medyoyna praketyeene Nog penakunet px. 3. Kamn6enn, MD, FACEP Poi JI. Ancox, PhD, MD, FACEP, FAAEM International Trauma Life Support AlorocnuitanbHaA NOMOLb Np TpaBMaxdene proton MT Shen non peaaruet ‘Dx. 3. KannGenn, goxtop Mesut, ‘unex American College of Emergency Physicians Poli. Ancon, noKrop cbwnococbim w Mes, ‘unex American College of Emergency Physicians ww American Academy of Emergency Medicine International Trauma Life Support AorocnutanbHan NoMoUb nipu TpaBMmax‘blisher fli Levin Alexander Publishers sistant Sarah Hesich [Acquitions Editor Siajana Repic Bruno Program Manager: Nonica Moos, Development Editor Jo Cepeda [Editorial Assistant Lisa Narne Project Management Lead: CyathiaZoaneveld Project Manager. ule Bodo? all Service Project Manager: Peggy Kellar, Energize Aptara id Director of Marketing David Gesell ‘Marketing Manager: Sri Hoch) Marketing Specialist: Michael Sisiaies ‘Marketing Assistant: Aroy rund ‘Manufacturing Buyer: Mary Ann Glortande Interior and Cover Art Director Dine Ernsberger Interior Designer: Suto Montage Gover Designer: Mary Siener Gover Photon Fuse/Gety Tzages: Blend Images -ERprectons Lid ‘Gety Images Steve DebenporyGetty Images Composition: Energizer Aptar Li Printing and Binding: Donwelley/Menashe Cover Printer: .R. Donnlley/Nenstha PYCCKOR MSAHHE eran: Mapa Bexssunsa, Anexeanapa Kye Koopman: Anexcanapa Kyben Teepenox u xoppermu pra Anpaxeneo, One Hacnnvens, Mapa Bent, Anni Kyat, oan Maran, Aptana peas Kanseapone Teepenox lan Avro, nsx Bao, utr KosconckaTlin pms Topo, Pampas Lepusoesa, Mympaaton Wasp ‘vali ovo aac: yw Zyacenia DIP: Bobrex Bopowcor Mewar: Lege, Bpakon ‘Credits and acknowledgment for content borrowed fom other sources and reproduced with permission. inthis textbook appear an the appropriate page ‘within et, ‘Copyright © 2016, 2012, and 2005 by Pearson Education, Ine or its affiliates. AT RightsReserved Priatad inthe United Sates of America “Thi publication is protected by copys and perms shld be obtaive ross the polishe prior to any proliblted production stragen retrieval systems, oF transmission in any form or by any means, eletenic, mechanical, photocopying, recording or obese. For information regarding permisions, quest forms iteeyppr cone wim be Foacon PINES ctor tats romsins dpurene pleas iit ee. pearsonedcomypermisiony. Authorized translation from the English language edition, eile: INTERNATIONAL TRAUMA LIFE SUPPORT FOR Emergency Care Providers, Eighth Eton: ISBN (134130790; by John Camel publiabed by Pearson Education, Ine, publishing as Prontice Hall Copyright (6) 2016 by Pearson Education, Incr isaliaes, All rights orervd, No part ofthis book may-be reproduced or transite in any oem ‘orby any means electronic or mechanical including photocopying, recording or ‘byany information storage retival system, wnthou! permission from Pearson Education, Tne Ree psea sameneoe. Hakata aces stat ayGuneasin Ke Woe Gare senpewssonei,nepeaats Hm coxpancnns m6 ops Um MSHA EpEAETEAHO, Drekrponicen ws sesaoneecsos aniovak foveKOrupoRaie, 2 WE Epes ‘resus xpanenits nouckasaopeuin Ges aeswennoro cornacka naasenbua ‘nto apa, Rissa language edition published by MedycynaPrakaycens, Copyright ©2018 Pycexoe mane parniiecran Mesmanma, Copyright © Kpaon 2018 1SBN978.83-7430-555-8 Swern acaesi percents POA) ‘ormcnanapeienseponsogeenin oto oc KAN TA Flee Wir eee poems cache enna were ‘rou Onis uta pba opsry oem estan ere ce Meant Rep pe, terepe exer ara orm ae 7TH YR ‘hs foro ross poueyps sane naomi pee a ‘ouermenresnt muni np sor, tan Pssst trSesoaropono, pou Tor a ys sacs hoaaeo Mme ‘Spovecnne apron canon Bye pshane mndoser sya wep OHNO Mee ‘pnepanat erm txanase pronoatin np ao ato purr, conwecvoc ayaa Pjromaeonon spraNeH arp een oe remnant ‘ronnu stanoyr poco aun © meso PONE Honrme srt cco a repuenncae BOK ene esta nase, m0 FTL nano Hapa Buso RIOR ‘tore yr es pecans potest Pee Dee, {rene maine somone Osun wens Baio pecans Ki incre pn Asnaperyptropennurmyeen sore {rene og epmsnscao# nono pore corepeenereyre sake maar apr spe eons. soar 908, ‘ons eyes peo Doorn posers EPC ‘ge ecortmoure abunncrpsch rec pan "eaves sone oat paoeogunIpuiassat pouenypui eGasusoncyoor fesepeon res eR ‘peace xxe nner er pene Aare sanefAbe Mee rererremoct an Aoeps once mma ae ttn temipepsesn ts poe ep near eh em ‘mor et nw werpemwarar onvan Sreane exe are sre ar setae rein nh asc caren sno a senaranann pt yactoro pore Osta takone ro enoeuyens omen Ano fosan sinh Meco oe ston Soot ober ene ¢ eames Ns MONA Serpe momouy earache sone pee ese "otra pow yen rome pos. ra ‘ro vnreni pager sncesne cacaven mer O10 eropu crys ween eacED RoR OY ur NODE ‘oronnnaaegsonn rae xe eesti at apo ‘onronc a enn eprops eo Swern caressa aepcoeaa a aorocarassao ane [paar neces sp ratings Hoa esse ep, ‘massa novo bone cyecnate nein SuaepAs eat urns cnpet mepescr nun ato ope pe ‘ewannoort nfo ae Ip ya oom Oo ocomnera nia ncptcfens Yoa Spone Bet ‘ecmurbonoce vepopatte oceoiny abe Hp S004 Sump pune abrcinainis sae we ne sane Ueypante ose repo opens py OAT hj xaxcmcten Boars epmanniccreaae rose peepee tmpeesette anon ut, an main once) el ener ‘npetencrypnen eet nepntae Brereton Tepac ‘ore ete prove (esepese a ye sah xopw xs, Hnto-Mexcunxo s¢ Texac. B 1972 roxy ‘ou Gx npurnauten jim o6ywensn cuacaTenbabax 6puray OKpyrA Keit Ha 6asov0m yposne — stor Moment cuvraerea avanoM ero sautTepeconaniocri ZorocnstTambHotk HeOTTOxKOH HOMO ‘uso, B Hacrosiee pens om snneTea nowerwsiNe weHOM 9TOI opranusauyan. C 1972 ropa oH Gian mesvapancxum KoopAstaTO- pom muorsx yeux mporpana ju criacarenelt — KaK Nem umicxuec cnacareneii, Tax »¢ napaMesutKos, B Hacromjee BpeMt OW BATCH OTCTABHBIM MERUEHCKHM KOOPAMHATOPOM OTO- ccouranbsioit rostomt urara Ana6anta, Hia yueGuoro upoexra s cdepe evenns tpasst xa aorocustras= owt oTante noanikna MexkAyHapoAHas accousal{us TPeHIepoD A } O pegaktopax 2px. 9. Kon6enn, JoKTop MeAMUMH!, unex American College of Emergency Phy: ns no nevemmo rpan — International Trauma Life Support, Ine. (ITLS). Joxtop Kauindenn snserea npeneenarenest atofi opra- aun € MomeHtTa ee coamaH. Toson 9. KownGenn ratoxe sateren asropom nepBoro 1sqaHHt ‘yteSttnka Basic Trauma Life Support cpenaxropoxe nocnenyronicx sronantit 0 nlacronmero noco61ia ¢ Homnins Haspaniten «Interna tional Trauma Life Support for Emergency Care Providers» (cIntermational Trauma Life Support»), a rakoke coaBropos KHAT «Homeland Security and Emergeney Medical Response» i «Tacti- cal Emergency Medical Essential Toxtop KovenGean npruiannexan x nepsoxy npenonanaten- cKomy coctasy Kageapst Heotioxnoit Mesoyi » Mequupin cxoit mnkone Vunmneposrera AnaGam » Bupysrene.B 1991 rosy on 6141 neponin, KTO onywin narpary American College of Emergency Medicine 3a piuratoumecn socrinsens nant: ambHoro sHaNenHA m OBnacTH orocHTanbItoTO cnacerts B 2001 roay ox Gua yzocroen Ronald D. Stewart Lifetime Achievement Award of EMS Physicians. B nacroamee spew om wa mentum, He npakruxyer, xuBer 8 Mowrromepst, unrar Ana6axta. Poii SI. AncoH, AoKTop tbunocodbun M MeAMMHEI, unex American College of Emergency Physicians u American Academy of Emergency Medicine Toxrop Poi Jl. Ancon sanacrea ZowerrToMt no neornonTOt Mem mune n Wake Forrest School of Medicine 1 xpexropom Komi- ‘Teta norocrucranbHoit MejtUAHI H Nequnnstt KaTacTpOp B Yolk @oppect. Ox Taxxe smnnercs otteutoM » Childress Institute for Pediatric Trauma yunnepen- ‘reta Yoiix @oppecr. B 1978 roy ox oxonen Saxananpriar Viorneperrera Bupmrxnivnt, a newes- Hui dbakynbrer 4 xoKropanrypy » Bowman Grey School ‘of Medicine Yunneperrreta Yoiix Soppecr (0 1959 1 1985 ronax). Cheunannsauie no KeoTROxKOM NeRUIIKHE OM OKOHUIA 1 Allegheny General Hospital » Tirrre6ypre, nar Tlexcnmnaiia. Heer mnjensio » o6nactx oxcrpenniot meni M orOCTD: vi ramsaolt meninges, spizannofe American Board of Emergency Medicine. Ou navan cow kapbepy 8 torociutransnoil memsayne 18 1970-x ronax 8 Kavecrme MenunyecKoro cracarena 8 Hio- Vlopxe. Hocne oxousanus yxuuepesrera on cram aneHo ‘Winston-salem rescue Squad 1 naan paGorat» 8 xaiecrne memst- sieKoro cracateaa » oxpyte ‘Dopeair. Tocne sanepuresmix cre- unansanys aoxrop Aacor sepxynes 8 Yansepcurer Yatix Dop- Pecr H jorocitransHy20 HomoMp» B oxpyre Dopcaltr n KavecrDe SaMecrifrexs MexDpMickoro AMpeKTopa B TeveNe 14 ner HepB sHeKoro jupektopa B TeveinKe nocresUNX 12 ner, Ox axTIEHO yacrnyer n nogroronke cnacarenefi. Joxtop Ancon yuacrayer 'spaGore ITLS ¢ 1980-x ono, B reyenne 15 ner on Gov equ Kum aupextopow orgeaa ITLS Cenepuof Kaponu, C 1990-x rogon on 6x1 uneWoM peanptonHost xonnerin ITLS 14 Gsin coanropos yueGumxa, Haitax ¢ 9roro sant, on cetea copenaktopom yue6nnka BNecTe ¢ oKropoM Kowanberm.