How to properly apply a splint for a broken leg bone

Home → Blog → Useful articles → First aid

First aid includes measures to eliminate the danger to the health and life of the victim and reduce the consequences of injuries. First aid is provided before the arrival of professionals. First aid, along with wound treatment and immobilization (immobilization), includes:

• emergency call for ambulance;
• taking measures to stop bleeding and restore the functioning of the heart and lungs (resuscitation);
• evacuating a victim from a dangerous area or transporting him to a place accessible to ambulance.

First aid is needed for:

1. Eliminating the threat to the victim’s life (restoring cardiac activity and breathing, stopping bleeding)
2. Prevention of complications (infection, frostbite, displacement due to fractures, etc.)
3. Ensuring transportation of the victim.

Immobilization

Immobilization is the creation of immobility of the affected area of ​​the body, the main measure to prevent painful shock. The victim cannot be transported without immobilization. Poor immobilization during fractures can lead to secondary displacement of fragments or secondary damage. There are transport and permanent immobilization. We are interested in transport.

Transport immobilization is carried out during the provision of first aid while the victim is being transported. For gunshot wounds, transport immobilization is always necessary, since rest prevents the development of infection. For transport immobilization, splints are used, and in the absence of splints, improvised means are used. During transport immobilization of the limbs, it is necessary to fix two joints (above and below the site of injury), and in case of a fracture of the shoulder and hip, three large joints of the limb must be fixed.

Immobilization is performed by immobilizing two adjacent joints located above and below the fracture site.

For open fractures, do not apply a splint to places where bone fragments protrude.

Immobilization using available means: a, b - for a spinal fracture; c, d — immobilization of the hip; d - forearms; e - collarbone; g - shins. If it is necessary to transport the victim, it is better to do this on a stretcher assembled from improvised means. If there are none, in some cases it is allowed to carry the victim.

Carrying the victim alone: ​​a - in the arms; b - on the back; c - on the shoulder. Carrying the victim together: a - the “one after the other” method; b - “lock” of three hands; c - “lock” of four hands.

How to apply a splint

The application of a splint for a tibia fracture is necessary in order to fix the injured limb and the damaged bone. Therefore, three tires are required to perform the manipulation. The first two are to fix the joints closest to the site of injury to the limb, in this case the knee and ankle. Also, for correct application of the splint, a sterile medical bandage or gauze is required.

If at the moment you do not have a special splint, then a similar device is made from scrap materials.

Transportation

The wounded are transported in a supine position, on the back with bent knees, on the back with the head down and lower limbs raised, on the stomach, on the side. Victims with head wounds, injuries to the skull and brain, spine and spinal cord, fractures of the pelvic bones and lower extremities are transported in a supine position. In the same position, it is necessary to transport all patients whose injury is accompanied by the development of shock, significant blood loss or unconsciousness, even short-term, patients with acute surgical diseases (appendicitis, strangulated hernia, perforated ulcer, etc.) and injuries to the abdominal organs.

Unconscious victims are transported in a prone position, with cushions placed under the forehead and chest. This position is necessary to prevent asphyxia. A significant proportion of patients can be transported in a sitting or semi-sitting position.

When transporting in the cold season, measures must be taken to prevent the victim from cooling down, because cooling in almost all types of trauma, accidents and sudden illnesses sharply worsens the condition and contributes to the development of complications. Particular attention in this regard requires wounded people with hemostatic tourniquets applied, victims who are unconscious and in a state of shock, with frostbite.

During transportation, it is necessary to monitor the patient, monitor breathing, pulse, and do everything to prevent aspiration of vomit into the respiratory tract during vomiting.

It is very important that the first aid provider, through his behavior, actions, and conversations, spares the patient’s psyche as much as possible and strengthens his confidence in the successful outcome of what is happening.

Help with fractures

Sequencing:

1. if there is an open fracture and there is heavy bleeding from the wound, stop the bleeding (apply a tourniquet or a pressure bandage);
2. applying a primary aseptic dressing to the wound;
3. pain relief (give analgesics, if available);
4. perform transport immobilization of the limb
5. if everything is complicated by shock, it is necessary to carry out the simplest anti-shock measures (warming, ingesting hot tea);

Splinting

A splint is a pad made of hard material that reinforces the bandage. A splint bandage consists of a splint, a soft pad and a bandage. You can use cotton wool, clothing, etc. as a soft pad.

• The tire can be made from scrap materials. Thick cardboard, planks, and sticks are suitable for this.
• When applying a splint, you must remember that the splint must cover the two joints adjacent to the fracture.
• The splint should not come into contact with the skin. This is especially important in places where bones are located close to the surface of the body.
• It is most convenient to apply splints on the sides of the limb, less convenient on the front or back sides of the limb.
• There should be a soft pad under the tire.
• It is necessary to carefully bandage the splint to the immobilized part of the body so that it cannot move.

Splint bandages for the upper limb

• If there is damage in the area of ​​the shoulder joint (clavicle, scapula, head of the humerus, surgical neck of the shoulder), it will be quite enough to bandage the arm, correctly bent at the elbow, to the body with a scarf.
• If there is damage in the area of ​​the elbow joint and forearm, a splint is applied to the shoulder and forearm from the outside, or two wooden splints are applied: one from the inside, between the shoulder and torso, the other on the lower forearm. Both splints should be well connected above the elbow joint. After which, the hand is suspended using two scarves.
• For fractures of the forearm bones, the splint is placed from the fingertips to the middle of the shoulder. The arm is bent at the elbow joint, at a right angle, the palm is facing the stomach, the fingers are bent, a roller is placed in the palm. The splint is bandaged along its entire length and then hung on a scarf.
• For fractures of the hand bones, the splint should go from the tips of the fingers to the middle of the forearm. The fingers should be bent and a roll of gauze or bandage should be placed in them. The palmar surface of the hand is slightly turned towards the stomach. After applying the splint and fixing the hand, the hand is suspended on a scarf.
• In case of a fracture of the humerus, the splint should cover the entire limb from the fingers to the shoulder girdle of the healthy side, fixing three joints. It will pass from the fingertips along the posterior surface of the forearm and shoulder to the back to the shoulder blade on the healthy side. If one ladder rail of sufficient length is not available, two short ladder rails can be used. After they are applied and fixed, the hand is suspended on a scarf or bandage.
• In case of a clavicle fracture, fixation is carried out with soft bandages. Immobilization can be achieved by hanging the limb on the injured side from a scarf.

