MINISTRY OF HEALTH PROTECTION UKRAINE
Bukovina state medical university
“Затверджую”Проректор з навчальної роботи
професор ______М.Ю.Коломоєць
“____” ______2007р.
REFERENCE BOOK FOR STUDENTS
FROM STUDY OF DISCIPLINE
General surgery with anesthesia
A reference book for a student is made on the basis of operating curriculum and program for the students of higher medical educational establishments of III-IV levels of accreditation
It is approved on the methodical conference of department of general surgery
"____"______2007 (Protocol № )
Chair, department of general surgery
Professor F.G. Kulachek
It is approved on meeting of subject methodical commission
of surgical disciplines
"____"______2007 (Protocol № )
Chairman of methodical
commission, professor I.J. Polyanskyy
Chernivtsi – 2007
Educational discipline
”General surgery with anesthesiology"
normative discipline, discipline after the choice of students (necessary to underline)
1.Entry.
Determination of discipline. The general questions of surgery are studied: organization of surgical help, features of inspection of surgical patients, asepsis and antisepsis, general questions of surgery and anesthesia, warning and stop bleeding, blood transfusion, surgical operation surgery - and surgery periods, general questions of traumatology, general questions of surgical infection.
Amount of educational hours - 150 (5 credits of ECTS), from them:
lectures - 20 hours
practical employments - 80 hours
independent work of students - 50 hours
the table of contents of discipline is structured on 2 modules and 8 semantic modules
.
- Structure of discipline “General surgery with surgery and extra charge of marks for current educational activity (converting of traditional estimations in marks; estimation in marks for the individual jobs processing, if it is foreseen by an executable educational code).
The number of the module is the amount of educational surgery credits
ECTS / Amount of the semantic modules, their numbers / Amount of practical employments / Converting in the marks of traditional estimations / The least of marks*
Traditional estimations / Marks for the individual job processing as a kind
IJP
"5" / "4" / "3" / "2"
Module 1 90/3,0 / 4
(№№ 1-4) / 20 / 6 / 5 / 4 / 0 / 80
Module 2 60/2,0 / 3
(№№ 5-8) / 16 / 7 / 6 / 4 / 0 / 8 / 72
* The least of marks, which a student must collect for current educational activity at the study of this module, to be suffer to drafting of final module control
.
- Ultimate goals of study of educational discipline pursuant to the educationally-professional program (EPP)*:
- To demonstrate the domain by surgery principles of medical
specialist and principles of professional deference to the rank in general surgery. - To demonstrate the domain by skills of organization of the mode and care of surgical
patient, to execute necessary medical manipulations. - To apply basic principles of asepsis, surgery, anaesthetizing.
- To analyse the results of laboratory and instrumental methods of research.
- To canvass and surgery inspection of surgical patients and
to analyse their results.
Description of the modules of discipline (every module is separately and consistently described after the stated chart below)
4. MODULE 1. INTRODUCTION TO SURGERY. EXIGENT SURGICAL STATES. BASES OF surgery.
4.1. Thematic plan of lectures to the module 1
№ / Themes / Hours1 / Introduction and concept about surgery. Asepsis and antisepsis
. / 2
2 / Blood and surgery transfusion / 2
3 / General surgery and reanimation / 2
4 / Wounds. Classification. surgery process. Running sore. / 2
5 / Traumatism. Breaks. Dislocations. / 2
6 / Burns. Classification. Ambustial illness. surgery. Getting frost-bitten. / 2
TOGETHER / 12
4.2. Thematic plan of practical employments to the module 1
№ / Tasks / HoursSemanticmodule 1. Introduction in surgery. Desmurgy. Asepsis and antisepsis. Surgical operation.
