Transport immobilization. Rules for applying splints

Moscow Department of Education

State budgetary educational institution

“School No. 000 named after. »

Report on the topic

“Transport immobilization. Main types”

Completed by: Maria Mukhanova 10 “B” class

Supervisor:

I. Introduction

1.1 Relevance

1.2 Purpose and objectives of the study

II. Main part

2.1 Types of immobilization

2.2 Tools transport immobilization

2.3 Standard transport tires

2.4 Transport immobilization for injuries of the neck, spine, pelvis.

2.5 Transport immobilization for injuries of the upper and lower limbs.

III. Research

IV. conclusions

4.1 Rules for transport immobilization

4.2 Complications of transport immobilization

V. References

1. Introduction

1.1 Relevance

Transport immobilization as an integral part of first aid is used in the first hours and minutes after injury. It often plays a decisive role not only in preventing complications, but also in preserving the lives of the wounded and injured. With the help of immobilization, rest is ensured, interposition of blood vessels, nerves, soft tissues, and spread of wound infection and secondary bleeding. In addition, transport immobilization is an integral part of measures to prevent the development of traumatic shock in the wounded and injured. Timely and correctly performed transport immobilization is the most important event first aid for gunshot, open and closed fractures, extensive soft tissue injuries, damage to joints, blood vessels and nerve trunks. Lack of immobilization during transportation can lead to the development severe complications(traumatic shock, bleeding, etc.), and in some cases to the death of the victim.

In the center of mass sanitary losses, in most cases, first aid for fractures and extensive wounds will be provided in the form of self- and mutual aid. Therefore the doctor medical center must be proficient in the technique of transport immobilization and teach its techniques to all personnel.

1.2 Goals and objectives.

Goal: Minimize complications in victims with various injuries at the first stage medical care.

Tasks:

1. Study the problem of transport immobilization.

2. Understand the types of transport immobilization.

3. Understand the features of transport immobilization for injuries in various situations.

4. Formulate the rules of transport immobilization.

5. Familiarize high school students with examples of transport immobilization.

6. Compare existing methods transport immobilization.

Main part

2.1. Types of immobilization

There are two types of immobilization: transport And medicinal.

Transport immobilization- creating immobility (rest) of the injured part of the body with the help of transport tires or improvised means for the time necessary to transport the victim (wounded) from the place of injury or stage medical evacuation to a medical institution. Immobilization is used for bone fractures, damage to joints, nerves, extensive soft tissue injuries, severe inflammatory processes limbs, wounds of large vessels and extensive burns.

Performed in medical institutions therapeutic immobilization for the period necessary for consolidation of the fracture, restoration of damaged structures and tissues.

Indications for transport immobilization:

Bone fractures;

Joint damage: bruises, ligament damage, dislocations, subluxations;

Damage to large vessels;

Damage to nerve trunks;

Extensive soft tissue damage;

Limb avulsions;

Extensive burns, frostbite;

Acute inflammatory processes of the extremities.

2.2. Means of transport immobilization

There are different means of transport immobilization standard, non-standard And improvised(from improvised means).

1.Standard transport tires- These are means of immobilization of industrial production. They are equipped with medical institutions and the medical service of the RF Armed Forces.

Currently, plywood, ladder, Dieterichs, plastic, cardboard, pneumatic, vacuum stretcher, and scarf tires are widely used.

Standard transport tires also include: medical pneumatic tires, plastic tires, vacuum tires, immobilizing vacuum stretchers (Fig. 1-4)

Fig.1. Pneumatic tires in packaging

Fig.2. Transport plastic tire

Fig.3. Medical pneumatic splints: a – for the hand and forearm; b – for the foot and lower leg; in – for knee joint

Fig.4. Immobilizing vacuum stretcher with the victim in a lying position

2.Non-standard transport tires- these splints are not produced by the medical industry and are used in individual medical institutions (Elansky splint, etc.; Fig. 5).

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Fig.6. Available means of transport immobilization

On the battlefield, when providing first aid to the wounded along with a stretcher in best case scenario Stair splints can be delivered, so transport immobilization often has to be performed using improvised means. The most convenient are wooden slats, bundles of brushwood, branches of sufficient length, pieces of thick or multi-layer cardboard can be used (Fig. 7). Less suitable for transport immobilization various items household items or tools, such as ski poles, skis, shovel handles, etc. Weapons and metal objects should not be used for transport immobilization.

Fig.7. Immobilization with improvised tires: a - from boards; b - from brushwood; c - made of plywood; g - made of cardboard; d - from skis and ski poles

2.3. Standard transport tires

Plywood tire made of thin plywood, curved in the form of a gutter (Fig. 8). They are light in weight, but due to the lack of plasticity they cannot be molded according to the shape of the limb and cannot be securely fixed; they are used mainly for immobilization of the wrist joint, hand, lower leg, and thigh as lateral additional splints.

Application technique. Select a tire of the required length. If you need to shorten it, break off a piece of the tire of the required length. Then a cotton-gauze pad is placed over the concave surface, a splint is applied to the damaged limb and it is secured with bandages.

Fig.8. Plywood tire

Ladder tire (Kramer) It is a metal frame in the form of a rectangle made of wire with a diameter, onto which thinner wire is stretched in the transverse direction in the form of a ladder with an interval of 3 cm (Fig. 9). The tire is easy to model, disinfected, and has high plasticity.

Stair tires must be prepared for use in advance. To do this, the entire length of the splint must be covered with several layers of gray compress cotton wool, which is fixed to the splint with a gauze bandage.

Application technique. Select a tire of the required length prepared for use. If it is necessary to shorten the tire, bend it. If it is necessary to have a longer tire, then two ladder tires are connected to each other, placing the end of one on top of the other. Then the splint is modeled according to the damaged part of the body, applied to it and fixed with bandages.

Fig.9. Stair tires (Kramer tires)

Transport splint for the lower limb (Diterichs) ensures immobilization of the entire lower limb with simultaneous extension along the axis (Fig. 10). It is used for hip fractures, injuries in the hip and knee joints. The tire is made of wood, consists of two sliding board branches (outer and inner), a plywood sole, a twist stick and two fabric belts.

Fig. 10. Transport splint for the lower limb (Diterichs): a - external lateral sliding branch; b - internal side sliding branch; c - plywood sole with wire frame; g - twist stick with recess; d - paired slots in the upper wooden strips of the side branches; e - rectangular ears of the wire frame of the sole

The outer branch is long, superimposed on the outer lateral surface legs and torso. The inner one is short, superimposed on the inner lateral surface of the leg. Each branch consists of two strips (upper and lower), superimposed on one another. The lower bar of each branch has a metal bracket, thanks to which it can slide along the upper bar without coming off it.

Application technique:

Prepare the side wooden jaws. The plywood sole is tightly bandaged to the shoe on the foot around the ankle joint. If there are no shoes on the foot, the ankle joint and foot are covered with a thick layer of cotton wool, fixed with a gauze bandage, and only after that a plywood sole is bandaged. A carefully modeled stair splint is placed on the back surface of the leg and strengthened spiral bandage. The lower ends of the outer and inner branches are connected using a movable transverse plate of the inner branch. After this, jaws are applied to the lateral surfaces of the lower limb and torso. Having carefully placed both branches, the splint is tightly attached to the body with special fabric belts, a trouser belt or medical scarves. Start stretching the leg. After traction, the splint is tightly bandaged to the limb with gauze bandages (Fig. 11).

Fig. 11. Transport immobilization with Dieterichs splint.

Plastic sling splint used for transport immobilization for fractures and injuries of the lower jaw (Fig. 12). It consists of two main parts: a rigid chin sling made of plastic, and a fabric support cap with rubber loops extending from it.

Application technique. A supporting fabric cap is placed on the head and strengthened with ribbons, the ends of which are tied in the forehead area. The plastic sling is lined with a layer of gray compress cotton wool on the inner surface, wrapped in a piece of gauze or bandage. The sling is applied to the lower jaw and connected to the supporting cap using rubber bands extending from it.

Fig. 12. Plastic sling-shaped splint: a - supporting fabric cap; b - general form applied splint

Stair tires currently remain the best means transport immobilization.

Transport tires are divided into fixing And combining fixation with traction.

From fixinggreatest distribution We received plywood, wire-ladder, plank, and cardboard tires.

TO combining fixation with traction include Thomas-Vinogradov and Diterichs tires. When transporting over long distances, temporary plaster casts are also used.

2.4. Transport immobilization for injuries of the neck, spine, pelvis.

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

1.Immobilization cotton-gauze bandage“Shantz-type collar” can be performed 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. This eliminates lateral head movement during transport.

2. When immobilized with an Elansky splint, a more rigid fixation is provided. The tire is made of plywood and consists of two halves, fastened together with hinges. When unfolded, the splint reproduces the contours of the head and torso. In the upper part 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. The splint is attached with ribbons to the body and around the shoulders. A layer of cotton wool is applied to the splint.

Transport immobilization for spinal injuries. The purpose of immobilization in case of spinal injury is primarily to eliminate the mobility of the damaged vertebrae during transportation, unload the spine and securely fixate the damaged area.

Transporting a victim with vertebral damage always poses a risk of injury to the spinal cord substance by the displaced vertebra. A blanket folded several times is placed on the marshmallow, and the victim is placed face up on it. An important point When transporting a patient with a spinal injury, it involves placing him on a stretcher, which should be performed by 3–4 people.

Transport immobilization for pelvic injury. Involuntary movements of the lower extremities can cause displacement of fragments. For immobilization in case of damage to the pelvis, the victim is placed on a rigid stretcher, giving him a position with semi-bent and slightly apart limbs, which leads to muscle relaxation and pain reduction. A cushion (blanket, clothing, rolled up pillow, etc.) is placed under the knee joints.

2.5.Transport immobilization for injuries of the upper and lower extremities.

Transport immobilization for damage to the shoulder girdle. When the collarbone and scapula are damaged, the main goal of immobilization is to eliminate the effect of the heaviness of the arm and shoulder girdle, which is achieved with the help of a scarf or special splints. Immobilization with a scarf is carried out by hanging the arm with a roller inserted into the axillary fossa.

Immobilization can be performed with a Deso-type bandage.

Transport immobilization for chest injuries. To immobilize the chest, especially with a fracture of the sternum and ribs, apply a pressure bandage made of gauze or sewn towels and place the victim in a semi-sitting position.

Transport immobilization for injuries of the upper extremities. Shoulder injuries. For fractures humerus in the upper third, immobilization is carried out as follows: the arm is bent in elbow joint at an acute angle. A cotton-gauze roll is placed in the armpit and bandaged across the chest to the healthy shoulder girdle. The forearm is suspended on a scarf, and the shoulder is fixed to the body with a bandage.

Immobilization with a ladder splint is performed for fractures of the diaphysis of the humerus. The splint should fix three joints - the shoulder, elbow and wrist.

Immobilization with a plywood splint is carried out by applying it over inside shoulder and forearm. The splint is bandaged. Forearm injuries. When immobilizing the forearm, it is necessary to turn off movements in the elbow and wrist joints. Immobilization is carried out using a ladder or mesh splint. When immobilizing with a plywood splint, cotton wool must be used to prevent bedsores.

Damage to the wrist joint and fingers. For injuries in the area of the wrist joint of the hand and fingers, a ladder or mesh splint, as well as plywood splints in the form of strips from the end of the fingers to the elbow, are widely used.

Transport immobilization for injuries of the lower extremities. The correct immobilization for a hip injury should be considered one that involves three joints at once and the splint goes from the armpit to the ankle.

Improvised splinting for hip fractures is carried out using various available devices. If they are absent, you can bandage the injured leg to the healthy one - autoimmobilization.

