Ministry of Health of Ukraine

Ukrainian Medical stomatological Academy

It is ratified
On meeting department
Of accident aid and military medicine
«___»_____________20___г.
Protocol №______
Manager of department
DMSc., assistant professor _____________ К.Shepitko

METHODICAL INSTRUCTION
FOR INDEPENDENT WORK OF STUDENTS
DURING PREPARATIONS FOR THE PRACTICAL LESSON

Educational discipline «Emergency First Aid»

Module № 1 Emergency and Combat First Aid
Topic 4 Types of Combat and Non-combat
Injuries. First Aid in Wounds, Fractures,
Lyxations and Strains.
Types of damage in combat and non-
Lesson 7 combatconditions.premedical care for
wounds,
fractures,dislocations,sprains.Premedical
care for wounds.
Сourse ІІ
Foreing students training dentistry
Faculty

Training of specialists of the second (master) level of higher of education

(название уровня высшего образования)
Areas of knowledge _______ 22 «Health protection»_________
(шифр и название области знаний)
Specialty ________222 «Medicine»________
(код и наименование специальности)

Poltava 2019
 Relevance of the topic:
Damages today occupy the 3rd place in the structure of mortality after cardiovascular
diseases and malignant neoplasms and come out on top as the cause of disability of
young people. During military operations and natural disasters, the frequency of injuries
increases sharply, which is defined by the concept of “traumatic epidemic”. The
provision of first aid to a patient with an injury belongs to the professional duty of a
doctor of any profile. However, untimely or incorrect tactics of first aid for a patient with
a fracture can lead to the development of complications.
Specific objectives:
Learn to recognize injuries of the upper and lower extremities, carry out transport
immobilization by various methods, and also deal with pain shock.
Basic knowledge, skills needed to study the topic (interdisciplinary integration):
Name of previous disciplines Acquired skills
1. human anatomy Anatomy of the head and neck, anatomy of
the chest, abdomen, pelvis and limbs.
Vascular system anatomy.
2. Normal physiology Anatomy of the head and neck, anatomy of
the chest, abdomen, pelvis and limbs.
Vascular system anatomy

Tasks for independent work in preparation for the lesson and in the lesson:
1. Anatomical features of the musculoskeletal system.
2. Types of limb injuries (sprains, dislocations, fractures: open and closed), causes and
signs.
3. Absolute signs of fractures.
4. Transport immobilization by personnel and adapted means.
5. The provision of medical care for open fractures ..
6. Pain, causes, scale of pain.
7. The fight against pain shock.

The list of basic terms, parameters, characteristics that a student must learn in
preparation for the lesson:

Термин Определение
1. Sprain damage to ligaments, muscles, tendons and
other tissues without violating their
anatomical integrity. Muscle tension most
often occurs as a result of a stroke or an
unsuccessful step when a person stumbles.
persistent shift of the articular surfaces of
2. Dislocation (luxatio) the ends of the bones beyond their
anatomical integrity and physiological
 mobility, causing impaired joint function.
Signs of a dislocation are: pain in the joint,
deformation of its contours, impaired joint
function, with palpation, an empty articular
fossa with a change in the shape of the joint
is determined, violation of the integrity of
the bone.

The main signs of a fracture include: pain,

swelling, hemorrhage, the appearance of
3. Fracture (fractura) abnormal mobility in the area of the
fracture, deformation of the bone or limb,
shortening of the limb due to displacement
of fragments, the inability to move in full.
With incomplete fractures of one of the two
bones of the forearm or lower leg, some of
the listed symptoms may be absent. With
open fractures in the wound, the ends of the
fragments are often visible. Large bone
fractures and open fractures are often
complicated by the development of
traumatic shock due to pain and blood loss.

this ensures the immobility of the bones at

4. Immobilization the fracture site. Real estate at the fracture
site is achieved by applying special tires or
improvised means and fixing the two
nearest joints (above and below the fracture
site).

