Pre-hospital errors and complications
Careless transfer of the casualty, as well as errors in applying splints and tourniquets, can lead to serious and life-threatening consequences. Secondary displacement of bone fragments can easily turn closed fractures into open ones when a sharp bone edge punctures the skin from within.
In addition, displaced bone fragments often injure adjacent neurovascular bundles, internal organs, or the spinal cord. This threatens the development of irreversible paralysis, profuse bleeding, and, in cases of abdominal organ damage, peritonitis.
Injuries of the external ear
Injuries to the auricle, ranging from superficial abrasions to complete avulsion, are dangerous due to wound infection. Bacterial contamination triggers the development of chondroperichondritis. This severe inflammation leads to subsequent melting of the cartilage tissue and irreversible ear deformation. Treatment of deep wounds involves primary surgical debridement and suturing.
If the impact was to the chin or the person fell onto the lower jaw, a fracture of the anteroinferior wall of the external auditory canal frequently occurs. The patient complains of bleeding and severe pain when chewing. Such injuries are often combined with trauma to the temporomandibular joint and the mastoid process.
For treatment, the bone fragments are gently reduced with a periosteal elevator, and turundas with anti-inflammatory ointments, such as chloramphenicol liniment, are placed in the canal. It is important to remember that blood discharge from the ear also occurs in fractures of the petrous part of the temporal bone, which requires mandatory CT scanning.
Chest injuries
Chest injuries are divided into open (penetrating and non-penetrating) and closed (contusions, compressions). The most frequent closed injury is a rib fracture. The patient experiences sharp localized pain that increases with coughing and anterior-posterior chest compression, breathing rapidly and shallowly. The sitting position noticeably improves the condition. The main danger is damage to the lung tissue by displaced fragments. The casualty must be provided with complete rest in a semi-sitting position and a cold compress applied to the impact site.
Open chest injuries are accompanied by a severe general condition, pronounced dyspnea, frothy blood coming from the wound, and characteristic bubbling or whistling sounds during breathing due to air suction.
First aid algorithm for open chest trauma:
- Do not give the casualty food or drink, and strictly forbid talking.
- Free the chest as much as possible from restrictive clothing that hinders breathing.
- Provide a semi-sitting position. If this is not possible, lay them on their side (strictly with the injured side down).
- Emergency seal the wound with airtight material (a piece of plastic wrap, foil, or simply a palm) to stop air suction during inhalation.
- It is strictly forbidden to independently remove any foreign objects from the wound.
Open injuries of the spine and spinal cord
Care is provided according to the standard basic life support protocol. The key task at this stage is to prevent secondary infection of the wound and stop blood loss.
The wound edges are thoroughly treated with an antiseptic. If moderate bleeding is observed, the wound cavity is packed with a special hemostatic sponge impregnated with an antibiotic (gentamicin), after which an aseptic dressing is applied. Such a patient must be transported on a rigid wooden spine board if standard stretchers are unavailable, with mandatory immobilization of the cervical spine.
In open chest trauma, lay the patient on the INJURED side — this allows the healthy lung to breathe fully and compensate for oxygen shortage.
Class and exam questions
How to properly transport a patient with open chest trauma if they cannot sit?
If the patient cannot maintain a semi-sitting position, they must be placed in a recovery position on their side, mandatory with the injured side down. This will limit the mobility of the traumatized half and ease the work of the healthy lung.
What is the danger of bleeding from the external auditory canal after a blow to the jaw?
It may indicate not only an isolated fracture of the auditory canal wall, but also serve as a sign of a fracture of the petrous part of the temporal bone. This critical condition requires immediate further evaluation, including computed tomography.
What to do with a foreign object protruding from a chest wound?
Foreign objects are strictly forbidden to be removed during first aid. They may act as a plug (tamponade of a damaged vessel), and their removal will provoke massive fatal bleeding.
What else to study on this topic
- Mechanisms of secondary displacement of bone fragments and the development of paralysis.
- Methods of performing otoscopy and testing vestibular function in ear injuries.
- Features of primary surgical debridement of deep wounds of the auricle.
- Rules for applying an occlusive dressing in penetrating chest wounds.
- Indications for use and mechanism of action of hemostatic sponges with antibiotics.
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