Transcript 05. Emergency medical care of mass destruction

I.Ya. HORBACHEVSKY TERNOPIL STATE
MEDICAL UNIVERSITY
Emergency medical care of mass
distruction
R.M. Lyakhovych
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Purpose of the organization and provision
of medical care at mass destruction
Значною проблемою у можливості
ураження людей є масові заходи
danger of mass measures
Quantitative characteristics of injury:
Trauma- injury of the body, its tissues or
parts caused by the influence of
mechanic, physical, chemical or mental
factors, which is conducted with local and
general reactions
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Isolated trauma- is a single injury at
any anatomic and functional region of
the body or organ.
Multi-trauma- few injuries at one
anatomic and functional region.
Associated trauma- few injuries, at
different anatomic and functional
regions.
Combined trauma- injury, which
appears as a result of simultaneous or
sequential influence of several traumatic
agents.
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Polytrauma- severe multiple and
combined injuries, which cause the
beginning of traumatic disease
(wound dystrophy) and need
immediate medical aid by life-saving
indications.
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In case of associated trauma dominates the
syndrome of mutual complexification, which
means that every single injury might not be
lethal, but together injuries might become lifethreatening.
(Fracture+ rupture of intestine+ injury of liver,
spleen)
Polytrauma is characterised with: syndrome of
mutual complexification, atypical symptoms of
damages, complicacy of diagnostic.
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“Traumatic disease” – is a phase of
pathologic process, which gradually develops in
case of severe injuries.Traumatic disease is
usually divided into 4 periods:
I - shock
II - period of early manifestations of traumatic
disease
III - period of late manifestations of traumatic
disease
IV - period of rehabilitation
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1. Subdural and epidural haematoma.
2. Haemopneumothorax
3. Splenic rupture
4. Damage to the liver
Fracture of the pelvic bones or/and other
injuries associated with large blood
loss.
The third pick of lethality appears in few
days or weeks after moment of injury
and is usually connected with multiple
organ failure and sepsis.
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Emergency medical aid is often provided in
extreme conditions, when additional factors
might harm not only patients, but also their
rescuers. In such cases medical workers
should follow these rules:
1. Check the safety of the place of accident and
if necessary ask professional rescuers or
police to help.
2. Determine the quantity of victims, way of
injuring, sources of danger in environment.
3. Define the necessity in additional
emergencies in case of many victims.
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Components of emergency medical aid at the
pre hospital stage:
Primary inspection ABCC’
Medical sorting
Intensive therapy
Secondary inspection (ABCDE)
Constant observation of the patients condition
Qualified and specialised medical help airways
B-breathing
Circulation
C’- cervical spine- with using of neck collar
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№
1
1
Name of the limb or its
segment and length of the limb
2
Anatomic points
Comment
Proximal
Distal
3
4
5
The arm is
completely
extended in
the elbow
Upper limb (total length)
The edge of the
acromial process
The apex of the styloid
process of the ulna
2.
Brachium (anatomic length)
Greater tubercle of the
humerus
Lateral epicondyle of
the humerus
3.
Forearm (anatomic length)
The apex of the tip of
the elbow
The apex of the styloid
process of the ulna
The forearm
is flexed at
right angel
in the elbow
4.
Lower limb (total length)
Spina iliaca anterior
superior
The apex of the medial
malleolus
The lower
limb is
completely
extended
5.
Femur and hip joint (total
length)
Spina iliaca anterior
superior
Joint line on the
medial side of the
knee
–
6.
Femur (anatomic length)
The apex of the greater
trochanther
Joint line on the lateral
side of the knee
–
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Tibia (anatomic length)
Joint line on the medial
side of the knee
The apex of the medial
malleolus
–
–
Classification of shock
Degree of
shock
Blood pressure
Pulse per minute
1 degree
90-100
90-100
2 degree
90-75
110-120
3 degree
75 and less
Over 130
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Open fracture of bones of forearm
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Probable complication of fracture or transportation without
immobilisation
Mechanism of radial nerve damage
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Splintered open fracture of both bones of right forearm at the level of lower 1/3
1
2
Combined
MOS
3
4
5
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Fractures of the pelvis
Without breaking of pelvic circle continuity
A.B. Fractures of the wing of
ilium
C.D. Fractures of sacrum
E. Fractures at the level of
iliosacralis articulation
F. Fractures of ishiadic and
pubic bone
G. Fracture of pubic bone
(horizontal ramous)
H. fracture of ishiadic bone
I. Fracture of pubic articulation
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Fractures of the pelvis
With breaking of pelvic circle continuity (Malign)
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1. Fracture at iliosacralis articulation
with dislocation.
2. Fracture of pubic bone with
dislocation.
3. Fracture of the ischiadic bone
with dislocation
Fracture-displacement of half-pelvis
Fracture of pelvic and iliosacralis
articulation with dislocation of
pelvic circle
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Fractures of the pelvis
Mechanisms of injury- direct and indirect
Clinic: pain, deformation of
the pelvic circle, specific
position of the limb, depends
on the type of fracture,
pathologic mobility.
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Transportation of the patient with pelvic
fracture
Patient with pelvic fracture should be transported on the
stretcher in position with flexed (30º-40º) knees and
femoral articulation (abduction 10º). This position is the
most physiological for the muscles, which are connected
with the pelvis and doesn’t cause additional dislocation (so
called “frog-position”).
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Shaft of femur fractures
Fractures of this localisation consist 40% of all femoral fractures.
Mechanism of the trauma: direct and indirect
Clinic: pain, oedema, pathologic mobility, bone fragments crepitating.
The specific feature of this trauma is often development of trauma shock and
blood loss (0,5-1,5 l), and if the patient is transported without immobilisation,
the risk of fat embolism growth.
There are fractures of upper, middle and lower 1/3 of femoral bone.
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Clinical examples
Combined trauma: fracture
of heel bone+burns
(treatment- mod apparatus
of Elizarov with
compression of bone
fragments)
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Displacements of foot
Subtalar open displacement of the foot
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Passive postural position
Passive postural position
Transporting immobilisation
The main principle is the immobilisation of joints, which are above
and lower than fracture
a - immobilisation with Cramer's splint in case of crus’ fracture
b - immobilisation with Diterichs' splint
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Use the rule of 4 catheters:
Nasal for oxygen
Gastric for evacuation of its contents (when patient
is unconscious)
Intravenous for infusions
Urinary for measuring of diuresis
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Glucocorticoids in case of hypovolemic shock.
Immobilisation of fractures- standard and improvisational
splints, contra shock clothes.
A/B therapy, beginning from “wide” antibiotics (cyfran,
zanocyn, cephalosporins).
Prevention of supercooling- warm coats, the optimal
climate control, warm liquids for drinking (except abdominal
trauma), warm infusion solutions 35º- 40º.
Symptomatic syndromes and corrective therapy.
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Transportation of patient with polytrauma
Treatment of patients at pre hospital stage needs
experienced medical workers and expensive medical
equipment. Every delay might cause life-threatening
complications. Those statements cause the necessity
of hospitalisation of such patients to the specific inpatient departments, where exists the possibility to
involve into treatment surgeons, neurosurgeons,
traumatologists, anaesthesiologists.
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All victims with polytrauma should be
hospitalized to the intensive care department
or antishock ward.
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Many thanks!
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