IMO Conventions

Advice.The casualty has venous hemorrhage (bleeding). A sterile gauze moistened with hydrogen peroxide should be pressed tightly to the wound for 3-4 min. The skin around the wound should be cleansed by 1% certimide solution (if the latter is not available use iodine or ethanol). If the wound is gape the margins of the wound should be brought together by the strip of adhesive plaster or «butterfly enclosures)). A dry sterile compressing bandage is applied.

 

              2. Motorman S (24) has a deep lacerated wound of (5x2x3 cm) the left front of the leg. On examination a wound with rough lacerated margins was found on the back surface of the middle part of the left front of the leg. The wound is bleeding profusily with pulsative stream. The bandage is saturated with blood. What should be done?

Advice: the casualty has combined venous and arterial bleeding. The skin around the wound should be immediately cleansed with gauze moistened with 1% solution of certimide (iodine or ethanol). A tight compressing bandage should be applied. The bandage should be pressed by hand or fingers for 3-5 min. If the bandage is still getting wet with blood the femoral artery should be pressed by fingers for 3-5 min tightly enough to stop bleeding into the bandage.

A pack with cooling agent should be applied on the wound. The bandage should not be removed after the bleeding has stopped.

Additional sterile bandaging should be applied above. The patient must be confined to bed for 24 hrs. Cold should be applied for 2-3 hrs. If he complains of pain analgine, paracetamol or pentalgine may be administered. Check if the patient was vaccinated for tetanus. If the patient had no antitetanic vaccination for the last 5 years an intramuscular injection of 250 ED of antitetanic immonoglobine and one doze of antitetanic anatoxin into the upper outer third of the arm are made. Make him drink as much as possible. Keep in touch with the doctor ashore.

 

Home task.

1. Find the translation of following word combinations.

First aid                                             сухой кусок (стерильной повязки)

External bleeding                              рана с выделениями (сочащаяся)                         

Emergency help                                стерильная повязка

Pat dry                                               лейкопластырь                                

Oozing wound                                   прямое сжатие

Loose debris                                      первая помощь

Sterile bandage                                  помощь в чрезвычайном положении                              

Direct pressure                                  шатающиеся (свободно движущиеся) осколки (обломки)

Adhesive tape                                    внешнее кровотечение

Last resort                                          последнее средство спасения

Gentle cleaning                                 мягкая (осторожная) очистка

 

2. Read and translate the text.

First Aid.

       First aid is appropriate for external bleeding. If bleeding is severe, or if shock or internal bleeding is suspected, get emergency help immediately.

       Calm and reassure the person. The sight of blood can be very frightening.

        If the wound is superficial, wash it with soap and warm water and pat dry. Superficial wounds or scrapes are injuries that affect the top layers of skin and bleeding from such wounds is often described as "oozing," because it is slow.

        Lay the person down. This reduces the chances of fainting by increasing blood flow to the brain. When possible, raise up the part of the body that is bleeding.

       Remove any obvious loose debris or dirt from a wound. If an object such as a knife, stick, or arrow becomes stuck in the body, DO NOT remove it. Doing so may cause more damage and may increase bleeding. Place pads and bandages around the object and tape the object in place.

Put pressure directly on an outer wound with a sterile bandage, clean cloth, or even a piece of clothing. If nothing else is available, use your hand. Direct pressure is best for external bleeding, except for an eye injury.

       Maintain pressure until the bleeding stops. When it has stopped, tightly wrap the wound dressing with adhesive tape or a piece of clean clothing. Place a cold pack over the dressing. Do not peek to see if the bleeding has stopped.

       If bleeding continues and seeps through the material being held on the wound, do not remove it. Simply place another cloth over the first one. Be sure to seek medical attention.

If the bleeding is severe, get medical help and take steps to prevent shock. Keep the injured body part completely still. Lay the person flat, raise the feet about 12 inches, and cover the person with a coat or blanket. DO NOT move the person if there has been a head, neck, back, or leg injury, as doing so may make the injury worse. Get medical help as soon as possible.

 

DO NOT

DO NOT apply a tourniquet to control bleeding, except as a last resort. Doing so may cause more harm than good. A tourniquet should be used only in a life-threatening situation and should be applied by an experienced person.

If continuous pressure hasn't stopped the bleeding and bleeding is extremely severe, a tourniquet may be used until medical help arrives or bleeding is controllable.

