When fractures are caused by accidental injuries, they are often combined with injuries to other tissues and organs of the body, such as cardiac arrest or respiratory arrest, shock, massive hemorrhage, pneumothorax and craniocerebral injury. Severe cases are often life-threatening. Therefore, we should classify the injuries according to their severity, and decide the focus and arrangement of emergency treatment. One of the following symptoms is serious injury: coma after trauma; Chest crush injury: accompanied by visceral injury or visceral injury can not be ruled out; Respiratory dysfunction; Quadriplegia or paralysis of both lower limbs; Pelvic fractures include progressive bleeding and shock.
First aid and ordinary care
1 First of all, let the patient out of danger in the right way. If the patient's limb is involved in the machine, stop the machine immediately and do everything possible to disassemble the machine to release the squeezed limb. Do not reverse or drag it. If the injured person is crushed by a heavy object, the heavy object should be removed first to avoid twisting the trunk, and the trunk should be moved to a hard board and then transferred to the hospital.
2, to estimate the life-threatening seriously injured patients, should take saving lives as the first principle, quickly send patients to the hospital, the nearest treatment, to buy time. At the same time, the bleeding wound should be stopped immediately: open pneumothorax should block the wound.
3. All suspicious fractures of the wounded are treated as fractures. Generally speaking, splint fixation is the simplest method.
4. For patients with closed fractures, it is not necessary to take off clothes or shoes and socks, so as to avoid excessive movement of injured limbs and increase pain. Fractures with exposed wounds should not be cut back, so as not to bring pollutants into the depth of the wounds and aggravate the pollution. For the severed limb, wrap it with sterile dressing, put it in plastic bags, put it in ice cubes, and send it to the hospital with the wounded.
Second, the wound to stop bleeding
Hemorrhage after trauma often leads to shock or even death of patients. Therefore, we must pay attention to the hemostasis measures in field first aid. Arterial bleeding is bright red and spurting, which can be life-threatening in a short time. Venous bleeding is dark red, flowing out of the wound evenly and continuously, which is not as dangerous as arterial bleeding, but it can also cause shock and even life-threatening for a long time.
1. Finger pressing to stop bleeding: use your fingers to press the artery near the wound heart to the deep part of the bone, blocking the blood flow, so as to achieve the purpose of temporarily stopping bleeding.
(1) Anterior head bleeding: The rescuer or patient presses the front of the tragus with his thumb against the superficial temporal artery of the mandibular joint.
(2) Hemorrhage of the posterior head: slightly press the posterior auricular artery outside the posterior auricular process.
(3) Facial bleeding: compressing the facial artery at 1.2 cm in front of the mandibular angle.
(4) Neck bleeding: Under the Adam's apple, the pulse of the common carotid artery can be felt at the front edge of sternocleidomastoid muscle, and the bleeding can be stopped by pressing it to the cervical vertebra, but it is forbidden to press both common carotid arteries at the same time.
(5) Upper limb bleeding: When the upper limb is bleeding, touch the pulsating subclavian artery downward and backward at the depression of the supraclavicular fossa and press it with your thumb.
(6) Where the forearm is bleeding and the pulse of the medial artery of the upper arm is most obvious, press the brachial artery to the humerus.
(7) Palm bleeding, press the ulnar and radial artery inside and outside the wrist with your hand.
(8) Lower limb bleeding: Touch the femoral artery slightly lower than the groin midpoint (thigh root), and press it with both thumbs to press the femoral artery toward the femur.
(9) Hemorrhage of the lower leg: press the popliteal artery in the middle of popliteal fossa. Foot bleeding, compression of posterior tibial artery under ankle joint and anterior tibial artery on dorsum of foot.
2. Pressure bandaging to stop bleeding: Apply sterile dressing or clean handkerchief to the patient's wound, and forcibly bandaging to stop bleeding, but pay attention to only compressing the vein to ensure the artery to continue flowing.
3, tourniquet hemostasis: tourniquet is a temporary measure, because it is easy to cause tissue necrosis, so it should be used with caution, mainly for bleeding that cannot be controlled by other methods.
(1) Rubber tourniquets and cloth tourniquets are acceptable, and ropes, iron wires and wires are not allowed.
(2) The common tourniquet is 1/3 on the upper arm and thigh. Forearms and calves should not be tourniquets.
(3) Before the tourniquet is tied, the limb must be raised for about 2 minutes to make venous blood return.
(4) The tourniquet should not be directly tied to the skin, but should be padded, such as cotton and cloth.
(5) The tourniquet should be moderately elastic, and the pulse of the distal artery should not be touched.
(6) After putting on the tourniquet, relax once every 15 ~ 30 minutes, every time 1 ~ 3 minutes. The binding time shall not exceed 1 hour, and shall be marked. Assign someone to untie and tie the tourniquet.
Third, bandage the wound.
The purpose of dressing is to protect the wound, reduce pollution, fix the fracture and relieve the pain. It's usually bandaged. In first aid, such as head, shoulders and materials, use clean clothes, towels, handkerchiefs and other materials instead.