Rib fractures

For isolated fractures of one or two ribs, the application of an immobilizing bandage is desirable. If three or more ribs are broken on one or both halves of the chest, you can use a simple bandage on the chest with a “belt.” The chest is bandaged tightly (pulled).

Splint bandages for the lower limb

• For fractures of the bones of the foot, the splint is placed from the tips of the toes to the middle of the shin, bending it in the shape of the letter “L”. The foot is at a straight angle to the shin. The splint is applied along the back of the lower leg and the plantar surface of the foot.
• In case of a fracture of the lower leg bones, three ladder splints are applied: one - along the back surface of the lower leg and along the plantar surface of the foot, pre-bent so that the foot is at an angle of 90° to the axis of the lower leg, the upper end should reach the middle of the thigh; the second and third are applied on the outer and inner sides of the limb from the base of the foot to the middle of the thigh.
• In case of a hip fracture, careful immobilization is required. For this, three splints are used: one splint length from the armpit to the inner edge of the foot, curved at the foot in the shape of the letter “L”, this splint is external; the second splint is applied to the back surface of the limb from the shoulder blade or buttock to the tips of the toes and is also curved; the third splint is located on the inner surface of the limb from the perineum to the edge of the foot.

In general, such recommendations in the field are very difficult to follow if you are not a professional carpenter. What to do if splinting is impossible is usually not written.

Splint bandages for injuries to the splint of the spine and head

Immobilization is achieved with two splints. The first splint is “put on” the head: it covers the crown, ears and both shoulders. The second splint is located between the shoulder blades on the back, then along the back of the head it passes to the crown and ends on the forehead, where it intersects with the first splint. Both tires are fastened together.

If splints are not available, two heavy sandbags can be used to immobilize this area, which are placed on the sides of the head of the victim lying on his back on a hard bed.

Splints for lumbar injuries

The first medical aid for injuries to the lumbar spine and pelvis will be to place the patient on a wooden board with legs apart and slightly bent at the knees - the so-called “frog” pose. The limbs must be secured by applying long splints along the entire body, tied to a shield, so that the patient does not move during transportation.

Splint bandage

Longuet bandage (splint) is a thick layer (or several) of gauze or bandage impregnated with plaster. It is used to immobilize a limb and immobilize the patient.

Before application, it should be well smoothed, without folds, and take a physiological shape. After the bandage has dried, it is secured on top with an elastic bandage. For greater effectiveness, the splint is applied to 2/3 of the limb.

Positive sides:

• it is possible to monitor the condition of those tissues that are open;
• can be removed if necessary;
• An increase in the volume of the leg (due to swelling) leads to stretching of the bandage.

Stop bleeding

Bleeding is the release of blood from a blood vessel to the outside, into the surrounding tissues and cavities of the body. According to the source, bleeding is distinguished: arterial, venous, arteriovenous, capillary and parenchymatous.

Capillary bleeding is stopped by applying a regular, even loose, bandage to the wound and raising the limb upward. This helps to reduce blood flow to the wound, the formation of a clot and stop the bleeding and is final. Venous bleeding is stopped by applying a pressure bandage. Apply several layers of gauze or a piece of cotton wool to the wound and bandage it tightly. The blood vessels are compressed, a blood clot is formed and bleeding stops. Arterial bleeding occurs when an artery is damaged. Blood flows out in a stream, a fountain. The amount of blood ejected depends on the caliber of the vessel and the size of the wound in the vessel. Arterial bleeding can be stopped in several ways, depending on the diameter of the bleeding vessel.

• pressing the artery above the wound;
• pressing the artery in the wound;
• applying a pressure bandage;
• application of a tourniquet;
• maximum limb flexion.

The damaged vessel is pressed with 2-3 fingers to the bone in typical places. Bleeding from the artery must be stopped immediately. The fastest way is to press the artery in the wound and press the artery above the wound. This method is difficult, but makes it possible to prepare a tourniquet to stop bleeding.

Arteriovenous bleeding is mixed bleeding. Blood quickly fills the wound. Pressing the vessel above the wound does not stop the bleeding, but the blood becomes dark. Pressing the vessel below the wound does not stop the bleeding; the blood turns scarlet. In essence, it is necessary to stop arterial and venous bleeding in parallel.

Parenchymal bleeding is hidden bleeding in the cavities or extremities. Blood enters the cavity (for example, abdominal) or tissues of the extremities. If the victim’s limb begins to swell, this means that the artery is damaged; it must be clamped above the suspected site of the artery rupture. Such bleeding is considered the most dangerous because it cannot be stopped outside the operating room. It's not even covered in first aid courses because it's usually fatal.

Acute blood loss

Symptoms of acute blood loss depend on the rate of flow and the volume of blood lost. The faster the bleeding occurs, the more severe the clinical picture of acute blood loss. Rapid blood loss; 1/3 of the blood volume is life-threatening, the loss of half of the total blood volume is fatal. With a weight of 65 kg, the blood volume is approximately 5 liters. Thus, a loss of 1.5-1.7 liters of blood is dangerous, and 2.5 liters is fatal.

Symptoms of acute blood loss: pallor of the skin and visible mucous membranes, pointed facial features. According to the victim's sensations - darkening of the eyes, tinnitus, dizziness, nausea and vomiting - this is explained by irritation of the cerebral cortex and vomiting center due to hypoxia. The pulse is frequent and weak. Decrease in arterial and central venous pressure. As the crisis develops, disruption of higher nervous activity increases: first, anxiety appears, then fear, panicked facial expressions, disorientation, confusion and loss of consciousness.

First aid for external bleeding is to stop the bleeding as quickly as possible by any means.

Application of a tourniquet

The tourniquet is not applied to the skin. To avoid squeezing the skin, it should be protected with a soft pad made of bandage or fabric. The tourniquet can also be applied to clothing, after straightening its folds. You should not apply a tourniquet in the middle third of the shoulder and in the upper third of the leg, so as not to injure the radial and peroneal nerves. Before applying a tourniquet, the limb is elevated to create an outflow of venous blood. The tourniquet is applied above the wound, as close to it as possible, without excessive tightening, until bleeding from the wound stops and the pulse disappears in the peripheral arteries. The tourniquet should be visible on the victim. Make a note on paper about the time of application and place it under the tourniquet. In summer, the duration of stay of the tourniquet on the limb should not exceed 2 hours, and in winter - 1 hour. When using the tourniquet in children, the time is reduced by half. Every hour, and in winter - half an hour, the tourniquet must be loosened for 10-15 minutes, and then tightened again if bleeding occurs again.