Transport immobilization of the lower leg. Produced using: special plywood tires, wire ladder tires, Dieterichs tires and improvised tires.

The most convenient and portable for tibial fractures is a ladder splint, especially in combination with a plywood splint. Immobilization is achieved by applying a ladder splint well modeled along the contours of the limb along the back surface of the limb from the gluteal fold with the addition of two plywood splints on the sides. The splints are fixed with a gauze bandage.

Study

We compare autoimmobilized and vacuum splints for lower leg injuries.

Criteria for evaluation:

1. Blend speed (in seconds)

2. Quality of splint application (can a person, after applying a splint, move his leg at the knee joint and ankle)

	Autoimmobilized	Vacuum
1. Overlay speed (in s)	1st person		1st person
2nd person		2nd person
3rd person		3rd person
4th person		4th person
5th person		5th person
6th person		6th person
2. Quality of splint application	Five out of six people were able to move their legs at the knee joint and ankle, which means the fixation was unreliable and inaccurate.	Zero out of six people were able to move their legs at the knee joint and ankle, which means the fixation is strong and reliable.

Study conclusion:

Vacuum splints are attached very securely, which cannot lead to incorrect fixation; they are fixed very quickly and easily than auto-immobilized ones. Autoimmobilized splints are rarely used in medicine, only when absolutely necessary.

conclusions

6.1. Transport immobilization rules

Transport immobilization must be performed efficiently and ensure complete rest of the injured part of the body or its segment. All actions must be thought out and performed in a certain sequence.

Basic rules when performing transport immobilization:

1. Transport immobilization of the injured body part should be performed at the site of injury as much as possible. early dates after injury or damage.

2. Before carrying out transport immobilization, it is necessary to administer an anesthetic to the victim. Before the analgesic effect occurs, the application of transport splints is unacceptable.

3. If there is bleeding, it must be stopped by applying a tourniquet or a pressure bandage (the wound dressing must be sterile).

4. To carry out transport immobilization, it is necessary to “turn off” at least two joints close to the damage.

5. Fixation of the damaged body part.

6. During transportation, a couple of people should hold it.

Thus, transport immobilization warns:

Development of traumatic and burn shock;

Deterioration of the victim's condition;

Transformation of a closed fracture into an open one;

Resumption of bleeding in the wound;

Damage to large blood vessels and nerve trunks;

Spread and development of infection in the area of injury.

4.2. Complications of transport immobilization.

The use of rigid transport immobilizing bandages when providing first aid to victims can lead to compression of the limb and the formation of bedsores.

Bedsores. Prolonged pressure from a tire on a limited area of a limb or torso leads to poor circulation and tissue necrosis. The complication develops as a result of insufficient modeling of flexible splints, use of splints without wrapping them with cotton wool and insufficient protection of bony protrusions.

Standard means of transport immobilization can be used repeatedly. As a rule, improvised means are not reused.

Before reusing standard means of transport immobilization, they must be cleaned of dirt and blood, processed for the purpose of disinfection and decontamination, restored to their original appearance and prepared for use.

Bibliography

1. Human Anatomy / Ed. . – M.: Medicine. – P. 7–485 p.

2. , Ankin fractures. Scientific and practical unification of emergency care and disaster medicine. – K., 1993.

3. Berezkina physical culture for diseases in orthopedics and traumatology. – M.: Medicine, 1986. – 220 p.

4. Mukhin V. M. Physical rehabilitation. – K.: Olympic Literature, 2000. – 424 p.

5. , Leshchinsky therapy for injuries of the osteoarticular apparatus. – Kyiv: Healthy, 1982. – 184 p.

6. Physical rehabilitation: Textbook for academies and institutes of physical culture / Under general ed.. prof. . – Rostov n / D: publishing house “Phoenix”, 1999. – 608 p.

Immobilization - creating immobility and rest for an organ, part or entire body during the period of transporting the victim from the scene of the incident to a medical institution.

Transport immobilization is the most important element of the complex anti-shock measures , therefore, it should be applied as early as possible after the injury, when providing first medical aid (with improvised means, autoimmobilization in the form of self- and mutual aid) and pre-medical aid (paramedics, dental technicians, nurses) medical care. Providing medical care requires certain skills and requires the mandatory use of standard immobilization devices. In order to save time when applying them, transport tires are prepared for use in advance. To do this, stair splints are wrapped with soft (cotton-gauze) pads, preparing special pads for Dieterichs splints, splints and mesh splints in order to prevent bedsores.

Transport immobilization should ensure fixation of the damaged part of the body in a functionally advantageous position, eliminate the mobility of bone fragments, prevent additional injury to soft tissues, blood vessels and nerves in the damaged area, reduce the risk of secondary bleeding, the development of traumatic shock and additional infection of the wound.

Indications for transport immobilization are bone fractures skeleton, damage to joints, large vessels and nerve trunks, extensive wounds and prolonged compression limbs, as well as burns and frostbite .

Proper immobilization for bone fractures is of particular importance. In the absence or improperly performed immobilization, the sharp, moving ends of bone fragments can damage nearby vessels, nerves and skin, turning closed fractures into open ones.

Basic principle of immobilization - immobilization of joints adjacent to the damaged area , which creates more complete peace in the damaged area. For example, if the bones of the forearm are fractured, it is necessary to eliminate mobility in the elbow and wrist joints (above and below the site of injury).

Transport immobilization is carried out using standard(produced by medical industry enterprises) and non-standard(improvised, adapted from scrap material) tires

When providing first aid As a rule, both types of tires are used at the scene of an incident. Non-standard tires are made from any solid material and available materials (boards, wooden panels, skis, ski poles, tree branches, fishing rods, shovel handles, sticks, bundles of twigs or reeds, etc.).

Sometimes you have to resort to the so-called autoimmobilization, fixing, for example, a damaged lower limb to a healthy one, a damaged arm to the chest using bandage Deso, scarf or waist belt.

For short-term immobilization for minor injuries, mainly soft tissues, various fixing bandages.

Of the standard tires included in the equipment kits of medical and nursing emergency medical teams, the most commonly used Kramer ladder splint And Dieterichs tire. They are used mainly for transport immobilization of the upper and lower extremities. The main advantage of these tires is the possibility of their individual modeling for each specific victim.

The Dieterichs splint is the only one that allows not only to provide immobilization of the injured lower limb, but also to carry out its traction (distraction). The tire consists of two sliding side bars (inner and outer) and a plywood “sole” fixed to the foot. When applying a splint, the outer side bar, which is longer, rests on the axillary fossa, and the inner, shorter one, rests on the perineal area.

A direct indication for the application of Dieterichs splints as transport immobilization is damage femur, hip and knee joints. Before applying the splint, the shoes are not removed; a plywood “sole” is attached to it, which should protrude 1.5 - 2.0 cm beyond the edge of the heel. The length of the outer and inner bars is selected according to the healthy limb: the length of the bar at the bottom should be 12-15 cm below the level of the sole of the foot. Both planks are connected at the bottom with a U-shaped movable board. Limb traction is carried out using a twist cord attached to the lower surface of the plywood sole. The slats of the splint are fixed to the body and to each other with belts or bandages, and during long-term transportation - with plaster bandages. The planks are fixed at 5 points:

In the chest area;

Upper third of the thigh;

Knee joint;

Lower third of the leg.

In this case, you should take into account the level of the bone fracture site and first fix the splint at levels above the fracture, and after traction - at levels below the fracture site. Traction is carried out until the length of the damaged and healthy limbs becomes equal. For transport immobilization of victims with almost any injuries universal remedy, allowing them to be fixed in any gentle or physiologically beneficial positions is a vacuum mattress (or vacuum immobilization stretcher). The mattress is a sealed double cover, filled 2/3 of the volume with polystyrene foam granules. There is air between the granules, they move easily, and the mattress can be compared to a soft feather bed. Externally, the mattress is very similar to a sleeping bag. After the victim has been placed on it and given the necessary position, the mattress is laced and the air is pumped out of it with a vacuum (reverse) pump to a vacuum of 500 mm Hg. Art. After 8-10 minutes, the mattress acquires the rigidity and strength of a monolith, since under the influence of external (atmospheric) pressure, polystyrene foam granules come into contact and firmly adhere to each other. Such a monolithic mattress follows all the contours of the victim’s body and does not allow even the slightest mixing of damaged body parts during any shaking, transportation in a vertical or lateral position.

A vacuum mattress as a means of transport immobilization is indispensable for injuries of the cervical, thoracic and lumbar spine, pelvic bones and hip joints, femur, shin bones, knee and ankle joints.

The design of the vacuum mattress allows for the most gentle transportation of victims off-road on any vehicle, down steep slopes of cliffs and rocks in mountainous areas, and extraction from the ruins of buildings or from mines. If a victim who is fixed in the mattress begins to vomit, simply turn the mattress on its side without injuring the victim by turning it.

For immobilization of the elbow joint, forearm, hand, knee joint, lower leg or foot. pneumatic tires, which are a two-layer hermetic cover with a zipper. The cover is put on the limb, the zipper is fastened and air is pumped into the interlayer space to give the tire rigidity. To remove a tire, first deflate the tire and then undo the zipper. The tire is easy to handle and X-ray permeable.

Less commonly used splint tires, with the help of which it is possible to immobilize only a straight section of the limb and which cannot be modeled.

Mesh tires made of thin wire and rolled up like a bandage. They can be used for transport immobilization of small bones of the foot or hand.

When carrying out transport immobilization, it is necessary to observe following rules:

Apply a splint as early as possible - at the scene of the incident. Only after this can the victim be transported to a medical facility;

If the victim is conscious and can swallow on his own, it is advisable to give him painkillers (0.5 g of analgin or its analogues and substitutes) to take orally before applying a splint. Giving the victim a small amount of wine, vodka, alcohol, hot coffee or tea also has a beneficial effect;

Splints should be applied carefully so as not to cause increased pain and not provoke the development of state of shock. The limbs should be given a physiological, comfortable position;

When creating immobility in the area of damage, it is necessary to fix (immobilize) at least two joints (one above, the other below the site of injury). In case of damage to the hip and shoulder, all three large joints of these limbs are fixed;

In case of an open fracture, before immobilization, it is necessary to treat the skin around the wound with iodine tincture and apply an aseptic bandage to the wound. If there is no sterile dressing, the wound should be covered with any clean cloth;

If there is bleeding, measures should be taken before immobilization to stop the bleeding (pressure bandage, application of a tourniquet, twist tourniquet, rubber bandage). The tourniquet is applied so that it can be removed without disturbing the achieved immobilization;

The splint should not be applied to exposed parts of the body: it is applied directly to the victim’s clothing or a cloth or cotton pad is placed under the splint;

When applying splints to areas of bony protrusions (ankle, epicondyle of the humerus, etc.), in order to avoid the formation of bedsores in these places, it is necessary to apply protective cotton-gauze pads. Before application, splints are wrapped in soft cloth, bandage or cotton wool;

Before applying a splint, it is advisable to first simulate it on a healthy limb or on yourself, and then apply it to the damaged part of the body;

Means of transport immobilization must be securely fastened and provide the effect of immobilization in the area of injury. The splint can be secured with a bandage, a special or regular belt, a strip of material, a rope, etc.;

IN winter time the immobilized part of the body must be additionally insulated;

It is not recommended to attempt to compare or correct the position of bone fragments, to traction the limb, to remove or reduce bone fragments into the wound, since the first will contribute to the development of shock, and the latter can cause bleeding or lead to additional infection of the wound.

Violations of the above rules for carrying out transport immobilization cause typical errors and the consequences they cause. complications in the victim's condition.

