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Complex of medical measures at the stages of toxemia and septicotoxemia1. Deintoxication therapy: · infusion therapy; · forced diuresis; · plasmosorbtion; · hemosorbtion; · lymphosorbtion 2. Prophylaxis and treatment of violations of energy and protein exchange: · high-calorie protein diet; · infusion of albumen, plasma, solutions of amino acids (aminozol, isovac, moriamin-2, polyamine-C and others), energy-supply solutions (glucose, fructose, sorbit, intralipid, lipophilics); · anabolic hormones (meatandrostenolon, fonobolil, retabolil); · vitamins; · at the signs of burned exhaustion corticosteroid hormones (prednizolon, hydrocortison) are used. 3. Prophylaxis of purulent complications: · purposeful antibiotic therapy; · immunotherapy (antistaphylococcus vaccine, staphylococcus antitoxin hyperimmune antistaphylococcus plasma, an antistaphylococcus gammaglobulin); · tissular stimulators (pentoxyfylline, methyluracil, tiotriazolin).
V². System of teaching tasks for verification of eventual level of knowledge:
Situation tasks
1. About hour ago a burn happened. The clothes poured by a benzine inflamed. A victim is excited, breaks a secret to get up, the laughter changes by weeping, beyond measure talkative, tries to tell about a case, assures that all will be normal with him, that feels not bad. Pulse 105 shots in a minute. AP is 145/95 mm Hg. How will you determine the area of burn? What stage of burned disease is a patient in? Answer: the area of burn can be defined by rule of nine or palm; patients is in the stage of burned shock.
2. A burn is about 45% surface of body. A victim is put on the brakes, into the contact enters hardly, moans poorly, face is pale; the lines of face are sharp. A pulse is frequent, AP is 85/40 mm Hg. Bandages got wet serosal excretions. A victim is just delivered in the burned department in 6 hours after a burn. What stage of burned disease developed at a patient? Answer: at a victim takes place the developed burned shock.
3. Victim D., 46 years, got a burn flame of hands, left forearm, front surface of trunk, right thigh. For determination of area of burned surface a doctor used the standard silhouette of figure of man, broken on squares which he shaded by crayons in accordance with localization and degrees of burn. What method of determination of area of burned surface did a doctor use? Answer: a doctor applied the method of determination of area of the burn on Viliavin.
4. Victim P., 34 years, is on treatment in the burned department after the affection by flame. There are on-the front trunk burns of the I-II-III gr. There are on brushes and forearm both arms is the II-III gr. The surgical roughing-out of burned surface is already executed to him. Burns of trunk a surgeon decided to treat by opened one and brush and forearm by the closed methods. On 3 days the temperature of body rose at a patient. He grumbles about headache, nausea, loss of appetite. At examination: the lines of face are sharp, skins covers are grey, lips are blue. In data test of blood are lowering of hemoglobin, leucocytosis and blood-sedimentation test increase, there is the change of leukocytic formula to the left. Hypoproteinemia makes progress, maintenance of remaining nitrogen was multiplied and there is a hyperglycaemia and acidosis. Albumen and hemocytes appeared in urine. What is stage of burned disease at a patient? Answer: the stage of toxemia developed at a victim.
5. A woman boiled linen. She added to the water a detergent and decolorant. At the removal of pan from a cooker suffering inverted it on herself and got a burn. Front surface of trunk forearm and hands are hyperemia, surface of burn is whitish with a bad algesthesia. Will you define a degree and area of burn. How will you formulate a diagnosis? Answer: thermal burn of front surface of trunk, forearms and hands I, II, IIIà gr. (27%) are at the victim, burned diseases, burned shock.
6. A victim is delivered in the admission department with the burns of right upper extremity|, front surface of trunk, face. There are burns ²², ²²²a, ²²²b degrees. General area of defeat is 23%. The common state is heavy, a patient is put on the brakes and consciousness is stored. External covers (except for a burned surface) are pale, dry, cold. A chill, thirst, nausea disturbs the patient. Breathing is 24 in 1 min, tachycardia is 120 beats in 1 min, hypotension. Hemoglobin is 160 g/l. Hematuria, albuminuria are noted. Your|yours| diagnosis? Answer: at a victim thermal burn which was complicated by burned shock of the II degree of weight.
