1.2.3. Injuries: bruises, sprains, dislocations. For any injuries, the following algorithm of actions is optimal: 1. Applying a bandage (stopping bleeding, if any).2. Creation of rest (immobilization).3. Pain relief (local cooling if possible).4. Giving

1.2.4. Bone fractures: closed and open. Limbs, spine, pelvis, ribs, collarbone. Fractures are one of the most severe types of blunt trauma. There are: complete (the bone is completely broken) and incomplete - there is a break or injury, open and closed. Symptoms

A head injury is very dangerous as there is a high risk of brain damage. In this case, swelling of the brain tissue very quickly occurs, which leads to wedging of part of the brain into the foramen magnum. As a result, the activity of vital centers responsible for breathing and blood circulation is disrupted, and a person can quickly lose consciousness and even die.

Another reason for the high risk of head injuries is the good blood supply to this part of the body, so if blood vessels are damaged, there is a high probability of rapid blood loss.

If such an injury occurs, it is necessary to stop the bleeding as quickly as possible and seek medical attention. medical care. Let's talk about first aid for a head injury.

Head contusions and soft tissue damage

The soft tissues of the head include skin, muscles, and subcutaneous tissue. When they are bruised, pain occurs, later - swelling (“bump”), redness of the skin, and then the formation of a bruise.

In case of bruise, it is necessary to apply cold to the affected area (a bottle of cold water, heating pad with ice), apply a pressure bandage and take the patient to medical institution. Additional examination necessary in order to exclude damage to the cranial bones.

Damage to soft tissues is accompanied by intense bleeding. Detachment of skin flaps, so-called scalp wounds, is also possible.

If the blood flows slowly and is dark in color, it is necessary to apply a tight bandage with sterile material (for example, a well-ironed bandage).

If blood spurts out, it means the artery is damaged. Pressure bandage in this case it won't help. If damaged, you can apply a rubber tourniquet horizontally above the forehead and above the ears. If there is minor blood loss, the victim is taken to the hospital in a sitting or lying position.

If the blood loss is extensive, the victim’s skin turns pale, becomes covered in cold sweat, excitement sets in, and then lethargy, urgent transportation is necessary.

The victim should be carefully placed on a flat surface, having first laid a blanket, clothes, etc. on it. It is recommended to place a bolster (pillow, jacket) under the shins. If the victim is unconscious, carefully place your palms on both sides under the lower jaw and, without significant effort, tilt your head back, pushing your chin forward. Clear oral cavity remove saliva or other contents with a clean handkerchief, then try to turn your head to the side to prevent vomit or other liquid from entering the respiratory tract.

Any foreign body located in the wound must not be moved, much less attempted to be removed. These actions can increase the extent of brain damage and increase bleeding.

To stop bleeding, you should first try to clean the skin around the lesion with a towel, and if possible, quickly treat the surface around the wound with a solution of brilliant green or. Then apply a pressure bandage to the wound: first, several layers of clean cloth or gauze; it is advisable to place a hard object on top (a remote control for equipment, a bar of dry soap, a comb, etc.) and bandage it well so that this object compresses the damaged vessel.

If the bleeding is severe and it is not possible to apply a bandage, you should press the skin near the edge of the wound with your fingers so that the blood stops flowing. Finger pressing the vessel must be carried out before the arrival of the ambulance.

A foreign body protruding from the wound should be fixed. This requires a long strip of bandage, a torn sheet, scarves tied together, and so on. The tape is placed so that the foreign body is in the middle, and the ends are wrapped around several times and secured to form a tight knot.

After stopping bleeding and immobilization foreign body it is necessary to apply ice or a heating pad with cold water closer to the wound, cover the victim well and urgently transport him in a lying position to a medical facility.

If there is a torn skin flap, it must be wrapped in a sterile cloth, preferably placed in a cold place (but not in ice) and sent along with the victim. A traumatologist will most likely be able to use it to restore soft tissue.

Closed head injuries

If the bones of the upper part of the skull are damaged, it is very difficult to determine whether there is a fracture without x-ray examination. Therefore, if the blow fell on scalp head, do not think that this is a simple bruise. The victim should be placed on a stretcher without a pillow, ice applied to the head and transported to the hospital. If such an injury is accompanied by vomiting, impaired consciousness, breathing and blood circulation, assistance should be provided according to the symptoms, including performing artificial respiration and chest compressions.

