MINISTRY OF THE HIGHER AND SECONDARY VOCATIONAL EDUCATION REPUBLIC OF UZBEKISTAN
MINISTRY OF HEALTH OF THE REPUBLIC OF UZBEKISTAN TASHKENT MEDICAL ACADEMY
The vice rector on study
prof. Teshayev O. R. ________
«_____» _________ 2012.
Chair: Traumatology orthopedics, VPH with neurosurgery.
Subject: Field surgery.
For medico-preventive faculty
On a subject: Wounds and their treatment at stages of medical evacuation. The Ranevy infection and
treatment at stages of medical evacuation.
Trauma Sochetannye's SRS-Emergency medical care and evacuation by the victim in an etapny order.
Practical занятия№ 1
TECHNOLOGY OF TRAINING
Tashkent-2012г.
Practical occupations No. 1
On a subject: Wounds and their treatment at stages of medical evacuation. The Ranevy infection and
treatment at stages of medical evacuation.
Trauma Sochetannye's SRS-Emergency medical care and evacuation by the victim in an etapny order.
1. Place of foresights of occupations, intercourses.
- chair traumatology orthopedics, VPH with neurosurgery, audience,
- office of emergency traumatology of the 2nd clinic of TMA,
- thematic patients or volunteers, scenarios of role-playing games, visual aids, distributing materials,
banners, X-ray pictures, distributing materials.
- new investment technological technologies, exhibition constructions, video films.
2. Duration of studying of a subject
180 minutes (4 class periods).
3. Occupation purpose:
To acquaint students with the basic principles of sorting of wounded, stages of medical evacuation,
types of the medical care rendered by the victim. To train students in volume of the medical
manipulations which are a part of each type of medical care; to principles of rendering of medical care
by the wounded at this or that stage
medical evacuation.
4. Pedogogichesky of a task.
- to fix the general the basic principles of sorting of wounded;
- to fix knowledge of rendering of the first medical wave with the victim at stages ME;
- to train students in volume of the medical manipulations which are a part of each type of medical care;
- to teach principles of rendering of medical care to wounded at this or that stage
medical evacuation.
5. Result of educational activity.
The student should know:
- stages of medical evacuation of wounded;
- the basic principle of sorting of wounded at this or that stage of the medical
evacuations;
- problems of medical evacuation at wounds and ranevy infections;
- types of the medical care rendered by the wounded;
- volume of the main actions rendered by the wounded at each type of the medical
help.
The student should be able:
To carry out practical skills - first-aid treatment to the wounded at wound of the bottom extremity.
6. Methods and technicians of training.
Case.
7. Sretstva of training.
- Manuals, video and photographic material, books.
- Training materials, X-ray pictures, educational films, plait, plaster material.
8. To form of education.
Individual work, work in groups, collective.
9. Training conditions
The audience having conditions for work in groups.
10. Mannitoring and estimates.
- Oral control: control questions, performance of educational tasks in groups.
- Written control: control questions, case.
Technological card of educational occupation.
Content of activity
Work stage
teacher
The I stage
Introduction
– 1.1. Calls an occupation subject, its purpose, tasks Listen
in
Students
educational
occupation
(10 mines)
5 minutes
and planned results of educational activity.
Write down
Independently
study
contents of a case and
1.2. Acquaints with an operating mode on occupation individually fill a leaf of the
and criteria of an assessment of results (see
analysis of situations.
methodical instructions for students).
1.3. Explains appointment a case-stadi and its
influence on development of professional knowledge.
1.4. Раздаёт case materials also acquaints with a
situation analysis algorithm (see methodical
instructions for students).
1.5. Gives a task independently to carry out the
analysis and to bring results in «A leaf of the analysis
of a situation».
II stage
2.1. Carries out quiz on purpose to make active
knowledge being trained on a subject:
Make change definition?
Make dislocation definition?
You know what basic principles of treatment of a
change and dislocations?
You know what methods of a conservative method
of treatment of changes and dislocations?
List complications of a conservative method of
treatment of changes and dislocations?
2.2. Divides students into groups.
Reminds work rules in group and ruled discussions.
2.3. Gives a task:
To carry out and discuss results of individual work
with a case (sheets of the analysis of a situation) in
Answer questions
mini-groups;
Share on groups.
