A wound is tissue damage human body- his skin and tissues, mucous membranes located deeper biological structures and organs.

The causes of injury are various physical or mechanical effects.

Wounds can be superficial, deep, or penetrating into body cavities. There are also stab, cut, bruised, chopped, lacerated, bitten and gunshot wounds.

Puncture wounds are the result of penetration of piercing objects into the body - a needle, nail, awl, knife, sharp sliver, etc.

Incised wounds are applied with sharp objects - a razor, a knife, glass, pieces of iron. They are distinguished by smooth edges and heavy bleeding.

Bruised wounds occur from the action of blunt objects - a blow from a stone, a hammer, parts of moving machines, as a result of a fall from a height. These are severe and dangerous wounds, often associated with significant tissue damage and bruising.

Chopped wounds are a combination of cut and bruised wounds. They are often accompanied by severe injury to muscles and bones.

Lacerations are characterized by crushing of damaged tissues, separation and crushing of the affected parts of the body.

Bite wounds are caused by the teeth of cats, dogs, other domestic and wild animals, as well as snakes. Their main danger is the possibility of extremely severe consequences (rabies, tetanus).

Gunshot wounds are a special type of injury. They are the result of the intentional or careless use of firearms and can be bullets, fragments, shotguns, balls, or plastic. Gunshot wounds usually have a large area of ​​damage, affecting internal organs, blood vessels and nerves. Most wounds bleed due to damage to blood vessels, but there are also so-called bloodless wounds.

First aid for wounds is aimed at stopping bleeding, protecting the wound from contamination, and creating peace injured limb.

Protecting the wound from contamination and microbial contamination is best achieved by applying a bandage.

Severe bleeding is stopped by applying a pressure bandage or a hemostatic tourniquet (on the limb).

When applying a bandage, the following rules must be observed:

You should never wash a wound yourself, especially with water, as this may introduce germs into it;

If pieces of wood, scraps of clothing, earth, etc. get into the wound. they can be removed only if they are on the surface of the wound;

Do not touch the surface of the wound (burn surface) with your hands, since there are especially many microbes on the skin of the hands; dressing should only be done with cleanly washed hands, if possible wiped with cologne or alcohol;

The dressing material used to close the wound must be sterile;

In the absence of sterile dressing material, it is permissible to use a cleanly washed scarf or piece of fabric, preferably white, previously ironed with a hot iron;

Before applying a bandage, the skin around the wound should be wiped with vodka (alcohol, cologne), and should be wiped in the direction away from the wound, and then lubricate the skin with iodine tincture;

Before applying a bandage, gauze pads are applied to the wound.

Bandaging the wound is usually done from left to right, in a circle. The bandage is taken in the right hand, the free end is grabbed with the large one and index fingers left hand.

Specific cases are penetrating wounds of the chest and abdominal cavity, and the skull.

With a penetrating wound into the chest cavity there is a risk of respiratory arrest and fatal outcome due to asphyxia (suffocation). The latter is explained by the fact that external atmospheric and intra-abdominal pressure are equalized. When the victim tries to breathe, air enters the chest cavity and the lungs do not expand. If the victim is conscious, he needs to urgently exhale, hold the wound with his hand and seal it with any available material (adhesive tape, sterile bag packaging, plastic bag). If the victim is unconscious, you should sharply press on his chest to simulate exhalation and also seal the wound. Artificial respiration is performed according to circumstances.

With a penetrating wound in abdominal cavity It is necessary to cover the wound with a sterile bandage. If the internal organs have fallen out, do not tuck them into the abdominal cavity under any circumstances, but simply carefully bandage them to the body.

Victims with penetrating wounds of the chest and especially the abdominal cavity should not be given anything to drink.

In case of a penetrating wound to the skull, fragments of protruding bones or foreign objects should be removed and the wound should be bandaged tightly. It is best to use standard dressing bags as a dressing material (Fig. 35). To open the package, take it in your left hand, grab the cut edge of the shell with your right hand and jerk off the seal. Take a pin from a fold of paper and fasten it to your clothes. Then, having unfolded the paper shell, take the end of the bandage, to which a cotton-gauze pad is sewn, in the left hand, and in the right hand - the rolled up bandage and spread the arms. When the bandage is stretched, a second pad will be visible, which can move along the bandage. This pad is used if the wound is through: one pad covers the entrance hole, and the second covers the exit; To do this, the pads are moved apart to the required distance. The pads can only be touched with hands from the side marked with colored thread. The reverse (unmarked) side of the pad is applied to the wound and secured in a circular motion with a bandage. The end of the bandage is pinned with a pin. In the case where there is only one wound, the pads are placed side by side, and for small wounds they are placed on top of each other.

There are rules for applying different types of dressings.

The simplest bandage is a circular one. It is applied to the wrist, bottom part shins, forehead, etc. When applying a circular bandage, the bandage is applied so that each subsequent turn completely covers the previous one.

A spiral bandage is used for bandaging limbs. They start it in the same way as a circular one, making two or three turns of the bandage in one place in order to secure it; Bandaging should begin with the thinnest part of the limb. Then they bandage in an upward spiral. In order for the bandage to fit snugly without forming pockets, twist it after one or two turns. At the end of bandaging, the bandage is secured with an elastic mesh or its end is cut along the length and tied.

When bandaging the area of ​​the joints of the feet and hands, eight-shaped bandages are used, so called because when they are applied, the bandage “all the time seems to form the figure “8”.

Bandages on the parietal and occipital regions are made in the form of a “bridle” (Fig. 36). After two or three fastening turns of the bandage around the head through the back of the head, it is brought to the neck and chin, then several vertical turns are made through the chin and crown, after which the bandage is directed to the back of the head and secured with circular movements. You can also apply a figure-eight bandage to the back of your head.

On scalp The head is covered with a bandage in the form of a “cap” (Fig. 37). A piece of bandage about 1.5 meters long is placed on the crown of the head, its ends (ties) are lowered down in front of the ears. Then make two or three fixing turns with a bandage (another) around the head. Next, pull the ends of the ties down and slightly to the side, wrap the bandage around them on the right and left alternately and lead it through the occipital, frontal and parietal regions until the entire scalp is covered. The ends of the ties are secured with a knot under the chin.

The bandage on the right eye begins with fastening turns of the bandage counterclockwise around the head, then through the back of the head the bandage is led under the right ear to the right eye. Then the moves alternate: one through the eye, the other around the head.

When applying a bandage to the left eye, fastening moves around the head are made clockwise, then through the back of the head under left ear and by eye (Fig. 38).

When applying a bandage to both eyes, after securing moves, alternate moves through the back of the head to the right eye and then to the left.

It is convenient to apply a sling-shaped bandage to the nose, lips, chin, and also to the entire face (Fig. 39). To prepare it, take a piece of a wide bandage about a meter long and cut it lengthwise at each end, leaving the middle part intact.

For small wounds, a sticker can be used instead of a bandage. A sterile napkin is applied to the wound, then the uncut part of the bandage (see above) is placed on the napkin, the ends of which are crossed and tied at the back.

Also, for small wounds and abrasions, it is quick and convenient to use adhesive bandages. The napkin is placed on the wound and secured with strips of adhesive tape. A bactericidal adhesive plaster, which has an antiseptic swab on it, after removing the protective covering, is applied to the wound and glued to the surrounding skin.

Fig. 39. Sling bandage

When bandaging a wound located on the chest or back, a so-called cruciform bandage is made (Fig. 40).

When the shoulder joint is injured, a spica bandage is used.

Headband applied for wounds of the head, elbow joint and buttocks.

When applying a bandage, the victim should be seated or laid down, because even with minor injuries, under the influence of nervous excitement or pain, a short-term loss of consciousness may occur - fainting.

The wounded part of the body must be given the most comfortable position. If the wounded person is thirsty, give him water (except for the cases indicated above), hot strong sweet tea or coffee.

Questions for self-control

1. What types of wounds do you know?

2. What is first aid for injury?

3. What rules should be followed when applying a bandage?

4. What are the specifics of providing first aid for a penetrating wound in the chest cavity?

5. What assistance is given to a penetrating wound in the abdominal cavity?

6. What assistance should be provided for a penetrating injury to the skull?

7. Name the main types of dressings.

8. Explain the technology for applying such types of dressings as circular, spiral and eight-shaped.

9. How are bandages in the form of a “bridle” and “cap” applied?

10. What kind of bandage can be applied to the nose, lips, chin, and also to the entire face?

11. For what wounds are cruciform and spica bandages used?

12. When wounding which parts of the body is a scarf bandage used?

A wound is an open injury with a violation of the integrity of the skin and visible mucous membranes. The main signs of a wound: gaping (divergence of the edges of the wound due to the contractility of the skin), pain (reaction of nerve endings to damage to the body) and bleeding.

To quickly heal the wound, prevent germs from entering it and injuring damaged tissues, the following basic rules of first aid must be observed:

1. It is forbidden to touch the wound, remove anything from it, tear off burnt clothing stuck to the wound (clothing can only be cut along the free edge), wash and lubricate the wound (you can lubricate the skin around the wound with iodine tincture).

2. The wound must be bandaged using only sterile dressing material.

3. Create rest for damaged tissues, since movement increases pain and can lead to shock¹ or other complications (bleeding, spread of infection in the wound). Depending on the nature, location and size of the damaged area, rest is achieved by placing the victim in a supine position, giving a certain position to the damaged organ, creating immobility (immobilization) of the damaged tissues or organ.

All wounds should be protected with bandages. When applying bandages, a number of rules should be followed. Bandaging should be done in the most comfortable position for both the wounded person and the person providing assistance. If the wounded person is lying down, then the person providing assistance should be on the side of the injured part of the body. To make bandaging easier, raise the damaged part of the body by placing a soft object under it, such as a coat or blanket. The part of the body on which the bandage is applied must be freed from clothing. During bandaging, the condition of the victim should be monitored. Bandaging begins with the application of several circular strengthening moves, covering the edges of the wound by 2...3 cm; then put a layer of cotton wool and secure it with a bandage, scarf or sling.

Rice. 32.3. Types of dressings:
a, b—spiral on the chest and knee, respectively; c, d, e, f - sling-shaped, respectively, on the crown, back of the head, nose, lower jaw; g - scarf on the elbow

The limbs are bandaged from the periphery, gradually moving towards their base. The layers of bandage are applied smoothly, without folds or pockets. Each subsequent layer of the bandage should cover the previous one by 1/2 of its width, then the bandage will hold well and apply even pressure.

There are different types of bandage dressings: circular, spiral simple and with kinks (spica-shaped), cruciform, eight-shaped, returning, etc. (Fig. 32.3). Mastery of the technique of applying bandages allows you to choose the best one when applied to wounds of various types, localization and extent. So, a circular bandage is applied to areas of the body that have a cylindrical shape: forehead, middle of the shoulder, wrist, lower third of the leg; spiral with bends - on parts of the body that have a cone shape: forearm, lower leg; figure-of-eight - on the back of the head, back of the neck, joints, etc.

A scarf bandage (Fig. 32.3, g) can be applied to any part of the body 2...3 times faster than a bandage bandage. Sling-shaped bandages are quickly and reliably applied to the crown, back of the head, nose, chin, forehead (Fig. 32.3, c, d, e, f).

In case of a penetrating wound to the chest, the signs of which are the passage of air through the wound during breathing and the release of foamy liquid, a sealing bandage is applied to the wound. To do this, use a material impermeable to air (in extreme cases, polyethylene film).

Topic No. 13: First aid for wounds and bleeding.

