T-shaped bandage. Demonstration of the technique of applying a T-shaped bandage to the perineum on a phantom according to the algorithm Diagnosis - hemorrhoidal bleeding

BANDAGES FOR THE ABDOMINAL AND PELVIC AREA

A simple spiral bandage can be applied to the area of ​​the upper abdomen, bandaging from the bottom up; the bandage on the lower abdomen must be fixed on the hips.

Spica bandage of the pelvis

Closes the lower abdomen, upper thigh, buttocks, outer surface of the upper third of the thigh and pelvis and inguinal region (Fig. 27).

Rice. 27. Spica bandage of the pelvis.

In a circular motion, the bandage is strengthened around the abdomen, then the bandage is led from back to front along the side and along the front surface of the thigh, then the thigh is circled from behind and in the inguinal region they cross the previous course. Raising the bandage along the front surface of the pelvis, they circle the body from behind and lead it back to the inguinal region, repeating the second and fourth moves. The bandage is fixed in circular motions around the abdomen. The cross of the tours must be placed along one line, while the bandage moves form an ear pattern.

Spike bandage on both groins

Spike bandage on both groins begins in a circular motion around the abdomen (Fig. 28).

Rice. 28. Spike bandage on both groins.

The bandage is led along the front surface of the abdomen through the left groin (2), then the first moves of the spike-shaped bandage of the left groin (3) are made. Having bypassed the body, they make several turns of the spike-shaped bandage of the right groin (4 and 5), return to the left groin (6 and 7), then again to the right groin (8 and 9), etc. The bandage is strengthened in circular motions around the abdomen (14 and fifteen).

Eight crotch bandage

If it is necessary to cover the perineum, the bandage can be made according to the same type as in fig. 28, but first you need to make several eight-shaped moves crossing at the crotch (1,2,3 and 4) around the upper parts of the thighs (Fig. 29).

Rice. 29. Applying an eight-shaped bandage to the perineum.

Upper limb bandages

BANDAGES FOR THE UPPER LIMB

Spiral finger bandage

The spiral bandage of the finger begins with circular passages in the wrist area (Fig. 30).

Rice. 30. Spiral bandage of the finger.

Then the bandage is led obliquely through the back of the hand (2), to the end of the diseased finger, and from here the whole finger is bandaged to the base (3-7) with spiral turns, then through the back of the hand (8) the bandage is led to the wrist, where it is fixed (9). If it is necessary to close the end of the finger, the bandage is applied as a returning bandage (Fig. 31).

Rice. 31. Applying a returning finger bandage.

Spiral bandage of all fingers

The spiral bandage of all fingers looks like a glove (Fig. 32).

Rice. 32. Spiral bandage of all fingers.

On the left hand, the bandage begins with the little finger, on the right - with the thumb.

Eight-shaped bandage of the thumb

The eight-shaped bandage of the thumb is performed according to the type of spicate (Fig. 33).

Rice. 33. Eight-shaped bandage of the thumb.

The bandage is strengthened in a circular motion on the wrist (1), it is led through the back of the hand to the top (2), from there, spirally wrapping the finger (3), on the back, and then on the palmar surface of the wrist, then again to its end, etc. , rising to the base of the finger and making all the moves, like the previous moves. The bandage is attached to the wrist.

Eight bandage brush

The brush is usually bandaged according to the type of an eight-shaped bandage (Fig. 34).

Rice. 34. Eight-shaped bandage of the brush.

The bandage begins in a circular motion at the wrist (1). The bandage goes obliquely along the back of the hand (2) and passes to the palm, is fixed with a circular move (3) and obliquely but the back of the hand returns to the wrist (4), crossing the second move. In the future, the second and fourth moves are repeated (5 and 6). Attach the bandage to the wrist (7).

Returning hand bandage

Together with the fingers, the hand is bandaged like a returning bandage (Fig. 35).

Rice. 35. Imposition of a returning bandage of the brush.

The bandage is started with two circular moves in the area of ​​the wrist joint (1), then the bandage is lowered along the hand (2) and fingers along the palmar surface, bending around the ends of the fingers, returning to the back of the hand (3, 4 and 5) and, turning the bandage over (6), impose a circular motion around the brush (7). Bending the bandage again, they lead it again along the palmar surface of the hand and fingers and, bending around the ends of the fingers, again lead it up and again fix it in a circular motion around the hand. The bandage is finally fixed in a circular motion around the brush.

Bandage on the forearm and elbow

A bandage is placed on the forearm in the form of a spiral bandage with kinks (Fig. 36).

Rice. 36. The bandage on the forearm is spiral with kinks.

They start with two or three circular moves, and then the bandage moves a little more obliquely than is necessary for a spiral bandage. With the thumb of the left hand, hold its lower edge, roll out the head of the bandage a little and bend the bandage towards you so that its upper edge becomes the lower one and vice versa. The bends of the bandage should be done on one side and along one line.

A bandage on the elbow joint is applied like a tortoiseshell with the elbow bent at an angle (Fig. 37).

Rice. 37. Turtle type bandage on the elbow (moves 1 and 2 - under the bandage).

Spike bandage on the area of ​​the shoulder joint

The bandage goes through a healthy armpit along the front side of the chest (Fig. 38) (1), goes to the shoulder; bypassing it along the front, outer and back surfaces, it passes from behind into the axillary fossa, and from it to the back, through the front and side surfaces of the shoulder (2), where this passage intersects with the previous one.

Rice. 38. Applying a spica bandage to the area of ​​the shoulder joint.

Armpit bandage

Rice. 39. Bandage on the armpit.

After applying the dressing, the entire axillary region is covered with a layer of cotton wool, and the cotton wool goes beyond its borders, and partially covers the upper part of the chest wall from the sides and the inner surface of the shoulder in the upper section. Only by strengthening this layer of cotton can the bandage be made more durable. The bandage is started with two circular tours in the lower third of the shoulder (1-2), then several turns of the spike-shaped bandage are made (3-9) and an oblique move is made along the back and chest through the shoulder girdle of the healthy side to the diseased axillary region (10 and 12). Then make a circular move, covering the chest and holding the vata (11 and 13). The last two moves along the chest - oblique and circular - alternate several times. The bandage is fixed with several moves of the spica bandage of the shoulder.

Bandage on the whole arm

The bandage for the whole arm begins in the form of a glove on the fingers and continues with a spiral bandage with kinks to the shoulder area, where it passes into a simple spiral bandage and ends with a spike bandage (Fig. 40).

Rice. 40. Bandage on the whole arm.

Bandage on the stump of the upper limb

When the shoulder is amputated, the bandage is applied like a spike-shaped bandage to the shoulder joint with the bandage returning through the stump and fixed with spiral tours on the shoulder (Fig. 41).

Rice. 41. Applying a bandage on the stump of the shoulder (like spike-shaped) and forearm.

When amputating the forearm, the bandage begins with a circular tour in the lower third of the shoulder, then the bandage descends along the forearm through its stump, returns up and is fixed with circular tours on the forearm (Fig. 41).

LOWER LIMB BANDAGES

Spiral bandage of the big toe

Separately, usually only one thumb is bandaged, and the bandage is made in the same way as on the arm; strengthen it around the ankles (Fig. 42), the remaining fingers are closed along with the entire foot.

Rice. 42. Spiral bandage of the big toe.

Eight-shaped bandage of the foot

To close the area of ​​the ankle joint, you can use a bandage of the eight-shaped type (Fig. 43).

Rice. 43. Eight-shaped foot bandage.

They start it in a circular motion above the ankles (1), going down obliquely through the rear of the foot (2); then make a move around the groan (3); rising up to the shin (4) but to its rear, they cross the second move. With such eight-shaped moves they cover the entire rear of the foot (5 and 6 ") and fix it with circular moves around the ankles (7 and 8).

Bandage on the foot (without bandaging the fingers)

The bandage is led along the foot (1) from the heel (Fig. 44) to the base of the fingers.

