Proponial assistance in damage to the spine. Proponial assistance in the injuries of the limbs

20.05.2020

Wound in medicine is called any damage to the mucous membranes, skin PokrovAs well as various tissues and internal organs caused by the impact of any force accompanied by a painful symptom of various intensity, gaping, as well as different types of bleeding.

Obtaining many types of wounds requires urgent medical care, as well as conducting first aid measures before the arrival of doctors. It is from the correctness and timeliness of provision prefigure Often depends the life of the victim.

First aid

Of course, the provision of first aid with injuries has many features, depend on the type of injury, its localization, the state of the victim, the scene of the incident and other points.

First medical care for injuries includes the following actions:

First aid for gunshot wound

Upon receipt of the first prefigure emergency care It is carried out according to a specific algorithm, regardless of which part of the body is injured. An exception is only the wound of the head.

It is important to immediately call ambulanceAt the same time assessing the state of the victim and establishing the localization of the wounds.

If a person is unconscious, you should not try to give it to the feeling, you can immediately begin to assist, the first thing that trampled his head back and turning the side to go into the lungs without any obstacles.

You do not need to try to move or transfer the victim, as well as turning it into any other position in which the face of the person providing first assistance in injuries will be more convenient for him.

It is important not to cause a person other damage. The most optimal not to change the victim's posture.

If a bullet remains in the resulting wound or somehow sticks out foreign objectOne should not pull it out, since such items, as a rule, constrain the bleeding, overlapping damaged vessels, their extract from the RAS provokes the gain of bleeding and complicates the state.

Should not also try to clean the wound from blood clots, dead fabrics and other elementsSince such actions usually lead to damage infection. If the wound is on the stomach and, at the same time, the internal organs discovering from it are visible, in no case can you try to go them.

The main purpose of providing first aid upon receipt of a gunshot wound is to stop bleeding, for which its type should be installed.

When blood leaves the wound with a pulsating flowing and has a bright scarlet color. In this case, it is necessary to find a damaged artery in the wound and overlapping it with a finger or wound to tampony.

When blood has a dark color and flows out of damage without ripple and pressure. In this case, it is necessary to impose harness (when the limb is injected).

If the wound is above the level of the heart, then the harness is superimposed above the wound, if the localization of damage is below the heart area, then the harness should be applied under the wound. When the body is injured, the wound must be tightly tampon.

After you should impose a dense gulling bandage and wait for the doctors' arrival.

Actions with knife and crushing injury

First of all, it is necessary to determine the nature of the wounds received and their number. If the wounds are somewhat, then the priority in the first aid is the one that has the greatest size, badly bleeding or is in place, life-threatening. These places include the inner surface of the hips, the top one third of the abdomen, district chest, Neck.

If a knife sticks out from the wound, it is impossible to pull it out, since it will keep the bleeding. Do not be afraid of the injury infection with the cutting subject stuck in it. Bacteria and other microorganisms begin to reproduce only 6 - 8 hours after entering the wound, and during this time the victim will be taken to the hospital and will receive a qualified help of specialists.

PMP when wounds

Upon receipt of any injury of head and injury, the first medical care should always be aimed at stopping the existing bleeding.

It is important to remember that even with small injury, bleeding can be very strong, which often scares people. It is explained by the fact that all vessels on the surface of the head are located very close to the skin, and therefore any damage causes quite intensive bleeding, but the wounds in this zone are healing very quickly.

An important feature of the head is that the bones of the skull are very close to the skin surface and subtle soft tissues, so best way Stop bleeding in injuries of the head is the overlay of the gulling bandage.

The rules for the imposition of the gulling bandage when heading head:

Close the area of \u200b\u200bthe wound wound with a sterile napkin of gauze and tightly press it to the cranial bones.
Using the bandage, fix the imposed bandage.
If the pressure of the superimposed bandage turns out to be insufficient to stop bleeding, and it will open again, you can simply squeeze the edge of the damage.

After overlaying the dressing and stopping bleeding, it is necessary to call an ambulance, and the victim to put on the back so that his head and shoulders are in the highlight.

To fix the dressing material applied to the wound, it is often imposed with a dense bandage of a tank type.

How to help the victim from the injury of the abdominal cavity

It can often be dangerous, because at the same time damage to the internal organs quite often occur, which can lead to very serious complications, for example, to the appearance of hidden internal bleeding or peritonitis, which is inflammation of the peritoneum. With such wounds, the main complexity is that at first glance it is impossible to assess the depth and danger of injury.

An important feature of the wounds in the abdomen is also the fact that a deep and dangerous wound may look relatively normal and not to cause anxiety, and the wound that does not represent a serious danger can look very terrible, severe and cause panic.

In addition, with such wounds there is a high risk of infection.

The main directions of the first aid upon receipt of the wounds of the abdomen are: determining the type of bleeding and its stop, as well as the maximum reduction in the risk of possible infection and shock propagation.

