Emergency Medicine Certificate Program

Credits: 3

Offered: Fall Semesters

This course will review Cardiovascular and Hematologic Emergencies. This course will give you the understanding on how to diagnose and treat CV and hematologic emergencies.

Cardiovascular Learning Outcomes

1. Describe the range of acute coronary syndromes, including stable angina, unstable angina, non-ST segment elevation MI and ST segment elevation MI.
2. Describe the suggested treatment of unstable angina and NSTEMI.
3. Describe the suggested treatment options for STEMI, including glycoprotein IIb/IIIa inhibitors, clopidogrel, thrombolytics and primary cardiac catheterization.
4. Describe the patient populations that are at risk for atypical presentations of acute coronary syndromes.
5. Basic understanding of the electrophysiology of the heart.
6. Understand and discuss the different anti-arrhythmic drugs.
7. Recognize the following types of cardiac dysrhythmias, as well as their treatments: ventricular, supraventricular and disorders of conduction.
8. Differentiate when one should defibrillate vs. cardiovert a patient with a dysrhythmia. Outline the indications for emergent cardiac pacing.
9. Describe some of the historical characteristics that make syncope more likely to be serious in nature. Describe the San Francisco syncope rules.
10. Describe the presentation, diagnosis and treatment of myocarditis and pericarditis.
11. Describe the risk factors, clinical features, diagnostic evaluation and treatment of endocarditis.
12. List the scenarios for which one must consider prophylactic antibiotic administration to a patient with a valve disorder.
13. Describe the pathophysiology and clinical presentations of both stenosis and regurgitation of the mitral and aortic valves.
14. Describe some of the complications that can be seen with prosthetic heart valves and the considerations when a patient with such a valve presents with a bleeding problem.
15. Understand the effect on the CV system with illicit drugs.
16. Describe the clinical significance of a patent foramen ovale and define cor pulmonale.
17. Describe the ED treatment options for both mild and severe decompensated heart failure and define how laboratory testing may aid in the diagnosis of decompensated heart failure.
18. Describe some presentations for hypertrophic cardiomyopathy and describe the murmur associated with this disease.
19. Define some risk factors for dilated cardiomyopathy and how a patient with this disease may present to the ED.
20. Understand when a pacemaker should be inserted and about pacemaker failure.
21. Describe some of the physiologic changes that take place after a cardiac transplant. Understand the bridging to transplant with a left ventricular assist device (LVAD).
22. Understand the clinical presentation, ED treatment and disposition of patients that present with hypertensive urgency vs. hypertensive emergency.
23. List the risk factors, clinical presentation, diagnostic evaluation, and treatment for aortic aneurysm and abdominal aortic aneurysm.
24. Define the risk factors for aortic dissection, presenting symptoms, and the appropriate ED work up and treatment.
25. understand the indication for a patient who needs extracorporeal membrane oxygenation (ECMO).
26. Define the patient at risk for ventricular aneurysm and how it is diagnosed.
27. Describe the presentation and treatment of pericardial effusion and tamponade.
28. Describe some of the risk factors for both arterial and venous thromboembolic disease, along with the symptoms and treatment of an acute arterial and venous occlusion. Describe when one should suspect an acute arterial insufficiency and some of the options for diagnostic evaluation in the ED.
29. Define the typical and atypical presentations for pulmonary embolism. Describe diagnostic options for suspected pulmonary embolism, as well as their sensitivity and specificity.
30. Understand the common fistula graft complications and how to treat them.

Hematologic Learning Outcomes:

