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1. Desmurgy,
Bleeding
Tell me - and I will forget,
show me - and I will remember
give it a try and I will understand.
(Chinese wisdom)
Lecturer: PhD, Rakhimov Azizjon Yakhyoyevich
Bukhara state medical
institute
Bukhara 2022 y
2. The desmurgy is a doctrine
about bandages, their use and
the correct imposing.
Bandage – means for treating damages and
diseases consisting of imposing on the
affected center of a dressing material and
fixing or immobilizing the most affected area.
3. Depending on features of a dressing
material of a bandage can be :
• SOFT (glue, cravat
bandage, strapping and at
al)
• FIRM, or rigid (splint,
starched, plaster)
(Cravat-косыночные, strapping-бинтование эластичным
бинтом, starched- крахмальный, splint – шина, plaster-
гипсовые)
4. Soft dressing materials
• Dressing material - it is
the material used for
imposing of bandages,
and also protection of
wounds and an burned
surface from additional
infection and damages.
• Dressing facility- the
products made of a
gauze material and
ready to use.
(facility- средства)
5. From a gauze and cotton wool are
produced :
• BANDAGE
• WADS (тампон, шарик)
• NAPKINS
• WADDED AND GAUZE
SMALL PILLOWS (ВАТНО-
МАРЛЕВЫЕ ПОДУШЕЧКИ)
• FIRST-AID DRESSING PACKS
• From cotton fabrics :
• MEDICAL KERCHIEFS
(МЕДИЦИНСКИЕ КОСЫНКИ)
• SUSPENSOR
• CONTOUR FIXING
BANDAGES
6. Bandage gauze unsterile
◼ bandages are the most widespread.
That the dressing lay correctly and
evenly, it is necessary to use a
bandage of the corresponding
width depending on the area of the
bandaged anatomic area. Bandage
divide on narrow (3 — 7 cm),
averages (10 — 12 cm), and wide
(14 — 18 cm). The patient to
whom the bandage is applied has to
be in a situation, convenient for it.
The bandaged part of a body has to
be available from all directions.
12. Mitella (sling [four-tailed]
bandage- пращевидная
повязка)
◼ These bandages consist of a
piece of bandage or a strip
(лента) of matter (вещество)
which both ends are cut in the
longitudinal direction. Such
bandages are applied a nose, a
chin, a sinciput (темя), a
forehead, a nape (затылок).
14. THE ROLLED PART OF BANDAGE
IS CALLED THE HEAD, AND THE
FREE END-BEGINNING.
BEGINNING
HEAD
15. Rules of imposing of a bandage
1. The patient should be seated or laid in a
comfortable position that the bandaged area
was not mobile and available.
2. The bandaged part of an extremity has to be
in situation in which it will be after imposing
of a bandage.
16. Rules of imposing of a bandage
3. Bandaging(Перевязывающий) has to stand facing the
patient to have an opportunity to observe his
state and to avoid unnecessary traumatizing
when imposing a bandage.
4. Width of bandage is chosen according to the
sizes of a wound of the bandaged somite
(сегмент тела, спинной сегмент).
17. Rules of imposing of a bandage
5. Bandage is rolled from left to right,
counterclockwise(против часовой стрелки). A bandage
head, as a rule hold in the right hand, and the
free end in left.
6. Bandaging is always made from the center to
the periphery (from below up).
18. Rules of imposing of a bandage
7. Bandaging is begun with 2-3 fixing tours
(i.e. circular rounds) bandage. The fixing
tours are imposed on the narrowest
uninjured area of a body around a
wound.
8. Each subsequent turnover of bandage has
to block previous on a half or on two
thirds of its width.
19. Rules of imposing of a bandage
9. Bandage is rolled without taking off its head
from a body surface that provides a steady
tension of bandage throughout a bandage.
10. If bandage is spent, and bandaging needs to
be continued, then at the end of bandage
underlayed the beginning of new bandage
and strengthen a circular tour, then
bandaging is continued.
