TERNOPIL STATE MEDICAL UNIVERSITY named by

TERNOPIL STATE MEDICAL UNIVERSITY named by

I.Ya. GORBACHEVSKY

«ASSERT»

First vice-rector

D.Sc., Prof.. I.R. Misula

«_____»__________2013

 

SYLLABUS  on « ANESTHESIOLOGY»

 

 

 

Department of  SURGERY AND ANESTHESIOLOGY № 2

 

Speciality “General Medicine" (7.110101)

 

The Curriculum structure on the  ANESTHESIOLOGY

 

The curriculum structure of the discipline

Number of academic hours

Course/Year of study

Semester

Type of evaluation

 

Auditorium

Students’ individual work

 

Subject/Module name

Name of module content

Total hours/ credits

Lectures

Practical classes

Seminars

 

ANESTHESIOLOGY

 

90 hours/

 

 

 

 

 

 

 

 

 

WORK PROGRAME

ANESTHESIOLOGY AND INTENSIVE CARE

Department of surgery is with anesthesiology № 2

 

Note: 1 credit - 30 hours; audience loading  - 77,7%, IWS – 23,3%

 

The program was made by D.Sc. Oliynyk O.V.

The program is discussed on meeting of department: 12 June in 2013,

protocol №  12   from 12.06.2013 Manager of department

of surgery is with anesthesiology № 2

D.Sc.                                                                                           Oliynyk O.V.

The program is accepted on meeting of cyclic methodical surgical disciplines

commission «_19__» June in 2013, protocol №  _3__   from    06.2013

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ternopil 2013

 

 

 

 

 

 

1. Explanatory note and Structure of ANESTHESIOLOGY

 

 PURPOSE AND TASK OF OBJECT: Study of anesthesiology  and intensive care will help students to get integral imagination about anesthesiology and intensive care as independent section of clinical discipline which studies and develops the question of theory and practice of  organism defense from the extreme influencing (aggressions) and uses the unique methods of adjusting and temporal substitution of vitally important functions from their violations (terminal states, anesthesia, special methods of researches and other).

Program of educational discipline “Anesthesiology and intensive care”  for medical universities  Ukraine  of  ІV level of accreditation  is made for  specialities  “Medical affair” 7.110101, “Paediatrics” 7.110104. A direction of preparation 1101 “Medicine”  in accordance  with educationally qualifying descriptions  (EQD)  and educationally professional programs (EPP)  of preparation of specialists, ratified from 16.04.03 in order № 239 “About claim of standards of higher education in direction of preparation  1101 “Medicine”. The study of anaesthesiology is carried out during  5 year of studies.

The term of studying in these specialties lasts for 1 year. The ultimate goals of disciplines are identical; therefore the united program on ANESTHESIOLOGY for these disciplines was created.

 According to the curriculum the study of ANESTHESIOLOGY is carried out during the 5th year (semester IX-X).

Physician, regardless of specialization, must know the bases of ANESTHESIOLOGY; therefore the training of skilled physician is impossible without the deep and concrete studying of ANESTHESIOLOGY.

The program is structured into the modules, semantic modules, themes in accordance with the requirements of "Recommendations on the development of educational disciplines" (Order of the Ministry of Public Health of Ukraine, N492 from 12.10.2004).

The program is made in accordance with the followings normative documents:

- by educationally qualifying descriptions and educationally professional programs of preparation of specialists

- by an experimental curriculum, developed on principles of the European credit-transfer system and by the ratified order of Health Care Ministry of Ukraine from 31.01.2005 № 52 “About assertion and introduction of new curriculum of preparation of specialists of educationally qualifying level “Specialist” of qualification “Physician” in higher educational establishments of IV level of accreditation of Ukraine after specialities “Medical affair”, “Paediatrics”

              - by the order of Health Care Ministry Ukraine № 414 from 23.07.07 «About making alteration in the order of Health Care Ministry  of Ukraine from 31.01.2005 ¹52 „About statement  and introduction of new curriculum of preparation of specialists of educationally qualifying level „Specialist” of qualification „Physician” in higher educational establishments of IV levels of accreditation of Ukraine after specialities „Medical affair”, „Paediatrics”,