The advantages of the stair rail are that

5. Stair tires (Cramer) they are well-modeled. Using this quality,
you can fix the limb in any position. The
second positive property of tires is the
versatility of the design. With their help,
you can immobilize any segment, any
damage. The disadvantage of the staircase
tire is that before applying them, it is
necessary to wrap them with soft material
in order to prevent pressure sores. It is
advisable to sheathe the tire with oilcloth
on top of the soft material, which will allow
for the sanitary treatment of used tires.

Theoretical questions for the lesson:

1. The cause and symptoms of injuries to the head, spine and pelvis.
2. Types of limb injuries (fractures: open and closed, sprains, dislocations of joints),
causes and signs.
 3. Absolute signs of fractures.
4. Features of the provision of medical care for open fractures. 5. Transport
immobilization by personnel and adapted means. 6. The tactics of actions and the
provision of medical assistance by a lifeguard in a traffic accident.

Practical work (tasks) that are performed in class:

  1. Carry out transport immobilization in case of damage to the upper limb with
improvised and time-related means.
  2. Carry out transport immobilization in case of damage to the lower limb by personnel
or improvised means.

The content of the topic:

Stretching - damage to ligaments, muscles, tendons and other tissues without violating
their anatomical integrity.
Muscle tension most often occurs as a result of a stroke or an unsuccessful step when a
person stumbles. Signs of muscle strain are sudden sharp pain, hemorrhage. On
palpation of such muscles, a depression, soreness is felt. Sprain can lead to tearing of its
individual fibers with hemorrhage in the thickness. Joint pain during movement,
swelling of the ligaments are noted.

Domestic stretch relief:

Apply cold to the damaged area, then apply a tight dressing. It is better to use an elastic
bandage for this. If you suspect a rupture, as well as if the pain and swelling do not go
away, consult a doctor, since in such cases it is often necessary to resort to surgery,
especially among athletes.

Dislocation (luxatio) - a persistent displacement of the articular surfaces of the ends of

the bones beyond their anatomical integrity and physiological mobility, causing a
violation of the function of the joint. Signs of dislocation are: pain in the joint,
deformation of its contours, impaired joint function, with palpation, an empty articular
fossa with a change in the shape of the joint is determined. In such cases, an objective
examination of the injured joint should be carried out in parallel with a similar
symmetrical joint, comparing their sizes and outlines.
The causes of traumatic dislocation are as follows:
- indirect trauma, when the place of application of force is distant from the damaged
joint (when falling on the arm of an outstretched arm there is a dislocation in the shoulder
joint);
- a sharp contraction of the muscles causes the movement of the articular surfaces, which
go beyond the normal mobility of the joint (for example, dislocation of the lower jaw
with too active yawning);
- much less often dislocations arise from direct injury - a blow to the joint.

First aid for dislocations:

1. Immobilization of a damaged limb with a scarf, tire, etc.
2. Cold on the affected area.
3. If you have a first-aid kit, you need to use painkillers.
 4. You should not independently correct the dislocation or try to provide a brush of
natural position! Exercise of the articular ends with subsequent immobilization is carried
out only by a doctor, immediately after a diagnosis is established.

Fracture (fractura) - violation of the integrity of the bone.

1. Depending on the cause of the fracture, the latter are classified into:
1.1. Traumatic - caused by external mechanical or physical stress.
1.1.1.Gunnel - fractures resulting from exposure to a bullet or shell fragment. They are
characterized by crushing of bones into large and small fragments, crushing of soft
tissues of the body at the fracture sites and tearing of parts of the limb.
1.2. Pathological - arising with minimal external impact or physiological movements
due to bone destruction by the pathological process (tuberculosis, tumors, osteomyelitis,
dystrophic disorders).

2 .Most common fractures are divided into:

Complete fractures without displacement of fragments;
- with displacement of fragments.
Incomplete: cracks and damages.

3.According to the shape and direction of fracture of the latter are divided into:
1 .Transverse fracture - the fracture line while perpendicular to the axis of tubular bones.
2. Longitudinal fractures - the fracture line is relatively parallel to the axis of tubular
bones.
3 .Oblique fractures - the fracture line runs at an acute angle to the axis of the tubular
bones.
4 .Spiral fractures that involve the rotation of bone fragments.
5. Comminuted fractures in which there is no single line of fracture, and the bone at the
injury site is divided into separate fragments.
6 .Wedge-shaped fractures in which one bone is inserted into another, forming a wedge-
shaped deformation; such fractures often occur in fractures of the spine.
7 .Impacted fractures, where the bone fragments are displaced proximally along the axis
of the tubular bone or remain outside the main plane of the cancellous bone.
8. Compression fractures, in which there are broken small bone fragments, without a
clear, single line of fracture.

