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Видео на тему: Витебский государственный медицинский университет - видео

Divergent bandage starts with a couple of circular fixing tours around the center of elbow joint. Then head of the gauze consistently ascends and descends to shoulder and forearm with overlapping previous tours to 1/2 or 2/3 of their width. Bandage is finished with circular fixing tours around the shoulder. Convergent bandage starts with a couple of circular fixing tours around the proximal third of forearm. Then head of the gauze ascends obliquely behind the ulnar fossa to the shoulder. After a round tour it descends obliquely across the ulnar fossa to the forearm higher the previous tour. After a round tour the gauze ascends again to the shoulder lower the previous tour. This sequence of motions repeats several times before covering of knee joint. Bandage is finished with circular fixing tours around the shoulder.Convergent bandage starts with a couple of circular fixing tours around the proximal third of lower leg. Then head of the gauze ascends obliquely across the popliteal fossa to the femur. After a round tour it descends obliquely across the popliteal fossa to the lower leg higher the previous tour. After a round tour the gauze ascends again to the femur lower the previous tour. This sequence of motions repeats several times before covering of knee joint. Bandage is finished with circular fixing tours around the femur. Divergent bandage starts with a couple of circular fixing tours around the center of knee joint. Then head of the gauze consistently ascends and descends to femur and lower leg with overlapping previous tours to 1/2 or 2/3 of their width. Bandage is finished with circular fixing tours around the femur.Bandage starts with a couple of circular fixing tours above the ankles. Then head of the gauze directed across the dorsal surface of the foot to the middle third of foot. After fixing circular tour around the foot bandage passes to the lower leg across the dorsal surface of the foot. After circular tour bandage return to the foot… This sequence of motions repeats several times. Bandage is finished with circular fixing tours around the lower leg above ankles. It`s possible to apply this bandage without intermediate tours around the foot and lower leg.Bandage starts with a couple of circular fixing tours around the wrist. Then head of the gauze consistently ascends spirally with twisting (on bandaging). Each next tour should overlap previous one to 1/2 or 2/3. Bandage is finished with circular fixing tours around the proximal third of the forearm. Spiral bandage on the lover leg is applied in the same way. The role of twisting is a prevention of pockets formation.Bandage starts with a couple of circular fixing tours around the wrist. Then head of the gauze directed across the dorsal surface of the hand to the tip of patient`s finger, located to the right relative bandaging (V finger on the right hand and I on the left hand). After descending spiral tours around the finger gauze returned across the dorsal surface of the hand to the wrist. Then, after fixing circular tour around the wrist, bandage alternately moves on other fingers. Bandage is finished with circular fixing tours around the wrist.Desault`s bandage Once the placement of cotton roll in the axilla, bandage starts with a couple of circular tours around the chest (direction of bandaging depends on injured side). These tours fix the injured hand to the trunk. Then head of the gauze passes obliquely to the shoulder girdle of injured hand, descends to the forearm and hang the hand (near the wrist) to the contralateral axilla. Then, across the patient`s back the gauze passes again to the injured shoulder girdle, descends forward to the injured forearm (near the elbow) and goes behind to the next round fixing tour. This sequence of motions repeats several times.Once the placement of cotton roll in the axilla, bandage starts with a couple of circular tours around the chest and injured shoulder (direction of bandaging depends on injured side). These tours fix the injured hand to the trunk. Then head of the gauze passes around the shoulder and up. Then gauze directed across the patient`s trunk to the shoulder and around it again. Each next tour should overlap previous tour to 1/2 or 2/3. This sequence of motions repeats several times before covering of all shoulder joint.Bandage starts with a couple of circular fixing tours around the wrist. Then head twisted to the left and passes along the dorsal and then ventral surface of the hand up to the wrist. Such recurrent motions are repeated several times. Then bandage is fixed to the hand