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SURGERY III AND MEDICAL/SURGICAL EMERGENCIES

Academic year and teacher
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Versione italiana
Academic year
2022/2023
Teacher
PAOLO CARCOFORO
Credits
9
Didactic period
Primo Semestre

Training objectives

The integrated teaching of Surgery III and Medical-Surgical Emergencies includes the modules of:
Anesthesiology,
General surgery,
Internal Medicine,
Pain therapy.

The teaching of the integrated course aims to:
- provide the theoretical and practical knowledge and useful tools to prepare the student to recognize urgent/emerging pathologies of surgical interest and define the appropriate diagnostic/therapeutic pathways;
- provide the knowledge to be able to recognize and deal with urgent and emergency situations in the medical field, to be able to evaluate different reactions and behaviors in relation to gender in urgent-emergency situations as well as promoting the most correct approach to pain management.

At the end of the course, students should be able to:

In terms of knowledge:

- apply the diagnostic-differential decision-making process and the treatment of diseases and syndromes that compromise vital functions, particularly in complex clinical situations;
- will be informed on the principles of Pain Therapy, on the pathophysiological mechanisms of pain and on the main pain control techniques.
- describe the initial approach to the patient presenting an urgent/emerging surgical pathology.
- describe the main pathologies of urgent/emerging surgical interest and their respective clinical pictures.
-Describe the first and second level radiological investigations useful for the evaluation of the patient suffering from an urgent/emerging surgical pathology and the respective radiological pictures.
-Describe the appropriate treatment (surgical versus conservative).

In terms of skills, at the end of the course the student:

- will be able to make diagnostic-differential decisions and treat diseases and syndromes that compromise vital functions, particularly in complex clinical situations.
- will be able to control the airways and tools used for this purpose,
- will be able to apply respiratory and cardiocirculatory monitoring;
-will have different reactions and behaviors in relation to gender in urgent-emergency situations.
- will be able to initially evaluate the patient suffering from an urgent/emerging surgical pathology, identifying the diagnostic path of the patient suffering from an urgent/emerging surgical pathology and interpreting the required laboratory and radiological investigations;
- will be able to define the appropriate therapeutic pathway.
Furthermore, the course also aims to deal with sex/gender implications, where available, validated diagnostic and treatment pathways or guidelines.

Prerequisites

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Modulo: 005987 - CHIRURGIA GENERALE
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GENERAL SURGERY
Knowledge of Human Anatomy, Pathology, Physiology, Clinical Methodology, Radiology, Surgery I and II.
ANESTHESIA and INTERNAL MEDICINE
Knowledge of the pathophysiological bases of the main diseases and medical syndromes, which involve an impairment of vital functions

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Modulo: 46467 - ANESTESIOLOGIA
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ANESTHESIA and INTERNAL MEDICINE
Knowledge of the pathophysiological bases of the main diseases and medical syndromes, which involve an impairment of vital functions

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Modulo: 47781 - MEDICINA INTERNA
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INTERNAL MEDICINE
Knowledge of the pathophysiological bases of the main diseases and medical syndromes, which involve an impairment of vital functions

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Modulo: 65383 - TERAPIA DEL DOLORE
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Knowledge of the pathophysiological bases of the main diseases and medical syndromes, which involve an impairment of vital functions

Course programme

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Modulo: 005987 - CHIRURGIA GENERALE
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GENERAL SURGERY
• Initial approach to the emergency surgery patient
• Primary and secondary evaluation in thoraco-abdominal trauma
• Peri-operative evaluation of the emergency surgery patient and prevention of peri-operative complications through a multimodal evidence-based approach
• Management of peri-operative complications
• Abdominal emergencies (Acute appendicitis, Acute diverticulitis, Biliary colic and Acute cholecystitis, Jaundice and cholangitis, Peptic ulcer, Mesenteric ischemia, Gastrointestinal bleeding, Acute pancreatitis, Bowel obstruction, Bowel perforation, liver rupture, splenic rupture, Abdominal Compartment Syndrome)
• Thoracic emergencies (pneumothorax, hemothorax, esophageal rupture, mediastinitis)
• Soft tissue infection, necrotizing fasciitis, compartment syndrome of the upper and lower limbs
•Vascular emergencies (Abdominal aortic aneurysm rupture, Critical limb ischemia)

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Modulo: 46467 - ANESTESIOLOGIA
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ANESTHESIOLOGY
• Initial approach to the patient with emergencies
• Approach to the patient with acute respiratory failure
• Approach to the patient with septic shock
• Approach to the patient with anaphylactic shock
• Approach to the patient with cardiogenic shock
• Approach to volume replacement therapy in different clinical situations
• Approach to the traumatized patient
• Approach to the patient with severe electrolyte disturbances
• Approach to the patient with multiple organ failure

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Modulo: 47781 - MEDICINA INTERNA
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INTERNAL MEDICINE
Clinical approach to emergency conditions: acute coronary syndromes, hypertensive crisis, hydro-electrolytic unbalance, high and low temperature diseases, drowning syndrome, dizziness (symptoms and causes), chronobiology of cardiovascular emergencies.

