Référentiel Officiel du Collège National des Enseignants d

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Référentiel"Officiel"du"Collège"National"des"
Enseignants"d'Anesthésie"et"de"Réanimation"(CESAR)"
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Version du 22 mars 2017

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SOMMAIRE"
!
"#!$%&&'(#!)*+,%-*&!.#/!0-/#,(-*-+/!.12-#/+34/,#!54*-,6*+,%-!6#+!7!.,/8%/,+,%-!.#/!4+9.,*-+/!.#!:;2<=!9-!>4?4>#-+,#&!
84.*(%(,@9#!*A%>.*-+!&1#-/#6A&#!.#/!@9#/+,%-/!*9!8>%(>*66#!.#/!0$)!*B*-+!+>*,+!7!&12-#/+34/,#!#+!7!&*!54*-,6*+,%-C!
$#!>4?4>#-+,#&!#/+!8,&%+4!8*>!&#!D>!=*+3,#9!52EF!GD*>,/H!#+!&#!D>!I#>+>*-.!:E50EJ"!G5%9#-HC!
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UE1:"Apprentissage"de"l'exercice"médical"et"de"la"coopération"interprofessionnelle!!
• -KLM!"*!/4N9>,+4!.9!8*+,#-+O!&*!(#/+,%-!.#/!>,/@9#/O!&#/!4P'-#6#-+/!,-.4/,>*A&#/!*//%N,4/!!
*9Q!/%,-/!!!L!
• -KRM!0+3,@9#!64.,N*&#!SL!
• -KTM!D>4&'P#6#-+!.1%>(*-#/!#+!&4(,/&*+,%-!UV!
"
UE5:"Handicap"-"Vieillissement"-"Dépendance"-"Douleur"-"Soins"palliatifs"-"Accompagnement!!
• -KSUSM!I*/#/!-#9>%83B/,%&%(,@9#/O!64N*-,/6#/!83B/,%8*+3%&%(,@9#/!.19-#!.%9&#9>!!
*,(9W!#+!.19-#!.%9&#9>!N3>%-,@9#!LS!
• -KSUXM!Y34>*8#9+,@9#/!*-+*&(,@9#/!64.,N*6#-+#9/#/!#+!-%-!64.,N*6#-+#9/#/!! LT!
• -KSUUM!2-#/+34/,#!&%N*&#O!&%N%>4(,%-*&#!#+!(4-4>*&#!!Z[!
• -KSLVM!$%--*\+>#!&#/!*/8#N+/!/84N,?,@9#/!.#/!/%,-/!8*&&,*+,?/!#-!>4*-,6*+,%-!!][!
"
UE6:"Maladies"transmissibles"-"Risques"sanitaires"-"Santé"au"travail!!
• -KS[LM!<#8+,N46,#!^!I*N+4>,46,#!^!;%-(46,#!.#!&1*.9&+#!#+!.#!&1#-?*-+!!RS!
"
UE8:"Circulation,"Métabolisme!!
• -KXX]M!<9>P#,&&*-N#!#+!N%68&,N*+,%-/!.#/!*A%>./!P#,-#9Q!!TX!
• -KXZ[M!Y>%9A&#/!.#!&14@9,&,A>#!*N,.%_A*/,@9#!#+!.4/%>.>#/!3B.>%_4&#N+>%&B+,@9#/!!T]!
"
UE10:"Le"bon"usage"du"médicament"et"des"thérapeutiques"non"médicamenteuses!!
• -KUSTM!$%-.9,+#!7!+#-,>!8%9>!&#!+>*,+#6#-+!64.,N*6#-+#9Q!#-!N*/!.`,-+#>P#-+,%-!!!
N3,>9>(,N*&#!%9!.#!(#/+#!,-P*/,?!8>%(>*664!! SSU!
• -KUX[M!Y>*-/?9/,%-!/*-(9,-#!#+!8>%.9,+/!.4>,P4/!.9!/*-(!!SXX!
"
UE11:"Urgences"et"défaillances"viscérales"aiguës!!
• -KUX]M!2>>a+!N*>.,*@9#!!SZX!
