19.06.2013

Bandages and dressings

The existing variety of dressings requires classification for a better understanding of their purpose. Currently, there is no single generally accepted classification of dressings. From our point of view, the following classification of dressings is one of the rational options.

9.1. CLASSIFICATION OF BANDAGES

According to the type of material used.

Soft:

a) bandages;

b) bandage-free (adhesive, scarf, sling-shaped, adhesive plaster, T-shaped, coverings).

Hard (tire, starch, gypsum). Depending on the purpose.

Wound dressings:

a) sorption;

b) protective;

c) activated by drugs;

d) atraumatic (promoting wound healing and protecting from drying and mechanical irritation).

Fixing - intended for fixing the dressing material on the wound.

Pressure bandages - creating constant pressure on any part of the body (to stop bleeding).

Occlusive (sealing) dressings - preventing air from entering the pleural cavity from the outside and disrupting the act of breathing.

Compression - designed to improve venous outflow of blood from the lower extremities.

Immobilizing bandages:

a) transport;

b) therapeutic (ensuring immobility of the damaged part of the body).

Corrective bandages - correcting the incorrect position of any part of the body.

Soft bandages include bandages applied using bandages, gauze, elastic, mesh-tubular bandages, and cotton fabric. Soft

dressings are varied. Most often, bandages are applied to hold dressing material (gauze, cotton wool) and medicinal substances in the wound, as well as to carry out immobilization while the victim is being transported to medical institution. Most often, bandages are used to apply soft dressings. Less commonly, other means (bandage-free) - adhesive, scarf, sling-shaped, T-shaped, contour bandages; mesh-tubular bandages.

Rigid dressings use hard material (wood, metal) or material that can harden: plaster, special plastics and starch, glue and

Most often in desmurgy, bandages are used to fix the dressing material in the wound to create optimal conditions tissue healing.

It is necessary to clearly understand the difference between dressing material and methods of fixation.

9.2 DRESSINGS AND WOUND DRESSINGS

The dressing material used during operations and for dressings must meet the following requirements: be biologically and chemically intact; have capillarity and good hygroscopicity; be minimally friable; soft, elastic, do not injure soft tissues; it is easy to sterilize without losing its qualities; be cheap to produce.

Based on their properties, modern dressing materials are divided into:

Sorptive;

Protective;

Activated by drugs;

Atraumatic.

Classic sorbents that are widely used are cellulose and its derivatives - cotton wool, gauze, lignin.

The most common dressing material used in surgical practice is gauze. Medical bleached hygroscopic gauze can be of two types - pure cotton and with an admixture of viscose. The difference is that gauze with an admixture of viscose is wetted 10 times slower than cotton gauze, but medicinal substances are absorbed worse on it, and repeated washing reduces its sorption capacity. The advantage of hygroscopic gauze is its high moisture capacity. Large and small napkins, tampons, turundas, balls and bandages, cotton-gauze medical dressings, and dressing bags are made from it. The annual consumption rate for a surgical bed is 200 m of gauze and 225 pieces of bandages.

A very valuable dressing material is cotton wool, which comes in two types - simple (non-fat-free) and hygroscopic. The latter has high suction capacity. Plain cotton wool is not hygroscopic and is used in surgery as a soft lining, for example, when applying splints, plaster casts, and also as a material that retains heat (warming compresses, etc.). The disadvantage of cotton wool is its relative high cost.

A cheap dressing material, which also has very high suction properties, is lignin - a specially processed wood of coniferous trees, produced in the form of layers of thin corrugated paper. Due to its low elasticity and strength, as well as its insufficient popularization among medical workers, lignin has not found widespread use. In general, any absolutely clean rag can be successfully used as a dressing material in extreme conditions. However, it is completely unacceptable to use artificial fiber fabrics for these purposes.

The insufficient amount of natural cotton materials, as well as the need to take into account the phases of the wound process, determine the development of non-woven synthetic materials. An example is a medical non-woven, thread-free canvas fabric made on the basis of cotton fibers, which has good plasticity and a sorption capacity of 1,400-2,400%. Based on the chemical modification of viscose fibers, medical surgical hygroscopic cotton wool “Viscelot-IM” with an absorption capacity of 2,000% has been developed.

Immobilization of cellulose sorbents on such fabrics increases the absorption capacity to 3,400%. Low cost and ease of sterilization determine the widespread use of such materials - cellulose gauze (Russia), “ES” (Germany), “Surgipad” (USA), etc.

The disadvantage of these materials is adhesion to the wound. This leads to injury to the granulations, with pain syndrome during dressings.

These disadvantages are absent in dressings with an absorbent layer of cellulose, which are represented by a non-adhesive internal and external water-repellent layer that prevents secretion from leaking. Currently, self-fixing cellulose wound dressings are produced with a hydrophobic micromesh on the wound side, a suction pad made of pure cotton wool and a soft non-woven base coated with hypoallergenic polyacrylate glue. For the treatment of small superficial wounds non-adhesive gel dressings with an integrated absorbent element made of cellulose wadding are produced. These dressings are highly absorbent and air permeable.

Combined sorption dressings with three-dimensional suction ability have been created based on cellulose material. In this case, discharge from the wound is distributed not only superficially, but throughout the entire volume of the dressing.

The range of dressings includes dressings based on carboxymethylcellulose, viscose, and oxidized cellulose. Multilayer dressings made of non-woven material such as “Biatraum” (Russia) have a gauze-like structure and consist of viscose fiber and polyester.

In addition to increasing the number of layers of cellulose material, special sorbent materials are placed in the bandage for this purpose.

According to the degree of affinity for water, all sorbents are divided into water-swelling and hydrophobic.

The sorption capacity of water-swelling sorbents is comparatively higher. This group sorbents realize their activity due to the combined action of three main factors - capillarity, high porosity and the effect of functional hydrophilic groups that bind water and components of wound exudate. Gelevin and others used for this purpose are not wound coverings in pure form and should be used with a gauze dressing.

Hydrophobic sorbents, in comparison with water-swelling ones, have a lower ability to absorb liquid, but actively sorb microorganisms. Hydrophobic sorbents include carbon, organosilicon, polyurethane, etc. The most widely used are polyurethane sponges, which have good permeability to air and water vapor. They are elastic and soft, and their sorption capacity is 1,800-2,000%.

Various carbon materials - vaulene, resorb, etc. - are widely used as hydrophobic wound sorbents. The use of carbon materials is advisable in the treatment of wounds with low exudation. Carbon sorbents are a convenient basis for the immobilization of various drugs.

Hydrocolloid dressings are effective sorption-active dressings. This type of dressing consists of swelling colloids that are encased in a self-adhesive elastomer. Hydrocolloid dressings are intended for the treatment of slightly and uninfected, as well as moderately and slightly exuding wounds, as well as wounds with areas of “dry” necrosis. Due to the properties of the hydrogel, a plasticizing effect on wound tissue is ensured, softening of necrotic formations during the diffusion of the gel under them and facilitating the removal of non-viable tissue.

Protective bandages. They perform the function of isolation, preventing the penetration of microorganisms into the wound, and also limit moisture loss. The main, and sometimes the only, structural element of such coatings is an elastic polymer film.

Protective bandages are divided into two groups:

Coatings used in finished form;

Coverings that form directly on the wound.

Coverings of the first group are transparent films attached to a healthy part of the body using adhesives. They allow you to monitor its condition without removing the film, but are effective only on wounds that are not accompanied by copious discharge exudate.

Insulating coatings of the second group are formed directly on the surface of the wound. For this purpose, aerosol compositions have been proposed, which, when applied to a wound for 1-2 minutes, will create a film coating due to the evaporation of the solvent. Film-forming aerosols include BF-6 glue, furoplast, “Lifuzol” (Russia), “Plastubol” (Hungary), etc. Coatings of this group are used to protect surgical wounds from infection, protect the skin from maceration and treat small skin wounds. Their advantages are simplicity and speed of application, which do not require high qualifications. medical personnel. Saving dressing material, the ability to monitor the condition of the wound without changing the dressing, the film is waterproof, allowing you to wash patients. The use of film-forming coatings is contraindicated for bleeding, contaminated, weeping wounds, and extensive skin damage.

For large skin defects, it is very important to limit the evaporation of tissue fluid. Dressings used for these purposes are presented in the form of a polymer film with controlled gas and vapor permeability. For the same purpose, bandages are made from silicone or natural rubber, polyvinyl chloride, polyurethane, polyamides, polyethylene, polystyrene, polypropylene, and silicone. IN last years a wound covering made from chitosan was obtained - “Chitosan” (Great Britain, Taiwan). This coating consists of a derivative of lobster chitin and is a semi-permeable biological membrane.

Drug-activated dressings. To increase the therapeutic effect of the dressings, they include medications of various directions of action. Nonwoven materials made of polyvinyl alcohol fibers activated with sodium dichloroisocyanurate or hydrogen peroxide, cotton dressings, fluorolone compounds, oxidized cellulose and viscose fibers, various sponges and films are used as carriers for the immobilization of medicinal substances. When introducing medications into dressings, combinations of them are often used. To combat infection, wound dressings include antiseptics (dioxidine, chlorhexidine, capatol, miramistin) - "Aseplen-K" and "Aseplen-D", sulfonamides, antibiotics, "Lincocel" (Belarus), nitrofurans - "Coletex", iodine - “Aserlen-I”. Silver ions and xeroforms are also used.

As a result of the immobilization of proteolytic enzymes on the polymer coating material, it is possible not only to extend the duration of the enzyme and reduce its therapeutic concentration, but also to limit the possibility of absorption of the drug into the bloodstream. For this purpose, enzymes are used - trypsin, chymotrypsin, lysozyme, terrilitin, etc. This group of wound coverings includes: “Polypore” - a polyurethane foam composition with immobilized trypsin; "Dalceks-trypsin" - trypsin immobilized on medical gauze; "Paxtrypsin" - trypsin immobilized on nylon knitted fabric; "Teralgin" is a porous sponge containing the enzyme terrilitin; "Ferantsel" (Belarus) - contains chymotrypsin immobilized on monocarboxycellulose.

In some cases, there is a need for local application of coatings with hemostatic properties. For this purpose, it is possible to use wound dressings containing gelatin and thrombin.

Atraumatic dressings. A serious drawback of many dressings is their sticking (adhesion) to the wound, as a result of which the dressings become painful, and most importantly, injury to regenerating tissue occurs. Currently, to eliminate these shortcomings, gauze dressings impregnated with paraffin and lanolin are used. However, such dressings are impermeable to air and do not have sorption properties.

