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V. Reference basis of action

Method of introduction of rotoglotcovogo povitrospryama

Povitrospryam is entered with the purpose of prophylaxis of mechanical asphyxia, as a result of falling back of language in the surgical stage of dovennogo anesthesia, at the comatose state. Stages of implementation:

- zaprocinouti head of patient;

- to open his mouth and enter returned on 180 degrees of povitrospryam above a language, not pushing the root of language backwards (it can vidtisnouti him by a spatula);

- to open out by povitrospryam curvature upwards;

- the end of povitrospryama must be found in gortanoglottsi.

Method of sanatsii of overhead respiratory tracts by means эlectrovidsmoctouvacha

Testimony: aspiratsiya, regourgitatsiya, accumulation of mucus or blood in overhead respiratory tracts. Sanatsiya of rotoglotci is conducted by a hard tip with a plenty of opening on an end by the conduct of him in a mouth and glotcou. Sanatsiya of nasal motions – by a similar tip from every nostril separately, closing other here. Sanatsiya of nosoglotci and traheobrahialnogo tree – by the soft smeared catheter with a recurvate end through Y-podibniy transitional or tube with the lateral opening (for creation of the dosed dilution).

VІ. System of teaching tasks for verification of eventual level of knowledges.

Situation tasks

a 1 Patient 58 years, operated concerning the cancer of blind gut – executed pravobichna gemicolectomiya. Concomitant illness – stenosis to the mitralnogo valve. After awakening there was the frequent breathing from ouchastyo auxiliary muscles, cyanosys developed. From a trachea began to be selected rose suds. What complication arose up? What exigent measures need to be conducted?

Answer: a patient has the edema of lights. It is needed to conduct aspiratsiyo of liquid from respiratory tracts, to begin inhalation by oxygen through an ethyl alcohol (if necessary – artificial ventilation of lights), to enter corticosteroidi, ganglioblocatori, diouretici, cardiac facilities, narcotic analgetici (only at presence of at the patient of consciousness).

2 Sick S., 46 years, it is operated concerning peritonitis. It is exposed during ftorotanovogo anesthesia, that pupils are narrow, the reaction on light is weak, absent rogivcoviy and glotochniy reflexes, arterial pressure, bradicardiya, went down. What stage of anesthesia at a patient?

Answer: a patient has the III3 stage of anesthesia.

3 Sick T., 65 years, hospitalized concerning the perforation of ulcer of 12-falling bowel. At a patient hypertensive illness is also exposed. To what type of anesthesia you will you give advantage?

Answer: as at a patient there was complication of ulcerous illness (perforation of ulcer), to him the shown urgent operative interference. The operation will be conducted in an abdominal region, therefore for its successful implementation necessary intoubatsiyniy anesthesia. Taking into account hypertensive illness, implementation of endotrahealnogo anesthesia will be optimum.

4 To the induction centre a patient, 38 years, is delivered, with complaints about intensive pain on all stomach, general weakness, that increases at inhalation. At a review: the state of middle weight. Skin pocrovi are pale. Temperature of body 36,9°S. Breathing superficial with frequency 16 in a 1 minute. Pulse 102 oud. in a 1 minute, rhythmic, weak filling. AT 110/70 mm of rt item A stomach is symmetric, in the act of breathing of participation does not take. At palpatsii is tense in all departments, on the type of "doshcopodibnogo", sharply sickly. Positive symptoms of irritation of peritoneum. Hepatic dullness is absent. A patient has the suspected perforativna gastric ulcer or 12-falling bowel. What method of anaesthetizing you will you offer?

Answer: to the patient the shown urgent operation – laparotomiya. The operation will be conducted in an abdominal region, therefore for its successful implementation necessary intoubatsiyniy anesthesia.

a 5 Patient 45 years, delivered to the induction centre with complaints about a general weakness, dizziness, nausea and vomit by "coffee-grounds". At the inspection: skin covers are pale. Pulse 110 in 1 hv., threadlike. AT 80/40 mm of rt item General blood test: NV - 80 g/l, eras.- 2,8h1012/l, Nt – 25%. The diagnosed sharp shlouncovo-cishcova bleeding. Conservative therapy during 4 o'clock of effect did not give. On a nazogastralnomou probe continued to flow out "coffee-grounds", blood clots. The shown ecstrenna operation.

Which from the types of anaesthetizing it is better to apply during the operation at the given patient?

Answer: to the patient the shown common anaesthetizing – anesthesia.

