Goals and Objectives

DuringyourrotationinEmergencyMedicine,youwillbeexpectedtoassessundifferentiatedemergency
departmentpatients,performafocusedhistoryandphysicalexamination,formulateapreliminarydifferential
diagnosisandinvestigationandmanagementplan,andthenpresentthesecasestoyourattendingstaff.Ifyoudo
seeanyacutelyillpatients,notifyyourattendingstaffimmediately.
Youareexpectedtoseeatleast50patientsduringyourrotation.Ofthese50patientsyouareexpectedtoseeat
leasttwoeachofthefollowingpresentations:
Chestpain(twodifferentcauses)
Abdominalpain(twodifferentcauses)
Shortnessofbreath(twodifferentcauses)
Trauma
Headache
Weakness/Dizziness
Allergic/Anaphylacticreaction
Behavioral/Psychiatricproblem
Toxicologicproblem
Alteredlevelofconsciousness

GeneralGoals
A.PatientAssessmentSkills
Performinganinitialevaluationofpatientswithawidevarietyofundifferentiatedmedical,surgical,
psychologicalandsocialproblems.InanEmergencyDepartmentsetting,thisrequiresanappropriately
focusedhistoryandphysicalexaminationbasedonapatient'spresentation.
Formulatingaworkingdifferentialdiagnosisandanefficientinvestigationplan,withappropriate,cost
effectiveuseoflaboratoryandradiologicalstudies.

B.PatientManagementSkills
Understandingtheconceptoftriageandprioritizationofcarewhensimultaneouslymanagingmultiple
patients.

Appreciatingtheimportanceoforganizationalskillsandefficiencyinmaintainingpatientflow.
PerformingproceduralskillspertainingtoEmergencyMedicine(seebelow).

C.RecognitionandManagementofEmergencies
Rapidlyrecognizingacutelifeorlimbthreateningillnessesorinjuries.
Demonstratingasystematic,prioritizedapproachtoresuscitationandstabilizationofmedical,surgical,
andtraumaticemergencies.

D.UnderstandingofEmergencyMedicine
UnderstandingtheroleoftheEmergencyDepartmentinthehealthcaresystemandhowitrelatestoother
hospitalandcommunityhealthservices.
UnderstandingtheroleofEmergencyPhysiciansinPrehospitalCare.

E.ProfessionalBehaviors
Effectivelycommunicatingwithpatients,colleaguesandotherhealthcareprofessionals.
Establishingandmaintainingeffectiveworkingrelationshipswithcolleaguesandotherhealthcare
professionals.
RecognizingandmanagingthepsychosocialandethicalissuesthatcommonlyariseintheEmergency
Department.
Acquiringgooddocumentationhabits,withconciserecordingofpertinentpositiveandnegativefindings.
Actinginaprofessionalethicalmannerincludingbeingpunctual,dressingappropriatelyandattending
mandatoryteachingsessions.

CourseObjectives
A.AttitudinalandProfessionalObjectives:
1. Demonstratingeffective,empatheticcommunicationwithpatientsandtheirfamilies.
2. Establishingandmaintainingeffectiveworkingrelationshipswithcolleaguesandotherhealthcare
professionals.Theimportanceofhonesty,integrity,responsibilityandprofessionalismwillbestressed.
3. Demonstratinganawarenessoftheunderlyingpsychosocialandsocioeconomicproblemsthatmay
precipitateanEmergencyDepartmentvisit.
4. Recognizingyourlimitationsandknowingwhentoaskforhelp.
5. AppreciatingthesignificanceofethicaldecisionsmadeintheEmergencyDepartment(e.g.,"DNR"

considerations),andtheimpactofthesedecisionsonthepatient,theirfamily,andthehealthcareworkers
involved.
6. Effectivelymanaging"difficult"patients(eg:violentpatients,drugseekers,alcoholics).
7. Demonstratinggooddocumentationhabits,withconciserecordingofpertinentpositiveandnegative
findings.
8. Recognizingtheimportanceofclearfollowupinstructions,giventheepisodicnatureofEmergency
Departmentcare.

B.CognitiveObjectives:
Attheendofthiscourse,studentswillbeableto:

PRINCIPLESOFEMERGENCYMEDICINE
1. DiscusstheroleoftheEmergencyDepartmentinthehealthcaresystem.
2. Demonstrateanunderstandingoftheconceptoftriage.
3. Distinguishseriouslyillorinjuredpatientsfromthosewithminorconditions.
4. Demonstratea"focused"historyandphysicalexamination.
5. DiscusstherolesofthevariousprovidersofPrehospitalCare.

RESUSCITATION
Outlinethefirstlineprioritiesofassessmentandtreatmentofanycriticallyillorinjuredpatient.
1. Describethecomponentsofaprimaryandsecondarysurveyinassessingacriticallyillorinjuredpatient.
2. Listtheacutelifeorlimbthreateningpossibilitiesinagivenclinicalpresentation.
3. Outlinethedifferentialdiagnosisandinitialmanagementofapatientwhopresentsinshock.
4. Outlinethefeaturesandtreatmentofapatientwithanaphylaxis.

SYMPTOMBASEDAPPROACH
Demonstratetheprinciplesofinitialevaluation,stabilization,andmanagementofpatientswiththefollowing
presentingsymptoms:
abnormalbehaviorandcoma
headache
chestpain
shortnessofbreath

abdominalpain
syncope
allergicreaction
weaknessanddizziness

SYSTEMBASEDCLINICALPROBLEMS
Demonstratetheprinciplesofinitialevaluation,stabilization,andmanagementofpatientswiththefollowingclinical
problemscommonlyencounteredintheEmergencyDepartment:
Respiratory
acuteasthmaandCOPD
pulmonaryembolism
pneumonia
Cardiovascular
unstableanginaandacutemyocardialinfarction
acutecongestiveheartfailure
cardiacdysrhythmiasincludingEKGinterpretation
Neurological
statusepilepticus
meningitis
acutecerebrovascularaccident
Opthalmological
Theapproachtotheredeye
Useoftheslitlampandtonometry

TRAUMA
1. Outlinethemanagementprioritiesinatraumapatientwithmultipleinjuries.
2. Outlinetheprinciplesofassessmentandmanagementofpatientswithheadinjuries.
3. Discussthegeneralapproachtotheassessingandmanagingcommonfractures,dislocations,andsoft

tissueinjuries.
4. Discusstheprinciplesoftetanusprophylaxis.

TOXICOLOGY
1. Outlinetheinitialassessmentandresuscitationofpoisonedpatients.
2. Discusstheuseofactivatedcharcoalasadecontaminant.
3. Discusstheroleofgastricemptyingprocedures.
4. Describethefollowing"toxidromes":anticholinergic,cholinergic,sympathetic,narcotic,sedativehypnotic.
5. Outlinethegeneralmanagementofpatientswithsubstanceabuseincludingbothintoxicationand
withdrawalstates

C.TechnicalandProceduralSkillsObjectives:
RequiredTechnicalSkills:

Studentswillberequiredtoperform,observeordiscussthefollowingskillsduringtheirclinicalexperiencein
EmergencyMedicine.
suturingminorwounds
applyingsplintsandcasts
intravenouslines
arterialpuncture
urinarycatheterinsertion
CPR
proceduralsedation
reductionoffractures/dislocations
lumbarpuncture
endotrachealintubation
RequiredInterpretiveSkills:
Studentswillberequiredtoperform,observeordiscussthefollowingskillsduringtheirclinicalexperiencein
EmergencyMedicine:
arterialbloodgases
electrocardiograms

radiographs(fivedifferenttypes)