In addition to gauze, polymer materials are widely used to create non-adhesive dressings. The principle of their design is that the surface of the cellulose or synthetic material, facing the wound, is covered with a thin film of a hydrophobic polymer, and in order for the dressing to not lose its sorption activity, the film is usually perforated. Polyethylene, polyvinyl chloride, polyamides, silicone, and polypropylene are used as materials for the hydrophobic layer. To increase the rate of absorption of exudate by the sorbent, it is proposed to coat the perforated film with surfactants, as, for example, in the Aseplen dressing.

Another way to make non-adhesive dressings is to cover the surface facing the wound with a thin layer of vacuum-sprayed metal, impregnated with silicone or acrylic resin containing ZnO, silver or aluminum powder.

The simplest and long-used atraumatic dressings are ointment dressings. The physical and mechanical properties of such dressings can vary due to the type of material used or the composition of the ointment base. Their use is indicated in patients with sensitive skin or intolerance to medications.

There is a group of adhesive but atraumatic sorbent coatings based on natural and synthetic polymers. This type of dressing does not need to be removed and remains in the wound until completely absorbed. Alginates belong to this group of wound dressings. In particular, “Algipor”, which is a mixed sodium-calcium salt of alginic acid, a polysaccharide obtained from seaweed.

The use of collagen to produce absorbable wound coverings is associated with its properties to stimulate fibroblastogenesis, lyse and replace connective tissue. The Kombutek-2 coating was developed based on soluble collagen; “Oblekol” is a collagen film with sea ​​buckthorn oil; "Gentacicol" - combination drug, containing gentamicin sulfate. These drugs are used to treat bedsores, donor skin sites and other wounds in the 2nd phase of the wound process. Absorbable dressings can also be made on the basis of synthetic polymers: polyglycolide, polylactide, etc.

9.3. FIXING BANDAGES

The dressing material on the wound should be applied so that it does not get knocked down and does not compress the damaged part of the body, providing, under certain indications, rest for the damaged organ, the most favorable functional position and free outflow of wound discharge.

There are quite a large number of ways to fix the dressing material, and each has certain indications.

Adhesive bandages

Adhesive dressings are applied to the area of ​​the postoperative wound and for small injuries. Their advantages:

By closing the wound area directly, you can observe the condition of the surrounding skin;

Easy and quick to apply;

Do not restrict the patient’s movements;

Economical.

The following adhesive dressings are available.

Adhesive bandages

The simplest form of strengthening dressing is an adhesive bandage. The adhesive plaster is produced in the form of rolls of tape of various widths. It adheres well to dry skin and is used to secure various bandages and seal small wounds. An adhesive plaster is also used when it is necessary to bring the edges of a granulating wound closer together and hold them in this position to speed up the healing process. An adhesive patch is used to treat fractures using continuous traction, especially in children. An adhesive plaster is of great importance when it is necessary to eliminate the connection of any cavity with the atmosphere, for example, in case of penetrating wounds chest. To apply such a bandage, take a piece of adhesive plaster that is larger than the wound. The first strip is placed at the lower edge of the wound, bringing its edges closer together. The second strip of plaster and each subsequent one in such a way that they cover the previous one by 1/3 of the width, like tiles on a roof, hence the name “tile-shaped” bandage. Adhesive dressings come off when wet, irritate the skin, and are labor-intensive and expensive for large volumes.

Cleola bandage

Currently, cleol is used for sticker bandages, which does not tighten and irritates the skin less. Its composition: rosin - 40 parts, alcohol 96° - 33 parts, ether - 15 parts, sunflower oil - 1 part. The procedure for applying an adhesive bandage: a dressing material is applied to the wound, and the skin around the wound is smeared with a cotton swab and a thin layer of cleol. After 30-60 seconds, when the glue begins to dry a little, glue a gauze napkin of the required shape and size, pressing it tightly to the skin and stretching it along the edges. The free edges of the gauze napkin that do not adhere to the skin are cut off.

Collodion dressing

Collodion is a solution of colloxylin in ether and alcohol. The solution is applied with a brush to the edges of a gauze pad placed over the dressing material. When the solvents evaporate, the collodion hardens, tightly fixing the bandage to the skin. The disadvantages of this dressing are skin irritation and discomfort as a result of skin tightening at the site of smearing with collodion; in addition, collodion is highly flammable. Currently, collodion dressings are used quite rarely.

Headbands

A scarf bandage is a common first aid bandage, since it does not require complex devices and can be quickly applied using a headscarf, sheet, piece of gauze, canvas, etc. A scarf is understood as a piece of triangular-shaped fabric, in which the base is distinguished (the long side ), the top (the angle opposite the base) and the ends - the remaining two angles.

When providing first aid, a scarf made from a headscarf can be used to apply a bandage and fix the dressing on almost any part of the body. However, most often a scarf bandage is used to suspend the upper limb, especially for injuries of the forearm and hand.

To fix the arm (Fig. 9-1), the latter is bent until right angle, and the scarf is brought so that the upper end is placed under the collarbone on the side of the affected arm, and the second end hangs down, the top of the scarf comes out from under the elbow. Having turned the upper end up in front of the forearm of the sore arm, it is passed to the shoulder girdle of the healthy side and to the back of the neck, where it is tied to the other end of the scarf. The top of the scarf is folded around the elbow and secured in front of the elbow with a pin.

Rice. 9-1. Using a scarf for immobilization shoulder girdle and upper limb

Using a scarf, you can apply bandages to the mammary gland (Fig. 9-2), foot, hand (Fig. 9-3) and head. When bandaging the head, the scarf is placed on the back of the head and crown, the top is lowered onto the face, the ends are tied on the forehead, then the top is folded in front of the tied ends and secured with a pin.

Rice. 9-2. Using a scarf to apply a bandage to the mammary gland

Rice. 9-3. Applying a scarf bandage to the hand. 1,2,3 - stages of applying a bandage

Sling bandages

In desmurgy, a sling is understood as a piece of gauze in the form of a ribbon 50-60 cm long, both ends of which are cut into longitudinal direction so that the middle 10-15 cm long is uncut (Fig. 9-4).

Rice. 9-4. Sling bandage

This bandage has 4 ends; the middle part is designed to cover the damaged area over the dressing material and secure the latter. A sling bandage is most often used on the face in the area of ​​the nose, forehead, back of the head, and chin as a temporary measure for holding tampons and temporary immobilization. Like a scarf, it does not seal the damaged area and is not durable.

The technique of applying a sling-shaped bandage on the nose to the chin is shown in Fig. 9-5 (a, b), and on the back of the head and crown - (c, d). A prerequisite when applying a sling is to cross its ends before tying.

T-shaped bandages

This bandage is convenient for holding dressing material on the perineum, scrotum and anus. Easy to manufacture, can be quickly applied and removed if necessary. Consists of horizontal and vertical (wider) strips of bandage, with the horizontal part going around the waist in the form

Rice. 9-5. Options for applying sling dressings

belt, and the vertical one - from the lower back through the crotch forward and tied to the same belt (Fig. 9-6). A T-shaped bandage can successfully replace the so-called suspension used to support the scrotum, for example, after surgery for hydrocele, orchitis, orchiepididymitis, etc.

Rice. 9-6. T-shaped perineal bandage

Bandages using elastic mesh-tubular bandages

To hold sterile material on the wound, tubular knitted bandages and elastic mesh-tubular bandages “Retilast” are widely used, which, having great extensibility, tightly fit any part of the body, do not unravel when cut and at the same time do not limit movements in the joints. They look like a tube woven from cotton and rubber threads and come in different diameters. Depending on the size, there are five numbers of tubular bandages: ? 1 - on the finger, ? 2 - on the forearm or lower leg, ? 3 - on the shoulder, ? 4 - on the thigh and head, N 5 can stretch so much that it can be put on a person's chest or stomach. Having a mesh structure, elastic mesh-tubular bandages provide the possibility of aeration and monitoring the condition of peri-wound tissues.

Bandages

Bandage dressings are the most common, as they meet the requirements for a modern rational dressing (strength, elasticity, porosity, creation of the required pressure, etc.). Currently, soft gauze with good elasticity is used almost exclusively for bandaging. Gauze bandages do not prevent the evaporation of moisture from the dressing. Bandages made of denser fabric (flannel, canvas, calico) are not currently used. The use of soft bandages remains to this day one of the most common ways to strengthen dressings, despite the widespread use of adhesive plaster, cleol, polymerizing plastics, synthetics, etc. This is explained by the versatility of bandages, their adaptability to any type of body surface and any pathological process. If we add to this the possibility of their combination with other methods of fixation, then the scope of their application becomes limitless.

The rolled part of the bandage is called the head, and its beginning is the free end. Bandages can be single-headed or double-headed (rolled from both ends to the middle), the latter are used in exceptional cases (headband). The back of the bandage, i.e. the surface facing the part of the body being bandaged is called the back, and the opposite side is called the abdomen, and when bandaging, the abdomen should be facing outward so that the bandage can easily and freely roll out on the surface of the bandaged area of ​​the body. The bandage can be narrow (up to 5 cm), medium (7-10 cm) and wide (12 cm or more). Each part of the body requires its own width of bandage.

Basic requirements for a bandage:

Cover the affected area of ​​the body;

Do not disrupt blood and lymph circulation;

Stay securely on the body area;

Be as neat as possible.

Rules for applying a soft bandage

Despite the widespread use of bandages, their application requires a certain skill, knowledge and ability. A correctly applied bandage does not bother the patient, is neat, firmly and permanently fixes the dressing.

material. In order for the bandage to lie correctly, you should use bandages of the appropriate width depending on the size of the anatomical area being bandaged. So, wide bandages are needed for the body, medium ones for the head, and narrow ones for the hand and fingers.

Bandaging consists of the following stages:

Applying the initial part of the bandage;

Applying the actual bandage moves;

Securing the bandage.

Bandaging rules

When starting to bandage, care should be taken to ensure that the patient is in a position that is comfortable for him, and that the part of the body to be bandaged is accessible from all sides.

A prerequisite is the application of a bandage with the patient in a horizontal position in order to prevent complications (shock, fainting). The exception is minor damage.

The bandage is applied in a position of the limb that is functionally most advantageous, especially when applying the bandage for a long time.

It is very important that the application of the bandage, like the bandage itself, does not cause the patient discomfort, which largely depends on the skill of the bandage. While bandaging, he should stand facing the patient in order to constantly monitor his condition.

Bandaging is very tiring and inconvenient if medical worker you have to bend down a lot or raise your arms up, so it is best to place the bandaged part of the body at the level of the lower chest of the bandage.

Applying a bandage should begin with the peripheral parts, gradually covering the central areas of the body with bandages. The exception is bandages on the hand, foot and fingers of the hand and foot, when the bandages are placed from the center to the periphery.

