Care of the injured and sick. Enemas

FUNDAMENTALS OF FIRST AID
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Care of the injured and sick. Enemas

Fundamentals of First Aid (OPMP)

enema called the introduction into the lower segment of the intestine of various fluids for therapeutic and diagnostic purposes.

Distinguish enemas cleansing, relaxing и washing, as well as medicinal, drip, nutritional.

Cleansing enemas are used for constipation, poisoning, before operations, childbirth, as well as before the use of medicinal, drip and nutritional enemas. The injected fluid, exerting a mechanical-temperature effect, enhances peristalsis and bowel movements.

To conduct a cleansing enema, you must:

pour 1 liter of warm water into Esmarch's mug (with a rubber tube);
fix the mug on a tripod at a height of 1-1,5 m;
open the tap and release some liquid from the tube in order to force air out of the system; Close the tap;
lubricate the tip with vaseline;
lay the patient on the left side with legs bent in the stomach;
insert the tip into the anus 3-4 cm towards the navel, then another 6-8 cm parallel to the coccyx;
open the valve on the rubber tube so that all the liquid passes into the intestines; Close the tap;
remove the tip and ask the patient to hold water for 10 minutes;
rinse and boil the tip.

To enhance the effect of an enema, you can dissolve soap in water (1 tablespoon of soap shavings from laundry or baby soap) or add 2-3 tablespoons of glycerin or vegetable oil.

Laxative enemas (oil and hypertonic) are used in cases where the introduction of large amounts of liquid is undesirable or ineffective.

Oil enemas appropriate for spastic constipation and inflammatory diseases of the large intestine. They usually use vegetable oils (sunflower, linseed, hemp) or vaseline oil heated to 37-38 ° C, in the amount of 100-200 ml, and for children - 30-50 ml.

To introduce oil into the intestines, use a pear-shaped balloon or a 100-200 ml Janet syringe, putting a rubber tip on them. Introduce oil slowly. An oil enema is usually done in the evening, since the release of the intestine occurs after 10-12 hours.

Hypertensive enemas with a 10% solution of sodium chloride or a 20-30% solution of magnesium sulfate is used for atonic constipation, edema, hypertension. Hypertonic solutions are administered in a heated form in an amount of 50-100 ml - with the same devices as with the introduction of oil.

Siphon enema is the most common type of wash enemas. Indications for its use are:

the need to free the intestines from feces and gases in the absence of the effect of cleansing enemas and laxatives;
the need to remove products of increased fermentation and putrefaction from the intestines, as well as bacterial poisons that have entered the intestines through the mouth.

To set up an enema, you need: a glass funnel (1-2 liters) with a rubber tube and a tip at the end, a bucket for draining, an oilcloth for bedding and 10-12 liters of clean warm water.

The vaseline-lubricated tip is inserted into the rectum to a depth of 20-25 cm, holding the funnel at a level above the lying patient and filling it with water. Then the funnel is lowered over the bucket, waiting for the water with intestinal contents to fill it, after which the water is poured out. The funnel raised up is again filled with water - and so on until the water is clear.

Medicinal, drip and hanging enemas are used 20-30 minutes after the action of a cleansing enema.

Medicinal enemas used for therapeutic effects on the intestinal mucosa or for the introduction of drugs into the body when they cannot be administered through the mouth. For the production of such enemas, a rubber balloon is used. The volume of one enema is from 50 to 200 ml. After the enema, the patient should lie down to keep the medicine for at least half an hour.

Drip enemas used for the introduction of large (up to 2 l) amounts of saline or 5% glucose solution for dehydration, intoxication, before and after surgery. When setting such an enema, a dropper is inserted between the mug and the tip. The required flow rate of drops (60-80 per minute) is regulated by a clamp.

Feeding of patients who are in an unconscious state is carried out in three ways: through a gastric tube, with the help of nutrient enemas, by parenteral route.

With nutrient enemas introduce milk, cream, broth, jelly, saline, etc.

Before the nutrient enema, a cleansing enema is made, and an hour later, the nutrient liquid heated to 37 ° C is slowly injected from the balloon into the rectum. The volume of liquid is not more than 250 ml; it is necessary to add 4-5 drops of opium tincture to it - to reduce intestinal motility. After a nutrient enema, the patient should lie down quietly for about an hour. Putting a nutrient enema is not recommended more than 4 times a day - because of the possibility of irritation of the rectum.

Authors: Aizman R.I., Krivoshchekov S.G.

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