EMERGENCY MEDICINE ROTATION LEARNING OBJECTIVES

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EMERGENCY MEDICINE ROTATION LEARNING OBJECTIVESStudents will be placed in a hospital-based emergency room to gain exposure to urgent and emergentcare. This rotation’s examination will focus on Emergency Medicine. The following pages outline thelearning objectives for this clinical experience. They are designed to guide students in their clinicalactivities and supplemental reading. It is not the Program’s intention that students will be exposed tothis complete list of objectives during the clinical experience. This section is designed to assiststudents in their preparation for the emergency medicine end-of-rotation exam.EM MEDICAL KNOWLEDGEUpon completion of this clinical experience (EM), the student will be able to: Understand etiology, epidemiology, risk factors and pathophysiology Evaluate clinical manifestations Formulate a differential diagnosis Develop an assessment (including recommendation and interpretation of laboratory,diagnostic and radiological studies/findings) Construct a patient-specific plan (including pharmacological/ non-pharmacological,patient education, procedural and necessary referrals) Describe prognosis, complications, prevention, patient education, and treatment goalsof the following diseases/disorders/symptoms.Airway ManagementRecognize and recommend appropriate airway management in the conscious patient,unconscious patient, pediatric patient and the patient with facial and neck trauma.Fluid ManagementDifferentiate and choose the appropriate type of IV fluidsTrauma/ Shocketiology of shock in a trauma patientshock – hypovolemic, cardiogenic, anaphylactic, neurogenicresuscitation fluids (crystalloids verses colloids)blunt verses penetrating traumatension pneumothoraxcardiac (pericardial) tamponadeflail chesttraumatic head injuryCPR (BLS, ACLS) ProtocolsC-spine clearance protocol (National Emergency X-radiography Utilization study (NEXUS) criteria)Respiratory EmergenciesPneumothorax, hemothoraxaspirationexacerbation of asthma/ COPDupper airway obstructionatelectasisepiglottitisClass 2020 Clinical Handbookrespiratory acidosis and alkalosispulmonary edemapneumonia (viral, bacterial and fungal)pulmonary emboluspleurisyretropharyngeal abscess93

peritonsillar abscessARDSrespiratory failureIdentify and recommend hospital admission for respiratory emergencies using appropriate criteria.Cardiovascular Emergenciesangina pectorisacute myocardial infarction (AMI)pericardial effusion and tamponadehypertensive emergencies/urgenciesEKG abnormalities:AsystoleQT prolongationAtrial (fibrillation, flutter)Sinus bradycardia, tachycardiaPVCsParoxysmal supraventriculartachycardiapericarditisaortic dissectioncongestive heart failureVentricular (tachycardia, fibrillation)AV block (1st, 2nd, Complete)Right and left bundle branch blockWolf-Parkinson-WhiteTorsade de PointesAppropriately and accurately identify and recommend and/or perform cardioversion, anddefibrillation.Identify and recommend hospital admission for cardiac emergencies through use of appropriatecriteriaGastrointestinal EmergenciesAppendicitisObstruction- small/large intestine, volvulusPerforated peptic ulcerBowel perforationDiverticulitisGastroenteritisAbdominal aortic aneurysmIschemic bowelSpelenic ruptureEsophageal spasm/esophagitisEsophageal varicesMallory-Weiss syndromeAcute pancreatitisIntussusception/volvulusMesenteric ischemiaHemorrhoids-thrombosedInfectious diarrheaHernias-incarcerated/strangulatedUpper and lower gastrointestinal bleedingCholecystitis/lithiasis/ biliary colicAcute hepatitisInflammatory bowel disease/toxic megacolonIdentify and recommend hospital admission for gastrointestinal emergencies through use ofappropriate criteria.Neurological EmergenciesGlasgow Coma ScaleLevels of consciousnessClass 2020 Clinical HandbookSubdural hematomaIntracerebral hemorrhage94

