Gunshot wound to the shoulder. The victim has a through gunshot (bullet) wound to the right shoulder. Temporary stop of bleeding

In many films and books, where to create more strong effect, main character should be wounded but not killed, he is shot in the shoulder (usually about three or four inches (7-10 centimeters) down from the shoulder and a few inches (about 5 cm) from the armpit). This is usually quite painful and is accompanied by the presence of a large number blood, but the hero often has no trouble using the injured limb later (by "later" I mean no more than a few minutes). Are such stab wounds so dangerous? What consequences can they have (lung damage, artery ruptures, etc.), and how believable are such scenes in films?

Of course, it all depends on the injury. Is it possible to create such a plot so that the main character survives after receiving a bullet? I am sure that four out of five gunshot wounds will be non-fatal. Is there really a safe place on human body where can you shoot? Of course not. In one case out of five you will be killed.

Surviving a gunshot wound is often described as luck, but don't expect it to be a fluke. For example, the case of Kenny Vaughn from North Carolina. In 1995, an apparently seriously pissed former neighbor shot Kenny about 20 times at point-blank range: in the chest, groin, stomach and limbs. Probably a miracle happened, but Vaughn survived.

He got lucky? Undoubtedly, and even more than we can imagine. Undoubtedly his greatest success was that his assailant did not shoot him in the head - a bullet hit between the ears is three times more dangerous than hit anywhere else.

The second lucky coincidence was that the shooter was using a .22 caliber rifle, a relatively underpowered weapon. If the attacker had used, say, a Bushmaster assault rifle, the result would likely have been significantly different. Regular rifle bullets, 0.22 in size, produce an energy equal to a maximum of several hundred foot-pounds. While the .223 caliber Bushmaster rifles, being marginally larger in diameter, have greater mass and muzzle velocity, produce 1,300 foot-pounds of energy, enough to shatter bone and rip skin to shreds.

Only speaking of Vaughn's third lucky coincidence, we can say with certainty that it was "pure" luck. He received several chest wounds, and we know that 85 percent of deaths are due to bullet wounds to the head or body. In his case, however, none of the bullets struck any vital organs or major blood vessels, and two passed within less than an inch (2.5 cm) of the heart.

It follows from the above that, assuming the existence of randomness, a fictional character can plausibly survive a gunshot wound to the shoulder if the weapon is classified as a low probability weapon. lethal outcome, for example, small and medium pistols. I draw your attention to the fact that a low probability of death does not mean safe - in any case, mortality from pistol wounds is quite high and accounted for almost half of all American murders in 2011.

Writers, of course, speak of wounds in the shoulder as non-fatal, since there is no life in this part of the body. important organs. In fact, wounds to the shoulder are quite dangerous. The shoulder contains the subclavian artery, which is connected to the brachial artery ( main artery hands), as well as with the brachial plexus, large nerve bundle, which controls the function of the hand.

When injured in brachial plexus, the person is more likely to be unable to "walk" five minutes later. A study of 58 victims with gunshot wounds to the brachial plexus found that 51 of them needed follow-up surgery due to the injury. blood vessel, severe pain and loss motor function. Concerning subclavian artery, a study conducted at New Orleans Hospital found that four of the 16 seriously injured died and one lost an arm.

All this proves that shoulder wounds are quite dangerous. What happens in real world? My friend analyzed 79 articles about people who were shot in the shoulder in 2012. Here are the most memorable ones.

A nine-year-old Pennsylvania girl who wore a black and white Halloween costume was shot in the shoulder by a relative who mistook her for a skunk.

A California weightlifter claimed to have sustained his shoulder injury when he dropped a dumbbell on a 0.22 caliber round that suddenly went off.

After an argument with a salesman over the price of condoms, a Detroit convenience store clerk pulled out a gun and fired a warning shot into the shoulder of a rebellious customer, who later died.

The last guy was the exception. Since only three of the 79 shoulder wounds led to the death of the victim. Therefore, writers and directors can safely write and shoot films with scenes of injuries to the shoulder, without fear of accusations of fantasy.