Lesson 1. Rules that must be followed when providing first aid for injuries. Performing injections and rules for applying bandages for wounds. Techniques for self-help and mutual assistance.

Types of bleeding. Blood loss and infection. Stop bleeding by pressing a finger on the bleeding vessel above the wound, bending the limb at the joint, applying a pressure bandage, applying a tourniquet or twisting it. Making a tourniquet from improvised materials.

The primary actions when providing first aid are the simplest ones urgent measures necessary to save the life and health of the victim in case of damage, accidents, etc. First aid is provided at the scene of the incident before the arrival of a doctor or delivery of the victim to the hospital, and its type is determined by the nature of the damage, the condition of the victim and the specific situation in the area emergency.

A wound is damage to the skin, deeper tissues and organs. Wounds make up the majority of damage in accidents and injuries. They are superficial and deep. Signs of a wound include gaping, bleeding, pain, and organ dysfunction.

If the wound is deep and there is bleeding, treatment of the wound begins by stopping the bleeding (section 7).

At heavy bleeding through a folded sterile napkin or other dressing material (bandage, gauze or clean cloth), press on the wound with your hand and hold it without lifting your hand for at least 20 minutes.

Please note that you should not waste time searching for sterile material.

After stopping the bleeding, the skin around the wound should be treated with a bandage, gauze or other material moistened with one of the disinfecting solutions - 3% hydrogen peroxide, 5% alcohol solution of iodine, 70% or 96% alcohol or another antiseptic available in the first aid kit. After the bleeding has stopped, the wound should be covered with a sterile cloth or bandage and bandaged tightly. Move the injured limb to an elevated position. If a fracture is suspected, perform immobilization (immobilization). If you don’t have a disinfectant solution at hand, simply cover the wound with a clean material (not cotton wool).

You cannot treat the wound with tincture of iodine or alcohol; treatment of the skin should only be done around it. Treating the wound itself will significantly increase the pain and can cause bleeding, shock and other complications, and will also slow down the healing time.

Only if the wound is superficial (scratches, abrasions, shallow wounds) and is heavily contaminated with soil, dirt, etc., the surface of the wound should be treated with a 3% solution of hydrogen peroxide, which cleans, disinfects and stops bleeding. Very dangerous microbes - tetanus and gangrene - can get into the wound with soil. After treatment, the wound must be bandaged and bandaged. In a medical institution (emergency room or other) they will definitely administer anti-tetanus serum.

To hold the dressing material, an elastic mesh-tubular bandage is convenient, which should be in an emergency first aid kit. Cover the wound with a sterile dressing, over which put on such a bandage, having previously stretched it. In addition, the dressing material can be fixed using an adhesive patch, which is glued with the sticky side to the skin, 1.5 -2.0 cm beyond the edge of the material (crosswise or asterisk). Do not use adhesive patch if there is heavy discharge from the wound, as well as on the scalp.

To provide first aid for extensive wounds and for burns, small and large sterile bandages are very convenient. A rescuer's first aid kit must contain analgin (to relieve or relieve pain) and Corvalol (heart drops). After treating the wound, before the doctor arrives or on the way to delivering him to the hospital or emergency room, if he is conscious, he should be given water, two analgin tablets and 30-40 heart drops. So, stop the bleeding, cover the wound with clean material and tightly bandage it. If the affected person is conscious, give him a drink of water and any available pain reliever (for example: analgin 2 tablets and 30-40 drops of Corvalol diluted in a glass of water).

Bleeding is the release of blood from damaged blood vessels.

A bandage is a dressing material used to cover a wound. The process of applying a bandage to a wound is called dressing.

Rules that must be followed when providing first aid. assistance for wounds. Methods to stop bleeding.

The human body without special consequences tolerates loss of only 500 ml of blood. The loss of 1000 ml of blood already becomes dangerous, and the loss of more than 1000 ml of blood threatens a person’s life. If more than 2000 ml are lost, it is possible to save the life of a bleeding person only if the blood loss is immediately and quickly replaced. Bleeding from a large arterial vessel can lead to death within minutes. Therefore, any bleeding should be stopped as quickly and reliably as possible. It must be taken into account that children and elderly people over 70-75 years old do not tolerate relatively small blood loss. First aid is aimed at stopping bleeding and protecting the wound from secondary infection.

Arterial bleeding is the most dangerous. In this case, bright red (scarlet) blood flows out in a pulsating stream in time with the contraction of the heart muscle. The rate of bleeding when a large arterial vessel is injured (carotid, brachial, femoral artery, aorta) is such that life-threatening blood loss can occur literally within a matter of minutes. If a small vessel is bleeding, it is enough to apply a pressure bandage. To stop bleeding from a large artery, you should resort to the most reliable method - applying a hemostatic tourniquet. If it is not there, then you can use improvised means for this purpose - a waist belt, a strong rope or a piece of thick fabric.

Venous bleeding is much less intense than arterial bleeding. From damaged veins, dark, cherry-colored blood flows out in a continuous, uniform stream. Venous bleeding is reliably stopped using a pressure bandage, without resorting to a tourniquet.

Capillary bleeding occurs due to damage to the smallest blood vessels (capillaries) - with extensive abrasions, superficial wounds. The blood flows out slowly, drop by drop, and if its coagulation is normal, the bleeding stops on its own. Capillary bleeding can be easily stopped using a regular sterile bandage.

Internal bleeding (in the abdominal cavity, chest cavity, skull) poses particular difficulties for self- and mutual assistance, since it is almost impossible to stop them. Internal bleeding can be suspected by appearance the victim: his skin turns pale, sticky cold sweat, breathing is rapid, shallow, pulse is rapid and weak filling. A person feels weakness, dizziness, tinnitus, darkening of the eyes. If such signs occur, immediately place the victim or place him in a semi-sitting position to ensure complete rest, and apply a plastic bag with ice or snow or a bottle of water to the suspected area of ​​bleeding (stomach, chest, head). cold water. If trouble happens far from a populated area, try to get the victim to a place where he can receive specialized medical care as quickly as possible. If this is not done, the victim will be doomed.

As a result of severe external or internal bleeding, acute anemia occurs. With significant blood loss (2-2.5 liters), there may be loss of consciousness due to bleeding of the brain and, if urgent measures are not taken, death may occur. First medical aid is to apply a pressure bandage to the wound, after which the victim should be laid on a flat surface to prevent bleeding of the brain; in case of significant blood loss and loss of consciousness, the victim is placed in a supine position, in which the head is lower than the body. If consciousness is maintained and there is no damage to the abdominal organs, the victim can be given hot tea or water. If there is no breathing or heartbeat, resuscitation is carried out. It should be remembered that the main method of treating life-threatening acute anemia is an urgent blood transfusion.

The second, very formidable general reaction of the body that accompanies severe injuries can be shock, the signs of which are: complete indifference of the victim to everything around him while maintaining consciousness, a quiet voice, pallor of the integument, cold sticky sweat, weak rapid pulse, shallow breathing, motionless (like a corpse) expression on the victim’s face. In some cases, in the initial phase of shock, phenomena of mental and emotional arousal are observed. The victims, who are in a state of shock, are next help: if there is a wound, it is necessary to apply a bandage, and in case of severe bleeding, a tourniquet; in case of a fracture, immobilize the limb; warm the victim - wrap him up, put heating pads at his feet; provide complete peace; give inside large number strong sweet tea, coffee. In such cases, a doctor is always needed.

You should never use any painkillers if you suspect diseases or injuries to the abdominal organs without consulting a doctor!

Making a tourniquet from improvised materials.

In emergency cases, you can use the following items at hand to temporarily stop bleeding: a trouser belt, a tie, a rope, or a rolled up handkerchief. A stick is inserted into the loop formed, with the help of which the twist is tightened until the bleeding stops and secured with a bandage. Attach a sheet of paper to the tourniquet indicating the time of its application. The use of thin or hard objects such as rope or wire can damage tissues and nerves, so their use is not recommended. The tourniquet can be left on the limb in the summer for no more than 2 hours (and in the winter outside the room - for 1.0 hour), since prolonged compression may cause necrosis of the limb below the tourniquet. The victim who has a tourniquet applied must be monitored.

A tourniquet is used only for extensive multiple wounds and crushes of the hand or foot.

In case of any bleeding, especially when a limb is wounded, it is necessary to give it an elevated position and ensure its rest.

DETERMINE THE TYPE AND DEGREE OF SEVERITY

DAMAGE

ALGORITHM FOR PROVIDING FIRST MEDICAL AID AT THE SITE OF AN INCIDENT

STOP EXTERNAL BLEEDING

GIVE A PAIN RELIEF MEDICINE

MEANS

APPLY AN ASEPTIC DRESSING

PERFORM TRANSPORT IMMOBILIZATION

COOL THE SITE OF INJURY, WARM THE IMPACTED PERSON

Minor injuries to the limbs.

Calm the victim;

If there is bleeding, apply a tourniquet or pressure bandage. Attach a note indicating the time;

Give 2 crushed analgin tablets under the tongue or another pain reliever;

Clear the wounded area for dressing. Treat the skin around the wound and the available (not sterile) dressing with a disinfectant liquid - iodine, alcohol, vodka. IN field conditions It is permissible to wash the wound with hydrogen peroxide or boiled (pure sea) water with the addition of potassium permanganate and furatsilin.

Cover the wound with a napkin, completely covering the edges of the wound. Do not touch the part of the napkin that is applied to the wound with your hands;

Bandage the napkin or secure it with an adhesive plaster.

Severe wounds of the extremities (bullet, shrapnel, gunshot and mine-explosive fractures, amputations):

If bleeding is severe, apply a tourniquet. Attach a note indicating the time;

Provide a safe location and rest for the injured limb;

Administer painkillers (from a tube syringe or otherwise) and antibiotics;

Dress the wound using an individual dressing bag or other clean or disinfecting material;

Apply a splint or bandage the injured leg to the healthy one;

Cover and calm the victim, give him tea and vodka.

Rules for applying a hemostatic tourniquet

1. A hemostatic tourniquet is applied when large arterial vessels are damaged.

2. In case of bleeding from the arteries of the upper limb, place the tourniquet on the upper third of the shoulder; in case of bleeding from an artery of the lower limb - on the middle third of the thigh.

3. A tourniquet is applied to the elevated limb. A soft pad is placed under the tourniquet: bandage, clothing, etc.

4. The tourniquet is applied tightly, but not excessively. Be sure to attach paper indicating the time of its application.

5. The tourniquet cannot be held for more than 1 hour; if the time for evacuation of the affected person to a medical facility is delayed, it is necessary to loosen the tourniquet for 10-20 seconds every 20 minutes.

6. If the rescuer does not have a special tourniquet at hand, you can use improvised means: a scarf, tie, suspender, belt, etc. (Fig. 20).

7. When a part of a limb is torn off, a tourniquet must be applied, even in the absence of bleeding (Fig. 20).

Remember that in case of arterial bleeding, a tourniquet must be applied above the bleeding site, after first elevating the limb. It is useless to apply a tourniquet around the wrist and ankles.

Other ways to stop bleeding

In cases where there are no limb fractures, methods can be used to stop bleeding by bending the limb as much as possible.

Strong bending of the knee stops bleeding from the arteries of the foot and leg. To increase pressure on the vessel, a roller made of a bandage or other material is used. Strong bending and bringing the knee towards the abdomen compresses femoral artery. When the axillary artery is injured, compression is carried out using a technique also presented in Figure 23. The hand is placed behind the back and pulled strongly to the healthy side, or both arms, bent at the elbow, are pulled back strongly and the elbow joints are tied behind the back. This stopping method is used very rarely.

