Fractures may be accompanied by skin rupture and bleeding

Violation of the integrity of the bone can occur due to injury or literally “out of the blue.” The limbs are most often affected. During a fracture, a person cannot take care of himself, because the painful shock prevents him from correctly assessing the situation. Providing first aid for a fracture lies entirely with the surrounding people, and the length of rehabilitation and the health of the victim will depend on how skillfully pre-medical measures are carried out.

The causes of fractures are varied:

• domestic injuries;
• traffic accidents;
• increased bone fragility;
• beatings;
• injuries at work.

The most dangerous fractures are those of the spine, which usually occur when falling from a height.

It is advisable for a person without medical education to provide assistance only when limbs are damaged. If there are signs of fractures in other anatomical areas, you should immediately call an ambulance.

What types of bone injuries are there?

The classification of fractures by location is quite complex and includes fractures of all bones. In general, all types of fractures can be divided into two groups:

• closed fractures - the integrity of the structures of bones, joints, muscles and blood vessels is violated, but the skin remains intact;
• open fractures - a violation of the integrity of the bone with a break in the skin - a severe type of injury.

These two types have a large number of differences in the clinic and in the rules for providing pre-medical care. All manipulations with the victim’s limbs must be carried out carefully, because it is unknown whether there are bone fragments and what the nature of the fracture is.

With a closed injury, the skin and muscles are not damaged. If the injury is open, bleeding is dangerous.

An open fracture has obvious signs and requires the rescuer to know how to stop bleeding. Further treatment usually consists of surgery and attempts to reassemble the bone so that it heals correctly. It is important for rescuers not to aggravate the situation with their actions.

When providing first aid, the main thing is not to turn a closed fracture into an open one. This significantly lengthens the recovery time and can provoke massive bleeding from the wound.

Symptoms

Symptoms of open and closed fractures are as follows:

• sharp pain in the limb, aggravated by attempts to move the fingers or passive movements;
• dysfunction of the joint;
• change in the anatomical position of the limb;
• increasing swelling and hematoma at the site of injury;
• a wound with bone fragments in it.

The rules for treating fractures are based on one principle - it is necessary to immobilize (immobilize) the injured limb so that the patient can be taken to a medical facility.

Important! Before you begin to provide first aid, you need to call an ambulance. If this is not possible, then you need to take care of the means of transporting the victim.

First aid for closed fractures

If there is a suspicion of a broken limb, then you need to remain calm. A closed fracture is often accompanied by abrasions and wounds on the skin. The injury may result in internal or external bleeding. It is also very important to anesthetize the victim when providing emergency care, because pain syndrome can lead to painful shock.

The procedure for providing first aid for fractures is briefly presented in the table.

Sometimes it is difficult to determine which fracture, since there is damage to the skin and it is not clear how deep it is. If in doubt, it is better to treat the fracture as open.

Action	Description
	Examine the limb to determine the type of fracture. If in doubt, it is better to treat the fracture as open. Next, you need to determine the sequence of further actions.
	When providing first aid in the event of a spinal fracture, it is prohibited to move the patient or place things under his head.
	If there are abrasions and wounds on the skin, they need to be treated. Any antiseptic is suitable for disinfection. The most common are Hydrogen Peroxide and Chlorhexidine.
	If moderate bleeding persists, you need to apply a clean pressure bandage; if there is no bleeding, then a regular clean napkin is enough.
	It is imperative to anesthetize the victim. Pain can lead to an increase in traumatic shock. In this case, the patient will behave actively, without assessing the severity of his condition. Ideally, you need to give an intramuscular injection with an anesthetic (Ketanov, Dexalgin, Baralgin). If it is impossible to administer the medicine parenterally, then you can give painkillers in tablets.
	To do this, you need to find any two straight pieces of wood or sticks. The splint is applied along the lateral surfaces of the limb to a distance covering three joints. The elements of the splint are fixed to the limb with bandages. When applying a splint, it is important to try to bring the limb into a physiological position.
	Ice should be wrapped in a towel and applied to the injury site. Cold will reduce swelling and bleeding.
	When all steps are completed, you need to take the victim to the emergency room.
	During transportation, try to position the patient so that there is no impact on the limb. If an ambulance has been called, you must wait for them.

