Lectures 3.
General questions traumatology. Traumatism. Sprains, broken bones.
Desmurgy.
Shock. Therapy of shock.
General questions traumatology.
Injuries (Greek trauma, traumatos, wound, injury)-set injuries incurred in a particular population for a limited period of time and are associated with different types of human activity. Depending on conditions and where injury happened distinguish injuries: industrial (manufacturing), agriculture, transport, sports, household, military and children.
This distribution allows to define a group of people to discover the cause and the conditions in which it originated, to identify and carry out preventive measures.
Injury or travmoyunazyvayut sudden, momentary effect on the human external factors (mechanical, thermal, chemical, radiation and other things) that causes the organs and tissues of the anatomical and physiological changes that are accompanied by local and general reactions.
Worldwide, injury is considered a priority health issue. Deaths from injury is the third place among the causes of death. It is not only medical but also a social problem as dying, usually people of working age.
In the first place instructure injuries are road traffic accidents, in which, in most cases, there are massive polytrauma often accompanied by internal bleeding. It is important that a body damaged by fire damaged the vessel as quickly and efficiently provided first aid and transported the patient to a specialized department.
It is believed that the blood loss of 700 ml has no effect on the overall condition of the victim and hemodynamic parameters. In most cases, this condition continues until one hour after the injury and started bleeding. Therefore, this time called “golden hour”.
Accordingly, the objective of the first pre-medical and medical care on site traffic and transportnoyipryhody prytransportuvanni is to ensure all measures to stabilize hemodynamics and extension of time “golden hour” by centralizing circulation (decrease blood circulation to the periphery of the body to redistribute it to the vital organs (heart, lungs, brain)).
This is achieved by introducing a large number of substitutes by bandaging the limbs or the use of antishock suit type “Chestnut” (Russia), which is squeezing small vessels, with the saved trunk bleeds provides transition 1.5-
This allows for hemorrhagic shock reduced mortality from 77 to 26%. However, equally important is the time to help since the delivery of the patient to the hospital for the surgery and the final stop bleeding. The most optimal time is half an hour ago, this time called “platinum half an hour.” *
Thus, if multiple trauma with internal bleeding skilled care will be provided within 90 minutes, the probability of survival of the victim is high. However, the remoteness of hospitals, lack of communication, inability to provide competent assistance at the scene, the complexity of diagnosis significantly reduces the survival rate of victims.
There are the following types of injuries:
injury outside work: transport (road, rail, tram, etc.), street (with pedestrian movement);
household, sport.
Injury industrial nature (industrial and agricultural).
intentional injuries (military-related suicide).
II. By the nature of damaging factors: mechanical, thermal, chemical, surgical, radiation and others.
III. The nature of damage:
– Closed (without damage to the skin and mucous membranes): slaughter (contusio), stretching (distorsio), gap (ruptura), sprains (luxatio), fractures (fractura);,
– Open (with damage to the skin and mucous membranes) wounds (vulnus);
– Penetrating into the cavity (with damage to the peritoneum, pleura, synovium, etc.);
– Penetrating into the cavity (without damage bar’yernyhobolonok);
– Single (damage only one body, one area);
– Multiple (damage to multiple body parts);
combined, polytrauma (injury of several organs);
– Combined (a combination of mechanical damage from radiation, chemicals and others.
IV. In place of application travmuvalnoyi forces: direct (pathological changes occur at the site of application of force) and indirect (damage occurring in the area remote from the area of application of force).
V. By the time of: acute (occurring immediately after one-stage action travyuvalnoho factor) and chronic (resulting from prolonged,
or repeated exposure travmuvalnoho factor (bursitis, epicondylitis, etc.).
Any injury is accompanied by both local and general changes in the body.
The local manifestations belongs pain, change in shape, color, and mucosal integrity of the skin, dysfunction of the damaged organ.
By general reaction body should include dizziness, collapse, shock.