Subarachnoid hemorrhageMeningitisEncephalitisSeizure disorders, status epilepticusAcute TIA/CVASpinal cord injuryGuillain-Barré syndromeHead traumaCerebral contusionHeadacheBasilar skull fractureHepatic encephalopathyRecognize and appropriately recommend the potential etiology and diagnostic approach andtreatment for syncope, dizziness, and vertigo.Identify and recommend hospital admission for neurological emergencies through use of appropriatecriteria.Musculoskeletal Trauma and tionsSprainTypes of aced articular stressclosed avulsionobliquetorusSpecificA. Shoulder/Arm1) anterior/posterior shoulder dislocation2) acromioclavicular separation3) humeral fractures4) clavicle fracturesB. Elbow1) subluxation radial head (nursemaid’s elbow)2) Supracondylar fractureC. Forearm/Wrist1) Colle’s Fracture2) Radial Fracture3) Ulnar fracture4) Scaphoid (Navicular) fractureD. Hand/Finger1) MCP ulnar collateral ligament2) sprain/rupture(gamekeeper’s thumb)3) phalanx fractures4) metacarpal fractures (Boxer’s)5) mallet fingerE. Ankle/foot1) malleolar fracturesClass 2020 Clinical Handbook95

2) fifth metatarsal (Jones’)3) calcaneous fractureF. Leg1) tibial fractures2) fibular fractures3) femur fracturesG. Salter-Harris I-VH. Knee1) patella fracture/dislocationI. Facial1) orbital blowout fractureJ. PelvicK. Hip1) intra-trochanteric fracture2) subcapital fracture3) Slipped Capital femoral epiphysis4) Legg-Calve-PerthesSoft tissue trauma/injuriesRotator Cuff tendonitis/bursitits/tearBiceps tendonitis/ruptureAnterior/posterior cruciate tearPatella tendon bursitis/ tendonitisCompartment syndromeNeck/SpineHerniationSpinal cord injuryCauda equine syndromeMedial/lateral epicondylitisMedial/lateral collateral ligament tearAchilles tendon ruptureVertebral fracturesWhiplashLow back painIdentify and recognize the most common fracture associated with the following complications:OsteomyelitisVolkmann’s ischemic contractureavascular necrosisfat emboli syndromeinhibited bone growth development in the pediatric patientWound CareTetanus prophylaxis and immunizationPrimary/secondary wound closuresAppropriate dressing and wound treatments based on wound typeDermatologic, Burns and Environmental EmergenciesHerpes zosterErythema multiformeSteven-Johnson’s SyndromeToxic epidermal necrolysisClass 2020 Clinical HandbookCellulitisSmoke inhalationBurns (all forms and degrees)96

Criteria for hospital and burn center admission for the burn patientUtilization of the Rule of NinesBites/Stings: all formsHeat cramps/heat exhaustion/heatRabiesstrokeDrug eruptionsFrostbite/ hypothermiaViral exanthemsEye, Ear, Nose, Oral Cavity EmergenciesEpistaxis (anterior, posterior)Foreign bodiesOcular painRetinal detachmentAcute angle-closure glaucomaCentral retinal artery occlusionOrbital and periorbital cellulitisCorneal abrasion and ocular traumaFacial traumaDental fractures/loss/avulsion/abscessPeritonsillar abscessSmiles for Life online module objectivesGynecologic and Obstetric EmergenciesEctopic pregnancyOvarian torsionPlacenta previaPreeclampsiaPelvic inflammatory diseasePelvic painAcute hearing loss and otalgiaRed eyeAcute visual lossChemical and thermal flash burnsHypemaOtitis media/externaAcute pharyngitis/laryngitisAcute sinusitis/mastoiditisBarotraumaRupture ovarian cystsPlacental abruptionSpontaneous abortionEclampsiaFetal distressMastitis/breast abscessGenitourinary ephritisTesticular torsionEpididymitisAcute renal failureProstatitisOrchitisPeripheral Vascular EmergenciesAbdominal aortic aneurysmAcute arterial occlusionDeep vein thrombosisEndocrine EmergenciesDiabetic ketoacidosisthyroid stormmyxemda comahyperglycemic hyperosmolar nonketotic syndromeacute adrenal crisishypoglycemiahyper/hypo calcemiaMetabolic, Fluid and Electrolyte Emergenciesalcohol ketoacidosisdehydrationClass 2020 Clinical Handbook97

