mbchb v block 18 (gnk 586) anaesthesiology...

Name of School

School of Medicine

MBChB V Block 18 (GNK 586)

Anaesthesiology

2013

©Copyright Reserved

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BLOCK 18

ANAESTHESIOLOGY (GNK586)

TABLE OF CONTENTS

A. ORGANISING COMPONENT 1. Block chairperson 2 2. Venues 2 3. Prescribed and recommended books 2 4. Evaluation 3 5. Timetable 5 6. Skills Lab & Case Studies Group Allocations 6 B. STUDY COMPONENT OUTCOMES IN THE BLOCK 7 Study units 10 C. HIV-Policy 27

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GNK586 – Anaesthesiology

The Anaesthesiology component of the block comprises of the basic principles of the theory and practice of anaesthesiology relevant to the generalist.

A. ORGANISING COMPONENT: BLOCK CHAIRPERSON: Dr S Spijkerman Anaesthesiology SBAH Tel: (012) 354-1510/2399 VENUES: All lectures and Anaesthesiology seminars: 3-10 BMS Building Evaluations: Refer to examination timetable PRESCRIBED AND RECOMMENDED BOOKS ANAESTHESIOLOGY: Prescribed books:

1. UP Dept of Anaesthesiology. Anaesthesiology: Undergraduate course. Pretoria: University of Pretoria; 2011.

Recommended books:

1. Morgan GE, Mikhail MS, Murray MJ. Clinical anaesthesiology. 3rd ed. New York: Langae Medical Books/McGraw-Hill; c2002.

2. Coetzee AR, editor. Principles of anaesthesia for the undergraduate student. Stellenbosch: Sun Press; 2008.

Anaesthesiology prize The South African Society of Anaesthesiologists’ medal (Horace Wells medal) for outstanding undergraduate achievement in Anaesthesiology will be awarded at the end of the student intern year to the student who has achieved the highest overall marks in Anaesthesiology. The calculation of marks will include performance in the Anaesthesiology component of Block 18, practical residence in Anaesthesiology during the fifth year and student intern complex (including the CPR course).

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EVALUATION IN BLOCK 18 ANAESTHESIOLOGY GNK 586

Class Block test

Block mark-a

> 60% <60%

First Block examb Promotion Optional

Block marka (½)+ First block exam mark-b (½) = Final block mark

Block mark-a confirmed as first block exam mark-b and recorded as final block mark-c

>50% <50%

Second Block examd

>50% <50%

Pass Fail

Morning rotation

*Students who exercise the option to write the First Block exam despite having met the requirements for promotion, will have their Final Block Mark-c calculated as follows: Block mark-a (½) + First Block exam mark-b (½)

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Requirements for promotion: (thus exemption from 1st block exam): 1. Block mark of 60 % or more 2. Case studies must be satisfactory; forms part of later portfolio assessment ILLNESS DURING EVALUATION: If a student is absent during evaluation due to valid reasons (as determined by the Faculty), the following applies: Class test → Oral test Block test → 1st Block exam (cannot promote) 1st Block exam → 2nd Block exam PS: THE 2nd Block exam is the FINAL EXAM EVALUATION AND DATES OF TESTS AND EXAMINATIONS: ANAESTHESIOLOGY GNK 586 Opportunity Date Format Contribution to block mark Morning rotation Already

completed 20%

Class tests 29 May 08:00*3 June 08:00*

CBTCBT

15%} 30%15%}

Block test 7 June* CBT 50%Block mark 100 %1st Block exam 14 June 08:00 CBTFinal block mark Average of Block mark and Block exam

mark 2nd Block exam 21 June 08:00 Written paper Maximum mark of 50%

* See roster for division of groups Please note: Marks earned during morning rotations during semester 1 form part of the block mark in Anaesthesiology. Requirements for promotion: (thus exemption from 1st block exam): 1. Block mark of 60 % or more

ánd 2. Proof of satisfactory attendance (100%) and participation in Anaesthesiology workshops ánd 3. Anaesthesiology resident mark at the end of the practical resident period (morning rotations) is 50%

or more

NO ADDITIONAL TEST IS SCHEDULED! If a student is not able to write the class test or the block test due to valid reasons (as determined by the Faculty), the student can NOT promote, and the block exam will count proportionally (value calculated according to specific test missed) more in calculating the final block mark. In other words, the block mark will count proportionally less in calculating the final block mark. If a student does not write the first block exam, the second block exam will be regarded as the first block exam (final block mark is calculated from it). The second block exam is the final exam.

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B. STUDY COMPONENT Outcomes in the block The disease conditions and clinical problems which you must be able to manage at the end of this block as well as the skills you should master, are indicated in the Study unit themes below. The modified Nijmegen classification is used to indicate the level of management.

