External trauma

Anti-shock measures at the pre-hospital stage

The foundation of saving a patient with severe injuries is competent anti-shock therapy. Its main goal is to prolong life and buy time for pathogenetic treatment and transportation to a specialized hospital. Therapy includes maintaining cardiac and respiratory function (drug-based blood pressure correction and respiratory stimulation), as well as preventing local and systemic infectious complications.

Basic measures are divided into four areas:

1. Stopping bleeding. Begins with basic first aid: digital pressure on the artery, maximum limb flexion, using an improvised tourniquet, or a pressure bandage. Ambulance paramedics additionally apply a hemostatic clamp to the vessel in the wound. Definitive hemostasis (arterial ligation in continuity or suture ligation) is performed in the trauma center.
2. Pain management. General narcotic and non-narcotic analgesics are used at all stages. Starting from the primary physician-assisted care stage, the regimen is supplemented with procaine nerve blocks.
3. Immobilization. Initially, any available improvised means are used. Medical personnel use standard transport splints, and in the specialized department (trauma center), plaster splints are added and definitive therapeutic immobilization is initiated.
4. Restoration of circulating blood volume (CBV). This is a crucial task for correcting homeostasis. At the first-aid stage, the victim is given alkaline drinks. Next, infusion therapy is initiated: saline (crystalloid) solutions are administered at the pre-hospital stage, and ambulance and specialized care physicians connect colloidal volume expanders.

Injuries to the external ear and ear canal

Auricle injuries occur due to impacts or contusions. They range from simple superficial abrasions to partial or complete avulsion.

• Complications: Deep wounds easily become infected, leading to the development of chondroperichondritis. This condition causes subsequent cartilage resorption and persistent deformation of the auricle.
• Treatment: Superficial defects are managed in the standard way. Deep wounds and avulsions require primary surgical debridement (PSD) and suturing.

Injuries to the external ear canal can be isolated, but are more often combined with trauma to the temporomandibular joint (TMJ), mastoid process, tympanic cavity, or inner ear.

• Mechanism: A fall onto the lower jaw or a blow to the chin often results in a fracture of the anteroinferior wall of the ear canal. The patient complains of pain when moving the jaw and bleeding from the ear.
• Red flag: Bleeding is also characteristic of a fracture of the petrous part of the temporal bone. To rule out this severe condition, a CT scan of the temporal bone is required.
• Diagnostics: An accurate diagnosis requires a comprehensive approach: taking an anamnesis, examination and probing of the wound, and otoscopy. X-rays of the temporal bones and TMJ, as well as an examination of hearing and vestibular function, are mandatory.
• Management: Includes primary surgical debridement, stopping bleeding with disinfectant solutions, repositioning bone fragments with a raspatory, and packing the canal with turundas soaked in anti-inflammatory ointments (e.g., Chloramphenicol). This prevents narrowing or atresia of the canal, as well as TMJ dysfunction.

Tympanic membrane injury and otalgia

The main principle in a ruptured tympanic membrane is to prevent infection from entering the middle ear cavity through the resulting defect.

• Tactics: As first aid, a sterile turunda is inserted into the ear canal for several days, and antibacterial drugs are prescribed.
• Prognosis: In 50% of patients, traumatic rupture heals spontaneously.
• Treatment: To stimulate regeneration, the defect is temporarily covered with a silastic film (conservative method). If spontaneous healing does not occur, surgical intervention is indicated — myringoplasty.

Separately in the context of pain syndrome, otalgia—severe paroxysmal pain deep in the ear or near the auricle—should be highlighted. Its key feature is that it is not associated with primary pathological manifestations in the ear itself, but is referred in nature.

Legal and organizational frameworks of first aid

First aid is a set of measures aimed at preserving and maintaining the life and health of victims until qualified medical care is provided. It is provided by persons obligated to do so by law (employees of the Ministry of Internal Affairs, State Fire Service, rescuers), as well as bystanders (mutual aid) or the victim themselves (self-aid).

According to Order of the Russian Ministry of Health No. 220n, the following indications for first aid are distinguished:

1. Unconsciousness.
2. Respiratory and (or) circulatory arrest.
3. Airway obstruction (e.g., by a foreign body).
4. External bleeding.
5. Traumas, wounds, and injuries (mechanical, chemical, electrical, thermal, radiation).
6. Poisonings.
7. Bites or stings of venomous animals.
8. Seizure with loss of consciousness.
9. Acute psychological stress reactions.

Class and exam questions

What else to study on this topic

• Technique of applying an improvised tourniquet and pressure bandage.
• Methodology for performing procaine nerve blocks in trauma.
• Surgical technique of myringoplasty.
• Differential diagnosis of otalgia.
• Symptomatic therapy to support cardiac and respiratory function.

Other topics in the "Additional Topics" section

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.