Limb immobilization: general patient care. Requirements for transport immobilization Immobilization of the right upper limb

Often, patients are faced with severe injuries and fractures, in which it is necessary to transport the victim to the hospital correctly. Immobilization for fractures can save a person's life and reduce the risk of serious complications and bone displacement.

Prompt and correct medical care should be carried out immediately after the injury, since fractures can be accompanied by serious bleeding, respiratory dysfunction and pain shock. How long the treatment will take in the future depends not only on the injury itself and the course of therapy, but also on how correctly the victim was given first aid.

Immobilization for fractures is divided into transport and medical. In the first case, measures are taken to transport the patient to a medical facility. Splints are usually placed to keep the broken bones immobile.

Therapeutic immobilization is indicated after examining the patient so that the bones heal normally and the patient does not feel pain. For these purposes, plaster casts, rigid orthoses, which are worn before the bones grow normally, can be used.

Transport immobilization for fractures is usually carried out with the help of special splints or improvised means that allow you to lay the broken limb on a flat surface and fix it firmly. A temporary splint can be applied not only by an ambulance worker, but also by an ordinary person who knows the rules of first aid.

Target

The main goal of transport immobilization is to ensure the immobility of the affected area. If a patient with a fracture is transported without immobilizing the affected bones, there is a risk of serious bleeding. In addition, bone fragments begin to injure surrounding tissues, which leads to complications.

With immobilization, the risk of pain shock is significantly reduced, since the fixed bone does not move and the nerve endings do not react. In addition, proper fixation prevents vascular squeezing and blood flow is normalized, which reduces the risk of inflammation in the tissues after injuries.

If the patient and his environment it is possible to call an ambulance, the first thing to do is to do just that. In this case, there is no need to apply a splint on your own with closed fractures, you need to remain in the position in which the patient found himself during the injury and not move the diseased limb.

Ambulance doctors independently and professionally immobilize the limb before transportation, for this they use special splints made of plastic, metal, wood or thick cardboard. If a long transportation of the victim is required, a plaster cast can be used right on the spot.

If there is an open fracture, you can’t just sit and wait, you need to provide first aid immediately. In the presence of arterial bleeding, a tourniquet is applied above the wound, while the wound should be lightly wrapped with gauze so that the infection does not get.

If there is a need to transport the patient to the hospital without the help of doctors, then you will have to immobilize the affected parts of the body yourself. Most often, there are no special tires at hand, so you can use a piece of wood or plywood, metal rods that can be fastened together, or thick cardboard.

First aid should be provided according to the following rules:

• After an injury, the patient should not be moved, turned over, set the bones and removed objects from the wounds. Do not pull the victim out of the car in an accident if there is no risk of explosion and other dangers. All these manipulations will inevitably lead to bleeding, serious bone displacements. It is especially dangerous to move a person with spinal injuries.
• First of all, the patient needs to inject an intramuscular anesthetic drug, for example, a non-steroidal anti-inflammatory drug - ibuprofen, you can also give a pill with the same effect, but the effect will be weaker. It is necessary to carry out a local injection of novocaine, if possible, but it is necessary to make sure that the patient is not allergic to it. It is impossible to perform anesthesia for head injuries, in this case, the patient needs an ambulance with the appropriate equipment.
• During immobilization, shoes or clothes should not be removed from the patient; I apply all splints superficially.
• All manipulations must be carried out very carefully, slowly, so as not to move the bone fragments.
• If the material needs to be adjusted to size, in no case should this be done on the patient himself. If you have a measuring tape or tape measure, you can accurately measure the length. In other cases, you need to adjust the tire on yourself or on a healthy limb of the patient, and not on the injured limb. Otherwise, there is a risk of mixing the bones with inaccurate movement.
• After immobilization, it is necessary to correctly transfer the patient, for this a stretcher is used. They can be made from improvised means. To do this, you need 2 sticks, for example, from a mop or shovel and a sheet, or clothes, belts and ropes are also suitable. Most importantly, the stretcher must be strong so that the victim does not fall.

It is important to understand that it is impossible to transport a victim with a fracture without immobilization, even over very short distances. When you try to lift the patient, the bones will shift, the fragments will spread into the soft tissues, damaging the blood vessels. Such actions will certainly lead to serious complications and pain shock.

Apply a tourniquet with an open fracture according to the following rules:

The application of a tourniquet is indicated only with severe bleeding, when the blood spurts out and there is a risk of large blood loss. In other cases, a pressure bandage above the wound is enough, so you should not panic ahead of time.

The imposition of a tourniquet without a base, and even with a violation of technology, can lead to complications. One of the most serious of these is limb amputation. To check if a tourniquet is needed, the limb is placed on a board, which is slightly raised so that the foot is higher than the head. If the bleeding stops, no tourniquet is needed. It is impossible to raise the leg with hip injuries.

• Apply a tourniquet above the wound on clothing. If there is no clothing, the fabric must be placed under the tourniquet.
• It is necessary to apply a tourniquet quickly above the wound, and on the contrary, remove it slowly, gradually weakening the pressure.
• It is necessary to record the time of applying the tourniquet on a note, putting it under the tourniquet. So doctors can subsequently estimate the time and weaken it in time.
• In winter, the tourniquet is applied for no more than 30 minutes - 1 hour, in summer for a maximum of 1-2 hours, after the time has elapsed, you need to slowly remove the tourniquet and leave the limb to rest for a couple of minutes, pinching the artery with your fingers. Then, if necessary, repeat the procedure, but apply a new tourniquet above the previous one. If such measures are not taken, the limb will lose its nutrition completely and begin to die.
• The bandage soaked with blood cannot be removed, as well as fragments and various objects removed from the wound, touching the wound with hands, washing it with water, alcohol and smearing it with iodine and brilliant green or other means. If an object sticks out of the wound, a bandage should be applied around it.
• If the arterial tourniquet was applied correctly, then there is no pulse under it.
• If an open fracture of the skull occurs, you need to cover the wound with a sterile bandage and call an ambulance.

Tire types

All tires for immobilization are divided into several types, depending on the materials used:

• • Pneumatic tires, or inflatable tires, are a medical product made from polyethylene. A tire is put on the limb, after which it is inflated through the tube. The air fixes the limb and creates a moderate pressure, which even allows you to stop the bleeding.
  • Metal tires are made of wire, they are called Kramer's tire.
  • Wooden and plywood splint is very convenient for immobilization, especially in emergency situations;
  • Plastic tires are very easy to use, they are easily bent and cut when heated in hot water, which allows them to be adjusted in shape and size. As the plastic tire cools, it stiffens and stays in place.
  • Cardboard tires are used very rarely, more often in emergency situations when there is no choice.

Peculiarities

Immobilization of various parts of the body must be carried out correctly. There are features of fixation of the upper and lower extremities, head and spine:

For immobilization of the lower limb you will need 2-4 straight objects, preferably boards, a clean cloth, a bandage or gauze. Gently put one board under the leg, and one on the right and one on the left. The place of contact of the board with the leg should be laid with a soft cloth or gauze in several layers.

For immobilization upper limb it is best to use a Kramer tire or a pneumatic one, but in its absence it is allowed to use boards, cardboard. In the most extreme cases, when there are no available materials, the hand is fixed with a scarf, scarf or bandage in a suspended state, it can also be tied to the patient's body.

The arm is usually taken a little to the side and bent at the elbow, a splint is applied to it and wrapped with a cloth or bandage. If a fracture occurs in the shoulder area, then a tissue roller should be placed in the armpit, and if the hand is fractured, the roller is placed in the palm.

With immobilization of the spine and ribs you need to be as careful as possible and not allow displacement or flexion in the spine, as you can damage the spinal cord. For immobilization, 4 boards are used, which are placed in length from head to toe, imitating a stretcher and under the buttocks and shoulder blades, then the boards are fixed.

When the ribs are broken, they need to be wrapped with a tight bandage, for this they use a clean cloth, bandages, or towels.

For neck immobilization the patient is placed on a stretcher and a soft roller is placed under the neck. It is also possible to use a soft collar, for this the neck is covered with cotton, which is fixed with a bandage. The bandage should not be tightly wound so as not to disturb the respiratory function.

For immobilization of the clavicle it is necessary to reduce the shoulder blades as much as possible and fix them in this position with an elastic bandage. If there is no bandage, a clean cloth can be used.

Video: First help for fractures / sprains. Immobilization

Sources

1. Traumatology and orthopedics. Textbook for students of medical institutes, edited by Yumashev G.S. Publishing house "Medicina" Moscow. ISBN 5-225-00825-9.
2. Kaplan A.V. Closed injuries of bones and joints. Publishing house "Medicine". Moscow.

CHAPTER 13 TRANSPORT IMMOBILIZATION FOR FRACTURES OF LIMB BONES, SPINE

A.I. Kolesnik

Transport immobilization for severe injuries is the most important first aid measure, in many cases saving the life of the victim.

The main task of transport immobilization is to ensure the immobility of fragments of broken bones and rest to the damaged area of ​​the body for the period of transportation of the victim to a medical institution. It contributes to a significant reduction in pain, without it it is almost impossible to prevent the development or deepening of traumatic shock in severe fractures of the bones of the limbs, pelvis and spine.

Ensuring the immobility of bone fragments and muscles to a large extent prevents additional tissue trauma. In the absence or insufficient immobilization during transportation of the victim, additional muscle damage is observed with the ends of bone fragments. There may also be injury to blood vessels and nerve trunks, perforation of the skin with closed fractures. Proper immobilization helps relieve spasm of blood vessels, eliminates their compression, thereby improving the blood supply to the damaged area and increasing the resistance of injured tissues to the development of wound infection at the site of injury, especially with gunshot wounds.

