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Anaesthesiology and Intensive Care. Toxicology
Study Course Description
Course Description Statuss:Approved
Course Description Version:9.00
Study Course Accepted:25.05.2022 10:51:04
| Study Course Information | |||||||||
| Course Code: | AURK_040 | LQF level: | Level 7 | ||||||
| Credit Points: | 3.00 | ECTS: | 4.50 | ||||||
| Branch of Science: | Clinical Medicine; Anaesthesiology and Resuscitation | Target Audience: | Medicine | ||||||
| Study Course Supervisor | |||||||||
| Course Supervisor: | Indulis Vanags | ||||||||
| Study Course Implementer | |||||||||
| Structural Unit: | Department of Anaesthesiology and Intensive Care | ||||||||
| The Head of Structural Unit: | |||||||||
| Contacts: | Riga, 13 Pilsoņu Street, VSIA P.Stradiņa KUS, 32. korpuss, ark rsu[pnkts]lv, +371 67069452 | ||||||||
| Study Course Planning | |||||||||
| Full-Time - Semester No.1 | |||||||||
| Lectures (count) | 0 | Lecture Length (academic hours) | 0 | Total Contact Hours of Lectures | 0 | ||||
| Classes (count) | 16 | Class Length (academic hours) | 3 | Total Contact Hours of Classes | 48 | ||||
| Total Contact Hours | 48 | ||||||||
| Study course description | |||||||||
| Preliminary Knowledge: | Knowledge gained in the courses studied in previous years is needed: types of surgery, topographical anatomy, clinical pharmacology, pathological physiology, clinical laboratory examinations, first aid during patient’s primary and secondary investigation on the site of accident, basic cardiopulmonary resuscitation and basic elements of shock. | ||||||||
| Objective: | Promote knowledge acquisition of types and stages of anaesthesia, preoperative risk assessment of surgery and anaesthesia, principles of intensive therapy in the most common situations at internal medicine, neurology and surgical clinics, as well as learning basics of advanced cardiopulmonary resuscitation. Provide knowledge of disaster medicine and organizational structure, material and technical provision, primary and secondary assessment of the casualty, basic principles of triage, manipulation and treatment, specific character of chemical catastrophes and their elimination, as well as knowledge of epidemiology of acute exogenous intoxications, toxicokinetics and specific nature of its of treatment, clinical course of certain types of poisoning, recommended treatment methods and inform about the most known contaminants. | ||||||||
| Topic Layout (Full-Time) | |||||||||
| No. | Topic | Type of Implementation | Number | Venue | |||||
| 1 | Disaster medicine: principles and methods for the classification of victims of accidents and disasters in the prehospital stage. START system "Gold lesson" in disaster medicine, medical documentation, problem solving. | Classes | 0.25 | clinical base | |||||
| 2 | Toxicology: introduction, general principles of diagnosis and treatment, poison information centre, intensive care in acute poisoning, poisoning by alcohol and surrogate alcohol. | Classes | 1.00 | clinical base | |||||
| 3 | Toxicology: poisoning with sedative-hypnotic substances. | Classes | 1.00 | clinical base | |||||
| 4 | Toxicology: poisoning with irritating and corrosive substances; poisoning with carbon monoxide. | Classes | 1.00 | clinical base | |||||
| 5 | Anaesthesiology and intensive care: advanced cardiopulmonary resuscitation. Defibrillation. | Classes | 2.00 | METC | |||||
| 6 | Anaesthesiology and intensive care: standard anaesthesia rules and documentation, patient's consent to anaesthesia, consultation of an anaesthetist before anaesthesia, assessment of the patient's physical condition according to the ASA physical status classification system. Clinical laboratory examinations to be performed by the patient prior to anaesthesia. Evaluation of respiratory tract before anaesthesia. Pre-medication. | Classes | 0.75 | clinical base | |||||
