Methodical pointing to work of students on practical employment

The thematic module 4.

Traumatism and damage

Practical employment №20

Theme: getting, elektrotravma frost-bitten

Theoretical questions for the vneauditornogo independent study and discussion to practical employment №20:

1. Reasons of origin of getting frost-bitten; the pathological states of organism of sick, which cause distribution of pathology.

2. Pathological changes in fabrics and organs of patient in time and after action of injuring holodovogo agent, electric current and lightning.

3. Classification of getting and elektrotravmi frost-bitten depending on the depth of defeat of fabrics.

4. Clinical picture of getting frost-bitten, elektrotravmi.

5. Diagnostics of getting and elektrotravmi frost-bitten with the use of subjective, objective, laboratory, instrumental and other additional (for example, roentgenologic) methods of research.

6. Grant of the first medical aid.

7. Determination of depth of defeat of fabrics at getting frost-bitten.

Literature:

Basic:

1. Metodichnі rozrobki for auditornoї that samostіynoї roboti studentіv.

2. Zagalna hіrurgіya / After red. S.P.Guchenko, M.D.Gelіbi, S.D.Hіmіcha – Kiїv.: Zdorov’ya, 1999.

3. Cherenko M.P., Vavrik G.M. Zagalna hіrurgіya z anestezіologієyu, by the bases of reanіmatologії that to doglyadu after hvorimi – Kiїv.: Zdorov’ya, 1999.

4. Gostishev V.K. General surgery: Studies. – M.: Medicine, 1993.

5. Gostishev V.K. "Guidance to practical employments on general surgery". M., "Medicine" - 1987.

Additional:

1. A.A. Simodeyko, S.S. Fіlіp, O.O. Boldigar Zagalna hіrurgіya in pitannyah і vіdpovіdyah. Uggorod, «Іva» - 2005.

2. S.M. Genik, M.V. Prokopishin, V.M. Krisa that іn. Situatsіynі zadachі z hіrurgії.Івано-Франківськ, «Lіleya-N.В» – 2003.

Distributing of marks which are appropriated to the students:

At mastering of theme № 20 from the thematic module № 4 for educational activity to the student the estimation for 4th is proposed by a ballnoy (traditional) scale which are after converted in marks as follows:

Estimation	Marks
“5”(fine)	6 marks
“4” (well)	4 marks
“3”(satisfactorily)	2 marks
“2” (unsatisfactorily)	0 marks

Tests and tasks for verification of initial level of knowledges

№a 20 Traumatism and damage

What changes of internal organs and fabrics come as a result of action on the organism of electric current?

considerable changes of structure of neurons

distroficheskie changes in muscles

breaks of internal organs

amiloidoz of buds

breaks of muscular fibres

What changes of internal organs and fabrics come as a result of action on the organism of electric current?

gangrene of extremity

deep changes of walls of vessels with vast necrosises

edema of cerebrum

hyperemia and hemorrhage in internal organs

necrosis of kanaltsev of buds

Name the reasons of death at elektrotravmah:

sharp paraproktit

ischemic stroke

sharp kidney insufficiency

stop of heart

the stop is breathing

What the first aid at elektrotravme consists in?

stop of further action of current on the victim one

stop of bleeding

anaesthetizing

conducting of reanimation measures

transports imobilizatsiya

CH

I eat to account for mainly conservative tactic of local medical treatment of elektrotravmi?

by the grave common condition of patient

by the vagueness of scopes of defeat in the beginning

by complication of operative interference

by the considerable changes in the wall of vessels on the large extent

by the defeat of the nervous system

Name the periods of development of getting frost-bitten:

reactive

latent

early

late

doreaktivniy

In the early reactive period of getting frost-bitten mark all, except for:

pain reaction

formation of bubbles on a skin

increase of temperature of body

toksemii (sometimes shock)

necrosis of fabrics

Name the clinical signs of the first degree of getting frost-bitten:

loss of pain sensitiveness

itch

loss of taktilnoy sensitiveness

growing of skin black

saving of taktilnoy that pain sensitiveness

Name the clinical signs of the first degree of getting frost-bitten:

pain

edema of fabrics with a sinyushnim marble tint

formation of bubbles

growing of skin black

hyperemia of skin

To local infectious complications of getting frost-bitten attribute all, except for:

limfangit, limfadenit

tromboflebit

carbuncle

gidradenit

ugly face

At getting of the II degree frost-bitten a bottom has a bubble the color:

white

rose

red

violet

black-grey

For a late reactive period at getting frost-bitten characteristic appearance:

pain reaction

moist gangrene of extremity

rise of temperature of fabrics

toksemiya

necrosis of fabrics

Than the II degree of getting frost-bitten is clinically characterized?

itch

edema of fabrics with a sinyushnim marble tint

hyperemia with a tsianotichnim tint and edema

formation of bubbles

growing of skin black

Name the clinical signs of getting of the III degree frost-bitten:

extremity cold to the feel after warming

the expressed edema of soft fabrics

formation of bubbles of gemorragicheskogo tint

taktilnaya is stored that pain sensitiveness

itch

Name the clinical signs of getting of the III degree frost-bitten

hyperemia with the tsianotichnim tint of izud

marble skin with a bagrovo-tsianotichnim tint

hyperemia with a tsianotichnim tint and edema

rozvitie gnoyno-nekroticheskogo process in place of defeat

Situation tasks.

you – doctor of first-aid. Arrived on the call. A man without consciousness lies in the street. Temperature of air -200 With, wind. At examination at a patient the sharp pallor of skin of fingers of hands is marked, a capillary pulse is not determined, fingers are crusty ice.