The severity of damage depends on many factors:
– Physical characteristics travmuvalnoho factor (shape, texture);
– Anatomical and physiological features of tissues and organs injured;
– The pathological state of tissues and organs at the time of injury;
– Conditions which are injured.
Slaughter
This damage tissues and organs without violating the integrity of the skin and mucous membranes, resulting in quick and short diyitravmuvalnoho factor. Diagnosis slaughter can be spotted only after exclusion of serious injuries (fractures, ruptured internal organs, etc.).
Pathologists changes at slaughter depends on the fault location, general condition, the patient’s age and other circumstances. It comes traumatic tissue edema, hemorrhage, or hematoma (usually at slaughter meat muscles).
The patient notes pain of varying intensity, swelling, bleeding and dysfunction. Pain at the time of injury is sharp, intense and depends on the location of slaughter. Often the pain initially decreases, and after 1 -2 hours increased, due growth traumatic edema. Most pain is trauma periosteum, shin bones, reproductive organs, large nerve trunks.
Swelling occurs due to permeation of tissues with blood, lymph, serous fluid exudate due to aseptic inflammation. its value depends on the density of the slaughter and subcutaneous fat.
Hemorrhage at the surface faces appear in the first few minutes, or hours after injury, with red color. In 5-6 days the color changes to blue-purple that caused the transition of oxyhemoglobin to reduced hemoglobin. At 10-12 days gets hemorrhage green (reduced hemoglobin turns into verdohemohromohen) and later – yellow (formed biliverdyn then-bilirubin).
Function body with small faces do not suffer. Severe dysfunction occurs in massive hemorrhages in the muscles, joints and more.
Treatment involves slaughter anesthesia (chloroethyl) in the first 2-3 days – immobilization of the injured area, blending bubble pack ice by applying bandages wheecessary anesthetic.
For large hematomas and hemarthrosis spend puncture with subsequent imposition compressive dressings. From 2-3 days prescribed thermal and elektroprotsedury aimed at resolution of hemorrhage: compresses, baths, UHF, eletroforez with potassium iodide, lidasa, himotrypsynom with 12 days – physiotherapy
Strain
This soft tissue damage that occurs when the force in the form of rods, without violating the anatomical continuity of tissues. Due to external influences articular surface temporarily diverge beyond the physiological norm, and the joint capsule, ligaments and muscles ukrepitelnye not damaged.
Often there is a sprain ankle joint. It is accompanied by swelling in the joints. Hemorrhage in the early days is hardly noticeable, and 3-4 days appears bluish-purplish spots. Movements in the joint limited and painful. Pain during exercise per axle limbs missing.
To impose joint compressive bandage and provide functional peace limb. In the first two days of applying cold, then – heat treatments.
Gap
Gap is damaged soft tissue FAST force as thrust, which exceeds the force of resistance anatomical tissues. Observed rupture of ligaments, muscles, fascia, tendons, blood vessels, nerve trunks.
The most common connection breaks ankle, knee and radial-carpal joints. If the gap is accompanied by damage to the ligaments of the joint capsule there is a hemarthrosis. This is especially true for kolinnohb joint, due to damage to the lateral and cruciate ligament and meniscus. Contours joint smoothed surrounding tissue increases in volume, flexion and extension of the joint limited and quite painful.
Muscle rupture may be partial or complete. Often there is a gap abdominal muscles and extensor extremities. In the area of the gap there is pain on palpation, with full fracture defect appears damaged muscle. Further, due to hematoma occurs tumor formation. Typically there is partial or complete absence of muscle function.
We provide peace of limbs and fix it in the position of closest approach of broken sections of muscles by immobilization transport or fixed (plaster) bus. In the early days of the prescribed cold, further heat-treatments. When complete rupture recommended surgical treatment – stitching the torn muscles, followed by immobilization of the limb for 14-15 days.
Prolonged compression syndrome
Syndrome of prolonged compression (crush syndrome, traumatic toxemia, positional compression syndrome) – a pathological condition caused by prolonged (4-8 hours) compression of the soft tissues of the extremities, which is based on ischemic necrosis of muscle toxicity products necrosis with development hepato-renal failure. The longer is a compression body part, the heavier the course of this syndrome. In 81% of cases damaged limbs, especially the lower.
