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Home , Wound healing

Ministry of Health of Ukraine Ukrainian Medical stomatological Academy

It is ratified On meeting department Of accident aid and military medicine «___»______20 __y. Protocol №_____ Manager of department

DMSc ., assistant professor ______К. Shepitko

METHODICAL INSTRUCTION FOR INDEPENDENT WORK OF STUDENTS DURING PREPARATIONS FOR THE PRACTICAL LESSON Educational discipline «Emergency First Aid» Module № 1 Emergency and Combat First Aid Topic 4 Types of Combat and Non-combat . First Aid in , Fractures, Lyxations and Strains Types of damage in combat and non- Lesson 6 combatconditions.premedical care for wounds ,fractures,dislocations,sprains.Premedical care for wounds. Сourse ІІ Foreing students training dentistry Faculty

Training of specialists of the second (master) level of higher of education (название уровня высшего образования) Areas of knowledge ______22 «Health protection»______(шифр и название области знаний) Specialty ______222 «Medicine», 221 «Stomatology»______(код и наименование специальности)

Poltava 2019

Relevance of the topic: The skin protects a person from negative external influences (friction, germs, stretching, pressure) and dehydration. It is rich in nerve endings and nerve fibers, which provide its sensitivity. Therefore, the skin should be carefully protected from injuries. Specific objectives: Know the causes and signs of soft wounds, penetrating and non-penetrating wounds of the skull, chest, abdomen. Protect soft tissue wounds by applying dressings. The technique of applying bandages for injuries to the skull, eyes, ears, lower jaw. Features of a chest , the concept of . Domestic care for open and intense pneumothorax. The specificity of dressings for penetrating wounds of the abdomen. Features of dressings in the presence of a foreign body in the wound. Basic knowledge, skills needed to study the topic (interdisciplinary integration): Name of previous disciplines Acquired skills 1. human anatomy Anatomy of the head and neck, anatomy of the chest, abdomen, pelvis and limbs. Anatomy of the vascular system. 2. Normal physiology Physiological basis of the functioning of the respiratory system.

Tasks for independent work in preparation for the lesson and in the lesson: 1. Protection of wounds. 2. The technique of applying bandages for injuries to the skull, eyes, ears, lower jaw. 3. Wounds of the chest. 4.Features of applying bandages for penetrating wounds of the abdomen. 5. Bandages in the presence of a foreign body in the wound.

The list of basic terms, parameters, characteristics that a student must learn in preparation for the lesson:

Term Definition 1.Wound violations of the integrity of the skin or mucous membranes with possible damage to the surrounding tissue.

2. Closed pneumothorax the accumulation of air in the pleural cavity, accompanied by atelectasis and termination of ventilation.

3. Open pneumothorax the accumulation of air in the pleural cavity in the presence of a gaping wound and a constant suction of air in the respiratory excursions of the thorax.

4. Valve pneumothorax the growing accumulation of air in pleural cavity, accompanied by progressive compression of the lung with a damaged 2

hand, and compression of the opposite lung, displacement of mediastinum to the healthy side

5. A puncture wound arises from the action of the knife, bayonet, blade sharpening, sewing, spades. These wounds have a small outer size and a large depth. Sometimes these wounds are through and through.

6. occurs as a result of the bullets of firearms. Such a wound is a wound channel filled wound detritus, and foreign bodies. Has a zone of traumatic of the tissues, as well as the zone of molecular concussion. 7. The phase of characterized by exudation, the development of an inflammatory , necrolysis, hydration. 8. Proliferation phase is characterized by a predominance of restorative, regenerative processes, the formation of dehydration. 9. phase it is the maturation of tissue and epithelialization of the wound.

Theoretical questions for the lesson: Theoretical questions for the lesson: 1. Causes and signs of soft tissue wounds, penetrating and non-penetrating wounds of the skull, chest, abdomen. 2. Features of combat injuries. 3.Protection of wounds. 3. The technique of applying bandages for injuries to the skull, eyes, ears, lower jaw. 4. to the chest. 5. Features of applying bandages for penetrating wounds of the abdomen. 6. Bandages in the presence of a foreign body in the wound. Practical work (tasks) that are performed in class: 1. Diagnosis of soft tissue wounds. 2. Diagnosis of penetrating wounds. 3. The technique of applying dressings to various parts of the body. 4. Technique of a puncture of the chest with intense pneumothorax. 5. The technique of applying various types of occlusive dressings. 6. The technique of applying bandages with an extraneous body in the wound. The content of the topic: The concept of wounds: definition, classification. 3

