The

1
2
PREFACE

The Egyptian Fellowship Board and The Emergency Medicine Scientific Council worked
collaboratively and closely to make this curriculum available for trainees’ guidance and support.
Postgraduate medical education worldwide is now governed by sets of academic standards that describe
the qualities and abilities of graduates. In addition, there are standards for the training processes, trainers’
selection and methods of assessment. Standards ensure transparency and clarify expectations.
The Egyptian fellowship board has already defined and published its standards for the general and
professional competencies expected from our graduates in different specialties upon successful
completion of training. These expectations are clearly reflected in the emergency medicine curriculum.

The curriculum describes what trainees will know and be able to do upon completion of training. In
additions, methods of teaching and learning needed to deliver the curriculum are outlined. The curriculum
also describes in details, expectations from trainees during their rotations in “The training rules and
regulations section”. Methods of assessment and examination regulations are also available in the last
section of the curriculum.

All topics covered during practical and theoretical study are outlined in tables. This will help trainees to
guide their readings and their choice of learning activities. In addition, all required clinical cases and
procedures are listed together with expected performance at various stages of training

To help our trainers, supervisors and maximize benefits, we provided a guide for required lectures at
various rotations and years. Mandatory courses are also mentioned and the Egyptian Fellowship Board
will work closely with emergency medicine scientific council to ensure proper organization and
implementation of courses at appropriate training stages.
We hope that all our trainees, trainers and educational supervisors will follow the guides provided in the
curriculum and cooperate with The Egyptian Fellowship Board and Emergency Medicine Scientific
Council to implement the curriculum in the best ways.

OSAMA ALI SHAZLY

Secretary General
Higher Committee of Medical Specialties

2018

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ACKNOWLEDGEMENT

This curriculum has been created through collaboration between The Emergency Medicine Scientific
Council and The Egyptian Fellowship Curriculum Committee. The following members of the Emergency
Medicine Scientific Council have made substantial contribution to the curriculum development as subject
matter experts;
PROF. DR. HUSSEIN SABRI ,
Professor of Anesthesiology and Intensive Care, Ain Shams University
Head of the Emergency Medicine Scientific Council
PROF. DR. MAMDOUH ZAKY
Professor of Orthopedics, Ain Shams University
DR. ATEF NASR
Senior Consultant in Emergency Medicine
PROF. DR. JEHAN EL-KHOLY
Professor of Anesthesiology, Cairo University
PROF. DR. ZEINAB SOUNBO L
Professor of Anesthesia, Mansoura University
PROF. DR. HESHAM WAGDY
Professor of general surgery, Ain Shams University
PROF. DR. MOHAMED MOUNIR EL -SAEID
Professor of Cardio-thoracic Surgery, Mansoura University
DR. AZZA ZOHDY
Consultant of Pediatrics, Ministry of Health
PROF. DR. FATMA AHMED ABD EL AAL,
Professor of Anesthesiology and Intensive Care, Assiut University
PROF. DR. HALA EL GENDY,
Professor of Anesthesiology and Intensive Care, Tanta University
DR. MONIRA TAHA ISMAIL,
Assistant Professor of Emergency Medicine, Suez Canal University
DR. ESRAA HAMDY NASSAR
Assistant Lecturer of Emergency Medicine, Tanta University
DR. AMR ELHASANY
Senior Consultant in Emergency Medicine
DR. WESAM MOHAMED ABDELAZIZ
Senior Consultant in Emergency Medicine

The Egyptian Fellowship Curriculum Committee has made significant contribution to the curriculum
through Collaboration with the council in the design and formulation of the educational structure. The
Member who participated in the work is
PROF. DR. Malak Shaheen
Professor of Pediatric pulmonary, consultant professional medical education, Ain Shams University

