classic bloodletting , in which blood is allowed to flow out of the body, this method is absolutely bloodless. Only a portion of the circulating blood is retained in three of the four extremities. This first lowers the preload of the heart chambers .

indication

The cardiac pulmonary edema , the most common form of pulmonary edema is not a lung disease. It occurs in acute left heart failure . The cause of the failure of the left heart is usually an acute decompensation in chronic heart failure , in which the left heart can no longer cope with the return of blood from the lungs due to weakness. The blood backs up in the pulmonary vessels and - due to the increased pressure as a result - fluid escapes into the lung tissue. This severely restricts the gas exchange.

execution

The “bloodless bloodletting” is achieved by applying tourniquets to three of the four extremities ( thighs and upper arms ) in such a way that no blood can flow back. To do this, the blood pressure cuffs are fixed and inflated to a pressure of 30 to 40 mmHg. The cuff pressure is thus safely above the blood pressure in the venous system. This is around 12–15 mmHg in the smaller, postcapillary veins and 5–6 mmHg in the large veins of the extremities. This means that although arterial inflow into the extremity is enabled, venous backflow is prevented.

In order to prevent tissue damage in the partially tied legs and arms , one extremity is supplied with full blood again every 15 minutes at the latest. This means that three of the four extremities - and the congested blood there - are not involved in the blood circulation. It makes sense to work with four alternately inflated blood pressure cuffs according to a fixed rotation pattern (change of the extremity supplied with blood, e.g. clockwise after five minutes, that is, one extremity is "tied" for a maximum of 15 minutes).

history

In 1806, the founder of the French medical clinic Jean-Nicolas Corvisart , citing the Italian doctor and anatomist Giovanni Battista Morgagni, described bloodletting. For the treatment of heart failure in the advanced stage ("aneurysms of the second degree heart") one should immerse the arms and legs in warm water. This directs the blood to the limbs and the heart and large vessels are emptied and relieved.

literature

  • Bodo Gorgaß, Friedrich W. Ahnefeld, Rolando Rossi, Hans-Dieter Lippert: Paramedic and paramedic. Springer, 2013. ISBN 978-3662097625 . P. 337f.
  • Harald Kämper: Emergencies in the alternative practitioner's practice. Karl F. Haug Verlag, 2010. ISBN 978-3830473596 . P. 71.
  • Sönke Müller: Memorix emergency medicine. 9th updated edition, Thieme, 2011. doi : 10.1055 / b-0034-36631 p. 141.

Individual evidence

  1. ^ Jean Nicolas Corvisart. Experiment on the diseases and organic injuries of the heart and great vessels. Translated from the second edition by Ludwig Rintel . C. Salfeld, Berlin 1814 (digitized version)
  2. ^ Jean Nicolas Corvisart. Essai sur les maladies et les lésions organiques du coeur et des gros vaisseaux. Extrait des leçons cliniques . Migneret, Paris 1806 (digitized version )