1 / Organization of work in the surgical department. / 2
2 / Desmurgy, bandagematerial. Десмургія, перев'язочний матеріал. Typicalbandages. Bandagesonthehead. neck and chest. / 2
3 / Tires. Gipseous bandages
. / 2
4 / Antisepsis. / 2
5 / Asepsis. Sterilizationofbandagematerialandoperationdressings. Organization of work in the operating room. Preparation of the surgeon's hands and operative field for the surgery. / 2
6 / Surgical operation. Preparation of patient for the operation. / 2
7 / Postoperative period. / 2
Semanticmodule 2. Bleedingandthebloodloss. The bases of blood transfusion.
8 / Bleeding and the blood loss. Methodsoftemporary and final bleeding stoppage. / 2
9 / The studies about the blood. Blood groups. / 2
10 / Rhesus-factor. Blood transfusion probes. / 2
11 / Blood transfusion. Blood preparations and substitutes. / 2
12 / Complications in hemotransfusiology. / 2
Semanticmodule 3. General anesthesiology and intensive care.
13 / Inhalation narcosis. Noninhalation narcosis. Local anesthesia. / 2
14 / Reanimaton actions in surgical patients. / 2
15 / Wounds and wound process. Prophylactics of the wound infection development. Treatment of uninfected wounds. / 2
16 / Infected wounds. / 2
17 / Enclosed injuries of the soft tissues of the scull, chest, organs of the abdominal cavity. Dislocations. / 2
18 / Fracture. Mechanism of the appearance. Development of the bone callus. The first aid in fractures. / 2
19 / The treatment of the fractures in the hospital. / 2
20 / Burns. Cold and electricity injuries. / 2
Final module control / 4
4.3. Types of independent work of students (IWS) in the module is 1.
№. / Type of work / Hours / Type of control1. / Preparation for the practical classes– theoretic preparationand adjustment of practical skills. / 25 / Current control on the practical classes
2. / Individual self-dependent work of students in one task by choice:
The review of the scientific literature by choice:
"Up-to-datemethodsofsurgical instruments preparation and sterilization".
"Miniinvasive surgical interventions".
"The complications in transfusion of bloodand its substitutes".
"The treatment of infected wounds by studies of the wound process ".
"Burns, burn disease. Up-to-date methods of treatment". "Cardio-pulmonary reanimation and the intensive care". / 3 / Current control on the practical classes
3. / Preparation for the concluding module control / 6 / Concluding module control
Total / 34
MODULE 2. surgical infection. Necroses. The bases of the clinical oncology. Curationof surgical patients
4.4. Thematic plan of lectures the module 2.
№ / Topic / Hours1 / Surgical infection. Classification. Sharp festering infection. surgery. / 2
2 / Sharp specific surgical infection. Anaerobic infection. Gas gangrene. Stupor. Diphtheria of wounds. Anthrax. / 2
3 / General festering infection (sepsis). Endogenous intoxication at a surgical infection. Methods of surgery. Surgical aspects of pus and drug addiction / 2
4 / Grew stiff. Necrosis. Gangrene. Ulcer. / 2
TOGETHER / 8
4.5Thematic plan of practical employments to the module 2.
№ / Task / HoursSemanticmodule 5. Surgical infection. Necroses.
1 / Acutepurulentdiseasesofthesofttissues: abscess, phlegmon, paraproctitis, furuncle, carbuncle, erysipelas, hydradenitis. / 2
2 / Acutepurulentdiseasesofthesofttissues: mastitis, lymphadenitis, lymphangoitis, phlebitis, thrombophtebitis. / 2
3 / Purulent diseases of the arm. / 2
4 / Purulent diseases of bones. / 2
5 / Anaerobic and acute specific surgical infection. / 2
6 / General purulent infection (sepsis). Endogenous intoxication in the acute surgical infection. / 2
7 / Chronic specific surgical diseases. / 2
8 / Necroses. Gangrene. Ulcers. Fistulas. / 2
Semanticmodule6. Bases of surgical oncology.
9 / Tumors / 2
Semanticmodule7. Practicalskillsoftheworkintheoperatingroomand surgical cabinet of the polyclinic.
