Emergency Medicine
I. Goals and Objectives:
The emergency medicine experience is designed to provide residents with a broad exposure to acute presentations of basic and complicated diseases in a wide variety of medical disciplines. Under direct supervision of an ER attending, residents are expected to develop the ability to diagnose, manage, and triage patients with these disease. It is expected that residents at all levels take histories from and examine the patients independently, and then consult with the senior ER attendings. It is expected that over the course of 3 years of Internal Medicine training, the house officer will be become familiar with the specific disease entities listed under the subspecialty disciplines sections of this curriculum.
Level based rotation goals and objectives:
PGY-1 & PGY-3
Patient Care: Take effective and efficient histories and physicals; formulate differential diagnoses; recognize urgent conditions; recognize acuity levels of patients; triage within the acute care setting; understand the indications, contraindications and risks of common procedures.
Medical Knowledge: Use literature and reference sources to increase knowledge base; demonstrate knowledge in the areas of underlying pathophysiology and the clinical aspects of simple and complicated disease states; apply knowledge in the treatment of patients.
Professionalism: Establish trust with patients and staff; exhibit honesty, reliability and responsibility in patient care; demonstrate respect for patients, staff, housestaff from other service areas and supervising faculty; understand limitations and ask supervisors for help when indicated.
Interpersonal Skills: Write understandable and legible notes; more fully develop ability to listen to patients and staff and communicate verbally and nonverbally in a productive manner; work effectively as a member of the health care team.
Practice Based Learning and Improvement: Understand limitation of knowledge and use references and literature to improve practice patterns; accept feedback and change behavior; ask for help when needed; learn from the outcomes of patients under your care and alter practice patterns to improve outcomes in the future.
Systems Based Practice: Advocate for patients; develop an understanding about the health care system/structure and develop mechanisms to utilize ancillary services to benefit patients.
II. DISCIPLINES COVERED DURING ROTATION
Allergy/Immunology
Goals and objectives
a) Principles, physiology and basic science: Develop a basic understanding of the immune system
b) Practice skills unique to Allergy
History and physical examination
Specific tests and procedures: use and interpretation: skin testing, desensitization
Preventive care: Avoidance of allergens
Patient education: Avoidance of allergens, availability of medications
Attitudes/values: Understand the psychosocial issues involved in patients with chronic allergic/immunologic diseases
c) Approach to presenting complaints/problems
Itching
Hives
Allergic rash
Upper respiratory complaints
Anaphylaxis
d) Specific diagnoses in Allergy
Hives
Anaphylaxis
e) Emergencies
Anaphylaxis
Exfoliation
f) Treatment modalities
Medication (antihistamines, steroids)
Desensitization
g) Technical skills:
Skin testing (familiarity)
Cardiology
Goals and objectives (supplemented by Cardiology rotation)
a) Principles, physiology and basic science: Understand the physiology of the heart as a pump, conduction system and the physiology of hypertension
b) Practice skills unique to Cardiology:
History and physical exam
Specific tests and procedures: use and interpretation: EKG, catheterization/angioplasty/stent placement, echocardiography, nuclear studies, tilt table testing, EP studies, holter monitor
Preventive care: risk factor modification
Patient education: risk factor modification, cardiac rehabilitation, diet, recognition of cardiac symptoms
Attitudes/values: Understand the impact of acute or chronic cardiac disease on the patient.
