Due to accidents, injuries at work and deliberate actions, various injuries to the skin, soft tissues and bones can occur. Crushed wounds do not appear very often, but there is still a chance of their occurrence in some cases. What are these wounds? Causes, symptoms, first aid and subsequent treatment.
Characteristic
A crushed wound is called an injury that arose as a result of mechanical compression. Most often, limbs are affected by these types of injuries, especially fingers. Wounds are difficult to treat, since the area of trauma is extensive, and their edges have an uneven surface.
What characterizes bruised and crushed wounds? They have a pronounced pain syndrome, which often leads to pain shock and loss of consciousness. In this case, arteries are rarely affected, so bleeding is moderate. With mechanical compression of the torso or head, a person receives lacerated wounds that are incompatible with life.
Causes of occurrence
Such injuries are one of the most dangerous, since fragments of bone that can be crushed inevitably fall into the wound; dust and dirt that mixes with leaking blood. The integrity of not only the skin, but also of the soft tissues is violated, ruptures of blood vessels are observed. There are several ways to get injuries of this kind:
- Traffic accidents, as a result of which the lower limbs can be crushed by an engine, which, in a head-on collision, goes into the cabin along the way, exerting strong pressure on the legs. Also, in accidents, people can get crushed wounds of the skull and trunk, which are incompatible with life. In this case, a person dies almost instantly. A complicating factor is that it can sometimes be difficult to pull a victim out of a mangled car.
- Non-observance of safety precautions when working at a construction site or any other hazardous production. Also, wounds can be caused by a malfunction of the used heavy equipment or inattention.
- Games and visits to unfinished houses, roofs, which can result in a fall from a height or injury due to broken beams, ceilings and other structural elements.
- In everyday life, crushed, bruised wounds can often be obtained with a strong blow with a hammer on the fingers.
Different causes of wounds lead to injuries of different danger, while all of them require immediate first aid and appropriate subsequent treatment.
Symptoms
The crushed wound of the finger or other part of the limb is notable for the complexity of the course, but it can be seen with the naked eye. Depending on the degree of complexity of the damage, as well as the presence of complications, such wounds may have the following manifestations:
- Superficial wounds can be distinguished by crushed skin and soft tissues. The bone remains intact.
- Deep crushed wounds affect the bone tissue, as well as the internal organs when squeezing the trunk.
- Purulent discharge can occur when an infection is connected. This complication often manifests itself in the absence of the necessary first aid, as well as late contact with doctors.
- As a result of ruptures of small capillaries, veins, and in rare cases, arteries, bleeding is observed, which can be weak, moderate and strong. Large bleeding leads to severe blood loss, as a result of which a person may lose consciousness and even die.
- A patient with an injury has a shock state, which manifests itself in clouding of consciousness, confusion of thoughts, disorientation in space and time, cold, sticky sweat, and the absence of reactions to external stimuli.
- With a crushed wound, a very severe pain occurs, which is difficult to stop with the help of traditional analgesics.
Pallor of the skin, a drop in blood pressure and increased heart rate are also observed.
First aid
The characterization of crushed wounds is disappointing, therefore, first of all, it is necessary to provide medical assistance to the victim. It should be provided by someone who is with the victim until the ambulance arrives. First aid for a crushed wound is as follows:
- If a patient is found under rubble or trapped in a car during a car accident, it is not recommended to try to pull a person on his own, as this is fraught with life-threatening problems. In this case, the only adequate help is to call the medical team and their expectation.
- A person with injuries that hit a small amount of soft tissue should be placed in a horizontal position. In this case, it is desirable that the affected limb is above the level of the heart.
- You can try to apply a tourniquet above the wound, while you should definitely remember and tell the doctors the time of its application.
In addition, it is recommended that the victim be given pain medication in tablets. The likelihood that it will work in case of pain shock is extremely small, however, with a small area of damage, tablet preparations can help.
First aid
A photo of crushed wounds shows the severity and danger of the situation (but will not be presented for aesthetic reasons), so a very important point in providing first aid is to call the doctors. They, in turn, must perform a number of the following activities:
- Release a person from the rubble or from the press. EMERCOM employees can also do this in the presence of doctors.
- To suppress pain shock or prevent it, the patient is given narcotic painkillers such as Morphine, Fentanyl, Tramadol, Omnopon. With minor wounds, the use of ordinary analgesics is allowed.
- Doctors must apply a tourniquet so that the victim does not die from blood loss.
- In case of heart rhythm failures, it is necessary to perform resuscitation measures, such as indirect heart massage and artificial respiration.
- A damaged limb must be immobilized.
These events can be carried out both at the scene of the incident with subsequent delivery to the medical facility, and in the ambulance along the way to it.
