Firearms of the upper limb. Firearm wounds what to do with a gunshot wound in the belly

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Bullet wound He is a severe injury at which a victim is needed to provide qualified first aid. With bullet injuries to any part of the body, first aid turns out to be equally.

When a person is detected with bullet injury, it is necessary, first of all, to see if it has strong bleeding, when blood from the wound follows the literally fountain, strong, strained jet. If such bleeding is available, then you should first stop it, and only after that call in " ambulance". If there is no such strong bleeding, then you should first call" ambulance ", and only after that proceed to render first aid.

If "ambulance" does not come for half an hour, it is not necessary to call it in principle. In such a situation, the first assistance to the victim is in place, and then organize its delivery to the nearest hospital. To do this, you can use your own car, passing transport, stretcher, etc.

Algorithm for first aid to the victim in bullet injuries in any part of the body except the head

1. Ask the victim's victim to understand a person or fainting in the mind. If a person is unconscious, do not attempt to bring it to the sense, as it is not necessary to first-aid;

2. Do not let the victim drink and eat if he is injured in the stomach. You can only make it lips with water;

3. The victim unconscious must be put in such a way that his head turned out to be trapped back and turned a little side. Such a position of the head will provide the patency of the respiratory tract, as well as create conditions for the removal of the vomites outward;

4. Try not to move the body of the victim, trying to give it the most convenient, in your opinion, the position. Remember that the fewer movements, the better for the victim with a gunshot wound. If you need access to various parts of the injured body, then move around it yourself;

5. Inspect the victim and find the outlet from the bullet, if any. Remember that it is necessary to process and apply a bandage on both holes - input and output;

6. If the bullet remains in the wound, then do not try to get it, leave any foreign object inside the wound canal. Attempting to pull the bullet can provoke bleeding;

7. Do not clean the wound from the blood, dead tissues and blood clots, as this can lead to very rapid infection and deterioration of the state of the wounded person;

8. If the fallen organs are visible from the wound on the stomach, do not register them!

9. First of all, it is necessary to estimate the presence of bleeding and determine its variety:

• Arterial - the blood of scarlet color, follows from the wound with a jet under pressure (creates the impression of the fountain), pulsates;
• Venous - the blood of dark red or burgundy color, follows from the wound with a weak jet without pressure, does not pulsate;
• Capillary - Blood of any color leaks from the wound drops.

If nothing can be considered in view of darkness, the type of bleeding is determined by the point. For this, the flowing blood is substituted with finger or palm. If the blood "beats" on the finger and is felt by obvious ripple, then blood bleeding. If the blood flows with a constant jet without pressure and pulsation, and the finger feels only gradual moisture and heat, then bleeding venous. If there is no clear feeling of flowing blood, but, providing assistance in his hands feels only sticky moisture, then bleeding capillary.

Under gunshot injection, the whole body inspects for bleeding, since it can also be in the field of inlet and outlet.

Bleeding stop methods:

• Arterial bleeding Stop by clamping the damaged vessel right in the wound with the subsequent tamponade or the imposition of a harness. The harness can only be applied to the limb - hand or leg;
• Venous bleeding Stop squeezing the vessel with your fingers outside. To do this, capture the skin with the vessel to be tissue and transmitted. In this case, it must be remembered that if the wound is above the heart, the vessel is shifted above the damage points. If the wound is below the heart, the vessel is shifted below the damage point. After stopping the venous bleeding with the squeezing of the vessel, it is necessary to make a wound tamponade or impose a gulling bandage. The gulling bandage can be applied only on the limbs;
  Important! If the tamponade, the harness or the gulling bandage is impossible to impose, then you will have to compress the vessel until the "ambulance" arrival or delivery of the victim to the hospital.
• Capillary bleeding Stop overlaying a simple bandage or pinching of vessels with fingers and holding them in this position for 5 to 10 minutes.

Rules for the execution of the wound tamponade. Find pieces of clean fabric or sterile dressing material (bandages, gauze). For tamponads, there will be long pieces of width no more than 10 cm. One edge of such a tape must be picked up deep into the wound. Then you should capture several centimeters of the fabric and push them into the wound, tightly pressed, so that in the end a peculiar "plug" in the wound channel is formed. Thus, the tissue should be shuffled into the wound until they fill it up to the skin surface (see Figure 1). In the process of wound rubble, it is necessary to keep the damaged vessel with a pinned fingers in the wound until you feel that the fabric turned out to be higher than the level of the broken vessel. After that, the fingers from the wound are pulled out, and the tamponade is produced further.

