Incised forehead wound. How to deal with a head injury: emergency care and treatment

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Headband - "cap".

Sling-like bandage on the forehead.

Soft tissue injuries to the scalp are always dangerous. They can be accompanied by heavy bleeding, bone damage, brain contusion (concussion) or cerebral hemorrhage (hematoma), the occurrence of cerebral edema and inflammation of the meninges (meningitis, encephalitis). Signs of damage to the brain and bones of the skull, the development of inflammatory complications are headache, nausea, impaired vision and sensitivity of the skin of the extremities or weakness in them, an increase in body temperature, clouding of consciousness up to its loss.

Help: 1. Clean and wash the wound. A wound contaminated with soil or any other foreign object must be cleaned using tweezers or by hand. Then the wound is thoroughly washed with hydrogen peroxide or a weak solution of potassium permanganate (2-3 grains per glass, preferably boiled, water). You can wash the wound with tap water. With severe bleeding, first of all, it is necessary to stop the bleeding.

2. Treat the skin around the wound. Before treating the skin, it is necessary to cut the hair at a distance of two centimeters around the wound. Then gently smear the edges of the wound with a solution of iodine, brilliant green (brilliant green), a saturated solution of potassium permanganate or alcohol. In this case, alcohol is strictly not allowed to enter the wound.

3. Stop bleeding. When bleeding from a wound of the scalp, it is most effective to pack it with a sterile napkin or a sterile bandage. You can use gauze, cotton wool or any clean cloth. The swab is tightly pressed to the edges and bottom of the wound for 10-15 minutes. If the bleeding does not stop, then a pressure bandage is applied to the tampon inserted into the wound.

4. Apply a bandage (preferably sterile). Applying a bandage on the wound of the scalp is carried out as follows: tear off a piece (tie) about 1 m in size from the bandage, put it on the top of the head, the ends are lowered vertically down in front of the ears; the patient himself or one of the assistants keeps them taut. The tour of the bandage starts from the left side at the level of the forehead, goes to the right side back to the back of the head, thus making two rounds with the obligatory fixation of the first round. The third round of the bandage is wrapped around the string either on the left or on the right, so that it overlaps the previous round of the bandage by 1/2 or 2/3. Each subsequent tour leads higher and higher until the entire scalp is bandaged. The last round of the bandage is tied to the remaining vertical part of the tie from either side. The vertical ends of the tie are fixed under the chin.

5. Apply cold. Cold is applied to the bandage in the wound area. Cooling the injured area reduces bleeding, pain, and swelling. You can apply an ice pack, ice wrapped in a plastic bag filled with cold water a heating pad or a cloth dampened with cold water. As it warms up, the ice is changed. As a rule, it is enough to keep the cold at the site of injury for 2 hours, proceeding as follows: 15-20 minutes the cold is kept at the site of injury, then it is removed for 5 minutes, and a new portion of ice is applied again for 15-20 minutes, etc.

6. Consult a doctor. External signs head injuries do not always reflect the condition of the victim. Invisible internal damage is fraught with danger to the life of the victim. You can not delay in contacting a doctor. In all cases of head injury, seek medical attention without delay.

Morphological features of some bodily injuries (principles of description). Educational guidelines for students and interns / ed. N.S. Edeleva. - Nizhny Novgorod, 1991.

A forensic medical expert and a clinician should be fluent in describing injuries in order to objectify the diagnosis, resolve questions about the instrument, mechanism, and prescription of the injury. The foregoing determines the feasibility of issuing these guidelines to assist the student, intern, aspiring medical examiner, and clinician. They will also be useful to employees of law enforcement agencies - police, prosecutors and courts.

Methodological recommendations "Morphological features of lesions (principles of description)" were compiled by a team - the head of the department, Doctor of Medical Sciences N.S. Edelev, associate professors E.G. Kolpashchikov and S.A. Volodin, assistant candidate of medical sciences L.I. Zaitseva-Ilyinogorskaya, assistants V.N. Barulin, A.D. Kvasnikov, I.P. Kraev, S.V. Pukhov and S.O. Ukhov.

Morphological features of some bodily injuries (principles of description)

bibliographic description:
Morphological features of some bodily injuries (principles of description) / Edelev N.S., Kolpashchikov E.G., Volodin S.A., Zaitseva-Ilyinogorskaya L.I., Barulin V.N., Kvasnikov A.D., Kraev I. .P., Pukhov S.V., Ukhov S.O. — 1991.

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/ Edelev N.S., Kolpashchikov E.G., Volodin S.A., Zaitseva-Ilyinogorskaya L.I., Barulin V.N., Kvasnikov A.D., Kraev I.P., Pukhov S.V. , Ukhov S.O. — 1991.

embed code on the forum:
Morphological features of some bodily injuries (principles of description) / Edelev N.S., Kolpashchikov E.G., Volodin S.A., Zaitseva-Ilyinogorskaya L.I., Barulin V.N., Kvasnikov A.D., Kraev I. .P., Pukhov S.V., Ukhov S.O. — 1991.

wiki:
/ Edelev N.S., Kolpashchikov E.G., Volodin S.A., Zaitseva-Ilyinogorskaya L.I., Barulin V.N., Kvasnikov A.D., Kraev I.P., Pukhov S.V. , Ukhov S.O. — 1991.

Foreword

The need to publish methodological recommendations "On the morphological features of some bodily injuries" is due to the lack of a clear scheme for describing bodily injuries in the educational literature on forensic medicine and clinical traumatology.

At the same time, as practice shows, not all injuries on the body of a traumatic patient are not only described in detail, but are not always fully recorded in medical records. Clinicians, as a rule, explain this circumstance by the urgency of providing medical care to the victim, when, in their opinion, it is inappropriate to make a detailed description of the injuries (the health and life of the patient sometimes do not depend on this), and even more so to detain attention in general to minor " minor" damage that does not affect clinical course main injury. Often, clinicians generally refuse to describe the injury (only a diagnosis is given), citing a lack of time in general. Meanwhile, the characterization of all manifestations of trauma in the aggregate is of decisive importance in solving many important issues, including for a forensic medical expert - about the instrument, mechanism and prescription of injury, the sequence of infliction of injuries, etc. It is well known that teachers of a number clinical departments train the future doctor to diagnose and treat trauma, but, unfortunately, they do not introduce the principles of describing bodily injuries. That is why attending physicians often substitute diagnostic concepts for data on the morphological features of a particular injury. Therefore, to resolve this significant disadvantage in the teaching of some provisions of forensic and clinical traumatology and the main essence of these recommendations is directed.

As noted above, the main issues of forensic medical examination of bodily injuries are the definition of the instrument, prescription and mechanism of injury. The solution of this problem is carried out in a complex, as a rule, in several stages using special laboratory and instrumental research carried out in various divisions of the forensic medical service. A certain role in this is played by clinicians (surgeons, gynecologists, traumatologists, radiologists, etc.), who are usually the first to meet with victims who have some kind of mechanical damage. In this case, the attending physician needs to fully and objectively describe the morphological features of the damage, because after some time the initial appearance of it can change significantly after the treatment. surgical care, further healing, etc. Not infrequently, a forensic medical expert, when performing an examination, deals with changes in appearance(for one reason or another) injuries, for which it is not possible to make a specific judgment about the tool, mechanism and prescription of the injury due to defects in the description of the injury. In general, the clinician must remember that the diagnosis of trauma should always be objectified by the signs of this or that injury, and not be replaced by diagnostic (even if correct) concepts. If there is no such description in the submitted medical documentation, then the forensic medical expert does not have the right to take into account the diagnosis, and even more so to determine the instrument and mechanism of injury, the period of its infliction. Thus, every clinician needs to know the principles of damage description and be able to apply this knowledge in appropriate cases, both in examining a patient with damage, and in forensic medical examination corpse or living person for injuries when he is involved as an expert doctor.