[naga 1 Tnaza 2 Taga 3 Tnaga 4 Tnapa 5 Tawa 6 Tnasa7 [nasa 8 Tnasa 9 Fnapa 10 napa 11 Oyenka mecta nponcuiecrsna 1 Ouertka coctonHua noTepneswero nocne Tpasmb 30 O6y4eHne HasbikaM OueHKM norepneswero 53 OGecnevenne npoxopmocTH pbixaTeMbHbIK nyrei 70 Texnuku oGecneveHvA npoxoqumocTH AbixatenbHex nytet 93. Tpasma rpygHoli knerkn 132 Tpapéa rpyavoit KnerKn — npakruyeckne rappin 155 Wok 163 190 Yepento-woarosan rpaawa (MT) 203 Vixdbysnonnas Tepanns Crnanbkas Tpasma 224 Tnapa 12 [napa 13 [naga 14 [napa 15 Tnaza 16 Tapa 17 Tawa 18 Tnapa 19 Tnasa 20 Tnapa 21 [napa 22 ChuanoHan Tpaskta — npakniveckne aoe 253 Tpapmei xneora 273 Tpaoui KonesHocTeh 283 ‘pasa KoHe4Hocrelt — npakTH¥eckne Hapbikn 308 Oxorn 322 ‘Tpasmel y gee 347 ‘Tpasabl y amy noxkunoro Bospacta 373 ‘Tpasa eo spema 6epementocrn 385, Taunext nog BnusHveM ankorona uvaproTuKos 396 Ocratioska cepaua 407 ‘Mepst npenocTopoxtiocr np KouTaKTe © kpoBbio H Gwonoraveckimnn mxocraun 421 Cnosapb 441ITLS for Emergency Care Providers, 8th Edition Roy L. Alson, PhD, MD, FACEP, FAAEM Associate Professor of Emergency Medicine and Director, Office of Prehospital and Disaster Medicine, Wake Forest University School of Medicine, Winston-Salem, NC; Medical Director, Forsyth County EMS, Winston-Salem, NC; Medical Advisor, Disaster Services, NC Office of EMS, Raleigh, NC James J. Augustine, MD Director of Clinical Operations, EMP Ltd, Canton, OH; Assistant Clinical Professor, Department of Emergency Medicine, Wright State University, Dayton, OH; Chair, ASTM Task Group F54,02.01, Standards for Hospital Preparedness Under ‘Committee E54 on Homeland Security Applications; former Medical Director, Atlanta Fire Rescue Department and the District of Columbia Fire and EMS Department. Jere Baldwin, MD, FACEP, FAAFP. Chief, Department of Emergency Medicine and Ambulatory Services, Mercy Hospital, Port Huron, MI Graciela M. Bauza, MD Assistant Professor of Surgery, University of Pittsburgh, Pittsburgh, PA Russell Bieniek, MD, FACEP Director of Emergency Preparedness, UPMC Hamot, Erie, PA William Bozeman, MD, FACEP, FAAEM Professor, Department of Emergency Medicine, and Associate Research Director, Wake Forest University School of Medicine, Winston-Salem, NC; Lead Physician, Tactical Operations, Forsyth County EMS, Winston-Salem, NC Walter J. Bradley, MD, MBA, FACEP Medical Director, Illinois State Police; SWAT Team Physician, Moline Police Department; Physician Advisor, Trinity Medical Center, Moline, IL Sabina A. Braithwaite, MD, MPH, FACEP, NREMTP Clinical Associate Professor of Emergency Medicine, University of Kansas Medical Center, Kansas City; Clinical Associate Professor of Preventive Medicine and Public Health, University of Kansas Medical Center, Wichita; Associate Medical Director, Medical Control Board, EMS System for Metropolitan Oklahoma City and Tulsa; Vice Chair, Board of Directors, International ‘Trauma Life Support vill Jeremy J. Brywezynski, MD Assistant Professor, Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN; Medical Director, Vanderbilt LifeFlight; Medical Director, Vanderbilt FlightComm:; Assistant Medical Director, Nashville (TN) Fire Department John E. Campbell, MD, FACEP Medical Director, EMS and Trauma, State of Alabama, Retired Alexandra Charpentier, EMT-P EMS Director, Heart of Texas Healthcare System EMS, Brady, TX Leon Charpentier, EMT-P Harker Heights (TX) Fire Chief, Retired James H. Creel, Jr. MD, FACEP Clinical Associate Professor and Program Director, Department of Emergency Medicine, University of Tennessee College of Medicine (UTCOM); Chief of Emergency Medicine, Erlanger Health System, ‘Chattanooga, TN ‘Ann M. Dietrich, MD, FAAP, FACEP Professor of Pediatrics, Ohio State University; Director of Risk Management, Section of Emergency Medicine, Columbus (OH) Children's Hospital; Pediatric Medical Advisor, Medflight of Ohio Ray Fowler, MD, FACEP, DBAEMS Professor and Chief Division of Emergency Medical Services, The University of Texas, Southwestern Medical Center, Attending Emergency Medicine Faculty, Parkland Memorial Hospital, Dallas, TX. Pam Gersch, RN, CLNC Program Director, AirMed Team, Rocky Mountain Helicopters, Redding, CA Martin Greenberg, MD, FAAOS, FACS Chief of Hand Surgery, Advocate Illinois Masonic Medical Center; Chief of Orthopedic Surgery, Our Lady ofthe Resurrection ‘Medical Center, Chicago, IL; Reserve Police Officer, Village of Tinley Park, IL; Tactical Physician, South Suburban Emergency Response Team; [TOA Co-Chair, TEMS Committee Kyee H. Han, MBBS, FRCS, FCEM Consultant in Accident and Emergency Medicines Medical Director, North East Ambulance Service NHS Trust; Honorary Clinical Senior Lecturer, The James Cook University Hospital, Middlesbrough, UKTloxrop Ancon rake wirepecyeren Memnutnoit xaracrpod. ‘On apnsetes menamanicxnst znpextopom North Carolina State ‘Medical Response System (NC SMA). Ox 6:11 npesaentom ‘Kowrrera xpnanicnoro pearuposania AMepiKancKoro Konnerst- yma wpaveii cxopoit wezuninickoit nomougs. B 2014-2016 rojax ‘ow Guin npeaygenrom Kowstrera xpuauicuoro pearuponassis NAEMSP. ‘Ox enyoeu National Disaster Medical System (NDMS) 2 reve- te 20 ner 1 8 Hacrosutee spesia asnnerca ‘iteHoM International ‘Medical Surgical Response Team East (IMSURT-E). Paxee out Guim KoManiaupom 3 saMecTitretem KoManaupa n North Carolina Disaster Medical Assistance Team (NC-DMAT-1),ITLS FOR EMERGENCY CARE PROVIDERS, 8TH EDITION Donna Hastings, MA, EMT-P, CPCC Chair, [TLS Editorial Board; CEO, Heart and Stroke Foundation of Alberta, NWT and Nunavut, Calgary, Canada Leah J. Heimbach, JD, RN, EMT-P Principal, Healthcare Management Solutions, LLC, White Hall, wy Eduardo Romero Hicks, MD, EMT Director, Sistema de Urgencias del Estado de Guanajuato, Guanajuato State Emergency System, México; Associate Professor, University of Guanajuato Nursing School, Guanajuato, ‘México; Medical Director, ITLS Guanajuato México Chapter Ahamed H. Idris, MD Professor of Surgery and Medicine and Director, DFW Center for Resuscitation Research, UT Southwestern Medical Center at Dallas, TX David Maatman, NRP/IC Kirk Magee MD, MSc, FRCPC Associate Professor, Dalhousie Department of Emergency Medicine, Halifax, Nova Scotia Patrick J. Maloney, MD Staff Physician, Denver (CO) Health Medical Center and Denver Emergency, Center for Children; Clinical Instructor, University of Colorado School of Medicine, Denver, CO David Manthey, MD, FACEP, FAAEM Professor of Emergency Medicine and Vice Chair of Education, ‘Wake Forest University School of Medicine, Winston-Salem, NC Leslie K. Mihalov, MD Chief, Emergency Medicine, and Medical Director, Emergency Services, Nationwide Children’s Hospital Associate Professor of Pediatrics at The Ohio State University College of Medicine Richard N. Nelson, MD, FACEP Professor and Vice Chair, Department of Emergency Medicine, ‘The Ohio State University College of Medicine Jonathan Newman, MD, MMM, FACEP Assistant Medical Director, United Hospital Center, Bridgeport, WV Bob Page, MEd, NRP, CCP, NCEE Edutainment Consulting and Seminars, LLC Wm. Bruce Patterson, Platoon CI Strathcona County Emergency Services Andrew B. Peitzman, MD Mark M. Ravitch Professor and Executive Vice-Chairman, Department of Surgery, and Chief, Division of General Surgery, University of Pittsburgh Paul E. Pepe, MD, MPH Professor of Emergency Medicine, Internal Medicine, Pediatrics, Public Health and Riggs Family Chair in Emergency Medicine, University of Texas Southwestern Medical Center and Parkland Emergency-Trauma Center; Director, City of Dallas Medical Emergency Services for Public Safety. Public Health and Homeland Security, Dallas, TX William F. Pfeifer, MD, FACS Professor of Surgery, Department of Specialty Medicine, Rocky Vista University College of Osteopathic Medicine: Mile High Surgical Specialists, Littleton, CO; Colonel MC USAR (ret) Art Proust, MD, FACEP ‘Associate Medical Director, SFVEMSS, Geneva, IL