Department of Physician Assistant Studies
Learning. Caring. Serving. Leading.
PAS 634: Emergency Medicine
3 Semester Hours
Course Director:
Office
Phone
E-mail
Diane Duffy, MD
Tracey Tonsor, PA-C
FC 205
FC 207
336-278-6848
336-278-6852
dduffy2@elon.edu
ttonsor@elon.edu
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.
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.
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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. Students will sign an Honor Pledge (electronically
or manually) each time an assignment is turned in or an examination is started to reaffirm their
complete understanding of the Honor Code of Elon University and their affirmation that their work
abides by that Code.
Required Textbooks:
1. All first-year required textbooks.
2. Emergency Medicine – A Comprehensive Study Guide, Companion Handbook by Cline, 5th Ed.
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
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TOPIC LIST
Cardiology
Chest Pain
Palpitations
Dyspnea on exertion
Orthopnea
Edema
Syncope
Conduction disorders*
Hypertensive emergencies
Hypotension~
Heart failure
Coronary heart disease⌃ 
Vascular disease
Valvular disease
Acute/Subacute bacterial
endocarditis
Pericardial effusion
Musculoskeletal
Pain
Swelling/deformity
Ecchymosis/erythema
Fractures/dislocations
(shoulder, forearm/wrist/
hand/, hip, knee, ankle/foot)
Soft tissue injury
Back strain/sprain
Low back pain
Cauda equina
Herniated disk
Osteomyleitis
Septic arthritis
EENT
Vision loss
Nasal congestion
Sore throat
Ear pain
Vertigo
Blepharitis
Conjunctivitis
Blow-out fracture
Corneal abrasion/ulcer
Dacryoadenitis
Foreign body (eye, ear, nose)
Glaucoma (acute angle
closure)
Hyphema
Macular degeneration
Optic neuritis
Orbital cellulitis
Papilledema
Retinal detachment
Retinal vein occlusion
Otitis externa
Acute otitis media
Trauma/hematoma external ear
Barotrauma/TM perforation
Labyrinthitis
Mastoiditis
Acute sinusitis
Epistaxis
Acute pharyngitis (viral,
Bacterial)
Peritonsillar abscess
Dental abscess
Acute laryngitis
Epiglottitis
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Hematology
Easy bruising
Fatigue
Aplastic anemia
Hemolytic anemia
Sickle anemia/crisis
Clotting factor disorders
Hypercoagulable states
Thrombocytopenia
Acute leukemia
Neurology
Vertigo
Seizure
Numbness/paresthesias
Weakness/paralysis
Loss of consciousness/
change in mental status
Loss of memory
Loss of coordination/ataxia
Headache (migraine/cluster
tension)
Meningitis
Encephalitis
Transient ischemic attack
Stroke
Subarachnoid hemorrhage/
cerebral aneurysm
Intracerebral hemorrhage
Altered level of consciousness
/coma
Epidural/subdural hematoma
Seizure disorders
Status epilepticus
Syncope
Guillain-Barré syndrome
Spinal cord injury
Revised 10/23/13
TOPICS (cont’d)
Gastrointestinal
Abdominal pain
Anorexia
Nausea/vomiting
Heartburn
Jaundice
Hematemesis
Melena; bleeding per rectum
Change in bowel habits/
diarrhea/constipation
Esophagitis
Mallory-Weiss tear
Peptic ulcer disease
Acute cholecystitis
Cholangitis
Acute hepatitis
Acute pancreatitis
Acute appendicitis
Diverticular disease
Ischemic bowel disease
Inflammatory bowel disease/
toxic megacolon
Obstruction (small bowel,
large bowel, volvulus)
Anal fissure
Hemorrhoids
Hernia (incarcerated/
Strangulated)
Infectious diarrhea
Dermatology
Itching
Rash
Discharge
Dermatitis (eczema, contact)
Drug eruptions
Stevens-Johnson syndrome
Toxic epidermal necrolysis
Bullous pemphigoid
Lice
Scabies
Spider bites
Viral exanthems
Herpes zoster
Cellulitis
Erysipelas
Impetigo
Burns
Urticaria
Pilonidal disease
Pressure sores
Psychiatry
Thought disorder
Changes in mood
Hallucinations
Suicidal/homicidal ideations
Depression
Generalized anxiety disorder
Panic disorder
Post-traumatic stress disorder
Substance abuse disorders
Domestic violence
Suicide
Women’s Health
Vaginal discharge
Pelvic pain/dysmenorrhea
Amenorrhea
Dysfunctional uterine
Bleeding
Endometriosis
Ovarian cysts
Vaginitis
Pelvic inflammatory disease
Mastitis/breast abscess
Spontaneous abortion
Ectopic pregnancy
Placenta previa
Premature rupture of
membranes
Fetal distress
Genitourinary
Dysuria
Hematuria
Suprapubic/flank pain
Incontinence
Nephrolithiasis
Testicular torsion
Cystitis
Epidiymitis
Orchitis
Prostatitis
Pyelonephritis
Urethritis
Acute renal failure
Glomerulonephritis
Fluid and electrolyte disorders
Acid/base disorders
* 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
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Assessment Activities:
End of rotation exam (25%), Preceptor Evaluation (65%), Professionalism (10%).