Naturally, a forensic medical expert must be able to perfectly describe injuries during the examination of a corpse or a living person (victim, accused, etc.) and critically and correctly assess the description of injuries, the validity of the clinical diagnosis of an injury recorded in the medical documentation submitted for examination.

1. GENERAL PROVISIONS

Bodily injury should be understood as any violation of the anatomical integrity or physiological function organs, tissues and systems of the body caused by mechanical, thermal, chemical, infectious, mental and other factors.

Injuries, as pathological phenomena, are extremely diverse, in one way or another they always cause harm to the body, disrupting its health and ability to work, often leading to death.

During a forensic medical examination regarding bodily injuries, the following must be reflected without fail:

• - the nature of the damage (diagnosis) - abrasion, bruising, wound, dislocation, bone fracture, separation, rupture, crush, etc.; their localization and properties;
• - type of weapon or means by which damage could be caused;
• - the mechanism of occurrence of damage;
• - prescription (term) of causing damage;
• - the severity of bodily injuries, indicating the qualifying sign.

In cases of death, it is necessary to establish a causal relationship between death and injury.

As for mechanical damage, they arise from the action of a tool (weapon) in relation to a person, as well as the movement of the person himself, followed by contact with an immovable object (tool, weapon).

There are three main types of mechanical damage - blunt, sharp, gunshot.

A blunt instrument can cause injury, both functional and anatomical. The latter include abrasions, bruises, bruised and bitten wounds, dislocations, bone fractures, ruptures, crushing and avulsions. internal organs.

When exposed to a tool, cut, stab, stab-cut, chopped damage occurs.

As a result of the action of firearms, corresponding specific injuries take place. Regarding each of the indicated injuries, when describing them in medical or forensic documentation, the doctor (clinician or forensic physician) should most fully and objectively note the characteristic signs and features. These include:

• - View. Medical definition of damage (wound, abrasion, bruising, fracture, dislocation, detachment, etc.);
• - Localization. In addition to indicating the area of ​​the body in which the damage is located (for example, “on the anterior surface of the left half of the chest”), the distance from the damage to the nearest known anatomical points along the system of rectangular coordinates should be noted (for example, “at a distance of 5.0 cm down from lower edge of the clavicle and 7.0 cm to the left of the edge of the sternum").
  In some cases, in particular, in case of gunshot, stab and stab wounds, in traffic accidents, etc., when the question of the mechanism of injury usually arises, it is necessary to determine the height of the location of the damage from the level of the plantar surface of the corresponding foot;
• - Direction. It is necessary to indicate the position of the length of the damage relative to the longitudinal axis of the body (it is desirable to determine the angle of deviation in degrees) - vertical, oblique, horizontal, in two directions, etc. It is advisable to orient some damage on the clock face (with the center at the midpoint of the light) .
• - The form. Applied to geometric shapes(for example, “irregularly oval bruise”, “rectilinear scratch”, etc.) or well-known objects (for example, “three-beam wound”, “crescent-shaped abrasion”, etc.). It cannot be noted that injuries (abrasions, bruises) have an irregular shape, this does not exist at all;
• - Color indicating both the main background and shades (for example, “a bruise is red-violet in the center and yellow-green along the periphery”).
• - Dimensions. The length and width of the lesions are given in centimeters or millimeters. It is not allowed to determine the size by eye and compare with the size of any objects (for example, with a coin, pea, egg, etc.). With stab-cut, cut and chopped wounds, no tissue defect is formed and therefore the damage has only one size - the length measured when the edges are joined. The second size, mistaken for the width, characterizes the degree of gaping of the wound, due to the location of the elastic fibers in this area of ​​the body;
• - Edge condition wounds (smooth, uneven, with small or large flaps, with notches, with jumpers; swelling, hemorrhage, sedimentation in the circumference, their location and nature);
• - End condition wounds (acute-angled, rounded, "T"-shaped, with notches and scratches; sedimentation and hemorrhage in the circumference);
• -Bottom(moist, drying, crusty - above, below or at the level of the skin, color);
• - Specific deposits and contamination(tightly adhering or falling off crusts of pus, blood, interstitial fluid, their location in relation to the surrounding skin; exogenous pollution, soot, unburned gunpowder grains, lubricating oils, dyes, earth, sand, rust, etc., their location and character).

Another important circumstance should be noted: it is necessary to indicate the exact number of injuries of one type or another in the victim. Such an account as “many”, “uncountable”, “single”, etc., is not allowed; it is required to clearly name the number of abrasions, bruises, wounds, etc.

It is well known that during a forensic medical examination of a corpse and living persons, a thorough examination and description of clothing is mandatory. Therefore, in case of death from an injury in medical institutions, along with the corpse, the clothes that were on the body of the victim at the time of the injury should also be sent to the morgue. The same applies to victims with certain injuries who were admitted to a hospital for treatment, if they also have corresponding damage to their clothes. At the same time, the clothes must be described, packed in a wax paper bag and marked with the full details of the patient (corpse) and the case history number. Clothing must be issued to law enforcement officers against a receipt, which is attached to the medical history.

Damage and characteristic soiling on clothing are taken into account when resolving many issues that arise in expert practice:

• - when injuries (for example, wounds on the body) are surgically treated and do not contain information necessary to judge the features of the injury instrument, or the wounds are in varying degrees of healing, and the description of the initial type of injury in the medical history is not complete enough;
• - in case of gunshot wounds inflicted through clothing, traces of a shot from close range remain on the latter (the so-called by-products - flame, gases, soot, unburned gunpowder grains), while they may be absent in the area of ​​​​the inlet on the skin; in such cases, a judgment on the distance of the shot can only be made after examining the clothes;
• - in case of traffic accidents, when clothing may show traces of vehicle parts in the form of damage (tears, slip marks, friction, etc.), as well as characteristic deposits (lubricating oils, metals, sand, slag, etc.);
• - in case of electrical injury, when traces of the metal of the electrical conductor can be detected on clothing.

Similar to injuries on the body, when examining clothes, the nature, localization, shape, size and other features of cuts, tears, defects, as well as characteristic dirt and other traces are noted in detail. When determining the location of the damage, the distance to it is measured from certain parts of the clothing - seams, edges, sides, etc. (according to the system of rectangular coordinates). On the different subjects clothes, it is desirable to use the same identification points.

Along with this, the clinician must remember that the edges of wounds excised during the primary surgical treatment and any other objects removed from the body of the victim during the operation should be stored, inform the investigator about this, who can send them for appropriate research to the forensic medical unit. or crime lab.

