Examples of descriptions of external injuries (from the point of view of a forensic expert). Injuries to the scalp First aid for injuries to the soft tissues of the head

23.04.2020

Headband - cap "\u003e

Headband - "cap".

Sling-like bandage on the forehead.

Injuries to the soft tissues of the scalp are always dangerous. They can be accompanied by profuse bleeding, bone damage, brain injury (concussion) or cerebral hemorrhage (hematoma), cerebral edema and inflammation of the lining of the brain (meningitis, encephalitis). Signs of damage to the brain and bones of the skull, the development of inflammatory complications are headache, nausea, blurred vision and sensitivity of the skin of the extremities or weakness in them, rise in body temperature, clouding of consciousness up to its loss.

Assistance: 1. Cleanse and rinse the wound. A wound contaminated with earth or any other foreign objectsmust be cleaned using tweezers or by hand. Then the wound is thoroughly washed with hydrogen peroxide or a weak solution of potassium permanganate (2-3 grains per glass, preferably boiled water). You can rinse the wound with tap water. In severe bleeding, the first step is to stop the bleeding.

2. Treat the skin around the wound. Before treating the skin, cut the hair two centimeters around the wound. Then gently grease the edges of the wound with a solution of iodine, brilliant green (brilliant green), a saturated solution of potassium permanganate or alcohol. In this case, alcohol is strictly not allowed to enter the wound.

3. Stop bleeding. When bleeding from a scalp wound, it is most effective to tampon it with a sterile napkin or sterile bandage. You can use gauze, cotton wool, or any clean cloth. The tampon is firmly pressed to the edges and bottom of the wound for 10-15 minutes. If the bleeding does not stop, then a pressure bandage is applied to the tampon inserted into the wound.

4. Apply a bandage (preferably sterile). The bandage is applied to the wound of the scalp as follows: tear off a piece (tie) about 1 m in size from the bandage, put it on the crown, the ends are lowered vertically down in front of the ears; the patient himself or one of the assistants keeps them taut. The bandage round starts from the left side at the level of the forehead, goes to the right side back to the back of the head, thus making two rounds with the obligatory fixation of the first round. The third round of bandage is wrapped around the tie, now on the left, then on the right, so that it overlaps the previous round of bandage by 1/2 or 2/3. Each subsequent round is driven higher and higher until the entire scalp is bandaged. The last round of the bandage is tied to the remaining vertical part of the tie on either side. The vertical ends of the tie are secured under the chin.

5. Apply cold. Cold is applied to the bandage in the area of \u200b\u200bthe wound. Cooling the wound site reduces bleeding, pain, and swelling. You can attach an ice pack, ice wrapped in a plastic bag filled cold water heating pad or cloth dampened with cold water. As it warms up, the ice is changed. As a rule, it is enough to keep the cold in the place of injury for 2 hours, proceeding as follows: the cold is kept at the site of injury for 15-20 minutes, then it is removed for 5 minutes, and a new portion of ice is applied again for 15-20 minutes, etc.

6. See a doctor. Outward signs of a head injury do not always reflect the condition of the victim. Invisible internal injuries are fraught with danger to the victim's life. Do not hesitate to see a doctor. In all cases of head injuries, it is necessary to consult a doctor immediately.

Wounded is called damage characterized by a violation of integrity skin, mucous membranes, and sometimes deep tissues and accompanied by pain, bleeding and dehiscence.

Pain at the time of injury is caused by damage to receptors and nerve trunks. Its intensity depends on:

the number of nerve elements in the affected area;
the reactivity of the victim, his neuropsychic state;
the nature of the wounding weapon and the speed of injury (the sharper the weapon, the fewer cells and nerve elements are destroyed, and therefore the less pain; the faster the injury is inflicted, the less painful sensations).

Bleeding depends on the nature and number of vessels destroyed when injured. The most intense bleeding occurs when large arterial trunks are destroyed.

The gaping of the wound is determined by its size, depth and violation of the elastic fibers of the skin. The degree of dehiscence of the wound is also related to the nature of the tissues. Wounds located across the direction of the elastic fibers of the skin usually have more gaping than wounds running parallel to them.

Depending on the nature of tissue damage, wounds can be gunshot, cut, stabbed, chopped, bruised, crushed, torn, bitten, etc.

Gunshot wound

Gunshot wounds occur as a result of a bullet or shrapnel wound and can be cross-cutting, when there are inlet and outlet wound holes; blind, when a bullet or shrapnel gets stuck in tissues; and tangents, in which a bullet or fragment, flying along a tangent, damages the skin and soft tissues without getting stuck in them. In peacetime, shot wounds are often encountered as a result of an accidental shot while hunting, careless handling of weapons, less often as a result of criminal actions. With a shot wound inflicted at close range, a large lacerated wound is formed, the edges of which are imbibed by gunpowder and shot.

Cut wound

Cut wounds - the result of exposure to a sharp cutting tool (knife, glass, metal shavings). They have smooth edges and a small area of \u200b\u200bdamage, but they bleed a lot.

Puncture wound

Puncture wounds applied with a prickly weapon (bayonet, awl, needle, etc.). With a small area of \u200b\u200bdamage to the skin or mucous membrane, they can be of considerable depth and pose a great danger due to the possibility of injury internal organs and the introduction of infection into them. Penetrating chest wounds may damage internal organs chest, which leads to impaired cardiac activity, hemoptysis and bleeding through the mouth and nasal cavity... Penetrating wounds of the abdomen can be with or without damage to internal organs: liver, stomach, intestines, kidneys, etc., with or without their loss from the abdominal cavity. Simultaneous injuries of the internal organs of the chest and abdominal cavity are especially dangerous for the victims' lives.

