The simplest methods of initial inspection at the pre-hospital stages

Pre-hospital stages, as indicated above, even with the most perfect organization work to some extent limited in their diagnostic and therapeutic possibilities, and in some cases, health workers may find themselves in such circumstances, where there is not only the modern technical means, but sometimes very necessary and simple equipment.
All this leads to expose the special discussion of the problems of primary health orientation, which we understand as the primary assessment of the nature of the injury and the gravity of the General condition of the victims, using only the simplest of clinical methods of questioning the victim, and witnesses, General and local inspection, determination of the degree of reaction at the surroundings, visual assessment functions of breathing, blood pressure measurement and evaluation of the pulse.
Primary care orientation can slagalica of the following elements: 1) assessment of the General state (first of all consciousness, the function of external respiration and blood circulation; 2) medicalinsurance the localization anatomical damage - head, thorax, pelvis, abdomen, legs, spine; 3)wyjasnienie nature of some gross anatomical damage - break, crush zone, fractures, wounds and other
These data can serve as a sufficient criteria to determine the nature of first aid.
Localization and character of anatomic (gross) damage can be found in the initial examination that is quite accessible even to persons without medical education.
To evaluate the function of external respiration in our view for the pre-hospital stage enough the following grades: external breathing is not broken, acute respiratory failure, stops breathing (apnea).
In other words, when primary care orientation is especially important and it is possible to install the breath, or is not, if there is, it violated or
not violated and, finally, if violated, to what extent.
Undisturbed can be considered rhythmic, smooth and relatively flat breath within 30 respiratory excursions per minute in the absence of cyanosis, and expressed wheeze.
Acute respiratory failure requiring in all cases of urgent measures can be observed in traumatic brain injury, compression of the brain, injuries to the chest, stomach or gas, with traumatic shock, mechanical asphyxia, electric shock and extensive thermal lesions.
Even in the initial examination of the victim acute respiratory failure relatively easily detected on the basis of the Following clinical signs: 1) the plaintiff (wounded) extremely restless, 2) the breath is shallow, sometimes irregular, frequent (often 30 min). In the act of breathing participate nostrils, inhaling intercostal spaces are drawn, the neck muscles are tense, 3) skin blue or pale bluish, acrocyanosis; 4) saphenous vein swollen; 5) a rich cold sweat.
When you attach a picture of pulmonary edema (wet lung) notes hoarse, loud, sometimes fiery breath.
In acute respiratory failure Central Genesis (traumatic brain injury) consciousness of the victim is often lost, pharyngeal and cough reflexes depressed may be regurgitation and vomiting, followed by aspiration of gastric contents.
Stop breathing is registered by the absence of visible chest excursion.
When assessing circulatory functions necessary to consider the degree of medical preparedness providing assistance. When non-medical and paramedical aid evaluation of the function of circulation is only possible to determine the presence or absence of heartbeat and heart to peripheral arteries, i.e. the orientation on the principle of "alive and dead".
Health workers at the prehospital stage, the following grading: 1) function of the circulatory not violated; 2) erectile phase of shock;
3) torpid phase of shock; 4) cardiac arrest.
About the normal circulatory functions can talk with satisfactory performance of the heart to peripheral arteries and normal for this age blood pressure (if possible to identify).
When erectile phase traumatic shock blood pressure is normal or elevated, the heart to peripheral arteries normal frequency or Ochsen, satisfactory filling or tense.
In this phase, draws the attention of the conscious mind of the victim, motor and language stimulation, loud complaints about pain and at the same time underestimating their condition. Painful reaction when erectile phase of shock raised the voice of the voiceless speech jerky, look restless, wandering. Paleness of skin sometimes followed by erythema. Cold sweat. The tone of skeletal muscles is increased. Persistent red dermographism.
Duration of erectile phase of shock varies in [a fairly considerable range from 1-2 minutes to several hours.
If the victim assistance will be provided a timely manner, or not fully, then erectile phase can pass in a torpid.
Because primary care orientation reasonably available only to ascertain development torpid phase traumatic shock without assessing severity, that in these conditions it is possible to refrain from classification degrees and be based on only the most common clinical signs include lethargy with preserved consciousness, adequate, but slow response on the surrounding arterial gipotenzia, paleness of skin, often with a cyanotic shade, decreased or normal body temperature, low muscle tone, weakened the tendon reflexes.
In agony all these signs reach the extreme severity, blood pressure is not specified, the heart to peripheral arteries is not defined or nedoschitaetsya, the mind is obscured or missing. When cardiac arrest palpitations not listening, or the heart to peripheral arteries is not defined (scheme 1).

Scheme 1. The simplest methods of primary health orientation
Task Types Methods
Determination of the nature and volume of necessary medical assistance On the severity of the General status (sohrannost of consciousness, the state of respiration, pulse, blood pressure); localization of anatomic lesions (head, neck, chest, abdomen, pelvis, spine, limbs); the nature visually determined anatomical damage (break, crush zone, wounds, open and closed fractures and other). General and local inspection, survey of the victim and witnesses, the establishment of the degree of reaction at the surroundings, the visual assessment of breathing, blood pressure measurement and evaluation of pulse

Criteria of estimation of external respiration function Evaluation criteria circulatory functions
A. At the stage of mutual assistance
Alive - dead - the presence or absence of respiratory movements of the chest and abdomen. Alive - dead - the presence or absence of heart rate and pulse.
B. At the stage of first aid
External breathing is not broken. The function of the circulatory system is not broken.
Acute respiratory failure. Traumatic shock (or erectile torpid phase).
Stop breathing. A cardiac arrest.