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Reference book for students of study of discipline “anesthesiology and intensive care”




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MINISTRY OF HEALTH OF UKRAINE

BUKOVYNIAN STATE MEDICAL UNIVERSITY





REFERENCE BOOK FOR STUDENTS OF STUDY OF DISCIPLINE

ANESTHESIOLOGY AND INTENSIVE CARE”





Chernivtsi, 2009

MINISTRY OF HEALTH OF UKRAINE

BUKOVYNIAN STATE MEDICAL UNIVERSITY


«ASSERT»


Act. prorector
of educational work

Professor. Yu.T.Akhtemiychuk


«____» ___________ 2009




REFERENCE BOOK FOR STUDENTS OF STUDY OF DISCIPLINE

ANESTHESIOLOGY AND INTENSIVE CARE”



Student’s reference book is composed on the basis of actual educational plan and program on educational subject of “anesthesiology and intensive care” for students of higher medical educational institutions of III-IVth accreditation levels (MHP of Ukraine, K., 2008).


It is approved on the methodical conference of the department of anesthesiology and intensive care on June, 15, 2009 (protocol № 19)


Chief of the department

of anesthesiology and intensive care,

professor V.M.Konovchuk


It is approved on meeting of subject methodical commission on surgical disciplines on June, 18, in 2009 (protocol № 3)


Chief of the subject

methodical commission, professor I.Yu.Polyansky




Chernivtsi, 2009

^ Educational discipline is

Anesthesiology and intensive care”


1. Introduction

Definition of the subject. The anesthesiology and intensive care studies and develops questions of the theory and practice of protection of an organism from influence of extreme factors; forms professional skills of regulation and time artificial replacement vital the important functions of an organism at infringement of their autoregulation.

Quantity of educational hours – 90 (3 credits ECTS), including:

  • lectures – 10 hours

  • Practical tutorials – 60 hours

  • Independent work of students – 20 hours

  • Contents of the subject is structured into 1 modules and 3 contents modules.


2. The structure of “Anesthesiology and intensive care“ and calculation of balls for current learning activity (convertation of traditional marks into balls; rating in balls for completion of individual tasks, if suggested by working educational program).



Module number, quantity of educational hours /quantity of ECTS credits

Quantity of contents modules, their numbers

Quantity of practical tutorials

Convertation of traditional marks into balls

Minimal balls quantity*

Traditional marks

Balls for completion of individual task as a way of SIW

"5"

"4"

"3"

"2"

Module 1 90/3,0

3

(№№ 1-3)

10

11

9

7

0

10

70


* Minimal balls quantity, which student must collect for current educational activity during studing this module, to be accepted to pass an final module control.


^ 3. Final aims of learning of educational discipline according to Educational-professional program (EPP)*:

  • To demonstrate knowledge of methods of diagnosis and assist in major syndromes, disorders of vital functions;;

  • To interpret basic clinical and laboratory indicators of violations of vital functions;;

  • To plan inspections and treatment of patients from infringements of the vital functions;

  • To diagnose clinical signs of death and terminal conditions to conduct cardiopulmonary and cerebral resuscitation;

  • To apply general principles and methods of anesthetic different surgical interventions;

  • To use basic principles of first aid to victims in the industrial and natural disasters;

  • To apply the basic algorithms of intensive care emergency conditions.


4. Description of modules discipline:

^ MODULE “ANESTHESIOLOGY AND INTENSIVE CARE”


Thematic plan of lectures




Theme

Amount of hours

1

General principles of anesthesia for surgical interventions

2

2

Acute respiratory failure: etiology, pathogenesis, clinic and intensive care

2

3

General principles of intensive therapy of acute poisoning

2

4

Shocks. Pathogenesis, classification, clinical manifestations and intensive care of posthemorrhagic hypovolemic shock

2

5

Acute violations of water-salt metabolism. The etiology, pathogenesis, clinic and intensive care

2




Total

10


Thematic plan of practical module



Theme

Amount of hours

^ Substantive module 1. General intensive care and anesthesiology

1

Cardiopulmonary and cerebral resuscitation.