Chopped wound

Chopped wounds applied with a heavy sharp object (checker, ax, etc.). They have unequal depth and are accompanied by bruises and crushing of soft tissues.

Bruised, crushed and lacerations are the result of exposure to a blunt object. They are characterized by uneven edges and are saturated with blood and necrotic tissue over a considerable extent. They often create favorable conditions for the development of infection.

Bitten wound

Bitten wounds most often applied by dogs, rarely by wild animals. Irregular wounds, contaminated with animal saliva. The course of these wounds is complicated by the development acute infection... Wounds after being bitten by rabid animals are especially dangerous.

Wounds can be superficial or deep, which, in turn, can be non-penetrating and penetrating into the cavity of the skull, chest, abdominal cavity... Penetrating wounds are especially dangerous.

With penetrating chest wounds, damage to the internal organs of the chest is possible, which causes hemorrhages. When a tissue bleeds, the blood soaks into it, forming a swelling called a bruise. If the blood soaks the tissues unevenly, then as a result of their expansion, a limited cavity filled with blood is formed, called a hematoma.

Penetrating wounds of the abdomen, as already noted, can be with or without damage to internal organs, with or without their prolapse from the abdominal cavity. Signs of penetrating wounds of the abdomen, in addition to the wound, are the presence of diffuse pain in it, muscle tension abdominal wall, bloating, thirst, dry mouth. Damage to the internal organs of the abdominal cavity can be in the absence of a wound, in case closed injuries belly.

All wounds are considered primarily infected. Germs can enter a wound along with a wounding object, earth, pieces of clothing, air, and also when you touch the wound with your hands. In this case, microbes trapped in the wound can cause its suppuration. A measure of prevention of wound infection is the earliest imposition of an aseptic dressing on it, preventing further entry of microbes into the wound.

Another dangerous complication of wounds is their infection with the causative agent of tetanus. Therefore, in order to prevent it, for all wounds accompanied by contamination, the wounded is injected with purified tetanus toxoid or tetanus toxoid.

Bleeding, its visible

Most wounds are accompanied by a life-threatening complication of bleeding. Under bleeding refers to the release of blood from damaged blood vessels. Bleeding can be primary if it occurs immediately after vascular damage, and secondary if it appears after some time.

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

Most dangerous arterial bleeding, in which a significant amount of blood can flow out of the body in a short time. Signs of arterial bleeding are scarlet blood color, its outflow in a pulsating stream. Venous bleeding unlike arterial, it is characterized by a continuous flow of blood without an obvious stream. In this case, the blood has a darker color. Capillary bleeding occurs when small vessels of the skin, subcutaneous tissue and muscles are damaged. With capillary bleeding, the entire surface of the wound bleeds. Always life threatening parenchymal bleeding, which occurs when internal organs are damaged: liver, spleen, kidneys, lungs.

Bleeding can be external and internal. When external bleeding blood flows out through the wound of the skin and visible mucous membranes or from cavities. When internal bleeding blood is poured into a tissue, organ or cavity, which is called hemorrhages. When a tissue bleeds, the blood soaks into the tissue, forming a swelling called infiltration or bruising. If the blood soaks the tissues unevenly and, as a result of their spreading, a limited cavity filled with blood is formed, it is called hematoma.Acute loss of 1-2 liters of blood can be fatal.

One of the dangerous complications of wounds is pain shock, accompanied by impaired vital functions. important organs... To prevent shock, an analgesic agent is administered to the wounded with a syringe-tube, and in its absence, if there is no penetrating wound to the abdomen, they give alcohol, hot tea, coffee.

Before proceeding with the treatment of the wound, it must be exposed. In this case, the outerwear, depending on the nature of the wound, weather and local conditions, is either removed or cut. First, they remove the clothes from the healthy side, and then from the affected side. In the cold season, in order to avoid cooling, as well as in emergency cases when providing first aid to the affected, in serious condition, clothes are cut in the area of \u200b\u200bthe wound. Do not tear off adhered clothing from the wound; it must be carefully trimmed with scissors.

To stop bleeding, press the bleeding vessel with a finger to the bone above the wound site (Fig. 49), giving the damaged part of the body exalted position, maximum flexion of the limb in the joint, the imposition of a tourniquet or twist and tamponade.

The method of finger pressing the bleeding vessel to the bone is applied for a short time, which is necessary to prepare a tourniquet or a pressure bandage. Bleeding from the vessels of the lower part of the face is stopped by pressing the jaw artery to the edge of the lower jaw. Bleeding from a wound in the temple and forehead is stopped by pressing the artery in front of the ear. Bleeding from major wounds to the head and neck can be stopped by pressing carotid artery to the cervical vertebrae. Bleeding from wounds on the forearm is stopped by pressing the brachial artery in the middle of the shoulder. Bleeding from wounds of the hand and fingers is stopped by pressing two arteries in the lower third of the forearm at the hand. Bleeding from wounds of the lower extremities is stopped by pressing femoral artery to the bones of the pelvis. Bleeding from wounds in the foot can be stopped by pressing the artery along the back of the foot.

Figure: 49. Points of finger pressure of arteries

A pressure bandage is applied to small bleeding arteries and veins: the wound is covered with several layers of sterile gauze, bandage or pads from an individual dressing bag. A layer of cotton wool is placed on top of the sterile gauze and a circular bandage is applied, and the dressing, tightly pressed against the wound, compresses the blood vessels and helps to stop bleeding. The pressure bandage successfully stops venous and capillary bleeding.

