Wounds of different localization. Wounds of various localization of leg pathology, accompanied by a purulent process

Any impaired integrity of the skin can entail the development of the infectious process. Powerful microbes penetrate the body through an open wound. In medicine, this phenomenon is called primary infection. The process can also begin later - this is secondary infection, it is characterized by a more difficult course.

The infected head of the shin, according to the international classification of diseases (ICD) in 10 edition, has several ciphers depending on the cause:

• S80. Surface. For example, a bruised, which is not accompanied by a violation of tissue integrity. The infection process is not developing immediately after injury.
• S81. Open leg wound. The purulent process begins as a result of dirt from clothing traumating item.
• S82. Fracture of the shin.
• S87. Scarmers of the shin.
• S88. Traumatic shin amputation.
• S89. Other and unspecified injuries.

Each of the listed states is characterized by a clinical picture, treatment regimen.

general description

Special plaster for open wounds

Infection of the wound can occur directly at the time of injury or after a while. In the latter case, the source becomes bandages surrounding the damaged zone of the mucous membranes, the foci of inflammation in the injury body.

Important: not all cases of microbial pollution of the Russian Academy of Sciences end in the development of the infectious process.

The probability of infection is determined by a whole complex of reasons:

• pollution intensity;
• the degree of violation of the viability of tissues;
• the total reactivity of the body (the ability to respond to stimuli from the external environment).

The nature of the microbes fell into the wound manifests 6-8 hours after injury. A favorable environment for their development is non-visual fabrics, areas of abundant hemorrhage. That is why it is an open wound more often than other damage is accompanied by purulent inflammation.

The development of infection is accompanied by:

• redness of the edges of the wound;
• separation of purulent content (if open);
• swelling of the damaged area;
• local temperature increase;
• painful syndrome.

In addition to local symptoms, there is a general deterioration in the health of the patient. This is manifested in the change in the leukocyte blood flow (the so-called shift of the formula to the left), a decrease in appetite, the increase in the pulse.

If a seam was imposed on the wound and the infection occurred during the operation due to insufficient cleaning of the damaged section, the pain syndrome will be brightly expressed.

Skin pathologies accompanied by a purulent process

An infected wound on the leg may develop as a result of various traumatic damage. The clinical picture as a whole is common - redness, swelling, mastering of pus. Tactics of treatment is determined by the general condition, against which the infectious damage was developed.

Breakproof

Inspection of the shine

You can get such an injury by doing sports, falling or directly contacting with solid objects. Often the bruised wound of the lower leg is diagnosed after hitting the feet of furniture, angles, shoals. Typically, injury is not complicated by serious consequences, provided that the medical care provided is timely provided.

With such damage, painful syndrome is pronounced, which is localized directly at the point of impact. If the pain shock is extensive, the victim may lose consciousness.

After some time, such symptoms appear:

• swelling of soft tissues;
• difficultness of movement;
• hematoma;
• the rise of pain syndrome.

The exact diagnosis establishes a doctor based on inspection, radiography results, ultrasound and MRI.

The purulent process when injected can develop in case of untimely treatment for medical care. This condition accompanies a number of pathologies:

Necrotic process on skin cover

Accompanies a strong injury. The victim with the diagnosed dying of the tissue is necessarily hospitalized.

Periostitis

Inflammation of the front portion of the shin due to the proximity of the skin and bone. The clinical picture is expressed by pain syndrome, an increase in body temperature. Periostitis is treated with medicines exclusively from the group of antibiotics.

Phlegmon

Purulent process, affecting tissues of ligaments, muscles, joints. If you do not start correct treatment in time, the process can affect the skeleton. The first stage of treatment is operational intervention. Next, the victim is prescribed physiotherapy and the course of drugs aimed at lifting immunity.

Open damage

FLEGMONAL EQUAL FORM DAMAGE

Open tight injuries - the result of contact with a blunt object, when the power of its exposure exceeds the natural ability of tissues to stretch.

Ripped wound of the leg

Accompanied by a violation of holistic skin cover, soft tissues. Causes are domestic injuries, accidents, incidents using cold or firearms, drop from height, careless handling of instruments. Ripped leg wounds are often found in children in the summer.

Main symptoms:

• pain syndrome;
• bleeding. Its intensity directly depends on what vessels were damaged.