by spiral tours of the gauze. Bandage is finished with circular fixing tours around the wrist.Bandage starts with a couple of circular fixing tours around the wrist. Then head of the gauze directed across the hand to the tip of patient`s thumb. After the spiral tour around the fingers tip gauze returns to the wrist. Then, after fixing circular tour around the wrist, bandage passes to the thumb proximally to previous tour. Each next tour should overlap previous one to 2/3. This sequence of motions repeats several times. Bandage is finished with circular fixing tours around the wrist.Bandage on the left eye Bandage starts with a couple of circular fixing tours around the forehead. On the left eye you should apply a piece of gauze. Then head of the gauze descends obliquely from the forehead to the left eye, passes under the left ear and rises via occipital region to the forehead. After a fixing circular tour this sequence of motions repeats several times. Bandage is finished with circular fixing tours around the forehead. Bandage on the right eye Bandage starts with a couple of circular fixing tours around the forehead. On the right eye you should apply a piece of gauze. Then head of the gauze passes above the left ear, descends obliquely across the occipital region under the right ear and ascends to the forehead via the right eye. After a fixing circular tour this sequence of motions repeats several times. Bandage is finished with circular fixing tours around the forehead.Hippocrates cap (recurrent bandage on the head) This bandage may be applied using two gauzes or one double headed gauze. If we use double headed gauze, bandage starts from the forehead. Both heads of the gauze are rolled out in opposite directions over the ears. They cross in the occipital region. Then one head continues circular movement and fix another one, that consistently directed to the forehead and back to the occipital region up to total covering of the temporal region. Bandage is finished with circular fixing tours around the forehead.Bridle bandage Bandage starts with a couple of circular fixing tours around the forehead. Then head of the gauze passes above the left ear, descends obliquely across the occipital region to the chin, and then ascends ahead of the left ear to the occipital region. After a series of such vertical tours gauze again passes up below the left ear to the occipital region and then to the forehead. Bandage is finished with circular fixing tours around the forehead.Bandage on the occipital area and neck (cross-shaped bandage on the occipital area) Bandage starts with a couple of circular fixing tours around the forehead. Then head of the gauze passes above the left ear, descends obliquely across the occipital region to the neck, and then ascends behind the left ear across the occipital region to the forehead. Then gauze again passes above the left ear to the occipital region. This sequence of motions repeats several times. Bandage is finished with circular fixing tours around the forehead.Bandage on both eyes (binocular) Bandage starts with a couple of circular fixing tours around the forehead. On both eyes you should apply pieces of gauze. Then head of the gauze descends obliquely from the forehead to the left eye, passes under the left ear to the occipital region, under the right ear and then ascends to the forehead via the right eye. After a fixing circular tour this sequence of motions repeats several times. Bandage is finished with circular fixing tours around the forehead.Cap bandage For this bandage we should use a gauze string (piece of gauze about 1 meter long). This gauze, thrown across the temporal region should be held by the patient or medical professional. Bandage starts with a couple of circular fixing tours around the forehead. Then head of the gauze moves around the right end of our string and goes to the occipital region; moves around the left string and goes to the frontal region. This sequence of motions repeats several times up to total covering of the temporal region. Bandage is finished by binding the gauze to the string and tying strings to each other.Desmurgy. General information Desmurgy (desmos – bandage, ergon – action) is the doctrine of medical dressings. There are many types of bandages. We`ll consider gauze bandages, that are commonly used for fixation of dressings to the wound and sometimes for immobilization of limb segments. Gauzes may have different width. Wide gauzes (≥10 cm) are suitable for bandaging of the trunk, medium thickness gauzes 6-10 cm) are best for the head, neck and limbs and narrow (﹤6 cm) – for fingers. Anatomically gauze can be divided into head and body. In most cases the head