The module 2: surgical infection. Bases of clinical oncology. Curation of surgical patients. The thematic module 1

Surgical infection. Necrosis

Practical employment №26

Theme: General suppurative infection (sepsis). Еndogenous intoxication at a surgical infection

І. Actuality of theme

The amount of patients grows a sepsis. Depending on the form of sepsis and variety of exciter lethality hesitates within the limits of 24-90 %. To weight of diagnostics of sepsis testifies circumstance that 23 % patients a correct diagnosis was set only post mortem. Complication of problem is yet and in then, that only at 45 % patients with the clinical displays of sepsis it is succeeded to find out bacteriemia.

In 2003 experts are in area of reanimation, intensive therapy and infectious diseases, presenting 11 international organizations developed recommendation on the conduct of patients with a heavy sepsis. These recommendations are developed under an aegis international motion «For the survival of patients with a sepsis».

The modern pictures of endogenous intoxication are linked, above all things, with the concept of multiorgan or plural insufficiency of organs. Thus there is nongraded or gradual development of insufficiency of heart, lights, liver, buds, brain and other, that results in high lethality (from 60 to 80% and higher). Diagnostics of violations of metabolism, as a rule, does not have time after development of pathological processes, including in a kind the imperfection. All of it does the problem of diagnostics and treatment of endogenous intoxication of very relevant.

Swift growth of amount of HIV-infected among surgical patients generates the row of problems, today unusual for practical doctors. Separate calculations show that risk of HIV-infecting through pricks 3% makes a needle for 5000 days of work with by patients AIDS. It is proved that among 18 000 American surgeons 47 to the end of life will have professionally purchased AIDS.

By the feature of epidemic AIDS in Ukraine is his primary distribution in the environment of parenteral drug addicts. In particular, from data of testing of association of "UNO AIDS", to 70% inspected drug addicts appeared HIV-infecting, and, consequently, they make dominant today in sew on to the country risk group.

ІІ. Aims of employment:

1. To know modern positions of concept sepsis, classification of sepsis (α=ІІ)

2. To know pathogenetic features of flow, modern methods of diagnostics and principles of treatment of sepsis (α=ІІ)

3. To know the theory of endogenous intoxication at a surgical infection, methods of deintoxication and immunocorrection (α=ІІ)

4. To know general information about HIV-infection, AIDS; surgical aspects of drug addiction (α=ІІ)

5. Able to set a role and place of laboratory-instrumental diagnostics in forming of diagnosis sepsis and endogenous intoxication (α=ІІІ)

6. Able to ground and build the plan of individual complex treatment (α=ІІІ)

7. Able to conduct measures in the case of contact with material, containing HIV in obedience to an order Ministry of Public Health of Ukraine №120 from 25.05.2000 (α=ІІІ)

Literature:

Basic:

1. Butyrsky A. General surgery. – Simferopol. 2004.

2. Gostishchev V.K. General surgery / The manual.– M.: GEOTAR-MED, 2003.– P. 182-186.

Additional:

1. Kushnir R.Lectures of General surgery. – 2005.

2. Methodological recommendations on surgical patients care. – Vinnitsa National Pirogov Memorial medical university. 2007.