However, in case of severe bleeding, a tourniquet or a twist made of improvised materials (belt, handkerchief, kerchief - Fig. 50, 51) should be applied above the wound. The tourniquet is applied as follows. The part of the limb where the tourniquet will lie is wrapped with a towel or several layers of bandage (lining). Then the injured limb is lifted, the tourniquet is stretched, 2-3 turns around the limb are made to squeeze the soft tissues somewhat, and the ends of the tourniquet are fixed with a chain and hook or tied with a knot (see Fig. 50). The correct application of the tourniquet is checked by the cessation of bleeding from the wound and the disappearance of the pulse on the periphery of the limb. Tighten the tourniquet until bleeding stops. Relax the tourniquet for a few seconds every 20-30 minutes to drain the blood and tighten again. In total, you can keep the tightened tourniquet for no more than 1.5-2 hours. In this case, the wounded limb should be kept elevated. To control the duration of the application of the tourniquet, remove it in a timely manner or make it loose, a note is attached under the tourniquet or to the victim's clothing indicating the date and time (hour and minute) of the tourniquet application.

Figure: 50. Methods for stopping arterial bleeding: a - tape hemostatic tourniquet; b - round hemostatic tourniquet; c - the imposition of a hemostatic tourniquet; d - swirl overlay; d - maximum flexion of the limb; e - double loop of the trouser belt

When applying a tourniquet, serious mistakes are often made:

a tourniquet is applied without sufficient indications - it should be used only in cases of severe arterial bleeding, which cannot be stopped by other means;
a tourniquet is applied to bare skin, which can cause its infringement and even necrosis;
the places for applying the tourniquet are wrongly chosen - it must be applied above (more neutral) the place of bleeding;
incorrectly tightening the tourniquet (weak tightening increases bleeding, and very strong tightens the nerves).

Figure: 51. Stopping arterial bleeding by twisting: a, b, c - sequence of operations

After stopping the bleeding, the skin around the wound is treated with a solution of iodine, potassium permanganate, brilliant green, alcohol, vodka, or, in extreme cases, cologne. Wadded
or with a gauze swab moistened with one of these liquids, the skin is lubricated from the edge of the wound outside. They should not be poured into the wound, as this, firstly, will increase the pain, and secondly, it will damage the tissues inside the wound and slow down the healing process. The wound should not be washed with water, covered with powders, ointment should be applied to the wound, cotton wool should not be applied directly to the wound surface - all this contributes to the development of infection in the wound. If there is a foreign body in the wound, in no case should it be removed.

In case of loss of viscera due to abdominal injury, they cannot be set into the abdominal cavity. In this case, the wound should be closed with a sterile napkin or sterile bandage around the fallen out viscera, put a soft cotton-gauze ring on the napkin or bandage and apply a not too tight bandage. With a penetrating wound to the abdomen, you can neither eat nor drink.

After completing all manipulations, the wound is closed with a sterile bandage. If there is no sterile material, pass a clean piece of tissue over an open flame several times, then apply iodine to the place of the dressing that will come into contact with the wound.

For head injuries, the wound may be bandaged using kerchiefs, sterile wipes, and an adhesive patch. The choice of dressing type depends on the location and nature of the wound.

Figure: 52. Applying a bandage on the head in the form of a "cap"

So a bandage in the form of a "cap" is applied to the wounds of the scalp (Fig. 52), which is strengthened with a bandage strip behind lower jaw... A piece of up to 1 m in size is torn from the bandage and placed in the middle on top of a sterile napkin covering the wounds on the crown of the head, the ends are lowered vertically down in front of the ears and kept taut. Around the head, a circular fastening move is made (1), then, upon reaching the tie, the bandage is wrapped around the carried and lead obliquely to the back of the head (3). Alternating the moves of the bandage through the back of the head and forehead (2-12), each time directing it more vertically, cover the entire hairy part heads. After that, the bandage is strengthened with 2-3 circular moves. The ends are tied with a bow under the chin.

If the neck, larynx or occiput is injured, a cruciform bandage is applied (Fig. 53). In circular moves, the bandage is first strengthened around the head (1-2), and then above and behind the left ear it is lowered in an oblique direction down to the neck (3). Then the bandage goes along the right lateral surface of the neck, closes its front surface and returns to the back of the head (4), passes above the right and left ears, repeats the moves made. The bandage is fixed with bandage moves around the head.

Figure: 53. Applying a cruciform bandage on the back of the head

For extensive head wounds, their location in the face area, it is better to apply a bandage in the form of a "bridle" (Fig. 54). After 2-3 securing circular moves through the forehead (1), the bandage is led along the back of the head (2) to the neck and chin, several vertical moves (3-5) are made through the chin and crown, then from under the chin the bandage goes along the back of the head (6) ...

A sling-like bandage is applied to the nose, forehead and chin (Fig. 55). A sterile napkin or bandage is placed under the bandage on the wounded surface.

The bandage on the eye begins with a fastening stroke around the head, then the bandage is carried out from the back of the head under right ear on the right eye or under left ear on the left eye and after that the bandage moves begin to alternate: one - through the eye, the second - around the head.

Figure: 54. Applying a headband in the form of a "bridle"

Figure: 55. Sling-like bandages: a - on the nose; b - on the forehead: c - on the chin

A spiral or cruciform bandage is applied to the chest (Fig. 56). For a spiral bandage (Fig. 56, a), tear off the end of the bandage about 1.5 m long, put it on a healthy shoulder girdle and leave it hanging obliquely on the chest (/). With a bandage, starting from the bottom from the back, spiral passages (2-9) bandage the chest. The loose ends of the bandage are tied. A cruciform bandage on the chest (Fig. 56, b) is applied from below in circular, fixing 2-3 moves of the bandage (1-2), then from the back to the right onto the left shoulder girdle (J), fixing in a circular motion (4), from below through the right shoulder girdle ( 5), again around the chest. The end of the bandage of the last circular move is secured with a pin.

