home Diseases Types and classification of industrial injuries by severity. What are the types of injuries and their classification?

Types and classification of industrial injuries by severity. What are the types of injuries and their classification?

The concept of trauma. Classification and characteristics of injuries.

Injury- these are factors external environment, causing tissue damage or functional impairment in the body without visible morphological changes in them.

Damage is a violation of the integrity or functional state of tissue that occurs as a result of exposure to any trauma. The body responds to damage with an appropriate protective adaptive reaction.

Classification

1. Mechanical injuries- the effect of mechanical force on the body. Injuries causing mechanical injuries are divided into surgical, accidental, birth, and wartime. They can be open or closed. Both are non-/direct, multiple and single.

Closed mechanical damage characterized by the preservation of the anatomical integrity of the skin and mucous membranes. These include bruises or contusions, sprains, ruptures of soft tissues and parenchymal organs, dislocations of joints, and violation of the integrity of bones. Due to the peculiarities of the anatomical and histological structure of the skin, it has great elasticity and strength. Therefore, its anatomical continuity can be preserved even in the event of severe injuries, when the organs and tissues underlying it are in a state of stretching, rupture, crushing, crushing, fracture and even fragmentation.

Open mechanical damage-wounds are characterized by separation of the skin, mucous membranes and underlying soft tissues, internal organs and bones. They are more susceptible than closed ones to repeated traumatic effects of the external environment, as well as to pollution and contamination with various microorganisms. These include wounds of various types and nature, open fractures and dislocations. Direct mechanical damage occurs at the site of application of traumatic mechanical force. Indirect - appear at a certain distance from the place of application of the traumatic impact.

2. Thermal injury They are less common than mechanical ones and are associated with exposure of animal skin to high (burns) or low (frostbite) temperatures.

3. Electrical injury associated with the passage of electric current or lightning through the body.

4. Radiation injury associated with more or less prolonged exposure to radiant energy or ionizing radiation. This type of injury does not cause an immediate defensive reaction in animals and is not recognized immediately after its application.

5. Chemical injury is a consequence of exposure to tissues of acids, alkalis, salts of heavy metals, chemical warfare agents and some chemical substances used for processing animals. Some chemicals cause predominantly local damage, while others, when absorbed through the skin and mucous membranes, have a toxic effect on the entire body.

7. Mental trauma occurs when fear is caused by the perception of external phenomena by the visual and auditory analyzer, as well as gross human influence that causes fear in animals. This injury is more often observed in animals with increased excitability and a predominance of excitatory processes over inhibitory ones. Each of the above injuries can be acute or chronic. Under the influence of acute injuries, tissue damage immediately occurs in the body, functional disorders, and acute reactive processes; in case of chronic injuries, these phenomena appear after prolonged or repeated exposure to it.

Combined trauma is also distinguished when the impact on tissue of one of the traumas, for example mechanical, is combined with the damaging effect on them of chemical or other trauma. Then more severe damage occurs in the body, often ending in the death of the animal.

Immediately after the application of heavy trauma, and sometimes at the moment of their application, there is a danger of developing collapse, shock, paresis, paralysis, loss of individual tissues, organs, body parts, possible sudden death. Mechanical injuries, especially wounds, are accompanied by bleeding, often threatening the life of the animal. Damage to the integument facilitates the penetration of infection into the tissues of the internal environment of the body and creates the risk of developing a general or local infection.

With extensive, especially closed, traumatic toxicosis often develops, caused by the absorption of products of the enzymatic breakdown of dead tissue. Under the influence of injuries, trophic disorders often develop, worsening or completely inhibiting regeneration. With major damage and tissue necrosis, even after favorable healing, extensive scars develop at the site of injury, complicating or completely eliminating the function of an organ or even entire parts of the body.

The outcomes of injuries of the same strength and duration of impact depend on the anatomical and physiological characteristics damaged tissues and organs, their vital importance, the presence of previous pathological changes, as well as from the functional state of the nervous system at the time of injury and the species reactivity of injured animals.

2. The concept of injury. Classification and principles of injury prevention.

Trauma is understood as a combination of various factors, causing damage body.

Currently there is a distinction the following types animal injuries:

1. agricultural;

2. operational;

3. sports;

4. transport;

5. random;

7. fodder, with its causal and damaging characteristics.

1. Agricultural injuries occurs as a result of violation of zoohygienic conditions and rules for keeping animals (drafts, poorly constructed floors and liquid drains, dampness, poor ventilation, malfunction of premises and equipment, insufficient walking areas and exercise, improper organization of large group housing), as well as due to improper and careless use means of mechanization, automation and electrification (violation of safety regulations).

2. Operational injuries observed with improper and excessive exploitation of animals.

3. Sports injuries, being a type of exploitation, is observed mainly in horses. Most often it is caused by improper training, inept management and underestimation of the physiological capabilities of the animal, as well as competition conditions, terrain, etc.

4. Transport injuries occurs in animals during transportation by rail, road, water and air transport. It is characterized by the relative mass and originality of damage to the static-dynamic apparatus of animals (sprains of the tendon-ligamentous apparatus, myositis, myopathosis, arthritis, pododermatitis, etc.).

5. Accidental injury is predominantly mechanical, thermal, chemical, electrical, and radiation in nature. It is often associated with meteorological and natural disasters. It is more difficult to predict and prevent than other types of injuries.

6. Military injuries- a set of mechanical, thermal, chemical, electrical and radiation damage caused to animals during war.

7. Feed injuries associated with feeding, feed preparation, feed quality, as well as the condition of pasture lands (contamination with metal objects, poisonous herbs etc.).

Clinical signs

For treatment, etiotropic therapy is used, aimed at eliminating the cause of shock and symptomatic, which includes the use of adrenaline, long-term (more than 5-6 hours) infusion therapy, oxygen therapy, as well as the administration of medications - antibiotics, diuretics to relieve pulmonary edema, steroid hormones, analgesics and others, depending on the severity of the condition and the dynamics of the disease.

Clinical signs

The erectile phase of shock develops at the moment of injury and lasts from several seconds to several minutes. Clinically, it manifests itself as a sharp, violent excitement: the animal makes strong sounds (squealing, growling, etc.), fights, and strives to free itself from fixation. The eyes are wide open, the pupils and nostrils are dilated, breathing is rapid; The pulse is frequent, strong filling, blood pressure is increased. Increased sweating may occur.

With a mild form of erectile shock and the cessation of severe painful stimulation, the animal emerges from the state of shock. In cases of moderate and especially severe forms, the erectile phase passes into the torpid phase of shock.

The torpid phase of shock is characterized by a sharp depression, a decrease in reflexes while maintaining “consciousness”; lack of response to newly inflicted pain; a decrease in all body functions, as a result of which the muscles become flaccid, the animal lies down or falls, lies motionless, weakly responding to auditory stimuli.

Breathing becomes shallow, irregular and rare, mucous membranes are pale; the pulse is weak, frequent, barely perceptible, blood pressure progressively drops; there is a glassy sheen to the cornea, the pupils are dilated and react sluggishly to light; body temperature decreases by 1-2°C; there is involuntary separation of feces and urine.

The blood gradually thickens; the amount of plasma decreases, as a result of which the number of red blood cells in the blood volume increases; hemodynamics worsen, cardiac activity weakens; metabolism is disrupted; Kidney function decreases, oliguria and even anuria occur; the functional state of other organs and systems changes.

With a favorable course and timely treatment, the torpid phase of shock ends with recovery, in other cases it passes into the paralytic phase due to exhaustion nerve centers and the occurrence of central paralysis. During this phase, body temperature decreases by 2°C and even 3°C, and blood pressure becomes very low. The pulse is barely perceptible, reflexes and other reactions to external stimuli are missing.

