How is an open wound treated? How to treat stab wounds? Foot stab wound emergency
stab wounds usually do not cause profuse bleeding. Often it seems that the wound closed almost instantly. However, this does not mean that treatment is not required.
stab wounds(for example, when a person steps on a protruding nail or pricks with a pin) can be dangerous due to the risk of infection. A sharp object may contain tetanus spores or other bacteria (especially if it is soiled in the ground). Stab wounds from animal bites, including domestic dogs and cats, may be associated with an increased risk of infection. The risk of infection is also increased when the puncture wound is located on the foot.
If the bite is deep enough and there is persistent bleeding, seek medical attention. Otherwise, take the following steps:
Stop bleeding. Minor cuts and abrasions usually stop bleeding on their own. If the bleeding does not stop, lightly press down on the wound with a piece of clean cloth or bandage. If the bleeding cannot be stopped (the wound bleeds heavily or the bleeding does not stop even after applying pressure to the wound for several minutes), seek emergency medical attention.
Cleanse the wound. Rinse thoroughly with clean water. Small surface foreign particles can be removed with tweezers treated with alcohol. For larger foreign bodies lodged deeper in the wound, see a specialist. Careful wound care reduces the risk of contracting tetanus. Wash the area around the wound with soap and a clean washcloth.
Apply an antibacterial cream or ointment. After treating the wound, apply a thin layer of antibacterial cream or ointment (neosporin, polysporin, etc.) to keep the surface of the wound moist. These remedies do not accelerate healing, but they prevent the development of infection, contributing to a better healing of the wound. Some ingredients in antibacterial ointments can in some cases cause small skin rashes. If rashes appear, the use of the ointment should be discontinued.
Put on a bandage. Healing in the air is usually faster, but the dressing protects the wound from contamination and infection.
Change your bandage regularly. Change the bandage at least once a day. Do this every time the dressing gets dirty or wet. If you are allergic to substances in the adhesive layer of many dressings, use non-adhesive dressings or sterile gauze pads and hypoallergenic paper tape that does not cause allergic reactions (usually these are available in a pharmacy).
Watch for signs of wound infection. If the wound does not heal for a long time or you notice redness, discharge, skin temperature rise or swelling in the area of the wound, see a doctor.
If the wound is deep, contaminated with human or animal saliva, or is on the foot, seek medical attention. He will examine the wound, treat and (if necessary) close the wound. If more than 5 years have passed since your last tetanus shot, your doctor may recommend a vigorous tetanus toxoid immunization within 48 hours of the injury.
If the wound is inflicted by an animal (especially a stray dog or wild animal), rabies is possible. Your doctor will prescribe antibiotics and recommend that you get a rabies vaccination. Such incidents should be reported to the hospital. If possible, the animal should be captured for a 10-day veterinary observation.
Stab objects and tools (a nail, a needle, an awl, a pointed metal rod or a wooden stick, etc.) are characterized by a narrow, elongated shape and a sharp end. The ratio of the size of the cross section at different levels of the working part of the stabbing objects allows us to distinguish among them conical, pyramidal, cylindrical, etc.
Close to piercing tools in terms of the nature of the damage caused are piercing-chopping objects, at the end of which there is an edge of relatively large sizes (chisel, chisel, screwdriver).
The mechanism of action of piercing objects is piercing and pushing apart tissues.
Features of a stab wound:
1) an inlet, the shape and dimensions of which are determined by the shape and dimensions of the cross-section of the piercing object, as well as the elasticity and contractility of the skin;
2) the edges of stab wounds are usually even, they can be upset, especially when a piercing object is used at an angle;
3) piercing objects can form a rubdown zone, more often on clothes;
4) the length of the wound channel is significant compared to the size of the wound. The channel may end blindly or with an outlet;
5) with a significant impact force, a piercing object can damage the bone. A hole appears corresponding to the size, shape, contour of its cross section at the level of immersion;
6) the presence of internal bleeding.
Questions that can be put to the decision of the SME in cases of stab injuries:
1) what tool caused the damage. If the wounds are penetrating, they can be mistaken for gunshot wounds, they have a belt of deposition (drying) and wiping in the circumference of the inlet. The absence of a tissue defect, signs of the action of concomitant factors of the shot, allow differentiation of these two types of damage. The wound channel along its entire length is examined in layers, while on dense tissues (bones, liver, kidneys) the shape and dimensions of the cross section of the piercing object are more clearly determined;
2) what is the length of the piercing object. The issue is resolved in a similar way to determining the length of a piercing-cutting object;
3) what is the shape and dimensions of the cross section of the piercing object. The shape of the sharp end and the dimensions of the cross-section of piercing objects at the depth of damage are largely reflected by the inlet of the stab wound. The size of the wound due to skin contraction will always be less than the diameter of the damaging object. If the object has a round cross section, then the shape of the wound is round, elliptical, slit-like. A piercing object with a multifaceted section forms a star-shaped wound;
4) in what direction, how much damage was done, by one's own or by an outside hand.