First aid for open fractures

If there are signs of severe arterial bleeding, when blood gushes out like a fountain, the time limit before the death of the victim is 3 minutes. Therefore, it is so important to begin emergency actions by stopping the bleeding.

Let us consider in detail what kind of first aid should be provided to a person with an open fracture. Once the fact of the presence of an open wound with bone fragments inside has been established, the following algorithm must be followed.

Actions	Description
	An ambulance should be called.
	Open fractures are often accompanied by bleeding, which can be life-threatening. Therefore, the first thing you need to do is stop the bleeding.
	Methods to temporarily stop bleeding are the application of a tourniquet or twist, which is applied 3-4 cm above the site of injury.
	Be sure to write down the installation time of the harness.
	In winter, the tourniquet should be applied for no more than half an hour. In summer this time can be increased to an hour.
	When the bleeding has stopped, you need to treat the wound. There is no need to try to remove bone fragments. The surrounding skin is treated. You can apply a clean bandage on top, but do not fix it tightly.
	Pain relief for the patient. It is best to inject an injection of painkiller intramuscularly. You will definitely need to tell the emergency physicians about this.
	Applying a splint. You need to grab three joints, trying not to move the limb too much. It is imperative to fix the splint, while taking measures to displace the bone fragments.
	The patient should be hospitalized as soon as possible.
	It is best to transport the victim with a medical team. The ambulance contains the necessary equipment for resuscitation if necessary.

For more information on the rules for applying a splint for various limb injuries and fractures, watch the video in this article.

What kind of help should a child receive?

In children, fractures develop according to the “greenstick” type without rupture of the periosteum. After an injury, the child will complain of pain, dysfunction, and changes in the size of the limb.

• If a limb is damaged, then a splint is applied according to all the rules.
• Then the child needs to be hospitalized.

The rules for immobilization in children do not differ from those in adults.

The doctor will be able to give an answer to what further treatment for an open or closed fracture awaits the victim after an x-ray.

When providing assistance for fractures, the rescuer needs to approach this task with all responsibility, because a person’s life may depend on the correctness of actions. It must be remembered that heavy bleeding and painful shock () can lead to a sharp deterioration of the condition. With blood loss, the victim may develop complications in the form of hemorrhagic shock () and hypovolemic shock ().

Lecture 8.11. First aid for fractures.

Correctly provided first aid for fractures reduces the number of possible complications by almost 2 times. In some cases, providing first aid for fractures saves a person’s life in the literal sense of the word. This applies to open types of bone fractures, in which severe bleeding may occur due to damage to large main blood vessels.

First aid for bone fractures largely depends on the type of injury and its consequences. A preliminary diagnosis of the victim’s condition is necessary.

There are three main types of traumatic fractures:

closed damage to bone structures without deformation from a physiological position;

closed type of injury with displacement of fragments and deformation of the anatomical part of the body;

an open fracture with rupture of external tissues and the formation of a wound surface that is prone to secondary infection.

A special group of such injuries includes intra-articular fractures that affect the heads and necks of the bones of the upper and lower extremities. These injuries are difficult to diagnose without the use of x-ray equipment.

This material presents the basic rules of first aid for fractures that are localized in various parts of the human body.

First aid for fractures should be careful

The main rule that a person providing assistance to victims must adhere to is extreme care and caution. The basic principle is do no harm. But damage to bone tissue can be caused even with the help of an awkward movement. Therefore, you need to follow certain rules and not make any attempts to restore the physiological position of the bones or the human body.

First aid for fractures should be careful and not include unnecessary body movements, which can be quite dangerous. This is especially true for fractures of ribs and vertebrae.

To begin with, we present the most characteristic symptoms of bone integrity disorders:

pain syndrome of pronounced intensity;

changing the visible configuration of a limb or body part due to changes in the anatomical structure of the damaged bone;

decrease or increase in the length of the injured limb;

limitation or lack of mobility in that part of the limb that is located below the site of traumatic impact;

crepitus (creaking or rubbing) when trying to palpate the bruise.