20. Rules of imposing of a bandage
11. Bandaging is recommend to be completed 2-3
circular tours imposed in a projection of the fixing
tours with which bandaging began.
12. The bandage ends with reliable fixing of the end of
bandage.
13. The node which fixed the end of bandage should not
be in a wound projection, on occipital and temporal
area, on spin, on a bottom surface of foot, on a
palmar surface of a hand.
21. Mistakes when imposing bandages
• If the bandage is applied hardly, or pressure of tours
of bandage unevenly in various parts of a bandage,
then there is a disturbance of a blood circulation in
peripheral departments of an extremity.
• Integrity(целостность) of a bandage is easily broken, or
the bandage slips(сползает) if incorrectly first fixing
tours of a bandage are made.
• At a weak tension of bandage the bandage quickly
slips.
22. Primary bandage -
it is for the first time the applied
bandage after an injury or
wound.
23. The bandages applied for treatment of injuries of a
body consist of two parts :
MEDICAL FIXING
REPRESENTS THE
DRESSING MATERIAL
WHICH DIRECTLY
ADJOINS(прилегать) TO
THE WOUND SURFACE
AND RENDERS(оказывает)
DIFFERENT TYPES OF
MEDICAL INFLUENCE
IT IS PRESENTED BY
VARIOUS DRESSING
MATERIALS WHICH ALLOW
TO HOLD RELIABLY THE
MEDICAL PART OF THE
BANDAGE IN THE FIELD OF
THE WOUND OR OTHER
DAMAGE
24. Classification of bandages by
technology of bandaging :
1. Circular (circular)
2. Spiral
3. Creeping bandage
4. cross [figure-of-eight] bandage
5. Turtle
6. spica [spiral reverse] bandage
7. Returned
25. ROUND (circular) bandage.
Consists of circular tours of bandage which are
located by one over another without shift.
Each bandage begins with circular tours of
bandage.
1 tour 2
round
3
roun
d
4
roun
d
30. Creeping bandage
After the fixing tours, the next tours of bandage
are put spirally. The distance between tours is
equal to bandage width.
1
tour
2
roun
d
3
round
32. cross [figure-of-eight] bandage
The bandage consists of bandage tours which
course reminds a form of a cross or the eight.
Decussation(перекрест) of tours of bandage is located
in a wound projection.
34. Turtle bandage
Tours of bandage repeat an eight form, at the same
time the subsequent tour is displaced rather previous
to the center or the periphery of a joint, forming the
convergent(сходящуюся) or divergent(расходящуюся) turtle
bandage.
wound
divergent
36. spica [spiral reverse] bandage
1. Represents a modified figure-of-eight bandage which tours,
being displaced up or from top to bottom, form the
ascending or descending spica bandages.
2. Successive(Последовательные) strips of material applied to the
body and the first part of a limb, or to the hand and a finger,
that overlap slightly so as to resemble an ear of wheat(колос
пшеницы).
wound
38. The Recurring bandage
bandage
The fixing circular tours on the acting
parts of a body
Bend bandage and lead
to the termination of the
protrudent(выступающей )
part of a body, then are
returned on an opposite
surface to the fixing
bandage tours
40. Imposing of any bandage, as a rule demands use of
various combinations of main types of bandaging.
So imposing of a bandage on all lower extremity
demands use all seven main versions.
41. Rules of imposing of sterile head
bandages
IN THE FORM OF
“CAP” (чепец)
IN THE FORM OF
"BRIDLE« (Уздечка)
42. Head bandage
"Hippocrates's hat"
More extensive areas cover with
bandages. All calvaria can be
covered with the so-called
returned bandage of the head
having a hat appearance. Having
fixed bandage by the circular
course (1) around the head, do in
front an flexure and lead bandage
on the side surface of the head a
little slantwise, above previous (2).
On a nape do the second flexure
and cover lateral face of the head
on the other side of (3).