MR, ASHRAF HAMDY

For his great help and valuable guidance

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The Committees consulted international and regional curricula in emergency medicine. The
external references for the development of this curriculum are
1. The Royal College of Emergency Medicine Curriculum
2. The American Council for Graduate Medical Education (Emergency Medicine Program
requirements and Practice models)
3. The Royal Australasian College Curriculum for training in Emergency Medicine.
4. Postgraduate Medical Education and Training Board UK (Guidelines for Curriculum
Development)

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CONTENTS

Introduction 7
Core Competencies of Emergency Medicine 9
The Structure of Emergency Medicine Training Program 14
Specific Requirements and Obligations 16
General Rules and Regulations 18
General Intended Learning Outcome 19
Emergency Medicine Rotations 20
First Part Syllabus 21
Detailed Curriculum of Emergency 25
Resuscitation 26
Anesthesia and pain management 29
Acid base and Electrolyte Disorders 31
Infectious Diseases and Sepsis 32
Rheumatology 33
Diabetes and other Endocrinology Disorders 35
Cardiac Emergencies 37
Respiratory Emergencies 39
Hepatic Emergencies 41
Gastrointestinal Emergencies 42
Hematological Emergencies 43
Oncological Emergencies 45
Neurological Emergencies 46
Renal Emergencies 48
Urology in the ER 50
Dermatological Emergencies 51
Psychiatric Emergencies 53
Trauma, Wounds and Burns 55
Orthopedic Emergencies 61
ENT Emergencies 64
Eye Emergencies 66
Vascular Emergencies 67
Gynecological and Obstetric Emergencies 68
Toxicology and Environmental Emergencies 70
Pediatric Emergencies 73
Pre-hospital Care 75
Lectures 78
Assessment Methods 82

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 INTRODUCTION
Rational statement
The purpose of this curriculum is to describe in explicit details, the knowledge, skills, behaviors and
attitudes expected from emergency physicians upon completion of training in Egyptian Emergency
Fellowship. The curriculum also describes the methods of teaching and learning that will be used to
facilitate the delivery of curriculum. In addition, it highlights the different methods of trainee's
performance evaluation that are going to be used whether formative or summative.

The curriculum contents have been formulated through the following methods:
1.1. Revision of previous Egyptian Fellowship Emergency medicine curriculum
1.2. Revision of international curricula for postgraduate training in emergency medicine. We
specifically mention the;
1.2.1. Royal College of Emergency Medicine, (UK) curriculum approved by the PMETB,
and the
1.2.2. Australian Royal College of Emergency Medicine curriculum
1.3. Consultation of experts in the field of emergency medicine and other related specialties.
Experts were consulted regarding their vision for emergency medicine practice in Egypt
and how international standards would fit. We also consulted them regarding the level
of knowledge and skills required in each training year and in each specialty while putting
in mind expected practice constrains
1.4. The curriculum then was revised by representative members of the Emergency Medicine
Scientific Council and approved by the Scientific Council in February 2008 and October
2013, May 2018

Curriculum aim
The aim of the Emergency Medicine curriculum is to equip trainees with the knowledge, skills and
attitudes required for the prevention, diagnosis, and management of the acute and urgent aspects of illness
and injury affecting patients of all age groups

Criteria of an Emergency Physician

Emergency Medicine is a field of practice based on the knowledge and skills required for the prevention,
diagnosis, and management of the acute and urgent aspects of illness and injury affecting patients of all
age groups with a full spectrum of undifferentiated physical and behavioral disorders. It is a specialty in
which time is critical.

1. The Emergency Physician (EP) looks after patients with a wide range of pathologies from the life
threatening to the self-limiting in all age groups.
2. The EP is expert in establishing the diagnosis and differential diagnosis especially in life
threatening situations.
3. The EP safely and effectively differentiates and places patients on care pathways which lead to
appropriate discharge with follow up when needed ,admission to an ED based observation unit or
admission into hospital.
4. The EP works in the difficult and challenging environment of the Emergency Department and is
able to re-prioritize and respond to new and urgent situations.
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5. The EP is part of amulti-disciplinary team where good communication and inter personal skills are
essential.
6. The EP is able to work both within and lead a team to ensure the patient’s needs are met.
7. The EP is able to work closely with a wide variety of in-patient teams and with primary care and
pre-hospital clinicians.
8. The EP is committed to the highest standards of care and of ethical and professional behavior
within the specialty of Emergency Medicine and within the medical profession as a whole.
9. The EP is caring, empathetic, conscientious and practices medicine without prejudice.

