Is pressure immobilization bandage recommended for North American snake bites. What are the key considerations for applying this technique. How does the scientific evidence support or refute its use. What potential risks are associated with pressure immobilization for non-neurotoxic envenomations.

Understanding Pressure Immobilization Bandage Technique

Pressure immobilization bandage (PIB), also known as pressure bandage with immobilization (PBI), is a first aid technique originally developed for neurotoxic snake bites. The method involves applying a firm bandage over the bite site and immobilizing the affected limb. Its primary goal is to slow the spread of venom through the lymphatic system, potentially delaying or preventing systemic envenomation effects.

How does PIB work? The bandage is applied with sufficient pressure to impede lymph flow without restricting arterial or venous blood circulation. Typically, this means a pressure between 40-70 mmHg for upper extremities and 55-70 mmHg for lower extremities. In practical terms, the bandage should be snug enough to allow a finger to slip under it with some resistance.

Controversy Surrounding PIB for North American Snake Bites

The use of PIB for North American snake bites has become a subject of debate among toxicology experts. Why is this technique controversial for North American envenomations? The primary concern stems from the fact that most venomous snakes in North America belong to the Crotalinae subfamily (pit vipers), which typically produce non-neurotoxic venom.

Are there potential risks associated with using PIB for non-neurotoxic envenomations? Some experts worry that applying PIB in these cases might concentrate the venom in the affected limb, potentially increasing local tissue damage. This concern is particularly relevant for pit viper bites, which often cause significant local effects such as swelling, tissue necrosis, and compartment syndrome.

Analysis of Recent First Aid Guidelines

Recent first aid guidelines published by the American Heart Association (AHA) and American Red Cross (ARC) have sparked controversy by including PIB as a recommended technique for snake bites. These guidelines suggest that PIB can be effective for both neurotoxic and non-neurotoxic snake bites, including those from American snakes.

How strong is the recommendation for PIB in these guidelines? The AHA/ARC recommendation is classified as Class IIa, Level of Evidence C. This classification indicates that while there is some evidence or expert opinion favoring the usefulness of the procedure, there is also conflicting evidence or divergence of opinion about its efficacy.

Key Concerns with the AHA/ARC Guidelines

• The recommendation may be applied inappropriately to North American Crotalinae envenomations
• The evidence grading may be higher than current scientific data supports
• The nuances of the recommendation grading system may not be fully appreciated by the general public

Scientific Evidence and Real-World Application

When considering the implementation of PIB for North American snake bites, it’s crucial to examine both the scientific evidence and the practical aspects of its application. What factors should be considered when evaluating the use of PIB?

1. Certainty regarding the species of snake involved
2. Expected time to arrival at a facility providing definitive care
3. Ability of lay individuals to distinguish between different snakebite scenarios
4. Likelihood of correct application and maintenance of immobilization

Has PIB been proven effective for North American snake species? While some studies have shown potential benefits of PIB for certain snake species, the evidence for its efficacy in North American pit viper bites is limited. Moreover, the potential risks of concentrating venom in the affected limb must be weighed against any potential benefits.

Historical Perspective on Snakebite First Aid

The history of snakebite first aid is riddled with practices that were initially thought to be beneficial but were later proven harmful or ineffective. Which once-common practices have been abandoned in snakebite management?

• Tourniquets
• Cryotherapy
• Incision and suction
• Electrotherapy
• Fasciotomy

Why were these practices discontinued? As scientific evidence accumulated, these methods were shown to be either ineffective in improving outcomes or, in some cases, actively harmful to patients. This historical context underscores the importance of thorough scientific evaluation before implementing new first aid techniques.

Expert Consensus on PIB for North American Snake Bites

In response to the AHA/ARC guidelines, several major toxicology organizations have issued a joint position statement regarding the use of PIB for North American Crotalinae envenomations. Which organizations have endorsed this position statement?

