Abstract - General idea of ​​injuries. Types of injuries. PMP for mechanical injuries - file n1.doc

Topic number 5. First aid for injuries.

General concepts of closed and open damage. 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. The concept of asepsis. Rules for handling sterile material. The concept of antiseptic. Primary bandage.

Workshops. Bandages on the head and neck, on the eyes, forehead, ear, hairy part head, lower jaw, chin. The imposition of bandages in the order of self - and mutual assistance. Mesh - tubular bandages.

Bandages on the chest, abdomen and crotch. Features of first aid and the imposition of an occlusive dressing for penetrating wounds chest with open pneumothorax and abdomen. Applying bandages in the order of self - and mutual assistance

Bandages for upper and lower limbs. Bandages for the upper limbs: the area of ​​the shoulder joint, shoulder, elbow joint, hand, fingers.

Bandages for the lower limbs: groin, upper thigh, hip joint, mid-thigh, knee-joint, leg, ankle joint, foot.

Features of applying bandages in winter. The imposition of bandages in the order of self - and mutual assistance.

It is known that a significant part of the victims who have received a severe, but not fatal injury, die precisely from the untimely provision of medical care. 1 hour after a severe injury, up to 30% of the 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”.

The concept of trauma and wound. Injuries can be open or closed. Open injuries include such injuries, an indispensable feature of which will be a violation of the integrity of the skin or the integrity of the visible mucous membranes.

Closed injuries include damage to the internal organs of the chest and abdominal cavity, brain, blood vessels and nerve trunks, closed bone fractures, bruises, soft tissue ruptures, sprains and tendons, dislocations in the joints, compression and concussion. When isolated closed injuries ah, there is no damage to the skin and 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 violated, a superficial wound . Superficial wounds, in which there is an incomplete violation of the skin or mucous membrane, are called abrasions.

If the integrity of the skin and the visible mucous membrane is violated, as well as the deeper lying tissues and organs are damaged, then deep wound. In cases where deep wounds damage inner shells anatomical cavities (cranial, thoracic, abdominal, articular), then such injuries are called penetrating. Wounds that have an inlet and outlet are called through . As a result of the penetration of the injuring 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 injuring object and tissue damage, cut, stab, chopped, bitten, torn, scalped, bruised, crushed and gunshot wounds are distinguished.

cut wound, applied with a sharp object, characterized by a predominance of length over depth, smooth edges, a minimum amount of dead tissue and reactive change around the wound.

chopped wound - arises from the impact of a heavy sharp object, has a great depth and volume of non-viable tissues.

Laceration - formed when exposed to soft tissues damaging factor exceeding their physical ability to stretch. its edges irregular shape, detachment or detachment of tissues and destruction of tissue elements over a considerable extent is noted.

stab wound - occurs when soft tissues are damaged by a needle, awl, nail, knife, bayonet, etc. These wounds are usually deep, often blind, with a small inlet 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 - arises from a blow with a blunt object, like a crushed wound, in which there is crushing and tissue rupture with a significant zone of primary and subsequently secondary traumatic necrosis with abundant microbial contamination.

bitten wound - occurs as a result of a bite by an animal or a person, is characterized by abundant microbial contamination and frequent infectious complications. It can include signs characteristic of torn, bruised and crushed wounds, and is often infected with pathogenic flora contained in the saliva of the bitten.

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 signs.

The variety of systems of firearms and ammunition causes a wide variety of gunshot wounds. The direct action of the projectile (bullet) causes crushing, tearing and splitting of tissues. As a result of the direct action of the projectile, wound channel, filled with destroyed tissue. Passing through the tissue, the firearm leaves a trace in the form of a so-called temporary cavity, which pulsates for several milliseconds. This is how it is formed concussion zone and indirect zones side impact of the projectile. Its value can exceed the size of zero or a fragment by 30-40 times, and the pressure in it can reach 100 atm.

The main signs of a wound are pain, gaping, bleeding, and dysfunction of the injured 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. Sharp kidney failure with massive damage to soft tissues;

7. Wound psychoses.

8. Post-traumatic stress disorder.

As well as complications associated with impaired function of the damaged organ.