Treatment. Rational therapy traumatic shock should be comprehensive, as early as possible, aimed at correcting all impaired vegetative processes and restoring functional disorders of the body.
The basic principles of treatment for shock are:
1) urgent cessation (blocking) of the flow of pain impulses from the injury zone to the cerebral cortex;
2) elimination of the cause (source) of painful irritation (trauma, surgery, etc.) and normalization of the function of the nervous system;
3) restoration of hemodynamics and increase in blood pressure;
4) cessation of toxemia and restoration of impaired metabolism.
Blocking pain impulses is achieved through the urgent use of novocaine blockades, the type of which is determined by the type and location of the damage that caused the traumatic shock. For open injuries of the thoracic organs (pneumothorax), a cervical vagosympathetic blockade is used, and for abdominal and pelvic injuries, a suprapleural novocaine blockade of the splanchnic nerves and borderline sympathetic trunks is used (according to V.V. Mosin). Positive effect can be obtained from intravenous administration of novocaine (0.25% solution at a dose of 1 ml/kg). Vitamins C, Bj, B6, B12 are urgently prescribed. To relieve shock during operations and injuries, bone fractures, local anesthesia (infiltration, conduction, epidural) is immediately administered, depending on the location of the injury, after which the consequences of the injury are eliminated. Penetrating wounds into the chest and abdominal cavities are closed with sutures after careful antiseptic treatment; in cases of intestinal prolapse, it is inserted into the abdominal cavity. To prevent and relieve painful irritation during bone fractures, a 2-3% solution of novocaine in 30% ethyl alcohol is injected into the fracture zone; if the nerve trunk is pinched, it is freed from bone fragments and an immobilizing bandage is applied.
After turning off pain reflexes, treatment is aimed at restoring impaired body functions. The animal is given absolute rest.

In the treatment of traumatic shock Blood substitutes and anti-shock fluids can be used. Protein-containing liquids are used as blood substitutes - colloidal infusin, aminopeptide, aminokrovin, gelatinol, etc. Among synthetic agents, polyglucin (dextran), polyvinol, polyvinylpyrralidone are recommended. The dose of the infused blood substitute depends on the severity of the traumatic shock, the characteristics of the injury and its complications - on average it ranges from 3-4 to 5-6 liters.
It must be remembered that any one transfusion agent should be administered, since most of them are antagonistic.
Note that recommended in some textbooks general surgery in case of traumatic shock, the prescriptions of anti-shock liquids by E. A. Asratyan and I. Popov are not harmless to the animal body due to the overestimated dose of sodium chloride in them. In the liquid of E. A. Asratyan, its dose exceeds the therapeutic dose by 8-10 times, and in the liquid of I. Popov - by 3-4. In this regard, the “camphor serum” according to the prescription of M. V. Plakhotin, which provides a high therapeutic effect, deserves attention. It contains the following items: camphor - 3 g, glucose - 100 g, calcium chloride - 20 g, physiological sodium chloride solution - 2000 ml. It is administered intravenously to large animals at a dose of 1500-2000 ml, to small animals - 150-200 ml. This liquid is also effective for secondary shock, the etiological factor of which is intoxication and infection. For these purposes, a 40% solution of hexamethylenetetramine is also used in a dose of 40-50 ml (large animals) with the addition of 10% calcium chloride and a dose of caffeine (intravenously). Both of the latter agents provide detoxification, remove toxins from the body, and reduce the permeability of capillaries and cell membranes. However, it should be remembered that in all cases of treatment for traumatic shock it is necessary to carry out complete or partial excision of dead tissue and careful drainage.

Prevention of traumatic shock is based on ensuring optimal zoohygienic conditions in the keeping, feeding and exploitation of animals, excluding mechanical and other types of injuries. When performing surgical operations, anesthesia is used to prevent surgical shock, local anesthesia and special novocaine blockades. Thus, to prevent shock, a suprapleural novocaine blockade is performed before abdominal operations (according to V.V. Mosin). To prevent pleuropulmonary shock during penetrating wounds and operations on the thoracic organs, a vagosympathetic blockade is performed, and a glucocorticoid is administered before surgery, which helps increase the body’s resistance to the development of postoperative shock.

Etiology of inflammation

Phases of inflammation

First phase inflammation is characterized by hydration phenomena (swelling), it occurs at the site of inflammation as a result of active hyperemia, exudation, acidosis, local metabolic disorders, redox processes and acid-base balance. Subsequently, hydration increases as a result of impaired blood and lymph circulation and activation of enzymatic processes, accumulation of physiological active substances and increased oncotic and osmotic pressure.

The main processes unfolding in the first phase boil down to the following: in the center of the inflammation, conditions are created for interstitial digestion of dead tissue and infection, and along the periphery, at the border with healthy tissues, processes of localization and limitation (barrierization) of the damage zone and the primary introduction of infection arise. First, a cellular barrier is formed, which gradually turns into a granulation barrier.

During the enzymatic breakdown of dead tissue, toxic products of tissue destruction (aseptic inflammation) or microbial toxins (in infectious inflammation) accumulate at the site of inflammation. In this case, tissue cells are additionally necrotic, leukocytes are damaged and die. As a result of enzymolysis and phagocytosis in the central part of the focus of infectious inflammation, dead tissue is liquefied, purulent exudate accumulates, and an abscess cavity is gradually formed, delimited from adjacent undamaged tissues by a granulation barrier. This barrier prevents the generalization of infection and the spread of necrosis to damaged tissue. Complete delimitation of the purulent cavity by the granulation barrier indicates the maturation of the abscess. As it matures, the inflammatory phenomena begin to weaken, and the inflammation enters the second phase.

Following the influence of a damaging agent, a reflex spasm of small blood vessels occurs in the damaged area; soon they expand, active hyperemia develops, blood flow accelerates, blood pressure and local metabolism increase. At the same time, histamine, acetylcholine, and leukotaxin are released, and potassium ions and other tissue breakdown products are released from damaged cells. By acting on the walls of blood vessels, these substances further enhance blood flow, increase local blood pressure, increase capillary permeability and exudation of the liquid part of the blood. Initially, small molecular proteins - albumins - penetrate into the tissues along with the exudate, later globulin proteins and, finally, fibrinogen. At the same time, leukocytes migrate from the vessels and accumulate in the tissues of the damaged area (especially in large numbers during purulent inflammation).

The accumulation of leukocytes in the inflammatory focus is accompanied by the development of phagocytosis and enzymatic action on the harmful agent.

Violation fat metabolism leads to the accumulation of fat and fatty acids in the exudate due to the breakdown and degeneration of cells. Incomplete oxidation of fats occurs, and a large amount of under-oxidized products accumulates at the site of inflammation.

Protein breakdown is carried out by enzymes of mesenchymal cells and proteolytic enzymes secreted by neutrophilic leukocytes. Under their influence, large molecules of polypeptides and amino acids are formed at the site of inflammation. The accumulation of under-oxidized products of carbohydrate, fat and protein metabolism and bound carbon dioxide is accompanied by an increase in the concentration of hydrogen ions and the development of acidosis. Initially, acidosis is compensated, since acidic foods are neutralized by alkaline tissue reserves (compensated acidosis). Subsequently, when blood and lymph circulation becomes difficult or completely stops at the site of inflammation, the concentration of hydrogen ions increases even more, and the alkaline reserves of tissues are depleted, decompensated acidosis occurs.

Due to the death and decay of cells in the exudate, the amount of potassium ions increases. The more intense the inflammation, the more potassium accumulates in the exudate. Their accumulation contributes to increased vascular permeability, increased pain, the development of neuro-dystrophic phenomena and necrotization of tissues with reduced viability.

The breakdown of tissue elements is accompanied by the splitting of large molecules into small ones, which leads to an increase in molecular and ionic concentrations. As a result of this, it increases osmotic pressure, and this leads to further disruption of blood and light circulation and adversely affects the functional state of cells. Along with this, oncotic pressure also increases, i.e., the dispersion of tissue colloids and their ability to attract and retain water increases. Towards the periphery of the inflammation, the oncotic pressure, as well as the concentration of hydrogen ions and potassium, gradually decreases. The described bio-physico-chemical changes that develop in the focus of inflammation contribute to hydration phenomena, i.e. swelling, primarily of damaged tissues, as well as increased proteolysis and active phagocytosis.

