How to properly and quickly provide assistance for a wound in the stomach? Damage to large blood vessels in the abdomen. Prolapse of internal organs

Wound in the stomach is always considered dangerous, because as a result of injury, internal vital organs could be damaged. Therefore, when a wound is found in the stomach first aid a person is treated in the same way, regardless of how the wound was received (stabbed, shot, etc.). The algorithm for providing assistance is slightly different only in cases of presence or absence in the wound foreign body. Let's consider both algorithms of first aid separately.

Important! Regardless of the presence or absence of a foreign object in the wound, it should be remembered that the wounded in the stomach should not be allowed to drink and eat, even if he asks. You can only moisten your lips with water and give a sip so that he rinses his mouth. Also, if you are injured in the stomach, you should not give the victim any medicine by mouth, as this can worsen the situation. Finally, when injured in the abdomen, painkillers should not be administered. Assistance is the same if the person is conscious or unconscious.

Algorithm for first aid in the presence of a foreign body in a wound on the abdomen

4. If there is a bullet or some other foreign object(for example, a knife, an ax, a pitchfork, an arrow, a nail, fittings, etc.), then it is impossible to remove, touch, try to loosen it or perform other actions with it! Do not remove anything from the wound on the abdomen, under any circumstances, as this may increase the amount of damage and lead to the death of the victim. If possible, then you should simply cut off the object protruding from the wound so that only 10-15 cm remains above the skin. If it is not possible to cut the object in the wound, then it should be left in the form in which it was found;

5. An object in the wound and sticking out should be immobilized with any long dressing material (bandages or pieces of cloth) - no shorter than 2 meters. If there is no such long dressing, then several short ones should be tied into one. To immobilize an object in a wound, a strip of dressing material should be thrown over it exactly in the middle so that two long free ends form. Wrap these ends of the dressing tightly around the object and tie with each other. An object wrapped in this way with several layers of dressing material will be well fixed;

6. After fixing a foreign object, a person is brought to a half-sitting position with legs bent at the knees, wrapped in blankets, and in this position they are transported or waiting for the arrival of an ambulance;

7. If there is a bullet, a shell fragment or other small foreign objects in the wound, then you do not need to try to get them. Such a wound in the abdomen requires assistance, as a simple open one, without paying attention to the existing foreign bodies.

Algorithm for first aid for prolapsed internal organs from a wound on the abdomen

1. If a wound in the abdomen is found, it should be estimated how quickly an ambulance can arrive. If the ambulance can arrive within half an hour, then you should first call it, and then start providing first aid to the victim. If the ambulance cannot arrive within 30 minutes, then immediately begin to provide assistance to the victim, and then transport the person to the nearest hospital on your own(by own car, passing transport, etc.);

2. Firstly, if a person is unconscious, his head should be thrown back and turned to one side, since it is in this position that air can freely pass into the lungs, and the vomit will be removed outside without threatening to clog the airways;

3. If any organs have fallen out of the wound on the abdomen, you should not try to put them back! Under no circumstances should the prolapsed internal organs be pushed back into the abdominal cavity;

4. The fallen organs just need to be gently moved as close as possible to each other so that they occupy a minimum area. Then all the fallen organs are carefully collected in a clean bag or in a rag. The ends of the bag or cloth are glued to the skin with adhesive tape or adhesive tape so that the fallen organs collected in them are isolated from environment. If by a similar method of isolation of fallen internal organs it is impossible to use the environment, then they do it differently. Several rolls of bandages or wound pieces of cloth are applied around the fallen organs. Then, over the rollers, the organs are covered with a clean piece of tissue or sterile gauze, after which the entire resulting structure is wrapped with a loose bandage (see Figure 1). It is important to remember that when applying bandages, the internal organs should not be squeezed or squeezed;

Figure 1 - Method for isolating prolapsed internal organs from the environment

5. After applying a bandage or fixing the prolapsed organs, it is necessary to give the person sitting position with half-bent legs, put cold on the wound and wrap the victim with blankets or clothes. Transport in a sitting position;

6. You should constantly moisten the fallen internal organs with water so that they remain moist. If the organs are in the bag, then add water with a syringe, piercing a small hole. If the organs are in a cloth or under an insulating bandage, then it should be regularly watered so that it is constantly wet. Moisturizing the fallen internal organs is necessary for their preservation. If the organs dry out, they will simply undergo necrosis, which means that doctors will have to remove them, since they will be effectively dead.

Algorithm for first aid for abdominal wound without prolapsed internal organs

1. If a wound in the abdomen is found, it should be estimated how quickly an ambulance can arrive. If the ambulance can arrive within half an hour, then you should first call it, and then start providing first aid to the victim. If the ambulance cannot arrive within 30 minutes, then you should immediately begin to provide assistance to the victim, and then transport the person to the nearest hospital on their own (by car, passing transport, etc.);

3. A wound on the abdomen should not be tried to carefully feel or check its depth with a finger;

4. If there is a bullet, a shell fragment or other small foreign objects in the wound, then you do not need to try to get them. First aid in such a situation is provided, not paying attention to a foreign object in the tissues;

5. If a gunshot wound is visible on a person’s stomach, then it should be examined for the presence of an exit hole. If there is an outlet, then it is also treated and a bandage is applied. If there are several wounds on the abdomen, then everyone is treated;

