Practical skills in medical practice

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Practical skills in medical practice

  1. 1. PRACTICAL SKILLS IN CLINICAL PRACTICE DR.AVINASH BHONDWE PRESIDENT I.M.A. Pune (2008-09)
  2. 2. Special Skills Minor Surgeries Stitches- Skin & Mucus Membranes Special Dressings Splints & Plasters I.V . Fluids & Injections ECG Spirometer Physiotherapy Refraction
  3. 3. Injections Ampoules Vials Prefilled Pen
  4. 4. Injection Sites
  5. 5. InjectionSites
  6. 6. Intravenous Injections I/V injections Salines 17 Jan 2010
  7. 7. IV Presentations
  8. 8. Syringe IV SETScalp Vein
  9. 9. Type of Needles
  10. 10. SUTURING SKINSUTURES MUCUS MEMBRANE DEEP WITH FACIA, FAT & SKIN MUSCLES BLEEDING FROM VESSELS
  11. 11. SUTURINGThere are several shapes of surgical needles: Straight 1/4 circle 3/8 circle 1/2 circle. Subtypes of this needle shape include, from larger to smaller size, CT, CT-1, CT-2 and CT-3.[3] 5/8 circle compound curve half curved (also known as ski) half curved at both ends of a straight segment (also known as canoe)
  12. 12. SURGICAL NEEDLES
  13. 13. SUTURING Needles may also be classified by their point geometry; examples include: taper (needle body is round and tapers smoothly to a point) cutting (needle body is triangular and has a sharpened cutting edge on the inside curve) reverse cutting (cutting edge on the outside) trocar point or tapercut (needle body is round and tapered, but ends in a small triangular cutting point) blunt points for sewing friable tissues side cutting or spatula points (flat on top and bottom with a cutting edge along the front to one side) for eye surgery
  14. 14. SURGICAL NEEDLES
  15. 15. Suture Material Types of sutures : Absorbable sutures such as plain,chromic, a traumatic catgut. Non absorbable or non absorbent sutures.
  16. 16. Reading the Suture Label Order Code Size Also: Name LENGTH NEEDLE SYMBOL Needle COLOR Absorbable or Non Company
  17. 17. Suture Material ABSORBABLE SUTURES: CATGUT A tough thin cord made from the treated and stretched intestines of certain animals, especially sheep. This type of suture are commonly used to suture the inner structure of the body Walls of the organs Rectal sheath Muscles Subcutaneous tissue Peritoneum Intestinal anastomosis
  18. 18. Suture Material 1) Plain catgut : These sutures are completely digested & absorbed by the tissue. Sizes of the absorbable catgut suture vary from 5/0 which is the finest to 2 which is the thickest.
  19. 19. Suture Material Chromic catgut : Chromic catgut an absorbable sterile strand derived from the intestinal submucosa of sheep. It is an absorbable suture The chromic catgut is of brown color & is absorbed slowly
  20. 20. Suture Material Atraumatic catgut It is another type which is used for ligating small blood vessels. Dexon (Polyglycolic acid) is also an absorbable suture synthetically prepared. It is available in various sizes such as 3/0 to 2. This suture is used as ties for small blood vessels & also for suturing peritoneum ,rectal sheath etc.
  21. 21. Non absorbable sutures  These types of sutures are not absorbed.  These sutures are used for closing or suturing outer surface of the body such as skin.  These sutures are cheaper, easy to handle easy to sterile ,have smooth surfaces & knot securely with the ends cut short.
  22. 22. Suture Material Silk suture : these suture are non absorbent. Their sizes vary from 10/0 to 2 . These are used for skin closure after abdominal operation. Linen suture : these sutures are also non absorbent .their sizes vary form 3/0 to 2 . These are used for skin closure in hernia operation. Monofilament Nylon suture ( Ethilon) : These are non absorbable suture. Their sizes vary from 10/0 to 2. these sutures are used as tension sutures in hernia repair.
  23. 23. Suture Material e) Prolene –Ethifex merseline : These non absorbent sutures are used for cardiovascular & plastic surgery. f) Metal Clips : these non absorbent types of suture are of various types such as : Michael clips Trazies Van petz VICRYL (polyelatine– 916) PROLENE (Polypropylene) POLYSTER (ethibond) POLYDIXONE SUTURE
  24. 24. SUTURES SIMPLE SUTURES
  25. 25. SIMPLE SUTURES
  26. 26. MATRESS SUTURES
  27. 27. SIMPLE CONTINUOUS SUTURES
  28. 28. Alternative Methods of Wound Closure STERI STRIPS
  29. 29. STAPLES SUTURING
  30. 30.  Superglues that contain acrylates Tissue adhesive may be applied to superficial wounds to block pinpoint skin hemorrhages and to precisely coat wound edges. Because of their bacteriostatic effects and easy application, they have gained increasing popularity. They have demonstrated either cosmetic equivalence or superiority to traditional sutures in various procedures, including sutureless closure of pediatric day surgeries, saphenous vein harvesting for coronary artery bypass, and blepharoplasty.
  31. 31. Wound Closure Using Super Glue
  32. 32. Minor Surgeries ABSCESS DRAINAGE- I/D CYST EXCISION LIPOMA EXCISION CORN EXCISION FOREIGN BODY REMOVAL AUROPLASTY NAIL BED ABSCESS I/D – NAIL EXCISION
  33. 33. ABSCESS DRAINAGE
  34. 34. AUROPLASTY
  35. 35. MINOR SURGERIESLIPOMA EXCISION CORN EXISION
  36. 36. SPECIAL DRESSINGS ELASTOCREPPE BANDAGEROLLER BANDAGE
  37. 37. Applying a Cravat Bandageto the Head Place middle of bandage over the dressing and wrap around the head.
  38. 38. Applying a Cravat Bandageto the Head  Cross the two ends snugly.  Bring ends back around and tie knot.
  39. 39. Applying a Roller Bandage For ankle:  Make two straight turns around instep.  Make figure-eight turn across front of foot, around ankle, and under arch.
  40. 40. Securing Bandages Loop method  Encircle body part with the looped and free ends and tie ends together.
  41. 41. SPLINT & PLASTERS
  42. 42. Plasters
  43. 43. ECG
  44. 44. SPIROMETER
  45. 45. REFRACTION
  46. 46. PHYSIOTHERAPY Short Wave Diathermy (SWD) Effective in Inflammation of Shoulder Joint, Elbow Joint , Cervical Spondylosis, Osteoarthritis, Ligament Sprains in Knee Joints, Low Back Ache, Heel Pain, Sinusitis Ultrasonic therapy: Ultrasonic waves are useful for treatment of Inflammation of Elbow Joint (Tennis Elbow), Plantar Fascitis (Heel Pain), Shortening of Muscle or Ligament, Inflammation of tendons (Suprasspinatus tendnitis), Ligament Sprain (Lateral Ligament Sprain of Ankle), Unhealed Scars
  47. 47. PHYSIOTHERAPYCervical Traction Lumbar Traction
  48. 48. Interferential Therapy (IFT) Computerized Interferential therapy is most advanced version; based on solid-state circuitry, extremely light weight, compact design and portable and user friendly systems. Interferential therapy can relieve pain, reduce swelling, activate cell function and promote healing &restors function. Choice for the treatment in Rheumatism, Arthritis, Muscle Strains, Sports Injuries, Neuralgia, Neuritis,

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