Training plan broken down by year
1th YEAR
Areas of training:
- Medical Clinic: 12 weeks.
- Critical Care Unit: 8 weeks.
- Respiratory Kinesiology: 4 weeks.
- Cardiac Critical Care Unit: 8 weeks.
INTERNAL MEDICINE (E1)
Specific objectives
- To know and use the electronic medical record of our hospital.
- Perform a complete physical examination, compiling a detailed and systematic medical history.
- Formulate a syndromic diagnosis using the data obtained from the medical history.
- To know the different isolation measures applied to hospitalized patients.
- To understand the fundamentals and implementation of biosafety standards.
- Know and apply the 5 moments of hand hygiene (WHO).
- To understand the methodological basis and interpretation of clinically relevant complementary studies in hospitalized patients: Chest X-ray, Ultrasound, ECG, laboratory tests, cultures, etc.
- Incorporate legal aspects of the performance as residents and of medical practice.
- To acquire knowledge that promotes the ethical practice of medicine.
- Develop effective communication with patients and the healthcare team.
- Develop attitudes of multidisciplinary and teamwork.
- Acquire concepts of fluid therapy and nutrition.
- Incorporate the concept of medicolegal value of the medical record.
strategy:
- Direct assistance under supervision of patients in the general inpatient ward.
- Ward tour and discussion of diagnostic-therapeutic strategies with the attending physicians.
- Being in charge of preparing the admission medical history and its daily evolution.
- Clinical history taking using the "problem-based evolution" approach.
CRITICAL CARDIOLOGY I (E2)
Specific objectives:
- Perform an appropriate medical history and physical examination on patients with cardiac signs and symptoms.
- Recognize electrocardiographic patterns of severe acute pathologies.
- To understand the diagnostic and therapeutic plan for the most frequent cardiac syndromes: Acute heart failure, decompensated chronic heart failure, acute coronary syndrome, microvascular coronary disease (MINOCA and INOCA), pulmonary thromboembolism, acute aortic syndrome, syncope, supraventricular arrhythmias, ventricular arrhythmias, pericardial effusion, cardiac tamponade, acute pericarditis, acute myocarditis, cardiogenic shock, effusive constrictive pericarditis, acute decompensation of valvular heart disease, acute and subacute endocarditis.
- Indications and use of electrical cardioversion.
- Indications and use of cardiac defibrillation.
- Indications for temporary and permanent pacemakers.
- Interpreting continuous electrocardiographic monitoring.
- To know the indications, contraindications, dilutions and adverse effects of the drugs used in critical cardiology.
Strategy:
- Patient care in the Coronary Unit.
- Teaching activities of the cardiology service.
- Discussion of clinical cases during ward rounds
- Preparation and presentation of a review monograph.
- Written feedback and presentation of what was learned and its applicability in Emergencies.
INTENSIVE CARE I (E3)
Specific objectives:
- Recognize the patient in critical condition.
- Understanding the pathophysiology and complications of critically ill patients.
- Use and interpret advanced neurological, hemodynamic, respiratory, and post-surgical monitoring tools.
- Evaluation and management of Sepsis and Septic Shock.
- Evaluation and management of intracranial bleeding.
- Evaluation and management of hemorrhagic and traumatic shock.
- Use, indication and contraindications of common drugs in critical care.
- Analgesedation in the critically ill patient.
- To understand the ethical and legal principles that apply to critically ill patients.
- Incorporate skills for performing invasive diagnostic and therapeutic procedures.
- Indications and modalities in dialysis.
- Insertion of hemodialysis catheters.
- Clinical diagnosis of brain death and organ donor maintenance.
Strategy:
- Direct assistance under supervision of patients admitted to intensive care.
- Ward tour and discussion of diagnostic-therapeutic strategies with attending physicians.
- Being in charge of preparing the admission medical history and its daily evolution.
- Medical history taking using the "problem-based evolution" approach.
- Performing invasive procedures under supervision.
- Participation in training activities of the service.
RESPIRATORY KINESIOLOGY I (E4)
Specific objectives:
- Respiratory physiology in spontaneous ventilation, non-invasive ventilation and invasive ventilation.
- Concepts of P-SILI and VILI.
- Assembly and use of non-invasive and invasive ventilation devices.
- Conventional and non-conventional indications for non-invasive ventilatory support.
