Complication of injury to the veins of the neck. Incised wound of the neck
Neck wounds can be classified according to the type of weapon used: stab, cut, gunshot. In practice it is possible to distinguish superficial and deep wounds. For superficial neck wounds damage: skin, superficial fascia, superficial blood vessels of the neck. With deep- large blood vessels, nerves, esophagus, trachea.
Clinical picture
The main sign of arterial injury is blood that pours out in a stream of scarlet color. In some cases, when the arteries are injured, there may be no bleeding due to the resulting spasm, intimal inversion and the formation of a blood clot. The main symptoms of damage to large arteries (carotid artery) are bleeding (primary and secondary), circulatory disorders (pallor of the skin, tachycardia, decreased blood pressure), purulent complications. Injuries to the arteries can lead to the formation of a pulsatile hematoma, which manifests itself as a pulsating swelling in the neck.
Damage to neck veins is less common than arteries. The main symptom is severe venous bleeding. Injuries to the veins of the neck (especially the internal jugular and subclavian veins) can be accompanied by a dangerous complication - air embolism, in which air is sucked in due to negative pressure in the chest. In addition, the veins of the neck do not collapse, as they are fused with dense fascia. In this case, tamponade of the right side of the heart with air may occur, followed by asystole and respiratory arrest.
For injuries of the trachea and larynx paroxysmal cough, severe shortness of breath and cyanosis appear. Air with foamy blood is sucked in and released through the wound. Difficulty breathing can be aggravated by blood flowing into the lumen of the larynx and trachea, which often leads to asphyxia and death. As a rule, subcutaneous emphysema of the neck, face, chest. These injuries often result in injury. thyroid gland, vascular bundle, esophagus. Signs of damage to the esophagus are pain when swallowing and saliva leaking from the wound.
First aid
A necessary first aid measure for wounding the veins of the neck, which also helps stop bleeding, is quick finger pressure, artificial respiration with cessation of pressure at the moment of exhalation, tamponade and pressure bandage; head immobilization. The patient should be referred for urgent surgical treatment.
Bleeding from the large arteries of the neck is stopped by pressing in the wound and along the middle of the neck medially from the pectoral-cleidomastial muscle to the tubercle of the transverse process VI cervical vertebra. It is possible to stop bleeding with wound tamponade, and in case of profuse bleeding it is necessary to tighten the skin with sutures over the tampons to hold them in place.
In case of injuries to the larynx and trachea, the main danger threatening the wounded person is getting into respiratory tract a large amount of blood, so first aid should be aimed at eliminating the threat of asphyxia. The patient should be in a semi-sitting position, the wound is left open for blood to drain out, sometimes a tracheotomy tube can be inserted through the wound, in other cases, if there is a threat of suffocation, a tracheotomy is necessary.
Those wounded in the neck are subject to the most urgent hospitalization for primary surgical treatment due to the possibility of damage to the organs of the neck.
Treatment
In the hospital, for injuries to the vessels of the neck, a final stop of bleeding is carried out.
For injuries of the esophagus and trachea, primary surgical treatment is performed, suturing the walls with subsequent drainage.
Postoperative care
Patients with neck injuries require careful care and monitoring. They are placed on a functional bed in a semi-sitting position. Nurse monitors the condition of the dressing to prevent secondary bleeding, ensures oxygen therapy through a catheter, monitors respiratory and circulatory function.
Patients with an injury to the esophagus after surgery are prohibited from drinking and eating by mouth. Feeding is carried out through a tube inserted into the stomach through the lower nasal passage. After tracheostomy, it is possible to develop dangerous complications. leading to asphyxia.
The internal cannula of the tube may become clogged with mucus, or it may fall out if it is not securely fixed; swelling of the tracheal mucosa may develop as a result of traumatization by the tracheotomy tube, wound suppuration, and bleeding. Therefore, in the first days after surgery, the patient should not be left alone, even for a short time, since the patient himself cannot call for help. The inability to communicate depresses the patient. It is necessary to explain to him that he will be able to speak if he covers the external opening of the tracheotomy tube with a finger wrapped in a sterile napkin.
