Univeristy of Mississippi is now a 1-4 program!

PGY-1 Year
The intern year consists of one month rotations on: Pediatric Emergency Medicine, Trauma Surgery, Anesthesia, Medical ICU, Surgical ICU, Neuroscience ICU, Renal Consults, Neurology Consults, Adult ED, Internal Medicine, Labor/Delivery/Obstetrics and finishes out the year in the Adult Emergency Department. Call is limited to the ICUs, Internal Medicine, and Trauma Surgery.

Didactics
Didactics have been carefully constructed around the core content for emergency medicine. Formal conferences are held for 2 1/2 hours on Tuesdays and Thursdays. Conferences include: Grand Rounds, Morbidity and Mortality, Trauma, Core Topics, Follow-up's, Journal Club and Specialty Conference. Every month is scheduled around a core topic (Cardiology, Neurology, etc) with reading, lectures, and other topics corresponding to that months topic. By the end of the month, each resident is required to take an online quiz which complements the didatic material for the month.

Residents are expected to develop teaching skills at the bedside and in lectures for Core Topics Conference. Residents also present cases at Morbidity and Mortality Conference.

Rotations
The adult emergency department records approximately 65,000 visits annually, and experience in the emergency department is a primary component of the residency curriculum. In fact, after the intern year, the bulk of the program's four years are spent in the department under the guidance of our full-time faculty. The remaining curriculum encompasses selected rotations relevant to emergency care. Residents on these rotations function as full members of the given service and are extended the appropriate patient care responsibilities. These rotations not only complement and expand emergency department training but also provide exposure to the extended care of patients.

The fourth year includes eight weeks of elective time during which the resident and faculty advisor develop an individualized curriculum to round out residency training. This could include specific rotations to which the resident feels he or she needs additional exposure, outside rotations for a broader experience or a concentrated block during which the resident focuses on a specialty area. The four-year training program is summarized below:

* Denotes Call Month

ADMINISTRATIVE
This rotation is combined with the TelEmergency rotation in the EM2 year. The requirements for the administrative rotation are outlined below. These requirements are to be completed during the allotted time period.

• Check out the reading material from the program coordinator and meet with the course director at least one week prior to the beginning of your rotation, The reading shall be completed during the assigned two weeks.
• Review twenty charts for quality of documentation and code them. The performance improvement nurse has a form that should be used to review these charts. Contact the program director or the faculty performance improvement representative prior to the start of this rotation.
• Attend staff meetings that fall during the administrative weeks to give the resident an idea of the administrative issues that arise in the day-to-day management of an emergency department.
• Several meetings will be scheduled with medical directors of emergency departments at outside hospitals, members of the UMC hospital administration, a medical malpractice carrier, etc., for additional insight on certain aspects of administration.
• Each resident will be assigned a short administrative project to complete during this rotation. Please meet with the course director to outline your project.

Goals:

• Learn basic principles of leadership and administration
• Develop an understanding of quality assurance, departmental economic issues, and risk management programs and their application to the operation of an emergency department
• Develop an understanding of the function of emergency medicine within the institution and its relationship with other departments
• Develop an understanding of the function of accrediting agencies and their relationship with emergency medicine

Objectives:

• Discuss the following concepts as they relate to Emergency Medicine: credentialing, career development, recruitment, budgeting, cost containment, health care financing, managed care, personnel management, public relations, marketing, hospital administration, practice management, contracts, work schedules
• Discuss JCAHO requirements relating to the Emergency Department with emphasis on staffing, equipment and supplies, facility, quality assurance and patient transfer regulations.
• Discuss hospital and Emergency Department administrative organization.
• Discuss cost containment as relates to emergency medicine.

ANESTHESIOLOGY
This 2 week rotation will be spent in the Adult and Pediatric Operating Rooms at UMC. Direct supervision will occur at all times. Immediate, postoperative, recovery room activities will also be supervised by attending and resident staff.