An important point is that the wound can have different nature For example, be transverse or longitudinal, and first aid in these cases will have some differences.

In the presence of a longitudinal wound, a person is placed on the back smoothly, and with the cross injury it is very important, putting a man on his back, bend his legs in the knees. Such a measure will reduce the tension and pressure on the wound.

If organs or part of the intestines are visible in the wound, you do not need to try to fix them and put in place. In this case, before applying the dressing, it is necessary to cover the wound with clean polyethylene and then on top, without tightening the bandage, impose a wide bandage. Before the arrival of emergency, you need to control the condition of the victim.

Proponial assistance when grabbing

First aid measures upon receipt of victims depend on whether a person is conscious or not. If the victim is in consciousness, the first thing should be asked to close his wound his palm, after which to plant a person, tilting him towards injury.

An important point is that if we tilt the patient to another (healthy) side, then the blood, which pours in the affected part, will put pressure on the intact lightweight, as well as on the heart, squeezing them, because of which their work will be disturbed, And there will be serious complications.

It is impossible to lay a person wound up, because it is very important that the blood has a free yield from the thoracic cavity. In addition, if the victim is located upstairs, the air will be sued into the cavity of the chest and stop this process will be very difficult.

So that the air does not penetrate the wound, it must be covered with a bandage, but before that you should ask the victim tightly close it with your hand. Prepare materials for the dressing, the hand should be removed and immediately impose a gauze napkin on the wound, which should be covered with a piece of polyethylene or a lot of material that does not transmit air. Such a bandage needs to be contiguous so that it cannot penetrate the air anywhere, or glue the edges of polyethylene with a plaster throughout the perimeter.

If the victim is unconscious, it is necessary to close the wound with his own hand, while as soon as possible should be imposed with a bandage with polyethylene and call an ambulance.

It is also very important that the person is wound down. The patient's condition should be controlled until the transmission of it into the hands of doctors, and it is necessary to be ready for the fact that at any time it may be necessary to carry out measures for resuscitation of a cardiovascular character.

How to stop bleeding and impose harness

Arterial bleeding in the area of \u200b\u200bthe neck, limbs or heads before the arrival of doctors can be stopped temporarily by finger pressed damaged vessel. Cress the artery should be slightly higher than the localization of bleeding, in the place where the vessel is unluckous, where there is no large amount of muscles and it can be tightly pressed against the bone.

There are also certain points in which the artery can be composed in order to quickly stop bleeding with a finger, as well as a fist or palm. As a rule, they coincide with places where you can easily try the pulse.

Arterial bleeding must be stopped as quickly as possible, since the life of a person depends on it. If such bleeding do not stop in time, then death can occur in a period of 15 to 50 minutes, depending on the intensity of blood outlet.

One of effective ways Stop arterial, as well as venous bleeding is. This creates a circular pressure on body tissue and vessels, which are pressed against the bone. But the imposition of a harness is possible only when the limbs are damaged, in other cases this method cannot be applied.

Not only special medical devices can be used as a harness., but also a piece of dense gum, a rubber soft tube, a tie, a scarf (with the exception of small nose), folded diagonally, a belt belt, any piece of strong matter or rubber bandage. Also harness can be replaced by a cuff from a medical tonometer.

It is important that when the harness is imposed, the skin infringement has occurredtherefore it is recommended to impose it, pre-wrapped the limb dense cloth or towel.

For proper overlay, the damaged limb is slightly lifted up, while the harness or other fixture is stretched and, without weakening the tension, turn the place of overlay several times, after which the construction is consolidated.

If the harness is tightened weakly, it is created stagnation of venous blood, but no bleeding stops. A misinterpretation of the harness will be evidenced by the misunderstanding of the cover of the limb, while venous bleeding may noticeably increase.

With proper imposition of the harness, the bleeding of the arterial type ceases immediately, the limb will pale quickly, the vascular pulsation disappears.

It is important not to drag harness stronger than it is necessary to stop bleeding, because in this case there may be a scramble of soft tissues under it, such as vessels, nerve fibers and muscles, which often leads to the appearance of a paralysis of the injured limb in the future.

After overlaying the harness, it is important to quickly impose a bandage on the wound and immobilize the endpostb, not allowing it to remain without blood supply for a long timeotherwise arises serious threat Omnation of fabrics. It is important that the harness was on the limb and squeezed it no longer than 1.5 hours.

Competently rendered first assistance in the injury of the spine - the key to the preservation of human life and human health. The damage to the spinal column represents a real danger and threatens with severe consequences. Let's try to figure out what types of spinal lesions exist and how to help the victim quickly and quickly.

