Templates: General Concepts

Approach to the Undifferentiated Patient

  • Introduction and Objectives
  • Sick vs. Not Sick
  • Identifying Indicators of Acuity
  • Basic Stabilization Principles
  • Developing and Prioritizing the Differential

Notes for author: Take the approach to a sick patient (your thought process, cues you look for and decisions you make) and put them in a sequential order for a student to understand.  Use the subtopics as a guide to structure the section.

Stabilization of the Acutely Ill Patient

  • Introduction and Objectives
  • The Primary Survey
    • Airway
      • Assessment
      • Intervention
    • Breathing
      • Assessment
      • Intervention
    • Circulation
      • Assessment
        • Shock
        • Coagulopathy
        • Trauma
      • Intervention

Notes for author: Take the actions you would perform as you go through an initial ABC (or CAB) assessment of a sick patient and put it on paper in a sequential fashion for students.  Use the subtopics as a guide to structure the section.

Basic and Advanced Life Support

  • Airway
    • Introduction and Objectives
    • For Each Technique/Maneuver
      • Indications
      • Description of Technique
      • Special Considerations
  • Breathing
    • Introduction and Objectives
    • For Each Intervention
      • Indications
      • Description of Intervention/Technique
      • Special Considerations
  • Circulation
    • Introduction and Objectives
    • Rhythm Interpretation
      • For each rhythm
        • Definition
        • Etiology
        • Diagnosis
      • Chest Compressions
        • Indications
        • Technique
  • Circulation
    • Introduction and Objectives
    • Electrical Therapies
      • Indications
      • Technique
      • Special Considerations

Notes for authors:  Focus on core BLS and ACLS principles to share with students.  It would be ideal to have video demonstrations or picture of correct ways of performing these techniques, or at least links to videos/pictures. 

Diagnostic Testing

  • ECG Interpretation (STEMI, specific rhythms, conduction abnormalities, electrolyte imbalances, pediatric ECG)
    • Introduction and Objectives
    • Common Etiologies
    • Clinical Presentation
    • ECG Interpretation
  • Radiographs (CXR, Abdominal series, CT brain, C-spine imaging)
    • Introduction and Objectives
    • Indications
    • Technique
    • Interpretation
    • Special considerations
  • Ultrasound (FAST, AAA, IVC in sepsis, venous access, pericardial effusion)
    • Introduction and Objectives
    • Indications
    • Technique
    • Interpretation
    • Special Considerations

Note to authors: The diagnostic imaging sections should contain image and videos that are examples of the conditions you are writing about.  Please consult with your colleagues at your home institution and across the country to find examples that are not copyrighted.

Lab Studies (Common labs, abdominal labs, d-dimer, lactate, ABG, BHCG, troponin, BNP)

  • Introduction and Objectives
  • Indications
  • Interpretation

Note to author: The lab studies section isn’t made to be a comprehensive review of the labs we order in the ED.  Put in context for them the major issues we deal with in the ED in relation to diagnosis of respective conditions so that they know when it is best to order certain studies.  Examples: the WBC count being elevated does not mean a patient has an infection like appendicitis and if normal a patient can still have appendicitis; Potassium can be elevated because it is hemolyzed and it is associated with electrolyte imbalances (discussed in another section); the d-dimer is only useful for ruling out low risk patients; how to correlate a serum BHCG with an US in early first trimester bleeding; a onetime normal troponin does not mean a patient didn’t have a heart attack

Procedures (wound care, I&D, LP, spinal immobilization, orthopedics, CVL, PVL/art line/IO)

  • Introduction and Objectives
  • Indications
  • Technique
  • Special Considerations

Documentation

  • Introduction and Objectives
  • Discuss section by section

Note to author: Provide good examples of each kind of documentation and what is acceptable or not when documenting.  Incorporate basic medical-legal considerations when writing each section.

Acute Pain Control

  • Introduction and Objectives
  • Route of medication
    • Indications
    • Examples of medications
    • Mechanisms of action
  • Procedural Sedation
    • Indications
    • Examples of medications
    • Mechanisms of action

Note to author: Students struggle with dosing and when to give basic pain medications.  Help them understand basic pain control concepts and how to utilize each type of medication best.  

Communication (Basic/team, rapport, consultation, hand-offs)

  • Introduction and Objectives
  • Case example of a poor communication with a bad outcome
  • Identify importance of communication topic
  • Discuss communication topic
  • Key tips for communication
  • Demonstrate a good communication with a good outcome to contrast initial case

Note to author: Structure this section so that the students understand the importance of good communication in the ED and have examples of what makes communication good versus poor. 

Emergency Medical Services

  • Introduction and Objectives
  • Brief history of EMS and its relation to EM
  • EMS as a system of care
  • Address topics

Note to author: Orient students to pre-hospital transportation of patients and how it intersects with EM

Aeromedical Transport

  • Introduction and Objectives
  • Brief  history of flight transport and its relation to EM
  • Flight transport as a system of care
  • Address topics listed (including flight versus EMS transport)

Note to author: Orient students to flight transportation of patients and how it intersects with EM

Professionalism

  • Introduction and Objectives
  • Importance of professionalism
  • How students should exhibit during their rotation in the ED

Note to author: This section does not have a formal structure at this time, so feel free to organize it how you want.  We want to emphasize the importance of professionalism in the ED and as a medical student.  In the end we want students to:

  • Demonstrate professionalism during interactions with patients, families, ED staff and consultants when caring for patients in the ED
  • Demonstrate a sensitivity towards individual and cultural diversity within the ED
  • Demonstrate professionalism on the rotation (ex. appropriate dress, language, punctuality)

Ethical Issues in the ED

  • Introduction and Objectives
  • Case example of an ethical issue in the ED
  • Discuss topics
  • Resolve case example using concepts discussed

Note to author:  We want to introduce students to major ethical challenges in the ED and the issues that surround them in the practice of EM.

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