Burns: emergency care. Emergency care for burns at the prehospital stage Emergency care for burns

Content

Such injuries cause a person to develop a severe general condition due to changes in blood composition, disruption of the central nervous system and the functions of internal organs due to intoxication. Timely and correct assistance will help reduce the damage from the burn to a minimum.

Classification of burns

The severity of the damage depends on several factors, including the height of the temperature, the duration of exposure to the harmful factor on the skin/mucous membranes, and the location of the injury. Especially serious damage is caused by steam and flame under pressure. More often people experience burns to the limbs and eyes, less often to the head and torso. The larger the surface of the damaged tissue and the deeper the damage, the higher the danger for the victim. Thus, a burn of 30% of the body surface is often fatal.

To provide first aid, it is important to know what type of burn was received. The speed and degree of tissue restoration of the patient after injury largely depends on how correctly pre-medical measures were chosen. Incorrect actions that do not correspond to the type of burn can aggravate the situation, further harming a person’s health.

According to the depth of the lesion

Minor burned areas of the body can be treated at home without resorting to medical help.

With large areas of burns, a large number of nerve endings are damaged and traumatic shock develops, so it is extremely important to go to the hospital in a timely manner.

There are the following degrees of injury from fire, electricity and chemicals:

First. These are superficial tissue injuries in which swelling, redness of the skin, and burning pain are observed. Symptoms disappear within 3-6 days, after which the dermis begins to renew itself through exfoliation. Pigmentation remains at the site of injury.
Second. Characterized by the appearance of blisters (blisters filled with liquid). In the damaged area, immediately or after some time, the surface layer of skin begins to peel off. The blisters burst, which is accompanied by intense pain. If tissue infection does not occur, healing occurs in approximately 2 weeks.
Third. Necrosis (necrosis) of the deep layers of the dermis occurs. After such burns, scars are sure to remain.
Fourth. This stage is characterized by necrosis and charring of deep-lying tissues. Damage may affect muscles, bones, subcutaneous fat, and tendons. Healing occurs very slowly.

By type of damaging factors

Providing first aid for a burn depends on the nature of the impact. There are several types of damaging factors by which burns are classified.

Type of burn injury	Impact factor	Possible consequences
Thermal	Contact with fire, boiling water, steam, hot objects.	As a rule, the hands, face, and respiratory tract are affected. When contacting boiling water, the damage is often deep. The steam can damage the respiratory tract; it does not leave deep damage on the skin. Hot objects (for example, hot metal) cause blisters and leave deep burns of 2-4 degrees of severity.
Chemical	Contact with the skin of aggressive substances - acids, caustic alkalis, salts of heavy metals.	Acids cause shallow lesions, with a crust appearing on the injured areas, which prevents the acid from penetrating deep into the tissue. Alkalies can leave deep damage to the skin. Zinc chloride and silver nitrate can only cause superficial lesions.
Electric	Contact with conductive materials.	Electrical trauma causes very serious, dangerous consequences. The current quickly spreads through tissues (through the blood, brain, nerves), leaves deep burns and causes disruption of organs/systems.
	Ultraviolet, infrared or ionizing radiation.	UV radiation is dangerous in the summer: injuries are shallow, but can be extensive, as a rule, they are grade 1-2. Infrared radiation provokes damage to the eyes and skin. The degree of damage depends on the duration and intensity of exposure to the body. Not only the dermis, but also nearby tissues and organs suffer from ionizing rays, although their damage is shallow.

First aid for burns

The first thing to do is to eliminate the damaging factor. After treating the affected areas of the body (the choice of method depends on the type of burn), an aseptic dressing should be applied to prevent infection of the body. First aid for burns also includes measures to prevent shock and transport the victim to a medical facility. It is extremely important to perform any actions carefully to avoid further tissue damage. First aid includes:

extinguishing burning clothing;
evacuation of a person from a dangerous zone;
removing smoldering or heated clothing;
careful removal of stuck things (they are cut off around the injury);
applying an aseptic dressing (if necessary, even over the remaining piece of clothing).