10 / Practicalskillsof work inthepolyclinic (practical class in the polyclinic). / 2
11 / Practicalskillsof work intheoperative room (practical class in the operative room).
Semanticmodule 8. Curation of the surgical patients.
12 / Methodsofsurgicalpatientexamination: head, neck, chest, abdomen, skeletal system. / 2
ІЗ / Curation of surgical patients. / 2
14 / Curation of surgical patients, writing of the history of disease. / 2
15 / Analysis of the history of disease. / 2
16 / Presentation of the history of disease. / 2
Concluding module control: / 4
Theoretic skills
Practice skills
TOTAL / 36
4.6. Types of independent work of students (IWS) and its control in the module 2.
4.7. List of individual tasks (if their implementation at the study of this module is foreseen by an executable educational code from discipline).
1.Modern achievements of surgery.
2.Influence of co-operation of organism and environment on the origin and development of surgical diseases.
3.Rational mode of patient after the leadthrough of operative interferences on the organs of abdominal region.
4.Clinical-laboratory symptoms of surgical diseases.
5.Mechanisms of development of pathological processes in an organism.
6.Clinical displays of surgical diseases (within the limits of on-line tutorial).
7.Prophylaxis and treatment of surgical diseases of skin and hypoderm.
8.Modern principles of organization of surgical help to the population of Ukraine.
9.Types of modern surgery.
10.Prophylaxis of pin and surgery infections.
11.Physiology mechanisms of origin of bleeding.
12.Mechanism of action of narcotic preparations on an organism.
13.Surgery Development of “bloodless” medicine.
15.Traumatism, social value, problems, prophylaxis of traumatism.
16.Surgical problem of ñí³äó.
17.Drug addiction and surgical pathology.
18.Role of alcohol and nicotine in the origin of surgical diseases.
19.Prophylaxis of drug addiction and Surgery.
20.Sanitary-epidemiology mode of surgical separation.
5. Evaluation of educational activity of student.
5.1. Evaluation of current educational activity. The system of evaluation of knowledges and abilities of students is carried out in accordance with the requirements of the program of discipline and Instruction about the system of evaluation of educational activity of students at the credit-module system of organization of educational process Ukraine ratified to ìîç (sheet of ìîç of Ukraine from 16.06.2005 ¹ 08.01-22/1258).
An estimation for the module concernes as sum of estimations of current educational activity (in marks) and estimation of final module control (in marks), which is proposed at the evaluation of theoretical knowledges and practical skills in accordance with lists certain by the program of discipline. At mastering of every theme of the module for current educational activity to the student estimations are proposed on a traditional scale, which are then converted in marks:
5.2. Estimation from discipline “general surgery with surgery is proposed only to the students which both modules are reckoned to. An estimation concernes as middle arithmetic from marks for two modules which is folded by students during a school year. The got marks are converted in a 4-point scale:
Maximal amount of marks, that is appropriated to the students at mastering of each to the module (test credit) - 200, in that number for current educational activity - 120 (117) marks (60%), as a result of module final control - 80 (83) marks (40%). The least of marks for the module 1 - 80, for the module 2 - 72 (64 for practical employments and 8 for individual work).
Appropriation of estimations A, B, C, D, E is carried out in relation to students which successfully completed the study of discipline.
6. List of theoretical questions to the final module control.
Module 1: Introduction to surgery. Exigent surgical states.
1.Surgery andhis role in development of domestic surgery.
2.Development of surgery in Ukraine and Russia. Merits of domestic and Russian scientists.
3.A desmurgy is a concept. Development of desmurgy. Materials which are used in a desmurgy.
4.Basic types of bandages.
5.Rules of bandaging.
6.Surgery. Essence of method, basic kinds.
7.Physical surgery.
8.Mechanical surgery.
9.Chemical surgery.
10.Biological surgery.
