ZA N I T I E No. 4.

SUBJECT : FIRST AID FOR WOUNDS.

Literature

Textbook by D.V. Marchenko "First health care for injuries and accidents”, pages 145-166.

Study questions

1. The concept of injury. Classification and types of injuries.

2. Types of bleeding.

3. General principles of first aid for wounds (stopping bleeding, wound disinfection, fixation of limbs, pain relief, safe transportation).

4. Basic rules for applying bandages. Individual dressing package (PPI).

5. Procedure for using the syringe tube.

6. Compliance with standard No. 11.

7. Application of a spiral dressing.

TEXT OF THE TEXTBOOK:

1. The concept of injury. Classification and types of injuries.

Blood is a universal liquid that ensures the saturation of every organ and tissue of our body with oxygen. In addition to this main transport function (along with oxygen, nutrients, enzymes, hormones, vitamins, etc. are delivered by the blood), the blood also performs others: it is thermoregulatory (maintaining a constant body temperature due to blood circulation throughout the body), and protective (production antibodies and protection against infection).

That is why any violation of the integrity of the vessel and the vascular system in general as a result of predominantly external influences can lead to serious “breakdowns” within our body and even threaten life.

This situation occurs as a result of injury.

The concept of injury.

So, a wound (or wound) is any violation of the integrity skin and underlying tissues (including blood vessels) as a result of external, mainly mechanical, influence.

Accordingly, signs of injury will be the following:

Bleeding (as a result of a violation of the integrity of the vessel);

Gaping (or divergence of the edges of the wound, approximately following the contour of the wounding object);

Impaired function of the injured (wounded) body part.

In addition, the victim will experience pain, as the nerve trunks are additionally injured. Pain in serious (extensive) wounds can be so intense that it can lead to the development of painful shock.

Characteristic of wounds, in addition to the above signs, is the presence of a wound channel - a cavity formed as a result of the passage of a wounding object into the depths of the body. It is by the location of the wounded channel, its direction, length, etc. that one can judge any properties of the wounding object.

Thus, wounds are characterized by the presence of bleeding, gaping and a wound channel.

Classification and types of injuries.

All injuries are divided into two large groups:

Penetrating (when the integrity of the internal membranes is violated and the wounding object enters one of the cavities of the human body - the skull, chest, abdomen or joints);

Non-penetrating (all other wounds).

According to the mechanism of injury All injuries can be divided into the following types:

Stabbed (with a small diameter of the external hole, a rather large depth of the wounded channel is characteristic);

Cut (quite extensive external damage with a shallow depth of the wounded canal);

Chopped (characterized by widespread crushing of the edges and extensive internal damage);

Bitten (characterized by the presence of an outline/pattern of teeth) - can be combined with the following type

Ragged (extensive external damage with a star-shaped shape);

Scalped (with this type of wound, the skin with the subcutaneous base is completely separated from the underlying tissue);

Firearms (as a result of the impact of a firearm projectile - bullets, shot, buckshot, etc.) (Fig. 2).

In its turn, gunshot wounds are divided into:

Blind (when there is only an entrance hole and the wounding projectile is located deep in the body);

Through (there are inlet and outlet openings; as a rule, the outlet is slightly larger than the inlet);

Tangent (superficial damage to the skin).

CONCEPT AND TYPES OF WOUNDS. PROVIDING FIRST

MEDICAL CARE

ABSTRACT

INTRODUCTION……………………………………………………………………………….3

1. Wounds. Classification, etiology, mechanism of injury………………..5

2. Complications of wounds…………………………………………………………….9

3. Providing first aid……………………………….13

CONCLUSION……………………………………………………………..18

LIST OF REFERENCES……………………….20

INTRODUCTION

Since wounds make up the majority of injuries to the body, their treatment is the basis of first aid for injuries. A person can get injured in any environment and at any time - at home, at work, at school, on the street, etc.

wounded

The clinical picture of wounds depends on the nature of the wound, the wounding projectile, the size of the wound, damage to the cavities and internal organs, violation of the integrity of blood vessels, nerves and bones.

Proper treatment of the wound prevents the occurrence of complications and reduces its healing time several times.

Therefore, each person is obliged to be able to provide assistance both to himself (self-help) and to another victim (mutual assistance). This is a simple procedure, so when learning first aid measures, its assimilation comes first.

First aid

Target – reveal the concept of “wound”, consider the classification of wounds and study the features of providing first aid for different types wound An object – wounds, types of wounds; P item – provision of first aid for various types of wounds.

Tasks:

1. Expand the concept of “wound”, consider the classification of types of wounds.

2. Identify the main complications of injuries.

3. Study the features of first aid for different types of wounds.

The abstract consists of an introduction, three paragraphs, a conclusion, and a list of references.

1. Wounds. Classification, etiology, mechanism of injury

A wound is a gaping violation of the integrity of the skin or mucous membranes.

A wound is a violation of the integrity of the skin, mucous membranes (superficial wounds), underlying tissues and internal organs (deep wounds).

Wounds that have been subjected to additional impact physical, biological or chemical factors(frostbite, burns, hard electromagnetic radiation, microbial contamination, aggressive chemical substances, ionizing radiation, etc.) are called combined.

Based on the nature of tissue damage, there are:

· Incised wounds caused by sharp objects (for example, razor, knife). The edges of the wounds are even and smooth. The wound is not deep, it gapes. The bottom of the wound is slightly destroyed, unless it is large vessels and nerves, for example, in the neck. Incised wounds are the most favorable for healing.

· Chopped wounds caused by a sharp but heavy object (axe, saber) resemble cut wounds in their clinical picture. Distinctive feature– more significant destruction of the wound bottom. Usually the adjacent tendons, muscles and even bone are damaged.

· Puncture wounds resulting from injury by sharp and thin long objects(knife, sharpening, awl, etc.). This is often extremely dangerous injuries, since a small, sometimes pinpoint wound does not gape, does not bleed and quickly becomes covered with a crust. At the same time, a wounding object could damage the lung, intestines, liver, and after some time anemia, pneumothorax or peritonitis are possible.

· Bruised wounds resulting from exposure to a blunt object (stick, bottle). The edges of the wound are crushed, as are the tissues in the wound itself. The latter are soaked in blood, dark in color, do not bleed or bleed slightly. Visible vessels are thrombosed.

· Lacerations that occur when a relatively sharp object slides across the surface of the skin with additional pressure on it. The wound is irregular in shape, with scalp-type flaps, and bleeding. The destruction of the underlying tissue depends on the force exerted on the wounding projectile. Typically, lacerated wounds, as well as bruised wounds, have a protracted healing process due to necrosis of destroyed tissue and suppuration in the wound.

· Poisoned wounds that occur when toxic substances enter them (snake venom, toxic substances).

· Gunshot wounds, which differ from all others in the characteristics of the wounding projectile, the wound channel and the course of the wound process.

Based on the causes of damage, wounds are divided into

· operating rooms;

· random.

