Vі. Tasks for verification of eventual level of knowledges.

Situation tasks for verification of eventual level of knowledges

During bandaging of patient with running sore a surgeon diagnosed the purulent and necrotic phase of wound process and laid down in a wound a bandage with balsamic liniment for A.V.Vishnevskiy. whether application of this preparation is Expedient in this case?

Answer. Application of preparations on a hydrophobic basis (liniment balsamic on A.V.Vishnevskiy), beside the purpose, because the fatty basis of ointment does not take in wound exudation, that does not allow to liquidate the edema of fabrics, does not interfuse with wound exudation, that blocks freed of antimicrobial preparations from the basis of ointment and does not possess power of penetration in fabric of wound, where pathogenic microorganisms nest.

During conducting of bandaging at a patient with O., 2 days to that operated concerning a furuncle front surface of right thigh, in a wound there is the presence of necrotic the masses, festering content, infiltration of its edges. What phase of wound process is characterized by the indicated signs? What properties the preparations for local medical treatment running sore of in this phase of wound process must possess?

Answer. By the indicated signs the purulent and necrotic phase of wound process, in which for local medical treatment of wounds multicomponent preparations of the combined action are applied, is characterized: antivomicrobial, drier, antiinflammatory and anaesthetic.

In the wound of patient T., which bandaging concerning suppuration of lower corner of laparotomic wound is conducted to, there is the presence of purulent and necrotic the masses, hyperemia, infiltration of edges of wound, local rise of temperature, pain at touching. Application of what preparations for local medical treatment running sore is shown to the patient in this phase of wound process?

Answer. In the purulent and necrotic phase of wound process expediently to use antiseptic solutions (Dekasan), oinment preparations on a modern hydrophilic hyperosmotic basis (Palisept, Oflokain-Darnitsa, Nitacid-Darnitsa), powder-like compositions on the basis of sorptive agents (Flotoxan, Metroxan). Application of preparations of one-way action (antiseptic solutions, for example, Decasan) is needed for washing of wounds during bandaging and conducting of lotic-scrub drainage.

To the patient S., 35 years, 3 days to that the operation is backwards executed dissection and drainage of phlegmon of right brush. Temperature of body of the patient 36,9 °C. Frequency of cardiac abbreviations – 88 blows for 1 mines., frequency of respiratory motions – 16 for 1 mines. Locally there is hyperemia of skin round a wound, edema of fabrics, purulent and necrotic excretions. In 1 l of blood of 6,3 × 10⁹ leucocytes. At microbiological research of biopsy fabric of wound the index of semination to the last makes microorganisms 3,9 × 10⁸ in 1 g.

What medical treatment follows to appoint to the patient in this case? Or shown to him system antibacterial therapy?

Answer. System antibacterial therapy to the patient is not shown for lack of signs of distribution of infectious process outside a primary hearth and its pointlessness from the edema of fabrics and violation of microcirculation. To the patient expediently to enter antibacterial preparations locally as multicomponent ointments, gel, compositions on the basis of sorptive agents.

Six days to that backwards to sick N. the surgical operation is executed dissection and drainage of postinjection abscess of upper-external quadrant of right buttock. In a wound the presence of serum is determined, development of granulation fabric which gradually fills walls and bottom of wound. What phase of wound process is characterized by the indicated signs? What basic requirements are pulled out to the preparations intended for local medical treatment running sore of in this phase?

Answer. By the indicated signs the ІІ phase of wound process is characterized – phase of granulations, for local medical treatment running sore which multicomponent preparations of the combined action, which provide reliable defence of granulation fabric from the mechanical damage, prophylaxis of second infection of wound, moderate drier effect and directed stimulation of reparative processes, are applied in.

At a patient with the granulating wound of front abdominal wall on 8 days after dissection and drainage of phlegmon a surgeon washed a wound by the Decasan solution and laid down in a wound a serviette with the ointment Nitacid-Darnitsa. Is it right a surgeon picked up preparation for medical treatment of wound in this phase?

Answer. Applying the preparation Nitacid-Darnitsa on a hyperosmotic basis for local medical treatment running sore in the phase of granulations is impossible, because surplus degidratation of fabrics will be instrumental in death of healthy cages and formation of the second necrosises, the same slowing the flow of wound process.

On 5 days after the operation of dissection and drainage of phlegmon of back surface of right brush and conducting of bandaging with the use of the preparation Nitacid-Darnitsa at a patient with on the front surface of right shoulder and forearm pouring appeared out, which is accompanied by the expressed itch. Than to account for appearance of pouring out and how a prevention similar phenomenon is?

