Report on the topic “Transport immobilization. Main types". Limb immobilization. Immobilization splints

In case of fractures and significant damage to soft tissues, immobilization must be used before transportation in order to create rest for the damaged part of the body, reduce pain, prevent further tissue damage (bone fragments), and also to prevent traumatic shock. The following types of transport immobilization are distinguished:

1) primitive immobilization, when healthy parts of the patient’s body are used. For example, if a leg is injured, it is bandaged to the other, healthy leg. Damaged hand bandaged to the body;
2) immobilization using improvised means. As such means, you can use a stick, a piece of board, a bundle of twigs or straw, etc.;
3) immobilization with transport tires prepared in advance at the factory.
Transport splints are divided into two groups - fixation and distraction.
Fixation splints. With the help of these splints, fixation (immobility) of the damaged part of the body is created. There are several types of fixation splints.
Kramer's splint, or ladder splint, is made of soft wire (Fig. 86).
Rice. 86. Kramer tire.

The splint can be given any shape necessary to immobilize a particular area of ​​the body.
A mesh splint, or Filberg splint, is a mesh made of soft wire. Easily rolls up. It is mainly used to immobilize the forearm, hand and foot.
Plywood tires are most often made in the form of a splint (gutter). Convenient for immobilizing the forearm and lower leg.
Distraction splints. Of this group of tires, the most widely used is the Dieterichs tire. It consists of four parts: plantar 3, outer (large size) 1, inner 2 and a twist stick with a cord 4 (Fig. 87). Used for injuries of the lower limb and hip joint.
When applied transport tires a number of rules must be followed. In addition to the damaged area, the splint must fix two adjacent joints. When immobilizing, rough manipulations should be performed. The victim’s clothes are not removed, and a bandage is applied only to the damaged area. The tire is covered with special cotton-gauze pads.



Applying a ladder splint. First, the splint is modeled according to the area of ​​the body on which it will be applied. So, at a fracture humerus the splint should start from the inner edge of the scapula of the healthy side, go along outer surface half bent in elbow joint of the adducted hand and end, slightly protruding beyond the fingertips (Fig. 88). If the forearm is damaged, the upper level of the splint is the middle third of the shoulder, the lower level is the ends of the fingers. If the neck is damaged, a kind of helmet is made from ladder splints: one is bent in the frontal plane along the contour of the head and both shoulder girdles, the other in the sagittal plane along the contour of the head, neck and back. The splints are tied together, covered with cotton-gauze pads and fixed to the head and both shoulder girdles (Fig. 89). If the shin is damaged, it is better to fix it on three sides: one splint is modeled according to back surface lower legs and feet from the tips of the fingers to the middle third of the thigh, the other two are fixed on the sides of the lower leg (outer and inner), and their plantar part is bent in the form of a stirrup for more durable fixation of the ankle joint (Fig. 90).



Application of a Dieterichs splint. The plantar part of the splint is fixed with a bandage to the plantar surface of the foot. The outer (external crutch) longer part is moved apart and secured in such a way that it starts from the armpit and, inserted into a metal spring in the plantar part, protrudes beyond it by 8-10 cm. Inner part The splint (inner crutch) is prepared in such a way that it rests on the groin and passes through the metal eyelet of the plantar part, protruding 8-10 cm beyond it. The end (hinge) part is bent at an angle of 90° and inserted into a special groove at the end of the outer part of the splint . The splint is fixed on the limb with circular strokes of the bandage. At the top, the outer part of the tire is secured with two belts. Using a twist stick, pull on the plantar part of the splint (Fig. 91).
Transportation of victims. Usually transportation is organized by the middle medical staff. When transporting a patient, care must be taken to With damaged area of ​​the body. All work is done quickly, clearly, but without unnecessary haste. Nurses must unquestioningly follow the instructions of nursing staff.
There are several types of transportation of the victim.
Movement With support for the patient is provided if his condition allows. The victim’s arm is thrown behind the helper’s neck and held by the hand (Fig. 92).
Carrying by hand. The victim is picked up: one hand covers the body, the other is placed under the knees, the patient wraps his hand around the neck of the helping person (Fig. 93).
Carrying on your back. The victim is on the helper’s back and holds his shoulders with his hands. The helper supports the patient by the lower third of the thighs with his own hands (Fig. 94).
Carrying by two persons using a “lock”. The four arms are folded in the form of a “lock” (Fig. 95). Each of the orderlies wraps his left hand around his right wrist, and the right one - left wrist another orderly. The patient sits down on this “seat” and grabs the orderlies by the shoulders (Fig. 96).
Carrying the patient in a semi-sitting position. One of the orderlies grabs the victim from behind under his arms, and the other stands between the patient’s legs and takes his thighs under his arms (Fig. 97).
Carrying on a stretcher. A stretcher is most convenient for carrying a patient (Fig. 98). They are available in the emergency room of all hospitals, at emergency stations medical care and in ambulances. You can make an improvised stretcher yourself. Depending on the type of injury, the patient on the stretcher is given the appropriate position.


