The victim has a through gunshot (bullet) wound to the right shoulder. Gunshot wounds of the upper limb

A gunshot wound is the result of exposure to damaging factors of various weapons (bullets, shot, fragments). Features of the damage include a specific structure, characteristic tissue changes, and healing. First aid tactics for a wounded person are determined by the location of the gunshot wound, the type of bleeding, and the severity of the damage.

It is important to make sure you are in a safe position after an incident. Call emergency services by calling 911.

First aid for a gunshot wound includes a clear algorithm of sequential actions. Because of high speed damaging elements, an uneven channel is formed. It is filled with damaged tissue fibers, clots, fragments of bones, projectiles and clothing. Non-through - a damaging element will remain at the bottom.

At the site of the gunshot wound, a “pulsating cavity” and a zone of dead tissue are formed. Sudden changes in pressure occur, which leads to displacement and contusion of internal organs. Bacteria and infection are introduced over a long distance. A peculiarity is secondary necrosis, which forms at the site of the lesion after a few hours or days. Fresh pockets of dying tissue appear. A perforating gunshot wound is characterized by an exit hole, which complicates first aid.

Threatening the life of the victim:

1. Bleeding - loss of 60% of blood is fatal to a person.
2. Injuries to the heart and brain are especially dangerous. Gunshot injuries to internal organs are quickly fatal.
3. Without first aid, loss of consciousness and death from painful shock are possible. A massive gunshot wound causes powerful nerve impulses.
4. Infection is the penetration of pathogenic microorganisms, which threatens the loss of limbs or death.

How to stop bleeding

Determine the type of blood loss from a gunshot wound for first aid: the artery is bright scarlet in color, pressure and pulsation are felt - a tourniquet must be applied. It's flowing from a vein thick blood burgundy color– a pressure bandage is applied. For small tangential hemorrhage, aseptic technique is used.

IN extreme conditions For first aid, you can use laces, a belt, or a scarf. And also other things that will replace the tourniquet. Examine the victim, determine the location of the lesion.

Use your fingers to apply pressure to the gunshot wound when providing first aid. In a position in which blood has stopped oozing, tamponade is performed with tissue napkins, bandages, gauze or pieces of clean clothing.

With one hand we fill the wound channel with a tampon, with the other we tighten the tourniquet above the bleeding site by 1-2 turns, blocking the damaged vessel.

Stopping involves temporary intervals to avoid complications. The first aid tourniquet can be left in place for 1.5 – 2 hours and for 1 hour in winter. Record the time of application and report the data to doctors.
Suitable for dressing: a clean piece of fabric, bandages. And also gauze slightly larger than the gunshot wound surface.

For first aid take solid object flat shape (purse, bar of soap, telephone). After making a tamponade, apply it to the gunshot wound. Cover the area with a bandage or pieces of clothing. Act quickly to provide strong pressure on soft tissues. This will reduce the lumen of the vessel and accelerate thrombosis.

What to do if you have a gunshot wound

Identify the location and degree of damage - first aid tactics will depend on this. First of all, you need to calm down and act according to plan. Assess the situation and carefully examine the victim.

First aid for a bullet wound of any location:

1. Inspect the victim's body completely, pay attention to the presence of an exit hole. Take measures to stop the bleeding.
2. Prevention of infection of a gunshot wound - bandage with an antiseptic. To help prevent the development of painful shock, apply ice.
3. Creating conditions for rest in case of a gunshot wound (the limbs should be located above the line of the heart, ensure immobilization - a stationary position of the damaged parts of the body).
4. Replenish blood loss, drink plenty of fluids (if the person is conscious and the gunshot wound is not localized in the abdominal cavity).
5. Protection from hypothermia (cover with warm clothes at hand).
6. Transportation.

For wounds in the limbs

First aid for gunshot wounds of the extremities:

1. Sharp broken edges of bones injure muscles, arteries and blood vessels. Eliminate any movement. Immobilize the person until paramedics arrive.
2. If the bleeding does not stop, apply a tourniquet above the gunshot wound. The second method of clamping the vessel in elbow joint: stopping bleeding of the forearm - a pressure bandage when bending the arm. For first aid, roll up a tight roller, press and secure the position with a bandage. Gunshot wound of the shoulder - compress the injured vessels with your fingers or tissue rolls. The lumen of the artery in the armpit is blocked by pressing humerus. The artery is pressed against internal area in the biceps attachment area. The subclavian vessel is pressed against the first rib under the collarbone.
3. In case of a gunshot wound, the victim’s arm is secured with a bandage. Ice is applied to prevent shock.

Similar first aid to stop blood loss is carried out with lower limbs. The femoral artery is pressed against the pubic bone. Cover the bleeding with two thumbs (one on top of the other).

Immobilization: fixation of a healthy limb and application of splints. Destruction of the pelvic bones is often accompanied by damage pelvic organs in case of gunshot damage. When providing assistance, the victim is transported on his back with a bolster in the popliteal areas.