- Assessment of respiratory failure.
- Ventilatory modalities in non-invasive to invasive ventilation.
- Take infection prevention measures and know the biosafety rules.
- To know the criteria for mechanical ventilation support and to apply its methods.
- Perform frequent skills related to respiratory care in patients.
- Usefulness of pulmonary and diaphragmatic ultrasound in patients with respiratory failure and with invasive and non-invasive mechanical respiratory assistance.
- Tracheostomy indications and care.
- Indications and care of different types of tracheostomy cannulas.
Strategy:
- Structured theoretical training of knowledge prior to the rotation.
- Assistance and monitoring of patients with respiratory assistance in ICU and CCU.
- Daily evolution of kinesiology clinical histories.
- Theoretical and practical classes of the service.
ANESTHESIOLOGY (E5)
Specific objectives:
- Anatomy of the upper respiratory tract,
- Global airway management algorithm.
- SMART MACOCHA ventilation failure prediction scores.
- Predictors of difficult airway LEMON.
- VORTEX approach to managing the difficult airway.
- Dosage, indications and contraindications for inhaled anesthetic agents, analgesics, intravenous anesthetics and neuromuscular blocking agents.
- Principles of regional anesthesia.
- Monitoring during general anesthesia.
- Use of supraglottic devices.
- Usefulness of Ultrasound in IOT.
- Usefulness of Ultrasound in predicting difficult airway.
- Usefulness of ultrasound in the evaluation of gastric contents.
Strategy:
- Rotations through outpatient, central, emergency and pediatric operating rooms.
EMERGENCY MEDICINE I (E6)
Specific objectives:
- Triage concept. Different triage models.
- Early warning score concepts: SOFA, NEWS, MEWS, SIRS.
- The chain of survival in hospitals and outside of hospitals.
- Basic cardiopulmonary resuscitation. Feedback systems.
- Electrical cardioversion.
- Concept of rapid response systems.
- Continuous invasive and non-invasive multiparametric monitoring.
- The neurological examination in the Emergency Department.
- Introduction to Critical Ultrasound.
- Major syndromes in the Emergency Department.
- Shock: initial approach. Usefulness of ultrasound in the diagnosis of undifferentiated shock. Fluid therapy: ROSE protocol.
- Sepsis: suspected diagnosis, possible diagnosis. Management algorithm. Usefulness of ultrasound in initial resuscitation.
- Chest pain: differential diagnoses. Usefulness of ultrasound.
- Acute coronary syndrome: diagnosis of STEMI, NSTEMI, microvascular disease. AHA chest pain algorithm. Utility of coronary CT angiography and cardiac MRI.
- Polytrauma: initial assessment. Concept and diagnosis of traumatic shock. Utility of E-FAST ultrasound.
- Ischemic stroke: Stroke Unit concept. Canadian NIHSS and Rankin scales. Indications and contraindications for thrombolysis and thrombectomy. Preparation for alteplase administration. Post-thrombolysis monitoring.
- Poisoning: Initial approach. Use of activated charcoal and gastric lavage. Indications for total intestinal irrigation. Skin decontamination. Use of PPE. Use of antagonists.
- Acute respiratory failure: initial assessment. Respiratory failure vs. ventilatory failure. Concept of P-SILI. Utility of ultrasound: BLUE and BEEP-FIRST protocols.
- Impaired consciousness: initial approach. Neuromonitoring. Utility of EEG laboratory tests and neuroimaging.
- Pain: scales for assessing the presence and intensity of pain. Concept of somatic, visceral, and neuropathic pain. Concept of multimodal analgesia. Non-pharmacological analgesia. Regional anesthesia.
- Psychiatric decompensation. Initial assessment. Need for physical restraint. Argentine Mental Health Law 26657.
- Anaphylaxis. Recognition. Management algorithm. Indications for the use of subcutaneous, intravenous, and inhaled adrenaline. Glucagon. Use of corticosteroids, antihistamines, and H2 blockers. Hemodynamic and respiratory support.
- Airway Management in Emergencies. Global Airway Management Algorithm.
- Oxygen therapy: oxygenation goals, oxygen therapy devices.
- Assist under supervision patients admitted to the Emergency Department.
- Discussion of diagnostic-therapeutic strategies with the rest of the team.
- Being in charge of preparing the admission medical history and its daily evolution.