What to do if there is external bleeding?

Don't get lost, do the following:

Press the wound with your fingers to stop bleeding;

Place the affected person horizontally;

Urgently send someone for an ambulance;

If you start to get tired, let one of those present press your fingers from above (it is necessary to keep the vessel pressed without stopping for at least 20 minutes; during this time, thrombosis of the damaged vessel usually occurs and the intensity of bleeding will decrease, this will eliminate the bleeding.

If there is bleeding from the cervical (carotid) artery, you should immediately compress the wound with your fingers or fist, and after this the wound can be stuffed a large number clean gauze. This method is called tamponing.

After ligating the bleeding vessels, the affected person should be given a soft drink and taken to the hospital as soon as possible.

What to do if you suspect internal bleeding?

Such bleeding can occur when you are hit in the stomach, fall from a height, etc. due to rupture of the liver or spleen. In the event that the victim complains of severe abdominal pain after a blow, or he loses consciousness after a blow to the stomach, one should think about the possibility of internal bleeding (into the abdominal cavity). Place the affected person in a semi-sitting position with legs bent at the knees (Fig. 23 a), and place a cold compress on the abdominal area. Cold compress or an ice pack is applied for 30 minutes, then the cold is removed, a break is taken for 30 minutes and the cold is applied again for 30 minutes. This alternation is carried out until hospitalization. You can't give him anything to drink or eat. Urgently arrange delivery to the hospital.

At strong impact bleeding into the chest may occur pleural cavity. If there was such a blow and the victim breathes with difficulty and begins to choke, you should give him a semi-sitting position with bent lower limbs and put a cold compress on his chest.

How to support the life of a person who has lost a lot of blood?

As a result of blood loss, changes occur in the human body that can become irreversible and lead to death. Therefore, to maintain the life of a person who has lost a lot of blood, it is necessary to take urgent measures. After you have stopped the bleeding (or it has stopped spontaneously), you must apply a pressure bandage to the wound. Then release the affected person from constrictive clothing to facilitate breathing (unfasten, remove). If the person is conscious and has no wounds in the abdominal area, you should give him sweet tea and lay him on his back so that his legs are raised and his head is down. This position will support the blood supply to the brain; the brain is most sensitive to its lack. It is necessary to organize the evacuation of the injured person to the hospital as quickly as possible.

How to stop bleeding elsewhere in the body?

What should you do if you see a strongly gushing (gushing) stream of blood where it is impossible to apply a tourniquet?

It is necessary to apply pressure to the bleeding vessel in the wound. To do this, squeeze the edges of the wound with your fingers, observing the intensity of the bleeding; if in this way it is not possible to stop the bleeding immediately, the wound is tightly packed with a clean bandage, a handkerchief and held in this position for at least 20 minutes. The injured person must be taken to the hospital as quickly as possible.

Gaping and infection of the wound

Gaping, i.e. separation of the edges of the wound, is dangerous because it creates the possibility of infection of the wound or, as doctors say, the possibility of wound infection. What is a wound infection? In nature, countless tiny living creatures live around us. Their size is so small that they are invisible to human eye; they can only be seen with a microscope that magnifies hundreds of times. These creatures are called microbes or bacteria, otherwise microorganisms. Microbes live everywhere: in the soil, in water, on plants, in a person’s home and on his household items, on the skin, hair and in the internal organs of humans and animals.right0 Microbes are varied in appearance. They can take the form of short sticks, straight or curved in the shape of a comma, the shape of balls or long spirals, similar to a corkscrew. The body of a microbe is so small that up to a thousand microorganisms can be placed in a row on a line 1 mm long (a tenth of a centimeter). Microbes reproduce by division. Each microbe divides in half, forming two new microbes, each of which in turn divides in two, and so on. The rate of this division is so high that in a day one microbe can produce “offspring” of hundreds of thousands of new microbes. Under unfavorable conditions, such as freezing, drying, especially heating, many types of microbes quickly die. Others just stop reproducing, but remain viable for a long time and, once in a suitable environment, come to life and reproduce again. Some microbes are so tenacious that only long boiling in water kills them completely. The importance of microbes in nature is enormous. Feeding on various organic substances - protein, starch, sugar, etc., they quickly destroy dead plants, animal corpses, and all kinds of impurities. In this case, the simplest components of dead organic matter, such as carbon, nitrogen, sulfur, phosphorus and others, are released into the soil or into the air. Living plants absorb these “elements” from the soil or from the air and again build from them an organic, complex substance - their stems, leaves and fruits. The animal eats the plants; from those contained in plants nutrients The animal body builds bones, meat and other tissues and organs. When an animal dies, its carcass is decomposed by bacteria, the constituent parts return to the soil and air, and everything starts all over again. Thus, with the help of microbes, a continuous circulation of substances occurs in nature. Without microbes, life on earth would have ceased long ago, since globe would be covered with the undecomposed remains of plants and animals, in which all the nutrients necessary for life would have accumulated uselessly. Many microbes are useful to humans. Some soil bacteria help legumes produce proteins that accumulate in the grains of peas, beans and other legumes. Microbes living in the gut healthy person, promote proper digestion. Man forced some of these tiny creatures to work for himself, using microbes in the dairy, tobacco and leather industries, in winemaking and bakery, in the processing of flax and hemp, etc. From some microscopic organisms the most valuable medicinal products are extracted - antibiotics: penicillin, streptomycin etc. Among microbes, a person has not only useful servants and friends, but also the most dangerous enemies that harm his health. Some microorganisms have the ability to produce strong poisons. Such a microbe is the causative agent of the disease; having settled in the human body, it poisons it and causes a painful state. The development of microbes in the human body that causes disease is called “infection,” and the resulting disease is called an infectious disease. Many diseases, including all contagious diseases, are infectious in nature, that is, they are associated with the proliferation of microbes in the human body. Microbes can infect various human organs, develop in his lungs or intestines, in the blood, in the liver, etc. Each infection occurs differently: the tuberculosis bacillus penetrates into human body through the lungs; infection with dysentery (bloody diarrhea) occurs through the mouth and digestive organs; infection with cholera also occurs. A person becomes infected with the plague through the bite of a flea that has sucked blood from a plague-ridden rat. And some pathogenic microbes infect a person through a wound, settling in the wound and causing a special painful process in it - inflammation, suppuration of the wound. These microbes are called causative agents of wound infection. A person in normal conditions life does not encounter such dangerous microbes as the plague bacillus or cholera “comma” (vibrio). And there are always a lot of microbes that cause wound infections around every person. They live in large numbers even on his skin, especially if the skin is not clean enough. These microbes cannot cause any harm to a person until he is injured - healthy, undamaged skin reliably protects the body from the penetration of microbes. But as soon as there is damage, for example, scratching or pricking, much less cutting through the skin, pathogens of wound infection can immediately enter the wound. The wound begins to fester, an abscess may form, and it is no longer difficult for microbes to penetrate deep into the body and even into the blood. Then the blood (and at the same time the whole body) becomes infected with a purulent microbe. It is clear that if even a small scratch or a small injection can lead to a dangerous purulent infection, then a large, deep, widely gaping wound is even more easily susceptible to wound infection and even more often leads to dangerous consequences. Each wound is an open door through which germs freely penetrate deep into the body. The wider the edges of the wound diverge, the easier it is for any dirt to get into it, and with it germs. The most dangerous is contamination of wounds with soil, especially black soil or well-manured garden soil. In such a land containing a large number of rotting organic matter, there are always a lot of especially dangerous microbes that cause very heavy defeat wounds. That is why the gaping of a wound is its first danger, and protecting the wound from infection by microbes is the first concern when assisting the wounded. We can say that if the wound has been protected from germs, then the most important and difficult part of the job has already been done. A wound that is not fatal in itself, that is, does not damage the heart, brain, large blood vessel or other organ important to life, can heal safely if there is no infection. If the wound becomes infected, it is impossible to say in advance how any minor wound may end; It is very difficult to fight germs that have already entered the wound. Although medicine has many remedies against microbes, it is not always possible to stop the development of an incipient wound infection. No matter how we treat an infected wound, it will always heal worse than a wound that was prevented from becoming infected. Protecting wounds from contamination is the first task when helping a wounded comrade or oneself. How does a newly inflicted gunshot wound become infected? Microbes - the causative agents of wound infections sometimes enter the wound at the very moment of its application, along with a bullet or shrapnel. The bullet, flying out of the barrel, does not contain microbes. But before it penetrates the body, it must penetrate a person’s clothing and skin. There are always germs on both the dress and the skin; There are especially many of them on worn underwear and on skin that has not been washed for a long time. A bullet can drag small particles of clothing or skin into the wound, and along with them germs. When an artillery shell, mine, aerial bomb, etc. explodes, clods of earth, dust or dirt are scattered around. The flying fragments themselves can be highly contaminated. In addition, when piercing a dress, an uneven jagged fragment often pulls out and carries with it into the wound a whole large piece of an overcoat, foot wraps or trousers, a lump of cotton wool or fur from a hat, and the like. At the same time, a very large number of microbes can get into the wound. But still, most wounds become dirty and infected with microbes not at the very moment of injury, but after it. Dirty clothes touch the wound, the wounded person falls on the dusty ground or in liquid mud; finally, very severe infection of the wound can occur when touching it with your hands; the skin of the hands contains microbes, even if the hands appear clean. The number of microbes that enter the wound along with a bullet or shrapnel will be less, the cleaner the clothes and especially the underwear. It is not for nothing that the Russian soldier has long established the custom of putting on a clean shirt before battle. But, of course, it is impossible to completely avoid the introduction of microbes into the body by a bullet or shrapnel. But it is quite possible to prevent the wound from becoming infected after an injury, to prevent microbes from getting into it from the ground, from the air, from the hands, and so on. This is achieved by bandaging the wound, i.e., applying a bandage to it that will protect the wound from contamination until the wounded person is taken to a medical station. The wound will be protected from infection only by a bandage that itself is completely clean, i.e., does not contain microbes on you. Dressing a wound with a dirty rag can often even increase the risk of infection. For dressing wounds, therefore, dressing material (gauze and cotton wool) is used, which is processed in a special apparatus with hot water steam. Even boiling water is fatal to germs, and water steam heated to a temperature of 120° above zero kills all germs within a few minutes. A bandage subjected to such treatment does not have a single living microbe on it. This dressing is called sterile. A sterile dressing provides reliable protection wounds from infection. Each fighter carries a sterile bandage in the form of an individual dressing package, which is designed to provide first aid for wounds. Two cotton-gauze pads and a rolled gauze bandage are enclosed in a double shell of waterproof parchment paper, which protects the dressing from contamination. Every soldier must know the structure of an individual dressing package and the rules for handling it. The dressing material remains sterile, that is, free from germs, only until it is touched. Touching the gauze with your fingertip leaves a stain of dirt on it, invisible to the eye, but containing many microbes. Therefore, the pads of the bandage and the bandage are placed in the bag so that you can take them out and unfold them without touching the side that will lie on the wound. There are two pads in the bag: one is tightly sewn to the end of the bandage, the other can move along the bandage in one direction or the other. This is done in case of a through wound, when one pad is placed on the entrance hole, the other on the exit hole. If there is only one wound, then both pads are placed on it, one on top of the other. The stationary pad is held by the short end of the bandage sewn to it; the movable pad, if necessary, is moved along the bandage by grasping it outer side, i.e. the one who will not be put a pad on the wound.

2. Applying bandages for various wounds

Head and neck bandages.

