The goal of this course is to provide a foundation for future physicians to be able
to recognize and initiate first line medical treatment of the acutely ill or injured
patient.
In general, students will:
Build their fund of knowledge through reading.
Apply the knowledge they have gained to different situations.
Show how they use information in a realistic setting.
Demonstrate their abilities and perform tasks in real encounters.
Society generally expects that all physicians possess basic knowledge in emergency
care and the skills to manage acute problems. It is anticipated that regardless of
what specialty a practitioner chooses, and irrespective of the type of setting or
location of that practice, emergencies unrelated to that practitioner’s specialty
will arise sooner or later. The physician should have the skills to recognize and
initiate treatment of that emergency until help arrives. Also, the public expects
physicians to give proper advice about when to be concerned about chest pain or a
headache, or problems such as a burn or laceration, epistaxis, a sprained or potentially
fractured extremity, diarrhea, or unintentional or deliberate ingestions. Once a patient
carries a diagnosis, one can look in a textbook for advice. The greater challenge
lies in the undifferentiated patient. Basic skills in recognition and evaluation
are critical in the education of physicians.
More specific goals for this course are:
Recognize the presence of a patient with a serious condition that necessitates urgent
attention.
Prioritize attention to those patients with more urgent conditions.
Take the first steps necessary to save a life, i.e. a) Open the airway. b) Ventilatory support with bag-mask-valve apparatus. c) Circulation augmentation with intravenous fluid. d) Hemorrhage control using external pressure.
Recognize and initially manage potentially dangerous and treatable poisonings in any
age group.
This could be a long list. Some examples are:
Treat superficial burns and recognize when higher level of care is required.
Assess injured extremities for possible fracture or dislocation and identify those
requiring x-rays and possibly referral.
Stabilize a patient who has had a seizure and determine the need for further evaluation.
Etc.
Perform a focused (when appropriate) or general history and physical – gather information
and assess for emergency.
Initiate emergency treatment as needed based on recognized emergency and on limited
information as available.
Formulate an appropriate differential diagnoses list, distinguishing diagnoses, which
are emergencies versus urgencies.
Conduct and follow through a work-up for the differential diagnoses.
Reassess the patient for response to treatment and redirect care plan as needed.
Identify which patients require further consultation or admission with or with out
a final diagnosis, and who may be safely discharged home with proper follow-up.
It is expected that the student will begin learning to interpret the information gathered
from the patient’s history and examination, proposing a scheme by which the patient
should have their problem worked up, an assessment of the problem and developing a
plan for further treatment, either inpatient or outpatient, including drug regimens.
Regardless of the specialty a physician finally enters, the clinician will have interactions
with ambulances, perhaps as first responders at an accident or instead to pick up
a patient who has collapsed in their office. Awareness to access to these services
as well as of the capabilities is vital. Students will spend time at the 911 Center
as well as spend ride-along time on an ambulance.
This includes the physicians in the emergency department, the nursing staff, ancillary
support staff, as well as consulting physicians. Effective communication and interaction
are valuable skills in any field, but perhaps none more so than in the emergency department.
Emergency Medicine in Undergraduate Education, Burdick, et al., Academic Emergency Medicine, Nov. 1988, 5, p. 1105-1110.
Undergraduate Curriculum, DeBehnke, et al., Academic Emergency Medicine, Nov. 1988; 5, p. 1110-1113.