- Clinical history taking using the "problem-based evolution" approach.
- Responsible for the preparation and transmission of data during the guard change.
2th YEAR
Areas of training:
- Critical Cardiology Unit: 8 weeks
- Critical Ultrasound at 4 weeks
- Gynecology and Obstetrics: 4 weeks
- Pediatric Emergencies: 4 weeks
EMERGENCY MEDICINE II (E7)
Specific objectives:
- Shock: initial approach. Usefulness of ultrasound in the diagnosis of undifferentiated shock. Fluid therapy: ROSE protocol. Objective assessment of fluid response. Vasopressors.
- Sepsis: Management algorithm. Usefulness of ultrasound in initial resuscitation. Usefulness of diagnostic imaging in identifying the infectious focus. Antibiotic therapy in the critically ill patient. Continuous and prolonged antibiotic infusion.
- Acute coronary syndrome: diagnosis of STEMI, NSTEMI, INOCA, MINOCA. Utility of coronary CT angiography and cardiac MRI.
- Cardiogenic shock. Early detection. SCAI Shock Scale. Use of inotropes and vasopressors. Invasive monitoring.
- Polytrauma: packing and tourniquet techniques. Use of pelvic straps, intraosseous access, massive transfusion protocol. Use of thromboelastography in trauma: initial assessment. Concept and diagnosis of traumatic shock. Utility of E-FAST ultrasound.
- Ischemic stroke: Stroke Unit concept. NIHSS, Canadian, and Rankin scales. Indications and contraindications for thrombolysis and thrombectomy. Preparation for alteplase administration. Post-thrombolysis monitoring.
- Poisoning: Initial approach. Use of activated charcoal and gastric lavage. Indications for total intestinal irrigation. Skin decontamination. Use of PPE. Use of antagonists.
- Acute respiratory failure: initial assessment. Respiratory failure vs. ventilatory failure. Concept of P-SILI. Utility of ultrasound: BLUE and BEEP-FIRST protocols.
- Impaired consciousness: initial approach. Neuromonitoring. Utility of EEG laboratory tests and neuroimaging.
- Pain: scales for assessing the presence and intensity of pain. Concept of somatic, visceral, and neuropathic pain. Concept of multimodal analgesia. Non-pharmacological analgesia. Regional anesthesia. Pharmacodynamics of the most commonly used analgesics. Contraindications. Renal and hepatic insufficiency. Etonox: nitric oxide. Analgesia in trauma. Multimodal analgesia. Regional anesthesia: concept. application.
- Oxygen therapy: oxygenation goals, oxygen therapy devices.
- Assembly and use of CAFO. ROX score.
- Arming and using VMNI. HARCOR score.
- Abdominal pain. Evaluation. Diagnosis of non-traumatic acute abdomen. Alvarado score. Usefulness of laboratory tests. Use of CT scans with and without double contrast. Usefulness of MRI.
Strategy:
- Assist under supervision patients admitted to the Emergency Department.
- Discussion of diagnostic-therapeutic strategies with the rest of the team.
- Being in charge of preparing the admission medical history and its daily evolution.
- Clinical history taking using the "problem-based evolution" approach.
- Responsible for the preparation and transmission of data during the guard change.
CRITICAL CARDIOLOGY II (E8)
Specific objectives:
- Formulate a diagnostic, therapeutic and monitoring plan for the most frequent etiologies: Acute Heart Failure, Decompensated Chronic Heart Failure, Acute Coronary Syndrome, Microvascular Coronary Disease (MINOCA and INOCA), Pulmonary Thromboembolism, Acute Aortic Syndrome, Syncope, Supraventricular Arrhythmias, Ventricular Arrhythmias, Pericardial Effusion, Cardiac Tamponade, Acute Pericarditis, Acute Myocarditis, Cardiogenic Shock, Effusive Constrictive Pericarditis, Acute Decompensation of Valvular Heart Disease, Acute and Subacute Endocarditis.
- Recognition of patients at risk of cardiogenic shock, their phenotypes, diagnosis and treatment. Use of recognition scales (SCAI-Shock).
- Indication and use of extracorporeal circulatory support devices (ECMO).
- Indications and use of transcutaneous and transvenous temporary pacemakers.
- Post-cardiac surgery patient: acute complications, hemodynamic and respiratory support.