In order not to harm the patient when providing a prefigure help, you need to know well a variety of damage to the spine. They are classified depending on the localization, degree and depth of the lesion, as well as the method of deformation of the bone-muscular apparatus. By the nature of damage, the vertebral injuries are divided into the following types:

The fracture is a violation of the anatomical integrity of the vertebrae, as well as muscles, blood vessels, nervous tissues, accompanied by the lack of motor activity and the rustling of life. It is more often diagnosed in the cervical spinal column.
Dislocation - damage to the joint joint as a result of the displacement above the vertebra with respect to the bottom. It is characteristic of the cervical part of the spine, less often arises in the department of the lower back area.
Injury - violation of the spinal column, preserving the overall structure of the spinal cord and in particular the vertebrae. It is often accompanied by the formation of bruises, necrosis of tissues and difficulty moving spinal fluid On the channel of the spine, damage to nerve roots. Basic and first lumbar vertebra are mainly traumatized, less often cervical.
Break intervertebral disc - protrusion of the inside or rupture of the outer layer, annoying and damaging nervous root.
Long squeezing syndrome - pathological disorders of organs and systems due to blood poisoning to toxins after a long massive crushing of soft tissues or compressing limb vessels.
Paraplegy - paralysis of the upper and lower extremities as a result of injury to the spinal cord.

At the place of damage diagnose injuries of cervical, chest, lumbar departments Spine, as well as simultaneous defeat of several parts. According to statistics, the most frequent violations associated with the lumbosacral department, while in 25% of cases, injuries of the cervical and thoracic part are diagnosed.

See also:

What can cause injury

Quickly navigate when providing timely assistance will help knowledge of damage mechanisms. To the one frequent reasons The defeat of the spine, leading to severe consequences, belongs:

Falling from height, as well as as a result of the loss of consciousness;
Injury due to careless diving in reservoirs;
Accidents (road transport, domestic, industrial, etc.);
Disproportionate load on the spine;
Excessive sports loads;
Injuries during childbirth;
Firearms, knife injuries and lesions as a result of explosions;.
The aging of the body, leading to the wear of the disks between the vertebrae and the sinking of the cloth cartilage;
Massive blow on the back;
Chronic diseases leading to a vertebral pillar (osteoporosis, tumor-shaped processes).

For different situations resulting in damage to the musculoskeletal system, it is characterized by its own stability of lesions of a particular part of the spinal column. With transport accidents, in most cases, the cervical department suffers, in production - lumbly-sacral. Generic complications lead to spine stretching.

See also:?

First Aid Rules

The spinal injury is a relatively serious damage to the body, which is risk for life and health. With the slightest detection of the defeat of the spine, it is important to conduct the necessary actions in a timely manner aimed at providing medical care on which the state of the person and its life depends. In such cases, it is important to competently assist before the arrival of specialists, requiring the usual human knowledge, practical experience and skill.

In order to maximally assist in the spinal injuries, you must first determine the place of lesion.

Cervical

This segment of the spine is most often injured as a result of automotive accidents. The "whip injury" is formed at the time of sudden damage leading to the sharp flexion and extension of the neck.

See also :.

The resulting displacement of cervical vertebrae and multiple bundles of ligaments require compliance with the following principles of first aid:

The psychological support of the victim, which is in a state of severe stress;
If a injured person claims that it is absolutely healthy, do not rush to agree: often the defeat of the neck of the neck is accompanied by the cranial and brain injury, the patient's condition can deteriorate after a certain time interval;
Do not focus solely on the injury of the musculoskeletal system, it is important to characterize general state Patient: It is possible to violate the efficiency of other organs and systems.

The main action under defeat cervical department Spine - creation of temporary stability, allowing to protect the spinal cord from mechanical injury threatening with hemorrhage and breaks nerve fibers. To do this, do the following activities:

When in the constraintful conditions (clamping, jams), if possible, carefully remove the victim, holding the neck and head with their hands.

Place a smooth solid surface. For a slight extension of the neck and prevent the further displacement of the vertebrae, put a small roller under the shoulders;
Surprise in the consciousness of a person in the obligatory observance of the state of rest. In the patient, in the absence of consciousness, turn the head of the head, because it will not allow the falling masses to the respiratory tract;
In case of impossibility of self-transporting in medical institution Call the ambulance brigade.

See also:?

If you are able to put on the neck of the victim, the gauze collar as an additional support tool.

Chest department

To damage the vertebrae of this segment, often combined with injury to the chest, characterized by an external asymptomatic flow. Durable Rib frame protects the vertebral pole, so defeats breast Department Rarely threaten the life of a person.

This spinal injury is accompanied by a pronounced painful syndrome, oppressing the work of the lungs and the heart. It is important to quickly deliver the victim in medical institution For careful examination and treatment.

See also :.

First aid for injuries of the chest department comes down to performing a number of actions that reduce the risk of developing complications:

Put the victim on a flat solid surface;
Frequently freezing chest;
In order to avoid damage to the spinal cord, do not let the patient make sharp movements;
Give the affected analgesic agents that reduce the negative impact of pain on the operation of the respiratory and cardiovascular system.