In case of penetrating wounds of the chest, a rubberized sheath should be applied to the wound with the inner sterile surface, and sterile pads of the individual dressing package (see Fig. 34) should be applied to it and bandaged tightly. In the absence of a bag, a sealed dressing can be applied using an adhesive plaster, as shown in Fig. 57. Strips of plaster, starting 1–2 cm above the wound, are glued to the skin in tiles, thus covering the entire wound surface. A sterile napkin or sterile bandage in 3-4 layers is placed on the adhesive plaster, then a layer of cotton wool and bandaged tightly.

Figure: 56. Applying a bandage on the chest: a - spiral; b - cruciform

Figure: 57. Applying a bandage with an adhesive plaster

Of particular danger are injuries accompanied by pneumothorax with significant bleeding. In this case, it is most advisable to close the wound with an airtight material (oilcloth, cellophane) and apply a bandage with a thickened layer of cotton wool or gauze.

A sterile bandage is applied to the upper abdomen, in which the bandage is applied in successive circular moves from the bottom up. On lower part the abdomen impose a spike-shaped bandage on the abdomen and groin (Fig. 58). It starts with circular moves around the abdomen (1-3), then the bandage moves from the outer surface of the thigh (4) around it (5) along the outer surface of the thigh (6), and then again make circular moves around the abdomen (7). Small non-penetrating wounds of the abdomen, boils are closed with a sticker using an adhesive plaster.

Figure: 58. Imposition of a spike-shaped bandage: a - on the lower abdomen; b - on the groin area

On upper limbs usually apply spiral, spike and cruciform bandages (Fig. 59). A spiral bandage on a finger (Fig. 59, a) begins with a stroke around the wrist (1), then the bandage is led along the back of the hand to the nail phalanx (2) and spiral moves of the bandage from the end to the base (3-6) and reverse along the rear hands (7) fix the bandage on the wrist (8-9). In case of damage to the palmar or dorsum of the hand, a cruciform bandage is applied, starting with a fixing stroke on the wrist (1), and then along the back of the hand to the palm, as shown in Fig. 59, b. Spiral bandages are applied to the shoulder and forearm, bandaging from bottom to top, periodically bending the bandage. A bandage on the elbow joint (Fig. 59, c) is applied, starting with 2-3 moves (1-3) of the bandage through the ulnar fossa and then with spiral moves of the bandage, alternately alternating them on the forearm (4, 5, 9, 12) and the shoulder ( 6, 7, 10, 11, 13) with crossing in the cubital fossa.

On the shoulder joint (Fig. 60), a bandage is applied, starting from the healthy side from the armpit along the chest (1) and the outer surface of the injured shoulder from behind through the armpit shoulder (2), along the back through the healthy axillary cavity to the chest (3) and, repeating the moves of the bandage until they cover the entire joint, fix the end on the chest with a pin.

Figure: 59. Bandages on the upper limbs: a - spiral on the finger; b - cruciform on the hand; c - spiral to the elbow joint

Bandages on lower limbs in the area of \u200b\u200bthe foot and lower leg are superimposed as shown in fig. 61. A bandage on the heel area (Fig. 61, a) is applied with the first move of the bandage through its most protruding part (1), then alternately above (2) and below (3) of the first move of the bandage, and for fixation make oblique (4) and eight-shaped (5) bandage moves. An eight-shaped bandage is applied to the ankle joint (Fig. 61, b). The first fixing move of the bandage is done above the ankle (1), then down to the sole (2) and around the foot (3), then the bandage is led along the back of the foot (4) above the ankle and returned (5) to the foot, then to the ankle (6 ), fix the end of the bandage with circular moves (7-8) above the ankle.

Figure: 60. Applying a bandage on the shoulder joint

Figure: 61. Bandages on the heel (a) and on the ankle joint (b)

Spiral bandages are applied to the lower leg and thigh in the same way as on the forearm and shoulder.

Bandage on knee-joint impose, starting with a circular stroke through the patella, and then the bandage moves lower and higher, crossing in the popliteal fossa.

On wounds in the perineal area, a T-shaped bandage or a bandage with a scarf (Fig. 62).

Figure: 62. Crotch bandage

When providing first aid for injuries, immobilization of the affected area and transportation to a medical facility can also be carried out according to indications.

1. Injured wound
Description... In the right half of the frontal region, on the border of the hairy part of the head, there is a "P" -shaped (when the edges are brought together) wound, with a side length of 2.9 cm, 2.4 cm and 2.7 cm. In the center of the wound, the skin is exfoliated in the form flap in the area of \u200b\u200b2.4 x 1.9 cm. The edges of the wound are uneven, sagged up to 0.3 cm wide, bruised. The ends of the wound are blunt. Gaps with a length of 0.3 cm and 0.7 cm extend from the upper corners, penetrating to the subcutaneous base. At the base of the flap, there is a stripe-shaped abrasion, 0.7x2.5 cm in size. Taking into account this abrasion, the entire damage as a whole has a rectangular shape, 2.9x2.4 cm in size. The right and upper walls of the wound are beveled, and the left one is undermined. Tissue bridges are visible between the edges of the injury deep in the wound. The surrounding skin is not changed. In the subcutaneous base around the wound, hemorrhage of a dark red color, irregular oval shape, measuring 5.6x5 cm and 0.4 cm thick.
DIAGNOSIS
Contused wound of the right half of the frontal region.