1. The usual position of the patient is on his back, with his head slightly raised, upper and lower limbs extended. At fainting The patient's head should not be raised on the support.
2. If the head is wounded, the patient is placed on his back, but with an elevated top part body and head. A blanket folded into a trench is placed under the head (head fixation).
3. If the front of the neck and upper respiratory tract the patient is placed in a semi-sitting position with the head tilted forward so that the chin touches the chest.
4. When wounded in the chest, the patient is carried in a semi-sitting position or in a position on the wounded side.
5. If the abdomen is wounded, a position on the back with legs bent at the knees is indicated. For this purpose, a blanket rolled up in the form of a cushion is placed under the patient’s knees.
6. When closed damage spine and pelvis, the patient should be in a supine position; in case of open injuries, on the side or stomach.
7. If the upper extremities are damaged, the patient is in a supine position with some tilt healthy side. The forearm is placed on the chest or stomach.
8. If damaged lower limbs the patient lies on his back with the injured limb elevated on pillows.
When carrying a patient on a stretcher, one orderly stands at the head end, the other at the foot end. The orderlies put hanging straps on their shoulders, grab the handles and at the same time lift the stretcher with the patient. The patient should be moved carefully, without pushing. When ascending and descending With stairs must be preserved horizontal position sick. In this regard, accordingly, one of the orderlies raises the end of the stretcher, and the other lowers it.
Transportation of victims can be carried out on any transport, but subject to the maximum possible rest for the patient. Better conditions to transport victims, they are created in special ambulance vehicles, ambulance planes and helicopters.
Healing (consolidation) of fractures. Consolidation of fractures has a complex pathogenesis. In the fracture zone, phenomena of aseptic (microbial-free) inflammation always occur. In the fracture zone, serous impregnation of soft tissues and a local increase in temperature appear. In the first days, a general temperature reaction may be observed, sometimes reaching 38°C. The reason for the increase in temperature is the absorption of blood and cellular decay products. Depending on the location of the fracture, a primary bone callus appears in the first 2-3 weeks. The process of its formation involves the blood spilled during the fracture, periosteum, Haversian canals of the bone and endosteal cells. Depending on where the callus is predominantly formed from, the following types are distinguished: 1) endosteal - from endosteal cells; 2) interostial - from Haversian canals; 3) periosteal - from the periosteum; 4) paraosteal - from the surrounding soft tissues.


When a callus forms, a number of structural changes occur dynamically. First, a primary callus forms in the fracture zone. It is quite soft and cannot be detected radiographically. In the future, it differentiates well bone and lime salts are deposited - secondary bone callus appears. The latter is dense to the touch, firmly holds bone fragments, is significantly larger in size than the damaged area of ​​​​the bone and surrounds the bone fragments in the form of a cuff. Secondary callus is clearly visible radiographically. Subsequently, the excess callus resolves and the fracture may not be detected at all.

ABSTRACT

by discipline: Physical rehabilitation in traumatology and orthopedics

SUBJECT: « Transport immobilization»

Plan

1. Transport immobilization and its types

2. Means of immobilization and its basic principles

3. Transport immobilization for injuries to the neck, spine, pelvis

4. Transport immobilization for injuries of the upper and lower extremities

1 . Transport immobilization and her appearance s

The word “immobilization” means “immobility,” and immobilization refers to the creation of immobility (rest) of an injured part of the body.

Immobilization is used for bone fractures, damage to joints, nerves, extensive soft tissue damage, severe inflammatory processes in the extremities, injuries to large vessels and extensive burns. There are two types of immobilization: transport and therapeutic.

Transport immobilization, or immobilization during the delivery of the patient to the hospital, despite the fact that it is a temporary measure (from several hours to several days), has great importance both for the life of the victim and for the further course and outcome of the damage. Transport immobilization is carried out using special splints, splints made from scrap materials, and by applying bandages.

2. Means of immobilization and its basic principles

Transport splints are divided into fixing splints and those combining fixation with traction.

Of the fixing devices, the most common are plywood, wire-ladder, plank, and cardboard tires.

Those combining fixation with traction include the Thomas-Vinogradov and Dieterichs splints. When transporting over long distances, temporary plaster casts are also used.

Plywood splints are made from thin plywood and are used to immobilize the upper and lower extremities.

Wire bars (Kramer type) are made in two sizes (110x10 and 60x10 cm) from annealed steel wire and are shaped like a ladder. Thanks to the ability to give the tire any shape (modeling), low cost, lightness and strength, the stair tire has become widespread.

The mesh splint is made of soft thin wire, is well modeled, and portable, but insufficient strength limits its use.

The Dieterichs tire is designed Soviet surgeon MM. Dieterichs (1871–1941) for immobilization of the lower limb. Wooden tire, painted. IN Lately The tire is made of lightweight stainless metal.

A plaster cast is convenient because it can be made into any shape. Immobilization with this splint is especially convenient for injuries to the lower leg, forearm, and shoulder. The inconvenience is that when transporting in this tire, you need to wait time not only until it hardens, but also until it dries, especially in winter.

