03.05.2019

Lung injuries

Urgent measures consist primarily of decompression pleural cavity or mediastinum with tension pneumothorax or pneumomediastinum, hermetic closure of a chest wound with open pneumothorax, correction of hypoxia and hypovolemia, replenishment of blood loss.

Minor wounds chest wall, especially in those areas where there are powerful muscle layers, do not require treatment and heal well under the scab. Wounds with a large area of damage should be carefully treated and sutured in layers to avoid suppuration and the occurrence of secondary pneumothorax.

Surgical tactics are determined by the characteristics of pneumothorax and hemothorax. Treatment should begin with puncture of the pleural cavity. For air aspiration, it is advisable to perform it in the second intercostal space along the midclavicular line, and to remove blood in the seventh-eighth intercostal space - along the posterior axillary line in order to avoid puncture of the thoraco-abdominal obstruction. Indicators of the effectiveness of puncture are the possible complete removal of blood and the creation of a vacuum in the pleural cavity with expansion of the lung.

Subsequent treatment is carried out under careful x-ray control; If air and fluid are detected in the pleural cavity, repeated punctures are indicated. If the vacuum is unstable and there is no tendency to expand the lung, the introduction of intercostal drainage is indicated. Depending on the severity of air blowing through the drainage, it may be necessary to introduce two or even three drainages. Continued tension of the pneumothorax and mediastinal emphysema, blowing a large amount of air, despite actively functioning drainages, are indications for thoracotomy.

If it is possible to eliminate tension in the pleural cavity, but blowing persists, then on the first day you can temporarily refrain from active aspiration and limit yourself to valve drainage according to Petrov-Bülau. Aspiration mode - before “gluing” the edges of the lung wound in the first days, the vacuum should be 15-20 cm of water. Art., high degree rarefaction can lead to ex vacue hemorrhage and prevent the lung wound from closing with prolapsed fibrin. J. Richter (1969) recommends achieving complete expansion of the lung within 8 days. According to our data, the lack of effect from aspiration within 3-4 days should be considered an indication for thoracotomy.

The second indication should be considered ongoing intrapleural bleeding, detected by puncture and the Rouvilois-Gregoire test. This approach to the treatment of lung injuries is used by most surgeons [Tsybulyak G.N., Vavilin V.A., 1977; Richardson T.D., 1978, etc.].

Careful weighing of the indications for surgery, skillful use of conservative measures and X-ray control can significantly reduce the number of thoracotomies for lung injuries.

The method of choosing access for thoracotomy in case of lung injury should be considered a standard lateral incision along the fifth-sixth intercostal space and along the seventh intercostal space if damage to the diaphragm is suspected. Standard thoracotomy with the patient in the supine position healthy side is low-traumatic and makes it possible to examine in detail and perform the necessary manipulations on the lung, its root and in all parts of the corresponding pleural cavity.

We emphasize once again that attempts to perform a thoracotomy by expanding the chest wound can end tragically: inconvenience is created during manipulation in the pleural cavity, combined injuries are visible, the edges of the chest wound are injured and suppuration occurs. After opening the pleural cavity and spreading the edges of the wound, the blood accumulated in the cavity is removed and used for reinfusion. Then the lung, mediastinum, and diaphragm are examined.

In the circumference of a stab wound of the lung, as a rule, there are no massive hemorrhages. Its edges are often smooth, and when you inhale, they diverge and allow air to pass through. If the peripheral zone of the lung is damaged, the wound is usually filled with bloody foam. In such cases, it is enough to apply several interrupted sutures using thin silk, nylon or lavsan threads. They should not be tightened too much, as the lung tissue is easily cut through. It is advisable to use thin round (preferably atraumatic) needles. Cutting needles, especially thick ones, are not suitable for this purpose. Good sealing is achieved by applying a thin layer of cyanoacrylic adhesive over the seam.

Superficial lung wounds do not need to be sutured. Having grabbed the damaged area with a clamp and slightly tightened it, apply a regular ligature.

Small caliber bronchi are sutured and tied with silk thread. Interrupted sutures are placed on slot wounds of larger bronchi. Maintaining patency when suturing crossed bronchi is an important condition success of the operation. Their ends are carefully sewn together with atraumatic needles charged with nylon, lavsan, chrome-plated catgut or supramid. Narrowing of the bronchial lumen leads to hypoventilation or atelectasis of the corresponding part of the lung.

