13.1. Examination of trauma patients
All patients with traumatic injuries should be seen promptly. The Emergency Nurses Association (ENA) has developed courses that teach how to examine trauma patients. In order to quickly identify life-threatening injuries and correctly prioritize treatment, primary and secondary examinations have been developed.
Initial inspection
The initial inspection begins with an assessment of:
Respiratory tract (A);
Breathing (B);
Neurological status, or disability (D);
Environmental conditions (E).
Let's take a closer look at the primary inspection of ABCDE.
BUT– before examining the airways in patients with trauma, it is necessary:
Immobilize the cervical spine with a cervical splint (collar), since until proven otherwise, it is believed that a patient with extensive injuries may have damage to the cervical spine;
Check if the patient can speak. If yes, then the airway is patent;
Check for blockage (obstruction) in the airways caused by the tongue (most common obstruction), blood, loose teeth, or vomit;
Clear the airway by applying pressure to the jaw or by lifting the chin to maintain cervical immobilization.
If the blockage is caused by blood or vomit, cleaning should be done with an electric suction. If necessary, a nasopharyngeal or oropharyngeal airway should be inserted. Remember that the oropharyngeal airway can only be used on unconscious patients. The oropharyngeal duct induces a gag reflex in conscious and semi-conscious patients. If the nasopharyngeal or oropharyngeal airway does not provide adequate air supply, the patient may need to be intubated.
IN- with spontaneous breathing, it is necessary to check its frequency, depth, uniformity. Blood oxygen saturation can be checked using oximetry. When examining, you need to pay attention to the following points:
Does the patient use additional muscles when breathing?
Are the airways heard bilaterally?
Is there any tracheal deviation or jugular vein swelling?
Does the patient have an open chest wound?
All patients with extensive trauma require hyperoxygenation.
If the patient is not spontaneously breathing freely or is not breathing effectively, a mask for artificial respiration is used prior to intubation.
C- when assessing the state of blood circulation, it is necessary:
Check for peripheral pulsation;
Determine the patient's blood pressure;
Pay attention to the patient's skin color - is the skin pale, hyperemic, or have other changes occurred?
Does your skin feel warm, cool, or damp?
Did the patient sweat?
Is there obvious bleeding?
If the patient has severe external bleeding, apply a tourniquet above the bleeding site.
All patients with major injuries need at least two IVs, so they may need large amounts of fluids and blood. If possible, use a heater for solutions.
If the patient has no pulse, perform cardiopulmonary resuscitation immediately.
D- for neurological examination, it is necessary to use the Glasgow Coma Scale (W.C. Glasgow, 1845–1907), which determines the basic mental status. You can also use the principle of THBO, where T is the patient's anxiety, D is the reaction to the voice, B is the reaction to pain, O is the lack of response to external stimuli.
It is necessary to maintain immobilization of the cervical region until an x-ray is taken. If the patient is conscious and his mental state allows, then you should proceed to a secondary examination.
E- To examine all injuries, it is necessary to remove all clothing from the patient. If the victim has been shot or stabbed, law enforcement clothing must be saved.
Hypothermia leads to numerous complications and problems. Therefore, the victim must be warmed and kept warm. To do this, it is necessary to cover the patient with a woolen blanket, warm solutions for intravenous administration.
Remember that the initial examination is a quick assessment of the condition of the victim, aimed at identifying violations and restoring vital functions, without which it is impossible to continue treatment.
Table 8 shows the algorithm of actions during the initial examination of patients with trauma.
Table 8
Initial examination of patients with trauma
Secondary inspection
After the initial inspection, a more detailed secondary inspection is carried out. During it, all injuries received by the victim are established, a treatment plan is developed and diagnostic tests are carried out. First, check breathing, pulse, blood pressure, temperature. If a chest injury is suspected, blood pressure is measured on both arms. Then:
- establish monitoring of cardiac activity;
- receive pulse oximetry data (if the patient is cold or in hypovolemic shock, the data may be inaccurate);
- use a urinary catheter to monitor the amount of fluid absorbed and excreted (the catheter is not used for bleeding or urination);
- use a nasogastric tube to decompress the stomach;
- with the help of laboratory tests, the blood type, hematocrit and hemoglobin levels are determined, toxicological and alcohol screenings are carried out, if necessary, a pregnancy test is done, and the level of electrolytes in the serum is checked.
