A wound is an open injury to the skin or mucous membranes resulting from mechanical impact.
wound channel - the space between the tissues, formed along the injuring object
TYPES OF WOUNDS
Sliced - the edges are even, profuse bleeding, heal relatively well, rarely suppurate.
Torn Andbruised - the edges are uneven, the bleeding is weak, there are a lot of damaged tissues, they heal worse, they often suppurate.
3. Stab - have great depth with little damage to the skin. Dangerous due to possible damage to internal organs. Appearance wounds do not always allow us to judge the severity of damage, so patients require observation
4 . firearms - with a small damage to the skin, a large damage in the depths of the tissues.
By type of woundchannels are distinguished:
a) Blind - there is an inlet, the injuring object gets stuck in the tissues
b) Through - there is an inlet and outlet
Feature of wounds on the head: profuse bleeding, tendency to scalping (formation of a skin flap during sliding blows).
WOUND HEALING
There are three phases (for any wounds):
1.Hydration- signs of inflammation (swelling, pain, redness). At hit of an infection - suppuration.
2.Dehydration- reduction of signs of inflammation, cleansing of the wound from dead tissues, growth of new tissues.
3.Final recovery- the wound is filled with new
tissue, a scar is formed.
TYPES OF HEALING
1. Primary tension- wound healing without infection. The edges of the wound come into contact, stick together and grow together in 7-10 days with the formation of a thin scar. The strength of the scar increases for several more weeks.
2 Secondary tension --- so all festering wounds heal. Prolonged inflammation and suppuration. Healing lasts from several weeks to several months with the formation of a wide and rough scar.
3. Healing under the scab This is how superficial wounds heal. A crust (scab) of dried blood forms on the surface of the wound, which protects the wound from infection. Therefore, you can not wet the scab with water, lubricate with ointments and remove ahead of time. When the wound is completely healed, the scab disappears.
First aid for injuries
First aid to the wounded is provided by himself or others.
1. Stop bleeding
2.Wound infection prevention.
3. Pain relief.
4.Hospitalization
a) In case of severe contamination of the wound, it is necessary to wash it with an aqueous solution of an antiseptic,
b) The skin around the wound is lubricated with an alcohol solution of an antiseptic. For head wounds, cut the hair around the wound,
c) A sterile bandage is applied to the wound.
When providing first aidIT IS FORBIDDEN:
1. Wash the wound with unboiled water
2. Pour alcohol solutions of antiseptics into the wound
3. Pour medicinal powders into the wound.
4. Remove foreign bodies from the wound
5. Apply cotton wool to the wound.
Hospitalization
With: damage to large vessels, nerves, tendons, joints that penetrate into the body cavities. - hospital admission.
With small wounds, hospitalization in the emergency room.
The concept of "open injury" includes all injuries with damage to the integrity of the skin. These include various injuries by mechanical factors, thermal and chemical burns, frostbite. The division of injuries into open and closed is important for determining treatment tactics, since open injuries are more likely to be exposed to microbial contamination and subsequent complication in the form of suppuration.
Injuries
Under the term "injury" It is customary to mean injuries caused by mechanical factors. An example is stab wounds, gunshot wounds, fallout, etc. They have an extensive classification depending on:
- from the traumatic factor;
- from the mechanism of influence of this factor (stab, cut wounds, etc.);
- from the presence of an outlet (through, blind);
- from interaction with cavities (penetrating, non-penetrating), etc.
But the main terrible complication that unites them is bleeding. It requires immediate action.
Signs of injury
Bleeding, depending on the vessel from which it originated, is capillary, arterial, venous and parenchymal.
capillary bleeding arises from capillaries, occurs when damaged surface layers skin. He tends to drip blood from the damaged area. Typically, in people who do not have hemophilia, this bleeding stops on its own and only occasionally requires a bandage. It usually accompanies all other bleeding, because arteries and veins are located in tissues penetrated by a capillary network.
arterial bleeding- the most serious and insidious. Arises from arteries. With such bleeding from the wound, bright scarlet blood spurts out as a fountain. Bleeding from large arteries, such as the femoral, carotid, lead to death in a matter of minutes.