See surgical diseases and injuries of the neck, larynx, trachea and esophagus
Saenko I. A.
Sources:
- Barykina N.V. Surgery/N. V. Barykina. - Rostov n/d: Phoenix, 2007.
- Barykina N.V. Nursing in surgery: textbook. allowance/N. V. Barykina, V. G. Zaryanskaya.- Ed. 14th. - Rostov n/d: Phoenix, 2013.
The integrity of the wall of an artery or vein may be compromised when closed or open injury. This leads to internal or external hemorrhage and weakened tissue nutrition (ischemia). With intense blood loss, vascular injuries are life-threatening. Treatment of such injuries requires urgent surgery.
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Types of vascular injuries
Internal bleeding, damaged internal organs
Depending on whether there are external signs of vascular injury, they are divided into open and closed. The former may be accompanied by a tear or complete dissection of the vascular wall.
Closed injuries are not accompanied by external bleeding, but they lead to thrombosis, intense internal hemorrhage, tissue ischemia, and aneurysm of the wall of a vein or artery.
The danger to life increases if the main vessel is damaged; it is lower if secondary blood pathways are injured. According to the type of injured vessel there are arterial, venous, capillary and mixed pathologies. Blood flow pathways in the arms, legs and neck, head and torso may be affected. Internal bleeding occurs when the thoracic or abdominal cavity
. In the case of polytrauma, all these types are combined with each other. 
Based on the nature of vessel ruptures, the following are distinguished:
- full,
- partial,
- through,
- tangentially,
- fenestrating (for puncture, wound by shrapnel).
Clinical signs of injury
The danger of vascular injuries depends on the intensity and type of damage received.
Open
Open wound Most often they manifest themselves in the form of external bleeding, but the vascular defect can be blocked by a thrombus or neighboring tissues, so in the presence of an open wound, sometimes there is no noticeable blood loss.
Injuries are also characterized by the passage of blood into soft tissues with the formation of a hematoma. Significant injuries lead to a drop in hemodynamics and the development of a state of shock. The most severe consequences are for arterial bleeding from large vessels.
Vascular injuries with open injuries come in three degrees of severity:
- Only the outer shell is damaged, the middle and inner layers are not affected.
- Through defect of the vascular wall.
- Full .
Closed
With open injuries, the direction of injury goes from the outside to the inside, and with closed injuries it is the opposite, so the most severe cases are accompanied by complete destruction of the inner layer - the intima of the vessel. With minor injuries, cracks form in it. This is typical for impacts with blunt objects. There is no external bleeding, but an intravascular blood clot forms, leading to ischemia.
Formation of a blood clot due to a bruised vessel Second degree of severity closed injuries vessels proceeds with a circular rupture of the intima and partly the middle layer. For example, in car accidents, a sharp impact leads to the formation of an aneurysmal sac in the area of the aortic isthmus. Severe injuries (third degree) are accompanied by extensive hemorrhages that compress the surrounding tissues. One option may be overextension with rupture due to a dislocated joint or a displaced fracture.
Symptoms of closed vascular injury:
Arteries
If a vessel from the arterial network is damaged, then there are the following characteristic signs:
- scarlet stream of blood;
- bleeding or rapidly growing hematoma with pulsation;
- Below the injury there is no pulse in the arteries;
- pale skin, then cyanotic color;
- numbness;
- pain that does not decrease after fixing the limb does not increase when palpated;
- the muscles become hard (rigidity), initially active movements are difficult, and subsequently passive movements are also difficult (contracture).
Ven
A wound to a venous vessel is manifested by a dark stream of blood, the limb swells, the peripheral veins overflow and swell, the blood stream is smooth. Formed hematomas are often small in size and do not pulsate. Unlike arterial bleeding, there are no signs of ischemia - there is a pulse in the artery, the skin is of normal color and temperature, movements in the limbs are possible (in the absence of a fracture or dislocation).
Vessels of the head and neck
Such injuries carry an increased risk to life. This is due to the following features:
- the airways are close and nerve plexuses, therefore, respiratory arrest and reflex cessation of heartbeat are possible;
- there is a threat of cessation of nutrition to brain tissue due to ischemia, or with the development of;
- abundant blood supply leads to large blood loss.
