Any violation of the integrity of the skin and soft tissues is called a wound.
Depending on the mechanism for obtaining a projectile or the object of inflicting injuries, they are divided into various types.
- The cut ones are applied with sharp cutting tools - a knife, a blade, including surgical wounds.
- stab wounds are applied with a thin sharp object and go deep into the tissues - with a long knife, bayonet, awl.
- Chopped ones are somewhat reminiscent of cut wounds, however, they are applied with a sharp and heavy object with great effort - for example, backhand with an ax.
- Bitten ones have a very specific character - they are applied by the teeth of animals or humans - this is a kind of combination of stab and lacerations.
- Gunshot wounds are also a fairly specific type of wound inflicted with a firearm.
- Poisoned - this is a special type of bitten wounds, however, their feature is the presence of one or another poisonous substance in the wound. Such wounds are caused by poisonous snakes, scorpions, poisonous spiders.
- Combined types of wounds - for example, a combination of stab wounds and cut wounds received simultaneously and inflicted by one object.
- Bruised wounds - we will talk about this type of wounds a little lower.
Definition
Injury with bleeding
A bruised wound is an injury to the skin and soft tissues caused by a blunt hard object. At great strength exposure often bruised wound is called bruised-crushed.
The main mechanisms for obtaining such an injury:
- Hit with a heavy blunt object.
- Fall onto a hard surface.
- Strong compression and stretching of tissues.
Contusion wounds are often obtained in everyday life, during fights and bodily harm, car accidents, and even in sports.
Types of bruised wounds include:
- Hematomas and bruises of soft tissues without breaking the integrity of the skin.
- Superficial violations of the skin - abrasions and erosion.
- Deep blunt injuries with violation of the integrity of the skin: ruptures, crushing of tissues.
Symptoms may accompany puncture wounds, so it will be necessary to clearly define whether it is a bruised wound or a combined one.
Peculiarities
Any injury has its own characteristics that determine the principles of treatment and further healing. Let's list character traits bruised wound.
The main specific feature of a bruised wound is its edges. The edges of the wound are uneven, often crushed, torn and saturated with blood and connective tissue fluid. Due to such features, such wound surfaces do not heal well and form rough scars.
Surface scratch
With bruised wounds, there is practically no such phenomenon, very characteristic of many wounds, as a wound channel. Stab wounds, gunshot wounds, chopped wounds have clearly defined wound channels, but in bruised cases it is difficult to trace.
Often, fragments from an injuring object remain in the wound - pieces of bark from a wooden object, sand and small stones when falling to the ground or asphalt, and other foreign contaminants. That is why such wounds must be thoroughly washed and sanitized with antiseptic solutions, since such small fragments significantly impair healing processes.
All bruised wounds are primarily infected. This means that in any case, various microorganisms got into the wound, since the injury was caused by a non-sterile object, in contrast to, for example, surgical wounds.
If the injury occurred far from a medical facility, it is important to be able to provide the victim with first aid. The main principle of providing first aid is: "Do no harm!". This is extremely important, because unnecessary and inept actions can cause more harm than the very reason for providing assistance.
We list the basic principles of first aid.
First of all, it is necessary to assess whether there is severe bleeding from the wound. Bruised wounds are in fact rarely accompanied by profuse bleeding, except for cases of deep damage to soft tissues with the capture of large vascular trunks.
Bruised head injury
If there is little or no bleeding, the wound must be washed. It is worth washing those wounds that are clearly contaminated with foreign fragments. Relatively clean surfaces can be left untouched. Hydrogen peroxide is ideal for washing. Formed upon contact with biological fluids. Foam pushes out small foreign bodies to the surface. Any antiseptic solutions are also suitable for washing: Chlorhexidine. Miramistin, a weak solution of potassium permanganate or boiled water with soap.
The edges of the wound should be lubricated with an alcohol solution: iodine, methylene blue, brilliant green and others. It is strictly forbidden to "fill" alcohol solutions into the wound cavity. Lubricate only the edges of the wound.
Place on the wound surface sterile napkin or gauze and bandage. If observed venous bleeding You need a pressure bandage. It is good to apply cold to the bandage.
If there are signs of arterial bleeding from the wound, a tourniquet should be applied. As a tourniquet, you can use any belt, belt, tape. The tourniquet is applied to the layer of tissue above the wound - approximately 10-15 cm should be retreated.
It is very important to attach a visible note under the tourniquet with exact time applying a tourniquet, since in summer the tourniquet can be kept for 1 hour, and in winter - 40-45 minutes. If you keep the tourniquet longer, the tissue will begin to die. Therefore, a tourniquet is applied only if there is arterial bleeding fountain and it never stops. Otherwise, you can only harm the victim.
The victim must be transported to any medical institution to provide professional medical care.
Treatment
In medicine, there is a classification of wounds (wounds of all types have been described above). Given the complex structure of the bottom and edges of the wound, the mandatory presence of pathogenic flora, contamination of the wound surface with foreign bodies and high risk infection, treatment of a bruised wound is enough difficult task. As a rule, surgeons or traumatologists deal with the treatment of such wounds, but we will list the basic principles of treatment.
