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the flow of blood from a ruptured blood vessel (同)hemorrhage, haemorrhage

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出血する / 出血;放血

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2016/04/14 11:35:03」(JST)

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Exsanguination is the process of blood loss, to a degree sufficient to cause death. One does not have to lose all of one's blood to cause death. Depending upon the age, health, and fitness level of the individual, people can die from losing half or two-thirds of their blood; a loss of roughly one-third of the blood volume is considered very serious. Even a single deep cut can warrant suturing and hospitalization, especially if trauma, a vein or artery, or another comorbidity is involved. It is most commonly known as "bleeding to death" or colloquially as "bleeding out". The word itself originated from Latin: ex ("out of") and sanguis ("blood").

Slaughtering animals

Exsanguination is used as a method of slaughter. Before the fatal incision is made, the animal may be rendered insensible to pain by various methods, including captive bolt, electricity or chemical. Without prior sedation, stunning or anesthetic, this method of slaughter is understood by some to cause a high degree of anxiety,^[1] although other studies contradict these findings.^[2] The captive bolt is placed against the skull of the animal, and penetrates to cause tissue destruction in the brain, incapacitating the animal so that the procedure may take place. Electricity is used mostly in porcine, poultry and domestic sheep, whereas chemical is used in injured livestock.

Continued pumping operation of the heart during exsanguination increases the rate of depletion, and thus hastens death, by raising the fluid pressure of the blood. Because the heart operates like a positive displacement pump, reduction of blood volume will not affect efficiency of cardiac output — deprivation of blood to the heart does gradually result in diminished function, but concurrently with similar death of other parts in the body.^{[citation needed]}

Quickly after the animal is incapacitated it is hung upside down by its hind limbs and an extremely sharp knife, in an orientation parallel to the ground, is fully inserted through the skin just behind the point of the jaw and below the neck bones. From this position, the knife is drawn forward away from the spine to sever the jugular veins, carotid arteries, and trachea. Properly performed, blood will flow freely and death will occur within seconds. Sheep and swine will reach brain death in under 10 seconds; however, larger animals, notably cattle may take up to 40 seconds to reach brain death. This period may extend to a couple of minutes if complications, such as arterial occlusion, occur. However, the animal's inverted position allows blood to flow more precipitously and thus makes an animal regaining consciousness before it is fully exsanguinated highly unlikely. In any case, animal welfare advisory councils clearly emphasize that the time from incapacitation to start of exsanguination should be prompt; recommending a time under 15 seconds.^[3]

Beyond the initial cost of purchasing a captive bolt, continued usage of the method is very inexpensive. The animal is incapacitated for the duration of the procedure, so it is one of the safest methods for the slaughterer.

Slaughter by exsanguination is mandated by Judaic kashrut (kosher) and Islamic dhabihah (halal) dietary laws. The double edged pointed knife is prohibited. Instead, a long knife with a squared off end is used that in Jewish law must be at least twice the width of the animal's neck. The operation of sticking or exsanguination is executed faster than when using the pointed knife, as four large blood vessels in the neck are severed simultaneously.

A 1978 study at the University of Veterinary Medicine Hanover indicates that these traditional methods, when executed as prescribed by the religious authorities, gave results which proved "...pain and suffering to the extent as has since long been generally associated in public with this kind of slaughter cannot be registered..." and that "[a complete loss of consciousness] occurred generally within considerably less time than during the slaughter method after captive bolt stunning."^[2]

In Islamic and Jewish law, captive bolts and other methods of pre-slaughter paralysis are generally not permissible, as consumption of animals found dead are regarded as carrion and stunned animals that are later killed will come into this category.

Various halal food authorities have more recently permitted the use of a recently developed fail-safe system of head-only stunning using a mushroom shaped hammer head that delivers a blow that is not fatal, proved by it being possible to reverse the procedure and revive the animal after the shock.^[4]

Cause of human death

Exsanguination is a relatively uncommon cause of death in human beings. Traumatic injury can cause exsanguination if bleeding is not promptly controlled, and is the most common cause of death in military combat. Non-combat causes can include gunshot or stab wounds; motor vehicle crash injuries; suicide by severing arteries, typically those in the wrists; and partial or total limb amputation, such as via accidental contact with a circular or chain saw, or become entangled in operating machinery.

Patients can also develop catastrophic internal hemorrhages, such as from a bleeding peptic ulcer, postpartum bleeding or splenic hemorrhage, which can cause exsanguination without any external signs of distress. Another cause of exsanguination in the medical field is that of aneurysms. If a dissecting aortic aneurysm ruptures through the adventitia, massive hemorrhage and exsanguination can result in a matter of minutes.

Blunt force trauma to the liver, kidneys, and spleen can cause severe internal bleeding as well, though the abdominal cavity usually becomes visibly darkened as if bruised. Similarly, trauma to the lungs can cause bleeding out, though without medical attention, blood can fill the lungs causing the effect of drowning, or in the pleura causing suffocation, well before exsanguination would occur. In addition, serious trauma can cause tearing of major blood vessels without external trauma indicative of the damage.

