Methods of immobilization of victims. Immobilization is a word with many meanings
Excerpt from the book by Leonid Mikhailovich Roshal
Immobilization begins only after the bleeding has stopped and the wound has been treated.
When performing immobilization, you cannot change the position of the limb.
Immobilization should provide reliable fixation, eliminating movement in the injured limb.
If your arm is injured, you can use a scarf or bandage the injured arm to your body. If a leg is injured, the injured leg can be bandaged to the healthy one. But it is possible to achieve the most reliable immobilization, ensuring the immobility of bone fragments for the time necessary to transport the victim to a medical facility, with the help of splints bandaged to the limbs.
If there are no special immobilization splints at hand (this is most often the case), you need to use improvised splints - boards, sticks, rods and other available material.
If rescuers or an ambulance are already on their way to you, there is no need to waste time and effort on immobilization using improvised splints.
The splint should not be bandaged tightly so as not to disrupt blood circulation in the damaged part of the body. Almost always, the splint should cover at least one joint above and below the fracture (the exception is fractures of the humerus and femur, in these cases the splint should cover all three joints of the limb).
What should the tire be like?
When applying a splint, you need to follow a few simple rules:
The splint is applied over clothing and shoes;
Splints must be applied so as not to move bone fragments;
The splint should not be applied on the side where the broken bone protrudes;
The places where the splint comes into contact with the limb should be covered with something soft - cotton wool, fabric, clothing.
Features of splinting for various fractures
For a humerus fracture:
Bend your arm at the elbow at a right angle;
Be sure to put it in axillary area a roller made of soft cotton wool or clothing, with a diameter of at least 8-10 cm;
Secure the shoulder and elbow joints with one solid object, and with another – the elbow and wrist joints (those near the hand);
Bandage the bent arm or hang it on a scarf.
At a fracture one or two forearm bones The elbow and wrist joints need to be fixed to the splint, a bolster is also placed in the armpit area, and the arm is suspended at a right angle on a scarf.
At a fracture femur Not one, but two splints are applied to the leg at once - on the inside and outside of the leg. The ankle and knee joints are fixed on the inside. In this case, the roller is placed under the groin, the splint should reach the groin fold. WITH outside the splint should go from the ankle joint to the knee and hip joints.
At a fracture shins two splints run along the outer and inner sides of the leg from the ankle to the knee joint or slightly higher. For other fractures, if possible, the ankle joint should be fixed at a right angle.
If there is no material at hand that would be suitable for making tires, for fixing upper limb it is bandaged to the victim’s torso, and the lower limb is bandaged to the healthy one.
25.11.2011
Excerpt courtesy of EKSMO publishing house.
Copying is possible only with the permission of the publisher.
Immobilization is a method of creating immobility in order to provide rest to the affected area of the body during injuries and diseases; the main measure to prevent pain shock (see), especially in severe injuries of the musculoskeletal system. Without reliable immobilization, it is impossible to transport the victim. Absence or poor immobilization for fractures of the extremities can lead to secondary displacement of fragments, damage to nearby nerve trunks, large vessels and muscles by the sharp ends of bone fragments.
There are temporary, or transport, immobilization, and permanent, or therapeutic immobilization.
Transport immobilization is carried out in the order of care (for example, in case of injury) while the victim is being transported to a medical facility. For gunshot wounds, transport immobilization is necessary even in the absence of a fracture, if there is significant damage to the soft tissue, since rest largely prevents the development of infection. Used for temporary immobilization various types tires (see), and in the absence of tires - various improvised means: boards, sticks, bundles of rods, etc. When transport immobilization of the limbs, it is necessary to fix two joints (above and below the site of injury), and in case of a fracture of the hip - three large joint limbs.
Constant immobilization is the most important healing factor, since thanks to the fixation of bone fragments in the correct position during fractures, conditions are created for favorable biological processes development of callus; for soft tissue wounds, immobilization promotes their speedy healing, with inflammatory processes- their speedy subsidence.
After surgical interventions or reduction of fragments in fractures, fixed, most often plaster, bandages and fixation devices are used to immobilize the limb various systems(Gudushauri, Ilizarov devices, etc.), as well as traction (see).
Constant immobilization is widely used for diseases and (in the form of cribs, corsets, etc.) for suppurative processes (hands, tendovaginitis, myositis, etc.). Plaster casts used not only in hospitals, but also in outpatient practice: for fractures of small bones of the hand, radius V typical place, ankles, etc. Bandages are applied in compliance with the rules and techniques of plaster technique (see). An incorrectly applied bandage, squeezing the tissue, can cause swelling, bedsores and even limbs, and also lead to contracture (see).
In orthopedics, immobilization is provided with the help of various structures introduced into the depths of the tissues and fastening the ends of the bones (see Osteosynthesis). With these methods of immobilization, you can very soon begin therapeutic exercises damaged limb, which prevents the development of muscle atrophy and contractures.
Paramedics and who, as a rule, provide first first aid victims must master the immobilization technique perfectly.
Every workshop, every dispensary should have a supply of a sufficient number of tires.
Immobilization of broken limbs
Immobilization of broken limbs is carried out using service splints.
Transport tires (they can be wooden; wire, which are available in several types, sizes, length 75-100 cm, width 6-10 cm, well modeled according to the relief of the limb, applicable for injuries of various locations; plastic, pneumatic, vacuum), produced by industry , are called standard (Fig.). In the absence of standard tires for transportation, improvised tires are used from improvised materials - boards, skis, plywood, twigs, etc. The basic rule for applying a transport tire is the immobilization of two segments adjacent to the damaged one. For example, for fractures of the lower leg bones, the splints are fixed with bandages to the foot, lower leg and thigh, for fractures of the shoulder - to the forearm, shoulder and chest.
Requirements for transport immobilization
The splint should be applied not only to the site of injury, but also to cover the two nearest joints; sometimes it becomes necessary to immobilize three nearby joints. This is done in order to eliminate movements in the joints that are transmitted to the damaged limb.
In addition, when a limb is fractured in a nearby joint, the head of the broken bone may dislocate.
The broken limb must be given the correct position. This measure reduces the possibility of injury to nearby tissues, vessels and nerves. For open fractures, a bandage is applied to the wound.
Before applying a splint, if possible, anesthesia should be performed. fracture limb therapy immobilization
A rigid splint should be applied to clothing, and cotton wool and soft fabric should be placed in areas of friction with bone protrusions.
Immobilization must be sufficient to immobilize the injured bone, as improper or incomplete immobilization may cause more harm than good.
First aid.
First of all, it is necessary to prevent infection from entering the wound and at the same time immobilize the injured limb. This will make the subsequent delivery of the victim to a medical facility less painful, and will also reduce the likelihood of displacement of fragments.
It is prohibited to correct a deformed limb, as this may increase the patient’s suffering and cause him to develop shock!
In case of an open fracture, the skin around the wound must be lubricated with iodine solution, apply a sterile bandage, and then begin immobilization. All types of fractures must be immobilized directly at the scene of the accident using transport tires or with improvised means (board, slats, bundles of brushwood, etc.). The most convenient to use are flexible Kramer tires.
Let us repeat once again the rules of immobilization for a fractured limb:
- - the splint must fix at least two joints, and in case of a hip fracture - all joints of the lower limb;
- - the splint is adjusted on yourself so as not to disturb the position of the injured part of the body;
- - apply the splint over clothing and shoes, which are cut if necessary;
- - to prevent compression of tissues in places of bone protrusions, soft material is applied;
- - the splint cannot be applied on the side where the broken bone protrudes.
Immobilization is usually carried out by two people - one of those providing assistance carefully lifts the limb, preventing the fragments from moving, and the other tightly and evenly bandages the splint to the limb, starting from the periphery. The ends of the fingers, if they are not damaged, are left open to control blood circulation. With a limited number of dressings, the splints are fixed with pieces of bandage, rope, and belts.
