Injuries incompatible with life
author: doctor Martynenko O.V.
Doctors of ambulance and centers of extreme medicine face daily injuries from injuries of varying severity. Patients with mild to moderate injuries can receive treatment on an outpatient basis or in the hospital ward. Victims with severe injuries are in intensive care units, and sometimes do not even have time to reach the hospital.
Causes of severe injuries
The cause of the injury can be:
- Knife and gunshot wound;
- injuries resulting from a traffic accident;
- injury from electric shock;
- falling from height;
- trauma associated with the characteristics of production.
Injuries incompatible with life are obtained by disrupting the work of one or more vital organs.
Head injuries incompatible with life
The main content of the cranium is the brain that regulates the work of the whole organism: it sends impulses to the organs and muscles, produces releasing hormones (regulating the endocrine glands) and finally has an oblong brain, to which the respiratory and vasomotor center is located. If the medulla oblongata is damaged, the person stops breathing and the ability of the vessels to reduce and maintain blood pressure is lost.
The severity of the craniocerebral box is determined on the scale of coma Glasgow. Assess three indicators in points:
Opening the eyes (spontaneous - 4; opens his eyes to the voice - 3; opens his eyes to the pain - 2;
there is no reaction - 1).
Speech reaction (the patient clearly answers the question posed, is oriented at the place, the date and time is 5, the orientation is broken, the speech is confused - 4, the patient is disoriented, the questions are answered incorrectly - 3; the patient makes unclear sounds - 2; missing - 1).
The motor reaction (the patient's movements correspond to the team of the doctor-6, the defensive reaction in response to the stimulus-5, the painful irritation of the patient is withdrawn by the limb-4, the pathological flexion as a response to the pain stimulus-3, the pathological extension to the pain stimulus-2, 1).
Evaluation of the results:
15 points - clear consciousness
13 - 14 points - stunning
9 - 12 points - a sopor
4 - 8 points - coma
3 points - brain death
Fracture of the base of the skull with damage to the medulla oblongata is a trauma incompatible with life.
When a hard object hits or falls over the head, a blood vessel in the brain can rupture to form a subdural (under the cerebral membrane) or an intracerebral hematoma. An increase in the hematoma causes compression of the brain substance, which in turn causes its swelling and swelling. Since the cranium is not capable of stretching, the brain substance is shifted towards the large occipital foramen and leads to the oblong brain cuffing into it, and respiratory and vascular paralysis, respectively. If the victim is quickly taken to a hospital and an operation is performed, then he has chances of life. The main guarantee of success is reliable hemostasis and adequate anti-edema therapy. Such an outcome is possible with epi- and subdural hematomas. Achieving reliable hemostasis with intracerebral hematomas is extremely difficult, so often they recur, continuing to squeeze the brain substance and aggravating the edema, which leads to a fatal complication-the oblong brain in the large occipital orifice.
Chest injuries incompatible with life
Traumas of the chest are dangerous for the possibility of damage to the lungs, heart and large vessels.
To threatening conditions in the damage to the respiratory system include: obstruction (blockage of the respiratory tract) foreign body, hemo- and pneumothorax, rupture of the lungs and bronchi,
Obturation with a foreign body trachea or bronchi leads to a reflex spasm of their smooth muscles and swelling of the walls. It is necessary, if possible, to remove the foreign body from the respiratory, and if these actions are not possible, make a conicotomy. Otherwise, death occurs in 5-6 minutes.
Pneumothorax occurs when a damage to the lung tissue (for example, the rib) and the flow of air into the pleural cavity. Pneumothorax is open, closed and valve. The most dangerous is the valve pneumothorax, since air from the lung and the environment can penetrate into the pleural cavity, but can not come out. In this case, a lung collapse with a fatal outcome may occur quickly. The first emergency aid with the closed and valve pneumothorax is to transfer it to the open one with subsequent drainage and installation of Bülow drainage (the tube is inserted at one end into the pleural cavity on the affected side, and at the other end, a finger from the glove cut in the middle is tied and this end is lowered into a tube with an antiseptic.)
Hematorex is also a life threatening condition. In this condition, blood accumulates in the pleural cavity from the vessel damaged during the trauma. If you do not help, the lung can also be collapsed with a lot of blood. Blood loss with hemorrhagic shock aggravate this condition. It is important to note that not massive bleeding in the absence of surgery leads to the formation of clots in the pleural cavity, and blood is a favorable breeding ground for the reproduction of microorganisms, which leads to prolonged purulent pleurisies and the subsequent formation of adhesions.
