IV. Table of contents of teaching Structural-logical chart of theme
W
ounds
C
lassification
of wounds
C
linical
picture wounds
Types of cicatrization of wounds
Medical treatment of wounds
Table of educational elements.
Wounds
Classification of wounds
On the character of damage
On to the reasons of damage
On inficovanosti
In relation to the cavity of body
The Coloti wounds
Rizani
Chopped
It Is Hammered
Are Lacerated
Are Bitten
Poisonous
Vognepalni
Operating-rooms
Accidental
Aseptic
Inficovani
Penetrable
Unpenetrable
General symptoms of wounds
Local symptoms of wounds
Sharp anaemia
Shock
Infection
Pain
Gaping
Bleeding
Primary
Second
Treatment of skin round a wound by antisepticami
Local anaesthetizing
Primary surgical treatment of wound
Aseptic bandage
V. Reference basis of action
Method of conducting of bandaging of clean wound
Before the beginning of bandaging a doctor dresses sterile gloves. A skin round a clean wound zmazouetsya by the brandy of iodine. By sterile pincers a gauze bandage from a wound is taken off. The review of wound is conducted, palpatsiya of edges with the purpose of early diagnostics of appearance of infiltration of edges, pathological excretions from a wound. Then a wound zmazouetsya by an iodine and is imposed aseptic serviette which is fixed by a sticking-plaster. Attention on the apodactilnist conducting of bandaging applies by a doctor.
Method of care of drainpipes.
Place of bandaging: clean bandaging, chamber of separation of abdominalnoi surgery. A doctor dresses an apron, mask, sterile gloves. Necessarily before the care of drainpipes it is needed to fix the quantity of excretions and their kind (serozni, gemoragichni, serozno-gemoragichni, and others like that). A doctor takes a sterile syringe, by a capacity 10 or 20 ml and connects him to the drainpipe. Then vidtyagoue the piston of syringe to itself, vidsmoctouyochi thus maintenance of tube. When in a tube there is no maintenance, this procedure must be conducted with the other drainages. If there is a necessity, outpour maintenance of syringe in a test tube and order to laboratory researches.
Method of removal of stitches from a clean wound
By clean hands in sterile gloves, by sterile pincers a skin is processed, a serviette from a wound is taken off. Then a wound zmazouetsya by solution of iodine. After it, by pincers a stitch embarks on a knot and is pulled up by pincers and scissors to appearance of white filament. Under her the scissors and filament are tricked into is cut, taken out. Again a wound zmazouetsya by an iodine and is imposed aseptic serviette.
Vі. System of teaching tasks for verification of eventual level of knowledges.
Situation tasks.
A patient entered permanent establishment concerning the for a slaughter wound of frontal area which he got 5 hours backwards. How to treat a wound?
Answer: the shown primary surgical treatment of wound with the economy carving of edges of wound and walls of wound with imposition of primary stitch.
At a patient the wound of front abdominal wall which is located in a right zdouhvinniy area is determined. At a review: a skin is pale, AT 100/60 mm rt.st., pulse 124 in 1 hv . It is exposed at implementation of primary surgical treatment of wound, that she gets to the abdominal region.
Diagnose. What surgical tactic?
Answer: a patient has the clinical picture of wound of front abdominal wall which gets to the abdominal region, internal bleeding?. To the patient shown laparotomiya, revision of organs of abdominal region. In the case of bleeding - stop of bleeding and conducting of zaminnicovoi gemostatichnoi therapy.
A patient acted concerning the for a slaughter wound of the left forearm, which he got 12 hours backwards. Wound not clean. A patient needs to be transported on large distance. Edges of wound of giperemovani, has not the slight swelling of edges of wound. Whether the shown primary surgical treatment of wound and what its features?
Answer: to the patient the shown primary surgical treatment of wound with imposition of the primary-deferred stitch.
A patient with two sword-cuts on palm's surface of the left brush acted in the surgical separation, which he got 3 hours backwards. What features of primary surgical treatment of such wounds?
Answer:Особливістю primary surgical treatment of wound there is the economy carving of edges and walls of wound, that to prevent formation of defect of skin, natyag of edges of pislyaoperatsiynoi wound in the place of stitches, formation of rough deforming scars, tension of function of brush.
In the surgical cabinet of district policlinic a patient which 3 hours was backwards bitten by an unknown dog is delivered. At a review: on a right shin six bitten-lacerated wounds filled by blood clots are exposed, with the easy edema and bolyochistyo round. What volume of help is needed to give to the patient?
Answer: the bitten wounds are not sewn up. It is necessary to conduct the rest room of wound, to process a skin round them by yodovmisnim antisepticom and impose an aseptic bandage. In addition, a patient needs to do the prophylactic inoculations against hydrophobia (antirabichna) and stupor.
Asked you to give first help to the man which half a hour therefore fell down with to the bicycle. On the external surface of right shin there is the large hammered-lacerated wound muddy by sand and dry grass. In Your arsenal there is a motor-car medicine chest. What volume of help you will you give to the victim?
Відповідь: перш за все потрібно дати хворому знеболюючі препарати. Потім обережно видаляються видимі чужорідні тіла. Шкіру навколо рани потрібно обробити 5 % спиртовим розчином йоду і накласти на гомілку стерильну бинтову пов’язку (спіральну з перекрутом бинту). Після цього потрібно організувати транспортування хворого у лікувальний заклад, де можливе надання кваліфікованої допомоги. Промивати водою або витирати рану перед накладанням пов’язки не потрібно.