This is due to the fact that the immobility of muscle layers, bone fragments and other tissues prevents the mechanical spread of microbial contamination through interstitial crevices. Immobilization ensures the immobility of blood clots in damaged vessels, and hence the prevention of secondary bleeding and embolism.

Transport immobilization is indicated for fractures and injuries of the bones and organs of the pelvis, spine, damage to the main vessels and nerve trunks, extensive soft tissue injuries, widespread deep burns, and prolonged compression syndrome.

The main methods of immobilization of the limbs in the order of first aid will be tying the injured leg to the healthy one, bandaging the injured upper limb to the body, as well as using improvised means. Ambulance crews have standard means of transport immobilization at their disposal.

Carrying out transport immobilization must necessarily be preceded by anesthesia (drug injection, and in a medical institution - novocaine blockade). Only the lack of necessary funds in place

incidents in the provision of self-help and mutual assistance justifies the refusal of anesthesia.

One of the most common mistakes in transport immobilization by improvised means is the use of short splints that do not provide fixation of two adjacent joints, due to which immobilization of the damaged limb segment is not achieved. This also leads to insufficient fixation of the tire with a bandage. An error should be considered the imposition of standard tires without cotton-gauze pads.

Such an error leads to local compression of the limb, pain, and pressure sores. Therefore, all standard tires used by ambulance crews are covered with cotton-gauze pads.

Incorrect modeling of stair splints also leads to insufficient fixation of the fracture site. Transportation of victims in winter requires warming of the limb with a splint.

13.1. GENERAL PRINCIPLES OF TRANSPORT IMMOBILIZATION

There are several general principles of transport immobilization, the violation of which can lead to a significant decrease in the effectiveness of immobilization.

The use of transport immobilization should be as early as possible, i.e. already when providing first aid at the scene using improvised means.

Clothing and shoes on the victim usually do not interfere with transport immobilization, moreover, they serve as a soft pad under the tire. Removal of clothes and shoes is done only when absolutely necessary. It is necessary to take off clothes from the injured limb. You can apply a bandage to the wound through a hole cut in the clothing. Before transport immobilization, anesthesia should be carried out: the introduction of a solution of promedol or pantopon intramuscularly or subcutaneously, and in the conditions of a medical clinic - the corresponding novocaine blockade. It must be remembered that the procedure for applying a transport splint is associated with displacement of bone fragments and is accompanied by an additional increase in pain in the area of ​​damage. If there is a wound, it should be covered with an aseptic dressing before splinting. Access to the wound is carried out by dissecting the clothing, preferably along the seam.

The imposition of a tourniquet according to relevant indications is also performed before immobilization. Do not cover the tourniquet with bandages. It is absolutely necessary to additionally indicate in a separate note the time the tourniquet was applied (date, hours and minutes).

With open gunshot fractures, the ends of bone fragments protruding into the wound cannot be set, as this will lead to additional microbial contamination of the wound. Before applying the tire should be pre-modeled, adjusted to the size and shape of the injured limb. The tire should not exert strong pressure on soft tissues, especially in the area of ​​protrusions in order to avoid the formation of bedsores, squeeze large blood vessels and nerve trunks. The tire must be covered with cotton-gauze pads, and if they

no, then cotton wool. In case of fractures of long tubular bones, at least two joints adjacent to the damaged limb segment must be fixed. It is often necessary to fix three joints. Immobilization will be reliable if fixation of all joints that function under the influence of the muscles of this limb segment is achieved. So, with a fracture of the humerus, the shoulder, elbow and wrist joints are immobilized; in case of fractures of the bones of the lower leg due to the presence of multi-joint muscles (long flexors and extensors of the fingers), it is necessary to fix the knee, ankle and all joints of the foot and fingers.

The limb should be immobilized in an average physiological position in which the antagonist muscles (eg, flexors and extensors) are equally relaxed. The average physiological position is shoulder abduction by 60°, hips by 10°; forearms - in a position intermediate between pronation and supination, hands and feet - in the position of palmar and plantar flexion by 10 °. However, the practice of immobilization and transportation conditions force some deviations from the average physiological position. In particular, they do not produce such a significant abduction of the shoulder and flexion of the hip in the hip joint, and flexion in the knee joint is limited to 170 °.

Reliable immobilization is achieved by overcoming the physiological and elastic contraction of the muscles of the damaged limb segment. Reliability of immobilization is achieved by strong fixation of the tire (belts, scarves, straps) throughout. During splinting, care must be taken with the injured limb to avoid additional injury.

In winter, an injured limb is more prone to frostbite than a healthy one, especially when combined with vascular damage. During transportation, the limb with the imposed splint must be insulated.

To immobilize the injured limb, various improvised means can be used - boards, sticks, rods, etc. In their absence, the injured upper limb can be bandaged to the body, and the broken leg to the healthy leg. The best immobilization can be carried out with the help of standard equipment: wire ladder tires, Dieterichs tires, plywood, etc.

Soft tissue bandages can be used as an independent method of fixation or as an addition to another. Cloth bandages are most often used for fractures and dislocations of the clavicle, fractures of the scapula (Dezo, Velpo bandages, Delbe rings, etc.), injuries of the cervical spine (Schanz collar).

If there are no other means for fixation, then these bandages, as well as scarves, can be used to immobilize fractures of the upper and even lower limbs by bandaging the injured leg to a healthy one. In addition, soft tissue bandages always complement all other methods of transport immobilization.

Immobilization with a cotton-gauze collar (Fig. 13-1). A pre-prepared high cotton-gauze bandage with a layer of cotton about 4-5 cm thick is applied circularly to the neck of the victim in the prone position. The bandage is fixed with gauze bandages. Such a collar, resting on top of the occiput and chin area, and from below - on the shoulder girdle and chest, creates peace for the head and neck during transportation.

Rice. 13-1. Immobilization with a cotton-gauze collar

13.2. TYPES OF TRANSPORT TIRES

Tire - the main means of transport immobilization is any solid pad of sufficient length.

Tires can be improvised (from improvised material) and specially designed (standard).

Standard splints are commercially available and can be made from wood, plywood [tires of the Central Institute of Traumatology and Orthopedics (CITO)], metal wire (mesh, Kramer stair splints) (Fig. 13-2), plastics, rubber (inflatable splints), and other materials.

For the implementation of immobilization, bandages are also needed, with which the tires are fixed to the limb; cotton wool - for pads under the limb. Bandages can be replaced with improvised means: a belt, strips of fabric, rope, etc. Instead of cotton wool, towels, fabric pads, bundles of hay, grass, straw, etc. can be used.

Rice. 13-2. Cramer stair rails

In 1932, Professor Dieterichs proposed a wooden splint for immobilization of the lower limb in case of injuries to the thigh, hip and knee joints, and the upper third of the leg. This splint is still in use today and is the most reliable method for transport immobilization (Fig. 13-3).

Rice. 13-3. Tire Dieterichs

The tire consists of two wooden crutches - outer and inner, sole and twist with a cord. The crutches are sliding, consist of two branches - upper and lower. The upper parts of the branches end with stops for the armpit and perineum.

They also have slots and holes for fixing them to the limbs and torso with a belt, strap or bandage. The inner crutch on the lower branch has a folding bar with a round window for the cord and a groove for the protrusion of the lower jaw of the outer crutch.

The sole has two lugs for holding crutches and two loops for attaching the cord.

Cramer's ladder tire. It is a long frame made of thick wire with cross bars (Fig. 13-4 a-d).

It can easily be bent in any direction, i.e. modeled. In each case, the tire is prepared individually, depending on the damaged segment and the nature of the injury. One, two or three tires can be used at the same time. On fig. 13-4 shows the fixation of the shoulder with a Kramer wire splint.

Chin splint. It looks like a grooved plastic plate bent in the longitudinal and transverse directions, it is used for fractures of the lower jaws (Fig. 13-5).

The holes in the tire are designed to drain saliva and blood, as well as to fix a stuck tongue with a ligature. The side end holes have three hooks for attaching head cap loops.

Pneumatic tires. They are the most modern method of transport immobilization. These tires have certain advantages: when inflated, they are automatically modeled almost perfectly on the limb, the pressure on the tissues is even, which eliminates bedsores. The tire itself can be transparent, which allows you to control the state of the bandage and the

Rice. 13-4. Cramer's splint with cotton-gauze lining. Shoulder fixation with Kramer splint

Rice. 13-5. Chin splint

limbs. Its advantages are especially noticeable in the syndrome of prolonged compression, when tight bandaging of the limb with immobilization is necessary. However, with the help of a pneumatic splint it is impossible to carry out immobilization in case of injuries to the hip, shoulder, since these splints are not designed to fix the hip and shoulder joints.

A variety of pneumatic tires are vacuum stretchers, which are used for fractures of the spine and pelvis.

To immobilize the upper limb, a standard medical scarf is often used, which is a triangular piece of tissue. It is used as an independent means of immobilization and as an auxiliary, more often to maintain the shoulder and forearm in a suspended state.

Extrafocal fixation devices

When transporting a patient from one medical institution to another, and in wartime, when transporting from one hospital to another, transport immobilization of the damaged segment is carried out using devices for extrafocal osteosynthesis - rod and pin (Fig. 13-6).

Rice. 13-6. Immobilization of the wrist joint with the Volkov-Oganesyan apparatus

This method of fixation is more reliable than a splint. However, it can only be performed by a qualified traumatologist in an operating room.

13.3. TECHNIQUE OF TRANSPORT IMMOBILIZATION OF THE UPPER LIMB

At the scene of the incident, immobilization of the entire upper limb, regardless of the location of the damage, can be carried out using simplified methods using improvised means. The entire upper limb is simply bandaged to the body. In this case, the shoulder should be placed along the mid-axillary line, the forearm bent at a right angle, and the hand should be inserted between two buttoned buttons of a jacket, coat or shirt.

