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Consultations, diagnostics, treatment
I APPROVE
First Deputy
general Director
Federal Road Transport Agency
department of the Ministry of Transport of the Russian Federation
O. V. SKVORTSOV
March 11, 1993
AGREED
Deputy Chairman
Central Committee of the Workers ' Union
road transport
and road management
N. D. SILKIN
January 28, 1993
STANDARD INSTRUCTION N 22
ON PROVIDING FIRST AID
IN CASE OF ACCIDENTS
The instruction contains the basic requirements for the labor protection of road workers of mass professions before the start of work, during their execution and at the end of work.
The instruction was compiled by the Central Trade Union with the participation of the Central Committee of the Trade Union of Road Transport and Road Workers.
It is intended for managers and specialists of road organizations in order to use it when developing instructions on labor protection in accordance with Article 145 of the Labor Code of the Russian Federation, taking into account the specifics of local conditions.
I. GENERAL PROVISIONS
1.
Accidents at work are the result of non compliance with the safety requirements set out in the rules and instructions for labor protection.
2. Non compliance with safety requirements occurs mainly due to ignorance of the rules and requirements of regulatory and instructional documents, a low level of production organization and production discipline, lack of control and failure to take disciplinary measures, irresponsibility and negligence of employees to the work performed, lack of a work culture and saving money for safety and labor protection, absence or non fulfillment of job instructions by employees.
3. Accidents, as a rule, are accompanied by various severity of consequences.
Timely and qualified assistance can save the victim from serious consequences.
4. The conditions for success in providing first aid to victims of accidents are the ability of the assisting person and the speed of his actions.
5. Every employee should be able to provide first aid to the victim.
To develop these qualities, appropriate training exercises are necessary, conducted by certified medical professionals at least 1-2 times a year.
6. Each working area must be provided with standard first aid equipment, the storage of which is entrusted to the responsible person.
7. Each worker, depending on the nature of the work and the conditions of its performance, must be provided with means of individual and collective protection.
Know the properties of harmful and dangerous substances, flammable and flammable substances and materials.
II.
METHODS OF PROVIDING FIRST AID
1.
FIRST AID IN CASE OF ELECTRIC SHOCK
1.1.
First aid measures depend on the condition in which the victim is located after his release from the effects of electric current.
1.2. To determine this condition, the following measures must be taken immediately:
- lay the victim on his back on a hard surface;
- check for the presence of breathing in the victim (determined visually by the rise of the chest; using a mirror);
- check whether the victim has a pulse on the radial artery at the wrist or on the carotid artery on the anterolateral surface of the neck;
- find out the condition of the pupil (narrow or wide); a wide pupil indicates a sharp deterioration in the blood supply to the brain.
1.3. In all cases of electric shock, calling a doctor is mandatory, regardless of the condition of the victim.
1.4. If the victim is conscious, but before that he was in a state of fainting, he should be put in a comfortable position (put under him and cover him with something from clothing) and ensure complete rest until the arrival of the doctor, continuously monitoring his breathing and pulse.
It is forbidden to allow the victim to move, and even more so to continue working, since the absence of severe symptoms after an electric shock does not exclude the possibility of subsequent deterioration of the victim's condition.
If it is not possible to quickly call a doctor, it is necessary to urgently deliver the victim to a medical institution, providing the necessary vehicles or stretchers for this.
1.5. If the victim is unconscious, but with a stable breathing and pulse, he should be laid down smoothly and comfortably, unbutton his clothes, create an influx of fresh air, give him ammonia to smell, spray his face with water and ensure complete rest.
If the victim does not breathe well very rarely and convulsively (like a dying person), he should be given artificial respiration and indirect (external) heart massage.
1.6. If the victim has no signs of life (breathing and pulse), he cannot be considered dead, since death is often only apparent.
In this condition, the victim, if he does not receive immediate first aid in the form of artificial respiration and external (indirect) heart massage, will really die.
Artificial respiration should be performed continuously both before and after the arrival of the doctor.
The question of the expediency or purposelessness of further artificial respiration is decided by the doctor.
1.7. When providing assistance to an imaginary dead person, every second is precious, so first aid should be provided immediately and, if possible, at the scene of the accident.
It is necessary to transfer the victim to another place only in cases when he or the person providing assistance continues to be in danger or when it is impossible to provide assistance on the spot.
1.8. In all cases, only a doctor has the right to declare death.
2. THE BASIC RULES THAT ARE MANDATORY IN THE PRODUCTION OF ARTIFICIAL RESPIRATION AND EXTERNAL HEART MASSAGE
2.1.
The revival of an organism affected by an electric shock can be performed in several ways.
All of them are based on artificial respiration.
