V. Reference basis of action

Method of conducting of infiltration anesthesia of skin

At first through a thin needle a «lemon crust» is created due to intercutaneous introduction of anesthetic. Then – the layered introduction 0,25 % solution of Novocain. Through the principle of tight creeping infiltrate, that spreads through the and aponeourosis sheaths, we continue a similar infiltration of tissues that are found below.

Method of conducting of explorer anesthesia on Oberstu-Lukashevichu

In the basis of finger we use tourniquet. Distally from the tourniquet, from a back surface, a needle is entered with a 2-5 ml syringe, filled with anesthetics. By introduction of the solution of anesthetic into the skin, the hypodermic cellulose of this area is anaesthetized. Then, conducting a needle on the lateral sides of basic phalanx of finger, thwart his surfaces, bring anesthetic into a subcutaneous subfatty cellulose and anaesthetize the nerves of finger in this place. For both sides, as a rule, use 5-8 ml 1 % solution of Novocain.

VI. System of teaching tasks for verification of eventual level of knowledge.

Situation tasks.

1. Patient L., 37 years, works in a mine, entered in the clinic with an inguinal scrotal hernia. For three years he has been ill. During the last three months the hernia was twice compressed however the restriction quickly has passed. Operative medical treatment is shown. It is definite, that expediently to execute the operation under the local anaesthetizing. Hallmarked on a sensitiveness to Novocain, the result of which is considered as sharply positive. Whether possible implementation of interference under the local anaesthetizing?

1. Answer: Implementation of operation it is possible under the local anaesthetizing, as an allergic reaction of organism behaves to Novocain only. Consequently, it is necessary to find drug, which the allergic displays of organism of patient will not be present to .

2. A patient 35 years, seamstress, entered clinic concerning chronic paraproctittis. At the inspection other diseases are not exposed. The executed spinal-cerebral anesthesia at the level of L lV-V 1% by solution of Sovkain. 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 anesthesia at a level higher than the D-XII vertebra?

2. Answer: In the process of implementation of spinal-cerebral anesthesia a punction needle passes through a skin, hypodermic cellulose, megostistie copulas, yellow copula, hard brain-tunic. Spinal-cerebral anesthesia higher the XII pectoral vertebra is not conducted, as a diaphragm and proper intercostal muscles is turned off from breathing. The stop of breathing can come.

3. Patient acted with complaints on pain in the area of the left subaxillary 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 subaxillary cavity appeared . At examination in this area - inflamated tissues are determined by sizes 3х2 sm. Hyperemia of skin are present, fluctuation. What testimonies to operative interference? What type of local anesthesia will you offer?

3. Answer: at a patient absolute testimonies to operative medical treatment – acute purulent surgical disease (abscess). The shown infiltration anesthesia by Vishnevskiy.

4. Patient T., entered proctologic department 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 fistula is determined, by a diameter to 0,2 mm. Palpation of it is sickly. Diagnosis is back rectal fistula. Surgical medical treatment is shown - deleting of fistula on the first method of Gabrial. What type of local anesthesia must be applied?

4. Answer: spinal anesthesia.

5. A patient entered surgical to the department with a diagnosis: abscess of postoperative scar of front abdominal wall, the state after taking of ileostome in. At examination in the right half of stomach, in the area of postoperative scar, dense moderately sickly infiltrate is determined 10х15 sm with softening influence in a center. Under local infiltration anesthesia, opening of abscess is done. During conducting of anesthesia by a mistake a 10% solution of Lidokain was used, as a result at a patient there had the symptoms of the acute poisoning. What will be clinical picture of display of poisoning by the anaesthetic matter?

5. Answer: Dizziness, nausea, weakness, death-damp, frequent pulse of the weak filling, decline of arterial pressure.

6. 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 hard edges, long to 1 sm. In the planned order a patient is operated. For anaesthetizing epidural-sacral anesthesia 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?

6. Answer: It is necessary to enter cardiac facilities, glucose, poliglyukin. For the removal of cramps in a rectum barbiturates is entered. Necessary inhalation by oxygen.

7. In patient N., on the third days after appendectomy, the displays of intestinal impassability appeared. For differential diagnostics there is the shown pararenal Novocain blockade. Where to execute punction, how to enter anestethic?

7. Answer: Punction at the level of bisector of corner between long muscles and costal arc, conducting of needle without a blood and liquid to feeling of failure.

8. At patient N., 28 years, with the hypodermic panariciy of middle phalanx of the ІІ finger of right brush the temperature of body to 38 degree. Patient feels pulsating pain, edema of finger. What your tactic? Choose the type of anaesthetizing.

8. Answer: at a patient there is the acutepurulent disease of finger – panariciy. Coming from that the state of patient became worse, it follows to consider that at a patient the stage of abscess of this disease. To the patient the shown urgent operative interference – opening and drinage of abscess. The operation needs to be conducted under anesthesia by Oberst-Lukashevich.

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

9. Answer: the hurt inguinal hernia is a testimony to the exigent surgical operation. As a patient declining years, with the present heavy concomitant diseases, common anaesthetizing to him contra-indicated. By the method of anaesthetizing it is needed to choose local anesthesia, namely – peridural.

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

10. Answer: the symptoms of poisoning to local anestethic developed at a patient. For getting a patient out of this state we appoint antihistaminic, cardiac, anaesthetic preparations.

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