Within 30 - 40 minutes after the injury, swelling of the soft tissues increases. Due to the disruption of the integrity of the blood vessels, an extensive subcutaneous hematoma can form, which looks like a bruise.

First aid for open and closed fractures

First aid for open and closed types of fractures begins with immobilization of the damaged part of the body. It is necessary to ensure the complete absence of any mobility. This event is aimed at preventing the displacement of bone fragments. But it also solves other problems: it helps stop bleeding and prevent the development of painful shock.

First aid for an open fracture should include measures aimed at preventing the penetration of secondary infection into the wound surface.

The basic algorithm of actions for providing first aid for an open fracture:

examination of the victim and assessment of his condition;

Give, if possible, an anesthetic to relieve acute pain;

treat the wound surface with a 3% solution of hydrogen peroxide, a 5% alcohol solution of iodine, Miramistin or any other antiseptic;

dry the wound surface with a sterile gauze pad;

open the sterile dressing bag and apply it without tightly applying a bandage to the wound surface;

select suitable objects to immobilize the limb (for this you can use special splints, straight sticks, boards, plastic hard objects with a flat surface;

without correcting the position of the limb, splints are applied and bandaged to the leg or arm so that they are tightly fixed;

An emergency medical team is called.

First aid for a closed fracture is provided in the same way. Moreover, if there is no wound surface, then you can skip the stage of antiseptic treatment and applying a sterile bandage.

Separately, it is worth dwelling on bleeding from open and closed bone fractures. In the first case, bleeding can be massive due to damage to large blood vessels by bone fragments. It is worth distinguishing venous bleeding from arterial bleeding, since the location for applying a rubber tourniquet depends on the type of pathology. During arterial bleeding, blood flows out continuously in pulsating streams and has a rich scarlet color. A tourniquet is applied above the bleeding site. With the venous type of bleeding, the blood flows slowly, in a continuous stream and has a dark cherry tint. In this case, the tourniquet is applied below the bleeding site.

For closed fractures, first aid to stop bleeding is provided using external means. The most accessible of them is ice or another source of cold. An ice pack is applied to the affected area. This method can reduce the size of the intracavitary hematoma and reduce the intensity of pain.

It is no secret that when a fracture occurs, the integrity of the bone is disrupted under the influence of a traumatic factor, the strength of which exceeds the strength of the skeleton. It has become commonplace that first aid is provided by doctors, but they do not always appear immediately at the scene of an incident. Often, the function of emergency doctors and paramedics falls on random passers-by or relatives. Providing on time and correctly first aid for fractures prevents the development of many complications and allows in some cases to save life.

All injuries to skeletal bones can be divided into two large groups, the first includes traumatic and the other pathological fractures. The main causes of traumatic injuries are impacts, road accidents, and falls from a height. And the main condition is that the bone tissue must be healthy. Damage of the second type occurs against the background of a disease that leads to a decrease in strength. Examples include osteoporosis, tuberculosis, and tumor; fortunately, such fractures are less common.

From left to right, an intra-articular, open and closed fracture is shown.

Types depending on severity

There are several types of injuries that determine the severity and tactics of further treatment. They also influence the tactics of providing first emergency aid. Highlight:

1. Closed fractures, in which there is no violation of the integrity of the skin. Such damage can occur without displacement and with a violation of the location of the fragments. The danger is that the fragments can injure surrounding formations and tissues.
2. Open fractures are characterized by a violation of the integrity of the skin and nearby organs or formations. With such injuries, bone fragments are visible in the wound. Also, the damage can be secondary open, when initially the skin was not damaged, but as a result of improperly provided first aid or transportation, the fragments lead to the appearance of a wound.
3. Separately, intra-articular fractures are distinguished, which can also be open or closed. When damaged, the integrity of the bone sections that form the joint is compromised.
4. Compression fractures are common in the spinal column. Since the structure of the body of any vertebra is spongy, its compression is called compression.