A wound is a lesion characterized by a violation of the integrity of the skin, mucous membranes, and sometimes deep tissues, which is accompanied by pain and . By their origin, wounds are gunshot, chopped, chopped, chopped, clogged, torn, bitten, operating. Surface and penetrating wounds are also distinguished (when the inner membranes of the abdominal, chest, and other cavities are damaged). A wound is a violation of the integrity of the skin or mucous membrane with possible damage to surrounding tissues. Wound Classification: 1. By the nature of the action of the subject, which injured, wounds are: - a arises from the action of a knife, bayonet, sharpening, awl, peaks. These wounds have small external dimensions with great depth. Sometimes such wounds are through. Due to the large depth of damage, and damage to internal organs can occur inside, which makes these wounds difficult to diagnose and especially dangerous from this. Also the risk of ; - a cut wound has equal intact edges and sometimes a considerable length. They bleed a lot. They arise as a result of the action of a knife, a scalpel; - the chopped wound is very similar to the cut, but the damage is much more extensive. Sometimes there is a collapse of soft tissues, crushing and bone fractures. Arise as a result of the action of the ax, saber; - a bruised wound occurs due to the impact of a blunt object (pipe, hammer, ax butt, etc.), when falling from a height. Due to damage to the vessels around the wound and their blockage, the nutrition of the edges of the wound with is disturbed and, as a result, their death. Do not underestimate the danger - such wounds are easily infected, which can cause a large infection; - crushed occurs as a result of limbs between moving parts; - laceration is characterized by torn pieces of tissue, uneven edges, damage to muscles, tendons, peeling of skin; - a scalped wound occurs as a result of a blow with a sharp object, moves tangentially to the surface of the skin. The peculiarity of this wound is that significant skin defects are formed, which leads to prolonged healing; - bitten occurs when a bite of animals, humans. The wound is deep, lacerated, with the presence of saliva, usually massive infection is characteristic; - a gunshot wound occurs due to the action of a bullet of a firearm. Such a wound has a wound channel filled with wound detritus, foreign bodies. It has a zone of traumatic tissue necrosis, as well as a zone of molecular concussion. Such wounds are very infected. There are stupid (when the bullet remained in the body) and penetrating (on the fly) wounds. Through wounds are characterized by the presence of an outlet, which is always larger than the inlet. Depending on the type of bullet and the firing distance, the wound channel may not be straight and cause great damage. Sometimes the outlet may be located on the side of the inlet (wounds to the head, chest, or abdomen with bulletproof vest). The inlet is characterized by the presence of so-called circle dots around the wound, black. The caliber of the weapon is determined from this trace (the size of the wound itself is usually smaller). A bullet can attract particles of clothing and equipment to the wound, which in turn can lead to infection; - poisoned wound occurs under the influence of toxic substances: organophosphorus substances, acids, alkalis.

2. According to the degree of pollution: 4

- aseptic (surgical wound); - contaminated with microbes (a wound formed in non-sterile conditions or applied in everyday life, at work, etc.)

3. The depth of damage: - surface - permeable - through - tangent - blind

4. By the nature of healing: - healing by primary intention itself is observed with incised wounds, when the walls and edges of the wound are connected to each other, when surgical wounds are sutured. In this case, the wound walls stick together, stick together among themselves due to the film. The primary tension during wound healing is characterized by irrigation of the edges of the wound without macroscopically visible intermediate tissue. Such healing is possible with a complete and close connection of the edges of the wound, but without tension of the tissues, in the absence of infection in the wound, in the absence of a hematoma, while maintaining the vitality of the edges of the wound, in the absence of foreign bodies, infected bodies and foci of necrosis; - healing under a scab - when a wound defect is covered with a crust (scab), which consists of blood, lymph, interstitial fluid. The scab performs a protective, barrier function, under it there is a reparative process due to the formation of granulation tissue and regenerating . After ettalization, the scab disappears. These types of healing do not have a qualitative difference between themselves, the wound healing process goes through all phases of development, the same cultures participate in regenerative processes. Wound healing ends with the formation of connective (scar) tissue; - healing by secondary intention is observed when the edges and walls of the wound are pressed against each other, when there is a cavity in the wound, a tissue defect, a lot of dead tissue, an infection develops. The healing of such wounds goes through the same phases of the wound process, and with primary tension. Nevertheless, necrosis, purulent process, wound cleansing, defect granulation, the formation of collagenic, elastic fibers with the formation of (scar) are observed. Secondary intention healing of wounds occurs through suppuration, granulation, wound contraction, scar formation and epithelization.

A wound process is an organism’s reaction to an injury characterized by successive leaking stages (phases) with pathological, biochemical and clinical features. The following phases (stages) of the wound healing process are distinguished: 1. The phase of inflammation, characterized by exudation, the development of inflammatory edema, necrolysis, hydration. 2. The proliferation phase, characterized by the predominance of regenerative, regenerative processes, the formation of granulation tissue, dehydration. 3. The healing phase is the maturation of scar tissue and epithelization of the wound.

