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Emergency

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Emergency

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Academic year 2024/2025

Course ID
SCB0230
Teachers
Giovanni Nicolao Berta (Lecturer)
Massimo Terzolo (Lecturer)
Adriana Boccuzzi (Lecturer)
Filippo Castoldi (Lecturer)
Enrico Bellato (Lecturer)
Rossella Reddavid (Lecturer)
Matteo Bianco (Lecturer)
Pietro Caironi (Coordinator)
Vincenzo Russotto (Lecturer)
Year
6th year
Teaching period
First semester
Type
Basic
Credits/Recognition
10 (80 hours of lectures, 40 hours of exercises)
Course disciplinary sector (SSD)
BIO/14 - pharmacology
MED/09 - internal medicine
MED/11 - cardiovascular diseases
MED/18 - general surgery
MED/33 - musculoskeletal system diseases
MED/41 - anaesthesiology
Delivery
Formal authority
Language
English
Attendance
Mandatory
Type of examination
Written and oral
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Sommario del corso

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Course objectives

The aim of the Integrated Course is to provide the pathophysiological and clinical bases for the diagnosis and therapy (including pharmacological aspects of the drugs employed) of the most common diseases related to emergency medicine and surgery.

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Results of learning outcomes

By the end of the course, the student will have acquired scientific and theoretical knowledge on clinical-instrumental diagnosis and treatment of the most common medical, surgical and traumatological emergencies, as well as on how to administer drugs during emergency.

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Program

Anesthesiology and Resuscitation

  • Acute Respiratory Distress Syndrome (ARDS) and severe acute respiratory failure
  • Acid-base equilibrium
  • Physiology and Pathophysiology of fluid therapy
  • Sepsis
  • Cardiovascular shock
  • Airway management
  • Basic Life Support Defibrillation (BLSD)
  • Advanced Trauma Life Support (ATLS).

Surgery

  • Generality about trauma, head trauma, thoracic trauma, abdominal trauma
  • Damage Control Surgery
  • Generality about acute abdomen (occlusive and peritonitic)
  • Acute appendicitis, acute cholecystitis, acute pancreatitis, acute diverticulitis
  • Ectopic pregnancy
  • Peptic ulcer
  • Intestinal ischemia
  • Digestive bleeding

Pharmacology

  • Main drugs used in emergencies.

Diseases of the musculoskeletal system

  • Traumatology: the basics
  • how to "read" the x-ray in ER
  • Management of the most common fratures (proximal femur, femoral shaft, proximal humerus, clavicle, wrist, scaphoid, tibial plateau, ankle)
  • Polytrauma
  • Pelvic trauma (fractures of the pelvic ring and of the acetabulum)
  • Open fractures
  • Joint dislocations (shoulder, elbow, hip, hip prosthesis, knee, patella, ankle)
  • Traumatic amputations of the limbs
  • Spinal cord trauma
  • Compartment syndrome

Internal medicine

  • Acute coronary syndromes
  • Pulmonary embolism
  • Emergencies in diabetic patients
  • The endocrinological emergencies (adrenal insufficiency, thyroid storm)
  • Hypertensive crisis
  • Acute respiratory failure
  • Acute circulatory failure
  • Sepsis
  • Acid-base balance.
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Course delivery

The integretaed course will be delivered through frontal lessons, which include the possibility of extensive discussions on the topic presented, as well as the discussion on clinical cases. In addition, simulation lab sessions will be proposed, as a complementary tool.

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Learning assessment methods

Exams (or assessment procedure) for all students attending the course during past academic years (Italian courses) will be performed according to the previous modality defined, which is described below.

Previous academic years (Italian courses)

The assessment includes both a written test and an oral examination.

Written test

  • The written test consists of 6 modules, each of which may include one or more open-ended questions or multiple-choice questions (MCQs). All questions will pertain topics included in the syllabus.
  • The total duration of the written test is 120 minutes.
  • The written test results in a fail mark if:
    1. Two or more modules are failed (i.e., mark lower than 18/30)
    2. One module is failed severely (as assessed by the exam committee)

In all the other cases, the written test is considered as passed

Oral examination

  • If the written test is passed, but one module is failed non severely, the student will be evaluated in an oral examination on the failed module and another module chosen by the exam committee.
  • If the written test is passed and the average mark is lower than 26/30, the student will be evaluated in an oral examination on a module chosen by the exam committee.
  • If all modules are passed and the average mark is equal to or higher than 26/30, the student may either accept the average mark as it is, without being evaluated in an oral examination, or may ask for an oral examination in case the student will be willing to improve the final mark.

Please note that the mark obtained with the written test is the starting point for the oral examination but does not guarantee a final passed mark. Depending on the level of preparation shown by the student, the oral examination may result in an improvement, confirmation or worsening of the written examination mark, until a failure of the entire exam.

 

Current academic years (English courses)

Exams (or assessment procedure) for all students attending the English course (starting from the academic years 2022-2023) will be performed according to the modality described below.

The evaluation includes both a written test and an oral exam.