Since splints for transport immobilization are not always available at the scene of an incident, it is necessary to use improvised material or improvised splints. For this purpose, sticks, planks, pieces of plywood, cardboard, umbrellas, skis, tightly rolled clothes, etc. are used. You can also bandage the upper limb to the body, and the lower to the healthy leg - autoimmobilization.

The basic principles of transport immobilization are as follows.

1. The splint must cover two and sometimes three joints.

2. When immobilizing a limb, it is necessary, if possible, to give it an average physiological position, and if this is not possible, a position in which the limb is least injured.

3. In case of closed fractures, it is necessary to perform light and careful traction of the injured limb along the axis before the end of immobilization.

4. For open fractures, reduction of the fragments is not performed - a sterile bandage is applied and the limb is fixed in the position in which it is located.

5. There is no need to remove the victim’s clothes.

6.You cannot apply a hard splint directly to the body: you must place a soft bedding (cotton wool, hay, towel, etc.).

7. While transferring the patient from the stretcher, an assistant should hold the injured limb.

8. We must remember that improperly performed immobilization can cause harm as a result of additional trauma. So, insufficient immobilization closed fracture can turn it into an open one and thereby aggravate the injury and worsen its outcome.

3. Transport immobilization for injuries to the neck, spine, pelvis

Transport immobilization for neck injuries. Immobilization of the neck and head is carried out using a soft circle, a cotton-gauze bandage or a special Elansky transport splint

1. During immobilization with a soft pad, the victim is placed on a stretcher and tied to prevent movement. A cotton-gauze circle is placed on a soft mat, and the victim’s head is placed on the circle with the back of the head in the hole.

2.Immobilization cotton-gauze bandage“Shantz-type collar” can be performed if there is no difficulty breathing, vomiting, or agitation. The collar should rest against the occipital protuberance and both mastoid process, and from below rest on the chest. This eliminates lateral movements heads during transportation.

3. When immobilized with an Elansky splint, a more rigid fixation is provided. The tire is made of plywood and consists of two halves, fastened together with hinges. When unfolded, the splint reproduces the contours of the head and torso. In the upper part of the tire there is a recess for the back of the head, on the sides of which there are two semi-circular rollers made of oilcloth. The splint is attached with ribbons to the body and around the shoulders. A layer of cotton wool is applied to the splint.

Transport immobilization for spinal injuries. The purpose of immobilization in case of spinal injury is primarily to eliminate the mobility of the damaged vertebrae during transportation, unload the spine and securely fixate the damaged area.

Transporting a victim with vertebral damage always poses a risk of injury from the displaced vertebrae. spinal cord. Immobilization in case of damage to the lower thoracic and upper lumbar vertebrae is carried out on a stretcher in the position of the victim on his stomach with a pillow or rolled up clothing placed under the chest and head to unload the spine. If the stretcher is equipped as rigid (a board, plywood tires, a sheet of plywood, etc.), a blanket folded several times is placed on the marshmallow, and the victim is placed on it face up. An important point When transporting a patient with a spinal injury, it involves placing him on a stretcher, which should be performed by 3–4 people.

Transport immobilization for pelvic injury. Immobilization of bone injuries of the pelvis is a difficult task, since even involuntary movements of the lower extremities can cause displacement of fragments. For immobilization in case of damage to the pelvis, the victim is placed on a rigid stretcher, giving him a position with semi-bent and slightly apart limbs, which leads to muscle relaxation and pain reduction. A cushion (blanket, clothing, rolled up pillow, etc.) is placed under the knee joints.

4. Transport immobilization for injuries of the upper and lower extremities

Transport immobilization in case of injury shoulder girdle. When the collarbone and scapula are damaged, the main goal of immobilization is to create rest and eliminate the heaviness of the arm and shoulder girdle, which is achieved with the help of a scarf or special splints. Immobilization with a scarf is carried out by hanging the arm with a roller inserted into the axillary fossa.

Immobilization can be performed with a Deso-type bandage (see figure).

Transport immobilization for injuries chest. To immobilize the chest, especially with a fracture of the sternum and ribs, apply a pressure bandage made of gauze or sewn towels and place the victim in a semi-sitting position. Immobilization can also be achieved with an adhesive plaster.

Transport immobilization for injuries of the upper extremities. Shoulder injuries. For fractures of the humerus in the upper third, immobilization is carried out as follows: the arm is bent at the elbow joint at an acute angle so that the hand rests on the nipple of the opposite side. A cotton-gauze roll is placed in the armpit and bandaged across the chest to the healthy shoulder girdle. The forearm is suspended on a scarf, and the shoulder is fixed to the body with a bandage.

Immobilization with a ladder splint is performed for fractures of the diaphysis of the humerus. The ladder splint for immobilization is wrapped in cotton wool and modeled after the patient’s uninjured limb or healthy person the same height as the patient. The splint should fix three joints - the shoulder, elbow and wrist.