All wounds, except wounds caused by sterile instruments during surgical operations, are considered infected (infected with microbes). At the moment of inflicting a wound, pathogenic organisms penetrate into the wound, together with the injuring tool, causing inflammatory and suppurative processes in the wounds. Of particular danger is the contamination of wounds with microorganisms that lead to the development of a general infection: tetanus, rabies, etc.

In addition to microorganisms, wounds can be contaminated with foreign bodies: scraps of clothing, earth, small pebbles, glass fragments, and in some cases, the injuring tools themselves can be in the wound.

Each wound is accompanied by bleeding. Depending on the type of blood vessels damaged during injury, bleeding from the wound is capillary, venous, arterial.

Rice. tenConvulsions in tetanus.

Microbes that enter the wound cause inflammation and suppuration in it and adjacent tissues. When streptococci enter the wound, it develops erysipelas, in which there is a pronounced reddening of the skin around the wound with uneven clear edges, an increase in temperature to 38-39 ° C, sharp deterioration general condition. When wounds are contaminated with earth, microbes that develop without air enter the tissues. They cause the development of gas gangrene (anaerobic infection), accompanied by putrefactive decay of tissues, the formation of air bubbles in the tissues. At the same time, the condition of the body affected is rapidly deteriorating due to general poisoning with toxins. Early signs of anaerobic infection: significant pain in the wound, a feeling of "bursting" of the soft tissues around the wound, increasing swelling, icteric skin tone. The wound is covered with a dirty gray coating. The appearance of crypitation (crunching) of tissues when pressed indicates the formation of gas bubbles in the tissues and more. severe defeat, the development of general poisoning of the body. At the same time, body temperature rises, breathing is disturbed, the pulse becomes frequent and is difficult to determine. A terrible complication of wounds (especially deep ones) is the ingress of tetanus pathogens into them. Mortality in tetanus reaches 28-40%. Toxins of the causative agent of tetanus affect the central nervous system. The first signs of the disease may appear after a few hours or days (up to 35 days). Are celebrated drawing pains in the muscles of the limbs, back and abdominal wall, twitching of the muscles in the wound, difficulty opening the mouth and chewing, tilting the head. The body temperature rises to 39-42 ° C, breathing and swallowing become difficult, the head throws back, convulsions of all muscles develop (Figure 10), and the affected person assumes a forced posture. Gas gangrene and tetanus are contagious diseases. Patients are subject to isolation, staff is allocated for individual care. Linen, tools and care items are thoroughly disinfected, and used dressings are burned.

Explosions at nuclear facilities may infect wounds with radioactive substances (RS), which are absorbed in small amounts into the blood and lymph, but mostly remain in the tissues. Half of these substances are removed from the wound with discharge when the dressing is changed. Wounds infected with RV heal more slowly, more often purulent infection. General radiation damage to the body with a slight ingestion of RW does not develop.

Aseptic and antiseptic. In order to prevent infection of wounds and to combat microorganisms that have entered the wound, strict adherence to the rules of asepsis and antisepsis is necessary.

Asepsis - a set of measures aimed at preventing the introduction of microbes into the wound. It is achieved with the strictest implementation of the basic requirement: everything that comes into contact with the wound must be sterile, that is, disinfected.

When providing first aid, you should not touch the wound with your hands, remove large foreign objects(glass fragments, bullets, pieces of clothing), cover it with non-sterile material, touch the wound with a non-sterile instrument, fill it with a solution of iodine alcohol, cologne, alcohol, vodka! It is necessary to treat only the skin around the wound with antiseptic solutions. Do not tear off clothing stuck to the wound, but carefully cut it around the wound! If it is difficult to remove the shoes when the wound is exposed, it is cut along the seam. On the scalp, if possible, cut the hair only around the wound, but do not remove it from the surface and from the inside. All items that may come into contact with the wound are decontaminated (sterilized). For this, the following sterilization methods are used: autoclaving (steam under pressure), dry heat treatment, calcination, boiling, roasting, keeping in antiseptic solutions, radioactive and ultraviolet radiation.