In case of damage to the breast segment of the spinal column, the support of the patient to the hospital is necessary, since the strong pain syndrome often leads to loss of consciousness.

With imperriburing wounds of the spine and the absence of neurological symptoms The final diagnosis is made only after conducting special research. Therefore, the procedure for providing a prefusion and qualified surgical care It is carried out as when wounds at all.

Algorithm for assistance in penetrating injuries of the spine.

To impose a aseptic bandage.
Ensure the passability of the upper respiratory tract.
Alestruction of non-nucleic and narcotic analgesics. Note. With high damage to the cervical spine, narcotic analgesics cannot be administered due to the danger of respiratory oppression.
Bearing (on a team) shifting the victim to the hard shield on the back.
Conduct the simplest anti-deposit measures. Note. Warming the injuries should be carried out carefully due to the danger of burns.
To register Pulsar Hell, neurological symptoms before starting the ambulance machine to assess their dynamics upon arrival in the hospital.
Transport victims to the neurosurgical department.

Treatment of spinal injuries

The treatment of spinal wounds is carried out in neurosurgical hospitals with the participation of a specialist-urologist. Indications for an emergency operation in open damage to the spine and spinal cord are penetrating injuries and the presence of foreign bodies in the spinal channel. In these cases, treatment begins with early (in the first 3-4 days) Laminectomy. Before the operation, in addition to the premedication, antibiotics are prophylactically introduced and the testimony is carried out by specific prevention of tetanus (PSHS or PSS in combination with Ca).

V.Dmitriev, A. Koshelev, A.Tert

"First aid and treatment with open source injuries" and other articles from the section

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The basic principle of stroke treatment of the wounded in the spine when identifying the syndromes of a complete or partial violation of the conductivity of the spinal cord is the most fast evacuation in VPhG. If possible, by passing the stage of providing qualified medical care, air transport.

First aid. Aseptic bandage is superimposed on the wound of the spine. With pronounced pain syndrome, 1 ml of 2% of the propelol solution is introduced. With the injury of thoracic or lumbar spine, the removal of the wounded from the battlefield is carried out in the position on the stomach with the help of stretcher, volokus, cloak tent.

Prefigure helpwith the injuries of the spine and the spinal cord, it is carried out by a paramedic, which controls the accuracy of the events conducted earlier and eliminates their disadvantages. Further transportation of the wounded is carried out on stretchets with a shield in the back position. In the absence of a shield, immobilization of the thoracic and lumbar spine is performed in a stretcher position on the stomach. When the cervical spine is injected, immobilization of the head and neck with a cottage-gauze collar or a Bashmakov bus (Fig. 1).

Fig. 1. Type view of Bashmakov:

a - Simulation of Bashmakov bus from two staircase tires,

b - immobilization of the cervical spine

First medical care. In medical sorting among the spinal and spinal cords wounded with firearms and uniform injuries, the following groups are distinguished:

1. In need of urgent events of the first medical care - wounded in the spine with symptoms acute respiratory failure or ongoing outdoor bleeding - They are sent to the dressing first. In acute respiratory failure, its reason is determined; If there is no asphyxia, or the pneumothorax in the accompanying breast injury, there are signs of wounding the cervical spine - it means that respiratory disorders are caused by damage and ascending spinal cord edema - necessary putting the air duct, tough immobilization of the head and neck, urgent evacuation. The forecast is unfavorable. With continuing bleeding from the wound, the best way to stop bleeding is a tight wound tamponade.

2. Wounded with combined thoracpinal and abdominospinal injuries, We have leading damage determining the immediate threat to life are wounds of breasts and abdomen. These wounded infusion container systems are installed, the immobilization of the spine in the sorting and evacuation compartment is performed, after which they are evacuated in the 1st stage for the nearest stages of medical evacuation - in Omhedb or immediately to the VPNHG.

3. Wounded with acute urine delay - they are satisted by catheterization bladder In the sorting swab.

4. Wounded in the spine, in the state of medium severity - They are sent to evacuation in the 2nd stage (preferably immediately in the VPVHG) after assisting the sorting platform.

5. Agroning - wounded with damage to the upright spine and spinal cord, located in terminal state with a sharp disruption of breathing and cardiac activity.

All wounded in the spine are introduced antibiotics, tetanus anatoksin, with blood loss and shock is infusion of crystalloid solutions. The main thing is transport immobilization. Transport immobilization of styling wounded on a stretcher with a rigid shield-legged under the back. When the cervical spine is injected, the immobilization of the head and neck of the Bashmakov tire is performed.

Gumanenko E.K.

Military Field Surgery

Wan It is called damage characterized by a violation of the integrity of the skin, mucous membranes, and sometimes deep tissues and accompanied by pain, bleeding and gaping.