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The main symptoms are: pain, bleeding, gaping wounds, functional traumatic disorders. Pain is inevitable in all accidental wounds, its intensity and duration depend on the topography of the wound, on the state of the central nervous system, on the subject of the wound, on the presence of foreign bodies, etc. The most painful wounds in the field of nerve trunks and plexuses, abdominal cavity, periosteum. Bleeding - observed from each wound, but the intensity and duration of it depends on the caliber of the damaged vessels, on the type of wounds, bleeding from lacerated, clogged, crushed wounds is less intense than with cut, chopped, when small leather and muscle vessels bleed, and even more so large. With lacerations, the ends of the vessels are crumpled, twisted, the walls collapsed and stick together. These circumstances contribute to stopping the bleeding. The gaping of a wound is the disclosure of its edges, associated with the elastic properties of wounded tissues, the direction of the wound, its depth, localization, size of the damage, and tissue defect. Functional disorders - occur with various wounds, they can be divided into trophic and vascular, which are closely intertwined. There are early complications (immediately after the lesion): bleeding, acute blood loss, anemia, shock, and late complications (after a few days). These include early and late secondary bleeding, suppuration of wounds, sepsis, etc. An infected wound must be distinguished from primary microbial contamination. The latter can also occur in wounds that are considered aseptic, sterile. Infected wounds are those when a purulent process and clinical signs of local and general infection develop. Infected wounds heal by the type of secondary tension, through a purulent granulation process. Examination of the wound should be thorough and comprehensive. Anamnesis information allows you to get information about a wounded item. When examining a wound determine: 1) the size, type of wound, the degree of tissue damage, its contamination; 2) detect the presence of deformities, the degree of active and passive movements in the joints; 3) the presence and nature of the pulse on the peripheral arteries of the limbs.

When a wound is localized in the chest, abdomen, auscultation, percussion, palpation and other additional studies (radiography, laparoscopy, etc.) are performed. The main goal of treating any wounds is to restore the shape and function of tissue damaged by injury, by combining the anatomical structures of tissue suturing. In order to achieve this main goal in providing assistance at different stages of treatment, the following activities are carried out. When providing first aid at the prehospital stage, a wounded person is carried out: - stop bleeding; - prevention of infection; - fight against shock; - immediate evacuation.

An aseptic or hemostatic tourniquet is applied depending on the nature of the bleeding.

Penetrating wounds.

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To understand the principles and mechanisms of proper first aid, you need to know what penetrating wounds are. In the human body are cavities that are tight and isolated from the external environment and other tissues of the body: - abdominal; - chest; - articular; - cranial. Vital organs are located inside the cavities, which require normal physical conditions and isolation from the environment for normal operation. That is why these organs are located in isolated and closed cavities, inside of which the necessary environment and conditions for their functioning are maintained. Definition and classification of penetrating wounds. Any wound during which there is a violation of the tightness of any of the four body cavities due to the ingress of a foreign body into it is called penetrating. Given that there are four cavities in the body, penetrating wounds depending on the location can be: 1. Penetrating 2. Penetrating wound to the chest cavity 3. Penetrating wound to the abdomen 4. Penetrating wound of the joint.

Penetrating wounds are always deep and can be inflicted by any relatively sharp and long object, for example, a knife, an ax, an arrow, a harpoon, a screwdriver, a nail, a chisel, and so on. In addition, a penetrating wound is formed when a bullet, shell fragments, mines, stone or any other heavy object gets into any cavity in the body. The algorithms and rules for first aid for penetrating wounds are determined by what kind of body cavity (abdominal, chest, cranial or articular) was damaged, and does not depend on what it was applied. Therefore, we consider the rules of first aid for injuries of all four body cavities separately. First aid in a critical situation begins with the fact that a penetrating wound must be recognized. To do this, you need to know exactly what kind and localization a penetrating wound can have. Penetrating should be considered any wound on the abdomen, chest, head or in the joint area with a depth of more than 4 cm. This means that if you stretch the sides of the edge of the wound, you can not clearly see its bottom, then it should be considered penetrating. You should not stick your finger inside the wound, trying to identify its bottom, since in the absence of experience in this way you can only deepen and expand the wound channel. Penetrating wounds externally can look like a very small hole, and therefore look harmless and safe. So such a wound located on the stomach, chest, head or joint is very dangerous.

A penetrating wound to the head can be inflicted on any part of the skull. Therefore, the wound inlet located on any part of the skull (under the hair, on the face, nose, mouth, eye, chin, etc.) should be considered a penetrating wound to the head.

