Methodical development of number 4
THE PRACTICAL LESSON FOR STUDENTS
MEDICAL FACULTY of discipline “emergency and emergency care”
Department of urgent and emergency care
Lesson № 4 (practical-6 hrs)
Theme Diagnosis and treatment of emergency conditions at the scene. Emergency medical services in mechanical injuries
Objective: To acquaint students with modern methods of diagnosis and treatment of acute coronary syndromes in the prehospital and early hospital stages, cardiogenic shock, hypertensive crisis, anaphylaxis, hypothermia, drowning, electric shock, coma unknown etiology, coma in diabetes, poisoning by an unknown gas poisoning unknown substance in accordance with approved protocols for emergency medical conditions. To acquaint students with the basic principles of diagnosis and treatment in the prehospital phase of mechanical damage skull, spine, chest, abdominal and pelvic organs, limbs. Diagnosis and tactics visiting teams with multiple trauma, the syndrome of long-term compression and crushing, internal and external bleeding, traumatic and hemorrhagic shock, and hemo-pneumothorax. To master the modern algorithm for emergency medical assistance to victims of a traffic accident. Bring to the attention of students and how to stop external bleeding machinery, transport equipment immobilization of different bone segments in the prehospital phase, puncture of the chest in a tight pneumothorax, methods of overlay occlusive dressings.
Professional motivation: It is known that various acute diseases, traumatic injuries, accidents, etc. require emergency medical care, the timeliness and quality of which depends on the health, and partly of life. Knowledge of the basic principles of modern medicine protocols for emergency conditions, coupled with a high level of practical skill development and timely and qualitative emergency medical activities performed at the hospital early hospital stage not only save the lives of patients (victims), but also further the successful treatment of illness or injury , thus preventing the development of serious complications.
Program Individual Students
1. Diagnosis, clinical course, treatment of acute coronary syndrome and cardiogenic shock.
2. Principles of diagnosis and treatment of hypertensive crisis according to clinical protocols for emergency medical conditions.
3. Diagnosis varieties and modern algorithm for emergency medical care to patients with anaphylactic shock.
4. Hypothermia, symptoms, diagnosis, course of warrants, emergency medical care.
5. Drowning, types, pathogenesis, clinical features, especially for emergency medical care.
6. Diagnosis and treatment of shock, including victims who are in a state of clinical death.
7. Coma, coma unknown etiology, coma, diabetes, diagnosis and treatment.
8. Poisoning unknown gas poisoning unknown substance, the basic criteria for diagnosis, clinic, emergency medical care in accordance with approved protocols for emergency medical conditions.
9. Causes, diagnosis and treatment of traumatic injuries of skull and spine.
10. Injuries to the thorax, the abdomen, the main clinical manifestations at the stage of primary and secondary inspection, emergency medical care.
11. Diagnostic and therapeutic tactics with injuries of the pelvis, pelvic organs and extremities.
12. Diagnosis and tactics visiting teams with multiple trauma, the syndrome of long-term compression and crushing.
13. The concept of internal and external bleeding, how to stop at different levels of pre-hospital care.
14. Traumatic and hemorrhagic shock, major diagnostic criteria, clinical features, pre-hospital and early hospital medical care
Sample tests and situational tasks:
1. Patient K., 50 years old, complains of headache, dizziness and nausea. An hour ago fell and hit his head on the curb. Lost consciousness for 10-15 min. On examination: pale skin, breathing, calm, smooth. Pulse – 54 for 1 min. BP – 110/60 mm Hg. century. The victim drowsy, emotionally excited, underestimates its critical state. Observed slight anisocoria, dependence right nasolabial folds, tongue rejected right. Muscle strength in his right hand lowered, increased tendon reflexes, sensory and coordination disturbances there. What kind of damage can think of in this case?
A. Concussion of the brain.
B. Bruising of the brain.
C. Compression of the brain.
D. Hemorrhagic shock.
E. Mental shock.
2. Examining a patient after an accident doctor diagnosed it closed head injury. What are the main forms are distinguished in the clinical course of closed head injury?