Brain contusion with damage to blood vessels When an artery ruptures, there is severe bleeding or a hematoma forms with pulsation on the side of the neck. It quickly spreads to the area above the collarbone, puts pressure on the esophagus, and a breakthrough into the pleural cavity is possible. There is often damage (isolated or combined with arterial damage) to the vein. In this case, the accumulation of blood may not be noticeable; when palpating the neck, small pulsations and swelling are noted.
Closed injuries are no less dangerous. Even light blows or manual therapy can cause dissection of the artery walls.
Arises severe pain, impaired blood supply to the brain with weakness in the limbs, slurred speech, facial asymmetry, unsteady gait, which allows one to suspect a stroke.
Limbs
Signs of vessel rupture depend on its diameter and depth of injury. Large arterial and venous trunks pass through the limbs. Gushing bleeding from the femoral and brachial arteries is possible; due to the high speed, clots do not have time to form in them. In such cases, patients require emergency care to prevent major blood loss.
Closed fracture with vein damage Blood flows out of a vein slowly, so most often blood clots form, but they can be washed away by the movement of blood. Venous bleeding is less intense, but it is not always possible to count on stopping it on its own. The most favorable option for vascular damage is capillary. In this case, the blood is similar to arterial blood, but the signs are only superficial, there is no ischemia.
If the blood clotting activity is normal, then such bleeding will stop when a bandage is applied.
Diagnostics
Most often, the results of a doctor’s examination are sufficient to detect a vascular injury. Angiography, ultrasound, CT and MRI are used to assess the consequences or choose surgical treatment tactics.
The diagnosis is made based on the following signs:
First aid
The amount of assistance at the first stage depends on the degree and type of damage:
- bruise– apply ice, first placing a cloth over the injury site;
- rupture of a capillary or small vein– a pressure bandage made of a bandage or any available fabric (belt, scarf, handkerchief, towel);
- arterial- pressing with a finger or fist, then apply a tourniquet to clothing or fabric in several layers, and under it a note with the time of application.
The use of a tourniquet is advisable only on the thigh or shoulder, since the vessels of the lower leg and forearm are located deep and cannot be compressed from the outside. The maximum time for which a limb can be clamped is 60 minutes for adults and up to 20 minutes for children.
The main assistance to the victim is immediate transportation to a medical facility, so you need to call as soon as possible ambulance. Before doctors arrive, you need to ensure the immobility of the injured limb. It must not be lifted, warmed or cooled.
Wounds to the neck are dangerous not only due to blood loss, but also due to the entry of air bubbles with subsequent embolism of cerebral vessels. Therefore, as soon as possible, you need to apply a rolled bandage or something similar to the bleeding site. To apply a bandage, the victim’s arm is raised up, and the turns of the bandage pass through it. This provides nutrition to the brain through the second, paired carotid artery.
Watch a video about first aid for injuries:
Surgical treatment
After admission to the hospital, the patient first receives infusion therapy to restore circulating blood volume. For this purpose, droppers with isotonic solutions of sodium chloride, glucose, Albumin, Reopoliglucin, Voluven, Refortan are used. Indicated in a volume of about 2 liters and 4 liters of solutions for damage to a large vessel.
Reconstructive surgery begins at a pressure of at least 100 mmHg. Art. and a pulse of about 100 beats per minute, but if the bleeding continues and threatens life, then the patient will be operated on immediately after hospitalization. Vascular operations are justified if there are signs of tissue viability - deep sensitivity is preserved, there is no muscle contracture. If these symptoms are present, the question of amputation is raised.
The integrity of the artery is restored in the following ways:
- side or circular seam;
- plastic surgery using your own vein or graft;
- connection of ends with a defect of no more than 2 cm.
In case of injury, veins are used, and if the damage is significant, then the thigh vein is isolated and used for plastic reconstruction.