22. Damage by piercing and cutting tools. Issues resolved by forensic medical examination
Injuries by piercing-cutting tools in the practice of experts are common, accounting for 30 to 40% of all injuries with sharp objects.
Stab-cut injuries are formed from the action of objects that have both piercing and cutting properties. These items include a variety of knives, although it may be a wedge-shaped piece of glass.
The mechanism of action of a piercing-cutting tool is that the sharp end pierces the tissue, penetrating deep into, and then the blade cuts them.
Piercing and cutting tools are divided into two types:
1) one-sided, they have a sharp blade, the blade is on one side. It can be Finnish, kitchen, shoe, penknives;
2) double-edged blade, the blades are on both sides (dagger, dagger).
The shape of stab wounds can be spindle-shaped, slit-shaped, wedge-shaped, arcuate, angular (the shape of the wound is determined by its edges), the depth of the wound (the length of the wound channel) always exceeds its length.
When the knife is not completely immersed, the expert measures the depth of the wound channel (for example, 10 cm) and concludes that the length of the blade was at least 10 cm. the abdominal wall easily sags during the blow, and after the knife is removed, it returns to its place.
In case of damage by a one-sided knife, a stereomicroscopic examination of clothing reveals a cut in the terminal transverse threads in the region of the sharp end, and a break in the threads in the region of the blunt end.
If the blade is inserted perpendicularly into the wound, the length of the wound corresponds to the width of the blade, given that the size of the wound is reduced due to skin contraction (approximately 10%).
If the blow came at an angle, the length of the skin wound will be greater than the width of the blade. The expert measures the width of the wound channel throughout, in dense organs (liver) uses the method of filling the wound channel with plasticine, paraffin, etc.
Layer-by-layer study of the wound channel makes it possible to make an assumption about the configuration of the part of the knife blade immersed in the body. The expert makes several cuts at a right angle to the wound channel, on each of them the length of the wound is measured, on the basis of which a graphic image of the wound channel is drawn up on paper.
Questions that can be put to the decision of the SME in cases of stab-cut injuries:
1) whether the damage could have been caused by a knife submitted for examination as material evidence;
2) the number of blows delivered;
3) in what sequence the damage was done.
23. Mechanisms of occurrence and features of chopped wounds. Issues resolved by forensic medical examination
Chopping tools are called axes, hoes, shovels, etc. The presence of a more or less sharp blade and a relatively large mass, as a rule, is their distinguishing feature. Since the chopping tool has a large mass, and its scope is considerable, the impact force is very significant. Chopped wounds are deep, accompanied by massive tissue destruction. In most cases, wounds are applied to the head area, so their danger to human life and health is obvious.
The edges of chopped wounds have a number of features. During the initial examination, they appear to be even, but with a deeper examination with a magnifying glass, notches and irregularities are always found, the severity of which depends on the degree of sharpness of the ax blade.
Sedimentation, a characteristic sign of chopped wounds, on fresh wounds is detected when viewed using stereomicroscopy. The epidermis is torn off from the edges of the wound by the side surfaces of the ax when it is immersed. The injury is pronounced if the blow was applied to a part of the body that has a large layer of soft tissues, since in this case the edges of the wound are significantly screwed inward and come into contact with the side surfaces of the ax over a long distance. The shape of the ends of chopped wounds depends on the position of the tool at the moment of inflicting the wound and on the depth of its immersion in the tissues.
From a slit-like fracture, cracks in the bones of the skull almost always depart, which can form bone fragments. If repeated blows are applied to the area of the first damage, then the areas of bones limited by cracks break inward and comminuted fractures form.
Notches are broken bones as a result of weak blows with a fairly sharp tool. They are shallow and do not penetrate to the inner bone plate.
The main questions for resolving the SME in cases of chopped damage:
1) what tool caused the damage;
2) what are the properties of the chopping tool;
3) whether the damage could have been caused by the action of the chopping tool submitted for examination.
The width of the blade is determined by the length and features of the wound. When examining the edges of the skin wound and the cut of the bone, the sharpness of the blade is assessed. Sharp axes form wounds with smooth edges, scaling along the edge of the skin wound is weakly expressed, there are no traces of blade sliding on the edges of the bone cut. Cracks are slightly pronounced. Chopped wounds are rarely inflicted with sharpened axes in practice. Usually blunt axes are used, which leave individual traces on the bones and cartilage. They can be used to identify wounds using stereomicroscopy, traceological methods of photoregistration and photooverlay.