1. Understand the different types of anemia.
2. Explain the physiology of the coagulation cascade and how the PT/PTT are utilized in assessing its function.
3. Describe the ED management of the bleeding patient. Summarize the indications and contraindications for blood product administration, including packed red blood cells, fresh frozen plasma, cryoprecipitate, platelets and specific clotting factors (e.g., Factor VII).
4. Describe the indications, contraindications and potential side effects of the following medications: Anticoagulants (warfarin, heparin, low-molecular weight heparin, direct thrombin inhibitors); Antiplatelet agents (aspirin, NSAIDs, clopidogrel, glycoprotein IIb-IIIa inhibitors) and Fibrinolytic agents (alteplase, reteplase, tenecteplase).
5. Differentiate the clinical presentation, diagnostic evaluation and treatment of patients who present with acquired platelet defects as a result of Idiopathic thrombocytopenia purpura (ITP), Thrombotic thrombocytopenia purpura (TTP), Hemolytic uremic syndrome (HUS), Disseminated intravascular coagulation (DIC) and HELLP syndrome.
6. Describe the mechanism of impaired homeostasis in the setting of liver disease, renal disease and HIV. Describe the ED treatment of congenital bleeding disorders, including von Willebrand disease and the hemophilias.
7. Explain the pathophysiology and treatment of sickle cell anemia and its potential complications, including vaso-occlusive pain crisis, acute chest syndrome, splenic sequestration, aplastic crisis and stroke, as well as common treatments for SSC.

Credits: 3

Offered: Fall Semesters

This course will review Neurologic, Infectious Disease and Pediatric Emergencies. The student will feel comfortable in appropriately recognizing these disorders, ordering the proper tests and treating the disease process.

Neurologic Learning Outcomes:

1. Understand the main components of the neurologic examination.
2. Understand the importance of time of symptom onset when considering a diagnosis of possible stroke.
3. Describe the benefits and potential risks of the following imaging modalities: CT, CTA, MRI/MRA, conventional angiogram.
4. Understand the differences between the pathophysiology, clinical presentation, diagnostic evaluation and treatment of TIA versus CVA.
5. Describe the role of acute blood pressure management in the ischemic stroke patient and understand the inclusion and exclusion criteria for TPA in the stroke patient.
6. Describe how a patient with a subdural/epidural or intracerebral hemorrhage may present and some of the risk factors for these conditions.
7. Explain the role of blood-thinning reversal agents and antihypertensives in the acute treatment of intracranial hemorrhage.
8. Describe the appropriate diagnostic evaluation and treatment of a patient who presents with altered mental status/coma.
9. Explain the difference between central and peripheral vertigo.
10. List the main causes of ataxia and gait disturbance. Describe the clinical evaluation and disposition of a patient who presents with acute onset of ataxia.
11. Understand the clinical presentation, diagnostic evaluation and treatment of following types of headaches: tension, migraine, cluster, spinal, meningitis and intracranial bleed.
12. Explain the role of CT imaging and lumbar puncture in the diagnostic evaluation of a suspected subarachnoid hemorrhage.
13. Describe the presentation, workup and treatment of pseudotumor cerebri.
14. Describe the presentation, diagnostic evaluation and treatment of the following infectious and inflammatory conditions: encephalitis and brain abscess.
15. Understand the clinical presentation and treatment of Bell’s palsy vs trigeminal neuralgia.
16. Describe the following types of seizures: absence, focal, generalized and febrile. Understand status epilepticus and explain the management of a patient with this condition. Define Todd’s paralysis.
17. The diagnostic evaluation and treatment of a patient who presents with a first-time seizure vs. a breakthrough seizure. Explain the significance of a post-traumatic seizure.
18. List some of the causes of seizures that are not the result of a primary neurologic problem.
19. Describe the clinical presentation and diagnostic evaluation of an intracranial mass.
20. Understand and be able to recognize some of the symptoms a patient may report that should prompt one to consider the diagnosis of multiple sclerosis. Explain how an exacerbation of multiple sclerosis may present and the appropriate workup and disposition.
21. Describe a dystonic reaction, possible etiologies and treatment options.
22. Describe the common patient scenarios in which the diagnosis of spinal-cord compression should be considered. Explain the diagnostic evaluation and treatment of this condition.
23. Describe the presentation and treatment of normal pressure hydrocephalus. Explain the clinical presentation, diagnostic evaluation and treatment of VP shunt malfunction or infection.

