Medicines needed for work in the dressing room. Dressings and wound dressings. Adhesive dressings are applied to the area of the postoperative wound and in case of small injuries. Their benefits

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Introduction
1. Bandage classification
2 . Dressings and wound dressings
3 . Fixing bandages
4 . Bandage types
5 . Private types of bandages on the body area

Introduction

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.

1. Classification of dressings

Bymindappliedmaterial.

Soft:

a) bandages;

b) bandage-free (adhesive, kerchief, sling-like, adhesive plaster, T-shaped, coatings).

Solid (tire, starch, gypsum).

ATdependenciesfromgoals.

Wound dressings:

a) sorption;

b) protective;

c) activated by drugs;

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

Fixing - designed to fix the dressing on the wound.

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

Occlusive (sealing) dressings - preventing the penetration of air into the pleural cavity from the outside and a violation of the act of breathing.

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

Immobilizing dressings:

a) transport;

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

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

Soft bandages include bandages applied with a bandage, gauze, elastic, mesh-tubular bandages, cotton fabric. Soft bandages are varied. Most often, dressings are applied to hold dressings (gauze, cotton wool) and medicinal substances in the wound, as well as to carry out immobilization for the period of transportation of the victim to a medical institution. Most often, bandages are used to apply soft bandages. Less commonly, other means (without bandages) - adhesive, kerchief, sling-like, T-shaped, contour dressings; mesh-tubular bandages.

Rigid dressings use a solid material (wood, metal) or a material capable of hardening: gypsum, special plastics and starch, glue, etc.

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

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

2. Dressing material 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 loose; soft, elastic, do not injure soft tissues; easy to sterilize and not lose their qualities; be cheap to produce.

According to their properties, modern dressings are divided into:

sorption;

protective;

drug activated;

atraumatic.

The classical sorbents that have found wide application 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 lies in the fact 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 bandages, dressing bags are made from it. The annual consumption rate for a surgical bed is 200 m of gauze and 225 bandages.

A very valuable dressing material is cotton wool, which is of two types - simple (non-fat-free) and hygroscopic. The latter has a high suction capacity. Plain cotton wool is not hygroscopic and is used in surgery as a soft lining, for example, when applying splints, plaster bandages, 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 wide application. In general, any but 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 canvas-stitched threadless fabric made on the basis of cotton fibers, which has good plasticity, with a sorption capacity of 1400-2400%. 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 tissues increases the absorption capacity up to 3400%. 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 the adhesion to the wound. This leads to granulation injury, with pain during dressings.

Cellulose-absorbing dressings do not have these shortcomings, they are represented by a non-adhering inner and outer water-repellent layer that prevents secretion from seeping out. Currently, self-adhesive cellulose wound dressings are produced with a hydrophobic micromesh on the side of the wound, a suction pad made of clean cotton and a soft base made of non-woven material coated with hypoallergenic polyacrylate adhesive. For the treatment of small superficial wounds, non-adhesive gel dressings are available with an integrated cellulose wadding absorbent element. These dressings are highly absorbent and air permeable.

On the basis of cellulose material, combined sorption dressings with a three-dimensional suction capacity have been created. In this case, the 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, 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 dressing for this purpose.

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

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

Hydrophobic sorbents, in comparison with water-swellable ones, have a lower ability to absorb liquid, but actively sorb microorganisms. Among the hydrophobic sorbents, carbon, organosilicon, polyurethane, etc. are distinguished. Polyurethane sponges, which have good air and water vapor permeability, are most widely used. They are elastic and soft, while their sorption capacity is 1800-2000%.

As wound sorbents of the hydrophobic type, various carbon materials are widely used - vaulene, resorb, etc. 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.

Effective sorption-active dressings are hydrocolloid dressings. Dressings of this type consist of swellable colloids encapsulated in a self-locking 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 tissues, softening of necrotic formations during diffusion of the gel under them and facilitating the removal of non-viable tissues are provided.

Protectivebandages. 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 dressings are conditionally divided into two groups:

coatings used in finished form;

coatings formed directly on the wound.

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

Insulating coatings of the second group are formed directly on the surface of the wound. For this purpose, aerosol compositions have been proposed, when applied to a wound for 1-2 minutes, a film coating will be created 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 highly qualified medical personnel. Saving dressings, the ability to monitor the state of the wound without changing the dressing, the film is waterproof, allowing you to wash patients. The use of film-forming coatings is contraindicated in bleeding, contaminated, weeping wounds, extensive skin lesions.

With large defects in the skin, 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, dressings are made of silicone or natural rubber, polyvinyl chloride, polyurethane, polyamides, polyethylene, polystyrene, polypropylene, silicone. In recent years, wound dressing from chitosan - "Chitosan" (Great Britain, Taiwan) has been obtained. This coating consists of a derivative of lobster chitin and is a semi-permeable biological membrane.

bandages,activatedmedicinaldrugs. To increase the therapeutic effect of dressings, they include drugs of various directions of action. As carriers for the immobilization of medicinal substances, non-woven 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. With the introduction of drugs in dressings, their combinations 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, xeroforms are also used.

As a result of the immobilization of proteolytic enzymes on the material of the polymer coating, it is possible not only to lengthen 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 dressings includes: "Polypor" - a polyurethane foam composition with immobilized trypsin; "Dalceks-trypsin" - trypsin immobilized on medical gauze; "Paxtripsin" - trypsin immobilized on a nylon knitted fabric; "Teralgin" - 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, thrombin.

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

In addition to gauze, polymeric materials are widely used to create non-stick dressings. The principle of their design is that the surface of a 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, polypropylene are used as materials for the hydrophobic layer. To increase the rate of absorption of exudate by the sorbent, it is proposed to cover the perforated film with surfactants, as, for example, in the Aseplen dressing.

Another way to make non-adhesive dressings is to coat 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 longest-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 drug intolerance.

There is a group of sticky but atraumatic sorbent coatings based on natural and synthetic polymers. Dressings of this type do not need to be removed and remain in the wound until completely absorbed. Alginates belong to this group of wound coverings. In particular, Algipor, which is a mixed sodium-calcium salt of alginic acid, a polysaccharide derived from seaweed.

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

3. Fixing bandages

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

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

Adhesivebandages

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

by closing the area of the wound directly, one can observe the state of the surrounding skin;

easy and quick to apply;

do not limit the movements of the patient;

economical.

Allocate the following adhesive bandages.

