Metodical Guide For Students I Semester

METHODICAL GUIDE FOR STUDENTS
Theme 1: CARDIO-PULMONARY RESUSCITATION- BLS (4 hours).
The relevance of the topic: Cessation of blood circulation is a terminal complication of any
critical condition, which may be the result of a serious illness or sudden damage by external
factors. That is why mastering the skills of providing emergency care is a must for every
graduate of a medical school.
II Educational goals:
1. To get acquainted (level 1) with the history of development of reanimatology in the world and
in Ukraine; Have an idea of current achievements and promising areas of research in the field of
cardiopulmonary resuscitation.
2. Know (Level 2):
A) causes of blood flow stops;
B) the peculiarities of the pathogenesis of blood flow and the prospect of recovery in the primary
lesion of various systems (central nervous system, respiratory and cardiovascular);
C) factors that determine the duration of clinical death;
D) impressions and impressions against resuscitation measures;
E) general rules for cardiopulmonary resuscitation;
E) the theoretical substantiation of the application of various methods and medical measures
during resuscitation;
3. Be able (level 3):
A) to determine the signs of clinical and biological death;
B) apply methods of restoration and maintenance of respiratory tract passage;
C) to conduct artificial ventilation of the lungs by different methods;
D) conduct an indirect heart massage.
4. Educational aims of the class (level 4):
Students must understand the moral and legal obligation of each medical professional, regardless
of the specialty, to be able to promptly identify the patient or the victim of clinical death and
provide emergency care, the need for periodic updating of skills and knowledge about methods
of cardio-pulmonary and cerebral resuscitation.
Materials for pre-admission independent work (for preparation for the aforementioned
topic of practical training).
3.1. Basic knowledge, skills, skills needed to study the topic
(Interdisciplinary integration):

Disciplines To know To be able
/
The providing:
1 Human anatomy Human anatomy
Structure of orolarynx and a skeleton
of the face. A structure of
mediastinum
2 Human physiology Conditions of blood supply to brain.

Spirography values. Influence of
breath on a status of cardiovascular
system and brain blood supply
The provided:
1 Neurology Postanoxic encephalopathy. Apallic to define a kind of
and akynetic syndrome infringement of
consciousness and coma
degree
to perform neurologic
inspection
Multisubject integration
1 Multiple organ Factors multiple organ failure
insufficiency syndrome in post resuscitation period
3.2. Question for individual oral questioning:

1. Clinical signs of preagonia, terminal pause and agony.
2. Clinical death. Signs of clinical and biological death.
3. Factors of development of clinical death and probability of restoration of independent blood
circulation under various mechanisms of its stop.
4. Determination of resuscitation. Stages of cardio-pulmonary and cerebral resuscitation.
5. The main provisions of modern methods of basic life support.
6. Technique of indirect (external, closed) heart massage.
7. Precardial Impact: Impressions and contraindications for use.
8. Methods of restoration and maintenance of passage of the respiratory tract during reanimation
measures.
9. What methods of artificial ventilation of lungs are used in CPR?
10. How do combinations of heart massage and artificial ventilation of the lungs with CPR?
11. What volume of resuscitation measures should be performed by a casual witness of sudden
death?
12. For what time do CPRs?
13. What is the team approach to CPR?
3.3. Tasks for self-control:

Task No. 1
During the repair and construction work on the production, the master accidentally
touched a bare electric cable with a voltage of 380 volts. After disconnecting it from the electric
current, the following clinical picture is determined: without consciousness, the electric bulb of
the left bristle, the skin and mucous of the pale-cyanotic color, single "agonal" inspirations, heart
tones are not heard, pulsation on the major arteries is absent, the pupils are enlarged, without
photoreactions.
How can we describe a patient's condition? Which emergency measures should be
applied?
Task number 2
A young man 25 years old, while swimming in the river, suddenly disappeared from the
surface of the water. With the help of outsiders he managed to find water and after 5-7 minutes.
Ship to shore Objectively: there is no consciousness, the color of the skin and mucous membrane
is expressed by the cyanotic, the pupils are enlarged, photoreaction is absent, respiratory
movements of the chest are not observed, pulsation of the peripheral and major arteries is not
determined.
What condition has developed in the patient? Which emergency measures should be
applied?
IV. Materials for independent classroom work