Technique for applying a tourniquet: the tourniquet is placed under the limb above the wound. One hand of the person applying the tourniquet is on the outer side, the other on the inner surface of the limb. The tourniquet is stretched and the stretched section is applied to the area of ​​passage of the main vessel. The first round is done with a cross to prevent its weakening. While constantly pulling the tourniquet, wrap it around the limb several times so that the paths of the tourniquet lie side by side, not on top of each other, and the area of ​​contact of the tourniquet with the skin is as wide as possible.

Algorithm of actions

• Before starting to provide assistance, it is necessary to free the injured leg from clothing and visually assess its condition.
• The places where the device will contact the open surface of the leg must be lined with shock-absorbing material: gauze or some kind of fabric. This is necessary in order to reduce pressure on the skin, as well as relieve pain during transportation.
• The limb must be secured very tightly, fixing it as carefully as possible, but not allowing strong squeezing.
• The splint is applied to the lower leg in such a way that the entire structure looks integral and covers the leg from the ankle joint to the knee, capturing it and preventing the leg from bending.
• Toes should not be covered with dressing material, even if they are damaged. By the condition and appearance of the fingers, one can determine whether blood circulation in the vessels of the limb is impaired and how severely.

In cases where the fracture is open, it is necessary to first wash the wound if possible and treat its edges with an antiseptic solution. Then apply a bandage to prevent bleeding. If sterile materials are not available, dress the wound with a clean cloth to minimize the risk of infection or infection.

Artificial respiration and chest compressions

Artificial ventilation

First of all, you should make sure that the airway is open and eliminate mechanical causes that impede breathing. To perform artificial lung ventilation using the mouth-to-mouth method, you must:

• position yourself to the right of the victim;
• lay the victim on his back, unbutton tight clothing;
• place a cushion under your shoulder blades to tilt your head back better;
• clean the mouth and throat of foreign bodies and mucus;
• to improve airway patency and prevent tongue retraction, tilt your head back, push your lower jaw forward and open your mouth;
• cover your mouth with gauze or a handkerchief;
• squeeze the wings of the nose with your fingers;
• take a deep breath, tightly clasp your lips around the victim’s mouth (nose) and with little effort blow air into the lungs.

The frequency of blowing is 14-15 per minute for adults, 20 for children, 30 for newborns. In adults, air must be blown in with such force that the chest expands. In children, insufflation is used with less force. For newborns, insufflation is performed simultaneously through the nose and mouth. When air is blown in, the victim’s chest rises; to create a passive exhalation, his head is turned to the side. Every 5-6 breaths it is necessary to check for a pulse in the carotid artery. Artificial ventilation is carried out until spontaneous breathing is restored.

Indirect cardiac massage

When breathing stops, the victim may stop cardiac activity. The person providing assistance is positioned to the left of the victim. The purpose of the massage is to create artificial blood circulation by rhythmically squeezing the heart between the sternum and the spinal column. In this case, the blood is pushed out of the heart into the arteries; after the compression stops, the heart (ventricles) straightens, and the blood returns back through the veins. Indirect cardiac massage technique

• the person providing assistance is positioned to the left of the victim
• The patient is placed on a hard surface on his back
• a strong blow with a fist is applied to the lower part of the sternum (just above the xiphoid process), in some cases this is enough to restore the heart rhythm
• The palms of both hands, one on top of the other, are placed on the lower sternum, the right palm is on top
• produce jerky pressure on the sternum (up to 60 per minute)
• pressure is applied with straightened arms, tilting the torso forward to provide sufficient force, while the sternum should move towards the spine by 4-5 cm

When performing chest compressions in infants, pressure is applied to the sternum with the tip of a finger or the thumbs of one hand. In infants, the frequency of compressions on the sternum is 100-120 per minute. Indirect cardiac massage is always performed together with artificial ventilation. If resuscitation is carried out by one person, then after every 15 pressures on the sternum, he should stop the massage and take 2 strong, quick breaths “from mouth to mouth”. If it is performed by 2 people, then 1 injection into the lungs should be made after every 5 pressures on the sternum. The person performing artificial respiration monitors the reaction of the pupils and the pulse. Resuscitation measures are effective if: a pulse appears, the pupils constrict, a reaction to light appears, pallor of the skin, cyanosis decreases, spontaneous breathing is restored. It makes sense to carry out resuscitation for 3-4 minutes if there is no resuscitation brigades and special equipment.

First aid for drowning

When drowning, water enters the respiratory tract and stomach. As a result, water penetrates into the blood and the water-salt balance of the body is disrupted. After this (we won’t go into details), breathing and heartbeat stop. It is conventionally accepted to distinguish two types of drowning: “pale” and “blue” asphyxia. With pale (white) asphyxia, a rapid reflex cessation of breathing and heartbeat occurs. Reflex laryngospasm develops and water does not enter the respiratory tract. The skin with this type of asphyxia is pale. With “blue” asphyxia, the respiratory tract is filled with water, and the victim’s skin is bluish in color.

With white asphyxia, artificial ventilation of the lungs is performed from mouth to mouth and indirect cardiac massage. With blue asphyxia - rapid removal of fluid from the respiratory tract: the victim is placed with his stomach on his bent knee, his head hangs down, pressing on the chest, water flows out of the respiratory tract and stomach. After this, the victim is placed on his back and resuscitation is performed (artificial ventilation and closed cardiac massage). Resuscitation measures are carried out until breathing is stable.

First aid for burns

• remove the victim from the burning room; extinguish the flame on the victim by covering the burning area with a thick cloth, covering it with sand or snow or immersing it in water; the victim can put out the fire himself by rolling on the ground
• in case of burn with boiling water, hot food, resin, i.e. In case of any thermal burn, you must quickly remove clothing soaked in hot liquid; Do not remove areas of clothing that have stuck to the skin; you must carefully cut off the clothing with scissors
• for chemical burns - remove clothes and wash the affected area with a stream of water for 15-20 minutes
• immerse the burned areas in cold water for 10-15 minutes (for burns of the upper extremities, you can place them under cold running water), this will reduce the pain and burning sensation
• Apply a sterile bandage to the affected area, or, if not available, any clean cloth.
• apply cold to the burned area (snow, ice in a plastic bag)
• carrying out anti-shock measures: give 1-2 tablets of analgin; wrap up and warm the victim; drink hot tea, as well as mineral water or a soda-salt solution (1 teaspoon of salt per 1 liter of water); perform transport immobilization for burns of the upper and lower extremities

This topic is very broad in terms of the degree of burns and sources of damage. The above is enough to ensure that there is something to do with the victim before the ambulance arrives.

