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Trendelenburg position. What is it, a photo is used for operations, X-rays, anaphylactic shock, which involves

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The special position of the body in which the pelvis level is above the level of the shoulder girdle, called the Trendelenburg position. This posture improves blood flow to the brain and, consequently - the outflow from her pelvic organs. Therefore, it is widely used in surgery, gynecology, cosmetic and emergency care.

The content of the article:

  • 1 when used
  • 2 Advantages and disadvantages
  • 3 testimony
  • 4 Contraindications
  • 5 The procedure step by step
  • 6 Video of the Trendelenburg position

when used

In medicine it is used in such cases:

1. When necessary blood flow to the pelvic organs:

  • gynecological surgery;
  • obstetrical pathology;
  • uterine bleeding;
  • operation on the rectum;
  • abdominal surgery;
  • Some dental procedures;
  • endoscopic or X-ray examination of the large intestine;
  • X-ray or endoscopic examination of the stomach and the esophagus;
  • some urological surgery.

2. When necessary blood flow to the brain:

  • at fainting;
  • shock;
  • collapse.

Depending on the type of surgery or examination position can take different angle - of 15 ° to 45 °.

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In cosmetics, this position is used in such cases:

  • gynecological cosmetology;
  • sex change;
  • Hymenoplasty;
  • liposuction in the abdomen and thighs;
  • closing upper palate defect or split lips with congenital abnormalities (cleft palate, cleft lip);
  • rhinoplasty.Trendelenburg position. What is it like to use in operations, X-rays, anaphylactic shock

Sometimes cosmetic surgery of the face are other provisions that are called "Angitrendelenburg". In this position the shoulder belt is above the pelvis, which is accompanied by an outflow of blood from the upper body and creates good conditions for the operation.

Advantages and disadvantages

Trendelenburg position - a position of the body, which improves access to internal organs. It was developed and offered for use gynecologist Trendelenburg, who noted that in the normal position of the body and internal organs of the gland complicate access to the uterus and ovaries.

And when the body is tilted by raising the lower body and lowering the top, a diaphragm rises, freeing space in the abdominal cavity.

special operating tables and chairs are now developed, which provide for the patient's inclination to them from different angles, which simplifies the process of operation and shortens the time of its implementation. Their mechanism allows for easy transfer of the patient from one location to another by only one person without assistance, and the costs of power and time.

Pros provisions: Cons provisions:
  • expansion of the surgical approach;
  • for fainting or shock creates the conditions for a quick exit from the state;
  • easy access during gynecological operations or some states in obstetrics;
  • easy to use.
  • difficulty in movement of the diaphragm;
  • increased intracranial pressure;
  • depression of respiratory function;
  • the development of respiratory acidosis;
  • conduction deterioration of the cardiovascular system;
  • bowel volvulus;
  • hemodynamic deterioration (the longer a patient is in that position - the indicators deteriorate more).

All the effects are short-lived Trendelenburg position. they are usually held after the restoration of the physiological situation, and sometimes it is necessary for some time to come back to normal performance. But, sometimes, this attitude leads to adverse effects (cerebral edema, acute ischemic stroke, hemorrhage).

Trendelenburg position - it's the best option for operations in gynecology. But people with large body mass, it is virtually useless.Trendelenburg position. What is it like to use in operations, X-rays, anaphylactic shock

On tilting the body to the internal organs diaphragm is displaced in the upper part of the body, freeing required for surgery or study space in the pelvis. But obesity omentum is too large and, even with a significant slope, fills the entire abdominal cavity.

Surgeons use it often enough, as with a minimum expenditure of time, effort and expensive equipment, you can create optimal conditions for the desired operation. But, at the same time, obese patients, the position does not provide the desired effect, or to achieve it needs a sharper angle.

During general anesthesia Trendelenburg position prevents aspiration of vomit, but is accompanied by regurgitation of gastric contents into the esophagus.