Bandaging begins with the first two securing rounds of the bandage.

The head of the bandage is held in the right hand, the beginning of the bandage in the left, the bandage is rolled out from left to right with the back along the bandaged surface of the body, without taking your hands off it and without stretching the bandage in the air. In some cases, bandaging can be done from right to left, for example when applying bandages to the right area of ​​the face and chest.

The bandage should roll smoothly and not form wrinkles; its edges should not lag behind the surface and form “pockets”.

The bandage should not be applied very tightly (unless a pressure bandage is required) so that it does not interfere with blood circulation, but also not very loosely so that it does not slip off the wound.

The bandager's hand should follow the direction of the bandage, and not vice versa.

When applying a bandage, except for a creeping one, each subsequent round covers the previous one by 1/3 or 1/2 of the width of the bandage.

To secure the bandage at the end of bandaging, the end of the bandage is torn or (better) cut with scissors in the longitudinal direction; both ends are crossed and tied, and neither the cross nor the knot should

lie on the wound surface. Sometimes the end of the bandage is folded over the last circular move or pinned to the previous rounds with a safety pin.

When removing the bandage, the bandage is either cut or unwound. The bandage begins to be cut away from the damaged area or on the side opposite to the wound. When unwinding, the bandage is collected into a ball, transferring it from one hand to the other at a close distance from the wound.

Mistakes when applying soft dressings

If the bandage is applied tightly, cyanosis and swelling occur, the temperature of the distal limb decreases, and throbbing pain appears. When transporting a patient with a tightly applied bandage in winter, frostbite of the distal limb may occur. If the described symptoms occur, the injured limb is placed in an elevated position. If there is no improvement after 5-10 minutes, the bandage must be loosened or replaced.

If the tension of the bandage is weak, the bandage quickly slips off. In this case, it is better to change it, ensuring the complete passive position of the injured limb when bandaging.

The integrity of the dressing is easily damaged if the first securing rounds are not done. To correct the error, the bandage must be bandaged, strengthened with cleol and adhesive tape.

9.4. TYPES OF BANDAGES

To correctly apply any bandage, you need to know the anatomical features of a particular part of the body and the so-called physiological positions in the joints. Different parts of the limbs have different shapes (cylindrical - shoulder, conical - forearm, lower leg), which must be taken into account when applying bandages. The nature of bandaging (more bends in the bandages) can also be influenced by more pronounced muscles in men and greater roundness in women. Taking these provisions into account, various types of bandages have been developed.

Circular or circular bandage(fascia circularis)

This is the simplest form of a bandage, in which all rounds of the bandage lie in the same place, completely covering each other. The bandage starts with it and ends with it; less often, it is used as an independent bandage on cylindrical areas of the body. In this case, the passages of the bandage, going from left to right, completely cover each other in a ring-like manner. At the beginning of bandaging, the first move of the bandage can be given an oblique direction by bending the edge, which is then secured with the second move (Fig. 9-7). A circular bandage is convenient for bandaging small wounds and is often applied to the shoulder, wrist joint, lower third of the leg, abdomen, neck, forehead.

Rice. 9-7. Circular bandage

Spiral bandage(fascia spiralis)

Used if you need to bandage a significant part of the body. Like any other bandage, it is started with circular moves of the bandage (2-3 layers), then the bandage is moved from the periphery to the center. In this case, the rounds of the bandage go somewhat obliquely from bottom to top and each next round covers 2/3 of the width of the previous one. As a result, a steep spiral is formed (Fig. 9-8).

Rice. 9-8. Spiral bandage

Rice. 9-9. Creeping bandage

Creeping or serpentine bandage(fascia serpenses)

This bandage is used mainly for quick and temporary strengthening of the dressing material over a significant extent of the limb. The creeping bandage begins with circular moves of the bandage, which are then converted into helical ones, from the periphery to the center and back. So that the turns of the bandage do not touch (Fig. 9-9). After securing the dressing material with a creeping bandage, further bandaging is continued in the usual ways, applying a spiral bandage.

Cross-shaped, or figure-of-eight, bandage(fascia cruciata ceu octoidea)

A bandage in which the bandages are applied in the form of a number 8 (Fig. 9-10). In this case, the moves of the bandage are repeated several times, and the cross is usually located above the affected area. This bandage is convenient for bandaging body parts with an irregularly shaped surface (ankle area, shoulder joint, hand, occipital area, perineum, chest).

Rice. 9-10. Cross bandage.

a - brush; b - chest; c - perineum; g - foot

A variation of the figure-eight bandage is spicate(fascia spica). Its difference from the cruciform is that the cross does not occur at one level, but gradually moves up (ascending bandage) or down (descending bandage). The intersection of the bandage resembles a spike in appearance, hence the name of the bandage (Fig. 9-11). Typically, a spica bandage is applied to the joint area.

A variant of the 8-shaped bandage is also tortoiseshell bandage, converging and diverging(fascia testudo inversa or reversa). This bandage is applied to the area of ​​large joints (elbow, knee). It consists of bandage moves,

Rice. 9-11. Spica bandage on hip joint

crossing on the flexor side of the joint and diverging in the form of a fan on the extension side. The diverging bandage begins with a circular motion through the center (the most protruding part) of the joint. Subsequent moves of the bandage lead above and below the previous ones, crossing on the flexor side of the joint and covering 2/3 of the previous moves until the affected area is completely covered (Fig. 9-12). The converging turtle bandage begins with circular moves of the bandage above and below the joint and also crossing on the flexor side of the latter. Further moves are brought closer to each other towards the convex part of the joint until the affected area is closed.

Rice. 9-12. Turtle headband.

Rice. 9-13. Returning stump bandage

Returning bandage (fascia reccurens)

It is usually applied to rounded surfaces (head, limb stumps). Such a bandage comes down to alternating circular moves of the bandage with longitudinal ones, running sequentially and returning back, until the stump is completely closed (Fig. 9-13).

It should be emphasized that a bandage on any part of the body cannot be only circular or only spiral, etc., since such a bandage can easily move, so it must be reinforced with 8-shaped moves in order to fit tightly to the surface of the bandaged part bodies. When bandaging a limb of unequal thickness, such as the forearm, it is advisable to use a technique called bending. The bend is performed in several rounds and the steeper the difference in the diameters of the bandaged part, the more pronounced the difference.

Improvisation and combination possible various types dressings when bandaging large areas of the body. So, when bandaging the entire lower limb, all 7 main dressing options can be used.

9.5. PARTICULAR TYPES OF BANDAGES FOR BODY AREAS

9.5.1. HEADBANDS

To apply a bandage to the head, bandages 5-7 cm wide are used. The most commonly used are: “hat”, “Hippocratic cap”, “cap”, “bridle”, bandage on one eye, on both eyes; on the ear, cross-shaped on the back of the head.

Simple bandage (cap)

This is a returning bandage that covers the calvarium (Fig. 9-14). Two circular passages lead around the head, capturing the region of the glabella and the region of the occipital protuberance (1). Then a bend is made in front, and the bandage is led along the side surface of the head obliquely, slightly higher than the circular one (2). Approaching the back of the head, make a second bend and cover the side of the head on the other side (3). After which the last two oblique moves are secured with a circular move of the bandage and then two oblique returning moves (5 and 6) are made again slightly higher than the previous ones (2 and 3) and again secure it.

This relatively simple dressing requires very good application technique. It is important that the bends of the bandage lie as low as possible and are better fixed in circular motions. Due to its low strength, it is not suitable for application in severely ill patients.

Rice. 9-14. Headband "cap"

Hippocrates cap

Standing facing the affected person, the bandager takes one head of a double-headed bandage in each hand and, unfolding them, applies one or two circular strokes around the head. Having brought both heads of the bandage to the back of the head, left head they bring it under the right one and make a bend, the right head continues its circular motion, and the left head, after the bend, goes in the sagittal direction through the crown of the head

forehead. In the forehead area, both heads meet: the right one goes horizontally, the left head again returns through the crown to the back of the head, where it again intersects with the horizontal course of the right head, etc. Longitudinal returning passages gradually cover the entire head. Thus, one part of the bandage makes anteroposterior moves, and the other makes circular moves. The bandage is secured in a circular motion of both heads around the head (Fig. 9-15).

Cap

A piece of bandage 50-75 cm long is placed transversely on the crown of the head so that the ends go down vertically in front ears, where they are held in a tense position by an assistant (sometimes the patient himself does this). On top of this bandage, the first horizontal strokes are made around the head so that their lower edge goes above the eyebrows, above the ears and above the occipital protuberance. Having reached the vertical tie on one side, the bandage is wrapped around it (a loop is made) and then on the forehead area in a slightly oblique direction, covering half the circular path. Having reached the opposite tie, they make a loop again and again lead in an oblique direction to the occipital region, half covering the underlying passage, etc. So each time, throwing the bandage over the vertical tape, they move it more and more obliquely until they cover the entire

Rice. 9-15. Headband “Hippocrates cap”

Rice. 9-16. Headband "bonnet"

head. The bandage is finished with circular moves of the bandage, tying a knot in front (Fig. 9-16). The ends of the vertical tape are tied under the chin to firmly secure the entire bandage.

Bridle type bandage

It is used for damage lower jaw, after reduction of dislocation, etc. (Figure 9-17). First, two horizontal circular strokes are applied around the head from left to right. Next, the bandage is passed over the ear of the left side obliquely upward through the back of the head under right ear and under the lower jaw in order to grab the jaw from below and come out from the left side in front of the left ear up to the crown. Then the bandage behind the right ear is brought back under the lower jaw, covering the front half of the previous move. Having made three such vertical moves, the bandage is led from behind the right ear forward onto the neck, then obliquely upward through the back of the head and made a circular move

Rice. 9-17. Bridle bandage

around the head, reinforcing previous rounds. Then they again go behind the right ear, then almost horizontally cover the entire lower jaw with the bandage and, coming to the back of the head, repeat this move again. Then they go under the right ear under the lower jaw obliquely, but closer to the front, then along the left cheek up to the crown and behind the right ear. Repeating the previous move, and then, going around the front of the neck, go to the back of the head above the right ear and finish the bandage with a circular horizontal move of the bandage.

One eye patch

The bandage begins in circular motions around the head, and for the right eye the bandage is applied from left to right, for the left eye, on the contrary, from right to left (Fig. 9-18). Having strengthened the bandage with horizontal strokes, lower it from behind down onto the back of the head and move it under the ear on the sore side obliquely through the cheek up, closing the sore eye. The oblique move is secured in a circular manner, then the oblique move is made again, covering half the previous one. So, alternating oblique and circular moves, the entire eye area is covered.