6

2

General questions anesthesiology.

6

3

Clinical anesthesiology

6
^
Substantive module 2. General issues of intensive care

4

Methods of diagnosis and correction of violations of water-electrolyte exchange and acid-base status (ABS)

6

5

Acute renal and hepatic insufficiency

6

6

Acute poisoning and coma.

6
^
Substantive module 3. Intensive Care Emergency Conditions

7

Acute respiratory failure

6

8

Disease and damage the respiratory system

6

9

^ Acute blood violations

6

10

Shock and traumatic injuries

3

11

^ Challenge studies: final modular control:

theoretical training

practical training

3



Total


60



Types of independent work of students and its control



Theme

Amount of hours

Type of control

1.

^ Preparation to the tutorials of the module – theoretical training and development of practical skills

10

The current control on the practical lessons

2.
^

Individual work on themes, which are not included in the plan of tutorials:








2.1

Intensive care of traumatic injuries: trauma, prolonged compression syndrome, elektrotravma

2

The final modular control

2.2

Clinical manifestations and diagnosis of acute heart failure, cardiac rhythm. The main areas of intensive care.

2

The final modular control

2.3

Intensive care convulsive and hyperthermic syndromes.


2

The final modular control

3.

Individual independent work of students in one of the topics of their choice:

Review of scientific literature on choice (individual task

task)

1

The current control on the practical lessons

4.
^

Preparation of final modular control


3

The final modular control



Total


20





The list of individual tasks:

  1. Brain death. Clinical and deontolohichni problems.

  2. Acute respiratory distress syndrome of newborns.

  3. The history of methods of anesthesia

  4. Tactics infusion therapy in shock conditions.

  5. Intracranial pressure as a criterion of adequacy of intensive care coma.

  6. Modern methods of efferent therapy.

  7. Multiple organ failure in critically ill surgical patients.

  8. Antibacterial therapy. Basic principles of antibiotic treatment.

  9. The pathophysiology of surgical sepsis: systemic inflammatory response syndrome, sepsis, septic shock.

  10. Immunocorrection in critical condition in surgical patients.

  11. Violation of heart rhythm. Antiarrhythmic therapy

  12. Risk operations and anesthesia


5. Estimation of educational activity of students *


Control forms and evaluation system are carried out in accordance with the requirements of the program of discipline and Instruction about the system of evaluation of educational activity of students at credit-module to the system of organization of educational process, Ukraine ratified by MH (2005)

An estimation for the module is determined as a sum of estimations of current educational activity (in score points) and estimation of final module control (in score points), which is proposed at the evaluation of theoretical knowledge’s and practical skills in accordance with lists, certain the program of discipline.

Maximal amount of score points, which is appropriated to the students at mastering each to the module (test credit), – 200, in a that number for current educational activity – 120 points (60%), as a result of module final control – 80 points (40%).

Current control is exercised at every practical training according to specific goals for each theme. When evaluating training activities students need to prefer standardized methods of control: testing, structured paperwork, structured control procedures and practical skills in conditions close to real.


^ 5.1. Evaluation of current training activities should be conducted in 3 phases:

1) initial (stantartyzovani control methods that reveal the independent work of students, for example - 10 tests for admission at least - 70%). Weight аssessment - 20% of the total assessment of current activities;

2) primary (execution of practical work, ability to analyze and interprytuvaty, make reasonable conclusions, solving situational problems, work near the bedside). Weight аssessment - 50% of the total assessment of current activities;

3) final (control skills, solve complex situational problems, setting the diagnosis, treatment appointment). Weight аssessment - 30% of the total assessment of current activities.

Weight of each topic within a module must be the same, but may be different for different modules of the same subjects and determined the number of subjects in the module.