7. A Victim Í., 30 years, got a burn steam and boiling water during the explosion of caldron. In 30 minutes he was delivered in surgical department. Burn of face, upper extremities and front surface of thorax are at the patient. In these places the skin is red color, covered by the bubbles of different size. A patient is uneasy, moans and wants to rise from a bed. There is tachypnoe, tachycardia (pulse is 100 beats in 1 min), AP is 150/90 mm Hg. What will a tactic of treatment of this victim? Answer: at a victim thermal burn I, II, IIIà degree (21%), burned shock; the antishock therapy is needed (catheterization of the central vein catheterization of the urinary bladder, filling in of CVB, diuretics, analgesics, antihistaminic, inhibitors of proteases, vitamins)
8. A victim, 25 years, during refueling of an accumulator poured right lower extremity| by sulphuric acid. The skin of front surface of right thigh and shin are red. What does a victim have? What is it necessary to give first help? Answer: in a victim chemical burn of right thigh and shin. The staggering part of extremity must be carefully washed by running water, to impose an aseptic bandage, transport a victim in the surgical separation.
9. During the treatment of burned surface a doctor founded on front of forearm large tense bubbles which have serosal-hemorragic content. Some they opened up independently, a purple surface defined on their bottom. What degree of a burn is possible at this patient? What to do with bubbles? How does treatment of the burned surface complete? Answer: in a victim possible ²²²à – ²²²b degree of burn. Bubbles must be exposed near foundation and to release from content. An aseptic bandage, for example, with solution of “Betadin” is imposed on a burned surface.
10. A victim with burns by flame is delivered in surgical department. Both upper extremities are red, covered by bubbles. The front surface of trunk looks like “marble”, burned surface is painless. Black epidermis is defined on a right hackle on all surfaces, which veins are translucent from under. How will you formulate a diagnosis? How will you write down the formula of burn defining a degree and area of defeat? Answer: at a victim thermal burn of both of upper extremities, front surface of trunk, right hackle (²² gr./18%, ²²²b gr./18%, IV gr./9%); burned shock.
11. A victim is delivered in the admission department of a hospital from the place of fire. Consciousness is oppressed. A face and hands is smoked, a nose and lips is burnt. Breathing is superficial, a cough is periodically is noted, expectoration of sputum with the blackly-grey including. What will your diagnosis and actions? Answer: the thermal burns of the face and hands, inhalation trauma (burn of respiratory tracts and toxic smoke inhalation) are at a patient. A victim must be hospitalized in the department of a reanimation and intensive therapy.
12. A victim is delivered in a state of a burned shock in the department of an intensive therapy and reanimation. The common area of the burn is 50% from the surface of body.. Mass of body is 80 kg What volumes of colloid and crystalloid solutions for intravenous antishock therapy will you sets to a victim in the first days. What speed do you enter solutions with? Answer: Infusion of 6 liters of solutions entered to a victim in the first days. During the first 8 hours it is necessary to enter 3 l, at next 8 o'clock – 1,5 l, at last 8 o'clock of the first days – 1,5 l.
13. A patient addressed to the policlinic with complaints about the burn on the rear of foot, which does not heal long time. It is set at questioning, that two months ago he outpoured hot fat on a leg. He treated by folk drugs independently. By sight on the rear of right foot the surface covered by granulation tissues is defined with residuals of dense necrotizing scab of black and with moderate purulent excretions. What is degree of burn? What will your medical tactic? Answer: the thermal burn of rear of right foot ²²²b degree at a patient. It necessary does necrectomy, liquidation of festering-inflammatory process in the area of burn, application in future avtodermoplastic.
VII. The method of conducting of employment is that organizational structure of employment Distribution of the marks appropriated to the students: At learning of the theme ¹19 of the module ¹1 for educational activity to the student mark is proposed after 4th to the ball (traditional) scale which is then converted in marks as follows:
Technological card of employment
Methodical pointing for work of students on practical lesson Module 1 Thematic module 1 Practical employment ¹19
Theme: Burns. Burned disease
Theoretical questions for the off-hour independent study and discussion on practical lesson ¹19:
1. Determination and classification burns 2. Methods of determination of area burn 3. Methods of prognostication of flow of burns 4. Local and general change in an organism at burns 5. Determination of burned disease, etiopatogenesis and clinical picture of every stage 6. First medical aid at thermal and chemical burns 7. Determination of depth and area of a burn, estimation of weight of a burn 8. An initial treatment of burned surface 9. Choice of method of local treatment of burn 10. Drafting infusion program by a victim with burned shock 11. Drafting of complex of medical measures at the different stages of burned disease