2. Injured wound
Description... There are three wounds in the right parieto-temporal part, 174 cm from the plantar surface and 9 cm from the anterior midline, in the 15x10 cm area (conventionally designated 1,2,3).
The wound is 1. spindle-shaped, measuring 6.5 x 0.8 x 0.7 cm. When the edges are brought together, the wound acquires a rectilinear shape, 7 cm long. The ends of the wound are rounded, oriented at 3 and 9 of the conventional clock face.
The upper edge of the wound is sieged to a width of 0.1-0.2 cm. The upper wall of the wound is beveled, the lower one is undermined. The wound in the middle part penetrates to the bone.
Wound 2, located 5 cm downward and 2 cm posterior to wound No. 1, has a star-like shape, with three rays oriented to 1.6 and 10 of the conventional clock face, 1.5 cm, 1.7 cm and 0 in length, 5 cm, respectively. The overall dimensions of the wound are 3.5x2 cm. The edges of the wound are stiffened to the maximum width in the region of the anterior edge - up to 0.1 cm, the posterior edge - up to 1 cm. The ends of the wound are sharp. The front wall is undercut, the back is beveled.
Wound 3, similar in shape to wound N 2 and located 7 cm upward and 3 cm anterior to wound N 1. The length of the rays is 0.6, 0.9 and 1.5 cm. The overall dimensions of the wound are 3x1.8 cm. Edges the wounds were sieged to the maximum width in the front edge - up to 0.2 cm, the back - up to 0.4 cm.
All wounds have uneven, sagging, crushed, bruised edges, and tissue bridges in the ends. The outer boundaries of sedimentation are clear. The walls of the wounds are uneven, bruised, crushed, with intact hair follicles. The greatest depth of wounds in the center, up to 0.7 cm for wounds No. 1 and up to 0.5 cm for wounds No. 2 and 3. The bottom of wounds No. 2 and 3 is represented by crushed soft tissues. In the subcutaneous base around the wounds there is hemorrhage, irregular oval shape, measuring 7x3 cm for wounds No. 1 and 4 x 2.5 cm for wounds No. 2 and 3. The skin around the wounds (outside of the sedimentation of the edges) is not changed.
DIAGNOSIS
Three contused wounds on the right parieto-temporal part of the head.

3. TARGET WOUND
Description.On the right half of the forehead, 165 cm from the level of the plantar surface of the feet and 2 cm from the midline, there is a wound of an irregular fusiform shape, measuring 10.0 x 4.5 cm, with a maximum depth of 0.4 cm in the center. The length of the damage is located, respectively, 9-3 of the conventional clock face. When comparing the edges, the wound acquires an almost rectilinear shape, without a tissue defect, 11 cm long. The ends of the wound are sharp, the edges are uneven, without sediment. The skin along the edges of the wound is unevenly exfoliated from the underlying tissues to a width up to: 0.3 cm - along the upper edge; 2 cm - along the bottom edge. In the resulting "pocket" is determined by a flat dark red blood clot. Hair along the edges of the wound and their follicles are not damaged. The walls of the wound are steep and uneven with small focal hemorrhages. There are tissue bridges between the edges of the wound in the area of \u200b\u200bits ends. The bottom of the wound is the partially exposed surface of the frontal bone scales. The length of the wound at the level of its bottom is 11.4 cm. Parallel to the length of the wound, a finely serrated edge of a fragment of the frontal bone, on which there are small focal hemorrhages, protrudes 0.5 cm into its lumen. No damage was found around the wound on the skin and in the underlying tissues.
DIAGNOSIS
Laceration of the right half of the forehead.

4. BITTED SKIN DAMAGE
Description. On the antero-outer surface of the upper third of the left shoulder in the area of \u200b\u200bthe shoulder joint, there is an unevenly pronounced red-brown annular sludge of irregular oval shape measuring 4x3.5 cm, consisting of two arcuate fragments: upper and lower.
The upper fragment of the sedimentation ring has dimensions of 3x2.2 cm and a radius of curvature of 2.5-3 cm. It consists of 6 banded irregularly expressed abrasions measuring from 1.2x0.9 cm to 0.4x0.3 cm, partially connected to each other. Central abrasions have the maximum size, and the minimum along the periphery of the sediment, especially at its upper end. The length of the abrasions is directed mainly from top to bottom (from the outer to the inner border of the semi-oval). The outer edge of sedimentation is well expressed, looks like a broken line (step-like), the inner edge is winding, indistinct. The ends of sedimentation are U-shaped, the bottom is dense (due to drying out), with an uneven banded relief (in the form of ridges and furrows extending from the outer border of the semi-oval to the inner one). The sediments are deep (up to 0.1 cm) at the upper edge.
The lower fragment of the ring has dimensions of 2.5x1 cm and a radius of curvature of 1.5-2 cm.Its width is from 0.3 cm to 0.5 cm.The outer border of sedimentation is relatively flat and somewhat smoothed, the inner border is sinuous and more distinct, especially on the left side of it. Here the inner edge of the sedimentation has a steep or somewhat subdued character. The ends of the sedimentation are U-shaped. The bottom is dense, grooved, deepest at the left end of the sedimentation. The bottom relief is uneven, there are 6 sunken areas located in a chain along the course of the abrasion, irregular rectangular in size from 0.5 x 0.4 cm to 0.4 x 0.3 cm and a depth of 0.1-0.2 cm.
The distance between the inner boundaries of the upper and lower fragments of the "ring" of sedimentation is: on the right - 1.3 cm; in the center - 2 cm; left - 5 cm. The axes of symmetry of both half-rings coincide with each other and correspond to the long axis of the limb. In the central zone of annular sedimentation, a blue bruise of irregular oval shape measuring 2 x 1.3 cm with indistinct contours is determined.
DIAGNOSIS
Abrasions and bruising on the antero-outer surface of the upper third of the left shoulder.