Primary surgical treatment: washing with antiseptic solutions, removal of foreign bodies, dead tissue, torn skin patches.
The imposition of surgical sutures. Sutures are necessary to stop bleeding from large vessels, as well as to achieve a better cosmetic effect during healing. Therefore, if it is possible to reduce the edges of the wound, surgeons try to do it.
Purpose antibacterial drugs. Most often, with minor injuries and good surgical treatment, you can either do without antibiotics at all, or limit yourself to local ointments or creams. However, with extensive wound surfaces, deep injuries and severe contamination of the wound, it is advisable to prescribe antibacterial drugs for oral administration.
Introduction of anti-tetanus serum. This is a special immunological drug designed to prevent the development of tetanus, a serious bacterial infection. The fact is that spores of tetanus bacteria are found in large numbers in the ground and objects contaminated by it. With primary contamination of the wound, spores can get on damaged tissue and cause tetanus.
The rate of healing of bruised wounds directly depends on the extent and depth of the wound, the speed and quality of the primary surgical treatment of the wound, the infection of the wound, and postoperative care.
A lot depends on individual characteristics and regeneration of a particular patient. Healing processes are slower in the elderly, patients with diabetes mellitus, debilitated people and those with impaired immune status.
I would like to note that extensive bruised wounds heal quite difficult, with the formation of rough scars and skin defects. That is why it is very important to carry out surgical treatment of the wound as quickly as possible and carefully monitor the wound during the healing period.
- this is tissue damage as a result of mechanical action. Accompanied by a violation of the integrity of the skin or mucous membrane. They differ in the mechanism of occurrence, method of application, depth, anatomical localization and other parameters. May or may not penetrate into natural closed body cavities (abdominal, thoracic, joint cavities). The main symptoms are gaping, pain and bleeding. The diagnosis is made on the basis clinical picture, in some cases, additional studies are required: radiography, laparoscopy, etc. Treatment is surgical.
ICD-10
S41 S51 S71 S81
General information
A wound is an extremely common traumatic injury. It is one of the main reasons for going to emergency rooms and issuing sick leave outpatients. It occupies a significant share in the list of reasons for hospitalization in the trauma and neurosurgical departments, as well as in the departments of abdominal and thoracic surgery. Extensive injuries and injuries with violation of the integrity of the vessels often cause the development of shock and acute blood loss and, along with penetrating wounds, can be fatal. Possible combination with TBI, fractures of limb bones, chest injury, pelvic fracture, kidney injury and blunt abdominal trauma.
Causes of wounds
Cause traumatic injury the most common is a domestic injury, somewhat less common are injuries resulting from accidents during sports, criminal incidents, road accidents, industrial injuries and falls from a height.
Pathogenesis
Four zones of the wound are distinguished: the actual defect, the zone of injury (contusion), the zone of concussion (commotion) and the zone with violation physiological mechanisms. The defect may take the form of a surface (for example, with scalped or extensive superficial bruised injuries), a cavity (for example, with incised and deep bruised wounds) or a deep channel (with stab, through and some blind gunshot injuries). The walls of the defect are formed by necrotic tissues, between the walls there are blood clots, pieces of tissue, foreign bodies, and in the case of open fractures, there are also bone fragments.
Significant hemorrhages are formed in the contusion zone, bone fractures and ruptures are possible internal organs. In the concussion zone, focal hemorrhages and circulatory disorders are observed - spasm small vessels, which is replaced by their stable expansion. In the zone of disturbed physiological mechanisms, passing functional disorders, microscopic hemorrhages and foci of necrosis.
Healing occurs in stages, through the melting of damaged tissues, accompanied by local edema and fluid release, followed by inflammation, especially pronounced with suppuration. Then the wound is completely cleared of necrotic tissues, granulations are formed in the area of the defect. Then the granulations are covered with a layer of fresh epithelium, and complete healing gradually occurs. Depending on the characteristics and size of the wound, the degree of its contamination and the general condition of the body, healing by primary intention, healing under the scab, or healing through suppuration (secondary intention) is possible.
Classification
Wounds are classified according to the set various signs. According to the circumstances of application in traumatology and orthopedics, accidental, combat and operational wounds are distinguished, according to the characteristics of the injuring weapon and the mechanism of damage - cut, torn, chopped, stab, bruised, gunshot, bitten and crushed. There are also wounds that are of a mixed nature, for example, lacerations and stab wounds. Depending on the shape, linear, patchwork, star-shaped and perforated wounds, as well as damage with loss of substance, are distinguished. Wounds with detachment or loss of significant areas of skin are called scalped. In the case when, as a result of an injury, a part of a limb is lost (shin, foot, forearm, finger, etc.), the damage is called traumatic amputation.
