Bandaging: application technique, types of bandages. Applying a heat-insulating bandage to patients with frostbite Technique for applying a heat-insulating bandage

1. A piece of soft tissue, folded several times, is applied to the affected area.

2. Cover this layer with oilcloth or waxed paper of such a size that it completely covers the wetted fabric.

3. Put an even larger layer of cotton wool on the oilcloth. You can use a bike, flannel, woolen scarf.

4. Fix all three layers with several turns of the bandage.

If the bandage was applied correctly, then after removing it, the fabric remains moist and warm.

BASIC CONCEPTS ABOUT ELECTRICAL TRAUMA AND ELECTRIC BURN

Electrical injury and burns from exposure to electric current or lightning strikes have their own characteristics of the course and, under certain conditions, can cause instant death of the victim even before assistance is provided.

Electrical trauma- this is an electric shock or lightning strike, accompanied by profound changes in the central nervous system, respiratory and cardiovascular systems, combined with local damage.

There are low voltage injuries and high voltage injuries. Low voltage currents are commonly used in household electrical appliances. More often, children who have access to sockets, switches, and wiring suffer from them. The general effect of a low voltage current is to convulsively contract the muscles, as a result of which the victim is unable to free himself from the source of voltage. There may be loss of consciousness, impaired cardiac activity and respiration. There have been cases of death from low voltage currents.

As a rule, brushes are subjected to local action of low voltage current. The skin on the hands is often damp, as a result of which it becomes a good conductor of electricity. The current penetrates deep into the tissues and destroys them. Usually, this results in deep burns of III-IV degree. As a result of such a burn, you can lose your fingers.

High-voltage burns are the most life-threatening. As a result of the general action of high voltage currents, death can occur instantly or even several hours after the cessation of the current. Often, victims lose limbs due to local exposure to high voltage. Such injuries occur upon contact with wires carrying high voltage technical current, when entering transformer boxes, during earthworks in the high voltage cable passage area and in other places specially marked with the “high voltage” sign.

The effect of current on the human body is presented in table. 10.

Table 10

The specific effect of current on the body and its consequences

Current action

Cell protein coagulation: tissue necrosis Thermal injury: burns, charring

Tissue dissection: tearing off parts of the body and limbs

Excitation of skeletal and smooth muscles: pain, convulsions, spasm of the respiratory muscles, spasm of arterioles, tissue hypoxia, respiratory and cardiac arrest

The immediate cause of death on the spot is most often: respiratory arrest of a central nature due to the effect of current on the structures of the brain; respiratory arrest of a peripheral nature due to spasm of the respiratory muscles; fibrillation (chaotic contractions) of the ventricles of the heart.

Remote causes of death can be: electric shock, which develops against the background of inhibition of brain functions, leading to disruption of the organs and systems of the body; late cardiac disorders that occur against the background of myocardial hypoxia due to spasm of the coronary arteries (infarction-like changes).

According to the severity of electrical injury can be:

light, when convulsions are noted without loss of consciousness and without disturbances in breathing and cardiac activity;

moderate, when, against the background of convulsions, there is a loss of consciousness, but without disturbances in breathing and cardiac activity;

heavy when, against the background of convulsions and loss of consciousness, respiratory and cardiac disorders are noted;

extremely heavy when, under the influence of current, a state of clinical death instantly develops.

With any severity of electrical injury, the victim must be hospitalized for observation in connection with the possible development of distant life-threatening complications.

The survival of the victim is also affected by current loops, that is, the path along which it passes through the body. It is especially dangerous when current loops affect vital organs. The place of current entry and exit is called current marks. P6| it can approximately be judged on the path of passage of the current loop. For example, if the input mark is located on the upper limb, and the exit mark is on the foot, then the current has gone into the ground, passing through the entire body of the victim. In such a situation, its direct effect on the heart muscle is not excluded.

For local treatment burn wounds use two methods: closed and open. At the beginning, the primary toilet of the burn wound is produced. Swabs moistened with a 0.25% solution of ammonia, 3-4% solution of boric acid, gasoline or warm soapy water, wash the skin around the burn from contamination, after which it is treated with alcohol. Scraps of clothing, foreign bodies, exfoliated epidermis are removed, large blisters are incised and their contents are released, small ones are often not opened, fibrin deposits are not removed, since wound healing occurs under them. Very contaminated areas of the burn surface are cleaned with a 3% hydrogen peroxide solution. The burn surface is dried with sterile wipes.