^ DISTRIBUTION POINTS, PRYSVOYUVANYH STUDENTS IN MODULE



Мodule

(current training activities)

Maximum score

Contents module 1

1

Topic 1

11

2

Topic 2

11

3

Topic 3

11

Contents module 2

4

Topic 4

11

5

Topic 5

11

6

Topic 6

11

Contents module 3

7

Topic 7

11

8

Topic 8

11

9

Topic 9

11

10

Topic 10

11




Content of modules

Individual independent work of students

At All

110

10

120

Final control modules, including:

80

Control of practical training

APPLY

Control of theoretical training




^ Total score

200


Note: While mastering the theme on traditional system of points awarded to a student: "5" - 11 points, 4 - 9 points, 3 - 7 points "2" - 0 points.

Maximum number of points for the current school student activities - 120

The student admitted to the outcome of modular control subject to fulfilling the requirements of the curriculum and in the case of ongoing training activities, he won at least 70 points (10 х 7 = 70). ^ He has the right to reproduce the missing subject or pereskladaty them on a positive assessment of not more than 3 times during the study module

Final control module the student is counted, if he won at least 50 points with 80 points.

While mastering each topic module for the current school student activity estimations are a 4-point scale traditional, which are then converted into points based on themes in the module. The program was applied such a system of converting the traditional assessment of points:


^ Traditional rating

Convert to points

Module: „Anesthesiology and Intensive Care"

5”

11

4”

9

3”

7

2”

0


^ Maximum number you can get a student to study the module is 120 points. It is calculated by multiplying the number of points corresponding evaluation "5", the number of subjects in the module with the addition of points for the individual independent work.

Minimum number of points you can get a student to study the module is 70 points. Calculated by multiplying the number of points that correspond to evaluating the "3", the number of subjects in the module.

^ Individual self-assessment of students (individual assignments):

Number of points for different types of individual independent work of students depends on its size and importance, but not more than 10 points. These points are added to the sum score for the current student training activities.

^ Evaluation of self-employment:

Evaluation of independent work of students, which provided the subject along with class participation, carried out during the current control of the theme on a classroom..

Evaluation of topics, which are made only on independent work and not included in the topics of classroom training sessions, supervised in the final modular control.


The final modular control:

The final modular control study carried out by the end of all those modules at the last class of the control module without any additional days for preparation

In the final control allowed students who attended all training sessions and lecture at the studied module scored points, no less than the minimum.

The form of the final modular control should be standardized and include control of theoretical and practical training. Specific forms of the outcome of modular control defined in a work study program.

The maximum number of points you can score a student at the time of final control module is 80.

Final control module is enrolled, if the student scored at least 50 points.


^ 5.2 Assessment of subjects exposed as the product of estimates for the current training activities and the resulting modular control.

Encouraging balls according to Scientific Board decision may be added to ball quantity for subject for students who have scientific publications or possessed prize positions for participation in subject Olympiad carried out between higher educational institutions of Ukraine etc.

Objectivity of estimation of student’s educational activity has to be checked by statistical methods (correlation quotient between current progress and results of final module control).


^ Conversion of balls quantity for subject into rates by ECTS scale

and 4-ball (traditional):

According to ECTS

By national scale

^ By BSMU scale (in balls)

A (excellent)

Excellent

180-200

B (very good)

Good

165-179

C (good)

150-164

D (good)

Satisfactory

135-149

E (weak)

120-134

FX

Unsatisfactory

with possibility of re-passing

70-119

F

Unsatisfactory

with obligatory repeated course

1-69



Balls quantity on subject, put into account of students, is conversed into ECTS scale next way:

Students’ percentage is determined on selection of present study year students within the limits of corresponding specialty.


ECTS rate

Rate by 4-ball scale

A

“5”

B,C

“4”

D,E

“3”

FX,F

“2”


^ FX, F rate is put of students who have just one module not put to account on subject after completion of studying it.

FX (“2”) rate is put to students who obtained minimal balls quantity for current educational activity, but did not pass final module control. They have a right to pass repeatedly the final module control but not more than two times according to curriculum ratified by the rector.

Students who obtained F rate after completion of the subject (did not fulfill educational program just on one module or did not gain minimal balls quantity for current educational activity) have to pass education on the subject repeatedly. The decision is taken by university stuff leaders according to normative documents approved according to maintained order.

Note: The transfer unit criteria assessment of students in the balls held by order № 377-6 of 14.07.2007 town on BSMU.