Damage to the chest or lung

With such localization, air can penetrate through the wound channel, which will lead to pneumothorax. If blood accumulates - hemothorax. Providing first aid becomes more difficult with a gunshot wound that goes through. The lung collapses, the position of the heart changes and large arteries mediastinum. The condition is extremely dangerous and quickly leads to death.

First aid measures for a bullet wound to the lung are aimed at stopping bleeding. A bandage made of airtight material is placed on the naked body. P In case of pneumothorax, attach a plaster on three sides at the wound site.

Before applying, ask the victim to exhale and hold their breath to release chest cavity from excess oxygen.

Press on the wound area and observe the person's condition. Talk to the victim, monitor breathing and movements chest. Press on the surface until a medical team arrives and helps. If the patient stops breathing, then artificial respiration. Do not give the victim food or drink. The wounded man assumes a half-sitting position with his legs bent.

Symptoms:

• labored breathing;
• coughing up blood, foam from a wound;
• blue discoloration of the skin of the face, lips, increased pain in the chest;
• state of shock.

Wound to the spine and neck

The most complex cases- gunshot wounds spinal column. For first aid, it is necessary to stop the bleeding and ensure the person’s immobility. It must not be moved, turned over or lifted. It is necessary to lay the victim on a hard surface as carefully as possible. Self-transportation to the hospital is prohibited.

Large vital arteries and veins are located in the neck; if they rupture, the blood supply to the brain is disrupted and death occurs within 30 seconds. It is necessary to compress the lumen of the vessels with the thumbs of both hands, pressing them below the wound. Carotid artery press against ledge 6 cervical vertebra. First aid should be provided and the position should be fixed until doctors arrive.

Wound in the stomach

After a gunshot injury, single or multiple perforations of the abdominal organs occur. In cases of prolapse, it is forbidden to set the insides abdominal cavity. For first aid, they are covered with fabric rolls and secured with bandages. Main point– moisten the dressing with water.

To prevent shock, apply cold. It is forbidden to consume water, food, tablets. Wounds to the abdomen are dangerous due to damage to the liver and spleen. Damage to the gallbladder provokes peritonitis. Patients with internal bleeding need hospitalization first medical care.

Head wound

Such a location of the projectile is characterized by loss of consciousness. Avoid blockage respiratory tract Vomiting can be done by tilting the victim's head to the side. In this position, air will pass freely into the lungs, and vomit will come out. First aid: measures to stop bleeding depend on the nature of the gunshot wound. For superficial damage, a septic bandage or head bandage is sufficient. A multi-layered one is tightly tied to the skull, which is used with severe bleeding.

It is forbidden to remove torn body tissues or remnants of clothing. The bandage should be a pressure bandage made of sterile material when the bleeding does not stop. A piece of fabric in 8-10 layers is applied to the damaged area, then pressed with an object and the bandage is tied to the head with 1 - 2 turns. For first aid, the patient is placed in a lying position with his legs elevated.

Damage to parts of the brain often causes cardiac and pulmonary arrest following a gunshot wound. You need to be ready to take action resuscitation care — indirect massage, artificial respiration.

Try to keep the victim calm and wrap him in blankets. Do not let the wounded person move and monitor his condition until paramedics arrive.

Features of applying a bandage

The correct position ensures the prevention of infection and hemostasis. It will also protect against rupture of tissues and blood vessels during transportation to the hospital.

To treat the area of ​​a gunshot wound, you will need to remove your clothing. The stuck one cannot be torn off - cut out a piece and leave it in place. For first aid, the shoes are removed from the heel or cut along the back surface, holding the limb.

1. Remove or insert protruding foreign bodies into the gunshot hole. Skin, body tissue, fragments, etc.
2. Wash and clean the wound surface, providing first aid.
3. The applied tourniquet should be in a visible place (medics should inform the time when blood loss began and stopped).

Transportation of the victim

If signs are observed heavy blood loss, the wounded person must be taken to the surgery department for assistance. Transport immobilization should be organized as soon as possible after a gunshot wound. If possible, first aid is performed.

For wounds on the extremities, a soft layer of clothing is created between the splint and the leg and secured with a bandage.

For first aid, ensure the immobility of several nearby joints. You can use a wide board or stick. In case of through wounds of the extremities with multiple bone fractures - to prevent blocking of large arteries and veins - the arms and legs are folded in a physiological position. For minor damage to soft tissues and bones, a mid-physiological position is given. Patient with symptoms state of shock needs resuscitation and first aid.

Wound healing and consolidation of gunshot fractures upper limb occur more favorably than the lower ones. Widespread purulent anaerobic infection, osteomyelitis is less common. The conditions for this are wide incisions, care in performing the procedure for excision of non-viable tissue, and, if necessary, timely secondary necrectomy, which should not be postponed if indicated. In the event of open wound and granulating surfaces, early secondary or late secondary seam, therefore, in such situations, you should definitely keep in mind the use of free skin grafting, and if necessary, use a skin stem according to Filatov.