Your diagnosis and actions?

From a district hospital in a clinic a patient with getting of both feet frost-bitten in a late reactive period is delivered. The state of patient is heavy. Both feet were swollen, sharp cyanosys of skin on them with a grey tint is marked, a sensitiveness is fully absent. On the line of demarcation – bubbles with festering content. Skin on the shins of giperimirovanaya. Temperature of body 38 With.

What diagnosis, additional inspections and medical tactic?

Surgical separation a patient with complaints about absence of sensitiveness in the fingers of feet entered, their edema. It appeared at collection of anamnesis, that the day before on a frost a public transport expected long. The fingers of feet froze. At a home warmed feet in hot bath, but a sensitiveness did not recommence. At examination: feet nabryaklie, cyanosys of fingers is marked, absence of sensitiveness in them, a capillary test is negative.

What Your diagnosis and medical measures?

A patient with getting of feet of the III-IV degree frost-bitten on fifth days after a trauma began to grumble about a weakness, rise of temperature of body to 39 ^0С, cough, shortness of breath. Both feet edematous, skin of shins of giperemirovanaya.

What complications could develop at a patient? What additional inspections for clarification of diagnosis you will conduct? Your medical tactic?

you arrived on the place of proishestviya as a doctor of first-aid. According to present persons, some minuts ago the victim got under action of electric current. Lost consciousness. There were cramps. Friends on work turned off the source of current. A patient lies on the floor. Breathing is absent, a pulse not palpiruetsya, the skin covers of tsianotichnie, pupils are wide, on light are irresponsive.

What Your diagnosis? Your actions?

Surgical separation a patient which 2 days to that backwards got the electro-burn of right brush of the IV degree entered. At examination: brush, forearm and shoulder sharply otechnie, hard at palpatsii. A sensitiveness in the fingers of brush is loosened.

What urgent surgical interference must you execute?

Patient And., 43 years, is delivered in a hospital after the protracted stay in a winter in mountains. At the receipt: complaints about pain in both feet and them zaterpanie. Objectively: the skin of feet is pale, cold, the sensitiveness of her is lowered, a pulsation on peripheral arteries is sharply loosened. The what first aid it is necessary to give to the victim?

A surgeon hospitalized a patient which strayed in a forest during a ski walk. Patient at consciousness, but is put on the brakes; the temperature of body, lowered to 32 0 the S. Starshiy colleague of surgeon advised to him together with medicinal therapy as quick as possible to warm a patient. By what method it is possible to do?

In the process of medical treatment of patient With., 36 years, the hospitalized 3 days to that backwards with the deep getting of right foot frost-bitten, a treating doctor exposed the increasing edema and cyanosys of the last, which was accompanied by the signs of growth of intoxication. A manager recommended to the colleague to conduct operative interference. What operation a talk goes about?

Patient With., 29 years, on 2th days after getting of lower extremities frost-bitten grumbles about feeling of raspiraniya in a right foot and lower third of shin. At examination the expressed edema of shin is exposed, hardness of muscles. The rise of temperature of body is established to 380 With, frequency of pulse – 100 ud/min. Your actions as a treating doctor?

During work on a frame-saw the workers heard the scream of colleague, which repaired an electric motor. In place of event exposed an electrician With., 29 years, which convulsively held on to the device not by a mistake turned off. What is needed to do above all things at the grant to the victim to the first aid?

At a patient With., 52 years, on the 2th week of medical treatment concerning the defeat by elektrotokom from a wound in overhead third of right shoulder the pulsating effluence of bright red blood is exposed. Sick pale, grumbles about dizziness, a pulse is threadlike. The HELL 80/60 mm.rt.st. What complication can be supposed at a patient?

Since an accidental passer-by succeeded to break contact, at the victim In., 24 years, the signs of vital functions are not exposed. The closed massage of heart and artificial respiration is begun and an ambulance is caused. Passed 20 minutes, but a medical brigade did not arrive. How long is it needed to conduct reanimation measures to the victim?

At the receipt in the hospital of the victim from action electric current a duty surgeon exposed on the palm of his right hand a white-grey spot by a diameter 4 mm the Common state of the victim satisfactorily, pulse 80 ud/min., the HELL 110/80 mm.rt.st. The victim renounces to lie down in a hospital. What must be done by a doctor?

Patient With., 34 years, is found on medical treatment in the separation of politravmi concerning elektrotravmi of right shin. As a result of deep necrosis of fabrics of foot and shin 2 weeks ago to him the extremity in overhead third of shin was amputated. Kultya after amputation by the primary pull did not heal over; the numerous nekrektomii were conducted. Lately there is the defect of skin by an area 25 square sm; a wound is covered by granulations. What subsequent medical tactic?