• American College of Medical Toxicology
• American Academy of Clinical Toxicology
• American Association of Poison Control Centers
• International Society on Toxinology
• European Association of Poison Centres and Clinical Toxicologists
• Asia Pacific Association of Medical Toxicology

What is the consensus among these organizations? The joint position statement concludes that PIB cannot be recommended as pre-hospital care in areas like North America, where non-neurotoxic snakebite predominates. This recommendation is based on the current state of scientific evidence and the potential risks associated with PIB use in these scenarios.

Challenges in Implementing New Snakebite Management Techniques

Introducing new practices in snakebite management requires careful consideration of various factors. What key questions should be addressed when evaluating a new snakebite management technique?

1. When should a new recommendation be put forward?
2. How should new techniques be introduced and implemented?
3. What level of evidence is necessary to support a change in practice?
4. How can the effectiveness and safety of new techniques be monitored in real-world settings?

Is there a risk in prematurely adopting new techniques? Yes, the history of snakebite management shows that premature adoption of techniques without sufficient evidence can lead to harm. Therefore, a cautious approach, backed by robust scientific evidence, is crucial when considering changes to established practices.

Future Directions in Snakebite First Aid Research

The controversy surrounding PIB for North American snake bites highlights the need for continued research in this field. What areas of study could help clarify the role of PIB in snakebite management?

• Comparative studies of PIB efficacy for different snake species
• Investigation of potential adverse effects of PIB in non-neurotoxic envenomations
• Research on the ability of laypeople to correctly apply PIB in emergency situations
• Development and evaluation of alternative first aid techniques for non-neurotoxic snake bites

How can future research address the complexities of real-world snakebite scenarios? Studies should aim to replicate real-world conditions as closely as possible, considering factors such as delayed access to medical care, variations in PIB application techniques, and the diversity of snake species encountered in different regions.

Importance of Context-Specific Recommendations

The debate over PIB use in North American snake bites underscores the importance of context-specific recommendations in medical practice. Why is a one-size-fits-all approach problematic in snakebite management? Different regions have varying snake species with diverse venom compositions, and healthcare resources and access can vary widely. Therefore, first aid recommendations must be tailored to the specific context of each region.

How can medical professionals balance the need for standardized guidelines with the requirement for context-specific recommendations? One approach is to develop tiered guidelines that provide general principles applicable to all regions, supplemented by specific recommendations tailored to local snake species and healthcare infrastructure.

Educating the Public on Snakebite First Aid

Given the complexities surrounding snakebite management, public education plays a crucial role in ensuring appropriate first aid. What key messages should be conveyed to the public regarding snakebite first aid?

• The importance of seeking immediate medical attention for all suspected snake bites
• Basic first aid measures that are universally recommended (e.g., keeping the victim calm and immobile)
• The potential risks associated with improper first aid techniques
• The importance of being able to describe or identify the snake species if possible

How can public education programs effectively communicate the nuances of snakebite management? Educational initiatives should focus on providing clear, actionable information while emphasizing the importance of professional medical care. They should also address common misconceptions about snakebite first aid and highlight the potential dangers of unproven or outdated techniques.

Role of Technology in Snakebite Management

Can technology play a role in improving snakebite first aid and management? Emerging technologies offer several potential applications in this field:

• Smartphone apps for snake identification and first aid guidance
• Telemedicine platforms for remote consultation with toxicology experts
• GPS-enabled emergency response systems for rapid location of snakebite victims
• Wearable devices for monitoring vital signs and venom spread in bite victims

How can these technological solutions be integrated with existing snakebite management protocols? While technology offers promising tools, it’s crucial to ensure that these solutions are validated for accuracy and effectiveness before widespread implementation. They should complement, rather than replace, established medical practices and expert judgment.

Ethical Considerations in Snakebite Management Research

Research into snakebite management techniques presents unique ethical challenges. What are some of the ethical considerations in conducting snakebite first aid studies?

• Balancing the need for robust evidence with patient safety
• Ensuring informed consent in emergency situations
• Addressing potential conflicts of interest in research funding
• Considering the ecological impact of research involving venomous snakes

How can researchers navigate these ethical challenges while advancing the field of snakebite management? Ethical guidelines specific to snakebite research should be developed, incorporating input from toxicologists, ethicists, and community stakeholders. These guidelines should address issues such as the use of animal models, the conduct of field studies, and the responsible reporting of research findings.