To apply bandages to the head and neck, use a bandage 10 cm wide.

Circular (circular) headband. It is used for minor injuries in the frontal, temporal and occipital areas. Circular tours pass through the frontal protuberances, above the ears and through the occipital protuberance, which allows you to securely hold the bandage on your head. The end of the bandage is fixed with a knot in the forehead area.

Cross-shaped headband. The bandage is convenient for injuries to the back of the neck and occipital region (Fig. 1). First, securing circular tours are applied to the head. Then the bandage is carried obliquely down behind the left ear to the back surface of the neck, along the right side surface of the neck, then goes to the front of the neck, it lateral surface to the left and obliquely raise the bandage along the back of the neck above the right ear to the forehead. The moves of the bandage are repeated required quantity times until the dressing covering the wound is completely closed. The bandage is completed with circular tours around the head.

Rice. 1. Cross-shaped (eight-shaped) headband

Hippocrates' cap. The bandage allows you to securely hold the dressing material on the scalp. Apply a bandage using two bandages (Fig. 2). The first bandage is used to perform two to three circular strengthening tours around the head.

Rice. 2. Stages of applying the “Hippocrates Cap” bandage

The beginning of the second bandage is fixed with one of the circular rounds of the first bandage, then the second bandage is passed through the cranial vault until it intersects with the circular course of the first bandage in the forehead area. After the intersection, the second bandage is returned through the cranial vault to the back of the head, covering the previous round by half the width on the left bandage. The bandages are crossed in the occipital region and the next round of the bandage is passed through the cranial vault to the right of the central tour. The number of returning strokes of the bandage on the right and left should be the same. Finish applying the bandage with two to three circular rounds.

Headband "bonnet". A simple, convenient bandage that firmly fixes the dressing on the scalp (Fig. 3). A piece of bandage (tie) about 0.8 m long is placed on the crown of the head and its ends are lowered down in front of the ears. The wounded person or an assistant holds the ends of the tie taut. Perform two fastening circular bandage rounds around the head. The third round of the bandage is carried out over the tie, circled around the tie and led obliquely through the forehead area to the tie on the opposite side. Wrap the bandage around the tie again and lead it through the occipital region to the opposite side. In this case, each stroke of the bandage overlaps the previous one by two-thirds or half. Using similar strokes, the bandage covers the entire scalp. Finish applying the bandage with circular turns on the head or fix the end of the bandage with a knot to one of the ties. The ends of the tie are tied with a knot under the lower jaw.

Rice. 3. Headband “bonnet”

Bridle bandage. Used to hold dressing material on wounds in the parietal region and wounds of the lower jaw (Fig. 4). The first securing circular moves go around the head. Further along the back of the head, the bandage moves obliquely towards right side neck, under the lower jaw and make several vertical circular moves, which cover the crown or submandibular area, depending on the location of the damage. Then the bandage from the left side of the neck is passed obliquely along the back of the head to the right temporal region and the vertical rounds of the bandage are secured with two or three horizontal circular strokes around the head.

Rice. 4. Bridle bandage

In case of damage in the chin area, the bandage is supplemented with horizontal circular moves, grasping the chin (Fig. 5).

Rice. 5. Bridle bandage with chin grip

After completing the main rounds of the “bridle” bandage, move the bandage around the head and move it obliquely along the back of the head, the right side surface of the neck and make several horizontal circular moves around the chin. Then they switch to vertical circular passages that pass through the submandibular and parietal regions. Next, the bandage is moved through the left surface of the neck and the back of the head and returned to the head and circular tours are made around the head, after which all rounds of the bandage are repeated in the described sequence. When applying the “bridle” bandage, the wounded person must keep his mouth slightly open, or a finger is placed under the chin while bandaging, so that the bandage does not interfere with opening the mouth and does not squeeze the neck.

The bandage for one eye is monocular (Fig. 6). First, horizontal fastening tours are applied around the head. Then, in the back of the head, the bandage is passed down under the ear and passed obliquely up the cheek to the affected eye. The third move (fixing) is made around the head. The fourth and subsequent moves are alternated in such a way that one move of the bandage goes under the ear to the affected eye, and the next one is a fixing one. The bandaging is completed with circular moves on the head. The bandage on the right eye is bandaged from left to right, on the left eye - from right to left.

Rice. 6. Eye patches: a – monocular patch on the right eye; b – monocular patch on the left eye; c – binocular patch on both eyes

The bandage on both eyes is binocular (Fig. 6 c). It begins with circular fixing tours around the head, then in the same way as when applying a bandage to the right eye. After which the bandage is applied from top to bottom to the left eye. Then the bandage is directed under the left ear and along the occipital region under the right ear, along right cheek on the right eye. The bandages shift downwards and towards the center. From the right eye, the bandage returns above the left ear to the occipital region, passes above the right ear to the forehead and again passes to the left eye. The bandage is finished with circular horizontal rounds of the bandage across the forehead and back of the head.

Neapolitan bandage for the ear area. The strokes of the bandage correspond to the strokes when applying a bandage to the eye, but pass above the eye on the side of the bandaged ear (Fig. 7).

Fig.7. Neapolitan ear bandage

Head scarf. The base of the scarf is placed in the back of the head, the top is lowered onto the face. The ends of the scarf are tied on the forehead. The top is folded up over the tied ends and secured with a safety pin (Fig. 8).

Rice. 8. Headband

Sling bandage. Sling-shaped head bandages allow you to hold dressing material in the nose (Fig. 9 a), upper and lower lips, chin (Fig. 9 b), as well as on wounds of the occipital, parietal and frontal regions (Fig. 10). The uncut part of the sling is used to cover the aseptic material in the wound area, and its ends are crossed and tied at the back (the upper ones are in the neck area, the lower ones are on the back of the head or on the crown).

Rice. 9. Sling bandage: a – nose; b - chin

Rice. 10. Sling-shaped headbands: a – on the occipital region; b – to the parietal region

To hold the dressing material on the back of the head, a sling is made from a wide strip of gauze or cloth. The ends of such a bandage intersect at temporal areas. They are tied on the forehead and under the lower jaw. In the same way, a sling-shaped bandage is applied to the parietal region and forehead. The ends of the bandage are tied at the back of the head and under the lower jaw.

Neck bandage. Apply with circular bandaging. To prevent it from sliding down, circular rounds on the neck are combined with rounds of a cruciform bandage on the head (Fig. 11).

Rice. 11. Circular bandage around the neck, reinforced with cross-shaped passages on the head

Chest bandages.

The conical shape of the chest and changes in its volume during breathing often lead to the bandages slipping. Bandaging the chest should be done with wide bandages and additional techniques for strengthening the bandages should be used. To apply bandages to the chest, gauze bandages with a width of 10 cm, 14 cm and 16 cm are used.

Spiral chest bandage. Used for chest wounds, rib fractures, treatment purulent wounds(Fig. 12). Before applying the bandage, a gauze bandage about a meter long is placed with the middle on the left shoulder girdle. One part of the bandage hangs loosely on the chest, the other on the back. Then, with another bandage, fastening circular tours are applied in the lower parts of the chest and in spiral moves (3-10) from the bottom up, the chest is bandaged to the armpits, where the bandage is secured with two or three circular tours. Each round of the bandage overlaps the previous one by 1/2 or 2/3 of its width. The ends of the bandage, hanging loosely on the chest, are placed on the right shoulder girdle and tied to the second end, hanging on the back. A belt is created, as it were, that supports the spiral passages of the bandage.

Rice. 12. Spiral chest bandage

Occlusive dressing. It is applied using an individual dressing package (PLP) for penetrating chest wounds. The bandage prevents air from being sucked into the pleural cavity during breathing. The outer shell of the bag is torn along the existing incision and removed without violating sterility inner surface. Remove the pin from the inner parchment shell and take out the bandage with cotton-gauze pads. It is recommended to treat the surface of the skin in the wound area with boric petroleum jelly, which provides a more reliable sealing of the pleural cavity. Without disturbing the sterility of the inner surface of the pads, unroll the bandage and cover the wound penetrating into the pleural cavity with the side of the pads that is not stitched with colored threads. Unfold the rubberized outer shell of the bag and cover the inner surface with cotton-gauze pads. The edges of the shell should be in contact with the skin lubricated with boron vaseline. The bandage is fixed with spiral rounds of the bandage, while the edges of the rubberized sheath are pressed tightly against the skin. In the absence of an individual dressing package, the bandage is applied using small or large sterile dressings. Cotton-gauze pads are placed on the wound and covered with a paper bandage cover, after which the dressing material in the wound area is fixed with spiral rounds of bandage.

Bandages for the abdomen and pelvis.

When applying a bandage to the abdomen or pelvis at the site of a wound or accident, gauze bandages with a width of 10 cm, 14 cm and 16 cm are used for bandaging.

Spiral bandage on the stomach. In the upper part of the abdomen, strengthening circular tours are applied in the lower parts of the chest and the abdomen is bandaged in spiral moves from top to bottom, covering the area of ​​damage. In the lower part of the abdomen, fixing tours are applied in the pelvic area above the symphysis pubis and spiral tours are carried out from the bottom up (Fig. 13). The spiral bandage, as a rule, is poorly maintained without additional fixation. The bandage applied to the entire abdominal area or its lower parts is strengthened on the hips using a spica bandage.

Fig. 13. Spiral bandage on the abdominal area, reinforced on the thigh with rounds of a spica bandage

Spica bandage for the hip joint. It is applied for injuries in the hip joint and surrounding areas. Bandaging is carried out with a wide bandage. The line of crossing of the bandage rounds corresponds to that part of the bandage that most reliably fixes the dressing covering the wound. According to the location of the line of crossing of the bandage rounds, they distinguish the following types spica bandages: anterior, lateral, posterior, bilateral. There are also ascending and descending spica bandages. If there is damage on the left, the person providing assistance holds the head of the bandage in right hand and performs bandaging from left to right; if there is damage on the right, the head of the bandage is in the left hand and bandaging is performed from right to left.

Descending anterior spica bandage (Fig. 14 a). It begins with reinforcing circular tours in the pelvic area. Then the bandage is carried to the front surface of the thigh and along the inner lateral surface around the thigh to its outer lateral surface. From here the bandage is lifted obliquely through groin area, where it intersects with the previous move, to the lateral surface of the body. Having made a move around the back, the bandage is again applied to the stomach. Then the previous moves are repeated. Each round passes below the previous one, covering it by half or 2/3 of the width of the bandage. The bandage is finished in a circular motion around the abdomen.

Fig. 14. Anterior spica bandage of the hip joint area: a – descending; b – ascending

Ascending anterior spica bandage (Fig. 14 b). It is applied in the reverse order as opposed to a descending bandage. Strengthening circular tours are applied in the upper third of the thigh. Then the bandage is passed from the outer lateral surface of the thigh through the groin area to the stomach, the lateral surface of the torso and around the torso along the front surface of the thigh to its inner surface. Then the moves of the bandage are repeated, with each subsequent round shifting upward from the previous one. A general view of the anterior ascending spica bandage is shown in Fig. 15.

Fig. 15. General view of the ascending anterior spica bandage on the hip joint area

Lateral spica bandage. It is applied similarly to the front one, but the crossing of the bandage moves is carried out along the lateral surface of the hip joint.

Posterior spica bandage. Bandaging begins with strengthening circular tours around the abdomen. Next, the bandage is led through the buttock of the sore side to the inner surface of the thigh, walked around it in front and raised obliquely again onto the body, crossing the previous path of the bandage along the back surface.