Another way is to create a hammock for hanging the upper limb. The half of the jacket, coat, overcoat is turned up and an arm bent at the elbow joint at an angle of 90 ° is placed in the formed groove.

The corner of the floor at the bottom edge is tied with twine (rope, bandage, wire) and strengthened around the neck or fixed with safety pins.

For the same purpose, you can pierce the floor at the lower corner with a knife and pass the bandage through the hole formed to hang the floor around the neck.

Instead of the floor of outerwear, you can use a towel, a piece of cloth, etc. In the corners, the towel is pierced with a knife (wire). Twine (bandage, rope) is passed through the holes formed, i.e. make two ribbons, each of which has two ends - front and back.

The forearm is placed in the gutter from the towel, the front ribbon at the end of the towel at the hand is passed to a healthy shoulder girdle and there it is connected to the back ribbon from the elbow end of the towel. The back braid at the hand is carried out horizontally backwards and in the lumbar region is connected with the front braid from the elbow end of the towel.

The standard scarf is widely used for hanging the upper limb. The patient is sitting or standing. The scarf is applied to the front surface of the chest with the long side along the midline of the body, and the top of the scarf is laterally, at the level of the elbow joint of the injured limb.

The upper end of the long side of the scarf is passed through the shoulder girdle of the intact side. The forearm, bent at the elbow joint, is wrapped around the lower half of the kerchief in front, its end is placed on the shoulder girdle of the diseased side and connected to the other end, drawn around the neck. The top of the scarf is bent in front of the elbow joint and fixed with a safety pin.

Immobilization in case of injuries of the wrist joint, hand and fingers

For transport immobilization in case of damage to this localization, a ladder (Fig. 13-7) or plywood splint is used, starting from the elbow joint and extending 3-4 cm beyond the ends of the fingers. The forearm is placed on the splint in the pronation position.

The hand should be fixed in a state of slight dorsiflexion, the fingers should be half-bent with the opposition of the first finger. For this, a cotton-gauze roller is placed under the palm (Fig. 13-8). It is better to bandage the tire starting from the forearm, the bends of the bandage are made under the tire to reduce pressure on the soft tissues. On the hand, circular tours of the bandage pass between the I and II fingers (Fig. 13-9).

Usually, only damaged fingers are bandaged to the roller on the tire, the undamaged ones are left open. Immobilization is completed by hanging the forearm on a scarf.

A ladder splint of the required length can also be used in another version, modeling its distal end in such a way as to give the hand a dorsiflexion position, with the fingers half-bent. If the I finger is not damaged, it is left free behind the edge of the tire. A cotton-gauze pad is bandaged to the tire.

If only fingers are injured, transport immobilization is the same as described above. You can limit yourself to fixing your fingers with a bandage to a cotton-gauze ball or roller and hang your forearm and hand on a scarf (Fig. 13-10).

Rice. 13-7. Stair rail

Rice. 13-8. Splinting and fixing the splint with a bandage

Rice. 13-9. Brush fixation

Rice. 13-10. Hanging a hand on a scarf

Sometimes the forearm and hand with a fixed roller are laid on a ladder rail and then hung on a scarf. The damaged I finger should be fixed on the roller in the position of opposition to the rest of the fingers, which is best done on a cylindrical roller.

Possible mistakes:

A cotton-gauze pad is not placed on the tire, which leads to local compression of soft tissues, especially over bony prominences, which causes pain; possible formation of bedsores;

The tire is not modeled, not bent longitudinally in the form of a gutter;

The tire is applied along the extensor surface of the forearm and hand;

The tire is short and the brush hangs down;

There is no cotton-gauze roller, on which the hand and fingers are fixed in a half-bent state;

The tire is not firmly fixed, as a result of which it slips;

Immobilization is not completed by hanging the limb on a scarf.

Immobilization for injuries of the forearm

In case of damage to the forearm, the splint should fix the elbow and wrist joints, start in the upper third of the shoulder and end 3-4 cm distal to the ends of the fingers. The ladder bus is shortened to the required length and bent at a right angle at the level of the elbow joint. The splint is bent longitudinally in the form of a gutter to ensure a better fit to the forearm and shoulder and fixed with a cotton-gauze pad. The assistant with the hand of the same name as the damaged one in the patient takes the hand, as for a handshake, and produces a moderate stretching of the forearm, while creating a counterhold with the second hand in the region of the lower third of the victim's shoulder. The forearm is placed on the tire in a position intermediate between pronation and supination; a cotton-gauze roller with a diameter of 8-10 cm is inserted into the palm facing the stomach. On the roller, the hand is dorsiflexed, the first finger is opposed and the remaining fingers are partially bent (Fig. 13-11).

In this position, the tire is bandaged and the limb is hung on a scarf. The use of a plywood splint does not provide complete immobilization, since it is impossible to firmly fix the elbow joint. Good immobilization of the forearm and hand is achieved by using a pneumatic splint.

Possible mistakes:

Tire modeling was made without taking into account the size of the patient's limb;

Soft padding under the tire is not applied;

Two adjacent joints are not fixed (short splint);

The hand is not fixed on the splint in the dorsiflexion position;

The fingers are fixed in an extended position, the first finger is not opposed to the rest;

The splint is not grooved and does not have a "nest" for soft padding in the olecranon area;

The hand is not suspended on a scarf.

Rice. 13-11. Ladder splint for fractures of the forearm. a - tire preparation; b - applying a tire and fixing the tire with a bandage; c - hanging a hand on a scarf

Immobilization for injuries of the shoulder, shoulder and elbow joints

In case of shoulder injuries, it is necessary to fix 3 joints: shoulder, elbow and wrist - and give the limb a position close to the average physiological, i.e. a position where the muscles of the shoulder and forearm are at rest. To do this, it is necessary to take the shoulder away from the body by 20-30 ° and bend it forward. Measure the length of the patient's limb from the olecranon to the ends of the fingers and, adding another 5-7 cm, bend the ladder splint across to an angle of 20 °. Then, retreating 3 cm to either side of the apex of the angle, the splint is extended 30° to create an additional “socket” at the level of the olecranon to prevent pressure on the splint (Fig. 13-12-13-14).

Outside the “nest”, the main branches are set at a right angle at the level of the elbow joint.

Further modeling of the tire is carried out by adding 3-4 cm to the length of the patient's shoulder for the thickness of the cotton-gauze pad and possible extension of the shoulder. At the level of the shoulder joint, the splint is not simply bent at an angle of about 115 °, but also spirally twisted. In practice, this is easier to do on the shoulder and back of the immobilizer. At the level of the neck, a sufficient oval bend of the tire is created to prevent pressure on the cervical vertebrae. The end of the tire should reach the shoulder blade of the healthy side. At the level of the forearm, the splint is grooved

Rice. 13-12. Preparation of a ladder splint for fractures of the humerus

Rice. 13-13. Applying a ladder rail and fixing the rail with a bandage

Rice. 13-14. Ladder rail overlay - hanging a hand on a scarf

bend. Two ribbons 70-80 cm long are tied at the corners of the proximal end for subsequent suspension of the distal end. A cotton-gauze pad is attached to the tire along the entire length. During splinting, the victim is sitting. The assistant flexes the limb at the elbow joint and produces extension and abduction of the shoulder. A special cotton-gauze roller is placed in the armpit, which is strengthened in this position with bandage rounds through a healthy shoulder girdle. The roller has a bean-shaped shape. Its dimensions are 20x10x10 cm. After applying the tire, the ribbons are pulled on it and tied to the corners of the distal end. The anterior one is carried out along the anterior surface of a healthy shoulder girdle, the posterior one along the back and through the armpit. The required degree of tension of the ribbons is determined by ensuring that the forearm is bent at a right angle with its free hanging. The forearm is placed in a position intermediate between pronation and supination; the palm is turned to the stomach, the hand is fixed on a cotton-gauze roller.

Bandaging the tire should begin with the hand, leaving the fingers free to control the state of blood circulation in the limb. Bandage the entire tire, paying special attention to the fixation of the shoulder joint, on the area of ​​​​which a spike-shaped bandage is applied.

The tire is fixed here with eight-shaped bandage tours, which also pass through the armpit of the healthy side. Upon completion of bandaging, the upper limb with a splint is additionally suspended on a scarf.

Possible mistakes:

The ladder tire is not modeled according to the size of the upper limb of the victim;

For the forearm, a short section of the splint is bent, as a result of which the hand is not fixed and hangs from the splint;

Do not form a "nest" in the olecranon padding splint, which will cause the splint to cause pain and may cause pressure ulcers;

The section of the splint for the shoulder exactly corresponds to the length of the shoulder, as a result of which an important element of immobilization is excluded - extension of the shoulder under the action of gravity of the forearm;

The tire in the area of ​​the shoulder joint is only bent at an angle, forgetting that without twisting in a spiral there will not be sufficient fixation of the shoulder joint;

The proximal section of the splint ends on the scapula of the damaged side, as a result of which fixation of the shoulder joint is not achieved. It is bad when the end of the tire covers the entire shoulder blade on the healthy side, since the movements of the healthy hand will lead to loosening of the tire, violation of fixation;

Tire bending to prevent pressure on the cervical vertebrae is not modeled;

The tire at the level of the forearm is not bent in the form of a gutter - the fixation of the forearm will be unstable;

The tire is applied without a soft pad (cotton-gauze or others);

A cotton-gauze roller is not placed in the armpit to abduct the shoulder;

Do not put a cotton-gauze roller under the palm;

Not the entire tire is bandaged;

The brush is not bandaged;

Bandage fingers;

The hand is not hung on a scarf.