First aid for gunshot wounds

Gunshot wounds (including multiple ones) in one area of the human body are called isolated; injuries of two or more areas of the body (head and limbs, head and chest, abdomen and limbs, etc.) are called combined.

Combined injuries are the most severe, and the mortality rate for some of them reaches 60-80%.

It is not possible to determine the extent and depth of the lesion at the first examination, therefore, victims with any gunshot wounds are subject to immediate hospitalization in a multidisciplinary surgical hospital.

HEAD WOUNDS

Features of gun wounds of the head in peacetime

In peacetime, craniocerebral gunshot wounds are much more diverse than gunshot wounds during the war. They are caused by firearms with service and non-service weapons (PM, AK, hunting rifles, self-propelled guns, gas weapon etc.), as well as non-firearms (guns for spearfishing, pneumatic guns, crossbows, etc.).

A feature of gunshot wounds of the skull and brain in peacetime is that the entrance wounds can be “point wounds” (2-3 mm in diameter), and the wound itself can be penetrating (for example, when wounded from a pneumatic weapon, shot or cut). In addition, there may be several such point penetrating wounds (when wounded by shot). The inlets themselves can be masked in the scalp, which makes their diagnosis difficult. When fired at close range or at close range, the shot charge inflicts a very severe wound, the wound is extensive and deep.

The peculiarities of head wounds include the fact that the vastness of the wound does not always indicate the severity of the injury: with a tangential or ricochet wound, the wound can be extensive, and brain damage is not as large as with a diametrical or radial wound.

The condition of patients is assessed by 3 parameters: by opening the eyes to sound and pain, verbal and motor responses to external stimuli.

During the initial examination, the patient's condition should be determined.

The most severe are explosive wounds, which, as a rule, are accompanied by shock. Traumatic shock in gunshot wounds of the head can occur against the background of an unconscious (coma) state.

Shock in most victims proceeds against the background of blood loss (both external and internal bleeding), so removing such a victim from shock is a very difficult task. Shock on the background of a head injury can occur with bradycardia (decrease in heart rate). This is a very formidable symptom, because. it may indicate the development of an intracranial traumatic hematoma requiring immediate surgical treatment.

Assistance in the prehospital stage

A victim with a head wound is taken out of shock in the same way as any other victim. He is given non-narcotic analgesics, non-steroidal anti-inflammatory drugs of analgesic action (analgin, aspisol, ketorolac, etc.).

Bone fragments protruding from the wound, foreign bodies should not be removed, since this can lead to severe bleeding (for example, from the venous sinuses), which cannot be stopped in an ambulance.

On the prehospital stage should be limited to applying to the wound aseptic dressing, with bleeding - pressing.

Transportation of victims

Metallic foreign intracranial bodies (bullets, lead castings, fragments, etc.) during transportation can be displaced both inside the skull and inside the brain. Therefore, the transportation of such wounded must be carried out with extreme caution. When transporting the wounded in a coma, he is laid on his side in order to prevent the penetration of vomit into the respiratory tract. The nose, mouth and throat of the victim should be sanitized from the contents (vomit, blood, etc.).

Victims with gunshot wounds to the head should be hospitalized in multidisciplinary hospital, which has a neurosurgical department and an on-duty neurosurgical service. In the absence of violations of consciousness, respiratory and circulatory functions, the wounded in the head can be taken to the emergency department of the hospital. The presence of the above violations is an indication for hospitalization of the victim in the intensive care unit.

WOUNDS OF THE NECK, CHEST, ABDOMEN AND PELVIS

In the affected civilian population of large cities, which, unlike military means, does not have individual armor protection, chest and (or) stomach wounds are most often observed. With such localization of wounds, damage often occurs to the border areas - the neck and pelvis. The nature of the emerging complications, measures to eliminate them and, in general, the volume of care at the prehospital stage for these types of injuries are practically the same.