To estimate and choose optimum options of actions
for a conservative method of treatment of changes
and dislocations;
To be prepared for presentation.
Carry out an educational
task.
Change
2.4. Coordinates, advises, directs educational activity.
Checks and estimates results of individual work:
sheets of the analysis of a situation.
2.5. Will organize presentation following the results
of the done work on the solution of a case, discussion
and a vzaimootsenka.
Change
2.6. Makes comments, pays attention to the actions
chosen in the course of the analysis for a conservative
method of treatment of changes and dislocations.
2.7. Reports the version of the decision.
Groups hold presentation of
results of work. Participate in
discussion, ask questions,
estimate.
Main 30 minutes.
2.8. Will organize performance by students of Measurement of relative and
absolute length of the
practical skills
bottom extremity
Examination of patients
III stage final and 3.1. Sums up to occupation, generalizes results of Measurement of relative and
educational activity, declares estimates individual and absolute length of the
estimated
collaboration.
bottom extremity
10 minutes.
3.2. Emphasizes value a case-stadi and its influence
on development of future expert.
3.3 Gives homework.
11. Motivation.
Carrying out this occupation gives the chance to the training will seize the basic principles of rendering
of the first medical care, inspection, types of anesthesia, immobilization principles, interpretation a Xray of pictures to make the preliminary diagnosis and to define further tactics of maintaining the
patient.
12. Boundaries subject and inside subject communications
Training of students on this subject, is based on knowledge of human anatomy, topographical anatomy
and operative surgery, radiology, anesthesiology resuscitation and sheathe surgeries.
13. Content of occupation
13.1. Theoretical part
Stages of medical evacuation. Etapnoye treatment with evacuation to destination - medical providing
wounded in maxillofacial area which is carried out in system of medical and evacuation actions, and
provides implementation of a principle of unity of process of treatment and evacuation. Stages of
medical evacuation - medical aid stations and the medical institutions which are settling down at various
distance from a battlefield and from each other which consistently there pass wounded at evacuation
from a battlefield or from the center of mass sanitary losses. Volume of medical care of this stage - set
of medical and evacuation actions which can be executed at this or that stage of medical evacuation.
The volume of the help isn't constant and can change depending on conditions of a fighting and medical
situation. At emergence of mass sanitary losses and a considerable overload of stages of medical
evacuation the volume of medical care will be reduced. Under favorable conditions the volume of
medical care can be expanded. Efficiency of rendering of medical care depends on the following factors:
• observance of a principle of continuity of medical and evacuation actions;
• uniform understanding of pathology of a fighting trauma;
• uniform principles of rendering of medical care and treatment;
• well adjusted medical documentation.
In medical documents should be reflected:
• localization and type of wound or damage;
• nature of the medical actions executed at this or that stage;
• rough term of treatment of the wounded and his further evacuation mission.
In modern system of etapny treatment with evacuation rendering of the following types medical
помощи.1 is to destination provided. The first medical care appears in the field of fight or in the center
mass sanitary потерь.2. The pre-medical help appears on a medical aid station of a battalion (MPB).3.
The first medical assistance appears on a medical aid station of a regiment (MPP) or бригады.4. The
qualified help appears in a separate medical battalion of a brigade and a separate medical company5.
