Syllabus for TWO YEARS DIPLOMA COURSE IN ANAESTHESIA TECHNOLOGY a JAMMU & KASHMIR STATE PARA-MEDICAL AND NURSING COUNCIL Tce Rec ees BET aeiuteteleteIst YEAR ANES-A 7 DIPLOMA IN ANAESTHESIA TECHNOLOGY IST YEAR SYLLABUS PAPER - A BASIC ANATOMY Introduction to Anatomy Basic Anatomical terminology Osteology- Upper limb — clavicle, scapula, humerous, radius, ulna Lower limb - femur, hipbone, sacrum, tibia, fibula Vertebral column Thorax - _Iniercostal space, pleura, bony thoracic cage, ribs sternum & thoracic vertebrae Lungs - Trachea, bronchial tree Heart - Surface anatomy of heart, chambers of the heart, valves of the heart, major blood vessels of heart, pericardium, coronary arteries. Skeleto-muscular system — Muscles of thorax, muscles of upper limb (arm & fore arm) Flexor and extensor group of muscles (origin, insertion, action) Excretory sytem - Kidneys, ureters, bladderhip bone, THEORY (i) (ii) (i) (ii) (v) (vi) PRACTICALS pRACrEes Mannequins to be provided for Teaching Osteology — Bones identification (right and left side) and prominent features and muscle attachment of the bone, clavicle, scapula, radius, ulna, humerous, femur, PHYSIOLOGY ae 1) The Cell: The Blood: Ist YEAR ANES-A sacrum, tibia, fibula. Cell Structure and functions of the various organelles. Acid base balance and disturbances of acid base balances (Alkalosis, Acidosis) Composition of Blood, functions of the blood and plasma proteins, classification and protein. Pathological and Physiological variation of the RBC. Function of Hemoglobin Erythrocyte Sedimentation Rate. Detailed description about WBC-Total count (TC), Differential count (DC) and functions. Platelets ~ formation and normal level and functionsIst YEAR ANES-A 5. 6. (vii) Blood groups and Rh factor Cardio-Vascular System: (i) Physiology of the heart (ii) Heart sounds (iii) Cardiac cycle, Cardiac output. (iv) Auscultatory areas. (v) Arterial pressures, blood pressure (vi) Hypertension (vii) Electro cardiogram (ECG) Respiratory system: (i) Respiratory movements. (ii) Definitions and Normal values of Lung volumes and Lung capacities. Excretory system: (i) Normal Urinary output (ii) Micturation (iii) Renal function tests, renal disorders. Reproductive system: (i) Formation of semen and spermatogenesis. (ii) Brief account of menstrual cycle. Central Nervous system: (i) Functions of CSFIst YEAR ANES-A 4 (i) (ii) (iii) Absorption of foods (iv) PRACTICAL 2. Endocrine system: : : Functions of the pituitary, thyroid, parathyroid, adrenal and pancreatic Hormones. Digestive system (for the students of Diploma in Scope Support Technology) Physiological Anatomy of the GIT. Food Digestion in the mouth, stomach, intestine Role of bile in the digestion. Determination of Blood Groups. Measurement of human blood pressure. Examination of Respiratory system to count respiratory rate and measure inspiration and respiration GENERAL PHARMACOLOGY 1. Introduction nd scope of Pharmacology Various routes of drug adminstration advantages and disadvantages. Biotransformation of drugs types and definition of Bio-transformation reactions. Excretion of drugs, definition and routes of drug elimination. General Mechanism of drug action and factors modifying drug action. Drug distribution, definition and factors, affeting drug distribution.Ist YEAR ANES-B 5 (PAPER B A. BIO-CHEMISTRY SEE MUISTRY * Carbohydrates Glucose and Glycogen Metabolism Proteins: Classification of Proteins and functions * Lipids: Classification of lipids and functions . Vitamins & Minerals: False Fat soluble vitamins(A,D,E,K) - vitamins — Water soluble B-complex vitamins- Principal m, Phosphorus, Magnesium Sodium, Potassium, Chlorine and sulphur)- Trace elements — Calorific value of foods ~ Basal metabolic