Follow the rules for using work tools. The universal rule tool to keep everything straight! Purpose and design

FOREWORD

The information necessary for mastering practical skills in operative surgery is not systematized and scattered across numerous manuals, which makes it inaccessible to most students in the learning process.

Based on literature data and practical experience teaching discipline, as well as in accordance with the curriculum in operative surgery for students of the medical and preventive faculty of higher medical educational institutions In 1997, we tried to help students acquire the necessary practical skills.

The manual, without prejudice to the program and curriculum, is freed from excessive phraseological (textual) load, editorially adapted to the level of Russian-language training of foreign students of 3-4 courses.

The presentation of the text is accompanied large quantity illustrations made at the department, as well as borrowed from domestic and foreign manuals.

This guide can be used for educational process not only by foreign students, but also by students of other faculties and departments in preparation for practical classes, tests and exams.

The authors express their gratitude to Associate Professor Z.A. Dundarov and Associate Professor V.N. Zhdanovich for valuable comments and suggestions on the form and content of this manual, as well as for the work on computer layout of the manual to the employee of Pozhtekhsnab LLC, the specialist in support of activities Masalsky A.Yu.

Due to the fact that this book is the first attempt to create such study guide, all suggestions and comments from readers will be greatly appreciated.

General surgical instrument aria, terms of use.

When using surgical instruments, certain general rules:

1. When performing any operation, you need to use only fully functional tools.

2. Each tool must be used only for its intended purpose.

3. When working, any tool must be held confidently, but at the same time easily. The surgeon's hand should feel not the handle of the instrument, but the working end part: the scalpel blade, the nose of the hemostatic forceps, etc. Excessively strong pressure reduces this feeling, makes the surgeon's techniques rough.

4. All instrumental actions should be as coordinated and expedient as possible, performed smoothly, rhythmically.

5. When working with instruments, exceptional attention should be paid to the careful handling of living tissues. Manipulations leading to bruising, crushing are extremely harmful to the subsequent healing of the wound.

Surgical instruments according to their functional purpose and for convenience of study are divided into two main groups: general surgical and special surgical instruments.

General surgical instruments are also divided into four groups according to their purpose:

1) tools for tissue separation;

2) hemostatic instruments;

3) auxiliary tools;

4) tools for joining tissues.

Special surgical instruments include instruments used in special areas of surgery (ophthalmology, neurosurgery, urology, etc.).

Fig.45 Tracheotomy technique: introduction of a cannula into the trachea.

from bottom to top (with upper tracheotomy 2-3 tracheal cartilage, middle - 3-4 cartilage, lower - 5-6 cartilage).

The opening of the trachea is accompanied by a cough with sputum. After the cough stops, a dilator is inserted into the tracheal cavity and, holding it in this position with one hand, the cannula is inserted with the other, placing its shield in the sagittal plane (Fig. 45). The diameter of the cannula should correspond to the length of the tracheal incision. The dilator is removed, the cannula is turned so that the shield is located in the frontal plane, and is advanced downward. With the correct position of the cannula, you can feel the stream of air coming out synchronously with breathing.

Starting from the corners, the wound is sutured in layers towards the cannula.

A small gauze napkin is brought under the cannula, and then the cannula is fixed by attaching two gauze tapes to its ears and tying them behind, on the patient's neck.

Fig.44 Tracheotomy technique: the trachea is fixed with a sharp hook, the beginning of the dissection of its cartilage.

Fig.1. Tissue separation tools.

a) abdominal scalpel;

b) pointed scalpel;

c) straight resection knife;

d) amputation knife;

e) blunt scissors;

e) pointed scissors;

g) Cooper scissors;

h) Richter scissors;

i) vascular scissors.

A scalpel is a sharp-edged surgical instrument used to sever soft tissues.

There are general surgical and special scalpels (ophthalmic, etc.). General surgical scalpels can be fully stamped and with removable blades. General surgical one-piece stamped scalpels are produced in two types: pointed and abdominal. Depending on the length of the blade, they can be: large (blade length 46.50 mm), medium (blade length 40.42 mm) and small (blade length 30.32 mm).

The scalpel has a handle and a blade; on the blade, the point, back and abdomen are distinguished (Fig. 2).