Assess the need for family presence. Relatives may need emotional support, the help of a clergyman or a psychologist. If any of the family members wish to be present during resuscitation procedures, explain all manipulations performed to the victim.
Try to calm the patient. The victim's fears may be ignored due to the haste. This may worsen the condition of the victim. Therefore, it is necessary to talk with the patient, explaining what examinations and manipulations he is undergoing. Encouraging words and kind intonations will help to calm the patient.
To improve the patient's condition, anesthesia is also done and sedatives are used.
Listen carefully to the patient. Gather as much information as possible about the victim. Then carefully inspect the victim from head to toe, turn the patient over to check for back injuries.
Memo "the sequence of collecting information from the patient"
Subjectively: what does the patient say? How did the incident happen? What does he remember? What complaints does he make?
Allergy history: does the patient suffer from allergies, if so, to what? Does he carry with him a memo for doctors (in the form of an engraved bracelet, an extract from the medical history or a medical card with contraindications to drugs, etc.) in case of emergency?
Medications: Does the patient take any medications regularly, and if so, which ones? What medication has he taken in the last 24 hours?
Anamnesis: what diseases did the victim have? Has he had surgery?
Time of last meal, last tetanus shot, last menstrual period (if the patient is of childbearing age, it is necessary to find out if she is pregnant)?
Events leading to injury: how did the incident happen? For example, a car accident could have occurred as a result of a myocardial infarction while driving, or a patient was injured as a result of a fall during fainting or dizziness.
Time limit.
Purposefulness.
Solving 3 main tasks: assessing the adequacy of breathing, assessing
blood circulation, elucidation of the degree of inhibition or excitation
CNS.
■ First task- assessment of the adequacy of breathing. On his inadequate
cottoniness, in addition to its absence, indicate signs of "decay
respiratory center "(all types of pathological breathing), pa
inspiratory radox or excessive shortness of breath in combination with pale qi-
anotic coloration of the skin.
■ Second task- assessment of blood circulation. indicative
understanding of central hemodynamics gives a definition
pulse, and skin color indirectly reflects the state of the periphery
cal blood flow. Comparative palpation of the pulse on the radial
and carotid arteries allows you to approximately determine the level of
blood pressure vein. Radial pulse disappeared
no at blood pressure below 50-60 mm Hg, on the carotid
arteries - below 30 mm Hg. Pulse rate is enough
formative indicator of the severity of the patient's condition. Required
take into account that the more pronounced hypoxia, the more pain
tachycardia may be replaced by bradycardia,
arrhythmia. It may be useful to calculate the "shock index"
sa "- the ratio of the pulse rate and the level of systolic
HELL. In children under 5 years of age, an index of more than 1.5 indicates shock, in
children older than 5 years - more than 1. Peripheral
blood flow indicate such prognostically unfavorable
signs such as "marbling" of the skin, cyanosis and "gi
posts."
■ Third task- ascertaining the degree of oppression or arousal
central nervous system disorders (disorder of consciousness, convulsions, muscle tone).
In children older than one year, determining the degree of loss of consciousness
niya presents no difficulty. The situation is aggravated when
baby, especially the first 2 months of life. IN
In these cases, a guideline for assessing consciousness can serve as
concentration reactions (to sound, visual stimuli)
niya) and emotional response to positive and negative
nye influences. If consciousness is lost, then it is necessary to
pay attention to the width of the pupils and the presence of their reaction to light.
Large, unresponsive pupils without a tendency to constrict
niyu - one of the symptoms of deep depression of the central nervous system. Such
patients should definitely check the reaction to pain and reflexes from the larynx and pharynx, which allow you to determine the depth of the coma and then the conditions of transportation. If consciousness is preserved, it is necessary to pay attention to how the child is inhibited or agitated, since these symptoms may be signs of intoxication and CNS hypoxia.
With convulsions, their combination with respiratory disorders, the state of muscle tone (hyper- or hypotension) and the nature of the convulsive syndrome (clonic or tonic) are taken into account. The lack of muscle tone and the tonic component of seizures most often indicate stem disorders.
Indications for first aid treatment At the pre-hospital stage, it is necessary to adhere to the principle of providing only the minimum sufficient amount of medical care, that is, carrying out only those activities, without which the life of patients and victims remains at risk. The volume of emergency care at the prehospital stage depends on the level of medical care: whether the doctor has medical staff and what kind of medical and technical equipment.
