Methodical instructions for students VI years
(Vascular Surgery)
Lesson № 19 (Practical – 6 hours).
TOPIC: CAUSES OF ACUTE EMBOLISM AND THROMBOSIS OF ARTERIES.
Topics: 1. Arterial thrombosis
2. Arterial embolism.
3. Surgical treatment of arterial thrombosis and embolism
Purpose: To be able to diagnose, to know the clinic of acute vascular insufficiency of the lower extremities, depending on the causes, clinical features of disease, and to justify the conservative and surgical treatment
Professional oriented students:
Statistics show an increase in acute arterial embolism and thrombosis – severe complications, which will meet the doctors of all specialties. However, the problem of care for patients with this disease is still far from solved, as evidenced by the high mortality rate – from 20 to 35%, and the high frequency of limb amputation at the gangrene – almost 20% of patients.
Injuries are an important social and medical problem. In recent years, increased the number of serious injuries and connected, which often lead to severe bleeding and death
Methodology for practical work
The practical part of the session 9.00 – 12.00
Algorithm for communication of students with patients with any pathology, which is seen on the subject (communication skills):
1. Greet and identify himself.
2. The face should be welcoming smile – this allows you to establish a trust relationship with the patient.
3. A patient in a pleasant form should explain the purpose of the visit, the subject and the duration of the conversation and get his consent.
4. If a patient only comes to the hospital to conduct correctly, and quiet conversation with his relatives, which together with the doctor to inform them about the previous diagnosis, hospitalization, for some surveys, which are scheduled to perform in the future.
5. Before the physical examination survey methods to explain what the patient survey will be carried out, indicate some discomfort and discomfort that may feel the patient at the time of the survey, noting bound by the survey in the diagnosis of this disease and to obtain his consent.
6. If you need transportation to the place of examination (visual room, X-ray, ultrasound study) to explain its need for the patient.
7. Prepare for the survey (for data pathologies meant inspection, palpation limb aortoarteriography, ultrasound vascular feet, Doppler) – wash your hands with warm water, put on signets, prepare tools for the performance of other diagnostic manipulation.
8. To hold something or other planned medical examination or manipulation.
9. Together with the attending physician in the correct and easy to understand format patient to explain the results of either survey.
10. Involve family and patient to talk in simple terms to explain to them the results of the survey data and in the presence of previous surveys to compare their results, be sure to ascertaining whether they understand your explanations.
11. Required only in the presence of the attending physician to substantiate the feasibility of surgical intervention for the treatment of this pathology in charge of the patient.
12. Following surgical treatment only in the presence of the attending physician and with his consent should communicate the results of surgical intervention the patient and his relatives as well as the possibility of this or early or late postoperative complications.
13. Under the conditions of examination of patients in the postoperative period should be explained to the patient as true to perform hygiene procedures and the like.
14. In polite to get consent from the patient to participate in the ligation.
15. Together with your doctor to explain to the patient, and when the needs and the immediate family, those or other actions regarding manipulations that have been implemented or planned to run in the future as well as the tactics of the subsequent treatment.
16. Finish the conversation should always be the wish of the patient the most rapid recovery.
Work 1
1. Collection of complaints, history, examination of the patient.
2. Identification of clinical symptoms and instrumental.
3. Grouping symptoms syndromes.
4. Determination of the leading syndrome.
5. Interpretation of laboratory – instrumental data
6. Rationale preliminary diagnosis
7. Differential diagnosis.
8. Formulation of clinical diagnosis.
9. Appointment of differentiated treatment programs according to the clinical protocol
Work 2. Browsing the Internet, reading room with cathedral library topical literature.