6 Sick L., 65 years, acted with complaints about peremignou lameness, senses of cold and parestezii in feet, pain in the first finger of right foot, rise of temperature of body to 38,3°. Considers itself a patient during 5 years, when pains in litcovih muscles at walking appeared. In connection with worsening of the state appealed on the reception hospitalized. Suffers by hypertensive illness by atherosclerotic coronaro-cardiosclerozom, blinking arrhythmia, N2a_. At a review: the common state of middle weight. The lowered feed. Skin pocrovi are pale, acrotsianoz. Breathing is loosened vezicoulyarne - single dry wheezes. Pulse 86 on 1 hv, unrhythmical. AT 140/90 mm of rt item A stomach takes part in breathing, symmetric. At palpatsii soft, painless on all departments. Locally: the first finger of right foot of black. A foot was swollen, hyperemia of skin, local gipertermiya. A pulsation on femoral arteries is lowered, on popliteal - is weakened, on the arteries of feet is not determined. Muscles of lower extremities of gipotrofichni, skin pocrovi are pale, the tourgor lowered, hair cover zbidneniy sharply, nail plates are turbid, thickened. The conducted conservative therapy of effect did not give - the phenomena of intoxication grew, the phlegmon of foot and lower third of shin developed. Vital testimonies are produced to amputation of right lower extremity at the level of middle third of thigh.

Which from the types of anesthesia it is better to apply?

Answer: to the patient the shown masochniy anesthesia.

7 During conducting of operative interference (opening of postin'ectsiynogo abscess) under masochnim anesthesia motive activity in extremities appeared at a patient.

What stage of anesthesia came at a patient?

Answer: the stage of excitation came at a patient.

8 From an operating-room in the chamber of intensive therapy translated sick Sh., 62 years, that carried under the combined anesthesia of gastrectomiyo, drenouvannya of abdominal region. In 15 minutes the independent breathing was halted, cardiac activity is well-kept. By a doctor-anaesthetist the lower jaw shown out, through a mouth entered povitrovid - the independent breathing is absent. After conducting of artificial respiration mouth the independent breathing recommenced to the mouth. Which from complications developed at the given patient?

Answer: at a patient there was falling back of language.

9 Sick C., 67 years, entered clinic on the first-aid concerning sharp impassability of bowels. It is ill on saccharine diabetes.

Choose the ob–rountouyte method of anaesthetizing, make the chart of the anaesthetic providing.

Answer: as at a patient sharp surgical disease of organs of abdominal region, namely intestinal impassability, to him the shown operative interference on to the vital shows. As an operation will be conducted in an abdominal region, intoubatsiyniy anesthesia will be the method of anaesthetizing. Taking into account the present at a patient concomitant disease (saccharine diabetes), in a peredoperatsiynomou period it will be needed to conduct correction of sugar of blood.

10 sick P., 47 years acted In the surgical separation, with a diagnosis the carbuncle of the back of head. The state heavy. Temperature of body 38,8°. 5 Days are ill.

What anaesthetizing it is necessary to expose gnoyac under? The Ob–rountouyte choice of method of anaesthetizing.

Answer: for conducting of adequate the necrectomii operation needs to be conducted under intravenous anesthesia. Local infiltration anaesthesia will be uneffective from localization, distribution of process; intoubatsiyniy anesthesia needs more difficult vehicle providing, more long conducting of operative interference will proceed, that is he is inadvisable.

concerning sharp appendicitis it was decided to conduct a 11 Operation under vehicle mascovim anesthesia. What respiratory contour you will apply: reversible or unreversible? Why? Transfer failing and advantages of each of them.

Answer: conducting of operative interference under the semiclosed respiratory contour is most expedient, so as he unlike closed does not cause gipercapniyo in the organism of patient and unlike opened and half-open cause not high concentration of anesthesia preparations in air of operating-room.

12 Sick C., a 51 year, entered permanent establishment with the signs of dislocation of the left shoulder. What method of anaesthetizing expediently to apply in this case?

Answer: setting of dislocation occupies the small interval of time. For the successful conducting of manipulation weakening of muscles of humeral is needed to the belt. Coming from the transferred terms, in this case intravenous anesthesia will be most expedient.

13 In the surgical separation it is delivered the victim F., 40 years, which got the vognepalne wound of thorax. What method of anaesthetizing you will you apply for conducting of operative interference?

Answer: as at a patient vognepalne wound, the volume of operative interference can be specified during operative interference, of long duration anesthesia is therefore needed, with muscular relacsatsieyo. Intoubatsiyniy (endotrahealniy) anesthesia answers these requirements.

14 Sick C., 57 years, conducting of resection of stomach for Bilrot-II is planned. What introductory and base the anesthesia can be applied?

Answer: a patient as can apply introductory anesthesia mascoviy or intravenous, as a base the anesthesia shown endotrehealniy.

15 Sick S., 34 years, setting of dislocation of thigh is planned. The method of anaesthetizing what, in your opinion, needs to be applied in this case?

Answer: to the patient the shown corotcotrivale anaesthetizing with the effect of weakening of muscles. Therefore it is needed to choose intravenous anesthesia.

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