CARDIOVASCULAR DISORDERS

Acute Coronary Syndromes - Diagnosis and Challenges

• Recognize electrocardiographic (ECG) criteria that warrant cardiac catheterization.
• Examine scenarios in which activating the catheterization team was deemed to be inappropriate.
• Review catheterization laboratory activation criteria for classic cases of ST elevation myocardial infarction (MI).
• Describe the specifics of the modified Sgarbossa criteria.
• Examine the ECG criteria for left main coronary artery occlusion, right ventricular MI, and posterior MI.
• Recognize the catheterization laboratory activation criteria in the setting of return of spontaneous circulation.
• Review ECG criteria for conditions mimicking acute MI.
• Recognize that not all coronary syndromes present primarily with chest pain.

Non-ST-Elevation Acute Coronary Syndromes - Surgical Invasive Management

• Identify the difference between urgent/immediate and early-invasive strategies.
• Review the use of GRACE scores to evaluate risk in patients with chest pain.
• Recognize findings on electrocardiography of a left main occlusion, a finding that often requires coronary artery bypass grafting.
• Identify patients who can undergo traditional exercise stress testing prior to discharge.
• Explain the updates and changes to guidelines for the management of ST elevation myocardial infarction.
• Describe the reason why warfarin is no longer considered standard anticoagulation therapy for certain patients.
• Describe the importance of using early clinical scoring systems to identify appropriate treatment strategies in acute coronary syndromes.

AIRWAY, VENTILATION, RESUSCITATION

Advanced Airway: Adult

• Characterize the settings in which succinylcholine use is contraindicated or indicated.
• Describe why the gag reflex should not be used in determining whether intubation is required.
• Identify the proper criteria for intubation.
• Describe the minimal requirements for proper rapid sequence intubation.
• List the indications for use of propofol as a first-line agent.
• Describe proper oxygenation in a patient with a class 3 Mallampati airway.
• Describe how to properly place an endotracheal tube in various settings and in different types of patients.

Airway: Pediatric

• List the common causes of airway obstruction in an infant.
• Explain why volume loss from active bleeding is concerning.
• Describe the management options for difficulty breathing in young children.
• Identify adverse events that can be directly attributed to succinylcholine use.
• Recognize that the selection of tube size is important in pediatric resuscitation.
• Describe the management of foreign bodies in the airways of children.
• Examine the use of rapid-sequence intubation in suspected epidural hematoma.
• Describe how to treat asthma in the setting of severe respiratory distress.
• Identify concerning pulmonary signs in a newborn.

Breathing: Ventilatory Support (Adult/Pediatric)

• List the indications for use of compression first vs ventilation first followed by cardiopulmonary resuscitation (CPR).
• Characterize the compression:ventilation ratios during CPR.
• Describe the indications for pressure-cycled ventilation.
• Describe the modes of ventilation in rapid sequence intubation.
• Identify the settings for which noninvasive ventilation is acceptable.
• Examine the appropriate ventilator settings in various clinical scenarios.
• Identify the concerns of intubation in patients with chronic obstructive pulmonary disease or acute respiratory distress syndrome.
• Examine the indications and contraindications of sedative agents (eg, propofol) in various patient scenarios.
• Describe possible causes of hypotension, pneumothorax, or hypoxia in patients following intubation.

Resuscitation: Adult Cardiac

• Examine the relationship between strength of recommendations and the respective scientific evidence support used in practice guidelines.
• Summarize the process by which a layperson establishes the need for cardiopulmonary resuscitation (CPR).
• Discuss the airway-opening step in the context of compression-only CPR.
• List the sequence of recommended maneuvers for opening of the airway in a trauma patient.
• Discuss the initial trained management of apnea in a patient with a pulse.
• Describe the proper compression rate and depth for CPR in an adult.
• Identify the indicators of adequate CPR.
• State the recommended compression to ventilation ratios for CPR in an adult when trained rescuers are present.
• Identify the indicators of proper preintubation ventilation in a patient experiencing cardiac arrest.
• Describe proper bag-valve mask placement in a toothless patient.
• Relate various approaches to confirming endotracheal tube placement to their reliability.
• Discuss the coordination of chest compression and ventilations in an intubated patient experiencing cardiac arrest.
• Summarize recommendations for the initial pharmacologic approach to all cardiac arrest algorithms.
• Discuss recommendations for initial antiarrhythmic drug therapy in all cardiac arrest algorithms.
• Relate pulseless rhythms to their underlying electromechanical problem.
• Characterize the appropriate management of symptomatic bradycardia.
• Discuss the use of beta blockers in patients with unstable ventricular arrhythmias in the context of cardiac ischemia.
• Summarize the recommendations for treating stable narrow complex tachycardia.
• Discuss resuscitation priorities in drowning persons in cardiac arrest.
• Relate various levels of cardioversion energy to their proper indication.
• Appropriately implement the opioid algorithm used by the American Heart Association.
• Describe appropriate CPR in a patient with accidental hypothermia.
• Discuss the management of cardiac arrest in a pregnant patient.
• Examine current recommendations for instructions to dispatchers regarding CPR.

