MINISTRY OF EDUCATION OF THE REPUBLIC OF UZBEKISTAN
MINISTRY OF HEALTH OF THE REPUBLIC OF UZBEKISTAN
TASHKENT MEDICAL ACADEMY
“Approved”
Vice-Rector O.R. Teshaev ____
«___»____________ 2012y
DEPARTMENT OF TRAUMATOLOGY-ORTHOPEDICS, NEUROSURGERY AND
MILITARY-FIELD SURGERY
Subject: Disaster medicine
FOR 7TH YEAR STUDENTS OF MEDICAL FACULTY
COMMON METHODIC SYSTEM
For practical lesson on theme:
Polytrauma. Providing medical help to victims of the polytrauma
TRAINING TECHNOLOGY
Tashkent – 2012
Compiled by:
-
Head of the Department of Traumatology, Orthopaedics, military surgery
with neurosurgery of Tashkent Medical Academy, Karimov M.Y., M.D.
-
Ibragimov D.I., Ph.D
Reviewers:
LESSON №3
Theme:Congenital and acquired diseases of the musculoskeletal system
Venue topics and equipment
-
Chair: Trauma-orthopedics, military surgery with neurosurgery;
Banners, X-ray pictures, handouts, photos and video material.
Amount of hours:
8 hours
Type of the lesson
Plan of the class
Purpose
lesson:
A student
know:
of
Amount of students: 8-10
Practical skills development
1. Introduction.
2. Theoretical part.
3. Analytical part:
- organizer
- tests
4. Practical part
To familiarize students to correctly diagnose, treat and assist the various
types of damage. Teach practical skills in the transportation
the
immobilization of bone injuries of the lower extremities apply casts,
splints and reduce a carry differential diagnosis with other injuries, and
referrals.
- Classification and types of fractures hip, leg, foot, pelvis and spine;
should - The main clinical signs of bone fractures hip, leg, foot, pelvis and spine;
- The principles of first aid;
- Survey methods, types of anesthesia and immobilization
practical skills - overlay technique of the cast, with fractures of hip, leg,
foot, pelvis and spine in orthopedic trauma patients.
-
A student should be
able to perform
-
Self-differentiate various types of fractures, and able to be sent to
the hospital.
Impose a transport bus with fractures of the lower extremities,
Transported in the correct position and skill in injuries of the pelvis
and spine.
Languet prepares and applies them in simple fractures.
Prepare a functional bed for treatment of injuries of the pelvis and
spine.
Learn the techniques of stretching through the loop Glisson of
injured spinal column
Justification of the theme
Pedagogical goals:

Learning
clinical evaluation of
children with inborn
hip displacement;

Teach students
the methods of
examination in cases
of inborn torticollis;

Applying of
languette in cases of
inborn hip dysplasia
Teaching methods
Forms of teaching
Equipment used
Teaching conditions
Integration between
the disciplines
Conducting the lesson allows students to get acquainted with the basic
principles of first aid, survey methods, types of anesthesia,
immobilization principles, interpreting X-ray images of local anesthesia
the fracture site, making plaster casts, overlay langetnyh and circular
plaster casts, the delivery of preliminary diagnosis and identification of
further tactics of the patient.
Brain storm, Interactive discussion,practical work, working with
documentation
Social work, work in groups, Individual work
Graphic organizers, flip charts, markers
Rooms for group studying
Training students on this topic, based on knowledge of human anatomy,
topographic anatomy and operative surgery, radiology, anesthesiology
and intensive care and general surgery.
Knowledge acquired by students during school hours, to allow first aid,
produce analgesia and immobilization and first aid
Monitoring and
evaluation
Oral , Written, tests
Technologic map of the lesson
Stages of
training and
time
st
1 stage
Introduction
to the lesson
10 min
5 min
Activity
Teacher
1.1The topic, its aim and expected results. Main terms of
the topic: to give the definition for etiologic, pathogenic,
symptomatic treatment. Show the plan of the topic.
To give the list of literature (attachment #9)
1.2Give live questions to taken students’ attention. It is
given the order of activities of organization of training
Students
Listen and write
Listen and write
process according to the plan and structure of the lesson.