However, the most effective method is "from mouth to mouth", carried out simultaneously with indirect heart massage.
2.2. Artificial respiration should be performed only if the victim does not breathe or breathes very poorly (rarely, convulsively, as if with a sob, like a dying person), as well as if the victim's breathing gradually worsens.
2.3. Artificial respiration should be started immediately after the victim is released from the effects of electric current and performed continuously until a positive result is achieved or there are indisputable signs of actual death (the appearance of cadaveric spots or rigor mortis).
2.4. There have been cases when the imaginary dead after an electric shock were brought back to life after a few hours.
2.5. During the production of artificial respiration, it is necessary to carefully observe the face of the victim.
If he moves his lips or eyelids or makes a swallowing movement with the larynx (adam's apple), you need to check whether he will not take an independent breath.
Artificial respiration should not be performed after the victim begins to breathe independently and evenly, since the continuation of artificial respiration can only cause him harm.
2.6. If, after a few moments of waiting, it turns out that the victim is not breathing, artificial respiration should be resumed immediately.
Before starting the production of artificial respiration, it is necessary:
- quickly, without wasting a second, release the victim from the clothes that restrict breathing - unbutton the collar, untie the tie or scarf, unbutton the trousers, etc.;
- just as quickly release the victim's mouth from foreign objects (remove false teeth, if any) and mucus;
- if the victim's mouth is tightly clenched, open it by extending the lower jaw.
2.7. To do this, you need to put four fingers of both hands behind the corners of the lower jaw and, resting your thumbs on its edge, push the lower jaw forward so that the lower teeth stand in front of the upper ones (Fig. 1 - here and further drawings are not given).
2.8. If it is not possible to open the mouth in this way, you should carefully insert a plate, a metal plate, a spoon handle or another similar object at the corner of the mouth between the posterior molars (but not the front ones), so as not to break the teeth, and use them to unclench the teeth.
3. THE METHOD OF ARTIFICIAL RESPIRATION "FROM MOUTH TO MOUTH" AND INDIRECT HEART MASSAGE
3.1.
The method of artificial respiration "from mouth to mouth" consists in the fact that the aid provider exhales from his lungs into the lungs of the victim through a special device (breathing tube) (Fig. 2), or directly into the mouth or nose of the victim.
3.2. This method is the most effective, since the amount of air entering the victim's lungs in one breath is 4 times more than with other methods of artificial respiration.
In addition, when using this method of artificial respiration, it is possible to control the flow of air into the lungs of the victim by a clearly visible expansion of the chest after each air injection and the subsequent decline of the chest after the end of the injection as a result of passive exhalation of air through the respiratory tract to the outside.
3.3. For the production of artificial respiration, the victim should be laid on his back, open his mouth and after removing foreign objects and mucus from his mouth (with a handkerchief or the end of a shirt) put a tube into it (Fig. 3): for an adult - with the long end 1, and for a child (teenager) - with the short end 2.
At the same time, it is necessary to ensure that the victim's tongue does not fall back and does not close the respiratory tract and that the tube inserted into the mouth gets into the respiratory tract in the throat, not in the esophagus.
To prevent the tongue from sinking, the lower jaw of the victim should be slightly pushed forward.
3.4. For disclosure of the larynx should tilt the victim's head back, placing the back of one hand and a second hand to put pressure on the forehead of the victim so that his chin was on one line with the neck (Fig. 4).
In this situation a head the lumen of the pharynx and upper respiratory tract greatly expanded and provided their full throughput, which is the main condition for the success of artificial respiration by this method.
3.5. In order to straighten the tube in the mouth and direct it to the windpipe, the lower jaw of the victim should also be slightly moved up and down.
Then, kneeling over the victim's head, the flange of the breathing tube should be tightly pressed to his lips, and the thumbs of both hands should clamp the victim's nose so that the air blown through the device does not come out again, bypassing the lungs.
Immediately after that, the caregiver makes several strong exhalations into the tube and continues them at a rate of about 10-12 exhalations per minute (every 5-6 seconds) until the victim's breathing is completely restored or until the doctor arrives.
3.6. In order to ensure the possibility of a free exit of air from the victim's lungs, the aid provider must release the victim's mouth and nose after each injection (without removing the device tubes from the victim's mouth).
3.7. With each injection, the chest of the victim should expand, and after the mouth and nose are released, they should descend independently.
To ensure a deeper exhalation, you can lightly press on the chest to help the air escape from the victim's lungs.
3.8. In the process of artificial respiration, the assisting person must ensure that the air he blows gets into the lungs, and not into the stomach of the victim.