• -KUXRM!0+*+!.#!N3%N!M!8>,-N,8#/!SRS!
o N*>.,%(4-,@9#!!SR]!
o /#8+,@9#!!STL!
o 346%>>*(,@9#!!XV[!
• -KUXTM!D>,/#!#-!N3*>(#!,664.,*+#!8>4_3%/8,+*&,'>#!#+!7!&1*>>,P4#!7!&13b8,+*&O!!
4P*&9*+,%-!.#/!N%68&,N*+,%-/!N3#c!9-!8%&B+>*96*+,/4!!XSU!
o 9-!A>d&4!!XXS!
o 9-!+>*96*+,/4!.#!&1*A.%6#-!!XXR!
o 9-!+>*96*+,/4!.9!+3%>*Q!!XUT!
o 9-!+>*96*+,/4!P#>+4A>%_64.9&&*,>#!!X[X!

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o 9-!+>*96*+,/4!.#/!6#6A>#/!!X[R!
• -KUUVM!e>,#-+*+,%-!.,*(-%/+,@9#!#+!N%-.9,+#!7!+#-,>!.#P*-+!9-!+>*96*+,/6#!N>*-,%_?*N,*&!!X]T!
• -KUUSM!$%6*!-%-!+>*96*+,@9#!.#!&1*.9&+#!!XRZ!
• -KUUUM!f.'6#!.#!g9,-Nh#!#+!*-*83B&*Q,#!!UVS!
• -KUUZM!i46%>>*(,#!64-,-(4#!!UVT!
• -KUUTM!D>,/#!#-!N3*>(#!.19-#!8*+,#-+#!*++#,-+#!.#!8>4_4N&*68/,#!!UXS!
• -KULUM!J-/9??,/*-N#!>4-*&#!*,(9W!!UUS!
• -KULLM!J-?#N+,%-!*,(9W!.#/!8*>+,#/!6%&&#/!!ULZ!
• -KU[VM!i46%>>*(,#!.,(#/+,P#!!U[[!
• -KU[XM!D4>,+%-,+#!*,(9W!.#!&1*.9&+#!!UZL!
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• -KU[LM!:4+>#//#!>#/8,>*+%,>#!*,(9W!.9!-%9>>,//%-!#+!.#!&1#-?*-+!!URZ!
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Item"n°4:"La"sécurité"du"patient."La"gestion"des"risques."Les"événements"
indésirables"associés"aux"soins"
"
Objectifs"pédagogiques"
_! :4?,-,>! &#/! -%+,%-/! .#! g9*&,+4O! <4N9>,+4O! 4P4-#6#-+!,-.4/,>*A&#! (>*P#! G0JjHO! 4P'-#6#-+! 8%>+#9>! .#! >,/@9#! G0D5HO!
>4/,&,#-N#C!
_!D>4/#-+#>!&#/!.%--4#/!@9*-+,+*+,P#/!/9>!&*!?>4@9#-N#!#+!&*!-*+9>#!.#/!0Jj!.*-/!&#!/B/+'6#!.#!/%,-/!k!0-@9a+#/!-*+,%-*&#/!
/9>!&#/!0JjO!4P%&9+,%-!.*-/!&#/!.,Q!.#>-,'>#/!*--4#/C!
_!$%--*\+>#!&#/!.4?,-,+,%-/!.#/!+#>6#/!/9,P*-+/!M!*-+,/#8/,#O!*/#8/,#O!.4/,-?#N+,%-O!.4N%-+*6,-*+,%-O!/+4>,&,/*+,%-C!
_!$%--*\+>#!&#/!8>%N4.9>#/!.13B(,'-#!.#/!6*,-/!#-!6,&,#9!.#!/%,-/O!#+!.1*-+,/#8/,#!.#!&*!8#*9!/*,-#O!.#!&*!8#*9!&4/4#!#+!
.#/!69@9#9/#/C!
_!$%--*\+>#!#+!#Q8&,@9#>!&#/!6#/9>#/!8>4P#-+,P#/!.#/!,-?#N+,%-/!*//%N,4#/!*9Q!/%,-/!GJ2<H!M!,-?#N+,%-!9>,-*,>#O!,-?#N+,%-!/9>!