Rice. 9-18. One eye patch

Rice. 9-19. Blindfold for both eyes

Blindfold for both eyes

After securing the bandage in circular motions (Fig. 9-19), it is led from the back of the head under the ear and made from bottom to top in an oblique motion, closing the eye on one side. Next, they continue to pass the bandage around the back of the head and across the forehead obliquely from top to bottom, closing the eye on the other side, then pass the bandage below the ear and across the back of the head, come out from under the ear on the opposite side and make another upward oblique move. So, alternating with each other, the oblique moves of the bandage gradually close both eyes. Secure the bandage with circular moves of the bandage.

Bandage on the ear area (Neapolitan bandage)

It begins with circular tours around the head (Fig. 9-20). On the sore side, the bandage is lowered lower and lower, covering the ear area and mastoid process. The last move is located in front along the lower part of the forehead and behind the occipital protuberance. Finish the bandage with circular moves of the bandage.

Figure-of-eight headband

It begins in circular motions around the head (forehead-occiput), then above the left ear descends to the back of the head, then goes under the right ear to the front surface of the neck from under the left corner of the lower jaw up through the back of the head above the right ear to the forehead (Fig. 9-21 ). By repeating these rounds, the entire back of the head is covered.

Quite often, “sling-shaped bandages” are used on the chin and nose, as well as scarf bandages, the application technique of which can be seen in the relevant sections.

Rice. 9-20. Ear bandage “Neapolitan cap”

Rice. 9-21. Figure-of-eight headband

9.5.2. BANDAGES FOR UPPER LIMB

Most often, the following bandages are applied to the upper limb: spiral - on one finger, spica - on the first finger, “glove”; returning and cruciform - on the hand; spiral - on the forearm; tortoiseshell bandages - on the elbow joint; spiral - on the shoulder; spica - on the shoulder joint; Deso and Velpeau dressings.

Spiral bandage

Used for injury to one finger (Fig. 9-22). First, strengthen the bandage with two or three circular strokes in the wrist area. Then the bandage is slanted

Rice. 9-22. Spiral bandage for one finger

Rice. 9-23. Thumb spica bandage

through the back of the hand (2) to the end of the sore finger, from where the entire finger is bandaged to the base using spiral moves. Next (8) the bandage is brought back to the wrist, where it is secured.

Bandage the thumb is made spica-shaped(eight-shaped) (Fig. 9-23). It starts similarly to the one described above. Next, apply the bandage along the back surface thumb to its apex (2) and in a semicircular motion cover the palmar surface of this finger (3). Then the bandage is led along the back of the hand to the wrist and again repeats the figure-of-eight move, each time going lower to the base of the finger. Attach a bandage to your wrist.

Rice. 9-24. Bandage on all fingers “knight's glove”

Rice. 9-25. Bandage on the hand “mitten”

Bandage on all fingers “knight's glove”

It is used when you need to bandage several fingers or all fingers separately. It begins as a bandage on one finger (see Figure 9-23). Having bandaged one finger in a spiral, the bandage is passed along the back surface through the wrist and the next one is bandaged in this way until all fingers are bandaged (Fig. 9-24). On the left hand, the bandage begins with the little finger, and on the right hand, with the thumb. Finish the bandage with a circular motion around the wrist.

Returning hand bandage “mitten”

It is applied when it is necessary to bandage the hand (Fig. 9-25) along with the fingers (for extensive burns and frostbite). The bandage begins with circular moves around the wrist (round 1). Then the bandage is passed along the back of the hand (2) onto the fingers and with vertical strokes it covers all the fingers from the palm and back (3,4,5). Then, in horizontal circular motions, starting from the ends, bandage the bandage on the wrist.

Turtle headband

It is applied to the joint area in a bent position (Fig. 9-26). They are divided into divergent and convergent. The converging bandage begins with peripheral tours above and below the joint (1 and 2), intersecting in the cubital fossa. Subsequent moves proceed similarly to the previous ones, gradually converging towards the center of the joint (4, 5, 6, 7, 8, 9). Finish the bandage in a circular motion at the level of the middle of the joint. A divergent bandage in the area of ​​the elbow joint begins with a circular move through its middle, then similar moves are made above and below the previous one. Subsequent passages diverge more and more, gradually covering the entire joint area. The passages intersect in the subulnar cavity. Secure the bandage around the forearm.

Rice. 9-26. Tortoise elbow bandage

Rice. 9-27. Spiral bandage on the forearm

Spiral bandage

Can be performed with or without kinks (Fig. 9-27). The second is convenient for bandaging body parts of equal thickness (shoulder, lower leg, thigh, etc.). The bandage begins with two or three circular moves, and then the rounds of the bandage go in a spiral, partially covering the previous rounds by two-thirds. Depending on the direction of bandaging, the bandage can be ascending or descending.

A bandage with bends is applied to conical-shaped parts of the body. After two or three circular moves, they begin to bandage with kinks. To do this, the bandage is led obliquely upward, pressing its lower edge with the thumb and bending the bandage so that its upper end becomes the lower one, then the bandage is led obliquely downwards, circled around the limb and repeating the bend again. The greater the degree of expansion of the limb, the steeper the bends. All bends are made on the same side and along the same line. In the future, if necessary, either make a simple spiral bandage or continue to bend the bandage.

Spica bandage

It is a type of eight-shaped (Fig. 9-28). It is applied to the shoulder joint area as follows. The bandage is passed from the healthy armpit along the front surface of the chest and then to the shoulder (move 1). Having gone around the shoulder in front, outside and behind, the bandage is passed through the armpit and raised obliquely onto the shoulder (move 2), crossing the previous round on the front surface of the chest and shoulder. Next, the bandage goes along the back of the back to the healthy armpit. From here the repetition of moves 1 and 2 (3 and 4) begins. In this case, each new move lies slightly higher than the previous one, forming the appearance of a spike at the intersection.

BandageDezo

Applied for fractures humerus and collarbones. The patient is seated and the arm is bent at the elbow at a right angle (Fig. 9-29). The first point is to bandage the shoulder to the body, which is achieved by applying a series of circular spiral moves from the healthy arm to the sick one (1). Next, use the same bandage to begin the second part of the bandage: from the axillary region of the healthy side along the front surface of the chest, the bandage is applied to the shoulder girdle of the sore side (2), from here vertically down the back of the shoulder under the elbows, picking up the elbow with a bandage, obliquely through the forearm into the armpit of the healthy side (3). From here, a bandage is passed along the back onto the sore shoulder girdle and down the front side of the shoulder (4). Going around the front of the elbow, the bandage is passed through

Rice. 9-28. Spica bandage for the shoulder joint

Rice. 9-29. Deso bandage

Rice. 9-30. Velpeau bandage

the back is obliquely into the healthy armpit, from where the repetition of moves begins (2, 3, 4). Such moves are repeated several times to obtain good fixation. Then hang the hand with a piece of bandage of sufficient width, securing it to the back (see Fig. 9-29).

Velpeau bandage

Used for temporary immobilization for clavicle fractures, after reduction of shoulder joint dislocations (Fig. 9-30). The arm on the injured side is bent in elbow joint so that an acute angle is formed, and the palm is located in the deltoid region on the healthy side. In this position, the limbs are bandaged. First, the hand is fixed with a circular bandage from the sore arm to the healthy one (1), which covers the shoulder and forearm of the sore side, goes through the healthy axillary fossa back. From here, they lift the bandage obliquely along the back from the damaged deltoid area, go around it from back to front, lower the bandage down the shoulder (2) and, picking up the elbow from below, direct it to the armpit on the healthy side (3). The moves of the bandage are repeated several times, with each vertical move of the bandage placed inward from the previous one, and each horizontal one below it.

9.5.3. BANDAGES ON THE TORSO AND PELVIS

When applying bandages to the torso and pelvis area, the following types are most often used: spiral on the chest and abdomen; bandage on one and both mammary glands; “T-shaped” - on the crotch; spica - on the buttock, groin area, hip joint.

Spiral chest bandage

Used for chest injuries (Fig. 9-31). The bandage is applied so that it does not slip off the chest. To do this, use additional bandage tape, which, before applying the bandage, is placed obliquely across the chest on the left side.

Rice. 9-31. Spiral chest bandage

Rice. 9-32. Breast bandage

shoulder and from there in an oblique direction across the back. Next, from the lower part of the chest, using spiral circular moves, going up, bandage the entire chest to the armpits, where the circular moves are secured. The freely hanging initial part of the tape is thrown over right shoulder and tied at the back with the other free end of the bandage.

Breast bandage

It is used both for traumatic injuries and for compression to stop lactation. The bandager is in front of the patient. The gland is slightly raised and held in this position. The bandage begins with circular passages below the mammary gland (Fig. 9-32), brought to the right side of the chest, from where, covering the lower and inner part of the mammary gland, the bandage is applied to the left shoulder girdle (2) and lowered obliquely along the back to the right armpit . Here, covering the lower part of the mammary gland in a circular motion, secure the previous move (3), bring the bandage again obliquely upward through the gland to the left shoulder girdle and repeat the previous moves. Gradually the bandage rises upward and covers the entire mammary gland. Secure the bandage with horizontal strokes.

Bandage on both breasts

The beginning of the bandage is fixed with two horizontal circular tours under the mammary glands (Fig. 9-33). The third round (2) is carried out from the lateral surface of the chest on the right under the right gland, lifting it into the left deltoid region. Thus, the first 3 rounds are the same as when applying a bandage to the right mammary gland. From the back, the bandage is passed into the right axillary fossa, under the right mammary gland (3), then under the left and obliquely along the back to the right deltoid region. From the right deltoid region, the bandage (4) is lowered under the left mammary gland, supporting it from the inside and below. From the left side surface of the chest, the bandage is applied to the back in a horizontal direction. So, the third round fixes the right mammary gland, the fourth - the left. Then the bandage is alternated, repeating the third and fourth rounds, each time placing the bandage higher than the previous round, until both mammary glands are covered with the bandage.

Rice. 9-33. Bandage on both breasts

T-shaped bandages

This type dressings are used for injuries and diseases in the perineal area and anus. Such a bandage consists of a strip of cloth or bandage, to the middle of which the end of another strip is sewn, or of a strip, through the middle of which another strip is thrown. The technique for applying them is shown in the “T-shaped dressings” section.

Spica bandage

Covers the lower abdomen top part thighs, as well as the buttock and groin areas. Depending on the place where the bandage crosses, the bandage can be inguinal, lateral or posterior. The inguinal spica bandage (Fig. 9-34) begins with circular passages around the abdomen, then the bandage is passed from back to front along the side, and then along the front and inner surfaces of the thigh. After this, the bandage is passed along the posterior semicircle of the thigh, extending from its lateral side obliquely into the groin area, where it intersects the previous round. Rising up and to the left, they go around the back semicircle of the body and again repeat the described eight-shaped moves. The bandage can be ascending, if each subsequent round is higher than the previous one, or descending. Secure the bandage in a circular motion around the abdomen.