Specialized medical care appears in specialized hospitals of hospital base. The sequence of rendering of
the listed types of medical care can be observed not always. It will depend completely on conditions of a
fighting and medical situation, and also existence of egresses. 2. The first medical care the First medical
care by the wounded in maxillofacial area is rendered in the field of fight or in the center of mass
sanitary losses by hospital attendants and sanitary instructors. In some cases it can be rendered to
wounded (self-help).Очень important that the staff not only knew features of wounds and damages of
maxillofacial area, but also was able to render effective first medical care correctly, if necessary. Actions
of the first medical care: 1. The prevention and fight against the developed asphyxia; At dislokatsionny
asphyxia - language piercing by a pin which is available in a first-aid dressing kit. Language should be
tightened to level of the remained foreteeth and in such situation to fix it bandage to clothes. At the
obturatsionny asphyxia developing more often as a result of obstruction of the top respiratory ways by
clots of blood and foreign matters, follows fingers and a gauze to clear an oral cavity and drinks. At
klapanny asphyxia (at this type of asphyxia the difficulty or lack of a breath is, as a rule, noted) it is
necessary to examine an oral cavity and, having found the valve, to fix it by means of a pin to
surrounding fabrics. At all other types of asfiksiya, including after language fixing by a pin, the wounded
should give situation on one side with the head turned towards wound. 2. Temporary stop of bleeding:
A bleeding stop from wounds of maxillofacial area carry out imposing of a pressing bandage. At the
strong arterial bleedings which are observing more often at wounds external or general sleepy arteries,
the most effective method - pressing of the general carotid to a cross-section shoot of the sixth cervical
vertebra. 3. An immobilization at fractures of jaws. The prashchevidny bandage is used. 4. Imposing of
primary bandage on a wound; 5. Introduction of anesthetics from a syringe tube, available in the
individual first-aid kit; 6. Reception of tabletirovanny antibiotics; 7. Gas mask putting on at stay on the
infected district; 8. A conclusion (carrying out) of wounded from a battlefield or from the center
поражения.3. The pre-medical help the Pre-medical help appears the medical assistant or the sanitary
instructor and pursues the same aims, as the first medical care, however on assistance is much wider
than possibility of the medical assistant. The pre-medical help includes the following actions: • fight
against asphyxia; • temporary stop of bleeding; • control and correction (if necessary) earlier imposed
bandages; • introduction warm and anesthetics, intake of antibiotics; • intake or hypodermic
introduction of antiemetic means (according to indications); • heating of the wounded being in a state
of shock; • thirst satisfying; • preparation for evacuation. Character and volume of medical care at
asphyxia and bleeding same, as well as when rendering the first medical care. Replacement of a
bandage make only when it completely doesn't correspond to the appointment (bleeding proceeds, the
wound is naked). In other cases bandages or a podbintovyvaniye (the got-off bandages, got wet blood
and a saliva) examine only. Satisfying of thirst carry out by means of the bandage slice which one end
place in a flask, and another - on a root of language of the wounded water gradually on a gauze arrived
in a mouth of the wounded.
13.2. Analytical part
GAME
«Who is more?, Who quicker?»
For work it is necessary:
1. Cards with questions on a subject (quantity of cards equally to number of students
in group: in each card on 5 questions).
2. Stop watch.
Work course:
1. The general time of game - 45 minutes.
2. Game is carried out in an oral look. Students serially extend cards with questions.
3. Within 3 minutes each student orally answers a series of questions (5) written on a card.
4. The teacher considers number of the right answers.
5. All students participate in game.
6. Questions on which the right answers weren't given, are discussed.
7 Answers of students are estimated in the following form:
the correct 5 answers - 0,8 points
the correct 4 answers - 0,7 points
the correct 3 answers - 0,5 points
the correct 2 answers - 0,3 points
right 1 answer of-0,1 points
the correct 0 answers - 0 points,
8. The point got by students is considered at exposure flowing occupation estimates.
9. In the lower free part of the magazine the mark about Yura's carrying out by the signature of the head
of group becomes.
GAME
«Who is more?, Who quicker?»
1. Call main types of wounds. Answer: Fire and not fire
2. Early complications at wounds.
Answer: Bleeding, damage of soft fabrics.
3. Types of gunshot wounds.
Answer: Getting, not getting, through, blind, tangents.
4. Types of not gunshot wounds.
Answer: reasonable, fragmentary, chipped, razmazhenny and chopped wound.
5. First aid at wound.
Answer: plait imposing, an aseptic bandage on a wound, anesthesia and an immobilization.
6. Types of surgical processing of a wound.
Answer: the primary, delayed and secondary surgical processing.
7. Zones of bullet wounds.
Answer: The ranevy suited, a necrosis, concussion of a soft fabric.
8. List 5 distinctive signs of bullet wounds from others
wounds
Answer: on structure, morphological changes, late complications, pathophysiological changes, weight,
healing terms.
9. Call 2 major factors defining size striking
actions of a fire shell.
Answer: weight and speed.
10. List 5 factors which influence behavior of a shell in fabrics.
Answer: density of fabrics, elasticity of damaged fabrics, a form
shell, the contents org-x in/in, the provision of a shell at the moment of blow.
11. Call 3 types of primary seam.
Answer: primary, primary провизорный, primary отстроченный.