Mario Luis Ramirez, MD, MPP ‘Tactical and Prehospital EMS Fellow and Clinical Instructor in Emergency Medicine, Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, TN Jonathan M. Rubin, MD, FAAEM Associate Professor of Emergency Medicine, Medical College of Wisconsin S. Robert Seitz, MEd, RN, NRP Assistant Professor, School of Health and Rehabilitation Sciences, Emergency Medicine Program, University of Pittsburgh; Assistant Program Director, Office of Education and International Emergency Medicine, University of Pittsburgh Center for Emergency Medicine: Continuing Education Editor, Journal of Emergency Medical Services; Editorial Board, International Trauma Life Support Corey M. Slovis, MD, FACP, FACEP, FAAEM Professor of Emergency Medicine and Medicine and Chairman, Department of Emergency Medicine, Vanderbilt University ‘Medical Center, Nashville, TN; Medical Director, Metro Nashville Fire Department and International Airport J.T. Stevens, NRP (ret.) Sun City, SC Ronald D. Stewart, OC, ONS, ECNS, BA, BSc, MD, FACEP, DSc, LLD Professor Emeritus, Medical Education, and Professor of Emergency Medicine and Anaesthesia, Dalhousie University, Halifax, Nova Scotia, Canada Shin Tsuruoka, MD Vice director and Chief of Neurosurgical Department, A Toride Medical Center, Toride, Japan; ITLS Japan Chapter Medical Diector Arlo Weltge, MD, MPH, FACEP Clinical Associate Professor of Emergency Medicine, University of Texas, Houston Medical School; Medical Director, Program in EMS, Houston Community CollegeHoward A. Werman, MD, FACEP. Professor of Clinical Emergency Medicine, The Ohio State University; Medical Director, Med Flight of Ohio Katherine West, BSN, MSEd, CIC Infection Control Consultant, Manassas, VA; Member JEMS Editorial Board Melissa White, MD, MPH Assistant Professor, Assistant Residency Director, and Medical Director, John's Creek Fire Department; Medical Director, Emory Emergency Medical Services; Associate Medical Director, Emory Flight/Air Methods, GA; Department of Emergency ‘Medicine, Emory University School of Medicine, Atlanta, GA Janet M. Williams, MD Professor of Emergency Medicine, University of Rochester (NY) Medical Center ITLS FOR EMERGENCY CARE PROVIDERS, oTH EDITION E. John Wipfier, Ill, MD, FACEP Attending Emergency Physician, OSF Saint Francis Medical Center Residency Program; Medical Director, STATT TacMed Unit, ‘Tactical Medicine; Sheriff's Physician, Peoria County (IL) Sheriffs Office; Clinical Associate Professor of Surgery, University of Hlinois College of Medicine, Peoria, IL Arthur H. Yancey Il, MD, MPH, FACEP. Deputy Director of Health for EMS, Fulton County Department of Health and Wellness, Atlanta, GA; Associate Professor, Department of Emergency Medicine, Emory University School of Medicine, Atlanta, GABocumoe wazanse noco6ins no ITLS — «International Trauma Life Support for Emergency Care Providers» 61110 o6nonneH0 Mt ponionvewo, uknovaa Nonefiune 1 nawGonee adebextinHie peuientia no yxony 98 nauwentom ¢ tpaswoft. SHaHHs o newex "pan nlocromno Mexisiorea, noaroMy paGowan rpynina TLS. npunoxavia nee yeux 118 OGNONIENIEE TERETOR » yseGnIKe 1 cooTHeTCTBIM CTeKYEM COCTOsMEM MeN HI.CKHX SHANE. 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Kpome toro, Guim yewwten mpitnupen, coraacto KoTO- POMY MACCHBHME BHELINHE KPOBOTENEHHAT ROTKHEL OBIT saMevieHist ocraMosenbt 8 Havane ocMoTpa. Korma pykonomrrem 6purayya mpononstr ouenxy, on nopyyaer ‘ocranbisin ctiacavenaMt pearuponar ia Hapywienst, o6Kapy- 2xettie mp ocMorpe. 970 fenaerca jyA8 Toro, wTOGKs yKPeMTS "pina, cormacto KoTopoMy PyKORORHTEN He MOET NpepHarh ‘ocmorp, sr06ut peut» mpoGremy — oH omxeH nopysKT Heos xojeanie jelicrass Apyriat wenaMt Gpuragsi, 30, B CHOK Ove eb, HORMepKNRACT KONILCTIH KOMAMIIMOR paGors M CHORUT K AUIMMMYMY Bpesta, MponerenHoe Ha MeCTe MpoHCMIECTBNA Taroke Goin saMeHeH NOpaAOK Tpex OcMorpos (mepBIIDIE ITLS-ocmorp, aanbueitumnit ITLS-ocmorp x nropusnsaii ITLS-ocaorp). Jaassefimacit ITLS-ocmorp npovomren 10 B10- puruuoro ITLS-ocworpa, koropoe sunserea Gonee pacpocrpa: HeHMDIM MOxeT ero SaMenTD. 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Taw HaliTis anopmaniio, nozesHyio 8 mpaKTHKe ya daxpennenns suant + «Additional Skills» — godanneno onucaune scrompaonaHns uyTpuxocrHoro rpysutnnoro aocryns Fast Responder TM. + sRole of Medical Helicopter» — o6uanmens janie. + «Trauma Scoring in the Prehospital Care Setting» — jo6arneno cxety zpuwka CDC. + «Tactical EMS» — 6uGnnorpadiis Guana o6Honnena, wro6u otpastrr» rexyimmit noyxomn cootsercram¢ XaprdpopackuntCoananne yueGuntKa n o6ysterie — caoxktias aaa, 1'970 Gbin0 641 HenosMorkwo Gea KoMaHLAHOH paBorws Jum MHOCIX Hs BTHX MORE To Guia paGora, noinomemtas c Hacroamelt moGosn0. ‘Mos Gnaronapuse ocoGenio rex pyaelt ITLS, Koropite nosytepyKA/IH HAC CHOMMN HERD, MCHPABNCHIAMH SaMeMAHHANO K TEKCTY, ‘310 611 orpontas paGora cTonDxiEx mopeli, KOTOPHte COTPYRINANH C HALO, 870 MP, KOHEHO, MPOMYCTHEM KOCO-TO, 34 TO MB MBI stems sapaniee ‘Mut xoren 6m noSnarogaput» cenpranuictos ckopolt NOMOUYt, KOTOPHIe HPOREPHUIH NPOREPKY MATEpHANOR JAA TeKyWNerO — yyxe socuoro — nananis International Trauma Life Support for Emergency Care Providers. Hx nowouye Guna jeficraute Gecennoi. Mat nprswarenbast Gary Bonewald, M.Fd., LP, Program Director/Coordinator, Wharton County Junior College, Emergency Medical Services Program, ‘Scott Craig, CCEMT-P, I/C, Associate Professor of EMS, Johnson County Community College, Overland Park, KS, Ronald Feller, MBA, NRP, Director, Emergency Medical Services, Oklahoma City Community College, OKC, OK, Jerry Findley, Licensed Paramedic, BS Health Admin, MA Organizational Leadership EMS Program Director, South Plains College, Lubbock, Texas, Scott Jones, EMT-P, MBAEMS Professor, Victor Valley College, Regional Public Safety Training Center, Apple Valley, CA, Richard Main, Paramedic, Engelstad School of Health, College cf Southern Nevada, Las Vegas, NV, Reylon Mecks, RN, BSN, MS, MSN, EMT, PhD Clinical Nurse Specialist, lank Children's Hospital ~ Des Moines, 1A, Christoper Mierek - CPT, MC, 4" MEB Surgeon, Dauntless Clinic OIC, Brandon Poteet ~ EMS Program Director, Grayson College, Denison, 1 Roy Ramos, NRP, Pre/CEO Heart EMTS LL. Pueblo, CO, Rintha Simpson, BS, NRP, NCEE, BS NRP Associate Professor of EMS, College, Lakewood, CO. ‘Jpxo Cenea, Haueny pesaxtopy, 3a ee Tepnewe w nyHKryambHoct, CCracui6o rakoke pykononctny 1 nepcontany AMR Las Vegas sa nosouyh m fboromarepianax Jason Blakley Christi Cservenyak Carla Murrew Jake Fan Nathen Van Wingerden Erie Dievendor Eme ono oco6oe cnacuGo pororpadax, Koropue HoMOrNs HpowLOcTppoBArs Texcr. Matepman mpeyocranten: Roy Alson, MD, FACEP Sabina Braithwaite, MD, FACEP James Broselow, MD Brant Burden, EMT-P Anthony Cellitti, NRP Alexandra Charpentier, EM-P ‘Leon Charpentier, EMT-P Stanley Cooper, EMT-P Delphi Medical Pamela Drexel, Brain Trauma Foundation David Effron, MD, FACEP Ferno Washington, Inc. Peter Gianas, MD Peter Goth, MD KING Airway Systems Kyee H. Han, MD, FRCS, FFAEM Michal Heron Eduardo Romero Hicks, MD Jeff Hinshaw, MS, PA-C, NRP Kelly Kirk, EMT-P ‘Masimo Corporation Lewis B. Mallory, MBA, REMT-P Bonnie Meneely, EMT-P Nonin Medical, Inc. North American Rescue Bob Page, MEd, NRP, CCP, NCEE William Pfeifer, MD, FACS Robert, Porter Don Resch. SAM Spli isTleveune tpasM — cana joporoctoauan oGracr» MeaMuyeHt CIA 1 8 Gombunencrse apyrutx crpax, B CLA tpassa an- eves verveproit neayuel mpirsituofi carepru no ncex Bospacrisax Epynnax H cnaBHoit MpHsKHOH eMepre y moxeli Ao 45 ner. B rpynme mogeli » wospacre or 15 30 24 mer Ha qomo Tpana prxonercs 73 % emepreit, Ha kaxnili cuepreninait cxyaa "npuxoguerca 10 roctucranuanponaritsx moxef 1 cori 10421 MX mpwenmont ornenenus. Taxa psicoxas rena Tpasne moTiEBupyeT ‘mac pacnpocrpaniirb ananita 0 wexesbia mporpuimaxtieKe Tpans pent conpyamxos ckopoft MenppttcKoit TOMOM Tlockonpxy pesysrar events Sacto onpeneaserca Bpenenen, [MpOUtemMIN OF TPaBsEAL AO OKOHYATENDHOrO XuPYprHseckorO eveits, 4peanimaiio warkito onnajters cnocoBHOCTHIO OLeHH, arb W jefleraonaTD mpi Texemsx Tpaswax. Lem» kypcow ITLS — naysurr» cracareneti canan GoicrpotM 1 epipexritmnon Mero ‘mast o6cxemosant iH neventia TaDKeNX TpasM. OGyseNHe COcTOMT 3 TeoperuMeckinx rap m NpaxTateckiex ynipaxHeNnt, KOTOPHE ‘Hosnonmor mupaorars coorsercrsyloute HaBsiKH, TOOL HOCTE sapepuuenia o6y'euma cracaTem Mor OuiTh YBepeN, 70 OM MOxKeT oGecttewiiTe HavIEKaIllyIO HOMOMYe AKepTBAM TpaBs @unocodua oueHkn w neveHua nayMeHTos, nony4uuswiux TpaBMy “Dokenbte spans, 18K 2e Kax OcTpuill KopoHapHBL CHHIAPOD i wnicyasrai — sto Goreantt, xorapsle SABHA OF PENH. ipamias casa sexy cpoxasut mpoexensisxuxpyprtveckoro ewes npovenroM sstaatsunex nocxe xpamae Gna anepaste omtcana joxropos P. Agancost Koya ua auaxceuurroro Lewrpa ‘xpanvarononint Banruntope, rar Mopuren Ipoanaai ova AauuNe, OH SABINA, TO eprBst NOMTpaBM, KOTOPHE Gouau npoonepyposania 8 tevenue 60 sammy nocte noayent TpADMML, HMGTI CAMHE BMICOKHE HAHCM Ha noERMHAHHC. On maanax aro sianenne waoxoruac vacoM». 