Shoulder fractures. Gunshot wounds with a fracture of the humerus account for about a third of all shoulder injuries. In addition to the deformation or malposition of the limb, pathological mobility at the fracture site, dysfunction of the limb, pain in the fracture zone, the results of measuring the length of the limb, one should also take into account such a sign as the presence of fat droplets in the wound discharge. Most often during surgical treatment of a firearm For a shoulder fracture, the wound is dissected, bone fragments and foreign bodies are removed, then soft tissue is excised.

Thus, when the shoulder is injured, relatively simple surgical procedures are performed, which is explained by the relatively small volume of muscles, the absence of dense fascial layers, less contamination of the wound, and a relatively high percentage of through wounds.

With gunshot wounds of the shoulder region, especially in the upper third of the shoulder, combined wounds are not so rare, when the same wounding projectile: a bullet, a fragment - first causes a fracture of the humerus, and then penetrates the pleural cavity, causing lung injury, blood vessels, and other anatomical formations. In some cases, along with a fracture of the humerus, the scapula may be injured, and bone fragments seriously injure the muscles of the suprascapular and subscapular region. Since the direction of soft tissue injury does not always correspond to the true direction of the wound channel, a thorough physical and radiological examination of the patient is especially important, including chest x-ray in two projections, and, if necessary, in more projections.

The question of the need for thoracotomy for such wounds should be decided on the basis of firmly established principles of military field surgery: thoracotomy is indicated only for ongoing intrapleural unstoppable bleeding, large hemothorax and for valvular pneumothorax that cannot be eliminated by conservative measures.

In case of severe small-comminuted fractures of the upper third of the shoulder, it may be necessary complete removal proximal end of the humerus. In this case, complete healing of the wounds is achieved and subsequently they resort to endoprosthesis replacement of the proximal end of the humerus. Since with such fractures it is not always possible to fix the fragments using a device external fixation, you have to resort to an abduction splint or thoracobrachial bandage. Immersion metal osteosynthesis for gunshot fractures of the bones of the forearm, and not only them, can be used only in extremely favorable situations: when

General good condition wounded, carefully performed surgical treatment, a sufficient number of well-supplied muscles, with the possibility of closing the wound without tension, good drainage, observation of the patient by the operating surgeon.

Gunshot fractures of the humeral diaphysis are usually through and through (Fig. 3.7). Surgical treatment of such fractures is carried out according to general rules, carefully protecting the radial nerve from additional trauma. With a gunshot fracture of the shoulder optimal methods fixations are the Ilizarov apparatus, as well as a plaster thoracobrachial bandage.

With through fractures of the shoulder and large exit holes, you can limit yourself to surgical treatment of only the exit hole.

In this case, sufficient access is provided, conditions for excision of non-viable tissue, comparison of bone fragments and subsequent drainage. A significant number of gunshot fractures of the humerus can be reduced after surgical treatment using an abduction splint fixed to the body with plaster rings. The same rings are used to secure the shoulder and forearm on the splint. If for some reason an external fixation device is not used for gunshot wounds of the shoulder or forearm, a thoracobrachial bandage can be used with the arm in abduction. The bandage is relatively easily tolerated by patients, simplifies their subsequent management and does not cause stiffness when the arm is fixed for 2-3 weeks. shoulder joint. This bandage is convenient to apply at the end of the operation under anesthesia. In the interval from the 5th to the 8th day in a thoracobrachial bandage, if necessary, cut out a “window” in the projection of the wound and carry out the necessary therapeutic measures, such as delayed suturing or loose skin grafting.

It is advisable to divide shortening of upper limb segments into functionally compensated (up to 4 cm), conditionally compensated (4-6 cm) and uncompensated (more than 6 cm). Forearm injuries. 2/3 of those wounded in the forearm are admitted to the hospital without signs of suppuration (Figure 3.8). Provided that surgical treatment is carefully performed and bone fragments are stablely fixed, the results of treatment of this category of wounded can be considered quite satisfactory. Transosseous osteosynthesis devices should be considered the method of choice for immobilizing fragments. For gunshot wounds of the forearm, it is often necessary to resort to free skin grafting to close skin defects.

A feature of gunshot wounds of the forearm is frequent nerve damage, requiring subsequent neurolysis and nerve suture.

A technique has been developed for inserting the needles on the bones of the forearm, as well as a special conductor that allows the needles to be inserted at the desired angle.

Using conservative and surgical methods treatment, it is possible to restore the anatomical integrity of the bones in almost 90% of the wounded. Approximately 10% of the wounded remain with persistent defects, false joints; characterized by a high percentage (more than 20) of contractures. Wounds to the hand. The variety of gunshot injuries to the hand is very large. It is not uncommon to be injured by shrapnel when the main localization of the injury is in another area. Extensive damage to bone, muscle and tendon structures occurs when the left hand is wounded at close range.

The main condition for a successful operation for a gunshot fracture of the hand is to perform it in a specialized hospital using special instruments, an operating microscope, etc.

It should be considered proven that intervention on the hand should be definitive, in other words: the operation should be carried out by a specialist who knows the methods of intervention on the hand. Consequently, such victims should be left in a specialized institution, and operated on at other stages only with the aim of stopping bleeding, prophylactic administration of antibiotics, applying a bandage and transport immobilization.