Prognosis for the patient
Factors that have an adverse effect on vascular injury:
- open damage;
- rupture of a large diameter artery;
- combined injuries (bones, soft tissues, nerve trunks are damaged, vital organs are affected);
- large blood loss;
- localization on the neck;
- More than 6 hours passed from the moment of injury to the operation.
The carotid artery is the most important blood vessel that supplies oxygenated arterial blood to all tissues of the head and in particular to the brain. Since blood from the heart flows through the arteries, bleeding from this type of vessel is the strongest and most dangerous. If the carotid artery is injured, it is necessary to urgently take rescue measures, since no more than three minutes remain before death. A delay of just 1 second and the person can no longer be saved.
General information about the carotid artery
The paired vessel departs from the thoracic aorta and immediately branches into 2 separate arteries, rushing to opposite sides of the neck. Near the larynx, at the level of the Adam’s apple, each channel branches into 2 more - internal and external. It is to the outer one that fingers are applied to listen to a person’s pulse.
The internal artery runs deep in the neck, so injury to this branch is unlikely. This happens, but extremely rarely. In the area of the temporal region, the internal artery penetrates the skull, where it is divided into many branches, which are divided into many more branches, and those into many more... With the help of such a complex highway, all brain cells receive blood from the heart, and with it the necessary for the implementation their functions are elements and oxygen. Injury to the internal artery is considered more dangerous than to the external one.
The external branch is located in another area - in front of the neck. Therefore, she is more open to injury. However, this does not happen very often. The external artery branches into a whole network of capillaries that supply blood to the eyes and face. During unbearable heat or jogging, you can notice their presence in the form of a slight blush.
When ligatures are applied to the external artery, no consequences are observed when professional medical care is provided. But when performing the same operation on all other parts of the carotid artery, irreversible consequences are possible.
As for the common carotid artery, most often one of its branches is injured - the right or left. In this case, the blood supply to all tissues of the head, and most importantly the brain, is disrupted. One surviving artery is not able to deliver the required amount of blood and oxygen to them, which can lead to softening, hemiplegia of the brain or death.
Most often, if one of the arteries is damaged, a person dies even before qualified assistance is provided. If the carotid artery is injured, it is necessary to act urgently! The only good news is that this kind of injury occurs quite rarely. After all, it is simply impossible to accidentally cut yourself, reaching the carotid arteries.
Signs of injury to the carotid artery
How to determine that the victim has a wound in the carotid artery? First, let's look at the differences between arterial bleeding and venous bleeding.
Arterial blood moves through channels away from the heart, so bleeding from the arteries is rapid and pulsating. The blood has a bright scarlet color and flows out of the damaged tissues like a fountain. The streams splash out gradually - simultaneously with each heartbeat. Those. synchronously with the pulse. This is why a person loses a huge amount of blood in a very short period of time. And the carotid artery, on top of everything, has an impressive size, which further accelerates the fatal process.
Venous bleeding is characterized by different symptoms - the blood flows out calmly, not in fountains, and has a dark tint.
Thus, damage to the carotid artery can be diagnosed by abundant splashes of bright scarlet blood, the frequency of which corresponds to the pulse. Help for arterial injuries is fundamentally different from measures taken for venous injuries.
All a person can do before the ambulance arrives is to prolong the victim’s life. And to do this you need to know how to stop the bleeding.
To stop arterial bleeding, several methods are used:
- finger pressure;
- application of a tourniquet;
- tamponade;
- dressing;
- applying a pressure bandage.
The most effective for such an anatomically complex area as the neck is finger pressure and subsequent application of a tourniquet. This is what first aid should consist of. It is impossible to tie the artery with a pressure bandage, since the person may die from suffocation. In addition, the circular bandage will also compress a healthy vessel on the opposite side, which will inevitably lead to death.
The first thing that needs to be done when you find a person with a bleeding carotid artery is to digitally press the vessel against the bony prominence (on one side only!). The action is performed in the area of the neck where the pulse from the artery can be clearly felt. This is the area located between the larynx and the protruding neck muscle - the anterolateral muscle. Having placed the fingers in this area, they are lowered 2 cm and the hole is felt. By pressing on it, the pulse is measured. But this is the pulse. First aid actions should be quick, almost instantaneous.