Resuscitation: Shock

• Describe the differential diagnoses of different types of shock.
• Characterize how to classify different stages of shock.
• Identify the appropriate laboratory studies to order for discerning a patient's length of incapacitation.
• Examine various causes of metabolic acidosis.
• Understand the misuse of imaging in patients with a high shock index.
• Calculate the correct mean arterial pressure.
• Describe how to correct bicarbonates in the setting of metabolic acidosis.
• Describe the lethal triad in hemorrhage shock.
• Recognize the clinical presentation and signs/symptoms of early septic shock.

ENDOCRINE, METABOLIC, & NUTRITIONAL DISORDERS

Basic Science Review: Acid-Base Regulation

• Use the delta-delta gap to determine if multiple metabolic processes are present.
• Recognize the contribution of albumin to the anion gap calculation.
• Henderson-Hasselbalch equation.
• Estimate carbonic acid concentrations in various settings.
• Describe the definitions of metabolic acidosis and respiratory alkalosis.

Basic Science Review: Regulation of Water and Osmolarity

• Define the meanings of osmolality and osmolarity and their importance.
• Describe the body's priorities and the interplay between pH, volume, and electrolytes.
• Describe the composition and distribution of fluids in the human body.
• Examine and apply the osmolal gap.
• Characterize the neurohormonal regulation of water and osmolarity.
• Identify the influence of intravenous fluid administration and the shifts that take place in compartments within the body with fluid or chemical administration.
• Describe the process of osmosis and diffusion.

Clinical Context: Acid-Base Disorders

• Appropriate and correctly interpret a blood gas value.
• Describe clinical scenarios in which understanding the item ingested will predict acid/base disturbances.
• Identify the delta gap and mixed gap/non-gap acidosis.
• Explain the epidemiology of acid-base disturbances in special patient populations.

Endocrine Disorders: Thyroid Gland

• Describe treatment of thyroid storm.
• Recognize the laboratory findings with thyroid storm.
• Discuss the mortality and course of treatment for hyperthyroidism.
• Discuss the findings of apathetic thyrotoxicosis.
• List the causes of hypothyroidism.
• Identify the findings in hypothyroidism.
• Recognize laboratory test results and findings in myxedema coma.
• Characterize the demographics of patients with myxedema coma.

TOXICOLOGIC DISORDERS

Acetaminophen Toxicity

• Characterize the 2011/2012 therapeutic dosing recommendations for acetaminophen.
• Define the pathophysiology of acetaminophen.
• Describe the toxicity of acetaminophen.
• List the 4 stages of acetaminophen-related liver toxicity.
• Understand the Rumack-Matthew nomogram and its clinical value.
• Describe the treatment for acetaminophen poisoning.
• Identify the mechanism of injury induced by acetaminophen.
• Identify the antidote for acetaminophen poisoning.
• List the limitations of the Rumack-Matthew nomogram.
• Describe dosing and the adverse events associated with the routes of administration of N-acetylcysteine.

Aspirin and NSAIDs Toxicity

• Identify nonsteroidal anti-inflammatory drug (NSAID) toxicities.
• Describe how to manage an NSAID overdose.
• Determine the differential diagnosis of an anion gap metabolic acidosis.
• Compare and contrast cyclooxygenase-2 and other NSAIDs.
• Define the spectrum of salicylate toxicity.
• Recognize signs and symptoms of chronic salicylism.
• Characterize the management of salicylate toxicity.

Cocaine and Other Sympathomimetics Toxicity

• Characterize the pathophysiology and potential complications of cocaine and other sympathomimetic drugs of abuse.
• Describe the therapy for acute cocaine and other sympathomimetic drug intoxication.
• Identify potential complications and appropriate therapy for cocaine and sympathomimetic intoxication.
• List the unique biochemical and pharmacologic characteristics of cocaine that distinguish it from other stimulant drugs with abuse potential.
• Understand the potential drug–drug interactions associated with cocaine and other sympathomimetics.
• List the unique characteristics of specific amphetamine derivatives.
• Differentiate sympathomimetic toxicity from other toxidromes such as antimuscarinic (anticholinergic) toxicity.
• Understand the potential toxicity from over-the-counter stimulants and "legal highs."
• Recognize potential complications from stimulant-induced rhabdomyolysis.