Chest injuries. Injuries to the chest can be penetrating if accompanied by a violation of the integrity of the parietal pleura, and non-penetrating when the pleura is not damaged. With non-penetrating wounds, only soft tissues of the chest wall (85%) are more often damaged, less often with fractures of the ribs, sternum and scapula. Penetrating wounds to the chest are more life-threatening for victims due to possible injuries inside the chest 7

organs and the occurrence of internal bleeding, mediastinal emphysema, pneumothorax, and pulmonary heart . Particularly severe are gunshot wounds to the chest. A bullet damages organs and tissues not only with a direct, but also with a side impact, destroying them at a considerable distance from the wound canal. The clinical picture of penetrating wounds of the breast depends on the whole on the nature of damage to the intrathoracic organs, the massiveness of and pneumothorax. The main symptoms of lung injuries are hemoptysis, and hemothorax. Penetrating wounds of the chest are characterized by a combination of the pleural cavity with the external space. They arise as a result of damage by cold steel or firearms, when glass falls on shards. Dangerous of the possibility of air entering the pleural cavity and collapse of the lung, damage to the vessels of the chest wall and internal organs, as well as the development of purulent complications. A sign of a penetrating wound is the appearance of a sucking sound, which coincides with the respiratory movements of the victim. Any chest wound should be treated at the scene by medical personnel with an occlusive dressing. With penetrating wounds, a number of syndromes may occur. Closed pneumothorax - accumulation of air in the pleural cavity, accompanied by the lungs and cessation of ventilation. The degree of impairment of lung function depends on the amount of air in the pleural cavity. Cause: the closed damage of the lung tissue - isolated or complicated by a fracture of edges, a small closed before the examination penetrating wound of the pleural cavity. Symptoms: slight shortness of breath, sometimes cyanosis. With a deep breath lag of the affected side. A significant weakening or complete absence of respiratory sounds during auscultation. Percussion - tympanic sound. Treatment in a hospital. Stretching of the lung by means of puncture of the pleural cavity, continuous suction or surgical treatment. Open pneumothorax - accumulation of air in the pleural cavity in the presence of a gaping wound and a constant suction of air in the respiratory excursions of the thorax. Causes: gunshot wounds of the chest, heavy transport trauma, edged weapons. With rupture of lung tissue, trachea or large bronchi is developing a similar clinical picture, which, however, may be fully intact chest wall - "internal open pneumothorax". Symptoms - the presence of a gaping wound and the distinctive sound of incoming into the pleural cavity during inspiration of air. The condition of the patient heavy, severe respiratory failure, which is associated not only with the shutdown of the breathing lung of the affected side, but also with a decrease in minute ventilation of the opposite lung. The allocation of bloody bubbles through the wound. The breath of the affected side is missing. Treatment. Immediate conversion of open pneumothorax to closed with an occlusive dressing (rubberized cloth, swab soaked in ointment or oil, adhesive tape, plastic film, PPI). When applying an occlusive dressing, attention should be paid to the possibility of developing valvular pneumothorax, which is accompanied by increasing respiratory failure. In this case, puncture decompression of the pleural cavity is necessary. After providing medical care, the patient is transported to the hospital in a half-sitting position for surgical treatment (surgical treatment and closure of the chest wound). During transportation - inhalation, promedol, glucose with corglycon intravenously, infusion anti-shock measures. Transporting the victim without an occlusive dressing is life threatening. 8

Tense valve pneumothorax is an increasing accumulation of air in the pleural cavity, accompanied by progressive compression of the lung from the damaged side, as well as compression of the opposite lung, displacement of the mediastinum to the healthy side. It occurs as a result of trauma and the formation of an internal or external valve mechanism, in which air on inspiration penetrates into the pleural cavity, and on exhalation, the opening is blocked and prevents air from escaping. It can take place with any damage to the chest wall, lung tissue and bronchus, accompanied by air into the pleural cavity. Symptoms Severe shortness of breath, cyanosis, a sense of fear. Tachycardia and a drop in blood pressure due to joining heart and vascular insufficiency. Lack of respiratory noise, tympanitis on the side of damage, mediastinal displacement to the healthy side. Compression of the main veins. Progressive respiratory failure after chest damage always requires the exclusion of valvular pneumothorax. Treatment. Excessive pressure in the pleural cavity should be immediately eliminated, since it threatens the life of the patient. The simplest measure is the puncture of the pleural cavity with a thick needle in the second intercostal space along the midclavicular line with the maximum possible air evacuation. After first aid, the patient should be immediately taken to hospital. It is better to use a trocar instead of a needle, insert a thin catheter through it, and after removing the trocar, fix the catheter with the valve to the skin. The device reliably drains the pleural cavity for the period of transportation and prevents damage to the lung by the end of the needle. With valvular pneumothorax, the patient cannot be transported without first normalizing the pressure of the pleural cavity (puncture, valve). A penetrating wound in the chest cavity can be located not only on the front surface of the chest, but also on the side, and on the back, and on the shoulders in the area of the clavicle. Any hole on the body located in the area of the ribs or on the shoulders near the collarbone should be considered a penetrating wound in the chest cavity and provide first aid in accordance with the relevant rules and algorithms. A penetrating wound into the abdominal cavity can be applied to any surface of the abdomen - from the side, front or back. This means that any wound located on the front or side wall of the abdomen, as well as on the back between the ribs and lower back, is considered to be a penetrating wound in the abdominal cavity. Also, a wound inflicted in the perineum or in the upper part of the buttock is considered to be a penetrating wound in the abdominal cavity. The possible localization of the penetrating wound on the buttocks and in the perineum should be remembered and if a wound channel with such localization is found, always provide first aid as with a penetrating wound of the abdominal cavity. A penetrating wound of a joint can be inflicted only in the area of large joints, for example, a knee, femur, elbow, etc. A wound in the joint area in combination with pain during bending and unbending movements is considered penetrating. The algorithm providing pre-medical aid in penetrating wounds into the chest cavity. 1. He saw a man with a penetrating wound in the chest cavity it is necessary to call "ambulance", and then proceed to the first aid. 2. Getting to the first aid man with a penetrating wound of the chest should be banned deep breathing and talking.