Importance of Interdisciplinary Collaboration

The complexity of snakebite management necessitates collaboration across multiple disciplines. Which fields should be involved in advancing snakebite first aid and treatment?

• Toxicology
• Emergency Medicine
• Herpetology
• Public Health
• Pharmacology
• Bioengineering
• Data Science

How can interdisciplinary collaboration enhance snakebite management research and practice? By bringing together experts from diverse fields, researchers can develop more comprehensive approaches to snakebite management. This collaboration can lead to innovative solutions that address the complex interplay of biological, medical, and social factors involved in snakebite incidents.

Commentary: Pressure Bandaging for North American Snake Bite? No!

J Med Toxicol. 2011 Dec; 7(4): 324–326.

Published online 2011 Nov 8. doi: 10.1007/s13181-011-0188-9

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Author information Copyright and License information Disclaimer

This issue of The Journal of Medical Toxicology includes a position statement regarding the use of pressure immobilization for the pre-hospital treatment of North American Crotalinae envenomation. This commentary discusses the background behind the creation of the position statement and explores the issues involved in applying science to real-world public health recommendations and practice.

Keywords: Pressure immobilization, Crotalinae, Envenomation

This issue of The Journal of Medical Toxicology includes a position statement regarding the use of pressure immobilization for the pre-hospital treatment of North American Crotalinae envenomation [1]. It has been jointly endorsed by the American College of Medical Toxicology, the American Academy of Clinical Toxicology, the American Association of Poison Control Centers, the International Society on Toxinology, the European Association of Poison Centres and Clinical Toxicologists, and the Asia Pacific Association of Medical Toxicology, and concludes that pressure bandage with immobilization (PBI) cannot be recommended as pre-hospital care in areas such as North America, where non-neurotoxic snakebite is the norm.

This position statement was formulated because of concern about recently published first aid guidelines of the American Heart Association (AHA) and American Red Cross (ARC) [2]. Those guidelines, designed to be applied by bystanders or the victim, included the following:

“Applying [PBI] with a pressure between 40 and 70 mm Hg in the upper extremity and between 55 and 70 mm Hg in the lower extremity around the entire length of the bitten extremity is an effective and safe way to slow the dissemination of venom by slowing lymph flow (Class IIa, LOE C). For practical purposes pressure is sufficient if the bandage is comfortably tight and snug but allows a finger to be slipped under it. Initially it was theorized that slowing lymphatic flow by external pressure would only benefit victims bitten by snakes producing neurotoxic venom, but the effectiveness of pressure immobilization has also been demonstrated for bites by non-neurotoxic American snakes….”

Even though the AHA/ARC recommendation is weak (Class II: “conditions for which there is conflicting evidence and/or a divergence of opinion about the usefulness/efficacy of a procedure or treatment.” Class IIa: “weight of evidence/opinion is in favor of usefulness/efficacy”; level of evidence C: “recommendation based on expert opinion, case studies, or standards of care.”) [3] and meant to apply to snakebites worldwide, we are concerned that the recommendations will be applied to North American Crotalinae envenomations. We are also concerned that this guideline was graded above the level of current evidence and that the subtleties of the recommendation grading system are very likely to be underappreciated by most.

The pre-hospital use of PBI in North American snakebite would be a major change in how such cases are managed. The history of snakebite first aid and emergency care is full of concepts that, despite initial theoretical appeal and/or anecdotal evidence, ultimately proved to be harmful. Once-common practices, such as tourniquets, cryotherapy, incision, suction, electrotherapy, and fasciotomy, have been eliminated as their effectiveness was refuted, and more importantly, evidence of harm emerged [4–9]. With this perspective, the introduction of a new practice must be based on the scientific demonstration of efficacy and safety.

The application of science to real-world scenarios can be complex. The aim of PBI is to sequester venom in the limb, delaying its arrival into the central circulation and thereby delaying or even preventing the onset of the potential systemic consequences of envenomation [10]. Apart from directly measuring the clinical efficacy of PBI for various endpoints, together with risks of harm of properly applied PBI, it is important to consider context-specific considerations. Key questions are: (1) the certainty regarding the kind of snake involved, (2) the expected time to arrival at a place where definitive therapy can be provided, (3) whether lay individuals are able to distinguish between scenarios with different management considerations, and (4) the likelihood that PBI will be applied correctly or incorrectly and that immobilization can be realistically maintained.