Antiseptics - a complex of therapeutic and preventive measures aimed at the destruction of microbes in the wound, the creation of conditions unfavorable for their development and penetration into the depths of the tissues. It is achieved by the use of antiseptic agents in the provision of first aid that kill microbes or retard their growth, mechanical removal of microbes from the wound during its surgical treatment, creation of unfavorable conditions in the wound for the reproduction of microbes by quartz irradiation, the introduction of drains to ensure the outflow of pus and wound liquids. The main antiseptics used to disinfect wounds: 3% hydrogen peroxide solution; 0.1-0.5% potassium permanganate solution; 2% solution boric acid; 5% share iodine tincture; 1-2% solution of chloramine B; 70% and 96% solutions ethyl alcohol; solution of furacilin at a dilution of 1:5000, etc.

Biological antiseptics include antibiotics, vaccines, serums, gamma globulins, toxoids. Aseptic and antiseptic methods complement each other in the fight against wound infection.

Bandages. The doctrine of bandages, their correct application and overlay for various injuries, is called desmurgy. Bandage - This is a dressing that closes the wound. The process of applying a bandage to a wound is called dressing. The bandage consists of 2 parts: the inner one, which is in contact with the wound, and the outer one, which fixes the inner part of the bandage on the wound. The inside of the dressing must be sterile. A dressing applied to a wound for the first time is called primary sterile.

Dressings are applied to close wounds and burn surfaces, prevent their infection and stop bleeding. Protective bandages protect the wound from drying out and mechanical irritation, reduce pain. Used to stop bleeding pressure bandages : a sterile napkin of several layers is applied to a bleeding wound, covered with cotton wool, and all this is tightly bandaged to the wound surface. Bandages that keep the injured part of the body immobile are called immobilizing . With a penetrating wound in the chest cavity impose occlusal (hermetic) bandage.

Bandages are soft and hard. Soft dressings are performed using gauze, elastic mesh-tubular bandages, cotton fabric, lignin. For hard dressings, gypsum, special plastics, starch, and glue are used.

Bandage technique. When applying dressings to wounds and burn surfaces, basic rules must be observed. The type of bandage applied in each case is determined by the nature of the injury and the goal (protecting the wound, stopping bleeding, fixing the damaged part of the body).

When applying a bandage, the victim must 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, that is, 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 with the elbow joint bent at a right angle, so that you can hang your hand on a scarf. A bandage on the lower limb, if the victim has to walk, is applied with the knee joint bent at a slight angle and the foot bent at a right angle. The wound is closed with a sterile material (napkin, bandage), which is fixed with a bandage. The head of the bandage is taken in the right hand, with the left hand the end of the bandage is applied to the side of the wound; 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 hand, straighten the bandage moves with the free hand. Bandaging is carried out from left to right, each subsequent move of the bandage closes 2/3 or half the width of the previous move. The applied bandage should not cause pain, disrupt blood circulation. Having finished bandaging on a healthy part of the body, you need to tie the end of the bandage torn longitudinally or fix 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) with circular bandage tours (4) - (5 ).

Repeating this technique several times, close the entire scalp. Finish applying the bandage with a circular bandage (10), the end of which is fixed with a pin.

Rice. 12. Bandage cap.

On wounds in the region of the crown, occiput, mandible impose bandage in the form of a bridle(Fig. 13). After two fixing moves through the forehead and occipital region (1), the bandage is transferred from behind to 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 moves through the forehead and occipital region (12).

Rice. thirteen. Bandage in the form of a bridle.

Ear bandage (Fig. 14) applied in a circular motion bandage through the frontal-occipital regions (1), (3), (5) with alternating bandage moves through the mastoid process (part of the temporal bone located behind the external auditory canal) and ear (2), (4), (6), finish circular moves (7).

Rice. fourteen. Bandage on the ear area.