The main task of the person who provides first aid is to prevent infection of the burn tissue. For this purpose, use a sterile bandage or an individual bag.

In the absence of these products, it is permissible to use clean cotton fabric, ironed or treated with an antiseptic (alcohol, vodka, potassium permanganate, etc.).

Pre-medical measures

The rules for providing first aid for burns provide for pre-medical measures only for grade 1-2 injuries. If the affected area covers an area of more than 5 cm, multiple blisters are observed on the tissues, and the victim feels intense pain, you should immediately call an ambulance. For serious burn injuries of grade 2 or higher, or if more than 10% of the person’s body is damaged, urgently hospitalize. It is prohibited to do the following as part of first aid:

move or carry the victim without first checking the pulse, breathing, presence of fractures, after loss of consciousness due to electric shock or other types of injuries;
treat burned tissues with any available means (butter or sour cream), this will aggravate the situation, since fatty foods disrupt the heat transfer of the skin;
clean the wound yourself in the absence of sterile bandages, cover the affected areas with fabrics with lint or cotton wool;
apply a tourniquet without an open wound with serious blood loss (this measure will lead to tissue death and amputation of the limb);
apply bandages without understanding how to do it correctly (if there is an urgent need, you can easily wrap the area of the burn injury with sterile material without pulling the burned area tightly);
puncture blisters (this will cause infection);
tear off clothes stuck to the wound (dry tissues should first be soaked, or better yet, wait for the doctors to arrive).

First aid for thermal burns

Mild injuries can often be successfully treated at home, but only if first aid was provided correctly. When receiving thermal injuries, after the cessation of exposure to the traumatic factor, you need to:

Cool the injured area under running cold water (the procedure should last at least 10-20 minutes).
Treat the skin with an antiseptic (but not iodine), then lubricate it with an anti-burn agent.
Apply a sterile, loose bandage to the wound.
In case of intense pain, give the victim an anesthetic - Nurofen, Aspirin, Nimesil or others.
If necessary, transport the patient to a medical facility.

With chemical

First, it is imperative to determine what substance caused the damage to the skin/mucous membranes. First aid for chemical exposure includes the following measures:

The injured area is thoroughly washed with water for at least 15 minutes. The exception is when the burn is caused by substances that react with water, for example, quicklime.
If the tissues have been burned with a powdery substance, remove it with a dry cloth before washing.
An antidote is used (for alkaline exposure, it is recommended to use a weak solution of citric acid or vinegar; for lime burns, the skin is treated with fat or lard, the acid is neutralized with a soda solution).
If the victim has swallowed a chemical substance, be sure to perform gastric lavage.

With electric

First medical aid for burns consists of isolating the victim from the damaging factor, after which you should check the victim for breathing and pulse and call an ambulance. If there are no vital signs, you need to:

Perform a closed cardiac massage.
Breathe mouth-to-mouth or mouth-to-nose.
Carry out resuscitation measures until the ambulance arrives.
Superficial injuries caused by electric shock are treated in the same way as a thermal burn.

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Attention! The information presented in the article is for informational purposes only. The materials in the article do not encourage self-treatment. Only a qualified doctor can make a diagnosis and give treatment recommendations based on the individual characteristics of a particular patient.

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First aid for burns - types of lesions, step-by-step algorithm of pre-medical actions

Burns are probably the most severe type of injury other than falling from a height. The most common types of damage are thermal damage (boiling water, hot objects, or open flames), although there may be other causes. Any more or less deep or large burn is a very serious injury that requires the constant attention of doctors.

Types of burns

According to the type of factor that caused the damage, they are divided into:

thermal caused by contact with hot objects, hot water or open flame;
chemical associated with contact with the skin and mucous membranes of various chemicals, most often acids or alkalis;
electric, arising under the influence of electric current;
radial, in which the main damaging factor is radiation (solar, radiation).

There is a second classification - according to the depth of tissue damage. It is important for determining the patient’s treatment tactics and prognosis of the outcome of the burn.