If air enters the abdomen, which can be detected by the absence of chest expansion and bloating, it is necessary to quickly release air by pressing on the upper part of the abdomen under the diaphragm and place the breathing tube in the desired position by repeatedly moving up and down the lower jaw of the victim.
After that, you should quickly resume artificial respiration in the above way.
3.9. If there is no necessary device at the scene of the incident, it is necessary to quickly open the victim's mouth (in the above way), remove foreign objects and mucus from it, tilt his head back (Fig. 5)and pull the lower jaw.
After that, the helper puts a gauze or a handkerchief on the victim's mouth, takes a deep breath and exhales forcefully into the victim's mouth (Fig. 6).
When blowing air, the assisting person tightly presses his mouth to the victim's face so that, if possible, he covers the entire mouth of the victim with his mouth, and holds his nose with his face.
3.10. After that, the rescuer leans back and takes a new breath.
During this period, the victim's chest descends and he arbitrarily makes a passive exhalation (Fig. 7).
In this case, it is necessary to lightly press his hand on the victim's chest.
3.11. If the victim resumes independent breathing, artificial respiration should be continued for some time until the victim is fully brought to consciousness or until the arrival of a doctor.
In this case, air injection should be performed simultaneously with the beginning of the victim's own inhalation.
3.12. During artificial respiration, the victim should not be allowed to cool down (do not leave him on wet ground, stone, concrete or metal floor).
Under the victim, you should lay something warm, and cover him from above.
4. EXTERNAL (INDIRECT) HEART MASSAGE
4.1.
In the absence of a pulse in the victim, in order to maintain the vital activity of the body (to restore blood circulation), it is necessary, regardless of the reason that caused the termination of the heart, to perform an external heart massage simultaneously with artificial respiration (air injection).
At the same time, it should be borne in mind that without proper and timely preliminary assistance to the victim before the arrival of a doctor, medical assistance may be delayed and ineffective.
4.2. External (indirect) massage is performed by rhythmic compressions through the front wall of the chest when pressing on the relatively mobile lower part of the sternum, behind which the heart is located.
In this case, the heart is pressed against the spine and the blood from its cavities is squeezed into the blood vessels.
By repeating the pressure with a frequency of 60-70 times per minute, it is possible to ensure sufficient blood circulation in the body in the absence of heart work.
4.3. To perform an external heart massage, the victim should be laid back on a hard surface (a low table, a bench or on the floor), expose his chest, remove the belt, suspenders and other clothing items that restrict breathing.
The assisting person should stand on the right or left side of the victim and take a position in which a more or less significant slope over the victim is possible.
Having determined the position of the lower third of the sternum (Fig. 8 "a"), the helper should put the upper edge of the palm of the hand bent to the point of failure on it, and then put the other hand on top of the hand (Fig. 8 "b") and press on the chest of the victim, slightly helping with the tilt of his body.
4.4. Pressure should be made with a quick push, so as to move the lower part of the sternum down towards the spine by 3-4 cm, and in overweight people by 5-6 cm.
The pressure force should be concentrated on the lower part of the sternum, which is mobile due to its attachment to the cartilaginous endings of the lower ribs.
The upper part of the sternum is attached immobile to the bony ribs and can break when pressed on it.
Pressure on the ends of the lower ribs should also be avoided, as this can lead to their fracture.
In no case should you press below the edge of the chest (on soft tissues), as you can damage the organs located here, primarily the liver.
Pressure on the sternum should be repeated approximately 1 time per second.
4.5. After a quick push, the hands remain in the achieved position for about one third of a second.
After that, the hands should be removed, freeing the chest from pressure, in order to allow it to straighten out.
This promotes the suction of blood from the large veins in the heart and its filling with blood.
4.6. Since pressure on the chest makes it difficult to expand it when inhaling, the injection should be performed in the intervals between pressure or during a special pause provided for every 4-6 pressure on the chest.
4.7. In the case that aid has no mate and forced to carry out artificial respiration and external cardiac massage one should alternate these operations in the following order: after two or three deep insufflations in the mouth or nose of the injured assisting produces 4-6 chest compressions, then produces 2-3 deep injection and again repeats 4-6 pressure to heart massage, etc.
(Fig. 9).
4.8. If there is an assistant, one of the helpers less experienced in this matter should perform artificial respiration (Fig. 10) by blowing air as a less complex procedure, and the second - more experienced - perform external heart massage.
In this case, the air injection should be timed to the time when the pressure on the chest stops or the heart massage is interrupted for the duration of the injection (for about 1 second).
4.9. If the persons providing assistance are equally qualified, it is advisable for each of them to perform artificial respiration and external heart massage, alternately replacing each other every 5-10 minutes.
Such alternation will be less tedious than continuously carrying out the same procedure, especially heart massage.
