Weights for skeletal traction (set). Assemble skeletal traction equipment Instruments for chest wall and thoracic surgery
Weights for skeletal traction (set) - used (used) in the treatment of skeletal traction with a Beller splint or other devices.
1. Weights for skeletal traction (set) - specifications:
Weights are made of nickel-plated structural steel.
2. Weights for skeletal traction (set) - product composition and delivery set:
The package includes:
loads (total weight 10 kg) - 1 set, including:
1 kg - 1 piece;
3 kg - 1 piece;
5 kg - 1 piece;
passport - 1 copy,
label - 1 pc.
Holders are not included in the kit, they are paid separately.
3. Weights for skeletal traction (set) - preparation for work:
3.1. Carry out re-preservation of cargo of 10 kg.
3.2. Carry out an inspection and check in accordance with paragraph 2.
3.3. Before use and in the process of further operation of a load of 10 kg, it must be disinfected according to OST 42-21-2-85.
4. Weights for skeletal traction (set) - application method:
Weights are applied taking into account the necessary load in the treatment by the method of skeletal traction.
The weights are hung on the hanging hook of the holder, unfolded at a right angle and installed on the disk platform.
When the load increases or decreases, weights are added or removed accordingly.
5. Weights for skeletal traction (set) - warranty:
5.1. The manufacturer guarantees the compliance of weights for skeletal traction with the requirements of TU 9452-155-01894927-98, provided that the consumer observes the operating and storage conditions.
5.2. Warranty period of operation - 12 months, warranty period of storage - 3 years.
5.3. During the warranty period, the manufacturer free of charge eliminates defects that have arisen through his fault by replacing.
Weights for skeletal traction (set) - conservation and storage:
6.1. Cargoes are subjected to conservation in accordance with GOST 9.014-78 for storage conditions 2(C): VZ-0, VU-1.
6.2. Cargo must be stored in indoors at air temperature from -50°C to +40°C in the manufacturer's packaging, and under operating conditions can be stored without packaging.
6.3. The air of the room in which the load of 10 kg is stored should not contain corrosive impurities.
Weights for skeletal traction (set) - PRICE: 1 kg - 750 rubles.
2 kg - 1500 rubles.
3 kg - 1750 rubles.
5 kg - 3000 rubles.
10 kg - 6000 rubles.
Also available in stainless steel - prices on request!
Orthopedic instruments are tools and devices used during operations and a number of surgical interventions in orthopedic and traumatology practice. Part of the orthopedic instrumentation is a purely traumatological instrumentation used in operations mainly only in traumatological patients. Depending on the purpose, orthopedic instruments are divided into: 1) orthopedic instruments intended for operations, and 2) orthopedic instruments for non-surgical interventions (imposing skeletal traction, applying and removing plaster bandages, etc.). When carrying out orthopedic and traumatological operations, in addition to special, general surgical instruments are also needed (see Surgical instruments). Sterilization of metal orthopedic instruments is carried out by boiling or autoclaving (see). Keep tools dry pure form in special cabinets. Hinges of locks of moving parts of orthopedic instruments must be lubricated vaseline oil. Sharp-edged tools can be stored in alcohol or a disinfectant solution and need to be sharpened periodically.
Orthopedic instruments intended for surgical interventions include instruments and sets of instruments for operations on bones, tendons, muscles and other soft tissues as well as special kits for certain types orthopedic and traumatological operations (for example, a set for intraosseous osteosynthesis of the femur, etc.). Depending on the purpose and principle of operation, orthopedic instruments can be divided into several groups.
Holding instruments - forceps and bone holders. Bone forceps are used to hold bone fragments (Fig. 1), and sequestral forceps are used to capture bone fragments (Fig. 2). To fix bone fragments in the wound and hold them during osteosynthesis (see), various bone holders are intended: Lambotta (Fig. 3), screw three-toothed (Fig. 4), etc. The bone holders are made detachable, which allows each branch to be brought separately under the bone and collected instrument in the wound. Depending on the diameter of the bone, the type of fracture, the features of the operating room and the operation itself, bone holders of various sizes are used, straight or curved at an angle. A blunt single-toothed bone hook is used to bring the bone fragment into the wound (Fig. 5).