Grade Scale and Grade Points
Percentage
89.50-100
85.50-89.49
79.50-85.49
75.50-79.49
69.50-75.49
Below 69.50
There is no rounding of grades.
Letter Grade
A
B+
B
C+
C
U
Grade points
4.0
3.3
3.0
2.3
2.0
0
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:
a. 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.
b. Perform a methodical, rapid, comprehensive, and accurate immediate assessment of
patients presenting to the emergency department with life threatening emergencies.
c. Perform a methodical, rapid, comprehensive, and accurate secondary assessment of
patients presenting to the emergency department.
2. 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
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3.
4.
5.
6.
7.
8.
9.
10.
11.
of a patient, be able to diagnose and initiate treatment for the presentations and/or diagnoses
listed in the Topic List.
Communicate with the supervising physician regarding the patient’s emergency status as soon
as possible
Apply basic techniques of CPR
a. Establish and airway
b. Initiate or sustain effective ventilation
c. Perform external cardiac massage
Be trained in ACLS and able to assist the medical team with cases in which advance life support
is required. Know the indications and complications associated with individual ACLS protocols.
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.
Be familiar with triage procedures in mass casualty situations.
Perform the following procedures:
a. Initiate IV therapy using sterile technique and universal precautions
b. Insert and remove a nasogastric tube
c. Insert and remove a urinary bladder catheter
d. Obtain bacteriologic, viral, fungal and antigen detection cultures
e. Participate in the placement of a central catheter
Perform and interpret the following laboratory procedures
a. Venipuncture for complete blood count, chemistry panels
b. Arteriopuncture for arterial blood gases
c. 12 lead EKG
For each of the following procedures be able to discuss the indications, contraindications,
complications, equipment needed, and proper technique
a. Defibrillation
b. Chest tube insertion
c. Venous cutdown
d. Thoracentesis
e. Paracentesis
f. Lumbar puncture
g. Joint aspirations
h. Tracheostomy
i. Cast and splint application
j. Endotracheal intubation
k. Intra-osseous (I/O) access
Perform the following clinical procedures under responsible physician supervision
a. Cleansing and debridement of wounds
b. Administration of local infiltrative anesthesia, or digital blocks as appropriate
c. Determination of major vessel, nerve or tendon involvement
d. Proper suturing of the laceration including using sterile technique and observing
universal precautions
e. Use of steri-strips or Dermabond
f. Drainage of abscesses
g. Application/changing of surgical dressings
h. Removal of sutures and staples
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i. Assess for need to administer tetanus booster
12. Given a patient or simulated model demonstrate the correct manner to splint a fracture or soft
tissue injury
13. Be able to recognize the following for the given radiologic study:
a. AP/Lateral view of bone: fracture, dislocations, osteolytic and osteoblastic lesions,
osteoporosis, degenerative changes
b. Flat plate and upright of abdomen: free intraperitoneal air, air/fluid levels within the
bowel, intra-abdominal calcification, psoas shadows, nonspecific abdomen, dilated
intestine
c. Chest PA/Lateral: pulmonary infiltrates, pulmonary nodules, atelectasis, cardiomegaly,
rib fractures, widened mediastinum, pleural effusions, normal chest x-ray.
14. 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.
15. 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.
16. Document the patient visit in an problem oriented manner to include
a. Presentation and history of present illness
b. Pertinent past and family medical history
c. Medications and allergies
d. Physical examination findings
e. Lab and diagnostic study results/interpretation
f. Assessment and management plan
g. Follow-up plans/appointments
17. Arrange for discharge or transfer from the emergency department
18. Communicate effectively with the patient, the attending physician and the receiving health
professional assuring a smooth and complete transfer of care.
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