Methodical pointing to work of students on practical employment

The thematic module 3.

General anaesthesiology is that reanimation

Practical employment № 11

Theme: local anaesthesia

Theoretical questions for the vneauditornogo independent study and discussion to practical employment № 11:

1. Value of local anaesthesia during conducting of surgical interferences and bandaging of sick.

2. Feeling of patient during conducting of local anaesthesia.

3. Determination of local and general anaesthesia.

4. Types of local anaesthesia.

5. Preparations which use for local anaesthesia.

6. Testimonies and contra-indications to local anaesthesia, and also advantages before other methods of anaesthetizing.

7. Technique of conducting of infiltration anaesthesia.

8. Technique of conducting of local anaesthesia on Oberstu-Lukashevichu (=3).

Literature:

Basic:

1. Metodichnі rozrobki for auditornoї that samostіynoї roboti studentіv.

2. Zagalna hіrurgіya / After red. S.P.Guchenko, M.D.Gelіbi, S.D.Hіmіcha – Kiїv.: Zdorov’ya, 1999.

3. Cherenko M.P., Vavrik G.M. Zagalna hіrurgіya z anestezіologієyu, by the bases of reanіmatologії that to doglyadu after hvorimi – Kiїv.: Zdorov’ya, 1999.

4. Gostishev V.K. General surgery: Studies. – M.: Medicine, 1993.

5. Gostishev V.K. "Guidance to practical employments on general surgery". M., "Medicine" - 1987.

Additional:

1. A.A. Simodeyko, S.S. Fіlіp, O.O. Boldigar Zagalna hіrurgіya in pitannyah і vіdpovіdyah. Uggorod, «Іva» - 2005.

2. A.A. Simodeyko, S.S. Fіlіp, O.O. Boldigar, Panto V.І. By Praktichnі naviki z zagalnoї hіrurgії z doglyadom after hvorimi. Uggorod, UgNU. – 2001.

Distributing of marks which are appropriated to the students:

At mastering of theme № 11 from rich in content to the module № 3 for educational activity to the student the estimation for 4th is proposed by a ballnoy (traditional) scale which are after converted in marks as follows:

Estimation	Marks
“5”(fine)	6 marks
“4” (well)	4 marks
“3”(satisfactorily)	2 marks
“2” (unsatisfactorily)	0 marks

Tests and tasks for verification of initial level of knowledges

A general anaesthesiology is that reanimation

What diseases the method of local anaesthesia on Lukashevichu-Oberstu is used at?

paranefrit

nail growing in

paraproktit

pankreonekroz

whitlow

asphyxia

What solutions can be used for local anaesthesia?

furagin

dikaїn

ftorotan

gemodez

novokaїn

poliglyukin

How does pain on a basic exchange operate?

the selection of adrenalin is multiplied

the selection in the blood of tiroksina diminishes

the selection of gistamina diminishes

the selection of serotonin diminishes

the selection of prostaglandina is multiplied

the selection of quinine diminishes

What solution of novocaine is used at vnutrikostnoy anaesthesia?

0,5 %

2%

3%

1%

0,25%

5%

Testimonies for retromammarnoy anaesthesia?

flegmonoznaya phase of mastitis

infiltration phase of mastitis

gangrenous phase of mastitis

retromammarniy abscess

seroznaya phase of mastitis

subareolyarniy abscess

What a vagosimpaticheskaya blockade is used for?

for the prophylaxis of reflex asphyxia

for the removal of paresis of intestine

for medical treatment of plevro-pulmonalnogo shock

for the prophylaxis of fibrillyatsii of ventricles of heart

for prophylaxis of plevro-pulmonalnogo shock

for poslableniya of musculature and prophylaxis of paraplegia

Anaesthesia after periduralnoy anaesthesia comes through:

5 minutes

10 minutes

15 minutes

20 minutes

25 minutes

30 minutes

What variety of local anaesthesia preliminary imposition of plait is needed at?

anaesthesia by cooling

vnutrisosudistaya anaesthesia

periduralnaya anaesthesia

vnutrikostnaya anaesthesia

the combined anaesthesia

spinal anaesthesia

For the repozitsii break of radial bone it is possible to apply in the lower third?