Special meaning has a hand injury in terms of the importance of the organ and the features of the anatomical structure. It should be considered quite justified in most cases to divide the treatment of hand wounds into two stages - primary surgical treatment and final reconstructive interventions in specialized medical institutions. American surgeons in Vietnam, with fairly good equipment and trained personnel, used a two-stage technique when wounding the hand.

When determining the period and type surgical intervention One should proceed primarily from the nature of the damage and its severity, the time that has passed since the injury or injury, and evacuation transport capabilities. It is also necessary to take into account the patient’s age, his general state, profession.

Gunshot wounds of the hand, as a rule, are accompanied by bone fractures, and with wounds of the fingers, tendons and very often joints are almost certainly affected, with the formation of extra- or intra-articular fractures.

A wound to the hand itself can rarely cause the wounded person to go into shock; in such cases, one or more other injuries should always be looked for. A delay in surgical debridement of the hand is fully justified if there is a good primary medical dressing and reliable immobilization, although a purulent infection is frequent companion wounds of the hand, especially when the bones of the wrist are damaged.

First aid for a hand injury consists of applying a sterile bandage, sometimes pressure bandage. For widespread injuries of the hand, immobilization with a scarf or using standard means is indicated. The wounded hand must be fixed in a functionally advantageous position, for which a thick ball of cotton wool is placed in the wounded person’s palm and the fingers are placed on it, the entire hand is bandaged to a ladder or mesh splint modeled on the palmar surface.

Rendering surgical care wounded in the hand should be limited at the stage of qualified surgical care only to stopping bleeding and immobilization, since without x-ray You cannot begin complex surgical treatment of a hand wound.

When surgically treating large wounds, the hands are preferable general anesthesia, conduction or intraosseous anesthesia can be used.

The surgeon must perform operations on the hand with the help of an assistant. The necessary conditions are a well-lit surgical field, sufficient time and a good surgical instrument and suture material.

Careful preparation surgical field very important: nails should be cut short, hair should be shaved, the entire brush should be washed thoroughly warm water with soap.

When performing interventions on the hand, good hemostasis is very important, which is controlled by periodically removing the tourniquet; The tourniquet should be on the arm for no more than 1 hour continuously. If the ulnar or radial arteries are injured, one of them can be ligated, but in no case both, as this will cause necrosis.

The skin on the hand can be excised only if it is undoubtedly non-viable; in other cases, even heavily contaminated skin should be preserved.

During surgical treatment, it is necessary to carefully examine the deep formations of the hand and determine the degree of damage to all structures. At severe injuries hand, a transverse incision of the transverse carpal ligament is advisable.

Necrotic muscles, blood clots, and foreign bodies are removed. It is advisable to preserve bone fragments that are not very dirty. Obviously non-viable tendons should be removed, but literally every millimeter of viable tissue must be fought for. Amputation of fingers is indicated in case of obvious necrosis. This especially applies to the first finger. Sometimes it is necessary to save at least part of the skin from the amputated finger to close the skin defect on the remaining one.

When amputating fingers, a flap is cut out, carefully ligating the blood vessels and sawing the phalanx with a thin file. After intersection, the tendons should be sutured to the periosteum. The ends of the destroyed nerves usually extend far to the sides. They should not be sought during initial surgical treatment; however, if possible, the ends of the nerves should be brought closer to relatively healthy tissues and the nerves should be fixed with non-absorbable suture material.

In most cases, it is better to close the wound with a delayed primary suture. The use of thin Kirschner wires is indicated for fixation of fractures and dislocations of the phalanges of the fingers. In case of intra-articular fractures of the interphalangeal or metacarpophalangeal joints, in cases where the articular ends of the bones are completely crushed, one should resort to very economical removal of these areas. We must not forget about the mandatory immobilization of the hand after any intervention on it.

The bandage should cover the entire wound, but not squeeze it. Healthy fingers should be visible. The hand is fixed in a functionally advantageous position. Surgical debridement a gunshot wound of the hand is not indicated for through wounds of the hand and fingers with pinpoint entry and exit holes, for tangential wounds of the fingers and hand, provided that the wound has smooth edges, as well as with superficial small-fragmented wounds. IN postoperative period Physical therapy is especially recommended for wounded people with injuries to the hand and fingers.

Thank you

A gunshot wound is a wound received as a result of shell fragments, bullets or shot entering the human body. Therefore, if a person is wounded by any factor related to a firearm, then such a wound should be regarded as a firearm and first aid render accordingly. First aid to a victim of a gunshot wound is provided according to the same rules, regardless of the specific damaging factor that caused the wound (bullet, shrapnel or shot). In addition, the rules for providing assistance are the same for gunshot wounds in different parts of the body.

Rules for calling an ambulance in case of a gunshot wound

If the ambulance does not arrive at the scene within 30 minutes, then you should independently transport the victim to the nearest hospital. To do this, you can use any means - own car, associated transport, etc.