1.3. it is announced the evaluation criteria of students’
activity (attachment #5)
Give answers to the
questions
Listen
2nd stage
Main part
30 min
15 min
2.1. To discuss the topic, to evaluate the knowledge of Give answers to the
students using new pedagogical technologies (attachment questions. Discuss,
#2)
give
definitional
questions
2.2. The private work of students for practice (attachment Discuss,
definite,
#3)
give questions on
2.3. analyze the situation independently, express the materials
of
problem, define the solution and give the solutions practical lesson.
(attachment #3.1)
Fill on sheet of
analyze on their
own and solve the
problems.
Break
45 min
2.4.solve the tests on their own ( attachment 2.3).
45 min
2.5.show the illustrative materials to students Present,
other
(presentations, slides, videos and others) and comment students participate
them.
in discussion and
give answers.
5 min
Break
90 min
Discuss the tests.
Venue topics and equipment
-
Graphic organizers, flip charts, markers
1. Justification of the theme
Justification of the theme
Conducting the lesson allows students to get acquainted with the basic
principles of first aid, survey methods, types of anesthesia, immobilization
principles, interpreting X-ray images of local anesthesia the fracture site, making
plaster casts, overlay langetnyh and circular plaster casts, the delivery of
preliminary diagnosis and identification of further tactics of the patient.
2. Integration between disciplines.
Training students on this topic, based on knowledge of human anatomy,
topographic anatomy and operative surgery, radiology, anesthesiology and
intensive care and general surgery.
Knowledge acquired by students during school hours, to allow first aid,
produce analgesia and immobilization, and providing first aid to patients.
3. Components of the lesson (point)
3.1. Theoretical part
The theoretical part includes:
Basic principles of treatment in polytrauma.
Mechanical trauma systems and organs are divided into isolated (monotrauma)
and polytrauma. Isolated damage or injury is called when one body or in relation
to musculoskeletal injury within the same anatomical and functional segments
(bones, joints). The internal organs - is damage to one organ in a single cavity,
damaged the main vessels and nerves-injury in the same anatomic area. In each of
the groups damage can be mono-or polyfocal. For example, damage to the small
intestine is polyfocal - wounded in several places, for the musculoskeletal system failure of one bone in several places (double, triple, fractures). Damage
musculoskeletal accompanied trauma of major vessels and nerves, must be seen
as a complication of trauma. The diagnosis in this case should be formulated as
follows: "Closed fracture of the right femur diaphysis, complicated by damage to
the femoral artery."
The term "polytrauma" is a generic term, including the followeing types of
mechanical damage: multiple, mix and match.
To multiple mechanical hazards include damage to two or more of the internal
organs in a single plane, and two or more anatomical and functional units
(segments) of the musculoskeletal system, such as the liver and intestine, fracture
of the hip and forearm.Associated injuries considered both damage to internal
organs and the musculoskeletal system, such as damage to the spleen and
bladder injury of the chest and fractured bones, brain injury and damage to the
pelvic bones.
Combined injuries called trauma of various traumatic factors: mechanical,
thermal, radiation. For example, a hip fracture and burn any area of the body is
called a combined injury. Possible and more options are combined effect of
damaging factors.
Multiple, mix and match injuries are particularly severity of clinical manifestations,
accompanied by a significant disorder of the vital functions of the body, the
difficulty of diagnosis, the complexity of treatment, a large percentage of
disability, high mortality. This kind of damage is often accompanied by a traumatic
shock, a large blood loss, cardiovascular and respiratory disorders, sometimes
terminal condition. This category of victims of trauma hospitals is 15-20%. On the
severity of multiple injuries show fatality rates. With isolated fractures it is 2%,
with multiple trauma is increased to 16%, and at multiple reaches 50% or more
(with combined injuries of the musculoskeletal system with the trauma of the
chest and abdomen).
Polytrauma is characterized by:
1.Nablyudaetsya so-called syndrome of mutual aggravation, such as blood loss,
because it is more in polytrauma or less severe contributes to the development of
shock, and in more severe which worsens injury and prognosis.
2. Sometimes combination creates a situation of incompatibility of the treatment
and damage. For example, an injury of the musculoskeletal system and treatment
is shown in narcotic analgesics, however, the combination of
damaged limbs with brain injury introduction is contraindication. So, for example,
a combination of injuries of the chest and fracture of the shoulder does not allow
to put the outlet bus or thoracobrachial bandage.
3. Increases frequency of severe complications, leading to critical state as massive
blood loss, shock, toxemia, acute kidney failure, fat embolism, thromboemboly.
4. effacement manifestation of clinical symptoms of cranio-abdominal injury are
seen, damage to the spine and abdomen, and the other associated trauma. This
leads to diagnostic errors and reviewing internal injuries abdomen.