The pediatrician on duty at the polyclinic works alone and all his "equipment" is placed in a medical bag. The doctor's bag should be equipped with a set of medicines to provide first aid for respiratory and circulatory disorders, convulsions, hyperthermia, pain syndrome, meningococcal infection.
1 The pediatrician of the ambulance station has an assistant (paramedic or nurse), and in addition to an equipped medical bag, there may be anesthesia and inhalation equipment (resuscitation mobile, stretcher and device for transport immobilization). The specialized resuscitation pediatric ambulance team includes a doctor and two paramedics, and the equipment allows for primary resuscitation, anesthesia and infusion therapy in such a volume as to provide first aid and transport a patient of any severity.
Secondary examination of the patient by organs and systems Skin and body temperature. Pay attention to the color of the skin, abrasions, hematomas, rashes. Consider pallor, the prevalence of cyanosis, marbling, hypostasis, "a symptom of a white spot." Pallor of the skin occurs with spasm of peripheral vessels (centralization of blood circulation in shock, anemia, hypothermia, etc.). Central cyanosis and/or acrocyanosis is a sign of heart failure;
peripheral and / or general cyanosis occurs with vascular, respiratory failure. “Marbling” of the skin is a spasm of the vessels of the microcirculatory bed, a “white spot” on the skin for more than 20 seconds after pressure is a sign of decompensation of the peripheral blood flow, metabolic acidosis. Hypostases - "paresis" of the terminal vascular bed, its complete decompensation. Gray-pale coloration of the skin may indicate bacterial intoxication, metabolic acidosis. Abrasions and hematomas may indicate damage (ruptures) of the liver, spleen, kidneys. Rash (allergic, hemorrhagic) is of great importance, especially when it is combined with lethargy, lethargy, tachycardia and a decrease in blood pressure.
Head and face. In case of injury, attention should be paid to
bruising (a symptom of "glasses", which may indicate a fracture
base of the skull), bleeding or liquorrhea from the ears and nose; edema
on the face, a sharp pallor of the nasolabial triangle (with infection,
scarlet fever).
Palpation of the head determines the pain points, tension or fall of the large fontanel, reaction to pressure on the tragus of the ear (acute otitis media), trismus of masticatory muscles (tetanus, FOS poisoning, spasmophilia).
At the same time, eye symptoms are assessed (pupil width, reaction to light, corneal reflex; nystagmus, the position of the eyeballs, which may be important in coma), the presence of icterus of the sclera, the tone of the eyeballs.
Neck. Detect swelling and pulsation of the cervical vessels (put
telny venous pulse - a symptom of heart failure, negative
negative - a sign of fluid accumulation in the pericardium), muscle involvement
in the act of breathing, deformities, tumors, the presence of hyperemia. Obligation
to assess neck stiffness (meningitis).
Rib cage. TO emergency situations related to damage
nyami or diseases of the chest, include: displacement
mediastinum with the possible development of the syndrome of "tension" in the hymen
oral cavity; progressive respiratory failure
telny ways; decrease in myocardial contractility.
Methods of physical examination should be aimed at identifying the clinical signs of these threatening conditions. For this purpose, inspection, palpation, percussion, auscultation are carried out.
Belly and lumbar region. Examination of the abdomen (flatulence, paresis
intestines, asymmetry, hernias). The main research method -
palpation. Determine the symptoms of peritoneal irritation (acute
pendicitis, invagination), the size of the liver, spleen (increase with heart failure, inflammation). Check abdominal reflexes (stem disorders), assess the skin fold (dehydration).
Spine, pelvic bones. Palpation and examination is carried out with
injuries, suspected inflammation.
Limbs. Determine the position, deformation, movement, lo
fecal soreness (injury). Waxy, paraffinic
skin fold on the front surface of the thighs - a sign of acute short
mental insufficiency in young children (Kish toxicosis) or
extreme degree of salt deficiency dehydration.
The examination is completed with an assessment of urine and feces, the frequency of urination and defecation in the child during the last 8-12 hours.