A cotton-gauze roll is placed into the armpit of the injured limb. The splint is fixed to the limb and torso with bandages. Sometimes the hand is suspended on a scarf. If the fracture is localized in the elbow joint, the splint should cover the shoulder and reach the metacarpophalangeal joints.

Immobilization with a plywood splint is carried out by applying it over inside shoulder and forearm. The splint is bandaged.

Forearm injuries. When immobilizing the forearm, it is necessary to turn off movements in the elbow and wrist joints. Immobilization is carried out with a ladder or mesh splint after it is curved with a groove and covered with a soft bedding. The splint is applied along the outer surface of the affected limb from the middle of the shoulder to the metacarpophalangeal joints. The elbow joint is bent at a right angle, the forearm is brought to an intermediate position between pronation and supination, the hand is slightly extended and brought to the abdomen. A thick roller is placed in the palm, a splint is bandaged to the limb and the hand is suspended on a scarf (see figure).

When immobilizing with a plywood splint, cotton wool must be used to prevent bedsores. To immobilize the forearm, you can use improvised material, observing the basic provisions to create immobility of the injured limb.

The outcome, treatment time and duration of disability due to injuries depend on the quality of first aid, including correct immobilization for bone fractures.

Immobilization– creation of immobility (rest) during various injuries or illness (or decreased mobility).

In addition to bone fractures, immobilization is used for injuries to joints, nerves, extensive soft tissue injuries, injuries to large vessels and extensive burns. There are two types of immobilization: transport and therapeutic. Transport immobilization– this is immobilization during the evacuation of the victim to a medical facility.

Transport immobilization contributes to prevention:

1 – gains pain, development of traumatic shock;

2 – the possibility of converting a closed fracture into an open one when soft tissues are damaged by bone fragments, incl. and skin;

3 – development of infection in the wound;

4 – possibility of bleeding if damaged blood vessels non-immobilized bone fragments and significant blood loss;

5 – damage to nerve trunks and sensory disturbances or motor function limbs;

6 – development of fat embolism as a result of blockage of a blood vessel by a drop of fat (including blood vessels in the brain, lungs, etc.).

Therapeutic immobilization is carried out for the entire period of treatment in specialized hospitals by specialist doctors: trauma surgeons, orthopedists, etc. First, the bone fragments are reduced, and then they are held in correct position(fixation) until union. Fixation is carried out using splints (most often plaster). Measures are also being taken to accelerate bone fusion; to increase the body's defenses; to prevent and combat infection in the wound; to normalize cardiovascular disorders, etc.

Means of transport immobilization. The main means of transport immobilization are various tires. Tires– these are devices designed to immobilize parts of the body in case of damage and diseases of bones, joints and soft tissues.

Transport tires are divided into splints, fixing splints and splints that combine fixation with traction (the latter includes the Diterichs splint). Tires are also divided into standard and improvised. TO standard include plywood, mesh, and wire ladder tires. Plywood piers (Fig. 15 a) consist of thin plywood and are used to immobilize the upper and lower extremities. A mesh splint (Fig. 15 b) is made of soft thin wire and is used to immobilize the bones of the hand and forearm.

Rice. 15

Wire ladder splints of the Kramer type come in two sizes: 120x11cm and 80x8cm and are used for fixing limbs and heads. As improvised tires, improvised materials are used: sticks, planks, pieces of plywood, umbrellas, skis, wooden blocks, shovels, bundles of brushwood, etc.

Transport immobilization rules:

1 – immobilization of the injured body part should be carried out, if possible, in early dates after injury;

2 – splints are applied at the scene of the incident, carrying the victim without immobilization is unacceptable;

3 – before applying a splint, the victim must be given an anesthetic;

4 – splints are usually applied over clothing and shoes;

5 – for open fractures, before applying a splint, apply a sterile bandage to the wound, and, if necessary, a tourniquet;

6 – you cannot apply a splint to a naked body; you must place soft material (cotton wool, a towel, etc.) under it;

7 – before applying a splint, the injured limb should be given a physiological position if possible;

8 – the splint should cover two joints (above and below the fracture), and for fractures of the shoulder and femur – three joints;

9 – a limb with a splint applied should be insulated in cold weather;

The purpose of transport immobilization is to prevent additional damage to tissues and organs, the development of shock when shifting and transporting the victim.

Indications for transport immobilization:

Transport immobilization rules:

If mobilization is improper, displacement of fragments during transfer and transportation can turn a closed fracture into an open one; moving fragments can damage vital parts. important organs- large vessels, nerves, brain and spinal cord, internal organs chest, abdomen, pelvis. Additional trauma to surrounding tissue can lead to shock.

For transport immobilization, standard Kramer and Dieterichs splints, pneumatic splints, vacuum immobilization stretchers, and plastic splints are used.

The Kramer stair tire is universal. These tires can be given any shape, and by connecting them together, you can create various designs. They are used to immobilize the upper and lower extremities and head.