1. Failure to comply with the requirement of mandatory immobilization of joints located above and below the site of injury; attempts to compare and correct the position of bone fragments; tire modeling directly on the victim; poor fixation of splints to damaged parts of the body; incomplete stopping of bleeding before applying transport immobilization are mistakes that can lead to the development or deepening of a state of shock in the victim.

2. Attempts to set bone fragments into the wound, poor initial treatment of the wound with an open fracture can contribute to the development of an infectious process in the wound.

3. The application of transport splints to exposed parts of the body, the absence of cotton-gauze pads in places of bone protrusions, and too tight bandaging when applying a splint can lead to complications such as compression great vessels and nerves, which leads to impaired blood supply and, possibly, to paralysis and paresis. From strong pressure on soft tissues and when there is insufficient blood supply, areas of necrosis, called pressure ulcers, may occur.

Word " immobilization" means "immobility", and immobilization means creating immobility (rest) of the injured part of the body.

Immobilization is used for bone fractures, damage to joints, nerves, extensive soft tissue damage, severe inflammatory processes in the extremities, injuries to large vessels and extensive burns. There are two types of immobilization: transport and therapeutic.

Transport immobilization, or immobilization while the patient is being transported to the hospital, despite the fact that it is a temporary measure (from several hours to several days), has great importance both for the life of the victim and for the further course and outcome of the injury. Transport immobilization is carried out using special splints, splints made from scrap materials, and by applying bandages.

Transport tires are divided into fixing and combining fixation with traction.

Of the fixing devices, the most common are plywood, wire-ladder, plank, and cardboard tires.

Those combining fixation with traction include the Thomas-Vinogradov and Diterichs splints. When transporting over long distances, temporary plaster casts are also used.

Plywood splints are made from thin plywood and are used to immobilize the upper and lower extremities.

Wire bars (Kramer type) are made in two sizes (110x10 and 60x10 cm) from annealed steel wire and are shaped like a ladder. Thanks to the ability to give the tire any shape (modeling), low cost, lightness and strength, the stair tire has become widespread.

The mesh splint is made of soft thin wire, is well modeled, and portable, but insufficient strength limits its use.

The Diterichs splint was designed by the Soviet surgeon M. M. Diterichs (1871-1941) to immobilize the lower limb. Wooden tire, painted. IN Lately The tire is made of lightweight stainless metal.

Gypsum bandage convenient in that it can be made in any shape. Immobilization with this splint is especially convenient for injuries to the lower leg, forearm, and shoulder. The inconvenience is that when transporting in this tire, you need to wait time not only until it hardens, but also until it dries, especially in winter.

Since splints for transport immobilization are not always available at the scene of an incident, it is necessary to use improvised material or improvised splints. For this purpose, sticks, planks, pieces of plywood, cardboard, umbrellas, skis, tightly rolled clothes, etc. are used. You can also bandage the upper limb to the body, and the lower one to the healthy leg - autoimmobilization.

The basic principles of transport immobilization are as follows.

1. The splint must cover two, and sometimes three joints.
2. When immobilizing a limb, it is necessary, if possible, to give it an average physiological position, and if this is not possible, a position in which the limb is least injured.
3. In case of closed fractures, it is necessary to perform light and careful traction of the injured limb along the axis before the end of immobilization.
4. In case of open fractures, the fragments are not reduced; a sterile bandage is applied and the limb is fixed in the position in which it is located.
5. There is no need to remove the victim’s clothes.
6. You cannot apply a hard splint directly to the body: you must place a soft bedding (cotton wool, hay, towel, etc.).
7. While transferring the patient from the stretcher, an assistant should hold the injured limb.
8. We must remember that improperly performed immobilization can cause harm as a result of additional trauma. Thus, insufficient immobilization of a closed fracture can turn it into an open one and thereby aggravate the injury and worsen its outcome.

Traumatology and orthopedics. Yumashev G.S., 1983

Target: know the indications, rules, methods and means of transport immobilization for wounds and injuries of various locations; practice skills in performing transport immobilization.

Questions to prepare for class

1. Definition of the concept of “transport immobilization”.

2. The importance of transport immobilization in the prevention of traumatic shock, bleeding, secondary tissue damage and infectious complications of wounds at the stages of medical evacuation.

3. Indications for transport immobilization.

4. Rules for transport immobilization.

5. Improvised and standard means of transport immobilization (set of universal disposable tires for transport immobilization, set B-2).

6. Application technique and selection of transport splints for various localizations of injuries to the upper and lower extremities, pelvis and spine.

7. Typical mistakes when carrying out transport immobilization.

Lesson equipment

Set B-2, B-5 (tires).

Sanitary instructor's bag.

Military medical bag.

Medical stretcher straps.

Sh-4 straps.

Stretcher.

Shield for those wounded in the spine.

Individual first aid kit AI-1.

Bandages 5 m x 10 cm, 7 m x 14 cm.

Individual dressing packages.

Plaster bandages.

Shants collar.

Test control of students' initial level of knowledge

Select one or more correct answers.

1. Transport immobilization:

a) creating rest for the injured part of the body during treatment in a hospital;

b) creating rest for the damaged part of the body during evacuation to the next stage of assistance;

c) pain relief during evacuation;

d) creating rest for the injured part of the body during evacuation from the MPP to the final stage of assistance;

e) creating rest for the injured part of the body during evacuation from the battlefield (place of injury) to the final stage of assistance.

2. Indications for transport immobilization:

a) mental disorder;

b) injury or damage to a part of the body;

c) asphyxia;

d) internal bleeding;

d) bone fractures.

3. Standard means of transport immobilization include:

a) Elansky tire;

b) ladder bus;

c) Dieterichs splint;

d) Bobrov's apparatus;

e) Shants collar.

4. Sh-4 straps are designed:

a) for transport immobilization for spinal injuries;

b) for transport immobilization in case of injuries to the pelvic bones;

c) to extract the wounded and injured from combat vehicles and hard-to-reach places;

d) for transport immobilization for head injuries;

e) for transport immobilization for wounds and damage to the upper extremities.

5. Mistakes when performing transport immobilization:

a) performing immobilization over clothing and shoes on the battlefield;

b) performing immobilization only after freeing a part of the body from clothing and shoes on the battlefield;

c) fixing the splints at the level of the bandage or tourniquet;

d) laying the bone protrusions with cotton-gauze pads;

e) pain relief after transport immobilization.

Definition and general issues Topics

Immobilization(immobilis- immobile) - a set of therapeutic measures aimed at creating peace in the damaged anatomical area in order to restore the anatomical relationships of the damaged parts of the body and prevent possible complications.

Transport immobilization- creating immobility (rest) of the injured part of the body with the help of transport tires or improvised means for the time necessary to transport the victim (wounded) from the place of injury (battlefield) or the stage of medical evacuation to a medical institution.

There are therapeutic and transport immobilization. In medical institutions, therapeutic immobilization is performed for the period necessary to consolidate the fracture and restore damaged structures and tissues.

Transport immobilization is carried out directly on the battlefield (site of injury) and at the stages of medical evacuation. Transporting a wounded person or a victim with fractures and extensive injuries without adequate transport immobilization is dangerous and unacceptable.

Timely and correctly performed transport immobilization is the most important first aid measure for

gunshot, open and closed fractures, extensive soft tissue damage, damage to joints, blood vessels and nerve trunks. Lack of immobilization during transportation can lead to the development of severe complications (traumatic shock, bleeding, etc.), and in some cases, to the death of the victim.

Experience of the Great Patriotic War showed that the use of the Dieterichs splint for hip fractures reduced the incidence of traumatic shock by half, the number of wound complications due to anaerobic infection by 4 times, and the number of deaths by 5 times.

In the center of mass sanitary losses, in most cases, first aid for fractures and extensive wounds will be provided in the form of self- and mutual aid. Therefore, the doctor of the medical center must be fluent in the technique of transport immobilization and teach its techniques to all personnel.

Indications for transport immobilization:

Bone fractures;

Joint damage: bruises, ligament damage, dislocations, subluxations;

Tendon ruptures;

Damage to large vessels;

Damage to nerve trunks;

Extensive soft tissue damage;

Limb avulsions;

Extensive burns, frostbite;

Acute inflammatory processes of the extremities.

Transport immobilization rules

Transport immobilization must be performed efficiently and ensure complete rest of the injured part of the body or its segment. All actions must be thought out and performed in a certain sequence.

Basic rules when performing transport immobilization.

1. Transport immobilization of the injured body part should be performed at the site of injury as soon as possible after injury or damage. The earlier immobilization is performed, the less additional trauma to the damaged area.

2. Before carrying out transport immobilization, it is necessary to administer an anesthetic to the victim (omnopon, morphine, promedol). It should be borne in mind that the effect of the anesthetic drug occurs only after 5-10 minutes. Before the analgesic effect occurs, the application of transport splints is unacceptable.

3. Transport immobilization at the stages of first and first aid is performed over shoes and clothing, since undressing the victim is an additional traumatic factor.

4. The injured limb is immobilized in a functional position: the upper limb is bent at the elbow joint at an angle of 90°, the hand is placed with the palm facing the stomach or placed with the palm on the surface of the splint, the fingers of the hand are bent, the lower limb is slightly bent at the knee joint, the ankle joint is bent at an angle of 90 °.

5. Flexible splints must first be modeled in accordance with the contours and position of the damaged part of the body (on a healthy limb or on oneself).

6. Before applying transport immobilization means, protect bony prominences (ankle bones, iliac crests, large joints) cotton-gauze napkins. The pressure of hard tires in the area of bone protrusions leads to the formation of bedsores.

7. If there is a wound, a sterile bandage is applied to it, and only after that immobilization is carried out. Applying a bandage and strengthening a splint with the same bandage is contraindicated.

8. In cases where the injury is accompanied by external bleeding, before transport immobilization it is stopped (tourniquet, pressure bandage), anesthetized, and the wound is covered with a sterile bandage.

9. Metal splints are pre-wrapped with cotton wool and bandages to prevent bedsores from direct pressure on soft tissues. When transported in winter, metal tires, when cooled, can cause local frostbite.

10. Before transportation in cold weather, the limb with a splint must be insulated by wrapping it in warm clothing,

blanket or thermal film. If the limb is in shoes, then the lacing should be loosened. Compliance with the listed general rules is mandatory when performing transport immobilization of injuries of any location.

Thus, timely and high-quality transport immobilization prevents:

Development of traumatic and burn shock;

Deterioration of the victim's condition;

Transformation of a closed fracture into an open one;

Resumption of bleeding in the wound;

Damage to large blood vessels and nerve trunks;

Spread and development of infection in the area of injury.

Means of transport immobilization

There are standard, non-standard and improvised means of transport immobilization (from improvised means).

These are industrially manufactured immobilization products. They are equipped with medical institutions and the medical service of the RF Armed Forces (tires included in the SS, SMV, sets B-2 and B-5).

Currently, plywood, ladder, Dieterichs, plastic, cardboard, pneumatic, vacuum stretcher, and scarf tires are widely used.

Standard transport tires also include: medical pneumatic tires, plastic tires, vacuum tires, immobilizing vacuum stretchers (Fig. 23-27).

Rice. 23. Pneumatic tires in packaging

Rice. 24. Transport plastic tire

Rice. 25. Medical pneumatic splints: a - for the hand and forearm; b - for the foot and lower leg; c - for the knee joint

Rice. 26. Immobilizing vacuum stretchers (NIV)

Rice. 27. Immobilizing vacuum stretcher with the victim in a lying position

Non-standard transport tires- these splints are not produced by the medical industry and are used in individual medical institutions (Elansky splint, etc.; Fig. 28).

