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Injuries

Injuries to the nose are among the most common injuries to the human body in both peacetime and wartime. In peacetime, damage to the soft tissues of the face, fractures of the nasal bones and other bones of the facial and brain skull are caused by domestic, industrial, sports and transport injuries. The nature of the damage is determined by the magnitude of the acting force, its direction, the characteristics of the injuring object. Injured facial tissues are easily infected with the formation of suppuration hematomas, phlegmon and venous thrombosis. Gunshot wounds usually cause more dangerous injuries. They are often accompanied by injuries of adjacent areas (maxillofacial region, orbits and brain skull), requiring the participation of related specialists in the treatment of the wounded.



Injuries to the nose and paranasal sinuses of a non-gnawing nature. Injuries to the nose and paranasal sinuses of a non-arboreal nature can be closed (without damage to the skin) and open (with damage to the skin).

Most injuries to the nose and paranasal sinuses are the result of a stroke inflicted in various ways, therefore they are considered as bruises.

In case of injuries to the nose and sinuses with a blunt object, the integrity of the skin of the face and nose can be preserved, however, significant damage to the subcutaneous soft tissues (crushing) and fractures of the bone structures of the facial and brain skull are possible.

Dull injuries of the external nose are accompanied by nosebleeds, hematoma around the nose and eyes, deformation of the external nose, respiratory failure and smell. In mild cases, nasal fractures can be limited to only a single or bilateral fracture of thin os nasales. In more severe cases, the damage captures the deep sections of the nose and bone structures of adjacent areas. Most often with blunt strokes, in addition to the bones of the nose, the bony structures of the orbit and its contents are damaged. In these cases, there are combined nasal injuries with various types of injuries (zygomatic bone, maxillary sinus, ethmoid labyrinth and orbit contents). The eyeball is injured to varying degrees. Often hemorrhages form in the chambers of the eye - hephemes dangerous to vision. However, there may be cases when, as a result of an injury, a multifibular fracture of the lower wall of the orbit occurs. In this case, the eyeball with minimal damage shifts to one degree or another in the maxillary sinus, which leads to enophthalmos. Often with injuries of the orbit, an occlusion of the oculomotor muscles occurs, causing diplopia (Danilichev V.F., Gorbachev D.S., 1997).

Damage to the medial wall of the orbit (usually the paper plate of the ethmoid bone) leads to the formation of subcutaneous emphysema, and if one of the labyrinth arteries (usually the anterior) is damaged, it can be accompanied by dangerous bleeding in the tissue of the orbit. Continued bleeding causes increasing exophthalmos, impaired circulation of the eyeball, which can lead to loss of vision (amovrosis).

A blunt trauma to the frontal bone leads to a fracture of the anterior wall of the frontal sinus, which is clinically manifested by retraction, often corresponding to the type of traumatic object. It was noted that fractures of the anterior wall of the frontal sinuses are more extensive, and bone fragments are more numerous, the larger the size of the frontal sinuses. Fractures of the posterior wall of the frontal sinuses are much less common. With small frontal sinuses and massive frontal bones, the base of the skull is damaged more often. Damage to the frontal sinuses, especially in the area of ​​the root of the nose and the medial wall of the orbit, can be accompanied by a violation of the integrity and function of the fronto-nasal canal.

A strong direct blow to the nose root during sports and martial arts, as well as during road accidents or in combat conditions when the frontal-facial zone hits the dashboard and other obstacles, can lead to very severe combined injury, t. n front-basal or frontal-facial injury (Povertovsky G., 1968, Danilevich M.O., 1996). In these cases, with possible minimal damage to the skin, there are numerous fractures of the bones of the external and internal nose, as well as adjacent bone formations. In this case, the outer nose can be roughly pressed inward. A deep fronto-nasal fold is formed. The trellis labyrinth is roughly damaged, moves posteriorly, sometimes to a considerable depth. In this case, the structures of the sphenoid bone can be injured.

Damage to the ethmoid bone and its sieve plate, related to a fracture of the anterior base of the skull, leads to rupture of the olfactory filaments (anosmia) and the appearance of subcutaneous emphysema on the face, which manifests itself in the form of swelling and crepitus. Air penetration into the cranial cavity is also possible (pneumocephalus). In some cases, with these fractures, a valve valve is formed, which causes dangerous injection of air into the cranial cavity.