If you are one on one with the victims, you will have to break it or your clean clothes with one hand, and the second to compress the damaged vessel without giving blood to flow. If there is someone else next, ask him to bring the cleanest things or sterile bandages.

Figure 1 - wound tamponade to stop bleeding

Rules for imposing harness. The harness can be applied only on hand or leg above the place of bleeding. You can use any long and tight object, for example, gum, tie, belt, etc. as a harness. Under the harness necessarily impose a dense fabric or leave the clothes of the victim (see Figure 2). Then the harness itself turns 2 - 3 times around the limb, strongly tightening it, so that the vessel is comprehended, and the blood stopped. The ends of the harness bind, and under it put a note with the exact overlay time. The harness can be left by 1.5 - 2 o'clock in summer and 1 hour in winter. However, doctors are not recommended to try to put the harness to people who have never been done before, at least on the mannequin, since the manipulation is rather complicated, and therefore it is more likely to harm than the benefit.

Figure 2 - Overlay Hump

Rules imposition rules. The wound is put a piece of sterile gauze at 8 - 10 of the additions or pure tissue and primed 1 - 2 turns of any dressing material (bandage, tissue, torn clothing, etc.). From above on the wound, some dense object with a flat surface (for example, a box, a control panel, a case from glasses, a piece of soap, soap, etc.) and tightly adhes it with dressing material. In this case, the subject literally pressed into soft fabricsSo that he passes the damaged vessel and, thus, stopped bleeding (see Figure 3).

Figure 3 - overlaying the gulling bandage.

10. If blood bleeding, it should be immediately stopped, postponing everything else because it is deadly for a person. At the sight of a jet of blood, do not look for materials for the harness, but simply shove your fingers directly into the wound, click on the damaged vessel and hold it. If, after the introduction of the fingers into the wound, the blood did not stop, then they should be moved around the perimeter, looking for such a position that will block the damaged vessel and, thus stop bleeding. At the same time, sticking his fingers, do not be afraid to expand the wound and tear some of the fabrics, since it is non-critical to survive the victim. Finding the position of the fingers in which the blood stops flowing, lock them in it and keep the harness or performing the wound tamponade before applying the wound. The optimal way is the wound tamponade, as the harness in the hands of a person who has never superimposed it, can only bring harm. Tamponada can be made when the wound is localized on any part of the body, and impose harness - only on hand or leg;

11. If the bleeding venous, tightly squeeze the skin with your fingers to be tissue, passing a damaged vessel. Holding a vessel compressed, impose a tamponade or a gulling bandage. The optimal method is Tamponade, since it is easier and can be imposed on the wound of any localization, and the gulling bandage is only on the limb;

12. If bleeding capillaryYou can simply press it with your fingers and wait 3 - 10 minutes until it stops. And you can simply ignore capillary bleeding by imposing a bandage to the wound;

13. If ditinon and novocaine are available (or any other pain relief drug), then enter them in the tissue near the wound on one ampoule;

14. Cut or break clothes around the wound, ensuring access to it;

15. If dropped out of the wound on the stomach internal organsthey must be accurately assembled into a package or a clean cloth, which to glue with a scotch tape or leukoplasty;

16. The skin around the inlet and outlet opening of the bullet wound (or only the input, if the bullet remained in the body) it is necessary to process any existing antiseptic (for example, furaticiline, manganese, chlorhexidine, hydrogen peroxide, vodka, wine, tequila, beer, or any alcohol-containing drink) . If there is no antiseptic, then the skin around the wound should be labeled with water (well, key, mineral water from the bottle, etc.). Processing is carried out as follows - an antiseptic or water is poured into a small area of \u200b\u200bleather, after which it gently wipe this place with a clean cloth, gauze or bandage in the direction from the edge of the wound to the periphery. Then wet the adjacent area of \u200b\u200bthe skin and wash it again with its cloth. For each skin section, tear a new piece of fabric or bandage. If the fabric does not work out, then a new, previously used, clean piece of a large cloth should be used to wip each subsequent skin area. Thus, wipe the entire perimeter around the wound;

17. If there is such an opportunity, then smear the skin around the wound with green or iodine;

18. Antiseptic, water, iodine or green in the wound do not pour! In the wound, you can fall asleep powder streptocide, if there is available;

19. If you can handle and smear the wound with greenflaw or iodine is impossible, then you do not need to do this;

20. After stopping the bleeding and processing of the wound, you must impose a dressing on the inlet and outlet (or only to the input, if the bullet is inside the body). If you do not have the experience of imposing a dressing simultaneously into two wounds that are from different sides of the body, do not try to do it. It is better to tie one wound first, and then the second, making it separately;

