The first emergency aid for multiple and combined injuries( injuries)
Combined and multiple injuries are among the most severe injuries with a high mortality rate both at the prehospital stage and in the hospital.
Combined are called such injuries, in which along with damage to the organs of the abdominal or thoracic cavity, the brain is damaged by the musculoskeletal system.
Multiple injuries are called when there are two or more lesions within the same organ and tissue system( multiple fractures of the ribs, fractures of two or more limb segments, etc.).
Similar injuries occur when a traumatizing force of a large area, weight or moving at high speed( fall from a high altitude, auto- and air crashes, natural disasters, earthquakes, floods, etc.) occurs.
Symptoms can be very diverse and depend on the location of lesions, and on the presence of traumatic shock, blood loss, craniocerebral disorders, acute respiratory failure, almost always complicating the course of combined trauma.
The clinical picture defines the leading damage, which is the greatest threat to the life of the victim. The leading damage can be several, and according to them, the combined injury is classified as follows:
• concomitant skull trauma;
• combined trauma of the musculoskeletal system.
In case of a combined trauma of the skull, there is a trauma of the skull of medium or severe degree, accompanied by fractures of the bones of the limbs, pelvis, spine, fractures of the ribs. Here, the cerebral disorders in the form of a sopor, a coma are clinically on the foreground. To cerebral disorders, blood circulation disorders, respiratory depression accompanying shock are added, which is always present with a combined trauma.
Combined trauma with abdominal damage may be accompanied by symptoms of internal bleeding or damage to the internal organs.
Injury of the locomotor system can be leading only with massive pelvic injuries, vertebral fractures with spinal cord injuries, limb ruptures.
In case of trauma, it is necessary to identify the leading injuries, as well as the presence of life-threatening conditions - shock, acute blood loss, acute respiratory failure, etc. The examination is carried out simultaneously with the start of treatment, quickly, carefully, without fuss. Assessing the condition, the paramedic primarily relies on the following parameters: consciousness( stunning, sopor, coma), blood circulation( pulse, blood pressure), respiration( the number of respiratory movements, the presence of pathological respiration, foreign bodies of the mouth, pharynx, obstructing or stopping breathing).
The victim is placed on a stretcher( preferably hard).Disturbances of respiration can occur as a result of occlusion of the respiratory tract by emetics, blood, dentures, and also with the westernization of the lower jaw and tongue. The mouth and pharynx are cleaned either by suction, or by gauze napkins on the clamp, or by wrapping a finger around the napkin. If necessary, open the mouth with a rotator. Then artificial respiration is initiated either with devices( such as CI-3M), or "mouth to mouth"( in the absence of independent breathing).If the above measures are carried out correctly, self-breathing is restored, often after that the victim comes to consciousness.
Simultaneously with artificial respiration, a jet injection of polyglucin( 400 ml intravenously) or bovine( 400 ml), prednisolone( 60 to 300 ml), hydrocortisone( 125-250 mg);When wounding large arteries, a tourniquet is applied. If the condition remains extremely severe, the pulse and blood pressure at a low level, puncture the second vein and pour 100 ml of 40% glucose with 10 units of insulin, continuing also the jet injection of polyglucin with hormones. With some stabilization of blood pressure at the level of 70-80 mm Hg. Art.and the appearance of a pulse on the periphery( radial artery) proceed to immobilize the fractures of the hip, shin, shoulder, forearm, as well as intraarticular injuries of the knee, ankle, elbow and wrist joints. Spending time on splintering small bones is not worth it.
For extensive wounds, sterile bandages are applied, reinforcing them with mesh bandages, for small wounds - sterile wipes, strengthening them with adhesive plaster. In the absence of trauma to the abdominal cavity, intravenously injected promedol 2% 1-2 ml;omnopon and morphine are contraindicated in cases of craniocerebral trauma, as they cause respiratory depression. In this case, you should enter analgin 50% - 2-4 ml;baralgin - 5 ml;maxi grams - 3-5 ml;trigan - 3-5 ml, intravenously. If, with combined trauma, there are absolute signs of damage to the abdominal cavity organs( prolapse in the wound of the intestinal loop, omentum, urinary flow, bile, etc.), drugs can and should be administered. Hospitalization of victims with multiple and combined injuries is performed in the intensive care unit. During transportation, intravenous infusion of blood substitutes continues. In the absence or violation of breathing - ventilation through the mask. If possible, the paramedic calls a specialized emergency room ambulance.