For thermal burns, depending on the depth of tissue damage, the following are distinguished:

I degree - burns in which the skin only turns red;
II degree – burns manifested by the appearance of blisters with transparent contents;
IIIA degree with the appearance of blood in the blisters;
IIIB degree with damage to all layers of the skin;
IV degree – burns in which soft tissues located under the skin (fatty tissue, muscles, tendons, ligaments, bones) are destroyed.

First aid is necessary for any degree of injury, since even the mildest injury is accompanied by severe pain. In addition, even after the cessation of exposure to heat on the skin, destructive processes in it can continue for quite a long time, aggravating the injury.

Life-threatening burns

Of course, not every burn poses a serious danger to the life of the victim. However, underestimating their severity can lead to serious consequences. People are subject to mandatory hospitalization if:

superficial burns of more than 20% of the body (for children and the elderly - 10%);
third degree burns covering 5% of the body surface;
burns of the second degree and higher, located in shockogenic zones: the perineum, face, hands and feet, the most important ligaments;
electrical injuries;
combinations of skin burns with thermal damage to the respiratory tract;
exposure to chemicals.

First aid for burns

Regardless of the cause of the burn, first aid should begin immediately. Every second aggravates the degree of damage, increases its area and depth, and worsens the prognosis for the victim.

First aid for thermal burns

The first principle is to stop exposing the skin to heat:

remove the victim from the hot water;
extinguish the flame by throwing a blanket, coat over the person, dousing with water, throwing snow and sand; the victim can put out the flames by rolling on the ground;
remove a person from under a stream of boiling water or hot steam.

First stage. Remove all smoldering clothing and jewelry from the victim, cutting them with scissors if necessary. The only exception is do not try to peel off synthetic items that have melted and stuck to the skin. They should be cut off, leaving the adherent parts in the wound.

Second phase- cooling of affected surfaces. To do this, use running water (best) or apply plastic bags or heating pads with snow, ice, or cold water. Cooling helps reduce pain and also prevents further damage to deep-lying tissues. It should be carried out for at least 10-15 minutes, but no measures should slow down the transportation of the victim to the hospital. If it is impossible to cool the affected tissue, the burn site should be left open for 10-15 minutes without bandaging - this will allow it to be cooled by the surrounding air.

Attention! It is strictly forbidden to open bubbles, no matter how scary they may seem. While the blisters are intact, the skin prevents infection from penetrating deep into the tissue. After opening them, microorganisms will enter the wound surface, causing infection and worsening the course of the injury.

At the third stage The burn surfaces are bandaged. To do this, use sterile dressings, generously moistened with an antiseptic solution (not iodine-based). Panthenol helps very well, which needs to be sprayed completely over the entire surface. For burns on the arms and legs, the burned fingers should be separated with gauze separators.

If no antiseptic is available, the dressings can be left dry. This is better than leaving the wound open and risking infection.

Attention!Never lubricate burns with fat, oil, cream, egg yolk and other substances that are recommended by people and the Internet! The result will be disastrous - fats form a film on the wound, through which heat is less able to escape. In addition, they impair the penetration into tissues of drugs that will be used to treat a person in a hospital. Finally, as a result of such “grandmother’s methods”, rougher scars are formed.

Fourth stage providing first aid for burns at home - pain relief. Doctors use narcotic analgesics for this, but at home you can give the victim analgin, baralgin, ketorol, dexalgin - any sufficiently strong painkiller. You can also numb the pain locally if you have special anti-burn wipes in your home, soaked in antiseptic and local anesthetic.

Fifth stage– correction of fluid loss. To do this, if the victim is conscious and does not have nausea or vomiting, he should be given tea, water, or fruit juice in a volume of 0.5-1 liters. Even if he doesn’t want to drink, try to persuade him: this will replenish fluid loss through the burn surface and prevent the development of the most dangerous complication - burn shock.

For chemical burns, first aid is provided to almost the same extent. The only difference is that the cessation of exposure to the harmful factor on the skin is carried out by washing off the chemical substance with a strong stream of water, preferably running.

Attention! Do not try to neutralize an acid with an alkali or vice versa, and do not use baking soda. The release of heat can make the burn combined (chemical + thermal), and the inevitable error in proportion will only aggravate the burn.

