Emergency medical and surgical care

A.Y. 2020/2021
4
Max ECTS
48
Overall hours
SSD
MED/09 MED/18 MED/41
Language
Italian
Learning objectives
The course aims to provide the student with the knowledge and ability:
i) to make early diagnoses and implement, at the same time, the most appropriate treatment in the main clinical situations that put at risk the survival of an entire human body or a part of it;
ii) to use early warning systems in cases of acute alterations of the vital balance.
Expected learning outcomes
The student is able to:
i) undertake cardiopulmonary resuscitation maneuvers;
ii) how approach patients with trauma emergencies and medical-surgical emergencies ; ii) know the advanced brady- and tachyarrhythmia treatment algorithms in urgencies, the principles of defibrillation and electrical cardioversion;
iii) know theoretically and interpret invasive hemodynamic monitoring of arterial pressure, central venous pressure, pulmonary artery pressure and wedge pressure;
iv) interpret blood gas analysis and know the main emergency drugs.
Course syllabus and organization

Single session

In the first semester the lectures will take place as concurrent classroms:
·in the classroom with a limited number of students, who have previously booked using the "lezioniUnimi" app with the unimi e-mail account username and password; (https://www.unimi.it/it/studiare/frequentare-un-corso-di-laurea/seguire…) and at the same time through the "Teams platform" for online students ;
· The student must wear a surgical mask for the entire duration of his/her stay in the classroom and to sit using every other free seat
· the lectures will be recorded and made available on the teacher's Ariel website for students with proven difficulties to connect during classes
· the lectures will take place at the San Paolo Hospital on the 3rd floor of Blocco C. Students must access classrooms via Blocco C and exit via the side blocks (students leaving Pauling and Fleming rooms towards Blocco B and students leaving Curie, Golgi and Pasteur rooms towards Blocco A).
Students must enter from the main hall (R floor) of the San Paolo hospital and undergo body temperature measurement by the infrared cameras. It is strongly recommended to use the stairs for classrooms entering and/or leaving.
NB for any further information check the unimi.it website: (Home Studiare Frequentare un corso di laurea Seguire il percorso di studi Orari delle lezioni)
Prerequisites for admission
The knowledge of semeiotics, systematics, principles of pathophysiology of medical and surgical pathologies of the adults and pediatric patient, in particular reference to cardio-respiratory system, neurological system, digestive system, endocrine and metabolic system. The knowledge of acute pathologies and reacutization of chronic pathologies and their acute pathological consequences on anatomy and physiology of the human body.
The knowledge of Pharmacology and toxicology principles.
The knowledge of normal values of laboratory tests and their alterations possibly life threatening.
Assessment methods and Criteria
The exam is made up of:
· a preliminary written test consisting of 30 multiple-choice questions (only one correct answer out of 4 options), which has to be conclude in 30 minutes. Each correct answer will give a score of 1 point; not given or incorrect answers will give a score of 0 point. Passing the written test with a minimum of 18/30 points allows admission to the oral examination.
· a subsequent oral examinaton in which the student will be evaluated for her/his ability to express with clarity and adequate language the pathophysiological, diagnostic and therapeutical basis of medical and surgical emergencies. The student will also be tested for her/his clinical reasoning skills, based on her/his acquired theoretical and practical knowledge, on realistic clinical cases. Passing the oral test will result in the final mark expressed in thirtieths.
Anaesthesiology
Course syllabus
Approaching the patient with:
· Consciousness disorders (disorders of mental state, metabolic encephalopathies and coma);
· Syncope and presyncope;
· Dyspnea;
· Fever and hyperthermia.

Emergencies in pneumology:
· Acute and chronic decompensated respiratory failure;
· Acute respiratory distress syndrome (ARDS).

Emergencies in neurology:
· Meningitis;
· Coma and delirium;
· Acute intoxications:
· CO intoxication;
· Alcohol intoxication;
· Substance intoxications (cocaine, opioids, THC, amphetamines, hallucinogens);
· Drugs intoxications (analgesics, sedatives, anxiolytics, antidepressants).