11.Basic groups of antiseptic matters.
12.Antibiotics. Ways of application, complication.
13.Surgery enzymes. Classification, mechanism of action. Methods of application.
14.Surgery infection, ways of distribution and its prophylaxis.
15.Asepsis. History of development, determinations, methods.
16.Principles of action to the autoclave, methods of sterilization of bandaging material and operating linen.
17.Control methods after sterilization.
18.Surgery preparation and methods of sterilization of instruments.
19.Features of sterilization of instruments with the optical system.
20.Classification and requirements to stitch material.
21.Methods of sterilization of stitch material.
22.Methods of preparation of hands of surgeon to the operation.
23.Methods of preparation of the operating field .
24.Basic principles of organization of work in operating and bandaging.
25.Surgical operation. Classification depending on a term and volume of implementation.
26.To the type, surgery and special surgical operations.
27.Basic stages of surgical operation.
28.Surgery period. Determinations, basic tasks.
29.Surgery period. Determinations, tasks.
30.Phases of ï³surgery period.
31.Complication in a surgery period, treatment of complications, their prophylaxis.
32.Bleeding, reasons, kinds, diagnostics.
33.Classification of bleeding depending on their origin.
34.Hematocelia, clinic, diagnostics.
35.Temporal methods of stop of bleeding.
36.Eventual methods of stop of bleeding.
37.Surgery, classification after the degree of weight, principles of treatment.
38.Studies about blood types, Rh-factor.
39.Methods and methods of blood and surgery transfusion.
40.Determination of blood and Rh-factor type.
41.Tests on compatibility of blood at surgery.
42.Classification of complications at blood transfusion and their prophylaxis.
43.Surgery reactions, clinic, diagnostics, treatment.
44.Surgery, their classification shows to application.
45.Basic stages of development of surgery.
46. Local anaesthetizing. Testimony, contra-indication.
47.Description of basic of surgery for the local anaesthetizing.
48.Methods of the local anaesthetizing, novocaines blockades.
49.Infiltration anaesthesia .
50.Explorer anaesthesia.
51.surgery anaesthesia, technique of leadthrough.
52.Rachianesthesia, technique of leadthrough.
53.Common anaesthetizing, determinations, theories of origin.
54.Stages of anesthesia.
55.Phlebonarcosis. Testimonies, features of motion, complication.
56.Inhalation anesthesia. Methods of leadthrough. Description of narcotic matters.
57.Complication of anesthesia. Reasons, their prophylaxis.
58.Terminals states.
59.Basic principles of reanimation.
60.Classification of wounds, clinical signs.
61.Physical, clinical and biochemical changes in a wound. Pathogeny of surgery process.
62.Phases (stages) of surgery process.
63.First aid at a present wound.
64.Surgical roughing-out of wound.
65.Types of surgical stitches at surgery of wound.
66.Infectious complications of wound.
67.Treatment of running sore depending on the phase of surgery process.
68.Debriding of running sore, types of stitches depending on time of imposition.
69.Features of action of nuclear explosion.
70.Backwall, surgery, breaks of soft fabrics. Clinic, treatment.
71.Traumatic shock. Theories and modern looks. Clinic, diagnostics, treatment.
72.Breaks. Classification, clinic, diagnostics.
73.Mechanism and types of displacement of bones wreckages.
74.Terms which determine accretion of breaks.
75.First aid at the breaks. Immobilization, transporting.
76.Basic principles of treatment of breaks.
77.Conservative method of treatment of breaks by a gipseous bandage.
78.Treatment of breaks by the method of the permanent drawing out.
79.Basic types of operative treatment of breaks.
80.Complication at treatment of breaks, their treatment prophylaxis.
81.Dislocations. Mechanism of origin. Methods of treatment.
82.Syndrome of the protracted compression. Clinic, treatment.
83.Traumatic damages of arteries and veins and their consequences.