Rice. 44. Applying a bandage on the foot (without bandaging the fingers).

Here they make a move around the foot; going first along the rear, then, wrapping on the sole and rising again to the rear (2), they cross the previous move. After the cross, the bandage is led along the other edge of the moan, reaching the heel, bypassing it from behind and repeating moves similar to the first and second. Each new move in the heel area is higher than the previous one, while the decussations are made closer to the ankle joint (11, 12).

Reversible foot bandage

If you need to close the entire foot, including the fingers, then, having made a circular move (Fig. 45) at the ankles, the bandage is continued with longitudinal moves going from the heel to the big toe along the lateral surfaces of the foot.

Rice. 45. Applying a returning foot bandage.

These moves should be superimposed very loosely, without tension. Having made several moves, repeat the previous bandage (Fig. 44).

Heel bandage

The heel area can be closed like a divergent tortoiseshell bandage (Fig. 46).

Rice. 46. ​​Applying a bandage on the heel region (like a tortoise).

The bandage begins with a circular move through the most protruding part, then moves are added to it above (2) and below (3) the first. It is advisable to strengthen these moves with an oblique move from the side, going from back to front and under the sole (4), in order to then continue the moves of the bandage above and below the previous ones.

Turtle knee bandage

Superimposed with a half-bent knee joint (Fig. 47).

Rice. 47. The imposition of a tortoise bandage on the area of ​​the knee joint:
on the left - with a half-bent knee joint and an eight-shaped bandage,
on the right - with an extended knee joint.

They start with a circular move through the most prominent part of the patella (1), then make similar moves in front alternately lower (2, 4, 6 and 8) and higher (3,5,7 and 9) of the previous one, and behind, almost covering the previous move . When the knee is unbent, a bandage of the eight-shaped type is applied to it, making circular turns above and below the knee joint and oblique with a cross in the popliteal fossa. A bandage is applied to the shin area according to the type of a conventional spiral bandage with kinks.

Bandage on the thigh area

They usually use a spiral bandage with kinks, strengthening it in the upper third to the pelvis with the passages of a spike-shaped bandage.

Bandage on the entire lower limb

The bandage for the entire lower limb (Fig. 48) consists of a combination of the bandages described above.

Rice. 48. Bandage on the entire lower limb.

Bandage on the stump of the lower limb

Such dressings are made according to the type of returning ones (Fig. 49).

Rice. 49. Applying bandages on the stump of the thigh:
on the left - according to the type of returning, on the right - spike-shaped.

For strength, it is fixed above the nearby joint. For example, when amputating a thigh, a spike-shaped bandage is applied that captures the inguinal region; when amputating a lower leg, the bandage is fixed above the knee joint, etc.

SIMPLIFIED BANDAGES

The vast majority of bandages described can be simplified to save material and time.

Simplified finger bandage

A simplified bandage of the finger (Fig. 50) is applied only to the finger, without bandaging the wrist, but only tying the ends of the bandage on it.

Rice. 50. Simplified bandage of the finger.

Simplified armpit bandage

They take a small piece of bandage and tie it in the form of an obliquely running ribbon through a healthy armpit into the shoulder girdle of the diseased side (Fig. 51).

Rice. 51. Simplified bandage on the left axillary region: on the left - in front; right - behind.

A bandage attached from the front to this strip is led to the axillary region, on the back it is thrown over the tape and led back. Such moves are made as many as necessary to hold the bandage. The same bandage is easy to apply in the area of ​​the buttocks and perineum, where it is reinforced with a strip of bandage that goes around the belt.

PATTERNS FOR BANDAGES (CONTINUE BANDAGES)

Bandages made from triangular or quadrangular pieces of cloth and bandages, made according to special patterns for various parts of the body (Fig. 52-56), are very diverse and convenient.

Rice. 52. Patterns of some types of cloth (contour) dressings for various parts of the body.

Rice. 53. Cloth bandages are applied to the stomach (left) and chest (right) and reinforced with gauze strips.

Rice. 54. Cloth bandages are applied to the sternum (left) and the neck and back of the head (right).

Rice. 55. Cloth bandages are applied to the area of ​​the shoulder joint (left) and the pelvic area (right).

Rice. 56. Cloth bandages are applied to the eye (left) and parotid region (right).

Bandages are used on the face, consisting of a series of strips and covering the area of ​​the lips, wings of the nose, and partially the forehead (Fig. 57).

Rice. 57. Simplified bandage on the face (left), mask on the right.

Such dressings are used, for example, for burns if there is no open treatment of the burn. Finally, bandages are applied to the face in the form of a mask, consisting of a piece of cloth with holes for the eyes, nose and mouth, and reinforced with ties at the back.

For the hand, the bandage can be cut from a quadrangular piece of fabric with holes for four or five fingers (Fig. 58).

Rice. 58. Simplified cloth bandage for the brush (left - pattern).

Dressings can be cut out of cloth and bandage, giving them the shape necessary in each individual case, for example, in the form of a bag for the stump. A similar bandage in the form of a bag can be sewn for a finger; it is strengthened at the wrist (Fig. 59).

Rice. 59. Simplified dressings in the form of a bag: on the left - for the stump; on the right - worn on the finger.

KNITTED MESH BANDAGES

Knitted mesh bandages (stocking, tubular) - a new type of soft retaining bandages.

Knitted knitting with a non-unraveling mesh of elastic threads, viscose staple or cotton yarn allows you to prepare tubular, like a stocking, circular sleeves or bags of various diameters. The mesh is rolled up in the form of a roll (Fig. 60).

Rice. 60. Knitted mesh bandages, rolled up in the form of a roll.

Rolls of knitted mesh are designated by numbers from 2 to 35 according to their width in centimeters.

When applying a bandage to the fingers, the numbers 2, 3 are used; for the hand, wrist joint, forearm, lower leg and foot - numbers 5, 7; for the shoulder, lower leg and thigh - numbers 10, 15; for the head, torso, pelvis and hip joint - numbers 25, 35. The application of a circular bandage does not consist in bandaging, but in putting a piece of bandage on the diseased area.

Stocking bandages are applied after closing the wound with cotton-gauze pads. A piece of the required length is cut from a roll of the appropriate diameter. Since the fabric, stretching in width, shortens in length, the cut piece should be 2 or even 3 times the required length of the bandage. After applying a dressing to the wound, a piece of a knitted sleeve is collected with an accordion, stretched as much as possible in diameter and put on a sore spot like a stocking. The mesh is straightened on the affected area of ​​the body, stretched along the length or in a helical manner. To prevent slipping of the bandage, the edges of the mesh are glued to the skin with glue or strips are cut from the edge of the weave and the resulting ribbons are tied around the diseased area of ​​the body.

Thus, bandages are applied throughout the lower leg (Fig. 61), fingers (Fig. 62), shoulder and forearm (Fig. 63).

Rice. 61. Knitted mesh shin bandage.

Rice. 62. Knitted mesh bandage on the fingers.

Rice. 63. Knitted mesh bandage on the shoulder and forearm.

To cover the fingers completely and when applying a bandage to the stump of the limb, one end of the cut piece of the mesh is tied and, stretching the resulting bag along the diameter, is put on the fingers (Fig. 64).

Ras. 64. Knitted mesh bandage on the fingers in the form of bags.

More firmly hold the dressing material bandages, fixed above the fingers (Fig. 65).

Rice. 65. Knitted mesh bandage on the first toe, fixed around the foot.

When applying a bandage to the area of ​​the shoulder and hip joints, it is convenient to fasten the bandages around the torso (Fig. 66) or pelvis (Fig. 67).

Rice. 66. Knitted mesh bandage on the area of ​​the shoulder joint, fixed around the chest.

Rice. 67. Knitted mesh bandage on the area of ​​the hip joint, fixed around the pelvis.

A purse-string is applied to the head (Fig. 68 and 69, 1) after cutting a hole for the face.

