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Anesthesiology and Emergency

Course developer

Prior knowledge

Vete2013, Anatomy of the Domestic Animals I

Vete2014, Anatomy of the Domestic Animals II

Vete2015, Anatomy of the Domestic Animals III

Vete4036, General Pathology I

Vete4105, Pharmacology, Pharmacotherapy and Toxicology I

Vete6022, Physiology I

Vete6023, Physiology II

Course abstract

The aim of the first part of the course is to provide students with the knowledge in reception, approach and stabilization of critical patient. In the second part of the course students acquire the newest conception in veterinary anesthesiology, frequently used anesthetic medications pharmacokinetics and pharmacodynamics, types of sedation, monitoring of anesthesia, combination of medications and usage in praxis. To achieve the aim contemporary methods are used, e.g. the theoretical basis is confirmed by working in surgery, with simulators and imitation of critical situations
Aim of Study Course
Acquire the basics of emergency medicine in critically ill patients as well as the basics of anesthesiology in order to successfully use knowledge and skills in veterinary practice.

Learning outcomes and their assessment

Knowledge: theoretical knowledge for approach to critical patient; theoretical knowledge about frequently used sedative, analgesic and anaesthetic medication pharmacology and possible combination of them – two tests
Skills: to distinguish a critical patient and solve the problem fast, but with effective outcome; to pick up the correct combination of medication used in anaesthesiology in individual dosage, to use the equipment for monitoring, inhalation and artificial ventilation – practical work in clinic.

Competence: the emergency care in sufficient level to work in praxis; anaesthesiology in sufficient level to work in small animal surgery – KEGa

Course Content(Calendar)

1. Introduction in emergency care. Introduction, test passing order. Terminology. Critically ill patient recognition and reception. Patient clinical examination. Stabilization of critical patient. 1 hour lecture, 2 hour laboratory work.
2. Shock diagnostics and action. Shock types. Veterinarian action when animal is in shock, methods dependent of shock type.
3. Emergency care in case of cardiovascular failure. Cardiovascular failure definition. Factors which predispose cardiovascular failure. Clinical signs. Prognosis. Treatment.
4. Emergency care in case of respiratory failure. Respiratory failure definition. Factor which predispose respiratory failure. Clinical signs. Prognosis. Treatment.
5. Fluid therapy. Antibacterial therapy in emergency care. Crystalloid and colloid fluid. Choice and use of antibiotics.

6. Monitoring of critical patients. Monitoring of cardiovascular, respiratory, neurological, endocrine, urogenital systems. Methods of enteral and parenteral feeding.
7. Emergency care in small animal practise. Clinical signs and diagnostics in specific situations. Diagnostic procedures, monitoring and treatment.
8. Emergency care in large animal practise. Clinical signs and diagnostics in specific situations. Diagnostic procedures, monitoring and treatment.
9. Emergency care in equine practise. Clinical signs and diagnostics in specific situations. Diagnostic procedures, monitoring and treatment.
10. Emergency care in reproduction and paediatric. Clinical signs and diagnostics. Diagnostic procedures, monitoring and treatment. Neonatal reanimation. 2-12 week old paediatric diseases.
11. History and terminology of anaesthesiology. Physiology. Introduction, test passing order. History of anaesthesiology, most often used anaesthetic groups, characterization of them, conception of balanced anaesthesia. Theory of receptors, general receptors (GABA, NMDA, α1 – α¬2-adrenoreceptor) their localization and function.
12. General anaesthesia. Subgroups. principles of action. Pharmacokinetics, pharmacodynamics, indications, contraindications, doses.
13. Inhalation anaesthetic agents. Volatile agents. Gas anaesthetics. Characterization, subgroups, principles of action, pharmacokinetics, pharmacodynamics, indications, contraindications, doses.
14. Dissociative anaesthetics. Subgroups. principles of action. pharmacokinetics, pharmacodynamics, indications, contraindications, doses.
15. Sedatives and miorelaxant Subgroups. principles of action. pharmacokinetic, pharmacodynamics, indications, contraindications, doses. Characterization, subgroups, principles of action, pharmacokinetics, pharmacodynamics, indications, contraindications, doses.
16. Analgesia. Local anaesthetic agents. Subgroups. principles of action. pharmacokinetics, pharmacodynamics, indications, contraindications, doses. Physiology of pain, pain detection, conception of multimodal analgesia, guidelines.