The pain at the moment of injury is caused by damage to the receptors and nerve trunks. Its intensity depends on:

the number of nerve elements in the damage zone;
the reactivity of the victim, its nervous mental state;
the nature of the wounding weapons and the speed of application of injury (the sharper weapons, the fewer cells and nerve elements are destroyed, and therefore the pain is less; the faster the injury is applied, the less pain).

Bleeding depends on the nature and amount of vessels destroyed. The most intensive bleeding happens when the destruction of large arterial stems.

The gaping of the wound is determined by its value, depth and disruption of the elastic fibers of the skin. The degree of gaping of the wound is also associated with the nature of the tissue. Wounds, located across the direction of elastic fibers of the skin, are usually distinguished by large gaping than wounds running parallel to them.

Depending on the nature of the injury of wound tissues, it can be firearms, cut, crushing, chopped, bruised, bruised, ribbon, bruised, etc.

Firear wounds may be through When there are inlet and outlet wound holes; blind When the bullet or fragments are stuck in the tissues; and tangent In which a bullet or fragment, flying on tangent, damages the skin and soft tissues, not to shoot them. In peacetime, fractional injuries are often the result of a random shot on the hunt, careless handling of weapons, less often due to criminal activities.
Rezany wounds - There are smooth edges and a small lesion zone, but heavily bleed.
Cheerful wounds -with a small zone of skin damage or mucosa, they can be considerable depth and represent a greater danger in connection with the possibility of damage to the internal organs and the infection in them. With penetrating breast injuries, damage to the internal organs of the chest is possible, which leads to a violation of cardiac activity, hemoptia and bleeding through the oral and nasal cavity. Especially dangerous for the life of victims simultaneous damage to the internal organs of the chest and the abdominal cavity.
Ranged wounds They have an unequal depth and are accompanied by injury and screaming of soft tissues.
Harked, swamped and ripped wounds Characterized by uneven edges and saturated with blood and dead tissues at a considerable distance. They are often created favorable conditions For the development of infection.
Branched wounds Most often dogs are applied, rarely wild animals. Wounds of irregular shape, polluted by saliva animals. The flow of these wounds is complicated by the development acute infection. Especially dangerous wounds after mad animals bites.

When penetrating breast injuries, damage to the internal organs of the chest, which is caused by hemorrhages. In case of hemorrhage in tissue, blood impresses them, forming swelling, called bruise. If the blood impresses the fabric unevenly, then due to the spreading of them, a limited cavity is formed, filled with blood flow, called hematoma.

Signs of penetrating wounds of belly, except for the wound, is the presence of spilled pain in it, muscle tension abdominal wall, bloating, thirst, dry mouth. Damage to the internal organs of the abdominal cavity may be in the absence of a wound, in the case of closed injuries belly.

When laying in the wound of the foreign bodyFor example, a knife cannot be deleted it. When first aid, the knife is fixed between two rolled rollers of the bandage attached to the body with a plaster.

All wounds are considered primary infected. Microbes can get into the wound together with a wounded object, land, pieces of clothing, air, as well as when touching the wound with hands. At the same time, the microbes can cause its suppuration. The prevention of the prevention of infection of the Russian Academy of Sciences is the earliest imposition on it a aseptic dressing, warning further admission to the wound of microbes.

Another dangerous complication of the Russian Academy of Sciences is their infection by the causative agent of the tetanus. Therefore, in order to prevent it with all injuries accompanied by pollution, purified anti-beadable anatoxine or anti-resistant serum is injected with wounded.

Bleeding

Most wounds are accompanied by a dangerous for the life of the victim by complication in the form of bleeding. Under bleeding It is understood by blood flow from damaged blood vessels. Bleeding can be primary, if it occurs immediately after damage to the vessels, and secondary, if it appears after some time.

Depending on the nature of damaged vessels, arterial, venous, capillary and parenchymal bleeding are distinguished.

Most dangerous arterial bleeding In which in a short time, a significant amount of blood can be poured from the body. Signs of arterial bleeding is a sharp blood color, her leakage of a pulsating jet. Venous bleeding In contrast to arterial, it is characterized by continuous flowing blood without a clear jet. In this case, blood is darker. Capillary bleeding It occurs during damage to small vessels of the skin, subcutaneous fiber and muscles. With capillary bleeding, the entire surface of the wound is bleed. Always dangerous for life Parenchimato bleeding, which occurs when damaged internal organs: liver, spleen, kidneys, lungs.

Bleeding can be external and internal. For Outdoor bleeding Blood flows through the wound of the skin and visible mucous membranes or cavities. For inner bleeding blood is poured into fabrics, organ or cavity, which is called title hemorrhages. In case of hemorrhage in the tissue, blood impresses them, forming swelling, called infiltrate or Blooding. If the blood impresses the tissues unevenly and due to the spreading of them, a limited cavity is formed, filled with blood, it is called Hematoma.Acute loss of 1-2 liters of blood can lead to death.

