INFECTION OF THE RAS.
There are billions of different bacteria on the wounds and the surface of the skin that enter the wound and infect it. Most often, the wound becomes infected pus native bacteria that cause the inflammatory purulent -inflammatory process that dramatically affects the healing of the wound and creates the danger of general purulent infection. Implement of microbial growth and caught in the wound at the time of wounding wounds with conductive object, called primary infection. Reinfection wounds after some period of time after injury is known as secondary Noah infection.
Secondary infection may occur at about rabotke wounds dirty hands, the use of dirty Nogo (non-sterile) dressing indirect villa treating wounds, improper application of the dressing during ligation. Perhaps penetration excite teley secondary infection in the wound of the blood vessels of the purulent center located in another part of the body (chronic angina, purulent inflammation of soft tissues, furunculosis, sinusitis etc.).
With extensive and deep wounds, a purulent-inflammatory process can proceed so violently and quickly that the body does not have time to create a protective shaft around the abscess. In such cases, the possibility of penetration of micro ERD into the bloodstream and spread them in all organs and tissues, – developing a common purulent infection (sepsis). Such complication is dangerous and often EMPTY INDICATES death even under the most intensive treatment.
Sepsis – a pathological condition caused by fallen into the bloodstream various micro organisms (Staphylococcus, Streptococcus and others.) And their toxins. The clinical manifestations of sepsis are extremely diverse. The most typical signs of the disease are: high body temperature (up to 40 ° C and above), accompanied by stunning chills, heavy sweats; a sharp deterioration in the general condition – nonsense gal lyutsinatsii, loss of consciousness. Pronounced shortness of breath, tachycardia, and a decrease in blood pressure are characteristic . Later, weight loss and exhaustion quickly increase, yellowness of the skin appears, and facial features become sharper. Such a wound complication is very dangerous since it often ends in death. Timely \ correctly provided assistance can prevent the development of this formidable complication.
In addition to pyogenic bacteria, more dangerous microbes that cause diseases such as tetanus and gas gangrene can get into the wound.
Tetanus. This infectious disease of thickets occurs when wounds are contaminated with earth, dust, manure during agricultural and transport injuries and fire from wound injuries.
The earliest signs of tetanus are high body temperature (40–42 ° C), appearing 4–10 days after the wound, involuntary twitching of mice in the wound area, pain in the stomach, abdominal muscles, difficulty swallowing, contraction of the facial muscle of the Latura of the face and spasm masticatory muscles (trismus), making mouth opening impossible. Somewhat later, excruciating cramps of all muscles (opisto tonus), arising from the slightest irritation, convulsions of the respiratory muscles and suffocation (Fig. 53) , are combined . Treating tetanus is a very difficult task. It is more effective than specialized institutions, since there is no specific treatment, and symptomatic treatment often requires special equipment and experienced personnel.
An effective means of controlling tetanus is specific tetanus immunization.
It is carried out by parenteral administration pillar nyachnogo adsorbed toxoid that provides immunity to tetanus organism for many years provided toxoid booster every 5-10 years.
With any injury in violation of intact stnosti skin and mucous membranes, burns and frostbite II and a degree, animal bites, out-of-hospital abortion, childbirth during birth at home without skilled care is necessarily spent extra particular about the prophylaxis of tetanus.
Persons who previously was conducted correct immunization to prevent tetanus administered 0.5 ml of the purified toxoid adsorbed (active they munizatsiya) regardless of the severity of the injury. Anti tetanus serum was not introduced in these cases. Not grafted and grafted incorrectly extra Spec ical tetanus prophylaxis is conducted actively-pass sive method – 1 ml of adsorbed tetanus toxoid and tetanus toxoid ME 3000 (MSS). With this method of immunization is necessary about continue the vaccination. After 30-40 days, 0.5 ml of toxoid is administered. To create a persistent immunity performed after 10-12 months revaccination – 0.5 ml stolbnyach Nogo toxoid.
Passive immunization is widely used. PSS is introduced, which contains specific antibodies against tetanus. Serum creates in the body pass -intensity short-lived immunity. One profilak cally dose – 3000 ME (1 ml) regardless of the age of the victim. This method of immunization is less reliable. Tetanus toxoid is added after about the reference sample at the sensitivity. GIS-intradermally at the vibrational surface forearm administered 0.1 ml of diluted hydrochloric MSS (1: 100). A sample is considered negative if, after 20 minutes, there is a papule with a diameter of not more than 9 mm with a small area of redness. In case of a negative sample, 0.1 ml of undiluted PSS is administered, and in the absence of reaction after 30-60 minutes, the entire dose. If the intradermal test is positive, PSS is not administered.
