The Concept of biomechanics

Biomechanics of man is an integral part of the applied sciences studying human movement. Motion of human body parts is movements in space and time, which are performed in many joints simultaneously and sequentially. Movements of joints in its form and nature are very diverse; they depend on an action of many applied forces. All movements are naturally integrated into holistic organized actions that a person manages with the help of muscles. One must remember the laws of the biomechanics of the body to avoid trauma for both patients and those who care for them.

Fundamentals of biomechanics were laid in ancient times. In his scientific writings “Parts of the movements and transportations of animals” Aristotle laid the foundation of what later, after 2300 years would be called a science of biomechanics. In his scientific treatises he describes the animal world and the laws of motion of animals and humans.

The greatest medic scientist of ancient time (after Hippocrates) was Claudius Galen (131-201 A.D. the). Galen understood the integrity of the organism and concluded that the nerves in its functional features are divided into three groups: going to the senses and performing the function of perception, going to the muscles and responsible for the movement and going to the organs and protecting them from damage. His main work is "About assigning of parts of the human body".

The development of mechanics in the Middle Ages was significantly influenced by the research of a great artist, mathematics, mechanics and engineer Leonardo da Vinci (1452-1519 year). Leonardo, of course, is the founder of functional anatomy, which is integral part of biomechanics. He described not only the topography of the muscles, but the value of each muscle for body movement. Studying the functions of the organs, he saw the body as a model of "natural mechanics". In his works he wrote: "the muscles always begin and end in touching bones, and they never begin and end on the same bones as they wouldn't have to move, except ourselves."

As the founder of the science of biomechanics is considered Giovanni Borrelli, Italian naturalist, Professor at the universities of Messina (1649) and Pisa (1656). In addition to work in the field of physics and astronomy, he worked on issues of anatomy and physiology from the position of mathematics and mechanics. He showed that the movement of the limbs and body parts of humans and animals at lifting weights, walking, running, swimming can be explained by the principles of mechanics. He was the first to interpret the movement of the heart as a muscle contraction, learning the mechanics of the movement of the chest; he set the passivity of the expansion of the lungs.

The first three-dimensional mathematical analysis of human gait was conducted by William Brown and his student Otto Fischer in 1891. Brown and Fisher for the first time studied the mass, volume, and center of mass of the human body (after researching on the corpses), and received data, which are long used as a biomechanical standard.

Knowledge of biomechanics is necessary for clinical medicine. In particular, the biomechanics of organs helps to understand the regulation of their work; biomechanics is the basis for the design of prosthetic and orthopedic products. Data of biomechanics are used for the diagnosis of the circulatory system, to identify indications and contraindications for operations on the heart and lungs, making the machine of artificial circulatory system; with the purpose of prevention and treatment of injuries; to develop a scientific system of training of athletes; the scientific organization of labor.

One must remember the laws of the biomechanics of the body to avoid trauma for both patients and those who care for them. The knowledge of peculiarities of the musculoskeletal system of the patient, its anatomical features, defects and virtues is necessary for the implementation of transportation of the patient, moving him into different positions, changing his position in bed. The staff should also know the capabilities of their musculoskeletal system to properly calculate the power and time required to transport or position change of the patient's body. Right transportation of the sick is one of the conditions supporting of high quality medical and diagnostic process, guaranteeing the safety of both patients and medical workers. In this regard, each of the participants of transportation must be familiar with the safety precautions and should be carefully instructed.

Transportation of a sick or disabled person, independent movement should be considered as a complex operation. Therefore, before implementing the transportation of such persons should be discussed a plan of action: goal and place of destination, the duration of the movement, type and method of transportation, number of participants, and the role of each of them, the shortest and safest route of movement, the position of the patient, his equipment, auxiliary means for movement. The transportation is directed by an experienced nurse, who in her turn receives instructions from the attending physician regarding the patient's needs and objectives for preventing the deterioration of his condition during transport.

It is important to prepare the patient for carrying out the movement. If the patient is able to assist health workers in transportation, you need to tell him about the goals of transportation, to consult on the most convenient position for transportation, painless methods of deduction, to clarify which of his hands can be used for the application of the method of capture and what leg he can use for support. If the patient is unable to interact with medical personnel, it is important to create a climate of confidence and peace, to warn about the beginning of the movement and, if necessary, to announce a few stages or overcoming any obstacles along the way. Monitoring the status of the patient is constantly performed by a nurse, she gives commands about speed, stops, acceptance of additional security measures or activities of medical care.