When immobilizing, it is necessary to fix at least two joints located above and below the fracture area to prevent mobility of the damaged limb segment.
Immobilization of shoulder fractures is best done with a Kramer splint. It is applied from the middle of the shoulder blade on the healthy side, then the splint goes along the back, goes around the shoulder joint, goes down the shoulder to the elbow joint, bends at a right angle and goes along the forearm and hand to the base of the fingers.
Before applying the splint, the person providing assistance first shapes it by applying it to himself: he places his forearm on one end of the splint and, grabbing the other end with his free hand, directs it along the back. outer surface through the shoulder girdle and back to the shoulder girdle of the opposite side, where he fixes it with his hand and makes the desired bend of the tire.
In case of a hip fracture, an external splint is applied from the foot to the axillary region, and an internal splint is applied to the groin.
Immobilization can be improved by additional application of a Kramer splint along the back of the thigh and sole of the foot.
In case of a hip fracture, the immobility of the entire limb is ensured by a long splint - from the foot to the armpit.
In case of a fracture of the lower leg bones, a Kramer splint is applied from the toes to the upper third of the thigh, in case of a foot injury - up to the upper third of the lower leg. In case of severe fractures of the tibia, the rear splint is strengthened with side splints.
In the absence of a Kramer splint, immobilization of tibia fractures is carried out with two wooden planks, which are fixed on the sides of the limb along the same length.
It is acceptable to immobilize the thigh and lower leg using the “leg to leg” method, which, however, is not very reliable and can only be used as a last resort.
If the bones of the foot are fractured, two ladder splints are applied. One of them is applied from the tips of the toes along the plantar surface of the foot and then, bent at a right angle, along the back surface of the lower leg, almost to the knee joint.
The splint is modeled according to the outline of the back surface of the shin. Additionally, a side splint is applied in the shape of the letter V, placed along the outer surface of the lower leg so that it covers the plantar surface of the foot like a stirrup. The splints are bandaged to the limb.
Fractures of the bones of the hand are immobilized with a splint laid on the palmar surface, after having previously inserted a piece of cotton wool or fabric into the palm.
If the bones of the forearm are fractured, at least the hand and the elbow joint area are fixed. The hand is suspended on a scarf.
First aid for pelvic bone fractures. Impact or compression of the pelvic area during a collapse, fall from a height, or being thrown by a shock wave can lead to fractures of the pelvic bones.
Fractures of the pelvic bones are accompanied by changes in the shape of the pelvis, sharp pain and swelling in the area of the fracture, inability to walk, stand, or raise the leg. A typical pose is the “frog pose,” when the victim lies on his back with his legs apart, half bent at the hip and knee joints.
CHAPTER 13 TRANSPORT IMMOBILIZATION FOR FRACTURES OF LIMB BONES, SPINECHAPTER 13 TRANSPORT IMMOBILIZATION FOR FRACTURES OF LIMB BONES, SPINE
A.I. Kolesnik
Transport immobilization in case of severe injuries is the most important first aid measure, ensuring in many cases saving the life of the victim.
The main task of transport immobilization is to ensure immobility of fragments of broken bones and rest of the damaged part of the body during the period of transportation of the victim to a medical facility. It helps to significantly reduce pain; without it, it is almost impossible to prevent the development or deepening of traumatic shock in severe fractures of the bones of the limbs, pelvis and spine.
Ensuring the immobility of bone fragments and muscles significantly prevents additional tissue trauma. In the absence or insufficient immobilization during transportation of the victim, additional damage to the muscles from the ends of bone fragments is observed. Injury to blood vessels and nerve trunks, and skin perforation in closed fractures are also possible. Proper immobilization helps relieve spasm of blood vessels, eliminates their compression, thereby improving blood supply to the damaged area and increasing the resistance of injured tissues to the development of wound infection at the site of injury, especially with gunshot wounds.
This is due to the fact that the immobility of muscle layers, bone fragments and other tissues prevents the mechanical spread of microbial contamination along intertissue cracks. Immobilization ensures immobility of blood clots in damaged vessels, and therefore prevents secondary bleeding and embolism.
Transport immobilization is indicated for fractures and wounds of the bones and organs of the pelvis, spine, damage to great vessels and nerve trunks, extensive soft tissue injuries, widespread deep burns, and prolonged compartment syndrome.
The main methods of immobilizing limbs in the order of first aid will be tying the injured leg to a healthy one, bandaging the injured upper limb to the body, as well as using improvised means. Ambulance teams have standard means of transport immobilization at their disposal.
Carrying out transport immobilization must necessarily be preceded by anesthesia (injection of drugs, and in a medical institution - novocaine blockade). Only lack of necessary funds on site
accidents when providing self- and mutual assistance justifies the refusal of pain relief.
One of the most common mistakes in transport immobilization using improvised means is the use of short splints that do not provide fixation of two adjacent joints, which is why immobilization of the damaged limb segment is not achieved. This also results from insufficient fixation of the splint with a bandage. It should be considered a mistake to apply standard splints without cotton-gauze pads.
Such an error leads to local compression of the limb, pain, and bedsores. Therefore, all standard tires used by ambulance crews are covered with cotton-gauze pads.
Incorrect modeling of stair splints also leads to insufficient fixation of the fracture site. Transportation of victims to winter time requires warming the limb with a splint applied.
13.1. GENERAL PRINCIPLES OF TRANSPORT IMMOBILIZATION
There are several general principles transport immobilization, the violation of which can lead to a significant decrease in the effectiveness of immobilization.
The use of transport immobilization should be as early as possible, i.e. already when providing first aid at the scene of an incident using available means.
Clothes and shoes on the victim usually do not interfere with transport immobilization; moreover, they serve as a soft pad under the tire. Removal of clothing and shoes is carried out only when absolutely necessary. You should start removing clothes from the injured limb. You can apply a bandage to the wound through a hole cut in the clothing. Before transport immobilization, pain relief should be performed: administration of a solution of promedol or pantopon intramuscularly or subcutaneously, and in a medical clinic - an appropriate novocaine blockade. It must be remembered that the procedure for applying a transport splint is associated with displacement of bone fragments and is accompanied by an additional increase in pain in the damaged area. If there is a wound, it should be covered with an aseptic dressing before applying a splint. Access to the wound is carried out by cutting the clothing, preferably along the seam.
A tourniquet is also applied according to appropriate indications before immobilization. The tourniquet should not be covered with bandages. It is absolutely necessary to additionally indicate in a separate note the time the tourniquet was applied (date, hours and minutes).
In case of open gunshot fractures, the ends of bone fragments protruding into the wound cannot be reduced, as this will lead to additional microbial contamination of the wound. Before application, the splint should be pre-modeled and adjusted to the size and shape of the injured limb. The tire should not have strong pressure on soft fabrics, especially in the area of protrusions, to avoid the formation of bedsores, squeeze large blood vessels and nerve trunks. The tire must be covered with cotton-gauze pads, and if they
no, then cotton wool. In case of fractures of long tubular bones, at least two joints adjacent to the damaged segment of the limb must be fixed. Often three joints need to be fixed. Immobilization will be reliable if fixation of all joints functioning under the influence of the muscles of a given limb segment is achieved. Thus, in case of a fracture of the humerus, the shoulder, elbow and wrist joints are immobilized; in case of fractures of the leg bones due to the presence of multi-articular muscles (long flexors and extensors of the fingers), it is necessary to fix the knee, ankle and all joints of the foot and fingers.