rate(BMR) ~ respiratory quotient(RQ) Specific dynamic action(SDA) - Balanced diet ~ Marasmus — Kwasoirkar BIOCHEMISTRY SYLLABUS FOR PRACTICALS 1. Benedict's test 2 Heat coagulation tests B. PATHOLOGY SENNLO GY Te Cellular adaptation, Cell injury & cell death. Introduction to pathology, ee ee eeIst YEAR ANES-B Overview: Cellular response to stress and | noxious stimuli. Cellular adaptations of growth and differentiation. Overview of cell injury and cell death. Causes of cell injury. Mechanisms of cell injury. Reversible and irreversible cell injury. Examples of cell injury and necrosis ** ee OH Inflammation. General features of inflammation Historical highlights Acute inflammation Chemical mediators of inflammation Outcomes of acute inflammation Morphologic patterns of acute inflammation Summary of acute inflammation Chronic inflammation Immunity disorders. General features of the immune system Disorders of the immune system Infectious diseases. General principles of microbial pathogenesis Viral infections Bacterial infections-Rheumatic heart disease. Fungal infections Parasitic infections Neoplasia. Definitions Nomenclature Biology of tumor growth benign and malignant dIst YEAR ANES-B co 7 neoplasms Epidemiology Carcinogenic agents and their cellular interactions Clinical features of tumors C. BASICS OF COMPUTER See VE COMPUTER URSE CONTENT: Introduction to computer — I/O devices — memories — RAM and ROM - Different kinds of ROM — kilobytes. MB, G computer — Different co} B their conversions — large Medium, Micro, Mini computers — mputer languages. Typing text in MS word — Formatting the text — using bold, italics — Bullets and n file insertion — choosing paper s Manipulating text — different font sizes, umbering — Pictures, Aligning the text and justify - ize — adjusting margins — Header and footer, inserting page No’s ina document — Printing a file with options ~ Using spell check and grammar — Find and replace — Mail merge — inserting tables in a document. Introduction to Internet — Google search — Exploring Explorer and Navigator — of files and images - Using search engine — the next using Internet Uploading and Download E-mail ID creation — Sending messages — Attaching files in E-mail — Introduction to “C" language — Different variables, declaration, Usage — writing small programs using functions and sub — functions.es . I collection of used items from User protective clothing ang urds, Ist YEAR ANES-B a p.cssD Procedur 1. Waste disposal § area, reception disinfections sage 99 2 Use of disinfectionts sorting and classification of , equipment for cleaning purposes, sharps, blunt lighted etc. contaminated high risk baby care - delicate instruments or hot care instruments, Cleaning process - use of detergents. Mechanical cleaning apparatus, cleaning instruments, cleaning jars, receivers bowls etc. trays, basins and similar hand ware utensils. Cleaning of catheters and tubings, cleaning glass ware, cleaning syringes and needles. 4. Materials used for wrapping and packing assembling pack contents. Types of packs prepared. Inclusion of trays ahd galliparts in packs. Method of wrapping and making use of indications to show that a pack of container has been through a sterilization process date stamping. General observations principles of sterlization. Moist heat sterlization. Dry heat sterlization. EO gas sterlization. H202 gas plasma vapo sterlization. Regional Anaesthetic techniques. a. Local anaesthetic technique b. Nerve blocks c. Spinal Anaesthesia d. Epidural anaesthesiael and YEAR ANES-A Diploma Anaesthesia Technology Course 2nd YEAR SYLLABUS PAPER -A Main Syllabus - Applied Anatomy and Physiology Clinical Pharamacology Clinical microbiology Medical Ethics. Medicine