For operations on the bone - dissection and chiselling, biting off, sawing, drilling, etc. - instruments with sharp sharpening are intended. For gouging and dissection of the bone, flat chisels (Fig. 6) and grooved chisels (Fig. 7) are used. Flat chisels can have one-sided or two-sided sharpening. For biting off bone protrusions, refreshing the edges of the bones, forceps are used: Luer - with grooved lips (Fig. 8) and Liston - with straight jaws (Fig. 9). These nippers can be straight, curved flat, curved along the edge, as well as articulated with a double gear. For sawing bones, frame saws, or arc saws, and Gigli's wire saws are designed. Usually 4 cutting blades are applied to the arc saw (Fig. 10) - wide, 2 medium and narrow. Gigli's saw (Fig. 11) consists of a twisted wire saw and two handles. This saw is used for sawing bone in hard-to-reach places. A saw is brought under the bone with a special conductor, then handles are inserted into the loops at its ends. Circular saws are intended for sawing out a bone graft - double with a fixed distance between them and single (Fig. 12). They are driven by an electric drive (Fig. 13).
To separate the periosteum from the bone, straight and curved rasps are used (Fig. 14). Scraping of cavities in the bones is carried out with sharp bone spoons (Fig. 15) of various sizes. For drilling recesses, holes, channels in the bones, the formation of articular surfaces during arthroplasty, milling cutters (Fig. 16) and drills of various sizes are used. There are special sets of cutters and drills (Fig. 17). To process the sharp ends of the bones, rasps with a large notch are used.
Instrumentation for operations on tendons, muscles and other soft tissues includes: tenotomes (Fig. 18), tendon hooks (Fig. 19), amputation knives (Fig. 20). For plastic surgery on the tendons of the hand and fingers, a set of Rozov’s tools is intended (Fig. 22), which includes tendon raspators, a tenotome, a transphalangeal awl, a conductor, a “goat’s leg” for separating, bougie. When working with instruments with sharp sharpening, elevators (Fig. 21) and retractors (Fig. 23) are used to protect soft tissues from damage.
The composition of orthopedic instruments necessarily includes various hammers (Fig. 24), necessary for working with chisels, for driving nails during osteosynthesis. Various types of fixators are used to fasten bone fragments. Intraosseous fixation for long fractures tubular bones is made using metal rods designed by Dubrov (Fig. 25), Kuncher (Fig. 26), CITO, etc. The set for intraosseous fixation (Fig. 27) includes rods of various lengths and diameters, a drill and drill bits, clamps, a hook for extracting the rod , triangular drill, hand vices, small chisels, single-pronged hooks, pliers, nozzle, awl, impactor and extractor. For osteosynthesis, bolts with nuts (Fig. 28), cerclage tapes (Fig. 29), bone plates (Fig. 30), screws (Fig. 31) are used. The slots of the screws and bolts must be deep enough to match the screwdrivers (Fig. 32). For osteosynthesis of fractures of the femoral neck, three-blade nails of various designs are used (Fig. 33), for the introduction of which special devices are used (Petrova - Yasnova, Kaplan, etc.).
A set of orthopedic instruments for skeletal traction with the help of spokes (Fig. 34) consists of a bracket, a spoke, a key, a spoke tensioner, a spoke retainer, wire cutters, a drill and a retainer. Terminals are also used for skeletal traction (Fig. 35).
A set of orthopedic instruments for applying and removing plaster bandages - see.
A significant part of the orthopedic instrumentation consists of instruments proposed for operations on joints and bones with their fresh injury. This is the so-called traumatological instrumentation. Modern orthopedic instrumentation can be divided into: 1) general instruments for orthopedic operations; 2) special instruments for osteosynthesis, alloplasty, for operations on the spine, etc.; 3) instruments for bloodless interventions.
Common tools include chisels, wire cutters, raspers, hooks, hoists, saws, milling cutters, bone-machining machines. In Bergmann bits, the blades go directly into the handle (Fig. 1). McEwan's bits have an octagonal handle and an extended impact platform (Fig. 2). The CITO set consists of chisels different sizes(Fig. 55): 6 chisels with double-sided sharpening, 6 chisels-chisels with one-sided sharpening, 9 grooved and 2 trapezoidal. known different types nippers: with straight jaws (Fig. 3), round (Fig. 4) and rectangular (Fig. 5). To exfoliate soft tissues from the bone, rasps are used: straight (Fig. 6), curved (Fig. 7) and oval (Fig. 8). To hold bones during operations, bone holders are used: two-horn (Fig. 9), three-horn (Fig. 10) and Lambott type (Fig. 11). It is often convenient to hold bone fragments with a single-pronged hook (Fig. 12). The following types of saws are used for bones: frame (Fig. 14) and knife (Fig. 13), and for figured dissection of bones - Gigli wire saw (Fig. 15) and Sivash continuous chain saw (Fig. 16). For drilling bones, cutters with a brace (Fig. 17) and mushroom-shaped (Fig. 18), driven by an electric motor, are used.