4. The integrity of the skin:

1. Closed fractures, which are not accompanied by wounds to tissues relating to the
fracture site, and injured bones are not combined with the external environment.
2. Open bone fractures, in which soft tissue injuries occur, and damaged bones come into
contact with the external environment.
5. For possible complications, fractures are divided into:
1. Complicated fractures: traumatic shock, damage to internal organs, bleeding, fat
embolism, wound infection, osteomyelitis, sepsis, complication of burns of various
origins and radiation damage is possible.
2. Uncomplicated fractures.

The main signs of a fracture include:

 pain, swelling, hemorrhage, the appearance of abnormal mobility in the area of the
fracture, deformation of the bone or limb, shortening of the limb due to displacement of
fragments, the inability to move in full. With incomplete fractures of one of the two
bones of the forearm or lower leg, some of the listed symptoms may be absent. With
open fractures in the wound, the ends of the fragments are often visible. Large bone
fractures and open fractures are often complicated by the development of traumatic shock
due to pain and blood loss. In case of doubt about the correctness of the diagnosis, it is
better to provide assistance, as with fractures.

Closed fracture help algorithm.

1. Anesthetize by i / m or s / c administration of pain medication. If they are in the
medicine cabinet; local anesthesia of the fracture zone can be done by administering
novocaine or lidocaine.
2. Immobilize and isolate the fracture site, preventing the victim from moving.
3. Reassure the victim.
4. To put the tire on the damaged place, using any improvised means. 5. If the tire is
properly applied, you can try to raise the damaged limb above body level to avoid
swelling.

First aid algorithm for open fractures.

1. Anesthetize with appropriate drugs.
2. Stop bleeding by applying a tourniquet or dressing.
3. Cover the injured area with a sterile dressing or bandage.
4. Ensure the real estate of the injured area and minimize the movement of the victim.
5. Carry out immobilization. Transport immobilization by personnel and adapted means.

Immobilization is the provision of immobility of the bones at the fracture site. The
immobility at the fracture site is achieved by applying special tires or improvised means
and fixing the two nearest joints (above and below the fracture site). Such
immobilization is called transport. It reduces pain and prevents the occurrence of shock.
The purpose of transport immobilization is to ensure the immobility of the damage zone
for the period of the victim's evacuation to the medical institution where he will receive
full treatment.

Transport immobilization aims at prevention:

- shock;
- secondary tissue damage;
- secondary bleeding;
- infectious complications of wounds.

Indications for transport immobilization are:

- massive soft tissue damage;
burns;
of frostbite;
- compartment syndrome;
- damage to blood vessels;
- damage to nerve trunks;
- damage to bones;
- damage of joints.

Rules imposing transport tires:

1. Transport immobilization should be done as early as possible since the injury.
2. Vehicle tires must ensure the immobilization of the at least two adjacent joints in
addition to the damaged segment of the limb. Three joint needs to be immobilized when
damage to the hip (hip, knee, ankle joints) and shoulder (shoulder, elbow and wrist
joints).
3. When immobilization of the limb should be possible to provide sredneaziatskoi
position, and if this is not possible, when a limb less injured.
4. Transport bus superimposed on top of clothing and shoes. On the one hand, it allows to
avoid additional injury of the damaged segment while undressing the victim, and on the
other hand, clothes or shoes act as additional spacers between the skin and the tires.
5. The bus must be hotmodelforu to the imposition. To model the tires on the patient is
unacceptable, because it leads to gross injury of the damaged segment, significantly
increases the pain.
6. Fractures before applying the Shuttle bus, you need to make a slight elongation of the
limb with correction of the axis of the latter. In most cases this allows to reduce the
displacement of bone fragments and thereby weakening the pressure on the surrounding
soft tissue. In open fractures do not, since the traction from the wound contaminated
debris "leave" under the soft tissue, further infecting the wound.
7. To prevent bedsores bus, if necessary, before applying must be wrapped with soft
material, and over bony prominences should be imposed strip of gauze or cotton wool.
8. In winter, the immobilized limb should further insulate.

