/ Department of Physician Assistant Studies
Learning. Caring. Serving. Leading.
PAS 634: Emergency Medicine
3 Semester Hours

Course Description: The Emergency Medicine clinical rotation is designed to teach students the recognition and treatment of acutely ill patients of all ages. This rotation will require honing of the student’s triage skills; learning to recognize and manage those conditions that need immediate attention and prioritizing care for those conditions which are less urgent.

Course Goals: The goals of the Clinical: Emergency Medicine rotation include:

  1. To apply the medical content and principles that define the care of emergency medicine patients.
  2. To provide opportunities for each student to develop the core PA competencies in a supervised emergency setting.
  3. To expose each student to an experienced and competent medical provider role model for the care of emergency medicine patients.

Course Director: / Office / Phone / E-mail
Diane Duffy, MD / FC 205 / 336-278-6848 /
Tracey Tonsor, PA-C / FC 207 / 336-278-6852 /

Learning Outcomes:

Upon completion of this course the clinical phase PA students will:

  1. Obtain and document an appropriate yet thorough problem-focused emergency history and physical examination utilizing all available information sources (e.g. patient, family, community)
  2. Describe common emergency problems including the pathophysiology, differential diagnoses, criteria for establishing a diagnosis, treatment and follow-up.
  3. Be able to recognize and manage life-threatening emergencies jointly with the multi-disciplinary physician-lead team.
  4. The student will demonstrate a systematic and thorough approach to the seriously ill child recognizing the role that understanding the developmental stage of a patient plays in the approach to, examination and treatment of a pediatric patient.
  5. Order and interpret diagnostic tests including laboratory results and imaging studies.
  6. Generate and implement an appropriate management plan, including treatment, follow-up plans, patient education and counseling.
  7. Discuss the appropriate use of medications in the emergency department related to such issues as dosage(taking into account considerations for pediatric, geriatric patients and women of reproductive age), indications, contraindications, interactions, complications and required monitoring.
  8. Determine the proper IV therapy for specific emergency and acute situations.
  9. Properly perform common emergency medicine procedures under the supervision of preceptor.
  10. Be able to communicate in a medically professional manner, both orally and in writing to the patient, the family and with health care professionals.
  11. Facilitate communication with the patient’s primary care physician to accomplish optimal transfer of care.
  12. Be aware of and responsive to the emotional and psychological effects of emergency care on the patient and his/her support system.

Teaching Methodologies: The content of this module will be presented through a variety of methods that include observation and participation at the clinical site, independent reading and participation in online activities developed to guide experiential learning.

Accommodations: Students requiring academic accommodations must follow the “Academic Support” policy in the Elon University DPAS Student Handbook.

Academic Honesty: All Elon PA students acknowledged their commitment to abide by the Elon Honor Code by signing the Honor Pledge during orientation.

Required Textbooks:

  1. All first-year required textbooks.
  2. CURRENT Diagnosis & Treatment Emergency Medicine, 7e

Library Resources:

  1. Textbooks, reference books, journals, online electronic databases.

Other Resources:

  1. *Moodle: Please check the course site frequently for new announcements, updated schedules, assignments and other course communication.
  2. Practicing physician assistants, physicians, allied health care providers and laboratory teaching aids