The depth of the open wound rarely goes on the fat layer. However, if the blow fell on the front of the shin, it is possible that muscle fibers will be noticeable, torn tendons. Particles of objects can fall into the wound, with which the limb in contact at the time of injury.

Separate items can scalize the skin during the strike, which leads to the appearance of hanging or even torn plots. It increases the risk of developing bleeding, hematoma.

Such a condition is observed with open fractures, as well as amputation of traumatic type.

The task of the doctor is to purify the wound to the remains of the affected fabrics, small particles of the object, which served as an injury.

Cutting wound of the leg

The result of injury to the leg is sharp. The edges are smooth, and the corners are sharp. The wound channel the length prevails over the width. It is possible to get this kind of injury in everyday life, clinging for something acute, during an accident or criminal attack.

The subject that caused the wound is usually not sterile, it increases the risk of the infectious process. The longer the time passed from the moment of injury before providing first aid, the higher the risk of infection.

Animal bites

The busted wound of the tibia according to the international classification of diseases 10 of the edition is encrypted by several codes - W53 - W55.

Fact: 1000 people account for 12 cases of dog bites. The ratio of cat bite - 16:10 000. The attacks of dogs are more often observed after noon.

Regardless of who bited, the clinical picture is similar. Symptoms of injury - abrasions, scratches, torn edges, scrambled fabrics.

As practice shows, in 75% of fixed cases of the bites of adults and children, cultures of pathogenic microorganisms are sown.

What complications are developing when infected

Plock to protect the wound from infection

Against the background of injury and weakened immunity develop an inflammatory process. In case of insufficient processing of the wound, signs of infection appear. Sepsis has an incubation period from 2 days to 2-4 months.

Sepsis of the shin is developing in several stages:

1. Acute. It is characterized by an increase in body temperature, fever. Skin covers acquire the earthy shade. The pulse proves very weakly, tachycardia is often noted, the activation of signs of anemia, blood pressure is reduced. Some affected leukocytosis is diagnosed. The surface of the wound is dry, it is easily damaged and bleeding. When identifying acute sepsis, doctors recommend surgery.
2. Subacute. The common clinical picture is similar to the symptoms of the acute period. But characterized by the complete absence of chills or its smaller intensity; the instability of fever; Increased spleen.
3. Chronic. At this stage, the infection has spread throughout the body and the treatment of an exceptional infected organ does not give the desired result. The main symptom is a fever of a wave-like character. It is possible that for some time the clinical picture will be completely absent. In some patients, tides are marked, attacks of increased sweating, the work of the internal organs is disturbed. With this form, treatment will be delayed for a long time.

Important : The severe course of the acute form of sepsis can lead to the death of the deceased 2-14 days after the injury. In the case of a subacute flow, death may occur for 60 days, and chronic - for the fourth month.

Medical tactic

Binding open wounds

Avoiding the development of an infected wound of the lower leg, if timely start treatment. Suppression of the infectious process accelerates wound healing.

To ensure pus outflow, accumulated deep under the crust, should be crowned. It is best for this to use hydrogen peroxide. Sometimes pus accumulates under the skin flap. In this case, the doctor makes a small hole on the edge of the flap and gently squeezes the contents.

Daily peroxide processing is a mandatory procedure with open, ribbon or busted shin wounds. After careful cleaning, it is necessary to impose an armband with ointment, so the wound will be heated faster.

If the patient has signs of phlegmon, necessarily surgical intervention.

During surgery, the surgeon reveals the wound with a special tool and excishes dead tissues.

It is also necessary to fence the microflora discharged to the study, its sensitivity to specific groups of antibiotics to choose the most effective drugs.

An infected head of the lower leg (code on the ICD - S81) is a traumatic damage caused by a disruption of the integrity of the skin with the concomitant addition of infection. The international classification of diseases allocates different types of wounds, affecting the area of \u200b\u200bthe knee joint. Injuries can have different features and manifestations.

Types of Ran.

The injury of the surface of the skin occurs as a result of the effects of various external factors. Wounds can wear both superficial and deep character with accompanying damage to vessels, ligaments, nerve endings.

Rvanis

Such a wound (S81.0) is distinguished by uneven edges, it is possible to separate the skin from the injured area. It occurs mainly in mechanical impact (an ankle in the working mechanism), in emergency situations, road traffic accidents. A characteristic feature is the scale of wound lesion, the presence of moderate gaping.