If the burn occurred under the influence of dry bulk substances, shake them off the skin as much as possible and only then begin rinsing. Try to avoid contact of substances with intact skin.

Electrical burns

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First aid for burns caused by electrical trauma should be started only after the impact of current on the victim and the rescuer has been reliably excluded. Turn off the breaker, turn the breaker, cut or discard the live wire. Then move the victim to a safe place and only then begin providing assistance.

The principles of treating an electrical burn at the prehospital stage do not differ from first aid for a thermal burn. However, the insidiousness of electrical trauma is that its external manifestations can be minimal, while internal damage often becomes catastrophic.

First, you should determine whether the person is conscious, whether he is breathing, whether he has a pulse. In the absence of these signs, you should not look for burns, but start immediately. Only when the patient is fully conscious can one deal with the local manifestation of injury - a burn.

Attention! Nothing you do should delay calling an ambulance in case of electrical injury! Electrical burns are completely unpredictable and people die not because of local damage to the skin, but because of severe disturbances in the functioning of the heart and nervous system.

Regardless of the degree of burns, treatment should begin as early as possible. High-quality assistance provided in the first seconds can alleviate the condition of the victim, improve the course of the disease, prevent the development of complications, and in some cases, save lives.

Thermal burns

First of all, stop exposure to damaging agents, cool the burn site and surrounding surface (directly or through clean linen, a rag) under running cold water at 20-25 ° C for 10 minutes (until the pain disappears).

Free the damaged area of the body from clothing (do not remove clothing, it is necessary to cut it after it has cooled). Also

Do not remove clothing that is stuck to the skin. In case of burns to the hands, it is necessary to remove the rings from the fingers due to the risk of ischemia!

A wet aseptic bandage with furacillin (1:5000) or 0.25% novocaine is applied to the burn site (for extensive burns it is better to use a sterile sheet). Do not pop blisters! It is not recommended to treat wounds with any powders, ointments, aerosols, or dyes before the patient is admitted to the hospital. Anesthesia is performed according to indications (non-narcotic analgesics). It is important not to give the child anything to drink so as not to overfill the stomach before the upcoming anesthesia during the initial treatment of the wound in a hospital setting. The victim is hospitalized in the burn department.

Chemical burns

To remove aggressive liquid, rinse the burned surface with plenty of running water for 20-25 minutes (except for burns caused by quicklime and organic aluminum compounds). Use neutralizing lotions: for acids, phenol, phosphorus - 4% sodium bicarbonate; for lime - 20% glucose solution.

When inhaling smoke, hot air, or carbon monoxide, in the absence of disturbances of consciousness, the child is taken out into fresh air, mucus is removed from the oropharynx, an air duct is inserted, and then inhalation of 100% oxygen is started through an inhaler mask. With increasing laryngeal edema, impaired consciousness, convulsions and pulmonary edema after intravenous administration of atropine and diazepam (can be in the muscles of the floor of the mouth), the trachea is intubated, followed by transfer to mechanical ventilation.

Burns of the eyeball

Terminal anesthesia is performed with a 2% solution of novocaine (in drops), copious rinsing of the conjunctival sac (using a rubber bulb) with a solution of furacillin (1:5000); if the nature of the damaging substance is unknown - boiled water. Apply a bandage. The victims are hospitalized and transported in a prone position.

Emergency care for burn shock

Anesthesia is carried out for burns up to 9% by intramuscular injection of analgesics; with a burn area of 9-15% - 1% promedol solution 0.1 ml/year IM. (if the child is over 2 years old). For burn areas up to >15% - 1% promedol solution 0.1 ml/year (if the child is over 2 years old); fentanyl 0.05-0.1 mg/kg IM in combination with a 0.5% solution of diazepam 0.2-0.3 mg/kg (0.05 ml/kg) IM or IV.

In case of I-II degree of burn shock, infusion therapy is not carried out at the prehospital stage. At III- IV degree of burn shock (circulatory decompensation) access to the vein is performed and infusion therapy is carried out with 20 ml/kg for 30 minutes with solutions of rheopolyglucin, Ringer or 0.9% sodium chloride solution; Prednisolone 3 mg/kg is administered intravenously. Oxygen therapy is carried out through a mask with 100% oxygen. The victim is urgently hospitalized in the intensive care unit of a burn center or multidisciplinary hospital.