THEORETICAL

KNOWLEDGE CLINICAL PICTURES SKILLS (Practical or Cognitive)

T 1 Interesting to know K 1 Aware of the entity V 1 Only know about the procedure / Is aware of the drug group’s potential place in therapy

T 2 Good to know K 2 Diagnose the condition V 2 Have seen the procedure / Can associate diagnoses / disease profiles and core therapy appropriately

T3 Handy / convenient to know

K 3 Make a preliminary or final diagnosis. Manage temporarily; and refer if necessary

V3 Can perform under supervision / Suggest and perform rational therapy under supervision

T4 Essential knowledge K 4 Diagnose and manage completely yourself

V4 Must be able to perform the procedure routinely yourself / Independently prescribe drugs rationally, and critically evaluate prescriptions

Critical outcomes for the block

After completion of the block, students will be able to:

Evaluation Method (a) Identify and solve problems through critical and creative thinking

Paper problem evaluations Seminars OSPE

(b) Gather, analyse, organise and critically evaluate information

Class tests

(c) Communicate effectively Seminars Tutorials

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1. Specific outcomes of study units: PAPER CASES: Lack of preparation or absenteeism will be penalised severely according to a predetermined manner and this will be reflected in the final mark! Specific problems / patient cases may be presented beforehand to the class and have to be prepared for the specific period! Study aims of paper cases: The student must be able to:

(i) Discuss the problems in a well-thought-through manner, after presentation by the lecturer and discussion thereof in an interactive way. A call to participation can be made to any student at any time.

(ii) research the problem beforehand (library, etc.) and to adequately prepare the relevant material in order to participate meaningfully during discussions.

SEMINARS: The manner of management of Seminars:

1) The class will be divided into 4 groups, limiting the amount of students attending a specific seminar, in order to ensure the personal participation of each student and aiming towards closer contact between facilitator and student.

2) Practical skills and knowledge will be improved during seminars and demonstrations will be conducted on a personal level.

3) The student will be exposed to the practical side of Anaesthesiology during the seminars, as well as during the stay within the Anaesthesiology department during the fifth year, with emphasis on the practice of Anaesthesiology.

4) Aspects of the knowledge relayed during the seminars will also be tested in theory.

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Anaesthesiology: Self Study Module: This module must be studied by the students on his or her own during week 1 to 3 (and will be tested in the class test): Self study module: Perioperative complications The recovery room Learning assumed to be in place: Knowledge already obtained in Anaesthesiology

(resident period in fifth year) Specific outcomes:

• Trauma - Describe the injuries sustained to the face and upper airway during

anaesthesia T4 - Describe the possible positional injuries (eg. neuropathies) sustained

during anaesthesia and the necessary preventative measures T4 • Physiological changes with positional changes

- Describe the circulatory- and respiratory effects of the different patient positions during anaesthesia T4

• Burns and electrical shock - Describe the causes and prevention of burns intraoperatively T4 - Explain the etiology, importance and prevention of macro- and

microshock T4 • Reflexes

- Identify and describe the sympathetic- and parasympathetic reflexes that may present during anaesthesia T4

- Describe the origin and effect of the following reflexes: - Oculo-cardiac T4 - Dilatation of the anus / servix T4 - Traction to the peritoneum T4 - Intubation response T4 - Laryngeal reflex T4

- Describe the predisposing factors to reflex elicited dysrhythms T4 • Respiratory complications

- Explain the causes, effects and management of hypoventilation with ensuing respiratory acidosis T4

- Discuss the causes, effects and management of hyperventilation with ensuing respiratory alkalosis T4

- Describe the causes and management of airway obstruction T4 - Define aspiration pneumonia and describe the causes, prevention and

management thereof T4 - Distinguish between laryngo- and bronchospasm (and manage) T4,K4 - Cardiovascular complications T4 - Define hypovolaemic shock and describe the causes (and manage)

T4,K4 - Describe the causes, clinical picture and management of septic shock

T4

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- Distinguish between anaphylactic- and anaphylactoid reactions and know the management thereof T4

- Explain the causes (and manage) intraoperative hypertension T4,K4 - Diagnose and suggest management for intraoperative myocardial

ischaemia T4,K3 • Air embolism

- Know the differential diagnosis and origin of intraoperative air embolism T4

- Explain the methods used in diagnosing air embolism T4,K2 - Describe the management of air embolism T4

• Introperative dysrhythms - Know and describe the normal electrophysiology of the heart T3 - Describe the factors that have to be considered when evaluating

dysrhythms T4 - Know the circumstances where the treatment of dysrhythms is mandatory

T4 - Explain the etiology of intraoperative dysrhythms T4 - Know the management of the most common perioperative dysrhythms

T4 - Know the indictions for the treatment of ventricular extrasystoles T4 - Describe the management of supraventricular tachycardia T4 - Classify bradydysrhythmias and know the perioperative management

thereof T4 • Recovery room

- Know (and apply) the routine management of a patient (from arrival to discharge) in the recovery room T4,V4