The limb should be immobilized in an average physiological position in which the antagonist muscles (eg, flexors and extensors) are equally relaxed. The average physiological position is shoulder abduction by 60°, hip abduction by 10°; forearms - in a position intermediate between pronation and supination, hands and feet - in a position of palmar and plantar flexion by 10 °. However, the practice of immobilization and transportation conditions force some deviations from the average physiological position. In particular, such significant shoulder abduction and hip flexion at the hip joint are not performed, and flexion at the knee joint is limited to 170°.
Reliable immobilization is achieved by overcoming the physiological and elastic contraction of the muscles of the damaged limb segment. Reliability of immobilization is achieved by strong fixation of the splint (with belts, scarves, straps) along its entire length. When applying splints, careful handling of the injured limb is necessary to avoid causing additional injury.
In the winter season, an injured limb is more susceptible to frostbite than a healthy one, especially when combined with vascular damage. During transportation, the limb with a splint must be insulated.
To immobilize a damaged limb, you can use various available means - boards, sticks, rods, etc. If they are not available, the damaged upper limb can be bandaged to the body, and the broken leg - to the healthy leg. The best immobilization can be achieved using standard means: wire ladder splints, Dieterichs splints, plywood splints, etc.
Soft tissue bandages can be used as an independent method of fixation or as an addition to another. Fabric bandages are most often used for fractures and dislocations of the clavicle, fractures of the scapula (Dezo, Velpeau bandages, Delbe rings, etc.), injuries to the cervical spine (Schanz collar).
If there are no other means for fixation, then these bandages, as well as scarves, can be used to immobilize fractures of the upper and even lower limbs - by bandaging the injured leg to the healthy one. In addition, soft tissue dressings always complement all other methods of transport immobilization.
Immobilization with a cotton-gauze collar (Fig. 13-1). A pre-prepared high cotton-gauze bandage with a layer of cotton wool about 4-5 cm thick is applied to the neck of the victim in a lying position. The bandage is fixed with gauze bandages. Such a collar, resting on top of the occipital protuberance and chin area, and from below - in the area of the shoulder girdle and chest, creates peace for the head and neck during transportation.
Rice. 13-1. Immobilization with a cotton-gauze collar
13.2. TYPES OF TRANSPORT TIRES
Tire - The main means of transport immobilization is any solid pad of sufficient length.
Tires can be improvised (from scrap material) or specially designed (standard).
Standard tires are produced by industry and can be made of wood, plywood [tires of the Central Institute of Traumatology and Orthopedics (CITO)], metal wire (mesh, Kramer ladder tires) (Fig. 13-2), plastic, rubber (inflatable tires) and other materials.
To implement immobilization, bandages are also needed to secure the splints to the limb; cotton wool - for padding under the limb. Bandages can be replaced with improvised means: a belt, strips of fabric, rope, etc. Instead of cotton wool, towels, cloth pads, bundles of hay, grass, straw, etc. can be used.
Rice. 13-2. Kramer ladder tires
In 1932, Professor Dieterichs proposed a wooden splint for immobilizing the lower limb with injuries to the hip, hip and knee joints and the upper third of the leg. This splint is still used today and is the most reliable method for transport immobilization (Fig. 13-3).
Rice. 13-3. Dieterichs tire
The splint consists of two wooden crutches - outer and inner, a sole and a twist with a cord. The crutches are extendable and consist of two branches - upper and lower. The upper parts of the branches end with stops for the armpit and perineum.
They also have slots and holes for fixing them to the limb and torso using a belt, strap or bandage. The inner crutch on the lower branch has a folding bar with a round window for the cord and a groove for the protrusion of the lower branch of the outer crutch.
On the sole there are two ears intended for carrying crutches, and two loops for securing the cord.
Cramer's ladder splint. It is a long frame made of thick wire with transverse crossbars (Fig. 13-4 a-d).
It can easily be bent in any direction, i.e. modeled. In every specific case The splint is prepared individually depending on the damaged segment and the nature of the injury. You can use one, two or three buses at the same time. In Fig. Figure 13-4 shows shoulder fixation with a Kramer wire splint.
Chin splint. It looks like a plastic plate curved in the longitudinal and transverse directions; it is used for fractures of the lower jaws (Fig. 13-5).
The holes in the splint are designed to drain saliva and blood, and also to fix a sunken tongue with a ligature. The side end holes have three hooks for attaching the loops of the head cap.
Pneumatic tires. Are the most modern method transport immobilization. These splints have certain advantages: when inflated, they are automatically molded almost perfectly to the limb, the pressure on the tissue occurs evenly, which eliminates bedsores. The splint itself can be transparent, which allows you to monitor the condition of the bandage and the
Rice. 13-4. Kramer splint with cotton-gauze lining. Shoulder fixation using a Kramer splint
Rice. 13-5. Chin splint
limbs. Its advantages are especially noticeable in case of long-term compression syndrome, when tight bandaging of the limb with immobilization is necessary. However, using a pneumatic splint it is impossible to immobilize injuries to the hip and shoulder, since these splints are not designed to fix the hip and shoulder joints.
A type of pneumatic splint is a vacuum stretcher, which is used for fractures of the spine and pelvis.
To immobilize the upper limb, a standard medical scarf is often used, which is a triangular piece of fabric. It is used in the form independent means immobilization and as an auxiliary, often for maintaining the shoulder and forearm in a suspended state.
Extrafocal fixation devices
When transporting a patient from one medical institution to another, and in wartime when transporting from one hospital to another, transport immobilization of the damaged segment is carried out using devices for extrafocal osteosynthesis - rods and spokes (Fig. 13-6).
Rice. 13-6. Immobilization wrist joint Volkov-Oganesyan apparatus
This method of fixation is more reliable than applying a splint. However, it can only be performed by a qualified traumatologist in an operating room.
13.3. TECHNIQUE OF TRANSPORT IMMOBILIZATION OF THE UPPER LIMB
At the scene of an incident, immobilization of the entire upper limb, regardless of the location of the injury, can be accomplished using simplified methods using available means. The entire upper limb is simply bandaged to the body. In this case, the shoulder should be positioned along the mid-axillary line, the forearm should be bent at a right angle, and the hand should be inserted between two buttoned buttons of a jacket, coat or shirt.
Another method is to create a hammock for hanging the upper limb. The hem of a jacket, coat, or overcoat is folded up and an arm bent at the elbow joint at an angle of 90° is placed in the resulting groove.
The corner of the floor at the bottom edge is tied with twine (rope, bandage, wire) and secured around the neck or secured with safety pins.
For the same purpose, you can pierce the floor at the bottom corner with a knife and pass the bandage through the resulting hole to hang the floor around the neck.
Instead of outerwear, you can use a towel, a piece of cloth, etc. The towel is pierced in the corners with a knife (wire). Twine (bandage, rope) is passed through the resulting holes, i.e. make two ribbons, each of which has two ends - front and back.
The forearm is placed in the towel groove, the front ribbon at the end of the towel near the hand is passed to the healthy shoulder girdle and there it is connected to the back ribbon from the elbow end of the towel. The back braid at the hand is drawn horizontally backwards and in the lumbar region is connected to the front braid from the elbow end of the towel.
A standard headscarf is widely used for suspending the upper limb. The patient is sitting or standing. The scarf is placed on the front surface of the chest with the long side along the midline of the body, and the top of the scarf is placed laterally, at the level of the elbow joint of the injured limb.
The upper end of the long side of the scarf is passed through the shoulder girdle of the uninjured side. The forearm, bent at the elbow joint, is wrapped around the lower half of the scarf in front, its end is placed on the shoulder girdle of the sore side and connected to the other end, drawn around the neck. The top of the scarf goes around the front of the elbow joint and is secured with a safety pin.
Immobilization for injuries to the wrist, hand and fingers
For transport immobilization for injuries in this location, a ladder (Fig. 13-7) or plywood splint is used, starting from the elbow joint and extending 3-4 cm beyond the ends of the fingers. The forearm is placed on a splint in a pronated position.