A. Concussion.
B. Bruising of the brain;
C. Compression of the brain;
D. All above.
E. All above and skull fractures.
3. Inspecting patient after accident doctor diagnosed his concussion. What are the main symptoms of this disease?
A. Short fainting.
B. Retrograde amnesia (loss of memory for events that preceded the injury).
C. Bradycardia, nausea, vomiting.
D. Pain during movement of the eyeballs.
E. All of the above listed symptoms.
4. Will define major complication in the case of traumatic brain injury:
A. Increased sensitivity to atmospheric conditions.
B. Encephalitis.
C. Meningitis.
D. Increasing intracranial pressure.
E. Mental shock.
5. Which of the following symptoms are not typical for traumatic brain injury?
A. Violation blood circulation.
B. Intracranial increase in venous pressure.
C. The development of cerebral edema.
D. Swelling of the brain substance.
E. The appearance of symptoms of intoxication.
Correct answers to the tests: Standards of answers: 1 – B 2 – D; 3 – E, 4 – D; 5 – D
4. Information generators:
A) basic:
1. American Heart Association in collaboration with the International Liaison Committee on Resuscitation (ILCOR)/ International Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. A Consensus on Science // Resuscitation. – 2004. – 46. – P. 103 – 252.
2. European Resuscitation Council. Immediate life support. 1- st Edition. Published by European Resuscitation Council Secretariat VZW, 2006.
3. Lattore F., Nolan J., Robertson C. et al. The ALS working group of the European Resuscitation Council. The European Resuscitation Council Guidelines 2003 for Adult Advanced Life Support Resuscitation. 2000. – 48. – P. 211 – 212.
4. Safar P, Bircher NG. Cardiopulmonary and cerebral resuscitation. 3rd ed.
5. John Campbell. International Trauma Life Support. USA. New Jersey 2008. P. 289.
B) additional:
1. www.erc.edu
5. www.bcs.com
11. www.eusem.org
12. http://zakon2.rada.gov.ua/laws/show/5081-17
13. http://pidruchniki.ws/17540906/bzhd/samodopomoga_vzayemodopomoga_nadzvichaynih_
14. http://www.bibliofond.ru/view.aspx?id=492657.
15. andskp.ucoz.ua/publ/boevaja_podgoto…
16. http://knowledge.allbest.ru/life/2c0a65625a3bc68b4c53a88421316d37_0.html
1. http://5ka.at.ua/load/medicina_ta_zdorov_39_ja/persha_domedichna_dopomoga_v_umovakh_nadzvichajnikh_situacijakh_pri_opikakh_obmorozhenni_udushenni_referat/37-1-0-20950
Methods of practical work (9.00.-12.00)
Work
Work №
When considering the topic of practical classes: “Emergency conditions in acute diseases and injuries of the chest” students receive situational puzzles and implement them on a mannequin from the relevant clinical protocols. learn causes, clinical features, diagnosis, first aid volume in patients with pulmonary hemorrhage, hemothorax, and posttraumatic stressful spontaneous pneumothorax, subcutaneous emphysema, pulmonary embolism, pericardial injuries, heart and large vessels, broken ribs and sternum. We consider the selection of the type and mode of transport affected depending on the nature of diseases and injuries of the chest and its organs during medical evacuation.
Covered topics concerning closed and open abdominal trauma (injury hollow parenchymal abdominal organs). Knife and gunshot wounds, symptoms, diagnosis, the amount of first-aid and treatment during medical evacuation. learn features emergency aid to victims of dislocations and fractures in emergency situations involving the practical operation of transportation immobilization. The variants of the disease with closed and open soft tissue injury (contusion, compression, tensile and tear), traumatic toxicosis (crush syndrome), their clinical signs, clinical course, local changes in injured tissues.
Students are implemented in practice and the concept of internal and external bleeding, how to stop at different levels of pre-hospital care. Defined the concept of trauma and hemorrhagic shock, major diagnostic criteria, clinical, pre-hospital and early hospital medical care of the voice acting modern principles of infusion therapy.
