RU2577241C1 - Method for first-aid treatment in case of injury - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to emergency medicine, and can be used for first aid at the injury. Method involves application of sterile Haemostatic sponge on the wound. Preliminary the collagen haemostatic sponge is impregnated with 5 ml of antibiotic solution containing 40 mg powder in 1 ml, as well as solution containing 25 mg Suprastin, and solution containing not less than 80 mg of lidocaine hydrochloride. Sponge is left on the wound under the band covered by no more than three days.

EFFECT: method provides conditions for prevention of early complications during transportation of patients with wound.

1 cl, 2 ex

Description

FIELD OF THE INVENTION

The invention relates to medicine, namely to disaster medicine.

State of the art

Soft tissue and organ injuries are the most common injuries sustained by victims and those involved in the elimination of a complicated emergency. It should be noted that in modern conditions, despite the high level of medicine, mortality in the focus of a complicated emergency can reach 40%. This is due to the untimely provision of medical care in the outbreak, the remoteness of the stages of medical evacuation and the use of obsolete materials and equipment for first aid. The main adverse factors acting upon injury are: the presence of long-lasting bleeding under an applied dressing, significant contamination of the wound surface with microorganisms that are resistant to most modern antibiotics used orally, severe pain due to significant contusion injury (prevalence in modern firearms of damaging elements blunt-shaped, asymmetric arrangement of the center of gravity of the striking element, combination of high initial speed and low weight of the striking element, the use of solid fragments of environmental objects as striking elements). It should be noted that the fleeting nature of modern hostilities, the mobility of military units and the absence of a classical separation scheme make it difficult to timely collect and evacuate the wounded to the stages of medical evacuation. In connection with the foregoing, the survival of victims in the outbreak of a modern complicated emergency depends on the quality of first aid.

The procedure for first aid is determined by order of the Ministry of Health and Social Development of Russia dated 04.05.2012 N 477н. In accordance with this order, two events are held:

- p. 7 of the measures for the inspection of the victim and a temporary stop of external bleeding (a survey of the victim for bleeding; finger pressing of the artery; applying a tourniquet; maximum flexion of the limb in the joint; direct pressure on the wound; applying a pressure dressing).

- p. 8.7 bandages for injuries of various areas of the body.

As a prototype, we adopted a description of first aid (earlier, before the entry into force of federal law No. 323-ФЗ of 11/21/11, the term "first aid" was used) in the textbook of V.M. Buyanova [Buyanov V.M. First aid. M .: Medicine, 1978. S.110-111]. First aid is to protect the wounds from contamination and infection, removing small foreign bodies without rinsing with water.

It should be noted that the military, police and rescuers have an individual first-aid kit (AI-1, AI-2, KIMGZ and their analogues), where there is a broad-spectrum antibiotic for oral use. For moderate and severe wounds and burns, 1-2 tablets of this antibiotic are used in accordance with the instructions in the medicine cabinet [Sakhno II, Sakhno VI Disaster medicine (organizational issues. M: GOU VUNMTS MZ FR, 2001 - S.124].

In addition, for the provision of first aid, various options for an individual dressing package can be used (regulated by GOST 1179-93) [Sakhno II, Sakhno VI Disaster medicine (organizational issues. M: GOU VUNMTS MZ FR, 2001 - S. 126-127]:

- an individual dressing bag, consisting of a package, a dressing kit that includes two absorbent pads and a fixing bandage, one of the pads being fixed motionless on the fixing bandage, and the second with the ability to move, characterized in that the pads contain at least two layers - atraumatic-sorption and a protective, fixing bandage is made of elastic knitted material, and the package has an outer layer of lavsan, a second layer of foil and an inner polyethylene layer [patent for invention No. 21641 50 from 07/09/1997, A61L 15/00, A61F 13/00].

- an antiseptic individual dressing bag, including a bag, a cotton pad, which contains an antiseptic substance and a patch for fixing the pillow on the wound surface [USSR copyright certificate 31578, cl. A61F 13/02, 1932].

- an individual dressing bag containing a gauze bandage and a compression pad attached to the inside of the strip at a point intermediate between the ends of the strip. And the outer side of the pillow has a support element of an impermeable flexible material covering the area. An adhesive layer is applied to the support element from its inner side, due to which it is attached to the strip and through the strip to the back side of the compression pad [US Pat. No. 3,421,502, class. A61L 15/00].