In addition to these concerns, the larger questions include when, how, and on what basis should a new recommendation in the management of snakebite be put forward? Moreover, when universal benefit may not result, should first aid training be guided by utilitarian endpoints in which many patients might benefit by an intervention that harms some, or even worse, harms many patients and benefits few?

When evaluating the application of PBI to Crotalinae envenomations, the science is incomplete. Randomized, prospective, controlled, studies of PBI in human Crotalinae envenomations have not been performed. Our current state of knowledge comes primarily from animal models and a few studies in neurotoxic snakebite, where local tissue injury is not the major concern. This is an entirely different clinical problem to that posed by Crotalinae envenomations, where local tissue injury predominates. Furthermore, extrapolating from animal models to humans can be problematic, especially when animal studies have used fatality from systemic effects—rather than tissue injury—as a primary end-point. The data on tissue injury in animal studies is limited, but a porcine study demonstrated that tissue pressures in a range that would, in other contexts, result in the consideration of fasciotomy, and which might result in ischemic injury, can occur from PBI [11]. Recent studies in humans have demonstrated that both trained and lay individuals applied PBI that resulted in either ineffective or tissue pressures in the same range [12–14]. Finally, the porcine study of Crotalinae envenomation used in support of the AHA/ARC guidelines [2] actually drew the opposite conclusion, stating: “On the basis of our findings, we cannot recommend pressure immobilization widely for viper envenomation…” [11].

Thus the existing science points away from adoption of PBI in Crotalinae envenomation rather than towards it. Given that 98% of North American venomous snakebites are by Crotalinae, that fewer than 0.2% of those victims die, and that virtually all have soft-tissue injury, the key question is whether deploying pressure immobilization as a first aid strategy in this context will lead to a large number of people with increased and/or permanent limb injury while saving virtually no lives [15, 16]. Clearly, more work needs to be done. But our interpretation of the current state of knowledge is that the potential for harm of PBI in the vast majority of Crotalinae envenomations outweighs the potential benefits.

In the context of limited evidence, it is understandable that learned and well-intentioned individuals may disagree. This makes the consensus of toxicologists and envenomation specialists worldwide in opposition to the use of PBI in the prehospital setting all the more striking. The six organizations that endorse the position statement represent the mainstream medical opinion among experts on four continents. There is currently strong consensus that this technique should not be promulgated or taught in areas where non-neurotoxic snakebite predominates. Thus, in North American Crotalinae snakebite, the evidence for PBI would be more properly graded as Class III: “conditions for which there is evidence and/or general agreement that the procedure/treatment is not useful/effective and in some cases may be harmful [3].”

In response to criticisms from members of the clinical toxicology community, the AHA and the ARC have acknowledged that their guideline regarding snakebite does not define the snake groups, geographic locations, and individual circumstances in which PBI might be applicable and also that the data regarding PBI in Crotalinae envenomation are limited and insufficient to deem PBI safe and effective. They are planning to clarify the guideline. For future guidelines, content experts from the position-statement-sponsoring organizations will be invited to assist in the writing (Rose Marie Robertson, personal communication 2011). We applaud the AHA and ARC for their evidence-based approach and their ongoing process of review and clarification.

We agree with the conclusions of the position statement: “The use of pressure immobilization for the pre-hospital treatment of North American Crotalinae envenomation is not recommended [1].”

In the absence of definitive data on much of the pre-hospital management of Crotalinae snakebite, the following recommendations are based on the best available evidence, as well as expert consensus [17, 18]:

1. Get a safe distance away from the snake.

2. Remove jewelry and loosen tight-fitting clothing.

3. Loosely splint or otherwise immobilize the extremity in a functional position.

4. As a default action, maintain the bitten extremity in a neutral position with regard to the heart. Other potential actions should be guided by an experienced clinician.

