|
|
|
||
|
Poslední úprava: prof. MUDr. František Duška, Ph.D. (11.09.2017)
|
|
||
|
Poslední úprava: prof. MUDr. František Duška, Ph.D. (11.09.2017)
Goals: 1. Act before they arrest: Recognise acutely sick patient. Do simple things fast and withou panic - learn ABCDE approach to an acutely deteriorating patient. Understand team dynamics in a crisis and how to deal with it. 2. Sepsis kills. Learn how to recognise and treat it. 3. Visit ICU. Learn that intensive care is mighty but it can be burdensome. When to offer it to your patients? |
|
||
|
Poslední úprava: prof. MUDr. František Duška, Ph.D. (11.09.2017)
Very practical little book is the Oxford classic (http://www.amazon.co.uk/Oxford-Handbook-Critical-Care-Handbooks/dp/019263190X). This can be supplemented by pathophysiology chapters from any reference textbook of your choice (i.e. Waldmann et al. Oxford Desk Reference - Critical Care, Oxford University Press, new ed. 2017) or check Guytons Physiology (It's all there!)
There is also plenty of free educational resources on the Internet based on FOAM platform (FOAM – Free Open Access Meducation) Check this one first https://lifeinthefastlane.com/collections/ Still not happy? Then try: Patient-centered acute care training (PACT) by European http://pact.esicm.org/index.php, paied now, but there is free version about to be released. Just check it. /cs/pracoviste/anesteziologie/vyuka/studijni-materialy/rozsirena-neodkladna-resuscitace/ European Resuscitation Council Guidelines 2015: www.erc.edu For geeks: www.acidbase.org Basic life support: http://www.lf3.cuni.cz/en/departments/anesteziologie/vyuka/studijni-materialy/resuscitation/ Advanced life support: http://www.lf3.cuni.cz/en/departments/anesteziologie/vyuka/studijni-materialy/advanced-resuscitation/index.html |
|
||
|
Poslední úprava: prof. MUDr. František Duška, Ph.D. (11.09.2017)
Credit: Minimum of 4 topics must be attanded to get a credit Exam: Consists of 4-subquestion. One practical (show on a model)-mincase, 1 basic science and 2 on the diagnosis and management of the critically ill. Rather than on details of multiorgan support, we put emphasis on testing candidates'understanding of mechanisms of critical ilnesses and their initial management. Questions> (randomly selected or tested in OSCE format]
1. Minicase/practical: Securing airways by a non-anaesthetist (perform on a model): face mask, insert laryngeal mask, hand ventilation technique with ambu-bag or Mapelson C circuit (2 and 4 hands ventilation). Draw saturation curve of haemoglobin. Explain Bohr effect. What is the massive-transfusion protocol? What is TRALI? Prevention of In-Hospital Cardiac Arrest: Early warning systems
2. Minicase/practical: Eldery man collapsed on a ward corridor, is unresponsive and not breathing – what do you do? Show on a model. Oxygen delivery determinants. List 8 reversible causes of cardiac arrest Give your empirical choice of an antibiotic (incl. doses) for following septic patients: a) 60 years old for severe community acquired pneumonia. b) I.v. drug used with presumed R-sided endocarditis. c) 16 years old girl with R-sided acute pyelonephritis. d) 50 y.o. with presumed bacterial meningitis
3. Minicase/practical: Middle aged man after MI developed VF on an ICU bed – describe steps how you would defibrillate Determinants of cardiac output. Define shock. What is the difference between shock and hypotension? DVT prophylaxis in critically ill patients. List 4 treatable causes of delirium in a hospitalized patient
4. Minicase/practical: Eldery lady 2 days after MI feels unwell and dizzy on an ITU bed, bradycardia 30/min on the monitor: describe your management Explain: Frank-Starling law. Mean systemic filling pressure. CVP as a backpressure for venous return. ICU-acquired weakness Describe Glasgow Coma Scale
5. Minicase/practical: You are called to see a young lady who looks very unwell, with tachycardia and hypotension 1st day after splenectomy for a haematological malignancy. Describe what do you do step-by-step. Cellular model of coagulation. Stress ulcer prophylaxis in the critically ill. Describe qSOFA score. What is it used for?