N*+34+#>!P*/N9&*,>#O!8-#96%-,#O!,-?#N+,%-!.9!/,+#!%84>*+%,>#C!
_!0Q8%/#>!&#/!(>*-./!8>,-N,8#/!.1%>(*-,/*+,%-!.#!&*!/4N9>,+4!/*-,+*,>#C!;*,>#!9-!8%,-+!/9>!&#/!.,??4>#-N#/!#-+>#!&*!;>*-N#O!&#/!
8>,-N,8*9Q!8*B/!#9>%84#-/!#+!&#/!E<2C!
_!:4?,-,>!#+!8%-.4>#>!&#/!(>*-.#/!N%68%/*-+#/!.#!&*!(#/+,%-!.#/!>,/@9#/!k!8>4N,/#>!&1,68%>+*-N#!.#!&*!N%68%/*-+#!;ie!
G?*N+#9>/!396*,-/!#+!%>(*-,/*+,%--#&/H!.9!>,/@9#!*//%N,4!*9Q!/%,-/C!
_!D>4N,/#>!&#/!.,??4>#-+#/!6,//,%-/!>#&#P*-+!.9!6,-,/+'>#!N3*>(4!.#!&*!/*-+4!#+!.#!&*!i2<C"
"
0."Points"clefs"
Les"points"clefs"à"retenir"
SC "*!(#/+,%-!.#/!>,/@9#/!#/+!9-#!*88>%N3#!>4N#-+#!#-!64.#N,-#O!,//9#!.9!6%-.#!.#!&`,-.9/+>,#!#+!.#!&`*P,*+,%-C!
XC "*!/4N9>,+4!.#/!/%,-/!?*,+!&`%Al#+!.`#Q,(#-N#/!>4(&#6#-+*,>#/C!
UC "#!A9+!.#!&*!(#/+,%-!.#/!>,/@9#/!#/+!.`#-N*.>#>!&`#>>#9>!396*,-#!#-!?,*A,&,/*-+!&#!/B/+'6#!G6,/#!#-!8&*N#!.#!
A*>>,'>#/!.#!8>4P#-+,%-O!.#!>4N984>*+,%-!#+!.`*++4-9*+,%-HC!
LC "#!.4P#&%88#6#-+!.`9-#!N9&+9>#!.#!/4N9>,+4!#/+!,-.,/8#-/*A&#!7!&*!(#/+,%-!.#/!>,/@9#/!#+!8*//#!8*>!&*!.4N&*>*+,%-!
.#/!4P'-#6#-+/!,-.4/,>*A&#/C!
[C "#/!64+3%.#/!.`*-*&B/#!.9!>,/@9#O!*!8>,%>,!%9!7!8%/+4>,%>,O!8#>6#++#-+!.#!8>,%>,/#>!&#/!*N+,%-/!7!6#-#>C!
ZC "`#??,N*N,+4!.#/!6#/9>#/!N%>>#N+>,N#/!>4*&,/4#/!.%,+!a+>#!4P*&94#!G%9+,&!.B-*6,@9#HC!
]C 0-!;>*-N#!#+!.*-/!.`*9+>#/!8*B/!#9>%84#-/!&*!.4N&*>*+,%-!.#/!4P'-#6#-+/!,-.4/,>*A&#/!(>*P#/!#/+!%A&,(*+%,>#C!
RC "`*-+,/#8+,#!#/+!9-!+#>6#!>4/#>P4!*9!+>*,+#6#-+!.#/!8&*,#/O!&*!.4/,-?#N+,%-!P,/#!7!8>4P#-,>!+%9+#!,-?#N+,%-!.#!&*!
8#*9!/*,-#C!
TC "*!8>4P#-+,%-!.#/!,-?#N+,%-/!&,4#/!*9Q!/%,-/!#/+!,-.,//%N,*A&#!.#!&`3B(,'-#!.#/!6*,-/!
SVC "#/!6#/9>#/!.#!8>4P#-+,%-!.#/!J2<!>#8%/#-+!/9>!&`*88&,N*+,%-!>,(%9>#9/#!.#/!6#/9>#/!.`3B(,'-#O!&`4&*A%>*+,%-!#+!
