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Файл:Введение в биомедицинскую инженерию. Учебное пособие
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providers are located. Telemedicine uses telecommunications to provide
connections between medical specialists and various clinics, hospitals,
and doctors that ________ first assistance to patients in order
to correctly diagnose, help, treat, consult, and continuously teach.
This is the most complete ________ of telemedicine that was given
by American Association of Telemedicine. Based on the experience
we gained during development of our «ARM» workstation for
radiologists and «ARM» workstation for mammography physicians,
as well as on the _________ of health care in Russia, we have developed
a product that received the name «Telemed-MT». It fulfills all modern
communication _________ to receive, save, and transfer diagnostic data
within the framework of performing remote patient diagnosis.
The main _______ of the system are:
• Modularity. Our installed ARM systems can be utilized, can
be converted into full-fledged telemedicine terminals;
• Opportunity to work via dedicated IT channels and via the
Internet (in both cases we set up protected data transfer channel);
• Unique technology of remote X-ray image review that permits
the examination of parts of the images ________ without sending the
entire image;
• Ergonomic interface that allows doctors at remote locations
to see and examine all patient’s data, including all images that have been
taken earlier.
Due to the introduction of telemedicine the following ______ are
solved:
• Preventive screening of the population;
• _________ in cost of medical services;
• Remote location receiving immediate care, and elimination
of isolation;
• _________ of the quality of service.
а) capabilities b) Increase c) advantages d) medical data
e) Decrease f) render g) definition h) online i) tasks j) real demands
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5. Choose the answer from the alternatives.
1. Telemedicine is aimed at:
a) patients’ cure
b) doctors communication
c) data transmission
2. Telemedicine uses:
a) workstations for different purposes
b) telecommunications
c) a wide range of medical equipment and modern informational
technologies
3. Quality of telemedical treatment depends on:
a) doctors’ skills
b) joined efforts of all the involved participants and used
equipment
c) modern technology
4. Telemedicine helps to solve problems of:
a) medical expenses
b) territorial isolation
c) quality of medical help
Discussion
Can BME improve the quality of medical care and treatment
all over the world?
What aspects of BME can make you choose this profession to
learn?
Video
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U n i t 3
ANAESTHESIA
Starting point
1. Before reading about anaesthesia, think about the subject in
general:
1) What is anaesthesia?
2) When and for what purpose is it used?
3) In what medicine branches is anaesthesia used?
4) What types of anaesthesia do you know?
2. Now read the text quickly. Note all the words or phrases
which you don’t know or are not sure of clearly.
Anesthesia, or anaesthesia (see spelling differences; from Greek
αν-, an-, «without»; and ασθησις, aisthēsis, «sensation»), has
traditionally meant the condition of having sensation (including the
feeling of pain) blocked or temporarily taken away. This allows patients
to undergo surgery and other procedures without the distress and pain
they would otherwise experience. The word was coined by Oliver
Wendell Holmes, Sr. in 1846. Another definition is a «reversible lack of
awareness», whether this is a total lack of awareness (e.g. a general
anaesthetic) or a lack of awareness of a part of the body such as a spinal
anaesthetic or another nerve block would cause. Anesthesia is a
pharmacologically induced reversible state of amnesia, analgesia, loss of
33
consciousness, loss of skeletal muscle reflexes and decreased stress
response. Today, the term general anesthesia in its most general form
can include:
− Analgesia: blocking the conscious sensation of pain;
− Hypnosis: producing unconsciousness;
− Amnesia: preventing memory formation;
− Paralysis: preventing unwanted movement or muscle tone;
− Obtundation of reflexes, preventing exaggerated autonomic
reflexes.
There are several forms of anesthesia. The following forms refer to
states achieved by anesthetics working on the brain:
General anesthesia: «Drug-induced loss of consciousness during
which patients are not arousable, even by painful stimulation.» Patients
undergoing general anesthesia can often neither maintain their own
airway nor breathe on their own. While usually administered with
inhalational agents, general anesthesia can be achieved with intravenous
agents, such as propofol.
Deep sedation/analgesia: «Drug-induced depression of
consciousness during which patients cannot be easily aroused but
respond purposefully following repeated or painful stimulation.»
Patients may sometimes be unable to maintain their airway and breathe
on their own.
Moderate sedation/analgesia or conscious sedation: «Drug-induced
depression of consciousness during which patients respond purposefully
to verbal commands, either alone or accompanied by light tactile
stimulation.» In this state, patients can breathe on their own and need no
help maintaining an airway.