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CORE COMPETENCIES OF EMERGENCY MEDICINE
Some of the competencies identified in this curriculum are those required of a hospital specialist in any
medical discipline whilst others are more specific to the practice of Emergency Medicine. However, it is
accepted that the levels of competence required of an Emergency Physician in specialized areas of
medical practice should be limited to those which determine whether and when urgent or immediate more
specialist referral is appropriate. Emergency Medicine complements and does not seek to compete with
other hospital medical disciplines.

The areas of competency in Emergency Medicine are:

1) Patient care
2) Medical knowledge
3) Communication, collaboration and interpersonal skills
4) Professionalism, ethical and legal issues
5) Organizational planning and service management skills
6) Education and research

1. PATIENT CARE
Emergency Physicians care for patients with a wide range of pathology from the life threatening to the
self-limiting and from all age groups. The attendance and number of these patients is unpredictable
and they mostly present with symptoms rather than diagnoses. Therefore the provision of care needs
to be prioritized, and this is a dynamic process.
The approach to the patient is global rather than organ specific. Patient care includes physical, mental
and social aspects. It focuses on initial care until discharge or referral to other health professionals.
Patient education and public health aspects must be considered in all cases. To ensure the above
patient care, EPs must particularly focus on the following:

1.1. Triage
EPs must know the principles of triage which is the process of the allocation and medical
prioritization of care for the pre-hospital setting, the Emergency department and in the event of
mass casualties. It is based mainly on the evaluation of vital parameters and key symptoms to
prioritize and categorize patients according to severity of injury or illness, prognosis and
availability of resources.
1.2. Primary assessment and stabilization of life threatening conditions
The ABCDE approach must be the primary assessment tool for all patients and does not require
a diagnostic work-up. It is a structured approach with which to identify and resuscitate the
critically ill and injured. EPs must be able to assess, establish and maintain:
[A] Airway
[B] Breathing
[C] Circulation
[D] Disability, and
[E] Exposure of the patient... Core Competences of Emergency Medicine
1.3 . Focused medical history
EPs must focus the initial medical history on presenting complaints and on clinical findings as
well as on conditions requiring immediate care.
1.4 Secondary assessment and immediate clinical management
EPs must perform secondary assessment with a timely diagnostic work-up focusing on the need
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 for early action. Clinical management must also include further aspects of health (physical,
mental and social).
1.5 Clinical decision making
EPs must be able to make clinical decisions including:
 Re-triage
 Immediate and/or definitive care provided in the ED
 Planning for admission or discharge
1.6 Clinical documentation
EPs must make contemporaneous medical records which focus on:
 relevant medical history
 main complaints and abnormal findings
 provisional diagnosis and planned investigations
 results of investigations
 conclusions and management decisions
 treatment
 patient information
1.7 Re-evaluation and further management
EPs must perform continuous re-evaluation of the patient, with adjustment of the provisional
diagnosis and care when it becomes necessary.

2. MEDICAL KNOWLEDGE AND CLINIICAL SKILLS

Emergency Physicians (EPs) need to acquire the knowledge and skills described in sections 3.2, 3.3,
3.4 and 3.5.

3. COMMUNIICATION, COLLABORATIION & INTERPERSONAL SKILLS

Emergency Medicine is practiced in difficult and challenging environments. Effective communication
is essential for safe care and for building and maintaining good relationships avoiding barriers such as
emotions, stress and prejudices. EPs must be able to use both verbal and non-verbal communication
skills, as well as information and communication technology. In the case of a patient who is
incompetent by virtue of age or mental capacity, communication should be with a parent or other legal
representative.