Classification prolonged compression syndrome:
I. Types of compression: compression point and squash.
II. By localization: head, chest, abdomen, pelvis, and extremities.
III. In combination: internal organs, bones and joints, major vessels and nerves.
IV. The degree of severity: mild, moderate and severe.
V. During the period of clinical course:
Time-compression;
-Postkompresiynyy period: early (first three days), intermediate (4-18 days) and late (more than 18 days).
VI. Combined damage:
prolonged compression syndrome + burn;
prolonged compression syndrome + frostbite;
prolonged compression syndrome + radiation damage;
prolonged compression syndrome + poisoning and other possible their
combination.
VII. In developed complications:
Disease-organs and systems (myocardial infarction, pneumonia, peritonitis, etc..)
Acute ischemia-damaged limbs;
Purulent-septic complications.
In the pathogenesis of the syndrome prolonged compression are the most important three factors:
-Painful stimulation;
-Traumatic toxemia due to suction products rozpadutkanyn primarily myoglobin, which blocks the renal tubules andleads to acute renal failure;
-Plasma and blood loss arising masyvnohonabryaku pressed areas of the body or limbs.
In the clinical course of three periods:
-Period increase in edema and circulatory failure, yakyytryvaye 1-3 days;
-Period of acute renal failure (with 3 days and lasts 9 12dib);
-Recovery period.
In the first period, immediately after the release of limb patients note pain, limitation of movement, weakness and nausea. Within a few hours increases swelling limbs. In patients with increased heart rate, decreased blood pressure, increased body temperature. On examination the limb initially observed pale skin and hemorrhage. After 30-40 minutes limb swells, increases in volume, the skin becomes uneven bahryanotsynyuvatoho color bubble appear with serous-hemorrhagic content. Fabrics limb palpation thick, resembling wood. Movement joints are impossible. Ripple peripheral arteries is not defined, disappear all kinds of sensitivity.
Gradually decreasing hourly and daily urine (up to 50-70 ml per day), the latter becomes lacquer red or dark brown color. In the period of acute renal failure patients feel better, but oliguria increases and becomes anuria, which may
cause death of the patient. With the development of acute renal failure patients subject to hemodialysis (artificial kidney).
Providing first aid performed before full release compressed limbs or the victim. Perform resuscitation on the system ABC, fired limb and immediately hold her tight bandaging or elastic gauze bandage. Higher compression is impose hemostatic tourniquet. Conduct transport immobilization, limb levy ice pack or cold water. Enter the means heart, analgesics, give drink 50-100 ml of alcohol. In the ambulance carried Continuous IV administration protivoshokovym liquids: Refortan, stabizolu, dextran and others.
Dislocations
Dislocation (luxatio) – called displacement of the articular surfaces of one or more bones in violation of their anatomical location and damage the integrity of the capsular ligaments, joint and surrounding tissue. When the articular surface of the face is not fully complete dislocation, if the stored partial contact of this dislocation is incomplete or subluxation. Most sprains happen in the shoulder and hip joints.
There sprains: traumatic, pathological (diseases that cause destruction of capsule-ligament apparatus and articular surfaces (tumors, inflammation)); congenital dislocation;
conventional (with a large stretch ligaments and improper treatment);
old – time nevpravleni.
The name given by name dislocation displaced distal bone. Thus, the dislocation of the shoulder joint is called a shoulder dislocation in the hip, thigh, etc.
If the damage or jamming nerve trunks called dislocation complicated. Dislocation of the shoulder usually occurs in the fall on the assigned arm and hip dislocation is more common in accidents in passengers due to the sudden collision car.