One of the dangerous complications of the Russian Academy of Sciences is painful shockaccompanied by violation of the functions of vital important organs. For the prevention of the shock, the anti-observative syringe tube is introduced, and in case of its absence, if there is no penetrating the abdomen, they give alcohol, hot tea, coffee.

Before proceeding with the processing of the wound, it must be exposed. In this case, the upper clothes depending on the nature of the wound, weather and local conditions or remove, or cut. First remove clothes from a healthy side, and then - with the affected. In the cold season, in order to avoid cooling, as well as in emergency cases, when providing first assistance, clothing in serious condition is cut in the wound area. It is impossible to tear off the wound junk; It must be carefully cutting as scissors.

To stop bleeding Use pinching with a finger of a bleeding vessel to the bone above the place of injury (Fig. 49), giving a damaged body part sublime position, Maximum flexion of limb in the joint, the imposition of a harness or twist and tamponade.

Method finger pressed the bleeding vessel to the bone is applied for a short time needed for the preparation of a harness or a gulling bandage. Bleeding from the vessels of the lower part of the person stops pressed the jaw artery to the edge of the lower jaw. Bleeding from wounds of temple and forehead stops pressed the artery ahead of the ear. Bleeding from large wounds heads and necks can be stopped by pressing sleepy artery To the cervical vertebrae. Bleeding from the Russian Academy of Sciences At the forearm stops pressed the shoulder artery in the middle of the shoulder. Bleeding from wounds brushes and finger hands stops by pressing two arteries in the lower third of the forearm of the brush. Bleeding from wounds lower extremities stops pressed femoral artery To the bones of the pelvis. Bleeding from wounds on the foot can be stopped by pressing the artery passing along the back of the foot.

Fig. 49. Points of the finger pressed arteries

On small bleeding arteries and veins are superimposed rose bandage : The wound is covered with several layers of sterile gauze, bandage or pads from an individual dressing package. On top of the sterile gauze, the wool layer is placed and the circular bandage is superimposed, and the dressing material, tightly pressed to the wound, squeezes blood vessels and contributes to stopping bleeding. The gulling bandage successfully stops venous and capillary bleeding.

However, with strong bleeding should be imposed above wound harness or twig of the primary materials (belt, nose handkerchief, a creek - Fig. 50, 51). Harness is superimposed as follows. A part of the limb where the harness will lie, wrap with a towel or several layers of bandage (lining). The damaged limb is then lifted, the harness is stretched, they make 2-3 turns around the limb to slide soft tissues to somewhat, and the ends of the harness using a chain and hook or tie up the node (see Fig. 50). The correctness of the imposition of the harness is verified by the cessation of bleeding from the wound and the disappearance of the pulse on the periphery of the limbs. Tighten the harness to stop bleeding. Every 20-30 minutes, relax the harness for a few seconds to glass blood and tighten again. You can keep the tightened harness no more than 1.5-2 hours. In this case, the wounded limb should be kept raised. To control the duration of the imposition of a harness, to take it in a timely manner, or produce a weakening, under the harness or to the clothes of the affected attachment attach a note with the date and time (hour and minute) of the harness.

Fig. 50. Methods for stopping arterial bleeding: A - tape hemostatic harness; b - round hemostatic harness; B - the imposition of a hemostatic harness; g - overlay twist; d - maximum flexion of limbs; E - Double loop of the trouser strap

When attaching a harness, serious errors are often allowed:

impose harness without sufficient testimony - it should be used only in cases of strong blood bleeding, which cannot be stopped in other ways;
the harness is applied to the naked skin, which can cause its infringement and even samples;
it is incorrectly chosen places for the imposition of a harness - it must be imposed above (neutral) the place of bleeding;
incorrectly tighten the harness (weak tightening enhances bleeding, and very strong - squeezes nerves).

Fig. 51. Stop arterial bleeding twist: a, b, in - sequence of operations

After stopping bleeding, the skin around the wound is processed with a solution of iodine, mangalls, diamond green, alcohol, vodka or, in extreme cases, cologne. Cotton or gauze tampon, moistened with one of these liquids, smeared the skin from the edge of the wound outside. Do not pour them into a wound, as it is, firstly, will strengthen the pain, and secondly, the fabric will damage inside the wound and slow down the healing process. The wound can not be washed with water, fall asleep with powders, apply ointment on it, can not be applied directly to the wound surface to apply cotton wool - all this contributes to the development of infection in the wound. If in the wound is foreign body, in no case should not be extracted.

In the event of an inception in the injury of the abdomen, they can not be rolled in abdominal cavity. In this case, the wound should be closed with a sterile napkin or a sterile bandage around the felling indoors, put a soft vanity ring on a napkin or bandage and impose not too tight bandage. With penetrating injury, it is impossible or drinking.

After completion of all manipulations, the wound closes with a sterile bandage. In the absence of sterile material, a clean piece of cloth swipe over the open flame several times, then apply iodine to the place of the dressing, which will come into contact with the wound.