Fig.2. Pointed scalpel.

b) blade;

c) the back of the blade;

d) belly of the blade;

e) the tip of the blade.

The handle of a general surgical scalpel is flat and its surface is slightly rough. The handle of the ophthalmic scalpel is four-sided. Currently, scalpels with removable blades are widely used. Blades for such scalpels are produced in three types: pointed, belly and radius, which have a specific purpose.

A belly scalpel is used to make long linear incisions on the surface of the body, a pointed one is used for deep incisions and punctures.

There are three main ways to hold a scalpel in your hand: in the form of a bow, in the form of a writing pen and in the form of a table knife (Fig. 3).

sheets of the second and third fascia fused along the midline and indicating the gap between the muscles, these sheets are cut along a grooved probe. After that, the sternohyoid muscles are revealed, which are bluntly separated and parted to the sides. Having parted the muscles, the cricoid cartilage and the isthmus of the thyroid gland lying under it are determined.

Fig.43 Tracheotomy tool kit:

a) a sharp hook to hold the trachea and larynx;

b) tracheal dilator;

c) tracheotomy cannula.

A sheet of the fourth fascia is dissected, fixing the isthmus to the cricoid cartilage in the transverse direction. After that, the isthmus is bluntly separated, together with the fascia covering it from behind, from the trachea and pushed back in a blunt way up or down, depending on the type of tracheotomy, exposing the tracheal rings. The larynx is fixed to facilitate dissection of the trachea by piercing the cricoid arch or the cricotracheal or cricothyroid ligament with a single-pronged hook. With the help of the specified hook, the larynx and trachea are pulled up. Taking in right hand a pointed scalpel with the blade up, the operator puts his index finger on the side of the blade and, not reaching the tip of the knife by 1 cm, cuts 2-3 cartilages (Fig. 44) of the trachea

4. Rules for the use of electrical installation mechanisms and tools

Proper operation mechanized tools and small-scale mechanization consists in regular maintenance of them, compliance with established regimes work and lubrication.

Electrical machines and electrified tools. Before issuance electrical machines for the production of works are checked special devices on the stand or with a megohmmeter, the serviceability of their electrical (insulation resistance, the presence and serviceability of grounding, the integrity of the cable insulation, etc.), as well as the mechanical parts (reliability of fastening threaded connections, serviceability of the gearbox, the presence of lubrication in bearings and gears, the correct sharpening and installation of the working tool). Before starting work, you must make sure that the voltage of the machine matches the mains voltage, that the grounding is in good condition, and that the machine is idling.

The correct operation of an electrified tool is also ensured by observing the established duration of its inclusion and the cleanliness of the content, i.e., the timely removal of chips, dust, construction trifles. During operation, it is necessary to monitor the state of lubrication of all machine components and, if necessary, replace it. The lubrication of electric drilling machines is usually changed every 200 hours of operation. Continuous lubrication of ball bearings and gears is provided by a stock of US-3 medium-melting grease, which is located in the bearing seats and the gearbox and is added once every two months.

The use of an electrified tool, in particular, electric drilling machines with a supply voltage of 220 V, increases the risk of injury (in the event of a breakdown in the insulation of the windings, the body of such a tool is energized with 220 V). Safety rules in construction prohibit the use of hand-held power tools with a supply voltage of 127 and 220 V in hazardous and high-risk rooms (power tools with a supply voltage of 42 V are allowed).

Single-phase electric drilling machines with a metal case are allowed to be connected directly to the 220 V network only with a three-wire flexible copper wire with a cross section of at least 1.5 mm² in a common sheath, and the third core must serve exclusively for grounding the machine frame. It is impossible to use the zero working core of the wire for grounding. The neutral and ground wires are connected to the ground network separately. The ground conductor is attached to the housing with a screw.

Before turning on the electric drilling machine, you should check the presence and serviceability of grounding, the condition of the insulation of the supply wire, the compliance of the voltage and frequency of the supply network, the operation of the switch (several trial inclusions). not allowed during work strong heating drilling machine (in which you can not keep your palm on its body). With a strong sparking of the collector, the machine must be turned off to eliminate its causes.