Symptoms

A preliminary diagnosis can be made based on characteristic symptoms. Common ones among them are:

• severe pain at the site of injury;
• the normal anatomical shape of the damaged area is disrupted;
• the site of injury swells;
• the limb lengthens or becomes shorter;
• characteristic crunch of fragments upon palpation;
• mobility at the site of injury is sharply impaired.

With open damage, massive bleeding from an artery or vein often develops. In this regard, special attention will be paid to primary care for open fractures. Bleeding occurs with a closed injury; depending on the bone, it has a different volume.

In case of any injury, one can identify the basic principles of action in relation to the victim. First medical aid for a fracture begins with the fact that the site of injury must be numbed. A cold object, which is wrapped in cloth and placed at the site of injury, will allow this to be done. You need to stand for about 20 minutes, after which a break is taken for 10. If the item is from the freezer, you can repeat the procedure no more than three times to avoid frostbite.

An analgesic tablet or an anesthetic injection into the muscle is indicated for damaged limbs. Fractures of the pelvis, ribs, and spine may be accompanied by a violation of the integrity of internal organs, and pain relief disrupts the clinical picture, complicating further diagnosis.

An open fracture is characterized by bleeding that must be stopped. This can be done using a standard tourniquet, using any available means (clothing, fabric, wire, rope) or simply applying a pressure bandage. In case of arterial bleeding, the tourniquet is applied above the site of injury; when a vein is bleeding, the tourniquet is applied below the wound. Be sure to attach a note with the time of application; you can write it on the body, in a visible place. The duration of application of the tourniquet is no more than 2 hours in summer, 1.5 in winter. If the hospitalization time exceeds the above periods, the tourniquet is slightly loosened. In some cases, finger pressure of the artery is indicated, however, it cannot be performed for a long time.

Bleeding from an artery is characterized by a gushing stream of bright red blood (due to oxygen). With venous blood loss, the stream is sluggish and has a dark cherry color.

Transport tires

After the bleeding has temporarily stopped, first aid for bone fractures includes immobilizing the site of injury. For these purposes, ready-made transport tires can be used or improvised materials can be used. You can find ready-made tires in an emergency room, a first-aid post, a trauma department, or when calling an ambulance. A simple person can use any material at hand, after wrapping it in cloth or bandage. To do this, you can use branches, skis or their sticks, boards, cardboard, metal rods, small diameter pipes, and much more.

The standard ones are:

• Dieterichs tire;
• Kramer wire tire;
• vacuum or pneumatic tires;
• Elansky splint (used for injuries to the head and cervical spine).

Any splints are applied over clothing, and a roll of cotton wool or fabric is placed on the bony protrusions. Providing first aid for a fracture of the lower limbs or arms with a wound includes treating it with a solution of hydrogen peroxide, applying a sterile bandage if possible, and cutting the clothing in this area. The main thing is to immobilize at least two joints, and in case of a fracture of the shoulder or hip - three. It is strictly prohibited to straighten any curvatures or fragments!

Immobilization for head and neck injuries

When the head and neck are injured, the danger lies in damage to the brain, large blood vessels, and nerves. The subtlety is that along with the head, the neck and the upper half of the torso must be fixed. To achieve the goal, a standard Elansky tire can be used. The victim's head is placed on the hole and secured with straps, which ensures reliable fixation.

If the ambulance team does not have an Elansky splint, then the technique proposed by Bashmakov will help get out of the situation. The head fixator is prepared from standard Kramer wire splints, wrapped in cotton wool and a bandage. The essence is the same as in the previous version. After which the victim can be taken to a medical facility.

Immobilization for fractures of the upper limbs and clavicle

To provide primary care for a broken arm, a standard Kramer ladder splint is used. It is located from the scapula of the healthy half of the body to the heads of the metacarpal bones of the affected limb. A splint is modeled on the healthy side of the victim.

The retainer is attached using a regular gauze bandage. The main indication for use is a fracture of the humerus and large joints (shoulder and elbow).

If the forearm is damaged, two joints must be fixed - the elbow and the wrist. The aforementioned Kramer tires or two wooden planks can be used. Correctly provided emergency care for limb fractures should include a certain position of the joints. At the elbow it is 90 degrees; in the palm there is a roller made of fabric or cotton wool or foam rubber. The absence of a fixator should not stop you; the limb can be bandaged to the body or a supporting bandage made of fabric can be used.

