jo Dressings Jlearning Objective 1 Identify the various types of | dressings. ‘A dressing is a sterile covering for a wound. All open ‘wounds need to be covered to prevent infection—and, in some cases, to control bleeding. A dressing also helps prevent further injury to the wound. It should be © Sterile, meaning that any microorganisms and spores on the dressing have been killed Aseptic, meaning that it is free of bacteria ith a bandage tightly enough to g but not so tightly that it stops blood circulation Large or deep wounds should always be cleaned and treated at a medical facility to reduce the risk of infection; don’t try to clean these wounds yourself. A medical professional can determine whether a tetanus shot is needed. Once you have provided basic first aid care by controlling bleeding, make sure a victim with a large or deep wound sees a medical professional. Figure 10-3. Multitrauma dressing Chapter 10 Bandaging 177 ‘The ideal dressing is layered, free of lint, consists of coarse mesh gauze to allow air to circulate to the ‘wound (which promotes healing), is bulky enough to immobilize tissues and protect the wound, is larger than the wound, and is soft, thick, and pliable. In an ‘emergency, you can use clean handkerchiefs, towels, sheets, cloth, or sanitary napkins as dressings. Never use elastic bandages, fluffy cotton, cotton balls, paper towels, toilet tissue, or any other material that could shred, disintegrate, or cling to the wound. A dressing is always placed against the wound, and the dressing is held in place with a bandage; the bandage is never placed directly against the wound. dressing A sterile covering for a wound sterile Free of all microorganisms and spores aseptic Free of bacteria Figure 10-2. Nonelastic, selfadhering dressing and roller bandages Figure 10-4. Burn dressings Scanned with CamScannerFirst Aid for Colleges and Universities There are several types of dressings (see Figures 10-1 through 10-4 on page 177): ‘© Aseptic—a sterile dressing © Wet—a moist dressing that is not necessarily sterile ‘+ Dry sterile—a sterile dressing free from moisture + Petroleum gauze—sterile gauze saturated with petroleum jelly to keep it from sticking to a ‘wound (often used to cover burns) * Occlusive—plastic wrap, petroleum gauze, or other dressing that forms an airtight seal (usually used for chest or abdominal wounds) * Compress—a bulky, usually sterile dressing in- tended to stop or control bleeding '* Universal—a dressing made from a 9-by-36-inch piece of thick, absorbent material (also called a trauma dressing) ‘+ Adhesive strips—a combination of a sterile dress- ing and a bandage, individually packaged and used for small wounds (often called Band-Aids®). ‘These may come in special shapes for wounds on fingertips or knuckles. Butterfly bandages and wound closure tape (steri-strips) help hold the edges of wounds together. Gauze Pads Gauze is used several ways in dressings; plain gauze can be used in place of a bandage compress to cover large wounds, Plain gauze in various-sized pads, designed for ‘smaller wounds, is sterilized and sold commercially in individually wrapped packages. Make sure you don’t touch the part of the gauze that will contact the wound. ‘The most popular sizes of sterile gauze pads are 2-by-2s, 4-by-4s, and 4-by-8s. In cases of major multi- ple trauma, nonsterile bulk packages of 4-by-4 dress- ings are often used. ‘Some gauze pads are penetrated with ointment or have a plastclke coating to prevent them from sticking to the wound. You can improvise by applying a small amount of antibiotic ointment, such as Neosporin, to the gauze pad before placing it against the wound. Be ‘careful to hold the gauze pad by its comer and touch it only with ointment to avoid contaminating it. Special Pads Large, thickly layered bulky pads, some with water- proof outer surfaces, are available in several sizes for quick application to an arm or leg or to a large area of the trunk. They are used where bulk is required to ‘stop profuse bleeding and to stabilize impaled objects. ‘Such special pads are also referred to as multitrauma dressings, trauma packs, general-purpose dressings, burn pads, or ABD dressings. You can use individually wrapped sanitary nep- kins in place of special pads when necessary; how- ever, even individually wrapped sanitary napkins are not sterile and can introduce infection to the