In case of damage to the scapula, good immobilization is achieved by hanging the upper limb on a scarf, and only in case of fractures of the neck of the scapula, immobilization with a ladder splint should be performed, as with injuries of the shoulder joint and shoulder. Transport immobilization for fractures of the clavicle can be carried out using an oval of Cramer's ladder splint, covered with cotton. The oval is placed in the axillary region and strengthened with bandages to the shoulder girdle of a healthy foot (Fig. 13-15). The forearm is hung on a scarf.

In case of clavicle fractures, immobilization can be carried out with a stick about 65 cm long, which is placed horizontally at the level of the lower angles of the shoulder blades. The patient himself presses it from behind with his upper limbs in the area of ​​​​the elbow bends; hands are fixed with a waist belt.

Rice. 13-15. Ladder splint for clavicle fractures

You should know that prolonged compression of the vessels with a stick causes ischemic pain in the forearm. Immobilization of the clavicle is performed with a figure-of-eight bandage from a scarf or a wide bandage.

The assistant rests his knee on the interscapular region and hands back the patient's shoulder joints. In this position, a figure-of-eight bandage is applied. A cotton-gauze pillow is placed in the interscapular region under the cross of the scarf.

Widely used for immo-

bilization of the clavicle with cotton-gauze rings, which are put on the upper limb and shoulder girdle and pulled together on the back with a rubber tube, in extreme cases with a bandage. The inner diameter of the ring should not exceed by more than 2-3 cm the diameter of the upper limb at the point of its transition to the shoulder girdle.

The thickness of the cotton-gauze tourniquet from which the ring is made is at least 5 cm. Immobilization with a figure-of-eight bandage or rings is supplemented by hanging the hand on a scarf.

Possible mistakes:

Do not hang the hand on a scarf during immobilization with rings or a figure-of-eight bandage and thereby do not eliminate the subsequent displacement of debris due to the severity of the limb;

Cotton-gauze rings are too large in diameter, as a result of which the necessary traction and fixation of the shoulder girdle are not created; rings of small diameter disrupt blood circulation in the limbs.

13.4. LOWER LIMB TRANSPORT IMMOBILIZATION TECHNIQUE

The simplest and fairly reliable transport immobilization in case of damage to the lower limb can be carried out at the scene by bandaging (binding) the injured lower limb to the healthy one.

For this purpose, bandages, an individual dressing bag, a waist belt, a scarf, a rope, etc. are used.

Immobilization for foot and toe injuries

In case of damage to the foot, its posterior section is given the position of plantar flexion at an angle of 120 °; the knee joint is bent to an angle of 150-160 °. In case of damage to the forefoot, it is fixed at an angle of 90 °, as a result of which the

necessitates fixation of the knee joint. The splint height is limited to the upper third of the lower leg (Fig. 13-16, 13-17).

Rice. 13-16. Ladder splint for fractures of the leg and ankle bones (splint and splint)

Rice. 13-17. Application of a ladder splint for fractures of the bones of the leg and ankle joint (fixation of the splint with a bandage)

It must be remembered that with injuries to the foot, significant traumatic edema and compression of soft tissues always occur.

This can lead to the development of pressure sores as a result of pressure from shoes or from tight bandaging. Therefore, before applying the splint, it is recommended to remove or cut the shoes.

Immobilization for closed fractures of the first finger is carried out with narrow strips of adhesive plaster, which are applied to the finger and foot in the longitudinal and transverse directions, but without much tension (freely) in order to avoid subsequent compression of the swollen soft tissues of the finger.

It is especially dangerous in this respect to apply closed circular patch strips.

Possible mistakes:

In case of damage to the hindfoot, the knee joint is not fixed;

In case of damage to the forefoot, the foot is fixed in the position of plantar flexion;

Shoes are not removed or cut if there is a threat of swelling.

Immobilization in case of injuries of the lower leg and ankle joint

In addition to bandaging to a healthy limb, any flat solid objects of sufficient length can be used. They are fixed along the injured limb with bandages, scarves, belts, handkerchiefs, rope, etc. In case of damage to this localization, it is necessary to fix not only the damaged lower leg, but also the knee and ankle joints, so the splints should reach the upper third of the thigh and capture the foot fixed at an angle of 90 ° to the lower leg. Reliable immobilization is achieved with two or three ladder splints. The posterior ladder splint is applied from the upper third of the thigh and 7-8 cm distal to the ends of the fingers. Before applying the tire must be carefully modeled. The foot pad is perpendicular to the rest of the tire. A "nest" for the heel is formed, then the splint follows the contours of the gastrocnemius muscle, in the popliteal region it is bent at an angle of 160 °. Side ladder tires are bent in the form of the letter "P" or "G". They fix the lower leg on both sides.

Shoes are usually not removed when applying a splint. The assistant, holding the heel area and the rear of the foot with both hands, holds the limb, slightly stretching and raising it, as when removing the boot, fixing the foot at a right angle. A cotton-gauze pad is placed on the rear tire. Plywood tires can be used as side tires - from the middle of the thigh and 4-5 cm below the edge of the foot. Good immobilization of the lower leg and foot is achieved by using pneumatic splints.

Possible mistakes:

Immobilization is carried out only by the rear tire, without side tires;

The splint is short and does not fix the knee or ankle joints;

Bone protrusions are not protected by cotton-gauze pads;

The rear ladder rail is not modelled.

Immobilization for injuries of the hip, hip and knee joints

Hip fractures are very common, especially in traffic accidents. Fractures of the femur, regardless of the level, are accompanied by traumatic shock and wound infection. This determines the particular importance of creating early and reliable immobilization for injuries to the hip, hip and knee joints, as well as the upper third of the leg. It is with such injuries that immobilization itself presents great difficulties, since it is necessary to fix 3 joints - the hip, knee and ankle (Fig. 13-18).

The best available standard hip immobilization splint is the Dieterichs splint (Fig. 13-19, 13-20). For more durable fixation of the injured limb, a posterior ladder splint is additionally used. An important condition for the successful application of the Dieterichs bus is the participation of two or, in extreme cases, one assistant.

Splinting begins with the fitting of the crutches. Branches of the external crutch are moved apart so that the head rests against the armpit, and the lower branch extends beyond the edge of the foot by 10-15 cm. by 10-15 cm. In the indicated positions

Rice. 13-18. Immobilization of the lower limb with Cramer's ladder splint

Rice. 13-19. Immobilization of the lower limb with a Dieterichs splint

Rice. 13-20. Limb traction with a Dieterichs splint

zhenii branches of crutches are fixed by introducing wooden rods of the upper branches into the corresponding holes of the lower ones. Then both branches are tied together with a bandage to prevent the rods from slipping out of the holes. The heads of the crutches are covered with a layer of cotton wool, which is bandaged. Trouser belts, straps or bandages are passed through the lower and upper slots in the branches. When preparing the rear ladder splint, it is initially modeled from the lumbar region to the foot. The bus is modeled by repeating the contours of the gluteal region, popliteal fossa (170 ° bend), gastrocnemius muscle. A cotton-gauze pad is bandaged to the tire along the entire length. Shoes are not removed from the injured foot.

It is also desirable to bandage a cotton-gauze pad to the rear of the foot in order to prevent possible pressure sores.

The imposition of the tire itself begins with the plywood sole being bandaged to the foot. The fixation of the sole should be sufficient, however, the wire loops and lugs of the sole are left free from bandages.

The distal end of the outer crutch is passed into the eye of the bandaged sole, and then the crutch is advanced up until it stops in the armpit. The belt or bandage introduced earlier into the upper slots of the crutch is tied on a healthy shoulder girdle over a cotton-gauze pad. Internal crutch spend

into the corresponding ear of the sole and advance until it stops in the perineum (ischial tuberosity). The folding bar is put on the protrusion (thorn) of the outer branch, the ends of the bandage (belt) threaded into the lower slots are passed into the middle slots of the outer branch and tied with some tension.

A rear ladder tire is placed under the limb, and cords are passed into the loops of the sole. Next, the limb is stretched behind the foot, another assistant, in the order of the counter-stop, shifts the entire tire up, creating some pressure with the heads of the crutches into the axillary fossa and perineum. The achieved traction is fixed by pulling the sole with a cord and a twist. It is wrong to perform stretching by twisting, as it will always be very limited, and therefore insufficient.

Cotton-gauze pads are placed between crutches and bone protrusions (at the level of the ankles, femoral condyles, greater trochanter, ribs). The Dieterichs tire is bandaged together with the posterior scalene from the level of the ankle joint to the armpit. Bandaging is done quite tightly. The area of ​​the hip joint is strengthened with eight-shaped bandages. At the end of bandaging, the tire at the level of the wings of the iliac bones is additionally strengthened with a waist belt (strap), under which, on the side opposite the tire, a cotton-gauze mattress is placed.

If there is no Dieterichs tire, immobilization is carried out with three long (120 cm each) ladder tires. The posterior ladder splint is modeled on the lower limb. The lower part of the splint should be 6-8 cm longer than the patient's foot. Then it is bent at an angle of 30 °, stepping back 4 cm from the bend, the long part is unbent by 60 °, creating a “nest” for the heel region. Then the splint is modeled according to the relief of the gastrocnemius muscle, an angle of 160 ° is created in the popliteal region. Then it is bent along the contour of the gluteal region. The entire tire is longitudinally bent in the form of a gutter and lined with a cotton-gauze pad, which is fixed with a bandage.

The second ladder splint is placed along the inner surface of the leg, its upper end rests against the crotch, U-shaped bend at the level of the foot with the transition to the outer surface of the lower leg. The third ladder splint rests against the armpit, runs along the outer surface of the torso, thigh and lower leg, and is connected to the end of the bent inner splint.

The second and third tires are also lined with cotton-gauze pads, which must necessarily be bent outward over the upper ends of the tires, abutting against the armpit and crotch. Bone protrusions are additionally covered with cotton wool. All tires are bandaged to the limbs and torso throughout. In the area of ​​the hip joint, the splint is strengthened with eight-shaped bandage tours, and the outer side splint at the lumbar level is strengthened with a trouser belt, strap or bandage.

