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Splinter infection pictures: First Aid Information for Splinters

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Splinter haemorrhage | DermNet NZ

Author(s): Dr Alice Manley, Core Medical Trainee, Southmead Hospital, North Bristol Trust, United Kingdom. DermNet NZ Editor in Chief: A/Prof. Amanda Oakley, Dermatologist, Hamilton, New Zealand. Copy edited by Gus Mitchell. February 2019.


What is a splinter haemorrhage?

A splinter haemorrhage is a longitudinal, red-brown haemorrhage under a nail and looks like a wood splinter. Seen end-on, the haemorrhage is in the lower part of the nail plate or underneath it.

Splinter haemorrhages

Who gets splinter haemorrhages?

Splinter haemorrhages can occur at any age; however, they are more common in older people [1,2].

  • In healthy individuals, splinter haemorrhages occur more frequently in men than women.
  • Splinter haemorrhages are more frequent in dark-skinned people than in light-skinned people.
  • The characteristics of patients who develop splinter haemorrhages relate to their underlying cause.

What causes splinter haemorrhages?

The most common cause of a splinter haemorrhage is trauma, including the application of an acrylic nail [3]. The longitudinal nature of splinter haemorrhages is explained by the orientation of the capillaries in the nail bed.

Infection

Splinter haemorrhages are present in 15–33% of patients with infective endocarditis in association with Osler nodes and Janeway lesions [3]. They may be due to septic emboli in the small vessels of the nail bed and the increased fragility of the vessel walls in sepsis [2,3].

Other infective causes include:

Skin disease

Splinter haemorrhages are common signs of psoriatic nail disease and nail disease due to lichen planus [3]. They can also be associated with a tumour.

Splinter haemorrhages due to a skin disease

Systemic diseases

Splinter haemorrhages may be due to microemboli or injury to vessel walls associated with vasculitis, including systemic diseases such as [3]:

Splinter haemorrhages are observed in patients with chronic kidney disease on haemodialysis or post-renal transplant, and may be explained by abnormal coagulation [3].

Drugs

Medications associated with splinter haemorrhages include [3]:

What are the clinical features of splinter haemorrhages?

Splinter haemorrhages present as longitudinal 1–3 mm red lines under the nail plate [2,3].

  • They can be single or multiple.
  • They may be asymptomatic or tender.
  • The red line moves distally with time (weeks to months).
  • Haemorrhages under the distal third of the nail plate are frequent and are usually a result of trauma such as a sports injury. They may be associated with subungual haematoma and nail splitting.
  • Proximal haemorrhages, especially affecting multiple fingernails, are more likely due to a systemic disease, especially in women.

What are the complications of splinter haemorrhages?

There are no complications of splinter haemorrhages themselves; complications arise as a consequence of the underlying disease process.

How is a splinter haemorrhage diagnosed?

A careful history and physical examination are required to determine the underlying cause.

The diagnosis of splinter haemorrhages is made clinically or with the aid of dermatoscopy [1].

Dermoscopy of splinter haemorrhages

What is the treatment for a splinter haemorrhage?

There is no specific treatment for a splinter haemorrhage.

Any treatment is targeted at an underlying systemic condition or at discontinuing a causative drug.

What is the outcome for a splinter haemorrhage?

If caused by trauma, a splinter haemorrhage grows out and disappears. Haemorrhages may continue to recur if the underlying cause remains.

Ultrasound picture of a wooden splinter evolved in phlegmon of the hand

J Ultrasound. 2010 Mar; 13(1): 38–40.

Language: English | Italian

Department of Radiological Sciences, University Hospital Policlinico Umberto I, Viale Regina Margherita, Rome, Italy

Corresponding author. Dipartimento di Scienze Radiologiche, Policlinico Umberto I, Viale Regina Margherita, 00161 Roma, Italy. [email protected]

Abstract

Introduction

To demonstrate the usefulness of ultrasound (US) in quickly and effectively diagnosing the presence of a foreign body in the superficial soft tissues.

Materials and methods

A young lumberjack underwent US examination due to pain and swelling of the back of his right hand. These symptoms are often due to the presence of a wooden splinter.

Results

On the back of the right hand, US demonstrated a hyperechoic line with acoustic shadowing surrounded by a hypoechoic halo suggesting a foreign body. Next to it in the same area, several hypoechoic areas were observed.

Conclusions

US can quickly identify the exact position of a foreign body embedded in the skin and soft tissues; US can furthermore provide information about the inflammatory process and its spreading.

Keywords: US examination, Subcutaneous, Foreign body, Phlegmon

Sommario

Introduzione

Dimostrare l’estrema utilità di un esame non invasivo, come l’ecografia, nel fare diagnosi veloce ed efficace di penetrazioni cutanee di corpi estranei.

Materiali e metodi

Abbiamo sottoposto a esame ecografico della cute e del sottocute della mano destra un giovane taglialegna che lamentava, da alcuni giorni, dolore, tumefazione e secrezione purulenta in corrispondenza della presunta sede di penetrazione di una spina lignea (dorso mano destra).

Risultati

L’esame ecografico, condotto a livello della presunta sede di penetrazione della spina, ha messo in luce la presenza di un’area lineariforme iperecogena, con cono d’ombra posteriore, circondata da un alone ipoecogeno; in tale sede si osservavano, inoltre, diverse aree irregolari ipoecogene, da riferire a un processo flogistico del sottocutaneo.

Conclusioni

L’esame ecografico permette non solo di localizzare con estrema precisione e velocità la sede del corpo estraneo, ma fornisce anche informazioni sulla reazione infiammatoria del tessuto circostante.

Introduction

Medical and surgical intervention is often required after accidental penetration of the skin and subcutaneous soft tissues by a foreign body. Diagnosis is easily made on the basis of clinical data including reference to an event which led to penetration by the foreign body and identification of a more or less extended area of inflammation. Removal of the foreign body is extremely important in order to avoid acute or chronic complications such as allergic reactions, inflammation or serious infections [1]. We report the US findings in a case where a wooden splinter had penetrated the subcutaneous soft tissues and caused formation of a phlegmon.

Presentation of the case

A 30-year-old man underwent ultrasound (US) examination of the skin and subcutaneous soft tissues of the right hand due to pain and local swelling following accidental puncture by a twig 3 days earlier while he was cutting wood. The patient reported that he had unsuccessfully tried to remove the foreign body. In the following days, the area had become painful and there was swelling associated with a purulent discharge from the site where the splinter had penetrated the skin. This clinical picture was unchanged at the time of examination.

US examination (Aplio XV, Toshiba, Japan) using a linear 7.5–14 MHz probe showed a hyperechoic line of about 27 mm with posterior acoustic shadowing over the metacarpal bones but extending deeply into the common extensor muscle of the finger, surrounded by a hypoechoic halo. This finding was associated with multiple confluent irregularly hypoechoic areas in the subcutaneous soft tissues () which suggested phlegmonous inflammation.

US image of the right hand. A 27-mm long foreign body is located under the common extensor muscle of the hand. Muscles and metacarpal bones.

US depiction of phlegmon surrounding the foreign body which has penetrated the subcutaneous soft tissue.

Sagittal US scan of the foreign body.

Discussion

Percutaneous penetration by a foreign body is a common reason for medical intervention. Usually the foreign body is a splinter of wood or a sliver of metal or glass which needs prompt removal to avoid inconvenient short- or long-term complications such as inflammation, infection or allergy [1,2].

First medical approach is a clinical examination of the affected area to identify superficial foreign bodies which can be seen or felt on palpation. Radiological examination can be useful in depicting radiopaque objects such as metal. However, in some cases the foreign body is not detected and its continuous presence in the soft tissues can cause inflammation [3]. In these cases the role of US is crucial [4]. Unlike traditional X-ray, US can depict also radiolucent foreign bodies which all appear hyperechoic with a halo or comet-tail artifact. A surrounding hypoechoic halo suggests an inflammatory process which may eventually cause abscess or granuloma.

Various authors have reported their experience describing the effectiveness of US guidance in the removal of foreign bodies [4,5]. US examination can localize a foreign body with great accuracy, but this method is also useful in pre-surgical examination to measure the distance between the splinter and the surface of the skin.

The limitation of US examination is the possibility of false-positive results due to calcifications and sesamoids in atypical positions which may mimic the presence of foreign bodies, as well as false-negative results due to coagulation and gas bubbles in open wounds which can prevent depiction of foreign bodies. However, despite these limitations US remains an extremely useful diagnostic procedure in injuries presented to the emergency department.

Conflict of interest statement

The authors have no conflict of interest.

References

1. Callegari L., Leonardi A., Bini A., Sabato C., Nicotera P., Spanò E. Ultrasound-guided removal of foreign bodies: personal experience. Eur Radiol. 2009;19(5):1273–1279. [PubMed] [Google Scholar]2. Boyse T.D., Fessell D.P., Jacobson J.A., Lin J., van Holsebeeck M.T., Hayes C.W. US of soft-tissue foreign bodies and associated complications with surgical correlation. Radiographics. 2001;21(5):1251–1256. [PubMed] [Google Scholar]3. Blankstein A., Cohen I., Heiman Z., Salai M., Diamant L., Heim M. Ultrasonography as a diagnostic modality and therapeutic adjuvant in the management of the soft tissue foreign bodies in the lower extremities. Isr Mes Assoc J. 2001;3(6):411–413. [PubMed] [Google Scholar]4. Dumarey A., De Maeseneer M., Ernest C. Large wooden foreign body in the hand: recognition of occult fragments with ultrasound. Emerg Radiol. 2004;10(6):337–339. [PubMed] [Google Scholar]5. Graham D.D., Jr. Ultrasound in the emergency department: detection of wooden foreign bodies in the soft tissues. J Emerg Med. 2002;22(1):75–79. [PubMed] [Google Scholar]

Nail Changes

Nails help protect the ends of our fingers and toes, and allow fingers to perform activities such as scratching or picking up things. Nails are normally present on each finger and toe. They are made up of the nail plate (the hardest part of the nail and the part that can be seen) and tissue that lies underneath the nail plate.

