Presentations on surgery for students. Presentation on the topic "Surgical operation. Postoperative period". Student scientific circle of the department

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Dressing the surgeon's gown

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Putting on gloves

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Position of the patient on the operating table

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Covering the surgical field

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Treatment of the surgical field

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Stages of a surgical operation

Surgical access Surgical reception Wound suturing

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STANDARD TERMS OF OPERATIONS

1. Careful handling of tissues - it is impossible to produce rough compression of tissues with instruments, cause overstretching and tears of tissues, by manually separating them. 2. Careful separation of the constituent anatomical structures, layer-by-layer stitching of organs and tissues. 3. Careful stopping of bleeding to prevent the development of anemia, secondary bleeding, purulent-inflammatory diseases in the postoperative period. 4. Prevention of wound infection is achieved by observing the rules of asepsis and antisepsis.

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PATHOPHYSIOLOGICAL CHANGES IN THE ORGANISM IN THE POSTOPERATIVE PERIOD

Catabolic phase: lasts 3-7 days; high consumption of energy and plastic materials (proteins, fats and carbohydrates); is a consequence of the activation of the sympathetic-adrenal system, hypothalamus and pituitary gland. Phase of reverse development: lasts 4-6 days; the breakdown of proteins, fats and carbohydrates stops and their active synthesis begins; there is a balance between cata- and anabolic processes. Anabolic phase: lasts 2-5 weeks, on average a month; increased synthesis of proteins, fats and carbohydrates; activation of the parasympathetic nervous system.

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HIGHLIGHTS OF INTENSIVE CARE IN THE POSTOPERATIVE PERIOD

1. The fight against pain narcotic (promedol, omnopon) and non-narcotic (droperedol, fentanyl, diclofenac) analgesics. 2. Prevention and treatment of respiratory failure; appointment of bronchodilators (eufellin, papaverine); oxygen therapy; breathing exercises; percussion chest massage. 3. Normalization of cardiovascular activity - the appointment of cardiac glycosides (strofontin, korglukon, digoxin); metabolites (riboxin); potassium preparations (potassium chloride); rheolytics (rheopoliglyukin, chimes, agapurin); coronary lytics (nitroglycerin, nitrong, sustak).

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4. Prevention of exogenous and endogenous infection, the appointment of synthetic penicillins (ampicillin, oxycillin); cephalosporins (kefzol, cloforan, cefazolin, cefotaxime); aminoglycosides (gentamicin, sisomycin, dobromycin, methylmecin); fluoroquinolones (pefloxacin, ciprofloxacin). 5. Reducing catabolic processes, the appointment of vitamins, anabolics (retabolil). 6. Prevention of thromboembolic complications prescription of anticoagulants (heparin, fraxiparin, clexane). 7. Infusion therapy to cover functional and pathophysiological fluid losses hemodynamic blood substitutes (polyglucin, reopoliglyukin, gelatinol, refortan); detoxifying blood substitutes (hemodez, polydez); protein blood substitutes (amino acids, albumin, protein); saline and glucose solutions.

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Homeostasis monitoring

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Blood gas monitoring

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POSTOPERATIVE COMPLICATIONS FROM THE SIDE OF THE ABDOMINAL CAVITY

GI suture failure Acute adhesive ileus Bleeding into the lumen of the abdominal cavity Bleeding into the lumen of the GI tract Abscesses of the abdominal cavity

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Localization of abdominal abscesses

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POSTOPERATIVE COMPLICATIONS OF THE SIDE OF THE RESPIRATORY SYSTEM

violations of bronchial conduction; atelectasis; hypostatic pneumonia; pleurisy.

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POSTOPERATIVE COMPLICATIONS ON THE SIDE OF THE CARDIOVASCULAR SYSTEM

acute cardiovascular failure; acute coronary insufficiency; coronary insufficiency; violation of the heart rhythm.

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Mastering the technology of pain relief Mastering the technology of pain relief In 1846, the American chemist Jackson and dentist W. Morton used the inhalation of ether vapors during tooth extraction. The surgeon Warren in 1846 removed a neck tumor under ether anesthesia. In 1847, the English obstetrician J. Simpson used chloroform for anesthesia and achieved unconsciousness and loss of sensitivity. Antiseptics - a method of fighting infection The English surgeon J. Lister (1827-1912) came to the conclusion that wound infection occurs through the air. Therefore, to combat microbes, they began to spray carbolic acid in the operating room. Before the operation, the surgeon's hands and the operating field were also irrigated with carbolic acid, and at the end of the operation, the wound was covered with gauze soaked in carbolic acid. Pirogov N.I. (1810-1881) believed that pus might contain a "sticky infection" and used antiseptic substances. In 1885, the Russian surgeon M.S. Subbotin performed sterilization of dressings to perform surgical interventions, which laid the foundation for the asepsis method. Bleeding F. von Esmarch (1823-1908) proposed a hemostatic tourniquet, which was applied to the limb both during an accidental wound and during amputation. In 1901, Karl Landsteiner discovered blood groups. In 1907 Ya. Jansky developed a method of blood transfusion.

