open injuries. Wounds. What is an open fracture, its types and signs What is an open injury in humans

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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Open heart injuries are one of the most dangerous injuries and are mainly caused by firearms or cold steel. In peacetime, stab wounds occur in about 95% of cases, and in wartime - gunshot wounds. Sometimes open damage heart tissues are applied with sharp fragments of ribs, the edges of a broken sternum, or a catheter.

According to statistics, open wounds of the heart account for about 13-15% of all penetrating chest injuries and are more often detected in men. The age of the victims is 16-40 years. As a rule, damage occurs on the anterior wall of the chest. And gunshot wounds usually lead to the death of the victim at the scene.

Thanks to the development of cardiac surgery, heart injuries are no longer always considered fatal. Thanks to the innovations that have appeared, it has become possible to perform suturing of the heart tissue and save the lives of the victims. However, despite new techniques, mortality in open wounds of the heart is still high and ranges from 12 to 22%.

An important moment in rescuing a wounded person with a similar injury are factors such as quick transportation to a surgical hospital (preferably a cardiosurgical profile) and the correct provision of emergency first aid. In many cases, these moments can be decisive for the life of the victim, and often it is the lack of timely qualified assistance, and not a mortal wound, that causes a fatal outcome.

In this article, we will introduce you to the types, manifestations, first aid rules and methods of treating open heart injuries. This information will help you properly provide emergency care to the victim and increase his chances of survival.

Sometimes gunshot injuries of the heart occur in peacetime.

Depending on the traumatic factor, open wounds of the heart are:

stab-cut - applied with cold weapons (knife, blade, etc.), metal pins, needle, etc.;
firearms - applied with firearms (bullets, shot or shell fragments);
combined - are applied by various damaging factors (for example, a gunshot wound and burn, mine-explosive injury, etc.).

Open heart injuries are more often single, in more rare cases - multiple. In especially dangerous traumatic situations, they can be combined with damage to other organs and tissues.

According to the degree of damage to the heart and surrounding tissues, wounds are:

non-penetrating - the cavity of the heart does not communicate with the pericardial sac;
penetrating - myocardial injury is through.

More often, the left ventricle of the heart is injured (I place), less often - the right ventricle (II place). It is extremely rare for atrial injury to occur. In addition to the chambers of the heart, injury can affect the coronary arteries, pathways, valves, papillary muscles, and the interventricular septum.

Why open heart injuries are extremely dangerous

The main dangers of heart injuries are as follows:

Damage to the heart leads to. With the accumulation of a large volume occurs, significantly disrupting cardiac activity. The heart cannot fully contract and can be compressed until it stops completely.
Injuries to the heart are accompanied by massive bleeding. The remaining organs cease to receive the necessary volume of blood, and their functions are inhibited. A particularly dangerous consequence of such injuries is oxygen starvation of the brain.
During a heart injury, the victim experiences such intense pain that he develops. Such a reaction of the body can further aggravate the condition of the victim.

Symptoms

An open heart injury can be suspected by the characteristic location of the chest wound above or near the projection of the heart. Such lesions are always accompanied by bleeding, and often it is external and profuse. In addition, the outflowing blood accumulates in the pericardial and pleural cavities.

Cardiac tamponade is found in approximately 76-86% of victims. Usually it develops in the first minutes after the injury, but sometimes it forms only a few hours (up to 24 hours) after the injury. This condition, characteristic of open heart injuries, is manifested by the following symptoms:

pallor;
feeling short of breath;
fear of death;
increasing cyanosis of the lips, tip of the nose and ears;
swelling of the veins in the neck;
pulse of weak filling;
violations of the frequency and rhythm of the pulse.

When examining a patient, a doctor can detect an increase in venous pressure and deafness of heart sounds (up to their complete absence). Sometimes, when listening to heart sounds, an uneven popping sound is determined, provoked by the accumulation of blood and air in the pericardial cavity. In addition, the general condition of the patient is aggravated by signs of massive bleeding: cold sticky sweat, pallor, hypotension, weak peripheral pulse.

During surgery, from 150 to 600 ml of blood can be extracted from the pericardial sac in case of heart injuries. Particularly unfavorable are injuries to the so-called "dangerous zones" of the heart - the upper sections and bases of the interventricular septum.

The condition of the victim with a heart wound is severe, and its severity is determined by the volume of total blood loss, the amount of blood accumulated in the pericardial cavity and the area of localization of damage in the myocardium.

Emergency assistance to the victim

First, most important point when providing emergency care to a victim with an open heart injury - call an ambulance

With open heart injuries, you must immediately call the ambulance team. Before the arrival of doctors, the victim should be provided with emergency assistance:

If a traumatic object (knife, fragment, dagger, etc.) is in the chest, then it should not be removed. Such actions will only aggravate the bleeding and worsen the condition of the victim.
The wounded should be laid on a flat hard surface and the head should be raised.
The victim must be reassured and explained that he cannot move and talk.
If the wounded man is unconscious, then his oral cavity should be examined and, if necessary, the airways should be freed from factors that impede breathing (vomit, blood clots, mucus, foreign objects). The patient's head must be turned to one side to prevent aspiration by vomiting and remember to constantly monitor breathing.
The wound should be treated with an antiseptic solution and a sealing aseptic bandage should be applied to it from gauze napkins (or folded pieces of a sterile bandage) and strips of adhesive plaster closely spaced to each other.
Before the arrival of the doctors, you can apply cold to the chest, give a Nitroglycerin tablet under the tongue and perform intramuscular injections of 2 ml of Analgin and 1 ml of Diphenhydramine (mix the drug solutions in one syringe) and 2 ml of Cordiamin (or Camphor).

Transportation of the victim to the surgical hospital should be carried out as sparingly as possible, in a prone position with a raised headboard.

Diagnostics

Often, the diagnosis of heart injuries at the prehospital stage is difficult due to the atypical localization of the wound. In other cases, typical symptoms open wound and cardiac tamponade allow for a correct diagnosis.

If the condition of the victim allows, then after arriving at the hospital, the following types of instrumental studies are carried out:

chest x-ray - signs of expansion of the cardiac shadow, weakening or absence of pulsation of the contours of the heart, the presence of fluid and air in the pericardial sac, smoothness of the waist of the heart, the presence of a foreign body in a fragment wound are revealed;
- violations of the pulse and heart rhythm are determined;
- signs of damage to the structures of the heart and hemopericardium are determined.

In addition, an urgent analysis is performed to determine the blood type.

In the past, exploratory pericardial puncture was often recommended to detect cardiac injury. However, in Lately many experts consider it inexpedient and risky, since blood in the pericardial sac is not always detected, already formed clots can interfere with its detection, and the implementation of this manipulation delays the start of radical treatment. The only exception is cases of confirmed cardiac tamponade, when pericardiocentesis is necessary as a therapeutic measure.

Treatment

All victims with heart injuries are subject to emergency hospitalization in the operating room. Cardiac tamponade can be treated with emergency pericardiocentesis, which is performed under local anesthesia.

Usually, due to the lack of time before interventions to repair heart injuries, the stage of preoperative preparation and resuscitation of the victim from the consequences of shock and circulatory disorders is carried out very quickly and can continue even after the start of the operation. To provide such assistance, anti-shock and symptomatic agents are used to replenish blood loss and maintain respiratory and cardiac activity.