5. Get to a hospital, preferably transported by an EMS provider. In general, supine positioning will prepare providers in managing possible effects such as hypotension and/or vomiting.

6. Avoid useless and/or potentially harmful interventions, such as tourniquets, incision, suction, cryotherapy, or electric shock.

Steven A. Seifert, Email: ude.mnu.dulas@trefiess.

Julian White, Email: [email protected].

Bart J. Currie, Email: ua.ude.seiznem@trab.

1. American College of Medical Toxicology, American Academy of Clinical Toxicology, American Association of Poison Control Centers, European Association of Poison Control Centres, International Society of Toxinology, Asian Pacific Association of Medical Toxicology (2011) Pressure immobilization after North American Crotalinae snake envenomation. J Med Toxicol. doi:10.1007/s13181-011-0174-2 [PMC free article] [PubMed]

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Pressure Immobilisation First Aid : School of Biomedical Sciences

Bites to the lower limb

1. Move the victim away from the snake. Calm and reassure them. Jewelry such as toe rings and ankle bracelets should be removed before the bandage is applied.

Regardless of where on the limb the bite has occurred, commence bandaging from just above the toes (leave these uncovered so that blood flow to the nail beds can be monitored).

Crepe bandages are ideal, but any flexible material may be used. Clothing, towels etc may be torn into strips.  Panty hose have been successfully used.

Do not take off clothing, as the movement of doing so will promote the movement of venom into the blood stream. Keep the bitten limb, and the patient, still.

Bandage upwards from the lower portion of the bitten limb. Even though a little venom may be squeezed upwards, the bandage will be more comfortable, and therefore can be left in place for longer if required.

2. The bandage should be as tight as you would apply to a sprained ankle.

3. Extend the bandage as high as possible up the limb.

4. Apply a splint to the leg. Any rigid object may be used as a splint.  e.g. spade, piece of wood or tree branch, rolled up newspapers etc.

5. Bind it firmly to as much of the leg as possible.

Keep the patient still. Lie the patient down to prevent walking or moving around.

Bites to the hand or forearm

Bandage as much of the arm as possible, starting at the fingers.

Use a splint to the elbow.

Keep the patient still. Lie the patient down to prevent walking or moving around.

Note: We do not recommend that the arm be bent at the elbow and placed in a sling as this can create a tourniquet effect at the elbow.

Bites to the trunk

If possible apply firm pressure over the bitten area. Do no restrict chest movement. Keep the patient still.

Bites to the head or neck

No first aid for bitten area. Keep the patient still.

Summary

1. Research stresses the importance of keeping the patient still. This includes all the limbs. Bring transport to the patient if possible.
2. DO NOT cut or incise the bitten area.
3. DO NOT apply an arterial tourniquet. (Arterial tourniquets, which cut off the circulation to the limb, are potentially dangerous, and are no longer recommended for any type of bite or sting in Australia.)
4. DO NOT wash the bitten area or suck the bite. The type of snake involved may be identified by the detection of venom on the skin. No attempt should be made to catch or kill the snake.
5. Note: Even if the bitten or stung person is ill when first seen, the application of pressure-immobilisation first aid may prevent further absorption of venom from the bite or sting site during transport to hospital.
6. If the bandages and splint have been applied correctly, they will be comfortable and may be left on for several hours. They should not be taken off until the patient has reached medical care.
7. The treating doctor will decide when to remove the bandages. If a significant amount of venom has been injected, it may move into the blood stream very quickly when the bandages are removed. They should be left in position until appropriate antivenom and resuscitation equipment have been assembled.
8. Bandages may be quickly reapplied if clinical deterioration occurs, and left on until antivenom therapy has been effective.
9. Hospital Staff 
   Please note that first aid measures are usually removed soon after the patient is admitted. Do not leave on for hours.

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Imposition of a plaster bandage from 2,000 rubles in Rostov-on-Don

A medical bandage can be an effective treatment tool in the hands of an experienced qualified doctor. The duration of the recovery period after a surgical operation or injury directly depends on the correct application of the bandage. Specialists of the Rostov medical center “Best-Clinic” are fluent in the techniques of applying dressings of all types and apply their experience in helping our patients.