Didactic Objectives:

• Develop airway management skills
• Develop familiarity with pharmacologic agents used in anesthesia and understand why certain anesthetic agents are preferable under various clinical circumstances
• Describe in detail the rapid sequence intubation
• Explain the four levels of anesthesia; compare the various ventilators, addressing their advantages and disadvantages
• Demonstrate knowledge of the anatomical landmarks and successfully perform regional nerve blocks
• Learn principles of pain management

Clinical Objectives:

• Demonstrate appropriate judgment regarding the need for airway intervention
• Perform endotracheal intubation by the oral and nasal routes demonstrating proper technique
• Occlude the esophagus to prevent regurgitation by applying cricoid pressure
• Understand the indications and contraindications of and be able to administer anesthetic agents, intravenous analgesia, and neuromuscular blocking agents.
• Perform commonly employed regional nerve blocks
• Gain familiarity with less often employed methods of airway management

Meeting Objectives:

• The objectives will be met through resident and attending staff teaching in the operating room, and through topic-oriented conference and case presentations.

EMERGENCY DEPARTMENT

EM 2 Year
During the first focused year in the Emergency Department, the focus of the resident will be primary patient care and expansion of knowledge base. He/she will have few, if any, supervisory or administrative functions. Supervision will be provided by emergency medicine senior residents and attending physicians.

Didactic Objectives:

• Achieving expertise in the core content topics is the expected didactic objective. The clinical exposure in the emergency department in conjunction with the didactic schedule and reading plan provides exposure to a large portion of the core content topics.

Clinical Objectives:

• Obtain a complete history and perform a directed physical examination.
• Recognize life-threatening conditions and quickly and precisely perform resuscitative and stabilizing measures on critically ill and injured patients
• Effectively triage patients so that the sicker patients receive medical attention first
• Develop a complete differential diagnosis for each clinical problem with which the patient presents
• Develop a problem-oriented approach to complex, critically ill patients
• Establish an ultimate diagnosis based on clinical evaluation and judicious use of laboratory and x-ray studies
• Initiate definitive medical care when appropriate and feasible
• Perform timely, safe dispositions on all types of patients seen in the emergency department, regardless of the severity of the problem
• Exercise good judgment in obtaining consultation on selected patients and concisely present patients in an orderly fashion to consultants
• Demonstrate a high degree of skill and sensitivity in dealing with other physicians and nursing and ancillary personnel in the emergency department
• Demonstrate the ability to manage multiple patients simultaneously in a timely fashion, realizing the importance of rapid movement of patients through the department
• Demonstrate ability to communicate effectively with patients and demonstrate sensitivity and empathy in dealing with patients
• Effectively carry out communication with advanced life support personnel in the field
• Exercise sound judgment in performing invasive procedures, accurately interpreting the indications for the procedures and weighing the benefit against any possible complications
• Recognize those procedures for which informed consent must be obtained

Skill Objectives:

• Recognize the indications for, and competently perform, emergency procedures
• Gain expertise in emergency airway management
• Effectively manage medical arrests and participate in the management of trauma arrests

Meeting Objectives:

• The objectives for these rotations will be met through bedside teaching, chart review, procedure labs and didactic conferences

EM 3 Year
In the third year of training each resident will be scheduled at least 50% of his/her time in the adult emergency department. In addition to primary patient care responsibilities shared by first year residents, the second-year resident will have some teaching and supervisory responsibilities. He/she will be expected to oversee care given by students, interns and first year residents, and will assist in teaching students and residents junior to him/her. He/she in turn will be supervised by the attending physician. It is during this year that the resident begins to widen his focus to include patient satisfaction issues, teaching, increasing awareness of patient flow and efficiency of the department as a whole.

Didactic Objectives:

• See EM2 Year objectives.