Lithium Toxicity

• Describe the neurologic findings of lithium intoxication.
• Describe the pharmacokinetics of lithium.
• Compare and contrast the presentation of acute versus chronic poisoning.
• Characterize decontamination options following an acute overdose of lithium.
• Manage and treat lithium poisoning.
• List indications for hemodialysis in the treatment of lithium poisoning.
• Identify endocrine complications of lithium use.
• Define the mechanism of hypernatremia as a complication of lithium use.
• Summarize the risks of lithium use during pregnancy.

Pesticide Toxicity (incl. Organophosphates)

• Characterize the toxicity of organophosphate pesticides.
• Describe the epidemiology of toxic alcohol ingestions.
• List the clinical end points of therapy for organophosphate pesticide toxicity.
• Understand the toxicity of lindane.
• Describe the toxicity of N,N-diethyl-meta-toluamide.
• List the general principles of treatment following pesticide exposures.
• Characterize the mechanism of action of dichlorodiphenyltrichloroethane, lindane, substituted phenols, and glyphosate.
• Describe the effects of pyrethrins and pyrethroids.

Toxic Alcohols

• Describe the pathophysiology of toxicity related to methanol, ethylene glycol, and isopropyl alcohol.
• Discuss the epidemiology of toxic alcohol ingestion.
• Describe the clinical signs and symptoms related to the toxicity of alcohols.
• Describe laboratory measurements that assist in the diagnosis of toxic alcohol ingestion, including the anion and osmolar gaps.
• Describe appropriate indications and dosing for fomepizole in the treatment of toxic alcohol ingestion.

EYE, EAR, NOSE & THROAT DISORDERS

Eye: Vascular Disorders

• Discuss amaurosis fugax as a sign of possibly impending stroke.
• Discuss the physical exam of a patient with central retinal artery occlusion.
• Discuss emergency management of central retinal vein occlusion.
• Compare central retinal vein occlusion to central retinal artery occlusion.

Nose: Infection and Inflammation

• Discuss the diagnosis of acute bacterial rhinosinusitis versus acute viral rhinosinusitis.
• Describe the imaging modality of choice in suspected cases of intracranial infection due to acute sinusitis.
• Appropriately treat patients with uncomplicated sinusitis.
• Relate rare combinations of symptoms to the high acuity diagnosis of cavernous sinus thrombosis.
• Recognize common symptoms of neonatal syphilis, a rare but highly infectious disease.
• Identify the classic presentations of various types of sinusitis.
• Discuss the association of a rash on the nose with the risk of possible vision loss.
• Describe the antibiotic controversy in treating bacterial sinusitis.

ENVIRONMENTAL DISORDERS

Drowning

• Discuss the currently accepted, national definition of drowning.
• Discuss the physiological effects of sudden immersion in very cold water.
• Discuss basic life support of a drowning victim during the water transport phase.
• Relate pathological changes of drowning to clinical morbidity.
• Discuss the role of therapeutic hypothermia in drowning victims.
• Discuss the initial management of hypoxia in a drowning victim.
• Discuss strategies for increasing oxygenation in a drowning victim who remains hypoxic after intubation.
• Discuss advanced life support in a hypothermic drowning victim in cardiac arrest.
• Discuss factors that substantially increase the risk of drowning and that should be part of any prevention counseling in the emergency department.
• Discuss the emergency department management of an intubated drowning victim.

Electrical and Lightning Injuries

• List factors that increase the injurious potential of electrical current.
• Discuss the resistance of various body tissues to conducting electricity and the clinical implications.
• Identify strategies for reducing the risk of a lightning strike in the outdoors.
• Relate the signs and symptoms of an electrical exposure to the corresponding injurious potential.
• Describe the appropriate management of oral electrical burns in children.
• Discuss the effects of high-voltage electric shock.
• Describe the appropriate field care of a resuscitated individual after a lightning strike.
• Discuss fluid resuscitation in an individual after a lightning strike.
• Characterize the principles of electroshock weapons/stun guns.
• Examine the cardiac effects of lightning strike.
• Discuss the management of mottled extremities after a lightning strike.

Frostbite

• Explain the terminology associated with cold-induced injuries.
• Summarize the physiologic processes that lead to tissue loss from frostbite.
• Discuss the classification of frostbite.
• Identify the risk factors that increase the likelihood of developing frostbite.
• Describe the prehospital approach to frostbite.
• State the ideal temperature range of water for rewarming frostbitten extremities.
• Discuss the clinical signs that indicate completion of the thawing process.
• Characterize appropriate management of clear blisters in a patient with second-degree frostbite.
• Discuss the management of hemorrhagic blisters seen in cases of third-degree frostbite.
• Summarize the appropriate treatment for chilblain.
• Recognize the most likely pathogens to complicate recovery from second- and third-degree frostbite.
• Summarize the indications for thrombolytic therapy.
• Examine the role of imaging in the emergency care of patients with frostbite.