Means of transport immobilization can be personnel (standard tires) or improvised and

meet the following requirements:
1. Ensure reliable immobilization of the damaged organ or limb.
2. If possible, ensure the fixation of the damaged limb in a functionally advantageous
position.
3. To be easy to use, since they have to be applied in difficult conditions.
4. Be portable.
5. To be inexpensive to manufacture. Even in the isolation period of catastrophes, it is
desirable to carry out transport immobilization using time cards: standard transport tires,
specially designed and adapted for the full immobilization of a particular segment.

The personnel types of tires:

Stair of the bus (Kramer's) have their advantages and disadvantages. The advantages of
stair tires is that they are well modeled. Using this quality, it is possible to fix the limb in
any position. The second positive feature of the tire is the versatility of the design. With
their help it is possible to conduct the immobilization of any segment, any damage. The
disadvantage of the ladder of tyre is that before applying they need to wrap a soft material
to prevent bedsores. Preferably on top of a soft material to cover the tire with oilcloth,
which will produce sanitary handling of used tires.
Bast tires are cheap, portable, but not modeled. Using these tires, it is possible to carry
out immobilization of any limb segment, but only in a straight position.
Mesh tyres are made of thin wire and wound in a roll, like a bandage. They are suitable
for immobilization of small bones e.g. of the foot or hand.
Bus Diterihs - the only just set "Shuttle bus" that allows for better immobilization to
produce and extract damaged feet. Bus Diterihs consists of four parts: two sliding bars
(internal and external), soles of podshipniki and twist stick and cord. Direct indications
for the splint of Diterihs is damage to the hip joint, knee joint and femur. Splinting of
Diterihs when damaged lower leg is not an error, but given their limited number and the
duration of the overlay, in injuries of the tibia is better to use other tires. Pneumatic tires
they look like double contour bandage with closure-snake. The kit contains splint for
immobilization of any limb segment. To immobilize the injured limb placed on a splint,
then a snake fastened, and the tire is inflated with air from the mouth, or using
compressed gas cylinders. The disadvantage of these tires is that they can be easily
damaged with the loss of the immobilization properties.

Vacuum tires are filled with granules.

In order for such a tire to obtain immobilization properties, it is necessary, on the
contrary, to pump air out of it. In the absence of personnel, immobilization can be
carried out by improvised means using any items (tree branches, sticks, boards, boards,
doors, cardboard, plywood, etc.) that allow, if not fully, at least partially to comply with
the above rules. In the absence of improvised means, the so-called autoimmobilization
should be used. The essence of the latter is that a damaged upper limb with gauze
bandages or a scarf is fixed to the body, and a damaged lower limb is fixed to a healthy
leg.

In injuries of the skull bones.

To prevent further damage and concussions of the head immobilization is carried out
with the help of cotton-gauze, inflatable backing circles or utility vehicles (blanket,
clothes, hay, and bags with sand or earth etc.) by creating a cushion of them around the
head. Immobilization of the head can be performed with the sling bandage, held under the
chin and fixed to a stretcher. If the head wound is located in the occipital region or the
fracture is in this zone, you need to carry the victim on their side. Patients with such
injuries very often there is vomiting, so they have to be constantly monitored to prevent
asphyxiation on vomit.

In injuries of the spine.