Fractures in the area of ​​the sphenoid bone can be accompanied not only by fractures of its bone structures, but also by damage to the wall of the internal carotid artery. In the event that death did not occur immediately after the injury, the development of an artery aneurysm is likely due to damage to adventitia. In the future (2-3 weeks after the injury), the appearance of sudden heavy nosebleeds, pouring into the nasopharynx and associated with the stratification of the formed aneurysm, is possible. Current advances in endovascular neurosurgery provide a chance to save such doomed patients.

Symptoms In the case of a fracture of the nasal bones during external examination, a deformation of the external nose, expressed to one degree or another, is determined (scoliosis, retraction of the nasal bridge, depression of its side walls). There is a swelling and swelling of the soft tissues of the nose and adjacent areas of the face. The hematoma, gradually increasing, makes it difficult to assess the magnitude of the deformity and reposition of the nasal bones.

Soft tissue swelling in the nose and on the face can also be caused by subcutaneous emphysema, which on palpation is defined as a light, crackling crackle (air crepitus). The latter is true evidence of damage to the paranasal sinuses, especially the ethmoid labyrinth. Palpation of fractures of the nasal bones and cartilage also captures bone-cartilaginous crepitus, which has a different character than air crepitus. The diagnosis of a nasal fracture is confirmed by x-ray examination. In case of combined injuries and fractures of the lower edge of the orbit, a step-like displacement of one bone fragment relative to another is determined by palpation at the fracture site (“symptom of a step”).

Hematoma of the soft tissues of the face is often accompanied by hemorrhage in the eyelids and around the orbit ("symptom of glasses"). In these cases, an X-ray examination is necessary, since the symptom may be the only sign of a fracture of the base of the skull. However, it is often extremely difficult to identify a small crack in the bones of the anterior base of the skull (sieve plate, wings of the sphenoid bone, orbital part of the frontal bone) during an X-ray examination.

To clarify the diagnosis, lumbar puncture is indicated. The presence of blood in the cerebrospinal fluid indicates subarachnoid bleeding and speaks in favor of a fracture of the bones of the base of the skull.

Fracture of the sieve of the nose may be accompanied by nasal liquorrhea. The latter becomes more noticeable when the head is tilted anteriorly. In the first days after the injury, a sign of nasal liquorrhea is the so-called. "double spot symptom." In the future, after the cessation of nosebleeds, discharge with nasal liquorrhea acquire a light character and become similar to discharge with vasomotor rhinitis. The presence of sugar, in a laboratory test collected in a test tube of fluid, indicates liquorrhea. Nasal liquorrhea threatens the development of intracranial complications (primarily meningitis).

Any, even the most minor injuries of the nose, as a rule, are accompanied by nosebleeds. The degree of its severity depends on the nature and severity of the injury, as well as on the internal factors of the patient’s health status (blood pressure, atherosclerosis, liver function, blood coagulation, etc.). Endonasal examination reveals tears of the mucous membrane and other damage to the walls of the nasal cavity (nasal septum, nasal concha). Significant deformation of the nasal septum and blood clots cause difficulty in nasal breathing and impaired sense of smell.

Fractures in the cartilage and bone sections of the nasal septum are accompanied by the formation of a hematoma. The blood spilled after the blow exfoliates the perichondrium and mucous membrane, usually on both sides. Symptoms of a hematoma are difficulty in nasal breathing, a nasal tone of voice. With anterior rhinoscopy, you can see a pillow-like thickening in the initial part of the septum from one or two sides, which has a bright red color. The hematoma has a tendency to suppuration and abscess formation. In these cases, headache may increase, body temperature may increase and chills may appear. Further development of suppuration of the hematoma of the nasal septum is fraught with melting of the quadrangular cartilage with subsequent retraction of the nasal dorsum and intracranial complications.

Treatment. Assistance is provided after assessing the patient's condition, the severity of the injury, establishing a more accurate diagnosis. For this purpose, in complex cases or if there is a suspicion of the presence of combined injuries, in addition to the ENT and X-ray examinations, an ophthalmologist, neurologist (neurosurgeon), as well as a maxillofacial surgeon should be consulted.

Assisting with bruises without bone fractures may be limited to stopping the bleeding from cold to the area of ​​injury (in the first hours) and the rest of the victim. With severe nosebleeds, anterior loop tamponade is necessary, and with its inefficiency, posterior nasal tamponade, a description of which is given when considering nosebleeds, is necessary.