- Describe the importance of continuous monitoring of the airway, effective breathing, blood pressure, pulse, oxygenation, level of consciousness, etc. T4

Study material: Anaesthesiology – An undergraduate course UP

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STUDY UNIT 1 Study unit theme: Antibiotics in surgery Learning assumed to be in place: The pharmacology of antibiotics The bacteriology of enteral organisms Specific outcomes: After completion of this Study unit theme: the students will be able to:

• Discuss the concepts of therapeutic and prophylactic therapy T4 • Classify wounds according to contamination T4 • Name the properties of bacteria which are important

in surgical wounds T3 • Explain the factors which cause wound infection with regard to

- Bacterial load T4 - Surgical technique T4 - Host resistance T4

• List expected organisms in various wounds and regions of the body T3 - To name the appropriate antibiotics for each situation T3 - To know the important side-effects and contra-indications

of these drugs T4 • List and explain the circumstances in which prophylactic antibiotics are justified

T3 - Know the accepted method of prophylaxis T4

• Discuss the principles of treatment of surgical sepsis T4 - naming the methods K3 - classifying soft tissue infections and name examples T3

Reference: Current surgical diagnosis and treatment. Way, Lawrence. Publisher McGraw Hill (Lange series). Chapter 8 Study unit theme: Basic principles of Anaesthesiology Learning assumed to be in place: No specific pre-existing knowledge is necessary Specific outcomes:

• Describe the requirements that the anaesthetist must adhere to T4 • Explain the components of anaesthesia T4 • Explain the phases of anaesthesia T4 • Describe the possible mechanisms of action of the anaesthetic agents T4 • Explain the medico-legal implications of anaesthetic practice T4 • Explain the importance of preoperative informed consent (and the

components thereof) T4 • Describe the absolute necessity of perioperative record keeping T4


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Study unit theme: Paper problem: Pitfalls in Anaesthetic Practice The students will be able to:

• Familiarise themselves with the possible traps and potential problems that confront the Anaesthetist, and the ways to identify and manage these problems under specific conditions.

• Become aware that certain problems are life-threatening and rapid appropriate action can be lifesaving.

• Accept that certain traps can be eliminated through thorough evaluation and monitoring of patients.

• Realise that the slogan “Prevention is better than cure” has to be endeavoured. • Place emphasis on the principle of proper and diligent record keeping in stating the

sequence of events with specific reference to litigation. • Implement preoperatively the term “informed consent” in all future anaesthetic

practice. • Realise that hypoxia, hypercarbia and hypovolemia are major enemies of healthy

anaesthetic practice, and that the prevention thereof by means of effective monitoring, is of the utmost importance to decrease morbidity and mortality.

• Evaluate why the omnipresence of the anaesthetist in theatre plays a major role in the avoidance of falling into traps related to anaesthetic practice.

• Falling into these traps can be minimised by constant upgrading of knowledge concerning recent developments in anaesthetic practice.

Study unit theme: Applicable physiology Learning assumed to be in place: Knowledge of basic cardiopulmonary physiology (Block 6 & 7) Specific outcomes:

• Describe the effects of general anaesthesia on the respiratory system T4 • Describe the physiological effects of mechanical ventilation T4 • Know the methods to minimise the effects of mechanical ventilation T4 • Describe the cardiovascular effects of general anaesthesia T4 • Explain the causes and effects of intraoperative hypocarbia T4 • Define hypocarbia and describe the systemic effects thereof T4


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Study unit theme: Administration of anaesthesia and monitoring Learning assumed to be in place: Applicable knowledge of anaesthetic apparatus

and the process of anaesthesia as mastered during residence period

Specific outcomes:

• Describe the requirements and purpose of the preoperative evaluation T4 • Know the necessary preparation of the patient scheduled for a surgical procedure:

fasting period, routine medication, dentition, emptying of the bladder, etc. T4

• Describe the precautions and preparation of medication, apparatus and the patient before induction T4

• Describe the routes of induction T4 • Know and apply: procedure of the rapid sequence induction T4,V4 • Know the basic components of a general anaesthetic T4 • Describe the responsibilities of the anaesthetist during general

anaesthesia T4 • Identify and describe the signs of a too light plane of anaesthesia T4,K2 • Identify and describe the signs of a too deep plane of anaesthesia T4,K2 • Describe the aims of intraoperative monitoring T4 • Understand, describe and apply in practice: routine monitors T4,V4 • Describe the minimal monitoring requirements T4 • Understand the place for more advanced monitoring: central venous

pressure, blood gasses, electrolytes, temperature, determination of bloodloss, oxymetry, capnography T4

• Describe in short the monitoring indicated in specific conditions T4 • Know the reversal process of general anaesthesia T4 • Know and describe the reversal of muscle relaxants and opioids T4 • Describe the importance of continuous monitoring and oxygenation T4 • Know all the aspects concerning endotracheal intubation