Pay attention to the following points when dressing with bandages:
1. When bandaging limbs, bandaging should be done from the distal end to the proximal end to promote venous return, and the tip of the finger (toe) should be exposed to observe blood circulation.
2. When dressing the bandage, the bandage should cover 1/2 of the width of the front bandage every week to fully fix it. The bandage must be wound from beginning to end for 2 weeks to prevent loosening.
Four. Fracture fixation
The purpose of fracture fixation is to avoid increasing injury, prevent the fracture end from shifting during transportation, and damage peripheral nerves, blood vessels and other soft tissues and internal organs, and at the same time relieve pain and facilitate transporting patients. Fixation in first aid first needs to determine whether there is a fracture.
Fracture injuries usually have the following characteristics: first, there is a clear history of limb or neck, waist and hip injuries. After the injury, swelling, pain and various functional disorders immediately appeared in the injured part. If it is a complete fracture, obvious deformity can occur. When moving the wounded, you can sometimes feel the bone friction sound or bone friction feeling, that is, the sound of the broken end rubbing against the obstacle. That is to say, after a serious trauma, if a certain part of the injured person has swelling, pain and dysfunction, it can be treated as a fracture, given appropriate external fixation, and then sent to the hospital for treatment.
There are car accidents and common fractures of clavicle, humerus of upper arm, ulna and radius of forearm, femur of thigh, tibia and fibula of calf, cervical vertebra, lumbar vertebra and pelvis, which need on-site fixation. Skull fracture, the small bones of hands and feet can only be temporarily bandaged, and they don't need to be fixed on site.
1, clavicle fracture fixation: clavicle fractures are mostly caused by falls or car accidents. After the injury, the shoulder can swell, the upper limbs can have severe pain, and sometimes there can be obvious uplift and other deformities. At the scene, it is only necessary to wrap and suspend the injured upper limb with a triangle towel, scarf or skirt, and limit the movement of the injured limb.
2. Fixation of humeral fracture of upper arm: After traumatic fracture of humerus, swelling, congestion, dyskinesia and pain of upper arm may occur, and sometimes obvious deformity may occur. If the symptoms are atypical, the injured limb can be straightened, the wrist should be straightened as far as possible, and the palm root should be lightly buckled, so that the strength can be transmitted to the upper arm fracture, which can cause pain. Humeral fracture can be pasted on the inside and outside of the upper wall with wooden sticks, magazines, books and hard paper clips. At the scene, the triangle towel and the upper wall can be folded into a belt or tied around with other cloth belts, ties, belts, etc. Turn 3-4 times, and then the upper wall can be hung and fixed on the trunk with a triangular towel or bandage. Note that all hard external fixators should be put on soft towels and other dressings before use, and should not be directly attached to limbs to avoid damaging skin, soft tissues, blood vessels and nerves. In the absence of wooden boards and other items, you can tie the upper arm to the trunk with multiple cloth belts, and then bend the elbow and hang it.
3, forearm fracture fixation: forearm has two long bones, ulna and radius. If a single fracture is relatively stable, the injured limb can be hung and fixed with a triangular towel. If both ulna and radius are fractured, the fixation principle is the same as that of upper arm fracture. It can also be simply supported under the forearm with books, magazines and other things, and then directly suspended and fixed. Pay attention to all elbows and wrists in order to really fix the forearm fracture. Any joint movement at both ends can drive the fracture to move. In addition, the forearm muscle space is narrow, and the fracture bleeding and swelling are serious, which can cause forearm osteofascial compartment syndrome, that is, compressing arterial blood vessels and making muscles ischemic and necrotic. Therefore, the tightness should be appropriate when binding and fixing, and the fixing belt should be adjusted in time.
4, femoral fracture fixation: the femur is thick, mostly caused by huge external forces such as car accidents, falling from high altitude or heavy objects, so it is often complicated with serious soft tissue injury or massive bleeding. The bleeding of closed fracture of femur (without skin rupture) can reach more than 800 ml, and the bleeding of open fracture will be more serious. If it is not fixed in time, the bleeding may be aggravated due to the activity of the broken end of the fracture, and symptoms such as blood pressure drop or shock often appear. After femoral fracture, the thigh is usually swollen seriously, which can cause angular deformity or shortening, local pain is severe, and it is impossible to stand, walk or even move. You can use a long wooden board or stick to smear it on the outside of the thigh from the injured armpit to the heel; The other board is attached to the inner thigh from the root of the thigh to the heel of the inner thigh, and the chest, waist, hip, thigh, knee joint and calf are bound and fixed with 6 ~ 8 pieces of cloth respectively, and finally the ankle joint is fixed at 90 degrees. Pay attention to all bony processes, such as quarter ribs, hips, knees, ankles, etc. , and ensure that they are used as dressing pads such as towels to prevent skin and soft tissue wear. When there is only one board, the board can be attached to the outside of the thigh for fixation; if there is no external fixation device, clothes can be put between the legs, and then the two lower limbs can be tied together with a tie, a belt or other cloth belts, and the healthy limb can be used as an external fixation device. This method can also be used for the fixation of leg fractures.