2. MORPHOLOGICAL FEATURES OF MECHANICAL DAMAGE

1. Damage from a blunt instrument

A blunt instrument usually compresses tissues and organs. If the impact is not large in strength, there may not be any traces left. As pressure increases, a blunt instrument begins to crush, tear and displace tissues, especially when they are located on a solid base (bones). In cases of integrity skin(the skin is relatively resistant to compression and stretching to a certain extent), only rupture of the subcutaneous vessels can be observed, and bruising occurs. If the skin, subcutaneous tissue and underlying tissues are torn, a wound is formed. An increase in load leads to damage to internal organs and bones, up to ruptures, crushing and separation.

a) an abrasion.

Abrasion is a violation of the integrity of the surface layer of the skin, capturing the epidermis and often the adjacent part of measles to the papillary layer. In this case, the epidermis at the site of damage exfoliates and is often absent. If only the epidermis is damaged, a superficial abrasion occurs, and if both the epidermis and the corium are damaged, a deep abrasion is formed, which may even be accompanied by bleeding from damaged vessels. The latter circumstance often makes it difficult to differentiate between an abrasion and a wound. It must be remembered that after the healing of the latter, a scar always forms, which never appears in place of a healed abrasion. One more circumstance should be noted: abrasions often occur along the edges of bruised wounds.

The shape of abrasions is the most diverse: crescent, oval, round, irregularly rectangular, star-shaped, etc.

As already noted, in the deposited area, the epidermis is partially or completely absent with an adjacent layer of corium. Therefore, at the beginning, the bottom of the abrasion is always below the level of the surrounding intact skin. Then, at the site of the abrasion, a crust forms, usually dry, brownish. It should be noted that the crust is a characteristic indicator of the lifetime of an abrasion.

During the abrasion, four stages are noted, the knowledge of which allows you to establish the prescription of its origin:

• - up to about 12 hours after the injury: the bottom of the abrasion is below the level of intact skin, the surface is slightly moist at first, with deep abrasions with a layer of gradually drying blood;
• - from 12 to 24 hours (occasionally up to 48 hours): dried, brownish with a reddish tint, the bottom of the abrasion begins to grow, as it were. Its level is compared with the surrounding skin, then becomes higher. It turns out a typical crust, characteristic of a lifetime abrasion;
• - from 3 to 10 days: from 3-4 days, the crust begins to peel off along the periphery, and disappears on days 7-12;
• - from 7 to 15 days, occasionally more. The surface at the site of the fallen crust with a deep abrasion is initially pink and smooth, gradually approaches in appearance to the neighboring areas of the skin, and any trace of the former abrasion gradually disappears.

Often, abrasions are inflicted posthumously. At the same time, the surface, devoid of the stratum corneum, dries up, a somewhat deepened yellowish-gray or brownish bottom appears, sometimes with a reddish tinge from translucent vessels (“parchment spots”).

b) Bruising.

From a blow or pressure with a blunt object, vascular rupture often occurs, the outflowing blood penetrates the surrounding tissues and impregnates them, forming a bruise. If a cavity filled with blood is formed (under exfoliated skin or between muscles, between the membranes of the brain, under the periosteum, etc.), then it is called a hematoma.

Bruising can be superficial or deep. The first ones are usually located in subcutaneous tissue.

Translucent through the skin, bruises first give it a weak, then a pronounced purple-blue color. If the bruise is localized in the corium, then the color of the bruise is purple. Depending on the amount of blood at the site of staining, there may be swelling, induration, and pain on palpation. Superficial bruises, especially in loose tissue, where blood is easily poured out, are noticeable after 20-30 minutes, and their intensity and area increase while the blood is poured out.
Initially (the first 2-3 days), deep bruising may not be detected. However, the coloring matter of the blood diffuses and later stains the skin more often immediately in a greenish or yellow color.

The shape of the bruise from various tools is most often oval. This is explained by the fact that the pressure of the outflowing blood is the same in all directions, and the resistance of the surrounding tissues is uneven, always less along the main mass of tissue cells and fibers and more in the transverse direction. Occasionally, bruising can clearly reproduce the shape of the striking surface (belt buckle, iron chain ring, etc.).

The initial color of the skin from translucence of the poured out blood is purple-blue; over time, the color changes: the bruise, as they say, “blooms”.

The most typical transition of the initial blue-purple color of the bruise to green, green to yellow, and yellow, gradually weakening, disappears. However, bruises (hemorrhages) on the mucous membrane of the eyelids, in the white of the eyes, on the mucous membrane of the lips do not change color, their purple-reddish color turns pale and disappears.

There are usually no traces left at the site of the bruise, but sometimes brownish pigmentation persists for a while.

The “flowering” of a bruise depends on changes in the blood pigment. The poured out blood quickly coagulates, the separated serum is soaked up. Depending on the breakdown of hemoglobin, the blue-purple color of the bruise can turn green if the formation of biliverdin dominates, and yellow if bilirubin is formed.

The blue-purple color of the bruise turns into green, usually 4-8 days from the moment of the incident, and then after another 5-7 days - into yellow, after which it gradually disappears.

c) Wounds.

A wound is a damage to the skin and visible mucous membranes, penetrating into the subcutaneous fat (or submucosal) tissue and deeper. Unlike abrasions, as already noted, wounds heal with the formation of a scar.

Wounds (bruised, torn, torn-bruised) have very characteristic edges, ends and wound surface.

So, the epidermis along the edges for a greater or lesser extent is partially or completely absent, the line of such sedimentation is uneven. The edges of the wound, that is, the skin with subcutaneous tissue, and sometimes the muscles, are uneven, crushed, saturated with blood, sometimes exfoliated from the underlying bones or fascia. The ends of the wounds can be extremely diverse, often they are of an indefinite appearance, sometimes they can be acute-angled. The bottom of the wound is uneven. In the circumference of the wound, as a rule, there is a significant bruising. Between the edges, especially in the area of ​​​​the ends, as a rule, thin, thread-like jumpers are found, formed by the most stable elements of the underlying tissues, more often bundles of connective tissue fibers.

d) Bone damage.

Damage to the bones as a result of the action of a blunt instrument is presented in the form of incomplete (cracks) and complete, closed and open, simple and complicated, multifragmented fractures. In case of damage to the bones of the skull, the following features should be noted: if the blow is applied perpendicularly, a fracture is formed in the form of cracks that diverge evenly along the radii. If the impact is applied at an angle in a certain direction, then it dominates among the outgoing cracks.

With a significant impact force of a blunt object with a small surface (9-16 cm 2), the corresponding area is knocked out or pressed into the bones of the skull, reproducing in general the shape and dimensions of the impacting surface. Fractures of the skull at a distance from the site of injury occur under the action of a large force and the presence of a wide impact surface due to a change in the configuration of the skull.

When the blunt-faced tool is improperly deepened, terrace-like fractures occur, while the impression in the bones of the skull forms a slope, sometimes consisting of two or three steps rising one above the other, forming a "ladder". Stepped impressions indicate the action of a blunt object at an angle.

2. Damage with a sharp tool.

As you know, sharp objects include: cutting (razor, knife, glass shard, ax, etc.), stabbing (awl, fork, pitchfork, nail, knitting needle, etc.), chopping (axe, hoe, checker , saber, shovel, etc.). piercing-cutting (knife, dagger, glass shard, etc.) tools.

Sharp tool - an object with a sharp blade or sharp end; possible tools that have a sharp blade and point. When exposed to such objects, cut, chopped, stab and stab-cut injuries occur.

a) cut wound.