43. Head bandage
"Hippocrates's hat"
• Having fixed flexures on the front and
back party by the circular course (4),
again, cover the side surface of the
head with the slanting courses (5 and
6), fix them by circular turn and so
continue, doing the side courses is
upwards and upwards, will not cover
all head yet. When imposing a bandage
it is necessary to try to do flexures
lower that they better could be
strengthened the circular courses. It
should be noted that this bandage is
fragile (хрупкий,непрочный) and to
impose its seriously ill, at wound of a
skull and after brain operations does
not follow as it can come off
(соскакивать)
44. Head bandage "Cap"
• Bandage "cap". The head which is the
most responding the modern
requirements of treatment of wounds the
bandage "cap" is. The bandage very
simple and convenient can be also
imposed without assistant. She never
slips and puts the sufficient pressure
upon a wound. The fact that from under
a headdress straps(лента) which should
be untied during meal for reduction of
pains, visible straps belongs to
shortcomings(недостаток) of a bandage.
The bandage "cap" is applied at the
wounds and burns which are localized
on the head to a stop of bleeding and
fixing of a dressing material.
45. Head bandage:
"Cap"
• Cut off a lace(шнурок) about 1 m long
from bandage and dispose(располагать)
its middle on a cinciput(темя, макушка).
The ends of a lace are held by the patient
or do the fixing tour around a forehead
and a nape. Bandaging is continued and
reach a lace, then bandage is wrapped
around a lace and conducted on a nape to
a lace on the other hand, again wrap
bandage around a lace and conduct
further around the head slightly above the
fixing tour. The repeated courses of
bandage completely close a scalp(pilar
part of the head-волосистую часть
головы ), bandage ties to a lace, and lace
ties under a chin.
46. Cross bandage on occipital area
• Cross bandage on a nape and a neck. Bandages on
a neck have to fix well a dressing material and at the
same time not hinder(стеснять) breath and not
squeeze(сжимать, давить) blood vessels, especially
veins. Therefore the circular bandage on a neck is not
reasonable(приемлемый) as the hard course of
bandage cannot be applied, and at poorly imposed
tours the bandage will rotate. Of these shortcomings it
is deprived(Лишена) crosswise or a figure-of-eight
bandage around a neck. By means of such bandage it
is possible to close lower parts of a front and back
surface of a neck after a thyroid gland operations or at
inflammatory processes. The cross bandage is
applied(применять, использовать) to fixing of a
dressing material on a neck and a nape. At furuncles
and an carbuncle the combined bandage on a neck and
occipital area in the form of the eight is used.
47. Bandage on one and two eyes
• Bandage on one eye (monocular). The
bandage is applied to fixing of a dressing
material in an eye at its damages and diseases.
Well imposed bandage approximately has to
adjoin densely, but not put pressure upon an
eyeglobe. Besides, it is necessary to watch
that ears remained open.
Impose the fixing tour of bandage around the
head, taking frontal and occipital
hillocks(бугры); behind bandage is lowered
down and direct under an ear lobe(мочка уха)
from a sore eye(больной глаз) through a
cheek up, closing this tour an eye; then direct
circularly the course around the head;
continue, alternating two-three courses.
49. Bandages on a manus
. Bandage on one finger
Begin a bandage with the fixing circular tours
around a wrist. Then bandage is conducted
slantwise through a back of the hand by the end
of a finger and from here begin to apply a spiral-
shaped bandage from below up to the finger
basis, further are returned to a wrist on the back
where do the circular fixing tours.
Bandage — a glove
Using the principle of bandaging of one finger, it
is possible to bandage serially all fingers of a
brush, having formed "glove". For convenience
of bandaging on the left hand the bandage begins
to be applied with V finger, on right — with I
finger.
.