Wounds are classified according to microbial contamination:

· antiseptic;

· microbially contaminated.

It is important to take into account the location of wounds (abdominal cavity, head, limbs, etc.) and the type of damaged internal organs (liver, intestines, lung, spleen, etc.) and tissues (bones, muscles, nerves, joints, blood vessels).

In relation to the closed planes of the human body (skull, chest, abdomen, joint) there are:

· penetrating – injuries resulting in damage to the internal serous membrane lining the cavity (dura mater, parietal pleura, parietal peritoneum, synovial membrane);

· non-penetrating wounds.

The clinical picture of wounds depends on the nature of the wound, the wounding projectile, the size of the wound, damage to cavities and internal organs, and violation of the integrity of blood vessels, nerves and bones. It consists of:

· local symptoms(pain, wound gaping, bleeding, dysfunction of the damaged segment);

· general symptoms (signs of an emerging complication of injury, for example, anemia, shock, peritonitis, etc.).

In a clean wound with good contact between the edges, they stick together. Dead cellular elements and bacteria are resorbed, there is an increased proliferation of connective tissue cells, which over time turn into a scar. It firmly connects the walls of the former wound - this is how the wound heals by primary intention.

If there was diastasis between the walls of the wound or developed purulent infection, wound healing proceeds slowly, with gradual filling with granulations from its bottom. This is healing by secondary intention.

Thus , we revealed the concept of “wound”, examined the classification of wounds, the etiology and mechanism of injuries. A wound is a violation of the integrity of the skin, mucous membranes, underlying tissues and internal organs. Wounds are distinguished by the nature of tissue damage (cut; chopped; stab; bruised; lacerated; poisoned; gunshot wounds); for reasons of wound damage (surgical, accidental wounds); by microbial contamination (antiseptic microbially contaminated wounds); in relation to closed planes of the human body (penetrating, non-penetrating wounds). Wounds that have been subjected to additional exposure to physical, biological or chemical factors (frostbite, burns, hard electromagnetic radiation, microbial contamination, aggressive chemicals, ionizing radiation, etc.) are called combined.

2. Complications of wounds

Whatever the injury, it is always dangerous for a person for two reasons: bleeding from the wound and suppuration of the wound .

With any injury, blood vessels are injured, as a result of which it is accompanied bleeding . Then, when blood flows out from the wound, we talk about external bleeding (with deep cut and chopped wounds).

With gunshot and stab wounds, wounds of internal organs that occur when struck by any blunt object, ruptures of the spleen, liver, kidneys, and large vessels are noted. In all such cases we are talking about internal bleeding, i.e. bleeding in the body cavity.

The bleeding may be profuse and life-threatening or minor. Highlight arterial bleeding which occurs when the arteries are damaged, capillary, occurs when small parts are damaged blood vessels,venous , which occurs when veins are damaged.

In case of intense bleeding from a wound (for example, when arteries are damaged), urgent measures must be taken to temporarily and subsequently completely stop the bleeding. The most severe complications of bleeding are:

· critical volume of blood loss incompatible with life;

cardiac tamponade due to internal bleeding (accumulation of blood in the pericardium),

· with intracranial hemorrhages, compression of the brain, etc.;

· cessation of blood supply to vital tissues and organs (brain tissue, heart, lungs) due to interruption of blood clots in the main vessels, in case of air embolism.

The wound is most often infected with pyogenic bacteria . It is known that there are millions of bacteria on the surface of the skin; at the same time, their number per 1 mm² of unwashed skin reaches 200 million. When the skin is unexpectedly wounded by a knife, stone, splinter or needle, billions of bacteria enter the wound, causing a purulent inflammatory process that complicates treatment during wound healing; V similar cases wounds heal with disfiguring scars. It is worth noting that if the wound is treated incorrectly (with unwashed hands, using contaminated dressings), infection of the wound with microbes increases even more.

The penetration of microbes into the thickness of tissues and blood vessels has bad influence not only on the timely healing of the wound, but also on the body as a whole.

As a rule, the wound becomes infected with pyogenic bacteria, but there are cases of infection with other bacteria. It is very dangerous for a wound to become infected with tetanus bacilli, which enter the wound from dust, soil and droppings. In such cases, the disease tetanus appears, which is expressed by muscle contractions of the neck, and there are difficulties in swallowing and chewing, contraction of the spinal and perioral muscles and, ultimately, spasms of the respiratory muscles and suffocation. If there is any suspicion of tetanus, treatment must be started immediately - otherwise the death of the victim will inevitably occur. Tetanus most often occurs due to transport and agricultural injuries. The most effective way to combat this disease is preventive vaccination antitetanus serum.

During the wound healing process purulent wounds It is advisable to distinguish the following stages:

1) inflammation,

2) formation and maturation of granulation tissue,

The identification of stages, despite their specific sequence, is conditional, since it is impossible to draw a strict line between the end of one stage and the beginning of another. Granulation tissue usually appears within 48 hours. After the inflammatory reaction subsides, the process of transformation, proliferation of fibroblasts, formation of new tissue begins - the process of reparative regeneration. Throughout the inflammatory reaction, starting from the moment of tissue damage, proliferative or productive phenomena (reproduction of cellular elements) are observed. These phenomena are especially pronounced in more late stages inflammation. As granulation tissue grows, connective tissue forms and matures, inflammatory phenomena subside, and epithelization occurs from the edges of the wound to its bottom.

Gas gangrene appears when a wound becomes infected with microbes that multiply in infected wounds without access to air. At the same time, when pressing on the wound area, you can hear crepitus (creaking), which is caused by the appearing gas bubbles. The patient experiences a sharp increase in temperature, and the affected skin is red.

Thus , dangers to the health and life of the wounded can be divided into immediate, arising at the time of injury or immediately after it, and late - after many hours and days. Therefore, when providing emergency care and during treatment, it is necessary to identify the most dangerous circumstances for a specific period of time and prevent possible complications. Immediate mortal dangers after injury are caused by the actual violation of the anatomical integrity and functioning of vital important organs and systems (the general reaction of the body in the form of shock, even more often due to massive blood loss). In a later period greatest danger for the outcome of the wound and for life, it represents the development of a wound infectious process, when secondary anatomical changes And functional disorders, a breakthrough of the purulent contents of the wound into the bloodstream is possible - general infection(sepsis), development of gas gangrene, tetanus. Failure to properly and timely treat a wound can be fatal for the victim.

3. Providing first aid

Since wounds make up the majority of injuries to the body, their treatment is the basis of first aid for injuries.

First aid - a set of emergency simple measures aimed at saving a person’s life, as well as preventing possible complications in the event of an accident, carried out directly at the scene of the incident by the victim himself or another person who was nearby.

This is a very simple procedure, therefore, when studying first aid measures, its assimilation comes first. Proper wound treatment prevents complications from occurring and reduces healing time by almost three times.