Venous bleeding appears when the venous vessels are damaged; it is less intense than arterial, it bleeds, the blood has a dark red color.
Parenchymal bleeding arises from damaged non-hollow organs (liver, spleen, kidneys, etc.) and is mixed. It can occur both with open wounds and with blunt injuries of the abdomen, lumbar region, that is, it is associated with a rupture of the organ. Without surgical intervention, a complete stop of parenchymal bleeding is impossible, however, as a first aid, it is necessary to apply an ice pack or a special thermal pack to the site in the projection area of the damaged organ.
The most common dangerous bleeding is venous, the source of which is superficial veins. Arteries lie deeper and therefore are damaged much less frequently.
The wound needs to be examined.. Here it is necessary to take into account, if possible, the mechanism of injury and the object that was injured, the location of the wound on the body, the presence of bleeding, contamination. For example, a perpendicular wound with an awl, a nail in the abdomen, chest, neck, or the passage of large arteries will pose a risk of occult bleeding. At the same time, there will be an inconspicuous, not disturbing trace on the skin. And the victim at the same time will feel a minimum of discomfort until the blood loss reaches a serious volume. So be careful when you look around. This greatly increases the chances of a favorable outcome. Another option is when an object sticks out of the wound, for example, a knife, a branch, etc. In this case, you cannot remove the object from the wound yourself! This is fraught with bleeding. It is enough to cover the edges with a dry or antiseptic-soaked napkin and take care of immediate delivery to a medical facility - preferably a surgical profile.
If, with an injury to the abdomen there is a prolapse of intestinal loops, then in no case should they be refilled! Such manipulations are sometimes beyond the power of even experienced surgeons. You just need to cover the fallen part of the intestine with a damp cloth and take the victim to the hospital as soon as possible. If the wound does not cause any fear for life, i.e. there is no visible intense bleeding, the threat of injury internal organs or hidden bleeding, it is enough to process it and, if necessary, apply a bandage. The wound is treated with an antiseptic, usually a 3% hydrogen peroxide solution or furacilin solution is used. A peroxide solution is more preferable, since, in addition to the disinfecting effect, it has a hemostatic effect. Large dirt can be removed with clean tweezers, then treat the wound with an antiseptic. The edges of the wound are treated with an alcohol solution of iodine or brilliant green. Of particular note is soil contamination or feces. Such wounds have a high risk of suppuration, and therefore must be treated with special care. If non-dangerous bleeding persists, a sterile bandage or bandage should be applied. You don't need to use ointments. It makes sense to show deep wounds with a divergence of edges in the emergency room on the first day: it may be advisable to apply sutures to bring the edges of the wound together. Then healing will come faster and the scar will be thinner, which will not only create a better cosmetic effect, but also prevent dysfunction, for example, of the hand, which happens with rough scars.
We must not forget that damage to the skin, even the smallest, can lead to infection with the causative agent of tetanus. Therefore, one should not forget about planned tetanus toxoid vaccinations.
When when injured, severe bleeding is detected, actions should be quick and clear. With venous bleeding, it is enough to apply a tight bandage bandage; in its absence, clothes may come up. Arterial bleeding requires the immediate application of a hemostatic tourniquet or a piece of tissue with a twist. There are certain rules for applying a tourniquet or its substitute:
- the tourniquet is applied above the wound and closer to it;
- after applying a tourniquet, bleeding should decrease, and the pulse below the applied tourniquet should not be palpable;
- tourniquet is applied in summer for up to two hours, and in winter - up to one and a half hours. Therefore, it is better to write down the overlay time on paper and attach it to the tourniquet. This will make it easier to assist with further transportation.
If it was not possible to transport the victim to a medical facility within the allotted time, you can remove the tourniquet for 10-15 minutes, while pinching the artery above the injury site with your finger.
However, if after removing the tourniquet bleeding resumed and is life threatening, the tourniquet is immediately applied back. Here we are talking about saving lives, not limbs.
In the case when there are no improvised means to stop the bleeding, or their search and manufacture take time, they resort to digital clamping of the artery. To do this, press with a finger or fist in the area of the projection of the artery above the site of injury. Pressing is carried out to the underlying bone under the vessel. This requires quite high physical costs.