Cardiac surgeries are performed under endotracheal anesthesia with the use of muscle relaxants. The surgeon performs an anterolateral thoracotomy on the left along the IV-V intercostal space. Further, for greater surgical access, the wound is expanded by crossing the cartilage of the ribs or by completely crossing the sternum.

After performing a pericardiotomy, the surgeon removes the blood and its clots. U-shaped sutures are applied to the heart wound through the entire thickness of the myocardium and carefully tied to prevent eruption. After that, the doctor conducts a thorough revision of the posterior sections of the heart to exclude a penetrating wound. If damage to large vessels is detected, lateral sutures are applied to them using an atraumatic needle.

In addition, intra-arterial blood infusion is performed before and during the intervention. After elimination of tamponade and suturing of the wound of the heart, it is replaced by a jet intravenous blood transfusion. This tactic of replenishing blood loss is explained by the fact that before these consequences of the injury are eliminated, the introduction of blood into the vein can cause overload of the heart.

After the operation, the patient is provided with sufficient anesthesia. He is undergoing final measures to replenish the lost blood, oxygen therapy, a course of antibiotic therapy and taking drugs to maintain cardiac activity are prescribed. In addition, close attention is paid to the timely removal of air and blood clots from the drained pleural cavity.

The decision on the gradual expansion of the patient's activity is decided by the surgeon, depending on the size and location of the wound, data on hemodynamics and ECG. Getting out of bed is usually allowed 8-10 or 20-25 days after the operation.

Open heart injuries are always extremely dangerous. The outcome of such wounds depends not only on the severity of myocardial damage and the rate of onset of cardiac tamponade, but also on the speed of providing emergency first aid and medical care.

Topic number 3. Open injuries - wounds

1. Wounds - open injuries. Types of wounds. Their characteristics, clinical signs and complications.

2. First aid to the wounded in the lesion and the rules for its provision.

3. Principles of wound treatment at the stages of medical evacuation.

4. Features of care for the wounded.

5. Focal purulent infection, clinic, treatment, prevention and features of patient care.

6. General purulent infection (sepsis), clinic, treatment, features of patient care and prevention.

7. Anaerobic infection (gas gangrene and tetanus). Etiology, local and general signs, treatment, care of the wounded and prevention.

1. Wounds - open injuries. Types of wounds, their characteristics, clinical signs and complications

Injuries (or injuries) are divided into open and closed.

Open wounds are wounds.

A wound is a mechanical damage to tissues, in which the integrity of the skin, mucous membranes, and often deeper tissues and organs.

In a nuclear missile war, wounds will occur in 35-40% of all cases of damage. In addition, injuries from conventional firearms cannot be ruled out.

A wound occurs as a result of exposure to the human body of any injuring object.

As a result of the penetration of a wounding object into the depth of the body, a narrow gap is formed, called the wound channel. The wound channel is filled with blood clots, fragments of dead tissue, bone fragments and foreign bodies.

Wounds are divided into:

Non-firearms;

Gunshot.

Depending on the nature of the wounding object, the following types of non-gunshot wounds are distinguished:

cut;

Chopped;

Stab;

bruised;

Ripped, etc.

Cut wounds occur due to the impact on the tissue of any cutting object (knife, glass, razor, etc.). The skin edges of the wound are torn, the underlying tissues are usually slightly damaged, the wound gapes, and bleeds heavily. The gaping contributes to the outflow of wound discharge with the simultaneous removal of a large number of microbes.

Such wounds suppurate less often, smooth edges contribute to their rapid adhesion and healing without complications.

Chopped wounds are formed when struck with a sharp heavy object (axe, saber, etc.). With them, significant damage to the underlying tissues is observed. Healing is slower.

Stab wounds are applied with sharp piercing objects (bayonet, knife, awl, needle, etc.). They are characterized by slight damage to the skin and significant damage to deeper organs and tissues. External bleeding with them is insignificant, but it can be very large in deeper tissues. Such wounds are very dangerous. Victims with stab wounds require close observation and often require urgent surgical treatment.

In conditions of war with the use of nuclear weapons, bruised, lacerated and crushed wounds resulting from the impact of secondary projectiles (stones, bricks, pieces of wood, etc.) will be frequent. They are characterized by uneven crushed edges, significant damage to surrounding tissues, and little bleeding. Due to the large crushing of tissues, necrosis of the edges of the wound is observed, which often causes the appearance of complications in the form of a wound infection.

Rupture-bruised wounds are accompanied severe pain and are often shocking.

A special and very important type are gunshot wounds.

Among them are distinguished:

Bullets;

fragmentation;

Shotguns, etc.

These wounds are varied. Shrapnel wounds are the most difficult.

Gunshot wounds can be:

through;

Blind;

Tangents.

With penetrating wounds, the injuring object penetrates the tissue through and through, while both inlet and outlet holes are formed. Most penetrating wounds are characterized by a mismatch between these holes (the dimensions of the outlet are much larger than the dimensions of the entrance).

Blind wounds are wounds in which the injuring object gets stuck somewhere in the tissues. They only have an inlet. With tangential wounds, the skin and superficially located tissues are damaged.

In a gunshot wound, there are:

1) zone of the wound channel;

2) a zone of traumatic necrosis, formed as a result of mechanical or thermal damage to tissues;

3) a zone of molecular concussion, in which no visible changes are observed, but there are necrobiotic changes that reduce the resistance of tissues to infection and their regenerative properties.

According to the degree of tissue damage, wounds are divided into superficial and deep. Deep wounds can be accompanied by damage to blood vessels, nerves, bones, tendons and internal organs. They are divided into:

Non-penetrating, when the barrier septum is not damaged (peritoneum, pleura, synovial membrane, etc.);

Penetrating when there is damage to the barrier septum that limits the cavity.

Distinguish:

Accidental wounds, which include all of the listed types of wounds;

Intentional (or operational).

All accidental wounds, including gunshot wounds, are primarily infected. RV or OB can get into the wound. Wounds contaminated with radioactive substances are called radioactive mixes. Wounds in which agents have entered are called poisoned (or chemical mixes). Intentional wounds are aseptic. However, if they are not properly cared for, they can become infected (secondarily infected wounds).

Any wound is characterized by the following main features:

Gaping (divergence of the edges of the wound);

bleeding;

Impairment of the function of the damaged part of the body.

Pain occurs as a result of damage to pain receptors, nerves and nerve plexuses. Its intensity depends on:

localization of the wound;

The nature of the injuring object;

The speed of injury;

The reactivity of the body of the victim and his neuropsychic state at the time of injury.

The gaping of the wound depends on the size and depth of the wound, the nature of the damage to the elastic fibers of the skin, and the ability of soft tissues to contract.

Bleeding is determined by the nature of the damage to the blood vessels, their caliber, blood pressure level and wound gaping.

Violation of the function of the damaged part of the body depends on the size of the wound, its localization.

Wound healing is a complex reaction of the body in response to injury. It is conditionally divided into three phases:

1) the hydration phase, which occurs immediately after injury and lasts for several days; characterized by inflammatory tissue edema, redness, soreness and local fever;

2) the dehydration phase, which is characterized by the resorption of hemorrhages, the dissolution of blood clots and non-viable tissues, the reduction of inflammation, the cleansing of the wound and the formation of granulation tissue and epithelium;

3) the final recovery phase (wound healing), which ends with the formation of scar tissue and epithelialization.

