dressing

1. CHAPTER FOUR
Dressings and Bandages
Dressing definition: is the immediate protective cover placed
over a wound.
• Sterile dressings are those which are free from germs prior
to use and are preferable to unsterile dressings.
1

2. Purpose of Dressings
– To assist in the control of bleeding
– To absorb blood and wound secretions
– To prevent additional contamination
– To relieve pain
2

3. Types of dressing
There are two types of dressing
1. Adhesive dressing, this type of dressings are used for dressing small
cuts and grazes.
• They consist of a gauze or cellulose pad and an adhesive backing.
2. Non adhesive dressing is a type of dressing used to dress large size
area wound unlike that of adhesive dressing.
3

4. Dressing procedure
• To apply clean dressing materials at home, hand washing, boiling the
dressing materials for 15 minutes, and then drying the dressing
materials with out contamination is the primary necessity.
• If available, ironed clothes or the inner surface of a folded cloth can
be used for immediate use.
• Do not touch or breathe or cough on the surface of a dressing that is
to be placed next to wound.
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5. Bandages
• A bandage is a strip of woven material used to hold a wound dressing
or splint in place.
• It helps to immobilize, support and protect an injured part of the
body.
Functions of bandages
A. To assist in the control of bleeding
B. To absorb blood and wound secretion
C. To prevent additional contamination
D. To ease pain
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6. E. Control or reduce swelling
F. Lift and transport casualty
G. Secure dressing and splint in position
H. Assist in immobilization
Kinds of Bandages
• The most useful commercially available bandages include:
1. Gauze bandages usually in roles of 1 meter long and 3, 5 or 8 cm
wide.
2. Elastic bandage of woven material in various widths and lengths.
3. Triangular bandages.
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7. 4. A binder of muslin (many tailed bandage) to be applied to the chest
or abdomen (a large towel or part of a sheet can substitute for a
binder). It is rarely used to cover large area of abdomen and chest.
5. Other emergency bandages can be formed from handkerchiefs,
household linen, belts, ties, socks or stockings.
6. Combinations of dressing and bandages.
7. Special pads.
7

8. A. Elastic Bandages
• They are expensive but can be laundered and used repeatedly for a
number of purposes. In using elastic bandages the first -aider must
take great care not to stretch the material too tightly. Putting an
elastic bandage too tight will hinder or constrict blood flow.
B. Gauze Bandages
• Skill is necessary in applying a gauze bandage to prevent its
• slipping and stretching. Gauze can be used as a bandage, almost on
any part of the body. Never apply wet gauze it will shrink as it dries
and become too tight.
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9. A gauze bandage can be used in different ways:-
• Circular bandages
• Spiral bandages
• Figure of eight bandages (for joint areas )
• Finger tip bandages ( formerly called recurrent )
C. Triangular Bandages
• Triangular bandages are useful as an emergency cover for the
entire scalp, and foot or any large areas.
• Such a bandage also is used as a sling for fracture or other injury of
the arm or hand.
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10. • The triangular bandage can be used as a circular, spiral or figure of
eight bandage.
• It can also be used as a tie for a splint, as a constricting band or as a
tourniquet.
D. Adhesive -Strip Dressings
• It is used for small wounds following through cleaning.
Application of Bandages
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11. General Principles
• A bandage should be snug (not too loose and not too tight).
• To ensure that circulation is not interfered with.
• Leave the person’s fingertips and toes exposed.
• Watch for swelling, change of color and coldness of the tips of
fingers or toes indicating interference with circulation.
• Loosen bandages immediately if the victim complains of numbness or
tingling sensation.
• Never apply a tight circular bandaged about a person’s neck.
• It may cause strangulation.
11

12. Methods of applying bandages on different locations
A. Arm Sling
• Prepare a triangular bandage.
• Place one end of the bandage over the injured shoulder and let the
other end hang down in front of the chest parallel to the side of the
body.
• Carry the point behind the elbow of the injured arm.
• Carry the second end of the bandage up over the shoulder and tie
the two ends together at the side of the neck not over the spine.
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13. • Bring the point of the sling and tie it.
• Make sure the ends of the fingers extend just beyond the base so
that you can observe whether or not the circulation is cut off.
• In all cases of fore arm or hand injury adjust the sling so that the
hand is elevated 10 or 12 cm above the level of the elbow.
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14. B. Triangular Bandage Folded as a Cravat (Neck Tie)
• To make a cravat bandage bring the point of a triangular bandage to
the middle of the base then fold length wise along the middle until
you obtain the desired width.
C. Triangular Bandage for the Scalp and Fore Head
• Fold a hem about 5 cm wide along the base.
• Place, compress and put the dressing in place with the hem on the
outside.
• Place the bandage on the head so that the middle of the base lies on
the forehead close down to the eyebrows and the point hangs down
the back.
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15. 15