6. First of all, the wound should be cleaned of blood and dirt. To do this, you need to take a few pieces of clean cloth, gauze, cotton or bandage. The fabric is abundantly moistened with water or any available antiseptic solution, for example, alcohol, Furacilin, Chlorhexidine, hydrogen peroxide, potassium permanganate, vodka, cognac, wine, champagne, etc. Then, with a wet piece of tissue, blood and impurities are carefully removed, making movements from the edge of the wound to the side. They go around the entire perimeter of the wound in a circle, removing contamination. If one circle was not enough to remove dirt, then the used cloth is thrown away, another piece is taken, moistened again in antiseptic solution or water and repeat the procedure. The fabric should be wetted abundantly;

7. After removing blood and dirt, if possible, you should smear the skin around the wound with iodine or brilliant green;
Important! Nothing can be poured into the wound - no antiseptics, no iodine, no brilliant green, no water, etc. All wound treatment comes down to removing dirt and blood from the outside, from the skin adjacent to the wound opening.

8. If there is nothing to treat the wound with, then they do not do this, but apply a bandage directly on the dirty and bloodied skin;

9. After treatment of the wound, a bandage is applied to it. It is optimal to use sterile bandages for this, but if there are none, then you can simply take clean pieces of fabric, for example, tearing them off clean clothes. First, the wound is covered with a small piece of cloth or gauze folded in 8-10 layers. Then this fabric or gauze is tightly tied to the body of the victim. If there is nothing to attach gauze or fabric to the body, then you can simply glue them to the skin with adhesive tape, adhesive tape or glue;

10. On the bandage, if possible, apply cold in the form of ice in a bag or water in a heating pad. You can not put ice on the wound without a bag, because as it melts, pathogenic microbes will be released that can quickly penetrate the wound. After applying the bandage, the victim should be given a sitting position with legs half-bent at the knees, cover him with blankets or clothes. The victim should be transported in a sitting position.

Important! Until a person with a penetrating wound in the abdominal cavity is taken to the hospital, it is absolutely impossible to give him water, feed and administer painkillers.

Open abdominal injuries are the result of stab, shrapnel or gunshot wounds.

signs

For open damage the abdomen is characterized by the following symptoms: sharp pain in the wound area, bleeding (Fig. 2), emotional arousal, rapidly increasing weakness, pallor of the skin, dizziness; with extensive, for example, fragmentation, injuries, eventration can be observed, i.e., prolapse of the abdominal organs (parts of the stomach, intestinal loops) through a wounded hole in the abdominal wall.

First aid for open abdominal injuries

First aid for open injuries of the abdomen is as follows: stopping bleeding by tamponade (tamponade), treating the wound according to general principles, anesthesia should be performed only by injection; during eventration - do not touch and do not adjust the prolapsed organs! They must be covered with a sterile napkin, gauze or any other clean cotton material, or a ring should be formed from rollers around the fallen organs so that it is higher than them; after which you can make a neat bandaging (Fig. 3).

In all cases of open injury to the abdomen, urgent hospitalization of the victim in a medical facility in the supine position is necessary.

First aid for wounding the abdomen is provided according to the following algorithm.

Bandages on the abdomen and pelvis. A spiral bandage is usually applied to the abdomen, but for the purpose of strengthening it often has to be combined with a spike-shaped bandage of the pelvis. The one-sided spica bandage is very comfortable. Depending on the purpose, it can cover the lower abdomen, upper third of the thigh and buttocks. Depending on the place where the bandage tours are crossed, there are posterior, lateral and anterior (inguinal) spica bandages. A reinforcing bandage is applied around the belt in circular tours, then the bandage is led from back to front along the side, then along the front and inner thighs. The bandage bypasses the posterior semicircle of the thigh, exits from it outer side and passes obliquely through the inguinal region to the posterior semicircle of the body. The moves of the bandages are repeated. The bandage can be ascending if each subsequent move is higher than the previous one, or descending if they are superimposed below (Fig. 76).

Bilateral spike bandage used to cover the upper thirds of both thighs and buttocks. Like the previous one, it starts in a circular motion around the belt, but the bandage is led along the front surface of the other groin, then along the outer surface of the thigh, covering its posterior semicircle, leading to inner surface and carried out along the inguinal region to the posterior semicircle of the body. From here, the bandage moves in the same way as with a one-sided spica bandage. The bandage is applied to both limbs alternately until the damaged part of the body is closed. The bandage is fixed in a circular motion around the body (Fig. 77).

Crotch bandage. Apply an eight-shaped bandage with the intersection of the bandage moves on the perineum (Fig. 78).

QUESTIONS OF TEST CONTROL FOR LESSON No. 6. Discipline "First Aid in Emergencies".

1. The upper border of the abdomen passes:

2. along the Lesgaft line;

2. The outer border of the abdomen passes:

1. from the xiphoid process along the costal arches;

2. along the Lesgaft line;

3. along the iliac crests, inguinal folds, the upper edge of the symphysis.

3. Bottom line abdomen passes:

1. from the xiphoid process along the costal arches;

2. along the Lesgaft line;

3. along the iliac crests, inguinal folds, the upper edge of the symphysis.

4. Cardiac opening of the stomach is located:

5. The bottom of the stomach is located:

1. to the left of the XI thoracic vertebra;

2. at the level of the X thoracic vertebra;

3. at level XII thoracic vertebra and the xiphoid process.

6. The lesser curvature of the stomach is located:

1. to the left of the XI thoracic vertebra;

2. at the level of the X thoracic vertebra;

3. at the level of the XII thoracic vertebra and the xiphoid process.