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Hut w KaKolt Apyrofi oGnacTH Ono Ke ARNACTER TAKIN HORXOAYEN, KAK pH TeseMIEE 2kepra Tpaam. Yacro Kus» NocTpajanuNex SaBHICHT OT BHIIMA- LA KZeTasaM, MHOrKe ms THX BaXKHMIX AeTaNER upocKosAT ene jo npuGeeria wa MecTo npontcutecraMA. Kax sex 6puragt cnacarens o6nsa0 ‘+ swat» criocoGm: nogroronsar xaperss cKopofi noMouyst, ¢r0OM ona cera Sni1a rovORO! K oTDesRy, + snare cami Goierpoil yrs x mecry mpoxcutecrana; nccae: OBAMA NoKasanu, #To ucriomsaonaNse Hawstraiyin (GPS) CoxparHo KaK ppeMst peaKitMs, TAK H TpattcnopruponKit wernt, + sar», KaK oueHHITS Necro MpoucuIecTaW, sroGt onpere: ruttb ero Geaomacnocrh ut MexanuaM nonyeHtia rpaBstot, + snare, sro onpegemier Geaonackocrs mecra mpoxcutecranst HymeTs paSorate n omacHenx yenOBHAX, + ocosuawar» coo orpasinuena Harb, Kora creAyer Bb Bars noMout, ‘+ ymers paGorars # xowanige Tax, roGer oGectewrrs xkeprant aipextannyio v coorsererayiomtyio nowottD, 1+ sar, Korea mogovimn x akeprse Kora Haars Tpaxenopris posxy,+ sar oGopynosame cnoeit Gpurages u noxnepxwBat» ero - xopoutext cocrosm, + stars soomensocr Gnranecaux Gomera cane Ope nynit x a (opranstosantize Ypansa-cicTes 1 xpuTepat "pavienopra TpanNaronarieckitit eH™p MOryT coKPATIET pen 10 oxNSareMHOTO xPYprHeCKOFO Neve. Bone sroro, cnacaren nomxcert TaKKe: ‘+ stave, ¢ wero Hawary, sHaTs BoNpOCH, KOTOPHE OH FONKEH Sagar, KaKute MeVicTBWA OM HONKEH BBUTOAMNTS, Bpems, B KoTOpoe OHM ODKEM 6st sanepmIeHEI, H KAK GsLcrpO 1M opranxaosanHo ubulomHaTs KmoYeBKKe MepompHsTHA no cnacersito XH. om Bis curaere, #10 eran Wena, TorAA Bb AOKI Pac- cratnes e nporpeccieit enacarens panto ceftvac. Hara sayasa — cacar tN, WTO MpoxdeccHnA CnaBHeR rpasUALHetH xopOWE penyraimef. Bon y Hac mnoxof setts, kr0-To inane 3 Ham ouim6xst ctpananvin nm rxHsHbAO. C CaMOTO Havama cKOpO; MenpNICKOH NoMOME NocrparanmMe w cnacaren norKGan lua-aa HeOpexnoctu K ONHcANNBNX Dime JeTanam. Morse a Hac nomi naxjtetT08, KoTOpIax Mat worn Got criactH,ecait {651 Mat Gan NewHoro Myapee, Golcrpee WH ye OpraHHSOHAHE He nenasire oum6ox — wet Goneuieh paxoctis, Yes or cnacetiit ‘eft-ro assum, Ho Mis TaKoKe HOCH IIPANB NOTE CBOM HEYA. BBEAEHME B KYPCHI ITLS H Bame ormomrene, # orxporrait yi uMtewor Gonbioe anavenne, ‘Bor oman Gort» noaesiens, nEHDaTemBIA! 1 GHICTPHL, MO H26e- raitre aMouoxianboro pearnpoBaiits, BonMeKIENH HlCtuINEIX eliernuti. Tipexje ncero, But jomkis NoctoshHo crpensrbca x roxy, ToGo ace Bau AeiicTEn Gon wanpaneste Ha 67ar0- rnonysne Bamero nanprerrta. Eon Baume npenwinyuee o6yuenne re noroToniino Back KaKoi-To cHTyaI{, ncerpa enpamsimastre ce6a: «Aro nyse ws Moero uauuenra?y Benn Bui noxyncrno- nai, 10 Bae Gombe He Romer, 970 OaHaNaer sto HaCryMERO mpopeccnowambioe suiropanne, « Bana adybexrusxocrs crano- sitTca ace Gone orpamrensoil, Een aro mpowsoriger, BaMt ce- yet o6panitncs 3a nomonyb1o (Bcem Hast Hyxtta TOMO ‘pit crpecce) umm ieKar® Apyryio pa6ory. C 1982 roga opransauyia ITLS (pantee BTLS) cocpenoroxwiia noe nmuvanne na onpenenennnc ontisanbnx jeiierantt, KOTO De HeoGxoAHO HIpenTpHAHATO B TeHeHME TEX HECKONBKIX WHIT. oTophte MMeIor cnacaTens Ha CHACeHMe HHH CRON TALINCHTO Henman enact ncex, Ho Moi crapiia mepen cOGoit em WAKOrIa ne norepar» naunenra, KoToptiit MoxkeT DBDKIET. 3aHi, conep- >xallmHecs avo Kaur, ory BaMt natoM NoMOND. Henomayiire xe now. 2x. 9. Kouinbenn, HoxTop MenMUHH, ‘uneu American College of Emergency Ph enakropInternational Trauma Life Support — oro acenutpian nexomep- ‘Yeckas opransalis, xoTopas saiaeTes MpenOTspalieniien eMepri i nupannaocts, nuspenolt tpaBsan, nocpeacrBoxt oGpasonanmus » oGnacra jorocntransHoro yxowa 2a nOcTpanas- tuts rpannaves ITLS — 9To wAeanbHbIA TPeHMHr OKasaHuAn NomouwW TpaBMMpoBaHHOmMy naywexty Yaus yaysumes. Yanes e ITLS, Boeere waa yayunnen sneesrrt yxoua aa noxepmesunivst ¢rpanwane. International Trauma Life Support —nexouocepccxaa opranisaLpi, 2aHMMaIOMAACs Ym} uetites € nonourbwo O6ysesu6 8 OGacTH rpapN — xoOp;)ONE yer ofpasonanite 1 o6ytenne ITLS no nceMty Mupy. Ccuovaunas » 1985 rony Kax Basic Trauma Life Support, » 2005 roay owa wast enoe naanane wa ITLS, #0634 non ‘tepraryr» cooe mexnynaposioe snasente. B nacroamee pens ITLS uncer Gonee 80 unnanos u yeGuerx sjerrpon » spe, Bnaroxapa elt cori racas cnacarene,cpes ero MesHLWHINCKOTO MePCOHA.A H Bpaveit YsHaNML © TaKTINAX 4 newenus, ogo6pennsx American College of Emergency Physicians ITLS — ngeansunit rpennr neers nanuena © tpanwof, noroMy "ro: + mpaxriciecksi: o6ysesine FILS peanernano, ¢ Gonsinyt NomecrsoM mpakrirveciae ynpaxcett, KoTOpHE oFasa- anc adeKTHBHAIN BO Bpens cHacatenD4BIx pabor sor MecTa MpowciecTBWA A0 onepan OHO, xvi + wworamnseckati: mucbopauuss, npenocranrentiaa Bo Bpenst o6yena, akryambHa H orpaxaer HocrenHMe TeHAeHKH ‘ nexenmu Tpanm, ‘+ rmGranit: Kypebs, Mponominne cerowo duintanon m yrebuEx eHTpos, a_antuponann K noKanbitKIM norpeduocram sempnopurerase, + opnenmmponannsuit wa Komananyio paGory: ITLS noep- uBaeT PORE KOMANA|NOTO TOAXOMA K HeseHIO TpABM, KOTO- put xopomo pa6oraer ® nosceaHesHoi mpaKTuKe 1.8 TO.Ke HPeMA HeHIET pont OTHENbIX WeHOE KOMAHAR, + ocHonannuti Ha HeornoxHot menumuHe: spasit cKoport omoupt, paGoTaiouyte exesMeBHO Ha NepBOM AMMAN, CTpE- Muitca cHexarh yueSuie warepuaail CruMyaMpyIontt J)08 YSACTHIKOB Ht B-TO2Ke BPeNGT OCHOBARHBUMI Ha KPOHOM Gasnce neoTnoxwoit mest, + Gpocatouniit mbison: sHaiien, nepenatitnie no aperia oByxe- ‘us, HOAMAMaIOT naauKKY KaYecTsa paGoTs, BAITOMHEHO; ‘cnacarermit; 310 npouexonutr Grarojapa wterpatyn conep- -xanHA ReKIQA € MpaxTHMeCKHOAM YpAAEHANSL 3HaHMA, KOTOpbie pa6oTaloT ITLS npeyocrasnaer suannx m wasbiKi pa oGecmeseHHA onmH: anbHoro yxona $a Maujte¥ToM loc Tpansta a ZoroctTAMID- nom oTane. Om mpenmaraer mmoxecrso sosmoxnocrelt ui o6yseni nlepconiara cnacarensabtx enyrx6 Ha HEX PORN no acexty sorpy. Kypen ITLS coerator extn, obywexite npn ‘NecKaIM HapbIkan c MoNOMIbIO TpetIAKepon, yNaDKHeNIIT OcMOTpA nalyuenra w ctesapsn & cuosysIApoNaHEMIX TpanMaTsvecKHEX CITY aupirx, Saumnun, mpoBome KAK HemIpepsiBHas BOSMOXKHOCTD ‘OG venus, ncrTOMBsyIOTEA B KAECT OcKOUA BO MHOTHEX Y4eGHNX nnporpansax pybix enyk6 ake TPeNOR rosITLS Provider TLS Provider sxmowaer b ce6x Kak sauinyo 16 9aco8 neKuAi empaxruveckxx sania (n SansicMMocTs oT NoxaMsHOrO GN ana — mpi. ep.) 1 axgaaen Ha Gazono% sus pacuunpenwom ponte ceprnguxaiyin FTLS. Muonauuowat nopxon Ha npa- -crctecxix crannax nosnoaser Ban sipaGorar HaBbiKt, COOT nercroytonyite ypontio cepridyexanat: + ocmonp 4 nevenne norepnepuero, + oGecrteveuse npoxonMMOcTs juXaTenbINAX HyTeMt Ha 6a30- ‘BoM st MponBUHyToM ypoBHe, + nomoSwmsauis HosxououMiKa, guaKyauls ¢ Mecra HpOKC- ecru, cnomsonanne KED, yaatenne iinema, Hcn01%30- aunt oproregHtlecKoit AOCKH Ht KOBINOBDNX HOCHTOK, + mvmoGunsaysa KoMeYHocTel 4 MeHOMsoBaHIE UTD as ooaraxen, + Rexommpeccns nanpaxentioro muenMoropakca wm xHAKOCT- nay tepamir (npoawnnyriit yposen) Brarogaps Komamnexciomy nogxomy X siannian a mpaxrusecKsnt apsikant ITLS Provider nonxoa Alaa ncex yponieli nepconana HeoMmOAHOK MeqKHCKOK NoMOUU — cHacareneii, epeswero witekoro nepeonana ¥ wpa ITLS Military TLS Military — 9r0 cransapruas sepena ITLS Provides, cooma ua noennoivt axcneprani. Cuenapi ananruponas x tpe60 BaNILEM, NpeABADNIEMBIN noeHHOMY nepcoxany. 