At present, mainly electrified mechanisms for punching work are used with a supply voltage of 220 V and double insulation, which consists of two stages independent of each other - working and additional. Working insulation is the basic insulation necessary for the operation of the machine and protection of the operator from injury. electric shock. This is a braid or enamel of winding wires, groove insulation of machine windings, impregnating varnishes and compounds, insulation of cable cores, wires and internal connections. Additional insulation plastic machine cases, insulating bushings, etc. are used. Electric drilling machines with a supply voltage of 42 V and increased frequency(200 Hz), safe in operation, but for the power supply of which large-sized portable frequency converters are required, so their use is limited.

To increase the safety of electric drilling machines for 220 V with one stage of isolation, they are powered from the mains through a special isolating transformer (with a transformation ratio of 1: 1), which has windings with reinforced insulation, made so that damage to the primary winding does not lead to the formation of a network potential during secondary winding. Consequently, the appearance of the network potential on the metal parts of the drilling machine is also excluded, even in the event of an insulation breakdown.

Performing work in installations under voltage or with partially stress relieved, is allowed in exceptional cases and only to electricians who have passed special training and briefing, after obtaining a work permit and always under the supervision of operating personnel. Pneumatic tools and welding transformers. The main requirement for the operation of a pneumatic tool is to lubricate it with turbine or solar oil every 4-5 hours of operation, and a new tool every 2-3 hours.

Before issuing, the toolmaker checks the tightening of all threaded connections in the machine or puncher, fills the oil cavity with clean mineral oil, fills the grease fittings with grease to lubricate the gearbox and bearings, tests idling, checks the compressed air pressure and the serviceability of the hose. A drop in compressed air pressure drastically reduces machine performance.

AT winter time pneumatic tool is covered with moisture from the condensation of vapors contained in compressed air which must be removed in a timely manner. In addition, before starting work, the pneumatic tool is heated.

Welding transformers require constant supervision and timely elimination of all faults. Care of transformers consists in keeping all their contacts in good condition and ensuring reliable grounding of the case, therefore it is necessary to periodically check the condition of the insulation, especially when the installation is operated outdoors.

Carbide working tool. The main performance indicators that determine the effectiveness of such a tool are its performance and reliability. Normal operation is right choice tool, timely sharpening, compliance with the drilling or punching mode. The bluntness of the working tool and the need for its sharpening are judged by a significant decrease in the rate of penetration, a noticeable increase in the required pressing force on it, as well as a drop in productivity. Excessive blunting can lead to the destruction of the working plates. Under normal use, the tool can withstand three or four sharpenings and provides a drilling speed of concrete bases about 1 ... 2 mm/s.

Storage, operation and repair of tools is carried out by the central tool shop, which consists of two services: a stationary tool workshop with a repair group and a mobile (by car) tool workshop.

In a stationary tool workshop, repairs (refurbishment), refueling, branding of tools, adjustment and testing of them idle and under load, as well as control over operation, equipment and quantity are carried out.

Scheduled preventive maintenance of machines and mechanisms is carried out in accordance with the instructions. Usually two types of repairs are planned - current and capital. Maintenance machines are divided into daily, performed during the work shift, and periodic, performed after the machine has worked out a certain amount hours. For new cars that have not passed overhaul, overhaul cycle is set. For machines that have undergone a major overhaul, the overhaul cycle is taken with a coefficient of 0.8.

mandrel; b - with a construction and assembly gun; in - with a shock pyrotechnic column. Tool sets To improve tool management for certain types electrical work created individual and brigade Individual tool kits for electricians on lighting, power networks and secondary circuits(types IN-3, NIZ-3, IN-4, NIK-4) are placed in...

The site and the chairman of the commission on labor protection, a mechanic and an electrician. They check: · the state of safety and industrial sanitation; work of the first stage; implementation of the project for the production of works; serviceability and safety of used machines, mechanisms, power plants and Vehicle; the timeliness of the issuance of overalls and protective devices; ...

In countries with developed market economy. It is aimed at observing the economic interests of all participants in investment and construction activities for the implementation of individual projects. 1. Initial data. Option No. 28 The project for the production of works is being developed for a typical large-panel building. The building contains 3 standard sections. The dimensions of the building in plan are 13.8 x79.2 m. The number of floors is 15. ...