Heat-Related Illnesses

• List medications known to increase the likelihood of heat stroke.
• Define the pathophysiology of heat-related illness.
• Characterize the presentation of heat stroke.
• Describe the necessary treatment for heat edema.
• Recognize the therapy necessary for treating a patient with heat cramps.
• Describe the appropriate cooling techniques used for patients with heat stroke.

Hypothermia: Accidental

• Define hypothermia in humans.
• Relate specific temperatures to the onset to each stage of hypothermia.
• Discuss the various categories of heat loss and the contribution of each category to heat loss in various situations.
• Discuss how rewarming can result in a drop rather than elevation of core temperature.
• Interpret an ECG with Osborn waves (J waves or hypothermic hump).
• Discuss hypothermia as a missed diagnosis in the urban homeless population.
• Discuss the risk of arrhythmias associated with hypothermia.
• Discuss the cardiopulmonary resuscitation of a patient with severe accidental hypothermia.
• Discuss interpretation of arterial blood gas results of a hypothermic patient.
• Explain cold diuresis.
• Relate a core temperature to the loss of the shivering reflex.
• Discuss intubation logistics in a hypothermic patient.
• Discuss active external and internal rewarming methods, including their indications.
• Discuss the pros and cons of various methods for obtaining a core temperature.
• Discuss guidelines regarding the cessation/non-initiation of cardiopulmonary resuscitation (CPR) in hypothermic patients.

High Altitude Disorders

• Describe symptoms of acute mountain sickness.
• Identify causes of high altitude illness.
• Discuss the prevention of high altitude illness.
• Explain the use of acetazolamide in high altitude illness.
• Describe radiographic findings in high altitude pulmonary edema.
• Identify symptoms of high altitude cerebral edema.
• Recognize complications of high altitude pregnancy.

Marine Animal Envenomations and Injuries

• Discuss the presentation of seabather’s eruption.
• Discuss the presentation of jellyfish envenomation.
• Discuss life-threatening marine envenomations.
• Discuss management of non-severe jellyfish stings.
• Relate marine animals to their respective medical dangers.
• Discuss management of a poisonous octopus bite.
• Discuss the effects of a puncture wound from the spines of a lion fish.
• Discuss management of a puncture wound from a scorpion fish.
• Discuss available antivenoms for marine animal envenomations.
• Discuss the differential diagnosis of a marine injury sustained in shallow water.
• Discuss management of a sting ray injury.
• Discuss the sea snake venom.
• Discuss sea urchin envenomation.
• Discuss management of sea urchin stings.
• Discuss the management of seal finger.
• Discuss the management of abrasions caused by rough shark skin.
• Discuss management of minor shark lacerations.
• Discuss the epidemiology, presentation, and management of barracuda bites.

Scuba Diving and Dysbarism

• Relate Boyle’s law to the physiologic effects of diving on lung volume.
• Examine Boyle’s law in relation to pulmonary inflation syndrome in a breath-holding event while ascending during a scuba dive.
• Discuss the signs of nitrogen narcosis during scuba diving.
• Summarize the phenomenon of excess tissue nitrogen in relation to the symptoms of decompression sickness.
• Describe the pathophysiology and presentation of mask squeeze.
• Identify the most concerning diagnosis in a patient with syncope after diving.
• Characterize the underlying pathology of the 3 most important high-morbidity syndromes associated with scuba diving.
• Identify therapeutic interventions for various diving syndromes.
• Recognize the signs of acute gas embolism and appreciate the urgency of recompression.
• Discuss oxygen toxicity in relation to breathing various special gas mixes during scuba diving.

Venomous Animal Injuries: Arthropods

• Describe the presentation and treatment of widow spider bites.
• Define the clinical manifestations and treatment of fire ant envenomation.
• Identify hymenopteran stings and their clinical management.
• Recognize and describe the toxicity of blister beetles.
• Define and understand the presentation and treatment of brown recluse spider bites.
• Explain the presentation, treatment, and clinical significance of scorpion envenomation.
• Describe the clinical presentation of toxic tarantula exposure.

Venomous Animal Injuries: Reptiles

• Describe the epidemiology of poisonous domestic and exotic snake envenomation in the United States.
• List the grading schemes that are used to describe the severity of rattlesnake envenomation.
• Describe appropriate prehospital and emergency department care of poisonous snake envenomations.
• Recognize the pathophysiology and clinical symptoms of rattlesnake and other poisonous snake envenomations.
• Describe appropriate indications and dosing for rattlesnake antivenom in the treatment of envenomation.

