- •The module 2: surgical infection. Bases of clinical oncology. Curation of surgical patients. The thematic module 1
- •Practical employment №26
- •III. Tests for verification of initial level of knowledges
- •IV. Table of contents of teaching
- •Endogenous intoxication at surgical infection. Methods of detoxication and immunocorrection
- •I. Methods of dialysis and filtration.
- •II. Plasmapheresis.
- •III. Sorptive methods.
- •VI. Spleenoperfusion.
- •Features of care and treatment of hiv-infection
- •In surgical department
- •Surgical aspects of drug addiction
- •V. Reference basis of actions
- •Drew out from an order of Public Health Ministry of Ukraine №120 from 25.05.2000
- •To the hiv-infection/aids patients"
- •Composition of medicine chest of "anti-aids"
- •Vі. Tasks for verification of eventual level of knowledges.
- •Vіі. Method of conducting and organizational structure of employment
- •Methodical pointing for work of students on practical employment The thematic module 1
- •Practical employment №26
V. Reference basis of actions
Table 1. Scale of Glasgow for determination of heaviness of coma
|
Index |
Numbers |
Maximum value |
|
Opens eyes: spontaneously on a call at a pain irritation there is not a reaction |
4 3 2 1 |
4 |
|
Speech: distinct entangled incoherent words illegible sounds absent |
5 4 3 2 1 |
5 |
|
Motions: executes commands can specify a sick place pulls back extremity at a pain irritation bending in reply to pain unbending in reply to pain absent |
6 5 4 3 2 1 |
6 |
|
The best index |
15 | |
|
The worst index |
3 | |
Table 2. Estimation of weight of the state of patient by system of SAPS
|
Clinical and laboratory indexes |
Marks | ||||||||
|
4 |
3 |
2 |
1 |
0 |
1 |
2 |
3 |
4 | |
|
Age, years |
|
|
|
|
<45 |
46-55 |
56-65 |
66-75 |
>75 |
|
Pulse, in a minute |
>180 |
140-179 |
110-139 |
|
70-109 |
|
55-69 |
40-54 |
<40 |
|
SAP, мм of mercury |
>190 |
|
150-189 |
|
80-149 |
|
55-79 |
|
<55 |
|
Temperature of body, °C |
>41 |
39,0-40,9 |
|
38,5-38,9 |
36,0-38,0 |
34,0-35,9 |
32,0-33,9 |
30,0-31,9 |
<30 |
|
Breathing rate, in a minute |
>50 |
35-49 |
|
25-34 |
12-24 |
10-11 |
6-9 |
|
<6 |
|
Mechanical ventilation |
– |
– |
– |
– |
– |
– |
– |
Yes |
– |
|
Urea, mmol/l |
>55,0 |
36,0-54,9 |
29,0-35,9 |
7,5-28,9 |
3,5-7,4 |
<3,5 |
|
|
|
|
Hematocrit, % |
>60,0 |
|
50,0-59,9 |
46,0-49,9 |
30,0-45,9 |
|
20,0-29,9 |
|
<20,0 |
|
Leucocytes, 109/l |
>40,0 |
|
20,0-39,9 |
15,0-19,9 |
3,0-14,9 |
|
1,0-2,9 |
|
<1,0 |
|
Glucose, mmol/l |
>44,5 |
27,8-44,4 |
|
14-27,7 |
3,9-13,9 |
|
2,8-3,8 |
1,6-2,7 |
<1,6 |
|
Potassium, mequ/l |
>7,0 |
6,0-6,9 |
|
5,5-5,9 |
3,5-5,4 |
3,0-3,4 |
2,5-2,9 |
2,0-2,4 |
<2,0 |
|
Sodium, mequ/l |
>180,0 |
161-179 |
156-160 |
151-155 |
130-150 |
|
120-129 |
110-119 |
<110 |
|
НСО3, mequ/l |
|
>40,0 |
|
30,0-39,9 |
10,0-19,9 |
|
5,0-9,9 |
5,0-9,9 |
<5,0 |
|
Scale of Glasgow, marks |
|
|
|
|
13-15 |
10-12 |
7-9 |
4-6 |
3 |
Table 3. Prognostication of probability of fatal outcome on the marks of the system of SAPS
|
Marks |
Forecast lethality, % |
|
4 |
– |
|
5-6 |
10,7 |
|
7-8 |
13,3 |
|
9-10 |
19,4 |
|
11-12 |
24,5 |
|
13-14 |
30,0 |
|
15-16 |
32,1 |
|
17-18 |
44,2 |
|
19-20 |
50,0 |
|
20 |
81,1 |
Appendix 1. Criteria of organ failure
|
Buds |
oliguria: excretion of urine less than 30 ml/hour; diuresis less than 480 ml/day; level of creatine more than 250 mcmol/l |
