Preface from the editors ................................................................ 7
Part 1. Fundamentals oF surgical care organization
1.1. general principles of surgical care organization .................................................................................... 9
General issues of the terminology and medical care organization....................................................................................... 9
Outpatient surgical care ........................................................10
Inpatient surgical care ............................................................10
General issues, terminology and periods of surgical treatment ..........................................................................................10
Preoperative period ................................................................12
Intraoperative period .............................................................13
Postoperative period ..............................................................14
1.2. surgical patient care .........................................................19
General principles of patient care ..............................................19
General patient care ...............................................................20
Techniques of medication administration ......................26
Postinjection complications ................................................31
Application of the simplest treatment procedures .....32
Specialized care of operated patients .......................................38
Surgeries on the thorax and thoracic organs ................38
Surgeries on the abdominal cavity and abdominal organs ...................................................................39
Urological surgeries ................................................................40
Proctological surgeries ..........................................................41
Care of critically ill and agonizing patients.....................41
1.3. desmurgy ...............................................................................43
Desmurgy: dressings, bandages, materials and techniques of making ....................................................................43
Classification of bandages ....................................................43
Roller bandage and its elements. Rules for bandaging ..................................................................................44
Techniques of applying roller bandages, triangular, four-tailed, adhesive and tubular elastic bandages .....45
1.4. asepsis and antisepsis .....................................................65
General information and terminology .....................................65
Basics of modern asepsis ..............................................................65
The main channels of infection and its prophylaxis .............65
Airborne droplet infection and its prophylaxis .............65
Contact infection and sterilization ...................................67
General principles of sterilization ......................................67
Physical methods of sterilization .......................................67
Chemical methods of sterilization .....................................69
Selected issues of sterilization ............................................69
Implantation infection and its prophylaxis ....................73
Endogenous infection and its prophylaxis .....................74
Hospital acquired infection and its prophylaxis ...........75
The problem of HIV-infection and other transmissible infections in surgery ....................................75
The sequence of actions to be followed by medical staff in case of medical accidents .......................................76
Basics and types of modern antisepsis .....................................77
Mechanical antisepsis ............................................................77
Physical antisepsis ...................................................................78
Chemical antisepsis .................................................................79
Biological antisepsis ................................................................80
Classical principles of rational antibiotic therapy ........80
1.5. general issues of pain, anesthetic management, intensive care of medical emergencies, cardiopulmonary and cerebral resuscitation .......81
Terminology used in anesthesiology and intensive care .....81
Essential ideas of pain in surgical practice ..............................83
Pain control: terminology and general issues ...............83
Methods of anesthesia ...........................................................84
Local anesthesia .......................................................................84
Some peripheral blocks with local anesthetics.............87
Intercostal nerve block ..........................................................87
Procaine retromammary block ...........................................87
Procaine short block ...............................................................88
Intrapelvic block according to Shkolnyk – Selivanov.....88
Postoperative pain and the main principles of its elimination .......................................................................................88
General information on pain associated with operative interventions, its mechanisms and the principles of pain control depending on the type
and extent of an operative intervention .........................88
General principles of intensive therapy ....................................93
General issues of diagnosis and intensive care of acute respiratory failure ...........................................................................95
General issues of diagnosis and intensive care of acute cardiovascular collapse and shocks ....................................... 100
Hypovolemic shock and blood loss ........................................ 102
Terminal states and patho physio logy of dying and clinical death ................................................................................. 105
Preagony .................................................................................. 105
Terminal pause ....................................................................... 106
Agony ........................................................................................ 106
Types of death ............................................................................... 107
Contents
Clinical death .......................................................................... 107
Biological death ..................................................................... 108
A complex of cardiopulmonary and cerebral resuscitation ........................................................................... 108
First stage of resuscitation (Basic life support (BLS)) ..................................................... 109
The second stage of resuscitation (Advanced cardiac life support (ACLS)) ......................... 112
test questions for part 1 ....................................................... 116
Part 2. general issues oF surgical Pathology
2.1. terminology, diagnosis and treatment of hemorrhages ........................................................................ 121
General issues of hemorrhage and principles of its classification.................................................................................. 121
Clinical presentations of acute and chronic hemorrhage ............................................................................ 123
Arrest of bleeding (hemostasis) ....................................... 125
2.2. Wounds and wound process ...................................... 129
General concepts of wounds and wound process .............. 129
Types of wound healing and phases of wound process ...................................................................................... 132
Principles of wound treatment ........................................ 136
Treatment of surgical wounds ......................................... 136
Treatment of newly infected wounds ........................... 137
Treatment of purulent wounds ........................................ 139
2.3. combat surgical trauma (prehospital care) ............. 141
2.4. thermal, chemical and cold injuries ...................... 151
Terminology of thermal and chemical injuries .................... 151
Thermal burns ........................................................................ 151
Burn disease ............................................................................ 156
Local treatment of burn wounds .................................... 159
Peculiarities of patient care in treatment of burns ............. 161
The main methods of rehabilitation of patients with burns ............................................................................... 161
Chemical burns ...................................................................... 162
Cold injury ............................................................................... 164
2.5. necroses, fistulas, ulcers .............................................. 169
Necrosis (local death of tissues) ............................................... 169
Gangrene ................................................................................. 171
Fistulas ............................................................................................ 173
Ulcers ............................................................................................... 175
2.6. Fundamentals of clinical oncology......................... 178