Clinical Objectives:
Same as EM2 year with the addition of:

• Evaluate patients more quickly and efficiently incorporate information from students and junior house officers into his own evaluation of the patient, thus making for a rapid evaluation, diagnosis and management of patients
• Instruct students and junior officers on the pathophysiology assessment, diagnosis and management of a large variety of injuries and illnesses; teach and assist junior house officers and students in the performance of emergency procedures
• Demonstrate ability to move patients efficiently through the department and acquire the skills to manage multiple patients simultaneously
• Demonstrate sound judgment when making the decision to admit patients
• Appropriately decide on admitting patients to the observation unit and oversee their care while in that unit

Skill Objectives:

• These objectives are the same as those for the first year rotations.
• Demonstrate expertise in trauma assessment, diagnosis, stabilization and disposition

Meeting Objectives:

• In addition to the means for meeting objectives for the first year rotations, these additional objectives will be met through close observation and critique of performance by attending physicians.

EM 4 Year
In the fourth year of the residency each resident will spend at least 50% his/her time in the adult emergency department.

During this time the resident will continue to do primary patient care; in particular he/she will direct the resuscitation of major trauma and critically ill medical patients.

The senior resident is responsible for the overall smooth functioning of the ED. This includes monitoring the number of patients in the waiting room, determining bed availability in the department and in the hospital, interacting with the charge nurse to efficiently use resources and space available, interacting with outside physicians in the transfer of patients, and maintaining communications with out-of-hospital care providers. Administrative decisions will be made by him/her in conjunction with the attending physician.

The senior resident will also supervise the care provided by students and house officers junior to him/her, and will assist in teaching students and junior house officers.

Didactic Objectives:

• See EM2 Year objectives.

Clinical Objectives:
In addition to meeting the objectives outlined for the seond and thir year rotations, the fourth year resident, upon completion of these rotations will be able to :

• Independently manage the emergency department in conjunction with the attending physician
• Confidently direct physician and nursing personnel in the delivery of care in the department
• Diplomatically settle disputes that arise over patient management and disposition
• Function effectively as trauma captain in major trauma resuscitations
• Make appropriate utilization of inpatient beds, especially when they are scarce
• Politely interact with outside physicians wishing to refer patients to this institution; make correct decisions regarding the appropriateness of patient transfers; exercise good judgment in specifying conditions for accepting transfer patients, placing emphasis on patient safety during transfer; and specify appropriate means of conveying transfer patients to the institution
• Provide an example for junior house officers in professional behavior and clinical expertise

Skill Objectives:

• See EM1 / EM2 objectives

Meeting Objectives:

• The objectives will be met by the same means as for the first and second years.

MEDICAL INTENSIVE CARE UNIT
This rotation will take place in the MICU/CCU of the Veterans Hospital or the MICU at University Hospital. Residents will work exclusively in this unit and be supervised by resident and attending staff.

Didactic Objectives:

• Describe the normal respiratory physiology
• Calculate an Aa gradient
• Interpret pulmonary function studies
• Demonstrate a basic understanding of the function of various types of ventilators
• Explain the pathophysiology of a variety of medical diseases
• Demonstrate a working knowledge of critical care monitoring devices, techniques and measurements

Clinical Objectives:

• Manage complex, critically ill patients
• Determine fluid needs based on complex hemodynamic parameters
• Initially establish and adjust ventilator settings
• Prescribe appropriate antibiotics for a variety of infections including septic shock of undetermined etiology
• Determine the need for intubation based on clinical and blood gas criteria
• Manage patients with massive gastrointestinal hemorrhage
• Determine which patients require ICU monitoring
• Determine when patients are brain dead
• Carry out advanced cardiac life support measures
• Learn appropriate use of paralyzing and sedating agents

Skill Objectives:

• Perform endotracheal intubation (nasal and oral)
• Perform endotracheal intubation over a fiber optic bronchoscopy
• Perform thoracentesis
• Insert a Swan-Ganz catheter using a Seldinger technique
• Insert an arterial line
• Attach monitoring lines to transducers and set up and utilize complicated monitoring equipment
• External and internal pacemaker placement

Meeting objectives:

• The objectives for this rotation will be met through bedside instruction by medical residents and critical care faculty and intensive care nurses, outside reading, and conferences.