4.10. The effectiveness of the external passage of the heart is manifested primarily in the fact that each pressure on the sternum leads to the appearance of pulsating vibrations of the artery walls in the victim (checked by another person).
4.11. With proper artificial respiration and heart massage, the victim shows the following signs of recovery:
- improvement of the complexion, which acquires a pinkish hue instead of a gray earthy color with a bluish tinge that the victim had before providing assistance;
- the appearance of independent breathing movements, which become more and more uniform as the assistance (recovery)activities continue;
- constriction of the pupils.
4.12. The degree of pupil constriction can serve as the most reliable indicator of the effectiveness of the assistance provided.
Narrow pupils in the revived person indicate a sufficient supply of oxygen to the brain, and, conversely, the beginning dilation of the pupils indicates a deterioration in the supply of blood to the brain and the need to take more effective measures to revive the victim.
Therefore, lifting the victim's legs about 0.5 m from the floor and leaving them in an elevated position during the entire time of external heart massage can help.
This position of the victim's legs contributes to a better blood flow to the heart from the veins of the lower body.
To maintain the legs in a raised position, something should be placed under them.
4.13. Artificial respiration and external heart massage should be carried out before the appearance of independent breathing and heart work, but the appearance of weak sighs (if there is a pulse) does not give grounds for I'm stopping artificial respiration.
In this case, as already mentioned above, the air injection should be timed to coincide with the beginning of the victim's own inhalation.
4.14. The recovery of the heart activity in the victim is judged by the appearance of his own regular pulse, which is not supported by massage.
To check the pulse, the massage is interrupted for 2-3 seconds, and if the pulse persists, this indicates the independent work of the heart.
If there is no pulse during the break, it is necessary to immediately resume the massage.
4.15. It should be remembered that even a short term cessation of reviving activities (1 min. and less) can lead to irreparable consequences.
4.16. After the appearance of the first signs of revival, external heart massage and artificial respiration should be continued for 5-10 minutes, timing the injection to the moment of one's own inhalation.
5. FIRST AID IN CASE OF INJURY
5.1.Germs located on the injuring object, on the skin of the victim, as well as in the dust, in the ground, on the hands of the assisting person and on dirty dressing material may be introduced into any wound.
5.2. In order to avoid infection with tetanus (a serious disease with a high percentage of mortality), we should pay special attention to wounds contaminated with earth.
An urgent call to a doctor for the administration of tetanus serum prevents this disease.
5.3. In order to avoid clogging of the wound during dressing, the first aid provider for wounds should wash his hands cleanly (with soap), and if it is impossible to do this for some reason, it is necessary to lubricate the fingers with iodine tincture.
It is forbidden to touch the wound itself even with washed hands.
5.4. When providing first aid, the following rules must be strictly observed:
- you can not wash the wound with water or any medicinal substance, cover it with powders and cover it with ointments, as this prevents the wound from healing, contributes to the introduction of dirt from the surface of the skin into it, which causes subsequent suppuration;
- you can not erase sand, earth, etc. from the wound, since it is impossible to remove everything that pollutes the wound in this way, but at the same time you can rub the dirt deeper and it is easier to cause infection of the wound; only a doctor can clean the wound properly;
- do not remove blood clots from the wound, as this can cause severe bleeding;
- do not wrap the wound with insulating tape.
5.5. To provide first aid in case of injury, an individual package available in the first aid kit should be opened, the sterile dressing material contained in it should be applied to the wound and bandaged with a bandage.
5.6. The individual package used to close the wound should be printed out so that the hands do not touch the part of the bandage that should be applied directly to the wound.
5.7. If there was no individual package, then a clean handkerchief, a clean cloth, etc. should be used for dressing.
On the place of the cloth, which falls directly on the wound, it is desirable to drip a few drops of iodine tincture to get a spot larger than the wound, and then apply a cloth to the wound.
It is especially important to apply iodine tincture in this way for contaminated wounds.
6. FIRST AID FOR BLEEDING.
External bleeding can be arterial and venous.
With arterial bleeding, the blood is scarlet and flows out in a pulsating stream (jerks); with venous bleeding, the blood is dark and flows out continuously.
The most dangerous is arterial bleeding.
In order to stop the bleeding, it is necessary to: - raise the injured limb; - close the bleeding wound with a dressing material, without touching the wound itself with your fingers; bandage the wounded place; - in case of severe arterial bleeding, if it does not stop with a bandage, apply compression of the blood vessels feeding the injured area by bending the limb in the joints, as well as with fingers, a tourniquet or a twist; in all cases of large bleeding, it is urgent to call a doctor.