Surgical tactics for deep lung wounds have some features. R. P. Askerkhanov and M. I.-R. Shakhshaev (1972) rightly note that superficial sealing of such wounds does not prevent the formation of intrapulmonary hematomas, which can subsequently become abscesses. Deep wounds of the lung, after preliminary ligation of damaged vessels and small bronchi, are sutured with 8-shaped sutures drawn to the bottom of the wound.

When suturing the lung, the UKL-40, UKL-60 devices are widely used, as well as the UO-40 and UO-60 suturing devices for applying linear two-line staggered sutures with tantalum staples. Thanks to this, it is possible to significantly reduce the duration of the intervention.

Processing laceration lung, in particular with gunshot wounds of the chest or closed injury, remove all crushed tissue and, depending on the degree of destruction, resort to wedge resection, removal of a segment, a lobe of the lung, or even the entire lung.

Patient D., 30 years old, was taken to emergency in serious condition 1 hour after he, while intoxicated, shot himself in the left half of his chest with a shotgun. Blood pressure 80/40 mm Hg. Art., pulse 100 per minute, weak filling. Sharp pallor skin. On the left, on the front wall of the chest, 2 cm below the nipple, there is a gunshot wound measuring 3x3 cm with burnt edges. She is bleeding profusely. Breath sounds on the left side cannot be heard.

Infusion of fluid into two veins. Thoracotomy under endotracheal anesthesia. About 1 liter was found in the pleural cavity liquid blood, which is collected for reinfusion; in the lingual and lower lobes of the lung there is a through wound in the root area.

Due to extensive injuries and ongoing bleeding, they were resected using UKL-40 and UKL-60 devices. A felt wad and pellets were removed from the chest wall wound. Fragments of the VIII rib were resected. Drainage was introduced into the pleural cavity. The chest wall wound is sutured. The postoperative period was complicated by pleural empyema. Recovery has come.

When deciding to remove damaged areas of the lung, the surgeon should do this as sparingly as possible to ensure maximum recovery respiratory function. IN in some cases severely injured segments have to be preserved. An example is a successful economical intervention for injury to lung tissue and lobar bronchus in a patient with severe bronchiectasis.

Patient P., 23 years old, was delivered 40 minutes after being injured on the right side of the chest when falling on a metal part. Extensive soft tissue defect of the chest wall. This area floats due to a fracture of the 5th and 6th ribs along the scapular and mid-axillary lines on the right. Shortness of breath, pallor, cyanosis of the lips, pulse 118 per minute, blood pressure 80/50 mm Hg. Art. A vagosympathetic blockade was made on the right, and 2 ml of a 2% promedol solution was administered.

During the operation under endotracheal anesthesia, an extensive rupture of the lower lobe leading to the root was discovered. A fragment of a rib was inserted into the lung wound, damaging the lower lobe bronchus for 1 cm. They decided to preserve the lobe, taking into account that the left lung was affected by bronchiectasis (shortly before the injury, the patient was examined for the purpose of resection of this lung).

Interrupted sutures were placed on the wound of the lobar bronchus, capturing the lung tissue. Damaged bronchi of smaller caliber are chipped and bandaged; the wound is closed with additional interrupted catgut sutures. Using the UKL-60 device, the crushed edge of the lobe was resected. When the pressure in the anesthesia machine increases, the wounded lobe is well inflated, a fragment of the 5th rib is removed, and the edges of the fragments of the 5th and 6th ribs are processed. Pleural cavity after administration of antibiotics and excision of torn edges skin wound sewn tightly in layers. Drainage was introduced through the eighth intercostal space. The postoperative period proceeded without complications.

Surgical intervention becomes more difficult if the bronchial wound has uneven edges or significant damage to its wall is detected. In such cases, the damaged portion of the bronchus is resected and an anastomosis is performed. To cover the anastomosis line, you can use the pleura, pericardium, and lung.

Patient P., 26 years old, was admitted 2 hours after a bilateral chest wound. The condition is extremely serious, bilateral valve pneumothorax. Severe suffocation and extensive, rapidly growing subcutaneous emphysema.