c) Approach to presenting complaints/problems:
Dyspnea
Chest pain
Palpitations
Edema
Claudication
Syncope
d) Specific diagnoses in Cardiology:
CAD: ischemia/myocardial infarction
Hypertension
Valvular disease
Arrhythmias
CHF
Pericardial disease
Hyperlipidemia
e) Emergencies:
Myocardial infarction/cardiogenic shock
Congestive heart failure/pulmonary edema
Malignant hypertension
Tamponade
Malignant arrhythmias
f) Treatment modalities:
Pharmacology
Pacemakers/Cardioversion/ICDs
Pericardiocentesis
CPR/ACLS
Stents/bypass grafting
Valvular surgery
g) Technical skills:
Central venous catheters
EKG interpretation
Dermatology
Goals and objectives
a) Principles, physiology and basic science: Understand basic skin physiology
b) Practice skills unique to Dermatology:
History and physical examination
Specific tests and procedures: use and interpretation: skin biopsy, KOH prep, Wood’s light, Tzanck prep
Preventive care: sunscreen, sun avoidance, routine skin examinations, diet
Patient education: topical ointments, sun avoidance, yearly skin examinations
Attitudes/values: Understand the psychosocial burden carried by patients with serious skin diseases
c) Approach to presenting complaints/problems:
Rash
Ulcers
Itching
Other skin lesions (bullae)
d) Specific diagnoses in Dermatology:
Eczematous dermatitis
Drug eruptions
Psoriasis
Disorders of sebaceous glands
Disorders of hair
Disorders of dermis and dermal-epidermal interface
Bullous diseases
Syndromes involving blood vessels
SLE
Metabolic and Heritable Disorders
Infections (bacterial, fungal, viral)
Syphilis
Insect bites and infestations
Neoplasms (benign/malignant)
e) Emergencies
Exfoliation
Burns
f) Technical skills: Biopsy
Endocrinology
Goals and objectives
a) Principles, physiology and basic science: Understand the physiology of the thyroid gland, testes and ovaries, adrenals, pituitary, parathyroid, pancreas
b) Practice skills unique to Endocrinology:
History and physical examination
Specific tests and procedures: use and interpretation: hormonal assays, thyroid scanning/imaging, osteoporosis imaging
Preventive care: exercise, diet
Patient education: exercise, diet, replacement medications, foot care (dm), BS management (dm)
Attitudes/values: Understand the issues confronted by patients with endocrinologic diseases
c) Approach to presenting complaints/problems:
Weight changes
Thyroid nodules, goiter
Hirsutism
Amenorrhea
Galactorrhea
Incidental adrenal mass
Abnormal Calcium homeostasis
Symptoms of abnormal blood sugar
Diabetic foot problems
Impotence
d) Specific diagnoses in Endocrinology:
Differential diagnosis of hyperthyroidism and hypothyroidism; euthyroid sick syndrome
Thyroid cancer
Ovarian functional abnormalities
Cushings
Hyperaldosteronism
Addison’s disease
Pituitary disease (adenomas)
Diabetes mellitus
Diabetes insipidus
SIADH/Hypernatremia
Hyperparathyroidism
Pagets’ disease
Osteoporosis
Multiple Endocrine Neoplasias
Pheochromocytoma
e) Emergencies:
Diabetic Ketoacidosis
Hyperosmolality/Hypoosmolality (hyponatremia)
Hyper/Hypocalcemia
Myxedema coma
Addisonian crisis
Hypoglycemia
f) Treatment modalities:
Radioactive iodine
Medications for hyperthyroidism/hypothyroidism
Treatment for diabetes mellitus
g) Technical skills:
Fingerstick glucose monitoring
Gastroenterology
Goals and objectives
a) Principles, physiology and basic science: Understand GI anatomy, physiology of digestion, neurohumoral interactions, liver anatomy and physiology
b) Practice skills unique to Gastroenterology
History and physical examination