Special tools are intended for operation of osteosynthesis (see). Lane’s plates (Fig. 21), Hick’s plates, curly plates, plates with a face screw (Fig. 20), plates with a slot for approaching and fixing bone fragments, hook plates and an apparatus for suturing fragments of tubular bones with titanium staples are referred to as bone fixators. , as well as an approaching bracket designed by Gertsmaia (Fig. 19). Intraosseous fixators are used in the form of nails of various designs: Kuncher (Fig. 24), Dubrov (Fig. 22), CITO (Fig. 23). Transosseous fixators include various screws, bolts with nuts and sets of so-called compression devices: the Sivash apparatus (Fig. 25), based on the rapid approach of bone fragments using two “worms” with special nuts with a rotating finger and two cobalt nails; apparatus Gudushaurn (Fig. 26), consisting of two pairs of half-arches and two pairs of V-shaped spokes; Ilizarov apparatus with X-shaped spokes; Grishin's apparatus (Fig. 58), consisting of two pairs of clamping devices and three nails.
The Ashkinazi apparatus for bones is built on the same principle. wrist joint(Fig. 27). The Greifensteiner technique is known, which makes it possible to bring bone fragments together with the help of two Kirschner wires stretched by one arc.
For alloplasty, many designs of endoprostheses of the femoral head of the Moore type (Fig. 28) and Judet type (Fig. 29) have been proposed, but they are gradually falling into disuse due to frequent poor long-term results. Currently using metal hip joint Sivash (Fig. 30) and a number of tools for its use: reamers of the medullary canal of the thigh (Fig. 32), knobs for immersing prostheses (Fig. 33), guides (Fig. 34).
A special group of orthopedic instruments is made up of instruments for operations on the spine.
The vertebral raspator (Fig. 31) differs in width, a certain radius of curvature and the angle of sharpening of the instrument. Fenestrated nippers (Fig. 35) make it easy to bite on one side of the arch of the spinous processes, if you need to limit yourself to hemilaminectomy. Nippers with a double bend along the rib and along the plane (Fig. 36) make it possible to work on the vertebral bodies through a small hole made by costotransversectomy. Beak-shaped nippers (Fig. 37) allow you to manipulate on intervertebral discs and deep within the medullary canal.
A set of spoons (Fig. 57) provides processing bone cavities in the depth of the surgical wound with anterior and posterior approaches. Kazmin's distractor (Fig. 38) makes it possible to eliminate spinal curvature during operations for scoliosis. Williams' metal plates are intended for posterior fixation of the spine, but the Sivash thermoplastic fixator (Fig. 40) is more convenient for this purpose, especially in patients with pronounced kyphosis and lordosis. This fixative can be shaped into any shape by placing it for 1-2 minutes. into hot water.
Instruments for operations on the hand and fingers are produced in sets: Degtyareva's set (Fig. 60), Kuster's set (Fig. 56), Khamaraya's set (Fig. 59). The tools in these sets differ not only in size and shape, but, most importantly, in the features of the working part.
Instruments for the bloodless treatment of orthopedic patients are divided into three groups: for the application and removal of plaster casts, for the treatment of skeletal traction and various splints for immobilization and functional treatment bone fractures. Plaster casts are applied on orthopedic tables (see Operating tables), on the Krasnobaev pelvic support (Fig. 39) and on the apparatus for applying plaster corsets (Fig. 46). To remove plaster casts, a special knife is used (Fig. 41), scissors (Fig. 42), a saw (Fig. 43), tongs for spreading the edges (Fig. 44), tongs for bending the edges (Fig. 45) and an electric gypsum cutter (Fig. 47). Skeletal traction (see) is performed using a spoke and Kirchner's arc (Fig. 52), a drill is attached to them for holding the spoke (Fig. 50). Of the tires, the most commonly used are: Kuzminsky's splint for the treatment of clavicle fractures (Fig. 48), Ivanov's splint for the treatment of forearm fractures (Fig. 49), Aleinikov's splint for the treatment of fractures of the shoulder and forearm (Fig. 53), Beler's splint for the treatment of bone fractures hips and lower legs (Fig. 51), the Sivash-Zdvizhkov splint (Fig. 54) to restore function in the hip and knee joints in the treatment of fractures of the hip and lower leg.