The main method for treating fractures of the nasal bones and other skull bones is reposition with subsequent fixation of their fragments. The optimal timing for reposition of nasal bones is considered to be the first 5 hours after the injury, or 5 days after it. This is due to the development of severe edema of the surrounding soft tissues, which makes it difficult to determine the correct location of the repaired fragments (Ovchinnikov Yu.M., 1995). Reposition is usually performed under local anesthesia (lubrication of the membrane with 5-10% cocaine solution or 2% dicainum solution with the addition of 2-3 drops of 0.1% adrenaline solution per 1 ml of anesthetic and infiltration anesthesia in the fracture area 1- 2% r-rom novocaine). The reduction of fragments should be carried out in the supine position of the patient. With scoliosis of the nose, when bone fragments are displaced in one direction or another, the shape of the nose is corrected by the force of the thumbs of both hands, covering the patient's face (Fig. 2.4.2), which creates the necessary conditions for the application of significant force required for reposition of bone fragments.

When bone fragments are pressed into the nasal cavity, they resort to intranasal manipulations using various tools. The blunt end of the Killian raspator, Kocher clamp with a piece of rubber tube worn on the branches can be used (Fig. 2.4.3). Convenient and a special elevator Volkova. The latter has a convex working end, corresponding to the shape of the nasal cavity, which contributes to an easier and more correct restoration of the configuration of the external nose (Dainyak LB, 1994).

After reposition of the nasal bones, their fixation is necessary. In all cases, loop tamponade of both halves of the nose is performed, which fixes not only the adjusted bones of the external nose, but also fragments of the deformed septum of the nose. Nasal tamponade prevents the formation of intranasal fusion (synechia), as well as hematomas of the nasal septum, and fixes the correct shape of the nose. In cases where there are doubts about maintaining the restored shape of the nose, they resort to the external fixation method using an adhesive plaster roller dressing, pellets and gypsum or collodion-fixation dressings made in the form of a butterfly (Fig. 2.4.4).

When establishing a hematoma of the nasal septum (which is confirmed by test puncture with a thick needle), surgical treatment is performed. Under local anesthesia (smearing of the mucous membrane with one of the solutions of an epimucous anesthetic), an incision is made in the region of the greatest protrusion of the hematoma (on one or both sides). It is advisable to excise a small piece of nasal mucosa to provide a wide outflow of the contents of the hematoma cavity. A rubber strip is introduced into the incision and a loose swab with antibiotics is produced. General antibiotic therapy is prescribed.

With combined injuries of the nose and orbit, accompanied by diplopia, an otorhinolaryngologist and an ophthalmologist participate in the treatment. From the medial paraorbital incision, the orbit is revised. Establish the nature of the damage.
The strangulated oculomotor muscles are released, and fragments of the bone walls are reduced to orbit. If it is not possible to restore the wall of the orbit (usually the lower, which is the upper wall of the maxillary sinus), it is performed with a plate of cartilage tissue, preserved by homocost or other plastic material.

Surgery on the orbit is usually combined with surgery on the maxillary sinus, which in these cases is opened through the anterior wall. The operation ends with a careful sinus tamponade (with coarse, excessive and tight tamponade, injury to the organ of vision, up to the development of amaurosis, is possible). The swab is removed through the anastomosis made in the lower nasal passage. A tampon in the maxillary sinus is located for a longer time than after conventional sanitizing operations - at least 7 days.

For this, in addition to general antibiotic therapy, regular tampon irrigation with a solution of antibiotics is also used. This operation is preferably performed in the first 2 weeks after injury. In such cases, it is possible to achieve good results of vision recovery in more than 80% of cases (Danilichev V.F., Gorbachev D.S., 1997).

Fractures of the maxillary sinus, not accompanied by visual impairment and significant damage to the walls of the sinus and orbit, confirmed by x-ray, are treated conservatively. Puncture of the maxillary sinuses in the first two days after the injury, in order to establish the fact of hemosinus and to remove the spilled blood, is not desirable. Clinical practice has shown that in this case, puncture leads to re-filling with blood. Blood poured into the sinus is partially resorbed and also removed due to the function of the ciliated epithelium. However, if signs of inflammation appear 3-4 days after the injury (body temperature rises, swelling and soreness in the area of ​​the projection of the sinus and lower eyelid increase), you should think about the transition of hemosinus to piosinus. In this case, puncture of the maxillary sinus should not be postponed. After removal of the pathological contents and washing of the sinus with an isotonic solution or solution of furatsillin 1: 5000 antibiotics are introduced into its cavity. General antibiotic therapy is prescribed. Repeated puncture is performed in accordance with clinical dynamics.

