Download Module No. 2. General Intensive Care

Львівський національний медичний університет
ім. Данила Галицького
Кафедра анестезіології та інтенсивної терапії ФПДО
МЕТОДИЧНА РОЗРОБКА
до практичних занять з анестезіології та інтенсивної терапії
для студентів V курсу медичного факультету
(англійська мова навчання)
Львів – 2011
Методичну розробку складено на основі типової навчальної програми
___________
Методичні рекомендації склали викладачі кафедри анестезіології та інтенсивної
терапії ФПДО: ас. Колупаєв О.В., ас. Волощук Р.Р.
Рецензент: ___________
Методичні рекомендації схвалені _________
Відповідальний за випуск ___________
Module 1. General Resuscitation and Anesthesiology
Theme 1. Cardio-Pulmonary and Cerebral Resuscitation
1. Development of reanimatology and intensive care in Ukraine and in the World.
2. Organization of reanimatology and intensive care in Ukraine.
3. Causes of primary cardiac arrest.
4. Stages of cardio-pulmonary and cerebral resuscitation.
5. Immediate stage of cardio-pulmonary and cerebral resuscitation.
6. Signs of clinical death.
7. Causes of airway obstruction and airway management techniques.
8. Technique of mechanical pulmonary ventilation and chest compressions.
9. Evaluation of efficiency of resuscitation.
10. Types of circulatory arrest.
11. Use of medications and routes of drug administration during resuscitation. ECG-based
diagnosis of type of cardiac arrest.
12. Indications for defibrillation and open-chest cardiopulmonary resuscitation.
13. Technique of defibrillation and safety during defibrillation.
14. 3rd stage of cardio-pulmonary and cerebral resuscitation.
15. Patient assessment methods and evaluation of survival possibility.
16. Pathogenesis and clinical course of post-arrest disease.
17. Decortication, decerebration, brain death. Clinical signs, biochemical methods and tests used
to diagnosed brain death.
18. Euthanasia. Problem of life and death.
19. Interaction between reanimatologists, related medical specialists and families of patients.
20. Deontology issues. Ethical and legal problems.
21. Intensive care management of post-arrest disease: improvement of tissue perfusion,
management of low-output syndrome, improvement of blood reology, restoration of gas
exchange and correction of metabolic disturbances.
22. Intensive care management of cerebral edema.
23. Improvement of cerebral metabolism and management of reperfusion-related complications.
Restoration of integartive function of the brain.
24. Resuscitation of children of different age (newborns, infants, children over 1 year) and the
elderly.
Sample Multiple Choice Questions
1. Pulseless electrical activity on ECG is defined as:
A.
B.
C.
D.
E.
Ventricular complexes less than 30 per min.
Irregular waveforms of different shape and high frequency
Any heart rhythm that should be producing a pulse but does not
Ventricular complexes more than 140 per min.
Baseline with no ventricular complexes.
2. Which compression/ventilation ratio is obligatory during CPR using chest compression and
ventilation via cuffed endotracheal tube?
A. 1:15.
B. 2:15.
C. 2:30.
D. Ventilation is not necessary.
E. Ventilation and compressions are provided without synchronization
Theme 2. General Anesthesiology
1. Definition of anesthesiology as a scientific and practical medical specialty focusing on
analgesia and management of vital functions.
2. The role of anesthesiology in the modern system of medical knowledge.
3. Development of anesthesiology in Ukraine and in the world. Organization of anesthetic
management in Ukraine.
4. Types of general anesthesia.
5. Theories explaining the nature of general anesthesia.
6. Classification of modern methods of anesthesia.
7. Components and methods of anesthesia: analgesia, sedation, muscle relaxation, maintenance
of adequate ventilation and gas exchange, circulation and metabolism.
8. Inhalational anesthesia. Equipment and instruments used for inhalational anesthesia.
9. Inhaled anesthetics: ether, halothane.
10. Stages and clinical characteristics of general anesthesia.
11. Non-inhalational anesthesia. Non-inhalational anesthetics: ketamine, thiopental sodium,
gamma-hydroxy butyrate, propofol.