Surgical instruments for dentistry of the German company Kohler can be bought -
All surgical instruments can be assembled into kits that allow you to perform typical surgical operations.
On the instrumental table of the operating sister there should be “connecting instruments” - i.e. those that only the operating sister works with - scissors, anatomical tweezers small and long, 2 forceps, 4 linen pins for processing and delimitation operating field.
The main set - it includes the tools of the general group, which are used in any operations and are included in the elements of the operation.
For specific operations, special tools are added to them.
Basic set of surgical instruments
Figure 12. Basic set of surgical instruments.
1 - clamp type "Korntsang" (according to Gross-Meyer) straight; 2 - linen caps; 3 - bulbous probe (Voyachek); 4 - grooved probe; 5 - a set of surgical needles; 6 - atraumatic needle with suture thread.
1. Korntsang, used to process the surgical field. There may be two.
2. Linen claws - for holding the dressing.
3. Scalpel - must be both pointed and belly, several pieces, because during the operation they have to be changed, and after the dirty stage of the operation - thrown away.
4. Clips hemostatic Billroth, Kocher, "mosquito", - are used in large quantities.
5. Scissors - straight and curved along the edge and plane - several pieces.
6. Tweezers - surgical, anatomical, pawled, they should be small and large.
7. Hooks (retractors) Farabeuf and serrated blunt - several pairs.
8. Probes - bellied, grooved, Kocher.
9. Needle holder.
10. Needles are different - a set.
Set of surgical instruments for PHO wounds (used to work only on soft tissues)
Removal of microorganisms that have entered the wound by excising the edges and bottom of the wound or dissecting tissues;
- removal of all damaged tissues, blood clots, which are a nutrient medium for microorganisms;
- conversion of all types of wounds into incised ones to speed up regeneration processes;
- thorough, complete and final hemostasis;
- restoration of the anatomical integrity of damaged tissues by suturing and, if necessary, draining the wound.
Indications: PHO are subject to:
Extensive soft tissue wounds with crushed, torn, jagged edges and heavily polluted
- all wounds with damage to large blood vessels, nerves, bones.
PST is carried out within 24 - 48 hours and should be, if possible, one-stage and comprehensive. Preparation for PST consists in dressing the skin around the wound, processing the surgical field according to the method used in this medical institution, premedication. PHO begins with general or local anesthesia.
Contraindications:
Shock, severe anemia,
- collapse, development of purulent inflammation.
For PHO, a common set of tools is used.
Set of surgical instruments for laparotomy
Figure 13. Laparotomy instrument set.
1 - rack retractor according to Goss; 2 - Collin's retractor; 3 - surgical retractor (mirror) according to Kocher; 4 - Reverden spatula
To perform an operation on any organ abdominal cavity perform a celiac or laparotomy.
Indications: used in acute and chronic diseases organs of the abdominal cavity and retroperitoneal space, injuries and injuries, sometimes for diagnostic purposes.
An extended general set is used - a general set, which is expanded with Gosse and Mikulich retractors, abdominal mirrors - Roux and saddle, liver and kidney mirrors.
- Expand hemostatic clamps and add Mikulich, Fedorov, fenestrated, hepato-renal clamps, ligature dissector and Deschamp's needle.
- Tweezers and scissors should be both small and large (cavitary).
- Intestinal and stomach ulcers,
- Reverden spatula,
- Liver probe and spoon.
Set of surgical instruments for appendectomy and herniotomy
Removal operation appendix and elimination of hernia.
Indications: acute attack appendicitis, infringement of hernial contents. The operation should be performed urgently, in the first hours from the onset of the disease. With an uninjured hernia - in the "cold" period, after complete examination sick.
A set of tools: a general surgical set is used, abdominal instruments are added - Mikulich clamps; ventral mirrors - saddle and Roux.
Set of surgical instruments for laparocentesis (abdominal puncture)
Figure 14 Trocar set.
It is carried out with ascites; a similar operation can be used to diagnose injuries and diseases of the abdomen.
A common set of tools is being assembled, because patients are obese and in order to insert a trocar, it is necessary to make an incision in the tissues, and then suture them. In patients with a small amount subcutaneous fat can only be used with a trocar.
Do not forget PVC tubes according to the diameter of the trocar!
Set of surgical instruments for cholecystectomy
Figure 15. A set of instruments for cholecystectomy.