16. D. Cravat Bandage for Forehead, Ears or Eyes
• Place the center of the cravat over the compress that covers the
wound.
• Carry the ends around to the opposite side of the head and cross
them.
• Bring them back to the starting point and tie them.
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17. E. Cravat Bandage for Cheek or Ear
• Use a wide cravat, start with the middle of the cravat over the
dressing that covers the cheek or ear.
• Carry one end over the top of the head and the other under the chin
• Cross the ends at the opposite side, bringing the short end back
around the forehead and the long end around the back of the head.
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18. Anchoring a bandage
• Place the end of the bandage on a base at the starting point.
• Encircle the part allowing the corner of the bandage end to protrude.
• Turn down the protruding tip of the bandage and encircle the part
again.
Securing of a bandage
• There are several ways to secure a bandage in place (safety pin,
applying adhesive tape, bandage clip, tucking in the end and tying).
18

19. Methods of bandaging
Circular turn
• Simply encircle the part with each layer of bandage super imposed on
the previous one.
• It is simplest of all bandage turns, however, its use is limited to
covering parts of uniform width such as the toes and head.
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20. 20

21. Open and closed spiral bandage of the limb
• It is a continuous encircling of the area to be covered with spiral
• turns spaced and closed. The bandage is completed by tying off. It is
used temporary for splinting and holding a large burn dressing in
place.
Figure of eight bandage for hand and wrist
• Anchor the bandage with one or two turns around the palm of the
hand
• Carry it diagonally across the front of the wrist and around the wrist.
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22. • Again carry it diagonally across the front of the wrist and back to the
palm.
• It is repeated as many times as necessary to fix the dressing properly.
• Complete it by tying off.
22

23. Finger tip bandage
• This is a series of back and forth runs called recurrent turn held in
place by circle and spiral turns.
• It is normally used to bandage fingers; the bandage may be adapted
to bandage the toes, scalp or stumps of limbs.
• This bandage is held in place with circular turns.
• From the finger or toe, take the end of the bandage diagonally across
the back of the hand to the wrist, encircle one or more times from
the opposite side of the wrist.
• Continue to the finger and loop.
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24. • Repeat the figure of eight several times and tie off at the wrist.
• Secure by tying.
24

25. 25

26. Figure of eight bandage for the ankle joint
• Anchor the bandage on the instep and take two or three additional
turns around the instep and foot.
• Carry the bandage diagonally upwards across the front of the foot
then around the ankle and diagonally downwards.
• Occasionally use an extra turn around the ankle and complete by
tying off
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27. 27

28. Unit VII
Bone & joint injures
1. Fracture
• A fracture is a break or crack in the continuity
of bone.
Cause
• Fractures occur when the bone is subjected to
stress greater than it can absorb.
• Fracture can be caused by:
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29. Fracture cont…
• Direct blow (by motor vehicle accidents, or
accidents related to fall and recreational and
sport activities)
• Sudden twisted motion
• Extreme muscle contraction
• Disease of the bone e.g. (Bone tumor)
29

30. Fracture cont…
• Some fractures result from very slight injuries,
particularly in older people, because of brittle or
abnormal bones.
• Although the bone is broken, adjacent structures
are also affected, resulting in soft tissue edema;
hemorrhage into the muscle and joints, joint
dislocations, ruptured tendons, severed nerves
and damaged blood vessels. Body organs may be
injured by the force that caused the fracture.
30

31. Fracture cont…
Types of fracture
Closed fracture
(simple fracture)
• Does not produces a
break in the skin.
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32. Fracture cont…
• Are much more common than open fracture.
• Accurate diagnosis is made with the assistance
of x-ray examination.
• Bone may be displaced and cause damage to
other internal tissues in the area. If the bone
ends pierce organs or major blood vessels, the
causality may have internal bleeding and
suffer shock.
32

33. Fracture cont…
Open fracture
/compound/
complex fracture
• One of the broken
bone ends may
pierce the skin
surface or there may
be a wound at the
fracture site.
33

34. Fracture cont…
• Some times the wound is caused by
machinery or other such as a bullet that
penetrates the skin and breaks the bone.
• Open fractures are much more serious
because of tissue damage, bleeding and the
danger of infection, because the fracture area
is always contaminated.
34

