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FEATURES OF OUTPATIENT MEDICAL CARE TO TRAFFIC ACCIDENT VICTIMS

 

V.J. GORBUNKOV, D.A. BUGAEV, A.V. DYADKOV

Stavropol State Medical Academy; Stavropol, RUSSIA

 

Introduction: traffic injuries prevention is one of the most important social and health problems of modern society.

Aim of work is to analyze structure of road accident victims’ primary visits to an outpatient trauma center of Stavropol city.

Materials and methods: 593 cases of road victims’ primary visits to the outpatient trauma center were analyzed.

Results: Men dominated among patients (52,8 ± 2,1%). Patients’ mean age was 43,2 ± 18,2 years. In 51,8 ± 2,1% (n = 307) cases, victims were transported by an emergency ambulance. The overwhelming majority of victims (85,2 ± 1,5%) visited the trauma center within the first six hours. Pedestrians dominated among victims: 56,0 ± 2,0% (n = 332) (t ≥ 2). The most frequent localization of injuries were extremities: 53,7% (n = 318) (t ≥ 2). There was no significant difference in frequency of upper and lower extremities injuries. In the least number of observations injuries of multiple localizations were recorded. The study revealed predominance of superficial injuries, contusions, sprains and joint capsule and ligament overexertion 46,7 ± 2,1 (n = 277) (t ≥ 2). There were registered no any patients in shock, with shaft or proximal femur fractures and with abdominal trauma. Quite high rate of patients with mild brain trauma was noticed: 17,0 ± 1,5 (n = 150).There are no any staff neurosurgeons in outpatient trauma center, thus all patients with brain trauma were sent to a hospital. Totally 123 (20,7 ± 1,4%) patient were sent to hospitals.

Conclusion: The overwhelming majority of patients initially visited outpatient trauma center need further treatment at the same institution (t ≥ 2). It should be noticed that 62,8 ± 3,3% of patients subsequently sent to the hospital, were taken initially to an outpatient clinic by an emergency ambulance. This unreasonably increased number of medical care steps. Necessity to develop an algorithm for improving efficiency of emergency ambulances and other medical institutions interaction is proved by the above mentioned fact.

 

FIRST EXPERIENCE OF SURGICAL TREATMENT OF HAND TRAUMA AND DISEASES IN OUTPATIENT SURGERY DEPARTMENT

 

V.J. GORBUNKOV, D.A. BUGAEV

Stavropol State Medical Academy, Stavropol, RUSSIA

 

Introduction: Hand trauma and diseases are one of the main causes for patients with musculoskeletal pathology to visit outpatient clinic for medical assistance.

Aim of work is to represent structure of patients treated in outpatient department of surgery.

Results: Outpatient department of surgery at the clinical-diagnostical outpatient medical center of Stavropol city is at service from September 2010 as a clinical base of the “Department of Outpatient Surgery” of the “Stavropol State Medical Academy”. One of the main scientific interests of the department is hand surgery. This helped to select patients with hand pathology for elective surgery in outpatient clinic. Previously patients with such pathology were treated in hospitals. During period from September 2010 to august 2011 - 38 patients with hand pathology were operated on. Among them: Dupuytren’s contracture – 3 patients, De Quervain disease – 2, ganglion – 2, hand fibroma – 2, angioma – 1, osteoid osteoma – 1, fractures of metacarpal bones – 4, fractures and dislocations of phalanx (except mallet finger) – 3, open injury of flexor tendons – 1, open injuries of extensor tendons – 2, mallet finger – 15, faulty stumps of fingers – 2. Different types of local anesthesia were used during surgery: conduction anesthesia at the level of carpal canal, finger block, Oberst anesthesia, infiltration anesthesia. Open palm method was applied for Dupuytren’s contracture treatment. Osteosynthesis of metacarpal bones was performed with K – wires. Type I of mallet finger according to Doyle classification was treated with tendon reinsertion, types IV B,C – with different technics of K-wires osteosynthesis. There were no any postoperative infections. One patient had recurrent mallet finger deformity. Good results were achieved in all other cases.



Conclusions :Operative treatment of hand trauma and diseases in outpatient surgery department is perspective way of municipal health care development in Stavropol city.

 

THE USE OF PROPOFOL IN SURGICAL INTERVENTIONS IN CHILDREN

 

C.N. GULIYEV, E.M. NASIBOVA

Azerbaijan Medical University, Baku, AZERBAIJAN

 

In the last decade in anesthesia practice widely used intravenous anesthetic propofol – a drug with unique pharmacokinetic and pharmacodynamic properties which are widely reflected in literature, although, unfortunately, most it related to Research in adult patients. Available to us in the domestic and foreign literature we have not met the special works devoted to the comparative study of propofol and ketamine anesthesia for surgery to ensure the children. At the Department of Pediatric Surgery AMU anesthesia with propofol was applied over 100 children over three years for pain relief at various manipulations in the hospital, “one day”, as well as during prolonged surgical interventions (both for induction and for maintenance of anesthesia). For an objective assessment of the vital body functions and clinical anesthesia, we used the following methods: ECG, EEG, to determine the frequency of respiration, heart rate and blood pressure non-invasive method, the saturation of arterial blood oxygen hemoglobin, study locomotors ataxia, drowsiness and orientation. The study showed that anesthesia provides a high degree of protection and protects the baby from the development of pronounced operational stress. Our little clinical experience with propofol showed that the rapid awakening and no side effects from anesthesia distinguishes it from other means of anesthesia (as for intravenous administration of ketamine, as well as for inhalation) is the most promising direction in pediatric anesthesiology and can be recommended for practice usage.


Date: 2014-12-28; view: 834


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