One of characteristic features The 21st century is mass traumatism. The main reasons for this are: the development of machine production, the rapid increase in road transport with the inexperience of many drivers and the low traffic culture on the roads.
Damage caused by domestic animals has become widespread.
The most severe damage, both in nature and in terms of complications and outcomes, is observed in disasters caused by natural forces or human technological activity.
In the structure of peacetime injuries, open injuries (wounds) pose a particular danger.
A distinctive feature of surgical injuries in emergency situations is the significant frequency of cases of multiple and combined injuries, which are accompanied by such severe complications as traumatic shock, acute blood loss, asphyxia, and prolonged compartment syndrome.
An open injury, or wound, is a gaping disruption of the integrity of the integument (skin, mucous membranes) with possible destruction of underlying tissues.
With open injuries, the wound channel inevitably becomes contaminated with pathogenic microorganisms, followed by the development of various inflammatory processes.
The main dangers that can be caused by development are complicated wounds accompanied by one or some of the following complications:
a) bleeding with the development of acute anemia;
b) shock, accompanied by dysfunction of vital organs;
c) penetration of infection;
d) the possibility of violating the integrity of vital organs.
The clinical picture of wounds consists of local and general symptoms.
TO local symptoms include pain, bleeding from the wound, wound gaping.
General symptoms include symptoms characteristic of a particular wound complication (acute anemia, shock, infection, etc.).
Pain at the time of injury is caused by damage to receptors and nerve trunks. The intensity of pain depends on:
1) on the number of nerve elements in the damage area:
2) from the reactivity of the victim’s body, his neuropsychic state. It is known that people react differently to pain. So, in case of fear, unexpected injury, etc. force pain increases significantly;
3) on the nature of the wounding weapon and the speed of injury: the sharper the weapon, the less the number of cells and nerve elements is destroyed, and the faster the injury is caused, the less pain.
Bleeding depends on the nature and number of vessels destroyed during injury. The most intense bleeding occurs when large arterial vessels are injured.
The gaping of a wound is determined by its size, depth and disruption of the integrity of the elastic fibers of the skin. The degree of wound gaping is also related to the nature of the tissue. Wounds located across the direction of the elastic fibers of the skin usually have a larger gape than wounds running parallel to them.
Closed injuries to tissues and organs include injuries accompanied by a violation of the integrity of skin and visible mucous membranes. There are: closed soft tissue injuries; organs located in cavities; bones and joints. The severity of the injury depends on the traumatic force, direction and duration of its impact, the area of the body area affected by injury, the state of the body and other factors. The following main types of closed injuries are distinguished: bruise, sprain, rupture and dislocation.
Injury- the most common closed mechanical damage to tissues and organs, caused by short-term exposure to a solid object on the surface of the body without violating the anatomical integrity of the skin, tissues, mucous membranes and organs. Such damage usually occurs when impacted by a hard object that has a large surface area and has little kinetic energy, as well as when the body falls onto a hard surface. This type of injury is characterized by unexpectedness, speed and short duration of the traumatic impact. In most cases, bruises are local in nature.
A bruise as a type of injury is characterized by local and general symptoms. Local symptoms include: pain of varying strength and duration; swelling in the area of the bruise; bruise, hemorrhage resulting from a rupture blood vessels; dysfunction of the damaged body part. With strong and extensive closed damage General symptoms characteristic of this type of injury also occur: increased body temperature, sleep and appetite disturbances, signs of anemia, and sometimes shock develops. Severe pain occurs with bruises of the periosteum, external genitalia, large nerve trunks and plexuses.
Providing first aid for bruises consists of applying a pressure bandage, cold (an ice pack for 40-50 minutes, with a break of 10-15 minutes), which helps reduce or stop hemorrhage, pain, etc. To improve the outflow of blood and lymph, the injured the limb is slightly raised. If a large area of tissue is bruised, severe pain may occur, which requires the administration of painkillers and transport immobilization.
From the 2-3rd day, treatment is carried out aimed at accelerating the resorption of hemorrhage. For this purpose, thermal procedures are carried out (warming semi-alcohol or oil compresses, warm heating pads, warm water baths with a temperature of 36.5-37°C). In case of an impact with hemorrhage, compresses with absorbable agents are applied to the muscles and joints. medicinal substances, physiotherapeutic treatment is prescribed. In the presence of a hematoma (blood tumor), puncture and suction of blood and administration of antibiotics are indicated.