To work out, including methods to stop bleeding: Overlay bundle or bundle twist, compressive bandages, finger pressing artery tightly wound tamponade, blending hemostatic clamp on the blood vessels and wound dressing them or within vessels.
Work
Work 4. The following classes of students traveling to the challenges within the ambulance crews. In the course of joint action with workers Ambulance students involved in the examination of the patient (victim), help to make diverse manipulation procedures (define AD, conduct intramuscular, intravenous injection, if necessary, removal of ECG imposing change on a limb, cervical collar , Blood tow of defibrillation, resuscitation, etc.). Returning from challenges in training room is their discussion, which examines a reach to ill, validity challenges, the quality of teams SMP, timeliness and accuracy exhibited diagnosis, treatment strategy based on current clinical protocols and possible relationship with the clinic ambulance service , hospital and SES.
The student should know:
1. Basic diagnostic criteria, clinical course, treatment of acute coronary syndrome and cardiogenic shock.
2. Principles of diagnosis and treatment of hypertensive crisis according to clinical protocols for emergency medical conditions.
3. Diagnostic algorithm modern varieties and providing emergency medical care to patients with anaphylactic shock.
4. Hypothermia, clinic, diagnosis, course of warrants, emergency medical care.
5. Drowning, types, pathogenesis, clinic, especially for emergency medical care.
6. Diagnosis and treatment of shock, including victims who are in a state of clinical death.
7. Coma, coma unknown etiology, coma, diabetes, diagnosis and treatment.
8. Poisoning unknown gas poisoning unknown substance, the basic criteria for diagnosis, clinic, emergency medical care in accordance with approved protocols for emergency medical conditions.
9. Causes, diagnosis, treatment of traumatic injuries of the skull and spine.
10. Injuries to the thorax, the abdomen, the main clinical manifestations at the stage of primary and secondary inspection, emergency medical care.
11. Diagnostic and therapeutic tactics in injuries of the pelvis, pelvic organs and extremities.
12. Diagnostics and tactics visiting teams at multiple trauma, the syndrome of long-term compression and crushing.
13. The concept of internal and external bleeding, how to stop at different levels of pre-hospital care.
14. Traumatic and hemorrhagic shock, major diagnostic criteria, clinical, pre-hospital and early hospital medical care
The student should be able to:
|
№ |
Habit |
The level of absorption |
|
1. |
Provide emergency medical care to patients with, acute coronary syndrome, kardvohennym shock, hypertensive crisis, anafilakt. shock |
3 |
|
2. |
Provide emergency medical care to victims of open and closed (concussion, contusion, compression) traumatic brain injury. |
3 |
|
3. |
Provide emergency medical care to patients with various types of drowning, electric shock, hypothermia. |
3
|
|
4. |
Perform diagnostics and treatment of coma, including dyfdiahnostyku and emergency medical aid com diabetes |
3 |
|
5.
|
Provide emergency medical care for poisoning the unknown gas poisoning unknown substance |
3 |
|
6. |
Hold the neck and spine immobilization using overlapping cervical collar, laying and fixing injured on the shipping board, use of chest vest immobilization during medical evacuation. |
3 |
|
7. |
Provide emergency medical care to patients with pulmonary hemorrhage and hemothorax. |
3 |
|
8.
|
Provide emergency medical care in open and closed (tight) pneumothorax, subcutaneous emphysema. |
3 |
|
9. |
Provide emergency medical care when chest rib fractures (fracture site pain, imposing leykoplastyrnoyi dressing). |
3 |
|
10. |
Perform puncture of pleural cavity for drainage and its Byulau (in phantom). |
3 |
|
11. |
Conduct clinical assessment of bleeding type and volume of blood loss. |
3 |
|
12 |
Make time stop external bleeding by mechanical means: a change in body position or limb overlay harness or bundle twist, compressive bandages, finger pressing artery longing tamponade wound overlay hemostatic clamp on the blood vessels. |
3 |
|
13. |
Make a final stop external bleeding by mechanical means, ligation of vessels in wound suturing blood vessels from surrounding tissue. |
3
|
|
14. |
Hold topical application of chemical and biological agents hemostasis. |
3 |
|
15. |
Identify the shock index Aldhovera – Storm on the basis of clinical heart rate and blood pressure. |
3 |
Options to control the test questions practice session № 4:
1. What first aid i advise you patient with traumatic brain injury?
A. Apply cold to the head;
B. Apply antihemorrhage means.
C. Enter antishock drugs.
D. Limit fluid.
E. Tips to follow salt-free diet.
2. What is a brain contusion?
A. Cerebral damage.
B. Focal damage to anatomical structures of the brain.
C. Necrosis of brain tissue.
D. Hemorrhage in the brain.
E. Reflex vasospasm certain areas of the brain.
A. Concussion of the brain.
B. Bruising of the brain.
C. Slaughter of the spinal cord.
D. Fracture of the cranial vault.
E. Fracture of the skull base.
4. Examining a patient after an accident doctor found it closed head injury. What is most characteristic of closed head injury?
A. Brain damage without violating the integrity of the head.
B. Brain damage without skull fracture.
C. Damage cover without disturbing the integrity of the head and skull fracture.
D. Damage to the soft tissues of the head without skull fracture.
E. Damage to the soft tissues of the head, skull fractures without violating the integrity of the dura mater.
5. Examining a patient after an accident doctor found his open head injury. What is most characteristic of open craniocerebral injury?
A. Damage to the skin, aponeurosis, muscle or periosteum, the skull bones;
B. Damage to the skin, aponeurosis, muscle or periosteum, dura mater;
C. Damage to the skin, aponeurosis, muscles, bones, skull, dura mater.
D. Damage to the skin, aponeurosis, muscle or periosteum while maintaining integrity, bones of the skull, dura mater
E. Damage to the dura mater, cranial bones, while maintaining the integrity of skin
6. Brigade EMC victim B., 52, 20 minutes. after an accident adventure. On examination the patient: severe subcutaneous emphysema oecks, face and left side of the chest. Skin and mucous membranes cyanotic. The veins on his neck stretched. Palpation of the chest wall on the left clearly defined crackling bone fragments (3-5 ribs). Breath left not bugged. Cardiac deaf. BP – 180/90 mm Hg. century. What kind of damage can think of in this case?
A. Fracture of ribs.
B. Closed pneumothorax.
C. Open pneumothorax.
D. Fracture of ribs and closed pneumothorax.
E. Chest trauma.
7. EMC doctor examined the patient during transport to hospital treatment and showed a sharp weakening voice shaking and percussion dullness lower left corner of the scapula. What kind of pathological condition can think of?
A. The presence of fluid in the pleural cavity.
B. The presence of pleural tumors.
C. Obturation of the lumen of the bronchus
D. Having all of the above pathological conditions
E. The presence of air in the pleural cavity.
8. After chest trauma with rib fractures hemopleura to diagnose the patient decided to perform a pleural puncture. In the place most appropriate to pleural puncture?