TOPIC LIST
Cardiology / ENT/Ophthalmology / Hematology
Chest Pain / Vision loss / Easy bruising
Palpitations / Nasal congestion / Fatigue
Dyspnea on exertion / Sore throat / Aplastic anemia
Orthopnea / Ear pain / Hemolytic anemia
Edema / Vertigo / Sickle anemia/crisis
Syncope / Blepharitis / Clotting factor disorders
Conduction disorders* / Conjunctivitis / Hypercoagulable states
Hypertensive emergencies / Blow-out fracture / Thrombocytopenia
Hypotension~ / Corneal abrasion/ulcer / Acute leukemia
Heart failure / Dacryoadenitis / Anemia
Coronary heart disease⌃ / Foreign body (eye, ear, nose) / Lymphomas
Vascular disease / Glaucoma (acute angle / Polycythemia
Valvular disease / closure) / Dermatology
Acute/Subacute bacterial / Hyphema / Itching
endocarditis / Macular degeneration / Rash
Pericardial effusion / Optic neuritis / Discharge
Cardiac tamponade / Orbital cellulitis / Dermatitis (eczema, contact)
Peripheral vascular disease / Papilledema / Drug eruptions
Arrhythmias / Retinal detachment / Stevens-Johnson syndrome
Angina / Retinal vein occlusion / Toxic epidermal necrolysis
Orthopedics/Rheumatology / Otitis externa / Bullous pemphigoid
Pain / Acute otitis media / Lice
Swelling/deformity / Trauma/hematoma - / Scabies
Ecchymosis/erythema / external ear / Spider bites
Fractures/dislocations / Barotrauma/TM perforation / Viral exanthems
(shoulder, forearm/wrist/ / Labyrinthitis / Herpes zoster
hand/, hip, knee, ankle/foot) / Mastoiditis / Cellulitis
Soft tissue injury / Acute sinusitis / Erysipelas
Back strain/sprain / Epistaxis / Impetigo
Low back pain / Acute pharyngitis (viral, / Burns
Caudaequina / Bacterial) / Urticaria
Herniated disk / Peritonsillar abscess / Pilonidal disease
Osteomyleitis / Dental abscess / Pressure sores
Septic arthritis / Acute laryngitis / Psychiatry
Costochondritis / Epiglottitis / Thought disorder
Bursitis/tendonitis / Tympanic membrane perforation / Changes in mood
Gout / Allergic Rhinitis / Hallucinations
Sprains/strains / Suicidal/homicidal ideations
Depression
Generalized anxiety disorder
Panic disorder
Post-traumatic stress disorder
Substance abuse disorders
Domestic violence
Suicide
TOPICS (cont’d)
Gastrointestinal / Pulmonology (cont’d) / Neurology (cont’d)
Abdominal pain / Pneumonia (bacterial, / Epidural/subdural hematoma
Anorexia / Viral, fungal, HIV-related) / Seizure disorders
Nausea/vomiting / Respiratory syncytial virus / Status epilepticus
Heartburn / Asthma / Syncope
Jaundice / Pleural effusion / Guillain-Barré syndrome
Hematemesis / Pneumothorax / Spinal cord injury
Melena; bleeding per rectum / Pulmonary embolism / Head trauma/concussion
Change in bowel habits/ / Acute respiratory distress / /contusion
diarrhea/constipation / syndrome / Bell’s palsy
Esophagitis / Foreign body aspiration / Obstetric/Gynecology
Mallory-Weiss tear / Tuberculosis / Vaginal discharge
Peptic ulcer disease / Lung cancer / Pelvic pain/dysmenorrhea
Acute cholecystitis / Endocrinology / Amenorrhea
Cholangitis / Palpitations / Dysfunctional uterine
Acute hepatitis / Heat/cold intolerance / Bleeding
Acute pancreatitis / Tremors / Endometriosis
Acute appendicitis / Hyperparathyroidism / Ovarian cysts
Diverticular disease / Hyperthyroidism / Vaginitis
Ischemic bowel disease / Thyroiditis / Pelvic inflammatory disease
Inflammatory bowel disease/ / Adrenal insufficiency / Mastitis/breast abscess
toxicmegacolon / Diabetes insipidus / Spontaneous abortion
Obstruction (small bowel, / Diabetic ketoacidosis / Ectopic pregnancy
large bowel, volvulus) / Non-ketotic hyperglycemia / Placenta previa
Anal fissure / Diabetes mellitus / Premature rupture of
Hemorrhoids / Cushing’s disease / membranes
Hernia (incarcerated/ / Hypothyroidism / Fetal distress
Strangulated) / Neurology / Abruption placenta
Infectious diarrhea / Vertigo / Intrauterine pregnancy
Gastritis / Seizure (symptom) / Urology/Renal
Gastroenteritis / Numbness/paresthesias / Dysuria
Diarrhea/constipation / Weakness/paralysis / Hematuria
Gastrointestinal bleeding / Loss of consciousness/ / Suprapubic/flank pain
Cirrhosis / change in mental status / Incontinence
Giardiasis and other parasitic / Loss of memory / Nephrolithiasis
Infections / Loss of coordination/ataxia / Testicular torsion
Pulmonology / Headache (migraine/cluster / Cystitis
Shortness of breath / tension) / Epidiymitis
Wheezing / Meningitis / Orchitis
Hemoptysis / Encephalitis / Prostatitis
Pleuritic chest pain / Transient ischemic attack / Pyelonephritis
Acute bronchitis / Stroke / Urethritis
Acute bronchiolitis / Subarachnoid hemorrhage/ / Acute renal failure
Acute epiglottitis / cerebral aneurysm / Glomerulonephritis
Croup / Intracerebral hemorrhage / Fluid and electrolyte disorders
Influenza / Altered level of consciousness / Acid/base disorders
Pertussis / /coma / Hernias