The Dieterichs tire consists of a sliding outer and inner plate, a plywood sole with metal brackets and a twist. The splint is used for fractures of the femur, bones that form the hip and knee joints. The advantage of the tire is the ability to create traction with its help.

Pneumatically, the tires are a two-layer sealed cover with a zipper. The cover is put on the limb, the zipper is fastened, and air is pumped through the tube to make the splint rigid. To remove the tire, deflate the air and open the zipper. The tire is simple and easy to handle, permeable to x-rays. Splints are used to immobilize the hand, forearm, elbow joint, foot, lower leg, and knee joint.

In the absence of standard tires, improvised means (improvised tires) are used: planks, skis, sticks, doors (for transporting a victim with a spinal fracture).

The standard plywood Elansky splint is used for head trauma and cervical region spine (Fig. 1). The flaps of the splint are deployed, a layer of cotton wool is applied on the side where there are semicircular oilcloth rollers to support the head, the splint is placed under the head and top part chest and secured with straps to the upper body. The head is placed in a special recess for the occipital part and bandaged to the splint.

To immobilize the head, you can use a cotton-gauze circle. The victim is placed on a stretcher, the head is placed on a cotton-gauze circle so that the back of the head is in the depression, after which the victim is tied to the stretcher to avoid movements during transportation.

Immobilization for a neck injury can be done using cotton and gauze if the patient is not vomiting or has difficulty breathing. 3-4 layers of cotton wool are bandaged around the neck so that the resulting collar rests with its upper end against the back of the head and mastoid processes, and with the lower end against the chest (Fig. 2).

Immobilization of the head and neck can be achieved by applying Kramer splints, pre-curved along the contour of the head. One splint is placed under the back of the head and neck, and the other is bent in the form of a semi-oval, the ends of which rest against the shoulders. The splint is fixed with bandages.

In case of a clavicle fracture, a Deso bandage or a scarf bandage with a roller placed in the armpit, or a figure-of-eight bandage is used to immobilize the fragments.

In case of a fracture of the humerus and damage to the shoulder or elbow joint, immobilization is carried out using a large Cramer's scalene splint, which the doctor first models on himself (Fig. 3). The limbs are given the position indicated in the figure, with a roller under the armpit. The splint secures all three joints upper limb. The upper and lower ends of the splint are fastened with a bandage, one end of which is drawn in front, and the other through the armpit on the healthy side. The lower end of the splint is hung around the neck using a scarf or belt (Fig. 4).

In the absence of standard means, transport immobilization for a fracture of the shoulder in the upper third is carried out using a scarf bandage. A small cotton-gauze roll is placed in the armpit and bandaged to the chest over the healthy shoulder. The arm, bent at the elbow joint at an angle of 60°, is suspended on a scarf, the shoulder is bandaged to the body.

To immobilize the forearm and hand, a small scale splint is used, to which the hand and forearm are bandaged with fixation of the wrist and elbow joints. The arm is bent at the elbow joint; after applying the splint, the hand is suspended on a scarf. In the absence of special splints, the forearm is suspended on a scarf or immobilized using a board, cardboard, or plywood with mandatory fixation of two joints.

For hip fractures, damage to the hip and knee joints, Dieterichs splints are used. The plantar plate of the splint is bandaged with a figure-of-eight bandage to the sole of the victim’s shoe. The outer and inner plates of the splint are adjusted to the patient’s height by moving them in brackets and secured with a pin. The outer bar should rest against the armpit, the inner bar should rest against groin area, their lower ends should protrude beyond the sole by 10-12 cm. The plates are passed through the staples of the sole plate and secured with a clamp. A cord is passed through the hole in the sole and tied on a twist stick. Cotton-gauze pads are placed in the ankle area and on the crutch plates. The splint is secured with straps to the body, and the slats are secured to each other. The leg is pulled out by the staples on the plantar plate (Fig. 5) and the twist stick is twisted. The splint is bandaged to the leg and torso. A Kramer splint is placed and bandaged under the back surface of the leg to prevent the leg from moving backward in the splint.

Cramer splints connected to each other can be used to immobilize the hip. They are applied from the outside, inside and back. Immobilization of three joints is mandatory.

For a tibia fracture, Kramer splints are used (Fig. 6). The limbs are fixed with three splints, creating immobility in the knee and ankle joints. Pneumatic splints are used to immobilize the lower leg and knee joint (Fig. 7).

If the pelvic bones are fractured, the victim is transported on a stretcher, preferably with a plywood or plank board underneath. Legs are bent in hip joints, place a cushion of clothing, a blanket, or a duffel bag under the knees. The victim is tied to a stretcher.

With a fracture of the spine in the thoracic and lumbar regions, transportation is carried out on a stretcher with a shield, with the victim in the position on his back with a small bolster under the knees (Fig. 9). The victim is tied to a stretcher. If it is necessary to transport the victim on a soft stretcher, he is placed on his stomach with a cushion under his chest. In case of a fracture of the cervical and upper thoracic spine, transportation is carried out on a stretcher with the victim in the supine position, with a bolster placed under the neck.