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Cnegyet nomtuTs 06 stux sonpocax 80 Bpema “ren mass. B KOHYe OGcy- Bropnantiit | Mosropwrs nepsniy cues. FTLS-oemorp | nosropno oye axaonolenoxaZaTenH pacchonpeTe BoawOXHOCTE NOToDNETA. ‘posecta Weepanorisecxoe oGenenosaine ‘Mposecta aeranvauposavewit ocwoTp (¢rorogt 201s) Aansneiumit | Tosropere nepensnyo ouevay. MTLS-ocmorP | fosropio ouenaTs wanna noxasareru v Npoaepue nowasaHu MotuTOpoS. Tlesropwo oGcnegoaarb wer, pceepis cocrosive nospexsiew sdexred oT NpoBeAeHHOrD neve Croc 1. Crannapmnsie mepesnpeaccToponsocTa (cpeacTea muguenyanHoi sayy) 2. Beaonachocre wecTa nponcwecTEM 3, Mepeirwias copruposxa (oOwee Kon¥ecTe9 norepnenun A, HeodkonyocTs 6 aonamuensioh nowouy mao oGopyRosaraNt ‘5. Mexanau Tpasrat Crangaptupie mepbi npegoctopoxHocTn Mento xa wecre nponcmecrns nanGonee Reposted KOHTaKT ¢ KpORBIO Hl APYTHMM HOTEN- ‘waexto napmyeponamnscnn narepuairase (other potentially infectious material — OPIM), ‘Sn yrpoast Gonee Aeranbio oncanis 8 Dave 22. 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B enysae rantenTa C1pabMosi weoGxosumo cnexyiouee OFopyaowanite: + cpescrea unqupunyanonoit sapere, + o6opynonarme max rpaxcnopra naxnenra (WocHnK, wwaxoGnTMSaMOREST CHAM uait mit 7. 1.) € cooTReTETRYIONLNDNT RCH pYOWAN PENANG Ht MpweMOCOGeMteDt oun craGuimisanian rononet, + momo6pannti no passepy westisai soporHuX na craGuaNsaN MeRHoro ormena + sacnopox n cpegctna sn oGecrievenns npoxoninocrn AunXarenosix nytel, 8 TOM wHtene oGopynonanue pia acraypanjar x MeIIOK AMBy € muIeRoit MacKest, + rpapsa-anresxa (nepensaounbifi watepuat, spoBoocranasiueBavouie BeulecTBa, KPoDe- ocranianmiinaromtit kryr/typHaKer, ToHOMeTp, oxtenRockon). Eom eoSxonsno crettansHoe o6opyaonatine 1A vsiMeNeN HOTEpREBAIE, ROME mae Kaperst cXopofk Momontys stmt AOMOnEMTenDisit NepcoHA, maonHITe Wx cpasy. Vitae rnoaoke, npH oxasaHHH NoMoM ManjeHTy, Ha.9TO MoaKeT He xDaTHtTs Bpentent, YOemtTec, 70 Bor nepenainn ocranbirsa cracatensvs camo BaKKY sKhOpMAlLTD: TORHOE MecromOAOKe- ve, eymecroyrompre onacocrit Ha Mecre nponcmecroua. B chy¥ae WaccoBSIX povcMecrBHit MOKET nOSHIKHYTs HeOGXOANMOCTS 8 YeTaMOBITEHHH SoHE OAIMAUA nH OCTaMbIX Opa, ‘criomsonanie nsinenenrx pamio¥AcTOT, CcrM TaKONMe NPEAOCTARTEHD, MOKET MONO -dyekTMBHOTE KoMMYHHKALMH. Mexanusm Tpasmel Kax tonxo But ySeqirrecs, s170 x natpewTy MoxHO GeaonacHo npuGauaueH, Hanae ouenky mexansowa rpapnoi, MexainiaM 1panmii MomeT OsITS O¥eEBIIAEH MociE OCMOTpA ‘Mecta npouemectaus, Ho Hora NeobxonuMo paccnpocitt» o enysnmmesica norepmenttero suai cormeteneit. Tpamica cansanbi c mepenaueh sneprint, KutHeTHveckan skeprita panna nnoomnite mponane;enii Macc (Mn) IERYINerOCR OBeEKTA Na KeaapaT cKOPOCTH (Y). 1 xmetnrsecxas snepran = 1 (mx 7) Or Bac He rpeSyercn yatenna susxear®, cKonDKO ateprin Grin0 MepERaHO pH TpasMe, no Bot ORK YMeT onpenenHeTb, GsinO MH CTORKHOReHME HDTsKOSHepreTiedecKinn (OAH apronoGuim sanesaer ApyTolt Ha napKoDk) sk wBteoKoDHepreT#tNecKHOX MpONCMeCTDHEN (aptowoGune spesaerer m jepeso pu ckopocts 64 a/sac), Popmyzta npHtBene, sTOGM [MONNepKIYTB, TO Ha KOnI4eCTBO SHeprHN Gombe BAAeT CKOPOCTD, HEAENM Macca, HeGonuioe ynemesente ckopocts muisinaer snasarrensioe ynenmene Koniecraa nepe- ‘apaenoit sHeprim. Tepesava axeprun nponcxogit no saKonan dussikxs NosTOMY moRpe DsKeNA CreayloT onperenentio saxoxomepHoctst (TaGn. 1-3). Same MEXAMDISMA TpaNdEL W ocosKanie cro RAKHOCTH HoMOraeT HaltTH y HOTEpERUIETO eXpHTAMe HlORPEAREHIA. Tiponoas ruyavemuoe oScrexonate noTepmesiero, Ha Harpanmente KOTOPOTO OKAaBIBAeTSRE es Do eer (Mexanname TpasMet ‘Tunwibie norenunanenie nospexaeHun 060i yap ‘+ operon weitoro oraena nocBoHowiN _AetPopunposanioe pynesoe Kaneoo cbrovayia rpyayoi xneTI ‘MRT! CT KoneH Ha. 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Trouauere, sro noreprtesuinte » sscoxooseprenseekix nponchiecrasiax Haxonaren 8 rpyme pitcxa niony vena Taoxena&x Tpass, Hecworps Ha HOPMa/LbuBle KSHEHIMe NOKaBaTeII, MW OTCyTCTBHE OveDIANNNX ANOTOMICECKIEX HONPEKAeHE pH HaYaNbwHO; olen, ¥ 5-15 5 ‘FAKNE MoTepneBMMNX Mose MpOABATEA NPHBHAKM THHKEAKX NOBPeKHeHM, KOTOPHIE {pe MosKxo Gyner neunbi np nosropusex ocMoTpax. Mak, BMCOKOSHEPreTIEcKoe pO uemectaue oGoanavaer coGolt orponnbit suGpoc MexoMrpompyenoN axeprint, KeAtor0 naupenra curraitre tpanympopaniie, noxa ne Gyget AoKasao nporunHoe Buxio ocosnars,snneTCs Mi Mexa¥oOM TpaBNt! Gu HK OKADA. OGupe MexaHiann, SAEEPHAILPaBMA-OewOrD x0por ‘kmovaior JITTI, najentte nbicorat ict. f. ToKarbitlte MexaHICMtH BAHRAIOT NomPex ent Noe OGcrexOdaiut ¢ronOES 30 iT, ompeneneunoix Yuacrkos Tea, Harp. HOXeBOe Palente B OGACTS KUBOTA IM AMY TAMU BAIMONAONeCs emhn wBiRAENA cronia, O6ue MexaubtaMet ypeGylor nponenenita GHICYPOFO YpaRsia-ocworpa ncerO Tend, —_onacin0e a nats spaswMecrunisi rpansia-oemorp o6cxe- Aonarive, npuwewsenoe np Nami oxaawioro ssexatntoa tpamsen 42x 1@0msposantioro nospescyests ‘OGeresosanne orpansseno o6racti ospexrer. crenents Hacropoxemocrst nena. aemuemumicrat eneuacTOM vanavina aaGonesanua surpass. Yy mauuesra, Bucoxan crenens wacto- oxcexttocru oGoanavaer, sro cyule- [ayer HWICOKAN BeponTHOTE Ham- ‘cus ypanans, Hakan crenea ace poxcenocri oGoanavaer, #70 picx amir rpasiat HK OUEHKA MECTA NPONCWECTEMS Toraa KAK IPH AOKAMBHBO MEXAHNaNAK MOKET NOHAAOGHTOCR TONDKO MecTHDIit TpaRMa- ocaorp, snnsouieecs orpastvennsst OGenenovansien NoopeATEHHHX YHOETKOB 1 CHCTEN. axrops, xoropaie HeoGxosnio paccorpers — 210 Hanpasiexsten cxopocTs BosnelicTBN, suieviea ovo x asavecke pasweps oTepuenilerO,@ TAKE MPHBHARE BELCDOSOIC- sa aueprint (nanp, ocHoouste xebopuaniat rpancnoprnoro cpexctea). OBnapyxena verxas aA» MExiy TAAECTHN TpaBMbH CKOPOCTHIO TPaskcToprioro cpeeTBa, ¥TO MOAHIO OTOC- Petonantio ones ro nospexneuas asToMOGKTA. Baxo NaitH OTBeTD Ka Ba BoMpoCe: “ro caywnnoce? Kaxwt paso nanyteu nonysin rpapns? Mexauna rpasnist — 910 nai mnctpysent copraposKi. Ox mpenocranner saiop- argo, Koropyio Bsr oGm3am cooSuVET» np MesIRIITHAL HeOTROMX coCTORRU out xupypry-tpaasaronory bpyesiHon oTaenenMu. CreneH HospeAeRI Tpaxcnoprior0 epejersa npeyuaraerea wenomssoaars xax uespanonorieveckut npusnax rpasits. HecKos13x0 ChunKOB NospexteHHOoro Tpaxcnoprnoro cpeacrna, EnenaKAMEE IpKhpoDok dporoxamepoi sa MecTe nposciecrBux, MoryTsoMOw nepcoHANy OTeNENK HEOTMOAHOA NOMOUIH OHeHITS enemy nsrcnoBonctentofi eprint, Basto MOCToAEHO YAYsUIATD CDOHSHAEDIA BOMPOCE -Mexanna3oB TPaBNBl, TO MoaponseT NOAePAUBATD BBICOKY/IO CTEMeM HACTOPORENMOCTHL Ju expureox nospeactensti Beerna pacewarpasaitre so3MoxHOCTD Hams OTeHMaMHSIX opperxemiti, oka OWN He GyAyT HeKMONeHID yenoBHsx Bomba MexaHv3mbi MexaHnyecknx nospexpeHui Mexanumecxite ronpexnensia — ocHosian npuriita cmepriocrs oT TpaBy 8 ape. B >To ‘ape omicausr nanGonee pacnpocrpavexsze wexawitas sexaHsiecxstxTpaaM, HeoGxomsNO Cconianars, sro amepris He cOsaeTCR K He WCve3aeT, a TOMDKO UsMeHReT CBO¥ GoPMY (3KDH coxpattents suepriss)- Coormetcrvettio, KNHeTHeCKaM aepria ABIOKENU ROWAUIA NOENO- rreca, Mitenso 9x2 nornonentas wepris 891ReTEH HABIBI XOMMOMENTON, BONAR ospeaxenne. Cyuectayor xpa octonintx Mexaniona MexaHHMeCKITX TpanM — TYNE H MpoHUKaOMIE (Ta6s. 1-4), xova y naurenra » ono 1 70 xe upens ory? Girt» nowpesten, wp19BaMHLE out wesaisawanit.B CUA ponixaioue KospexreHs sonsiores OcHoDH0! UPHSHION ocmrrameaivin wononbrx ayaciun. Ja cexexois mecrwocra CUA x 37 Mmpa ® wes0s (Ga npenenasan 301 Goenssx xeiicrani) masnoit npuuinton roemieranndauinK aBneTex'rpanssa ZryaBint mpessierox (rysaH panna). AopoxkHo-TpancnoptHbie nponcwectsnA Tlarrepiin nonpexcxenuit nenencrane cromknoneHult captomoGunsbts, MOTONUKTAN, ReaRe- ‘xomann (KeanpounKmanmn), rienponrKnasen % Tpaxtopanat otmwaTER. CoorseTeTREHHO, Bur AOMKIEN NpHNATS BO BHUIMANINe, "TO BCE TpanCHopriie CronKHOBENNA MpOHCKOMT ak Tp ongenbithnx co6srta (PHC. 1-1): + cronknonene rpartcnoprioro cpencrsa, + cronxionexne tena norepnesmero, + ctonkiosexue oyrpensix opraion, upimosyauiee «ux paspeisy espopmanyint PE ea Ce Ly ‘Tyne rpasmet Npomnxarowne Tpasies + pesxoe sawennerme now ABvAKeHNW enepen (comMvosexie) | + orHACTparuae paneNe + peaxoe seprimansioe sameanewie (nagene) * womesce panes ‘+ nepeaava sHeprn Tynan npeayeran(SoRcSaneKaR > paonwe na NenopsIOCe Ga, ayn) peawerasPricywox 1-1. Tpit cronktoseni npit TT: A) cronksoverie ToaxenopTvoro chencraa; 6) cToniiosetate Tena noTepnesiuero; B} CTONKHCBeHMe BAYTPEHHID OPraHOE (prorpagu © Mak C We) Pacemoxpun JITTI, npit koropoM anrouobun» Bpesaetes B jepeBo co ckopoctoto 64 xl. Cronxsionene c nepenow mpnnosinr k HeMenTeHHOt OcTaKOMKe ABTOMOGHINA C BUICBOGOKE- LneM 9Heprins, noopexnaiouel 1 