Vі. Reference basis of action

A tasks which stand before the surgical separation of policlinic.

Grant to the population of skilled Medicare and conducting of health prophylactic measures in the district of activity of policlinic. To give medical help a surgeon must both in a policlinic, and on house.

Work of surgeon in a policlinic has the features. At first, a surgeon in most cases works one, not being in a position to get consultation at the colleague, as it is in permanent establishment. It, undoubtedly, requires considerable knowledges of surgical illnesses from him; secondly, a plenty of patients during the reception, limits time for raising of diagnosis and choice of correct method of medical treatment. In addition, a surgeon in a policlinic can not conduct the dynamic full time supervision after patients; thirdly, a surgeon not always in good time can get data of the special methods of research from that diagnostic cabinets work on the graph. Quite often he gets necessary information the next day; fourthly, the order of reception of patients is often violated by appearance of the different patients which need the immediate help.

The structure of surgical separation can be different and relies on the quantity of visits. In small district policlinics the surgical separation consists of consulting room and bandaging, which is located alongside. At a plenty of visits, except for the mentioned apartments, it is necessary to have an operating-room for conducting of aseptic operations ( the operations at inflammatory processes can be executed in bandaging room).

In accordance with norms and rules of health establishments, the area of consulting room must be 10-15 m², bandaging – 15-16 m², thus, on every table is added 8 m². Sizes of operating hall 3,2 х 4,5 not less than.

In a surgical cabinet it is necessary to have table, two-three chairs, couch for the review of sick (for the comfort at undressing and dressing of patient it follows to shut a couch off by a screen), negatoscope for X-rays (Rö-grams); in bandaging – table for a sterile instrument, dinner-wagon (small table) for medicines and solutions which are used during work; closet for saving of medications and bandaging materials, support for boxes of Shimmelbush with sterile linen and bandaging material, two chairs. Also in her it is necessary to have all, that it is needed for washing of hands, and also small stand for saving of plaster of Paris bandages and instruments for the removal of plaster of Paris bandages.

The equipment of operating-room foresees the presence of operating table, movable small table for surgical instruments, 2-4 of spiral stools, supports for boxes of Shimmelbush with sterile linen and bandaging material, closet for sterilization of surgical instruments, small operating set or general surgical tool.

The computation norms of loading of doctor of surgical type in a policlinic on 1 work hours are made: for a surgeon – 9, traumatologist and orthopedist – 7, urologist – 5, oncologist – 5 patients. Patients, who apply first, as a rule, make to 50% from the common quantity of visits of surgical cabinet. Work of surgeon on house – 10-12% from a working day.

The reception, inspection, statement of the diagnosis and medical treatment of patients to which not necessary hospitalization, is the basic task of surgeon in a policlinic. In addition, is continued treatment the patients written out from surgical department.

At the inspection of patients all necessary methods are used: physical (review, palpation and auscultation), instrumental (roentgenological, endoscopic, ultrasonic), laboratory (blood tests, urine, bacteriological, stercoral and serological research, cytological research of tissue after puncture and fluids of organism).

For medical treatment of patients both conservative and operative methods are used. As a rule, the operations are small on a volume and short time continues. They can be executed both in urgent, and in the planned order. For the planned operations it is necessary to select a separate day.

Every ambulatory operation needs to be executed at the sufficient anaesthetizing. In most patients local Novocain anesthesia is used, but at mastitis, paraproctitis, deep forms to the whitlow (felon), phlegmons of brush and other such anaesthetizing uneffective. In such cases it is needed to apply general anesthesia with participation of the prepared anesthesiologist.

The operations and manipulations in a policlinic can be exigent and planned.

To the exigent operations belong:

• reanimation measures (artificial respiration, intubation of trachea, tracheotomy, the closed massage of heart);

• stop of bleeding (temporal that eventual);

• primary surgical treatment of wounds (except for penetrable);

• dissection of the superficial located abscesses of subcutaneous basis (except for the area of neck), furuncles, that with abscess, hidradenitis, whitlow (felon) (the operation at festering processes must execute in default of at the patient of signs of heavy general festering intoxication and saccharine diabetes).

The planned operations are following:

• deleting of small of high quality tumors of soft tissues (atheroma, lipoma, hygroma and an.) with obligatory direction of preparation for histological research. Patients with the pigmented tumors of skin, leukoplakia, keratosis of lips, hemangioma, new formations of milk glands, polyps and fibrosis knots of crotch and anal opening must be operated in the conditions of permanent establishment.

• carving of mucus bags of bursitis;

• deleting of nail growing in;

• puncture of joints for diagnostics and medical treatment;

• deleting of the superficial located organized hematoma (couvercle), if there is a confidence, that she does not pulsate;

• imposition on the wound of the second stitches;

• deleting of the superficial located strange bodies.

Preparation of the operating field, hands of surgeon, treatment of instruments of operation it is needed to conduct in strict accordance with the rules of asepsis.

The large value in work of surgeon of policlinic is had by timely hospitalization of patient in permanent establishment.

Testimonies for urgent hospitalization are:

1. sharp surgical diseases which need the exigent operation and can not be executed in the conditions of policlinic;

2. damage of organs at which impossible ambulatory medicare;

3. sharp surgical infection which needs large on a volume surgical interference or permanent care of patients;

4. hospitalization at suspicion on the sharp surgical disease with the purpose of dynamic supervision.

The planned hospitalization is conducted, in the case:

1. medical treatment of disease needs the considerable volume of operating interference;

2. medical treatment of chronic diseases in the conditions of policlinic uneffective;

3. the inspection of patients needs the special apparatus, or the special terms of inspection;

4. small operations at seriously sick patients.

Planned patients to which illness does not threaten to the life and they can be comprehensively inspected in a policlinic are hospitalized.

During the reception a surgeon conducts considerable part of time in bandaging. At presence of one bandaging the clean bandaging needs to be done above all things, festering – second time.

Work of doctor-surgeon of policlinic contains medical treatment of the patients written out from permanent establishment, examination of temporal or firm loss of capacity, health centre system of patients. In addition, he fills an ambulatory card, sick-leave authorization and sheet of consideration, writes recipes, and appoints consultation of specialists and inspection.

Success of work of surgeon relies on the level of professional preparation of medical sister (nurse). The trained nurse can independently execute most bandaging, but no one bandaging must not be executed without the supervision of doctor-surgeon.