Nails receive blood and nutrition from the body. They are attached to the body by the nail bed which is kind of like a root and receives nutrients to keep the nails healthy and to allow new nail cells to form and grow. As they grow, the newer cells push out the older cells. The older cells are pushed forward and get flatter and harder which forms the nail plate. The nail plate does not have living cells which is why nails can be cut without pain.

Nail changes are different problems that can happen to fingernails, toenails, or both. Certain types of cancer and cancer treatments can cause changes to the nails. The changes can happen in the nail bed or in the nail plate itself. Nail changes can be temporary or may last.

Types of nail changes

Depending on what is causing changes in your nails, you might notice changes in how they look, feel, and work. You might also notice changes in the tissue around or under your nails. Some common nail changes include:

  • Changes in thickness and strength of nails causing nails to become weaker
  • Painful, delicate nailbeds, fingers, or toes
  • Dry or cracked skin in the cuticles around the nailbed
  • Changes in the color  of the nails or nailbeds (either discolored areas or over-pigmented, darker than usual areas)
  • Ridges, markings, pits, spots, splitting and other unusual or irregular marks in the nails
  • Lifting of the nail plate off of the nailbed, or the nail plate falling off
  • Slower nail growth than usual , or temporary lack of growth .

Nail changes in people with cancer

Some treatments for cancer can cause damage or changes to nails. Usually the treatments that cause nail changes are medications, but radiation can also cause nail changes. Different treatments can affect normal cells, like nail cells, in different ways. And their side effects can also affect nails differently. One, two, a few, or all of your nails could be affected by changes. Some changes occur soon after you begin treatment, but others may happen weeks or months after treatment begins. Some might be temporary and others might be long-lasting or permanent.

Remember that while some cancers and cancer treatment can cause changes in your nails, non-cancer conditions and medications can also cause them. It’s important to talk to your doctor about all medical problems you might have and about the medications, vitamins, minerals, and supplements you are taking so your risk can be discussed and you know what to expect.

Nail changes to look for

  • Dark areas near the cuticle of the nail (subungual lesions): These look like bruises under the nails, and are usually along the bottom edge of the nail, near the cuticle. These kinds of color changes can be seen in nail cancer (called melanoma) and can also be a side effect of some types of drugs used to treat cancer.
  • Fissures: Small thin cracks or deep cuts or tears in the finger tips, nail plate or bed, which can be very painful.
  • Hemorrhages (splinter hemorrhage): Tiny red lines in the nails that are tiny areas of bleeding under the nail plate.
  • Hyperpigmentation: Nail plates are usually translucent (clear). Some medications or radiation can cause a darkening of the skin, or nail itself. Usually this darkening is temporary, but sometimes it is permanent and can occur in some parts of the nail, or all over the nail.
  • Inflammation (paronychia): Redness, and sometimes swelling of the nailbed and surrounding finger or toe, sometimes with an infection that is bacterial or fungal, which can be very painful and can limit your ability to do normal daily activities.
  • Lifting of the nail plate (onycholysis): This is usually a temporary condition but can be upsetting. If the nail lifts away from the nailbed, it makes the nail likely to fall off, and it becomes a place where an infection could easily happen.
  • Nail loss: Complete loss of the nail plate. Some medications cause the nail plate to loosen entirely and be lost. This is temporary but can be painful and can increase the risk of infection.
  • Ridges or lines in the nail plate: Some medications cause different looking ridges or different colored lines in the nail plate. These may happen and remain throughout treatment and will usually grow out once the nail grows completely. Usually these types of changes are not painful.

Cancer treatments that can cause nail changes

Some medications used to treat cancer can stop the growth of nails altogether while you are taking them. If you are getting treatment in cycles, the nails may begin to grow a little in between the cycles, but may produce white horizontal lines in the nail plate, called Beau’s lines. These are harmless and will usually grow out once treatment is over.

Here are some of the changes you may have in your nails, and some of the drugs to treat cancer than can cause them. Being on more than one drug that can cause nail changes might increase how severe the side effects will be.

Type of nail change

Some cancer treatments that can cause It

Dark areas in cuticle

Targeted therapy antiangiogenic multikinase inhibitors (sorafenib, sunitinib)

Over-pigmented (hyperpigmented) nails

Chemotherapy such as Bleomycin, capecitabine, cyclophosphamide, dacarbazine, danorubicin, doxorubicin, idarubicin, melphalan, methotrexate

Targeted therapy such as EGFR inhibitors (erlotinib, gefitinib) and monoclonal antibodies ( cetuximab, panitumumab),

 

Fissures (deep grooves)

Targeted therapy or immunotherapy monoclonal antibodies (cetuximab, panitumumab)

Hemorrhages (splinter hemorrhage)

Chemotherapy taxanes (doxorubicin, docetaxel, paclitaxel, nab-paclitaxel)

Inflammation (paronychia)

Chemotherapy taxanes (doxorubicin, docetaxel, paclitaxel, nab-paclitaxel)

Targeted therapy EGFR inhibitors (erlotinib, gefitinib, dacomitinib),  monoclonal antibodies (cetuximab, necitumumab, panitumumab), and mTOR inhibitors (everolimus, temsirolimus)

Lifting of the nailbed (onycholysis)

Chemotherapy such as dacarbazine, daunorubicin, and mitoxantrone

Targeted therapy such as mTOR inhibitors (everolimus, temsirolimus)

Nail loss

Chemotherapy such as bleomycin and 5-fluorouracil (5-FU)

Ridges, lines, creases, or other discoloration

Chemotherapy such as cyclophosphamide, doxorubicin, docetaxel, hydroxyurea, idarubicin, ifosfamide, and 5-fluorouracil (5-FU)

Managing nail changes

Many changes to nails that happen during cancer treatment can affect their appearance. For example, ridges or lines in your nails are not usually painful, but cause changes in how your nails look and feel. Once the treatment causing changes is done, the changes will usually go away over time as the nail grows out. The nail changes likely to be temporary include:

  • Changes in nail color (dark areas; hyperpigmentation)
  • Splinter hemorrhages
  • Ridges, lines and creases in the nail

For minor, non-painful nail changes, the following might be helpful:

  • Protect splitting, ridges, and delicate nails by using a water-soluble nail lacquer, or a prescription nail polish (that your doctor can provide) to protect your nails.
  • Biotin (a dietary supplement) may be prescribed to strengthen your nails. Ask your doctor if it is safe for you to take biotin.

Some changes, however, are painful or involve an infection, and require treatment.  Talk to your doctor about what is best for your situation before trying anything at home.

  • Nail inflammation (paronychia): Treatment recommended by your doctor might include using a steroid ointment, and white vinegar and water soaks (1 part vinegar to 1 part water), disinfecting soaks, or oral anti-inflammatory medications, or antibiotics
  • Lifting of the nailbed (onycholysis): Surgical removal of part of the nail plate may be recommended to relieve pain.
  • Nail infections (bacterial or fungal): Antibacterial ointment may be recommended by your doctor and applied regularly to the nail and nailbed
  • Fissures (deep grooves that may open or cause nail splitting): Surgical removal of part of the nail plate may be recommended to relieve pain

What the patient can do

It may not be possible to prevent nail changes, but you can do some things to help manage minor nail changes, and to avoid making them worse. Some things you can do include:

  • Check your hands and feet every day to look for changes in your nails.
  • Use a water-soluble nail lacquer on nails that have ridges, are delicate, or are splitting, to strengthen and protect them.
  • Let your health care team know as soon as you see nail changes.
  • Keep your nails trimmed short. Short nails are less likely to break or get caught.
  • Keep your nails clean to avoid infections
  • Protect your hands when putting them in water (such as washing dishes), gardening, or cleaning. Wear work gloves when doing these tasks to protect your nails
  • Do not get professional manicures while you are getting treatment for cancer
  • Wear loose-fitting shoes
  • Avoid pressure to your nail beds (both fingers and toes)
  • If you are taking a taxane drug (especially docetaxel), consider applying cold packs to nails for 15 minutes before the infusion of the drug, during the infusion, and for 15 minutes after the infusion. This may prevent nail lifting.

It’s important to tell your health care team as soon as you notice any expected or unexpected changes to your nails. Prevention and avoiding injuries to your nails is an important part of keeping your nails as healthy as possible.

If you get medicine to treat your nail changes, be sure to tell your doctor how the medication is working for you or if new problems come up.

Questions to ask about nail problems

If you are concerned about nail problems or if you are at risk for nail changes, here are some questions to ask your health care team:

  • Should I wear a protective nail lacquer? If not, why not?
  • Can I continue my current nail care and treatment? Be sure to explain if you get special salon treatments, such as acrylic or gel nails or polish.
  • Can my treatment cause nail changes? What changes should I expect?
  • When can I expect these changes to start? When will they end?
  • Is there anything I can do to avoid these changes?
  • If I notice a change in my nails, what should I do?
  • Are there other medications I should avoid if I have nail changes?
  • Will having nail changes cause me to have to slow down, pause, or stop my cancer treatment? If this happens, what are my choices?