For an incised wound, a rectilinear or arcuate shape is very characteristic. As a rule, the damage gapes, having, at the same time, a spindle-shaped form. Only when the edges approach each other, the wound acquires its true (original) shape and size. The edges of the incised wounds are even. A flat surface is also inherent in the side walls of wounds. It is clearly visible throughout the muscles, blood vessels and cartilage when they fall into the cut. The length of incised wounds, as a rule, exceeds the width and depth, and the cross section has the shape of a wedge (when the wound gapes) or a rectilinear slit (if the edges are close together). The ends of the damage are acute-angled, sometimes from the end of the wound, more often where the incision ends, a thin incision departs.

The depth of the wound is not the same throughout: it decreases according to the direction of extraction of the blade from the tissue.

b) Chopped wound.

Chopped wounds usually capture not only soft tissues, but also the underlying bones. These injuries, like incised wounds, rectilinear or arcuate, gape due to the divergence of the edges, the latter are usually even and smooth, the shape of the ends depends on the active part of the chopping tool (axe, cleaver, ax, etc.), and can be acute-angled, "Th>," M "-shaped. The blade of a chopping tool, penetrating into the bone, acts like a wedge. If the blade penetrates deeply, and its cross section grows significantly as it deepens, then cracks appear at the ends of the cut, fractures along the edges, and with repeated blows, comminuted fractures resembling damage from a blunt tool.

c) stab wound.

Stab injuries have a puncture wound and a wound channel going deep; occasionally there is also an exit hole. The nature of stab wounds on the skin is determined by the part of the damaging object that immediately follows the sharp end. Under the action of a cylindrical-conical object, due to the elastic properties of the skin, a slit-like wound is formed with ends similar to acute-angled ones, sometimes the damage can be raw along the edges. In flat bones, a sharp-conical tool causes the appearance of a hole, the shape and dimensions of which reproduce the cross section of the traumatic object.

The type of skin wound from a pointed tool with edges is determined by the latter, since tissue cuts with sharp ribs are attached to the splitting action of the cone (cylinder), as a result of which stellate wounds are formed, more often of a three- and four-beam shape.

d) Stab wound.

Penetrating into tissues, a piercing-cutting tool (knives and daggers) pierces and cuts them, and a stab-cut injury is formed, which has a wound at the injection site and a channel going deep. The wound has smooth edges and acute-angled ends (under the action of a dagger) “M”, “Th>-shaped, rounded and acute-angled (under the action of a knife) ends. As a rule, the wound is a broken line in the form of an obtuse angle, formed due to the main (as a result of immersion of the injection) and additional (when the blade is removed) incisions. The length of the main cut is used to judge the maximum width of the blade of the tool throughout the submerged part to the level of submergence. In a stab-cut skin wound - one size (length), determined by closing the edges. Under the action of the knife, the part of the skin wound adjacent to the butt end is the main size. When exposed to a dagger, it is possible to determine the localization of the main incision only when using special methods research (see guidelines "Laboratory research methods for forensic medical examination of mechanical damage" - Gorky, 1990). In this case, it is only necessary to indicate the dimensions (the length of the main and additional incisions, the depth of the wound channel).

3. Gunshot injuries.

The inlet gunshot hole, as a rule, is round or oval, characterized by a tissue defect (“minus” tissue). This trait is easily determined by the formation skin folds arising when trying to close the edges of the wound. The edges of the hole are even or finely scalloped with belts of wiping and sagging (in fact, they merge with each other and represent a grayish ring 0.1 to 0.3 cm wide). With the so-called "close" shot in the area of ​​​​the inlet gunshot hole, by-products of the shot can be determined - the action of the flame (singing the ends of the hair), gases (as a rule, the mechanical, thermal and chemical effects of gases occur with the so-called shots at partial stop), soot and unburnt grains of gunpowder. In this case, it is necessary to measure the area and indicate the form of distribution of soot and gunpowder grains. This is advisable for the subsequent decision on the issue of the distance of the shot. In case of a shot wound, it is necessary to ascertain the number of inlets, the distance between them and the area of ​​dispersion in order to formulate conclusions about the distance of the shot. A shot at a geometric (full) stop is accompanied by the formation of a "punching mark" in the form of an abrasion, bruise or superficial bruised wound around the hole. The wound channel in the body can be through and ends with an outlet, in fact, representing a laceration. They represent a specific feature of bone tissue damage. In flat bones, a rounded inlet is formed, equal in diameter to the pool. Towards the exit, the hole expands; on the opposite plate it is always larger. In general, the bullet hole of a flat bone has the characteristic shape of a truncated cone with the apex facing the entrance.

Application 1.

DAMAGE DESCRIPTION DIAGRAM

A. General characteristics

1. VIEW - wound, abrasion, bruising, fracture, dislocation, detachment, etc.
2. LOCALIZATION - distance along the system of rectangular coordinates from anatomical points, as well as from the sole of the foot.
3. DIRECTION - vertical, oblique (relative to the longitudinal axis of the body), horizontal, in two directions to etc., orientation on the hour dial.
4. VALUE - for bruises, abrasions, wounds with tissue defects (for example, gunshot wounds) - two sizes, for linear wounds (cut, bruised, chopped, stab-cut, stab wounds) - one size; for round wounds (damage) - diameter.
5. SHAPE - respectively geometric: rounded, square, oval, triangular, rectangular, three-beam, striped, irregularly rounded, irregularly triangular.
6. REACTIVE CHANGES - redness, swelling, purulent discharge, emphysema (intensity, prevalence).
7. SPECIFIC POLLUTIONS - blood, soot, gunpowder grains, lubricating oils, etc. (intensity, color, area, shape, direction).

B. Detailed characteristics.

1. WOUND - edges: even, uneven (finely serrated, wavy, scalloped, etc.), furrowed, crushed, etc.; ends: acute-angled, rounded, "M" - and "T"-shaped with upsetting, tears, notches, etc.; bottom: tissue bridges, broken bones, crushed tissues, foreign inclusions.
2. ATTRACTION - bottom: moist, drying, covered with a crust (above, below, at the level of the surrounding skin), color.
3. BRUISED - color in the center and on the periphery, clarity, blurring of the contour, swelling along the length and in the circumference, etc.
4. FRACTURE - shape, direction of the edge (bevel, overhang), displacement, fragments (shape, position, etc.), damage to surrounding tissues.

Appendix 2

DAMAGE DESCRIPTION SAMPLES.

1. Bruised wound.

On the skin of the right parietal region, 1.5 cm above the auricle, there is an irregularly triangular lesion in the form of three rays extending from an imaginary center. The first ray is directed upwards and backwards towards the back of the head, its length is 2.5 cm; the second goes anteriorly in the direction of the forehead, its length is 2.0 cm; the third is directed downward auricle, its length is 2.2 cm. The upper edges of the first and second rays, the left of the third are beveled, and the opposite ones are undermined. The edges of the wound are not even, with small tears, the underlying soft tissues are crushed, fringed with many dotted bluish-black inclusions. In the depth of the wound, closer to the ends, there are transverse tissue bridges (bridges). The wound gapes slightly, exposing the underlying intact bone.

2. Bumper fracture.

In the middle third of the left femur, at a distance of 82 cm from the plantar surface of the corresponding foot, there is a comminuted fracture. The line goes from back to front somewhat obliquely from top to bottom and in the middle of the bone is divided into two, the first goes up at an angle of about 45 ° to its length, the second - at an angle of about 30 ° down. The fracture lines form an irregularly triangular bone fragment measuring 4.0×0.5 cm. The edges of the bone fragment are coarsely serrated. At 1.5 cm short of the point of splitting of the fracture line, a filiform tortuous crack 2.5 cm long extends upward at an angle of about 40°.