Algorithm for providing first aid to a victim with a gunshot wound to any part of the body except the head

2. If a person is unconscious, his head should be tilted 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 outward without threatening to clog the airways;

3. Try to minimize the amount of movement of the victim, as he needs rest. Do not try to move the victim to what you think is a more comfortable place or position. Provide first aid to the person in the position in which he is. If in the process of providing assistance you need to get to some parts of the body, move around the victim yourself, and move him minimally;

4.

5. Do not clean the wound of blood, dead tissue or blood clots, as this can lead to very rapid infection and deterioration of the wounded person's condition;

6. If prolapsed organs are visible from a wound on the abdomen, do not set them!

7. First of all, you should evaluate the presence of bleeding and determine its type:

• Arterial– blood is scarlet, flows out of the wound in a stream under pressure (creates the impression of a fountain), pulsates;
• Venous– blood is dark red or burgundy in color, flows out of the wound in a weak stream without pressure, does not pulsate;
• Capillary– blood of any color flows out of the wound in drops.

If it is dark outside, the type of bleeding is determined by tactile sensations. To do this, place a finger or palm under the flowing blood. If the blood “beats” on the finger and a clear pulsation is felt, then the bleeding is arterial. If the blood flows in a constant stream without pressure or pulsation, and the finger feels only gradual moisture and warmth, then the bleeding is venous. If there is no clear sensation of blood flowing out, and the person providing assistance feels only sticky moisture on his hands, then the bleeding is capillary.
In case of a gunshot wound, the entire body is examined for bleeding, since it can be in both the entrance and exit areas.

8. If the bleeding is arterial, then it should be stopped immediately, since every second in such a situation can be decisive. Having seen a gushing stream of blood, there is no need to try to look for materials for a tourniquet and remember how to apply it correctly. You just need to stick the fingers of one hand directly into the wound from which blood is pouring and plug them into the damaged vessel. If, after inserting your fingers into the wound, the bleeding does not stop, then you should move them around the perimeter, looking for a position that will block the damaged vessel and thereby stop the bleeding. At the same time, when inserting your fingers, do not be afraid to widen the wound and tear some of the tissue, since this is not critical for the survival of the victim. Having found the position of your fingers at which the blood stops flowing, fix them there and hold them until you apply a tourniquet or perform tamponade on the wound.

For wound packing you need to find pieces of clean cloth or sterile dressings (bandages, gauze). Before packing the wound, the fingers pressing the vessel must not be removed! Therefore, if you are alone with the victim, you will have to tear him or your clean clothes with one hand, and squeeze the damaged vessel with the other, preventing blood from flowing out. If there is someone else nearby, ask them to bring the cleanest things or sterile bandages. Tear the items into long strips no more than 10 cm wide. To pack the wound, take one end of the fabric with your free hand and insert it deep into the wound, still holding the vessel clamped with your other hand. Then push several centimeters of tissue tightly into the wound, compacting it to form a kind of “plug” in the wound canal. When you feel that the fabric is above the level damaged vessel, remove your fingers pressing it. Then quickly continue to push the tissue into the wound, compacting it until you fill the channel all the way to the surface of the skin (see Figure 1). From this moment the bleeding is considered to have stopped.

Figure 1 – Wound tamponade to stop bleeding

Wound tamponade can be performed when it is localized on any part of the body - limbs, neck, torso, abdomen, back, chest, etc.

If there is arterial bleeding on an arm or leg, then after pinching the vessel with your fingers, you can apply a tourniquet. Any long object that can be wrapped around a limb 2-3 times and tied tightly, for example, a belt, tie, wire, etc., is suitable as a tourniquet. A tourniquet is applied above the bleeding site. A tight bandage is applied directly under the tourniquet or clothing is left on (see Figure 2). The tourniquet is twisted very tightly around the limb, compressing the tissue as tightly as possible. Having made 2 - 3 turns, the ends of the tourniquet are tightly tied and a note with exact time its imposition. The tourniquet can be left on for 1.5 – 2 hours in summer and 1 hour in winter. However, doctors do not recommend trying to apply a tourniquet to people who have never done this before, at least on a dummy, since the manipulation is quite complex, and therefore more often causes harm than good. That's why in the best possible way stops arterial bleeding is pinching the vessel with your fingers in the wound + subsequent tamponade.

Figure 2 – Application of a tourniquet

Important! If it is impossible to apply a tamponade or tourniquet, then you will have to compress the vessel until an ambulance arrives or the victim is taken to the hospital.

9. If venous bleeding, then to stop it you need to strongly compress the skin with the underlying tissues, thereby squeezing the damaged vessel. It must be remembered that if the wound is located above the heart, then the vessel is clamped above the point of damage. If the wound is located below the heart, then the vessel is clamped below the point of damage. While keeping the vessel compressed, it is necessary to tamponade the wound (see point 5) or apply a pressure bandage. Wound tamponade is the optimal method because it has high efficiency and does not require any special skills, and therefore can be used by anyone in critical situation. Tamponade can be performed on any part of the body, and a pressure bandage is applied only to the extremities - arms or legs.