Providing emergency care for injuries to the lower leg bones

A person who has sustained a lower limb injury must immediately, before the medical team arrives, receive first aid. The correctness of actions in this situation can influence the further course of events.

It is very important to follow all the rules for providing assistance so as not to harm the person.

1. First of all, you need to call doctors to the victim.
2. While awaiting their arrival, you need to take a few simple but necessary actions:

• if possible, take measures to relieve pain in the victim;
• give painkillers and put ice on the shin;
• it is necessary to calm the person down, try to bring him out of the state of shock if he is very excited.

1. If a fracture is suspected, immediate fixation of the limb is required. This is done using a device called a splint.

It is very important not to try to straighten the injured leg, change its position, or move it, as this will cause suffering to the person and may also negatively affect the future healing of the injured limb.

If you don’t have a special tire at hand, you can imitate it. Take a hard, flat, oblong object (a board or plywood will do) and place the injured limb on it, carefully securing it with a belt or something similar. Be sure to place fabric or gauze between the improvised splint and the limb.

Frostbite

Frostbite is tissue damage caused by exposure to cold. They are observed both at low temperatures and at temperatures above zero degrees (1-5°C). In the development of frostbite, a significant role is played by: increased air humidity, wind force, wet clothing, excessive sweating of the skin, tight shoes, prolonged immobility, fatigue, malnutrition, shock, and the presence of alcohol intoxication.

Most often, frostbite affects the nose, ears, fingers and toes, and less often the knee joints and buttocks. During frostbite, two periods are distinguished: latent reactive periods. In the hidden, the effect of cold on the fabric continues. The victim notes a tingling sensation and slight pain. The skin in the area of ​​frostbite is cold, pale, and skin sensitivity decreases. These changes are associated with spasm of blood vessels and metabolic disorders. The reactive period begins after the tissues are warmed, i.e. after the cold ceases. During this period, signs of inflammation and necrosis appear, associated with the depth of tissue damage.

Actions to help:

• Warm the frostbitten area of ​​the body, restore blood circulation by warming, massaging until the skin turns red, becomes sensitive, and becomes able to move your fingers. Give the victim a warm drink.
• If within a few minutes the skin does not acquire a normal appearance, then it is necessary to place the affected part in warm water, followed by treating the skin with alcohol and applying an insulating bandage.
• If watery blisters appear on the body, cover them with a napkin (bandage) after treating with alcohol.
• Wrap the affected limb in a warm cloth, elevate it, and fix it, which will reduce swelling.
• Give me a painkiller.

When providing first aid, you should not: rub the affected areas with snow, lubricate them with greasy ointments, or warm them up intensively.

Diaphyseal fractures of the leg bones

Treatment of diaphyseal fractures of both tibia bones, regardless of location, has no fundamental differences. These fractures are always accompanied by displacement of bone fragments, therefore, when the patient is admitted to the hospital, it is advisable to constantly apply skeletal traction.

Constant traction can be an independent method of treatment or combined with the subsequent use of a plaster cast or surgical treatment. During the period of treatment of a patient in traction, it is necessary to ensure the possibility of repositioning the fracture, interposition of tissues, the condition of the skin of the soft tissues of the injured limb, and assess the general condition of the patient to determine subsequent treatment tactics. Depending on the doctor’s experience, it is possible, bypassing constant traction, to apply one or another method of conservative or surgical treatment.

Constant traction is carried out on a standard splint. The fracture site is first anesthetized: 20-25 cm of a 32% novocaine solution is injected into the hematoma. A pin is inserted into the heel bone and tightened with a staple. The creation of a bed on the splint for the tibia and femur is of great importance for the reposition of the fracture. To do this, two hammocks with ribbons must be put on the splint: one for the shin, the other for the thigh. The hammock should be pulled loosely to create a bed in the shape of the calf muscle. By changing the tension of the hammock, you can give different positions to the bone fragments. It has become common practice to bandage a splint with gauze bandages to create a bed. This is incorrect and unacceptable, since the meaning of the possibility of repositioning bone fragments with the help of hammocks is lost.

The leg is placed on a splint, the foot is strengthened in a vertical position: a bandage is glued to the foot with cleol or a hammock stocking is put on the sole. To traction the tibia, a load of 6-8 kg is hung and after 20-30 minutes the fracture is reduced, taking into account the existing displacement of the fragments. Longitudinal traction is carried out by a load behind the bracket, which eliminates displacement along the length and angle. In transverse fractures, the valgus position often remains unresolved, which in the case of healing of the fracture sharply impairs the function of the joints. Normally, the lower leg has some curvature inward, i.e., a varus position. To eliminate the valgus position, lateral traction with the help of soft rings is used or a bandage is applied. The valgus position can be corrected by turning the foot medially and fixing the foot in this position on a special splint. Anterior and posterior displacement of bone fragments is achieved by tensioning the hammock.

After repositioning the fracture, the load is reduced to 3-5 kg, which is enough to hold the fragments in the correct position. Then a control x-ray is taken.

During the first 3 weeks, it is necessary to daily monitor the position of the leg on the splint and the possibility of secondary displacement of bone fragments. Control is exercised by all medical personnel involved in the treatment of the patient, and by the patient himself. If the patient cannot control the position of the leg in skeletal traction, then treatment with this method is pointless.

Clinical control of the fusion of the tibia is the ability to actively raise the tibia with the load removed, while the patient should not feel pain in the area of ​​the fracture. A tibia fracture heals during the normal course of the reparative process after 1.5-2 months. This period is the period of clinical fusion, when only periosteal callus is formed, sufficient for the patient to walk with crutches, carrying out a measured load on the leg. After the traction is removed, the patient walks with crutches for another 1.5-2 months, touching the floor with the injured leg and gradually increasing the load. Then he walks for the same period with a stick. Treatment of a fractured leg bone with constant traction takes 5-6 months. From the first days, constant traction must be combined with therapeutic exercises, which consist of active movements of the foot, fingers and muscle tension.

