The methodical pointing for work of students on practical employment

Semantic module 4.

Traumatism and damage

Practical employment # 14

Theme: wounds and wound process. Prophylaxis of development of infection in a wound. Treatment of clean wounds

Theoretical questions are for a study and discussion:

1. Features of surgical structure of wounds, which matters for motion, diagnostics and their treatment.

2. Classification of wounds.

3. Clinical symptoms of wound.

4.Diagnostic features of separate types of wounds;

5. Modern phases of wound process and it diagnostic value;

6. Method of anaesthetizing and method of primary surgical treatment for patients with clean wounds.

7. Method of carrying for bandaging of clean wound.

8. Method of care of drainage tubes.

9. Method of remove of sutures from a clean wound.

Literature:

4. Butursky A. “General surgery”. (Simferopol 2004)

5. S. I. Shevchenko; A. A. Tolkoglas and etc. “Surgery” (Kharkov 2004)

6. Methodological Instruction.

Distributing of marks which are appropriated students:

At mastering of theme 14 from rich in content the module # 4 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

wounds and wound process. Prophylaxis of development of infection in a wound. Treatment of clean wounds

1. For a fresh|esh| wound characteristically all, except for:

6. to the chylorrhea

7. pain

8. bleeding

9. cramps of muscles

10. cleft (hiatus)

2. What the degree of gaping of wound is related to:

7. in depth damage

8. by localization of wound

9. by the damage of nervous barrels|trunk|

10. by the damage of fascies

11. by the damage of muscles and tendons

12. by direction of elastic fibres of skin

3. Microorganisms at the primary infecting get in a wound from:

7. to pincers at bandaging, at debriding

8. scalpel

9. hands of surgeon

10. skins of injured

11. surgical filaments

12. clothes of patient

4. What wounds heal over quick other:

7. cut wound

8. chopped wound

9. bitten wound

10. hammered wound

11. scratch wound

12. crush wound

5. In a wound many factors assist development of infection, except for:

7. haematomas

8. damage of nerves

9. blood loss

10. shock

11. exhaustion

12. to absence of foreign bodies

6. For the local signs of inflammation characteristically all, except for:

7. edema

8. cyanosys

9. increase of temperature

10. violation of sensitiveness of skin

11. parafunction

12. pain

7.In what wounds more reliable development of infection?

7. cut

8. bitten

9. chopped

10. firing

11. placed on face

12. scalped

8. There is a wound with the limited area of necrosis of edge of skin. What does need to be executed?

7. to conduct the urgent prophylaxis of tetenus

8. to appoint UVCH to the wound

9. to impose a bandage with hypertonic solution

10. to impose a bandage with ointment of Vishnevskiy

11. to drain a wound

12. to carve the dead area of skin

9.For I of phase of wound healing in a clean wound characteristically all, except for:

7. to development of acidosis

8. increase of quantity of hydrions

9. increase of ions of calcium

10. increase of quantity of ions of kalium|

11. increase of permeability of vessels

12. to development of alkalosis

10. There are different types of healing of wound, except for:

7. primary

8. detained

9. under a scab

10. repeated

11. secondary

12. deferred

1. A patient entered to surgical department with slaughter wound of frontal area which he got 5 hours ago. How do treat this wound?

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?

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?

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?

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?

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?

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?

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?

ANSWERS

Tests:

1 – a, d;

2 – b, f;

3 – d, f;

4 – a, e;

5 – b, f;

6 – b, d;

7 – b, d;

8 – a, f;

9 – c, f;

10 – b, d;

Tasks:

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. 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.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.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.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.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.Answer: carved edges, paries and bottom of wound; stopped bleeding; removed foreign bodies; removed nonviable fabrics.

8.Answer: 24 hours