Moscow Department of Education

State budgetary educational institution

“School No. 000 named after. »

Report on the topic

“Transport immobilization. Main types"

Completed by: Maria Mukhanova 10 “B” class

Supervisor:

I. Introduction

1.1 Relevance

1.2 Purpose and objectives of the study

II. Main part

2.1 Types of immobilization

2.2 Means of transport immobilization

2.3 Standard transport tires

2.4 Transport immobilization for injuries of the neck, spine, pelvis.

2.5 Transport immobilization for injuries of the upper and lower extremities.

III. Research

IV. conclusions

4.1 Rules for transport immobilization

4.2 Complications of transport immobilization

V. References

1. Introduction

1.1 Relevance

Transport immobilization as an integral part of first aid is used in the first hours and minutes after injury. It often plays a decisive role not only in preventing complications, but also in preserving the lives of the wounded and injured. With the help of immobilization, rest is ensured, interposition of blood vessels, nerves, soft tissues, and spread of wound infection and secondary bleeding. In addition, transport immobilization is an integral part of measures to prevent the development of traumatic shock in the wounded and injured. Timely and correctly performed transport immobilization is the most important first aid measure for gunshot, open and closed fractures, extensive soft tissue injuries, damage to joints, blood vessels and nerve trunks. Lack of immobilization during transportation can lead to the development of severe complications ( traumatic shock, bleeding, etc.), and in some cases even to the death of the victim.

In the center of mass sanitary losses, in most cases, first aid for fractures and extensive wounds will be provided in the form of self- and mutual aid. Therefore, the doctor of the medical center must be fluent in the technique of transport immobilization and teach its techniques to all personnel.

1.2 Goals and objectives.

Goal: Minimizing complications in victims with various injuries at the stage of first aid.

Tasks:

1. Study the problem of transport immobilization.

2. Understand the types of transport immobilization.

3. Understand the features of transport immobilization for injuries in various situations.

4. Formulate the rules of transport immobilization.

5. Familiarize high school students with examples of transport immobilization.

6. Compare existing methods transport immobilization.

Main part

2.1. Types of immobilization

There are two types of immobilization: transport And medicinal.

Transport immobilization- creating immobility (rest) of the injured part of the body with the help of transport tires or improvised means for the time necessary to transport the victim (wounded) from the place of injury or the stage of medical evacuation to a medical institution. Immobilization is used for bone fractures, damage to joints, nerves, extensive soft tissue damage, severe inflammatory processes in the extremities, injuries to large vessels and extensive burns.

IN medical institutions therapeutic immobilization is performed for the period necessary for fracture consolidation and recovery damaged structures and fabrics.

Indications for transport immobilization:

Bone fractures;

Joint damage: bruises, ligament damage, dislocations, subluxations;

Damage to large vessels;

Damage to nerve trunks;

Extensive soft tissue damage;

Limb avulsions;

Extensive burns, frostbite;

Acute inflammatory processes limbs.

2.2. Means of transport immobilization

There are different means of transport immobilization standard, non-standard And improvised(from improvised means).

1.Standard transport tires- These are means of immobilization of industrial production. They are equipped in medical institutions and medical service RF Armed Forces.

Currently, plywood, ladder, Dieterichs, plastic, cardboard, pneumatic, vacuum stretcher, and scarf tires are widely used.

Standard transport tires also include: medical pneumatic tires, plastic tires, vacuum tires, immobilizing vacuum stretchers (Fig. 1-4)

Fig.1. Pneumatic tires in packaging

Fig.2. Transport plastic tire

Fig.3. Medical pneumatic splints: a – for the hand and forearm; b – for the foot and lower leg; c – for the knee joint

Fig.4. Immobilizing vacuum stretcher with the victim in a lying position

2.Non-standard transport tires- these splints are not produced by the medical industry and are used in individual medical institutions (Elansky splint, etc.; Fig. 5).

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Fig.6. Available means of transport immobilization

On the battlefield, when providing first aid to the wounded along with a stretcher in best case scenario Stair splints can be delivered, so transport immobilization often has to be performed using improvised means. The most convenient are wooden slats, bundles of brushwood, branches of sufficient length, pieces of thick or multi-layer cardboard can be used (Fig. 7). Various household items or tools are less suitable for transport immobilization, such as ski poles, skis, shovel handles, etc. Weapons and metal objects should not be used for transport immobilization.

Fig.7. Immobilization with improvised tires: a - from boards; b - from brushwood; c - made of plywood; g - made of cardboard; d - from skis and ski poles

2.3. Standard transport tires

Plywood tire made of thin plywood, curved in the form of a gutter (Fig. 8). They are light in weight, but due to the lack of plasticity they cannot be modeled according to the shape of the limb and cannot be securely fixed; they are used mainly for immobilization wrist joint, hands, shins, thighs as lateral additional splints.