Possible mistakes:

Immobilization is performed without assistants;

Do not apply cotton pads to bony prominences;

Immobilization is carried out without a rear tire;

The upper end of the Dieterichs tire is not fixed to the body or is fixed only with a bandage that folds, slides, as a result of which the fixation is weakened;

Strengthening the tire with a waist belt is not used - immobilization of the hip joint will be insufficient (the wounded person can sit down or lift the body);

The sole is fixed weakly, it slips off;

Do not fix the crutches of the Dieterichs tire using special slots in the branches;

Stretching is done not with hands by the foot, but only by rotating the twist - stretching will be insufficient;

Weak traction - the heads of the crutches do not rest against the armpit and perineum;

Excessive traction can lead to pressure sores in the Achilles tendon, ankles, and dorsum of the foot.

Immobilization in traumatic limb amputation

This situation occurs, as a rule, with railway injuries, accidents when working on woodworking machines, etc. The application of a splint in these cases is intended to protect the end of the stump from repeated damage during transportation of the wounded. At the scene of the incident, an aseptic dressing is applied to the stump, and then immobilized with improvised means (board, plywood, stick) or bandaged to a healthy leg; the stump of the upper limb - to the body. The stump of the forearm and hand can be hung with a hollow jacket, jacket, tunic, shirt, as when immobilizing injured fingers, hands and forearms. If the severed part of the limb hangs on the skin flap, then the so-called transport amputation is performed, and then the stump is immobilized with a U-shaped curved ladder splint, which is applied to an aseptic dressing. A cotton-gauze pad must be placed under the tire. Immobilization can be carried out using boards or two plywood splints, which should protrude 5-6 cm beyond the end of the stump. When using any splint, fixation of the joint adjacent to the stump is necessary.

13.5. TECHNIQUE OF TRANSPORT IMMOBILIZATION OF THE HEAD, SPINE AND PELVIS

Immobilization for injuries of the skull and brain

In case of damage to the skull and brain, it is necessary to create conditions that ensure depreciation during transportation. However, it is not advisable to fix the head motionless to the body with splints, since another threat arises - aspiration of vomit, and with splints applied, it is difficult or impossible to turn the head in order to prevent such aspiration.

Simple improvised means of immobilization (laying the head on a soft bedding in the form of a circle) provide sufficient shock absorption during transportation and do not interfere with head rotation. For this purpose, rolls of clothes, etc. are used. The ends of the roll are tied with a bandage, belt, rope. The diameter of the formed ring should correspond to the size of the head

who has been trading. Turn the head to one side to avoid aspiration of vomit. Transportation is also possible on a slightly inflated backing circle or simply on a large pillow, a bundle of clothes, hay, straw with the formation of a recess in the center for the head.

Transport immobilization in case of neck injury

Immobilization of the neck and head is carried out using a soft circle, a cotton gauze bandage or a special Elansky transport tire.

When immobilized with a soft backing circle, the victim is placed on a stretcher and tied to prevent movement. A cotton-gauze circle is placed on a soft bedding, and the victim's head is placed on the circle with the back of the head in the hole.

Immobilization with a cotton-gauze bandage - a “Schanz-type collar” - can be performed if there is no difficulty breathing, vomiting, or arousal. The collar should rest against the occiput and both mastoid processes, and from below rest on the chest, which eliminates lateral head movements during transportation.

When immobilized with the Elansky splint (Fig. 13-21 a), a more rigid fixation is provided. The tire is made of plywood, consists of two half-leaves fastened together with loops. When expanded, the splint reproduces the contours of the head and torso. In the upper part of the tire there is a notch for the back of the head, on the sides of which there are two semicircular rolls of oilcloth. A layer of cotton wool or a soft tissue lining is applied to the tire. The tire is attached with ribbons to the body and around the shoulders (Fig. 13-21 b).

Possible mistakes:

Fixation of the head with tires, excluding turns to the sides;

During transportation, the head is not turned to one side;

The head mat is not massive enough, the necessary cushioning during transportation is not provided.

Rice. 13-21. Immobilization of the victim with a splint Elansky (a, b)

Immobilization for jaw injuries

Bone fragments and the entire jaw are sufficiently fixed with a sling-like bandage. Fragments of the lower jaw are pressed against the upper jaw, which acts as a splint. However, the sling-like bandage does not prevent posterior displacement of debris and retraction of the tongue. A more secure fixation is achieved with a standard plastic chin splint (Fig. 13-22). First, they put a special cap on the head of the victim, which is included in the tire kit. The cap is fixed on the head by tightening the horizontal band intended for this. The chin splint-sling from the concave surface is lined with a cotton-gauze pad and pressed against the chin and the entire lower jaw from below. If there is a wound, then it is covered with an aseptic bandage, and the tire is applied to the bandage.

Loops of elastic bands from the head cap are put on hooks in the figured cutouts of the side sections of the tire. In this way, the splint is fixed to the cap with elastic traction, the broken jaw is pulled up and fixed. Two rubber loops on each side are usually sufficient for a good fit. Too much traction increases pain and leads to displacement of debris to the sides.

With damage to the jaws, retraction of the tongue and the development of asphyxia are often observed. The tongue is pierced horizontally with a safety pin. The pin is fixed to the clothes with a bandage

Rice. 13-22. Chin splint immobilization

or around the neck. The doctor or ambulance paramedic stitches the tongue in a horizontal direction with a thick ligature, with some tension, ties it to a special hook in the middle of the pick-up splint. In this case, the tongue should not protrude outward, beyond the front teeth, in order to avoid biting it during transportation.

A victim with jaw injuries and a splint is transported lying face down, otherwise there is a threat of aspiration of blood and saliva. Under the chest and head (forehead) it is necessary to put a roll so that the head does not hang down and the nose and mouth are free. This will ensure breathing and the flow of blood, saliva. In a satisfactory condition, the victim can be transported while sitting (head tilted to one side).

Possible mistakes:

A sling tire is applied without a cotton-gauze pad;

Elastic traction with rubber loops for the sling tire is asymmetrical or too large;

Transportation is carried out in the position of the wounded on a stretcher face up - saliva and blood flow and aspirate into the respiratory tract; possible asphyxia;

The fixation of the tongue when it retracts is not provided.

Immobilization for spinal injuries

The purpose of immobilization for spinal injuries is to prevent displacement of broken vertebrae in order to prevent compression of the spinal cord or its re-traumatization during transportation, as well as damage to the vessels of the spinal canal and the formation of hematomas there. The immobilization of the spine should be carried out in the position of its moderate extension. On the contrary, flexion of the spine on a soft sagging stretcher contributes to the displacement of damaged vertebrae and compression of the spinal cord.

Transportation of the victim with a superimposed splint is possible on a stretcher both on the stomach and on the back. In case of damage to the thoracic and lumbar spine, the patient is placed on a shield - any rigid, non-bending plane. The shield is covered with a double-folded blanket. The victim is placed on his back (Fig. 13-23 b). Very reliable immobilization is achieved using

Rice. 13-23. Transport immobilization in case of spinal fracture. a - position on the stomach; b - position on the back

two longitudinal and three short transverse boards, which are fixed behind the torso and lower limbs. If it is not possible to create a non-bending plane or there is a large wound in the lumbar region, then the victim is placed on a soft stretcher on his stomach (Fig. 13-23 a).

In case of damage to the spinal cord, the victim must be tied to a stretcher in order to prevent passive movements of the body during transportation and additional displacement of the injured vertebrae, as well as the patient slipping off the stretcher. To shift such victims from a stretcher to a stretcher, from a stretcher to a table, three of us should: one holds his head, the second brings his hands under his back and lower back, the third - under the pelvis and knee joints. They lift the patient all at the same time on command, otherwise dangerous flexion of the spine and additional injury are possible.

Possible mistakes:

During immobilization and transportation, moderate extension of the spine is not provided;

The cardboard-cotton collar is small and does not interfere with head tilts;

The imposition of two ladder splints in case of injuries of the cervical spine is carried out without an assistant, who, while holding the head, moderately unbends and stretches the cervical spine;

Ladder or plywood tires are not sewn to the stretcher to create a rigid plane. During transportation, the tires slip out from under the patient, the spine bends, which causes additional trauma with possible damage to the spinal cord;

When laying the victim on a soft stretcher on the stomach, under the chest and pelvis do not place rollers;

The victim, especially with spinal cord injury, is not tied to a stretcher.

Immobilization for pelvic injuries

Transportation of patients with pelvic injuries (especially in violation of the integrity of the pelvic ring) may be accompanied by displacement of bone fragments and damage to internal organs, which aggravates the state of shock that usually accompanies such injuries. At the scene of the incident, with a wide bandage, a towel, the pelvis is circularly tightened at the level of the wings of the ilium and large skewers. The victim is placed on the shield, as in the case of fractures of the spine. Both legs are tied together, having previously laid a wide cotton-gauze pad between the knee joints, and a high roller is placed under them, and a pillow-shaped roller is placed under the head (Fig. 13-24).

Rice. 13-24. Transport immobilization for pelvic injuries

If it is possible to create a rigid bedding, it is permissible to lay the victim on a conventional stretcher in the “frog” position. It is important to tie the knee bolster to the stretcher, as it is easily displaced during transport. Sufficient conditions for transport immobilization are created when the patient is placed on a stretcher with a hard bedding of 3-4 interconnected ladder tires. The latter are modeled to give the victim a “frog” position. The ends of the tires, which are 5-6 cm longer than the patient's foot, are bent at a right angle. At the level of the popliteal fossae, the splints are bent in the opposite direction at an angle of 90°. If the proximal sections of the splints are longer than the patient's thigh, they are again bent parallel to the plane of the stretcher. In order to prevent extension of the tires under the knee joints, the proximal section of the tires is connected with a distal bandage or braid. Tires are placed on a stretcher, covered with cotton-gauze pads or a blanket, and the patient is laid down, whom it is desirable to tie to a stretcher. In this case, you can leave free access to the perineum in order to ensure the emptying of the bladder and rectum.

