First aid for mechanical injury

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FUNDAMENTALS OF FIRST AID
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First aid for mechanical injury

Fundamentals of First Aid (OPMP)

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First aid complex (PMP) for mechanical injury includes three types of sequential activities:

1. Immediate cessation of the effects of the damaging factor.

2. Direct medical manipulations.

3. Evacuation of the victim to a medical facility subject to the rules of transportation.

К mechanical injury include injuries of a closed and open nature, depending on the integrity of the skin and mucous membranes, having de facto damage either only to soft tissues (internal organs, muscles, ligaments, tendons, skin, joint capsules), or bone tissue - fractures (closed and open ).

Closed soft tissue injuries of the musculoskeletal system include bruises, sprains, ruptures, dislocations, and prolonged compression syndrome. To closed injuries of internal organs - concussions, bruises, compression, ruptures.

Open wounds are classified depending on the type of injuring object and are divided into penetrating and non-penetrating, depending on the probability of penetration of the injuring object into the human cavity with the threat of damage to internal organs and subsequent complications (bleeding, infection, etc.).

Mechanical trauma has a number of common signs, which include pain, swelling, dysfunction, as well as a number of symptoms characteristic of each type of injury.

Bruising is the result of being struck by a blunt object or falling onto a blunt object. There are ruptures of blood and lymphatic vessels - hence the pronounced edema.

Sprains and ruptures of ligaments, tendons, muscles are combined under the general name "damage" and differ in the degree of morphoanatomical manifestations. With ruptures, palpation (palpation) and a visual defect of the tissue is determined.

In case of dislocations, the forced characteristic position of the limb, deformity in the joint area, lack of active movements in the joint, change in the axis and length of the dislocated limb, sometimes a “key” symptom (spring-return action in the joint) is manifested.

Long-term compression syndrome is the result of many hours (4, 6, 8 or more) of the impact of gravity in the form of earth, rock, building debris, etc. on large areas of the body with large muscle mass (mainly limbs). There is a mild degree - squeezing up to 4 hours, medium - up to 6 hours, severe - up to 8 hours, extremely severe - more than 8 hours when squeezing two limbs. The syndrome develops after release from the blockage and manifests itself in the development of traumatic toxicosis, the cause of which is the ingress of toxic decay products of cells and tissues susceptible to ischemia and oxygen starvation into the bloodstream. Severe edema develops, blisters with bloody contents form on the skin. The patient goes into traumatic shock. The decay products that enter the bloodstream lead to kidney failure on the 3-4th day.

Wounds are characterized by specific signs in the form of gaping (divergence of edges) and a wound channel (cavities in the tissues from the penetration of a wounding object).

Traumatic bone fractures occur under the influence of a mechanical factor and are manifested in a complete violation of the integrity of the bone. The absolute signs of fractures include shortening of the limb, deformity at the site of injury, abnormal mobility at the site of injury, bone crunch (crepitus) when palpating the fracture site, and increased pain when the limbs are loaded along the axis.

Injuries to internal organs during mechanical trauma are relevant primarily in relation to vital abdominal organs, such as the brain, lungs, mediastinum, liver, spleen, pancreas, gastrointestinal tract, bladder, kidneys.

Closed brain injuries include concussion, contusion, and compression. These injuries occur as a result of a blow to the head or head on hard objects.

A concussion is characterized by a short-term loss of consciousness, nausea, vomiting, loss of memory of previous events, headache, dizziness, noise in the head, unsteady gait. These phenomena are reversible.

A brain contusion is a more severe injury than a concussion, as anatomical changes occur in the brain. Cerebral symptoms are more pronounced (prolonged loss of consciousness, repeated vomiting, respiratory failure, bradycardia, dilated pupils, impaired reaction to light). There are focal symptoms of impaired facial expressions, vision, speech, sensitivity of various parts of the body.

Compression of the brain develops as a result of pressure on the brain of bone fragments during a skull fracture, pressure during intracranial bleeding or traumatic cerebral edema. This injury is characterized by the presence of an asymptomatic light period of time (sometimes lasting several hours), then general cerebral and focal signs similar to those observed with brain contusion increase.

Injuries to other abdominal organs are dangerous, primarily from the point of view of internal bleeding, pneumothorax, and rapidly developing infectious complications (Table 5.1).

