Med-Challenger's American Board of Emergency Medicine Certification review makes it easy to maintain emergency medicine board certification.New Fall Content Updates, Lifelong Value
On October 6th, 2019, Med-Challenger announced the release of fourth quarter updates to it’s best-selling ABEM Emergency Medicine ConCert & Certification reviews. The new updates (listed below) are available immediately.
Emergency Medicine Certification Review Updates for Fall 2019
“This release contains significant new material across many of the topics covered by the EM model, “ said David Beard, CEO of Challenger Corporation. “It represents the result of Challenger’s commitment to maintaining the highest quality standards in the industry, and to constantly review core content for changes in Emergency care.”
Updated topics include airway management, acute cardiovascular disorders, resuscitation guidelines, shock, toxicological issues, and traumatic presentations in the ER, among others. Full list below.
“Challenger’s subscription model and continuous updates, as well as our coverage of state-required credits, LLSA materials and ACEP credits, make our Emergency Medicine review a very unique offering,“ said Robert Sweeney, Executive Director.
Check out what's new in Emergency Medicine...
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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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.
- 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
- 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
- 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.
- 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.
- 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.
- 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.
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