BLEEDING IN CHILDREN

PULMONARY BLEEDING

Causes of pulmonary hemorrhage: chest injuries; acute and chronic purulent inflammatory processes in the lungs (bronchiectasis, abscesses, destructive pneumonia), pulmonary tuberculosis; hemorrhagic thrombovasculitis; pulmonary hemosiderosis.

Clinical picture

Foamy bloody fluid, ichor and sometimes scarlet blood are released from the mouth and nose; vomit and stool do not change color. In the lungs, upon auscultation, an abundance of moist, predominantly fine-bubble rales are heard. The child suddenly turns pale, weakness and adynamia occur.

Urgent measures

The child is placed in a semi-sitting position; evaluate the color of the skin and mucous membranes, determine the nature of breathing, pulse, blood pressure; examine the nasopharynx; ensure free passage of the upper respiratory tract; oxygen therapy is started. The patient is urgently hospitalized in the surgical department.

GASTROINTESTINAL BLEEDINGS

Causes of gastrointestinal bleeding: ulcers and erosions, tumors, diverticula of the digestive tract, varicose veins of the esophagus or stomach.

Clinical picture

There may be vomit the color of “coffee grounds”, black stools, and less often the presence of scarlet blood in the vomit and stool. Their color is affected by the location of the bleeding. Severe pallor of the skin, dizziness, weakness, and abdominal pain appear. With significant blood loss, blood pressure decreases. In cases where bleeding occurs against the background of intussusception, thrombusculitis, or intestinal infection, it is accompanied by a detailed clinical picture of the underlying disease.

A child with any signs of gastrointestinal bleeding should be hospitalized according to the profile of the underlying disease. In case of massive bleeding, children are hospitalized in the surgical department. Before hospitalization, an ice pack or a cloth moistened with cold water is applied to the epigastric or umbilical area (depending on the location of the bleeding). Give a 5% solution of epsilon-aminocapriic acid 5 ml/kg with thrombin to drink. If blood pressure is reduced, then albumin or gelatinol 10 ml/kg is injected intravenously before transportation.

1. Urgently stop the exposure of the victim to high temperature. smoke, toxic combustion products, and also remove his clothes. 2. Cool the burned areas. It is advisable to immerse the burned areas in cold water or wash them with a stream of tap water for 5-10 minutes. For burns of the face and upper respiratory tract, mucus is removed from the oropharynx and an air duct is inserted. 3. Anesthetize and begin anti-shock measures: administer promedol or omnopon; - anti-shock blood substitutes (polyglucin, gelatinol). 4. Apply an aseptic bandage. Apply a dry cotton-gauze bandage to the burned surface, or, if it is not available, a clean cloth (for example, wrap the victim in a sheet). 5. The victim must be given at least 0.5 liters of water to drink with 1/4 teaspoon of sodium bicarbonate and 1/2 teaspoon of sodium chloride dissolved in it. Give 1-2 g of acetylsalicylic acid and 0.05 g of diphenhydramine orally. 6. Urgent hospitalization. In the hospital The burned person is administered analgesics and sedatives, and antitetanus serum. After this, the epidermis that has peeled off in large areas is removed, and the blisters are incised and the liquid is released from them. The burn surface for superficial burns is painful, so mechanical cleaning is allowed only in case of severe soil contamination by irrigation with antiseptic solutions. You should not try to wash bitumen if you are burned by it. Anti-burn dressings with a metallized surface or sterile dressings with water-soluble ointments (levomekol, levosin, dioxykol, dermazin) are applied to burn wounds. Subsequent dressings with the same ointments are carried out daily or every other day, until the wounds are completely healed. After healing of IIIA degree burns, keloid scars may develop in their place. In order to prevent them, especially for burns of the face, hands and feet, elastic pressure bandages are applied to newly healed wounds. For the same purpose, physiotherapeutic treatment (ultrasound, magnetic therapy, mud therapy) is prescribed.

