First aid in trauma: immobilization and anti-shock

Principles of transport immobilization

The patient's position during transportation strictly depends on the location of the injury. Proper positioning minimizes secondary fragment displacement and prevents additional trauma to neurovascular bundles.

Spine and pelvic injuries

Lower thoracic and lumbar spine: the patient is transported on their back. To preserve the natural physiological lordosis, a bolster must be placed under the lumbar region. Alternatively, transportation in a prone position is acceptable, with a wide bolster placed under the victim's chest and head.
Pelvic bone fractures: transportation is carried out exclusively on the back. A bolster is placed under the popliteal region (the "frog" position). A special structure made of tied and bent ladder splints can be used to securely fix this bolster.

Application of vacuum devices and casts Vacuum stretchers and mattresses are the preferred devices for pelvic and spinal injuries. They provide the most complete immobilization possible, as they allow for rigid fixation of the body in almost any required position while conforming to its contours.

Plaster splint bandages can be used as an alternative for transport immobilization.

Advantages: the ability to perfectly mold the bandage to the anatomical contours, which is critically important during prolonged evacuation.
Disadvantages: the bandage requires a long drying time to reach maximum strength; exposure to moisture causes softening and complete loss of fixing properties.
Mandatory rule: a soft padding (made of cotton and gauze) must always be placed under the plaster.

Stage-by-stage anti-shock measures: hemostasis and analgesia

Combating traumatic shock begins at the scene of the incident and continues at all stages of medical evacuation.

1. Stopping bleeding

First aid and primary pre-hospital care: temporary cessation of external bleeding is performed. Digital arterial pressure, a tourniquet-improvised tourniquet, maximum limb flexion, or a pressure bandage is applied.
Primary medical and emergency care: placement of a hemostatic clamp directly on the bleeding vessel in the wound is added to the above measures.
Primary specialized care (in the trauma center): definitive cessation of external bleeding is carried out. This includes applying a ligature to the vessel in the wound or ligating the vessel proximally.

2. Pain management

At all stages (from first aid to specialized care), general narcotic and non-narcotic analgesics are used.
Starting from the stage of primary medical and emergency care, the analgesia regimen is augmented with local novocaine blocks.

3. Immobilization devices by stage

First aid: fixation is carried out using any improvised means.
Primary pre-hospital, medical, and emergency care: standard transport splints are used.
Specialized care: standard splints, plaster splints, and transition to therapeutic immobilization.

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Restoration of blood volume and support of vital functions

Homeostasis correction and restoration of circulating blood volume are the most important tasks of shock therapy. Infusion tactics expand as the patient is moved closer to the hospital:

First aid: the victim is given alkaline drinks (if there are no abdominal contraindications).
Primary pre-hospital care: basic infusion therapy—intravenous administration of saline (crystalloid) solutions—is added to the oral intake.
Medical, emergency, and specialized care: the regimen is supplemented by the administration of colloid solutions (plasma volume expanders) to effectively retain fluid in the vascular bed.

Support of cardiac and respiratory function At the pre-hospital stage, therapy is predominantly symptomatic in nature. It includes medical correction of falling blood pressure and stimulation of depressed respiration.

The main goal of these measures in severe polytrauma is to prolong the patient's life, stabilize their condition for transportation, and buy time for full-scale pathogenetic treatment. Additionally, prevention of infectious complications, which can be both local and systemic, is carried out at all stages.

Class and exam questions

In what position is a patient with a pelvic bone fracture transported?

The patient is placed strictly on their back. A bolster is necessarily placed under the popliteal region to relax the muscles (the "frog" position).

What must be done before applying a plaster splint?

A soft cotton-gauze padding must be placed under the plaster splint to protect the skin and soft tissues from compression and maceration.

What does the restoration of blood volume begin with at the first pre-hospital stage?

At the earliest stage, blood volume restoration begins by giving the victim alkaline drinks, followed by intravenous administration of saline (crystalloid) solutions.

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What else to study on this topic

Method of applying a pressure bandage and improvised tourniquet
Technique for performing novocaine blocks in trauma
Classification and selection of crystalloid and colloid solutions
Formation of a fixing structure from ladder splints for the pelvis
Prevention of local and systemic infectious complications in wounds

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First aid in chest and abdominal trauma