One of the most severe injuries is a fracture of the base of the skull. It occurs when falling from a height, and this fracture damages the brain. A characteristic symptom of this injury is the release of colorless fluid (CSF) or blood from the ears or nostrils. In addition, in case of injury facial nerve facial asymmetry appears. There may be a rare pulse. A day later another one develops characteristic symptom: hemorrhages in the eye sockets, reminiscent of panda eyes or glasses.

Transporting such a victim should be as careful as possible, without shaking the stretcher. The patient can be positioned on them in two ways: lying on his stomach, but under strict control so that there is no vomiting. The second way is to carry the person in a supine position, but at the same time pin the tongue 2 cm from its edge with a sterilized (heated) safety pin to the collar. You can also open the victim’s mouth slightly and place a bandage over the tongue, attaching it to lower jaw to prevent tongue retraction and choking.

When vomiting, the patient's head is carefully turned to one side.

Maxillofacial trauma

The bruise is accompanied by swelling and pain. The lips quickly swell and become inactive. First aid is a pressure bandage and cold applied to the injury site.

If the lower jaw is fractured, a person is unable to speak. There is copious flow of saliva from the half-open mouth. Even if consciousness is preserved, if the jaw is broken, there is a danger of tongue retraction and suffocation.

Fracture upper jaw observed less frequently. It is accompanied by severe pain and very rapid accumulation of blood in the subcutaneous tissue changing the shape of the face.

The first action in such a situation is to fix the tongue and prevent it from retracting. Then, with a finger wrapped in a clean cloth, you should clean the oral cavity.

Sometimes develops heavy bleeding, which does not stop after applying the bandage. In this case, you need to press one of two points with your finger:

• in front of the tragus of the ear near the cheekbone;
• on the lower jaw in front of the anterior edge masticatory muscle(approximately level with the corner of the mouth).

In case of ineffectiveness, the carotid artery on the injured side will have to be pressed before the doctors arrive.

It is necessary to secure the jaw fragments. To do this, wrap a stick or ruler in a clean cloth and pass it through the mouth, and the protruding ends are tightly fixed with a bandage around the head.

The victim is transported lying on his stomach to prevent him from choking on blood. If the patient has turned pale or dizzy, the lower end of the stretcher should be raised to improve blood supply to the brain. At the same time, care must be taken to ensure that the bleeding does not increase.

Dislocation of the lower jaw

It can develop as a result of strong yawning, laughter, or a blow. Elderly people experience habitual jaw dislocation.

Signs:

• open mouth;
• severe drooling;
• difficulty moving the jaw;
• speech is almost impossible.

Help with habitual dislocation consists in its reduction. The person providing assistance stands in front of the victim, who is sitting on a chair. Injected into the mouth thumbs along the lower molars. The jaw is forced back and down. If the procedure is successful, jaw movements and speech are restored.

To provide first aid you need:

* Correctly assess the nature and severity of the injury.

* Knowing the nature of the injury, commit correct actions on first aid.

The bullet, penetrating the body, causes damage to the latter. These injuries have certain differences from other injuries to the body that should be taken into account when providing first aid.

First, the wounds are usually deep and the injuring object is often left inside the body.

Secondly, the wound is often contaminated with tissue fragments, projectiles and bone fragments.

These features of a gunshot wound should be taken into account when providing first aid to the victim.

The severity of the injury should be assessed by:

* the location and type of entrance, the behavior of the victim and other signs.