Specific tests and procedures: use and interpretation: liver tests, upper and lower GI endoscopy, capsule endoscopy, guiaic testing, liver/spleen scanning, CT/MRI, UGI and small bowel series, barium enema, ERCP/ultrasonography, GI motility studies, stool examinations, bleeding scan, oral cholecystogram, TIPS procedure, liver biopsy
Preventive care: alcohol, typlenol, diet, colon cancer screening, hepatitis immunization
Patient education: alcohol, smoking, diet, fiber, alcohol rehabilitation
Attitudes/values: Understand the burden carried by patients with GI and liver disease and their families, understand the psychosocial dynamics surrounding alcoholism
c) Approach to presenting complaints/problems:
Abdominal pain
Diarrhea/constipation
Appetite/weight changes
Jaundice
Nausea and vomiting
Perianal discomfort
Dysphagia/non-cardiac chest pain
Abnormal liver tests
Post exposure hepatitis prophylaxis
Malabsorption
Liver failure
Iron deficiency anemia
Pharmacology and side effects of GI mediciation
Obesity
Malnutrition
Hematemesis, rectal bleeding, melena, GI bleeding
d) Specific diagnoses in Gastroenterology:
Esophagitis/Esophageal strictures/reflux, spasm, carcinoma
Achalasia
Ulcer disease
Gastric cancer/gastrinoma
Pancreatic insufficiency, pancreatitis, pancreatic carcinoma
Carcinoid syndrome
Irritable bowel syndrome
Colitis: ulcerative, Crohn’s, ischemic, infectious
Cholelithiasis, cholecystitis, cholangitis
Hepatitis: viral, drug induced
Alcoholic liver disease
Alpha I antitrypsin deficiency
Hemochromatosis, hemosiderosis
Primary biliary cirrhosis
Cirrhosis
Esophageal varices
Divericulosis/diverticulitis
Hepatorenal syndrome
Sprue
Whipple’s disease
AIDS and the GI tract
Appendicitis
Colonic polyps and cancer
Peritonitis
e) Emergencies:
GI bleeding
Acute hepatic failure
Acute cholangitis, acute choecystitis
Severe pancreatitis
Surgical emergencies: bowel performation, acute abdomen
f) Treatment modalities:
Drug therapy
Enteral alimentation, parenteral alimentation (TPN)
TIPS
Esophageal dilatation, dilatation of webs, strictures, rings
Schlerotherapy/banding of varices
ERCP with gall stone removal, papillotomy
Endoscopic treatment of bleeding lesions
g) Technical skills:
Nasogastric tube placement
Paracentesis
Geriatrics
Goals and objectives (supplemented by Geriatrics rotation)
a) Principles, physiology and basic science: Understand the physiology of aging, understand the hazards of hospitalization in older adults, understand home/institutional safety issues for older adults
b) Practice skills unique to Geriatrics
History and physical examination
Specific tests and procedures: use and interpretation: psychosocial testing
Preventive care: falls, decubiti, diet, advanced directives
Patient and caregiver education: social interaction, falls, decubiti, diet, advanced directives
Attitudes/values: Understand the difficulties that some individuals face with age, respect patient dignity
c) Approach to presenting complaints/problems:
Confusion and other changes in behavior
Incontinence
Anemia
Weight loss
Changes in appetite
Bruises/fractures
Physical limitations: inability to ambulate, transfer etc
Elder care
Osteoporosis
d) Specific diagnoses in Geriatrics:
Dementia
Delirium
Incontinence
Parkinson’s disease
Anemia
Cancer
Depression
Polypharmacy
Elder abuse
e) Emergencies:
Elder abuse
Change in mental status
f) Treatment modalities:
Medications (including anticoagulation in the elderly)
Institution of supporting care (home care, day care, family meetings)
Surgery
Age appropriate health care maintenance
g) Technical skills:
Advanced directives
Skill with family meetings
Work with bioethics team
Work with health care team for disposition
Hematology
Goals and objectives
a) Principles, physiology and basic science: Understand the basic pathways involved in hematopoiesis, hemostasis and the immune system.