It should be applied to the limb between the bleeding site and the heart and tightened so bleeding can be controlled by applying direct pressure over the wound.

To make a tourniquet, use bandages 2 to 4 inches wide and wrap them around the limb several times. Tie a half or square knot, leaving loose ends long enough to tie another knot. A stick or a stiff rod should be placed between the two knots. Twist the stick until the bandage is tight enough to stop the bleeding and then secure it in place.

Check the tourniquet every 10 to 15 minutes. If the bleeding becomes controllable, (manageable by applying direct pressure), release the tourniquet.

DO NOT peek at a wound to see if the bleeding is stopping. The less a wound is disturbed, the more likely it is that you'll be able to control the bleeding.

DO NOT probe a wound or pull out any embedded object from a wound. This will usually cause more bleeding and harm.

DO NOT remove a dressing if it becomes soaked with blood. Instead, add a new one on top.

DO NOT try to clean a large wound. This can cause heavier bleeding.

DO NOT try to clean a wound after you get the bleeding under control. Get medical help

 

When to Contact a Medical Professional

Seek medical help if:

Bleeding can't be controlled, required the use of a tourniquet, or was caused by a serious injury.

The wound might need stitches.

Gravel or dirt cannot be removed easily with gentle cleaning.

You think there may be internal bleeding or shock.

Signs of infection develop, including increased pain, redness, swelling, yellow or brown fluid, swollen lymph nodes, fever, or red streaks spreading from the site toward the heart.

The injury was due to an animal or human bite.

The patient has not had a tetanus shot in the last 5-10 years.

 

Vocabulary.

To reassure [¸ri:ə'ʃuə] - заверять, уверять, убеждать

The brain –мозг, ум

The pad - мягкая прокладка, мягкая подкладка; подушечка

The tourniquet ['tuəniket] – кровоостанавливающий жгут

The limb – конечность

The knot – узел

The stiff rod – жесткий (негибкий) стержень (прут, ветка)

To peek – осматривать, взглянуть на

To probe – щупать, ощупыватьthe stitch – шов, стежок

Gravel – мочевой (почечный) песок

 

3. Restore the sentences in the proper order how you can render the first aid for external bleeding.

1.  Put pressure directly on an outer wound with a sterile bandage, clean cloth, or even a piece of clothing.

2. Lay the person down.

3. Place a cold pack over the dressing.

4. If the wound is superficial, wash it with soap and warm water and pat dry.

5. Simply place another cloth over the first one.

6. When possible, raise up the part of the body that is bleeding.

7. Maintain pressure until the bleeding stops.

8. Calm and reassure the person.

9. Place pads and bandages around the object and tape the object in place.

10. Keep the injured body part completely still.

11. This reduces the chances of fainting by increasing blood flow to the brain.

12. Lay the person flat, raise the feet about 12 inches, and cover the person with a coat or blanket.

13. When it has stopped, tightly wrap the wound dressing with adhesive tape or a piece of clean clothing.

 

4. What mustn’t you do when rendering the first aid for external bleeding?
5. Translate into English.

Правила наложения кровоостанавливающего  жгута:

 

1. Жгут накладывают при  повреждении крупных артериальных  сосудов конечностей.

 

2. При кровотечении из  артерий верхней конечности жгут  лучше расположить на верхней  трети плеча; при кровотечении  из артерий нижней конечности - на средней трети бедра.

 

3. Жгут накладывают на  приподнятую конечность: подводят  под место предполагаемого наложения,  энергично растягивают (если он  резиновый) и, подложив под  него мягкую прокладку накручивают несколько раз (до полной остановки кровотечения). Концы жгута надежно завязывают или скрепляют.

 

4. Жгут должен быть наложен  туго, но при этом не следует  излишне сильно сдавливать ткани  конечности, так как возможны  очень тяжелые осложнения; время  наложения жгута необходимо указать  в записке, прикрепленной к  одежде больного, а также в  медицинских документах, сопровождающих  его.

 

5. Нельзя накладывать жгут  на нижнюю конечность более  чем на 90 мин, а на плечо - более 45 мин.

 

 

 

Fracture.

 

A fracture is a break or crack in bone.

 

1. Closed fractures

Closed (or simple) fractures are those not related to open wounds on the surface of the body, although there may be a laceration over or near the fracture site.