1 - ligature dissector; 2 - hepatic mirror; 3 - spoon for removing gallstones
It is used for diseases of the gallbladder, liver, liver injuries.
Surgical instruments:
1. General set of tools, extended for laparotomy
2. Fedorov clamp
3. Ligature dissector, Deschamps needle
4. Liver mirrors,
5. Liver probe and liver spoon
6. Hepato-renal clamp
7. A scoop used for wounding the liver to remove blood from the abdominal cavity.
Set of surgical instruments for resection of the stomach
Figure 16. Gastric-intestinal Lane clamp, double.
Figure 17 Lever gastric stapler.
It is used for perforated and common stomach ulcers and 12 - duodenal ulcer, with gastric injury, stomach tumors.
Tools:
1. Advanced general set for laparotomy
2. Pulp
3. Liver mirrors
4. Fedorov clamp, ligature dissector
5. Window clamps
Tools for operations on chest wall and bodies chest cavity
Instruments are used for injuries of the chest wall, for penetrating wounds, for injuries of the organs of the chest cavity, purulent pathology and specific diseases organs.
Tools:
1. General tool kit,
2. Doyen's rib cutter and Doyen's rib cutters,
3. Screw mechanical retractor,
4. Luer terminals,
5. Fedorov clamp,
6. Ligature dissector and Deschamp's needle.
7. Special instruments used in cardiovascular surgery.
Set of surgical instruments for craniotomy
Instrument set - a common instrument set is used, but when expanding the wound, the use of pointed hooks is necessary.
Figure 18. Special set of instruments for craniotomy.
1 - brace with a set of cutters
2 – Dahlgren cutters, Luer cutters
3, 4 - raspators - straight and curved
5 - Volkman's bone spoon
6 - Jigli saw with handles and Palenov guide
1. Rasp
2. Brain spatulas in various widths
3. Rubber balloon "pear"
4. Special neurosurgical hemostatic forceps
Tracheostomy set
Figure 20. Tracheostomy set.
1 - blunt hook for isthmus thyroid gland; 2 - a sharp hook to hold the larynx and trachea; 3 - tracheal dilator; 4,5,6 - tracheostomy cannula assembled and disassembled.
Opening windpipe. An emergency tracheostomy is performed to immediately provide air access to the lungs, with blockage respiratory tract, in patients with tumors of the larynx or vocal cords.
Indications:
Damage to the larynx and trachea;
- stenosis of the larynx and trachea on the soil inflammatory processes and neoplasms;
- foreign bodies trachea and larynx;
- the need for prolonged IVL.
Tools:
1. General purpose tools.
2. Special tool kit:
- Single prong hook - small blunt hook
- Trousseau's tracheal dilator
- Double tracheostomy cannulas of various sizes, consisting of outer and inner tubes. The outer tube has holes on the side for ribbons with which it is tied around the neck.
Set of surgical instruments for skeletal traction
Figure 21. A set of tools for skeletal traction.
1 - hand drill; 2 - Kirschner bracket with a wire for skeletal traction.
This set does not require a common set of tools. It is used to stretch the bone in case of a fracture.
Tools:
Drill, manual or electric
- Kirschner bracket
- Set of spokes
- Nut wrench
- Spoke tension wrench
This set also requires rubber stoppers that fix the gauze ball.
A set of surgical instruments for limb amputation
Figure 22. A set of instruments for amputation of a limb.
1 - retractor; 2 - Jigli wire saw; 3 - Palenov's handles; 4 - hemostatic tourniquet; 5 - a set of amputation knives.
Removal of the distal limb.
Indications:
limb injuries;
- malignant tumors;
- necrosis of tissues as a result of frostbite, burns, obliterating endarteritis.
The purpose of amputation: saving the patient's life from severe intoxication and infection emanating from the lesion and creating a workable stump suitable for prosthetics.
Set of tools:
General surgical set
1. Tourniquet
2. A set of amputation knives.
3. Raspator for shifting the periosteum
4. Arc or sheet saw and Jigli wire saw
5. Liston or Luer bone cutters
6. Rasp for smoothing sawdust of bones
7. Safety razor blade in Kocher clamp for truncation of nerve trunks
8. Olier or Farabefa bone holder
9. Retractor for protecting soft tissues when sawing bones and for shifting soft tissues before sawing
10. Volkmann's spoon
A set of surgical instruments for suturing and removing sutures
For suturing
1. Surgical tweezers.
2. Needle holder.
3. A set of needles.
4. Scissors.
To remove stitches
1. Anatomical tweezers.
2. Pointed scissors.
EAT. Turgunov, A.A. Nurbekov.