Depending on the state of the tissues, wounds with a large and small area of damage are distinguished. The tissues surrounding the wound with a small area of damage, for the most part, remain viable, only the areas that were in direct contact with the traumatic instrument are destroyed. These injuries include stab and cut wounds. cut wounds has parallel even edges and a relatively shallow depth with a relatively large length, and with timely adequate treatment, as a rule, heal with a minimum amount of suppuration.
Blood can leak out (external bleeding) and into a natural body cavity (internal bleeding). In the latter case, an accumulation of blood is formed with compression of the corresponding organ and a violation of its function. With hemothorax, compression of the lung is observed, with hemopericardium - the heart, with hemarthrosis - all structures of the joint, etc. Minor superficial injuries, as a rule, are not accompanied general symptoms. In severe injuries, there is a decrease in blood pressure, tachycardia, pallor of the skin and mucous membranes, nausea, dizziness, weakness and increased respiration.
Diagnostics
With small superficial wounds that are not accompanied by general symptoms, the diagnosis is made by a traumatologist based on the clinical picture. A detailed study is carried out in the process of PST. With extensive and deep wounds with a violation of the general condition, additional studies are needed, the list of which is determined taking into account the location of the damage. For injuries in the chest area, a chest x-ray is prescribed, for damage to the abdomen, an abdominal x-ray, ultrasound or laparoscopy, etc. If a violation of the integrity of blood vessels and nerves is suspected, consultation with a neurosurgeon and a vascular surgeon is required.
Wound treatment
Small superficial injuries are treated in a trauma center. With extensive and deep wounds, open fractures, penetrating wounds, suspected violation of the integrity of internal organs, blood vessels and nerves, hospitalization in the trauma, surgical or neurosurgical department is required. The need for suturing is determined depending on the duration of the traumatic impact. Primary surgical treatment is carried out only on the first day after the injury and in the absence of signs of inflammation.
PHO is performed under local anesthesia or anesthesia. The wound is washed, blood clots and foreign bodies are removed. The edges of the wound cavity are excised, the cavity is washed again and sutured in layers, leaving drainage in the form of a rubber outlet, tube or half-tube. If the area of damage is normally supplied with blood, there are no foreign bodies left, the surrounding tissues are not crushed or crushed, and the edges are firmly in contact throughout (both on the surface and in depth), the wound heals by primary intention. After about a week, signs of inflammation disappear and a tender skin scar forms.
Injuries older than a day are considered as stale and are not subject to suturing. The wound heals either under the scab, which takes a little longer, or through suppuration. In the latter case, pus appears, a demarcation shaft forms around the damage zone. Suppuration is accompanied general reaction organism - there is intoxication, fever, an increase in ESR and leukocytosis. In this period, dressings and active drainage are carried out. If necessary, purulent streaks are opened.
With a favorable course, after about 2 weeks, the wound is cleared, the healing process begins. At this time, both local and general symptoms inflammation, the patient's condition is normalized. The outcome is a rougher scar than with primary tension. At significant defect tissue self-healing may not occur. In such cases, plasty with a free skin flap or a displaced skin flap is required.
Lecture #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 a violation of the integrity and more deeply located tissues. The cavity formed between the tissues as a result of the penetration of the injuring object into the depths of the body is called the wound channel.
Wound classification:
Depending on the nature of the injuring object, there are stab, cut, chopped, bruised, torn, gunshot, bitten wounds. The sharper the object and the faster the damage is applied, the less damaged the edges of the wound.
By degree of damage wounds are divided into superficial and deep. Deep wounds can be accompanied by damage to blood vessels, nerves, bones, tendons, and internal organs. Deep wounds penetrating into the cavity (abdominal, chest, skull) are called penetrating. All other types of wounds, regardless of their depth, are called non-penetrating.
Presence or absence of infection in the wound, aseptic and infected wounds are distinguished.
All wounds, except wounds applied with a sterile instrument under sterile conditions during surgery, should be considered infected. A wound that has been exposed to another factor (poison, agents, radiation) is called complicated.
Characteristic certain types wounds.
stab wounds arise when exposed to sharp weapons - a prick with a knife, bayonet, needle. This type the wound is characterized by a small, even outer opening and usually a great depth. Since the wound channel is narrow, due to tissue displacement "(muscle contraction, skin displacement), it becomes intermittent zigzag. This makes stab 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 tissues, which in turn can cause later complications.
cut 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 translated into incised wounds, which ensures their rapid healing.
Chopped wounds arise when damage is inflicted with a sharp but heavy object (axe, checker, etc.). Since the injuring object is sharp, a wound appears that looks like a cut, but since the injuring objects are rather thick, the edges of the wound are always crushed to one degree or another.
bruised wounds there is a result of the impact of a blunt object on tissues (hammer, stone, etc.). The edges of the bruised wounds are crushed, uneven, soaked in blood. As a result of damage to the 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 are easily infected.
gunshot wounds are the result of damage from a firearm. Depending on the type of weapon, they distinguish: bullet wound, shot wound, shrapnel wound (mine, grenade, projectile). The least damage to soft tissues is inflicted by a bullet.