Spinal injuries often happen when falling from a height, straight and strong blow in the
back (autotravi). Fractures of the cervical spine are often observed when hitting the
bottom when diving. Fracture of the spine - especially severe trauma. Its characteristics is
a very strong pain in the back even with a slight movement attempts. When spinal
fracture and possible spinal cord injury (rupture, compression), which is manifested by
paralysis of the limbs (lack of mobility) and conductive disorders of sensitivity. Fractures
of the spine, even a small displacement of the vertebrae can cause rupture of the spinal
cord, that's why it is strictly forbidden to put or to put on feet of the victim. First of all we
must create conditions for complete immobilization. The purpose of immobilization in
injuries of the spine is the elimination of the ability to move the patient, namely: damaged
vertebrae, reducing pressure on the spine and a reliable fixation of the site of damage.
Transporting such a patient is dangerous because misaligned vertebrae can injure the
spinal cord. To transport such victims needed to be on a solid stretcher (Board, Board,
door). In cases of transporting the patient in the supine position with bandages fixed with
both hands on the torso, and the legs in the knee and ankle joints.
Fractures of the vertebrae of the thoracic or upper lumbar vertebrae, the patient should be
transported on a stretcher in position on the abdomen, tucked under the chest and head
pillow or clothes. In the case of a fracture of the cervical spine transportation spending on
the back with the immobilization of the head, as in injuries of the skull. Under the neck
the victim enclose the cushion of the clothes. In such cases it is advisable fixation to the
elbow. After the imposition of such tyres they tied below and above the fracture to the
humerus, and the forearm is hung on the headscarf.
In injuries of the forearm is necessary to exclude the movement in the elbow and the
beam-carpal joints. For immobilization use of a ladder splint or a splint made from
improvised means. The tire is superimposed on the outer surface of the hands, bent at a
right angle. It privinchivayut to the forearm, which hung with scarves.
In case of damage of the beam-carpal joint and wrist the splint is wrapped with cotton, is
imposed from the ends of the fingers to the elbow on the Palmar surface of the hands.
With significant damage to the tire is applied also on the back surface. Brushes have a
physiological position, and in the palm of the patient is placed dense cushion.

With damage to the lower extremities.

Reliable immobilization for hip injuries should be considered such when three joints are
involved and the splint goes from the inguinal cavity to the foot. Convenient to use is the
Diterichs tire, which provides the necessary conditions - fixing and traction at the same
time. This splint is used for hip and lower leg fractures at all levels. Successfully use the
Cramer stair tires. Two of them are connected longitudinally, fixed from the inguinal
cavity to the edge of the foot, taking into account its bend on the inner arches of the foot,
the third tire is placed from the gluteal fold to the tips of the fingers. Extensively used
makeshift tires. During transport immobilization of the lower leg (fracture), the knee and
ankle joints are fixed. For proper tire application, it is necessary that the assistant lifts the
lower leg by the heel and, supposedly removing the boot, gently pulls it out. Then the
tire from the external and internal sides is bandaged to the damaged limb. It is possible,
using one ladder tire, to impose on the back surface of the leg from the gluteal fold to the
foot with a bend on it. Such a tire is previously bent in the form of physiological bends
of the leg.

With damage to the pelvis. A pelvic fracture is one of the most severe bone injuries,
which is often accompanied by damage to internal organs and severe shock. It is caused
by falling from a height, squeezing, direct strong blows. A sign of injury is a very sharp
pain in the pelvic area with a slight movement and a change in position of the victim. In
case of fractures of the pelvic bones, it is impossible to immobilize with the help of tires,
therefore, the patient must be placed on a flat firm surface (shield, doors), the legs bent at
the knee and hip joints, the hips slightly apart (the frog position), put a tight roller from
the pillow under the knees blankets, coats, hay, etc. 25-30 cm high. Tie to this surface.

With fractures of the ribs. Fractures of the ribs occur with strong direct blows to the
chest, squeezing, falling from a height, etc. For fractures of the ribs, sharp pains in the
fracture area are characteristic, which intensify with breathing, coughing, and a change in
body position. The sharp edges of the fragments may damage the lungs with the
subsequent development of pneumothorax and internal pleural bleeding. First aid
consists in the immobilization of the ribs, which is done by applying a tight circular
bandage to the chest. In the absence of a bandage, you can use a towel, a sheet for this.
The most painless transportation to the hospital must be carried out, having rendered the
victim a sitting position.

Materials for self-control:

TESTS:
1. How to transport a victim with a broken pelvis?
1. on back with head lowered;
2. on the side with a bent lower extremity;
3. * on the back with legs bent at the knees, the hip joints that are deployed outside legs;
4. on back with legs bent at the knees and hip joints;
5. on my stomach.