&`*88&,N*+,%-!.#!N%-.9,+#/!7!+#-,>!8>4N,/#/!#-!N*/!.#!N%&%-,/*+,%-!%9!,-?#N+,%-!7!A*N+4>,#/!69&+,>4/,/+*-+#/C!
"
1."Définitions"
Qualité"
<#&%-!&`e=<!,&!/`*(,+!.`9-#!m.46*>N3#!@9,!.%,+!8#>6#++>#!.#!(*>*-+,>!7!N3*@9#!8*+,#-+!&*!N%6A,-*,/%-!.`*N+#/!
.,*(-%/+,@9#/!#+!+34>*8#9+,@9#/!@9,!&9,!*//9>#>*!&#!6#,&&#9>!>4/9&+*+!#-!+#>6#!.#!/*-+4O!N%-?%>646#-+!7!&`4+*+!
*N+9#&!.#!&*!/N,#-N#!64.,N*&#O!*9!6#,&&#9>!N%d+!8%9>!9-!6a6#!>4/9&+*+O!*9!6%,-.>#!>,/@9#!,*+>%('-#!#+!8%9>!/*!
8&9/!(>*-.#!/*+,/?*N+,%-!#-!+#>6#!.#!8>%N4.9>#/O!.#!>4/9&+*+/!#+!.#!N%-+*N+/!396*,-/!7!&`,-+4>,#9>!.9!/B/+'6#!
.#!/%,-/n!oSpC!!
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Sécurité"
"*! /4N9>,+4! .#/! /%,-/! #/+! A*/4#! /9>! &#! 8>,-N,8#! .#! -#! 8*/! -9,>#! *9Q! 6*&*.#/O! N`#/+_7_.,>#! &`*A/#-N#! 8%9>! 9-!
8*+,#-+! .`*++#,-+#! ,-9+,&#! %9! 8%+#-+,#&&#! *//%N,4#! *9Q! /%,-/! .#! /*-+4! oSpC! 0&&#! /`,-+'(>#! .*-/! &*! N9&+9>#! .#!
/4N9>,+4O!m#-/#6A&#!N%34>#-+!#+!,-+4(>4!.#!N%68%>+#6#-+/!,-.,P,.9#&/!#+!%>(*-,/*+,%--#&/n!.%-+!&`%Al#N+,?!#/+!
&*!>4.9N+,%-!.#/!.%66*(#/!&,4/!*9Q!/%,-/!oXpC!
"
Evènement"indésirable"grave"(EIG)"
$%-/+,+9#!9-!4P'-#6#-+!,-.4/,>*A&#!*//%N,4!*9Q!/%,-/!G0J2<H!+%9+!,-N,.#-+!8>4l9.,N,*A&#!7!9-!8*+,#-+!3%/8,+*&,/4!
/9>P#-9! &%>/! .#! &*! >4*&,/*+,%-! .`9-! *N+#! .#! 8>4P#-+,%-O! .`9-#! ,-P#/+,(*+,%-! %9! .`9-! +>*,+#6#-+! oUpC! J&! #/+!
N%-/,.4>4!N%66#!(>*P#!.*-/!&#/!N,>N%-/+*-N#/!/9,P*-+#/M!!
• .4N'/! ,-*++#-.9O! 8#>+#! 8#>6*-#-+#! .`9-#! ?%-N+,%-! -#! >4/9&+*-+! -,! .#! &`4P%&9+,%-! -*+9>#&&#! .#! &*!
6*&*.,#O!-,!.9!+#>>*,-!.9!8*+,#-+!k!
• =,/#!#-!l#9!.9!8>%-%/+,N!P,+*&!k!
• i%/8,+*&,/*+,%-!%9!8>%&%-(*+,%-!.`3%/8,+*&,/*+,%-C!
!
Evènement"porteur"de"risque"(EPR)"
0P'-#6#-+!-`*B*-+!8*/! #-(#-.>4!.#!N%-/4@9#-N#!(>*P#!8%9>!&#!8*+,#-+!Gm8>#/@9#!*NN,.#-+nH!.%-+!&`*-*&B/#!