Table 5.1. First aid for mechanical injury

Type of injury, complications	Emphasis	First aid
Musculoskeletal injuries
Soft tissue injury		Cold, pressure fixing bandage, thermal procedures from the 3rd day
Stretching muscles, ligaments, tendons		Cold, pressure fixing bandage, thermal procedures from the 3rd day
Rupture of the mouse, ligaments, tendons		Cold, pressure fixing bandage, thermal procedures from the 3rd day, limb splint
Dislocations in the joints		Painkillers, cold on the joint, fixing bandage (bandage, scarf, splint)
Bone fractures
Closed	Traumatic shock	Dealing with the shock, putting on a splint
Open	Bleeding, shock	Stop bleeding, fight shock, splint
Long squeezing syndrome	Shock	Shock control, tight sterile bandage on the limb, cold on the limb, splint on the limb, copious fluids, hospitalization, transport in the supine position
Injuries of internal organs
Concussion	Loss of consciousness	Rest, observation, hospitalization, transport in the supine position
Brain contusion	Loss of consciousness, focal symptoms	Rest, observation, hospitalization, transport in the supine position
Type of injury, complications	Emphasis	First aid
Strangulated brain	Light interval, increase in symptoms
Rupture of the internal organs of the abdominal, chest cavity, pelvic cavity	Internal bleeding	Peace, hunger, local cold; inside calcium chloride, vikasol, hospitalization, transportation in the supine position
Wounds		Removal of foreign objects, blood clots, non-viable tissues from the surface of the wound; surface irrigation with aseptic solutions (3% hydrogen peroxide, solutions of furacilin, rivanol, potassium permanganate), sterile dressing
Penetrating Wounds
Heads	Cerebral edema	Washing the wound with aseptic solutions, the edges of the wound - with an alcohol solution of iodine; sterile dressing; hospitalization, transport in the supine position
chest	Pneumothorax	Washing the wound with aseptic solutions, the edges of the wound - with an alcohol solution of iodine; hermetic (occlusive) bandage due to the risk of pneumothorax; hospitalization, transport in supine position
abdominal cavity	Bleeding into the abdominal cavity, peritonitis	Washing the wound with aseptic solutions, the edges of the wound with an alcohol solution of iodine (do not set anything!); sterile dressing; cold on the abdomen; lying position; regimen without food intake, restriction of drinking, rest, intramuscular antibiotics; hospitalization, transport in supine position
Bleeding
Arterial		Finger pressure of the vessel, maximum flexion of the limb in the joint, then tourniquet or pressure bandage
Venous		Finger pressing of the vessel, maximum flexion of the limb in the joint; then a pressure bandage
capillary		Pressure bandage and elevated position of the limb
mixed		Choice of method from those listed according to the leading type of bleeding
Internal		Cold, calm; calcium chloride, vikasol
From the nose		The position on the back, the head is raised; on the bridge of the nose and the back of the neck - cold. Compress the wings of the nose; insert a gauze swab moistened with hydrogen peroxide or a solution of calcium chloride into the nose; don't blow your nose
Out of the ear		Place a sterile ball of gauze into the external auditory canal, make an aseptic bandage on the ear
Shock traumatic		Eliminate the traumatic factor, in case of bleeding - a temporary stop of bleeding; the introduction of painkillers (promedol, omnopon, analgin); warming (warm clothes, blanket, hot tea, broth, coffee), alcohol (no more than 100 ml of vodka); specific treatment for a specific injury (limb immobilization with a splint for fractures; immobilization with a bandage for closed soft tissue injury; wound dressing (alcohol bandage for SDS, etc.))
wound infection	Acute purulent inflammation of tissues, gas gangrene, tetanus	Primary wound treatment (see Wounds). Antibiotics. Antiogangrenous, antitetanic serum.

First aid for mechanical injuries can be divided into measures for the specific treatment of the injury itself and the fight against traumatic complications - bleeding, shock, concomitant damage to vital organs, the possible addition of an infectious onset (wound infection).

General principles of PMP for mechanical injury (in order of relevance):

1. Temporary stop of bleeding (elevated position of the limb, maximum flexion of the limb in the joint, pressure bandage on a bleeding wound, tourniquet, widespread use of cold).

2. The fight against traumatic shock (painkillers, rest, warming, treatment of the underlying disease).

3. Immobilization of the injured limb, body part using a variety of fixing dressings: bandage, scarf, splint (standard or improvised material).

4. Prevention of infectious complications (application of aseptic and antiseptic rules, administration of antibiotics).

5. Specific methods of assistance for a specific injury.

Author: Mikhailov L.A.

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