Protecting a wound from infection is best achieved by applying a bandage and following following rules:

· Do not touch the wound with your hands, as there are especially many microbes on the skin of the hands;

· the dressing material used to close the wound must be sterile.

To treat a wound, you need gauze, cotton wool, a bandage and some other disinfectant. It goes without saying that dressing wounds should be done with clean, washed hands.

Wound care involves shaving the hair and cleaning the skin around the wound from dirt and foreign particles with balls soaked in alcohol, ether, iodine or other antiseptics. It is advisable to treat the wound itself with a 1-2% solution of hydrogen peroxide, as well as sterile soap or saline solutions.

If the wound is bleeding very heavily, you must first stop the bleeding. Then they begin to bandage the wound. If there is no disinfectant solution, simply cover the wound with sterile gauze, then apply a layer of cotton wool and bandage the wound.

If you have any disinfectant at your disposal - gasoline, iodine tincture, hydrogen peroxide - then the skin around the wound wipe twice or thrice with gauze or cotton wool moistened disinfectant solution. This treatment is more effective in combating the penetration of bacteria into the wound from surrounding areas of the skin.

IN as a last resort When there is no gauze or bandage, the superficial wound can be covered and bandaged with a clean handkerchief. The abrasions are washed with hydrogen peroxide and bandaged. A bandage is placed over the napkins to hold the napkins in place. Usually a bandage is used for this. If it is not available, the napkin can be secured with strips of adhesive plaster.

The wound is not allowed

· rinse with water, and even more so with alcohol or iodine tincture;

· fill it with any powders, and also do not apply any ointment to it;

· directly on the wound with cotton wool.

If any tissues protrude from the wound - the brain, intestines - then they are covered with clean gauze, but under no circumstances are they set back.

1 - temporal

2 - jaw

3 - sleepy

4 - radial

5 - shoulder

6 - axillary

7 - femoral

8 - tibial

Rice. 1. Points of pressure on arteries during bleeding

In case of intense external bleeding, urgent digital pressure is needed arterial vessel just above the wound site exactly where it is closest to the bone.

Pressing the arteries to stop bleeding is applicable only for the short time necessary to prepare for the application of a tourniquet or twist (Fig. 1).

To stop capillary and weak venous bleeding enough overlay soft bandage, elevated position of the limb.

At contaminated wound Tetanus prophylaxis is needed: to prevent anaphylactic reaction first, 0.1 ml of antitetanus serum is injected subcutaneously, after 40 minutes - another 0.1 ml, and after 40 minutes the rest of the amount (up to 1 ml) is injected intramuscularly.

Large wounds of the extremities that are contaminated with soil, manure, as well as wounds with impaired circulation due to rupture of large vessels or prolonged application of a tourniquet, etc., pose a danger due to probable development gangrene for life. The mixture of anti-gangrenous serums is dissolved in 100-150 ml of physiological solution and initially 1-2 ml is administered intramuscularly, and after 2-3 hours, if not allergic reaction, remaining quantity .

Thus , we examined the features of providing first aid for injuries. Proper wound treatment prevents complications from occurring and reduces healing time by almost three times. Protecting a wound from infection is best achieved by applying a bandage while observing the following rules: do not touch the wound with your hands, since there are especially many microbes on the skin of the hands; the dressing material used to close the wound must be sterile. If the wound is bleeding very heavily, you must first stop the bleeding. Then they begin to bandage the wound. The wound should not be rinsed with water, much less alcohol or iodine tincture; cover it with any powders, and also do not apply any ointment to it; directly onto the wound with cotton wool.

CONCLUSION

wounded refers to any damage to the integrity of the mucous membranes or skin of the human body and underlying tissues.

Wounds are distinguished by the nature of tissue damage (cut; chopped; stab; bruised; lacerated; poisoned; gunshot wounds); for reasons of wound damage (surgical, accidental wounds); by microbial contamination (antiseptic microbially contaminated wounds); in relation to closed planes of the human body (penetrating, non-penetrating wounds).

Wounds that have been subjected to additional exposure to physical, biological or chemical factors (frostbite, burns, hard electromagnetic radiation, microbial contamination, aggressive chemicals, ionizing radiation, etc.) are called combined.

Dangers to the health and life of the wounded can be divided into immediate, occurring at the time of injury or immediately after it, and late, many hours and days later. Therefore, when providing emergency care and during treatment, it is necessary to identify the most dangerous circumstances for a specific period of time and prevent possible complications.

Immediate mortal dangers after injury are caused by the actual violation of the anatomical integrity and functioning of vital organs and systems (the general reaction of the body in the form of shock, even more often due to massive blood loss).

In a later period, the greatest danger to the outcome of the wound and to life is the development of a wound infectious process, when secondary anatomical changes and functional disorders may occur, a breakthrough of the purulent contents of the wound into the bloodstream is possible - general infection (sepsis), the development of gas gangrene, tetanus. Failure to properly and timely treat a wound can be fatal for the victim.

First medical aid is a set of emergency simple measures aimed at saving a person’s life, as well as preventing possible complications in an accident, carried out directly at the scene of the incident by the victim himself or another person who was nearby.

Proper wound treatment prevents complications from occurring and reduces healing time by almost three times. Protecting the wound from infection is best achieved by applying a bandage.

Protecting a wound from infection is best achieved by applying a bandage while observing the following rules: do not touch the wound with your hands, since there are especially many microbes on the skin of the hands; the dressing material used to close the wound must be sterile.

If the wound is bleeding very heavily, you must first stop the bleeding. Then they begin to bandage the wound.

The wound should not be rinsed with water, much less alcohol or iodine tincture; cover it with any powders, and also do not apply any ointment to it; directly onto the wound with cotton wool.

LIST OF REFERENCES USED

1. Artyunina G.P., Gonchar N.T., Ignatkova S.A. Fundamentals of medical knowledge: Health, illness and lifestyle. – Pskov, 2003. – 292 p.

2. Fundamentals of medical knowledge / Ed. Yu.S. Tarasova. – In 2 volumes: T.1. – Samara, 1996. – 175 p.

3. Basics preventive medicine and first medical aid: Textbook / L.V. Vysochina, V.N. Kleimenov, A.I. Sinyushkin and others; Under general ed. M.G. Romantsova. Kaliningrad univ. - Kaliningrad, 1996. - 103 s

4. Traumatology: national guide / ed. G.P. Kotelnikova, SP. Mironov. - M.: GEOTAR-Media, 2008. - 808 p.

5. encyclopedic Dictionary medical terms. – M. – 1591 p.

Traumatology: national guide / ed. G.P. Kotelnikova, SP. Mironov. - M.: GEOTAR-Media, 2008. - 808 p.: P. 76.