The most common cause of polytrauma are road and rail accidents (collisions,
pedestrian accidents), falling from a height. In most cases, affected individuals
aged 20 to 50 years. Care and treatment of patients with multiple and combined
trauma faced with difficulties related to the severity of their general condition and
the complexity of diagnosing primary damage.
Before the examination by a doctor hospital patient with multiple injuries are not
allowed to change position on a stretcher and left alone without supervision.
Since in combined traumas injury severity of the body is different, the treatment
is in hospital identifies dominant damage in determining the severity of the
condition. It is important for medical tactics of follow up if performing surgery.
In severe concomitant injury treatment can be divided into three periods:
Resuscitation; treatment; rehabilitating
The treatment focused on the damage can lead to change. For example, at the
cranio-abdominal injury, when there is intra-abdominal bleeding, damage to the
dominant abdominal injury, and therapeutic measures should first be directed to
stop internal bleeding. After the elimination of bleeding and restore blood loss
treatments focus moves to the head injury. Unconsciousness of the patient with
associated trauma often caused by severe traumatic brain injury.
Distinct hemodynamic result from acute blood loss, which can be associated with
multiple injuries of the musculoskeletal system, or associated injuries of the chest
and abdominal cavities. Sharp respiratory failure is usually caused by chest trauma
(multiple "fenestrated" or bilateral rib fractures, hemo-and pneumothorax.
With an estimated initial assessment test for urinary tract. At the end of the
indicative survey and establish the lead further damage of affected often have a
short break for coming and antishock measures, which include complex and
surgical emergency interventions.
For a more detailed survey to coincide with the start antishock activities when
improves the general condition of the victim. The difficulty of diagnosis and
creates a series of tactical difficulties in providing assistance to victims with
polytrauma.
Features to help at the pre-hospital level.
Treatment started in the prehospital setting, continue in stationary conditions. On
admission the patient with multiple injuries in the emergency room is necessary
to:
thorough and prompt investigation to provide skilled care;
check dressings, immobilization, correctness applying tourniquet and correcting
identified deficiencies. The first (resuscitation) period. During this period,
immediately begin to fight with the shock. In the intensive care unit should be
carried out complex treatment: stabilization of circulation, total pain relief,
reliable immobilization, oxygen therapy, early surgery, correction of disability.
Victim before inspection must be completely stripped. Pay attention to the
general view of the patient, color and mucous membranes, heart condition,
location of wounds, abrasions, bruises, position (forced, passive, active), allowing
approximately reveal damage. Explore percussion and auscultation chest, palpate
the abdomen. X-rays will clarify the diagnosis in intensive care without shifting the
patient.
If breathing is difficult, you need to examine your mouth and remove mucus,
blood, vomit, dentures, fixing sink into the cavity of the larynx language. On
examination of the chest excursion define her breathing, retraction and bulging of
the chest, air is forced into the wound, swelling of the neck veins. Increasing
dullness of heart sounds on auscultation may induce doctors to think about the
damage the heart and its tamponade, particularly in cases where there is a wound
in the chest heart projection. If hemopneumathorax is diagnosed, remove liquid
and suck the air from the pleural cavity of a syringe, put a rubber drain. This will
eliminate respiratory failure and complete examination of the patient. If the
victim is found with associated trauma injuries of the heart or major joints, lung
injury and tension pneumothorax, open pneumothorax with progressive
deterioration of general condition, you must immediately begin the operation, in
spite of the associated injuries of other body areas. With closed abdominal
trauma should be made celiocentesis and laparoscopy.
Second treatment period.
The main problem is the choice in polytrauma of optimal time of surgery.
According to the urgency of the operation, and its volume is divided into four
groups of victims:
The first group consists of patients with lesions that rapidly lead to death if not
provided with emergency care. This massive bleeding from rupture of
parenchymal organs (liver, spleen), cardiac tamponade, extensive lung damage,
the double "fenestrated" or "valve" broken ribs, etc. Typically, these come in
heavy casualties, and sometimes in a terminal state with blood pressure below a
critical level. For external arterial bleeding spend only a temporary hemostasis:
clamping rope. If found broken limbs to carry out transport immobilization.