On the occipital region and neck superimposed figure-of-eight bandage(Fig. 15) https://pandia.ru/text/78/198/images/image008_26.jpg" align="left" width="318" height="161 src=">

Rice. sixteen.Eight bandage

on the right (a) and left (b) eyes.

Eight bandage on the right eye (a) and on the left eye (b) - explanations in the text (Fig. 16) Eye patch superimposed as follows: first, a fixing circular motion of the bandage (1) is made, which goes from the back of the head under right ear on the right eye (2), and under left ear- on the left eye. Bandage moves alternate through the eye and around the head (Fig. 14). The bandage for both eyes consists of a combination of two bandages applied to the left and right eye.

On the nose, lips, chin(Fig. 17) a sling-like 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="> Bandages on the chest (Fig. 18). The simplest of these bandages is spiral . A bandage 1-1.5 m long should be put 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 bandage moves from right to left (2) - (8). I cover the bandage with the course of the 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 behind (11).

Rice. eighteen. Spiral bandage on the chest

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 closed the wound with this napkin, an oilcloth or cellophane is placed on top of it, a layer of cotton wool and tightly bandaged. In extreme cases, when there is no individual dressing bag at hand, a plaster, and the condition of the affected person is severe and it is impossible to hesitate, 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 dressing 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">healthy side depressions through outer surface(1) injured shoulder, then back to armpit and on the shoulder (2), along the back through the armpit of the healthy side (3) to the shoulder, and then the bandage moves are repeated, moving up to the shoulder joint and shoulder girdle (4).

elbow joint (Fig. 23) the bandage is applied with spiral bandage moves, alternately https://pandia.ru/text/78/198/images/image016_16.jpg" align="left hspace=12" width="96" height="164">

A cruciform bandage is applied to the hand . (Fig. 24) The bandage is fixed on the wrist (1) in two or three moves, then it is led obliquely along the back of the hand (2) to the palm, in two or three circular moves (3) from the palmar surface obliquely along the back of the hand (4) to the wrist, then the bandage moves

Rice. 24.Cruciform wrist bandage .

https://pandia.ru/text/78/198/images/image019_9.jpg" align="right" width="69" height="133 src="> Spiral bandage on the finger (Fig. 25) start with two or three bandage moves from the wrist (1), then lead the bandage along the back surface (2) to the nail phalanx of the finger, make circular moves to the base (3)-(6), through the wrist (7), if necessary, bandage 2 -th (8) and subsequent fingers

Rice. 25. Spiral bandage on the finger.

Bandages on the stomach. The most time-consuming and difficult is the application of bandages for severe abdominal trauma. When the upper abdomen is injured, a spiral bandage is applied with circular bandage moves from the chest down..jpg" align="right" width="288" height="213">

(Fig. 27) which is started with two or three circular moves around the waist, then the bandage is led through the buttock and perineum, reverse stroke around the waist through the crotch, etc., repeating the moves of the bandage, crossing in front, tightly close the external genitalia,

Rice. 27. Eight bandage on the crotch.

Apply to the knee joint converging or divergent bandages (Fig. 28.)

https://pandia.ru/text/78/198/images/image023_9.jpg" align="right" width="120" height="149 src=">

Rice. 28. Converging (a) and diverging (b)

knee bandages. b

The first fixing move 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) to the foot; repeating" bandage bandage, end the bandage with circular moves above the ankle (7), (8). This bandage not only protects the wound, but also fixes the joint.

When applied heel bandages the first move of the bandage is made through its most protruding part, then alternately above and below the first move, continuing from the sole with oblique moves around above the ankle, then the moves of the bandage are repeated above the second and below the third move 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 strokes of the bandage through the heel, supraheel region (1), (3), (5), (7), (9), (11) and the back of the foot (2), (4), (6),

The main requirement for applying bandages is to comply with the rules of asepsis and antisepsis, to ensure the most convenient physiological position of the injured part of the body, to exclude the possibility of impaired blood supply, and to securely fix the bandage on the damaged part of the body.

Rice. 29. Spike bandage on the foot.

When providing first aid, you need to quickly free the wound from clothing(shoes) and put a bandage on it. For these purposes, a medical dressing package is intended. (PPM).