of the gauze must be held in the right hand and tail – in the left hand. So, mostly bandage is applied from left to right. Bandaging usually consists of 3 stages: starting (circular) fixing tours, the main part of the bandage and final fixing circular tours. There are several rules of bandaging: - Bandaging medical professional should be in front of the bandaged patient; - Patient should be in a comfortable position (sitting or lying); - The bandaged part of the body should be in a physiological position; - Bandaging of limbs should start from their distal parts; - Each next tour should overlap the previous one to 1/2 or 2/3 of its width; And, of course, bandage should be convenient, cosmetic, perform its functions well and don`t compress excessively soft tissues.Biological test. Before the transfusion of blood components (RBC, FFP) after negative in vitro tests we should perform infusion of small doses of transfused component with assessment of patient`s condition. Algorithm of the test: 1. Fill the infusion system with saline and start transfusion. 2. Change the package of saline to the blood component. 3. Transfuse 10-15 ml of RBC. 4. Stop the transfusion for 3 minutes and assess patient`s condition. 5. If asymptomatic perform this test 2 times more. 6. Absence of symptoms after 3-times transfusion of 10-15 ml of blood component every 3 minutes (negative test) means that you can continue the transfusion. Appearance in the patient such symptoms as tachycardia, shortness of breath, redness of face, chest pain or low back pain require to stop transfusion of this package, change it to some crystalloid solution, use diuretics and hormones. Биологическая проба. Перед началом трансфузии компонентов крови (эритроциты, СЗП), помимо проб на совместимость, проводимых in vitro, следует провести троекратную трансфузию малых доз трансфузионной среды с оценкой состояния пациента. Алгоритм выполнения: 1. Инфузионная система заполняется физиологическим раствором и присоединяется к венозному катетеру пациента. 2. Физиологический раствор меняется на гемакон с эритроцитами. 3. Производится переливание 10-15 мл эритроцитов, после чего трансфузию останавливают, и в течение 3 минут наблюдают за состоянием пациента. Если состояние не изменилось, пробу повторяют ещё 2 раза. 4. При троекратной отрицательной биологической пробе можно производить трансфузию всего пакета с компонентом крови. 5. Появление у пациента таких симптомов как тахикардия, одышка, затруднённое дыхание, гиперемия лица, боли в пояснице или груди требует немедленного прекращения трансфузии, замены пакета с кровью на кристаллоидный раствор, использования диуретиков и гормонов для предотвращения повреждения почек.АВО-compatibility test (individual compatibility). Equipment: white plate with cells for serums, patient`s serum, donor`s RBC, glass slides or sticks for mixing the blood and serums, hourglass on 5 minutes or timer. Algorithm of the test: 1. Plate should be marked with the patient`s name. 2. Put a drop of patient`s serum in the cell. 3. Take a little drop of donor`s RBC (ratio 1:10) and mix with the serum. 4. Wiggle the plate for 5 minutes. 5. After 5 minutes check presence of agglutination. If it present (positive test) donor`s RBC and patient`s serum are incompatible, so this package of RBC can`t be transfused. Negative test means compatibility. Проба на индивидуальную совместимость эритроцитов донора и сыворотки реципиента по группе АВО. Оборудование: планшет с лунками для сывороток, сыворотка крови реципиента, эритроциты донора, предметные стёкла или палочки для перемешивания крови и сывороток, песочные часы на 5 минут или таймер. Алгоритм выполнения: 1. На планшете указывают фамилию или номер истории болезни пациента. 2. В одну из лунок добавляется 2 капли сыворотки реципиента (пациента). 3. В лунку с сывороткой вносится маленькая (соотношение крови и сыворотки 1:10) капелька исследуемых эритроцитов донора и перемешивается с сывороткой. 4. Планшет периодически покачивают в течение 5 минут. 5. Через 5 минут оценивают результат: наличие агглютинации (положительная проба) говорит о несовместимости эритроцитов донора с сывороткой реципиента и недопустимости переливания данного пакета с эритроцитами. Отрицательная проба говорит о совместимости по АВО.Rh-compatibility test. Equipment: Test tube (marked with the patient`s name); patient`s serum, donor`s RBC, solution of 33% polyglucin, hourglass on 5 minutes or timer, saline (0,9% NaCl) Algorithm of the test: 1. Put inside the test-tube 2 drops of recipient`s (patient`s) serum, 1 drop of donor`s RBC, 1 drop of 33% polyglucin. 2. Mix the tube content by shaking. 3. Put the tube horizontally and slowly turn for 5 minutes. 