hyper/hypo natremiarespiratory acidosis/alkalosishyper/hypo kalemiametabolic acidosis (anion and non-anion gap)/alkalosisToxicologyAspirin overdoseDigoxin overdoseopiate overdosecocaine /antidotesacetaminophen overdose and toxicitysedatives and hypnotics (benzodiazepines)Psychiatric EmergenciesSuicide/homicide ideationsPanic attack/anxiety disordersPsychosisHallucinationsAbuseSexual abuseChild abuseanticholinergic overdoseantiepileptic overdoseethanol and other toxic alcoholscarbon monoxide poisoningDepressionBipolar disorderSchizophreniaSuicide attemptElder abuseDomestic/intimate partner violenceEM PHARMACOTHERAPEUTICSStudents will also be expected to discern the properties of the following drug or drug classesincluding mechanism of action, interactions, contraindications, and major and common sideeffects. Students will also be expected to discern the appropriate patient education and necessaryfollow up required for the following drugs or drug classes. Analgesics Antihypertensives Anesthetics- topical, local Antipsychotics Antispasmotics/anticholinergics Antianxiolytics Antiarrhythmics Cardiac medications Antibiotics- oral, IV Corticosteroids Anticoagulants Diuretics Ophthalmological medications Antidepressants Antidiarrheals Respiratory medications Antiemetics ThrombolyticsEM SKILLSRecognize, perform and/or assist in the following procedures and identify the indications andpotential complications (when applicable) for each: Airway management Cardiopulmonary resuscitation Anterior nasal packing Chest tube placement Application of splints Clearance of cervical spine Application of wound dressings Control of superficial hemorrhageClass 2020 Clinical Handbook98

Digital/field blockFluorescein corneal examinationIncision and drainageInjectionsIV access- peripheral, central lineLocal anesthesia infiltration Lumbar punctureNasogastric tube placement SuturingRemoval of superficial foreign bodiesUrinary catheterizationVenipunctureEM DIAGNOSTIC STUDIESStudents will be expected to appropriately recommend, interpret the findings, and recognize theindications/clinical significance of the following diagnostic studies. In addition students will beexpected to discern appropriate management (including counseling and informed consent) whenabnormalities are found in the following routine tests, and recognize the potential complications foreach: Pulse Oximetry Peak Flow Blood type and cross X-ray (chest, abd, Sodium FerritinKUB) Carbon Dioxide DDimer 12 Lead ECG& Albumin Therapeutic drugRhythm StripLevels Lipase Stool occult blood hCG Amylase MSK X-ray/MRI CBC & Differential Cardiac enzymes Rheumatoid factor Glucose TSH Cholesterol Panel ESR CT scan Wound C&S BUN Urine Analysis BNP Creatinine Urine C&S Blood C&S Fluid Analysis HgA1C ABGs Potassium Anion gap PT, PTT, INR AST/ALT Calcium Toxicology screens Alkaline Phosphatase Magnesium Chloride ultrasonographyAQUIFER CASES1.2.3.4.5.6.Family Med 27: 17 year old male with groin painInternal Med 1: 49 year old man with chest painInternal Med 4: 67 year old woman with shortness of breath and lower leg swellingInternal Med 7: 28 year old woman with lightheadednessInternal Med 22: 71 year old man with cough and fatigueInternal Med 30: 55 year old woman with leg painSee Appendix E for suggestions of additional cases to complete.END OF EMERGENCY MEDICINE LEARNING OBJECTIVESClass 2020 Clinical Handbook99

Toxicology screens . AQUIFER CASES . 1. Family Med 27: 17 year old male with groin pain 2. Internal Med 1: 49 year old man with chest pain 3. Internal Med 4: 67 year old woman with shortness of breath and lower leg swelling 4. Internal Med 7: 28 year old woman with lightheadedness 5. Internal Med 22: 71 year old man with cough and fatigue 6.

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Assistant Professor of Medicine, Section of Emergency Medicine, Baylor College of Medicine, Houston, TX Scott D. Weingart, MD, FCCM Associate Professor of Emergency Medicine, Director, Division of ED Critical Care, Icahn School of Medicine at Mount Sinai, New York, NY Susan R. Wilcox, MD Former Attending Physician in Emergency Medicine/Surgical .

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