Double-sided spica bandage for the pelvic area (Fig. 16). It begins with strengthening circular tours around the abdomen. On the right side of the abdomen, the bandage is led obliquely down to the front surface of the left thigh, go around the thigh until it intersects with the previous move on the front surface of the thigh. From here the bandage is lifted onto the body. They circle it around the back again to the right side. Next, bring the bandage down to the right thigh, go around it with inside and along the front surface they intersect the previous round. Then they return the bandage obliquely along the front surface of the abdomen to the torso, make a semicircular move around the back and bring the bandage back to the left thigh, repeating the previous rounds. Each subsequent round moves upward from the previous one. The bandage is completed with a fixing circular tour around the abdomen.

Rice. 16. Double-sided spica bandage for the pelvic area.

Spica bandage on the perineum (Fig. 17). After a fixing tour around the abdomen, the bandage is passed obliquely from the right side surface of the abdomen along its front surface to the perineum and from the inner surface of the left thigh, a semicircular move is made along the back surface with a transition to the front surface of the left thigh. Then the bandage is moved obliquely along the front surface of the abdomen to the beginning of this move, that is, to the right lateral surface of the abdomen. They make a move around the back, and on the left, the bandage is directed obliquely through the stomach to the perineum, goes around the back surface of the left thigh in a semicircular move and returns again to the side surface of the body, after which the already known tours are repeated.

Fig. 17. Spica bandage for the perineum

T-shaped bandage for the perineum. If necessary, the bandage can be quickly applied and removed. The bandage is easy to make (Fig. 18). A horizontal strip of bandage is placed around the waist and tied in the abdomen. Vertical strips passing through the perineum and holding the dressing material are fixed to a horizontal strip in the abdominal area.

Fig. 18. T-shaped perineal bandage

Scarf bandage on the hip joint and buttock area (Fig. 19). The middle of the scarf covers the outer surface of the buttock, placing the base of the scarf in the upper third of the thigh. The top of the scarf is secured to the belt or to a second scarf folded along its length and drawn around the body. Then the ends of the scarf are wrapped around the thigh and tied on its outer surface.

Fig. 19. Bandage for the hip joint and buttock area

Scarf bandage on both buttocks and perineum (Fig. 20). The scarf is laid so that the base runs along the lower back. The ends of the scarf are tied in front on the stomach, and the top is passed, covering the buttocks, through the crotch in front and secured to the knot from the ends of the scarf. In a similar way, but in front, a scarf is applied to cover the front of the perineum and external genitalia.

Rice. 20. Scarf bandage on the perineum and both buttocks

Bandage on the scrotum (Fig. 21). The jock belt is passed around the waist and secured with a buckle or knot. The scrotum is placed in a suspensor pouch, and the penis is brought out through a special hole in the supporting pouch. Two ribbons attached to the bottom edge of the pouch are passed through the crotch and attached to the back of the belt.

Rice. 21. Bandage on the scrotum

Bandages for the upper limb.

Returning finger bandage. Used for injuries and diseases of the finger, when it is necessary to close the end of the finger (Fig. 22). The width of the bandage is 5 cm. Bandaging begins along the palmar surface from the base of the finger, goes around the end of the finger and moves the bandage along the back side to the base of the finger. After bending, the bandage is carried along a creeping path to the end of the finger and bandaged in spiral rounds towards its base, where it is secured.

Rice. 22. Returning finger bandage

Spiral bandage on the finger (Fig. 23). Most hand wraps begin with circular securing strokes of the bandage in the lower third of the forearm just above the wrist. The bandage is passed obliquely along the back of the hand to the end of the finger and, leaving the tip of the finger open, the finger is bandaged in spiral moves to the base. Then the bandage is returned to the forearm through the back of the hand. Bandaging is completed with circular rounds in the lower third of the forearm.

Fig.23. Spiral bandage finger

Spiral bandage for all fingers (“glove”) (Fig. 24). It is applied to each finger in the same way as to one finger. Bandaging on the right hand begins with the thumb, on the left hand - with the little finger.

Fig.24. Spiral bandage for all fingers of the hand (“glove”)

Spica bandage for the thumb (Fig. 25). Used to close the area of ​​the metacarpophalangeal joint and elevate the thumb.

Rice. 25. Spica bandage for the thumb

After securing the moves above the wrist, the bandage is led along the back of the hand to the tip of the finger, wrapped around it and along the back surface again to the forearm. With such moves they reach the base of the finger and the end of the bandage is secured to the wrist. To cover the entire thumb, the bandage is supplemented with returning rounds.

Cross-shaped bandage on the hand (Fig. 26). Covers the dorsum and palmar surfaces of the hand, except for the fingers, fixes the wrist joint, limiting the range of movements. The width of the bandage is 10 cm. Bandaging begins with securing circular tours on the forearm. Then the bandage is passed along the back of the hand onto the palm, around the hand to the base of the second finger. From here, along the back of the hand, the bandage is returned obliquely to the forearm. To more securely hold the dressing on the hand, the cross-shaped moves are supplemented with circular moves of the bandage on the hand. Complete the application of the bandage in circular motions over the wrist.

Rice. 26.Cruciform (eight-shaped) bandage on the hand

Returning bandage on the hand (Fig. 27). Used to hold dressing material when all fingers or all parts of the hand are damaged. When applying cotton-gauze pads or gauze napkins to wounds or burn surfaces, it is necessary to leave layers of dressing material between the fingers. The width of the bandage is 10 cm. Bandaging begins with securing rounds above the wrist, then the bandage is passed along the back surface of the hand onto the fingers and with returning strokes they cover the fingers and hand from the back and palm. After which the bandage is applied creepingly to the fingertips and in spiral rounds the hand is bandaged towards forearm, where the bandage is completed in circular motions above the wrist.

Rice. 27. Returning hand bandage

Scarf bandage for the hand (Fig. 28). Place the scarf so that its base is located in the lower third of the forearm above the area of ​​the wrist joint. The hand is placed with the palm of the hand on the scarf and the top of the scarf is folded onto the back of the hand. The ends of the scarf are circled several times around the forearm above the wrist and tied.

Fig.28. Scarf bandage for hand

Spiral bandage on the forearm (Fig. 29). To apply a bandage, use a 10 cm wide bandage. Bandaging begins with circular strengthening rounds in the lower third of the forearm and several ascending spiral rounds. Since the forearm has a cone-shaped shape, a tight fit of the bandage to the surface of the body is ensured by bandaging in the form of spiral rounds with bends to the level of the upper third of the forearm. To make a bend, hold the bottom edge of the bandage with the first finger of your left hand, and with your right hand make a bend towards you 180 degrees. The top edge of the bandage becomes the bottom, the bottom - the top. At the next round, the bend of the bandage is repeated. The bandage is fixed with circular bands of bandage in the upper third of the forearm.

Fig.29. Spiral ascending bandage with bends on the forearm (technique for performing bandage bends)

Turtle bandage for the elbow joint. In case of damage directly in the area of ​​the elbow joint, a converging turtle bandage is applied. If the injury is located above or below the joint, use a divergent turtle bandage. Bandage width – 10 cm.

Converging tortoiseshell bandage (Fig. 30). The arm is bent at the elbow joint at an angle of 90 degrees. Bandaging begins in circular strengthening rounds either in the lower third of the shoulder above the elbow joint, or in the upper third of the forearm. Then, using eight-shaped rounds, the dressing material is closed in the area of ​​damage. The passes of the bandage intersect only in the area of ​​the elbow bend. The eight-shaped rounds of the bandage are gradually shifted towards the center of the joint. Finish the bandage with circular tours along the joint line.

Fig.30. Converging tortoiseshell elbow bandage

Divergent tortoiseshell bandage (Fig. 31). Bandaging begins with circular fastening rounds directly along the line of the joint, then the bandage is alternately applied above and below the elbow bend, covering two-thirds of the previous rounds. All passages intersect along the flexor surface of the elbow joint. Thus, the entire area of ​​the joint is covered. The bandage is finished in circular motions on the shoulder or forearm.

Rice. 31. Diverging turtle bandage for the elbow joint

Scarf bandage on the elbow joint (Fig. 32). The scarf is placed under the back surface of the elbow joint so that the base of the scarf is under the forearm, and the top is under the lower third of the shoulder. The ends of the scarf are passed to the front surface of the elbow joint, where they are crossed, circled around the lower third of the shoulder and tied. The top is attached to the crossed ends of the scarf on the back of the shoulder.

Rice. 32. Scarf bandage for the elbow joint

Spiral shoulder bandage (Fig. 33.). The shoulder area is covered with a regular spiral bandage or a spiral bandage with kinks. A bandage 10–14 cm wide is used. In the upper parts of the shoulder, to prevent the bandage from slipping, bandaging can be completed with rounds of a spica bandage.

Fig. 33. Spiral bandage on the shoulder

Shoulder scarf (Fig. 34). The scarf is placed on the outer side surface of the shoulder. The top of the scarf is directed towards the neck. The ends of the scarf are drawn around the shoulder, crossed, brought to the outer surface of the shoulder and tied. To prevent the bandage from slipping, the top of the scarf is fixed using a loop of cord, a bandage or a second scarf drawn through the opposite armpit.

Rice. 34. Shoulder scarf

Spica bandage for the shoulder joint. Used to hold dressing material on wounds in the shoulder joint and adjacent areas. The intersection of the bandage rounds is performed directly above the dressing material covering the wound. The width of the bandage is 10-14 cm. On the left shoulder joint, the bandage is bandaged from left to right, on the right - from right to left, that is, the bandaging of the spica bandage is carried out in the direction of the side of the injury. There are ascending and descending spica bandages on the shoulder joint area. Ascending spica bandage (Fig. 35 a, b). Bandaging begins with circular fastening rounds in upper section shoulder, then the bandage is applied to the shoulder girdle and along the back to the axillary region of the opposite side. Next, the bandage moves along the front side of the chest to the front surface of the shoulder, along the outer surface around the shoulder into the armpit, with a transition to the outer surface of the shoulder joint and shoulder girdle. Then the rounds of the bandage are repeated with an upward shift of one third or half the width of the bandage. Bandaging is completed with circular tours around the chest.

Rice. 35. Spica bandage on the shoulder joint: a, b – ascending; c, d – descending

Descending spica bandage (Fig. 35 c, d). Apply in reverse order. The end of the bandage is fixed in circular passages around the chest, then from the axillary region of the healthy side, the bandage is lifted along the front surface of the chest to the shoulder girdle on the injured side, bended around it along the back surface and through the axillary region brought to the front surface of the shoulder girdle. After which the bandage is moved along the back to the axillary region of the healthy side. Each subsequent figure-of-eight move is repeated slightly lower than the previous one. Bandaging is completed with circular tours around the chest.

Spica bandage for the axillary region (Fig. 36). To reliably hold the dressing material on the wound in the axillary region, the spica bandage is supplemented with special rounds of bandage through the healthy shoulder girdle. It is recommended to cover the dressing material in the area of ​​injury with a layer of cotton wool, which extends beyond the axillary area and partially covers top part chest. Bandage width – 10-14 cm. The bandage begins with two circular rounds in the lower third of the shoulder, then several moves of an ascending spica-shaped bandage are made and an additional oblique move is made along the back through the shoulder girdle of the healthy side and the chest into the damaged axillary region. Then a circular stroke is made, covering the chest and holding a layer of cotton wool. Additional oblique and circular moves of the bandage are alternated several times. Bandaging is completed with rounds of a spica bandage and circular rounds on the chest.

