Desmurgy. Characteristics of dressings matherials . General rules of bandaging. Types and classification of bandaging materials. Manufacture of surgical dressings matherials. Classification of dressings. Typical bandage dressing. Rules of bandaging.
Dressings bandages, adhesive, scarves, plaster. Types of bandages: protection, shaking, therapeutic, corrective. Examine the evidence and elaborate technique blending different types of bandages.
Desmurgy. Technology bandaging on the head, abdomen and thorax. Dressings on limbs. Work out the imposition of varieties of dressings for different anatomical parts of the body, depending on the evidence.
Desmurgy (from the Greek words desmos – bunch, dressing, ergon-action) – the doctrine of dressings, principles and rules of the overlay.
Under the bandage understand the complex tools that are used to protect wounds pathologically altered skin from exposure to various environmental factors. In the narrow sense of dressing is a means to secure or retain wound dressings. The process of imposing it on the wound is called racking.
Bandager – complex and demanding procedure. Wrong imposed bandage can cause serious complications and have the same negative effects as poorly executed operation. There are certain requirements as to the very bandages in general and the rules regarding its imposition. Any band should:
possible to carry out its mission, to ensure physiological conditions for the functioning of the body or body;
be not too free, but not too tight (except for special bandages), does not infringe blood and limfrobih, be comfortable for the victim, not to cause psychological discomfort, have aesthetic appearance.
For a clearer understanding of the purpose and application of bandages, they allocate (classified) according to the material functionality, stages of care. Functional bandages causes vybirpevnoho material and stage of care (first aid, doshpytalnyy Hospital and stages) determine the form of tools for racking.
Depending on the type of material distinguish the following groups of dressings:
– Soft bandage: bandage with gauze, bandages, fabric, gauze-kleolni, plastyrni with film-forming aerosols.
– Solid dressings, or that harden: tire (hard) bands of various materials (wood, metal, plastic), bandages with plaster, starch, new polymeric materials (fibrohlas, resin) in the process overlay are solid. By functionality is divided into protective bandages, fixing, compressing, hemostatic, occlusion, immobilization, adjustment and bandages to extract.
With protective bandages covering wound surface of the wound and other damage to the body surface. Apply gauze or cloth bandages, lypkoplastyr, film-forming aerosols.
With record locking bandages bandages in the area of its imposition. To apply this patch, adhesive substances, elastic tubular bandages.
Appointment of compressive bandages – maintain uniform pressure on a certain area of the body. These bands are superimposed on areas where there is no threat of respiratory function (neck) or blood flow (inguinal area). For this purpose lypkoplastyr (with umbilical hernia in an infant), elastic bandage (on the joints, limbs), ointment preparations (zinc-gelatin bandage dressing in diseases of the veins of the lower extremities.
Haemostatic dressings are designed to stop bleeding from a wound (mainly capillary or arterial doshpytalnomu on stage). This is achieved by using special materials (hemostatic sponge, gauze, fibrynoutvoryuvalni plate type «Tachocomb» ^ or elastic pressing the space bleeding or trunk vessels (eg, temporal artery).
Occlusal (airtight) dressings are used mainly for doshpytalnomu stage in penetrating wounds of the chest to prevent pneumothorax. For this purpose, individual or standard dressing (IPP), or any material that is not breathable.
Adjustment dressings designed to create pressure on a certain part of the body to change its location or form. To do this, use substances that harden (casts boots with clubfoot) Pavlik stirrup leather.
Immobilization bandages used for property injured limb or its fragment to prevent the development of complications (shock, hemorrhage, displacement of fragments, etc.).. To do this, use tire dressings: wood, plywood (tire Diterihsa) wire (staircases splint Cramer), metal (standard splint) and plastics (pneumatic tires and splints).
Bandages to extract used in Hospital stage in the hospital. Most of them are complex structures made of metal, wood or wire (eg, compression-distraction apparatus Ilizarov).
V.Kazitskyy, M.Korzh in 1986 proposed a classification of soft dressings:
I. Defensiveness
II. Reinforcement.
III. Special.
standard, individual dressing (IPP), dressing pack (PP), sterile bandages, cotton-gauze pads sterile, cotton-gauze strip, contour bandage suspensory, rubber sealed bandage Belov;
Custom: economical, zinc-gelatin; bandage, suspensory; lypkoplastyrna, hermetyzuvalna, pov’yazkana buttocks Zhyude bandage, fixation on limb Wedge pillow.
