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Anesthesiology and Emergency

Course developer

Prior knowledge

Vete4105, Pharmacology, Pharmacotherapy and Toxicology I

VeteB004, Anatomy of the Domestic Animals III

VeteB010, Physiology II

VeteB041, Pathology and Forensic Veterinary Medicine II

Course abstract

In the first part of the course, students learn the latest concepts in veterinary anesthesiology, including commonly used anesthetic medications, pharmacokinetics and pharmacodynamics, types of sedation, anesthesia monitoring, medication combinations, and practical application. The aim of the second part of the course is to provide students with the knowledge in reception, approach, and stabilization of critical patients. 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: emergency care at a sufficient level to work in practice; anaesthesiology at a sufficient level to work in small animal surgery – CECA

Course Content(Calendar)

1. Brief introduction, procedures for written colloquia, and contact-hour schedule. History of anaesthesiology, terminology, groups of drugs used in anaesthesiology, their representatives and brief characteristics, and the concept of balanced anesthesia. Recognition and admission of the critically ill patient. Primary and secondary patient assessment. Monitoring of anesthetized patients and patients requiring emergency care. Lecture (2 h) and laboratory session (2 h).
2. Drugs used in anaesthesia. General anaesthetic agents (inhalational and injectable). Sedative agents. Opioids. Local anaesthetic agents. Pharmacological drug groups and their general characteristics, pharmacokinetics, pharmacodynamics, indications, and contraindications. Lecture (2 h).
3. Pain physiology and analgesia. Pain assessment (pain scoring systems), methods of analgesia, the concept of multimodal analgesia, and relevant guidelines. Combinations of anaesthetic agents. Anaesthetic machine. Intubation. Lecture (2 h) and laboratory session (2 h).
4. Shock. Diagnosis and management of shock. Understanding the pathophysiology of shock. Types of shock. Veterinary management of animals in shock. Principles of emergency treatment according to the type of shock. Blood transfusion. Lecture (2 h).
5. Cardiopulmonary resuscitation and resuscitation algorithms. Blood transfusion procedure. Lecture (2 h) and laboratory session (2 h).
6. Fluid therapy in emergency and critical care. Fluid therapy in shock patients. Crystalloid and colloid (natural and synthetic) fluids. Lecture (2 h).
7. Emergency management of respiratory failure. Definition of respiratory failure. Predisposing factors. Clinical signs. Prognosis. Treatment and emergency management. Lecture (2 h) and laboratory session (2 h).
8. Gastrointestinal and urinary tract emergencies. Emergency management of gastrointestinal and urinary tract conditions. Clinical signs, prognosis, and treatment. Lecture (2 h).
9. Practical aspects of fluid therapy and intravenous catheterization. Practical aspects of fluid therapy and patient preparation. Syringe pumps and infusion pumps. Fluid therapy calculations. Intravenous catheter placement: technique, catheter sizes, and potential complications. Laboratory session (2 h).
10. Practical management of urinary tract emergencies. Basic principles of urinary bladder catheterization and cystocentesis. Laboratory session (2 h).
11. Gastric dilatation–volvulus (GDV): diagnosis and treatment. Methods and procedures for providing enteral nutrition. Esophagostomy tube placement. Nasogastric tube placement. Laboratory session (2 h).
12. Central nervous system emergencies. Emergency management of central nervous system conditions, including trauma and seizures. Diagnostic procedures and monitoring. Basic principles of treatment. Laboratory session (2 h).
13. Emergency care and anaesthesia in ruminants. Clinical signs and diagnosis of species-specific emergency conditions. Diagnostic procedures and monitoring. Treatment of specific conditions. Laboratory session (2 h).
14. Emergency care and anaesthesia in horses. Clinical signs and diagnosis of species-specific emergency conditions. Diagnostic procedures and monitoring. Treatment of specific conditions. Laboratory session (2 h).
15. Emergency care and anaesthesia in exotic animals. Clinical signs and diagnosis of species-specific emergency conditions. Diagnostic procedures and monitoring. Treatment of specific conditions. Laboratory session (2 h).

16. Emergency management of reproductive conditions, Caesarean section. Clinical signs and diagnosis. Adaptation of anaesthetic protocols for Caesarean section. Neonatal resuscitation. Laboratory session (2 h).

Requirements for awarding credit points

Final exam is a multiple-choice test with one correct answer.
Access to exam:
1. All tests should be successfully passed, with a mark of at least 4. Complete 2 tests: a multiple-choice test (test score 60%) and one Clinical and Epidemiologicals Case Report (CECA).
2. Lecture and seminar attendance: 70%; study report on the topic for a missed lesson. If more than 30% attendance is missed and no topics are prepared, the course should be repeated. The exam may be taken 2 times; the third time is before the exam commission.

Description of the organization and tasks of students’ independent work

The purpose of CECA is to learn how to describe the pharmacokinetics and pharmacodynamics of various latest and most currently used anesthetics, including indications and contraindications, and to analyze drug compliance for 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 CECA should be prepared according to the methodological regulations developed by the Methodological Commission. The analysis should include the following sections: title page, introduction, theoretical part, discussion, conclusions, recommendations, literature used. CECA work must be submitted to the lecturers at a given time; the defense of the CECA is carried out orally during Surgery Techniques and Topographical Anatomy II practical classes. The oral defense time per student is up to 10 minutes. At the beginning of the semester, students are informed about the defense process, including details of the defense procedure.
During the semester, each student must independently attend the simulation and skills laboratory to acquire essential Day One clinical skills, following a checklist provided by the lecturer in the e-studies system at the beginning of the semester.
At the end of the semester, students will undertake a practical assessment. Each student will draw an examination ticket containing four clinical procedures. To pass the assessment, the student must correctly perform at least three of the four procedures. The practical assessment also includes procedures covered within the Surgery Techniques and Topographical Anatomy II course. The course provides detailed information about the practical assessment procedure at the beginning of the course.

Criteria for Evaluating Learning Outcomes

Student skills are evaluated according to the procedures specified in the laboratory work tasks. Tests for the study course and the CECA are evaluated according to the 10-point scale indicated in the LBTU Study Regulations. A test result is accepted from 4 points. Tests and CECA must be evaluated with a successful grade to access the exam.
Tests for the study course:
1. test in anaesthesiology 2. test in emergency care

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 the second cycle professional higher education program: Veterinary Medicine.