Rice. 68. Knitted mesh headband.

Rice. 69. Some options for applying knitted mesh bandages to certain parts of the body:
1 - on the head; 2 - on the chest; 3 and 8 - on the brush; 4 - on the stump; 5 - on a groan; 6 - on the area of ​​the knee joint; 7 - on the pelvic region and buttocks; 9 - on the area of ​​the elbow joint.

A circular bandage is applied to the chest with its reinforcement with straps or circularly tied ribbons cut out of the mesh (Fig. 70).

Rice. 70. Knitted mesh bandage on the chest, secured with straps.

A mesh bandage is prepared for the pelvic region and buttocks by cutting out side holes in the mesh, and put it on like shorts (Fig. 71 and 69, 7).

Rice. 71. Knitted mesh bandage on the pelvic area.

A bandage in the form of a T-shirt with cut holes for the hands can be applied to the chest (Fig. 69, 2). Also, after cutting holes for the fingers, a bandage is applied to the hand and several fingers (Fig. 69, 3 and 8). A circular bandage is applied to the elbow and knee joints (Fig. 69, 8 and 9). On the foot - like a sock (Fig. 69, 5), on the entire hand - in the form of a mitten, on the stump of a limb - in the form of a bag (Fig. 69, 4).

Indications for the use of such dressings can be very wide both in outpatient and hospital settings, especially with a mass flow of victims. Knitted bandages can also be used as a uniform bedding when applying plaster bandages. The advantage of such dressings is the simplicity of technique, speed of application, saving time and consumption of dressing material, as well as the absence of restriction of movements of the diseased part of the body. Knitted bandages can be reused after they have been washed and sterilized.

PRESSURE BANDAGES

Pressure bandages can be applied to areas of the body where compression does not threaten breathing (neck) or blood supply (axillary fossa).

Adhesive bandage with a rigid pad can be used for umbilical hernia in infants.

bandage pressure bandage

When applying a bandage, pressure can be created either by tight bandaging (for example, a bandage on the knee joint for hemarthrosis), or by using a soft pad (ball of cotton, roll of bandage) placed on top of a cotton-gauze pad. The latter technique is convenient, for example, if necessary, to create pressure in the region of the temporal artery. The turns of the bandage lead over the pelota.

Zinc gelatin dressing

Zinc-gelatin bandage best of all provides uniform elastic pressure around the entire circumference of the entire segment of the limb.

Zinc-gelatin bandage with Unna paste is applied to the limb after the bath. In the presence of edema, the limb is kept in an elevated position to subside the edema. The skin of the foot and lower leg is smeared with warm paste and bandaged with a gauze bandage. When bandaging, it is impossible to overturn the bandage, it is better to cut it so that pockets do not form. After secondary lubrication with paste, new rounds of bandage are applied, smearing each layer until a bandage of 4-5 layers of gauze is obtained. Instead of bandages, you can use a thread stocking with a cut off finger end. The stocking is impregnated with a zinc-gelatin mass and pulled over the limb. The dressing is changed after 2-3 weeks.

Dressings with film-forming substances

A dressing with film-forming substances simultaneously protects the wound and does not require additional fixation on the surface of the body. The synthesis of special polymeric materials made it possible to use new, harmless polymers for patients - plastubol (a Hungarian drug), butyl methacrylate with methacrylic acid and linetol - bumetol (a domestic drug). These drugs are more convenient to use in aerosol packaging (in spray cans).

An aerosol of polymer is sprayed onto the wound and surrounding skin. After evaporation of the solvent, a protective film is formed. The can is held vertically 25-30 cm from the surface to be coated. A film forms after a few seconds. It is advisable to apply 3-4 layers of polymer, repeating the spraying half a minute after the previous layer has dried. Store the can upside down. The solvent is flammable and its mixture with air is explosive.

Such dressings are indicated only in the absence of significant discharge from the wound (microtrauma, superficial burns, etc.). Postoperative wounds sewn up tightly can be covered with a protective film without any other dressing. If the wound secret exfoliates the film in the form of bubbles, the latter can be cut off, the discharge removed and the polymer sprayed again. After 7-10 days, the film itself leaves the skin. If necessary, remove it earlier using tampons moistened with ether.

The advantage of film coatings is the possibility of observing the state of the wound edges through the film and the absence of unpleasant sensations of skin tightening, characteristic of collodion dressings. In addition, the polymer film does not irritate the skin.

With open microtraumas after lubrication with an alcoholic solution of iodine, other protective films are also widely used, in particular, from BF-6 glue or B-2 glue with the addition of formalin ( “Shkolnikov's glue”).

Protective films can also be obtained using products containing antiseptics and collodion.

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   Methodical development

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   Methodical development

   Hang higher than the rest of the body. Adhesive plaster traction is widely used in surgery... . Treatment: 1) antibiotic therapy; 2) immobilization of the hand; 3) ointment bandages; 4) X-ray therapy; 5) case novocaine blockade. Peritonitis...

A spiral bandage is applied from the bottom up. In the lower part of the abdomen, such a bandage should be reinforced with a spike-shaped pelvic bandage (Fig. 51).

The imposition of this bandage on the right half of the pelvis, inguinal, gluteal regions and the upper thigh begins with circular moves of the bandage on the abdomen. Then they lead obliquely from top to bottom along the outer, and then the anterior-inner surface of the thigh and, bypassing its back semicircle, lift it up, crossing the previous move. The cross can be made in or behind it. Having passed the bandage along the anterior surface of the abdominal wall, they circle the posterior semicircle of the body with it and direct it obliquely again, repeating the previous moves. A bandage is applied to the left inguinal region and the left half of the pelvis in the same way, but the bandage is led around the left thigh and crosses are made in the left inguinal or gluteal region.

Spica bandage on both inguinal regions(Fig. 52). They begin to impose it, like a spike-shaped bandage of the pelvis; the first moves of the bandage are made on the left inguinal region, and after the bandage is bypassed along the back semicircle of the body, it is transferred to the right inguinal region. The moves of the bandage on the left and right inguinal regions alternate, applying a bandage higher and higher.

Bandages on. Usually a T-shaped bandage (fig. 27) or a bandage on both inguinal regions is sufficient, but it is better to make eight-shaped moves around the thighs before applying it (fig. 53). A more complex bandage - with bandage moves that cross at the perineum (Fig. 54).

Dressing rules:

The injured part of the body must be raised (for example, put the wounded leg on a roll of clothing). If the chest is wounded, it is advisable to seat the wounded and lean his back against some object. When the abdomen is wounded, the wounded person should lie with his stomach up, and a bundle of clothes is placed under his sacrum. During the bandaging of the head, the wounded must keep his mouth open or put a finger under his chin so that the applied bandage does not interfere with opening his mouth and does not squeeze his neck.

The bandage is usually held in the right hand, and the bandage is held with the left and the bandage is straightened. The bandage is led from left to right and rolled out without lifting it from the surface of the body. Each subsequent move of the bandage should cover the previous one, by 1/2 or 2/3 of its width.

To bandage the limbs begin from the periphery and the bandage moves towards the root of the limb. Intact fingertips should be left open so that blood circulation can be monitored through them.

After applying the bandage, check if the bandage is tight, if it is too loose, if it will not slip and unwind.

Head and neck bandages

Bandage for crown, occiput and lower jaw – « Bridle". After a fixing move around the head, the bandage is led obliquely along the back of the head to the right side of the neck and under the chin. From here, several vertical moves are made until the crown or chin is closed. Then the bandage is led to the back of the head and fixed with a move around the head. When bandaging the chin, additional moves are made to this bandage. After a fixing move around the head, the bandage is led obliquely in the back of the head, along the surface of the neck and horizontal moves are made around the chin, and then they again go to vertical moves and fix the bandage in a circular move around the head.