| 7 | Anaesthesiology and intensive care: general stages and types of anaesthesia, its practical provision, medications to be used. Standard and extended monitoring of the patient's condition in anaesthesiology. Evaluation and interpretation of clinical, biochemical, water-electrolyte analysis, blood gas composition and acid-alkaline balance. Patient postoperative analgesia. | Classes | 1.00 | clinical base | |||||
| 8 | Anaesthesiology and intensive care: regional anaesthesia, its types (central neuraxial blockade – spinal and epidural anaesthesia, peripheral nerve and nerve block) and the medication to be used. | Classes | 1.00 | clinical base | |||||
| 9 | Anaesthesiology and intensive care: methods for providing respiratory passage (manual methods, nasal and oropharyngeal airways, laryngeal mask, larynx tube, tracheal intubation, extreme cricotireotomy). | Classes | 1.00 | clinical base | |||||
| 10 | Mechanical lung ventilation. ARDS | Classes | 1.00 | clinical base | |||||
| 11 | Anaesthesiology and intensive care: sepsis definition III, diagnostic criteria, treatment and stabilization of initial condition. | Classes | 1.00 | clinical base | |||||
| 12 | Anaesthesiology and intensive care: investigation and assessment of critically ill patients (Glasgow, APACHE II, SOFA, and other scales). Patient monitoring (including blood gas analysis) and intensive care principles. Coma patients and practical intensive care for them. ICU. | Classes | 1.00 | clinical base | |||||
| 13 | Anaesthesiology and intensive care: shock. Pathogenetic classification of shock (hypovolemic, cardiogenic, obstructive, distributive shock). Intensive therapy in the event of shock. Infusion therapy. Basic transfusiology. | Classes | 1.00 | clinical base | |||||
| 14 | Anaesthesiology and intensive care: haemostatic disorders in intensive care and anaesthesiology. Evaluation of the coagulation system. Interference correction. DIC. | Classes | 1.00 | clinical base | |||||
| 15 | Anaesthesiology and intensive care: Enteral and parenteral nutrition in intensive care unit practice MODS. Replacement therapy principles. | Classes | 1.00 | clinical base | |||||
| 16 | Clinical case studies. Preparing for the exam. | Classes | 1.00 | clinical base | |||||
| Assessment | |||||||||
| Unaided Work: | Preparing the subject of the class in advance; using the recommended literature and Internet sources followed by their evaluation and practical application during classes. Presentation of PowerPoint presentations on the researched topics. | ||||||||
| Assessment Criteria: | Examination (multiple choice test; analysis of clinical cases preforming triage as well as analysing cases of acute poisoning; OSCE type examination in advanced cardiopulmonary resuscitation including defibrillation; airway management techniques and patient artificial lung ventilation.) Assessment criteria in theoretical multiple choice test: more than 75% correct answers. Assessment criteria performing advanced cardiopulmonary resuscitation including defibrillation on a manikin – knowledge and practical skills in using basic resuscitation algorithm assessing ambient safety, checking for a response, dialling for help, opening the airway, breathing check, chest compression, lung ventilation with a manual ventilator, preparing defibrillator for use, heart rate analysis, defibrillator charging, defibrillation safety inspection, practical defibrillation, 2 minutes of cardiopulmonary resuscitation, repeated heart rate analysis, pulse and breathing test, intravenous medication input as well as description of the subsequent tactics. In total, at least 28 points must be obtained according to a special assessment table, which corresponds to 70% of precisely performed manipulations. Opening of the airways requires knowledge of the practical application of the devices, ability to perform quick and safe input into airways, ventilation control and provision, and fixation of the injected tube. | ||||||||
| Final Examination (Full-Time): | Exam (OSCE) | ||||||||
| Final Examination (Part-Time): | |||||||||
| Learning Outcomes | |||||||||