Application technique. Select a tire of the required length. If you need to shorten it, break off a piece of the tire of the required length. Then a cotton-gauze pad is placed over the concave surface, a splint is applied to the damaged limb and it is secured with bandages.

Fig.8. Plywood tire

Ladder tire (Kramer) It is a metal frame in the form of a rectangle made of wire with a diameter, onto which thinner wire is stretched in the transverse direction in the form of a ladder with an interval of 3 cm (Fig. 9). The tire is easy to model, disinfected, and has high plasticity.

Stair tires must be prepared for use in advance. To do this, the entire length of the splint must be covered with several layers of gray compress cotton wool, which is fixed to the splint with a gauze bandage.

Application technique. Select a tire of the required length prepared for use. If it is necessary to shorten the tire, bend it. If it is necessary to have a longer tire, then two ladder tires are connected to each other, placing the end of one on top of the other. Then the splint is modeled according to the damaged part of the body, applied to it and fixed with bandages.

Fig.9. Stair tires (Kramer tires)

Transport splint for the lower limb (Diterichs) ensures immobilization of the entire lower limb with simultaneous extension along the axis (Fig. 10). It is used for hip fractures, injuries in the hip and knee joints. The tire is made of wood, consists of two sliding board branches (outer and inner), a plywood sole, a twist stick and two fabric belts.

Fig. 10. Transport splint for the lower limb (Diterichs): a - external lateral sliding branch; b - internal side sliding branch; c - plywood sole with wire frame; g - twist stick with recess; d - paired slots in the upper wooden strips of the side branches; e - rectangular ears of the wire frame of the sole

The outer branch is long, superimposed on the outer lateral surface legs and torso. The inner one is short, superimposed on the inner lateral surface of the leg. Each branch consists of two strips (upper and lower), superimposed on one another. The lower bar of each branch has a metal bracket, thanks to which it can slide along the upper bar without coming off it.

Application technique:

Prepare the side wooden jaws. The plywood sole is tightly bandaged to the shoe on the foot around the ankle joint. If there are no shoes on the foot, ankle joint and the foot is covered with a thick layer of cotton wool, fixed with a gauze bandage, and only after that the plywood sole is bandaged. A carefully modeled ladder splint is placed along the back surface of the leg and reinforced with a spiral bandage. The lower ends of the outer and inner branches are connected using a movable transverse plate of the inner branch. After this, jaws are applied to the lateral surfaces of the lower limb and torso. Having carefully placed both branches, the splint is tightly attached to the body with special fabric belts, a trouser belt or medical scarves. Start stretching the leg. After traction, the splint is tightly bandaged to the limb with gauze bandages (Fig. 11).

Fig. 11. Transport immobilization with Dieterichs splint.

Plastic sling splint used for transport immobilization for fractures and injuries lower jaw(Fig. 12). It consists of two main parts: a rigid chin sling made of plastic, and a fabric support cap with rubber loops extending from it.

Application technique. A supporting fabric cap is placed on the head and strengthened with ribbons, the ends of which are tied in the forehead area. The plastic sling is lined with inner surface a layer of gray compress cotton wool, wrapped in a piece of gauze or bandage. The sling is applied to the lower jaw and connected to the supporting cap using rubber bands extending from it.

Fig. 12. Plastic sling-shaped splint: a - supporting fabric cap; b - general form applied splint

Stair tires currently remain the best means transport immobilization.

Transport tires are divided into fixing And combining fixation with traction.

From fixing The most common tires are plywood, wire-ladder, plank, and cardboard.

TO combining fixation with traction include Thomas-Vinogradov and Diterichs tires. When transporting over long distances, temporary plaster casts are also used.

2.4. Transport immobilization for injuries of the neck, spine, pelvis.

Transport immobilization for neck injuries. Immobilization of the neck and head is carried out using a soft circle, a cotton-gauze bandage or a special Elansky transport splint

1. Immobilization with a cotton-gauze bandage “Schanz-type collar” can be done if there is no difficulty breathing, vomiting, or agitation. The collar should rest against the occipital protuberance and both mastoid processes, and rest on the chest below. This eliminates lateral head movement during transport.

2. When immobilized with an Elansky splint, a more rigid fixation is provided. The tire is made of plywood and consists of two halves, fastened together with hinges. When unfolded, the splint reproduces the contours of the head and torso. In the upper part of the tire there is a recess for the back of the head, on the sides of which there are two semi-circular rollers made of oilcloth. The splint is attached with ribbons to the body and around the shoulders. A layer of cotton wool is applied to the splint.

Transport immobilization for spinal injuries. The purpose of immobilization in case of spinal injury is primarily to eliminate the mobility of the damaged vertebrae during transportation, unload the spine and securely fixate the damaged area.

Transporting a victim with vertebral damage always poses a risk of injury to the spinal cord substance by the displaced vertebra. A blanket folded several times is placed on the marshmallow, and the victim is placed face up on it. An important point in transporting a patient with a spinal injury is placing him on a stretcher, which should be performed by 3-4 people.

