First emergency care at multiple and combined injuries ( injuries )
Combined and multiple trauma are among the most severe damage with high mortality as a pre-hospital and hospital.
combines call such an injury in which, along with the damage of the abdominal or thoracic cavities, of the brain are damaged musculoskeletal system.Multiple
call such injury when there are two or more damage within one organ and tissue systems (multiple rib fractures, fractures of two or more segments of the limbs, etc.).
These injuries occur when the application traumatic force large area, weight or moving at a high speed (fall from a great height, auto and plane crashes, natural disasters, earthquakes, floods, etc.).
Symptoms can be very diverse and depend on the localization of the lesions and the presence of traumatic shock, hemorrhage, cranial disorders, acute respiratory failure, almost always complicating during concomitant injury.
determines the clinical picture leading damage that poses the greatest threat to the life of the victim.Lead can damage a few, and in accordance with
• concomitant injury of the skull;
• concomitant injury of the musculoskeletal system.
When combined trauma of the skull has a moderate or severe skull trauma that accompanies limb fractures, pelvis, spine, rib fractures.There clinically to the fore brain disorders in the form of sopor, coma.For brain disorders are added circulatory disorders, respiratory accompanying shock, which when combined trauma has always been.
concomitant injury with damage to the stomach may be accompanied by symptoms of internal bleeding or damage to internal organs.
trauma of the musculoskeletal system may be leading only with massive damage of the pelvis, spine fractures, spinal cord injury, tearing off limbs.
case of injury is necessary to identify major damage, and the presence of life-threatening conditions -. Shock, acute blood loss, acute respiratory failure, etc. The survey is carried out simultaneously with the start of therapeutic measures, quickly, carefully, without any fuss.Assessing the state paramedic primarily based on the following parameters: consciousness (stunning, stupor, coma), circulation (pulse, blood pressure), breathing (the number of respiratory movements, pathological types of breathing, foreign body oral cavity, pharynx, hindering or stopping breathing).
victim is placed on a stretcher (preferably rigid).respiratory disorders can be due to blockage of airway vomit, blood, dental prosthesis, as well as zapadenii lower jaw and tongue.Oral cavity and pharynx purified either suction or gauze at a time, or wrapping cloth thumb.If necessary, open mouth gag.Then, begin rescue breathing or devices (such as IQ-ZM), or "mouth to mouth" (in the absence of spontaneous breathing).When properly carried out the above activities is a restoration of spontaneous breathing, often followed by the victim regains consciousness.Simultaneously
artificial respiration poliglyukina begin bolus (400 ml intravenously) or ropoliglyukina (400 mL), prednisone (60 to 300 ml), hydrocortisone (125-250 mg);while wounding large arteries applied a tourniquet.If the condition remains extremely serious, pulse and blood pressure at a low level, the second punctured vein and pour 100 ml of 40% glucose with 10 units of insulin, continuing as bolus polyglucin with hormones.At a certain stabilization of the blood pressure of 70-80 mm Hg.Art.and the appearance of the pulse at the periphery (radial artery) proceed to immobilize fractures of the femur, tibia, shoulder, forearm, as well as intra-articular injuries of the knee, ankle, elbow and wrist joints.Spending time in the splinting of fractures of the small bones is not necessary.
In extensive wounds impose sterile bandages, strengthening their mesh bandages on smaller wounds - sterile wipes, strengthening them plaster.In the absence of abdominal injury intravenous promedol 2% 2.1 ml;omnopon and morphine are contraindicated in traumatic brain injury, as it causes respiratory depression.In this case, enter analginum 50% - 2-4 ml;Baralginum - 5 ml;maksigam - 3.5 ml;Trigan - 3.5 ml intravenously.If concomitant injury are absolute signs of damage abdominal organs (prolapse into the wound loops of intestine, omentum, the expiration of urine, bile, etc.), Drugs administered can and should be.Hospitalization of patients with multiple and associated injuries is carried out in the intensive care unit.During transport, continue intravenous krovozameniteley.In the absence or respiratory failure - ventilation through a mask if possible, it is a specialized intensive care paramedic ambulance.