Surgical sciences and Imaging diagnostic techniques II

Module anesthesiology - reanimation basics

ANESTHESIOLOGY AND SURGERY
Anesthesia and Emergencies Module

Academic Year 2023/2024 - Instructor: Francesca Rubulotta
Expected Learning Outcomes

At the end of the course, the student should have acquired clinical skills and reasoning regarding the approach to the most common emergency situations, basic competencies related to conducting anesthetic and perioperative procedures, knowledge of the role of intensive care, as well as an understanding of the pathophysiology of pain and its treatment.

Understand the relationships between anesthetic risks and psychiatric emergencies, in particular:

• Medical emergencies encountered in critically ill patients
  
• Surgical emergencies encountered in critically ill patients
  
• Physical conditions that can also lead to multiorganfailure and complex disorders (predisposition)

1. Sepsis

• Definition of sepsis, noting that severe sepsis and septic shock are severe manifestations of sepsis, which is a potentially lethal syndrome characterized by widespread malfunction of multiple organs simultaneously. This alteration is due to an inflammatory response of the body to external infectious agents, primarily bacteria... but not only.

• Therapy: with particular attention to the role of antibiotics, which must be administered promptly, and fluid therapy. Early recognition of sepsis is essential, and cultures should always be taken before administering the first dose.

• Surviving Sepsis Campaign: an international campaign for the fight against sepsis. Since 2004, this group has provided guidelines to reduce the incidence of sepsis.

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3. Shock

• Definition of shock: for example, shock is a state of organ hypoperfusion leading to dysfunction and cell death. The mechanisms may involve reduced circulating volume, cardiac output, and vasodilation, sometimes with the exclusion of the capillary bed from blood perfusion.

• Definition and causes of cardiac shock: adult and pediatric

• Definition and causes of hemorrhagic shock: adult and pediatric

• Definition and causes of anaphylactic shock: adult and pediatric

• Definition and causes of septic shock: adult and pediatric

• Differential diagnosis of shock: The tests for the differential diagnosis of various shock syndromes range from simple blood draws to sophisticated methods: complete blood count, creatinine, blood gas analysis, ECG, chest X-ray, echocardiogram, CT scan, coronary angiography, pulmonary angiography.

• Brief notes on the therapy for the various types of shock: intervention varies based on the cause, and a multidisciplinary team is essential. Shock represents an emergency and is potentially lethal.

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4. Trauma (triage)

• Introduction, epidemiology, incidence as one of the leading causes of death in adults and, above all, a significant cause of disability. The costs that trauma imposes on society are extremely high.

• What are the issues faced by patients with severe trauma in intensive care: infections, hemorrhages, mobilization, recovery of basic functionality, respiratory and motor rehabilitation, nutrition, and more.

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5. Airways in Anesthesia and Emergency

• Presentation of devices for manual ventilation: masks. Describe the risk of aspiration and the measures to adopt, such as having a suction device nearby.

• Presentation of supraglottic devices for ventilation (laryngeal masks). Describe the risk of aspiration, misplacement, and the measures to adopt, such as having a suction device nearby. Explain why they are used by paramedics in ambulances.

• Presentation of devices for invasive ventilation (endotracheal tubes). Describe the risk of aspiration and the measures to adopt, such as having a suction device nearby.

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6. Pre-operative Fasting

• What are the indications for pre-operative fasting? In which patients should it be reduced and in which prolonged?

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7. Anesthetic Risks

The population of adults using medications, narcotics, alcohol, and cigarettes are at risk. Let’s evaluate the extent together.

• Risks of opioid dependence after a demolitive procedure or trauma. Long-term use of opioid analgesics can cause dependence, and patients may start to abuse them after discharge. What to do? How to recognize it? What would you recommend for following up with these patients?

• Similarly, there is a risk of relapse after anesthesia for patients who have recovered from opioid dependence. This is a very common phenomenon in America, where doctors discharge patients with high doses of opioid medications. What can be done to prevent a relapse?

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8. Ethics

• Importance of informed consent for anesthesia.

• Importance of informed consent for anesthesia in pediatrics.

• Description of the issue of organ transplantation (where organs are implanted and patients are followed until discharge).

• Description of the issue of euthanasia.

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9. Central and Peripheral Venous Access: Indications, Contraindications, and Complications.

Venous access for dialysis and hemofiltration.

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10. Sedation: mechanism of action, indications, and complications.

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11. Local Anesthetics: Mechanism of Action, Indications, Complications, and Toxicity (LAST)

Nerve blocks of dental interest.

11. BLS for Adults and Pediatrics.

The exam is an oral assessment, conducted in person, collectively for all subjects of the integrated course. Learning verification may also be conducted online if conditions require it. The exam consists of an interview in which questions will be asked on topics related to the contents of the educational program.
Formative assessments may be arranged (useful for assessing the knowledge status of students for a more targeted treatment of program topics) before the final exam. Preparation and discussion of a clinical case may be required before the final exam.
Examples of frequent questions and/or exercises:
What symptoms may indicate an acute myocardial infarction?

The final judgment will be formulated taking into account A) the level of knowledge of the program topics, B) the ability to apply such knowledge to solve specific problems, demonstrating maturity in clinical reasoning related to the program topics; C) clarity of exposition, D) use of medical-scientific language.
For the final grade allocation, the following parameters will be considered:
Grade 29-30 with honors: The student has an in-depth knowledge of the program topics, is able to promptly and correctly integrate and critically analyze the presented situations, independently solving even highly complex problems, making autonomous critical analysis and connections; has excellent communication skills and masters medical-scientific language.
Grade 26-28: The student has good knowledge of the program topics, is able to integrate and analyze the presented situations in a critical and linear way, can quite independently solve complex problems, and presents topics clearly using appropriate medical-scientific language;
Grade 22-25: The student has a fair knowledge of the program topics, albeit limited to the main subjects; is able to integrate and analyze the presented situations critically but not always in a linear manner, and presents topics fairly clearly with reasonable language proficiency. Shows independent analysis only on moderately complex topics;
Grade 18-21: The student has minimal knowledge of the program topics, has modest ability to integrate and critically analyze the presented situations, and presents topics sufficiently clearly although the use of language is poorly developed. Such skills emerge only with help from the instructor;
Failed exam: The student does not possess the minimum required knowledge of the main content of the course. The ability to use specific language is very poor or nonexistent, and they are unable to independently apply the acquired knowledge