5. CUT WOUND
Description.On the flexion surface of the lower third of the left forearm, 5 cm from the wrist joint, there is a wound (conventionally designated N 1) of an irregular fusiform shape, measuring 6.5 x 0.8 cm, when the edges are brought together - 6.9 cm long. From the outer (left) at the end of the wound parallel to its length, there are 2 incisions, 0.8 cm long and 1 cm long, with smooth edges ending in sharp ends. 0.4 cm from the bottom edge of wound No. 2, parallel to its length, there is a superficial intermittent incision 8 cm long.The bottom of the wound at its inner (right) end has the greatest steepness and depth up to 0.5 cm.
2 cm down from the first wound there is a similar wound No. 2), measuring 7x1.2 cm. The length of the wound is oriented horizontally. When the edges are brought together, the wound acquires a rectilinear shape, 7.5 cm long. Its edges are wavy, without sedimentation and crushing. The walls are relatively even, the ends are sharp. At the inner (right) end of the wound, parallel to the length, there are 6 skin incisions with a length of 0.8 to 2.5 cm, at the outer one - 4 incisions, 0.8 to 3 cm long.The bottom is represented by dissected soft tissues and has the greatest steepness and the depth at the outer (left) end of the wound - up to 0.8 cm. In the depth of the wound, a vein is visible, on the outer wall of which there is a fusiform-shaped through injury, 0.3x0.2 cm in size.
In the tissues surrounding both wounds, in an oval-shaped area with dimensions of 7.5x5 cm, there are multiple dark-red hemorrhages merging with each other, irregular oval, sizes from 1x0.5 cm to 2x1.5 cm with uneven indistinct contours.
DIAGNOSIS
Two cut wounds the lower third of the left forearm.

6. PUNCH-CUT WOUND
Description.
On the left half of the back, 135 cm from the plantar surface of the feet, there is an irregular spindle-shaped wound with dimensions of 2.3 x 0.5 cm.The length of the wound is oriented at 3 and 9 of the conventional clock dial (provided that the correct vertical position body). After bringing the edges together, the wound has a rectilinear shape with a length of 2.5 cm. The edges of the wound are even, without sedimentation and bruising. The right end is U-shaped, 0.1 cm wide, the left in the form of an acute angle. The skin around the wound is free from damage and contamination.
On the posterior surface of the lower lobe of the left lung, 2.5 from its upper edge, there is a horizontal slit-like injury. When the edges are brought together, it acquires a rectilinear shape, 3.5 cm long. The edges of the damage are even, the ends are sharp. The lower wall of the damage is beveled, the upper one is undermined. On the inner surface of the upper lobe of the lung at the root, at 0.5 cm of the above-described damage, there is another (slit-like shape with smooth edges and sharp ends). There are hemorrhages along the wound channel.
Both injuries are connected by a single rectilinear wound channel, which has a direction from the back to the front and from the bottom up (provided that the body is in the correct vertical position). The total length of the wound channel (from a wound on the back to damage to the upper lobe of the lung) is 22 cm.
DIAGNOSIS
Stab-cut blind wound of the left half of the chest, penetrating into the left pleural cavity, with through damage to the lung.

7. CHOPPED WOUND
Description. On the antero-inner surface of the lower third of the right thigh, 70 cm from the plantar surface of the feet, there is a gaping wound of an irregular fusiform shape, measuring 7.5x1 cm.After bringing the edges, the wound takes a rectilinear shape, 8 cm long.The edges of the wound are smooth, sagging, bruising, the walls are relatively smooth. One end of the wound is U-shaped, 0.4 cm wide, the other in the form of an acute angle. The wound canal has a wedge-shaped shape and the greatest depth is up to 2.5 cm at its U-shaped end, ends in the muscles of the thigh. The direction of the wound channel from front to back, from top to bottom and from left to right (subject to the correct vertical position of the body) The walls of the wound channel are even, relatively smooth. In the muscles around the wound channel, hemorrhage of an irregular oval shape, measuring 6x2.5x2 cm.
On the front surface of the inner condyle of the right femur, the injury is wedge-shaped, measuring 4x0.4 cm and up to 1 cm deep, its longitudinal axis is oriented accordingly 1-7 of the conventional clock face (provided that the bone is in the correct vertical position). The upper end of the lesion is U-shaped, 0.2 cm wide, the lower end is sharp. The edges of the lesion are even, the walls are smooth.
DIAGNOSIS
Chopped wound of the right thigh with a notch of the inner condyle of the femur.

8. BURN BY FLAME
Description.On the left half of the chest there is a red-brown wound surface, irregular oval in shape, measuring 36 x 20 cm. The area of \u200b\u200bthe burn surface, determined according to the rule of "palms", is 2% of the entire surface of the victim's body. The wound is covered in places with a brownish scab, which is dense to the touch. The edges of the wound are uneven, coarse and finely wavy, slightly raised above the level of the surrounding skin and wound surface. The greatest depth of the lesion is in the center, the smallest - along the periphery. Most of the burn surface is represented by a bare subcutaneous base, which has a moist, shiny appearance. In some places, red small focal hemorrhages, oval in shape, measuring from 0.3 x 0.2 cm to 0.2 x 0.1 cm, as well as small thrombosed vessels, are determined. In the central part of the burn wound, there are separate areas covered with greenish-yellow pus-like overlays, which alternate with pinkish-red areas of young granulation tissue. In places on the wound surface, soot deposits are determined. Fluffy hairs in the wound area are shorter, their ends are “bulbous” swollen. When dissecting a burn wound in the underlying soft tissues pronounced edema is determined in the form of a gelatinous yellowish-gray mass, up to 3 cm thick in the center.
DIAGNOSIS
Thermal burn (flame) of the left side of the chest III degree 2% of the body surface.