Wounds to the extremities

The first thing you should pay attention to when providing first aid for injured limbs is the presence of bleeding. If the arteries of the thigh or shoulder are destroyed, death from blood loss can occur within a second. So, if you are wounded in the arm (and the artery is damaged), death from blood loss can occur within 90 seconds, and loss of consciousness within 15 seconds. By the color of the blood we determine whether it is venous or arterial bleeding. Deoxygenated blood dark, and the arterial one is scarlet and comes out of the wound intensely (a fountain of blood from the wound). Bleeding is stopped by applying a pressure bandage, tourniquet, or wound packing. When a tourniquet is applied, venous bleeding stops below the wound, and arterial bleeding stops above the wound. It is not recommended to apply a tourniquet for more than two hours. This time should be enough to deliver the victim to a medical facility. For venous bleeding, it is advisable to apply a pressure bandage rather than a tourniquet. A pressure bandage is applied to the wound. Wound tamponade for injuries of the extremities is rarely performed. To pack a wound, you can use a long, narrow object to tightly pack the wound with a sterile bandage. The higher the artery is affected, the faster blood loss occurs. The arteries of the limbs are projected onto the inner side of the thigh and shoulder (those areas where the skin is more difficult to tan).

As a result of excessive blood loss, hemorrhagic shock develops. The pain can be so severe that it causes painful shock.

ANTI-SHOCK MEASURES FOR BLOOD LOSS:

1. Immediate stop of bleeding.

2. Giving the victim a body position in which the limbs are slightly elevated.

3. Immediate replenishment of blood deficiency with blood-substituting solutions.

4. Antishock drugs, painkillers.

5. Providing warmth.

6. Call an ambulance.

The second thing to do is possible fractures bones. In case of fractures, the limb must be immobilized. It is better not to try to move the limb at all, because... broken bones have sharp edges that can damage blood vessels, ligaments and muscles. The wound should be covered with a sterile bandage. Self-transportation of the victim is possible.

GUNSHOT WOUND OF THE HEAD

Does not always cause instant death. Approximately 15% of those injured survive. Wounds to the face are usually accompanied by an abundance of blood due to the large number of vessels located in the facial part of the skull. A head injury should be considered a concussion. The victim may lose consciousness due to the raush and show no signs of life, but the brain may not be damaged. If there is a gunshot wound to the head, the victim is laid horizontally and kept at rest. It is better not to touch the head wound (excluding facial wounds) (cover with a sterile napkin), and immediately call an ambulance. If breathing and heart stop, perform artificial respiration and cardiac massage. Facial wounds with copious discharge blood: clamp the wound with a sterile swab. Self-transportation is not recommended or must be carried out with all precautions.

GUNSHOT WOUND OF THE SPINE

With spinal injuries, there may be momentary loss consciousness. The victim is immobilized (layed down). If there is bleeding, apply a bandage. For head and spine injuries, first aid is limited to immobilizing the victim and stopping possible bleeding. In case of respiratory and cardiac arrest, indirect massage heart and artificial respiration. Self-transportation is not recommended.

GUNSHOT WOUND OF THE NECK

The injury may be complicated by damage to the larynx and damage to the spine and carotid arteries. In the first case, the victim is immobilized, and in the second, the bleeding is immediately stopped. Death from blood loss due to injury carotid artery may occur within 10-12 seconds. The artery is pinched with your fingers, and the wound is immediately tightly packed with a sterile bandage. Gentle transportation.

GUNSHOT WOUND IN THE CHEST AND ABDOMEN

All organs located in human body divided into three sections: the pleural cavity, the abdominal cavity and the pelvic organs. The organs located in the pleural cavity are separated from the organs located in the abdominal cavity by the diaphragm, and the abdominal organs are separated from the pelvic organs by the peritoneum. When internal organs are injured, blood does not always pour out, but accumulates in these cavities. Therefore, it is not always easy to judge whether large arteries and veins are affected by such injuries. Stopping bleeding is difficult. Injuries to the organs of the pleural cavity may be complicated by internal bleeding, pneumothorax, hemothorax, or pneumohemothorax.

Pneumothorax is the entry of air through the wound opening into the pleural cavity. Occurs with knife and gunshot wounds chest, and also when open fractures ribs The volume of the chest is limited. When air gets there, it interferes with breathing and heart function because... occupies the volume used by these organs.

Hemothorax is the entry of blood into the pleural cavity. Occurs with knife and gunshot wounds to the chest, as well as with open rib fractures. The volume of the chest is limited. When blood gets there, it interferes with breathing and heart function because... occupies the space used by these organizations. Pneumothorax is the entry of both blood and air into the pleural cavity.