X-ray revealed that right lung completely pressed to the root, the left one is collapsed to 2/3. Pneumothorax is accompanied by mediastinal emphysema. The pleural cavity on the left was punctured. Only by constantly sucking out the air is it possible to maintain the lung in a straightened state. The pleural cavity is drained, active aspiration is installed.

Right thoracotomy under endotracheal anesthesia. The lung is collapsed, the insufflated gas freely exits through a defect of the upper lobe bronchus measuring 0.5x1 cm with uneven edges. Wedge-shaped excision of the damaged area of the bronchus; its ends are connected with interrupted silk sutures, and the edge of the lung is hemmed to the suture line. After restoration of patency bronchus lung managed to straighten it completely. The patient's condition began to improve quickly, postoperative period proceeded without complications.

Damage to large great vessels for injuries lung root accompanied by massive bleeding. According to our observations, damage to the side wall of the root vessels is more common, rather than their complete intersection, which sometimes makes it possible to stop fatal bleeding by applying sutures. Unfortunately, most of these wounded people die before they can be transported to a hospital.

Upon completion of the manipulations lung pleural the cavity is cleared of residual blood and accumulated fluid using wet wipes or aspiration; Antibiotics are injected into the pleural cavity. After a small intervention, when there is no reason to fear the accumulation of air or exudate, they are limited to introducing drainage through the eighth intercostal space. If the injury was significant and the operation was complex, then two drains have to be installed: through the eighth and second intercostal spaces. Contusional lung injuries in themselves usually do not pose a direct threat to the victim’s ulceration. The main task in their treatment is the active prevention of atelectasis, edema, pneumonia and abscess formation.

The first priority in restoring normal breathing is to provide sufficient excursions chest. For this purpose, cervical vagosympathetic blockade and, in the presence of rib fractures, anesthesia of fracture sites or epidural anesthesia are indicated. Then normal ventilation in the damaged area of the lung should be restored. When coughing is difficult, aspiration of mucus from the trachea and bronchi with a nasotracheal catheter is very effective. Great importance we attach microtracheostomy. If there is no effect, therapeutic bronchoscopy is performed.

With atelectasis, all attention is focused on restoring bronchial patency, activating the patient and preventing inflammatory complications.

Therapeutic measures for “wet” lung give good results only when applied early. They boil down to ensuring good aeration, inhaling oxygen, novocaine blockades, in some cases - to tracheostomy and mechanical ventilation, dehydration therapy.

For warning inflammatory processes and secondary atelectasis are used next complex measures:
1) repeated blockade of fracture sites, cervical vagosympathetic according to A. V. Vishnevsky or blockade of the stellate ganglion according to Minkin; 2) breathing exercises, exhale with slight resistance (inflating rubber circles, bags); 3) antibacterial therapy and administration of proteolytic enzymes parenterally and endotracheally; 4) cardiovascular therapy according to indications; 5) oxygen inhalation.

The patient should be placed on a functional bed in a semi-sitting position.

Thus, in case of lung injuries, surgical treatment is undertaken with ongoing massive bleeding, intractable hypertensive pneumothorax and mediastinal emphysema, as well as with deterioration of the condition caused by lung injury. According to our data, the need for thoracotomy for lung injuries with penetrating wounds occurs in 48.5%, and with closed trauma - in 2.4% of victims.

Classification. There are closed and open lung injuries.

Closed lung injuries: 1. Lung contusion. 2. lung rupture. 3. crushed lung. Lung ruptures can be single or multiple, and in shape - linear, polygonal, patchwork.

There are open injuries (wounds) of the lung: stab wounds and gunshot wounds.

A.V. Melnikov and B.E. Linberg distinguish three zones of the lung: dangerous, threatened, safe.

The danger zone is the root of the lung and the hilar area, where large vessels and bronchi of the 1st and 2nd order pass. Damage to this area is accompanied by profuse bleeding and tension pneumothorax.

The threatened zone is the central part of the lung. Pass here segmental bronchi and vessels.

The safe zone is the so-called lung cloak. Includes peripheral part lung, where small vessels and bronchioles pass.

Lung contusion

Lung contusion is damage to lung tissue while maintaining the integrity of the visceral pleura. Lung contusions are divided into limited and extensive.