7. The liver is located at the level of:

1. X-XI thoracic vertebrae;

2. VIII - IX thoracic vertebrae;

3. VIII - VII thoracic vertebrae.

8. The spleen is located:

1. in the right hypochondrium at the level of the IX-XI ribs along the mid-axillary line;

2. in the left hypochondrium at the level of the IX-XI ribs along the mid-axillary line;

3. in the left hypochondrium on level VIII- IX ribs along the mid-axillary line.

9. Spleen:

1. paired parenchymal organ;

2. unpaired parenchymal organ;

3. paired cavity organ.

10. The spleen has an approximate size:

1.8x5x1.5cm;

11. The spleen has a mass:

1. about 80g;

2. about 100g;

3. about 150 g.

12. Total length of skinny and ileum about:

13. The length of the large intestine is on average equal to:

14. Kidney:

1. paired organ;

2. not a paired organ.

15. The kidney has a size of about:

16. A kidney has a mass of approximately:

17. Kidneys are located:

1. in the hypochondrium;

2. in the scapular region;

3. in the lumbar region.

18. The kidneys are located on the sides of the spine at the level of:

1. from the XI thoracic to the I lumbar vertebra;

2. from the XII thoracic to the II lumbar vertebra;

3. from the X thoracic to the XII thoracic vertebra.

19. After you have determined at the scene what exactly happened, you must:

1. make sure that nothing threatens you;

2. determine the presence of a pulse in the victim;

3. find out the number of victims.

20. During the initial examination of the victim in the third place, perform:

3. breath check.

21. The pulse of the victim, who is unconscious, is checked for:

1. radial artery;

2. brachial artery;

3. carotid artery.

22. In the abbreviation of the ABC international rescue practice, the letter B stands for:

23. During the initial examination of the victim, first perform:

1. checking the reaction of the victim;

2. gently tilt the head of the victim;

3. breath check.

24. The presence of consciousness in a person is usually determined by:

1. pulse;

2. his reactions to the word;

3. breath.

25. The breath of the victim, who is unconscious, is checked for:

1. 5 - 7 seconds;

2. 60 seconds;

3. 1-2 minutes.

26. Resuscitation measures will be more effective if they are carried out:

1. on a hospital bed;

2. on the sofa;

3. on the floor.

27. In the abbreviation of the ABC international rescue practice, the letter C denotes:

1. artificial lung ventilation (ALV);

2. control and restoration of airway patency;

3. external (indirect) cardiac massage (NMS).

28. Closed liver injury is characterized by:

1. pain in the right side;

2. pain in the left side;

29. For a closed injury of the spleen, the following is typical:

1. pain in the right side;

2. pain in the left side;

3. pain in the right inframammary region.

30. In case of damage to the hollow organs of the abdomen, there are the following signs:

1. sharp pains behind the sternum, a rare pulse;

2. sharp pains spreading throughout the abdomen, "plank-shaped abdomen", rapid pulse, shortness of breath;

3. sharp pains in the right inframammary region, hemoptysis.

The content of the article

The incidence of gunshot wounds in the abdomen overall structure wounds in the Great Patriotic War ranged from 1.9 to 5%. In modern local conflicts, the number of abdominal wounds has increased to 10% (M. Ganzoni, 1975), and according to D. Renault (1984), the number of wounded in the abdomen exceeds 20%.

Classification of abdominal wounds

Depending on the type of weapon, wounds are divided into bullet, shrapnel and inflicted with cold steel. First world war shrapnel wounds of the abdomen amounted to 60%, bullet wounds - 39%, wounds inflicted by cold weapons - 1%.
During the Second World War, shrapnel wounds to the abdomen were 60.8%, bullet wounds - 39.2%. During the military operations in Algeria (A. Delvoix, 1959), zero wounds were noted in 90% of the wounded, shrapnel - in 10%.
According to the nature of damage to tissues and organs of the abdomen, wounds are divided into:
I. Non-penetrating wounds:
a) tissue damage abdominal wall,
b) with extraperitoneal damage to the pancreas, intestines, kidneys, ureter, Bladder.
II. Penetrating wounds of the abdominal cavity:
a) without damage to the abdominal organs,
b) with damage to hollow organs,
c) damaged parenchymal organs,
d) with damage to hollow and parenchymal organs,
e) thoracoabdominal and abdominothoracic,
e) combined with injury to the kidneys, ureter, bladder,
g) combined with injury to the spine and spinal cord.
Non-penetrating wounds of the abdomen without extraperitoneal damage to organs (pancreas, etc.) are in principle classified as mild injuries. Their nature depends on the size and shape of the wounding projectile, as well as on the speed and direction of its flight. With a flight path perpendicular to the surface of the abdomen, bullets or fragments at the end can get stuck in the abdominal wall without damaging the peritoneum. Oblique and tangential wounds to the abdominal wall can be caused by projectiles with high kinetic energy. In this case, despite the extraperitoneal passage of a bullet or a fragment, there may be severe bruises of the small or large intestine, followed by necrosis of a section of their wall and perforative peritonitis.
In general, with gunshot wounds only of the abdominal wall clinical picture milder, but there may be symptoms of shock and symptoms of a penetrating injury to the abdomen. In the conditions of the MPP, as well as the admission and sorting department of the OMedB or hospital, the reliability of diagnosing an isolated injury to the abdominal wall is reduced, so any injury should be considered as potentially penetrating. Medical tactics at the WFP is reduced to the urgent evacuation of the wounded in the OMedB, in the operating room they conduct an audit of the wound in order to establish its true nature.
During the Great Patriotic War penetrating wounds of the abdomen were 3 times more common than non-penetrating ones. According to American authors, in Vietnam penetrating wounds of the abdomen occurred in 98.2% of cases. Injuries where a bullet or shrapnel does not damage an internal organ are extremely rare. During the Great Patriotic War, in 83.8% of the wounded operated on the abdominal cavity, damage to one or several hollow organs was found at the same time. Among the parenchymal organs in 80% of cases, there was damage to the liver, in 20% - to the spleen.
In modern local conflicts of the 60-80s with penetrating wounds of the abdomen, damage to hollow organs was observed in 61.5%, parenchymal organs in 11.2%, combined injuries of hollow and parenchymal organs in approximately 27.3% (T. A. Michopoulos, 1986). At the same time, in case of penetrating wounds of the abdomen in 49.4%, the inlet was located not on the abdominal wall, but in other areas of the body.
During the Great Patriotic War, shock was observed in more than 70% of those wounded in the stomach. During the operation, 500 to 1000 ml of blood was found in the abdomen of 80% of the wounded.