When dislocation occurs pronounced pain in the following days decreases; disappear active and passive movements in the joint. Terms limb is forced, it rotated, deformed joints, sinks, head bone is absent in the joint and defined elsewhere (such as in the groin). Relative limb length decreases, the absolute – no change. In passive joints in the joint marked resilience dislocated bone. When shoulder dislocation victim tries to maintain a healthy arm damaged, and if cant torso towards damage.
First Aid is to immobilize the limb, bandage, deodora injected analgesics, topically applied cold. The patient was sent to the hospital. Reduction of dislocation doctor performs after preliminary X-ray examination.
For reduction of dislocation doctor need 1 -2 assistants. Depending on the type of dislocation and its location, there are certain tricks reduction: by Kocher, with Dzhanelidze by Hippocrates.
After ending shoulder dislocation reduction fix plaster splints or bandage deodora for 15-20 days, after which the prescribed thermal treatments and therapeutic exercises.
Fractures
Fracture (fractura) – a partial or complete disruption of the integrity of the bone under the influence of high-speed power. Fractures are congenital (occurring during fetal development) and acquired (resulting from the mechanical factors). Fractures that occur during childbirth attributed to acquired (obstetrics). There are more pathological fractures that occur in diseases of bone (osteomyelitis, tumor, cyst).
The frequency of fractures of the upper limbs occur in 50% of cases, the lower extremities – in 31%, pelvis and spine – 12% cherepav 6%, other – 1%. ‘
On the mechanism of fractures divided: compression fractures (compression) fractures from bending;
fractures from twisting (torsion, helical, spiral) blocks – detached fragment of bone at the site of attachment of tendons and muscles.
Given the extent of damage Fractures are divided into complete and incomplete. The latter include crack – oxide fracture type “green branches”, which mainly occur in children.
In relation to the axis of the plane of the fracture bone distinguished:-transverse-fracture line perpendicular to the axis of the bone, buck-fracture line parallel to the axis of the bone; hand – fracture line is directed obliquely to the axis;
– Helical or spiral;
– splinter.
There are single and multiple fractures. If the damage splinter adjacent organs fractures are divided into uncomplicated and complicated.
While maintaining the integrity of the skin is called closed fractures, the damage it – open.
In most cases, fractures involving displacement of primary fragments: side, the length, angle and rotary.
In addition, there may be a secondary displacement of fragments during transportation, rearrangement injured due to muscle strain or reliance on the injured limb. Localization distinguish diaphyseal fractures, when damaged, the middle part of the tubular bone (diaphysis) and epiphyseal (intraarticular), when damaged, the pineal gland, which has a sponge-like structure.
On examination, the victim must pay attention to its position it. When injuries are usually forced position because the patient healthy limb trying to reduce the load on the damaged or elected position, which relax the muscles of the trunk in fractures of the spine and pelvis.
There are absolute (characteristic only for fractures) and relative (may occur with other injuries) signs of fractures.
Absolute signs:
deformity of limbs in the zone of fracture, crepitus bone fragments in friction with one another; absolute shortened limbs, abnormal mobility in the area of the fracture.
The presence of only one of these characteristics confirms the diagnosis of fracture. Relative signs: pain in the area of the fracture, which increases with the axial load on the bone, the presence of hematoma, edema and swelling of tissues in the zone of fracture, limb dysfunction. Fractures may be complicated by bleeding, traumatic shoyum, fat embolism. In open fractures external bleeding, and when closed – the blood forms a hematoma at the fracture site and in the surrounding tissues.
For the treatment of lower extremity there fractures traction with special tires Belera and skeletal traction system
Traumatic shock – the general reaction to the great damage that manifests inhibition of vital functions due to the profound changes at the level of microcirculation and occurrence of hypoxia, manifested cardiovascular, respiratory, endocrine failure and profound disorders of the nervous system. Fat embolism caused by getting fat, bone marrow in large vascular or pulmonary circulation.
To clarify the diagnosis and identify the nature of the displacement of bone fragments conduct radiography in two orthogonal projections.
First Aid with mechanical trauma
The main objectives of aid are:
Termination damage factors and interventions to improve or restore cardiac activity and respiration, temporary stop bleeding, blending and aseptic immobilization bandages.