To prevent air from entering the pleural cavity, it is necessary to apply an airtight bandage to the wound - a gauze cloth coated with boron ointment or petroleum jelly, a piece of polyethylene, extreme case- Press the wound tightly with your palm. The victim is placed in a semi-sitting position. Stopping bleeding is difficult. Transportation is gentle.

If there is a wound in the heart area, the worst is assumed. Help determine heart injury external signs such as rapid (instant) deterioration of the victim’s condition, sallow complexion, quick loss consciousness. It should be noted that death as a result of acute heart failure (when the heart is injured) does not always occur. Sometimes there is a gradual decline in the body’s activity as a result of the pericardium filling with blood and, as a result, difficulty in the functioning of the heart. Assistance in such cases should be provided by a specialist (pericardial drainage, suturing of a cardiac wound), who should be called immediately.

The pericardium is the cavity in which the heart is located. When the heart is injured, blood can enter this cavity and compress the heart, interfering with its normal functioning.

GUNSHOT WOUND OF THE ABDOMINAL CAVITY

For injuries to the abdominal organs, I place the victim in a semi-sitting position. Prevention of wound infection. In case of severe blood loss - antishock therapy.

Prevention of wound infection:

*disinfect the edges of the wound;

*apply a sterile napkin.

GUNSHOT WOUND OF THE PELVIC ORGANS

Injuries to the pelvic organs can be complicated by fractures of the pelvic bones, ruptures of arteries and veins, and nerve damage. Urgent Care for wounds in the pelvic area - anti-shock measures and prevention of wound infection. With wounds to the gluteal region, there may be profuse bleeding, which is stopped by a tight tamponade of the bullet entrance hole. For fractures pelvic bones And hip joint the victim is immobilized. Gentle transportation. Self-transportation is not advisable.

USEFUL TIPS

When providing first aid, dressing material is always needed. When it is not at hand, you have to use a handkerchief, parts of clothing; but if you find a place to store the gun, then maybe a sterile bag will fit in your pocket. A first aid kit is required in the car. At home, it is advisable to have a first aid kit no worse than a car one. The most necessary thing for blood loss is blood replacement solutions, sold in pharmacies without a prescription along with an intravenous injection machine.

Do not forget that some advice can be obtained over the phone when calling an ambulance. It is better if by the time you call an ambulance you have correctly determined the injury and condition of the victim. Remember that there are often cases when the victim could not be saved due to the fact that, based on the message from those who called the ambulance, the operator sent a doctor of a different profile to the scene of the incident.

In some cases, self-delivery of the victim to the hospital is preferable (faster). City hospitals are on duty on a rotating basis. The address of the duty hospital can be found by calling the ambulance phone. The dispatcher can warn the emergency room of the hospital where you intend to deliver the wounded person about the nature of the injury so that the medical staff can prepare to receive the victim.

⚠ HOW TO REMOVE A BULLET

According to statistics, per one inhabitant of the planet there is one and a half Kalashnikov assault rifles, considering that there are 30 rounds in the clip, this is quite enough to fill you with lead like a mincemeat, so if you faint at the sight of blood and, if you pinch your finger, blow on it in the old fashioned way , as in childhood, it’s better to immediately forget about military field surgery.

However, if you are not a timid person, then here we will tell you how to remove a bullet after a gunshot wound (as an option, remove a shell fragment) and about the rules that an improvised operating room must comply with if you really find yourself in the military field conditions, and the infirmary is no longer there, because it was just bombed.

Immediately after injury

Do not rush to immediately pull the foreign object out of the body; a large blood vessel may be hit and severe bleeding will occur after removing the object.

Apply a tourniquet to arterial bleeding(blood bright color and flows like a fountain) above the wound site (the bandage is located between the wound and the heart), and when a vein is wounded, a tight compressive bandage is applied lower along the vessel (the wound is located between the bandage and the heart).

Do not forget that you should not stop the blood supply to the wounded limb for more than 2 hours, after which allow at least 15 minutes for recovery normal operation blood flow, after which the tourniquet can be reapplied (in case of dangerous arterial bleeding).

Provide warmth to the wounded person and place his body in a position in which his arms and legs are above body level.