Terminology and classification of neoplasms ..................... 178
General symptomatology and diagnostics of neoplasms 180
Principles of tumors treatment ............................................... 184
Prophylaxis and early diagnostics of tumors ....................... 186
test questions for part 2 ....................................................... 188
Part 3. clinical transFusiology
3.1. general issues of transfusion medicine ............... 193
3.2. immunological fundamentals of blood transfusion .................................................................................. 194
Concept of group antigens and blood antibodies .............. 194
3.3. the abo blood group system ..................................... 196
The ABO blood groups ................................................................ 196
Determination of the ABO blood types ........................ 197
Blood typing with the help of monoclonal antibodies ............................................................................... 197
Determination of blood group by the cross method (double reaction) .................................................................. 197
3.4. the rhesus-antigen system ........................................ 199
The Rh antigen system: .............................................................. 199
Determination of Rh blood group by using monoclonal antibodies (colyclones) ............................................................... 199
Errors in the ABO and Rh blood typing .................................. 200
3.5. methods of transfusion of blood components and products .................................................. 201
3.6. technique of transfusion of blood components and products .................................................. 203
3.7. modern approaches to blood transfusion therapy .......................................................................................... 207
Classification of transfusion mediums ................................... 207
Blood components ...................................................................... 207
Blood-derived medicinal products .......................................... 209
3.8. complications of transfusion therapy .................. 211
3.9. Blood donation ................................................................ 215
3.10. legal aspects of blood transfusions ................... 216
Legal aspects of hemotransfusions ................................ 216
test questions for Part 3 ....................................................... 219
Part 4. surgical inFection
General issues of the development, diagnosis and treatment of inflammatory and purulent diseases ............ 221
4.1. Purulent diseases of the skin and subcutaneous tissues ................................................... 223
Purulent diseases of the skin and subcutaneous fat (furuncle, carbuncle, abscess)................................................... 223
Phlegmon ....................................................................................... 226
Hidradenitis ................................................................................... 228
Erysipelas ....................................................................................... 229
Erysipeloid ...................................................................................... 231
4.2. inflammatory diseases of lymphatic vessels and nodes .................................................................... 232
Lymphangitis ................................................................................ 232
Lymphadenitis .............................................................................. 233
4.3. infections of the hand ................................................... 235
Felon (whitlow) (purulent processes of the fingers)............ 236
Purulent diseases of the hand .................................................. 242
4.4. inflammatory diseases of the glandular organs ............................................................................................ 245
Mastitis ........................................................................................... 245
Lactational mastitis .............................................................. 245
Parotitis ........................................................................................... 247
4.5. Purulent diseases of bones and joints .................. 249
General issues of the development, diagnosis and treatment of osteomyelitis ........................................................ 249
Hematogenous osteomyelitis .......................................... 251
Posttraumatic osteomyelitis ............................................. 253
Purulent disease of the joints .................................................... 254
Acute purulent arthritis ...................................................... 254
Acute bursal abscess ............................................................ 256
4.6. anaerobic infection ....................................................... 258
Clostridial surgical infection (gas gangrene) ....................... 258
Nonclostridial anaerobic surgical infection ......................... 261
4.7. specific surgical infection ........................................... 263
Tetanus ........................................................................................... 263
Anthrax ........................................................................................... 266
Diphtheria of wounds ................................................................. 267
test questions for Part 4 ....................................................... 269
Part 5. general issues oF Patient examination
5.1. the sequence and methodology of examination of a surgical patient ............................... 273
Patient’s complaints .................................................................... 273
Characteristics of pain by location ................................. 274
Vomiting ................................................................................... 275
Hiccup ....................................................................................... 276
Heartburn ................................................................................ 276
Dysphagia ................................................................................ 276
Eructation ................................................................................ 277
Regurgitaion ........................................................................... 277
Disturbance of the large bowel emptying ................... 277
Urination disorders............................................................... 277
Menstrual disorders ............................................................ 277
General weakness ................................................................. 277
Vertigo ...................................................................................... 278
History of the present illness ..................................................... 278
Patient’s life history ..................................................................... 278
Evaluation of patient’s general condition ............................. 279
5.2. technique of physical examination of a patient .................................................................................. 281
Skin and visible mucous membranes ..................................... 281
Lymph nodes ................................................................................. 281
Muscular system and osteoarticular apparatus ................. 281
Head and face ............................................................................... 282
Neck ................................................................................................. 282
Thorax ............................................................................................. 283
Respiratory organs ...................................................................... 283
Cardiovascular system ............................................................... 283
Abdomen........................................................................................ 284
Digestive apparatus ............................................................. 284
Rectum and perianal region ..................................................... 285
Urinary system .............................................................................. 285
Nervous system and psychic state .......................................... 286
Assessment of local status ......................................................... 287
5.3. supplementary methods of patient examination ............................................................................... 288
Laboratory methods of examination ..................................... 288
Instrumental methods of examination ................................. 288
Endoscopic methods of examination ............................ 288
Ultrasound methods of examination ............................ 293
Roentgenological and radiological methods of examination ....................................................................... 294
5.4. documentation of patient’s condition ................. 298
test questions for Part 5 ....................................................... 299
Control tests ................................................................................. 301
References ..................................................................................... 326