* Atrial fibrillation/flutter, supraventricular tachycardia, bundle branch block, ventricular tachycardia/fibrillation, premature beats

~ Cardiogenic shock, orthostatic hypotension

⌃ Acute MI, (non-ST/ST segment elevation), angina pectoris, unstable angina, Prinzmetal/variant angina)

 Aortic aneurysm/dissection, arterial occlusion/thrombosis, phlebitis

 Aortic stenosis, aortic regurgitation, mitral stenosis, mitral regurgitation

Assessment Activities:

End of rotation exam (30%), Preceptor Evaluation (60%), Professionalism (10%).

Grade Scale and Grade Points

Percentage / Letter Grade / Grade points
89.50-100
85.50-89.49
79.50-85.49
75.50-79.49
69.50-75.49
Below 69.50 / A
B+
B
C+
C
U / 4.0
3.3
3.0
2.3
2.0
0

There is no rounding of grades.

Note: For further information regarding academic standing in the Department of Physician Assistant Studies, please see the Student Handbook.

Grading Criteria:

  1. Demonstrate acquisition of a strong basic science and medical science knowledge base as demonstrated on the written examination/quizzes.
  2. Demonstrate satisfactory self-directed learning skills, clinical reasoning skills, commitment to patient-centered care and professionalism as evidenced by satisfactory performance on the preceptor evaluation.
  3. Demonstrate a commitment to learning and professionalism by actively participating in all clinical activities and exceeding the professional behavior standards and minimum requirements for clinical rotations available in the Elon PA Student Handbook.

Instructional Objectives:

  1. Clinical Skills:
  2. Elicit an appropriate complete or partial history from the patient or third party should the patient be a child or unable to supply a complete history. Determine the need for other resources (e.g., past records, consultation, other members of the health care team) to expand knowledge of the patient’s history.
  3. Perform focused or comprehensive physical examination appropriate for the age and gender of the patient, reason for visit, urgency of the problem and patient’s ability to participate in the examination.
  4. Perform a methodical, rapid, comprehensive, and accurate immediate assessment of patients presenting to the emergency department with life threatening emergencies.
  5. Perform a methodical, rapid, comprehensive, and accurate secondary assessment of patients presenting to the emergency department.
  6. Select and interpret the appropriate initial and subsequent laboratory and diagnostic studies based upon initial impressions determined from the history and physical examination and considering the indications and risks for those studies.
  7. Given a patient or appropriate historical, physical or laboratory data and considering variables such as patient age, pregnancy and other factors that would alter the approach to or treatment of a patient, be able to diagnose and initiate treatment for the presentations and/or diagnoseslisted in the Topic List.
  8. Evaluate severity of patient condition in terms of need for medical and/or surgical referral, admission to the hospital or other appropriate setting.
  9. Select the application or the technique required for common clinical interventions identifying appropriate monitoring of patients after interventions, including checking for compliance, adverse events and effectiveness.
  10. Communicate with the supervising physician regarding the patient’s emergency status as soon as possible
  11. Apply basic techniques of CPR
  12. Be trained in ACLS and able to assist the medical team with cases in which advanced life support is required. Know the indications and complications associated with individual ACLS protocols.
  13. Understand the indications and use of standard emergency medications and recommend appropriate administration recognizing situations in which dosing regimens are modified based on individual patient characteristics as in pediatric and geriatric patients and women of reproductive age. Identify key safety factors related to the administration of medications (oral, topical, sublingual, subcutaneous, intramuscular, rectal, otologic, vaginal, and ophthalmic).
  14. Be familiar with triage procedures in mass casualty situations.
  15. Perform the following procedures:
  16. Initiate IV therapy using sterile technique and universal precautions
  17. Insert and remove a nasogastric tube
  18. Insert and remove a urinary bladder catheter
  19. Obtain bacteriologic, viral, fungal and antigen detection cultures
  20. Participate in the placement of a central catheter
  21. Perform the following clinical procedures under responsible physician supervision
  22. Cleansing and debridement of wounds
  23. Administration of local infiltrative anesthesia, or digital blocks as appropriate
  24. Determination of major vessel, nerve or tendon involvement
  25. Proper suturing of the laceration including using sterile technique and observing universal precautions
  26. Use of steri-strips or Dermabond
  27. Drainage of abscesses
  28. Application/changing of surgical dressings
  29. Removal of sutures and staples
  30. Assess for need to administer tetanus booster
  31. Given a patient or simulated model demonstrate the correct manner to splint a fracture or soft tissue injury
  32. Be able to recognize the following for the given radiologic study:
  33. AP/Lateral view of bone: fracture, dislocations, osteolytic and osteoblastic lesions, osteoporosis, degenerative changes
  34. Flat plate and upright of abdomen: free intraperitoneal air, air/fluid levels within the bowel, intra-abdominal calcification, psoas shadows, nonspecific abdomen, dilated intestine
  35. Chest PA/Lateral: pulmonary infiltrates, pulmonary nodules, atelectasis, cardiomegaly, rib fractures, widened mediastinum, pleural effusions, normal chest x-ray.
  36. Present to the physician a brief synopsis of the patient’s present illness, pertinent positive and negative findings and the diagnostic and therapeutic regimen recommended.
  37. Select a clinical therapeutic plan that considers the cost, efficacy, possible adverse reactions, contraindications, and drug interactions for medications selected.
  38. Identify the risks for, and signs and symptoms of, drug interactions resulting from poly-pharmacy in the therapeutic regimen.
  39. Recognize the appropriate actions to take in response to acute, specific drug toxicity.
  40. Counsel patient and family regarding the health problem including incorporating the patient and family’s perspective with the medical explanation of the disease process, therapy and its rationale, therapeutic options, prognosis and health care services available.
  41. Document the patient visit in an problem oriented manner to include
  42. Presentation and history of present illness
  43. Pertinent past and family medical history
  44. Medications and allergies
  45. Physical examination findings
  46. Lab and diagnostic study results/interpretation
  47. Assessment and management plan
  48. Follow-up plans/appointments
  49. Arrange for discharge or transfer from the emergency department
  50. Communicate effectively with the patient, the attending physician and the receiving health professional assuring a smooth and complete transfer of care.

Emergency Medicine Rotation Expectations

Successful completion of the Emergency Medicine rotation will be evidenced by:

  1. Completion of the 6 week Emergency Medicine rotation.
  2. Documentation of a minimum of 100 patient encounters over the course of the rotation to include visits for:
  3. Acute illnesses
  4. Emergent illnesses
  5. Evaluation and treatment or self-study of the diagnoses listed in the Topic List of the Emergency Medicine syllabus.
  6. Completion of appropriate deliverable for Clinical Year Seminar (may include admission history and physical, or procedure notes).
  7. Participation/observation and documentation of the following procedures, as available:
  8. Intra-muscular injection
  9. Incision and drainage
  10. Initiate IV therapy using sterile technique and universal precautions
  11. Obtain bacteriologic, viral, fungal and antigen detection cultures
  12. Cleansing and debridement of wounds
  13. Administration of local infiltrative anesthesia, or digital blocks as appropriate
  14. Proper suturing of laceration
  15. Use of steri-strips or Dermabond
  16. Drainage of abscesses
  17. Application/changing of surgical dressings
  18. Removal of sutures and staples
  19. Lumbar puncture
  20. Casting and splinting
  21. Have achieved a passing grade (69.5% or greater) for the course from the following assessments:
  22. End of Rotation exam
  23. Preceptor Evaluation
  24. Professional Assessment Tool
  25. Contacting Clinical Education Team at any point in rotation to discuss concerns regarding the ability to achieve the above.

1

Revised 1/15/16