To apply a pressure bandage you need to find a clean piece of fabric or sterile bandage that completely covers the wound, and any dense object with a flat surface (for example, a box, control panel, glasses case, bar of soap, soap dish, etc.) that will put pressure on the vessel . A bandage of dressing material is also needed, such as a bandage, gauze, pieces of clothing or any clean cloth. First, place a piece of clean cloth on the wound and wrap it with 1 - 2 turns of a bandage or dressing tape made from scrap materials (torn clothes, pieces of fabric, etc.). Then place a dense object on the wound and tightly tape it to the limb, literally pressing it into the soft tissue (see Figure 3).

Figure 3 – Applying a pressure bandage

Important! If it is impossible to either tamponade the wound or apply a pressure bandage, then you will have to compress the vessel with your fingers until the ambulance arrives or the victim is taken to the hospital.

10. If capillary bleeding, then just press it with your fingers and wait 3 - 10 minutes until it stops. In principle, capillary bleeding can be ignored by applying a bandage to the wound without stopping it.

11. If possible, one ampoule of Dicynone and Novocaine, Lidocaine or any other painkiller should be injected into the tissue near the wound to stop bleeding;

12. Cut or tear clothing around the wound;

13. If you fall out of a wound on your stomach internal organs, then they are simply carefully collected in a bag or a clean cloth and glued to the skin with tape or adhesive tape;

14. If there is any antiseptic solution, for example, Furacilin, potassium permanganate, hydrogen peroxide, Chlorhexidine, alcohol, vodka, cognac, beer, wine or any alcoholic drink, you should carefully wash the skin around the wound with it. However, you should not pour antiseptic into the wound! It is only necessary to treat the skin around the wound. If there is no antiseptic, then you can simply use clean water (spring water, well water, bottled mineral water, etc.). The simplest and effective way Such skin treatment is as follows: pour an antiseptic onto a small area of ​​skin and quickly wipe it with a clean piece of cloth in the direction from the wound to the periphery. Then pour over another area of ​​skin and wipe it either with a new clean piece of cloth or with a clean part of the cloth that has already been used once. Treat all the skin around the wound in this way;

15. If it is impossible to treat the wound, then this does not need to be done;

16. After treating the wound, if possible, you should lubricate the skin around it with brilliant green or iodine. Neither iodine nor brilliant green should be poured into a wound!

17. If you have Streptocide powder, you can pour it into the wound;

18. After stopping the bleeding and treating the wound (if possible), apply a bandage to it. To do this, cover the wound sterile bandage, gauze or just a piece of clean cloth. A layer of cotton wool or a small twist of fabric is applied on top. If the wound is located on the chest, then instead of cotton wool, apply a piece of any oilcloth (for example, a bag). Then all this is tied to the body with any dressing material (bandages, gauze, pieces of fabric or clothing). If there is nothing to attach the bandage to the body, then you can simply glue it with tape, adhesive tape or medical glue;

19. If there are prolapsed organs on the abdomen, then before applying a bandage they are covered with rolls of fabric and bandages. After which the bandage is applied over the rollers without squeezing the organs. Such a bandage on the abdomen with prolapsed internal organs should be constantly watered with water to keep it moist;

20. After applying the bandage, you can put ice in a bag on the wound area to reduce painful sensations. If there is no ice, then there is no need to put anything on the wound;

21. Place the victim on a flat surface (floor, bench, table, etc.). If the wound is below the heart, then elevate the victim's legs. If the wound is in the chest, then give the victim a semi-sitting position with legs bent at the knees;

22. Cover the victim with blankets or existing clothing. If the victim is not wounded in the stomach, give him something sweet. warm drink(if possible).

23. If blood has soaked the tamponade or dressing and is oozing out, it does not need to be removed or changed. In this case, another bandage is simply applied on top of the blood-soaked bandage;

24. If possible, take an antibiotic wide range actions (Ciprofloxacin, Amoxicillin, Tienam, Imipinem, etc.);

25. While waiting for an ambulance or transporting a victim to the hospital by any other means of transport, it is necessary to maintain verbal contact with him if the person is conscious.

Important! If you are wounded in the stomach, you should not give the person anything to eat or drink. You should also not give him any medications through the mouth.

Algorithm for providing first aid to a victim with a gunshot wound to the head

In today's turbulent world, you need to be prepared for any situation. And sometimes you just need to know a few simple rules that can save a person's life. This article should talk about what a gunshot wound is and what assistance can be provided to a wounded person before the ambulance arrives.

About terminology

At the very beginning, you need to understand the concepts that will be actively used in the article. So, a wound is damage to organs and tissues, which is accompanied by a violation of the integrity of the skin. Wounds are accompanied by pain, bleeding, separation of the edges of the damaged areas and, of course, often disruption of the normal functioning of the damaged part of the body. A gunshot wound is an injury caused by a firearm.

About types of wounds

It is also worth saying that a gunshot wound can be different. The first classification is depending on the presence of inlet and outlet openings:

1. Blind wound. In this case, the object that caused the injury gets stuck in the person’s body.
2. Through wound. In this case, the object that wounds the body passes through the tissue.