Scope of assistance at the scene

As with any emergency pathology (disease, injury, poisoning), first of all, at the scene of the incident, the severity of the general condition of the victim should be assessed: the degree of impaired consciousness, breathing and hemodynamics.

In contrast to gunshot wounds of the skull, consciousness is practically not affected by gunshot wounds of other localization.

Respiratory disorders(obstruction of the upper respiratory tract)

Obstruction of the upper respiratory tract occurs when a large amount of blood enters the tracheobronchial tree from a gunshot wound of the lung or in case of injury to the facial skeleton, cervical or thoracic part of the trachea, bronchi. The cause of airway obstruction can also be vomit, foreign bodies (dentures).

Airway obstruction is eliminated mechanically. At the scene of the incident, the oral cavity is emptied with napkins.

With a sharp depression or lack of breathing, the victim must be provided with artificial respiration from the first minutes.

Sometimes at the prehospital stage (in the conditions of Moscow) there are indications for endotracheal intubation (for example, with continued bleeding from the nasopharynx, oral cavity and laryngopharynx, when it is impossible to maintain airway patency without inflating the cuff of the endotracheal tube).

blood loss

Massive ongoing bleeding can be external and/or internal.

External bleeding. Most often, it is observed from the outlet and can be quite intense, therefore, at the scene of the incident, the doctor should immediately examine the possible places of the outlets, which are often located on the opposite side of the body. External bleeding is stopped by tamponade with sterile wipes and the application of an aseptic dressing. The greatest difficulty in stopping external bleeding occurs with gunshot wounds to the neck. In such cases, a member of the finger in a sterile glove (or through a sterile napkin) with force presses the vascular bundle of the neck at the site of injury to the transverse processes of the cervical vertebrae, providing temporary hemostasis. Such compression should be constant, up to the transfer of the victim to the doctor on duty of the hospital. During long transportation, you have to change your hand or even a member of the duty team.

Internal bleeding. The first aid provider has almost no ability to influence the intensity of internal bleeding. The only effective measure to save such victims is surgical intervention, so it is necessary to deliver the victim to the surgical hospital as soon as possible.

The task of the caregiver is to ensure the safety of the transportation of the victim. It should be emphasized that the more time has passed since the injury, the less likely preservation of the erectile phase of shock: it is known that military field surgeons practically do not observe it (the erectile phase of shock is the initial phase, characterized by a sharp excitation of the central nervous system, speech and motor excitation, and the absence of a critical attitude to one's condition).

For any gunshot wound of the neck, chest, abdomen, pelvis, the use of painkillers is indicated. Priority should be given to intravenous administration of non-narcotic analgesics. Fentanyl can be used as a narcotic pain reliever. It should, however, be remembered that morphine depresses respiration, and fentanyl depresses consciousness.

A strong shockogenic effect on the wounded has a prolapse of internal organs in case of abdominal wounds, when from the wound abdominal wall a strand of the greater omentum or intestinal loops (intact or damaged) fall out. In such cases, after the use of painkillers, an aseptic dressing should be applied to the prolapsed organs, turning Special attention on the inadmissibility of compression of the prolapsed organs. Prolapsed organs cannot be repositioned.

Transportation of the wounded

Victims with gunshot wounds of the neck and abdomen are transported in a horizontal position, with gunshot wounds of the chest - in a half-sitting position, with gunshot fractures of the pelvis - in a horizontal position, but with rollers placed under the area of the knee joints.

The wounded with stable hemodynamics can be taken to the emergency department of the hospital, where the issue of the need for a preoperative examination will be resolved.

The victim with severe respiratory disorders and unstable hemodynamics should be taken directly to the operating room of the nearest multidisciplinary hospital. Hospitalization of the seriously injured intensive care unit is a serious mistake, because leads to loss of time, which can cost the life of the victim.