Rice. 28. Transport immobilization of the head with an Elansky splint

Improvised tires are made from various available materials (Fig. 29).

On the battlefield, when providing first aid, at best, ladder splints can be delivered to the wounded along with a stretcher, so transport immobilization more often has to be performed with improvised means. The most convenient are wooden slats, bundles of brushwood, branches of sufficient length; pieces of thick or multi-layer cardboard can be used (Fig. 30). Various household items or tools are less suitable for transport immobilization, such as ski poles, skis, shovel handles, etc. Weapons and metal objects should not be used for transport immobilization.

Rice. 29. Available means of transport immobilization

If there are no standard or improvised means at hand, transport immobilization is carried out by fixing with a bandage upper limb to the torso, and the damaged lower limb to the uninjured one. Immobilization done in a primitive way should be replaced with standard splints as soon as possible.

Standard transport tires

Plywood tire made from sheet plywood, bent in the form of a gutter (Fig. 31). Plywood splints are produced in lengths of 125 and 70 cm. They are light in weight, but due to the lack of plasticity they cannot be molded to the shape of the limb and securely fixed; they are used mainly for immobilization of the wrist joint, hand, shin, thigh as lateral additional splints.

Application technique. Select a tire of the required length. If you need to shorten it, use a knife to cut the surface layers of plywood on both sides and, placing it, for example, on the edge of a table along the cut line, break off a piece of the tire of the required length. Then a cotton-gauze pad is placed over the concave surface, a splint is applied to the damaged limb and it is secured with bandages.

Rice. thirty. Immobilization with improvised tires: a - from boards; b - from brushwood; c - made of plywood; g - made of cardboard; d - from skis and ski poles

Ladder tire (Kramer) It is a metal frame in the form of a rectangle made of wire with a diameter of 5 mm, onto which a thinner wire with a diameter of 2 mm is stretched in the transverse direction in the form of a ladder with an interval of 3 cm (Fig. 32). Stair tires are available in lengths of 120 cm, width 11 cm, weight 0.5 kg and length 80 cm, width 8 cm, weight 0.4 kg. The tire is easy to model, disinfected, and has high plasticity.

Modeling- this is the process of changing the shape of the splint according to the shape and position of the part of the body on which this splint will be applied.

Rice. 31. Plywood tire

Rice. 32. Stair tires

Application technique. Select a tire of the required length prepared for use. If it is necessary to shorten the tire, bend it. If it is necessary to have a longer tire, then two ladder tires are connected to each other, placing the end of one on top of the other. Then the splint is modeled according to the damaged part of the body, applied to it and fixed with bandages.

Transport splint for the lower limb (Diterichs) ensures immobilization of the entire lower limb with simultaneous extension along the axis (Fig. 33). It is used for hip fractures, injuries in the hip and knee joints. For fractures of the tibia, foot bones and injuries in the ankle joint, the Dieterichs splint is not used.

The tire is made of wood, when folded it has a length of 115 cm, weight 1.6 kg, consists of two sliding wooden branches (outer and inner), a plywood sole, a twist stick and two fabric belts.

Rice. 33. Transport splint for the lower limb (Diterichs): a - external lateral sliding branch; b - internal side sliding branch; c - plywood sole with wire frame; g - twist stick with recess; d - paired slots in the upper wooden strips of the side branches; e - rectangular ears of the wire frame of the sole

The outer branch is long, superimposed on the outer lateral surface of the leg and torso. The inner one is short, superimposed on the inner lateral surface of the leg. Each branch consists of two strips (upper and lower) 8 cm wide, superimposed on one another. The lower bar of each branch has a metal bracket, thanks to which it can slide along the upper bar without coming off it.

On the top bar of each branch there are: a transverse crossbar - a backrest for resting on axillary area and perineum; paired slots for holding fixing belts or scarves, with the help of which the splint is attached to the torso and thigh; a peg nail, which is located at the lower end of the top strip. The bottom bar has a row of holes in the middle. The pin and holes are designed to lengthen or shorten the splint depending on the height of the victim. A transverse plate with a hole 2.5 cm in diameter in the center is hinged to the lower bar of the inner branch. The plywood sole of the tire on the lower surface has a wire frame that protrudes on both sides of the sole in the form of rectangular lugs. The wooden twist stick, 15 cm long, has a groove in the middle.

Application technique

1. Prepare the side wooden jaws:

The slats of each branch are moved apart to such a length that the outer branch rests on the armpit against the armpit, the inner branch rests on the perineum, and their lower ends protrude 15-20 cm below the foot;

The upper and lower slats of each branch are connected using a peg nail, the joint is wrapped with a piece of bandage (if this is not done, then during transportation the peg may jump out of the hole in the lower bar, and then both slats of the jaw will shift along the length);

Backrests and inner surface Both branches are covered with a thick layer of gray cotton wool, which is bandaged to the splint (it is possible to use pre-prepared cotton gauze strips with ties sewn to them), it is especially important that there is enough cotton wool in places of contact with the bony protrusions of the pelvis, hip and knee joints, and ankles.

2. The plywood sole is tightly bandaged to the shoe on the foot with eight-shaped bandage rounds around the ankle joint. If there are no shoes on the foot, the ankle joint and foot are covered with a thick layer of cotton wool, fixed with a gauze bandage, and only after that a plywood sole is bandaged.

3. A carefully molded ladder splint is placed along the back of the leg to prevent sagging of the lower leg, and it is strengthened with a spiral bandage. In the area corresponding to the popliteal region, the scalene splint is bent in such a way as to give the limb a position of slight flexion at the knee joint.

4. The lower ends of the outer and inner branches are passed through the wire staples of the plywood sole and connected with the help of a movable transverse plank of the inner branch. After this, jaws are applied to the lateral surfaces of the lower limb and torso. The inner branch should rest against the perineal area, and the outer one should rest against the axillary region. Having carefully placed both branches, the splint is tightly attached to the body with special fabric belts, a trouser belt or medical scarves. The splint is not yet bandaged to the leg itself.

5. Start stretching the leg. To do this, a strong cord or twine, secured to a metal frame on a plywood base, is passed through a hole in the movable part of the inner jaw. A twist stick is inserted into the loop of the cord. Carefully stretch the injured limb lengthwise with your hands. Traction is carried out until the crutches rest tightly against armpit and perineum, and the length of the damaged limb will not be equal to the length of the healthy one. The cord is shortened by twisting to keep the injured limb in an extended state. The wooden twist is fixed to the protruding edge of the outer jaw.

6. After traction, the splint is tightly bandaged to the limb with gauze bandages (Fig. 34).

Errors when applying a Dieterichs splint.

Applying a splint before bandaging the sole.

Fixation of the splint without cotton pads or insufficient amount of cotton in the areas of bony protrusions.

Insufficient modeling of the scalene splint: there is no deepening for the calf muscle and the splint arches in the popliteal region.

Attaching the splint to the body without the use of belts, medical scarves and paired slots in the upper arms of the branches. Attachment with bandages alone does not achieve the goal: the bandages quickly weaken, the upper end of the splint moves away from the body, and immobilization in the hip joint is disrupted.

Insufficient traction without the splints resting on the armpit and perineum.

Too much traction painful and pressure sores on the dorsum of the foot and Achilles tendon. To prevent such a complication, it is necessary to perform traction not with a twist, but with your hands, while applying very moderate force. The twist should only serve to hold the limb in an extended position.

Plastic sling splint used for transport immobilization for fractures and injuries of the lower jaw (Fig. 35). It consists of two main parts: a rigid chin sling made of plastic, and a fabric support cap with rubber loops extending from it.

Rice. 34. Transport immobilization with a Dieterichs splint: a - folded splint; b - disassembled tire; c - attaching the plywood sole; d - passing the lower strips of the side branches through the ears of the wire frame of the sole; d - adjusting and fixing the side branches of the splint to the body and leg; e - strengthening the twist; g - general view of the applied splint

Rice. 35. Plastic sling-shaped splint: a - supporting fabric cap; b - general view of the applied splint

Application technique. A supporting fabric cap is placed on the head and strengthened with ribbons, the ends of which are tied in the forehead area. The plastic sling is lined with a layer of gray compress cotton wool on the inner surface, wrapped in a piece of gauze or bandage. The sling is applied to the lower jaw and connected to the supporting cap using rubber bands extending from it. To hold the sling, one middle or rear rubber loop on each side is usually sufficient.

Dieterichs splints and stair splints currently remain the best means of transport immobilization. Some standard means of transport immobilization, for example, a plastic transport splint, a medical pneumatic splint, and vacuum immobilizing stretchers, are produced by industry in limited quantities and have no practical significance in the daily activities of the medical service.

Errors and complications during transport immobilization

Errors when performing transport immobilization make it ineffective and often lead to serious complications. The most common of them.

Using unreasonably short tires using improvised means. As a result, means of transport immobilization do not provide complete immobilization of the damaged area.

Application of means of transport immobilization without first wrapping them with cotton wool and gauze bandages. The cause of the error, as a rule, is haste or the lack of tires prepared in advance for application.

Inadequate or insufficiently careful modeling of wire splints according to the contours and position of the injured body part.

Insufficient fixation of the splint to the damaged part of the body with a bandage. Saving a bandage in such cases does not allow keeping the splint in the position required for immobilization.

The ends of the splint are too long or not securely fastened when bandaging. This contributes to additional trauma, creates inconvenience during transportation, and does not allow the limb to be given a comfortable position.

An infrequent but very dangerous mistake is to close the hemostatic tourniquet with a bandage when strengthening the splint. As a result, the tourniquet is not visible and is not removed in a timely manner, which leads to necrosis of the limb.

Complications of transport immobilization. The use of rigid transport immobilizing bandages when providing first aid to victims can lead to compression of the limb and the formation of bedsores.

Limb compression occurs as a result of excessively tight bandaging, uneven tension of the bandage, and increased tissue swelling. When a limb is compressed, throbbing pain appears in the area of injury to the limb, its peripheral parts swell, the skin becomes bluish color or turns pale, fingers lose mobility and sensitivity. If the above signs appear, the bandage must be cut at the area of compression and, if necessary, bandaged.

niya on a limited area of the limb. If these signs appear, the bandage must be loosened and measures must be taken to relieve the tire pressure.

Careful implementation of the basic rules of transport immobilization, timely monitoring of the victim, and attentive attention to his complaints allow timely prevention of the development of complications associated with the use of means of transport immobilization.

Transport immobilization for injuries of the head, neck, spine

Creating immobilizing structures for the head and neck is very difficult. Attaching the splint to the head is difficult, and on the neck, rigid fixing grips can lead to compression of the airways and large vessels. In this regard, for injuries to the head and neck, the simplest methods of transport immobilization are most often used.

All immobilization actions are usually performed with an assistant, who must carefully support the victim’s head and thereby prevent additional injury. The transfer of the victim onto a stretcher is carried out by several people, one of whom supports only the head and ensures that sharp jolts, rough movements, and bends in the cervical spine are inadmissible.

Victims with severe injuries to the head, neck, and spine must be provided with maximum rest and prompt evacuation using the most gentle means of transport.

Transport immobilization for head injuries. Head injuries are often accompanied by loss of consciousness, tongue retraction and vomiting. Therefore, placing the head in a motionless position is undesirable, since when vomiting, vomit may enter the Airways. Immobilization for skull and brain injuries is primarily aimed at eliminating shocks and preventing additional head contusion during transportation.

Indications for immobilization are all penetrating wounds and skull fractures, bruises and concussions accompanied by loss of consciousness.