With combined fractures of the maxillary sinus and zygomatic bone, surgery on the maxillary sinus is combined with reposition of the displaced fragment of the zygomatic bone. The zygomatic bone fragment raised by the hook is fixed with a metal wire suture, which is removed after 1.5 - 2 months. All operations on the maxillary sinus end with a loop tamponade and the imposition of an anastomosis with the nasal cavity through the lower nasal passage.

Fracture of the paper plate of the ethmoid bone, as already noted, can be accompanied by damage to one of the ethmoid arteries (usually the anterior). Bleeding from this artery leads to increased pressure in the orbit, exophthalmos and impaired blood circulation in the eyeball, which can lead to blindness for several hours. A timely produced drainage medial paraorbital incision with loose tamponade of orbital tissue can save the situation.

To combat liquorrhea caused, usually, by a fracture of the sieve of the ethmoid bone, and to prevent the development of intracranial complications, the patient is prescribed strict bed rest for 3 weeks. The patient's position in bed is half-sitting. Assigned restriction of fluid intake and dry eating. Regular lumbar punctures are performed to reduce intracranial pressure. Preferably, especially during the first week after the injury, a prolonged looped nasal swab. General and local antibiotic therapy is prescribed. If liquorrhea is not eliminated within 3-4 weeks, the question is raised about the operative plastic surgery of the cerebrospinal fluid.

In case of fractures of the frontal sinuses, after assessing the patient’s condition together with a neurosurgeon and an ophthalmologist, surgical treatment is performed. Depressed bone fragments of the anterior wall, which remain in contact with the soft tissues (periosteum), are carefully repaired. In some cases, they can be fixed with wire seams. The back (brain) wall is being revised. With its fractures, it is necessary to expose the dura mater. В случае ее повреждения дальнейшая тактика диктуется нейрохирургом. Оценивается состояние лобно-носового соустья. При сохранении его проходимости операция заканчивается оставлением временного дренажа через переднюю стенку. Многие ринохирурги (для улучшения дренажа поврежденной пазухи) разрушают межпазушную перегородку.

До настоящего времени не решен вопрос о сохранении травмированной пазухи с наложением лобно-носового соустья (при его повреждении) или, напротив, ликвидации ее путем эвисцерации слизистой оболочки и пломбировки пазухи различными пластическими материалами.

Наши клинические наблюдения показали, что любое пломбирование лобных пазух рано или поздно заканчивается нагноением, отторжением пломбировочного материала и развитием остеомиелита лобной кости, трудно поддающегося лечению. Поэтому позиция ЛОР клиники Военно-медицинской академии заключается в обязательном сохранении данной природой лобной пазухи и восстановлении лобно-носового соустья.

Фронто-базальные переломы, относятся обычно к наиболее тяжелым травмам и, по-видимому, являются наиболее сложным из всех видов сочетанных травм носа и околоносовых пазух. При лечении таких больных обязательно участие нейрохирурга и других смежных специалистов. Оперативное лечение возможно только при стабильном состоянии больного. Оно направлено на восстановление благообразия лица, нормальных анатомических взаимоотношений околоносовых пазух и прилегающих костных структур. В ряде случаев необходима ревизия передней черепной ямки, устранение и пластика выявленных дефектов. В конечном счете, операция имеет цель предотвращение развития серьезных функциональных нарушений.

При ограниченной фронто-базальной травме, когда имеется только перелом костей носа, решетчатого лабиринта с умеренным смещением носовых структур вовнутрь лицевого черепа, в первые сутки после травмы возможен более простой способ устранения деформации. It is as follows. Под общей анестезией специальным массивным крючком, введенным в одну из половин носа, захватывается область решетчатого лабиринта. Осторожно, но настойчиво, прилагая определенные усилия, внедренные костные структуры носа вытягиваются кнаружи и репонируются до придания наружному носу и лицу прежнего состояния. Операция заканчивается плотной двусторонней петлевой тампонадой носа.