4. In 5 minutes add 3-4 ml of saline inside the tube. 5. Close the tube with the plague and flip 2-3 times (without shaking). 6. Check a result visually on the lite: presence of agglutinates in the clear fluid (positive test) means incompatibility of transfused RBC with patient`s serum. Uniform staining of the fluid (negative test) means incompatibility. 7. Final assessment is carried out under the microscope. Проба на резус-совместимость эритроцитов донора и сыворотки реципиента (с использованием 33% полиглюкина). Оборудование: маркированная пробирка (с фамилией или номером истории пациента); сыворотка крови реципиента, эритроциты донора, раствор 33% полиглюкина, песочные часы на 5 минут или таймер. Алгоритм выполнения: 1. На дно пробирки помещают 2 капли сыворотки реципиента, 1 каплю эритроцитов донора и 1 каплю 33% раствора полиглюкина. 2. Содержимое пробирки аккуратно перемешивается путём встряхивания. 3. Пробирка опускается до горизонтального положения и медленно поворачивается, чтобы содержимое растекалось по стенкам. 4. Через 5 минут в пробирку добавляется 3-4 мл 0,9% раствора NaCl. 5. Пробирка закрывается пробкой и переворачивается 2-3 раза (без взбалтывания). 6. Оценка результата: визуальное (в проходящем свете) наличие агглютинатов эритроцитов на фоне просветлённой сыворотки (положительная проба) говорит о несовместимости крови донора и реципиента и недопустимости переливания данного пакета с эритроцитами. Равномерное окрашивание содержимого пробирки (проба отрицательная) говорит о совместимости. 7. Окончательный результат оценивается под микроскопом.Before starting work with body fluids (like blood) it is necessary to wear protective clothing: mask, cap, glasses, gloves, apron. ABO-typing test. Equipment: white plate with cells for serums; standard serums of two series, a sample of analyzed blood, glass slides or sticks for mixing the blood and serums, saline (0,9% NaCl), hourglass on 5 minutes or timer. Algorithm of the test: ABO-typing should be carried out in the room with temperatures ranging from 15 to 25̊ С. 1. Plate should be marked with the patient`s name. 2. Checking the expiry dates and appearance of serums. 3. Put one big drop of О, А and В serums of two different series to six cells. 4. Add to each serum one little drop (ratio 1:10) of analyzed blood by sticks or corners of the glass slide and mix. 5. Wiggle the plate. 6. After 3 minutes put inside each cell with visible agglutination 1 drop of saline (to prevent false agglutination). 7. Wiggle the plate up to 5 minutes. 8. After 5 minutes check presence of agglutination (flakes from RBC): absence of agglutination in all cells means the first group О(I); agglutination with serums O and В – the second group А(II); agglutination with serums O and А – the third group В(III). In agglutination inside all 6 cells we should perform the test with АВ-serum; absence of agglutination means that tested group is the fourth АВ(IV). Перед тем, как приступить к работе с биологическими жидкостями, необходимо надеть защитную одежду: маску, шапочку, очки, перчатки, фартук. Определение группы крови по системе АВО при помощи стандартных изогемагглютинирующих сывороток. Оборудование: планшет с лунками для сывороток; стандартные изогемагглютинирующие сыворотки двух серий, образец исследуемой крови, предметные стёкла или палочки для перемешивания крови и сывороток, физиологический раствор хлорида натрия (0,9%), песочные часы на 5 минут или таймер. Алгоритм выполнения: Определение группы крови проводится в помещении с хорошим освещением и температурой воздуха от 15 до 25̊ С. 1. На планшете указывают фамилию или номер истории болезни пациента. 2. Необходимо проверить сроки годности сывороток, отсутствие в них посторонних включений. 3. В 6 лунок помещают по 1 большой капле сывороток групп О, А, В двух различных серий. 4. Палочкой или уголком предметного стекла в каждую лунку с сывороткой вносится маленькая (соотношение крови и сыворотки 1:10) капелька исследуемой крови и перемешивается с сывороткой. 5. Планшет периодически покачивают в течение 3 минут. 6. Через 3 минуты в лунки, где визуально имеется агглютинация, добавляют по 1 капле 0,9% NaCl для предотвращения неспецифической агглютинации. 7. Продолжают покачивать планшет до 5 минут. 8. Через 5 минут оценивают наличие агглютинации (хлопья из склеившихся эритроцитов): отсутствие агглютинаци во всех шести лунках – группа О(I) первая; наличие агглютинации с сыворотками групп O и В – группа А(II) вторая; наличие агглютинации с сыворотками групп O и А – группа В(III) третья; при наличии агглютинации во всех 6 лунках проводят аналогичную реакцию с сывороткой группы АВ, отсутствие агглютинации говорит о том, что группа крови АВ(IV) четвёртая.