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. Anesthesia (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 fracture or injury, open and closed. Symptoms.

A head wound is very dangerous, as there is a high probability of brain damage. In this case, swelling of the brain tissue occurs very quickly, which leads to wedging of a part of the brain into the foramen magnum. As a result, the activity of vital centers responsible for breathing and blood circulation is disrupted, while 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 the 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 soon as possible and seek medical advice. medical care. Let's talk about first aid for a head injury.

Head injuries and soft tissue injuries

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

In case of a bruise, it is necessary to apply cold to the affected area (a bottle with cold water, a 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.

Soft tissue injuries are accompanied by intense bleeding. Detachment of skin flaps, the so-called scalped wounds, is also likely.

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

If the blood spurts out, then the artery is damaged. pressure bandage won't help in this case. If damaged, you can apply a rubber band horizontally above the forehead and above the ears. With a slight 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, covered with cold sweat, excitement sets in, and then lethargy, urgent transportation is necessary.

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

Any foreign body in the wound should not be moved, let alone attempted to be removed. These actions can increase the volume of brain damage and increase bleeding.

To stop bleeding, first try to clean the skin around the lesion with a towel, if possible, quickly treat the surface around the wound with a solution of brilliant green or. Then apply a pressure bandage on the wound: first, several layers of clean cloth or gauze, it is advisable to put a solid object on top (a remote control from equipment, a piece of dry soap, a comb, etc.) and bandage it well so that this object squeezes 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 pressure 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 ribbon of bandage, torn sheets, handkerchiefs tied together, and so on. The tape is placed so that the foreign body falls on its middle, and the ends are wrapped around several times and fixed to form a tight knot.

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

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

Closed head injury

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 hairy part head, do not think that this is a simple bruise. The victim must be put on a stretcher without a pillow, put ice on his 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, up to performing artificial respiration and chest compressions.

One of the most serious injuries is a fracture of the base of the skull. It occurs when falling from a height, with such a fracture, the brain is damaged. A characteristic symptom of this injury is the release of a colorless liquid (liquor) or blood from auricles or nostril. In addition, in trauma facial nerve facial asymmetry appears. There may be a rare pulse. A day later, another one develops characteristic symptom: hemorrhages in the eye sockets, resembling panda eyes or glasses.

Transportation of such a victim should be as careful as possible, without shaking the stretcher. The patient can be placed 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 a person in the supine position, but at the same time pin the tongue 2 cm from its edge with a sterilized (calcined) safety pin to the collar. You can also open the victim's mouth and lay a bandage over the tongue, attaching it to mandible for the prevention of falling tongue and suffocation.

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

Maxillofacial injury

The injury is accompanied by swelling and pain. Lips quickly swell and become inactive. First aid - a pressure bandage and cold on the site of injury.

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

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

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

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

• in front of the tragus of the ear at the cheekbone;
• on the lower jaw in front of the front edge masseter muscle(approximately at the level at the corner of the mouth).

In case of ineffectiveness, it will be necessary to press down the carotid artery on the affected side before the doctors arrive.

You need to fix the fragments of the jaw. To do this, a stick or ruler is wrapped in a clean cloth and passed through the mouth, and the protruding ends are tightly fixed with a bandage around the head.

Transportation of the victim is carried out lying on his stomach so that he does not choke on blood. If the patient turns pale, his head is spinning, the lower end of the stretcher should be raised to improve the blood supply to the brain. In this case, care must be taken not to increase bleeding.

Dislocation of the lower jaw

It can develop as a result of strong yawning, laughter, on impact. Elderly people have a habitual dislocation of the jaw.

Signs:

• open mouth;
• severe salivation;
• difficult movements in the jaw;
• speech is almost impossible.

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

For first aid it is necessary:

* Accurately assess the nature and severity of the injury.

* Knowing the nature of the injury, commit right action for first aid.

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

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

Secondly, the wound is often contaminated with tissue fragments, projectile 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 place and type of the inlet, the behavior of the victim and other signs.

LIMB WOUNDS

The first thing you should pay attention to when providing first aid for injured limbs is the presence of bleeding. With the destruction of the arteries of the thigh or shoulder, death from blood loss can occur within a second. So, with a wound in the arm (and damage to the artery), death from blood loss can occur within 90 seconds, and loss of consciousness within 15 seconds. By the color of the blood, we determine venous bleeding or arterial bleeding. Deoxygenated blood dark, and arterial - scarlet and is knocked out of the wound intensively (fountain of blood from the wound). Bleeding is stopped with a pressure bandage, tourniquet, or tamponade of the wound. When a tourniquet is applied, venous bleeding stops below the wound, and arterial bleeding stops above the wound. Applying a tourniquet for more than two hours is not recommended. This time should be enough to transport the victim to a medical facility. For venous bleeding, it is preferable to apply a pressure bandage rather than a tourniquet. A pressure bandage is applied to the wound. Wound tamponade with injuries of the extremities is rarely performed. For tamponade of the wound, you can use a long, narrow object to tightly stuff the wound with a sterile bandage. The higher the artery is affected, the faster the blood loss occurs. The arteries of the extremities 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 profuse blood loss, hemorrhagic shock develops. The pain can be so severe that it causes pain shock.