Rules bandager
Authority (limb segment), which is superimposed bandage should be at chest level person who performs ligation and damaged part of the body of the victim should be as available for ligation. Authority (limb segment), which is superimposed band should be at the time of imposition in that same position in which it will be located after ligation in the treatment or transportation. This situation should be functionally convenient. Muscles patient (especially limbs) should be as relaxed. In case of damage to extremities dressings should be used to support or assistive devices.
– During blending dressings to prevent the occurrence of secondary complications in the damaged organ or limb segment due to displacement of fragments of bones, their vascular compression or nerve trunks, further microbial contamination of wounds and more.
– Ligation should start at the top of (peripheral) edge toward broader (proximal) to better retention bandage and its consolidation
– Tours bandage imposed with a constant and uniform tension dlyaunyknennya folds and constrictions.
– Typically, bandage left to right (against clockwise). This head bandage should be right ruts, beginning of bandage – on the left.
– When applied dressings (except crawling) each subsequent round should cover the previous round by 1/2 or 2/3 of the width of the bandage. If bandage over – at the end of the previous bandage enclose, beginning of a new circular confirms progress and continue bandaging.
– End bandage reinforce stitching thread or break his end by 10-30 sm in length, crisscross each other, encircles around the desired segment and tie a knot on the side opposite to the site of injury or English pin fixed to one of the neighboring tours.
Errors in imposing soft bandages
If bandage imposed tight, it may be bluish, swelling of the skin, reducing the temperature of the distal limb discomfort, throbbing pain may worsen bleeding from the wound, which is located below the overlay bandage (the phenomenon of venous tourniquet). Sometimes it can develop neuritis, necrosis or gangrene of individual sections of the limb. When transporting the victim with loss of consciousness winter, frostbite can occur distal extremity. In the case of the above complications bandage partially cut.
When wrapping limbs some tours bandage may be placed too tightly, others – not tight bandage so easily becomes uninhabitable. This bandage is better to replace. Integrity headbands easily broken if not taken first fixing tours. This bandage should pidbyntuvaty and then flash rounds bandage threads.
With little tension bandage dressing can quickly spovzty. Its better to replace.
The main types of bandage bandages
Any band consists of simple strokes bandage. At the beginning and end of bandaging impose fixing circular tours bandage.
Circular (Circular) bandage (fasciacircularis) (Fig. 1) consists of several circular turns of bandage imposed at the same place, completely covering all the previous rounds. This bandage is placed upon the body, whose shape is similar to the cylinder (head, shoulder, lower third of the tibia, phalanges, radial-carpal joint).
Spiral bandage (fasciaspiralis) (Fig. 2) is applied if necessary wrap large area of the body. This bandage impose upward, first – 2-3 circular tour, and then they are sent obliquely upwards on the basis that each subsequent round is closed 2/3 the width of the previous one. Typically, such a bandage put on the body parts that have a cylindrical shape (trunk, shoulder, lower leg and forearm).
Fig.1. Circular bandage Fig.2. Spiral bandage
With varying thickness segments of the limb (leg, thigh, forearm, shoulder) achieve a proper fit bandage impossible because spiral bandage to apply with excesses. In place of inconsistencies round bandage and a surface that bandage to hold the bottom edge of bandage first finger left hand and right hand do bend towards you at 180 °. This top of the bandage becomes lower and lower – upper. Progress continues to place the bandage fixing the first finger of the previous round. In the next round the bend bandage repeat. Excesses bandage should be on one line, preferably on the side of the injury. Excesses bandage to perform until the bandage part of the body that has the shape of a cone.
Creeping bandage (fasciaserpences) resembles a spiral (Fig. 3).
Fig.3. Creeping bandage
After Fixing tours bandage impose helical so that its tours are not touched. Intervals mizhturamy bandage should roughly match the width of the bandage. Creeping dressing is less robust than a spiral, so it is used for temporary holding dressings on limbs if they are damaged to a significant extent.