EPs must be able to demonstrate communication and interpersonal skills that include the following:
3.1. Patients and relatives
EPs should give special attention to involving the patient in decision-making, seeking informed
consent for diagnostic and therapeutic procedures, sharing information, breaking bad news,
giving advice and recommendations on discharge and also communicating with populations
with language barriers.
3.2. Colleagues and other health care providers
Important skills for an EP are sharing information on patient care, working as a member or the
leader of a team, referring and transferring patients
3.3. Other care providers such as the police, the fire department and social services
EPs must give attention to respecting patient confidentiality.
3.4. Mass media and the general public
EPs must be able to interact with the mass media according to the hospital policy in a
constructive way, giving correct information to the public and at the same time respecting the
privacy of the patient.
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4. PROFESSIIONALISM AND OTHER ETHICAL AND LEGAL ISSUES
4.1. Professional behavior and attributes
The general professional behavior and attributes of Emergency Physicians must not be adversely
influenced by working in stressful circumstances and with a diverse patient population. They
must learn to identify their educational needs and to work within their own limitations. They
must be able to self-motivate even at times of stress or discomfort. They must recognize their
own as well as system errors and value participation in the peer review process [8, 9]
4.2. Working within a team as a leader or a member of the team
EPs must understand the role of colleagues in other specialties and must be able to lead or to
work effectively even in a new or large team often under considerable stress.
4.3. Delegation and referral
EPs must understand the responsibilities and potential consequences of delegating, referring to a
colleague in another discipline or transferring the patient to another physician, health care
professional or health care setting.
4.4. Patient confidentiality
EPs must understand the law regarding patient confidentiality and data protection.
They must know what confidentiality problems arise when dealing with relatives, the police,
EMS communication, telephone discussions and the media.
4.5. Autonomy and informed consent
EPs must respect the right of competent patients to be fully involved in decisions about their
care. They must also value the right of competent patients to refuse clinical procedures or
treatment. They must understand how the ethical principles of autonomy and informed consent
affect emergency practitioners ... Core Competences of Emergency Medicine
4.6. The competent/incompetent patient
EPs must be able to assess whether a patient has the competence to make an informed decision.
They must also understand the legal rights of a guardian or adult with power of attorney and
when they treat minors. They must be familiar with those aspects of mental health legislation
which relate to competence.
4.7. Abuse and violence
EPs must be able to recognize patterns of illness or injury which might suggest physical or
sexual abuse or domestic violence to children or adults. They must be able to initiate appropriate
child or adult protection procedures. They must also learn to prevent and limit the risks of
violence and abuse to staff working in an emergency setting.
4.8. Do not attempt to resuscitate (dnar) and limitations of therapeutic interventions
EPs must learn to discuss with colleagues and in a professional and empathic manner with
relatives the initiation or possible discontinuation of active interventions when this is considered
to be medically appropriate [10]. They must understand when and how they should use advance
directives such as living wills and durable powers of attorney.
4.9. Medico-legal issues
EPs must operate within the legal frame work of the country in which they are working.
4.10. Legislation and ethical issues in emergency medicine
EPs should have an understanding of ethics and law, as well as the legal aspects of bioethical
issues in Emergency Medicine. They must be able to make a reasoned analysis of ethical
conflicts and develop the skills to resolve ethical dilemmas in an appropriate manner. They must
also look to the law for guidance, although the law does not always provide the answer to many
ethical problems.
Ethics in Emergency Medicine help to prepare EPs to face new ethical dilemmas in their
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 practice [9, 11]. The use of ethical analysis provides the framework for determining moral duty,
obligation and conduct. EPs must learn to identify, refine, and apply general moral principles to
their practice related to:
 Patient autonomy (informed consent and refusal, patient decision making capacity,
treatment of minors, advance directives, the obligations of the Good Samaritan statutes).
 End of life decisions (limiting resuscitation, futility).
 The physician-patient relationship (confidentiality, truth telling and communication,
compassion and empathy)
 Issues related to justice (duty, ethical issues of resuscitation, health care rationing, moral
issues in disaster medicine, research, resuscitation issues in pregnancy).