Description:
Stab wounds - characterized by a small area of tissue damage, usually has smooth edges. Wounds in the chest and abdomen can be very dangerous, since with a long wounding object, damage to internal organs is possible. With stab wounds of the extremities, emergency care is necessary in cases where there is damage to the main vessels and nerves. Stab wound - when the inlet is less than the depth of the wound channel (in the absence of damage to the main vessels, bleeding is insignificant). The healing of these wounds after surgical treatment is often favorable.
Symptoms:
Clinical manifestations are determined by the characteristics of a particular wound.
Depth of tissue penetration:
* Blind
* Through
According to the anatomical features of the wound site:
* With internal damage (usually listed)
* No damage to internal organs
According to the complications of the wound site:
* With massive bleeding (in case of damage to large vessels)
* With partial prolapse of internal organs (with a significant size of the wound gate).
Causes of occurrence:
It occurs, as a rule, as a result of a wound with a stabbing weapon or an object (dagger, steel bar). Rarely found in its pure form, most often combined with another type of wound (stab-cut).
Treatment:
For treatment appoint:
First aid:
Applying a sterile dressing.
- Applying a tourniquet (if required).
- Evacuation to a medical facility.
Qualified medical care:
It is caused by complications of a particular wound. In the absence of complications, after washing the wound, layer-by-layer suturing along the wound channel follows.
- tissue damage, in which the depth of the wound channel exceeds the width of the inlet. Such a wound has even edges and is applied with a thin sharp object (awl, sharpening). Pure stab wounds are rare. In trauma practice, combined injuries are more often observed - stab wounds inflicted with a knife or dagger. Massive external bleeding in puncture wounds is usually absent, the condition in the initial stages often remains satisfactory, which can lead to an underestimation of the severity of the injury. The diagnosis is made on the basis of anamnesis and external examination data. If damage to the internal organs is suspected, additional studies are required: chest x-ray, laparoscopy, etc. Operative treatment: PST, suturing, dressings.
Stab wound - a wound with smooth edges, a small inlet and a deep wound channel. Possible causes of damage are a criminal incident (sharpening), an accident (falling on a pin), a car accident, industrial or natural disaster. It can penetrate into the natural cavities of the body (abdominal, thoracic, joint cavity), accompanied by damage to nerves, blood vessels and internal organs. Sometimes associated with TBI, bone fractures, closed chest injury, blunt abdominal trauma, and genitourinary system injuries.
Taking into account the depth of penetration in traumatology and surgery, all wounds are divided into penetrating and blind. Taking into account the features that have a significant impact on the prognosis and treatment tactics, there are wounds without damage and with damage to internal organs. Taking into account the presence of local complications, wounds complicated by massive bleeding or partial prolapse of internal organs are distinguished.
The pathogenesis of stab wounds
Features of damage depend on the localization of the stab wound. It should be noted that such injuries should be treated with particular vigilance, not excluding severe injuries based on the small size of the inlet and the satisfactory condition of the patient. With wounds caused by sharpening, the depth of the wound channel can be 15-20 cm with an inlet size of only 1-2 cm. Wounds inflicted by an awl reach 8-10 cm in depth, and the length of the channel left by a metal pin cannot be predicted at all without PHO.
Injuries in the area of neurovascular bundles may be accompanied by damage to blood vessels and nerves. At the same time, the absence of massive external bleeding does not exclude damage to the vessels, since after removing a sharp object, the tissues sometimes shift, clog the narrow wound channel, and the blood does not pour out, but into natural cavities or surrounding tissues.
The likelihood of damage to internal organs depends on the location. With a wound in the chest area, damage to the lungs and heart is possible, in the abdomen - damage to the liver, spleen, intestines, in the neck - damage to the trachea, larynx and esophagus, in the lumbar region - damage to the kidney, etc. It should be borne in mind that the possibility injury of one or another internal organ depends not only on the anatomical zone, but also on the direction and depth of the wound channel. So, with a stab wound of the abdomen, inflicted from the bottom up, damage can be observed not only to the liver, spleen or stomach, but also to the organs of the chest. And with a similar location of the inlet, but the wound channel directed from front to back, damage to the kidney is possible.
Another distinguishing feature of such wounds is the increased likelihood of developing a wound infection. This feature is due to the fact that bacteria and impurities that have entered the wound cavity are poorly washed out by the blood and remain in the tissues. In addition, blood that has poured out not outside, but into the surrounding tissues, creates a favorable environment for the reproduction of microbes.