In injuries of the head On the wound can be superimposed bandages using slaves, sterile napkins and sticky plastering. Selecting the type of bandage depends on the location and character of the wound.

Fig. 52. Overlay bandage on the head in the form of "Chepts"

So, on the wounds of the hair Head The bandage in the form of "Chepts" is superimposed (Fig. 52), which is strengthened by the bandage strip for low jaw. The bandage is torn off a piece of up to 1 m and put it on the middle over the sterile napkin, covering the wound, on the area of \u200b\u200bthe pattern, the ends are descending vertically down in front of the ears and retain in the stretched state. Around the head makes a circular fixing course (1), then, reaching the strings, the bandage turns around in carrying and leading a space on the back of the head (3). Alternating bandage strokes through the back of the head and forehead (2-12), every time you guide it more vertically, closed all miscellaneous Heads. After that, 2-3 circular strokes strengthen the bandage. Ends tie the bow under the chin.

When the neck is injected , the larynx or the nape is superimposed by a cross-shaped bandage (Fig. 53). The circular strokes of the bandage first strengthen around the head (1-2), and then above and behind the left ear, it is descended in the oblique direction down the neck (3). Next, the bandage goes on the right side surface of the neck, closes its front surface and returns to the back of the head (4), passes above the right and left ear, repeats the moves made. The bandage is fixed by the stroke of the bandage around the head.

Fig. 53. The imposition of a cross-shaped dressing on the back

With extensive wounds of the head The location in the field of the face is better to impose a bandage in the form of "bridle" (Fig. 54). After 2-3 fixing circular moves through the forehead (1), the bandage leads on the back of the neck (2) on the neck and chin, make several vertical moves (3-5) through the chin and the topic, then from the chin, the bint goes on the back of the back (6) .

On the nose, forehead and chin impose a rapid dressing (Fig. 55). Under the bandage on the wounded surface lay a sterile napkin or bandage.

Bandage on the eye start with the fixing stroke around the head, then the bandage leads with a nape under the right ear on the right eye or under left ear On the left eye and after that begin to alternate the moves of the bandage: one - through the eye, the second - around the head.

Fig. 54. Overlay bandage on the head in the form of "bridles"

Fig. 55. Prasevoid bandages: A - on the nose; B - on the forehead: in - on the chin

On breasts Apply a spiral or crucible bandage (Fig. 56). For a spiral dressing (Fig. 56, a), the end of the bandage is about 1.5 m long, put it on a healthy adapter and leave to hang space on the chest (/). Bandom, starting from below from the back, spiral strokes (2-9) bintuten chest. Free hanging ends of the bandage bind. The cruciform dressing on the chest (Fig. 56, b) is replaced from the bottom with circular, locking 2-3 strokes of the bandage (1-2), then from the back to the right on the left adapter (J), which fixes the circular run (4), from the bottom through the right adapter ( 5), again around the chest. The end of the bandage of the last circular stroke fix the pin.

With penetrating injuries of the chest On the wound, it is necessary to impose an internal sterile surface with a rubberized shell, and on it sterile pillows of the package of individual dressing (see Fig. 34) and tightly bandaged. In the absence of a package, hermetic bandage can be applied using a leucoplasty, as shown in Fig. 57. The strips of the plaster, starting at 1-2 cm above the wound, tilely glued to the skin, thus closing the whole wound surface. A sterile napkin or a sterile bandage of 3-4 layers is put on the leafoplasty, then the wool layer and tightly borne.

Fig. 56. The imposition of bandages on the chest: A - spiral; b - cruciform

Fig. 57. The imposition of a dressing of adhesive

Particular danger is injured, accompanied by pneumothorax with significant bleeding. In this case, it is most advisable to close the wound with an airtight material (oilcloth, cellophane) and impose a bandage with a thickened wool layer or gauze.

A sterile bandage is superimposed on the top of the abdomen, at which the bandaging is carried out by successive circular strokes from the bottom up. On the low part The abdomen impose a coole-shaped bandage on the stomach and the inguinal area (Fig. 58). It begins with circular strokes around the belly (1-3), then the stroke of the bandage from the outer surface of the hip (4) goes around it (5) along the outer surface of the hip (6), and then again make circular moves around the abdomen (7). Small impermeal wounds of the abdomen, boils are closed with a label using a leucoplasty.