Regional State Autonomous Educational Institution secondary vocational education Dobryansk Humanitarian and Technological College them. P.I. Syuzev"

Nursing care in surgery

Lecturer: Pishchuleva T.V.

• A patient - a person (individual) who needs and receives nursing care
• Nursing - part of medical health care, a specific professional activity, science and art aimed at solving existing and potential health problems in a changing environment.
• Environment Wednesday- a set of natural, social, psychological and spiritual factors and indicators that are affected by human activity.

Health is a state of physical, spiritual, mental and social well-being and not merely the absence of disease or infirmity

(WHO 1947)

• Patient Care - sanitary gipurgia (gr. hypourgiai - to help provide a service) - medical activities for the implementation of clinical hygiene in a hospital, aimed at alleviating the patient's condition and contributing to his recovery.
• Patient care is of particular importance in surgery as an extremely important element in surgical aggression, which mitigates its adverse effects and to a large extent affects the outcome of treatment.

• "Surgery" in literal translation means handiwork, skill (chier - hand; ergon - action)
• surgery is one of the main sections of clinical medicine that studies various diseases and injuries, for the treatment of which methods of influencing tissues are used, accompanied by a violation of the integrity of body tissues to detect and eliminate the pathological focus.

• Surgical care is a medical activity aimed at helping the patient to meet his basic needs of life (food, drink, movement, emptying the intestines, bladder, etc.) and during pathological conditions (vomiting, coughing, respiratory disorders, bleeding, etc. .).

1. optimization of the patient's living conditions that contribute to the course of the disease

2. accelerate patient recovery and reduce complications

3. fulfillment of doctor's prescriptions

• General Surgical Care is to organize sanitary - hygienic and medical-protective regimes in the department.
• The sanitary and hygienic regime includes:

Organization of cleaning of premises;

Ensuring patient hygiene;

Prevention of nosocomial infection (the term comes from the Latin nosocomium - hospital and from the Greek. nosokomeo- care for the sick

Creating a favorable environment for the patient;

Provision of medicines, their correct dosage and use as prescribed by a doctor;

Organization of high-quality nutrition of the patient in accordance with the nature of the pathological process;

Proper manipulation and preparation of the patient for examinations and surgical interventions.

• The causative agents of surgical infection are pyogenic microbes - aerobes (staphylococcus, Streptococcus, S treptococcus pneumoniae) and anaerobes(gas gangrene wand - Clostridium perfringens , tetanus stick - Cltridosium tetani) .
• These pathogens cause specific or non-specific infection, acute or chronic.

• A necessary condition for the penetration of the pathogen into the body is the presence of entrance gate.
• The portal of entry can vary in size, from a large wound to a bite or injection site.

• Ways of penetration of infection into the wound - the pathogen can get into the surgical wound in an exogenous way i.e. from the environment, or endogenous- from an inflammatory focus in the body itself (furuncle, purulent tonsil, carious tooth).

• exogenous route:

Air - through the air;

Drip - through the liquid that got into the wound;

Contact - through objects in contact with the wound;

Implantation - through objects that must remain in the wound for the required time.

• Endogenous way:
• - hematogenous - with blood flow;
• - lymphogenous - with lymph flow.

Local reaction:

Hyperemia (redness);

Edema (swelling);

Local temperature increase;

Function violation.

• signs general reaction:

Weakness, malaise;

Headache;

Nausea, vomiting;

Increased body temperature, chills;

Changes in the blood test.

• To fight germs in the wound Lister proposed a number of activities and called them antiseptic.
• Bergman chose a different path infection control: preventing it from entering the body, and suggested other measures called asepsis.
• Antiseptics is to fight an infection that has already entered the wound, therefore it is a therapeutic method, and asepsis- prophylactic.

• Asepsis- this is a set of measures that ensure that microbes do not enter the human body, including the surgical wound.

Organizational measures (zones of special regime);

Physical factors (ventilation, cleaning, UVI);

Chemicals (disinfectants, antiseptics, etc.).

Operating room;

resuscitation;

treatment room;

Dressing room.