Rice. 36. Spica bandage for the axillary area

Scarf bandage on the shoulder joint area (Fig. 37). The medical scarf is folded with a tie and the middle is brought into the axillary fossa, the ends of the bandage are crossed over the shoulder joint, passed along the front and back surfaces of the chest and tied in the axillary region of the healthy side.

Fig.37. Scarf bandage for the shoulder joint area

Scarf bandage for hanging the upper limb (Fig. 38). Used to support an injured upper limb after application soft bandage or transport immobilization bandages. The injured arm is bent at the elbow joint at a right angle. An unfolded scarf is placed under the forearm so that the base of the scarf runs along the axis of the body, its middle is slightly above the forearm, and the top is behind and above the elbow joint. The upper end of the scarf is placed on the healthy shoulder girdle. The lower end is placed on the shoulder girdle of the damaged side, covering the forearm in front with the lower smaller part of the scarf. The ends of the scarf are tied with a knot above the shoulder girdle. The top of the scarf is wrapped around the elbow joint and secured with a pin to the front of the bandage.

Fig.38. Upper limb suspension bandage

Deso bandage (Fig. 39). It is used for temporary immobilization of the injured arm in case of clavicle fractures by bandaging it to the body. The width of the bandage is 10-14 cm. Bandaging is always carried out towards the injured arm. If the bandage is applied to the left hand, bandage in the direction from left to right (bandage head in the right hand), on the right hand - from right to left (bandage head in the left hand).

Fig.39. Deso bandage In the axillary fossa of the damaged side, before starting bandaging, place a roll of compressed gray non-absorbent cotton wool wrapped in a piece of wide bandage or gauze. A roller is inserted to eliminate the lengthwise displacement of clavicle fragments. The injured arm is bent at the elbow joint at a right angle, pressed to the body and the shoulder is bandaged to the chest with circular rounds (1), which are applied below the level of the cushion located in the axillary region on the side of the injury. Next, from the axillary region of the healthy side, the bandage is led obliquely upward along the front surface of the chest to the shoulder girdle of the damaged side (2), where the bandage should pass through the central fragment of the clavicle closer to the lateral surface of the neck. Then the bandage is moved down along the back of the shoulder under the middle third of the forearm. Having covered the forearm, the bandage is continued along the chest to the axillary region of the healthy side (3) and along the back obliquely upward to the shoulder girdle of the damaged side, where the bandage is again passed through the central fragment of the clavicle closer to the lateral surface of the neck, after which the bandage is carried down along the front surface shoulder under the elbow (4). From under the elbow, the bandage is led in an oblique direction through the back into the axillary region of the uninjured side. The described moves of the bandage are repeated several times, forming a bandage that provides reliable immobilization of the upper limb. The bandage is secured in a circular motion over the shoulder and chest.

Bandages for the lower limb.

Returning bandage on the toes. Used for diseases and injuries of the toes. The width of the bandage is 3-5 cm. The bandage is usually used to hold the dressing material on wounds of 1 toe and rarely to cover other toes, which are usually bandaged along with the entire foot. The bandage starts from the plantar surface of the base of the toe, covers the tip of the toe and guides the bandage along it back surface to base. Make a bend and creep the bandage to the tip of the finger. Then they bandage it with spiral rounds to the base, where the bandage is fixed.

Spiral bandage on the first toe (Fig. 40). The width of the bandage is 3-5 cm. Usually only one thumb is bandaged separately. It is recommended to begin bandaging with strengthening circular tours in the lower third of the shin above the ankles. Then the bandage is passed through the dorsum of the foot to the nail phalanx of 1 finger. From here, the entire toe is covered with spiral rounds to the base and again through the back of the foot the bandage is returned to the lower leg, where the bandage is finished with fixing circular rounds.

Fig.40. Spiral bandage for big toe

Spica bandage on the first toe (Fig. 41). The width of the bandage is 3-5 cm. Like all spica bandages, the spica bandage for the first toe is bandaged in the direction of the injury. On the left foot, the bandage is applied from left to right, on right foot- from right to left. Bandaging begins with strengthening circular tours in the lower third of the lower leg above the ankles. Then the bandage is passed from the inner ankle to back side foot to its outer surface and along the plantar surface to the inner edge of the nail phalanx of the first toe. After a circular turn on the first toe, the bandage is moved along the dorsum of the foot to its outer edge and the bandage is moved in a circular turn through the plantar surface to the outer ankle.

Fig.41. Spica bandage for the big toe

Each subsequent round of the bandage on the first toe is shifted upward in relation to the previous one, thus forming an ascending spica-shaped bandage. A returning bandage on the peripheral parts of the foot. Used for diseases and injuries of the peripheral parts of the foot and fingers. The width of the bandage is 10 cm. Each finger is covered with a dressing material separately, or all fingers together with gauze pads between them. Then they begin to bandage the foot. Circular strengthening tours are applied in the middle parts of the foot. Then, using longitudinal returning tours from the plantar surface of the foot through the tips of the toes to the dorsum and back, the entire width of the foot is covered. The bandage is carried along a creeping path to the tips of the fingers, from where the foot is bandaged in spiral rounds to the middle. The bandage on the foot usually does not hold well, so it is recommended to finish the bandage with strengthening figure-eight rounds around the ankle joint with fixing circular rounds above the ankles.

Returning bandage for the entire foot (Fig. 42). It is used for foot injuries when it is necessary to cover the entire foot, including the toes. Bandage width – 10 cm.

Rice. 42.Returning bandage for the entire foot

Bandaging begins with circular fixing rounds in the lower third of the shin above the ankles. Then the bandage is transferred to the foot, from the side of the inner ankle on the right foot and from the outside ankle on the left, and several circular strokes are applied along the lateral surface of the foot to the first toe, from it back along the opposite lateral surface of the foot to the heel. From the heel, the bandage is carried in a creeping motion to the tips of the fingers and the foot is bandaged in spiral moves in the direction of the lower third of the lower leg. In the area of ​​the ankle joint, the technique of applying a bandage to the heel area is used (Fig. 44). Finish the bandage with circular rounds above the ankles.

Cross-shaped (eight-shaped) bandage on the foot (Fig. 43). Allows you to securely fix the ankle joint in case of ligament damage and some joint diseases. The width of the bandage is 10 cm. The foot is placed in a position at a right angle to the lower leg. Bandaging begins with circular fixing rounds in the lower third of the shin above the ankles. Then the bandage is moved obliquely along the dorsum of the ankle joint to the lateral surface of the foot (to the outer surface of the left foot and to the inner surface of the right foot). Perform a circular motion around the foot. Next, from the opposite side surface of the foot along its back, they cross the previous course of the bandage obliquely upward and return to the lower leg. Again, perform a circular motion over the ankles and repeat the eight-shaped strokes of the bandage 5-6 times to create reliable fixation of the ankle joint. The bandage ends in circular motions on the shins above the ankles.

Rice. 43. Cross-shaped (eight-shaped) bandage on the foot

Bandage on the heel area (tortoiseshell type) (Fig. 44). Used to completely cover the heel area like a divergent tortoiseshell bandage. The width of the bandage is 10 cm. Bandaging begins with circular fixing rounds on the shins above the ankles. Then the bandage is applied obliquely down the back surface to the ankle joint. The first circular tour is applied through the most protruding part of the heel and the dorsum of the ankle joint and circular strokes are added to it above and below the first one. However, in this case, there is a loose fit of the bandage to the surface of the foot. To avoid this, the bandages are strengthened with an additional oblique motion of the bandage, running from the back surface of the ankle joint down and anteriorly to the outer lateral surface of the foot. Then, along the plantar surface, the bandage is moved to the inner edge of the foot and the diverging rounds of the tortoiseshell bandage continue to be applied. The bandage ends in circular circles in the lower third of the shin above the ankles.

Fig.44. Heel bandage

Spica-shaped ascending bandage on the foot (Fig. 45). It is used to reliably hold dressing material on the dorsal and plantar surfaces for injuries and diseases of the foot. The toes remain uncovered. The width of the bandage is 10 cm. Bandaging begins with circular fixing rounds through the most protruding part of the heel and the back surface of the ankle joint. Then, from the heel, the bandage is moved along the outer surface of the right foot (on the left foot - along the inner surface), obliquely along the back surface to the base of the first toe (on the left foot - to the base of the fifth toe). Make a full circle around the foot and return the bandage to the back surface at the base of the fifth toe (on the left foot - at the base of the first toe). Along the back of the foot, they cross the previous round and return to the heel area on the opposite side. Going around the heel from behind, repeat the described eight-shaped rounds of the bandage, gradually shifting them towards the ankle joint. The bandage ends in circular circles in the lower third of the shin above the ankles.

Fig.45. Spica bandage on the foot

Foot bandages. There are scarves that cover the entire foot, heel area and ankle joint.

Scarf bandage for the entire foot (Fig. 46 a, b). The plantar area is covered with the middle of the scarf, the top of the scarf is wrapped, covering the toes and the back of the foot. The ends are brought to the back of the foot, crossed, and then wrapped around the shin above the ankles and tied with a knot on the front surface.

Fig.46. Bandages for the foot: a b – for the entire foot; c – on the heel area and ankle joint area

Scarf bandage on the heel area and ankle joint (Fig. 46 c). The scarf is placed on the plantar surface of the foot. The base of the scarf is located across the foot. The apex is located along the back surface of the ankle joint. The ends of the scarf are crossed first on the back of the foot, and then over the top of the back surface of the ankle joint and the lower third of the lower leg. The ends are tied on the front surface of the shin above the ankles.

Spiral bandage with bends on the lower leg (Fig. 47). Allows you to hold the dressing material on wounds and other injuries of the lower leg, which has a cone shape. The width of the bandage is 10 cm. Bandaging begins with fastening circular rounds in the lower third of the shin above the ankles. Then they make several circular spiral rounds and on the cone-shaped area of ​​the lower leg they switch to bandaging with spiral rounds with bends similar to the spiral bandage on the forearm. The bandage ends in circular circles in the upper third of the leg below the knee joint.

Rice. 47. Spiral bandage on the shin ( general view)

Scarf bandage on the shin (Fig. 48). The base of the scarf is wound around the shin in a helical manner. The lower end of the scarf is carried over the ankle area and directed slightly upward, where it is secured with a pin. The other end of the scarf is covered from above in a circular motion, and the end is also secured with a pin.

Fig.48. Shin bandage

Turtle bandage for the knee joint. Allows you to securely hold the dressing material in the area of ​​the knee joint and the areas immediately adjacent to it, while movements in the joint are slightly limited. If there is damage directly in the area of ​​the knee joint, a converging turtle bandage is applied, and if there is damage near the knee joint, a divergent bandage is applied. The bandage is applied in a position of slight flexion in the joint. Bandage width – 10 cm.

Converging turtle bandage on the knee joint area (Fig. 49 a, b). Bandaging begins with fastening circular tours in the lower third of the thigh above the knee joint or in the upper third of the lower leg below the knee joint, depending on where the wound or other damage is located. Then, converging figure-of-eight rounds of bandage are applied, crossing in the popliteal region. The bandage ends in circular circles in the upper third of the leg under the knee joint.

