Lecture number 26

1. When bleeding

There are arterial, venous and capillary bleeding. Blood from a gaping wound is poured out in a light red color rhythmically, in a pulsating stream during arterial bleeding, and a dark color in a continuous continuous stream during venous bleeding. Capillary bleeding - blood from damaged small vessels flows like a sponge.

When providing first aid, a temporary stop of bleeding is used.

Ways to temporarily stop bleeding

Stopping arterial bleeding should always begin with finger pressure on the artery. To do this, the pulsation of the artery is felt, which is pressed against the bone with a finger for a short time, necessary to apply a pressure bandage, tourniquet or twist. Bleeding from a wound located in the region of the shoulder girdle, shoulder and forearm is stopped by pressing the subclavian artery against the XNUMXst rib in the supraclavicular region, and the brachial artery against the humerus along the inner edge of the biceps muscle. In case of arterial bleeding from wounds of the lower limb, the femoral artery in the inguinal fold should be pressed against the pubic bone.

Elevation of the limb, wound tamponade, and a tight pressure bandage can help stop both profuse and most arterial bleeding.

Forced flexion of the limb with fixation in an excessively bent position squeezes the arterial vessel. This effect is enhanced if a tight cotton-gauze roller or any other object is placed on the elbow joint or knee joint and then the limb is firmly fixed in an excessively bent position with a trouser belt.

To stop bleeding from the subclavian region and the upper half of the shoulder, the roller is placed in the axillary region.

The arms, bent at the elbow joints, are brought behind the back and tightly fixed one to the other.

Twisting (tourniquet) is used only when simple and safe methods cannot stop the bleeding, and is used more often when bleeding from an amputated stump.

When applying a twist (tow), the following rules must be observed:

1) give the limbs an elevated position;

2) apply a tourniquet above the wound and as close to it as possible;

3) the tourniquet is superimposed on clothes or some kind of padding (shawl, scarf, towel);

4) stop bleeding with one or two rounds;

5) securely fasten the applied tourniquet;

6) it is unacceptable to stay a tourniquet on the limbs for more than 2 hours in summer and 1 hour in winter;

7) it is necessary to mark in a conspicuous place (forehead of the victim) the date and time of applying the tourniquet;

8) in winter, a limb with an applied tourniquet should be wrapped in clothes or a thick layer of cotton wool.

Victims with temporarily stopped bleeding should be urgently delivered to a surgical hospital in a horizontal position on a shield or stretcher.

2. For closed injuries

Closed injuries include:

1) bruises;

2) damage to ligaments and tendons;

3) dislocations.

Bruises - closed injuries of soft tissues without violating the integrity of the skin, which occur when struck with a blunt object, when falling on a hard surface.

First aid for traumatic bruises. In order to prevent hemorrhage, it is necessary to hold the cold at the site of the bruise, provide the affected organ with absolute rest and apply a pressure bandage. In case of bruises of the head, chest, abdomen, accompanied by severe pain and deterioration of the general condition, the victim must be urgently shown to the doctor.

Sprain or damage to the ligamentous apparatus of the joint occurs with sudden impulsive movements in the joint, significantly exceeding the limits of normal mobility in it, or may be the result of a direct blow to a tense tendon.

The most common injuries of the ligaments of the ankle, interphalangeal, wrist and knee joints, while the smoothness of the contours of the joint, limitation of function and pain in the projection of the damaged ligaments are determined.

First aid:

1) application of cold to the joint area;

2) immobilize the joint with a fixing 8-shaped bandage;

3) give painkillers to drink;

4) send to the emergency room.

The tendons most commonly injured are the extensor tendons of the fingers, the quadriceps femoris, and the calcaneal (Achilles) tendon. First aid consists in immobilizing the limb with improvised means in a position that ensures the convergence of the ends of the tendon.

Dislocation - this is a displacement of the articulated ends of the bones with damage to the joint capsule and ligamentous apparatus of the joint. With a dislocation, acute pain, joint deformity, limitation of active and passive movements, and a forced position of the limb appear.

Dislocations in large joints can be accompanied by significant damage to soft tissues, blood vessels and nerve trunks, which determines the urgent direction of the victim to the hospital. First aid for dislocation includes: application of cold, giving an elevated position to the injured limb, immobilization of the damaged joint with improvised means, the need to deliver the victim to a trauma center.

3. For fractures

Fracture (violation of the integrity of the bone) can be closed and open (with damage to the skin).

With a fracture, acute local pain is noted, which increases with the movement of the limb and the load on it along the axis, swelling and an increase in the circumference of the limb segment at the level of the fracture. Absolute signs of a fracture: deformation of the damaged segment and pathological bone mobility.

