Purpose: Working off of practical skills on urgent medicine.
Problems of training:
- Trauma. Bruises, dislocations, changes.
- First medical care.
Main questions of a subject:
At changes and considerable damages of soft fabrics before transportation for the purpose of rest creation for the damaged part of a body, reduction of pains, preventions of further damage of fabrics ( pieces of bone), and also it is necessary to apply an immobilization in order to prevent of traumatic shock.
Distinguish the following types of a transport immobilization:
- Primitive immobilization, when healthy sites of a body of the patient are used. For example, an injury foot bandage to other, healthy foot. The injured hand bandage to a trunk;
- Immobilization make-shifts. It means, that it’s possible to use a stick, a piece of a board, a bunch of rods or straw etc.;
- Immobilization the transport tires which have been in advance prepared by a factory way.
- Transport tires share on two groups — fixation and distraction.
Ruled impose of transport tires:
- The transport immobilization should be made as soon as possible from the damage moment.
- Transport tires should provide an immobilization besides the damaged segment of an extremity of at least two adjacent joints.
- At an immobilization of an extremity it is necessary to give to it physiological situation.
- Transport tires are imposed over clothes or footwear.
- At the closed changes before imposing of the tire it is necessary to make easy extension of an extremity with correction of an axis by the last. It is impossible at open changes.
- The tire should be mîdel before imposing.
- The tire should be wound with a soft material.
Sequence of measures at an injury of a backbone
- Primary inspection (the vital functions, at elimination of asphyxia, it is necessary to remember inadmissibility of turn of the head at a trauma of cervical department of a backbone).
- Ensuring passable of respiratory ways.
- Work of a full immobilization of a backbone (transport of lying on a rigid stretcher, at damage of cervical department - under a neck and shoulders enclose clothes parcel, lateral motions of the head strictly limit, put from sides sacks with sand, it is possible to carry out an immobilization a wadded and gauze bandage or a collar such as Shants).
- -In the presence of the complicated trauma (paresis, paralyses, plegia) - infusion therapy of shock degidratation therapy, in/v enter 500-1000 mg a hydrocortisone; make Novocain blockade of interspinal intervals; at an urination delay - make a bladder catheterization.
At an injury of the top or bottom extremity it is necessary to carry out:
- Survey and a palpation on symmetry and existence of angular curvatures or deformations.
- Check of distal pulse and capillary filling.
- Assessment of sensitivity of an extremity, bending and flex off, muscular force and symmetry of movements (probable symptoms of a fracture of an extremity: a swelling, hypostasis, hemorrhage in a fabric, a hematoma, local morbidity - strengthening of pains at loading on an axis; violation of function and compelled position of an extremity, authentic signs: shortening of an extremity or lengthening, deformation of an axis of an extremity, pathological mobility, a palpation of the ends îf bone in a change zone).
- Carrying out anesthesia.
- Carrying out transport an extremity immobilization without carrying out attempts of a reposition of changes (in/m Promedol 2 %-1 ml or Tramal 2ml, in a change place – Novocain 1-2 % solution 15-20 ml, at intra articulate changes - a puncture).
At the closed changes
- before imposing of the tire it is necessary to make easy extension of an extremity with correction of an axis by the last. It is impossible at open changes;
- the tire should be wound with a soft material;
- the tire should be model before imposing;
Ladder tires (Kramer) - with their help it is possible to make an immobilization of any segment, any damage. Diterikh`s tire allow to make an immobilization and extension of the injured foot. Direct indications for its imposing are injuries of a coxofemoral joint, knee and injuries of a femur, at a fracture of a shin isn't a mistake, but it is better to use other tires.
Mesh tires are suitable for an immobilization of small bones (foot or a brush).
In the absence of organic means use make-shifts. At damage of a humeral belt (damage of soft fabrics, fractures of a clavicle, a shovel) - an immobilization by imposing of a bandage of Dezo or a triangular bandage.
At open changes:
- to make a temporary stop of external bleeding (in cases of massive bleeding from change area forcedly on an extremity leave a plait, at bleeding of small intensity try to stop a pressing bandage after adequate anesthesia, is inadmissible to set acting in a wound the pieces îf bones;
- to begin infusion therapy off shock (see point 4) bones according to indications. - to carry out anesthesia.
The basin is «A shock - zone» since it is rich with vessels and nerves, pelvic bodies (an urethra, a bladder, a rectum, female genitals) also can be damaged.
- - to lay the victim on a back on a firm surface, under fossa poplitea - the simulated ladder tires or the soft roller, it is best of all a pneumatic stretcher;
- therapy off shock (infusion therapy according to the standard scheme);
- a stop of external bleeding, especially from buttock area (in this zone imposing of clips or a sewing of fabrics in a wound is admissible);
- for anesthesia an anesthetic directly into a damage zone (a change of a sacrum, a tailbone, a gap symphysis);
- at absence urinate-let out urine with a soft catheter, in unsuccessful attempts make a bladder puncture (on the average line on 0.6-1 sm above a pubic joint)
- at open damages enter anticonvulsive serum and anatoxin;
- in/m enter an antibiotic of a wide range of action.
Training and teaching methods: small groups, discussion, situational tasks, work in pairs.
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