The second group includes patients with multiple injuries without profuse
bleeding and deep breathing disorders - with damages hollow organs of the
abdomen, the valve pneumothorax, intracranial hematomas, closed severe
injuries of the limbs. Operations are usually carried out in the first hours after
admission. In the presence of fractures or rib fractures perform anesthesia
locations, blockades, and a plaster bandage or skeletal traction.
The third group consists of patients with severe injuries dominant musculoskeletal
system without excessive bleeding. Surgical procedures performed only after
removing the victims from traumatic shock. Because of the risk, operations,
shown only in open fractures of limbs in the form of a thorough debridement of
wounds, amputations for extensive crushing limbs and signs of frailty.
The fourth group consists of patients with injuries of several segments of the
limbs without traumatic shock, the presence of open lesions performed primary
surgical wound care, medical immobilizing limbs. Generally, osteosynthesis was
carried out at the threat of buckling neurovascular structures, perforation of the
skin fragments. Where indicated, fixation produce the most gentle methods using
compression-distraction unit.
With selection of treatment of multiple fractures should strive not only to restore
the anatomical and functional relationships, but also facilitate care for the victims,
to ensure, possibly earlier to activate it. More than 40% of patients with multiple
fractures closed a conservative treatment, skeletal traction, application of plaster
casts. Osteosynthesis with compression-distraction apparatus facilitates care to
operate, it allows for early mobilization and the load on the limb. If the damage of
the two adjacent segments generally use a combination of several methods of
stable osteosynthesis. For example, at the turn of the femur and tibia hold stable
intramedullary femoral fixation pin and the imposition of massive compressiondistraction device on the shin.
Third rehabilitation period. In this period of immobilization after the cessation of
treatment should press for physiotherapy and health resort treatment of
complications associated with multiple injuries.
Traumatic shock - a life-threatening complication of severe damage, which is
broken, and then steadily deteriorating regulation functions of the vital organs
and systems. In this regard, developing circulatory disorders, disturbed
microcirculation, resulting in hypoxia of tissues and organs can be seen.
During shock distinguish two phases: erectile and torpid. In erectile phase the
patient is conscious, his face pale, eyes restless, there is motor and language
stimulation. Torpid phase of shock seen in the oppression of the mind, a sharp
decrease in reaction to the pain of the stored mind. Marked fall in arterial and
venous pressure.
Torpid phase of shock is divided into 4 degrees.
Shock 1 degree (light) - the pupils react to light, blood pressure 100 mm Hg, pulse
100/min on, breathing 20 - 22/min.
Shock 2 degree (moderate) - sluggish pupils react to light, blood pressure of 80-90
mm Hg, pulse 120/min, breathing shallow.
Shock Grade 3 (severe) - overall condition is serious, the maximum blood pressure
below 75 mm Hg, heart rate above 130/min, respiration dramatically speeded up.
Shock Grade 4 - terminal state, inhibition of the vital functions of the body pass
into clinical death.
3.1 Using a three-step interactive teaching method
"Who more? Whofaster?"
Students need: Cards with questions on the topic (the number of cards equal to
the number of students in a group, in each card 5 questions)
Stopwatch
Progress: The game is played in an oral form, students alternately drawn cards
with questions, within 3 minutes of each student verbally answers a series of
questions on the card, the teacher counts the number of correct answers.
The
game
involves
all
students,
total
time
45
minutes
Questions
that
were
not
answered
correctly,
are
discussed
Students'
responses
are
evaluated
using
the
following
form:
Each
of
the
5
questions
valued
at
20
points:
The correct answers to 5 questions -100 points
The correct answers to 4 questions - 80 balls
Correct answers to 3 answers - 60 balls
Correct answers to the two questions - 40 points
Correct answer to one question - 20 points.
9.Student score is recorded for billing current assessment
10. In academic journal teacher makes notes on the game.
Game: "Who more? Who faster? "
1. What kinds of shared mechanical trauma? Monotravma, polytrauma.
2. What is an isolated injury? Damage within the same anatomical - functional
segment.
3. Name an example of complicated injuries: Fracture with nerve damage and
major vessels, etc.
4. What types of physical damage includes the term "polytrauma"?
Multiple, combined and combined.
5. Give the definition of "multiple trauma." Damage to two or more of the same
plane.
6. Give the definition of "associated trauma." Organ damage in two or more
planes.
7. Give the definition of "combined injury". Injury due to the action of various
factors.
8. What are the characteristics of polytrauma. Syndrome mutual complication:
blood loss contributes to the development of shock, injury and worsens the
prognosis.
