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This is the syllabus of 3rd year bsc anaesthesia and Ot technology explain it like a teacher teaching to students
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Here is a complete teacher-style explanation of all three topics visible in your syllabus. I will go through each unit one by one, just like a classroom lecture.
3rd Year BSc Anaesthesia & OT Technology - ICU & Critical Care Module
(Continuing from previous units...)
HIV in the ICU
Class, before we move to the new units, let me finish the tail end of the previous section. HIV in the Intensive Care Unit is something you will encounter. Patients with HIV have weakened immune systems (CD4 count below 200 = AIDS). In ICU, these patients are prone to opportunistic infections - PCP pneumonia, cryptococcal meningitis, CMV, TB. Your job is to monitor for these, maintain isolation precautions, and ensure antiretroviral therapy is NOT stopped even in ICU.
Bed Sore Management - also called pressure ulcers or decubitus ulcers. ICU patients lie still for long periods. Bony prominences (sacrum, heels, occiput) get compressed and develop tissue necrosis. Stages go from Stage 1 (redness) to Stage 4 (bone exposed). Prevention = 2-hourly turning, air mattresses, keeping skin dry. Treatment = wound dressings, debridement for severe cases.
Surgical Site Infections (SSI) - classified as Superficial (skin only), Deep (fascia/muscle), or Organ/Space (inside body cavity). Diagnosed by signs of infection at wound site within 30 days. Management = antibiotics guided by culture, wound opening, irrigation, delayed closure.
Unit 8: Respiratory Disorders - 6 Hours
"This is one of the most important units for ICU work, class. Almost every ICU patient has some form of respiratory problem. Pay close attention."
1. Mechanical Ventilation
When a patient cannot breathe on their own - either because their lungs have failed, or they are post-surgery under general anaesthesia - we use a mechanical ventilator. This machine does the breathing FOR the patient.
Key settings you must know:
- Tidal Volume (TV) - volume of air per breath, typically 6-8 mL/kg
- Respiratory Rate (RR) - breaths per minute, usually 12-20
- FiO2 - fraction of inspired oxygen (0.21 = room air, 1.0 = 100% oxygen)
- PEEP - Positive End-Expiratory Pressure - keeps alveoli open between breaths
Think of it this way: the ventilator is like a pump that pushes air in and lets it come out, on a set timer.
2. Non-Invasive Ventilatory Support Modes (NIV)
"Class, 'non-invasive' means no tube goes into the airway. We use a tight-fitting mask instead."
- CPAP (Continuous Positive Airway Pressure) - delivers one constant pressure. Used in sleep apnea, mild respiratory failure.
- BiPAP (Bilevel Positive Airway Pressure) - delivers two pressures: higher when patient breathes in (IPAP), lower when breathing out (EPAP). Used in COPD, pulmonary oedema.
Benefits: patient can speak, eat (briefly), less infection risk compared to a tube. Used when the patient is conscious and cooperative.
3. Invasive Ventilatory Support - Basic Modes
"Now we go into the trachea with an ETT (endotracheal tube) or tracheostomy. These are the basic modes you MUST know for exams."
| Mode | Full Name | What It Does |
|---|---|---|
| CMV / AC | Controlled Mandatory Ventilation / Assist Control | Machine gives every breath; patient's effort can trigger a breath |
| SIMV | Synchronized Intermittent Mandatory Ventilation | Machine gives set breaths AND allows patient's own breaths in between |
| PSV | Pressure Support Ventilation | Patient breathes spontaneously; machine adds pressure support to each breath |
AC mode = full support (post-op, very sick patients)
SIMV + PSV = used for weaning the patient off the ventilator gradually
4. Oxygen Therapy & Basic Respiratory Care
Oxygen delivery systems - from least to most concentration:
| Device | FiO2 Delivered |
|---|---|
| Nasal Cannula | 24-44% |
| Simple Face Mask | 40-60% |
| Non-Rebreather Mask (NRM) | Up to 90% |
| Venturi Mask | Precise (24%, 28%, 35%, 40%, 60%) |
Basic respiratory care also includes: humidification of gases, suctioning of secretions, breathing exercises, incentive spirometry, and monitoring SpO2.
5. Aspiration
"Class, aspiration means inhaling something into the lungs that should not be there - most commonly stomach contents (vomit)."
This is a major anaesthesia risk - called Mendelson's Syndrome when gastric acid enters the lungs. It causes chemical pneumonitis (acid burns the lung tissue) and can lead to aspiration pneumonia.
