The methodical pointing is to work of students on practical employment

Semantic module 3.

General anesthesiology and reanimation

Practical employment # 13

Theme: reanimation measures for surgical patients.

Theoretical questions are for a study and discussion:

1. Classification of the terminal states.

2. Clinical displays of preagony, agony, different types of death.

3. Principles of treatment of the terminal states.

4. Method of artificial ventilation of lungs.

5. Method of indirect massage of heart .

Literature:

Butursky A. “General surgery”. (Simferopol 2004)

S. I. Shevchenko; A. A. Tolkoglas and etc. “Surgery” (Kharkov 2004)

Methodological Instruction.

Distributing of marks which are appropriated students:

At mastering of theme 14 from rich in content the module # 4 for educational activity an estimation is proposed a student for traditional scale which converted to points as follows:

Estimation	Points
“5”(fine)	6 points
“4” (well)	4 points
“3”(satisfactorily)	2 points
“2” (unsatisfactorily)	0 points

1.Method of reanimation at acute asphyxia?omy

1 oxygen therapy

2 indirect massage of heart

3 artificial ventilation of lungs by a method «mouth to mouth»

4 artificial ventilation of lungs by a method «mouth to nose»

5 conico or tracheotomy

6 thoracotomy

2.What symptoms can we find during the asystole ?

1 bradicardia

2 tachycardia

3 convulsive, unrhythmical breathing

4 cardiac activity is absents

5 violation of exchange processes

6 absence of pulse

3.Leadthrough of defibrillation is necessary at:

1 acute stop of heart

2 bradicardia below 40 in 1 minute

3 fibrillation of atrium

4 fibrilation of ventricles

5 preagonal state

4.During the leadthrough of indirect massage of heart it is necessary to place in the grown man a palm:

1 on verge of middle and lower third of breastbone

2 in fifth intercostal space

3 on overhead third of breastbone

4 in fourth intercostal space

5 in the area of handle of breastbone

6 in the underbody of breastbone

5.Symptoms of efficiency of indirect massage of heart:

1 appearance of tendon reflexes

2 expansion of pupils

3 narrowing of pupils

4 absence of pulse is on carotids

5 appearance of pulse

6 cyanosys of skin covers

6.The final diagnosis of stop of heart set on the basis of?

1 absence of consciousness

2 absence of pulse on carotids

3 wide pupils

4 EKG

5 diffusive hypoxia

7.What is the correlation between artificial ventilation and indirect massage of heart during the leadthrough of reanimation?

1 1:5

2 2:15

3 1:7

4 1:3

5 1:2

8.The indirect massage of heart is conducted with force :

1 approaching of breastbone to the spine on 5 sm

2 approaching of breastbone to the spine on 2 sm

3 approaching of breastbone to the spine on 1 sm

4 approaching of breastbone to the spine on 10 sm

5 approaching of breastbone to the spine on 7 sm

1. From an operating-room the patient R. is translated in the chamber of intensive therapy, that carried under the combined anesthesia a gastrectomy, draining of abdominal region. In 15 minutes after interference the independent breathing was halted, cardiac activity is stored. Reanimatologist is shown out lower jaw, through a mouth entered of air-duct - the independent breathing absents.

What from complications did develop for this patient? How to give a help to the patient?

2. A patient during 2 days got conservative therapy concerning traumatic shock of the III degree as a result of the closed break of bones of pelvis. A patient is shown out of shock. During X-ray examination in lungs found out plural shallow atelectasiss. Did this heavy complication develop as a result ?

3. Patient, 82 years old, had a stop of heart and breathing; in anamnesis – cardiac insufficiency lasted. On 5 minute of pneumocardial reanimation which began in time, proceeding in cardiac activity is not registered. Does it cost to continue reanimation measures? What prognosis, during a subsequent reanimation, in relation to proceeding in cardiac activity?

4. A child has the sudden stopping of breathing, become blue skin, disappearance of pulse on main vessels and narrowing of pupils. What near-term measures need to be conducted.

5. Woman of 64th with an unstable stenocardia during walking fallen down suddenly. A duty doctor at a review is establish a fainting fit, absence of pulsation on and. carotis and tones of heart, narrow pupils and liquid shallow breathing. What diagnosis? What first medical aid?

6. For the patient of 75-years old, which is in intensice therapy department concerning the heart attack of myocardium, there was fibrilation of ventricles. The immediate complex of reanimation measures is effective, picked up a thread sines rhythm. Objectively: AP 130/80, shortness of breath, – 24 in 1 minute, auscultation – from the right side of breathing not determined, during percusion is a box sound. Roentgenologic: two-bit of liquid. Specify the most reliable reason of complication which developed?

7. A patient is in the state of clinical death. Artificial ventilation of lights is conducted by a method «from a mouth to the mouth» and indirect massage of heart. A doctor paid a regard to that air does not pass in the respiratory tracts of patient, and his chairman on a trunk are in one plane. Is there what reason of unefficiency of artificial respiration in this situation? Subsequent actions of doctor?

8. The child 10 years old delivered ashore in 3 minutes after sinking. Objectively: a pulse on peripheral arteries is not determined, pupils are moderato extended, poorly react on light. Skin covers are pale with a cyanochroic tint. In the cavity of mouth sand, silt; breathing is sharply low-spirited. What urgent and primary measures at the grant of help to suffering?

ANSWERS

Tests:

1 – 3, 4;

2 – 4, 6;

3 – 1, 4;

4 – 1, 6;

5 – 3, 5;

6 – 2, 4

7 – 1, 2;

8 – 1, 5.

Tasks:

1.Answer: the reflex stop of breathing developed for a patient. It is needed to conduct artificial ventilation of lights «mouth in a mouth», or by the respiratory sack of Ambu.

2.Answer: this patient is with ‘shocked lung’.

3.Answer': we must to prolong a pneumocardial reanimation farther. Fully picking up a thread cardiac activity is impossible.

4. Answer: it is needed quickly to conduct reanimation measures a child: artificial ventilation of lights, the massage of hear.

5.Answer: at sick displays of clinical death are absence of consciousness, pulsation, on carotids, the photoharmose of pupils absents. It is needed without delay to begin reanimation measures – indirect massage of heart, artificial ventilation of lights.

6.Answer: for a patient breaks of ribs and breastbone are with injuring of parietal pleura by wreckages as a result of leadthrough of reanimation measures.

7.Answer: at the sick falling back of language. It is needed to show out a lower jaw downward and forward, to get a language, prolong to conduct reanimation measures.

8 .Answer: it is needed to release overhead respiratory tracts a patient from sand and to the silt, to eliminate the presence of water in respiratory tracts (to delete water if is). After it to conduct reanimation measures after to the generally accepted chart.