The hand should be fixed in a state of slight dorsiflexion, the fingers should be half-bent with the first finger opposed. To do this, place a cotton-gauze roll under the palm (Fig. 13-8). It is better to bandage the splint starting from the forearm; bends of the bandage are made under the splint to reduce pressure on the soft tissues. On the hand, circular rounds of the bandage pass between the 1st and 2nd fingers (Fig. 13-9).
Usually, only damaged fingers are bandaged to the roller on the splint; undamaged fingers are left open. Immobilization is completed by hanging the forearm on a scarf.
A ladder splint of the required length can be used in another version, modeling its distal end so as to give the hand a dorsiflexion position, with the fingers half-bent. If the first finger is not damaged, it is left free behind the edge of the tire. A cotton-gauze pad is bandaged to the splint.
If only the fingers are injured, transport immobilization is the same as described above. You can limit yourself to fixing your fingers with a bandage to a cotton-gauze ball or roller and hang your forearm and hand on a scarf (Fig. 13-10).
Rice. 13-7. Ladder bus
Rice. 13-8. Applying a splint and fixing the splint with a bandage
Rice. 13-9. Fixing the hand
Rice. 13-10. Hanging a hand on a scarf
Sometimes the forearm and hand with a fixed bolster are placed on a ladder splint and then suspended on a gusset. The damaged first finger should be fixed on the roller in a position opposed to the other fingers, which is best done on a cylindrical roller.
Possible mistakes:
A cotton-gauze pad is not placed on the splint, which leads to local compression of the soft tissues, especially over the bony protrusions, which causes pain; possible formation of bedsores;
The tire is not modeled or bent longitudinally in the form of a groove;
The splint is applied along the extensor surface of the forearm and hand;
The tire is short and the hand hangs down;
There is no cotton-gauze roller on which the hand and fingers are fixed in a bent state;
The tire is not fixed firmly, as a result of which it slips;
Immobilization is not completed by hanging the limb on a scarf.
Immobilization for forearm injuries
For injuries to the forearm, the splint should fix the elbow and wrist joints, start in the upper third of the shoulder and end 3-4 cm distal to the ends of the fingers. The ladder splint is shortened to the required length and bent at a right angle at the level of the elbow joint. The splint is bent longitudinally in the form of a groove to ensure a better fit to the forearm and shoulder and is fixed with a cotton-gauze pad. The assistant, with the hand of the same name as the patient’s injured one, takes the hand, as if for a handshake, and produces a moderate extension of the forearm, while simultaneously creating counter support with the second hand in the area of the lower third of the victim’s shoulder. The forearm is placed on a splint in a position intermediate between pronation and supination; A cotton-gauze roller with a diameter of 8-10 cm is placed in the palm facing the stomach. On the roller, dorsiflexion of the hand is performed, opposition of the first finger and partial flexion of the remaining fingers (Fig. 13-11).
In this position, the splint is bandaged and the limb is suspended on a scarf. The use of a plywood splint does not provide complete immobilization, since it is impossible to firmly fix the elbow joint. Good immobilization of the forearm and hand is achieved using a pneumatic splint.
Possible mistakes:
The splint was modeled without taking into account the size of the patient's limb;
No soft padding was used under the tire;
Two adjacent joints are not fixed (the splint is short);
The hand is not fixed on the splint in the dorsiflexion position;
The fingers are fixed in an extended position, the first finger is not opposed to the others;
The tire is not grooved and does not have a “nest” for soft laying in the area olecranon;
The hand is not suspended on a scarf.
Rice. 13-11. Application of a ladder splint for forearm fractures. a - tire preparation; b - applying a splint and fixing the splint with a bandage; c - hanging a hand on a scarf
Immobilization for injuries of the shoulder, shoulder and elbow joints
In case of shoulder injuries, it is necessary to fix 3 joints: shoulder, elbow and wrist - and give the limb a position close to the average physiological one, i.e. position when the muscles of the shoulder and forearm are in a resting position. To do this, you need to move your shoulder away from your body by 20-30° and bend it forward. Measure the length of the patient’s limb from the olecranon to the ends of the fingers and, adding another 5-7 cm, bend the ladder splint across to an angle of 20°. Then, retreating 3 cm on both sides from the apex of the angle, the splint is unbent by 30° to create an additional “socket” at the level of the olecranon process in order to prevent the pressure of the splint on the process (Fig. 13-12-13-14).
Outside the “socket”, the main branches are installed at a right angle at the level of the elbow joint.
Further modeling of the splint is carried out by adding 3-4 cm to the length of the patient's shoulder for the thickness of the cotton-gauze pad and possible traction of the shoulder. At the level of the shoulder joint, the splint is not only bent at an angle of about 115 °, but also spirally twisted. In practice, it is easier to do this on the shoulder and back of the person performing immobilization. At neck level, a sufficient oval bend of the splint is created to prevent pressure on the cervical vertebrae. The end of the splint should reach the shoulder blade of the healthy side. The tire is grooved at forearm level
Rice. 13-12. Preparation of a ladder splint for humerus fractures
Rice. 13-13. Applying a ladder splint and fixing the splint with a bandage
Rice. 13-14. Applying a ladder splint - hanging the arm on a scarf
bend. Two ribbons 70-80 cm long are tied at the corners of the proximal end for subsequent suspension of the distal end. A cotton-gauze pad is attached to the splint along its entire length. While applying the splint, the victim sits. The assistant bends the limb at the elbow joint and performs traction and abduction of the shoulder. IN armpit a special cotton-gauze roll is placed, which is strengthened in this position with rounds of bandage through the healthy shoulder girdle. The roller has a bean-shaped shape. Its dimensions are 20x10x10 cm. After applying the splint, the ribbons on it are pulled and tied to the corners of the distal end. The front one is carried out along the front surface of the healthy shoulder girdle, the back one is carried out along the back and through the armpit. The required degree of tension of the straps is determined by ensuring that the forearm is bent at a right angle while it hangs freely. The forearm is placed in a position intermediate between pronation and supination; the palm is turned to the stomach, the hand is fixed on a cotton-gauze roller.
Bandaging the splint should begin with the hand, leaving the fingers free to control the state of blood circulation in the limb. The entire splint is bandaged, paying special attention to fixing the shoulder joint, the area of which is covered with a spica bandage.
The splint is fixed here with figure-of-eight rounds of the bandage, also passing through the armpit of the healthy side. Upon completion of bandaging, the upper limb with the splint is additionally suspended on a scarf.
Possible mistakes:
The stair splint is not modeled according to the size of the victim’s upper limb;
For the forearm, a short section of the splint is bent, as a result of which the hand is not fixed and hangs from the splint;
Do not form a “nest” in the splint for a soft lining under the olecranon, because of which the splint will cause pain and can cause bedsores;
The section of the shoulder splint exactly matches the length of the shoulder, thereby eliminating important element immobilization - traction of the shoulder under the influence of gravity of the forearm;
The splint in the area of the shoulder joint is only bent at an angle, forgetting that without spiral twisting there will be no sufficient fixation of the shoulder joint;
The proximal part of the splint ends on the scapula of the injured side, as a result of which fixation of the shoulder joint is not achieved. It is bad when the end of the splint covers the entire shoulder blade on the healthy side, since movements of the healthy arm will lead to loosening of the splint and disruption of fixation;
The bend of the tire is not modeled to prevent pressure on the cervical vertebrae;
The splint at the level of the forearm is not bent in the form of a groove - the fixation of the forearm will be unstable;
The splint is applied without a soft pad (cotton-gauze or other);
A cotton-gauze roller is not placed in the armpit to abduct the shoulder;
Do not place a cotton-gauze roll under the palm;
Not the entire splint is bandaged;
The brush is not bandaged;
Bandage your fingers;
The hand is not suspended on a scarf.
