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Vendajes clase Traumatologia y Ortopedia — Transcript

by Eric CAmiro · 3,144 words · 453 segments · language en · Watch on YouTube

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0:06All right, well, good morning to all
0:08the students. So, we are, um, I’m
0:13going to give you a little talk about
0:15immobilizations and bandages. We’ll
0:19start with bandages because an
0:21immobilization is nothing more than a
0:23bandage, just slightly modified. In the
0:27rules of bandaging, the first thing we
0:30have to do, rule number one, is first
0:33of all prepare the bandage and what we
0:36are going to use, the water. The place
0:40where the patient will be positioned
0:42and the comfort too, and also the
0:43comfort of the surgeon, right? Or the
0:46orthopedist. Meanwhile, we are going to
0:48prepare the material. Look, for the
0:51material, we are going to use this type
0:54of bandage called cotton padding. This
0:59padding is a very, very thin fabric; at
1:02the same time, it is hypoallergenic, it
1:04doesn't cause problems, and it’s to
1:07protect bony prominences. Uh, it’s to
1:11protect the prominences, it can be done
1:13however one wants, right? It adapts to
1:16the shapes of the bone, to the shapes
1:18of the forearm, of everything, right?
1:21That, that is the cotton padding. And
1:24for sizes there, look, 5 cm, 7, five,
1:31seven, 10, and 15. Those are the
1:36standard everyday sizes. Well, that’s
1:38the cotton padding. And next, we have
1:43the elastic bandages in the same sizes.
1:475 cm, 10 cm, 7, excuse me, 10, and 15.
1:55And now we will also see the plaster
1:58bandages, the same sizes so as not to
2:02get confused: 5, 7, 10, and 15. That is
2:07the material that is going to be used,
2:09well, routinely. For what? For 95%of
2:12immobilizations. That doesn’t mean
2:17they are the only sizes, they are just
2:19the standard sizes, the ones that are
2:22required, because there are also
2:24elastic bandages that come in 20 and
2:26there are some of 30 for abdominal
2:28bandages and so on, right? But those
2:32are the ones we are going to work with
2:34on this occasion. As point number two,
2:38the second rule is the preparation of
2:40the patient and also the preparation of
2:41the person who is going to apply the
2:43bandage. In this, we are going to see,
2:47uh, we are going to see the segment we
2:50are going to bandage. It must be
2:53cleaned, right? Because we are not
2:55going to put the bandage over the mud
2:57and dirt the patient is carrying. It
2:59must be cleaned, we must remove rings,
3:02bracelets, things they might be wearing
3:04, right? And also when we are going to
3:09apply the bandage, it must be placed in
3:11a comfortable position, both for the
3:13patient and for the orthopedist, who is
3:15the one applying it. Next, we have the
3:19limb that we are going to immobilize,
3:23right? We choose the appropriate
3:26bandage. Let's say, for example, if I
3:29am going to bandage, we are going to
3:31bandage this ankle, well, the
3:32corresponding bandage is a 10-
3:34centimeter one; a 15-centimeter one
3:36would be too much. Uh, it will bunch up
3:40here, the bandage will be bothersome,
3:42and a 5-centimeter one would be too
3:44small. So, in this case, the choice is
3:47a 10-centimeter bandage. And we are
3:50going to start the bandaging. Well, we
3:52take out this bandage. Bandages always
3:56come with clips here; we have to remove
3:58them, of course. We begin the bandaging
4:01. The bandaging must always be from
4:04distal to proximal, not the other way
4:07around. Uh, well, then upon starting,
4:11perhaps, the bandage must always be
4:14started, uh, trying to leave the
4:16fingers free. And it starts with one or
4:23two turns, and the unrolling of the
4:25bandage should always be from left to
4:28right, because if we do it, well, the
4:30other way, well no, no...unless one is
4:33left-handed, right? Uh, then always
4:38when one finishes the bandage, the heel
4:41and the toes should remain uncovered,
4:44because that is a pressure surface and
4:47the friction here with inner fabric.
4:51And then the tips of the fingers are
4:54for checking circulation above all, the
4:56capillary refill that can be seen on
4:59the skin by applying pressure, it turns
5:04white and should fill up again, right?