Infectious Disease Learning Outcomes:

1. Describe the clinical presentation, diagnostic evaluation, and ED treatment of common tick-borne infections, including: Lyme disease, Rocky Mountain spotted fever.
2. Describe the clinical presentation, diagnostic evaluation, and ED treatment of common protozoan infections, including: Malaria and Toxoplasmosis.
3. Evaluate the pathophysiology and rationale for aggressive early goal directed therapy in the ED treatment of sepsis and septic shock.
4. Describe HIV infection from the time of initial infection to the development of frank AIDS. Also, evaluate the current classes of antiretroviral medications and their major side-effects.
5. Describe the management of occupational exposure of a health care worker to potentially infectious bodily fluids, including the indications for the initiation of HIV prophylaxis.
6. List the common opportunistic infections that occur in patients with AIDS, and how such infections are treated: cryptococcal meningitis, Toxoplasmosis, Pneumocystis pneumonia, cytomegalovirus retinitis, esophageal candidiasis, and tuberculosis.

Pediatric Emergency Learning Outcomes:

1. Describe the physical exam findings and be able to treat Croup, epiglottitis, bronchiolitis and a retropharyngeal abscess.
2. Understand the management of neonatal fever and abdominal pathology such as appendicitis, pyloric stenosis and intussusception.
3. Understand the workup and management of Henoch-schonlein purpura, hemolytic syndrome, Kawasaki’s disease, acute rheumatic fever, tetralogy of Fallot, pulmonary atresia and cyanotic syndrome.
4. Understand how to review pediatric x-rays for orthopedic injuries.
5. Understand when an orthopedic injury is child abuse.
6. Understand how to replace IV fluids for a pediatric patient.

Credits: 3

Offered: Winter Semesters

This course will review the OB/GYN, Ophthalmological, ENT and Psychiatric Emergencies. The student will be able to recognize, order the appropriate tests and treat these emergencies.

OB/GYN learning outcomes

1. Describe the normal physiologic changes that occur with pregnancy.
2. Explain the symptoms of molar, ectopic pregnancy and how the quantitative HCG levels and ultrasound aid in its diagnostic evaluation.
3. Define symptomatic and asymptomatic bacteriuria. Describe how this finding is addressed in the pregnant patient.
4. Understand how to diagnose and treat hyperemesis gravidarum.
5. Understand the added risk factors for DVT, thyroid dysfunction and cardiomyopathy.
6. Describe the clinical presentation, diagnostic evaluation and ED treatment of preeclampsia, eclampsia and HEELP syndrome.
7. Describe the causes of vaginal bleeding in each trimester and understand the different types of miscarriage.
8. List the risk factors, clinical presentation, diagnostic evaluation and treatment for placental abruption and placental previa.
9. Explain the conditions in which a pregnant patient should receive RhoGAM in the ED.
10. Define dysfunctional uterine bleeding and the ED workup and disposition of this condition.
11. Understand the process of a normal delivery and list which fetal positions are not safe for vaginal delivery.
12. Describe the management of a shoulder dystocia and nuchal cord.
13. Explain the indications and steps in performing an episiotomy.
14. Explain the steps to quickly assess the newborn (i.e., APGAR score).
15. Define premature labor and describe how it is handled if encountered in the ED.
16. Understand maternal complications of labor and delivery.
17. Explain what classes of drugs are safe in pregnancy and what drugs are contraindicated.
18. Describe how radiographic imaging is approached in the pregnant patient.
19. Discuss high-risk pregnancies with chronic health conditions, such as hypertension, diabetes and asthma.
20. Define premature rupture of membranes. Explain how this condition is diagnosed and treated.
21. Define endometritis and explain its diagnosis and treatment.
22. List the common causes of vaginal discharge and discuss how the wet prep aids in the diagnostic evaluation.
23. Describe how to diagnose and treat yeast vaginitis, trichomoniasis and bacterial vaginosis.
24. Describe how to diagnose and treat genital warts and genital herpes.
25. Describe the clinical presentation and treatment of a Bartholin’s gland abscess.
26. Define pelvic inflammatory disease and toxic shock syndrome and discuss its diagnosis, treatment and complications.
27. Understand the signs and symptoms of a tubo-ovarian abscess.
28. Understand the risk of sterility with pelvic infections.
29. List the signs and symptoms of ovarian cysts. Explain the ED treatment and disposition of this condition.
30. Discuss how ovarian torsion presents and the workup and treatment of this condition.
31. Understand breast infections, including abscess and mastitis, and when to refer for mammogram.
32. Explain the clinical, diagnostic and therapeutic concerns of trauma in the pregnant patient.