             - by recommendations in relation to educational program of educational disciplines development, of Ukraine ratified an order from 24.03.2004 after ¹152 “About claim of recommendations in relation to educational program of educational disciplines” development with changes and additions, Health Care Ministry of Ukraine from 12.10.2004

              - by the order of Health Care Ministry of Ukraine from 31.01.03 № 148 “About measures on realization of positions of Bolonskoy of declaration in the system of higher medical and pharmaceutical education”;

- by instruction about the system of evaluation of educational activity of students on condition of the credit-module system of organization of educational process(Medical education in the world and in Ukraine. 2005).

Anesthesiology and intensive care as educational discipline is inalienable part of clinical medicine, that is why study of substantive provisions of this area of science - the moment of preparation of doctor of any specialty is important:

à) it is based on a study – anatomy of man students; to histology, biochemistry,   physiology, physiopathology’s;  internal medicine, paediatrics,  pharmacology, and integrated with these disciplines;

b) bases of study of aanesthesiology and intensive care of the urgent states students which arise up in the clinic of internal medicine, paediatrics, surgery,  traumatology and orthopaedy, neuro-surgery,  urology, obstetrics and gynaecology, and other educational disciplines, where the methods  of anaesthetizing and intensive care which foresees integration of teaching with these disciplines and forming of abilities to apply knowledge in the process of consequent teaching and professional activity are used ;

â) gives possibility to get practical skills and form professional abilities for diagnostics and grant  of the first medical aid and intensive care at definite pathosiss and in the period of care of patients.

Organization of educational process is carried out after the credit module system in accordance with the requirements of Bologn  process.

Program of discipline “Anesthesiology and intensive care” is structure-forming on  one module in the complement of 3 semantic modules. The volume of the educational loading of students is described in the test credits which are set off students at the successful mastering by them proper the module (test credit).

Module: Anesthesiology and intensive care

Semantic modules:

           1. Common guest ions of  anesthesiology and intensive care

    2. Intensive care of  acute cardio-vascular and respiratory systems

 

 The types of educational activity of students in obedience to a curriculum is:

 Lectures, practical employments, independent work of students (IWS), consultations of teachers. Thematic plans of lectures, practical employments, IWS provide realization in the educational process of all of themes which enter in the complement of the semantic modules.

         The themes of lecture course expose the problem questions of the proper sections of discipline.

Practical clinical employments  provide for:

·                    a review  and research  of patients is in the department of intensive care with the discussion of plan and tactic of their treatment;

·                    review and research  of patients, planned  on an operation, work in operating room;

·                    a mastery the special practical skills is on phantoms and models;

·                    practical use  of methods of diagnostics and intensive  treatment;

·                    decision of clinical situational tasks and tests.

 

Current educational activity of students is controlled on practical employments in accordance with concrete aims and during individual work of teacher with students.

It is recommended to apply the followings methods of determination of level of preparation of students:

1.     computer tests;

2.     clinical situational tasks;

3.     estimation and interpretation of laboratory and instrumental inspections;

4.     control of practical skills

5.     verbal questioning.

Final control of mastering the module is carried out on his completion on a concluding control  session.

An estimation of progress of student from discipline is rating and proposed on a multimark scale as a middle arithmetic estimation of mastering the module and has determination by credit system and by a traditional scale, accepted in Ukraine.

Departments have a right to make alteration in an on-line tutorial scope to 15% depending on organizational and technical possibilities, directions of scientific researches, but must execute on the whole the volume of requirements from discipline in obedience to the ultimate goals of EQD after direction of preparation and curriculum.

 

 

 

 

 

 

 

 

 

 

 

 

 

DESCRIPTION OF CURRICULUM FROM DISCIPLINE “ANESTESIOLOGY AND INTENSIVE CARE”

 

 

 

Module Common questions of  anesthesiology and intensive care

 

Pneumocardial and cerebral resuscitation.