Your responsibilities during this rotation are as follows:

• Contact th OB Department to find out which chief resident you will work with and need to contact. This should be done two weeks prior to the beginning of the rotation.
• You will be assigned to OB Receiving one week and L&D the other week, with flexibility to move between units if the assigned area has little or no ongoing patient activity, with approval of the supervising faculty and senior resident. The shift you work (either day or night shift) shall be determined by yourself and the OB chief resident. Night shifts afford you more freedom and less competition with other rotators and medical students for procedures.
• You will be expected to round on the postpartum ward patients on weekdays and one weekend out of the two-week rotation. The other weekend you will be off.
• You are responsible for reading the OBGYN section of Harwood-Nuss at this time.

OB Receiving:
While in OB receiving, the resident will evaluate patients in labor, pregnant patients with specific complaints (for example, dysuria, abdominal pain, vaginal bleeding) and evaluate complications of pregnancy (premature labor, early rupture of membranes, preeclampsia, eclampsia). You should also become familiar with reading fetal heart monitors.

L&D:
While in L&D the resident will be taught to assess the patient in active labor, will perform vaginal deliveries, repair episiotomies and assist with cesarean sections. Residents will be taught and supervised by OBGYN residents and attending physicians.

3-Wiser Routine Postpartum:
In the last 1 to 2 hours of a night rotation or the first 1 to 2 hours of a day rotation, you will round on routine postpartum patients, including preferentially those delivered by you the previous day (s). Hopefully some continuity of care will be enjoyed from day to day, and a mix of patients to be discharged or retained for another day will be seen. Residents will be taught and supervised by OBGYN residents, faculty, or Dr. Avis Haynes, a certified nurse midwife on the OBGYN faculty who oversees the routine postpartum obstetric service.

Didactic Objectives:

• List the differential diagnosis for vaginal bleeding (pregnant and non-pregnant patients)
• Define the four stages of labor
• Discuss the phases of the menstrual cycle
• Discuss the pharmacology of birth control pills and compare and contrast the available preparations
• Discuss the advantages and disadvantages of various contraceptive methods
• Discuss the pathophysiology of preeclampsia/eclampsia, abruptio placenta, and placenta previa
• Outline the pathophysiology, epidemiology, the acute and long-term complications and treatment regimens for PID
• Understand the pathophysiology, diagnosis and treatment of ectopic pregnancy
• Acquire understanding of the technique of culdocentesis and its rare indications.

Clinical Objectives:

• Perform a complete gynecological evaluation including a pelvic examination
• Determine when delivery is imminent and perform a vaginal delivery
• Correctly diagnose and stabilize patients with ruptured ectopic pregnancy
• Appropriately utilize pelvic ultrasound in diagnosing pelvic masses, intrauterine pregnancies and possible ectopic pregnancies
• Recognize the signs of preeclampsia and make the appropriate disposition
• Correctly classify abortions based on physical examination and make the appropriate disposition.

Skill Objective:

• Perform incision and drainage of Bartholin duct abscess
• Remove IUD’s
• Assist in performing cesarean sections
• Remove a vaginal foreign body
• Insert a vaginal packing
• Repair minor vaginal lacerations
• Assess stages of labor and perform unassisted vaginal delivery

Meeting Objective:

• The objectives for this rotation will be met through outside reading, bedside teaching, demonstration of procedures, and didactic conferences

PEDIATRIC EMERGENCY DEPARTMENT
EM1 and EM 2 residents rotate for four weeks in the Pediatric Emergency Department at the University Hospital. Resident function in this department will be very similar to that in the adult Emergency Department. Residents will be responsible for patient assessment, stabilization, diagnosis, management and disposition. Supervision will be by pediatric attending staff. Contact the Pediatrics Chief Resident six weeks before the rotation to give requests for days off.