Ophthalmologic Learning/ENT Learning Outcomes

1. Understand the types of conjunctivitis and their treatment.
2. Describe the presentation and treatment of the following ophthalmologic emergencies: HSV and Herpes zoster infections of the eye, blepharitis, corneal abrasions, corneal ulcer, dacryocystitis, periorbital and orbital cellulitis.
3. Understand the difference between chalazion and hordeolum and understand when to use a slit lamp.
4. Describe and understand the presentation and treatment of acute angle closure glaucoma, iritis, optic neuritis, retinal detachment, ruptured globe, subconjunctival hemorrhage, hyphema, orbital blowout fracture, ultraviolet keratitis, ocular chemical exposures and ocular foreign bodies.
5. Understand papilledema and what it implies.
6. Describe the presentation and treatment of acute angle glaucoma.
7. Understand when you need to look for in a retinal detachment.
8. Discuss the management of foreign bodies of the ear.
9. Describe the presentation and management of labyrinthitis.
10. Explain the presentation and treatment of mastoiditis.
11. Signs and symptoms of Meniere’s disease.
12. Discuss the evaluation and treatment of otitis externa, otitis media and tympanic membrane perforation.
13. Describe the management of lacerations of the ear.
14. Compare and contrast the clinical presentation, diagnostic evaluation and treatment of anterior versus posterior epistaxis.
15. Discuss the management of septal perforation.
16. Evaluate the diagnosis and treatment of acute and chronic sinusitis.
17. Discuss the clinical presentation, diagnostic evaluation and treatment of the following infectious/inflammatory disorders: Ludwig’s angina, stomatitis, parotitis, epiglottis, laryngitis, tracheitis, oral candidiasis, periapical abscess, peritonsillar abscess, pharyngitis, retropharyngeal abscess, sialolithiasis, dentalgia, TMJ disorders and gingival disorders.
18. Understand tracheostomy evaluation and when a tracheostomy is indicated.
19. Understand the complications from a new tracheostomy and how an airway obstruction can occur when having a tracheostomy.

Psychiatric Learning Outcomes

1. Explain the various emergent medical conditions that can be thought to be a psychiatric disorder.
2. Describe the various factors used to evaluate suicide risk.
3. Apply the mental status examination in the evaluation of the psychiatric patient.
4. Evaluate the various criteria employed in determining the appropriate disposition of the psychiatric patient (voluntary vs. involuntary admission, discharge or medical admission).
5. What are the indications, contraindications and adverse effects of commonly used psychiatric medications used in the acute setting, including antipsychotics and anxiolytics.
6. Demonstrate the ability to use appropriate methods to restrain (e.g., chemical, physical) an acutely agitated or violent patient. What medications are used?
7. Describe the presentation, differential diagnosis and treatment of common Axis I disorders that present to the ED, including schizophrenia and other psychotic disorders, mood disorders, anxiety disorders, substance-induced disorders, cognitive disorders (e.g. delirium, dementia), adjustment disorders, eating disorders, somatoform disorders, factitious disorders and psychiatric disorders due to a general medical condition.
8. Define the process by which alcohol and drug abuse/withdrawal are both identified and treated.

Credits: 3

Offered: Winter Semesters

This course will review Trauma, Nontraumatic Musculoskeletal Disorders, Abdominal and Chest Emergencies. The student will be able to recognize and treat the disorders. The student will feel comfortable seeing and treating these patients in the emergency department.