One eye patch begins with a fixing move around the head. From the back of the head, the bandage is led under the right ear to the right eye or under the left ear to the left eye (depending on which eye is being bandaged). The third move is fixing, around the head. The fourth and subsequent moves are alternated so that one move of the bandage goes under the ear to the sore eye, and the other move is fixing, goes around the head.

Bandage on the back of the head also begins with a fixing move around the head (first and second moves). The third move leads to the back of the head and to the neck on the right. Circled around the neck, the bandage is lifted again to the back of the head (fourth move) above the right ear and on the forehead. Repeating the third and fourth moves, close the entire occipital region and secure the end of the bandage with moves around the head.

Bandage around the neck. A bandage is applied to the neck with circular bandaging and several eight-shaped moves are made to the back of the head.

Bandage on the scalp - « Cap » . One section of the bandage (tie) about 0.5 m long is placed on the crown, and its ends are lowered down in front of the ears. The wounded person himself or assisting him pulls the ends of the tie. The first move of the bandage is done around the head over the tie, then the bandage is wrapped around the right tie and led obliquely along the forehead to the left tie, wrapped around it and led to the crown. With such moves, the entire scalp is covered, and the ends of both ties are fixed with a knot.

Sling bandage. On the nose, lips and chin, the bandage is fixed with a sling. A sling is a piece of bandage 60-70 cm long, both ends of which are cut in length. With the middle uncut part, the sling is placed on the nose, lip or chin, and the ends are tied at the back, the lower ones on the back of the head (crown), the upper ones on the neck.

Bandages on the chest, abdomen and perineum

Spiral chest bandage. Unwind about a meter of bandage and leave it on the left shoulder girdle. From the left shoulder, the bandage is led to the back and the chest is bandaged in spiral moves, starting from the bottom. The initial end of the bandage is thrown over the right shoulder and tied back to the other end.

In case of a penetrating wound of the chest with an open pneumothorax, to prevent air being sucked into the pleural cavity, before applying a cotton-gauze pad, the wound is closed with a rubberized outer shell of an individual dressing bag (inner side to the wound) or the wound is sealed with an adhesive plaster (hermetic bandage). If a small or large sterile dressing is used, then a paper wrapper of the dressing is placed on top of the cotton-gauze pad applied to the wound.

Spiral bandage on the abdomen impose in its upper part in circular spiral moves, bandaging from top to bottom.

Spike bandage impose on the lower abdomen, groin, upper thigh and buttocks. Having made a fixing move around the abdomen, the bandage is led from back to front along the lateral and front surfaces of the thigh, and then, circling around the back around the thigh, along the front surface of the thigh and inguinal region, they cross the previous move and circle around the body from behind. With these moves, the bandaged area is closed and the end of the bandage is fixed in a circular motion around the abdomen.

Bandage on both inguinal areas consists of a combination of spike-shaped bandages on the right and left groin.

Crotch bandage. Around the upper part of the thighs, several eight-shaped moves are made, crossing at the crotch. To prevent the bandage from slipping, the front moves of the bandage lead, as with a spica bandage.

T-shaped crotch bandage consists of a belt (bandage) running horizontally around the waist. The end of the bandage tied to the belt is led back to front through the crotch and tied to the same belt in front.

To strengthen bandages on the scrotum use a suspensory. The scrotum is placed in a suspensory bag, putting the penis through a special hole. The suspensorium is fixed with a ribbon extending from the upper edge of the bag, like a belt, and two other ribbons attached to the lower edge of the bag are passed through the crotch and tied back to the belt.

Notebook

By discipline: "Treatment of surgical patients"

Specialty: 060501 Nursing

Student(s) of group 21"M"

Teacher:

Rumyantseva O.V.

BLEEDING:

This is an outpouring of blood from their blood vessels in violation of the integrity of their walls.

Classification:

1. Taking into account time:

1) primary bleeding, starting immediately after injury, injury.
2) early secondary bleeding that occur for the first time hours and days after injury (before the development of infection in the wound). More often they occur from the expulsion of a blood clot by blood flow with an increase in intravascular pressure or when a vessel spasm is relieved.
3) late secondary bleeding, which can begin at any time after the development of infection in the wound.

2. In the direction of blood flow:

1) Explicit :

- internal- bleeding in the body cavity, communicating with the external environment - gastric bleeding, bleeding from the intestinal wall, pulmonary bleeding, bleeding into the bladder cavity, etc.

- external bleeding- blood is poured out of damaged vessels, mucous membranes, skin, subcutaneous tissue, muscles, blood enters the external environment.

2) Hidden:

Bleeding is called hidden, in case of hemorrhage in the body cavity, which do not communicate with the external environment, is the most dangerous type of bleeding.

3. For a damaged vessel:

(depending on which vessel is bleeding, there may be bleeding):

1) capillary- superficial bleeding, blood is close to arterial in color, looks like a rich red liquid, blood flows out in a small volume slowly, the so-called “blood dew” symptom, blood appears on the affected surface in the form of small, slowly growing drops resembling dew drops or condensate.

Bleeding is stopped with a tight bandage. With adequate blood clotting ability, it resolves on its own without medical attention.

2) Venous bleeding characterized by the fact that dark-colored venous blood flows from the wound. Blood clots that occur during injury can be washed away by the blood flow, so blood loss is possible, in the absence of assistance, a gauze bandage must be applied to the wound. If there is a tourniquet, then it must be applied above the wound, a soft bandage must be placed under the tourniquet. And a note with the exact time the tourniquet was placed.

3) Arterial- easily recognized by a pulsating stream of bright red blood that flows out very quickly.

Rendering the first aid: it is necessary to start with clamping the vessel above the injury site.

4) Parenchymal- observed with injuries of parenchymal organs (liver, pancreas, lungs and kidneys), spongy bone and cavernous tissue. In this case, the entire surface (wound) bleeds.

In parenchymal organs and cavernous tissue, parenchymal vessels do not contract, do not go deep into the tissue and are not squeezed by the tissue itself, bleeding is very profuse and short-lived. It is very difficult to stop such bleeding.

5) mixed bleeding- occurs when the arteries and veins are simultaneously injured.

Most often, with damage to parenchymal organs (liver, spleen) with a developed network of arterial and venous vessels, as well as with extensive injuries of the chest and abdominal cavity.

4. According to the severity and resulting blood loss, acute anemia:

1) 1 degree- The general condition of the patient is satisfactory. The pulse is somewhat quickened, sufficient filling. BP is normal. Hb 8; BCC velocity deficit is not more than 5% up to 500 ml.

2) 2 degree- a state of moderate severity, the pulse is frequent. AF reduced to 80 mm Hg. Hb up to 8% gr, BCC deficiency - 5% 500-1000ml.
3) 3 degree- the condition is severe, the pulse is thready. BP 60mmHg Hb - up to 5 gr%, BCC deficiency 30% 1500ml.

4) 4 degree- the state borders on agony. Pulse and blood pressure are not determined. Hb - 5 g%, BCC deficiency 30%; 3000-3500ml.

5.By origin:

1) traumatic- occurs as a result of a traumatic effect on organs and tissues. their strong characteristics. With traumatic bleeding under the influence of external factors, an acute violation of the structure of the vascular network at the site of injury develops.

2) Pathological- is a consequence of pathophysiological processes occurring in the patient's body. The cause of it may be a violation of the work of any of the components of the cardiovascular and blood coagulation systems. This species develops with a minimal provoking effect or without it at all.

EFFECTS:

The danger of any bleeding is that, as a result of which the amount of CK falls, cardiac activity and the supply of tissues (especially the brain), liver and kidneys with oxygen worsen.

With extensive and prolonged blood loss, anemia (anemia) develops. Blood loss is very dangerous in children and the elderly, the body which does not adapt well and the BCC rapidly decreases. Of great importance is the fact that blood flows from a vessel!

For example:

When small vessels are damaged, blood clots form, blood clots close the lumen of the vessel, and bleeding stops on its own. If the integrity of a large vessel, such as an artery, is broken, then the blood beats, flows, expires quickly, which can lead to death in just a few seconds.