|
Liver |
level of bilirubin more than 34 mcmol/l; a level of АSТ and АLТ is higher than norm in 2 times |
|
Cardiovascular system |
AP less than 90 mm of mercury, sympathomimetics is required; tachycardia, РаСО2≤49 mm of mercury |
|
Lungs |
mechanical ventilation or insufflation of oxygen is needed for maintenance of РО2>60 mm of mercury and РаСО2>50 mm of mercury |
|
Central nervous system |
dormancy; sum of marks on the scale of Glasgow less than or 6 is equal (without sedative therapy) |
|
System of blood |
leucocytes more than 10×109 /l; тромбоциты less than or 20 000/mcl is equal; index of hematocrit less than or 20% is equal |
|
System of haemocoagulation |
thrombocytes less than 10×109 /l; fibrinolysis more than 18% |
|
Gastrointestistinal tract |
dynamic intestinal impassability, steady to therapy during more than 8 hours |
Post-display prophylaxis
If the transferred facilities of defence appeared uneffective and a display happened to the biological environment of patient, the infection of surgeon can be prevented, applying the proper prophylaxis of seroconversion.
Seroconversion is an immune answer of organism for penetration of virus, accompanied the products of antibodies. Seroconversion arises up at the end of latent period and testifies to the infection.
In any case it follows a display immediately to shut down, remove the damaged gloves or contaminating clothes, to process the place of display by virucidal antiseptics or 70% ethyl alcohol.
Case of professional display to HIV it is necessary to register and begin antiretroviral therapy in obedience to recommendations. Each month it is during a semiyear necessary to inspect a surgeon for the purpose infection of HIV. Treatment of HIV-infection, purchased a doctor during implementation of official duties, is guaranteed Law of Ukraine "On prevention of disease AIDS and to social defence of population" and by changes to him.
Algorithm of post-display prophylaxis
|
Measure |
Comment |
|
Treatment of display place by antiseptics |
Throw out the damaged glove. In the case of damage of skin covers remove a few drops of blood from the place of prick or cut. The place of display is processed virucidal antiseptics (sterillium, betadin, iodobac, 70% ethyl alcohol). In the case of hit of biological environment on mucous membranes wash them plenty of water, apply suitable for this purpose antiseptic (for example, 1% solution of iodovidon) |
|
Antiretroviral prophylaxis |
In obedience to recommendations |
|
Documenting of case of display |
In a hospital of patient chart and circumstances, volume, duration, mechanism and type of display, risk degree, serologic status of patient, accepted measures of prophylaxis, register in a separate magazine. If it is known that patient HIV-infecting, mark, whether he got antiretroviral preparations and which one. Administrations of medical establishment report about the case of display |
|
Serologic examination |
Through 1½, 3 and 6 month conduct enzymoimmunoassay for the purpose HIV-infected of doctor and patient (if serostatus last unknown). At presence of hardwares and necessity it can find out the fact of HIV-infecting considerably before (in the first days), applying polymerase chain reaction to DNA- or RNA-viral origin |