6 Inmovilizaciones

Introduction to Practical Trauma Management

Overview of the Course

• This course focuses on practical applications rather than theoretical knowledge, emphasizing hands-on skills like immobilizations and bandaging.

• The instructor highlights that everyone is susceptible to trauma, whether from work accidents, road incidents, or sports injuries.

Types of Injuries and Initial Response

• Understanding how to respond to various types of trauma is crucial for providing effective care outside hospital settings. Various materials can be used for immobilization in emergencies.

• Different types of bandages are introduced, including elastic bandages, gauze, triangular bandages, and adhesive strips (curitas). A circular bandage technique will also be covered later.

Extrication Techniques

Importance of Extrication

• The term "extrication" refers to safely removing a patient from an accident scene; this process is critical for the patient's survival and recovery. Proper techniques can significantly impact outcomes.

Historical Context of Immobilization

Evolution of Treatment Methods

• Historical evidence shows that as far back as 300 BC, fractures were treated with splints; understanding this evolution helps contextualize modern practices in immobilization techniques.

• Various methods have been developed over time for immobilizing fractures beyond just casts and bandages; traction methods are also discussed as part of historical treatment approaches.

Modern Immobilization Techniques

Types of Traction

• Skeletal traction involves using pins inserted into bones to apply weight for fracture reduction; it requires careful calculation based on the patient's body weight (10% rule). This method ensures stability during healing.

• If skeletal traction isn't feasible, skin traction can be applied using adhesive strips and pulleys while still adhering to the 10% body weight guideline for effectiveness.

External Fixation Devices

• External fixators serve as another method for stabilizing fractured bones by anchoring them with pins placed away from the fracture site; these devices come in various designs tailored for specific injuries.

Objectives of Immobilization

Key Goals in Injury Management

• The primary objectives include pain management (analgesia), preventing further tissue damage from movement, maintaining proper alignment during healing (reduction), and avoiding complications such as muscle contractures due to immobility or spasms.

• Effective immobilization allows bone healing by keeping fractures stable until they form a callus; failure to do so may lead to severe complications requiring surgical intervention if not managed properly.

Understanding Trauma and Treatment

The Impact of Trauma on Functionality

• Trauma leads to functional limitations, often physiological, to avoid pain. For example, an animal instinctively immobilizes an injured limb to prevent discomfort.

Types of Treatment for Injuries

• Treatment is categorized into three stages: emergency treatment at the accident site, definitive treatment in a medical facility, and rehabilitation post-injury. Each stage is crucial for recovery.

Importance of Immobilization

• Immobilization is essential for maintaining proper alignment of fractured bones to ensure healing. It should encompass both proximal (e.g., knee) and distal (e.g., ankle) joints when treating leg fractures.

Considerations for Elderly Patients

• In elderly patients (over 60), the duration of immobilization must be minimized to prevent joint stiffness or "frozen" joints, which can hinder movement even with therapy efforts.

Types and Techniques of Bandaging

Understanding Bandages

• Bandages are strips made from various materials used to wrap body parts for protection or support; they come in different sizes and types depending on the injury location. Examples include elastic bandages and gauze rolls.

Proper Application Techniques

• Effective bandaging requires that the injured area remains relaxed during application; the operator should position themselves adjacent to the injury site while ensuring comfort for the patient. Always start with two circular turns before proceeding with additional layers.

Functions of Bandaging

• Bandages serve multiple purposes: protecting wounds from environmental exposure, controlling bleeding through compression, immobilizing injuries, and securing splints or protective equipment like casts or slings.

Types of Bandage Techniques

• Various techniques exist such as:

• Circular: wraps around without advancing.

• Helicoidal/Espiral: overlaps previous layers while moving upward.

• Spiral inverted: covers areas by advancing while applying pressure correctly on limbs or joints. Each technique has specific applications based on injury type and location.

Techniques for Effective Bandaging

Basic Bandaging Techniques

• The initial step involves making two circular turns with the bandage to secure it properly on the anatomical region.

• A figure-eight bandage is introduced, starting from one shoulder and crossing over to the opposite axilla, ensuring that all turns are crossed at the back.

• This figure-eight technique is crucial for treating fractures and dislocations, providing necessary support.

Advanced Bandaging Methods

• The capelina bandage begins similarly with two circular turns, followed by alternating forward and backward placements of the finger to secure it effectively.

• Elastic bandages should always be cushioned underneath; using cotton instead of foam is recommended for comfort.

Sling Application

• Proper placement of a sling involves securing it around the neck while ensuring that knots are positioned to avoid injury to spinal processes.