Although with very severe injuries (limbs). Bleeding may be large, as there is vasospasm.

All changes in the body during bleeding can be divided into:

1) General changes - they are mainly aimed at compensating for blood loss. In the heart, there is a decrease in the contractile activity of the myocardium, which leads to a decrease in cardiac output and further reduces the CVD.

In the Lungs, due to insufficient blood circulation, pulmonary edema develops, which leads to the so-called shock lung. Due to a decrease in blood flow in the kidneys, filtration decreases and anuria develops, centroglobular necrosis develops in the liver.

Parenchymal jaundice may occur.

2) Local changes - in case of bleeding disorders, the diagnosis becomes based on a visually observed hemorrhage. With internal bleeding, the diagnosis is made on the basis of the general condition of the patient, his analysis and additional studies. When bleeding from the lungs, the blood comes out of the mouth, has a beautiful color and foams. When bleeding from the esophagus, as a rule, the blood is also scarlet. In gastric bleeding, the blood escaping through the mouth is the color of coffee grounds.

If hemorrhages pass in the intestines, the stool becomes tarry in color.

*When bleeding in the renal pelvis, the urine becomes red \ macro

First aid for bleeding.

Ways to stop bleeding are divided into two types - temporary and final.

A temporary stop is used for emergency assistance on the spot until the patient is stopped in the hospital. Finally, only in the operating room.

Improvised means: rope, belt, cloth, etc.

First aid tactics

The person providing assistance assesses the volume and intensity of blood loss. Depending on this and on the presence or absence of the necessary materials, the optimal way to stop bleeding is determined. The type of bleeding is then assessed. There are venous, arterial, capillary bleeding. Next, you should make sure that there is no intracavitary bleeding. In the case of first aid in case of damage to large main vessels, the victim should be taken to a medical facility as soon as possible to provide him with qualified medical care.

When providing first aid, it should be remembered that methods of temporarily stopping bleeding without a health hazard can be used for no more than 1-3 hours. In case of damage to large main vessels, mandatory qualified medical care is required.

Management of bleeding in the hospital

After taking measures to temporarily stop bleeding, the nature and cause of bleeding is assessed and a decision is made on the need to apply methods for the final stop of bleeding.

In case of bleeding from small vessels that has not resumed after the termination of temporary methods of stopping bleeding, there is no need for definitive hemostasis.

In case of damage to large vessels, the presence of abdominal bleeding, extensive or deep wounds, final hemostasis should be performed to reliably stop blood loss.

With most bleeding from small arteries and veins, as well as from capillaries, the bleeding stops spontaneously.

Methods for temporarily stopping bleeding. The most reliable method is the imposition of a tourniquet, but it is used mainly in the limbs (see a-d). The application of a tourniquet on the neck (with bleeding from the carotid artery) with a strap or through the armpit of the healthy side is rarely resorted to. You can use the Cramer splint applied to the healthy half of the neck, which serves as a frame. A tourniquet is pulled on it, which presses down on the gauze roller and squeezes the vessels on one side.

Harness application:

a-preparation for the application of a tourniquet;

b-the beginning of the overlay;

c-fixation of the first round;

tourniquet applied;

d-imposition of a tourniquet on the neck.

In the absence of a splint, you can use the hand on the healthy side as a frame, which is placed on the head and bandaged. Applying a tourniquet to compress the abdominal aorta is dangerous due to the fact that trauma to the internal organs can occur. A tourniquet is a rubber tube (Esmarch's tourniquet) or a 1.5 m long tape, ending with a metal chain on one side and a hook on the other. With established arterial or in doubtful cases with massive bleeding, a tourniquet is applied above the injury site. The intended area of ​​application of the tourniquet is wrapped with a soft material (towel, sheet, etc.), i.e., a soft pad is created. The tourniquet is strongly stretched and applied closer to the chain or hook, 2-3 rounds are made with a tourniquet, subsequent turns weaken, then the hook is attached to the chain. The time of application of the tourniquet must be indicated, since compression of the artery by a tourniquet for more than 2 hours on the lower limb and 1 "/ 2 hours on the upper one is dangerous due to necrosis of the limb. pallor of the skin of the limb.If it is necessary to transport the wounded for more than 1 "/2-2 hours, the tourniquet should be periodically removed for a short time (10-15 minutes) until the arterial blood flow is restored. In this case, the damaged vessel is pressed down with a tupfer in the wound or the artery is pressed digitally. Then the tourniquet is applied again slightly above or below the place where it was located. Subsequently, if necessary, the procedure for removing the tourniquet is repeated, in winter - after 30 minutes, in summer - after 50-60 minutes.

After applying the tourniquet, the limb is immobilized with a transport splint; in the cold season, the limb is wrapped to prevent frostbite. The victim with a tourniquet is transported in a supine position after the introduction of analgesics, transportation is carried out in the first place.

Rough and prolonged compression of tissues with a tourniquet can lead to paresis and paralysis of the limb, both due to traumatic damage to the nerve trunks and as a result of ischemic neuritis that develops as a result of oxygen starvation. Oxygen starvation of tissues below the applied tourniquet creates fertile ground for the development of anaerobic gas infection, i.e., for the growth of bacteria that multiply without oxygen. Given the risk of developing severe complications, it is better to temporarily stop bleeding by applying a pneumatic cuff to the proximal part of the limb. In this case, the pressure in the cuff should slightly exceed the arterial pressure.

Places of pressure of arteries at a temporary stop of bleeding.

Finger pressure on the arteries

A - sleepy

B - submandibular

B - temporal

G - subclavian

D - shoulder

E - axillary

F - femoral

Finger pressing of the artery for a long time, if performed correctly, leads to the cessation of bleeding, but it is short-term, since it is difficult to continue pressing the vessel for more than 15-20 minutes. The artery is pressed in those areas where the arteries are located superficially and near the bone (Fig. 9, 10): the carotid artery is the transverse process of the VI cervical vertebra, the subclavian is the I rib, the humerus is the region of the inner surface of the humerus, the femoral artery is the pubic bone . The pressure of the brachial and femoral arteries is good, the carotid artery is bad. It is even more difficult to press the subclavian artery, which is located in such a temporary shunt, arterial circulation is restored. It can function from several hours to several days, until the possibility of a final stop of bleeding presents itself.

Pressure point of the arteries:

In case of severe bleeding from the vessels of the neck and face, to stop it, the carotid artery is pressed against the cervical vertebra along the inner edge of the sternocleidomastoid muscle (see figure).
Bleeding from limbs can be stopped by flexion. To do this, a gauze roller is placed in the elbow or popliteal fossa, depending on the place of bleeding, and then the limb is bent and bandaged as much as possible. A more convenient and reliable method is the application of a tourniquet (see figure).
In this case, the limb is pulled 5-10 cm above the injury site with several tight turns of the rubber tourniquet until the bleeding stops completely. In the absence of a special rubber band, you can use a twist-twist from a handkerchief or a piece of cloth.

But in any case, the tourniquet cannot be applied directly to the body (you need to put a piece of cloth, a bandage) and keep it for more than 1.5 hours. As experimental studies have shown, prolonged application of a tourniquet is extremely dangerous. It not only disrupts blood circulation in the limbs, but also leads to deep degenerative processes in the internal organs, in the brain, the heart muscle, and often causes the development of shock.
Therefore, after the allowable period has elapsed, the bleeding vessel is pressed with a finger and the tourniquet is relaxed for a while, until the limb turns pink and warm again. If the bleeding does not stop, the tourniquet is applied again slightly above or below the previous place.
With a slight bleeding, it is enough to press the bleeding area with a sterile napkin and, after applying a small cotton wool roller, bandage it tightly. At low air temperatures, the limb on which the tourniquet is applied must be carefully wrapped to avoid frostbite.
Nosebleeds are stopped with the help of cotton or gauze balls, which are plugged (tightly clog) the bleeding nostril. It is recommended to seat the victim, tilt his head back and put a napkin moistened with cold water, a bundle with ice or snow on the bridge of the nose and forehead. When applying the cold stop method, it should be remembered that after 40-45 minutes of exposure to cold, dilatation (expansion) of the vessels occurs. Do not apply cold stop for more than 30 minutes.