NERVOUS SYSTEM DISORDERS

Central Nervous System Disorders: Demyelinating/Inflammatory

• Understand the disease classification of multiple sclerosis (MS).
• Describe the classic triad of optic neuritis in the setting of MS.
• Characterize the initial symptoms of MS.
• Identify the signs and symptoms of central pontine myelinolysis.
• Recognize the acute clinical presentation of disseminated encephalomyelitis.
• Identify the symptoms characteristic of neuromyelitis optica.

Central Nervous System Disorders: Spinal Cord Syndromes

• Compare complete versus incomplete spinal cord syndromes.
• Discuss the signs and symptoms of central cord syndrome.
• Examine the incidence of different types of incomplete cord syndromes.
• Summarize the clinical findings in patients with central cord syndrome.
• Compare the clinical findings in cord lesions and discuss the appropriate diagnostic testing.
• Describe the clinical findings in Brown–Séquard syndrome.
• Discuss the work-up of spinal cord symptoms in a patient with multiple sclerosis.
• Consider transverse myelitis and its diagnostic evaluation.
• Describe the initial radiographic approach to healthy patients with new-onset, atraumatic back pain.
• Compare the clinical findings of syringomyelia and atraumatic spinal cord disorders.

Selected Cranial Nerve Disorders

• Discuss the importance of double-simultaneous stimulation test.
• Identify the standard screening test for the sensory function of crania nerve V.
• Recognize the clinical signs of trigeminal neuralgia.
• Define the treatment for trigeminal neuralgia.
• Describe disorders associated with peripheral cranial nerve lesions.
• Outline the treatment for Bell palsy.
• Identify signs and symptoms of vestibular schwannoma.
• Discuss the diagnostic test for vestibular schwannoma.
• Analyze the differential diagnosis of diabetic mononeuropathy.
• Outline the prognosis for diabetic cranial mononeuropathy.
• Recognize the symptoms and diagnostics associated with cerebral venous thrombosis.
• Describe the management for cerebral venous thrombosis.
• Identify disorders characterized by optic neuritis.
• Discuss treatment options for optic neuritis in patents with multiple sclerosis.
• Summarize the signs and symptoms of cranial nerve III lesion.
• List the signs and symptoms of a trochlear nerve lesion.
• Discuss the signs and symptoms of abducens nerve palsy.

HEMATOLOGIC AND ONCOLOGIC DISORDERS

Transfusions

• Calculate appropriate transfusion volumes in children.
• Describe the management of sickle cell anemia in an aplastic crisis.
• Identify common causes of and therapeutic options for acute reactions to hemolytic transfusions.
• Recognize how to best manage blood transfusions in an emergency situation when time is limited.
• List the storage requirements for packed red blood cells (PRBCs).
• List common acute complications of repeat blood transfusions.
• Describe common reactions to blood transfusions.
• Describe the appropriate administration of fresh frozen plasma.
• Identify the appropriate indications for PRBC transfusions in a variety of clinical scenarios.
• Examine alternative therapies when prothrombin complex concentrate is unavailable.
• Recognize the rise in platelet count level following transfusion in a variety of clinical scenarios.
• State clinical practice guidelines for platelet counts in bleeding and nonbleeding patients.
• Describe the appropriate method for quickly diluting red blood cells.
• Describe how to reverse the effects of warfarin in patients receiving anticoagulation.
• Identify the various traits of warfarin-reversing agents.

ABDOMINAL AND GASTROINTESTINAL DISORDERS

Appendicitis

• Characterize the pathophysiology of acute appendicitis.
• Describe the contribution of laboratory testing to the diagnosis of appendicitis.
• List the unique characteristics of pediatric appendicitis and diagnostic scoring methods.
• Identify the unique challenges of diagnosing appendicitis in women and acute appendicitis during pregnancy.
• Characterize the criteria for an ultrasonographic diagnosis of appendicitis.
• Describe the appropriate management for acute appendicitis.
• Describe the appropriate use of imaging in the diagnosis of appendicitis.
• Identify the limitations of computed tomography in the diagnosis of appendicitis.

Disorders of the Liver

• Describe the clinical presentation and management of alcoholic hepatitis, hepatic encephalopathy, brucellosis, yellow fever, amatoxin poisoning, heat stroke, hepatic sinusoidal obstruction syndrome, alpha-1 antitrypsin deficiency, and coinfection with hepatitis B virus (HBV)/HIV.
• Identify the clinical presentation and bacteriology of spontaneous bacterial peritonitis.
• Outline the management of and appropriate procedures for occupational exposure to HBV.
• Recognize the presentation of acute hepatitis C virus (HCV) infection.
• Characterize the clinical presentation and pathogenesis of leptospirosis.
• Identify the increased risk of fulminant hepatic failure among pregnant women infected with hepatitis E virus.
• Discuss the initialdiagnostic workup for suspected HCV infection.
• Examine the link between HCV infection and cryoglobulinemic vasculitis.
• Recognize the etiology of drug reaction with eosinophilia and systemic symptom syndrome.
• List the etiologies and presentation of infectious mononucleosis.