Diagnostics
It is not difficult to determine the presence of a crushed wound, since it has a rather specific appearance. Diagnostic measures include a medical examination of a damaged limb, as well as clarification of the circumstances in which the injury was received. Also, in some cases, X-ray diagnostics are recommended to determine bone integrity.
Surgical aid
With bruised lacerated and crushed wounds in almost all cases, surgical intervention is required. An experienced surgeon performs the following actions:
- Damaged, and not subject to subsequent repair, soft tissues are excised.
- After that, the edges of the wound open. This is necessary in order to thoroughly rinse it from associated contaminants. For this, cotton and gauze swabs are used, as well as a large amount of saline, chlorhexidine or hydrogen peroxide.
- A drainage is installed in the wound cavity to ensure the outflow of excess fluid, including pus.
- After this, a sterile dressing is applied, which should be replaced daily until the wound is completely healed.
The operation is carried out under general anesthesia, since a person is not able to survive it without entering into a deep sleep. Also, in cases of severe damage, the surgeon decides to amputate the limb.
Drug therapy
Crushed wounds are characterized by a long healing period, therefore, to speed it up, as well as to avoid serious consequences, treatment with drugs is used:
- To accelerate the recovery of soft tissues, the patient is recommended to use such ointments as Levomekol, Betadin, and Tetracilin.
- Anti-inflammatory drugs - "Solcoseryl", "Actovegin", "Traumeel".
- To stop the pain syndrome, such drugs as Tramadol, Morphine are used. In the subsequent stages of healing. when the intensity of the pain decreases the victim is offered drugs such as "Ketanov", "Analgin".
- To prevent infection, it is necessary to take broad-spectrum antibiotics for 10-14 days. The most commonly prescribed drugs are Augmentin, Levomycetin, Levofloxacin, and Tetracycline.
- With large blood loss, the patient is prescribed droppers with saline and glucose, as well as a blood transfusion.
The wound can begin to fester, in this case, washing it with antiseptic agents is also connected to daily dressings.
Weeping Wound Treatment
In some photos of crushed wounds, you can notice that they can have a weeping character. This means that there is always liquid discharge from the wound, which significantly worsens the healing process. The following methods are used to treat wet wounds:
- Daily treatment with antiseptics, for example, with Miramistin.
- To reduce the amount of discharge, dressings with a 10% sodium chloride solution are used. It is recommended to change such dressings every 4-5 hours.
- As a drying agent can be used powders - "Xeroform", "Baneocin".
- Especially effective are such ointments - "Streptocid", "Mafenid", "Foodizin".
Wound treatment should be supervised by surgeons, so such a patient is shown to be in a hospital.
Healing period
The time of complete healing of the wound can be delayed for a long time, especially if the damage is characterized by its vastness. On average, the period of complete healing can drag on for several months or several years. The patient should spend the first 2-3 months in the hospital to monitor his condition, especially if the injury was severe. After this, treatment is carried out at home. It is also noted that on the hands these lesions heal faster, since blood circulation is better organized than on the lower extremities.
Possible consequences
Crushed wounds cannot heal without complications. This is especially true for those who have a large lesion area. The most common consequences are:
- A large number of scars in the affected area, which can tighten the skin, causing inconvenience.
- Partial loss of sensation, which occurs due to excision of a large amount of skin, as well as the formation of keloid scars.
- Paresis or paralysis.
- Loss of limb function due to extensive damage to ligaments and soft tissues.
The most severe consequence is loss of limb due to amputation. This happens in the case of extensive damage to the soft and bone tissues, the restoration of which is considered impossible.
Dressing at home
Often, after the patient is discharged from the hospital, he will need daily wound dressings. If necessary, you can call a nurse to your home from the nearest clinic, but you can learn how to make them yourself. Close relatives are most often involved in this. Ligation is performed according to the following algorithm:
- First you need to remove the old bandages. If part of them has dried up to the wound, then it must be carefully soaked in an antiseptic solution.
- After that, you need to process the entire surface of the wound. Most often, Chlorhexidine or Miramistin is chosen for these purposes, since they have a mild effect and do not cause discomfort to the victim.
- The surface of the wound must be covered with a sterile cloth and fix its edges with adhesive plaster.
- After that, you can proceed directly to the dressing with a bandage.
It is recommended to carry out such manipulations daily. This will allow the wound to be aired, which is necessary to prevent decay.
Conclusion
Crushed wounds are a rather difficult injury for both the injured and the treating surgeon. In this case, success depends not only on the professionalism of the doctors, but also on the timeliness of the assistance they provided, so the ambulance for the victim must be called immediately. Before arrival, if the patient is not clamped, you can give him first aid.