Characterization of individual groups of soft dressings
Soft dressings are very diverse. The most common of these are protective and fixing. Type of protective dressings depends on the nature and scope of damage conditions blending dressings, duration of stay in the body. Depending on the type of dressings and how to fix the body distinguish Glue, scarves, praschepodibni, contour, bandages and mesh-tubular bandages.
Adhesive bandages. Finely sliced, chopped, torn, clogged wounds, abrasions, scratches can protect adhesive bandages.
To this end, apply glue BF-6, both alone and in combination with antibiotics or monomycin levomitsetinom (levoplast), glue number 88 with erythromycin and others. After 5 minutes of applying the adhesive to the wound and surrounding skin film is formed, which can protect the wound from infection 3-4 days. It is washed with water, does not interfere with and promotes wound epithelization. Glue is applied to the wound only in the absence of bleeding, as in this case, the film builds tissue content increases pain and the film quickly becomes unusable. In addition, the skin around the wound should be dry and clean, with no signs of inflammation in the wound and around the zone of injury.
Dressings can be fixed to the edges of the skin using kleolu, Kolodiy, lypkoplastyru, special medical adhesives.
Kleol factory preparation consisting of 40 parts of rosin, 33 parts 96% ethanol, 15 parts ether and 1 part oil. The wound is closed in several layers of gauze wipes. Around them on a narrow strip of skin layer impose kleolu. Gauze, which in size slightly larger than the area of wound dressing, in a strained applied to the deposited layer kleolu and kept in this position for 2-3 minutes. Napkin firmly attached to the skin and reliably captures povyazku on the wound. After removing the label remains kleolu removed from the skin swab is soaked in ether.
Kolody – a volatile liquid that is a mixture of ether, ethanol and cellulose nitrate. Technology blending kolodiyevoyi dressing is the same as kleolovoyi. Kolody dries slightly charge the skin, so it can cause the patient discomfort.
In modern terms kleolova and kolodiyeva bandages when administering first aid practically applied and have historical and theoretical interest.
Leykoplastyrni bandages. Plasters – a strip of fabric that is coated on one side with a special glue. Plasters produced in the form of coils of different sizes. Adhesive side of the adhesive plaster is sterile and can be imposed directly on the wound. Strips of plaster can be applied on top of the dressing and fix it to the skin. Leykoplastyrni headbands are very comfortable wheecessary nontraumatic bring together the wound edges.
To close small wounds, abrasions used bactericidal patch, which comes in special packaging. At the center of the surface
patch to be glued, is a porous material soaked in antiseptic substance.
Overlay wound dressings plaster bactericidal
This patches is very small pores, which helps to prevent the skin irritation does not affect the healing process of wounds. Note itso prolonged exposure to skin lypkoplastyru cause any skin irritation (dermatitis).
Film-forming aerozoli.Taki aerosols obtained by mixing the film-forming composition of Freon. Mixture filled glass or metal cans with lids spray. Clicking on the head spray liquid trickle out from a container. The solvent evaporates quickly and within a few seconds on the skin formed elastic protective film. Aerosol film affects the microflora of wounds and prevents “their secondary infection because it contains antibacterial broad-spectrum antibiotics.
Bumetol (butyl methacrylate polymer Methacrylic acid + + linetol) – one of the most common film-forming aerosols. Tape does not prevent evaporation vody and aeration skin because it has tiny pores through which does not get an infection. The pharmaceutical industry produces protyopikovi wound healing and aerosol medications, Livian, Vinizol, Levovinizol, Oksytsyklozol. These drugs include antibiotics (chloramphenicol succinate, oxytetracycline hydrochloride), antiseptics (citral, tsyminal), anti-inflammatory and wound-healing agents (prednisolone, vinilin, linetol, vitamin D3), etc.
Film-forming aerosols are easy to apply, quickly create a protective film does not require special training, can be widely used in the provision of self-help and mutual aid. Especially indicated aerosol application tapes at risk of postoperative infection stitches secretions from the fistula, urine, feces, and others. Protective film well kept on the skin, does not cause discomfort in patients and is waterproof. In the pharmaceutical market in Ukraine can be found such drugs – Plastbutol (Hungary) Akuhol (Czech Republic), Nobekutan (Sweden), Likvidoplast (Germany), etc.