STUDY UNIT 2: Study unit theme: Seminar: Anaesthetic apparatus After this seminar the student will be able to orientate him/herself regarding anaesthetic apparatus, the mechanism of action of these apparatus and various safety aspects. The following aspects will be covered: (a) Anaesthetic machine and components (b) Ventilators (c) Anaesthesia circuits (d) Vaporisers

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(e) Airway apparatus (f) Resuscitation apparatus Study material: Anaesthesiology – An undergraduate course UP Study unit theme: Paper problem 2: Drugs and Anaesthesia (i) Previously acquired knowledge of Pharmacology must be applied here. (ii) The pharmacotherapy of diseases already exposed to in Internal Medicine and Surgery

must be known and applied here. (iii) The interactions between pharmacological agents and drugs used in anaesthetic

practice must be appreciated and applied. (iv) Safe alternatives to existing therapy must be applied (regarding the application process

of anaesthesia). (v) The systemic effects of certain agents used in disease conditions must be appreciated. Study unit theme: Preoperative evaluation and medication Learning assumed to be in place: Basic background knowledge of pharmacology, general disease conditions and

examinations techniques Specific outcomes:

• Describe the aims of the preoperative visit T4 • Explain the importance, for the anaesthetist, of a systemic history

and thorough clinical investigation T4 • Know the indications for special investigations T4 • Understand and explain the purpose of the preoperative clinical

examination T4 • Know the indications for the postponement of elective procedures T4 • Know the aims of preoperative medication T4 • Know the indications for anticholinergic agents, sedatives and opioids T4 • Describe the preoperative alterations to existing medication that are

necessary in specific conditions, eg. diabetes T4 • Know the interactions between existing medications and the importance

thereof to the anaesthetist T4 Study material: Anaesthesiology – An undergraduate course UP Study unit theme: Induction agents Learning assumed to be in place: Basic pharmacological principles that you have

been exposed to (SA 14, Block 3) Specific outcomes:

• Know the classification of intravenous induction agents T4 • Describe the basic pharmacokinetics and pharmacodynamics of the

following agents:

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Sodium thiopentone T4 Methohexital T4 Etomidate T4 Ketamine T4 Propofol T4 Midazolam T4

• Know the indications, contraindications, unwanted effects and unique uses of all the induction agents T4

• Understand and describe the process of neurolept anaesthesia T4 • Define the term "TIVA" and give the advantages and disadvantages

thereof T4 • Describe the physical appearance and application of induction T4 • Have a basic knowledge of the dosages of induction agents T3

Study material: Anaesthesiology – An undergraduate course UP Study unit theme: Inhalation agents Learning assumed to be in place: Basic pharmacological principles that you have

been exposed to (SA 14, Block 3) Specific outcomes:

• Describe the properties of the ideal induction agent T4 • Know the stages of general anaesthesia according to Guedel T4 • Define the term “blood-gas partition coefficient” and know the applicable

values T4 • Define: “second gas effect” and “diffusion hypoxia” T4 • Define the minimum alveolar concentration and know the applicable

values and factors that influence it T4 • Know the pharmacokinetics and pharmacodynamic of:

Halothane T4 Enflurane T4 Isoflurane T4 Sevoflurane T4 Desflurane T4 Diethylether T3

• Have applicable knowledge of N2O as carrier gas T4 • Know the importance of CO2 in anaesthesia practice T4

Study material: Anaesthesiology – An undergraduate course UP Study unit theme: Skeletal muscle relaxants Learning assumed to be in place: Basic pharmacological principles that you have

been exposed to (Block 3)

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Specific outcomes:

• Know the applicable anatomical and physiological principles regarding the neuromuscular junction T4 • Know the types of neuromuscular blocks T4 • Understand and describe the differences between the depolarising- and nondepolarising blocks T4 • Know and describe the applicable pharmacokinetics and -dynamics of

suxamethonium T4 • Know the indications, contraindications en unwanted effects of suxamethonium

T4 • Know and describe the pharmacokinetics and -dynamics of the following

nondepolarising skeletal muscle relaxants: Pancuronium T4 Alcuronium T4 Atracurium T4 Cis-atracurium T4 Vecuronium T4 Mivacurium T4

Rocuronium T4 Gallamine T3 Tubocurarine T3

• Describe the signs pointing to insufficient curarization T4 • Know the methods of monitoring the neuromuscular junction T4 • Know and describe the reversal of the nondepolarising muscle

relaxants T4 • Identify the signs of insufficient reversal of skeletal muscle relaxants T4 • Know, describe and identify the causes of prolonged apnoea T4

Study material: Anaesthesiology – An undergraduate course UP Study unit theme: Impairment of liver and kidney function Learning assumed to be in place: Existing knowledge of the pathophysiology of

these specific organ systems (Block 3, 8, 11, SA7)