Answer. At a patient allergic reaction on preparation Nitacid-Darnitsa which arose up as a result of unbearable of one of its components: nitazol or streptocid. For warning of origin of similar reactions follows before application of this ointment to conduct a intradermic test on bearable to these preparations.

Three days ago a patient an own dog bit for a shin. At research in the surgical cabinet of policlinic at a patient on the back surface of right shin in the its middle third an bite-ragged wound is exposed 2×1 sm with the selection from her of festering exudation. Define medical tactic for a patient?

Answer. Surgical treatment running sore without taking to the last in, imposition of bandage with ointment on a hydrophilic hyperosmotic basis, antitetanic vaccination.

At a patient on 4th days after appendectomy on a background complete calming down again appeared pulling pains in area of postoperative wound, a temperature rose, leucocytosis is marked.

What it follows to think about? Tactic of further medical treatment is which?

At a patient it follows to suppose suppuration of postoperative wound. At presence of local hyperemia of edges, slight swelling, edema, infiltrate or softening influence it is necessary to conduct sounding of wound between stitches by a valleculate or button-type probe. At appearance of pus the stitches must be immediately taken out, the edges of wound are divorced. After it produce the careful rest room of wound and drainage of her serviette with ointment on a hydrophilic hyperosmotic basis.

In a traumatological point the victim is delivered with the infected sword-cut of palm's surface of right brush. Active bend motions in the interphalangeal joints of the ІІ-V fingers are absent.

About the damage of what anatomic educations it follows to think? Your medical tactic.

The victim has the infected sword-cut of right brush with crossing of tendons of the superficial and deep flexors of ІІ-V fingers.

In the induction centre came the victim with the blind stab-cut wound of the left shoulder. Got the wound 3 days to that backwards.

In area of wound the slight swelling, sickliness is determined. From a wound the scanty ichor-festering separated is selected.

Surgeon produced the careful rest room of wound, tightly tamponned her by a tampon with ointment on a hydrophilic basis, imposed a bandage. To the patient the urgent specific prophylaxis of stupor is conducted.

What error is assumed by a surgeon?

An error is that a wound tightly tampon, that, undoubtedly, hinders to the outflow of wound content.

At a patient after the wound by the nail of palm's surface of brush the edema of back surface appeared on the second days, pain increased. Skin of the around chopped wound of angry, hot by a touch. At palpation of fabric round a wound the sickly compression is determined, from a wound a turbid serum is selected. What phase an inflammatory process is found in? What medical treatment follows to appoint to the patient?

Answer. An inflammatory process is found in the phase of infiltration. Operative medical treatment is not shown. It follows to appoint system antibacterial therapy, thermal, physical therapy procedures. If infiltrat does not regress, the festering melting will happen, it follows to halt conservative medical treatment and execute operative interference – dissection and drainage of abscess.

To sick O., 42 years, the operation is executed dissection and drainage of abscess concerning posttraumatic osteomielitis of the left thigh complicated by a near-osteal phlegmon. On 12th days a wound is clean, by sizes 16×4×4 sm, hyperemia of skin around and infiltration of edges of wound is not present, walls and bottom are covered by bright red granulations.

What operative interference is shown in the given clinical situation?

Answer. At presence of granulate wound, without the clinical signs of infection, on 8-15 days after surgical treatment the operation of imposition of the second early stitch is shown.

Patient T. it was operated concerning festering syrinx of lumbar to the region, caused by a foreign body (left during the executed the day before lumbar sympatectomy gauze serviette). A postoperative period was complicated by development of the coagulopathic bleeding from a wound, that forced long time to hold a hemostatic tampon at back of wound. In 23 days a wound cleared up, granulates, the edges of wound are presented by scar fabric, without hyperemia of skin and edema.

What operative interference is shown in the given clinical situation?

Answer. At presence of scar wound, on 20-30 days after the operation, without the clinical signs of infection the operation of imposition of the second late stitch is shown, with excision of scars, granulations and mobilization of edges of wound.

In a policlinic a patient which through 1,5 days after the receipt of deep scratch of back surface of finger of brush experienced pulsating pain in the area of wound appealed on the reception of surgeon. A wound defect is locally marked 1,0×0,2×0,3 sm, hyperemia of skin, edema of fabrics round a wound, strengthening of pain at motions in the nearest joints.

What tactic of surgeon must be?

Answer. To the patient operative medical treatment which consists in excision of edges and bottom of wound with the purpose of decline of level of microbial contamination is shown. Taking in wound is impossible. Locally it follows to apply preparations on a hydrophilic hyperosmotic basis (Palisept, Oflokain-Darnitsa). It is obligatory to immobilization of gipseous longeta, on testimonies – specific prophylaxis of tetanus.