Combined Bachelor's + Master's degree in Medicine and Surgery

Medical-surgical emergencies (2018/2019)

Course code
4S01142
Credits
8
Coordinator
Enrico Polati

Teaching is organised as follows:
Unit Credits Academic sector Period Academic staff
CHIRURGIA D'URGENZA 1 MED/18-GENERAL SURGERY See the unit page See the unit page
MEDICINA D'URGENZA 3 MED/09-INTERNAL MEDICINE Lezioni 1° semestre 2°- 6° anno Domenico Girelli
BLSD - BASIC LIFE SUPPORT DEFIBRILLATION 1 MED/41-ANAESTHESIOLOGY 1°-5° anno: attività pratiche e tutoriali 2° semestre Enrico Polati
TERAPIA DEL DOLORE, INTENSIVA, ANESTESIOLOGIA 3 MED/41-ANAESTHESIOLOGY Lezioni 1° semestre 2°- 6° anno Leonardo Gottin
Enrico Polati

Learning outcomes

Module: MEDICINA D'URGENZA
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To give to the students a basic knowledge on the main medical urgencies and emergencies, including early recognition of life-threatening conditions, flow-charts regarding the main acute syndromes.


Module: TERAPIA DEL DOLORE, INTENSIVA, ANESTESIOLOGIA
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The course aims to provide the students with the adequate knowledge related to both medical and surgical emergencies. Particular attention is paid to the clinical-diagnostic pathway of specific pathologies, so as to provide the students with the information which are required to differentiate them and start an appropriate and rapid diagnostic procedure.
Single treatments are individualized within their specific context (territory, home, ambulante, E.R., floor, I.C.U, etc). Furthermore, all treatments are proposed on the basis of available Evidence Based Medicine.
During the course all students are given the possibility to follow a cycle of Advance Life Support lessons, which aim to provide cornerstone information for an adequate Cardio-Pulmonary Resuscitation (CPR).
Course Objectives include also principal anesthesiological techniques, surgical patient preparation for both planned and emergent interventions, acute and chronic pain pathophysiology.



Module: CHIRURGIA D'URGENZA
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The aim of this course is to provide the students with the knowledge concerning the treatment of both medical and surgical emergencies. Particular relevance is given to the clinical-diagnostic framework of the different pathologies, in order to recognize them and to implement a proper and quick diagnosis and treatment.

Syllabus

Module: MEDICINA D'URGENZA
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APPROACH TO ACUTE CHEST PAIN IN THE EMERGENCY ROOM.
Rapid recognition of life-threatening conditions (Acute Coronary Syndromes, Pulmonary Embolism, Hypertensive Pneumothorax, Mediastinitis, Aortic Dissection, Pericardial Tamponade). Differential diagnosis (principles).
ACUTE CORONARY SYNDROMES (ACS)
ST-Elevation Myocardial Infarction (STEMI), Non ST-Elevation Myocardial Infarction (NSTEMI), Unstable Angina (UA).
Definitions, pathophysiology, symptoms. Principles of treatment of ACS. Recognition and management of the main complications, like cardiogenic shock and arrhythmias (particularly Ventricular Fibrillation and III-degree Atrioventricular Block. The main drugs used for cardiovascular urgencies and emergencies (mechanism of action, indications/contraindications, adverse reactions).
PRICIPLES FOR RAPID INTERPRETATION OF THE ELECTROCARDIOGRAM.
AORTIC DISSECTION.
Definition, pathophysiology, symptoms. Principles of diagnosis and treatment.
CARDIOGENIC ACUTE PULMONARY EDEMA.
Definitions, pathophysiology, symptoms. Principles of diagnosis and treatment.
NON-CARDIOGENIC ACUTE PULMONARY EDEMA (Acute Respiratory Distress Syndrome, ARDS)
Definition, pathophysiology, symptoms. Principles of diagnosis and treatment.
VENOUS THROMBOEMBOLISM (VTE).
Deep Venous Thrombosis (DVT) and Pulmonary Embolism. Definition, pathophysiology, symptoms. Risk factors. Strategies for VTE prevention. Diagnostic algorithms. Role of the Well’s score (or other similar scores) and of D-dimer. Principles of VTE treatment.
MAIN ACUTE ORGAN FAILURES. ACUTE LIVER FAILURE.
Definition, pathophysiology, symptoms. Porto-Systemic Encephalopathy.
Main acute complications in the cirrhotic patient. Principles of diagnosis and treatment. MAIN METABOLIC URGENCIES. MAIN ACUTE COMPLICATIONS IN THE PATIENT WITH DIABETES MELLITUS. DIFFERENT TYPES OF DIABETIC COMA.
Classification. Definition, pathophysiology, symptoms. Principles of diagnosis and treatment.
MAIN INTOXICATIONS/POISONING.
Approach in the emergency room. Clinical recognition based on physical examination (vital signs, ocular signs, body temperature, halitosis, cutaneous discoloration). Acetaminophen intoxication. Acute alcoholic intoxication. Opioid intoxication. Cocaine intoxication. CO intoxication.



Module: TERAPIA DEL DOLORE, INTENSIVA, ANESTESIOLOGIA
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Educational program
The students should
- recognize human clinical situations of emergency
- identify medical treatment priorities in emergent situations
- plan an appropriate diagnostic procedure
- identify the most suitable medical and/or surgical treatment within the patient context
- be able to carry out an adequate and efficient CPR
- know and solve all problems related to surgical patient preparation
- know principale anesthesiological techniques
- know pain psychological implications, diagnostic pathways to adequately identify a pain syndrome and therapeutic device to treat different pain syndromes.


Module: CHIRURGIA D'URGENZA
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- Recognize how approach emergency situation in Trauma and in emergency surgery according to established guidelines
- To know how to diagnose and treat the main surgical emergency
- To know how approach patients with major abdominal and Thoracic Trauma

Assessment methods and criteria

Oral and unique. The student will be asked questions about 2-3 topics ( medical emergencies, surgical emergencies, anesthesia, intensive care medicine and pain therapy) from a 2-lecturer commission which will be drawn on the first exam day.

Reference books
Author Title Publisher Year ISBN Note
Kasper Gl, et al. Harrison's Principles of Internal Medicine, 19th Edition, Mc Graw Hill, 2018
Corazza Gino Roberto, Perticone Francesco, Violi Francesco SIMI Handbook Terapia Medica (Edizione 1) EDRA 2017
Maurizio Chiaranda Urgenze ed emergenze. Istituzioni PICCIN 2016
Marino PL The ICU book-terapia intensiva Ed. Masson, Milano 1999




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