The process of wound healing depends on many general and local conditions. Of the general conditions, it is necessary to indicate the influence of age (in young wounds heal better than in the elderly or old people), many diseases (avitaminosis, anemia, diabetes, tuberculosis, etc.), in which wounds heal more slowly. Of particular note is the negative effect of radiation sickness on the course, healing processes and outcomes of wounds.

Various OM and RV entering the wound also slow down the healing process.

The most favorable is healing by primary intention. It occurs when the edges of the wound come into contact (which happens when suturing), the absence of infection, foreign bodies and dead tissue; the edges of the wound stick together and grow together within 6-8 days with the formation of a thin linear scar. Uncomplicated surgical and incised wounds heal by primary intention.

Healing by secondary intention occurs within a few weeks and months, accompanied by prolonged inflammation and suppuration. After cleansing of dead tissues and foreign bodies, the wound is gradually filled with a special newly formed tissue (granulation) and heals with the formation of an extensive scar. Granulation tissue serves as a mechanical and physiological barrier that prevents the absorption of microbial decay products and their toxins from the wound, as well as the penetration of infection.

Healing under the scab is observed with superficial damage to the skin. A scab in the form of a dark brown crust is formed when blood and lymph dry on the surface of the wound. It well protects the wound from external influences and, thanks to its porous structure, sucks out the wound secret, which dries up on its surface. Therefore, it is not necessary to prematurely remove the scab, and also lubricate it with ointments. After the scab falls off, a surface covered with fresh epithelium remains.

Any wound can become complicated:

secondary bleeding;

Wound infection.

Shock and bleeding will be dealt with in later lectures. As for wound infection, we will get acquainted with it in this lecture.

2. First aid in the focus of mass destruction and the rules for its provision

The successful provision of first aid to the wounded in the focus of mass destruction depends on a number of circumstances:

1. First of all, it is necessary to quickly assess the situation and take measures to stop the impact of damaging factors on people (put out burning clothes, stop the effect of electric current, pull them out from under the rubble, etc.).

2. Quickly examine and correctly assess the condition of the victims. When examining the victim, it should be established whether he is alive or dead, determine the type and severity of the injury, whether there was and continues to bleed.

3. Examining the victims, it is necessary to determine the sequence of providing them with first aid. The sequence of its rendering should be as follows:

1) help for those who are choking;

2) assistance to the wounded with penetrating wounds of the chest and abdominal cavities;

3) assistance to the wounded with significant bleeding from wounds;

4) assistance to victims who are in an unconscious or shock state;

5) assistance to victims with significant fractures;

6) help to persons with minor wounds and fractures.

4. First aid to the wounded should be directed to:

a) stop bleeding

b) prevention of secondary infection of wounds;

c) prevention of wound infection;

d) immobilization of the injury site;

e) carrying out the simplest anti-shock measures;

e) carrying out resuscitation;

g) prompt delivery of victims to the OPB.

To prevent secondary infection of the wound, prevent shock and stop bleeding, the bandage applied correctly and on time is of great importance.

To bandage a wound, especially for fractures, bleeding, you must first carefully and correctly remove clothing or shoes. Such a need also arises in case of thermal and chemical burns, clothing fires and in other cases.

In case of damage to the upper limb, clothes are removed first from a healthy arm. Then, holding the injured hand, gently pulling on the sleeve, take off her clothes.

If the victim lies on his back, and it is impossible to put him down, then the clothes from the upper half of the body and arms are removed in the following sequence: carefully pull the back of the shirt (dress, coat, etc.) up to the neck and transfer it over the head to the chest, then remove it from the sleeve healthy hand; last of all, the injured arm is released by pulling off the clothes from it by the sleeve. From the lower part of the body, clothes are removed in a similar sequence.

In cases where it is impossible to painlessly remove clothes for examination and dressing the wound, it is cut with a knife or scissors, preferably along the seam if it passes close to the wound site.

The incision is made in the form of a valve:

Two horizontal (above and below the wound);

One vertical, connecting horizontal cuts from any side.

Boots are removed together, gradually pulling them off their feet, or cut.

If you have to help a wounded person in an area contaminated with RS or OM, remove or cut clothing with extreme care so that these substances do not get into the wound.

After removing clothes (shoes) or throwing the valve aside, inspect the wound.

When examining a wounded person and assisting him, it is forbidden to examine the wound with a finger or any instrument, as this can cause a secondary infection to enter it. In general, care for the wounded should take place with the maximum observance of the rules of asepsis.

Before applying the bandage, the caregiver should dust off the hands, keeping them away from the wound, and wipe them with a gauze pad moistened with a 2% solution of chloramine or some other disinfectant solution.

If on the surface of the wound there are loose pieces of clothing or any other foreign bodies, they are carefully removed without touching the surface of the wound. Foreign bodies that have penetrated deep into the tissues should not be removed, as this may cause or increase bleeding and promote infection. Any washing of the wound is prohibited. It is recommended to lubricate the edges of the wound twice with an alcohol solution of iodine, and in the absence of it, wipe the edges with ethyl alcohol, water or cologne.

After applying a bandage, fix it with several moves of the bandage and cover it with a valve, which is especially important in winter. The valve is fastened to the clothes with pins. Over the valve, you can apply several moves of the bandage.

We will get acquainted with the types of bandages and the method of applying them to various parts of the body in practical exercises.

It must be remembered that in case of injuries, any sudden movements, turning over, movements sharply increase the pain, which can significantly worsen the general condition of the victim, cause shock, cardiac arrest, breathing. Therefore, lifting an injured limb or an injured person should be done with extreme caution.

Prevention of wound infection is carried out with the help of antibacterial agent No. 1 from the individual first-aid kit. This tool is a broad-spectrum antibiotic (chlortetracycline) of 100 thousand units in 1 tablet. It is contained in 2 square cases without coloring in nest No. 5. The contents of one case (5 tablets) should be taken immediately after the wound, washed down with water. The contents of the second pencil case (5 tablets) should be taken after 6 hours.

Ways to stop bleeding, immobilization in case of bone fractures, the simplest anti-shock measures will be considered in subsequent lessons.

3. Principles of wound care
at the stages of medical evacuation

From the focus of the lesion, the wounded and affected are sent to the OPB, where they are provided with first medical aid.

First aid consists of:

Correcting or applying bandages for wounds;

The final stop of bleeding;

The introduction of antibiotics, toxoid, painkillers;

Replacing improvised means with transport tires;

Carrying out anti-shock measures;

Carrying out surgical interventions according to vital indications, etc.

In profiled hospitals in the suburban area, all the wounded are provided with specialized medical care in full - from primary surgical treatment wounds and removing the victim from a state of shock to the most complex operations. The provision of specialized surgical care and treatment of the wounded in profiled hospitals in the suburban area begins with the primary surgical treatment of wounds, which is understood as the first surgical intervention in order to prevent wound infection and create the most favorable conditions for wound healing. Distinguish:

Early surgical treatment carried out in the first 24 hours after injury;

Delayed (for 2 days);

Late (after 2 days).