12. Regional anesthesia. Types and methods of regional anesthesia.
13. Technique and methods of epidural puncture and catheterization.
14. Peculiarities of out-patient and urgent general anesthesia.
15. Choice of method of analgesia for urgent surgery.
16. Preparation of patients for surgery and anesthesia.
17. Complications of general and regional anesthesia.
18. Occupational hazards in anesthesiology.
Sample Multiple Choice Questions
1. At which level is subarachnoid puncture usually performed for spinal anesthesia in adults?
A.
B.
C.
D.
E.
S3-S4
L3-L4
Th3-Th4
C3-C4
Th10-Th11
2. Which of the following medications may cause hallucinations?
A.
B.
C.
D.
E.
Diazepam
Ketamine
Propofol
Sodium Thiopental
Droperidol
Theme 3. Clinical Anesthesiology
1.
2.
3.
4.
5.
Choice of anesthesia for head and neck surgery. General anesthesia in neurosurgery.
Choice of anesthesia for thoracic surgery.
Choice of anesthesia for abdominal surgery.
Choice of anesthesia for trauma and orthopedic surgery.
General anesthesia in obstetrics and gynecology: anesthesia for labor, general anesthesia for
small obstetrical procedures, anesthesia for cesarean section.
6. Physiological peculiarities of anesthesia for children and elderly patients.
7. Intensive care and preparation of patients for surgical treatment of antrum stenosis, ileus,
peritonitis, pancreatitis. Intensive care in the early post-operative period.
Sample Multiple Choice Questions
1. A patient is scheduled for thigh fracture fusion. Expected duration of surgery is 2.5 hours.
Select the most appropriate anesthesia technique.
A.
B.
C.
D.
E.
Femoral nerve block
Spinal anesthesia
IV anesthesia with spontaneous ventilation
Sciatic nerve
Infiltration anesthesia
2. A patient with a history of COPD is scheduled for inguinal hernia surgery. Select the most
appropriate anesthesia technique.
A.
B.
C.
D.
E.
IV anesthesia with mechanical ventilation
Epidural anesthesia
Endotracheal anesthesia
Lumbar plexus block
Mask anesthesia
Module No. 2. General Intensive Care
Theme 4. Diagnosis and Management of Disorders of Fluid, Electrolyte
and Acid-Base Balance
1.
2.
3.
4.
5.
6.
7.
Physiology of homeostasis.
Pathophysiology of fluid-electrolyte and acid-base balance
Homeostatic functional system, molarity, osmolarity
Fluid balance disorders – etiology, diagnosis and correction
Electrolyte disorders – Na, K, Cl, Ca; etiology and correction
Physiologic pathways of regulation ofacid-basebalance.
Types of acid-base imbalance, methods of diagnosis and intensive treatment of metabolic
acidosis and metabolic alkalosis
8. Types of acid-base imbalance, methods of diagnosis and intensive treatment of respiratory
acidosis and respiratory alkalosis
9. Diagnosing of hypovolaemia
10. Haemocorrecting medications, indications and contraindications for use.
11. Infusion therapy: ways of infusions, basic principles, peculiarities in childhood and elderly
patients
12. Complication of infusion therap
13. Basic principles of parenteral feeding. Drugs and rules of parenteral feeding, control of
effectiveness,peculiarities in childhood and elderly patients.
Sample Multiple Choice Questions
1. Which of the following indicates respiratory acidosis (arterial blood sample)?
A.
B.
C.
D.
E.
рН 7.12, рСО2 24 mmHg
рН 7.56, рСО2 22 mmHg
рН 7.02, рСО2 64 mmHg
рН 7.62, рСО2 62 mmHg
рН 7.40, рСО2 18 mmHg
2. Which of the following indicates metabolic acidosis (arterial blood sample)?
A.
B.
C.
D.
E.
рН 7.40, рСО2 18 mmHg
рН 7.22, рСО2 56 mmHg
рН 7.62, рСО2 62 mmHg
рН 7.02, рСО2 64 mmHg
рН 7.12, рСО2 22 mmHg
Theme 5. Acute Renal Failure. Acute Hepatic Failure.
1.
2.
3.
4.
5.
Anatomy and physiology of the urinary system
Acute renal failure: classification and pathophysiology
Clinic, physiologic and biochemical disorders in ARF. Methods of diagnosis.
Intensive care of ARF according to stages.