3. Stab wound.

On the skin of the chest on the left, 7.0 cm below the middle of the clavicle, 8.0 cm to the left of the midline of the sternum and 147.0 cm from the plantar surface of the corresponding foot, there is a linear wound in the form of a 120° obtuse angle), open up and to the right ; the upper side of the wound is 3.0 cm long, the lower side is 1.5 cm. Its edges are even, the upper end is acute-angled, the lower one is "L"-shaped. The width of the wound in the region of the lower end is 0.1 cm. No specific impurities and inclusions were found in the edges and ends of the wound. The wound moderately gapes, penetrates through all layers of the anterior chest wall into the pleural cavity.

4. Entrance gunshot damage (shot at geometric emphasis).

On the skin of the chest on the left, 10.0 cm below the middle of the clavicle, 7.0 cm to the left of the midline of the sternum and 152.0 cm from the plantar surface of the corresponding foot, there is a wound of a rounded shape with a diameter of 0.9 cm, with a smooth edge and an annular stripe wide from 0.1 cm at the lower pole to 0.2 cm at the upper one in the form of an area of ​​the missing superficial layer of the skin (girdle of sedimentation). Around the wound there is a rounded area of ​​depression 2.7 cm in diameter and up to 0.2 cm deep. The surface of the depression is covered with gray-brown contamination in the form of a mottled pattern.

5. Gunshot bullet wound of the skull.

On the frontal brush on the right, 6.0 cm above the middle of the superciliary arch and 176.0 cm from the plantar surface of the corresponding foot, there is a through damage of a rounded shape with a diameter of 0.9 cm with a smooth edge. From the side of the inner bone plate around this hole, there is chipping of the bone substance with a diameter of up to 1.5 cm, the edge of the damage is wavy. Thus, the wound channel in the bone has the form of a truncated cone, expanding and the side of the inner bone plate.

6. Damage caused by technical electricity (“Electric Tag”).

On the skin of the outer-lateral surface lower third right forearm, 2 cm above the wrist joint, in the vertical direction there is an injury in the form of an oval-extension abrasion measuring 5x1.7 cm. Its edges are uneven, wavy lines along the mud. The bottom is grayish-white, deepened, dense, the surface layer of the skin is absent in places, raised in places and exfoliated to the periphery. There are no signs of redness and hemorrhages in the area of ​​damage and in the surrounding skin.

7. Strangulation furrow.

On the neck of the corpse there is a single, obliquely ascending from front to back, open strangulation furrow, interrupted on the back surface. On the front surface of the neck, it runs horizontally in the projection of the upper edge of the thyroid cartilage. Then its branches pass to the lateral surfaces of the neck in an upward and backward direction at angles mandible. On the left, the furrow is located 1 cm below the angle of the jaw and 3 cm below the earlobe, on the right, 0.5 cm and 2.5 cm, respectively. Further, its branches pass to the back surface, go up to hairy part heads and lose their mark. With a mental continuation of the branches of the furrow, they are connected at an obtuse angle of about 100 ° in the region of the occiput. The bottom of the furrow is brownish-gray, deep, dense, smooth, with the surface layer of the skin confused in places in the form of small whitish scales. The width of the furrow ranges from 0.7 to 0.5 cm. Its greatest depth, up to 0.4 cm, is expressed in the anterolateral parts of the neck. There is an overhang of the marginal skin ridges, especially the upper one, and small dotted dark red scattered hemorrhages in them and along the bottom of the furrow.

Non-gunshot trauma to the soft tissues of the face is 40-50%.

Classification of injuries of soft tissues of the maxillofacial region.

I group. Isolated damage to the soft tissues of the face:
- without violation of the integrity of the skin or oral mucosa (bruises);
- with violation of the integrity of the skin of the face or mucous membrane (abrasions, wounds).
II group. Combined damage to the soft tissues of the face and bones of the facial skull (with or without violation of the integrity of the skin of the face and mucous membranes).
The nature of soft tissue damage depends on the impact force, the type of traumatic agent and the location of the damage.
bruises
They occur with a weak blow to the face with a blunt object, while the subcutaneous fat, muscles and ligaments are damaged without breaking the skin. As a result, a hematoma (hemorrhage) and post-traumatic edema are formed. The hematoma lasts 12-14 days, gradually changing color from purple to green and yellow.
Abrasion
It occurs when the integrity of the surface layers of the skin is violated, which does not require suturing. It is most often observed in the chin, zygomatic bone, nose and forehead.
Wound
It is formed when the skin is damaged when struck with a sharp or blunt object with sufficient force, which violates the integrity of the skin.
The wound may be:
- superficial (damaged skin and subcutaneous tissue);
- deep (with damage to muscles, blood vessels and nerves);
- penetrating into cavities (nose, mouth, paranasal sinuses);
- with or without tissue defects;
- with damage (or without) bone tissue;
- cut, chipped, chopped, torn, torn-bruised, bitten, depending on the type and shape of the injuring object and the nature of tissue damage.
Clinical characteristics

Features of the anatomical structure of the maxillofacial region and injuries of the soft tissues of the face.

Rich vascularization (good healing and danger of heavy bleeding).
- Rich innervation (possible pain shock, loss of sensitivity, paralysis of mimic muscles).
- Availability salivary glands, tongue, large vessels and nerves (impaired function of swallowing, eating - chewing, difficulty speaking. When the parotid-chewing region is injured, salivary fistulas are formed, when injured facial nerve- paresis of mimic muscles).
- The presence of a false defect (gaping of the wound due to contraction of mimic or chewing muscles).
- Violation of the hermeticism of the oral fissure, as a result of which there is constant salivation (loss of fluid and nutrients) and the inability to take ordinary food.
- Rupture of the oral mucosa due to its damage to the teeth.
- Disfigurement with a significant gaping of the wound (discrepancy between the type of the wounded and the degree of damage).
- There may be a true defect in the tissues of the nose, lips, ears, etc., leading to disfigurement and functional impairment.
- Development of contractures of the jaws in the long term.

Local complaints

They depend on the type of damage.
bruises- Complaints of pain, swelling, bluish bruising. They arise as a result of damage to the subcutaneous fat and muscles without breaking the skin, which is accompanied by crushing of small-caliber vessels, imbibition of tissues with blood.
abrasions- Worried about skin damage or OSM. Pain due to a violation of the integrity of the surface layers of the skin (epidermis) or mucous membrane.
incised wound- the patient complains of trauma to the skin, accompanied by bleeding and pain. There is damage to the entire thickness of the skin or oral mucosa, dissection of blood vessels, fascia, muscles, loose fiber, nerve trunks.
stab wound- Complaints of minor damage to soft tissues, moderate or heavy bleeding, pain at the site of injury. There is the presence of an inlet and a wound channel, profuse bleeding when large vessels are injured.
chopped wound- the patient notes extensive damage to soft tissues, accompanied by profuse bleeding (possibly damage to the bones of the facial skeleton).
Laceration- the presence of a wound with uneven edges (possibly with the presence of flaps and soft tissue defects), severe hemorrhages, moderate or severe bleeding, pain.
bruised wound- the presence of a wound, hematoma, hemorrhage, the presence of flaps, tissue defects, the surrounding tissues are crushed.
bitten wound- the presence of a wound with uneven edges, the formation of flaps with imprints of teeth on damaged skin or on intact skin, there may be a tissue defect, bleeding, pain.

