V. Reference basis of action

The first aid at getting frost-bitten

- transporting of patient in the warm apartment;

- moist clothes, shoe must be taken off;

- grinding of the areas of body got frost-bitten. Feature: gently to massage the area of nugeno by a hand, woolen, but not rough tampon, that there were no scratches – gates for penetration of infection;

- greasing of skin by an alcohol after grinding;

- imposition of dry teploizolyatsionnoy bandage;

In a clinic:

- intravenous and endarterial introductions are infuziya of preparations which improve krovotok;

- protivostolbnyachnaya prophylaxis (introduction of protivostolbnyachnoy whey in a dose 3000 AE and tetanic anatoksina.

The first aid at the common cooling of organism

- transporting of patient in the warm apartment;

- to assess the body of patient with hot-water bottles;

- hot tea, coffee;

In a clinic:

- infuziya of warmed-up salt solutions (atsesol, disol, the Ringera solution);

- liquidation of atsidoza (laktasol, sodium gidrokarbonat);

- liquidation of gipoksii (oksigenoterapiya, reopoliglyukin).

Determination of depth of defeat of the fabrics got frost-bitten by means spirit test

By means wadding or gauze marbles and ethyl alcohol treatment of the staggered area is conducted. At presence of at the sick getting of a 1-2 item frost-bitten, a test will be positive. Takes place the pain and temperature giperesteziya. If at a patient getting of a 3-4 item frost-bitten, a test will be negative, a patient will not feel to pain that will testify to the defeat of skin on all its layer with the skunk of malpigievogo layer and derivata of skin, hypodermic-fatty cellulose.

Vі. System of teaching tasks for verification of eventual level of knowledges.

Situation tasks.

you – doctor of first-aid. Arrived on the call. A man without consciousness lies in the street. Temperature of air -200 With, wind. At examination at a patient the sharp pallor of skin of fingers of hands is marked, a capillary pulse is not determined, fingers are crusty ice.

Your diagnosis and actions?

Answer: a patient has the heavy common supercooling, heavy holodovaya trauma of fingers of hands, doreaktivniy period. It is needed on the cyst of hands to impose teploizoliruyushie bandages and leave a patient in permanent establishment.

From a district hospital in a clinic a patient with getting of both feet frost-bitten in a late reactive period is delivered. The state of patient is heavy. Both feet were swollen, sharp cyanosys of skin on them with a grey tint is marked, a sensitiveness is fully absent. On the line of demarcation – bubbles with festering content. Skin on the shins of giperimirovanaya. Temperature of body 38 With.

What diagnosis, additional inspections and medical tactic?

Answer: A patient has getting of feet of the IV degree, moist gangrene frost-bitten, the phenomenon of ascending inflammation and expressed intoxication. Generalizatsiya of infection is possible. It is necessary to check a blood for sterility, to conduct sowing of pus from bubbles on mikrofloru and sensitiveness of her to the antibiotics. To the patient infuzionnaya detoksikatsionnaya therapy, complex antibakterialnoe medical treatment, is appointed. In addition, on feet it is needed to execute nekrektomiyu.

Surgical separation a patient with complaints about absence of sensitiveness in the fingers of feet entered, their edema. It appeared at collection of anamnesis, that the day before on a frost a public transport expected long. The fingers of feet froze. At a home warmed feet in hot bath, but a sensitiveness did not recommence. At examination: feet nabryaklie, cyanosys of fingers is marked, absence of sensitiveness in them, a capillary test is negative.

What Your diagnosis and medical measures?

Answer: at a patient it is possible to forecast getting of the III-IV degree of fingers of feet frost-bitten. He quickly needs to impose teploizolirushie bandages on feet and begin to conduct complex medical treatment, that includes endarterial introduction of sosudosugivayushih facilities, anticoagulants, dezagregantov, preparations of reologicheskoy orientation, trombolitichnuyu therapy for renewal of circulation of blood in the staggered segments.

A patient with getting of feet of the III-IV degree frost-bitten on fifth days after a trauma began to grumble about a weakness, rise of temperature of body to 39 ^0С, cough, shortness of breath. Both feet edematous, skin of shins of giperemirovanaya.

What complications could develop at a patient? What additional inspections for clarification of diagnosis you will conduct? Your medical tactic?