Surgical instruments
Equipment: a syringe with a capacity of 10 m, needles - 2, Kirschner's knitting needles - 2, a drill - manual or electric, a cyto arc, a set of keys for expanding the arc and fixing the knitting needles in it, two clamps of the knitting needles, tweezers - 2, a hemostatic clamp - 1, scissors, sterile balls, sterile wipes, towels, iodonate, alcohol, 1% - 2% solution of novocaine in ampoules, cables, cargo, Beller's tire
Compilation of a set of tools for applying and removing plaster bandages
Equipment: basin for water, scissors for dissection plaster cast, plaster bandage pliers, plaster bandage saw, plaster bandage knife, dressing material, material scissors
Implementation of transport immobilization with standard tires for injuries of bones, joints and soft tissues of the extremities.
Cramer splint
Equipment: Cramer splints, rollers, bandages, kerchief bandage, soft pads, cotton-gauze pads
Preparation for manipulation:
1. Before applying, the tire is wrapped and put in a cover made of oilcloth or plastic film
2. An inscription is made on the cover (exchange fund)
Performing manipulation:
Shoulder fracture:
1. Wash your hands in a hygienic way
2. Check for a fracture
3. Explain to the victim the meaning of the manipulation, the need for it, reassure the patient
4. Have the casualty sit comfortably facing you.
5. Select the bar length. Remember the rule: obligatory fixation of the above- and underlying joints from the fracture site, and in case of a shoulder fracture, immobilization of 3 joints is required
6. Apply the splint to a healthy limb from fingertips to elbow joint and in this place bend it at a right angle
7. Reattach the splint from elbow to shoulder joint and at this point bend it at an obtuse angle of 115 degrees, the end of the splint should reach the opposite shoulder joint or the inner edge of the opposite shoulder blade
8. Apply the prepared tire from the fingertips to the opposite shoulder joint or the inner edge of the opposite shoulder blade
9. Give the injured limb a mid-physiological position: put a small cotton roll into the armpit to slightly abduct the shoulder (up to 20 degrees); the forearm in the elbow joint is bent at an angle of 90 degrees and given a position between supination and pronation; the hand is extended at the wrist joint to an angle of 45 degrees
10. In order to avoid additional trauma to the injured limb, the splint is applied over clothes and shoes
11. Lay cotton wool in the places where the bones protrude (epericondyles, processes, etc.)
12. Place your injured hand on the inside of the simulated tire
13. Tie the ends of the tire through a healthy shoulder girdle and axillary fossa
14. Put the roller in the palm of your hand, bandage the splint in the area of the wrist joint with an eight-shaped bandage
15. Bandage the elbow splint with a tortoiseshell bandage
16. Bandage the splint in the area of the shoulder joint spica bandage
17. Monitor the patient's condition
With a fracture of the leg
1. Cotton-gauze pads, pads, etc. are applied to the bony protrusions of the limb.
2. One tire is modeled for rear surface, bending it according to the profile of the leg. The foot is placed at right angles to the shin.
3. For better fixation of fragments of the bones of the lower leg, it is necessary to additionally apply 2 more tires on the sides of it so that they cover the foot in the form of a stirrup
4. Tires are fixed with gauze bandages
5. Monitor the patient's condition
With hip fracture
1. Cotton-gauze pads are applied to the bone protrusions of the limb (for the prevention of bedsores)
2. Splint 110 cm long, modeled according to the bulge of the heel and calf muscle, laid on the back of the leg
3. Two other tires, fastened together along the length, come from armpit along the outer surface of the limb to the foot, covering the last, as well as the rear tire with its end, curved in the shape of the letter G. This tire laying prevents plantar sagging of the foot
4. If there is a sufficient number of ladder rails, it is advisable to lay the 4th rail along inner surface thighs and lower legs, and also bend its lower end in the shape of the letter G - for the sole
5. Tires are strengthened with gauze bandages
6. Monitor the patient's condition
Skeletal traction is a functional method of treatment.
The main principles are the relaxation of the muscles of the injured limb and the gradual loading.
Indications for implementation:
1. Pronounced displacement of fragments along the length.
2. Late admission of the patient.
3. Inefficiency of one-stage reduction.
4. In the preoperative period to improve the condition of bone fragments before their fixation.
5.B postoperative period.
