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Management of patients :
conservative anti-inflammatory therapy is conducted on the general principles of treatment of purulent process .
Surgical treatment is applied in all kinds of panaritiums . Dermal panaritiums removed flaking epidermis, with subcutaneous panaritiums surgery shown after the first sleepless night .
Postoperative immobilization is carried out the damaged area with antibiotics , warm baths , physiotherapy.
As a preventive measure it is necessary to hand hygiene , to prevent the emergence and conduct timely treatment microtrauma .
Pandaktilit - purulent inflammation of all the tissues of the finger. Often the result of improper treatment of tenosynovitis , bone and articular felon . Comes purulent fusion of bones, joints , tendons and soft tissue . Marked a sharp pain, fever up to 38 ° C and above , leukocytosis in the blood up to 15 000-20 LLC , a shift in the formula of blood left. Finger sharply increased in volume , irregular skin cyanotic , multiple fistulas, no movement in the joints .
Pandaktilita only operative treatment and involves the removal of a finger.
acute
chronic .
Periostitis - purulent inflammation of the periosteum . Clinical course - and Periostitis sarcoma can occur in bone. However, they often come from the epiphyseal end , accompanied by destructive changes in the cortical department.
The principles of treatment are the same as in other purulent processes .
serous , purulent , hemorrhagic purulent
putrid
Phlegmon - acute diffuse purulent inflammation of subcutaneous , intramuscular , retroperitoneal and other types of fiber. Unlike abscess cellulitis with purulent process is not limited , and is distributed by a loose fiber spaces . According to the nature and form of exudate distinguish cellulitis . Depending on the site are the epi - and subfascial ( intermuscular ) forms a diffuse inflammation of fiber. Often localized abscess in the subcutaneous tissue , which is associated with a weak resistance to this part of the infection, its frequent injuries.
paranephritis
paraproctitis
In some locales abscess has special names : - at the perirenal tissue inflammation - inflammation in paraproctium etc.
The disease often begins with a sudden rise in body temperature to 40 ° C, chills, headache , general malaise . Temperature often is permanent. Locally there are swelling, redness of various kinds, palpation marked local increase in temperature , tight painful infiltration , which gradually softens to form foci fluctuations . Course of the disease is rarely favorable , more process progresses , capturing vast areas and accompanied by severe intoxication .
Management of patients :
Conservative treatment is permissible only in the initial stages of development process. It boils down to the purpose of bed rest , rest the affected limb creation , intramuscular administration of large doses of antibiotics , fluid intake , compliance dairy plant-based diet . Used cardiac and painkillers. Topically applied obkalyvanie tissues in circumference cellulitis solutions of antibiotics and novocaine , dry heat, UHF . Sometimes under the influence of conservative opposite occurs development process. When limiting process and the formation of an abscess (limited abscess ) operative treatment .
Surgical treatment is performed under the constraint of the process and the formation of an abscess , as well as the progression of the process. Conducted an autopsy cellulitis one or more parallel slits . Wound loosely with gauze tamponiruyut hypertonic saline .
If after surgery and continuing to improve the overall treatment does not occur , you need to think about the development of local or systemic complications ( burrowing pus , septic conditions , etc.). When treatment failure and there is a threat to life in the localization of cellulitis on a limb amputation shows it .
Boil - acute necrotic inflammation of the hair follicle and the surrounding tissues . Infection introduced through broken skin (cracks , scratches ) . Patient's general condition is satisfactory, when localizing a boil on the limbs or trunk sometimes there is an increase in body temperature to 37,5 ° C. Before the appearance of boils marked itching and tingling of the skin at a single site . The skin in the area of infiltration is pink with a bluish tint . When palpation soreness . After 1-2 days on top of infiltration appears small collection of pus , which erupts. The hole closes crust. After 5-10 days after disease tissue deep infiltration exposed purulent fusion , and necrotic masses stand as a rod with the remnants of pus. Ranka covered with granulations . Infiltration and decrease pain , recovery occurs . Boil formed on the spot several retracted scar.
Most often boils localized on the dorsum of the forearm , wrist , back of the neck , lower back, buttock , thigh. Especially severe boils different localized in the face ( lips , nose , cheeks ), since in this region may prompt the spread of infection to the development of purulent meningitis .