Trauma Emergencies Learning Outcomes

1. Describe how to perform a primary and secondary survey in evaluation of the trauma patient as outlined in the Advanced Trauma and Life Support (ATLS) guidelines.
2. Explain the importance of considering the mechanism of injury in trauma patients.
3. Understand how to calculate patients Glasgow Coma Scale (GCS) in the evaluation of patients following head trauma.
4. Assess the trauma patient’s vital signs and recognize the potential of significant trauma in the presence of normal vital signs.
5. Explain the use of radiographs and labs in the initial management of the trauma patient and understand their limitations.
6. Describe treatment priorities in the patient that presents with multisystem trauma.
7. Describe the role of the focused assessment with sonography in trauma (FAST) exam in the trauma patient.
8. Describe the signs and symptoms of hemorrhagic shock.
9. Name the indications and contraindications for emergency procedures in the trauma patient, such as endotracheal intubation, cricothyroidotomy, tube thoracostomy, emergency department thoracotomy and central venous catheter insertion. Describe in detail how these procedures are performed and their possible complications.
10. Understand the difference between blunt and penetrating trauma and the workup.
11. Describe the treatment in the head trauma patient.
12. Describe the principle of primary and secondary brain injuries in the head trauma patient.
13. Describe the management of spinal-cord injuries. Name the indications and potential benefit of steroids in patients with significant neurologic deficits following spinal-cord trauma.
14. Describe the presentation, physical findings, diagnostic evaluation, and treatment of traumatic aortic disruption, cardiac contusion, pulmonary contusion, rib fractures, clavicle fracture, sternal fracture, flail chest, hemothorax, pericardial tamponade and pneumothorax.
15. Describe the most commonly encountered intra-abdominal injuries in blunt abdominal trauma and how these injuries are diagnosed and treated.
16. Describe the different genitourinary organ traumatic injuries that can be seen.
17. Explain the management of patients who present with pelvic fractures. Appreciate the potential for severe hemorrhage in addition to intra-abdominal and pelvic organ injuries.
18. Describe the presentation, physical findings, diagnostic evaluation and treatment of bony and soft tissue facial trauma.
19. Explain the management of traumatic amputations. Understand the proper means in which to preserve the amputated appendage.    
20. Describe the management of common joint dislocations and fractures, including glenohumeral, elbow, interphalangeal, hip, knee and ankle.
21. Understand the signs and symptoms of compartment syndromes and understand their treatment.
22. Evaluate patients with open fractures and penetrating joint trauma and explain the appropriate ED treatment of such injuries.
23. Describe the diagnostic approach and ED treatment of nontraumatic neck and back pain.
24. Understand the workup and treatment for a spinous process fracture, transverse process fracture and a compression fracture.
25. Name the various “red flags” that should prompt diagnostic imaging and specialty consultation in cases of neck or back pain.
26. Compare and contrast the clinical presentation of spinal-cord compression, disk herniation and spinal epidural abscess.
27. Name the limitations of plain films and computed tomography (CT) scans in the evaluation of nontraumatic neck and/or back pain.
28. Explain the indications for obtaining an emergent MRI in patients with neck or back pain.
29. Describe the clinical presentation, diagnostic evaluation and treatment of common hand infections, including cellulitis, flexor tenosynovitis, deep space infections, closed fist injuries, paronychia, felon and herpetic whitlow.
30. Understand how to treat an infection from an animal bite.
31. Describe how to perform an arthrocentesis of the major joints. Know how to interpret the results of joint fluid analysis to differentiate septic arthritis and other causes (e.g., gout, pseudogout).
32. Describe the clinical presentation, diagnostic evaluation and treatment of common overuse syndromes, including carpal tunnel syndrome, De Quervain’s tenosynovitis, plantar fasciitis and tendonitis.
33. Describe the management of sprains, strains and tendon injuries.