1) View the training videos:
Cardio-pulmonary resuscitation: basic support for life.
2) Mastering the practical skills of SALM on a mannequin:
execution of P. Safar's triple means;
the use of air ducts;
applying face mask or "key of life";
performance of mechanical ventilation by the methods "from mouth to mouth" and "from the
mouth to the nose";
implementation of mechanical ventilation on the baby's dummy by the method of "mouth to
mouth and nose";
performing indirect heart massage on the mannequin of an adult;
performing indirect heart massage on the baby's dummy;
Implementation of basic life support by two intensive care units.
V. Recommended literature:
1. Educational:
Basic:
1. Anaesthesiology and Intensive Care= :
. .. . .: , 2010. 312 .
2. Mitchell P. Fink Textbook of critical care Elsevier Saunders, 2005. 2358 .
3. Ake Grenvik, Stephen M. Ayres, William C. Shoemaker Textbook of critical care W.B.
Saunders, 2000 2227 .
Additional:
1. William C. Shoemaker, W. Leigh Thompson, Peter R. Holbrook, Gwen Berry Textbook of
critical care Saunders, 1984. 1063 .
2. Joseph M. Civetta, Robert Wesley Taylor, Robert R. Kirby Critical care Churchill
Livingstone, 2007. 267 .
3. Robert R. Kirby Critical care Lippincott-Raven, 2012. 2363 .
4. Paul L Marino The ICU Book Williams & Wilkins, 2009/ - 715 p.
Theme 2: CARDIO-PULMONARY RESUSCITATION- ALS (4 hours).
The relevance of the topic: Cessation of blood circulation is a terminal complication of any
critical condition, which may be the result of a serious illness or sudden damage by external
factors. That is why mastering the skills of providing emergency care is a must for every
graduate of a medical school.
II Educational goals:
1. To get acquainted (level 1) with the history of development of reanimatology in the world and
in Ukraine; Have an idea of current achievements and promising areas of research in the field of
cardiopulmonary resuscitation.
2. Know (Level 2):
A) causes of blood flow stops;
B) the peculiarities of the pathogenesis of blood flow and the prospect of recovery in the primary
lesion of various systems (central nervous system, respiratory and cardiovascular);
C) factors that determine the duration of clinical death;
D) impressions and impressions against resuscitation measures;
E) general rules for cardiopulmonary resuscitation;
E) the theoretical substantiation of the application of various methods and medical measures
during resuscitation;
3. Be able (level 3):
A) to determine the signs of clinical and biological death;
B) apply methods of restoration and maintenance of respiratory tract passage;
C) to conduct artificial ventilation of the lungs by different methods;
D) conduct an indirect heart massage.
4. Educational aims of the class (level 4):
Students must understand the moral and legal obligation of each medical professional, regardless
of the specialty, to be able to promptly identify the patient or the victim of clinical death and
provide emergency care, the need for periodic updating of skills and knowledge about methods
of cardio-pulmonary and cerebral resuscitation.
Materials for pre-admission independent work (for preparation for the aforementioned
topic of practical training).
3.1. Basic knowledge, skills, skills needed to study the topic
(Interdisciplinary integration):

/
The providing:
1 Human anatomy Human anatomy
Structure of orolarynx and a skeleton
of the face. A structure of
mediastinum
2 Human physiology Conditions of blood supply to brain.

Spirography values. Influence of
breath on a status of cardiovascular
system and brain blood supply
The provided:
1 Neurology Postanoxic encephalopathy. Apallic to define a kind of
and akynetic syndrome infringement of
consciousness and coma
degree
to perform neurologic
inspection
Multisubject integration
1 Multiple organ Factors multiple organ failure
insufficiency syndrome in post resuscitation period

14. Features of measures on restoration of independent blood circulation on stage .
15. Reversible causes of clinical death.
16. Types of blood circulation stops.
17. Electrodefiltration: definitions, types, purpose and effects of application.
18. Equipment for defibrillation.
19. Overlays of electrodes for defibrillation.
20. Electrodefibrilation technique by non-automatic biphasic defibrillator.
21. 1 or 3 discharges when ventricular fibrillation?
22. Features of defibrillation in children.
23. What is the number of defibrillator digits, is there a limitation when defibrillating?
24. Features of defibrillation in the presence of an implanted cardioverter defibrillator.
25. Criteria for termination of resuscitation measures.
26. Clinical and laboratory methods of diagnosis of brain death.
27. Auxiliary methods of diagnostics of brain death.
28. Post-resuscitation Disease - Definition and Stages.
29. Stages of exiting the coma after clinical death.
30. General principles of intensive care of postreantism disease.
Task No. 1
A patient who is on treatment in a therapeutic department has suddenly stopped blood
circulation. Medical staff started reanimation measures. Venous access is not available.
Determine the most rational way to administer adrenaline to restore cardiac activity in this case.
What venous access will you offer to continue the withdrawal of a patient from a state of clinical
death?
Task number 2
You were urgently called to the ward of the department of general surgery to help the
patient with anesthesia breathing depression. Patient 35 years old, weighing 90 kg after
appendectomy. The condition is extremely severe: no consciousness, enlarged pupils, skin and
mucous membranes, pale-cyanotic, muscular hypotension, single superficial breaths, pulse in the
radiation and carotid arteries is not determined. ECG revealed large wave ventricular fibrillation.
Evaluate the condition of the patient and assign a complex of reanimation measures.
IV. Materials for independent classroom work