5:07Or also on the nail. On the nail it is
5:11easier to see it, yes? On one little
5:14finger, on another, on all of them. But
5:17if the patient has their nails painted,
5:18well, that is the drawback. That is why
5:20whenever we are going to perform a
5:22medical procedure, we must remove the
5:23nail polish. But well, that can be
5:25overlooked, right? So, this is a
5:28bandage for an ankle. So here the
5:33indicated one is the 7-centimeter
5:35bandage. Wait. Well, all bandages come
5:39with their little cover, right? So, the
5:48same rules, right? From distal to
5:51proximal. Let's see. We begin. And
5:56always the unrolling of the bandage
5:58from left to right, like a clock. Here,
6:02here it is important to leave the
6:05knuckles free. We are bandaging the
6:09wrist. Yes, that this doesn't end up
6:12being too tight. Once with two little
6:17turns. I think that here is enough. And
6:22now, we're going up. When wrapping the
6:31wrist, it's good to wrap halfway up the
6:33forearm, right? Not just little wraps
6:36that reach here, right? The bandage
6:42indicated for it was the 7 cm one. Well
6:49, I'm making this video for you, right?
6:51For my students, right? So if there are
6:56any errors, well, don't pay attention
6:58to that. And that's how a wrist bandage
7:08should look. They should be able to
7:11move their little fingers. To clean the
7:15interdigital spaces and ensure they can
7:17move the thumb perfectly well, because
7:20I frequently see errors where the
7:22bandages go all the way up here, right?
7:26Then the patient can't clean themselves
7:28well when the bandage is removed, and I
7:31don't know why, but a variety of fungi
7:33accumulate here, causing a very
7:34unpleasant odor. So, that's why it
7:37should be a correct bandage. This is a
7:40wrist bandage. Well, now we are going
7:43to immobilize. Well, we are going to
7:45apply a bandage including the wrist and
7:48elbow. So, it's always preferable to
7:52have the patient lying down rather than
7:54sitting in the air, right? And then
7:57it's very important that the elbow is
7:59at 90 degrees. And here, an assistant
8:03will always help us, right? Or the
8:05assistant we have, or the nurse, in
8:07short. And then this position is very
8:09important. Well, because you shouldn't
8:13put it too pronated or too supinated,
8:16but in the middle. Yes? So, once our
8:21patient is positioned, we have our
8:23bandages chosen. Here I have planned to
8:27use the one for the wrist up to the
8:29middle third, and from there use the 10
8:32cm one, right? We are going to start
8:36with the same rules from distal to
8:38proximal, always leaving the
8:48metacarpophalangeal joints free for the
8:50reason I already told you, right? and
8:54we start our bandage. The pressure at
9:00which the bandage is applied is a
9:03matter of sensitivity, right? Not too
9:07tight, but not too loose either, but
9:10for that, you have to practice. Here we
9:13reach the fold again. The same thing I
9:15told you about the ankle. Here, the
9:17figure-eight so the edge of the bandage
9:20doesn't start to bother the fold. Here
9:23we do, at least, the first one has to
9:25be a figure-eight, right? I use two
9:29figure-eights here. Make sure it covers
9:31the elbow. No problem here. And now,
9:33over the figure-eight, the bandage
9:36falls into place. Well, I went off here
9:38. To finish the dressing, you also need
9:42to use the 10 cm bandage, but the other
9:45one. At this point, there's no need for
9:50the figure-eight, right? Because the
9:53lower figure-eight is already providing
9:55protection. If we have excess bandage,
10:05we can go back a bit, no problem. And
10:11we finish our dressing. Uh, this is a
10:14dressing that includes the wrist and
10:17the elbow. These clips. One, two. And
10:26there we have the dressing. What can
10:35bandages be used for? Well, for
10:38abrasions, when someone has suffered a
10:41wound and we sutured it, provided there
10:43is no fracture, because if there is a
10:46fracture, then things change, right?
10:50Then you need to use an immobilization,
10:52for dermo-epidermal lesions, or a burn.
10:56Well, that is when bandages are used.
10:58Uh, so with this we finish the forearm
11:02dressing, which includes the wrist and
11:05elbow. Now we are going to apply a
11:09bandage called a Velpeau. This bandage
11:14will be useful for, for example,
11:17shoulder issues, collarbone problems,
11:20humerus problems, and this area, the
11:23shoulder girdle. Uh, so, of course, you
11:26have to remove the patient's clothing,
11:28right? So, you instruct the patient
11:32first to put their hand on their head,
11:34because our bandage will pass through
11:37here so it doesn't get in our way,
11:39right? And the first step is to place
11:44cotton here in the armpit to handle
11:46sweat. Like this, yes? And then she
11:51will place her arm like this at 90
11:53degrees. with the by touching her head.
12:00And now we will start our bandage. Yes,
12:03start here at the elbow. We pass, no.
12:10We pass under the little elbow. You can
12:18make two turns here. And now we change.