Symptoms of stab wounds
With fresh stab wounds on the skin, a small wound hole of a rounded shape with smooth edges is revealed. If a traumatic object (for example, a pin) remains in the wound, its edges are bent inward. Bleeding is usually minor. With stab wounds, the hole is slit-like or angular, the edges are even, one or both ends of the wound are sharp. Bleeding, as a rule, is not intense, but more blood is poured out than with stab wounds.
Other clinical manifestations depend on the localization of wounds, the presence or absence of damage to internal organs, nerves and blood vessels. A rapid increase in the volume of the damaged anatomical zone, combined with weakness, dizziness and fainting, indicates bleeding into the surrounding tissues, increasing shortness of breath in case of an injury in the chest area - lung damage, pneumothorax or hemothorax, weakness, shock phenomena and percussion dullness of sound in case of injuries to the abdomen - about possible damage to parenchymal organs (liver, spleen).
The edges of the infected wound are hyperemic, local hyperthermia is detected. Serous or purulent discharge is visible in the wound channel. Due to the development of infection in depth and poor outflow of contents, significant swelling of the surrounding soft tissues is often observed. Patients complain of intense jerking or throbbing pain. Symptoms of general intoxication are observed: fever, chills, weakness, fatigue, headaches.
Diagnosis and first aid for stab wounds
The diagnosis is established on the basis of the anamnesis and the results of an external examination. The volume of additional studies depends on the condition and complaints of the patient, the localization of the wound, the intended direction and depth of the wound channel. To assess blood loss, a complete blood count is done. If lung damage is suspected, a chest x-ray and a consultation with a thoracic surgeon are indicated; if damage to the abdominal organs is suspected, an abdominal surgeon's consultation and laparoscopy (if there are sufficient grounds) are indicated. Suspicion of damage to a large vessel is the basis for a consultation with a vascular surgeon, suspicion of nerve damage - for a consultation with a neurosurgeon.
With light bleeding, the skin around the wound should be washed and disinfected, and then a sterile dressing should be applied. In case of massive bleeding, it is necessary to apply one of the methods for temporarily stopping bleeding (apply a tourniquet or pressure bandage, tamponade the wound). If a sharp object (pin, sharpening) remains in the wound, it should not be removed, as this can lead to increased bleeding and the development of shock. All patients with stab wounds are subject to immediate evacuation to a specialized medical facility.
Treatment of stab wounds
Traumatologists treat fresh stab wounds without damaging internal organs. Patients with suspected damage to internal organs, nerves and blood vessels are referred to the appropriate specialists: thoracic surgeons, abdominal surgeons, cardiac surgeons, urologists, vascular surgeons, neurosurgeons, etc. Treatment of infected stab wounds is carried out by surgeons.
In the presence of a fresh, uncomplicated puncture wound, PST is indicated, which is usually performed under local anesthesia. The doctor flushes with solutions of peroxide and furacilin, examines the wound channel with a finger or probe, if possible excised contaminated areas and sutured the tissues in layers. To improve the outflow, stab wounds must be drained with half-tubes or rubber graduates. The drains are removed 1-3 days after the operation, the sutures are removed on the 8-10th day. Patients with deep wounds, muscle damage and significant blood loss are subject to hospitalization in the trauma department. With minor soft tissue injuries, outpatient treatment in an emergency room is possible. In the postoperative period, UHF and antibiotic therapy are prescribed.
Damage to the internal organ is an indication for an appropriate abdominal operation. If the lung is injured, a thoracotomy is performed, if the abdominal organs are damaged, a laparotomy, etc. The doctor performs an audit, sutures the damaged organ and performs other therapeutic measures (the list of measures and tactics of surgical treatment depends on the characteristics of the wound). All patients with damage to internal organs are hospitalized.
Infected wounds are opened, washed and drained. Local treatment is carried out against the background of antibiotic therapy. First, broad-spectrum antibiotics are used, then the drug is prescribed taking into account the sensitivity of the detected microorganisms. Depending on the condition of the patient, treatment can be both inpatient and outpatient.
Prognosis for stab wounds
The prognosis for uncomplicated stab and stab-cut wounds is more favorable than for lacerated and torn-bruised ones. Relatively clean and even edges provide the best conditions for healing. However, the risk of infection with such wounds is higher than with shallow incised wounds. The prognosis for complicated wounds depends on the characteristics of the injury (the severity of damage to certain organs, the volume of blood loss, the presence or absence of shock).