What Is a Splinter Hemorrhage? – Wellness


What It Is

A splinter hemorrhage, also commonly known as a fingernail hemorrhage, actually resembles a splinter underneath the nail. These small areas of bleeding or hemorrhaging under fingernails or toenails often take the shape of straight lines.

The nail bed contains many small blood vessels. Since the nail bed’s anatomic structure is arranged in longitudinal grooves and ridges, when there is a small amount of bleeding within one of these grooves, the overlying nail plate traps the blood. The nail bed is linear in its construction so the blood takes on the appearance of a straight line. Eventually small clots form and the bleeding stops.

Symptoms

Thankfully, there is no pain or discomfort associated with splinter hemorrhages, other than the initial trauma that may have caused it, if that is the case. The only way you can tell you have a hemorrhage is by a visible red stain under the nail plate.

If the splinter hemorrhage is the result of another condition such as Raynaud’s disease, for example, then there may be discomfort as a result of that particular condition or disease.

Causes

Splinter hemorrhages are often caused by some type of hard impact or other physical trauma to the nail bed and should not be a cause for concern. “There really is no way to prevent them from occurring,” says Nancy Satur, M.D., North Coast Dermatology Associates in Encinitas, Calif.

“In healthy individuals, the most common cause is acute trauma to toenails or fingernails usually associated with tennis, jogging, or hockey,” adds Jessica Luu, D.P.M., of JT Enterprises Corporation. “But less vigorous activities such as playing with a frisbee or golf can cause trauma to the capillaries of the vascular nail bed.”

However, there are some instances where a splinter hemorrhage may be a sign of something more serious.

Onychomycosis (fungal infection), for example, can give rise to splinter hemorrhages. Nail psoriasis may also cause hemorrhaging of the nail bed. In this condition, there is a thinning of the upper layer of the nail bed. Blood vessels are closer to the nail plate , so splinter hemorrhages are easier to develop.

Some medications may also cause splinter hemorrhages. Aspirin, for example, slows the coagulation process of the blood. Medications that are sold over-the-counter for headaches, arthritis, and other minor pains may also cause nail bed hemorrhaging.

If splinter hemorrhaging occurs on more than one nail the chances of your client having an underlying disorder or disease are more likely. And if they occur on more than one nail and frequently reappear, it may be a sign of a connective tissue disorder such as lupus, which is serious and requires medical evaluation and treatment.

Clients with Raynaud’s disease may also suffer from splinter hemorrhages. Clients with this condition are oversensitive to cold and if they do develop a hemorrhage the tips of their fingers may also be discolored and look pink, blue, or white.

On rare occasions, people with endocartitis (disease of the heart valves) can develop hemorrhages. Since they suffer from high fever, anemia, and heart murmurs they are usually already under the care of a physician.

They may also be associated with vasculitis (inflammation of the blood vessels) or microscopic clots that damage small capillaries (microemboli), says Dr. Luu.

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How to Treat It

Treatment depends on the underlying cause of the splinter hemorrhage. But the only way to get rid of a splinter hemorrhage is to simply let it grow out. Since it is deposited on the under surface of the nail plate, the splinter hemorrhage will grow out with the nail and the nail bed over a period of time and disappear completely. This usually takes a few months.

“The nail will grow out, but it may grow back abnormal,” adds Dr. Luu.

If the splinter hemorrhage is caused by certain medications, the medication should be discontinued if possible.

If the hemorrhage is the result of a fungal infection or nail psoriasis, then obviously treating those underlying conditions will cause the bleeding to disappear and no longer recur.

If the cause is trauma from a sports-related activity, keeping the nails trimmed short can prevent these hemorrhages, says Dr. Luu.

 

Your client may want to check her shoes to be sure the toenails are not hitting the inside of the shoe if the splinter hemorrhages are occurring on the toenails. This can happen with abnormally shaped toes or when wearing shoes that don’t fit properly. Clients may want to have the shoes modified to accommodate an abnormally shaped toe, suggests Tammy Brown, D.P.M., of JT Enterprises Corporation.

“Local pharmacies often carry a variety of toe pads and specialty shoe providers can often loosen an area of tightness in a shoe to accommodate an abnormal digit,” says Dr. Brown.

Splinter hemorrhages that persist over a period of time should be medically evaluated to rule out the possibility of a blood disorder or other condition a person may not be aware of.

Considerations for Nail Techs

If a client comes to you with a splinter hemorrhage on her nail, fear not. While a hemorrhage may look ugly you can still work on the area of the nail that it’s on, says Dr. Satur. However, you should handle the hemorrhaged area with care. Filing, buffing, or handling a nail with a hemorrhage should be performed gently so the underlying nail bed is not traumatized.

Before you begin a service conduct a client consultation, especially if you’re dealing with a new client. Before you begin working on the injured nail ask your client what happened to it. Chances are she’ll tell you she injured it, but if she hasn’t, advise her to have her physician check it out promptly.

And while your client would probably love to camouflage that nasty hemorrhage with polish it may be a good idea to have her get it checked out before you apply anything on the nail.

“If there are systemic causes involved the client should be referred to a physician so her medical issues can be treated or addressed before that client can cover up the nail with nail polish or acrylic nails,” says Dr. Luu.

If a client has a splinter hemorrhage on more than one nail or has recurring hemorrhages you should advise her to see her physician if she hasn’t done so already. It may be a sign of a more serious disease or condition.

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Puncture Wounds | CS Mott Children’s Hospital

Do you have a puncture wound?

This is a wound caused by a sharp, pointed object going through the skin. Puncture wounds are deeper and narrower than cuts.

How old are you?

Less than 12 years

Less than 12 years

12 years or older

12 years or older

Are you male or female?

Why do we ask this question?

  • If you are transgender or nonbinary, choose the sex that matches the body parts (such as ovaries, testes, prostate, breasts, penis, or vagina) you now have in the area where you are having symptoms.
  • If your symptoms aren’t related to those organs, you can choose the gender you identify with.
  • If you have some organs of both sexes, you may need to go through this triage tool twice (once as “male” and once as “female”). This will make sure that the tool asks the right questions for you.

Do you have an eye injury?

Do you have an injury caused by a fishhook?

Do you have a deep wound in your head, neck, chest, or belly?

A deep puncture wound in any of these areas could damage the internal organs.

Yes

Deep puncture wound to head, neck, chest, or belly

No

Deep puncture wound to head, neck, chest, or belly

Are you having trouble breathing (more than a stuffy nose)?

Yes

Difficulty breathing more than a stuffy nose

No

Difficulty breathing more than a stuffy nose

Has the pain lasted for more than 8 hours?

Yes

Pain for more than 8 hours

No

Pain for more than 8 hours

Is the pain getting worse?

Have you been injected with something under high pressure, like oil or paint from a sprayer?

Yes

Injection under high pressure

No

Injection under high pressure

Is there a deep puncture in or over a joint?

A puncture that goes into a joint can be serious.

Yes

Deep puncture in joint area

No

Deep puncture in joint area

Do you have a wound on your arm, leg, hand, or foot that is more than just a scratch?

For an arm or leg wound, is the skin below the wound (farther down the limb) blue, pale, or cold to the touch and different from the other arm or leg?

This may mean that a major blood vessel was damaged and that blood is not reaching the rest of the arm or leg.

Yes

Skin is blue, pale, or cold below an arm or leg injury

No

Skin is blue, pale, or cold below an arm or leg injury

Can you move the area below the injury normally, even though it may hurt?

Yes

Able to move limb normally below injury

No

Unable to move limb normally below injury

For an arm or leg wound, is there any numbness, tingling, or loss of feeling around the wound or below the wound (farther down the arm or leg)?

This may mean that a nerve was damaged.

Yes

Numbness, tingling, or loss of feeling around or below an arm or leg injury

No

Numbness, tingling, or loss of feeling around or below an arm or leg injury

Do you think you may have a fever?

Are there red streaks leading away from the area or pus draining from it?

Do you have diabetes, a weakened immune system, peripheral arterial disease, or any surgical hardware in the area?

“Hardware” includes things like artificial joints, plates or screws, catheters, and medicine pumps.

Yes

Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area

No

Diabetes, immune problems, peripheral arterial disease, or surgical hardware in affected area

Have you been stuck with a used or dirty needle?

Yes

Stuck with used or dirty needle

No

Stuck with used or dirty needle

Is there an object stuck in the wound, and you can’t get it out?

You may not be able to remove it because of where or how deep the wound is or because it causes severe pain.

Is the object large or small?

Large means things like a nail or piece of wood that is at least 2 in. (5.1 cm) long and anything bigger than that. Small means things like a pencil tip or a small splinter or sliver.

Large

Large embedded object

Small

Small embedded object

Did you have swelling or bruising within 30 minutes of the injury?

Yes

Swelling or bruising within 30 minutes of injury

No

Swelling or bruising within 30 minutes of injury

Has the swelling or bruising raised a lump that’s more than about 1. 5 in. (4 cm) across or deep? This would be bigger than a golf ball or Ping-Pong ball.

Yes

Lump bigger than golf ball or Ping-Pong ball

No

Lump bigger than golf ball or Ping-Pong ball

Do you have a puncture wound in your foot?

Yes

Puncture wound in foot

Did the object go through a shoe or boot?

An object that has enough force behind it to go through a shoe can cause serious injury to the foot. Puncture wounds in the sole of the foot also have a high risk of infection.