12:32Is there a 15 cm one? A 15 cm one. Here
12:40we pass this bandage under the forearm.
12:50We can secure the first bandage. with
12:53the little clips. And here we can add a
13:01second bandage because the first one is
13:04not enough, right? Yes, seeing our
13:12second bandage. and it is finished off
13:34with a bandage that passes over the
13:37shoulder again. The first thing we did,
13:51this, this is the Velpeau dressing. Yes
13:56. This can be complemented with some
14:02adhesive tape or else or else with the
14:07little clips, right? That's it. That is
14:11the bandage. Now we are going to do
14:34some immobilizations. Immobilizations
14:38must be done when there are fractures
14:41or a third-degree sprain, or if we
14:44suspect the sprain might be accompanied
14:48by a fracture, but at this point, the
14:51bone structures are involved, which is
14:54why a regular bandage wouldn't work.
14:58Here we are going to apply an
15:00immobilization. So, the first thing we
15:03have to do is prepare our splint, right
15:05? So, the first thing we are going to
15:10do is take a plaster bandage, choosing
15:13it according to the size of the segment
15:17we are going to immobilize. We take
15:21measurements. Yes, it can be seen. Yes,
15:24it can be seen.
15:25We take the measurement of the size the
15:29splint will be. Yes, that is the size.
15:33We mark it here. Good. And now we have
15:37to prepare the splint. Let's keep an
15:41eye on it here, right? This is done
15:43with three small bandages. There are
15:47the three of them, see? And so we make
15:49our we prepare our splint. There it is.
16:09This is the size. Likewise, with cotton
16:15padding of the same width, we can take
16:20the measurement for the splint itself.
16:28We add two layers, three layers, four
16:33layers, and more or less with five
16:35layers. That is the measure. Yes? So,
16:40we already have all our elements to
16:42prepare the splint; we prepare a
16:45bandage. We also look at the size and
16:49thickness of the leg we are going to
16:50immobilize, and I think a size 10 will
16:52work well. So, having all this ready,
16:57we are going to prepare the splint by
16:59wetting it, right? Well, we wet our
17:03splint, take it out, squeeze it, we
17:14remove the excess water. It shouldn't
17:18have such an exaggerated, such an
17:22exaggerated amount of water. It can be
17:24seen. And we are going to place it on
17:28top of what we previously prepared. And
17:33the last little pass with with another
17:40piece. And now, it's time to put it on
17:43the patient. And the more cushioned
17:47part, with five or six thin layers of
17:48cotton padding, is the one that will be
17:50in contact with the skin. And the other
17:52layer is just so that the bandage
17:54doesn't stick and when we want to
17:56remove it, it isn't difficult for us.
17:59Well, here, here we absolutely need an
18:01assistant. Uh, well, so let's see.
18:07Let's see. So, we are going to
18:08immobilize the ankle and we start the
18:10bandaging. Besides, since we assume the
18:18ankle or tibia is fractured, the
18:21assistant has to hold it. Here, it is
18:50recommended to use two bandages. Two
18:53bandages. You are using the 15 one, but
19:11really that which I am doing I do this
19:43so that when the patient is lying down,
19:45the blanket or sheet doesn't bother
19:47their face, right? Always, before the
20:09plaster sets, it must be molded, right?
20:13don't let it deform, leave the five
20:19little toes out and we wait a moment
20:28for the plaster to set. We wait, we
20:42wait a little while and as you can see
20:45now it is quite firm and the ankle is
20:48well immobilized, or the distal third
20:51of the tibia, or it could be fractures
20:53of the talus, calcaneus, or metatarsals
20:56. Immobilization is used for all of
21:00this. Remember, this is something I
21:04told you very clearly, the best
21:06analgesic for a fracture is
21:08immobilization, not medication. If you
21:11don't immobilize it, you could give
21:14them morphine, a double dose of
21:16morphine, and you won't take the pain
21:18away. Uh, so, immobilization and a
21:21simple analgesic is better. That is the
21:24best thing. So, it is an immobilization
21:28of the distal third and the entire foot
21:31for all the problems of that area that
21:33I just mentioned to you. Very well. Now
21:39here, let's assume the patient has a
21:41forearm fracture. Here the assistant is
21:45very important, because the patient
21:48cannot do this alone, they have to be
21:51helped, and the position is slight
21:53supination. That is the functional
21:56position. The elbow at 90 degrees, and
22:00the assistant is very important there.
22:03So, we are going to apply a splint,
22:05following the same steps. We take the
22:07measurement up to behind the
22:13metacarpophalangeal joints, but you
22:15have to give it a little more, at least
22:183 cm extra, because when you wet the
22:20bandage it shrinks. So we'll make it up
22:24to here. Yes, you can see it, right?