The lateral spica bandage (Fig. 9-35) is applied similarly to the groin bandage, however, the crossing of the bandage moves is carried out along the lateral surface of the hip joint.

Rice. 9-34. Inguinal spica bandage

Rice. 9-35. Lateral spica bandage for the hip joint

The posterior spica bandage, like the previous ones, begins with a circular tour around the abdomen. Then the bandage is passed through the buttock on the sore side to the inner surface of the thigh, goes around it in front and is raised obliquely again onto the body, crossing the previous path of the bandage along the back surface. Having made a semicircular move around the abdomen, repeat the previous rounds several times, gradually moving them downwards. The bandage is completed with a strengthening circular move around the abdomen.

9.2.4. BANDAGES FOR LOWER LIMB

When bandaging the lower extremities, the following types of bandages are most often used: spiral and spica for the finger; cruciate and returning to the foot; bandage for the whole foot, for the whole foot without toes, spiral for the shin, tortoiseshell bandages for knee-joint; spiral on the thigh.

Spiral finger bandage

It is used for diseases and injuries of the first toe (Fig. 9-36). The bandage is fixed in circular circles in the area of ​​the ankle joint. Then a bandage is passed through the dorsum of the foot to the distal phalanx of the first toe. From here, spiral tours are used to cover the entire toe to the base and again through the back of the foot the bandage is returned to the ankle joint, where the bandage is finished with fixing circular tours.

Spica bandage for finger

Used less frequently. It is applied in the same way as on a finger.

Rice. 9-36. Spiral toe bandage

Rice. 9-37. Full foot bandage

Full foot bandage

Start with circular moves around the ankles. Next, they walk around the foot several times along its lateral surfaces, covering the toes and heel (Fig. 9-37). These moves are applied loosely, without tension, so as not to cause bending of the fingers. Next, starting from the tips of the toes, bandage the foot, as when applying the previous bandage.

On the right leg, the bandage starts from the outside of the foot, on the left - from the inside (Fig. 9-38). A bandage (1) is placed along the edge of the right foot from the heel towards the toes, reaching the level of the base of the toes. Along the back of the foot, direct the bandage to the inner edge of the foot and make a circular motion, wrapping it onto the sole. Next, the bandage is raised again to the rear, obliquely crossing the previous round (2). After crossing, the bandage is directed along the inner edge of the foot, applying it as low as possible, reaching the heel, which is walked around from behind and a move similar to that described is repeated (3, 4). Each new move in the heel area is placed higher than the previous one, while the crosses are made closer and closer to the ankle joint (5-12). The bandage is fixed around the ankles.

Rice. 9-38. Bandage for the entire foot without toes

When applying a cruciform bandage, the bandage is secured around the lower leg, then passed obliquely through the back of the foot and, after a semicircular move on the plantar surface, returned to the back of the foot, where a cross is made through the previous move of the bandage (Fig. 9-39). Having completed this figure-of-eight move, they make the next one, gradually reaching the base of the foot, where the bandage is secured.

Heel bandage

More often, a diverging turtle bandage is applied. They begin to bandage in a circular motion through the heel. Subsequent rounds are placed above and below the first. These moves are strengthened with an oblique move from the side of the heel, going from back to front with a transition to the plantar surface and dorsum of the foot, the area of ​​the ankle joint and down to the foot, making crosses on the back of the fold.

Rice. 9-39. Cross-shaped bandage on ankle joint

Rice. 9-40. Turtle headband.

a - divergent; b - convergent

Tortoise knee bandage

It is applied with the joint in a bent position. It can be divergent or convergent (Fig. 9-40). A divergent bandage in the knee area begins with a circular move through the middle of the joint (1), then similar moves are made above and below the previous one (2 and 3). Subsequent moves diverge more and more, gradually covering the entire joint area (4, 5, 6, 7, 8, 9). The passages cross in the popliteal cavity. Secure the bandage around the thigh. The converging bandage begins with peripheral tours above and below the joint, crossing in the popliteal fossa. Subsequent moves proceed similarly to the previous ones, gradually converging towards the center of the joint. Finish the bandage in a circular motion at the level of the middle of the joint.

9.6. PRESSURE, SEALING AND COMPRESSION

BANDAGES

Pressure bandages

Pressure bandages are applied to reduce the size of hemorrhage in the tissues at the site of injury, to reduce the amount of swelling and create rest in the injured limb, to stop all types of bleeding (capillary, venous and arterial), to carry out compression sclerotherapy of varicose veins, to reduce lactation. Compression is carried out by tightly bandaging the damaged or affected area by applying a circular, spiral or cruciform bandage. Using latex or cotton-gauze pads under the bandage increases the degree of compression by 4 times.

Sealing dressings

The application of an occlusive (sealing) bandage for a penetrating chest wound is a means of providing first aid to the victim, as it prevents air from entering the pleural cavity.

For these purposes, an individual dressing package (IPP) is used. The IPP consists of a bandage and one or two cotton-gauze pads attached to it. One pad is fixedly attached to the free end of the bandage, and the other can move along it (Fig. 9-41).

Rice. 9-41. Individual dressing package

The sterile dressing material is wrapped in parchment paper and covered on the outside with a rubberized or cellophane shell. The rubberized shell is torn along the cut and removed, then the paper shell is unrolled. The inner side of the rubberized shell is used as a sealing material, which is applied to the wound, the edges of which have been pre-treated with iodine solution. Take the roll with your right hand, the end of the bandage with your left, unfold the pads and apply to the wound with the side that was not touched by your hands ( inner side). For penetrating gunshot wounds, one pad is placed on the entrance hole, the other on the exit hole, after which the pads are bandaged, and the end of the bandage is secured with a pin. The pin is located under the outer shell of the bag. In this case, it is important not to touch the inner side of the pads applied to the wound with your hands. The outer side is stitched with colored thread. If there is one wound entrance, the pads are placed one on top of the other or side by side.

If there is no dressing bag for sealing, you can use a material that does not allow air to pass through (rubber, plastic film, oilcloth, etc.). As a last resort, you can use a cotton-gauze bandage thickly lubricated with ointment. Before applying a sealing bandage, the edges of the wound are treated with iodine, then lubricated with any fat (vaseline, cream, vegetable fat, etc.), preferably sterile. After this, an air-impermeable material is applied to the wound and the skin around it, and on top - a regular tight bandage, the turns of which go around the chest. For a bandage, you can use a towel or sheet, which is wrapped around the victim’s chest and tied tightly on the healthy side.

The wound can be sealed with strips of adhesive plaster applied in the form of a tiled bandage so that the edges of the wound are brought closer together and the strips of plaster overlap each other.

Compression bandages

Treatment with compression bandages plays a key role in complex treatment patients with pathology of the veins of the lower extremities.

Compression therapy is indicated for all acute and chronic diseases of the veins of the lower extremities. The only contraindication to compression treatment is chronic obliterating diseases of the arteries of the lower extremities. The therapeutic effect of compression agents is realized mainly by reducing the diameter of the veins, which leads to improved functioning of the valve apparatus and an increase in the rate of venous return. It has been established that a decrease in the diameter of a vein by 2 times leads to an increase in the linear speed of blood flow through it by 5 times. Along with macrohemodynamic effects, elastic compression improves microcirculatory function.

For compression treatment, elastic bandages are most often used, which, depending on the degree of stretching, are divided into 3 classes: short (bandage elongation is no more than 70% of the original length), medium (70-140%) and high or long (more than 140%) , stretchability. This characteristic is indicated on the packaging of the bandage, and it is necessary for the correct selection of the product.

When applying a compression bandage, the following basic principles must be followed:

At the time of applying the bandage, the foot should be in a position of supination and dorsiflexion, preventing the formation of folds of the bandage in the ankle area, which can damage the skin during movement;

It is always started from the proximal joints of the toes with a hammock grip on the heel;

The roll of bandage must be unrolled outward in the immediate vicinity of skin;

The bandage must follow the shape of the limb, that is, its tours must be applied in ascending and descending directions alternately, which will ensure its strong fixation;

The bandage should be applied with light tension at the beginning of each round, and each subsequent turn should overlap the previous one by 2/3 of the width.

The most significant thing is that as the elastic bandage is applied, the degree of compression gradually decreases from the level of the ankles to the popliteal fossa, giving the patient the feeling of a tight-fitting boot. As for the upper level of the elastic band, ideally it should be 5-10 cm above the affected venous segment. However, practically its reliable fixation on the thigh is possible only with the use of special adhesive bandages. Therefore, the upper border should be just below the knee joint, and the tail of the bandage should be fixed to the bandage with a special hairpin or safety pin.

When a compression bandage is applied correctly, the fingertips turn slightly blue at rest, and when movement begins, their normal color is restored. However, violations arterial blood supply(numbness of the toes, paresthesia) should not be present. It is important to emphasize that failure to comply with these simple requirements, in particular, tightening the bandage in the upper third of the shin, creates

Using “nooses” to secure the bandage can significantly impair blood circulation.

Along with elastic bandages, another type of compression products is used. We are talking about special medical knitwear (socks, tights), manufactured using machine knitting using seamless technology. Depending on the degree of compression and purpose, it is divided into preventive and therapeutic. Prophylactic, creating pressure at the ankle level of at least 18 mm Hg. Therapeutic, which, depending on the compression class, provides pressure at the ankle level from 18.5 to 60 mm Hg. Therapeutic compression hosiery is selected by the doctor, taking into account the nature and location of the pathology, as well as the size of the limb.

In addition to the above soft compression products for chronic venous insufficiency, complicated by trophic ulcers, hard bandages are also widely used. We are talking about Kefer-Unna zinc-gelatin dressings. Treatment with zinc-gelatin dressings, along with the compression effect, eliminates the possibility of skin sensitization and creates a favorable microclimate that promotes ulcer healing. The paste used for these dressings has the following composition: Gelatinae 30.0; Zinci oxydi, Glycerini aa 50.0; Aq. destill. 90.0.

Before applying the bandage, the patient is placed in a horizontal position, the affected leg is raised at an angle of 45-60 °C for 15-20 minutes. Before use, the paste is heated to a liquid state and applied in an even layer to the lower leg and foot. Bandage tightly with a gauze bandage without a border in one layer. A layer of paste is applied again and bandaged again in one layer. Thus, alternately lubricate and bandage the limb four times. After about 10 minutes, the bandage dries, it is sprinkled with talcum powder and bandaged again with a regular gauze bandage, which can be changed as it gets dirty. The bandage is applied for 3 weeks, then it is changed and so on until the ulcer is completely healed.