xepeno, n avroMOGuiNb. Henouek, HaxosAicn B aBTOMO- Gu0Te, Bce ene AHIEKETER co CKOPOCTHIO 64 KM/, TOKA He OCTAHORHTEA MPH cTONKHONEHHL € HeroanioxnBNS npesMeTaMH (HaNp., PemeH GeaoTIaeHOCTH, PyeBOE KOHECO, BerpOBOE texto wit npHGopias avers). Bator MOMENT BUIReNeKKeR SHeprHtA MpHosHET K NoNpe 2KNEHNAM. TexAM MEMENTOS TpancHOprHOro cpexeTBa, OpraMth BUYTPH NeNOBEKA TAKE _Rpsoxyrrea Co ckopocto¥o 64 Kw/s, OKA He OCTAHORSTER, YAAPAACh O HEMOMRIORHSIC OB EXT (raxue kax siyrpentian nosepxnocrs wepena, rpyzuuta, pynesoe Koneco, npu6opHaa nawenD) ven arsounas kere HX chaaKu (WaKIp, AOpTa se aprepKensstof cpnsKe). B 3TOM MPH -Mepe (aBTOMOGHb versus NepeBO) HoHMaHLte MexaHtNa TPaBNI KaK peaKOro 3aMeTeHUA "Ups ypuvxeniss arepex (BHICOKODMepreTHECKOe MPONCUIECTANE) 8 COBOKYHIHOCTH€ BEICOKOH CTerteHbio HACTOPOKEMHOCTHE OMKHO BUISBATE OFECHOKOCHHOCTE BOIMOKHSIM HaMHICEM ‘TpamMt: Tpapma ronossl, NOBpexReHNE UIeIHOTO OTHeNA NOABOHONIKA, KOHTY3NA CePA, nio6as 1a 12 cMeprenvix tpannt rpy;Wo!t KneTKM (ceMepreADaA AIOKMHAy; NoRpeRseN onncanr » nape 6), nospexenta oprasios OprouHOMt NOMOCTA H CkeNeTHO-MEIMLESIME ‘pants (ocoeuo nepenomts 1 nbiBHX TaaoGenpertioro cycrana). Yrobu oGwacnutT», Kaxwe cwb TyT AeMtcTByIOT, paccmoTpM nepsoil axon HioTOHA: ween ‘Ha Teno He eHicTAYIOT CHITA HEMH HX FeiCTRHe CKOMMeNICApORAHO, TO RaHWoe Tex0 MpeOInaeT 3 COCTORKIIHOKOM WK paBHOMepHorO NpaMOniNefiHOro wNrKeHEAY.[euPxeHINE CoMaeTER ‘cmon (o6MeHoM sHeprit). M TaKHM Ke OBpasoN cota OcraNaNMHBaer ARICKEH. Femi 9TOT ‘oGnen sMepriteh mieeT MecTO B TeZE YenOBEKa, MpoNcXoMMT Noupexstene TKaxtef. [pute cTomknonesis anromo6ita Xopoiio Kntmoctpmpyer mepnisit saKor Hesorona, Kumteritaeckas ovepriia ABIDKEIMA TpaxcnoprHoro cpencTHa BiePeN NOCNOUIRETEH, KAK TOMDKO KEAN ero 4acTh pHexanio OcTakannnpaerea pH cronkwonetns, ToMnere, eT0 Teno HaxORAIIeTOCR ‘B canowte wenoneKa TaIKe ADYEKETCA CO CKOPOCTBIO G4 KM)" BIELOTH No OCTAHOBKIC BeNeACTBMEsropnaneie Pucynox 1-2. Bropsuniie cronkHoseHn® sonencrave peaxoro samennenis npu TTI. B arom onysae [eaynkTaroN aTopHoro CTonkHOReHIIR SENATOR CAABNHBAHME PeGeHKA MENA HE NDMCTETHyTIM TeNOM ‘maTepi v pynestim Konecon, ‘yaapa o muyrpenuue siemens asromoGus. Ionuwanse 97or0 Mexanusnia nosmOnaeT mes ‘BuN{eTD MHOrve HOTeMLUFamPHDIe TpasN ITosMutTe o creRyOMLEX MOMCKASKAX: + nehopwanwcrpasicnoprnoro cpeteria (yxasnisaior Ha sanefictmoBaMuase cima — o6seH ‘ueprief), + nebopmanonc Seca cnyer? (yxaanisaor aera, © Koropnie ynapnitca norepnes- unit — o6 ex oneprieit), + monpexenentix (netbopxatyi) sin xapakrepHinie tpanvent y norepneninero (ykaannator 1a To, KAKI acTaMM Te7a OH YAApIATCA). Kpome tpex ynommnytanx shite, MoryT npoxsoftrH onommrTenbubte cronKHOBeHHM [pen ‘Merit n anroMo6sine (kita, cyMkn, 6arax, 8 TaIOKE APYTHE HACCAAMPH) MOTYT KAK CHAAAEL, [ABIDKYUNLECH C TOF -Ke CKOPOETHI, 110 H ABTOMOGHIM, HAKECTH NOBPERMEHHK AION, HAXO- ads nepen Hind, Taki cromxoneHNA NanbiRao BropwNBi Harsh MpHMEpOM. MoxeT Gott cityaun, B KOTOpO He mpuctérayrati naccaxnp nepast peSeuKa Ha KONERAS cmp peakow aantejemut m MoMeHT CroMODeHA CRanAABAeT PeBeHKA MEY CBONM TETOM. sempuBopxo# naxensi0 (Puc. 1-2). {px asrowoGunbHom cronkHoseNmH ¢ MaesnOM C3aqM MOFYT METH MecrO MHOTOKPATHBE CTonkHOBeHIIA, Kora aBTOMOGIIM HaHOCHT YRap APYTOMY ABTOMOGITIN CHAIN, HB CBO ovepene nonytaer yrap oT asromo6ucna, cnenyrontero 3a Kut, Tawke, TpaxcTopTHMle cpenCTEA, rocae yAapa C ORHHM OF KEKTOM HACTO MeKMHOT HAMpADMEHNe ADIOKENHA H CTANKMBAIOTCR YKE apynist jee Tpersi TpanciopTHDin cpeacTHOM, Hn € KenoRBIEANB:M OG EKTOM. ITOT Mexarmam noxoxs Ha J{TTI ¢ nepenopatnarinent, Tax KaK MONHt B TpaxcmoprHom cpemcTBe rnonnepratorca jeiicraino amepraatc pasmiesimax nampannesit, Lacto B TAKHK CTY"ARX CHOAO "NpenBHeT? BOSMOKHAE TpanNi. HeoGxosHIMO GEICTPO, HO TILATENDHO, MeKATD TORCKASKH. ity pi tpantcnopriioro cpesicraa, Tote, 170 pi MHOTOKpATHBIX CTONKHOREHIAX TORK Geaonacnocr saupamaet TonDKO OF NepBoro Ynapa. Cymecrayior pasmisanste opyst tpantcnoprianx cronkHonentt 1 KOKNOR H3 MIX cnoiicT= ‘eH onpemeneHie TarrepHbi HospeRIENHT. HloKe ripuBeneH HATS KanGonee pactipo- crpanentianx Gop tpattcnoprinsx cromHonestk + noGonoe cronkHonente, + Goxonoe cromuosenme,+ cromuosenne ¢ naesnow csaa, + cromosenme c nepesopasunaniien, ‘+ cromosenne ¢ spauenest (soxpyr neprukanbuot OCH) MloGosoe cronkHoBeHue Tipu {ATI c noGoxbin cronkHowentiem He mpucrérnyroe pemtimn Beaonac- HOCTH Teno siesaMHO Mpexpamaer jwrKeHHe. Tlepejasa aneprin cnocobHa nexaoarb aniorouncnedtbie Hoapexstenits, Tania or BetpoROTO cteK/a BOSKHKAKTT pK pesKOM TOPMOREHN, MPH KOTO Pom He mpuicrérHyrotii Nenovex ¢ cHtMO; YAapaeTcR oO neTPoDOE CTEKNO (Phe. 1-3), Ipy Tako mexaniame BeposTiocts Nowpexeniit oxeHb Rena. Obparue ocoG0e BHUMAKHE Ha HOIMOXHOCTH cepResHAtK NoRpERReNMi AoaxarenDuDsx nyTefi K meiHorO OTHe:Ia TOIBOKONHIEKA. Tlowais o 1pex orgenbnix cronxnonentiax, o6parire nitimanie Ha enenyromce: PMGYHOK 1-3. Tipit no}o8oM cTankHoseHnA ansuicTen nospexyen nprsnsiores eerposiaa (cTekNOW, pyres KaNECOM HF NpHOpHOnaENBIO + cronxntonense Tena notepnenmero — snayritar Ha pasGwrrox wexposom (Tura mateswo rpegneasne Nara Dyno, rex, Shuto ‘+ cronkwonenme rpauicnopruoro cpegcraa — xehopymponatiiaa nepex- + cromkuoneuse nuyrpeumux opraion — nonpexyeniin wosra no Tay «ykap-nporussoyaap», rpanMst MarkuAx TKaKet (cKaNIL, AHO, wea), nepe- asrnGaxne/cruGanme mieiiHoro o1jena nosHoHOYMNKa. ‘sTlayriay a nerponos crexne 1 onpenenente MexaHtNMa TPARAEM ROMDKHIS! nBIaRAT nIcoxyo cteteHs HacToposeHHOCTH KACaTENSHO BOAMOKHBIX CRIT HOBpEAEH e- oro orjexa noanoniosiun. Tonona o6nKNO YaapxeTex 0 ReTpoROE cTEKNO, FO MpHRORUET x enocpeacrsennoitrpanwarisauin nya x ro708e, Buea nPHaKAKH Tabs BKMOMANTT eG nopeass, ccamvart m yusn6is. OXY MoryT RUIERAeT Kpatte Apaseario, Te ne Menee, Xetowennno 349aHH43MH AMAAIOTER NOAEPAKA MPOXOAUNOCEH AMATENBHX HYTet CO CTa um2anmes metoro ovtena noakoKONIAKa H OXeHKa YpoBtt coatan. ‘panna or pynesoro xoneca vaule scero setpevaiorea y He mpuerérayrax powrenet input noGon0x cronkuioveus rpautenopruoro eperctsa. Bogsren Moker nnocteReTRIt yhapuersct 0 wetponioe crexzo. [Li we npuicréruytoro nomyrera pynenoe Koneco —9T0 cabiaa emepronocnas acto TpaHcHoprioro cpejcrsa, H so6as creseNb jesbopmalthn pyienoro xoreca (ochorpure ero Hog cayameiicn noxyunkof GesonacioctH) OnE Bia3bEBaT BLICO- yo nacropoxenoct KacareMHO TpasM tha, lle PYRO! KATA 1 OPIOUINOR HOTOCTHL Pynenoe xoneco cocrour ns Komi pynenoi xonoutat (Puc. 1-4). Konno —a10 nlomypxect- ag, Moxps1Tan nmacTiKoM MeTaymsCueckas OkPYAMOCTD, pIRPENACHHAN K HeNOABIEHOMY necruGaenomy crox6y, no cyt urparomesty pom Tapani. Vecnonosyx xonennino tpofivor cronxHovensi, nposepsre Hartuse exexyroueo: + cromknonenme rpanenoprioro cpexcrna — muurre aedopmaiyeo nepexuiel sacri ‘rpanciropruoro cpeacrsa, + cromkHosenue Texa norepnesutero — nponeppre pynepoe Koneco Ha nanos wa jedbopwanysio KOnBIa, H Ha 1iOG0e cMeeHKe Pynenort KONOHKH, — smurte rparataseckyio Taryuposky + cronknonenue muyrpenuux oprastor (oumpernannvo) wa xoxe norepnesiiero. Tpansinl NH nOGOBOM CTONKHOREKIEN HoAHOCTHWO aaBNKEAT OF MacTHE Tena, KOTOpaN cramnipaeten € pyreBhM KOnecoM, NpHGOPHOH awe! WM pyrun sneMenTami mutreppepa tpaxcnoprioro cpencrsa. IIpuanaks Tpanst Moryr Gurr saMerHis cpaay (nenocpencrnennas rpasnarisaivcs), Nanp. pak pax pra noxGopoaka, yisi6si/ reNaTows Ha nepesnefi oGnacrH mest, ‘panwarisieckie Taryuponkit na nepewe ronepx- NocTH rpynvofl xneTKst 1 TewaTomts a Koxe xunoTa. Hexoropne BHemIHie mpiaaxn PMCYHOK 1-4, ToBpeKseHA oF pynenorD MOryT GuITb Ha BHM. eNBa SaMeTHBIMH, HH, HAOGOPOT, APaMaTINNHEAM, HO, To Gonee —KONECAFRABA1 — OWEHKA MECTA nPoMcwECTEHA ‘nospexens or yaapa 0 npHEOpHyIO nave aBTOMOGHA ) ponent! ‘Besonacnoeny ‘pap anya ‘Tpaswe! wer Pucynox 1-5. Mlosperyenus or npuGopHol raves ako, OWN MOryr MpexcTaRast® namin Repxyuiny aiicBepra. Bonee rmyGoxute Crpyerypae W oprant MoryT Ooirb cKpOITo NOBPEAACHB BCNCACTENE AEHCTBH CHBMEALOUNEX CHL, CABD- nwa cia, a TaKOKE NepeMentene KuNLeTHeCKOM aneprHM, Opran, npuxpesttennie a conaxax — pyra aoprh, neve, cenedenKa, NOSKH m KaMHIeS- ink — nocnpisasunnst x cARITAKONIAM KlOBPEAAEHIEM. 