Transport immobilization

Immobilization ( from Latin immobilis - "immovable") - the creation of the immovability( rest) of a certain part of the human body for various injuries and diseases. Allocate transport and medical immobilization. Transport immobilization is carried out using standard means that the industry produces, and from improvised materials, mainly on an outpatient basis. To perform therapeutic immobilization, specialized means are used. It is performed both in outpatient and inpatient settings.

Basic first aid measures for fractures of bones:

1) creation of bone immobility in the fracture region - immobilization;

2) undertaking measures aimed at combating shock or preventing it;

3) the organization of the fastest delivery of the victim to medical institutions.

Rules for carrying out transport immobilization:

• the tires must be securely fixed and well fixed to the fracture area;

• The tire can not be applied directly to the naked limb, the tire, the limb should be covered with cotton, wrapped in bandage;

• Two joints must be fixed above and below the fracture, and with hip fractures, all joints of the lower limb should be fixed.

For transport immobilization it is necessary to create a stationary state of the damaged part of the human body during transportation, usually to a medical facility. Most often, such immobilization is performed with various bone fractures, burns( especially deep ones), damages of blood vessels and nerve trunks, inflammatory processes, etc. In case of bone fractures by means of transport immobilization, it is possible not to allow a repeated displacement of bone fragments and, consequently, new muscle injuries, injuries of blood vessels and nerve trunks. Since the damaged parts of the human body are stationary, this does not allow the intensification of pain, which can cause traumatic shock. Such immobilization can also perform the function of preventing damage to blood vessels, various bleeding, traumas of nerve trunks, as well as the spread of infection in the wound. Since blood clots in the damaged vessels are stationary, the development of bleeding and embolism is also impossible. The implementation of transport immobilization should be approached very seriously, as the correct implementation removes the spasms of the blood vessels, and consequently improves the blood supply to the damaged area and increases the resistance of the injured tissues of the infection, which is especially important in cases of gunshot wounds. Since the layers of muscles, bone fragments and other damaged tissues are in a stationary state, this prevents the spread of microbial contamination along interstitial fissures. And this is another plus of proper transport immobilization.

There are several principles of transport immobilization, the violation of which can lead to a strong decrease in the effectiveness of immobilization.

1. The use of transport immobilization should be as early as possible, i.e.already in the provision of first aid at the scene with the use of improvised or specialized means.

2. With closed fractures, it is not necessary to remove clothes from the victim, as it, as a rule, does not interfere with transport immobilization, but, on the contrary, serves as a soft lining under the tire. Remove clothing and shoes should be only when absolutely necessary, and should begin with a damaged limb.

3. Anesthesia should be performed before transport immobilization, as this is a very important part of first aid, especially with various injuries of the musculoskeletal system. As a method of choice for combating pain in prehospital injuries, it is possible to recommend combined anesthesia with the help of novocain blockades( with fractures of long tubular bones), superficial anesthesia with nitrous oxide, trichlorethylene, ketorol, etc. Do not forget that when a transportthe tire is displaced bone fragments, as well as pain in the area of ​​damage.

4. If there are open wounds, they must necessarily be closed with an aseptic bandage before the tire is applied. If access to the wound is prevented by clothing, then it should be removed.

5. It is also recommended to apply a tourniquet before immobilization according to the relevant indications, and it should not be covered with bandages. And be sure to indicate in the note the time of applying the harness( date, hours and minutes).This ensures continuity at various stages of medical care and helps the wounded with a tourniquet in the first place, which otherwise can lead to the necrosis of the limb.

6. With open fractures, the ends of the bone fragments protruding into the wound should not be inserted, as this may lead to additional penetration of the microbes into the wound. Apply a sterile bandage and fix the limb in the position in which it was in the

moment of injury. In the case of closed fractures, when there is a threat of perforation of the skin, partial reassembly is performed by lightly and carefully extending the injured limb along the axis, and then the tire is applied.

7. The superimposed tire should not exert excessive pressure on soft tissues, especially in the area of ​​the protrusions( in order to prevent the occurrence of pressure sores), squeeze the large blood vessels and nerve trunks. It is impossible to impose a rigid tire directly on the body, it is necessary to lay a soft lining. Tire should be covered with cotton, and if it is not, then clothes, grass, hay and other improvised materials.

8. If long tubular bones are broken, then at least two joints adjacent to the injured limb segment should be fixed. There are cases when you need to fix three joints, mainly with fractures of limb bones. Immobilization will be considered reliable when all joints that function under the influence of the muscles of this segment of the limb are fixed. Thus, with a fracture of the bones of the lower leg, the knee, ankle and all joints of the foot and fingers should be fixed.

9. It is necessary to immobilize the limb in the average physiological position, in which the muscles-antagonists( for example, flexors and extensors) are equally relaxed, and if this is not possible, then in such a position that the limb is least injured. The position is the average physiological if:

• the shoulder is withdrawn by 60 °;

• 10 ° hip;

• The forearm is in the position between pronation and supination;

• Brush and foot - in the position of palmar and plantar flexion by 10 °.

