*95792*
Medical sciences/ public
health services
As. prof. Dubitskiy A.A.
Medical university Astana, Kazakhstan
TYPICAL ERRORS
OF THE MEDICAL PERSONNEL FIRST AID AT DIAGNOSTICS AND TREATMENT TRAUMATIC
DAMAGES
Erroneous diagnostics of the medical personnel of the first help at a
serious trauma accompanied by traumatic shock, was the basis for revealing and
elimination of lacks of diagnostics and its treatment at a pre-hospital stage
[1].
In the present work the errors admitted by students of improvement of
professional skill (32 doctors and 18 medical assistants of station of fast and
urgent medical aid of Astana and 16 doctors of branch of Republican center of
science of urgent medical aid are presented and commented at questioning in the
training beginning.
We result most typical of them:
- 51,9% of medical assistants and 37,1% of doctors, underestimating a role
hypovolemia, considered a pain as a principal cause of development of traumatic
shock;
- 78,1% of medical assistants and 66,3% of doctors inadequately treated an
arterial hypertension and bradycardia, characteristic for an accompanying heavy
craniocereberal trauma, as absence of symptoms of traumatic shock;
- 82,4% of medical assistants and 86,5% of doctors considered, an arterial
hypotension as an obligatory sign of traumatic shock of any degree, forgetting
about indemnification phase;
- 67,1% of doctors and 33,4 % of medical assistants didn't know volumes
blood loss, corresponding to degrees of traumatic shock. Also, 36,2% of doctors
and medical assistants have been given the underestimated figures of volume
blood loss at a skeletal trauma (for example, at the closed crisis of a hip);
- 62,8% of medical assistants and 42,6% of doctors have appointed
catastrophically insufficient volume infusion therapies at a pre-hospital stage at traumatic shock;
- 62,4% of medical assistants and 39,7% of doctors at the closed trauma of
a stomach at all didn't spend infusion infusional therapy,
unfairly being afraid to increase speed of an internal bleeding.
Thus only 20,2 % of doctors and 12,7% of medical assistants have specified
in observance of a principle of correct completion кровопотери in this case, changing speed of infusion depending on size of arterial
pressure.
- 70,4% of medical assistants and 57,3% of doctors unfairly early applied
stimulators of blood vessels at treatment of traumatic shock of any degree;
- 70,2% of medical assistants and 63,4% of doctors underestimated an
arrhythmia at victims as clinical a sign of a possible bruise or heart wound;
- Only 31,7% of medical assistants and 87,8 % of doctors have correctly
specified a place of a puncture of a pleural cavity at a pheumothorax;
The most adequate way of restoration of passableness of respiratory ways at
a pre-hospital stage at victims in a clod of 70,6 % of cadets named a trachea
intubation, from them of 22,8 % only theoretically(!) owned this technique;
- Oxygen inhalation at traumatic shock would be appointed only 40,3% of the
interrogated employees of the first help;
- Only 36,6% of doctors and medical assistants named the indication for
transfer into artificial ventilation of lungs pathological breath at victims in
a clod;
- 98,3% of cadets didn't consider necessary carrying out of artificial
ventilation of lungs at rough infringement of mechanics of breath because of a
trauma of a costal skeleton.
Thus 84,5% of medical assistants and 79,3% of doctors first help didn't own
a design procedure of parameters of equipment room artificial ventilation of
lungs.
- In 50,1% of answers unreasonable refusal of application of narcotic
analgetics has been revealed at a heavy skeletal trauma, and 67,3% of pupil
have chosen an intramuscular way of introduction of preparations.
- 63,6 % of medical assistants and 53,2 % of doctors have refused anesthesia
at a skeletal trauma and the accompanying closed trauma of a stomach, ignoring
possibility of use of short-range analgetics;
- Necessity of application of a collar of Chance at falling from height has
been specified 12,0% of cadets;
- At the decision of the clinical problem the trauma with progressing
infringement of the vital functions was which condition heavy сочетанная, 52,8 % of listeners didn't spend a transport immobilization at crises of
extremities, considered it as a task of second importance.
Thus, having carried out the analysis of questionnaires and reports of the
decision of clinical problems on a theme «The Trauma. Traumatic shock», the
typical errors supposed at a pre-hospital stage by our cadets - the exit
personnel of the first help have been revealed at diagnostics and treatment of
the given pathology.
It has helped to correct a lecture course and the plan of carrying out of
seminars and a practical training on the given theme.
At repeated (on the termination of courses) questioning of 12 doctors and
18 medical assistants (are defined by a method of casual sample) the average
percent of errors has made 1,4%.
Literature:
1. Dubitskiy A.A. Analyses of erroneous diagnostics of the medical
personnel of the first help//Тhe Manual. -
Astana, 2009. - 51 with.