IV. Table of contents of studies Structurally logical chart of theme|
Wounds
Classification of wounds
Clinical symptomsof wounds
Types of healing of wounds
Treatment of wounds
Table of educational elements.
Wounds
Classification of wounds
On character of damage
For to cause of damage
Infected
In relation to a perigastrium
Split wound
Cut
Chopped
Hammered
Lacerated
Bitten
Poisonous
Firing
Postoperative
Casual
Aseptic
Infected
Penetrable
Nonpenetraiting
General symptoms of wounds
Local symptoms of wounds
Acuteanaemia
Shock
Infection
Pain
Gaping
Bleeding
Primary
Secondary
Treatment of skin around a wound by antiseptics
Local anaesthetizing
Surgical treatmentof wound
Aseptic bandage
V. Reference basis of action
Method of bandaging of clean wound
Before the beginning of bandaging a doctor puts on sterile gloves. A skin around a clean wound grease the tincture of Iodine. Sterile pincers are take off a gauze bandage from a wound. The examination of wound, palpation of edges is conducted with the purpose of early diagnostics of appearance of infiltration of edges, pathological excretions from a wound. After that a wound grease an Iodine and add an aseptic serviette which is fixed a sticking-plaster.
A method of care of drainage tubes.
Place of bandaging: clean bandaging room, chamber of department of abdominal surgery. A doctor puts on an apron, mask, sterile gloves. Necessarily before the care of drainage tubes it is needed to fix the quantity of excretions and their kind (serosal, hemorragic, serosal-hemorragic, and others like that). A doctor takes a sterile syringe by a capacity 10 or 20 ml and connects it to the drainage tube. After draws off the piston of syringe to itself with aspiration contentof tube on this grow. When there is not content in a tube, this procedure must be conducted with other drainages. If there is a necessity, contentce of syringe is outpoured in a test tube and order to laboratory researches.
A method of removing of sutures from a clean wound.
By clean hands in sterile gloves, sterile pincers are process a skin, a serviette is taken off from a wound. After that a wound grease solution of Iodine. After that sutures embark pincers on a knot and pulled up pincers and scissors to appearance of white filament. Under it scissors and filament are tricked into cut, taken out. Again a wound grease an Iodine and an aseptic serviette is imposed.
VI. System of teaching tasks for verification of eventual level of knowledge.
Situation tasks.
1. A patient entered to surgical department with slaughter wound of frontal area which he got 5 hours ago. How do treat this wound?
1.Answer: the primary surgical treatment of wound with the economy carving of edges of wound and paries of wound with imposition of primary sutures.
2. Patient has the wound of front abdominal wall which is located in a right iliac area. At a examination: a skin is pale, arterial pressure is 100/60 , pulse is 124 in 1 min . At implementation of primary sergical treatment found that this wounds it gets to the abdominal region.
Diagnose. What is surgical tactic?
2. Answer: this patient is with clinical picture of wound of front abdominal wall which gets to the abdominal region, internal bleeding?. Laparotomiya, revision of organs of abdominal region is rotined a patient. If we find internal bleeding we must stop it..
3. To surgical department entered a patient with two sword-cuts on palm's surface of the left brush, which he got 3 hours ago. What features of primary surgical treatment of those wounds?
3.Answer': economy carving of edges and paries of wound, to prevent formation of defect of skin, drew on edges of postoperative wound in the place of sutures, formation of rough deforming scars, tension of function of brush.
4.A patient which was 3 hours ago bitten by an unknown dog is delivered to the surgical cabinet of district policlinic. At a examination: on a right shin found six bitten-lacerated wounds, filled blood clots, with an light edema and sickliness around. What help does need to be given a patient?
4.Answer: the bitten wounds are not sewn up. Around of them to process a skin iodic antiseptic and impose an aseptic bandage. In addition, it is needed to do prophylactic inoculations a patient against rabies and tetanus.
5. To a hospital a patient is delivered with a sword-cut by sizes 2,5x0,4 sm in top third of right forearm, which the unknown inflicted him 2 hours ago. What volume of surgical treatment does need to be provide a patient?
5.Answer: for a patient a clean sword-cut is with even and free of necrosis edges, that allows to expect on primary cicatrization. With the purpose of prophylaxis of the secondary infecting skin round a wound it is necessary to process solution of antiseptic, to stop bleeding, carve edges and bottom of wound, impose primary sutures. It is also needed to conduct the urgent prophylaxis of tetanus.
6.In a traumatology department a patient is delivered with infected sword-cut wound of palm's surface of right brush. Active bend motions absent in the interphalangeal joints of II-IV of fingers. About the damage of what anatomic formations is it needed to think? What is Your medical tactic?
6.Answer: patient with the sword-cut of right brush is infected with the damage of tendons of superficial and deep flexors of II-IV fingers. It is necessary round a wound to process a skin iodic antiseptic, to conduct the final stop of bleeding, wash a wound using antiseptic solutions and to put in several stitches. To impose primary sutures on tendons, including it is not desirable on nerves. Last possibly only a bit to draw together.
7. In the medical card of patient P., 43 years, hospitalized in surgical department, a surgeon did a record about the primary surgeon treatment of wound. What volume of help did this a surgeon?
7.Answer: carved edges, paries and bottom of wound; stopped bleeding; removed foreign bodies; removed nonviable fabrics.
8.A victim R. is delivered to a surgical department with firing wound of thigh that he got about 14 hours ago. What are maximally possible terms of primary surgical treatment of wound from the moment of wound?
8.Answer: 24 hours
Distributing of marks which are appropriated students:
At mastering of theme 11 from rich in content the module # 3 for educational activity an estimation is proposed a student for traditional scale which converted to points as follows:
-
Estimation
Points
“5”(fine)
6 points
“4” (well)
4 points
“3”(satisfactorily)
2 points
“2” (unsatisfactorily)
0 points