Improvised splints: a) for a fractured shoulder, b) forearm

If the collarbone is damaged, the hand on the side of the injury is fixed with a scarf. A figure-of-eight bandage or Deso can also be applied.

To apply a circular (eight-shaped) bandage, the forearms are retracted as far back as possible, in this position they are fixed with bandages or thick fabric. When fingers are broken, the injured person is fixed to a healthy one or to a piece of cardboard.

Damage to the lower extremities and pelvis

First aid for fractures of the limbs with damage to the pelvic bones should be provided comprehensively. Immediately after an injury, the victim should be moved as little as possible, as the risk of bleeding increases. It is not possible to immobilize this area with a splint; transportation is carried out on a stretcher or a hard surface (door or shield) in the Volkovich position. The legs are bent at the knees and spread apart, a blanket or rolled-up mattress is placed under them.

The provision of first aid for a leg fracture in the hip area has special features. Immobilization of this area is carried out using a Dieterichs splint made of plywood. The long part is located outside and reaches the armpit. The short part is placed from the inside from the groin to the foot. A plywood “sole” or footrest is attached to the foot, which is stretched by twisting. The splint, due to gradual stretching, allows you to immobilize three joints: ankle, knee and hip. Since large vessels and nerves can be damaged by fragments, the principle of operation allows them to be slightly shifted into place. In the absence of a Dieterichs fixator, first aid for fractures of the limbs can be provided with a long Kramer splint or any available means. Also, the injured limb can be fixed to a healthy one, and in this position the victim can be taken to a medical facility.

First aid for a fracture of the lower extremities in the shin area can be provided using the above-mentioned wire splint. Several of them are applied: two on the sides and one on the back with the obligatory grip of the foot along the plantar surface. The knee and ankle joints are immobilized, the angle at which should be 90 degrees, you can use improvised materials. Finger fractures do not need to be immobilized; it is enough not to step on them during transportation.

Tactics for fractured ribs and spine

No less important than providing first aid for fractures of the limbs is the tactics of action for damage to the ribs and spine. This is due to an increased risk of injury to vital organs and structures. Multiple and comminuted rib fractures can cause damage to the lungs and pleura. The result can be pneumothorax, in which air accumulates in the pleural cavity. With hemothorax, blood accumulates, leading to impaired breathing and cardiac function.

And if first aid for limb fractures begins with immobilization, then if the chest is damaged, such tactics may be erroneous and lead to injury to the lung or pleura. For multiple fractures, a circular bandage can be applied, but not a rigid one, as this may impair breathing. It is correct to bandage while exhaling, otherwise the retainer will not fulfill its purpose and will fall off. Recently, tying sheets or a towel is not used due to the risk of developing congestive pneumonia and injuries to internal organs.

When there is a wound through which air enters or exits, which is manifested by a characteristic whistle, a bandage is applied to it. But first, polyethylene (a sterile bandage wrapper) is placed on the wound, followed by a layer of cotton wool, which is fixed with a circular bandage. This will prevent air from entering the pleural cavity. The victim is transported to the hospital only in a half-sitting position.

Actions after a spinal column injury have their own subtleties, knowledge of them will prevent the development of disability. Any fracture of this area carries the risk of damage to the spinal cord or nerves, which leads to impaired mobility (paresis) or complete immobility (paralysis). Transportation is carried out only on a solid stretcher or shield, door.

Shifting from one place to another is carried out by a group of people who support the shoulder girdle, pelvis, legs, and head. Such manipulations are done as few times as possible. Rigid cushions are placed under the neck, lower back and knees to help maintain the spinal column in a physiological position. If transportation over a long distance is required, the victim is firmly fixed to the shield.

For any fracture, first aid should include pain relief and bleeding control. Transport immobilization is mandatory; each part of the body has its own characteristics. If everything is done correctly, it is possible to prevent the development of hemorrhagic (associated with blood loss) and traumatic shocks, complications from the spinal cord or brain. As a result, the fusion process improves, the recovery period and the risk of disability are reduced.