10. But different cases of immobilization, as well as transportation conditions, make it necessary to go for small deviations from the average physiological position. For example, do not perform significant shoulder detachment and flexion of the hip in the hip joint, and in the knee joint bend at 170 °.

11. Reliable immobilization can be achieved if physiological and elastic contractions of the muscles of the damaged limb segment are overcome. Elastic contraction is expressed in decreasing the length of the muscle, as the attachment points of the bone attach to the bone fracture.

12. The best immobilization is provided by tires, which are very firmly fixed, and all over the damaged limb.

13. In order not to injure an even more damaged limb, you should handle it very carefully. It is better, if the tire will be imposed by another person, who will hold the limb in a certain position and help gently move the victim from the stretcher.

14. In the cold season, the injured limb can be frostbitten, especially if the vessels are damaged, so the injured limb must be insulated before transport.

Do not forget that incorrect immobilization can cause very great harm to human health. For example, if you do not create a complete immobility of the limb with a closed fracture, it can go into the open.

Technique of immobilization is determined not only by the trauma features, but also by the conditions in which it has to be produced. For example, if you do not have standard( table-type) tires, you can use various tools( sticks, umbrellas, etc.).Timber tires are used in accordance with their purpose and structure.

In general, splinting is the immobilization of damaged areas of the human body using special devices, which are called tires. All tires used in the modern world should be divided into groups.

1. By designation:

• transport vehicles used during transport immobilization;

• therapeutic, used in medical immobilization.

2.Po principle of action:

• fixation, which help to create immobility of damaged areas, fixing the adjacent joints;

• distraction, due to which immobilization is achieved by fixation and extension( distraction).

3. According to the manufacturing conditions:

• standard( time-based) that the industry produces. They are mainly equipped with hospitals, clinics, as well as ambulances. These include ladder tires( they are a design in the form of closed rectangles made of metal wire, they can be easily modeled, disinfected), plastic( consisting of plastic strips reinforced with aluminum wire, close to staircases), plywood, pneumatic( consisting oftwo layers of polymer film, equipped with a zipper and a valve for air injection, which creates a good immobilization of the injured limb), vacuum( consisting of two layers of rubber-clothEve shell, inside which are small plastic pellets) and Dieterichs tire;

• non-standard, i.e.tires that are not manufactured by the industry and which are not part of the standard tire set;

• Improvised, or primitive, - tires that are manufactured with a variety of materials at hand. It can be various sticks, slats, bars, umbrellas, etc.

4. By splitting individual limb and trunk segments for:

• upper and lower limbs;

• the spine and pelvis;

• Head and neck;

• of the thorax and ribs.

Let's consider in more detail the technique of carrying out transport immobilization for various localization of damages.

The permanence of the neck and head can be achieved with a soft circle, cotton-gauze bandage( a collar type Shantsa) or a special transport bus Elanskogo. When carrying out immobilization with a soft lining circle, the victim should be laid on a stretcher and tied to limit it in movements. Then the circle itself should be placed on a soft litter, and the victim's head - on a circle in such a way that the nape is in the hole. Immobilization with a cotton-gauze bandage is recommended only if the victim has difficulty breathing, vomiting and arousal. At the same time, the collar tire should rest against the occipital mound and in both mastoid processes, and from below - rest on the thorax. This will help to eliminate head movements during transportation. When using the Elanskii bus, the most rigid fixation is achieved. Such a tire is made of plywood, it is a construction of two halves-flaps, which are connected together by loops;so it can be added and deployed. In expanded form, the tire repeats the contours of the head and trunk. In its upper part there is a hollow for the occipital part of the head, and on its sides two semicircular platens of oilcloth are stuffed. On the tire you need to put a layer of cotton wool and attach it with ribbons to the trunk and around the shoulders.

2. Transport immobilization for spinal injuries

The use of immobilization in such cases is performed in order to achieve immovability of the damaged vertebrae for further transportation, and also to relieve the spine and fix the immediate area of ​​damage. Transportation of such victims always picks up the danger of injuring the spinal cord by a displaced vertebra. Therefore, a very important condition is the correct and careful placement of a person on a stretcher. It is better if several people participate in it( 3-4).

3. Transport immobilization in case of damage to the shoulder girdle

In case of damage to the shoulder girdle, immobilization serves to create rest and eliminate the effect of the severity of the arm and shoulder belt by means of a kerchief or special tires. To do this, hang a hand with a roller, embedded in the armpit. When carrying out this immobilization, tires are most often used, which are also used to treat fractures of the clavicle under stationary conditions. It is possible to use a dezo dressing.