ANTI-SHOCK MEASURES FOR BLOOD LOSS:

1. Immediate stop of bleeding.

2. Giving the victim such a body position in which the limbs will be slightly raised.

3. Immediate replenishment of the lack of blood with blood-substituting solutions.

4. Antishock agents, painkillers.

5. Provide warmth.

6. Call an ambulance.

The second thing to do - 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. It is possible to self-transport the victim.

GUNSHOT WOUND OF THE HEAD

Doesn't always cause instant death. Approximately 15% of the wounded survive. Wounds in the face are usually accompanied by an abundance of blood due to the large number of vessels located in the front 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 affected. In the presence of a gunshot wound to the head, the victim is laid horizontally, provide peace. It is better not to touch the head wound (excluding facial wounds) (cover with a sterile napkin), and immediately call an ambulance. In case of respiratory and cardiac arrest, perform artificial respiration and heart massage. facial wounds with copious excretion blood: the wound is clamped with a sterile swab. Self-transportation is not recommended or carried out with all precautions.

GUNSHOT WOUND OF THE SPINE

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

GUNSHOT WOUND OF THE NECK

The injury can be complicated by damage to the larynx and damage to the spine, as well as 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 can come within 10-12 seconds. The artery is clamped with fingers, and the wound is immediately tightly packed with a sterile bandage. Gentle transportation.

GUNSHOT WOUND TO THE CHEST AND ABDOMEN

All organs located in human body divided into three sections: pleural cavity, abdominal cavity and pelvic organs. The organs located in the pleural cavity are separated from the organs located in the abdominal cavity by the diaphragm, and the organs of the abdominal cavity are separated from the organs of the small pelvis 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 in such injuries. Stopping bleeding is difficult. Injuries to the organs of the pleural cavity can be complicated by internal bleeding, pneumothorax, hemothorax or pneumohemothorax.

Pneumothorax - the entry of air through the wound opening into the pleural cavity. Occurs with stab and gunshot wounds chest, as well as at open fractures ribs. The volume of the chest is limited. When air gets there, it interferes with breathing and heart function. occupies the volume used by these bodies.

Hemothorax is the entry of blood into the pleural cavity. It happens with stab and gunshot wounds of the chest, as well as with open fractures of the ribs. The volume of the chest is limited. When blood gets there, it interferes with breathing and heart function. occupies the volume used by these orgpns. Pneumohemothorax - the ingress 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 smeared with boron ointment or petroleum jelly, a piece of polyethylene, on extreme case- tightly clamp the wound with the palm of your hand. The victim is seated in a semi-sitting position. Stopping bleeding is difficult. Transportation is gentle.

In the presence of a wound in the region of the heart, the worst is assumed. Help to identify a heart injury external signs such as rapid (instantaneous) deterioration of the condition of the victim, sallow complexion, fast 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 extinction of the activity of the body as a result of filling the pericardium with blood and, as a result, the difficulty of the heart. Assistance in such cases should be provided by a specialist (drainage of the pericardium, suturing the wound of the heart), which 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 squeeze the heart, interfering with its normal work.

GUNSHOT WOUND OF THE ABDOMINAL CAVITY

In case of injuries of the abdominal organs, the victim is seated in a semi-sitting position. Wound infection prevention. With severe blood loss - antishock therapy.

Wound infection prevention:

*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 in case of injuries to the pelvic area - anti-shock measures and prevention of wound infection. With injuries to the gluteal region, there may be profuse bleeding, which is stopped by tight tamponade of the bullet entry hole. For fractures pelvic bones And hip joint the victim is immobilized. Gentle transportation. Self-transport is not recommended.

USEFUL TIPS

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

Do not forget that some advice can be obtained by phone during an ambulance call. It is better if by the time you call an ambulance you will correctly determine the wound and the condition of the victim. Remember that there are not rare cases when the victim could not be saved due to the fact that, based on the message of 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. The address of the hospital on duty can be obtained by calling the ambulance number. The dispatcher can warn the emergency room of the hospital where you intend to deliver the wounded, about the nature of the injury, so that the medical staff is prepared to receive the victim.

⚠ HOW TO EXTRACT THE BULLET

According to statistics, one inhabitant of the planet accounts for one and a half Kalashnikov assault rifles, given that there are 30 rounds of ammunition in a clip, this is quite enough to stuff you with lead like a farshmak, 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 is better to immediately forget about military field surgery.

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

Immediately after injury

Do not rush to immediately pull out a foreign object from the body, a large blood vessel may be affected and after removing the object, severe bleeding will open.