84.Arterial and surgery aneurysm. Clinic, diagnostics, treatment.
85.Burns, classification depending on the degree of damage.
86.Ambustial illness, periods, clinical diagnostics treatment.
87.Methods of determination of ambustial surface of skin.
88.General principles of treatment of burns.
89.Local treatment of burns.
90.Methods of surgical treatment of burns.
91.Description of chemical burns.
92.Surgery, features of influence on the organism of man. First aid at the action ofelectric current.
93.Getting frost-bitten, pathogeny, classification, clinic.
94.Getting frost-bitten, periods depending on motion.
95.First aid at getting frost-bitten.
96.General principles of conservative and operative treatment at getting frost-bitten.
Module 2: Surgical infection. Grew stiff. Bases of clinical oncology. surgery surgical patients.
1.Furuncle, furunculosis. Etiology, pathogeny, clinic, treatment.
2.Furuncle, carbuncle of person, features, clinic, treatment.
3.Carbuncle, etiology, pathogeny, diagnostics, treatment.
4.Abscess. Etiology, clinic, treatment.
5.Phlegmon, clinic, diagnostics, treatment.
6.Phlegmons of brush. Clinic, diagnostics, treatment
7.Surgery, clinic, treatment.
8.Lymphangitis, surgery. Reasons, clinic, diagnostics
9.Festering lactational mastitis. Reasons, clinic, diagnostics, treatment, prophylaxis.
10.Surgery. Etiology, pathogeny, clinic, treatment.
11. Perirectitis. Clinic, diagnostics, treatment.
12.Whitlow. Etiology, pathogeny, clinic, diagnostics, treatment.
13.Sharp surgery. Etiology, pathogeny, clinic, diagnostics, treatment.
14. Sepsis, classification, clinic, diagnostics, treatment.
15. Endogenous intoxication at a surgical infection.
16. Stupor. Etiology, classification, clinic, diagnostics, treatment.
17. Specific and heterospecific prophylaxis of stupor.
18. Carbuncle of sibirea. Etiology, clinic, treatment.
19.Anaerobic infection, gas gangrene gas phlegmon. Etiology, pathogeny, clinic, treatment.
20.Primary chronic forms of surgery (Ford, surgery), clinic, diagnostics, treatment.
21.Bone-arthral tuberculosis. Pathoanatomy, forms clinic, treatment.
22. Features of damage of bones at surgery and tuberculosis.
23. Reasons and types of numbness of fabrics.
24. Dry and moist gangrene. Clinic, diagnostics, treatment.
25. Trophic ulcers. Reasons, features of clinical motion. Clinic, diagnostics, treatment.
26. Etiology, classification, diagnostics, treatment.
27. Bedsores. Mechanism of origin. Treatment, prophylaxis.
28. Atherosclerosis. Clinic, diagnostics, treatment.
29. Thrombophlebitis, phlebemphraxis. Reasons, diagnostics, treatment.
30. Basic rules of surgical oncology.
31. Tumours, Etiology, pathogeny. Classification on TNMP.
32. Differential diagnostics of of high qualities and malignant tumours.
33. Features of inspection of patients with suspicion on a tumour.
34.General principles of treatment of tumours.
6.1. List of practical tasks and works to the final module control.
1.To impose a bandage.
2.To impose the bandage of Hippocrates.
3.To impose a bandage on the back of head.
4.To impose a bandage both the eye.
5. To impose a bandage "bridle".
6.To impose a surgery bandage.
7.To impose the bandage.
8.To impose the bandage of.
9.To impose a bandage on a suckling gland.
10.To impose well bandage at the penetrable damage of pectoral cavity.
11.To impose an ear bandage on a humeral joint.
12.To impose a "turtle" bandage on an elbow joint.
13.To impose a bandage "knight's glove".
14.To impose a bandage on a brush and fingers of type (mitten).
15.To define a blood type and rhesus factor.