In the event of a fire threat, the state fire supervision authorities have the right to suspend construction work. 1.12 Technical and economic characteristics of the facility: "Specialized enterprise for the manufacture of assembly blanks" Duration of construction, months 14 Duration of the preparatory period, months 2 Cost of construction and installation works, thousand c.u. ...

Forbidding- in the form of a red circle with a white field inside, a symbolic image of black on the inner white field, crossed out by an inclined red stripe.

“It is forbidden to smoke!”, “It is forbidden to use open fire!”, “Stop! Passage is prohibited”, “Do not drink! technical water”, It is forbidden to pour water on electrical equipment!”, “It is forbidden to eat food”

Warning- a yellow triangle with the apex up, with a black border and a symbolic image of black.

"Carefully! Explosive substances”, “Caution! Flammable substances”, “Attention! Before starting the mechanism, give a warning signal”, “Caution! Don't stand under the load"

prescriptive- a green square with a white border along the contour and a white square-shaped field.

“Wear a respirator here”, “Wear protective goggles here”, “Check the concentration of methane”, “Check the concentration of carbon monoxide”.

pointing- a blue rectangle with a white border with a white square inside, on which a symbolic image or an explanatory inscription is applied in white.

"Fire extinguisher on the right", "Smoking area on the left", "Crane drinking water left".

Warning posters for electrical installations:

"High voltage! Dangerous for life”, “Do not turn on! People work”, “Work here”, “Grounded”

Identification painting of pipelines: water - green, steam - red, air - blue, combustible and non-combustible gases - yellow, acids - orange, alkalis - purple.

6. Rules for the use of tools.

When performing work, use only serviceable tools specially designed for this purpose.

It is forbidden to use foreign objects as a tool.

The tool at the workplace must be positioned so that it cannot roll or fall.

It is forbidden to put the tool on the railing of the fences or the unprotected edge of the scaffolding site, scaffolding, as well as near open hatches, wells.

When transporting or carrying the tool, sharp parts must be protected.

The working part of the pneumatic tool must be properly sharpened and free of damage, cracks, gouges, and burrs.

It is necessary to work with a pneumatic impact tool in goggles and vibration protection equipment. Working with pneumatic tools in the area increased noise must wear PPE (ear muffs, earplugs or antiphons).

Grinding machines, saws and planes must have a protective fence of the working part.

The heads of hammers and sledgehammers must have a smooth, slightly convex surface without gouges, chips, potholes, cracks and burrs.

The handles of hammers, sledgehammers and other percussion tools must be made of strong wood without knots and cross-section and must be oval in cross-section along the entire length, be smooth and not have cracks.

The impact tool (chisels, barbs, notches, cores, etc.) must have a smooth occipital part without cracks, burrs, work hardening and bevels. There should be no damage at the working end. The length of the impact tool must be at least 150 mm. When working with a percussive tool, workers must wear protective goggles. The screwdriver must be selected according to the width of the working part (blade), depending on the size of the slot in the head of the screw or screw.

The dimensions of the gap (capture) of the wrenches should not exceed the dimensions of the heads of the bolts (faces of the nuts) by more than 0.3 mm. The use of gaskets with a gap between the planes of the jaws and heads of bolts or nuts is more than allowed. The working surfaces of the wrenches should not have knocked down bevels, and the handles should not have burrs. The wrench size should be marked on the handle. When loosening and tightening nuts and bolts prohibited lengthen wrenches with additional levers, second wrenches or pipes. If necessary, use a wrench with long handles.

Sliding keys must not have a gap in the moving parts.

When working in a gassed environment, it is necessary to use a tool that excludes sparking (made of non-ferrous metal or black, but richly lubricated with grease or other lubricant).

Various types of tools that are actively used by professionals and home craftsmen to perform construction and repair work, when installing plumbing fixtures and other activities, play an important role. It is no coincidence that in recent times the issues of operation and maintenance of various categories of goods are quite relevant. Proper maintenance is also great importance not only for the safety of the working properties of the tool, but also for the safety of the user in the process of work. Set out in various sources the rules for working with the tool are clear to all users.