wound. Bandage Compresses A bandage compress (see Figure 10-5) is a special dressing designed to cover open wounds and to help control bleeding. It consists of a pad made of several thicknesses of gauze attached to the middle of a strip ‘of bandaging material that can simply be secured by tying. The pad sizes range from 1 to 4 inches. Unless otherwise specified, all bandage compresses and all gauze dressings should be covered with open trian- gular, cravat, or roller bandages. * Figure 10-5. Already prepared bandage compresses are available in individual packages. Scanned with CamScanner[id2-Bandages earning Objective 2 Identify the various types of | 7B See j The most common kind of bandage is the adhesive strip, such as a BandAid®. There are many other types ‘and sizes of bandages, though. A bandage Holds a dressing in place over a wound ‘« Creates pressure that controls bleeding «Helps keep the edges of the wound closed ‘¢ Secures a splint to an injured part of the body «Provides support for an injured part of the body Properly applied, bandages promote healing, pre- vent severe complications, and help the victim stay comfortable. Bandages should be properly applied and ‘well secured; if a bandage becomes loose, wounds may bleed or become infected, and broken bones can fur- ther displace. The two most common mistakes in bandaging are ‘bandaging too loosely and bandaging too tightly. Ban- ages should be firm enough to hold the dressing in place, but not so tight that they restrict circulation, ‘Most bandages gradually stretch, so check to make sure itis still holding the dressing in place. You should immediately loosen any bandage that is too tight. The following are signs that a bandage is too tight: © The skin around the bandage becomes pale or bluish in color (cyanotic). * The victim complains of pain, usually only a few minutes after you apply the bandage. * The skin beyond the bandage (distal) is cold. + The skin beyond the bandage (distal) is tingling or numb, ‘The victim cannot move his or her fingers ot toes. ‘Triangular Bandages A standard triangular bandage (see Figure 10-6) is ‘made from a piece of unbleached cotton cloth approx- imately 40 inches square; the square is folded diago- nally, then cut along the fold. A triangular bandage is easy to apply and can be handled so the part over the dressing won't be soiled. When applied correctly, a triangular bandage can be used on most parts of the body and does not slip off. Figure 10-6. Triangular and cravat bandages A triangular bandage can be used fully opened or folded into a cravat; it is most commonly used to © Support fractures and dislocations © Apply splints © Form slings ‘© Make improvised tourniquets In an emergency, you can make a triangular ban- dage from a clean handkerchief, a cotton towel, or a clean piece of shirt. If a regular-sized bandage is too short, tie a second bandage to one end. Cravat Bandages "Learning Objective 4 Demonstrate how to apply cravat _ bandages to different pars ofthe body. occlusive Waterproof and airtight gauze pads Commercially manufactured, individually wrapped sterile pads made of gauze special pads Large, thickly layered bulky pads used to control bleeding and stabilize impaled objects bandage Material used to hold a dressing in place triangular bandage Triangle-shaped piece of cloth used to apply splints and form slings Scanned with CamScanner180 FirstAid for Colleges and Universities Folded, a triangular bandage becomes a cravat. To make a cravat (see Figure 10-6), make a 1-inch fold along the base of the triangular bandage. © To make a wide cravat, bring the point to the cen- ter of the folded base, then place the point under- neath the fold. ‘© To make a medium cravat, make a wide cravat, then fold lengthwise along a line midway be- tween the base and the new top of the bandage. © Tomake a narrow cravat, make a medium cravat, then repeat the lengthwise fold one more time. Roller Bandages ‘The most popular and easy-to-use roller bandage is a self-adhering (nonelastic), form-fitting roller ban- dage, which can be secured easily with several over- lapping wraps and can then be cut and tied or taped in place (see Figures 10-7 through 10-15). Roller ban- dages come in a variety of widths and lengths, rang- ing from ‘/ inch to 12 inches wide and as long as 10 yards. Because they adhere to themselves, they are easy to use. Examples of commercial self-adhering roller bandages are Kerlix and Kling. Roller bandages can also be used as dressings. To apply a roller bandage over a dressing Place the end of the roller bandage on the dress- ing, then wrap it around the body part in a circu- lar fashion. 