50. Bandages on the lower
extremity
The turtle bandage turns out when one part of
bandage is imposed on a roundish surface, and an
opposite part of bandage meets in a bottleneck. Then
the top of a bandage reminds a tortoise shell. The
turtle bandage can be applied, for example, knee and
elbow joints, area of a heel.
Bandage on foot
Bandage is imposed along foot from a heel to the
basis of fingers. Here make the move around foot; at
first bandage is conducted on the back, then turned
on a sole and rise by the back again, crossing the
previous course. After decussation bandage is
conducted on other edge of foot, reaching a heel,
bypass it behind and repeat the first and second
courses. Each new course in a heel have above
previous, decussations do closer to an ankle joint
51. Bandages on an upper extremity
and trunk
The crosswise, or star-shaped bandage on a breast
begins with the circular course fixing bandage
around a thorax. Then on the front surface of a
breast bandage is conducted up in the slanting
direction on the right on the left shoulder girdle,
through a back cross on the Right shoulder girdle
and lowered slantwise in the left axillary hollow.
Then bandage is conducted cross through a back in
the right axillary hollow, through the left shoulder
girdle from here, repeating the second and third
courses. The bandage is fixed by the course around
a breast.
52. Bandages on a thorax
Dezo's bandage.
Having pressed the hand bent at right angle in an elbow joint
to a trunk do a number of circular rounds through a thorax
and a shoulder - the first part of a bandage. Its second part is
imposed other bandage, having fixed the end of the first on a
trunk or having tied up the second bandage by the end of the
first. Through an axillary hollow of the healthy party
bandage is directed on the front surface of a thorax slantwise
to a shoulder girdle of the struck party, from here vertically
down the back surface of a shoulder under an elbow, then,
having bypassed an elbow, behind beforehand through a
forearm and a breast in an axillary hollow of the healthy
party, on a back, slantwise on a shoulder girdle of the struck
party and down the front surface of a shoulder from here.
Having bypassed an elbow in front back, bandage is
conducted through a back in a healthy axillary hollow then
repeatedly repeat the second, third and fourth courses. At
correctly applied bandage the courses of bandage form a
triangle figure on spin. The bandage is finished and fixed by
the circular courses through a shoulder and a trunk.
Impose at an injury of a clavicle, shoulder,
forearm
53. Bandages on a thorax
Bandages on a thorax.
Spiral bandage of a breast. The bandage
piece length apprx. 1 m is put the middle
on the left shoulder girdle after that the
spiral courses in the direction up twist
all thorax to axillary hollows and here
fixed by the circular course. Freely
hanging part of bandage is thrown
through the right shoulder and
connected with the end hanging on spin.
The spiral bandage keeps stronger if to
impose on a bandage strip on each
shoulder girdle. When binding strips two
straps holding a bandage turn out.
54. HERMETIC BANDAGE it is imposed at pheumothorax–
suction of air in a pleural cavity as a result of the getting
wound
1. To press a palm to a
wound that air did
not come through it
to a chest cavity
2. To apply occlusive
dressing a wound
55. Triangular bandages
Triangular bandage. In a desmurgy understand
the triangular piece of matter received when
cutting on the diagonal of a square made of
cloth or a female head scarf as a kerchief. The
long party of a kerchief is called the basis, a
corner against the basis — a top and other two
corners — the ends. A part of a kerchief
between the basis and a top is called the middle.
From 1 sq.m of fabric cutting on one diagonal
receive two big kerchiefs, and cutting on two
diagonals — four small kerchiefs. Kerchiefs as
means of fixing of a dressing material do not
provide a dense prileganiye of a dressing
material to body tissues, but can be used at first-
aid treatment, imposing of the first bandage for
the period of transportation in medical
institution. Triangular bandages are applied to
creation of rest of an upper extremity at a
fracture of bones of a forearm or shoulder,
fixing of a dressing material.
57. Bleeding or HEMORRHAGE
Bleeding is the outflow of blood from
its channel into the tissues and cavities of
the body (abdominal, chest, skull, joints,
etc.) or into the external environment.
