Module 4: Emergency Medicine

Module Authors

Rosslynn S. Byous, MS, PA-C
Assistant Professor, Department of Physician Assistant Education
Western University of Health Sciences, Pomona, CA

Diana Lithgow, RN, MSN, FNP-C
Assistant Professor, Master of Science in Nursing/Family Nurse Practitioner Program
Western University of Health Sciences, Pomona, CA

By the end of this Review Concept you should be able to:

• Describe the goals of the emergency medical team member in providing patient care
• Explain the importance of cerebral resuscitation in emergency care
• Explain the central purpose of basic life support measures
• Define and differentiate Basic Life Support measures and Advanced Cardiac Life Support measures
• Define the ABCs of Basic and Advanced Life Support
• Describe circumstances in which defibrillation of a patient may be necessary
• Explain the role of differential diagnoses in the emergency care process
• List common clinical presentations of emergency patients
• Differentiate somatic and visceral pain

By the end of this Review Concept you should be able to:

• State three cornerstones of managing chest pain
• Explain the sequence of events that causes pain secondary to acute myocardial thrombosis
• Describe recommendations for the triage of emergency patients who present with chest pain
• Summarize the medical and financial impact of ischemic heart disease and myocardial infarction (MI)
• List risk factors associated with ischemic heart disease
• Describe the clinical signs and symptoms associated with ischemic heart disease and chest pain
• Describe physical examination procedures and laboratory studies used to confirm a diagnosis of ischemic heart disease
• Summarize management and therapeutic protocols for emergency patients with ischemic chest pain
• Describe additional therapies used to improve the outcomes of patients being treated for ischemic heart problems

By the end of this Review Concept you should be able to:

• Define common abnormal breathing patterns for the following conditions: o Dyspnea o Hypoxia o Hypercapnia
• Define each of the conditions listed above and describe the related pathophysiological mechanism or mechanisms
• List the etiologies and clinical manifestations associated with each of the conditions listed above
• Outline procedures and protocols for the diagnostic workup and clinical management for patients with each of the conditions listed above.

By the end of this Review Concept you should be able to:

• Describe the epidemiology, etiology, and pathogenesis of adult bacterial pneumonia and acute respiratory distress syndrome (ARDS)
• List risk factors that predispose individuals to adult bacterial pneumonia
• List pathogenic agents most often responsible for pneumonia infections
• Describe the clinical presentation of pneumococcal pneumonia and ARDS
• Describe procedures and typical findings in the physical assessment and diagnostic testing of patients with pneumococcal pneumonia
• Summarize treatment options and management priorities in cases of pneumococcal pneumonia
• List complications of unresolved pneumonia
• Describe physical exam procedures and typical findings in patients with ARDS
• Explain how diagnostic testing helps isolate the underlying cause of ARDS
• Summarize treatment and management priorities for patients with ARDS

By the end of this Review Concept you should be able to:

• Define asthma and describe its pathogenesis
• Describe the epidemiology of asthma
• List common triggers for asthma attacks
• Describe the clinical presentation of asthma and related examination procedure
• List medical conditions that have symptomatology similar to that of asthma
• Cite tests that are used in the differential diagnosis of asthma, and expected findings for each.
• Summarize treatment priorities and clinical interventions for the patient experiencing an acute asthma attack
• Compare and contrast pharmacological agents that are commonly used in the treatment of acute asthma attacks
• Describe discharge considerations for the asthma patient

By the end of this Review Concept you should be able to:

• Identify three types of abdominal pain
• Describe the etiology, pathogenesis, and clinical presentation of:
  • Somatic pain
  • Visceral pain
  • Referred pain
• Identify typical patterns of visceral pain
• Differentiate between intra-abdominal pain and extra-abdominal pain in terms of etiology and clinical characteristics
• Differentiate the clinical presentation of intra-abdominal pain caused by peritoneal inflammation, obstruction of a hollow viscus, and vascular disturbances
• List metabolic and neurogenic causes of abdominal pain
• Outline protocols and procedures in the diagnostic workup of the patient with abdominal pain

By the end of this Review Concept you should be able to:

• Define diabetic ketoacidosis (DKA)
• Describe the epidemiology and clinical presentation of DKA
• Outline assessment priorities and common findings for patients with DKA
• Describe the steps involved in assessing the emergency patient for DKA
• Describe laboratory studies that should be conducted on patients with DKA
• Outline the processes and procedures in managing patients with DKA

