Ateneo - UPO

The module provides the methodological tools for the advanced assessment of patients in critical conditions. It explores physical examination techniques (inspection, palpation, percussion, auscultation) integrated with multi-parameter monitoring for the rapid and systematic evaluation of vital functions (respiratory, cardiovascular, and neurological).

Douglas, G., Nicol, F., & Robertson, C. Macleod's Clinical Examination.
Lynn S. Bickley. Bates' Guide to Physical Examination and History Taking.
Teaching materials, scientific articles, and guidelines provided by the teacher.

The main objective is to provide the student with the skills to:
Knowledge and understanding: To deepen the pathophysiological and semiotic frameworks of the main alterations of vital functions in critically ill patients.
Applying knowledge and understanding: To integrate objective physical examination data with advanced technological monitoring parameters to support clinical decision-making.
Making judgements: To know how to critically interpret signs and symptoms for the early identification of clinical deterioration and intervention priorities.
Communication skills: To develop accurate technical-scientific language for the transmission of clinical information within the multidisciplinary emergency team. To know and be able to use effective communication models with patients or relatives in emergency situations.
Learning skills: To acquire a method for constant updating international guidelines and emerging technologies for the assessment of critically ill patients.

Students are expected to possess basic knowledge of the pathophysiology and semiotics of the main time-dependent conditions in cardiology, pulmonology, and neurology. Basic knowledge of physiopathology and clinical aspects of shock and acid-base balance are also required as well as electrocardiography and management and organizational aspects related to emergency care settings.

Interactive lectures.
Discussion of real clinical cases from the emergency-urgency context.

In the case of students with specific learning disabilities (DSA), the Teacher will be available, in synergy with the DSA Help Desk Service, to meet the specific needs that will be presented, with the aim of maintaining maximum autonomy of the person, enhancing personal skills. To start this process, it will be sufficient to send an email to the Course Coordinator (luigi.castello@med.uniupo.it). The methods of learning assessment will also be adapted to specific needs, as provided for by the University system.

Assessment Methods
The assessment of learning outcomes is conducted in an integrated manner through a single evaluation test, which covers:
1)Semiotics and assessment of vital signs
2)Advanced nursing assessment
3)Advanced Life Support (ALS)
4)Invasive and non-invasive clinical and instrumental monitoring

The assessment consists of a written exam featuring educational/organizational case studies developed by the course instructors. Each case is associated with Multiple Choice Questions (MCQs), featuring 4 response options, only one of which is correct.
The questions are designed to evaluate acquired knowledge, applied understanding, and autonomy of judgment.
The number of questions for each module is proportional to the number of ECTS (CFU) credits assigned, based on the criterion of 4 questions per credit, up to a maximum of 12 questions per module. Consequently, the total number of questions varies according to the number of modules within the integrated course. Specifically, for the Integrated Course in Models and Methodologies for Educational Design, Teaching, Clinical Leadership, and Consultancy, the total number of questions will be 32.
Each question is awarded 1 point. The final result is re-scaled to a range of 0 to 32, where:
18 points represents the minimum passing grade (equivalent to 18/30).
31 or 32 points represents the maximum grade (30/30 cum laude).
The exam will be duration of 48 minutes.

Advanced Assessment Methodology: The ABCDE systematic approach in the critically ill patient.
Respiratory Semiotics: Chest inspection, respiratory dynamics, lung percussion and auscultation; interpretation of arterial blood gas (ABG) analysis.
Cardiovascular Semiotics: Evaluation of capillary refill time, peripheral and central pulses, cardiac auscultation; invasive and non-invasive hemodynamic monitoring.
Neurological Semiotics: Assessment of consciousness level (Glasgow Coma Scale), pupil examination, and lateralizing signs.
Clinical Integration: Correlation between semiotic findings and monitored vital parameters; early recognition of shock and acute respiratory failure.

It is expected that, upon completion of the module, the student will be able to:
Knowledge and understanding: Describe the clinical signs and pathophysiological mechanisms of acute organ failure.
Applying knowledge and understanding: Perform a focused physical examination (ABCDE approach) and correctly interpret hemodynamic and respiratory monitoring tracings.
Making judgements: Discriminate between clinical presentations of varying severity, anticipating potential complications.
Communication skills: Document the performed assessment accurately and concisely, using validated assessment scales. Effective and empathic communication with patients and relatives.
Learning skills: Independently integrate new scientific evidence into the practice of advanced nursing semiotics.