Yes

Object went through a shoe or boot

No

Object went through a shoe or boot

Many things can affect how your body responds to a symptom and what kind of care you may need. These include:

  • Your age. Babies and older adults tend to get sicker quicker.
  • Your overall health. If you have a condition such as diabetes, HIV, cancer, or heart disease, you may need to pay closer attention to certain symptoms and seek care sooner.
  • Medicines you take. Certain medicines, such as blood thinners (anticoagulants), medicines that suppress the immune system like steroids or chemotherapy, herbal remedies, or supplements can cause symptoms or make them worse.
  • Recent health events, such as surgery or injury. These kinds of events can cause symptoms afterwards or make them more serious.
  • Your health habits and lifestyle, such as eating and exercise habits, smoking, alcohol or drug use, sexual history, and travel.

Try Home Treatment

You have answered all the questions. Based on your answers, you may be able to take care of this problem at home.

  • Try home treatment to relieve the symptoms.
  • Call your doctor if symptoms get worse or you have any concerns (for example, if symptoms are not getting better as you would expect). You may need care sooner.

Symptoms of infection may include:

  • Increased pain, swelling, warmth, or redness in or around the area.
  • Red streaks leading from the area.
  • Pus draining from the area.
  • A fever.

Pain in adults and older children

  • Severe pain (8 to 10): The pain is so bad that you can’t stand it for more than a few hours, can’t sleep, and can’t do anything else except focus on the pain.
  • Moderate pain (5 to 7): The pain is bad enough to disrupt your normal activities and your sleep, but you can tolerate it for hours or days. Moderate can also mean pain that comes and goes even if it’s severe when it’s there.
  • Mild pain (1 to 4): You notice the pain, but it is not bad enough to disrupt your sleep or activities.

Pain in children under 3 years

It can be hard to tell how much pain a baby or toddler is in.

  • Severe pain (8 to 10): The pain is so bad that the baby cannot sleep, cannot get comfortable, and cries constantly no matter what you do. The baby may kick, make fists, or grimace.
  • Moderate pain (5 to 7): The baby is very fussy, clings to you a lot, and may have trouble sleeping but responds when you try to comfort him or her.
  • Mild pain (1 to 4): The baby is a little fussy and clings to you a little but responds when you try to comfort him or her.

Certain health conditions and medicines weaken the immune system’s ability to fight off infection and illness. Some examples in adults are:

  • Diseases such as diabetes, cancer, heart disease, and HIV/AIDS.
  • Long-term alcohol and drug problems.
  • Steroid medicines, which may be used to treat a variety of conditions.
  • Chemotherapy and radiation therapy for cancer.
  • Other medicines used to treat autoimmune disease.
  • Medicines taken after organ transplant.
  • Not having a spleen.

With severe bleeding, any of these may be true:

  • Blood is pumping from the wound.
  • The bleeding does not stop or slow down with pressure.
  • Blood is quickly soaking through bandage after bandage.

With moderate bleeding, any of these may be true:

  • The bleeding slows or stops with pressure but starts again if you remove the pressure.
  • The blood may soak through a few bandages, but it is not fast or out of control.

With mild bleeding, any of these may be true:

  • The bleeding stops on its own or with pressure.
  • The bleeding stops or slows to an ooze or trickle after 15 minutes of pressure. It may ooze or trickle for up to 45 minutes.

You may need a tetanus shot depending on how dirty the wound is and how long it has been since your last shot.

  • For a dirty wound that has things like dirt, saliva, or feces in it, you may need a shot if:
    • You haven’t had a tetanus shot in the past 5 years.
    • You don’t know when your last shot was.
  • For a clean wound, you may need a shot if:
    • You have not had a tetanus shot in the past 10 years.
    • You don’t know when your last shot was.

Symptoms of difficulty breathing can range from mild to severe. For example:

  • You may feel a little out of breath but still be able to talk (mild difficulty breathing), or you may be so out of breath that you cannot talk at all (severe difficulty breathing).
  • It may be getting hard to breathe with activity (mild difficulty breathing), or you may have to work very hard to breathe even when you’re at rest (severe difficulty breathing).

Seek Care Today

Based on your answers, you may need care soon. The problem probably will not get better without medical care.

  • Call your doctor today to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don’t have one, seek care today.
  • If it is evening, watch the symptoms and seek care in the morning.
  • If the symptoms get worse, seek care sooner.

Seek Care Now

Based on your answers, you may need care right away. The problem is likely to get worse without medical care.

  • Call your doctor now to discuss the symptoms and arrange for care.
  • If you cannot reach your doctor or you don’t have one, seek care in the next hour.
  • You do not need to call an ambulance unless:
    • You cannot travel safely either by driving yourself or by having someone else drive you.
    • You are in an area where heavy traffic or other problems may slow you down.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Call 911 Now

Based on your answers, you need emergency care.

Call 911 or other emergency services now.

Put direct, steady pressure on the wound until help arrives. Keep the area raised if you can.

Sometimes people don’t want to call 911. They may think that their symptoms aren’t serious or that they can just get someone else to drive them. Or they might be concerned about the cost. But based on your answers, the safest and quickest way for you to get the care you need is to call 911 for medical transport to the hospital.

Eye Injuries

Fishhook Injuries

Wound Foreign Body Removal: Overview, Indications, Contraindications

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  • Granuloma – types, diagnosis and treatment

    On this page

    What is a granuloma?

    A granuloma is a tiny cluster of white blood cells and other tissue that can be found in the lungs, head, skin or other parts of the body in some people. Granulomas are not cancerous. They form as a reaction to infections, inflammation, irritants or foreign objects.

    What are the types of granulomas?

    Foreign body granulomas

    This type of granuloma develops when the body’s immune system reacts to an object or irritant that penetrates the skin, eye or body. They can form in reaction to:

    • foreign objects such as splinters
    • bee stings and spider bites where parts of the insect’s body are left behind
    • substances that irritate the person, including red tattoo ink and the silica in talcum powder
    • injections, including corticosteroids and dermal fillers, such as collagen
    • surgical stitches

    Skin granulomas

    Several types of granuloma can affect the skin. The most common is granuloma annulare, a harmless skin condition that causes raised pink or flesh-coloured bumps under the skin. The bumps are usually found over bony areas, like the elbow, and may have a distinctive ring shape. They often affect hands and arms, but can also affect legs, feet, trunk or face.

    What causes granulomas?

    Granulomas form when immune cells clump together and create tiny nodules at the site of the infection or inflammation.

    A granuloma is the body’s way:

    • to contain an area of bacterial, viral or fungal infection so it can try to keep it from spreading; or
    • to isolate irritants or foreign objects

    Granulomas most frequently form in the lungs, but can also be found in the liver, the eye or under the skin. They can be felt as a lump or can show up on x-rays and during other investigations.

    Granulomas caused by other conditions

    Granulomas can be part of conditions such as:

    • sarcoidosis — a non-infectious disease that can cause multiple granulomas in different parts of the body, but especially in the lungs
    • chronic granulomatous disease — an inherited immunodeficiency condition that starts in childhood and leads to recurring bacterial and fungal infections
    • Crohn’s disease and inflammatory bowel disease
    • rheumatoid arthritis

    How are granulomas diagnosed?

    Your doctor or specialist will take a medical history and examine you if they suspect you might have granulomas. They may ask for tests such as a blood test, x-rays or CT scans, genetic tests or a needle biopsy.

    Scans may show numerous minute granulomas in an organ such as the lungs. These can help diagnose the underlying cause.

    With skin granulomas, your doctor may only need to do a physical examination to confirm a diagnosis.

    How are granulomas treated?

    Some people with a granuloma need treatment, buts others may not. It depends on the type of granuloma.

    For example, people with chronic granulomatous disease may be given antibiotics and other treatments to try to prevent further infections. Find out more about chronic granulomatous disease treatment here.

    More than half of all people affected by sarcoidosis recover without treatment within 3 years. Learn here about sarcoidosis treatment.

    Most forms of granuloma annulare get better without treatment. Sometimes, however, people want treatment for cosmetic reasons and may be given corticosteroids or phototherapy. Find out more about granuloma annulare treatment here.

    Are granulomas cancerous?

    Although granulomas may appear cancerous, they are not — they are benign.

    Occasionally, however, granulomas are found in people who also have particular cancers, such as skin lymphomas. So it is important to consult a doctor if you notice persistent lumps on your skin or have other symptoms of illness.

    Combat surgical trauma in modern realities

    Providing medical care to patients with combat surgical trauma is one of the most important problems of medicine. Due to the suddenness of the occurrence, the rarity and massiveness of the admission of victims, this pathology is of great difficulty for doctors of the civil health care system. At the same time, at present, the main burden of providing medical care falls precisely on civilian specialists.

    Orientation to the principles of military field surgery

    Gunshot and explosive (mine-explosive) wounds of various locations in the absence of armed conflicts occur in the form of sporadic cases, and are characterized by the involvement of specialists in various fields, long-term treatment and long-term rehabilitation. When providing medical assistance to victims of various types of firearms, one should be guided by the principles of military field surgery.

    The document establishing the general requirements for the provision of specialized care to patients is the Resolution of the Ministry of Health of the Republic of Belarus dated February 22, 2018 No. 19.1 “On the approval of the clinical protocol” Treatment of patients with gunshot wounds in inpatient conditions. ”

    The study of the development and course of gunshot wounds is engaged in military field surgery, in which the following terminology is adopted.