Adhesive plasters bandages

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

Cleol bandage

Currently, cleol is used for sticker bandages, which does not tighten and irritate 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 is applied to the wound, and the skin around the wound is smeared with a cotton swab with a thin layer of glue. After 30-60 seconds, when the glue begins to dry out a little, a gauze napkin of the required shape and size is glued, pressing it tightly against the skin and stretching along the edges. The free edges of the gauze napkin that do not stick to the skin are cut off.

collodion bandage

Collodium is a solution of colloxylin in ether and alcohol. The solution is applied with a brush to the edges of a gauze pad applied over the dressing. When the solvents evaporate, the collodion solidifies, 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 lubrication with collodion, in addition, collodion is highly flammable. Currently, collodion dressings are used quite rarely.

kerchiefbandages

A kerchief is a common first aid bandage, since it does not require complex devices, it can be quickly applied using a headscarf, sheet, gauze flap, canvas, etc. A kerchief is a piece of triangular-shaped fabric in which a base is distinguished (long side ), the top (the angle lying against the base) and the ends - the other two corners.

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 the kerchief bandage is used to suspend the upper limb, especially for injuries of the forearm and hand.

dressing material

To fix the arm (Fig. 1), the latter is bent to a right angle, and the scarf is brought in so that the upper end fits 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 wrapped the upper end up in front of the forearm of the diseased hand, it is carried out on the shoulder girdle of the healthy side and behind the neck, where it is connected to the other end of the scarf. The top of the scarf is bent around the elbow and secured in front of the elbow with a pin.

Rice. 1 . Using a scarf to immobilize the shoulder girdle and upper limb

With the help of a scarf, bandages can be applied to the mammary gland (Fig. 2), foot, hand (Fig. 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 bent in front of the tied ends and secured with a pin.

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

Rice. 3 . The imposition of a scarf bandage on the brush. 1,2,3 - bandaging steps

sling-likebandages

A sling in desmurgy is a piece of gauze in the form of a ribbon 50–60 cm long, both ends of which are notched in the longitudinal direction so that the middle 10–15 cm long is uncut (Fig. 4).

Rice. 4 . sling bandage

This bandage has 4 ends; the middle part is designed to cover the damaged area over the dressing and secure the latter. The sling bandage is most often used on the face in the area of the nose, forehead, neck, chin as a temporary measure for holding tampons and temporary immobilization. Like a kerchief, it does not seal the hermetically damaged area and is fragile.

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

T-shapedbandages

This bandage is convenient for holding the dressing on the perineum, scrotum and anus. It is easy to manufacture, if necessary, can be quickly applied and removed. It consists of horizontal and vertical (wider) strips of bandage, with the horizontal part going around the waist in the form of a belt, and the vertical part - from the waist through the crotch forward and tied to the same belt (Fig. 6).

Rice. 5 . Options for applying sling dressings

The T-shaped bandage can successfully replace the so-called suspensory used to support the scrotum, for example, after surgery for dropsy of the testicle, with orchitis, orchiepididymitis, etc.

Rice. 6 . T-shaped crotch bandage

BandagesWithusingelasticmesh-tubularbandages

To hold the 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 incised, and at the same time do not restrict movements in the joints.

They look like a tube woven from cotton and rubber thread and come in different diameters.

Depending on the size, five numbers of tubular bandages are distinguished: 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 worn on the chest or stomach person.

Having a mesh structure, elastic mesh-tubular bandages provide the possibility of aeration and monitoring of the state of peri-wound tissues.

Bandagebandages

Bandage bandages are the most common, as they meet the requirements for a modern rational bandage (strength, elasticity, porosity, creation of the necessary pressure, etc.). At present, soft gauze, which has good elasticity, is almost exclusively used for bandaging. Gauze bandages do not prevent the evaporation of moisture from the bandage. Bandages made of denser fabrics (flannel, canvas, calico) are not currently used. The use of soft bandages remains to date one of the most common ways to strengthen the dressing, despite the widespread use of adhesive tape, glue, polymerizing plastics, synthetics, etc. This is due to the versatility of bandages, their adaptability to any type of body surface and any pathological processes. 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 up part of the bandage is called the head, and its beginning is the free end. Bandages can be single-headed and double-headed (rolled from two ends to the middle), the latter are used in exceptional cases (headband). The back of the bandage, i.e. the surface facing the bandaged part of the body is called the back, and the opposite side is called the abdomen, and when bandaging the abdomen should be turned outward so that the bandage can easily and freely roll out on the surface of the bandaged body area. The bandage is narrow (up to 5 cm), medium (7-10 cm) and wide (12 or more cm). Each part of the body requires its own bandage width.

Basic requirements for a bandage bandage:

cover the affected area of the body;

do not disturb blood and lymph circulation;

hold securely on the body area;

be as neat as possible.

Rules overlays soft bandage bandages

Despite the high prevalence of bandage dressings, their imposition requires a certain skill, knowledge and skill. A properly applied bandage does not disturb the patient, it is accurate, firmly and for a long time fixes the dressing material. In order for the bandage to lie correctly, bandages of the appropriate width should be used, depending on the size of the anatomical region being bandaged. So, for the torso, wide bandages are needed, for the head - medium, for the hand and fingers - narrow.

Bandaging consists of the following steps:

imposition of the initial part of the bandage;

the imposition of the actual moves of the bandage;

fixing the bandage.

Rules bandaging

When starting bandaging, care should be taken to ensure that the patient is in a comfortable position for him, and the bandaged part of the body 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 such a position of the limb, which is functionally the most beneficial, especially when applying a bandage for a long time.

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

Bandaging is very tiring and uncomfortable if the health worker has to bend over or raise his arms up, so it is best to position the bandaged part of the body at the level of the lower chest of the bandager.

Bandaging should begin with the peripheral parts, gradually covering the central areas of the body with bandage tours.

The exception is bandages on the hand, foot and fingers of the hand and foot, when the bandage tours are located from the center to the periphery.

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

The head of the bandage is held in the right hand, the beginning of the bandage is in the left, the bandage is rolled from left to right with the back on the bandaged surface of the body, without taking your hands off it and without stretching the bandage in the air.

In some cases, bandaging from right to left can be carried out, for example, when bandages are applied to the right area of the face and chest.

The bandage should roll smoothly, without wrinkling; its edges should not lag behind the surface and form "pockets".

The bandage should be applied not too tight (unless a pressure bandage is required) so that it does not interfere with blood circulation, but not too loose so that it does not slip from the wound.

The hand of the bandager should follow the course 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 fix 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 for the last circular move or pinned to previous rounds with a safety pin.

When removing the bandage, the bandage is either cut or unwound.

Start cutting the bandage away from the damaged area or from the side opposite to the wound.

When unwinding, the bandage is collected in a lump, shifting it from one hand to another at a close distance from the wound.

Mistakes at overlay soft bandages

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

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

The integrity of the bandage is easily broken if the first fixing rounds are not made. To correct the error, the bandage must be bandaged, strengthening it with glue and adhesive tape.

4. Types of bandages

In order to properly apply any bandage, it is necessary 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 a different shape (cylindrical - shoulder, conical - forearm, lower leg), which must be taken into account when applying bandages.