If a gunshot or shrapnel wound is located in the chest area, there is a possibility of pneumohemothorax, which occurs if blood and air enter the pleural cavity located in the chest. This can be avoided by bandaging the wound with an airtight bandage (an ordinary napkin covered with a layer of Vaseline will also work),

a piece of polyethylene or, if nothing is at hand, simply clamp it with your palm.

You need to have time to tightly clamp the wound on the artery with your fingers and quickly pack it with a sterile bandage. And remember, for the first time you have 10 seconds at most.

Operating room rules

Only a certified surgeon can carry out successful operations in military field conditions, and in extreme situations, a person who is at least somewhat familiar with anatomy, so that when pulling out a bullet in passing, you do not immobilize a limb, accidentally cut a tendon, or hit an important vessel. Everyone else needs to focus on sterilizing the instruments and ensuring the most comfortable conditions for the surgeon and the patient during the operation.

The most effective tools for carrying out operations in military field conditions - a knife and tweezers.

Everything needs to be sterilized, including gauze bandages or a respirator from a surgeon, soak the metal in alcohol and keep it on fire, harden the steel, then put it back in alcohol until the operation itself. A sterile apron and thoroughly washed and soaked hands in alcohol, if you do not have sterile rubber gloves.

How to remove a bullet

Before removing the bullet, check to see if it has gone through. You need to remove the bullet (fragment) as soon as possible, otherwise it will begin to slowly poison the body due to metal oxidation products. The exception is such serious injuries when vital organs, the head or spinal cord, or there is a possibility that the wounded person may die from blood loss during the operation. This is again the case if help will come not soon and all the rules of the operating room in the conditions of military field surgery were observed.

If the wounded person is conscious, then it is necessary to give alcohol as an anesthesia and squeeze something between the teeth so that you do not harm yourself with your teeth and tongue. It is very difficult to pull out a bullet alone; blood will constantly pour into the wound, preventing you from properly seeing the situation. It would be best to take on your “team” an assistant who will suck out the interfering blood, for example, with a pre-sterilized enema, not to mention the fact that the responsibility for carrying out such an operation can also be shared with him. Remember, it is the blood that fills the gunshot wound that will VERY hinder the removal of the bullet quickly.

The patient is breathing, the bullet was used as a souvenir, but a huge number of microbes have just been introduced into the wound. You can disinfect it with alcohol, or you can be more extreme - pour gunpowder into the wound and set it on fire. The method is also good because it stops bleeding, but most likely it will lead to suppuration, especially if the wound is deep.

A participant in the war with Japan, he reported that trepanations were carried out 299 times under his leadership. Later, he published the famous manual “On Military Field Wounds of the Skull,” recognizing that these injuries are the most dangerous, although cases were recorded when a person received a bullet in the forehead and did not die.

Kutuzov phenomenon

In the mass consciousness Kutuzov appears in the image of a “one-eyed” field marshal, as he is shown in the film of the same name Vladimir Petrov(1943). A group of Russian, Ukrainian and American neurosurgeons reconstructed two bullet wounds into the commander’s head and made an assumption about their high degree of danger to life. In fact, the fact was accepted that these injuries were fatal. So, during the Russian-Turkish War, in the battle of Alushta on July 23 (according to some sources, 24), 1774, Mikhail Illarionovich received a bullet in the left temple, which came straight out of the right temple. By the way, Kutuzov wore the black bandage for only a few months - in rehabilitation period. According to the Chief General V. M. Dolgorukova, this wound “distorted” the hero, but preserved his vision. The second time Kutuzov was wounded in the head on August 18, 1788 in the Battle of Ochakovo. This time the bullet pierced the head from the left cheek, exiting under the base of the skull. Neurosurgeon Mark Proyle from the Barrow Neurological Institute (USA) in this regard, said that such wounds make a person suspicious, cautious and even indecisive, saying that this is why Kutuzov chose to surrender Moscow, while other Russian generals offered to defend the capital.

