Dressings and Individual Dressing Packets (IPP)

Individual Dressing Packet (IPP)

The IPP is specially designed for use in mass casualty settings. It consists of a gauze bandage and two cotton-gauze pads. The main design feature of the packet is that one pad is rigidly fixed to the bandage, while the second can be moved freely along its entire length. This design solution makes it possible to cover not only single wounds, but also through-and-through wounds.

The packet has a reliable double packaging. The inner layer consists of waxed paper, while the outer layer is a hermetic rubberized shell. It is important to remember that this shell performs an independent medical function: it is used to create an airtight occlusive dressing in penetrating chest trauma (pneumothorax). The kit also includes a safety pin for the final fixation of the material.

Algorithm for using an IPP:

1. Tear the outer rubberized shell along the special notch.
2. Remove the pin.
3. Open the inner paper wrapper.
4. Take the prepared bandage head in your right hand. Unroll the material very carefully, under no circumstances touching the inner surfaces of the cotton-gauze pads with your fingers.
5. Slide the movable pad to the required distance. If the wound is single, place the pads next to each other or superimpose them. If the wound is through-and-through, cover the entrance wound with one pad and the exit wound with the second.
6. Secure everything with circular turns of the bandage.
7. Secure the end of the bandage reliably with the pin.

Goals and stages of performing a dressing

The dressing process is an important therapeutic and diagnostic procedure. Indications for its implementation include any pathological conditions involving a breach of skin integrity: wounds, ulcers, burns, frostbite, tissue necrosis, and external fistulas. The procedure is performed exclusively in specially equipped rooms — dressing rooms, on dressing tables.

Dressings perform two main functions:

• Therapeutic: creation of a favorable environment for healing.
• Diagnostic: the physician assesses the nature and extent of the pathological process, monitors the dynamics of the disease, and identifies possible complications. During the procedure, probing of fistulous tracts and fistulography are also performed.

Stages of performing a dressing:

1. Visual inspection of the wound.
2. Performance of diagnostic and therapeutic manipulations (instrumental examination, thorough washing, sampling of material for bacteriological culture or smears).
3. Repeated toilet of the wound (performed mandatory if pus has appeared after manipulations or traces of antiseptics remain).
4. Treatment of the skin around the wound defect with an antiseptic solution.
5. Application of a sterile dressing.

Pain management and removal of the old dressing

Dressing changes are divided into scheduled and emergency. On a scheduled basis, the material is changed when it is soaked with wound discharge, exudate, pus, or contaminated with urine or intestinal contents. Urgent revision is required if anaerobic infection is suspected or in case of heavy soaking with blood, which directly indicates secondary hemorrhage.

Since manipulations within the wound (necrectomy, probing, installation of drains and tampons) can be extremely painful, adequate pain management is required. Non-steroidal anti-inflammatory drugs (NSAIDs) or narcotic analgesics (solutions of fentanyl, morphine, trimeperidine, metamizole sodium) are used. In particularly complex cases, short-term inhalation or non-inhalation anesthesia is resorted to.

The technique of removing an old dressing is subject to a strict rule: minimal trauma. Rough removal causes acute pain, provokes bleeding, and destroys young granulation tissue and epithelium.

• The material is carefully cut with scissors away from the wound itself.
• If the bandage has adhered, it must be soaked off. For this purpose, solutions of hydrogen peroxide, furatsilin, isotonic sodium chloride solution, or procaine solution are used. The liquid is poured on top, or the limb is completely immersed in a container with the solution.
• After softening, the dressing is gently removed with tweezers, lifting the material strictly along the wound.

What else to study on this topic

• Indications and technique for primary surgical debridement (PSD) of freshly infected wounds.
• Types of antiseptics used for wound toilet and soaking dressings.
• Features of applying an occlusive dressing in open pneumothorax.
• Clinical signs of anaerobic infection upon wound inspection during a dressing change.
• Technique for performing fistulography and probing of fistulous tracts.

Other topics in "CHAPTER 10. GENERAL ISSUES IN TRAUMATOLOGY"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.