b) Practice skills unique to Hematology
History and physical examination
Specific tests and procedures: use and interpretation: CBC, peripheral smear, reticulocyte count, Fe studies, B12 studies, tests assessing hemolysis, Hb electrophoresis, SPEP/UPEP, coagulation tests, antibodies
Preventive care: nutritional requirements for hematopoiesis, monitoring patients on anticoagulation
Patient education: living with chronic hematologic diseases (ex SS), medications, signs of bleeding, risks of transfusions
Attitudes/values: Understand the burden on patients living with chronic pain (ex SS)
c) Approach to presenting complaints/problems:
Pallor, orthostasis
Recurrent infections
Bleeding
Thrombosis
Lymphadenopathy
Splenomegaly
d) Specific diagnoses in Hematology:
Diseases of RBC: Anemias: aplastic, Fe deficiency, B12 deficiency, chronic disease, hemolytic, sickle cell; Hemoglobinopathies
Diseases of WBC: Neutropenia, Leukocytosis, Malignancies (leukemia, lymphoma, multiple myeloma)
Diseases of Platelets: thrombocytopenia, thrombocytosis
Hemostatic disorders: ex. Hemophilias, von Villebrand disease, circulating anticoagulants, ITP, DIC/TTP/HUS, hypercoagulable states
Hematologic complications of systemic conditions: ex: AIDS, connective tissue diseases, alcohol, organ failure (ex renal), sepsis, pregnancy
Hematologic complications of medical therapies: ex drug toxicities
e) Emergencies:
Pancytopenia
Severe anemia
Blast crisis/leukostasis
Superior vena cava syndrome
Hyperviscosity
Severe thrombocytopenia
DIC/HUS/TTP
Bleeding
Transfusion reactions
f) Treatment modalities:
Anticoagulation
Use of blood components
Use of growth factors
Selected antineoplastic agents
Pheresis
Other: ex: prednisone, gamma globulin, DDAVP
g) Technical skills:
Peripheral blood smear interpretation
Therapeutic phlebotomy
Bone marrow biopsy/aspiration
Infectious Diseases/HIV
Goals and objectives
a) Principles, physiology and basic science: Understand microbiological virulence factors, host defenses and the principles of antibiotic therapy
b) Practice skills unique to I.D.
History and physical examination
Specific tests and procedures: use and interpretation: gram stain/acid fast stain, tzanck prep, nuclear medicine scans, antibotic sensitivity testing, institutional antibiotic restriction, nosocomial infections and infection control, use of blood cultures, skin testing
Preventive care: immunizations, TB screening, rheumatic fever prophylaxis, endocarditis prophylaxis, travel medicine, surgical wound prophylaxis, nosocomial infections
Patient education: value of immunizations, risk from highly contagious diseases, HIV risk reduction
Attitudes/values: Understand the needs of patients and families with chronic diseases (ex. HIV)
c) Approach to presenting complaints/problems:
Fever/FUO
Respiratory infections
Urinary infections
Intra abdominal infections
Diarrhea
Cardiovascular infections
CNS infections
Skin/soft tissue infections
Bone and joint infections
Sexually transmitted diseases
Nosocomial infections
Infections in compromised hosts
Infected prostheses
Postoperative and post traumatic infections
Travel medicine
Antibiotics: allergies and reactions
Antibiotic/ Antretroviral resistance
Sepsis syndromes
d) Specific diagnoses in I.D.:
HIV; HIV drug resistance
Pseudomembranous colitis
Hepatitis (viral)
Herpes infections
Atypical and typical pneumonias
Tick born diseases
Toxic shock syndrome
Sexually transmitted diseases (GC, syphilis, chlamydia)
Vibrio cholerae
Listeriosis
Meningitis (bacterial and viral)
Encephalitis
Fungal diseases
Cat scratch disease and bacillary angiomatosis
TB and other mycobacterial diseases
Amebiasis
Malaria
Infectious diarrhea
e) Emergencies:
Septic shock/ toxic shock
Overwhelming bacterial or fungal infection
Meningitis
f) Treatment modalities:
Antibiotics; Antiretrovirals; Antivirals
Surgery
Immunotherapy
Hematopoietic colony stimulating factors
Anti-toxins
g) Technical skills:
Gram stain and AFB stain
Lumbar puncture
Blood cultures
Nephrology
Goals and objectives
a) Principles, physiology and basic science: Understand basic glomerular and tubular function, electrolyte and water handling in the kidney and acid-base physiology
b) Practice skills unique to Nephrology
History and physical examination
Specific tests and procedures: use and interpretation: urinanalysis (with Uosm), sonography, CT/MRI, nuclear scans, renal biopsy
Preventive care: microalbuminuria in dm, monitoring of renal lab tests
Patient education: diet, adherence to antihypertension medications, symptoms of uremia, pre-dialysis counseling
Attitudes/values: understand the psychosocial issues surrounding chronic illness, dialysis and withdrawal of dialysis
c) Approach to presenting complaints/problems:
Dysuria
Hematuria
Edema anasarca
Flank pain
Changes in urine volume
Obstructive uropathy
Proteinuria/nephrotic syndrome
Glomerulonephritis
Use of nephrotoxic agents
Dosage modification in renal failure
Hypertension
d) Specific diagnoses in Nephrology:
Infections of the kidney
Acute renal failure
Chronic renal failure (including dialysis and transplantation)
Hereditary kidney diseases (ex Polycystic)
Electrolyte abnormalities (ex. Hypo/hypernatremia (SIADH, DI), hypo/hypercalcemia, hypo/hyperphosphatemia, hypo/hypermagnesemia, hypo/hyperkalemia)
Acid-base abnormalities
Renal complications of systemic diseases
Nephrolithiasis
Hypertension
Renal Tumors
Glomerular Diseases (nephrosis/nephritis)
Kidney diseases in pregnancy
e) Emergencies:
Acute hyperkalemia
Anuria
Severe acidosis/alkalosis
Uremia (indications for dialysis)
Hypertensive crisis
f) Treatment modalities:
Medications (ACEI, ARB, BP medications)
De-obstruction (stents, nephrostomy, lithotripsy)
Erythropoietin
g) Technical skills:
Familiarity with renal biopsy
Urinalysis interpretation
Fundoscopic exam
Neurology
Goals and objectives (supplemented by Neurology rotation)
Principles, physiology and basic science: Understand basic neurological pathways and how that translates into neurological function
Practice skills unique to Neurology
History and physical examination
Specific tests and procedures: use and interpretation: CT/MRI, EEG, LP
Preventive care: understand importance of BP control as it relates to CVA events
Patient education: BP control, importance of medication adherence, signs and symptoms of cerebral events
Attitudes/values: Understand the psychosocial issues in patients with chronic neurologic diseases
c) Approach to presenting complaints/problems:
Change in mental status
Seizures/Twitching
Focal weakness
Headache
Neck stiffness
d) Specific diagnoses in Neurology:
Coma
Headache
Seizures/status epilepticus
Disorders of gait and coordination
Disorders of mentation and language
Acute intracranial catastrophes
Extrapyramidal disorders
Demyelinating diseases
Central nervous system infections
Neurologic complications of AIDS
Psychogenic disorders with neurologic presentation
Myasthenia gravis, Guillain-Barre and other neurologic diseases with respiratory presentation
CVA/TIA
Indications for anticoagulation
e) Emergencies:
Acute change in mental status
Status epilepticus
Meningitis
Increased intracranial pressure
f) Treatment modalities:
Medications
Anticoagulation
Physical and occupational therapy
g) Technical skills:
Lumbar puncture
CT/MRI
Neurological examination
Oncology
Goals and objectives (supplemented by Oncology rotation)
a) Principles, physiology and basic science: Understand the genesis of malignancy, behavior of malignant cells and unique characteristic of various tumors. Understand chemotherapy
b) Practice skills unique to Oncology
History and physical examination