Tags: bandages
Start of activity (date): 06/19/2013 10:48:00
Created by (ID): 1
Keywords: bandage, bandage, dressing

A bandage is a medical device that is used to protect a damaged surface from infection entering the body. It is important to follow the rules for applying bandages to wounds to provide first aid to the victim.

Treatment of injuries begins with disinfection and primary surgical treatment. Depending on the type of damage, further treatment tactics are determined. Carrying out initial treatment of the wound and applying a bandage is the most acceptable method therapy for minor injuries. In case of complications, surgery may be necessary with sutures to tighten the edges of the injury.

Depending on the material, there are: soft bandage types of dressings, pressure hemostatic, adhesive and waterproof.

Bandage sterile

Apply to stop bleeding, to fix a limb after injury. An assortment of different materials is presented in the pharmacy: elastic, sterile and non-sterile bandages.

A sterile wound dressing ensures the regeneration process. Compliance with the rules of asepsis and antisepsis during application protects the surface from the penetration of infection from the external environment.

Depending on the nature of the roll, the bandage is classified:

• single-headed - presented in the form of a round roller, the second side is free, not fixed;
• double-ended - rolled with two ends towards the center for ease of circular dressing.

There are wound dressings made from gauze bandages: cap, circular, sling-shaped, ascending, descending, figure-eight, spica-shaped, Deso, T-shaped.

Pressing

It is worth applying pressure bandages to the wound for minor injuries in emergency situations in order to temporarily stop bleeding before hospitalization. An individual dressing package can be found in the driver’s first aid kit or made from available material. The basis includes:

• sterile sponge;
• a cotton-gauze pad or a piece of fabric folded into a tight roll;
• bandage for fastening to the skin.

The rules for applying pressure material state that for venous bleeding it can be used on a wound of any location, while for arterial bleeding it can be used only on the extremities.

Self-adhesive

Self-adhesive wound dressing is a material that adheres to the skin for the purpose of fixation. There are several overlay methods:

1. Using adhesive liquid: Cleol, Collodion, BF-6. The sterile cut is glued along the edge and applied to the skin. The bandage is easily separated from the wound with ether or alcohol. Disadvantages include high risk allergic reaction to the components of a substance. It is necessary to treat the skin with an antiseptic after removing the glue.
2. Band-Aid. Before application, it is necessary to thoroughly dry the area of ​​the wound and the skin around it, since the edges may not stick tightly or peel off when the adhesive part comes into contact with moisture.

Advantage of adhesive plaster:

• lack of air penetration into the wound;
• reliable fixation;
• wide range of application of this bandage on various parts of the body;
• no additional material or fastening required;
• can be applied to the delicate skin of the face, neck, groin, fingers and toes.

Among the disadvantages, one can note an allergy to the components of the adhesive substance. Do not use the patch on the scalp due to poor adhesion and painful removal.

Waterproof

Waterproof material is applied for minor injuries, when the surface is already beginning to dry out, there is no deep extensive damage to soft tissues. Dressings protect the wound from infection and mechanical irritation when bathing in a bath, swimming in a pool or open water. The materials have good protective properties, absorb exudate, and do not allow moisture to pass through from the outside.

Features of applying bandages for various wounds

The manipulation must be performed by a specially trained person. It is advisable to bandage the damaged area when visiting a doctor. The wound is first treated with aseptic solutions and cleaned of foreign objects: fragments, pieces of clothing, dirt, shotgun pellets.

The bandage should completely cover the wound surface from external action. Select the material: viscose, gauze, elastic oilcloth.

The victim is placed in a comfortable position. When applying, follow the rules of compression - the bandaged area should not turn pale or blue, or lose sensitivity.

The algorithm for effective bandaging of a limb is to apply the material in the direction from the periphery to the center: from the foot to the thigh, from the hand to the shoulder. Each turn half overlaps the previous one.

The basic rule when bandaging burns is that the bandage should never come into contact with the damaged areas. Do not apply fibrous, loose materials, which can easily be soldered when the wound dries.

Preference should be given to the aseptic, antiseptic option, but in the absence of one in in case of emergency It is permissible to use any available means. Then the victim must be taken to the hospital.

When to apply pressure bandages to a wound

Indications for the use of pressure dressings are as follows:

• bleeding of severe or moderate severity - capillary, venous, arterial;
• in case of serious massive bleeding from large vessels of the groin, forearm, and axillary region, pressure bandages are temporarily used;
• in the postoperative period;
• when a wound is combined with an open injury to the pleural cavity, during chest decompression.

Contraindications and rationality for long-term use of pressure compresses can be determined by a specialist doctor. After stopping the bleeding, you should immediately go to the hospital.

Review of specific pharmaceutical dressings

The pharmaceutical industry offers a wide range of products for various types of wounds:

product name	Material characteristics
TenderWet, Hydroclean hartmann	Multi-layer hypoallergenic bandage from the super-absorbent class. The structure allows the continuous release of disinfectant liquid with the absorption of wound exudate. The necrotic areas are moistened, softened and rejected.
PermaFoam	The spongy appearance of the material, due to its low adhesion, stimulates the growth of granulation tissue and, when applied, protects the wound from secondary pathogenic microflora.
It affects injury by converting calcium alginate into gel masses that bind the exudative component, which helps cleanse the damaged surface and accelerate regeneration.
Hydrocoll Thin hartmann, Comfeel Plus	Hydrocolloid material for application to trauma is represented by a polyurethane membrane, which is capable of allowing air to pass through, but does not allow liquid and infectious particles to penetrate inside.
Нydrosorb, Сosmopor	Contains a sorption gel inside to absorb exudate from wounds, disinfect, and moisturize its surface.
Tegaderm, Medakom, Farmaplast, Voskosorb	Made from non-woven material. After application, it effectively absorbs discharge from the wound surface of any nature. It has hypoallergenic properties and is widely used in surgery.

The choice of a certain type of dressing is based on the severity and characteristics of the damage, the speed of healing, and the presence of an exudative component.

How often should I change

In cases of active discharge of exudate from the wound, dressing must be carried out daily. For minor injuries to the chest, abdomen, or head, apply a bandage every 7-10 days. The frequency of application of fixing material depends on the presence of complications. After surgery, the bandage is changed the next day. Then the procedure is repeated every two days until the stitches are removed.

The process of treating wounds is determined individually by the attending physician. You should not apply it yourself in case of serious injuries to avoid negative reactions.

Or incisions during surgery often require subsequent dressings. They help to injure the wound less, reduce the risk of dangerous microbes and contaminants getting into it, and prevent children from disturbing the area of ​​the sutures, scratching them or tearing off scabs. This helps to heal wounds by primary intention - this term refers to the smooth fusion of the edges with virtually no scar or with a thin, delicate scar. There are several stages in applying bandages, especially when it comes to bandaging; these also include treating wounds with antimicrobial and antiseptic components. In a hospital, dressings are carried out in a special room, but if the wound is not dangerous, dressings can often be carried out at home, by the parents themselves.

Types of dressings for children

In children, several types of bandages are used to close a wound or immobilize a limb:

• Adhesive plaster
• Bandage
• Plaster
• Polymer

The last two types are used only in a hospital, for immobilization of injured limbs during or. Parents can use the first two types when treating wounds or fixing damaged limbs.

Minor wounds, adhesive bandages for children

To treat small wounds and abrasions, you can use an adhesive plaster to protect them from external influences. Today, pharmacies sell two types of adhesive plaster: roll , with a continuous adhesive surface, and bactericidal , in the center of which there is a layer of material impregnated with bactericidal components. The edges of the wound are usually not sealed with a roll, but bandages made of gauze or other materials are fixed. Germicidal plasters are used to close minor wounds, cuts, and scratches.

For minor wounds, after washing and treating the wound, remove the protective layer from the adhesive plaster, and without touching the wound with your hands, stick it on, covering the damaged area with the bactericidal part. The edges are tightly fixed with the sticky part to the skin.

If the edges of the wound are smooth, to bring its edges together, you can use a special polymer patch-staple . The wounds are pre-treated, then the edges are brought together and fixed in such a position that healing is actively formed.

note

Change the patch as the central layer becomes saturated or as directed by a doctor, for small wounds, as it gets dirty.

Bandages: immobilization and wounds

To immobilize a limb during dislocations or fractures, any type of bandage is suitable - sterile and non-sterile. To apply bandages to open wounds or injuries, only sterile bandages and gauze should be used.

In case of damage to the limbs with suspected dislocations, fractures or sprains, in order to injure the damaged area less before examination by a doctor, immobilization bandages . They are applied using bandages of different widths, as well as splints (dense improvised structures). The damaged area must be tightly fixed within the boundaries of two joints to the splint by winding a bandage in order to completely immobilize the affected part. After this, you need to go to the emergency room. If the damage is extensive, it is worth calling an ambulance and ensuring the child is completely immobile until it arrives.

If this is applying a bandage to a wound, it is necessary to pre-treat it - rinse it with hydrogen peroxide, miramistin or furacillin, treat the edges of the wound with antiseptics. All procedures should be carried out only with cleanly washed hands, without touching the surface of the wound and its edges.

All dressings used in wound treatment are only sterile. If there are no sterile materials at hand, you need to use clean, ironed handkerchiefs, pieces of white cotton fabric, ironed with a hot iron and steam.

Before bandaging the wound, several layers of sterile gauze are applied to its surface; the edges should not fiber and fly apart into threads so that they do not get into the wound. After applying a layer of gauze, the wound is bandaged, doing this in a circular motion from left to right, the free end is held with two fingers of the second hand, fixing it with two turns of the bandage.

note

When treating a wound, you cannot apply cotton wool to it; its fibers stick to the edges and are then very difficult to remove, which will bring pain and additional discomfort to the child. Overlay open wound maybe only gauze or special materials.

Stopping bleeding from a wound

If the resulting wound is accompanied by bleeding, it must be stopped before applying a bandage. Bleeding can be of three types - arterial, with damage to the arteries different sizes, venous or capillary.

At arterial bleeding blood flows out under pressure, in pulsating waves, bright scarlet in color. Such bleeding can be stopped by applying a tourniquet above the artery, tightly squeezing it and stopping the flow of blood.

The duration of application of such a tourniquet in summer is up to 30-60 minutes, in winter - up to 90 minutes. The application time must be indicated directly on the skin or on a piece of paper placed under the tourniquet; this is extremely important for doctors.

At venous bleeding dark blood flows out in a steady stream. You can also stop it by applying a tourniquet below the wounded area. The rules for applying it are similar; you also need to record the time when the tourniquet was applied.