Traumatology: national guide / ed. G.P. Kotelnikova, SP. Mironov. - M.: GEOTAR-Media, 2008. - 808 p.: P.76-77

Fundamentals of medical knowledge / Ed. Yu.S. Tarasova. – In 2 volumes: T.1. – Samara, 1996. – 175 p.: P.18

Traumatology: national guide / ed. G.P. Kotelnikova, SP. Mironov. - M.: GEOTAR-Media, 2008. - 808 p.: P.77

Fundamentals of preventive medicine and first medical aid: Textbook / L.V. Vysochina, V.N. Kleimenov, A.I. Sinyushkin, etc.; Under general ed. M.G. Romantsova. Kaliningrad univ. - Kalininrad, 1996. - 103 pp.: P. 59

Artyunina G.P., Gonchar N.T., Ignatkova S.A. Fundamentals of medical knowledge: Health, illness and lifestyle. – Pskov, 2003. – 292 p.: P. 234

Fundamentals of medical knowledge / Ed. Yu.S. Tarasova. – In 2 volumes: T.1. – Samara, 1996. – 175 p.: P.19

Artyunina G.P., Gonchar N.T., Ignatkova S.A. Fundamentals of medical knowledge: Health, illness and lifestyle. – Pskov, 2003. – 292 p.: P. 234

Traumatology: national guide / ed. G.P. Kotelnikova, SP. Mironov. - M.: GEOTAR-Media, 2008. - 808 p.: P.77

Fundamentals of preventive medicine and first medical aid: Textbook / L.V. Vysochina, V.N. Kleimenov, A.I. Sinyushkin, etc.; Under general ed. M.G. Romantsova. Kaliningrad univ. - Kalininrad, 1996. - 103 pp.: P.60

Artyunina G.P., Gonchar N.T., Ignatkova S.A. Fundamentals of medical knowledge: Health, illness and lifestyle. – Pskov, 2003. – 292 p.: P.242

Fundamentals of preventive medicine and first medical aid: Textbook / L.V. Vysochina, V.N. Kleimenov, A.I. Sinyushkin, etc.; Under general ed. M.G. Romantsova. Kaliningrad univ. - Kalininrad, 1996. - 103 pp.: P.60

Fundamentals of medical knowledge / Ed. Yu.S. Tarasova. – In 2 volumes: T.1. – Samara, 1996. – 175 pp.: P.24

Artyunina G.P., Gonchar N.T., Ignatkova S.A. Fundamentals of medical knowledge: Health, illness and lifestyle. – Pskov, 2003. – 292 p.: P.243

Fundamentals of preventive medicine and first medical aid: Textbook / L.V. Vysochina, V.N. Kleimenov, A.I. Sinyushkin, etc.; Under general ed. M.G. Romantsova. Kaliningrad univ. - Kalininrad, 1996. - 103 pp.: P.61

Artyunina G.P., Gonchar N.T., Ignatkova S.A. Fundamentals of medical knowledge: Health, illness and lifestyle. – Pskov, 2003. – 292 p.: P.236

Fundamentals of medical knowledge / Ed. Yu.S. Tarasova. – In 2 volumes: T.1. – Samara, 1996. – 175 pp.: P.22

Fundamentals of medical knowledge / Ed. Yu.S. Tarasova. – In 2 volumes: T.1. – Samara, 1996. – 175 p.: P.25

Classification of wounds according to the nature of tissue damage.

This classification is the most comprehensive. Depending on the nature of tissue damage and the type of wounding weapon, the following are distinguished:

· Incised wounds

· Stab and stab wounds

· Bruised wounds and crush wounds

· Gunshot wounds

· Lacerations

· Chopped wounds

· Bite wound

Incised wounds . An incised wound is a wound caused by a sharp cutting object (knife, glass, razor, etc.). Such a wound can have either a linear or patchy appearance and be accompanied by the loss of a section of tissue (scalped wound). Despite the variety of appearance and position, incised wounds have many general properties. Due to the elasticity of the skin, the edges of the wound diverge, a gaping of the wound occurs, and the deeper parts of the wound are easily accessible for inspection and it is usually not difficult to find out which tissues and organs are damaged. Depending on the location and direction of the incised wound, the gaping of its edges is different; so, wounds that are inflicted along the way diverge the least skin folds, for example, transverse incisions in the neck and abdominal wall. This property of wounds is the basis for surgeons’ use of so-called normal incisions during operations, i.e., incisions running along the folds of the skin (parallel to Langer’s lines). Due to good contact between the edges, such wounds produce barely noticeable scars upon healing. If the wound is inflicted perpendicular to Langer's lines, such wounds will gape widely and, after healing, leave noticeable and even rough scars. In surgery, surgeons perform parallel incisions when opening abscesses, which ensures good drainage of the wound.

The linear shape of the wound is beneficial for healing in cases of infection. The properties of the edges of the incised tissue are even more important for the favorable course of an incised wound. In a wound caused by a sharp cutting object, the edges of the cut tissues are slightly damaged, the tissues lose little vitality and ability to respond to infection. These properties of incised wounds are very favorable for healing and most often such wounds heal by primary intention.

The pain with an incised wound (of course, in the absence of injury to large nerve trunks) is incomparably less than with other types of wounds, due to minor damage to the nerve endings; in addition, she weakens soon after being wounded. Bleeding, especially when large vessels are injured, can be significant. The severity of the gaping, as already mentioned, depends on the relationship of the inflicted wound to Langer's lines.

Stab and stab wounds . Puncture wounds include injuries caused by a knife or bayonet ( stab wound), nail, awl, stiletto, etc.

A puncture wound inflicted by a sharp stabbing instrument is characterized by a deep canal and often significant damage to internal organs with a small external hole; therefore according to appearance It is difficult to judge the depth and severity of the wound. With a deep wound channel, there are often damage to large vessels, and there may be no external bleeding, but the patient may experience significant hemorrhage in the tissue or, what is even more dangerous, in the cavity (thoracic, abdominal). Such bleeding may not be noticed during the initial examination.

An important feature of puncture wounds is also the fact that when infection gets into such a wound, due to the presence of hemorrhages in the tissue and the tortuous and narrow channel of the wound, which makes it difficult to release wound fluid, a purulent process occurs with the possible development of complications: phlegmon or abscess.

In most cases, puncture wounds, especially penetrating ones, accompanied by damage to internal organs, nerves, tendons, and large vessels, require serious surgery in the first hours after injury. We recognize the presence of such injuries by bleeding (vascular injury), by sensitivity disorders, paralysis of an entire group of muscles and the absence of movements in them (nerve injury), by the inability to perform any specific movement, for example, flexion and extension of a finger (tendon injury). . In case of a stab wound to internal organs, the signs will be the release of the contents of hollow organs into the wound, traumatic shock, and so on. However, with injuries to internal organs obvious signs Damage often appears late. Therefore, if internal organs are injured, it is urgent to carry out the appropriate diagnostic measures(X-ray, ultrasound, laparocentesis, diagnostic puncture and etc.).