Contusion of the lung (concussion of the lung) with trauma is another life threatening condition. During the injury, concussion and compression of the lung occurs, but the integrity of the visceral pleura is not impaired. When the lung contusion occurs, small hemorrhages to the alveoli and impregnation from the blood or the lung tissue are crushed, bronchi and blood vessels are damaged with the formation of a cavity in the lungs, which is filled with blood and air. This condition often occurs as a severe shock ("shock lung") with increasing respiratory insufficiency and hemoptysis. The diagnosis is confirmed by radiography. With severe contusion of the lung, even with a timely begun treatment, the lethality is very high. Anyway, you need to know what to do with a broken rib .
From the heart to deadly injuries include a bruised heart and cardiac tamponade. With a bruise of the heart, the patient may have complaints of chest pains like angina pectoris. An ambulance can diagnose a rhythm disturbance in the type of ventricular and supraventricular tachycardia, extrasystole, ventricular fibrillation, which is confirmed after electrocardiography. In severe cases, the bruise of the heart can lead to its rupture.
Cardiac tamponade is a serious life-threatening condition that occurs when the heart is injured, with the accumulation of blood in the pericardial cavity, which complicates the work of the heart. Clinically, this condition manifests itself as rapidly growing symptoms of respiratory failure, and if assistance is not provided in time, then death occurs.
Other injuries incompatible with life
Damage to large arteries is accompanied by massive bleeding with the development of severe shock. The first medical help is pressing the vessel in the wound above the injury site. In the absence of assistance, the patient dies within one hour (depending on the diameter of the damaged vessel).
Fractures of large bones can also be accompanied by damage to large vessels (for example, when injured by the femoral artery without medical assistance, the victim dies within 10 minutes). The second fatally dangerous complication in the fracture of the tubular bones is fat embolism. The bone marrow, which is a fatty tissue can penetrate through damaged blood vessels and be transported to the pulmonary arteries by the blood stream, where the fat embolus closes the lumen of the vessel, thereby turning off the lung's gas exchange site. On the roentgenogram it is visible as a heart attack of the lung (lighter than healthy tissues). When obturatsii massive embol of a large vessel in the lung, death may occur in 30 minutes.
The urgent states that we examined, which develop as a result of various damaging actions, present a real threat to life, and some of them even do not lend themselves to medical correction. It is worth emphasizing that a severe pain shock that develops in response to the resulting injury in itself can already cause death and waiting for the development of complications in damaged organs and systems.
author: doctor Kuznetsov MA
Despite the fact that the skeleton of the legs is more massive than the upper extremities - injuries of the lower extremities, in particular the lower leg, are quite common among the population.
author: ambulance doctor Buren'kova NV
Compression fractures of the spine are quite serious injuries, but they are not so common. Only 1-2% of all spinal injuries. The more dangerous they are, the fact that they lead to disability of the child if they are treated incorrectly.
Doctor A. Deriushev
Fracture of the rib is a common trauma, therefore, as a rule, the main role is played by the presence of such a trauma. It can be a fall, a blow. Trauma can be obtained in everyday life, during a traffic accident, while playing sports, etc.
author: doctor Martynenko O.V.
The human brain is the most complex and poorly studied area of the human body. He controls the work of all organs and systems, ensures the maintenance of vital functions, but, unfortunately, is not capable of regeneration. Leading scientists were able to clone in modern laboratories any organs other than the human brain. Any craniocerebral injury of varying severity is dangerous for human health and life. If the victim still managed to survive after a traumatic brain injury, the consequences will still remain.
author: doctor Buren'kova NV
Production will be considered only that trauma, which is received during working hours in the performance of its direct functional duties. If in the workplace you were engaged not in what is supposed to be and were injured, it will not be considered production.
author: doctor Tyutyunnik DM
Damage is a violation of an integral structure at the tissue, cellular or organ level that results from the effects of damaging agents. Damage to the maxillofacial area occurs due to the influence of mechanical factors - solid, blunt and sharp objects, moving mechanisms, including firearms; physical factors - thermal and radiation damage; and chemical factors - damage by acids, alkalis and other chemical agents. There are also combined injuries.
author: doctor Martynenko O.V.
Neglect of safety rules, non-observance of traffic rules can lead to serious injuries, which pose a serious threat to the health and life of the victim. Prospects for the preservation of life and the future recovery depends on the timely proper assessment of the severity of the victim at the scene and the provision of first aid.