儿科学-培训课件PPT
儿科学-培训课件PPT,儿科学,培训,课件,PPT
Teaching Plan 1st Semester 2015-2016 Course title Pediatrics School offering the course The 1st Clinical College Department Pediatrics Teacher in charge Sun Yi Academic position Associate Professor Class Nanshan Class Grade 2012 Number of students 24 Guangzhou Medical University deans officeTeaching Plan of Guangzhou Medical UniversityCourse titlePediatricsLecture topicRespiratory Distress SyndromeTeacher in chargeSun YiThe secondary schoolThe 2nd Clinical CollegeDepartmentPediatricsAcademic positionAssociateProfessorTimeSep 16th,2014, Week 3, Wednesday, Section 3Class hours1 hourClassNanshan Class Grade 2012Lesson typeTheoryTextbookPediatrics by Chen Shubao, Science Press,2012.Teaching Objectives and Requirements:After this class, students should:1. Understand the etiology and pathophysiology of respiratory distress syndrome (RDS) in newborns. Understand the relationship between prematurity and RDS. 2. Master the clinical presentations of neonatal respiratory distress syndrome.3. Know the management for neonatal respiratory distress syndrome.The main points, key points and difficult points:Main points: The etiology, pathophysiology, clinical presentations, diagnosis and management of respiratory distress syndrome in neonates. Key points:1. Clinical characteristics and chest X-ray appearance of RDS. Master the diagnosis.2. The effects of assisted ventilation and surfactant replacement therapy in management.Difficult points: 1. The roles of pulmonary surfactant.2. Pathophysiology of RDS.Teaching Methods:Theory lecture, PBLTeaching media:PPT, CAI, VideoDesign of Teaching Process:Teaching ContentsMethodsTimeRespiratory Distress Syndrome1. Overview Neonatal respiratory disease syndrome (RDS) is a common disease in prterm infants. It is also called hyaline membrane disease. Patients develop progressively respiratory distress very early after birth. The mortality rate is less than 10%. Some babies leave chronic lung disease. Emphasize it is important to be a good doctor to treat and diagnose patients timely and appropriately for avoiding severe sequelae and an unfortunate family. The incidence and severity increase with decreasing gestational age2. Etiology Immature alveolar structure: Decreased number and size of alveoli, weak chest wall muscles. Mature Lung Immature Lung The most important cause for RDS is pulmonary surfactant(PS) deficiency:A. Surfactant is produced by alveolar typecells from 24 weeks and increase rapidly till 35 weeks. So the more premature babies get more possibility to develop RDS. B. The roles of PS is to decrease suface tension at air-liquid interface, then keep the lung open, maintain normal ventilation and oxygenation.Introduce (RDS) briefly.Write “RDS”on the board. Use 3 pictures: 2 pictures with RDS on ventilator.1 picture to explain hyaline membrane in the alveoli.Value teaching: To be a good doctor is very important.Compare the al- veolar number and size between mature and immature lungs.Difficult point:Explain the effects of surfactant and how surfactant decr- ease the surface tension. 3 min5 minC. Surfactant compressed over surface of alveolus with stronger bonding and reduces increasing surface tension during expiration.3. Pathophysiology4. Risk factorsIncluding prematurity, infants of diabetic mothers, cesarean delivery without labor, perinatal asphyxia, multiple birth and male.5. Clinical presentations Patients develop progressively respiratory distress over the first few hours after birth, especially the firt 6 hours. Signs include tachypnea, grunting, nasal flaring, chest retraction, cyanosis and decreased breath sounds bilaterally.Chest X-ray: Diffuse reticular-granular pattern in both lung fields, ground glass signs, air bronchograms, small lung volumes, unclear cardiac border and white lung.6. Diagnosis Learn diagnosis with a case: Baby boy borned at 32 weeks, C-section delivery due to antenatal bleeding, BW 1.8Kg, developed respiratory distress at 10 minutes after birth, blood gas shows a mixed respiratory and metabolic acidosis, ground glass sign in chest X-ray. Questions: How to interpret the blood gas? What is your diagnosis? Rule out pneumonia for differential diagnosis.7. Management General treatment: keep the baby warm, maintain balanced fluid and nutrition, cardiac support if necessary, give antibiotics before ruling out infection.Respiratory support: oxygen, nasal CPAP, mechanical ventilation, and surfactant replacement therapy.8. ProphylaxisHow can we prevent RDS or at least alleviate it? Antenatal steroids Regular prenatal care Prevent preterm labor Postnatal surfactant9. Summary, questions and referencesSummarize the main points for RDS. Leave questions for home. Provide references and give email address. 