| Knowledge: | Upon completion of the study course students will be able to name and describe different methods of anaesthesia and intensive care, recognize and describe shock (especially hypovolaemic, anaphylactic, septic), carry out advanced cardiopulmonary resuscitation, will be able to name and describe changes in pathophysiological and biochemical processes as a result of surgical trauma, the devastating effects of pain syndrome on the organism and transmission of a nociceptive impulse to the CNS, describe types of pain syndrome blocks in reflector rim sections, basic principles of anaesthesia, its types, their advantages and side effects, specific character of preoperative examination of a surgical patient, evaluation of the physical condition of a surgical patient using ASA scale, as well as basic principles of preparing a surgical patient at the pre-operative stage and perioperative care, critical condition and basic intensive care. On completion of the study course students will have acquired basic knowledge of relief principles in disaster medicine, will be able to provide emergency assistance to the highest possible number of victims in the shortest possible time according to the principle of priority, as well as will have acquired basic knowledge of clinical toxicology – pathways of toxic substances into the body, toxicokinetic considerations, treatment options and characteristic features. Will be able to describe the organisation of Civil Protection System in the country, the duties of state institutions in the civil protection system, to describe individual behaviour when hearing the alarm, to describe personal protective equipment in case of catastrophes and evacuation measures in case of disasters. | ||||||||
| Skills: | Students will be competent in cardio-electrical defibrillation, basic in-depth cardiopulmonary resuscitation; they will be able to ensure airway permeability with instrumental methods (airways, laryngeal mask, laryngeal tube, Combitube, endotracheal intubation, cricotireotomia), will be able to assess the condition of a comatose patient. Will be able to carry out triage of the victims at the scene and in hospitals, will be able to provide victims with vital functions and required emergency treatment according to the nature of the disaster and injury, will be able to use personal protective equipment; will be able to diagnose acute intoxication, assess their severity and extent of the required treatment based on the anamnesis, patient complaints, clinical symptoms and laboratory findings. | ||||||||
| Competencies: | Students will be able to use the acquired knowledge and skills when performing advanced cardiopulmonary resuscitation, analysing types and phases of general and regional anaesthesia, surgery and anaesthesia risks, analysing most common situations in intensive care; they will have competence to interpret clinical, biochemical, water-electrolyte tests as well as interpret the blood gas composition and acid-base balance parameters, coagulation indicators, refer them to specific clinical situations and link them with overall examination process, co-interpret clinical and laboratory kidney and liver failure symptoms, link them with overall condition and develop competent action plan, attribute central haemodynamic parameters to a specific clinical situation and link them to overall examination process, be able to develop immediate action plan and far-reaching action tactics for patients with complex and long-term health problems, and coordinate the actions with other members of healthcare system, to analyse the situation, demonstrate an individual approach to the patient, balance between applying general operational guidelines and a creative approach to each clinical case, to make argument-based, verifiable and scientifically-driven decisions about the health and life of a patient. Will acquire competence for the assessment of medical consequences and potential dangers of a disaster, on triage of victims and on the extent of emergency care at different stages of disaster relief with limited medical resources; the competence to take individual decisions, as appropriate, while working in a team and following general disaster management instructions; the competence on risk factors for acute exogenous intoxication, epidemiology, about the arguments of an acute toxicological patient, drawing up argument-based, immediate action plan for diagnosis, differential diagnosis and far-reached action tactics linking them to a specific clinical situation and demonstrating the individual attitude towards the patient. | ||||||||