12. Call 2 types of pollution of wounds
Answer: primary and secondary
13. List 4 forms of sepsis in clinical practice the Answer: the general, sharp, chronic, reklentiruyushchy
14. List 3 forms of an anaerobny infection till speed of a current
diseases
Answer: lightning, fast-progressing, slowly progressing.
15. List 3 types (form) of an anaerobny infection on character
local changes
Answer: gas, edematous, displaced.
16. Call 2 forms of an anaerobny infection on depth of process. Answer: deep (subfastsialny), superficial
(epifastsialny).
17. List 5 early symptoms of an anaerobny infection.
Answer: complaints to narrowness of a bandage, severe pains, formation of bubbles, «ligature
symptom», decrease or sensitivity loss
18. Specify 5 local symptoms of an anaerobny infection.
Answer: the small krovyanisty separated - «varnish blood», muscles of gray color, on skin bubbles with
krovyanisty, transparent or muddy liquid, the brown or blue coloring, an unpleasant, putrefactive smell
from a wound. 19. List 3 types of operations at an anaerobny infection.
Answer: the wide "lampasny" cuts which are combining with an issecheniye of struck fabrics,
amputation (ekzartitikulyatsiya).
20. Call 4 degrees of a clinical course of tetanus.
Answer: I degree (an easy form), II degree (average weight), III degree (a heavy form), IV degree (very
heavy form).
21. Call 2 types of immunization for the purpose of the tetanus prevention. Answer: Early the active,
combined active and passive.
22. Call 3 main reasons for lethal outcomes at tetanus.
Answer: complications from respiratory organs, complications from cardiovascular system, sepsis result
of secondary purulent infections.
23. List 5 types complex treatment at tetanus.
Answer: symptomatic, syvorotochny therapy, anticonvulsive, complex antibacterial, completion of loss
of liquid.
24. List 5 most often meeting mistakes at
to surgical processing of wounds.
Answer: an incomplete section of a wound, excessive activity of the surgeon, insufficient audit of the
wound, incorrectly carried out local anesthesia, bad washing of hands and gloves, bad disinfection of
tools.
25. Call 4 types of the necessary help the wounded in the field of fight.
Answer: imposing on a bandage wound, anesthesia by means of a syringe tube, plait imposing at
bleeding, an immobilization at wounds of extremities.
13.2.1. Situational tasks:
1-situational task
In the field of fight the wounded who was wounded in a foot was found. At survey skin covers pale, the
Hospital attendant, having quickly examined the wounded, found out that in the right of a shin the
wound in the size of 0,2x10,0 cm, edges equal is noted, bleeds.
• Your preliminary diagnosis
• What category of victims should carry the wounded?
• What type of medical care should be rendered to the patient?
• What actions will alleviate suffering of the wounded when rendering this type of the help?
2-situational task
From a battlefield the wounded K.Pri survey is deduced the being bled wound in the left shoulder is
noted. At survey the following is revealed: The ranevy suited, a zone of primary necrosis.
• Your preliminary diagnosis.
• What type of medical care should be rendered to the patient?
• With what wounds it is necessary to differentiate?
• VOP tactics.
3-situational task
On the fourth stage of medical evacuation the wounded arrived. At survey: there is fragmentary, very
painful wound in the field of the left foot, skin is edematous, rough-red color, places vials, at a palpation
the krepitatsiya is noted.
• Name of the fourth stage of medical evacuation.
• Preliminary diagnosis.
• Dif. diagnostics.
• Tactics of the doctor.
13.2.2 Practical part
First-aid treatment to the wounded at wound of the bottom extremity.
Purpose: To master equipment of first-aid treatment to the wounded in the field of fight at
wound.
Equipment: Valanter, couch, plait, Kramer's tire.
Carried-out stages (steps).
It is not
executed
Actions
№
Stages
1.
2.
3.
Introduction аналгетика.
Imposing of a plait is higher than a wound place.
Imposing of an aseptic bandage.
4.
Extremity immobilization.
Transportation of the wounded on a stretcher on the
following stage of evacuation.
5.
(0 points)
0
0
0
It is completely
correctly
executed
20
20
20
0
20
0
20
In total
100
14. Forms of control of knowledge, skills and abilities
1. - the oral;
2. - the written;
3. - situational tasks;
4. - to show abilities of performance of practical skill.
