The module 1: Introduction to surgery.

The urgent surgical states.

Bases of anaesthesiology and reanimatology

The thematic module 4

Traumatism and damages

Practical employment № 15

Theme: Infected wounds

І. Actuality of theme

Presently 35-40 % the patients of surgical type are made by patients with the festering-inflammatory diseases, postoperative festering complications develop on the average at 30% patients. In the general structure of lethality in surgical permanent establishments the quantity of death cases in connection with infectious complications arrives at 42-60 %.

Coming from difficult pathogeny of wound process taking into account his phase, and also character of exciter and his sensitiveness to medicinal preparations, the differentiated approach to the choice of medications for local medical treatment of infected and festering wounds is needed.

ІІ. Purposes of employment:

1. To know determination of concept the infected wound(α=ІІ).

2. To know phases of wound process at patients with purulent wound(α=ІІ).

3. To know the types of draining of wounds(α=ІІ).

4. To know the types of the second surgical stitches and method of their imposition(α=ІІ).

5. Able to conduct surgical treatment of the infected wound(α=ІІІ).

6. Able to conduct the fence of material for cytological, microbiological and histological researches for control of wound process flow(α=ІІІ).

7. Able to choose preparation for local treatment of purulent wounds according to the phase of wound process(α=ІІІ).

Literature:

Basic:

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

2. Shevchenko S.I. and others. Surgery. – Kharkov. 2004

Additional:

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

2. Methodological recommendations on surgical patients care. – Vinnitsa National Pirogov Memorial medical university. 2006.

Tests for verification of initial level of knowledges

Name terms necessary for development of surgical infection in the organism of man.

а) presence of saprophytes;

б) presence of «entrance gates» for an infection (+);

в) saving of integrity of skin covers;

г) decline of immunobiologic resistance of macroorganism (+);

д) high title of antibodies.

Name the protective barriers of local reaction of organism on a getting to him purulent infection.

а) fascia;

б) spinal cord;

в) pleura;

г) granulation billow (+);

д) pyogenic shell (+).

Infection of wound, which it is possible at, is named the second:

а) violation of asepsis in the moment of providing of the first aid;

б) during the first 3-5 days from the moment of wound;

в) infection by the hospital cultures of microorganisms (+);

г) in the moment of receipt of trauma;

д) violation of asepsis at bandaging (+).

At primary infection microbes in a wound get with:

а) pincers at surgical treatment;

б) hands of surgeon;

в) skins of injured (+);

г) stitch material;

д) scotching objects (+).

What time do microbes in a wound begin to show the activity through?

а) 1-4 h;

б) 6-8 h (+);

в) 10-12 h;

г) 24 h;

д) 3-5 min.

For the local signs of inflammation characteristically all, except for:

а) edema;

б) cyanosys (+);

в) pains;

г) full of suffering mien (+);

д) rises of temperature.

In what wounds more probably there is development of infection?

а) cut;

б) appearing after a blow on teeth (+);

в) located on a face;

г) chopped (+);

д) scalped.

What maximally possible terms of primary surgical treatment of wound from a moment the wound?

а) to 12 h;

б) to 24 h (+);

в) to 48 h;

г) before appearance of signs of development of infection;

д) to 8 days after the wound.

Preparations for local medical treatment purulent wound of in the purulent and necrotic phase of wound process must possess the following effects, except for:

а) drier;

б) local excitant (+);

в) antiulceric (+);

г) antimicrobial;

д) anaesthetic.

What testimonies to deleting of drainages at medical treatment purulent wound?

а) sterile sowing of wound separated (+);

б) absence of ambient inflammation (+);

в) insignificant festering separated;

г) presence of blood in a wound;

д) aesthetically unbeautiful type of wound.

Running sore in the first phase of inflammation is characterized to all, except for:

а) high microbic seeding;

б) presences of granulation tissue (+);

в) by the expressed violations of local microcirculation;

г) serum (+);

д) by the presence of purulent and necrotic detritus.

What preparations are shown for local medical treatment purulent wound in the first phase of wound process?

а) liniment balsamic on A.V. Vishnevsky;

б) ointments on a water-soluble basis (+);

в) physiological solution;

г) ointments on a fatty basis;

д) hyperosmotic preparations on the basis of sorptive agents (+).

Basic tasks of local medicinal medical treatment purulent wound in the purulent and necrotic phase of wound process?

а) suppression of infection (+);

б) adsorption of products of microbic and tissue disintegration (+);

в) stimulation of reparative processes in a wound;

г) defence of granulations from drying out;

д) prophylaxis of second infection.

Basic tasks of local medicinal medical treatment purulent wound in the phase of granulations?

а) stimulation of reparative processes in a wound (+);

б) adsorption of products of microbic and tissue disintegration;

в) anaesthetizing;

г) prophylaxis of second infection (+);

д) activating of tearing away of necrotic tissues.

What phases do not answer the flow of wound process:

а) anaerobic (+);

б) granulations;

в) cicatrizations (+);

г) purulent-necrotic;

д) epitelization.