Equipment:
1. Tray with sterile wipes.
2.Syringe and needles.
3. Glasses for iodonate, alcohol and 2% novocaine.
4. Scissors, tweezers - 2 pcs.
5. Drill manual or electric.
6, Clamp CITO.
7. Kirchner spoke.
8. Rubber plugs.
Manipulation #37
Skeletal traction
Skeletal traction- functional method of treatment. The main principles are the relaxation of the muscles, the injured limb and the gradual loading.
Indications (for traction)
1) pronounced displacement of fragments along the length
2.) late admission of the patient
3) inefficiency of one-stage reduction
4) in the preoperative period to improve the condition of bone fragments before their fixation
5) in the postoperative period
Equipment:
1. Tray with sterile wipes, balls
2.Syringe 10ml needles
3. Glasses for iodonate, alcohol and novocaine (2%)
4. Scissors, tweezers - 2 pcs.
5.Drill manual or electric
6. Bracket, knitting needles, rubber cork Cyto Kirchner
Pin insertion sites:
1.heel bone
2. upper metaphysis (tuberosity) of the tibia
3.above the condyles of the thigh
Technique:
(carried out by a doctor in strict observance of asepsis)
1. Process the operating field
2. Limit the operating field
3.Produce local anesthesia in the area of the introduction of the spokes.
4.Introducing the needle with a drill in the transverse direction
5. Put on sterile panty napkins at the ends of the knitting needles and press them with stoppers
6. Attach the CITO arc to the needle.
7. Tie a cord to the arc
8. Put your foot on the Beler splint.
9. Throw the cord over the Beler bus block and install a load from 2 to 10 kg.
Bed preparation:
1. Shield longitudinally or transversely at the foot end for limb abduction
2. Raise the foot end
3. Reinforce the Balkan frame above the bed.
Limb care:
1. Stop at an angle of 90 with the help of a load thrown over the block forward of the foot.
2. Pillows under the ankle and foot knee-joint"bagel", under the heel
3.Observation of blood circulation: foot temperature, feel the movement of the fingers, the pulsation of the arteries of the foot.
Manipulation #38
Carry out tests on the quality of gypsum
1. When squeezing in a fist, the gypsum should not stick together into a lump.
2. Mix two parts of gypsum with one part of water to a homogeneous mushy mass in an enameled basin with a layer of 1-2 cm, after 5-10 minutes. the plaster should become hard enough that no dents form on its surface when pressed with a finger.
3. Mix 1 part of gypsum and 1 part of water, roll up the ball, notice when it sets. Drop the ball from a height of 1.5 meters to the floor, it should not break.
4. When mixed with water, gypsum should not smell like rotten eggs.
Manipulation #39
Preparation of a plaster bandage
Equipment:
1. Gauze bandage - 1 pc.
2.Gypsum powder.
3. Oilcloth.
Order of execution:
1. A thin layer of gypsum is applied to the table and a part of a gauze bandage is spread on top (50-100cm)
2. A layer of gypsum is poured onto the bandage and the gypsum is rubbed into the pores of gauze with vigorous movements of the brush.
3. Having loosely folded the rubbed part of the bandage into a roll 5-7 cm wide, gypsum is successively rubbed into the following parts of the bandage.
4. The roll of the plaster bandage should be loose, this will ensure rapid and simultaneous impregnation of the bandage when it is immersed in water.
Manipulation #40
Emergency specific prophylaxis for tetanus in the unvaccinated
Equipment:
1.Tetanus toxoid SA - 1 ml.
2. Anti-tetanus serum PSS - 3000 IU
3. Anti-tetanus serum developed PSS 1 ml. 1:100
4. Syringes 1g, 2g, 1 with division 0.1
5. Needles for subcutaneous and intradermal injections
6.Kidney trays 2 pcs.