First aid for frostbite consists of transferring the victim to a warm room and wrapping him up. applying a heat-insulating cotton-gauze bandage to the limb. He is given tea, coffee, hot food, and 1-2 g of acetylsalicylic acid orally. Rubbing frostbitten areas of the body with snow is contraindicated, as it leads to multiple microtraumas of the skin. Upon admission to the hospital, the victim is warmed for 40-60 minutes in a bath with a weak solution of potassium permanganate, gradually increasing the temperature from 18 to 38 "C. Let's allow a gentle massage from the periphery to the center. At the earliest possible time, a mixture of the following composition is injected into the artery of the affected limb : 10 ml of 0.25% solution of novocaine, 10 ml of 2.4% solution of aminophylline, 1 ml of 1% solution of nicotinic acid: similar intra-arterial infusions are indicated in the following days. Nursing interventions: 1. Follow the doctor’s orders: - monitor the general condition of the patient. Monitor the air temperature in the room, it should be 34 -35 "C; - measure body temperature. Blood pressure. pulse: - administer medications: anticoagulants (heparin), fibrinolytics (fibrinolysin), antispasmodics (no-spa. papaverine), antiplatelet agents (aspirin, trental), nicotinic acid, antibiotics; prepare for various diagnostic and therapeutic procedures. 2. Preparation and implementation of dressings: - strict adherence to the rules of asepsis and antisepsis to prevent infection; - prepare everything for pain relief; - in case of frostbite of the 1st degree, the affected the skin is lubricated with alcohol and an aseptic bandage is applied.

HIV infection. Epidemiology, clinical picture, diagnosis and prevention.

HIV– human immunodeficiency virus – the causative agent of HIV infection. AIDS– acquired immunodeficiency syndrome is the final stage of HIV infection, when a person’s immune system is so damaged that it becomes unable to resist any type of infection. Any infection, even the most harmless one, can lead to severe illness and death. Human immunodeficiency virus belongs to the family retroviruses(Retroviridae), genus of lentiviruses (Lentivirus). The name Lentivirus comes from the Latin word lente, meaning slow.

The acute febrile phase appears approximately 3-6 weeks after infection. It does not occur in all patients - approximately 50-70%. The rest immediately enter an asymptomatic phase after the incubation period.

Manifestations of the acute febrile phase are nonspecific:

Fever: increased temperature, often low-grade fever, i.e. not higher than 37.5ºС.

Sore throat.

Enlarged lymph nodes: the appearance of painful swellings in the neck, armpits, and groin.

Headache, eye pain.

Pain in muscles and joints.

Drowsiness, malaise, loss of appetite, weight loss.

Nausea, vomiting, diarrhea.

Skin changes: skin rash, ulcers on the skin and mucous membranes.

Serous meningitis can also develop - damage to the membranes of the brain, which is manifested by headache and photophobia.

The acute phase lasts from one to several weeks. In most patients it is followed by an asymptomatic phase. However, approximately 10% of patients experience a fulminant course of HIV infection with a sharp deterioration in their condition.

Asymptomatic phase of HIV infection

The duration of the asymptomatic phase varies widely - in half of HIV-infected people it is 10 years. The duration depends on the rate of virus reproduction. During the asymptomatic phase, the number of CD 4 lymphocytes progressively decreases; a drop in their level below 200/μl indicates the presence of AIDS. The asymptomatic phase may not have any clinical manifestations. Some patients have lymphadenopathy – i.e. enlargement of all groups of lymph nodes.

Advanced stage of HIV - AIDS

At this stage, the so-called opportunistic infections– these are infections caused by opportunistic microorganisms that are normal inhabitants of our body and under normal conditions are not capable of causing disease.

There are 2 stages AIDS:

A. Decrease in body weight by 10% compared to the original.

Fungal, viral, bacterial infections of the skin and mucous membranes:

Candidal stomatitis: thrush is a white cheesy coating on the oral mucosa.

Hairy leukoplakia of the mouth is white plaques covered with grooves on the lateral surfaces of the tongue.