Such wounds are most prone to infection, the development of purulent complications. Ripped damage requires long healing, which is fraught with the replacement of normal tissue structures with connecting.

Rezana

This wound of ankle (S81.0) occurs when exposed to sharp objects. A characteristic feature of this species is smooth edges, bleeding due to damage to blood vessels throughout the area of \u200b\u200binjury.

Doctors include cutting wounds to one of the safest. Timely appeal to the doctor, the compound and stitching of smooth edges contributes to rapid healing, regeneration, practically excludes unpleasant consequences like scars and scars.

Kolotany

Such a wound is of multiple character (code according to the ICD10 - S81.7): it differs in a small diameter, but a sufficiently impressive depth penetrating the cavity of the fabric. Bleeding is not always observed. Doctors indicate the high risks of the addition of purulent processes caused by the narrowness, depth and winding direction of the wound hole.

Bite

Code S81.0. From the title it becomes clear that the wound occurs due to the bite of an animal (home or wild). It is distinguished by uneven edges and quite large depth. The scale and seriousness of busting damage depends on the size of the animal and the degree of bite.

By the initial pollution of saliva, there is a high probability of suppuration, infection and other adverse effects. Therefore, in such situations, it is required not to simply carry out disinfection, but also make vaccination against rabies and tetanus.

Open

Such a wound (S81) is accompanied by a gap of the skin. It has high risks of the development of the purulent process as a result of the fall of pathogeful microorganisms through the subject of wound, clothing, etc. With a large depth of the wound hole, there may be accompanied damage to muscular fibers, vessels, nerve endings, ankle joint and bone.

Infected

This complicated injury (code S81), characterized by the addition of infectious processes. The provoking factor is the pathogenic pathogens, bacteria that penetrate the wound opening.

Accompanied by redness and hyperemia of skin, swelling, pronounced pain syndrome. In launched and severe clinical cases, general intoxication of the body with a clinical picture characteristic of this state may be observed.

Causes and symptoms

Among the possible reasons for the emergence of the head of the head of the doctor, they allocate:

• mechanical damage;
• emergencies, road traffic accidents;
• bites;
• impact acute subject.

The symptoms of the open wound are specific, noticeable even with the naked eye. Among the main clinical signs are distinguished:

• gap skin;
• hiatus;
• bleeding (can be both strong and insignificant);
• doodle on the side of the edge of the skin, forming a wound surface;
• pain syndrome.

For infection, such symptoms like redness of the skin around the affected area are characterized, pronounced painful sensations, swelling, increase in local body temperature, possibly the presence of purulent discharge. In particularly severe cases, there is no intoxication of the body, accompanied by a feverish state, headaches, nausea and bits of vomiting, with a general weakening.

Diagnostics

The diagnosis of RAS of the shin is not difficult for doctors. The diagnosis is made on the basis of the examination of the patient, based on the clinical picture, collected by the anamnesis. With very deep wounds, additional radiography or ultrasound examination may be required in order to eliminate damage to bone tissue, nerves, tendons, joints.

First aid

In order to avoid infection and other unpleasant complications, when obtaining the wound of the knee joint, it is important to provide a timely to the victim of competent first aid.

First of all, the injured area is treated with the help of an antiseptic solution, after which they impose a sterile bandage (from ankle to hip).

In the case of bleeding, the applause of a gouring gauze bandage is required, which before the bandaging should be tightly pressing the palm for several minutes. The damaged limb is desirable to give an exalted position by placing a roller or pillow under it.

If the victim complains of severe painful sensations, it is possible to give it a tablet of an analgesic drug.

A special danger is large, large-scale wounds. In such cases, it is necessary to ensure the immobilization of the limb (from the ankle to the hip), using any blowdown agents, bandages or gauze tissue, after which it is possible to deliver the patient into the trauma.

Treatment

Therapy RAS implies a rejection and disinfection. For these purposes, the injured area is regularly treated with iodine or green. With open wounds, it is recommended 1-2 times throughout the day to handle the place of injury by antiseptic means, after which it is imposed with a bandage with wound-healing ointments (levomexol).

In the event of inflammation, the infectious process should be referred to a doctor, which will prescribe competent treatment with the use of antibiotic, painkillers, non-steroidal anti-inflammatory drugs.