First aid consists in transport immobilization of the limb, most often with the help of splints made from improvised materials (boards, plywood strips, etc.).

Properly performed transport immobilization prevents an increase in the displacement of bone fragments and reduces pain during transportation of the victim, and hence the possibility of developing traumatic shock, especially with a hip fracture. In the absence of means for splinting, the upper limb can be hung on a scarf or fixed to the body, the lower limb can be bandaged to a healthy limb.

When providing first aid to patients with open fractures, it is necessary to lubricate the skin around the wound with an alcohol solution of iodine.

With an open fracture, it is absolutely unacceptable to reduce the bone fragments protruding to the surface into the wound or cover them with soft tissues, since together with them infectious agents can penetrate into the deep tissues. Several sterile napkins should be applied to the bone fragments protruding from the wound.

With an open fracture of the limb with heavy bleeding, it is necessary to apply a hemostatic tourniquet (twist) above the fracture, which is applied before immobilization. To stop bleeding, apply a pressure bandage to the wound area. Fix the limb and deliver the victim to a specialized hospital.

When providing first aid, one should not seek to correct the existing deformity of the limb.

General principles of immobilization for fractures.

In case of fractures of long tubular bones, at least two joints adjacent to the damaged limb segment must be fixed. It is often necessary to fix three joints. Immobilization will be reliable if fixation of all joints that function under the influence of the muscles of this limb segment is achieved. So, with a fracture of the humerus, the shoulder, elbow and wrist joints are fixed; in case of a fracture of the bones of the lower leg, it is necessary to fix the knee, ankle and all joints of the foot and fingers.

The limb should be fixed in an average physiological position, in which the flexor and extensor muscles are equally relaxed.

During splinting, care must be taken with the injured limb to avoid additional injury. It is advisable to apply a splint with an assistant who holds the limb in the desired position.

4. For wounds

Wounds can be very diverse depending on their origin, degree of tissue damage, microbial contamination, location, depth. Wounds can differ in the nature of the injuring weapon or object: cut, chopped wounds, stab wounds are the deepest and most dangerous; bruised wounds, bitten wounds - dangerous with the possibility of rabies.

With deep wounds, not only the skin with subcutaneous tissue is damaged, but also muscles, bones, nerves, tendons, ligaments, and sometimes large blood vessels. There may be penetrating wounds, accompanied by damage to internal organs. When injured, bleeding, pain, and almost always gaping, i.e., divergence of the edges of the wound, necessarily occur.

It should be remembered that all wounds are infected. In the first hours after the wound, the microbes are mostly still on the surface of such a fresh wound and in a static state, that is, they do not yet multiply and do not show their painful properties. This must be taken into account when providing first aid.

First aid for injury - protection of wounds from secondary pollution. The surrounding skin around the wound should be smeared twice with an alcoholic solution of iodine and a sterile dressing should be applied, avoiding touching the wound itself. Foreign bodies embedded in tissues should not be removed, as this may increase bleeding. Any washing of the wound is prohibited!

1. At scalped wounds the flap is often torn off to the side, with the subcutaneous tissue outward. In this case, it is urgent to lift the flap and also lubricate its skin surface with an alcohol solution of iodine. If the wound bleeds profusely, assistance begins with a temporary stop of bleeding - applying a pressure bandage to the wound, and in case of severe bleeding - applying a tourniquet. In severe wounds of the extremities, transport immobilization is necessary.

The victim must seek medical attention without fail. A patient with any wound must necessarily enter tetanus toxoid and toxoid.

2. In case of bite wounds inflicted by any animal, the victim, after first aid, is immediately sent to the emergency room, where the issue of the presence or absence of indications for prophylactic vaccination against rabies is decided.

3. In case of poisoned wounds (snake bites), one should: squeeze out the first drops of blood from the wound; suck out the poison by mouth for 15-20 minutes (it is safe if the oral mucosa is healthy and saliva is often spit out); lubricate the bite site with a solution of iodine or diamond; apply a bandage; to immobilize the limb; give the victim plenty to drink; transport the victim to the nearest medical facility. It is forbidden: to apply a tourniquet on the affected limb; cauterize the bite site; make incisions in the skin to remove the poison.

5. Drowning

Heating - filling the respiratory tract with liquid (usually water) or liquid masses (silt, mud), causing acute respiratory and cardiac impairment.