9. What are the characteristics of polytrauma. The situation is "incompatible
therapy": the injury shows the drugs, and the combination of the introduction of
CCT is contraindicated.
10. What are the characteristics of polytrauma. Develop severe complications
such as massive blood loss, shock, toxemia, acute renal failure, fat embolism,
thrombosis, etc.
3.2 Analytical part of the topic:
Questions for self-control:
1. What damage of these are combined?
a) closed fracture of the right femur, a compound fracture of the left femur and
tibia;
b) II degree burns forearm fracture of the radius in a typical place;
c) IV-VI fracture of ribs on the right, a concussion;
d) a fracture of the pelvis with the damage of the bladder.
2. Specify the damage which fracture of the pelvis is dominant.
a)
b)
c)
d)
e)
fracture of the pubic bone, hip fracture in the middle third;
type Malgenya broken pelvis, ruptured spleen;
central hip dislocation, fracture of humerus;
type of fracture of the pelvis Malgenya, burn brush III-IV degree;
symphysis rupture, an intracranial hematoma.
3. Which of the following is included in the scope of the first medical aid in
combined radiation on the expressions?
a) prophylactic blood transfusion;
b)
c)
d)
e)
partial sanitation;
complete sanitization;
primary debridement;
introduction of antidotes, antibiotics and tetanus toxoid.
4. For intracranial hematoma is characterized by:
a)
b)
c)
d)
loss of consciousness;
tachycardia;
anizoreflexiya;
a sharp drop in blood pressure.
5. What is a reliable sign of a skull fracture?
a) anisocoria;
b) a symptom of "points";
c) nausea and vomiting;
d) nasal or ear liquorrhea;
e) stiff neck.
6. The scope of the first medical aid to victims with penetrating wound of the
chest include:
a) vagosympathetic blockade;
b) infusion therapy;
c) puncture of the pleural cavity;
d) thoracotomy when indicated.
7. Specify the optimal puncture site with pleural pneumothorax:
a) in the seventh intercostals space on post axillaries line;
b) in the second intercostal space at the middle clavicle line;
c) in the tenth intercostal space on the shoulder line;
d) in the area where the subcutaneous emphysema was most pronounced;
e) in the second intercostal space at the shoulder line.
8. When providing first aid to the injured penetrating wound of the abdomen
and internal organs eventration should:
a) to inject narcotic analgesic;
b) straighten eventriatedorgans in the abdominal cavity;
c) impose a protective cover;
d) water to moisten the bandage.
9. Reliable sign of penetrating wounds of the abdomen are:
a) loss of the packing of the wound;
b) positive symptom Shetkin - Blumberg;
c) the expiration of the intestinal contents of the wound;
d) localization of the wound in the abdominal wall.
10. Tension abdominal wall may occur in:
a) discontinuities ulcer;
b) fractures of the pelvis;
c) fractures of the vertebrae in the neck;
d) superficial wounds of the abdominal wall.
Answers: 1 - c; 2 - c; 3 - b; 4 - a; 5 - d; 6 - a; 7 - b; 8 - a; 9 - a; 10 - a.
4.Analytical part
4.1 Commonly seen mistakes in providing primary medical help
1
• The severity of additional traumas is not evaluated. Before
transporting the patient, you should check for fractures, dislocations,
respiratory patyways
2
• Giving medications, applying unguenta without understanding of
pathological processes. It leads to worsening of the patient’s
condition.
3
• Independent cleaning of burned areas of the body in the conditions
of the lack of bandages and anesthetics.
4
5
• Incorrect application of bandages- leads of increase of edema
• Wrong sorting of the victim. First helping those who are yelling and
asking for a help. As a result, more severe patients who are
unconscious die because of the lack of the medical help.
4.2 Situational case:
In the emergency room the patient taken in serious condition. History of the
patient fell from a height of 5 meters during the construction work. Objectively: a
vague consciousness of the patient, questions answers without merit. Sluggish
pupils react to light. Blood pressure 80/60 mm Hg, pulse 120/min weak filling.
Shortness of breath, a surfactant. Local: marked deformity of the right hip and left
leg, abdomen palpation tense.
Step
1
2
3
4
5
6
7
8
9
Necessary set of actions performed by the student
Receiving patient in the study GPs (used non-verbal and verbal skills of interpersonal
communication). Carefully collected complaints (major: vague consciousness of the
patient, questions answers without merit.).