5. ORGANIISATIONAL PLANNING AND SERVICE MANAGEMENT SKILLS

This competence is needed to enhance the safety and quality of patient care and work environment.
Emergency Physicians must continuously adapt and prioritize existing and available resources to
meet the needs of all patients and maintain the quality of care.
5.1. Case management
EPs must be able to provide and balance the different care processes between the individual
patient and the total case-mix. After primary and secondary assessment, they may refer a patient
to another point of contact within the health care or social network. They must provide clear
guidance to those patients discharged without formal follow up.
5.2. Quality standards, audit and clinical outcomes
It is important that EPs use evidence-based medicine and recognize the value of quality
standards to improve patient care which is effective and safe. They must be able to undertake
audit and use clinical outcomes, including critical incident reporting, as ways of continuously
improving clinical practice.
5.3. Time management
EPs must be able to manage the individual patient as well as the overall patient flow in a timely
manner which is dependent upon available resources, accepted medical standards and public
expectation. EPs must also learn to manage their own time in an effective way.
5.4. Information management
EPs often manage patients for whom limited information is available. They may need to
communicate with other agencies to obtain relevant information whilst respecting the
confidentiality of the patient. Patient data collected during the process of care must be accessible
to all involved health care professionals through adequate documentation.
EPs need a broad knowledge of the latest advances in medicine and must be able to access and
manage information relevant to the specific care of an individual patient.
5.5. Documentation
EPs are responsible for clear, legible, accurate, contemporaneous and complete records of
patient care where the author, date and time are clearly identified. Documentation is a
continuous process and all entries must be made in real time as far as possible.

6. EDUCATIION AND RESEARCH:

6.1. Self-education and improvement
EPs must develop their knowledge and practice in EM by continuous education. They have to
identify areas for personal improvement and learn to implement patient care based on scientific
evidence.
6.2. Teaching skills
EPs must be involved in teaching undergraduate, graduate and post graduate health care
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 students, and the general population. They must also continuously develop the skills to be
effective teachers....
6.3. Critical appraisal of scientific literature
EPs must be able to investigate and evaluate their own practice. They must learn to use
evidence-based medicine and guidelines, where applicable, and become familiar with the
principles of clinical epidemiology, biostatistics, quality assessment and risk management.
6.4. Clinical and basic research
EPs must understand the scientific basis of EM, the use of scientific methods in clinical research
and the fundamental aspects of basic research. They must be able to critically review research
studies and be able to understand, present and implement them into clinical practice. They
should understand the process of developing a hypothesis from a clinical problem and of testing
that hypothesis. They should also understand the specific aspects of obtaining consent as well as
the ethical considerations of research in emergency situations.

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 STRUCTUTRE OF THE EM TRAINING PROGRAM

The Egyptian Fellowship Board requires four years of supervised training program that must be
conducted in accredited hospitals before sitting for the final examination.
A list of accredited hospitals will be announced yearly by the board.
The emergency medicine training program follows your graduation from medical school and it does not
require any further postgraduate studies as an entry requirement. It consists of four years of residency in
emergency medicine. During the entire training program the candidate must be dedicated full time and
must be fully responsible for patient care both at emergency and routine settings.

 FIRST YEAR
1- The trainee should spend the first five months in accredited departments including the care
of adults (four months) and children (one month). He should then spend one month in
surgery rotation and two months in general medicine rotation. One month should be spent in
anesthesia department and operative theater and one month in ICU department, one month in
neuro-surgery, one month in CT surgery (rotation table page 20).
2- Candidate should attend and study the curriculum of applied basic science and fundamentals
of emergency medicine during this year. He should attend at least 75% of lectures in these
subjects. He should pass successfully through the first part Fellowship Exam before being
promoted to the third year of training.
3- He should be actively involved and fully responsible for patient care including sharing in
making decisions about diagnosis and management under supervision of the consultants.
4- He must attend 75% of weekly meetings including patients' rounds, tutorials and journal
clubs
5- His performance will be monitored by His trainer and a report made of his performance on
monthly basis to the Egyptian Fellowship Board.