Fig. 58. Overlay of a collective dressing: A - on the lower abdomen; b - on the inguinal region

On the upper limbs Typically impose spiral, accosate and cruciform dressings (Fig. 59). Spiral bandage on the finger (Fig. 59, a) Start around the wrist (1), then the bandage leads to the rear of the brushes to the nail phalange (2) and make spiral strokes of bandage from the end to the base (3-6) and reverse the rear Brushes (7) fix the wrist bandage (8-9). The cross-shaped bandage during damage to the palm or back surface of the brush is applied, starting from the fixing stroke on the wrist (1), and then on the rear of the brush to the palm, as shown in Fig. 59, b. On the shoulder and forearm put spiral dressings, Bifuya from the bottom up, periodically intricate the bandage. The bandage on the elbow joint (Fig. 59, c) is imposed, starting 2-3 strokes (1-3) of the bandage through the elbow hole and further with spiral strokes of the bandage, alternately alternating them on the forearm (4, 5, 9, 12) and shoulder ( 6, 7, 10, 11, 13) with intersecting in the elbow yam.

On the shoulder joint (Fig. 60) The bandage is applied, ranging from a healthy side of the axillary depression on the chest (1) and the outer surface of the damaged shoulder from behind through the axillary shoulder (2), along the back through a healthy armpit on the chest (3) and, repeating the strokes of the bandage until you close the entire joint, fix the end on the chest pin.

Fig. 59. Bandages on the upper limbs: A - spiral on finger; b - cruciform on a brush; in - spiral on the elbow joint

Bandages on lower limbs In the area of \u200b\u200bthe foot and lower legs are superimposed as shown in Fig. 61. A bandage to the heel area (Fig. 61, a) is imposed by the first passage of the bandage through the most protruding part (1), then alternately above (2) and below (3) the first stroke of the bandage, and for fixing they make oblique (4) and Eight-shaped (5) Bandage moves. An eight-shaped bandage is superimposed on an ankle joint (Fig. 61, b). The first fixing stroke of the bandage is made above the ankle (1), further down on the sole (2) and around the foot (3), then the bandage leads on the back of the foot (4) above the ankle and return (5) on the foot, then on the ankle (6 ), fix the end of the bandage with circular strokes (7-8) above the ankle.

Fig. 60. Overlay bandage on the shoulder joint

Fig. 61. Armbands on the heel area (a) and on the ankle joint (b)

They impose spiral dressings just as on the forearm and shoulder.

Bandage on knee-joint They are applied, starting from a circular stroke through a traded cup, and then the strokes of the bandage go lower and above, crossing in a patented jamb.

On wounds in the crotch area imposed T-shaped bifting bandage Or a bandage with a kink (Fig. 62).

Fig. 62. Tightband for crotch

When first aid, the immobilization of the affected area and transportation to the medical institution may also be carried out.

What to do when snake bite?

1. Since any movements enhance lymph and blood circulation, contributing to the spread of a poison from the bite, the victim is necessary to ensure complete peace in the horizontal position.

2. If the snake bit through clothes, it must be removed to ensure access to the wound. In addition, there may be traces of poison.

Since the striking limb will, as a rule, it will be necessary to swell it to free it from the rings of bracelets.

3. So that the infection does not get into the wound, it is closed with a plaster or impose a sterile bandage, which weakened as the edema develops.

Until now, in some guides to provide emergency care in the first 10-15 minutes after the snake bite, perform active removal of poison from the wound by suction. Pouring poison does not pose a threat to assisting under the condition of the integrity of the mucous membrane of the oral cavity (no erosion).

This procedure, indeed, will remove some poison, but it will be negligible to have a significant effect on the outcome. In addition to the fact that the suction of poison does not have clinical advantages over other methods of first aid, it takes time and can deepen damage.

4. At the entire length of the busting limb, it is necessary to impose a comprehensive dressing with a pressure of 40-70 mm Hg. Art. on the upper limb and 55-70 mm RT. Art. on the lower limb.

Previously, the use of a squeezing band to slow down lymphotok and, therefore, the spread of the poison was recommended only when snake bite with a neurotoxic poison, but later the effect was proven for other poisonous snakes.

The problem consists only in the correctness of the bandage imposition: weak pressure - inefficiently, excessive pressure can cause local ischemic tissue damage. In practice, it is enough for such a bandage to comprehend the limb, without delivering anxiety, and allowed to slip her finger without effort.

5. Abundant drinking will help speed up the removal of the poison of snakes and tissue decay products.

6. Analgesics will reduce painfulness, antihistamines will reduce allergic reaction on the snake poison

7. After providing first aid of the victim, it is necessary to deliver as quickly as possible to the nearest therapeutic institution. As mentioned above, the victim should be provided to physical peace, so transportation is carried out only on stretchers; The bite limb for immobilization can be contacted against a blackboard or stick.

What should not be done after the snake bite?

Contraindicated:

Cuts and cavity of the wounds, slip the bite space by any drugs (including novocaine, adrenaline), introduction to the oxidant bite area. It is possible only to process the edges of the wound with iodine for the purpose of disinfection.
Harness overlay. The imposition of a harness does not so much warns the spread of poison, how much exacerbates the development of ischemic complications against the background of disseminated blood intake and tissue trophic disorders.
Acceptance of alcohol. Alcoholic beverages enhance suction rate snake poison and the degree of intoxication.