Carefully collected history of the disease and find out the beginning and over: fell from a
height of 5 meters during the construction work
Learned the history of life. a vague consciousness of the patient, questions answers
without merit. Sluggish pupils react to light. Blood pressure 80/60 mm Hg, pulse
120/min weak filling. Shortness of breath, a surfactant. Local: marked deformity of the
right hip and left leg, abdomen palpation tense.
Risk factors controlled vs uncontrolled. (age, sex) Identified the problem of the patient:
vague consciousness
Started physical examination (the student must demonstrate the correct and consistent
study of the patient with the appropriate syndrome).
Preliminary diagnosis – Shock of the second stage
(Category 2).
Plan Survey (Students need to plan a survey of the patient):
- Determining respiratory rate (Category 3.1);
- Palpation of the chest (Category 3.1);
- Compression of the chest in the frontal and sagittal planes (Category 3.1);
- Auscultation of the chest (Category 3.1);
- Measurement of blood pressure (Category 3.1);
- Complete blood count, urinalysis (Category 3.1);
- - Chest X-ray in the direct projection (Category 3.2).
The student must justify and explain the purpose of the study.
Independently carried out the necessary amount of research in MRA:
- Determining the frequency of respiratory
- Palpation of the chest
- Compression of the chest in the frontal and sagittal planes
- Auscultation of the chest
- Measurement of blood pressure
- CBC
- Urinalysis
(student must demonstrate to perform almost all the stages of skill with simultaneous
10
11
interpretation of the data.)
After a comprehensive survey of student demonstrates knowledge of the treatment of
objective laboratory and instrumental data (from the student requires a qualitative
analysis of the data and the conclusion).
Differentialdiagnosis with other types of shocks (rightly refers the patient to a
consultation with a specialist.)
The final diagnosis Second stage traumatic shock ( category 2)
12
(student must coordinate his final diagnosis with a specialist).
13
14
15
16
17
18
19
20
On his return from the patient consultation or hospitalization GPs:
• reassess the patient's condition (it is made with the final diagnosis of disease, phase of
activity, the flow on the basis of professional judgment or discharge summary);
• collects data from the patient or his relatives on the recommendations of the
designated non-medicated, and treatment with medicines;
 • the indications to perform or repeat a series of laboratory and instrumental studies
to determine the further tactics.
Determine the form in which the prevention of patient needs (D-IIIB). Inform the patient
and discuss the practical steps the relevant type of prevention.
Amended and recommended continuation of non-drug treatment:
• Half-bed rest;
• «Breathing Exercises";
• A balanced diet (strict compliance energy value and the mineral composition of the
diet of the organism's age, enriching the diet products containing calcium and
magnesium, the inclusion in the diet of fresh fish);
• Use regular permissible exercise control exercise physiologist;
Explained to the patient whether to keep (if necessary) medication, indicating dose,
time, and duration of the multiplicity of medications.
The first step of treatment is providing anti shock actions, send to ER and there provide
required further medical help.
Analgesics, NSAIDs, Antibiotics, Desintocsication therapy, Hormonal therapy
Set a date and time of follow-up visit the patient in the joint venture or SVP for
feedback.
The student has identified a group of follow-up and briefed about the purpose of
medical examination of the patient (group D IIIB):
Starting from the time of the diagnosing inborn hip dislocation, the patient should be
under regular surveillance.
The main therapeutic recreational activities are:
• Training a mother of a healthy lifestyle;
• Physical therapy and exercise therapy in the Department of Rehabilitation;
 • Improvement in the sanatorium (spa treatment).
Turning to the observers, the student demonstrates the theoretical knowledge and
practical steps of all kinds of prevention (primary, secondary, tertiary).
Turning to the observers, the student demonstrates the theoretical knowledge and
practical steps on stage clinical examination of the respective disease.
Additional information to the case studies
(for students)
Those obtained in the pre-hospital study number 2
• BMI 32.1
Wrist circumference – 5.6
• Body temperature - 36.5
Patient is unconscious
Completebloodcount: № 2
• Hemoglobin - 100 g / l;
• Red blood cells - 4-5x10 * 12 / L;
Blood pressure 80/60 mm Hg,
Pulse 120/min weak filling.
