MedInTO Medicine and Surgery

Emergency

Emergency

Academic year 2023/2024

Sommario del corso

• Course objectives
• Results of learning outcomes
• Program
• Course delivery
• Learning assessment methods
• Suggested readings and bibliography
• Notes
• Teaching Modules
• Teaching tools
• Course card

Course objectives

The aim of the Integrated Course is to provide the scientific and theoretical basis for the diagnosis and therapy of the most common diseases and traumas of competence of the medicine and the emergency surgery. In addition, the Student should know the more common drugs utilized in Emergency

Results of learning outcomes

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

Program

Anesthesiology and Resuscitation

• Acute Respiratory Distress Syndrome (ARDS) and severe acute respiratory failure
• Acid-base and fluid-electrolyte balance according to Stewart
• Physiology and Pathophysiology of infusion fluids
• 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.

Course delivery

Frontal teaching                                                                                                                  

Learning assessment methods

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

• The assessment is divided into a written test and an oral exam. 
• The written test consists of 6 modules, each of which may include one or more open-ended questions or multiple-choice questions. All questions will cover topics included in the syllabus.
• The written test lasts 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 in a major way (as established by the exam committee)
• The written test is passed, and the student enabled to take the oral examination, if:
  1. All modules are passed, and the average mark is 26/30 or lower. In this case, the student will be assessed on a module chosen by the exam committee.
  2. Only one module is failed. In this case, the student will be assessed on the failed module and another one chosen by the exam committee.
• If all modules are passed, and the average mark is 26/30 or higher, the student is able to accept the mark without taking the oral examination
• The written test mark is the starting point for the oral examination but does not guarantee a pass mark. Depending on the level of preparation shown by the student, the oral examination may result in improvement, confirmation or worsening of the written examination mark. Please note that it’s possible to fail the oral examination altogether.

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

• Slides and learning material will be provided by the lecturer.
• Laurence Brunton; Bjorn Knollmann, Goodman and Gilman's The Pharmacological Basis of Therapeutics.

Orthopaedics and traumatology

• Ashley Blom, David Warwick, Michael Whitehouse, Apley & Solomon's System of Orthopaedics and Trauma, 10th Edition, CRC Press 2017.

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

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.

Teaching Modules

• Emergency - module of Anesthesiology (SCB0230F)
• Emergency - module of Cardiovascular Diseases (SCB0230E)
• Emergency - module of General Surgery (SCB0230D)
• Emergency - module of Internal Medicine (SCB0230B)
• Emergency - module of Musculoskeletal System Diseases (SCB0230C)
• Emergency - module of Pharmacology (SCB0230A)

• Teaching material
• Exams and finals
• Class schedule
• Go to Moodle
• Register for the course
• Enrolled students
• Invia email agli studenti registrati
• Export table