Didactic Objectives:

• Demonstrate an understanding of normal physiology and growth and development of children
• Compute dosages of drugs and intravenous fluids on a per kilogram basis and have familiarity with the Broselow tape
• Discern the differences between adults and children in their responses to a number of clinical conditions including: dehydration, hemorrhagic shock, head trauma, drug ingestions (and envenomation), meningitis and hypoxia
• Reproduce the normal immunization schedule for children
• Repeat guidelines for tube size selection for endotracheal, chest, and nasogastric tubes and for Foley catheters
• Demonstrate an understanding of the pathophysiology, diagnosis and treatment of disease states unique to childhood or predominantly seen in childhood

Clinical Objectives:

• Perform an effective clinical assessment of sick and injured children
• Demonstrate confidence and comfort in dealing with children and their parents
• Accurately diagnose common childhood diseases
• Manage pediatric multiple trauma cases
• Appropriately work up and manage fever in young children
• Diagnose and manage otitis media
• Recognize and treat decompensation from upper and lower respiratory diseases
• Estimate the degree of dehydration from the clinical appearance
• Order appropriate intravenous fluids (type and amount)
• Manage pediatric poisonings
• Diagnose and manage fractures, dislocations, acute arthritis and other pediatric orthopedic problems like: epiphyseal injuries (including slipped capital femoral epiphyses and Osgood-Schlatter’s disease), rickets and osteogenesis imperfecta
• Demonstrate sensitivity in dealing with grief reactions of family members of severely ill, injured or recently expired children

Skill objectives:

• Perform endotracheal intubation (oral and nasal), demonstrating proper technique, in children ranging in age from less than 1 to 14 years
• Perform nasogastric tube insertion and gastric lavage
• Perform Foley catheter insertion
• Draw arterial blood gases in infants and children
• Demonstrate expertise in obtaining venous access in children of all ages / including intraosseous infusions
• Perform femoral central venous pressure line insertion in children greater than one year of age
• Perform venous cutdowns
• Remove cerumen impactions in children using a cerumen spoon
• Remove foreign bodies of the ear and nose
• Assist in the removal of upper esophageal foreign bodies
• Perform lumbar puncture in children of all ages
• Perform diagnostic peritoneal lavage
• Perform tube thoracostomy
• Apply orthopedic splints and casts
• Suture simple and complex lacerations
• Perform arthrocentesis
• Interpret pediatric x-ray studies

Meeting Objectives:

• The objectives for this rotation will be met through bedside teaching by resident and attending staff, outside reading, daily chart reviews and topic oriented lectures, weekly grand rounds and weekly resident conferences

Didactic Objectives:

• Describe the normal respiratory physiology
• Calculate an Aa gradient
• Interpret pulmonary function studies
• Demonstrate a basic understanding of the function of various types of ventilators
• Explain the pathophysiology of a variety of pediatric diseases
• Demonstrate a working knowledge of critical care monitoring devices, techniques and measurements

Clinical Objectives:

• Manage complex, critically ill pediatric patients
• Determine fluid needs
• Initially establish and adjust ventilator settings
• Prescribe appropriate antibiotics for a variety of infections including sepsis of undetermined etiology
• Determine the need for intubation based on clinical and blood gas criteria
• Determine which patients require ICU monitoring
• Determine when patients are brain dead
• Carry out advanced cardiac life support measures
• Learn appropriate use of paralyzing and sedating agents

Skill Objectives:

• Perform endotracheal intubation (nasal and oral)
• Perform thoracentesis
• Insert venous arterial lines
• Set up and utilize complicated monitoring equipment
• Perform invasive pediatric resuscitations, monitor unstable patients, and direct major resuscitations. A major resuscitation is patient care for which prolonged physician attention is needed and interventions such as defibrillation, cardiac pacing, treatment of shock, intravenous use of drugs (e.g. thrombolytics, vasopressors, neuromuscular blocking agents), or invasive procedures (e.g. cutdowns, central line insertion, tube thoracostomy, endotracheal intubation) which are necessary for stabilization and treatment. The resident must have the opportunity to make admission recommendations and direct resuscitations.