Capillary bleeding usually the most insignificant, blood oozes evenly from the entire surface of the wound, it is red in color, flows out without pressure. You can stop it by pressing a clean cloth or sterile bandage to the wound area for 5-10 minutes.

After the bleeding has stopped, they begin to treat the wound and apply a bandage, and if necessary, show the child to the doctor.

Correct application of the bandage

It is important to use only sterile material, which should always be in the first aid kit; if these are outdoor conditions, you should use any clean cloth for a temporary dressing. The larger the wound, the wider and thicker the bandage should be.. If it is a small wound, let's use a small bactericidal patch or cotton-gauze bandage. A piece of cotton wool should be wrapped in a bandage so that its fibers do not get into the wound, and placed over the wound, secured with a wrap of the bandage or an adhesive plaster. It is capable of absorbing blood and ichor, purulent discharge, tissue fluid. Pharmacies today sell ready-made cotton-gauze dressings and wound treatment products made from modern materials.

When fixing the bandage with a bandage, it is not attached tautly, rolling it over the surface. Initially, a fixing turn of the bandage is made, then another one, and after that the bandage is gradually bandaged from the center to the periphery, each subsequent skein half overlaps the previous one.

What should you know about bandages?

If the wound size is less than 2 cm, a bandage is not required (unless it is a puncture and deep wound). After treatment, you can cover it with a bactericidal plaster or a special coating (BF glue, films for treating wounds). It is important that such a bandage has perforations so that the wound breathes and does not get wet and heals well.

Conventional wounds that are treated with dressing and bandaging are opened by unwinding the bandage and exposing the wound. If the material has dried to the wound, you can soak it with hydrogen peroxide or a solution of miramistin, furatsilin. You cannot remove dried bandages with a jerk; this causes pain and disrupts the integrity of the wound, impairing its healing.

Introduction

The science of life safety explores the world of hazards operating in the human environment, developing systems and methods for protecting people from dangers. In the modern understanding, life safety studies the dangers of the industrial, domestic and urban environment, both in the conditions of everyday life and in the event of emergency situations of man-made and natural origin.

bandage fracture burn victim

Rules and techniques for applying bandages for wounds

Wounds are mechanical violations of the integrity of the skin or mucous membranes. There are wounds of cuts, stabs, chopped, bruised, crushed, lacerated, gunshot and others.

Wounds can be superficial, when only the upper layers of the skin are damaged (abrasions), and deeper, when not only all layers of the skin are damaged, but also deeper tissues ( subcutaneous tissue, muscles, etc.).

If a wound penetrates into any cavity - chest, abdominal, skull - it is called penetrating.

Most wounds bleed due to damage to blood vessels.

First aid for wounds is aimed at stopping bleeding, protecting the wound from contamination, and restoring the injured limb.

Protecting the wound from contamination and microbial contamination is best achieved by applying a bandage; For dressings, gauze and cotton wool, which are highly hygroscopic (the ability to absorb liquid), are used. Heavy bleeding stop by applying a pressure bandage or hemostatic tourniquet (on the limbs).

When applying a bandage, the following rules must be observed:

• 1. You should never wash a wound, as this may introduce germs into it.
• 2. If pieces of wood, scraps of clothing, earth, etc. get into the wound. they can only be removed if they are on the surface of the wound.
• 3. Do not touch the surface of the wound (burn surface) with your hands, since there are especially many microbes on the skin of the hands.
• 4. Dressing should be done only with cleanly washed hands, if possible wiped with cologne or alcohol.
• 5. The dressing material used to close the wound must be sterile.

In the absence of sterile dressing material, it is permissible to use a cleanly washed scarf or piece of fabric, preferably white, previously ironed with a hot iron.

6. Before applying a bandage, the skin around the wound should be wiped with vodka (alcohol, cologne), and should be wiped in the direction away from the wound, and then lubricate the skin with iodine tincture.

Before applying a bandage, gauze pads (one or more, depending on the size of the wound) are applied to the wound, after which the wound is bandaged. Bandaging is usually done from left to right, with circular moves of the bandage, the bandage is taken in right hand, its free end is grabbed with the thumb and forefinger of the left hand.

Rules for opening a first aid dressing package: to open the package, take it into left hand, with the right hand, grab the cut edge of the shell and jerk the gluing off. They take a pin from the fold of paper and fasten it on their uniform, unfolding the paper shell, take the end of the bandage, to which a cotton-gauze pad is sewn, in their left hand, and in their right hand - the rolled up bandage and spread their arms. the bandage is stretched, and a second pad will be visible, which can move along the bandage. This pad is used if the wound is through. one pad closes the inlet, and the second the outlet, for which the pads are moved apart to the required distance. The pads can only be touched with hands from the side marked with colored thread. Downside pads are placed on the wound. They are secured with circular moves of the bandage, and the end of the bandage is pinned with a pin. In the case where there is only one wound, the pads are placed side by side, and for small wounds, they are placed on top of each other.

Rules for applying different types of bandages: the simplest bandage - circular - is applied to the wrist, lower leg, forehead, etc. When applying it, the bandage is applied so that each subsequent turn completely covers the previous one.

A spiral bandage (these bandages are used when bandaging limbs) is started in the same way as a circular bandage, making two or three turns of the bandage in one place in order to secure it. Moreover, they begin to bandage from the thinnest part of the limb. When bandaging in spirals, in order for the bandage to fit tightly without forming pockets, after one or two turns it is turned over; at the end of bandaging, the bandage is secured with a pin or its end is cut along the length and tied.

When bandaging the area of ​​the joints of the foot and hand, eight-shaped bandages are used, so called because when they are applied, the bandage always seems to form the number “8”.

When bandaging a wound located on the chest or back, a so-called cruciform bandage is used.

When the shoulder joint is injured, a spica bandage is used.

A scarf bandage is applied when the head, elbow joint and buttock are injured.

A sling-shaped bandage is applied to the chin, nose, back of the head and forehead. To prepare it, take a piece of a wide bandage about 1 m long and cut it lengthwise at each end, leaving the middle part intact. For small wounds, a sticker can be used instead of a bandage.

When applying a bandage, the victim should be seated or laid down, because even with minor injuries, under the influence nervous excitement, pain may result in a short-term loss of consciousness - fainting.

The application of bandages for penetrating wounds of the abdomen and chest has some features. Thus, with a penetrating wound to the abdomen, the insides, most often intestinal loops, may fall out of the wound. It is impossible to set them into the abdominal cavity - only a surgeon can do this during surgery; such a wound must be closed with a sterile gauze cloth and the stomach bandaged, but not too tightly, so as not to squeeze the prolapsed entrails.

With a penetrating wound to the chest, with each inhalation, air is sucked into the wound with a whistle, and with exhalation, it comes out through it with a noise. Such a wound must be closed as quickly as possible. To do this, put several layers of gauze and a thick layer of cotton wool on the wound and cover it with a piece of oilcloth, compress paper, the rubberized shell of an individual bag or some other material that does not allow air to pass through, and then bandage it tightly.

When applying bandages to wounds and burn surfaces, basic rules must be followed. The type of bandage applied in each specific case is determined by the nature of the injury and the intended purpose (protecting the wound, stopping bleeding, fixing the damaged part of the body, etc.).

When applying a bandage, the affected person must be given the most comfortable position so as not to cause additional pain. The bandaged part of the body should be located in a physiological position, i.e. in the one that the affected person will occupy after first aid is provided to him. Thus, a bandage is applied to the upper limb with the elbow joint bent at a right angle so that the arm can be suspended on the scarf. If the affected person has to walk, a bandage is applied to the lower limb with the knee joint bent at a slight angle and the foot bent at a right angle. When applying a bandage, it is necessary to monitor the facial expression of the affected person - this will allow you to determine in time his reaction to pain.
You must not remove fragments from the wound, touch the wound with your hands, or fill it with alcoholic iodine solution, cologne, alcohol, or vodka! Only the skin around the wound needs to be treated. You should not tear off clothing stuck to the wound, but should carefully trim it around the wound! If it is difficult to remove the shoes when the wound is exposed, they are cut along the seam. On the scalp, if possible, cut off the hair only around the wound, but do not remove it from the wound. The wound is covered with sterile material (napkin, bandage), which is secured with a bandage. The head of the bandage is taken in the right hand, the end of the bandage is applied to the side of the wound with the left hand; rolling out the bandage, apply a bandage by rotating its head around the bandaged part of the body, intercepting the head of the bandage alternately with the right and left hands, and straightening the bandage with the free hand. Bandaging is carried out from left to right, with each subsequent move of the bandage covering half the width of the previous move. The applied bandage should not cause pain or interfere with blood circulation. Having finished bandaging on a healthy part of the body, you need to tie the end of the bandage that is torn longitudinally or secure the end of the bandage with a pin.

Twelve rules for applying bandages:

1. The patient should be seated or laid in a comfortable position so that the bandaged area is motionless and accessible to bandaging.

2. The person providing assistance must stand facing the patient in order to be able to observe him.

3. Bandaging is always done from the periphery to the center (from bottom to top).

4. Beating is carried out counterclockwise (with the exception of applying Deso, spica bandages to the mammary gland).

5. Bandaging begins with the fastening stroke of the bandage.

6. Each subsequent turn of the bandage should cover the previous turn by half or two-thirds.

7. The head of the bandage should be moved along the surface to be bandaged,
without leaving her.

8. Bandaging should be done with both hands (one hand
roll out the head of the bandage, and the other - straighten its passages).

9. The bandage should be tensioned evenly so that its strokes do not move and do not lag behind the bandaged surface.

10. The bandaged area of ​​the body should be given this position
knowing what it will be like after applying the bandage.

11. When applying a bandage to parts of the body that have a cone shape (thigh, lower leg, forearm), to better fit the bandage, it is necessary to twist the bandage every 1-2 turns.

12. At the end of applying the bandage, the bandage is secured.

Bandages for head trauma

Most often applied to wounds in the scalp area. headband(rice.). This bandage is considered the most comfortable and reliable, because... the possibility of its displacement is excluded. The wound is covered with a sterile napkin and a layer of cotton wool. Then a piece of bandage-tie (1) up to 1 m long is lowered through the crown with equal ends in front of the ears. Holding the ends of a piece of bandage in a taut position, make 2-3 circular moves through the forehead and back of the head (2) over the stretched bandage-tie on the right and left (11) - (13), gradually covering the entire cranial vault with its moves. The end of the bandage (14) is connected to one of the ties and under the chin is tied to another tie.

Rice. Headband-bonnet

Headband-cap(fig.): first secure the bandage with two circular moves through the forehead and occipital region, then, alternately bending it in front and behind (1) - (9), fix the ends (places of bends) with circular turns of the bandage (4) - (5). Repeating this technique several times, cover the entire scalp. Finish applying the bandage with circular moves of the bandage (10), the end of which is secured with a pin.

