IV. Table of contents of teaching

Injury (trauma) is synchronous infouence of the external factor to call in tissues focal anatomical and functional violation to accompany general reaction of the oganism .

Mechanical

Thermal

Electric current

Chemical

External factor

Wound

Thermal burns

Chemical burns

Electro-trauma

Fracture

Chilblain

Disjunction

Radioactive emanation

General beco-ming too cold

Radioactive burns

Contuse

Distension

Rupture

Opened

Closed

Combined

Concussion

Not penetrating

Penetrating

Traumatism is aggregate of traumas on definite territory (in country, city and others) or among definite contingent of people.

Industrial

Non industrial

Farming

Military

Everyday

Transport

Industrial

Sports

Closed damages of mild tissues

Injury (ñontusio) is the closed mechanical damage of fabrics or organs without obvious violation of their anatomic integrity. This is one of the most widespread closed damages of mild tissues. More frequent than all the opened body parts are damaged (head, extremities). The degree of weight of damage depends on force of blow, protected of this body part by clothes, fatty hypoderm.

First aid at injury: cold into place of injury (towel moistened by cold water, ice-bag), elevated position of the damaged body part, imposition of pressing bandage. At strong injury it is necessary to carry out immobilization of the hurt extremity by the improvised facilities. If haematoma large and there here is no damage of large blood vessel, execute its puncture, aspirate a blood, enter antibiotics, whereupon lay on a tight bandage. In the case of suppuration of haematoma an abscess is unsealed.

Tension (distorsio) is the damage of soft tissues with the partial breaks. Tension usually arises up at the sudden flounce.

Treatment in the case of tension is the same, as well as at injury.

The break (ruptio, ruptura) is caused by surplus tension of tissues, which exceeds the scopes of their elasticity and endurance. As a skin has plenty of elastic fibers and easily stretches more frequent there are the rupture of muscle, trusses, nerves, tendon.

At the incomplete rupture of muscle execute immobilization of extremity during 2-3 weeks. At the complete break is treatment only operative is sewing together of muscle with subsequent immobilization of extremity during 2-3 weeks.

The concussion (commotio) is the closed mechanical damage of separate organs and tissues which is characterized by the function their without the rough| morphological changes. Most practical meaning has the concussion of the head brain and organs of thorax.

The clinical signs of concussion consist mainly in the disorder of function the damaged organs and tissues that is accompanied by insignificant pain.

Compression (compressio). Sight this damage soft tissues cuddle to the hard object or compress between two hard objects. In the case of clench of soft tissues, especially extremities, dangerous complication develops, is known under the name of syndrome of the protracted compression.

Damages of head

Concussion of the head brain. It is relatively easy cerebral trauma without the organic damage of cerebral matter. Typical| clinical signs: brief loss of consciousness, retrograde amnesia, single vomiting, head pain, dizziness, shaky gait.

Injury of the cerebrum. It is heavier cerebral trauma which is accompanied by the anatomic changes in the cerebral matter (local damage of cerebral fabric, hemorrhage, edema). Typical clinical signs: expressed cerebral symptoms (prolonged loss of consciousness, frequent vomiting, violation of breathing and cardiac activity, expansion of pupils and violation of their photoharmose, head pain, dizziness), the hearths symptoms of violation of central nervous activity concerned depending on localization of injury. At spinal puncture a blood can defined in a neurolymph.

Compression of cerebrum. It arises up as a result of compression of cerebrum at an intracranial haematoma. A clinical picture develops gradually from a growing haematoma. Name this interval of time “light” (to a few hours). Gradually increasing intracranial and hearths symptoms stipulate deceleration of pulse, expansion of pupil, loss of consciousness, there are cramps, paresises and paralyses, violations of reflexes.

Damage of bones of skull. Distinguish the breaks of vault and foundation skulls, cracks and fragments breaks. The pressed breaks stipulate local injury or compression of medullary substance. Damages of foundation of skull stipulates as a rule grave condition of a patient. Disorders of breathing, bleeding from a nose, ears and also effluence of neurolymph join to the general cerebral symptoms. Under a skin round eyes appear hemorrhage (symptom of “eyepieces”).

First medical aid. At the closed damages of skull and cerebrum of victims it is necessary quickly to deliver in medical establishment. At a cranial cerebral trauma in a time of evacuation rest the head of a victim in a pillow (twisted overcoat up, etc.). Fixing by tires is executed only at the combined damages of skull and neck department of spine. For warning of hit of blood or anacanthartic the masses in respiratory tracts turn the head of a victim on a side.

Some offer a head during transporting to fix by a sling which fasten under a chin and attach to the stretchers. If a victim is in the swoon state and also there is the danger of falling back of the tongue, fix a head by bandages in position on to the side. For this purpose this reason round a head and under a chin lay on a bandage the ends of which firmly attach to the handles of stretchers. Head it is also possible to fix assessing it by sacs with sand.

At the wound of veins especially neck there can be air embolism. The phleborrhagia is stopped with a squeezing bandage. On the area of bleeding lay on clean gauze, over it bandage or gauze built once or twice. If near at hand there is no squeezing bandages, bleeding can be stopped with a way pinning of site of bleeding by fingers.