Concrete aims:

·        To differentiate  the different types of reasons of death

·        To formulate basic principles  of pneumocardial and cerebral resuscitation

·        To make the charts of lead through of infusion therapy at pneumocardial and cerebral resuscitation

·        To select basic syndromes, that characteristic for pneumocardial and cerebral resuscitation

·        To perform pneumocardial and cerebral resuscitation

·        To formulate basic principles  of intensive care of the postresuscitation disease

 

General questions of  anesthesiology

Common description of  anesthesiology like a science.

History of anesthesiology.

Components of general anesthesia.

Stages of the anaesthetic providing. Premedication, its kinds.

Preparation of patients to the operation and anaesthesia.

Clinic of anaesthesia by ether.

Mask method of general anaesthesia.

Intratracheal anaesthesia. Testimony, method of lead through.

Pharmacology of muscular relaxants

Complication of general anaesthesia.

Inhalation anaesthetics: pharmacokinetics, clinical motion.

Kinds and methods of regional anaesthesia.

Properties of  opioid analgetics.

 

Clinical anesthesiology

A choice of method of anaesthetizing and feature of the anesthetic providing in the  case of operations on a head and neck. General  anesthesia  in neuro-surgery.

A choice of method of anaesthetizing and feature of the anesthetic providing in operations on the organs of pectoral cavity.

A choice of method of anaesthetizing and feature of the anesthetic providing in the operations on the organs of abdominal region.

A choice of method of anaesthetizing and feature of the anesthetic providing in traumatology and orthopaedic  operations.

General anesthesia  in obstetrics and gynecology: anaesthetizing of births, general anesthesia in small obstetric interferences, anesthesia in  a Caesar section.

Physiology and physiopathology features of lead through of general anesthesia for children and  older patients.

Intensive care and preparation of patients with stenos of goalkeeper, intestinal impassability, peritonitis, pancreonecrosis. Intensive care is in perioperating period.

 

 

Methods of diagnose  and correction of violations of water-electrolyte exchange  and acid-basic state (ABS)

Physiology mechanisms of maintenance of internal environment of organism, methods of its control. Physiopathology of water-electrolyte exchange and acid-basic state. Concept about the homoeostatic functional system, molarity. Types of violations of exchange of water, their reason, and methods of diagnostics and correction. Exchange of basic electrolytes - sodium, potassium, chlorine,  calcium, are reasons of possible violations, methods of correction.

Physiology and buffer systems of ABS. Types of violations of the acid-basic state, methods of laboratory diagnostics and intensive care of metabolic acidosis, metabolic alkalosis, respirator acidosis and respiratory alkalosis.

Features of adjustment of active reaction of organism for children and older people.

Methods of determination of deficit of water volume. Description of preparations  of hemodynamic infusions, indication and contra-indication to their application. Ways of introduction. Features of infusion therapy for children and older people. Complication of infusion therapy.

Bases of parenterally feeding. Description of preparations of parenterally feed governed and control after its  efficiency. Features of parenteral feed for children and  older people .

 

 

Acute kidney and hepatic  failure

Anatomy and physiology of the urinary system. AKI, its forms, physiopathology, clinical motion and biochemical disturbances. Methods of diagnostics. Algorithms of intensive care (IT) of the different stages of AKI.  Methods of the out renal cleaning (haemodialysis, hemofiltration, ultra filtration, peritoneal dialysis).

Etiologic factors, physiopathology of development, clinical motion of acute hepatic insufficiency. Methods of IT of acute hepatic insufficiency.

 

Comatose states and acute  poisonings .

A concept is about the acute poisonings. Classification of poisonings. General  principles of intensive care. Intensive care of the poisoning  by tranquilizers, barbiturates, narcotics, ethyl and methyl spirits,  gas, acids, poisonous mushrooms. Application of methods of extracorporeal detoxication.

First aid  at the bites of insects and animals.

Methods of differential diagnostics of the comatose states. Depth-finding comma. Intensive care of commas of different aetiology . Intensive care of cerebral, convulsive and hyper thermal syndromes, oedema in children’s.