Written test

  • The written test consists of 30 MCQs pertaining topics included in the syllabus for all the modules included in the course.
  • The total number of MCQs is divided into each single module according to their relative credit weight (CFU): 9 questions for Internal Medicine, 9 questions for Anesthesiology, 3 questions for Pharmacology, 3 questions for Musculoskeletal System Diseases, 3 questions for General Surgery, 3 questions for Cardiovascular Diseases.
  • Each MCQ includes 4 possible true-or-false answers, each of them may be true or false (i.e. total of 120 true-or-false questions).
  • The total duration of the written test is 60 minutes.
  • Each single correct answer to a true-or-false question will correspond to a mark value of 0.3.
  • The written test is passed if the average mark is equal to or greater than 18/30, provided that the number of correct true-or-false questions for each single module equals at least 50% of the total number of them (18 true-or-false questions for Internal Medicine and Anesthesiology; 6 true-or-false questions for Pharmacology, Musculoskeletal System Diseases, General Surgery and Cardiovascular Diseases).

Oral examination

  • If the written test is passed and the average mark is lower than 25/30, the student will be evaluated in an oral examination on a module chosen by the exam committee.
  • If the written test is passed and the average mark is equal to or greater than 25/30, the student may either accept the average mark as it is, without being evaluated in an oral examination, or may ask for an oral examination, in case the student will be willing to improve the final mark.

Please note that the mark obtained with the written test is the starting point for the oral examination but does not guarantee a final passed mark. Depending on the level of preparation shown by the student, the oral examination may result in an improvement, confirmation or worsening of the written examination mark, until a failure of the entire exam.

Suggested readings and bibliography

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Anesthesiology and Resuscitation

  • Ashbaugh DG, Bigelow DB, Petty TL, Levine BE. Acute respiratory distress in adults. Lancet. 1967 Aug 12;2(7511):319-23. DOI: 10.1016/S0140-6736(67)90168-7
  • Rubenfeld GD, Caldwell E, Peabody E, Weaver J, Martin DP, Neff M, Stern EJ, Hudson LD. Incidence and outcomes of acute lung injury. N Engl J Med. 2005 Oct 20;353(16):1685-93. DOI: 2010.1056/nejmoa050333
  • Slutsky AS, Ranieri VM. Ventilator-induced lung injury. N Engl J Med. 2014 Mar 6;370(10):980. DOI: 10.1056/nejmc1400293
  • Gattinoni L, Caironi P, Cressoni M, Chiumello D, Ranieri VM, Quintel M, Russo S, Patroniti N, Cornejo R, Bugedo G. Lung recruitment in patients with the acute  respiratory distress syndrome. N Engl J Med. 2006 Apr 27;354(17):1775-86. DOI: 10.1056/nejmoa052052
  • ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA. 2012 Jun 20;307(23):2526-33. DOI: 10.1001/jama.2012.5669
  • Gattinoni L, Caironi P, Pelosi P, Goodman LR. What has computed tomography taught us about the acute respiratory distress syndrome? Am J RespirCrit Care Med. 2001 Nov 1;164(9):1701-11. Review. DOI: 10.1164/ajrccm.164.9.2103121
  • Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. The Acute Respiratory Distress Syndrome Network. N Engl J Med. 2000 May 4;342(18):1301-8. DOI: 10.1056/nejm200005043421801
  • Brower RG, Lanken PN, MacIntyre N, Matthay MA, Morris A, Ancukiewicz M, Schoenfeld D, Thompson BT; National Heart, Lung, and Blood Institute ARDS Clinical Trials Network.. Higher versus lower positive end-expiratory pressures in patients with the acute respiratory distress syndrome. N Engl J Med. 2004 Jul 22;351(4):327-36. DOI: 10.1056/nejmoa032193
  • Guérin C, Reignier J, Richard JC, Beuret P, Gacouin A, Boulain T, Mercier E, Badet M, Mercat A, Baudin O, Clavel M, Chatellier D, Jaber S, Rosselli S, Mancebo J, Sirodot M, Hilbert G, Bengler C, Richecoeur J, Gainnier M, Bayle F, Bourdin G, Leray V, Girard R, Baboi L, Ayzac L; PROSEVA Study Group.. Prone positioning in severe acute respiratory distress syndrome. N Engl J Med. 2013 Jun 6;368(23):2159-68. DOI: 10.1056/nejmoa1214103
  • Fencl V, Leith DE. Stewart's quantitative acid-base chemistry: applications in biology and medicine. Respir Physiol. 1993 Jan;91(1):1-16. Review. DOI: 10.1016/0034-5687(93)90085-o
  • Langer T, Ferrari M, Zazzeron L, Gattinoni L, Caironi P. Effects of intravenous solutions on acid-base equilibrium: from crystalloids to colloids and blood components. Anaesthesiol Intensive Ther. 2014 Nov-Dec;46(5):350-60. doi:10.5603/AIT.2014.0059. Review. DOI: 10.5603/ait.2014.0059
  • Myburgh JA, Mythen MG. Resuscitation fluids. N Engl J Med. 2013 Dec 19;369(25):2462-3. DOI: 10.1056/nejmra1208627
  • John A Myburgh, Simon Finfer, Rinaldo Bellomo, Laurent Billot, Alan Cass, David Gattas, Parisa Glass, Jeffrey Lipman, Bette Liu, Colin McArthur, Shay McGuinness, Dorrilyn Rajbhandari, Colman B Taylor, Steven A R Webb, CHEST Investigators; Australian and New Zealand Intensive Care Society Clinical Trials Group, Hydroxyethyl starch or saline for fluid resuscitation in intensive care. N Engl J Med. 2012 Nov 15;367(20):1901-11. DOI: 10.1056/nejmoa1209759
  • Caironi P, Tognoni G, Masson S, Fumagalli R, Pesenti A, Romero M, Fanizza C, Caspani L, Faenza S, Grasselli G, Iapichino G, Antonelli M, Parrini V, Fiore G, Latini R, Gattinoni L; ALBIOS StudyInvestigators. Albumin replacement in patients with severe sepsis or septic shock. N Engl J Med. 2014 Apr 10;370(15):1412-21. DOI: 10.1056/nejmoa1305727
  • Linee guida di Basic Life Support Defibrillation (BLSD); American Heart Association; Italian Resuscitation Council.
  • Linee guida di Advanced Trauma Life Support (ATLS); Americal College of Surgeons.
  • Diapositive utilizzate durante le lezioni.