Limited personnel access;

Compliance with the uniform;

Implementation of aseptic standards (room cleaning).

• Asepsis ensured disinfection and sterilization.
• Disinfection- this is the destruction of only vegetative forms of pathogenic and opportunistic microbes
• Sterilization- this is the complete destruction of microbes and their spores in the sterilized material
• All items that come into contact with the wound must be sterile!

• Sterilization is carried out physical methods(steam, air, in the environment of heated balls) and chemical(chemicals, gases).

PHYSICAL STERILIZATION METHOD Air sterilization (dry hot air)

Mode

sterilization

T, o C

Control

Time

Name

sterilization quality

objects

Type of packaging material

• Vitamin C
• succinic acid
• thiourea
• Thermal indicator tape IS-180

Metal and glass products

• sucrose
• Thermal indicator tape IS-160

kraft package

Silicone rubber products

Optimal Mode

sack wet-strength paper, Term storage 3 days

Two-layer packaging made of crepe paper for medical purposes

gentle mode

Term storage 20 days

without packaging

Term storage immediately up to 6 hours in aseptic conditions

Steam sterilization method (autoclaving )

Mode

T, o C

sterilization

Р, atm

Time, min

Control

Name of objects

quality

Type of packaging material

sterilization

• Urea
• Thermal indicator tape IS-132

• Benzoic acid
• Thermal indicator tape IS - 120

• Dressing and suture material;
• Surgical underwear;
• Metal and glass products

Products made of rubber, latex, polymeric materials

Sterilization box without filter

Double calico packing

Paper bag unimpregnated

Wet-strength bag paper

Crepe paper for medical purposes (single-layer packaging)

Term storage 3 days

Sterilization box with filter

Crepe paper for medical purposes (two-layer packaging)

Term storage 20 days

Modes are given to specific sterilizers.

Prevention of air infection

Wet cleaning of premises;

Ventilation (reduces the number of microbes in the air by 30%);

Wearing overalls and removable shoes by staff;

UFO premises.

Types of cleaning of the operating room (Order of the Ministry of Health of July 31, 1978, No. 720)

- preliminary performed before starting work and consists in wiping horizontal surfaces and turning on a bactericidal lamp to disinfect the air;

- current, carried out during the operation - a fallen ball, a napkin rise from the floor, blood is wiped off;

- intermediate- between operations, all used material is removed and the floor is wiped;

- final, at the end of the day, the floor and equipment are washed, airing is carried out;

- general- Walls, windows, equipment, floors are washed once a week.

• Wet cleaning is carried out with a disinfectant - this is a complex consisting of 6% hydrogen peroxide and 0.5% detergent or 1% activated chloramine solution (with the addition of 10% ammonia).
• After cleaning, the bactericidal lamp is turned on for 2 hours.

• Zone of absolute sterility - this is the operating room, preoperative and sterilization room of the operating block.
• High Security Zone - this is a room for putting on overalls, storing anesthesia equipment and processing tools.
• Restricted zone - this is a room for storing drugs, instruments, surgical linen, a room for the personnel of the operating unit.
• General mode zone - These are the offices of the head of the department of the senior nurse.

Droplet infection prevention

Wearing masks in the operating room and dressing room.

It is forbidden to conduct unnecessary conversations during the operation and bandaging;

It is forbidden to be in the operating room and dressing room for people with acute respiratory infections and with pustular diseases.

Prevention of contact infection

Surgical hand antisepsis;

Sterilization of gloves;

Sterilization of dressings and surgical linen;

Sterilization of surgical instruments;

Treatment of the operating field.

• mechanical treatment to wash away germs from the surface of the skin and open the pores;
• chemical treatment to destroy microbes remaining on the skin and deep in the pores;
• the use of a chemical capable of tanning the skin, i.e. closing the pores.

• It is forbidden to take part in the operation if there are cuts, pustules, long nails or nails covered with varnish on the hands.
• Spasokukotsky-Kochergin method - wash hands under running water with soap for 1 minute;
• they wash their hands with a sterile gauze cloth for 3 minutes in 2 enameled basins with 0.5% ammonia: in the first basin up to the elbow, in the second - only the hands and wrists;

• wipe the hands with sterile wipes, then the forearms of the hands;
• hands are treated for 5 minutes with 96% ethyl alcohol, nail beds with 5% alcohol tincture of iodine.
• According to Alfeld - hands are washed with 2 sterile brushes for 5 minutes. under a stream of warm, running water with soap, dry with sterile wipes, treat hands with 96% ethyl alcohol and 10% iodine solution, nail beds and skin folds.