infiltration anaesthesia

case blockade

anaesthesia by greasing

introduction of a 2% novocaine to the haematoma of site of fracture

periduralnuyu anaesthesia

blockade on Kulen-Kampfu

What complication meets at implementation of paranefralnoy novocaine blockade?

necrosis of fabrics

allergic reaction

wound of bud

regurgitatsiya

peredozirovanie

wound of ureter

What signs of poisoning of anestetikami at local anaesthesia?

shortness of breath

violation of cerebral circulation of blood

bradikardiya

anuriya

expansion of pupils

dizziness

What from the transferred methods of local anaesthesia behave to the explorers?

anaesthesia by cooling

anaesthesia by greasing

periduralnaya anaesthesia

endarterial anaesthesia

spinal anaesthesia

vnutrikostnaya anaesthesia

What complication can arise up at anaesthesia by novocaine?

peredozirovanie

anafilakticheskiy shock

accidental introduction of preparation to the artery

kropivnitsa

accidental introduction of preparation to the vein

the chemical irritation of fabrics is necrosis

What solutions of novocaine can be used for a paranefralnoy blockade?

1%

5%

10%

2%

0,25%

0,5%

What preparations are applied at medical treatment of poisoning of anestetikami?

antibiotics

cardiac glikozidi

proteoliticheskie enzymes

antihistaminic preparations

anticoagulants

mishechnie relaksanti

Situation tasks.

Sick L., 37 years, works of mine, entered clinic concerning пахвово-scrotum hernia. Three years are ill. During the last three months the hernia was twice hurt, however the restriction quickly has passed single-handed. Operative medical treatment is shown. It is definite, that expediently to execute the operation under the local anaesthetizing. Hallmarked on a sensitiveness to novocaine, the result of which is considered as sharply positive. Whether possible implementation of interference under the local anaesthetizing?

Sick, 43 years, a driver complains on pain in an epigastralnom area, heartburn, loss of mass of body, seasonal intensification of disease. It is ill 8 years ulcerous illness of duodenum. In connection with intensification, during a month treated oneself in the gastroenterology separation without the expressed effect. It is translated in surgical permanent establishment. On the second days after hospitalization the abundant bloody vomiting began suddenly . The diagnosed bleeding from a duodenal ulcer, deficit of volume of circulatory blood 1,5 litres, composition of blood is not changed, the deficit of vnekletochnoy liquid is not present. The conducted conservative gemostaticheskaya therapy. Bleeding is stopped. After days the decline of quantity of red corpuscles and haemoglobin in bloods, insignificant deficit OTSK is definite, deficit of intertissue liquid to 18%. What factors affected its redistribution, that provides constancy of composition of blood and water spaces of organism of man? In the case of operative interference or possible resection of stomach under local anaesthesia by infiltration of his svyazochnogo vehicle on all perimeter? What the N.I. Pirogova study about the case structure of fabrics consists in?

A patient 35 years, seamstress, entered clinic concerning chronic paraproktita. At the inspection other diseases are not exposed. Protipokazan to the operation it is not. Carving of svisha is shown. The executed spinal-cerebral anaesthesia at the level of L lV-V 1% by solution of sovkaina. What anatomic educations are passed by a needle in the area of spine, between the L IV-V vertebrae, to be before included in a spinal-cerebral channel? Why is it impossible to conduct spinal-cerebral anaesthesia at a level higher than the D-XII vertebra?

Patient with, acted with complaints on pain in the area of the left podmishechnoy cavity, general weakness, indisposition, rise of temperature of body to 38 degrees. Considers itself a patient about 24 hours, when pain in the area of the left podmishechnoy cavity appeared . At examination in this area infiltrat is determined by sizes 3х2 see. Skin round him giperemirovana, are present signs of flyuktuatsii. What testimonies to operative interference? What type of local anaesthesia will you offer?