Specific outcomes:

• Define the types of diabetes mellitus T4 • Describe and diagnose the endorgan pathology (regarding DM) of

Importance to the practice of anaesthesiology T4,K2 • Know and diagnose the metobolic derangement in diabetes mellitus T4,K2 • Describe the perioperative management of type 1 diabetes mellitus

for both minor and major procedures T4 • Describe the perioperative management of type 2 diabetes mellitus

for both minor and major procedures T4

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• Know the complications of both type 1 and type 2 diabetes mellitus T4 • Describe the fluid therapy applicable to diabetes mellitus T4 • Describe the perioperative management of the pregnant diabetic T4 • Understand and describe the importance of the preoperative evaluation

of the patient with impaired renal function T4 • Describe the preoperative preparation of the patient with impaired renal function

T4 • Describe the physiological and metabolical derangements of importance

to the anaesthetist in chronic renal failure T4 • Describe the perioperative administration of fluid and medication in the

patient with impaired renal function T4 • Describe the perioperative complications found in renal failure that are of

importance to the anaesthetist T4 • Know and describe the different anaesthetic approaches towards the

patient with obstructive- and infective jaundice T4 • Describe the place of halothane in the jaundiced patient T4 • Define the hepatopulmonary- and hepatorenal syndromes and realise

the importance thereof to the anaesthetist T4 • Describe the importance of liver function tests and the interpretation

thereof T4 • Know and describe the anaesthetic considerations in the jaundiced

patient T4 Study material: Anaesthesiology – An undergraduate course UP

STUDY UNIT 3: Study unit theme: Seminar: Monitoring After this seminar the student will be able to:

• explain and apply basic monitoring during Anaesthesia; • grasp the importance of documentation by means of the anaesthetic report chart to

relay the monitoring, and to be used as a reference during litigation; • form an opinion regarding minimal monitoring during certain procedures; • relay the specific roll of the different monitoring apparatus; • realise the shortcomings of monitors; • realise that the presence of the anaesthetist in theatre cannot be replaced by any of

the monitors at our disposal; • acquire a basic knowledge of the following monitors:

ECG Blood pressure Oximeter Capnograph Central venous catheter Urine output Flow directed catheter (pulmonary artery) Temperature

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Nerve stimulator Study unit theme: Endocrine diseases Learning assumed to be in place: Existing knowledge of the pathophysiology of

these specific organ systems (Block 3, 8, 11, SA7) Specific outcomes:

• Define the types of diabetes mellitus T4 • Describe and diagnose the endorgan pathology (regarding DM) of

importance to the practice of anaesthesiology T4,K2 • Know and diagnose the metabolic derangement in diabetes mellitus T4,K2 • Describe the perioperative management of type 1 diabetes mellitus

for both minor and major procedures T4 • Describe the perioperative management of type 2 diabetes mellitus

for both minor and major procedures T4 • Know the complications of both type 1 and type 2 diabetes mellitus T4 • Describe the fluid therapy applicable to diabetes mellitus T4 • Describe the perioperative management of the pregnant diabetic T4 • Diagnose thyroid diseases and describe the anaesthesia implication K2 • Diagnose adrenal diseases and describe the anaesthesia implications T4,K2

Study material: Anaesthesiology – An undergraduate course UP Study unit theme: Paper problem 3: The paediatric anaesthesia After preparation and discussion the student must know that:

(i) the paediatric patient is not merely a small adult and should not be approached as such; (ii) there are major physiological and anatomical differences between the child and the

adult concerning anaesthetic practice; (iii) specific apparatus are used in paediatric anaesthesia; (iv) there are specific dangers embodied in paediatric anaesthesia; (v) there is no place for the occasional paediatric anaesthetist; (vi) different anaesthetic agent dosages are used and these must be known and applied. Study unit theme: Rational use of glucocorticosteroids Learning assumed to be in place: All knowledge regarding the glucocorticosteroid

hormones (SA 14) is required. Specific outcomes:

• Know the mechanism of action and the effects of cortisone T4 • Know and compare the different semi-synthetic glucocorticosteroids T4 • Understand the hypothalamus–hypophysial-adrenal axis and

negative feedback T4

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• Explain the rational use of the different glucocorticosteroid preparations in the following diseases: - asthma and hayfever T4 - auto-immune diseases such as rheumatoid arthritis T3

• Explain the unwanted effects of the glucocorticosteroids T4 • Prescribe a short course or long term glucocorticosteroid therapy V4

Reference: Indexed as follows: Glucocorticosteroids, bronchial asthma, hayfever,

rheumatoid arthritis, skin diseases Study material: Anaesthesiology – An undergraduate course UP Study unit theme: Malignancies of the lung: therapy Learning assumed to be in place: Knowledge of the anatomy and physiology of the

lung (Blocks 4 and 6), as well as the clinical pictures discussed in Block 6.