The protective film is also formed when applied to a wound or a mixture of liquid Novikov Cherniak.
Synthetic adhesive compositions are often used to prepare the surgical field: sticky tape circ (Operating Aseptic Film Adhesive). This film has a polymer base thickness of about thirty microns on one side of which bears a special polymer adhesive that is selective stickiness to the skin. Before using fabric skin degreased and treated with antiseptic solution. Sterile forceps pull the film from the package and remove the paper. Sticky layer stretched film imposes on dry land operative field and carefully from the center to the periphery of the pad grind it to the skin. Then through the film perform operational section. After surgery, the film is removed. This operating wound securely isolated from the surrounding skin
Bandana headbands. These headbands imposed by a piece of cloth that is cut or folded in a right triangle-kerchief. Medical industry standard produces scarves for providing first aid size 135x100x100 cm, which is pressed a cube dimensions 5x3x3 sm One or more scarves can apply a bandage to secure any area of the body (Fig. 5).
For blending scarf dressing on the upper extremity, forearm placed in the middle of scarves so that bouquet was situated near the edge of the headscarf (base). One end (back of arm) is carried on top of a healthy shoulder, the second – above the damaged shoulder, and bind them together so that the forearms squares were bent at right angles. The third end with some tension encircles around the shoulder and fixed by pins to the front of the headscarf.
Fig.5. Overlay scarf bandages on various parts of the body.
Sling dressing. Imposing For this type of dressings required wide bandage or strip of cotton cloth length 75-80 sm strip with both ends cut in the longitudinal direction so that the central part remained uncut in length, which is necessary to close the area damage . This uncut portion impose in the transverse direction to the wound site, incised end crisscross and connect the upper with the lower ends. Most of these bands are superimposed on different parts of the head (Fig. 6).
Fig.6. sling bandage
a-oose b – on the chin
Bandages bandages. Bint – a strip of gauze length 5-
Gauze bandage easily takes the form of the body, which bandage. Swathe bandage to create uniform pressure on the fabric and functional body or limb peace.
The bandages on his head and neck
Bandage “Hippocratic cap” (Fig. 76), which covers the scalp, given time is mostly historical value as poorly recorded and easily slips. Therefore, in practice BANDAGES prefer “cap” and “bridle”.
The bandage “cap” imposed following chyanom (Fig. 7B). Segment bandage length of one meter impose symmetrically on the crown. The ends of the bandage loosely hanging on both sides of the head. At the level of the eyebrows and occipital hill impose first circular coil at the ends that hang freely, on each successive development make a loop around the free end, then bandage lead through the neck to the other side of the head, which again make revolution around the free end, and bandage running across the forehead to the other side. Each subsequent round gradually shifted towards the crown until such time as the bandage is not shielding the entire surface of the scalp. Loose ends tied under the chin.
Fig.7. Bandages on his head: a – return б – “cap Hippocrates’ в -” cap “г -” bridle “, d – Neapolitan, е-in one eye; ж – in both eyes, з – cross bandage oeck .
Bandage “bridle”, except the scalp, also closes the side surface of the face, chin, temples and forehead (Fig. 7g). its start with 2-3 circular tour through the forehead and neck, and then drained his ear and transferred to the rear, and then – to the right and front of the neck, then drive on the left cheek vertically up front ear. Make the desired number of vertical tour, covering the crown and nape, then bandage again spend behind the ear on the occipital area, neck, making horizontal tours for fixation.
Union bandage used to stop bleeding from the temporal artery. Impose it with a double-headed bandage. Wrapping begin with whiskey healthy side in the horizontal plane. At the site of injury do decussation (to increase pressure on the wound often placed under the bandage cotton-gauze ball), and then drive bandage perpendicular to the first round (in the frontal plane). Again hold both heads through healthy temple to lesions crosse roblyattam and bandage in the horizontal plane.
Bandage on one eye. If your right eye bandage, bandage held in his right hand and, on the contrary, if the left eye bandaging head bandage shift in the left hand and keep the bandage from right to left. The first imposes a circular tour around the head. The following turns are over the ear healthy side and under the ear from damage (Fig. 7th).