Meeting the Objectives:

• The objectives for this rotation will be met through bedside instruction by medical residents and critical care attendings and intensive care nurses, outside reading, and conferences.

PREHOSPITAL
Emergency Medical Services is a critical component of emergency medicine and, as such, the education of the resident in EMS is very important. One week in the junior year is dedicated to in-depth EMS training ( EMS rotation). In addition to clinical exposure to ground and air ambulance services, the resident will be given mandatory reading assignments.

 During this one-week rotation the resident will get a concentrated exposure to prehospital care. The bulk of the time on this rotation will be spent on paramedic ambulances. The resident is required to complete four 12-hour shifts with AMR or three 12-hour shifts with AMR and one 12-hour shift with AirCare. The resident may do more shifts than this minimum if they desire.

When riding on the ambulance, the primary role will be one of observation and assisting as requested. The intent for this component of the rotation is to learn how the EMS system and personnel work, not to replace these individuals. Instruction during this rotation will be primarily through the emergency department attending in charge of EMS coordination and through paramedics.

During the remainder of their residency program, residents will be allowed the opportunity to fly with the helicopter on appropriate cases when they are working in the emergency department and time and space permit. Electives are available for any resident with more interest in EMS including air medicine. Residents also have the opportunity to participate in the education of paramedic students if they wish.

You will be required to turn in the ride log sheets to the program coordinator at the completion of your rotation.

Didactic Objectives:

• Describe the concepts of on‑line and off‑line medical control
• Relate background and history leading to the development of EMS systems
• Define what a National Registry EMT basic (A), intermediate (I) and paramedic (P) can do in the field
• Trace the development of helicopter air ambulance services in the United States
• Discuss who regulates ambulance services and establishes equipment guidelines for them
• Discuss quality assurance measures for ambulance personnel, particularly at an advanced skill level
• Discuss disaster management principles
• Demonstrate an understanding of radio communications and the various systems that are available

Clinical Objectives:

• Demonstrate an appreciation of the difficulties encountered by prehospital personnel in delivering care
• Assist in the resuscitation and stabilization of patients at the scene and en route to the hospital

Skill objectives:

• Assist in extricating patients from damaged motor vehicles
• Better understand management issues for EMS services, both air and ground units.

Meeting Objectives:

• The objectives of this rotation will be met through outside reading, sessions with the emergency attending and other personnel as outlined and by bedside instruction by paramedics.

TELEMERGENCY
This rotation provides exposure to a wide variety of adult and pediatric patients in multiple rural emergency departments. In addition, it allows for familiarization with state of the art technology utilized to direct patient care in remote areas distant from the primary clinical teaching site.

During each Telemergency shift the resident will link-up with supported emergency departments throughout the state. Patients at remote sites will initially be evaluated by specially trained nurse practitioners that will in turn present each patient to the Telemergency physician via telemedicine equipment. The resident's responsibilities will include supervising and directing the patient care provided by the nurse practitioners. Staff supervision and guidance is available 24 hrs/day by the Emergency Department attending.

Rotating residents will be an integral part of the Telemergency quality assurance and performance improvement program. This will include evaluating/reviewing medical records of telemergency patients and performing follow-up on a percentage of patients seen. Critical evaluation of medical treatment provided will occur with the end goal being the development and implementation of continuing education for residents and nurse practitioners in order to continue to provide quality emergency medical care.

Responsibilities:

• Obtain shift schedule
• Contact the faculty director of the rotation 1-2 weeks prior to rotation to arrange familiarization with equipment and to obtain reading and administrative assignments
• Assist in the teaching (initial training) and continuing education of Nurse Practitioners
• Perform designated number of Telemergency shifts during rotation.

Objectives:

• Discuss limitations of rural emergency medicine and specific challenges related to providing EM in a rural setting.
• Discuss how technology can be used to overcome the challenges of providing quality medical care in remote and rural areas.

Meeting Objectives:

• The objectives for this rotation will be met through outside reading, demonstration of equipment usage, and didactic conferences.