Stretching- this is a tear of tissues while maintaining their anatomical integrity. When tissue ruptures, anatomical integrity is not maintained. Tendon ligaments and muscles are most often affected by sprains and tears. Such injuries occur after a sharp and rapid contraction of tissues and organs or excessive stretching, for example, as a result of lifting heavy weights, running, hitting with a blunt object, etc.
Symptoms for sprains and tissue ruptures are the same as for bruises, but are more pronounced. First health care for sprains and tissue tears is the same as for bruises.
Sprains are treated in the same way as bruises, but thermal procedures are prescribed 3-5 days after the injury. When tissue ruptures, immobilization is performed. Complete rupture of tendons and muscles requires surgical intervention: suturing and plaster cast for 2-3 weeks.
Dislocation- persistent displacement of the articular ends of bones beyond the limits of their normal mobility. Dislocations are distinguished between complete (articular surfaces do not touch one another) and incomplete (articular surfaces partially touch).
Depending on the origin, dislocations are divided into congenital and acquired. The first arise in the prenatal period as a result of improper or insufficient development of articular surfaces; acquired ones are most often the result of injuries. Traumatic dislocations account for 80-90% of all cases of dislocations with the most common localization in the shoulder and elbow joints. Most often they are caused by external force, less often by excessive muscle contraction.
Any dislocation is characterized by: pain in the joint, which increases during movement or palpation of the joint; forced position of the limb, characteristic of each type of dislocation; deformation in the joint area; dysfunction of the joint; change in limb length (most often shortening). In addition, swelling and soreness may occur.
Emergency care for sprains includes:
- ensuring rest of the injured limb by immobilizing it with standard splints, a fixing bandage or improvised means;
- administration of painkillers;
- application of cold to the joint area to reduce bleeding, swelling, pain;
- application of a primary aseptic dressing to the wound for open traumatic dislocations;
- urgent transportation of the patient to medical institution for reduction of dislocation.
Treatment is aimed at restoring the normal position of the bones in the joint, keeping them in this position and maximizing full recovery functions of the damaged joint.
Review questions
- List closed soft tissue injuries.
- Describe each type of closed soft tissue injury.
- Tell us about emergency care for bruises, sprains, and dislocations.
Topic No. 5. First aid for injuries.
General concepts of closed and open injuries. The concept of a wound, the danger of injury (bleeding, contamination of the wound, damage to vital organs). Penetrating wounds of the skull, chest, abdomen. Symptoms, first aid. Concepts about asepsis. Rules for handling sterile material. Concept of antiseptics. Primary dressing.
Practical lessons. Bandages on the head and neck, on the eyes, forehead, ear, scalp head, lower jaw, chin. Applying bandages is okay by yourself and mutual assistance. Mesh-tubular bandages.
Bandages on the chest, abdomen and perineum. Features of first aid and application of an occlusive dressing for penetrating wounds chest with open pneumothorax and abdomen. Applying bandages as a matter of self-help and mutual aid
Bandages for the upper and lower limbs. Bandages for the upper extremities: area of the shoulder joint, upper arm, elbow joint, hand, fingers.
Bandages for lower limbs: groin area, top part hips, hip joint, mid thigh, knee-joint, shin, ankle joint, foot.
Features of applying bandages in winter. Applying bandages is a matter of self-help and mutual assistance.
It is known that a significant proportion of victims who received severe, but not fatal injuries, die precisely from the delay in providing medical care. 1 hour after a severe injury, up to 30% of victims die for this reason, after 3 hours - 60%, after 6 hours - up to 90%. It is no coincidence that the first hour from the beginning of the disaster, when not a single minute can be lost, was called the “golden hour.”
Concept of injury and wound. Injuries can be open or closed. TO open injuries include such injuries, an indispensable sign of which will be a violation of the integrity of the skin or the integrity of visible mucous membranes.