Tetanus toxoid is not administered if after the first revaccination no more than 6 months have passed, and after the second – no more than a year.
When injected into the wound of germs breeding in the conditions of absence of air (anae detail) infection in the wound tissue around it develop severe inflammation. The earliest award Nacom beginning complications, often 24-48 hours after injury, is the emergence of feelings raspiraya-tion in the wound, which quickly turns into unbearable pain. Around the wound, tissue swelling soon appears. Skin to make cold, covered with dark-toe contact, pulsation vessels disappear. When tissues are compressed in the wound area, crepitus is felt under the fingers (crunch, creak). This is due to the formation of gas bubbles in this disease, which penetrate the tissues. Body temperature rises rapidly to 39–41 ° С.
Leche of gas gangrene consists of the following elements:
- the introduction of antigangrenous sera;
- hirurgich skoe treatment – broad dissection of the affected organ or tissue ablation;
- local treatment with drugs that produce oxygen (hydrogen peroxide).
The forecast is always serious.
Most often, gas gangrene, sepsis, tetanus develop with extensive injuries with crushed, non-viable tissues in the wound, which serve as a good breeding ground for microorganisms. The benefit of pleasant factors for microbial growth YaV lyayutsya malnourished patients, cooling and so on.. Sometimes for the development of severe complications for quite a few hours. Hence it is evident the importance of speedy delivery of the wounded in the hospital to provide timely Noah medical care and the introduction of specific proti vostolbnyachnoy and protivogangrenoznoy sera.
The main measure of prevention of wound infection – urgent implementation of the operation – primary hirurgich tion treatment of a wound. This operation should be vypol Nena in the first 6 hours after injury.
Primary surgical treatment.
The primary to stringing, t. E. Without suppuration, heal a wound incised and operating deposited under aseptic conditions. All accidental wounds are infected and no surgery heal by secondary intention, t. E. With suppuration, slow dead tissue rejection, by the degree of filling wound granulation and subsequent conductive scarring.
Surgery, while to the torus made excision wound edges throughout the channel, called the primary surgical Obra Botko. When this operation is excised and removed infitsi Rowan and crush the tissue, foreign bodies, to carry lyayut final stop bleeding, followed conductive stratified suturing wounds. Primary debridement carried out in the first hours after the injury, allowing for a significant number of cases to achieve alive Lenia wound by primary intention. This processing is camping best prevention of sepsis, gas gangrene and tetanus.
BASIC PRINCIPLES OF FIRST AID MEASURES FOR INJURIES
The basis of first aid for wounds – first elements naya debridement. At the first moment after injury, the most formidable danger is bleeding.
The reason for the majority of deaths after wound Nij is the acute blood loss, so the first mero acceptance must be sent to stop the blood flow cheniya any possible way (vessel pressing, compressive bandage et al.).
- An equally important first aid task is to protect the wound from contamination and infection. Correct about rabotka wound prevents the development of complications in the wound and almost 3 times reduces the time it heals. Obrabot ku wound should be clean, better prodezinfi -skilled hands. When applying an aseptic dressing, do not touch with your hands those layers of gauze that will directly come into contact with the wound. In the absence of antiseptic substances, the wound can be protected by simply applying an aseptic dressing (bandage, individual bag, scarf). In the presence dezinfi tsiruyuschih agents (hydrogen peroxide, furatsilina solution, an alcoholic solution of iodine, gasoline, etc..) Before impose aseptic bandage must skin around the wound 2-3 times wiped with a piece of cotton or gauze moistened with an antiseptic substance, while trying to remove dirt, scraps of clothing, earth from the surface of the skin. This prevents wound infection with okra zhayuschey skin after applying the patch.
- The wound cannot be washed with water – this contributes to infection.
- Should not enter cauterizing boiling antiseptic substances into the wound surface.
Alcohol, iodine alcoholic solution, gasoline cause death of cells, which promotes wound suppuration and sharp Wuxi leniyu pain, which is also undesirable. Do not remove dirt and foreign bodies from the deep layers of the wound, as this leads to further infection of the wound and may cause complications (bleeding, damage to op ganas). Small foreign bodies introduced in the skin (Zano PS, thorns, splinters of glass, and metals), causing pain, making the fabric of the infection and can cause the development of severe inflammation (abscess, felon). Therefore, when providing first aid, it is advisable to remove also foreign bodies. It is easiest to remove dirt, sand, and soil from abrasions by washing abrasions with hydrogen peroxide. Splinters, spines and other small foreign body is extracted by a pin cetane needles can fingers. After removal inorod Nogo body wound to be treated by any ANTISEPT cal solution. Foreign bodies of large wounds can be removed only by a doctor in the production of primary hirur cal treatment.