Extracorporeal detoxication (haemodialysys, haemofiltration, ultrafiltration, peritoneal
dialysis)
6. Etiology and pathophysiology of acute hepatic failure
7. Clinical features and treatment of acute hepatical failure
Sample Multiple Choice Questions
1. Acetaminophen poisoning is typically associated with:
A.
B.
C.
D.
E.
Acute urinary retention
Acute liver failure
Acute heart failure
Malignant hypertermia
Arterial hypertension
2. Coagulopathy as the symptom of hepatic failure develops due to:
A.
B.
C.
D.
E.
DIC syndrome
Lack of blood clotting factors
Thrombocytopathy
Hyperproteinemia
Increased blood bilirubine
Theme 6. Acute poisonings and comatose conditions.
1.
2.
3.
4.
5.
6.
7.
8.
9.
Understanding of acute poisonings.
Classification of poisononings.
General principles of management of acute poisoning.
Intensive care management of acute poisonings: tranquilizers, opiates, barbiturates,
organophosphates, ethanol, methanol, carbon monoxide, acids, alkali, poizonous
mushrooms. Extracorporeal detoxication methods.
Emergency care for insect and animal bites.
Differential diagnosis of coma.
Coma depth determination.
Intensive care management of different types of coma (hypoglycemic, hyperglycemic,
hyperosmolar, hepatic, uremic).
Intensive care management of cerebral edema, seizures and hyperthermia in children.
Sample Multiple Choice Questions
1. Which of the following is the antidote to acetaminophen:
A.
B.
C.
D.
E.
Acetyl cycteine
Methylene blue
Flumazenyl
Naloxone
Ethanol
2. Which syndrome is most typical for ethylene glycol poisoning?
A.
B.
C.
D.
E.
Acute liver failure
Acute renal failure
Visual symptoms
Skin lesions
Agitation, hallucinations
Module No. 3. Intensive Care Management of Critical Conditions
Theme 7. Acute Respiratory Failure (ARF)
1. Physiology of breating. Non-respiratory functions of lungs.
2. Anatomy and physiology of respiration in children and elderly patients.
3. Etiology, pathogenesis, classification and clinical course of ARF, diagnostic algorhythms.
4. Types, clinical signs and diagnosis of hypoxia.
5. Clinical signs of hypercapnia.
6. Methods of intensive care management of ARF.
7. Airway management techniques.
8. Methods of pulmonary drainage.
9. Management of hypoxemia.
10. Method of supplemental oxygen delivery.
11. Indication for constant positive airway pressure (CPAP) in spontaneous ventilation.
12. Indications for mechanical ventilation.
13. Contraindications and possible complications of mechanical ventilation.
14. Hyperbaric oxygenation. .
15. Peculiarities of intensive care management of acute respiratory failure in children.
Sample Multiple Choice Questions
1. Which of the following indicates hyperventilation?
A.
B.
C.
D.
E.
PaO2 109 mmHg
PaCO2 71 mmHg
PaCO2 23 mmHg
FiO2 0.40
PaCO2 40 mmHg
2. Which of the following leads to acute hypercapnia:
A.
B.
C.
D.
E.
Hypovolemia
Hyperventilation
Increased FiO2
Decreased FiO2
Hypoventilation
Theme 8. Diseases of the Respiratory System
1.
2.
3.
4.
5.
6.
7.
8.
Intensive care management of postoperative acute respiratory failure.
Intensive care management of acute respiratory failure due to pneumonia.
Intensive care management of acute respiratory failure due to status asthmaticus.
Intensive care management of acute respiratory failure due to pulmonary edema.
Intensive care management of acute respiratory failure due to near-drowning.
Intensive care management of acute respiratory failure due to pulmonary embolism.
Intensive care management of acute respiratory failure due to massive aspiration.
Intensive care management of acute respiratory failure due to adult acute respiratory
syndrome.
9. Intensive care management of acute respiratory failure due to neonatal acute respiratory
distress syndrome
Sample Multiple Choice Questions
1. Which shifts are typical for early stage of severe asthma exacerbation?
A.
B.
C.
D.
E.