The method of constant traction must meet the following requirements: ensure early and satisfactory reposition of fragments, optimal muscle traction, eliminate muscle retraction in the pathological position of bone fragments, promptly prevent and eliminate the entrapment of soft tissues between fragments, ensure reliable consolidation of bone fragments, maintain the physiological tone of the muscles of the injured limb and the function of nearby joints, maintain the tone of the whole body.

Difficulties in meeting these requirements for skeletal traction are associated primarily with the imperfection of the equipment used - the only industry-produced standard Beler splint for the treatment of tibia fractures. This splint is produced in one size with constant hip and knee angles, which in many cases does not allow for a position of rest and muscle relaxation. The roller blocks with which the Beler tire is equipped do not rotate well, which is why some of the traction is lost. The weight of the load required for repositioning the fragments and the fabric cords used to suspend it instead of nylon fishing line increase. The use of a detailed system of damper skeletal traction makes it possible to reduce the load for repositioning. There was no need to lift the foot end of the bed for countertraction, which led to a decrease in mortality in the group of elderly patients from exacerbation of concomitant cardiopulmonary diseases.

Many authors emphasize that the standard Beler splint has very limited capabilities for repositioning fragments and stabilizing them during treatment.

To eliminate displacements at an angle in the frontal plane, as well as to eliminate displacements in width, the standard Beler tire does not have devices. Most often, to eliminate these types of displacement, cotton-gauze loops with weights, pressure pads, etc. are used. These methods of reposition are non-physiological, since as a result of prolonged pressure of loops and pads on the lower leg, local blood circulation is disrupted, and swelling of the limb develops with symptoms of chronic venous insufficiency , constant pressure on soft tissues, blood vessels, and nerves can lead to their damage.

A more advanced way to eliminate displacements in width and varus-valgus deformities is lateral damped skeletal traction. It is carried out with two bayonet-shaped knitting needles held towards each other near the fracture site; skeletal traction is performed through these spokes through damper springs. The negative aspects of the method should be considered additional trauma to soft tissues and the potential for infection of the fracture area.

To eliminate the rotational displacement of a peripheral fragment of the tibia and stabilize it on the Beler splint, there are many devices, most of which boil down to hanging a knitting needle tensioned in a bracket to the transverse crossbar of the Beler splint or its modifications. For this purpose, bandage strips, springs, nylon threads, etc. are used, equipped with one or another mechanism to regulate their length and, consequently, correct rotational displacement. It is possible to eliminate rotational displacement by attaching a special support pad to the foot, which in turn is suspended from the crossbar of the Beler splint.

The most perfect one for repositioning and stabilizing fragments in the achieved position is the one created at the NIISP named after. N.V. Sklifosovsky special splint for the treatment of shin fractures. This splint allows you to eliminate shortening, angular and rotational displacements, and also stabilize the distal fragment in the achieved position.

Treatment of shin bone fractures on a splint is carried out as follows. After anesthetizing the fracture area, passing the needle through the heel bone and tensioning it in the bracket, the limb is placed on a splint, previously tightened with a hammock. The wire, tensioned in the bracket, is secured in the post clamps, which gives the distal bone fragment stability during traction. A damper spring and a cord are attached to the bracket, which is thrown over the block and the load necessary for skeletal traction is hung on it. Having placed the shin on the splint, a hammock is modeled under the shin, and the hammock should end 2-3 cm distal to the area of ​​the shin fracture. This position of the limb on the splint allows for free manipulation of the peripheral fragment of the tibia during reposition.

Reposition is carried out as follows. Displacement along the length is eliminated by selecting a load using skeletal traction. Indirect fastening of a peripheral fragment of the tibia on a movable carriage moving on ball bearings along guides ensures constant direction and smooth traction of bone fragments.

Elimination of displacement of fragments at an angle in the sagittal plane is achieved by adjusting the height of the rod: by rotating the nut, the height of the rod is increased (to eliminate the angle open posteriorly) or decreased (to eliminate the angle open anteriorly).

Angular displacement of fragments in the frontal plane is eliminated by adduction or abduction of the peripheral fragment. To do this, change the position of the transverse rod in the horizontal plane. By changing the position of the same rod in the vertical plane, rotational displacements of the peripheral fragment are eliminated.

The correct position of shin bone fragments after reposition is monitored using radiographs. If necessary, eliminate remaining types of displacements.

Skeletal traction is carried out until a primary callus is formed, after which a plaster cast is applied. A negative feature of constant traction in the treatment of tibia fractures is the long period of time the patient remains in a supine position. To reduce bed rest, it is possible to combine traction with plaster immobilization. After 3-4 weeks from the moment of injury, the patient can be released from skeletal traction and transferred to a plaster cast. By this time, a primary bone callus has formed, i.e., clinical healing of the fracture occurs, and there is no need to fear secondary displacement of the fragments.

Plaster casts applied to the lower leg can be classic - from the middle third of the thigh to the tips of the fingers and shortened, leaving the adjacent knee joint free from fixation. These dressings are called functional.

Conservative treatment is carried out for the following indications:

• for oblique, comminuted, helical and transverse fractures of the tibia, if angular, rotational displacement and shortening are eliminated in the acute period, the displacement in width does not exceed 2/3 of the diameter of the tibia. Angular displacements up to 5° are permissible;
• for non-displaced fractures;
• with closed and converted to closed open fractures of the tibia with and without displacement;
• for fractures at the level of the lower, middle and upper third diaphysis, as well as for fractures of the distal metaepiphysis.

Contraindications are: irreversibility of angular, rotational displacements, shortening, complete displacement in width; soft tissue interposition; lack of contact with the patient.

Angular, rotational displacements and shortening are usually easily corrected with conservative methods. Width displacement is difficult to eliminate completely without surgery. Provided that the fracture has healed, such displacement does not impair function or cosmetics. The same applies to small angular deformations. It should be emphasized that, both functionally and cosmetically, a small varus is preferable to a valgus, and an angle open anteriorly is preferable to an angle open posteriorly.

The entire course of functional treatment of tibia fractures can be divided into 4 stages.

Stage I - the period from the moment the patient is admitted to the hospital. Primary immobilization in the acute period is no different from the generally accepted technique.

Upon admission, after radiography, the fracture site is anesthetized with 20-30 ml of a 2% novocaine solution. If the fracture is displaced, then under local anesthesia, a pin is passed through the heel bone and skeletal traction is established on a standard splint.