Every day many patients are admitted to the Department of Maxillofacial Traumatology. Approximately 70% of cases are treated with a fracture of the lower jaw. This frequency of injuries is due to the anatomical structure of the lower jaw, a more advanced position in relation to other bones of the facial skeleton.

The nature of the injury can be mechanical (sports, falls, fights, accidents) or pathological (osteomyelitis, tumor).

Classification

Fractures usually occur in weak areas of the lower jaw bone: the neck of the condylar process, the angle of the jaw, the midline, the canine and mental foramen areas.

In accordance with how many fragments were identified during the examination, fractures are divided into:

• single;
• double;
• triple;
• multiple;
• splintered.

Remember! The greater the number of fractures, the more difficult it will be to restore the bone to its previous state.

Highlight:

• Full - passing through the entire thickness of bone tissue. They are divided into displaced and non-displaced fractures.
• Incomplete - when the cortical plate is preserved on one side (cracks).

Also, the type of fracture depends on the location of the damage:

• middle - injury occurred in the incisor area;
• lateral - the fangs were damaged;
• angular - the affected area touches the molars;
• cervical - in the area of ​​the temporomandibular joint.

Did you know? Damage to the jaw, accompanied by a violation of the integrity of the skin and mucous membrane of the oral cavity, is called open.

Symptoms

There is acute pain at the fracture site when moving the lower jaw, changes in bite, mobility of fragments, bleeding and rupture of the mucous membrane.

General symptoms indicating a fracture are also possible:

• formation of bruises under the skin;
• the face in the area of ​​injury swells.

Broken bones disrupt the symmetry of the face, problems arise with clarity of speech, diction, words are very difficult to parse. In severe situations, a fracture can disfigure the face: numerous deformities, swelling in the cheekbones, swelling of the face, etc.

Algorithm for providing assistance for a jaw fracture

In case of a fracture of the lower jaw, the following immediate actions must be taken:

• apply a sling bandage that can help support the lower jaw - this can stop the ongoing destruction of the bone;
• apply an antiseptic bandage to stop bleeding;
• the artery should be clamped, provided that the blood flows strongly and forcefully, and is bright red in color;
• allow the victim to breathe freely, which requires clearing the mouth of dried blood and vomit, moving the tongue away when it gets stuck;
• you need to use a cool compress to reduce the swelling that occurs with a closed fracture;
• the victim should quickly end up in the hospital in the dental department, and must be transported in a sitting position.

In case of a fracture of the lower jaw, if there is damage to the skin, tetanus prophylaxis is carried out. Antibiotics are prescribed to treat infected wounds.

Important! Specialists first use painkillers to prevent painful shock and subsequent loss of consciousness.

When the lower jaw is fractured, you need to be extremely careful with the remaining bone fragments and teeth, which are also still fixed to the periosteum. If they fall out, then such teeth are immediately removed from the mouth, otherwise they can cause infection.

In the case of incomplete attachment of the alveolar process to the body of the occipital part of the skull, areas that do not have a connection with soft tissues should also be eliminated.

Dentist surgeons apply surgical sutures to stop bleeding on the skin and mucous membranes.

Ways to fix a damaged jaw

To fix a damaged jaw, you can use a special bandage that will strengthen the position of broken bones, prevent their possible movement, and eliminate the risk of hidden injury, which usually occurs as a result of the impact of bone fragments on soft tissue through friction. The bandage can be used for no longer than two hours. It is used only if it is impossible to use a better fixation option. You can also additionally use a bandage to tie the bone fragments to the entire jaw.

It is also possible to fix the position of the jaw (temporarily) using a ligature.

Specialized care includes conservative and surgical methods of immobilization. With conservative methods, the most widely used are Tigerstedt's aluminum wire splints and Vasiliev's tape splint.

Worth knowing! For such a fracture, various diagnostic methods are used, such as radiography, orthopantomography, MRI, CT.