Anesthesiologists note that the position utrudnyaet intubating laryngeal tracheal tube, as This situation seriously consider the epiglottis and glottis, and insert a tube directly into the larynx.

testimony

In order to give the patient Trendelenburg position, the following indications:

  • surgery on the rectum;
  • in gynecology surgery (ovarian cysts);
  • ectopic pregnancy;
  • urological surgery;
  • fluoroscopic examination of the esophagus, stomach and duodenum;
  • sudden drop in blood pressure;Trendelenburg position. What is it like to use in operations, X-rays, anaphylactic shock
  • fainting;
  • shock.

Before the appointment of the position of the patient is necessary to fully explore, not to miss the contraindications. The exception is the drop in blood pressure and all kinds of shock. In this case, the Trendelenburg position is always needed immediately.

It is not nada only when there is a suspected fracture of the spine. Therefore, the injured after the accident, just lift the leg and fix the cervical spine. After giving a patient position, you are ready to survey and emergency assistance.

Using Trendelenburg position provides the release of the upper respiratory tract and prevents the tongue, making it easier to assist the process and saves time for the next stages of resuscitation patsiena.

Intensivists, physicians and emergency room admissions office in the provision of emergency care is widely used position as the position of the larynx time prevents the tongue root, which simplifies the further work and frees from the time required to ensure patency of the upper airway ways.

Obstetricians use position at an ectopic pregnancy. They note that in the second and third trimester pregnant length of stay in such a position should be minimal, since the diaphragm physiologically is already high, and the hemodynamic load further increases, which increases the risk of complications and hemodynamic edema brain.

Also Trendelenburg position worsens the blood supply to the fetus, which can lead to its hypoxia and, as a result of a syndrome of internal developmental delay.

Radiologists and doctors of functional diagnostics celebrate empowerment with the provisions of Trendelenburg, the possibility of a more accurate diagnosis, leading to the correct diagnosis and successful treatment.

Dentists use position for better access to the oral cavity. The most frequently performed in the dental surgery Trendelenburg position, but sometimes tooth extraction, particularly molars, also occurs in this position. Doctors say better access to hard to reach places and faster conducting dental procedures.

Contraindications

Contraindications to the use position are the heart, lungs and brain pathology, which is a vital organ, so before planning surgery or investigation in this position, it is sure to need to gather medical history and conduct a general survey body.

Among the main contraindications include such states:

  • ascites - fluid accumulation in the abdominal cavity;
    Trendelenburg position. What is it like to use in operations, X-rays, anaphylactic shock
    Trendelenburg position forbidden to take with ascites
  • the presence of blood in the peritoneal cavity, pus;
  • advanced age;
  • expressed cerebrovascular sclerosis;
  • severe heart failure;
  • ovarian cysts;
  • risk of miscarriage during pregnancy;
  • restriction of respiratory function (severe COPD, asthma).

The presence of fluid in the abdomen can lead to rapid spread of infection through the body, in the case of flowing in its peritoneal pockets spleen or liver. And when the presence of a malignant tumor metastasis possibly in adjacent organs. Therefore Trendelenburg position is allowed to carry out only after removal of the fluid from the abdominal cavity.

You should also carefully prescribe a procedure for diseases of the cardiovascular system, especially in adults, blockades of different nature, ventricular arrhythmia. After position increases the systole and slow heart rate, that the blockade or arrhythmia produces an undesirable effect.

pulmonary disease limits the application of the provision, therefore, need to consider the risks and benefits before his appointment. Bronhografii conduct other necessary investigations, to consider the possibility of receiving a bronchodilator, in order not to provoke an attack of bronchial obstruction or asthma.

The procedure step by step

Trendelenburg position - a variant of body position, which provides a good overview on X-rays of the abdomen or surgical treatment in proctology and gynecology. In all cases the preparation for the procedure takes place similar, but has its differences.