The nature of bandaging (more kinks in the bandages) can also be influenced by more pronounced musculature in men and greater roundness in women.

Taking into account these provisions, various types of bandage dressings have been developed.

circular,orcircular,bandage (fascia circularis )

This is the simplest form of a bandage dressing, in which all the tours of the bandage fall on the same place, completely covering each other. They begin with it and finish the bandage with it, less often it is used as an independent one on areas of the body of a cylindrical shape. In this case, the moves of the bandage, going from left to right, cover each other completely in an annular fashion. At the beginning of bandaging, the first move of the bandage can be given an oblique direction by bending the edge, which is then fixed with the second move (Fig. 7). A circular bandage is convenient for bandaging small wounds and is more often applied to the shoulder, wrist joint, lower third of the lower leg, abdomen, neck, forehead.

Rice. 7 . circular bandage

Spiralbandage (fascia spiralis )

It is used if it is necessary to bandage a significant part of the body. It, like any other bandage, begins with circular bandages (2-3 layers), then the bandage is led from the periphery to the center. At the same time, the tours of the bandage go somewhat obliquely from the bottom up and each next tour closes 2/3 of the width of the previous one. As a result, a steep spiral is formed (Fig. 8).

Rice. 8 . spiral bandage

Rice. 9 . creeping bandage

creepingorserpentine,bandage (fascia serpenses )

Such a bandage is used mainly for the rapid and temporary strengthening of the dressing over a considerable length of the limb. A creeping bandage is started with a circular bandage, which is then transferred into a helical bandage, from the periphery to the center and back. So that the turns of the bandage do not touch (Fig. 9). After fixing the dressing with a creeping bandage, further bandaging is continued in the usual way, applying a spiral bandage.

cruciform,oreight-shaped,bandage (fascia cruciata ceu octoidea )

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

Rice. 10 . Cross bandage. a - brush; b - chest; c - perineum; g - foot

A variation of the eight-shaped bandage is spike-shaped (fascia spica). Its difference from the cruciform is that the cross does not pass at the same level, but gradually moves up (ascending bandage) or down (descending). The place where the bandage crosses in appearance resembles an ear, hence the name of the bandage (Fig. 11). Usually, a spica bandage is applied to the area of \u200b\u200bthe joints.

A variant of the 8-shaped bandage is also turtlebandage,converginganddivergent (fascia testudo inversa or reversa). Such a bandage is applied to the area of large joints (elbow, knee). It consists of bandage moves that cross on the flexion side of the joint and diverge in the form of a fan on the extensor side.

Rice. 11 . Spica bandage on the hip joint

A diverging bandage begins with a circular motion through the center (the most protruding part) of the joint. Subsequent bandage moves are above and below the previous ones, crossing on the flexion side of the joint and covering 2/3 of the previous moves until the affected area is completely closed (Fig. 12).

A converging turtle bandage is started with circular bandages above and below the joint and also crossing on the flexor side of the latter.

Further moves bring them closer to each other to the convex part of the joint until the affected area is closed.

Rice. 12 . Turtle bandage. a - divergent; b - convergent

Rice. 13 . Returning bandage on the stump

Return bandage ( fascia recurens )

It is usually applied to rounded surfaces (head, limb stumps). Such a bandage is reduced to the alternation of circular bandage moves with longitudinal ones, going sequentially and returning back, until the stump is completely closed (Fig. 13).

It should be emphasized that a bandage bandage on any part of the body cannot be only circular or only spiral, etc., since such a bandage can easily be displaced, therefore it must be reinforced with 8-shaped passages in order to fit snugly against the surface of the bandaged part body. When bandaging a limb of unequal thickness, for example, the forearm, it is advisable to use a technique called an inflection. The bend is performed in several rounds and the steeper, the sharper the difference in the diameters of the bandaged part.

Improvisation and a combination of different types of dressings are possible when bandaging large areas of the body. So, when bandaging the entire lower limb, all 7 basic bandage options can be used.

5. Particular types of bandages on the body area

HEADBANDS

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

Simplebandage (cap)

This is a return bandage that covers the cranial vault (Fig. 14). Two circular passages lead around the head, capturing the region of the glabella and the region of the occiput (1). Then an inflection is made in front, and the bandage is led obliquely along the lateral surface of the head, slightly higher than the circular one (2). Going to the back of the head, make a second bend and cover the side of the head on the other side (3). After that, the last two oblique moves are fixed with a circular bandage and then again two oblique returning moves (5 and 6) are made slightly higher than the previous ones (2 and 3) and it is fixed again.

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 applicable for imposition in severe patients.

Rice. 14 . Headband "hat"

HatHippocrates

Facing the victim, the bandager takes one head of a double-headed bandage in each hand and, deploying them, applies one or two circular moves around the head. Having brought both heads of the bandage to the back of the head, the left head is brought under the right one and a kink is made, the right head continues its circular course, and the left one, after the kink, goes in the sagittal direction through the crown to the forehead. In the forehead area, both heads meet: the right one goes horizontally, while 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, anteroposterior moves are made with one part of the bandage, and circular with the other. The bandage is fixed with circular passages of both heads around the head (Fig. 15).

Cap

A piece of bandage 50-75 cm long is placed in the transverse direction on the crown of the head so that the ends descend vertically down in front of the auricles, where an assistant holds them in a taut position (sometimes the patient himself does this). On top of this bandage, the first horizontal moves are carried out around the head so that their lower edge goes over the eyebrows, over the auricles and over the occiput. Having reached the vertical tie on one side, the bandage is wrapped around it (a loop is made) and then on the forehead area somewhat in an oblique direction, covering half the circular course. Having reached the opposite tie, they again make a loop and again lead in an oblique direction to the occipital region, half covering the underlying passage, etc. So each time, throwing the bandage over a vertical tape, they lead it more and more obliquely until they cover their entire head.

Rice. 15 . Bandage "hat of Hippocrates"

Rice. 16 . Bandage "cap"

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

Bandagetypefrenulums

It is used for damage to the lower jaw, after reduction of dislocation, etc. (Fig. 17). First, two horizontal circular moves are applied around the head from left to right. Next, the bandage is led over the ear of the left side obliquely upward through the back of the head under the right ear and under the lower jaw in order to grab the jaw from below and go from the left side in front of the left ear up to the crown.

Then the bandage behind the right ear is again led 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 to the neck, then obliquely up through the back of the head and a circular move is made around the head, strengthening the previous rounds.

Rice. 17 . Bandage "bridle"

Then they again go behind the right ear, then almost horizontally cover the entire lower jaw with the bandage and, having come 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. Having repeated the previous move, and then, having rounded the neck in front, they go to the back of the head above the right ear and finish the bandage with a circular horizontal bandage.