By the end of this Review Concept you should be able to:

• List examples of common ocular emergencies
• Outline assessment priorities and diagnostic procedures for patients with ocular emergencies
• Describe the clinical presentation of ocular emergencies such as:
  • Subconjunctival hemorrhage
  • Hyphema
  • Corneal abrasions
  • Foreign bodies
  • Chemical and thermal trauma
  • Traumatic iritis/iridocyclitis
  • Periorbital or ocular contusion
  • Blowout fractures
  • Central retinal artery occlusion (CRAO)
• Outline procedures and protocols in the diagnostic workup of the patient with the ocular emergencies described above
• Outline procedures and protocols in the clinical management of the patient with the ocular emergencies described above

By the end of this Review Concept you should be able to:

• Describe the epidemiology of ear pain and associated clinical manifestations
• Outline assessment priorities and diagnostic procedures for patients with ear pain
• Outline epidemiology, clinical presentation, and principle treatment options for the following common otological emergencies:
  • Cerumen impaction
  • Foreign body
  • Otitis externa (swimmer's ear)
  • Auditory tube dysfunction
  • Otitis media
• Describe the epidemiology and clinical presentation of peritonsillar abscess
• Outline procedures and protocols in the diagnostic workup of the patient with peritonsillar abscess
• Outline procedures and protocols in the clinical management of the patient with peritonsillar abscess
• Describe the epidemiology and clinical presentation of anterior and posterior epistaxis
• Outline procedures and protocols in the diagnostic workup of the patient with epistaxis
• Differentiate procedures and protocols in the clinical management of the patient with anterior bleeds and posterior bleeds List complications that may affect patients being treated for anterior and posterior epistaxis

By the end of this Review Concept you should be able to:

• Identify the three major types of toxicodendron plants
• Describe how patients contract dermatitis from contact with toxicodendron and how it spreads to other areas of the skin
• Describe the clinical presentation of toxicodendron-induced dermatitis
• Outline the procedures and protocols for the diagnostic workup and clinical management of the patient with toxicodendron-induced dermatitis
• Describe the epidemiology and clinical presentation of toxic epidermal necrolysis (TEN) and staphylococcal scalded skin syndrome (SSS)
• Outline the procedures and protocols for the diagnostic workup of patients with TEN and SSS
• Differentiate the procedures and protocols for the clinical management of patients with TEN versus SSS

By the end of this Review Concept you should be able to:

• Outline assessment priorities for patients with orthopedic emergencies
• Describe the steps involved in assessing a patient for spinal cord injury
• State the muscles that are tested during a motor screening of a patient with possible spinal cord injury
• State the landmarks that are tested during a sensory screening of a patient with possible spinal cord injury
• Describe additional tests that should be conducted on patients with suspected spinal cord injury
• Outline the recommended steps in managing patients with orthopedic emergencies

By the end of this Review Concept you should be able to:

• Describe the epidemiology and pathogenesis of childhood fever
• Explain the relationship between fever and bacteremia
• Describe the clinical presentation of childhood fever, including associated symptoms
• Outline procedures and protocols in the diagnostic workup of the febrile child
• List clinical indicators and differential diagnoses for the febrile child
• Outline procedures and protocols in the clinical management of the febrile child
• Describe the epidemiology and management of febrile seizures

By the end of this Review Concept you should be able to:

• Outline assessment priorities for pediatric patients with respiratory emergencies
• Describe the steps involved in assessing a pediatric patient for respiratory emergencies
• Describe additional tests that should be conducted on pediatric patients with suspected respiratory emergencies
• Outline the recommended steps in managing pediatric patients with respiratory emergencies
• Evaluate the extent of the pediatric respiratory emergencies

By the end of this Review Concept you should be able to:

• Describe the epidemiology of sudden infant death syndrome (SIDS)
• Describe the pathogenesis and clinical presentation of SIDS
• Outline procedures and protocols for the diagnostic workup of the patient who died from SIDS
• Outline procedures and protocols for the clinical management of the patient who has experienced an apparent life-threatening event (ALTE)
• Describe the epidemiology of childhood trauma
• Differentiate signs and symptoms of mild or moderate trauma from that of severe trauma
• Differentiate the activities included in the primary and secondary survey of the childhood trauma patient
• Outline procedures and protocols for the clinical management of child with traumatic injuries

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