Surgery

  • F. Charles Brunicardi, Dana K. Andersen, Timothy R. Billiar, David L. Dunn, Lillian S. Kao, John G. Hunter, Jeffrey B. Matthews, Raphael E. Pollock, Schwartz’s Principles of Surgery, 11th edition, McGraw-Hill 2019
  • Moshe Schein, Paul N. Rogers, Ari Leppäniemi, Danny Rosin, Jonathan E. Efron, Schein's Common Sense Emergency Abdominal Surgery, 4th Edition, TFM 2016.

Pharmacology

Orthopaedics and traumatology

Internal Medicine

  • Dennis L. Kasper ... [et al.], Harrison Principi di Medicina Interna, Ambrosiana, 2017.
  • Shivani Misra et al., Diabetic ketoacidosis in adults BMJ 2015;351:h5660. DOI: 10.1136/bmj.h5660
  • Ebenezer A. Nyenwe *, Abbas E. Kitabchi, Evidence-based management of hyperglycemic emergencies in diabetes mellitus, Diabetes Research And Clinical Practice 94 (2011) 340-;351. DOI: 10.1016/j.diabres.2011.09.012
  • M. W. Savage et al., Joint British Diabetes Societies guideline for the management of diabetic ketoacidosis, Diabet. Med. 28, 508-;515 (2011). DOI: 10.1111/j.1464-5491.2011.03246.x
  • Ronald Van Ness-Otunnu, Jason B. Hack, Hyperglycemic Crisis, The Journal of Emergency Medicine, Vol. 45, No. 5, pp. 797-;805, 2013 C. DOI: 10.1016/j.jemermed.2013.03.040
  • Ali S. Raja et al., Evaluation of Patients With Suspected Acute Pulmonary Embolism: Best Practice Advice From the Clinical Guidelines Committee of the American College of Physicians  Annals of Internal Medicine, Vol. 163 No. 9, 3 November 2015. DOI: 10.7326/m14-1772
  • Marco Roffi, Carlo Patrono, Jean-Philippe Collet, Christian Mueller, Marco Valgimigli, Felicita Andreotti, Jeroen J Bax, Michael A Borger, Carlos Brotons, Derek P Chew, Baris Gencer, Gerd Hasenfuss, Keld Kjeldsen, Patrizio Lancellotti, Ulf Landmesser, Julinda Mehilli, Debabrata Mukherjee, Robert F Storey, Stephan Windecker, ESC Scientific Document Group, 2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC), European Heart Journal, doi:10.1093/eurheartj/ehv320.
  • Patrick T O'Gara, Frederick G Kushner, Deborah D Ascheim, Donald E Casey Jr, Mina K Chung, James A de Lemos, Steven M Ettinger, James C Fang, Francis M Fesmire, Barry A Franklin, Christopher B Granger, Harlan M Krumholz, Jane A Linderbaum, David A Morrow, L Kristin Newby, Joseph P Ornato, Narith Ou, Martha J Radford, Jacqueline E Tamis-Holland, Carl L Tommaso, Cynthia M Tracy, Y Joseph Woo, David X Zhao, 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines, Journal of the American College of CardiologyVol. 61, No. 4, 2013. DOI: 10.1016/j.jacc.2012.11.018


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Notes

The assessment procedure detailed above holds for all students (even those who took the course in past academic years).

Students with DSA or disabilities are kindly requested to take note of the reception services and support services offered by the University of Turin, and in particular of the procedures required for exam support.

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Teaching Modules

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