Bruised and crushed wounds. This group includes wounds inflicted by any blunt instrument (a stick, a pipe, a part of a person’s body, any hard objects, a surface from a fall). The main property of bruised wounds is a significant amount of non-viable, bruised and crushed tissue at the edges of the wound, which does not give normal reaction against infection and are nutrient material for the development of the latter. Such wounds are very prone to infection, and the purulent process often continues for a long time and the wound heals only after its edges have become necrosis and dead tissue has been rejected. Therefore, bruised wounds rarely heal by primary intention, and during surgical treatment, the edges of the wound are extensively excised and, if possible, all damaged tissue is removed from the depths of the wound.

A distinctive property of bruised and crushed wounds is relatively little bleeding when even significant vessels are damaged. Wounds such as the separation of both thighs under the wheels of a tram or train would result in fatal bleeding if the wounds were cut, but under the influence of a blunt instrument (in this case wheels), the vessel is crushed over a considerable distance. The inner lining of the vessel (intima), torn over an even greater extent, hangs in the form of rags into the lumen of the vessel, which promotes rapid blood clotting and the formation of blood clots. Painful sensations from bruised and especially crushed wounds can be very intense and prolonged, since nerve endings are damaged over a considerable distance.

Lacerations . Like bruises, lacerations are formed when exposed to a blunt or sharp object, but directed at an acute angle to the surface of the body. With lacerations, significant detachment occurs, and sometimes scalping of soft tissue over a large area. In this case, the exfoliated area of ​​skin may lose nutrition and become necrotic. Pain from lacerations is usually very significant and prolonged; the severity of bleeding depends on the size and type of damaged vessels.

Sometimes lacerations can occur due to perforation of soft tissue from the inside by the sharp ends of broken bones. This situation often occurs with defects in the provision of first aid (refusal to immobilize limbs in case of fractures or rough manipulations during transport immobilization).

Chopped wounds . Chopped wounds are inflicted by a massive sharp object (axe, shovel, hoe, saber), and therefore occupy an intermediate position between cut and bruised wounds, combining their features to varying degrees. With chopped wounds, internal organs and bones are often damaged. The area of ​​tissue damage is significant, and massive necrosis often develops. The pain syndrome is significant, the bleeding is moderate or moderate, but hemorrhages into the thickness of the tissues or cavity are pronounced (with a penetrating wound).

Bite wounds. Occur as a result of bites from humans and animals.
Figure 6.2 Bite wound (large dog bite)

They are a special type of wound. Their peculiarity lies in the highest degree of infection, due to the penetration of virulent microflora of the oral cavity of humans and animals with saliva, therefore the consequence of this type of wound can be infection of a person with rabies, followed by death.

Figure 6.3 Through bullet hole: entry (top), exit (bottom)

Gunshot wounds. In peacetime, as a rule, they occur very rarely, more often as a result of careless handling of weapons. The most common gunshot wounds are bullet wounds (bullets from automatic small arms, revolvers), and somewhat less common are shot wounds.

The effect of a bullet on a living organism is determined by a living force equal to half the product of the mass of the bullet and the square of the speed, and the resistance provided by the tissues into which the bullet hits.

Shot wounds, as a rule, are multiple, often superficial, but when shot at close range, penetrating wounds into the chest and abdominal cavity, and the skull are possible.

Based on the type of injury, gunshot injuries can be divided into through and blind. Penetrating wounds are those in which a bullet or shrapnel passes through the body and there are entry and exit holes. The inlet is usually smaller than the outlet, its edges are retracted, and the edges of the outlet are often turned out.

This difference is especially pronounced in wounds with bone damage, when bone fragments are carried away by the bullet and tear soft tissue and skin at the exit hole. With a penetrating wound, the wound channel may not have a straight direction, since the direction of the bullet (fragment) upon impact with the bone may change. When a bullet gets stuck somewhere in the tissue, a blind wound occurs. A bullet getting stuck is often due to an impact with a bone, but in some cases, especially when wounded from long distances (at the end), the bullet has such little living force that it cannot penetrate through soft elastic tissue.

In blind wounds, foreign bodies are usually removed during primary processing wound If the foreign body has not been removed, then in the future there often becomes a need to remove it due to the fact that the foreign body supports the suppurative process or puts pressure on vital organs, etc. In some cases, the foreign body (bullet, shot) is completely does not make itself felt, remaining in the body of the wounded for many years. In this case, especially with a deep location, given the difficulties and dangers of removing a foreign body, it is better not to touch it. A connective tissue capsule is formed around the foreign body, separating it from the surrounding tissues.

If the bullet that wounded the patient only superficially touched the body, then the wound will be tangential in the form of a strip without an entrance or exit hole. These injuries are usually minor.

Often, with gunshot wounds, damage to internal organs is observed. A special group consists of abdominal wounds (skull, chest and abdominal cavities), in which damage to certain organs comes to the fore in the entire picture of the disease.

Vascular damage is of great importance, often resulting in massive bleeding, as well as damage to nerves, joints and bones. Damage to soft tissues from a gunshot wound from a bullet can be very different.

There are three zones in a gunshot wound: wound channel zone, in which they are located necrotic tissue, and sometimes pieces of clothing. The wound channel is surrounded zone of traumatic necrosis formed as a result of mechanical or thermal damage to tissues. Both zones contain pathogens and necrotic tissues, which serve as a nutrient medium for the former. Around the second zone there is a third zone - molecular shock zone; in this zone, tissues have reduced resistance to infection and less ability to regenerate and are often susceptible to late (secondary) necrosis.

Wounds are damage to tissues and organs, accompanied by a violation of the integrity of the skin (mucous membrane), accompanying pain, bleeding, separation of damaged edges (gaping) and dysfunction of the damaged part of the body. Superficial wounds in which there is incomplete damage to the skin or mucous membrane are called abrasions. Depending on the presence of the inlet and outlet openings of the wound canal, wounds are called blind - with a wounding object stuck in the tissue, and through - when it passes through. In addition, there are soft tissue injuries (skin, subcutaneous tissue, muscles, tendons, blood vessels, nerves), bone damage, as well as wounds that penetrate and do not penetrate body cavities. A penetrating wound is a wound when the object that caused it penetrates the pleural, abdominal, articular, cranial cavities of a person, the chamber of the eye, etc. With penetrating wounds of the chest and abdominal cavity, damage to the organs located in them is common. According to the mechanism of application, the nature of the wounding object and tissue damage, wounds are cut, punctured, chopped, bitten, torn, scalped, bruised, crushed, or gunshot.

Torn a wound is formed when a mechanical damaging factor impacts soft tissues in a way that exceeds their physical ability to stretch. Its edges always have irregular shape, tissue detachments or avulsions and tissue destruction are noted.

Chopped wound - a wound caused by a heavy sharp object. It has greater depth and a larger volume of non-viable tissue than an incised wound.

Cut a wound inflicted by a sharp object (knife, glass, etc.) is characterized by a predominance of the length of the damaged area over its depth, smooth edges, a minimum volume of dead tissue and reactive changes around the wound. A scalped wound is characterized by complete or partial detachment of the skin, and on the scalp of almost all soft tissues, without significant damage. A bruised wound and a crushed wound are possible when struck by blunt objects and are characterized by crushing and rupture of tissue with a significant area of ​​primary and subsequently secondary traumatic necrosis with abundant microbial contamination of damaged tissue.

