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Treatment of injuries of the nose and paranasal sinuses at the stages of evacuation

Self-help and mutual assistance. It is carried out in the manner of self-help, mutual assistance by a nurse or medical examiner. In case of bruises accompanied by nosebleeds, try to stop the bleeding by pressing the wings of the nose to the nasal septum. Snow, ice, or cloth moistened with cold water is applied to the outer nose. With abrasions on the skin or superficial wounds, an aseptic dressing is applied from an individual dressing bag. In case of serious injuries, accompanied by a serious condition of the wounded, it is necessary first of all to prevent the immediate threat of death (removal of the wounded from the rubble, burning rooms, fighting vehicle). The wounded person should be given a body position in which blood flow into the airways is prevented. An aseptic dressing from an individual dressing bag is applied to the wound, and with dense pressure they try to reduce bleeding from the nose and external wound. The wounded are carried out from the place of defeat in a position that prevents the threat of asphyxiation.

First aid It is carried out by a paramedic or nurse and aims to supplement first aid measures. Previously applied dressings are monitored and enhanced. Cotton swabs (dry or moistened with 3% hydrogen peroxide solution) are introduced into the bleeding nasal cavity. A sling bandage is applied.

Medical assistance and qualified surgical care. It is carried out in OMEDB or in a surgical mobile field hospital (KhPPG). With ongoing nosebleeds, anterior, and, if necessary, posterior nose tamponade is performed. The bandage on the external wound is examined. When bleeding from a wound, it is necessary to re-swab it, or apply a ligature to a visible bleeding vessel. In the case of persistent bleeding, accompanied by symptoms of acute blood loss and the failure of tamponade, they bandage the vessels throughout (usually the external carotid artery). Measures are being taken to compensate for blood loss and maintain cardiovascular activity.
Foreign bodies are removed taking into account the "quadruple scheme" of V. I. Voyachek. When there are signs of suffocation caused by reactive phenomena in the pharynx and larynx or other reasons, a tracheostomy is performed. Antibiotic therapy is prescribed.

Specialized ENT care. It is carried out in a specialized surgical mobile hospital for the wounded in the head, neck and spine (SCPH), as well as in a specialized surgical evacuation hospital (SCHEG). Given the modern means of evacuation (helicopters and other types of ambulance aircraft), these hospitals can come directly from the scene of military operations and receive injuries or gunshot wounds. In such cases, the wounded, bypassing the intermediate stages of evacuation, in the shortest possible time (within a few hours) fall into conditions where they can be provided with specialized surgical care.

The presence in these hospitals of qualified otorhinolaryngologist surgeons and related specialists (neurosurgeon, ophthalmologist and maxillofacial surgeon), equipped with the necessary instruments, x-ray and other diagnostic medical equipment allows for a wide range of specialized care. The final stop of nosebleeds and bleeding from external wounds (by tamponade, ligation of vessels in the wound, ligation of the great vessels) is carried out.

Surgical treatment of wounds of the face, nose, paranasal sinuses, adjacent areas with reposition and immobilization of bone fragments is performed. Foreign bodies not removed at the previous stages of evacuation are also removed, also taking into account V.I. Voyachek's “quadruple scheme”.

Surgical treatment should be performed in full and include, with appropriate indications and conditions, plastic surgery on soft tissues.
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Treatment of injuries of the nose and paranasal sinuses at the stages of evacuation

    In the nasal cavity and paranasal sinuses, as in other ENT organs, there are benign and malignant neoplasms, very diverse in morphological structure and clinical manifestation. A distinct border is often impossible to draw with many benign and malignant tumors. Modern classifications of tumors, including the nose and paranasal sinuses, are bulky and
  2. Malignant tumors of the nose and paranasal sinuses
    Malignant diseases of this localization - cancer and isarcoma, as a rule, are primary. They are relatively rare, more often in middle-aged and elderly men. Most often, the primary malignant process affects the maxillary, then the ethmoid, frontal and sphenoid sinuses. Rarely, the nasal septum is the source of the malignant tumor. Malignancy
    The study of the nose and paranasal sinuses, after identifying the needles and clarifying the anamnesis, begins with an external examination and palpation. Upon examination, pay attention to the condition of the skin and soft tissues, the absence or presence of defects, the symmetry of both halves of the face, as well as the shape of the external nose. Palpation should be done carefully. With soft hand movements, the presence or
  4. Clinical physiology of the nose and paranasal sinuses
    Distinguish between upper and lower respiratory tract. The nose and paranasal sinuses, pharynx with the oral cavity and larynx belong to the upper respiratory tract, the trachea, bronchi with bronchioles of the alveoli - to the lower. Normal for a person is breathing through the nose. The nose performs, in addition to the respiratory, protective, resonant and olfactory functions, and also participates in the regulation of the depth of breathing and lacrimation,
    The nose and its paranasal sinuses, being the upper part of the respiratory tract, play an important role in the interaction of the body with the environment, while performing a number of interrelated physiological functions. The following nasal functions are distinguished: 1) respiratory, 2) protective, 3) resonator (speech) and 4) olfactory. In addition, the nose, as an important element in the formation of a single ensemble of the face, is endowed with and
  6. Research methods for the nose and paranasal sinuses
    They produce an external nose nose, places of projection of the paranasal sinuses of the nose on the face. Patch of the external nose: the index fingers of both hands are located along the back of the nose, with light massaging movements they feel the areas of the root, slopes, back and tip of the nose. Palpate the front and lower walls of the frontal sinuses, figuring out the patient's sensations. Thumbs of both hands
  7. Surgery for diseases of the nose and paranasal sinuses
    The most common operations for diseases of the nose and paranasal sinuses include polypectomy, endoscopic interventions in the paranasal sinuses, opening the maxillary sinus (Caldwell-Luc operation), rhinoplasty, septoplasty. Preoperative period Patients often have marked nasal breathing disorders due to polyps, nasal curvature
  8. Fracture of the bones of the nose and paranasal sinuses
    Case: Face asymmetry is determined in the form of deformation of the external nose, lowering of the front walls of the sinuses, damage to the skin, pain on palpation (sometimes along with this, crunching, crepitation of bone fragments and air in the subcutaneous tissues), edema, hematoma of the eyelids and usually bleeding from the nose. Depending on the depth of damage, fractures can be isolated or combined with a head injury
  9. Microendoscopic methods of surgical intervention in the nasal cavity and paranasal sinuses
    There are a number of options for endonasal endoscopic microoperations, however, all the techniques can be combined into two main varieties - these are classic methods according to Messerklinger and Wiegand, they are designed to restore the natural ventilation and drainage paths, with the smallest changes in the anatomical structures and the maximum gentleness of the mucous membrane. Most widely
  10. Foreign bodies of the nose and paranasal sinuses
    Most often, foreign bodies are found in children who have the habit of putting various objects (beads, buttons, stones, coins, berry seeds, seeds and other small objects) in the nose of themselves or their gullible peers. In adults, foreign bodies get into the nose under random circumstances (for example, during sleep on the hayloft, a piece of straw may be drawn into the nose when breathing). More
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