It does not matter which of the carotid arteries is damaged - internal, external or common - finger pressure is carried out exactly in the described place. The common artery is located here, which means the blood will not continue to move upward in any case. Pressure with your fingers is applied towards the spine, you must try to press the vessel against it.
However, if the wound is located presumably below this zone, apply pressure below the wound. The fingers are placed in the cavity between the larynx and the large cervical muscle.
Immediately after pressing, bleeding from the carotid artery will stop. But not a single person is able to continue it for more than 5 minutes, because tense hands get tired and the force of pressure weakens. The slippery flowing blood also interferes with these actions. The gained time must be spent on organizing another method to prevent blood loss. And it’s better if a second rescuer does this.
Application of a tourniquet
To apply a tourniquet, you must have sufficient qualifications so as not to harm the victim. But given that he has little time, in some cases the skill of applying a tourniquet can be useful to an amateur.
Instead of a splint, use the victim’s hand located on the side opposite to the wound. Raise it up and bend it at the elbow. The forearm should be on the vault of the skull. Shoulder - along the ear.
The tourniquet is placed around the neck, capturing the limb used as a splint. This hand performs the function of protecting the intact artery from compression. After all, the brain receives nutrition only from it. Do not place a tourniquet on bare skin. Place a thick gauze swab under it, be sure to be clean! If possible, I place it a few centimeters below the wound, since a completely cut artery (and this is possible) can slide lower and it will not be possible to stop the bleeding.
If the injury to the carotid artery may well be not the only injury, you cannot use the victim’s hand instead of a splint. For example, after a car accident. If a bone is broken in the arm, its fragments can damage other vessels. It's better to use a board.
Another known method of applying a tourniquet is the Mikulich method. But you should have a Kramer tire at hand, so this method can only be used in special conditions. During finger pressure, the wounded person is seated vertically, and a Kramer splint is installed on the side opposite to the injury. It should protrude in front of the trachea by about 2 cm. Place a roller under the tourniquet, stretch it with your hands and wrap the neck through the splint and roller. Tied on a splint.
After placing the tourniquet, you should write a note to the emergency physicians, noting the time the procedure was completed. The note can be placed under the bandage used for subsequent bandaging of the neck. This is necessary because the tourniquet cannot be used for a long time.
If you perform all actions quickly and correctly, there will be a chance to save lives. But stopping the blood flow is only the first step on the path to salvation.
Medical assistance
How to stop bleeding after removing a splint? Medical assistance, i.e. The final stop of bleeding is carried out using the following methods:
- Application of a vascular suture.
- Dressing.
Ligation is indicated in cases where the artery is wounded close to the bifurcation, and it is not possible to apply a vascular suture. For those who don’t know, bifurcation is a splitting of the main blood vessel. In the situation under consideration, this is a bifurcation of the carotid artery into internal and external.
According to statistics, in 25% of cases, ligation of the common carotid artery ends in death, which is why they resort to this method in the most extreme cases. Before ligation, the patient should be prepared and the maximum flow of arterial blood to the brain should be ensured. For this purpose, the patient is placed on the operating table so that his lower limbs are elevated and higher than his head.
During the operation, the victim's head is tilted back and turned in the direction opposite to the wound. The vessels are exposed in the area of the carotid triangle - by dissecting layer by layer of tissue from the upper corner of the thyroid cartilage and along the anterior edge of the cervical muscle - the sternocleidomastoid. The length of the incision is 8 cm. The hypoglossal nerve is shifted to the side (outward).
Ligation of the external carotid artery is more successful and does not entail consequences. This happens because the second external artery is located on the opposite side of the neck. True, it is much more difficult to damage it, since it is smaller in size.
Preparing the patient for surgery is the same as in the previous version. But the incision is made from the lower part of the jaw and runs along the front of the same muscle. The incision ends at the upper part of the thyroid cartilage. The muscle is moved to the side. The exposed vaginal wall of the neurovascular bundle of the medial cervical triangle is dissected. Ligation of the artery is carried out in the interval between the lingual and thyroid arteries.