Esophagus, Stomach, and Duodenum

• Describe the clinical presentation of esophageal dysphagia.
• Outline the differential diagnosis of oropharyngeal dysphagia.
• List the priorities in the management of caustic ingestion.
• Identify methods for verifying placement of a nasogastric tube.
• Define the resuscitation goals in variceal hemorrhage.
• Characterize the treatment strategies in variceal hemorrhage.
• Formulate a differential diagnosis for upper gastrointestinal bleeding in the setting of cirrhosis.
• Describe the diagnostic work-up for esophageal perforation.
• Characterize the clinical presentation of achalasia.
• Outline treatment options for dyspepsia induced by nonsteroidal anti-inflammatory drug use.
• List the management principles for gastric volvulus.
• Describe the diagnostic work-up for a patient with suspected Zollinger-Ellison syndrome.
• Describe the management of a bleeding peptic ulcer.
• Recognize the risk factors for recurrent bleeding from peptic ulcer disease.
• Examine the potential complications of Zenker diverticulum.
• Examine the appropriate diagnostic work-up for esophageal perforation.
• Characterize the diagnostic work-up necessary for substernal chest pain.
• Identify the appropriate management techniques for gastroesophageal reflux disease.
• Describe the differential diagnosis of infectious esophagitis.
• Recognize the presentation of and provide appropriate treatment for Helicobacter pylori infection.
• Examine the management principles of perforated peptic ulcer.
• Define the differential diagnosis of gastric outlet obstruction.
• Outline the management of duodenal diverticula.

Infectious Gastroenteritis

• Recognize symptoms of Giardia infection.
• Discuss the classic presentation of Clostridium perfringens.
• Discuss the classic presentation of enterohemorrhagic Escherichia coli (EHEC).
• Discuss the most common viral cause of day care gastroenteritis.
• Discuss the classic symptoms of Campylobacter enteritis.
• Identify a case presentation of the Anisakis parasite.
• Discuss the presentation of botulism.
• Discuss the treatment of Brucella melitensis.
• Discuss the symptoms of hemolytic-uremic syndrome (HUS) and possible treatment mistakes.
• Discuss the diagnosis and treatment of cholera.
• Discuss ciguatera fish poisoning.
• Discuss gastroenteritis due to preformed toxin.
• Identify risk factors for Helicobacter pylori.
• Discuss acquisition of cryptosporidium.
• Discuss risk factors and presentation of Escherichia coli infection.
• Discuss treatment of Listeria monocytogenes.
• Manage nontyphoidal Salmonella.
• Discuss risk factors for and presentation of Yersinia.
• Discuss likely pathogens of gastroenteritis outbreaks in cruise ship groups.
• Discuss treatment of amebiasis.
• Discuss pathogens associated with raw oysters that can also cause a wound infection.
• Discuss invasive enteric organisms that cross the intestinal barrier.

TRAUMATIC DISORDERS

Burns: Thermal

• Identify burn patterns concerning for child abuse.
• Outline the diagnostic approach to inhalation injury.
• Review the safety of topical antimicrobials in the setting of pregnancy.
• Identify clinical hallmarks and describe the management of full-thickness burn injuries.
• Recognize ventilatory compromise requiring chest escharotomy.
• Determine criteria to initiate formula-guided fluid resuscitation.
• Determine fluid-resuscitation strategies for patients with burn injuries.
• Identify patients at risk for a difficult airway following a burn injury.
• Describe the impact of inhalation injury on resuscitation requirements after burns.

EENT Trauma: Nose

• Identify a retained foreign body in the nasal cavity.
• Explain the appropriate management of open facial fracture.
• Describe the appropriate evaluation of septal hematoma.
• Detail the anatomy of the nose.
• Describe the management of atraumatic epistaxis.
• Diagnose systemic causes of recurrent epistaxis.
• Recognize the signs and symptoms of posterior nasal bleeding.
• List the major complications of nasal trauma.
• Identify the appropriate treatment for barosinusitis.
• Recognize the differences between anterior and posterior epistaxis.