Drowning can be caused by fatigue when swimming long distances, injury - a bruise on stones or hard objects when diving, as well as alcohol intoxication. Fainting can occur with a sharp sudden change in temperature when immersed in water; after overheating in the sun; redistribution of blood due to the overflow of the stomach with food; with muscle strain; from fear during an accidental fall into the water.

The nature of assistance to the victim depends on the severity of his condition. If the victim is conscious, he needs to be calmed, take off his wet clothes, wipe his skin dry, change clothes; if consciousness is absent, but the pulse and breathing are preserved, the victim should be allowed to inhale ammonia, free the chest from tight clothing; to activate breathing, you can use the rhythmic twitching of the tongue.

In the absence of cardiac activity and respiration, the simplest methods of reviving the body are used. First of all, you need to remove the fluid from the respiratory tract. To this end, the caregiver puts the victim on his bent knee with his stomach, while the victim's head hangs down, and water can pour out of the upper respiratory tract and stomach. After removing the water, they immediately begin artificial respiration, after quickly cleaning the victim's mouth from sand, silt, and vomit.

The most effective methods of artificial respiration are mouth-to-mouth and mouth-to-nose. During artificial respiration, the victim is in a supine position with his head thrown back sharply. This position of the head contributes to the most complete opening of the entrance to the larynx. Breathing mouth to mouth and mouth to nose is best done through gauze or other thin fabric. While blowing air into the mouth, the nose is clamped; when blowing into the nose, the mouth of the victim should be closed and the lower jaw pushed forward. Simultaneously with artificial respiration, an external heart massage is performed, producing 3-4 pressures on the chest after each breath (blowing). Attempts to revive a drowned person by rocking on a sheet, blanket, etc. (pumping out) are pointless and should not take place.

In any condition of the victim, measures are taken to warm the body by rubbing, massaging the upper and lower extremities.

All this is carried out immediately after removing the drowned person from the water (on the shore, in a boat, on a raft) until the arrival of a doctor or delivery of the victim to the hospital, where he will be provided with qualified medical care.

6. With solar heat stroke

Heatstroke - a painful condition that occurs as a result of general overheating of the body with prolonged exposure to high ambient temperatures.

Heat stroke occurs because when overheating and excessive sweating, the body loses a large amount of fluid, the blood thickens, and the balance of salts in the body is disturbed. In severe conditions, this leads to oxygen starvation of tissues, in particular the brain.

Sunstroke occurs when direct sunlight hits an uncovered head. Usually, this causes overheating of the body and mainly affects the central nervous system.

The first signs of sunstroke:

1) lethargy;

2) weakness;

3) nausea;

4) headache;

5) dizziness;

6) darkening in the eyes;

7) the face turns red;

8) sometimes there is a slight increase in body temperature.

With further overheating, the body temperature rises to 38-40 ° C, vomiting appears, fainting may occur, and sometimes even convulsions. In severe cases, excitation, hallucinations, delirium, convulsions of the type of epileptic seizures, loss of consciousness, coma are observed. Pulse, respiration become more frequent, arterial pressure goes down.

Before the arrival of a doctor, the victim should be laid in the shade or in a well-ventilated area. Bubbles with ice or cold water are applied to the head, as well as to the area of ​​large vessels (lateral surfaces of the neck, armpits, inguinal regions). The victim is wrapped in a wet sheet, blown with cold air, since the evaporation of water from it will slightly reduce the temperature. They bring cotton wool with ammonia to the nose. Thirst is quenched with cold water, tea, coffee. When breathing stops, artificial respiration is performed.

With moderate and severe sunstroke, the victim must be taken to a medical facility for medical assistance.

To avoid heat or sunstroke, you must follow the rules of being in the sun, the correct drinking regimen.

7. For burns, frostbite

First Aid thermal burns. It is necessary to carefully remove the smoldering remnants of clothing from the victim. It is impossible to tear off the remnants of clothing adhering to the burn surface, they must be cut with scissors along the border of the burn and a bandage applied directly to them.

I degree burns are treated with 70% alcohol. For burns of the II degree, after treatment with alcohol, apply a dry sterile dressing to the burned surface, for III-IV degrees, apply a sterile dressing. For extensive burns of any degree, the victim should be wrapped in a clean sheet, carefully wrapped in blankets and taken to a medical facility as soon as possible. When providing first aid, it is forbidden to open blisters, apply any lotions, rinses, ointment bandages.

To prevent shock, rest, warming and painkillers are used, drinking plenty of water in the form of a soda-salt solution (1 tsp of table salt and 1/2 tsp of baking soda per 1 liter of water). When transporting the burned, if possible, they are placed on an undamaged part of the body and carefully wrapped up and given as much warm drink as possible.