Organizing and providing favorable conditions for the transport of the victim to the medical facility. The main requirement in assisting traumatized, especially with polytrauma, which often occurs in accidents, no harm to the victim!
After the release of the victim or of his body from damaging subject to a survey traumatized SAMPLE, where:
S (sign and symptoms) – complaints symptoms;
A (allergies) – the presence of allergies to medications the means;
M (medication) – drugs that can accept up to incident;
P (past / present medical history) – transferred and existing disease;
L (last meal or oral intake) – the last meal;
E (events before the empergency) – events before and during the event mechanism of injury that subject. Then carry out a detailed examination of the victim under the DRABCDE:
D (dranger) – overview of the scene;
R (response) – level of consciousness;
A (airway) – airways;
B (breathing) – breathing;
C (circulation) – circulation (pulse, blood pressure);
D (disability) – a brief neurological examination;
E (exspose) – exposure of damaged body parts. In case of violation of respiratory and cardiac activity should start resuscitation. Day clarify the state of mind of the victim examined by the AVPU:
A (alert) – consciousness is preserved;
V (voice) – responds to voice;
P (pain) – responds to pain;
U (unresponsive) – no reaction.
If the victim in mind and requires resuscitation, it is necessary to clarify the complaints and symptoms PQRST:
P (provokes) – that provokes symptoms
Q (quatity) – that improves or worsens the symptoms
R (region) – localization or irradiation of pain
S (severity) – severity of complaints (10 point scale)
T (time) – when started, when the action stopped traumatic force
If the victim abruptly broken or absent breath, stepped into cardiac arrest immediately begin resuscitation phases ABC for S.Safarom. Other stages of resuscitation performing medical resuscitation teams in cars and offices. Patients with multiple injuries, especially poterpshi in traffic accidents often have characteristic damage. The driver in a frontal collision the car may have a horizontal wound on the head from a mirror, a reflection of the front of the chest from the steering wheel with a broken rib and sternum, and vertical knee wound, sometimes combined with a high fracture shin bones from hitting the dashboard. Not excluded in the absence of head restraints, fracture of the cervical spine. As passengers – damage whiplash, concussion infarction, lung damage (breaks) of the liver, spleen, posterior hip dislocation in the hip joint. Recognition of damage difficult in unconscious and confused patients. Under these conditions rightly guided by the general rule: when the damage found in two separate remote locations (eg, head and lower limb) then there is a high likelihood of injury in the middle of the body, the abdominal organs: liver, spleen, intestine, kidney, ureters. Fracture of the pelvis are gaps urethra and bladder, especially when it was crowded at the time of injury.
Securing the airway is an important point and it is carried out directly in the evacuation of the victim from the car or from under travmuvalnyh debris. From the cab of the truck poterpshoho carefully extracted and, in the absence of vertebral fractures, body, limbs, put it on his right shoulder, right hand grasping the leg, and the left hand (Fig. 38). When pulling out the victim’s car together, one taking him on the arm, and the second captures the tibia and femur.
To ensure the airway, preventing asphyxia vomit poterpshoho placed on the left side, as shown in
Patients undressing. To remove clothing and shoes should be under the general rules. Primarily remove clothes from healthy limb, and then – with the damaged. If it is difficult to remove clothing and there is a need to process the wound to stop the bleeding, then cut the clothes better.
Transport victim to ambulances or other transport is dependent on the condition of the victim.
Moving with support – the hand of the victim accused the neck of those who help and support for the wrist.
Moving on hand – take the victim to the hands and one hand covering the torso, another plant under the knee. The victim covers his neck that he endures.
Carry on the back – the victim is on his back who carries arms and clinging to shoulder.
Transferring a patient in half-sitting position. One person covered under the hands of the victim from behind, the other is between the legs of the victim and takes the hand of his thigh.
Moving two people with “lock”. The victim sits on a “seat” and includes hands on the shoulders of those who provide assistance
Moving on stretchers. Burden is in all departments of hospitals and ambulances. To conclude nanoshi at large polytraumas to three.