Manufacturers do not always take this issue responsibly, many do not accompany the tool detailed documentation about possible injury due to improper operation and a reduction in its service life. Most often, the kit includes papers in which the emphasis is only on the main characteristics and limiting technical specifications. There is rarely talk about immediate safety when working with tools.

Rules for working with tools and devices

Any list of rules for the operation of a particular type of equipment or fixture begins with the correct choice, the correspondence of the model to the purpose and nature of the work. It is important to use the tool only for the range of operations indicated by the manufacturer. Be sure to consider the size and production characteristics tool. For example, wrenches are matched to appropriately sized nuts and bolt heads. Pay attention to the sponge keys, they should not be cracked.

To work with tools of electrified, pneumatic and pyrotechnic type, persons who have undergone appropriate training are allowed. Compliance with safety precautions when working with tools of such a plan is a prerequisite.

When working with the tool, it is not recommended to facilitate your efforts with the help of additional levers, handles and other auxiliary devices. For example, hitting equipment that is not intended for this with a hammer is absolutely not worth it.

When carrying or transporting hand tool care must be taken to ensure that its sharp parts are covered with a cover.

Before starting work, check for nicks and roughness on the surface of the hand tool handle. The handles of pressure tools (chisels, files, chisels, etc.) must be equipped with metal rings. Impact types equipment such as chisels, barbs, etc. should be checked for cracks, burrs, bumps in the back of the head.

Safety when working with tools is paramount. Depending on the specifics of the work performed, it is necessary to use certified personal protective equipment.

A special moment is the preparation of the workplace. It is important that nothing superfluous interferes with you while doing the work, while work zone was well lit. Try to keep your workspace free of children and animals. Otherwise, there is a risk of getting into trouble.

In addition to following the rules when working with tools and devices, it is important to carry out proper care and timely service.

Tool care and maintenance

In order to prolong the useful life of the tool, it is recommended to carry out a daily preventive examination, it is necessary to monitor the working parts - hinges, screws, etc.). If the statistics are to be believed, then more injuries on construction sites and at home are caused by a malfunction of the tool or violation of the instructions for use.

It is strongly not recommended to work with a faulty tool. Small defects should be repaired in a timely manner, and to eliminate more serious breakdowns, it is necessary to involve a specialist. Regular checkups and preventive measures contribute to increased productivity and quality levels, as well as eliminate unnecessary financial expenses.

Cleaning and wiping tools daily after a job is one of the golden rules to extend the life of your equipment. To avoid corrosion on metal elements, you should store the tool in a dry state and lubricate working parts with oil in a timely manner, including hinges, axles, threads and other rubbing surfaces.

rules safe operation tools and fixtures and the main recommendations of the manufacturer - these are the main guides for any user. Safety requirements are provided not only by various standards, but also by instructions and working drawings, and are also contained in text documents tool making and repair. Do not ignore the rules when working with tools and devices, it is in your own interests to extend their service life and ensure personal safety.

Applied in construction works ah tool - rule - belongs to the category measuring instruments. With this universal tool, we can maintain accuracy in various repair work. Let's take a look at what's what.

What is a rule - precise definitions

The name of this tool is directly related to measurement terms. For a simpler understanding, this name comes to a greater extent from the term "correctly". In fact, it is such a tool that allows us to carry out construction work correctly and does not allow us to make mistakes. Today it is already difficult to find a construction industry where this miracle tool is not available. What does it represent this device? Usually this is a perfectly flat rail, which allows you to find flaws during a flatness check.

Alternatively, it can be used in wood, but is currently available in metal. Initially construction tool rule was designed to check for dents or bulges on various types planes. While this feature continues to be widely used, the tool has proved useful in other construction jobs as well.

Rule - a tool for plastering and not only

Let's first compare the two versions of this instrument, as we have already said, the rule can be either wooden or metal. But what distinguishes these two types? In theory, these instruments are completely identical, even slats, what can I say. But if you use wooden rule for plaster , then we can say with confidence that in a day it will be impossible to use it.