Possible mistakes:

A bandage was not applied to tighten the pelvis in case of violation of the integrity of the pelvic ring;

The legs are not bent at the knee joints and are not interconnected;

The popliteal roller and the victim himself are not fixed on the stretcher;

Ladder rails are not tied longitudinally to fix the right angle under the knee joints.

13.6. MODERN MEANS OF TRANSPORT IMMOBILIZATION

Over the past 10 years, thanks to research and development, the medicine of disasters and extreme situations has replenished with new unique products for transport immobilization based on the use of new technologies and waterproof materials, disposable transport splints (Fig. 13-25, 13-26), forearms, shins, thighs (with traction).

Rice. 13-25. Set of disposable transport tires

Rice. 13-26. A set of disposable transport tires in the work of the GP

Peculiarities:

Simultaneous assistance to several victims;

Retain immobilizing properties after application for at least 10 hours;

Made from environmentally friendly materials;

Have a long shelf life in the package;

Do not require special disposal methods.

Execution: four large and two small blanks with markings indicating the lines of folds and cuts to obtain the required tire option.

A set of transport folding tires (KShTS)

Purpose: immobilization of the upper and lower extremities. Completed: from sheet plastic, PVC fabric, cellular polypropylene, sling.

Peculiarities:

Simple, convenient and reliable in handling;

When folded, they occupy a small volume, which allows you to place tires in any packing, backpacks, unloading vests;

Radiolucent; equipped with straps with fasteners for fixing;

Waterproof (Fig. 13-27).

Set of transport stair tires (KSHL)

Designed for immobilization of the upper and lower extremities. Does not require prior preparation. The tires are equipped with straps with fasteners for fastening (Fig. 13-28 a, b; 13-29).

Rice. 13-27. A set of transport folding tires (KShTS)

Rice. 13-28. A set of transport stair tires (KSHL) (a, b)

Rice. 13-29. Bandage kerchief (PC) for fixing the elbow joint and forearm

Set of transport collars (KShVT)

Designed for immobilization of the cervical spine made of light plastic with a soft gasket made of synthetic material on the side adjacent to the body of the victim. Easily processed with common detergents and disinfectants (Fig. 13-30).

Rice. 13-30. Splint-collar set for immobilization of the cervical spine

Tire folding device (UShS)

Purpose: immobilization of the cervical and thoracic spine with simultaneous fixation of the head - immobilization of the thigh and lower leg (Fig. 13-31).

Rice. 13-31. Immobilization of the cervical and thoracic spine with simultaneous fixation of the head using a UShS folding splint

Vacuum immobilization means

All vacuum products consist of a chamber filled with synthetic granules and a protective cover. Protective covers of cameras are made of durable moisture-resistant fabric and equipped with fixing straps. When air is pumped out, the product takes and retains the anatomical shape of the immobilized part of the body and provides the necessary rigidity (Fig. 13-32).

Peculiarities: radiolucent, have thermal insulation properties.

Operating conditions: temperature, from -35 to +45 °С.

Current Care: treated with conventional detergents and disinfectants.

Rice. 13-32. Vacuum splints for immobilization of the cervical spine, upper and lower extremities

Purpose: immobilization of the cervical spine, upper and lower extremities.

Set of tires for vacuum transport KShVT-01 "Omnimod"

Designed for immobilization of limbs and cervical spine in fractures. Tires are supplied in sets (Fig. 13-33).

Rice. 13-33. Set of tires for vacuum transport KShVT-01 "Omnimod"

Peculiarities: protective covers of the cameras are made of durable moisture-resistant fabric and equipped with fixing straps, they are transparent to X-rays, and have thermal insulation properties.

Vacuum immobilizing mattress MVIO-02 "COCOON"

Purpose: immobilization for spinal injuries, fractures of the femur, pelvic bones, polytrauma, internal bleeding and shock conditions (Fig. 13-34, 13-35).

Rice. 13-34. Scheme of work of a vacuum mattress

Rice. 13-35. Vacuum mattress in action

Peculiarities: the mattress allows, depending on the type of injuries received, to immobilize and transfer the victim in the desired position; special sections make it possible to carry out reliable immobilization in case of combined and combined injuries.

Kit composition: mattress, vacuum pump, repair kit, stiffening ribs, transport linkage.

Detachable bucket stretchers NKZhR-MM

Detachable stretchers are designed for the most gentle transfer of victims with severe injuries to vehicles during evacuation (Fig. 13-36). Stretchers help to significantly reduce the deformation and pain of the patient during loading and shifting.

Rice. 13-36. Transportation of the victim using a vacuum bucket stretcher

A distinctive feature of the stretcher is their simplicity and ease of bringing under the victim. The speed and reliability of fixation allow in a limited space without difficulty to lift the patient, move and shift him. Carabiner-type locks provide quick and reliable fixation of the stretcher in the transport position.

Under immobilization understand the creation of immobility (rest) of the damaged part of the body. Immobilization is used for bone fractures, injuries of joints, nerves, extensive soft tissue injuries, severe inflammatory processes of the extremities, injuries of large vessels and extensive burns. There are two types of immobilization: transport and medical.

Transport immobilization, or immobilization for the time of delivery of the patient to the hospital, is a temporary measure (from several hours to several days), but it is of great importance both for the life of the victim and for the further course and outcome of the injury. Transport immobilization is carried out by means of special or improvised tires and by applying bandages.

Transport tires subdivided into fixing and combining fixation with traction. Of the fixing tires, plywood, wire-ladder, plank and cardboard are most widely used. Combining fixation with traction include the Dieterichs bus. When transporting over a long distance, temporary plaster bandages are also used.

Plywood tires used for immobilization of the upper and lower extremities.

Wire busbars(Cramer type) are made in two sizes (110X10 and 60X10 cm) from steel wire. Such tires are light, durable and widely used in practice.

mesh tire made of soft thin wire, well modeled, portable, but lack of strength limits its use.

Tire Dieterichs designed by a Soviet surgeon to immobilize the lower limb. The tire is wooden, but nowadays it is made of lightweight stainless steel.

Gypsum bandage It is convenient in that it can be made in any shape. Immobilization with this bandage is especially convenient in case of damage to the lower leg, forearm, shoulder. The disadvantage is that you have to wait until the bandage hardens and dries.

Since tires for transport immobilization are not always at the scene of an accident, it is necessary to use improvised materials or improvised tires. For this purpose, use sticks, planks, pieces of plywood, cardboard, umbrellas, skis, tightly rolled up clothes etc. You can also bandage the upper limb to the body, and the lower limb to the healthy leg (autoimmobilization).

Basic principles of limb transport immobilization:

• The tire must necessarily capture two, and sometimes three adjacent joints.
• When immobilizing a limb, it is necessary, if possible, to give it an average physiological position, and if this is not possible, a position in which the limb is least injured.
• With closed fractures, it is necessary to carry out a slight and careful extension of the injured limb along the axis before the end of immobilization.
• With open fractures, fragments are not reduced: a sterile bandage is applied and the limb is fixed in the position in which it is located.
• Do not remove clothing from the victim.
• It is impossible to impose a hard tire directly on the body: it is necessary to put a soft bedding (cotton wool, hay, towel, etc.).
• An assistant should hold the injured limb while transferring the patient from the stretcher.

It must be remembered that improperly performed immobilization can be harmful as a result of additional trauma. Thus, insufficient immobilization of a closed fracture can turn it into an open one, aggravating the injury and worsening its outcome.

Transport immobilization in case of pelvic injury

Immobilization of bone injuries of the pelvis is a difficult task, since even involuntary movements of the lower extremities can cause displacement of fragments. For immobilization in case of damage to the pelvis, the victim is placed on a rigid stretcher, giving him a position with half-bent and slightly apart legs, which leads to muscle relaxation and pain reduction. A roller is placed in the popliteal areas: a blanket, clothes, a folded pillow, etc. (Fig. 1).

Rice. 1. Transport immobilization in case of pelvic injury

Transport immobilization in injuries of the lower extremities. Proper immobilization in case of damage to the hip should be considered one that captures three joints at once, and the splint is applied from the armpit to the ankles.

Immobilization with a Dieterichs bus

This splint combines the necessary conditions for proper immobilization in case of a fracture of the femur - fixation and traction at the same time. It is suitable for all levels of hip or tibia fracture. The tire consists of two wooden sliding bars of various lengths (one 1.71 m, the other 1.46 m), 8 cm wide, a wooden foot stand (“sole”) for stretching and a twist stick with a cord (Fig. 2). A long bar is applied to the outer surface of the thigh from the armpit, and a short bar is placed on the inner surface of the leg. Both slats have transverse struts at the top for stop. Since the bars are sliding, they can be given any length depending on the height of the victim. A “sole” is bandaged to the foot, which has a cord attachment; an emphasis with a hole through which the cord is passed is hinged on the inner bar of the tire. After applying the tire, twist the cord to tension. The tire is fixed to the body with soft bandages.

Rice. 2. Applying a Dieterichs bus

a - medial bar of the tire; b - lateral plank; c - plantar part of the tire; g - twist; d - fixation of the sole; e - fixing the tire with a belt to the torso and thigh; strengthening the twist after stretching the limb; h - immobilization of the limb with a splint in the finished form.

With simultaneous fractures of the ankles, injuries of the ankle joint and foot, the Dieterichs splint cannot be applied.