3) View the training videos:
Catheterization of peripheral veins;
Catheterization of the central vein;
Laryngeal mask setting for an adult;
Laryngeal mask setting for children;
Intubation of the trachea;
Conducting CPR with a Zool reanimation board.
4) Acquaintance with practical skills of CMLM on a mannequin:
execution of mechanical ventilation on a dummy using the bag Ambu;
execution of mechanical ventilation on the mannequin manual and automatic defibrillator;
use of monitor equipment when performing CPR;
performing a mannequin defibrillation;
use of the automatic defibrillation on the mannequin.
V. Recommended literature:
5.1. Educational:
Basic:
. .. . .: , 2010. 312 .
Saunders, 2000 2227 .
Additional:
4. Paul L Marino The ICU Book Williams & Wilkins, 2009. - 715 p.
Theme 3. GENERAL QUESTIONS OF ANESTHESIOLOGY (4 hours)
. Theme relevance:
Dynamical development of surgery in XVIII-XIX centuries has led to state of things that
even professionally performed surgeries led to failures because the patient perished from pain
shock on the operation table or at the early postoperative period. Therefore, occurrence of
powerful anaesthetics and methods of anaesthesiological maintenance has served as the essential
stimul to medicine development in general. The doctrine about pain has passed in its
development some stages. The considerable contribution to its development was brought by
scientists of Russia, Soviet Union, Ukraine. The actuality of the theme is caused by necessity of
perception of anesthesiology as complete science about maintenance of safety of the patient
during operation, about methods of intensive therapy and resuscitation.
In arsenal of the anaesthesiologist today there is enough quantity of pharmacological
preparations of various groups for maintenance of various kinds and methods of anaesthesia. The
student should know about narcosis, classification of kinds of anaesthesia, the general
indications and contra-indications to the basic methods of inhalation, non-inhalation anaesthesia,
the regional anaesthesia, necessary equipment for their carrying out, monitoring of the patient in
operation room and in intensive care unit. The future doctor should have conception about
complications of anaesthesia and professional harms in anesthesiology.
Educational objectives:
1. To familiarise with (level 1):
Historical preconditions of occurrence of the doctrine about pain, methods of anaesthesia of
operations in pre-narcotic epoch.
History of the first ether narcosis.
Stages of development of the doctrine about anaesthesia in Russia and Ukraine.
Preconditions of occurrence of anesthesiology as separate clinical specialty and science.
Definition of anesthesiology as independent medical specialty, science and discipline.
Interrelation of anesthesiology with other clinical disciplines.
Organizational forms anesthesiology services in Ukraine.
Concept about narcosis, its differences from regional anaesthesia.
Classification of types and methods of the general and regional anaesthesia.
Theories of the general anaesthesia (coagulation, lipids, of superficial tension, adsorbtion,
gypocsic, water microcrystals, membrane).
Components of anaesthesia (the general, specific).
The polycomponent theory of the general anaesthesia.
Stages of the anesthesiology maintenance.
Methods of surgical and anaesthetic risk by V.A.Gologorsky and by American Society of
anaesthesiologists (ASA).
Premedication, its goal, types and components.
The inhalation narcosis, its advantages and disadvantages.
Clinical pharmacology of drugs for inhalation anaesthesia (aether, N2O, halothane).
Clinic of aether narcosis by Guedel-Artuzio-Zhorov (stages, levels, clinical picture).
Ways of inhalation anaesthesia (mask, endotracheal).
Non-inhalation narcosis, its advantages and disadvantages.
Ways of non-inhalation anaesthesia (intravenous, intramuscular, rectal).
Clinical pharmacology of drugs for non-inhalation anaesthesia (ketamine, thiopental sodium,
oxybutyrate sodium, propofol).
Indications and contra-indications for non-inhalation anaesthesia with different anaesthetics.
Regional anaesthesia, its advantages and disadvantages.
Types and methods of regional anaesthesia (spinal, epidural, plexus, trunk, conduction,
infiltration, application).
Clinical pharmacology of drugs for regional anaesthesia (lidocaine, bupivacaine, dicaine,
novocaine).
Complications of general anaesthesia.
Complications of regional anaesthesia.
Features of out-patient anesthesiology.
Principles of preoperative care and choice of method of anaesthesia in urgent surgeries.
Concept about professional harms in anesthesiology.
B. 2. To know (level 2):

To prepare a workplace of the anaesthesiologist for general anaesthesia.
To provide open airways by air line.
To diagnose of regurgitation of gastric contents and its aspiration.
To insert gastric tube.
To predict difficult airways intubation by Mallampati system.
To provide spinal and epidural puncture, catheterization of the last (on the phantom).
To calculate the volume of infusions at elective operative intervention.
To define a puncture point for conduction anesthesia on the arm and leg.
C. To be able (level 3):

Preoperative survey of the patient.
To make-up the plan of preoperative analysis of the patient and its preparation for elective
operation.
Choice a type and method of anaesthesia.
Interpretation of results of instrumental and laboratory data of investigation of the patient.
Definition of surgical and anaesthetic risk by V.A.Gologorsky and by ASA.
Choice of appropriate size of facial mask, laryngeal masks, intubations tube, gastric tube.
To give the compulsory ventilation by facial mask.
III. Purposes of personal development: for future doctors it is necessary to learn to

perceive anesthesiology as a specialty providing life maintenance of the patient at surgery and in
any critical condition; to be improved, bringing up in himself responsibility for the made clinical
decisions, the humane relation to the patient, without dependence from a condition in which it is;
to cultivate the skills of the evidence based information search about new approaches to pain
care and intensive care of patients at life-threatening conditions.
IV. Interdisciplinary integration:
Disciplines The nobility To be able
The providing:
1. Human anatomy Structure of the central and peripheral
nervous system, vegetative nervous
system, systems of blood circulation,
breath, urination, digestion.
2. Operative surgery Topography of the top parts of respiratory To define a puncture
with topographical system, topographical marks of nervous place at spinal and
anatomy trunks and plexuses, spinal cord and its epidural anesthesia,
covers. regional anesthesia on
the arms and legs.
3. Physiology Functions of vegetative nervous system. To diagnose vagotony,
Indicators of clinical and biochemical sympathicotony.
analyses of blood, urine.
4. Pathophysiology The mechanism of development of To analyze the data of
allergic, toxic reactions, laryngospasm, clinical-biochemical
bronchiolospasm. Pathogenesis of inspection of the
hypovolemic, anaphylactic shocks. patient.
5. Pharmacology Pharmacodynamics and To compare
pharmacokinetics of anaesthetic drugs, advantages and lacks
local anaestetics, narcotic analgetics, of various means for
neuroleptics, tranquilisatores, muscle anaesthesia carrying
relaxants. out.
6. Internal medicine Clinic of acute respiratory, cardiac, To diagnose critical
vascular, renal, hepatic insufficiency. conditions.
7. Pediatrics Anatomic-physiological features of the To calculate daily
vital systems of the child. liquid requirements.
8. Surgery, obstetrics Acute surgical obstetrics and gynecologic To estimate the
and gynecology pathology. severity of condition
of the patient with
acute surgical
pathology.
The provided:
9. Internal medicine, Influence of anaesthesiological To provide

