in hospital emergency departments, in addition to operating and dressing, there gipsovalnaya.It is designed not only for cast application and Longuet, but also for the production of certain operations: reduction of dislocation, skeletal traction, etc.
In gipsovalnoy requires the same adherence to aseptic techniques, as well as in the dressing room.Imposition of casts is great art: you must not only know the rules of the overlay in order to fix the limb, but also to alleviate the suffering and not to impede circulation.
If the cast is enhanced pain after overlay, increased swelling, it must be assumed that the plaster cast is superimposed bad.
best to bandage using gauze bandages soaked in plaster.Gypsum is a powder similar to flour.If it is mixed with water, it turns mushy bystrozastyvayuschaya weight.To check the quality of the gypsum used a number of samples.
1. Take equal portions of plaster and water at room temperature and mixed.Weight 6-7 minutes should solidify and harden.The resulting plate
2. Take the plaster into a fist and squeeze tightly;if it is of good quality, then it falls apart after a release of the fist, the poor quality of gypsum will be on the palm in the form of a lump with fingerprints.
3. Gypsum mixed with water, shall make odor of rotten eggs.
To plaster did not lose their properties, it should be stored in a dry place in a tightly closed box.Sometimes it is desirable to slow the solidification of gypsum, while it is mixed with cold, rather than hot water, add the starch paste.To accelerate its hardening the gypsum is mixed with warm water (30-35 ° C).After his overlay, you can use a hair dryer or dry air bath.
advantage of the plaster bandage is that it creates an immobilization, for maximum peace of the wound, prevents her from getting a secondary infection, and granulating wounds - from the trauma.Excess wound discharge is well absorbed in the plaster cast, since gypsum is highly hygroscopic.This provides favorable conditions for the healing of wounds and fractures.
to cast application you need the following equipment:
• special table on which the patient can be given a desired position;
• oilcloth aprons;
• rubber gloves;
• Various stands and accessories (rollers, oilcloth cushions, etc.);
• bandages and cotton wool.
Types fixing plaster casts.
1. Circular (solid) patch covers limb circumferentially.
2. Splint - sleeve made of gypsum, which is applied to the damaged segment of a limb.Splint may be removable and non-removable.
3. fenestrated plaster bandage is a bandage with a circular "window" over the wound.
4. Bridges bandage consists of two shells, held together by one or more bridges.
5. The hinge bandage consists of two plaster shells connected together by two metal plates with a hinge.In addition, there are gypsum plaster corset and cot.
should comply with certain rules.
1. In order to achieve complete rest, especially for fractures, it is necessary to establish a fixed position not only of the damaged bone, but the two nearest joints.
2. The limb should be kept perfectly still until complete hardening plaster.
3. During bandaging is necessary to watch each round bandage to bandage lay flat.It should be equally fitting but do not push.
4. The ends of the fingers should be left open.
5. In places where there are bony prominences, it is necessary to put a wool (preferably a simple, not hygroscopic, so it is more elastic and does not absorb sweat).
6. Before laying the patient on the bed under the mattress to put a shield, as laying on the bed with a grid can lead to a change in the cast.
7. While the bandage does not dry, do not cover it with a blanket or sheet.
8. In the first days after the imposition of bandages nurse should follow, if she moved, there is no pressure.In the case of edema, cyanosis should immediately put in the doctor's reputation.
9. should be held marking After applying bandages.Write her three dates: the date of fracture, the gypsum overlay date, the day of the alleged withdrawal.
Currently made plaster casts by the factory, but is prepared plaster bandages themselves in some hospitals.
Preparation of plaster bandages.
1. To prepare the plaster bandages used bandages made of white gauze, as a yellow hygroscopic.Bandage should not be longer than 3 m. With such length plaster bandages good enough waterproof and easy to use.
2. The board applied the oilcloth, into a flat tray poured gypsum.At the end of the bandage and plaster is poured a little more time is carried out evenly on top of the hand along the unwound part of the bandage, plaster rubbing until all soaked bandage.
3. Nagipsovanny end loosely rolled up, so as not to spill the plaster.Fold in the dry box horizontally.
Besides bandages, splints and prepare - bandage strips of a certain size, folded in several layers (3-4 layers - a thin splint, 6-8 layers - thick).Longuet folded loosely, like bandages, and begins to take shape at both ends to the middle.
Technique cast application on parts of the body.
Apply for fractures, inflammation, spinal deformity.There are 2 types of corset:
• rekliniruyuschy (unload);
• redressiruyuschy (fixing).
corset height depends on the localization process in the spine.There are low, medium and high corsets.