64+3%.,@9#! ?*P%>,/#>*! &*! N%68>43#-/,%-! .#/! N*9/#/! .#! /9>P#-9#O! 6*,/! *9//,! N#&&#! .#/! 6%.*&,+4/! .#! &*!
>4N984>*+,%-!*B*-+!8#>6,/!7!+#68/!/*!.4+#N+,%-!#+!/%-!+>*,+#6#-+!oSpC!
!
Résilience"
=#/9>#!.*-/!&*@9#&&#!9-!/B/+'6#!#/+!N*8*A&#O!#-!8#>6*-#-N#O!.#!8>4P#-,>O!.#!.4+#N+#>O!.`*++4-9#>!&#/!.*-(#>/!
%9!&#/!,-N,.#-+/O!%9!.`B!>#64.,#>!oSpC!
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Antisepsie"
J&! /`*(,+! /#&%-! &`*//%N,*+,%-! ?>*-q*,/#! .#! -%>6*&,/*+,%-! G2;)e5HO! .`9-#! m! %84>*+,%-! *9! >4/9&+*+! 6%6#-+*-4!
8#>6#++*-+O!*9!-,P#*9!.#/!+,//9/!P,P*-+/O!.*-/!&*!&,6,+#!.#!&#9>!+%&4>*-N#O!.`4&,6,-#>!%9!.#!+9#>!+%9/!&#/!6,N>%_
%>(*-,/6#/!#+^%9!.`,-*N+,P#>!&#/!P,>9/!#-!?%-N+,%-!.#/!%Al#N+,?/!?,Q4/C!"#!>4/9&+*+!.#!N#++#!%84>*+,%-!#/+!&,6,+4!
*9Q! 6,N>%_%>(*-,/6#/! #+^%9! *9Q! P,>9/! 8>4/#-+/! *9! 6%6#-+! .#! &`%84>*+,%-! nC! "#! $%6,+4! 09>%84#-! .#!
)%>6*&,/*+,%-!,-.,@9#!@9#!N#!+#>6#!#/+!>4/#>P4!*9!+>*,+#6#-+!.#/!,-?#N+,%-/!N%-/+,+94#/O!7!/*P%,>!9-#!8&*,#C!
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Aseptie"
<#&%-!&`2;)e5O!N#&*!N%-/+,+9#!9-!m!#-/#6A&#!.#!6#/9>#/!8>%8>#/!7!#68aN3#>!+%9+!*88%>+!#Q%('-#!.#!6,N>%_
%>(*-,/6#/!nC!"#!A9+!#/+!.#!8>4P#-,>!+%9+#!N%-+*6,-*+,%-!.#!8&*,#!%9!*9+>#/!/,+#/!/#-/,A&#/!7!&`,-?#N+,%-!+*-+!#-!
/*&&#!.`%84>*+,%-O!@9`*9!-,P#*9!.#!&`9-,+4!.#!/%,-/O!&%>/!.#!+>*,+#6#-+/!%9!.`#Q8&%>*+,%-/C!
!
Désinfection"
$`#/+! 9-#! m! %84>*+,%-! *9! >4/9&+*+! 6%6#-+*-4! 8#>6#++*-+! .`4&,6,-#>! %9! .#! +9#>! +%9/! &#/! 6,N>%_%>(*-,/6#/!
#+^%9! .`,-*N+,P#>! &#/! P,>9/! ,-.4/,>*A&#/! 8%>+4/! 8*>! .#/! 6,&,#9Q! ,-#>+#/! N%-+*6,-4/O! #-! ?%-N+,%-! .#/! %Al#N+,?/!
?,Q4/C!"#!>4/9&+*+!.#!N#++#!%84>*+,%-!#/+!&,6,+4!*9Q!6,N>%_%>(*-,/6#/!#+^%9!*9Q!P,>9/!8>4/#-+/!*9!6%6#-+!.#!
&`%84>*+,%-!nC!$#!+#>6#!.4/,(-#!.%-N!9-#!%84>*+,%-!P,/*-+!7!8>4P#-,>!+%9+#!,-?#N+,%-!.#!&*!8#*9!/*,-#!/#&%-!&#!
N%6,+4!#9>%84#-!.#!-%>6*&,/*+,%-C!
!