6.4 Types and methods of patients’ transportation

For patients’ transportation are used special tools: wheelchairs, gurney, and stretchers. At using, you must carefully consider the design, check the functioning of all parts.

In ambulances patients are transported lying on a stretcher with a raised head or foot end (depending on the diagnosis) or sitting (Fig. 10).

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Figure 10. Ambulance car

Children are transported on the hands. The assistant nurse should be in all cases be in the salon next to the patient and to monitor his status and, if necessary, to help. It is allowed for relatives or friends to accompany the patient. Children, as a rule, are accompanied by their parents. After transportation of infectious patient ambulance car is subjected to disinfection. Staff must change their robes. More than one infectious patient can be transported only if they suffer from the same infectious disease, taking into account the degree of contagion rates in different periods of the disease. Transportation of extremely heavy patients is only allowed by resuscitation teams. Before transportation it is necessary to conduct a complex of therapeutic measures aimed at stabilizing the state.

At transportation of critically ill patients for far distances it is necessary to comply with the following rules:

• To take into account the interests of the patient

Transportation of critically ill patients is associated with certain risks that should always be justified. If the goal of transportation (treatment in a specialized clinic) exceeds the expected benefit of the treatment in the clinic, where the patient is then this risk should go.

· Minimum stabilization of the patient’s status

This is the condition of the patient in which the vital systems (respiratory, cardiovascular) are in a stable condition. Transportation of patients over long distances is not recommended if the patient is in a state of shock, with a hematoma in his head before surgery, with acute myocardial infarction, with pathology of the abdominal cavity before surgical treatment.

• The necessary equipment of the ambulance

The vehicle must be equipped as intensive care ward. It should be comfortable and convenient for the patient. A long way implies a longer stay of the patient on the couch, which is equipped with additional cushioning. The head of the patient is fixed in a special holder, which makes it possible to avoid the consequences of vacillation and shaking (Fig. 11).

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Figure 11.

Resuscitation ambulance car

Technical equipment of turbine resuscitation ambulance car allows it to be more maneuverable at driving, not creating a higher vibration and not to swing at speed. Ambulance car completes list of the necessary equipment: apparatus of artificial ventilation of lungs, patient’s monitor, defibrillator, stock of oxygen to ensure the function of the lungs and breathing, the full set of drugs, devices for dosed supply of drugs, drips, and solutions. The resuscitation ambulance cars have refrigerators and cold boxes.

Resuscitation team consists of a physician of intensive care and sister of anesthesia who carry out continuous monitoring of the patient. If necessary the patient is accompanied by a second doctor, specialization of whom depends on the disease profile of the patient. If this is the patient with stroke, he is accompanied by a neurologist or neurosurgeon, if a patient with severe concomitant injuries and trauma he is accompanied by a surgeon or orthopedist, if a patient with surgical pathology (with drainage in the postoperative period) - surgeon, etc. Mandatory condition during transportation over long distances is the presence of a co-driver. As a rule, the number of people involved in transportation, is not less than 5 persons.

The recommended distance for the transportation of bed-ridden patients on the ambulance should not exceed 600 km. However, in some cases, when there are no other means of transportation (air, rail), can be taken the decision to transport the patient over a distance of 600 km, when at the first place are such factors as the patient's disease and his location.

In hospital, type of transportation and Department (medical, intensive care), in which the patient will be delivered are determined by the physician depending on the disease and the severity of the patient's condition. There are three ways - the patient can go independently accompanied by medical personnel, must be transported in a sitting position in a wheelchair or lying on a gurney. Patients who move independently are transferred from the admission Department to the ward accompanied by nursing staff (nursing sisters or hospital cleaner). Patients who are not able to move, are transported to the Department on a stretcher or in a wheelchair. Means of transportation (wheelchairs, stretchers) are provided with a mattress, covered with oilcloth and sheets, put under a pad under the head (striped pillow case and cover in fabric). For the prevention of nosocomial infections linen should be changed after each patient and threw into a bag for dirty clothes, mattress and pad should be twice wiped with a rag soaked in disinfectant solution.

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Дата добавления: 2015-10-29