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3. If the person is unconscious, you should throw back his head back and turn to one side, because in this position air can freely pass into the lungs, and vomit will be removed to the outside do not clog airway. 4. If the wound is any object (knife, axe, harpoon, arrow, chisel, nail, rebar, etc.), in any case, do not pull it as this can lead to additional damage to internal organs and, consequently, to death. If an object is protruding from the wound long, try to trim it neatly, leaving only a small portion (about 10 cm above the skin). If an object is protruding from the wound, cut or shorten the other ways is impossible, then you should leave it the way it is. 5. It is necessary to fix and stabilize the object in the wound, so he did not move and did not move. The fixation of the object in the wound is necessary, because any move could trigger additional trauma to the bodies significantly worsen the condition and prognosis of the victim. This can be a foreign object stuck in the wound, to impose a roller bandage or any cloth with two sides, then the structure will be fixed with a bandage, plaster or tape. Then tightly wrap the subject of dressing material and tie the end. Wrapped several layers of bandages item will be well fixed. And the heavier or longer the object, the more layers of the dressing material should wrap around it to lock it; 6. If the wound is not any foreign object, you should tightly cover the hole with his hand to prevent the access of air. If the body has two holes - an input and output (area can be 10 times more input), then you should cover them both. Then, if possible, it is necessary to apply a sealing bandage over the wound. If a bandage is impossible to apply, you have to clamp the palms of wounds before the arrival of "emergency" or during the period to transport the victim to the nearest hospital; 7. To overlay occlusive dressing use of PPI. The provision of first aid. Superficial wounds do not bleed much, so their edges are smeared with 5% iodine (without iodine entering the wound). A sterile napkin is taken from an individual bag, a wound is covered, and the wound area is bandaged. If the edges of the wound are widely dispersed and time allows (there are not many victims), the edges of the wound are brought together by 2-3 strips of adhesive tape, a sterile dressing is applied. The algorithm for the provision of medical care for penetrating wounds in the abdominal cavity. 1. As soon as a person with an abdominal injury has been discovered, it is necessary to begin to provide premedical care. 2. When starting first aid, a person with a penetrating wound in the abdominal cavity should not be given a drink or a meal, even if he urges. To quench your thirst, you can only moisten your lips with water or give the victim a mouth rinse. 3. If a person is unconscious, his head should be thrown back and turned to the side, since it is in this position that air can freely pass into the lungs, and vomit will be removed without threatening to block the airways. 4. In the process of providing assistance, painkillers should not be administered to a person with a penetrating wound to the abdomen. 5. If there is any object in the wound (knife, ax, harpoon, pitchfork, chisel, nail, reinforcement, etc.), in no case pull it out, as this can lead to additional damage to internal organs and, accordingly, to the death of the injured person within a short period of time (5 to 20 minutes). You can only try to carefully trim the object, leaving a small