Abdominal Emergencies Learning Outcomes

1. Describe how abdominal wall hernias are diagnosed and explain the appropriate treatment and disposition patients who present with this condition.
2. Explain how the following disorders of the esophagus may present, how they are diagnosed and their appropriate treatment, such as esophagitis, GERD, caustic exposures, dysmotility, Boerhaave’s syndrome, foreign bodies, Mallory-Weiss syndrome, strictures and stenosis and varices.
3. Understand viral hepatitis.
4. Describe the complications of liver failure and cirrhosis, such as bleeding, hepatic encephalopathy, hepatorenal syndrome and spontaneous bacterial peritonitis. List the laboratory abnormalities that may be encountered with these conditions.
5. Explain how cholecystitis may present, how one would work up a patient with this suspected diagnosis and the appropriate management of this disease.
6. Describe the syndrome of ascending cholangitis and how it is treated.
7. Explain how pancreatitis is diagnosed and treated.
8. Compare and contrast acute and chronic pancreatitis.
9. Explain the complications of ulcerative colitis.
10. Describe the typical symptoms of Crohn's disease.
11. Explain the diagnostic approach to the patient with Crohn’s disease who presents to the ED with abdominal pain.
12. Understand the workup and treatment for diverticulitis.
13. Describe the diagnosis and management of irritable bowel syndrome.
14. Describe the appropriate diagnostic approach and treatment for the patient who presents with diarrhea.
15. Understand treatment for Meckel’s diverticulum.
16. Describe the risk factors, clinical presentation, diagnostic evaluation and treatment for partial and complete bowel obstruction.
17. Describe the common symptoms of peptic ulcer disease and gastritis and how they may be managed in the ED.
18. Compare and contrast the clinical presentation, diagnostic evaluation and treatment of upper vs. lower GI bleeding.
19. Compare and contrast a mechanical bowel obstruction versus an ileus.
20. Explain the risk factors, clinical presentation, diagnostic evaluation and treatment of an aortoenteric fistula.
21. Describe the manifestations of mesenteric ischemia, as well as the risk factors, diagnosis and treatment.
22. Describe the typical and atypical manifestations of acute appendicitis, as well as the diagnostic approach to the patient with possible appendicitis.
23. Describe the patient populations in which acute appendicitis is commonly missed.
24. Compare and contrast the pathophysiology, clinical presentation, diagnostic evaluation and treatment of gastric, cecal and sigmoid volvulus.
25. Describe the clinical presentation, diagnostic evaluation and treatment of toxic megacolon.

Chest Emergencies Learning Outcomes

1. Discuss some of the etiologies of noncardiogenic pulmonary edema and how to treat this entity.
2. Explain the presentation and treatment of a pleural effusion.
3. Understand the presentation and workup for tuberculosis.
4. Discuss the pathophysiology and nuances of treatment of an exacerbation of asthma.
5. Define bronchitis and describe its treatment.
6. Explain the diagnosis and treatment of an exacerbation of COPD.
7. What are some of the complications of cystic fibrosis?
8. Describe the clinical presentation, diagnostic evaluation and treatment for a patient who presents to the ED following exposure to toxic gases/fumes.
9. Describe the signs and symptoms of costochondritis. Also, what is the treatment?
10. Explain the diagnosis and treatment of mediastinitis.
11. Explain the risk factors, clinical presentation, diagnostic evaluation and treatment for pneumomediastinum and pneumothorax.
12. Compare and contrast the pathophysiology, diagnostic evaluation and treatment for spontaneous pneumothorax vs. tension pneumothorax.
13. Discuss the various types of pneumonia, including patterns of presentation and treatment such as aspiration, atypical, bacterial, fungal and viral.
14. Identify and treat ARDS.

Credits: 3

Offered: Summer Semesters

This course will review Environmental, Toxicological and Dermatological Emergencies. The student will be able to recognize and treat the disorders. The student will feel comfortable seeing and treating these patients in the emergency department.

