Gypsum technique

In the traumatological departments of the hospital, in addition to the operating room and dressing room, there is a gypsum. It is intended not only for the imposition of plaster casts and longots, but also for the production of certain operations: the repositioning of the dislocation, the skeletal traction, etc.

In gipsovalnoy requires the same compliance with asepsis, as in the dressing. The imposition of plaster casts is a great art: it is necessary not only to know the rules of imposing to fix a limb, but also to alleviate suffering and not to interfere with blood circulation.

If, after applying the of the cast bandage , the pain increases, the swelling is increased, it should be considered that the plaster bandage is poorly applied.

It is best to apply a bandage with gauze bandages impregnated with gypsum. Gypsum is a powder similar to flour. If it is mixed with water, then a pulp-like, quick-hardening mass is obtained. To check the quality of gypsum, a number of samples are used.

1. Take equal portions of gypsum and room temperature water and mix. Mass after 6-7 minutes should be set and hardened. The resulting plate must break, and not crumble.

2. Take gypsum in a fist and tightly squeeze;if it is of good quality, then after unclenching the fist, it will crumble, plaster of poor quality will lie on the palm in the form of a lump with fingerprints.

3. Gypsum mixed with water should not smell rotten eggs.

To ensure that the gypsum does not lose its properties, it should be stored in a dry place in a tightly closed box. Sometimes it is desirable to slow down the setting of gypsum, then it is mixed with cold, not warm water, starch paste is added. To accelerate the hardening of gypsum, it is mixed with warm water( 30-35 ° C).After applying it, you can use a hair dryer or a dry-air bath.

The advantage of the cast is that it creates an immobilization, ensures maximum peace of the wound, protects it from secondary infection, and the granulating wound from trauma. The excess wound detachable is well absorbed into the gypsum bandage, since gypsum has a high hygroscopicity. All this provides favorable conditions for the healing of wounds and fractures.

The following equipment is required for applying gypsum dressings:

• a special table where you can give the patient the necessary position;

• oilcloth aprons;

• rubber gloves;

• various stands and accessories( rollers, oil-cushions, etc.);

• Bandages and cotton wool.

Types of fixing gypsum dressings.

1. A circular bandage covers the limb along the circumference.

2. Tutor - sleeve made of gypsum, which is superimposed on the damaged segment of the limb. The tread may be removable and not removable.

3. The final plaster bandage is a circular dressing with a "window" over the wound.

4. The bridge consists of two sleeves, fastened together by one or more bridges.

5. The hinged dressing consists of two gypsum sleeves, interconnected by two metal plates with a hinge. In addition, there is a gypsum corset and plaster bed.

Some rules should be observed.

1. To achieve complete rest, especially in fractures, it is necessary to create a fixed position not only of the damaged bone, but also the two nearest joints.

2. The limb should be held completely immovable until the gypsum solidifies completely.

3. During dressing application, it is necessary to follow each round of bandage so that the bandage lies flat. It should fit evenly, but do not press.

4. The ends of the fingers should be left open.

5. In places where there are bony protuberances, it is necessary to lay cotton wool( preferably simple, not hygroscopic, as it is more elastic and does not absorb sweat).

6. Before placing the patient on the bed under the mattress, place a shield, as laying on the bed with the netting can lead to a change in the plaster bandage.

7. While the dressing is not dry, do not cover it with a sheet or blanket.

8. In the first days after the bandage is applied, the nurse must monitor whether she has shifted or not. In the event of the appearance of edema, cyanosis should immediately notify the doctor.

9. After the dressing is applied, markings must be made. Write on it three dates: the date of the fracture, the date of the casting of gypsum, the day of the alleged withdrawal.

At present, gypsum dressings are manufactured by the factory way, however, in some medical institutions gypsum bandages are prepared themselves.

Preparation of gypsum bandages.

1. To make gypsum bandages use bandages made of white gauze, since yellow is non-hygroscopic. The bandage should not be longer than 3 m. At this length, the gypsum bandage is sufficiently wet and easy to use.

2. On the table, put an oilcloth, in a flat tray pour gypsum. At the end of the bandage, a little gypsum is poured and several times uniformly carried from above with a hand along the untwisted part of the bandage, rubbing the gypsum until the whole bandage is impregnated.

3. The gypsumized end is loosely rolled up so that the plaster does not spill out. Fold in a dry box horizontally.

In addition to the bandages, they also prepare straps - strips of bandage of a certain size, folded in several layers( 3-4 layers - thin longite, 6-8 layers - thick).Longets fold loose, like bandages, and begin to fold from both ends to the middle.

Technique of imposing gypsum dressings on separate parts of the body.

Gypsum corset.

Applied for fractures, inflammatory processes, deformities of the spine. There are 2 types of corset:

• reclining( unloading);

• regressing( fixing).