35. Fracture cont…
Open fractures are graded as:-
• Grade I - is a clean wound less than 1 cm long.
• Grade II - is large wound without extensive
soft-tissue damage.
• Grade III - which is highly contaminated and
has extensive soft-tissue damage, is the most
severe.
35

36. 36

37. Fracture cont…
Sign and symptom
There may be:-
• Deformity, swelling, discoloration & bruising at
the fracture site.
• Shortening, bending or twisting of a limb.
• Pain (continues and increasing in severity until
the bone fragments are immobilized).
37

38. Fracture cont…
• Course granting (crepitus) of the bone ends
that can be heard or felt.
• Difficulty in moving a limb normally or at all
(e.g. inability to walk).
• Sign of shock (rapid pulse, pale, cold and
clammy skin, sweating).
• A wound, possibly with bone ends protruding.
38

39. Fracture cont…
• If the victim is conscious, he will usually be
able to provide clues to possible fracture. He
may recall his position before the injury and
relate what happened as he fell or struck
some object.
Management
• Advice the causality to be calm. Support the
injured part with your hands or ask a helper to
do this, until it is immobilized.
39

40. Fracture cont…
• For firmer support, bandage the injured part
of an affected part of the body. Make sure
that the bandage is tied on the uninjured site.
– For upper limb fracture immobilize the arm
against the trunk.
– For lower limb fracture, bandage the uninjured leg
to the injured one.
• Arrange to transport the causality to hospital.
40

41. Fracture cont…
• Treat for shock, if necessary by raising the
legs. However, do not raise the injured limb
because this cause the causality more pain (to
reduce hemorrhage and swelling).
• Check the circulation beyond the bandage
every 10 minutes. If the circulation impaired,
loosen the bandage.
41

42. Fracture cont…
Caution
• Do not move the causality until the injured
part is secured and supported, unless he/she
is in danger of fire, Co poisoning, explosion,
drowning or other life threatening
emergencies.
• Do not allow the causality to eat, drink or
smoke as a general anesthesia may be
needed.
42

43. Fracture cont…
Additional management for open wound
• Put on gloves if available. Loosely cover the
wound with a large, clean, non-fluffy pad or
sterile dressing. Apply pressure to control
bleeding but do not presses on a protruding
bone, do not wash the wound & do not insert
your finger into it.
43

44. Fracture cont…
• Carefully place clean padding over and around
the dressing. If bone fragment is protruding,
cover the entire wound with a large bandage
or pad, if not available use sheets or towels.
-Do not replace bone fragments.
-Bandage firmly but not so tightly not to
impair circulation.
44

45. Fracture cont…
• Immobilize the injured part as for a closed
fracture, and arrange to transport the
causality to hospital.
• Treat for shock, if necessary, monitor and
record vital signs and level of response. Check
the circulation beyond the bandage every 10
minutes.
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46. Splinting
• Splints are devices applied to the arms, legs
or trunk to immobilize the injured part when a
fracture is suspected.
• They decrease pain and shock by preventing
motion of the broken bone ends and the
adjacent joints.
• They also protect against further injury during
transportation for medical treatment.
46

47. Splinting cont…
• There are many types of splint available
commercially. However, very satisfactory
emergency splints can be made from
corrugated card board, news papers, boards,
straight sticks, rolled-up blankets, pillows etc.
• The splint should be long enough to extend
the joint on either side of a suspected
fracture.
47

48. Splinting cont…
• Joint should be immobilized above and below
the location of the suspected fracture.
• If the victim complains of numbness, tingling
sensations or inability to move his fingers or
toes, loosen ties immediately, otherwise
permanent nerve damage may result.
• Never test for fracture by having the victim
move the part or try to walk on a possibly
broken leg.
48

49. Splinting cont…
• Do not allow the victim to move his head (or
do not move it yourself) when there is a
possible neck or spine injury. Movement may
cause further damage to the spinal cord and
result in paralysis.
• Splint may be held in place by strips of cloth
torn from skirts , large handkerchiefs,
neckties, bandages or other similar materials.
49

50. 2. Dislocation
• It is joint injury in
which the bones are
partially or
completely pulled
out /displace of
position.
50

51. Dislocation cont…
• It can be caused by a strong force (as a result
of fall or a direct blow) wrenching the bone
into an abnormal position or by violent muscle
contraction.
• This very painful injury most often affects the
shoulder, jaw or joints in the thumbs or
fingers.
51