• The veló bandage covers both shoulder and thorax while leaving hands free; cushioning is essential in areas prone to skin irritation.

Specialized Bandages

• The Gil Cristi bandage is suitable for hot climates and serves a similar purpose as the veló but uses a cotton tube for immobilization.

• This method allows easy access for hand movement while stabilizing upper limb injuries effectively.

Immobilization Techniques

• Both Gil Cristi and Belpoy bandages immobilize shoulder and elbow joints, which aids in healing from fractures or dislocations.

• A cervical collar is vital during extrication procedures to prevent further injury to potentially damaged cervical regions.

Finger Immobilization Strategies

• For finger injuries, either an overlapping technique or Mataró splints can be used; these splints feature aluminum sheets with padding.

• Care must be taken with compression techniques as they can lead to complications such as skin irritation or damage to blood vessels.

Understanding Splint Usage

• Splints serve dual purposes: providing rigidity while allowing some elasticity. They are critical in preventing movement at fracture sites.

What is Gypsum and Its Uses?

Origin and Composition of Gypsum

• Gypsum has been used for analgesia and to reduce bleeding; it originates from marine deposits dating back 200 million years when continents were submerged in oceans.

• The mineral is utilized extensively in construction, decoration, and various applications since its discovery by humans. Spanish colonizers introduced gypsum to Latin America for aesthetic purposes in architecture.

Properties and Hardening Process

• Pure gypsum appears white but can vary in color due to impurities, with a chemical formula of calcium sulfate dihydrate (CaSO₄·2H₂O).

• The hardening process involves grinding gypsum into powder, heating it to remove water through thermal calcination, resulting in dehydrated crystals.

• When rehydrated with water, the gypsum undergoes a chemical reaction that restores its original hardness rather than simply drying out.

Application Techniques

• The time required for gypsum to set varies based on environmental factors like temperature and humidity; immersion in water does not prevent hardening.

• Different types of splints are named based on their application area; examples include brachiopalmar (arm to palm), antebrachiopalmar (forearm to palm), and others specific to upper or lower limbs.

Importance of Immobilization

• Proper immobilization techniques are crucial for fractures; proximal and distal joints must be stabilized. For example, a leg fracture requires knee and ankle immobilization.

• In cases of femur fractures, both hip and knee joints should be immobilized using appropriate splinting methods.

Splinting Techniques

• To create a splint for upper limbs, 8–10 layers of plaster are recommended; measurements should be taken accurately before applying the material.

• Cotton padding is essential beneath the plaster layer for comfort. After wetting the plaster bandage, it is applied over the cotton padding.

Advanced Splinting Options

• Prefabricated splints such as vacuum or inflatable types offer modern alternatives for immobilization. These can provide intelligent compression during use.

• Spinal boards are also mentioned as tools for patient transport while minimizing further injury during movement.

First Aid Techniques for Immobilization

Basic Materials and Initial Steps

• The importance of using multiple layers, including gauze bandages and adhesive fabric, is emphasized. Begin by placing a stockinette to prevent allergies; if unavailable, cotton can be used directly.

• When applying a cast splint, the process involves wrapping with two circular turns followed by an elliptical turn and finishing with two more circular turns.

Specific Splinting Techniques

• A small splint is demonstrated for finger immobilization. It’s crucial to secure it with adhesive tape in the volar region rather than the dorsal area to avoid discomfort.

• Various materials such as wood, cardboard, or clothing can be utilized for emergency immobilization. It's acceptable to immobilize one limb using another healthy limb as support.

Emergency Transport Considerations

• Emphasizes that fractures must be stabilized before transporting a patient to prevent further injury or exposure of soft tissues.

Use of Tourniquets

• Tourniquets are described as compressive dressings used in severe bleeding situations. They should not remain on longer than 1.5 hours for upper limbs and 2 hours for lower limbs due to risks like necrosis leading to amputation.

Creating an Emergency Cervical Collar

• Instructions are provided on making an emergency cervical collar from cardboard and other materials like toilet paper and football socks, ensuring safety through rounded edges.

• Proper padding is essential when creating the collar; this helps maintain cervical stability during transport after an accident.

Importance of Knowledge and Decision-Making

• Stressing the necessity of immobilizing the cervical region in accidents where injuries may not be immediately apparent; erring on the side of caution can save lives.

Practical Application and Training

• The knowledge gained from these techniques will guide practical application during emergencies. Making informed decisions at critical moments is vital for effective first aid response.