Rehabilitation

The restoration after the treatment of RAS of the shin is a short nature. For a month, the patient is recommended to refrain from increased physical exertion, sports (in order to avoid discrepancies in the edges of the wound surface). The good effect will give the use of vitamin and mineral complexes, immunomodulators that activate the protective mechanisms of the body, regeneration.

Possible complications

An open head of the lower leg (in the ICD-10 code S81) in the absence of timely first aid and proper treatment can provoke unwanted consequences:

• suppuration;
• attachment of infectious processes;
• phlegmons;
• intoxication of the body;
• inflammatory processes;
• sepsis, blood infection;
• strong bleeding.

Some of the listed complications threaten not only the health, but also the life of the victim. However, they can be easily avoided, disinfecting and correctly treating the wound on the legs.

Prevention

Events to prevent RASs are primarily attentive at home and care when working with various mechanisms, travel and other extremal situations.

In order to prevent infection and related complications, first aid is important, disinfection, warning penetration into the wound dust, dirt, microbes and bacteria.

The wounds of the leg - common phenomenon. Upon receipt of such damage, it is necessary to process the injured surface in time with an antibacterial agent and further use the treatment methods recommended by the doctor. Immediately seek medical help is required when signs of attachment of infection, suppuration.

Infected cavities of soft tissues are complicated wounds with impaired integrity of the skin, attachment of pathogenic microflora. Penetration of microbes provokes the development of suppuration, negative symptoms, slowing down the regeneration process. Select classification ciphers for damage to the hip, knee, ankle, fingers are presented in the section S81.0; S81.8, for pathology, the infected wound of the foot Code of the ICD 10: S91.

Surface infection can occur at the time of damage or a while. On ICD 10, among the features of infections are distinguished:

• the primary process is the cause of infected wounds lies in the injury in an initially contaminated object, contacting microbes from clothing, penetration of foreign bodies;
• secondary - the layering of secondary contamination of more than a day from the moment of the foot injury, the source serves the dressing material, air-drip infection, pollution of the region of the region, insufficient surgical processing during disinfection, non-compliance with the recommendations of the doctor;
• development of symptoms of inflammation on the ICD, signs of purulent lesion: swelling, swelling of the joint, local hypertermia, high body temperature, general weakness, malaise, tachycardia;
• in case of damage to the internal organs with deep wounds (the wound, torn, cutting defect) seams are superimposed.

On ICD 10, the likelihood of developing the infection of the lower extremities, in particular the foot, depends on many factors:

• degree of pollution;
• depth of injury;
• impairment impairment;
• concomitant diseases weakening organism;
• incorrect treatment of wounds on the foot.

International Classification

The infected damage of the lower extremities occurs quite often, the different nature of the integrity of the skin of the foot, the muscular layer, the fractures of various kinds creates an extensive group of diseases of the field of traumatology, surgery.

Feet

According to the classification of the ICD-10, the open wound of the ankle and foot has S91 cipher.

Damage to the foot, even without complications, are a threat, the main load of the body falls on the ankle joint, the soles of the foot. Such injuries require immediate medical intervention, the risk of disorders of free movement in the future, the displacement of bone structures, the development of inflammatory reactions.

According to the ICD 10, the infected wound of the foot with the suppuration is the reason for immediate surgery.

Shin

The pathological process of an infected head of the leg of the Code of the ICD 10 has S81.9. The suppuration is the most common type of lower limb defeat, this part is most vulnerable to injuries (stretching, blows, scratches, open fractures, bruises with skin dissection and soft tissues).

Clinical symptoms include: redness, swelling, strong soreness, local hyperemia, mastering in pus.

The purulent shin process, as well as the feet, may be complicated by the development of serious complications of the infected area:

• skin necrosis, muscle layer with deep lesions of the leg;
• periostitis;
• flegmon and abscess.

Hips

The infected infected wound in the area of \u200b\u200bthe hip joint and the hips is classified by cipher on the ICD-10 S71.0.

The defeat is much less common than on the foot, the bone-muscular frame is protected from external influence, the protection of clothing prevents the application of even small scratches, abrasion.

In the formation of an infected injury, edema is observed, soreness when moving (especially to settle), sweeping pains along the nerve endings, increases the risk of hematogenous propagation due to the close location of the main vessels.