The height of the corset depends on the localization of the process in the spine. Distinguish between low, medium and high corsets.

Reclining corsets are made in a horizontal position. They can be removable and non-removable.

The procedure is as follows:

1. The patient is placed on a special orthopedic table in such a way that the lower limbs and pelvis are located lower than the upper part. This creates an extension of the spine back, correction of deformity. In this position, the spine is fixed with a plaster corset. It takes 12-14 gypsum bandages and one gauze bandage 16 cm wide.

2. The trunk is wound with a gauze bandage, on which two circular rows of gypsum bandages are laid so that on the top of the front surface they fit above the sternum cutting - with an average corset, at a low -at the level of the axillae, with a high grip covered the entire neck and the occipital region of the head. Along the spinous processes lay a longite of 6-8 layers, half a meter in length, and on the sides - two longs 35-40 cm long, on top - 2-3 circular gypsum bandage.

3. The edges of the corset are sealed according to general rules.

A special type of removable plaster bandage. It is designed for the patient to lie in it, so it is modeled in the lying position of the patient.

Indications - tuberculosis, deformation of the spine, as well as transportation with spinal injuries.

Overlap technique:

• the patient lies on the stomach, stretches his legs and slightly retracts. The back is covered with gauze, which is stretched and smoothed, so that there are no wrinkles. Prepare wide gypsum bandages( platters) in the amount of 5-7 pieces;

• two assistants lower the plyatrs into the water, then, when they are soaked, not squeezing, placed side by side on the table, stretched and evenly stretched on the back of the patient, on the back form layer by layer second, third layer. After each layer carefully modeled;

• When the cot is hardened, draw the border with an ink pencil. The cot is removed, cut off with a sharp knife along the border;

• after drying the crib the patient falls into it.

Patients in a plaster crib require careful care. With careful care, they should be periodically released from the crib, after the patient with the crib turns over on the stomach, the nurse should remove the crib and inspect the back. At the slightest changes in the skin caused by pressure, it is necessary to rub the back with camphor alcohol.

Circular-plaster bandage on the shoulder joint

Used for fractures of the shoulder, shoulder joint.

1. Conducted with the help of an assistant, who holds the affected hand in the allotted position.

2. Gypsum is started in the form of circular bandages of the bandage from the wrist joint with the transition to the forearm, the shoulder, through the shoulder joint to the chest. The most durable bandage should be in the area of ​​the shoulder joint.

3. To hold the limb in its assigned position, use a stick whose ends are covered with a plaster bandage and are grafted to the middle third of the forearm and to the bandage on the trunk. In this case, the limb is well retained in the fixed state.

Bandage on the elbow and wrist joint

Apply from the upper third of the shoulder to the middle palmar crease. Indications for its superposition are fractures of the elbow and wrist joints, osteomyelitis of the bones of the forearm.

1. The patient sits down, one assistant holds the limb in a bent to 90 ° in the elbow joint.

2. A gypsum longite 40-50 cm long is placed on the outer surface of the shoulder to the elbow, along the rear of the forearm. Longuet is fixed by circular strokes in 4-5 layers. After applying the bandage, the fingers should move freely and contract into a fist.

Bandage for wrist joint

Shown for fractures of the wrist and metacarpal bones.

1. It is applied so as to fix the wrist and the head of metacarpal bones. Brushes are given the right position, most often the back bend at an angle of 25 °.

2. The manufactured lingetum is applied on the back surface of the forearm and hand and strengthened circularly.

Hip and hip bandage( co-curative dressing)

Used for gunshot wound of the hip joint, tuberculous coxitis, after the operation on the hip joint.

1. A special orthopedic table is required to apply this dressing. With the help of special devices give the limb a certain position.

2. When applying a bandage of reliable strengthening in the hip joint, an eight-shaped or spiky bandage of the inguinal region is achieved, as well as strengthening of the outer-lateral part of the longus, fixed by the circular strokes of the gypsum bandage.

Shin bandage

Used for fractures of the lower leg bones. The bandage fixes the knee and ankle joints and is langet-circular.

1. Initially, apply a posterior longus 80-90 cm long and 15 cm wide into 5-6 layers and strengthen with 4-5 gypsum circular bandages.

2. Particular care should be taken to dress the bandage around the ankles and Achilles tendon.

An ankle bandage is applied as a "sapozhok" bandage or a bandage with a stirrup along Volkovich.

1. The bandage is removed only with permission and under medical supervision.

2. Carefully cut along the length, the edges of the incision are unbent and carefully remove the limb.

3. If the bandage is difficult to remove, a napkin with hypertonic salt solution is applied to it.

4. After removing the bandage, the limb is washed with warm water and soap. Skin in places of abrasions or rubbed with an alcohol solution of brilliant green.