MEDIC ST 5014AHO - Anaesthesia, Pain Medicine & Intensive Care V Pt1

Teaching Hospitals - Semester 1 - 2016

The course information on this page is being finalised for 2016. Please check again before classes commence.

The clinical attachments are a program of clinical education through a selection of placements so that students will be competent in history-taking, patient examination and management. This includes problem formulation, investigations, treatment (pharmacological and non-pharmacological), counselling, good communication skills, the practice of empathetic medicine, and a sound knowledge base that allows diagnosis and management of common disorders to be carried out under appropriate supervision. Some students will have the opportunity to undertake their training for an extended period of time in a rural or remote setting.

  • General Course Information
    Course Details
    Course Code MEDIC ST 5014AHO
    Course Anaesthesia, Pain Medicine & Intensive Care V Pt1
    Coordinating Unit Medicine
    Term Semester 1
    Level Undergraduate
    Location/s Teaching Hospitals
    Contact attachments, common program & research
    Available for Study Abroad and Exchange N
    Prerequisites Year 4 MBBS Exam
    Restrictions Available to MBBS students only
    Course Description The clinical attachments are a program of clinical education through a selection of placements so that students will be competent in history-taking, patient examination and management. This includes problem formulation, investigations, treatment (pharmacological and non-pharmacological), counselling, good communication skills, the practice of empathetic medicine, and a sound knowledge base that allows diagnosis and management of common disorders to be carried out under appropriate supervision. Some students will have the opportunity to undertake their training for an extended period of time in a rural or remote setting.
    Course Staff
    RAH ICU contact:
    A/Prof Mary White
    Email: Mary.White@health.sa.gov.au

    RAH Anaesthetics contact:
    Dr Julia Coldrey
    Email: Julia.Coldrey@health.sa.gov.au

    RAH & TQEH Pain and Palliative Care contact:
    A/Prof Pam Macintyre
    Email: Pamela.macintyre@adelaide.edu.au

    The Queen Elizabeth Hospital Anaesthetics and ICU contact:
    Dr Thava Visvanathan
    Email: thava1@optusnet.com.au

    Lyell McEwin Hospital contact:
    Dr Lynda D’Souza
    Email: Lynda.D'Souza@health.sa.gov.au
    Course Timetable

    The full timetable of all activities for this course can be accessed from Course Planner.

    The course timetable for the APIC rotation is made available to students on the first day of the rotation.
  • Learning Outcomes
    Course Learning Outcomes
    The course objectives for the anaesthesia component are:
    1. Preoperative Assessment
    1.1. Rational ordering of Preoperative investigations
    1.2. Assessment Cardiorespiratory reserve
    1.3. Airway assessment
    1.4. Consent
    1.5. Management of peri-operative medications
    1.5.1. Hypoglycaemics
    1.5.2. Anticoagulants/Antiplatelet agents
    1.5.3. Herbal preparations
    1.5.4. Other
    1.6. Fasting Guidelines
    1.7. Pre-medication (bronchodilators, reflux prevention, etc.)

    2. Pharmacology (brief overview)
    2.1. iv induction agents
    2.2. inhalational agents
    2.3. muscle relaxants
    2.4. reversal agents
    2.5. local anaesthetics (safe doses, routes of administration, toxicity & its treatment)

    3. Monitoring (basic overview)
    3.1. Pulse oximetry
    3.2. Capnography
    3.3. ECG
    3.4. Blood pressure

    4. Emergency Anaesthesia
    4.1. EMST principles (primary survey)
    4.2. Rapid Sequence Induction
    5. Gas Exchange
    5.1. Oxygen therapy– routes and delivered concentrations
    5.2. Hypoxia – differential and management
    5.3. Hypercarbia – differential and management

    6. CVS crises
    6.1. BLS/ALS pricinples
    6.2. mangement of cardiac arrest
    6.3. management of anaphylaxis

    7. Co-morbidites (outline of principles and peri-operative implications)
    7.1. Gastro-oesphageal reflux
    7.2. Asthma
    7.3. Sleep Apnoea
    7.4. Diabetes
    7.5. Ischaemic heart disease
    7.6. Obesity