Specific outcomes:

• Classify lung tumours T4 • Know the most important lung tumours. T4 • Know the most important etiological factors. T3 • Know the most important etiological factors. T3 • Know the clinical manifestations of the general types. T3 • Define 'paraneoplastic syndrome' and tabulate the clinical T4

manifestations thereof K2 • Describe Superior vena cava syndrome (clinical, causes,

complications, treatment, prognosis) T4 Study unit theme: Pain management Learning assumed to be in place: Knowledge already obtained on the physiology

of pain (Block 3) Specific outcomes:

• Know the detrimental effects of pain, specifically concerning the respiratory-, cardiovascular-, gastrointestinal- and endocrine systems T4

• Explain how the body can modulate pain T4 • Be familiar with the pharmacokinetics and pharmacodynamics of the

different agents used in treating pain: - non-steroidal anti-inflammatory drugs T4 - opioids T4

• Describe the different aspects concerning the routs of administering analgesics:

- orally T4 - intramuscularly T4

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- intravenously T4 - patient controlled T4 - neuraxial blockade - epidural T4

- spinal T4,V4 - brachial plexus T4 - intercostal T3 - intrapleural T3 - penile T3 - peripheral infiltrations T4

• Know that there are other modalities for the alleviation of pain, eg. transcutaneous electrical nerve stimulation, psychotherapy, etc. T3

Study material: Anaesthesiology – An undergraduate course UP Study unit theme: The severely injured patient Learning assumed to be in place: Knowledge already obtained concerning the

management of trauma (Block 17) Specific outcomes:

• Be familiar with (and apply) the phases of resuscitation T4,V4 • Know, identify and correct the signs of hypovolaemia T4,V4 • Know and interpret the awake shock index T4 • Be familiar with the monitoring of the severely injured patient T4 • Be familiar with the anaesthetic implications of the severely

injured patient T4 • Be familiar with the anaesthetic techniques applicable in the

management of the severely injured patient T4 Study material: Anaesthesiology – An undergraduate course UP Study unit theme: Anaesthesia for ENT procedures

Anaesthesia for dentalprocedures Anaesthesia for the open eye injury

Learning assumed to be in place: Existing knowledge pertaining to the

tonsillectomy and eye injury (Block12) Specific outcomes:

• Describe the basic anaesthetic principles pertaining to the tonsillectomy T4 • Describe the problems and management of anaesthesia for head and

neck surgery T4 • Describe and manage the posttonsillectomy bleeding T4,K4 • Know all the aspects regarding the antibiotic coverage for heart valve

lesions scheduled for head and neck procedures T4 • Define the concepts “conscious sedation” and “relative analgesia” and describe the

indications T4

20

• Diagnose and propose treatment for dysrhythmias during dental procedures K4

• Evaluate anticholinergic drugs as premedication T4 • Describe the factors that influence intraoccular pressure and the

manipulation thereof in the open eye injury T4 • Describe the rapid sequence induction for the open eye injury T4

Study material: Anaesthesiology – An undergraduate course UP Study unit theme: Hypoxia Learning assumed to be in place: Existing physiology knowledge on oxygen

transport (Block 3, 6 and 7) Specific outcomes:

• Define the following concepts: - hypoxia T4 - hypoxaemia T4 - ischaemia T4 - types of hypoxia T4 - oxygen flux (describe the formulae) T4

• Describe the clinical presentation (of hypoxia) and diagnose hypoxia K4 • Describe the perioperative measures to prevent hypoxia T4 • Describe the etiology and mechanisms of hypoxia during anaesthesia T4 • Know the following concepts:

- early postoperative hypoxia T4 - late postoperative hypoxia T4

Study material: Anaesthesiology – An undergraduate course UP Study unit theme: Paediatric Anaesthesia Learning assumed to be in place: Existing paediatric knowledge (Block 9, 10) Specific outcomes:

• Grasp the importance of the preoperative visit, parent contact and premedication in the paediatric patient T4

• Know the applicable anatomical and physiological differences between children and adults that are of importance to the anaesthetist T4

• Know the paediatric anaesthesia equipment T4 • Know the perioperative paediatric fluid management T4 • Identify the problems peculiar to paediatric anaesthesia T4 • Know the perioperative risks inherent to neonatal anaesthesia T4 • Know the management of a child with a preoperative airway infection T4 • Know the basic fluid-, electrolyte- and energy requirements of the child T4

21

• Understand the principles regarding blood replacement in the child T4 Study material: Anaesthesiology – An undergraduate course UP

STUDY UNIT 4 Study unit theme: Seminar: Regional techniques After the seminar the student must understand: (a) that local and regional techniques are increasingly important in the context of

