Bandages, Splints, Casts 2
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What are the different types of bandages?
- simple padded bandage
- wet to dry dressing
- robert jones bandage
- paw bandage
Describe simple padded bandages.
- light and protective
- minimal support
- cover lacerations, incision
What is wet to dry dressing used for?
debriding necrotic tissue
How do we do wet to dry dressing?
damp gauze using sterile saline and cover with dry gauze
Why should we avoid cutting gauze when doing a wet to dry dressing?
small fibers may become embedded in tissue
Are wet to dry bandages painful to remove?
yes, may need analgesia
What do Robert Jones bandages look like?
bulky, heavy padding
What does Robert Jones bandages provide?
support and compression to limb
What are some indications for using a Robert Jones bandage?
- severe soft tissue injury
- prevent edema accumulation in limb
- temporary support of fracture before surgery
- provide support after limb surgery
How do we apply a paw bandage?
- clean and dry the wound
- pad between toes, under dew claw, under carpal pad
- start on top of paw, roll down around the bottom of the paw then back again in the reverse direction
- then wrap around foot from distal to proximal
What are the different types of slings?
What is the Velpeau sling used for?
- hold foreleg against chest and prevents movements
- for shoulder problems
What is the Ehmer sling used for?
- prevents weight-bearing in hip
- used for hip luxations (closed - no surgery or open - surgery)
What does the Ehmer sling force?
forces head of femur into acetabulum
What does the Ehmer sling do to the hip joint?
internal rotation and abduction of hip joint
What are the different types of splints?
- Mason Meta splint
- Thomas splint
What are the different types of casts?
- plaster of Paris
What are splints and casts used for?
immobilization of certain fractures for long bones distal to elbow or stifle
What is fracture reduction?
putting the ends of the broken bone back together
Who should do fracture reduction?
What are the two types fo fracture reductions?
- internal fixation
- external fixation
What are internal fixations used for?
What do we use for internal fixations?
What can internal fixations cause and why?
may cause infection because it is invasive
What does internal fixation not do?
does not immobilize joints proximal and distal to the fracture
Does aftercare for internal fixations take as much effort as external fixations?
no, the aftercare is easier
What are external fixations used for?
certain simple fractures in certain locations
What do we use for external fixations?
splints and casts
Are fractured bone ends well opposed in external fixation?
What are some advantages to external fixations?
- no surgical risk (infections, hemorrhages)
- less risk of infection
- original healing is not disrupted
- less costly than internal fixation
Are external fixations ALWAYS less costly than internal fixations? Why or why not?
no, if the patient messes with the splint or cast and the owner has to keep coming in to get it repaired then it could get expensive or after the external fixation is complete and the fracture did not heal properly and the patient needs an internal fixation then it could get more expensive
What are the costs of an external fixation that we should put on the estimate?
- original exam
- follow - up xrays
- anesthesia for cast removal
- cast removal
What are some disadvantages to external fixations?
- less precise reduction
- more likely to have non-union (require surgery)
- aftercare takes more effort
- cannot see fracture site
- must immobilize joints proximal and distal to fracture site
- disuse atrophy of limb muscles and causes stiff joints
What are splinting and castings used for?
- simple fractures
- long bones
- minimal displacements
What do we need to immobilize when applying a splint or cast?
- the fracture site
- joints distal and proximal to the fracture site
- entire limb, for all practical purposes
What is the aftercare like for splints and casts?
same as for bandages
What do we need to do to wounds before splinting?
Should we cast over wounds?
How can we make sure we pad correctly for splints and casts?
- do not overpad
- watch for pressure points
Should we avoid rotation of the limbs during casting and splinting?
yes, especially lateral rotation
Should we use anchor strips when applying a splint?
How do we apply a splint?
- wrap limb with cast padding from toe to proximal end of splint
- fix splint material over padding - distal end extending to toes
- reflect ends of anchor strips and attach to splint
- cover splint with adhesive tape
- check reduction of fracture after splint is complete
- radiograph through splint to make sure fracture is reduced
What do we need to do to the radiograph setting when taking a radiograph through a splint?
What is another name for a Mason Meta splint?
What does a Mason Meta splint look like?
- channeled, with rounded distal end
- may have foam padding
What does the Meta Mason splint need to support?
limb from elbor or hock distally
What does the thomas splint immobilize?
limb distal to elbow or stifle joint
What does a Thomas splint look like and how do we put it on?
- circle fitted to axillary or inguinal area, long loop around toes
- best to assume the natural position of the limb
- can apply some traction
When do we use casts?
to stabilze certain fractures distal to the elbow or stifle
Describe fiberglass casts.
Is a fiberglass cast waterproof?
Describe plaster of Paris cast.
Is a plaster of paris cast waterproof?
How do we apply a plaster cast?
- soak cast material in water
- wrap the limb from toes up, spiral with 50% overlapping
What happens to the plaster cast as it hardens?
it heats up
What does the setting time of a cast depend on?
How long does it take a fast setting cast to set?
5 - 8 minutes
How long does it take an extra - fast setting cast to set?
2 - 4 minutes
What can speed up setting time?
use warm water
The wetter the material, the _____ the setting time.
Why do we usually use general anesthesia to apply a cast?
- pain control
- relax muscles
- so the patient holds completely still
When we are applying the cast we need to make sure the limb does not _____ or _____.
How do we apply the stockinette?
- cut twice as long as the limb
- roll up to apply, unroll over limb
- overlap both ends
- flatten hair underneath
How do we apply the cast padding?
- spiral with 50% overlap
- start at toes
- use minimal padding
How do we apply the cast material?
- spiral with 50% overlap
- enough to support the weight of the patient
- leave the 2 middle toes exposed
- extend cast as high as you can
What do we do once the cast is dry?
- pull down stockinette over cast
- reflect anchor tapes, tape securely to cast
- apply tape to secure
Should the patient be hospitalized overnight once you apply a cast? Why or why not?
- to keep patient quiet and comfortable
When should to cast be rechecked?
the next day and then in 3 - 7 days, then every 1 - 2 weeks until removed
Should we take a radiograph before we remove the cast? Why or why not?
yes to make sure the fracture is healed enough
So we need to anesthetize the patient during the cast removal?
What do we use to remove the cast?
- cast cutters - hand held saw or AStryker saw
- cast spreader
How do we cut the cast off?
- cut lengthwise on either side
- cut down to padding
- do not cut the patient
What does a cast spreader do?
break cast in half lengthwise
What are the advantages of a cast?
- relatively easy to apply
- can mold to exact shape required
- easy to store materials
- good for certain fractures distal to elbow and stifle
What are the disadvantages to using a cast?
- heavy and awkward
- aftercare required
- cannot use over open wounds or sutured incisions
- requires anesthesia
- if severe swelling occurs the cast may compromise circulation
- risk of non-union
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