Transportation victim. After restore breathing, stop bleeding conduct immobilization of the injured parts of the body or limbs. Best of health to transport cars, airplanes, helicopters. It is important to take care that the victim was protected from external factors: cold, rain, snow, possible overheating. In freight transport better transport victims on the bottom body, in the car – in the back seat or in the front, with a reclined back, locking the victim’s belt.
TRANSPORT and therapeutic immobilization
Transport immobilization is conducted to provide skilled medical care during transport the victim to a hospital. it is conducted not only in fractures and dislocations or suspected them, but also for large damage soft tissue wounds.
In most cases, immobilization is improvised. Use the handy tools or healthy parts of the body: the damage to her feet pribintovyvayut healthy, injured arm pribintovyvayut to the body or used clothing, belts, boards
Transportation imobilizatsiyni tires are divided into two groups: fixation and distraction. By fixation tires include mesh back Filberha and Kramer They are durable, easily modeled on any area of the body. Tires Cramer are two sizes: 60×10 110×10 sm. These tires are used primarily to immobilize the humerus, forearm, hands, legs and feet.
When applied mesh tire previously modeled it on the healthy limb of the victim, the third person or by itself .
Fractures of the humerus tire should start from the inner edge of the blade healthy side, go along the outer surface of bent (90 °) of the elbow resulted hand and end on finger.
Shin better fixating three tires, one modeled on the back of the leg and foot from the toes to the middle third of the thigh, the other two are fixed on either side of the tibia, while plantar flexing portion in the form of stirrups for better fixation of ankle joint. If the damage neck with mesh tires made “helmet”.
In mesh tire used cardboard, plywood or plastic materials.
For immobilization of limbs using vacuum tires. They come in three types: Type I – for additions and forearm, II type – for feet and legs, III-type for knee.
Distraction tire Diterihsa (Fig.44.) Used in hip fractures and hip joint. It consists of four parts plantar, internal, external with chopsticks-twist with lace and sliding bars with stops at the top and straps for fixing to the torso and hips.
Tire usually impose over clothes and shoes. By foot pribintovyvayut pidoshvovu of tires having fastening strap and two loops for attaching exterior and interior trims. The inner part of the tire (inner loop) placed on the inner thigh, groin vpyrayut transmitting lower end through the loop foot so that its end is speaking from her 8-
The outer contour of the fix so that it began from inguinal hollow and reach the foot passes through the outer loop soles and performed at 8-
Basic principles and rules of transport immobilization
Tyres have to capture two joints (above and below the fracture), and sometimes – and three (fractures hip – hip, knee, ankle, shoulder fractures, shoulder, elbow and wrist).
When immobilizing the limb to give it a physiological position or a position in which the least injured limb. In open fractures reposition fragments do not carry, and impose a sterile bandage and the limb is fixed in the position in which it is located.
When applied to the body wire tires to put cotton-gauze pads and more. DRI closed fractures tires impose on clothes
While shifting the victim or nosh on a stretcher injured limb support assistant.
Poorly executed immobilization may harm the victim: yes fracture may be open, cause massive bleeding due to damage to blood vessels bone fragments. Transport immobilization of fractures of the bones of shoulder girdle and upper extremities. Clavicular fractures – in inguinal put hollow shaft with wool or clothing with the size of a fist and can hold immobilization – Dezo dressing, cross dressing with two shoulder joints .
Fractures of the humerus in the upper third, arm bent at the elbow at 60 ° so that the tassel fell on his shoulder healthy side in inguinal fossa put shaft and fix it into the chest through a healthy shoulder. Forearm hung on squares and fixation shoulder to the chest. Diaphysis fracture shoulder immobilization conduct tire Cramer, simulate it in inguinal fossa put roller bandages and fix the tire. Fractures in the elbow joint tire grabs his shoulder and comes to the metacarpophalangeal joints. With no standard means of shoulder fractures using improvised tires with branches, pieces of boards, umbrellas, automobile pump. This immobilization spend two tires.