In the first phase of inflammation in horses and dogs, serous (aseptic inflammation) or serous-purulent ( infectious inflammation) exudation and pronounced proteolysis (melting) of the dead substrate, while in cattle and pigs serous-fibrinous or purulent-fibrinous exudation with sequestration phenomena is observed, proteolysis is weakly expressed. As a result, dead tissue in these animals lingers at the site of inflammation for a longer time. Their rejection occurs due to the developing purulent-demarcation inflammation. The process of sequestration is accompanied by the formation of a granulation barrier with a relatively small accumulation of pus between it and the sequestered dead tissues. During the process of sequestration, the dead substrate is also subjected to enzymatic melting. The sequestered piece of dead tissue is then slowly lysed by proteolytic and other enzymes, and when open damage(wounds, burns) is rejected into the external environment.

Second phase inflammation is characterized by a decrease in all signs of inflammation and a gradual normalization of bio-physico-chemical disorders that arose in the first phase. This contributes to the development of dehydration phenomena (swelling) at the site of inflammation. Against the background of which, compensatory and restorative processes predominate in the inflammatory focus, accompanied by compaction of connective tissue colloids, cell membranes and a decrease in capillary permeability. At the same time, the barrierization (localization) of the inflammation site by the developing granulation tissue is completed. Subsequently, it can turn into a connective tissue capsule, as a result of the development of which more perfect isolation (encapsulation) of the source of inflammation occurs. If in this phase exudative processes predominate over proliferative ones, then self-cleansing of the body from tissue decay products and microorganisms occurs by removing the contents, for example, an abscess, into the external environment.

Following this, regeneration becomes the main process at the site of inflammation. Thanks to this, the tissue defect that arose as a result of the alterative (destructive) phenomena of the first phase of inflammation is replaced mainly by connective tissue elements, which then turn into a scar. This occurs against the background of gradual normalization of trophism and metabolism. In this regard, in the inflammation zone, the amount of potassium and under-oxidized products decreases, oncotic and osmotic pressure and acidosis decrease, exudation decreases significantly, and the emigration of leukocytes and their phagocytic reaction decreases. At the same time, the number of histiocytic elements increases, the macrophage reaction increases, and regeneration processes unfold more fully than in the first phase. Recovery is coming.

Outcome of inflammation

Distinguish full resolution inflammatory process And incomplete resolution of the inflammatory process.

Complete resolution of the inflammatory process is an outcome when damaged tissue is restored at the site of the inflammatory focus and their function is restored. Typically, this outcome is often observed on the mucous membranes of the gastrointestinal tract. intestinal tract, respiratory tract, as well as for minor damage.

Incomplete resolution of the inflammatory process is an outcome when connective tissue grows in place of dead tissue. This process is usually observed in cases of significant damage to organs or tissues. The function of organs decreases.

6. Stages of development of the inflammatory process.

7. Clinical manifestation serous manifestation.

8. Clinical manifestation of serous-fibrinous inflammation.

9. Clinical manifestation of fibrinous inflammation.

10. Principles of treatment of aseptic inflammation.

Etiology and pathogenesis

Most often, purulent processes are caused by various types of staphylococci; a large number of them are found on objects surrounding the animal, on itself, which creates conditions for infection of any accidental wound.

Their pathogenic effect is associated with the release of toxins that destroy blood cells and enzymes that coagulate and destroy proteins. Their virulence in pus increases sharply, which explains the particular danger of infection with purulent discharge from wounds.

Purulent processes can be caused by Escherichia coli, which is always present in large quantities in the intestinal contents and on the contaminated surface of the animal’s body. The process caused by Escherichia coli is characterized by putrefactive melting of tissues; it is especially important during purulent processes in the abdominal cavity. If the barrier function of the gastrointestinal mucosa is disrupted, Escherichia coli can penetrate into the general bloodstream and cause intoxication and even sepsis.

Pneumococcus causes an inflammatory process that is fibrinous in nature; the localization of such processes can be different.

Fibrinous – purulent inflammation develops when infected with Pseudomonas aeruginosa, which saprophytes on the skin in areas rich in sweat glands. Its development significantly inhibits tissue regeneration in the wound.

In the development of the purulent process, the routes of introduction and spread of pathogens are important. Undamaged skin and mucous membranes serve as a reliable barrier through which pyogenic microorganisms cannot penetrate. Damage to this barrier can occur as a result of mechanical trauma, thermal injuries, chemicals and other traumatic factors. In this case, the size of the damage is not decisive for the penetration of microbes. Through a defect in the integument, microbes enter the intercellular gaps, lymphatic vessels and, with the flow of lymph, are carried into deeper tissues: skin, subcutaneous tissue, muscles and The lymph nodes. Further spread and development of the purulent process depends on the number and virulence of the invading microbes and the immunobiological forces of the organism itself.

Purulent infection encounters significant resistance in areas of the body with a good blood supply.

Moments that favor the development of pyogenic microbes when they penetrate through a defect are:

1. the presence in the area of injury of a nutrient medium for them (hemorrhages, dead tissue):

2. simultaneous penetration of several types of microbes - polyinfection

3. penetration of microbes with increased virulence.

The body's reaction to purulent infection has local and general manifestations.

Sepsis

Sepsis is a severe infectious disease caused by various pathogens and their toxins, manifested by a peculiar reaction of the body with a similar clinical picture, despite the difference in pathogens.

Classification

1. By time of manifestation clinical signs distinguish between primary and secondary sepsis

Primary (cryptogenic)-hidden, associated with autoinfection, when the primary focus of inflammation cannot be found.

Secondary- develops against the background of the existence of a purulent focus in the body.

2. According to the localization of the primary focus: surgical, umbilical, gynecological.

3. By type of pathogen: coccal, colibacillus, anaerobic.

4. By source: wound, postoperative, inflammatory

5. By time of development: early (up to 10-14 days from the moment of damage) and late (2 weeks or more from the moment of damage).

6. By type of clinical course:

Fulminant-characterized by rapid generalization of the inflammatory process. The duration of the course is 5-7 days, and most often death.

Spicy-characterized by a more favorable course. The duration of the course is 2-4 weeks.

Subacute- lasts 6-12 weeks with a favorable outcome

Chronic If it is not possible to eliminate acute sepsis, then it turns into chronic stage, which lasts for years with periodic exacerbations and remissions.

7. According to clinical and anatomical characteristics: septicemia (without metastases), septicopeemia and pyaemia (with secondary metastatic purulent foci).

Pathogenesis

In the mechanism of sepsis development, 3 factors are important:

1. Microbial - number, type and virulence of microbes.

2. Type of entrance gate (the nature of tissue destruction or the size of the purulent focus, its location, the state of blood circulation in this area).

3. Reactivity of the body, that is, the state of immunity and nonspecific resistance of the body.

The development of sepsis is caused not so much by the properties of the pathogen as by an acute disorder of local immunobiological mechanisms, which the body is unable to suppress, creating a protective barrier at the level of the entrance gate for infection.

Microbes and their toxins, having entered the bloodstream, in many cases can no longer be destroyed due to a breakdown in the biological defense system.

The clinical picture is determined by the form of sepsis.

Septicemia

Septicemia is a toxic form of sepsis. It occurs acutely or lightning fast, often with death.

Characterized by massive influx of toxins into the blood with severe general intoxication. At the same time, bacteria are also found in the blood.

The entry of toxins and tissue breakdown products into the blood leads to severe overirritation of the peripheral nerves, spinal cord and brain.

In this regard, septicemia occurs with early suppression of protective adaptive and immunobiological reactions. As a result, the body’s ability to localize the inflammatory focus is suppressed and acute anaerobic processes occur.

Septicemia is characterized by severe depression, refusal of water and food, cachexia, increased body temperature, and persistent fever.