Pathanatomy: in the area of the bruise there is hemorrhagic penetration of the lung parenchyma without sharp boundaries, destruction of the interalveolar septa. There may be destruction of lung tissue, bronchi, and blood vessels with the formation of a cavity filled with air and blood in the lung. When a lung is contused, atelectasis, pneumonia, and an air cyst of the lung develop.

The clinical picture depends on the size of the area of lung damage.

With limited bruises of the lungs, the victim’s condition is satisfactory, less often - moderate severity. There is pain at the site of injury, shortness of breath, cough, and hemoptysis. Blood pressure is not changed, the pulse is slightly increased. On auscultation, there is a weakening of respiratory sounds over the site of the injury with the presence of moist rales. Percussion sound is dull. On a survey radiograph: in the pulmonary field, an oval or spherical darkened area with indistinct, blurry contours is visible.

With extensive bruises of the lungs, the patient’s condition is moderate or severe. The victims are admitted in a state of shock and severe respiratory failure with shortness of breath up to 40 breaths per minute, cyanosis of the facial skin, blood pressure is reduced, and tachycardia reaches high numbers. Auscultation of breathing on the injured side is sharply weakened, with moist rales.

Diagnostics. 1. Clinic. 2. Survey fluoroscopy (graphy) of the chest. 3. Tomography. 4. Bronchoscopy. 5. Computed tomography.

Treatment: 1. Relief of pain syndrome (novocaine blockades, analgesics). 2. Antibacterial therapy. 3. Vascular therapy. 4. Restoration of normal drainage function of the bronchi. 5. Breathing exercises. 6. Physiotherapy.

Clinically and radiologically, lung contusions occur in 2 scenarios: 1. With adequate conservative treatment, the process is completely stopped after 10 days.

2. The so-called post-traumatic pneumonia, which can be treated conservatively within 10-14 days or a lung abscess develops.

Wounds and ruptures of the lung

Lung injuries in which lung tissue is damaged and visceral pleura. Blood and air enter the pleural cavity.

Characteristic signs of lung damage: 1. Pneumothorax. 2. Subcutaneous emphysema. 3. Hemothorax. 4. Hemoptysis.

All victims with closed lung injuries are divided into the following groups:

1. with pneumothorax; 2. with valve pneumothorax; 3. with hemothorax.

For open lung injuries, another group is added - with open pneumothorax.

Clinic: 1. General symptoms damage. 2. Specific symptoms.

Common symptoms include: pain, signs of bleeding, shock, respiratory failure. Specific symptoms include: pneumothorax, hemothorax, subcutaneous emphysema, hemoptysis.

Diagnostics: 1.Clinic. 2. Plain radiography (scopy) of the chest. 3. Ultrasound of the chest. 4. Pleural puncture. 5. thoracoscopy 6. Pho wound.

Treatment: General principles of treatment depend on the type and severity of the lung rupture or wound. They include: elimination of pain, early and complete drainage of the pleural cavity for the purpose of rapid expansion of the lung, effective maintenance of airway patency, sealing of the chest wall for open injuries, antimicrobial and supportive therapy.

If the lung is damaged with an open pneumothorax, first of all, the wound is pierced, the open pneumothorax is sutured and the pleural cavity is drained. The vacuum mode during aspiration for gluing the edges of a lung wound is 15-20 cm of water column.

If the lung is damaged with a small hemothorax, a puncture of the pleural cavity is performed and blood is removed from the sinus. For moderate hemothorax, drainage of the pleural cavity with blood reinfusion is indicated.

Indications for thoracotomy for lung injuries:

1. Profuse intrapleural bleeding. 2. Continued intrapleural bleeding - if 300 ml of blood per hour or more is released through the drainage, with a positive Ruvilois-Gregoire test. 3. Intractable conservative tension pneumothorax.

Operative access for lung injury is lateral thoracotomy in the 5-6 intercostal space.

Operational tactics: For superficial wounds or damage to the peripheral zone of the lung, interrupted sutures are applied. For this, thin silk, nylon or lavsan threads are used.