2. How to transport the victim unconscious (coma)?

1. on the side;
2. * on her back with her head turned to the side;
3. on her stomach with her head turned to the side;
4. in polusidya position;
5. in a standing position.

3. Injured shoulder, the victim is evacuated:

1. walk;
2. lying down with a cushion on the healthy side;
3. lying on the back ;
4. * in a seated position;
5. on my stomach.

4. The absolute signs of fracture are:

1. bleeding, shock, skin lesions, pain;
2. pain, bleeding, skin damage, deformation of the limb, shortening of the limb;
3. * deformity of the limb, shortening of the limb, crunching at the site of fracture,
abnormal mobility;
4. pain, bleeding, unconsciousness, swelling, abnormal mobility, crispy;
5. swelling, pain, bleeding, deformity of limbs, inability to move the limb.

5. Bus Diterihs (for transport immobilization) is:

1. 2 lot of boards, spin, leg-piece;
2. 2 crutches, cane, leg-piece;
3. * external, internal, crutches, twist, plantar section;
4. 3 lot of boards, wand, shoulder straps, twist;
5. 3 lot of boards, crutches, straps.

6. In the case of the syndrome of the prolonged compression in the presence of crushed
tissues is performed:
1. rubbing of extremities, heat;
2. immobilization limbs, cold;
3. * tourniquet, immobilization of the limb;
4. rubbing limbs, limb immobilization;
5. immobilization of a limb, imposing a twist.
7. With an open fracture of the upper third of the arm with arterial bleeding after overlay
harness transport immobilization is carried out:
1. from the ends of the fingers to the shoulder joint;
2. from wrist joint to the shoulder joint;
3. * from the ends of the fingers to the spine;
4. from the radiocarpal joint to the spine;
5. from fingers to shoulder a healthy side.

8. The victim, T., 35 years, cherz 30 minutes rushed to the emergency ward of the
hospital after a road traffic accident. During the inspection the doctor established: severe
subcutaneous emphysema on the neck, face and right half of the chest. The skin of the
face and mucous membranes cyanotic. Veins of the neck are strained. Palpation of the
chest on the right is clearly defined crepitus bone fragments. Breathing right is not
listening. What kind of damage you can think of in this case?
1. * fractured ribs and closed pneumothorax;
2. fracture of the ribs;
3.open pneumothorax;
4. chest trauma;
5. closed pneumothorax.

9. After falling victim K., felt pain in the upper half of the chest, function the top of the
brush is broken in the region of the clavicle noticeable distortion. Type of damage?
1. * a fracture of a clavicle;
2. fracture of the humerus;
3. dislocated shoulder joint;
4. closed injury of the chest;
5. closed pneumothorax.

10. Male 60 L., fell on the designated right hand, the pain, the bleeding, the wound
visible bone fragments. What measures of first aid?
1. * anesthesia, bandaging, immobilization of the limb;
2. apply the bandage;
3. surgical treatment;
4. exercises bone fractures, bandaging;
5. to be hospitalized in a medical facility.

Литература

Основная литература:

1. Материалы подготовки до практических занятий.

2. Домедична допомога (алгоритми, маніпуляції): Методичний посібник /
В.О.Крилюк, В.Д.Юрченко, А.А.Гудима [та ін.] – К.: НВП “Інтерсервіс”, 2014. - 84
с.

Дополнительная литература:

1. Стандарт підготовки І-СТ-3: Підготовка військовослужбовця з тактичної

медицини (видання 2). К: “МП Леся”, 2015. – 148 с.
2. Електронна версія Стандарту підготовки І-СТ-3: Підготовка військовослужбовця
з тактичної медицини (видання 2) – http://www.medsanbat. info/standart-pidgotovki-i-
st-3-vidannya-2-pidgotovka-viyskovosluzhbovtsya-z-taktichnoyi-meditsini/ (назва з
екрану).
3. Видео сюжети:
www.youtube.com/playlist?list=PLGVZyDkrMM_QrjemyQ5j56G8sQolHsYoG

Guidelines prepared by
PhD in medical sciences A. Levkov