From the point of view of psychological contact, the initial examination is like a first date ... The first date is when the doctor meets the patient, and the patient meets the doctor. It was not by chance that I compared the initial examination with the first date. The expectations from the first date are always very high... But the further communication between the doctor and the patient often depends on the first meeting, when a long and trusting contact can be established, and the patient will be able to find her HER DOCTOR. A specialist and a person you trust and are not afraid of. A gynecologist, a visit to which you do not put off, but on the contrary - you call for any reason and for no reason. A doctor to whom you are not shy to ask a stupid question, and you will always be sure that you will receive a patient and calm explanation. From the point of view of medicine, the primary medical examination is the most voluminous and lengthy (if it is carried out correctly) and takes from 30 minutes to an hour. The inspection begins from the moment when the woman enters the office, how she sits down and what she says at the same time. A woman is always nervous when she comes to a gynecologist ... A woman is especially nervous when she comes to a new doctor, a new gynecologist ... Everything unknown usually causes fear, so some excitement before the first visit to the gynecologist is quite natural, especially given the intimate nature of this process , and especially if the gynecologist is a man. However, many experienced women specifically choose a man as a gynecologist, considering him a more attentive and professional specialist. A woman almost always experiences a feeling of insecurity, embarrassment or even fear, and for her this is stress, since this is a very delicate issue and concerns intimate organs and aspects of life. Some women, due to their modesty, are embarrassed even to talk about their problems, and then they have to give out "all the secrets" to the doctor and undergo an examination in the most hidden places of the body. But remember that you don’t owe anything to anyone, and you don’t have to justify yourself to anyone for the circumstances of your life, or special sexual hobbies, but you will have to talk about many things (even very intimate ones) - the accuracy of information helps correct diagnosis ... But embarrassment can be overcome by realizing that you don’t need to undress right away ... The patient and I have time to do our first evaluation of each other... It is more difficult for a doctor, he always sees the patient for the first time, not knowing anything about her ... The patient, in order to understand what a doctor is, has more opportunities. She asks her friends and acquaintances, reads the doctor's thoughts and answers on his personal website on the Internet, and can assess the doctor's personality already at the first conversation! The patient can refuse to be examined by this doctor and choose another if the doctor seems unpleasant to her during the conversation ... This is your right and I will not blame you for this act ... So, our acquaintance begins with a conversation. 1. CONVERSATION (STUDY OF COMPLAINTS AND LIFE HISTORY). I first talk with you, listen to your complaints. However, I am always interested exactly your complaints, Your vision and feeling of the disease (and not the opinion and diagnoses of doctors). Therefore, when preparing for the initial appointment, try to analyze - what is bothering you? You, and only you. Try to remember - from what (with what symptoms, after what event your problems BEGAN)! Try to formulate your complaints in advance. It is very important to remember when they appeared and how they proceed. Your periods when was last period. Remember time of onset of sexual activity, number of sexual partners, features of sexual activity and methods of protection from unwanted pregnancy. Must be clearly stated all your pregnancies ending in childbirth, abortion or miscarriage. And, please, don't start your visit to the doctor with "dumping" all the accumulated analyzes and conclusions on the table. I will ask you questions that may seem irrelevant, sometimes even outrageous, but these insignificant little things (or intimate details, and these are not "little things" at all) often help in making a diagnosis, since many diseases are associated with conditions life, work, sexual activity, stress, etc. There are no embarrassing topics at the gynecologist's appointment! Everything you tell me will remain within the walls of this office, I will keep all your secrets. Therefore, it is necessary to answer all questions frankly, because the key to success is mutual cooperation. And very often many women's problems (for example, long unmotivated pulling pains in the lower abdomen, irritability) are associated with problems in sexual life ... After a conversation, studying complaints and finding out your history, a medical examination begins. For the examination, the doctor needs you to undress. My advice, do not come to the gynecologist in clothes that cannot be removed in parts (for example, in overalls). And then it may happen that you have to be completely naked for a while (this will not bother me, but you?) 2. MEDICAL EXAMINATION. Inspection begins with the study your body type, the nature of body fat, the distribution and amount of hair on the body, the condition of the skin and features of appearance, examination thyroid gland and large lymph nodes, examination and palpation (palpation) your mammary glands. They form part of the female reproductive (reproductive) system. Body type, skin and fat distribution on the body, hair condition and growth, thyroid gland and mammary glands - can tell a doctor a lot about a woman patient (about hormonal changes, chronic diseases). 