General complaints

Bruises, abrasions, bruised wound, bitten wound, laceration - common complaints are usually absent.
A cut wound, a stab wound, a chopped wound - complaints will depend on the severity of the damage: pallor of the skin, dizziness, weakness. Occurs due to blood loss.
History of injury. The injury can be industrial, household, transport, sports, street, in a state of alcoholic intoxication. It is necessary to find out the time of occurrence of the injury and the time of contacting a doctor. With late referral to a specialist or improperly rendered assistance, the frequency of complications increases.
Anamnesis of life. It is important to know concomitant or past diseases, bad habits, working and living conditions, which can lead to a decrease in the general and local defenses of the body, disruption of tissue regeneration.
General state. May be satisfactory moderate, hard. It is determined by the severity of the damage, which can be combined or extensive.

Local changes in damage to the soft tissues of the face

fresh damage

bruises- the presence of a bruise of a bluish-red color and tissue edema with spread to the surrounding soft tissues, palpation is painful.

abrasions- the presence of an injury to the surface layer of the skin or mucous membrane of the lips and oral cavity, petechial hemorrhages, hyperemia. More often observed on the protruding parts of the face: nose, forehead, zygomatic and chin areas.
incised wound has incised smooth edges, usually gaping, several centimeters long. The length of the wound is several times greater than its depth and width, it bleeds profusely; palpation of the edges of the wound is painful.

stab wound has a small inlet, a deep, narrow wound channel, bleeds moderately or profusely, palpation in the wound area is painful, bleeding from the nose is possible. The depth of penetration depends on the length of the weapon, the applied force and the absence of obstacles in the path of penetration of the weapon (bone). Possible profuse bleeding when large vessels are injured, as well as the destruction of the thin wall of the maxillary sinus.
chopped wound- a wide and deep wound, has even raised edges, if the wound is inflicted by a heavy sharp object. On the edges of a wide wound there is sedimentation, bruising, additional ruptures (cracks) at the end of the wound when injured with a blunt object. In the depth of the wound, there may be bone fragments and fragments in case of damage to the facial skeleton. There may be severe bleeding from the wound (nose, mouth) with penetrating wounds in the oral cavity, nose, maxillary sinus.
Laceration has uneven edges, moderate or extensive gaping, there may be flaps when one skin or a whole layer comes off; hemorrhage into the surrounding tissues and their detachment, palpation of the wound area is painful. This wound is applied with a blunt object and occurs when the physiological ability of tissues to stretch is exceeded, and can mimic the formation of a defect.
bruised wound has an irregular shape with flared edges. Additional breaks (cracks) may extend from the central wound in the form of rays; pronounced hemorrhages on the periphery and edema.
bitten wound has uneven edges and resembles a laceration in character, often with the formation of flaps or a true tissue defect with the presence of an imprint of teeth. Bleeding is moderate, palpation in the wound area is painful. It is more often observed in the area of ​​the nose, lips, ear, cheeks. Traumatic amputation of tissues, part or all of an organ may occur

Additional research methods

Examination of the wound channel with a probe inserted into it. It is carried out to determine the length of the wound channel and its location in relation to vital organs.
Radiography.
- stab wound- there may be damage to the bone in the form of a hole as a result of a perforated fracture of the bone or the presence of a foreign body (part of a broken off injuring object).
- Vulnerography of a stab wound- if it is impossible to examine the wound with a probe, a radiopaque substance is injected into the wound channel and x-rays are taken.
- chopped wound- the presence of bone damage and bone fragments in case of damage to the bones of the facial skeleton.
- bruised wound- the presence of a fracture gap in the area of ​​damage to one or another part of the facial skeleton (upper or lower jaw, zygomatic arch, nose bones).
General clinical tests blood. It is carried out with extensive blood loss in the case of incised, stab and chopped wounds to determine the blood type and Rh factor for the purpose of blood transfusion.

Differential diagnosis of facial soft tissue injuries

bruises: differentiated from hematoma in blood diseases.
- Similar symptoms: the presence of a bruise of a bluish-red color.
- Distinctive symptoms: no history of trauma, pain.
abrasions: differentiated from scratches.
- Similar symptoms: violation of the integrity of the surface layers of the skin, not strong pain.
- Distinguishing symptoms: thin linear damage to the surface layers of the skin.
incised wound: differentiated from chopped wound.
- Similar symptoms: damage to the skin or mucous membrane and underlying tissues, bleeding, pain.
- Distinctive symptoms: extensive damage to soft tissues, hemorrhage into surrounding tissues, deep wound, often accompanied by damage to the facial skeleton.
Laceration: differentiated from bite wound.
- Similar symptoms: the presence of a wound irregular shape, torn, uneven, scalloped edges, flaps or soft tissue defects may form, bleeding, pain.
- Distinctive symptoms: the teeth of an animal and a person are a wounding weapon, their prints can remain on the skin in the form of bruises.
incised wound: differentiated from stab wound.
- Similar symptoms: damage to the integrity of the skin or mucous membrane, bleeding, pain.
- Distinctive symptoms: the presence of a small, sometimes pinpoint inlet and a long deep wound channel.

Treatment of facial soft tissue injuries

Urgent care: held on prehospital stage to prevent infection of the wound and bleeding from small vessels. The skin around the wound is treated with an iodine solution, the bleeding is stopped by applying a bandage.
For abrasions, the primary dressing can be performed using a protective film of film-forming preparations applied to the wound. With simultaneous damage to the bone, transport immobilization is applied.
Treatment of the patient in the clinic
Indications: bruises, abrasions, cut, stab, laceration, bruised and bitten wounds of small size, requiring a small excision of its edges and subsequent simultaneous suturing.
Bruise treatment: cold in the first two days, then - heat for resorption of the hematoma.
abrasion treatment: antiseptic treatment, heals under the crust.
Treatment of cut, stab, torn, bruised, bitten wounds. PST of the wound is performed.
PHO is a set of measures aimed at speedy and uncomplicated wound healing. PHO should be radical, immediate and final.

Stages of PHO.