Projections of the main large arteries — inner part hips, popliteal fossa, inner part of the shoulder, armpit, anterolateral surface of the neck in the lower third.
Also sometimes gives desired effect maximum flexion and elevation of the limb.
With injuries to the face, more often - the frontal and temporal regions, quite intense bleeding occurs even from small wounds. The imposition of a conventional bandage leads to the fact that it instantly gets wet and the bleeding continues.
In this case, it is necessary to apply a roller from an unwound bandage to the wound, then tightly tie it with a second bandage.
This is usually enough to almost completely stop the bleeding, which makes it possible to get to a medical facility where hemostatic sutures will be applied.
For the purpose of pain relief for wounds, you can take a tablet of analgin or any other pain reliever. With intense pain, you can perform an intramuscular injection of 2 ml of analgin, and more effectively - 2 ml of ketorol or its analogues.
If there is a large wound, especially when it has been contaminated, and there is no possibility of seeking qualified medical care, it will not be superfluous to take an antibiotic. For this, broad-spectrum antibiotics are used, for example, 200 mg of doxycycline or an injection of 500,000-1,000,000 IU of penicillin.
Non-penetrating open abdominal trauma is an injury to the soft tissues of the abdominal wall. It is characterized by pain, bleeding from the wound. Soreness is often diffuse, often there is muscle tension. The non-penetrating nature of the wound is established during the PST of the wound, which is also a therapeutic measure. It is extremely important to trace the course of the wound channel to its very last point.
Penetrating open abdominal trauma often accompanied by damage to internal organs. In this case, its clinic is quite pronounced and similar to the clinic of a complicated closed injury. In the absence of damage to the internal organs, the clinic is erased and more resembles that of a non-penetrating wound. Reliable signs of a penetrating injury are eventration of internal organs and a clear clinic of intra-abdominal bleeding or peritonitis.
Emergency care includes the fastest possible delivery to the surgical hospital. Anesthesia and infusion therapy are also performed. An aseptic bandage should be applied to the wound. Eventriated organs should not be set, this will only lead to contamination of the abdominal cavity, and if there is a wound on the intestine, to abundant contamination with intestinal contents.
Treatment in the presence of eventration, peritonitis and a manifest clinic of intra-abdominal bleeding is operative - median laparotomy, revision of the abdominal cavity, stop bleeding, restoration of damaged organs or their removal, sanitation of the peritoneum, drainage of the abdominal cavity and gastrointestinal tract according to indications. A fundamentally important point is the revision of the entire wound channel to the last point, regardless of the need to dissect adhesions, ligaments, parietal peritoneum, mobilization of organs, penetration deep into the retroperitoneal tissue. PST of the wound is also performed. The management of the postoperative period does not differ from that with a closed injury.
In the absence of eventration and reliable signs of internal bleeding and damage to internal organs, treatment and diagnostic tactics can be implemented in the form of two options.
1. Traditional. PHO of the wound is performed, if the wound penetrates into the abdominal cavity, a median laparotomy is performed. Expansion of the traumatic defect for revision and surgical admission in the abdominal cavity is unacceptable.
2. Dynamic laparoscopy. Before or after PST, the wound is performed laparoscopy. In the presence of blood or the contents of hollow organs in the abdominal cavity, the treatment is surgical. If there are no pathological changes, laparoscopy is repeated after 3-4 hours. Signs of damage to internal organs with it will be the presence of blood and the contents of hollow organs, as well as inflammation of the peritoneum - hyperemia, serous-sanitary exudate. It is important that the same doctor who performed the first examination evaluate changes during a second laparoscopy. If there are no changes, the next tactic is to monitor the patient.
Dangers of injury to the abdomen:
Immediate: traumatic shock, acute blood loss.
Nearest: suppuration of the wound, retroperitoneal phlegmon, intra-abdominal abscesses, peritonitis, sepsis, developing fistulas, pneumonia.
Distant: formed fistulas, adhesive disease of the abdominal organs, ventral hernias.
Injury open (t. apertum) T., in which the integrity of the outer integument is broken.
Big Medical Dictionary. 2000 .
See what "trauma open" is in other dictionaries:
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