Second classification, depending on the subject of injury:

1. Injury to soft tissues - skin, muscles, nerve endings, tendons, blood vessels.
2. Bone damage.

The following classification is depending on the penetration of the wounding object:

1. Wound penetrating into the body cavity. In this case, the bullet penetrates the abdominal, cranial, articular and other cavities of a person.
2. A wound that does not penetrate the body cavity.

And the last classification is based on the mechanism of wound application. In this case, a distinction is made between cut, stab, chopped, bitten, scalped, crushed, bruised, lacerated and, of course, gunshot wounds.

First aid

Correctly provided first aid for a gunshot wound is very important. After all, sometimes it happens that before the ambulance arrives, a person can die, simply without waiting for the most simple actions from strangers. And everything happens because people most often simply do not know what is the right thing to do and what needs to be done to protect a person from death. How can you help a victim if he has a gunshot wound?

1. At the very beginning, the wound must be freed from clothing. This is necessary in order to evaluate it and understand how serious the bleeding is.
2. Next, it is imperative to stop the bleeding, even if it is insignificant at first glance. If there is not much blood coming out, you can simply raise the wound site so that it cannot leak out (if the limbs are injured). IN otherwise the bleeding site must be pinched with a finger (pressing the blood artery). Next, you need to try to apply a tourniquet slightly above the wound itself. If there is nothing suitable at hand, you need to tear off a strip of fabric from your clothing and firmly press the area above the wound.
3. Treatment of the wound. Only if the bleeding has stopped should you try to wash and disinfect the wound. For this, it is good to use alcohol or hydrogen peroxide. Next, the area around can be treated with iodine to avoid infection. And only after this can the wound be bandaged with a sterile bandage. All these medications should be available in any car first aid kit. So if a gunshot wound occurs, you should try to stop any car and ask the driver for a first aid kit.
4. If the bullet hits the bone (it is very difficult to determine this “by eye”), the site of the wound must be carefully recorded. So, you will need to apply a splint. Any available materials can be useful for this.
5. It is important to remember that a person with a gunshot wound cannot always be moved or transported independently. Sometimes a bullet damages internal organs in such a way that the slightest unskilled movement can greatly harm a person. So it is best not to touch the wounded person until the ambulance arrives. The only thing is that you need to try to protect it from hypothermia, overheating or rain.

Wounded limb

Separately, it is also necessary to talk about the dangers of gunshot wounds to the extremities. So, these are the most common wounds. In addition, they are very dangerous, because they are fraught with severe blood loss. Therefore, in the case of a gunshot to a person’s limb, at the very beginning you need to find the wound itself and do everything to stop the bleeding. By the way, by its color you can determine whether it is venous or arterial. Deoxygenated blood It has dark color. The arterial one is most often scarlet, and it also comes out of the wounded person’s body like a fountain. If the bleeding is venous, it is better to apply a pressure bandage rather than a tourniquet. In any case, it is worth remembering that all these auxiliary items can be applied to the body for no more than two hours (most often during this period of time the wounded person is already transferred to the hands of ambulance doctors). You also need to determine whether the integrity of the person’s bones is compromised. If a bone is broken, it must be immobilized. It is also worth remembering that if a person has a gunshot wound, he may suffer. In this case, you need to give it. If you don’t have one at hand, don’t panic. After a while, the wounded man’s consciousness will return. There is no need to hit the cheeks to bring a person to his senses.

Head wound

Probably the most dangerous is a gunshot wound to the head. After all, the survival rate in such cases is not too high - about 16%. But with such a wound, it is also necessary to provide assistance to the victim. Here it is worth saying that if a person is wounded in the face, there will be a lot of blood, since this is where multiple vessels are located. Loss of consciousness by a person does not mean his death; this is worth remembering. The order of steps for a head injury:

1. The wound should be covered with a sterile cloth. If it bleeds a lot, you can try to stop the bleeding with a cotton swab.
2. It is best for the human body to be positioned horizontally.
3. It is not worth transporting the wounded person yourself; it is better to wait for the ambulance to arrive.
4. If a person's heart has stopped, artificial respiration and cardiac massage must be performed.

Neck and spine

It’s not difficult to figure out what gunshot wounds look like; photos in this case are the first clues. So, in case of injury to the neck or spine, you must remember that the person should absolutely not be transported. The only thing is you need to put it on a hard surface. If your neck is bleeding, you need to try very quickly to stop the bleeding. After all, if it is punctured from blood loss, you can die within 15 seconds. So, you need to put a bandage on your neck. If it doesn’t help, you need to pinch the artery with your finger and remain in this position until the ambulance arrives.

Wound to the chest, stomach

Separately, you also need to consider a gunshot wound to the stomach and chest. So, at the very beginning, it must be said that the human body is divided into three main zones: pleural, abdominal and pelvic organs. If a person is injured internally, blood begins to accumulate in these areas. In this case, it is impossible to stop the bleeding on your own. Complications of internal organ injuries:

1. Pneumothorax. This is the entry of air into the pleural cavity through the gunshot site.
2. Hemothorax. This is the entry of blood into the pleural cavity.
3. Pneumothorax. This is the entry of air and blood together into the pleural cavity.

You can only try to prevent the entry of air. So, to do this, the wound needs to be covered with dense material or pressed with your hand.