Rekliniruyuschie corsets are made in a horizontal position.They may be removable and non-removable.
1. The patient is placed on a special orthopedic table in such a way that the lower limbs and pelvis are situated lower than the upper part.This creates an extension of the spine back, deformation correction.In this position, the fixation of the spine produce a plaster corset.Requires 12-14 plaster bandages and a gauze bandage width 16 cm
2. The body wrap around gauze bandage, which placed two series of circular plaster bandages so that the top surface on the front, they were placed above the sternal notch -. With an average corset, with a low- at the level of the armpits, with a high capture covered the entire neck and occipital region of the head.Along the spinous processes put longetu of 6-8 layers, two feet long, and on each side - two splints in length 35-40 cm on top - for 2-3 circular stroke plaster bandage.
3. The edges of the corset are buried under the general rules.
special kind of removable cast.It is intended to lay it in the patient, so its simulated patient in a supine position.
Indications - Tuberculosis, spine deformation, as well as transportation of spinal damage.
• patient lies on his stomach, legs and pulls gently removes.His back is covered with gauze, which pull and smooth to avoid wrinkles.Harvest the full width of the broad gauze plaster bandage (plyatry) in an amount of 5-7 pc .;
• Two assistant plyatry lowered into the water, then when they get wet, not pressing, placed side by side on the table, stretched and uniformly stretched on the back of the patient, on the back layers formed the second, the third layer.After each layer is carefully modeled;
• cot when solidified ink pencil outline border.Crib is removed, cut with a sharp knife along the border;
• drying beds after the patient falls into it.
Patients in the gypsum bed requires careful maintenance.Subject to careful care of periodically should be exempt from the crib, after the patient along with the crib turn over on his stomach, the nurse should remove crib and inspect the back.At the slightest changes in the skin caused by the pressure, it is necessary to rub the back with camphor spirit.
circularly-cast on the shoulder joint
Apply with shoulder fractures of the shoulder joint.
1. Navigate using the assistant, who keeps the affected arm in the retracted position.
2. gypsum begin in the form of circular turns of the bandage on the wrist joint with the transition to the forearm, upper arm, through the shoulder joint on the chest.The most durable bandage needs to be in the area of the shoulder joint.
3. To hold the limb in the position to give it using a stick, the ends of which are covered with a plaster bandage and prigipsovyvayutsya to the middle third of the forearm and a bandage on the body.This limb is kept well in the locked state.
bandage on the elbow and wrist joints
Impose from the upper third of the shoulder to the middle palmar creases.Indications for its imposition are fractures of the elbow and wrist joints, osteomyelitis forearm.
1. The patient sits, one assistant holds the limb bent to 90 ° at the elbow.
2. Plaster splint length of 40-50 cm is placed on the outer surface of the shoulder to the elbow, on the rear of the forearm.Longuet fixed circular strokes in 4-5 layers.After applying a bandage fingers should move freely and compressed in a fist.
bandage on the wrist joint
shown in fractures of the wrist and metacarpal bones.
1. It is applied so as to fix the wrist joint and the head of the metacarpal bone.Brushes attached to the desired position, usually dorsiflexion angle of 25 °.
2. The manufactured longetu impose on the dorsum of the forearm and hand and strengthen circularly.
bandage on his thigh and hip joint (koksitnaya bandage)
Apply with gunshot wound hip tuberculosis Cox, after surgery on the hip joint.
1. requires a special orthopedic table for imposition of bandages.With the help of special devices attached to the limb a certain position.
2. When applying the bandage reliable strengthen the hip spica reach vosmiobraznoy or dressing the groin area, as well as the strengthening of the outer-side of the splint, fixed circular strokes plaster bandage.
Apply with tibia fractures.The bandage fixes the knee and ankle joints and is longetno-circular.
1. First, back splint is applied 80-90 cm long and 15 cm wide by 5-6 layers and enhance 4-5 plaster bandage circular strokes.
2. Particular care should be otmodelirovat bandage ankle and Achilles tendon.On
ankle impose a plaster cast of the type "boot" or bandage with stirrup for Volkovich.
1. The bandage is removed only with the permission and under the supervision of a physician.
2. Carefully cut along the length, cut edges and gently straightened the limb removed.
3. If it is difficult to remove the bandage, it imposes a napkin with a hypertonic saline solution.
4. After removing the bandage the limb washed with warm soapy water.Skin abrasions in places or pureed lubricated with an alcoholic solution of brilliant green.