Professionalizing activities:
· Basic cardiopulmonary resuscitation;
· Advanced arrhythmias algorithm;
· Invasive airway management;
· Non-invasive ventilation;
· Principles of electrical defibrillation and cardioversion;
· Invasive monitoring (AP, CVP, PAP, WP)
· Emergencies drugs;
· "Cento Antiveleni" and toxicology database consultation.
· Acute and chronic pain: pathophysiology and principles of therapy;
· Organization of Acute Pain Service service and law 38/2010.
Teaching methods
The program is made up of:
· during the 2° year of study: professionalizing course of "Basic Life Support and Pediatric Life Support" (1CFU) including 3 two-hours frontal lessons, 1 one-hour practical lesson and 3 six-hours experiences on board of ANPAS-associated emergencies ambulances.
· during the 6° year of study: 26 two-hours frontal lessons (4 CFU) about following topisc: 1. Framing of critically ill patient / acute variations of vital parameters / MET activation 2. Acute respiratory failure / ARDS 3. Cardiac arrest / ACLS /arrhythmias 4. NIMV + COPD and asthma 5. Cardiogenic shock 6. Pneumonia 7. Invasive ventilation 8. Hemodinamic monitoring 9. AMI / ACS 10. Heart failure / VTE 11. hypertensive crysis / cardiogenic pulmonary edema 12. Acute aortic syndromes 13. Hemorragic shock and blood transfusions 14. Politrauma 15. Septic shock 16. Acid-base and hydroelectrolytic equilibrium / fluid therapy 17. Acute kidney injury and CRRT 18. Anesthesia and sedation 19. Coma and delirium 20. Miningitis 21. hypoglycemia, ketoacidotic coma, hyperhosmolar coma 22. Nutritional aspects 23. Acute abdomen 24. Pancreatitis 25. Intoxications 26. Emergency pharmacology.
· during the 6° year of study: professionalizing courses of "Advanced Trauma Life Support" (1CFU) and "Advanced Cardiac Life Support" (1CFU) including a short theoretical and practical cardiopulmonary resuscitation course and 2 six and a half-hours work shifts in the emergency department.
· during the 6° year of study: professionalizing course of " Acute and Chronic Pain Management" (1CFU) including 7 hours of frontal lessons and 3 six-hours experiences with anesthesiologists/intensivists/oncologists working at San Paolo Hospital.
Teaching Resources
· Paul L. Marino, The ICU Book, Terapia Intensiva, principi fondamentali. Quarta edizione, Ed. Masson. (Ed. italiana a cura di Giorgio Conti)
General surgery
Course syllabus
Approaching the patient with:
· Shock (cardiogenic, obstructive, distributive, hypovolemic);
· Thoracic pain;
· Abdominal pain;

Trauma emergencies:
· Approaching multiple trauma patient;
· Thoracic trauma;
· Abdominal trauma;
· Vascular emergencies;
· Musculoskeletal trauma.

Emergencies in gastroenterology:
· Gastrointestinal bleeding;
· Acute and chronic hepatic failure clinical manifestations;
· Acute pancreatitis;
· Acute abdomen;
· Intestinal obstruction and pseudo-obstruction syndromes.

Emergencies in pneumology:
· Pneumothorax.

Emergencies in cardiology:
· Acute aortic diseases;
Teaching methods
The program is made up of:
· during the 2° year of study: professionalizing course of "Basic Life Support and Pediatric Life Support" (1CFU) including 3 two-hours frontal lessons, 1 one-hour practical lesson and 3 six-hours experiences on board of ANPAS-associated emergencies ambulances.
· during the 6° year of study: 26 two-hours frontal lessons (4 CFU) about following topisc: 1. Framing of critically ill patient / acute variations of vital parameters / MET activation 2. Acute respiratory failure / ARDS 3. Cardiac arrest / ACLS /arrhythmias 4. NIMV + COPD and asthma 5. Cardiogenic shock 6. Pneumonia 7. Invasive ventilation 8. Hemodinamic monitoring 9. AMI / ACS 10. Heart failure / VTE 11. hypertensive crysis / cardiogenic pulmonary edema 12. Acute aortic syndromes 13. Hemorragic shock and blood transfusions 14. Politrauma 15. Septic shock 16. Acid-base and hydroelectrolytic equilibrium / fluid therapy 17. Acute kidney injury and CRRT 18. Anesthesia and sedation 19. Coma and delirium 20. Miningitis 21. hypoglycemia, ketoacidotic coma, hyperhosmolar coma 22. Nutritional aspects 23. Acute abdomen 24. Pancreatitis 25. Intoxications 26. Emergency pharmacology.
· during the 6° year of study: professionalizing courses of "Advanced Trauma Life Support" (1CFU) and "Advanced Cardiac Life Support" (1CFU) including a short theoretical and practical cardiopulmonary resuscitation course and 2 six and a half-hours work shifts in the emergency department.
· during the 6° year of study: professionalizing course of " Acute and Chronic Pain Management" (1CFU) including 7 hours of frontal lessons and 3 six-hours experiences with anesthesiologists/intensivists/oncologists working at San Paolo Hospital.
Teaching Resources
· Paul L. Marino, The ICU Book, Terapia Intensiva, principi fondamentali. Quarta edizione, Ed. Masson. (Ed. italiana a cura di Giorgio Conti)
Internal medicine
Course syllabus
Emergencies in cardiology:
·Heart failure and acute pulmonary edema;
· Hypertensive emergencies;
· Acute coronary syndromes;
· Pericarditis and heart tamponade;
· Arrhythmias.