    Gunshot wound – violation of the integrity of the skin or mucous membranes, inflicted by a firearm. In the form of a wounding projectile, bullets can act, including rubber, fragments, balls and other damaging elements.

    Gunshot wound – a particular type of injury, including the body’s response to a gunshot wound.

    Three zones are distinguished in a gunshot wound: the wound canal is a tissue defect itself, which is a tortuous wound filled with wound detritus, blood clots, foreign bodies, and fragments of a wounding projectile.

    Zone of primary necrosis – limits the wound defect, represents crushed tissues that have lost their viability in the process of receiving a gunshot wound, and must be completely removed during surgical treatment.

    A distinctive feature of a gunshot wound is the presence of a zone of secondary necrosis, which occurs as a result of the impact of high energy of the wounding projectile (lateral impact energy) on the tissue at a considerable distance from the wound channel.

    Gunshot wounds

    Mine-explosive, explosive and shrapnel wounds are a special type of gunshot wound.

    Mine-explosive wounds represent the destruction of tissues of any localization or separation of segments of the limbs as a result of exposure to the human body of explosive ammunition when the body is in the area of ​​direct damaging effect of gaseous detonation products of an explosive or an explosive shock wave.

    Explosive injuries – open and closed injuries resulting from the propelling action of explosive ammunition, the impact of surrounding objects on the human body or the action of explosive ammunition in reserve, as well as as a result of falling from equipment at the time of detonation.

    Shrapnel wounds – injuries sustained as a result of the impact on the human body of fragments of explosive ordnance.

    By analogy with a gunshot wound, an explosive (mine-explosive) injury includes three zones: traumatic and coagulation necrosis, necrotic and dystrophic changes, microcirculatory disorders.In this case, the leading can be lesions of the central nervous system, lungs, heart and large vessels, hollow and parenchymal organs, and the musculoskeletal system.

    Injuries to the head and spine due to mine and explosive trauma

    Are the most common component of a multifactorial lesion. Penetrating wounds of the skull are the most difficult, the criterion for making a diagnosis is damage to the dura mater, since it is a reliable barrier to the penetration of infection into the cranial cavity.

    In the phase of clinical compensation and clinical subcompensation, focal symptoms are usually detected, but there are no violations of vital functions. The phase of moderate clinical decompensation is characterized by the appearance of bradycardia, arterial hypertension, infrequent and deep breathing, which reflect an increase in cerebral edema and impaired vital functions.

    The phase of deep clinical decompensation is manifested by the change of bradycardia to tachycardia, hypertension to hypotension, rare and deep breathing to frequent and superficial.It develops against the background of a coma and characterizes the dislocation of the brain of the first degree, when its trunk, as a result of edema or compression, is infringed in the opening of the cerebellar tentorium, which is a complication of severe brain damage or a late stage of its compression.

    The terminal phase develops with a second-degree dislocation of the brain – wedging of the trunk in the foramen magnum. It is manifested by progressive tachycardia and hypotension, the appearance of abnormal breathing rhythms, up to a stop, and is characteristic of extremely severe brain damage and irreversible stages of its compression.

    Less common spinal injuries, while determining the degree of spinal cord injury in the early stages is rather difficult due to the development of spinal shock – the initial symptom complex of spinal cord dysfunction, which significantly exceeds the volume of neurological disorders that corresponds to the true level of damage. Deep neurological disorders can also occur with an explosive injury in the absence of damage to the bone structures of the spine.This is usually associated with hemorrhage into the brain substance, epidural and subdural hematomas, as well as compression of the spinal cord by areas of the intervertebral disc prolapsing into the spinal canal.

    Explosive chest injuries

    Explosive chest injuries deserve special attention. Their clinical manifestations depend on the nature of the damage arising mainly as a result of the impact on the body of a shock wave and the fall of the body on solid objects when it is thrown away.

    The leading factor determining the nature and severity of explosive chest injuries is damage to internal organs and bones, dysfunction of external respiration, shock and blood loss. Another important factor that has a great influence on the clinical course of this type of injury is rib fractures, in which a rib valve is formed, which performs paradoxical movements and contributes to the rapid development of hypoxia.

    The most common manifestations of explosive chest trauma are hemothorax and hemopneumothorax, heart and lung contusion.The nature of explosive wounds in the soft tissues of the chest is different and depends on the type of explosive device.

    In the presence of a chest wound, a survey radiography is performed and in the absence of hemo- or pneumothorax, the wound toilet is performed without progressive revision and examination of the wound canal. Otherwise, active actions with chest wounds can lead to iatrogenic pneumothorax.

    An increase in the boundaries of the heart, the smoothness of its contours indicate a wound to the heart.X-ray examination facilitates the diagnosis of post-traumatic pulmonitis. Mediastinal injury is usually accompanied by emphysema and the corresponding clinical and radiological picture.

    Abdominal injuries

    In case of explosive injuries of the abdomen, the emerging disorders are due to the sum of pathological influences, including mainly massive blood loss, endotoxicosis, and dysfunction of vital organs.

    A feature of this type of damage is mainly a closed injury to the parenchymal organs (liver, spleen, kidneys).

    Great diagnostic difficulties due to the syndrome of mutual burdening require a careful dynamic examination of the wounded. It must be remembered that abdominal pain and bloating, impaired intestinal motility, palpation pain and tension of the abdominal wall can also occur with bruises of the soft tissues of the abdomen or significant hematomas of the retroperitoneal space without damage to internal organs.

    Deterioration of the victim’s condition (hypotension, persistent or increasing tachycardia, etc.) in the absence of a tangible effect from intensive infusion-transfusion therapy indicates ongoing bleeding, of course, if other sources are excluded.

    Hematuria usually indicates damage to the bladder or kidneys. In all cases, it is necessary to inspect the anus and digital examination of the rectum.

    The main radiological symptoms of a closed abdominal trauma are: gas content in the abdominal cavity or retroperitoneal space; the presence of fluid in the abdominal cavity; bloating and movement of the stomach and intestines; violation of the position, shape and function of the diaphragm.

    If an injury to the kidneys, ureters and bladder is suspected, intravenous urography, retrograde pyelography, cystography, and urethrography are performed.

    A very important diagnostic method is laparocentesis, the indications for which are: unclear clinical picture of intra-abdominal injuries; severe concomitant trauma to the skull, chest, pelvis with loss of consciousness; concomitant injury of the chest, spine, pelvis, when signs of an acute abdomen appear.After laparocentesis, if the result is negative, drainage is left in the abdominal cavity for 1–2 days for diagnostic observation.

    It is always necessary to carefully evaluate point wounds of the lumbar region, since they can cause dangerous damage to the organs of the retroperitoneal space.

    It should not be forgotten that even with wounds that do not penetrate into the abdominal cavity by the force of a lateral impact of a wounding projectile, damage to internal organs is possible.

    Explosive injuries of limbs

    They should be classified among the most severe injuries. The mechanism of occurrence, namely the impact of the damaging factors of the explosion, causes multiple and extensive wounds with the destruction of soft tissues, bones and joints. The clinical picture and diagnosis of avulsion of a limb in mine-explosive injury is generally not difficult. Initial examination of the stump with the identification of the nature of the bone and soft tissue lesions usually provides a basis for the diagnosis.

    In conscious victims, it is important to clarify the exact circumstances of the injury and a detailed study of complaints. It is mandatory to document the damage using photographic equipment.

    A consistent and possibly complete examination of all body parts without exception is absolutely necessary – exceptions cannot be justified!

    Treatment methods

    The main method of treating gunshot and mine-explosive wounds at the stage of qualified medical care is surgical debridement of wounds.

    Primary surgical debridement of a gunshot wound is a surgical intervention performed mainly under general anesthesia in an operating room in order to prevent wound infection and create favorable conditions for wound healing.

    Secondary surgical treatment is a surgical intervention aimed at eliminating complications in a gunshot wound.

    Surgical treatment can be performed for primary or secondary indications two or more times, while the name of the operation will be formulated as repeated (primary or secondary) surgical treatment.

    Primary surgical treatment includes the following steps:

    1. Dissection of the wound. The length of the incision should be sufficient to inspect the wound channel for performing surgery on damaged organs and tissues. Fasciotomy is an integral part of the initial surgical treatment on a segment of the limb, it is performed with the purpose of decompression of the muscle sheaths, as well as to prevent the development of anaerobic infection.In case of a mine-explosive injury, this stage is often not carried out due to crushing of tissues and the absence of a wound channel.

    2. Removal of foreign bodies.

    3. Excision of non-viable tissues. The skin is excised sparingly, only clearly necrotic areas are removed, taking into account the need for subsequent closure of the wound defect, the subcutaneous tissue is widely excised without clear signs of viability.

    4.Surgical intervention on damaged organs and tissues. The volume of this stage of primary surgical treatment and the choice of the involved medical specialists depend on the type and location of the lesions identified. In case of explosive wounds of the limbs, amputations of the injured limb are most often used.

    5. Wound drainage. The method of choice for non-extinguished wounds is to perform passive drainage with various types of graduates and tubes.

    6.Closing the wound. The primary suture after surgical treatment of the wound is not applied. This is due to the presence of a zone of secondary necrosis in the wound channel of a gunshot wound and the need to create conditions for rejection of newly formed foci of necrosis, which can form within 2–3 days after injury. An exception is wounds in areas with good blood supply and a low risk of developing a wound infection: face, scalp, genitals. On surgical wounds located outside the wound channel and formed as a result of additional approaches, the imposition of primary sutures is allowed.It is imperative to perform sealing of the pleural, abdominal, articular cavities. The skin and subcutaneous tissue are not sutured.