Treatment of the wound and the skin around it with warm water and soap or hydrogen peroxide solutions, alcohol or gasoline. The hair around the wound is shaved off.
- Local or general anesthesia.
- Revision of the wound, removal of foreign bodies.
- Economical excision of the edges of the wound (crushed or clearly non-viable tissues).
- Mobilization of wound edges. If necessary, cut out counter triangular flaps.
- Layered wound closure. With penetrating wounds in the oral cavity, the mucous membrane is first sutured, then the muscle and skin. When the lips are injured, the muscle is first sutured, then the border is compared and the first suture is applied at the border with the skin, then the mucous membrane and skin are sutured.
A blind suture is applied to the wound within 48 hours, and if the victim has been taking antibiotics since the injury, then up to 72 hours. late dates you can not sew up the wound tightly. In the area of ​​natural holes, the wound is led on a rubber tube to prevent their narrowing with scars after healing.
At large defects the skin is temporarily sutured to the mucosa.
When the parotid gland is injured, the parenchyma, parotid-masticatory fascia, fiber and skin are sutured in layers.
PST of the wound must be carried out before the appearance clinical signs wound infection.
PST performed before 24 hours after injury is called early, between 24 and 48 hours after injury - primary delayed (carried out to prevent wound infection and create the most favorable conditions for wound healing), and carried out after 48 hours - primary-late (carried out with late treatment of the patient).
Secondary (repeated) debridement wounds is carried out in order to eliminate the wound infection. It can be carried out in any phase of the wound process. It is especially appropriate in the phase of inflammation, since it provides the most rapid removal of dead tissue, transferring the process to the regeneration phase.
During the secondary surgical treatment, the walls of the purulent wound are excised (complete surgical treatment of the purulent wound). If it is impossible to open pockets and cut the wound, selective excision of non-viable tissues is performed (partial surgical treatment of a purulent wound).
Labor expertise. The patient needs to be released from work for the entire period of treatment and healing of wounds after injury.
Treatment of a patient in a hospital
Indications: chopped, bruised, lacerated and bitten wounds, combined with bone damage, requiring plastic surgery with flap displacement.
Hospitalization of patients is carried out by urgent care. The department conducts clinical, radiological and laboratory examination sick. It is also necessary to consult an anesthesiologist to prepare the patient for surgery.
Treatment of chopped, torn, bruised wounds, combined and multiple wounds.
Under local or general anesthesia, PST of the wound is performed (the steps are described above) and surgical methods for closing the wound defect are used: the imposition of early, initially delayed and late sutures, as well as plastic surgery. Wound PST provides for a single-stage primary recovery operation, widespread use of primary and early delayed skin grafting, recovery operations on vessels and nerves.
If it is possible to perform a radical PHO, then the wound can be sewn up tightly.
early primary surgical suture It is used as the final stage in PST in order to restore the anatomical continuity of tissues, prevent secondary microbial contamination of the wound and create conditions for its healing by primary intention.
With extensive crushed, contaminated and infected wounds, it is not always possible to produce a radical PST of the wound, and therefore it is rational to carry out general antimicrobial therapy for several days, local treatment of wounds with the introduction of gauze swabs with Vishnevsky ointment. If acute inflammation subsides significantly 3-5 days after PST, a primary delayed suture can be applied to the wound. Expectant management is necessary in order to ensure the complete excision of necrotic tissues, which will be evidenced by the subsidence of acute inflammatory phenomena and the absence of new foci of necrotic tissues. Suturing will reduce the chance of infection of the wound and speed up its healing.
If the inflammation subsides slowly, then the suturing of the wound is postponed for several days until the first granulations appear, the rejection of necrotic tissues and the formation of pus stop. At this time, the wound is carried out under a gauze pad moistened with a hypertonic solution or Vishnevsky's ointment.
The sutures placed on the cleaned wound 6-7 days after PST are called late primary sutures. Sewing a wound that is not completely cleared of necrotic tissues will inevitably lead to its suppuration, which is aimed at sanitation of the wound. The use of a hypertonic solution and Vishnevsky's ointment promotes the outflow of exudate from the walls of the wound, subsides acute inflammation and activates the regeneration of connective tissue, the growth of granulations and the rejection of necrotic tissues.
In cases where the wound cannot be sutured 7 days after PST due to the presence of inflammation, it is continued to be treated by the above method until it is filled with granulations. In this case, the phenomenon of wound contraction is observed - spontaneous convergence of the edges of the wound due to the contraction of myofibrils in myofibroblasts granulation tissue. In this case, the sutures are applied to the wound without excising the granulations. These sutures, placed within 8-14 days after POS, are called early secondary sutures.
Late secondary sutures are applied 3-4 weeks after PST of the wound. When scar tissue is formed in the wound, which prevents the convergence of its edges, it is necessary to mobilize the tissues surrounding the wound and excise a strip of skin along the edges of the wound with a width of 1-2 mm.
When suturing wounds on the lateral surface of the face, in the submandibular region, penetrating wounds, to ensure the outflow of exudate, drainage should be introduced in the form of a rubber strip. Be sure to impose external layer-by-layer sutures in order to create contact of the wound walls throughout and introduce drainage for the outflow of wound discharge.
To prevent the development of tetanus, patients must be injected with tetanus toxoid.
Rehabilitation and dispensary observation
AT postoperative period carry out treatment aimed at preventing infection and fighting it, increasing the body's immune forces, antibiotic therapy (both locally and intravenously, intramuscularly and in the form of ointments). For this, antibiotics, sulfonamides and other medications are used, taking into account the nature of the microflora.
Physiotherapy is used in all phases of the wound process to fight infection, as well as to stimulate reparative processes.
For further stimulation of reparative processes, therapy is carried out in a polyclinic.

Damage to the soft integument of the skull are closed and open. Bruises are closed, wounds (wounds) are open. Bruises occur as a result of hitting the head against hard objects, hitting the head with a hard object, when falling, etc.

As a result of the impact, the skin and subcutaneous tissue are damaged. From damaged blood vessels, blood flows into the subcutaneous tissue. When galea aponeurotica is intact, the outflowing blood forms a limited hematoma in the form of a protruding swelling (bump).

With more extensive damage to the soft tissues, accompanied by a rupture of the galea aponeurotica, the blood that has poured out of the damaged vessels forms a diffuse swelling. These extensive hemorrhages(hematomas) in the middle are soft and sometimes give a feeling of unsteadiness (fluctuation). These hematomas are characterized by a dense shaft around the hemorrhage. When feeling a dense shaft along the circumference of the hemorrhage, it can be mistaken for a skull fracture with pressure. A thorough examination, as well as an x-ray, makes it possible to correctly recognize the damage.

Wounds of the soft tissues of the head are observed as a result of injury from both sharp and blunt instruments (blunt violence). Injury to the soft integument of the skull is dangerous because local infection can spread to the contents of the skull and lead to meningitis, encephalitis and brain abscess, despite the integrity of the bone, due to the connection between the superficial veins and the veins inside the skull. The infection can also spread through the lymphatic vessels. Simultaneously with the injury of soft tissues, the bones of the skull and the brain can be damaged.

Symptoms. Symptoms depend on the nature of the injury. Cut and chopped wounds bleed heavily and gape. Stab wounds bleed a little. In the absence of infection complications, the course of wounds is favorable. If the wound was treated in the first hours, it may heal by first intention.

Symptoms of bruised wounds correspond to the nature of the wound. The edges of the bruised wound are uneven, with traces of a bruise (crush), soaked in blood, in some cases they are detached from the bone or underlying tissues. Bleeding is less abundant due to thrombosis of crushed and ruptured vessels. Contusion wounds can penetrate to the bone or be limited to soft tissue damage. characteristic feature lacerated wounds is a significant detachment from the underlying bones and the formation of flaps.
special kind damage to the scalp is the so-called scalping, in which a larger or smaller part of the scalp is torn off.