Fig.49. Turtle bandage for the knee joint: a, b – converging; c – divergent

A diverging tortoiseshell bandage for the knee joint (Fig. 49 c). Bandaging begins with securing circular tours through the most protruding part of the patella. Then eight-shaped diverging moves are performed, crossing in the popliteal region. The bandage is completed with circular rounds in the upper third of the leg or the lower third of the thigh, depending on where the injury is located. If it is necessary to apply a bandage to the lower limb in an extended position, use a spiral bandaging technique with kinks. The bandage begins with circular moves in the upper third of the leg and ends with fixing rounds in the lower third of the thigh. Spiral bandage with bends on the thigh. It is used to hold dressing material on wounds and other injuries of the thigh, which, like the lower leg, has a cone shape. The width of the bandage is 10-14 cm. Bandaging begins with fastening circular tours in the lower third of the thigh above the knee joint. Then the entire surface of the thigh is covered from bottom to top using spiral strokes of the bandage with bends. As a rule, such bandages on the thigh are poorly maintained and easily slip off. Therefore, it is recommended to complete the bandage with rounds of a spica bandage on the hip joint area.

Bandages on the stumps of the limbs.

They are applied for avulsions of various parts of the upper and lower extremities, diseases and injuries of the stumps of the shoulder and forearm, thigh and lower leg. When bandaging the limb stump, the returning bandage technique is used. The stumps of the limbs are usually cone-shaped, so the bandages are poorly held and require additional strengthening. Bandage width – 10-14 cm.

Technique for applying a returning bandage (Fig. 50). Bandaging begins with securing circular tours in the upper third of the affected limb segment. Then hold the bandage with the first finger of the left hand and make a bend on the front surface of the stump. The bandage moves in the longitudinal direction through the end part of the stump to the rear surface. Each longitudinal stroke of the bandage is secured in a circular motion. The bandage is bent on the back surface of the stump closer to the end part and the bandage is returned to the front surface. Each returning round is fixed with spiral strokes of the bandage from the end part of the stump. If the stump has a pronounced cone-shaped shape, then the bandage is stronger when the second returning stroke of the bandage passes perpendicular to the first and intersects at the end of the stump with the first returning tour at a right angle. The third returning stroke should be carried out in the interval between the first and second. The returning strokes of the bandage are repeated until the stump is securely bandaged.

Fig.50. Returning bandage on the thigh stump

Returning bandage on the stump of the forearm (Fig. 51). The bandage begins in circular motions in the lower third of the shoulder to prevent the bandage from slipping. Then the bandage is passed to the stump of the forearm and a returning bandage is applied. Bandaging is completed with circular rounds in the lower third of the shoulder.

Fig.51. Returning bandage on the stump of the forearm

Returning bandage on the stump of the shoulder (Fig. 52). The bandage begins in circular motions in the upper third of the shoulder stump. Then a returning bandage is applied, which is strengthened before completion with the moves of a spica bandage on the shoulder joint. The bandage is completed with circular rounds in the upper third of the shoulder.

Fig.52. Returning shoulder stump bandage

Returning bandage on the stump of the leg. The bandage begins in circular motions in the upper third of the lower leg. Then a returning bandage is applied, which is strengthened with eight-shaped moves of the bandage on the knee joint. The bandage is completed with circular rounds in the upper third of the lower leg.

Returning bandage on the thigh stump. The bandage begins in circular motions in the upper third of the thigh. Then apply a returning bandage, which is strengthened with moves of a spica bandage on hip joint. The bandage is completed with circular tours in the pelvic area.

Scarf bandage on the thigh stump (Fig. 53). The middle of the scarf is placed on the end of the stump, the top is wrapped on the front surface of the stump, and the base and ends of the scarf are wrapped on the back surface. The ends of the scarf are wrapped around the upper third of the thigh, forming a bandage, tied on the front surface and the top is fixed to the knot.

Fig.53. Bandage on the thigh stump

Similarly, bandages are applied to the stumps of the shoulder, forearm and lower leg.

3. Types of bleeding and their consequences

Bleeding can be arterial, venous, capillary and parenchymal. In the case of arterial bleeding, the blood is bright red (scarlet) in color and flows from the damaged vessel in an intermittent stream. Such bleeding poses a great danger due to rapid blood loss. With venous bleeding, the blood is dark red in color and flows out in a continuous stream. In the case of capillary bleeding, blood oozes from the wound in drops. Parenchymal bleeding is observed when damaged internal organs(liver, kidneys, etc.). Bleeding that occurs from open wound, called external. Bleeding, in which blood flows from the vessel into the tissues and body cavities (thoracic, abdominal, etc.), is called internal. It is customary to distinguish between primary and secondary bleeding. Primary occurs immediately after injury. Secondary bleeding begins a certain time after it due to the expulsion of a blood clot that has blocked the vessel, or as a result of injury to the vessel by sharp bone fragments or foreign bodies. The cause of secondary bleeding may be careless provision of first aid, poor immobilization of the limb, shaking of the victim during transportation, development of suppuration in the wound. The danger of bleeding to the health and life of a person is determined by the amount of blood shed, the speed of bleeding, the age of the victim, the nature of concomitant lesions, etc. For For an adult, blood loss of 1.5–2 liters is life-threatening. Bleeding is the main cause of death on the battlefield, and therefore the main first aid measure for the wounded is to temporarily stop bleeding. With acute blood loss, victims experience darkening of the eyes, shortness of breath, dizziness, tinnitus, thirst, nausea (sometimes vomiting), pale skin , especially limbs, and lips. The pulse is frequent, weak or almost unpalpable, the extremities are cold. Fainting is sometimes observed. In case of damage to the lungs, gastrointestinal tract or genitourinary organs, blood may be found in sputum, vomit, feces and urine, respectively. Large blood loss leads to loss of consciousness in the victim. Loss of blood, as already noted, is the main cause of death on the battlefield. In case of acute blood loss, after stopping the bleeding, a large amount of fluid should be introduced into the body to compensate for the lack of circulating blood. The wounded are given something to drink strong tea, coffee, water. It should be remembered that if the internal organs of the abdomen are injured, the victim should not be given anything to drink. In order to improve blood supply to the brain and other vital organs, it is necessary to elevate the victim’s legs. The wounded person should be warmed up. Blood loss is compensated by transfusion of blood, blood plasma, and blood-substituting fluids to the wounded. They are advised to give oxygen. In case of injury to the capillaries, venous vessels and small arteries, bleeding can stop spontaneously as a result of blockage of the vessel with a blood clot.

4. Methods to temporarily stop bleeding

Temporary stopping of bleeding is achieved by applying a pressure bandage, tourniquet or twist (Fig. 54), pressing the artery to the bone along its length.

Rice. 54. Methods for temporarily stopping bleeding: a - with a pressure bandage, b - with a tourniquet, c - with a twist. The final stop of bleeding is done when surgeons treat wounds in the dressing room and operating room. In case of any bleeding, especially if a limb is damaged, the damaged area should be given an elevated position and rest should be ensured. This helps to lower blood pressure in the blood vessels, reduce blood flow in them and form a blood clot. Bleeding from small wounds and capillary bleeding can be stopped by applying a pressure sterile bandage. In order to better compress the vessels, a cotton-gauze pad of PPI or a sterile bandage is applied to the bleeding wound in the form of a tampon. To temporarily stop bleeding on the torso, only this method is suitable, since others are unacceptable.

Pressing the artery along its length, i.e., along the bloodstream, closer to the heart is a simple and accessible way in various situations to temporarily stop arterial bleeding. To do this, the vessel is pressed in a place where one or another artery does not lie very deep and it can be pressed against the bone. At these points, you can determine the pulsation of the arteries when palpating with your fingers (Fig. 55).

Rice. 55. Methods of pressing the arteries of the head

In case of bleeding in the face and scalp, you need to press the submandibular and temporal arteries. In case of bleeding on the neck, press carotid artery to the spine at the inner edge of the sternocleidomastoid muscle.

A pressure bandage in the neck area is applied in such a way that blood circulation is maintained on the uninjured side (Fig. 56).

Rice. 56. Applying a pressure bandage in the neck area

Bleeding at the base of the upper limb is stopped by applying pressure subclavian artery in the supraclavicular region (Figure 57).

Rice. 57. Pressure of the artery in the supraclavicular region

The brachial artery is pressed against the bone of the shoulder along the edge of the biceps muscle (Fig. 58).

Rice. 58. Pressure of the brachial artery.

Bleeding in the forearm and hand can be stopped by placing a roller in the elbow bend and bending the arm to the maximum at the elbow joint.

The arteries of the lower leg are pressed in the popliteal fossa, after placing a soft cushion in it and bending the leg at the knee joint as much as possible. In case of arterial bleeding in the area of ​​the lower limb, the femoral artery is pressed in the groin or at the inner edge of the quadriceps muscle (Fig. 59).

Rice. 59. Compression of the femoral artery

To successfully stop bleeding, the arterial vessel must be compressed with the pulp of two to four fingers. This method of stopping bleeding is used as a short-term measure. It must be supplemented with a quick tourniquet. Application of a tourniquet is the main way to temporarily stop bleeding on the battlefield when large arterial vessels of the limb are injured. A rubber band is used for this. It consists of a rubber band 1–1.5 m long, with a metal chain attached to one end and a hook to the other. Before application, the tourniquet is stretched, then wrapped 2–3 times around the limb so that the turns lie side by side. The ends of the tourniquet are secured with a chain and hook or tied with a knot (Fig. 60).

Rice. 60. Method of applying a tourniquet

The tourniquet is applied above the wound (closer to the heart) directly on clothing, or the area where the tourniquet is to be applied is wrapped in several layers of bandage or other material. It is important that the tourniquet is not applied too loosely or too tightly. If the tourniquet is applied loosely, the arteries are not completely compressed, and bleeding continues. Due to the fact that the veins are pinched with a tourniquet, the limb becomes engorged with blood, its skin becomes bluish and the bleeding may increase. In case of strong compression of the limb with a tourniquet, the nerves are injured, which can lead to paralysis of the limb. Correct application of the tourniquet leads to stopping bleeding and paleness of the skin of the limb. The degree of compression of the limb by the tourniquet is determined by the pulse in the artery below the place where it is applied. If the pulse disappears, it means that the artery is compressed by the tourniquet. The limb on which the tourniquet is applied should be wrapped warmly. The tourniquet that is applied should not be held for a long time. It should not exceed 2 hours, otherwise necrosis of the limb may occur. Therefore, an inscription is made on the bandage or on the skin with an indelible pencil indicating the time of application of the tourniquet. For this purpose, you can use a note. If after 2 hours the wounded person is not taken to the dressing room or operating room to completely stop the bleeding, the tourniquet should be temporarily loosened. To do this, press the artery with your fingers above the place where the tourniquet is applied, then slowly, so that the blood flow does not push out the formed thrombus, the tourniquet loosen for 5-10 minutes and tighten it again. Temporarily loosening the tourniquet in this way is repeated every hour until the victim receives surgical care. A wounded person wearing a tourniquet must be monitored, as the tourniquet may become loose, leading to renewed bleeding.

In the absence of a tourniquet, to temporarily stop bleeding, you can use available materials: a rope, a belt, a twisted handkerchief, etc. Using improvised means, the limb is tightened in the same way as with a rubber band, or a twist is made, the end of which is bandaged to the limb (Fig. 61).

Fig.61. Twist application method

Injuries

Wounds are damage to body tissue due to mechanical impact, accompanied by a violation of the integrity of the skin and mucous membranes, and sometimes deeper tissues ( subcutaneous tissue, muscles).

Wounds can be gunshot, cut, chopped, stab, bruised, crushed, lacerated, bitten, etc.

Gunshot wounds occur as a result of a bullet or shrapnel wound. They can be through (there are entry and exit wound openings), blind (a bullet or fragment is stuck in the tissue) and tangential (a bullet or fragment, flying tangentially, damages the skin and soft fabrics without getting stuck in them).