Prevention in OT:
- Nil by mouth (NBM) before surgery - 6 hours solid food, 2 hours clear fluids
- Rapid sequence induction (RSI) with cricoid pressure (Sellick's manoeuvre)
- Positioning (left lateral, head down)
6. Severe Asthma
In the ICU, we deal with Status Asthmaticus - an asthma attack that does NOT respond to standard bronchodilators and is life-threatening.
Signs it is severe: unable to speak in full sentences, SpO2 < 92%, silent chest (no wheeze = no air moving = very bad sign), tachycardia > 120, PaCO2 rising (sign of fatigue).
Management:
- High-flow oxygen
- Nebulised Salbutamol + Ipratropium
- IV Hydrocortisone (systemic steroids)
- IV Magnesium Sulphate (bronchodilator)
- If failing: intubation and mechanical ventilation (difficult and dangerous in asthma - use with caution)
7. Acute Respiratory Failure in COPD
"COPD patients are tricky - they have chronic high CO2 (hypercapnia) and LOW oxygen. Their breathing drive is based on LOW O2 - called the hypoxic drive."
If you give too much oxygen to a COPD patient, you remove their breathing drive and they stop breathing. So we target SpO2 of 88-92% in COPD - not the usual 95%+.
Type 1 RF = Low O2, normal CO2 (e.g., pneumonia, pulmonary oedema)
Type 2 RF = Low O2 + High CO2 (e.g., COPD exacerbation, neuromuscular disease)
Treatment: controlled low-flow oxygen, NIV (BiPAP is first-line), IV bronchodilators, steroids, antibiotics if infection.
8. Chest Physiotherapy, Positioning for Drainage & Respiratory Exercises
"This is where your practical OT/Anaesthesia skills directly help patients breathe better."
- Chest Physiotherapy (CPT): Percussion (clapping on chest wall) and vibration to loosen secretions, followed by postural drainage.
- Postural Drainage positions: Different lung segments drain with gravity in different positions (e.g., lower lobe = tip patient head-down; upper lobe = sit upright).
- Respiratory Exercises: Deep breathing exercises, incentive spirometry (patient takes slow deep breath into a device), coughing techniques.
- ACBT (Active Cycle of Breathing Technique): breathing control → thoracic expansion exercises → forced expiration technique (huffing).
Unit 9: Neurologic Disease & Dysfunction - 4 Hours
"Now we move from the lungs to the brain. ICU patients frequently have neurological problems - sometimes that IS why they came to ICU."
1. Sedation Score
ICU patients on ventilators are often sedated. Too much sedation = complications (hypotension, prolonged ICU stay). Too little = patient in pain, pulls out tubes.
We use standardized scoring tools:
- RASS (Richmond Agitation-Sedation Scale): -5 (unarousable) to +4 (combative). Target is usually -1 to 0 (lightly sedated, easily arousable).
- Ramsay Scale: 1 (anxious, agitated) to 6 (no response). Older scale, still used.
Daily "sedation holidays" - stop sedation briefly each day, assess the patient, restart if needed.
2. Elevated Intracranial Pressure (ICP)
Normal ICP = 5-15 mmHg. Elevated ICP = > 20 mmHg, which is a medical emergency.
Cushing's Triad (classic sign of dangerously raised ICP):
- Hypertension (rising BP)
- Bradycardia (slowing heart)
- Irregular breathing (Cheyne-Stokes or ataxic)
Causes: Head injury, brain bleed, meningitis, hydrocephalus, brain tumour.
Management:
- HOB (Head of Bed) elevated 30 degrees
- Avoid hypoxia and hypercapnia
- Mannitol (osmotic diuretic - pulls water out of brain)
- Hypertonic saline
- Controlled hyperventilation (lowers PaCO2 → vasoconstriction → reduces ICP temporarily)
- Decompressive craniectomy in severe cases
3. Altered Consciousness & Coma in the ICU
Levels of consciousness: Alert → Confused → Drowsy → Stuporous → Comatose
Causes of coma in ICU - use the acronym AEIOU-TIPS:
- Alcohol/drugs
- Epilepsy
- Insulin (hypo/hyperglycaemia)
- Opiates
- Uraemia
- Trauma
- Infection (meningitis, encephalitis)
- Poison
- Stroke/Structural
Assessment: Pupils (size, reactivity), motor response, breathing pattern, GCS.
4. Seizures & Status Epilepticus
Status Epilepticus = a seizure lasting more than 5 minutes, OR two or more seizures without recovery of consciousness between them. This is a medical emergency.