In case of burns of the respiratory tract from inhaled hot air (in case of fire) or smoke, shortness of breath, hoarseness, cough occurs. It is urgent to send the victim to the hospital, regardless of the severity of the skin burn.

Chemical burns most often occur when various chemicals come into contact with the skin or mucous membranes: strong acids, alkalis, volatile oils, phosphorus, as well as from prolonged exposure to gasoline or kerosene vapors.

First aid: immediate and abundant washing for 5-10 minutes of the affected area with water, preferably under pressure. In case of burns with lime or phosphorus, it is necessary to first remove the remnants of the substance in a dry way and only then proceed to washing. The affected area is washed with neutralizing solutions: for burns with acids or phosphorus - 2% solution of bicarbonate soda or soapy water, for burns with alkalis - 1-2% solution of citric, acetic or boric acid. Then a dry bandage is applied, and in case of burns with phosphorus, lotions are made from a 2-5% solution of copper sulfate or a 5% solution of potassium permanganate. For burns with phosphorus, oil dressings should not be used.

The victim with any kind of frostbite is placed in a warm room. The patient is given hot tea, coffee, wine.

The whitened part of the body is rubbed with cleanly washed, moistened or lubricated hands with sterile vaseline, and best of all with alcohol or vodka until the frostbitten place turns red and becomes warm.

You can not perform rubbing with snow, as it cools the skin. Dirty and sharp pieces of ice can damage and contaminate frostbitten skin. At the end of rubbing, dry the frostbitten area, wipe it with alcohol and apply a clean bandage with a thick layer of cotton wool on it.

You should not lubricate the frostbitten part of the body with iodine tincture or any fat, as this makes subsequent treatment difficult. If swelling has already set in or blisters have appeared, then rubbing can not be done.

8. In case of poisoning

Poisoning with household chemicals. After a strong acid or alkali enters the body, it is urgent to call an ambulance. Immediately remove saliva and mucus from the mouth. If there are signs of suffocation, apply mouth-to-nose artificial respiration. When vomiting, it is strictly forbidden to wash the stomach, as acid or alkali can enter the respiratory tract. This procedure can only be performed by a healthcare professional. The victim is given 2-3 glasses of water to drink. Never attempt to neutralize toxic liquids. This leads to the formation of carbon dioxide, distension of the stomach, increased pain and bleeding. With the development of suffocation, the victim should be urgently sent by any transport to a medical institution. In case of poisoning with household chemicals (not containing acid or alkali), before the doctor arrives, the patient should be vomited (if he is conscious). Patients in an unconscious state should be laid so that their head is lowered and turned to one side so that the contents of the stomach do not enter the respiratory way. In case of retraction of the tongue, convulsions, when the jaws are tightly closed, gently tilt the head back and push the lower jaw forward and upward to ensure breathing through the nose.

In case of poisoning with sleeping pills or sedatives (sedatives), the victim must be laid down with his head raised. Rinse the stomach with 1-2 liters of water, induce vomiting by pressing on the root of the tongue. Then give strong tea to drink, eat 100 g of black crackers. You can't give milk. It accelerates the entry of the poisoning drug into the intestines and prevents its removal from the body.

An unconscious patient is strictly forbidden to wash the stomach. Water can be inhaled and cause death by suffocation. If the victim is not breathing or his breathing is oppressed, it is necessary to perform artificial respiration.

In case of alcohol poisoning, the victim must inhale vapors of ammonia, give 3-4 glasses of water to drink (with the addition of 1 tsp of baking soda per glass), induce vomiting, drink strong tea or coffee.

In case of poisoning with methyl alcohol or ethylene glycol, it is necessary to give 100-150 ml of ethyl alcohol (vodka) to drink, if the victim is conscious, since it is an antidote, it slows down the decay of methyl alcohol.

In case of mushroom poisoning, immediately take the patient to the hospital. Before the arrival of the doctor, rinse the stomach with a soda solution or a solution of potassium permanganate, and the intestines - using laxatives (castor oil, bitter salt), make an enema. The patient is given salted water to drink.

In case of poisoning with inhaled chlorophos or karbofos, take the patient out into the air, remove contaminated clothing, and wash open areas of the body with water.

When swallowing a pesticide, gastric lavage is done 4-5 times: give 3-4 glasses of salted water to drink and induce vomiting. Then take a laxative - 1 tbsp. l. bitter salt. It is very good to take 5-6 tablets of besalol or becarbonate orally.

Authors: Alekseev V.S., Zhidkova O.I., Tkachenko I.V.

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