    8. Peri-operative Fluid Management
    8.1. Water, Na+, K+ 8.2. Blood transfusion and transfusion triggers

    9. Recovery
    9.1. Analgesia (see pain week)
    9.2. Confusion
    9.3. Hypo/hypertension
    9.4. Nausea and vomiting
    9.5. Airway/breathing issues

    10. Skills
    10.1. iv cannulation
    10.2. chin lift/jaw thrust
    10.3. oropharyngeal/nasopharyngeal airway insertion
    10.4. bag and mask ventilation

    The objectives of the pain component are:
    1.    Assessment of pain in relation to clinical diagnosis, classification and response to therapy
    2.    Knowledge of the pharmacology of drugs commonly used in pain management
    3.    Develop a familiarity with drug and non-drug techniques commonly used in pain management
    4.    Develop pain management strategies required to competently fulfil the role of an intern.

    The objectives of the ICU component are:
    1.    Revision of physiology and pharmacology in a case-based, clinical setting
    2.    Approach to the management of critically ill patients
    a.    Essentials of identification, triage and management of critically ill patients
    b.    Principles of life-support and monitoring systems
    c.    Practical aspects of advanced life support
    3.    Understanding of the ethical issues involved in the care of critically ill patients
    4.    Revision of basic and advanced life support skills (BLS, ALS)
    University Graduate Attributes

    No information currently available.

  • Learning Resources
    Required Resources
    N/A
    Recommended Resources
    Pain:
    •    Acute Pain Management: Scientific Evidence 3rd edition, 2010: see http://www.anzca.edu.au/fpm/resources/books-and-publications
    •    Macintyre and Schug, Acute Pain Management: a practical guide, WB Saunders, 3rd edition 2007
    •    Therapeutic Guidelines: Palliative Care: available via the University of Adelaide library
    •    Australian Medicines Handbook: available via the University of Adelaide library

    Anaesthesia:
    •    Introductory anaesthetics textbook such as:
    o    Gwinnutt, Lecture Notes: Clinical Anaesthesia, 4th edition, 2012
    o    Harley and Hore, Anaesthesia an introduction, 5th edition, 2012 
    Online Learning
    Students are recommended to review the SMTS pain and palliative care content available on MyUni as well as the relevant lectures on pain and analgesia from the MLTU website.
  • Learning & Teaching Activities
    Learning & Teaching Modes
    Core teaching process for ICU includes:
    1.    Small and large group teaching sessions ie. lectures and tutorials
    2.    Skills sessions (simulator sessions)
    3.    Case presentations
    4.    Clinical attachments with ward rounds
    5.    Self-directed study
    6.    Presentation of ICU related topics

    The pain component learning is delivered via:
    1.    Lectures
    2.    Clinical attachments to acute pain, chronic pain and palliative care
    3.    Tutorials
    4.    Group work and group presentation
    5.    Case based discussion of chronic pain and palliative care
    6.    Self-directed learning

    The anaesthetics teaching and learning modes include:
    1.    PBL sessions
    2.    Clinical attachments in theatre, OPD and recovery
    3.    Simulator sessions
    4.    Self-directed learning.
    Workload

    The information below is provided as a guide to assist students in engaging appropriately with the course requirements.

    The information below is provided as a guide to assist students in engaging appropriately with the course requirements.

    Workload for the individual students will vary from week to week but students can assume that on average they will work a 45 hour week which will include clinic sessions, lectures (both delivered and online), seminars, tutorials and private study but does not include after hours call.
    Learning Activities Summary
    For all components, students are expected to attend all clinical rounds and rostered tutorials and participate actively in these.

    Anaesthetics
    RAH: Students will be provided with handouts on initial assessment and management of trauma, management of shock and preoperative care and will be expected to have read this in preparation for the PBL sessions, along with material available on the MLTU website.
    TQEH: Students are requested to pre-read the PBL on local anaesthetics available on the MLTU website for their PBL on the first Monday afternoon. All other PBLs and rostering will be notified during orientation and material will be available on website.