As a rule, the primary toilet of a burn wound is performed after a preliminary injection of 1-2 ml of a 1% solution of promedol or omnopon under the skin.

private method treatment is more common and has a number of advantages: it isolates the burnt surface, creates optimal conditions for local medical treatment of burn wounds, provides more active behavior of patients with significant burns and their transportation. Its disadvantages are laboriousness, high consumption of dressings and painful dressings.

These shortcomings are devoid of open method of treatment. With it, the formation of a dense scab on the burned surface is accelerated under the influence of the drying effect of air, ultraviolet radiation or lubrication with substances that cause protein coagulation. However, this method of treatment makes it difficult to care for victims with extensive deep burns, there is a need for special equipment (cameras, special frames with electric bulbs), there is an increased risk of nosocomial infection, etc.

Each of the methods has certain indications and they should not be opposed, but their rational combination is necessary.

Superficial burns of the II and III degrees with the open method of treatment heal on their own. The open method should be used for burns of the face, genitals, perineum. A burn wound with an open method of treatment is lubricated 3-4 times a day with an ointment containing antibiotics (5 and 10% synthomycin emulsion) or antiseptics (0.5% furacilin, 10% sulfamilon ointment). With the development of suppuration, it is advisable to apply bandages. When deep burns are detected and granulating wounds are formed, it is also better to switch from an open method of treatment to a closed one.

Currently, mafenide (sulfamilon hydrochloride) in the form of a 5% aqueous solution or 10% ointment is successfully used, especially in cases where the microflora of burn wounds is insensitive to antibiotics. Preparations containing silver and non-hydrophilic sulfonamides (silver sulfadiazine) are gaining distribution. They have a pronounced antibacterial effect, promote epithelialization at optimal times.

With a favorable course, II-degree burns self-epithelialize within 7-12 days, III-degree burns by the end of the 3-4th week after the injury.

With deep burns, the formation of a scab continues for 3-7 days as wet or coagulative (dry) necrosis. In the first case, the spread of necrosis, a pronounced suppurative process, and intoxication are noted. Rejection of a dry burn eschar begins from 7-10 days with the formation of a granulation shaft and ends by 4-5 weeks. In stages, the burn eschar is separated from the underlying tissues and removed. With deep burns in the first 7-10 days, the main task is to create a dry burn eschar by drying the burn surface with a solux lamp, using ultrasonic irradiation, and treating with weak solutions of potassium permanganate. To accelerate the rejection of the scab, chemical necrectomy, proteolytic enzymes, 40-50% salicylic or benzoic acid are used.

3. Applying heat-insulating dressings

First, the frostbitten limb must be bandaged, moreover, very loosely! Then, wrap with a thick layer of cotton wool. An oilcloth or 2-3 layers of plastic film are applied over the cotton wool. In conclusion, this whole "layer cake" is wrapped in a woolen fabric: a scarf, shawl, handkerchief or blanket.

Such a thermally insulating bandage provides the effect of a thermostat. A frostbitten limb isolated from a direct heat source continues to maintain sub-zero temperatures for some time. Heat comes to it from the center, as if sneaking up imperceptibly, gradually, which entails not a sharp, but a gradual increase in the temperature of the frostbitten area. It is fundamentally important that blood circulation is restored first, and then tissue thawing occurs. A few hours later, after the restoration of blood circulation, the bandage can be removed.

With the timely and correct application of the heat-insulating bandage, after its removal, no blisters are found under it, and therefore the wound heals without scarring. But most importantly, even in the most severe cases, amputations can be avoided.

required:

a) in the pre-reactive period

b) in the reactive period

60. On the burnt surface is superimposed:

a) dressing with furacillin

b) dressing with synthomycin emulsion

c) dry sterile dressing

d) dressing with a solution of tea soda

61. Cooling the burnt surface with cold water is shown:

a) In the first minutes after injury

b) only with 1st degree burns

c) not shown

62. A typical attack of angina pectoris is characterized by:

a) retrosternal localization of pain

b) duration of pain for 15-20 minutes

c) duration of pain for 30-40 minutes

d) duration of pain for 3-5 minutes

e) the effect of nitroglycerin

e) irradiation of pain

The optimal position for the patient during an attack

angina is the position:

c) lying on your back with legs raised

d) lying on the back with the lowered foot end

64. Conditions under which nitroglycerin should be stored:

a) t - 4-6 degrees

b) darkness

c) sealed packaging

65. Contraindications for the use of nitroglycerin are:

a) low blood pressure

b) myocardial infarction

c) acute cerebrovascular accident

d) traumatic brain injury

e) hypertensive crisis

66. The main symptom of a typical myocardial infarction is;

a) cold sweat and severe weakness

b) bradycardia or tachycardia

c) low blood pressure

d) chest pain lasting more than 20 minutes

First aid to a patient with acute myocardial infarction

includes the following activities:

a) lay the patient down

b) give nitroglycerin

c) ensure complete physical rest

d) immediately hospitalize by passing transport

d) if possible, administer painkillers

In a patient with myocardial infarction in the acute period,

develop the following complications:

b) acute heart failure

c) false acute abdomen

d) circulatory arrest

e) reactive pericarditis

69. Atypical forms of myocardial infarction include:

a) abdominal

b) asthmatic

c) cerebral

d) asymptomatic

d) fainting

In the abdominal form of myocardial infarction, pain can

feel:

a) in the epigastric region

b) in the right hypochondrium

c) in the left hypochondrium

d) to be encircling

d) all over the stomach

e) below the navel

71. Cardiogenic shock is characterized by:

a) restless behavior of the patient

b) mental arousal

c) lethargy, lethargy

G). decrease in blood pressure

e) pallor, cyanosis

1. Moisten a piece of soft cloth, folded several times, in water at room temperature, squeeze lightly and apply to the affected area.

2. Cover this layer with oilcloth, waxed paper, the casing of an individual dressing bag, cellophane of such a size that it completely covers the wetted fabric.

3. Put an even larger layer of cotton wool on the oilcloth, you can use the pads of an individual dressing bag, woolen fabric, flannel, bike, clean footcloth.

4. Fix all three layers with a few turns of the bandage.

5. If the bandage is applied correctly, then after it is removed, the fabric remains moist and warm.

Recovery occurs in 5-7 days. However, the frostbitten area becomes more sensitive to cold. Persons with frostbite II, III and IV degrees are sent to the first-aid post.

General freezing is accompanied by a significant decrease in body temperature. The freezing first appears lethargy, speech and movements slow down, accompanied by trembling and drowsiness. In this state, people tend to fall asleep and lose consciousness. Due to the continuing decrease in body temperature, respiration and cardiac activity first weaken, and then stop. There comes the so-called clinical death. At the same time, if the body temperature has not fallen below 22 - 25 degrees, the freezing person can save his life. The victim should be taken to a warm room as soon as possible, if possible, placed in a bath, the water temperature in which should be increased from 20-25 to 40 degrees in 20-30 minutes. In the absence of a bath, the victim is warmed with heating pads. If possible, he should be given warm sweet drinks and alcohol. In the absence of breathing and cardiac activity, perform artificial respiration and heart massage.

The most important practical measures to protect against frostbite are the prevention of sweating of the feet, serviceable, free, dry shoes and clothes, as well as active movements (walking, running) made in the cold, hot tea and food.

In winter, during exercises, to protect against the cold, it is necessary to apply available measures to dry clothes and shoes.

When following a car, you should sit with your back in the direction of travel.

The floor of the body must be covered with straw or other improvised materials. On halts, you should get out of the car and do jogging.

At low temperatures, frostbite can occur when touching with bare hands the metal parts of combat vehicles, instruments, weapons and tools. To avoid this, all work should be done with gloves or mittens.

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The use of gum bandages in periodontology is possible at the stages of etiotropic and restorative (surgical) treatment. When conducting etiotropic local therapy with some prolonged gel, ointment forms, the dressings perform an isolating function, ensuring their long-term retention in the periodontal pocket. They prevent the dissolution or dilution of the concentration and leaching of oral fluid of drugs.

The use of a gum bandage after surgical treatment provides:

1. Protection of the postoperative wound from the external environment.

2. Minimizing postoperative wound infection.

3. Control of postoperative bleeding.

4. Closer fit of the mucosal flap to the underlying bone tissue, especially in cases where the flap is displaced apically.

5. Creation of the best conditions for healing, by protecting the surface of the postoperative wound from trauma during chewing and the accumulation of plaque.

6. Reducing pain during eating, talking, tongue movements.

7. Creation of more comfortable conditions for the patient in the postoperative period.

To achieve these goals, the gum dressing must meet the following requirements:

Be soft and pliable so that it is convenient to place it on the dental arch and alveolar process and easily adapt to its surface.
. Have a short curing time.
. After hardening, do not deform, firmly fix on the gum, do not move or break.
. After hardening, have a smooth surface to prevent mechanical irritation of the mucous membrane of the lips and cheeks.
. Be biocompatible with the tissues of the oral cavity, do not contain substances that provoke an allergic reaction in a particular patient.
. To be resistant to oral fluid, have a slight pleasant taste or be tasteless, odorless.
. Have an antimicrobial effect to ensure the control of dental plaque in the postoperative period.