outline Principles of Anaesthesia Basic Anaesthetic techniques APPLIED ANATOMY AND PHYSIOLOGY RELATED TO ANAESTHESIA Se NO ANAESTHESIA RESPIRATORY SYSTEM SSSERATORY SYSTEM A. Structure and function of the respiratory tract in relation to respiratory system Role in humidificatlon Obstruction in airways Movement or vocal cords, Cord palsies. Trachea & Bronchial tree - vessels, nerve supply, respiratory tract, reflexes, bronchosparm Layers, Surfactantsand YEAR ANES-A B. Respiratory Physiology + Control or breathing . Respiratory muscles - diaphragm, intercostals . Lung volumes - dead space, vital capacity, FRC ete. Pleural cavity - intrapleural pressure, pneumothorax. Work of breathing - airway resistance, compliance Respiratory movements’ -under anaesthesia. Tracheal tug - signs, hiccup ¢. Pulmonary Gas Exchange And Acid Base Status * Pulmonary circulation Pulmonary oedema, Pulmonary hypertension Pulmonary function tests. Transfer of & gases - oxygen Carbondioxideand YEAR ANES-A 7 i . Acid base status, definitions, acidosis types, Alkalosis types, buffers in the body. D. Oxygen: properties, storage, supply, hypoxia E. Respiratory failure, type, clinical features, causes. CARDIOVASCULAR SYSTEM Anatomy - Chambers of the heart, major vasculature. Coronary supply, innervation. Conduction system. Cardiac output - determinants, heart rate, preload, after load. Coronary blood flow& myocardial oxygen supply ECG Arrhythmias cardiovascular response to Anaesthetic & surgical procedures, Hypotension - causes, errects, management. ~« Cardio pulmonary resuscitation. Myocardial infarction, hypertension.‘and YEAR ANES-A FLUIDS AND ELECTROLYTES Body Fluids - Composition Water, sodium and potassium balance LY, Fluids - composition & administration LY. Cannulation. IV. BLOOD TRANSFUSION Blood grouping, storage, administration Clinical Pharmacology ANTISIALAGOGUES Atropine, Glycophyrrolate SEDATIVES | ANXIOLYTICS 1 Diazepam, Midazolam, Phenergan, Lorazepam, | Chloropromazine, Trichlopho NARCOTICS Morphine, Pethidine, Fentanyl, Pentazozine ANTIEMETICS ANTIEMETICS, Metaoclopramide, Ondanseteron, Dexamethasone | ANTACIDS Na citrate, Gelusil, Mucaine gel. H2 BLOCKERS Cimetidine, Ranitidine, Famotidineand YEAR ANES-A INDUCTION AGENT Thiopentone , Diazepam, Mid Propofol, Etomidate. azolam, Ketamine, MUSCLE RELAXANTS Depolarising - Suxamethonium, Non d. -Pancuronium, Vecuronium, rocuranium lepolar:sing Atracurium, INHALATIONAL GASES Gases - 02, N20, Air Agents - Ether-, Halothane, Isofllurane, Saevoflurane, Desflurane REVERSAL AGENTS Neostigmine, Glysopyrrolate, Atropine, Nalorphine, Naloxone, Flumazenil (Diazepam) LOCAL ANAESTHETICS Xylocaine, Preparation, Local - Bupivacaine - Topical, Prilocaine-jelly, Emla - Ointment, Etidocaine. Ropivacaine EMERGENCY DRUGS Adrenaline : Mode or administration, dilution, dosage, , Effects, lsoprenaline Atropine, bicarbonate, calcium, ephedrine, xylocard, ; lonotropes : dopamine, dobutamine, amidaron2nd YEAR ANE S-A 14 Aminophylline, hydrocortisone, antihistamlnics, potassium. Cardlovascular drugs Antihypertensives Antiarhythmics Beta - Blockers Ca - Channel blockers. Vasodilators - nitroglycerin & sodium nitroprusside Respiratory system- Bronchodilators, respiratory stimulants o Bronchiolytic agents Renal system Diuretics, furosemide, mannitol Obstetrics - oxoytocin,methergin Miscellaneous - Antibiotics, paracetamol, diclofenac- IV fluids,various preparations Nacl, Ringer lacatate, haemaceal,hetastarch heparin,protamine, insulin,analgesics, nsaid, ibuprufen, ketorolac, CLINICAL MICROBIOLOGY Sterilization & decontamination- | o Dry Heat © Moist Heat Sterilization - II o Chemical methods o Gaseous methods o Filtration Wound Infection & Urinary Tract Infections