2. Crisscross the bandage over itself as you circle ‘until the complete wound area is covered. Do not cover the fingers or toes. 3. Fasten the bandage in place with tape, Make sure the tape is adhered to the skin; if itis used simply to fasten one part of the bandage to another, the bandage will slip. Do not use adhesive tape on cloth or gauze bandages, because it will not stick. ‘You can also use two gauze rolls, wrapping alter- nately around ‘and across the wound until it is wrapped completely. Elastic roller bandages are applied in the same way and are used to control swelling, support an in- jured limb, or provide continuous pressure. Make sure the elastic roller bandage is not too tight; frequently check the color and warmth of skin beyond the ban- dage. Generally, elastic roller bandages are not used over open wounds. eae Figure 10-7. Head and/or eye bandage. In case of€® injury, cover both eyes. 10,3~Principles of Dressing and ©" Bandaging Learning Objective 6 Des | esing and banding wounds ‘There are no hard-and-fast rules daging wounds; often, adapt Scanned with CamScannerif , ae a Figure 10-8. Head or ear bandage. Keep the bandage neat the eyebrows and low at the back of the head, Figure 10-10. Elbow bandage. Use a figure-8 pattern, covering half to three-fourths of each previous layer. far more important than even the best-intentioned . Tules. In dressing and bandaging, use the materials you have on hand and the methods to which you can best adapt, as long as you meet the following conditions: + Never touch the wound itself or the part of the | dressing that goes against the wound, ‘* Material used for dressings should be as clean as Possible (sterile, if you can get it). Chapter 10 Bandaging — 181 Figure 10-9. Shoulder bandage. Begin at the lowest part of the arm and work toward the shoulder; wrap ina figure-8 across the chest, under the opposite arm, and across the back. Figure 10-11. Lower arm bandage. Make the bandage ‘more secure by stating atthe wrist and moving up to the wider part of the arm. «Bleeding is controlled; generally, you should not bandage any wound with anything other than a pressure bandage until bleeding has stopped. eravat A folded triangular bandage roller bandage A form-fitting bandage designed to be wrapped around a wound site Scanned with CamScanner| di 182 ‘First Aid for Colleges ‘and Universities Figure 10-12. Thigh and ankle bandages. Make the Figure 10-15. Knee bandage. Keeping the knee slightly * thigh bandage more secure by starting at the knee and pent, start with two wraps around the kneecap, then moving toward the wider part of the thigh. use a figure-8 wrap, covering half to three-fourths of . each previous layer. Figure 10-14. Hand bandage. Begin by wrapping twice around the palm, then use a figure-8 pattern to wrap diagonally from palm to wrist and back. Figure 10-15. Foot or ankle bandage. Use a figure-8 Pattern to provide compression for an ankle. Begin with two wraps around the foot’s instep, then use figure-8 tums to wrap diagonally from foot to ankle and back. Scanned with CamScanner-the dressing is opened carefully and handled so it "Goes not get contaminated. Always wash your hands before dressing and bandaging a wound, ‘The original dressing is not removed; if blood. soaks through, add another dressing on top of the original. |, The dressing adequately covers the entire wound. + Bandages are not placed directly against the wound. + Wounds are bandaged snugly, but not too tightly. 