Forearm fracture using Cramer splint or Filberha with mandatory locking elbow and wrist joints, before transporting the patient is injected or given pain relievers.
Transport immobilization with lesions of the spine and pelvis. When spinal injuries and fractures almost always a traumatic shock and dysfunction of the pelvic organs. Therefore, reliable immobilization and careful transportation is the key to further the patient and his treatment.
So the victim injected anesthetic and heart means. Transportation is best handled ambulance on a stretcher solid, makeshift shield or in the back of the truck.
When investing victim caot prevent displacement of the spine. Fracture of the cervical spine immobilization is cotton-gauze roller or tire Yelanskoho. Victim transported on the back of the upturned head and platen throat. Fracture of thoracic and spinal spine or pelvis victim lay on his back with a roller under your knees.
With an open fracture of the spine transported on the stomach. In recent years, used to transport victims with fractures of the spine immobilization vacuum tire
Transport immobilization of fractures of the lower extremities. At the turn of the thigh, hip and knee joints used standard splint Diterihsa.
In its absence can use splint Cramer interconnected. they impose on the outer, inner and posterior surface of the limb. Immobilization three joints required.
Improvised splinting for fractures of the hip performed improvised means (skis, poles), and in case of their absence can prybyntuvaty injured limb to healthy.
When fractures shin used splint Cramer, creating a stillness in the knee and ankle joints. Recently, the use of pneumatic splints.
Therapeutic immobilization
The largest spread was immobilization with gypsum bandages
Gypsum (deep fried at 140 ° C calcium sulfate) is a fine powder that is mixed with water has the ability to quickly harden. On air plaster absorbs moisture, so it is stored in a tightly sealed boxes and factory made plaster bandages in a plastic-sealed packages. Plaster bandages are wide (23 sm), medium (17 sm) and narrow (
-Gypsum powder compressed in his fist. If it’s good quality, topislya roztyskannya fist he crumbles when bad-is in the form of lumps.
-Equal servings of plaster and water mix on a plate. The resulting mass mayezastyhnuty after 5-6 min., While pressing fingers nerozchavlyuvatys on its surface should not serve water.
-Gypsum and water mixed in a 1:1 ratio and produce a ball that after 7-10 min. hardens. When this ball drop from a height of one
meter, it should not break.
For slow freezing, gypsum diluted with cold water to speed-kneaded in a warm (35-40 ° C). Plaster bandages can prepare yourself, rubbing powder gypsum bandage. Soak the plaster bandages or splints (several layers of bandages certain length and width) hold true. Dry bandage take two hands on the edges and placed on the surface of the water, bandage yourself get stuck in the water. Wheo longer stand vesicles air – Gypsum zmochyvsya. In summing bandage fingers of both hands and gently grip the sides to remove excess water (Fig. 50). Then either put the plaster on the body, or form Longuet foot.
All casts are divided into: circular, cutting-removable; vikonchasti; prosthetic; tire; lonhetni; lonhetno-circular; torakobrahialni; koksytni; honitni; corsets; beds (Fig. 51).
When applied cast follow the rules:
-Extremity or the relevant part of the body provide physiological abofunktsionalnoho starting position;
-Limb should support all tassel, not fingers;
-Except for the damaged body part immobilization subject dvasusidnihsuhloby;
-If the plaster cast applied to the substrate, then this metykrasche use non-absorbent cotton that impose on
Bone performances;
-When applied bandages to cover every move of the previous round. To change the direction of the course of the tour, you caot go too plaster bandage it pruned from the opposite side and straightened;
– Bandage should not compress tissue and not be too loose, after dressing overlap check if it does not compress the main vessels (cyanosis, edema, cold, numbness, lack of pulsation).
For overlapping gypsum are special instrumentes: extension table, pelvis, apparatus for applying corsets. Read the casts by mechanical or electrical saws for plaster, scissors, scalpels, cutter Shtill.