Requirements for awarding credit points

Final exam (6th semester). Multiple choice test with 30 questions and one correct answer.
Access to exam:
1. All tests should be successfully passed, mark 5 at least, In complete 2 tests written (multiple choice test (test score 60%)) and one Clinical and epidemiological case analysis work (KEGA)
2. Lecture, seminar attendance 70%, study report on the topic for a missed lesson. If more than 30 % missed attendance and no topics prepared, study course should be repeated.
Examination - possible 2 times, the third with a Institute provided commission.

Description of the organization and tasks of students’ independent work

The purpose of KEGAis to learn how to describe various latest and most currently used anesthetic’s pharmacokinetics and pharmacodynamics, including indications, contraindications, and to analyze drugs compliance to the animal in the necessary surgical procedure based on guidelines for balanced anesthesia. Be able to analyze the physiological parameters of animals during anesthesia.
The analysis of a clinical case should be prepared methodically according to the rules developed by the LUA VMF Teaching Methodology Commission. The analysis should include the following sections: title page, introduction, theoretical part, discussion, conclusions, recommendations, literature used. KEGA's work must be submitted to the lecturers at a given time, defense of KEGA is carried out orally, during practical classes. The oral defense time per student is up to 10 minutes. Students are informed about the course of defense with details of the defense process.

Criteria for Evaluating Learning Outcomes

Student skills are evaluated in accordance with the procedures specified in the tasks of the laboratory work. Tests of the study course and the work of KEGA are evaluated in accordance with the criteria of the 10-point system scale indicated in the LLU Study Regulations. A test result is accepted from 5 points. Tests and KEGA must be evaluated with a successful grade, to access the exam.
Tests for the study course:
1. test in emergency care
2. test in anaesthesiology

Compulsory reading

1. Elizabeth A. Rozanski, John E.Rush., Small Animal Emergency and Critical Care Medicine: A Colour Handbook, Manson, 2012, 304 lpp
2. Douglass K. Macintire, Kenneth J. Drobatz, Steven C. Haskins, William D. Saxon Manual of Small Animal Emergency and Critical Care Medicine 2nd Edition. Willey-Blackwell, 2012. 704 lpp.
3. Deborah Silverstein DVM, DACVECC, Kate Hopper BVSc, MVSc, DACVECC Small Animal Critical Care Medicine, 2nd Edition. Elsevier, 2015. 1152 lpp.
4. Louise L. Southwood, Pamela A. Wilkins Equine Emergency & Critical Care Medicine. Manson Publishing, 2014. 880 lpp.
5. Bradford P. Smith, DVM Large Animal Internal Medicine, 4th Edition. Mosby, 2009. 1872 lpp.
6. Kurt A. Grimm, Leigh A. Lamont, William J. Tranquilli, Stephen A. Green, Sheilah A. Robertson, Veterinary Anaesthesia and Analgesia, The Fifth Edition of Lumb and Jones. Willey-Blackwell, 2015. 1074 lpp.
7. K. W. Clarke MA, VetMB, DVA, DVetMed, DipECVAA, FHEA, MRCA, FRCVS, C. M. Trim BVSc, DVA, DipACVAA, DipECVAA, MRCVS, L. W. Hall MA, BSc, PhD, DVA, Dr (Hons Causa) Utrecht, DipECVAA, DipACVA (Hon), FRCA, FRCVS (deceased) Veterinary Anaesthesia, Eleventh Edition. Saunders Elsevier, 2014. 685 lpp.

Further reading

1. Rebecca Kirby, Elke Rudloff, Drew Linklater Small Animal Emergency and Critical Care Medicine: Self-Assessment Color Review, Second Edition (Veterinary Self-Assessment Color Review Series). CRC Press, 2015. 254 lpp.
2. Donald C. Plumb, Plumb's Veterinary Drug Handbook, 8th Edition. Wiley-Blackwell, 2015. 1296 lpp.

3. Jim E. Riviere, Mark G. Papich, Veterinary Pharmacology & Therapeutics, Tenth Edition. Wiley-Blackwell, 2018. 1542 lpp.

Periodicals and other sources

1. http://cliniciansbrief.com

Notes

Compulsory course of study programme Veterinary medicine, 6th semester. Practicals in small groups (4-6 students).