4 pictures.Difficult point:Analyze how pre- term infants with surfactant deficien- cy develop progress- sively respiratory distress. Use a flow chart to explain the pathophysiology of RDS clearly.Write “V/Q=1” on the board.Briefly go through these risk factors for RDS.Key pointLay stress on the interpretation for the clinical charact- eristics and chest X-ray appearance, explain why they develop.Watch a video to give students a clear impression for those symptoms.Use 2 pictures of chest X-ray to intro- duce the changes in radiology.Key pointIntroduce a case to help students to understand this disease. Ask the students to interpret the blood gas and give a diagnosis. encourage students to think actively and help them to analyze the case. 1 picture: a chest X-ray of the case.Main pointIntroduce the ma- nagement for RDS. Analyze how CPAP works for RDS? Describe surfact- ant replacement therapy.11 pictures.Go through the prophylaxis for RDS briefly. Introduce the new advance- ment for postnatal surfactant in proph- ylaxis.Emphasize the key and difficult points with ques- tions.Welcome contacts with email for questions.4 min2min8min5 min7min4 min2mininteractive Question-and-Answer and class discussion:1. What is the difference between these two pictures?(slide 7)2. If the alveoli keep contracting, what will happen at last? (slide 10)3. If the gas diffusion was restrained by the hyaline membrane, what will happen then?(slide 12)4. What can you see from this X-ray?(slide 15)5. What does the blood gas tell us?(slide 18)6. Your impression for this case?(slide 19)Summarization and Homework:Summary: RDS is a very common disease in preterm infants. Surfactant deficiency is the main etiology for it. Right and timely diagnosis and treatment is very important. Students should master the clinical characteristics of RDS: progressively respiratory distress over the first few hours after birth and characteristically chest X-ray appearances. Surfactant replacement therapy has specific effects and assisted ventilation helps. Students will get comprehension in how important it is to a family if a preterm baby obtain good treatment and prognosis. Emphasize the importance to be a good doctor.Homework:1. What is the roles for surfactant?2. What are the clinical characteristics for neonatal RDS?3. How do you treat a baby with RDS?The Innovation of Teaching:1. Heuristic mode of teaching. Questioning through the class. 2. Guide the students to analyze the case and think actively.3. Use video and pictures to get better understandings.4. Give references to students for self-study.5. Intruduce new progress in prophylactic administration of surfactant in extremely preterm infants.Recommended References:1. Pediatrics,Edited by Shen Xiaoming, Wang Weiping,Edition 8,Peoples medical publishing house.2. Averys Diseases of the Newborn, Edited by CA. Gleason & SU. Devaskar, 2012. 3. The Newborn LungNeonatology Questions and Controversies, Edited by Eduardo Bencalari, 2009.view of teaching and research officeTeaching postscript: The class was going very well. Students concentrated on the class and answered the questions very actively. I tried to explain those inexplicable medical terms in simple general English and that really helped for understanding. The introduction of etiology and pathophysiology contributes to good comprehension for the clinical manifestations and managements. By the help of multimedia and case study, students understood the disease really well with clear impression. The students understood most of the contents of this class. The time arrangement was just right. Students understood the key points and difficult points clearly. This was an impressive and effective teaching.
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