Rice. 8.16. Headband-cap

Apply to wounds in the face, chin, and sometimes on the scalp. bandage in the form of a bridle(rice.).

Fig.. Bandage in the form of a bridle - explanations in the text

After two securing moves through the forehead and occipital region (1), the bandage is transferred to the back of the neck and chin (2), then several vertical moves (3) - (5) are made through the crown and chin. From under the chin, the bandage is passed to the back of the head (6) through the forehead (7), then the order of the bandage moves is repeated until the surface of the back of the head, crown, and lower jaw is covered. If you need to cover the chin with a bandage, then make additional moves (8), (9) through the chin and neck and vertical ones (10), (11) and end with circular moves through the forehead and occipital region (12).
Bandage on the ear area(Fig..) is applied in a circular motion of the bandage through the fronto-occipital regions (1), (3), (5) with alternating strokes of the bandage through the mastoid process (part temporal bone, located behind the external auditory canal) and the ear (2), (4), (6), end in circular passages (7).

Rice. . Bandage on left ear

Apply to the occipital region and neck eight-shaped (cruciform), bandage(so called because of the shape and movement of the bandage) (Fig.).

It begins with two circular passes of the bandage through the fronto-parietal regions (1), then the bandage is led above the ear to the back of the head (2) and at the angle of the lower jaw on the other side is brought out to the front surface of the neck, then from under the lower jaw through the occipital region (3) on the forehead. Subsequently, the order of the bandage moves is repeated (4), (5), (6) and ends around the head (7). This type of bandage can also be applied to the chest, hand, etc.

Fig. Eight-shaped headband

Eye patch called monocular and is applied as follows: first, a fastening circular motion of the bandage (1) is made, which goes from the back of the head under the right ear to the right eye (2), and under the left ear to the left eye. The bandage moves alternate through the eye and around the head. When applying a bandage, remember that the bandage is applied to the affected eye. A bandage for both eyes consists of a combination of two bandages applied to the left and right eyes (called binocular). It starts out the same way as an eye patch.

Rice. 8.20. Bandage on the right eye (a) and on the left eye (b)

On the nose, forehead, chin superimposed sling bandage(Fig.), placing a sterile napkin (bandage) on the wound. When applying headbands, you can use a mesh-tubular bandage.

Rice. 8.21. Sling bandage on the nose (a), forehead (b), chin (c)

Bandages for chest trauma

The simplest of these dressings is spiral(rice.). A bandage 1-1.5 m long should be placed on the left shoulder girdle (1), hanging its ends equally behind and in front. On top of it, starting from the bottom of the chest, they go in spiral passages, going up from right to left (2) - (8). The bandage is finished with a bandage running from the right armpit, connecting 1 (9) with the free end in front (10) and tying it on the forearm with the other free end hanging at the back (11).

Rice. Spiral chest bandage

Rice. Cross bandage on the chest

Cross bandage on the chest (Fig.) is applied from the bottom of the chest, starting with two or three circular moves (1), (2) of the bandage, then the bandage moves from the right armpit along the front surface (3) to the left shoulder girdle with a fixing circular move (4) and from the back through the right shoulder girdle (5): the bandage moves are repeated in the indicated order until the entire surface of the chest is covered with the bandage.

Used to secure the shoulder girdle and shoulder Deso bandage. It is used to immobilize fractures of the bones of the forearm, shoulder, and dislocations in the shoulder joint. Before applying the bandage, the arm is bent at a right angle at the elbow joint, with the palmar surface facing the chest. A cotton wool pad is placed in the armpit to abduct the shoulder. The Deso dressing consists of 4 moves. Bandaging is done towards the sore side. With two or three strokes of the bandage (1) - (2), the shoulder is fixed to the body, then the bandage is passed from the back into the armpit of the healthy side, onto the shoulder girdle of the sore side, lowered down under the elbow and, fixing the forearm, passed into the armpit of the healthy side (3 ), along the back through the shoulder girdle of the diseased side, lowered down the shoulder under the elbow, then obliquely along the back through the armpit of the healthy side, and then the moves of the bandage (4), (5) are repeated several times until the shoulder girdle is completely fixed. When the bandage is applied correctly, the bandages do not extend over the shoulder girdle of the healthy side, but form triangles in front and behind the chest.

Fig.. Deso bandage

Upper limb bandages

A protective and at the same time fixing bandage is applied to the shoulder joint. On the shoulder joint(Fig. 8.25.) Bandaging begins from the armpit of the healthy side through the outer surface (1) of the injured shoulder, then into the back of the armpit and onto the shoulder (2), along the back through the armpit of the healthy side (3) onto the shoulder, and then the moves of the bandage are repeated, moving upward to the shoulder joint and shoulder girdle (4).

To the elbow joint(Fig. 8.26.) The bandage is applied in spiral strokes of the bandage, alternating them on the forearm (1), (2), (6), (8), (10) and shoulder (3), (4), (5), (7), (9) with crossing in the ulnar fossa, fixing the bandage (II).

Rice. Bandage on the shoulder Fig. Bandage on the elbow joint

Spiral bandages are applied to the shoulder and forearm, bandaging from bottom to top with a bend in the bandage. The bend of the bandage is performed as follows: with the thumb of the free hand, press the lower edge of the last round, bend the bandage, while it top edge becomes bottom. With this method of bandaging, a tight fit of the bandage and good fixation of the bandage are achieved.

Rice. Spiral bandage on the forearm

A cross-shaped bandage is applied to the hand(Fig.) and "mitten"(fig.) The bandage is fixed on the wrist (1) in two or three strokes, then it is passed obliquely along the back of the hand (2) to the palm, in two or three circular strokes (3) from the palmar surface obliquely along the back of the hand (4) to the wrist , then the moves of the bandage are repeated (5), (6), (7 ); b The inturation is completed by securing the end of the bandage to the wrist (8).

Fig. Cross-shaped bandage on the hand

Fig.. Bandage on the hand “mitten”

If the fingers are damaged, the bandage is applied to each finger separately (Fig.)

Rice. 8.31. Finger bandages:

a-finger bandage; b-bandage on all fingers (glove); c-bandage for 1 finger, spica type; g-finger bandage of the returning type
Spiral finger bandage(Fig. 8.32.) start with two or three strokes of the bandage from the wrist (1), then move the bandage along the back surface (2) to the nail phalanx of the finger, make circular strokes to the base (3) - (6), through the wrist (7 ), if necessary, bandage the 2nd (8) and subsequent fingers.

Rice. . Spiral finger bandage

Bandages for injuries of the lower extremities and abdomen

Rice. . Bandage on the abdominal area and hip joint a-bandage on the abdominal area; b - bandage on the hip joint or groin area

Rice. . Wrist bandage

a - fixing stroke of the bandage (1); b - circular moves of the bandage (2, 3); c — transfer of the bandage to the forearm (4); d — fixing moves of the bandage on the forearm (5, 6); d — returning the bandage to the hand (7); e - subsequent circular moves of the bandage on the hand (8) and securing the bandage

Spiral dressings are applied on the thigh and shin as well as on the shoulder and forearm.
On knee-joint apply a converging or divergent bandage (Fig.)

Rice. Bandage on the knee joint: a - converging, b - divergent
On the ankle joint apply a figure-of-eight bandage (Fig.). The first fixing stroke of the bandage is made above the ankle (1), then the bandage is led down to the sole (2) around the foot (3) and along its back surface (4) above the ankle (5) onto the foot; repeating the moves of the bandage, finish the bandage in circular moves above the ankle (7), (8). This bandage not only protects the wound, but also fixes the joint.
When applied tie on the heel area the first stroke of the bandage is made through its most protruding part, then, alternately, above and below the first stroke, continuing from the sole with oblique strokes around above the ankle, then the strokes of the bandage are repeated above the second and below the third stroke in the opposite direction, through the sole; the end of the bandage is fixed above the ankle.

On the foot(Fig. 8.35,8.36.) apply a spica bandage with alternating passes of the bandage through the heel, supraheel area (1), (3), (5), (7), (9) and the dorsum of the foot (2), (4), (6), (8), (10), (12); The end of the bandage (13) is fixed above the ankles.

Rice. . Ankle bandage

Rice. . Spica joint foot bandage

Rice. Technique for applying a figure-of-eight bandage to the foot and ankle joint:
a-fixing move on the foot (1); b-circular movements on the foot (2,3); c- transfer of the bandage to the lower leg (4); d - fixing moves on the lower leg (5.6); d - return of the bandage to the foot (7); e-subsequent circular movements on the foot (8) and securing the bandage
On the stump of a limb a returning bandage is applied (Fig.) as follows: the wound is covered with a sterile napkin, a cotton-gauze pad and they are fixed alternately in circular (1), (2), (3), (5), (7), (9) and longitudinal ( 4), (6), (8) moves of the bandage.

The most time-consuming and difficult is applying bandages for severe abdominal injuries. When the upper abdomen is wounded, a spiral bandage is used in circular motions of the bandage from the chest down.

If the wound is located in the lower abdomen or groin area, apply spica bandage(rice.

Having made two or three circular moves (1) - (3) in the lower abdomen, the bandage is passed from behind to the front surface of the thigh (4) and around it (5), and then through the groin area (6) to the lower abdomen, performing the necessary the number of circular moves, if you need to close the wound in this area (7) - (9), or one circular move followed by repeating (4), (5), (6) moves of the bandage on the thigh and through the groin area - if necessary, close the wound in the groin area.

Rice. . Bandage on the stump of a limb

Rice. Bandage on the lower abdomen and groin area
Bandages on the perineum and lower limbs. For perineal injuries, a T-shaped bandage is convenient: take a piece of bandage, tie it in the form of a belt at the waist, then make moves of the bandage through the perineum, and, securing them to the belt in front and behind, fix the napkin applied to the wound.

For more extensive perineal wounds, it is advisable to apply figure-of-eight bandage, which they begin with two or three circular moves around the waist, then pass the bandage through the buttock and perineum, make a reverse move around the waist through the perineum, and so on, repeating the moves of the bandage, crossing in front, tightly covering the external genitalia.
To the pelvic area apply a spica bandage, starting with circular moves of the bandage on the waist, then make successive moves around the thigh and waist in the form of a figure eight, ending the bandaging.

The chapter provides the basic methods of applying bandages to various areas of the body. There may be various modifications of these dressings. The main requirement for applying bandages is compliance with the rules of asepsis and antisepsis, ensuring the most comfortable physiological position of the damaged part of the body, eliminating the possibility of impaired blood supply, and reliable fixation of the bandage on the damaged part of the body.