Не переводится компьютером!!!
In a hospital a patient with a sword-cut is delivered by sizes 2,5х0,4 sm in overhead third of right forearm, which inflicted unknown him 2 hours backwards. What volume of surgical help is needed to give to the patient?
Answer: a patient has a fresh rizana wound with even and free of necrosis edges, that allows to expect on primary cicatrization. With the purpose of prophylaxis of second inficouvannya a skin round a wound must be processed by solution of antiseptica, to stop bleeding, to carve edges and bottom of wound, to impose primary stitches. Also it is needed to conduct the urgent prophylaxis of stupor.
A patient with the lacerated wound of the left thigh acted in the surgical separation. 12 Hours passed from the moment of wound. At a review the easy edema of fabrics round a wound is marked, the edges of wound are unequal, sinyoshni. What medical tactic you will you choose?
Answer: in this case even in default of symptoms of inflammation to hope on cicatrization of wound by primary natyagom it does not cost without surgical treatment. In the conditions of operating-room a wound needs to be widely cut, that it was possible to see its all parts at back, to carve necrotizovani and nonviable fabrics and impose primary stitches. Between stitches the wound it is necessary by drenouvati rubber ribbons. The prophylaxis of stupor is conducted necessarily.
In a travmatologichniy point a patient with the cosopoperechnoyo inficovanoyo sword-cut of palm's surface of right brush is delivered. Active bend motions in the migfalangovih joints of the II-IV fingers are absent. About the damage of what anatomic educations it is needed to think? What Your medical tactic?
Answer: a patient has the inficovana rizana wound of right brush with the damage of tendons of superficial and deep zginachiv of the II-IV fingers. It is necessary to process a skin round a wound by yodovmisnim antisepticom, to conduct the final stop of bleeding, to wash a wound by solutions antiseptichnimi and put in several stitches. To impose a primary stitch on tendons, including on nerves not desirably. Last it is possible only a bit to draw together.
A patient with the blind coloto-rizanoyo wound of the left shoulder came in the induction centre. Got the wound 4 days ago. In the area of wound the slight swelling is determined, bolyochist. From a wound серозно-festering maintenance in a two-bit is selected. The surgeon of induction centre executed the high-quality rest room of wound, tightly tamponouvav by its tampon, moistening him by hypertensive solution of chloride of sodium, imposed a bandage. To the patient the executed urgent specific prophylaxis of stupor. What error was assumed by a surgeon?
Answer: an error consists in tamponouvanni of wound, that is a barrier for the ranovogo outflow and can assist to subsequent development of festering process.
In a travmatologichniy point a patient with the large scalped wound of hairy part of head is delivered. A trauma happened 1,5-2 hours backwards. He the stupor sick prishepleniy. What volume of skilled help is needed to give to the patient?
Answer: foremost it is needed widely to cut a hair round a wound. A wound must be carefully cleaned from contaminations, well to wash by antisepticami, fully to remove a hypodermic fatty cellulose from part of the scalped skin, and also carve crumpled, sinyoshni and the crov’yo edges impregnated with. Farther in a chess order the perforativni opening on the scalped part of skin are inflicted. The last is laid on a wound and fixed by separate stitches to its edges.
In a district hospital there is the delivered boy which half a hour was therefore bitten by a snake. A child grumbles about pain in a right foot. A boy is put on the brakes, sleepy. On the rear of foot two little wounds with a hemorrhage in their area and expressed edema are found. Your actions?
Answer: a patient higher than place of bite must quickly impose a plait with the purpose of creation of vein stagnation (peretiscannya of arteries is impermissible). In the place of bite and intramuscular in an intershovel area enter on 10 ml polivalentnoi antitocichnoi protizmiinoi whey. From wounds it can vidsmoctati poison by a bloodsucking jar, the place of bite is carved sometimes. It is needed to create rest to the staggered extremity on 3-4 days. Desirably to execute a circular novocaine blockade the place of bite 0,5 % by solution of novocaine and 0,1-0,2 ml 0,1 % solution of adrenalin, and also intravenously to enter 5 ml 10 % solution of calcium of chloride.
In the medical card of sick P., 43 years, hospitalized in surgical permanent establishment, a duty surgeon did a record about conducting of primary surgical treatment of wound. What volume of help was executed by a surgeon?
Answer: carved edges, walls and bottom of wound; stopped bleeding; deleted foreign bodies; deleted nonviable fabrics.
In the surgical separation it is delivered the victim F., 40 years, which got the vognepalne wound of thigh 14 hours backwards. What maximally possible terms of primary surgical treatment of wound from the moment of wound?
Answer: to 24 hours
In a policlinic a boy, 9 years, is delivered, with the wound of right shoulder. According to the victim, he was struck to the edges of ink-pencil by a comrade on a school desk. At a review on the lateral surface of shoulder there is a point wound with the slight swelling round. Next to her under a skin a strange body rozmirom 0,3х0,5 sm is determined. What help it is necessary to give to the child?
Answer: it is needed to carve the site of damage together with the tag of pencil, to impose pharmacist stitches.