21. Before overlaying the dressing, cover the wound with a piece of clean matter, gauze or bandage (8 - 10 additions), on top of which put a piece of cotton wool or tissue twists. If the wound is located on the chest, then instead of the wool impose a piece of any oilcloth (for example, a package). If there is no package, then any piece of fabric should be wrapped with a vaseline, oil, ointment for a fat basis, etc., and put it on the wound of his breast. All this is climbing tight to the body by any dressing material, for example, bandages, pieces of matter or stripes of torn clothing. If you need to take a bandage to the body, it can be simply glued with a tape, adhesive plane or medical glue;

22. In the presence of fallen organs on the abdominal wall, they are pre-folded around the perimeter with rollers from the fabric. Then these rollers are loosely, not squeezing the internal organs, grind to the body with any dressing material (see Figure 4). Such a dressing on the stomach with the fallen internal organs should be constantly watering with water so that it is wet;

Figure 4 - overlay bandages with abdominal cavity

23. After overlaying a dressing on the wound area, it is possible to make a cold (ice in a package or water in the heating floor). If the cold is absent, then nothing on the wound is not needed (for example, snow or slices of icicles in winter);

24. Place the victim on a flat surface (floor, shop, table, etc.). If the wound below the heart, then lift the legs of the victim. If the wound in the chest, then give the victim a half-sided position with the legs bent in the knees;

25. Take the wounded man with blankets or clothing;

26. If the blood has soaked a tamponade or a bandage and frowning out, do not remove it. Over the bandage, impregnated with blood, just impose another one;

27. If it is possible, you should enter intramuscularly any antibiotic wide spectrum Actions (Ciprofloxacin, Amoxicillin, Tienam, Imphene, etc.). If the wound is not in the stomach, you can drink an antibiotic in tablets;

28. In the process of expectation of ambulance or transportation of the victim to the hospital, any other transport must be supported with a verbal contact with him, if a person is conscious.

Algorithm for first aid to the victim when bullery injuries

A bullet wound in the head is very dangerous and in most cases fatal, but approximately 15% of victims still survive. Therefore, the first help is needed to render.
1. Call "ambulance";
2. Check the victim to understand whether it is conscious. If a person in fainting, do not try to bring him into consciousness;
3. If a person is unconscious, tighten his head back and at the same time turn a little side. This is necessary to ensure good respiratory tract, as well as for the unimpeded removal of the vomit;
4. Try not to move the victim, since each extra movement for it can be dangerous; Treat the first help to a person in the pose in which it is. If in the process of assistance you need to get to some parts of the body, move around the victim yourself, trying not to move it yourself;
5. If the bullet remains in the skull, do not touch it and try to get it!
6. If the parts of the brain fell out of the wound, then you do not attempt to go back!
7. On a wound hole in the skull with a fallen brain or without such, it should be simply imposed a sterile napkin and not tight to climb it to the head. All other necessary bandages impose without affecting this area;
8. Carefully inspect the head of the affected person for bleeding. If bleeding is detected, you need to stop it. For this, the damaged vessel with the fingers is pressed against the bones of the skull and retain within a few minutes, after which they impose a crushing or simple bandage. A simple bandage is a dense wrapping of a section with bleeding with any girlfriend dressing material (for example, bandage, gauze, cloth, torn clothing). The gulling bandage on the head is imposed in the same way as to the limb. That is, first the wound is covered with cloth or gauze, rolled in 8 to 10 layers and primed it with 1 - 2 turnover of dressing material. On top of the dressing on the place of bleeding, any tight object with a flat surface (the console, a piece of soap, soap, a case from glasses, etc.) and adhes it, carefully adding soft tissues;

• What doctors should contact if you have firearms upper limb

What is firearms of the upper limb

Exceptional diversity gunshot wounds of the upper extremities Determined, on the one hand, the characteristics of a wounding projectile, on the other, the features of the bone structure. The complexity of the diagnosis of the true nature of damage, the severity of sorry for fractures of soft tissues, the total heavy response of the body on any firearm is characteristic of gunshot wounds. There are a large number of firearms classifications.

Healing of the wounds and consolidation of firearms of the upper limbs occur more favorable than the lower. Common purulent, anaerobic infection, osteomyelitis are less common. The conditions for this are broad cuts, carefulness in the implementation of the procedure of excision of non-viable tissues, if necessary, timely secondary necritectomy, which should not be postponed in the presence of indications. In the event of open wound and granulating surfaces, early secondary or late secondary seam can not always be applied, so in such situations it is necessary to keep in mind the use of free skin plastics, and if necessary, use the skin stem in Filatov.