A gunshot wound can be through, when the wounding object passes through and has an inlet and outlet; 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 inlet with a through wound is always smaller than the outlet. With a blind gunshot wound, the injuring object gets stuck in the tissues of the wounded person and becomes a foreign body. Fragments of damaged bone also become foreign bodies, which, necrotic in the depths of soft tissues, often lead to suppuration of the wound.
Gunshot wounds are often multiple and combined. Combined wounds are those in which a projectile passes through a number of organs and cavities (for example, the abdominal cavity, diaphragm, pleural cavity) and causes dysfunction of several organs. Therefore, in the treatment of gunshot wounds, the main attention should be paid to the wound channel. By examining it, one 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, as the fragments have jagged edges, sometimes of considerable size. Rough edges cause the introduction of various objects into the wound (clothes, earth, skin), which increase and contaminate the wound. Extensive crushing of tissues, abundant accumulation of blood in the wound channels contribute to rapid infection and the development of severe purulent inflammation.
Wound symptoms.
Each wound is characterized by:
pain
gaping
bleeding.
Hiatus wounds - 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), height blood pressure and the nature of the wound. The less damaged tissue (cut, chopped wounds), the more pronounced bleeding. In crushed tissues, the vessels are crushed and thrombosed, so bruised wounds bleed a little.
The nature of wound healing depends on the general condition of the victim (age, nutrition, accompanying illnesses, beriberi, etc.), as well as on local conditions, i.e. the nature and type of the wound, the degree of its contamination, etc.
Wound healing.
Wounds can heal in two main ways - primary intention and secondary intention.
Wound healing that proceeds quickly, without complications and ends in a few days with a complete restoration of tissue integrity with the formation of a thin linear scar is called primary tension. The main condition for primary tension is the absence of dead and crushed tissues, blood clots (hematomas) and infection in the wound. In addition, for wound healing by primary intention, it is necessary that the edges of the wound fit snugly against each other and are viable.
Rice. Healing by first intention
In cases where the wound gapes, its edges are significantly damaged, there are dead tissue, blood clots, foreign bodies in it, an infection develops in the wound - healing is slow, by gradually filling the wound with granulation tissue with the release of pus and exudate. This wound healing is called secondary tension . The scar that occurs 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 some extent and without surgical intervention heal by secondary intention. Surgical intervention - primary surgical treatment - excision of the edges of the wound and the wound channel, removal of dead and crushed tissues, foreign bodies, followed by a blind suture of the wound, carried out in the first hours after injury, allows you to transfer infected and crushed wounds into incised aseptic ones and in a significant number of cases achieve primary tension.
Healing under the scab observed with superficial skin lesions (burns, abrasions, scratches). The scab arises from the blood and lymph poured into the wound, which, drying up, form a crust - a scab. Under the scab, the epidermis is restored. The scab falls off on its own after full recovery skin. The scab should not be forcibly removed, as this will lead to a disruption in the process of epidermal recovery and the development of granulation tissue at the site of the wound, which will delay healing. If the restoration of the skin during primary tension occurs within 4-7 days, then with secondary tension - within a few weeks or months. Hence the importance of the primary surgical treatment of accidental wounds.
Rice. Scheme of wound healing by primary intention without scar formation.
Occurs without suppuration and the formation of visible interstitial tissue with the subsequent development of a linear scar. It proceeds in wounds with even viable edges, lagging behind each other by no more than 1 cm, in the absence of wound infection. A typical example of such healing are surgical wounds.
Rice. The scheme of delayed primary healing (healing by the type of 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 wound infection and the presence of extensive defects tissues that do not allow primary comparison of the walls of the wound.
Rice. Scheme of healing under the scab.
Occurs without scar formation in superficial wounds with preserved germ layer of the skin. Rapid regeneration of the epidermis occurs under a scab consisting of fibrin and shaped elements blood.
Wound treatment. (for amateurs)
Primary wound care
First what needs to be done when injured is to stop the bleeding that has arisen. 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). With shallow wounds and the absence of pain, painkillers may not be administered, however, if the wound is at least somewhat serious, pain relief should not be abandoned.
Third is wound care antiseptic. Usually in such cases I use a solution of chlorhexidine bigluconate, sold in pharmacies. You can also use a 3% hydrogen peroxide solution (at the same time it will help stop bleeding), but chlorhexidine still disinfects better. During the washing of the wound, all foreign bodies must be carefully removed - they will interfere with healing. It is desirable 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 bandage should be changed daily.
Fifth- the introduction of antibacterial drugs. In field conditions, it is better to "defend" with drugs in any case, using them in the form of capsules from the 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 a normal outflow of pus and wound discharge from the wound. There will be a 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 engage in wound closure in field conditions. In the campaign, there is a high probability of suppuration of wounds, and in a sutured wound, ideal conditions are created for the development of infection. Plus, there is a lack of oxygen, which can lead to anaerobic infections. Of course, if you have a medical education and relevant experience, you may well be able to suture the wound competently, avoiding complications. However, for everyone else, it can only be recommended to treat the wound with an antiseptic and apply a bandage, and then repeat this procedure daily. It is good to use dressings with a 10% solution table salt(not necessarily sterile) - they draw fluid and pus onto themselves. If the wound is narrow, and when the bandage is applied, the edges close tightly, it is advisable to lay a thin strip of rubber or film (thoroughly treated with alcohol and available antiseptics) between the edges of the wound to give the pus a path for outflow.