Bandageon theoneeye

The bandage begins with circular moves around the head, and for the right eye, the bandage is led from left to right, for the left, on the contrary, from right to left (Fig. 18). Having strengthened the bandage with horizontal moves, lower it from behind down to the back of the head and lead it under the ear from the diseased side obliquely up through the cheek, closing the sore eye. An oblique move is fixed in a circular way, then an oblique move is made again, covering half the previous one. So, alternating oblique and circular moves, they cover the entire area of \u200b\u200bthe eye.

Rice. 18 . One eye patch

Rice. 19 . Bandage for both eyes

Bandageon thebotheyes

After fixing the bandage with circular moves (Fig. 19), it is led from the back of the head under the ear and an oblique move is made from the bottom up, closing the eye on one side. Then they continue to lead the bandage around the occipital region of the head and through the forehead obliquely from top to bottom, closing the eye on the other side, then they carry out the bandage below the ear and across the back of the head, come out from under the ear from the opposite side and make another upward oblique move. So, alternating with each other, the oblique moves of the bandage gradually close both eyes. Fix the bandage with a circular bandage.

Bandageon theregionear (Neapolitanbandage)

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

eight-shapedbandageon theback of the head

It begins in circular tours around the head (forehead-back of the head), then over 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 over the right ear to the forehead (Fig. 21). Repeating these tours, close the entire back of the head.

Quite often, "sling-like bandages" are used on the chin and nose, as well as kerchief bandages, the technique of applying which can be found in the relevant sections.

Rice. 20 . Ear band "Neapolitan hat"

Rice. 21 . Eight bandage on the back of the head

BANDAGESON THEUPPERLIMB

Most often, the following dressings are applied to the upper limb: spiral - on one finger, spike-shaped - on the first finger, "glove"; returning and cruciform - on the brush; spiral - on the forearm; turtle bandages - on the elbow joint; spiral - on the shoulder; spike-shaped - on the shoulder joint; bandages Deso and Velpo.

Spiralbandage

It is used for trauma to one finger (Fig. 22). First, the bandage is strengthened with two or three circular moves in the wrist area. Then the bandage is led obliquely through the back of the hand (2) to the end of the diseased finger, from where the entire finger is bandaged to the base with spiral passages. Then (8) the bandage is brought back to the wrist, where it is fixed.

Rice. 22 . Spiral bandage for one finger

Rice. 23 . Thumb bandage

Bandage on thebigfingeris being donespike-shaped ( eight-shaped) (Fig. 23). It starts in the same way as above. Next, the bandage is led along the back surface of the thumb to its top (2) and the palmar surface of this finger (3) is covered with a semicircular stroke.

Then the bandage is led along the back of the hand to the wrist and the eight-shaped move is repeated again, each time going down to the base of the finger. Attach the bandage to the wrist.

Rice. 24 . Bandage on all fingers "knight's glove"

Rice. 25 . Bandage on the brush "mitten"

Bandageon theallfingers " knightlyglove"

It is used when you need to bandage several fingers or all fingers individually. It begins as a bandage on one finger (see Fig. 23). Having bandaged one finger spirally, the bandage is led along the back surface through the wrist and the next one is bandaged in this way until all fingers are bandaged (Fig. 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.

Bandageon thebrushreturning " mitten"

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

Turtlebandage

Superimposed on the area of the joints in a bent position (Fig. 26). They are divided into divergent and convergent. The convergent dressing begins with peripheral tours above and below the joint (1 and 2), crossing in the cubital fossa. Subsequent moves are similar to the previous ones, gradually converging to the center of the joint (4, 5, 6, 7, 8.9). Finish the bandage with a circular stroke 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 moves diverge more and more, gradually closing the entire area of the joint. The moves intersect in the subulnar cavity. Fasten the bandage around the forearm.

Rice. 26 . Turtle elbow bandage

Rice. 27 . Spiral bandage on the forearm

Spiralbandage

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

A bandage with kinks is applied to the conical parts of the body. After two or three circular moves, they begin to bandage with kinks. To do this, the bandage is led obliquely upwards, pressing down 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 the bend is repeated again. The greater the degree of expansion of the limb, the steeper the bends. All folds are made on one side and along one line. In the future, if necessary, either make a simple spiral bandage or continue to bend the bandage.

Spikebandage

It is a kind of eight-shaped (Fig. 28). It is applied to the area of the shoulder joint as follows. The bandage is led from the side of a healthy armpit along the front surface of the chest and further to the shoulder (stroke 1). Having bypassed the shoulder in front, outside and behind, the bandage is led through the armpit and raised obliquely to the shoulder (stroke 2), the previous round is crossed on the front surface of the chest and shoulder. Next, the bandage goes along the back of the back to a healthy armpit. From here begins the repetition of moves 1 and 2 (3 and 4). At the same time, each new move lies slightly higher than the previous one, forming an ear shape at the intersection.

BandageDeso

Superimposed with fractures of the humerus and collarbone. The patient is seated, the arm is bent at the elbow at a right angle (Fig. 29). The first moment consists in bandaging the shoulder to the body, which is achieved by imposing a series of circular spiral moves from the healthy arm to the patient (1). Next, the second part of the bandage is started with the same bandage: from the axillary region of the healthy side along the front surface of the chest, the bandage is led to the shoulder girdle of the diseased side (2), from here vertically down the back of the shoulder under the elbows, grabbing the elbow with a bandage, obliquely through the forearm into the armpit of the healthy side (3). From here, a bandage is led along the back to the sore shoulder girdle down the front side of the shoulder (4). Having bypassed the elbow in front, the bandage is led obliquely through the back into a healthy armpit, from where the repetition of moves begins (2, 3.4).

Rice. 28 . Spike bandage on the shoulder joint

Rice. 29 . Bandage Deso

Rice. 30 . Velpo bandage

Such moves are repeated several times to obtain a good fixation. Then they hang the hand with a piece of bandage of sufficient width, strengthening it to the back (see Fig. 29).

BandageVelpo

It is used for temporary immobilization for fractures of the clavicle, after reduction of dislocations of the shoulder joint (Fig. 30). The arm from the damaged side is bent at the elbow joint to form an acute angle, and the palm is located in the deltoid region on the healthy side. In this position, the limbs are bandaged. First, the arm is fixed with a circular bandage from the diseased arm to the healthy one (1), which covers the shoulder and forearm of the diseased side, goes back through the healthy axillary fossa. From here, the bandage is lifted obliquely along the back from the damaged deltoid region, go around it from back to front, lower the bandage down the shoulder (2) and, grabbing the elbow from below, direct it to the axillary fossa from the healthy side (3). The bandage moves are repeated several times, with each vertical bandage move placed inside the previous one, and each horizontal one below it.

...