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part sticking out of the wound - 10 cm above the skin. If it is impossible to cut or shorten the object in a wound in other ways, then you should leave it in this form. 6. The object in the wound should be recorded that he did not move and does not shift during transport or repositioning of the victim's body. 7. After fixing a foreign object in the wound should be provided to the victim sitting position with bent knees feet. In this position the victim wrapped in blankets and sitting transporterowych. 8. If the wound is not any subject, but dropped out internal organs, in any case, do not try to straighten them! Do not put your into the abdominal cavity prolapsed organs, because it can result in very rapid death of the victim from shock. In such a situation, carefully to collect all the fallen bodies in a clean cloth or in a bag and stick it with tape or band-aid to the skin close to wounds. The internal organs can not be pressed and flatten. If the stick pack or a rag with the organs to the skin is nothing, you should isolate them from the external environment in a different way. Around the authorities should impose rollers of gauze or fabric. Then on top of cushions you should make a bandage, not pressing and not pressing the prolapsed organs. 9. After you apply the bandage or fixation of prolapsed organs shall provide to the person sitting with bent legs, put on the wound with the cold and to wrap up the victim with blankets or clothing. To be transported in a sitting position. 10. Until the patient is taken to hospital, it is necessary to moisten the fallen bodies of water so they were constantly wet. If allowed to dry the fallen bodies, they will have to be removed because they will die. 11. If the wound is not any subject, then you should apply a clean sterile dressing. For this 8 - 10 layers of cheesecloth or bandage or piece of cloth with two additions put on the wound to completely shut down. Then strapped gauze or cloth to the body. If you tape the gauze or cloth to the body is nothing, you can just glue them to the skin with tape, plaster or glue. 12. On the armband, subject to availability, apply cold in the form of ice pack or ice water in the bottle. After applying the bandage should provide a victim sitting position with bent knees, feet, and cover it with blankets or clothing. To transport an injured person should be in the sitting position. Important! While the man with a penetrating wound to the abdomen is delivered to the hospital, it is absolutely impossible to drink, feed and to enter pain medications. Bandage technique. Bandage Cap, overlay technique in pictures. Dressing “Cap” is the most reliable dressing for the scalp. It is simple in execution and firmly fixes the material. It is possible to overlay without an assistant. Bandage “Cap” does not slip and makes good pressure on the wound. The disadvantages of this bandage: the need to untie the straps with food to reduce pain, and the straps can be seen from under the headgear. Appointment: head wounds (stopping bleeding and fixing dressings). Equipment: a bandage of medium width (10 cm) and a length of 80 - 90 cm.

The technique of applying the dressing “Cap”:

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1. Take the cut of the bandage length 80 - 90 cm Positioning the midpoint of the segment of the bandage on the parietal region of the head; the end of the bandage keeps the patient or assistant. 2. Take the beginning of the bandage in his left hand, a head bandage in the right. Fixing to do a tour around the forehead and nape. 3. To hold the bandage on the front surface to the strings. To round it in a loop and keep a bandage on the back of the head to the opposite side to the other strings. 4. To draw the bandage back around the tie and lead at the frontal part of the head above the fixing of the tour. Similarly to a bandage on the back of the head. 5. Repeat circular strokes around the head, covering the previous course of 1/2 or 2/3 to full coverage of the head. 6. Close completely the repeated moves of the bandage scalp. 7. Turn the bandage around one end of drawstring and secure with a knot. 8. To tie under the chin segment of the bandage, the ends of which were held by the patient.

Hippocrates cap. The Hippocratic cap is one of the varieties of the bandage that rotates on the head, which is applied using either a two-headed bandage or bandages 10 cm wide fastened together. A bandage is applied to stop bleeding and fixation of dressing for wounds and of the parietal part of the head. Equipment: double-headed bandage (option for preparing a bandage with two heads: take 2 bandages, expand them to a length of 15 cm, put the end of one bandage on the end of the other (turn towards each other) a bandage with two heads will come out).

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Hippocrates cap, bandage scheme. 1. Apply a bandage to the occipital part of the head and guide both heads of the bandage to the frontal region. Important: the first fixation tour of the bandage should extend below the external occipital protrusion. 2. To make an excess and to lead both heads of a bandage to an occipital area. 3. Make an inflection. Transfer the bandage heads: the left head to the right hand, and the right head to the left hand. 4. A bandage in the left hand lead through the parietal region of the head to the frontal, a bandage in the right hand lead around the head to the frontal part. 5. Make a bend in the forehead. A bandage in the right hand lead through the parietal region of the head to the back of the head (covering half of the previous round), the bandage in the left hand is carried around the head to the back of the head. 6. Transfer the bandage heads from the right hand to the left and vice versa. 7. Bandage this way until the parietal region of the head closes. Important: the final round tours of the bandage should also be placed below the frontal tubercles and the occipital protrusion, otherwise the bandage will easily fall off your head. 8. Fix the bandage in the left hand in the back of the head; with a bandage in the right hand make a tour around the head. Make a kink in the back of the head, lead the bandage with your right and left hand towards each other in the frontal part. 9. Tie to a knot. Cut off the rest of the bandage.