Treatment . In most cases, after careful pre-treatment the wound itself and adjacent areas can be enough to put stitches on the wound, and for small wounds - a pressure bandage. In case of severe bleeding, the bleeding vessels should be tied off. Only a fresh, uncontaminated wound can be sutured. When the wound is contaminated, the objects that have fallen into the wound are removed with tweezers, the edges of the wound are lubricated with a solution of iodine tincture, the edges of the wound are refreshed (primary treatment of the wound is performed), a solution of penicillin is poured into the wound (50,000-100,000 IU in a 0.5% solution of novocaine) or infiltrated with a solution penicillin wound edges, after which the wound is completely or partially sutured. In the latter case, the graduate is injected under the skin. By subsidence inflammatory process a secondary suture can be applied to the wound. In some cases, intramuscular injection of a solution of penicillin is prescribed. If the wound is completely sewn up, and signs of inflammation appear in the following days, the sutures should be removed and the wound opened.
For the purpose of prophylaxis, anti-tetanus serum is administered to all wounded, and in case of severe wounds, especially those contaminated with earth, anti-gangrenous serum.

Care . Hair on the head contributes to pollution and makes it difficult to treat the skin and wound, and therefore it should be shaved as much as possible around the wound. When shaving, care must be taken not to introduce infection into the wound - it should be covered with a sterile napkin. Shaving is performed from the wound, not to the wound.

Any head injury is considered dangerous, as there is a high probability. At the same time, edema of the brain tissue develops rapidly, which leads to wedging of a part of the brain into the foramen magnum. The result of this is a violation of the activity of vital centers that are responsible for breathing and blood circulation - a person quickly loses consciousness, the probability of death is high.

Another reason for the high risk of head injuries is the excellent blood supply to this part of the body, which leads to large blood loss in case of damage. And in this case, it will be necessary to stop the bleeding as soon as possible.

It is important for everyone to know how to competently provide first aid for head injuries - correctly carried out activities can really save the life of the victim.

Head injuries and soft tissue injuries

To soft tissues The head includes skin, muscles and subcutaneous tissue. If they are bruised, then pain occurs, a swelling may appear a little later (the well-known “bumps”), the skin at the site of the bruise becomes red, and a bruise subsequently forms.

In case of a bruise, it is necessary to apply cold to the injured area - it can be a bottle of cold water, a heating pad with ice, a bag of meat from the freezer. Next, you need to apply a pressure bandage and be sure to deliver the victim to medical institution even if it feels great. The fact is that only a specialist can give an objective assessment of the state of health, exclude damage to the cranial bones and / or.

Soft tissue injury can also be accompanied by heavy bleeding, detachment of skin flaps is possible - doctors call this a scalped wound. If the blood flows slowly and has dark color, then you need to apply a tight bandage to the wound with a sterile material - as an improvised tool, for example, an ordinary bandage or a piece of fabric ironed on both sides with a hot iron is suitable. If the blood spurts, then this indicates damage to the artery and the pressure bandage in this case becomes absolutely useless. It will be necessary to apply a tourniquet horizontally above the forehead and above the ears, but only if the scalp is damaged. If the victim has a slight blood loss (help was provided quickly), then he is taken to the hospital in a sitting or lying position - it is strictly forbidden for him to stand. If the blood loss is extensive, then the victim's skin rapidly acquires a pale hue, cold sweat appears on his face, arousal may occur, which turns into lethargy - urgent hospitalization is necessary and strictly accompanied by an ambulance brigade.

Algorithm of first aid action:

1. The victim is placed on a flat surface, which is covered with something - a jacket, a blanket, any clothes. A roller is placed under the shins.
2. If the patient is, then you need to put your palms on both sides under his lower jaw and slightly tilt your head back, while pushing your chin forward.
3. The victim's mouth should be cleaned of saliva with a clean handkerchief, and then you need to turn your head to the side - this will prevent vomit from entering the respiratory tract.
4. If the wound is foreign body, then in no case should you move it or try to remove it - this can increase the volume of brain damage and significantly increase bleeding.
5. The skin around the lesion site is cleaned with a towel or any cloth, then a pressure bandage is applied to the wound: several layers of cloth / gauze, then any solid object (TV remote control, bar of soap) on top of the wound and bandaged well so that the object squeezes the vessel.
6. If the bleeding is too strong and it is not possible to apply a bandage, then it is necessary to press the skin around the wound with your fingers so that the blood stops flowing. Such finger pressing must be carried out before the arrival of the ambulance team.

After the bleeding has been stopped, ice or a bottle of cold water can be applied to the wound, the victim himself should be carefully covered and urgently delivered to any medical institution.

Note:if there is a detached skin flap, then it must be wrapped in a sterile cloth (or any other rag), placed in a cold place (it is forbidden to apply it to ice!) And sent along with the victim to a medical facility - most likely, surgeons will be able to use this skin flap for performing operations to restore soft tissues.

Closed head injury

If the upper part of the skull has occurred, then it is almost impossible to determine whether there is a fracture without. Therefore, when hitting the scalp, it would be a mistake to think that there was only a bruise. The victim must be placed on a stretcher without a pillow, ice should be applied to the head and taken to a medical facility. If such an injury is accompanied by impaired consciousness and breathing, then assistance should be provided in accordance with the symptoms present, up to indirect massage heart and artificial respiration.

the heaviest and dangerous injury head is considered a fracture of the base of the skull. Such an injury often occurs when falling from a height, and brain damage is characteristic of it. hallmark fracture of the base of the skull - the release of a colorless liquid (liquor) or blood from the ears and nose. If at the same time an injury of the facial nerve also occurred, then the victim has facial asymmetry. The patient has a rare pulse, and a day later hemorrhage develops in the eye sockets.

Note:transportation of the victim with a fracture of the base of the skull must be extremely careful, without shaking the stretcher. The patient is placed on a stretcher on his stomach (in this case, it is necessary to constantly monitor the absence of vomiting) or on his back, but in this position his head should be carefully turned to his side if he begins to vomit. In order to avoid retraction of the tongue during transportation on the back, the patient's mouth is slightly opened, a bandage is laid under the tongue (it is pulled out a little forward).

Maxillofacial trauma

With a bruise, severe pain and swelling will be noted, the lips quickly become inactive. First aid in this case consists in applying a pressure bandage and applying cold to the injury site.

With a fracture of the lower jaw, the victim cannot speak, profuse salivation begins from the half-open mouth. A fracture of the upper jaw is extremely rare, accompanied by acute pain and rapid accumulation of blood in the subcutaneous tissue, which radically changes the shape of the face.

What to do in case of jaw fractures:

Note:transportation of such a patient to a medical facility is carried out lying on his stomach. If the victim suddenly turned pale, then you need to raise the lower end of the stretcher (or just the legs if you are transporting yourself) so that a rush of blood goes to the head, but you need to make sure that the bleeding does not increase.

Dislocation of the lower jaw

This injury is very common, because it can happen when laughing, yawning too much, when hit, and in older people there is a habitual dislocation of the jaw.

Signs of the condition in question:

• open mouth;
• severe salivation;
• there is no speech (the victim makes lowing sounds);
• jaw movements are difficult.

Help lies in the reduction of dislocation. To do this, the one who provides assistance, you need to stand in front of the victim, sitting on a chair. The thumbs are inserted into the mouth along the lower molars. Then the jaw is forced back and down with force. If the manipulation was carried out correctly, then the movements in the jaw and the speech of the victim are immediately restored.

Note:when repositioning, the jaw of the victim spontaneously closes with great amplitude and force. Therefore, before carrying out the procedure, you need to wrap your fingers with any cloth and try immediately after the appearance of a characteristic click (this joint has fallen into place) to immediately pull your hands out of the victim’s mouth. Otherwise, it is possible to cause injury to the one who provides assistance.