Vіі. Method of conducting and organizational structure of employment

Distributing of marks which can be got by a student:

At mastering of theme № 26 a thematic module 1 for educational activity to the student the estimation for 4th is proposed to the traditional scale which is then converted in marks as follows:

Estimation	Balls
“5” (perfectly)	6
“4” (well)	4
“3” (satisfactorily)	2
“2” (unsatisfactorily)	0

Methodical pointing for work of students on practical employment The thematic module 1

Surgical infection. Necrosis

Practical employment №26

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

Theoretical questions for the independent study and discussion on practical employment №22:

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. 2006.

Distributing of marks which can be got by a student:

At mastering of theme № 26 a thematic module № 1 for educational activity to the student the estimation for 4th is proposed to the traditional scale which is then converted in marks as follows:

Estimation	Balls
“5” (perfectly)	6
“4” (well)	4
“3” (satisfactorily)	2
“2” (unsatisfactorily)	0

Tests for verification of initial level of knowledges №26

1. That less characteristically for a sepsis?

а) tachycardia;

b) leucocytosis;

c) anury;

d) drop in the temperature of body;

e) presence of purulent hearth.

2. To collect blood on the bacterial sowing it is necessary at a sepsis:

а) at the normal temperature of body of patient;

b) at a chill;

c) in 6-12 hours after abolition of antibiotics;

d) on height of temperature reaction;

e) at once after the slump of temperature.

3. The followings behave to the permanent symptoms of sepsis:

а) chill;

b) low temperature of body;

c) bacteriemia;

d) presence of purulent hearth;

e) icteric skin and sclera.

4. What general clinical displays of sepsis?

а) dizziness;

b) weakness;

c) driving sweat;

d) bradycardia;

e) vomiting.

5. Original appearance of wound at a sepsis has the followings signs:

а) abundant pus;

b) scanty pus;

c) bright hyperemia of tissues in area of wound;

d) tissues of wound of dirty-grey color;

e) absence of edema of wound tissues.

6. The displays of systemic inflammatory response syndrome it is been:

а) apathy;

b) be swollen on feet;

c) icteric skin;

d) breathing frequency more than 20 in a minute;

e) leucocytosis more than 12×10⁹ /л.

7. To the specific types of sepsis behave:

а) senile;

b) anaerobic;

c) staphylococcous;

d) mycotic;

e) actinomycotic.

8. To complications of sepsis does not attribute:

а) pneumonia;

b) bedsores;

c) thromb embolism;

d) cachexy;

e) fall of hairs.

9. Whatever types of temperature curves meet in the period of developing sepsis:

а) remittance;

b) hectic;

c) undulating;

d) wrong;

e) permanent.

10. The basic signs of bacterial-toxic shock followings:

а) oligury;

b) falling of arterial pressure;

c) increase of arterial pressure;

d) bradycardia;

e) leukopenia.

11. A sepsis is characterized by the presence of 3 basic factors, except for:

а) source (hearth) of infection;

b) systemic inflammatory response syndrome;

c) outbreak;

d) negative result of sowing of blood;

e) presence of the second (metastatic) hearths of infection.

12. What changes in composition blood are characteristic for a sepsis?

а) anaemia;

b) increase of maintenance of lymphocytes;

c) leukopenia;

d) diminishing of level of globulins;

e) diminishing of level of albumens.

13. Whatever medical measures can be recommended at a sepsis?

а) dissection of purulent hearth;

b) introduction of antibiotics;

c) limitation of introduction of liquid;

d) hot compress on a purulent hearth;

e) vitaminous therapy.

14. That is most essential at treatment of sepsis?

а) strict bed mode;

b) antibiotic therapy;

c) treatment of concomitant disease;

d) liquidation of primary hearth;

e) exposure of the inherited factor.

15. Name the feature of antibiotic therapy at a sepsis:

а) use of medium therapeutic doses of preparation;

b) use of maximal doses of preparation;

c) conducting of antibiotic therapy under control the medicinal sensitiveness of microflora;

d) use of monotherapy;

e) abolition of antibiotics after the offensive of clinical convalescence.

Situation tasks for verification of eventual level of knowledges

1. At patient В., to which 3 days operative interference was ago executed concerning the carbuncle of left buttock a temperature of body is 38,2 °С. How to conduct the fence of blood of patient for sowing on sterility?