Knee Sustava

Classification number of the disease Infected wound of the knee joint The code for the ICD 10 is S81.0. In addition to the symptoms, the attachment of atypical microflora characteristic of the shin and foot attachment, provokes:

• increased joints in size with a stretching capsule, pain of cutting, stitching;
• to the touch knee hot, sensitive;
• through open surfaces or purulent fistulas, serous content of inflammatory character is separated, gray viscous liquid.

Foot Foot

Defeating the infection of the lower limbs on the ICD 10 S91.1 according to the international classification. There is a more severe course, especially when infection and localization of the wound in interfalance intervals, constant friction of the foot, maceration, the absence of personal hygiene is only aggravated by the purulent process, contribute to the growth of pathogenic microflora.

Treatment and why it is dangerous to delay it

On ICD 10, procedures for eliminating infected complications, the speedy healing is divided into subgroups:

1. General procedures on the recommendation of the doctor - to handle the edge of the wound, clean from granulation tissue, the daily stop of the foot with the overlapping of fresh sterile bandages, compliance with the rules of personal hygiene, damage care.
2. Conservative therapy. On ICD 10, the method includes an impact on the infected area by local drugs (ointment of Vishnevsky, Levomecol, ichthiolic liniment, chlorhexidine, hydrogen peroxide, Miramistin, ethyl alcohol) and systemic therapy (antibacterial drugs, disinfecting parenteral solutions, immunco-corrective means, vitaminotherapy) Bacterial component of an infected wound, speeding the regeneration of the foot.
3. A surgical method that includes surgical interference with complicated situations (phlegmons, deep suppuration with the formation of pyrogenous cavities). Open the surface, necrotic, purulent-affected fabrics are excised with a scalpel. On ICD 10, then treated with antibacterial solutions, if necessary, apply seams, a sterile bandage over the wound. After the procedure may remain a scar.

The danger in the absence of adequate therapy of the infected area of \u200b\u200bthe foot in the spread of infection on the ICD 10, the massive dissemination of microbes into the internal organs with a violation of their function, when infecting blood - sepsis, increases the threat of the patient's life with the probability of death.

Forecast recovery

With timely treatment, a thorough diagnosis of the infected wound from the foot of the medical personnel, compliance with the patients of all recommendations regarding treatment, preventing the recurrence of the disease The forecast is favorable. According to the ICD 10, the total cure is up to 96-100%.

With complicated purulent processes with the presence of blood infection, the risk of serious disorders in the body, with infected damage to internal organs, irreversible pathological changes, the forecast with a favorable result for life is 10,65-71%.

Only adequately selected therapy with antibacterial drugs, the rehabilitation of purulent foci can help completely get rid of infected wounds on the foot.

RCRZ (Republican Center for Health Development MD RK)
Version: Archive - Clinical Protocols MD RK - 2007 (Order No. 764)

Open wounds, exciting several body areas (T01)

general information

Short description

Wound - damage to the body tissues due to mechanical impact, accompanied by a disruption of the integrity of the skin and mucous membranes.

Protocol code: H-S-026 "Wounds of various location"

Profile: surgical

Stage: hospital

Code (codes) on the ICD-10:

T01 Open wounds exciting several body areas

S21 Open Breast Wound

S31 Open wound of belly, bottom back and pelvis

S41 Open wounds of the shoulder belt and shoulder

S51 Open wound forearm

S61 Open Wrist Wriths and Brushes

S71 Open wound of the area of \u200b\u200bhip joint and hips

S81 Open Heaven Wound

S91 Open wound of the field of ankle joint and foot

S16 muscle injury and tendons at the neck level

S19 Other and Uncomfortable Neck Injuries

S19.7 Multiple Neck Injuries

S19.8 Other clarified neck injuries

S19.9 Neck Needed Injury

T01.0 Open Head and Neck Wounds

T01.1 Open wounds of chest, abdomen, bottom of the spin and pelvis

T01.2 Open wounds of several areas of the upper (their) limbs

T01.3 Open wounds of multiple areas of lower (their) limbs

T01.6 Open wounds of several areas of the upper (their) and lower extremities

T01.8 Other combinations of open wounds, exciting multiple areas of the body

T01.9 Multiple Open Wounds Uncomputed

Classification

1. Koloty - as a result of the effects of an acute subject.

2. Rezanny - as a result of the effects of an acute long object, the size of at least 0.5 cm.

3. Harvested - as a result of the impact of a large mass or high speed.

4. Bribuled - as a result of the bite of an animal, less often, man.

5. Scalped - skin depletion occurs and subcutaneous tissue from the subjectable tissues.

6. Firearms - as a result of firearms.

Diagnostics

Diagnostic criteria:

Pain syndrome in the injured limb;

Forced position of the injured limb;

Restriction or absence of limb mobility;

Changes in soft tissues above the fracture site (swelling, hematoma, deformation, etc.);

Capital at the palpation of the alleged injured shin section;

Related neurological symptoms (no sensitivity, cooling, etc.);

Skin damage according to the classification given;

X-ray signs of injury to be tissues.

List of major diagnostic activities:

1. Determining the type of injury in accordance with the classification given.

2. Determining the degree of violation of the function of the injured authority (the volume of movements).

3. Clinical examination of the patient (see diagnostic criteria).

4. X-ray examination of the injured tibia in 2 projections.

5. Common blood test.

6. General urine analysis.

7. Coagulogram.

8. Biochemistry.

9. HIV, HBsag, Anti-HCV.

List of additional diagnostic events:

1. Definitions of blood group and rhesv factor.

2. Determination of sensitivity to antibiotics.

3. Definition of blood sugar.

Treatment

Tactics of treatment

Treats of treatment: Timely diagnosis of wounds, taking into account their location, the definition of therapeutic tactics (conservative, operational), prevention of possible complications.

Treatment: The need for anesthesia depends on the type of wound according to the classification. Taking into account the disorders of the integrity of the skin, mandatory the introduction of anti-beaded animal.

Conservative treatment:

1. Primary surgical processing of the wound.

2. In the absence of infection of the wound, antibioticoprophylaxis is not carried out.

Operational treatment:

1. The imposition of primary seams in the absence of signs of injury infection.

2. Antibiotic pylaxis is carried out within 3-5 days with wounds obtained more than 8 hours ago with a high risk of infection:

Wounds of moderate gravity and heavy;

Wounds reaching bones or joints;

Hand wounds;

Immunodeficiency condition;

Wounds of external genital organs;

Branched wounds.

3. Operational treatment of the Russian Academy of Sciences is shown in confirmation of damage to the nervous or vascular beam.

The results of multicenter studies have established that when using antibiotic porphylaxis, patients with wounds decreases the risk of purulent-inflammatory complications.

Patients can be divided into 3 risk groups:

1. Injuries with skin damage and soft tissues less than 1 cm long, the wound is clean.

2. Injuries with damage to the skin with a length of more than 1 cm in the absence of pronounced damage to the tissues or significant displacements.

3. Any injuries with pronounced damage to the tissues or traumatic amputation.

Patients 1-2 risk groups need to introduce a dose of antibiotics (as early as possible after injury), mainly with the action for gram-positive microorganisms. For patients of risk group 3, antibiotics acting on gram-negative microorganisms are prescribed.

Antibiotic schemes:

Patients 1-2 risk groups - amoxicillin 500 thousand after 6 hours, 5-10 days per OS;

Patients 3 risk groups - amoxicillin 500 thousand after 6 hours, 5-10 days per os + clavulanic acid 1 tablet 2 times.

List of basic medicines:

1. * Amoxicillin tablet 500 mg, 1000 mg; Capsule 250 mg, 500 mg

2. * Amoxicillin + clavulanic acid pills coated with a shell of 500 mg / 125 mg, 875 mg / 125 mg, powder for preparing a solution for intravenous administration in bottles of 500 mg / 100 mg, 1000 mg / 200 mg

3. * Cefuroxime powder for the preparation of a solution for injection in a bottle of 750 mg, 1.5 gr

4. Ceftazidim - powder for preparing a solution for injection in a bottle of 500 mg, 1g, 2 g

5. TIKARCHILLIN + CLAVULANIC ACITE, LIFILIZED POWER 3000 mg / 200 mg for the preparation of a solution for intravenous infusion

6. * Nitrofural 20 mg Table.

List of additional medicines: no.

Treatment Efficiency Indicators: Healing wounds, restoring the functions of damaged organs.

* - Preparations included in the list of basic (vital) drugs.