Head Trauma

• Apply the Glasgow Coma Scale.
• Analyze the probabilities of injury in cases of blunt head trauma.
• Outline the mortality rate associated with subdural hematoma.
• Recognize the clinical findings of basilar skull fracture.
• Describe the appropriate medical treatment for severe head trauma.
• Summarize the indications for computed tomography in cases of head trauma.
• Identify the findings associated with epidural hematoma.
• Recognize the first signs indicative of the Cushing reflex.
• Summarize the electrocardiographic changes seen in patients with head injuries.
• Characterize the immediate treatment necessary for patients with intracranial hypertension.
• Review the disposition criteria in cases of minor head trauma.
• Describe the frequency of types of major head injury patterns visible on imaging in early phases of injury.
• Recognize the appropriate treatment of scalp lesions and lacerations.
• Outline the pathology of skull fractures.
• Analyze the clinical correlation of anatomic injury location to injury potential in cases of head trauma.
• Review the appropriate follow-up care after mild concussive injury.
• Summarize the appropriate treatment of children with trauma to the head.
• Describe the medical management of penetrating head trauma.

Multiple and Blast Injuries

• Prioritize the needs of a patient with multiple injuries.
• Differentiate between various types of shock.
• Recognize common injury patterns associated with MVAs.
• Learn the importance of the secondary survey and the need to reassess trauma patients.
• Describe how blast injury complicates the resuscitation of trauma patients.

Orthopedic Injuries: Cervical Spine

• Examine spinal cord injuries that occur in the absence of fractures.
• Characterize spinal imaging criteria used in pediatric patients.
• Identify methods of intubation in the setting of cervical spine injury.
• Recognize stable and unstable cervical spine fractures.
• List the common characteristics of anterior teardrop cervical spine fracture.
• Describe the importance of understanding the mechanism of injury to determine the likely stability of the injury.
• Analyze the rate of asymptomatic minor defects observed on magnetic resonance imaging of the cervical spine.
• Define and describe the findings of clay shoveler's fractures.
• Appropriately characterize the Jefferson fracture by classification.
• Recognize radiographic findings of unilateral facet dislocation.
• Review clinical findings in bilateral facet dislocation syndromes.
• Analyze the differences between the Canadian C-Spine (cervical-spine) Rule and National Emergency X-Radiography Utilization Study algorithm.
• Summarize the indications for evaluating an arterial injury in the presence of cervical trauma.
• Discuss the pathology of the Jefferson fracture.
• Describe the appropriate trauma cervical spine imaging in the pregnant patient.
• Highlight common psychological difficulties in dealing with potentially seriously injured children.
• Examine the clinical findings and initial treatment of spinal cord injury without radiographic abnormality.
• List key factors in cervical spine injury in children.
• Classify the type of injury based on the Quebec Whiplash Associated Disorders Classification scale.
• Describe the clinical criteria of a hangman's fracture.
• Review the determination of stability of spinal fractures using the 3-column method of Denis.

Orthopedic Injuries: Foot

• Describe criteria for ordering foot radiographs.
• Examine appropriate therapy for patients with first metatarsal fractures.
• Discuss treatment for mid-shaft metatarsal fractures and Jones fractures.
• Identify appropriate treatment options for patients with fifth metatarsal fractures.
• Define criteria useful for clinically suspicious Lisfranc fractures.
• List the challenges of diagnosing a Lisfranc injury.
• Appropriately manage stress fractures.
• Diagnose stress fractures on imaging.
• Characterize the treatment of displaced hallux fracture.
• Examine appropriate management for distal phalanx fractures.
• Describe appropriate treatment for sesamoid fractures.
• Diagnose perineural fibrosis.

Orthopedic Injuries: Hand

• Identify management of proximal interphalangeal joint fractures.
• Describe the management of subungual hematomas, finger amputations, partial fingertip amputation, zone 6 lacerations, and closed-fist injuries.
• Discuss initial management strategies to avoid the complications of phalangeal malunion.
• Examine the acceptable clinical tolerance of fracture angulation for a fifth metatarsal fracture.
• Identify unstable zone 1 injuries to the distal phalanx.
• Discuss terms and definitions of the nail.
• Characterize the injury pattern of a skier’s thumb.
• Examine the appropriate assessment of injuries to the proximal interphalangeal joint.
• Identify a strain from a sprain in an ulnar collateral ligament injury.
• Discuss the management for high-pressure injection injuries and finger amputations.
• Discuss ischemic risks of an amputated finger.
• List causes of acute mallet finger injury.
• Examine the motor function of ulnar nerve.
• Identify radiographic views for diagnosing carpal–metacarpal dislocations.
• Recognize closed nerve injuries.
• Discuss structures commonly coinjured in vascular finger injuries.
• Identify possible challenges in diagnosing flexor tendon injuries.
• Examine the correlation between a patient’s initial presentation and the severity of high-pressure injection injuries.
• Identify signs and symptoms of compartment syndrome.
• Pinpoint the anatomic location of the median nerve in the hand.