Stabbed a wound occurs when soft tissue is damaged by a needle, awl, nail, knife, bayonet and other sharp elongated objects. Such a wound is usually deep and blind, has a relatively small entrance hole and may be accompanied by damage to blood vessels and internal organs.

Bitten the wound, as a result of an animal or human bite, is characterized by abundant microbial contamination and frequent infectious complications, sometimes very dangerous (rabies, etc.). It may have signs characteristic of lacerated, bruised and crushed wounds, and is often infected with pathogenic flora contained directly in the saliva of the bite victim.

Firearms a wound is the result of exposure to damaging factors of a firearm (fragments, bullets, shot). It differs significantly from all other types of wounds in structure, nature of local and general changes, the course of healing processes. Gunshot wounds from explosive bullets and bullets with a displaced center of gravity are especially life-threatening. With a through-and-through gunshot wound, an entrance and exit opening are formed, and the entrance opening is always smaller than the exit opening. As a result direct action a fragment or bullet creates a wound channel. It, especially with shrapnel wounds, carries scraps of clothing, soil, and destroyed tissues that contaminate the wound, which, in cases of extensive crushing, blood accumulation, and damage to internal organs, contributes to the development of severe forms of purulent and other complications. Effect physical impact gunshot factors on fabric depends, on the one hand, on their properties of damaging factors - size, shape, mass, flight speed, on the other - on the structure and physical properties affected tissues - their density, elasticity, water content, presence of elastic, strong or fragile structures. Each such wound is contaminated with microbes. It is customary to distinguish between primary and secondary microbial contamination. Primary contamination occurs at the very moment of inflicting the wound; secondary contamination, as a rule, is associated with violation of the rules of asepsis during dressings and operations and manifests itself in the form purulent complications. First aid to the wounded includes immediate stoppage of bleeding using a tourniquet or pressure bandage, application of a primary aseptic dressing to the wound, administration of painkillers, immobilization of body parts for bone fractures, significant damage to soft tissue, large vessels and nerves. The primary aseptic dressing protects the wound from secondary infection, since it absorbs and provides a temporary delay in infectious agents, toxins and decay products of damaged tissue entering the wound, preventing the development of wound infection and shock.

Lecture No. 3

Open injuries (wounds)

Violations of the integrity of the skin, mucous membranes and the surface of internal organs, occurring as a result of mechanical or other impact, are called a wound. Damage to the skin is usually accompanied by damage to the integrity of deeper tissues. The cavity formed between tissues as a result of penetration of a wounding object deep into the body is called a wound canal.

Classification of wounds:

Depending on the nature of the wounding object, there are stab, cut, chopped, bruised, lacerated, gunshot, bite wounds. The sharper the object and the faster the damage is done, the less damage is done to the edges of the wound.

^ By degree of damage wounds are divided into superficial and deep. Deep wounds may be accompanied by damage to blood vessels, nerves, bones, tendons, and internal organs. Deep wounds that penetrate into the cavity (abdominal, chest, skull) are called penetrating. All other types of wounds, regardless of their depth, are called non-penetrating.

^ By the presence or absence of infection In the wound, aseptic and infected wounds are distinguished.

All wounds, except those caused by a sterile instrument under sterile conditions during surgery, should be considered infected. A wound that has been exposed to another factor (poison, chemical agents, radiation) is called complicated.

^ Characteristics of certain types of wounds.

Puncture wounds occur when exposed to a sharp weapon - an injection with a knife, bayonet, or needle. This type The wound is characterized by a small, smooth external opening and usually great depth. Since the wound channel is narrow, due to tissue displacement (muscle contractions, skin displacement), it becomes intermittent zigzag. This makes puncture wounds especially dangerous, since it is difficult to diagnose the depth of damage and possible injuries to internal organs. Unnoticed damage to internal organs can cause internal bleeding, peritonitis or pneumothorax. Very often, a piercing weapon, such as a needle, remains in the tissue, which in turn can cause later complications.

^ Incised wounds can be applied with a sharp cutting object (knife, razor, glass, scalpel). Incised wounds have smooth edges. Most accidental wounds during surgical treatment are converted into incised wounds, which ensures their rapid healing.

^ Chopped wounds occur when damage is caused by a sharp, but heavy object(axe, sword, etc.). Since the wounding object is sharp, a wound appears that is similar in appearance to a cut, but since the wounding objects are quite thick, crushing of the edges of the wound always occurs to one degree or another.

^ Bruised Wounds is the result of the impact of a blunt object on tissue (hammer, stone, etc.). The edges of the bruised wounds are crushed, uneven, and soaked in blood. As a result of damage to blood vessels and their thrombosis, malnutrition of the wound edges and their necrosis quickly occur. Crushed tissue are an excellent breeding ground for microbes. Because of this, bruised wounds easily become infected.

^ Gunshot wounds are the result of injury from a firearm. Depending on the type of weapon, they are distinguished: bullet wound, shot wound, fragmentation wound (mine, grenade, shell). The least damage to soft tissue is caused by a bullet.

A gunshot wound can be through, when the wounding object passes through and has an entrance and exit opening; blind when an object gets stuck in the body; tangent, when the object caused superficial damage, passed next to the organ, only partially touching it. The entrance hole in a penetrating wound is always smaller than the exit hole. In a blind gunshot wound, the wounding object gets stuck in the tissues of the wounded person and becomes a foreign body. Fragments of damaged bone also become foreign bodies, which, necrotizing deep in the soft tissues, often lead to suppuration of the wound.

Gunshot wounds are often multiple and combined. Combined wounds are those in which the wounding projectile passes through a number of organs and cavities (for example, the abdominal cavity, diaphragm, pleural cavity) and causes dysfunction of several organs. Therefore, when treating gunshot wounds, the main attention should be paid to the wound channel. By examining it, you can determine the depth of the wound, the degree of damage to internal organs and soft tissues, and detect a foreign body.

Shrapnel gunshot wounds are often multiple and always cause more extensive tissue damage, since the fragments have jagged edges, sometimes of significant size. Uneven edges cause the penetration of various objects into the wound (clothing, soil, skin), which enlarge and contaminate the wound. Extensive tissue crushing, copious accumulation blood in the wound canals contribute to rapid infection and the development of severe purulent inflammation.

Symptoms of wounds.

Every wound is characterized by:

1. 
   pain,
2. 
   gaping
3. 
   bleeding.

Pain is especially intense at the time of injury and depends on the sensitivity of the area where the wound is inflicted. The most sensitive are fingers, teeth, tongue, genitals, and anus. The intensity of pain gradually decreases during the wound healing process. A sharp increase in pain, a change in their character (bursting, throbbing pain) indicate a developing complication in the wound: suppuration, development anaerobic infection.