9. BURNING WITH HOT WATER
Description. On the front surface of the right thigh, there is a burn wound of an irregular oval shape, measuring 15x12 cm. The area of \u200b\u200bthe burn surface, determined according to the “palms” rule, is 1% of the entire surface of the victim's body. The main part of the burn surface is represented by a group of merging bubbles containing a cloudy yellowish-gray liquid. The bottom of the blisters is a uniform pink-red surface of the deep layers of the skin. Around the blister zone there are areas of skin with a soft, moist, pinkish-reddish surface, on the border of which there are zones of peeling of the epidermis with its filmy exfoliation up to 0.5 cm wide. The edges of the burn wound are large and small wavy, somewhat raised above the level of the surrounding skin, with "tongue-shaped" protrusions, especially from top to bottom (subject to the correct vertical position of the thigh). Fluffy hair in the wound area is not changed. When a burn wound is dissected in the underlying soft tissues, a pronounced edema is determined in the form of a gelatinous yellowish-grayish mass, up to 2 cm thick in the center.
DIAGNOSIS
Thermal burn with hot liquid on the front surface of the right thigh, II degree, 1% of the body surface.

10. THERMAL BURNING BY FLAME OF THE IV DEGREE
In the chest, abdomen, gluteal regions, external genitals and thighs, there is a continuous burn wound of irregular shape with wavy, uneven edges. Borders of the wound: on the left chest - subclavian region; on the right chest - costal arch; on the back on the left - the upper part of the scapular region; on the back on the right - the lumbar region; on the legs - the right knee and the middle third of the left thigh. The wound surface is dense, red-brown, in places black. On the border with intact skin, striped erythema up to 2 cm wide. Fluffy hair in the wound area is completely singed. On incisions in the underlying soft tissues, pronounced gelatinous yellow-gray edema up to 3 cm thick.

11. LIGHTNING BURNED
In the occipital region, in the center, there is a round dense light gray scar 4 cm in diameter with thinning of the skin, soldered to the bone. The borders of the scar are even, they rise in a roller-like manner in the transition to intact skin. There is no hair in the area of \u200b\u200bthe scar. When internal research: Scar thickness 2-3 mm. There is a round defect of the outer bone plate and spongy substance 5 cm in diameter with a flat, relatively flat and smooth surface, similar to a "polished" surface. The thickness of the bones of the cranial vault at the level of the cut is 0.4-0.7 cm, in the area of \u200b\u200bthe defect the thickness of the occipital bone is 2 mm, internal bone plate not changed.

Penetrating injuries, wounds penetrating into the cavity
12. PUNCH-CUT WOUND
Description. On the left half of the chest, along the midclavicular line in the 4th intercostal space, there is a longitudinally located wound, of an irregular fusiform shape, measuring 2.9x0.4 cm. Top part rectilinear wounds 2.4 cm long; lower - arched, 0.6 cm long. The edges of the wound are even, smooth. The upper end of the wound is U-shaped, 0.1 cm wide, the lower end is sharp.
The wound penetrates the pleural cavity with damage to the left lung. The total length of the wound channel is 7 cm, its direction: from front to back and somewhat from top to bottom (with
condition of correct vertical position of the body). There are hemorrhages along the wound channel.
DIAGNOSIS
Stab and cut wound of the left half of the chest, penetrating into the left pleural cavity with damage to the lung.

13. FIRING THROUGH-THROUGH BULLET WOUND
On the chest, 129 cm from the level of the soles, 11 cm below and 3 cm to the left of the sternal notch, there is a 1.9 cm rounded wound with a tissue defect in the center and a circular sling around the edge, up to 0.3 cm wide. uneven, scalloped, bottom wall slightly sloping gently, the upper one is undermined. The organs of the chest cavity are visible at the bottom of the wound. Along the lower semicircle of the wound, the imposition of soot on a crescent-shaped area, up to 1.5 cm wide.On the back, 134 cm from the level of the soles, in the region of the 3rd left rib, 2.5 cm from the line of the spinous processes of the vertebrae, there is a slit-like wound shape (without tissue defect) 1.5 cm long with uneven, finely patchwork edges, turned outward and rounded ends. A white plastic fragment of the cartridge container will stand from the bottom of the wound.

Examples of fracture injuries description:
14. FRACTURE OF THE RIB
There is an incomplete fracture on the 5th rib to the right between the angle and the tubercle, 5 cm from the articular head. On the inner surface, the fracture line is transverse, with smooth, well-matched edges, without damage to the adjacent compact substance; the fracture area gapes slightly (signs of stretching). Near the edges of the rib, this line bifurcates (at the top edge at an angle of about 100 degrees, at the bottom edge at an angle of about 110 degrees). The formed branches pass to the outer surface of the rib and gradually, thinning, are interrupted near the edges. The edges of these lines are finely toothed and are not tightly comparable, the walls of the fracture in this place are slightly beveled (signs of compression.)

15. MULTIPLE FRACTURES OF THE RIB
On the left middle axillary line, 2-9 ribs are broken. Fractures are of the same type: on the outer surface, the fracture lines are transverse, the edges are even, tightly comparable, without damage to the adjacent compact (signs of stretching). On the inner surface, the fracture lines are oblique-transverse, with coarsely serrated edges and small splits and peak-like bends of the adjacent compact substance (signs of compression). From the zone of the main fracture along the edge of the ribs, there are longitudinal linear splitting of the compact layer, which become hairy and come to naught. On the scapular line on the left, 3-8 ribs are broken with similar signs of compression on the outer and stretching on the inner surfaces described above.

Injuries to the soft integuments of the skull are closed and open. Closed include bruises, open - wounds (injuries). Contusions occur as a result of hitting the head with hard objects, hitting the head with a hard object, falling, etc.

The impact damages the skin and subcutaneous tissue. From damaged blood vessels, blood is poured into the subcutaneous tissue. When the galea aponeurotica is intact, the outflowing blood forms a limited hematoma in the form of a protruding swelling (lump).