Basic classifications of wounds

Damage and lesions of the skin and mucous membranes can have a different nature of appearance, different manifestations and depth of involvement of the skin membranes and mucous tissues. So, penetrating wounds are injuries that are accompanied by the destruction of the integrity of the peritoneum, pleura, joint membrane, walls and cavity of internal organs. Non-penetrating, in turn, do not affect the cavity membranes.

Wounds can also be postoperative, for example, after abdominal surgery and, or accidental, which were obtained as a result of an accident.

Depending on whether a purulent infectious process is present in the wound bed, it can be infected, contaminated (if there are no signs of suppuration in the wound), or aseptic, that is, obtained as a result of a “clean” operation.

If we talk about the method of getting injured and the type of injuring object, doctors distinguish between stab, cut, chopped wounds, injuries of the bruised type, torn and bitten. In addition, a wound can be a gunshot wound if it appeared after exposure to the human body of a firearm.

According to the degree of penetration of the wound into the body, the most harmless are superficial, that is, literally affecting the upper 2-3 millimeters of the skin. Deep wounds reach more than a few centimeters in depth. The tangential type of wounds implies that the tissue is cut off by the subject of injury. The wound has an outlet through which the object leaves the body.

Blind wounds are formed if a traumatic object, for example, a bullet, remains in the body, getting stuck in tissues, organs, bones. Such lesions do not have an outlet. Through wounds, on the contrary, are characterized by the presence of two holes on the body - input and output. The object that caused the wound leaves the body on its own.

Treatment of various types of wounds, use of dressings

Determining the presence of a wound in a person is quite simple - usually this lesion is accompanied by severe pain, bleeding. If the blood vessels are affected, the affected person has a strong loss of blood, while the blood may ooze profusely, flow out or be a pulsating stream. The edges of the wound diverge, exposing the inside of the torso, limbs or head. In some cases, the pain can be so severe that a person develops a pain shock.

Treatment of a wound begins, mainly, with the provision of first aid to a person. To do this, you must first determine the type of injury, its degree and depth. If the victim is bleeding, it must be stopped as soon as possible to prevent profuse blood loss. One way to stop bleeding is to apply a pressure bandage.

However, the implementation of dressing is relevant not only at the stage of first aid. In medical practice, specialists distinguish two types of wound treatment:

with bandages;
without dressing.

The second type is also called open. It is accompanied by the appearance of the so-called "crust" on the wound - a hard scab that protects the surface of the wound from bacteria and dirt getting into it. On the other hand, the crust somewhat slows down the processes of epithelialization of the lesion, which is why it heals longer. Wounds that have a large area are especially inconvenient to treat with an open scheme. That is why today the most preferred method is the treatment of wounds in a humid environment, which does not allow the formation of a scab, and also helps to remove exudate (effusion) from the wound cavity. In addition, treatment with dressings keeps the wound moist, preventing dehydration and preventing re-infection.

The dressing of the wound is intended to provide a therapeutic effect on it, and to maintain the most comfortable environment for healing with protection from mechanical impact or dirt ingress.

In this case, the bandage on the wound must have some properties:

when dressing, the effusion is removed from the wound, a normal level of tissue moisture and temperature is maintained in it;
the material passes air well, while retaining pathogenic microorganisms;
the dressing does not contain toxic components;
the material covering the wound easily leaves it without drying to the wound.

Why are bandages applied to the injured? Functions of dressings in the treatment of wounds:

exudate removal;
destruction of toxins and bacteria;
stimulation of cleansing from necrosis processes;
maintaining normal moisture in the wound;
provision of wound ventilation;
protection against mechanical damage;
prevention of infection;
stimulation of the processes of regeneration and restoration of cells.

Dressing materials, main types of wound dressings

For a long time, sterile gauze wipes impregnated with special drugs remained the simplest and most common material for preparing a bandage for treating wounds. Today, many hospitals and medical institutions still use gauze in the form of wipes to cover the wound surface, as this material is clean, sterile, natural, and has a low cost. The disadvantage of gauze, like any textile, is a weak level of binding of effusion from the wound, and an increased ability to adhere to the wound surface, although the material has good absorbent properties and is sufficiently breathable. As a result, gauze dressings on wounds are quickly saturated with secretions from them, and firmly adhere to the surface of the injury, which makes the wound heal worse, and each dressing change procedure becomes a real test for the victim.

Modern medical science has developed so-called interactive dressings that act on the wound not by drinking them with any chemical or biological drugs, but by the physical and mechanical properties of the dressings themselves.

The interactive ones are:

superabsorbents;
alginates;
sponge bandages;
hydrocolloids;
hydrogels and amorphous hydrogels;
films;
atraumatic ointment bandages;
non-woven absorbent composite dressings.

Super absorbers. They are a multilayer bandage that looks like a pillow. The composition contains cellulose, as well as a special sorbent - polyacrylate superabsorbent powder. Before applying to the lesion site, the sorbent is activated with Ringer's solution. The substance of the solution after applying the bandage enters the wound over the next day. So, thanks to the superabsorber, it is possible to ensure continuous washing of the wound, due to which the areas of necrosis are separated. Wound effusion, which is secreted by damaged tissues, in turn, is absorbed by the sorbent powder. The constant flow of Ringer's solution into the wound bed contributes to its autolytic cleansing, and stimulates wound granulation.

In this way, deep, superficial and tangential wounds can be treated and packed.

Alginates. By alginates is meant a non-woven fabric made from calcium alginate fibres. In dry form, the cloth and dressings made from it are used for packing wounds.

In the contents discharged by the wound, sodium salts are present. The action of the dressing is based on their reaction with alginate fibers, which, upon swelling, turn into a hydrophilic wet gel that fills the wound. Due to the absorption of bacteria by the gel, it is possible to reduce the concentration of pathogenic microorganisms in the wound cavity, so the risk of re-infection is reduced.

Dressings of this type allow you to control profuse wound exudation, stimulate the growth of granulation tissue. They can be used to treat acute and chronic wounds.

Moist gel-like consistency creates a balanced wound environment, prevents the wound from drying out, and does not stick to it.

Sponge bandages. Such products are based on foaming polymers. They have a high absorbent and ventilation capacity due to their structure. In addition, they have shock-absorbing and barrier properties. They create a normally moist environment in the wound due to the effect of vertical absorption, while the wound remains isolated from secondary infection.

Modern sponge coatings are made from polyurethane foam with an open pore structure. Their size decreases in the direction from the middle to the surface of the bandage. The composition also contains a special hydrophilic matrix to enhance the absorption of fluid separated from the wound. Spongy dressings and dressing materials are particularly relevant for the treatment of heavily exuding wounds.

For the treatment of bedsores located in different parts of the body, there are sponge bandages with anatomical features for the sacrum, elbows, and heels.

Foam dressings with a hydroactive gel layer are a device designed to prevent the wound bed from drying out and adhesion.