- Pericardiocentesis in cardiac tamponade.
- Usefulness of echocardiography in critical cardiology.
Strategy:
- Patient care in the Coronary Unit.
- Teaching activities of the cardiology service.
- Discussion of clinical cases during ward rounds.
- Preparation and presentation of a review monograph.
- Written feedback and presentation of what was learned and its applicability in Emergencies.
- Simulation laboratory: pericardiocentesis.
OBSTETRICS AND GYNECOLOGY (E9)
Specific objectives:
- Perform a complete gynecological and obstetric examination.
- Metrorrhagia. Diagnosis. Pharmacological and non-pharmacological treatment. Indications for dilation and curettage.
- Bleeding in the first and second trimesters of pregnancy. The usefulness of ultrasound.
- Spontaneous abortion and induced abortion. Indications for dilation and curettage.
- Dead and retained fetus. Diagnosis.
- Gynecological infections: vaginitis, cervicitis. PID.
- Assessment of victims of sexual abuse.
- Evaluate and treat pregnancy complications.
Strategy:
- Assist under supervision patients admitted to the Gynecology Service.
- Attend pre-labor and delivery rooms.
- Being in charge of preparing the admission medical history and its daily evolution.
- Clinical history taking using the "problem-based evolution" approach.
- Responsible for the preparation and transmission of data during the guard change.
PEDIATRIC EMERGENCIES (E10)
Specific objectives:
- Interview the child and the mother.
- Vital signs and monitoring in children. Normal values.
- A systematic approach to treating a child with serious illnesses or injuries. Assess - Identify - Intervene.
- Perform High Quality CPR on Infant.
- Perform High Quality CPR on a Child.
- Use of AEDs in Infants and Children.
- Pain assessment in children.
- Recognition of respiratory distress vs. respiratory failure. Upper airway obstruction. Lower airway obstruction. Lung tissue disease. Impaired respiratory control. Pharmacological treatment.
- Recognition of shock in children. Usefulness of ultrasound in undifferentiated shock. Compensated shock. Hypotensive shock. Types of shock: cardiogenic, distributive, obstructive, hypovolemic. Fluid therapy. Vasopressors.
Strategy:
- Patient care within the Pediatric Emergency Service, assisted by a staff physician and supervised by the area coordinator.
- Incorporation into the academic activity of the area.
CRITICAL ULTRASOUND (E11)
Specific objectives:
-Comprehensive hemodynamic assessment. The 10 clinical questions: FUSIC HD.
- Diagnosis of Shock: RUSH, FALLS.
- Diagnosis of dyspnea: BLUE.
- Diagnosis of right venous congestion: VexuS.
- Diagnosis of potentially surgical injuries in Trauma: E-FAST and accessory views.
-Diagnosis in ACLS: SESAME.
- Diagnosis of chest pain.
-Evaluation of gastric contents prior to IOT.
-Transcranial Doppler. Diagnosis of MCA obstruction. Vasospasm. Brain death.
- Gallbladder. Diagnosis of gallstones and acute cholecystitis.
- Bladder. Qualitative and quantitative content evaluation.
- Kidney. Renal trauma. Pyelocaliceal dilatation.
- Obstetric ultrasound. Fetal viability. Traumatic complications.
Strategy:
- Implementation of protocols with direct supervision.
- Creation of a portfolio with 15 cases for each of the objectives.
3nd YEAR
Areas of training:
- Trauma Rotation: 8 weeks.
- Critical Echocardiography: 8 weeks (part-time)
- Critical Care Unit: 8 weeks
- Respiratory kinesiology: 4 weeks
TRAUMA (E12)
Specific objectives:
- Initial management of prehospital trauma/polytrauma.
- Assessment and diagnosis of polytrauma. ISS. AIS scale.
- Standardized assessment of the polytrauma patient. CABCDE. Prevention of hypothermia.
- Non-operative treatment. Damage control strategy concept. Utility of endovascular therapy.
- Hemorrhagic shock. Goals of hemodynamic resuscitation. Concept of permissive hypotension. Assessment and management of severe hemorrhage in trauma. Use of tranexamic acid. Massive transfusion protocol in trauma. Thromboelostography. Use of blood products. Utility of whole blood, packed red blood cells, fresh frozen plasma, platelet concentrate, and clotting factor concentrate. Colloids vs. crystalloids. Traumatic coagulopathy. Calcium replacement. Use of a warming blanket.