Pathogenesis (what happens?) During gunshot wounds of the upper extremities

• Fractures shoulder

Fracture Fracture shoulder bone come about 4/3 of all wound wounds. In addition to the deformation or vicious position of the limb, pathological mobility at the site of the fracture, disorders of the limb function, soreness in the fracture zone, the results "measurement of the length of the limb should be taken into account and such a sign as the presence of fat droplets in the wound separated.

For firearms The shoulder area, especially in the upper third of the shoulder, are not so rare combined injuries, when the same wounded shell: a bullet, a fragment - first causes a fracture of the shoulder bone, and then penetrates the pleural cavity, determining the wound of light, blood vessels, other anatomical formations . In some cases, together with the fracture of the shoulder bone, the blade is possible, and bone fragments are seriously wounded the muscles over and the subband area. Since the direction of injury of soft tissues does not always correspond to the true direction of the wound channel, careful physical and x-ray examination of the patient is especially important, including chest radiography in two projections, and if necessary, in a greater number of projections.

The question of the need for thoracotomy with such wounds should be solved on the basis of firmly established principles of military-pillar surgery: thoracotomy is shown only with continuing intracerenely unearth bleeding, large hemostatic and at a valve pneumothorax, unreasonable conservative activities.

• Early forearm

The hospital comes 2/3 wounded in the forearm without signs of suppuration. Under the condition of carefully performed surgical treatment and stable fixation of bone fragments, the results of the treatment of this category of wounded can be considered quite satisfactory. The method of choice for immobilization of fragments should be considered the devices of percussion osteosynthesis. With firearms, the forearm often have to resort to free skin plastic to close the skin defects.

Feature of firearms of forearm It is frequent damage to nerves, requiring subsequent neurolization and a seam of nerve.

• Wounds of the brush

A variety of gunshot damage brushes is very large. Not uncommon - injured by fragments in the main localization of injury in another area. Extensive damage to bone, muscle and tendon structures occurs when the left brush is injected into the focus.

Treatment of firearms of the upper extremities

• Fractures shoulder

Most often, in the surgical treatment of firearm, the shoulder dissection, the removal of bone fragments and foreign bodies, then excision of soft tissues. Thus, when the shoulder injected, relatively simple surgical manipulations are made, which is explained by the relatively small volume of muscles, the absence of dense fascial becks, less pollution of the wound, a relatively high percentage of through injuries.

With severe finelyosculated overpressure of the upper third of the shoulder, it may be necessary to complete the removal of the proximal end of the shoulder bone. In this case, the full healing of wounds is achieved and subsequently resort to the endoprosthetics of the proximal end of the shoulder bone. Since with such fractures, it is not always possible to fix fragments using an external fixation apparatus, you have to resort to the removal tire, a storm bandage. Submersible metalosynthesis for firearm bones of forearm bones, and not only of them can only be applied in exceptionally favorable situations: with the general good condition of the wounded, thoroughly performed surgical treatment, sufficient quantity of well-blooded muscles, with the possibility of closing the wound without tension, good drainage, Observing the patients with the surgeon operated.

Firearm shoulder diaphysis, as a rule, through. Surgical processing of such fractures are carried out by general rules, carefully protecting ray nerve from additional traumatization. With a gunshot fracture of the shoulder, the optimal methods of fixation are the device of orvarova, as well as a plaster thoracic bandage.

With cross-cutting shoulder fracturesand extensive outlet holes can be limited to surgical treatment of only outlet. In this case, sufficient access is provided, conditions for excision of non-viable tissues, comparison of bone fragments and subsequent drainage.

A significant number of firearms of the shoulder bone can be reputed after surgical treatment on a removal tire fixed to the body with gypsum rings. The same rings fix the shoulder with the forearm on the tire.

If, when the shoulder firearms, the forearm for what causes the reasons is not applied to the external fixation unit, you can use a thoracicarized bandage in the hand position in the assignment. The bandage is relatively easily transferred to patients, simplifies the subsequent maintenance of them and when fixing his hands for 2-3 weeks, does not cause tug-excitiousness in the shoulder joint. Such an armband is convenient to impose at the end of the operation under anesthesia. In the interval from the 5th to the 8th day, the "window" in the wound projection, if necessary, discharge the "window" in the wound projection, and carry out the necessary therapeutic measures, such as overlapping the delayed seams or free skin plastic.

It is advisable to divide the shortening of the segments of the upper limb to functionally compensated (up to 4 cm), conventionally compensated by (4-6 cm) and noncompensated (more than 6 cm).

• Early forearm

The technique of introducing spokes on the bones of the forearm, as well as a special conductor, which allows the needles at the desired angle.