INJURIES OF THE MUSCLE-MOTOR APPARATUS

Features of gunshot wounds of the musculoskeletal system

Gunshot wounds of the musculoskeletal system, caused by bullets or shrapnel, are accompanied by severe blood loss due to extensive damage to soft tissues, bones and main vessels. The high energy of the injuring projectile causes fractures that are comminuted and finely comminuted in nature, often with secondary damage to bone fragments large vessels. Mine-explosive wounds are often accompanied not only by direct damage by fragments, but also by the secondary penetration of foreign bodies into the tissues of the extremities (chips, glass fragments, scraps of tissue). Removal of foreign bodies at the site of injury can cause additional vascular damage and increase blood loss. In case of gunshot injuries of the extremities, special attention must be paid to the nature of the damage - a blind or penetrating wound. This is due to the fact that the exit bullet hole can be located away from the inlet hole (on a different segment of the limb). Inadequate diagnosis can lead to an insufficiently complete stop of bleeding and aggravate general state injured during transport.

The scope of care at the prehospital stage

Even during the Great Patriotic War, the military medical doctrine of the treatment of gunshot wounds was formulated and put into practice. It includes the following provisions: all gunshot wounds are primarily infected; the only reliable method of preventing the development of infection is the timely surgical treatment of wounds; most of the victims need early primary surgical treatment of wounds; surgical treatment carried out in the first hours after injury provides a better prognosis. These provisions of the doctrine are unchanged at the present time, but the methods of their implementation have changed.

The medical tasks of providing assistance at the prehospital stage are: temporary stop of bleeding; limb immobilization; replenishment of blood loss and anesthesia.

Temporary stop of bleeding

A temporary stop of bleeding is achieved by pressing the damaged vessel in the wound or along the length, by applying pressure bandage, imposing a hemostatic tourniquet or clamp on the vessel, leaving it in the wound.

With venous bleeding, characterized by a slow outflow of blood of a dark cherry color, the imposition of a pressure aseptic bandage is indicated. In the case of deep damage to soft tissues, a tight tamponade of the wound is necessary with fixation of the tampon from above with a pressure bandage. Tamponade is absolutely contraindicated in wounds located in the axillary and popliteal fossae, since it can lead to severe limb ischemia.

In case of arterial bleeding, a symptom of which is a pulsating outflow of bright red blood from a wound, a certain sequence of manipulations is shown, including: clamping the vessel over, applying a tourniquet, applying a hemostatic clamp.

Finger pressure of the vessel throughout is necessary for wounds in the upper third of the shoulder and thigh, i.e. in areas where the imposition of a hemostatic tourniquet is not possible. Finger pressure is carried out until the delivery of the victim to the hospital.

Most effective method temporary stop of bleeding - the imposition of a hemostatic tourniquet. This manipulation is indicated only for massive arterial (not venous!) bleeding from the vessels of the limb. A tourniquet is applied above the site of bleeding and as close as possible to the wound. The rules for applying a tourniquet are as follows:

the place of application of the tourniquet is wrapped with a soft material (clothing, napkins, bandage);

the tourniquet is stretched and 2-3 turns are made around the limb, the ends of the tourniquet are fixed with a chain and crochet or tied in a knot;

the limb must be tightened until the bleeding stops completely. The correct application of the tourniquet is determined by the absence of pulsation in the peripheral vessels. Wrong overlay tourniquet can lead to increased venous bleeding;

the time of application of the tourniquet is indicated in a note attached to the victim's clothing and in the accompanying documents;

the tourniquet can be on the lower limb for no more than 2 hours, and on the upper - no more than 1.5 hours. In the cold season, these periods are reduced by 30 minutes.

The use of a band tourniquet carries the risk of developing limb compression with subsequent tissue ischemia, since it is impossible to determine the force of tourniquet pressure on soft tissues. Therefore, it is more expedient to use pneumatic or mechanical harnesses that allow you to create a strictly metered pressure that exceeds arterial pressure in a particular victim, no more than 10-20 mm Hg.