The internal branch of the carotid artery is damaged even less frequently, since it runs very deep and is well protected. Its dressing is done according to the same rules as external dressing. Possible consequences.
When you see a person with a wounded carotid artery, you need to act quickly and decisively. Only with timely assistance can the victim survive. Don't panic. As you know, fear is the main enemy of man!
damage and is due to the anatomical structure of the neck. Fortunately, the number of these injuries is small, since the surface of the neck makes up a small part of the surface of the body. In addition, thanks to the protective reflex, the neck is also protected from injury.
Treatment of a superficial uncomplicated wound is simple and no different from the treatment of other similar wounds.
In contrast to this treatment of deep injuries neck is a very important task, since even with a seemingly insignificant entrance hole, severe combined damage to many organs can be hidden. Therefore, the severity of the damage is determined not by the size of the wound, but by the combination and danger of these injuries to life.
The outcome of the damage depends on the timeliness and correctness of the measures taken. Even the smallest (only the size of a pinhead) hole in the esophagus or trachea, if not noticed, opens up wide opportunities for infection to penetrate from the depths. In these cases, the inflammatory process very quickly spreads to the mediastinum, threatening the life of the patient. Therefore, the treatment of complex neck injuries should be entrusted to a surgeon who has a good knowledge of anatomy, an experienced diagnostician and operator in this field.
If we compare traumatic and surgical injuries with each other, we can establish mainly differences only depending on causes, depending on the type of wounding object. Traumatic injuries to the neck area are caused either by blunt force or by a sharp object. During surgery, damage can occur due to rough action with hooks or fingers, as well as with the tip or side surface of the instrument. All these damages are fraught with dangerous consequences. Their elimination must be carried out in a sufficiently qualified manner.
Damage to the main arteries and veins of the neck
When a neck injury occurs, one of the biggest dangers is bleeding. Deeply penetrating damage often reaches the great vessels. The victim is in danger life-threatening blood loss for several minutes before anything can be done. If it is possible to temporarily stop the bleeding (pressure with a finger, etc.) and the patient can be taken to the operating room, then there is still hope of saving him.
If there is a deep injury to the neck, immediate and thorough revision with wide access is necessary. Damage to the great vessels of the neck may not be accompanied by external
bleeding, but the patient remains in a life-threatening situation. Soft fabrics necks arranged in layers one behind the other make it difficult for blood to flow out. However, a pulsating hematoma may form between the tissues. By squeezing the surrounding vital communications, this hematoma becomes dangerous (suffocation). Over time, a pulsating hematoma forms a false aneurysm (aneurysma spurium), which is also life-threatening for the patient. These complications can be prevented if the victim is immediately operated on from a wide approach, identifying the source of bleeding and reliably eliminating it.
Damage to the arteries of the neck
Bleeding from the common and internal carotid arteries can be stopped by applying a ligature only if there is no other way to eliminate the damage (suture of the vessel, plastic patch and plastic replacement of the lost area). Such a need arises only in very rare and exceptional cases. According to Moore,V. N. Shevkunenko, D. Ya. Yaroshevich, ligation of the common carotid artery is fatal in 12-38% of cases, and in 23-50% of cases it is associated with severe brain disorders. If the common or internal carotid arteries are ligated in a victim in shock, the prognosis becomes even worse: deaths increase to 60%, and the incidence of brain disorders to 75%.
Minor damage to the great vessels is repaired using a parietal suture or closing the defect with a patch from a vein. If there is a significant defect in the vessel, there is a need for autovenous or alloplasty.
Puncture wounds penetrating into the subclavian region are very dangerous for the life of the victim, with damage to the subclavian artery. If the pleura is also damaged, a fatal leak of blood into the pleural cavity may occur. To stop bleeding from the subclavian artery, a fairly wide access is required. It is achieved by sawing the collarbone (using a Jigli saw), by exarticulating the sternal end of the clavicle and retracting it to the side or performing a thoracotomy.
Bleeding from small vessels is stopped by ligation. The external carotid artery is subject to the same ligation. It should be mentioned here that stopping bleeding in the mouth and nose, as well as from the tongue in case of damage or due to a painful process of the facial part of the head is very difficult or even impossible. In such cases, the method of choice is to locate and bandage in an area outside the damage to the external carotid artery (rice. 2-13).