For deep wounds of the lung: the wound channel is inspected, blood clots are removed, foreign bodies. If necessary, the lung tissue is dissected above the wound channel. During the inspection, damaged vessels are sutured and ligated and small bronchi. Particular care is taken to inspect wounds at the root of the lung. A deep lung wound must be sutured tightly, without leaving dead spaces. To achieve this, the wound is sutured to its full depth with one thread or several rows of sutures. For stitching, a round, large, steeply curved needle is used.

With extensive destruction of the edge of the lung, wedge-shaped atypical resection is indicated. The lung, within the healthy tissue, is sutured twice with a UKL apparatus.

If lung tissue is crushed within one or more segments, resection of one or more segments is performed. In case of massive destruction of lung tissue within one lobe, a lobectomy is performed. If the entire lung is destroyed or its root is damaged, a pneumonectomy is indicated.

After the intervention on the lung is completed, the pleural cavity is freed from blood clots and pleural drainage is installed according to Bulau. Before suturing a thoracotomy wound, it is necessary to ensure that the lung or its remaining part is fully expanded.

Damage to the trachea and bronchi.

Classification: distinguish between closed and open injuries of the trachea and bronchi.

Depending on the depth of damage, there are incomplete (damage to the mucous membrane or cartilage) and complete (penetrating into the lumen). Complete ruptures can occur with separation of the ends of the bronchi and without separation. Damage to the bronchi is extremely rarely isolated. More often, the lungs, mediastinum, and large vessels are simultaneously damaged. Damage to the trachea occurs due to knife and gunshot wounds to the neck.

Clinic: depends on the location and extent of damage.

Characteristic signs: 1. Emphysema of the mediastinum. 2. Subcutaneous emphysema. 3. Hemoptysis. 4. Tension pneumothorax. 5. Wound on the neck, communicating with the trachea.

With all types of damage to the trachea and bronchi, ventilation disturbances occur with severe respiratory failure. Sometimes asphyxia develops.

With open injuries to the trachea, air mixed with blood whistles out of the neck wound.

With combined injuries of the trachea and bronchi, signs of shock, blood loss, and respiratory failure come to the fore.

Diagnostics: 1. Clinic. 2. Plain radiography of the chest. The main radiological signs of bronchial damage are: mediastinal emphysema, pneumothorax, pulmonary atelectasis, subcutaneous emphysema. 3. Bronchoscopy. 4. thoracoscopy 5. computed tomography. It is imperative to examine the esophagus. Indirect signs of bronchial damage are: excessive release of air through the pleural drainage, ineffective drainage of the pleural cavity, collapse of the lobe or lung against the background of pleural drainage, increasing mediastinal emphysema.

Treatment: The main task of the preoperative period is to ensure and maintain airway patency. For mediastinal emphysema, a cervical mediastinotomy is performed. In case of tension pneumothorax, pleural drainage is installed in the 2nd intercostal space. If damage to the bronchus or thoracic trachea is suspected or a diagnosis of bronchial damage has been established, an urgent thoracotomy is indicated. The most convenient is the lateral approach. In case of isolated damage thoracic of the trachea, a longitudinal or longitudinal-transverse sternotomy is performed.

ABOUT

operative tactics: There are the following types of operations for damage to the bronchi: 1. suturing the wound defect; 2. excision of the edges of the defect, wedge-shaped or circular resection with restoration of lumen patency; 3. end-to-end anastomosis when the bronchus is separated; 4. lobectomy or pneumonectomy.

Indications for suturing are small wounds and defects. For lacerated and bruised wounds, the edges of the wound are excised to restore bronchial patency. Indications for pneumonectomy: significant destruction of lung tissue, inability to restore bronchial patency, damage to the vessels of the lung root.

There is no article in the Criminal Code of the Russian Federation directly providing for criminal liability for a knife wound. Is it so? Knife wounds are considered bodily injuries. Answers to questions about the liability that may arise for stabbing are found in Chapter 16 of the Criminal Code of the Russian Federation “Crimes against life and health.” Legal illiteracy can play a cruel joke, and even with the Criminal Code at hand, it is not possible for a person who is far from the code of criminal laws of the country to determine the possible punishment, as well as assess the need to immediately seek qualified legal assistance.

Types of bodily injury

Bodily injury is considered to be a disruption of the functioning of the human body, as well as harm or change in the anatomical structure of the body that arose under the influence of various factors environment.

The legislation classifies injuries as follows:

lungs;
moderate severity;
heavy.