A. In the second intercostal space on the mid-clavicular line;
B. In the IV intercostal space in mid-clavicular line;
C. In UI-UII-axillary intercostal space on the back or shoulder line;
D. As in the intercostal space along the mid-axillary line;
E. IV intercostal space in the posterior axillary line.
9. Identify the typical clinical signs of open pneumothorax:
A. Hard general condition of the patient.
B. Forced position.
C. Subcutaneous emphysema.
D. Bold air bubbles and blood from a wound with a distinctive sound when breathing.
E. Chest pain.
10. What first aid measures in case of closed pneumothorax?
A. Closed pneumothorax transferred into the open.
B. Anti-shock administered drugs.
C. Conduct initial debridement.
D. Impose occlusion.
E. Administered hemostatic means?
11. What is the first aid to patients with open pneumothorax?
A. Bronchoscopy.
B. Pleural puncture.
C. Initial treatment of wounds.
D. Thoracotomia i s audit of the chest.
E. Overlay occlusion dressing.
12. Identify the mechanism of formation of valvular pneumothorax.
A. I The air is coming out of the wound during breathing.
B. Air enters the wound i is obtained by breathing.
C. Air gets into the wound does not work when i go.
D. There is a valve that does not let air.
E. Air enters through the bronchus, and goes through the wound.
13. Patient, 38 years old, 20 min. after stab wounds breast. Left in section VII intercostal space, the posterior axillary line knife wound size 1×2 cm clouded his consciousness. Skin pale. During the examination of the victim emerged collapse with loss of consciousness. The patient was covered with cold sweat, blood pressure dropped to 60/40 mm Hg. century. What should be done in the first place?
A. Develop infusion therapy, stabilize geodynamics;
B. Develop urgent blood transfusion with regard to blood group and Rh factor and stabilize geodynamics;
C. Develop infusion therapy and promptly perform puncture and drainage of the pleural cavity;
D. Develop infusion therapy and promptly deliver to the operating room for emergency thoracotomy;
E. Carry out resuscitation.
14. What first aid should be given to the patient with penetrating chest wound open pneumothorax?
A. Apply occlusal aseptic bandage.
B. Apply adhesive bandage with plastic wrap.
C. Hold paravertebral blockade.
D. Hold vasosympatic blockade.
E. Run puncture of the pleural cavity.
15. What WEST necessary priority to providing first aid in case of penetrating injury to the abdomen?
A. Stop the bleeding.
B. Enter spasmolytics, pain.
C. Drugged place injuries novocaine.
D. Enter cardiovascular drugs.
E. Apply aseptic bandage the wound.
16. What is the main symptom develops when damages hollow organs of the abdominal cavity?
A. Pain in the abdomen.
B. Faces of Hippocrates.
C. The increase in white blood cell count in the blood.
D. Symptom Schotkina-Blumberg.
E. Symptom Pasternatskogo.
17. Infusion therapy of shock should start with intravenously administration:
A. Hemodez
B. Isotonic solution of sodium chloride
C. Polihlyukina
D. Hypertonic glucose solutions
E. 5% glucose solution
18. 413 crew emergency caused to the victim 40 years with stab wounds in the back at the left shoulder. Objectively \: hard condition, conscious, euphoric, AT 90/50 mm Hg, Ps-120/hv, poor volume. Breathing shallow, BF-34/hv. With wounds oozing blood. What tactics medical emergency?
A. Urgent transport to the surgical department
B. Infusion therapy
C. Tracheal intubation, artificial ventilation
D. Introduction sympathomimetics
E. Puncture of large vessels, jet entering polyglucin
19. The crew emergency medical care due to patient 40, who treated leg wound received at home. The patient’s condition progressively worsened during the week \: developed weakness, shortness of breath. When viewed \: the patient’s condition is extremely serious, skin pale, dry, cold, marked cyanosis of the lips, acrocyanosis, body temperature -40,0 ° C, BH-32/hv, SC-60/30 mmHg, PS- 132/hv, leg swelling, flushed to the hip. What is the most likely diagnosis?
A. Hypovolemic shock
B. Anaphylaxis
C. Cardiogenic shock
D. Toxic shock
E. Traumatic shock
20. As a result of hitting the truck in the upper third of the left femur patient felt a sharp pain permanent nature, which is greatly enhanced when attempting movements. Patient caot move independently determined bleeding clinical examination, deformation of the type “breeches” sharp pain on palpation in the upper third of the left hip, shortening of the lower extremity. Preliminary diagnosis.
A. Fracture of femur
B. Slaughter of soft tissue
C. Damage to the hip muscle chairman of four
D. Dislocation of the hip-
E. Thigh bruise
Methodical instruction made assistant professor RM Liakhovich
Discussed and approved at a meeting of
9 June 2013 Protocol № 10