Hand treatment with Pervomour (solution C-4, 720 order)

• Preparation of Pervomura solution for treating the surgeon's hands: 171 ml of H 2 O 2 33% and 81 ml of 85% formic acid are poured into a glass flask, shake and refrigerate for 90 minutes (1.5 h).
• The resulting mixture is diluted with distilled water. up to 10 liters .
• The resulting solution during the day can be used to treat hands and the surgical field.

Processing steps:

Hands are washed with soap in running water for 1 minute (without brushes), dry with a towel;

Wash hands in pervomur solution for 1 minute (30 seconds to the elbow and 30 seconds only the hands and the lower third of the forearms);

Dry with a sterile napkin, first the hands, then the forearms to the elbow of the glove

Hand treatment with chlorhexidine bigluconate (gibitan)

• The working solution of chlorhexidine bigluconate is prepared by diluting the initial 20% solution of chlorhexidine bigluconate with 70% ethyl alcohol in a ratio of 1:40.

Processing steps:

Wash hands with running water and soap, dry with sterile wipes;

Hands are treated with several gauze balls, moistened with 0.5% alcohol solution of chlorhexidine bigluconate at least 3 minutes first to the elbow, then the wrists and hands;

Dry with a sterile cloth;

Put on sterile rubber gloves.

• Processing is carried out in basins for 5-7 minutes, after which the hands are dried with a sterile napkin.
• The disadvantage of this method is the processing time.
• Synthetic film coating of the surgeon's hands with cerigel for 2-3 minutes, cerigel is carefully applied to the skin of the hands to form a film.
• Brun's method, which consists in treating hands with 96% ethyl alcohol for 10 minutes.

• Stepping- hands are processed in a certain sequence - from the fingertips to the elbow, and cleaner skin during processing should not touch a less clean area.
• Punctuality(wash according to the scheme)
• Symmetry

Sterilization of surgical linen and dressings

• Sterilization of surgical linen and dressings is carried out by autoclaving. Sterilization mode - 2 atm., 132 ° C, 20 min.

Terms of preservation of sterility:

Bix without filter: unopened - 3 days; opened - 6 hours;

Bix with filter: unopened - 20 days; opened - 6 hours

Stages of processing surgical instruments (OST 42-21-2-85 and Order of the Ministry of Health of July 12, 1989 No. 408)

1st stage - disinfection

• physical way - this is boiling in distilled water for 30 minutes or in a 2% soda solution for 15 minutes;
• chemical antiseptics -3% chloramine 60 min, 6% peroxide 60 min or with 0.5% detergent 60 min

2nd stage - pre-sterilization cleaning

3rd stage - sterilization

• Dry heat method
• Autoclaving

• chemical method

Hydrogen peroxide 6% for 180 min. (3 hours) at 50°C; 18 °C - 360 min. (6 hours)

Deoxon1 1%, 18% for 45 minutes at 20°C;

Sidex 2% 4-10 hours

Rinse in 2 containers with sterile water for 5 minutes each;

Wrap in a sterile sheet and store in a sterile container.

Can be used within 3 days.

• on the eve of the operation, the patient takes a bath or shower for the purpose of hygienic preparation of the skin;
• Immediately before the operation, the skin of both planned and emergency patients is treated with an antiseptic, dried, dry shaving is performed, and then treated with alcohol.

Widely and consistently (from the center to the periphery), the entire operation area is processed twice, and not just the place of the future incision;

Then the place, limited by sterile sheets, is processed;

Be sure to process the area at the end of the operation before suturing, and after suturing.

• The source of such infection can be suture material, drains, catheters, endoprostheses, transplanted organs and multiple metal structures used in traumatology and orthopedics.
• All implants must be sterile, otherwise they will become a source of purulent-septic processes.

• Threads of artificial or natural origin are used as suture material.
• For example: silk, nylon, lavsan, cotton thread, polyester, horsehair, etc.
• Factory methods of sterilization of suture material are the best - this is radiation sterilization with gamma rays or gas mixtures. These methods are used both for threads of natural origin, and for artificial threads.

• Nylon and thin silk are sterilized in formic acid for 10 minutes, then washed 3 times in distilled water, stored in 96% alcohol. Alcohol is changed every 10 days.
• According to Sitkovsky - skeins of catgut are dipped into the air for 24 hours, then wiped and dipped in a 2% solution of potassium iodide
• According to Kocher, the suture material is degreased in ether for 12 hours, then it is transferred to 70% alcohol for 12 hours, then transferred to a 1: 1,000 solution of mercury dichloride and boiled in this solution for 10 minutes. Store in 96% alcohol until use.

