Základní životní funkce by lonyoo

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									The Vital Functions The Course 14
The course is divided into two parts - The first one is orientated to the field of anaesthesiology, second one is focused on problem of critical care. Criteria : seminars and practical part attendance - 100% case report discussion or seminar work

1. part - anaesthesiology Seminar No.1 The seminar work profile. Anaesthesiology and CCM hystory characteristic organization terminology

Seminar number 2. Anaestetic equipment, construction, international safety standards /ISO/, function, the most important parts. Anaestetic systems - circles , paediatric. The vaporizers - construction. The monitoring during anaesthesia / neuromuscular block incl./ Seminar No 3. Pharmacology of anaesthetic agents General anaesthesia – introduction, complications. Treatment-

maintainance,

recovery.

The

Seminar number 4 Locoregional anaesthesia, physiological basis, pharmacology of the local anaestetic agents. The types of the most frequently used blockades for upper and lower extremities Clinical implications.

Seminar number 5. Perispinal regional anaesthesia - epidural and subarrachnoidal approach. Clinical implicattion. Paediatric anaesthesia.

Critical care 2nd and 3rd week Seminar number 6. Respiratory insuficiency The basic anatomical structures participating in ventilation a gas excange, regulation of the breathing, physiological volumes, ventilation mechanics parametres / compliance, resistance. time constant, the physics - the most important laws , distribution of the gases . The surfactant. Cardiopulmonary physiology, intrapulmonary shunt. Dead space anatomical and physiological. Ventilation - perfusion ratio. Oxygen transport. The work of breathing.. Respiratory insuficiency- stratification. Partial respiratory insuficiency, global respiratory insuficiency. Obstructive and restrictive disorders. Clinical profile / epiglottitis, laryngitis, pneumonia. ARDS, asthma, chronic obstructive bronchopulmonary disease /. Fluid and electrolytes disorders, acid- bases balance, hypercapnia, hypocapnia, respiratory ane metabolic alkalosis and acidosis, the way of compensation. Respiration and ventilation Indication for oxygen therapy. Humidification and nebulization. The systems used in oxygen therapy. Oxygen toxicity. Respiratory pharmacology. The function of mucociliar escalator. CPAP. Specific aspects of children

Seminar number 7 Mechanical ventilation. The basic diferences between sponteneous and arteficial breathing. Adverse effects - pulmonary parenchyma and circulation. Intubation and tracheostomy, General indications of arteficial ventilation and also specific ones /brain oedema and acid–base disorders/ The ventilators – negative pressure generators, positive pressure generators. Constant flow generators Conventional and non-conventional types of ventilation. How to choose the mode of ventilation. Parameters of control breath. Characteristic of control breath – flow, pressure a volume curve. Volume distribution. Endexpiratory pressure. Dynamic PEEP. Ventilator settings. Pressure volume curves. Monitoring of ventilation. Ventilation modes and their combination. Mandatory ventilation , pressure control and volume controle ventilation. Open airway approach. Recent possibilities of ventilation technology. Weaning from ventilator. Extubation. Ventilation strategy in frequent clinical situations / asthma, chronic obstructive pulmonary disease, chest trauma, ARDS/. The complex therapy and care / positioning, social and ethical aspects/ . Nonconventional modes of ventilation - indications. Specific aspects of children

Seminar number 8 Circulatory insuficiency. Physiological aspects, haemodynamic parametres – measured and calculated. Monitoring . Pathophysiology of the shock states. The basic stratification – cardiogenic, obstructive, hypovolemic and distributive. Mixed shock. Charakteristika, léčba. Pharmacotherapy of circulatory insuficiency. Inoconstrictors and inodilators, antiarytmics, vasopresors a vasodilators. Plazmaexpanders and electrolyte solutions. Volume challenge. Hypotension – algorithm. Circulation monitoring in CCM Cardiac output. Central venous cannulation. The complications. Swan-Ganz catheter. Oclusion pressure of PA. Praeload and afterload. Echocardiography in CCM.

Specific aspects in paediatric patients.

