Emergency medical care of mass distruction

1. I.Ya. HORBACHEVSKY TERNOPIL STATE MEDICAL UNIVERSITY Emergency medical care of mass distruction R.M. Lyakhovych

2. Purpose of the organization and provision of medical care at mass destruction

3. danger of mass measures

10. Quantitative characteristics of injury: Trauma- injury of the body, its tissues or parts caused by the influence of mechanic, physical, chemical or mental factors, which is conducted with local and general reactions

11. Isolated trauma- is a single injury at any anatomic and functional region of the body or organ. Multi-trauma- few injuries at one anatomic and functional region. Associated trauma- few injuries, at different anatomic and functional regions. Combined trauma- injury, which appears as a result of simultaneous or sequential influence of several traumatic agents.

12. Polytrauma- severe multiple and combined injuries, which cause the beginning of traumatic disease (wound dystrophy) and need immediate medical aid by life-saving indications.

14. In case of associated trauma dominates the syndrome of mutual complexification, which means that every single injury might not be lethal, but together injuries might become life-threatening. (Fracture+ rupture of intestine+ injury of liver, spleen) Polytrauma is characterised with: syndrome of mutual complexification, atypical symptoms of damages, complicacy of diagnostic.

16. “Traumatic disease” – is a phase of pathologic process, which gradually develops in case of severe injuries.Traumatic disease is usually divided into 4 periods: I - shock II - period of early manifestations of traumatic disease III - period of late manifestations of traumatic disease IV - period of rehabilitation

19. 1. Subdural and epidural haematoma. 2. Haemopneumothorax 3. Splenic rupture 4. Damage to the liver Fracture of the pelvic bones or/and other injuries associated with large blood loss. The third pick of lethality appears in few days or weeks after moment of injury and is usually connected with multiple organ failure and sepsis.

20. Emergency medical aid is often provided in extreme conditions, when additional factors might harm not only patients, but also their rescuers. In such cases medical workers should follow these rules: 1. Check the safety of the place of accident and if necessary ask professional rescuers or police to help. 2. Determine the quantity of victims, way of injuring, sources of danger in environment. 3. Define the necessity in additional emergencies in case of many victims.

22. Components of emergency medical aid at the pre hospital stage: Primary inspection ABCC’ Medical sorting Intensive therapy Secondary inspection (ABCDE) Constant observation of the patients condition Qualified and specialised medical helpairways B-breathing Circulation C’- cervical spine- with using of neck collar

24. Classification of shock

26. Open fracture of bones of forearm

27. Probable complication of fracture or transportation without immobilisation Mechanism of radial nerve damage

28. Splintered open fracture of both bones of right forearm at the level of lower 1/3 1 2 Combined MOS 3 4 5

29. Fractures of the pelvis Without breaking of pelvic circle continuity A.B. Fractures of the wing of ilium C.D. Fractures of sacrum E. Fractures at the level of iliosacralis articulation F. Fractures of ishiadic and pubic bone G. Fracture of pubic bone (horizontal ramous) H. fracture of ishiadic bone I. Fracture of pubic articulation

30. Fractures of the pelvis With breaking of pelvic circle continuity (Malign) 1 1. Fracture at iliosacralis articulation with dislocation. 2. Fracture of pubic bone with dislocation. 3. Fracture of the ischiadic bone with dislocation Fracture-displacement of half-pelvis Fracture of pelvic and iliosacralis articulation with dislocation of pelvic circle

31. Fractures of the pelvis Mechanisms of injury- direct and indirect Clinic: pain, deformation of the pelvic circle, specific position of the limb, depends on the type of fracture, pathologic mobility.

32. Transportation of the patient with pelvic fracture Patient with pelvic fracture should be transported on the stretcher in position with flexed (30º-40º) knees and femoral articulation (abduction 10º). This position is the most physiological for the muscles, which are connected with the pelvis and doesn’t cause additional dislocation (so called “frog-position”).

33. Shaft of femur fractures Fractures of this localisation consist 40% of all femoral fractures. Mechanism of the trauma: direct and indirect Clinic: pain, oedema, pathologic mobility, bone fragments crepitating. The specific feature of this trauma is often development of trauma shock and blood loss (0,5-1,5 l), and if the patient is transported without immobilisation, the risk of fat embolism growth. There are fractures of upper, middle and lower 1/3 of femoral bone.

34. Clinical examples Combined trauma: fracture of heel bone+burns (treatment- mod apparatus of Elizarov with compression of bone fragments)

35. Displacements of foot Subtalar open displacement of the foot

36. Passive postural position

37. Passive postural position

38. Transporting immobilisation The main principle is the immobilisation of joints, which are above and lower than fracture • a - immobilisation with Cramer's splint in case of crus’ fracture • b - immobilisation with Diterichs' splint

48. Use the rule of 4 catheters: Nasal for oxygen Gastric for evacuation of its contents (when patient is unconscious) Intravenous for infusions Urinary for measuring of diuresis

49. Glucocorticoids in case of hypovolemic shock. Immobilisation of fractures- standard and improvisational splints, contra shock clothes. A/B therapy, beginning from “wide” antibiotics (cyfran, zanocyn, cephalosporins). Prevention of supercooling- warm coats, the optimal climate control, warm liquids for drinking (except abdominal trauma), warm infusion solutions 35º- 40º. Symptomatic syndromes and corrective therapy.

50. Transportation of patient with polytrauma Treatment of patients at pre hospital stage needs experienced medical workers and expensive medical equipment. Every delay might cause life-threatening complications. Those statements cause the necessity of hospitalisation of such patients to the specific in-patient departments, where exists the possibility to involve into treatment surgeons, neurosurgeons, traumatologists, anaesthesiologists.