When X-rays or X-rays of the digestive tract should follow these rules:

  1. Exclude medication for several days before the procedure, except for items needed for the daily administration in chronic diseases of the heart, lung, and diabetes. You can also leave an activated carbon and simethicone preparations, they help cleanse the stomach and intestines from excessive gas formation and accumulation of excess mucus.
  2. Smoking patients forbidden to smoke in the survey day.Trendelenburg position. What is it like to use in operations, X-rays, anaphylactic shock
  3. Before the procedure is necessary to remove all metal jewelry and dentures.
  4. The last meal should be 10-12 hours. to study and consist of easily digestible foods. should not be a product that cause flatulence in the diet. Allowing a small amount of water in the day of the test.
  5. If necessary the enema.

The procedure itself includes the following items:

  • laying the patient on a special function table;
  • followed by fixing;
  • shoulders fix the stops to prevent slipping;
  • radiography or fluoroscopy intestine in a horizontal position;
  • changes in body position with raised pelvis (head end is lowered to 5-15 °, the maximum angle of - 45 °);
  • arrest of breathing for a few seconds with simultaneous image.

If it is a stomach X-ray with contrast it with barium, the barium is inserted before procedure done a few shots to maximize the capture all the necessary diagnostics GIT.

Position allows you to diagnose a hernia of the diaphragm, stomach ulcers and duodenal ulcers, as well as polyps and tumors of the abdominal cavity. If necessary, the procedure can be carried out during pregnancy, but only the 2nd and 3rd trimesters.

After researching the patient should drink at least 2-3 liters of water a day to the substance completely out of the body. For 3-5 days, depending on the individual metabolism, can be observed the violation of a chair, his painting in white color, and constipation. After complete removal of barium, a chair normal.

Gynecological and urological operations preparations for operations held similarly. Difference is the feature of receiving liquid. In this case, it is necessary to limit. Also gynecological surgery performed on a chair, often in combination with lithotomy position (with lowered down), thereby reducing torsional stresses on the lumbar region.

When Proctologic operations must-see destination is the enema.Trendelenburg position. What is it like to use in operations, X-rays, anaphylactic shock

When syncope or sudden drop in blood pressure when you need urgent assistance, laying on the table are missing in order to save time.

The procedure consists of the following items:

  • put the patient on any hard surface;
  • placed under the cervical spine roll of towels, clothes or other materials at hand;
  • leg lift at an angle of 35-45 °;
  • check the airway, heart rate and pulsation in the carotid artery;
  • vymeryat blood pressure;
  • take place before the nasal passages with cotton wool soaked with ammonia;
  • proceed to the emergency room.

Trendelenburg position - this is the first thing to do when a swoon, because such a situation It provides compensation for physiological organism, a rush of blood to the brain and the gradual exit from the independent fainting.

If the cause is a drop in blood pressure, the situation contributes to its increase. Securing the position does not require special costs of power, so it can cope with each. Also, it does not take a long time, which has a positive impact on the continued provision of assistance that can be performed in parallel if several people are present.

Estheticians use position at the cosmetic surgery of the external genitalia, sex change. The Trendelenburg position is the best one for this type of operation, because it promotes the outflow of blood from the lower part of the body and prevents significant bleeding during surgery.

Using the Trendelenburg position in different fields of medicine and cosmetology making operations and research more accurate and comfortable. Therefore, in most cases, doctors strongly recommend holding them in this position.

Wide range of applications Trendelenburg position requires a precise knowledge of its performance by physicians of different specialties. Considering all the benefits of its use, should still bear in mind the conditions under which it is strictly prohibited.

The Trendelenburg position is an easy procedure that can lead to unexpected and adverse outcome. Therefore, before using it is necessary to study in detail the problem of the patient and concomitant disease. Only after that, the procedure will bring the most benefit in the treatment, and in the examination of the body.

Registration of the article: Vladimir the Great

Video of the Trendelenburg position

How is the installation of the patient in the Trendelenburg position:

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