Rice.2~13. Main area supplied by the external carotid artery
Rice. 2-14. Isolation and ligation of the external carotid artery within the carotid triangle
External carotid artery found in the sleepy triangle (rice. 2-14). The incision is made from the mastoid process along the anterior edge of the sternocleidomastoid muscle to the level of the lower edge of the thyroid cartilage. An oblique incision can also be made. After dissection of the platys-
we and the superficial fascia muscle are pulled outward by the hook. Flowing into the inner jugular vein The facial vein crosses the surgical field and is ligated between two ligatures. The ligature of the central stump should not be too close to the jugular vein, since re-ligating it if the ligature slips off with a short stump will be difficult. By bluntly dissecting, they reach the vascular sheath, which is dissected longitudinally. The internal jugular vein is retracted outwards with a hook, the common carotid artery is dissected, trying not to damage the vagus nerve passing through the vascular sheath behind the vessels. Climbing along the common carotid artery, one finds its branch: the medial branch is the external carotid artery. To eliminate errors, they go up along the course of this vessel and find the nearest of the lateral branches, which confirms the correctness of the selected vessel, since the internal carotid artery has no branches.
Damage to the veins of the neck
Damage to the main veins of the neck (rice. 2-15) dangerous not so much because bleeding, how much due to the possibility of occurrence air embolism. During entry into the gaping vein lying in the wound cavity, air is sucked in with a characteristic squelching sound by contractions of the heart. A small embolism causes only a passing illness that does not cause complications. If there is more extensive penetration of air into the right cavity of the heart, instant death may occur. Therefore, if the main veins are damaged, you should first of all prevent the possibility of
Rice. 2-15. Venous network of the neck
In peacetime they are more common stab and cut wounds of the neck. Cuts are always accompanied by profuse external bleeding. Stab and stab wounds (knife) are more dangerous, as they often lead to injury to large vessels, including the carotid artery, and hemorrhage into the internal organs compresses the larynx and trachea.
Damage to deep veins creates negative pressure in them and thereby (during inhalation) promotes the suction of air; from this, air develops. It is accompanied by a characteristic whistling noise from the suction of air and a bluish complexion. In this case, breathing is disrupted. becomes frequent and difficult to palpate due to weak filling of the arteries.
Providing first (ambulance) aid, immediately squeeze the central part of the bleeding vessel and place the victim in a horizontal position (best with the head tilted down). Then you need to bandage the vessel.
Since wounds make up the bulk of possible damage to the body, proper treatment of them is the basis of first aid for injuries. Proper wound treatment prevents the occurrence of complications (bleeding, suppuration, ulceration, blood poisoning), and reduces the healing time by almost three times.
To treat a wound, you need cotton wool, gauze, a bandage and a disinfectant (iodine, alcohol, etc.). Dressing should be done with clean hands.
If the wound is bleeding heavily, you must first stop the bleeding quickly. Then start dressing. If there is no disinfectant (say, in case of a car accident in a place remote from settlements), it is enough to cover the wound with clean gauze, then apply a layer of cotton wool and bandage it.
If there is some kind of disinfectant (hydrogen peroxide or even gasoline), then the skin around the wound is first wiped twice or thrice with gauze or cotton wool moistened with a disinfectant solution. This treatment is more effective.
When there is no bandage or gauze at hand, a superficial wound can be covered reverse side sterile adhesive tape and then bandage with a clean handkerchief.
The abrasions are washed with hydrogen peroxide and bandaged.
The wound should not be washed with water, much less alcohol or iodine tincture, because the disinfectant solution leads to the death of damaged cells, thereby causing significant pain.
The wound should not be covered with powders, nor should any ointment be applied to it; It is forbidden to place cotton wool directly on it.
If any tissue protrudes from the wound (say, a section of muscle, part of the trachea, etc.), then they are covered with clean gauze, but under no circumstances are they pressed in!
In case of serious injuries, after first aid is provided, the victim must be transported to a medical facility.