6. List of questions for final module control
^

Substantive module 1. General intensive care and anesthesiology


  1. Clinical death, determination, diagnosis.

  2. Instantaneous stage CPCR.

  3. Signs of effectiveness resuscitation, indications for termination of resuscitation.

  4. Specialized stage CPCR.

  5. Types of stopping blood circulation and their diagnosis.

  6. Medications that are used on high-stage cardio-pulmonary and cerebral resuscitation, their dose.

  7. Inputting medications during resuscitation and the reasons.

  8. Technics of electric defibrillation.

  9. Indications for closed heart massage.

  10. Complications of resuscitation.

  11. Postresuscitation period.

  12. The concept of decortication, decerebration, brain death.

  13. The main directions of treatment Postresuscitation period.

  14. Intensive care of cerebral edema.

  15. Classification of types of anesthesia.

  16. The main nodes anesthesia machine.

  17. Measures to prevent fires and explosions in the operating.

  18. Breathing сircuits, advantages and disadvantages.

  19. Inhaled anesthetics: pharmacokinetics, clinical course.

  20. Components of general anesthesia.

  21. Stages of anesthesia.

  22. Premedication, its species.

  23. Preparing patients for surgery and anesthesia.

  24. Clinic anesthetized with ether.

  25. Mask method of general anesthesia.

  26. Endotracheal anesthesia. Indications, methods.

  27. Pharmacology of muscle relaxants.

  28. Complications during general anesthesia.

  29. Aninhalation anesthetics: pharmacokinetics, clinical course.

  30. Types and methods of regional anesthesia.

  31. Peculiarities of general anesthesia in outpatient and urgent conditions

  32. Features prepare patients for surgery and anesthesia.

  33. Physiological and pathophysiological features of general anesthesia in children and sick elderly.

Substantive module 2. General intensive care

  1. The role of water and electrolytes in the body.

  2. The concept of osmolarity, its correction.

  3. Clinical signs of dehydration and hydration.

  4. Hypertonic dehydration. Causes, clinical signs, methods of correction.

  5. Isotonic dehydration. Causes, clinical signs, methods of correction.

  6. Hypotonical dehydration. Causes, clinical signs, methods of correction.

  7. Hypertensive hydration. Causes, clinical signs, methods of correction.

  8. Isotonic hydration. Causes, clinical signs, methods of correction.

  9. Hypotonical hydration. Causes, clinical signs, methods of correction.

  10. Causes and symptoms of hypo-and hypernatraemia, treatment.

  11. Pathophysiological disturbances in hypo-and hyperkalemia, clinic, diagnosis, correction.

  12. Violation of exchange of chlorine.

  13. Buffer systems of the body.

  14. The concept of disorders, diagnosis, correction.

  15. The concept of alkalosis, diagnosis, correction.

  16. Characteristics of solutions for infusion therapy.

  17. Indications for parenteral nutrition.

  18. Peculiarities of infusion therapy and correction of violations of water-electrolyte metabolism and acid-base status in diabetes mellitus.

  19. Peculiarities of infusion therapy and correction of violations of water-electrolyte metabolism and acid-base status in the postoperative period.

  20. Peculiarities of infusion therapy and correction of violations of water-electrolyte metabolism and acid-base status with pyloric stenosis.

  21. Peculiarities of infusion therapy and correction of violations of water-electrolyte metabolism and acid-base status in intestinal obstruction.

  22. Peculiarities of infusion therapy and correction of violations of water-electrolyte metabolism and acid-base status during peritonitis.

  23. Peculiarities of infusion therapy and correction of violations of water-electrolyte metabolism and acid-base status of pancreatic necrosis.

  24. Causes and pathogenesis of acute renal failure (ARF).

  25. Differential diagnosis of pre-renal, real and postrenalnoy oligourii, anuria. Laboratory diagnosis of acute renal failure.