Cut and puncture wounds have a small damage area and smooth edges. The walls of such wounds remain viable, bleeding heavily. These wounds are less likely to become infected than others. Penetrating puncture wounds with a small area of ​​damage to the skin or mucous membrane can be of considerable depth and pose a great danger due to the possibility of damage to internal organs and the introduction of infection into them (this can result in inflammation of the peritoneum and blood poisoning).

Chopped wounds have unequal depth, are accompanied by bruising and crushing of soft tissues.

Bruised and crushed wounds usually have a complex shape, uneven edges, soaked in blood, and dead tissue over a considerable extent. As a rule, they create favorable conditions for the development of infection.

Lacerations occur as a result of rough mechanical action, often accompanied by detachment of skin flaps, damage to tendons, muscles and blood vessels, and are subject to severe contamination.

Bite wounds are always infected with the saliva of animals, insects or humans and are the most dangerous, since it is impossible to exclude infection of the victim with the rabies virus.

All wounds, except operating wounds, are considered primarily infected.. Microbes enter the wound along with the wounding object, soil, pieces of clothing, from the air and when touching the wound with your hands. Microbes that get into the wound can cause suppuration and complications such as erysipelas. A measure to prevent wound infection is to quickly apply aseptic dressing, preventing further entry of microbes into the wound.

Diagrams 7 and 8 show the procedure for providing first aid to a victim with extensive and minor wounds.

In case of extensive injury, it is unacceptable wash the wound with any liquid containing alcohol: this can lead to increased traumatic shock and necrosis of the wound edges with the subsequent development of severe complications.

A bandage is a dressing material, sometimes containing medicinal and some other substances, which is used to close the wound. The process of applying a bandage to a wound is called dressing. The bandage consists of two parts: the inner part, which is in contact with the wound, and the outer part, which secures and holds the bandage on the wound. Interior the dressings must be sterile.

As a dressing material, you can use gauze, white and gray cotton wool, and scarves. The dressing material should be hygroscopic, absorb blood and pus from the wound well, dry quickly after washing, and be easy to sterilize.

A bandage that is applied for the first time, called primary sterile. When applying bandages, care must be taken not to cause unnecessary pain to the victim. The head of the bandage should be held in the right hand, and the bandage should be done from left to right, while with the left hand you need to hold the bandage and smooth out the passages of the bandage (Fig. 3).

The bandage is rolled out without lifting it from the bandage surface, from left to right, with each subsequent move (round) covering the previous one by half. The bandage is not applied very tightly (except in cases where special pressure is required) so as not to interfere with blood circulation, and not very loosely so that it does not fall off the wound. Some types of dressings are shown in Figure 4. Before applying the primary dressing, you need to carefully treat the wound without causing pain to the victim.

Depending on the nature of the wound, weather and local conditions, the victim’s outer clothing is either removed or cut. First, remove clothes from the healthy side, then from the affected side. In the cold season, in order to avoid chilling, as well as in emergency cases of first aid for those seriously injured, clothing is cut in the area of ​​the wound. You cannot tear off any clothing that is stuck to the wound; it must be carefully cut off with scissors and then a bandage must be applied. Put the removed clothes on in the reverse order: first on the affected side and then on the healthy side.

A pressure bandage performs three functions: prevents secondary infection, stops bleeding, and provides rest to the damaged surface..

Questions and tasks

1. Which bleeding is called external and which is called internal?

2. What type of bleeding can be classified as if blood flows from the wound continuously, calmly and has a dark color?

3. What are the rules for providing first aid for bleeding?

4. What methods do you know of temporarily stopping bleeding?

5. What is the purpose of a pressure bandage?

6. In what places should the artery be pressed to stop bleeding?

7. How to properly apply a tourniquet in case of damage to large arterial vessels in injuries to the legs and arms?

8. If there is bleeding from an arm or leg, doctors recommend elevating the arm or leg. Why do you think?

9. Name the signs of internal bleeding.

11. How are wounds classified?

12. What should be done to prevent wound contamination?

13. Name the sequence of first aid for major and minor wounds.

Task 13

From the following signs, select those that are characteristic of venous and arterial bleeding:

a) scarlet blood flows out of the wound in a pulsating stream;
b) blood oozes over the entire surface of the wound, it is difficult to stop;
c) the blood is dark in color, does not pulsate, and flows out of the wound calmly and continuously.

Task 14

Temporarily stopping bleeding can be done in several ways. Choose the correct answers from the given ones:

a) by finger pressure of the arterial vessel below the wound site;
b) applying an aseptic bandage to the bleeding site;
c) applying a tourniquet 3-5 cm above the wound;
d) by finger pressure of the arterial vessel above the wound;
e) maximum extension of the limb;
f) applying a pressure bandage to the bleeding site;
g) applying a tourniquet 3-5 cm below the wound;
h) maximum flexion of the limb;
i) giving the injured limb an elevated (slightly above the chest) position;
j) minimal flexion of the limb.

Task 15

The most reliable way to stop bleeding in case of damage to large arterial vessels of the arms and legs:

a) applying a pressure bandage;
b) finger pressure;
c) application of a tourniquet;
d) maximum flexion of the limb.
Select correct option answer.

Task 16

What method can be used to stop bleeding from the vessels of the hand or forearm. Choose the correct answer from the options below:

a) move the victim’s shoulders back as far as possible and secure them behind the back with a wide bandage;
b) place a roll of rolled material into the elbow joint, bend the arm at the elbow joint and fix the forearm to the shoulder.

Task 17

From the given answer options, select those that determine maximum time applying a tourniquet in summer and winter:

a) no more than 30 minutes;
b) no more than 60 minutes;
c) no more than 90 minutes;
d) no more than 120 minutes;
e) no more than 150 minutes.

Task 18

b) name the rules and sequence of applying a tourniquet to the upper limb to stop bleeding;
c) answer how and in what order first aid should be provided to the driver after the bleeding has stopped.

Task 19

While sawing off a piece of board, the saw suddenly jumped out of the carpenter's hand and injured his leg below the knee. Scarlet blood flows out from the wound in the shin in a pulsating stream. You need:

a) determine the type of bleeding and give its characteristics;
b) answer in what cases the method of maximum flexion of the limb is used to stop bleeding;
c) answer how and in what sequence it is necessary to stop the carpenter’s bleeding from the lower leg, using the method of maximum flexion of the limb.

Task 20

Your neighbor is a surgeon. He promised to give you a tour of the hospital if you prepare and answer the following questions:

a) how bleeding is classified; what is the difference between venous bleeding and arterial bleeding;
b) what methods of temporarily stopping bleeding do you know;
c) in what places on the human body are the pressure points of the arteries to stop bleeding.

Task 21

Your classmate scratched his hand during labor class. You need:

a) determine the type of damage and answer what is the difference between closed and open damage;
b) answer what a wound is, what general signs have injuries and how they differ from each other;
c) answer how and in what order you will provide first aid to your classmate.

Task 22

How to properly provide assistance for deep and extensive wounds? Choose yours from the options offered further actions and determine their order:

a) give the victim a sedative;
b) disinfect the wound;
c) ensure immobility of the injured part of the body;
d) measure temperature;
e) stop bleeding;
f) apply a sterile bandage;
g) deliver the victim to a trauma center;
h) before sending to the emergency room, give the victim an anesthetic.

Task 23

As a result of a car accident, a man received a wound to the scalp. Upon examination, a wound measuring 3x5 cm was found in the parietal region on the left, profuse bleeding. List the scope of required first aid. What kind of bandage and how should it be appropriate to apply to the victim?

Task 24

While playing football, a young man received a wound to his elbow joint. Upon examination, a wound measuring 2.5 x 1.0 cm, slightly bleeding, and superficial, was found on the back surface of the right elbow joint. List the scope of required first aid. What bandage should be applied to the victim?

A wound is damage to body tissue, in which the integrity of the skin or mucous membranes is necessarily compromised. In outbreaks mass destruction and during natural disasters, injuries are most often caused by glass fragments and fragments of various objects as a result of a shock wave and the destruction of structures or buildings.

The wound can lead to life-threatening bleeding, and the entry of microbes into the wound, causing it to fester, is also life-threatening for the victim. Severe wounds with bleeding, broken bones and burns can lead to the development of shock and pose a threat to the life of the victim.

Bleeding can be arterial (if the arteries are damaged), venous (if the veins are damaged) and capillary (if the capillaries are damaged). The most dangerous is arterial bleeding, in which a stream of bright red (scarlet) blood flows out of the wound under pressure, as if in jerks.

In addition, internal bleeding is distinguished when blood is poured into internal cavities body (the cavity of the chest, abdomen, skull), and externally when blood flows out through the wound.

Rice. 1. Places of possible compression of the arteries to the underlying bones.

Rice. 2. Methods of digitally pressing the arteries to the underlying bones.

What to do if there is external bleeding. Capillary bleeding can be easily stopped by simply applying a pressure bandage to the wound. Before this, the skin around the wound is smeared with iodine, which destroys the microbes on the skin, then a napkin (preferably sterile, i.e., disinfected) made of several layers of gauze or some other clean cotton fabric is applied and bandaged tightly. If the bandage gets wet, then put another napkin on top and bandage it. Usually such a pressure bandage is sufficient for venous bleeding; in this case, the limb should be given an elevated position.

In case of arterial bleeding, in case of damage large arteries you need to act quickly. Knowing where the arteries can be pressed against the underlying bones (Fig. 1), you should first stop the bleeding in this way. The vessel is pressed, squeezing strongly with your fingers, as shown in Fig. 2. For bleeding on the extremities, it is best to apply a standard cloth or rubber tourniquet or a twist from improvised means - a belt, a piece of fabric, etc. (Fig. 3).

Rice. 4. Sequence of applying a rubber tourniquet.

Rice. 3. Rubber band.

Rice. 5. Stopping arterial bleeding with a twist:
a - tying a knot; b - twisting with a stick; c - securing the stick.

A tourniquet or twist, applied with force, tightens the limb and compresses the walls of the bleeding artery. Methods and techniques for applying a tourniquet or twisting are shown in Fig. 4 and 5.

When applying a tourniquet or twist, the following rules should be followed:
- under the tourniquet (twist) a fabric folded in several layers is placed on the skin so as not to pinch the folds of the skin;
- the tourniquet must be tightened until the pulse disappears and the bleeding stops; the tourniquet must not be applied too tightly, as tissue necrosis is possible;
- a note must be placed under the tourniquet (twist) indicating the exact time of its application in 24-hour terms (for example, 02 hours 25 minutes). This is done so that at the medical station where the victim is admitted, it is known when the tourniquet is applied in order to avoid tissue necrosis.

The tourniquet or twist can be held for no more than 1-2 hours. If bleeding continues when it is removed, then the tourniquet is loosened for a few minutes and tightened again, while simultaneously pressing the bleeding vessel with a finger.

Rice. 6. Stop bleeding by maximally flexing the limb.

In addition to a tourniquet, you can stop bleeding on a limb by bending it as follows (Fig. 6). To do this, make a roller from gauze or other soft material and place it under the bend (in the popliteal fossa, armpit, elbow), at the same time bend the limb with force and secure it in this position with a bandage.

Internal bleeding it is practically impossible to stop in the order of self-help and mutual assistance. With explicit internal bleeding or if it is suspected, the victim should be provided with complete rest and a rubber bladder or plastic bag with snow or ice (a flask or bottle of cold water) should be applied to the suspected area of ​​bleeding (stomach, head, chest). Such a victim is carefully transported on a stretcher to a medical station.