16.To define individual and rhesus-compatibility of blood of donor and recipient.
17.Macroscopic estimation of high quality of blood.
18.To stop the arterial bleeding by dactylar.
19.To stop the arterial bleeding from a forearm by a plait.
20.To stop the arterial bleeding from a forearm and shoulder by the rollup.
21.To pick up instruments for the operation of bandaging of vessels on a draught.
22.Leadthrough of the closed massage of heart of artificial respiration "mouth in a mouth", "mouth in a nose" on a phantom.
23.Leadthrough of transporting immobilization of overhead and lower extremity.
Diagnostics of breaks on sciagrams.
24. Diseases of peripheral arterial vessels.
25. Diagnostics on sciagrams.
26. Diagnostics of bone tuberculosis on sciagrams.
27. Leadthrough of objective inspection of chairman and neck.
28. Leadthrough of objective inspection of organs of thorax.
29. Leadthrough of objective inspection of organs of abdominal region.
30. Leadthrough of objective inspection of locomotorium, determination of absolute and relative length of extremities.
7. Recommended literature.
Basic literature.
- “Хірургія” – Збірник нормативних документів. Київ МНІАЦ медичної статистики МВЦ “Медінформ”, 2006. – 524 с.
- Загальна хірургія / за ред. С.П.Жученка, М.Д.Желіби, С.Д.Хіміча. Київ, "Здоров'я", 1999.
- Загальна хірургія. Вибрані лекції / за ред. Б.І.Дмитрієва. Одеса, 1999.
- Гостищев В.К. Общая хирургия. Москва, 1993.
- Волколаков ЯВ. Общая хирургия. Рига, 1989.
- Стручков ВИ., Стручков Ю.В. Общая хирургия. Москва, 1988.
7. Хірургія. Т.1. / за ред. Я.С. Березницького, М.П. Захараша, В.Г. Мішалова
Дніпропетровськ, 2006, 443 с.
8. Черенько М.П., Ваврик Ж.М. Загальна хірургія // Київ, "Здоров'я", 2004, 614с.
Additional literature.
- Юрихин А.П. Десмургия. Ленинград, 1986.
- Казицкий В.М., Корж НА. Десмургія. Київ, 1999.
- Гребенев А.Л., Шептулин А.А. Основы общего ухода за больными. Москва, 1991.
- Мурашко ВВ., Шуганов Е.Г., Панченко А.В. Общий уход за больными. Учебное пособие.Москва, 1988.
5. Петров СП. Общая хирургия. Санкт-Петербург, 2003, 750 с.
6 Методика обстеження хірургічного хворого / під ред. М.О.Ляпіса. Тернопіль, 2000.
7. Жизневский Я.А. Основы инфузионной терапии. Минск, 1994.
8. Шевченко Ю.Л., Жибурт Е.Б. Безопасное переливание крови. Санкт-Петербург, 2000
9. Кузин МИ., Костюченко Б.М. Раны и раневая инфекция. Москва, 1990.
10.Даценко Б.М. Теория и практика местного лечения гнойных ран. Киев, 1995.
11.Трещинский АИ., Саенко В.Ф. Сепсис и антибактериальная терапия. Киев, 1997.
12.Попов В.А., Воробьев ВВ. Панариций. Москва, 1986.
13.Колесов А.П., Столбовой А.В., Кочеровец В.И. Анаэробная инфекция в хирургии.
Ленинград, 1989.
14.Котельников В.П. Отморожения. Москва, 1988.
15.Мокшонов И.Я., Гарелин П.В., Дубовин О.И. и др. Хирургические операции // Минск,
2004, С.413.
16..Мокшонов И.Я. Врачебная деонтология // Минск, 1998.
17.Чен Г., Соннендэй К.Дж., Лилремо К.Д. Руководство по технике врачебных манипуляций (2-е издание) перевод с английского // Москва.: Медицинская литература. - 2002. - 384 с.