Low РаО2, high РаCО2
High РаО2, high РаCО2
Low РаО2, low РаCО2
High РаО2, low РаCО2
Normal РаО2, high РаCО2
2. Which of the following is indicated for management of asthma exacerbation?
A.
B.
C.
D.
E.
Beta-1 agonists
Beta-2 agonists
Beta-2 blockers
Beta-1 blockers
Alpha-1 agonists
Theme 9. Acute Disorders of Circulation
1.
2.
3.
4.
5.
6.
Physiology and pathophysiology of circulation.
Systemic transport of oxygen as a marker of adequacy of circulation.
Pathophysiology and pathogenesis of acute circulatory disorders
Types of critical discirculation: cardiac and vascular failure, hypovolaemia.
Criteria of microcirculatory disorders
Etiology, clinic and diagnosis of Acute Heart Failure; basic principles of intensive care of
AHF
7. Etiology, clinic and diagnosis of cardiac arrhythmias; basic principles of intensive care
8. Functioning of cardiovascular system and treatment of its disorders in different age;
9. Pathophysiology, diagnosis, clinical manifestation and intensive care of collapse and
syncope
Sample Multiple Choice Questions
1. Which of the following is indicated to treat severe arterial hypotension due to miocarditis?
A.
B.
C.
D.
E.
Rapid infusion of normal saline
Dobutamine
Nitroglycerine
Furosemide
Atropine
2. Increase of CVP suggests:
A.
B.
C.
D.
E.
Right heart overload
Hypovolemia
Peripheral vasodilation
Intracranial hypertension
Peripheral vasoconstriction
Theme 10. Shock and Traumatic Injuries
1. Shock – definition and classification.
2. Pathophysiology, diagnosis, clinical manifestation and intensive care ofhaemorrhagic shock
3.
4.
5.
6.
7.
8.
Pathophysiology, diagnosis, clinical manifestation and intensive care of traumatic shock
Pathophysiology, diagnosis, clinical manifestation and intensive care of burn shock
Pathophysiology, diagnosis, clinical manifestation and intensive care of anaphylactic shock
Pathophysiology, diagnosis, clinical manifestation and intensive care of septic shock
Infusion therapy and transfusion in treatment of different types of shock, infusion solutions
Pathophysiology, diagnosis, clinical manifestation,intensive care and complications
preventing in severe brain trauma
9. Pathophysiology, diagnosis, clinical manifestation,intensive care and complications
preventing in poly trauma
10. Pathophysiology, diagnosis, clinical manifestation,intensive care and complications
preventing in crash syndrome
11. Pathophysiology, diagnosis, clinical manifestation,intensive care and complications
preventing in electric shock
Sample Multiple Choice Questions
1. Which of the following is the drug of choice for management of anaphylactic shock:
A.
B.
C.
D.
E.
Epinephrine
Phenylephrine
Nor-epinephrine
Normal saline
Dopamine
List of Practical Skills
1. Airway management techniques
2. Manual artificial ventilation
3. Indirect heart massage by chest compressions
4. Electrical defibrillation
5. Mechanical ventilation using the Ambu bag and S-tube
6. Methods of oxygen delivery
7. Determination of type and degree of respiratory failure
8. Central venous pressure measurement
9. Calculation of water balance and determination of degree of dehydration
10. Calculation of deficit of the main electrolytes
11. Diagnosis of acid-base disorders. Calculation of infusion volume.
12. Methods of detoxication (gastric lavage, forced diuresis).
13. Evaluation of consciousness level.
14. Methods of mechanical ventilation of newborns and infants
15. Technique of chest compression in newborns and infants
Suggested Literature
1.
Intensive Care Medicine, 6th Edition. Irwin R.S., Rippe J.M. – Lippincott Williams &
Wilkins. – 2008.
2.
ICU Book, 3rd Edition. P. Marino. – Lippincott Williams & Wilkins. – 2007.
3.
Clinical Anesthesia, 6th Edition. P.G.Barash, B.F.Cullen et al. – Lippincott Williams
Wilkins. – 2009.
4.
2010 International Consensus on Cardiopulmonary Resuscitation and Emergency
Cardiovascular Care Science With Treatment Recommendations. Nolan J.P. et al.
Resuscitation. 2010 Oct;81 Suppl 1:e1-25. (available at www.erc.edu).