3. MEDICAL GYNECOLOGICAL EXAMINATION. During this and subsequent stages, you will have to undress and be in a special gynecological chair. Its design may be different, but the essence is ultimately the same: the woman is located in it, reclining or lying down, with her pelvis closer to the front edge and with her legs wide apart, raised up and bent at the knees, the ankles of which rest on special supports. Having taken the required position, try to relax as much as possible - it will be more convenient and easier for you and the doctor. I took care of you and bought a comfortable, beautiful and rather expensive gynecological unit (Polish-made, and Poles love and respect women). EXAMINATION OF EXTERNAL GENITAL ORGANS. The study on the gynecological chair begins with a careful examination of the condition of the external genitalia (perineum, clitoris, labia minora and labia majora). Sometimes I examine tissues under magnification (through a colposcope). INTRAVAGINAL EXAMINATION. Next, I conduct an examination with gynecological mirrors, which allow you to examine the walls of the vagina and cervix, the color, amount and nature of the discharge. The dimensions of the mirrors are small and the instrument fits freely into your vagina. If the patient is still a virgin, examination with a mirror is not performed. The only obstacle and cause of pain during examination may be your fear, causing tension in the muscles of the perineum. If you take the examination calmly and relax the muscles of the perineum, then the examination will not cause you any trouble ... During the examination in the mirrors, material is taken for laboratory research - a smear for flora and a smear for the presence of pathological cells (oncocytology). 4. COLPOSCOPY WITH DIGITAL PHOTOGRAPHY AND DOCUMENTATION OF IMAGES. At the initial examination (and always once a year), I conduct a colposcopy for all my patients - examination of the cervix under high magnification, with the possibility of photographing the changed areas. Using this method, it is possible to determine cervical erosion, leukoplakia, papillomatosis and other inflammatory or oncological changes. If necessary, under colposcopy guidance, I take biopsy(a small piece of tissue with special forceps) of the altered area and send the material for histological examination (the tissue is stained in a special way and examined under a microscope with high magnification) and an accurate diagnosis is made. 5. ULTRASONIC EXAMINATION WITH THE VAGINA SENSOR. In a transvaginal examination, the transducer is inserted into the vagina. This method is one of the leading and most reliable research methods in gynecology. The sensor almost directly comes into contact with the organ under study, so there is no need to fill the bladder, the study is not hampered by obesity, adhesions, the presence of scars on the anterior abdominal wall. The accuracy and quality of examination with a vaginal ultrasound probe is 10 times higher than conventional ultrasound, which examines the pelvic organs through the abdominal wall, while painfully overfilling the woman's bladder. 6. VAGINAL GYNECOLOGICAL EXAMINATION. After examination in the mirrors and ultrasound of the pelvic organs, I spend bimanual vaginal examination. In this case, the fingers of the right hand in a sterile glove are inserted into your vagina, and the internal genital organs (uterus, ovaries, bladder) are palpated through the abdominal wall with the left hand. With sufficient relaxation of the muscles of the perineum and abdominal wall by the patient, the procedure is painless. RECTAL RESEARCH. Women after 30 years, and according to indications, and earlier, a digital rectal examination of the rectum (examination through the anus - anus) is performed, which makes it possible to more accurately judge the condition of the genital organs and timely identify the pathology of the rectum (hemorrhoids, fissures, cancer). Virgins it is also necessary to examine on a chair (in the presence of a mother or a nurse), examining the condition of the external genital organs and the hymen, located at the entrance to the vagina. The internal organs are examined with a digital examination through the rectum, which allows the doctor to assess the size and condition of the uterus and appendages. The girl in this study retains her virginity. For an ultrasound examination of a virgin, it is necessary to FILL THE URINARY BLADDER, since it is impossible to perform a vaginal ultrasound for a girl who is not sexually active. The female body is complex and completely hormone dependent- subject to fluctuations in hormone levels, so it is often necessary to carry out additional methods research, some of which we do ourselves in our center, some - in our direction in other medical institutions. A competent gynecologist will help you maintain your health and beauty, push back old age and improve the quality of life only with your help! And carefully analyze what list of services you are offered for 50-70 hryvnias in other medical centers or examinations "at the dirty window sill" by pull. Do not skimp on the most valuable thing - the health of your intimate organs ... - then you will have to undress four times and pay for various services of different specialists in each office and, as a result, no one is responsible for you as a whole (for your body)!Candidate of Medical Sciences, obstetrician - gynecologist of the highest category
gynecologist-endocrinologist and doctor of ultrasound diagnostics
SEMENYUTA Alexander Nikolaevich
Knowledge of the mechanism of injury helps to conduct an initial examination purposefully. If the patient fell off his chair at home and complains of abdominal pain, then you have time for a more thorough and detailed examination and examination, and psychologically, we do not expect serious damage with such an injury mechanism. Although I remember a case from practice when they brought a young woman who stumbled, fell, got up, lost consciousness. Delivered by ambulance. After examination, a rupture of the spleen, intra-abdominal bleeding was diagnosed. But if the patient was hit by a car or fell from the 5th floor, his hemodynamics is extremely unstable, and the presence of an unstable pelvic fracture is not clinically determined, then with a high degree of probability, intra-abdominal localization of the catastrophe can be assumed. During the initial examination, the patient should be completely undressed. If the victim is conscious, to your question - where does it hurt? - He can answer adequately and accurately. But even in this case, it is necessary to examine the whole body in detail: the scalp, the cervical spine, the region of the clavicles and their joints, the rib cage (paying special attention to the detection of subcutaneous emphysema, chest lagging, the presence of paradoxical breathing, auscultation data, etc.). etc.), the pelvic area with stress tests and bladder catheterization, limbs and joints.