Specific tests and procedures: use and interpretation: biopsies, imaging modalities, tumor markers, cytology
Preventive care: environmental exposure, smoking cessation, alcohol cessation, diet, screening, genetic counseling
Patient education: appropriate cancer screening, self examination, diet, sunscreen/sun exposure, smoking cessation
Attitudes/values: Understand the psychosocial issues in patients with cancer, weigh the risks and benefits of therapy, understand the physical symptoms and signs of chemotherapy, advanced directives and DNR
c) Approach to presenting complaints/problems:
Adenopathy
Mass/nodule
Cancer of unknown primary
Acute neurologic events
Superior vena cava obstruction
Electrolyte abnormalities (hypercalcemia, hyponatremia)
Pericardial tamponade
Infectious and hematologic complications of therapy
Weight loss
Hemoptysis and airway obstruction
Nausea and vomiting
d) Specific diagnoses in Oncology
Lung cancer
Head and Neck cancer
Breast cancer
Esophageal cancer
Gastric cancer
Pancreatic cancer
Hepatocellular cancer
Colorectal cancer
Prostate cancer
Bladder cancer
Renal cancer
Testicular cancer
Uterine cancer
Cervical cancer
Ovarian cancer
Lymphoma (Hodgkins/non-Hodgkins)
Leukemias
Osteosarcoma
Brain tumors
Skin cancer
Cancer related to HIV/post transplant
e) Emergencies:
Superior vena cava syndrome
Spinal cord compression
Brain metastases with increased intracranial pressure
Hypercalcemia
Tumor lysis syndrome
Pericardial tamponade
Infections
Cytopenias
GI obstruction
Obstructive uropathy
Hemolytic uremic syndrome
f) Treatment modalities:
Chemotherapy
Radiation therapy
Molecular targeted therapies
Surgery
Antiemetic therapy
Pain management
Nutritional support
Hospice care
f) Technical skills:
Bone marrow aspirate/biopsy (familiarity)
Pulmonary
Goals and objectives (supplemented by Pulmonary rotation)
a) Principles, physiology and basic science: Understand the physiology of respiration, gas exchange, oxygen delivery, lung defense mechanisms and anatomy of the lungs
b) Practice skills unique to Pulmonary
History and physical examination
Specific tests and procedures: use and interpretation: spirometry/lung volumes/diffusion capacity, CXR/CT, sputum gram stain/AFB, PPD, ABG, V/Q scan, angiography, venography, thoracentesis, bronchoscopy, pleural biopsy, sleep studies, exercise testing
Preventive care: smoking cessation, industrial exposure, environmental exposure, TB screening and prevention, DVT prophylaxis
Patient education: smoking cessation, breathing exercises, asthma education
Attitudes/values: Understand the issues faced by individuals with chronic pulmonary diseases
c) Approach to presenting complaints/problems:
Acute respiratory failure
Dyspnea
Cough
Hemoptysis
Chest pain
Hypoxia
Hypercapnia
Somnolence/sleep disturbance
Lung nodule
Pleural effusion
Wheezing
Anticoagulation therapy
Thoracentesis/Chest tube insertion
d) Specific diagnoses in Pulmonary:
Lung cancer
Pneumonias and other infections
Alpha I antitrypsin deficiency
Cystic fibrosis
Vasculitis
Sacrcoidosis
Drug toxicity
Pneumoconioses
ARDS
Pneumothorax
Empyema
COPD
AIDS related pulmonary diseases
e) Emergencies:
Acute respiratory failure
Tension pneumothorax
Lung collapse
Hemoptysis
Upper airway obstruction
Acute pulmonary embolus
f) Treatment modalities:
Oxygen therapy
Bronchodilator therapy
Antibiotic therapy
Mechanical ventilation
Anticoagulation/ IVC filter/thrombectomy procedures
Cancer chemotherapy
g) Technical skills:
ABG
Thoracentesis
Intubation (familiarity)
Skin testing
Mechanical ventilation
Rheumatology
Goals and objectives
a) Principles, physiology and basic science: Understand the role of immunologic mechanisms in rheumatic diseases, understand the anatomy and physiology of joints and tendons
b) Practice skills unique to Rheumatology
History and physical examination