As long as it "flows" from the wound, ointment preparations should not 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 tissues, and the process of granulation formation begins (the growth of a 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 like Levosin and Levomekol. Usually ointments can be applied only for 3-4 days. At this time, suction bandages with saline solution no longer needed. When the wound is completely clean, you can try to pull 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 healing (advanced)
Primary surgical treatment of the wound.
The main point of wound treatment is the primary surgical treatment of the wound. Inflammatory phenomena in the wound develop quite quickly. Already after 6 hours, the first signs of inflammation in the wound can be observed: swelling and hyperemia appear. Thanks to antibiotics and some sulfa drugs possible term primary processing is equal to 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 the removal of necrotic, contaminated and infected tissues and the convergence of the wound edges.
Each dressing should 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 tools - 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. With the same tools, capturing balls moistened with ether or alcohol, they treat the skin around the wound, they also apply a new bandage.
The appearance of pain in the wound, redness and swelling of its edges, an increase in temperature indicate the developing suppuration of the wound. In such cases, it is necessary to remove the stitches and dilute the wound. If the wound heals 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 is different depending on the phase of the wound process. Developing inflammation creates a kind of protective barrier, ensures the rejection of dead tissues and their removal along with the invading microflora. Early period the course of a purulent wound is characterized by the development of an acute inflammatory response(first phase). In this case, there is a pronounced swelling of the tissues, redness, copious excretion tissue fluid into the lumen of the wound and the formation of pus (hydration stage) - Pus is an inflammatory exudate containing leukocytes (white blood cells), dead and living bacteria, an enzyme that has the ability to melt tissues. The process occurring during this period ensures the rejection of dead tissues and the formation of a protective shaft from the granulation tissue.
Rice. Spongy granulation tissue in inadequate wound healing
After rejection of necrotic areas, the wound is cleaned and quickly filled with granulation tissue (dehydration stage), which is gradually replaced connective tissue(second phase).
The main task in the treatment of infected and purulent wounds in the first period is to create conditions for a good outflow of exudate, pus and separation of necrotic tissues, as well as to take measures to prevent infection from entering the body from the wound. A satisfactory outflow of pus can occur only with a wide opening of the abscess and the destruction of all pockets and streaks. This is achieved by applying additional incisions and mechanical removal dead tissue, fragments, foreign bodies. Wound drainage 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. A certain influence on the course of the purulent process during this period is exerted by antiseptic solutions injected into the wound. The destruction of microbes that occurs in this case, the slowdown in their growth and reproduction reduces the risk of infection and poisoning of the whole organism and favorably affects the protective processes occurring in the wound. It is very important during this period to increase blood flow to the wound. This is achieved by using heat in the form of heating pads, dry-air hot baths. However, warm compresses should not be used, as they sharply disrupt the outflow of pus and increase the absorption of toxic products into the body. Not less than important point is the creation of rest to the wound up to the use of immobilizing dressings (tires, plaster splints, etc.).
Treatment of wounds in the second phase is mainly reduced to the protection of 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. Have an adverse effect wet dressings that violate the processes of replacement of granulations by connective tissue. Protection of wounds and granulations is carried out by applying aseptic oil dressings (fish oil, vaseline oil). It is necessary to achieve complete filling of the wound with granulations. The wound is considered healed when it is fully epithelialized.
Wound care.
Care for an infected and purulent wound must be carried out very carefully. When changing the bandage, washing the wound, inserting tampons, etc., asepsis is the most important. Particular attention should be paid to protecting the skin around the wound from infection. Pus that gets on the skin can lead to a violation of its integrity and spread inflammatory process. The skin can be protected by applying a layer of fat, ointment or paste to it. In this regard, Lassar's pasta is the best. Dressings should be made only with tools (two tweezers), trying not to contaminate the skin around the wound, as well as your own hands. It is better to protect your hands with gloves and after each dressing wash them with soap and water without removing them from your hands.
Removal of dried bandages, swabs and drains should be done carefully. For painless separation of the dressing from the wound, in some cases it is necessary to moisten the bandage with hydrogen peroxide. Before proceeding to the toilet of the wound, it is necessary to lubricate the skin with tincture of iodine. good action renders the wound washing with its weak antiseptic solutions (hydrogen peroxide, furacillin, rivanol, potassium permanganate). Hydrogen peroxide in the wound quickly decomposes, releasing a large number foam, which carries away with it pieces of necrotic tissue, pus and significantly reduces the unpleasant putrefactive odor.
Especially carefully it is necessary to monitor the introduced drainages (rubber tubes and strips). Their prolonged stay in the wound can lead to the development of bedsores of closely located organs (vessels, intestines, etc.). To reduce the possibility of wetting the dressing on the wound, it is necessary to apply a sufficient layer of dressing material (gauze, cotton wool, lignin).
