PCW of wound (primary surgical treatment): a set of instruments, medicines

A wound is tissue damage by mechanical means in the presence of breaches of the integrity of the skin. The presence of a wound, and not a bruise or bruising, can be determined by such signs as pain, gaping, bleeding, dysfunction and integrity. The wound is wounded in the first 72 hours after injury, if there are no contraindications.

Types of wounds

Each wound has a cavity, walls and a bottom. Depending on the nature of the damage, all wounds are divided into chipped, cut, chopped, bruised, bitten and poisoned. During the conduct of the PCW wound it must be taken into account. After all, the nature of the trauma depends on the characteristics of the first aid.

• Stab wounds are always applied with a stabbing object, for example, with a needle. A distinctive feature of the damage is greater depth, but small damage to the covers. In view of this, it is necessary to make sure that there are no injuries to blood vessels, organs or nerves. Stab wounds are dangerous because of mild symptoms. So, if there is a wound on the abdomen, there is a chance of liver damage. This is not always easy to see when conducting a PCO.
• The cut wound is applied with a sharp object, so the destruction of the tissues is not great. At the same time, a gaping cavity is easy to inspect and perform PCO. Such wounds are well treated, and the healing is carried out quickly, without complications.
• Chopped wounds appear due to damage caused by a sharp but heavy object, such as an ax. In this case, the lesions differ in depth, characterized by the presence of wide gaping and bruising adjacent tissues. Because of this, the ability to regenerate decreases.
• Bruised wounds appear when using a blunt object. These injuries are characterized by the presence of many damaged tissues, strongly impregnated with blood. When conducting PCWs, wounds should be taken into account that there is a possibility of the appearance of suppuration.
• Bitten wounds are dangerous by penetrating the infection with the saliva of the animal, and sometimes the person. There is a risk of developing acute infection and the appearance of a rabies virus.
• Poisoned wounds usually occur when there is a bite of a snake or spider.
• Gunshot wounds differ in the type of weapons used, features of damage and penetration trajectories. The probability of infection is high.

The presence of suppuration plays an important role in the conduct of PCW. Such injuries can be festering, freshly infected and aseptic.

The purpose of conducting PWO

Primary surgical treatment is necessary to remove harmful microorganisms that have fallen into the wound. For this, all damaged dead tissue is cut off, as well as blood clots. After this, seams are applied and drainage is performed, if necessary.

The procedure is necessary in the presence of damage to tissues with uneven edges. This is also required by deep and contaminated wounds. The presence of damage to large blood vessels, and sometimes bones and nerves also requires the performance of surgical work. The PCO is carried out simultaneously and exhaustively. The surgeon needs the help of the patient for up to 72 hours after the wound is applied. Early PXO is carried out during the first 24 hours, conducting on the second day is a delayed surgical intervention.

Tools for PGO

A minimum of two copies of the kit are required for the initial treatment of the wound. They are changed during the operation, and after the dirty stage - they are recycled:

• Clamp "Korntsang" direct, which is processed by the operating field;
• Scalpel pointed, bryzy;
• Linen caps used to hold bandages and other materials;
• Clamps Kocher, Billroth and "mosquito", are used to stop bleeding, while conducting PCW wounds they are used in huge quantities;
• Scissors, they are straight, and also curved along a plane or an edge in several copies;
• Probes of Kocher, gutter and bellied;
• Set of needles;
• needle holder;
• Tweezers;
• Hooks (several pairs).

The surgical set for this procedure also includes suture material, needles for injections, syringes, bandages, gauze balls, rubber gloves, all kinds of tubes and napkins. All the items that are needed for conducting PCWs - suture and dressing kits, instruments and medicines intended for the treatment of wounds - are laid out on the surgical table.

Necessary medicines

Primary surgical treatment of the wound is not without special medications. Most often used are:

• 70% alcohol;
• 3% hydrogen peroxide solution;
• 1% iodopyrone solution or 0.5% chlorhexidine bigluconate solution;
• 10% NaCl solution;
• 0.25% - 0.5% solution of novocaine.

Stages of PGO

Primary surgical treatment is carried out in several stages:

1. Inspection of the wound with its subsequent treatment with an antiseptic.
2. Removal of damaged tissues, foreign bodies, bone fragments. The wound is cut as necessary.
3. Stop bleeding.
4. Drainage.
5. Stitching.

How is the PGO done

For the surgical intervention the patient is placed on the table. Its position depends on the location of the wound. The surgeon should be comfortable. The wound toilet is performed, the surgical field is processed, which is delimited by sterile disposable linen. Next, the primary tension is applied, aimed at healing the existing wounds and injecting anesthesia. In most cases, surgeons apply the method of Vishnevsky - inject 0.5% solution of novocaine at a distance of two centimeters from the edge of the cut. The same solution is injected from the other side. With the correct reaction of the patient to the skin around the wound, there is a "lemon crust". Gunshot wounds often require the patient to be given general anesthesia.

The edges of damage up to 1 cm are held by the Kochher clamp and cut off by a single block. When performing the procedure, a non-viable tissue is cut off on the face or fingers, after which a tight seam is applied. Gloves and tools are being replaced.

The wound is washed with chlorhexidine and examined. The stab wounds, having small but deep incisions, dissect. If the edges of the muscles are damaged, they are removed. So do with the splinters of bones. Then hemostasis is performed. The internal part of the wound is treated first with a solution, and then with antiseptic preparations.

The treated wound without signs of sepsis is sewn tightly with the primary hand suture and covered with an aseptic bandage. Stitches are carried out, evenly covering all the layers in width and depth. It is necessary that they touch each other, but not tighten. When performing the work, you need to get a cosmetic suture after healing.

In some cases, the primary seams are not superimposed. A cut wound can have more serious damage than it seems at first glance. If there is any doubt, the surgeon uses a primary-delayed seam. This method is used if the wound has been infected. Suturing is carried out to fatty tissue, and the seams are not tightened. A few days after observation, the wound is sutured to the end.

Wounds from bites

The PCO wound, bitten or poisoned, has its differences. When bites are not poisonous animals is a high probability of infection with rabies. At an early stage, the disease is suppressed by rabies serum. Such wounds in most cases become purulent, so the PCOs are trying to delay. When the procedure is performed, the primary-delayed seam is applied and antiseptic medications are applied.

A wound obtained from a snake bite requires the imposition of a tight bundle or bandage. In addition, the wound is frozen with novocaine or cold applied. To neutralize the poison, antiserum serum is introduced. Spider bites are blocked by potassium permanganate. Before this, the poison is squeezed out, and the wound is treated with an antiseptic.

Complications

Incompetent treatment of the wound with antiseptics leads to suppuration of the wound. An improper means of anesthesia, as well as causing additional injuries, causes the patient's anxiety due to the presence of pain.

Rough attitude to tissues, poor knowledge of anatomy lead to damage to large vessels, internal organs and nerve endings. Insufficient hemostasis causes the appearance of inflammatory processes.

It is very important that the initial surgical treatment of the wound be carried out by a specialist according to all the rules.