In the first phase, when there is an acute purulent inflammatory process with abundant purulent discharge, it is advisable to use wet suction dressings, i.e. dressings moistened with hypertonic solutions (10% sodium chloride solution or 25% magnesium sulfate solution). It is possible to use wet dressings with antiseptic substances (furacillin, antibiotics). IN last years successfully use proteolytic enzymes (trypsin, chymotrypsin, etc.). As an anti-inflammatory agent, they are used in the form of solutions intramuscularly and topically in the wound.

In some cases, for a better outflow of wound discharge, gauze strips (tampons), rubber or plastic tubes (drainages) are inserted into the wound.

Through them, wounds are sometimes washed with solutions of antibiotics or antiseptics.

In the first phase of healing, dressings are done quite often (daily or every other day), due to abundant purulent discharge.

In the second phase, it is advisable to apply various ointment dressings (Vishnevsky ointment, penicillin, furacilin ointment, synthomycin emulsion, etc.).

At this stage, dressings are rarely done (after 2-3 days or less).

With all more or less significant wounds in the limbs, immobilization (scarf, splint) is necessary to create peace and conditions for better healing. In addition, physiotherapeutic treatment (UHF, Sollyuksin, etc.) and physiotherapy exercises are often used.

General treatment is of great importance (administration of antibiotics, blood transfusion, autohemotherapy, balanced diet and etc.).

If the wound does not heal for a long time, resort to skin grafting.

Thus, in case of injuries, complex treatment is often required, i.e. a reasonable combination of local and general therapeutic measures.

4. Features of care for the wounded

Successful treatment of the wounded depends largely on care. The main danger is the possibility of infection of the wound. Keeping the bed and skin in hygienic conditions helps prevent secondary infection.

It is necessary to ensure that the dressing is dry and reliably isolates the wound from the environment. Ingestion of urine, feces, water from heating pads can cause suppuration. This dressing must be changed immediately.

Regardless of the nature of the surgical intervention and the state of the dressing on the 2nd day after the operation, a dressing is performed. Remove wipes soaked with blood. The edges of the wound are lubricated with 5% iodine solution, tampons are changed and, if necessary, drains and an aseptic dressing is applied.

In the following days, it is necessary to carefully monitor the condition and position of the bandage.

If the bandage has gone astray, then it should be strengthened or a new one applied, and if necessary, a full bandage should be made.

If the bandage is soaked with blood, this should be reported to the doctor immediately.

If it gets wet with pus, you should make a dressing or put a layer of cotton wool on top and bandage it.

Dressings for the wounded should be done in a special dressing room (clean or purulent) in compliance with asepsis rules.

Much attention is paid to the conduct of therapeutic exercises, hygiene regimen, providing high-calorie nutrition.

5. Focal purulent infection. clinic, treatment, prevention and features of patient care

The most common complication of wounds is wound (surgical) infection. Contamination of the wound is not yet its infectious complication, and even with abundant microbial contamination, such a complication may not develop.

For the development of wound infection are of great importance:

a) the general condition of the body of the victim (the state of its immunobiological properties);

b) the condition of the tissues in the area of damage (the more blood circulation is disturbed in the area of injury, the more crushed tissues, the more likely the development of infectious complications);

c) the number of microbes that have invaded the wound (their characteristics and pathogenic properties).

According to the clinical course, wound infection is divided into acute and chronic. In its turn acute infection can be purulent, anaerobic, specific and putrefactive.

Purulent infection is divided into focal and general. The causative agents of purulent infection are pyogenic microbes. They cause a local purulent-inflammatory process, which is based on local circulatory disorders: vasodilation, violation of their permeability and exit through the walls of the vessels into the tissues of leukocytes and exudate. A protective shaft is created around the infiltrated infection (infiltration phase). Leukocytes devour (phagocytose) microbes.

Dead white blood cells, microbes, tissues and exudate form pus.

This inflammatory process is accompanied by redness and swelling of the edges of the wound, fever, severe pain and discharge of pus from the wound.

As a result of the impact of microbial waste products (toxins) and tissue decay products on the body, a general reaction of the body occurs.

A general morbid condition, malaise, sweating, weakness develops. The body temperature rises, the number of leukocytes in the blood increases, the ESR accelerates.

The described picture is called acute inflammation. If acute inflammation proceeds sluggishly, for a long time, they speak of chronic inflammation.

Under certain conditions, pyogenic bacteria can cause acute purulent inflammation in intact organs and tissues.

Let's take a look at some of these diseases.

Furuncle is an acute purulent inflammation of the sebaceous gland and hair follicle. It begins with the appearance of a round, painful seal (infiltrate) of a reddish-cyanotic color. In the center of the infiltrate, after 4-6 days, a small area of whitish tissue necrosis (rod) is formed. Over time, the rod is rejected, the phenomenon of inflammation subsides, the resulting cavity is cleared of pus and heals.

Carbuncle is an acute purulent inflammation of several adjacent sebaceous and sweat glands along with the surrounding skin and fatty tissue. They are usually localized on the back of the neck, in the lumbar region, on the face.

Initially, there are several infiltrates that merge and form a swelling covered with shiny skin. The center of the infiltrate dies, several purulent heads appear on the skin, and then holes, from which a purulent-necrotic mass is released. After its release, the inflammatory phenomena subside.

An abscess (abscess) is a limited accumulation of pus in tissues and organs, which is formed as a result of tissue melting. It begins with inflammatory infiltration. A granulation shaft develops around the infiltrate. In the future, the infiltrate expands and protrudes above the surface of the body in the form of swelling, which gradually undergoes purulent softening. The skin at the site of softening becomes thinner and torn, pus is poured out.

With a deep location of the abscess, pain and dysfunction come to the fore. Such abscesses often break into the surrounding tissues, forming purulent streaks.

Phlegmon is a diffuse purulent inflammation of the connective tissue. Unlike an abscess, a phlegmon does not have clear boundaries and quickly spreads to surrounding tissues. At the site of development of phlegmon, there is diffuse swelling, severe pain, local fever and redness of the skin, which does not have sharp boundaries. The skin is tense, the folds are smoothed out. At the beginning of the disease, the inflammatory infiltrate is dense, then softening occurs.

Erysipelas is an acute inflammation of the skin or mucous membrane. It begins acutely, with chills and a sudden increase in body temperature to 39-40 °. Redness appears on the skin, which is accompanied by swelling and soreness. Erysipelatous inflammation lasts 6-10 days, then gradually disappears. It should be remembered that erysipelas is an infectious disease. It can be carried by instruments and dressings.

Lymphangitis is an inflammation of the lymphatic vessels. It is characterized by the appearance of red painful stripes on the skin, going from abscesses to the nearest regional lymph nodes. Inflammation of the lymphatic vessels, as a rule, is accompanied by regional lymphadenitis.

Lymphadenitis is an inflammation of the lymph nodes. The nodes increase in size, become sharply painful. In some cases, they soften and form an abscess.

Phlebitis is inflammation of the wall of a vein. Ultimately, leads to thrombophlebitis.

Thrombophlebitis is an inflammation of a vein, which is accompanied by blockage of its lumen by a formed thrombus (clot). With damage to the surfaces of the veins in places of greatest pain, thickened veins are felt in the form of dense strands. The skin is edematous, hyperemic. The defeat of deep veins is accompanied by edema, cyanosis, dilatation of superficial veins, pain.