52. Dislocation cont…
• Dislocation may be associated with torn
ligaments or with damage to the synovial
membrane which lines the joint capsule.
• In some cases joint dislocation can have
serious consequence. If vertebrae in the spine
are dislocated, the spinal cord can be
damaged. Dislocation of the shoulder or hip
may damage the major nerves that supply the
limbs and result in paralysis.
52

53. Dislocation cont…
• In a severe dislocation of any joint, there will
be also fracture of the bones involved.
• In many cases, it can be difficult to distinguish
a dislocation from a closed fracture. If you are
in any doubt, treat the injury as a fracture.
53

54. Dislocation cont…
Sign and symptom of dislocation
• Severe pain and difficulty in moving the area.
• Swelling and bruising around the joint.
• Shortening, bending or twisting of the area.
• Tender to touch.
54

55. Dislocation cont…
Management
• Advice the causality to keep calm, support the
injured part, in a position of maximum
comforts for the causality, before you
immobile it.
• Immobilize the injured part with padding,
bandages and slings for firm support; bandage
the injured part to an unaffected part of the
body.
55

56. Dislocation cont…
• Arrange to transport the causality to hospital.
Monitor and record vital signs.
• Check the circulation beyond the bandages
every 10 minutes. If the circulation is
impaired, loosen the bandages.
56

57. Dislocation cont…
Caution
• Do not try to reposition a dislocated bone into its
socket because of further injury. (To blood
vessels, nerves and supporting structures in the
area).
• Do not move the causality until the injured part is
secured and supported, unless he is in danger. Do
not allow the causality to eat, drink or smoke, as
a general anesthetic may be needed.
57

58. 3. Strains and sprains
• The softer structures around bones and joints-
the ligaments, muscles and tendons may
injured in several ways. Injuries to these soft
tissues are strains and sprains.
• They occur when tissues are over stretched
and partially or completely torn by violent or
sudden movement for this reason strains and
sprains are frequently associated with
sporting activities.
58

59. Strains
• Strains are injuries to
muscles occur when
the muscle is
overstretched and
may be partially
torn.
59

60. Strain cont…
• It often occurs at the junction of the muscle
and the tendon (that join the muscle to bone.)
• Injuries in these areas are usually
accompanied by bleeding into the surrounding
tissue, which can lead to pain, swelling and
bruising.
60

61. Sprain
• One common form
of ligament injury is
a sprain.
• It is the tearing of a
ligament at or near a
joint.
61

62. Sprains cont…
• It is often due to a sudden or unexpected
wrenching motion that pulls the bones in the
joint too far apart and tears the surrounding
tissue.
• The ankle, fingers, wrists and knees are most
often sprained.
62

63. Sprains cont…
Sign/symptom
• Swelling
• Tenderness
• Pain during motion
• Discoloration
 It is usually impossible to tell a sprain from
closed fracture without an x-ray.
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64. Management for strain and sprain
• Strain and sprains should be treated initially
by the "RICE" procedure.
R - Rest the injured part
I - Apply Ice or cold compress
C - Compress the injury
E - Elevate the injured part
64

65. Management for strain and sprain
cont…
• Advise the causality to sit or lie down. Support
the injured part in a comfortable position.
• Cool the area by applying an ice pack or cold
compress. This will reduce swelling, bruising and
pain.
• Apply gentle pressure (compression) to the
injured part by surrounding the area with cotton
wool and securing with bandage. Check
circulation beyond the bandage every 10
minutes.
65

66. Management for strain and sprain
cont…
• Raise (elevate) and support the injured part to
reduce the flow of blood to the injury. This
action will help to minimize bruising in the
area.
• If the pain is severe, or the causality is unable
to use the injured part, take or send the
causality to hospital.
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67. Chapter 6
Shock
• Is the life threatening condition that happens when vital organs
in the body not getting enough blood flow
• Leads to failure of vital organs and heart
67

68. Types
• Hypovolemic
• Septic
• Anaphylactic
• Neurogenic
• cardiogenic
68

69. Clinical features
• Fat pulse
• Pale
• Cold or clammy skin
• Sweating
• Fast and shallow breathing
• Grey-blue skin
• Weakness and dizziness
• Nausea, thirst
• Weak pulse, low BP,restlessness, gasping for air
• unresponsive
69

70. causes
• Severe bleeding
• Heart problems
• Body fluid loss
• Severe allergic reaction
• Severe infection
• Following spinal cord injury
70

71. First aid for shock
• Treat the underlying cause
• Lie down
• Raise the leg
• Call for help
• Loosen tight clothing
• Keep them warm and calm
• Monitor level of response
71

72. Thank you!
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