| Clinical Skills: | |||||||||
| No. | Skill | Level | |||||||
| 1 | Analysis of arterial blood gases | A - Beginner level | |||||||
| 2 | Bag-mask ventilation | B1 - Basic level | |||||||
| 3 | Cardiopulmonary resuscitation (basic) | B2 - Intermediate level | |||||||
| 4 | Combined spinal-epidural anaesthesia | C1 - High level | |||||||
| 5 | Defibrilation | B2 - Intermediate level | |||||||
| 6 | Epidural anaethesia | C1 - High level | |||||||
| 7 | High O2 concentration mask placement | B2 - Intermediate level | |||||||
| 8 | Intraoperative monitoring | C1 - High level | |||||||
| 9 | Laryngeal tube insertion | B1 - Basic level | |||||||
| 10 | Nasopharyngeal airway insertion | B1 - Basic level | |||||||
| 11 | Oropharyngeal airway insertion | B1 - Basic level | |||||||
| 12 | Spinālā anestēzija | C1 - High level | |||||||
| 13 | Total intravenous anesthesia (TIVA) | C1 - High level | |||||||
| Bibliography | |||||||||
| No. | Reference | ||||||||
| Required Reading | |||||||||
| 1 | Praktisko nodarbību materiāli un E-studiju resursi. | ||||||||
| 2 | Klīniskā anestezioloģija un intensīvā terapija. I. Vanaga un A. Sondores redakcijā. Medicīnas Apgāds, 2017, 1295 lpp. | ||||||||
| 3 | V. Liguts. Intensīvās terapijas rokasgrāmata. Rīga: Medicīnas apgāds. 2008. (akceptējams izdevums) | ||||||||
| 4 | Miller's Anesthesia, 2-Volume Set. 9th Edition, October 7, 2019. Elsevier. | ||||||||
| 5 | Ārvalstu studentiem/For international students: | ||||||||
| 6 | Miller's Anesthesia, 2-Volume Set. 9th Edition, October 7, 2019. Elsevier. | ||||||||
| Additional Reading | |||||||||
| 1 | A. Sondore. Anestezioloģijas pamati vairāk kā 1000 jautājumos un atbildēs. Rīga: Nacionālais Apgāds, 2016. | ||||||||
| 2 | B. Mamaja. Anestēzija pediatrijā. Rīga, RSU, 2008. | ||||||||
| 3 | E. Vasiļevskis. Reģionālās anestēzijas ABC. Nacionālais Apgāds, 2008. | ||||||||
| 4 | I. Vanags, E. Daugulis, P. Tominš. Anestezioloģija, reanimatoloģija un intensīvā terapija. Rīga: Nacionālais Apgāds, 2002. | ||||||||
| 5 | Smith and Aitkenhead's Textbook of Anaesthesia: Expert Consult. Online & Print, 7th Edition, Kindle Edition, by Jonathan Thompson (Author, Editor), Iain Moppett (Author, Editor), Elsevier; 7th edition, April 9, 2019 | ||||||||
| 6 | Morgan and Mikhail's Clinical Anesthesiology. 7th Edition, by John Butterworth, David Mackey, John Wasnick. McGraw Hill / Medical; June 3, 2022. | ||||||||
| 7 | Clinical Anesthesia. 8th Edition, by Paul G. Barash, Michael K. Cahalan MD, Bruce F. Cullen MD, et.al. LWW; May 19, 2017. | ||||||||
| 8 | Textbook of Critical Care. 7th Edition - November 27, 2016. Editors: Jean-Louis Vincent, Frederick Moore. Elsevier. | ||||||||
| 9 | European Resuscitation Council Guidelines for Resuscitation 2021. Resuscitation (Elsevier), 2021, 161. | ||||||||
| 10 | Ārvalstu studentiem/For international students: | ||||||||
| 11 | European Resuscitation Council Guidelines for Resuscitation 2021. Resuscitation (Elsevier), 2021, 161. | ||||||||
| 12 | Clinical Anesthesia. 8th Edition, by Paul G. Barash, Michael K. Cahalan MD, Bruce F. Cullen MD, et.al. LWW; May 19, 2017. | ||||||||
| Other Information Sources | |||||||||
| 1 | http://www.anest.lv/ | ||||||||
| 2 | http://www.esahq.org/ | ||||||||
| 3 | http://www.anaesthesiologists.org/ | ||||||||
| 4 | http://www.shocksocieties.org/international/shockjournal/ | ||||||||
| 5 | http://www.esicm.org/ | ||||||||
| 6 | http://www.intensive.org/ | ||||||||