 

2. Open fractures

Open (or compound) fractures are those associated directly with open wounds. An open fracture may result external violence or may produced by injury from within as broken ends of a bone protrude through the skin at the time of the accident or later through the skin at the time of the accident or later through motion or mishandling of the fractured bone.

 

Causes of Fractures

The most common causes of fractures are motor vehicle accidents, or accidents related to falls and recreational and sports activities. Some fractures result from very slight injuries, particularly in older people, because of brittle or abnormal bones.

 

Signs and symptoms of Fractures

If an accident victim is conscious he will usually be able to provide clues to possible fractures. He may recall his position before the injury and relate what happened as he fell or struck some object. In addition—

He may have heard or felt a bone snap.

He may indicate the location of pain and tenderness and difficulty in moving the injured part.

He may also report a grating sensation of broken bones rubbing together.

He may report abnormal or false motion in an area of the body.

 

Other signs of fracture include—

Differences in the shape and length of corresponding bones on the two sides of the body.

Obvious deformities

Swelling

Discoloration

Pain or tenderness to touch

 

First Aid Principles

To maintain an open airway and apply artificial respiration if indicated.

To rescue, if necessary, and to protect against further injury.

To call for an ambulance, if indicated, or medical assistance.

To prevent motion of the injured parts and the adjacent joints.

To elevate involved extremities, if possible, without disturbing the suspected fracture.

To apply splints, if modern ambulance service is not available, if there is a delay in transportation, or in less serious injuries before seeking medical assistance for diagnosis and treatment.

Do not attempt to set (or reduce) a fracture or try to push a protruding bone end back.

 

 

1. Third mate (28) complains of severe pain in left upper arm. Descending the accommodation ladder he fell down and hurt his left upper arm. He felt the crunch. The injured cannot use his left arm, it is bent in the elbow and he supports it with his right hand. On palpation of the upper arm the casualty complains of severe pain in the upper 'third of the upper arm bone. Percussion of the bent left arm elbow makes the pain in the upper third of the upper arm worse. What should be done?

Advice: A fracture of the upper arm bone might be suspected. Intramuscular injection of morhpine (1 ml. or 2 ml. analgin) is recommended Left arm up to the shoulder blade should be immobilized by means of the Cramer's splint or by any other means with fixation of the elbow and shoulder joint. A surgeon should be consulted in the nearest port.

 

2. Motorman (28) fell down on the deck on his right hand. He felt a sharp pain and a crunch in his right wrist. On examination a swelling of the right wrist joint and back of the hand were found. Voluntary movement of the hand are not possible, forced movements are highly painful. What should be done?

Advice: The casualty has a fracture of an outer bone of the forearm with dislocation of fragments. Pain should be relieved by means of analgin, parecetamol or pentalginum. Forearm up to the elbow joint should be immobilized by inflatable splint and supported by triangular sling. A surgeon should be consulted.

 

3. Second mate (32) sprained his foot, he cannot use his foot. There is a severe swelling in the area of the outer ankle joint with subcutaneous hematoma. Voluntary movements of the foot are possible but highly painful. Palpation in the area of the outer ankle joint is highly painful too. Squeezing of lower third of the shin makes the pain worse. What should be done?

Advice: The man has a fracture of the outer part of the ankle joint. To relieve pain analginum, paracetamol or pentalgin should be administered. The leg should be immobilized from the toes up to the upper third of the shin by means of an inflatable splint. A surgeon should be consulted in the nearest port.

 

4. Motorman (34) complains of severe pain in his right foot. An iron pig has fallen on his foot. On examination a swelling of the foot was found but he can move it. Pulling and pushing of the first (big) toe results in worsening of the foot pain.

Advice: A fracture of the first long bone of the right foot might be suspected. To relieve pain analginum, paracetamol or pentalgin should be administered. An inflatable splint should be applied from the toe up to the middle part of the shin. A surgeon should be consulted in the nearest port.

 

 

Home task.

       If splinting and transportation are necessary, the bone end may slip back when the limb is straightened for splinting.

       If an ambulance or rescue squad can arrive within a short period after an accident, when an injured person obviously requires hospitalization, do not attempt to move the victim unless there is danger of fire, carbon monoxide poisoning, explosion, drowning, or other life-threatening emergencies. Above all, in attempting rescue, do not drag victims out of vehicles, or from under wreckage, or throw them on the ground in your haste to save their lives.