Closed injuries include injuries internal organs chest and abdominal cavity, brain, blood vessels and nerve trunks, closed fractures bones, bruises, soft tissue ruptures, sprains of ligaments and tendons, dislocations in joints, compression and contusions. With isolated closed injuries, there is no damage to the skin or visible mucous membranes.
Wounds.
Violation of the integrity of the skin, mucous membranes, deeper tissues and internal organs as a result of mechanical or other impact is called wound.
If with open wounds only the integrity of the skin or visible mucous membrane is compromised, superficial wound . Superficial wounds, in which there is incomplete disruption of the skin or mucous membrane, are called abrasions.
If the integrity of the skin and visible mucous membrane is compromised, as well as deeper underlying tissues and organs are damaged, then deep wound. In cases where deep wounds damage the internal membranes anatomical cavities(cranial, thoracic, abdominal, articular), then such injuries are called penetrating. Wounds that have an entrance and exit opening are called end-to-end . As a result of the penetration of a wounding object into the tissues, their destruction to the entire depth of the wound, a cavity is formed, which is called wound channel.
According to the mechanism of application, the nature of the wounding object and tissue damage, wounds are distinguished as cut, stab, chopped, bitten, torn, scalped, bruised, crushed and gunshot.
cut wound, caused by a sharp object, is characterized by a predominance of length over depth, smooth edges, a minimum volume of dead tissue and reactive changes around the wound.
Chopped wound - occurs from the impact of a heavy sharp object, has great depth and volume of non-viable tissue.
Laceration - formed when soft tissues are exposed to a damaging factor that exceeds their physical ability to stretch. Its edges are irregularly shaped, there is detachment or separation of tissue and destruction of tissue elements over a significant extent.
Puncture wound - occurs when soft tissue is damaged by a needle, awl, nail, knife, bayonet, etc. These wounds are usually deep, often blind, with a small entrance hole and may be accompanied by damage to blood vessels, hollow and parenchymal organs.
scalped wound - characterized by complete or partial detachment of the skin, and on the scalp - almost all soft tissues without significant damage.
Bruised wound - occurs from a blow with a blunt object, like a crush wound, in which there is crushing and rupture of tissue with a significant area of primary and subsequently secondary traumatic necrosis with abundant microbial contamination.
Bite wound - occurs as a result of a bite by an animal or a person, characterized by abundant microbial contamination and frequent infectious complications. It may include signs characteristic of lacerations, bruises and crushed wounds, and often becomes infected pathogenic flora, contained in the saliva of the bite.
Gunshot wound. Wounds inflicted by firearms differ significantly from all other wounds in their structure, nature of damage and healing time, and in a number of other characteristics.
Variety of systems firearms and ammunition causes a wide variety of gunshot wounds. The direct action of the projectile (bullet) causes crushing, rupture and splitting of tissue. As a result of the direct action of the projectile, wound channel, filled with destroyed tissue. Passing through the tissue, a firearm projectile leaves behind a trace in the form of a so-called temporary cavity, which pulsates for several milliseconds. This is how it is formed shaking zone and zones of indirect action side impact of a projectile. Its size can exceed the size of a zero or fragment by 30-40 times, and the pressure in it can reach 100 atm
The main signs of a wound: pain, gaping, bleeding, as well as dysfunction of the damaged part of the body. The severity of these signs depends on the type of wound.
Complications of wounds.
2. Acute blood loss.
3. Pneumo(hemo) thorax (accumulation of air or blood in the pleural cavity).
4. Infectious complications, including peritonitis, sepsis, erysipelas, etc.
5. Anaerobic infection.
6. Spicy renal failure with massive damage to soft tissues;
7. Wound psychoses.
8. Post-traumatic stress disorder.
As well as complications associated with dysfunction of the damaged organ.
All wounds, except those caused by sterile instruments during surgery, are considered infected (contaminated with germs). At the moment of injury, pathogenic organisms penetrate into the wound, along with the wounding weapon, causing inflammatory and suppurative processes in the wounds. Of particular danger is contamination of wounds with microorganisms leading to the development of a general infection: tetanus, rabies, etc.
In addition to microorganisms, wounds can be contaminated with foreign bodies: scraps of clothing, soil, small stones, glass fragments, and in some cases, the wounding instruments themselves can be in the wound.