First there was drinking, then -electric drill

In fact, the first effective tool for craniotomy when treating soldiers wounded in the head was a wire saw for cutting out a bone flap, which was folded back along with soft tissues. The author of the head saw, oddly enough, was an Italian obstetrician Gili. It was he who proposed this instrument in 1894, which immediately gained worldwide popularity among doctors. And in 1908, a French surgeon T. de Martel described a method of using a conventional electric drill to drill through the internal bone plate. Further F. Krause started using an electric suction pump, and G. Cushing silver clips to ensure hemostasis during brain surgery. Practically with this set of tools, doctors met the First world war.

Bullet speed

In 1914-1919, combinations of gunshot and mine-explosive damage during open injury, as well as barotrauma with cerebral contusion. Then they began to pay attention to the speed of the bullet piercing the skull. If at the moment of impact it was less than 100 m/s, then brain damage was observed along the bullet channel, slightly larger than the diameter of the bullet. It also turned out that more high speed became a source of additional damage due to shock waves and temporary cavitation. There was practically no chance of surviving in these conditions. However, the Mexican revolutionary Wenceslao Moguel(Wenseslao Moguel), who was executed by soldiers of a firing squad on March 18, 1915, survived despite being shot in the head. Having received 8 bullets, he fell to the ground. After that, an officer approached him and “finished off” the revolutionary almost point-blank. After the soldiers left, Wenceslao Moguel woke up and reached his own people on his own. He did not seek medical help and recovered fairly quickly.

To spite all the deaths

The war against German fascism, according to Soviet doctors, was characterized by an increase in head wounds: from 7.8% in 1942? m to 12% in 1945, while the severity of injuries also increased. Boris Vsevolodovich Gaidar, Head of the Military Medical Academy of the Armed Forces of the Russian Federation, Lieutenant General medical service, corresponding member of the Russian Academy of Medical Sciences, wrote in this regard: “As a neurosurgeon, I will dwell in some detail on the features of providing neurosurgical care to the wounded. Penetrating wounds to the skull were particularly severe; Among all those killed on the battlefield, those wounded in the skull and brain accounted for 30.9%. At the end of the war, the rate of surgery for those wounded in the skull in specialized hospitals increased significantly. At the stage of qualified medical care, they operated only on urgent indications(continuing external or intracranial bleeding, ventricular injury with profuse liquorrhea). This system of providing neurosurgical care to those wounded in the skull made it possible to reduce the incidence of brain abscesses from 70% in the First World War to 12.2% in the Great Patriotic War.”

Shooting America in the head

Doctors Felix Viñas And John Pilitsis cited statistics according to which approximately 2 million Americans annually seek medical help with various injuries heads, while traumatic brain injuries are the leading (fourth leading) cause of death (among people under the age of 44 years). Of these, approximately one third (35%) of all fatalities occur precisely because of gunshot wounds to the head. Targeted shooting in the skull, according to neurosurgeons, lies in the popularization of this type of murder in mass culture and in the uncontrolled firearms market. Despite advances in medicine, mortality from penetrating injury to the brain remains very high. At the same time, not everyone dies. Perhaps this is why queries on the topic “how to survive being shot in the head” in American search engines are breaking all records.

Chances of salvation

Best known in Lately There was an attempt on the life of a member of the US Congress Gabriel Giffords January 8, 2011 in Tucson. The attacker, suffering from paranoid schizophrenia, shot Giffords in the head with a Glock pistol (and also killed 6 other people). The bullet from the back of the head passed right through the skull in the area of ​​the left hemisphere of the brain. At the request of the public, her attending physician Keith Black from Los Angeles spoke about the chances of surviving a head wound. “Almost everything depends on the area of ​​the brain that was hit, as well as the speed and whether the bullet went through,” Black explained. - If the bullet passes through both hemispheres, then the probability of death is much greater than in the case of Gabrielle. The brain is somewhat redundant, and can sometimes lose up to half, leaving a person alive.” The chances of recovery are higher if the deep structures of the brain, such as the brain stem and thalamus, are not damaged. Internal hemorrhage due to damage to blood vessels is also a danger. In general, it is possible to save people who have not stopped breathing and blood pressure remains quite high: both functions are necessary to maintain adequate oxygen supply to the brain. There are few such “lucky” people, as statistics show - about one in ten. And only if help was provided in a timely manner.