Vіі. Method of conducting and organizational structure of employment

Distributing of marks which can be got by a student:

At mastering of theme № 15 a thematic module 4 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 2

Traumatism and damages

Practical employment № 15

Theme: infected wounds

Theoretical questions for the independent study and discussion on practical employment №15:

8. To know determination of concept the infected wound.

9. To know phases of wound process at patients with purulent wound.

10. To know the types of draining of wounds.

11. To know the types of the second surgical stitches and method of their imposition.

12. Able to conduct surgical treatment of the infected wound.

13. Able to conduct the fence of material for cytological, microbiological and histological researches for control of wound process flow.

14. Able to choose preparation for local treatment of purulent wounds according to the phase of wound process.

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.

Distributing of marks which can be got by a student:

At mastering of theme № 15 a thematic module № 4 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

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 purulent 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.

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?

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?

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?

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?

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?

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?

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?

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?

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?

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.

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?

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?

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?

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?

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?