In case of injuries to the scapula, good immobilization is achieved by hanging the upper limb on a scarf, and only in case of fractures of the neck of the scapula should immobilization be performed with a ladder splint, as in the case of injuries to the shoulder joint and shoulder. Transport immobilization for clavicle fractures can be achieved using an oval made of a Kramer ladder splint covered with cotton wool. The oval is placed in the axillary region and secured with bandages to the shoulder girdle of the healthy foot (Fig. 13-15). The forearm is suspended on a scarf.
For clavicle fractures, immobilization can be carried out with a stick about 65 cm long, which is placed horizontally at the level of the lower corners of the shoulder blades. The patient himself presses her from behind with his upper limbs in the area of the elbow bends; the hands are secured with a waist belt.
Rice. 13-15. Applying a ladder splint for clavicle fractures
You should know that prolonged compression of blood vessels with a stick causes ischemic pain in the forearm. The clavicle is immobilized with a figure-of-eight bandage made from a scarf or a wide bandage.
The assistant rests his knee on the interscapular area and with his hands pulls the patient’s shoulder joints back. In this position, a figure-of-eight bandage is applied. A cotton-gauze pad is placed in the interscapular area under the cross of the scarf.
Quite widely used for immo-
bilization of the collarbone with cotton-gauze rings, which are put on the upper limb and shoulder girdle and tightened on the back with a rubber tube, or, in extreme cases, with a bandage. The internal diameter of the ring should not exceed by more than 2-3 cm the diameter of the upper limb at the point of its transition to the shoulder girdle.
The thickness of the cotton-gauze tourniquet from which the ring is made is at least 5 cm. Immobilization with a figure-of-eight bandage or rings is supplemented by hanging the hand on a scarf.
Possible mistakes:
Do not hang the arm on a scarf during immobilization with rings or a figure-of-eight bandage and thereby do not eliminate subsequent displacement of the fragments due to the gravity of the limb;
Cotton-gauze rings are too large in diameter, as a result of which the necessary traction and fixation of the shoulder girdle is not created; rings of small diameter interfere with blood circulation in the extremities.
13.4. TECHNIQUE OF TRANSPORT IMMOBILIZATION OF THE LOWER LIMB
The simplest and fairly reliable transport immobilization in case of damage to the lower limb can be carried out at the scene of the incident by bandaging (tying) the injured lower limb to the healthy one.
For this purpose, bandages, an individual dressing package, a waist belt, a scarf, a rope, etc. are used.
Immobilization for foot and toe injuries
In case of damage to the foot, its posterior part is placed in plantar flexion at an angle of 120 °; the knee joint is bent to an angle of 150-160°. In case of damage anterior section her feet are fixed at an angle of 90 °, as a result of which the
makes it necessary to fix the knee joint. The height of the splint is limited to the upper third of the shin (Fig. 13-16, 13-17).
Rice. 13-16. Applying a ladder splint for fractures of the shin bones and ankle joint (splint and splint application)
Rice. 13-17. Application of a ladder splint for fractures of the shin bones and ankle joint (fixation of the splint with a bandage)
It must be remembered that when the foot is injured, significant traumatic swelling and compression of the soft tissues always occur.
This can lead to the development of bedsores as a result of pressure from shoes or tight bandaging. Therefore, before applying a splint, it is recommended to remove or cut shoes.
Immobilization for closed fractures of the first finger is carried out with narrow strips of adhesive plaster, which are applied to the finger and foot in the longitudinal and transverse directions, but without much tension (loosely) to avoid subsequent compression of the swollen soft tissues of the finger.
It is especially dangerous in this regard to apply closed circular strips of plaster.
Possible mistakes:
In case of damage to the hindfoot, the knee joint is not fixed;
In case of damage to the forefoot, the foot is fixed in a plantar flexion position;
Shoes are not removed or cut when there is a risk of swelling.
Immobilization for injuries of the lower leg and ankle joint
In addition to bandaging to a healthy limb, any flat hard objects of sufficient length can be used. They are fixed along the damaged limb with bandages, scarves, belts, handkerchiefs, rope, etc. In case of damage to this location, it is necessary to fix not only the damaged lower leg, but also the knee and ankle joints, so the splints should reach the upper third of the thigh and capture the foot, fixed at an angle of 90 ° to the lower leg. Reliable immobilization is achieved using two or three ladder splints. A posterior scalene splint is applied from the upper third of the thigh and 7-8 cm distal to the ends of the fingers. Before application, the splint must be carefully modeled. The foot area is perpendicular to the rest of the tire. A “socket” is formed for the heel, then the tire follows the contours calf muscle, in the popliteal region it is bent at an angle of 160 °. The side stair tires are bent in the shape of the letter “P” or “G”. They secure the lower leg on both sides.
Shoes are usually not removed when a splint is applied. The assistant, holding the heel area and the back of the foot with both hands, holds the limb, slightly stretching and lifting it, as when removing a boot, fixing the foot at a right angle. A cotton-gauze pad is placed on the rear tire. Plywood can be used as side splints - from the middle of the thigh and 4-5 cm below the edge of the foot. Good immobilization of the lower leg and foot is achieved by using pneumatic splints.
Possible mistakes:
Immobilization is carried out only by the rear splint, without the side splints;
The splint is short and does not fix the knee or ankle joints;
Bone protrusions are not protected by cotton-gauze pads;
The rear ladder tire is not modeled.
Immobilization for injuries of the hip, hip and knee joints
Hip fractures are very common, especially in road traffic accidents. Fractures of the femur, regardless of level, are accompanied by traumatic shock And wound infection. This determines the particular importance of creating early and reliable immobilization for injuries of the hip, hip and knee joints, as well as the upper third of the leg. It is with such injuries that immobilization itself presents great difficulties, since it is necessary to fix 3 joints - the hip, knee and ankle (Fig. 13-18).
The best available standard splint for hip immobilization is the Dieterichs splint (Figs. 13-19, 13-20). For more durable fixation of the injured limb, a rear staircase splint is additionally used. An important condition for the successful application of a Dieterichs splint is the participation of two or, in extreme cases, one assistant.
Applying a splint begins with adjusting the crutches. The branches of the external crutch are moved apart so that the head rests against the armpit, and the lower branch extends 10-15 cm beyond the edge of the foot. The head of the internal crutch should rest against the perineum (ischial tuberosity), the distal end, excluding the folding bar, extends beyond the lower edge of the foot by 10-15 cm. In the indicated areas
Rice. 13-18. Immobilization of the lower limb with a Cramer's scalene splint
Rice. 13-19. Immobilization of the lower limb with Dieterichs splint
Rice. 13-20. Limb traction using Dieterichs splint
In this case, the branches of the crutches are fixed by inserting wooden rods of the upper branches into the corresponding holes of the lower ones. Then both branches are tied to each other with a bandage to prevent the rods from slipping out of the holes. The heads of the crutches are covered with a layer of cotton wool, which is bandaged. Trouser belts, straps or bandages are passed through the lower and upper slits in the jaws. When preparing the posterior scalene splint, it is initially modeled from the lumbar region to the foot. The splint is modeled following the contours of the gluteal region, popliteal fossa (bend at an angle of 170°), and gastrocnemius muscle. A cotton-gauze pad is bandaged along the entire length of the splint. Shoes are not removed from the injured leg.
It is also advisable to bandage a cotton-gauze pad to the back of the foot in order to prevent possible bedsores.
The application of the splint itself begins with bandaging a plywood sole to the foot. The fixation of the sole should be sufficient, but the wire loops and ears of the sole should be left free of bandages.