Bandage bridle. A very comfortable headband, the indications for which are: damage to the face, lower jaw, frontal part of the head. Equipment: bandage 7-10 cm wide, hairpin or adhesive plaster, scissors. Bridle dressing technique:

1. To position the patient to face him. The first round, firming, apply a circularly around the head through the frontal and occipital hillocks. 2. To hold the bandage obliquely to the occipital region on the lateral surface of the neck, under the ear to the chin and upwards on the opposite side of the face in front of the opposite ear. 3. To make the right amount (depending on damage) vertical circular moves through the parietal and chin region, the front of the ears. 13

4. From under the chin area to bring the bandage on the back of the head, to carry out obliquely upward, to reach the forehead. 5. Make circular moves around the head through the occipital and frontal bossing. 6. To mark the end of the bandage on the front of the head over the wound surface. The bandage on one eye. Patch one eye (monocular) depending on the affected eye has certain characteristics. Before bandaging the affected eye, it is necessary to cover eye protective or therapeutic cotton-gauze pad. There are two schemes applying this bandage, depending on the direction of oblique circular tours, directly covering the eye (top-down or bottom-up).

Features when applying oblique circular moves on one eye from top to bottom: it is more convenient to bandage the left eye from right to left (relative to the patient), the right eye is left to right, and when applying oblique moves from bottom to top, on the contrary, bandage the left eye should be left to right, right eye - from right to left.

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The technique of applying a blindfold in one eye: 1. Make a circular reinforcing passage around the head through the frontal and occipital tubercles, starting from the side of the sore eye. 2. Lower the bandage down curving towards the back of the head and guide it under the earlobe on the sore side obliquely down the cheek, closing the sore eye with this move. 3. The oblique course is fixed with a circular - fixing tour of the bandage around the frontal and occipital region of the head. Next, they make in turn an oblique move (the previous oblique move, overlaps several) and a circular move around the head. 4. Repeating these circular moves around the head and through the eye area, the required number of times reaches the closure of the diseased eye. The bandage is fixed by cutting the end of the bandage and tied to a knot (on the other side of the damaged eye). A bandage on both eyes (binocular). Indications for applying a bandage to both eyes: fixing dressings in the eye area with damage and , postoperative period. Binocular dressing technique: A blindfold for both eyes, pattern of application. 1. Before applying the dressing, it is necessary to seat the patient facing him. Eyes are covered with cotton-gauze pads. 2. The blindfold on both eyes begins with a circular tour around the head through the frontal and occipital tubercles. Bandage from left to right. 3. In the nape of the neck bandage is lowered obliquely down. 4. Then remove the bandage under the earlobe, leading obliquely up the right cheek through the facial area, while closing the right eye, on the forehead. 5. Having made a circular (circular) move around the head, lead the bandage through the facial region obliquely down through the left eye under the earlobe to the back of the head. 6. Thus, we alternate the tours several times laying them on top of each other, covering both eyes, until the eye sockets are completely closed. 7. At the end, we strengthen the bandage with a circular horizontal round and fix the bandage. When applying a bandage, do not impose tours on the auricles.

Bandage Deso. 15

Indications for the Deso dressing: immobilization of the upper limb to the chest during collarbone fractures, as well as after the reduction of the shoulder dislocation. When applying a bandage to the upper limb, a physiological position is provided. First, the shoulder to the body is fixed, then the wrist joint is held, and finally, the ulnar joint of the injured side. The joints of a healthy upper limb remain free, and the patient can make any movement with a healthy hand. Equipment: bandage 20 cm wide, cotton-gauze roller, scissors, pin or adhesive plaster. Note: the fixing tour of the bandage is always carried out to the sore arm around the body, tightly pressing their shoulder to the chest. When applying a bandage to the left hand, the bandage moves from left to right, and when bandaging the right hand from right to left, the arm is given a bent position in the elbow joint at a right angle, the elbow is slightly retracted, and the shoulder is brought up during the bandaging process. Application technique of the bandage Desault: Bandage Desault, scheme overlay. 1.The desault bandage is applied after the preliminary investments in the axilla cushion of cotton wool wrapped in gauze. After gently bend the injured limb at the elbow joint, lead, and pressed to the chest. 2.Make two clips rounds of bandage in the chest and injured arm in the shoulder area, back, and axilla from the healthy limb. 3.Lead the bandage through the armpit of the healthy side on the front surface of the chest obliquely to the shoulder girdle patient side. 4.To omit the bandage down the back surface of the patient's shoulder under the elbow. 5.Go around the elbow and supporting the forearm to direct the bandage obliquely in the axilla healthy side. Lead the bandage from the armpit on the back on the affected shoulder girdle. 6.Lead the bandage from the shoulder girdle on the anterior surface of the patient's shoulder under the elbow and around the forearm. To send a bandage on the back in the armpit of the healthy side. Repeat tours of the bandage until it locks the shoulder. 7.To finish a bandage fixing two rounds in the chest and injured arm in the shoulder area, back. Chop off the end of the bandage pin. If the bandage is superimposed on a long time, tours of the bandage should flash.