Treatment of focal purulent infection should be comprehensive. Treatment consists of local and general. Local treatment depends on the phase of the process. In the phase of infiltration, the most effective are chipping the inflammatory focus with solutions of novocaine with antibiotics, dressings with Vishnevsky ointment, and cold. In the phase of suppuration, surgical treatment is necessary - opening and draining the abscess. In the future, wet dressings with a hypertonic solution, a solution of furacilin in combination with proteolytic enzymes, bacteriophages are shown.

In general treatment, an important place is occupied by antibacterial agents: antibiotics, sulfonamides. The introduction of gamma globulin, staphylococcal toxoid, blood transfusion and protein blood substitutes are aimed at increasing the body's defenses. Physiotherapeutic treatment is also used: ultraviolet irradiation, UHF currents. With a pronounced process, limb immobilization is indicated.

It is important to care for patients with focal purulent infection, especially for patients with erysipelas. It must be remembered that erysipelas can be transmitted from one person to another, so the patient must be isolated.

If he is placed in a general ward, then the medical staff must strictly observe the rules of asepsis and hygiene.

The patient is prescribed bed rest. The room must be well ventilated. To increase the body's defenses, the patient should receive high-calorie dairy and vegetable and fortified food with plenty of fluids.

The dressing material is burned after use. In the dressing room, wet cleaning and irradiation with bactericidal lamps are carried out.

6. General purulent infection (sepsis). clinic, treatment, features of patient care and prevention

General purulent infection (sepsis) is a serious infectious disease. It is caused by a variety of pyogenic bacteria, more often staphylococcus and streptococcus.

As you know, microbes and their toxins from the purulent focus through the blood and lymphatic pathways are carried throughout the body and deposited in various organs. Such a spread of infection occurs with any local purulent process. However, in most cases, microbes die due to the high protective forces of the body, and the disease is not complicated by sepsis.

Conditions such as anemia, exhaustion, beriberi, etc. favor its occurrence.

In addition, of no small importance in the occurrence of sepsis is the state of the entrance gate of infection, i.e. primary purulent focus. The presence in the wound of foreign bodies, blood clots, non-viable tissues create favorable conditions for germs to multiply and spread infection.

Signs of sepsis are very diverse. The permanent ones are: heat body (39-40°), chills and profuse sweat. In parallel with the appearance and development of fever, disorders of the nervous system are noted:

Headache;

insomnia or drowsiness;

Increased irritability;

Excitation or, conversely, a depressed state;

Sometimes a clouded consciousness or even a mental disorder.

Violations of the functions of the cardiovascular system are expressed in a decrease in blood pressure, an increase and weakening of the pulse.

Changes in the digestive system are manifested:

Deterioration or complete loss of appetite;

nausea;

Dryness and overlay of the tongue;

Constipation or diarrhea.

The function of the liver is disturbed, often with the development of jaundice, kidneys, the spleen is enlarged.

In the presence of a purulent wound, its appearance changes: the surface becomes dry, lifeless, the growth of granulation stops.

The duration of the disease can be different. With fulminant sepsis, the wounded often dies within 2-3 days. In chronic forms, the disease can last for several weeks or even months.

Treatment consists of a set of measures aimed at:

Elimination of the source of infection;

Restoration of disturbed body functions.

A radical surgical intervention is performed in the zone of the primary focus (opening of the abscess, drainage of the wound, etc.).

Antibacterial therapy with antibiotics and sulfa drugs is of great importance.

Apply means that increase the body's resistance and its protective properties (transfusion of blood, plasma or blood substitutes, autohemotherapy, the introduction of calcium chloride, etc.).

The most important therapeutic factor is a balanced diet (rich in proteins and vitamins).

To combat dehydration and intoxication, patients should receive a large number of liquids (up to 2-3 liters) in any form.

Symptomatic agents are used according to the appropriate indications:

For pain - painkillers;

With insomnia and arousal - sleeping pills or sedatives.

The most important part of the overall treatment is careful patient care. He must be given complete rest. To do this, it should be placed in a ward with a small number of patients, and it is better to isolate. The ward should be regularly ventilated and kept in perfect cleanliness(daily wet cleaning, irradiation with bactericidal lamps).

Of particular importance is the condition of the bed. Linen must be clean, dry and without wrinkles. In addition, careful skin care is necessary to prevent bedsores. The patient needs to be turned over several times a day, inspected and wiped with camphor alcohol areas of the body that are subjected to compression. If necessary, use cotton or rubber backing pads.

To prevent pulmonary complications, the patient should be given a semi-sitting position, breathing exercises and learn to cough up phlegm. It is very important to carry out thorough oral care, monitor bowel activity (for constipation - cleansing enemas at least 1 time in 2 days or other measures aimed at enhancing intestinal motility: 10% sodium chloride solution intravenously, proserpine or pituitrin intramuscularly).

Be sure to determine the daily diuresis (control over kidney function).

During the recovery period, much attention is paid to enhanced nutrition of the patient, therapeutic exercises and muscle massage.

Prevention of sepsis consists of:

Compliance with the rules of asepsis in the provision of first aid for injuries and surgical interventions;

Early and rational primary surgical treatment of wounds;

Rational treatment of any purulent focus in the body;

Laser irradiation, UFO.

7. Anaerobic infection (gas gangrene and tetanus). Etiology, local and general signs. treatment, features of care for the wounded and prevention

Anaerobic infection is caused by anaerobes, i.e. microbes that grow in the absence of air. The most common forms of anaerobic infection are gas gangrene and tetanus.

Gas gangrene is one of the most severe complications of wounds, more often observed during wars. In the Great Patriotic war it was found in 0.5-1% of the wounded. The causative agents of gas gangrene are widespread in nature. There are especially many of them in feces, manure soil, dust, on contaminated skin, etc.

The development of gas gangrene is facilitated by:

Extensive muscle damage;

wound contamination;

Violation of blood circulation (in particular, when applying a hemostatic tourniquet), etc.

Unlike the inflammatory process caused by pyogenic bacteria, gas gangrene proceeds without signs of inflammation and is characterized by tissue necrosis, edema development and gas formation in the tissues. In addition, the body is poisoned by the products of the vital activity of microbes (toxins) and the decay products of dead tissues.

The extremities are predominantly affected, especially the lower ones. Signs of gas gangrene appear mainly 3-4 days after injury. Initially, there are sharp arching pains in the wound, and the general condition of the wounded person worsens (the temperature rises to 39-40 °, the pulse quickens to 130-150 beats per minute, blood pressure decreases to 80-90 mm Hg, breathing quickens, excitement sets in, pallor appears, etc.).

Then, tissue edema appears in the wound area, which gradually spreads throughout the limb, the skin color changes (at first it is pale, then it becomes covered with brown and blue spots), the skin becomes cold.

When feeling the tissues around the wound, crepitus (crunching) appears due to the accumulation of gases. Muscles first take on the appearance of boiled meat, bulge out of the wound, then become dark, with a greenish tint. Gas bubbles are released from the wound.

With a developed disease, the only way to save the wounded is by emergency surgery. The operation consists in deep longitudinal incisions over the entire thickness of the affected tissues and excision of the focus of necrosis. In the most severe cases, the limb is amputated.

