Methodical instruction for students V- years
(Vascular Surgery)
Lesson № 10 (PRACTICAL - 6 hours)
THEME: Injuries vessels.
Topics: 1. Trauma arteries
2. Trauma veins
3. Combined vascular injury
Purpose: To be able to diagnose, to know the clinic injuries
limb vessels, depending on the causes, clinical features of disease, and to
justify the conservative and surgical treatment
Professional oriented students:
Until recently, injury and
damage to blood vessels were considered pathological, specific wartime.
Nevertheless, many domestic and foreign authors
have convincing evidence of a significant increase in the number of
injuries of major blood vessels in time of peace, which in the overall
structure of injury reach 2%.
The rapid development of
industry and technology, agricultural mechanization, household contribute to
the high level of injuries. This situation increases the importance of
emergency angiosurgery in addressing these important social objectives, as a
reduction of disability and reduce the time not disability, early medical and
vocational rehabilitation of victims.
Further improvement in the
quality of treatment of injuries of major vessels is dependent on improvements
in diagnostic techniques, the introduction of new diagnostic and medical
equipment, developing operational methods, the introduction of modern science,
pharmacology, rehabilitation, rational organization of the Vascular Service.
In peacetime, the share of
damage to major vessels of the upper extremities account for 32,3%, lower
extremities - 58,8%.
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 aortoarteriograffiya,
ultrasound vascular leg doplerograffiya) - 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. Anatomical functional
characteristics of arteries and veins of upper extremities
3. Etiology of vascular
injury
4. Pathogenesis of vascular
injury
5. Classification of
vascular injury
6. Clinic injuries arteries
7. The clinic combined
injuries
8. Diagnosis of vascular
injuries
7. Temporary stop bleeding
8. Final stop bleeding
9. Factors convolution and
coagulation systems
10. Postoperative management
of patients with vascular injury
Break - 12.00-12.30
Seminar discussion of theoretical issues - 12.30-14.00
Theme № 1 Trauma arteries
1. Causes of injury of the
arteries.
2. Clinical characteristics
of injuries of the arteries.
3. Classification of
injuries of the arteries.
4. Differential diagnosis of
arterial injury.
5. Surgical tactics in
injuries of the arteries
6. Methods of operative
treatment of injuries of the arteries.
7. Features of the
postoperative period after surgery on the injured arteries.
8. Indications for
conservative treatment, drugs that are used.
9. Anticoagulants,
fibrinolytic thrombolytic drugs.
10. Control methods for
convolution system, their characteristics.
Theme № 2 Trauma veins
1. Causes of injury veins.
2. Clinical characteristics
of injured veins.
3. Classification of
injuries veins.
4. Differential diagnosis of
venous injury.
5. Surgical tactics in
injuries veins
6. Methods of operative
treatment of injured veins.
7. Features of the
postoperative period after surgery on the injured veins.
8. Indications for
conservative treatment, drugs that are used.
9. Anticoagulants,
fibrinolytic thrombolytic drugs.
10. Control methods for
convolution system, their characteristics.
Theme № 3 Combined vascular
injury
1. Causes of combined
injuries of the vessels.
2. Clinical characteristics
of combined injuries of the vessels.
3. Classification of
vascular injury.
4. Differential Diagnosis of
combined injuries of the vessels.
5. Surgical tactics in
combined injuries of vessels
6. Methods of surgical
treatment of combined injuries of the vessels.
7. Features of the
postoperative period after surgical intervention for combined injuries of the
vessels.
8. Indications for conservative
treatment, drugs that are used.
9. Anticoagulants,
fibrinolytic thrombolytic drugs.
10. Control methods for
convolution system, their characteristics.
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.
The seminars discussion of theoretical issues
Sample test items and
situational problems.
1.
A patient admitted to hospital with a gunshot wound in the lower groin
ligament. Injury what vessel should be suspected?
2. A patient admitted to hospital with a gunshot wound in the popliteal
fossa. Injury what vessel should be suspected?
A.
Popliteal
artery
B.
Common
femoral artery
C.
Common
iliac
D.
Aorta
E.
Internal
iliac artery
3. Where, anatomically, is the most dangerous part brachial artery
ligation:
A.
No
right answer
B.
Distal
separation of the deep artery of arm
C.
In
the middle
D.
In
the lower third of
E.
Near
the ulnar artery
4. The vessel should be bind:
A.
Near
the injury
B.
Distal
from the injury site
C.
On
the middle of damage
D.
It
does not matter
E.
In
place of separation of the artery
5. Complications the stop bleeding by ligation of the vessel:
A.
Rebleeding
B.
Ischemic
contracture of the limbs
C.
Trophic
ulcer
D.
The
complications do not develop
E.
Paresis
of the limbs
The student should be able to:
1. To assess the
aorto-arteriogramu
2. Rate coagulogram.
3. Evaluate the results
ultrasound research
4. Apply thrombolitic drugs
and anticoagulants.
5. Appoint conservative
therapy for vascular injury
6. Determine the ripple in
the typical spots on the major arteries of the lower extremities.
7. Apply methods to
temporarily stop bleeding.
8. Appoint conservative
therapy in acute blood loss.
The answers to tests and
situational tasks:
1- Common femoral vein
2 - Popliteal artery
3 – A
4 – A
5 - A
Sources of information:
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. – 2Т.1.
5. 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
Обговорено на засіданні кафедри
"03" червня 2014 р. протокол №2