Applying conservative and operational treatment methods, it is possible to restore the anatomical intake of bones from almost 90% of the wounded. Approximately 10% of the wounded remained persistent defects, false joints; Characterized by a high percentage (more than 20) contractures.

• Wounds of the brush

The underlying condition of the successful operation with a gunshot fracture of the brush is to produce it in a specialized hospital using a special toolkit, operational microscope, etc.

It should be considered proven that the intervention on the brush should be final in other words: the operation must be carried out by a specialist who owns the methods of interventions on the brush. Consequently, such victims should be left in a specialized institution, and operate on other stages only to stop bleeding, preventive introduction of antibiotics, imposing bandages and transport immobilization.

Of particular importance is injured brush in terms of the importance of the organ and characteristics of the anatomical structure. In most cases, the dismemberment of the treatment of injuries for two stages should be considered quite substantiated in most cases - primary surgical treatment and final reconstructive interventions in specialized medical institutions. American surgeons in Vietnam with quite good equipment and prepared frames were used when the brush was injected by a two-stage technique.

When determining the term and type operational intervention It should be proceeded primarily from the nature of damage and its gravity, the time that has passed since the injury or injury, evacuating capabilities. It is also necessary to take into account the age of the patient, its general condition, profession.

Gunshot injuries of the brush are usually accompanied by bone fractures, and when the fingers are injured, the tendons and very often joints with the formation of outside or intra-articular fractures suffer.

In itself, the injury of the brush rarely cause the shock state of the wounded, in such cases should always look for another or more damage. The delay in conducting surgical treatment of the brush is quite justified with a good primary medical bandage and reliable immobilization, although purulent infection is a frequent satellite wounds of the brush, especially when damaged the wrist bones.

First aid when the brush is injectedit consists in overlapping a sterile dressing, sometimes the gulling bandage. With common damage, the brush shows the immobilization of a shelter or with the help of tablet. The wounded brush needs to be recorded in a functionally advantageous position, for which the wool is wounded into the palm, and the fingers are placed on it, the whole brush is born to the ladder or mesh tire meshed over the palm surface.

Provision surgical carethe wounded in the brush should be limited at the stage of qualified surgical assistance only to the stopping of bleeding and immobilization, since without an X-ray, it is impossible to begin the complex surgical processing of the wound of the brush.

In case of surgical treatment of extensive wounds, brushes are preferable to general anesthesia, conductive or intraosia anesthesia can be used.

Operations on the brush surgeon should produce using an assistant. The necessary conditions are a well-lit operating field, a sufficient amount of time and a good surgical instrument and suture material.

Careful preparation of the operating field is very important: nails need to crash, hair shave, thoroughly wash the whole brush with warm water with soap.

With interventions on the brush, a good hemostasis is very important, which is controlled by periodic removal of the harness; The harness should be on hand no more than 1 hour continuously.

In case of injury to the elbow or radial arteries, one of them can be tied up, but in no case is not both, as it will cause necrosis.

The skin on the brush is excised only if it is undoubtedly unbelievable; In other cases, even severely contaminated skin should be saved.

During surgical treatment, it is necessary to carefully explore deep formation of the brush, determine the degree of damage to all structures. With severe injuries, the brush is advisable cross-section of the transverse casal bundle.

Necrotized muscles, blood clots, foreign bodies Remove. Not very dirty bone fragments are advisable to save. Obviously, non-viable tendons should be removed, but you need to fight literally for each millimeter of viable tissues.

Amputes of the fingers are shown in the case of their explicit necrosis. This is especially true of finger. Sometimes it should be saved at least part of the skin with an amputed finger to close the skin defect on the remaining.

With the amputation of the fingers cut the flap, thoroughly ligatory blood vessels And repellent phalanx with a thin sawdow. The tendons after the intersection should be sewn to the periosteum.

The ends of the destroyed nerves usually go far to the sides. They should not be sought for primary surgical treatment, however, if possible, the ends of the nerves should be closer to relatively healthy tissues and fix the nerves with non-disseminating suture.

In most cases, close the wound is better than the delayed primary seam. The use of thin spokes of Kirchner for fixing fractures and dislocate the phalange of the fingers is shown. With intra-articular fractures of interphalangeal or multiplated joints in cases where the articular ends of the bones are completely fragmented, it should be resorted to a very economical removal of these sites. You must not forget about the mandatory immobilization of the brush after any intervention on it.

The bandage must close the whole wound, but not to press it. Healthy fingers should be visible. Locking the brush is carried out in a functionally advantageous position.

Surgical treatment of gunshot wounds of the brush is not shown in through wounds of brushes and fingers with point inlet and outlet holes, with tangent wounds of fingers and brushes, provided that the wound has smooth edges, as well as surface fine wounds.