IMPORTANT NOTICE
Trainees must pass successfully all the foundation courses before being promoted
to the second year of training.
Full information about the foundation courses is available at the EF website and
administration office.

 SECOND YEAR
1- The trainee should spend four months in emergency department rotation and one month in
each of the following specialties; pediatric emergency, obstetrics and gynecology, plastic
surgery, orthopedics and coronary care units. In addition, he should spend two weeks block
rotations in each of the following specialties; toxicology, radiology, otolaryngology and
ophthalmology.
2- Rotations according to table (see page 20 )
3- They should be responsible under supervision for patients' routine work.
4- They must take supervised shifts according to the hospitals requirements and regulation.
5- They must go into ambulance calls either alone or with seniors according to hospital needs
6- They must respond to hospital departments emergency consultations as defined by the
hospital rules and regulations

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 THIRD YEAR
1- The trainee should spend four months in emergency department rotation, one month in
pediatric emergency medicine rotation, one month in general surgery, two months in
intensive care units, one month in neuro psychiatry, one month in neurosurgery and one last
month could be spent as an elective in any specialty related to emergency medicine
2- Rotations according to table ( see page 20)
3- He should also be involved in the preparation of short thesis or audit project on a subject
approved by the supervisor of the Emergency fellowship training program.

 FOURTH YEAR
1- The Emergency department rotation in the fourth year: one month in pediatric emergency
rotation, two months in ICU including Surgical ICU, one month in ophthalmology, ENT,
CCU, and two months as an elective rotation (see page 20).
N.B. Aim of Surgical ICU rotation,
a. As an operating room
b. Nutritional support
c. Significant head injury
d. Resuscitation end point
e. Traumatic shock, ARDS
f. Medical problems and infection in operated patients
g. Mechanical ventilation
2. Every candidate should also be involved in the preparation of short thesis or audit project on
a subject approved by the supervisor of the emergency fellowship training program.
3. During this year every candidate should present his essay according to the rules put by the
scientific council (attached)
4. During the last 3 month, candidates sit for the second and third part exam. And who pass
them are granted the graduation degree
5. The third part exam consists of OSCE and structured viva exam

The final graduation score reflects the competence in knowledge, skills, communication and
problem solving.

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 SPECIFIC REQUIREMENTS & OBLIGATIONS
1. DURING THE EMERGENCY DEPARTMENT ROTATIONS
1.1. The trainee will be responsible for supervised admission to the emergency room through:
1.1.1. Emergency assessment of the case and rapid documentation of initial data
1.1.2. Request of investigations, recording and interpreting the results
1.1.3. Initiation of management including resuscitation and stabilization
1.1.4. Request for proper consultations
1.2. He should be responsible for safe and timely referral in indicated conditions
1.3. He should lead ambulance team services upon request
1.4. He should respond to calls for help in the management of life threatening conditions in different
hospital departments according to his level of training and the action requested

2. DURING THE HOSPITAL ROTATIONS

(Departments other than emergency department)
2.1. The admitted patients
2.1.1 The trainee will be responsible for supervised admission of patients from the outpatient
department or emergency room.
2.1.2 He will share in the completion of the following documents under super vision for each
case
 Complete history and physical examination form.
 Investigation requests, (laboratory, radiology, pathology, etc.).
 Results of the investigations.
 Plan of management.
 Daily progress notes.
 Order and medication sheets
 Order the necessary diagnostic procedures
 Discussion of the case with the trainer and consultants
 Discharge summaries.
 Sick leaves and medical reports.
 The Trainee should inform the senior staff of any high risk patient admissions
2.2. Outpatient clinics
The trainee should attend the outpatient clinics related to the rotation and its
subspecialties as requested by trainers and supervisory staff..
2.3. Mandatory clinical and academic activities
The trainee should attend and participate in the mandatory academic and clinical activities of the
department. Attendance and participation should not be less than 75% of the total number of
activities within any training rotation / period including.
 Daily morning endorsement meetings
 Clinical round presentation, at least once weekly to cover various
 topics, problems, research, etc.
 Journal club meeting.
 Interdepartmental Meetings
 Mortality and morbidity conferences