Answer: in the reactive period of holodovoy trauma at a patient possible development of pneumonia or sepsis. For clarification of diagnosis it is needed to conduct roentgenologic research of lights and research of blood from a vein on sterility. In addition, it is needed to execute nekrektomiyu on feet and continue dezintoksikatsionnuyu and antibakterialnuyu therapy.

you arrived on the place of proishestviya as a doctor of first-aid. According to present persons, some minuts ago the victim got under action of electric current. Lost consciousness. There were cramps. Friends on work turned off the source of current. A patient lies on the floor. Breathing is absent, a pulse not palpiruetsya, the skin covers of tsianotichnie, pupils are wide, on light are irresponsive.

What Your diagnosis? Your actions?

Answer: A patient has heavy elektrotravma which was complicated by the stop of heart and breathing. It is necessary quickly to begin artificial ventilation of lights and closed massage of heart for getting a patient out of the state of clinical death.

Surgical separation a patient which 2 days to that backwards got the electro-burn of right brush of the IV degree entered. At examination: brush, forearm and shoulder sharply otechnie, hard at palpatsii. A sensitiveness in the fingers of brush is loosened.

What urgent surgical interference must you execute?

Answer: in this case sick quickly it is needed to execute dekompresionnuyu fastsiotomiyu on a shoulder and forearm by longitudinal lampasnimi cuts for warning of second mionekroza.

Patient And., 43 years, is delivered in a hospital after the protracted stay in a winter in mountains. At the receipt: complaints about pain in both feet and them zaterpanie. Objectively: the skin of feet is pale, cold, the sensitiveness of her is lowered, a pulsation on peripheral arteries is sharply loosened. The what first aid it is necessary to give to the victim?

Answer: to grind the area of body got frost-bitten; to oil a skin by an alcohol after grinding; to impose a termoizoliruyushuyu bandage.

A surgeon hospitalized a patient which strayed in a forest during a ski walk. Patient at consciousness, but is put on the brakes; the temperature of body, lowered to 32 0 the S. Starshiy colleague of surgeon advised to him together with medicinal therapy as quick as possible to warm a patient. By what method it is possible to do?

Answer: To dip the victim in bath with water temperature of which during 20 minutes to promote from 36 to 40 degrees With.

In the process of medical treatment of patient With., 36 years, the hospitalized 3 days to that backwards with the deep getting of right foot frost-bitten, a treating doctor exposed the increasing edema and cyanosys of the last, which was accompanied by the signs of growth of intoxication. A manager recommended to the colleague to conduct operative interference. What operation a talk goes about?

Answer: a patient needs to execute nekrektomiyu.

Patient With., 29 years, on 2th days after getting of lower extremities frost-bitten grumbles about feeling of raspiraniya in a right foot and lower third of shin. At examination the expressed edema of shin is exposed, hardness of muscles. The rise of temperature of body is established to 380 With, frequency of pulse – 100 ud/min. Your actions as a treating doctor?

Answer: immediately to execute fastsiotomiyu for warning of necrosis of fabrics.

During work on a frame-saw the workers heard the scream of colleague, which repaired an electric motor. In place of event exposed an electrician With., 29 years, which convulsively held on to the device not by a mistake turned off. What is needed to do above all things at the grant to the victim to the first aid?

Answer: By a wooden or rubber object to push away the source of current from the victim.

At a patient With., 52 years, on the 2th week of medical treatment concerning the defeat by elektrotokom from a wound in overhead third of right shoulder the pulsating effluence of bright red blood is exposed. Sick pale, grumbles about dizziness, a pulse is threadlike. The HELL 80/60 mm.rt.st. What complication can be supposed at a patient?

Answer: the second arterial bleeding.

Since an accidental passer-by succeeded to break contact, at the victim In., 24 years, the signs of vital functions are not exposed. The closed massage of heart and artificial respiration is begun and an ambulance is caused. Passed 20 minutes, but a medical brigade did not arrive. How long is it needed to conduct reanimation measures to the victim?

Answer: before appearance of independent palpitation and breathing or arrival of doctor.

At the receipt in the hospital of the victim from action electric current a duty surgeon exposed on the palm of his right hand a white-grey spot by a diameter 4 mm the Common state of the victim satisfactorily, pulse 80 ud/min., the HELL 110/80 mm.rt.st. The victim renounces to lie down in a hospital. What must be done by a doctor?

Answer: to hospitalize a patient and conduct treatment of «signs of current».

Patient With., 34 years, is found on medical treatment in the separation of politravmi concerning elektrotravmi of right shin. As a result of deep necrosis of fabrics of foot and shin 2 weeks ago to him the extremity in overhead third of shin was amputated. Kultya after amputation by the primary pull did not heal over; the numerous nekrektomii were conducted. Lately there is the defect of skin by an area 25 square sm; a wound is covered by granulations. What subsequent medical tactic?

Answer: to conduct free autodermoplastiku.