6. Minicase/practical: A patient with end-stage kidney disease presents periarrest with bradycardia and broad QRS complexes. Point-of-care potassium level is 9.1 mmol/l. Describe the management. Lactate: biochemistry, role as a severity marker and target, types of lactic acidosis. Focused assessment with ultrasonography – cardiac, periprocedural, FAST scan. Dose, way of administration, effects and side effects of adrenalin: role and dosing in CPR and anaphylaxis
7. Minicase/practical: Describe the equipment and drugs in a resuscitation trolley on a ward. Monro-Kellie doctrine. Autoregulation of cerebral blood flow – how do I know whether a patient maintained or lost the autoregulation?. Differential diagnosis of metabolic alkalosis Dose, way of administration, effects and side effects of amiodaron
8. Minicase/practical: Young lady just admitted to a ward with presumed pyelonephritis suddenly develops an itchy rash, shortness of breath, lightheadedness and starts vomiting. What do you do? Renin-angiotensin-aldosteron system and natriuretic peptides. Organ donation after cardiac death (DCD) – describe a typical donor and briefly the procedure Dose, way of administration, effects and side effects of morphine for acute pain
9. Minicase/practical: An eldery lady with known congestive heart failure presents with sudden onset shortness of breath, cyanosis and cough with frothy sputum. BP 150/90. Describe your initial management in simple steps. Central venous pressure – discuss its role in predicting fluid responsiveness. Give your empirical choice of an antibiotic (incl. doses) for following septic patients: a) 71 years old with perforated coecal tumour b) 16 yers old with bacterial meningitis c) a ventilated trauma patient with pneumonia 5th day d) a diabetic with necrotizing fasciitis Describe nasal-high flow oxygen therapy
10. Minicase/practical: Middle aged homeless man was found unconscious on a bench in the park in winter. Central body temperature 29 C, HR 35, BP 80/40. Describe the management. Explain the principle of time-dependent vs. dose dependent killingof bacteria by antibiotics. Give examples. Prone positioning: pathophysiology (use West zones) and the use. Diagnostic criteria and measures how to prevent ventilator-associated pneumonia
11. Minicase/practical: Young man was brought in combative and febrile 39 C, he has purple rash on his legs and neck stiffness. Describe initial management. Describe stages of haemorhagic shock and compensatory responses and clinical signs. Sedation (|examples of drugs) and daily sedation holds (Why they are important?) Draw and describe a pressure curve of a volume-controlled breath in a patient without spontaneous breathing efforts
12. Minicase/practical: Middle age lady has been treated at home with oral amoxycyllin for presumed pyelonephritis, now presents very sick and hypotensive. Describe your management. Draw and describe a normal curve of arterial blood pressure. Early and late complication of subarrachnoidal haemorhage. Can we prevent them? Define sepsis (SEPSIS-3, 2016) and septic shock
13. Minicase/practical: Eldery gentleman develops shortness of breath shortly after placing a subclavian central venous catheter. He is deteriorating quickly and X-ray technician is on a lunch break. What do you do? Explain what are airway resistance and dynamic pulmonary hyperinflation. Principles of ventilator setting after intubating a patient with severe obstruction. Dying in ICU. Principles of compassionate care. Dose, way of administration, effects and side effects of alteplase
14. Minicase/practical: Eldery lady with a rich psychiatric history attempted suicide by taking unknown amount of tricyclic antidepressives and benzodiazepines. She is haemodynamically stable, but unresponsive to verbal commands, only moans in response to painful stimuli. What do you do? Passive leg-arise test: describe purpose, procedure and interpretation Explain the difference between euthanasia and withdrawal of life-sustaining treatments. Describe principles of patient-controlled analgesia. Give an example when it may be useful.