Removing the bullet

As mentioned above, gunshot wounds are very dangerous to human life (photos of the wounded are the first confirmation of this). However, in some cases, if there is absolutely no way to get qualified medical care, you can try to remove the bullet yourself. But this must be done very carefully and only if the arrival of doctors is impossible for certain reasons. Algorithm of actions:

1. First, the one who will carry out all the actions prepares. Hands need to be treated with antiseptic.
2. The skin around the wound is treated with an antiseptic.
3. If possible, you should give pain relief to the wounded person. This could be the drug “Spazmalgon” or an ampoule of the drug “Novocain”. If this is not the case, a hard object should be given to the person’s teeth.
4. Using a knife, you need to slightly increase the size of the bullet hole. Next, treat everything again with an antiseptic.
5. Using treated tweezers, you need to try to get the bullet. One must try not to touch large blood arteries, as a person may die due to blood loss.
6. After the operation, the wound must be treated again and a bandage applied.

Expertise

If a person is injured, you need to call not only an ambulance (although it comes first), but also the police. Thus, a forensic medical examination of gunshot wounds will also be mandatory. It is designed to answer the following questions:

1. Nature of the injury.
2. Direction of the wound channel, shot.
3. The distance that was between the offender and the victim.
4. Type of weapon used.
5. Number of bullet wounds.
6. The sequence of inflicting bullet wounds (if there was more than one).
7. Whose hand caused the damage: your own or the hand of another person.

It is worth saying that the forensic medical examination of gunshot wounds gives the investigation multiple important answers to questions, thanks to which it can move several steps forward.

Arrival of doctors

It is very important in case of a gunshot wound. So, only specialists can provide that assistance to a person that can save his life. However, the importance cannot be diminished at all. After all, this can also save the life of the victim.

Application of a pressure bandage using PPI is carried out according to the algorithm.

The victim has a through gunshot (bullet) wound to the right shoulder.

Response standard

Demonstration of the technique of applying a T-shaped bandage to the perineum on a phantom according to the algorithm.

DAMAGE SYNDROME

Problem No. 7

While on duty, a security guard at a private enterprise was attacked and received a gunshot wound to the right shoulder.

Objectively: on the front surface of the middle of the right shoulder there is a moderately bleeding wound, irregularly rounded, on the back surface there is a similar wound of somewhat larger size with uneven edges. From the anamnesis it turned out that the victim was shot at a distance of about 30 m with a pistol. A paramedic was on duty at the health center of a neighboring enterprise, and the victim turned to him.

Tasks

1. Formulate a presumptive diagnosis and justify it.

2. Create an emergency algorithm first aid.

3. Demonstrate the technique of applying a pressure bandage to the shoulder using a customized dressing package as appropriate to the situation.

The conclusion is based on anamnesis (the victim was attacked) and an objective examination of the right shoulder (the presence of a through wound with entry and exit holes characteristic of a gunshot wound; bleeding from the wound).

2. Algorithm for providing emergency first aid:

A) visual inspection wounds;

b) cleaning the wound and applying an aseptic pressure bandage;

c) hang your hand on a scarf;

d) immediately inform the duty department of the Ministry of Internal Affairs by phone. 02 about what happened;

e) call an ambulance team.

Problem No. 8

A victim of an attack by a criminal armed with a knife was brought to the police station by the police.

Complaints: pain in the right half of the chest and right hand, weakness, dizziness.

Objectively: the condition is moderate, the victim is excited. Pulse 90 per minute, blood pressure 100/70 mm Hg. Art. The skin is pale, on the inner surface of the middle third of the right shoulder there is an incised wound - 2.5-3 cm, severe pulsating bleeding. On the anterior surface of the right half of the chest there are multiple incised wounds within the skin, minor bleeding.

Tasks

1. Formulate and justify the presumptive diagnosis.

2. Create and justify an algorithm for providing emergency care.

3. Demonstrate a technique for temporarily stopping arterial bleeding, as applied to this case, 2-3 ways (on a phantom).

1. Diagnosis: Incised wound of the right shoulder, with damage to the brachial artery. Hemorrhagic shock I degree.

The diagnosis was made based on:

a) medical history and complaints of pain, weakness, dizziness;

b) objective examination data: pallor, loss of integrity skin right shoulder with strong, pulsating bleeding.

2. Algorithm for providing emergency care:

a) to stop bleeding, you must first apply finger pressure to the brachial artery at the inner edge of the biceps muscle to the humerus, then apply a tourniquet above the wound, indicating the time of its application (place a pad under the tourniquet);

b) to relieve pain, administer 1-2 ml of 50% analgin solution intramuscularly;

c) apply an aseptic bandage to the shoulder wound to prevent infection;

d) immobilize the limb using a scarf to reduce pain;

e) clean the wound on the anterior surface of the chest to prevent infection;

f) call an ambulance for hospitalization in surgery department Central district hospital, for carrying out final stop arterial bleeding, PSO wounds, tetanus prevention;

g) transport the patient on a stretcher, in a supine position.

All manipulations are performed with gloves.