Abdominal Injury Clinic

The clinic and symptoms of penetrating gunshot wounds of the abdomen are determined by a combination of three pathological processes: shock, bleeding and perforation of a hollow organ (intestine, stomach, bladder). In the first hours, the clinic of blood loss and shock dominates. After 5-6 hours from the moment of injury, peritonitis develops. Approximately 12.7% of the wounded have absolute symptoms of penetrating abdominal injuries: prolapse of the viscera from the wound (omentum, intestinal loops) or outflow from the wound channel of fluids corresponding to the contents abdominal organs(bile, intestinal contents). In such cases, the diagnosis of a penetrating wound of the abdomen is established at the first examination. In the absence of these symptoms accurate diagnosis penetrating wounds in the abdomen at the MPP is difficult due to the serious condition of the wounded, due to the delay in removal from the battlefield, unfavorable weather conditions(heat or cold in winter time), as well as the duration and traumatic nature of transportation.
Features of the clinical course of injuries of various organs

Injuries of parenchymal organs

For injuries of parenchymal organs, abundant internal bleeding and accumulation of blood in the abdomen. At penetrating wounds diagnosis of the abdomen is helped by the localization of the inlet and outlet. By mentally connecting them, one can roughly imagine which organ or organs were affected. With blind wounds of the liver or spleen, the inlet is usually localized either in the corresponding hypochondrium or, more often, in the region of the lower ribs. The severity of the symptom (including blood loss) depends on the size of the damage caused by the injuring projectile. In case of gunshot wounds of the abdomen from the parenchymal organs, the liver is most often damaged. In this case, shock develops, in addition to blood, bile is poured into the abdominal cavity, which leads to the development of an extremely dangerous biliary peritonitis. Clinically, spleen injuries are manifested by symptoms of intra-abdominal bleeding and traumatic shock.
Injuries to the pancreas are rare - from 1.5 to 3%. Simultaneously with the pancreas, nearby organs are often damaged. large arteries and veins: celiac, superior mesenteric artery etc. There is a great danger of developing pancreatic necrosis due to vascular thrombosis and exposure to the damaged gland of pancreatic enzymes. Thus, in the clinic of pancreatic injuries in different periods either symptoms of blood loss and shock, or symptoms of acute pancreatic necrosis and peritonitis prevail.

Hollow organ injuries

Wounds of the stomach, small and large intestines are accompanied by the formation of one or more (with multiple wounds) holes of various sizes and shapes in the wall of these organs. Blood and gastrointestinal contents enter the abdominal cavity and mix. Blood loss, traumatic shock, large outflow of intestinal contents suppress the plastic properties of the peritoneum - generalized peritonitis occurs before the delimitation (encapsulation) of the damaged area of the intestine has time to develop. When revising the large intestine, it must be borne in mind that the inlet in the intestine can be located on the surface covered with the peritoneum, and the outlet - on areas not covered by the peritoneum, i.e., retroperitoneally. Unnoticed exit holes in the colon lead to the development of fecal phlegmon in the retroperitoneal tissue.
Thus, in case of gunshot wounds of hollow organs in the wounded, the symptoms of traumatic shock dominate in the first hours, and after 4-5 hours, the peritonitis clinic prevails: abdominal pain, vomiting, increased heart rate, tension in the muscles of the abdominal wall, abdominal pain on palpation, gas retention, flatulence, cessation of peristalsis, Shchetkin-Blumberg symptom, etc.

Injuries of the kidneys and ureters

Injuries to the kidneys and ureters are often combined with injuries to other organs of the abdomen, so they are especially difficult. In the perirenal and retroperitoneal tissue, blood mixed with urine quickly accumulates, forming hematomas and causing an increase in the posterolateral sections of the abdomen. Urinary infiltration of hematomas is accompanied by the development of paranephritis and urosepsis. Haematuria is constant in kidney injuries.
Clinically, injuries of the ureters on the first day do not manifest themselves in any way, later symptoms of urinary infiltration and infection appear.
Shock, bleeding and peritonitis not only form the clinic early period gunshot wounds of the abdomen, but also play a crucial role in the outcome of these severe wartime wounds.