57
58. Classification of bleeding
Anatomical classification:
• A. Arterial – scarlet, pulsating
• B. Venous – dark, flowing
• C. Capillary – mixed (dark cherry) colors,
flows at a slow speed
• D. Parenchymal – often scarlet in color,
flows at a high rate
58
63. For a reason :
• A. Under the influence of a mechanical factor
• B. Destruction of the vascular wall in certain
diseases
• C. Changes in the vascular wall for
neurotrophic reasons
• D. When atmospheric pressure fluctuates
• G. Changes in the blood coagulation system
• E. Increased venous pressure
63
64. Based on clinical manifestations :
• A. External bleeding
• B. Internal bleeding
• C. Occult bleeding
64
68. Depending on the time of bleeding:
• A. Primary bleeding
• B. Secondary bleeding:
a) early secondary bleeding
b) late secondary bleeding
c) severe bleeding
d) chronic bleeding
68
73. By severity
1. mild degree - 10%; ≈up to 500.0
2. moderate degree is 10-20%; 500.0-1000.0
3. Severe degree - 21-30%; 1000.0-1500.0
4. Massive blood loss - <30%; <1500.0
73
74. CAUSES OF BLEEDING ARE:
• 1. Injury to the wall of a blood vessel
• 2. Purulent fusion of the vascular wall
• 3. Rupture of the vessel wall with an increase in blood
pressure.
• 4. Rupture of the vessel wall with a sharp decrease or
increase in atmospheric pressure.
• 5. Violations of the permeability of the vessel wall
• 6. Change in blood chemistry.
• 7. Action of toxins
• 8. Violation of the vitamin balance in the body.
74
75. DEPENDING ON WHERE THE BLOOD IS
POURED OUT, THEY DIFFER:
• 1. Bleeding – outwards or into the cavity
• 2. Hemorrhages – in the parenchyma of the
tissue
• 3. Hematoma - accumulation of blood in
the tissue
75
76. Latin terms used for bleeding and hemorrhage
• Petechia - Limited hemorrhage Into the skin
• Purpura - Limited mucosal hemorrhage
• Ecchymosis - Extensive bleeding into the skin or
mucous membrane
• Sugillatio and suffusion - Flat limited hemorrhage in
the subcutaneous tissue
76
77. • Vibices - Stripe hemorrhage in the skin
• Haematoma - A large but limited collection of
blood
• Epistaxis - Bleeding from the nose.
• Gastrorragia - Bleeding from the stomach
• Enterorrhagia - Bleeding from the intestines
• Haemoptoe, haemoptysis - Expectoration and
coughing up blood
77
78. • Haematemesis – Vomiting blood
• Haematuria - Excretion of blood in the urine
• Menorragia, нypermenorroea – Excessive
menstrual bleeding with a preserved menstrual
cycle
• Metrorragia – Bleeding from the uterus
• Encephalorragia – Brain hemorrhage
• Haemopericardium – Hemorrhage into the
pericardial cavity
78
79. • Haemothorax - Hemorrhage into the pleural cavity
• Haemoperitoneum- Abdominal hemorrhage
• Haemotometra - Hemorrhage of the uterus
• Haemotocele – Hemorrhage mainly into the vaginal
membrane of the ovary
• Haemophthalmia – Hemorrhage in the eyeball
• Melaena – Bleeding from the gastrointestinal tract
together with feces
• Haemorroe – Bleeding from the anus
79
80. THE DIFFERENCE BETWEEN ARTERIAL AND
VENOUS BLEEDING
SIGNS ARTERIAL VENOUS
Color scarlet somewhat darker
stream pulsating isn' t pulsing
state rapidly deteriorating slower
acute anemia comes quickly slower
air embolism never happen it may occur
80
81. Clinical picture of internal bleeding:
general symptoms:
• a. pallor
• b. dizziness
• c. fainting
• d. tachycardia
• progressive decrease in A/D
local symptoms :
• а. with ruptures of parenchymal organs,
hemoperitoneum, hemothorax. 81
82. b. abdominal pain, symptoms of irritation of the
peritoneum.