Program self-students
1. Anatomical functional characteristics of arteries and veins of the lower extremities.
2. The etiology, pathogenesis and classification of acute ischemia of lower extremities.
3. Factors convolution and protivosvertochnoy systems.
4. The mechanism of thrombosis.
Break – 12.00-12.30
Seminar discussion of theoretical issues – 12.30-14.00
Theme № 1. Arterial thrombosis
1. The causes of arterial thrombosis.
2. Clinical characteristics of arterial thrombosis.
3. Classification of arterial thrombosis.
4. Differential diagnosis of acute thrombosis of major arteries.
7. Indications for conservative treatment, drugs that are used.
8. Anticoagulants, phybrinolytic, thrombolytic drugs.
9. Control methods for convolution system, their characteristics.
Theme № 2 Arterial embolism
1. Causes of arterial embolism.
2. Clinical characteristics of arterial embolism.
3. Classification of arterial embolism
4. Differential diagnosis of arterial embolism
7. Indications for conservative treatment, drugs that are used.
8. Anticoagulants, fibrinolytic, thrombolytic drugs.
9. Control methods for the convolution system, their characteristics
Theme № 3 Surgical treatment of arterial thrombosis and embolism
1. Indications for surgical treatment of arterial thrombosis
2. Indications for surgical treatment of arterial embolism
3. Contraindications to surgical treatment of arterial thrombosis
4. Contraindications to surgical treatment of arterial embolism
5. Access to the main arteries
Break – 14.00-14.15
Hour self-study students – 14.15-15.00
– Tutorial test licensing examinations «Step 2»;
– Assessment of students who have not passed on the eve of the test control system «Moodle»;
– Letting students practical skills in the corresponding entry in matrikulyar book.
Sample test items and situational problems.
1. The patient admitted to hospital with a diagnosis: embolism the left popliteal artery . What is the most probable cause of embolism?
2. The patient admitted to hospital with suspected embolism the left popliteal artery. What is the symptom will testify in favor of embolism?
3. What phase hemocoagulation inhibits heparin:
A. Only the formation of thrombin
B. No right answer
C. Only the formation of fibrin
D. Only the formation of thromboplastin
E. It operates on the phase of thrombotic
4. Indirect anticoagulants include:
A. Preparation of 4-oksikumarina
B. Preparations of alkaloids
C. Fibrinolytic drugs
D. Pentoksiphylin
E. Thrombolitic drugs
5. The absolute contraindication of anticoagulants include:
A. Bleeding of any location, hemorrhagic diathesis
B. Aplastic anemia
C. Respiratory failure
D. Cardiovascular insufficiency
E. Lack of cerebral circulation
The student should be able to:
1. Septic endocarditis
2. Apply trombolitichiskie drugs and anticoagulants.
3. Appoint conservative therapy for acute lower limb ischemia.
4. Determine the ripple in the typical spots on the major arteries of the lower extremities.
5. Rate dopplerometry.
6. Apply methods to temporarily stop bleeding.
7. Appoint conservative therapy in acute blood loss.
The answers to tests and situational tasks:
1. Septic endocarditis
2. Severe pain in the limbs
3. A.
4. A.
5. A.
Information:
Basic:
1. Jack L. Cronenwett, Wayne Johnston Rutherford’s Vascular Surgery. 7th Revised edition. – Elsevier -Health Sciences Division. – 2010.
2. Alun H. Davies and Colleen M. Brophy (Eds) Vascular Surgery. – Springer. – 2006.
3. Э. Ашера Сосудистая хирургия по Хаймовичу. – Москва 2010. – Бином. – Т.1.
4. Э. Ашера Сосудистая хирургия по Хаймовичу. – Москва 2010. – Бином. – Т.1.
5. 1. Hospital surgery / Edited by L. Kovalchuk, V. Sayenko, G. Knysov, M. Nychytailo . – Ternopil: Ukrmedknyga, 2004.
6. Materials for practical classes
Additional:
1. К. Заринш, Б. Гевертс. Атлас по сосудистой хирургии. – Москва 2009. – Гэотар– Медиа
Обговорено на засіданні кафедри
“03” червня 2014 р. протокол №2