Hemodynamic disorders immediately develop: tachycardia, increased heart rate. Blood pressure drops, heart sounds become muffled. Breathing quickens, cyanosis of the mucous membranes and areas of skin without hair appears.

Periodically, animals develop agitation, accompanied by a convulsive state. Excitement is replaced by lethargy, the skin and sclera are jaundiced (hemolysis of red blood cells).

Sometimes you can palpate an enlarged spleen, which is accompanied by a painful reaction on the part of the animal. Subcutaneous hemorrhages are sometimes noted.

In dogs, perversion of taste, nausea and vomiting, profuse diarrhea - all this leads to dehydration.

In sick animals, due to severe trophic disturbances, bedsores appear, the number of red blood cells and the percentage of hemoglobin sharply decrease. The amount of billy ruby in the blood increases.

In the primary focus, purulent-necrotic, putrefactive or gangrenous tissue breakdown is detected.

Pyemia

It is characterized by bacteremia and purulent metastases in various organs.

During this process, microbes, entering the bloodstream from the primary focus, are transported to the capillaries of various organs, where they settle, creating purulent lesions.

Sometimes secondary infected blood clots can form here and travel to other organs, where secondary purulent metastases develop.

Septicopyemia

With septicopyemia, protective-adaptive, immunobiological reactions are not completely suppressed. Therefore, septicopyemia has a more favorable course. It occurs acutely and subacutely.

In cattle and pigs, microbial metastasis is more often through the lymphatic vessels; in dogs and horses - hematogenous route of metastasis.

Ulcers are localized in various organs and tissues, and can be single or multiple. The settling of microbes in tissues is facilitated by slow blood flow. This depends on the structure of the capillaries, weakening of cardiac activity, general weakness, sensitization of the body and other reasons.

General changes in metastatic forms of sepsis, they are characterized by a severe general condition, refusal of food and water. High body temperature is also characteristic, but with periodic remissions. Daily fluctuations in body temperature are 2-4 0C. and when the temperature drops, there is severe sweating.

Remitting fever is combined with intermittent fever. This type of fever with a temporary decrease in temperature indicates a periodic decrease in the flow of microbes and their toxins into the blood. This is usually associated with maturation and the formation of a granulation barrier around the abscess.

A new rise in temperature indicates a secondary breakthrough of the infection beyond the metastatic focus.

Local changes in the primary lesion are characterized by progressive edema, necrosis, delayed formation of the granulation barrier, pain in muscles and joints.

As a result of prolonged or massive toxic-microbial exposure, thermoregulation is disrupted:

In case of severe general condition, arrhythmic pulse of weak filling and decreased blood pressure - the temperature is slightly increased.

Every person has encountered trauma in life. They arise in a wide variety of situations and according to the most various reasons. It is these problems that I want to talk about now. So, injuries. What is it? When and how they arise, what they are and what kind of help should be provided first - read about it further.

Terminology

Initially, you need to understand the terminology that will be used in this article. Injuries are violations not only of the integrity, but also of the functionality of organs and tissues that occur as a result of exposure to environmental factors. At the same time, we also need to understand what injury is. So, this is a certain number of injuries (their totality), which are repeated under certain circumstances in the same population groups over the same period of time. It is worth noting that injuries are a statistical indicator that makes it possible to draw a complete picture of a particular type of injury in certain population groups. It must be said that these indicators are very important. After all, they make it possible to analyze the epidemiology of various types of injuries, as well as choose the right paths prevention.

Mechanical injuries

Having understood that injuries are problems that arise as a result of environmental factors, it is also worth considering their different classifications. Initially we'll talk about mechanical injuries. In this case, mechanical force is applied, as a result of which certain damage occurs. If we were talking about animals, a mechanical injury would be an injury from a harness, batog, chain (on which dogs are kept). In humans, such injuries are divided into several subtypes:

However, this is not the only classification of mechanical injuries. They are also divided into:

direct (occur in a certain place as a result of the application of a traumatic mechanical force) and indirect (appear close to the place of application of the traumatic force (for example, a dislocation as a result of a jump from a height);
multiple and single;
closed (the integrity of the skin and mucous membranes in this case is not violated; these can be bruises, and open (as a result, the mucous membranes, as well as the integrity of the body tissues, are disrupted; most often these are dislocations and open fractures).

Damage that occurs as a result of mechanical trauma

If a person has been injured, it is imperative to figure out what exactly it is. Thus, as a result of mechanical injuries, the following damage can occur:

Abrasions. In this case, the integrity of the epidermis is compromised (the vascular or surface layer suffers, lymphatic or blood vessels are damaged). It is also worth noting that the surface of the abrasion is always wet at first, then it becomes covered with a crust of coagulated blood and plasma. This roughening disappears over time, and a special pigmentation of the skin may remain at the site of the abrasion for some time (the color will be somewhat lighter than the normal skin). Abrasions heal completely within about a week or two after receiving them.
Bruising. They are formed at the site of mechanical damage as a result of rupture of blood vessels. So, the blood is visible through the top layer of the skin, so the color of such an injury is visible in blue-red tones. Over time, the color of the bruise will change, indicating that it will soon disappear (from purple-blue to green-yellow). The time for complete recovery depends on many reasons and varies from person to person (factors that influence the speed of recovery: depth, size and location of the damage).
Dislocations. This is a different kind of displacement of bones in the joints (so-called joint injuries). Occurs mainly in upper limbs, extremely rarely - in the lower ones. May be accompanied by tissue ruptures. Eliminated by experienced doctors.
Bone fractures. This is a violation of the integrity of the bones of the entire human skeleton. Often accompanied by damage to nearby tissues, ruptures of blood vessels and muscles, as well as various types of hemorrhages. Fractures can be closed (occur inside soft tissues) or open (a rupture of the skin occurs, as a result of which the broken bone communicates with the external environment).
Wounds.

More about wounds

In this case, the integrity of the tissue and mucous membrane is damaged. Wounds often penetrate deep tissue. It is important to note that this type of trauma can be dangerous for a person for the following reasons: bleeding may occur; infection can leak through tissue tears; there is a risk of violating not only the integrity, but also the functionality of internal organs.

There are which are divided depending on the conditions of occurrence:

Cut. They occur as a result of exposure to a sharp sliding object (most often a knife).
Stabbed. They are applied with an object that has a small cross-section.
Stabbed and cut.
Torn. They arise due to tissue overstretching.
Bitten, which arise as a result of the impact of teeth on human tissue.
Chopped. They are applied with a heavy sharp object (most often an ax).
Crushed. In this case, not just rupture occurs, but also tissue crushing.
Bruised. Appear as a result of a blow with a blunt object (or from a blow to a blunt object).
Firearms. They arise as a result of the use of a firearm or injury from fragments of explosive ammunition.
Scalped wounds- these are those that result in the separation of an area of skin.
Poisoned. They occur when poison gets into the wound as a result of an injury or bite.

Other types of injuries

So, injuries are damage to body tissues, as well as individual organs. In addition to mechanical ones, the following types are also distinguished:

Thermal injuries. They arise due to the effect of high or low temperature on the body. Damage that can occur as a result of thermal injury: burns (caused by exposure to too high temperatures) and frostbite (the body is then exposed to low temperatures). It is worth noting that it is the second type of injury - frostbite - that poses the greatest danger. And all because they have a so-called “latent period”, when the body’s signals about problems are too weak and even almost invisible.
Electrical injury. In this case, lightning or technical electric current passes through the human body. As a result of this, damage occurs, most often burns.
Chemical injuries can be obtained as a result of exposure to the body of acids, alkalis, salts of heavy metals, etc. It is important to note that certain chemicals can cause local damage, while others penetrate deep into the body, causing more serious harm.
Radiation injury. It occurs as a result of an effect on the body or, more simply put, radiation.
Biological trauma capable of causing various infections, viruses, bacteria, as well as poisons, toxins and allergens.
Mental trauma. This is a special type of this problem. And all because it is extremely difficult to classify such an injury. It usually occurs as a result of difficult experiences. Leads to various painful reactions from the vegetative and mental spheres (this can be either simple neuroses or depressive states).

