Dr. Tamás Gál Semmelweis University Department of Traumatology February 24, 2009

For the purpose of holding dressings of all kinds in place, to obtain compression, to give support, or correct deformities, and finally, to immobilize splints.

We can increase their usefulness by applying certain substances after the bandage has been put on or we may apply the same substances in the bandage material and hardening will occur in the meshes of the bandage. These materials are plaster of paris, starch, glucose or silicate of sodium.

1. To stop or slow bleeding 2. To prevent (further) infection Therefore, only sterile dressings should be used.

1. The area of the wound must be cleaned (lots of water or weak disinfectant) 2. The area of the wound is disinfected (iodine, Betadine, Dodesept, mercurochrome) 3. If possible, particles or debris should be removed via sterile tweezers If the debris is deep or is large in size, it should not be removed – only in ER/Trauma Center

Covers the wound in case of minimal bleeding. Sterile gauze is placed onto the wound, then wrapped with gauze bandage. Bandaging should exceed the length of the wound by at least 1-1 cm. Extremity injuries should be wrapped from distal to proximal direction. Joint movement should not be impaired.

Can be used for both arterial and venous bleeding If extremity bleeding – raise the extremity above the level of the body Cover the wound with a sterile gauze Wrap the dressing with gauze bandage Cover the sterile dressing with thicker padding, then tightly wrap the padding to the extremity The patient must be transported to the ER/Trauma Center

Trauma Center Tetanus vaccination  Passive immunization: tetanospazmin binding - human tetanus immunoglobulin,  Active immunization: Tetanus anatoxin Clean, disinfect wound. Debridement. Check circulation, sensation, movement Look for signs of infection

Radiologic examination: x-ray (can help determine bone injury, metal debris in wounds) Go to operating room Lidocain allergy Administer anaesthetics (and wait it out) Clean and disinfect the wound again If necessary, excise the edges of the wound Place monofil sutures loosely, never a continuous suture Dress the wound

Distorsions, sprains Fractures

Used for injuries of the shoulder area Acromioclavicular luxation, fracture Fracture of the surgical neck of the humerus After the reduction of shoulder dislocations Alternatively, Ramofix with triangle splint can be used

Fracture of the fifth metacarpus Occurs in fights – punching If reduction is stable, a fist bandage can be used rather than a cast splint Fixation time is still 6 weeks

Symptoms include swelling, pain to pressure and movement Treatment: Rest Ice the area (Chloraethyl spray) Raise the extremity to a level above the heart Wrap the joint with elastic (Ace) bandage If necessary, NSAID (diclofenac or ibuprofen) gel or oral administration

Used as transport splints for fractures of extremities It is a wire ladder like splint, wrapped with gauze Should be shaped to the healthy extremity Fixation of both joints surrounding the injury Aluminum splints are used for finger injuries

Used for contusions, distorsions, non- dislocated fractures, reduced fractures Requires min. 6-8 layers of plaster cast, gauze bandage (non-stitched) After drying, must be cut and rewrapped Check circulation, sensation, movement After swelling has gone down, circular cast can then be administered