The splint must be applied very firmly to each tooth, repeating the curve of the dentition. As a result, it is the teeth and wire that will support the damaged jaw. The average duration of immobilization, depending on the severity and location of the fracture, is 3–5 weeks. If inflammatory complications occur, the period increases to 6 weeks.

How does recovery work?

It is difficult for the patient to chew food, regardless of whether surgery has been performed, a splint has been installed, or there is a bandage for fixation. Liquid food promotes rapid rehabilitation. It is best to include meat broths, cereals, dairy products, grated vegetables and fruits in the menu. Bone fusion is a very long process, and the patient must gradually switch from such a children's diet to a normal diet.

In conclusion, it should be noted that it is highly not recommended to self-medicate with traditional medicine. The process of bone restoration must be constantly monitored by specialists.

Give a painkiller

Perform transport immobilization

Using standard or improvised means

Apply cold to the fracture site.

Carefully evacuate the injured person to a medical facility

Security questions

1. Give a classification of damage.

2. What are the causes and predisposing factors for the development of shock?

3. Name anti-shock measures.

4. What are the signs of dislocations?

5. What types of fractures do you know?

6. What are the main signs of fractures and their complications?

7. The main goal and objectives of immobilization for fractures?

8. Name the basic rules of immobilization for fractures.

9. List the basic requirements when performing immobilization of fractures of the clavicle, ribs, shoulder and forearm bones.

10. List the basic requirements when performing immobilization of fractures of the femur and tibia.

FIRST AID FOR WOUNDS

Wounds

Wounds are open tissue injuries in which the integrity of the skin, mucous membranes and underlying tissues (subcutaneous tissue, muscles, etc.) is damaged as a result of mechanical or other impact. The cavity that forms between tissues when damaged by a wounding object is called a wound canal.

Wounds can be different, depending on their origin, location, depth, degree of tissue damage, microbial contamination (infection), etc.

There are superficial and deep wounds. Superficial wounds are characterized by damage to the skin and mucous membranes. Deep wounds are accompanied by damage to blood vessels, nerves, bones, tendons, and internal organs. Wounds in which the internal membranes of cavities (skull, chest, abdominal) are damaged are called penetrating.

Wounds exposed to any physical or biological factors (poisonous, poisonous, radioactive substances) are called complicated.

Depending on the nature of the wounding object, wounds are cut, punctured, chopped, bruised, torn, gunshot, or bitten. The sharper the object and the faster the damage is done, the less damaged the edges of the wound are.

Incised wounds occur when damaged by a sharp cutting object (knife, razor, glass, scalpel). The wounds have smooth, undamaged edges, remain viable, bleed heavily and are deep.

Puncture wounds- applied with a piercing object (needle, knife, bayonet, awl). Penetrating puncture wounds with a visible small area of ​​tissue damage have a significant depth, as a rule, are accompanied by damage to internal organs, which can cause internal bleeding, peritonitis (inflammation of the peritoneum) and pneumothorax (penetration of air into the pleural cavity).

Chopped wounds- occur when damage is caused by a sharp and heavy object (axe, saber). They have unequal depth, are accompanied by tissue bruising and crushing of tissue, and are often accompanied by bone damage .

Bruised wounds- are the result of exposure to a blunt object (stone, hammer, brick). The edges of the wound are uneven and soaked in blood. Crushed tissues are a good breeding ground for microbes, so they are always infected.

Lacerations are the result of gross mechanical impact, accompanied by detachment of skin flaps, damage to tendons, muscles, blood vessels, and are subject to severe contamination.

Gunshot wounds- arise as a result of bullet and shrapnel wounds, as well as shot wounds. They can be through, when there are entrance and exit wound openings (the entrance opening is smaller than the exit opening); blind when a bullet or shrapnel gets stuck in the tissue; tangents, in which the wounding object flies tangentially, damaging the skin and soft tissues without getting stuck in them.

Shrapnel wounds can be multiple and are accompanied by extensive tissue damage. The uneven edges of the fragments carry scraps of clothing, soil, and flaps of skin into the wound, which increases the likelihood of tissue infection and severe purulent inflammation.

Bite wounds occur from bites of humans and animals (dangerous due to the possibility of contracting rabies), and are always infected with saliva.