Minimal sedation or anxiolysis: «Drug-induced state during which
patients respond normally to verbal commands.» Though concentration,
memory, and coordination may be impaired, patients need no help
breathing or maintaining an airway.
The level of anesthesia achieved ranges on a continuum of depth of
consciousness from minimal sedation to general anesthesia. The depth
of consciousness of a patient may change from one minute to the next.
The following refer to the states achieved by anesthetics working
outside of the brain:
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Regional anesthesia: Loss of pain sensation, with varying degrees
of muscle relaxation, in certain regions of the body. Administered with
local anesthesia to peripheral nerve bundles, such as the brachial plexus
in the neck. While traditionally administered as a single injection, newer
techniques involve placement of indwelling catheters for continuous or
intermittent administration of local anesthetics.
Spinal anesthesia: Refers to a Regional block resulting from a
small volume of local anesthetics being injected into the spinal canal.
The sub arachnoid block results in a loss of pain sensation and muscle
strength, usually up to the level of the chest (nipple line or 4th thoracic
dermatome).
Epidural anesthesia: Regional block resulting from an injection of a
large volume of local anesthetic into the epidural space. This is basically
an injection around the spinal canal.
Local anesthesia is similar to regional anesthesia, but exerts its
effect on a smaller area of the body.
3. Now answer the questions before the text using the
information given in it. Try to give detailed answers.
4. Match the phrase on the left to the definition on the right.
Check that your ideas make sense in the context of the text.
1. General anesthesia
2. Deep sedation/analgesia
3. Moderate sedation/analgesia
or conscious sedation
a) Drug-induced state during
which patients respond normally
to verbal commands
b) Regional block resulting from
an injection of a large volume of
local anesthetic into the epidural
space
c) Drug-induced loss of
consciousness during which
patients are not arousable, even
by painful stimulation
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4. Minimal sedation or anxiolysis
d) Refers to a Regional block
resulting from a small volume of
local anesthetics being injected
into the spinal canal
5. Regional anesthesia
6. Spinal anesthesia
7. Epidural anesthesia
8. Local anesthesia
e) It is similar to regional
anesthesia, but exerts its effect
on a smaller area of the body
f) Drug-induced depression of
consciousness during which
patients cannot be easily aroused
but respond purposefully
following repeated or painful
stimulation
g) Loss of pain sensation, with
varying degrees of muscle
relaxation, in certain regions of
the body
h) Drug-induced depression of
consciousness during which
patients respond purposefully to
verbal commands, either alone or
accompanied by light tactile
stimulation
5. Mark the following statements as true (T) or false (F). Prove
your point of view.
1. Anaesthesia allows patients to undergo surgery and other
procedures with the distress and pain they would otherwise
experience.
T/F
2. Anesthesia is a pharmacologically induced reversible
state of amnesia, analgesia, loss of consciousness, loss of
skeletal muscle reflexes and decreased stress response.
36
T/F
3. Today, the term general anesthesia in its most general
form can include only blocking the conscious sensation of
pain and producing unconsciousness
T/F
4. Patients undergoing general anesthesia can often neither
T/F
maintain their own airway nor breathe on their own.
5. Patients undergoing moderate anesthesia cannot breathe
T/F
on their own and need help maintaining an airway.
6. Spinal anesthesia is similar to regional anesthesia, but
T/F
exerts its effect on a smaller area of the body.
7. Paralysis means producing unconsciousness. T/F
8. Obtundation of reflexes prevents exaggerated autonomic
T/F
reflexes
6. Skim the text about anaesthesia. Find an appropriate
heading for each section (1 – 8).
A. Is anaesthetic safe?
B. What is it like after the operation?
C. What is an anaesthetic?
D. How do people feel when they wake up?
E. What does the anaesthetist do?
F. How and where does the patient wake up?
G. Who is the anaesthetist?
H. Where and how does the patient go to sleep?
Written by Dr Gordon FN Smith, consultant anaesthetist
(1) An anaesthetic is used to temporarily reduce or take away
sensation, usually so that otherwise painful procedures or surgery can be
performed. Throughout the procedure, different types of medicines are
added or removed to relieve the pain and maintain the right level of
unconsciousness.
(2) A consultant anaesthetist is a specialist doctor who, after
qualifying in medicine, spends about six years training in the specialty
of anaesthesia. Anaesthetists see patients while being trained, but a
consultant supervises them during all procedures.