The distal end of the external crutch is inserted into the eye of the bandaged sole, and then the crutch is pushed up until it stops in the armpit. The belt or bandage previously inserted into the upper slots of the crutch is tied on a healthy shoulder girdle over a cotton-gauze pad. The internal crutch is carried out
into the corresponding eyelet of the sole and push it all the way into the perineum (ischial tuberosity). The folding bar is put on the protrusion (spike) of the outer jaw, the ends of the bandage (belt) threaded through the lower slits are passed into the middle slits of the outer jaw and tied with some tension.
A rear ladder splint is placed under the limb, and cords are inserted into the loops of the sole. Next, the limb is pulled by the foot; another assistant, as a counter-support, moves the entire splint upward, creating some pressure with the heads of the crutches in the axillary fossa and perineum. The achieved traction is fixed by pulling the sole with a cord and twisting it. It is wrong to perform traction by twisting, since it will always be very limited and therefore insufficient.
Cotton-gauze pads are placed between the crutches and bony protrusions (at the level of the ankles, femoral condyles, greater trochanter, ribs). The Dieterichs splint is bandaged together with the posterior scalene from the level of the ankle joint to the armpit. The bandaging is done quite tightly. Region hip joint reinforced with figure-of-eight rounds of bandage. At the end of bandaging, a splint at the level of the wings iliac bones additionally reinforced with a waist belt (strap), under which a cotton-gauze mattress is placed on the side opposite the splint.
If there is no Dieterichs splint, immobilization is carried out with three long (120 cm) stair splints. The posterior scalene splint is modeled along the lower limb. The lower part of the splint should be 6-8 cm longer than the patient’s foot. Next, it is bent at an angle of 30 °, departing 4 cm from the bend, the long part is extended by 60 °, creating a “nest” for the heel area. Then the splint is modeled according to the relief of the calf muscle, and an angle of 160° is created in the popliteal region. Then it is bent along the contour of the gluteal region. The entire splint is bent longitudinally in the form of a groove and lined with a cotton-gauze pad, which is fixed with a bandage.
The second stair rail is placed along inner surface legs, with the upper end resting on the perineum, bent in a U-shape at the level of the foot with a transition to the outer surface of the lower leg. The third ladder splint is placed in the armpit, passed along the outer surface of the torso, thigh and lower leg and connected to the end of the curved inner splint.
The second and third splints are also lined with cotton-gauze pads, which must be bent outward over the upper ends of the splints, resting on the armpit and perineum. Bone protrusions are additionally covered with cotton wool. All splints are bandaged to the limb and torso along the entire length. In the area of the hip joint, the splint is reinforced with figure-of-eight rounds of the bandage, and the outer side splint at the lumbar level is reinforced with a trouser belt, strap or bandage.
Possible mistakes:
Immobilization is carried out without assistants;
On bony protrusions do not apply cotton pads;
Immobilization is carried out without a back splint;
The upper end of the Dieterichs splint is not fixed to the body or is fixed only with a bandage, which folds and slides, as a result of which the fixation is weakened;
Reinforcement of the splint with a waist belt is not used - immobilization of the hip joint will be insufficient (the wounded person can sit down or raise the torso);
The sole is fixed weakly, it slides off;
The crutches of the Dieterichs splint are not fixed using special slots in the jaws;
The traction is not done with the hands on the foot, but only by rotating the twist - the traction will be insufficient;
Weak traction - the heads of the crutches do not rest against the armpit and perineum;
Excessive traction can cause pressure sores in the Achilles tendon, ankles, and dorsum of the foot.
Immobilization for traumatic amputation of a limb
This situation occurs, as a rule, in the case of railway injuries, accidents when working on woodworking machines, etc. The application of a splint in these cases is intended to protect the end of the stump from repeated damage during transportation of the wounded person. At the scene of the incident, an aseptic bandage is applied to the stump, and then immobilization is carried out using improvised means (board, plywood, stick) or by bandaging it to the healthy leg; stumps of the upper limb - to the body. The stump of the forearm and hand can be hung with the hollow of a jacket, jacket, tunic, shirt, as when immobilizing injured fingers, hands and forearm. If the severed part of the limb hangs on the skin flap, then a so-called transport amputation is performed, and then the stump is immobilized with a U-shaped curved ladder splint, which is applied to an aseptic bandage. A cotton-gauze pad must be placed under the splint. Immobilization can be carried out using boards or two plywood splints, which should protrude 5-6 cm beyond the end of the stump. When using any splint, fixation of the joint adjacent to the stump is necessary.
13.5. TECHNIQUE OF TRANSPORT IMMOBILIZATION OF THE HEAD, SPINE AND PELVIS
Immobilization for injuries of the skull and brain
In case of damage to the skull and brain, it is necessary to create conditions that provide shock absorption during transportation. However, fixing the head motionless to the body with splints is impractical, since another threat arises - aspiration of vomit, and with splints applied, it is difficult or impossible to turn the head in order to prevent such aspiration.
Simple improvised means of immobilization (laying the head on a soft mat in the form of a circle) provide sufficient shock absorption during transportation and do not interfere with head rotation. For this purpose, rolls of clothing, etc. are used. The ends of the roll are tied with a bandage, belt, or rope. The diameter of the resulting ring should correspond to the size of the head
who suffered. To avoid aspiration of vomit, the head is turned to the side. It is also possible to transport it on a slightly inflated cushion circle or simply on a large pillow, a bundle of clothes, hay, straw with a depression formed in the center for the head.
Transport immobilization for neck injuries
Immobilization of the neck and head is carried out using a soft circle, a cotton gauze bandage or a special Elansky transport splint.
When immobilizing with a soft pad, the victim is placed on a stretcher and tied to prevent movement. A cotton-gauze circle is placed on a soft mat, and the victim’s head is placed on the circle with the back of the head in the hole.
Immobilization with a cotton-gauze bandage - a “Schants type collar” - can be done if there is no difficulty breathing, vomiting, or agitation. The collar should rest against the occipital protuberance and both mastoid processes, and rest on the chest below, which eliminates lateral movements of the head during transportation.
When immobilized with the Elansky splint (Fig. 13-21 a), a more rigid fixation is provided. The tire is made of plywood and consists of two halves, fastened together with hinges. When unfolded, the tire reproduces the contours of the head and torso. At the top of the tire there is a recess for the back of the head, on the sides of which there are two semi-circular rollers made of oilcloth. A layer of cotton wool or soft tissue lining is placed on the splint. The splint is attached with ribbons to the body and around the shoulders (Fig. 13-21 b).
Possible mistakes:
Fixation of the head with tires, eliminating side turns;
During transportation, the head is not turned to the side;
The headrest is not massive enough and does not provide the necessary shock absorption during transportation.
Rice. 13-21. Immobilization of the victim with an Elansky splint (a, b)
Immobilization for jaw injuries
The bone fragments and the entire jaw are sufficiently fixed with a sling-like bandage. Fragments of the lower jaw are pressed against upper jaw, which performs the function of a bus. However, the sling bandage does not prevent the fragments from moving posteriorly and the tongue retracting. More reliable fixation is achieved with a standard plastic chin splint (Fig. 13-22). First, they put a special cap on the victim’s head, which is included in the splint kit. The cap is fixed on the head by tightening the horizontal braid intended for this purpose. The chin splint-sling from the concave surface is lined with a cotton-gauze pad and pressed to the chin and the entire lower jaw from below. If there is a wound, it is covered with an aseptic bandage, and a splint is applied to the bandage.
Loops of elastic bands from the head cap are placed on hooks in the curly cutouts of the side sections of the tire. In this way, the splint is fixed to the cap with an elastic cord, the broken jaw is tightened and fixed. Two rubber loops on each side are usually sufficient for a good fit. Too much traction increases the pain and leads to the displacement of debris to the sides.