    In the postoperative period, the victim is prescribed complex antibiotic therapy, taking into account the anaerobic spectrum of microorganisms, infusion therapy, drugs that improve microcirculation.

    Surgical debridement of a gunshot wound is not performed in the presence of multiple small superficial blind splinter wounds of soft tissues; through bullet and shrapnel wounds with pinpoint (up to 1 cm in diameter) inlet and outlet holes without bleeding and strained hematomas; blind shrapnel wounds of the soft tissues of the back, gluteal region without signs of bleeding; superficial tangential wounds.

    In these cases, a gunshot wound toilet is performed, including the treatment of the skin around the wound and washing the wound with an antiseptic solution, injecting the tissues around the wounds with antibiotics, draining the wound canal with a PVC tube or rubber graduate, applying an aseptic bandage.

    For information

    The main institution providing assistance to victims with gunshot and mine-explosive wounds is the Republican Center for the Treatment of Gunshot Wounds and Mine-Explosive Injuries on the basis of the 432th Main Military Clinical Medical Center of the Armed Forces of the Republic of Belarus.The center possesses the forces and means to provide assistance to the wounded, especially when they arrive en masse. Well-coordinated work of the team, accumulated experience, versatility of specialists allow us to achieve good and excellent results in the treatment of this category of patients.

    Military field surgery is taught at the department of the same name of the military medical faculty of the Belarusian State Medical University and is an integral part of the training of doctors of all specialties. For doctors-surgeons of the health care system on the basis of the department, there are continuing education courses “Military field surgery: features of the organization and provision of medical care in conditions of armed conflicts and peacetime emergencies.”Knowledge of military field surgery, fortunately, is rarely used by doctors in Belarus, however, theoretical training and practical skills in organizing and providing assistance to victims of combat surgical pathology are part of the state security of our country.

    Dmitry Klyuiko, Head of the Department of Military Field Surgery of the Military Medical Faculty of the Belarusian State Medical University, Candidate of Medical Sciences. Sciences, Associate Professor, Colonel of the Medical Service ;
    Sergey Zhidkov, Professor of the Department of Military Field Surgery of the Military Medical Faculty of the Belarusian State Medical University, Dr. med.Sci., Professor
    Medical Bulletin , 24 August 2020

    90,000 Technogenic emergencies – Official website of the Administration of St. Petersburg

    The most common sources of man-made emergencies are fires and explosions that occur:

    – at industrial facilities;
    – at facilities for the extraction, storage and processing of flammable, combustible and explosive substances;
    – on transport;
    – in mines, mine workings, subways;
    – in buildings and structures for residential, social and cultural purposes.

    FIRE is an out of control combustion process that destroys material values ​​and poses a threat to human life and health. A fire breaks out in Russia every 4-5 minutes and about 12 thousand people die from fires every year.

    The main causes of a fire are: malfunctions in electrical networks, violation of the technological regime and fire safety measures (smoking, making an open fire, using faulty equipment, etc.).NS.).

    The main fire hazards are heat radiation, high temperatures, the toxic effect of smoke (combustion products: carbon monoxide, etc.) and reduced visibility during smoke. The critical values ​​of the parameters for a person, with prolonged exposure to the indicated values ​​of hazardous fire factors, are:

    – temperature – 70 C o
    – thermal radiation density – 1.26 kW / m 2 ;
    – concentration of carbon monoxide – 0.1% by volume;
    – visibility in the smoke zone – 6-12 m.

    EXPLOSION is a combustion accompanied by the release of a large amount of energy in a limited volume in a short period of time. The explosion leads to the formation and propagation of a blast shock wave at a supersonic speed (with an excess pressure of more than 5 kPa), which exerts a mechanical shock on the surrounding objects.

    The main damaging factors of the explosion are an air shock wave and fragmentation fields formed by flying debris of various kinds of objects, technological equipment, explosive devices.

    PREVENTIVE MEASURES

    The number of preventive measures may include measures aimed at eliminating the causes that can cause a fire (explosion), limiting (localizing) the spread of fires, creating conditions for the evacuation of people and property in case of fire, timely fire detection and notification, extinguishing fire, maintaining fire suppression forces in constant readiness.
    Compliance with technological modes of production, the maintenance of equipment, especially energy networks, in good condition allows, in most cases, to exclude the cause of fire.
    Timely fire detection can be achieved by equipping industrial and domestic premises with automatic fire alarm systems or, in some cases, with the help of organizational measures.
    Initial fire extinguishing (before the arrival of the forces caused) is successfully carried out at those facilities that are equipped with automatic fire extinguishing installations.

    HOW TO PROCESS IN FIRE AND EXPLOSION

    If a fire is detected, react to the fire quickly, using all available methods to extinguish the fire (sand, water, fire extinguishers, etc.).etc.). If it is impossible to extinguish the fire in the shortest possible time, call the fire department of the company (if available) or the city (by phone 01).
    When evacuating burning rooms and smoky places, pass quickly, holding your breath, protecting your nose and mouth with a damp, dense cloth. In a very smoky room, crawl or crouch down – in the space adjacent to the floor, clean air stays longer.
    When looking for victims, call them. If a person’s clothes are on fire, help to throw them off or throw any blanket on the burning person and press firmly.If air access is restricted, combustion will quickly stop. Don’t let the person with the burning clothes run away.
    Do not go near explosive objects and do not touch them. If there is a threat of an explosion, lie on your stomach, protecting your head with your hands, away from windows, glazed doors, walkways, stairs. If an explosion occurs, take measures to prevent fire and panic, provide first aid to the injured.
    If a building is damaged by a fire or explosion, enter it carefully, making sure to enter it carefully, making sure that there is no significant damage to floors, walls, electricity, gas and water supply lines, gas leaks, fires.
    If you live near an explosive object, be careful. Sirens and intermittent beeps of enterprises (vehicles) mean the signal “Attention to all!” When you hear it, immediately turn on the loudspeaker, radio, or television. Listen to the information message about the emergency and act according to the instructions of the territorial Civil Defense and Emergency Situations.

    90,000 Soft tissue wounds: Causes and treatment

    What are soft tissue wounds?

    Soft tissue injuries include injuries to the skin, mucous membrane, deep-lying tissues (subcutaneous tissue, muscles, etc.)), as well as tendons, blood vessels and nerves. As a result of a violation of the integrity of the skin, microbial contamination of the wound surface occurs, which can lead to the development of infection.

    According to the damaging factor, wounds are divided into mechanical, thermal (burn) and chemical; on the weapon of injury – for wounds from blunt, sharp objects, guns and weapons, firearms and weapons; by the nature of the damage, wounds are classified into bruised, torn, combined, bitten, stabbed, cut, stab-cut, chopped, sawn, combined bullet, shot, fragmentation.

    By the depth of damage, superficial wounds are distinguished, located in various layers of the skin, and deep ones, passing in deep-lying tissues. Wounds of internal organs and joints, communicating with the external environment by the wound channel, are called open, and wounds, the wound channels of which pass through the cavities or ending in them, are called penetrating wounds. Wounds of internal organs that do not communicate with the external environment are classified as closed.

    Causes

    Cut wounds result from the direct impact of sharp weapons on the surface of the skin.

    Chopped wounds form when a sharp weapon is lowered onto the skin at an angle.

    Puncture wounds are the result of deep penetration of a sharp thin instrument. Possible injury to cavities or joints.

    Contusible wounds occur when any part of the body comes into contact with a rigid obstacle and there is a solid support in the form of the bones of the skull or other bone.

    Crushed, crushed wounds are formed as a result of the impact of a blunt tool with a wide surface when opposed to a solid support.

    Bite wounds. As a result of a bite by an animal or a person, highly virulent pathogens of wound infections can enter the wound.

    Symptoms

    It is possible to suspect a closed injury if you know the mechanism of the injury (for example, a blow with a blunt object) and in the presence of one or more signs: bruising, swelling, pain.
    Some indications suggest the nature of the injury. For example, swelling and deformity can mean a closed fracture. A bruise on the head, bloody discharge from the nose, ears and mouth – possible injury to the cervical spine or brain.Bruises on the chest, deformation, violation of symmetry – possible injury to the chest with damage to the ribs and sternum. Breathing problems may indicate a lung injury. Large bruises on the abdomen – possible injury to an internal organ.

    Wound signs vary depending on the type and depth of tissue damage. As a rule, any damage accompanies pain, possibly a violation of the integrity of the skin, as well as bleeding.

    Diagnostics

    For small superficial wounds that are not accompanied by general symptoms, the diagnosis is made on the basis of the clinical picture.A detailed study is carried out during the primary treatment of the wound. With extensive and deep wounds with a violation of the general condition, additional studies are needed, the list of which is determined taking into account the localization of the damage. In case of injuries in the chest area, a chest X-ray is prescribed, in case of abdominal injuries – an abdominal X-ray, ultrasound or laparoscopy, etc. If you suspect a violation of the integrity of blood vessels and nerves, consultation of a neurosurgeon and a vascular surgeon is required.

    Treatment

    First aid consists in the primary surgical treatment of the wound, during which foreign bodies are removed from the wound, bleeding stops, the wound is washed with antiseptics, and non-viable tissues are excised. The issue of the prevention of tetanus and rabies (if the wound is bitten) is also resolved. Wounds with a pronounced inflammatory process are not sutured, they are drained. The infected wound heals by secondary intention. Dressings and drainage changes are performed daily.General treatment consists of anti-inflammatory therapy, the introduction of hemostatic agents, pain relievers.