Every wound is accompanied by bleeding. Depending on the type of blood vessels damaged during injury, bleeding from the wound can be capillary, venous, or arterial.
Rice. 10Tetanus convulsions.
Microbes that enter the wound cause inflammation and suppuration in it and adjacent tissues. When streptococci get into the wound, erysipelas develops, in which there is pronounced redness of the skin around the wound with uneven, clear edges, an increase in temperature to 38-39 ° C, and a sharp deterioration in the general condition. When wounds are contaminated with soil, microbes enter the tissue and develop without access to air. They cause the development of gas gangrene ( anaerobic infection), accompanied by putrefactive tissue decay and the formation of air bubbles in the tissues. At the same time, the condition of the affected person quickly deteriorates due to general poisoning of the body with toxins. Early signs of anaerobic infection: significant pain in the wound, a feeling of “bursting” of the soft tissue around the wound, increasing swelling, a jaundiced tint of the skin. The wound is covered with a dirty gray coating. The appearance of tissue crunching (crunching) when pressed indicates the formation of gas bubbles in the tissues and more severe damage, the development of general poisoning of the body. At the same time, the body temperature rises, breathing becomes impaired, the pulse becomes frequent and difficult to determine. A serious complication of wounds (especially deep ones) is the entry of tetanus pathogens into them. The mortality rate for tetanus reaches 28-40%. Tetanus toxins affect the central nervous system. The first signs of the disease may appear after several hours or days (up to 35 days). Marked nagging pain in the muscles of the limbs, back and abdominal wall, twitching of muscles in the wound, difficulty opening the mouth and chewing, throwing back the head. Body temperature rises to 39-42° C, breathing and swallowing become difficult, the head falls back, and cramps of all muscles develop (Figure 10), and the amazed man takes a forced pose. Gas gangrene and tetanus are contagious diseases. Patients are subject to isolation, and staff are assigned to provide individual care for them. Linen, instruments and care items are thoroughly disinfected, and used dressings are burned.
During explosions at nuclear facilities, wounds may become infected with radioactive substances (RS), which are absorbed in small quantities into the blood and lymph, but mostly remain in the tissues. Half of these substances are removed from the wound with the discharged contents when the dressing is changed. Wounds infected with RV heal more slowly and are more often complicated by purulent infection. General radiation damage to the body does not develop with a slight exposure to radioactive substances.
Asepsis and antiseptics. In order to prevent infection of wounds and combat microorganisms that have entered the wound, strict adherence to the rules of asepsis and antiseptics is necessary.
Asepsis - a set of measures aimed at preventing the introduction of microbes into the wound. It is achieved with the strictest fulfillment of the basic requirement: everything that comes into contact with the wound must be sterile, that is, disinfected.
When providing first aid, do not touch the wound with your hands, remove large foreign objects from it (shards of glass, bullets, scraps of clothing), cover it with non-sterile material, touch the wound with a non-sterile instrument, fill it with an alcohol solution of iodine, cologne, alcohol, vodka! Only the skin around the wound should be treated with antiseptic solutions. You should not tear off clothing stuck to the wound, but should carefully trim it around the wound! If it is difficult to remove the shoes when the wound is exposed, they are cut along the seam. On the scalp, if possible, cut off the hair only around the wound, but do not remove it from the surface or inside it. All objects that may come into contact with the wound are disinfected (sterilized). For this, the following sterilization methods are used: autoclaving (steam under pressure), treatment with dry heat, calcination, boiling, burning, exposure to antiseptic solutions, radioactive and ultraviolet irradiation.
Antiseptics - a set of therapeutic and preventive measures aimed at destroying microbes in the wound, creating conditions unfavorable for their development and penetration deep into tissues. It is achieved by using antiseptic agents during first aid that kill microbes or retard their growth, mechanically removing microbes from the wound during surgical treatment, creating unfavorable conditions in the wound for the proliferation of microbes by irradiating it with quartz, introducing drains to ensure the outflow of pus and wound liquids. Basic antiseptics used for wound disinfection: 3% hydrogen peroxide solution; 0.1-0.5% solution of potassium permanganate; 2% solution boric acid; 5% iodine tincture; 1-2% solution of chloramine B; 70% and 96% solutions ethyl alcohol; furatsilin solution at a dilution of 1:5000, etc.