For non-displaced fractures, after anesthesia, a deep posterior plaster splint is applied to the middle third of the thigh, the limb is placed in an elevated position. Immobilization with a plaster splint can also be performed for stable fractures without shortening after immediate elimination of angular and rotational displacements. It is very important that early post-traumatic swelling goes away completely. If a circular bandage is applied to a swollen leg, then after a few days the tightness of its fit is inevitably lost, a void appears between the skin of the leg and the plaster and the fragments are displaced.

It is unacceptable to apply a circular plaster cast immediately after an injury. Increasing swelling and hematoma can cause compression and necrosis of soft tissues.

For non-displaced fractures, primary immobilization is carried out for 3-14 days, for displaced fractures - from 2 to 4 weeks.

Stage II - fixation of the fracture with a circular plaster cast.

Circular cast with heel. A thin industrial-style cotton stocking is put on the leg from the toes to the lower third of the thigh. A stop is placed under the middle third of the thigh and longitudinal traction is applied to the knitting needle with a bracket with the help of an assistant or a load with a force that prevents the formation of an angle open anteriorly. The patient is recommended to completely relax the muscles of the lower leg and thigh; this is also facilitated by the knee position being bent to 130-140°. Then a deep posterior plaster cast, 8-10 layers thick, is applied from the end of the fingers to the level of the tibial tuberosity. In front, the edges of the splint should overlap. The bandage is strengthened with circular rounds of 2-3 medium-sized plaster bandages. For fractures of the lower and middle thirds of the tibia, the upper edge of the bandage in front ends at the lower pole of the patella and gently descends along the sides posteriorly to the level of the tibial tuberosity, allowing full range of motion in the knee joint. Before the plaster hardens, it is necessary to hold the foot at an angle of 90°, carefully model the bandage over the arch of the foot, the area of ​​the condyles of the tibia and the head of the fibula, the area of ​​the ankles, and the anterior inner surface of the tibia. In the upper and middle thirds of the leg, the bandage is modeled in such a way that its cross section approaches the shape of a triangle. To do this, you need to remove the support from under the thigh, straighten the knee and press the still damp bandage to the surface of the table, stroking the front inner and outer surfaces of the bandage at the level of the upper and middle thirds with your palms; the back surface of the bandage will become flattened. This modeling creates greater rotational stability. For fractures of the upper third of the leg, the bandage is extended proximally with circular rounds of plaster bandage to the level of the upper pole of the patella (the knee joint is bent at an angle of 170°).

The position of the fragments is controlled radiographically. Then the staple and wire are removed and the heel is plastered to the bandage with a fulcrum slightly anterior to the longitudinal axis of the tibia. When the plaster dries, after 1 - 2 seconds the upper edge of the bandage applied to the lower leg is modeled.

When treating with skeletal traction, it is often not possible to completely eliminate valgus deformities with axial traction alone. The advisability of using lateral traction by a pilot is questionable, since constant local pressure can lead to necrosis of soft tissues. We can recommend immediate correction of the remaining angular displacements at the time of applying the plaster cast. After this, radiography is performed; The bandage dries within 2 days. These days, the patient gets used to an upright position, sits with his legs dangling, and in the absence of dizziness, begins to walk with crutches without stepping on the broken leg.

As soon as the plaster cast is completely dry, the patient is recommended to walk with the help of two crutches with a measured load on the leg. The amount of load is controlled by the patient himself: he must focus on pain. The load is increased gradually until pain occurs.

After 3-5 days of walking with a load, a control x-ray should be taken to identify possible secondary displacements. If an angular displacement occurs, it can be corrected using the same plaster cast. To do this, the plaster is cut transversely at the level of the fracture at 3A of the perimeter on the side where the angle is open. The deformity is corrected and a plaster wedge is inserted into the resulting gap. Additionally, the bandage is strengthened with circular rounds of one plaster bandage. Repeat radiographic control. After a daily break, the axial load is resumed.

The patient can be discharged from the hospital immediately after applying a circular plaster cast with a heel, if there is confidence that he will independently perform the loading regime. The patient comes for examination a week later with control radiographs. Otherwise, it is better to teach the patient walking skills in a hospital.

For low metaphyseal and epimetaphyseal fractures, a circular bandage with a heel remains for the entire period of immobilization, on average up to 2.5 months from the date of injury. For other fractures, the bandage is replaced with a “sleeve”.

Circular plaster cast "sleeve". A stocking is put on the leg and a thigh support is installed, as described earlier. The heel rests on the table. A zinc-gelatin bandage 3-5 layers thick of a soft gauze bandage is applied to the foot from the base of the toes to a level 3-4 cm above the joint space of the ankle joint and allowed to dry for several minutes.

Roll out a plaster splint in the shape of a truncated cone with a length from the top of the outer ankle to the lower pole of the patella. A T-shaped incision is made on the lower narrow side of the splint and it is applied to the anterior surface of the tibia diaphysis. The front edge of the bandage (the horizontal part of the T-shaped incision) is located 1.0-1.5 cm above the level of the ankle joint gap. The side parts of the splints are used to form pads that fit tightly to the ankles. The rear edge of the bandage is level with the front. The splint is fixed with circular rounds of 2-3 medium-sized plaster bandages. An 8-shaped bandage of soft gauze bandage is applied to the ankle joint area to accurately model the lower edge of the bandage according to the shape of the ankles and allow the plaster to dry in this position. After 1-2 days, the soft bandage is removed.

The “sleeve” plaster cast allows full range of motion in the knee and ankle joints. An elastic zinc-gelatin bandage, practically without complicating the movements of the ankle joint, restrains swelling of the foot. In addition, by adhering to the plaster, such a bandage to some extent increases the stability of the position of the “sleeve” on the diaphysis of the leg. In the absence of Una paste, this part of the bandage can be made from an industrial-style elastic ankle joint.

Stage III - application of a circular “sleeve” bandage and walking with full weight bearing on the leg. The bandage is applied after the patient has begun to walk in a circular bandage with a heel with full load, without experiencing pain at the fracture site. Patients usually acquire this skill by the 2nd month from the date of injury. Changing the dressing is possible both in the hospital and on an outpatient basis. After removal of the plaster, clinical and radiological monitoring of the fusion and position of the fragments is carried out. Usually by this time there is no pathological mobility at the fracture site. If limited stiffness is detected, then after applying the sleeve, radiography should be repeated to assess the axis of the leg. If there is pronounced painless mobility at the fracture site, it is necessary to decide on surgical treatment. Walking with full load on the leg is resumed after 1 - 2 days, i.e. after the bandage has dried. During the first days, the patient is advised to walk carefully, even with crutches, to allow the ankle joint to adapt to the sudden return of mobility. After gaining sufficient skill and confidence, patients can begin to perform heel and toe exercises.