    In case of profuse blood loss, the issue of replenishing the volume of circulating blood (BCC) is resolved, blood substitutes and blood components are introduced. Subsequently, with severe cicatricial contractures and deformities, a restorative operation can be repeated.

    Most often, superficial wounds do not bleed much. Therefore, help consists in bandaging the wound. Before this procedure, the edges are smeared with an antiseptic, making sure that it does not get into the wound.

    The wound is covered with a sterile napkin and bandaged. If the edges of the wound are widely dispersed, before applying the bandages, they must be brought closer together (but not until they are closed) and in this position fixed with 2-3 strips of adhesive plaster.

    Do not rinse the wound with water (danger of infection), alcohol or iodine tincture. The disinfectant solution, getting into the wound, causes the death of damaged cells, and also causes significant pain. Do not put any ointment on the wound, and also put cotton wool directly into the wound.

    Do not forget about vitamin therapy. Vitamin deficiency dramatically slows down the reparative (restorative) processes.

    To accelerate wound healing, proper nutrition of patients is important, especially those who have undergone traumatic shock, severe infection or major surgery. They need a complete diet with increased amounts of protein and vitamins. Physiotherapy is indicated primarily for purulent wounds of the upper extremities. Physiotherapeutic procedures play an important role: UFO, UHF, etc.

    90,000 Ukrainian doctors told about the wounds received by the soldiers of the Armed Forces of Ukraine near Debaltseve: Ukraine: Former USSR: Lenta.ru

    The hospitals of Kharkov and Dnepropetrovsk continue to receive wounded soldiers of the Armed Forces of Ukraine (AFU) in the Debaltseve region. In particular, the head physician of the Mechnikov Dnepropetrovsk hospital, Sergei Ryzhenko, on Thursday, December 22, on the air of the 112 Ukraine TV channel, said that five servicemen had been delivered to the medical facility.

    “One of them is in critical condition.He is 29 years old. He has a mine-explosive wound to the head, a penetrating wound to the brain, wounds to the face, eyes, and wounds to his right leg. He’s on a ventilator. He underwent surgery, at 4 am they just finished, we hope that he will survive, ”Ryzhenko said.

    Dnepropetrovsk “34th TV channel” published a story from the city hospital number 2. A serviceman got here who received burns of 80 percent of his body. According to him, a mine hit the position where he was, “the stove and a barrel of diesel fuel overturned, everything caught fire.”

    Materials on the topic

    00:10 – December 22, 2016

    Thirst for the boiler

    Why did the Ukrainian security forces try to break through to Debaltseve

    On the Facebook page of volunteers in Kharkov, it is noted that new wounded are arriving every day. “They are driving and driving. The wounds are different – contusions (there are serious ones), frostbite, infections, fragmentation, subversive ones, ”the message says.

    A day earlier, the representative of the People’s Militia of the self-proclaimed Luhansk People’s Republic (LPR) Andrei Marochko said that the Armed Forces of Ukraine, when trying to break through the defense of the militia, lost 40 people killed, another 50 wounded.According to him, the security forces in the village of Kalinovka also lost two infantry fighting vehicles.

    On December 19, the LPR reported that Ukrainian security forces attacked militia positions along the entire contact line near Debaltseve.

    The armed conflict in Donbass began in the spring of 2014 after an attempt by the new Kiev authorities to suppress demonstrations in Donetsk and Luhansk regions by force.

    Children’s Rights Commissioner under the President of the Russian Federation

    19.10.2020

    Today, 27 children previously taken out of the Syrian Arab Republic were handed over to their relatives.

    Children underwent the necessary medical examination and a number of quarantine measures related to the prevention of the spread of coronavirus infection. All the children tested negative for Covid-19, no serious diseases were detected, relatives were allowed to take them home.

    “Children now begin a new life – without the horrors of war, explosions, shots, without the constant feeling of hunger and fear.Of course, memories are still fresh, some of the children still have scars from shrapnel wounds, but the love and care of their relatives, I am sure, will help to cope with everything. We, of course, remain in touch, rehabilitation work will be carried out with families without fail, specialists will be connected to help children adapt to new living conditions, ”said the children’s ombudsman.

    Children returned to their relatives will go to 5 regions of the Russian Federation: 17 children – to Dagestan, 4 – to the Penza region, 2 each – to the Tyumen and Volgograd regions, as well as to the Chechen Republic.

    “But as long as our children remain where the fighting is going on, we will not be able to be calm. Another 27 Russian children from the Al-Khol camp were able to take DNA tests, at the moment, the documents for the export of more than 90 minors from Syria have already been fully prepared, we are preparing for the next flights, ”says the Ombudsman.

    Anna Kuznetsova once again thanked everyone who does not remain indifferent to the work of returning Russian children to their homeland – representatives of the Ministry of Foreign Affairs of the Russian Federation, the Ministry of Defense of the Russian Federation, the Ministry of Health of the Russian Federation, the leadership of the Syrian Arab Republic, representatives of the Kurdish side.

    Work to locate and return home minor citizens of the Russian Federation in Iraq and Syria began in the summer of 2017. It is organized and carried out on behalf of the President of the Russian Federation. Under the Commissioner for the Rights of the Child, a special interdepartmental commission has been created to assist in the return of children to their homeland. During Anna Kuznetsova’s visit to Damascus in 2019, during a working meeting with Syrian President Bashar al-Assad, an agreement was reached on humanitarian cooperation in this area.During the work of the interdepartmental commission under the children’s ombudsman, 224 children were returned to the Russian Federation from the zones of armed conflicts in the Middle East: 122 from Iraq and 102 from Syria.

    Press Service of the Commissioner for the Rights of the Child under the President of the Russian Federation

    “We coped with wounds and we are coping here”: how COVID-19 is treated in the DPR

    https://ria.ru/20200615/1572943035.html 19

    “We coped with wounds and we are coping here”: how COVID-19 is treated in the DPR – RIA Novosti, 15.06.2020

    “We coped with injuries and we are coping here”: how the DPR treats COVID-19

    The number of detected cases of COVID-19 in the self-proclaimed Donetsk People’s Republic reached 833, 38 people died, but the Ministry of Health notes that the situation in … RIA Novosti, 15.06.2020

    2020-06-15T13: 10

    2020-06-15T13: 10

    2020-06-15T13: 10

    The spread of coronavirus

    in the world

    Donetsk people’s republic

    covid coronavirus -19

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    DONETSK, June 15 – RIA Novosti. The number of detected cases of COVID-19 in the self-proclaimed Donetsk People’s Republic reached 833, 38 people died, but the Ministry of Health notes that the situation is generally stable, there is no sharp increase in the incidence. Epidemiologists note that there is no wide spread of the new coronavirus infection among the population of the republic, but they do not undertake to predict the further development of the situation.On March 11, the World Health Organization declared the outbreak of the new coronavirus infection COVID-19 a pandemic. A new challenge for medicine in the DPR The first case of COVID-19 was confirmed in the DPR at the end of March. By this time, an operational headquarters had been created in the republic to prevent the spread of COVID-19, a high alert regime was introduced, departments in hospitals for hospitalizing patients with coronavirus were identified and prepared. The Makiivka Clinical Mining Hospital is one of these. She accepts the most severe patients with confirmed coronavirus and respiratory distress.According to the head physician Anna Rudnichenko, the new department was created on the basis of the anesthesiology department back in March. It is designed for 15 people, but if necessary, it can be expanded to 20 beds. The first confirmed COVID-19 patient was admitted on April 7. More than 50 people have already passed through the department. “When the patients went, we were already accepting and assisting them on a regular basis. From the point of view of adjusting the conditions for patients, we practically did nothing. From the point of view of ensuring the safety of the staff, we had to think over the distribution of flows, how to enter , where to dress, how to be processed, how to go out, where to leave clothes for disinfection, “Rudnichenko told RIA Novosti.According to her, one of the main difficulties that doctors faced at the beginning was the atypical course of the disease and the pneumonia caused by it. In treating such patients, doctors focused mainly on the methods used in Russia. “The problem with these COVID pneumonias is that they are practically invisible on X-rays in the early stages of development. A person walks, even his temperature may not rise. radiographically everything is fine.It happens that in the evening a patient has one picture, and the next day it is completely different.Very rapid development of the clinic. Pneumonia is completely unpredictable, “- said Rudnichenko. The head physician notes that the department is provided with the necessary medicines, and the doctors – protective suits, respirators, shoe covers. in the department and discharged with full recovery, was 91. “Yes, there are certain difficulties, but they are due to the fact that we have never encountered this, we have never treated this infection, we have never encountered this type of pneumonia.But we are doing it. In 2014 (when the conflict began in Donbass – ed.), We also did not face mine and explosive injuries, shrapnel injuries, gunshot wounds, we learned all this from the wheels. And we coped, “Rudnichenko said. Restrictions gave results Due to the threat of the spread of the new coronavirus, a number of restrictions were introduced by the decree of the head of the republic Denis Pushilin: transport and premises.In addition, the entry of citizens without registration or a certificate of permanent residence is prohibited, and mandatory self-isolation for 14 days has been introduced for arrivals. For violation of restrictions in the DNR, administrative and criminal liability is provided. Spain, the United States, where, among other things, a very high mortality rate has been recorded, “DPR Minister of Health Olga Dolgoshapko told reporters.According to her, the situation with coronavirus infection in the republic is stable, there is no sharp increase in the incidence rate. According to the Ministry of Health, the DPR is fully provided with drugs for the treatment of coronavirus infection, as well as the necessary medical equipment. They come mainly from Russia, and there are also sufficient test systems for detecting COVID-19. The Ministry of Health said that a large batch of tests for 10 thousand studies has recently been received.The testing itself is carried out on the basis of the Republican Center for Sanitary and Epidemiological Surveillance. “Three laboratories are now participating. We are equipped with modern equipment for carrying out these studies. This is also a gift from the Russian Federation. Before that, such studies were carried out on the territory of the DPR on a single scale. Now we can actually conduct them on At first, there were about 60 studies per day, now we are doing 250-300 “, – told RIA Novosti Director of the Department of the State Sanitary and Epidemiological Service of the DPR Dmitry Klishkan.According to him, in almost three months of the high alert regime in the DPR, more than 6 thousand tests for coronavirus were carried out. There are about a thousand samples in the queue for research. Initially, the laboratory base of the republic was not ready for such research, but now it is expanding. “Another laboratory is being opened on the basis of the Donetsk clinical territorial association. The possibility of opening a laboratory on the basis of the Donetsk Medical University, a central research laboratory, is being studied,” Klishkan said.He clarified that tests for COVID-19 in the republic are carried out only for medical reasons: infected with the infection, patients with pneumonia, people who have come into contact with the sick and have symptoms of infection, as well as doctors with clinical manifestations of coronavirus. However, in the near future, it is planned to start conducting research for everyone. Forecasts Klishkan assures that there is no widespread COVID-19 in the republic, although there is a slight increase in the incidence. But it is difficult to predict the further development of the situation, he said.”So far, we have a tendency to increase: two people who are sick infect three people. This is insignificant, but an increase. We hope that the complex of measures taken will lead to a decrease in the incidence. In the fight against airborne infections, the main (method – ed.) Is vaccination. But at the moment we cannot offer it. Therefore, we must fight with quarantine and restrictive measures, “- said the director of the department. According to him, the further development of the situation depends on a number of factors. Among them are the weather conditions, the duration of the restrictive measures, their observance by the inhabitants of the republic.