Often during the boil complicated lymphadenitis , thrombophlebitis , significant swelling of surrounding tissue resulting from stagnation .
Management of patients :
conservative treatment depends largely on the form of the disease , the localization process and related complications. With a single furuncle produce thorough toilet inflammatory skin around the hearth ( rubbing alcohol 70% solution of brilliant green 0.5-1% , 2% salicylic alcohol , etc.) . Hair carefully cut out a round hearth , hearth to bandage with hypertonic saline . Apply dry heat : hot water bottles solljuks , UHF . General methods of treatment used antibiotics that are injected intramuscularly. It is recommended to drink plenty , in severe cases, intravenous fluid administration is carried out . When localizing a boil on his face shows strict bed rest . Patients prohibit talking, chewing.
Surgical treatment is indicated for the development of complications ( cellulitis , abscesses ) .
Ulcers. This limited necrosis of the skin and deeply lying tissues that occurs when sharp weakening processes regenaratsii .
Causes of ulcers :
impaired circulation , lymph circulation ;
changes in the vessel walls ( atherosclerosis , occlusive disease , Raynaud's disease , etc.);
tissue damage ( mechanical, chemical , thermal, electrical , radiation );
of infection ( purulent , tuberculosis, syphilis , actinomycosis , etc.);
metabolic disorders ( diabetes, scurvy ); trophic disorders ( syringomyelia , tabes dorsalis etal . )
ulceration of tumors.
flat
at great depths .
chronic
Clinical symptoms and course of the disease determines the cause , cause the development of ulcers and reactive powers of the body. Localization, appearance and size of the ulcers are different. Most ulcers are often localized in the lower third of the leg . In appearance and ulcers are Discharge depends on the cause of ulcers - sukrovichnye or purulent . Bottom is covered with ulcers often necrotic masses of gray, sometimes greenish . Edges are smooth or irregular , sloping , podrytymi , calloused density soft. Change surrounding tissues : skin pigmented , thin, can be blue- purple color . Often there is swelling of the surrounding tissues , maceration of the epidermis. Subjectively, patients report pain in the extremities , fatigue when walking, muscle twitching . Ulcerative process has often flow with periodic exacerbations .
Management of patients :
basic principles of conservative treatment are: 1) the creation of the rest of the affected area ; 2 ) ensure the effective outflow content of ulcer area ( bandage with hypertonic saline , antiseptic , etc.); 3 ) careful toilet skin around the wound ; 4) ointment bandages after filling the ulcer granulation ; 5) moxibustion pathological granulation ( silver nitrate ); 6) sparing rare dressings ; 7) increasing the overall resistance of the organism ( recommended caloric intake , vitamin , etc.).
The aim of surgery is to release the plague of abnormal granulation and scarring that impede blood flow to tissues . Operations can be made for plastic closure of defect tissues.
Chapter 3
Emergency Medicine . Basics resuscitation and terminal conditions
Emergency Medicine
Falling asleep to the ground
Need to dig up the victim, quickly disassemble stones , boards, ground and carefully put it. Clears the nose and mouth . If the victim is unconscious and has no breathing, immediately begin rescue breathing . For exterior damage , provide relevant assistance . Fainting ammonia tip moistened handkerchief or cotton wool and gently bring to a patient's nose . Upon cooling, the body draped his heaters , hot water bottles , rubbing the skin with a brush. With the weakening of cardiac kordiamin administered caffeine .
lightning stroke
Lightning Strike is similar to an electric shock high-frequency voltage , the same event . Skin appear red stripes zigzag shape (local paralysis vessels). In severe cases, death occurs.
burns
I
II
III
IV
shock
acute toxemia
septicotoxemia , convalescence .
Burns occur from direct exposure to high temperature , thermal radiation , corrosive chemicals , electricity, X-ray and radio beam . Observed : power - appear redness , burning , soreness, swelling , and limited lesion ; degree - on the skin bubbles form , pronounced pain or swelling; degree ( deep burns ) - characterized by scab formation , followed by a deep necrosis ; degree ( charring ) - damage to muscles, tendons , bones , etc. With extensive lesions arise burn disease , during which different periods ( first 48 hours ) , (up to the 10th day )
Keeping victims.
Necessary activities are carried out in sequence.