pediatrics, surgery, maintenance on the vital organs and preoperative
traumatology, systems functions. preparation of patients
obstetrics and with a various
gynecology pathology.
Intrasubject integration
10. Emergency The organization of anaesthesiological To provide of patients
medicine services in the conditions of peace and sorting in depending
wartime. on weight of a
condition of the
victim.
V. Materials of the methodical maintenance of the classes.

7.1. Materials of the control of a preliminary stage.
7.1.1. Materials for the initial test control:
(applied separately)
7.1.2. Materials for individual oral interrogation ( level):

1. Classification of modern methods of anaesthesia.
2. The basic parts of the anaesthesia machine.
3. Actions of prevention of ignition and explosions in the operative room.
4. Respiratory contours, advantages, disadvantages.
5. Components of the general anaesthesia.
6. Stages of the general anaesthesia maintenance.
7. Premedication, its types.
8. Clinic of aether narcosis.
9. The mask method of the general anaesthesia.
10. The endotracheal narcosis. Indications, technique.
11. Complications of the general anaesthesia.
12. Kinds and methods regional anesthesia.
13. Features of the general anaesthesia in out-patient and urgent conditions.
14. Features of preparation of patients to operation and narcosis.
15. Physiological and pathophysiological features of carrying out of the general anaesthesia at
children and patients of old age.
7.1.3 Materials for the organization of methodical maintenance of self-preparation of

students.
Problem Instructions
1. To learn classification of modern types To find out differences between the general and
of anaesthesia. local anaesthesia. To specify the classification of
the general anaesthesia by the form and the
quantity of anaesthetics, by ways and methods of
carrying out of anesthesia.
2. To define the basic clinical symptoms To construct the structurally-logic scheme which
of infringement of functions of the includes the complaints, data of the objective
vital systems of an organism of the inspection, methods of diagnostics and feature of
patient this prepares for operative carrying out of preoperative preparation
intervention. (depending on kind of an intervention - planned or
urgent).
3. To make the plan of inspection of the To acquire clinical inspections, duties for patients
patient this prepares for operative which are hospitalized for operative treatment.
intervention.
4. To study criteria of definition of The standard criteria are the initial physical
degree of the operational-anaestesia condition of the patient, volume and traumatism of
risk and choice a method of the the future operation.
anesthesia maintenance.
8. Literature
8.1. Educational:
Basic:
1. Robert R. Kirby Critical care Atlas of Clinical Anesthesiology, Churchill Livingstone, 1997
V. 1 Churchill Livingstone, 1997. 267 .
2. Alan R. Aitkenhead, Ronald Mervyn Jones Clinical anaesthesia Churchill Livingstone,
1996 780 .
Additional:
Theme 4: METHODS OF DIAGNOSTIC AND CORRECTION OF VIOLATIONS OF

WATER-ELECTROLYTE AND ACID-BASIC STATE EXCHANGE (4 hours)
I. Actuality of theme: Disorders of homoeostasis are always registered in patients with serious
pathology: disturbances of water-electrolyte exchange, acid-basic state, disturbances of
osmolarity. It may occurs in patients with sharp surgical pathology of organs of abdominal
region, traumatic damages, hypovolemick shock, diseases, accompanied with a fever, vomit,
diarea, sweating, in patients with organ and system (respiratory, heart, hepato-lienal, CNS)
insufficiency, disturbances of buffer systems. It may occur also in the cases of pathological water
and electrolytes losses of, damages of mechanisms of receipt and mastering of water and food
products. That is why doctor of each specialty should diagnose and interpret violation of water-
electrolyte exchange and acid-basic state, know pharmacology of solution for infusion and be
able to apply them in the complex of intensive therapy.
II. Educational whole employment:

1. To familiarise (level 1):
Physiological mechanisms of maintenance of internal environment of organism, methods
of its control;
physiopathology of water-electrolyte exchange and acid-basic state;
concept about the homoeostatic functional system, osmolarity;
types of violations of water exchange, methods of its diagnostics and correction;
exchange of basic electrolytes - sodium, potassium, chlorine, calcium, their possible
violations, methods of correction;
physiology of buffer systems of human organism;
types of violations of the acid-basic state;
methods of laboratory diagnostics and intensive therapy of metabolic acidosis, metabolic
alkalosis, respiratory acidosis and respiratory alkalosis;
peculiarities of functions of organism of older persons and children;
methods of determination of circulating blood volume deficit;
clinical pharmacology of drugs used for treatment of water-electrolyte exchange and acid-
basic state disturbances;
ways of injections of fluid solution in human organism,
peculiarities of infusion therapy for children and seniors;
complication of infusion therapy;
bases of parenteral feeding;
Description of preparations, used for parenteral feeding and methods of its action control;
features of parenteral feeding for children and older people.
B. Can provide next skills (level 2):

to be able to calculate osmolarity of plasma, volumes of water sectors of organism, day's
balance of water and electrolytes;
to determine the deficit of water in the sectors of organism, basic electrolytes and to
conduct their correction;
to choose the kind of infusion solutions for the correction of water-electrolyte exchange;
to diagnose the types of violations of acid-based state using clinical signs and laboratory
researches;
to choose the methods of correction of homoeostasis in the case of different variants of
violations of water-electrolyte and acid-base exchange.
C. To be able (level 3):

to determine the diagnosis of violations of water-electrolyte exchange and acid-
basic state;
to calculate the deficit of water and electrolytes for concrete patients;
to create a plan of intensive therapy for patients with the different variants of
violations of water-electrolyte exchange and acid-basic state;
to prescribe a parenteral for a concrete patient.
I. Materials for independent students work.