Put a tourniquet on arterial bleeding(blood bright color and beats with a fountain) above the wound (the bandage is located between the wound and the heart), and if the vein is injured, a tight compressive bandage is lower along the vessel (the wound is located between the bandage and the heart).

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

Keep the casualty warm and position his body so that 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 will happen 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 do),

a piece of polyethylene or if there is nothing at hand, just holding it with the palm of your hand.

You need to have time to tightly clamp the wound on the artery with your fingers and quickly plug 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 somehow familiar with anatomy, so that when pulling out a bullet in passing, one does not immobilize a limb, accidentally cutting a tendon, or not touching an important vessel. Everyone else needs to take care to sterilize the instruments and provide the most comfortable conditions for the surgeon and the patient during the operation.

Most effective tools for carrying out an operation in military field conditions - a knife and tweezers.

Everything needs to be sterilized, including gauze bandage or a surgeon's respirator, metal in alcohol and hold on fire, harden the steel, and then again in alcohol until the operation itself. Sterile apron and hands thoroughly washed and soaked in alcohol if sterile rubber gloves are not available.

How to take out a bullet

Before removing the bullet, see if it went right through. It is necessary to take out the bullet (fragment) as soon as possible, otherwise it will 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 during the operation may die from blood loss. Again, this is if help will come not soon and all the rules of the operating room in the conditions of military field surgery are observed.

If the wounded person is conscious, then alcohol should be given as anesthesia and something should be clamped between the teeth so that he does not harm himself with his teeth and tongue. Pulling out a bullet alone is very difficult, blood will constantly pour into the wound, preventing you from properly seeing the situation. It would be best to take an assistant to your “team” who will suck off 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 flooding the gunshot wound that will make it VERY difficult to extract the bullet quickly.

The patient is breathing, the bullet went into a souvenir, but a huge amount of microbes has just been brought into the wound. It can be disinfected with alcohol, or it can be more extreme - pour gunpowder into the wound and set it on fire. The method is also good because it stops the bleeding, but most likely it will come to suppuration, especially if the wound is deep.

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

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 head of the commander and made an assumption about the high degree of their danger to life. In fact, the fact that these injuries were fatal was recognized. So, during the Russian-Turkish war in the battle near Alushta on July 23 (according to some sources, 24) July 1774, Mikhail Illarionovich received a bullet in his left temple, which went right through his right temple. By the way, Kutuzov wore a black armband for only a few months - in rehabilitation period. According to General-Anshef V. M. Dolgorukov, this wound "contorted" the hero, but preserved his sight. The second time Kutuzov was wounded in the head on August 18, 1788 in the Battle of Ochakov. This time the bullet pierced the head from the side of the left cheek, flying out under the base of the skull. Neurosurgeon Mark Proyle from the Barrow Neurological Institute (USA) said in this regard that such injuries make a person suspicious, cautious and even indecisive, they say, that is why Kutuzov preferred to surrender Moscow, while other Russian generals offered to defend the capital.

First there was a drink, then -electric drill

In fact, the first effective tool for trepanation of the skull when assisting soldiers wounded in the head was a wire saw for sawing out a bone flap, which was thrown back together with soft tissues. The author of the saw for the head, oddly enough, was an obstetrician - Italian Geely. It was he who in 1894 proposed this tool, which immediately gained worldwide popularity among doctors. And in 1908 a French surgeon T. de Martel described the method of using a conventional electric drill to drill through the internal bone plate. Further F. Krause began to use an electric 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 appeared quite widely on the battlefields. open injury, as well as barotrauma with brain contusion. At the same time, they began to pay attention to the speed of a bullet piercing the skull. If at the time of the collision 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 to survive in these conditions. However, the Mexican revolutionary Wenceslao Moguel(Wenseslao Moguel), who was executed on March 18, 1915 by the soldiers of the firing squad, survived despite a control shot to the head. After receiving 8 bullets, he fell to the ground. After that, an officer approached him and almost point-blank "finished off" the revolutionary. After the soldiers left, Wenceslao Moguel woke up and independently reached his own. He did not seek medical attention and quickly recovered.

All deaths out of spite

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 more detail on the features of providing neurosurgical care to the wounded. Penetrating wounds of 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 operability of the wounded in the skull in specialized hospitals increased significantly. At the stage of qualified medical care, only urgent indications(continued external or intracranial bleeding, injury to the ventricles with abundant liquorrhea). Such a 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.”

Headshot America

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

chances of salvation

Most famous in Lately assassinated a member of the US Congress Gabriel Giffords January 8, 2011 in Tucson. An 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 region 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 right 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 affected. The danger is also represented by internal hemorrhage due to damage to the blood vessels. In general, it is possible to save people who have not stopped breathing and blood pressure remains high enough: both functions are necessary to maintain an adequate supply of oxygen to the brain. Such "lucky ones", as statistics show, are few - about one in ten. And then, if help was provided in a timely manner.