Southern Africa; (b) the pharmacology of local anaesthetic agents concerning toxic reactions and allergic

manifestations; (c) how to prepare a patient scheduled for a regional technique; (d) the necessity of absolute sterility when performing regional techniques; (e) the importance of knowing the toxic dosages of local anaesthetic agents; (f) the importance of identifying, and the ability to treat, a toxic reaction to local agents; (g) the importance of knowing (and having the skills to perform) the following local

anaesthetic techniques: - Infiltrations - Peripheral nerve blocks - Bier block - Brachial plexus blocks - Spinal block - Epidural block

(h) how to identify and manage all possible complications related to regional techniques. Study unit theme: Paper problem 4: The pregnant patient After preparation and discussion the student must: (i) be able to apply applicable knowledge of Obstetrics; (ii) take notice of the physiological changes during pregnancy; (iii) realise that there are no difference between elective and emergency cases concerning

general anaesthesia; (iv) be knowledgeable regarding the management of pregnancy related diseases; (v) appreciate and counteract the dangers of teratogenicity, especially during the first 12

weeks of pregnancy (vi) be able to emphasise the place of regional techniques in modern obstetric anaesthesia

management

22

Study unit theme: Local anaesthetic agents Learning assumed to be in place: Existing knowledge regarding the pharmacology

of the local anaesthetic agents (residence in Anaesthesiology)

Specific outcomes: The learner will acquire knowledge and application of the following at the level indicated:

• The applicable pharmacokinetics and –dynamics of the local anaesthetic agents T4

• The signs and symptoms of a toxic systemic reaction and know the management thereof T4,K4

• The maximum safe dosages of all the generally used local anaesthetic agents and the reasons for the addition of adrenaline T4

• The practical advantages and disadvantages of regional techniques T4 • The indications and contraindications of the regional techniques T4 • The preparation, monitoring and complications of regional

procedures T4 • All the aspects pertaining spinal blocks (know and apply in practice) T4,V4 • The epidural technique and be familiar with the contra-Indications and complications

T4,V2 • The differences between spinal- and epidural blocks T4 • The applicable anatomy of the brachial plexus and describe the

different approaches, precautions, indications, contraindications and complications of each approach T4,V2

• The technique of the Bier’s block (Know and perform) T4,V4 • The technique of peripheral infiltrations (Know and perform) T4,V4

Study material: Anaesthesiology – An undergraduate course UP Study unit theme: Dysrrhythmias Learning assumed to be in place: Knowledge already obtained pertaining the

electrophysiology of the heart and the electrocardiogram (Block 6,7 and residence)

Specific outcomes: • Know the basic electrophysiology of the heart T4 • Identify and classify common perioperative dysrrhythmias T4,K2 • Circumscribe the aetiology of perioperative dysrrhythmias T4 • Circumscribe the dysrrhythmogenic effect of anaesthetic agents T4 • Circumscribe reflex induced dysrrhythmias T4 • Identify, know and sketch the EKG changes associated with the more

frequent electrolyte disturbances T4,K2 • Know the effects of hypothermia on the heart T4 • Identify the indications for the active treatment of dysrhythmias T4 • Circumscribe the management and treatment of the more frequent

perioperative dysrhythms

23

T4 • Know the basic pharmacology of the antidysrhythmic agents in

frequent use T4 Study material: Anaesthesiology – An undergraduate course UP Study unit theme: Intra-operative cardiac arrest and CPR Learning assumed to be in place: Existing knowledge of CPR previously obtained

(SA 9 and Anaesthesia residence period) Specific outcomes:

• Describe the dangers of cerebral hypoxia T4 • Know and describe the basic principles of CPR T4 • Define and diagnose cardiac arrest intraoperatively T4,K3 • Describe role of monitoring as an aid in the diagnosis and

management of cardiac arrest T4 • Describe the phases of CPR T4 • Manage an airway during resuscitation V4 • Be familiar with the technique and apply external cardiac massage T4,V4 • Know the pharmacotherapy of cardiac arrest T4 • Know the controversies regarding CPR and pharmacotherapy T4 • Describe the process of defibrillation and cardioversion T4,V4 • Describe the correct actions in case of:

- Ventricular fibrillation T4 - Asystole T4 - Electromechanical dissociation T4

Study material: Anaesthesiology – An undergraduate course UP Study unit theme: Obstetric Anaesthesia Learning assumed to be in place: Existing knowledge of the physiology of

pregnancy and basic obstetrical care (Block 9) Specific outcomes:

• Know the physiological changes during pregnancy and the importance thereof to anaesthesia T4

• Know the anaesthetic risk factors concerning the pregnant woman and the applicable precautionary measures, eg. the prevention of aspiration T4

• Identify and manage the aortocaval compression syndrome T4,K4 • Know and describe all the problems relating to anaesthesia and the

pregnant woman T4 • Know and describe the normal sequence of actions during an anaesthetic

for a caesarian section T4 • Know the place, advantages and disadvantages of regional techniques

for caesarean sections T4

24

• Identify the indications, contraindications and complications of regional techniques in the pregnant woman T4