Alcoholics and others with liver disease can also suffer from exsanguination. Thin-walled, normally low pressure dilated veins just below the lower esophageal mucosa called esophageal varices can become enlarged in conditions with portal hypertension. These may begin to bleed, which with the high pressure in the portal system can be fatal. The often causative impaired liver function also reduces the availability of clotting factors (many of which are made in the liver), making any rupture in vessels more likely to cause a fatal loss of blood.

References

^ AVMA Guidelines for the Euthanasia of Animals: 2013 Edition (PDF). American Veterinary Medical Association. 2013. ISBN 978-1-882691-21-0.
^ ^a ^b Schulze W, Schultze-Petzold H, Hazem AS, Gross R. Experiments for the objectification of pain and consciousness during conventional (captive bolt stunning) and religiously mandated (“ritual cutting”) slaughter procedures for sheep and calves. Deutsche Tierärztliche Wochenschrift 1978 Feb 5;85(2):62-6. English translation by Dr Sahib M. Bleher
^ "Report on the Welfare of Farmed Animals at Slaughter or Killing. Part 1: Red Meat Animals" (PDF). Defra. 2003.
^ Masood Khawaja (6 October 2001). "Definition of Halal". Halal Food Authority. Archived from the original on 2009-04-27. Retrieved 2011-10-24.

English Journal

[Effects of hypoxia preconditioning on serum NGB and S-100B in patients with intracranial aneurysm surgery].

Li SQ1, Cao XD, Yu DS, Li Y.Author information 1Department of Anesthesiology, West China Hospital, Sichuan University, Chengdu 610041, China.AbstractOBJECTIVE: To study the clinical effects of hypoxia preconditioning (HPC) and its effects on serum neuroglobin (NGB) and S-100B level in the patients undergoing intracranial aneurysm surgery.
Sichuan da xue xue bao. Yi xue ban = Journal of Sichuan University. Medical science edition.Sichuan Da Xue Xue Bao Yi Xue Ban.2013 Sep;44(5):747-51, 755.
OBJECTIVE: To study the clinical effects of hypoxia preconditioning (HPC) and its effects on serum neuroglobin (NGB) and S-100B level in the patients undergoing intracranial aneurysm surgery.METHODS: Forty patients scheduled to intracranial aneurysm surgery were randomly.divided into 2 groups: HPC g
PMID 24325104

Finger tourniquets: two safe and cost effective techniques and a discussion of the literature.

Martin-Smith JD1, van der Rijt R, Kelly J.Author information 1Department of Plastic and Reconstructive Surgery, Cork University Hospital, Wilton, Cork City, Ireland.AbstractFinger tourniquets are used in a variety of operative procedures in both the trauma and elective setting. A wide range of methods are used in clinical practise as there is no standardised method. Many of the methods in use have significant drawbacks such as the inability to exsanguinate the digit or the more concerning problem of inadvertently leaving the tourniquet on the digit on completion of the procedure. We discuss two techniques that are quick, cheap and easy that do not have these drawbacks. There is a brief discussion of the literature assessing the various attributes of published methods. We feel that the adoption of these methods could result in easier and safer finger exsanguination and haemostasis.
Hand surgery : an international journal devoted to hand and upper limb surgery and related research : journal of the Asia-Pacific Federation of Societies for Surgery of the Hand.Hand Surg.2013;18(2):283-5. doi: 10.1142/S0218810413970022.
Finger tourniquets are used in a variety of operative procedures in both the trauma and elective setting. A wide range of methods are used in clinical practise as there is no standardised method. Many of the methods in use have significant drawbacks such as the inability to exsanguinate the digit or
PMID 24164139

[Perioperative management in outpatient arthroscopy of the knee joint].

Müller-Rath R1, Ingenhoven E, Mumme T, Schumacher M, Miltner O.Author information 1Arthroskopische Chirurgie, Orthopädische Praxisklinik Neuss, OPN, Neuss. mueller-rath@opn-neuss.deAbstractAIM: Nowadays, complex arthroscopic procedures of the knee joint, such as ACL reconstruction, are routinely carried out on an outpatient basis. The reduced time spent with the patient places high demands on the surgeon with regard to the management of such cases. The aim of this study was to evaluate the current standards of perioperative management following outpatient arthroscopic surgery of the knee in Germany.
Zeitschrift für Orthopädie und Unfallchirurgie.Z Orthop Unfall.2010 May;148(3):282-7. doi: 10.1055/s-0029-1240784.
AIM: Nowadays, complex arthroscopic procedures of the knee joint, such as ACL reconstruction, are routinely carried out on an outpatient basis. The reduced time spent with the patient places high demands on the surgeon with regard to the management of such cases. The aim of this study was to evaluat
PMID 20135619