AT postoperative period The healing physical culture is especially shown in the injuries of brush and fingers.

Read: I. To make the victim as soon as possible, observing all precautions. I. Symptoms caused by intrauterine tumor distribution II. Primary inspection of the victim and first aid for states, II. Symptoms caused by the turnout of the tumor R2: The wall of the right atrium near the cuspis septalis of the three-rolled valve V2: Muscles and fascias of the area of \u200b\u200bthe shoulder joint. The muscles and fascia shoulder. Topography of the axillary depression and shoulder. Muscles, fascia and forearm topography.

Task number 1.

During the service of the service, the guard of the private enterprise was attacked and received a gunshot wound On the right shoulder.

Objectively: On the front surface of the middle of the right shoulder there is a moderately bleeding wound, incorrectly rounded shape, on the rear surface - a similar wound a few large sizes with uneven edges. From the anamnesis it turned out that the victim was shot at a distance of about 30 m from the pistol. In the healthy support of the neighboring enterprise, Feldscher duty, to whom the victim turned.

Tasks

1. Word an estimated diagnosis and justify it.

2. Make an emergency prefigure algorithm.

3. Demonstrate the applying technique of the applying bandage on the shoulder using the individual dressing packet in relation to the situation.

Reference standard

In the victim through a gunshot (bullet) wound the right shoulder.

The conclusion is based on an anamnesis data (the victim has been attacked) and an objective study of the right shoulder (the presence of an end-to-end wound with inlet and outlet holes characteristic of firearms; bleeding from the wound).

- This is a wound resulting from the operation of shells (bullets, shrapnel, boch, fragments, fractions), released from firearms. The distinctive features of gunshot wounds are the heavy response of the body, massive damage to the tissues, a significant duration of healing, a large amount infectious complications and fatal outcomes. Pathology is diagnosed on the basis of anamnesis, data inspection and x-ray examination. Treatment includes anti-deposit measures, replenishment of blood loss, PHO with ears or removal of damaged organs, dressing and antibiotic therapy.

MKB-10.

W34 x95

General

Firear wound - a set of damage resulting from the operation of a projectile released from firearms. In character and flow differs from other types of wounds. It is accompanied by the formation of a large array of non-viable tissues and a severe overall response of the body. There is a tendency to long-term healing and frequent complications.

Under gunshot wounds, all kinds of damage to organs and tissues can be observed: violation of the integrity of the nerves, muscles and vessels, fractures of the bones of the body and limbs, damage to the chest, as well as damage to any hollow and / or parenchymal organs (larynx, liver, etc.). Wounds with damage to the internal organs are of great danger to life and often end with a fatal outcome. The treatment of gunshot wounds, depending on the defeat of certain organs and tissues, trauma-orthopedists, thoracic surgeons, vascular surgeons, abdominal surgeons, neurosurgeons and other specialists can be engaged.

The reasons

Firear wound is the main type of injuries when conducting hostilities. In peacetime, it is consistent with respect to rarely and may become the result of criminal incidents or accidents on the hunt.

Pathogenesis

For firearms, RAS are characterized by certain features that distinguish them from other types of injuries. A zone of dead tissues (primary necrosis) is formed around the wound channel. The wound canal has an uneven direction and length. With end-to-end injuries, the outlet of the significant diameter occurs. In the wound, foreign particles are detected, drawn there due to the high speed of the projectile. After some time, new sections of dead tissues are formed around a firearm (foci of secondary necrosis).

The destructive action of the projectile is due to two components: a direct impact, that is, direct effect on the tissue and side blow, that is, the action of a shock wave that instantly forms the zone high pressurethrowing cloth to the side. Subsequently, the formed cavity sharply "shallows", a wave with negative pressure occurs, and the tissues are destroyed due to the huge difference of negative and positive pressure.

Taking into account the peculiarities of the traumatic effect in any firearm, three zones are distinguished: a wound channel or a wound defect (direct exposure zone), the contusion area (in this zone, primary necrosis is formed) and the resolution area is formed in this zone). The wound defect can be true or false. The true defect is formed when the tissue section is pulled out ("minus" fabric), false - with a reduction in disconnected tissues (for example, when reducing damaged muscles).

Classification

Treatment of firearms

First of all, it is necessary to stop the bleeding. With minor or moderate bleeding, the wound is closed with a gulling bandage, with abundant impose harness above the location of damage. The victim gives painkillers, if possible, they perform intramuscular injection of analgesics. The patient is placed in a horizontal position (exception - injured in chest, in which to facilitate the respiration, the patient should be given a sedentary or semi-dyed position), immobilization using special tires or submitted means.