5. Fixation of tibia and fibula fracture of calf: The front end of tibia of calf is close to the skin, and it is easy to pierce the skin after fracture, resulting in open fracture or bone exposure. It is necessary to actively stop bleeding and repair it as soon as possible. In addition, the calf is similar to the forearm, and bleeding and swelling after closed fracture are easy to lead to osteofascial compartment syndrome and muscle ischemia and necrosis. Therefore, when fixing, we should also be careful not to bind too tightly to prevent poor blood supply at the distal end of the limb. The fixation method of calf fracture is similar to that of thigh. You can stick sticks, cardboard and magazines on the inside and outside of the legs, then bind them with cloth belts for 5-6 times, and finally fix them on both ankles with a 90-degree "8" bandage. Cloth or clothing pads must also be used under external fixtures to prevent skin and soft tissue wear; The length of the board also needs to exceed the knees and ankles of the upper and lower legs in order to really play a fixed role. When the external fixator cannot be found, the injured limb can also be bound and fixed with the contralateral healthy limb.
6. Fixation of pelvic fracture: The pelvis is an important supporting structure for continuous trunk and lower limbs. When the hip or sacrococcygeal part is squeezed, hit or scraped, the integrity of pelvis is often destroyed. If the pelvic fracture does not damage the organs in the pelvic cavity, the biggest danger in its early stage is that the broken ends of the fracture move with each other and cause massive bleeding, leading to the death of the wounded in shock. Therefore, after a car accident or other serious trauma, if the injured person has pain in both hips and suspects a pelvic fracture, it should be bandaged and fixed as soon as possible. You can wrap the whole hip with clothes, sheets, tarpaulins or triangular towels, and tie the two hips tightly so that the fractured pelvis is surrounded and fixed by pressure. Then let the wounded lie flat on the hard board, take the knee position, and put clothes under the knee to alleviate the pain of the wounded.
7. Fixation of thoracolumbar fractures: Thoracolumbar fractures are also common injuries in trauma. When the original bone lock connection structure between the upper and lower vertebral bodies is lost, even a slight rotation or flexion of the vertebral bodies may damage the spinal cord and cause paraplegia. Therefore, when examining the wounded, it is found that the back tenderness is obvious and the local swelling is difficult to move, so it should be treated as a lumbar fracture. You can lie on your back on a wooden board or a long desk with shoulder width, pad your head and neck, knees and ankles with clothes, and then fasten your forehead, shoulders, chest, buttocks, thighs, calves and ankles with cloth belts respectively. Pay attention when moving the wounded, treat the wounded as logs, and do not bend or twist the spine. When many people carry a stretcher to transport the wounded, they can use prone position to make the spine slightly extend backwards; Don't let the wounded take the supine position and make their spine bend. The spine is usually injured by excessive flexion caused by external force, so the mechanism of repeated injury should be prevented as much as possible in post-injury treatment.
8, matters needing attention when fracture fixation
(1) Effective hemostasis and wound dressing should be performed before the open fracture is fixed.
(2) When fixing, put some soft pads on the splint, bone process and joints to avoid skin necrosis caused by long pressing time.
(3) The fixation of the injured limb should exceed the upper and lower joints of the fracture.
(4) Don't roll the gauze too tightly. Fingers or toes should be exposed when fixing limbs, so as to observe blood circulation of limbs.
Verb (abbreviation of verb) Treatment of fracture patients
When transporting and transferring patients, we should choose the appropriate transportation methods and tools according to the specific conditions of patients.
If the illness is mild and the transport distance is short, you can use bare-handed handling methods, such as supporting method, hugging method, double-pulling method and flat-hugging method. If a fracture of thoracic vertebrae is suspected, three people must cooperate to deal with it. One person holds the scapula, one person holds the waist and buttocks, and the other person holds both lower limbs. At the same time, the three people should gently lift or roll the patient to the hard board. The trunk of the injured person shall not be twisted or bent. Patients suspected of cervical spine injury should be carried by 3 ~ 4 people, not by rolling method, but by plate support method. One person specially holds the patient's head, maintains a neutral position and slightly pulls along the longitudinal axis of the body. Don't turn your head. The other 2 ~ 3 people are supported horizontally on the stretcher, with a small pillow under the neck and a cushion or sandbag to fix the head left and right. For patients with pelvic fracture, soft pads can be lined on both sides of the buttocks, and wide cloth (or trousers) can be used to support the buttocks of the wounded, which is convenient for transportation.
Care in transit:
1, the position should be placed correctly to ensure that the body and stretcher are firmly fixed. Coma and irritability should be restrained by cloth belt to avoid being injured again.
2, keep the respiratory tract unobstructed, oxygen when necessary. During transportation, the pulse and breathing are often measured, and the pupil and wound bleeding are checked. If any abnormality is found, it should be handled in time.
3. For patients with fracture fixation and tourniquet, observe the blood supply of the distal limb every 30 minutes, and release it in time if it appears blue or pale.
4. Changes of injury, measures taken, tourniquet time, etc. The process of transshipment should be recorded in a notebook to provide clues for doctors during rescue.