Immobilization with a ladder splint

For immobilization with a ladder splint for hip fractures, three splints are taken: two of them are tied along the length from the armpit to the foot, taking into account its bending to the inner edge of the foot, the third splint is applied from the gluteal crease to the fingertips. If there are several splints, a fourth one can also be applied - from the crotch to the inner edge of the foot (Fig. 3).

Rice. 3. Transport immobilization of the lower limb in case of hip injury

a - ladder tire assembly; b - tire overlay.

Immobilization with plywood tires is carried out in the same way as with ladder tires. Improvised splinting for hip fractures is carried out with various improvised devices.

In their absence, you can bandage the injured leg to a healthy one.

Transport immobilization of the lower leg is carried out using special plywood splints, wire ladder splints, Dieterichs splints and improvised splints. For the correct application of the splint in case of fractures of the bones of the lower leg, it is necessary for the assistant to lift it by the heel and, as if taking off the boot, began to smoothly pull the leg. Then the tires are bandaged from the outer and inner sides with the expectation that they will go over the knee joint at the top, and behind the ankle joint at the bottom. The most convenient and portable for fractures of the lower leg is a ladder splint, especially in combination with plywood (Fig. 29). Immobilization is achieved by applying on the back surface of the limb from the gluteal fold a ladder splint well modeled along the contours of the limb with the addition of two plywood splints on the sides. The tires are fixed with a gauze bandage.

Rice. 4. Transport immobilization with stair splints in case of lower leg injury
a - preparation of stair tires; b - tire imposition.

Immobilization for fractures is the main first aid tool that ensures the immobility of the bones. The fact is that the movements, whether they are arbitrary or not, that the victim makes during delivery to the doctor, cause him serious harm. Immobilization minimizes additional trauma to soft tissues and blood vessels from sharp bone fragments at the fracture site, and reduces the possibility of shock, significant bleeding, or the development of an infectious complication. The timing of immobilization depends on the distance to the medical institution and ranges from several hours to 2-3 days.

Types of fractures and the need for first aid

It is customary to distinguish between pathological fractures that occur with various bone diseases and traumatic fractures that occur as a result of a large dynamic load on the bone during injury. Chronic fractures occur somewhat less frequently, in the case when the loads on the bone were, although not excessive, but prolonged.

Traumatic fractures are usually divided into:

• closed;
• open, when in addition to a broken bone there is also a wound;
• intra-articular, in which blood accumulates in the joint capsule.

Each of the species, in turn, can be with or without displacement of bone fragments.

There are pronounced signs by which it is possible to determine the presence of a fracture in the victim:

• severe pain at the site of injury;
• with a limb injury - a change in shape and size in comparison with the uninjured one;
• bone mobility at the site of injury, which was not observed in the normal state;
• inability to move the injured limb.

Open fractures are also dangerous because pathogens can get into the wound and infection can develop. Damage to tissues by bone fragments causes bleeding, often significant. If the fracture is open, the bleeding is external, and if it is closed, internal bleeding develops, which is no less dangerous. If there are several fractures, or they are open and severe, traumatic shock often develops, requiring urgent medical measures. One of the important points in the treatment of fractures is qualified first aid, the main activities of which are:

• anesthesia;
• stop bleeding if the fracture is open:
• prevention of occurrence of shock or measures to combat it;
• ensuring the immobility of the injury site by immobilization, which reduces pain and prevents shock;
• urgent delivery of the victim to a medical facility.

Use of splints for fractures

Types of tires for fractures

Standard ready-to-use tires vary in size and design features. They are more often designed to immobilize the upper or lower limbs, and in some cases - to stretch them.

Standard tires are made from different materials:

• steel mesh or wire, such as Cramer flexible ladder bars;
• wood: from slatted wooden structures, such as Dieterichs tires;
• plastics;
• thick cardboard.

In the event that transport immobilization is required for a relatively long period, plaster bandages or splints are used. The peculiarity of such tires is that they are made individually for each victim. They fix bone fragments well and fit snugly to the body. A relative disadvantage of this option of immobilization can be considered the difficulty of transporting the victim in frosty weather, while the tire is still wet.

It often happens that ready-made standard tires are not at hand. In this case, it makes sense to use improvised materials nearby. Usually boards or thick rods are used, thin rods can be knitted in the form of a knit for convenience.

It must be borne in mind that if rescuers or a medical team are already on their way to help the victim, it is not necessary to build an impromptu splint from improvised material, it is more expedient to wait for professional help.

Immobilization splint rules

Algorithm for applying an immobilization splint to the upper limbs

• the injured arm is bent at an angle of 90 degrees;
• under the arm, in the axillary fold, you need to put a roller of clothes or soft material, about 10 cm in size;
• if a bone in the shoulder is broken, it is most convenient to use a flexible standard Cramer splint; in its absence, improvised rigid materials are used;
• fix the shoulder and elbow joints with one improvised rigid and solid splint, and the second with the elbow and wrist joints;
• the bent arm must be hung on a scarf.

In case of a fracture of the bones of the forearm, the elbow and wrist joints are fixed with a splint, a roller, 8-10 cm in size, is placed in the armpit. The arm is bent at an angle of 90 degrees and suspended on a scarf. Sometimes it happens that a solid object for making an impromptu tire cannot be found. In this case, the broken bone of the forearm can be fixed by bandaging it to the body.

It is better not to bandage the fingertips with a fracture of the upper limbs, so it is more convenient to control blood circulation.

Immobilization for other types of fractures

In case of a fracture of the femur, one splint is applied on the inside of the injured limb, fixing the knee and ankle joint. Such a splint should reach the groin, where a soft roller with a diameter of about 10 cm is necessarily placed. On the outside of the leg, the splint is laid so as to fix all three joints: femoral, knee and ankle. Joints should be grasped to exclude movement in them; otherwise it will be transferred to the area of ​​the broken bone. In addition, such fixation prevents dislocation of the head of the damaged bone.

This is how a splint is applied for a hip fracture

In case of a fracture of the lower leg, splints are also applied along the inner and outer surface of the injured limb, fixing the knee and ankle joint. If it is not possible to find improvised material for the device of the immobilization splint, the injured leg can be fixed by bandaging it to the uninjured leg. However, such a measure is considered insufficiently reliable, and is used in extreme cases.

It is unacceptable to transport victims with fractures, even for short distances, without immobilization.

In case of a fracture of the collarbone, you need to hang the victim's hand on a scarf bandage. If the medical facility is far enough to get, you need to apply a figure-eight bandage to pull the shoulder girdle back and fix it in this position.

If immobilization is required for fractures of the ribs, a tight fixing bandage is applied to the chest, having previously anesthetized the victim. The chest is bandaged on exhalation, while the tightened ribs make only minimal movements during breathing. This reduces pain, and removes the risk of additional soft tissue injury from debris. Uncomplicated fractures of the ribs heal quickly, but complications are serious if the internal organs are injured by broken ribs.

When the foot is broken, the Cramer's flexible splint is applied to the upper thirds of the lower leg, modeling it along the contour of the back surface.

First aid for severe fractures

Fractures of the pelvic bones are severe, life-threatening damage to the victim, characterized by sharp pains, the inability to walk, stand, and raise the leg. To provide first aid, the victim is placed on a rigid stretcher down with his back, while his legs are left in a half-bent state. Soft cushions should be placed under the knees.

The most severe injury is considered to be a fracture of the spine, which can occur with a strong blow to the back or during a fall from a height. The victim experiences acute pain, there is swelling, protrusion of damaged vertebrae.

When providing assistance, you need to be extremely careful, since the displacement of the vertebrae often leads to damage to the spinal cord and its rupture.

The victim is placed on a hard surface, doing this on command, while avoiding kinks in the spine. Then they are fixed with wide straps. In case of a fracture of the upper spine, it is necessary to place soft cushions in the neck area.

Immobilization- this is the creation of immobility (rest) of the damaged part of the body. Applies to:
- bone fractures:
- damage to the joints;
- nerve damage;
- extensive damage to soft tissues;
- severe inflammatory processes of the extremities;
- injuries of large vessels and extensive burns.
Immobilization is of two types:
- transport;
- medical.
Transport immobilization - carried out at the time of delivery of the patient to the hospital; this is a temporary measure (from several hours to several days), but it is of great importance for the life of the victim and for the further course and outcome of the damage. It is provided by means of special or improvised splints and by applying bandages.
Transport tires are divided into:
- fixing;
- Combining fixation with traction.
Of the fixing tires, the most common are:
- plywood, used for immobilization of the upper and lower extremities;
- wire (Cramer type), made of steel wire. Such tires are light, durable and widely used in practice;
- wire ladder;
- plank (Diterichs splint, designed by a Soviet surgeon to immobilize the lower limb. The splint is wooden, but at present it is made of lightweight stainless metal);
- cardboard.

26.1. Gypsum bandage

Performs the functions of both transport and therapeutic immobilization. Convenient in that it can be made in any shape. Immobilization with a plaster bandage is convenient in case of damage to the lower leg, forearm, shoulder. The inconvenience lies only in the fact that it takes time to dry and harden the bandage. Today, new modern materials are also used. For example, CELLON - plaster bandages, represented by a thin creamy structure, providing exceptionally good opportunities for modeling (Fig. 227). Bandages made of plaster bandage CELLON (Fig. 228) are thin, strong, uniform in thickness. After 30 minutes, a light load is acceptable. They transmit X-rays well. Synthetic bandages CELLAKAST Xtra are currently being produced, providing high-strength and stable fixation of the fracture with a very low weight of the bandage. The bandages are made of fiberglass threads impregnated with polyurethane resin. The dressing made of these bandages has an excellent X-ray transmission ability and ensures skin respiration. Bandages are available in beige, blue and green. Rice. 228. Applying a bandage from a CELLON bandage.