Transport immobilization

Immobilization is used to immobilize a part of the body for the period of removal of the victim from the scene. Immobilization of the injured limb should be performed not only for bone fractures, but also for extensive soft tissue injuries, which is an anti-shock measure. The methods of immobilization of injured limbs include the use of service and pneumatic splints. The basic rules for splinting are as follows: it is necessary to ensure the immobility of at least two nearby joints, giving the limb a functionally advantageous position; the tire is modeled according to the part of the limb on which it is applied; the tire should be applied to a soft pad (clothing) and fixed with bandages.

Emergency care for different localization damage

Scope of provision emergency care depends on the location of the damage.

Hand damage

Stop bleeding - the imposition of a pressure aseptic bandage, the elevated position of the limb. In the absence of the effect of these measures, a hemostatic tourniquet is applied to the forearm or to the hand. When the brush is crushed - immobilization with a splint.

Forearm injury

Stop bleeding - the imposition of a pressure aseptic bandage. Positional control of bleeding by flexion of the forearm in elbow joint(with localization of damage in the lower third - the middle third of the segment). A tourniquet may be applied to the forearm.

In case of damage to the forearm in the upper third and in the area of the elbow joint, the imposition of pressure bandages and immobilization in splints covering two segments of the limb (forearm and shoulder) are indicated. A tourniquet is applied to the lower third of the shoulder.

Shoulder injury

Stop bleeding - the imposition of a pressure aseptic bandage or hemostatic tourniquet. Clamping of blood vessels throughout by splinting. With continued bleeding, digital clamping of the main vessels of the armpit region, as well as the use of rollers from improvised materials for this purpose with fixation of the injured limb to the chest.

Foot injury

Stop bleeding - the imposition of a pressure aseptic bandage. When the foot is crushed - immobilization with a splint.

Shin injury

Stop bleeding - the imposition of a pressure aseptic bandage. Immobilization of the limb with splints.

Hip injury

Stop bleeding - the imposition of a pressure aseptic bandage or hemostatic tourniquet. Immobilization: a) fixation to a healthy limb; b) the imposition of tires; Due to significant blood loss in this type of damage, antishock therapy is indicated.

Pelvic bone injury

The attitude to first aid in case of gunshot injuries of the pelvic area should be based on the fact that often this injury is combined and is accompanied by damage to internal organs.

Transportation of the victim must be carried out in the supine position with a roller in the popliteal areas.

Spinal injury

Diagnosis of spinal injury at the prehospital stage is a difficult task, accompanied by additional trauma and delays the timely delivery of the victim to the hospital.

With localization of external damage in the projection of the spine and low blood pressure, immobilization is necessary (on the back, on a rigid stretcher).

Transportation of victims

A gunshot injury requires the fastest delivery of the victim to a specialized medical institution. The course and outcome of the lesion depend on how quickly and how correctly assistance is provided.

At isolated damage hand, it is necessary to transport the victim to a hospital with a specialized department of hand surgery; in case of damage to other localizations - delivery to a multidisciplinary medical institution with a trauma department.

If the wounded person has shock and severe blood loss due to arterial bleeding, which required the application of a hemostatic tourniquet, the victim should be transported directly to the operating unit. The presence of shock and venous bleeding, stopped by a pressure bandage, is an indication for the delivery of the wounded to the intensive care unit.

Magazine NSB "Keeper"

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Weapon wounds in peacetime are even more diverse than in war time. Gunshot wounds are inflicted intentionally or through careless handling of a machine gun, a hunting rifle, a gas pistol, a self-propelled gun. This group also includes damage by non-firearms: pneumatic guns, crossbows, spearguns, etc.

The peculiarity of such lesions is that the inlets are often pinpoint, with a small diameter (2-3 mm), and the gunshot wound itself often occurs with a hit in the cavity.

In addition, there are several point injuries, for example, when hit by a shot, which makes it difficult to provide assistance. When fired from close range or point-blank range, the damage is wider and deeper.

Brief first aid instructions

First aid for gunshot wounds is urgently regardless of which part of the body is damaged and which striking element caused damage: buckshot, shot, bullet, shell fragment.