Biological antiseptics include antibiotics, vaccines, serums, gamma globulins, and toxoids. Aseptic and antiseptic methods complement each other in the fight against wound infection.
Bandages. The doctrine of bandages, their correct use and application for various injuries is called desmurgy. Bandage - This is a dressing material that is used to close a wound. The process of applying a bandage to a wound is called dressing. The bandage consists of 2 parts: the inner part, which is in contact with the wound, and the outer part, which secures the inner part of the bandage to the wound. The inside of the dressing must be sterile. A bandage applied to a wound for the first time is called primary sterile.
Bandages are applied to cover wounds and burn surfaces, prevent infection and stop bleeding. Protective dressings protect the wound from drying out and mechanical irritation and reduce pain. Used to stop bleeding pressure bandages : a sterile napkin of several layers is applied to the bleeding wound, covered with cotton wool, and the whole thing is tightly bandaged to the wound surface. Bandages that provide immobility of an injured part of the body are called immobilizing . In case of a penetrating wound, a occlusal (hermetic) bandage.
Bandages are soft and hard. Soft dressings are made using gauze, elastic mesh-tubular bandages, cotton fabric, and lignin. For rigid dressings, plaster, special plastics, starch, and glue are used.
Technique for applying bandages. When applying bandages to wounds and burn surfaces, basic rules must be followed. The type of bandage applied in each specific case is determined by the nature of the injury and the intended purpose (protecting the wound, stopping bleeding, fixing the damaged part of the body).
When applying a bandage, the victim should be given the most comfortable position so as not to cause additional pain. The bandaged part of the body should be located in a physiological position, i.e. in the one that the affected person will occupy after first aid is provided to him. So, a bandage is applied to the upper limb when bent at a right angle elbow joint so that you can hang your hand on a scarf. Bandage on lower limb, if the victim has to walk, apply it with the knee joint bent at a slight angle and the foot bent at a right angle. The wound is covered with sterile material (napkin, bandage), which is secured with a bandage. The head of the bandage is taken in the right hand, the end of the bandage is applied to the side of the wound with the left hand; Rolling out the bandage, apply a bandage by rotating its head around the bandaged part of the body, intercepting the head of the bandage alternately with the right and left hands, straightening the bandage with your free hand. Bandaging is carried out from left to right, with each subsequent move of the bandage covering 2/3 or half the width of the previous move. The applied bandage should not cause pain or interfere with blood circulation. Having finished bandaging on a healthy part of the body, you need to tie the end of the bandage that is torn longitudinally or secure the end of the bandage with a pin.
https://pandia.ru/text/78/198/images/image004_46.jpg" align="left hspace=12" width="156" height="132">kinks) in circular rounds of the bandage (4) - (5 ).
Repeating this technique several times, cover the entire scalp. Finish applying the bandage with circular moves of the bandage (10), the end of which is secured with a pin.
Rice. 12. Headband cap.
For wounds in the crown, back of the head, lower jaw impose bandage in the form of a bridle(Fig. 13). After two securing moves through the forehead and occipital region (1), the bandage is transferred to the back of the neck and chin (2), then several vertical moves (3)-(5) are made through the crown and chin. From under the chin the bandage is led to the back of the head (6) through the forehead 
(8), (9) through the chin and neck and vertical (10), (11) and end with circular passages through the forehead and occipital region (12).
Rice. 13. Bandage in the form of a bridle.
Bandage on the ear area
(Fig. 14) applied in a circular motion 
bandage through the frontal-occipital areas (1), (3), (5) with alternating moves of the bandage through mastoid(part of the temporal bone located behind the outer ear canal) and ear (2), (4), (6), end with circular moves (7).
Rice. 14. Bandage on the ear area.
Apply to the occipital region and neck figure-of-eight bandage(Fig. 15) https://pandia.ru/text/78/198/images/image008_26.jpg" align="left" width="318" height="161 src=">
Rice. 16.Figure-of-eight bandage
on the right (a) and left (b) eye.
Figure-of-eight bandage on the right eye (a) and on the left eye (b) - explanations in the text (Fig. 16) Eye patch is applied as follows: first make a fastening circular move of the bandage (1), which goes from the back of the head under right ear on the right eye (2), and under left ear- on the left eye. The bandage moves alternate through the eye and around the head (Fig. 14). The double eye patch consists of a combination of two patches applied to the left and right eyes.