When the jaws are damaged, retraction of the tongue and the development of asphyxia are often observed. The tongue is pierced horizontally with a safety pin. A pin is fixed to clothing with a bandage
Rice. 13-22. Immobilization with a chin splint
or around the neck. The doctor or ambulance paramedic pierces the tongue horizontally with a thick ligature and, with some tension, ties it to a special hook in the middle of the picking splint. The tongue should not stick out beyond the front teeth in order to avoid biting it during transportation.
A victim with jaw injuries and a splint is transported lying face down, as otherwise there is a risk of aspiration of blood and saliva. It is necessary to place a roll under the chest and head (forehead) so that the head does not hang down and the nose and mouth are free. This will ensure breathing and flow of blood and saliva. At satisfactory condition the victim can be transported while sitting (head tilted to one side).
Possible mistakes:
The sling splint is applied without a cotton-gauze pad;
The elastic traction of the rubber loops for the sling splint is asymmetrical or too large;
Transportation is carried out in the position of the wounded person on a stretcher, face up - saliva and blood flow and aspirate into the Airways; asphyxia is possible;
Fixation of the tongue when it is retracted is not ensured.
Immobilization for spinal injuries
The purpose of immobilization for spinal injuries is to prevent displacement of broken vertebrae in order to prevent compression of the spinal cord or re-traumatization during transportation, as well as damage to the vessels of the spinal canal and the formation of hematomas there. The spine should be immobilized in a position of moderate extension. On the contrary, bending the spine on a soft sagging stretcher promotes displacement of damaged vertebrae and compression of the spinal cord.
It is possible to transport a victim with a splint on a stretcher, either on the stomach or on the back. For injuries to the chest and lumbar regions The patient's spine is placed on a backboard - any rigid, non-bending plane. The shield is covered with a blanket folded in half. The victim is placed on his back (Fig. 13-23 b). Very reliable immobilization is achieved using
Rice. 13-23. Transport immobilization for spinal fracture. a - position on the stomach; b - supine position
two longitudinal and three short transverse boards, which are fixed to the back of the body and lower limbs. If it is not possible to create a non-bending plane or there is a large wound in the lumbar region, then the victim is placed on a soft stretcher on his stomach (Fig. 13-23 a).
If the spinal cord is damaged, the victim must be tied to a stretcher in order to prevent passive movements of the torso during transportation and additional displacement of the damaged vertebrae, as well as the patient sliding off the stretcher. Three people should move such victims from stretcher to stretcher, from stretcher to table: one holds the head, the second puts his hands under the back and lower back, the third - under the pelvis and knee joints. Everyone lifts the patient at the same time on command, otherwise dangerous flexion of the spine and additional injury are possible.
Possible mistakes:
During immobilization and transportation, moderate extension of the spine is not ensured;
The cardboard-cotton collar is small and does not interfere with head tilt;
The application of two ladder splints for injuries to the cervical spine is carried out without an assistant, who, holding the head, moderately extends and stretches the cervical spine;
Ladder or plywood splints are not sewn to the stretcher to create a rigid plane. During transportation, the tires slip out from under the patient, the spine bends, which causes additional trauma with possible damage to the spinal cord;
When laying the victim on a soft stretcher on the stomach, do not place bolsters under the chest and pelvis;
The victim, especially with a spinal cord injury, is not tied to a stretcher.
Immobilization for pelvic injuries
Transportation of patients with pelvic injuries (especially when the integrity of the pelvic ring is damaged) may be accompanied by displacement of bone fragments and damage to internal organs, which aggravates the shock state that usually accompanies such injuries. At the scene of the incident, a wide bandage or towel is used to tighten the pelvis circularly at the level of the wings of the ilium and greater trochanters. The victim is placed on a backboard, as with spinal fractures. Both legs are tied together, having previously placed a wide cotton-gauze pad between the knee joints, and a high bolster is placed under them, and a pillow-shaped cushion is placed under the head (Fig. 13-24).
Rice. 13-24. Transport immobilization for pelvic injuries
If it is possible to create a hard bedding, it is permissible to place the victim on a regular stretcher in the “frog” position. It is important to tie the popliteal bolster to the stretcher, as it can easily move during transportation. Sufficient conditions for transport immobilization are created by placing the patient on a stretcher with a hard bedding of 3-4 interconnected ladder splints. The latter are modeled to give the victim a “frog” position. The ends of the splints, which are 5-6 cm longer than the patient’s foot, are bent at a right angle. At the level of the popliteal fossa, the tires are bent in the opposite direction at an angle of 90°. If the proximal parts of the splints are longer than the patient’s thigh, they are once again bent parallel to the plane of the stretcher. In order to prevent extension of the splints under the knee joints, the proximal part of the splints is tied to a distal bandage or tape. The splints are placed on a stretcher, covered with cotton-gauze pads or a blanket, and the patient, who is preferably tied to the stretcher, is laid down. In this case, you can leave free access to the perineum in order to ensure emptying Bladder and rectum.
Possible mistakes:
A bandage that tightens the pelvis is not applied when the integrity of the pelvic ring is damaged;
The legs are not bent at the knee joints and are not connected to each other;
The popliteal cushion and the victim himself are not secured to the stretcher;
Stair rails are not connected longitudinally for fixation right angle under the knee joints.
13.6. MODERN MEANS OF VEHICLE IMMOBILIZATION
Over the past 10 years, thanks to research and development, the medicine of disasters and extreme situations has been replenished with new unique products for transport immobilization based on the use of new technologies and waterproof materials, disposable transport splints (Fig. 13-25, 13-26) for the forearm, shins, thighs (with traction).
Rice. 13-25. Set of disposable transport tires
Rice. 13-26. A set of transport tires for one-time use in the work of GPs
Peculiarities:
Simultaneously providing assistance to several victims;
Retain immobilizing properties after application for at least 10 hours;
Made from environmentally friendly materials;
They have a long shelf life in packaging;
They do not require special disposal methods.
Execution: four large and two small blanks with markings indicating the lines of folds and cuts to obtain the required tire option.
Set of transport folding tires (KShTS)
Purpose: immobilization of the upper and lower limbs. Completed: made of sheet plastic, PVC fabric, cellular polypropylene, sling.
Peculiarities:
Simple, convenient and reliable to use;
When folded, they occupy a small volume, which allows you to place the tires in any packing, backpacks, unloading vests;
Radiolucent; equipped with belts with fasteners for fixation;
Waterproof (Fig. 13-27).
Set of transport ladder tires (KSHL)
Designed for immobilization of the upper and lower extremities. Does not require preliminary preparation. The tires are equipped with belts with fasteners for fastening (Fig. 13-28 a, b; 13-29).
Rice. 13-27. Set of transport folding tires (KShTS)
Rice. 13-28. Set of transport stair tires (KSHL) (a, b)
Rice. 13-29. Headscarf bandage (PC) for fixation of the elbow joint and forearm
Set of tire collars for transport (KShVT)
Designed for immobilization of the cervical spine made of lightweight plastic with a soft padding of synthetic material on the side adjacent to the victim’s body. Easily processed with conventional detergents and disinfectants (Fig. 13-30).
Rice. 13-30. Set of collar splints for immobilization of the cervical spine
Folding bus device (USHS)
Purpose: immobilization of the cervical and thoracic spine with simultaneous fixation of the head - immobilization of the thigh and lower leg (Fig. 13-31).
Rice. 13-31. Immobilization of the cervical and thoracic spine with simultaneous fixation of the head using a folding USHS splint
Vacuum immobilization devices
All vacuum products consist of a chamber filled with synthetic granules and a protective cover. The protective covers of the cameras are made of durable, moisture-resistant fabric and equipped with fixing straps. When pumping out air, the product takes on and maintains the anatomical shape of the immobilized body part and provides the necessary rigidity (Fig. 13-32).
Peculiarities: radiolucent and have thermal insulation properties.
Terms of Use: temperature, from -35 to +45 °C.
Routine care: processed with conventional detergents and disinfectants.
