The Wound - damage of fabrics of an organism owing to the mechanical influence, integrities of a skin accompanied by infringement and mucous membranes.
Depending on the form ranyathego a subject or a wound type of weapon divide on rezannihe, rublennihe, chipped, fragmentary, ushiblennihe, bitten and fire.
Rezanye of a wound put subjects or a cold steel, having keen edges, (a knife, glass, a razor edge). Such wounds have equal edges, usually gape and strongly bleed. The pain at rezanihkh wounds is expressed to a lesser degree, than at other kinds of wounds.
Rublenye of a wound are put by an axe, a draught. On the they are similar with rezannihmi, but deeper and are sometimes accompanied by damage of bones.
Chipped wounds are put by pricking subjects - a needle, a nail, a bayonet, a knife, etc. For them is characteristic small ranevoe an aperture in a skin, but fabrics are thus damaged usually enough deeply, an internal of the person is sometimes damaged also. The external bleeding is usually insignificant.
Lacerations arise at wounds by splinters of shells, at hit of the person under wheels of moving transport etc. At edge lacerations rough, surrounding fabrics are strongly damaged. A bleeding small, painful sensations always the considerable.
Ushiblennye of a wound on appearance are similar to the fragmentary. Ushiblennye wounds arise at strong blow by a stone or other stupid subject, at collapses, shock wave influence.
If fragmentary or ushiblennihe wounds are accompanied by extensive damage of fabrics, them name smashed.
Fragmentary, ushiblennihe and the smashed wounds are often accompanied by development ranevoyj infections.
the Bitten wounds are caused by teeth of animals and the person. The infection always containing in a mouth usually gets to the bitten wounds. They it is frequent nagnaivayutsya and badly heal.
Bullet wounds are put by bullets, splinters of shells, fraction. The wounds put by fire-arms, happen fragmentary, ushiblennihe or smashed. At gunshot wounds fabrics are strongly damaged, quite often bullet or a splinter, getting to skeleton bones, splits up them for parts, and bone splinters in addition damage soft fabrics.
At various wounds and damages microbes get to a wound together with ranyathim a subject, pieces of clothes, a tree, earth clods and so forth, from air, and also at a touch to a wound hands on which microbes always are available in a considerable quantity.
Wounds infected with microbes, name infected, and arising thereof disease - ranevoyj an infection.
the Infected wound in some hours or days becomes covered by touch, its edges become otechnihmi, the surrounding skin reddens, pains in a wound, usually abating through some hours after wound, renew. Body temperature raises, and the state of health of the victim worsens.
In protection of wounds from pollution by microbes and in struggle with ranevoyj an infection an important role play antiseptics and aseptika.
Antiseptics - destruction of the bacteria which have got to wounds by application of antibiotics, chemical and other means which name antiseptic, or antiseptics. As antiseptic tanks use a solution khloramina, iodic tincture, spirit, peroxide of hydrogen, etc. However, application of antiseptic tanks to achieve utter annihilation of microbes in a wound it is not possible more often. Antibiotics (penicillin, streptomycin, etc.) More effectively operate.
Aseptika - a way of protection of wounds from infection with microbes. For this purpose it is necessary, that subjects adjoining to a wound did not contain microbes. Materials and subjects which at all do not contain on itself microbes, are called as sterile. Utter annihilation of microbes in a dressing, on tools and other subjects is called as sterilisation.
Most reliably sterilisation of subjects is reached by high temperature application - boiling water, water steam, hot air and a flame. However, not all can be disinfected in such a way (for example, integuments in circles of the wounds, some surgical tools spoiling under the influence of high temperature). Therefore to disinfecting of some objects apply antiseptics.
Ways aseptiki and antiseptics supplements each other and promotes effective struggle with ranevoyj an infection.
the Wound represents danger as a result of an arising bleeding and pollution possibility its microbes. Bleedings happen arterial, venous, capillary and parenkhimatoznihe.
At an arterial bleeding blood from the damaged artery beats a faltering stream and has brightly - red (scarlet) colour. Such bleeding is the most dangerous, as blood being under pressure follows from an artery quickly enough.
At a venous bleeding blood following from a wound darkly - red colour. It follows from the damaged vessel a continuous stream.
At a capillary bleeding blood exudes from a wound, as from a sponge with drops. Such bleeding is usually easy for stopping, having applied a wound a bandage.
Parenhimatoznym name a bleeding from damaged internal parenkhimatoznihkh bodies (for example, from a liver, a kidney, a spleen). As in an internal it is a lot of arteries, veins and capillaries, parenkhimatoznoe the bleeding happens plentiful and long, and separate vessels it is not visible, and all bleeds ranevaya a surface.
the Main task at first-aid treatment is the fast stop of a bleeding since considerable krovopoterya weakens the victim and can lead to development of shock and even to its destruction.