Environmental Emergencies Learning Outcomes

1. Describe the pathophysiology, diagnosis and treatment of frostbite and trench foot.
2. Explain the physiologic changes and possible complications of hypothermia.
3. Describe an appropriate approach to rewarming the hypothermic patient.
4. Explain the relationship between hypothermia and cardiac dysrhythmias and cardiac arrest.
5. Compare and contrast heat exhaustion and heatstroke.
6. Describe the body’s response to heat stress.
7. Compare and contrast the clinical presentation, diagnostic evaluation and treatment of prickly heat, heat cramps, heat tetany, and heat syncope.
8. Describe the clinical presentation, diagnostic evaluation, and treatment of a patient with heatstroke.
9. List preventive measures for heat-related illnesses.
10. Describe the clinical features and treatment of the more common snake bites.
11. Describe the clinical features and treatment of a gila monster bite.
12. Explain the clinical features, diagnostic evaluation and treatment of bites from the following marine animals: sharks, barracudas and moray eels.
13. Describe the treatment of coral-induced injuries.
14. Explain antibiotic therapy for an injury occurring in the marine environment.
15. Explain the appropriate treatment of the various types of jellyfish, octopus, starfish, sea urchin and sponge envenomations.
16. Describe the clinical features and treatment of a stingray envenomation.
17. Describe the treatment of a sting from the following venomous fish, such as stone fish, scorpion fish, and lion fish.
18. Describe the clinical features and ED treatment of local and systemic reactions to bee stings.
19. Describe the characteristics and treatment of fire ant bites.
20. Describe the characteristics and treatment of a bite from a Loxosceles spider.
21. Describe the pathophysiology and treatment of a black widow spider bite and a tarantula bite.
22. Describe the pathophysiology of barotrauma of ascent and barotrauma of descent during deep-sea diving.
23. Explain the symptoms and treatment of decompression sickness.
24. Explain the presentation and treatment of arterial gas embolism.
25. Describe nitrogen narcosis.
26. Compare and contrast “dry drowning” with “wet drowning."
27. Explain the physiologic changes that occur as a person ascends to a high elevation. Describe the process of acclimatization.
28. Describe the clinical features, pathophysiology and treatment of acute mountain sickness.
29. Describe high-altitude cerebral edema and cerebrovascular syndromes of altitude.
30. Describe high-altitude pulmonary edema and its treatment.
31. List some chronic illnesses that may be exacerbated at high altitudes.
32. Describe the pathophysiology of the fluid and electrolyte abnormalities that can be seen in the burn patient. Explain the method of fluid resuscitation in these patients.
33. Describe how to estimate burn size and depth.
34. List the criteria for transfer of a burn patient to a burn unit.
35. Describe inhalational injuries and their treatment.
36. Describe the ED care of a burn victim.
37. Explain the indications for an escharotomy in the burn patient.
38. Explain how an electrical injury or lightning injury may impact the following body systems: cardiac, CNS, spinal cord, PNS, skin, eyes, ears, mouth, GI, muscles and vascular.
39. Explain the treatment of electrical injury in the pregnant patient.
40. Explain the disposition of the patient with an electrical injury or lightning.

Toxicology Learning Outcomes

1. Describe the initial steps in the treatment of the overdose patient with respect to the primary survey (airway, breathing, circulation).
2. Integrate history, vital signs, physical exam findings, and immediately available bedside tests (e.g., blood glucose, ECG) in order to help gauge the severity of toxic ingestions.
3. Describe the indications and contraindications of common antidotes, including naloxone, N-acetylcysteine, sodium bicarbonate, physostigmine, digoxin fab, glucagon, calcium gluconate, fomepizole, dextrose, methylene blue, deferoxamine, octreotide, pralidoxime, pyridoxine, activated charcoal and vitamin K.
4. Evaluate the limitations of the urine drug screen in the treatment of patients who present to the ED with acute drug overdoses.
5. Compare and contrast the common toxic ingestions that can result in an anion gap metabolic acidosis.
6. Compare and contrast the physical findings found in the common “toxidromes,” including opioid, sympathomimetic, cholinergic, anticholinergic, salicylates and serotonin syndrome.
7. ECG findings in patients who present with possible tricyclic antidepressant toxicity.
8. Describe the diagnostic approach and treatment of toxic alcohol ingestion, including methanol, ethylene glycol and isopropyl alcohol.
9. Distinguish between the various possible opiate overdose scenarios, including heroine, methadone, fentanyl and oxycodone.
10. Evaluate the clinical features, potential complications and treatment for sympathomimetic toxicity.
11. Compare and contrast the clinical presentation, diagnostic approach and treatment of acute vs. chronic salicylates toxicity.
12. Describe the approach to the patient with acute acetaminophen toxicity. Evaluate the role of the Rumack-Matthew nomogram. 
13. Describe the presentation, diagnostic evaluation and treatment of other toxic ingestions, including alcohol, benzodiazepines and other sedatives, digoxin, beta blockers, calcium channel blockers, phenytoin, lithium, nonsteroidal anti-inflammatory drugs (NSAIDs), iron, hydrocarbons and volatile substances, caustics and hypoglycemic agents.