ee — CC“YEAR ANES-A 15 Blood stream Infections Respiratory tract Infcetion S.Typhi, Salmonel1a Paratyphi ‘K, Salmonella Typhimurium Catheter, IV associated Infections Hospital acquired infections & prevention of hospital acquired infections Hepatitis C MEDICAL ETHICS Medical ethics - Definition - Goal - Scope Code of conduct - Introduction - Basic principles of medical ethics — Confidentiality Malpractice and negligence - Rational and irrational drug therapy2nd YEAR ANES-B 16 2nd YEAR PAPER - B PRINCIPLES OF ANAESTHESIA MEDICAL GAS SUPPLY. MEDI Compressed gas cylinders Colour coding Cylinder valves; pin index. Gas piping system Recommendations for piping system Alarms & safety devices. ANAESTHESIA MACHINE Hanger and yoke system Cylinder pressure gauge Pressure regulator Flow meter assembly Vapourizers - types, hazards, mail\tenance, filling and draining, etc. BREATHING SYSTEM General considerations: humidity & heat Common components - connectors, adaptors, reservoir bags. Capnography ; etc02 Pulse oximetry Methods of humidification. Classification of breathing system Mapleson system -abcdef Jackson Rees system, Bain circuitFACE Non rebreathing valves - ambu valves The circle system Components Soda lime, indicators MASKS & AIRWAY LARYNGOSCOPES ES AINA LARYNGOSCOPES ANA Types, sizes Endotracheal tubes - Types, sizes. Cuff system Fixing, removing and inflating cuff, checking tube position complications. ESTHESIA VENTILATOR AND WORKING RA VENTILATOR AND WORKING PRINCIPLES. MONITORING ECG Sp02 Temperature IBP CvP BASIC ANAESTHETIC TECHNIQUES HISTORY OF ANAESTHESIA First successful clinical demonstration: Pre - historic ( ether) era Inhalational anaesthetic era Regional anaesthetic era Intravenous anaesthetic era2nd YEAR ANES-B 18 * Modem anaesthetic era : + Minimum standard of anaesthesia * Who should give anaesthesia? PRE-OP PREPARATION: 7 Pre anaesthetic assessment~ History — , past history - disease / Surgery / and personal history - Smoking / alcohol General physical assessment, systemic examination — CVS, RS, CNS INVESTIGATIONS Routine - Haematological - their significance - Urine - E.C.G. - Chest X - ray Endocrine, hormonal assays - Echocardiography - Angiography - Liver function test - Renal function test Others Special Case acceptance: ASA grading - I, II, Ill, IV. V i. PRE - ANAESTHETIC ORDERS: Patient = - Informed consent - — NPO - Premedication - advant ee ages, drugs Special instructions - if any Machine - Checking the machine 02, N20, suction apparatus Seand YEAR ANES-B 19 7 > ubes, Girways ssibility systems Laryngoscops, et t - Things for IV acce - Other monitoring K. INTRAOPERATIVE MANAGEMENT * Confirm the identification of the patient * Monitoring - minimum Noninvasive & Invasive monitoring Induction - drugs used Endotracheal intubation Maintenance of anaesthesia Positioning of the patient Blood / fluid & electrolyte balance Reversal from anaesthesia - drugs used Transferring the patient Recovery room - set up and things needed POST OPERATIVE COMPLICATIONS & MANAGEMENT Postoperative problems Nausea & Vomiting Sore throat Laryngeal granuloma Neurological complications. Awareness Vascular complications. Trauma to teeth Headache2nd YEAR ANES-B 20 Backache Ocular complications Auditory complications MAJOR CATASTROPHES © Mortality o Causes of death o Cerebral damage © Prevention. Basic Intensive Care 1. MONITORING AND DIAGNOSTIC PROCEDURES IN I.C.U. * Central Venous access. * ECG monitoring. * Invasive hemodynamic monitoring 2. GENERAL CARE OF PATIENT IN 1.C.U. Eye Bladder Care Care of mechanically ventilated patient Tracheostomy, humidification Vascular lines - arterial, venous line Radiography Physiotherapy - chest physiotherapy N. MEDICAL ETHICS e©000000 Medical