- Imaging study of the polytrauma patient. Utility and indications of whole body CT. Different protocols.
- Airway management in the polytrauma patient. Emergency cricothyroidotomy using the scalpel-bougie technique. SIR in trauma. Drugs.
- Analgesia in the polytrauma patient. Concept of multimodal analgesia. Non-pharmacological interventions. Fracture alignment and reduction. Inhalational medications. Usefulness of nitrous oxide and methoxyflurane. Ketamine. Fentanyl. NSAIDs. Ultrasound-guided regional anesthesia.
- Head trauma. CGS. Recognition of hypertension. Indications for CT scan, recognition of extradural hematoma, subdural hematoma, subarachnoid hemorrhage.
- Cervical trauma. Airway trauma. Utility of ultrasound. Cervical spinal cord injury. Mechanisms of injury. Nexus C-Spine scales. Indications for CT and MRI. Concepts of immobilization vs. mobility restriction. Imaging in penetrating trauma.
- Spinal cord trauma, spinal shock.
- Chest trauma. Usefulness of E-Fast. Tension pneumothorax. Chest tube insertion technique. Pulmonary contusion. Massive hemothorax. Cardiac tamponade. Indications for emergency thoracotomy.
- Abdominal compartment syndrome. Recognition. Methods for measuring intra-abdominal pressure.
- Genitourinary Trauma (renal, ureteral, bladder, urethral). Recognition. Usefulness of CT, Ultrasound and MRI.
- Splenic and hepatic trauma. Classification. Endovascular therapy vs. open surgery.
- Facial and Ocular Trauma. Types of facial fractures. Usefulness of 3D reconstruction CT.
- Musculoskeletal and vascular trauma to the extremities. Compartment syndrome. Utility of the ultrasound ankle-brachial index.
- Trauma in special populations: the elderly, pregnant women, and children. Differences in approach.
- Lead a multidisciplinary team for the treatment of polytrauma patients.
Strategy:
-Full-time rotation through trauma center.
- Completion of Advanced Trauma Life Support (ATLS) course.
INTENSIVE CARE II (E14)
Specific objectives:
- Sedation. Sedation goals. Concept of daily sedation window. Clinical assessment scales. Monitoring of deep sedation. Bispectral Index (BIS).
- Pain in patients under mechanical ventilation. Pain assessment scales. CPOT.
- Post-surgical patient. Complications. Resuscitation.
- Percutaneous tracheostomy. Technique. Management of complications.
- Renal replacement therapy. Dialysis. Hemofiltration. Hemodiafiltration. Indications.
- Refractory septic shock. Use of methylene blue.
- Myopathy and polyneuropathy of the critically ill patient.
- Delirium. Recognition. Prevention measures. Assessment scales. Pharmacological and non-pharmacological treatment.
Strategy:
- External rotation Intensive Care Service Pirovano Hospital CABA.
RESPIRATORY KINESIOLOGY II (E15)
Specific objectives:
- Prevention and diagnosis of VILI. Lung protection strategies.
- Oxygenation goals in critically ill patients.
- Prevention measures for ventilator-associated pneumonia.
- Tracheostomy indications and care.
- Indications and care of different types of tracheostomy cannulas.
- Asynchronies in mechanical ventilation. Recognition. Diagnosis. Management.
Strategy:
- Structured theoretical training of knowledge prior to the rotation
- Assistance and monitoring of patients with respiratory assistance in ICU and CCU.
- Daily evolution of kinesiology clinical histories.
- Theoretical and practical classes of the service.
CRITICAL ECHOCARDIOGRAPHY (E16)
Specific objectives:
- Cardiac windows. Utility of the subxiphoid window.
- Estimate central venous pressure and right atrial pressure
- LV systolic function (“Eye Balling”, Simpson, Teichholz, Tei Index)
- VTI TSVI. Estimation of SV, VMC and Cardiac Index. Distance-minute.
- Aorta. Viewing windows. Diameter measurement. Acute aortic syndromes.
- Pericardial effusion. Quantification. Cardiac tamponade in 2D and pulsed Doppler
- PET 2D signs (Mc. Connell and D-Shape); TAPSE
- Ischemic heart disease: cardiac segmentation. Coronary territories. Dyskinesia, hypokinesia and akinesia.