General urine analysis: № 2
• Quantity - 150 ml;
• Color - light yellow;
• Relative density of urine - 1015
• Transparency - transparent;
• Response - sour;
• Protein - abs;
• The bile pigments - negative
• Epithelium - 1-2-3 in sight
• White blood cells - 2-3-4 in sight
number 2
Ro ": On the plain film of the chest in frontal projection hip dislocation. Deformities of the
chest. No fractures are seen. (students receive hands on the corresponding Ro ", without
interpretation and conclusion)
5. Practical skills
Providing first aid to the patient with an open fracture of the left shin bone,
closed fracture of the right femur, brain concussion and a suspected fracture of
the cervical vertebrae.
1. Purpose: Examination of patient for the open and closed injuries if fractures are suspected.
2.Indication: open fracture of the left shin bone, closed fracture of the right femur, brain
concussion and a suspected fracture of the cervical vertebrae.
3. Equipment: table for casts, gauze bandages, syringe, spiritus, medications
4. Performed steps (stages).
№
Not
performed
(0 points)
All properly
executed
1. The correct approach to the patient, laying his correctly
10
0
2. Introduction narcotic analgesic.
10
0
3. Imposition of aseptic wound dressings left shin
20
0
4. Immobilization of the cervical collar part of the spinal column
by Chance.
20
0
5. Immobilization tires (Cramer Dieterichs) of both lower
extremities.
10
0
6. Immobilization tires (Cramer Dieterichs) of both lower
extremities.
10
0
20
0
100
0
7.
Activities
Transporting a patient on a stretcher in the hospital profile.
9. Total:
Each practical skills assessed on a 100-point scale, and this score is multiplied by
the appropriate factor.
The overall score for student practical skills is the sum of points for all skills. A
passing score must be at least 55% of the maximum score.
6. Forms of controlling knowledge and skills








Oral answer
Active participation in a discussion
Results of the written works
Solving tests
Performing practical skills
OSCE questions
Handouts
Printouts
6.1. Types of students’ knowledge control
While grading the students the following criteria are taken into consideration:
№
Score
Catching up %
Excellent
Good
100%-86%
85%-71%
Satisfactory
70-55%
Poor
54%-37%
Bad
36% ва
ундан
кам
1
Theoretical part
20-19 points
18-17
points
16-15
points
14-13
points
12 points
2
Analytic part:
15-14 points
13-12
points
11-10
points
9-8 points
76points
Organizer
3
Test
15-14 points
13-12
points
11-10
points
9-8 points
76points
4
Practical part
40-34,4points
34-28,4
points
28-22
points
21,6-14,8
points
14,4
points
5
Test questions
10-7,9
7,75-5,6
5,5-4,25
4,1-2,5
2,4
points
When assessing students' knowledge is taken into account the following
indicative criteria:
№
Points
Score
Level of student’s knowledge
1
96-100
Depending on the situation, to make the right
decision and concludes.
In preparation for practical training uses
additional literature (both native and English).
Essentially independently analyzes the problem
of disaster medicine.
Themselves can examine the patient and
correct diagnoses plan assigns emergency
medical care and prevention of complications.
Shows high activity, creativity during interactive
games. Correctly solve situational problems
with full justification of the answer. During the
discussion of the CDS is actively asking
questions, making additions. Practical skill
performs confidently, understand the essence.
2
91-95
In preparation for practical training uses
additional literature (both native and English).
Essentially independently analyzes the problem
of disaster medicine. Themselves can examine
the patient and correct diagnoses plan assigns
emergency medical care and prevention of
complications. Shows high activity, creativity
during interactive games. Correctly solve
situational problems with full justification of the
answer. During the discussion of the CDS is
actively asking questions, making additions.
Practical skill performs confidently, understand
the essence.
Excellent
«5»
3
86-90
Essentially independently analyzes the problem
of disaster medicine. Shows high activity,
creativity
during
interactive
games.
Correctly solve situational problems, justifies
treatment is prevention plan. AFI knows
musculoskeletal system, says confidently. There
is an exact representation of the etiology,
pathogenesis, clinical picture, can carry
differential diagnosis, prescribe treatment, can
take
preventive
measures.
Practical skill performs confidently, understand
the
essence.
Properly collect history, examines the patient,
makes a preliminary diagnosis. Can interpret
the data Ro "research. Actively involved in the
discussion
CDS.
Shows high activity during interactive games.
Correctly solve situational problems, but can
not assign a specific treatment, confuses the
names of immobilization. AFI knows
musculoskeletal system, says confidently. There
is an exact representation of the etiology,
pathogenesis, clinical picture, can carry
differential diagnosis, prescribe treatment, but
can not carry out preventive measures.