22:29One bandage, two bandages, three
22:34bandages, we take the measurement, put
22:37three bandages, and make our splint.
22:42Like this. This is how it's done so you
22:45don't struggle. You already saw how
22:48once you reach your internship, well,
22:50you can at least unroll the bandages,
22:52right? There it is. That is the length
22:54of the bandage we are going to use. So
22:57we apply the cast padding the same way,
23:00the same thing. One, two, three, four
23:16and five. And we leave it like that. We
23:22have our splint ready now, the
23:23measurement we took, we wet it, we go
23:28like this, we squeeze out the excess
23:32water by grabbing the edges and there
23:39it is. We take it to where we prepared
23:42the padding. We apply the last one. And
23:51there it is. And now, time to apply the
23:56splint. I already told you that the
23:58part with the most layers is the one
23:59that goes in contact with the patient.
24:12We start with our bandage. Don't forget
24:33the figure-eight we mentioned. There it
24:59is. Here, it is important for the
25:12surgeon to shape the forearm a little
25:14bit, so it isn't so angled, but rather
25:16remains more or less aligned, right?
25:22Those immobilizations are done during
25:25the initial treatment of fractures,
25:27which we have already seen. Eh, that
25:32has to be done perfectly well by the
25:34general practitioner. When the patient
25:42arrives at the hospital, they shouldn't
25:45be in pain; they should be immobilized.
25:51Well, after seeing the bandaging and
25:54immobilization workshop, I also want to
25:57tell you that other types of materials
26:00exist, right? It's not just plaster; I
26:04also want to show you, for example,
26:07these fiberglass bandages. These
26:13fiberglass bandages have a feature; the
26:15technique to apply them is the same,
26:17there are no changes. The advantages of
26:22fiberglass are that it weighs nothing,
26:24it weighs a third of what plaster
26:27weighs, and you can also apply splints
26:29or complete casts, right? Now, when you
26:35are going to apply a splint or a
26:38complete fiberglass cast, what we put
26:41on first is this sock-like thing called
26:45stockinette, and it is placed like this
26:48, as if it were a sock; it comes in
26:52meters and you unroll it as far as you
26:55want, right? Yes. This little fabric is
27:00called stockinette. Well, there are two
27:04sizes, some are 8 cm and others are 11
27:07or 12 cm. And since it has the capacity
27:12to stretch, they can be used perfectly
27:16well. After having put on the
27:19stockinette instead of the usual
27:21bandage, we use this, which is the
27:23equivalent of padding, right? We call
27:28it fiberglass padding; it's finer, more
27:31cushioned, same sizes, same technique.
27:36We make our splint and we apply it. And
27:40in the end, we always put on an elastic
27:42bandage of the type already known. See?
27:46This can also be used to apply a splint
27:49or to apply a definitive cast. It's a
27:53bit more expensive for the patient, but
27:55that is the least of it, right? Well,
27:57now I want to show you another type of
28:00bandages called self-adhesive bandages.
28:04They are very thin and have the
28:06characteristic that, in addition to
28:07bandaging, they adhere to themselves.
28:10Look, cut it here, Gabriel. Cut here.
28:17which are, well, more comfortable
28:19bandages. They work like a bandage,
28:22they don't get in the way. It’s
28:34skin-colored, but it’s the same thing
28:38, right? These are the same principles.
28:42This can be used for a common, everyday
28:44bandage like the one we put on at the
28:47beginning, or for after minor surgeries
28:49where there isn't, uh, much of a wound,
28:51really. which are called self-adherent
28:56bandages. There are three sizes. I
28:59brought you some of two, seven, 10, and
29:01I think the other is 15, which is
29:03rarely used. Those aren't the two
29:07bandages, but the two, uh, standard
29:09widths, right? Widths, two standard
29:11widths. Uh, and there are, you are
29:14going to find other types of
29:16immobilizations, you're going to find
29:18other types of bandages, some very
29:19sophisticated ones, uh, that offer
29:21certain advantages, but the principles
29:23are the same. Uh, that does not change,
29:26it really doesn't change. Everything,
29:29everything is encompassed in what I
29:31just mentioned. Well, I hope this video
29:35has been useful to you. I like doing
29:38things live, for one of you to have
29:40applied the bandage, for you to bandage
29:42each other, because that is how you
29:44learn best. But well, given this
29:47situation, we have no choice but to
29:49continue this way. I hope what I have
29:52just taught you has been useful. Thank
29:54you very much.

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