Apply specific treatment with antigangrenous sera. A mixture of sera in the amount of 150-200 thousand AU is diluted in 250 ml of isotonic sodium chloride solution or 5% glucose solution and injected slowly intravenously, by drip. Of the symptomatic drugs, sleeping pills (luminal), sedatives (bromine preparations, valerian), painkillers (promedol, morphine), and heart remedies are prescribed.

The patient is injected with up to 3-4 liters of liquid, blood is transfused, antibiotics, HBO, chemisorption are prescribed.

Careful patient care is of particular importance. The patient is isolated in a separate room. All items that he came into contact with must be destroyed (dressings, tires), disinfected or sterilized. The room should be calm and quiet.

Service personnel should use special gowns, gloves, and aprons in the ward.

The contaminated linen of the patient is soaked in a 2% soda solution and boiled in the same solution for an hour. For the treatment of wounds, special tools are isolated, which, after each dressing, are sterilized by boiling in a 2% soda solution (fractionally) or by dry heat.

The nurse must administer all prescribed medications in a timely manner, monitor the amount of urine excreted, the cleanliness of the skin, the general condition of the patient, and report all changes to the doctor.

To prevent gas gangrene, you must:

Do not disturb blood circulation when applying bandages, tourniquets;

Conduct good immobilization of fractures;

Enter antigangrenous serum (30 thousand AU);

Timely and correctly conduct primary surgical treatment of wounds.

Tetanus is a common acute infectious disease caused by tetanus bacillus. She and her spores are widely distributed in nature. Once in the wound, the sticks multiply and secrete a toxin, which, being absorbed, affects mainly nervous system.

Incubation period ranges from 1 to 36 days (usually 7-10). The symptoms of tetanus are very characteristic. They consist in the appearance of pulling pains in the wound and muscle cramps. Cramps usually begin with chewing muscles. Initially, it is difficult to open the mouth, and then there is a reduction of the jaws ("trismus"). Further, convulsions capture the mimic muscles, as a result of which a peculiar facial expression arises, resembling a tense smile ("sardonic smile").

Spasms gradually spread to the occipital muscles, muscles of the back and the whole body. With convulsions, the patient can take a variety of positions, for example, arches back in the form of an arc (opisthotonus).

Spasm of the muscles of the body often passes to the muscles of the pharynx, diaphragm, esophagus, intestines, bladder. This leads to corresponding disorders (spasm of the pharynx - to difficulty in swallowing, spasm of the glottis - to respiratory failure, etc.).

The cramps are very painful. They often begin under the influence of an insignificant external stimulus (light, noise, pain, etc.). At first, convulsions are rare, with a short duration (1-2 seconds), then they become more frequent up to 2-3 times per hour. During the period of the highest development, the number of attacks can reach 40 per hour. The strength of convulsions is so great that fractures of bones (often the spine) can occur.

Body temperature rises to 40-42 °, breathing and pulse become more frequent, profuse sweat appears. Death occurs from suffocation and paralysis of the heart muscle.

In the treatment of tetanus, the administration of antitetanus serum is of primary importance. It is administered intravenously at 100-150 thousand AU (in 250 ml of isotonic sodium chloride solution) for 2 days in a row; subsequently reduce the dose.

Tetanus toxoid is injected subcutaneously in 1 ml every 5 days (3 times).

Anticonvulsant therapy consists in the appointment of a neuroplegic mixture, which includes:

1 ml of 2.5% chlorpromazine;

1 ml of 2% promedol;

2 ml of 2.5% diphenhydramine;

0.5 ml 0.05% scopolamine.

The mixture is administered 2-4 times a day.

If the mixture is ineffective, a tracheotomy is performed, muscle relaxants with controlled breathing are used.

The patient is placed in a separate room, where it is necessary to create complete rest and eliminate all irritants that can cause convulsions. The bed should be protected to prevent the patient from falling during seizures.

Caring staff should treat the patient with care, and all procedures should be performed under anesthesia in the non-convulsive period. Due to significant dehydration, patients should receive 3-4 liters of fluid. If the patient does not urinate on his own, it is necessary to release urine with a catheter 2 times a day.

The patient is fed through a permanent thin probe inserted into the stomach through the nose, the food should be high-calorie, rich in vitamins.

As with sepsis, you need to monitor regular stools, timely urination, clean skin, prevent bedsores, pneumonia, etc.

Prevention of tetanus consists in the introduction of anti-tetanus serum (3000 AU) and toxoid to each wounded person.

If the wound is large and contaminated with soil, 2 doses should be administered. In case of severe injury, it is recommended to re-administer the serum after 7 days.

For all wounds, 1 ml of tetanus toxoid must be injected simultaneously with serum in another part of the body. After 5-6 days, 2 ml of toxoid is re-introduced.

Primary debridement of wounds and the timely administration of antibiotics are of great importance in prevention.

To identify early symptoms, the nurse should offer each wounded man in the morning and in the evening to open his mouth, bend his head to his chest.

Noticing the difficulty of any of these movements, you should immediately report to the doctor.

Traumatic brain injury refers to damage to the muscle layer of the head, bones and brain structure. This group of pathologies occurs in people of all ages. Of particular danger are open craniocerebral injuries, as they have a number of severe complications, which, in turn, can lead to death.

Types of TBCI (classification developed by N. N. Petrov):

Damage to the soft tissues of the head. In this case, injuries with open injuries of the skin, muscle layer and aponeurosis are considered.
Nonpenetrating open traumatic brain injury. This group includes injuries with damage to the muscle layer and bones of the skull, but the structures of the brain must remain intact.
Penetrating traumatic brain injury. Damage is characterized by a violation of the integrity of the structural formations of the brain.

There are five periods during the pathological process:

The initial or acute period is the time from the moment of injury to three days. It is characterized by bleeding, development of inflammation and necrosis in damaged tissues.
The period of early complications lasts about 30 days. There are serous and purulent discharge from the wound, structural changes in brain tissue. There are frequent cases of severe inflammation of the meninges.
Elimination of early complications, limiting the development of infection. The stage lasts about 4 months. The infectious focus is limited and eliminated, regeneration and healing of tissues occurs.
Late complications are a long stage, it can take about three years. There is a final healing of the wound, late consequences may be detected.
Long-term consequences. They occur 24 to 36 months after the injury.

According to the severity of all head injuries are:

Mild degree - minor open injuries while maintaining the integrity of the cranium and brain.
Moderate severity - violation of the integrity of the soft tissues and bones of the skull with minimal complications.
Severe trauma - a violation of the structural integrity of the brain with severe and / or multiple complications is detected. Such damage threatens the life of the patient.

Causes

Causes of TBI:

Road traffic accidents cause both open and closed head injuries.
Gunshot wounds.
Injuries with sharp objects (knife, sharpening, awl, and so on).
Sports injury.

The above injuries can be obtained under any circumstances, at the time of violence or while doing work.

Symptoms of pathology

The clinical picture will depend on the type of injury. An open head injury may have symptoms of concussion, bruising, and compression of the brain. Signs of this pathology are manifested brightly and are noticeable immediately after the injury:

Sharp pain at the time of injury.
Violation of consciousness. It is suppressed or completely absent. Loss of consciousness can be short-term, in severe cases (with extensive lesions of the meninges) coma develops.
Breathing becomes frequent (tachypnea).
Hypertension (upward change in blood pressure) that does not last long.
There may be a single vomiting, nausea is not always the case.
There is a general weakness.
Sensation of heat and rush of blood to the head. The face turns red.
Cold and clammy sweat appears on the skin.
Dizziness.
Pain in the head.
Meningeal symptoms (stiff neck, pathological neurological symptoms) may be observed.
If the patient has convulsions, then this indicates the occurrence of hematomas and / or brain contusion.
In the presence of internal bleeding, coma develops gradually.