Dressings communication in both eyes begin to apply just like a bandage on one eye. Then go through the nuchal hump on the other side under the ear, then lead up, closing the other eye. Tours crisscross bandage over the bridge of the nose. The bandage complete circular tour around the head. Ears are left open (Fig. 7zh).
The bandage on one or both ears is the same as dressing on one or both eyes, but close ear on the affected side and leave open the eye. You can also follow bandage “bridle”, closing the ear.
Bandages on the chest, abdomen and pelvis
Chest, upper and middle abdomen can safely close spiral bandage Shylovtseva or crosswise bandage (Fig. 8).
To prevent bias simple spiral bandage placed on the bottom half of the abdomen, it is fixed to the femur by spicate dressing. Impose it as follows: the last tour of the back area leading through the ilium, is sent down to the front of the thigh and perform circular tour around it, then bandage directed obliquely upwards on the anterior surface of the stomach to the upper border of the bandage, which serve several circular tour .
Then make another tour that captures bandage the thigh: his lead on the back obliquely down to the ilium, and then through the groin to the thigh. Bandage fix circular tour, transfer it to the anterior abdominal wall, where complete bandage several overlapping spiral rounds.
Fig.8. Bandages on the chest: a – spiral b – dressing Shylovtseva в – cross bandage
Bandage on inguinal area
Inguinal area most conveniently close spicate bandage (Fig. 9a). Bandage fix circular round belly. If you need to close the right groin, bandage are from left to right, and left – right to left. The next tour is oblique – after entering the lumbar region of his directing obliquely down over sacrum, buttocks and the greater trochanter of the femur, remove the front of the thigh, then bandage impose obliquely down the outside inwards, looking around the thigh behind the front surface to lonnogo joints and through the iliac area on the opposite side of the lumbar region. Then impose the required number turivpo go first oblique tour with some of their displacement. To create spicate bandage oblique tours can be combined with circular, allowing securely close the lower abdomen, buttocks, groin and upper third of the thigh. Finish bandage circular rounds on the stomach.
Fig.9. Bandages on the inguinal area and perineum: a – spicate, б, в – cross bandage on the perineum.
Bandage on perineum
This bandage impose follows (fig.9 б,в): bandage fix two circular rounds on his stomach, then impose vosmerkoobraznaya bandage from the crossroads of the perineum. Circular tour becomes slanting through the right groin in the crotch, back-through the left buttock area to the left iliac bone, then through the left groin and perineum on the right buttock area to the right iliac bone. For durability headbands vosmerkoobraznaya tours should combine with circularly around the abdomen.
Bandages on upper limb
Upper limb has a complex configuration, so dressing on it are very different and each includes a combination of different types of bandages.
On fingers brush can impose two kinds of dressings.
Recurrent bandage on finger (Fig. 10a). Originally impose several sharivbynta turn – on the back and on the palmar surface of the finger, which record the circular round at the base and then screw-up nail phalanx. Shape final bandage overlapping spiral upward tours. Fix bandage at the base of the finger. Similar bandage can be applied to all fingers and tassel – bandage “glove”.
Spiral bandage on finger (Fig. 106) is superimposed narrow bandage. A few rounds of circular bandage record in the area of the wrist. When wrapping the right brush tours impose left to right, left – right to left. From wrist bandage carried obliquely to dorsum additions to the base of the finger. Then impose two spiral downward rounds to nail phalanx, then-upward spiral bandage to the base of the finger. Bandage deduce through interfinger span on back of the hand to the wrist, where his record circular tour. Consistently moving the other fingers and repeating the above steps, you can put a bandage on all his fingers – “glove”.
Fig.10. Bandages on fingers: A – reverse b – spiral, в – “glove”.
Spicate bandage on I finger and begins with fixing the bandage on the wrist, then bandage are obliquely through the back surface of the brush and thumb and turn through the back of the hand to the radial-carpal joint. Further, these tours are repeated cross several times successively shifting crosse bandages on his fingers to his foundation. Fix bandage on the wrist.
Bandage on tassel and radial-carpal joint is a combination of circular and cross dressings. Impose a few circular tours on areas of the radial-ulnaris joint, back of the hand through the bandage conducted through 1st interfinger interval on the palmar surface of brush and put a few circular tours tassel. Bandage return via the rear hand on the forearm. Cross tours repeated several times with weave their grazing the surface of the brush. Bandage fixed circular rounds in the area of the wrist joint. Forearms can safely close as spiral bandage (Fig. 10c).