  26. Stage of clinical course of acute renal failure.

  27. Basic principles of treatment of acute renal failure.

  28. Uremic coma, the principles of intensive care.

  29. Indications for hemodialysis.

  30. The calculation of daily fluid requirements of patients with acute renal failure.

  31. Causes of acute hepatic failure.

  32. Clinical manifestations of acute hepatic failure. Laboratory diagnosis.

  33. Basic principles of treatment of hepatic injury.

  34. Hepatic coma, the principles of intensive care.

  35. Basic principles of intensive therapy of acute poisoning.

  36. Basic principles of forced diuresis.

  37. Extracorporal methods of detoxification, indications and contraindications, equipment, technics performance.

  38. Principles of antidote therapy.

  39. Pathogenesis, clinic and intensive therapy for methanol poisoning.

  40. Pathogenesis, clinic and intensive therapy of poisoning with ethyl alcohol and its surrogates.

  41. Pathogenesis, clinic and intensive therapy of poisoning with opiates and barbiturates.

  42. Pathogenesis, clinic and intensive care in cases of poisoning organophosphorus compounds.

  43. Pathogenesis, clinic and intensive therapy in cases of poisoning by acids and alkalis.

  44. Pathogenesis, clinic and intensive therapy for carbon monoxide poisoning.

  45. Pathogenesis, clinic and intensive care in cases of poisoning by poisonous mushrooms.

  46. Features emergency insect stings and animal.

  47. Types of violations of consciousness, evaluation of the depth of impaired consciousness.

  48. Principles of intensive therapy in comatose states of various origin.

  49. Pathogenesis, clinic and intensive therapy of hypoglycemic coma.

  50. Pathogenesis, clinic and intensive therapy hyperglycemic coma.

  51. Pathogenesis, clinic and intensive care hyperosmotic coma.

  52. Pathogenesis, clinic and intensive care hyperthermic syndrome in children.

Substantive module 3. Intensive care emergency conditions

  1. Classification of hypoxia, the clinic, the differential diagnosis of different types of hypoxia.

  2. Hypercapnia, clinic.

  3. Hypocapnia, clinic.

  4. Classification of acute respiratory failure.

  5. Basic principles of intensive therapy of acute respiratory failure.

  6. Oxygen therapy: methods, indications, toxic effects of oxygen.

  7. Ventilation, indications, methods, criteria for performance.

  8. Methods of restoring patency of the airways and improving the drainage of lung function.

  9. Remediation of the tracheobronchial tree and oropharynx.

  10. Principles of differential treatment of asthma.

  11. Emergency assistance for various types of pulmonary edema.

  12. Aspiration syndrome, pathogenesis, clinical manifestations, intensive care.

  13. Intensive therapy of postoperative acute respiratory failure.

  14. Intensive care at different types of drowning.

  15. Respiratory distress syndrome of adults, the etiology, pathogenesis, clinical features, intensive care.

  16. Intensive care pulmonary artery and its branches.

  17. Types of acute circulatory disorders.

  18. Pathogenesis, clinical features and intensive therapy of acute heart failure.

  19. Pathogenesis, clinical manifestations and intensive therapy of acute cardiac arrhythmia.

  20. Pathophysiology, diagnosis, especially leakage and intensive therapy for dizziness and collapse.

  21. Pathogenesis, clinical manifestations and intensive therapy of traumatic shock.

  22. Pathogenesis, clinical manifestations and intensive therapy of hemorrhagic shock.

  23. Pathogenesis, clinical manifestations and intensive therapy of burn shock.

  24. Pathogenesis, clinical manifestations and intensive therapy of anaphylactic shock.

  25. Pathogenesis, clinical manifestations and intensive therapy of toxico-infectious shock.

  26. Intensive care in electrical accident.

  27. Intensive therapy for a syndrome of prolonged compression.

  28. Intensive care in polytrauma.



^ 6.1. List of practical tasks to the final modular control

  1. Ensuring airway.

  2. Of artificial ventilation simplest methods ( "mouth to mouth", "mouth to nose").

  3. Implementation of indirect cardiac massage.

  4. Of electrical defibrillation.

  5. Artificial ventilation by Ambu bag and with S-shaped tube.

  6. Methods of oxygen therapy.

  7. Determining the type and degree of respiratory insufficiency.

  8. Measurement of central venous pressure.

  9. Calculation of daily water balance, determine the degree of dehydration.

  10. The calculation of the deficit the major electrolytes (potassium, sodium, chlorine), the choice and calculation of the number of solutions for the correction of electrolyte imbalance.