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(3) The anaesthetist takes a careful look at the history of the
patient's general health and uses this information to decide how best to
offer care. During the operation, the anaesthetist stays with the patient at
all times to make sure they are comfortable and safe. This includes
controlling pain, replacing body fluids and measuring and controlling all
the vital functions of the body such as the heart beat, blood pressure and
brain and kidney function.
(4) Anaesthetics are almost entirely safe, but every operation
carries a very slight risk. A recent survey in the UK showed that death
due to anaesthesia occurred in about five in every million anaesthetics
given.
(5) Patients are given a small injection in the hand to make them go
to sleep. This usually takes place in a room next to the operating theatre.
Some patients – especially children – have an anaesthetic cream rubbed
onto the skin beforehand so that they won't even feel the injection.
Others are given a mixture of gases to put them to sleep very quickly.
(6) After the operation, the anaesthetist stops giving the medicines
that were keeping the patient unconscious and he or she is taken to a
recovery room where there are specially trained staff. The longer the
operation, the longer it takes to wake up. When the patient has woken up
completely, they are taken back to the ward. Occasionally, people
recover consciousness in the operating theatre once their operation is
over. This is quite safe.
(7) Patients often feel cold and slightly confused. They may have
pain or feel a bit sick, but these symptoms can be treated when the
anaesthetist visits the patients to check that they are alright.
(8) How people feel after the operation depends on the kind of
surgery they have had. They will be encouraged to get out of bed as
soon as possible and will usually be allowed to eat and drink in the first
few hours after a minor operation.
http://www.netdoctor.co.uk/health_advice/facts/anaesthetic.htm
7. Guess what definitions in column B correspond to the term
in column A. Check that your ideas make sense in the context of the
text.
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1) anaesthetic
a) the state of being without normal sensory
awareness; insensibility
2) sensation
3) unconsciousness c) essential to maintain life
4) operation d) causing or characterized by anaesthesia
5) safe
6) vital f) a gaseous anaesthetic, such as nitrous oxide
7) gases g) affording security or protection from harm
8) symptom h) the power of perceiving through the senses
b) any manipulation of the body or one of its
organs or parts to repair damage, arrest the
progress of a disease, remove foreign matter,
etc
e) any sensation or change in bodily function
experienced by a patient that is associated with
a particular disease
8. Read the text about anaesthetic agents. Some words and
word combinations have been removed from the article. Choose
from the words the one which fits each gap. Translate the text.
Anaesthetic agents
Volatile agents are specially formulated organic liquids that
evaporate readily into 1 ______, and are given by inhalation for
induction and/or maintenance of 2 ______ anesthesia. Nitrous oxide and
xenon are 3 ______ at room temperature rather than liquids, so they are
not considered volatile agents. The ideal anesthetic vapor or gas should
be non-flammable, 4 ______, lipid-soluble, and should possess low
blood gas solubility, have no end organ (heart, liver, kidney) toxicity or
side-effects, should not be metabolized, and should be 5 ______ when
inhaled by patients.
Certain pharmacokinetic 6 ______ of volatile agents have become
another point of comparison. Most 7 _______ of those properties is
known as the blood: gas partition coefficient. This concept refers to the
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relative solubility of a given agent in 8 ______. Those agents with a
lower blood solubility (i.e., a lower blood–gas partition coefficient; e.g.,
desflurane) give the anesthesia provider greater rapidity in titrating the
depth of anesthesia, and permit a more rapid 9 ______ from the
anesthetic state upon discontinuing their administration. In fact, newer
10 ______ agents (e.g., sevoflurane, desflurane) have been popular due
to their versatility for a faster emergence from anesthesia, thanks to their
lower blood–gas partition coefficient.
а) – important; b) – non-explosive; c) – blood; d) – vapors;
e) – volatile; f) – gases; g) – non-irritant; h) – general; i) – properties;
j) – emergence.
9. Now scan the text about the anaesthetic machine and in
each passage find English equivalents of the following Russian
terms:
Anaesthetic machine
http://www.ganfyd.org/index.php?title=Anaesthetic_machine
(1) Anaesthetic machine
The anaesthetic machine is used by anaesthetists to support the
administration of anaesthesia. The most common type of anaesthetic
machine in use in the developed world is the continuous-flow
anaesthetic machine, which is designed to provide an accurate and
continuous supply of medical gases (such as oxygen and nitrous oxide),
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