If shipping in honey. The establishment is difficult or postponed, in the paragraph of primary medical care, copyright measures are carried out and carried out the prevention of the wound infection, introducing antibiotics intramuscularly, washing the wound channel antibiotics solutions, as well as performing the wound area.

The volume and order of therapeutic activities in a specialized institution are determined taking into account the state of the patient. CONSTRUCTION CONSTRUCTION OF THE CCC is carried out, copyright measures are carried out, surgical processing of the Russian Academy of Sciences. In the course of surgical intervention, the polluted and non-visual tissues are excreted, the wound is washed and drained. Damaged vessels are tied up, damaged organs are partially excised and sheds or completely removed, small bone fragments are removed, large fragments are compared. Usually on initial stage With complex and unstable fractures impose skeletal extracts.

In the wound channel of a small diameter of the seams on a gunshot wound, it is not imposed, with a large defect, the edges of the wound are compared, using rare single seams. Contraindication to the conduct of surgical intervention is the agonal state and traumatic shock. Surgical treatment is not subject to shallow tangents, multiple fragmentation and small superficial "swinkers" firearms.

In the postoperative period, antibiotics are prescribed, hypovolemia correction continues, dressing. Subsequently, the imposition of deferred primary seams (after 5-6 days), early secondary seams (after 10-12 days) and late secondary seams (after 3 weeks). Since firearms, as a rule, are heal through the suppuration, in a remote period, with such damage, reconstructive interventions are often required: skin plastic, plastic of tendons, restoration of nerves, intra and outside osteosynthesis, etc.

In the modern troubled world you need to be prepared for any situation. And sometimes you just need to know a few simple rules that can save the life of a person. In this article, you should talk about what wound a firearm and what kind of help you can have a wounded person before the "ambulance" arrival.

About terminology

At the very beginning, you need to deal with the concepts that will be actively used in the article. So, the wound is damage to organs and tissues, which is accompanied by a disruption of the integrity of the skin. The wounds are accompanied by pain, bleeding, the discrepancy between the edges of damaged sites and, of course, is often a violation of the normal functioning of the damaged part of the body. Rana Firelock is damage gained with firearms.

About the types of Ran.

It is also worth saying that the firearm wound can be different. The first classification - depending on the presence of an input and outlet:

1. Sleeping wound. In this case, the subject of injury is stuck in the human body.
2. Through wound. In this case, the subject wounded through the fabrics through.

Second classification, depending on the subject:

1. Watching soft tissues - leather, muscles, nerve endings, tendons, vessels.
2. Bone damage.

Next classification - depending on the penetration of a wounded item:

1. Pouring body wound into the cavity. In this case, the bullet penetrates into the abdominal, cranial, articular and others.
2. Wound impenetrable body wound.

And the last classification - by the mechanism of application of wound. In this case, it is distinguished by a cut, crushed, chopped, bite, scalp, swollen, bruised, torn and, of course, firearms.

Prefigure help

Very important is the right assistance provided for firearms. After all, sometimes it happens that before the arrival of the emergency room, a person can die, just without waiting for the most simple actions from strangers. And everything happens because people most often simply do not know how to do it right and what to do to protect a person from death. How can I help the victim if he has wounded firearms?

1. At the very beginning, the wound need to be released from clothes. It is necessary in order to evaluate it and understand how serious is bleeding.
2. Next, it is necessary to stop the bleeding, even if it is at first glance and insignificant. If blood leaves a little, you can simply raise the place of injury so that it can not be found (if the limbs are injured). Otherwise, the place of bleeding should be pinned with a finger (having transferred the blood artery). Next, you need to try to impose harness a little higher than the wound. If there is nothing suitable at hand, you need to tear off the clothes strip of fabric and strongly take place above injury.
3. Wound processing. Only if the bleeding stopped, the wound need to be rinsed, to disinfect. To do this, use alcohol or hydrogen peroxide. Next, the place around can be treated with iodine to avoid infection. And only after that the wound can be tied with a sterile bandage. All these medicines must be in any car aid kit. So if a gunshot wound happened, you need to try to stop any car and ask the first-aid kit at the driver.
4. If the bullet fell into the bone (it is very difficult to determine this "on the eye"), the place of injury needs to be carefully fixed. So, you will need to impose a bus. For this, any blowing materials can be useful.
5. It is important to remember that a person with a gunshot wound can not always move, independently transport. Sometimes a bullet damages internal organs so that the slightest unskilled movement can greatly harm the person. So before the arrival of the "ambulance" wounded is best not to touch. The only thing you need to try to protect against hypothermia, overheating or rain.