Soft Tissue Neck Trauma

• Discuss the basic epidemiology of neck trauma.
• Examine unique injuries, potentially missed injuries, and the mortality rate in cases of penetrating neck trauma.
• Summarize the clinical anatomy of the neck and standard injury zones.
• Review airway techniques in neck trauma.
• Examine the anatomic neck zones for trauma care and the immediate management of life-threatening neck wounds.
• Recognize the clinical implications of the locations of injuries to the neck.
• List common and unique injuries that can clinically identify deep-structure damage locations in the neck.
• Summarize the management of common neck wounds.
• Examine the timing of neurologic injury evaluation in blunt neck trauma.
• Describe the mechanisms of tracheolaryngeal injury.
• Characterize the major components of hanging injury and airway management methods in hanging.
• Analyze the differences between systemic and pulmonary venous air embolism.
• Summarize the significance of Horner syndrome in cases of neck trauma.
• Identify signs that may require urgent or emergent surgical intervention.

Special Populations: Geriatric Trauma

• Discuss pitfalls of vital signs to indicate shock in geriatric trauma.
• Identify clinical signs and symptoms concerning for elder abuse.
• Diagnose spinal cord injury in the absence of vertebral fractures.
• Describe the risk factors for traumatic brain injury in the elderly.
• Identify the morbidity and mortality associated with rib fractures among elderly patients.
• Outline the management of therapeutic anticoagulation in the elderly trauma patient.
• Examine the risks associated with falls among the geriatric population.
• Discuss the factors complicating intubation among elderly trauma patients.
• Summarize the considerations for trauma resuscitation in elderly patients.
• Recognize signs of occult hip fracture in the geriatric population.

Special Populations: Trauma in Pregnancy

• Characterize the management of a pregnant woman involved in a motor vehicle collision.
• Identify emergent indications for cesarean delivery in trauma patients.
• Describe situations in which cardiopulmonary resuscitation should be continued or discontinued in the pregnant patient.
• Understand the indications for perimortem cesarean delivery.
• Recognize that fetal distress is the most sensitive indicator of placental abruption.
• Characterize the risk of radiation exposure to the fetus when plain radiographs are necessary in pregnant trauma patients.
• Understand the meaning of negative and positive results on the Kleihauer-Betke test.
• Identify the first indicator of significant maternal hemorrhage in the setting of blunt abdominal trauma.
• Describe the similarities and differences.

Trauma: Thoracic - Chest Wall

• Recognize the importance of injury to the chest wall.
• List the physical findings of injury to the chest wall.
• Describe the radiographic views necessary in patients with trauma to the chest.
• Review diagnostic updates to upper rib fracture.
• Summarize the diagnostic evaluation of secondary injuries related to rib fractures.
• Recognize the complications of sternal fractures.
• List the key points of flail chest injury.
• Explain key management updates in the treatment of thoracic trauma.
• Recognize subtle but severe injuries in patients after wearing ballistic vests.
• Identify the presentation of traumatic asphyxia.

Trauma: Thoracic - Esophageal Injuries

• Describe the diagnostic evaluation for caustic substance ingestion, esophageal injury and perforation, and Boerhaave syndrome.
• Examine the timeline of caustic ingestion pathology.
• Describe the appropriate evaluation of penetrating neck injury.
• Recognize that esophageal perforation may occur in blunt injury.
• Summarize the epidemiology of esophageal injury.
• Describe the classic presentation of Boerhaave syndrome.
• Differentiate esophageal tear symptoms based on location of injury.

Thoracic - Pulmonary Injuries

• Review the delayed presentations of thoracic trauma.
• Analyze a clinical contraindication to positive pressure ventilation in thoracic trauma.
• Identify a major cause of persistent pneumothorax.
• Examine secondary injuries often present in pulmonary contusion.
• List the problems of fluid resuscitation in patients with pulmonary contusion.
• Examine the utility of the initial history in determining patient disposition in thoracic trauma.
• Describe the clinical means of judging the severity of pulmonary contusion.
• Recognize the radiographic findings of pneumothorax.
• Describe the sensitivity of initial plain radiography in the evaluation of thoracic trauma to detect pneumothorax.
• Examine alternative management options in the delayed presentation of pneumothorax.
• Recognize the clinical indications for tube thoracostomy.
• List the indications for urgent thoracotomy.
• Review the sensitivity of clinical signs of tension pneumothorax.
• Describe the indications for emergent thoracotomy.
• List the reasons for persistent brisk hemothorax bleeding in thoracic trauma.
• Examine the foibles of supine chest x-rays in the setting of trauma.
• Review the manifestations of traumatic air embolism.
• List the indications for emergency department thoracotomy.