On the nose, lips, chin(Fig. 17) A sling-shaped bandage is applied, placing a sterile napkin (bandage) on the wound.
https://pandia.ru/text/78/198/images/image010_18.jpg" align="left" width="168" height="144 src="> Chest bandages (Fig. 18). The simplest of these dressings is spiral . A bandage 1-1.5 m long should be placed on the left shoulder girdle (1), hanging its ends equally behind and in front. On top of it, starting from the bottom of the chest, there are circular moves of the bandage from right to left (2) - (8). I close the bandage with a bandage coming from the right armpit, connecting it (9) with the free end in front (10) and tying it on the forearm with the other free end hanging at the back (11).
Rice. 18. Spiral chest bandage
cell.
https://pandia.ru/text/78/198/images/image012_17.jpg" align="right" width="144" height="189 src=">Vaseline" href="/text/category/vazelin/ " rel="bookmark">vaseline. Having covered the wound with this napkin, put oilcloth or cellophane on top of it, a layer of cotton wool and bandage it tightly. In extreme cases, when there is no individual dressing package or plasters at hand, and the condition of the affected person is serious and cannot be delayed, improvised material is used. To do this, you can use any clean, airtight material (cellophane, a piece of rubber, oilcloth). The technique for applying such a bandage is similar to that for applying an individual dressing package.
https://pandia.ru/text/78/198/images/image014_14.jpg" align="left hspace=12" width="131" height="174">the depressions of the healthy side through outer surface(1) the injured shoulder, then the back in armpit and onto the shoulder (2), along the back through the armpit of the healthy side (3) onto the shoulder, and then the moves of the bandage are repeated, moving upward by shoulder joint and shoulder girdle (4).
Elbow joint (Fig. 23) the bandage is applied in spiral strokes of the bandage, alternately https://pandia.ru/text/78/198/images/image016_16.jpg" align="left hspace=12" width="96" height="164">
A cross-shaped bandage is applied to the hand
. (Fig. 24) The bandage is fixed on the wrist (1) in two or three strokes, then it is moved obliquely along the back of the hand (2) to the palm, in two or three circular strokes (3) from the palmar surface obliquely along the back surface of the hand (4) to the wrist, then the bandage moves
Rice. 24.Cross-shaped bandage on the hand .
https://pandia.ru/text/78/198/images/image019_9.jpg" align="right" width="69" height="133 src="> Spiral finger bandage (Fig. 25) start with two or three strokes of the bandage from the wrist (1), then move the bandage along the back surface (2) to nail phalanx finger, make circular moves to the base (3)-(6), through the wrist (7), if necessary, bandage the 2nd (8) and subsequent fingers
Rice. 25. Spiral finger bandage.
Belly bandages. The most time-consuming and difficult is applying bandages for severe abdominal injuries. When the upper abdomen is wounded, a spiral bandage is used in circular motions of the bandage from the chest down..jpg" align="right" width="288" height="213">
(Fig. 27) which they begin with two or three circular moves around the waist, then pass the bandage through the buttock and perineum, make a reverse move around the waist through the perineum, etc., repeating the moves of the bandage, crossing in front, tightly covering the external genitalia,
Rice. 27. Figure-of-eight bandage on the perineum.
Apply to the knee joint convergent or divergent bandages (Fig. 28.)
https://pandia.ru/text/78/198/images/image023_9.jpg" align="right" width="120" height="149 src=">
Rice. 28. Convergent (a) and divergent (b)
bandages for the knee joint. b
The first fixing stroke of the bandage is made above the ankle (1), then the bandage is led down to the sole (2) around the foot (3) and along its back surface (4) above the ankle (5) onto the foot; repeating the steps of the bandage, the bandage is completed in a circular manner moves above the ankle (7), (8). This bandage not only protects the wound, but also fixes the joint.