You can quickly stop arterial bleeding by pressing the bleeding vessel with your fingers to the underlying bone above the wound (closer to the trunk).
Bleeding from the vessels of the lower part of the face is stopped by pressing the maxillary artery to the edge of the lower jaw.
The bleeding from the wounds of the temple and forehead is stopped by pressing the artery in front of the ear.
Bleeding from large wounds of the head and neck can be stopped by pressing the carotid artery to the cervical vertebrae.
6.5. Bleeding from wounds of the armpit and shoulder is stopped by pressing the subclavian artery to the bone in the supraclavicular fossa.
6.6. Bleeding from wounds on the forearm is stopped by pressing the brachial artery in the middle of the shoulder.
Bleeding from wounds on the hand and fingers is stopped by pressing two arteries in the lower third of the forearm at the hand.
The bleeding from the wounds of the lower extremities is stopped by pressing the femoral artery to the pelvic bones.
6.9. Bleeding from wounds on the foot can be stopped by pressing the artery running along the back of the foot.
Pressing the bleeding vessel with your fingers should be done quite strongly.
6.10. More quickly and reliably than pressing with fingers, bleeding can be stopped by bending the limb in the joints (Fig. 11).
To do this, the victim should quickly roll up his sleeve or trousers and, making a lump of any material, put it into the hole formed when bending the joint located above the injury site, and strongly bend the joint over this lump until it refuses.
In this case, the artery passing through the bend, which supplies blood to the wound, will be squeezed.
In this position, the leg or arm can be tied or tied to the torso of the victim.
7. STOPPING ARTERIAL BLEEDING WITH A TOURNIQUET OR TWIST
7.1.
When flexion in the joint can not be used (for example, with a simultaneous fracture of the bone of the same limb), then with severe arterial bleeding, the entire limb should be pulled over, applying a tourniquet .
As a tourniquet, it is best to use some elastic, stretchable fabric, a rubber tube or tape, suspenders, etc.
Before applying the tourniquet, the limb (arm or leg) should be raised.
7.4. If the assisting person has no assistants, then the preliminary pressing of the artery with the fingers can be entrusted to the victim himself.
7.5. The tourniquet is applied to the part of the shoulder or hip closest to the trunk.
The place where the tourniquet is applied should be wrapped with something soft, for example, several layers of bandage or a corresponding piece of cloth.
7.6. You can also apply a tourniquet over a sleeve or trousers.
7.7. Before applying a tourniquet, it should be stretched, and then tightly bandaged the limb, leaving no skin areas not covered with it between the turns of the tourniquet.
The tightening of the limb with a tourniquet should not be excessive, since the nerves may be tightened and affected; the tension of the tourniquet should be brought only to the cessation of bleeding.
If it is found that the bleeding has not completely stopped, several additional turns of the tourniquet should be applied (more tightly).
It is forbidden to keep the applied tourniquet for more than 1.5-2 hours, as this can lead to necrosis of the exsanguinated limb.
In addition, after an hour, it should be for 5-10 minutes.
remove the tourniquet to give the victim a rest from the pain, and the limbs to get some blood flow.
Before removing the tourniquet, it is necessary to press the artery through which blood flows to the wound with your fingers.
The tourniquet should be dissolved gradually and slowly.
After 5-10 minutes, the tourniquet is applied again.
7.10. In the absence of any stretchable tape at hand, you can tighten the limb with a "twist" made of non stretchable material: a tie, a belt, a twisted scarf or towel, a rope, a belt, etc.
(Fig. 13).
7.11. The material from which the twist is made is circled around the raised limb, covered with the appropriate litter, and tied with a knot on the outside of the limb.
A solid object in the form of a stick is threaded into this node (or under it), which is twisted until the bleeding stops.
It is impossible to tighten the "twist" too much.
Having twisted to the necessary extent, the wand is tied so that it cannot spontaneously unwind.
7.12. When bleeding from the nose, the victim should be seated or laid down, slightly tilting his head back, unbutton the collar, apply a cold lotion on the bridge of the nose and on the nose (changing it as it warms up), squeeze the soft parts (wings) of the nose with your fingers.
Insert a piece of sterilized cotton wool or gauze moistened with hydrogen peroxide into the nose.
7.13. In case of bleeding from the mouth (bloody vomiting), the victim should be placed on a stretcher and immediately taken to a medical institution.
8. FIRST AID FOR FRACTURES, DISLOCATIONS, BRUISES AND SPRAINS
In case of fractures and dislocations, the main task of first aid is to ensure a calm and most comfortable position for the injured limb, which is achieved by its complete immobility.
This rule is mandatory not only to eliminate pain, but also to prevent a number of additional damage to the surrounding tissues, due to piercing them with a bone from the inside.