Огнестрельные ранения носа и околоносовых пазух. Подробное описание травм носа и околоносовых пазух мирного времени в значительной степени облегчает рассмотрение боевых травм, нанесенных холодным и огнестрельным оружием. Они могут быть разделены на три группы: 1) не проникающие в носовую полость, 2) проникающие ранения с повреждением костных образований носовой полости и околоносовых пазух, 3) сочетанные ранения с повреждением смежных органов и анатомических образований (полость черепа, орбиты, ухо, челюстно-лицевая зона). Эти ранения могут сопровождаться функциональными расстройствами: нарушением дыхания, обоняния, зрительными и неврологическими нарушениями, сильным кровотечением. В дальнейшем они могут осложниться вторичными процессами (остеомиелитом, перихондритом). Возможно стойкое выключение утраченных в результате ранения функций.

В подавляющем большинстве случаев боевые ранения носа и околоносовых пазух являются огнестрельными. Во время Великой Отечественной войны наибольшее число огнестрельных ранений (65,3%) было осколочным. Пулевые ранения составили всего 33,6%. На долю остальных ранений, в т.ч. нанесенных холодным оружием, пришлось только 1,1%. Статистика огнестрельных ранений локальных войн последних десятилетий определяется характером боевых действий и использованием того или иного вида оружия.

Важнейшей особенностью огнестрельных ранений является раневой канал со всеми его свойствами, изучение которых составляет предмет военно-полевой хирургии. Необходимо отметить, что осколочные ранения вызывают более тяжелые повреждения. Также значительные повреждения наносятся пулей с неустойчивым центром тяжести. Многочисленные костные стенки и образования, формирующие лицевой череп, также оказывают влияние на характер раневого канала. Наличие входного и выходного отверстий указывает на сквозное ранение, причем величина входного отверстия чаще всего бывает меньше величины выходного. В тех случаях, когда ранящий снаряд, проходящий через мягкие ткани и кость, застревает в раневом канале, говорят о слепом ранении.

Изолированные слепые ранения носа и околоносовых пазух не представляют особой опасности. Пуля или осколок, пройдя через мягкие ткани и кости лицевого скелета, застревают в одной из пазух, вызывая гнойные воспаления их (Хилов К. Л.,1960). Интересно, что еще Н. И. Пирогов, основываясь на опыте Крымской войны, отмечал, что из всех проникающих ранений человеческого тела наиболее благоприятными являются изолированные ранения отдельных околоносовых пазух (в первую очередь верхнечелюстных). Наличие большого числа инородных тел и большого количества пораженных пазух отягощает прогноз.

Гораздо опаснее для жизни огнестрельные ранения носа и околоносовых пазух, при которых повреждаются прилегающие области - полость черепа, глазницы, основание черепа, крылонебная ямка. Опасность таких сочетанных ранений обусловлена расположением в указанных областях жизненно важных органов и структур, имеющих большое функциональное значение, а также повреждением крупных кровеносных сосудов и нервов.

Ранение крылонебной ямки чревато повреждением крылонебного узла и челюстной артерии, в результате чего возникает сильное кровотечение. Ранение области глазницы может сопровождаться повреждением глазного яблока, амаврозом и развитием флегмоны глазницы и слезного мешка.

Не менее опасным является ранение решетчатого лабиринта, особенно ситовидной пластинки и его задних решеток, при повреждении которых, наряду с другими опасными повреждениями, вероятно и ранение зрительного нерва. В таких случаях наступают слепота (в т.ч. двусторонняя), аносмия, диплопия, слезотечение и назальная ликворея.

Также тяжелые нарушения возникают при ранении клиновидной кости и ее пазухи. Топографо-анатомические особенности этой области не исключают поражение внутренней сонной артерии, кавернозного синуса, перекреста зрительных нервов и гипофиза. Возможны сильное кровотечение, образование аневризмы, тромбоз кавернозного синуса с последующим развитием септикопиемии и менингита, слепота, тяжелые эндокринные расстройства.

Мелкие инородные тела при слепых огнестрельных ранениях имеют тенденцию к инкапсулированию. Крупные инородные тела, особенно расположенные вблизи жизненно важных органов, обычно приводят к прогрессирующим осложнениям. Определение точной локализации инородного тела в области носа, околоносовых пазух и прилежащих областей, а также удаление их нередко представляет непростую задачу. Вот почему клиника слепых огнестрельных ранений носа, околоносовых пазух и пограничных областей составляет один из труднейших разделов оториноларингологии (Хилов К. Л.,1960).