When applied heel bandages the first stroke of the bandage is made through its most protruding part, then alternately above and below the first stroke, continuing from the sole with oblique strokes around above the ankle, then the strokes of the bandage are repeated above the second and below the third stroke in the opposite direction, through the sole; the end of the bandage is fixed above the ankle. On the foot (Fig. 29) impose spica bandage alternating passes of the bandage through the heel, supracalcaneal region (1), (3), (5), (7), (9), (11) and the dorsum of the foot (2), (4), (6),
The main requirement for applying bandages is compliance with the rules of asepsis and antisepsis, ensuring the most comfortable - physiological position of the damaged part of the body, eliminating the possibility of impaired blood supply, and reliable fixation of the bandage on the damaged part of the body.
Rice. 29. Spica bandage on the foot.
When providing first aid, you must quickly remove clothing from the wound(shoes) and put a bandage on it. A medical dressing package is intended for these purposes. (PPM).
The procedure for preparing to apply a dressing package is as follows:
1. Tear the rubberized shell along the cut and remove it.
2. Remove the pin from the fold of the paper casing, tear the casing and discard it.
3. With your left hand, take the end of the bandage and, stretching the bandage, unfold it until the head of the bandage is released (approximately one turn).
4. Right hand take the head of the bandage and, stretching the bandage, unfold the bandage.
5. Touch with your hands only the side of the pads that is stitched with colored thread. If necessary, you can move the movable pad to the desired distance.
6. Bandage the pads and secure the end of the bandage with a pin. If necessary, a pin can be used to pin away clothing cut over the wound.
If there is bleeding, it must be stopped using the simplest methods - pressure bandage, tourniquet, twist (see “Bleeding”). According to indications, painkillers are administered using a syringe tube.
The technique of using a syringe tube consists of the following steps:
Puncture the membrane and remove the cap;
Removing air from the syringe tube;
Penetrating wounds of the skull (symptoms, first aid).
Injuries to the skull and brain are divided into open (wounds) and closed.
Closed injuries are divided into:
Concussions;
Brain contusions;
Compression of the brain.
Open damage is divided into:
Penetrating wounds of the skull (in the presence of damage to the dura mater);
Non-penetrating wounds of the skull (if intact);
With closed injuries, the rescuer should not waste time trying to determine whether it is a concussion or a bruise. (because urgent first aid is the same). It is much more important to understand whether there are symptoms of increasing compression of the brain (rapid deterioration of the affected person’s condition with increasing respiratory and circulatory disorders).
It is generally accepted that in most cases, when the soft tissues of the head are dissected to the full depth, there is a concussion with corresponding general cerebral symptoms (short-term impairment of consciousness, memory loss, headache, nausea, vomiting, pallor, increased blood pressure).
Brain contusions, in addition to general brain symptoms They also give local effects (dilation of the pupil on one side, smoothed out folds of the face on one side, cramps in one hand, etc.).
Help:
Rest in a lying position;
Cold on the head;
Aseptic dressing. A foreign body should not be removed from the wound, as it often plugs the wound and prevents excessive bleeding;
Transport immobilization using a Shants collar;
Evacuation lying down, in a position on your side, place a pillow under your head to soften the shaking.
Penetrating chest wounds (symptoms, first aid)
The classification of chest wounds is varied. Chest injuries are divided into:
Open (wounds) and closed;
Penetrating and non-penetrating;
With and without damage to bones (ribs, sternum, collarbone, scapula). With closed injuries, hemothorax and pneumothorax (accumulation of blood or air in the pleural cavity) are common.
As blood (and air) enters the pleural cavity, compression of the lung occurs until it is completely or almost completely turned off from the act of breathing (Fig. 30)
Rice. thirty. Hemothorax on the right.
Along with this, there is a shift of the mediastinum to the healthy side, which can significantly impede the work of the heart and contribute to the development of oxygen deficiency. Tension pneumothorax develops with characteristic symptoms - cold sweat, blue discoloration of the skin and mucous membranes, subcutaneous emphysema (crunching under the skin), swelling of the neck veins.
Soreness" href="/text/category/boleznennostmz/" rel="bookmark">pain on palpation of the abdomen, its bloating. Reliable symptoms of a penetrating wound to the abdomen are only prolapse of intestinal loops or omentum into the wound, or leakage of intestinal contents or bile from the wound (for kidney damage - leakage of urine (Figure 32).