TOXICOLOGY ROTATION
During this rotation the resident will serve as a member of the Clinical Toxicology consult team at the University of Mississippi Medical Center. They will carry a cellular phone and serve as the initial contact for physician-requested consults from the Mississippi Poison Control Center. The resident will also be responsible for initially seeing hospital and ED patients for whom toxicology consults have been requested. These patients may be in the Adult or Pediatric Emergency Departments or hospital inpatients at the University Medical Center. The resident will also see patients during scheduled outpatient clinics. The resident will participate with patient rounds as scheduled and toxicology conferences at the Mississippi Regional Poison Control Center.

Didactic objectives:

• Outline the approach to poisoned patients given the variables of type of ingested substance and clinical condition of the patient
• Discuss the pathophysiology and management of common poisonings
• Demonstrate an understanding of the toxicology laboratory and how to use that service
• Develop a reasonable differential diagnosis given a set of signs and symptoms after an unknown ingestion (toxidromes)
• Develop a familiarity with toxicology reference materials including texts and computer data bases
• Develop an understanding of the problems associated with assessing chronic chemical exposures, including environmental and agricultural exposures

Specific topics for exposure during the rotation include:

• The pharmacology, and toxicology, diagnosis and management of common overdose syndromes
• Pharmacokinetics
• Gastric decontamination procedures and indications
• Airway management in the poisoned patient
• Hemodynamic support of the poisoned patient
• Alkaline and acid burns
• Hemodialysis and charcoal hemoperfusion
• Venomous snake bites
• Venomous spider bites
• Antidotes
• Withdrawal syndromes
• Poisondex use
• Computer database and internet sources for toxicology

Clinical Objectives:

• Properly assess poisoned patients
• Provide supportive care to seriously poisoned patients
• Decide which patients should undergo gastric emptying
• Administer appropriate antidotes for specific poisonings
• Determine which types of poison exposures would benefit from hemodialysis or hemoperfusion
• Determine when a poison center consultation is appropriate
• Recognize which patients require admission and/or intensive care monitoring and which patients can be observed in and discharged from the emergency department
• Advise other physicians on appropriate management of the poisoned patient

Skill objectives:

• Use Micromedex and Internet resources to obtain toxicology information.
• Calculate loading and maintenance doses of certain drugs
• Read nomograms for salicylate and acetaminophen ingestions
• Order appropriate studies from the toxicology laboratory

Meeting objectives:

• The educational aspects of this rotation will be augmented with a didactic series of lectures on medical toxicology that will be presented throughout the year. The following reference materials will be used for this rotation and the resident should be familiar with these.

Didactic Objectives:

• Reading requirement – The textbook entitled Ultrasound in Emergency Medicine by Heller and Jehle shall be completed by the end of the elective. Books are to be returned to Lisa May.
• Attendance is mandatory at all didactic sessions.
• Residents shall present an interesting ultrasound case or lecture during EM Conferences. This may be presented outside of the scheduled elective month.
• The basics of emergency medicine ultrasound shall be reinforced during this elective as well as an introduction to advanced applications such as musculoskeletal ultrasound and transesophageal echocardiography.
• Credentialling in EM ultrasound shall be discussed.
• Ultrasound machine ‘trouble shooting’ shall be presented.

Clinical Objectives:

• Residents shall perform 20 hours per week of hands-on scanning within the department of emergency medicine. This shall not be performed at the same time as an assigned resident clinical shift. Residents shall identify their availability to the attending faculty on duty in the emergency department. The resident shall not be the primary resident responsible for the patient upon which the ultrasound was performed.
• Residents are responsible for documentation of each ultrasound performed. Videotape of scans are encouraged for review sessions.
• It is projected that 50 – 75 scans can be completed during this month rotation.

Meeting Objectives:

• Participating residents are required to have completed the introductory course in emergency medicine ultrasonography (UMC) or provide documentation of completion of an acceptable equivalent basic emergency ultrasound course (as approved by the course director).