       If possible, even in the midst of a crowded street or highway, take the time to tie a victim’s injured leg to his uninjured one, or bind his injured arm to his chest or side.

       Lift and move an unconscious victim as though there is injury to his neck or spine.

       Wait for adequate help—at least three and preferably four persons—and obtain a rigid support for the victim’s back, if possible.

       Following a neck or spinal injury during water activity, float the victim to shore without bending his neck or back. Do not lift the victim out of the water without a back support.

       Delegate others to telephone for an ambulance and the police, if necessary, and to assist in maintaining order in the area of the accident.

        If an open fracture is evident or suspected, treat the wound as outlined previously:

Remove or cut away the victim’s clothing.

Control hemorrhage by applying pressure through a large sterile (or clean) dressing over the wound.

       Do not wash the wound, do not probe it, and do not insert your fingers into it.

If a fragment of bone is protruding, cover the entire wound with a large, sterile bandage compress or pads; if these are not available, use freshly laundered sheets or towels.

       Do not replace bone fragments.

       Apply splints if necessary, according to the location of the fracture. Then elevate the limb slightly to reduce hemorrhage and swelling. Open fractures should have priority over closed fractures for transportation and medical treatment, unless associated injuries dictate otherwise.

 

First aid.

1.Try to maintain the patient still and composed. Prevent unneccessary movement arising out of anxiety or fear.

2.Examine the person closely for the presence of other injuries and call for medical help. If medical help is quickly available, handover the pateint to them for futher treatment.

3.If there is a break in the skin surface, it can be rinsed to remove any visible dirt or other potential contamination. Howver, vigorous flushing or scrubbing of the wound should be avoided.

4.The broken bones can be immobilised with either a splint or string. Rolls of newspaper or strips of wood can be used. It is impotant to immobilize the area both above and below the injured bone.

5.Ice packs can be applied to reduce pain and swelling (Not to be placed directly over the wound.

NOTE: DO NOT move the person if a head, neck, or back injury is suspected as this can worsen the injury, leading to lifethreatening complications.

 

 

Lesson 4.

Blood pressure.

Blood pressure is the force or the measurement of the force applied to the walls of the arteries by the blood in the body. It is determined on the basis of the force, the amount of blood pumped and the size and flexibility of the arteries.

 

Around one in every three adults in the United States is suffering from high blood pressure, and nearly one-third of these people don't know that they owe this disease. This is due to the fact that there are no defined symptoms of blood pressure. As a matter of fact, many people have high blood pressure for years without having even a hint of it.

 

Your blood pressure keeps changing. These changes depend on the activity, temperature, diet, emotional state, posture, physical state, and the medication used by you. The pressure of blood when the heart beats, is at its highest and is known as systolic pressure. And the pressure of blood when the heart rests between beats is the lowest and is called diastolic pressure. Your blood pressure is calculated in accordance with the systolic and diastolic pressures. Both these numbers are very important. Generally, blood pressure is written as 120/80 mmHg (measured in millimeters of mercury, a unit for measuring pressure). In the written form, the systolic pressure is the first or the top number and the diastolic pressure is the second or the bottom number. For example: If the systolic pressure of a person is 120 and the diastolic pressure is 80, then it would be written as 120/80 mmHg.

 

Blood pressure can be divided into high blood pressure and low blood pressure. Both conditions are injurious for your health. So it is better to prevent the disease from taking its root into you. It is rightly said that prevention is better than cure. There is no point in developing the lethal condition and then spend your whole life under the agony of its pernicious consequences.

 

• What Causes High Blood Pressure?

 

The causes of high blood pressure vary. Causes may include narrowing of the arteries, a greater than normal volume of blood, or the heart beating faster or more forcefully than it should. Any of these conditions will cause increased pressure against the artery walls. High blood pressure might also be caused by another medical problem. Most of the time, the cause is not known. Although high blood pressure usually cannot be cured, in most cases it can be prevented and controlled.

 

 Home task.

• Treatment of High Blood Pressure

 

It is important to take steps to keep your blood pressure under control. The treatment goal is blood pressure below 140/90 and lower for people with other conditions, such as diabetes and kidney disease. Adopting healthy lifestyle habits is an effective first step in both preventing and controlling high blood pressure. If lifestyle changes alone are not effective in keeping your pressure controlled, it may be necessary to add blood pressure medications. In this section you will learn about blood pressure-lowering lifestyle habits and blood pressure medications.