The module 1: Introduction to surgery.

the urgent surgical states.

bases of anaesthesiology and reanimatologY

The thematic module 2

Bleeding, blood loss. Bases of hemotransfusiology

Practical employment № 8

Theme: Bleeding, blood loss. Methods of temporal and eventual stop of bleeding

І. Actuality of theme

The loss of blood presents an instant danger for the life of the victim, and his fate relies on immediate actions of doctor. The danger of blood loss is related to development of hemorrhagic shock, weight of which is conditioned by intensity, duration of bleeding and volume of the lost blood. The rapid loss of a 30% volume of circulatory blood conduces to sharp anaemia, hypoxia of cerebrum and can end by death of patient. A medical personnel must own the methods of temporal stop of bleeding, to know the clinical signs of the second bleeding and his danger for the life of patient.

ІІ. Purposes of employment:

1. To know classification of bleeding on etiology, mechanism of origin, terms of origin, anatomic features, pathogenesis of bleeding, compensate and adaptation mechanisms at bleeding (-І).

2. To know terms, touching bleeding and violations of hemostasis (-І).

3. To master the local and general clinical signs of bleeding. To know pathogenesis and clinical flow of hemorrhagic shock (-ІI).

4. To be able to diagnose bleeding, to distinguish the closed and opened bleeding (-ІII).

5. To be able correctly treated the signs of hemorrhagic shock, to estimate the state of patient and foresee the consequences (-ІII).

6. To be able to give first help – to conduct the temporal stop of bleeding (-ІII).

7. To be able to estimate the got results of inspection of patient with bleeding, to set a diagnosis in accordance with classifications, to designate the plan of medical treatment – final stop of bleeding and compensation of blood loss (-ІV).

Literature:

Basic:

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

2. Gostishchev V.K. General surgery / The manual. – M.: GEOTAR-MED, 2003. – P. 46-55.

3. 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.

Interdisciplinary integration

Discipline	To Know	To Be Able
Preliminary
Anatomy	Anatomic features of vessels	To define the type of vessel
Histology	Structure of vessels
Normal physiology	Physiology and biochemistry of hemostasis	To estimate the state of the system of hemostasis on coagulogram
Subsequent
Pathological anatomy	The pathogistologic signs of bleeding, violations of circulation of blood, of disseminational intravascular coagulation syndrome
Pathological physiology	Pathogeny of shock, violations of circulation of blood, of disseminational intravascular coagulation syndrome
Surgical illnesses	Classification, pathogeny and clinical signs of bleeding	To diagnose, to give first help, to appoint medical treatment
Intradisciplinary
Asepsis and antiseptis	Rules of asepsis and antiseptis	To impose an aseptic bandage
Blood transfusion	Rules of blood transfusion	To conduct blood transfusion
Transports immobilization	Immobilization governed	To conduct immobilization
Trauma	Principles of helping at a trauma	To give first help to injured
Wounds	Clinical picture and first aid at wounds	To conduct the revision of wound, to give first help
The terminal states, reanimation	Clinical signs of the terminal states	To conduct reanimation measures
Postoperative period	Features of care of patients after the operation	To take the care of after a patient after the operation

Tests for verification of initial level of knowledges

Indicate the methods of physical stop of bleeding:

а) application of cold (+);

b) tampon of wound;

c) gemostatic sponge;

d) electro-coagulation (+);

e) vascular stitch.

What general clinical signs are characteristic for bleeding?

а) weakness (+);

b) nausea;

c) dizziness (+);

d) pains in a heart;

e) cyanosys.

What methods of temporal stop of bleeding can be applied at the damage of large arterial vessels?

а) the elevated position of extremity;

b) imposition of plait (+);

c) imposition of styptic clamp in a wound (+);

d) application of gemostatic sponge;

e) imposition of pressing bandage.

What preparations are used for the local stop of bleeding?

а) gemostatic sponge (+);

b) foam-rubber sponge;

c) trombin (+);

d) gematogen;

e) the washed red corpuscles.

The reason of the late second bleeding is:

а) the rise is arterial pressure;

b) festering melting of blood clot (+);

c) liquidation of spasm of vessels;

d) arrosion of wall of vessel (+);

e) sliding of ligature off.

The reason of the early second bleeding is all, except for:

а) suppuration of wound (+);

b) wound of vessel (+);

c) extrusion of blood clot;

d) sliding of ligature off;

e) the promoted arterial pressure.

Name the chemical matters used for the stop of bleeding.

а) ε-aminocapronic acid (+);

b) rheopolyglucin;

c) physiological solution;

d) heparin;

e) vikasol (+).

The biological methods of stop of bleeding are:

а) tampon wounds by a stuffing-box (+);

b) tampon wounds of muscle (+);

c) tampon wounds by a cartilage;

d) introduction of adrenalin;

e) intravenous introduction of ε-aminocapronic acid.

A pressing bandage as a method of temporal stop of bleeding is not shown at:

а) bleeding from the veins of forearm;

b) damage of carotid (+);

c) bleeding from soft fabrics of head;

d) wound of region of popliteal pit (+);

e) bleeding from soft fabrics of thorax.

What localization of source of bleeding melena is characteristic for?

а) lung;

b) stomach (+);

c) spleen;

d) duodenum (+);

e) sigmoid bowel.

Due to what at sharp blood loss there is natural compensation of reduction of volume of circulatory blood and is supported viability of organism?

а) vasoconstriction (+);

b) rises of central vein pressure;

c) autohemodilution (+);

d) vasodilatation;

e) drink of water.

What groups the symptoms of bleeding divide by?

а) obvious;

b) hidden;

c) local (+);

d) temporal;

e) general (+).

What groups all methods of stop of bleeding divide by?

а) premedical;

b) final (+);

c) temporal (+);

d) vascular;

e) mechanical

Continuous maximal on duration time of imposition of plait on lower extremity in a winter makes:

а) 3 h;

b) 4 h;

c) 1 h (+);

d) 2 h;

e) 0,5 h.

Continuous maximal on duration time of imposition of plait on lower extremity makes in summer:

а) 3 h;

b) 4 h;

c) 1,5 h;

d) 2 h (+);

e) 0,5 h.