Dermatology Learning Outcomes

1. Identify and describe the appropriate ED care for the following types of dermatitis: toxic epidermal necrolysis, exfoliative dermatitis, seborrheic dermatitis, alopecia areata, venous stasis, eczema, contact dermatitis, poison ivy and psoriasis.
2. Identify and describe the appropriate ED care for the following maculopapular lesions: erythema nodosum and erythema multiforme.
3. Identify the following vesicular/bullous lesions: pemphigus vulgaris and bullous pemphigoid.
4. Identify the following skin manifestations of infectious diseases: pityriasis, scarlet fever, Rocky Mountain spotted fever, measles, varicella, Herpes zoster, rubella, roseola, Kawasaki’s disease, toxic shock syndrome, disseminated gonococcal infection and meningococcemia.
5. Describe different infestations, such as bed bugs, lice and scabies.
6. Identify and describe the treatment for the following skin infections: abscesses, cellulitis, erysipelas, impetigo, staphylococcal scalded skin syndrome, candida infections, tinea infections, erythema infectiosum, herpes simplex, molluscum contagiosum and warts.
7. Describe and understand the treatment and workup for necrotizing fasciitis.

Credits: 3

Offered: Summer Semesters

This course will review Renal/Urogenital, Metabolic and Immunologic Emergencies. The student will learn how to identify and treat these emergencies. The student will be comfortable in treating these disorders in the emergency room setting.

Renal and Urogenital Emergencies Learning Outcomes

1. Describe the signs, symptoms and ED treatment of acute and chronic renal failure.
2. Describe the electrolyte abnormalities associated with chronic renal failure.
3. Evaluate the indications for emergent hemodialysis, with and without access.
4. Compare the chronic complications of hemodialysis and peritoneal dialysis.
5. Describe the management of vascular access associated hemorrhage in the HD patient.
6. Describe the symptoms, testing and treatment of urinary tract infections, acute cystitis and pyelonephritis.
7. Etiologies and diagnostic approach to acute testicular/scrotal pain, including epididymitis, testicular torsion, testicular trauma, prostate, BPH, outlet obstruction and orchitis.
8. Describe the signs, symptoms and ED treatment of Fournier’s gangrene.
9. Describe the clinical presentation, differential diagnosis, diagnostic evaluation and ED treatment of renal colic.
10. Understand the clinical features and management of bladder stones.
11. Diagnostic evaluation of hematuria and causes.
12. Describe the potential complications of common urologic procedures, including lithotripsy, ureteral stents, urinary catheterization and percutaneous nephrostomy.
13. Understand the presentation and management of priapism.
14. Understand the presentation and management of phimosis and paraphimosis.

 Metabolic and Endocrine Emergencies Learning Outcomes

1. Describe the clinical presentation and diagnostic evaluation of type 1 and type 2 diabetes.
2. Understand the treatment of hypoglycemia.
3. Understand the diagnosis and treatment of acute complications of diabetes mellitus, including diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic nonketotic syndrome (HHNS).
4. Understand long-term complications of diabetes, such as retinopathy, nephropathy and neuropathy.
5. Signs, symptoms and treatment of alcoholic ketoacidosis.
6. Understand hyper- and hypoparathyroidism.
7. Clinical presentation and ED treatment of hyperthyroid states from thyrotoxicosis to thyroid storm.
8. Describe the treatment of hypothyroidism and myxedema coma.
9. List the common causes of primary and secondary adrenal insufficiency.
10. Describe the clinical presentation and ED treatment of adrenal crisis.
11. Evaluate the proper use and various dosages of corticosteroids in the treatment of adrenal insufficiency in the setting of physiologic stressors.
12. Describe the signs, symptoms and treatment of electrolyte disturbances including hyper-/hypokalemia, hyper-/hyponatremia, hyper-/hypocalcemia, hyper-/hypomagnesemia and hyper-/hypophosphatemia.

 Immunologic Emergencies Learning Outcomes

1. Describe the signs, symptoms and treatment of hypersensitivity reactions, including urticaria, anaphylaxis, angioedema and drug allergies.
2. Describe the common complications and treatment of common collagen vascular disorders, including Raynaud’s syndrome, Reiter syndrome, systemic lupus erythematosis (SLE), scleroderma and rheumatoid arthritis.
3. Describe the signs, symptoms and treatment of problems that arise following transplantation (heart, lung, liver, kidney), focusing on rejection and complications of chronic immunosuppressive therapy.