In periodontology, 2 types of gum dressings are used:

1. Eugenol-containing.
2. Not containing eugenol.

Eugenol-containing gum dressings have been used since 1923. They are based on zinc oxide and eugenol mixed into a homogeneous plastic mass. Dressing powder contains magnesium dioxide, rosin, which gives strength to the dressing, tannic acid (bacteriostatic, astringent action), cellulose fibers (resistance in oral fluid, strength) and zinc acetate (hardening catalyst). In addition to clove oil, thymol, color additives and fruit oil (apricot, peach, lemon, etc.) are included in the composition of the liquid to mitigate the irritating effect of clove oil and as a fragrance. In addition, these oils increase the plasticity of the dressing. They can be prepared in advance according to the recipe and kept in the refrigerator wrapped in wax paper.

The side effects inherent in eugenol-containing dressings (burning sensation, increased sensitivity of periodontal tissues, possible development of allergic reactions to ingredients) have led many doctors to abandon their use and prefer eugenol-free gingival dressings, the main components of which are fatty acids and metal oxides. These are, as a rule, official, ready-made forms. One of the most commonly used dressings is Soe-Rak, which is prepared by mixing the contents of two tubes to the desired color. One of them contains zinc oxide, oil (as a plasticizer), resin (to improve adhesion to the gums) and a fungicide. The second tube contains coconut fatty acid, resin and chlorothymol, which provides the dressing with antimicrobial properties.

The ready-made forms of gum dressings include Wasorask, Reprask. The composition of the latter includes amyl acetate, butyl flatal, zinc oxide, zinc sulfate, filler. Cyanoacrylate dressings are another option for eugenol-free dressings. They are a gel, liquid or aerosol, which are applied immediately to the postoperative wound, previously well dried, and harden within 5-10 seconds.

These dressings adhere well to any surface (smooth, rough, uneven) and last from two to seven days. Some manufacturers add antimicrobials (chlorhexidine, nitrofurans) or antibiotics (oxytetracycline, neomycin) to cyanoacrylate dressings, however, in order to avoid unforeseen complications, it is necessary to carefully collect an allergic history before using them. In order to remove or prevent tooth hypersensitivity, it is recommended to include fluoride varnishes in the dressing immediately before application.

Gingival bandage application technique

Before application, a good hemostasis of the wound is carried out, it is cleaned with a 1.5-3% solution of hydrogen peroxide, dried with warm air, isolated from saliva. A two-component dressing is prepared by mixing on a plate according to the instructions. The finished form is taken from the package with a sterile spatula and rolled into a roller.

The application of the prepared bandage begins with the tooth distal from the wound on the vestibular surface of the gum.

It should cover the gingival margin no more than "/3 ​​of the height of the crown and attached gingiva. With a cotton ball, the bandage is slightly pushed into the gingival embrasure space, without filling the gingival or periodontal pocket. Modeling it is completed either by light pressure with a finger (gloved) , lubricated with a thin layer of petroleum jelly to prevent sticking, or with a lip (cheek).In the same way, the gingival margin is isolated from the lingual (palatal) surface.Do not apply a bandage in excess, since it may be displaced, irritated up to a gag reflex; should not interfere with occlusion.It hardens in 20-30 minutes.

The optimal period for the presence of a gum dressing after surgical treatment is up to 7 days. If necessary, it can be increased. However, the bandage should be removed, the wound examined, and its antiseptic treatment should be carried out. To isolate drugs in the periodontal pocket, the gingival bandage is applied from 2-3 hours to a day. It depends on the dosage form of the medication introduced into the pocket, the duration of its action.

If the bandage is deformed, broken, then after anesthesia and antiseptic treatment of the gums, it can be re-applied or “repaired”.

Polishing of the root surface in the postoperative period is indicated no earlier than a week after the removal of the bandage. The use of soft rubber cups, fine strips and fine abrasive pastes is recommended.

Hygienic manipulations in the oral cavity by the patients themselves should be carried out carefully so as not to damage the bandage. The additional appointment of antimicrobial rinses is recommended.

Protective gingival dressings are mainly used after curettage, gingivectomy, mucogingival and osteomucogingival operations. Protective gingival dressings are used after curettage, gingivectomy, some mucogingival operations using free cheap grafts, and also in osteomucogingival surgery.

A. S. Artyushkevich
Periodontal diseases