The procedure for preparing for the application of a dressing package is as follows:

1. Tear apart the rubberized sheath along the notch and remove it.

2. Remove the pin from the fold of the paper shell, and tear the shell 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 sewn 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 chip off clothing cut over the wound.

If there is bleeding, it must be stopped using the simplest methods - a 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 of the membrane and removal of the cap;

Removing air from the syringe tube;

Penetrating wounds of the skull (symptoms, first aid).

Damage to the skull and brain are divided into open (wounds) and closed.

Closed injuries are divided into:

Concussions of the brain;

Brain bruises;

Brain compression.

Open injuries are divided into:

Penetrating wounds of the skull (in the presence of damage to the dura mater);

Non-penetrating wounds of the skull (if it is preserved);

With closed injuries, the rescuer should not waste time recognizing whether it is a concussion or a bruise? (since urgent first aid the same). It is much more important to figure out whether there are symptoms of increasing compression of the brain (rapid deterioration of the condition of the affected person 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 of the brain with corresponding general cerebral symptoms (short-term impairment of consciousness, memory loss, headache, nausea, vomiting, pallor, increased blood pressure).

Bruises of the same brain, in addition to general brain symptoms give and local (expansion of the pupil on the one hand, the folds of the face are smoothed on the one hand, convulsions in one hand, etc.).

Help:

Rest in the supine position;

Cold on the head;

Aseptic bandage. A foreign body should not be removed from the wound, since it often plugs the wound and prevents heavy bleeding;

Transport immobilization using the Shants collar;

Evacuation lying, in the position on the side, put a pillow under the head to soften the shaking.

Penetrating wounds of the chest (symptoms, first aid)

The classification of chest injuries is diverse. Chest injuries are divided into:

Open (wounds) and closed;

Penetrating and non-penetrating;

With damage to the bones (ribs, sternum, collarbone, shoulder blades) and without damage. With closed injuries, hemothoraxes and pneumothoraxes (accumulation of blood or air in the pleural cavity) are frequent.

As blood (and air) enters the pleural cavity, the lung is compressed 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 complicate the work of the heart and contribute to the development of oxygen deficiency. Tension pneumothorax develops characteristic symptoms- cold sweat, blue skin and mucous membranes, subcutaneous emphysema (crunching under the skin), swelling of the jugular veins.

Soreness" href="/text/category/boleznennostmz/" rel="bookmark"> soreness on palpation of the abdomen, its swelling. Reliable symptoms of a penetrating wound of the abdomen are only prolapse of intestinal loops or omentum into the wound, or outflow of intestinal contents or bile from the wound (for kidney damage - urine leakage (Figure 32).

Closed abdominal injuries are very insidious: in the first hours, even with damage to internal organs, they are extremely poor in symptoms, and the erectile stage of a very rapidly developing shock masks a dangerous picture of the pathology.

Rice. 32. Penetrating wound of the abdomen.

Help: sterile dressing, anesthesia, speedy evacuation. No attempts to reposition the prolapsed entrails! Prohibition of food and drink!

First aid for injuries.

1. Determine general state affected (pulse, respiration, consciousness, blood pressure), termination of human exposure to the damaging (traumatic) factor.

2. Stop bleeding from the wound (applying a pressure aseptic bandage to the wound).

3. Wash the wound with a disinfectant solution (hydrogen peroxide, saline, etc.) or, in extreme cases, with clean running water if a non-penetrating wound.

4. Remove freely lying foreign bodies without touching the wound surface with your hands. Foreign bodies deeply embedded in the wound are not removed. If a knife, a large piece of glass or another injuring 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 5% iodine tincture, avoiding the ingress of iodine into the wound, so as not to cause additional chemical burn wounds.

6. Close the wound with sterile napkins, on top of which put a layer of cotton, bandage tightly.

7. In case of extensive wounds or wounds in the area of ​​the joints, immobilize the limb.

8. The imposition of a hermetic (occlusive) dressing in case of a penetrating wound of the chest with an open or valvular pneumothorax in order to transfer it to a closed one;

Call " ambulance»or deliver the victim to a surgical hospital.

