WordNet

the flow of blood from a ruptured blood vessel (同)hemorrhage, haemorrhage
formerly used as a treatment to reduce excess blood (one of the four humors of medieval medicine)

PrepTutorEJDIC

出血する / 出血;放血
瀉血(しゃけつ)(静脈を切って血を流す高血圧などの治療法) / 流血

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2013/10/26 10:32:46」(JST)

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"Bleeding out" redirects here. For the Imagine Dragons song, see Bleeding Out (song). For the Korn song "Bleeding Out", see The Path of Totality.

Exsanguination is the process of blood loss, to a degree sufficient to cause death. One does not have to lose literally 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").

The slaughtering of animals in the meat industry[edit]

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.

While the animal is incapacitated, a pointed knife 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 severing the jugular vein, carotid artery, and trachea. Properly performed, blood should flow freely with death occurring within a few minutes. Sometimes the same procedure is repeated on the other side of the neck, severing vein and artery on the other side.

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.^[3]

Cause of human death[edit]

Exsanguination is a relatively uncommon and dramatic cause of death in humans.

Traumatic injury can cause exsanguination if bleeding is not stymied. It is the most common cause of death on the battlefield. Non-battlefield causes can include murder by shooting or stabbing; motor vehicle accidents; suicide by cutting arteries, typically those in the wrists; and partial or complete amputation of limbs with circular saws and chain saws.

Patients can also develop catastrophic internal hemorrhages, such as from a bleeding peptic ulcer, postpartum bleeding or splenic hemorrhage, which can cause exsanguination even without any external bleeding. Another cause of exsanguination in the medical field is that of aneurysms. If a dissecting aortic aneurysm ruptures through the adventitia, this can result in massive hemorrhage and exsanguination in a matter of minutes. It is a relatively common cause of unexpected, sudden death in patients who seemed previously well.^{[citation needed]} 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 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 may ulcerate or be torn ("Mallory-Weiss syndrome") during the violent vomiting of the alcohol leading to massive bleeding and sometimes exsanguination. The 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[edit]

^ AVMA Guidelines for the Euthanasia of Animals: 2013 Edition. 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
^ Masood Khawaja (6 October 2001). "Definition of Halal". Halal Food Authority. Archived from the original on 2009-04-27. Retrieved 2011-10-24.

UpToDate Contents

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1. 成人外傷におけるショックの一次評価およびマネージメント initial evaluation and management of shock in adult trauma
2. 成人外傷患者における重症骨盤骨折 severe pelvic fracture in the adult trauma patient
3. 成人における上部消化管出血のまれな原因 uncommon causes of upper gastrointestinal bleeding in adults
4. 成人における外傷の初期マネージメント initial management of trauma in adults
5. 成人における胸痛の鑑別診断 differential diagnosis of chest pain in adults

English Journal

Outcomes following military traumatic cardiorespiratory arrest: A prospective observational study.

Tarmey NT, Park CL, Bartels OJ, Konig TC, Mahoney PF, Mellor AJ.SourceDepartment of Military Anaesthesia and Critical Care, Royal Centre for Defence Medicine, Birmingham Research Park, Vincent Drive, Edgbaston, Birmingham B15 2SQ, United Kingdom.
Resuscitation.Resuscitation.2011 Sep;82(9):1194-7. Epub 2011 May 10.
AIM: To determine the characteristics of military traumatic cardiorespiratory arrest (TCRA), and to identify factors associated with successful resuscitation.METHODS: Data was collected prospectively for adult casualties suffering TCRA presenting to a military field hospital in Helmand Province, Afg
PMID 21621315

Bullet embolization to the external iliac artery after gunshot injury to the abdominal aorta: a case report.

Jaha L, Ademi B, Ismaili-Jaha V, Andreevska T.SourceDepartment of Vascular Surgery, University Clinical Center of Kosova, Rrethi i Spitalit pn, 10000 Prishtina, Republic of Kosova. ljaha@yahoo.com.
Journal of medical case reports.J Med Case Reports.2011 Aug 5;5(1):354.
ABSTRACT:INTRODUCTION: Abdominal vascular trauma is fairly common in modern civilian life and is a highly lethal injury. However, if the projectile is small enough, if its energy is diminished when passing through the tissue and if the arterial system is elastic enough, the entry wound into the arte
PMID 21819587

Japanese Journal

Reproductive toxicity of Echinodorus grandiflorus in pregnant rats

BRUGIOLO Sonia Sin Singer,PETERS Vera Maria,PIMENTA Daniel Sales,AARESTRUP Beatriz Juliao Vieira,BRUGIOLO Alessa Sin Singer,RIBEIRO Dayana Mendes,DE OLIVEIRA GUERRA Martha
Journal of toxicological sciences 35(6), 911-922, 2010-12-01
… On the 15th day, pregnant animals were euthanized by exsanguination under anesthesia. …
NAID 10026963237

Utility of microdialysis to detect the lactate/pyruvate ratio in subcutaneous tissue for the reliable monitoring of hemorrhagic shock

OHASHI Hitoshi,KAWASAKI Naruo,FUJITANI Shigeki,KOBAYASHI Katsutoshi,OHASHI Maiko,HOSOYAMA Akiko,WADA Takafumi,TAIRA Yasuhiko
Journal of smooth muscle research = 日本平滑筋学会機関誌 45(6), 269-278, 2009-12-01
… Six rats died due to hemorrhagic shock by 350 min (Group D) while six rats had survived for the 350 min period after exsanguination (Group A). … These data was obtained at intervals of 50 min after exsanguination up to a period of 250 min and compared between Groups A and D. … In particular, serum lactate levels increased again after a period of more than 150 min following exsanguination. …
NAID 10025994002