Open craniocerebral injuries are characterized by external bleeding and the presence of an open injury. Penetrating lesions are characterized by the presence of the following pathological symptoms:

speech disorder;
limitation of motor activity;
emotional lability;
cerebral symptoms.

PTSD includes the following symptoms:

pain in the head, they can be constant or periodic;
irritability;
tearfulness;
weather sensitivity;
temporary incapacity for work.

Coma often accompanies this type of injury. It is a sign of the development of intracranial bleeding. But with open injuries, this situation complicates the diagnosis.

pronounced coma. The patient's consciousness is absent, but the reaction to painful stimuli remains.
deep coma. It is characterized by the absence of consciousness and reaction to painful stimuli. Respiration and cardiac activity are disturbed, muscle tone changes.
terminal coma. Pupil dilatation is determined, muscle tone is sharply reduced. Reflex reactions are suppressed or absent. Cardiac and respiratory functions are sharply reduced. Human vital activity is supported by means of artificial lung ventilation and stimulation of cardiac activity.

Complications of PTBI

Open craniocerebral injuries have many complications, and they can be both early and late. Negative consequences must be eliminated, as they can lead to disability or death of the patient.

Complications:

1. Non-infectious (early). They are directly related to the wound itself:

Bleeding and hemorrhage. This is the earliest complication that occurs immediately after injury. Bleeding may be profuse. In the presence of hemorrhage, there is an increase in neurological symptoms and a sharp decrease in vital signs.
Shock. This complication is not common in open head injuries. It occurs if the patient has multiple injuries or massive blood loss.
Liquorrhea - outflow of cerebrospinal fluid. This condition can lead to the development of meningitis.
Brain prolapse. As a rule, this pathological condition develops within the first 30 days from the moment of injury. The protrusion may be various shapes and magnitude.

2. Infectious (late). They arise as a result of exposure to an infection that enters the wound:

Meningitis and mningoencephalitis. If the wound is treated poorly, then infection of the soft tissues occurs in its area. Then the infection enters the wound canal and spreads to the meninges. With deep penetration of pathogenic microflora, encephalitis with corresponding symptoms joins meningitis.
Infectious lesion of the wound channel. This can lead to the occurrence of cerebrospinal fluid swims and fistulas, as well as osteomyelitis (with infection of the skull bones).
A brain abscess is the presence in the main organ of a cavity filled with pus. It is formed at the site of hematomas, around inert debris and foreign bodies that have entered the brain tissue through the wound channel.
Adhesions and the formation of calluses and scars.
Convulsive syndrome. Convulsions can be single and serial, and also have the character of status epilepticus.

Urgent Care

Emergency assistance is provided directly at the scene. It is carried out by medical professionals. Algorithm for providing first aid to the victim:

Stop bleeding and apply an aseptic dressing to the wound.
In case of violation of cardiac and respiratory functions, artificial ventilation of the lungs and indirect heart massage are performed. In some cases, adrenaline is injected.
It is necessary to hospitalize the patient as soon as possible. Its transportation is carried out only after immobilization (the head must be securely fixed).
Monitoring the condition of the victim during transportation.

Diagnostics

Examination and assessment of the patient's condition is carried out in the emergency room of the neurosurgical department. This is done in order to determine the type of injury and treatment tactics.

Diagnostic methods:

Surgical examination. There is an assessment of damage, the identification of associated pathologies.
A neurological examination is performed to determine meningeal, focal and cerebral symptoms.
X-ray examination. It is necessary to take pictures of the skull in at least two projections. This method allows you to clarify the nature and depth of the lesion.
ECHO-EG is performed to detect hematomas, cerebral edema, hemorrhages.
Computed and magnetic resonance imaging are the most expensive and accurate methods for diagnosing craniocerebral injuries.

Treatment

To avoid infection of the wound, it is necessary to carry out primary surgical treatment (PSD). It is provided in layers: first, the skin around the wound is processed, then they move deep into the wound. For severe and extensive injuries, PST is performed in an operating room using general or local anesthesia. Antiseptic solutions, antibacterial drugs, hydrogen peroxide are used (to stop bleeding). If large vessels are damaged, they are sutured.

In many cases, open craniocerebral injuries require surgical treatment with revision of the wound cavity, removal of foreign objects and removal of bone fragments. After surgery, the patient is placed in the intensive care unit.

Treatment and principles of intensive care:

Patients with injuries of any complexity are shown strict bed rest.
24-hour monitoring of vital signs (respiratory rate, pulse, blood pressure).
If a person's respiratory function is depressed, then artificial ventilation of the lungs is carried out.
To relieve pain, the use of analgesics is indicated.
When the pressure level changes, appropriate medications are used. With hypotension and massive blood loss, infusion therapy is necessary (Polyglukin, Reopoliglyukin, saline). If hypertension develops, then intravenous administration"Magnesia": it has a diuretic effect and reduces the level of pressure. Also, the patient is prescribed "Furosemide" and given a forced position with an elevated head end.
Nootropics are prescribed to normalize metabolic processes in brain tissues.
The use of hormonal drugs ("Dexamethasone") from the group of corticosteroids.
Since patients have excessive nervous excitement, they are prescribed sedative drugs.
Antibacterial medicines are used for therapeutic and prophylactic purposes. They contribute to the elimination of an already developed infection and prevent the appearance of secondary infection.
It is necessary to ensure the supply of nutrients to maintain the vital activity of the body. Patients require infusion feeding or easily digestible food in liquid or semi-liquid form.
Therapy of concomitant diseases and injuries.
In the presence of a convulsive syndrome, treatment is carried out using anticonvulsant drugs.
Prevention of development of complications.

Consequences of TBI

The consequences of open craniocerebral injuries are varied. They depend on several factors:

the age of the victim;
the severity of the injury;
general condition of the body at the time of receiving TBI.

Both complete recovery and consequences of varying severity are noted. A lethal outcome, which often ends in a severe injury, is more often stated in older people (from 55 years old) than in a young person. However, the occurrence of long-term consequences in mild TBI is not excluded:

violation of the sensitivity of the upper or lower extremities;
visual disturbances;
chronic headaches;
emotional deviations;
memory loss;
deterioration or complete loss of ability to work;
development of depression and epilepsy;
disability.

Performed by student gr. P-302

Petrov I.V.

(date and signature)

Accepted by teacher

Assoc., Ph.D. Ivanov V.P.

Rostov-on-Don

Topic number 4. First aid for open injuries.

Topic questions:

1. Classification of wounds, their clinical signs and complications. PP for wounds.

2. Prevention of wound infection (purulent, anaerobic, specific).

3. PPI, purpose, use. Bandages on the limbs.

A wound is damage to the skin, deeper tissues and organs. Wounds make up most damage from accidents and injuries. They are superficial and deep. Signs of a deep wound are gaping, bleeding, pain, and dysfunction of the organ. With a superficial wound, only the integrity of the skin or mucous membrane is violated, incomplete damage to the skin (mucosa) is called an abrasion or scratch. Abrasions are more extensive and are usually applied with a blunt object, scratches have a small area and are applied with sharp objects.