1 Bandages are not too loose; neither the dressing nor the bandage should shift or slip. + There are no loose ends of cloth, gauze, or tape that could get caught; when possible, you should tie bandage ends in a square knot (see Figure 10-16), then tuck them under. If the knot causes discomfort, place a gauze or cloth pad under it, «+ The bandage covers all edges of the dressing, «+ Tips of the fingers and toes are left exposed when arms and legs are bandaged so you can check for impaired circulation. Figure 10-16, Tying a square knot Chapter 10 Bandaging 183 ‘A small bandage on an arm or leg is covered with a larger bandage to more evenly distribute the pressure and to avoid creating a pressure point. The body part is bandaged in the position in which it is to remain; you can bandage over a joint, but don’t try bending the joint after you apply the bandage ‘Ask the victim how the bandage feels; if itis too light, loosen it and make it comfortable but snug. Never use a circular bandage around the neck; it could cause strangulation. Applying Special Dressings and Bandages Pressure Dressings Pressure dressings are those that are applied snugly enough to create pressure against the wound. Use a pressure dressing to control profuse bleeding. 1. Cover the wound with a bulky, sterile dressing. 2. Apply direct pressure with your hand over the dressing until bleeding stops. 3. Apply a firm roller bandage (preferably self- adhering) and monitor continuously for signs that the bandage is too tight. You can also use an air splint or a blood pressure cuff to hold a pressure dressing in place (see Chapter 6). Use an elastic roller bandage only in cases of difficult-to-control, profuse bleeding, 4. If blood soaks through the original dressing and bandage, do not remove them; leave them in place and apply another dressing and roller bandage over the originals. Slings are used to support injuries of the shoulder, ‘arms; or ribs. If available, use a commercial triangu- Jar bandage as a sling; in an emergency, you can use a belt, necktie, scari, or similar article. In an emergency, you can also create a sling by pinning the sleeve of a shirt or jacket to the front, ele- vating the wrist and hand to the proper position. Scanned with CamScannertea Fist Aid fr Colleges and Universities 2 3 Figure 10-17. Triangular bandage as an armi sling. Support the arm slightly away from the chest, with the ‘wrist slightly higher than the elbow. Bring the lower point up and behind the neck; tie to secure. To tie a triangular sling that will support an in- jured arm (see Figure 10-17), follow these steps: 1. Place one end of the base of an open triangular bandage over the shoulder of the uninjured side. 2, Allow the bandage to hang down in front of the chest so its apex will be behind the elbow of the injured arm. 3. Bend the arm at the elbow with the hand slightly elevated (four to five inches). When possible, the fingertips should be exposed so you can monitor for impaired circulation. 4, Bring the forearm across the chest and over the bandage. : 5. Carry the lower end of the bandage over the shoulder of the injured side, and tie a square knot at the uninjured side of the neck; make sure the kknot is at the side of the neck. 6. ‘Twist the apex of the bandage and tuck it in or pin it at the elbow. Figures 10-18 through 10-31 illustrate how to apply triangular bandages and cravats to the forehead or scalp, jaw or face, eye, ear, chest or back, shoulder, elbow, hand, hip, leg, knee, ankle, and foot. Figure 10-18. Triangular bandage for forehead oF salt Scanned with CamScannerFigure 10-19. Triangular bandage for chest or back Figure 10-20, Triangular bandage for the shoulder 1 2 3 4 5 Figure 10-22. Triangular bandage for the hip Figure 10-21, Triangular bandage for the hand Scanned with CamScanneri” 186 First Aid for Colleges and Universities a te TG Figure 10-23, Triangular bandage for the foot ‘ Figure 10-26. Cravat for eye if treating an injury oO Figure 10-25. Cravat for eyeball or eye socket, both eyes must be cove ae Prevent movement of the injured eye. Scanned with CamScanneryay a, cravat for elbow rigor 107 Ati Figure 10-28, Cravat for knee eh igure 10-29, Cravat for leg Us Figure 10-30, Cravat ankle wrap pe Figure 10-31. Cravat pressure bandage—palm of hand“ © A dressing is a sterile covering for a wound; the ideal dressing is layered and consists of coarse gauze. * Never use as a dressing paper towels, toilet tis- sue, or other material that could shred or cling to the wound. ‘A bandage holds a dressing in place and does not touch the wound. ‘An airtight (occlusive) dressing can be improvised from plastic wrap or petroleum gauze. ‘Signs that a bandage is too tight include paleness or bluish discoloration (cyanosis) of the skin around the bandage and cold, tingling, or numb ‘skin beyond the bandage. THiangular, cravat, and roller bandages are special kinds of bandages. ‘Make sure you understand the following key terms: © cravat © roller bandage Scanned with CamScanner