 

 

Module Intensive care of  acute cardio-vascular and respiratory systems

 

Concrete aims:

·        To identify the clinical signs of acute respiratory insufficiency

·        To select the different types of acute respiratory insufficiency

·        To formulate basic principles of intensive care of different types of acute respiratory insufficiency

·        To plan tactic of intensive care of acute disorders of breathing of the different kinds of the urgent states (asthmatic state, lungs oedema, sinking, tromboembolia of pulmonary artery and its branches, aspiration syndrome, respiratory disstress syndrome of adults).

·        To identify the clinical signs  of acute cardiac  insufficiency

·        To classify and differentiate  the different types of the shock states

·        To master the grant of the first medical aid at the different types of shock

·        To determine the features of motion and intensive care at a heavy craniocerebral trauma, polytrauma, electrotrauma .

 

Acute respiratory failure

Physiology and breathing physiopathology. Unrespirative functions of lungs. Anatomical  feature of the breathing system for children and older persons.

Aetiology and pathogen of ARI, classification, clinical motion. Algorithms of diagnostics. Hypoxia, its kinds, clinical signs, diagnostics. Hypercapnia, clinical signs.

Methods of intensive care of ARI. Backer-ups free communicating of respiratory tracts and improvement of drainage function of lungs. Methods of oxygen therapy. Testimony to application of the spontaneous breathing under constantly by positive pressure and artificial ventilation of lungs, its contra-indication, and complications. Application of hyperbaric oxygenation .

Intensive care of children with acute respiratory insufficiency.

 

 

Disease of the respiratory system

Intensive care of acute respiratory insufficiency in a preoperative period,  at the asthmatic state, lungs edema, sinking, tromboembolia of pulmonary artery and its branches, aspiration syndrome, respiratory  dysstress syndrome of the adults and   new-born.

 

 

Acute violations of circulation of blood

Physiology and physiopathology of circulation of blood. System transport of oxygen, as an index of adequacy of function of the cardiac-vessel system.

Mechanisms of development of acute circulator insufficiency. Determination of types of critical disorders of hemodynamic of cardiac and vascular insufficiency, hypovolemia. Criteria of disorder of microcirculation.

Reasons of origin, clinical signs and diagnostics of acute cardiac insufficiency, violations of cardiac rhythm. Basic directions of intensive therapy. Age-old features of the cardiac system and mechanisms of development of critical disorders of hemodynamic and their treatment.

Physiopathology, diagnostics, features of motion, and intensive care at dizziness and collapse.

 

Shock states

Shock, types of shock. Physiopathology, diagnostics, features of motion, intensive care of the different types  of shock (hemorrhagic, traumatic, ambustial, anaphylactic, septic). Features of infusion therapy of different types of shock, description of infusions solutions .

A physiopathology, diagnostics, intensive care and measures of prevention of complications, in patients with heavy craniocerebral trauma, polytrauma, electrotrauma

 

 

Structure of test credit – to the module

“Anesthesiology and intensive care”

Audience work   - 77,7%, ISW – 23,3%

 

 

 

Thematic plan of lectures to the module “Anaesthesiology and intensive care”.

 

 

Thematic plan of practical lessons of the module

“Anaesthesiology and intensive care”.

 

LIST OF PRACTICAL SKILLS OF DISCIPLINE

 

 

 

         

8. A LIST OF QUESTIONS  FOR FINAL CONTROL

 

 

CONTROL FORMS

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 the credit-module system of organization of educational process, Ukraine ratified  Health Care Ministry (2005)

 

 

 

 

LITERATURE

1. Barash Clinical Anaesthesia.  4th ed. K.: High School, 2009. - 399 p.

2. Guide to intensive therapy. Ed. AI Treschynskoho, FS Glumcher K.: High School, 2004. - 582 p.3. Emergency medical care.

3. Sumin SA Urgent states. Moscow: OOO "MNA", 2010. - 752 p.

4.  Handbook for practical training in anaesthesiology and critical care medicine. Parts I and II / ed. L.V.Usenko. - K.: Health 2009.1995.

5. Paul L. Marino Intensive care / M.: Heotar Medicine, 2008. - 726 p.

6.. Safar P. Byher ND Resuscitation. - Moscow: Medicine, 2008. - 216 p.