Wounding limbs

Separately, it is also necessary to tell about what hazards carry firearms of the limbs. So, this is the most common wounds. In addition, they are very dangerous, because fraught with the strongest loss of blood. Therefore, in the case of a firearm of the limb at a person, at the very beginning it is necessary to find the wound itself and do everything so that the blood stops. By the way, in its color you can determine, venous it is or arterial. Venous blood is dark color. The arterial is most often Ala, also it comes out of the body of the wounded fountain. If the bleeding is venous, it is better to impose not harness, but a gulling bandage. In any case, it is worth remembering that all these auxiliary items can be imposed by no more than two hours on the body (most often during this period of time the wounded is already transmitted to the hands of the "ambulance". It is also necessary to determine whether the human integrity is not disturbed. If the bone is broken, it must be fixed in the realmost position. It is also worth remembering that if a person has wound a firearm, he can happen in this case, if not, if there is no such hand, do not panic. Through the time consciousness to the wounded will return. Beat on the cheeks, leading a person in feeling, no need.

Head wound

The most, probably dangerous, is a gunshot wound head. After all, the percentage of survival in such cases is not too high - about 16%. But with such an injury, the victim also needs. It is worth saying that when a person's injury, a person will have a lot of blood, since it is here that multiple vessels are located. The loss of consciousness by man does not mean his death, it is worth remembering. The order of steps when heading a head:

1. Wound need to be covered with a sterile napkin. If it is bleeding badly, you can try to stop the bleeding with a cotton swab.
2. It is best that the human body is located horizontally.
3. It is not worth transporting the wounded independently, it is better to wait for the "ambulance" arrival.
4. If a person has stopped the heart, you need to do artificial respiration And heart massage.

Neck and spine

It is easy to figure out how firearms look like, in this case - the first prompts. So, in case of injury to the neck or spine, you need to remember that a person categorically cannot be transported. The only one, you need to put it on a solid surface. If the bleed neck, you need to try to stop blood very quickly. After all, if it breaks away from the loss of blood, you can die after 15 seconds. So, on the neck you need to impose a bandage. If it does not help, the artery should be pinned with a finger and be in this position before the "ambulance" arrival.

Wound in chest, belly

Separately, it is also necessary to consider a gunshot wound in the stomach and chest. So, at the very beginning it is necessary to say that the human body is divided into three main zones: pleural, abdominal and small pelvis organs. If the person's wound is internal, the blood begins to accumulate in these areas. Stop bleeding in this case is independently impossible. Complications of injuries of internal organs:

1. Pneumothorax. It is air from the pleural cavity through a firewall.
2. Hemotorax. It is a blood getting into the pleural cavity.
3. Pneumohemotorax. It is hit by the pleural cavity of air and blood together.

You can try to prevent only air from entering. So, for this, the wound need to be covered with a dense material or to hold the hand.

Removing bullets

As already mentioned above, firearms are very dangerous for human life (the photos of the wounded is the first confirmation of this). However, in some cases, if absolutely no opportunity to get a qualified medical care, You can try to independently remove the bullet. But it is necessary to do it very carefully and only if the arrival of physicians is impossible for certain reasons. Algorithm of actions:

1. First, one who will carry out all actions are preparing. Hands need to be treated with antiseptic.
2. An antiseptic is treated with leather around the wound.
3. If possible, you need to give an anesthetic to the wounded. It may be a drug "Spasmalgon" or ampoule means "Novocain". If this is not, in the teeth, a person needs to give a solid subject.
4. With the help of a knife you need to slightly increase the size of the bullet hole. Next, everything is processed again by an antiseptic.
5. With the help of the treated tweezers, you need to try to get a bullet. Need to try not to hurt big blood arteriesSince a person can die because of that e. blood loss.
6. Wound after the operation must be processed again, impose a bandage.

Expertise

If a person's wound occurred, it is necessary to call not only "ambulance" (although it is first of all), but also police officers. Thus, the forensic medical examination of firearms will also be obligatory. She is designed to respond to the following questions:

1. Character of injury.
2. Direction of the wound canal, shot.
3. Distance that was between the criminal and the victims.
4. Type of weapon used.
5. The number of bullet wounds.
6. The determine the flushing wound sequence (if it was not one).
7. Whose hand was caused damage: own or other person.

It is worth saying that the forensic medical examination of firearms gives a consequence of multiple most important answers to questions, thanks to which it can move a few steps forward.

The arrival of physicians

It is very important for firearms. So, only experts can assist the person who can save him life. However, it is not possible to diminish importance because it can also save the life of the victim.