Medical care for gunshot wounds of the abdomen

First aid

First aid on the battlefield (in the lesion): a quick search for the wounded, applying a large stomach to the wound (especially when bowel loops, omentum fall out of the wound) wide aseptic dressing. Each fighter must know that it is impossible to set the insides that have fallen out of the wound. The wounded man is given analgesics. In case of combined injuries (wounds), appropriate medical care is provided. For example, with a combined injury to the abdomen and damage to a limb, it is produced transport immobilization etc. Evacuation from the battlefield - on a stretcher, with a large blood loss - with the head end lowered.

First aid

Pre-hospital care (MPB) is somewhat wider than the activities of the first medical care. Fix the previously applied bandage. The bandage applied to the LSB should be wide - cover the entire abdominal wall, immobilizing. Enter analgesics, cardiac drugs, warm and provide gentle transportation to the MPP on a stretcher.

First aid

First medical aid (MPP). Main urgent measures aimed at ensuring the evacuation of the wounded to the next stage of evacuation in as soon as possible. During triage divide the wounded in the stomach into 3 groups:
I group- wounded in condition moderate. Fix bandages or put on new ones, administer antibiotics, tetanus toxoid and morphine hydrochloride. The fallen out insides do not set. With sterile tweezers, carefully lay sterile gauze pads between the loops of the intestines and the skin and cover them with large dry gauze compresses on top so as not to cause cooling of the intestinal loops along the way. Compresses are fixed with a wide bandage. In cold weather, the wounded are covered with blankets, covered with heating pads; cooling exacerbates the shock. These wounded are evacuated first of all by ambulance transport (preferably by air), in the supine position with bent knees, under which a roller should be placed from a blanket, overcoat or pillowcase stuffed with straw.
II group- wounded in serious condition. To prepare for evacuation, anti-shock measures are performed: pararenal or vagosympathetic blockades, intravenous administration polyglucin and painkillers, respiratory and cardiac analeptics, etc. When the condition improves, they are urgently evacuated by ambulance to the stage of qualified surgical care. WFP personnel should know that in case of abdominal wounds, you can neither drink nor eat.
III group- the wounded remain at the MPP terminal state for care and symptomatic treatment.

Qualified medical care

Qualified medical care (OMedB). In OMedB, where qualified surgical care, according to indications, all those wounded in the stomach are operated on. Critical Role belongs to medical triage. Not the timing from the moment of injury, but general state the patient and the clinical picture should determine the indications for surgery.
The principle: the shorter the period before the operation of the wounded with a penetrating wound of the abdomen, the greater the chances of a favorable success, does not exclude the correctness of another principle: the more severe the condition of the wounded, the more danger most operating injury. These contradictions are resolved by carrying out a thorough medical sorting of the wounded in the stomach, in which distinguish the following groups:
I group- Wounded with symptoms of ongoing massive intra-abdominal or intra-pleural (with thoraco-abdominal wounds) bleeding are immediately sent to the operating room.
II group- wounded without clear signs of internal bleeding, but in a state of shock II-III degree are sent to an anti-shock tent, where for 1-2 hours antishock therapy. In the process of treating shock, two categories of victims are distinguished among those temporarily inoperable: a) the wounded, who managed to achieve sustainable recovery of the most important vital functions with a rise in blood pressure up to 10.7-12 kPa (80-90 mm Hg). These wounded are sent to the operating room; b) wounded without clear signs of internal bleeding requiring urgent surgical treatment in whom it was not possible to restore the disturbed functions of the body, and arterial pressure remains below 9.3 kPa (70 mmHg). They are recognized as inoperable and are sent for conservative treatment to the hospital department of the OMedB.
III group- late delivered wounded, whose condition is satisfactory, and peritonitis tends to be limited - they are sent to the hospital for observation and conservative treatment.
IV group- wounded in a terminal condition, they are sent to the hospital department for conservative treatment.
Group V- wounded with non-penetrating wounds of the abdomen (without damage to internal organs). Tactics in relation to this category of the wounded largely depends on the medical and tactical environment in which the OMedB operates. As noted, any injury to the abdominal wall in the MPP and in the OMedB should be considered as potentially penetrating. Therefore, in principle, in the OMedB, if conditions permit (a small flow of the wounded), each wounded person in the operating room should have an audit of the wound of the abdominal wall in order to visually verify the nature of the wound (penetrating or non-penetrating). In case of a penetrating wound, the surgeon is obliged, having completed the primary surgical treatment of the wound of the abdominal wall, to make a mid-median laparotomy and make a thorough revision of the abdominal organs.
In an unfavorable medical and tactical situation, after indications of medical care (antibiotics, painkillers), the wounded should be urgently evacuated to the VPG.
Principles of surgical treatment of penetrating gunshot wounds of the abdomen