Strategy:
- Basic theoretical training prior to the rotation.
- Part-time rotation through Echocardiography Laboratory.
- Performing echocardiographic examinations under supervision.
EMERGENCY MEDICINE III (E17)
Specific objectives:
-Acid-base status. Alterations and management of the ABG.
-Hypoglycemia. Diabetic ketoacidosis and hyperosmolar nonketotic state
-Electrolyte disorders: Hyponatremia/Hypernatremia. Electrolyte disorders: K, Ca, Mg, P
-Rhabdomyolysis
-Hyperthyroidism. Recognition. Treatment of thyroid storm. Use of beta-blockers, corticosteroids, and antithyroid drugs. Adrenal insufficiency in emergencies. Indications for empirical treatment. Stress dose. Screening tests.
-Seizures and status epilepticus. Life support measures. Pharmacological treatment of epileptic seizures. Status epilepticus. Management protocol. Benzodiazepines, levetiracetam, thiopental, lacosamide. Non-convulsive status epilepticus. Value of EEG and neuroimaging
Intracranial bleeding. Extradural hematoma, subdural hematoma, subarachnoid hemorrhage, subacute subdural hematoma. Presumptive diagnosis. Neuroimaging. Cerebral resuscitation and neurocritical care. Utility of transcranial Doppler.
-Neuro-ophthalmology in Emergencies. The neuro-ophthalmological examination. Internuclear ophthalmoplegia. NAION.AION.
- Neuromuscular diseases. Myasthenia gravis. Myasthenic crisis: recognition and confirmatory diagnosis. Guillain-Barré syndrome: typical and atypical forms (ASMAN and AMAN). Measurement of FVC (Pimax and Pemax) for prediction of intubation.
-Intracranial hypertension. Clinical, ultrasound, and CT assessment. Use of mannitol and hypertonic saline. Multimodal neuromonitoring: concept and limitations
- Dizziness and vertigo. AVS.t-EVS, s-EVS. Study using the TITRATE protocol. Diagnostic maneuvers for BPPV. Dix-Hallpike maneuver. Epley and Lampert repositioning maneuvers.
Spinal syndromes. Spinal cord transection. Spinal cord hemisection. Spinal shock. Transverse myelitis. Central cord syndrome. Spinal cord ischemia.
- Headaches. Primary. Secondary. Atypical facial pain.
-Abnormal movements: Acute dystonias. Differential diagnosis. Acute treatment. Diphenhydramine, biperiden
- Delirium. Recognition and diagnostic scales. Non-pharmacological and pharmacological approaches. Investigation of triggering causes. Use of neuroleptics, sedatives, and antipsychotics
- Protocol for Accidental Exposure to Fluids and Sharps.
- HIV in the Emergency Department: Antiretrovirals: Drug Interactions and Adverse Drug Reactions. Diagnosis of Acute Infections. Tuberculosis in the Emergency Department
-Emerging and re-emerging infectious diseases: Hantavirus; Zika, Chikungunya, Dengue, Hemorrhagic fevers, Yellow fever, Rabies, Tetanus, Botulism, Leptospirosis. Legionellosis.
-Skin and soft tissue infections. Deep neck space infections.
-CNS infections: Brain abscesses, Meningitis; Encephalitis, Epidural abscess. Eye infections.
-Urinary tract infection. Recurrence. Asymptomatic bacteriuria.
Abdominal infections. Diarrhea. Clostridium difficile infection. Cholera
-Respiratory infections: upper and lower. Pneumonia.
-Myocarditis, endocarditis, pericarditis infections associated with cardiovascular devices
- Osteoarticular infections. Septic arthritis; Osteomyelitis
- Approach to fever of unknown origin. Traveler's fever.
-Infections in immunocompromised patients: Infection in solid organ transplantation. Infections in bone marrow transplant recipients. Infections in cirrhotic patients. Infections related to biologic therapy.