Always pay special attention to the participation of the abdomen in breathing. This is an important sign, and if you ask the patient to "inflate" and "pull in" the stomach and at the same time the anterior abdominal wall makes full-fledged excursions, then the likelihood of a catastrophe in the abdominal cavity is minimal. Careful superficial and deep palpation will help determine the area of local (or diffuse) pain, protective muscle resistance, and identify positive symptoms of peritoneal irritation. In case of damage to hollow organs, already during the initial examination, rather sharp diffuse soreness, muscle tension and a positive symptom of Shchetkin-Blumberg are often determined. One of the leading physical signs of intra-abdominal bleeding is the symptom of Kullenkampf (the presence of severe symptoms of peritoneal irritation without rigidity of the anterior abdominal wall). Percussion is less informative, especially with combined fractures of the pelvic bones. In such cases, it is impossible to lay the patient on his side to determine the movement of dullness, and in the supine position, a shortening of the percussion sound often indicates the presence of only a retroperitoneal hematoma. The absence of peristalsis is more common with damage to the intestine or mesentery. With concomitant TBI with impaired consciousness, the diagnosis of intra-abdominal injuries is even more complicated. It is with such combinations of injuries that more than 50% of diagnostic laparotomies are performed. In such situations, the identification of hemodynamic instability comes to the fore, and if systolic blood pressure is determined at the level of 80-70 mm, then already during the first 10-15 minutes it is necessary to conduct an ultrasound of the abdominal cavity or (if it is impossible) to perform lapascopy. In the absence of a laparoscope, perform a laparocentesis. According to modern sources, the sensitivity, specificity, and accuracy of ultrasonography for diagnosing intra-abdominal bleeding range from 95 to 99%. .
In patients with unstable hemodynamics, ultrasound and laparoscopy come to the fore. According to the authors, the accuracy of ultrasound in kidney damage was 100%, in liver ruptures - 72%, spleen - 69%, intestines - 0%. CT is considered the main diagnostic method in hemodynamically stable patients. Many authors recommend the use of additional CT in all cases when ultrasound showed negative results, but there is a clinic of intra-abdominal injuries, and even when ultrasound gave positive results. Particularly difficult is the differential diagnosis of intra- and retroperitoneal bleeding. The next stage of the examination is radiography of the abdominal cavity. Preoperative preparation.
Since operations for injuries of the abdominal organs are mainly resuscitation operations, i.e. to life-saving operations, and they should be performed as soon as possible after admission to the hospital, then preparation for them should take a minimum of time. Some of the resuscitation measures should also be referred to preoperative preparation: tracheal intubation and sanitation of the tracheobronchial tree (if indicated); parallel determination of blood group and Rh factor (express method); initiation of infusion therapy to eliminate critical hypovolemia; preventive drainage of the pleural cavity (even with limited pneumothorax); installation of a urinary catheter and control over urine output; the introduction of a gastric tube with the evacuation of the contents. Preparation for the operation ends with the processing of the future surgical field (shaving, soap, antiseptics). In terminal patients with a clinic of ongoing intra-abdominal bleeding, balloon occlusion of the descending thoracic aorta can be performed as a method of supporting hemodynamics before surgery.
Before the intervention, if intra-abdominal bleeding is suspected, antibacterial prophylaxis of infection should be carried out by intravenous administration of 1 g of semi-synthetic penicillins (ampicillin, carbenicillin, etc.), if damage to hollow organs is suspected, a combination of aminoglycosides (gentamicin, kanamycin), cephalosporins and metronidazole.