Temporary stop.

Tourniquet (in winter - no more than 30 minutes, in summer - no more than 1 hour). With arterial bleeding, it is applied above the injury site, with venous bleeding - below. When applying a tourniquet, it is necessary to put a note with the time of application and be sure to apply the tourniquet to the tissue in order to avoid pinching the limb. To do this, you can use the clothes of the victim.

Finger pressure - external

Maximum limb flexion - external

Ice application - external

Insert a tampon - internal

Ultimate Ways to Stop

Vascular closure

Tamponade of the wound - in case of impossibility of suturing the vessels

Vessel embolization – with this method, an air bubble is introduced into the vessel, which is fixed on the vascular wall exactly at the site of damage. Most often used in operations on the vessels of the head.

Hemocoagulation - with the help of the introduction of natural and artificially synthesized hemocoagulants locally and into the general bloodstream.

Harness application:

The place of the proposed application of the tourniquet is wrapped with a towel with a piece of cloth, several layers of bandage

The tourniquet is stretched and 2-3 turns are made around the limb along the specified substrate, the ends of the tourniquet are fixed either with a chain and a hook, or tightened with a knot

The limb must be tightened until the bleeding stops completely;

· - the time of application of the tourniquet must be indicated in a note attached to the clothing of the victim, as well as honey. Documents accompanying the victim.

With a properly applied tourniquet, bleeding from the wound stops and the peripheral pulse on the limb is not determined by palpation. You should know that the tourniquet can be kept for no more than 2 hours on the lower limb and no more than 1.5 hours on the shoulder. In the cold season, these periods are reduced. A longer stay of the limb under the tourniquet can lead to its necrosis. It is strictly forbidden to apply bandages over the tourniquet. The tourniquet should lie so that it is conspicuous.

After applying a tourniquet, the victim must be immediately transported to a medical facility for the final stop of bleeding. If the evacuation is delayed, then after the critical time has elapsed, the presence of the tourniquet for partial recovery of bleeding must be removed or loosened for 10-15 minutes, and then applied again slightly above or below the place where it was located. For the period of release of the limb from the tourniquet, arterial bleeding is prevented by finger pressure of the artery throughout. Sometimes the procedure for loosening and applying the tourniquet has to be repeated: in winter every 30 minutes, in summer after 50-6 minutes.

To stop arterial bleeding, you can use the so-called twist from improvised means. When applying a twist, the material used should be loosely tied at the required level and form a loop. Insert the stick into the loop and, rotating it, twist it until the bleeding stops. After that, the specified stick is fixed. It must be remembered that the application of a twist is a rather painful procedure; in order to prevent infringement of the skin during twisting and reduce pain, some kind of dense gasket is placed under the knot. All the rules for applying a twist are similar to the rules for applying a tourniquet.

To temporarily stop bleeding at the scene, it is sometimes possible to apply a sharp (maximum) flexion of the limb, followed by its fixation in this position. This method of stopping bleeding is advisable to use in case of intensive bleeding from wounds. The maximum flexion of the limb is performed in the joint above the wound and the limb is fixed with bandages in this position. So in case of injury to the forearm and lower leg, the limb is fixed in the elbow and knee joints. In case of bleeding from the vessels of the shoulder, the arm should be brought to failure behind the back and fixed; when the thigh is injured, the leg is bent at the hip and knee joints and the thigh is fixed in a position brought to the stomach.

Often the bleeding succeeds, it will stop with a pressure bandage. Several sterile napkins are applied to the wound over which a thick roll of cotton wool or bandage is tightly bandaged.

To temporarily stop venous bleeding, in some cases it is effective to create an elevated position as a result of placing a pillow, clothing, or other suitable material under the injured limb. This position should be given after applying a pressure bandage to the wound. It is advisable to put an ice pack and a moderate load such as a sandbag on top of the bandage on the wound area.

The final stop of bleeding is carried out in the operating room, tying the vessel in the wound or throughout, stitching the bleeding area, applying a temporary shunt.

It should be remembered that any movement of the limb stimulates blood flow in it. In addition, when blood vessels are damaged, blood coagulation processes are disrupted. Movement can cause additional vascular damage. Splinting limbs can reduce bleeding. In this case, air tires are ideal, but tires of any type will also be useful.
The intensity of venous bleeding can be significantly reduced by raising the limb above the level of the heart. Effective in combination with direct pressure.
Stopping bleeding, especially from a large main vessel (carotid, femoral arteries) is only a temporary measure, but nevertheless it is necessary, because it allows you to prevent a large loss of blood, which in. conditions of autonomous existence can be fatal.
The fastest, albeit short-term way to stop bleeding is to press the vessel with your finger.

In case of arterial bleeding, clamping the vessel proximal to the site of injury stops bleeding, and in case of venous bleeding, it intensifies it. Anatomists and surgeons have identified the points at which pressure on the vessel during arterial bleeding has the greatest effect (see figure - a).

When the brachial artery is injured, it is pressed with a finger to the bone along the inner edge of the biceps muscle (see figure - b).

The femoral artery is pressed against the femur along the inner edge of the quadriceps muscle (see figure - c).

Desmurgy

Desmurgy(from the Greek δεσμός - “connection, bandage” and έργον - “case”) - a branch of medicine that studies the rules for treating wounds, dressings and methods for applying them.

It is customary to distinguish between the definition of "bandage" from "bandaging". The latter is usually superimposed only on wounds or ulcers and consists of individual tissues and substances brought into direct contact with the wound. The first one has the task of holding dressings and is generally applied for various purposes: to hold dressings; for pressure on a diseased part of the body, when the pressure itself is required as a therapeutic technique (pressure bandage); to immobilize (immobilize) the affected limb (fixed bandages), etc. For this purpose, use bandages (see), scarves, scarves and slings.

Bandages are single-headed, when they are rolled up with a roller that has one free end, double-headed, when they are rolled into two rollers and both ends of the bandage are rolled up inside them and only the middle is free, and multi-headed (or complex), when another bandage is sewn at a right angle one (T-shaped bandage), two (four-headed, or double T-shaped, bandage) or more bandages.

Bandages are prepared gauze, canvas, flannel, rubber. Most often, the former are used, and gauze for bandages is used dressed or starched, in the form of soft and in the form of hygroscopic gauze. Dressed gauze bandages are wetted when applied and, when dried, form a rather dense bandage. Bandage bandages, depending on the bandage, are circular, spiral, serpentine, eight-shaped, spicate, tortoiseshell, returnable and criss-crossing. In addition to bandages, scarves are also used for dressings, which, being folded in various ways, allow an extremely diverse use of them. Dr. Major introduced them into surgical practice more than 50 years ago, which is why such dressings are also called Major's. A scarf folded diagonally gives a scarf; twisted handkerchief - a tourniquet used to strongly squeeze any parts of the body (for example, in case of bleeding). Examples of the diverse use of scarves can be seen in the table.

At present, large scarves are being prepared with drawings of various bandages, for which such scarves are appropriate. Slings are made from a long quadrangular piece of linen, which is folded transversely and cut lengthwise through both layers from the side with the free end not less than two-thirds of its length when folded. Such a quadrilateral, being expanded, has 4 free ends and a solid middle. Slings are four-headed, six-headed, etc. Sling-like bandages often replace bandages with great success.