Strategy:
- Assist under supervision patients admitted to the Emergency Department
- Discussion of diagnostic-therapeutic strategies with the rest of the team
- To be in charge of preparing the admission medical history and its daily evolution
- Medical history taking using the "problem-based evolution" approach
- Responsible for the preparation and transmission of data during the guard change
4nd YEAR
Areas of training:
- Optional Rotation: 4 weeks
EMERGENCY MEDICINE IV (E18)
Specific objectives:
-Acute kidney injury: Measurement of GFR in different scenarios; concept and limitations; Glomerular function assessment. Renal functional reserve. Most frequent causes of AKI. Prerenal, renal, and postrenal differential diagnosis. Utility of ultrasound and Doppler. Acute complications: acidosis, hypercalcemia, pericarditis, hypervolemia, uremia. Diagnostic methods. Indications and methods of extracorporeal renal replacement therapy: new filtration techniques: hemofiltration, hemodiafiltration, etc.
-Acute urinary retention. Acute scrotal pain. Priapism. Hematuria. Renal, ureterovesical, and bladder stones.
Prostatitis. Difficult placement of bladder catheter; Bladder irrigation in hematuria
-Leukemia: concept and types. Anti-leukemic drugs. Complications of anti-leukemic chemotherapy treatment. Leukostasis. Hyperviscosity. Tumor lysis syndrome.
-Platelet disorders. Autoimmune thrombocytopenic purpura. Suspected diagnosis. Immunoglobulin and plasmapheresis; Henoch-Schönlein purpura (TTP)
-Complications of oncohematological treatments. Molecular targets in oncohematology. Toxicity from biological agents. Types of acute respiratory infections (ARIs). Complications. Classification and treatment. Complications in hematopoietic stem cell transplant recipients.
Thromboembolic disease: risk assessment scales. Deep vein thrombosis: diagnostic workup and plan. Prophylaxis measures. Indications for sodium heparin, LMWH, and NOACs. Prophylaxis in special populations: neoplasms, chronic renal insufficiency, bleeding diathesis, patients on anticoagulant therapy, high-risk surgeries, and patients at high risk of bleeding. DVT of the upper extremities. DVT associated with venous catheters, DVT in cancer patients. Splanchnic DVT (Budd-Chiari, mesenteric, renal, portal, ovarian). Treatment of thromboembolic disease: medical, surgical, and endovascular.
-Bleeding and overdose in patients on antiplatelet therapy and oral anticoagulants with heparins, coumarin derivatives, and niacin. Evaluation and treatment. Idarusizumab; Andexanet; dialysis. Thrombolytic overdose. Bleeding diatheses: Von Willebrand hemophilia; hemophilia, etc. Disseminated intravascular coagulation.
-Massive hemorrhage: Massive transfusion protocol. Prediction scores. Utility of elastography. Restrictive vs. liberal strategies. Acute hemorrhage: Platelet transfusion, use of plasma, factor concentrate, tranexamic acid, desmopressin, recombinant factor VIIa.
- Emergency Anticoagulation. LMWH Heparins. Fondaparinux: Pharmacology. NOACs. Initiation and Monitoring in the Emergency Department. Pharmacodynamics. Adverse Reactions: Diagnosis and Management
- Transfusion Therapy in Emergencies. Indications. Types of blood components. Compatibility testing. Acute transfusion complications: Acute hemolytic reaction, fever in transfused patients, anaphylactic reaction, TRALI, volume overload, clinical strategy for severe transfusion reactions.
- Anemia. The laboratory in anemias. Hemolytic anemias. Hemoglobinopathies. Sickle cell crisis.
- Acute Pancreatitis: definition and classification of mild and non-mild pancreatitis management. Etiology. Severity Scores: Atlanta, Bisap, Apache II. Fluid therapy in acute pancreatitis. Nutrition in acute pancreatitis.
- Esophagus: Mallory-Weiss syndrome. Hiccups. Esophagus, stomach and duodenum (dysphagia, foreign bodies, esophageal perforation, esophagitis, gastritis and peptic ulcer, gastric volvulus)
- Anus and rectum: Hemorrhoidal crisis. Anal-perineal abscess. Anal fistula. Rectal foreign body
- Biliary tract: Cholecystitis, cholangitis. Tokyo Guidelines. Choledochal syndrome. Utility of ultrasound and MRI.
- Fecal bolus: pathophysiology, diagnosis, and treatment. Opioid-induced constipation. Constipation in pediatrics. Types and correct use of laxatives. Gastroenteritis. Acute diarrhea. Use of antidiarrheals: Loperamide, Racecadotril, Probiotics. Usefulness and types of diet
- Liver cirrhosis: complications. Refractory ascites. SBP. Esophageal variceal bleeding. Management protocol. Use of vasopressors. Terlipressin, Octreotide, Somatostatin. Hepatic encephalopathy. Types. Classification. Causes. Hepatorenal syndrome. Acute liver failure. Acute-on-chronic liver failure. Liver transplant complications. Non-cirrhotic portal hypertension.