Seminar number 9. Consciousnees alteration Clasification, diferential diagnosis, scoring systems. GCS Brain lesion - indicatio of critical care. Coma. Intracranial hypertension, brain swelling. Autoregulation of cerebral perfusion. Intracranial pressure measurment. Cerebral perfusion pressure. Monitoring and therapeutical protocol. Jugular oxymetry Focal lesions of CNS.Multimodal monitoring. Pharmacotherapy. Craniocerebral trauma.Ethical aspects. Brain death. Transplant program. Specific aspects of children.

Seminar number 10. Intoxication Definition. Endogenous and exogenous Basic profile. Diagnostical approach and clinical symptomatology. Antidotes a elimination procedures. Extracorporal elimination – haemodialyses and hemoperfusion. Indication. Complex care Drug addiction – profile, symptomatology, treatment. Ethylalcohol intoxication. Specific aspects of children Seminar number 11. Nutrition in critical care. Stress response, hormonal regulation, intermediary metabolism of glucose, fat and protein. Immune systém reaction. Malnutrition in CCM. Parenteral nutrition, enteral nutrition. Possibilities of combination Glucose in critical illness. Insulin resistence. Aminoacids - essencial and – non essencial

Basic profile – balanced, organ specific. Pharmacological effects of aminoacids, Glutamine. Arginine. Immunonutrition. Nitrogen balance, non – protein energy. Fatty emulsions. Perspectives in critical illness treatment. PUFA. Trace elements, vitamins. Electrolytes, fluid balance. Measurment of energy requirments. Respiratory quotient. All in one Enteral nutrition in critical illnees. Basic profiles. Polymeric a eligomeric nutrition. The way of administration. Fibre in nutrition. Specific needs of critical ill patients. Specific aspects of children

Seminar 12 Syndrom of systemic inflammatory response. Multiple organ dysfunction. DIC.

Definition. Role of immune systém in patogenesis of syndroms Inflamatory mediators, lipoperoxidation, toxic radicals of oxygen. Cytokines, . Capillary leak syndrome. SOFA ARDS - therapy. Gut failure , risks, prevention Sepsis, septic shock, severe sepsis, septic syndrome Antibiotic therapy in critical illness. Therapy, accepted algorithms.

DIC . Diagnosis and therapy.

Stratification. Specific aspects of children.

Seminar Number 13 Organ failure in critical care. Multiple trauma Renal insuficiency, definition, stratification. Causes of renal failure. Pharmacotherapy, monitoring of renal functions. Therapeutical possibilities, continous veno – venous extracorporal elimination methods. Liver failure, definition, basic stratification. Komplex therapy in liver failure. Pharmacotherapy. Laboratory profile, clinical picture. Liver encephalopathy. Indication of Critical Care, monitoring. .Major trauma – AIS,ISS,TRISS, the most important algorithms. Specific aspects of children

Seminar number 14 Panel discussion. Case reports.

Seminar Number 15 Case report, presentation of seminary work Credit

Practical training

Practical training no 1. Anestesiological approaches in critical care. Pharmacological problems in anaesthesiology – intravenous and inhalation anestetics, muscle relaxants etc. Practical training no. 2 Practical training of intubation. Practical training no 3. Practical aspects of anaesthesia and critical care - introduction and maintainance of general anaesthesia in different surgical specializations. Practical training no 4. Practical training of locoregional specialization

anaesthesia in diferent surgical

Practical training no.5 Sedative and analgetic drugs used in anaesthesia . / University dept. of Pharmacology/

Practical training no. 6 Demonstration of the patients - respiratory insuficiency. Critical Care Dept. 1 hour, case reports. Practical training no. 7 The ventilators, how to set the ventilator Demonstration of clinical cases from the point of wiev of ventilation support. Case reports. Practical training no. 8 Clinical case presentation - circulatory disturbances. Invasive monitoring –of CVP, systemic pressure.

Practical training no.9 . Demonstration of clinical cases - brain oedema, case reports.

Practical training no. 10

Elimination methods - practical training, clinical cases. Practical training no. 11 Nutrition in critical illness - case reports, Metabolic monitoring.

Practical training no.12 Critical care nursing Practical training No. 13. Termination of critical care. Case reports. Practical training no 14. Case reports. Practical training no 15. Case reports – discussion, presentation of seminary work. Credit


								
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