For oblique, helical and comminuted closed fractures, immobilization continues on average up to 2.5 months from the date of injury. The time period is increased by 2-3 weeks for transverse and open fractures, as well as if, when changing the plaster cast at the fracture site, mobility was determined and if the patient walked with crutches for a long time without fully loading the leg. Immobilization stops when clinical healing of the fracture is achieved: absence of pathological mobility and pain under axial and angular loads. On radiographs the fracture line is still visible. In general, when using a “sleeve” bandage, the doctor is not limited in terms of immobilization by fear of developing joint contractures. It causes much less inconvenience to patients; they can walk in regular shoes. It is not recommended to overly tighten immobilization, since the bandage, strictly limiting the muscles of the lower leg, prevents the final restoration of their mass and strength, and does not allow the full development of movements in the ankle joint.

In some cases, a “sleeve” bandage can be applied immediately after the period of primary immobilization, bypassing a circular plaster cast with a heel: for fractures of the upper and middle thirds without displacement, cracks, stable isolated fractures of the tibia. Usually a 2nd period of immobilization is necessary. Elimination of movements of the ankle joint and, consequently, movements of muscles and tendons in the fracture zone creates greater comfort, reduces pain and the patient can more quickly achieve full weight bearing on the leg when walking.

Stage IV is the period of final rehabilitation. After removal of the plaster, clinical and radiological monitoring is carried out.

If immobilization is carried out without changing the plaster cast, then after its removal, rehabilitation measures are aimed mainly at developing movements in the ankle joint. Patients are recommended to switch to walking with the help of crutches for 1 - 2 weeks to adapt the joint to mobility, while the load on the leg should be maintained. Active therapeutic exercises, massage, and physiotherapy are carried out.

After cessation of immobilization with the “sleeve,” the range of motion of the ankle joint is 70-80% of the range of motion of the joint of the intact limb. Patients can walk without additional external support, some of them practically do not limp and, in fact, do not need any special rehabilitation. Persons with mental, light physical work and students can sometimes be immediately discharged to work. In other patients, rehabilitation is aimed primarily at restoring the strength of the lower leg muscles.

The functional method of treating a tibia fracture with a shortened plaster cast is highly effective and allows for recovery in an average of 5 months. Functional activity does not interfere with, but, on the contrary, promotes consolidation of the fracture. Early axial load and active movements in the knee joint improve blood circulation and virtually eliminate muscle atrophy, osteoporosis, and persistent joint contractures. Final rehabilitation is not difficult. Late introduction of axial load, on the contrary, worsens functional results.

Surgical treatment. Indications for surgery for tibia fractures are as follows:

• conservatively irreducible fractures;
• double fractures of the tibia with large displacement;
• tissue interposition;
• the danger of violating the integrity of the skin with bone fragments, compression of peripheral nerves and blood vessels;
• open fractures.

Surgery for fractures of both bones of the leg should be performed only on the tibia, since when its integrity is restored, the fibula, as a rule, fuses. Surgical reduction of fragments without additional fixation is unacceptable at the present stage.

In case of diaphyseal fractures of the tibia, in contrast to diaphyseal fractures of other locations, osteosynthesis of the tibia can be successfully performed with all currently existing fixators: extramedullary (screws, bolts, plates), intramedullary (rods, pins), non-focal devices (Ilizarov, Kalnberza, Volkova -Oganesyan and others). This is facilitated by the simplicity of surgical approaches and the relative ease of repositioning bone fragments due to the absence of a muscle layer on the anterior inner surface of the tibia.

There are many opinions in the literature that prove the advantage of one type of osteosynthesis over another. This dispute is pointless, since with correctly performed osteosynthesis and the absence of postoperative complications, all methods allow you to restore normal function of the lower leg no earlier than 4-5 months. The results of treatment depend not only on the method of osteosynthesis, but also on the professional skills and abilities of the doctor.

Preference should be given to the type of osteosynthesis that, firstly, is less traumatic and also convenient for the patient in the postoperative period; secondly, it makes it possible to leave the patient in the postoperative period without external plaster fixation, to begin early loading of the limb and to ensure movement in large joints.

Osteosynthesis of the tibia with metal screws or bolts is convenient for helical fractures with a long fracture line. The method is simple, it allows you to achieve a good comparison of bone fragments and their immobility. In the postoperative period, a plaster cast should be applied to the lower leg for a period of at least 2 months.

Osteosynthesis of the tibia with a plate can be used for all types of fractures. It is better to use a durable metal plate with 8-12 screws. This type of osteosynthesis does not require a plaster cast. The plates must be fixed on the outer surface of the tibia, where there is a muscle layer. Laying massive plates along the inner surface of the tibia is simpler, but dangerous due to the possibility of developing skin necrosis.

Intramedullary osteosynthesis of the tibia with a Bogdanov-type rod is impractical even for transverse fractures, since it requires full plaster immobilization for the entire period of fracture healing.

The strength of fracture fixation depends on the diameter of the intramedullary pin inserted. Reaming the medullary canal makes it possible to use stronger pins, which provide good fixation of fragments and do not require additional fixation in the postoperative period. Reaming should be performed when the fracture is located distal or proximal to the narrowed part of the medullary canal of the tibia. During osteosynthesis of the tibia, strong fixation can be ensured with pins with a diameter of 9-12 mm.

Osteosynthesis of the tibia can be performed after open and closed reduction. In closed reduction, the pins are inserted into the medullary canal through the proximal metaphysis without exposing the fracture site. Its advantage over the open method is the preservation of periosteal tissue at the ends of the fragment, less risk of infection of the fracture, less trauma and blood loss.

A massive metal pin is inserted into the medullary canal of the tibia, both in open and closed reduction.

A skin incision of about 4 cm is made along the anterior surface of the tibia above the site of the tibia fracture. After exposing the fragments through the surgical wound, drills are used to expand the bone marrow canal to the required size. Then the leg is bent at the knee joint at an angle of 90°, placing the foot on the operating table, and a skin incision is made from the middle of the patella to the proximal epiphysis of the tibia along the inner edge of the patellar ligament. Next, a cut about 2 cm long is used to open the fibrous capsule of the knee joint (the synovial membrane should not be damaged). In this case, on the epiphysis of the tibia, you can palpate the extra-articular area, which is the site of insertion of the pin.