3.1. Base knowledge, abilities, skills, necessary for the study of the theme (interdisciplinary
integration)
3.2. Base knowledge, abilities and skills, necessary for the study of theme (interdisciplinary
integration):
Disciplines To know To be able to perform

1. Previous disciplines:
1. Physiology Functions of organs and systems of To measure the index of
organism in a norm hematocrit, volume of
circulating blood, PH of
urine
Pathological Functions of organs and systems of To measure the indexes of
physiology organism in pathological states BP, CVP, volume of
circulating blood, PH of
urine, cardiac extras in
patients with pathological
condition
Biochemistry, A volume of water in an organism, its To interpret the clinical and
colloidal distributing between sectors, organs biochemical indexes of
chemistry, and systems, concentration of basic homoeostasis, got in laboratory
biophysics electrolytes in plasma and cells of researches
organism, osmolarity, parameters of
acid-based state
2. Interdisciplines integrations:
1. Methods of Research methods of investigations Calculations with using of
investigations of water condition in an organism basic formulas for
(receipt, distributing between sectors) determination of deficit of
in a norm and pathology. Law of water, correction of
electroneutrality. Law of violations of osmolarity.
isoosmolarity in norm and pathology; To calculate osmolarity of
measuring of osmolarity. plasma; different
Concept about the acid-basic state hemoconcentrative indexes,
(buffer systems of organism). Law of To estimate the type of
stable concentration of hydrogen ions. hypohydration.
To interpret the indexes of
ionograms, osmolarity,
To calculate the deficit of
water and electrolytes.
2 Methods of Basic formulas for the correction of To optimize the kinds of
intensive deficit of water, violations of intensive therapy of different
therapy osmolarity; ways and methods of their variants of violations of
correction; chemical composition of homoeostasis; to prescribe
solution for infusion therapy. parenteral feeding; to be able
to choose optimal infusion
remedies and to conduct
intensive therapy.
Questions for the individual control:

1. Concept about osmolarity and its correction.
2. Clinical signs of dehydration and overhydration.
3. Hypertonic dehydration. Reasons of origin, clinical signs, methods of correction.
4. Isotonic dehydration. Reasons of origin, clinical signs, methods of correction.
5. Hypotonic dehydration. Reasons of origin, clinical signs, methods of correction.
6. Hypertonic overhydration. Reasons of origin, clinical signs, methods of correction.
7. Hypotonic overhydration. Reasons of origin, clinical signs, methods of correction.
8. Isotonic overhydration. Reasons of origin, clinical signs, methods of correction.
9. Hypotonic overhydration. Reasons of origin, clinical signs, methods of correction.
10. Reasons and signs of hypo- and hypernatremia, methods of treatment.
11. Physiopathology of violations of hypo- and hyperkaliemia, clinic, diagnostics,
corrections.
12. Violation of chlorine exchange.
13. Buffer systems of organism.
14. Concept about acidosis, its diagnostic and correction.
15. Concept about alkalosis, its diagnostic and correction.
16. Description of solutions for infusion therapy.
17. Prescription of parenteral feeding.

1. Patient G., 33 years, 76 kg, complaints on a general weakness, feeling of heavy in epigastria,
frequent vomit after the use of meal and water. In anamnesis- 6 years of ulcerous illness of
stomach. A pyloristenosis was diagnosed endoscopically. It was estimated next laboratory
indexes of plasma: K+ - 3,0 mmol/l, Cl- - 88 mmol/l; PH - 7,49; paCO2 - 48 mm. mercury.; BE
is (+5) mmol/l.
What type of violation of homoeostasis does take a place?
2. Patient O. was delivered in the hospital. He is 66 years old, body weight is 67 kg, Diagnosis:
diabetes mellitus, hyperglycemic comma. It was discovered: sugar of blood 33,2 mmol/l, K+ -
3,2 mmol/l; Na+- 156,0 mmol/l, Cl-- 112,0 mmol/l; PH - 7,37; PaCO2 is 45 mm mercury; BE is
(-1,2) a mmol/l. You should specify a diagnosis, type of violations of homoeostasis and tactic of
intensive therapy.
IV. Materials for audience independent work