Before providing assistance, it is necessary to correctly assess the condition of the victim, the severity and severity of the wound, the nature of the injury, the type of gunshot wound. The course and outcome of the injury will depend on how quickly and correctly assistance was provided.

First aid for a gunshot wound includes the following:

wait medical team, constantly talking with the person, if the ambulance arrives no earlier than in half an hour, ensure the transportation of the victim to the hospital on their own. Next, we will consider in detail some of the types of gunshot wounds: bullet wounds of the arms and legs, chest, head, spine and neck, abdomen.

First aid for injured hands and feet

The main thing that they pay attention to in gunshot wounds of the extremities is the presence of bleeding.

If the femoral or brachial artery is damaged, a person loses consciousness in 10-15 seconds, death from blood loss occurs in 2-3 minutes - therefore, immediate first aid is necessary.

It is important to determine the type of bleeding: bright, scarlet, gushing from the wound in a pulsating stream. the blood is dark, burgundy in color, flows from the wound with less intensity. When blood seeps out of the wound in drops, resembling a sponge.

First aid measures for gunshot wounds to the arms and legs:

In case of bleeding from the arteries, apply a twist above the wound indicating the exact time;
At profuse bleeding from a vein, you can also either twist below the wound or apply a pressure bandage.

Features of applying a pressure bandage

In case of a gunshot wound of the extremities, when applying a pressure bandage, it is necessary:

In place of the hearth, you need to put a 4-layer napkin;
Fix the fabric on the limb with three rounds of gauze bandage;
Use a pressure pillow, apply it from above so that it covers the edges of the wound;
Fix the roller with a bandage, the bandage should be applied with a tight pressure so that the blood stops;
The pressure pad should be in the form of a dense tight roller, in its absence, use any means at hand;
If the wound is foreign object, it is impossible to apply a bandage until it is removed.

The injured person must be given a body position in which the limbs will be above the level of the heart.

In some situations, with bullet wounds, tamponade is used to stop the blood. For this manipulation, the wound hole is stuffed with sterile dressing material using a thin long object.

The second important circumstance for any injuries of the arms or legs is the presence of fractures.. When a fracture is present, any movement of the limbs should be excluded before the arrival of doctors, since the sharp edges of the bone further damage the soft tissues and blood vessels.

How to transport the victim?

If you plan to deliver the victim to a medical facility on your own, you must transport immobilization limbs, for this use any improvised means.

The tire is applied, capturing two adjacent joints, and secured with bandages or any tissue.

Gunshot wounds to the chest

A gunshot to the chest refers to difficult circumstances and is accompanied by shock and complications. Fragments, ricochet bullets cause destruction of the ribs, sternum, shoulder blades, damage the lungs, pleura.

Fragments of bones penetrate deeply into the tissues of the lungs, pneumo- and / or hemothorax is possible.

When organs inside the chest are damaged, blood fluid does not always flow out, sometimes it accumulates there, so it is difficult to judge damage to blood vessels in gunshot wounds.

Hemothorax

When blood enters the chest cavity, hemothorax occurs, blood interferes with breathing, disrupts the function of the heart, since the volume of the chest has a limit, and blood occupies the entire volume.

Pneumothorax

Through the wound, air seeps into the pleura, the presence of a constant communication with the atmosphere causes open pneumothorax. Sometimes the inlet of the wound is clamped, then the open pneumothorax turns into a closed one.

There is also a pneumothorax with a valve, when air freely enters the chest cavity, its return is prevented by a valve, which was formed as a result of a gunshot wound.

When providing the first medical care in case of a gunshot wound to the chest, the condition of the person and the nature of the wound must be taken into account:

If the bullet hit the heart, one can assume the most worst case . By outward signs the victim - the person quickly loses consciousness, the face acquires an earthy hue - it immediately becomes clear what happened, but death does not always occur.

Rapid delivery of the victim to the doctors, where he will be drained, sutured in a heart wound, can save a life.