4. Transport immobilization in case of upper limb injuries

Shoulder damage. In various cases of fractures of the humerus in the upper third, the arm should be bent at the elbow at an acute angle so that the brush lies on the nipple of the opposite side. If the body is bent in the direction of the injured shoulder, then it is necessary to put a cotton-gauze roll into the armpit and fix it with a bandage. Then the forearm should be suspended on a kerchief, and the shoulder should be fixed with a bandage. In the case of a fracture of the diaphysis of the humerus, it is recommended to immobilize using a ladder tire. To do this, the tire is wrapped with cotton and performed by modeling it on an intact limb. In this case, the tire should fix the shoulder and elbow joints. If the tire is modeled at a distance that equals the length of the victim's forearm, the tire must be bent at a right angle, and the other hand grab the other end of the tire and bend it to the back. In the armpit of the injured arm, also put a cotton-gauze roll, and then fix the tire with bandages to the limb and trunk. In case of a fracture in the elbow joint area, the tire should be placed so that it covers the shoulder up to the metacarpophalangeal articulations. Immobilization with a plywood tire is performed by applying it over the inner surface of the shoulder and forearm. The tire is fixed with a bandage to the shoulder, elbow, forearm, and hands, while only the fingers remain free. When performing immobilization with the help of improvised means, it is necessary to ensure that the upper end of the improvised tire on the inner side reaches the axilla, the other end on the outer side protrudes beyond the shoulder joint, and the lower ends - by the elbow. After the tires are applied, they are tied down below and above the fracture site to the shoulder brush, and the forearm is suspended on a kerchief.

Forearm damage. In order to produce immobilization of the forearm, it is necessary to exclude movements in the ulnar and wrist joints. At the same time, use a ladder or mesh tire, which is first bent by a groove and covered with a soft litter. It should be imposed on the outside of the injured hand from the middle of the shoulder to the metacarpophalangeal articulations. In this case, the arm is bent at the elbow at a right angle, and the forearm is given the middle position between pronation and supination, the wrist is slightly unbent and leads to the abdomen. In the palm of the hand put a thick cushion, the tire is fixed with a bandage to the limb and hang the hand on the scarf.

When using a plywood tire, wool should be used to avoid the formation of pressure sores. To create a stillness of the forearm, it is also possible to use also an improvised material.

Damage to wrist and fingers .When the lesion was localized in the area of ​​the wrist joint of the hand and fingers, the use of ladder and plywood tires was widely used. In this case, the spikes must be covered with cotton, then they can be applied from the palm side. If the damage is very severe, then the tire should be applied from the back of the palm. The tire with the bandage is fixed to the hand, but the fingers are left free. This is necessary in order to be able to observe the blood circulation.

Brush is brought to the average physiological position, and a thick roller is placed in the palm.

5. Transport immobilization in case of pelvic injuries

To perform immobilization in case of pelvic injuries, the victim should be carefully placed on a stiff stretcher, giving him a position with semi-bent, slightly dilated limbs, so that the muscles relax, this will lead to a reduction in pain. A roller is placed under the knees, which can be made from improvised materials.

6. Transport immobilization in case of damage to the lower extremities

If the hip is injured, immobilization is necessary, in which three joints are seized and the tire is applied from the armpit area to the ankle.

Immobilization with Dieterichs bus. The Dieterichs splint is necessary for proper immobilization with a fracture of the femur. It performs fixation and simultaneous stretching. The tire can be used for various hip and shin fractures. It is a construction of two wooden sliding bars of different length and width of 8 cm, there must be a wooden stand under the foot for traction and a stick-twist with a cord. A long bar is placed on the outside of the thigh from the armpit, and a short one is placed on the inner side of the leg. The two bars at the top for the stop are cross struts. Since the bars can move apart, they can be given the desired length. To the foot with the bandage fix the "sole", in which there is a special fastening for the cord. After the tire is applied, the cord should be tightened to tension, and the tire should be bandaged to the body.

The Dieterichs splint is not allowed to be used for fractures of the ankles, ankle and foot injuries combined with fracture of the thigh.

Immobilization with a ladder tire. If the thigh is broken, then for the immobilization it will take three tires, two of which are connected along the length from the area of ​​the axillary fossa to the end of the foot, and the third is placed on the surface from the gluteal fold to the fingertips.

Plywood tires in these cases are used similarly to staircases.

Transport immobilization of the leg. In case of shin injury, immobilization should be carried out with the help of special plywood and ladder tires, as well as Dieterichs tires and improvised tires.

In order to correctly apply the tire, the assistant needs to lift the calf by the heel and gently pull it toward him. Then the tires from the outer and inner sides are fixed at the top for the knee joint, and below - for the ankle.

To carry out transport immobilization should be taken with all responsibility, errors are unacceptable, since they can lead to very serious consequences. Also, do not use short tires, because their use will be ineffective. And if it is not enough to fix the tire firmly with a bandage all over the limb, then this can lead to constrictions, compression and disruption of the blood supply.