Classification of injuries by severity

Various kinds medical injuries They are also distinguished by severity. According to this criterion, the following are distinguished:

Severe injuries. In this case, the deterioration in health is sharp and significant. The ability to work is impaired for a period of a month or more.
Moderate injuries. The changes in the body are pronounced. A person is considered disabled for 10 to 30 days.
Minor injuries. Disturbances occurring in the body are considered minor. There is no loss of performance.
Acute injuries. They arise as a result of the action of one or another traumatic factor.
Chronic injuries. They arise as a result of exposure to the same place on the body by the same traumatic factor.
Microtraumas. In this case, tissue cells are injured.

Classification depending on environmental factors

Injuries are also distinguished depending on environmental factors. In this case, it is customary to talk about the following types:

Industrial injuries. That is, those that arise in factories.
Military trauma - can be received as a result of military actions.
Agricultural injuries occur in fields, barnyards, etc.
Domestic injuries can occur in the home.
Transport injuries are caused by vehicles.
Sports injuries occur as a result of playing sports (both professional and ordinary).
Childhood injuries can occur in a person who has not yet reached the age of 14.

First aid

Immediately after an incident such as injury, the victim must be provided with all possible assistance as soon as possible. This will of course vary depending on various factors. However, it should be noted that in most cases, after any injury, it is best to seek medical help: go to the nearest medical institution. Or, if necessary, call an ambulance. After all, only a qualified specialist can cope with problems of varying severity.

What to do in this or that case

As mentioned above, care for injuries will differ significantly. However, in any case, a person must know what actions he should take first.

Treatment

It is important to note that treatment for injuries can also vary greatly. It will vary depending on the damage itself. IN in rare cases You can help yourself as best you can. In most cases, treatment should be prescribed exclusively by a doctor. Eg, brain injury is treated for a very long time. At the same time, the costs will be very serious. With ordinary bruises, there is often no need to seek medical help. And to get rid of them, no material costs are required at all.

Consequences

What can be the consequences of injuries? There is also no clear answer here. It all depends on what kind of damage the person received. So, if there was an ordinary bruise or bruise, after a certain time there will not even be an external reminder of it. If a fracture occurs, there will be consequences. They may not be visible from the outside. But they will definitely stay inside. Moreover, in this case, the broken parts of the body often remind me of myself. They say about this: “cool” for the weather. The most serious are the consequences of radiation injuries.

Text:

Rosa Ismailovna Yagudina, d.f. Sc., prof., head. department of organization drug provision and pharmacoeconomics and head. laboratory of pharmacoeconomic research of the First Moscow State Medical University named after. I. M. Sechenov.

Evgenia Evgenievna Arinina, Candidate of Medical Sciences, Leading Researcher at the Laboratory of Pharmacoeconomic Research of the First Moscow State Medical University named after. I. M. Sechenov.

Currently, injuries, especially when spring ice begins, are one of the main causes of disability, disability and mortality, and therefore are of great socio-economic importance.

Injuries accompany a person throughout his life. Among the total number of visits by emergency medical services teams, almost 30% are associated with accidents. Injury rate in Russian Federation is 8730.3 cases per 100 thousand adult population, that is, annually there are an average of about 9 injuries per 100 people.

Classifications and types of injuries

Term injury(from Greek trаuma- wound) means a violation of the integrity of tissues and organs as a result of exposure to environmental factors.

There are several classifications of injuries. One of them divides injuries according to the time of their occurrence into acute and chronic.

Acute injury is a simultaneous impact of various external factors (mechanical, thermal, chemical, radiation, etc.) on the human body, leading to disruption of the structure, integrity of tissues and the functions they perform.
Chronic injury is damage that occurs as a result of repeated and constant low-intensity exposure to the same traumatic factor (this includes most occupational diseases).

According to the type of damaging moment, all injuries can be divided into:

mechanical,
thermal (burns, frostbite),
chemical,
barotrauma (damage due to a sharp change in external pressure),
electrical injuries,
combined (combination of mechanical and non-mechanical damage, for example, fracture and burn, etc.).

The circumstances of the injury are highlighted separately:

household,
production,
sports,
combat, etc.

The presence or absence of damage to the integrity of the skin divides injuries into open and closed.

Injuries can also be divided according to the extent of damage:

isolated (damage to one organ or within one segment of the musculoskeletal system);
multiple (damage to several organs or several segments of the limbs, that is, there are simultaneous fractures of two or more segments or parts of the musculoskeletal system);
combined (simultaneous damage to internal organs and the musculoskeletal system).

Any injury is accompanied by bleeding or swelling with the development of local inflammation and possible subsequent tissue necrosis. Severe and multiple injuries are usually accompanied by traumatic shock and are very life-threatening.

Top list of injuries

The most common types of mechanical injuries in the world are: bruise, sprain, dislocation, rupture of ligaments, muscles and tendons, as well as bone fracture. Among them, the leading position, undoubtedly, is occupied by a bruise: not a single person can claim that he has never received such an injury in his life.

Bruises: distinctive features and treatment

Injury- this is a closed mechanical damage to tissues and organs of the body without visible damage to the outer integument, which occurs when struck by a blunt object with relatively low kinetic energy or with a significant impact surface. A bruise sometimes accompanies other injuries (fracture, etc.).

As a rule, a bruise is accompanied by a rupture small vessels with subsequent hemorrhage developing as a result of a violation of the integrity subcutaneous tissue. The clinical picture of a bruise depends on the mechanism of injury, the force and location of application of the traumatic agent, the age and condition of the victim. Most often, external bruises occur on unprotected areas of the body - the head, limbs (especially in children).

Contusion of superficial soft tissues is always accompanied by swelling of the injury site as a result of the skin being soaked in lymph, blood and developing local aseptic inflammation. The amount of swelling depends on the severity of the disruption of the subcutaneous tissue at the site of the injury. In the area of the cranial vault, the layer of fiber is insignificant, and therefore the swelling here is usually small, and on the face, even with a relatively mild bruise, massive swelling develops.

A bruise is usually accompanied by pain of varying intensity. Thus, with bruises of large nerves and their endings, the pain is always sharp, shooting. The hematoma itself can develop at the site of the injury either after a few minutes or after several hours or even days, which is determined by the depth of the injury. The color of the hematoma depends on the age of the injury: a fresh one has a purplish-bluish color, after 3-4 days it becomes blue-yellow, and on the 5-6th day it becomes yellow. Bruises of the torso and limbs (shoulder, thigh) are accompanied by intense hematomas, bursting pain, sometimes with superficial numbness. When a joint is bruised, severe swelling is observed, and sometimes hemarthrosis develops. A significant accumulation of blood or synovial fluid in the joint is an indication for puncture.

At slight bruise minor hemorrhages and swelling resolve on their own within a few days. The degree of head injuries and spinal cord should be evaluated by a neurologist or neurosurgeon.

Tears and sprains

Stretching And gap- closed damage to the ligamentous apparatus of the joint without violating its anatomical continuity, affecting all elastic structures of the human body. Sprains include joint sprains, muscles and tendons. As a rule, the sprain itself occurs as a result of movements that are not characteristic of a given joint or exceed them in strength and direction and is accompanied by a temporary divergence of the articular surfaces beyond their physiological norm, exceeding the permissible elasticity and strength of the tissues. Most often, the ligaments of the knee and ankle joints are injured, less often - the elbow, shoulder and acromioclavicular joints.

The clinical picture of a sprain is sharp pain at the time of injury, an increase in the volume of the joint (hemorrhage into the periarticular tissues), and dysfunction of the joint. A sprain, like a bruise, can be accompanied by hemarthrosis. A physical examination reveals sharp pain in the damaged ligament, and sometimes non-physiological mobility of the joint. In some cases, immediately after a sprain, the joint or limb is still functioning, but after a while intense, constant pain appears, limiting mobility.