The optimal time for providing first aid is the first 30 minutes after the victim is injured. Often, however, help must be provided immediately. It is quite obvious that in the case significant amount affected, first aid is provided to the most needy of them and is limited to urgent measures.

As a result of external influence, including the impact of damaging factors of sources of emergency situations, a person may experience damage to the body (trauma). Damage to the body (trauma) is a violation of the integrity and functions of human tissues and organs.

Depending on the nature and strength of the external impact, injuries are divided into closed and open injuries (closed and open injuries).

Closed injuries are injuries to soft tissues and internal organs, skeletal system, blood vessels, etc. while maintaining the integrity of the skin and mucous membranes.

Closed injuries include bruises, dislocations, sprains, closed fractures of the upper and lower extremities, closed skull fractures, etc. With closed injuries, as already noted, the integrity of the skin and mucous membranes is preserved, and damage can be judged by indirect signs.

For example, when a bruise is often torn small blood vessels. At the same time, the integrity of the skin is not broken, but at the site of the bruise, due to internal hemorrhage, it turns purple or purple, swells and becomes painful - a bruise (bruise) is formed.

If the ligaments of any joint (ankle, knee, elbow, shoulder) are damaged, individual fibers of the ligament are torn, nearby blood vessels suffer, resulting in hemorrhages into the surrounding tissues and accumulation of blood in the joint cavity of the stretched ligament. In this case, the joint increases in size (swells up), the blue of the outflowing blood shines through the skin, the injured area is painful when palpated.

Open injuries, or wounds, are injuries in which the integrity of the skin, mucous membranes is violated throughout their entire thickness (often deeper than lying tissues and organs).

The characteristic signs of any wound are: damage to the integrity of the skin (skin); bleeding; pain.

In an emergency, wounds occur when a person is exposed to a mechanical damaging factor.

Depending on the specific type of mechanical damaging factor that caused the injury, there are cut, chopped, stab, bruised, torn, gunshot wounds.

According to the depth of damage, wounds are divided into superficial (shallow damage, when only the integrity of the skin is violated) and deep (in addition to violation of the integrity of the skin, the subcutaneous layer, muscles and even bones are damaged).

In relation to body cavities, penetrating and non-penetrating wounds are distinguished.

Penetrating wounds are characterized by damage to internal organs, which causes a complicated pathological condition affected.

The most common are penetrating wounds of the skull, chest, abdomen, in which complex pathological conditions are possible.

One of characteristic features The 21st century is a massive 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 culture of traffic on the roads.

Damage caused by domestic animals has become widespread.

The most severe injuries, both in nature and in terms of complications and outcomes, are observed in disasters caused by natural forces or human technological activity.

In the structure of peacetime injuries, open injuries (wounds) are of particular danger.

A distinctive feature of injuries of the surgical profile in Emergencies is a significant frequency of cases of multiple and combined injuries, which are accompanied by such severe complications as traumatic shock, acute blood loss, asphyxia, prolonged compression syndrome.

An open injury, or wound, is a gaping violation of the integrity of the integument (skin, mucous membranes) with the possible destruction of deeper tissues.

With open injuries, the wound channel is inevitably contaminated with pathogenic microorganisms, followed by the development of various inflammatory processes.

The main dangers that can be provoked 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 a violation of the functions of vital organs;
c) infection penetration;
d) the possibility of violating the integrity of vital organs.

The clinical picture of wounds consists of local and general symptoms.

Local symptoms include pain, bleeding from the wound, gaping of the wound.

Common 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 area of ​​damage:
2) from the reactivity of the body of the victim, his neuropsychic state. It is known that people react differently to pain. So, with fear, unexpected injury, etc. the strength of pain increases significantly;
3) on the nature of the injuring 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 applied, 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 the wound is determined by its size, depth and violation of the integrity of the elastic fibers of the skin. The degree of wound gaping is also related to the nature of the tissues. Wounds located across the direction of the elastic fibers of the skin usually have a greater gaping than wounds running parallel to them.