Sick T., entered proktologicheskoe separation with complaints about pain in the area of anus, which increases during the act of defecation, festering excretions near a rectum, general weakness. At outward examination in 2 sm. from an anal edge, on 9 hours the outward opening of svisha is determined, by a diameter to 0,2 mm At finger research of rectum in area of back kripti is determined internal opening of svisha. Palpatsiya of her is sickly. Motion of svisha of transfinkterniy. DIAGNOSIS: Back transsfinkterniy rectal svish. Surgical medical treatment is shown - deleting of svisha on the first method of Gabrial. What type of local anaesthesia must be applied?

A patient with entered surgical to the separation with a diagnosis: abscess of posleoperatsionnogo scar of front abdominal wall, the state after taking of ileostomi in. At examination in the right half of stomach, in the area of posleoperatsionnogo scar, dense moderately sickly infiltrat is determined 10х15 sm with softening influence in a center. Under local infiltration anaesthesia, opening of abscess is done. During conducting of anaesthesia by a mistake a 10% solution of lidokaina was used, as a result at a patient there was the picture of the sharp poisoning. What will be clinical picture of display of poisoning by the anaesthetic matter?

Patient with L., entered clinic with complaints on pain in the area of anus, selection of bright red blood from a rectum during the act of defecation. At finger research of rectum megascopic internal haemorrhoidal knots are determined. On 6 o'clock of conditional clock-face - chronic crack of anal channel with kaleznimi edges, long to 1 sm. In the planned order a patient is operated. For anaesthetizing epiduralno-sakralnaya anaesthesia is used. In 15 minutes, after the beginning of operation, a patient suddenly lost consciousness, there were cramps. What it is necessary to take measures for the fight against complication which arose up?

Sick N., on the third days after appendektomii, the displays of intestinal impassability appeared, it is possible spaechnogo geneza. For differential diagnostics there is the shown paranefralnaya novocaine blockade. Where to execute punktsiyu, how to enter anestetik?

At sick N., 28 years, with the hypodermic whitlow of middle phalanx of the ІІ finger of right brush the temperature of body to 38о rose S. Poyavilas pulsating pain, edema of finger. What your tactic? Choose the type of anaesthetizing.

Patient To., 74 years, entered clinic on the first-aid concerning the hurt right-side inguinal hernia. It is ill concomitant illnesses: by bronchial asthma, saccharine diabetes. What your actions? What type of anaesthetizing you use and why? What concentration of solution of novocaine will you apply in this case?

After successful implementation of operation of apendektomii concerning sharp flegmonoznogo appendicitis (under infiltatsionnoy anaesthesia) at a patient the hyperemia, dermatitis, appeared in 3 hours, edema of fabrics in the area of operative interference, signs of serdechno-sosudistogo collapse (pallor, sticky death-damp, drop in the temperature of extremities, sharp decline of arterial pressure). About development, what complication it is possible to think? Appoint medical treatment.

To sick N., 67 years, spinal anaesthesia for amputation of the left lower extremity was conducted (concerning a moist gangrene). During conducting of anaesthesia of patient began to grumble about a stuffiness, lost consciousness. Skin covers of steel of tsianotichnimi, HELL went down to 80/60 to mm of rt item What complication arose up at a patient?

At a patient with P., 23 years, pregnancy is diagnosed 20 weeks, hypodermic abscess of right buttock. What medical treatment to appoint as a patient? How to anaesthetize a patient?

After DTP there is the driver of machine without consciousness, very pale. In 40 minutes the brigade of first-aid of signs of breaks of bones did not expose. On a forehead there is a cone-shaped haematoma. HELL 80/50 mm of rt st; pulse 144 ud/min. A stomach is soft, takes part in the act of breathing. At palpatsii of ribs – krepitatsiya on a right middle-clavicular line. Breathing frequency 27 for a 1 minute. What threatening complication can develop at a patient? How profilaktirovat him?

In a surgical cabinet the victim is delivered with the sword-cut of lower third of right shoulder measuring 3х0,5 sm, which he got during a fight in the street (after a trauma passed 18 hours). What help it is necessary to give to the patient in permanent establishment? What method of local anaesthesia will you offer for anaesthetizing?