Vіі. Method of conducting and organizational structure of employment

Distributing of marks which can be got by a student:

At mastering of theme № 8 a thematic module № 2 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

Reference card for the study and working of practical skills off on diagnostics and providing of the first aid at bleeding

№	List of educational actions	Methodical pointing to educational activity	Independent work of students
Theoretical
1	Define notion of bleeding, haemorragic shock, disseminational intravascular coagulation syndrome
2	Lead classification of bleeding	Reasons and types of bleeding
3	Transfer principles of providing of the first aid, indicate testimonies for every type of temporal stop of bleeding
Practical
1	Collect anamnesis at a patient with the gastric bleeding	To pay attention on the feature of origin of bleeding	Work on the inspection of patients
2	To impose a styptic plait, to conduct the finger pinning of arteries	To define testimonies for imposition of plait, finger pinning	It is conducted by students one on other
3	Establishment of diagnosis, providing of the first aid, setting of medical treatment to the patient with bleeding from varicose the extended veins of lower extremity	To classify bleeding, to define the volume of the first aid, therapeutic tactic	Work with patients

Independently to fill table of typical symptoms and principles of the first aid at bleeding

Signs	Arterial	Venous	Capillary	Parenchymatous
Color of blood
Intensity of bleeding
Localization
Possible complications
General symptoms
Temporal stop of bleeding
Optimum method of medical treatment

Methodical pointing for work of students on practical employment The thematic module 2

Bleeding, blood loss. Bases of haemotransfuziology

Practical employment № 8

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

Theoretical questions for the independent study and discussion on practical employment №8:

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.

2. To know terms, touching bleeding and violations of gemostasis.

3. To master the local and general clinical signs of bleeding. To know pathogenesis and clinical flow of haemorrhagic shock.

4. To be able to diagnose bleeding, to distinguish the closed and opened bleeding.

5. To be able correctly treated the signs of haemorrhagic shock, to estimate the state of patient and foresee the consequences.

6. To be able to give first help – to conduct the temporal stop of bleeding.

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.

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.

Distributing of marks which can be got by a student:

At mastering of theme № 8 a thematic module № 2 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

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.

Situation tasks for verification of eventual level of knowledges

At a 70-years-old patient suffering by varicose expansion of hypodermic veins of lower extremities, bleeding from the torn knot on the internal surface of lower third of right shin was suddenly opened. From a wound enough intensively by a languid stream a dark blood is poured out. What volume of the first aid must be rendered to the patient?

Youth, 17 years, during a journey in a bus, offered a right hand in a window. A freight machine by the side of which the stuck out a hand was touched went to the meet. Traumatic amputation of right overhead extremity at the level of middle third of shoulder happened (extremity hangs on the shred of skin). A scarlet blood to gush from the damaged arteries. How to stop bleeding?

In the surgical department a patient with a stab-wound in popliteal pit is delivered. At the revision of wound the damage of popliteal artery is set, but you do not own the technique of vascular stitch. What actions will you undertake?

In receiving rest a man 48 years with complaints about a weakness, dizziness is delivered, moderate pains in left subcostal region. It is known from anamnesis, that 12 hours ago he fell off a stair, a blow was the left costal arc on a region. On the eve of receipt there was a fainting fit.

A patient lies in the forced position. The change of position of body strengthens stomach-aches. Skin covers are pale. Pulse — 120 blows in a minute. Arterial pressure — 90/50 mm of mercury column. Palpation are marked moderate tension of muscles of abdominal wall, dulling of percussional sound in left subcostal region and gently sloping places of stomach. Haemoglobin of blood — 98 g/l.

Your hypothetical diagnosis and tactic?

In receiving rest a man is delivered with the closed trauma of thorax on the left. Objectively: skin covers are pale. Pulse — 100 blows in a minute. Arterial pressure — 110/65 mm of mercury column. Are marked sickliness and crepitation bone fragments in a projection the VIII, IX and X ribs on the right on a medioaxillar line. Percussion on the right in lower departments is determined dull sound, breathing is not listened (in position of patient sitting). On a sciagram, except for the breaks of the indicated ribs, intensive shade with a horizontal level to the border of the VII rib is additionally exposed.

Your the diagnosis and tactic?

A patient 30 years, suffering during 7 years by ulcerous illness of stomach, during past days marked an increasing weakness, dizziness. In the morning, showing a leg, he on a few seconds lost consciousness. After it singly there was vomiting as "coffee-grounds" and melena. Skin covers are pale. A stomach is soft, painless.

What Your hypothetical diagnosis? What urgent additional researches must be executed for confirmation of Your supposition? Where and what method you will send a patient to medical treatment?

At a patient to which the operation concerning inguinal hernia was produced in the morning, to evening bandage on the wound of beginning abundantly to get wet a blood. Applied during a hour locally ice-bags and sacs with sand of effect were not given.

What complication in an early postoperative period arose up at a patient? Your further tactic?

Youth with complaints about pains in a right shin and increasing slight swelling of her after falling from a motorbike appealed to you. A trauma happened near a half-hour backwards. At examination on the front surface of middle third of shin is present slight swelling by sizes 10x6x5 sm. A skin above her cyanotic. At palpation are marked sickliness and fluctuation. A pulse on the back artery of right foot is stored.

Your diagnosis? What help will you give to the victim?

In receiving rest of hospital a patient with complaints on pain in the left knee-joint after the receipt of trauma is delivered. Motions in a joint are limited, sickly. A joint has a spherical form. The ballot of patella is marked. On the sciagram of damage bones are not set.

Your the diagnosis and medical measures?

Clinic a patient with the closed trauma of stomach entered. At the receipt the symptoms of the intra-abdominal bleeding are expressed. As a result of urgent operation (laparotomy) are set break of front surface of right stake of liver measuring 6x3x4 sm, hemoperitoneum.

How to produce the final stop of bleeding from the damaged liver? What to do with the blood poured out in an abdominal region?

During amputation of lower extremity at the level of lower third of thigh after imposition of ligature on a femoral artery with the last a clamp was taken off. From a wound under large pressure by pulsating motions began to gush blood of scarlet.

What the reason of bleeding is in? How to produce the temporal and final stop of bleeding? How to prevent such complication?

During diagnostic punction of tumular formation in lower third of shin in a syringe began under constraint to take blood of dark-cherry blossom. Where did the needle of syringe get? How to stop bleeding?

During work with a circular saw a failure on a machine-tool happened and works by the splinter of saw the sword-cut of lower third of shoulder was inflicted. To the patient with the purpose of temporal stop of bleeding a styptic plait was imposed. Transporting of patient in traumatology department took 3 hours. What error was assumed? What can arise up complication and as him prevent?

At a patient K., 65 years old, the operation of deleting of foreign body of the left lumbar region was executed. In the same day in the evening the bandage of patient abundantly got wet a blood, a wound bleeds on all surface. A patient reported that to him the day before during a month anticoagulant therapy which halted a week ago was conducted. At determination of time of rolling up of blood for the Lee-White index made 11 minutes. Name the reason of bleeding and method of final his stop.

At sick E., 62 years, the operation is executed cholecystectomy, choledoholytotomy, outward drainage of common bile-duct concerning the mechanical icterus caused by violation of outflow of bile because of hit of calculus in a common bile-duct. During the operation considerable bleeding of fabrics pays on itself the attention. What the reason of such state is in? What additional medical measures must be conducted?