To immobilize the head, as a rule, improvised means are used. The stretcher for transporting the victim is covered

soft bedding in the head area or a pillow with a depression. A thick cotton-gauze donut ring can be an effective means of softening shocks and preventing additional head injury (Fig. 36). It is made from a dense strand of gray wool 5 cm thick, closed with a ring and wrapped in a gauze bandage. The victim's head is placed on the ring with the back of the head in the hole. In the absence of a cotton-gauze “donut”, you can use a roller made from clothing or other improvised means and also closed in a ring. Victims with head injuries are often unconscious and require constant attention and care during transportation. You should definitely check whether the victim can breathe freely and whether there is nosebleed, in which blood and clots can enter the respiratory tract. When vomiting, the victim's head should be carefully turned to the side, with a finger wrapped in a handkerchief or gauze, it is necessary to remove the remaining vomit from the mouth and pharynx so that it does not interfere with free breathing. If breathing is impaired due to the retraction of the tongue, you should immediately push out the tongue with your hands. lower jaw forward, open your mouth and grab your tongue with a tongue holder or napkin. To prevent repeated retraction of the tongue into the oral cavity, you should insert an air tube or pierce the tongue with a safety pin along the midline, pass a piece of bandage through the pin and fix it taut to a button on the clothing.

Rice. 36. An improvised head splint in the form of a roller closed in a ring: a - general view of the splint; b - position of the victim’s head on it

Transport immobilization for injuries of the lower jaw

carried out by a standard plastic sling splint. The technique of using the splint is described in the section “Means of transport immobilization”. Immobilization of the lower jaw is indicated for closed and open fractures, extensive wounds and gunshot wounds.

In case of prolonged immobilization with a plastic chin splint, it becomes necessary to water and feed the patient. You should feed only liquid food through a thin rubber or polyvinyl chloride tube 10-15 cm long, inserted into the oral cavity between the teeth and cheek to the molars. The end of the polyvinyl chloride tube should be pre-melted so as not to damage the oral mucosa.

When a standard sling splint is not available, the lower jaw is immobilized with a wide sling bandage or a soft frenulum bandage. Before applying a bandage, you need to place a piece of thick cardboard, plywood or a thin board measuring 10x5 cm, wrapped in gray wool and a bandage, under the lower jaw. A sling-shaped bandage can be made from a wide bandage or a strip of light fabric.

Transportation of victims with injuries to the lower jaw and face, if the condition allows, is carried out in a sitting position.

Transport immobilization for neck injuries and cervical spine spine. The severity of the damage is determined by the large vessels, nerves, esophagus, and trachea located in the neck area. Injuries to the spine and spinal cord in the cervical region are among the most severe injuries and often lead to the death of the victim.

Immobilization is indicated for fractures of the cervical spine, severe injuries to the soft tissues of the neck, and acute inflammatory processes.

Signs severe injuries neck: inability to turn the head due to pain or keep it upright; curvature of the neck; complete or incomplete paralysis of the arms and legs due to spinal cord injury; bleeding; a whistling sound in the wound when inhaling and exhaling, or accumulation of air under the skin when the trachea is damaged.

Immobilization with stair splints in the form of a Bashmakov splint. The tire is formed from two ladder tires of 120 cm each. First, they are bent

one ladder splint along the lateral contours of the head, neck and shoulder girdles. The second splint is curved according to the contours of the head, back of the neck and thoracic spine. Then both tires are wrapped with cotton wool and bandages and tied together, as shown in Fig. 37. The splint is applied to the victim and reinforced with bandages 14-16 cm wide. Immobilization must be performed by at least two people: one holds the victim’s head and lifts him, and the second applies and bandages the splint.

Rice. 37. Transport immobilization with a Bashmakov splint: a - modeling of the splint; b - wrapping tires with cotton wool and bandages; c - bandaging a splint to the victim’s torso and head; d - general view of the applied splint

Immobilization with a cardboard-gauze collar (type of Shants collar). The collar can be prepared in advance. It is successfully used for fractures of the cervical spine. A shaped blank measuring 430x140 mm is made from cardboard, then the cardboard is wrapped in a layer of cotton wool and covered with a double layer of gauze, the edges of the gauze are sewn together. Two ties are sewn at the ends (Fig. 38). The victim's head is carefully lifted and a cardboard-gauze collar is placed under the neck, the ties are tied in front.

Rice. 38. Cardboard collar like the Shants collar: a - pattern made of cardboard; b - the cut collar is wrapped in cotton wool and gauze, ties are sewn on; c - general view of immobilization with a collar

Immobilization with a cotton-gauze collar. A thick layer of gray cotton wool is wrapped around the neck and tightly bandaged with a bandage 14-16 cm wide (Fig. 39). The bandage should not put pressure on the neck organs or interfere with breathing. The width of the layer of cotton wool should be such that the edges of the collar tightly support the head.

Errors in transport immobilization for head and neck injuries.

Careless transfer of a patient onto a stretcher. It is best if one person supports your head when moving it.

Immobilization is performed by one person, which leads to additional injury to the brain and spinal cord.

The fixing bandage compresses the organs of the neck and makes it difficult to breathe freely.

Lack of constant monitoring of the unconscious victim.

Rice. 39. Immobilization of the cervical spine with a cotton-gauze collar

Transportation of victims with injuries to the neck and cervical spine is carried out on a stretcher in a supine position with the upper half of the body slightly elevated.

Transport immobilization for injuries of the thoracic and lumbar spine

Victims with spinal cord injuries require particularly careful transportation, as additional damage to the spinal cord is possible. Immobilization is indicated for spinal fractures, both with and without spinal cord damage.

Signs of spinal damage: pain in the spine, worsening with movement; numbness of skin areas on the torso or limbs; the victim cannot independently move his arms or legs.

Transport immobilization for spinal injuries is achieved by eliminating the sagging of the stretcher panel in some way. To do this, a plywood or wooden shield (boards, plywood or ladder tires, etc.) wrapped in a blanket is placed on them.

Immobilization using ladder and plywood splints. Four stair splints 120 cm long, wrapped in cotton wool and bandages, are placed on a stretcher in the longitudinal direction. 3-4 splints 80 cm long are placed under them in the transverse direction. The splints are tied together with bandages, which are pulled between the wire gaps using a hemostatic clamp. Plywood tires can be laid in a similar way. The shield of tires formed in this way is covered on top with a blanket folded several times or with cotton-gauze bedding. Then the victim is carefully transferred onto the stretcher.

Wooden slats, narrow boards and other means are laid and firmly tied together (Fig. 40). Then cover them with bedding of sufficient thickness, shift the victim and fix him.

If there is a wide board, it is permissible to lay and tie the victim to it (Fig. 41).

Rice. 40. Transport immobilization for damage to the thoracic and lumbar spine using narrow boards: a - front view; b - rear view

To transport and carry a wounded person, you can use a door removed from its hinges (Fig. 42). Instead of boards, you can use skis, ski poles, poles, placing them on a stretcher. However, those parts of the body with which these objects will come into contact should be very carefully protected from pressure in order to prevent the formation of bedsores.

With any method of immobilization, the victim must be secured to the stretcher so that he does not fall when carrying, loading, climbing or descending stairs. Fixation is carried out with a strip of fabric, a towel, a sheet, a medical scarf, special belts, etc. It is necessary to place a small pad of cotton wool or clothing under the lower back, which eliminates its sagging. It is recommended to place rolled-up clothing, a blanket or a small duffel bag under your knees. During the cold season, the victim should be carefully wrapped in blankets.

In extreme cases, in the absence of standard splints and available means, a victim with a spinal injury is placed on a stretcher in a prone position (Fig. 43).

Rice. 41. Transport immobilization for injuries of the thoracic and lumbar spine using a wide board

Rice. 42. Position of the victim on the shield in case of spinal injury

Rice. 43. Position of a victim with a spinal injury when transported on a stretcher without a shield

Errors in transport immobilization for injuries of the thoracic and lumbar spine.

The absence of any immobilization is the most common and serious mistake.

Lack of fixation of the victim on a stretcher with a shield or a splint using improvised means.

Absence of a cushion under the lumbar spine. Evacuation of the victim must be carried out by a sanitary

transport. When transporting by conventional transport, it is necessary to lay straw or other material under the stretcher to minimize the possibility of additional injury. Spinal injuries are often accompanied by urinary retention, so during long-term transportation it is necessary to promptly empty the bladder using a catheter.

Transport immobilization for fractures of ribs and sternum

Fractures of the ribs and sternum, especially multiple ones, may be accompanied by internal bleeding and severe breathing and circulatory disorders. Timely and correctly performed transport immobilization helps prevent severe complications of chest injuries and facilitates their treatment.

Transport immobilization for rib fractures. Along with damage to the ribs, damage to the intercostal vessels, nerves and pleura may occur. The sharp ends of broken ribs can cause damage lung tissue, which leads to the accumulation of air in the pleural cavity, the lung collapses and is switched off from breathing.

The most severe breathing disorders occur with multiple rib fractures, when each rib is broken in several places (fenestrated fractures). Such injuries are accompanied by paradoxical movements of the chest during breathing: when inhaling, the damaged section of the chest wall sinks, preventing the expansion of the lung, and when exhaling, it bulges (Fig. 44).

Signs of rib fractures: pain along the ribs, which intensifies with breathing; limitation of inhalation and exhalation due to pain; crunching sound in the fracture area during breathing movements of the chest; paradoxical movements of the chest with fenestrated fractures; accumulation of air under the skin in the area of the fracture; hemoptysis.

Immobilization for rib fractures is carried out by tight bandaging, which is performed with incomplete exhalation, otherwise the bandage will be loose and will not perform any fixing function. It must be taken into account that a tight bandage restricts the respiratory movements of the chest and prolonged immobilization can lead to insufficient ventilation of the lungs and deterioration of the victim’s condition.

In case of multiple fractures of the ribs with paradoxical respiratory movements of the chest (fenestrated fractures), a tight bandage is applied to the chest at the site of injury (battlefield) and the victim is evacuated as quickly as possible (Fig. 45). If evacuation is delayed by more than 1-1.5 hours, external fixation of a fenestrated rib fracture should be performed using the Vitiugov-Aibabin method (Fig. 46, 47).

Rice. 44. The mechanism of paradoxical movement of the chest wall in fenestrated rib fractures

Rice. 45. Fixing bandage for rib fractures

Rice. 46. Plastic plate for external fixation of fenestrated rib fractures

Rice. 47. Fixation of a fenestrated rib fracture using the Vitiugov-Aibabin method: a - vertical plane; b - horizontal plane

For external fixation of the fracture, use a plate of any hard plastic measuring 25x15 cm or a fragment of a ladder splint about 25 cm long. Several holes are made in the plastic plate. The soft tissues of the body are sutured with surgical threads and tied to a plastic splint or a fragment of a ladder splint curved along the contour of the chest.

Transport immobilization for sternal fractures. Fractures of the sternum are combined with contusion of the heart. Injury to the heart, pleura, lung, and damage to the internal mammary artery are also possible.

Immobilization is indicated for fractures of the sternum with significant displacement or mobility of bone fragments.

Signs of a sternal fracture: pain in the sternum, increasing during breathing and coughing; sternum deformity; crunching of bone fragments during respiratory movements of the chest; swelling in the sternum area.

Transport immobilization is carried out by applying a tight bandage to the chest. In the back area, a small cotton-gauze roll is placed under the bandage in order to create hyperextension posteriorly in thoracic region spine.

With pronounced mobility of sternum fragments, there is a risk of damage to internal organs. In this case, immobilization should be carried out using the Vitiugov-Aibabin method. A plastic splint or a fragment of a ladder splint is placed across the sternum.

Errors in transport immobilization for fractures of the ribs and sternum.