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    in the world, Donetsk People’s Republic , coronavirus covid-19

    DONETSK, June 15 – RIA Novosti. The number of detected cases of COVID-19 in the self-proclaimed Donetsk People’s Republic reached 833, 38 people died, but the Ministry of Health notes that the situation is generally stable, there is no sharp increase in the incidence.

    The department is confident that the timely introduced restrictive measures have avoided a massive spread of the disease. Epidemiologists note that there is no wide spread of the new coronavirus infection among the population of the republic, but they do not undertake to predict the further development of the situation.

    The World Health Organization declared an outbreak of the new coronavirus infection COVID-19 a pandemic on March 11.

    New challenge for medicine DNR

    The first case of COVID-19 was confirmed in the DNR at the end of March. By this time, an operational headquarters had been created in the republic to prevent the spread of COVID-19, a high alert regime was introduced, departments in hospitals were identified and prepared for hospitalizing patients with coronavirus.

    Clinical Mining Hospital in Makeyevka is one of these.She accepts the most severe patients with confirmed coronavirus and respiratory distress. According to the head physician Anna Rudnichenko, the new department was created on the basis of the anesthesiology department back in March. It is designed for 15 people, but if necessary, it can be expanded to 20 beds. The first confirmed COVID-19 patient was admitted on April 7. More than 50 people have already gone through the department. March 19, 2020, 14:44We did almost nothing in terms of accommodating the patient environment. From the point of view of ensuring the safety of personnel, we had to think over the distribution of flows, how to enter, where to dress, how to handle, how to leave, where to leave clothes for disinfection, “Rudnichenko told RIA Novosti.

    According to her, one of the main difficulties faced In the beginning, doctors had an atypical course of the disease and the pneumonia caused by it.In treating such patients, doctors were guided mainly by the methods used in Russia.

    “The problem of these COVID pneumonias is that in the early stages of development they are practically invisible on X-rays. A person walks, his temperature may not even rise. At the initial stages, radiographically, everything is fine. It happens that in the evening the patient has one picture, but the next day is completely different. The clinic is developing very rapidly. Pneumonia is completely unpredictable, “said Rudnichenko.

    13 June 2020, 06:03 Spread of coronavirus The biologist listed the hidden symptoms of coronavirus

    The head physician notes that the department is provided with the necessary medicines, and the doctors – protective suits, respirators, shoe covers.With experience in the treatment of a new infection, their own developments appear. According to her, the oldest patient who underwent treatment in the department and was discharged with full recovery was 91 years old.

    “Yes, there are certain difficulties, but they are due to the fact that we have never encountered this, we have never treated this infection, we have never encountered this type of pneumonia. But we are coping. In 2014 (when the conflict began in Donbass – ed.) We also did not face mine and explosive injuries, shrapnel injuries, gunshot wounds, we learned all this from the wheels.And we coped “, – said Rudnichenko. April 23, 2020, 10:43 am a number of restrictions: mass sports and cultural and entertainment events are prohibited, the opening hours of cafes and restaurants have been reduced, and a mandatory mask regime has been introduced in public transport and on premises.In addition, the entry of citizens without registration or a certificate of permanent residence is prohibited, and mandatory self-isolation for 14 days has been introduced for arrivals. For violation of restrictions, the DPR provides for administrative and criminal liability.

    “Thanks to the timely introduction by the head of the DPR of a number of restrictive measures, the massive spread of the disease and a large number of cases of a severe course of the disease were avoided. We managed to prevent the scenario of events that we could observe, for example, in Italy, Spain, the USA, where, a very high mortality rate, “DPR Health Minister Olga Dolgoshapko told reporters.

    According to her, the situation with coronavirus infection in the republic is stable, there is no sharp increase in the incidence.

    June 12, 2020, 10:48 am Spread of coronavirus A new symptom associated with coronavirus has been named

    Provision with tests and medicines

    According to the Ministry of Health, the DPR is fully provided with medicines for the treatment of coronavirus infection, as well as the necessary medical equipment. They come mainly from Russia.

    There are also sufficient test systems to determine COVID-19.The Ministry of Health said that a large batch of tests for 10 thousand studies has recently been received. The testing itself is carried out on the basis of the Republican Center for Sanitary and Epidemiological Surveillance.

    “Three laboratories are now participating. We are equipped with modern equipment for carrying out these studies. Also a gift from the Russian Federation. Before that, such studies were carried out on a single scale in the DPR. Now we can actually conduct them on the stream. At first, there were about 60 studies per day, now we are doing 250-300 “, – Dmitry Klishkan, director of the department of the state sanitary and epidemiological service of the DPR, told RIA Novosti.

    June 3, 2020, 22:48 There are about a thousand samples in the queue for research. Initially, the laboratory base of the republic was not ready for such research, but now it is expanding.

    “One more laboratory is being opened on the basis of the Donetsk clinical territorial association.The possibility of opening a laboratory on the basis of Donetsk Medical University, a central research laboratory, is being studied, “Klishkan noted. with sick and having symptoms of infection, as well as doctors with clinical manifestations of coronavirus.However, in the near future it is planned to start conducting research for everyone.

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    Predictions

    Klishkan assures that there is no wide spread of COVID-19 in the republic, although there is a slight increase in the incidence. But it is difficult to predict the further development of the situation, he said.

    “While we have an upward trend: two people who are sick infect three people. This is insignificant, but an increase. We hope that the set of measures taken will lead to a decrease in the incidence.In the fight against airborne infections, the main (method – ed.) Is vaccination. But at the moment we cannot offer it. Therefore, it is necessary to fight with quarantine-restrictive measures, “said the director of the department.

    According to him, the further development of the situation depends on a number of factors, including weather conditions, the duration of restrictive measures, their observance by residents of the republic.

    April 18, 2020, 19: 33InfographicsTop 15 G-20 countries by COVID-19 lethality

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    View 90,000 The Ministry of Defense reported that one of 6 servicemen received a gunshot wound, five were wounded by shrapnel.Tigran Abrahamyan

    Facebook post of Tigran Abrahamyan, former adviser to the President of Artsakh, deputy from the “I have the honor” bloc

    On October 14, the Artsakh Defense Army reported that the Azerbaijani armed forces opened fire on one of the bases of the Defense Army, as a result of which 6 soldiers were injured.

    Following this incident, advisers to the Artsakh President stated that the attack was carried out using an unmanned aerial vehicle.It turns out that there was not a gunshot wound, but an injury from a splinter of a UAV projectile.

    A day after the incident, according to the Defense Army, Azerbaijani armed formations opened fire towards the ambulance of the Defense Army, which was at the front line at that moment.

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    Since there was a lot of conflicting information about the incident, I wrote a letter to the Ministry of Defense.

    I had the following questions:

    1.Please indicate the names and surnames of 6 wounded servicemen and separately provide the state of health of the latter.

    2. In fact, what kind of wounds were received by 6 servicemen of the Defense Army – gunshot or shrapnel?

    3. Are there any injured in the episode of the attack on the ambulance?

    In a reply letter, the Minister of Defense said that Albert Sarukhanyan’s condition is grave, Khachik Gorgian’s condition is moderate, Kajik Arshakyan’s condition is satisfactory, Hrayr Hakobyan’s condition is serious, Edgar Hovakimyan’s condition is satisfactory, Lernik Chakhifalakyan’s condition is serious.