Summarizing all the above, the treatment of infected and purulent wounds can be represented schematically. in the following way. The wound is opened wide with the elimination of pockets, streaks and bridges. For the first 2-3 days, gauze swabs moistened with hypertonic solutions (10% saline solution, 25% magnesium sulfate solution) are introduced into the wound for better outflow. Tampons well absorb the contents of the wound, which enters the upper layers of the dressing. hypertonic solutions not only improve the release of pus, decaying tissues 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 often, 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 Vishnevsky 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 (streptocid, sulfadimezin), antibiotics (penicillin, streptomycin). The final stage treatment is aimed at protecting granulations and the epithelium growing on them from damage, re-infection with simultaneous active therapeutic exercises.
For some types of infected wounds (burns, frostbite), open treatment in order to achieve drying of the wound surface under the action of air and light. Drying of the wound leads to the death of microorganisms. Wound protection from contamination and re-infection is achieved by placing the wound surface under a frame equipped with thermal reflectors (electric lamps).
Care of patients with open injuries. Successful treatment wounded depends largely on care. The main danger is the possibility of infection of the wound. Keeping the bed, skin in hygienic conditions helps prevent secondary infection. First of all, it is necessary to monitor the applied bandage. The bandage should be dry and securely covering the wound from the environment. Contact with the bandage of urine, feces, water from heating pads and glaciers can cause wound suppuration. This dressing must be changed immediately. When the bandage is abundantly wetted with discharge from the wound, cotton wool should be placed on the bandage and it should be bandaged. Particularly sensitive should be treated to the patient's complaints of pain in the wound, the appearance of chills and fever. All this may indicate a 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.
28.01.2016
There are superficial and deep. When superficial, the integrity of the skin and mucous membranes is violated, deep ones are accompanied by damage to blood vessels, nerves, bones, tendons. Wounds penetrating into the cavity (abdominal, thoracic, craniocerebral) are called penetrating. They are distinguished depending on the nature of the injuring object.
a- stab wound;
b - stab wound;
c - incised wound;
g - chopped wound;
d - bruised wound;
e - bitten wound;
g - lacerated wound;
h - gunshot wound.
Stab occur when exposed to a knife, bayonet, needle, awl. Stab wounds are especially dangerous. Unnoticed damage to the internal organs can cause internal bleeding, peritonitis and pneumothorax.
cut wounds can be applied with a sharp cutting object (knife, razor, glass, scalpel). Such wounds have even, intact edges.;
Chopped wounds occur when damage is inflicted with a sharp but heavy object (axe, checker, etc.) and are often accompanied by bone damage.
bruised wounds- the result of the impact of a blunt object (hammer, stone, etc.).
The crushed tissues are favorable environment for the reproduction of microbes.
Depending on the type of projectile, a bullet wound, a shot wound, and a fragmentation wound are distinguished.
A gunshot wound can be through, when the wound has an inlet and outlet; blind if the object gets stuck in the body; tangential, when the object caused superficial damage and it passed next to the organ, only partially hitting it. Foreign bodies, remaining in the body, cause its suppuration. Shrapnel wounds are often multiple and always cause extensive tissue damage: The uneven edges of the fragments carry along clothes, earth, skin, which increases the contamination of the wound.
Bleeding depends on the type of vascular damage (artery, vein, capillaries), the height of blood pressure and the nature of the wound. With incised and chopped wounds, bleeding is most pronounced. In the crushed tissues, the vessels are crushed and thrombosed. Therefore, bruised wounds bleed a little. Some exceptions are wounds of the face and head. In their soft tissues, there are an extremely large number of capillary vessels, so any head injury is accompanied by significant bleeding.
First aid . The cause of most deaths after injury is acute blood loss, so the first measures should be aimed at stopping bleeding by any means. possible way: tourniquet, pressing the vessel, pressure bandage, etc. (see Bleeding).
Wound protection from contamination and infection. Wound treatment should be carried out with clean, better disinfected hands. Do not touch with your hands those layers of gauze that will be in direct contact with the wound. In the presence of disinfectants (hydrogen peroxide, furacilin solution, tincture of iodine, alcohol, etc.), before applying aseptic bandage, it is necessary to wipe the skin around the wound 2-3 times with a piece of gauze or cotton wool moistened with an antiseptic, while trying to remove dirt, scraps of clothing, and earth from the skin surface.
The wound should not be washed with water- it promotes infection. Cauterizing agents should not be allowed to fall directly on the wound. Alcohol, iodine tincture, gasoline cause the death of damaged cells, which contributes to wound suppuration, and a sharp increase in pain, which is also undesirable. Foreign bodies and dirt should not be removed from the deep layers of the wound, as this leads to even more infection of the wound and can cause complications (bleeding, organ damage).
The wound is not allowed cover it with powders, apply ointment on it, you can not apply cotton wool directly to the wound surface - all this contributes to the development of infection.