    Pain
    Students are expected to complete the recommended readings:
    1.    Revisit 4th year lectures on pain and analgesics
    2.    Macintyre and Schug – Acute Pain Management
    a.    Chapter 3 – Assessment of pain
    b.    Chapter 4 – pharmacology of opioids
    c.    Chapter 6 – non-opioid and adjuvant analgesic drugs
    d.    Chapter 7 – routes of systemic opioid administration
    e.    Chapter 8 – patient-controlled analgesia
    f.    Chapter 9 – epidural analgesia
    g.    Chapter 12 – acute neuropathic pain
    h.    Chapter 14 – elderly, opioid-tolerant and substance abuse patients
    3.    Therapeutic Guidelines – Palliative Care
    a.    Chapter – Getting to know your drugs
    b.    Chapter – Pain
    4.    Macintyre PE, Loadsman JA, Scott DA. Opioids, ventilation and acute pain management. Anaesth Intensive Care. 2011 Jul;39(4):545-58
    5.    Coldrey JC, Upton RN, Macintyre PE. Advances in analgesia in the older patient. Best Pract Res Clin Anaesthiol. 2011 Sep; 25(3):367-78
    6.    Huxtable CA, Roberts LJ, Somogyi AA, Macintyre PE. Acute pain management in opiod-tolerant patients: a growing challenge. Anaesth Intensive Care. 2011 Sep;39(5):804-23
  • Assessment

    The University's policy on Assessment for Coursework Programs is based on the following four principles:

    1. Assessment must encourage and reinforce learning.
    2. Assessment must enable robust and fair judgements about student performance.
    3. Assessment practices must be fair and equitable to students and give them the opportunity to demonstrate what they have learned.
    4. Assessment must maintain academic standards.

    Assessment Summary
    Assessment for the APIC rotation is a combination of the individual assessments for each sub-rotation. It is based on attendance, presentation assessments and clinical competency.
    Assessment Related Requirements
    See Assessment Detail
    Assessment Detail
    Pain
    1.    Attendance at and participation in clinical rounds and tutorials
    2.    MCQ paper based on material covered in acute pain and pharmacology lectures in year 4. See chapters 3,4,6,7 in Macintyre and Schug.
    3.    Group presentation of allocated clinical “patient in pain” case
    a.    The presentation should not exceed 30 min
    b.    The presentation is a group effort – all students should discuss the case and be prepared to answers any questions asked by the examiners.

    Anaesthesia
    1.    Attendance at and participation in clinical activities  including simulator session
    2.    Participation in PBL sessions
    3.    TQEH: in addition to 1&2, each student is required to research and present a 15-20 minute presentation on a preoperative scenario at the end of their second week.
    4.    LMH: in addition to 1&2, student are required to present a case.

    ICU
    1.    Professional behaviour
    2.    Participation in clinical activities
    a.    Attendance, including out of hours (minimum 95% attendance required to pass rotation)
    b.    Actively seeks learning opportunities
    c.    Contributes to patient discussion
    3.    Medical competence
    a.    Thorough history and physical examination skills
    b.    Concise and accurate case presentations
    4.    Theoretical knowledge
    a.    Good knowledge base with ability to apply to clinical situations
    5.    ICU presentation.

    Submission
    N/A
    Course Grading

    Grades for your performance in this course will be awarded in accordance with the following scheme:

    NOG (No Grade Associated)
    Grade Description
    CN Continuing

    Further details of the grades/results can be obtained from Examinations.

    Grade Descriptors are available which provide a general guide to the standard of work that is expected at each grade level. More information at Assessment for Coursework Programs.

    Grades for your performance in this course will be awarded in accordance with the following scheme: GS4

    GS4

    Grade    Description
    NGP Non-Graded Pass
    Satisfactory
    U Unsatisfactory
    F Fail


              

    Final results for this course will be made available through Access Adelaide.

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