St John first aid guide for dressings and bandages

When it comes to managing wounds, choosing the appropriate dressing is essential as they come in various types and sizes. Never use a sterile dressing that is past its expiration date.

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A bandage is applied over a dressing when treating a wound. A roller bandage helps keep the dressing secure, while a triangular bandage can serve as an arm sling or assist in controlling bleeding. It can also provide support or immobilization for injuries affecting bones or joints, or act as makeshift padding for painful areas. For fingers or toes, a tubular gauze bandage holds the dressing in place.

Dressings

Sterile Wound Dressings

Wound dressings are typically packaged sterily, requiring careful opening by someone with clean hands or gloves. To prevent contamination, keep the dressing within the packet until it is ready for application.

Dressings intended for bleeding control must be bulky to apply enough pressure to the injured site. The common dressing type integrates wool or cellulose, enveloped in a light cotton fabric, and is referred to as a 'combine dressing'.

Major wound dressings marked as BPC or BP (due to their inclusion in the British Pharmacopoeia) consist of a sterile combine dressing with a connected bandage, suitable for crater wounds or controlling severe bleeding.

Sterile gauze squares primarily serve to clean wounds, so avoid using cotton wool as its fibers can stick to healing wounds.

Sterile Non-Adherent Dressings

Thin dressings are suitable for minor wounds, enhancing healing and typically possess a non-adherent surface. Such dressings often feature a plastic film on one or both sides with numerous perforations. If only one side has the film, that side must be placed against the wound, ensuring fluids can pass through into an absorbent layer, hence maintaining a dry condition.

Other non-adherent dressings may be specially coated to prevent sticking to the wound surface, always being applied with the non-adherent side against the wound. Some manufacturers design both sides to be non-adherent to minimize errors in application.

These dressings are particularly useful for extensive surface injuries like abrasions or burns.

Improvised Dressings

In emergencies, various materials can be utilized for makeshift dressings. A bulky pad to control bleeding can be crafted from clean, non-fluffy material or several facial tissues.

For a minor burn or scald, you might use a clean piece of plastic wrap initially. For serious burns, however, sterile coverings are crucial to prevent infection. Cooling the injury should continue until a sterile dressing can be applied.

Bandages

Roller Bandages

Roller bandages come in different styles, dictated by their intended use.

They are employed to:
- Secure dressings on wounds
- Maintain pressure over bulked pads to control bleeding
- Provide support for injured limbs or joints
- Apply pressure to a limb

Materials used for roller bandages range from lightweight cotton, crepe, to elasticized crepe depending on the required pressure level. A lightweight cotton bandage is optimal for securing dressings, while a crepe or elasticized variant is designed for supporting or applying firm pressure on soft tissue injuries.

Applying Roller Bandages

Selecting the appropriately sized roller bandage is important for effective application. The following widths are generally suggested:

• Lower arm, elbow, hand, and foot: 75 mm.
• Upper arm, knee, and lower leg: 100 mm.
• Large leg or trunk: 150 mm.

Opt for a bandage with slight stretch in its fabric weave to make it easier to use and ensure it stays secured for extended periods. Correct application techniques are crucial for providing comfort and support.

Key Steps for Effective Roller Bandage Use:

• Position the injured part comfortably before bandaging.
• Hold the bandage tightly rolled, wrapping from the top down without unrolling too much at a time.
• Start with a locking turn to secure it.
• Work from the middle of the limb outward.
• Ensure each turn overlaps at least two-thirds of the previous one.
• Cover any padding completely and finish with a straight turn.
• Secure with a safety pin or adhesive tape; avoid metal clips.

For bandaging the lower arm or leg:

• Apply appropriate padding over the area.
• Start with a diagonal locking turn beneath the padding.
• Work upward covering two-thirds of the previous turn and finish with a straight turn, securing it properly.

For bandaging the elbow or knee:

• Begin with a full turn over the joint to secure.
• Alternate turns just below and above the joint, exposing portions of the previous turns as needed.
• Avoid excess turns that might add pressure to the joint.
• Finish with a full turn above the joint and secure.

For bandaging the hand or foot:

• Cover the area with appropriate padding.
• Start with a locking turn at the wrist or ankle, then wrap across to the base of fingers or toes.
• Work upwards, repeating the process until completely covered.
• Conclude with a circular turn around the wrist or ankle and secure.

Triangular Bandages

Typically made from a cotton or calico square cut in half diagonally, triangular bandages have multiple uses including functioning as a sling or immobilizing broken limbs and soft tissue injuries.

Sling

• Open form as a sling offers support for upper body injuries.

Broad-Fold Bandage

• Used with the apex folded down twice for lower body injuries.

Narrow-Fold Bandage

• Can control severe bleeding or immobilize a lower limb when folded correctly.
• Utilized for upper body injuries as a collar-and-cuff sling.

Padding

• Form a folded pad for major wounds or to provide cushioning.

Tying a Reef Knot with a Triangular Bandage: Using a reef knot helps securely fasten it in position without slipping. It is comfortably situated if done correctly.

1. Wrap the left bandage end over and under the right.
2. Wrap the right end over and under the left to complete.
3. Pull firmly from both sides for a secure flat knot.

Arm Sling: Used to support an injured arm or hand.

• Encourage the patient to position their arm for comfort.
• Hold the bandage with the base down, placing the top point under the arm around the neck until resting on the shoulder.
• Bring the lower point up to the upper point and then tie securely with a reef knot.
• Ensure circulation by checking fingertip color in comparison to the unaffected arm.

Elevation Sling: For injuries requiring the arm to be elevated.

• Encourage the patient to position their arm across their body.
• Place the bandage with the top going over their supported arm and across the back.
• Avoid pressure on injuries while securing the knot.

Collar-and-Cuff Sling: Holds the arm with comfort during warm weather.

• Create a clove hitch with loops of bandage.
• Position it appropriately to tie a reef knot avoiding neck pressure.

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A waterproof adhesive bandage is a flexible, thin layer composed of layered materials that provides a protective cover over damaged skin. It features sticky edges on one side with an absorbent, non-sticky middle patch, which can have antibacterial properties based on its design. This pad is placed over wounds, burns, ulcers, abrasions, cuts, and incisions to shield the skin from further harm.

Functions of a Waterproof Adhesive Bandage:

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Benefits of Waterproof Wound Covers:

• Packed in sterile plastic bags, waterproof bandages maintain sterility.
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