Specific tests and procedures: use and interpretation: arthrocentesis, synovial biopsy, arthroscopy, autoantibodies, serologic tests, MRI/CT/US, synovial fluid analysis
Preventive care: diet, osteoporosis prophylaxis, vaccines/infection prophylaxis
Patient education: coping with chronic disease and chronic pain, understand cytoxic drugs, joint protection, exercise
Attitudes/values: Understand the impact of chronic disease and chronic pain on patients
c) Approach to presenting complaints/problems:
Monoarticular arthritis
Polyarticular arthritis
Low back pain
Neck pain
Diffuse muscle pain
Raynaud’s phenomenon
Sicca syndrome
Uveitis
Breast implants
Rash/vasculitis
Glomerulonephritis associated with systemic disease
Entrapment syndromes
d) Specific diagnoses in Rheumatology:
RA/JRA
SLE
Antiphospholipid syndrome
Systemic schlerosis
MCTD
Sjogren’s syndrome
Myositis
Systemic necrotizing vasculitis
Cryoglobulinemia
Polymyalgia rheumatica
Temporal Arteritis
Polychondritis
Ankylosing spondylosis/Reiter’s syndrome
Psoriatic arthritis
Acute rheumatic fever
Osteoarthritis
Infectious arthritis
Lyme
Sarcoidosis
Gout/CPPD
Fibromyalgia
HIV associated arthropathy
Osteonecrosis
Osteoporosis
Reflex sympathetic dystrophy
Radiculopathy
Spinal stenosis
e) Emergencies:
Septic arthritis
Lupus crisis
Scleroderma renal crisis
Cervical spine subluxation
CNS vasculitis
Mesenteric vasculitis
Thrombosis
f) Treatment modalities:
NSAID (including COX-2 inhibitors)
Antimalarials
Penicillamine, Gold
Cytotoxic drugs (AZA, Methotrexate, chlorambucil, leflunimide, CTX)
Cyclosporin
Sulfasalazine
IL-1 inhibitors
TNF blockade
Steroids
IV IG
Plasmapheresis
Intraarticular therapy
Physical therapy
Synovial surgery
Joint replacement
g) Technical skills:
Arthrocentesis
Punch skin biopsy
Orthopedics
Goals and Objectives
a) Principles, physiology, and basic science:
b) Practice skills unique to Orthopedics
History and physical examination
Specific tests and procedures: autoantibodies, serologic tests, MRI/CT, synovial fluid analysis
Preventive care: diet, osteoporosis prophylaxis
Patient education: coping with chronic disease and chronic pain, joint protection, ROM and muscle strengthening exercises
Attitudes/values: Understand the impact of chronic disease and chronic pain on patients
c) Approach to presenting complaints/problems:
Monoarticular arthritis
Polyarticular arthritis
Low back pain
Neck Pain
Foot/Ankle pain/trauma
Fractures of the long bones
Joint swelling/effusions
Shoulder injuries
Knee injuries
d) Specific diagnoses in Orthopedics:
Septic arthritis
Herniated disc disease
Fractures (arm, leg, ankle/foot)
Ankle sprains
Tendonitis
Entrapment syndromes
Rotator cuff tear
Shoulder dislocation
Meniscal tears of knee
Ligament tears of knee
Osteoarthritis
Rheumatoid arthritis
e) Emergencies:
Septic arthritis
Cervical spine subluxation
Acute fractures (humerus, femur, tibia/fibula, ankle/foot)
f) Treatment modalities:
Joint aspiration
Setting of fracture
NSAIDS
Steriods
Joint replacement
Ace bandage
Tendon injections
g) Technical skills:
Arthrocentesis
General Surgery
Goals and Objectives
a) Principles, physiology, and basic science:
b) Practice skills unique to General Surgery
History and physical examination
Specific tests and procedures: CT Scan, ultrasound, MRI interpretation
Preventive care: diet
Patient education:
Attitudes/values: understanding patients’ psychosocial stress related to undergoing operative procedures
c) Approach to presenting complaints/problems:
Abdominal pain
Rectal bleeding
Hematemesis
Nausea and Vomiting
Nonhealing wounds
Post-op infections
Skin infection
d) Specific diagnoses in General Surgery:
Cholecystitis
Cholanigitis
Appendicitis
Diverticulitis
Pancreatitis
Perforated intestine
Hemorrhoids
Colonic AVM
Colitis
Wound infection
Post-op pneumonia, etc.