Protected dressings of this type can remain on the wound surface until it is completely healed and epithelialized.

Hydrocolloids. A kind of membrane-type dressings, with particles of an absorbent substance enclosed in an elastomer with a self-fixing function. Sorbent crystals, due to the swelling property, have good absorbing abilities. The membrane of hydrocolloid dressings in this case acts as a barrier to bacteria and infections. In the process of absorption of wound effusion, the sorbent crystals turn into a gel that fills the wound cavity, due to which a normal level of moisture in the wound bed is achieved.

Until the microparticles are completely filled with liquid, the gel retains the ability to absorb wound liquid contents. If the bandage has taken the form of a bubble, then it is time to change it. The bandage can also be used as a patch, due to its adhesive properties, and as the crystals turn into a gel, its ability to stick is reduced, as a result of which the bandage remains glued to the skin only in unaffected areas. During dressing, the gel is removed from the wound bed with Ringer's solution.

Hydrogels. Dressings of this type consist of a semi-permeable membrane, and a gel of polyurethane polymers, which is attached to it. Gels do not change their original shape upon contact with a liquid, they have a moderate absorbent capacity. Ensuring a normal level of moisture in the wound is achieved due to the chemical composition of the gel - it contains up to 60%. The structure of the gel is able to bind and absorb wound effusion for several days after applying the dressing. By maintaining the right level of moisture and ventilating the wound surface, regeneration and healing are stimulated.

The membrane of hydrogel dressings is a barrier to microorganisms and moisture from the outside. Such dressings do not stick to the wound, are easily removed during dressings, without causing pain to the patient. In addition, hydrogel dressings are transparent, which makes it possible to observe wound healing processes without removing the dressing.

amorphous hydrogels. The composition of the dressing includes water, glycerin, carboxymethylcellulose, hydroxymethylcellulose - substances that maintain a sufficient level of moisture in the wound. Amorphous hydrogel is characterized by a combination of moisturizing and liquid absorption properties. In addition, the gel contains Ringer's solution to stimulate the formation of granulation tissue.

Amorphous hydrogel dressings can be successfully combined with superabsorbents, sponge and alginate dressings.

Films. They are characterized by the property of maintaining the level of moisture in the wound bed. They are tightly fixed, and due to transparency, they make it possible to observe the healing process without removing the bandage each time for examination. Their advantages are intensive barrier properties, protection from mechanical and thermal effects, from moisture and bacteria from the outside.

Atraumatic ointment bandages. Ointment dressings are multilayer nets made of synthetic or cotton fabric, in which cells of various sizes are provided, containing a medicinal ointment. Their use requires parallel application of dressings with sorbents. Atraumatic ointment dressings can be on the surface of the wound for more than a day, they do not stick to it, do not dry out the wound bed. Due to the sufficient width of the cells, the bandage provides a normal outflow of wound effusion. In the process of dressing, such a bandage does not injure the surface of the wound.

Non-woven absorbent composite dressings. The products are highly absorbent, multi-layered, and contain non-woven sorbents such as cellulose. Such materials do not stick to the wound due to the presence of a hydrophobic surface, and their absorbency is almost 2 times higher than the capabilities of conventional cloth-based absorbent dressings.

The outer membrane of the dressing has a water-repellent property and protects the wound from the ingress of microorganisms into it.

To date, the most atraumatic for the patient and convenient for medical personnel are interactive dressings for wound treatment. These products are made from synthetic and natural materials, have the ability to maintain an appropriate level of moisture, do not stick to wounds. Interactive dressings simultaneously provide air circulation, exudate binding, sufficient moisture, as well as protection from external influences and microbes. All this contributes to faster healing of wounds.

Motorists and pedestrians, ordinary people, in a word, all people who have anything to do with providing medical care for injuries or injuries.

The use of various types of dressings is due to the need to protect wounds from infection, immobilize the damaged area, drain cavities and wounds, and tamponade wounds to stop bleeding. They are used during and after surgical operations, during first aid, for the implementation of dressings of any type.

The concept of "dressings", referring to the categories of medical science of desmurgy, is related. Medical scientists note that dressings are called devices for dressing patients.

General classification, purpose, requirements for dressings

Dressings are multifunctional products, which are threads, fabrics, films, various non-woven materials. They can be used by industrial enterprises for the manufacture of dressings, or used by physicians and end users. According to their structure, materials can be natural, synthetic or mixed. The most popular dressing materials are cotton wool and gauze.

The main classification of medical cotton wool implies its division into hygroscopic and compressive. The first is highly absorbent, it is successfully used to stop bleeding, to apply therapeutic dressings with drugs. Compressed cotton is used in the application of splints and warm compresses.

Cotton wool is a natural material, it is produced from natural cotton fibers, and can be dressing and compress unbleached, or cleaned dressing. The first is not intended for direct contact with the wound surface, it is made from cotton fiber and does not undergo degreasing. The second type of cotton wool can be sterile or non-sterile, and medical and hygienic tampons are made from it.

Viscose wadding is made from specially processed cellulose.

If we consider the material by application, we can distinguish:

cotton hygroscopic eye cotton;
hygienic;
surgical.

The first two types can be sterile or non-sterile. Surgical cotton is produced only sterile.

Gauze is a special medical fabric, but with a rarer arrangement of longitudinal and transverse threads, which makes it look like a mesh. Manufacturers offer different types of gauze:

harsh;
bleached gyroscopic;
cotton clean;
cotton with an admixture of viscose.

What can dressings be used for? Usually dressing the patient is performed for:

protection of the wound site from heat, cold, dust, dirt, its disinfection;
preventing the entry of pathogenic microorganisms into the wound;
fixing dressing therapeutic agents at the site of the lesion;
providing a therapeutic effect on the wound process;
removal of pieces of tissue, decay products of toxins, allergens from the affected area.

The main properties of any dressing are atraumaticity and strength, if necessary, sterility. Dressing materials should be elastic, air permeable and impervious to microorganisms.

Dressings of various forms used for medical manipulations:

bandages;
packages;
napkins;
tampons;
plasters;
wound coverings;
medicinal sponges.

Medical bandages

Bandages are products that are made from various types of fabrics, have a certain elasticity, density, strength, and are a canvas with absorbent capacity and ventilation.

There are such types of bandages:

gauze;
tissue;
gel;
plaster;
bandage;
mesh;
tubular;
elastic;
hard;
self-adhesive.

The areas of application of medical bandages can be first aid or qualified medical care, traumatology, sports.

Dressing packages

Products that are ready-made dressings to be applied to a wound to prevent blood loss and infection, contamination and infection. The kit includes a sterile hydrophilic bandage and a cotton pad, which is sewn to one of the ends of the bandage, or is located freely. There may be one or two pads. Both products are wrapped in parchment paper, and are in a rubberized sterile bag.