Shingles is a manifestation of the reactivation of the varicella zoster virus, the causative agent of chickenpox. It manifests itself as severe pain and rashes in the form of blisters on large areas of the skin, mainly the torso.

Repeated frequent occurrences of herpetic infection.

In addition, patients constantly suffer from pharyngitis (sore throat), sinusitis (sinusitis, phronitis), and otitis (inflammation of the middle ear).

Bleeding gums, hemorrhagic rash (bleeding) on the skin of the hands and feet. This is associated with developing thrombocytopenia, i.e. a decrease in the number of platelets - blood cells involved in clotting.

B. Decrease in body weight by more than 10% from the original.

At the same time, others are added to the infections described above:

Unexplained diarrhea and/or fever for more than 1 month.

Tuberculosis of the lungs and other organs.

Toxoplasmosis.

Helminthiasis of the intestines.

Pneumocystis pneumonia.

Kaposi's sarcoma.

Blood transfusion therapy. Indications and contraindications. Blood and its preparations.

Transfusion of blood components must be carried out according to strict indications. Use blood components only depending on the purpose of the blood transfusion. The main indications for transfusion of blood components and products are restoration or maintenance of oxygen transport function of blood and hemostasis.

For blood transfusion therapy, currently primarily blood components are used: red blood cell mass, red blood cell concentrate, red blood cell suspension, washed red blood cell mass (suspension), platelet concentrate (suspension), plasma, as well as blood and plasma preparations.

Transfusion of hemocomponents for the purpose of detoxification, parenteral nutrition, and stimulation of the body's defenses is unacceptable.

Blood transfusion is carried out by a doctor authorized to perform blood transfusion.

A compatibility test for blood groups of the ABO system is performed within 5 minutes. on a plane at room temperature.

Test technique. For examination, a white plate with a wetted surface should be used. On the plate write the surname, initials and blood group of the patient and donor and the number of the container with blood.

Place 2 - 3 drops of the patient's serum on the plate and add a small drop of donor blood there so that the ratio of blood to serum is approximately 1: 10. Mix the blood with the serum with a dry glass rod, shake the plate slightly, then for 1 - 2 minutes. leave it alone and shake it again periodically, while simultaneously observing the progress of the reaction for 5 minutes.

Interpretation of reaction results. If agglutination of erythrocytes has occurred in the mixture of the patient's serum and donor's blood - agglutinates are visible first in the form of small, then large lumps against the background of completely or almost completely discolored serum - this means that the donor's blood is incompatible with the patient's blood and should not be transfused to him. If the mixture of donor blood and patient serum after 5 minutes. remains homogeneously colored, without signs of agglutination, this means that the donor’s blood is compatible with the patient’s blood in terms of ABO blood groups.

Traumatic shock. Clinic and emergency care.

Traumaticshock - syndrome that occurs with severe injuries; characterized by a critical decrease in blood flow in tissues (hypoperfusion) and is accompanied by clinically pronounced circulatory and respiratory disorders.

Main clinical signs. Traumatic shock is characterized by inhibited consciousness; pale skin color with a bluish tint; impaired blood supply, in which the nail bed becomes cyanotic; when pressed with a finger, the blood flow is not restored for a long time; the veins of the neck and limbs are not filled and sometimes become invisible; breathing rate becomes more frequent and becomes more than 20 times per minute; pulse rate increases to 100 beats per minute or higher; systolic pressure drops to 100 mmHg. Art. and below; there is a sharp cooling of the extremities. All these symptoms are evidence that a redistribution of blood flow occurs in the body, which leads to disruption of homeostasis and metabolic changes, becoming a threat to the life of the patient or injured person. The likelihood of restoration of impaired functions depends on the duration and severity of shock.