Materials for self-control: TESTS: 1.The victim, T., 35 years in 30 minutes rushed to the emergency ward of the hospital after a road traffic accident. During the inspection the doctor established: severe subcutaneous emphysema on the neck, face and right half of the chest. The skin of the face and mucous membranes cyanotic. Veins of the neck are strained. Palpation of the chest on the right is clearly defined crepitus bone fragments. Breathing right is not listening. What kind of damage you can think of in this case? 1. * Fractured ribs and closed pneumothorax. 2. Fracture of ribs. 3. Open pneumothorax. 4. Chest trauma. 5. Closed pneumothorax.

2. After falling victim K., felt pain in the upper part of the chest, function the top of the brush is broken in the region of the clavicle noticeable distortion. Type of damage? 1. * Fracture of the clavicle. 16

2. Fracture of the humerus. 3. Dislocation of the shoulder joint. 4. Closed chest trauma. 5. Closed pneumothorax.

3. Male, 60 years old, fell on the designated right hand, the pain, the bleeding, the wound visible bone fragments. What measures of first aid? 1. * Anesthesia, bandaging, immobilization of the limb. 2. Dressing. 3. Surgical treatment. 4.Exercises bone fractures, bandaging 5. to be hospitalized in a medical facility.

4. As a result of a strike in the facial area of the head, the man 30 years, is celebrated widely open mouth, the victim can not chewing, swallowing and speaking of complicated, the lower jaw is pushed forward. With the aim of immobilization at the damage of the lower jaw can be used: 1. * A bandage "bridle". 2. Bandage Desault. 3. Cross dressing. 4. Bandage "cap". 5. Cap Of Hippocrates.

5. В результате взрыва, пострадавший П., 4 часа находился под обломками разрушенного дома. Обе сдавленные нижние конечности удалось освободить из- под обломков лишь через 6 часов. Развитие какого патологического процесса грозит больному? 1. * Острая почечная недостаточность. 2. Фибринолиз. 3. Метаболический алкалоз. 4.Септический шок. 5. Гиперкоагуляция с распространенным тромбозом.

6. Injured D., 45 years old, received a penetrating wound in the stomach, as a result of a fall on a sharp object. What first aid measures should I take first? 1. * Apply an aseptic dressing to the wound, immediately hospitalize. 2. Stop the bleeding. 3. Enter anesthetic. 4. Remove foreign objects from the wound. 5. Apply a tourniquet. 7. According to the degree of medical consequences, 5 categories of transport accidents are determined. I category is: 1. Up to 3 victims. 2. * Up to 5 injured. 3. Up to 10 injured. 4. 1 injured. 5. There is no right answer.

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8. According to the degree of medical consequences, 5 categories of transport accidents are determined. II category is: 1.5-10 affected. 2. * 6-15 injured. 3.25 injured. 4. Up to 10 injured. 5. More than 30 victims.

9. According to the degree of medical consequences, 5 categories of transport accidents are determined. Category III is: 1. * 16-30 injured. 2. 20-40 injured. 3. 30-50 injured. 4. 10-15 injured. 5. 6-15 injured.

10. According to the degree of medical consequences, 5 categories of transport accidents are determined. IV category is: 1. More than 50 victims. 2. * 31-50 injured. 3. 45 injured. 4. Up to 50 injured. 5. More than 40 victims.

Литература Основная: - Домедична допомога (алгоритми, маніпуляції): Методичний посібник / В.О.Крилюк, В.Д.Юрченко, А.А.Гудима та ін. - К.: НВП "Інтерсервіс", 2014. - 84 с. - Тарасюк В.С., Матвійчук М.В., Паламар І.В., Корольова Н.Д., Кучанська Г.Б., Новицький Н.О. Медицина надзвичайних ситуацій. Організація надання першої медичної допомоги: Підручник. - К.: «Медицина», 2011. – 526 с. - Тарасюк В.С., Матвійчук М.В. Паламар М.В., Поляруш В.В., Корольова Н.Д., Подолян В.М. Малик С.Л., Кривецька Н.В. Перша медична (екстрена) допомога з елементами тактичної медицини на до госпітальному етапі в умовах надзвичайних ситуацій. – К.: Медицина, 2015. - Стандарт підготовки: Фахова підготовка санітарного інструктора роти (батареї). – Вид. 1. - К. : «МП Леся», 2015. Дополнительная: - Наказ МОЗ України «про заходи щодо удосконалення надання екстреної мед. допомоги населенню в Україні. № 500 від 29.08.2008р. - Олена і Віктор Пінчук «Навчальна програма «Військова медицина на полі бою» (Combat Medicine)» Київ, Україна, 2015, 255 с. - Руководство по доврачебной помощи при ранених. – Перевод на русcкий язык ООО «Русская медицинская корпорация» (Tactical Combaf Casualti Care (TCCC), редакція от 28 октября 2013

Guidelines prepared by PhD in medical sciences A. Levkov 18