26.2. Principles of transport immobilization

Tires for transport immobilization are not always available at the scene of the incident, in which case it is necessary to use improvised material or improvised tires. For this purpose, sticks, planks, pieces of plywood, cardboard, umbrellas, skis, tightly rolled up clothes, etc. are used. You can also bandage the upper limb to the body, and the lower limb to the healthy leg (autoimmobilization).
Basic principles of transport immobilization:
- the tire must necessarily capture two, and sometimes three adjacent su;
- when immobilizing a limb, it is necessary to give it an average physiological position; if this is not possible, then the position in which the limb is least injured;
- in case of closed fractures, before the end of immobilization, it is necessary to carry out an easy and careful traction of the injured limb along the axis;
- in case of open fractures, reduction of bone fragments is not performed;
- with open fractures, a sterile bandage is applied to the wound and the limb is fixed in the position in which it is located;
- do not remove clothes from the victim;
- it is impossible to impose a hard tire directly on the body, it is necessary to put a soft bedding (cotton wool, hay, towel, etc.);
- an assistant should hold the injured limb while transferring the patient from the stretcher.
It must be remembered that improperly performed immobilization can be harmful as a result of additional tissue trauma. So, insufficient immobilization of a closed fracture can turn it into an open one, aggravating the injury and worsening its outcome.

26.3. Transport immobilization in case of neck injury

Immobilization of the neck and head is performed using a soft circle, cotton-gauze bandage or a special transport tire.
When immobilized with a soft backing circle, the victim is placed on a stretcher and tied to prevent movement. A cotton-gauze circle is placed on a soft bedding, and the victim's head is placed on the circle with the back of the head in the hole.
Immobilization with a cotton-gauze bandage - a "Schanz-type collar" - can be performed if there is no difficulty breathing, vomiting, or arousal. The collar should rest against the occiput and both mastoid processes, and from below - rest on the chest. This eliminates lateral movement of the head during transport.

26.4. Transport immobilization in case of spinal injury

Elimination of mobility of damaged vertebrae during transportation;
- unloading of the spine;
- Reliable fixation of the damaged area.
Transportation of a victim with spinal injury always poses a risk of being injured by a displaced vertebra of the spinal cord. Immobilization in case of damage to the spine is carried out on a stretcher, both in the position of the victim on the stomach with a pillow or folded clothing under the chest and head to unload the spine, and in the supine position with a roller under the back (Fig. 229).
An important point in the transportation of a patient with a spinal injury is his placement on a stretcher, which should be performed by 3-4 people.

26.5. Transport immobilization in case of damage to the shoulder girdle

In case of damage to the clavicle or scapula, the main goal of immobilization is to create rest and eliminate the effect of the gravity of the arm and shoulder girdle, which is achieved using a scarf or special splints. Immobilization with a scarf is carried out by hanging the arm with a roller placed in the armpit. You can make immobilization bandage Dezo (Fig. 230, 231).

26.6. Transport immobilization in case of damage to the upper limbs

In case of a fracture of the humerus (Fig. 232) in the upper third, immobilization is carried out as follows:
- the arm is bent at the elbow joint at an acute angle so that the hand lies on the nipple of the mammary gland from the opposite side;
- a cotton-gauze roller is placed in the armpit and bandaged through the chest to a healthy shoulder girdle;
- the forearm is hung on a scarf;
- the shoulder is fixed with a bandage to the body.

26.6.1. Immobilization with ladder and plywood rail

Carried out with a fracture of the diaphysis of the humerus. Stair rail for immobilization is wrapped with cotton wool and modeled on the patient's intact limb. The tire should fix three joints:
- shoulder;
- elbow;
- radiocarpal.

A cotton-gauze roller is placed in the axillary fossa of the injured limb. With bandages, the tire is fixed to the limb and torso. Sometimes the hand is hung on a scarf (Fig. 233). If the fracture is localized in the area of ​​the elbow joint, the splint should cover the shoulder and reach the metacarpophalangeal joints.
Immobilization with a plywood splint is carried out by imposing it on the inside of the shoulder and forearm. The tire is bandaged to:
- shoulder;
- elbow;
- forearm;
- brushes, leaving only fingers free.

26.6.2. When immobilized with improvised means

They use sticks, bundles of straw, branches, planks, etc. In this case, certain conditions must be observed:
- from the inside, the upper end of the tire should reach the armpit;
- its other end from the outside should protrude beyond the shoulder joint;
- the lower ends should protrude beyond the elbow.
After splinting, they are tied below and above the fracture site to the shoulder, and the forearm is hung on a scarf (Fig. 234).

26.6.3. Forearm injuries

When immobilizing the forearm, it is necessary to exclude the possibility of movements in the elbow and wrist joints. Immobilization is carried out with a ladder (Fig. 235) or mesh splint. To do this, it must be curved with a gutter and lined with soft bedding. The tire is applied along the outer surface of the affected limb from the middle of the shoulder to the metacarpophalangeal joints. The elbow joint is bent at a right angle, the forearm is brought to the middle position between pronation and supination, the hand is slightly unbent and brought to the stomach. A dense roller is put into the palm, the splint is bandaged to the limb and the hand is hung on a scarf. When immobilized with a plywood tire, in order to avoid bedsores, cotton must be underlain. To immobilize the forearm, you can also use the material at hand, following the basic rules for creating immobility of the damaged limb.

26.6.4. Injuries to the wrist and fingers

For injuries in the area of ​​the wrist joint of the hand and injuries to the fingers, a ladder or mesh splint curved in the form of a groove is widely used, as well as plywood splints in the form of strips from the end of the fingers to the elbow. Tires are covered with cotton wool and applied from the palm side. It is bandaged to the hand, leaving the fingers free to monitor blood circulation. The brushes are given an average physiological position, and a dense roller is placed in the palm.

26.7. Transport immobilization in case of pelvic injury

Immobilization in case of pelvic injury is a difficult task, since even involuntary movements of the lower extremities can cause displacement of bone fragments. For immobilization in case of damage to the pelvic bones, the victim is placed on a rigid stretcher, giving him a position with half-bent and slightly spread legs, which leads to muscle relaxation and pain reduction. A roller is placed in the popliteal regions (Fig. 236): a blanket, clothes, a folded pillow, etc.

26.8. Transport immobilization for injuries of the lower extremities

Correctly performed immobilization in case of damage to the thigh (Fig. 237) captures three joints at once, and the splint should be applied from the armpit to the ankles.

26.8.1. Immobilization with a Dieterichs bus

This splint for proper immobilization in case of a fracture of the femur combines the necessary conditions:
- fixation;
- simultaneously stretching.
It is suitable for all levels of hip or tibia fracture. It consists of two wooden sliding bars of various lengths, a wooden footrest (“sole”) for stretching and a twist stick with a cord (Fig. 238). A long bar is applied to the outer surface of the thigh from the armpit, and a short bar is placed on the inner surface of the leg. Both slats have transverse struts at the top for stop.

Since the bars are sliding, they can be given any length depending on the height of the victim. A “sole” is bandaged to the foot (Fig. 239), which has a fastening for a cord; an emphasis with a hole through which the cord is passed is hinged on the inner bar of the tire. After applying the tire, the cord is twisted to tension. The tire is fixed to the body with soft bandages.

Attention! With simultaneous fractures of the ankles, injuries of the ankle joint and bones of the foot, the Dieterichs splint cannot be applied!

26.8.2. Immobilization with a ladder splint

For immobilization with a ladder tire (Fig. 240), 3 tires are taken for hip fractures;
- two of them are tied along the length from the armpit to the foot, taking into account its bending to the inner edge of the foot;
- the third tire is applied from the gluteal fold to the fingertips;
- in the presence of several tires, you can impose a fourth

Immobilization with plywood tires is carried out in the same way as with ladder tires.
Improvised splinting is carried out with various improvised devices.

26.9. Transport immobilization of the lower leg

Can be done with:
- special plywood tires;
- wire tires;
- ladder rails;
- tires Diterikhs;
- improvised tires.
For the correct application of the splint in case of fractures of the bones of the lower leg, it is necessary that the assistant lifts it by the heel and, as if removing the boot, begins to smoothly pull the leg. Immobilization is achieved by applying on the back surface of the limb - from the gluteal fold - a ladder splint well modeled along the contours of the limb (Fig. 241) with the addition of two plywood splints on the sides. Tires are bandaged from the outer and inner sides with the calculation that they go above the knee joint, and below - behind the ankle joint. The structure is fixed with a gauze bandage (Fig. 242).

Test tasks:

1. Specify a tire not intended for transport immobilization:
a. Pneumatic.
b. Diterichs.
c. Beler.
d. Kramer.
e. Mesh.
2. Add:
In case of a fracture of the limbs, it is necessary to immobilize at least _____________ nearby joints (the answer is entered as a number).
3. Add:
In case of a hip injury, it is necessary to immobilize the ________________ joint (answer
entered as a number).
4. Transport immobilization is used for:
a. Reducing the pain syndrome.
b. Reducing the likelihood of complications.
c. Prevention of further displacement of bone fragments.
d. Treatment of fractures and dislocations.
5. With an injury to the musculoskeletal system, pain reduction is achieved:
a. Comfortable position of the victim.
b. Stop bleeding.
c. Immobilization and anesthesia.
d. Applying a pressure bandage.
6. Transportation of the victim with a clavicle fracture:
a. In a sitting position, leaning back.
b. In a hard lying position, on the back.
c. In the frog position.
d. Lying on your stomach.
7. In case of a closed fracture of the leg at the scene, the following is performed in the first round:
a. Tire preparation.
b. Immobilization.
c. Anesthesia.
8. Traumatological patients should be activated:
a. from the first day after the injury.
b. From the second week after the injury.
c. An individual and timely approach is needed.
d. After the end of drug treatment and consultation of an exercise therapy doctor.