Prevention of endogenous infection

The patient enters the hospital, already having the necessary minimum of examinations (fluorography, blood and urine tests, ECG, the conclusion of a dentist, gynecologist, etc.);

If the source of infection is found, then the planned operation is postponed until it is eliminated;

If the patient has been ill with acute respiratory infections, then the operation is postponed for at least 2 weeks. since recovery.

• Active is the subcutaneous injection of staphylococcal toxoid: from a dose of 0.1 ml / day, it is increased by 0.2 ml, bringing it up to 1 ml, and then in the reverse order, reduced to 0.1 ml / day;
• Passive - hyperimmune anti-staphylococcal serum is injected before the operation.

The material was prepared by the teacher of biology of the MOU "Secondary School No. 198" Yapparova Tatyana Vladimirovna

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Stages of surgical treatment: preparation of the patient for surgery, anesthesia (anesthesia), surgical intervention. Stages of the operation: surgical access (incision of the skin or mucous membrane), surgical treatment of the organ, restoration of the integrity of tissues disturbed during the operation.

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Classification of operations by nature and purpose:

Diagnostic operations allow the surgeon to make a more accurate diagnosis and are, in some cases, the only diagnostically reliable method. Radical operations completely eliminate the pathological process. Palliative operations facilitate the general condition of the patient for a short time. Classification of operations by nature and purpose: Emergency operations require immediate implementation (stop bleeding, tracheotomy, peritonitis, etc.). Urgent operations can be postponed while the diagnosis is being clarified and the patient is preparing for surgery. Planned operations are performed after a detailed examination of the patient and the necessary preparation for the operation.

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Features of modern surgery

becomes reconstructive surgery, that is, aimed at restoring or replacing the affected organ: a vessel prosthesis, an artificial heart valve, strengthening the hernia ring with a synthetic mesh, etc.; becomes minimally invasive, that is, aimed at minimizing the area of ​​intervention in the body - mini-accesses, laparoscopic technique, X-ray endovascular surgery. Such areas as neurosurgery, cardiac surgery, endocrine surgery, traumatology, orthopedics, plastic surgery, transplantology, ophthalmic surgery, maxillofacial surgery, urology, andrology, gynecology, etc. are associated with surgery.

slide 5

Historical information

Renaissance Ambroise Pare (1517-1590) - French surgeon replaced the technique of amputation and ligation of large vessels. Paracelsus (1493-1541) - a Swiss doctor developed a technique for applying astringents to improve the general condition of the wounded. Harvey (1578-1657) - discovered the laws of blood circulation, determined the role of the heart as a pump. In 1667, the French scientist Jean Denis performed the first human blood transfusion. XIX century - the century of major discoveries in surgery Topographic anatomy and operative surgery were developed. Pirogov N.I. performed a high section of the bladder in 2 minutes, and amputation of the lower leg - in 8 minutes. The surgeon of the army of Napoleon I Larrey performed 200 amputations in one day.

slide 6

Mastering the technology of anesthesia In 1846, the American chemist Jackson and dentist W. Morton used the inhalation of ether vapors during tooth extraction. The surgeon Warren in 1846 removed a neck tumor under ether anesthesia. In 1847, the English obstetrician J. Simpson used chloroform for anesthesia and achieved unconsciousness and loss of sensitivity. Antiseptics - a method of fighting infection The English surgeon J. Lister (1827-1912) came to the conclusion that wound infection occurs through the air. Therefore, to combat microbes, they began to spray carbolic acid in the operating room. Before the operation, the surgeon's hands and the operating field were also irrigated with carbolic acid, and at the end of the operation, the wound was covered with gauze soaked in carbolic acid. Pirogov N.I. (1810-1881) believed that pus might contain a "sticky infection" and used antiseptic substances. In 1885, the Russian surgeon M.S. Subbotin performed sterilization of dressings to perform surgical interventions, which laid the foundation for the asepsis method. Bleeding F. von Esmarch (1823-1908) proposed a hemostatic tourniquet, which was applied to the limb both during an accidental wound and during amputation. In 1901, Karl Landsteiner discovered blood groups. In 1907 Ya. Jansky developed a method of blood transfusion.

Slide 7

Russian surgery

Surgery in Russia began to develop in 1654, when a decree was issued to open bone-cutting schools. Pharmacy appeared in 1704, and in the same year the construction of a plant for surgical instruments was completed. Until the 18th century, there were practically no surgeons in Russia, and there were no hospitals. The 1st hospital in Moscow was opened in 1707. In 1716 and 1719 two hospitals are put into operation in St. Petersburg.

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