Such a dressing device is often used to provide first aid for burns, gunshot and stab wounds, in addition, each soldier should have an individual dressing bag while in the war zone.

Napkins

These medical devices can be gauze dressings, as well as medical ones. They are made of high-density canvas, in strict accordance with the requirements of GOST. Dressing wipes are highly hygroscopic, and the seam must have a high tightness.

Gauze napkins are two-layer cuts of gauze, which are available in packs of 5, 10, 20, 40 pieces.

Medicinal napkins are a tissue cloth treated with medicinal agents - healing or antiseptic.

What are medical wipes used for? They are used for:

draining wounds;
disinfection of the wound surface or cavity;
dressing pads to prevent direct contact between injury and dressing;
prevention of wound contamination.

Medical tampons

Gauze strips up to 50 centimeters long, up to 10 centimeters wide, can be folded into 3-4 layers, with edges wrapped inside. They are used for tamponade of wounds, limiting the area of operation, sometimes for drainage. Turundas are called narrow strips of gauze material up to 2 centimeters wide, less than 10-15 centimeters long. Prepared in the same way as tampons, they are used to drain and prepare the drainage of narrow wounds and fistulas. Gauze balls are another type of tampons, which are small pieces of gauze folded in several layers, and having the shape of a triangle or quadrangle. These materials are necessary for draining wounds, abdominal injuries, for treating the hands of the surgeon and the skin of the operated person in the operating area. Cotton-gauze balls have a similar look and scope, but are made from cotton wool wrapped in gauze.

plasters

Used as dressings, they can be integumentary or fixative: the former contain medicinal substances, the latter do not.

Fixing patches are relevant for use in surgery or traumatology, they fix dressings. Cover plasters are necessary for the treatment of certain diseases and mechanical damage, they are used in dermatology.

Another name for these products is adhesive plasters. In the form of an adhesive plaster can be:

striped;
tape.

On the one hand, the patch has a sticky surface. Cover patches are provided with a gauze pad on the sticky side to prevent injury to the wound due to sticking of the patch.

Dressing plasters can be made in the form of coils, or in individual packaging by the piece.

Wound dressings for dressings

A relatively new, modern invention on the dressing market. They are used, most often, to treat chronic wounds. It is depending on the type of wound that the coatings can have a different shape and composition, for example, intended for cleaning, removing organic fragments, granulation or epithelialization of the wound.

Wound dressings are available in the form of:

spongy;
alginate;
hydrogel;
hydrocolloid coatings.

Special dressings are made from these funds for the absorption of wound exudate, to control the processes of hydration of the wound. Another type of coatings are membranes and vapor-permeable films.

Why are wound dressings more versatile and of better quality for treating wounds? The use of films, membranes and spongy coatings solves the problem of dressings drying out, can have an adhesive effect on tissues, some types of agents do not require further removal from the wound at all, since they resolve themselves over time.

Films for closing the wound surface usually contain antiseptics or healing agents. Such films are Aseplen-D, Aseplen-K, Viniplen.

Biological wound dressings, for example, "Biokol-1", has the form of a transparent, porous and elastic film. After application, it self-fixes on the wound, stimulates cell regeneration, thereby accelerating the healing process. Such a tool is completely atraumatic, has a slight anesthetic effect. It is used to treat trophic ulcers, burn lesions, donor wounds.

Covering sponges

This remedy is a dosage form of a dosed or non-dosed character, with a porous structure, of various shapes and masses. The material contains medicinal, antiseptic and excipients.

In appearance, such a sponge looks like a dry, porous plate of white color, with a yellowish tinge, which can have a variety of sizes. Products are made from biological materials, such as seaweed, skin or tendons of cattle, and are produced individually in sterile packaging.

Hemostatic sponges are prepared on the basis of human blood plasma, calcium chloride and aminocaproic acid are added to it. In the process of topical application, the superimposed sponge gradually resolves. May contain collagen, thrombin, fibrin, available in vials.

Gelatin Absorbable Sponge is a sterile, hardened foam that dissolves well in water. In the tissues of the human body, it undergoes a process of resorption. The tool is used to stop bleeding during surgical interventions.

Collagen sponges are made in the form of porous sterile plates containing collagen fibers. These medical products have adhesive, hemostatic, absorbent properties, so they are often used for laying on wound surfaces, and are also combined with natural polymers and medicines (pectin, antibiotics, chitosan).

Requirements for the use of dressings: preparation, sterilization

Gauze for surgery and dressing procedures is prepared in the form of napkins of several sizes - 8x8 centimeters, 50x10 centimeters, 50x30 centimeters.

A napkin of the appropriate size is separated from a piece of canvas, after which the edges are folded inward along the cut, the napkin is folded into 4 layers. Ready-made wipes can be used in a dry state, or moistened in a warm sterile sodium chloride solution, for example, if you need to protect the intestinal loops and peritoneum from drying out during abdominal operations.

Tampons in the form of long strips of gauze are prepared in the amount of 5-10 centimeters in width, 20-30 centimeters in length. The cut edges are folded inward, the prepared tampons are folded along the length, and then in 4 layers.

Tampons according to the Mikulich method, as well as small tampons in sizes of 10x10 centimeters, are used by surgeons during operations. They must be folded in such a way that the crumbling edges of the canvas do not crumble into the wound.

Clean wounds are covered with strips or stickers from a strip of cotton wrapped in gauze. Methods of fixation - collodion or cleol bandage applied on top.

The main method of sterilizing dressings during their preparation is autoclaving, that is, sterilization in an autoclave. What is an autoclave? This sterilization apparatus is used to disinfect instruments, materials, medical supplies. Sterility is achieved by treating objects with hot water vapor at a pressure above normal atmospheric pressure. The temperature in the autoclave reaches 125-135 degrees Celsius, while in the dry-heat cabinet, materials and objects are processed at temperatures up to 180-190 degrees, which significantly increases their wear. Autoclaving is also one of the methods for sterilizing surgical linen, as well as surgical dressings.

The duration of the disinfection procedure at 0.5 atmosphere is usually about an hour - this time is enough to destroy most of the known pathogens. If the pressure reaches 1 atmosphere, the process is reduced to 45 minutes, at 1.5 atmospheres, sterilization lasts 30 minutes. At 2 atmospheres, the steam temperature reaches 134 degrees Celsius, and the processing time takes 15-20 minutes.