Emergencies in pneumology:
· Pneumonia - pulmonary abscess - pleural empyema;
· Asthma;
· Acute pulmonary embolism;

Emergencies in hematology:
· Hemostasis - anticoagulant oral drugs adverse effects and overdose;
· Anemia and hemorrhagic diathesis;
· Blood transfusions adverse effects in hemorrhagic shock patient;
· Hemophilia;
· Intravascular disseminated coagulation and thrombotic thrombocytopenic purpura.

Emergencies in endocrinology and metabolism:
· Diabetic emergencies (hypoglycemia, ketoacidotic coma, hyperhosmolar coma);
· Hypoglycemia;
· Hyper- and hypothyroidism;
· Electrolyte disorders:
· Hypo- and hypernatremia;
· Hypo- and hyperkalemia;
· Hypo- and hypercalcemia;
· Hypo- and hyperphosphatemia;
· Acid-base disorders.

Emergencies in nephrology:
· Acute kidney injury;
· Extracorporeal renal replacement therapy.
Teaching methods
The program is made up of:
· during the 2° year of study: professionalizing course of "Basic Life Support and Pediatric Life Support" (1CFU) including 3 two-hours frontal lessons, 1 one-hour practical lesson and 3 six-hours experiences on board of ANPAS-associated emergencies ambulances.
· during the 6° year of study: 26 two-hours frontal lessons (4 CFU) about following topisc: 1. Framing of critically ill patient / acute variations of vital parameters / MET activation 2. Acute respiratory failure / ARDS 3. Cardiac arrest / ACLS /arrhythmias 4. NIMV + COPD and asthma 5. Cardiogenic shock 6. Pneumonia 7. Invasive ventilation 8. Hemodinamic monitoring 9. AMI / ACS 10. Heart failure / VTE 11. hypertensive crysis / cardiogenic pulmonary edema 12. Acute aortic syndromes 13. Hemorragic shock and blood transfusions 14. Politrauma 15. Septic shock 16. Acid-base and hydroelectrolytic equilibrium / fluid therapy 17. Acute kidney injury and CRRT 18. Anesthesia and sedation 19. Coma and delirium 20. Miningitis 21. hypoglycemia, ketoacidotic coma, hyperhosmolar coma 22. Nutritional aspects 23. Acute abdomen 24. Pancreatitis 25. Intoxications 26. Emergency pharmacology.
· during the 6° year of study: professionalizing courses of "Advanced Trauma Life Support" (1CFU) and "Advanced Cardiac Life Support" (1CFU) including a short theoretical and practical cardiopulmonary resuscitation course and 2 six and a half-hours work shifts in the emergency department.
· during the 6° year of study: professionalizing course of " Acute and Chronic Pain Management" (1CFU) including 7 hours of frontal lessons and 3 six-hours experiences with anesthesiologists/intensivists/oncologists working at San Paolo Hospital.
Teaching Resources
· Paul L. Marino, The ICU Book, Terapia Intensiva, principi fondamentali. Quarta edizione, Ed. Masson. (Ed. italiana a cura di Giorgio Conti)
Anaesthesiology
MED/41 - ANAESTHESIOLOGY - University credits: 2
Lessons: 24 hours
General surgery
MED/18 - GENERAL SURGERY - University credits: 1
Lessons: 12 hours
Professor: Baisi Alessandro
Internal medicine
MED/09 - INTERNAL MEDICINE - University credits: 1
Lessons: 12 hours