C. tension of the abdominal muscles.
d. dullness in the lateral parts of the abdomen.
G. if in the pleura. cavity – shortness of breath,
dullness, weakening of vocal tremor and
respiratory noises during auscultation.
82
83. METHODS OF TEMPORARY
STOPPING OF BLEEDING
• The imposition of Esmarch's tourniquet (or improvised
material).
• Finger pressure of the vessel to the bone.
• Applying a clamp to a bleeding vessel.
• Maximum flexion of the limb at the joint.
• Applying a pressure bandage.
• Elevation of a limb.
• Tamponade of the wound.
• Finger pressing of the vessel in the wound
83
85. Rules of an applying a
tourniquet:
• To impose a plait as it is possible closer to a
wound and only on a soft lining
• To attach a note with the indication of time
and date of an applying a tourniquet to a plait
or clothes of the victim
• It has to be well noticeable therefore the plait
should not be closed a bandage
86. Rules of an applying a tourniquet
• To provide a transport immobilization
• Evacuation first of all
• To periodically weaken a plait and to impose
on the new place. To weaken each 1 hour, in
the summer in the winter – 2 hours.
87. Improvised materials:
• It is possible
• kerchief,
• napkin,
• piece of a canvas,
• tie,
• belt
• It is
impossible:
• wire,
• electric wire,
• telephone cable,
• thin rope, cord
88. Tape tourniquet
CAT = combat application tourniquet; RMT
= ratcheting medical tourniquet; SOFTT-W =
special operations tactical tourniquet–wide;
SWAT-T = stretch wrap and tuck tourniquet.
95. METHODS FOR THE FINAL STOP
OF BLEEDING
• mechanical methods.
• thermal methods.
• Chemical methods.
• biological methods.
95
96. MECHANICAL STOPPING
METHOD METHODS
• Ligation of a vessel in a wound.
• Ligation of the vessel throughout.
• Vascular suture.
• Pressure bandage.
• Tamponade.
96
107. physical methods to stop bleeding
• Application of an ice bubble
• Application of tampons soaked with hot
antiseptic, isotonic solutions
• Electrocoagulation
• Laser
107
112. METHODS OF THE BIOLOGICAL
METHOD OF STOPPING
• Tamponade of a bleeding wound with its
own tissues: omentum, muscle, adipose
tissue, fascia.
• Transfusion of small doses of blood, fresh
plasma, serum, platelet mass, fibrinogen,
antihemophilic plasma, etc.
112
113. Biological methods of stopping
• Introduction of vitamin K (vikasol), direct
blood transfusion.
• Local application of blood derivatives:
thrombin, hemostatic sponge, fibrin film,
biological antiseptic tampon.
113
118. Erectile phase
• Duration is no more than 30 minutes
• Motor and hyperphrenia
• Increase in respiratory rate
• Increase in heart rate
• Increase in the ABP
119. Torpid phase
• More than 30 minutes
• The increasing block
• Increase in heart rate
• Increase in pulse
• Sharp decrease in the ABP
• The accruing anury.
120. Principles of rendering software:
• To remove the shock cause (a bleeding stop,
an immobilization, anesthesia)
• To give transport situation depending on a
type of an injury or to give antishock
situation
• To dress a cervical collar
121. Principles of rendering software:
• To reduce clothes pressure
• To calm the victim
• To warm, cover with a blanket
• To give warm drink (if there is no suspicion of a
stomach injury)
• To provide the fastest transportation in MPI
122. Principles of rendering software:
• If transportation is impossible, then the
victim cannot be left unguarded: to carry out
control of heart rate, the ABP, respiratory
rate, response of the victim
• To be ready to carrying out cardiopulmonary
resuscitation.