8.1. Skull fracture
In case of a fall on the head or a blow to the head that caused unconsciousness, bleeding from the ears or mouth, there is reason to assume the presence of a skull fracture.
First aid in this case should consist in applying cold objects to the head (a rubber bubble with ice or cold water, cold lotions, etc.).
8.2. Spinal fracture
When falling from a height or during landslides, if there is a suspicion that the spine is broken (sharp pain in the spine, it is impossible to bend the back and turn), first aid should be reduced to the following: carefully, without lifting the victim, slip a board under him or turn the victim on his stomach face down and strictly ensure that when turning or lifting the victim, his torso does not bend (to avoid damage to the spinal cord).
8.3. Fracture and dislocation of the collarbone
Signs - pain in the collarbone and pronounced swelling.
First aid:
- put a small lump of cotton wool, gauze or any other material in the armpit of the damaged side;
- the arm, bent at the elbow at a right angle, should be bandaged to the trunk (Fig. 14); it should be bandaged in the direction from the sick arm to the back;
- tie the arm below the elbow with a scarf to the neck;
- attach a cold object to the area of damage (a rubber bubble with ice or cold water, etc.).
8.4. Fracture and dislocation of the bones of the hands
Signs - pain along the course of the bone, an unnatural shape of the limb, mobility in a place where there is no joint (in the presence of a fracture), swelling.
First aid: apply appropriate splints (Fig. 14), if for some reason there were no splints, then, just as with a broken collarbone, the hand should be hung on a scarf to the neck, and then bandaged it to the trunk, without putting a lump in the armpit.
If the arm (with dislocation) it lags behind the trunk, something soft should be laid between the arm and the trunk (for example, a bundle of clothes, bags, etc.).
Attach a cold object to the place of damage.
In the absence of a bandage and a scarf, you can hang your hand on the field of the jacket.
8.5. Fracture and dislocation of the bones of the hand and fingers
If a fracture or dislocation of the bones of the hand is suspected, the hand should be bandaged to a wide (palm wide) splint so that the splint starts from the middle of the forearm and ends at the end of the fingers.
A lump of cotton wool, a screw, etc. should be placed in the palm of the damaged hand beforehand, so that the fingers are slightly bent.
A cold object should be attached to the place of damage.
8.6. Fracture and dislocation of the lower limb
Signs - pain along the course of the bone, swelling, an unnatural shape in a place where there is no joint (with a fracture).
If the femur is damaged, strengthen the diseased limb with a tire, plywood, stick, cardboard or any other similar object so that one end of the tire reaches the armpit and the other reaches the heel (Fig. 15).
If necessary, a second tire is placed from the perineum to the heel.
This ensures complete rest of the entire lower limb.
The splints are tightly bandaged to the limb in 2-3 places, but not near and not at the fracture site.
If possible, the tire should be applied without lifting the legs, but holding it on the pole.
Push the bandage with a stick under the lower back, knee or heel.
A cold object should be applied to the place of damage.
8.7. Rib fracture
Signs - pain when breathing, coughing and moving.
First aid: tightly bandage the chest or pull it off with a towel during exhalation.
8.8. Bruises
If you are sure that the victim received only a bruise, and not a fracture or dislocation, a cold object (snow, ice, a rag soaked in cold water) should be applied to the place of the injury and the bruised place should be tightly bandaged.
In the absence of a wound, the skin should not be lubricated with iodine, rubbed and a warming compress should not be applied, since all this only leads to increased pain.
In case of abdominal bruises, fainting, sharp pallor of the face and severe pain, you should immediately call an ambulance to send the victim to the hospital (there may be ruptures of internal organs followed by internal bleeding).
You should also do this for severe bruises of the whole body due to a fall from a height.
8.9. Sprain of the ligaments
When spraining ligaments, for example, when twisting the foot, a sign of which is a sharp pain in the joint and swelling, first aid consists in applying a cold object, tight bandaging and rest.
9. FIRST AID FOR BURNS
9.1.
Burns are of four degrees, from mild redness to severe and continuous necrosis of extensive areas of coca, and sometimes deeper tissues.
9.2. The first degree of burn is characterized by redness of the area of coca affected by the factor.
The second degree of burn is the appearance of bubbles at the site of exposure to the factor.
The third degree of burn is incomplete death of tissue in the area of the body exposed to the factor.
The fourth degree of burn is a continuous necrosis of tissues in the entire thickness to the bones.
9.3. In case of severe burns, it is necessary to remove the dress and shoes from the victim very carefully - it is better to cut them.
The burn wound, being contaminated, begins to fester and does not heal for a long time.