2. Sick, 92 years, 2 days was ago operated concerning the deep intermuscular phlegmon of right thigh. At examination the general state of patient is heavy, on questions answers behind time. Temperature of body 38,3 °С, pulse 100 after 1 mines, unrhythmical. Arterial pressure is 80/40 mm Hg. Breathing frequency – 28 after 1 minute. Global analysis of blood: Нb – 50 g/l, leucocytes – 14,3 × 10⁹ /l, red corpuscles – 2,8 × 10⁹ /l, to red cells concretion speed – 34 mm/hour. Kreatine – 260 mcmol/l, bilirubine – 35 mcmol/l. Diuresis 400 ml for day.

Formulate a diagnosis.

3. At patient T., 80 years, on 4 days after implementation of resection of sigmoid bowel the symptoms of irritation of peritoneum appeared concerning a shrine, on the survey sciagram of organs of abdominal region is a gas presence under the domes of diaphragm. Concerning postoperative peritonitis on a background insolvency of stitches of anastomosis of patient was executed relaparotomy. A sepsis, kidney insufficiency, developed for a patient.

Name the basic criteria of kidney insufficiency at a sepsis.

4. Patient of Ш., 46 years, entered surgical separation for urgent operative treatment concerning оstеоmyelities of stump of right foot at the level of Shopar joint, complicated the phlegmon of right shin. For a patient a sepsis, hepatic insufficiency, is diagnosed.

On what criteria is it possible to testify to the presence of hepatic insufficiency?

5. To sick P., 79 years, which is in a clinic with a diagnosis phlegmon of crotch, sepsis, in connection with instability of hemodynamics arterial pressure is supported at the level of 120/80 mm Hg by permanent intravenous tiny infusion 10 ml 4% dopamine on 200 ml of physiological solution.

You will transfer the basic criteria of insufficiency of the cardiovascular system.

6. In a reanimation separation there is patient with destructive pancreatitis, complicated a retroperitoneal phlegmon and sepsis at which on 3 days after operative interference the signs of organ insufficiency appeared outside central nervous system. You will transfer the basic criteria of organ insufficiency outside central nervous system.

7. To the young man was 18 years executed laser phlebectomy. In 1 days after an operation the state the sick was sharply worsened, pain appeared in area of postoperative wound, a temperature rose to 39,1 °С. A patient has tachycardia (a pulse is 130 shots after 1 minute), breathing frequency – 30 after 1 minute. In a grave condition he was delivered in the induction centre of hospital an ambulance. On what criteria is it possible to draw a conclusion about a presence at patient of organ insufficiency from the side of the system of blood?

8. To the patient S. operative interference is executed concerning the poured out purulent inflammation of the checked spaces of pelvis. Wounds on next days are washed solutions of antiseptics, drain adequately, fabrics of bottom of wound are dim, achromatic color. The temperature of body sticks to at the level of 38,0-38,5 °С, there are tachycardia (105 shots after 1 minute), leucocytosis (12,4 × 10⁹ /l), bilirubinemia (level of bilirubin of 36 mcmol/l).

Why without regard to adequate dissection and drain of purulent hearth does hyperthermia proceed for a patient? What criteria of syndrome of system answer for inflammation are observed for this patient?

9. Patient In., 70 years, hospitalized with a diagnosis abscessed furuncle of right forearm. Objectively: temperature of body 38,1 °С, frequency of cardiac reductions – 102 after 1 minute, breathing vesicular, hepar, spleen not megascopic.

What treatment is shown sick? In what case is it possible to assert about a presence at patient of sepsis?

10. During a fight 4 days ago a man got the wound of right brush after a blow to the teeth of man which, as turned out then, HIV- infected. What stage of HIV- infected at injured and what method can a diagnosis be confirmed?

11. After the injection of narcotic matter a syringe which contained tailings of blood of HIV- infected of patient, infecting of other man happened. After this time passed 2. What stage of HIV- infection at infected and what is it characterized?

12. At patient the post-injection phlegmon of left lower extremity (after introduction of narcotic matter in area of inguinal fold) is mark an increase and sickliness of practically all of groups of outward lymph nodes.

What stage of HIV- infection at infected and what is it characterized? What difference from the stage of incubation?

13. At patient HIV-infection there is a loss of weight less 10%, mycotic, viral defeats of mucous and skin covers. What stage of HIV-infection at infected?

14. At patient HIV- infection is a loss of weight less 5% and noncommunicative sarcoma of Kaposhi. What stage of HIV- infection at infected?

15. At patient which used injection drugs, furunculosis and phenomena of subsharp encephalitis developed. Antibacterial therapy which was conducted was adequately ineffective and a patient perished during a month. Why did a patient have such defect of the immune system? What disease is it characteristic for?