Protocol

Emergency medicine has enjoyed increasing popularity and stature in osteopathic medical schools throughout the United States. It occupies a unique niche in medical education in that it provides students with the opportunity to see an a varied patient population with a wide variety of illnesses and conditions. This experience will stress diagnostic skills, ability to prioritize patient care and exposure to new diagnostic skills, i.e., toxicology and environmental injuries, and different views of problems that they may have only seen in the hospital' or other practical settings.

Objectives

Learning objectives for the emergency medicine rotation relate to the following areas:

• cognitive knowledge
• psychomotor skills
• problem solving
• professional development

By the end of the four-week emergency medicine rotation, the student is expected to have achieved, at a minimum, the following objectives through reading, conference attendance, observation, discussion and hands-on clinical experience.

List of objectives

1. Core Content Area: ADULT RESUSCITATION OBJECTIVE
   1. Describe and perform various types of airway control, oxygenation, and ventilation.
   2. Identify and list treatment options for the following dysrhythmias: ventricular fibrillation, asystole, pulseless electrical activity, ventricular tachycardia, first, second, and third degree heart blocks
   3. List and describe the intravenous access techniques for the peripheral and central circulation
2. Core content area: TRAUMA OBJECTIVE
   1. Discuss the components of the history in a multiple trauma patient
   2. Discuss the four sequential phases of management of the multiple trauma patient. Outline the components of the primary and secondary trauma survey and discuss the recognition and management of immediate life threatening injuries.
3. Core content area: SHOCK OBJECTIVE
   1. Discuss the etiologies and pathophysiologic mechanisms of shock.
   2. Describe the physical findings of patients in varying degrees and types of shock.
   3. Discuss the management of the varying degrees and types of shock in adults and children.
4. Core content area: CHEST PAIN OBJECTIVE
   1. Discuss the evaluation and management of the patient with chest pain, discussing the differential diagnosis, the relative importance of the history, physical examination and diagnostic studies and the cost of admission versus risk of discharge
   2. Evaluate a patient or simulate various scenarios of patients with chest pain.
5. Core content area: DYSPNEA OBJECTIVE
   1. Discuss the differential diagnosis of dyspnea. Discuss the initial evaluation and management of the dyspneic patient.
   2. Discuss the identification, evaluation and management of upper airway causes of dyspnea. Describe the presentation, evaluation and management of the patient with lower airway causes of dyspnea.
   3. Discuss the presentation, evaluation and management of the cardiovascular causes of dyspnea
   4. Evaluate a patient or simulate various scenarios of patients with dyspnea.
   5. Discuss the evaluation of the chest radiograph, soft tissue neck films.
6. Core content area: ALTERED MENTAL STATUS (COMA, SYNCOPE, SEIZURES, EMERGENCY PSYCHIATRY)
   1. Discuss the pathophysiology and differential diagnosis of the comatose patient
   2. List the critical actions in the management of a comatose patient.
   3. Explain the diagnosis studies and procedures used in evaluating the comatose patient.
   4. Demonstrate the evaluation of a comatose patient.
   5. Demonstrate the evaluation of the cerebral CT radiograph.
   6. Demonstrate or verbalize the procedure for a lumbar puncture.
   7. Discuss the pathophysiology and differential diagnosis of syncope
   8. Perform the history and physical examination pertinent to the evaluation of a patient with syncope.
   9. List the diagnostic studies and/or procedures used to evaluate the syncopal patient.
   10. Discuss the management of the syncopal patient.
   11. Describe the evaluation and pathophysiology of seizures
   12. Discuss the management of seizures in the emergency department.
   13. Describe the mental status examination and the psychiatric interview
   14. Discuss the evaluation and management of delirium and dementia. Discuss the use of diagnostic studies.
   15. Perform a mental status examination.
   16. Describe the evaluation and management of the violent patient. Discuss protective measures for the patient and staff. Discuss involuntary commitment.
   17. Describe the evaluation and management of the suicidal patient. Discuss involuntary commitment.
7. Core content area: HEADACHE OBJECTIVE
   1. Discuss the history and physical examination pertinent to the evaluation of a patient with headache. Discuss the pertinent diagnostic studies and procedures. Discuss the management of the patient with headache
   2. Demonstrate neurologic exam and fundoscopic exam.
8. Core content area: FEVER
   1. Discuss the evaluation and management of the febrile adult or child. Highlight the important points of history, physical examination and discuss the use of laboratory and other diagnostic tests
   2. Describe the use of antibiotics and the decision process of admission versus discharge.
9. Core content area: ABDOMINAL PAIN OBJECTIVE
   1. List the key points to be obtained in the history and to be addressed on the physical examination of the patient with abdominal pain, addressing the differential diagnosis in adults and children
   2. Discuss the use of laboratory and radiologic evaluation of the patient with abdominal pain.
   3. Review the salient points of examination plain films with the student.
10. Core content area: VAGINAL BLEEDING OBJECTIVE:
    1. List the causes of ovulatory and anovulatory bleeding and their emergency department management
    2. Describe the evaluation and management of the patient with suspected ectopic pregnancy.
    3. Discuss the causes, evaluation and management of early and late bleeding during pregnancy. Discuss the classifications and miscarriage (reading p 676-684).
    4. Perform pelvic exams under supervision.
11. Core content area: OPHTHALMOLOGIC EMERGENCIES
    1. List the common causes of conjunctivitis, keratitis, iritis and the presentation of acute glaucoma and periorbital cellulitis. Describe their management in the emergency department
    2. Discuss the presentation, evaluation, and management of corneal foreign bodies and abrasions, ocular penetration, hyphema, dislocated lens, retinal detachment and corneal burns.
12. Core content area: ENT EMERGENCIES OBJECTIVE
    1. Evaluation and management of the patient with epistaxis
    2. Discuss the differential diagnosis of pharyngitis, appropriate history, physical examination, diagnostic studies, treatment and complications.
13. Core Content Area: MUSCULOSKELETAL INJURIES OBJECTIVE
    1. Describe the clinical finds, evaluation and treatment of dislocation of the shoulder.
    2. Discuss the mechanisms of injury, presentation and management of fractures of the clavicle, humerus, radius, ulna, hip, femur, tibia and fibula, ankle and foot
    3. Discuss the evaluation and management of common sprains.
    4. Describe the presentation, evaluation and management of common injuries and infections of the hand
    5. Discuss the Salter-Harris classification of fractures.
    6. Discuss the treatment of "sprains" in the pediatric patient with open epiphyses.
14. Core content area: WOUND CARE
    1. Discuss the evaluation of a wound
    2. Discuss wound cleansing, debridement and closure. Discuss anesthetic use, suturing materials and technique, and dressings (reading p 289-292).
    3. List the indications for and use of tetanus, rabies, and antibiotic prophylaxis
15. Core content area: TOXICOLOGY OBJECTIVE
    1. Discuss initial stabilization and management of the poisoned patient with regard to ABC's, supportive care, formulation of a troxidone from the history and physical exam, use of naloxone, glucose/glucagon, decontamination, prevention of absorption, dilution and enhanced excretion, antidote use
16. Core content area: PEDIATRICS OBJECTIVE
    1. Discuss the evaluation of the pediatric patient with a febrile illness, the use of the Rochester criteria, and the necessity of a "septic work up"
    2. Discuss the presentations of the neonate with a serious illness such as meningitis, pneumonia, or sepsis
    3. Discuss the accurate assessment of pediatric vital signs
    4. See C3, Fl, F6, F12, HI, H2, II, M5, and M6 for other pediatric objectives.