Why dressings are applied

Dressings are necessary to achieve the following goals:

• protection of the wound surface from external factors and infection
• pressurizing internal organs to stop internal bleeding
• retention of drugs on the surface of the wound
• immobilization of the site of dislocation or fracture

The purposes pursued when applying dressings can be very different, so there are many varieties of medical dressings that differ from each other in the application technique and dressing materials used. Also, dressing is carried out not only for injuries of the limbs, but also after surgical procedures, for example, during operations on the face.

Types of dressings

Different types of dressings are used in modern medicine:

• Pressure

A medical pressure bandage is commonly called a tourniquet and is applied when venous or capillary bleeding occurs. It is also effective when used to stop bleeding from large arteries. It is important to know that a pressure bandage should not be left on the body for a long period of time (in the cold season, the tourniquet must be removed after two hours from the moment of application, and in the warm season – after one hour).

• Occlusal (preventing air and moisture exposure to the wound)

This type of bandage has a powerful therapeutic effect, as it accelerates the formation of epithelium on the surface of the wound, protects the wound from external factors and improves the granulation process. Occlusive dressings are applied during the treatment of dermatological diseases, and are also often used in military field surgery.

• Medicinal (ensuring the supply of medicinal substances to the wound)

When such dressings are applied, the material used is impregnated with the drug. Thus, a long-term access of the drug to the wound surface is achieved. Naturally, the drug bandage can be on the body for a strictly defined time, after which it is necessary to perform a dressing.

• Retainers

Retaining bandages are widely used in sports medicine. Medical dressings of this variety are applied to athletes to ensure the fixation of the joints in case of instability resulting from sports injuries. Retaining dressings are made of modern elastic materials, making their use as comfortable as possible for patients.

• Compression

Bandages of this variety are very effective in the treatment of diseases of the veins of the legs. After applying the bandage, the patient should experience the feeling of a tight-fitting boot, while the toes should not go numb. Compression bandages are applied using special elastic bandages.

• Immobilization (immobilization)

Immobilization dressings are also called transport dressings because they are applied to patients to ensure immobility at the time of transport of the patient. They are applied for joint injuries, fractures, suppurative processes of the limbs and soft tissue injuries, characterized by a large area.

• Aseptic

The main function of an aseptic medical dressing is to prevent infection from entering the wound surface. To apply a dressing of this type, a sterile gauze napkin is used, used in several layers, and cotton wool. Also, an aseptic dressing helps to dry the wound.

• Corrective (providing correction of deformities)

These dressings are applied with an elastic or mesh-tubular bandage, wadding and cotton fabric. Corrective dressings allow you to eliminate congenital or acquired body deformities.

Dressings can be applied using different types of materials. They are thus divided into three categories:

• Splints (hard bandages)

When applying a splint, it is necessary to lay the areas of bony protrusions with a soft material so that abrasions and bedsores do not form under the dressing.

• Soft
• Hardening (starch and gypsum)

Plaster casts are most often used in the treatment of fractures and are an effective means of immobilization. They are very durable and allow the patient to perform an X-ray examination without removing the dressing.

The comfort of the patient and the therapeutic effect of dressings directly depends on the quality of the consumables used in the application.

What is an application kit

This term refers to a collection of medical consumables needed to make various types of dressings that are applied for first aid purposes.

Before surgery

After surgery

Located in Rostov-on-Don, the Best Clinic medical center is fully equipped with modern dressing materials that allow patients to receive high-quality medical care at affordable prices.

Attention! Please check the prices before visiting a specialist!

Prices for applying a bandage

Service name

Price, rub

Applying fixing plaster bandages – hand

2,000

Applying fixing plaster bandages – elbow joint

3000

Imposition of fixation plaster cast – shoulder joint

4000

Imposition of fixation plaster bandages – knee joint

4,500

Imposition of fixation plaster bandages – ankle joint

2,000

Assistance in case of injury (during the period of ice) displacement of the ends of the bones in the joints relative to each other with a violation joint bag. It most often occurs in the shoulder, less often in the hip, ankle and elbow joints as a result of an unsuccessful fall or bruise.