15. Minicase/practical: Your colleague anaesthetist is intubating a trauma patient and asks you to perform a manual in line C-spine stabilization. Show on a model how you do it. Describe spinal precautions: types of cervical collars and log-roll technique. Determinants of cerebral perfusion pressure. Starling resistor principle. Why intensive is not appropriate when it cannot alter the outcome (avert death)? Describe what is a pressure support ventilation (CPAP/ASB)
16. Minicase/practical: Young man is recovering from traumatic brain injury, spontaneously breathing via a tracheostomy. You are called to him as he suddenly develops cyanosis and ineffective respiratory efforts. What do you do? Describe a tracheostomy tube: function of inner tubes, speakuing valve. Volume challenge: what it is and how would you evaluate its effect. Dangers of fluid underresuscitation and overload. Explain the importance of obtaining blood cultures in sepsis. What is de-escalation of antibiotics? Describe a pressure-controlled ventilation (e.g. BIPAP)
17. Minicase/practical: Middle age man was hospitalized due to alcohol overdose. He woke up well and was extubated. An hour later he develops tonic-clonic seizures. Management? Describe when an arterial catheter is needed? Principle of direct measurement of arterial pressure. Differential diagnosis of hyperchloridaemic (low SID) metabolic acidosis Dose, way of administration, effects and side effects of noradrenalin
18. Minicase/practical: An adolescent girl took 20 g of paracetamol 12 hours previously in a suicidal attempt. She is conscious and her vitals are stable. Your management? Normal and stress starvation: list 5 differences Brain(stem) death: concept, diagnosis, care of deceased organ donor. Dose, way of administration, effects and side effects of heparin
19. Minicase/practical: You are chaperoning to a CT scan a lady with presumed stroke. She develops hypotension, chest pain and breathing problems shortly after her CT angiography of the brain. Describe your management. Brainstem reflexes – afferentation, center, efferentation, clinical investigation: vestibuloocular, corneal/lash, pupilar, oculo-cardiac, cough, gag, breating. Apnea test. ARDS: Berlin definition and dif. diagnosis Describe the management of a comatous survivor of out-of-hospital cardiac arrest.
20. Minicase/practical: Eldery man on warfarin for atrial fibrillation has GCS 6 and right pupil unresponsive to light after he had fallen in the waiting room of your clinic. His vitals are otherwise stable. CT head is being arranged and help on their way. Describe the management in the meantime. Cushing reflex. Management of blood pressure in acute neurological catastrophes (stroke, TBI, SAH). Infection of C. difficille. Postantibiotic diarrhea. Describe the management of acute exacerbation of COPD, incl. the role of NIV
21. Minicase/practical: Two hours after pulling out epidural catheter in a hip surgery patient, the patient starts complaining of sudden onset tingling in legs and paraplegia. What do you do? Describe complications of epidural analgesia. Describe the difference between infection and colonization. Differential diagnosis of metabolic acidosis with elevated (strong) anion gap Describe the acute management of stroke – indications and contraindications of trombolysis.
22. Minicase/practical: Describe insertion of a nasogastric tube in spontaneously breathing and and in a ventilated patient. Confirmation of position, risks. Crystalloids: balanced vs. normal saline. Describe effects (on circulation and acid-base) and side effects. Explain main rules for teamwork and communication in a crisis. Intraabdominal hypertension and compartment syndrome – what is the difference? Treatment?
23. Minicase/practical: Describe BACT procedure. Regulation of osmolarity. What is a non-osmotic ADH secretion. ARDS: principles of ventilator setting, lung-protective ventilation concept Name antagonists (incl. dosage) for following drugs: a) opioids b) benzodiazepines c) paracetamol
24. Minicase/practical: Advanced airway management: describe endotracheal intubation Low flow oxygen therapy: nasal prones, rebreathing and non-rebreathing – indication, FiO2 at usual flows, advantages, disadvantages List 3 main pillars of the management of sepsis Dose, way of administration, effects and side effects of phenytoin
25. Minicase/practical: Your consultant made a mistake and you think she is treating a patient for a wrong diagnosis. Explain a strategy how to speak up and challenge an authority when the patient is at risk. Describe stepwise approach in the management of intracranial hypertension in TBI patients Describe indications and initial setting of non-invasive ventilation Dose, way of administration, effects and side effects of tranexamic acid.
26. Minicase/practical: Describe how a central line is put in. Physiology of termoregulation, non-infective fever. Describem the management of haemorhagic shock Draw and describe the circuit for continuous venovenous hemodiafiltration. |
|
||
|
Poslední úprava: Ondřej Kubánek (10.10.2013)
Themes of conferences : ? Emergency medical system ? organization, specific features, case reports ? Transplantology ? Anaesthesia of animals , anaesthesia and crime. ? Difficult airways ? what the next ? Case reports ? Evidence based medicine in intensive care. Case reports |