Excessively tight chest bandaging, which limits ventilation and worsens the victim’s condition.

Tight bandaging of the chest, when bone fragments are turned towards the chest cavity, pressure from the bandage leads to even greater displacement of the fragments and injury to internal organs.

Long-term (over 1-1.5 hours) fixation of fenestrated rib fractures with a tight bandage, the effectiveness of which is insufficient for such injuries.

Transportation of victims with fractures of the ribs and sternum is carried out in a semi-sitting position, which creates better conditions for ventilation of the lungs. If this is difficult, you can evacuate the victim while lying on his back or on his healthy side.

Fractures of the ribs and sternum, as indicated above, may be accompanied by damage to the lung, heart contusion, and internal bleeding. Therefore, during the evacuation of victims, constant monitoring is necessary in order to promptly notice signs of increasing respiratory and cardiac failure, increasing blood loss: pallor of the skin, rapid, irregular pulse, severe shortness of breath, dizziness, fainting.

Transport immobilization for upper limb injuries

Injuries to the shoulder girdle and upper extremities include scapula fractures, fractures and dislocations of the clavicle, injuries to the shoulder joint and upper arm, elbow joint and forearm, wrist joint, bone fractures and damage to the joints of the hand, as well as ruptures of muscles, tendons, extensive wounds and burns of the upper extremities.

Immobilization for clavicle injuries. The most common injury to the clavicle should be considered fractures, which, as a rule, are accompanied by significant displacement of fragments. Acute

the ends of the bone fragments are located close to the skin and can easily damage it.

In case of fractures and gunshot wounds of the clavicle, nearby large subclavian vessels and nerves can be damaged brachial plexus, pleura and apex of the lung.

Signs of a clavicle fracture: pain in the collarbone area; shortening and changing the shape of the collarbone; significant swelling in the collarbone area; movements of the hand on the side of the injury are limited and sharply painful; pathological mobility.

Immobilization for clavicle injuries is carried out with bandage bandages. The most accessible and effective method of transport immobilization is to bandage the arm to the body using a Deso bandage.

Immobilization for scapula fractures. Significant displacement of fragments in scapula fractures usually does not occur.

Signs of a scapula fracture: pain in the scapula area, aggravated by moving the arm, loading along the axis of the shoulder and lowering the shoulder; swelling above the shoulder blade.

Immobilization is carried out by bandaging the shoulder to the body with a circular bandage and hanging the arm on a scarf (Fig. 48) or by fixing the entire arm to the body with a Deso bandage.

Immobilization for injuries of the shoulder, shoulder and elbow joints carried out for shoulder fractures, joint dislocations, gunshot wounds, damage to muscles, blood vessels and nerves, extensive wounds and burns, purulent-inflammatory diseases.

Signs of shoulder fractures and injuries to adjacent joints: severe pain and swelling in the area of injury; pain increases sharply with axial load and movement; change in shoulder shape

Rice. 48. Transport immobilization of the arm for a scapula fracture

and joints; movements in the joints are significantly limited or impossible; pathological mobility in the area of the shoulder fracture.

- the most effective and reliable method of transport immobilization for injuries of the shoulder, shoulder and elbow joints. 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 using a ladder splint

120 cm long. The upper limb is fixed in a position of slight anterior and lateral abduction of the shoulder (a soft roller is inserted into the axillary region on the side of the injury), the elbow joint is bent at a right angle, the forearm is positioned so that the palm faces the stomach. A roller is placed into the brush (Fig. 49).

Rice. 49. Position of the fingers during immobilization of the upper limb

Tire preparation:

Measure the length from the outer edge of the scapula of the healthy side of the victim 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 (Fig. 50);

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, make the necessary corrections;

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 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 cotton wool and bandages.

The splint prepared for use is applied to the injured arm, the upper and lower ends of the splint are tied with ribbons, and the splint is strengthened with bandages. The hand along with the splint is suspended on a scarf (Fig. 51).

To improve the 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. 52).

Rice. 50. Modeling of a scalene splint for transport immobilization of the entire upper limb

Rice. 51. Transport immobilization of the entire upper limb with a ladder splint: a - applying the splint to the upper limb and tying its ends; b - strengthening the splint with bandaging; c - hanging a hand on a scarf

Rice. 52. Fixation of the upper end of the ladder splint during immobilization of the upper limb

Mistakes when immobilizing the shoulder with a ladder splint.

The upper end of the splint reaches only the shoulder blade of the affected side; very soon the splint moves away from the back and rests on the neck or head. With this position of the splint, immobilization of injuries to the shoulder and shoulder joint will be insufficient.

There is no tape at the upper end of the tire, which does not allow it to be securely fixed.

Poor tire modeling.

The immobilized limb is not suspended from a scarf or sling.

In the absence of standard splints, 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 about 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, a piece of thick cardboard in the form of a trench can be laid with the inner and outer surface shoulder, which creates some immobility

at a fracture. The hand is then placed on a scarf or supported by a sling.

Immobilization with Deso bandage. For shoulder fractures and damage to adjacent joints, immobilization is carried out by applying a Deso-type bandage. Correctly performed immobilization of the upper limb significantly alleviates the condition of the victim, and special care is not required during evacuation. However, the limb should be periodically examined so that if the swelling in the area of injury increases, tissue 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 bandages should be loosened or cut and bandaged. Transportation is carried out in a sitting position, if the condition of the victim allows.

Immobilization for injuries of the forearm, wrist joint, hand and fingers. Indications for transport immobilization should include all fractures of the forearm bones, injuries to the wrist joint, fractures of the hand and fingers, extensive soft tissue injuries, deep burns, and purulent-inflammatory diseases.

Signs of fractures of the bones of the forearm, hand and fingers, damage to the wrist joint and joints of the hand: pain and swelling in the area of injury; the pain increases significantly with movement; movements of the injured arm are limited or impossible; change in the usual shape and volume of the joints of the forearm, hand and fingers; pathological mobility in the area of injury.

Immobilization with a ladder splint- the most reliable and effective type of transport immobilization for injuries of the forearm, extensive injuries to the hand and fingers. The ladder splint is applied from the upper third of the shoulder to the fingertips, the lower end of the splint protrudes 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 retracted to the back (Fig. 53). A cotton-gauze roller is placed in the hand to hold the fingers in a semi-flexed position.

A ladder splint 80 cm long, wrapped in 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 forearm splint 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, or the hem of a shirt.

Rice. 53. Transport immobilization of the elbow joint and forearm: a - with a ladder splint; b - using improvised means (using planks)

Immobilization for limited injuries of the hand and fingers.

Injuries to 1-3 fingers and injuries to the hand that involve only part of the dorsal or palmar surface should be considered limited. In these cases, it is not necessary to immobilize the injured area by immobilizing the elbow joint.

Immobilization with a ladder splint. The splint prepared for use is shortened by bending the lower end and modeled. The splint should cover the entire forearm, hand and fingers. Thumb is set in opposition to the third finger, the fingers are moderately bent, and the hand is abducted back side(Fig. 54, a). After strengthening the splint with bandages, the arm is suspended on a scarf or sling.

Immobilization with plywood splint or improvised materials is carried out in a similar way with the obligatory insertion of a cotton-gauze roller into the hand (Fig. 54, b).

Rice. 54. Transport immobilization of the hand and fingers: a - immobilization with a ladder splint; position of the hand and fingers on the plywood bus

Errors in transport immobilization of the forearm and hand.

Immobilization of the forearm in a position where the hand is turned with the palm towards the splint, which leads to the crossing of the bones of the forearm and additional displacement of bone fragments.

The upper part of the ladder splint is short and covers less than half of the shoulder, which does not allow immobilization of the elbow joint.

Lack of immobilization of the elbow joint in case of forearm injuries.

Fixing the hand on a splint with extended fingers in case of damage to the hand and fingers.

Fixation of the thumb in the same plane with the other fingers.

Bandaging injured fingers to uninjured ones. Intact fingers should remain free.

Victims with injuries to the forearm, wrist joint, hand and fingers are evacuated in a sitting position and do not require special care.

Transport immobilization for pelvic injuries

The pelvis is a ring formed by several bones. Pelvic injuries are often accompanied by significant blood loss, the development of shock, damage Bladder and rectum. Timely and correctly performed transport immobilization has a significant positive effect on the outcome of the injury.

Indications for transport immobilization for pelvic injuries: all fractures of the pelvic bones, extensive wounds, deep burns.

Signs of a pelvic bone fracture: pain in the pelvic area, which sharply intensifies when moving the legs; forced position (legs bent at the knees and adducted); sharp pain when palpating the wings of the pelvis, pubic bones, or when squeezing the pelvis in the transverse direction.

Transport immobilization consists of placing the wounded on a stretcher with a wooden or plywood shield in a supine position.

The shield is covered with a blanket and cotton-gauze pads are placed under the back surface of the pelvis to prevent the formation of bedsores. A tight bandage is applied to the pelvic area with wide bandages, a towel or a sheet. The legs are bent at the hip and knee joints and separated. An overcoat roll, a duffel bag, a pillow, a blanket, etc. are placed under the knees, creating the so-called frog position (Fig. 55). The victim is fixed to the stretcher with sheets, a wide strip of fabric, and fabric belts.

Rice. 55. Transport immobilization for pelvic injuries on a stretcher with a shield

Immobilization errors in pelvic injuries.

Careless repositioning of the victim, which in case of fractures leads to additional damage from the sharp ends of bone fragments of the bladder, urethra, rectum, and large vessels.

Transporting the victim on a stretcher without a shield.

Lack of fixation of the injured person to the stretcher.

Pelvic injuries may be accompanied by damage to the bladder and urethra, so during evacuation it is necessary to pay attention to whether the victim has urinated and what color it is.

urine, whether there is any blood in the urine, and promptly report this to the doctor. Urinary retention of more than 8 hours requires bladder catheterization.

Transport immobilization for injuries of the lower extremities

Transport immobilization is especially important for gunshot injuries of the lower extremities and is the best remedy in the fight against shock, infection and bleeding. Imperfect immobilization leads to a large number of deaths and severe complications.

Immobilization for injuries of the hip, hip and knee joints. Hip injuries are usually accompanied by significant blood loss. Even with a closed fracture of the femur, blood loss into the surrounding soft tissue is 1.5 liters. Significant blood loss contributes to the frequent development of shock.

Indications for transport immobilization: closed and open hip fractures; dislocations of the hip and lower leg; damage to the hip and knee joints; damage to large vessels and nerves; open and closed ruptures of muscles and tendons; extensive wounds; extensive and deep burns of the thigh; purulent-inflammatory diseases of the lower extremities.

The main signs of damage to the hip, hip and knee joints: pain in the hip or joints, which sharply increases with movement; impossibility or significant limitation of movements in joints; change in the shape of the hip, pathological mobility at the fracture site, shortening of the hip; change in the shape and volume of joints; lack of sensitivity in the peripheral parts of the lower limb.

The best standard splint for injuries of the hip joint, femur and severe intra-articular fractures in the knee joint is Dieterichs tire(Fig. 56). Immobilization will be more reliable if the Dieterichs splint is reinforced with plaster rings in the area of the torso, thigh and lower leg in addition to the usual fixation. Each ring is formed by applying 7-8 circular rounds of plaster bandage. There are 5 rings in total: 2 on the torso, 3 on the lower limb. In the absence of a Dieterichs splint, immobilization is performed using ladder splints.