Sometimes internal organs (brain, intestines), tendon can fall into the wound. When treating such a wound, it is impossible to immerse the fallen organs into the depth of the wound, a bandage is applied over the fallen organs.
First aid for soft tissue injuries of the head . Thanks to the fact that under soft tissues are the bones of the skull, in the best way temporary stop bleeding is an imposition pressure bandage. Sometimes bleeding can be stopped by finger pressure on the artery (external temporal - in front auricle, external maxillary - at the lower edge mandible, 1-2 cm from its corner).
When the head is injured, brain damage (concussion, bruise, compression) often occurs simultaneously. The wounded must be laid in a horizontal position, create peace, apply cold to the head, organize immediate transportation to surgical hospital.
Penetrating wounds chest are extremely dangerous, since they can damage the heart, aorta, lungs, and other vital organs. Most importantly, air begins to enter the pleural cavity and an open pneumothorax develops, as a result of which the lung collapses, the heart moves and shock develops.
The first aid provider must know that the hermetic closure of such a wound can prevent or significantly reduce the development of this serious condition. It is possible to securely close the wound of the chest with a sticky patch applied in the form of a tile, or with a rubberized wrapper from an individual package, you can thickly soak gauze with vaseline, use oilcloth, film, applying a pressure bandage. Required anti-shock measures. Patients are transported in a semi-sitting position.
abdominal wound extremely dangerous, even a small wound can lead to terrible complications that require immediate surgery - internal bleeding and leakage of intestinal contents into abdominal cavity with the subsequent development of purulent (fecal) peritonitis.
Prolapsed organs cannot be insert into the abdominal cavity. After treating the skin around the wound, sterile gauze is applied to the fallen organs, over it and on the sides of the organs - thick layer cotton wool and do bandage. You can close it with a towel, a sheet, stitching the edges with a thread.
Who among us has not fallen and injured his arm or leg? When we broke a knee, my mother smeared it with brilliant green for us and covered it with a band-aid. But what if the damage is more serious? How to stop the bleeding? How to provide emergency assistance to a person on the verge of death? Everyone should know the answers to these and other questions. Therefore, we will consider what wounds are and how to help a person cope with injuries.
What is a wound
A wound is a violation of the integrity of an organ or tissue as a result of the action of a mechanical factor, accompanied by bleeding, pain or divergence of the edges.
Wounds can occur for absolutely different reasons. Some appear as a result of a random combination of circumstances, others - after surgery, others - as a result of the actions of people around them. The classification is very broad. Consider what wounds are.
Types of wounds
Towards human body:
- Penetrating - wounds that go inside the body and cause damage to internal organs. This condition is very dangerous, because it is not visible from the outside what degree of damage. Internal bleeding without first aid, can lead to death.
- Non-penetrating.
What are the wounds according to the circumstances of receipt:
- random;
- operating rooms.
Often, an infection develops at the site of injury. Depending on the degree of sepsis, there are:
- festering wounds;
- contaminated - random, but without signs of suppuration;
- aseptic - after surgical operations using antibacterial agents.
The largest classification group differs in the mechanism of application and the type of injuring object:
- chipped;
- cut;
- chopped;
- bruised;
- torn;
- bitten;
- scalped;
- firearms.
For the first time, we encounter the concept of first aid in the lessons of life safety. What are the wounds, their features and the nature of the damage, we will consider in more detail.
cut wounds
The reason for their occurrence is the impact of a sharp object on the skin area. It can be anything: a piece of glass, metal, a razor or other household items. You can even get hurt with paper. Under high pressure mechanical damage divides the tissue into two halves. The peculiarity is that the area of the wound itself is small, but can be of different depths.
The pain is not severe, but there may be profuse bleeding if the injury has damaged major blood vessels. An object that damaged the tissue, or its particles, may remain in the wound. In this case, it will be easy to take it out. With this type of injury, rupture of muscles, tendons, and nerve endings is not ruled out. If a sharp object has gone very deep, you will have to suture. In cases of minor injuries, the wound will heal itself.
stab wounds
Returning to the question of what kind of wounds are (in the 5th grade on OBZh this topic is given Special attention), you need to know that stab injuries are isolated separately. They differ in that the blow is applied with a sharp long object, with deep penetration. These items include: knife, knitting needle, awl, sharpening, bayonet, sword. The main feature is damage to internal tissues, possibly organs. A wound of this type has a small inlet, but it is very difficult to predict which organ is damaged inside. If the blow was delivered to the heart, sudden death may occur. Therefore, if the item remains inside the wound, it is better not to remove it until the ambulance arrives.
Stab injuries have complications. The inlet closes very quickly, because it is narrow, and favorable conditions are created inside for the development of infection. The next stage - pus spreads throughout the body, general sepsis may begin with intoxication and high temperature. In addition, without urgent assistance, bleeding and bruising of internal organs can lead to sad consequences, up to death.