Since the harm is caused to health, accordingly, the degree of liability is determined in proportion to the damage caused by the impact attack, and not by the amount of damage, the area affected, or the nature of the objects that caused the injury.

No lawyer, no matter what, can accurately determine the nature of the harm caused to the human body. highly qualified he neither possessed nor will be able to. This right is assigned by law to such a category of professionals as court medical expert being an employee medical institution or having permission to conduct special research and for the provision of medical services.

Minor injuries are characterized by a short-term deterioration in health or an insignificant loss of ability to work. Moderate injuries are characterized by significant loss of ability to work in a ratio of less than one third of general condition health, as well as long-term harm to the health of the victim.

When defining severe injuries, the legislation provides a list of specific human organs, injuries of which entail a threat to the life of the victim, loss of ability to work by at least one third, absolute loss of professional suitability, cessation of certain physical conditions(pregnancy).

Unfortunately, in our country, a fairly common type of crime that encroaches on human life and health is stabbing.

Most often they occur at home, as a result of abuse alcoholic drinks. At the same time, recognition of a knife through an examination as a bladed weapon does not constitute criminal liability. a necessary condition.

Depending on the attitude of the accused person to the crime he has committed, the act is qualified as attempted murder or assault. varying degrees damage.

Most often, responsibility for this type attacks on human life and health occur under the following articles:

Causing grave damage (Article 111 of the Criminal Code of the Russian Federation).
Causing medium degree damage (Article 112 of the Criminal Code of the Russian Federation).
Causing minor injuries (Article 115 of the Criminal Code of the Russian Federation).

Each of the described articles contains in the preamble a qualifying feature that entails a higher penalty. To commit a crime, weapons or objects acting as weapons are used.

An ordinary household knife does not have the characteristics of a bladed weapon. The thickness, length of the blade and handle are not intended for injecting. Despite this, the knife acts as a weapon.

Without proper knowledge in the field of medicine, it is very difficult to determine the nature of the damage and possible consequences their application for the life and health of the victim. At the same time, liability comes for causing severe and moderate injuries that occurred under the influence of passion (Article 113 of the Criminal Code of the Russian Federation) or when exceeding the limits of necessary defense (Article 114 of the Criminal Code of the Russian Federation). Responsibility is significantly different from that which occurs for the same actions that led to the death of the victim (Articles 105, 107, 108, 109 of the Criminal Code of the Russian Federation).

For example, a person is injured in abdominal cavity, even if it is not accompanied heavy bleeding, may end fatal, if vitally important internal organs. Moreover, without a special examination by a qualified specialist of the victim, it is impossible to determine which organs are affected and what consequences this will lead to.

At first glance, a slight penetrating leg wound, accompanied by significant blood loss, without medical assistance can lead to the death of the victim. In this case, the perpetrator will be held liable for premeditated murder or manslaughter.

Procedure for filing a police report

Legislatively, the procedure for filing a statement with the police is regulated by Article 141 of the Code of Criminal Procedure of the Russian Federation.

It can be supplied to following forms:

oral;
written.

Application forms submitted above are equivalent. Oral form involves the mandatory entry of data into the protocol from the words of the applicant, and in the absence of such an opportunity, a report official law enforcement agency. Verbal statements are also called crime reports. In both forms prerequisite acceptance is the presence of the applicant’s installation data.

Anonymous messages are not considered as grounds for initiating criminal proceedings. Applications are subject to mandatory registration with established by law ok. Maximum term their consideration for making a legal decision is a period of 30 days.

The result of a review by a law enforcement agency may be:

Criminal proceedings.
Issuance of a decision to refuse to initiate proceedings in the absence of corpus delicti.
Transfer of the message to the jurisdiction or to the court.

We should not forget the fact that it is the responsibility of the doctor providing medical care the victim, includes notifying the competent authorities about all “criminal” injuries: gunshots, knife wounds, beatings, and so on.

Accordingly, without the intention of reporting an offense, it will not be possible to avoid communication with law enforcement officers regarding the nature of the injuries received. At the same time, in order to initiate a criminal case for causing grievous or moderate bodily harm, a statement from the victim is not required.

Proceedings for these crimes are conducted in public, regardless of the wishes of the victim.