During closed reposition of fragments, a straightener with a diameter of 3-4 mm is inserted through the proximal metaphysis, advanced into the medullary canal of the distal fragment, and a pin is inserted along it under radiographic control.

Compression-distraction osteosynthesis of the tibia can be used for any type of tibial fracture. The lower leg, like no other segment, due to its anatomical structure, is convenient for treatment with compression-distraction devices. Transosseous osteosynthesis of the tibia should be resorted to if conservative methods are ineffective.

Compression-distraction devices are used for reliable fixation of the tibia and reposition of fragments. The advantages of the method include low morbidity compared to immersion osteosynthesis, and the disadvantages include the inconvenience of the patient at home with a bulky apparatus.

Good fixation of shin fragments can be ensured by a device with 4 rings, and at least 2 spokes must be passed through each ring or half-ring. Two rings should be located in the proximal and 2 in the distal fragments. For helical or oblique fractures with a long fracture plane, counter-lateral compression can be used with knitting needles with a thrust platform or bayonet-shaped ones. The tension of the spokes fixed in the rings tightly compresses the bone fragments along the fracture planes.

Indispensable conditions for the treatment of shin fractures using the compression-distraction method are walking with a load and movements in the knee and ankle joints, as they help restore blood supply.

Treatment of isolated fractures of the tibial diaphysis has certain features. This is explained by the fact that the intact fibula makes it difficult to reposition the fracture in the presence of displacement of fragments of the tibia, and in the absence of displacement it is a “spacer” that prevents the comparison of bone fragments and their fusion.

Isolated fractures of the tibia, especially transverse ones (even without displacement), quite often do not heal, so in such cases surgical intervention is advisable. Treatment with plaster casts or constant traction is carried out according to the same principle as for a fracture of both bones of the leg.

Treatment of an isolated fracture of the fibular diaphysis is not difficult, since fractures of the fibula with and without displacement do not impair function and, as a rule, always heal. The displacement of bone fragments is always insignificant, mainly to the side, since the intact tibia is a “spacer” and prevents the fragments from moving along their length. Walking should be limited for the first 2-5 days, and after pain is eliminated, you can walk with weight bearing on the leg without external fixation.

Fractures of the head of the fibula may be accompanied by damage to the peroneal nerve. Typically, nerve damage is caused by a bruise and is subject to conservative treatment. In case of complete damage to the nerve, suturing it is indicated. The peroneal nerve is difficult to recover even after surgery. The result of nerve damage is foot drop. If there is irreversible loss of peroneal nerve function, orthopedic surgery on the foot should be performed.

Electric shock

When electrocuted, the muscles begin to contract convulsively. This causes pain and muscle paralysis. Due to spasm of the vocal cords, the victim cannot call for help. If the current does not stop, then after a while loss of consciousness and cardiac arrest occurs. In addition, the passage of current leads to burns of the skin and internal tissues and blood clotting. The procedure for dealing with electrical injuries is as follows:

• turn off the power source
• evacuate the victim from the affected area
• if the heartbeat stops, start chest compressions
• After the pulse appears, place the victim on his side
• call an ambulance
• Monitor the condition of the victim; repeated cardiac arrest may occur.

Types of tires

• Cramer splint for fracture - helps to fix limbs and other parts of the body. It is a prefabricated mechanism for movement, consisting of three elements (attached to the sides and under the injured limb). The gauze must be sterile; for safety, a layer of cotton wool is placed in front of the solid elements.

• Diterichsa - made from wooden objects, immobilizes the injured area well. Fixation is performed in two planes.

• Inflatable – available only from the mobile ambulance team. It is placed under the limb, slightly inflated and secured with a gauze bandage.

Help with poisoning

Poisoning is the entry of a toxic substance into the body. In case of poisoning through the mouth, gastric lavage must be provided. Give a glass of clean water to drink. For one liter of water, add a dessert spoon of salt (10 g) and a teaspoon of baking soda (5 g). After drinking every 300-500 ml of water, you should induce vomiting by touching the root of the tongue with your fingers. The total volume of liquid taken during gastric lavage should be at least 2500-5000 ml. Gastric lavage is carried out until the “clean lavage waters”. In the absence of consciousness, the stomach cannot be washed.

Within the framework of the article, inhalation poisoning is considered only in terms of household and carbon monoxide. Signs of carbon monoxide poisoning: pain in the eyes, ringing in the ears, headache, nausea, vomiting, loss of consciousness, redness of the skin. Signs of household gas poisoning: heaviness in the head, dizziness, tinnitus, vomiting, severe muscle weakness, increased heart rate, drowsiness, loss of consciousness, involuntary urination, bluish skin, shallow breathing, convulsions.

The procedure is as follows:

• take the victim out into the fresh air (do not allow yourself to be poisoned)
• if there is no heartbeat or breathing, perform resuscitation measures
• lay the victim on his side
• call an ambulance

In general, when to call an ambulance depends on the situation. If you are the only one helping someone, you first need to make sure that the victim is breathing, and then call. Otherwise, the ambulance may not make it in time.

What not to do when providing first aid

• You should never be a hero. Evacuation of a victim from a danger zone must be approached carefully. Otherwise, instead of one victim there will be two.
• In case of an accident, do not remove the victim from the car. It is better to turn off the ignition and disconnect the battery. In general, it is better not to move an injured person unless you know what you are doing. It is worth getting the victim out of the car only in case of fire.
• Recession of the tongue. If a person is unconscious, but there is breathing, do not remove his tongue from his larynx. There is such a misconception, you shouldn’t do this. Lay the victim on his side or tilt his head back - the airways are open.
• In case of food poisoning, potassium permanganate crystals are often used to lavage the stomach. They need to be dissolved in water at a temperature above 70 degrees, that is, in hot water. Undissolved potassium permanganate crystals cause ulceration of the gastric mucosa. Proper gastric lavage is described above.
• If a person chokes (food gets into the upper respiratory tract), do not hit him on the back. The situation can be made worse. You need to calm the person down and ask him to take a few slow breaths and sharp exhalations. The body's protective reaction in such cases is coughing. When exhaling, it is better to lean forward slightly.
• During an epileptic attack, do not unclench the person’s teeth. It is necessary, during the active seizure phase (convulsions), to hold the patient’s head so that he does not damage it, and during the second phase (sleep), turn him to the side.