Hiatus wound - the divergence of its edges - depends on the elasticity and ability of soft tissues to contract. The more and deeper wound, the greater the divergence of the edges.

Bleeding from the wound depends on the type of damaged vessels (artery, vein, capillaries), the height of blood pressure and the nature of the wound. The less damaged the tissue (cut, chopped wounds), the more pronounced the bleeding. In crushed tissues, the vessels are crushed and thrombosed, so bruised wounds bleed little.

The nature of wound healing depends on general condition victim (age, nutrition, accompanying illnesses, vitamin deficiency, etc.), as well as from local conditions, i.e. the nature and type of wound, the degree of its contamination, etc.

^ Wound healing.

Wounds can heal in two main ways - primary intention and secondary intention.

Wound healing, which proceeds quickly, without complications and ends after a few days with the complete restoration of tissue integrity with the formation of a thin linear scar, is called primary intention. The main condition for primary intention is the absence of dead and crushed tissue, blood clots (hematomas) and infection in the wound. In addition, for a wound to heal by primary intention, it is necessary that the edges of the wound fit tightly together and be viable.

Rice. Healing by first intention

In cases where the wound gapes, its edges are significantly damaged, there is dead tissue, blood clots, foreign bodies, an infection develops in the wound - healing proceeds slowly, by gradually filling the wound with granulation tissue with the release of pus and exudate. This type of wound healing is called secondary intention . The scar that appears after wound healing by secondary intention is rough, uneven, wide, and can subsequently wrinkle and cause contractures and stiffness of the joints.

Only incised and surgical wounds inflicted under aseptic conditions can heal by primary intention. All accidental wounds are infected to one degree or another and heal by secondary intention without surgery. Surgical intervention- primary surgical treatment - excision of the edges of the wound and the wound channel, removal of dead and crushed tissue, foreign bodies, followed by a closed suture of the wound, carried out in the first hours after injury, allows you to convert infected and crushed wounds into aseptic incised wounds and, in a significant number of cases, achieve primary intention .

Healing under the scab observed with superficial damage to the skin (burn, abrasion, scratch). A scab arises from blood and lymph poured into the wound, which, when dried, form a crust - a scab. Under the scab, the epidermis is restored. The scab falls off on its own after the skin is completely restored. The scab should not be forcibly removed, as this will disrupt the restoration process of the epidermis and the development of granulation tissue at the site of the wound, which will delay healing. If skin restoration with primary intention occurs within 4-7 days, then with secondary intention - within several weeks or months. This implies the importance of primary surgical treatment of accidental wounds.

Rice. Scheme of wound healing by primary intention without scar formation.

Occurs without suppuration and formation of visible interstitial tissue with subsequent development of a linear scar. It occurs in wounds with smooth, viable edges that are no more than 1 cm apart from each other, in the absence of wound infection. A typical example of such healing is surgical wounds.

Rice. Detainee scheme primary healing(healing by primary intention) is healing without suppuration with delayed closure of the wound with sutures.

Rice. Scheme of healing by secondary intention.

Occurs through suppuration with the formation of visible connective tissue and the subsequent development of a rough scar. Occurs with the development of a wound infection and the presence of extensive tissue defects that do not allow initial comparison of the wound walls.

^ Rice. Healing pattern under the scab.

Occurs without scar formation in superficial wounds with the germ layer of the skin preserved. Rapid regeneration of the epidermis occurs under a scab consisting of fibrin and shaped elements blood.

^ Treatment of wounds. (for amateurs)

Primary treatment of wounds

First What needs to be done when injured is to stop the bleeding that occurs. If the bleeding is capillary and the wound is shallow, this step can be skipped.

Second- this is to anesthetize the victim (it is better to use injectable forms of painkillers, for example, intramuscularly inject ketarol or, in extreme cases, analgin). For shallow wounds and lack of pain syndrome Painkillers may not be administered, but if the wound is at least somewhat serious, you should not refuse painkillers.

Third- this is the treatment of a wound antiseptic. Usually in such cases I use a solution of chlorhexidine bigluconate, sold in pharmacies. You can also use a 3% solution of hydrogen peroxide (at the same time it will help stop bleeding), but chlorhexidine still disinfects better. When washing the wound, you must carefully remove all foreign bodies - they will interfere with healing. It is advisable to treat the edges of the wound with 5% tincture of iodine, making sure that iodine does not get into the wound.

Fourth- applying a bandage. The dressing should be changed daily.

Fifth- introduction antibacterial drugs. In camping conditions, it is better to “protect” yourself with medications in any case, using them in the form of capsules from a camping first aid kit (cephalexin 2 capsules 3 times a day, ciprofloxacin 250-500 mg 2 times a day).

^ Treatment of purulent wounds

The main thing in the treatment of a purulent wound is to ensure normal outflow of pus and wound discharge from the wound. There will be normal outflow - the wound will heal normally. If pus accumulates in the wound, there will be no healing, despite all efforts.

That is why it is not recommended to suture wounds while traveling. During a hike, there is a high probability of wounds becoming suppurated, and a sutured wound creates ideal conditions for the development of infection. Plus, there is a lack of oxygen, which can lead to an anaerobic infection. Of course, if you have medical education and relevant experience, you will be able to suture the wound correctly, avoiding complications. However, for everyone else, we can only recommend treating the wound with an antiseptic and applying a bandage, and then repeating this procedure daily. It is good to use dressings with a 10% solution of table salt (not necessarily sterile) - they draw out fluid and pus. If the wound is narrow, and when applying a bandage the edges close tightly, it is advisable to place a thin strip of rubber or film (carefully treated with alcohol and available antiseptics) between the edges of the wound to give the pus a path for outflow.

As long as the wound is “flowing”, ointment preparations cannot be used - they impede the outflow of wound discharge. Ointments will be needed at the second stage, when the wound is cleared of pus and non-viable tissue, and the process of granulation formation begins (the growth of special tissue on the walls of the wound, which will subsequently fill the entire wound and become the basis for the scar). These granulations must be protected from damage, so it is good to lubricate them with ointments such as Levosin and Levomekol. Usually ointments can be used only for 3-4 days. At this time, suction dressings with saline solution no longer needed. When the wound is completely clean, you can try to tighten the edges of the wound with a bandage or narrow (3-4 mm wide) strips of plaster to speed up healing.

Rice. - Granulation tissue is a sign of an adequate healing process

^ Wound treatment (advanced)

Primary surgical treatment of the wound.

The main point of wound treatment is primary surgical treatment of the wound. Inflammatory phenomena in the wound develop quite quickly. After just 6 hours, you can observe the first signs of inflammation in the wound: swelling and hyperemia appear. Thanks to antibiotics and some sulfa drugs possible deadline primary treatment is 18-24 hours. However, the sooner the treatment is carried out, the more conditions for wound healing by primary intention. The main task of primary surgical treatment is to remove necrotic, contaminated and infected tissue and bring the edges of the wound closer together.