Practical
skills
to
step
through.
Properly collect history, examines the patient,
makes a preliminary diagnosis. Can interpret
the
data
Ro
"research.
Activelyinvolvedinthediscussion.
4
76-80
6
71-75
Good
«4»
Correctly solve situational problems, knows
how to put on the classification of the clinical
diagnosis, but can not assign a plan of
treatment
and
prevention.
AFI knows musculoskeletal system, says
confidently. There is an exact representation of
the etiology, pathogenesis, clinical picture and
differential diagnosis, but can not prescribe
medication. Practical skill to perform, but
confusing
steps.
Properly collect history, examines the patient,
makes a preliminary diagnosis. Can interpret
the data Ro "research. Actively involved in the
discussion CDS.
7
66-70
8
61-65
Correctly solve situational problems, but can
not justify the clinical diagnosis. AFI knows
musculoskeletal system, says confidently. There
is an exact representation of the etiology,
pathogenesis and clinical, but can not carry out
differential diagnosis and prescribe treatment.
Properly collect history, examines the patient,
but can not assess the severity. May partly
interpret data Ro "research. Actively involved in
the discussion CDS.
Satisfactory.
«3»
9
55-60
10
54 -30
Has general knowledge about disaster
medicine, but doesn’t know clearly. Mixes the
muscle-skeletal system. Individualy can’t ask
and examine the patient. Can’t interpret the Xray investigations. Doesn’t participate in
discussion of CDS.
Bad.
«2»
11
20-30
Making mistakes in solving situational problems
(can not put a diagnosis on classification).
Knows clinic injury, but said uncertainly. Has a
faithful representation on disaster medicine,
but can not relate to the pathogenesis of the
clinic. History was not focused, not on the
inspection scheme. Can not interpret the
research data. Passive when discussing CDS.
VeryBad.
«2»
Doesn’t have any knowledge about disaster
medicine. Doesn’t know the anatomy of
muscle-skeletal system.
For showing up in class, for having educational
equipment(stethoscope and note books) and
specific clothing
7. TIMING OF MAINTENANCE ACTIVITIES.
Time
08.30-09.15
09.20-10.05
10.20-11.05
11.10-11.50
12.30-13.15
Events
1. Theoretical analysis of
the theme " congenital and
acquired diseases of the
musculoskeletal system
"the main clinical signs of
bone fractures hip, leg,
foot, pelvis and spine, the
principles of first
aid,survey, the types of
anesthesia, the principles
of immobilization.
2. Solution and analysis of
situational challenges.
Conducting practical skills,
interpretation of X-ray
images;
Local anesthesiathe
fracture site;
Preparation
casts;the imposition
oflanguet and circularcasts
Supervision of patients
with injuries of bones
shoulder, forearm and
hand in the office
Content
1. Test baseline level of
preparedness ofstudents.
Poll students on lessons
using the game "weak
link"
2.Test clinical thinking of
students
Materials
1. Banners
corresponding subject
classes, test
questions.
2. Situational tasks
relevant topic classes
Check the level of
preparedness of
studentsto practical skills
X-Ray pictures, tires,
syringes, procaine 1%, plaster bandages
Each student is
supervised by the
Chamber of patients with
certain clinics involved in
the application of plaster
cast and skeletal traction
Patients appropriate
subject classes,
plaster, bandages,
bus Beller, hook,
string and weight
Report on supervised
patients.
Each student will report
on the work done during
the patient's supervision.
Rentgent pictures, Xray view box. Tables.
Analysis of students'
knowledge
Baseline data, the
correctness of the
decision and the
analysis of situational
tasks, skills and
supervision of
patients
Summing up the final
results and assessment of
students' knowledge
8 Test questions:
1.
2.
3.
4.
5.
Definiton of the polytrauma.
Types of polytrauma.
Classification of traumatic shock.
Classification of crush syndrome.
Frequently seen complication of traumatic shock form inner organs.
9. Recommended Reading
1.
2.
3.
4.
5.
6.
Yumashev GS "Trauma and Orthopedics, Moscow,"Medicine "1990. - 575s.
Musalatov HA "Trauma and Orthopedics, Moscow,"Medicine "1995. -s.
A. Kaplan, "Damage to bones and joints," Moscow, "Medicine> 1979. -568s.
www.jbjs org.uk
www.traumatic.ru
www.trauma.bd.ru