4.1. List of educational practical tasks which must be executed on practical lesson:
1. To conduct the clinic and laboratory inspection of patients with diabetes mellitus; to estimate
the degree of violations of water-electrolyte and acid-base state, optimize the chart of infusion
therapy and prescribe plan of treatment.
2. To conduct the clinic and laboratory inspection of patients in a postoperative period; to
estimate the degree of violations of water-electrolyte and acid-base state, to optimize the chart of
infusion therapy and prescribe plan of treatment.
3. To conduct the clinic and laboratory inspection of patients with stenosis of goalkeeper; to
4. To conduct the clinic and laboratory inspection of patients with intestinal impassability; to
5. To conduct the clinic and laboratory inspection of patients with peritonitis; to estimate the
degree of violations of water-electrolyte and acid-base state, to optimize the chart of infusion
6. To conduct the clinic and laboratory inspection of patients with pancreonecrosis ; to estimate
the degree of violations of water-electrolyte and acid-base state, to optimize the chart of infusion
V. 8. Literature
8.1. Educational:
Basic:
. .. . .: , 2010. 312 .
Saunders, 2000 2227 .
Additional:
1. William C. Shoemaker, W. Leigh Thompson, Peter R. Holbrook, Gwen Berry Textbook
of critical care Saunders, 1984. 1063 .
Theme 5. ACUTE KIDNEY AND ACUTE LIVER FAILURE (4 hours)
. Theme urgency: Acute kidney failure (insufficiency) is a multietiological syndrome, caused

by fast, plural, potentially reversible infringement filtration-concentration, excretory and
incretory functions of kidneys, owing to infringement of an intranephritic blood-groove and
occurrence of destructive infringements of cages glomerulus and nephritic tubules. Acute liver
failure (insufficiency)) - is characterised by presence at the patient symptoms of cholestasis,
cytolysis, synthetic and desintoxycationes insufficiency, mezenhimal-inflammatory and
immuno-inflammatory syndromes. AKI and ALF -it quickly progressing statuses dangerous to a
life which can become complicated coma development. Lethality at sharp nephritic insufficiency
reaches 80 %, at sharp hepatic insufficiency - 50%. Therefore it is necessary to be able to
diagnose quickly these statuses, and accordingly in time to begin adequate therapy.

1. To familiarise (level 1):
Anatomy and physiology of kidneys.
Sharp nephritic insufficiency: forms SNI, an aetiology, pathophysiology.
Clinic and biochemical infringements at SNI
Methods of diagnostics SNI.
Intensive therapy SNI.
Indications to effective therapies.
Kinds of efferent therapies (a haemodialysis, a haemofiltration dialysis).
Physiology of liver.
SHI: an aetiology, pathophysiology.
Clinic SHI.
Methods of intensive therapy SHI.
2. To know (level 2):
Inspections of patients with SNI and SHI.
Interpretations of laboratory inspections of patients with SNI and SHI.
To estimate results of tool inspections of patients with SNI and SHI.
Job with a assignment leaves of the inpatient and leaves of purposes of patients with SNI and
SHI.
3. To be able (level 3):
to Diagnose SNI.
to Diagnose form SNI.
to make the plan of intensive therapy of patients with different forms of SNI.
to Diagnose SHI.
to Make the plan of intensive therapy of patients with SHI.
to Define indications for carrying out therapies.
III. The Purposes of development of the person: it is necessary for young experts to seize
inspection techniques, developing in itself clinical thinking on the basis of understanding
pathophysiology processes which occur in an organism of the patient; to bear responsibility for
interpretation of results of researches and intensive therapy.
IV. Interdisciplinary integration:

The providing:
1. Human Anatomy of kidney
anatomy Kidneys blood circulation
Structure of nephron
Liver blood circulation
Structure of hepato sites.
Physiology Functions of organs and systems of organism
are in a norm
Pathophysiolo Function of organs and systems of organism Define AP, CVP, V of
gy at patois. BC
1. Research Egestion of foods of metabolism Calculate osmolarity of
methods Kidney adjusting plasma
Formation of urine To estimate the type of
Neuroendokrine adjusting of rens hydratation
Metabolic functions of liver To interpret the results of
Biliation. laboratory and
A role of liver is in hemopoesis instrumental researches
A role of liver is in erythropoesis
Clinical and biochemical indexes of function
of liver
2 Methods of Reasons are ARI and AHI Able to minimize

intensive Providing of adequate level of indexes of nephro- and hepatotoxic
therapy central hemodynamics and respiratory action of medications
function
Correction of aquatic-electrolits and To optimize the charts of
metabolic violations intensive therapy of sick
Providing of adequate feed with different variants
Symptomatic therapy of AHI violations of
A prophylaxis of development and treatment homoeostasis, able to
of complications are ARI and AHI conduct intensive therapy
Testimonies to therapy
IV. Questions for the individual verbal questioning of II of level:
1. Anatomy and physiology of the urinary system.

2. Determination is AKF, aetiology, physiopathology.
3. What do distinguish forms AKF?
4. A clinic is AKF.
5. What biochemical and physiology violations do take place at AKF?
6. What methods of diagnostics are AKF?
7. Intensive therapy is AKF, basic stages.
8. What testimonies for efferent therapy?
9. What do distinguish the methods of efferent therapy?
10. Physiology of liver.
11. Aetiology, physiopathology of development of ALF.
12. Clinic of ALF.
13. What methods of intensive therapy of ALF
Tasks for self-control:

Task 1
The patient is 85 years old delivered by the ambulance to the hospital emergency roomwith
complaints of pain in the abdomen. During the last 2 days - no diuresis. In anamnesis - an
adenoma of the prostate gland. Palpation of the abdomen in the suprapubic region showed a
tense circular formation. Total blood test - erythrocytes - 5 * 1012 / l, leukocytes 8 109 /l, ESR
14 mm/h, in biochemical analysis - plasma creatinine 0.198 mmol/l, urea 12 mmol/L, K-4
mmol/l, bilirubin - 12 mol/l.
What laboratory parameters indicate initial post-renal failure?
Task 2
A 85-year-old patient has been taken to the emergency room, after relatives have found him at
home without consciousness. examination - the ammonia smell from the patient's mouth.
Kussmaul's breath. Tones of the heart muted 80 / min, rhythmic. AT 100/60 mm Hg. Art. In the
suprapubic region, a tense circular formation is palpated. Total blood test - erythrocytes - 5 *1012
/l, leukocytes 10 * 109 /l, ESR 14 mm / h, plasma creatinine 0.788 mmol / l, urea 48 mmol/l, K-
5.8 mmol/l, Na-120 mmol/l, bilirubin - 12 mmol/l, plasma glucose - 4 mmol/l.
Where should the patient be hospitalized?
V. Task for independent work on the basic stage of employment:
1. To conduct the inspection of patient with ARI.

2. To conduct the inspection of patient with AHI.
3. To conduct the clinical-laboratory inspections of patient with ARI, to estimate the got results.
4. To conduct the clinical-laboratory inspections of patient with AHI, to estimate the got results.
5. To work out a plan of inspection of patient with ARI.
6. To work out a plan of inspection of patient with AHI.
7. To work out a plan of intensive therapy of patient with ARI.
8. To work out a plan of intensive therapy of patient with AHI.
9. To analyse the individual medical map of patient with ARI.
10. To analyse the individual medical map of patient with AHI.
8. Literature
8.1. Educational:
Basic:
. .. . .: , 2010. 312 .
Saunders, 2000 2227 .
Additional:

4. Paul L Marino The ICU Book Williams & Wilkins, 2009 - 715 p.
Theme 6: THE GENERAL PRINCIPLES OF THE URGENT HELP FOR ACUTE
POISONINGS (4 hours).
I. Theme relevance: Over the past decades, the so-called toxic situation arose all over the
world and in Ukraine in particular. It was caused by rapid growth of chemical and pharmaceutical
industry, environmental pollution, poor keeping to the rules of labor protection and safety
engineering as well as by using various toxic chemicals in private life, by creation of home
medicine chest and practice of self treatment with potent drugs, by increase of a number of
suicide attempts and etc. All this has led to the rise of acute exogenous poisoning every year and
a number of hospitalized patients with this pathology have reached one person per a thousand of
people annually. When poison get into the human body the natural ways of detoxification work,
but their possibilities are restricted by the functional limit of the excretory organs (liver, kidneys,
lungs, digestive system and skin). In this case poisoning causes decompensation conditions and
often tragic consequences. Then the role of anesthesiologist is to stimulate these organs, but it
often has a little effect and artificial methods of excretion or neutralization of the toxic substances
must be used with application of extracorporeal detoxifications methods.
1. To familiarise (level 1) To get acquainted with the scientific progress in epidemiology, origin,
diagnostic, clinical pictures, first aid and intensive care of th acute exogenous poisonings.
2. To know (level 2):
The main groups of poison substances;
The ways of entrance of poisons to the organism;
The essence of the conception lethal synthesis;
The clinical stages of acute exogenous poisonings;
The main directions of treatment for poisonings;
establishment of adequate airway (head position, oral and nasal airway, laryngeal masks);
3. To be able (level 3):
oro- and nasogastric intubation;
gastric lavage;
peripheral and central venous cannulation;
introduction of the constant urethral catheter (Foley);
administration of oxygen inhalation;
connection patients to monitors;
establishment of adequate airway (head position, oral and nasal airway, laryngeal masks);
prevention of decubituses and position squeeze;
feeding through nasogastric tube;
estimation of consciousness level;
methods of physical cooling of hyperthermia
To master the ability.
To make provisional diagnosis and to work out the plan of examination of the patient with
acute exogenous poisoning;
To make differential diagnosis of illnesses, that have got similar symptoms;
To make the plan of carring out osmotic forced alkaline diuresis;
To administer antidotic treatment;
To define qualitative and quantitative composition of substitution infusion therapy;
To evaluate the general condition of the patient by monitoring her basic physiological
functions;
To calculate the daily rations for tube feeding;
To administer anticonvulsant treatment for children and adults;
To project directions to struggle with hyperthermia.
(The 3-rd level)
I. Objectives of the personality development: Young specialists need to master the methods of
collecting anamnesis from the victim or his relatives, establishing a positive psycho-emotional
connection with them, be able to apply in practice the knowledge gained in diagnosing and treating acute
exogenous poisonings and diseases that are accompanied by significant violations of consciousness, up
to comatose condition.
IV. Materials for pre-admission independent work (for preparation to

the abovementioned topic of the practical lesson).
4.1. Basic knowledge, skills, skills needed to study the topic (interdisciplinary integration):
N Subject To know To master

The providing:
1. Chemistry Chemical structure of some To define corrosive poisons by
poisons. litmus paper.
2. Physics Physical condition of some poisons.
3. Biochemistry The ways of biotransformation of
some poisons to form more toxic
combinations.
4. Surgery Methods of diagnosis of acute Stomach intubations
(surgical) abdomen. Vena cannulation
Bladder catheterization
5. Therapy Methods of examination of To diagnose the main

patients. pathological syndrome
The provided:
6. Toxicology. The main clinical manifestation of To determine the indications
acute poisonings. for extracorporeal methods of
detoxification.
1. Methods of Main and additional methods of the To estimate the degree of
examination. examination. disturbance of the main
Diagnosis, clinical Indication for extracorporeal physiological parameters of the
characteristics of methods of detoxification. patient.
the disease and To evaluate general condition
treatment of of the patient and to determine
patients with the main pathological
poisoning. syndromes.