Depending on the mechanism of inflicting a wound and the nature of the injuring object, the following types of wounds are distinguished:

Stab that occurs when exposed to sharp objects (bayonet, knife, screwdriver, awl, etc.). Wounds have a small external opening and, as a rule, are of great depth, and are often penetrating. Such a wound may not be immediately noticed and thereby miss such consequences as internal bleeding, peritonitis (inflammation of the peritoneum) or pneumothorax (the appearance of air in the pleural cavity);

Sliced, applied with a sharp cutting object (razor, knife, glass, etc.). Such wounds have even edges and considerable depth;

Chopped, arise as a result of exposure to a sharp heavy object (most often an ax). Such wounds are more extensive than incised ones and are often accompanied by damage to the bones of the skeleton;

Bruised wounds are the result of the impact of a blunt object (hammer, stone, etc.). The edges of such wounds are uneven, crushed, easily infected;

Gunshot wounds are inflicted by a projectile (bullet, shot) from a firearm. Such wounds can be perforated and (the wound has an inlet and outlet); with blindness (when the projectile gets stuck in the body);

to and satelny m and causing superficial damage to the skin; with numerous, usually multiple and causing tissue damage over a large area. These wounds are usually infected and prone to purulent inflammation;

A scalped wound is characterized by complete or partial detachment of the skin (and on the head - of all soft tissues of its scalp) from deeper located formations;

Bite wounds are characterized by the fact that they are infected with microflora from the oral cavity of the animal, including the possibility of infection with the rabies virus. Wounds inflicted by reptiles (snakes, scorpions, etc.) may contain poisonous substance. Such wounds are called poisoned.

The purpose of a primary wound dressing is to stop bleeding and prevent secondary infection.

In cases where it is impossible to painlessly remove clothing to examine the victim, it is cut, preferably along the seam near the wound. The incision is made in the form of a valve (two horizontal incisions - above and below the wound and one vertical, connecting the horizontal incisions on any one side). Having thrown the valve aside, the wound is treated and a primary bandage is applied to it. The purpose of the primary dressing is to stop bleeding and prevent secondary infection. The bandage is fixed with several moves of the bandage and covered with a valve (which is especially important in winter). The valve is fastened to the clothes with pins. Over the valve, you can still impose a few moves of the bandage. In the zone of contamination with radioactive or toxic substances, it is necessary to remove or cut clothing very carefully so that these substances do not get into the wound.

In the event that the wound is deep and there is bleeding, the treatment of the wound begins with stopping the bleeding.

In case of severe bleeding through a folded sterile napkin or other clean material (not necessarily sterile), press on the wound with your hand and hold it for at least 20 minutes (clot formation time).

After stopping the bleeding, the skin around the wound should be treated with one of the disinfectant solutions - 3% hydrogen peroxide, 5% alcohol solution of iodine, 70% or 96% alcohol or another antiseptic. Processing is carried out in the direction from the wound to the periphery. Do not treat the wound itself with tincture of iodine or alcohol (alcohol-containing solutions). This will greatly increase the pain and can cause bleeding, shock, and other complications, as well as slow down the healing time. Only if the wound is superficial (scratches, abrasions, shallow wounds), and heavily contaminated with earth, dirt, etc., the surface of the wound should be treated with a 3% hydrogen peroxide solution, which cleans, disinfects and stops bleeding. Very dangerous microbes - tetanus and gangrene - can get into the wound with the earth.

Then the wound should be covered with a sterile napkin and bandaged tightly. If necessary, you can use any clean fabric, well ironed with a hot iron on both sides. In the event that there is no disinfectant solution and dressing on hand, simply cover the wound with a clean cloth (but not cotton wool).

Move the injured limb to an elevated position. If a fracture is suspected, immobilize (immobilize).

It is not recommended to remove foreign bodies from the deep layers of the wound, because. this can cause unexpected heavy bleeding.

Dropped into the wound internal organs(an intestinal loop, a greater omentum, a piece of the brain, tendons, etc.) is prohibited to be immersed deep into the wound, trying to return the organs to their place.

For bitten wounds, first aid consists in washing the wound and surrounding tissues with clean water and soap, applying a sterile dressing and delivering the victim to a medical facility, where tetanus toxoid will be administered.

To hold the dressing, an elastic mesh-tubular bandage is convenient, which is worn over the bandage. In addition, the dressing can be fixed with an adhesive patch, which is glued to the skin with a sticky side, 1.5-2.0 cm beyond the edge of the material (crosswise or with an asterisk). Do not use a sticky patch if there is a strong discharge from the wound, as well as on the scalp.

For first aid for extensive wounds and burns, small and large sterile dressings are very convenient. In the rescuer's first aid kit, there must be analgin (to relieve or relieve pain), corvalol (heart drops), ammonia. If the victim is conscious, after treating the wound before the doctor arrives or on the way to the hospital (trauma center), he should be given water, two tablets of analgin (it is better to grind the tablets into powder and pour under the tongue with 1 tablespoon of water), if necessary - 30-40 heart drops, give a breath of ammonia vapor. Injured limbs should be immobilized in case of extensive wounds and evacuated in a position corresponding to the severity of the condition (sitting, lying down).

Never use any painkillers for suspected diseases or injuries of the abdominal organs without a doctor's examination! The intake of liquids and food is absolutely forbidden. The wound is treated general rules and close with an aseptic bandage, not tight. Transportation of such victims is carried out in a prone position with a raised upper body and legs bent at the knees. On the stomach, over the bandage, put something cold.

In case of traumatic amputation of a finger (or phalanx of fingers) of a foot or hand, part of the auricle, tip of the nose and other small parts of the body, they must be urgently placed in a portable hypothermic (cooling) bag-container and delivered to a medical institution together with the victim. The fragment separated from the body can be placed in one, and then in the second, sealed plastic bag of sufficient size, and covered with ice. It is important that water from melting ice does not get on exposed fabrics. For the same reason, in no case should the amputated fragment be washed with water. To prevent freezing, the amputee should not come into direct contact with a source of cold. Wounds arising from traumatic amputation should be treated according to the general rules (control of bleeding, prevention of shock, control of respiratory and cardiac activity).

In the case of an open penetrating wound of the chest, air enters the pleural cavity, which leads to an increase in pressure in this cavity and a decrease in the respiratory function of the lung (pneumothorax). Hermetic closure of the wound with an occlusive dressing (or pressing the wound with the palm of your hand) and evacuation to a specialized medical institution are necessary.

With a high amputation of the lower limb with ineffectiveness or impossibility of direct compression of the wound, the method of choice is pressing the abdominal aorta against the spine at the height of the umbilicus.

The procedure for first aid for injuries:

Stop the bleeding;

Examine the victim;

Call an ambulance;

Treat the wound;

Put a bandage on the wound;

Give the victim an appropriate position depending on the location of the injury;

Perform the simplest anesthesia techniques (apply cold to the wound area, perform immobilization);

If necessary, transport the victim to a medical facility.

It is forbidden:

Reposition prolapsed organs;

Remove protruding bone fragments from the wound;