Treatment protocol (step-up approach):
- Benzodiazepines first: IV Lorazepam or Diazepam (0-5 minutes)
- Phenytoin/Fosphenytoin or Levetiracetam (5-20 minutes)
- Phenobarbital (20-40 minutes)
- General anaesthesia with Propofol, Midazolam, or Thiopentone if refractory (> 40 minutes)
Airway protection is ALWAYS the first priority - turn patient on side, oxygen, prepare for intubation.
5. Neurological Evaluation / Monitoring
In ICU, continuous neuro monitoring includes:
- Pupillary reflexes - PERLA (Pupils Equal and Reactive to Light and Accommodation)
- ICP monitoring - via intraventricular catheter (EVD) or bolt
- EEG monitoring - for non-convulsive seizures
- Cerebral perfusion pressure (CPP) = MAP - ICP. Target CPP > 60 mmHg
- Transcranial Doppler - blood flow velocity in cerebral vessels
- AVDO2 - arteriovenous oxygen difference (cerebral oxygen extraction)
6. Glasgow Coma Scale (GCS)
"Class, this is absolutely something you will use every single day in ICU and OT. Memorise it fully."
| Component | Response | Score |
|---|---|---|
| Eye Opening (E) | Spontaneous | 4 |
| To voice | 3 | |
| To pain | 2 | |
| None | 1 | |
| Verbal Response (V) | Oriented | 5 |
| Confused | 4 | |
| Inappropriate words | 3 | |
| Incomprehensible sounds | 2 | |
| None | 1 | |
| Motor Response (M) | Obeys commands | 6 |
| Localises pain | 5 | |
| Withdrawal | 4 | |
| Abnormal flexion (Decorticate) | 3 | |
| Extension (Decerebrate) | 2 | |
| None | 1 |
Total GCS = E + V + M → Maximum = 15, Minimum = 3
- GCS 13-15 = Mild
- GCS 9-12 = Moderate
- GCS ≤ 8 = Severe (intubate and ventilate - "GCS 8, intubate")
Unit 10: Cardiovascular Disease & Dysfunction - 3 Hours
"Class, no ICU patient survives without their heart pumping. This unit covers what happens when the pump fails."
1. Cardiovascular Failure
Also called circulatory shock - the heart cannot maintain adequate perfusion to vital organs.
Types of Shock:
| Type | Mechanism | Example |
|---|---|---|
| Cardiogenic | Heart pump failure | MI, arrhythmia, cardiac tamponade |
| Hypovolemic | Volume loss | Haemorrhage, burns, dehydration |
| Distributive | Vasodilation / maldistribution | Septic, anaphylactic, neurogenic |
| Obstructive | Mechanical obstruction | Pulmonary embolism, tension pneumothorax |
Common features of shock: Hypotension (MAP < 65 mmHg), tachycardia, cold/clammy skin, oliguria (urine < 0.5 mL/kg/hr), altered consciousness.
2. Inotropic Support
"When the heart is failing, we give drugs to make it beat stronger or regulate vascular tone. These are called inotropes and vasopressors."
| Drug | Action | Use |
|---|---|---|
| Dopamine | Inotrope + vasopressor (dose-dependent) | Cardiogenic shock, hypotension |
| Dobutamine | Mainly inotropic (increases contractility) | Cardiogenic shock, low cardiac output |
| Norepinephrine (Noradrenaline) | Vasopressor (vasoconstriction) | Septic shock - FIRST LINE |
| Adrenaline (Epinephrine) | Strong inotrope + vasopressor | Cardiac arrest, anaphylaxis |
| Vasopressin | Vasopressor | Refractory septic shock |
All these drugs are given as continuous IV infusions through a central line. Never as a bolus (can cause cardiac arrest). Rate is titrated to maintain MAP > 65 mmHg.
Exam Tips for This Module
- GCS = E4V5M6 is normal (15/15). GCS ≤ 8 = intubate.
- Status epilepticus = > 5 minutes. First drug = Benzodiazepine.
- Cushing's Triad = Hypertension + Bradycardia + Irregular breathing (raised ICP).
- COPD oxygen = target SpO2 88-92%, NOT 98-100%.
- Shock first-line vasopressor = Norepinephrine for septic shock.
- NIV = no tube, just mask. CPAP = one pressure. BiPAP = two pressures.
- Aspiration prevention = NBM + RSI + cricoid pressure.
- Sedation target in ICU = RASS -1 to 0.
Study these units systematically. Units 8, 9, and 10 together form the backbone of critical care management that you will apply from Day 1 of your clinical postings. Good luck!
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