The sanctions in the articles providing for punishment for causing damage to life and health include the following types:

Responsibility is listed from the mildest, which occurs for causing minor bodily injuries, to the most severe, indicated by the additional parts of Article 111 of the Criminal Code of the Russian Federation.

We should also not forget that the pre-trial investigation authorities and the court itself, when deciding on the choice of a preventive measure, will take into account mitigating and aggravating circumstances.

In addition to the mitigating circumstances specified in Article 61 of the Criminal Code of the Russian Federation, when assigning punishment, the reconciliation of the accused with the victim will also be taken into account; in this case, a written statement from the victim about the absence of claims against the person under investigation is welcomed.

If a knife wound is classified as a serious or moderate crime, criminal proceedings will be continued upon the fact that the person received severe or moderate bodily injuries, regardless of the wishes of the victim.

If involved in criminal proceedings as an accused influential person, or possessing certain material benefits. There are often so-called cases of “delaying out” procedural actions at the stage of pre-trial proceedings or directly when considering a crime in court.

In this case, most in effective ways accelerations are:

attracting funds to the process mass media;
appealing the actions of police officers to the prosecutor's office (the Prosecutor General's Office or territorial representative office).

There is also a procedure for petitioning higher authorities, which are entrusted by law with the function of monitoring the actions of institutions of first instance, but this practice may be ineffective due to the interest and coherence of actions of representatives of the law enforcement system in order to obtain benefits.

Based on the nature of crimes that harm human life and health, taking into account the parties involved in these offenses, the most important universal recommendations for both the victim and the accused will be:

immediate appeal for qualified legal assistance;
involvement in conducting forensic medical examination independent expert;
commission at the pre-trial stage of all necessary actions, which can be taken into account as mitigating or aggravating circumstances when assigning punishment.

If intent is proven in the stabbing and the act is qualified as attempted murder, reconciliation of the parties to terminate the legal proceedings will not be enough, no matter in what form it occurs. It is worth noting that the condition alcohol intoxication will be accepted by the court as an aggravating circumstance.

> > survival in peacetime > knife wound, first aid for a knife wound

Anything can happen in life.
Be ready for anything!

It’s not possible to look at everything possible situations and in order to provide high-quality assistance in case of a knife wound, you must have medical education and practice, but it is still worth trying to provide first aid, which can prolong a person’s life, before the ambulance arrives, having at least minimal knowledge.

Knife wound to the lung area

Knife wound to the chest

If you hear a suction sound when you breathe during a knife wound, the first step is to close the wound - without even waiting for help to arrive.

If possible, the wounded person should inhale and exhale. After exhaling completely, press down on his chest. Then try to quickly cover the wound with a plastic bag, oilcloth, or something similar to prevent air from entering the wound. Stick a bandage on top. Apply a cooling pack or something cold, this will at least help relieve the pain and slow down the bleeding. If the wounded person feels worse after this or has difficulty breathing, remove the bandage, allow the air to escape from the chest cavity and close the wound again.

See if you're free Airways the victim, whether there is a pulse and breathing. If the person is conscious, they need to be seated or the head and shoulders elevated. This will prevent blood from filling the intact part of the chest cavity, and healthy lung will be able to continue working.

What to do if the knife is in the wound?
If the knife is in the wound, do not remove it. If you take out the knife, blood will begin to flow out heavily, and the person may not survive until help arrives. Secure the knife with a thick bandage or tape to prevent it from moving and seek immediate medical attention.

What to do if any organ protrudes from the wound?

If any organ is protruding from the wound, cover it with a sterile bandage or clean cloth. To prevent it from drying out, water the bandage with clean drinking water before the ambulance arrives.
Do not touch it or try to put the organ back in.

How do doctors deal with a stab wound?

Doctors check to see if breathing is normal. It may be necessary to insert a tube into the chest to expand the lung, allowing proper pressure in the chest and allowing blood to flow out if there is a hemothorax. In some cases, oxygen and a mechanical ventilator are needed to maintain breathing.
Then the bleeding is stopped. It's possible surgical intervention. If there is slight bleeding, the wound is bandaged with sterile bandages. Painkillers, antibiotics and a tetanus shot may be prescribed to avoid infection.

Everything that doesn't kill us makes us stronger. Be ready for anything!