8.Sterile cotton balls
Medicines for first aid anaphylactic shock:
Adrenaline solution 1 ml. No. 3, 0.25% solution of novocaine, prednisone - 1 bottle, strophanthin or corglicon, 40% glucose solution - 20 ml
Manipulation algorithm
Strict observance of the rules of asepsis and antisepsis
| Stages | Execution tools |
| 1. Wash your hands thoroughly under the tap, wipe and treat with 96% alcohol. | Soap, towel, cotton balls with alcohol - 1 pc. |
| 2. Take an ampoule of SA, check the expiration date. Treat with alcohol, shake, open, draw 1 ml from the ampoule with a syringe with a needle. SA. | SA ampoule - 1 ml, ball with alcohol, syringe - 1 pc., needles - 2 pcs. |
| 3. Enter subcutaneously into the shoulder. | 2 balls with alcohol. |
| 4. Take an ampoule of PSS (red marking) 1:100, wipe it with alcohol, open it, draw 0.2 - 0.3 ml with another syringe with a needle and division 0.1 and replace the needle with an intradermal one. | PSS ampoule 1:100, syringe 1 g, needles (1 of them for intravenous injections), balls with alcohol. |
| 5. Enter 0.1 ml intradermally (flexion surface of the forearm). | Treat the skin of the forearm with alcohol twice. |
| 6. Evaluate the results after 20 minutes. Measure the papule with a ruler. | Ruler. The reaction is considered negative if the papule is no more than 0.9 cm. If the papule (edema, redness) is more than 0.9 cm, the reaction is positive and the introduction of PSS should be stopped. |
| 7. In case of a negative intravenous test from the blue marking ampoule PSS-300 IU, inject 0.1 ml subcutaneously. in outer surface shoulder. | A syringe with a division of 0.1, an ampoule of PSS-300 IU, a needle-2 pcs. (Dial one, inject the other). Evaluate the reaction after 30 minutes. Close the ampoule with a sterile ball. |
| 8. After 30 min. Inject the remaining dose of serum subcutaneously into the shoulder with a sterile syringe, change the needle | Open ampoule PSS, 2 g syringe, 2 needles, 96% alcohol. |
Manipulation #41
Assemble a set of instruments for tracheostomy
Equipment:
1. Korntsang - 2 pcs.
2. Linen claws - 4 pcs.
3.Scalpel - 2 pcs.
4. Surgical tweezers - 2 pcs
5. Kocher hemostatic clamps - 5 pcs.
6. Scissors - 1 pc.
7. Needle holder with a needle - 1 pc.
8. Farabeuf hook retractors - 1 pair
9. Single-pronged hook - 1 pc.
10. Tracheostomy cannula - 1 pc.
11. Trousseau tracheal dilator - 1 pc.
12. Sterile tray - 1 pc.
Manipulation #42
Tracheostomy care
Prevention of asphyxia, trecheitis, pneumonia.
Equipment:
1. On the bedside table:
A glass with a disinfectant solution and tweezers in it, a rubber catheter in a glass with a disinfectant solution
Sterile wipes, turundas, button probe, gloves, balls in a small bix
Furacilin solution for washing the catheter
4% soda solution, long pipettes, sterile oil, pipette
Iodonate solution
3% hydrogen peroxide
0.5% chlorhexidine bigluconate
2. Near the bed - electric suction.
Order of execution:
1.Wash your hands with soap and dry with a towel.
2.II and I with the fingers of the left hand fix the plates of the outer cannula of both sides (so that it does not move and does not fall out)
3. Shutter - "flag" of the external tracheostomy cannula to move to the top with your finger right hand(separate outer and inner cannula)
4.I and II fingers of the right hand nurse takes the "ears" of the inner cannula.
5. Traction towards itself with an arcuate movement of the right hand, the nurse removes the inner cannula from the outer one. Put in a kidney-shaped tray with a solution of 6% peroxide.
6. With the palmar surface of the hand, the nurse checks the patency of the outer tube - the movement of air flow.
7. The removed inner cannula is cleaned with a curved button probe, rinse antiseptic solution(clear the inner cannula from crusts and mucus)
8. Fixing the plates of the outer cannula I and II with the fingers of the left hand, inject a few drops of a 4% soda solution into the hole of the outer cannula. Let the patient cough up (sputum thinning).
9. Suck out mucus, crusts from the tube with a catheter (cannula patency)
10. Continuing to fix the outer cannula by the plates with the fingers of the left hand, take the inner cannula I and II with the fingers of the right hand by the “ears” and insert it into the outer cannula in an arcuate motion.
11. Shutter - lower the “flag” of the outer tube down (fix the inner cannula with the outer one).
12. Drop 2-3 drops of sterile oil with a pipette (to eliminate drying and crusting)
13. Change the napkins under the tube and wash the skin.
14. The outer tube is attached behind the neck with ribbons inserted into the slot of the plate (fixation of the tracheostomy cannula to the neck)
15. The tracheostomy cannula is covered with a moistened napkin in 2 layers (humidification of the inhaled air).
16. The internal cannula is cleaned, as necessary, with an electric suction.
Catheter sterility!!!
Manipulation #43