Everyone knows that plaster is brought to readiness with water. Accordingly, the tree absorbs moisture, and after drying, the wooden guide simply loses its shape, and even edges can become arched. What can not be said about a tool made of metal, aluminum is mainly used. The tool in this design, first of all, is light and convenient, which is a positive indicator during the work. Changing the shape and its failure is excluded, unless, of course, this is mechanical damage.

As mentioned earlier, the matter does not end with the use of a plastering tool, here is a list of construction works where the rule is widely applied:

• Laying tiles, where it is necessary to correctly observe the plane relative to the horizon and vertical.
• Application of soft elastic fillers, in this case the rule is used as a large spatula.
• Tie device, very handy tool for leveling mortar on the floor.
• Ceiling device, just such a tool can help to get a perfectly flat ceiling surface.

Despite these comparative characteristics, both versions of the tool are used in construction. They try to use the rule of wood in work where there is no contact with dampness, metal is used everywhere.

Getting to know each other better - how to use the tool?

I would like to note right away that this line of tools also has its own specifics, which lies in the size of the models. In hardware stores we can find standard set, which includes the dimensions: 1 m, 1.5 m 2 m, 2.5 m. It makes no sense to produce models of longer length, since not every specialist uses the 2.5 m rule. Although a real master has in his arsenal the entire line of models from the shortest to the longest.

If this is the first time you hold a building rule in your hands, we will now tell you how to use this tool with an example. For simplicity, let's check the quality of the wall after plastering. To do this, attach the rule with an edge to the wall, it is desirable that the guide be vertically even. If the wall is plastered with high quality, the rail should not walk vertically, but should fit snugly along the edges to the wall. You also need to check the wall relative to the horizon and diagonally.

If there are bulges on the wall, then our check will immediately detect this, since on the bulge a flat plank will walk without having a snug fit. If there are flaws in the form of depressions on the plane, we can find them by looking at the plane at an angle. Against the background of a flat surface of the guide, gaps in the form of depressions will be visible. If you find flaws in the form of depressions when checking the plane, do not worry, building codes allow such gaps. In the future, putty will hide them. In the case of bulges, the situation is different, they must be unambiguously removed.

Building rule with a level: help to the master

As we have already said, with the help of the rule we observe a certain accuracy during the construction work. But in order to determine the zero mark of the plane, you still have to resort to the help building level. Usually, rules are applied to the edge, and thus the horizontal or vertical plane is checked. This, of course, causes a lot of inconvenience, which can subsequently provide erroneous data.

But today this is over, for the convenience of taking measurements in hardware stores you can buy building rule with level, where the very design of the instrument already provides for built-in measuring cones. The convenience of such a tool is obvious, now it is enough to attach the guide to the plane, and you will see the exact indicators that interest you. In some cases, such a tool is much more convenient than the usual aluminum rule.

A practical example - plastering walls under the rule

Let's get back to the plaster and on this example Let's look at how to use such a tool in practice. Moreover, the rule is associated with plastering more than with other types of work. According to technological data, wall plastering is usually a high-quality work. Also, such plaster can be performed on beacons and without them.. We will focus on plastering with the use of beacons.

1. First of all, you need to install a beacon rail, which will provide us with a future flat surface. The rail is mounted on the wall, using putties, observing vertical alignment and horizontal. All these moments can be controlled by a rule with a level.
2. After that, you just need to give installed beacons settle down. This is done so that the fastening points are qualitatively frozen, and the lighthouse is firmly held on the wall, usually it takes twenty-four hours.
3. After the beacons have settled, you can start plastering. It is desirable that it be elastic, do not make it too thick.
4. Apply with a painter mortar mixture between two light rails. After the pointed side of the rule, cut off the excess.
5. If you see that there are pits on the surface in the form of a lack of mortar, apply additional plaster mixture and delete the excess again by the rule.
6. If your plaster layer thickness exceeds five millimeters, do not try to level the surface immediately, let the first layer settle and dry. If you try to continue working, the applied mortar may begin to fall off due to its weight.
7. After applying the second layer and leveling the surface with the rule, the finished surface must be rubbed with a plaster float and leveled to zero.

It is possible that the first time you will not succeed, but with due diligence, you will very quickly fill your hand and do it with high quality plastering work.