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Modulo: 65383 - TERAPIA DEL DOLORE
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PAIN THERAPY
Pathophysiological basis of pain. Clinical classification of the different types of pain. Pharmacological principles of drug therapy in different contexts. Personalization of care in chronic diseases: palliative care, frail patient.

Didactic methods

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Modulo: 005987 - CHIRURGIA GENERALE
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GENERAL SURGERY
The module of general surgery provides:
• frontal lessons with analysis of the diagnostic/therapeutic pathways for different emergency surgery pathologies and discussion of clinical cases;
• attendance at the surgical ward and the operating room.

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Modulo: 46467 - ANESTESIOLOGIA
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The module provides: frontal lessons with analysis of the diagnostic/therapeutic pathways for different pathologies and discussion of clinical cases.

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Modulo: 47781 - MEDICINA INTERNA
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The module of INTERNAL MEDICINE include frontal lessons, discussion of clinical cases, exercitations

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Modulo: 65383 - TERAPIA DEL DOLORE
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The module of PAIN TERAPY include frontal lessons, discussion of clinical cases, exercitations

Learning assessment procedures

The achievement of the learning outcomes will be verified by means of a written and oral exam:
The written test consists of 60 multiple-choice quizzes with 4 possible answers.
EVALUATION CRITERIA: Evaluation: 0.5 points for correct answer, 0 points for missing or incorrect answer.
The oral exam takes place through the discussion of a clinical case. A clinical case will be proposed to the student, with possible presentation of laboratory investigations and/or instrumental investigations (e.g. direct X-ray abdomen, CT abdomen, etc ...)
EVALUATION CRITERIA: the verification of the student's ability to establish a diagnostic hypothesis and the appropriate diagnostic/therapeutic path.

The grade will depend on the student's ability to:
1) conduct the initial evaluation of the patient affected by an urgent/emerging surgical pathology;
2) request and interpret the investigations useful for reaching the diagnosis;
3) define a differential diagnosis and know the diagnosed pathology;
4) choose the appropriate surgical or conservative treatment based on the diagnosed pathology.
The final grade will derive from a weighted average of the grades of the modules of general surgery, internal medicine, and anesthesiology.
The exam will take place on a single date at the end of the first semester.

Reference texts

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Modulo: 005987 - CHIRURGIA GENERALE
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GENERAL SURGERY
"Chirurgia”, di Renzo Dionigi. Editore Masson.
“Chirurgia Generale” a cura di Francesco Minni. Edizione CEA - Casa Editrice Ambrosiana. 2019 ISBN 978-88-08-32049-0
“Emergency Surgery” edited by Adam Brooks, Bryan A. Cotton, Nigel Tai, Peter F. Mahoney, David J. Humes. Blackwell Publishing Ltd. 2010 ISBN: 978-1-405-17025-3
“Emergency Surgery Manual” edited by Massimo Sartelli e Fausto Catena. Alpes Italia 2008 ISBN: 8889923326

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Modulo: 46467 - ANESTESIOLOGIA
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ANESTHESIOLOGY
- Maurizio Chiaranda, Urgenze ed Emergenze - Istituzioni, Piccin Ed. Padova, Quinta edizione
- Harrison, Principi di Medicina Interna, McGraw-Hill Ultima edizione
- “Urgenze ed Emergenze” a cura di Maurizio Chiaranda. Edizione Piccin. 2016 ISBN: 978-88-299-2783-8

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Modulo: 47781 - MEDICINA INTERNA
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INTERNAL MEDICINE
Harrison's Principles of Internal Medicine, McGraw-Hill
Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine, Elsevier
American Heart Association (www.americanheart.org)
European Society of Cardiology (http://www.escardio.org/Pages/index.aspx)
Italian Society of Cardiology (http://www.sicardiologia.it/Sito/)
Italian Society of Internal Medicine (http://www.simi.it/)
Italian Society of Emergency Medicine (http://www.simeu.it/)

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Modulo: 65383 - TERAPIA DEL DOLORE
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PAIN THERAPY
Teacher notes