В диагностике инородных тел огнестрельного происхождения применяют различные рентгенологические укладки, линейную и компьютерную томографию. Полость носа, а также раневые каналы могут быть использованы для введения рентгеноконтрастных зондов, которые помогают ориентироваться в локализации инородного тела (Воячек В. И., 1953).

Учитывая трудности удаления инородных тел, а также возможность развития опасных функциональных и других (зрительных, внутричерепных) осложнений, В. И. Воячек на основании опыта Великой Отечественной войны предложил т.н. "четверную схему", которой следует придерживаться для установления показаний к операции по их извлечению.

Схема основывается на четырех главных комбинациях.

Все инородные тела делятся на: 1) легко извлекаемые; 2) трудно извлекаемые; 3) вызывающие какие-либо расстройства (по обусловливаемой этими телами реакции); и 4) не вызывающие таковых. Получаются четыре комбинации: 1) легко доступные, но вызывающие расстройства, - удаление обязательно; 2) легко доступные, но не вызывающие расстройств, - удаление показано при благоприятной обстановке (с целью профилактики будущих осложнений или при настойчивом желании раненого); 3) трудно доступные, но не вызывающие расстройств, - операция или противопоказана вообще, или делается при опасностях, угрожающих раненому в дальнейшем течении ранения; 4) трудно доступные, но сопровождающиеся расстройствами соответствующих функций, - показано извлечение, но ввиду сложности операции она должна производиться с особыми предосторожностями.

Возможны и переходные формы, при которых преобладают признаки того или другого характера.
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Injuries