Surgery

Surgical treatment of gunshot wounds of the abdomen is based on the following firmly established provisions:
1) surgical intervention, performed no later than 8-12 hours from the moment of injury, can save the wounded with a penetrating wound of the abdomen and damage to internal organs;
2) the results of surgical treatment will be the better, the shorter this period, say, 1-1.5 hours, i.e. before the development of peritonitis, which is possible during the evacuation of the wounded from the battlefield or from the MPP by air (helicopter) transport;
3) on the WFP of the wounded with ongoing intra-abdominal bleeding delay for transfusion therapy is impractical, therefore, resuscitation, including transfusion therapy, during transportation of the wounded by air or ground transport is highly desirable and necessary;
4) medical institutions where surgical care is provided to the wounded with penetrating abdominal wounds (OMedB, SVPKhG) should be staffed with a sufficient staff of highly qualified surgeons with experience in abdominal surgery;
5) operations for penetrating wounds of the abdomen should be provided with perfect anesthesia and adequate transfusion therapy. Preferable endotracheal anesthesia with the use of muscle relaxants and the use of novocaine solution to block the reflexogenic zones in the process surgical intervention;
6) laparotomic incision should provide access to all parts of the abdominal cavity, the technique of operations should be simple to perform and reliable in terms of the final result;
7) operations on the abdominal organs should be short in time. To do this, the surgeon must quickly and well navigate in the abdominal cavity and have a good command of the technique of surgery on the abdominal organs;
8) after the operation, the wounded in the stomach become non-transportable for 7-8 days; 9) peace, care, intensive therapy should be provided where a laparotomy was performed on a wounded person in the abdomen.
FROM technical side operations with penetrating wounds of the abdomen have some features. First of all, the actions of the surgeon should be aimed at finding the source of bleeding. Usually it is accompanied by damage (injuries) to the liver, spleen, mesentery, small and large intestines, less often - the pancreas. If, in the process of searching for a damaged vessel, a wounded intestinal loop is found, it should be wrapped in a damp cloth, stitched with a thick thread through the mesentery, withdraw the loop from the wound to the abdominal wall and continue the revision. The source of bleeding can be primarily parenchymal organs (liver and spleen). The way to stop bleeding depends on the nature of the damage. With cracks and narrow wound channels of the liver, plastic closure of the damaged area with a strand of the omentum on the leg can be performed. With tweezers, a strand of the omentum is inserted into the wound or crack, like a tampon, and the omentum is fixed to the edges of the liver wound with thin catgut or silk sutures. Also come with small wounds of the spleen and kidneys. With more extensive wounds, liver ruptures, individual large vessels and bile ducts should be tied up, non-viable areas removed, U-shaped sutures should be applied with thick catgut, and before they are tied into the liver wound, a pedunculated omentum should be placed. When the pole of the kidney is torn off, the wound should be economically excised and sutured with catgut sutures, using as plastic material strand of gland on the leg. With extensive destruction of the kidney and spleen, it is necessary to remove the organ.
Another source of bleeding is the vessels of the mesentery, stomach, omentum, etc. They are ligated according to general rules. In any case, attention should be paid to the condition of the retroperitoneal tissue. Sometimes a retroperitoneal hematoma empties into the abdominal cavity through a defect in the parietal peritoneum. The blood poured into the abdominal cavity must be carefully removed, since the remaining clots can be the basis for the development of a purulent infection.
After the bleeding has stopped, the surgeon should proceed with the revision gastrointestinal tract to find out all the damage caused by a firearm wounding projectile, and to make a final decision on the nature of the operation. Inspection begins with the first encountered damaged loop of the intestine, from it they go up to the stomach, and then down to the rectum. The inspected loop of the intestine should be immersed in the abdominal cavity, then another loop is removed for inspection.
After a thorough examination of the gastrointestinal tract, the surgeon decides on the nature of the surgical intervention: sewing up minor holes in the stomach or intestines, resection of the affected area and restoration of the patency of the intestinal tube, resection of the affected area small intestine and the imposition of an anastomosis "end to end" or "side to side", and in case of damage to the large "intestine, bringing its ends outward, fixing to the anterior abdominal wall like a double-barreled unnatural anus. If this fails, then only the end of the proximal segment of the large intestine is brought to the anterior abdominal wall, and the end of the distal segment is sutured with a three-row silk suture. In the indicated cases (wounds of the rectum), they resort to the imposition of an unnatural anus to the sigmoid colon.
Each of the methods has its indications. With minor and rarely located holes in the intestine, they are sutured only after economical excision of the edges of the inlet and outlet holes. Resection is performed with large wound openings and its complete breaks, with separation of the intestine from the mesentery and injury of the main vessels of the mesentery and in the presence of several closely spaced holes in the intestine. Resection of the intestine is a traumatic operation, so it is performed according to strict indications. In order to combat increasing intoxication, intestinal paresis and peritonitis, intestinal decompression is performed (transnasal through appendicocecostomy, cecostomy -small intestine; transnasal and transanal (unnatural anus) - thin and colon). At the same time, the abdominal cavity is widely drained according to Petrov. The elimination of the fecal fistula is carried out in the SVPCHG. The issue of drainage of the abdominal cavity is decided individually.
After laparotomy, the wound of the anterior abdominal wall is carefully sutured in layers, since the wounded in the abdomen in the postoperative period often have a divergence of the abdominal wound and intestinal eventration. To avoid suppuration subcutaneous tissue and phlegmon of the anterior abdominal wall, skin wound are usually not sewn up.
Most frequent complications in postoperative period those wounded in the stomach have peritonitis and pneumonia, so their prevention and treatment is given priority.