With more extensive damage to soft tissues, accompanied by a rupture of galea aponeurotica, the blood poured out of the damaged vessels forms a diffuse swelling. These extensive hemorrhages (hematomas) in the middle are soft and sometimes give a swelling (fluctuation) sensation. These hematomas are characterized by a dense shaft around the hemorrhage. When a dense shaft is felt around the circumference of the hemorrhage, it can be mistaken for a skull fracture with pressure. A thorough examination, as well as an X-ray, make it possible to correctly recognize the damage.

Injuries to the soft tissues of the head are observed as a result of injury with both sharp and blunt instruments (blunt violence). Injury of the soft integument of the skull is dangerous because a local infection can spread to the contents of the skull and lead to meningitis, encephalitis and brain abscess, despite the integrity of the bone, due to the connection between the superficial veins and the veins inside the skull. The infection can also spread through the lymphatic vessels. At the same time as soft tissue injury, the bones of the skull and brain can be damaged.

Symptoms Symptoms depend on the nature of the injury. Cut and chopped wounds bleed profusely and gape. Puncture wounds bleed little. In the absence of complications from infection, the course of wounds is favorable. If the wound was treated in the first hours, it can heal by primary intention.

The symptoms of bruised wounds correspond to the nature of the wound. The edges of the bruised wound are uneven, with traces of bruising (crushing), soaked in blood, in some cases they are detached from the bone or underlying tissues. Bleeding is less profuse due to thrombosis of crushed and ruptured vessels. Bruised wounds can penetrate to the bone or be limited to soft tissue damage. A characteristic feature laceration is a significant detachment from the underlying bones and the formation of flaps.
A special type of damage to the scalp is the so-called scalping, in which more or less part of the scalp is torn off.

Treatment. In most cases, after careful pretreatment of the wound itself and the adjacent areas, it is sufficient to apply stitches to the wound, and for small wounds, a pressure bandage. In case of severe bleeding, the bleeding vessels should be bandaged. Only a fresh, uncontaminated wound can be sutured. If the wound is contaminated, the objects trapped in the wound are removed with tweezers, the edges of the wound are smeared with a solution of iodine tincture, the edges of the wound are refreshed (produce primary processing wounds), pour into the wound a solution of penicillin (50,000-100,000 IU in 0.5% solution of novocaine) or infiltrate the edges of the wound with a solution of penicillin, after which the wound is sutured in whole or in part. In the latter case, the graduate is injected under the skin. After subsiding inflammatory process a secondary suture can be applied to the wound. In some cases, intramuscular injection of a solution of penicillin is prescribed. If the wound is completely sutured, and signs of inflammation appear on the following days, the stitches should be removed and the wound open.
For prophylaxis, anti-tetanus serum is administered to all the wounded, and anti-gangrenous serum for severe wounds, especially those contaminated with earth.

Leaving. Hair on the head contributes to dirt and makes it difficult to cleanse the skin and wounds, and therefore should be shaved off as much as possible around the wound. Care must be taken when shaving to avoid introducing infection into the wound by covering it with a sterile tissue. Shaving is done from a wound, not a wound.

First medical and first aid with injuries

Wounds - open mechanical injuries, accompanied by a violation of the integrity of the skin (mucous membranes) with damage to deep-lying tissues (vessels, nerves, tendons, bones, internal organs).

All wounds, except operating rooms, are primarily infected. The main clinical signs wounds are pain, bleeding, dehiscence, dysfunction of the affected area of \u200b\u200bthe body.

Sequencing when providing assistance:

1. Stop bleeding by any known method (finger pressing of the vessel, applying a pressure bandage, tourniquet, etc.).

2. Anesthetize the wounded.

3. If possible, treat the skin around the wound with antiseptics (3% hydrogen peroxide solution, furacilin solution, iodonate, etc.). For shallow wounds, small foreign bodies (glass, metal) can be removed with tweezers or a clamp.

4. Apply an aseptic dressing to the wound. The wound cannot be covered with powders, ointment, cotton wool should not be applied to it - all this contributes to the development of infection in the wound. When presenting to the wound, the fallen out internal organs (brain, omentum, intestine) are strictly prohibited from being immersed in the cavity. The bandage must be applied over the fallen organs.

5. With multiple injuries of the limbs, they are immobilized bilization with tires or improvised means.

6. The wounded, who have the phenomenon of shock, severe blood loss, receive infusion anti-shock therapy.

7. The wounded are immediately transported to medical institution depending on the severity of the condition in a sitting (lying) position, accompanied by a medical worker.

First medical and first aid for craniocerebral trauma

Contusions of soft arable head

They occur with direct trauma caused by blunt objects and when hitting hard objects. They are accompanied by subcutaneous subgaleal hemorrhages. Hemorrhages in the subcutaneous tissue are usually limited in the form of swelling ("bumps") due to the dense cellular structure of the tissue, which does not allow the outflowing blood to spread freely to the sides. With hemorrhages under the aponeurosis, a diffuse swelling is formed.

Sequencing:

1. Apply a pressure bandage.

3. Coldness on the head.

4. In case of large aponeurotic hematomas, the patient is referred to a doctor for puncture and suction of the hematoma.

Head soft tissue injuries

They are accompanied by large bleeding associated with a large number of branched vessels of the subcutaneous tissue. Severe bleeding occurs with cut and chopped wounds of the soft tissues of the head. The wounds usually gap. Detachment of soft tissues occurs with the formation of flaps. A special type - scalped wounds - a significant part of the soft integument is torn off. Headache, dizziness worries.

Sequencing:

1. Depending on the type and strength of bleeding, it is stopped (an aseptic bandage, a pressure bandage, hemostatic clamps are applied, finger pressure arteries).

2. Coldness on the head.

3. The patient is at rest, placed in a horizontal position on his back.

4. A cotton-gauze circle, a pillow, an inflatable rubber circle, auxiliary means (clothes, blanket, straw, etc.) are placed under the head.

5. The victims are transported to a hospital accompanied by a paramedic.