Very insidious closed injuries abdomen: in the first hours, even with damage to internal organs, they are extremely poor in symptoms, and the erectile stage of a very quickly developing shock masks the dangerous picture of the pathology.
Rice. 32. Penetrating abdominal wound.
Help: sterile dressing, pain relief, prompt evacuation. No attempts to reposition the prolapsed entrails! Prohibition of food and drink!
First aid for injuries.
1. Define general state affected (pulse, breathing, consciousness, arterial pressure), stopping the impact on a person of a damaging (traumatic) factor.
2. Stop bleeding from the wound (applying a pressure aseptic bandage to the wound).
3. Rinse the wound with a disinfectant solution (hydrogen peroxide, saline, etc.) or, as a last resort, with clean running water if the wound is not penetrating.
4. Remove loose foreign bodies without touching the wound surface with your hands. Foreign bodies deeply embedded in the wound are not removed. If a knife, large piece of glass or other wounding object sticks out of the wound, they must be covered with sterile napkins, cotton wool, and stabilized in the wound with a bandage.
5. Treat the skin around the wound with 5% iodine tincture, avoiding iodine getting into the wound, so as not to cause additional chemical burn wounds.
6. Cover the wound with sterile napkins, put a layer of cotton wool on top, and bandage tightly.
7. In case of extensive wounds or injuries in the joint area, immobilize the limb.
8. Application of a hermetic (occlusive) bandage for a penetrating wound of the chest with an open or valve pneumothorax in order to convert it to a closed one;
Call " ambulance"or deliver the affected person to a surgical hospital.
The optimal time to provide first aid is the first 30 minutes after the victim receives an injury. However, quite often help must be provided immediately. It is quite obvious that in the case of a significant number of victims, first medical aid is provided to those most in need and is limited to emergency measures.
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First aid
Prevention of shock
1. Stop bleeding.
2. Eliminate possible additional trauma to the patient by:
Carefully apply a bandage to a wound or burn surface;
Proper splinting for fractures and dislocations;
Proper transportation (create a comfortable position);
Warnings for cooling the victim’s body: wrapping him in warm clothes, drinking hot drinks (if the abdominal organs are not damaged).
In case of shock, the effectiveness of treatment depends on the speed and timeliness of assistance.
1. The bleeding stops.
2. Places of fractures, dislocations, and bruises are anesthetized and immobilized with splints.
3. An aseptic bandage is applied to the wound.
4. Used medications:
1) analgesics – medications, selectively reducing pain. Distinguish narcotic, which, along with the analgesic effect, cause a kind of intoxication and sleep, and when long-term use– drug dependence (promedol, morphine), and non-narcotic analgesics, which are characterized by four main effects: 1) analgesic; 2) antipyretic; 3) anti-inflammatory; 4) immunosuppressive (analgin, acetylsatilic acid, indomethacin, etc.). Non-narcotic analgesics are not used for severe pain caused by injuries, surgical interventions, because are not effective in these cases.
2) antihistamines have specific activity, blocking histamine receptors, with allergic reactions. At the same time, they have anesthetic activity, potentiate (strengthen) the effect of analgesics, sedatives(diphenhydramine, suprastin, diprazine);
3) cardiovascular drugs, plasma replacement solutions.
4) glucocorticosteroids– cortisone, hydrocortisone.
Damage (trauma) - is it anatomical or functional disorders tissues and organs of the body under the influence external factors.
Basic types of damage depending on the reason causing them:
mechanicallye arising under the influence of mechanical force (for example, during a fall, impact, exposure to a blast wave, etc.);
physicallye, arising from exposure to high or low temperature (for example, burns, frostbite, etc.), electric current, penetrating radiation, etc.;
chemicallye, which arise when tissues are exposed to various chemical substances: acids, alkalis, OM, etc.
Depending on the condition of the skin and mucous membranes, there are:
open injuries (wounds), when the integrity of the outer integument is damaged to one degree or another (wounds, open dislocations and fractures, burns, etc.).
closede, i.e. those injuries in which the integrity of the skin and mucous membranes is not damaged (soft tissue bruises, sprains, most dislocations and fractures, etc.). They can occur both in superficial tissues and in the thoracic and abdominal cavities, in the cranial cavity and joints.