• Describe the anaesthetic implications of the patient scheduled for a emergency procedure T4

• Describe (and perform) the steps in the process of performing a rapid sequence induction T4,V4

Study material: Anaesthesiology – An undergraduate course UP Study unit theme: Anaesthetic considerations in cardiovascular- respiratory conditions Learning assumed to be in place: Existing knowledge of the physiology,

pathology, diagnostics and management of these disease conditions (Block 6 and 7)

Specific outcomes: The learner will acquire scientific knowledge pertaining to the following:

• The importance of the preoperative history and examination in these disease conditions T4

• The principles involved in the administration of anaesthesia in the presence of cardiac failure T4

• The principles involved in the administration of anaesthesia in the presence of ischaemic heart disease T4

• The principles involved in the administration of anaesthesia in the presence of cardiac valve lesions T4

• The principles involved in the administration of anaesthesia in the presence of systemic hypertension T4

• The principles involved in the administration of anaesthesia to the patient with an artificial cardiac pacemaker T4

• Circumscribe and diagnose COPD T4,K2 • The anaesthetic implications of COPD T4 • The preoperative preparation en perioperative management of the patient with

COPD T4 • The pharmacotherapy applicable to bronchial asthma T4 • The management of acute intraoperative bronchospasm T4


25

Study unit theme: Specific problems: Anaemia, porphyria, obesity, neurosurgical procedures

Learning assumed to be in place: Existing knowledge of the above mentioned

diseases (Block 3, 8, 17) Specific outcomes:

• Define anaemia and know the importance thereof to the anaesthetist T4 • Know the importance (for the anaesthetist) of distinguishing between

acute- and chronic anaemia T4 • Know the perioperative approach towards blood transfusion T4 • Diagnose porphyria in the preoperative phase T4,K3 • Know the safe and contentious drugs concerning the

administration of anaesthesia and the management of pain in the porphyric T4

• Define and quantify obesity T4 • Describe the pathology of obesity from the viewpoint of the anaesthetist T4 • Describe the anaesthetic implications of obesity T4 • Describe the perioperative management of the obese patient T4 • Describe the factors that influence intracranial pressure T4 • Describe the basic anaesthetic considerations in neurosurgery T4 • Know the perioperative management of raised intracranial pressure

and describe the measures to decrease intracranial pressure T4 • Describe the techniques and pharmacotherapy aimed at cerebral

protection T4 • Give sound reasons for the postponement of surgical procedures

with the necessary motivations T4


STUDY UNIT 5 Study unit theme: Seminar: Airway management

After this seminar the student must know and understand: (a) the utmost importance of preoperative airway evaluation in order to determine the

ease of intubation, the basic tests must be know; (b) the importance of airway maintenance as a route for effective ventilation and

oxygenation; (c) a plan of action when confronted with the difficult airway; (d) the signs and symptoms that will point towards a difficult intubation when evaluating

the airway. (e) physically evaluate the airway and determine the ease of intubation (f) be familiar with the methods to secure an airway

26

(g) describe, and perform in practice, the steps followed when conducting an endotracheal intubation

(h) know and perform the methods used for confirming the correct placement of the endotracheal tube

(i) know the complications of endotracheal intubation (and the management thereof)

(j) know the advantages and limitations of the laryngeal mask (k) be able to physically place the laryngeal mask (l) know the management of the difficult intubation:

- expected difficult intubation - unexpected difficult intubation

(m) know the general approach towards obtaining and maintaining the airway in a patient with an airway injury

(n) know and describe the signs of hypoxia Study unit theme: Fluid- and blood transfusion Learning assumed to be in place: Existing knowledge concerning resuscitation

(Block 17) Specific outcomes:

• Know (and apply) the importance of the perioperative evaluation of the fluid- and electrolyte status T4,K4

• Diagnose (and manage) perioperative hypovolaemia T4,K4 • Know the anaesthetic implications of the different electrolyte

disturbancesand propose a technique for correction T4 • Define the term osmolality T4 • Know the composition of the solutions used for resuscitation T4 • Classify the plasma volume expanders and know their side-effects

and limitations T4 • Express yourself on the controversy: Crystalloids versus Colloids during resuscitation T3 • Know the differences between maintenance fluid and resuscitation

fluid T4 • Know the composition of the different types of maintenance fluids T4 • Know the indications for rehydration- and replacement fluids T4 • Know the composition of the different types of replacement fluids T4 • Know the preservatives used for blood T4 • Know the storage requirements for blood and blood products T4 • Describe the risks and unwanted effects of blood transfusion T4 • Describe all the changes that take place in stored blood T4 • Define a massive blood transfusion T4 • Know and understand blood grouping T4 • Describe the indications for blood transfusion


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pay

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luvi

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ss f

or 2

8 da

ys

mbchb v block 18 (gnk 586) anaesthesiology...

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