- Celiac Disease. Inflammatory Bowel Disease: Types, Severity Classification. Hospitalization Criteria. Treatment.
- Acute abdomen: Medical and surgical. Medical and surgical ileus. Acute appendicitis. Acute diverticulitis. Appendageitis. Acute intestinal ischemia: superior mesenteric ischemia, inferior mesenteric ischemia. Gastric and intestinal volvulus. Intussusception in pediatric patients. Imaging diagnosis of acute abdomen. Value of MRI.
- Gastrointestinal bleeding: Upper gastrointestinal bleeding. Glasgow Blatchford scores. Indications for urgent vs. delayed upper gastrointestinal endoscopy. Use of omeprazole. Lower gastrointestinal bleeding. Oakland score. Imaging diagnosis of gastrointestinal bleeding: CT angiography; ACR Appropriateness Criteria. CT: GI bleeding; CT angiography, scintigraphy, digital angiography. Meckel scan.
- Acute alcoholic hepatitis. Cholestasis of pregnancy. Dili.
-Toxisyndromes: Asphyxiation syndrome, cholinergic syndrome, upper airway irritation syndrome, sympathomimetic syndrome, CNS depression syndrome, hallucinatory and delirious syndrome. Diagnosis and treatment of withdrawal syndromes
- Drug poisonings: Paracetamol; Salicylates, Antipsychotics; Antidepressants (Tricyclic MAOIs; SSRIs; SNRIs); Barbiturates, Opioids, Digoxin; Tricyclic antidepressants; OACs.
- Intoxications from Drugs of Abuse. New designer drugs
-CO poisoning
-Poisoning from Household Products
-Poisoning from agricultural products
-Ethanol and Alcohol Poisoning
-Poisoning from industrial products
-Poisoning from Plants and Mushrooms
-Poisoning from stings and bites. Myiasis
-Detoxification techniques in poisonings: dialysis, hemofiltration, hemodiafiltration. MARS Etc.
- Use of antidotes and toxicological indications
-Immersion injuries. Drowning. High-altitude medicine. Dysbarism.
-Thermoregulation. Methods for taking core temperature. Concepts of conduction, convection, radiation, and evaporation. Hypothermia: Causes, classification, and complications. Indications and methods of passive and active rewarming. CPR protocol in severe hypothermia. Frostbite. Pathophysiology of frostbite. Thawing. Heat injuries: Causes. Heat stroke. Cooling methods.
-Burns. Assessment of chemical and electrical burns.
Strategy:
- Assist under supervision patients admitted to the Emergency Department
- Discussion of diagnostic-therapeutic strategies with the rest of the team
- To be in charge of preparing the admission medical history and its daily evolution
- Medical history taking using the "problem-based evolution" approach
- Responsible for the preparation and transmission of data during the guard change
Resident Assessment Methods
- Multiple Choice type theoretical exams.
- Direct Observation of Procedural Skills (DOPS).
| FIRST YEAR |
|
| Medical clinic: 3 months |
|
| Coronary Unit: 2 months |
|
| Kinesiology: 1 month |
|
| ICU: 2 months |
|
| Anesthesiology: 1 month |
|
| Emergencies: 2 months |
|
| Holidays: 4 weeks |
|
| SECOND YEAR |
|
| Anesthesiology: 2 sem |
|
| hypercritical UCO: 2 months |
|
| Pediatrics: 1 month |
|
| Ultrasound: 1 month |
|
| Obstetrics: 1 month |
|
| Emergencies: 5 months and 2s |
|
| Holidays: 4 weeks |
|
| THIRD YEAR |
|
| Trauma: 2 months |
|
| Emergencies: 5 months and 2s |
|
| Burn ICU: 2 months |
| Anesthesiology: 2 weeks |
|
| Echocardiogram: 2 months |
|
| Holidays: 4 weeks |
|
| FOURTH YEAR |
|
| Elective: 2 months |
|
| Emergencies: 9 months |
|
| Holidays: 4 weeks |