- an individual dressing bag containing a cushion and a fixing element fixed to the outside, for example a bandage, with two ends, one of which is of limited length, and the other is in the roll. The bag pad is provided with at least one loop proportional to the roll of the bandage and located on the free end of the bandage of a limited length, or a slot located along the side edge of the pad [see USSR certificate of authorship 1635984, cl. A61F 13/00, 1991].

All of the above methods have the following disadvantages:

1) the impossibility of completely stopping bleeding in the wound - it is assumed that bleeding will stop on its own when the dressing is soaked, however, when transporting a wounded man in a complicated emergency, it is impossible to provide gentle transportation, as in everyday activities; in addition, the victim himself can carry out some actions caused by the changed combat situation, which leads to the displacement of the bandage and the breakdown of the thrombus formed in the wound;

2) the low effectiveness of oral administration of antibacterial drugs, due to the inability to maintain a high concentration of the antibacterial drug for a long time (fractional parenteral administration is necessary), the low concentration of the antibacterial drug in the wound leads to the rapid growth of antibiotic-resistant strains of microorganisms;

3) prolonged expressed local pain syndrome, which makes it difficult for the victim to move or move independently: intramuscular administration of an anesthetic drug (2% solution of promedol) gives an analgesic effect after 30 minutes from the moment of administration, lasting 2-3 hours, in addition, in the first hour from the moment of administration there may be a state of euphoria, a lack of fear of death, a decrease in the speed of decision-making;

4) extraction of small contaminants without washing the wound and initial surgical treatment in the field is impossible, washing the wound with disinfectant alcohol-containing solutions can lead to pain shock, washing the wound with water leads to infection of the wound, washing the wound with hydrogen peroxide, aqueous solutions of furacilin or chlorhexidine bigluconate leads to destruction blood clots on damaged vessels

5) the introduction of a sorbent layer into the dressing can lead to the development of anaerobic infection by creating a favorable oxygen-free nutrient medium and sealing the wound surface from oxygen.

In the claimed method, the listed disadvantages are eliminated.

Disclosure of invention

The objective of the invention is to reduce losses during first aid and transportation and the place of medical care among people injured in the area of complicated emergency

The technical result of the method is to provide the best conditions for preventing the development of early complications during transportation of the injured person, namely providing a sterile oxygen-permeable dressing with a pronounced local hemostatic effect (hemostatic sponge), suppressing the growth of pathogenic microorganisms (due to local use of a broad-spectrum antibiotic at the maximum daily dosage), prolonged local anesthesia (due to the use of an aqueous solution of lidocaine hydrochloride and not less than 80 mg), and reducing the probability of local sensibizizatsii and local allergic reaction to a haemostatic sponge, or antibiotic or lidocaine (by the use of 25 mg Chloropyramine hydrochloride)

The implementation of the invention

The claimed technical result can be achieved in the field if there are drugs readily available in the pharmacy network that do not require special permission for their purchase:

1. The preliminary stage.

1.1. We buy the following drugs at the pharmacy:

- Collagen hemostatic sponge in sterile packaging (e.g. 50 × 50 mm),

- Gentamicin-K solution for intramuscular and intravenous administration (40 mg in 1 ml, in a package of 10 ampoules of 1 ml),

- Lidocaine 2% solution for injection (20 mg in 1 ml, in a package of 10 ampoules of 2 ml)

- Suprastin (chloropyramine hydrochloride) solution for injection (20 mg in 1 ml, in a package of 5 ampoules of 1 ml),

1.2. We put sterile scissors and sterile anatomical tweezers on a sterile tray. We carry out the processing of hands according to one of the generally accepted methods.

1.3. We open the package of the hemostatic sponge on one side and remove the sponge on the tray.

1.4. Spray the entire surface of the hemostatic sponge evenly with the following preparations:

- on one side of the hemostatic sponge 5 ml of gentamicin solution,

- on the other hand, a hemostatic sponge 4 ml of lidocaine solution + 1.25 ml of suprastin solution.