  11. Determination of types of disturbance of acid-base status and the calculation of the volume of infusion of funds for the correction.

  12. Detoxification (gastric lavage, forced diuresis).

  13. Assessment of consciousness.

  14. Methods of artificial ventilation in infants and young children.

  15. Indirect cardiac massage in newborn and young children.



7. Literature.

Basic literature:

  1. Carl L. Gwinnutt. / Lecture notes on clinical anaesthesia. Second edition. Blackwell Publishing, 2004. – 176 p.

  2. Colquhoum M.C., Handley A.J., Evans T.R. / ABC of resuscitation. Fifth edition. – BMJ Publishing Group, 2004. – 126 p.

  3. Tchuev P.M., Vladyka A.S. / Intensive care in emergency. Odessa. The Odessa State Medical University. 2005. – 100 p.


Additional literature:

  1. Anthony J. Handley, Rudolph Koster, Koen Monsieurs at all / Adult basic life support and use of automated external defibrillators. European Resuscitation Council Guidelines for Resuscitation 2005.

  2. Cohen А.J. Physiologic Concepts in the Management of Renal, Fluid and Electrolite Disorders in the Intensive Care Unit // Intensive Саrе Medi­cine / Edited Bу J. М. Rippe, R. S. Irwin, М. Р. Fink, F. В. Cerra. - Vo1. - Boston; New York; Toronto; London: Little, Brown & Со., 950 p.

  3. Deitch Е.А. Burn Management // Intensive Care Medicine / Edited Bу J.М. Rippe, R.S. Irwin, М.Р. Fink, F.В. Cerra. - Vol. I.I.- Boston; New York; Toronto; London: Little, Brown & Со. – 1965 p.

  4. Hosenpud Jeffrey D. Congestive Heart Failure. Third Edition. Lippincott Williams & Wilkins, 2007. 833 p.

  5. International Liaison Committee on Resuscitation. / Adult basic life support. European Resuscitation Council Guidelines for Resuscitation 2005.

  6. Irwin R.S., French С.Т., Mike R.W. Respiratory Adjunct Therapy // Intensive Care Medicine / Edited By J.М. Rippe, R.S. Irwin, М.Р. Fink. Р.В. Сеrrа.- Val. I.-Воstоn; Nеw Уоrk; Toronto; London: Little, Brown &Со. – 787 p.

  7. Irwin R.S., Рrattеr М.R. А Physiologic Approach to Managing Respiratory Failure / Ibid. – 587 p.

  8. Linden С.N. Diаgrnosis and Difierentia1 Diagnosis of Poisoning ∕∕ In­tensive Care Mcdicine ∕ Edited Bу J.М. Rippe, R.S. Irwin, М.Р. Fink, F.В. Cerra. - Vol.1 - Boston; New Уork; Toronto; London: Little, Brown & Со., 1996. – 1487 p.

  9. Paraskos J.А. Cardiopulmonary Resuscitation ∕∕ Intensive Care Ме­dicinc ∕ Edited Bу J.М. Rippe, R.S. Irwin, М.Р. Fink, F.В. Сеnа. ­Val. 1. - Boston; New Уork; Toronto; London: Little, Brown & Со., Р. 307­336

  10. Peter J.F. Baskett, Jerry P. Nolan, Anthony J. Handley at all / Principles of training in resuscitation. European Resuscitation Council Guidelines for Resuscitation 2005.

  11. Taylor R. Cardiovascular Diseases: A Handbook. Springer, 2005. 294 p.

  12. Topol Eric J, Califf Robert M, Prystowsky Eric N, Thomas James D, Thompson Paul D. Textbook of Cardiovascular Medicine. 3rd ed. Lippincott Williams & Wilkins, 2006. 1664 p.

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