Rice. 56. Transport immobilization with Dieterichs splint fixed with plaster rings

Immobilization with ladder splints. To immobilize the entire lower limb, 4 stair splints, each 120 cm long, are required. If there are not enough splints, immobilization can be carried out with 3 splints. The tires must be carefully wrapped with a layer of cotton wool of the required thickness and bandages. One splint is curved along the contour of the buttocks of the back of the thigh, lower leg and foot, forming a depression for the heel and lower leg muscles. In the area intended for the popliteal region, arching is performed in such a way that the leg is slightly bent at the knee joint. The lower end is bent in the shape of the letter L to fix the foot in a position of flexion at the ankle joint at a right angle, while the lower end of the splint should grip the entire foot and protrude 1-2 cm beyond the fingertips. The other two splints are tied together along the length. The lower end of the outer tire is L-shaped, and the inner

it is bent in a U-shape at a distance of 15-20 cm from the lower edge. An elongated splint is placed along the outer surface of the torso and limbs from the axillary region to the foot. The lower curved end wraps the foot over the rear tire to prevent foot drop. The fourth splint is placed along the inner lateral surface of the thigh from the perineum to the foot. Its lower end is also bent in the shape of the letter U and placed behind the foot over the curved lower end of the elongated outer side splint (Fig. 57). The splints are reinforced with gauze bandages.

Rice. 57. Transport immobilization with ladder splints for injuries of the hip, hip and knee joints

Similarly, in the absence of other standard splints, the lower limb can be immobilized with plywood splints. At the first opportunity, ladder and plywood tires should be replaced with a Dieterichs tire.

Errors when immobilizing the lower limb with ladder splints.

Insufficient fixation of the external extended splint to the body, which does not allow reliable immobilization of the hip joint. In this case, immobilization will be ineffective.

Poor modeling of the rear ladder tire. There is no recess for the calf muscle and heel. There is no bending of the splint in the popliteal region, as a result of which the lower limb is immobilized completely straightened in the knee joint, which in case of hip fractures can lead to compression of large vessels by bone fragments.

Plantar drop of the foot as a result of insufficiently strong fixation (there is no modeling of the lower end of the side splints in the form of the letter L).

The layer of cotton wool on the splint is not thick enough, especially in the area of bony protrusions, which can lead to the formation of bedsores.

Compression of the lower limb due to tight bandaging.

Immobilization using improvised means, performed in the absence of standard tires (Fig. 58). For immobilization, wooden slats, skis, branches and other objects of sufficient length are used to ensure immobilization in three joints of the injured lower limb: hip, knee and ankle. The foot must be placed at a right angle at the ankle joint and pads made of soft material must be used, especially in the area of the bony protrusions.

Rice. 58. Transport immobilization using improvised means for injuries of the hip, hip and knee joints: a - from narrow boards; b - using skis and ski poles

In cases where there are no means for transport immobilization, the “leg to leg” fixation method should be used. The damaged limb is tied to the healthy one in 2-3 places, or the damaged limb is placed on the healthy one, also tied in several places (Fig. 59).

Immobilization of the injured limb using the “foot-to-foot” method should be replaced by immobilization with standard splints as soon as possible.

Evacuation of victims with injuries to the hip, hip and knee joints is carried out on a stretcher in a lying position. To prevent and timely identify complications of transport immobilization, it is necessary to monitor the state of blood circulation in the peripheral parts of the limb. If the limb is bare, then monitor the color of the skin. With clothes on

and shoes, it is necessary to pay attention to the victim’s complaints. Numbness, coldness, tingling, increased pain, the appearance of throbbing pain, cramps in calf muscles are signs of circulatory disorders in the limb. It is necessary to immediately loosen or cut the bandage at the point of compression.

Rice. 59. Transport immobilization for injuries of the lower extremities using the “foot to foot” method: a - simple immobilization; b - immobilization with light traction

Immobilization for injuries of the leg, foot and toes.

Indications for performing transport immobilization: open and closed fractures of the shin bones, ankles; fractures of the bones of the foot and fingers; dislocations of the bones of the foot and fingers; ankle ligament damage; gunshot wounds; damage

muscles and tendons; extensive wounds of the leg and foot; deep burns, purulent-inflammatory diseases of the lower leg and foot.

The main signs of injuries to the lower leg, ankle joint, foot and toes: pain at the site of injury, which intensifies when moving the injured lower leg, foot or toes; deformation at the site of injury to the lower leg, foot, fingers, ankle joint; increase in the volume of the ankle joint; sharp pain with gentle pressure in the area of the ankles, foot bones and fingers; impossibility or significant limitation of movements in the ankle joint; extensive bruising in the area of injury.

Immobilization is best achieved with a T-shaped curved rear stair splint length 120 cm and two side ladder or plywood tires 80 cm long. The upper end of the tires should reach the middle of the thigh. The lower end of the side stair rails is bent L-shaped. The leg is slightly bent at the knee joint. The foot is positioned at a right angle to the shin. The splints are strengthened with gauze bandages (Fig. 60).

Immobilization can be performed with two 120 cm long ladder splints. To immobilize minor injuries of the ankle joint and ankles, injuries of the foot and toes, only one ladder splint located along the back of the lower leg and the plantar surface of the foot is sufficient. The upper end of the splint is at the level of the upper third of the shin (Fig. 61).

Transport immobilization of the stump of the femur and lower leg is carried out using a ladder splint, curved in the shape of the letter P, in compliance with the basic principles of immobilization of the injured part of the limb.

Errors in transport immobilization of injuries of the lower leg, ankle joint and foot with ladder splints.

Insufficient modeling of the scalene splint (no recess for the heel and calf muscles, no arching of the splint in the popliteal area).

Immobilization is performed only with the rear ladder splint without additional lateral splints.

Insufficient fixation of the foot (the lower end of the side splints is not curved in an L-shape), which leads to plantar sagging.

Rice. 60. Immobilization of injuries of the lower leg, ankle joint, and foot with three ladder splints: a - preparation of ladder splints; b - application and fixation of splints

Rice. 61. Transport mobilization of ankle and foot injuries using a ladder splint

Insufficient immobilization of the knee and ankle joints.

Compression of the lower limb with a tight bandage while strengthening the splint.

Fixation of the limb in a position where the tension of the skin over the bone fragments remains (the front surface of the leg, ankle), which leads to damage to the skin over the bone fragments or the formation of bedsores. Skin tension caused by displaced bone fragments in the upper half of the leg is eliminated by immobilizing the knee joint in a position of full extension.

Immobilization of injuries to the lower leg, ankle joint and severe injuries to the foot in the absence of standard splints can be done with improvised means. Protecting bony protrusions with cotton wool, cotton-gauze pads or soft cloth, immobilization is carried out using improvised means, capturing the entire foot, ankle joint, shin, knee joint and thigh to the level of the upper third.

For injuries to the foot and fingers, immobilization from the tips of the fingers to the middle of the lower leg is sufficient. As a last resort, in the absence of any means of immobilization, immobilization using the “foot to foot” method is used.

Victims with injuries to the lower leg and foot, if their condition allows, can move on crutches without putting stress on the injured limb. Transportation of such wounded people can be carried out in a sitting position.

Transport immobilization for multiple and combined injuries

Multiple damage- these are injuries in which there are two or more injuries within one anatomical area (head, chest, abdomen, limbs, etc.).

Combined injuries- these are injuries in which there are two or more injuries in different anatomical areas (head - lower limb, shoulder-chest, thigh-abdomen, etc.).

Multiple injuries of the limbs include two or more injuries located both within one limb (upper, lower) or even one segment of the limb (thigh, lower leg, shoulder, etc.), and on different limbs simultaneously (thigh-shoulder, hand-shin, etc.).

In the case when a wounded person has injuries to two or more anatomical areas or two or more injuries to the extremities, it is necessary first of all to establish which of these injuries determines the severity of the victim and requires priority medical measures at the time of assistance.

You should always remember that multiple and combined injuries are accompanied by life-threatening and severe local complications. First aid often includes measures aimed at preserving the life of the victim. Resuscitation measures (stopping bleeding, indoor massage heart, artificial respiration, replacement of blood loss) must be carried out at the scene of the incident, if possible, without moving the victim. Transport immobilization is an important part of the complex of anti-shock measures and is carried out immediately after completion of actions to save the life of the victim.

Combined head injuries. Immobilization of the head and associated injuries to the limbs, pelvis and spine does not have any significant features and is performed using known methods.

Particularly severe breathing disorders are accompanied by traumatic brain injury in combination with damage to the chest. In these cases, carefully performed transport immobilization of the damaged area of the chest is extremely necessary.

Combined chest injuries. Injuries to the chest in combination with injuries to the extremities require the use of some special techniques of transport immobilization. When applying a Dieterichs splint to the lower limb or a ladder splint to the upper limb, difficulties arise, since the splints need to be fixed to the chest. In such cases, it is necessary to create a protective frame over the damaged area of the chest using a ladder or plastic splint, and then attach standard splints on top of the protective frame.

Immobilization of both upper extremities, performed using ladder splints using the usual method, is very difficult for wounded people with combined chest injuries. In such cases, transport immobilization of the upper limbs with two U-shaped splints is less traumatic. The victim is placed in a semi-sitting position. Both upper limbs are bent at the elbows

joints at right angles and place the forearms parallel to each other on the stomach. A prepared ladder splint 120 cm long is bent in the shape of the letter P so that its middle part corresponds to the forearms stacked on top of each other. A U-shaped frame is placed on both upper limbs, the ends of the frame are curved along the contours of the back and tied together with a cord. The forearms folded together are fixed to the middle part of the frame with a bandage, then both shoulders are strengthened to the side parts with separate bandages. The second U-shaped splint covers the chest and limbs from the back at the level of the middle third of the shoulder (Fig. 62).

Rice. 62. Transport immobilization with ladder splints for multiple injuries of both upper extremities: a - U-shaped splint; b - dual tires

You can form a frame from two ladder splints, bent separately onto the right and left arms, as in a unilateral fracture, and fastened together.

Multiple limb injuries. Transport immobilization for multiple limb fractures is performed according to general rules. Immobilization of multiple injuries of the lower limb should be performed with a Dieterichs splint and only in its absence - with other means of transport immobilization. Significant difficulties arise with bilateral limb fractures, when a large number of standard splints are required for immobilization. If there are not enough tires, you should combine standard and improvised means. In these cases, it is advisable to use standard splints to immobilize more severe injuries, and improvised means for less severe injuries.

The main mistake when providing first aid to victims with combined and multiple trauma is the delay in evacuation to the next stages of medical care.

Carrying out resuscitation measures and carrying out transport immobilization must be clear, fast and extremely economical.

Reuse of transport immobilization devices

Standard means of transport immobilization can be used repeatedly. As a rule, improvised means are not reused.

Dieterichs tire freed from contaminated layers of cotton wool and bandage soaked in blood and pus, wiped with a disinfectant solution. Fabric belts are soaked in a disinfectant solution, then washed and dried. The treated tire is assembled into the stowed position. The slats of the outer and inner side branches are aligned in length. The tire parts are connected to each other.

Plywood tire is freed from contaminated layers of cotton wool and bandage, treated with a disinfectant solution, after which the tire is ready for reuse. If the tire is significantly saturated with pus and blood, it must be destroyed (burned).

Ladder tire. Contaminated layers of bandage and gray wool soaked in blood or pus are removed. The tire is straightened by hand or with a hammer and thoroughly wiped with a disinfectant solution (5% Lysol solution). Then the splint is again covered with gray wool and wrapped with a bandage.

If the layers of cotton wool and bandage on a used splint are not dirty, then they are not changed. The ladder splint is straightened by hand and bandaged with a fresh bandage.

Plastic sling splint. The plastic sling is treated with a disinfectant solution and cleaned with detergents. The support cap is soaked in a disinfectant solution, washed and dried.