Hospitalization

Indications for hospitalization: Emergency.

Information

Sources and literature

1. Protocols for the diagnosis and treatment of diseases of the Ministry of Health of the Republic of Kazakhstan (Order No. 764 of 28.12.2007)
   1. 1. Evidence of medicine. Clinical recommendations for practicing doctors. - Moscow, Geotar-Honey .- 2002.- S.523-524 2. Surgery. Guide for doctors and students. - Moscow, "Geotar-Honey" .- 2002.- S.576- 577 3. National Guideline Clearinghouse. Practice Managment for Prophylactic Antibiotic Use in Open Fracture: Eastern Association for the Surgery of Trauma.- 2000.- P.28 4. National Guideline Clearinghouse. Preoperative Test: The Use of Routine Preoperative Tests for Elective Surgery: Evidence, Methods & Guidance. London.-Nice.- 2003. 108p.

Information

List of developers: Ermanov E.Z. NC Surgery MS RK

Attached files

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Wound - injury of any part of the body (especially caused by physical influence), manifesting the integrity of the skin and / or mucous membrane.

If the patient noted signs of phlegmon, the obligatory procedure is surgical intervention. During the operation, an autopsy is opened by a special tool of the wound, then the surgeon is excised by dead tissues.

It is also necessarily a fence of the wound discontinued microflora, its sensitivity to specific groups of antibiotics.

Tortured pain in the joints?

• permanent swelling and numbness;
• inflammation and discomfort;
• unbearable pain when walking;
• horrible appearance.

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Frequency. Dog bites celebrate 12: 1,000 population. Cat bites - 16:10 000.

Code for the international classification of diseases of the ICD-10:

The reasons

Risk factors . Dogs often bite in the afternoon, especially in warm or hot weather, do not like half-way people. Cats more often bite in the morning. Acceptance of alcohol: dogs do not like alcohol smell.

Symptoms (signs)

Clinical picture - The branched wounds are represented by abrasions, scratches, the edges of the wound are usually torn, smakeed.

Diagnostics

Research methods . 75% of burglary wounds are infected - it is possible to evry the culture of microorganisms. X-ray study of the affected area to eliminate damage to the bone and observation in dynamics when suspicious of osteomyelitis appear.

Treatment

TREATMENT

Surgery. Primary surgical treatment of wounds with removal of non-viable tissues. Wounding is possible if the bite happened no more than 12 hours ago, a full primary surgical treatment was carried out, as well as the surgeon confidence in the impossibility of developing infection in the wound. The imposition of primary-delayed seams after 3-5 days after the bite is optimally optimally infected with the wounds and the impossibility of preventing the development of infection only by primary surgical treatment. When bone fractures, a tire is needed.

Drug therapy

The introduction of anti-cancer serum for rabies prevention.

The introduction of tetanus anatoksin (immunized patients, if more than 5 years have passed after the last vaccination) - see the tetanus.

Anti-resistant immunoglobulin of a person with incomplete primary immunization (see tetanus).

Preventive therapy in the first 12 hours after bite .. Phenoxymethylpenicillin in 500 mg inside 4 p / day (Children of 50 mg / kg / day inside 2 p / day) for 3 days .. other drugs - amoxicillin 500 mg inside 3 p / day adults and 40 mg / kg / day 3 p / day children, or amoxicillin + clavulanic acid at 250-500 mg inside 3 p / day adults and 20-40 mg / kg / day 3 p / day children.

When the first signs of infection - amoxicillin + clavulanic acid (before obtaining results of bacteriological research).

Alternative therapy (prophylactic or empirical) in patients with allergies to Penicillin .. doxycycline. Contraindicated to children up to 8 years old, pregnant and nursing women .. Ceftriaxone or erythromycin. Cefalexin should not be used due to the stability of P. Multocida strains .. Approximately 10% of patients with allergies on penicillin develops a cross-allergy to cephalosporins.

Complications . Septic arthritis. Osteomyelitis. Extensive damage to soft tissues with scarring and subsequent deformation, sometimes with loss of functions. Sepsis. Bleeding. Gazda gangrene. Rabies. Tetanus. Cat scratch disease.

Forecast. In the absence of complications, the wounds are healing by secondary tension after 7-10 days.

MKB-10 . W54. Bite or punched by a dog. W55 Bite or blow caused by other mammals