  1. LESSON 13 First aid for injuries. Closed soft tissue damage. Traumatic brain injuries. Damage to the chest. Transport immobilization for injuries.
    Purpose: To teach students the differentiological diagnosis of various traumatic conditions, the rules of first aid to the victim. Test questions 1. Injury. Definition Classification of injuries. 2. Closed soft tissue damage. Injury. First aid. 3. Stretching. Complaints First aid. 4. The gap. Complaints First aid. 5. The syndrome of prolonged crushing. Pathogenesis. The clinical picture.
  2. The mechanism of injury. Classification of injury types
    A. External forces Newton’s law of inertia: “A moving body continues to move until an external force acts on it.” 1. The horizontal moment. Force = MA = MDD = V2 - V1 / t = braking V2 = final speed V1 = initial speed 2. Gravity. Force = GmM / R2 = mg g = GM / R2 = acceleration due to gravity = 9.8 m / s2 R = radius of the Earth; G = grav. Constant; M = mass
  3. Major injuries
    Victims of major injuries impose significant requirements on all hospital workers, and especially doctors and sisters, who assist the patient in the first hours from admission, therefore management schemes for patients with severe injuries have been developed. In this review, we will discuss the management of severely injured patients and the principles of anesthesia in these patients. We emphasize the importance of recognizing the mechanism of injury
  4. Aortic injury
    Aortic trauma can be penetrating and non-penetrating. Regardless of the type of injury, it can cause massive hemorrhage, requiring emergency surgery. Penetrating trauma to the aorta is obvious, while a closed trauma is difficult to recognize unless it is identified purposefully. Closed aortic trauma usually occurs with large negative acceleration: sudden braking, with automobile
  5. Car injury
    Due to the constant increase in car accidents in recent years, not only the number of dead and injured, but also the number of forensic medical examinations has increased. Currently, about 15% of the total number of examinations of living persons and up to 20% of the total number of autopsies in connection with a violent death are made in connection with a car accident. Under a car accident
  6. Injury treatment methods
    A comprehensive approach is required in the treatment of major injuries, and the assessment and management technique should be the same for all patients. Therefore, most modern approaches to the treatment of injury follow strict protocols, which reduces the likelihood of errors in diagnosis. The most common system is the integrated life support program for trauma, developed and distributed by the American
  7. Травмы
    Характеристика травматических повреждений в детском возрасте Травматические повреждения в детском возрасте являются одной из частых причин обращения за медицинской по мощью. The danger of injury, in addition to a direct violation of the function and integrity of one or another organ, lies in the possibility of bleeding and the development of shock. The amount of emergency care depends on the specifics of the injury. К повреждениям
  8. Traffic injury
    In the second half of the 20th century, the number of all types of transport increased sharply, which led to a significant increase in the number of transport injuries. Transport injury - a set of damages caused by the external and internal parts of a moving vehicle, as well as damage that occurs when a person falls from a moving vehicle. Transport injuries include:
  9. Birth injury.
    Birth trauma - the destruction of tissues or organs of the fetus that occurs during childbirth due to the action of mechanical forces. Birth trauma is manifested by tears, fractures, crushing of tissue at the site of mechanical stress and is often accompanied by circulatory disorders. Birth trauma often develops when the size of the fetus does not match the size of the mother's pelvis (anatomically narrow pelvis, excessive
  10. Pharyngeal injury
    In everyday life, internal (through the nose or mouth) pharyngeal injuries of the pharynx by foreign bodies or a pharyngeal burn with chemicals are more often noted, less often thermal. Patients with pharyngeal injuries and burns are subject to hospitalization. First aid consists in washing the pharynx with disinfectant solutions, for burns - with neutralizing liquids (a solution of soda or acetic acid), the introduction of painkillers and
  11. Nervous system injuries
    Trauma to the nervous system is one of the most common human pathologies. Craniocerebral trauma and spinal trauma are distinguished. Traumatic brain injury accounts for 25-45% of all traumatic injuries. This is due to the high level of injuries in car accidents or traffic accidents. Traumatic brain injuries are closed (CCT) when
  12. Chest injury
    Breast injury - an isolated or complex damage to the integrity of the skin, bone skeleton, internal organs of the chest. Allocate closed and open (injured) chest injury. CLOSED BREAST INJURY Causes of severe chest injuries are traffic accidents, industrial accidents, accidents, domestic and criminal injuries. The severity of clinical manifestations is mainly due to
  13. Eardrum Injury
    Cause Injury of the eardrum is direct and indirect. Direct trauma often occurs in children during the game, in adults when cleaning the ear canal with a match, knitting needle, pin, and also when trying to remove a foreign body on their own. Direct trauma is often combined with skin lesions. Also, an eardrum injury can occur with a drop in atmospheric pressure, a sharp drop in
  14. АНЕСТЕЗИЯ ПРИ ТРАВМЕ
    В США травма — это первая по частоте причина смерти в возрастной группе от 1 до 35 лет. Травма является причиной каждой третьей госпитализации в США. Летальность от травмы имеет следующую структуру: в половине случаев смерть наступает немедленно, в 30% случаев — в течение нескольких часов после травмы (концепция "золотого часа"). Поскольку многим пострадавшим требуется экстренная операция,
  15. Ear Injury
    According to the damage-causing factor, ear injuries are divided into mechanical injuries, thermal injuries, electrical injuries, actinotrauma (damage by radiant energy), chemo-injuries, aku, vibro-, baro- and accelereotrauma. They arise in domestic conditions, in production, transport, during sports and in military service. Injuries are isolated and combined with damage to neighboring organs (brain,
  16. Спинальная травма
    Спинальная травма чаще всего возникает при чрезмерном сгибании и переразгибании позвоночника в наиболее подвижным местах, что наблюдается у ныряльщиков, при падении с высоты, на спину, при авто- и мототравмах, сильном прямом ударе сзади. Д - ка: Анамнестические данные; боли в точке приложения травмирующей силы и при пальпации по линии остистых отростков, болезненность при мягкой осевой
  17. BREAST CELL INJURY
    EPIDEMIOLOGY Nearly 500,000 Americans suffer from chest injuries each year. In most cases, these are non-penetrating damage resulting from car accidents. In fatal disasters, more than half of deaths are directly caused by severe thoracic injury. Fortunately, most of the survivors who manage to be delivered to the hospital survive. Most of
  18. Вопрос 1. Понятие о травме
    Травмой или повреждением называется внезапное воздействие внешнего агента (механического, физического, химического, психического, лучевого), вызывающее в тканях и органах анатомические и физиологические нарушения, которые сопровождаются общей и местной реакцией организма. Это так называемая острая травма. Постоянное воздействие на ткани слабых, однообразных внешних раздражителей называется
  19. Скелетная травма
    Объем обследования 1. Выяснить механизм и время получения травмы. 2. Локализация травмы, боль, вынужденное положение или деформация в месте повреждения, снижение или отсутствие активных движений. 3. Определить объем кровопотери (дефицит ОЦК), в том числе — внутриполостной и внутритканевой. 4. Цвет кожных покровов — цианоз, акроцианоз, бледность, "мраморность", гипергидроз. 5.
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