There are ways of a time and definitive stop of a bleeding. The raising of the damaged extremity, pressing of the damaged vessel concerns the first in a wound (bandage) or throughout its (fingers), the maximum bending of an extremity, imposing a bleeding stop a plait (zakrutki). Ways of a definitive stop of a bleeding apply at processing by surgeons of wounds in dressing and operational premises of medical institutions.
the Raising of an extremity above trunk level reduces inflow of blood and promotes formation of a clot of blood in a vessel and to the bleeding termination.
At artery damage it is necessary to press immediately one or several fingers it to subject bone between a wound and heart. A belly aorta and a femoral artery squeeze a fist.
At damage of large arteries of extremities on 8-10 sm above a place of a bleeding over clothes or a bandage impose krovoostanavlivayuthiyj a plait (Pic. 1).
Pic. 1 Typical places of imposing of a plait
1 - on a shin; 2 - on a hip; 3 - on a forearm; 4 - on a shoulder; 5 - on a shoulder at its wound; 6 - on pakhovuyu area at high wound of a hip
For this purpose it bring under an extremity and stretching wrap up round it before the bleeding termination (Pic. 2).
The Excessive tightening of a plait can become the reason of development of a paralysis of an extremity. The subsequent 2-3 coils impose with smaller effort without a backlash between them and with each other. Use as a plait of rubber bandage allows to squeeze fabrics less damaged.
Pic. 2 Imposing a bleeding stop a plait and - preparation for plait imposing; in - stages of imposing of a plait; g - the plait is imposed.
It is supposed to hold a plait no more than 1,5 hours, and in cold conditions - no more than 1 hour. Otherwise can arise omertvlenie fabrics. Therefore under last coil of a plait enclose a note with instructions of time of its imposing. If evacuation is tightened, it is necessary on 5 - 10 minutes, preliminary having pressed fingers an artery, to weaken a plait and again to impose it a little above. Further it repeat in each half an hour. After imposing of a plait an extremity shiniruyut. In the absence of a plait it is possible to use a belt (Pic. 3.) or zakrutkoyj (Pic. 4.) from an improvised material (a scarf, a material piece).
Pic. 4 Stop of an arterial bleeding zakrutkoyj and - knot setting; - a twisting a stick in - fastening by a stick.
Pic. 3 Use of a zone belt as a plait.
Applied for zakrutki a material 2-3 times obkruchivayut round an extremity, having enclosed lining preliminary made of cloth and the dense platen made of cloth over a place of passage of an artery, and then the ends knot. Over knot put one end of a stick in length of 20-25 sm and over it fasten the second knot. Then turn a stick until the bleeding will not stop. That zakrutka it was not untwisted, the second end of a stick adhere to an extremity. Rules of control over an extremity and zakrutkoyj are similar to rules at plait imposing.
In the absence of crises the arterial bleeding can be stopped extremity fixing in position of the maximum bending. To strengthen squeezing of vessels on a bend in a popliteal, elbow or axillary pole place the dense platen from clothes or the rolled bandage (Pic. 5).
Pic. 5 Stop of an arterial bleeding the maximum bending of extremities at wound of vessels
and at a shoulder root; shins and stops; in - a hip
the Small arterial, venous or considerable capillary bleeding stop imposing of a pressing bandage for what over a wound one or two small pillows of a first-aid kit impose depending on intensity of a bleeding and hardly bandage. For boljshego squeezings of a vessel over small pillows it is possible to put the second rolled bandage. If at damage of an artery the bandage strongly gets wet and from under it blood starts to appear, impose a plait.
At a strong venous bleeding it is necessary to press preliminary a venous vessel below a wound.
Getting wounds and the closed damages can cause an internal bleeding in chest and belly cavities, in soft fabrics. As a result there can be a sharp anaemia (pallor of a skin and mucous membranes, frequent weak filling pulse, the general weakness, dizziness, noise in ears, dimness and flashing of "front sights" in eyes, a nausea). It is necessary to deliver such victims as soon as possible in medical institution, carrying out along the line antishock actions.
the infection which has got to a wound is not less hazardous to health in later period. For protection of a wound against pollution it close a bandage. But before to apply a primary bandage at first-aid treatment, it is necessary to bare a wound without polluting it and without causing a pain to the amazed. Outer clothing remove or cut (unstitch on a seam). At wounds of extremities it is necessary to take off clothes at first from a healthy extremity, and then from the damaged. The bottom clothes, linen and footwear usually unstitch on a seam for an exposure of area of wound, then clothes edges carefully turn on. In the winter to avoid cooling of the wounded man, it is better to do a cut in the form of the valve (two horizontal cuts - above and below a wound - and one vertical), turned out valve put at bandaging aside.
After an exposure of a wound it quickly examine. Thus it is impossible to touch a wound, clearing it of pollution, to grease or wash out any solutions, to delete the splinters which were in it of bones, pieces of the clothes which have stuck to a wound, etc. It is impossible to set the dropped out internal, to use for bandaging an unsterile material. Preliminary a skin round a wound grease with iodine tincture. After bandage imposing, at necessity, clothes put on upside-down, i.e. at first a sick extremity, and then on healthy, with the valve from clothes cover a bandage and fix from above bandage.
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