Literature: 1. Butursky A. “General surgery”. (Simferopol 2004) 2. S. I. Shevchenko; A. A. Tolkoglas and etc. “Surgery” (Kharkov 2004) 3. Methodical pointing
Distribution of the marks appropriated to the students: At learning of the theme ¹19 of the module ¹1 for educational activity to the student mark is proposed after 4th to the ball (traditional) scale which is then converted in marks as follows:
Òema ¹19 1 Indicate the methods of determination of area of burn of body: 1 “rule of foot” 2 “rule of ten” 3 B.N.Postnicov’s method (1949) 4 On the special standard tables 5 Viliarevsky’s method
2. From local symptoms at the burn of Ï degree note everything except for: 1 Sickliness 2 Numbness 3 Bubbles 4 Edema 5 Hypoesthesia
3. Scorched disease will emerge at adult victims with? 1 Superficial burn 15% 2 Deep burn 12% 3 Superficial burn 9% and deep burn 9% 4 Deep burn 6% 5 Deep burn 5% and superficial 8%
4. Prognosis at burns is defined: 1 On Pirogov’s index 2 On the index of Franc 3 By rule of nine 4 By rule of hundred 5 On of Postnicov’s index
5. Eliminate the incorrectly indicated stages of flow of scorched disease: 1 Reduction 2 Sharp kidney insufficiency 3 Sharp toxemia 4 Burned shock 5 Hemoconcentration
6. Eliminate the incorrectly indicated stages of flow of scorched disease: 1 Reduction 2 Chronic kidney insufficiency 3 Burned shock 4 Hemodilution 5 Septicotoxemia
7. It is characteristic for burned shock: 1 Unexpressed erectile phase 2 Expressed erectile phase 3 Centralization of circulation of blood 4 Absence of torpid phase 5 Increase of CBV (circulating blood volume) 8. It is characteristic for burned shock: 1 Unexpressed erectile phase 2 Depositing of blood in shocks organs 3 Centralization of circulation of blood 4 Absence of torpid phase 5 Increase CVP
9. There is all at burns shock, except for: 1 Olygo- or anury 2 Increase of CBV 3 Increase of relative closeness of urine 4 azotemia, proteinemia, hemoglobinemia 5 Increase CVP
10. Scorched disease at adults can develop at deep burns: 1 3% 2 7% 3 10% 4 15% 5 8%
11. Scorched disease at adults can develop at superficial burns: 1 3% 2 10% 3 14% 4 20% 5 25%
12. Specify the clinical signs of burned shock
13. Specify the clinical signs of sharp toxemia
14. Specify the clinical signs of septicotoxemia Situation tasks
1. About hour ago a burn happened. The clothes poured by a benzine inflamed. A victim is excited, breaks a secret to get up, the laughter changes by weeping, beyond measure talkative, tries to tell about a case, assures that all will be normal with him, that feels not bad. Pulse 105 shots in a minute. AP is 145/95 mm Hg. How will you determine the area of burn? What stage of burned disease is a patient in?
2. A burn is about 45% surface of body. A victim is put on the brakes, into the contact enters hardly, moans poorly, face is pale; the lines of face are sharp. A pulse is frequent, AP is 85/40 mm Hg. Bandages got wet serosal excretions. A victim is just delivered in the burned department in 6 hours after a burn. What stage of burned disease developed at a patient?
3. Victim D., 46 years, got a burn flame of hands, left forearm, front surface of trunk, right thigh. For determination of area of burned surface a doctor used the standard silhouette of figure of man, broken on squares which he shaded by crayons in accordance with localization and degrees of burn. What method of determination of area of burned surface did a doctor use?
4. Victim P., 34 years, is on treatment in the burned department after the affection by flame. There are on-the front trunk burns of the I-II-III gr. There are on brushes and forearm both arms is the II-III gr. The surgical roughing-out of burned surface is already executed to him. Burns of trunk a surgeon decided to treat by opened one and brush and forearm by the closed methods. On 3 days the temperature of body rose at a patient. He grumbles about headache, nausea, loss of appetite. At examination: the lines of face are sharp, skins covers are grey, lips are blue. In data test of blood are lowering of hemoglobin, leucocytosis and blood-sedimentation test increase, there is the change of leukocytic formula to the left. Hypoproteinemia makes progress, maintenance of remaining nitrogen was multiplied and there is a hyperglycaemia and acidosis. Albumen and hemocytes appeared in urine. What is stage of burned disease at a patient?
5. A woman boiled linen. She added to the water a detergent and decolorant. At the removal of pan from a cooker suffering inverted it on herself and got a burn. Front surface of trunk forearm and hands are hyperemia, surface of burn is whitish with a bad algesthesia. Will you define a degree and area of burn. How will you formulate a diagnosis?
6. A victim is delivered in the admission department with the burns of right upper extremity|, front surface of trunk, face. There are burns ²², ²²²a, ²²²b degrees. General area of defeat is 23%. The common state is heavy, a patient is put on the brakes and consciousness is stored. External covers (except for a burned surface) are pale, dry, cold. A chill, thirst, nausea disturbs the patient. Breathing is 24 in 1 min, tachycardia is 120 beats in 1 min, hypotension. Hemoglobin is 160 g/l. Hematuria, albuminuria are noted. Your|yours| diagnosis?