Chopped wounds
We have already considered what kind of wounds a person has depending on the subject of damage: stab and cut. But there is a third type - chopped. In this case, the blow is applied with a sharp heavy object with great force in a perpendicular direction or at an angle to the tissues. It can be: an ax, a checker, a saber, a sword.
Characteristic features are: deep penetration, large area of damage, bruising of nearby tissues. The wound is accompanied severe pain, heavy bleeding, internal and external hematomas. Vessels, nerves, bones, internal organs can be damaged.
bruised wounds
We continue to consider what wounds are. Another type is bruises. They occur as a result of the impact of a blunt hard object on tissues in those places where there is a solid support in the form of bones. This type of damage is very common in everyday life. Anything can fall on your leg: a chair, a magnet, a hammer, a saucepan.
Often bruised wounds are not accompanied by external injuries. The skin remains intact, but there may be internal breaks muscles, tendons, blood vessels, nerve endings. Bruises are characterized by the presence of hematomas.
If the blow was so strong that it damaged the skin, then the edges of the wound will be uneven, they will become saturated with blood and lose their vitality, which leads to necrosis. Seems to be very strong pain syndrome. The person may even lose consciousness. For wounds of this type, damage to the bones, their crushing, is characteristic.
lacerations
Much has been written about the types of wounds in medical reference books. But not all sources distinguish lacerations in separate group. This type of injury is somewhat similar to a bruise, but on a more serious scale. Most often it occurs as a result of a sharp blow with a heavy sharp object, during accidents, collisions, accidents.
Rupture wounds are characterized by extensive damage to the skin, torn joints, muscles, and blood vessels. Possible damage to the integrity of the bone. Such an injury is accompanied by heavy bleeding, pain, dark brown clots accumulate in the wound.
If you are interested in what color is the ichor from the wound, then it is usually transparent with a yellowish tinge. When combined with blood cells, the clots become burgundy or dark brown. With severe wounds, a lot of ichor is released.
bite wounds
As the name implies, they result from the bite of animals or humans. But unlike all other types of wounds, the danger of these lies in the fact that there is a high probability of contracting dangerous diseases or dying from poison.
The damage area is small. But due to the fact that the skin is affected by dangerous microflora, local or general complications often occur.
Dangerous bites of squirrels, rats, mice. They are carriers of "rat disease" (sodoku). From dogs, foxes, you can catch rabies.
poisoned wounds
They develop as a result of the bite of poisonous insects or creeping reptiles. A poisonous substance enters the human body, which spreads in the blood and blocks the work of many organs and systems, leads to severe neurological diseases or is the cause of death.
The most poisonous snakes: viper, rattlesnake, cobra, muzzle.
The most dangerous insects: rat fleas, Tick-borne Encephalitis, brown recluse spider, tsetse fly.
First aid for a snake bite is as follows:
1. Set aside panic and lay the victim on the ground. Put something soft under your head. The horizontal position will slow down the distribution of the poison.
2. If it is not known exactly what kind of snake has bitten, you need to observe the victim. The absence of swelling, pain suggests that the animal was not poisonous. If the victim is known to be at risk deadly danger Since the snake was poisonous, you should immediately proceed to the following steps.
3. Apply a tourniquet above the bite to prevent the poison from spreading through the bloodstream.
4. Start sucking the poison out of the wound. This can be done if the oral cavity rescuer no mucosal damage.
5. Give a lot to drink before the ambulance arrives.
gunshot wounds
We examined what wounds are as a result of exposure various items. But there is another type - gunshot wounds that occur at the moment when a person is shot from a firearm. Such wounds damage tissues, go far inside or penetrate through. They take a very long time to heal and have severe complications.
- nerve endings, muscles, blood vessels are damaged;
- accompanied by fractures of bones, torso, head;
- the functioning of internal organs is disrupted: lungs, liver, spleen;
- available fatal outcome In most cases.
Gunshot wounds are divided according to the nature of penetration into:
- blind - the bullet remains inside the body;
- through - the bullet passes through;
- tangents - the bullet only partially touches the skin without getting inside.
First aid
What are the wounds, we told in detail, it's time to move on to the question of how to help the victim.
Before providing emergency care, you need to determine the type of injury. But there is special recommendations which you need to know and apply in any case.
1. Stop bleeding. If the blood does not fountain with great force, then it is venous or capillary. Apply a tight bandage. Otherwise, arterial bleeding is observed, which can be stopped by applying a tourniquet above the damaged area.
2. The wound is treated with 3% hydrogen peroxide, the skin around it - with any antiseptic.
3. In case of bruises, apply cold as soon as possible.
1. Wash the wound with water.
2. Fill with brilliant green, iodine or other means.
3. Independently remove stuck parts of the impact object or bone fragments.
4. Apply cotton wool, ointments, powders.
5. In case of injury to the abdomen, do not give the victim to drink.
If the victim has lost consciousness, try to bring him to his senses. You need to constantly talk to him, keep in touch.
In a panic, do not forget to call ambulance immediately after the incident. If you wait too long for the car, you should try to transport the victim yourself, giving him comfortable position sitting or lying down.