Help with a head injury

When a person loses consciousness with a gunshot wound to the head, it is not necessary to bring him out of a swoon, you cannot waste time on this. All actions should be aimed at stopping the blood, for this you need to put a piece of a sterile bandage folded in several layers on the wound and tightly wrap it around your head.

At heavy bleeding head wound dressing should be pressure, using a dense pad that presses the soft tissue against the skull.

Then you should give the person lying position on a hard plane, ensure peace and wait for the arrival of doctors.

When shooting the head, breathing often stops, the heart stops.. In such situations, the victim must indirect massage hearts and artificial respiration It is not recommended to take the victim to a medical institution on your own.

Gunshot wound to the spine and neck

When the spine is damaged by a weapon wound, a short loss of consciousness occurs. Help with wounds spinal column is to stop the blood and provide rest for the person. It is undesirable to move the victim, to independently transport him to a medical institution.

Bullet wounds of the neck are often accompanied by a violation of the integrity of the larynx, as well as damage to the cervical arteries.

In the event of a wound in the neck, the bleeding must be stopped immediately., carotid artery press with fingers, or apply a pressure bandage using the victim's hand, which is raised up, then wrapped around the neck with the hand.

Sometimes the neck, larynx, and spine are simultaneously affected. Help in these situations comes down to stopping the bleeding and providing peace to the victim.

First aid for a wound in the stomach

The gunshot of the abdomen includes three pathologies:

Bleeding;
perforation hollow organs(stomach, Bladder, intestines).

If the organs fell out, you can not put them back into the stomach, they are lined with tissue rollers, then they are bandaged. The peculiarity of the dressing is that it should always be in a wet state, for this it must be watered.

To reduce pain, cold is placed over the bandage on the wound. When the bandage is soaked through, the blood begins to ooze out, the bandage is not removed, but a new bandage is made over the old one.

When wounded in the stomach, you can’t drink and feed the victim, you also can’t give him medicines through the mouth.

All gunshots of the abdomen are considered to be primary infected, must be made antiseptic treatment gunshot wound and primary surgical treatment, which is done in the first hours after injury. These activities provide the best further prognosis.

When injured, the abdomen sometimes suffers parenchymal organs e.g. liver. The victim experiences shock, in addition to blood, bile flows into the abdominal cavity, bile peritonitis occurs. The pancreas, kidneys, ureters, and intestines also suffer. Often, along with them, adjacent ones are damaged. large arteries and veins.

After providing first aid, the victim is taken to a medical facility, where he is provided with qualified and specialized medical care.

During the years of the Great Patriotic War gunshot wounds shoulder joint accounted for 24% among injuries of large joints, in local military conflicts of recent decades - 14%. They are characterized by significant damage to soft tissues (66.5%), articular parts of bones (37.2%), large vessels and nerves (7.8%), a high frequency of general (12.8%) and purulent (30.4%) ) complications.

Depending on the nature of the damage, there are puncture wounds of soft tissues and perforated fractures caused by bullets that did not lose stability in flight, and comminuted fractures with significant defects in soft tissues and bones due to the blasting action of injuring projectiles.

Diagnostics. Pay attention to forced position hands, smoothness of the contours of the joint, the presence, size of the wounds of the inlet and outlet, indicating the direction of the wound channel, the expiration synovial fluid, deformation of the joint and limitation of movements in it. Peripheral blood circulation and innervation, X-ray data are evaluated.

Treatment. In the presence of point wounds of soft tissues, perforated, marginal fractures, comminuted fractures without displacement of fragments and the absence of foreign bodies, they are limited to their treatment with antiseptics, puncture of the joint and infiltration of paravulnar tissues with antibiotic solutions, drainage of soft tissue wounds and immobilization plaster cast.

Indications for primary surgical treatment are extensive soft tissue wounds with crushed bone fractures, incl. with damage to the neurovascular bundle. The operation is performed under anesthesia. Only foreign bodies are subject to removal. The wound of soft tissues and the joint is abundantly washed, all its departments are drained. If possible, the joint capsule is sutured. Immobilization is performed with a thoracobrachial plaster cast or external fixation device.