3a HCKTHONEHIEM paspsina TORKOTO ome, 9TH NORPERACHIR ABAAIOTCR HCTONADNNOM CKPHTHX KPOBOTEMCHICA I reMOp- paritiecxoro moxa. Cyannusarouute Noapexxenitx Xapaxrepast AUX nersits, cepaua, nad para x movenoro Myabipa, BAKU CHAEHTOM — MAIxATeMEHAR HEOCTATOMHOCTS, KOTOPA Monker Gir» cnexcrBiiem yumn6a nerKoro, meBMoTopaKca, AMlaparManbHofi rpHDKGt (SBYKIE nepucraznie nag pyawom knerKost 1 dpnoraui spy kere, Fipu rewarosax crenxi _pyaviof xaevxs enenyet nogespenar’ KOlryaiio MHOKapsa, tO TpebyeT MoMDETOpIOATA cep esworo pirsta x, eenh ect nosweniocT, perucrpasuic IKI m 12 orneneni. logos ror, pynenoe Koneco — s70 eweprenbito onacnag Wacth Tpaxtcnopuoro cpencras, ‘enoco6iias npiuniats nospex ens, sorve us KoropHrX kansIeTCs cKpsrTM, JeopeaNNs pystevoro xonleca — aro rpevoxaistl npyostak, Honsuuatouuilk creren Bauiesi 1actopo:xetiHo- cH, O6 aos o6mxarentato HeoGxomuso cooBulirs Npasy NpeMHOFO OFAENEHIE. Tlospenxgeuvs or yaapa 0 npuGopryio nanlenb anromoGiinx ame Rcero KacaHOTER He MpHt- crérnyrx naccascupon, Takive YAapH MpHBORAT K PaIMISHLIM TpaBMAN B aaBHINOCTH ‘or wacrH 1e1a, KovopoM Yaapuetea norepmenuuti, ale Acero 9r0 Tpasb mila i KoneHei; ‘omiaxo, onsicant enysauea apyrux tpapyt (Prt 1-5).TRABA1 — OWEHKA MECTA nPoMcwEcTERA Comacio Kontlerupi rpofinoro ctonkwosenua, o6parire sunarase Ha: + cromuonenne rpancnopioro cpencrpa — novpexseuia nepenuell ac, + cromuopenne Tera norepesmiero —nporom/xedopmauyix npxGopuo nasens, + cromonenue nuyrpemmrx opranon — pants mia, rpanMs Moara no sexannascy “yaap-npotsoygap», nepepasraGantelcruGanue WeiHoro OrAea HosBOHOUNIEKG, "pannth tava, Gestpennnsx KOcTeH i KOR. ‘pany auua, Mosra n mesinioro oTAena NosBOMONAMKa yx yromuHasMce, Kax w mpH yuINGE "pyawofi xeren, tpana Konena Moxker Gur «nepxyuncoh alicGeprar. Konews Yacto yaapa- 1oTca B MpuGopHyio navens, Tpassea morker Gurr paswofi texectM — HaYHHAH OT NPOCTOrO yuuiGa sanepuian cioxHiNM TepetoMoM KoneHHON YaueuKst, TaIoKe MUOr|A BOSHIKAET BIBHX KonleHa. KpoMe Toro, KUMeTHYECKaR SNeprHLA MOAT GHITD NepenHA AAMBIU, RBIABI- as nepenom Geapentiolt KOCTIC Hin Nepenon/auBHX Tasobexpennoro cycrana, Vora oTepresumnit woxer yRapuToca 0 MpuGopuyio naHens razoM, WO TIpABORUIT K epenOMy asa, B 1. 4 H Hepetomy BepLAyARHON sagan. STH TPaBMeL CHAsAMB! CO IHALMTENBHDAI BHYTPeMHDMN KPOBOTeveHAH, H KAK cHesIETIE — c moKOM. Coxpanite BBICOKYHO Cre- Nei HactopoxenHocrH, 1 Hceta nponOUsTe HamenauyHO Geapemuste KOcTeM, OcrOpOxHOE Se eMIKaTHOe CKaTHE TaSa H MaLTETTAKHO TOMIOTO couneMeHIE. Peskoe TopMOKENE YaCTO CONPOBOKILETEH BTOPUNHEIM CTOAKHOREIIEAN ¢ CIEAAIIPE aqui naccaxmpantn nan mpeaseTana us saquei Yacru rpaxccnopruoro cpenctoa. 97H yaapo Moryr HanecrH cMeprenbuble tpannt Boxosoe cronkHopenne Boxosoe cromknosennte noxoxe 1a noCoRoe, ¢ AOGannexten nepena 9ueprit 8 GoKOHON vanponstenn (Puc. 1-6), Cornacto wouter tposintoro cronKuonenti, mere enenytowyee + cronkHosenue rpancnopruoro cpegcra — munsre neponcamste jeopMaui TpaHc- opruoro cpejicrHa; Mposepsre, ¢ Kako cropoHt HacTyMHT Yaap — co croporss nowt: ‘ren wit naccaxknpa, + cronxuonenne texa norepnesmero — onpesemure creneus jeopmaine jnepi (Hamp, auepusie nomOKOTHMKHL, HapyKHOe HIM RAYTpeHHee RGyKate Rep H), + cronkHoneHMe BHYTPeHHNX Opraton — HeBOSMOKHO MpeRBHAETs HoBpEReHLE Ha OCHOBAHHM Hapy2HOHO- non. O6paritre niwanite Ha To, “To ONpeneneMHBIe HoBpERTEKHA MOH MpEABHRETE, 4 ollewka nospacra norepmientiero i oKPY-xaoIleh OBCTaOBKH MOIYT YKABMBATD Ma RPYPHE nepoxtiste rpannii. B cnyasx, Koma Y NoTepnenmero ecr» conyTersyrowse saGonenaHHs (amp. nmaGer, cepaewno-cocyancrate s2Gonceanint, xpoHnieckat O6CTPYRTHEHAA GOTESHE ‘nerkitx), 1 OF prnewaer nekaperoa (Hamp. avimHKoarynaWrH), oxaaaiite oMONK HOTep- Heputenty yonoxcHserca n Tpebyet KOMIeNcHOTO MomXONa. STH HAGMOREHILE MeCTA POH IneermWA naPKH LA MpaBMABHOrO jlAMHeAILeTO MeNeNNA H ROAM GuIT Mepenan BPAsy ompenenita 1eotmOxWO} ONOUN. HecuactHpie cny4a np paGore Ha TpakTope [pyroe Gonsiuce woropHsosaniioe tpatenoprivce cpescrs, KoTOpoe HeOGxogmiMO sHars cttacarenio— ato tpaxtop. Bo bce miipe oxon0 50% woex HecHCTHIX cay aes 8 cenbcKOM xosailerne enasain ¢ onpoxsgianantien Tpaxtopa. Exeronto raxxe onyya npuaoNeT xc rent oxon0 200 wenonex » CUA m Katlage, n rucamam cuepret supe. Xora Gonee nosute maxenn Tpaxtopos oGOpyROBAN cTeManin SesONsCHOCTH, TaRMOON AK SERDTTa or nepesopassaim (rollover protection sytem — ROPS), y unorwx craputx mogeneh raxite cucrems oteyrersyor. {ZMsa ocuosiesx tuna tpaxropos — sanenpumoainte u nonHonpusomune. B oGoux ranax LeNTp Tmxectu rpanchopraoro cpecTsa HaxonHTEA BHCOKO, M TOSTOMY Taxie TpaKropa ‘en onporuasisacres (Pwe. 1-14), Bonsimaicrno ueceactnac: cnywacs co Cucprexatt wexanoM npoutcxogar s pesymrare oupornassania c npunsenvnannen popurena.B 6ons- susutcTae cnysaes rpaxrop onporasissctea naGox (8556); pn aToM BeposTHOcT> NpAsas- TMBaEA BoRMTena Howe, ak KaX y wero CCTs mlaHe BUMpHArHyTS ux Ours BNOpoLENN tpaxropa, Onpoxsgstbanin wasan cryunorcn perce, Xo BepOnTHOCTS TOTO, #70 BORNTENDSrnABA4 OUENKA MECTA nPonCWECTBMA onager # yonymky w Byer Mpuaanien — mosie, Tax KaK y HeTO MONTH Her BOSMOKHOCTH Tlepansinnit sexasnsw tpanyent — cnanacnne, Tixkecr® Tpasnat aapicut or Toro, Kaka act» Tena ctaneva. JJonomntrensiiie Mexau¥aMi — 3To XHNEHYECKITE OH OT BetsHta, JAUBOABNOTO TOIMAEA, CHAPABINIMECKOH AUTKOCTHL H ABKE OF KUCHOTSA 4a AKKYMYTATOPR, Cayuatorca taxke Tepwarveckie OXON OF HarpeTsX Yacrelt ABNTateNR Wat BOSTOPAHA Tommi, H nocnesuee, rpasnnposauntt nomtTens MoxeT JULTeMbHOe BPEMA HAXONTDCA Ges nomoupt, ect oM/oxa paGoran opt Heormoxne meponpustiia: oGesomacitTs MecTo npowcuiectoHa, Gesormararen>no nposecrit epBitsieoth OCMOTP pecycuMTaIpOKHIIe MeponpHATH. CaeAyIOULKE BOTOCH HCMOAKSY- vores Kak HeK-mMcT mpi yeranounessnr GesonacHocTH Mecta mpowcmtecTsst + Burxmowen aac apurarens? + SaGnoxnponaint au sane xoneca? + Bern mm yreuxa Tormmisa, yrposa nocnnasenenia? + Bern nm yresxa rnapannneckoi ainAKocTa mi akHIKOCTH 3 pajwmaropa? Tloxa omy cnacarem, ocvarpisaet nauetTa, Apyrue cnacaten pornkisa craGWaSNposT® "panvop.[lepea tes, ak mpeg Kayo 80 ROMMIKY MpNOAWATTPaKTOp, HeOGLOsHMO ompejenins ero yertp naxecta. Llp texecra pacionoxcelt npxGasitenbno Ka 25 eM we 1 wa 60 cat xiepeny OF Zanmeti Oc 8 3anmenpHtPOAKON TpaKTOPe, H TprasepHO TOcepeADEAE — ‘ aontompospos rpaxope ‘axe Kax tparoptc Ohio oUpoaUmbaIoTER Ha MATKOM EpYHTE, OUPeseATE NEHA TKECT Moxker 631m eno, HoaToMy TpaKrop Heo6xomuiao NOsEHMaTS O¥eKTs OcTOpAKHO, "106 soGexars ovepevean npmanmimarat Yeurnsnan Hee TpaxTopa w OGHrIHO ATED BpeD aannens, Moxso oncurarecepteamiccrpann Yactoy NOTePMEBILeTO MORE BUCHOGOAAENA I~ no ect rpaxropo pasnnaerea THxeTIA OK, TAK KAK KPonbTOETYnGeT H pane pHAaAMERHSLe sacra teaa, Kex tps apyrcespanaxco chatentew, Neen Yerpaietten Mpsasnitpa Heo6- sospimo oGecremn newosmn rytrramsone Gonhuoro mvaeTpa, Tak KaK NOCKE HSAKE ANIA nnoreprienarero y era wexer paanutsca rumorowsas, Eom masgtets 68 B AOBYLKE TENN penny neroliee Moar pasBitTscx CHHApOM smATeMSHOrO caaBeHIK (xPau-cHHApON). Mro6e Gxicrpo 1 Genonacno melicrsopars Mpit NecHacTHBIX cnYuARK, COMDAHBIE c paGoTO sv Tpaxrope, Opnrajans, EpOMe YMeig KAECTBeRANO OKAAHIKETE NOMOMD MPH TPARNE, NEOGROSHONO odyenite no romseMy Tapers NANI, Mpovcwectena c manbimu TpancnopTHEiMn cpeactsamn Tipyrne mannie rpattcnopranie cpercrna, nportcmectnitn ¢ KOTOpENMIKTIoMaNaIOT 8 KaTETOpIND TIT, nkmoxayor 8 ce6x worounke, keagpoune (ATV), rHapounnsat (PWC) 1 eHeroxont Bomueremn inc samme HHCYeAC He ae, ROMEO Ke, He MpuIcTerty as. Eon nomHTEND obepracren 10G0B0My Win GoKonOMy cTOAKHOBENHANG Haeany CHAK, NepeBoparHAsO, {Fo eqinFicTRenTsNA CMOCOBAMH 3aNITE AORALOTEA MAHERPH YRTONENIA, SAMUTHAR OROKAA (6-74, mien, KoxkaHian one BOTKIEKH) i NOTMOMENE KiMeTICeCKOM stepriat tpaKc- opr cpegcraom (namp., cKonIAKEHHe Ha MOTONDKEAC). 