Therefore, you can not touch the burned area of the skin with your hands or lubricate it with any ointments, oils, vaseline or solutions.
The burned surface should be bandaged in the same way as any wound, covered with a sterilized material from a bag or a clean ironed linen cloth, and put a layer of cotton wool on top and fix everything with a bandage.
After that, the victim should be sent to a medical institution.
This method of first aid should be used for all burns, whatever they are caused by: steam, voltaic arc, hot mastic, rosin, etc.
At the same time, you should not open bubbles, remove mastic, rosin or other resinous substances that stick to the burned place, since removing them, it is easy to tear off the skin and thereby create favorable conditions for infection of the wound with microbes, followed by suppuration.
It is also impossible to tear off the burnt pieces of clothing that have stuck to the wound; if necessary, the stuck pieces of clothing should be cut off with sharp scissors.
9.4. In case of eye burns with an electric arc, cold lotions should be made from a solution of boric acid and the victim should be immediately referred to a doctor.
9.5. In case of burns caused by strong acids (sulfuric, nitric, hydrochloric), the affected area should be immediately thoroughly washed with a fast flowing stream of water from a tap or bucket for 10-15 minutes.
You can also lower the burned limb into a tank or bucket of clean water and move it intensively in the water.
After that, the affected area is washed with a 5% solution of potassium permanganate or a 10% solution of baking soda (one teaspoon of soda per glass of water).
After washing, the affected areas of the body should be covered with gauze soaked in a mixture of vegetable oil (linseed or olive) and lime water in an equal ratio.
9.6. If acid or its vapors get into the eyes and mouth, it is necessary to wash or rinse the affected areas with a 5% solution of baking soda, and if acid gets into the respiratory tract, breathe with a 5% solution of drinking soda sprayed with a spray gun.
9.7. In case of a burn with caustic alkalis (caustic soda, quicklime), the affected area should be thoroughly washed with a fast flowing stream of water for 10-15 minutes.
After that, the affected area should be washed with a weak solution of acetic acid (3-6% by volume) or a solution of boric acid (one teaspoon per glass of water).
After washing, the affected areas should be covered with gauze soaked in a 5% solution of acetic acid.
9.8. If caustic alkali or its vapors get into the eyes and mouth, the affected areas should be washed with a 2% solution of boric acid.
9.9. In case of glass wounds and simultaneous exposure to acid or alkali, first of all, neo it is necessary to make sure that there are no glass fragments in the wound, and then quickly wash the wound with an appropriate solution, lubricate the edges with an iodine solution and bandage the wound using sterile cotton wool and a bandage.
The victim should be immediately referred to a doctor after first aid.
The solutions listed above should always be available in the first aid kit.
10. FIRST AID FOR FROSTBITE
10.1.It is not recommended to rub the frozen parts of the body with snow, since small pieces of ice often come across in the snow, which can scratch the frostbitten skin and cause suppuration.
To rub the frozen parts of the body, dry warm gloves or cloth should be used.
10.2. In the room, the frostbitten limb can be immersed in a basin or bucket of water at normal room temperature.
Gradually, the water should be replaced with warmer water, bringing it to body temperature (37 degrees C).
10.3. After the frostbitten place turns red, it should be lubricated with fat (oil, lard, boric ointment) and tied with a warm bandage (wool, cloth, etc.).
10.4. After dressing, the frostbitten arm or leg should be kept elevated, which relieves pain and prevents complications.
11. FIRST AID IN CASE OF CONTACT WITH FOREIGN BODIES
11.1.
If foreign bodies get under the skin or under the nail, it can be removed only if there is confidence that this will be done easily and completely.
If there is the slightest difficulty, you should consult a doctor.
After removing the foreign body, it is necessary to lubricate the wound site with iodine tincture and apply a bandage.
11.2. Foreign bodies that have got into the eyes, it is best to remove by washing with a jet of boric acid solution or clean water.
Washing can be done from a kettle, with cotton wool or gauze, putting the victim on the healthy side and directing the jet from the outer corner of the eyes (from the temple) to the inner (to the nose).
You should not rub your eyes.
11.3. Foreign bodies in the respiratory throat or esophagus should not be removed without a doctor.
In all cases, you should immediately consult a doctor.
12. FIRST AID IN CASE OF FAINTING, HEAT AND SUNSTROKE AND POISONING
12.1.
In case of fainting (dizziness, nausea, tightness in the chest, lack of air, darkening in the eyes), the victim should be laid down, lowering his head and lifting his legs, give him a drink of cold water and sniff cotton wool moistened with ammonia.
You should not put lotions and ice on your head.
The same should be done if the fainting has already occurred.