Closed injuries of tissues and organs include injuries accompanied by a violation of the integrity of the skin and visible mucous membranes. There are: closed injuries of soft tissues; organs located in the cavities; bones and joints. The severity of the injury depends on the traumatic force, the direction and duration of its impact, the area of ​​the injured part of the body, 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 frequent closed mechanical damage to tissues and organs caused by a short-term impact on the surface of the body of a solid object without violating the anatomical integrity of the skin, tissues, mucous membranes and organs. Such damage usually occurs when a solid object that has a large surface area and little kinetic energy is impacted, as well as when a body falls onto a hard surface. This type of injury is characterized by unexpectedness, speed and short duration of the traumatic effect. Bruises in most cases are local in nature.

Bruising as a type of injury is characterized by local and general symptoms. Local symptoms include: pain different strength and duration; swelling in the area of ​​injury; bruising, hemorrhage, which was formed as a result of rupture of blood vessels; dysfunction of the affected body part. With strong and extensive closed injuries, there are also general symptoms characteristic of this type of injury: fever, sleep and appetite disturbances, signs of anemia, sometimes shock develops. Severe pain occurs with bruises of the periosteum, external genital organs, large nerve trunks and plexuses.

First aid for bruises consists in applying a pressure bandage, cold (ice pack for 40-50 minutes, with a break of 10-15 minutes), which helps to reduce or stop hemorrhage, pain, etc. To improve the outflow of blood and lymph damaged slightly elevate the limb. With a bruise of large tissues, severe pain may occur, which require the administration of painkillers and transport immobilization.

From the 2-3rd day, treatment is carried out aimed at accelerating the resorption of the hemorrhage. For this purpose, thermal procedures are carried out (warming half-alcohol or oil compresses, warm heating pads, warm water baths with a temperature of 36.5-37 ° C). When hit with hemorrhage in the muscles and joints, compresses with absorbable medicinal substances are applied, and physiotherapy is prescribed. In the presence of a hematoma (blood tumor), puncture and suction of blood, administration of antibiotics are indicated.

stretching- this is a tear of tissues while maintaining their anatomical integrity. When tissue is ruptured, anatomical integrity is not preserved. Tendon ligaments and muscles are most often subjected to sprains and ruptures. Such injuries occur after a sharp and rapid contraction of tissues and organs or their 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 aid for sprains and tissue ruptures 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 is ruptured, immobilization is performed. Full break tendons, muscles requires surgical intervention: suturing and plaster cast for 2-3 weeks.

Dislocation- persistent displacement of the articular ends of the bones beyond their normal mobility. There are complete dislocations (articular surfaces do not touch each other) and incomplete (articular surfaces partially touch).

Depending on the origin, dislocations are divided into congenital and acquired. The first ones occur in the prenatal period as a result of improper or insufficient development of the articular surfaces, acquired are most often the result of injuries. Traumatic dislocations account for 80-90% of all cases of dislocations with the most frequent localization in the shoulder and elbow joints. Most often they are caused by external force, less often by excessive muscle contraction.

For any dislocations are characteristic: pain in the joint, which increases during movement or palpation of the joint; forced position of the limb, characteristic of each type of dislocation; deformity in the joint area; dysfunction of the joint; change in the length of the limb (most often shortening). In addition, swelling and soreness may be observed.

Emergency care for dislocations includes:

• ensuring the rest of the injured limb by immobilizing it with standard splints, a fixing bandage or improvised means;
• the introduction of painkillers;
• application of cold to the joint area to reduce bleeding, swelling, pain;
• the imposition of a primary aseptic bandage on the wound with open traumatic dislocations;
• urgent transport of the patient to medical institution to reduce dislocation.

Treatment is aimed at restoring the normal position of the bones in the joint, keeping them in this position and full recovery function of the injured joint.

Review questions

1. List closed soft tissue injuries.
2. Describe each type of closed soft tissue injury.
3. Tell me about emergency care with bruises, sprains, dislocations.