Each dressing must be carried out in compliance with the rules of asepsis. Objects in contact with the wound must be sterile, so all dressings are carried out with instruments - the so-called instrumental dressing. Instruments can only be used for one dressing, after which they are sterilized again.

Tweezers are used to remove the last layers of the dressing. Using the same tools, grasping balls moistened with ether or alcohol, treat the skin around the wound, and apply a new bandage with them.

The appearance of pain in the wound, redness and swelling of its edges, and an increase in temperature indicate developing suppuration of the wound. In such cases, it is necessary to remove the stitches and open the wound. If wound healing proceeds without complications, then after 5-7 days the sutures are removed and the wound is considered healed.

^ Treatment of purulent wounds.

Treatment of purulent wounds varies depending on the phase of the wound process. The developing inflammation creates a kind of protective barrier, ensures the rejection of dead tissue and their removal along with the embedded microflora. Early period The course of a purulent wound is characterized by the development of an acute inflammatory reaction (first phase). In this case, pronounced tissue swelling, redness, copious discharge tissue fluid into the wound lumen and the formation of pus (hydration stage) - Pus - inflammatory exudate, containing leukocytes (white blood cells), dead and living bacteria, an enzyme that has the ability to melt tissue. The process occurring during this period ensures the rejection of dead tissue and the formation of a protective wall of granulation tissue.

Rice. Spongy granulation tissue with inadequate wound healing

After rejection of necrotic areas, the wound is cleaned and quickly filled with granulation tissue (dehydration stage), which is gradually replaced by connective tissue (second phase).

The main task in the treatment of infected and purulent wounds in the first period is to create conditions for good outflow of exudate, pus and separation of necrotic tissue, as well as to take measures to prevent the penetration of infection from the wound into the body. A satisfactory outflow of pus can occur only with a wide opening of the abscess and the destruction of all pockets and leaks. This is achieved by applying additional incisions and mechanical removal of dead tissue, fragments, and foreign bodies. Outflow from the wound can be improved by the use of hypertonic solutions and ointments, which increase exudation and at the same time increase the flow of pus from the wound into the dressing. Antiseptic solutions injected into the wound have a certain influence on the course of the purulent process during this period. The destruction of microbes that occurs, slowing down their growth and reproduction, reduces the risk of infection and poisoning of the entire body and has a beneficial effect on the protective processes occurring in the wound. It is very important to increase blood flow to the wound during this period. This is achieved by using heat in the form of heating pads and dry-air hot baths. However, warming compresses should not be used, as they sharply disrupt the outflow of pus and increase the absorption of toxic products into the body. No less important point is to create rest for the wound up to the use of immobilizing dressings (splints, plaster splints, etc.).

Treatment of wounds in the second phase mainly comes down to protecting granulations from damage and secondary infection. During this period, the use of hypertonic and antiseptic solutions is contraindicated, as they destroy granulations and slow down their growth. Wet dressings have an unfavorable effect, disrupting the process of replacing granulations with connective tissue. Protection of wounds and granulations is carried out by applying aseptic oil dressings ( fish fat, Vaseline oil). It is necessary to achieve complete filling of the wound with granulations. The wound is considered healed when it is completely epithelialized.

^ Wound care.

Care for an infected and purulent wound must be carried out very carefully. When changing the dressing, washing the wound, inserting tampons, etc., the most important thing is to maintain asepsis. Particular attention should be paid to protecting the skin around the wound from infection. Pus entering the skin can lead to damage to its integrity and spread inflammatory process. The skin can be protected by applying a layer of fat, ointment or paste. In this regard, Lassara pasta is the best. Dressings should be made only with instruments (two tweezers), being careful not to contaminate the skin around the wound, as well as your own hands. It is better to protect your hands with gloves and wash them with soap and water after each dressing without removing them.

Removal of dried dressings, tampons and drains should be done carefully. For a painless separation dressing material In some cases, the wound should be moistened with hydrogen peroxide. Before you start cleaning the wound, you need to lubricate the skin with iodine tincture. Good action washes the wound with weak antiseptic solutions(hydrogen peroxide, furacillin, rivanol, potassium permanganate). Hydrogen peroxide in a wound quickly decomposes, releasing large quantity foam, which carries away pieces of necrotic tissue, pus and significantly reduces the unpleasant putrefactive odor.

Particular care must be taken to monitor the inserted drains (rubber tubes and strips). Their prolonged stay in the wound can lead to the development of bedsores of nearby organs (vessels, intestines, etc.). To reduce the possibility of the dressing getting wet, it is necessary to apply a sufficient layer of dressing material (gauze, cotton wool, lignin) to the wound.

Summarizing all of the above, the treatment of infected and purulent wounds can be presented schematically as follows. The wound is opened wide with the elimination of pockets, leaks and bridges. For the first 2-3 days, gauze swabs moistened with hypertonic solutions (10% sodium chloride solution, 25% magnesium sulfate solution) are inserted into the wound for better outflow. Tampons absorb wound contents well, which enter the upper layers of the dressing. Hypertonic solutions not only improve the release of pus, decaying tissue and blood clots from the wound, but also have a bactericidal effect, creating unfavorable conditions for the growth and reproduction of bacteria. After cleansing the wounds, they proceed to treatment with ointment dressings. At first, tampons are also used, but they are changed less frequently, after 3-5 days. When good granulations appear, the introduction of tampons is stopped, since they are already foreign bodies and make healing difficult. It is necessary to switch to tampon-free treatment with ointment dressings. The most common is Vishnevsky's ointment (Ol. Cadini 3.0; Xeformil 3.0; Ol. Ricini 100.0), which has a weak irritant and antiseptic effect and provides good drainage of the wound. It is possible to use ointments containing sulfonamides (streptocide, sulfadimezin), antibiotics (penicillin, streptomycin). The final stage treatment is aimed at protecting granulations and the epithelium growing on them from damage and re-infection while simultaneously performing active therapeutic exercises.

For some types infected wounds(burns, frostbite) used open treatment in order to achieve drying of the wound surface under the influence of air and light. Drying the wound leads to the death of microorganisms. Protection of the wound from contamination and re-infection is achieved by placing the wound surface under a frame equipped with thermal reflectors (electric lamps).

Caring for patients with open injuries. Successful treatment of the wounded depends largely on care. The main danger is the possibility of wound infection. Maintenance of the bed, skin in hygienic conditions helps prevent secondary infection. First of all, you need to monitor the applied bandage. The dressing should be dry and reliably cover the wound from environment. Contact of urine, feces, water from heating pads and glaciers on the bandage can cause the wound to fester. This bandage must be changed immediately. If the dressing gets wet excessively with discharge from the wound, cotton wool should be placed on the dressing and bandaged. You need to be especially sensitive to the patient’s complaints about pain in the wound, the appearance of chills and increased body temperature. All this may indicate developing suppuration in the wound and necessitates control dressing,

During the first 3-5 days, it is necessary to create rest for the damaged organ.