15. Criteria of an assessment of the current control on a subject: «Open changes. Traumatic
osteomyelitis»
№
1
Progress in (%) and points
96-100
Mrk
Level of knowledge of the student
Depending on a situation can make the
correct decision and sums up. By
preparation for a practical training uses
additional literature. Independently
analyzes essence of a problem at treatment
congenital deformations of the
musculoskeletal device. Can independently
examine the patient and correctly makes
the diagnosis (congenital to deformation of
the musculoskeletal device). Shows high
activity, a creative approach at carrying out
interactive games. Correctly solves
situational problems with complete
justification of the answer. During SRS
discussion actively asks questions, does
additions
2
91-95
Excellent
«5»
3
4
86-90
By preparation for a practical training uses
additional literature (as on native, and in
English). Independently analyzes essence of
a problem of the basic principles at
treatment congenital deformations of the
musculoskeletal device. Can independently
examine the patient and correctly makes
the diagnosis (congenital to deformation of
the musculoskeletal device). Shows high
activity, a creative approach at carrying out
interactive games. Correctly solves
situational problems with complete
justification of the answer. During SRS
discussion actively asks questions, does
additions. Practical skill carries out surely,
understands essence.
Independently analyzes essence of a
problem at treatment congenital
deformations of the musculoskeletal
device. Shows high activity, a creative
approach at carrying out interactive games.
Correctly solves situational problems,
proves treatment, makes the plan of
preventive actions. Knows, tells surely. Has
exact representations on an etiology,
патогенезу, to clinic, can carry out
differential diagnostics, to appoint
treatment, can carry out prevention in
traumatology and orthopedics. Practical
skill carries out surely, understands
essence. Correctly collects the anamnesis,
examines the patient, makes the
preliminary diagnosis. Can interpret data of
laboratory researches. Actively participates
in SRS discussion.
Shows high activity at carrying out
interactive games.
76-80
6
Correctly solves situational problems, but
can't appoint concrete treatment, confuses
dosages of preparations. Knows, tells
surely. Has exact representations on an
etiology, патогенезу, to clinic, can carry
out differential diagnostics, to appoint
treatment, but can't carry out prevention
congenital deformation of the
musculoskeletal device.
71-75
Good
«4»
7
66-70
Correctly solves situational problems, but
can't prove the clinical diagnosis. Knows,
tells surely. Has exact representations on
an etiology, патогенезу and clinic, but can't
carry out differential diagnostics and to
appoint treatment.
8
61-65
Correctly collects the anamnesis, examines
the patient, but can't estimate weight of a
condition. Can partially interpret data of
laboratory research. Actively participates in
SRS discussion.
satisfactorily «3»
Has the general representations about
treatment methods in traumatology and
orthopedics, tells not surely, confuses.
Can't independently interrogate and
examine the patient. Can't interpret data of
laboratory researches. Doesn't participate
in SRS discussion
9
55-60
10
54 -30
Unsatisfactorily«2»
Has no exact representation of the basic
principles treatment congenital
deformation of the musculoskeletal device.
Doesn't know.
11
20-30
Unsatisfactorily«2»
For presence of the student on occupation,
in due form, itself has writing-books,
manuals.
16. Trauma Com. SRS-. Emergency medical care and evacuation by the victim in an etapny order.
Control questions.
1. What emergency medical care at evacuation?
2. To Raskozhita immobilization of patients emergency medical care?
3. Types of sochetanny traumas.
4. Clinic of sochetanny traumas.
5. Rendering stages medical care at evacuation at sochetanny traumas.
17. Control questions
1. To make definition of concept medical evacuation to destination.
2. To list the main objectives of medical evacuation.
Z.Chto is called as stages of medical evacuation of wounded. To list
main stages.
4. What basic principles on which make sorting of wounded.
5. Types of medical care.
6. The main actions carried out at each type of the medical
help.
7. Call classification of wounds.
8. Call classification of ranevy infections.
9. For what periods treatment of wounds shares.
10. Call often meeting complications at wounds.
18. Recommended literature
1. Musalatov H.A. «Traumatology and orthopedics of» M «, Medicine» 2007; 567с.
2. «Instructions on field surgery» V.N.Byalin, L.N.Bisenkov, P.G.Bryusov, etc. M 2000. - 415с.
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