Spicate bandage on tassel
The bandage on the elbow impose bending arms at the elbow angle of 90 ° (Fig. 12). Bandaging several rounds of fixed circular shoulder just above the joint, and then perform cross bandage, which converges with the crossing of tours in the area cubital fossa. Recent tours covering the ulnar bone. Fix circular bandage round the shoulders.
Spicate bandage on the shoulder joint. (Figure 13.) On the shoulder near the inguinal fossa impose three circular tours. With inguinal fossa begin the fourth, leading him up obliquely on the outer surface of the shoulder on his back and then around the chest before this tour. Fifth round bandage lead through the area shoulder joint, slightly covering the previous round, obliquely down around the shoulder and through the inguinal fossa on the anterior surface of the shoulder joint, which goes into the next round, similar to the fourth. Consistently shift tours bandage, completely cover the area joint.
The bandage Dezo used for fixing the entire upper extremity (Fig. 14a). Before her laying in the inguinal area set light cotton-gauze roller, hand pressed against the body and bend at the elbow at 90 °.
Fig.12. Bandage on the forearm and “Turtle” bandage on elbow joint area.
Fig.13. Bandage on the shoulder joint and upper limb
After this circular rounds fix shoulder to chest, from healthy to diseased side. With the inguinal cavity healthy hand bandage spend the anterior surface of the chest on the sore shoulder, transferred back lowered to the elbow, picked up the elbow, forearm and tassel and return the bandage in the inguinal area. Then spend obliquely round the back at shoulder sick hands, transferred forward to the elbow, bend around it and back to back to inguinal cavity healthy side. These tours are repeated several times and finish their horizontal circular bandaging.
Fig.14. Bandages Dezo (a) and Velpo (b).
The bandage Velpo often used after shoulder dislocation reduction (Fig. 14 b). Tassels patient hands put a healthy shoulder. Bandage circular rounds from the patient side, gradually locking arm to the torso. Then keep bandage in inguinal cavity healthy side and the back obliquely to the patient’s shoulder. After this is down round the outside of the shoulder, elbow and envelopes obliquely upwards to hold the healthy inguinal basin. These tours are conducted several times before recording the limbs.
Bandages on the lower limb
Bandage on I finger begins with fixing bandage several rounds at circular pits tibia (Fig. 15). Next tour conducted by the rear foot and
Recurrent bandage on the distal foot. Fix circular bandage several rounds of the tibia, remove it on the dorsum of the foot, throw over your fingers and close the sole of the foot, where the bandage bend and return to the back surface.
A few rounds pivoting cover the entire distal foot, then these tours confirms an upward spiral bandage. Bandage confirms circular rounds of the tibia (Fig. 16).
Fig.15. Spiral bandage on I finger at foot
Figure 16. Bandages on foot: a – return b – spicate в – cross bandage.
Bandage on the whole foot. Bandaging circular rounds fix the tibia and close the side of the foot circular rounds (tension) through the heel and toes. These tours are fixed upward spiral bandage from the toes to the tibia (Fig. 16 б).
Cross bandage for ankle joint. On the leg bones in the area in the direction from left to right impose several circular tours. From inside ankle bandage transferred on the dorsum of the foot to its outer edge, looking around at the cross around the foot and through the back surface leading to the outer ankle, and then – around the shin. These crossing tours repeated several times. Bandage fix the tibia (Fig. 16 в).
Fig. 17. Turtle bandage on foot.
Turtle bandage on the heel area (Fig. 17). Starting two circular tours through the heel and the front surface of the ankle joint. Impose the following tours that diverge alternately above and below the joint. These tours reinforce progress bandage around the heel area, then cross bandage on his ankle joint.
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 (Fig. 45).
Transport immobilization of fractures clavicle
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
Improvised immobilization tires onthe upper limb ‘
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 (Fig. 47).
Stretcher for transporting a patient with a fracture of the spine
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 .
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.
Splint improvised from boards fractures leg
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
Stages of preparation gypsum bandage
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 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).
Different types of gypsum bandages on the lower limb
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.