ethics - Definition - Goal - Scope Code of conduct - Introduction — Basic Principles of medical ethics -a a eT Cc MEDICINE OUTLINES Te ‘onfidentiality a) Malpractice and negligence - Rational and irrational drug therapy Disorder of haemoporesis - Anaemias - iron deficience anaemia, Infections diseses - Sepsis and septic stock, fever of unknown origin, infective endocarditis, infective of skin, muscle, soft tissue, infection control in hospital, diseases caused by bacteria, viruses, myobacterm, viruses, fungi and Protozoa and helminthes, common secondary infection in HIV. Diseases of CVS - congenital RHD - Rheumatic fever, CAD, Peripheral vascular diseases. Respiratory system - asthma pneumonia Kidney & Urinary tract - acute renal failure, Glomerulonephritis, Haemodialysis, Transplant, Urinary tract infection Liver and biliary tract disease - Viral hepatitis, alcoholism Endocrinology and metabolism * Diabetes mellitus, Hyper - and hypothyroidism2nd YEAR ANES-B 2 Brief Aspects to be Covered TOPIC Domain Medical_Gas Must Know 1. compressed gas cylinders 2. Colour coding different gas cylinder and pipe line system 3. Cylinder storage space and things to remember while empty and full cylinder storing. 4. Diameter index safety system. 5. Medical gas pipe line system and station outlets. 6. Alarms and safety devices in pipe line gas supply. Desirable to Know 7. Oxygen concentrator working principle, their uses and care. Nice to know 8.Air compressor 2. Gas administration Must Know devices 1. Anaesthesia masks : Types / sizes. 2.Flow meters 3.Gas Regulators Desirable to Know 1.Flow restrictors Oxygen Therapy Must Know a Definition, causes and responses to hypoxemia. 2. Clinical signs of hypoxemia. 3. Goals of oxygen therapy. 4. Evaluation of patients receiving oxygen therapy 5. Hazards of oxygen therapy. Anaesthesia Must Know] -Boyles Machine Machine and its function.————— 23 2. Modern anesthesia machine. | 3. Hanger and Yoke system 4. Cylinder pressure gauge 5. Pin index 6. Pressure regulator 7. Vaporizers- TYPES, Hazards, Maintenance, Filling and drainage. 8.Flow meter assembly 5. Breathing System Must Know 1. Open, Semi closed and Closed Circuits, Classification of breathing system 2. Mapleson breathing system | 3. Jackson and Rees system 4. Bain circuit 5. Non rebreathing valves- Ambu valves \6 Injection Must Know Techniques 1. Intra muscular and insertion of Intra Venous cannulas. 2. Handling of sterilized syringes and needles. Fluids and Must Know Electrolytes 1. Type of fluid (Crystalloids & Colloids) 2. Steps to prepare I.V. drip 3. Indication of specific fluid and their complication Gas Analyzers Must know and monitoring 1. Pulse oxymeter 2. Oxygen Analyser / sensor H 3. EtCO2 Monitor / Capnography Nice to Know A.Transcutaneous oxygen monitor2nd YEAR ANES-B 4 » Resuscitation Must know Techniques 1, Basic life support (Airway, Breathing, and Circulation) 2. Equipment utilized for it, 3. Drugs used in CPR, 4. Defibrillation . Artificial Airways Must Know 10. Artificial Ain 1. Types of airways (Nasal/Oral) and features, 2. Sizes, colour coding, and methods of insertion 3. Indications for use 11 Pre op and Must Know ; Post op care 1. Checking and preparation of Anaesthesia trolley and Eqpt 2. Pre operative preparation of patient. 3. Management of pre operative and post operative rooms. 4. Transportation Techniques of Patient in conscious, semi conscious and unconscious patient to and fro — operation theatre. 12 Anesthesia Equipment Must Know Maintenance 1. Cleaning, Disinfection & Lsterilization sterilisation 2. Physical / chemical methods 3. Testing of sterilization 4. Critical /semicritical /Non critical devices 5. Levels of Disinfection Desirable to Know 1. Reusable items