Cellulits
Skin abscess
e) Emergencies:
Cholecystitis
Cholangitis
Appendicitis
Perforated intestine
Colonic AVM
f) Treatment modalities:
Cholecystectomy
Appendectomy
Hemicolectomy
Hemorroidectomy
Supportive care: bowel rest/NPO
IV antibiotics
Wound care
Incision and drainage of abscess
g) Technical skills:
Incision and drainage of abscess
Wound care/dressing changes
Urology
Goals and Objectives
a) Principles, physiology, and basic science:
b) Practice skills unique to Urology
History and physical examination
Specific tests and procedures: urine dipstick, CT Scan, ultrasound, and MRI interpretation
Preventive care:
Patient education:
Attitudes/values: understanding patients’ psychosocial stress related to undergoing operative procedures
c) Approach to presenting complaints/problems:
Dysuria
Renal colic
Incontinence
Hematuria
Pelvic pain
Erectile dysfunction
Urinary hesitancy or frequency
d) Specific diagnoses in General Surgery:
Urinary tract infection
Pyelonephritis
Nephrolithiais
Stress incontinence
Overflow incontinence
Urinary obstruction
Erectile dysfunction
Benign prostatic hypertrophy
Prostate cancer
Bladder cancer
Renal tumors
e) Emergencies:
Urinary obstruction
f) Treatment modalities:
Surgical resection of tumors
Alpha blockers
Erectile dysfunction medication classes
Lithotripsy
Prostatectomy
Antibiotics
Kegel exercises
Foley catheter insertion
g) Technical skills:
Urine microscopic analysis
Foley catheter insertion
Pelvic exams
Gynecology
Goals and Objectives
a) Principles, physiology, and basic science:
b) Practice skills unique to Gynecology
History and physical examination: performing pelvic exams and collecting specimens (e.g. PAP smear, endocervical discharges)
Specific tests and procedures: wet mounts
Preventive care: safer sex counsel, family planning, contraception care
Patient education: safer sex counsel, contraception care
Attitudes/values: Understanding the impact of pregnancy or termination of pregnancy on patients’ psychological health
c) Approach to presenting complaints/problems:
Pelvic pain
Vaginal discharge
Dysuria
d) Specific diagnoses in Gynecology:
Pelvic Inflammatory Disease
Pregnancy
Ovarian Cyst
Ovarian Tortion
Urethritis
Urinary Tract Infection
Uterine Fibriods
Tubal Pregnancy
e) Emergencies:
Ovarian Tortion
Tubal Pregnancy
f) Treatment modalities:
Emergency Contraction
D & C
g) Technical skills:
Performing pelvic exams
Examining wet mounts, KOH Preps
Toxicology
Goals and objectives: understanding the prevention, diagnosis and management of alcohol, heroin, cocaine, and other toxins overdose and withdrawal in patients
a) Principles, physiology and basic science
b) Practice skills unique to Toxicology
Specific tests and procedures: use and interpretation
Preventive care: understand referral sources for detox
Patient education: withdrawal symptom education
Attitudes/values: understand the interplay between substance abuse and psychiatric illness. Develop empathy skills for caring for patients with these illnesses.
c) Approach to presenting complaints/problems:
Acute ingestion
Suicidality
Acute withdrawal symptoms
Chronic dependence
d) Specific diagnoses in Toxicology
Alcohol overdose
Alcohol withdrawal
Heroin overdose
Heroin withdrawal
Acetaminophen overdose
Chronic substance use
e) Emergencies:
Acute ingestion
Acute withdrawal
f) Treatment modalities:
Charcoal administration
Narcan administration
Psychiatric care
g) Technical skills
Placing an NGT tube
II. ROUNDS AND CONFERENCES
Rounds:
A senior ER faculty is assigned to oversee each houseofficer. After independently taking a history and performing a physical exam on an assigned patient, the resident will present the case to the attending. The attending will confirm the findings with the patient and together they will formulate a triage decision and acute treatment plan. Although the ER attending oversees many housestaff during the same time period, this “rounding” takes place one-on-one.