Rice. 13-32. Vacuum splints for immobilization of the cervical spine, upper and lower extremities
Purpose: immobilization of the cervical spine, upper and lower extremities.
Set of vacuum transport tires KSHVT-01 “Omnimod”
Designed for immobilization of limbs and cervical spine in case of fractures. Tires are supplied in sets (Fig. 13-33).
Rice. 13-33. Set of vacuum transport tires KSHVT-01 “Omnimod”
Peculiarities: The protective covers of the cameras are made of durable, moisture-resistant fabric and are equipped with fixing straps, transparent to x-rays, have thermal insulation properties.
Vacuum immobilizing mattress MVIo-02 “COCOON”
Purpose: immobilization for spinal injuries, fractures of the femurs, pelvic bones, polytraumas, internal bleeding And states of shock(Fig. 13-34, 13-35).
Rice. 13-34. Diagram of operation of a vacuum mattress
Rice. 13-35. Vacuum mattress in action
Peculiarities: the mattress allows, depending on the type of injury received, to immobilize and transfer the victim in the desired position; special sections make it possible to carry out reliable immobilization for combined and concomitant injuries.
Set contents: mattress, vacuum pump, repair kit, stiffeners, transport straps.
Demountable bucket stretcher NKZhR-MM
Detachable stretchers are designed for the most gentle transfer of victims with severe injuries to vehicles during evacuation (Fig. 13-36). Stretchers help to significantly reduce the deformation and pain of the patient during loading and transferring.
Rice. 13-36. Transporting a victim using a vacuum bucket stretcher
A distinctive feature of stretchers is their simplicity and ease of placement under the victim. The speed and reliability of fixation make it possible to easily lift, carry and reposition a patient in a limited space. Carbine-type locks provide quick and reliable fixation of the stretcher in the transport position.
Immobilization of the upper limb is carried out in the presence of signs of shoulder fractures and damage to adjacent joints, burns, injuries of a large vessel (brachial artery).
Immobilization with a ladder splint is the most effective and reliable way transport immobilization for shoulder injuries.
The splint should cover the entire injured limb - from the shoulder blade of the healthy side to the hand on the injured arm and at the same time protrude 2-3 cm beyond the fingertips. Immobilization is performed with a 120 cm long ladder splint. The upper limb is immobilized in the position of slight anterior and lateral abduction of the shoulder. To do this, a ball of cotton wool is placed in the axillary area on the side of the injury, the elbow joint is bent at a right angle, the forearm is positioned so that the palm of the hand is facing the stomach. A cotton roller is placed into the brush (Fig. 1).
Rice. 1. Position of the fingers when immobilizing the upper limb
Preparing the tire (Fig. 2):
Measure the length from the outer edge of the victim’s shoulder blade to the shoulder joint and bend the splint at an obtuse angle at this distance;
Measure the distance from the upper edge of the shoulder joint to the elbow joint along the back surface of the victim’s shoulder and bend the splint at this distance at a right angle;
The person providing assistance additionally bends the splint along the contours of the back, back of the shoulder and forearm.
It is recommended to bend the part of the splint intended for the forearm into the shape of a groove.
Having tried the curved splint on the victim’s healthy arm, the necessary corrections are made.
If the tire is not long enough and the brush hangs down, its lower end must be extended with a piece of plywood tire or a piece of thick cardboard. If the length of the tire is excessive, its lower end is bent.
Two gauze ribbons 75 cm long are tied to the upper end of the splint wrapped in gray cotton wool and bandages (Fig. 3).
The splint prepared for use is applied to the injured arm, the upper and lower ends of the splint are tied with braids and the splint is strengthened with bandages. The arm along with the splint is suspended on a scarf or sling (Fig. 4).
Rice. 4. Transport immobilization of the entire upper limb with a ladder splint:
a – applying a splint to the upper limb and tying its ends; b – strengthening the splint with bandaging; c – hanging a hand on a scarf
To improve fixation of the upper end of the splint, two additional pieces of bandage 1.5 m long should be attached to it, then pass the bandage around the shoulder joint of the healthy limb, make a cross, circle it around the chest and tie it (Fig. 5).
Rice. 5. Fixation of the upper end of the ladder splint when immobilizing the upper limb
In the absence of standard tires immobilization is carried out using a medical scarf, improvised means or soft bandages. Immobilization with a medical scarf. Immobilization with a scarf is carried out in the position of slight anterior abduction of the shoulder with the elbow joint bent at a right angle. The base of the scarf is wrapped around the body approximately 5 cm above the elbow and its ends are tied on the back closer to the healthy side. The top of the scarf is placed upward on the shoulder girdle of the injured side. The resulting pocket holds the elbow joint, forearm and hand. The top of the scarf on the back is tied to the longer end of the base. The damaged limb is completely covered by a scarf and fixed to the body. Immobilization using improvised means. Several planks and a piece of thick cardboard in the form of a trench can be laid on the inner and outer surfaces of the shoulder, which creates some immobility during a fracture. The hand is then placed on a scarf or supported by a sling. Immobilization with Deso bandage. In extreme cases, immobilization for shoulder fractures and damage to adjacent joints is carried out by bandaging the limb to the body with a Deso bandage. Correctly performed immobilization of the upper limb significantly alleviates the condition of the victim and special care during evacuation, as a rule, it is not required. However, the limb should be periodically examined so that if swelling in the area of injury increases, compression does not occur. To monitor the state of blood circulation in the peripheral parts of the limb, it is recommended to leave the terminal phalanges of the fingers unbandaged. If signs of compression appear, the bandage should be loosened or cut and bandaged.
Transportation is carried out in a sitting position, if the condition of the victim allows.
Immobilization with a ladder splint is the most reliable and efficient look transport immobilization for forearm injuries. The ladder splint is applied from the upper third of the shoulder to the fingertips, the lower end of the splint is 2–3 cm. The arm should be bent at the elbow joint at a right angle, and the hand should be facing the stomach and slightly abducted. back side, a cotton-gauze roller is placed in the hand to hold the fingers in a semi-flexed position (Fig. 6a).
Rice. 6. Transport immobilization of the forearm: a – with a ladder splint; b - using improvised means (using planks)
A ladder splint 80 cm long, wrapped in gray cotton wool and bandages, is bent at a right angle at the level of the elbow joint so that the upper end of the splint is at the level of the upper third of the shoulder; the section of the splint for the forearm is bent in the form of a groove. Then they apply it to the healthy hand and correct the defects of the modeling. The prepared splint is applied to the sore arm, bandaged along its entire length and hung on a scarf. The upper part of the splint intended for the shoulder must be of sufficient length to reliably immobilize the elbow joint. Insufficient fixation of the elbow joint makes immobilization of the forearm ineffective. In the absence of a ladder splint, immobilization is carried out using a plywood splint, a plank, a scarf, a bundle of brushwood, and the hem of a shirt (Fig. 6 b).
TEST CONTROL QUESTIONS 20. BELOW 5 OUT OF 20 QUESTIONS.
1. The shoulder girdle has:
1. two areas;
2. three areas;
3. four areas.
2. Upper limit of the shoulder:
1. bottom edge is large pectoral muscle;
2. the lower edge of the latissimus dorsi muscle;
3. a horizontal line drawn along the lower edge of the pectoralis major muscle and the latissimus dorsi muscle.
3. Maximum terms, on which a tourniquet can be applied in the warm season:
1. no more than 120 minutes;
2. no more than 90 minutes;
3. no more than 60 minutes.
4. To support the injured upper limb after application soft bandage or transport immobilization bandages are used:
1. Deso bandage;
2. scarf bandage for suspending the upper limb;
3. converging tortoiseshell bandage.
5. For hand injuries, use:
1. converging turtle bandage;
2. spiral ascending bandage;
3. scarf.