Prospects for improving pre-hospital care for wounded with gunshot penetrating wounds to the chest


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Abstract

Abstract. The analysis of injuries, life-threatening consequences and outcomes of treatment of wounded with penetrating chest wounds and the results of approbation of a prototype (medical) disposable set «UD-02v» for the elimination of strained and open pneumothorax, hemothorax, pleural drainage and collection of spilled blood with the possibility of subsequent reinfusion at the pre-hospital stage is presented. The prototype of the «UD-02v» set was created as part of the implementation of the state defense order in 2018. Its creation is due to the fact that despite the improvement of medical care at the stages of medical evacuation and the widespread use of individual armor protection, chest injuries currently remain a frequent type of combat surgical injury, accounting for 6 to 12% of all injuries. The main cause of death of injured and injured with chest injuries remains blood loss caused by continuing intrapleural bleeding and concomitant damage to other anatomical areas. Stressful pneumothorax, together with intrapleural bleeding, account for 93% of preventable causes of fatal chest injuries at the pre-hospital stage. Untimely elimination of the consequences of severe breast injuries should be considered as a negative factor affecting the outcome of treatment, and significant improvement in treatment results should be expected only in the case of early elimination of the most severe consequences of breast injuries. The developed set of «UD-02v» exceeds foreign medical devices in its medical and technical characteristics, and is the most promising for acceptance for the supply of the Armed forces of the Russian Federation as part of the samples of complete and service equipment.

About the authors

K. P. Golovko

Military medical academy of S.M. Kirov

Author for correspondence.
Email: vmeda-nio@mail.ru
Russian Federation, Saint Petersburg

V. Yu. Markevich

Military medical academy of S.M. Kirov

Email: vmeda-nio@mail.ru
Russian Federation, Saint Petersburg

T. Yu. Suprun

Military medical academy of S.M. Kirov

Email: vmeda-nio@mail.ru
Russian Federation, Saint Petersburg

A. B. Vertiy

Military medical academy of S.M. Kirov

Email: vmeda-nio@mail.ru
Russian Federation, Saint Petersburg

S. E. Komyagin

Limited Liability Company "Novoplast-M"

Email: vmeda-nio@mail.ru
Russian Federation, Saint Petersburg

N. A. Zhirnova

Military medical academy of S.M. Kirov

Email: vmeda-nio@mail.ru
Russian Federation, Saint Petersburg

I. M. Samokhvalov

Military medical academy of S.M. Kirov

Email: vmeda-nio@mail.ru
Russian Federation, Saint Petersburg

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Supplementary files

Supplementary Files
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1. JATS XML
2. Fig. 1. Set for elimination of tension and open pneumothorax, hemothorax, drainage of the pleural cavity and collection of spilled blood with the possibility of subsequent reinfusion (medical) disposable "UD-02v"

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3. Fig. 2. Creation of a tension pneumothorax (carboxytorax)

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4. Fig. 3. X-ray of the breast. Tension pneumothorax, mediastinum displaced to the left

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5. Fig. 4. Drainage catheter (isp. 1) is held deep into the pleural cavity by 4–5 cm

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6. Fig. 5. X-ray of the breast. The tension pneumothorax is eliminated, the drainage catheter is visualized in the IV intercostal space

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7. Fig. 6. Attaching the blood collection container

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8. Fig. 7. Collection of blood for reinfusion

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9. Fig. 8. X-ray of the breast. The hemothorax is eliminated, the catheter is visualized in the VIII intercostal space

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10. Fig. 9. Performing reinfusion from the container into the femoral vein of the animal

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11. Fig. 10. Changes in hemodynamic parameters (in% relative to the initial values) when modeling a tension pneumothorax with its subsequent elimination

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12. Fig. 11. Changes in hemodynamic parameters (in% relative to the initial values) when modeling hemothorax with its subsequent elimination and reinfusion of outflowing blood

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Copyright (c) 2020 Golovko K.P., Markevich V.Y., Suprun T.Y., Vertiy A.B., Komyagin S.E., Zhirnova N.A., Samokhvalov I.M.

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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

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