Specialized medical care

Specialized medical care in the GBF is carried out in specialized hospitals for those wounded in the chest, abdomen, and pelvis. It provides full clinical and x-ray examination and treatment of the wounded, as a rule, already operated on for gunshot wounds of the abdomen at the previous stage medical evacuation. Treatment includes repeated operations about peritonitis and subsequent conservative treatment, opening of abscesses of the abdominal cavity, surgery intestinal fistulas and other reconstructive operations on the gastrointestinal tract.
The prognosis for gunshot wounds of the abdomen in our time remains difficult. According to N. Mondor (1939), postoperative mortality in those wounded in the stomach is 58%. During the events on Lake Khasan, the mortality rate among those operated on was 55% (M. N. Akhutin, 1942). During the Great Patriotic War, mortality after abdominal surgery was 60%. In modern local wars, thoracoabdominal wounds give 50% of mortality, isolated abdominal wounds - 29% (K. M. Lisitsyn, 1984).
With combined radiation injuries surgical treatment of gunshot wounds of the abdomen begins at the stage of qualified medical care and must be combined with treatment radiation sickness. Operations should be simultaneous and radical, since as radiation sickness develops, the risk increases sharply infectious complications. In the postoperative period, a massive antibiotic therapy, transfusion of blood and plasma substitutes, the introduction of vitamins, etc. With combined combat injuries of the abdomen, the terms of hospitalization should be extended.

Abdominal injury may be open and closed. They occur when hitting the steering wheel or when injured by objects with sharp edges.
Closed abdominal trauma: with or without damage to internal organs.
Abdominal injury:
- penetrating wounds with or without damage to internal organs.
- non-penetrating wounds.
Reliable signs penetrating wound:
- prolapsed abdominal organs are visible in the wound.
- intestinal contents or bile flow from the wound.
During the first aid phase, abdominal trauma considered to be penetrating.
At strong blow there may be damage to the abdominal organs:
- parenchymal organs (liver, spleen, kidneys);
- hollow organs (stomach, intestines, bladder);
- large blood vessels (abdominal aorta, inferior vena cava) and vessels of organs (intestines, stomach, liver, spleen).
suspect damage to the hollow organs of the abdominal cavity possible if the following symptoms are present:
- strong acute (" dagger") pain;
- later - spilled Blunt pain all over the stomach;
- vomiting, thirst;
- forced position on its side, legs tucked to the stomach (“embryo position”);
- the abdomen may be swollen, painful, hard "like a board."
In case of damage (trauma) of hollow organs, their contents flow into the abdominal cavity and cause life-threatening inflammation of the abdominal cavity - peritonitis.
Damage (trauma) parenchymal organs(liver, spleen, kidneys) and blood vessels of the abdominal cavity dangerously increasing latent blood loss.
suspect internal bleeding into the abdominal cavity if the following symptoms are present:
- pale, cold, moist skin;
- violation of consciousness from arousal to unconsciousness;
- frequent, shallow or irregular breathing;
- the pulse is quickened, it is difficult to determine due to a pronounced decrease in blood pressure;
- with very large blood loss, there may be a slowing of the pulse.
recognize damage to internal organs, especially in the first minutes after the injury, is quite difficult and such victims require speedy evacuation from the scene for a thorough examination and observation in a surgical hospital.
What is in our stomach?

First aid for abdominal trauma

Do not forget about the observance of the main principles of the provision of PP:
- make sure it's missing additional danger for yourself and the victim;
- call the ambulance service;
- swipe if necessary resuscitation or stop bleeding
- inspect the victim for other, less dangerous injuries;
- provide first aid depending on the nature of the injuries found;
- prepare the victim for transportation;
- keep constant monitoring of his condition until the arrival of qualified medical personnel.
First aid for closed injury
Pulse at the wrist is palpable, affected in the mind, complaints of severe pain:
- lay on your back with a raised shoulder-head end and a roller under half-bent knees (photo 125).
- in case of vomiting - lay on one side.
- "cold" on the stomach.
The pulse on the wrist is not palpable:
- lay on your back, raising your legs 30-40 cm (photo 126).
- in case of vomiting - lay on one side.
- "cold" on the stomach.
- self-transportation to medical institution admissible only if the ambulance is expected to arrive later than 30 minutes!
First aid for abdominal wounds
- Give the victim a position in accordance with the severity of the injury.
Apply a sterile, wet dressing to the wound.

Forbidden!
- give water to the victim.
- Reposition prolapsed organs into the abdominal cavity.
- remove foreign bodies from the abdominal cavity.
- impose pressure bandage on prolapsed organs.
- apply "cold" to the prolapsed organs.

First aid algorithm

Indications:

Closed injury: strong pain in the abdomen, symptoms of shock. Muscle tension in the anterior abdominal wall.

Open trauma: severe pain in the abdomen, symptoms of shock. Muscle tension in the anterior abdominal wall. A wound in the area of the abdominal wall from which blood, feces, bile, urine flows, bowel loops fall out.

Assistance sequence:

Closed injury: cold on the stomach. Transport on a stretcher on the back. Place a roller with a diameter of 10-12 cm under the knees. Sodium etamsylate 2, 0. in / m, cardiomin 2.

It is forbidden! Administer pain medication. Give to drink.

Open trauma: do not remove anything from the wound, do not set the intestines. Put a cotton-gauze bagel around the fallen out loops of the intestine. Apply a wide, non-tight bandage. Anesthetize with promedol 2% - 2. Transport on a stretcher on the back, under the knees with a roller with a diameter of 10 cm. Oxyenotherapy. Sodium etamsylate 2, cardiomin 2. It is forbidden! Give to drink.

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Any injury to the abdomen is always considered dangerous, since internal organs may be affected, and it is impossible to determine this at first glance, as well as assess the severity of the injury.

Therefore, the first aid to the victim is always the same, regardless of the type of injury (gunshot, knife, etc.). But providing assistance in the presence of a foreign body or protruding organs has some differences from the general algorithm.