Damages of thorax

Injury of thorax. Signs of injury: pain which increases during respiratory motions. Heavy injury is accompanied by development of pleuropulmonal shock (pallor of skin, shortness of breath, expectoration by a blood, low pulse frequent and low arteriotony, sometimes is pneumoderma which defined at palpation as a “crepitus”).

First aid. To lay a victim on stretchers with a turn on the damaged side in assidenous position, it is adequate to anaesthetize.

Breaks of ribs. Signs: pain in the proper half of thorax, lag of its at respiratory motions, painfulness at palpation in the site of fracture of rib. The complicated breaks of ribs with the damage of pleura and intercostal arteries cause hemothorax (expectoration by a blood, subcutaneous emphysema, pleuropulmonal shock).

First aid. Rest. Dense circular bandage (only in a time of transporting). In heavy cases are anaesthetizing, cardiovascular drugs and inhalation of oxygen.

Wound of thorax. Penetrative and no penetrative (with the damage or without the damage of pleura). Signs: pleuropulmonal shock, pneumothorax, hemothorax, subcutaneous emphysema expectoration by a blood (at the damage of pulmonary tissues).

Pneumothorax is accumulation of air in the cavity of pleura. Closed, opened, valvular pneumothorax is distinguished

Hemopneumothorax is accumulation of blood and air in a pleura cavity.

First aid. At opened pneumothorax it is necessary to impose an occlusal bandage. At valvular pneumothorax it is necessary drainage of the pleura cavity on Bulau. Transport a victim in position «sit».

Damages of abdomen

Closed damages of abdomen. Quite often cause the damage of hollow organs (intestine, stomach, urinary bladder) or parenchymatous (liver, spleen, kidneys) which are accompanied by bleeding in an abdominal cavity with agile growth of picture of sharp anemia. Signs: pain, swelling of abdomen, symptoms of irritation of peritoneum, tensions of muscles of front wall of abdomen, signs of increasing anemia. A patient often lies on back or on to the side with arcuated in knees and coxofemoral joints.

First aid. It needs cold on an abdomen and urgent hospitalization in surgical permanent establishment.

Opened damages of abdomen. Penetrative in an abdominal cavity and no penetrative (with the damage of peritoneum or not) damages happen. The penetrative damages are often accompanied by the damages of internals. Clinical signs are similar to the closed damages; here is a wound on a front abdominal wall.

First aid. At penetrative damages of abdominal cavity to a victim lay on a wound an aseptic bandage (falling organs out do not set from an abdominal region!) and transport in position lying in surgical permanent establishment.

Traumatic toxicosis

Traumatic toxicosis (syndrome of the prolonged compression) is the original pathologic condition which is conditioned by the prolonged compression of soft tissues of extremities. Thus there is circulatory ischemic necrosis of muscles, intoxication by the products of disintegration with development of hepatic-kidney insufficiency.

It arises up after freeing of extremity of a victim from under the fragments of the blasted house, accumulations of soil and others like that. Pathogenic factors which assist to development of traumatic toxicosis are: 1) pain irritant; 2) traumatic toxemia; 3) loss plasma and blood.

Periods of clinical flow

Period of growth of edema and vascular insufficiency (early, lasts 1-3 days); clinical signs: pain, impossibility of motions|, in a few hours there is the edema of extremity which is progressively multiplies and the skin of it gets a crimson-leaden color with gradual formation of extravasations and bubbles with serosal-hemorragic content, the temperature of body rises, pallor skin is pallor, weakness, the picture of a shock develops. There is oliguria (to 70-100 ml| of urine in days). Urine here gets a lacquered-red color; maintenance of albumen in it is 600-1000 mg/l.

Period of sharp kidney insufficiency (intermediate, lasts from 3rd days to 9-12 days); clinical signs: renewal of circulation of blood, progressive growth of signs of kidney insufficiency (transition of oliguria in an anuria, growth of urea, kreatinine in a blood) with development of the expressed uremia to 5-7 days.

Decubation (late, after 12-14 days); clinical signs: the state of a victim gets better, nitrogenemia diminishes, day's diuresis is restored, the edema of extremity diminishes, a sensitiveness is restored, but the cells of necrosis of soft tissues is present, atrophy of muscles.

Treatment. In place of incident the adequate anaesthetizing by narcotic drugs is implemented, application of the elastic bandage on extremity, immobilization by a transporting splint, urgent hospitalization. Antishock and deintoxication therapy are carried out in a surgical department. Intravenously enter antishock and plasma extender solutions, albumin, donor plasma, baking soda (the common quantity of liquid is 3000-4000 ml/days). Antibiotics of wide spectrum of action are necessary. Locally surround extremity by ice-bags during 2-3 days with changing of bubbles every 3-5 hours. If the symptoms of sharp kidney insufficiency grow it needs conduct the wide section of soft tissues, but in cases of traumatic toxicosis which threatens to life of a victim conduct urgent amputation of extremity. For treatment of kidney insufficiency is needed, at presence of testimonies, to use hemodialysis.

In the period of decubation conduct treatment of purulent wounds, necrosis, gangrene by commons rules.