- The wound can not fill powders, ointment impose on it, not directly to the wound when imposes wool – all contribute to the development of infectious tion in the wound.
Sometimes internal organs (brain, intestines, tendon) can fall into the wound. When treating such a wound, it is impossible to immerse the fallen organs deep into the wound, a bandage is applied over the fallen organs.
With extensive injuries of extremities should be pro conduct their immobilization. An important task of first aid to the wounded is their speedy delivery to a medical institution. The early hour Chez victims received medical care, the effectiveness tive treatment. It must be remembered that the early delivery should not compromise the right transporte ings. The wounded should be transported in a position in which harmful effects, concussions are excluded to the maximum and the nature of the wound, its location and the degree of blood loss are taken into account. All wounded whose trauma accompanied was given a shock, and significant blood loss, optionally walk transported in a supine position.
FIRST AID MEASURES FOR HEALES, BREAST CELLS AND ABDOMIN
First aid for wounds of the soft tissues of the head should be directed to stop ku bleeding. Due to the fact that under the soft TCA nyami are the skull bone, the best way vre mennoy hemostasis is overlay squashing conductive dressing. Occasionally bleeding can be stopped by pressing of the finger artery (temporal outer – in front of the auricle, the outer jaw – the CUT has mandible edge 1-2 cm from its corner). When a head is injured, the greatest danger lies in the fact that brain damage (concussion, bruising, compression) often occurs simultaneously. First aid for such a wound – to give the wounded horizons Talnoe position to create peace, to make the cold to go fishing and to organize immediate transport to a hospital.
Penetrating wounds of the chest is extremely dangerous because when they can be damaged by the heart, aorta, lungs and other vital organs, injuries which lead to severe vnut rennemu bleeding and rapid death. Penetrating wounds of the chest and without damage to vital organs pose a great danger to life. This is due to the fact that when wound in pleural hydrochloric cavity penetrates the air and develops open pneumothorax. As a result, lung collapses, about come displacement and compression of the heart of a healthy lung, developing a common grave condition – plevropulmonalny shock.
The first aid provider should know that hermetically closing such a wound can prevent the development of this formidable complication or significantly reduce it. Reliably close the wound of the chest with a sticky patch applied in the form of tiles. In the absence of a patch the wound should be closed rubberized wrap the individual pa chum and bandaged it tightly. An occlusive dressing can be applied using gauze densely soaked with petroleum jelly, oilcloth, airtight film, etc., applied as a pressure dressing. About the need to conduct anti-shock measures. The wounded must be transported in a half-sitting position.
Wounds of the abdomen (abdominal wall) Extraordinary but dangerous: even small wounds can penetrate be conductive, that may damage the bodies bryush hydrochloric cavity. This entails extremely formidable complications requiring immediate surgery: internal bleeding and the expiration of intestinal contents into the abdominal cavity with the subsequent development of purulent (fecal) inflammation of the peritoneum (peritonitis).
When providing first aid, the wound of the anterior abdominal wall is treated according to the general rules for the treatment of wounds. With extensive wounds, abdominal organs (eventation), sometimes damaged, can fall out through an opening in the abdominal wall. Such a wound should also be covered with an aseptic dressing.
Dropped organs cannot be inserted into the abdominal cavity – this will lead to peritonitis. After treating the skin around the wound, sterile gauze is applied to the fallen organs, a thick layer of cotton wool is placed over the gauze and on the sides of the organs, and all this is covered with a circular bandage bandage. You can close the towel, easy there, sew the thread edges. At wounded from eventration orga new abdominal cavity is developing very fast shock, for this it is necessary to carry out anti-shock CELEBRATION ment, except for the introduction of fluids through the mouth.
Due to the fact that for any injuries to the stomach WHO can damage internal organs, the victim is prohibited to feed, drink, give medication by mouth. When the intestine is penetrating wounds accelerates time vitie peritonitis.
Transport the wounded in the stomach need to rely SRI lying with raised upper body and knees bent legs. This situation reduces pain and prevents the spread of the inflammatory process in all parts of the abdomen.