There are 3 degrees of sprain:

I - simple sprain without anatomical damage to collagen fibers, with moderate pain and slight swelling of the soft tissues.

II - partial rupture ligaments, with severe pain, rapid bleeding into the soft tissues, hemarthrosis, swelling and dysfunction of the joint.

III - complete rupture of the ligament, with very severe pain (sometimes with a bang at the time of injury), hemorrhage into the tissue surrounding the joint, hemarthrosis, pronounced swelling, a sharp dysfunction of the joint with a change in the axis of the limb.

Joint dislocation: treatment and signs

Dislocation- this is a persistent displacement of the articular ends of bones beyond the limits of their normal mobility, often accompanied by rupture of the capsule, ligaments and exit of the articular end of the bone from joint capsule. Dislocations can be acquired (traumatic, habitual, etc.) or congenital. Based on the degree of displacement of one articular surface in relation to the other, complete and incomplete dislocations, or subluxations, are distinguished - maintaining partial contact of the articular surfaces. Traumatic dislocations, in turn, are divided into fresh (up to three days), stale (up to three weeks) and old (more than three weeks).

Dislocations, as a rule, are accompanied by muscle damage: ruptures of entire muscles or individual muscle fibers, stretching of some and relaxation of others with a sharp disruption of muscle synergy. Extra-articular fractures are also possible.

At the moment of dislocation, a characteristic sound resembling cotton is usually heard. On physical examination, swelling, sharp pain, deformation of the limb, its unnatural position, difficulty and limitation of movement in the joint and limb are noted. Associated pallor and numbness indicate damage to nerves and blood vessels. During palpation, the location and degree of displacement of the articular end of the bone and the characteristic sign of resistance are determined (after the cessation of physical impact on the limb, it takes its original position).

After eliminating the dislocation, the limb is fixed in the average physiological position. This promotes muscle rest, gradual restoration of their tone, and healing of the capsule. The duration of joint fixation depends on its anatomical and physiological characteristics. Functional treatment of dislocations begins with immobilization followed by rehabilitation measures.

N.B.! It is not recommended to attempt to reduce a dislocation without a specialist!

Bone fractures: treatment and symptoms

Fracture- violation of the integrity of the bone under the sudden influence of a force that exceeds the elasticity of bone tissue and is applied both directly at the site of damage and away from it. With fractures, damage to the muscle fibers adjacent to the bone, surrounding vessels, and nerves almost always occurs. When the integrity of the skin is damaged under the influence of a traumatic object or a sharp piece of bone, an open fracture is formed. If the integrity of the skin is not broken, then the fracture is called closed. The most common are fractures of the long bones of the extremities (shoulder, forearm, femur, tibia). The main signs of a fracture are the crunching of bones at the time of injury, quickly developing tumor at the site of damage, unnatural deformation of the damaged area, painful sensations with careful palpation, the inability to move the injured limb. However, the final diagnosis is usually made only after radiographic examinations, so the main task in case of fractures is to prevent the victim’s well-being from deteriorating until he receives medical assistance.

N.B.! IN Unlike a bruise, with a fracture the function of the limb is impaired at the time of injury (the exception is incomplete fractures - cracks).

First aid for fractures consists of transport (temporary) immobilization of the injury site. The main type of transport immobilization of the limbs is splinting (Kramer, Diterichs splints, medical pneumatic splint). Standard transport tires can be either complex in design or simple - made of wire or plywood, but factory-made (they are used exclusively by medical workers - ambulance personnel, etc.).

In cases of first aid, you can use improvised splints - made of plywood, hard cardboard, pieces of thin boards, sticks, bundles of twigs, etc. In the absence of suitable available means, the injured arm can be fixed to the body with a scarf or the edge of clothing (shirt, hollow jacket), and bandage the leg to the healthy leg. It is also necessary to fix at least two joints located above and below the damaged area to completely eliminate mobility of the damaged area. Transport immobilization immobilizes a broken bone or dislocated joint, reduces pain and prevents further development of the injury, so it must be performed as early as possible. Sometimes splints are placed over clothing and shoes. If there are no bandages, then the splint can be fixed with tape, a tie or any elastic material: the main thing is that the bandage should not be too tight and impede blood circulation. In the cold season, in order to prevent sudden cooling or frostbite, the limb with a splint is covered with warm clothes.

If there is an open wound due to a fracture, an aseptic bandage is first applied, and only after that immobilization is carried out. It is also advisable to apply cold to the wound area and the entire affected segment. A pressure bandage should be applied to a victim with an open fracture by 2 people - one of them fixes the damaged limb, pulling it along the axis, and the other secures the bandage (necessarily on the naked body). Several folded sterile napkins or a sterile rolled bandage are placed on top of a sterile or medicated napkin on the bleeding wound, with the help of which the bleeding tissue is pressed. Each round of the bandage is applied with uniform, fairly large force. It is not allowed to wrap a limb with separate rounds of bandage (this can lead to impaired blood circulation in it). A feeling of numbness, goose bumps, and cyanosis of the fingers are signs of compression of the blood vessels, as well as poor circulation. In these cases, the bandage is cut or replaced, and the splint is applied again. With prolonged compression, crush-syndrome, or “myorenal syndrome” (long-term compression syndrome), develops. In this case, in addition to the symptoms described above, pain appears, then shock develops. These symptoms decrease after 1-3 hours, but then increase again when the limb is released. Separately, there is a syndrome of positional compression, which develops in people who are in the same position for a long time, while individual parts of the body are compressed by their own body (with alcohol, drug poisoning, etc.).

In case of an open fracture, the administration of antitetanus serum is also indicated in accordance with the instructions. good transport immobilization prevents increased displacement of fragments, reduces pain during transportation of the victim, and, therefore, reduces the possibility of traumatic shock, especially with a hip fracture.

N.B.! If a fracture is suspected, transporting the victim even a short distance without immobilization is unacceptable!

Symptoms of fractures

Spinal injury- pain in the back, legs, spinal deformity, increased sensitivity in areas of injury, numbness and paralysis of the limbs. If there are no symptoms (if there is obvious trauma), then most likely the victim is in shock (excitement, increased breathing and pulse, vomiting and loss of consciousness). Compression fractures of the vertebral bodies occur mainly when falling on the legs, buttocks, and during forced flexion of the torso. When falling headfirst, the cervical and upper thoracic vertebrae are damaged. When falling on the legs and buttocks, predominantly the bodies of the lumbar and lower thoracic vertebrae are damaged. Clinically, compression fractures appear constant pain in the area of injury, limited mobility in the spine, pain when pressing along the axis of the spine, muscle tension at the site of injury with irradiation to the abdomen, difficulty breathing. Paresis, paralysis and dysfunction of the pelvic organs are observed mainly with displaced fractures of the vertebral bodies.

N.B.! If a spinal injury is suspected, the victim should not be moved independently (movement of the head, neck, back can cause or worsen paralysis, etc.).

Traumatic brain injury - headache, tinnitus, dizziness, nausea, vomiting, possible loss of consciousness and memory. In such cases, emergency specialized medical care is required.

Pelvic fracture- pain at the site of injury, moderate swelling and bruising that appears on the second day after injury, positive symptom"sticky heel"

Treatment of injuries

Treatment of all types of injuries has almost the same algorithm of care. First of all, this is the so-called first aid:

cooling the affected area;
analgesic therapy (if necessary);
local anti-inflammatory and resorption therapy;
immobilization (if necessary);
transporting the victim to a specialized medical facility (if necessary).

Specialized medical care for injuries includes: surgical treatment of wounds (if any), tetanus vaccination, analgesic and antimicrobial therapy, plaster casting, surgery. The group of non-steroidal anti-inflammatory drugs used most often at various stages of trauma care. Table 1 presents the classification of non-steroidal anti-inflammatory drugs (NSAIDs) by INN, used both systemically and locally.