7. A Victim Í., 30 years, got a burn steam and boiling water during the explosion of caldron. In 30 minutes he was delivered in surgical department. Burn of face, upper extremities and front surface of thorax are at the patient. In these places the skin is red color, covered by the bubbles of different size. A patient is uneasy, moans and wants to rise from a bed. There is tachypnoe, tachycardia (pulse is 100 beats in 1 min), AP is 150/90 mm Hg. What will a tactic of treatment of this victim?
8. A victim, 25 years, during refueling of an accumulator poured right lower extremity| by sulphuric acid. The skin of front surface of right thigh and shin are red. What does a victim have? What is it necessary to give first help?
9. During the treatment of burned surface a doctor founded on front of forearm large tense bubbles which have serosal-hemorragic content. Some they opened up independently, a purple surface defined on their bottom. What degree of a burn is possible at this patient? What to do with bubbles? How does treatment of the burned surface complete?
10. A victim with burns by flame is delivered in surgical department. Both upper extremities are red, covered by bubbles. The front surface of trunk looks like “marble”, burned surface is painless. Black epidermis is defined on a right hackle on all surfaces, which veins are translucent from under. How will you formulate a diagnosis? How will you write down the formula of burn defining a degree and area of defeat?
11. A victim is delivered in the admission department of a hospital from the place of fire. Consciousness is oppressed. A face and hands is smoked, a nose and lips is burnt. Breathing is superficial, a cough is periodically is noted, expectoration of sputum with the blackly-grey including. What will your diagnosis and actions?
12. A victim is delivered in a state of a burned shock in the department of an intensive therapy and reanimation. The common area of the burn is 50% from the surface of body.. Mass of body is 80 kg What volumes of colloid and crystalloid solutions for intravenous antishock therapy will you sets to a victim in the first days. What speed do you enter solutions with?
13. A patient addressed to the policlinic with complaints about the burn on the rear of foot, which does not heal long time. It is set at questioning, that two months ago he outpoured hot fat on a leg. He treated by folk drugs independently. By sight on the rear of right foot the surface covered by granulation tissues is defined with residuals of dense necrotizing scab of black and with moderate purulent excretions. What is degree of burn? What will your medical tactic?
Answer’s:
1 3,4 6 2,4 11 4,5 2 2,5 7 2,3 3 1,2 8 2,3 4 2,4 9 2,5 5 2,5 10 3,4
1 Answer: the area of burn can be defined by rule of nine or palm; patients is in the stage of burned shock. 2 Answer: at a victim takes place the developed burned shock. 3 Answer: a doctor applied the method of determination of area of the burn on Viliavin. 4 Answer: the stage of toxemia developed at a victim. 5 Answer: thermal burn of front surface of trunk, forearms and hands I, II, IIIà gr. (27%) are at the victim, burned diseases, burned shock. 6 Answer: at a victim thermal burn which was complicated by burned shock of the II degree of weight. 7 Answer: at a victim thermal burn I, II, IIIà degree (21%), burned shock; the antishock therapy is needed (catheterization of the central vein catheterization of the urinary bladder, filling in of CVB, diuretics, analgesics, antihistaminic, inhibitors of proteases, vitamins) 8 Answer: in a victim chemical burn of right thigh and shin. The staggering part of extremity must be carefully washed by running water, to impose an aseptic bandage, transport a victim in the surgical separation. 9 Answer: in a victim possible ²²²à – ²²²b degree of burn. Bubbles must be exposed near foundation and to release from content. An aseptic bandage, for example, with solution of “Betadin” is imposed on a burned surface. 10 Answer: at a victim thermal burn of both of upper extremities, front surface of trunk, right hackle (²² gr./18%, ²²²b gr./18%, IV gr./9%); burned shock. 11 Answer: the thermal burns of the face and hands, inhalation trauma (burn of respiratory tracts and toxic smoke inhalation) are at a patient. A victim must be hospitalized in the department of a reanimation and intensive therapy. 12 Answer: Infusion of 6 liters of solutions entered to a victim in the first days. During the first 8 hours it is necessary to enter 3 l, at next 8 o'clock – 1,5 l, at last 8 o'clock of the first days – 1,5 l. 13 Answer: the thermal burn of rear of right foot ²²²b degree at a patient. It necessary does necrectomy, liquidation of festering-inflammatory process in the area of burn, application in future avtodermoplastic.
Date: 2015-02-03; view: 1121
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