In order to apply a pressure bandage, flannel and especially rubber bandages are most often used. Having sufficient elasticity, the flannel bandage evenly presses on the part of the body being bandaged, without cutting into its surface anywhere and without forming constrictions on the skin. Rubber bandages are either made of pure rubber, or made of paper or silk fabric, and exert uniform pressure, therefore they are used with great success in many diseases (edema, chronic ulcers of the lower extremities, etc.). Rubber bandages and rubber tourniquets are often applied to stop bleeding, and sometimes during operations in order to bleed the operated parts. So called. immobilization of any affected limb is best achieved by immobilization of bandages. The easiest way is to use tires, splints, superimposed on the limb being tied, around which a bandage is circled. But such dressings are applied for a short time and are replaced by hardening dressings that remain for a very long time. A wide variety of substances are used to harden the dressing: egg white, paste, glue, liquid glass, cottage cheese with lime, gypsum, shellac, gutta-percha, felt.

But gypsum is most appropriate, and for lighter dressings - a paste or good liquid glass, especially in combination with tires from a folder or gutta-percha. For plaster casts, the finest and dryest gypsum powder is rubbed into the bandage; plaster bandages are dipped into a deep bowl of cold water, and when they are sufficiently saturated with water, they are applied to a suitably prepared limb to be bandaged. On top of the bandage, another plaster gruel is smeared. After the bandage and gruel have dried, a hard bandage is obtained, which completely eliminates the ability of the bandaged limb to move. For a paste bandage, paper or linen bandages are used, which, when unfolded, are pulled through the paste. Such dressings dry very slowly, and therefore, for greater strength, they also use cardboard or gutta-percha splints. Liquid glass dressings are obtained by lubricating linen or paper bandages with a large paint brush with a solution of potassium silicate in water. Such dressings are very light, but have little ability to counteract the displacement of the bones.

The art of applying bandages, especially bandages, must be studied practically and requires great skill and skill, since in case of inept application not only the intended goal is not achieved, but great harm can be done to the patient. So, for example, an incorrectly applied pressure bandage can cause swelling and even necrosis of the underlying part. At present, desmurgy, as a separate subject, is taught in almost all medical faculties, and in paramedic schools and communities of sisters of mercy, it is considered one of the most important subjects.

Bandage it is used for small or tightly sutured wounds, boils, for approaching the edges of granulating wounds (Fig. 3), for rib fractures (Fig. 4), and also after reduction of umbilical hernias (Fig. 5). A patch bandage is applied from the coil of an adhesive patch after it is unwound or with a bactericidal adhesive patch after the protective film is removed from it. The plaster is applied with a sticky side directly to small wounds, abrasions, scratches after they have been treated with an iodine alcohol solution or over the dressing material with strips of various shapes (Fig. 1). The strips should capture areas of the skin in the circumference of the dressing (Fig. 2).

Zinc gelatin dressing used to apply constant pressure for varicose ulcers of the lower leg.
Powdered gelatin (200 g) is placed in cold water (200 ml) to swell. Excess water is drained and a vessel with softened gelatin is placed in a water bath (in another vessel with boiling water), stirred until the gelatin becomes liquid. Mix 100 g of zinc oxide with 300 ml of water and add 100 g of glycerin. This mushy mass is added with stirring to the gelatin and then poured into a flat cup, where it solidifies into a paste. Before applying a zinc-gelatin bandage, the paste must be heated in a water bath and, when the paste becomes mushy, lubricate the skin of the foot and lower leg with it; a bandage bandage is applied on top (4-5 layers), additionally smearing each layer with paste.

Cleol bandage used in the same cases as the patch. A gauze rolled up in several layers is applied to the affected area, the skin in a circle is smeared with cleol. When it starts to dry out (filaments form between the finger and the skin when touching it), a gauze napkin is applied in one layer, pulling it and pressing it tightly against the skin smeared with cleol. Cut off excess gauze. Sometimes, when applying bandage dressings, for their greater strength, the skin around the wound is lubricated with cleol.
Cleol recipes: pine or spruce resin 30 g, ether 100 g, linseed oil 0.1 g or rosin 40 g, alcohol 95 ° 33 g, ether 15 g, sunflower oil 1 g. When adding antiseptic substances (furatsilin) ​​or antibiotics (synthomycin) can be used to lubricate abrasions, scratches and superficial cuts. Healing takes place under a film covering the wound.

collodion dressing used in the same cases as the patch. Having covered the wound with a dressing, a gauze napkin is applied over it. Its free edges, adjacent directly to the skin, are moistened with collodion and wait until it dries (Fig. 6).

Bandages with rubber adhesive. With uniform lubrication of the applied dressing with rubber glue (a solution of rubber in a mixture of ether and gasoline), you can protect it from getting wet.
Such dressings are useful in young children to protect the wound from wetting with urine.

kerchief bandages. A kerchief is a triangular piece of cloth or a scarf folded diagonally (Fig. 7). Its long side is called the base, the angle opposite it is called the top, and the other two angles are the ends. Bandages are used most often in first aid. The most convenient sling for hanging the arm (Fig. 8). The middle of the scarf is placed under the forearm bent at a right angle, the top is directed to the elbow, one end goes between the body and the arm, the other over the arm. The ends are tied around the neck. To improvise a scarf, you can use a strip of cloth, a towel (Fig. 9), the floor of a jacket (Fig. 10).
A kerchief can be applied to any part of the body, for example, it can cover the entire scalp (Fig. 11), mammary gland (Fig. 12), hand (Fig. 13), elbow joint (Fig. 14), buttocks (Fig. 15), lower leg (Fig. 16), foot (Fig. 17). Having folded the scarf along the base in the form of a tie, it can be used to apply a bandage on the axillary region and shoulder girdle (Fig. 18). Two kerchiefs, one of which is folded with a tie, can cover the area of ​​the shoulder joint (Fig. 19), the buttocks and the upper thigh (Fig. 20).

bandage bandages

sling bandage- a strip of bandage or cloth, both ends of which are cut longitudinally (Fig. 21). It is more often used on the face (Fig. 22), chin (Fig. 23), occiput (Fig. 24) and crown (Fig. 25).

T-band- a strip of cloth or bandage, to the middle of which another strip is sewn or thrown over it (Fig. 26). The horizontal part is fixed around the waist, and the vertical part passes through the crotch (Fig. 27) and is tied or pinned to the first strip.

bandage bandages most convenient, as they best hold the dressing and apply uniform pressure. When applying a bandage, the patient should be in a comfortable position, and the bandaged part of the body should be motionless and accessible to the bandager. The leg should be straightened, the foot should be at a right angle (Fig. 28), the arm bent at the elbow (Fig. 29), the shoulder should be slightly abducted from the body, the fingers should be slightly bent with the I and V fingers opposed (Fig. 30). When bandaging the pelvis, abdomen and thigh, it is convenient to use special stands (Fig. 31) or sliding tables.
The bandager stands facing the patient to monitor his condition and see if he is causing pain. Bandaging is carried out from the bottom up, from left to right, that is, clockwise. With the right hand, the head of the bandage is deployed, with the left hand they hold and straighten its moves.
Each turn of the bandage (tour) should cover the previous half or 2/3 of its width; fix the end of the bandage on the side opposite the wound, cutting it along the length and tying it around the bandaged part. When bandaging any part of the body, the following types of bandage bandages are used: circular (circular), spiral (Fig. 62), creeping, cruciform (Fig. 37) or eight-shaped, spike-shaped (Fig. 64) and turtle (Fig. 63).
Simplified dressings. To save dressings, dressings can be simplified (Fig. 78-80).

The most commonly used bandage (Fig. 81), suspensory, dressings of various shapes according to patterns on the sternum (Fig. 82 and 83), the back of the neck (Fig. 84), on the shoulder (Fig. 85), inguinal region (Fig. 86), on the eye (Fig. 87), parotid region (Fig. 88), face (Fig. 89), hand (Fig. 90), finger (Fig. 91), stump (Fig. 92).