Table 1. Classification of NSAIDs by chemical structure

Subgroup
Salicylates	Acetylsalicylic acid Diflunisal Lysine monoacetylsalicylate
Pyrazolidines	Phenylbutazone
Indoleacetic acid derivatives	Indomethacin Sulindac Etodolac
Phenylacetic acid derivatives	Diclofenac
Oxycams	Piroxicam Tenoxicam Lornoxicam Meloxicam
Propionic acid derivatives	Ibuprofen Naproxen Flurbiprofen Ketoprofen Tiaprofenic acid
Alcanons	Nabumethon
Sulfonamide derivatives	Nimesulide Celecoxib Rofecoxib
Anthranilic acid derivatives	Mefenamic acid Etofenamate
Pyrazolones	Metamizole Aminophenazone Propyphenazone
Para-aminophenol derivatives	Phenacetin Paracetamol
Heteroarylacetic acid derivatives	Ketorolac

Also, for various types of injuries, anti-inflammatory and absorbable ointments, gels and tinctures containing substances of plant and animal origin (horse chestnut, troxerutin, lemon balm and eucalyptus oils, camphor, pork fat, turpentine, menthol, methyl salicylate, rutoside, carbomer 940, disodium EDTA, benzalkonium chloride, lidocaine, heparin, sperm whale acids). Their use can significantly reduce treatment time by reducing swelling, local inflammation and improving local peripheral circulation in the affected areas.

Even the smallest injury at first glance can have serious complications. Therefore, at the slightest suspicion of a dislocation, fracture or other serious injury, you must urgently seek help from a specialized medical institution.

Update: October 2018

Any injury that ends in pain, bruising and limited mobility is unpleasant, to say the least. But often behind a banal bruise there are more severe consequences: sprains, dislocations and fractures. And some bruises can lead to health complications. Therefore, it is important to be able to distinguish between these conditions and consult a doctor in time.

What is a bruise?

A bruise is a closed injury to tissues or organs as a result of mechanical impact. Depending on the location, volume and depth of the damaged tissue, the force of the impact, bruises can have different manifestations. For example, a well-known bruise is a hemorrhage due to damage to blood vessels. The remaining symptoms are also familiar to many.

Signs of injury:

Pain after mechanical impact
Swelling (due to edema and hemorrhage)
Bleeding into damaged tissue (hematoma)
Increased skin temperature and redness over the injured area
Limitation of the function of a specific organ or part of the body

Painful sensations arise at the moment of injury, then somewhat dull. But as the hematoma and tissue swelling grow, the pain may appear again with a vengeance. Particularly unpleasant sensations occur in places without a fat layer, on the front surface of the lower leg, for example. Sometimes the pain and swelling are so strong that it is difficult to distinguish between a fracture and a bruise.

First aid:

Rest for the affected part of the body, its elevated position (raise the limb, lie on the opposite side, etc.)
Applying a pressure bandage
On the first day, apply cold (to prevent hematomas). Ice packs must be removed periodically to avoid damaging blood vessels due to low temperatures. It is best to immediately apply a pressure bandage for 25-30 minutes, then apply for 10-15 minutes every 2-3 hours.
In case of severe pain, swelling, or large bruises, it is recommended to consult a doctor. Specialist supervision may also be necessary for bruises of the head, internal organs and other dangerous locations.
There is no need to rub the bruise or warm it in the first two days (after 48 hours you can warm it)
It is important to remember that first aid for fractures and bruises, dislocations and sprains is absolutely identical: rest, cold, pain relief.

Health care:

The medical institution may prescribe physiotherapy and novocaine blockades for pain relief
Surgical treatment for severe injuries: puncturing the skin and pumping out blood from large hematomas, clearing fluid from the joint cavity, administering antibiotics.

What is stretching?

Damage caused by traction, and not accompanied by a violation of tissue integrity, is called sprain. Tendons, ligaments and muscles - that is, elastic parts of the body - suffer. Typically, tissue damage occurs in the joint area.

Signs of stretching:

Pain at the site of injury (especially when moving, repeating the mechanism of injury)
Swelling
Sometimes - a slight hemorrhage (bruise, see)
Limitation of function of the injured body part

First aid:

Rest and elevated position of the limb
Cold to the site of injury (as with bruises)
Fixing bandage on the joint (elastic bandage)
In case of severe pain, swelling and worsening of the condition, consult a doctor. More serious injuries have similar symptoms - ligament rupture, for example, which often requires surgical treatment. In addition, it can be difficult to understand whether a sprain or a fracture caused such dynamics.
There is no need to rub or heat the damaged area for the first 2 days.

Health care:

Pain relief if necessary
Physiotherapy after pain subsides
Gentle treatment for the damaged part of the body
Recovery usually occurs within 1-4 weeks

What is a dislocation?

A dislocation is a permanent separation of joint surfaces that are normally adjacent to each other. Usually occurs as a result of mechanical impact (more often in middle-aged men). If articular surfaces are not completely separated, this phenomenon is called subluxation. Its symptoms are similar to a complete dislocation.

Signs of dislocation

Severe joint pain
Impossibility active movement in the joint
Forced position of the limb (least painful)
Often - external deformation of the joint, relative shortening of the limb

Treatment of dislocations

Trying to cure a sprain at home with poultices, lotions, and compresses is a very dangerous undertaking. A doctor can correct a fresh dislocation (up to three days) much easier than an old one, so every minute after an injury counts. Under no circumstances should you correct a dislocation yourself, as you can worsen the situation by tearing ligaments, muscles, and even breaking a bone. The only thing you can do is to ensure maximum peace injured person, apply ice and call an ambulance, or quickly get to the emergency room yourself.

Health care

Pain relief (often with strong narcotic drugs)
Repositioning a dislocated limb (there are special techniques for each type of dislocation)
Applying a bandage to the reduced limb to restrict movement
Recovery period: physiotherapy, therapeutic exercises.
Surgical treatment for habitual dislocations (when the slightest injury causes the joint to “pop out” again and again).

What is a fracture?

A fracture is a violation of the integrity of a bone, which is caused by mechanical action or a pathological process in the body. Due to the huge variety of types of bones in the human body, there are many types of bone fractures (see).

Types of fractures:

Signs of a fracture

Treatment of fractures

Fractures are often accompanied by other injuries, skin wounds and bleeding. Therefore, the most important thing is to provide first aid before the doctors arrive. In this case, there is no point in wondering whether a fracture or dislocation caused the pain. First aid will be the same.

First aid:

If there is bleeding, stop it using one of the following methods:
- apply pressure to a vessel visible in the wound
- apply a pressure bandage
- apply a tourniquet when heavy bleeding(indicate the time in the note, keep no more than 1-1.5 hours)

Cover the wound with a clean, or better yet, sterile material.
Administer painkillers
Ensure the immobility of the broken part of the body (using splints, fixing the joints located adjacent to the fracture site)
Apply cold to the injury site
If the fracture is closed, then you need to start with pain relief

Health care

Pain relief (often novocaine blockades)
Comparison of bone fragments and their fixation
- conservative ( plaster casts, skeletal traction)
- surgically (manually or using special devices, internal or external osteosynthesis)
Antibiotic therapy (for open fractures and after operations)
Physiotherapy during the recovery period
Physiotherapy

Injuries in children

Children, due to their mobility and immature musculoskeletal system, often receive bruises, ligament damage and even fractures. It is even more difficult to distinguish them at home than in adults. It is difficult for a child to describe the pain; he may be frightened by the injury or the prospect of seeing a doctor. There are the most common injuries in babies that can be suspected at home. But making a diagnosis often requires an examination by a specialist.

Radial head subluxation

Young children, especially girls under 3-4 years of age, often get this type of subluxation when pulling their arms. For example, parents or a nanny pull the baby by the arms to avoid falling. This injury has even been called "nanny's elbow." The main symptom is a click (not always) and sharp pain in the elbow with any movement of the forearm. The baby does not allow him to move his sore arm. If you keep the limbs at rest, the pain noticeably weakens. The doctor at the emergency room usually immediately identifies such a typical injury by the position of the limb, makes a reduction and sends the child home. Additional treatment not required.

