First aid for injuries

General principles of the pre-hospital stage

First aid for any wounds is based on a strict algorithm that must be performed consistently and rapidly. The main goal is to stabilize the patient's condition for safe transport to the surgical department.

Action algorithm:

• Hemorrhage control. This is the top priority. For venous bleeding, applying a pressure bandage is sufficient. If pronounced arterial or massive venous bleeding is observed, the application of a hemostatic tourniquet is indicated.
• Wound management. The skin around the wound defect is carefully treated with an iodine solution or iodopyron (a complex of iodine and potassium iodide). Only freely lying large foreign bodies are allowed to be removed from the wound. Important: it is strictly unacceptable to explore the wound with a finger or a surgical probe. Such actions carry a high risk of additional damage to blood vessels and nerve trunks, and also contribute to the infection of deep tissue layers.
• Bandage application. Sterile wipes, individual dressing kits (IDK), or cotton-gauze pads are used to cover the defect.
• Transport immobilization. Used according to strict indications: the presence of open fractures or extensive soft tissue damage (e.g., in lacerated and contused wounds). Standard medical or improvised splints are used as immobilization means.

Penetrating chest wounds (open pneumothorax)

The main threat in an open pneumothorax is the free communication of the pleural cavity with the external environment, which disrupts respiratory mechanics. The main goal of care is immediate sealing of the defect.

Procedure for applying an occlusive (sealing) dressing:

1. Treat the wound edges with an iodine solution.
2. Apply an airtight material.

Technique for using an individual dressing package (IDP): The rubberized shell of the individual dressing package is applied directly to the wound with the inner sterile side. Cotton-gauze pads are placed over the shell and tightly bandaged to the chest.

Alternative sealing materials: If an IDP is not available, any airtight material (cellophane, oilcloth) can be used. As a last resort, a cotton-gauze dressing pre-soaked generously with sterile vaseline or another harmless ointment is permitted. The sealing material is always applied directly over the defect, covered on top with a cotton-gauze dressing, and fixed with a bandage.

Adhesive plaster method: The wound edges are brought as close together as possible. Adhesive plaster strips are applied in a 'shingle' pattern — each subsequent strip must overlap the previous one by exactly half of its width, ensuring a secure closure.

Penetrating abdominal wounds

Abdominal wounds require extreme caution due to the high risk of internal organ damage and the development of peritonitis. The general algorithm includes applying an aseptic dressing, and in the presence of external bleeding, a pressure hemostatic bandage.

Tactics for evisceration (prolapse of internal organs): In extensive abdominal wounds, prolapse of intestinal loops or omental folds outward is possible.

• Strictly prohibited: attempting to push any prolapsed organs back into the abdominal cavity.
• Correct actions: the prolapsed tissues must be gently covered on top with sterile gauze wipes, a sterile bandage, or a voluminous cotton-gauze pad. After that, a neat circular bandage is applied over the abdomen to fix the material without compressing the organs themselves.

Class and exam questions

What else to study on this topic

• Technique for applying a pressure bandage and hemostatic tourniquet
• Rules of transport immobilization using standard and improvised splints
• Pathophysiological mechanisms of open pneumothorax development
• Particulars of transporting casualties to the surgical department
• Pharmacological properties of iodopyron and its use in surgery

Other topics in "CHAPTER 10. GENERAL ISSUES IN TRAUMATOLOGY"

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