Brief instructions for assistance

Especially important point when injured in the abdomen, which must be taken into account when providing first aid, is that the victim is strictly forbidden to give food and drink, even if he asks for it. It is only allowed to wet his lips with clean water and, if necessary, you can rinse your mouth without swallowing water.

Oral medications, including painkillers, should also not be given. As for painkillers, they cannot be given to a person on their own when the abdomen is wounded.

First aid for a wound in the abdomen is as follows:

First aid for penetrating wounds of the abdomen

If a person has a wound in the abdomen, it is important to immediately assess the situation. If an ambulance can arrive at the scene within half an hour, then the first thing to do is call the doctors and then proceed to provide first aid.

If the ambulance can reach the victim for a long time, measures should be taken immediately. first aid, and then deliver the person to the nearest clinic on their own.

If a person is unconscious, this does not interfere with first aid, especially in the case of an open penetrating wound to the abdomen or any other part of the body. You should not try to bring him to his senses, you just need to lay him on a flat surface, bend your knees, put a roller of clothes under them and tilt the person’s head back, turning it to the side to ensure free passage of air.

No need to feel the wound on the stomach, and even more so try to find out its depth. by dipping a finger or hand into it. At gunshot wound examine the victim and determine possible presence bullet exit hole. If it is available, it must also be processed, as well as the input, and a bandage should be applied. If there are several wounds in the abdomen, then everything will be treated, starting with the largest and most dangerous injuries.

It is important to stop if it is profuse, for which it is necessary to correctly determine its type, after which the wounds should be treated and cleaned of dirt and blood.

For cleaning, you need to use a clean cloth, gauze, bandages soaked in hydrogen peroxide, any solution of an antiseptic or potassium permanganate (furatsilina). In the absence of such drugs, you can use any alcoholic beverage.

Cleaning of the wound is carried out in the direction away from the edges of the damage around the entire perimeter. The cloth should be soaked in the solution abundantly. In some cases, one treatment may not be enough for a complete cleaning. In this case, you will need another piece of cloth or bandage soaked in an antiseptic solution.

Can't fill antiseptic preparations into the wound, as well as water and other liquids. Contaminants should be removed only from the surface of the skin surrounding the wound and its edges.

If possible, the skin around the wound should be treated with brilliant green or iodine to prevent secondary infection. After that, you need to apply a bandage and deliver the victim to the clinic. During transport, an ice pack or other source of cold may be applied over the dressing.

Algorithm of actions in case of injury in the presence of a foreign body

First aid in this case is carried out according to the general algorithm, but it is important to take into account special points, as well as pay attention to a number of rules, non-compliance with which can lead to the death of the victim.

In case of a gunshot wound, if a bullet remains in the wound, in no case should you try to remove it yourself, as this can lead to the onset of serious bleeding, life threatening person.

The ban on extraction also applies to any other object in the wound, primarily to the one that was injured. Therefore, in no case should the knife be removed as part of first aid when knife wound in the abdomen or abdominal cavity. The traumatic object closes the damaged vessels, pinching them and holding back the bleeding. They can only be removed in the hospital, in the operating room, where doctors can provide assistance in any situation.

Assistance in the presence of organs falling out of the wound

The general algorithm for providing first aid in this case is also relevant, but has some special points that must be observed. First of all, if internal organs are visible when injured in the abdomen, it is necessary to evaluate general situation, such as how quickly an ambulance can get to the scene.

If a team of doctors can reach the victim within half an hour, then the first thing to do is to call ambulance and then begin first aid measures. If doctors need more time, they should immediately begin to provide assistance, and then deliver the person to the clinic on their own or passing transport.

If a person with a wounded stomach is unconscious, it is necessary to tilt his head back and turn it slightly to the side so that air freely enters the lungs.

If the internal organs have fallen out of the wound on the abdomen, in no case should you push them back and try to set them back into the abdominal cavity. If there are several organs that have fallen out (or the intestines have fallen out), it is necessary to move them as close as possible to each other so that the area occupied by them is minimal. After that, as carefully and very carefully as possible, all organs should be placed in a piece of clean tissue or a clean bag, the edges of which must be glued with a plaster or ordinary tape to the victim's skin around the wound.

It is very important to isolate the prolapsed organs from any environmental influences and protect them from possible damage.

If it is impossible to isolate the fallen organs in this way, the procedure is carried out a little differently. You should prepare several rollers of clean cloth or bandages, cover the fallen organs with them and cover them on top with a piece of gauze or a clean cloth. After that, it is necessary to carefully and not tightly fasten the structure to the body of the victim at the site of the injury.

It is very important to take into account that the internal organs, when applying such a bandage, should not be squeezed even slightly, since this can lead to many complications.

After fixing the prolapsed organs in any of these ways, the victim should be given a normal sitting position, while his legs should be half-bent at the knees. Cold should be applied to the wound, but it is important that the ice pack be wrapped in a cloth or towel. After this, the victim must be wrapped in a blanket (this is mandatory). Transportation of a person with such a wound should be carried out in a sitting position.

During transportation to the clinic, it is important to constantly moisten the fallen organs with clean water, preventing them from drying out. If the organs are placed in a bag, then water can be poured inside from a conventional syringe. If they are in a tissue or under a special bandage, then it will be enough to periodically impregnate dressing water without drying out.

It is important to remember that the drying of the surface of the internal organs, caught in the air, will lead to their necrosis, due to which doctors will be forced to remove them. With necrosis, vital important organs death comes.