Transport immobilization for pelvic injury. Involuntary movements of the lower extremities can cause displacement of fragments. For immobilization in case of damage to the pelvis, the victim is placed on a rigid stretcher, giving him a position with semi-bent and slightly apart limbs, which leads to muscle relaxation and pain reduction. A cushion (blanket, clothing, rolled up pillow, etc.) is placed under the knee joints.

2.5.Transport immobilization for injuries of the upper and lower extremities.

Transport immobilization for damage to the shoulder girdle. When the collarbone and scapula are damaged, the main goal of immobilization is to eliminate the effect of the heaviness of the arm and shoulder girdle, which is achieved with the help of a scarf or special splints. Immobilization with a scarf is carried out by hanging the arm with a roller inserted into the axillary fossa.

Immobilization can be performed with a Deso-type bandage.

Transport immobilization for chest injuries. To immobilize the chest, especially with a fracture of the sternum and ribs, apply a pressure bandage made of gauze or sewn towels and place the victim in a semi-sitting position.

Transport immobilization for injuries of the upper extremities. Shoulder injuries. For fractures of the humerus in the upper third, immobilization is carried out as follows: the arm is bent at the elbow joint at an acute angle. A cotton-gauze roll is placed in the armpit and bandaged across the chest to the healthy shoulder girdle. The forearm is suspended on a scarf, and the shoulder is fixed to the body with a bandage.

Immobilization with a ladder splint is performed for fractures of the diaphysis of the humerus. The splint should fix three joints - the shoulder, elbow and wrist.

Immobilization with a plywood splint is carried out by placing it on the inside of the shoulder and forearm. The splint is bandaged. Forearm injuries. When immobilizing the forearm, it is necessary to turn off movements in the elbow and wrist joints. Immobilization is carried out using a ladder or mesh splint. When immobilizing with a plywood splint, cotton wool must be used to prevent bedsores.

Damage to the wrist joint and fingers. For injuries in the area of ​​the wrist joint of the hand and fingers, a ladder or mesh splint, as well as plywood splints in the form of strips from the end of the fingers to the elbow, are widely used.

Transport immobilization for injuries of the lower extremities. The correct immobilization for a hip injury should be considered one that involves three joints at once and the splint comes from armpit to the ankle.

Improvised splinting for hip fractures is carried out using various available devices. If they are absent, you can bandage the injured leg to the healthy one - autoimmobilization.

Transport immobilization of the lower leg. Produced using: special plywood tires, wire ladder tires, Dieterichs tires and improvised tires.

The most convenient and portable for tibial fractures is a ladder splint, especially in combination with a plywood splint. Immobilization is achieved by applying a ladder splint well modeled along the contours of the limb along the back surface of the limb from the gluteal fold with the addition of two plywood splints on the sides. The splints are fixed with a gauze bandage.

Study

We compare autoimmobilized and vacuum splints for lower leg injuries.

Criteria for evaluation:

1. Blend speed (in seconds)

2. The quality of the splint (can a person move his leg after the splint is applied? knee joint and ankle)

Study conclusion:

Vacuum splints are attached very securely, which cannot lead to incorrect fixation; they are fixed very quickly and easily than auto-immobilized ones. Autoimmobilized splints are rarely used in medicine, only when absolutely necessary.

conclusions

6.1. Transport immobilization rules

Transport immobilization must be performed efficiently and ensure complete rest of the injured part of the body or its segment. All actions must be thought out and performed in a certain sequence.

Basic rules when performing transport immobilization:

1. Transport immobilization of the injured body part should be performed at the site of injury as soon as possible after injury or damage.

2. Before carrying out transport immobilization, it is necessary to administer an anesthetic to the victim. Before the analgesic effect occurs, the application of transport splints is unacceptable.

3. If there is bleeding, it must be stopped by applying a tourniquet or a pressure bandage (the wound dressing must be sterile).

4. To carry out transport immobilization, it is necessary to “turn off” at least two joints close to the damage.

5. Fixation of the damaged body part.

6. During transportation, a couple of people should hold it.

Thus, transport immobilization warns:

Development of traumatic and burn shock;

Deterioration of the victim's condition;

Transformation of a closed fracture into an open one;

Resumption of bleeding in the wound;

Damage to large blood vessels and nerve trunks;

Spread and development of infection in the area of ​​injury.

4.2. Complications of transport immobilization.

The use of rigid transport immobilizing bandages when providing first aid to victims can lead to compression of the limb and the formation of bedsores.

Bedsores. Prolonged pressure from a tire on a limited area of ​​a limb or torso leads to poor circulation and tissue necrosis. The complication develops as a result of insufficient modeling of flexible splints, use of splints without wrapping them with cotton wool and insufficient protection of bony protrusions.

Standard means of transport immobilization can be used repeatedly. As a rule, improvised means are not reused.

Before reusing standard means of transport immobilization, they must be cleaned of dirt and blood, processed for the purpose of disinfection and decontamination, restored to their original appearance and prepared for use.

Bibliography

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