Disinfection of standard tires is carried out by double treatment with an interval of 15 minutes with a swab generously moistened in a disinfectant solution (5% Lysol solution, 1% chloramine solution).

Tires used for transport immobilization for traumatic injuries complicated by anaerobic infection are disinfected in a special way.

Anaerobic infection is transmitted by direct contact. Spores of anaerobic infection pathogens are resistant to environmental factors. In this regard, used dressings and splints made from wood (Diterichs splints, plywood splints) must be burned. Stair splints can be reused only after disinfection, treatment with detergents and sterilization with steam under pressure in steam sterilizers (autoclaves); in exceptional cases, sterilization is carried out by calcination over fire.

Degassing and decontamination of standard means of transport immobilization

If organophosphorus toxic substances get on the tires, degassing is carried out by treating the tires with a swab moistened with a 12% ammonia solution (a solution of ammonia diluted in half with water). After treatment with ammonia solution, the tires are washed with running water.

Degassing of tires when contaminated with toxic substances of blister action is carried out with a slurry of bleach (1:3), which is applied to the surface of the tire for 2-3 minutes, and then washed with running water. Contaminated with persistent toxicants

tires are treated with substances with a swab soaked in a 10-12% alkali solution, and then washed with a stream of water. It is recommended to wipe wood products with vegetable oil after degassing. Tires made of plastic are soaked in a 10% chloramine solution. Transport tires contaminated with radioactive substances are wiped with a damp swab and then washed with water containing detergents. Before reuse, tires must be tested for residual radioactivity.

Preoperative preparation - This is a system of measures aimed at preventing intra- and postoperative complications.

Preparing the patient for elective surgery consists not only in carrying out preventive measures, but also in correcting the activity of altered organs in order to increase their functional reserves and, as a consequence, reduce the risk of surgery.

General events are performed on all patients, regardless of the nature of the operation and disease.

Special Events are carried out depending on the nature of the disease and the type of intervention.

Preparing the patient for planned surgery

After a comprehensive examination of the patient (medical examination data, data from biochemical blood tests, general blood and urine tests, blood group, Rh factor, fluorography, ECG, necessary diagnostic tests), he is given:

General events

Psychological preparation of the patient: - conversation between the doctor and the patient before the operation (convince of the need

operations, obtain his written consent, instill hope in

successful outcome of the operation); - attentive, kind, affectionate attitude of junior and middle

medical personnel to the patient.

An important role in the preoperative period is played by the fight against insomnia and pain (sleeping pills, tranquilizers, painkillers, hypnosis are used).

On the eve of the operation

1. The patient is prescribed a diet (maybe a light dinner or fast).

2. In the evening he is given a cleansing enema.

3. The patient takes a hygienic bath or shower.

4. Changes underwear and bed linen.

5. The patient is examined by an anesthesiologist and prescribed premedication.

6. The patient is given premedication (sleeping pills, tranquilizers).

On the day of surgery

1. In the morning, the patient is given a cleansing enema.

2. His surgical field is shaved.

3. They remove his dentures, lenses, prosthetic limbs, hearing aid, rings, watches (given to the head nurse for safekeeping).

4. He is not given anything to drink or food to eat.

5. 30 minutes before surgery you are asked to urinate.

6. They give premedication and explain that he may feel drowsiness and dry mucous membranes.

7. In a semi-asleep state, the patient is carefully (where there is a pillow, blanket and sheet) transported on a gurney to the operating room (accompanied by a nurse) and carefully transferred to the operating table.

Preparing the patient for emergency surgery

When preparing for emergency surgery on a patient the shortest possible time against the background of drug therapy, the following is carried out:

1. A minimum of laboratory tests (general blood and urine analysis, blood type and Rh factor).

2. Partial sanitization (wiping contaminated areas of the body).

3. The patient's dentures, rings, and watches are removed.

4. Removes all makeup and nail polish. Makeup obscures the true color of the skin, which can make it difficult to assess gas exchange.

5. Pumping out the contents of the stomach (if the patient has recently eaten and the operation will be performed under anesthesia).

6. Shaving the surgical field.

7. The patient is asked to urinate himself (in a severe and unconscious state, the patient undergoes catheterization of the bladder).

8. Premedication.

9. Transporting the patient to the operating room in a semi-asleep state on a gurney.

Special measures for the preoperative preparation of the patient consist of a number of activities related to the operation on a specific organ

The purpose of transport immobilization is to prevent additional damage to tissues and organs, the development of shock when shifting and transporting the victim.

Indications for transport immobilization:

Damage to bones and joints Extensive soft tissue damage to the limb Damage to large vessels and nerves of the limb Inflammatory diseases of the limb ( acute osteomyelitis, acute thrombophlebitis).

Transport immobilization rules:

immobilization should be carried out at the scene of the incident; shifting or carrying the victim without immobilization is unacceptable; before immobilization, it is necessary to administer painkillers (morphine, promedol); if there is bleeding, it should be stopped by applying a tourniquet or a pressure bandage; the wound dressing should be aseptic; the splint is applied directly to the clothing, but if it has to be applied to the naked body, then cotton wool, a towel, and the victim’s clothing are placed under it; on the limbs, it is necessary to immobilize the two joints closest to the injury, and in case of a hip injury, all three joints of the limb; in case of closed fractures, when applying a splint, it is necessary to perform a slight traction along the axis of the limb using the distal part of the arm or leg and fix the limb in this position; with open fractures, traction is unacceptable; the limb is fixed in the position in which it found itself at the time of injury; a tourniquet applied to a limb must not be covered with a bandage securing the splint; When repositioning a victim with a transport splint applied, it is necessary for an assistant to hold the injured limb.

If mobilization is improper, displacement of fragments during transfer and transportation can turn a closed fracture into an open one; moving fragments can damage vital organs - large vessels, nerves, brain and spinal cord, internal organs chest, abdomen, pelvis. Additional trauma to surrounding tissue can lead to shock.

For transport immobilization, standard Kramer and Dieterichs splints, pneumatic splints, vacuum immobilization stretchers, and plastic splints are used.

The Kramer stair tire is universal. These tires can be given any shape, and by connecting them together, you can create various designs. They are used to immobilize the upper and lower extremities and head.

The Dieterichs tire consists of a sliding outer and inner plate, a plywood sole with metal brackets and a twist. The splint is used for fractures of the femur, bones that form the hip and knee joints. The advantage of the tire is the ability to create traction with its help.

Pneumatically, the tires are a two-layer sealed cover with a zipper. The cover is put on the limb, the zipper is fastened, and air is pumped through the tube to make the splint rigid. To remove the tire, deflate the air and open the zipper. The tire is simple and easy to handle, permeable to X-rays. Splints are used to immobilize the hand, forearm, elbow joint, foot, lower leg, and knee joint.

In the absence of standard tires, improvised means (improvised tires) are used: planks, skis, sticks, doors (for transporting a victim with a spinal fracture).

A standard Elansky plywood splint is used for head and cervical spine injuries (Fig. 1). The flaps of the splint are deployed, a layer of cotton wool is applied on the side where there are semicircular oilcloth rollers to support the head, the splint is placed under the head and top part chest and secured with straps to the upper body. The head is placed in a special recess for the occipital part and bandaged to the splint.

To immobilize the head, you can use a cotton-gauze circle. The victim is placed on a stretcher, the head is placed on a cotton-gauze circle so that the back of the head is in the depression, after which the victim is tied to the stretcher to avoid movements during transportation.

Immobilization for a neck injury can be done using cotton and gauze if the patient is not vomiting or has difficulty breathing. 3-4 layers of cotton wool are bandaged around the neck so that the resulting collar with its upper end rests against the back of the head and mastoid processes, and the lower one - into the chest (Fig. 2).

Immobilization of the head and neck can be achieved by applying Kramer splints, pre-curved along the contour of the head. One splint is placed under the back of the head and neck, and the other is bent in the form of a semi-oval, the ends of which rest against the shoulders. The splint is fixed with bandages.

In case of a clavicle fracture, a Deso bandage or a scarf bandage with a roller placed in the armpit, or a figure-of-eight bandage is used to immobilize the fragments.

In case of a fracture of the humerus and damage to the shoulder or elbow joint, immobilization is carried out using a large Cramer's scalene splint, which the doctor first models on himself (Fig. 3). The limbs are given the position indicated in the figure, with a roller under the armpit. The splint secures all three joints of the upper limb. The upper and lower ends of the splint are fastened with a bandage, one end of which is drawn in front, and the other through the armpit on the healthy side. The lower end of the splint is hung around the neck using a scarf or belt (Fig. 4).

In the absence of standard means, transport immobilization for a fracture of the shoulder in the upper third is carried out using a scarf bandage. A small cotton-gauze roll is placed in the armpit and bandaged to chest over your healthy shoulder. The arm, bent at the elbow joint at an angle of 60°, is suspended on a scarf, the shoulder is bandaged to the body.

To immobilize the forearm and hand, a small scale splint is used, to which the hand and forearm are bandaged with fixation of the wrist and elbow joints. The arm is bent at the elbow joint; after applying the splint, the hand is suspended on a scarf. In the absence of special splints, the forearm is suspended on a scarf or immobilized using a board, cardboard, or plywood with mandatory fixation of two joints.

For hip fractures, damage to the hip and knee joints, Dieterichs splints are used. The plantar plate of the splint is bandaged with a figure-of-eight bandage to the sole of the victim’s shoe. The outer and inner plates of the splint are adjusted to the patient’s height by moving them in brackets and secured with a pin. The outer bar should rest against the axillary fossa, the inner one - in the groin area, their lower ends should protrude 10-12 cm beyond the sole. The plates are passed through the staples of the plantar plate and secured with a clamp. A cord is passed through the hole in the sole and tied on a twist stick. Cotton-gauze pads are placed in the ankle area and on the crutch plates. The splint is secured with straps to the body, and the slats are secured to each other. The leg is pulled out by the staples on the plantar plate (Fig. 5) and the twist stick is twisted. The splint is bandaged to the leg and torso. A Kramer splint is placed and bandaged under the back surface of the leg to prevent the leg from moving backward in the splint.

Cramer splints connected to each other can be used to immobilize the hip. They are applied from the outside, inside and back. Immobilization of three joints is mandatory.

For a tibia fracture, Kramer splints are used (Fig. 6). Limbs are fixed with three splints, creating immobility in the knee and ankle joints. Pneumatic splints are used to immobilize the lower leg and knee joint (Fig. 7).

If the pelvic bones are fractured, the victim is transported on a stretcher, preferably with a plywood or plank board underneath. The legs are bent at the hip joints, a cushion of clothing, a blanket, or a duffel bag is placed under the knees. The victim is tied to a stretcher.

With a fracture of the spine in the thoracic and lumbar regions, transportation is carried out on a stretcher with a shield, with the victim in the position on his back with a small bolster under the knees (Fig. 9). The victim is tied to a stretcher. If it is necessary to transport the victim on a soft stretcher, he is placed on his stomach with a cushion under his chest. In case of a fracture of the cervical and upper thoracic spine, transportation is carried out on a stretcher with the victim in the supine position, with a bolster placed under the neck.

and fractures of the spine, pelvis, severe multiple injuries transport immobilization is used using immobilization vacuum stretchers (NIV). They are a sealed double cover on which the victim is placed. The mattress is laced up. The air is sucked out of the cover using a vacuum suction with a vacuum of 500 mm. rt. Art., kept for 8 minutes so that the stretcher acquires rigidity due to the convergence and adhesion of polystyrene foam granules, with which the mattress is filled to the fullest extent. In order for the victim to occupy a certain position during transportation (for example, half-sitting), he is given such a position during the period of air removal (Fig. 10).