It is characterized by severe pain, immobility of the joint, a change in its shape.

A dislocation cannot be reduced by oneself, as this will only increase the suffering of the victim and aggravate the injury. In case of dislocation of the shoulder joint, the hand is placed on a scarf or tightly bandaged to the body.

Sprains and ruptures of the ligaments of the joints occur as a result of sudden and rapid movements that exceed the physiological mobility of the joints. The most commonly affected are the ankle, wrist, and knee joints. There is a sharp pain in the joint during movement, swelling, bruising when the ligaments are torn.

First aid consists of tight bandaging by applying a pressure bandage, a compress (cold) and resting the limb. Bruises are among the most common injuries in emergency situations and at home.

Bruises is damage to tissues and organs without breaking the integrity of the skin and bones. The degree of damage depends on the impact force of the area of ​​the damaged surface and part of the body, its significance for the body. It is natural to imagine that a blow to the finger with a hammer is less dangerous than the same blow to the head.

The main signs of bruises include pain, swelling and bruising at the site of contact with the injuring object. The choice of first aid methods depends on the location and severity of the injury. Complete rest is created for the bruised limb, an elevated position is given, a tight pressure bandage is applied to the site of the bruise, a cold compress or an ice pack can be put.

A contusion of the head is very serious in its consequences, as it can be accompanied by concussion and contusion of the brain.

Signs of a concussion include loss of consciousness at the scene, possible nausea and vomiting, slow pulse.

The victim is given complete rest, a cold compress, ice in a bubble on the head. With all possible precautions, the patient should be sent to a medical institution as soon as possible. For transportation, it is placed with its back on a shield, and its head on a soft pillow. To fix the neck and head, a soft fabric collar is applied to the neck.

From a pathoanatomical and clinical point of view, a fracture is a set of bone injuries with a violation of its integrity and simultaneous damage to the surrounding soft tissues. The degree and nature of damage can be very diverse. The treatment of bone fractures aims to save the life of the victim, prevent possible complications and, in the shortest possible time, restore the integrity of the bone, the function of the limb and the patient’s ability to work.

Treatment should begin at the scene. Success largely depends on the timely and correct provision of first aid (at the scene and on the way to evacuation to a medical institution).

Temporary immobilization of the limb must be carried out immediately. Poor immobilization or transportation without prior good immobilization of the limb can cause a number of complications (additional trauma to the skin, muscles, blood vessels and nerves) and cause increased bleeding, pain, shock, embolism and spread of infection. When immobilizing a broken limb with splints, two joints are necessarily immobilized – one above and the other below the fracture.

Means of fixing the damaged area of ​​the body, used when delivering the patient to a medical institution, is called transport immobilization. It is the most important link in providing first aid to the victim. Immobilization eliminates the mobility of bone fragments and secondary injury to the neurovascular bundles, spinal cord, internal organs, skin, reduces pain, and helps prevent shock and fat embolism. The absence of transport immobilization or its incorrect use can adversely affect the course and outcome of a traumatic disease.

Basic requirements for transport immobilization:

1. Maximum immobilization of the damaged area of ​​the body. In case of fractures, it is imperative to fix the joints lying above and below the injury site. The exceptions are fractures of the radius in a typical location and fractures of the ankles.
2. Fixation dressings must not cause tissue compression. To avoid bedsores and circulatory disorders, the protruding points of the body are covered with soft pads, and constrictions are eliminated.
3. Immobility of limbs is performed in a functionally advantageous position.

Transport immobilization is carried out with soft tissue bandages, splints.

Can be used as an independent fixing method or as an addition to another. Cloth dressings are most often used for fractures and dislocations of the clavicle, fractures of the scapula, injuries of the cervical spine. In cases where there are no other means for fixation, the listed bandages, as well as scarves, can be used to immobilize fractures of the upper and even lower limbs – bandaging the injured leg to a healthy one. In addition, soft tissue bandages always complement all other methods of transport immobilization.

The most acceptable and commonly used method of fixation during the transportation of casualties.