12.2. In case of heat and sunstroke, when a person working in a hot room (for example, in a boiler room), in the sun or in stuffy windless weather, suddenly feels weakness and headache, he must be immediately released from work and taken out into fresh air or into the shade.
12.3. If there are sharp signs of malaise (weak heart activity - frequent, weak pulse, unconsciousness, shallow, weak moaning breathing, convulsions), it is necessary to remove the victim from a hot room, transfer to a cool place, lay, undress, cool the body, fan the face, wet the head and chest, spray with cold water.
If breathing stops or it is sharply disturbed, artificial respiration should be performed.
Consult a doctor immediately.
12.4. When poisoning with toxic gases, including carbon monoxide, acetylene, natural gas, gasoline vapors, etc., headache, tinnitus, dizziness, nausea, vomiting appears; there is a loss of consciousness, a sharp weakening of breathing, dilation of the pupils.
If such signs appear, you should immediately take the victim to fresh air and arrange the supply of oxygen for breathing.
At the same time, you must immediately call a doctor.
If there is a noticeable weakening of breathing, it is necessary to perform artificial respiration with simultaneous supply of oxygen to the victim.
In the absence of oxygen, first aid should be provided in the same way as in case of fainting.
If possible, the victim should drink a large amount of milk.
12.5. In case of chlorine poisoning, in addition to taking the above measures, the victim should be allowed to inhale highly diluted ammonia.
12.6. When poisoning with copper compounds, there is a taste of copper in the mouth, excessive salivation, vomiting with green or blue green masses, headache, dizziness, abdominal pain, severe thirst, difficulty breathing, weak and irregular pulse, temperature drop, delirium, convulsions and paralysis.
12.7. When the first signs of poisoning with copper compounds appear, a prolonged gastric lavage with water or a solution of 1:1000 potassium permanganate should be immediately performed; burnt magnesia, egg white and a large amount of milk should be given inside.
12.8. In case of poisoning with lead or its compounds, a metallic taste appears in the mouth, a whitish color of the tongue and oral mucosa, headache, nausea, vomiting with grayish white masses, colic.
In this case, it is necessary to immediately perform gastric lavage with a 0.5-1% solution of Epsom salt or a solution of Glauber's salt.
12.9. In case of poisoning with mercury or its compounds, the victim should be washed with water lime or burnt magnesia, and milk or protein water should be given inside.
The listed funds (except for perishable ones) should always be in the first aid kit.
13. FIRST AID TO DROWNED PEOPLE
13.1.A person pulled out of the water has a lot of water or foamy liquid in the upper respiratory tract.
Without wasting time, you should remove water from the stomach of a drowned person.
You can open your mouth and remove water in one move: the rescuer puts the victim's chest on his hip, simultaneously passes his hands under the victim's armpits and puts his thumbs on the upper edges of the lower jaw on both sides, presses the chin with the other four fingers of both hands, lowering the victim's lower jaw down and pushing it forward.
13.2. Having opened the victim's mouth, the rescuer proceeds to remove the water.
It is not necessary to strive to remove it all, it is important to ensure that there is no water and foam in the upper respiratory tract.
After the water is removed, artificial respiration is started using the "mouth to mouth" or "mouth to nose" method.
All preparation for artificial respiration should be carried out quickly, but with caution.
13.3. Drowned people who have turned white, as a rule, do not have water in the respiratory tract, therefore, after extraction from the water, it is necessary to immediately begin artificial respiration and heart massage.
THE LIST OF THE USED LITERATURE
1.
ETKS of works and professions of workers, vol. 3. Construction, installation and repair and construction works.
Moscow, Stroyizdat, 1988.
2. SNiP 3.06.03-85.
Highways.
M., Gosstroy of the USSR, 1986
3.
Safety regulations for the construction, repair and maintenance of highways.
M., Transport, 1979
4.
Collection of standard instructions on labor protection for the main professions and types of work in motor transport enterprises.
Moscow, NIAT, 1990
5.
Recommendations for training workers of the main professions in safe working methods.
M., NIAT, 1990
6.
Safety rules for the operation of electrical installations.
M., Energoatomizdat, 1987
7.
Rules on safety and industrial sanitation in the construction and repair of urban roads, work at asphalt concrete plants and production bases of road organizations.
M., Stroyizdat, 1980
8.
Collection of standard instructions on labor protection in construction.
K., "Budivelnik", 1983.
9. The builder's Reference book.
Loading and unloading operations.
M., Stroyizdat, 1988.
10. Standard instructions for labor protection during loading and unloading operations.
Minavtodor RSFSR.
M., Transport, 1979
11.
Recommendations for personal protective equipment.
Minavtodor of the RSFSR, 13.03.79 N FROM 5/22.
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