First aid for injuries

Algorithm of actions for knee joint trauma

If damage to the knee joint is suspected, assistance begins with a primary assessment. The physician must rule out life-threatening conditions: shock, acute limb ischemia, ongoing hemorrhage, and respiratory failure.

Next, the local status is assessed: a medical history is taken to clarify the mechanism of injury, followed by inspection and palpation. It is critically important to check for distal blood supply and innervation disorders.

The basic diagnostic method is radiography in two standard projections. Subsequent tactics depend on the results:

• In the presence of hemarthrosis, joint puncture is performed, the contents are evacuated, and a local anesthetic (novocaine) is administered. The detection of fat droplets in the fluid indicates an occult intra-articular fracture.
• If there is no fracture, functional tests are performed to assess the ligaments and menisci (ultrasound or MRI are prescribed if necessary).

Treatment tactics are divided into four options:

1. Option A: Temporary immobilization (plaster, skeletal traction) and preparation for surgery.
2. Option B: Rigid conservative fixation.
3. Option C: Functional treatment using removable orthoses.
4. Option D: Emergency surgical intervention.

Any of the options is concluded with a mandatory course of rehabilitation to restore the range of motion and strengthen muscles.

Chest injuries: types and symptoms

Chest injuries are divided into closed (contusions, compressions, lung ruptures) and open (penetrating and non-penetrating). They may be accompanied by bone fractures or occur without them.

The most common closed injury is a rib fracture. It occurs due to a severe impact or compression (e.g., from a fall or traffic accident). The main danger is that displaced bone fragments can damage lung tissue and cause internal hemorrhage.

Symptoms of a rib fracture:

• Local pain that sharply intensifies with coughing.
• Tenderness when compressing the chest in the anteroposterior direction.
• Shallow, shortened breathing.
• It is significantly easier for the victim to sit than to lie down.

Symptoms of an open trauma:

• Severe general condition, pronounced dyspnea, and labored breathing.
• Presence of a wound from which frothy blood is discharged.
• Characteristic bubbling, hissing, or whistling sounds during respiratory movements.

First aid rules for chest trauma

Assistance tactics strictly depend on the nature of the injury.

In case of closed trauma:

• Place the victim in a semi-sitting position.
• Limit any movement; do not move the patient without extreme necessity.
• If external bleeding is present, stop it and clean the wound.
• Apply a cold compress (ice) to the site of the contusion or fracture.

In case of open trauma:

• Immediately seal the wound to prevent air suction during inhalation. Use your palm, foil, or thick plastic wrap.
• Place the victim in a semi-sitting position. If sitting is impossible, lay the person in a stable recovery position on their side, with the injured side down.
• It is strictly forbidden to remove foreign objects from the wound.
• The patient must not be given anything to drink or eat, and must not talk. Clothing that restricts breathing must be unbuttoned or removed.

Historical excursion: from Avicenna to CITO

The development of traumatology has a rich history. Avicenna already described methods of bone fragment reposition in detail. During the Renaissance, Ambroise Paré revolutionized military field surgery: he introduced vascular ligation instead of cauterization, proved the necessity of amputations within healthy tissue, and laid the foundations of the doctrine of sepsis.

In Russia, bone-setting has actively developed since the 17th century. In 1654, the first Moscow Medical School was established, where Pervushka Petrov, the founder of domestic orthopedics, taught. E.O. Mukhin, who published the work "First Principles of Bone-Setting Science" in 1806, and I.F. Bush made outstanding contributions.

In 1932, the specialty was officially designated as a separate branch of surgery. V.V. Gorinevskaya and V.N. Rozanov played a huge role in its formation. The key figure of the Soviet period was N.N. Priorov, who headed the Central Institute of Traumatology and Orthopedics (CITO) established in 1940. Due to the high level of medical development, during the Great Patriotic War, 72% of wounded soldiers were returned to duty, and the accumulated experience gave an impetus to the rapid development of osteosynthesis and prosthetics techniques in the post-war period.

Class and exam questions

What else to study on this topic

• Methods of bone fragment reposition in the historical works of Avicenna
• Ambroise Paré's doctrine on amputations and blood vessel ligation
• Organization of prosthetic and orthopedic care in the post-war period
• Functional tests to identify injuries of the capsular-ligamentous apparatus
• Types of therapeutic immobilization and bracing for limb injuries

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