1. Epidemiology of acute exogenous poisoning.
2. Classification of poisonous substances.
3. Ways of poisoning into the body.
4. The concept of "lethal synthesis".
5. Basic principles of IT acute poisoning.
6. Natural ways of removing toxic substances from the body.
7. Methods and features of withdrawal of poisonous substances from the gastrointestinal tract.
8. Basic principles and methods of forced alkaline osmotic diuresis.
9. Basis of detoxification capacity of the liver.
10. Extracorporeal methods of detoxification, indications and contraindications, technical means,
technique of execution.
11. Principles of antidote therapy.
Task No. 1
A 36-year-old man was taken to an intensive care unit with complaints of burning pains in the mouth,
behind the sternum in the course of the esophagus and in the epigastric region. From the anamnesis it
became known that she casually 12 hours ago drank 50 ml of an unknown fluid that was in a bottle of
vodka. After that she appeared with the above-mentioned complaints, which were accompanied by
vomiting movements. Objectively: the patient is excited, on the skin around the mouth and on the tongue
is visible chemical burns of the - degree, which moderately bleed. Swallowing is difficult, painful.
From the mouth you can hear the smell of vinegar. The patient was urinating - about 150 ml of urine of
dark brown color was obtained.
Make a diagnosis and plan an additional survey and intensive care.
Task No 2
At the hospital's emergency, an ambulance car delivered two men in a coma. According to the attendants
it became known that they drank 100 ml of vodka of unknown origin. Shortly after receiving her, they
had a severe headache, nausea, pain in the epigastrium, reduced visual acuity, and then a coma condition.
Objectively: condition of the cerebral deficiency - coma and breath - hyperventilation, moderate arterial
hypotension, mouth smell of alcohol, in laboratory tests, metabolic acidosis.
Suggest the most likely diagnosis, make an additional survey plan, emergency care and antidote therapy.
V. Materials for independent classroom work
5.1. List of educational practical tasks to be performed on practical lesson:
to examine a patient with acute exogenous poisoning
to analyze the history of diseases with the evaluation of laboratory and additional survey
methods
to establish monitoring monitoring of physiological parameters of patients
perform the necessary medical therapeutic manipulations (adjust oxygen inhalation, carry out
the upper respiratory tract toilet, provide venous access, enter the gastric probe and urethral
catheter, etc.)
make a plan for an additional survey and write the appointment letter for intensive care of the
examined patients.
V. Literature
Educational:
Basic:
. .. . .: , 2010. 312 .
Saunders, 2000 2227 .
4. Miller R.D. Millers anesthesia. 6th ed. Philadelphia (PA): Elsevier Churchill Livingstone;
2005. - 1158 .
Additional:
4. Paul L Marino The ICU Book Williams & Wilkins, 1998. - 640 p.
5. Hack JB, Hoffman RS. General management of poisoned patients. In: Tintinalli JE, Kelen
GD, Stapczynski JS, Ma OJ, Cline DM, eds. Emergency Medicine: A Comprehensive Study
Guide. 6th ed. Columbus, OH: McGraw-Hill; 2006: chap 156.
Head of department professor Titov I.I.

Metodical Guide For Students I Semester

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METHODICAL GUIDE FOR STUDENTS

Theme 1: CARDIO-PULMONARY RESUSCITATION- BLS (4 hours).

2 Human physiology Conditions of blood supply to brain.

3.2. Question for individual oral questioning:

3.3. Tasks for self-control:

IV. Materials for independent classroom work

Theme 2: CARDIO-PULMONARY RESUSCITATION- ALS (4 hours).

2 Human physiology Conditions of blood supply to brain.

3.2. Question for individual oral questioning:

3.3. Tasks for self-control:

IV. Materials for independent classroom work

Theme 3. GENERAL QUESTIONS OF ANESTHESIOLOGY (4 hours)

B. 2. To know (level 2):

C. To be able (level 3):

III. Purposes of personal development: for future doctors it is necessary to learn to

9. Internal medicine, Influence of anaesthesiological To provide

V. Materials of the methodical maintenance of the classes.

7.1.2. Materials for individual oral interrogation ( level):

7.1.3 Materials for the organization of methodical maintenance of self-preparation of

Theme 4: METHODS OF DIAGNOSTIC AND CORRECTION OF VIOLATIONS OF

II. Educational whole employment:

B. Can provide next skills (level 2):

C. To be able (level 3):

I. Materials for independent students work.

Disciplines To know To be able to perform

Questions for the individual control:

3.3. Tasks for self-control:

IV. Materials for audience independent work

. Theme urgency: Acute kidney failure (insufficiency) is a multietiological syndrome, caused

II. Educational whole employment:

IV. Interdisciplinary integration:

2 Methods of Reasons are ARI and AHI Able to minimize

IV. Questions for the individual verbal questioning of II of level:

1. Anatomy and physiology of the urinary system.

Tasks for self-control:

V. Task for independent work on the basic stage of employment:

1. To conduct the inspection of patient with ARI.

1. William C. Shoemaker, W. Leigh Thompson, Peter R. Holbrook, Gwen Berry Textbook of

IV. Materials for pre-admission independent work (for preparation to

N Subject To know To master

5. Therapy Methods of examination of To diagnose the main

4.2. Question for individual oral questioning:

Head of department professor Titov I.I.

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