Subperiosteal fractures

The bone of a small child has a number of structural features, so they often experience subperiosteal fractures, when the bone is broken but the periosteum is intact. It looks like a green bush branch when you try to break it off. Such fractures are more difficult to diagnose even with x-rays. Only a specialist knows how to distinguish a fracture from a bruise in this case. But bones in children also heal three times faster than in adults, which significantly speeds up recovery time.

How to distinguish injuries from each other?

In some cases, anyone can make a diagnosis. For example, the appearance of a bruise after hitting a corner with your foot, accompanied by mild pain, is most likely a bruise. And the gaping of bone fragments through the wound is an open fracture. There are also signs that allow us to make a presumptive diagnosis.

	Injury	Stretching	Dislocation	Fracture
Pain	At the moment of injury, then weakens and becomes dull. As swelling increases, it may worsen	At the time of injury, acute, intense, may intensify over time	Intense at the time of injury, intensifies when attempting to move	Intense at the time of injury, aggravated by movement and touch
Edema	Often	Sometimes	Often	Often, strong
Change in limb length	No	No	Yes	Often
Pathological mobility outside the joint	No	No	No	Often
Crepitation of bone fragments	No	No	No	Often
Deformation of the damaged body part	No	No	Often	Often
Increased pain when pressing on the injury site	Often	Often	Often	Often
Axial load symptom	No	No	No	Positive (increased pain)
Joint deformity	No	No	Often	For intra-articular fractures, with capsule rupture
Blood in the joint	Sometimes, when blood bleeds from a hematoma into a joint	Sometimes	Often	For intra-articular fractures
Changing the limb axis	No	No	Often	Occurs (with severe displacement of fragments)
Active (independent) movements	Saved		Impossible	Impossible or extremely painful and limited
Passive movements	Saved	Saved	Limited due to increased pain	Extremely painful and limited

The final diagnosis can only be made by a traumatologist. First aid for dislocations and fractures is only a way to alleviate the condition until the ambulance arrives. Therefore, for all types of injuries that cause inconvenience, it is better to contact a specialist at the emergency room. Sometimes all it takes is one look at the injury and a couple of questions to determine the type of injury. But more often it is necessary to use X-ray diagnostics, and sometimes MRI, CT and other methods.

All of the above signs are more related to limb injuries. But there are certain parts of the body that react completely differently. With head injuries, the symptoms may be completely inconsistent with the nature of the injury. So, a brain contusion cannot be seen on x-ray. But it can manifest as poor health and loss of consciousness. A fracture of the skull bones can be accompanied only by a mild headache, but can be complicated by serious hemorrhage. Therefore, there are cases when you need to see a doctor even without obvious complaints about your health.

You need to see a doctor if:

Injured head, chest, spine, stomach
Trauma associated with a child falling from a height (especially in the head area)
A crash was heard at the time of the injury
The pain that arose at the time of injury does not subside, but intensifies
There is a significant wound at the site of injury, bleeding
Swelling intensifies
A bruise from a bruise does not “bloom” over time (that is, does not turn yellow), but turns red, and the skin becomes hot.
There are no active or passive movements in the injured limb
There is a decrease or complete disappearance of sensitivity in the limb
The condition worsens (loss of consciousness, decrease or increase in blood pressure, shortness of breath, urinary retention).

A frequent type of injury is a wound - this is damage directly to the skin and mucous membranes with a violation of their anatomical integrity due to mechanical action.

Injuries have different circumstances of occurrence: they can be inflicted accidentally, received in combat, or result from a surgical operation. So, let's take a closer look at what types of wounds there are and what first aid needs to be provided.

Classification of wounds and their characteristics

Each injury has its own characteristics, but there are also general signs: internal and/or external, physical pain, gaping, that is, the divergence of the edges of the wound surface.

Depending on how the injury occurred and what object it was inflicted with, the injury can be: stab, cut, chopped, torn. There are also bruised, bitten, scalped or gunshot wounds.

A scratch, ulcer, erosion, rupture of organs without violating the integrity of the outer covering of the skin is not considered a wound.

First aid depends on the type of wound. Next, you will be presented with the types of wounds and their characteristics, methods of treating them, and what first aid should be provided depending on the type of damage.

– this type of wound has a small puncture size, the skin damage is insignificant, but the traumatic object very often touches the internal organs, since the depth of the wound is most often greater than its diameter.

Distinctive signs of puncture injuries:

Smooth edges of the entrance puncture;
Slight redness around;
The bleeding is not severe;
When the striking object remains in the wound, its edges are turned inward.

Puncture wounds are most often caused by an awl, nail, sharpening, pin, awl. The longer the tool, the further it penetrates directly into the tissue, the greater the risk of injury. These types of injuries occur in a criminal environment, in domestic conflicts, as well as in careless handling of sharp objects at work or at home.

– this type of injury occurs due to the action of a sharp flat object. Clear edges can be easily matched, so the wound heals faster.

The severity of the injury will depend on the force of the impact and the size of the striking object. The clinic can be different if the object touches the neurovascular bundle, large vessels and nerve fibers are damaged.

Signs of cut wounds:

Wide clearance with different depths;
Deep soft tissue defect;
Heavy bleeding;
Gaping surface;
Unbearable pain.

The victim experiences shortness of breath, weakness, dizziness, and possible loss of consciousness. When pathological microorganisms penetrate the wound, symptoms of intoxication occur: chills, headache, nausea, fever.

– can be inflicted by a heavy object with sharp edges: an ax, a shovel, a saber, as well as machine parts in production. They are rare, but severe damage often leads to disability in patients.

Features of chopped wounds:

Large depth and area of damage;
A massive object causes bruising and proliferation of adjacent tissues;
Moderate wound gaping;
Internal organs are often damaged, and physiological amputation is possible.

The chopped type of injury has a high risk of infection and purulent complications. causes noticeable cosmetic defect, normal tissues are replaced by connective ones.

Irreversible contractures develop in the limbs, in which it is impossible to bend and straighten in one or more joints. The functioning of internal organs is impaired.

– appear as a result of application with a blunt object: a stone, a brick, a stick, a bottle. The wound is often shallow, but high energy damage often damages internal organs. Head injuries cause brain damage, chest injuries damage the lungs and heart.

Types of wounds according to the presence and severity of the infectious process

With any injury, various pathological microorganisms enter the affected area; it is believed that all accidental injuries are infected.

According to the severity of infection, wounds are:

Other injury classifications

According to the number of injuries, wounds are: single, multiple - a wound is caused by one object several times, combined - with simultaneous injury to several anatomical areas.

Injuries of the head, neck, torso and extremities vary by location.

By type of complication: complicated and uncomplicated.

Types of wounds depending on the type of healing:

Healing with primary intention without inflammation;
Healing secondary intention with suppuration and granulation;
Healing under the scab.

Classification of wounds according to the nature of tissue damage:

With damage to soft tissues;
With damage to nerve fibers;
With damage to arteries and large veins;
With damage to bone and joint structures;
With damage to internal organs.

According to the amount of damage, injuries are divided into:

With a small area of skin damage– the edges are barely noticeable, the area of necrosis is minimal. Such wounds include stab, cut, and surgical wounds;
With a large area of damage– there is a lot of non-viable tissue, extensive hemorrhages, for example, with bruises, lacerations, gunshot injuries.

General first aid for wounds

First aid depends on the type of wound. For any type of injury, it is of great importance. First of all, it is necessary to determine its type. and the bleeding is stopped by applying a tight pressure bandage - using. Be sure to call an ambulance.

When treating a wound, the following manipulations are prohibited::

It is necessary to carry out anti-shock measures: apply cold to the wounded area, immobilize, hand over to the victim comfortable position for transportation.

During the provision of first aid, you need to constantly talk with the victim and maintain verbal contact with him. When is arrival medical personnel It is expected that it will not be possible to try to deliver the victim to a medical facility on your own.

Now you know how to provide first aid correctly and in a timely manner medical care, you need to know the types of wounds and their signs.