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Keaapounknet (all-terrain vehicle — ATV) Knanpowsns cosnananvcs KaK Tpane: ‘noprie epencrna jrix mpoesna no nepeceténHoR MectHOcTs. TlepnonaNato OHM HCTOME- aonannce wnaxensuans depm, panso oxorunKanin. K cOxANEWIL, MOTE MoM BOCMPI ator wx Kak Goicrpoxominte MIpyiKy. Heocropoxkioe H Hempaninnitoe MpHMeHenne BaApOWUKTOB MpXBe7O K MOCTOAKNHO YeenuKBaWUteic TPABNATHSALNKM M EMEPTHOCTH, or necuacrusrx enysaen — stro 0co60 rpycrHo, NacTo cpeNt over NoTOAX mozeit. YnoTpe- Gnewie ankorons Hepeako SRAKETEA NONONUFTENDABI aKFOPOM B ITI NPOHCIeCTRIA Jiwa Gasonnix msaiina ATV — sesnexonix tpaxcnoprHarx cpercrs — Tpexxonecrie (Gonme ne npowsnogsrca H nootowy penne) i sernipexxonecmiie. Yersipexkonecttt ‘otsaitn oGecriesnimaer pasyMnyio CraGNADNOCTH H YipaRAKeMOCTD, B-TO BpEN KAK TPEXKO mectioe nessfexonHoe TPAHEOPTHOE cPeNCTBO 149-98 BBICOKO PACHONORCHHOTO WeHTP THRE- crm cknonno x ompokHAEIaKINO MPH Peskur Monoporax. Hipxe nepewutcnen HanGonce ‘tacrive mexaHnsneod TpaBM: + onporanuinanne rpancnopruoro cpeacts + nnagenue soxuetens naw naccaxupa, + peakoe saMemmenne cKopocr# qiCKeNNA BORUTeNA BCnegCTEMe CToMKOBeHKHA Tpaste- oprvoro epesicnsa c HenioqasCAHNIM OGBEKTOM, + nospexnenua men no Tuny «rpanmir Genseuott nepenia (clothesline injuries), #70 mpi [SORIT K THAKEOMY MapyilleHiNO MpOxOMIMOCTH sxATENDHIIX My TENE Tlonyyermiie nonpexcjenis saniert or mexanvaa rpani x nopaxenuork vacrit tena, Cayeiie ‘MACTWe TpABhtd — 970 TleperoMBL, MOTORHHa M3 KOTOPHIX pHXOMIETE Ha REPXIHON YACTD ‘ena sue sgadparmns, 1 MoToBHHEA — Hoke AMadparmes. OcHOBHATE HOnpExeNts KoCTeH xacaores Known, rpyAMMDL u peGep. HeoGxonnMo TawKe TmaTeNSHO HEKATH MpUSHaKH ‘TpanM rononMt it NoaBOHOAHNKA. Fnapouwnnes (personal watercraft — PWC) licnomsonanme rqporsnenon, taxis ax Jet Skit, Sea-Doo", wan WaveRunner* crano nontynspuol opmoit axrusKoro Orasxa ria noge. B CITA dpynxiwonupyior Gonee Munniiona ryqpomicxon. To zansiim Beperonoft ‘oxpanst CUA 8 2006 roay 8 24 % Bcex mponcuectaiti, cAszaHRAKX c mancpexcran, qurypuponant oxpur sian Gonee rumpouitenon. B Kanmbopnun (CHIA) ruxpowwKnst coctasnmor 16 % Bcex saperncrpHpoRAHHN HnaBcpeACTS, HO C HINDI cBABaHO 55% eEX ‘pane. Tpanwarvsatnis, TpeSyouan rocmramaarin, na nyApouaKTAX 9 8,5 pas mame, exenit Ha MoTOpHBIE NONKAX B CIA o6iyee Konmecrno HecHacTHMX Eay'aeD, NeTaNMHUEE KexOAOB, TPARM BIIIIE ‘npw ncnomss0paMH OTAPHITENX MoTOpHBX OOK. B 10 °K RPEMA, ACTOTA /leTaDHEX MeXoNOM Mt TpaNMt HHiMle MH HCMOTISOBAKIEN rHyAPOUKOD, TAK KAK Y HHEX nbHNe MpOULeAT HeCIACTHX cny¥aeR, NO cPaRHeHNWO C KOIINECTROM SaperitcTpHPORAKHDIX IIARCPEACTR (oro cxonHo ¢ caryanntel, HostNKAIOMeH MPH cpanHeHA YACTOTM TPARMATHSALUMM MEY ‘Maunsiayi 4 Moromtnxnassn). YaorpeGnensse anxorons na Boxe sHasHITeNHO TloBHAaeT puCK HeCHACTHMX CAY4ACH H EFAADHEAX HEXOROR [expowexa cnpoexrupovau raxvis O6pas0N, 10 HM MoxkHO yupanMAT> CHA, cTOH Mn crOR sua Konetiax, upisi€t 3a BomUeNeM MOLY HAXOWATKCA OM AH Goable NACEKHIPOB, CHA- ox apy se apyrons, Fipowikx moxker 6sierpo pasornarbca Jo iicoKOM eKOPOCTE pit 2T0M Y wero Her aGconoTHo HnkaIGIX TopNosHnx MexaHSI08, KaK i MOTONMKAD, IMpOURAS he oGecnewinaior HiKaxoi sauueTH nompETemO YH naccaxxupadt. BombuNIICTHO TpaDM camvanis co CTOKHOBEHHANUFHNPONVKNa, KaK € NPYFMN HNAREPEACTRADI, TAK H C NCHOR- swxunsnan OGyexTaNst, Hamp. CnpHCTaHAMON HM HLM AependeD. BorounsucrH NecHacTHaNK caytaen npoucxoxNT 1-24 HenHLINATeNBNOCTH RONTEAA, e70 HEOMTHOCTH 1 OMIKGOX. Ocosewmocrs rujpousKa m TOM, NTO OH MpHBORHTER m jDOKEH 3a CHET NOTOKA DOR su1Gpacsisaenoro M13 ABHFATEAK, A pH BAAOYEHHOM ABHTATENE YIPaBAT CHAPOUPHEAOM nnenoowoxrio. 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Ont» we, span GyAyT 9aBuCeTb OF TOTO, KaKAA HACT esa Ga nopaxexa, HeoGxojva(o nomHiCTs 0 BoaNaAHo' conytereyrowe ramorepaao Hacroe nowpe- 2xvlese TPH MenONBAORAHEIE CHerOxORA — wBHCETBIMEK® WAM «rpanwa Genbenof nepeRts» — nysaoutcecs mpu mpoesae 19 uproot sa60pON,[ToMHITe © EKPHITHX HoRPeAREMIAS 1uefinoro omena noanowoika 30 PHEKE HapyHLEMAK MpOxOANHOCTH ABLATED Ty eh Tpasmel newexopos Haesq anrooGiina Ha newlexoja Wowk aceraa aaKasonmacten cepbeauBinnt rpansanct BHYtpenKINX opravion it repenowasN KOCTel, KE NPM WLAKOR eKOPOCTH TPaxcnoprHora cpenctea, Tak KaK Macca abTOMOBHINA HACTONBKO BENHIKa, HTO Y>KE HeGOMULOH cKOpOCTH ocraToxHo, TOU BhLaAaTD HbICONOSHEepreTaecKyW TPaRNy. HaesA Nps BCOKOH CKOPOCTHA ‘kavacrpoduryen 8 cboux noctexcrBitax. Paaruvaior ma CusizanWnx Mexay cobOm MexaxntaMa Tam, Tepeinnrt — Korma Ganutep arrowtoGinna yaapser etexona, x BtOpihii — KoORa Teno, noxysIamie Yexopente WRENCH te epenasu aepres, yaapatewexo Sevtno st KaKolt-aNGo ATO O6 eR. Bypoctive 06H nRonysaior aByeTopoHtte Tepenowst roneHek WOE KONeH, a TakeKe PasMiNble BTOPUMHNE “panna, Kora velo yaapaeven © Kaslor awroMOGiLN Mt 3ateM o aeMD,FlerHE IINKE PocTOM, nosromy Gasmep ymapser ix & ras 11% rynosmue. Lpts oxBpacbipamor oF npasicnoprHore cpescrna ners o61e%N0 YAapmoren © aesinw ronowos (wropuasan rpansa), Knaccittecxiit "pasnanmveckiit nartepH ounicad ak xpuana Youxenna (Waddells Triad) — Ganmep up ‘unniaer nepenowsi Ge"penviof KocTi Suu asa, PeGeNOK Hony'iaer YRaP 8 rpy;anyO KETKY _xpoinon 11 Ky20B0M sToMo6iias, a TaRKe HORyaAeT Yepenvo-MosrOBylo TpABMy NPA Yzape © noporxuioe Hoxpuimve, Hoxoxnit narrepm naGniaxaeren HY BEpOcKUAX, HO noxamHBaLHA ‘noapescaeiil sapsipyer B anitcuMtocrs o7 asicorst norepneauiero,[Tpmieas B81208 ta j{TTI ‘cHaesOM a HeMIeXOja, GynbTe FOTORN K HepenoMaM KoCTei, 1paBMaM BHYTPEHHIX OpraKos 2 vepensto-Noarosiam zpaasast Nagenua c BpicoThl ‘Mexarntaa rpanseat nips nasieniit ¢ neicorat — 970 neprunxamioe sameqmene. 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Kaxaa vacrs Tena Goina nopaxcna?FRABA1 — OWEHKA MECTA nPoMCWECTBMA ipa J{ TT onpenensce dbopmy cronkwoneniia mn ocmotpicre auyrpentte u sews noHpe- 2xneHMA TpanicoprKoro cpencrEa. Tipu necwacrunix caywanx na TpaxTopax HeoOxONHINO CO HCewN MepaNH nPeROCTOPONOCT cTaGiuusnpoBATe NaMLHY, HTOGEI MPegOTSpArHtTs MoMyYeHKe BrOpHNHBIX TpaBM. Novep- nenuuns. [pn naennax ¢ BHcoTs HeoGxoAAMO OMEN, € KAKOIt BUICOTH HacTyNItnO THajenne, Ha KaKyIo HOBePxHOCTS M KAKO HacTHIO Tena ynapwrcs MoTepresmni. pH KONO “rmix panax RaxHO YsHarb, KANO‘ jUMHM GhIMO eBBHe MOK KAKHM Yr/IOM HaweceHK past Tipu ornecrpenbutsx panennax narkia mubopmanier o Tame opyxsis, KanKGpe pacctos- i, ¢ Koroporo Guim caenau muicrpen. Hudopyaniia 0 Tom, 10 crys oruociter K BuicoKoDHeprerieckiO (Hamp, nazeHHe € BHCOTH, CTOMKHOReHMe TpaLicHOprHBK cperCTA), TAKKE BHATIA JUIN BpAta OTHE ‘eormoxKno nonoupe, [lo npHOSITHM w GoNbiIELY Bpasty OMeNeHA HeoTAOKHO! rOMOUE {ani xpypry-tpasntaronory KpoMe micbMeHHOrO OTeTA HEOGKOANMO NPEAOCTABIETH TAIOKE yrmuik panopr. Braroaps oroit nribopsamgior H muicoxoit crertenn MactopaxeHHOCTHL Bu moxcere aan Baulemy naywerry HaxSombuntt anc Ha Ropxtnasee BuGnvorpacus Almogy G. Mintz ¥, Zamir Gi wep Suicide bombing stacks can external signs predet interna) injuries? Ann, Sarg 2006: 243 (4): $41-46 ‘Alson RL, Paterson WI: Access ra on scene — rapid vehicle enty provider anual. TLS, Downers Grove, 2006 American Academy of Pediatrics, Commitee on Injury and Poison Prevention: Peranal watercraft se by children and adolescents Petrie 2000; 105 (2): 452-453 BrinsildK. i wep: Bombings: injury patterns and cate curriculums, Course offered by the American Collegeof Emergency Physicians (ACEP) and the Centers fr Disease Cottl and Prevention (CDC) Information page accesred December 27,2014, t wewaceporpblstijary! ‘Campbell LE, Prefer Ws Kagel A TLS military. TLS, Downers Grove tl, 2014 Campbell, Smith J: Tncendiaries and explosives ne Homeland security and emergency medical response, McGraw-Hill, New York 2008117-139 De Haven H: Mechanical analysis of survival nfl from heights fifty to one hundred and fit fet. Injury Prev, 200; 6 (1): 62-68, Jacob L, Borns KJ: "the Harford consensus to improve survivability in mas casually events proces to policy Am. J. Disaster Med, 20149 (1): 67-71 Newgird CD, Martens KA, Lyons EM: Crash scene photography in motor vehicle crashes without airbag deployment. Acad. Emerg, Md, 2002 9 (9): 924-909, Sochor M, Althoff 8, Bose D. i wap Gas intact asures safe cervical spine protocol J. Emerg. Med 201s a4 Ge ea1-636 Wightman JM, Glas SLs Explosions and blast injures. Ann, Emerg, Med, 2001; 37 (6): 661-678OueHKa CocTosHnA notTepneswero nocne TpaBMbI Jopn E. Campbell, MD, FACEP doh T, Stevens, NREMT- Laon Charpentier, EMT-P Alexancra Charpentier, NREMT-P Reconocimiento Pimario. Baarie wstgpne Pian progied Primami Pregled —-Valutaione Primaria Enquéto Pimsire Schnell Taurauntersuchung eM pal primarn pregied Els6 attekintés Uenu Kniovesbie cnosa - Nocne osHakomnenna c STOW rnaBoii YuTaTenb anaunes SAMPLE, o> ane AVPU, Geicrpbili Tpasma-ocMoTp, ©’ sTopHunei ITLS-ocmorp, 1. HageaTe avant! OusHKi M1 UsHaNaMsHOrO neNeHHA oTepnesuiero Noone TPABMe) 2. 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