1.5. Carefully place the obtained hemostatic sponge in the previous package, seal the cut edges of the package (for example, using the Secunda household device for sealing packages). Storage of a package made at home should not exceed 2-3 days.

2. Application:

- when wounded, we cut clothes around the wound, remove earth, pieces of clothing from the wound, exclude the presence of arterial bleeding from a large vessel (or applying a tourniquet, if it is impossible to tightly plug it with several hemostatic sponges with reinforcement with gauze napkins)

- open the pre-prepared package, put a hemostatic sponge on the wound or lay it in the wound channel (either side),

- we apply a pressure bandage using improvised means or an individual dressing bag.

3. Result control:

- with the correct selection of the size of the hemostatic sponge (complete overlap of the skin defect area or complete filling of the wound channel when it is plugged), bleeding stops within 10-15 minutes,

- during the first 3-5 minutes there will come a decrease in pain in the wound area, a feeling of numbness will appear at the place of application of the sponge,

- during transportation of the victim during the first day, body temperature should not rise above subfebrile values.

4. Further treatment is carried out in a medical institution: on the third day, the hemostatic sponge can be partially lysed, partially fixed to soft tissues; its removal during the initial surgical treatment is not difficult. Repeated administration of gentamicin is not recommended due to the presence of an ototoxic effect with prolonged use.

The novelty of the proposed method lies in the fact that for the first time a combination of intra-local (local) application of a local hemostatic drug, a broad-spectrum antibiotic, a local anesthetic drug and an antihistamine drug in the first minutes after injury is proposed.

The method is widely available, cheap, does not require special medical knowledge, can be carried out in the field, in a complicated emergency, in conditions of direct combat contact during urban combat.

Distinctive features of the method:

- the hemostatic sponge is saturated with a broad-spectrum antibiotic at the maximum daily dosage,

- the hemostatic sponge is impregnated with 25 mg of chloropyramine hydrochloride,

- the hemostatic sponge is saturated with an aqueous solution of lidocaine hydrochloride of at least 80 mg,

- the duration of the hemostatic sponge on the wound is not more than three days.

The proposed method is illustrated by the following examples:

Clinical example No. 1.

Citizen, aged 23. He received a through wound to his right shoulder. 1 ml of a 2% solution of promedol was introduced, an aseptic dressing was applied using an individual dressing bag. Severe pain, movement became possible 25 minutes after the administration of promedol. The dressing is significantly saturated with blood. When moving with the left hand, it protects the right, it cannot carry a payload. 5 tablets of antibiotic No. 2 were given orally from the AI-1 medicine cabinet. Transportation from the outbreak on the second day, body temperature 38.1 °. Before transportation, reinforcement of the dressing was required.

Further purulent complication was revealed, repeated surgical treatment, active wound drainage were carried out.

Forecast - a cosmetic defect in the area of injury is likely, impaired motor skills of the hand.

Clinical example No. 2.

Citizen, aged 24. He received a shrapnel wound of the soft tissues of the outer surface of the left thigh. The striking element is visible deep in the wound. Introduced 1 ml of a 2% solution of promedol, a bandage was applied according to the proposed method. The pain syndrome was stopped in the first 5 minutes. It moves independently, leaning on a stick, can carry a payload. She notes that she does not feel the place of injury, the presence of a foreign body in the wound does not interfere with movement. When moving, there is a slight increase in the impregnation of the dressing with blood. 5 tablets of antibiotic No. 2 were given orally from the AI-1 medicine cabinet. Transportation from the outbreak on the second day, body temperature 37.3 °. Dressing in satisfactory condition, no reinforcement required.

Later, during the initial surgical treatment, the wound is slightly inflamed, purulent discharge is insignificant. Passive wound drainage was performed.

The prognosis is favorable - an insignificant cosmetic defect in the wound area is possible, the limb performance is not broken.

Claims (1)

A first aid method for injuring, including applying a sterile hemostatic sponge to a wound, characterized in that the previously collagen hemostatic sponge is impregnated with 5 ml of an antibiotic solution containing 40 mg of gentamicin in 1 ml, as well as a solution containing 25 mg of suprastin and a solution containing at least 80 mg of lidocaine hydrochloride, and leave the sponge on the wound under a pressure dressing for no more than three days.