Shock is a dynamic process, and without treatment or with late provision of medical care, its milder forms become severe and even extremely severe with the development of irreversible changes. Therefore, the main principle of successful treatment of traumatic shock in victims is to provide comprehensive assistance, including identifying violations of the vital functions of the victim’s body and carrying out measures aimed at eliminating life-threatening conditions. Any shock, including traumatic, is characterized by a traditional division into two successive phases:

erectile (excitement phase). Always shorter than the inhibition phase, characterizes the initial manifestations of TS: motor and psychoemotional agitation, restless eyes, hyperesthesia, pale skin, tachypnea, tachycardia, increased blood pressure;

torpid (braking phase). The clinic of excitation is replaced by a clinical picture of inhibition, which indicates a deepening and aggravation of shock changes. A thread-like pulse appears, blood pressure drops to levels below normal until collapse, and consciousness is impaired. The victim is inactive or motionless, indifferent to his surroundings.

The torpid phase of shock is divided into 4 degrees of severity:

I degree: mild stupor, tachycardia up to 100 beats/min, systolic blood pressure at least 90 mmHg. Art., urination is not impaired. Blood loss: 15-25% of the bcc;

II degree: stupor, tachycardia up to 120 beats/min, systolic blood pressure at least 70 mm Hg. Art., oliguria. Blood loss: 25-30% of the bcc;

III degree: stupor, tachycardia more than 130-140 beats/min, systolic blood pressure no more than 50-60 mm Hg. Art., no urine output. Blood loss: more than 30% of the total blood volume;

IV degree: coma, pulse in the periphery is not detected, the appearance of pathological breathing, systolic blood pressure less than 40 mm Hg. Art., multiple organ failure, areflexia. Blood loss: more than 30% of the total blood volume. Should be regarded as a terminal condition.

Emergency care for traumatic shock:

Place the victim in a horizontal position;

Treat any ongoing external bleeding. If blood leaks from an artery, apply a tourniquet 15-20 cm proximal to the bleeding site. In case of venous bleeding, a pressure bandage will be required at the site of injury;

In case of first degree shock and no damage to the abdominal organs, give the victim hot tea, warm clothes, and wrap him in a blanket;

Severe pain is eliminated by 1-2 ml of 1% promedol solution intramuscularly;

If the victim is unconscious, ensure airway patency. In the absence of spontaneous breathing, mouth-to-mouth or mouth-to-nose artificial respiration is required, and if there is also no heartbeat, then urgent cardiopulmonary resuscitation is required;

Urgently transport a transportable victim with severe injuries to the nearest medical facility.

Postoperative period, early and late postoperative complications.

Postoperative period- the period of time from the end of the operation until recovery or complete stabilization of the patient’s condition.

All postoperative period in the hospital they are divided into early (1-6 days after surgery) and late (from the 6th day until discharge from the hospital). During the postoperative period, four phases are distinguished: catabolic, reverse development, anabolic and the phase of weight gain. The first phase is characterized by increased excretion of nitrogenous wastes in the urine, dysproteinemia, hyperglycemia, leukocytosis, moderate hypovolemia, and loss of body weight. It covers early and partly late postoperative period. In the phase of reverse development and the anabolic phase, under the influence of hypersecretion of anabolic hormones (insulin, growth hormone, etc.), synthesis predominates: electrolyte, protein, carbohydrate, and fat metabolism are restored. Then the phase of weight gain begins, which, as a rule, occurs during the period when the patient is on outpatient treatment.

The main points of postoperative intensive care are: adequate pain relief, maintenance or correction of gas exchange, ensuring adequate blood circulation, correction of metabolic disorders, as well as prevention and treatment of postoperative complications. Postoperative pain relief is achieved by administering narcotic and non-narcotic analgesics, using various options for conduction anesthesia. The patient should not feel pain, but the treatment program should be designed so that pain relief does not depress consciousness and breathing.

When a patient is admitted to the intensive care unit after surgery, it is necessary to determine the patency of the airways, the frequency, depth and rhythm of breathing, and the color of the skin. Impaired airway patency in weakened patients due to retraction of the tongue, accumulation of blood, sputum, and gastric contents in the respiratory tract require therapeutic measures, the nature of which depends on the cause of the obstruction. Such measures include maximum extension of the head and extension of the lower jaw, insertion of an air duct, aspiration of liquid contents from the airways, bronchoscopic sanitation of the tracheobronchial tree. If signs of severe respiratory failure appear, the patient should be intubated and transferred to artificial ventilation .