Wounds. Health care

FUNDAMENTALS OF FIRST AID
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Wounds. Health care

Fundamentals of First Aid (OPMP)

wounds are called tissue damage, accompanied by a violation of the integrity of the integument (skin and mucous membranes).

Signs of wounds: pain, gaping of the edges of the wound, bleeding and dysfunction of the injured part of the body. The severity of these signs is determined by the severity of the injury: the heavier it is, the stronger the pain, the more profuse bleeding from the wound and the more severely the functions of the wounded part of the body suffer. Each wound has an inlet (a place where the integrity of the skin or mucous membrane is violated) and a wound channel (tissue damage along the path of the injuring object). If a wounding object passes through the human body and exits it, then an exit hole appears at the exit point.

According to the type of wounding object, all wounds are divided into two large groups:non-firearms и firearms.

Non-gunshot wounds can be inflicted with cold weapons (dagger, blade, bayonet, knife, ax), secondary flying objects (brick, wooden objects, glass fragments, etc.), as well as a needle, nail, human or animal teeth.

Among this group of wounds, wounds are distinguished:

cut;
bruised;
torn;
crushed;
scalped;
chopped;
bitten;
poisoned;
infected.

Gunshot wounds are inflicted by a bullet, shell fragments, shot. They are characterized by a number of common patterns:

1. Extensive tissue damage (damage to the skin, muscles, bones, internal organs). There are three zones of damage: the zone of the wound channel, in which the tissues are not viable, crushed; a zone of traumatic necrosis (severe mechanical damage to tissues) and a zone of concussion, when there is no gross destruction, but the viability of tissues is reduced and there is poor resistance to infection.

2. Contamination of wounds with earth, pieces of clothing, skin that enter the wound channel area and infect the wound.

3. Accession to the action of the injuring object of the action of the bone fragments that appeared during the injury, the hydraulic pressure of body fluids. Due to the combined action of these factors, in case of a right-through wound, the exit hole from the bullet is usually much larger than the entrance hole.

Wounds are classified according to the depth of tissue damage. superficial и deep. According to the nature of penetration into the tissues, wounds are distinguished:

tangents - the injuring object only touches the tissues;
blind - the injuring object does not leave the human body;
through, or through wounds, when the wound has two openings: inlet and outlet.

In relation to infection, wounds are distinguished clean, infected и purulent.

Surgical wounds are usually clean, since infection is excluded. Infected wounds include accidental wounds; in the first 6-8 hours, microbes are located along the edges of the wound - they adapt, adapt to new conditions, and later penetrate into the depths of the tissues, begin to multiply rapidly and cause suppuration.

Purulent wounds include wounds in which an inflammatory process has already developed. Such a wound is swollen, painful; the edges of the wound are inflamed, pus flows from it. Usually, infected wounds become purulent if they have not undergone radical treatment in time.

In relation to the cavities of the human body, wounds are distinguished, penetrating in the cavity and not penetrating.

There are three main cavities in the body: the cavity of the skull, chest and abdomen. Each of these cavities is surrounded by soft and bony tissues, only the walls of the abdominal cavity are mostly soft tissue. The innermost shell for the cranial cavity is the dura mater, for the chest - the parietal pleura, for the abdominal cavity - the parietal peritoneum.

If, when the wall of each of the cavities is wounded, the innermost shell of the cavity is not damaged, then such a wound is considered non-penetrating.

In case of wounding of the entire thickness of the wall of the cavity with damage and the inner shell, the wound is considered penetrating into the cavity. It can be lighter - without damage to the organs of this cavity and severe - with damage to the organs.

But even with a lighter penetrating wound without damage to the organs, the entrance gates open for infection that enters the cavity and can cause inflammatory processes in the organs (inflammation of the brain, lungs, and abdominal organs).

The depth, spread of the wound, the anatomical area in which the wound is inflicted, determine the severity of the injury. With injuries, the following main complications may develop:

pain shock - a severe general condition caused by a stream of pain impulses coming from the wound, since a large number of sensitive neuroreceptors are damaged during injury;
blood loss. Depending on how well the area of injury is vascularized (supplyed with blood vessels), blood loss can be from small to severe, up to the development of acute massive blood loss;
wound infection - getting microbes into it - can occur at the time of injury and later, including when helping the patient.

First aid should focus on the prevention of possible complications of injury and the fight against them. To prevent blood loss, it is necessary to stop the bleeding as soon as possible. The nature of the actions in this case will be determined by the type and degree of bleeding: with arterial bleeding - any of the methods of circular compression of the limb, with venous bleeding - the imposition of pressure bandages. Various methods of temporarily stopping bleeding can also be used.

In order to combat pain in severe injuries, the victim should be injected from a syringe tube with one of the analgesics. During the Great Patriotic War, adults were given alcohol inside. Children are administered non-narcotic analgesics in a dose corresponding to the age of the child.

In the presence of extensive wounds, immobilization is advisable - immobilization of the damaged part of the body with the help of transport tires or improvised means. In summer, the wounded should not be overheated, in winter - supercooled. It should be moved to a shelter.

Wounds inflicted by firearms and cold steel, as well as random objects, are primarily infected, since the infection enters the tissue at the time of injury. Primary infection may not be massive. A serious danger is secondary infection, when the microbial flora enters the tissues after injury - from the surrounding skin, from polluted air, from environmental objects.

In the lesion to prevent secondary infection, a sterile dressing is applied to the wounds using an individual dressing bag. The injured part of the body is freed from clothing (unscrew, rip, remove if possible), the healthy skin around is well lubricated with a 5% alcohol solution of iodine.

The rubberized bag of an individual dressing bag is torn according to the marks on the bag, a sterile bandage and sterile pads are removed from waxed paper. The pads are taken by hand in the place where they are stitched with colored threads, while the inside of the pads is kept sterile, and it is with this side of the pad that they are placed on the wound and fixed with a bandage. One of the pads is movable, it can be moved.

If the wound is large or the burn surface is extensive, the pads can be deployed, while it is also necessary to keep their interior intact. Sometimes it is necessary to use large individual dressing bags or special contour dressings. The end of the bandage is pinned with a safety pin, which is in the package, or torn and tied, but so that the knot is not on the wound or the supporting part of the body.

Heavily contaminated skin around the wound can be washed well with soap and water (preferably boiled), furacilin solution, hydrogen peroxide, and then dried and treated with a 5% alcohol solution of iodine. Then apply a sterile bandage. In the absence of an individual dressing bag, use a clean cotton cloth (sheet, towel, napkin, scarf, etc.).

If there is a wound in the area of the scalp, it is necessary to wipe the head with a clean towel or napkin moistened with water to remove blood, cut the hair within a radius of 5 cm around the wound, disinfect the skin with 5% alcohol solution of iodine, and then apply a sterile bandage.

In cases of severe injuries, the following sequence of execution is advisablerelief activities:

1) temporary stop of bleeding;

2) the introduction of painkillers;

3) applying a sterile dressing;

4) performing immobilization;

5) transportation to a medical institution. Possible wound complications:

1. Shock (traumatic or posthemorrhagic, due to blood loss).

2. Anemia (anemia, decrease in hemoglobin due to blood loss).

3. Intoxication as a result of the absorption of tissue decay products in case of ingestion of toxic substances or the development of inflammation. One of the manifestations of intoxication is fever (fever). ,

4. Specific infectious diseases (tetanus, etc.).

Authors: Aizman R.I., Krivoshchekov S.G.

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