If the device is in good working order, the staff only needs to monitor the sterilization mode, the readings of the pressure gauge and the timer. For faulty devices, additional tests and indicators of sterility are provided, for example, the Mikulich test. Its essence lies in the fact that the word “sterilized” is written on a strip of paper, after which the paper is treated with starch paste. After drying, a piece of paper is covered with Lugol's solution, due to which it acquires a blue color. The word written on paper becomes invisible. After drying the paper, it is laid in the material, which is further sterilized. Due to exposure to temperatures above 100 degrees, the word written on paper shows through again. Control can also be carried out using benzoic acid, sulfur, Aspirin, resorcinol, urea. Substances in a powder or solid state are placed in test tubes, sealed with a lid, and under the influence of temperature in an autoclave, the substance melts, forming a compact mass after cooling.

How does the device work? The autoclave has double metal walls, between which there is water, the lid is closed, the water from below is heated to a boil. When boiling, water vapor fills the inner cavity of the autoclave. Before this, the material to be sterilized is placed in a bix or bag and sent to the autoclave. Bix has a lid, on the side surfaces there are holes in it for the passage of steam. After completion of the autoclaving process, the holes are closed with a special metal rim to achieve tightness. Outside the autoclave, these bixes can be stored for up to 2 days. From the inside, biks are lined with a napkin or cloth.

A mandatory requirement for the sterility of dressings is their dryness. Wet or wet materials cannot be considered sterile.

In emergency cases, if we are not talking about the operational preparation of dressings, but, for example, first aid at home, any clean material that has been previously ironed on both sides with a hot iron can be used for dressing. If there is no iron at hand, the canvas is treated with a solution of boric acid, potassium permanganate, rivanol, or other sterilizers.

In addition to aseptic dressings, antiseptic dressings are used in medicine - gauze and cotton wool soaked in solutions of antiseptics or antibiotics to maintain the sterility of the material. It should be noted that antiseptic materials are used quite rarely, since they can have a significant effect on the affected tissues, destroy them, or cause irritation.

Bandaging of superficial abrasions and wounds can be carried out with a plaster or bactericidal paper impregnated with silver salts. The paper is moistened with sterile water, and then applied to the wound.

To stop bleeding, materials impregnated with appropriate agents, as well as wound dressings, are used.

Individual dressing bags are convenient to use for first aid - they are ready for use, the materials do not need to be further sterilized. Usually they are present in the first-aid kits of vehicles, in syndromic packing, as well as in individual military first-aid kits.

The package must indicate the method of opening the package, suitable in order not to violate its sterility. Before using a factory-made individual bag, it is imperative to check the integrity of the bag shells.

Accounting, storage and placement of dressings in medical institutions

The need to account for medical supplies - medicines, materials, devices - is due to the fact that budgetary institutions receive them under a strict report, and all of the listed categories are purchased for budgetary funds.

Bandages, films, bandages, plasters, sanitary napkins, cotton wool of any type, anti-burn dressings, dressing bags, bandages, adhesive plasters, and other devices for direct contact with wound surfaces are recognized as dressings for accounting purposes.

If there is a pharmacy in a medical institution, the materials are accounted for at retail prices for the total amount of the cost, and subject-quantitative accounting is not carried out. The receipt of materials to the pharmacy is carried out with the verification of the invoice from the manufacturer or seller. After verification, the accounts are entered into a special registration book.

The release of dressings to medical personnel occurs only to responsible persons of offices or departments on invoices. In this case, the recipient signs for the receipt of the material in a special journal. Invoices are issued in two copies - one remains in the pharmacy, the other - with the financially responsible person of the office or department.

There is also a record of dressings lost as a result of damage. They draw up an act for the write-off of material assets that have become unusable. The act is drawn up in two copies by a commission with the participation of the chief accountant of a medical institution. Funds that have come into a state unsuitable for consumption and use are subject to destruction in the presence of the commission.

If there is no pharmacy in the medical institution, accounting takes place in a slightly different way, namely by the piece. The release of medical dressings is made in the amount of a ten-day requirement. There is a jointly drawn up delivery schedule. The received funds are stored in the offices of the cabinets.

In addition to the general audit and accounting, dressings received for use in a hospital, clinic or specialized medical center are also subject to accounting.

Receipt and internal movement of medical supplies are made on the basis of:

invoices from the supplier;
acceptance certificate;
statements on the issuance of material assets for the needs of the department (office);
notifications.

The packaging marking of any product or device must contain the name and address of the manufacturer, the mass or size of the product, the date of manufacture or expiration date, sterile or non-sterile product, acceptable method of opening, designation of technical specifications, GOST.

How are dressing materials stored? This requires special furniture - cabinets, drawers, racks, covered from the inside with light oil paint, with pallets that must always be clean. They must be placed in dry and well-ventilated areas. Cabinets, shelves, racks should be periodically treated with a 0.2% bleach solution or chloramine solution for disinfection. According to the storage conditions, sterile devices are stored in their original packaging; such material cannot be stored in the primary opened packaging. The rooms in which the material is located must have a stable temperature so that the packaging does not collect condensate when it drops. Shelf life - no more than 5 years.

As for non-sterile products, they can be stored wrapped in thick paper or in cloth bags on pallets and racks. According to the storage rules, sudden temperature changes, the formation of mold and fungus, as well as the appearance of dampness in the room should not be allowed. Breaking the integrity of the package or getting it wet means that a particular item can no longer be considered sterile.

Gypsum bandages are stored in dry rooms, preventing their mechanical damage. On average, the shelf life is 5 years.

For all medical devices and preparations, including dressings, certain consumption rates are provided for per bed or per department. The calculation of the norm should take place on the basis of real costs for different types of patients. It is established by orders, instructions and other by-laws of the authorized body on health issues.

Reuse of dressings and their disposal

Can consumables such as dressings be reused? Sterile bandages, individual dressing bags, plasters, wound dressings are disposable and are not subject to sterilization after application to patients.

Re-disinfection of used bandages, tampons, wipes in order to save money may be advisable - they can be washed and sterilized in autoclaves, for example, after operations, but only if they were not stained with pus.

Gauze, which is reused, after washing, has a pronounced lower suction capacity. The materials used are soaked in cold water or in a solution of ammonia at a concentration of 0.5%, and this must be done before the blood has dried. Then they are washed, boiled, rinsed, dried, sterilized in autoclaves. The purpose of these materials at the end of all procedures is only the implementation of dressings.

The characteristic of the potential hazard of the used dressings allows them to be classified as group B of medical waste - potentially hazardous and infectious waste that must be disposed of.

The recycling algorithm for such materials includes several stages. Initially, they are collected throughout the medical facility, then moved to temporary storage on the territory of the organization. The next step is the disinfection of waste, after which they are transported from the territory of the institution, burned, buried or destroyed in any other way.

Materials for the implementation of medical dressings can be fabric or cotton, natural and synthetic. Some of them are subject to periodic sterilization and reuse, others must be disposed of and cannot be reused.

Medicines needed for work in the dressing room. Dressings and wound dressings. Adhesive dressings are applied to the area of ​​the postoperative wound and in case of small injuries. Their benefits