Bandages on the head and neck

Return bandage(Fig. 32) has the form of a cap and covers the vault of the skull. Having fixed the bandage around the head, make an inflection in front and lead the bandage along the side surface of the head above the circular one. The same inflection at the back of the head allows you to cover the side surface of the head on the other side. Having fixed the kinks with a bandage around the head, they are repeated, making oblique moves higher and higher until they cover the entire head. A slightly stronger bandage with a double-headed bandage (Hippocratic hat). The moves of one head of the bandage will be circular, the other - oblique, going sequentially one after the other. A bandage with a cap is more durable and convenient (Fig. 33), for the imposition of which a piece of bandage about one meter in size (tie) is torn off, placed in the middle on the top of the head and the ends are held taut. After the circular motion of the bandage, having reached the tie, wrap the bandage around it and lead obliquely to the occipital or fronto-parietal part. flipping over
bandage around the tie on both sides, impose its tours higher and higher (Fig. 34), until the entire cranial vault is covered. The ends of the vertical ribbon (strings) are tied under the chin. When applying a bandage to the right eye, making a circular move, they descend further down to the back of the head and lead them, covering the auricle and eye. Oblique moves alternate with circular ones until the entire eye is covered. The bandage is applied to the left eye in the same way, but the head of the bandage is held in the left hand and circular and oblique moves are made from right to left (Fig. 35). The bandage on both eyes (Fig. 36) is started with a circular bandage through the forehead, then an oblique move is made, covering the left eye. Having passed the bandage below the auricle and around the back of the head, they lead it under the right ear and cover the right eye. Having fixed the previous moves in a circular manner, they repeat the oblique ones, making them lower and lower with a cross in the frontal region.

cruciform bandage on the occipital region and neck (Fig. 37). The bandage fixed in a circular motion is lowered obliquely along the occipital region to the neck behind and below the right ear. Then the bandage is carried out along the side and front surface of the neck under the chin, below the left ear through the occipital region. Repeating the moves of the bandage, crossing at the back of the head, rise higher and higher. The bandage is strong, but it should not be applied tight, so as not to squeeze the neck.
Bandage supporting the lower jaw (Fig. 38). Having fixed the bandage with a horizontal stroke through the forehead, they lead it obliquely through the back of the head and the lateral surface of the neck and, having reached the chin area, they switch to vertical bandage passages through the temples and crown of the head. These passages can cover the entire cranial vault. The same bandage can also serve to close the chin region, if several horizontal passages are attached to it, covering the chin, alternating with vertical ones through the temporal regions and the crown (Fig. 39). To create pressure on the temporal region, a nodal bandage is convenient, applied with a double-headed bandage with passages crossing in the temporal region (Fig. 40). A Neapolitan bandage is convenient for the area of ​​​​the ear and mastoid process (Fig. 41), when applied, after fixing the bandage, oblique tours are made around the head, descending lower and lower and covering the auricle and the area of ​​​​the mastoid process. Bandaging the neck is one of the most difficult tasks, as tight bandages make it difficult to breathe, and loose bandages are easily dislodged. They are applied according to the type of cruciform bandages of the occipital region (Fig. 42) and chest (Fig. 43) with a decrease in the number of circular passages and their replacement with oblique ones.

Bandages on the chest

A spiral bandage is convenient (Fig. 44). So that it does not stray, one or two so-called armholes are applied. Having torn off a piece of bandage, put it in the middle on the left shoulder girdle, the ends are lowered along the chest and back. A bandage is applied over this strip (armhole) with spiral passages rising from the bottom up. The ends of the armhole are tied in the area of ​​the right shoulder girdle. The ends of the two armholes are also tied (Fig. 45).
Cross-shaped bandage on the chest (Fig. 46). The bandage is fixed in a circular motion and lead from the right axillary region obliquely along the chest to the left supraclavicular, across the back transversely to the right supraclavicular and obliquely along the chest to the left axillary. On the back, the bandage is directed to the right axillary region, and then all previous moves are repeated, placing the tours of the bandage on the front surface of the chest higher and higher. Bandages for the mammary glands. Applying a bandage on the right mammary gland begins with a circular motion of the bandage along the chest, below the mammary glands (Fig. 47). The next course of the bandage is made oblique, covering the lower-inner part of the gland and directing it to the left supraclavicular region. On the back, the bandage is lowered obliquely from top to bottom into the right axillary region and covers the outer-lower part of the gland with it. In the future, the same moves are repeated, applying bandage tours higher and higher until the entire gland is covered. A bandage is applied to the left mammary gland in the same way, but the head of the bandage is held in the left hand and turns are made from right to left. Bandaging on both mammary glands (Fig. 48) begins, as well as on the right mammary gland. Having covered the lower-inner and outer parts of the gland, the bandage is carried out under the left mammary gland in an oblique direction along its lower-outer surface, it is lifted obliquely along the back to the right supraclavicular region, from there - into the gap between the glands, covering the inner-lower part of the mammary gland. Then all the turns of the bandage are repeated in turn, covering both mammary glands with them all the higher.
Bandage Deso used for bandaging the arm to the body in order to provide first aid for a fracture of the collarbone, shoulder (Fig. 49). For bandaging the left hand to the body, the bandage is held as usual, and for bandaging the right hand, the head of the bandage is held in the left hand and bandaged from right to left.
The first part of the bandage consists of one or many circular bandage moves over the arm pressed to the body and bent at the elbow joint. A roller of cotton wool wrapped with a piece of gauze or bandage is first placed in the axillary fossa. To apply the second part of the bandage, the bandage from the axilla of the healthy side is led obliquely along the anterior surface of the chest to the supraclavicular region of the diseased side, lowered from the back from top to bottom under the elbow, covered with a bandage forearm and directed obliquely along its anterior surface to the axillary cavity of the healthy side. On the back, the bandage is directed obliquely to the supraclavicular region and down the front surface of the shoulder. Covering the elbow with a bandage in front, it is carried out on the back and obliquely along it into the armpit of the healthy side. All moves are repeated, while triangles are formed on the front and back surfaces.
Velpo bandage(Fig. 50) is more often used after reduction of a dislocated shoulder, when a hand bent at the elbow joint with a hand placed on the supraclavicular region is bandaged to the body. First, the bandage is led horizontally, from under the armpit of the healthy side, along the back is transferred to the area of ​​the shoulder joint and along the shoulder from top to bottom, covering the elbow and forearm, is directed to the armpit of the healthy side. All moves are repeated, with the horizontal tours being placed lower than the previous ones, and the vertical ones more and more inward.

Bandages on the abdomen and perineum

A spiral bandage is applied from the bottom up. In the lower part of the abdomen, such a bandage should be reinforced with a spike-shaped pelvic bandage (Fig. 51).
The imposition of this bandage on the right half of the pelvis, inguinal, gluteal regions and the upper thigh begins with circular moves of the bandage on the abdomen. Then the bandage is led obliquely from top to bottom along the outer, and then the anterior-inner surface of the thigh and, bypassing its back semicircle, is lifted up, crossing the previous move. The cross can be made in the groin or posterior to it. Having passed the bandage along the anterior surface of the abdominal wall, they circle the posterior semicircle of the body with it and direct it obliquely again, repeating the previous moves. A bandage is applied to the left inguinal region and the left half of the pelvis in the same way, but the bandage is led around the left thigh and crosses are made in the left inguinal or gluteal region.
Spica bandage on both inguinal regions(Fig. 52). They begin to impose it, like a spike-shaped bandage of the pelvis; the first moves of the bandage are made on the left inguinal region, and after the bandage is bypassed along the back semicircle of the body, it is transferred to the right inguinal region. The moves of the bandage on the left and right inguinal regions alternate, applying a bandage higher and higher.

Bandages on the crotch. Usually a T-shaped bandage (fig. 27) or a bandage on both inguinal regions is sufficient, but it is better to make eight-shaped moves around the thighs before applying it (fig. 53). A more complex bandage - with bandage moves that cross at the perineum (Fig. 54).