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3. OTHER REQUIREMENTS
3.1. The log book
The trainee should keep a Log Book where he records all activities and skills performed and
learned during the training program. The activities should be dated and categorized to whether
been performed by the trainee him/herself or as an assistant or participant. Each activity
registered in the Log book should be counter signed by the trainer and finally the educational
supervisor. The Trainer and educational supervisor shall sign the completed Log Book.
3.2. The research or audit project
The trainee shall undertake at least one research project or audit during the training program
under the guidance and supervision of a nominated supervisor (nominated by the scientific
council). Such project or mini thesis should be written before the trainee is accepted for
admission to the final certifying examination.
3.3. Before completion of the training program
The trainee should have completed satisfactorily the Rotations described in the structure of the
program and performed him/herself and assisted in the various requested procedures

17
 GENERAL RULES AND REGULATIONS

1. HOLIDAYS AND ON CALL DUTIES

According to Ministry of Health and Population regulation

2. EVALUATION PROCEDURES
2.1. Performance of the trainee shall be evaluated on regular and continuous basis the evaluation
process should involve all aspects of the training including theoretical, clinical and
investigative procedures skills as well as the attendance and participation.
2.2. The trainers who are required to write confidential reports of the performance of each trainee
should evaluate the trainee periodically. The trainee should not be allowed to proceed in the
training program and move to the next rotation unless he/she attains a satisfactory level of
performance acceptable to the responsible trainer and educational supervisor.
2.3. The trainee shall not be allowed to proceed to year 3 before successfully passing the first part
Exam

3. INTERRUPTION OF TRAINING
It is not permissible to interrupt such a structural training program except in major unavoidable
circumstances. Such circumstances should be convincing and approved by the Secretary General. The
Interruption once approved should not be for more than one year. Interruption of the training program
for more than one year shall result in dismissal from the program and cancellation of the preceding
training period.

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 GENERAL INTENDED LEARNING OUTCOME

By the end of training in emergency medicine, trainees will be able to:

1. Apply wide varieties of knowledge about disease causation, patho-physiology, clinical
presentation and management at the point of patient care. This knowledge includes life threatening
and emergency diseases affecting both adults and children at various body organs and systems

2. Watch over patients with a wide range of pathologies from the life threatening to the self-limiting
in all age groups.

3. Establish the diagnosis and differential diagnosis especially in life threatening situations.

4. Identify the critically ill and injured, provide safe and effective immediate care and initiate or
plan for definitive care.

5. Perform resuscitation and all other practical procedural skills mentioned in the curriculum

6. Appropriately differentiates between various patients expected pathways from hospital admission
to safe discharge

7. Works in the difficult and tough environment of the Emergency Department, prioritize patients
and tasks and be able to respond to new urgent situations

8. Work effectively as a member or a leader of a multi-disciplinary team and practice good

communication skills

9. Refer appropriately for in-patient care, primary care or specialized clinicians.

10. Be committed to the highest standards of care and behave ethically and professionally as
expected from emergency physicians and all health care professionals

11. Continuously improve his practice by utilizing the best available research evidence and be
committed to lifelong learning

12. Educate colleagues and junior doctors about matters related to individual patient care and good
medical practice

19
 EMERGENCY MEDICINE ROTATION CHART
Emergency
Medicine
Rotations

First Year Second Year Third Year Fourth Year

Emergency Emergency Emergency Emergency

Medicine, 5 Medicine, 4 Medicine, 4 Medicine, 5
Months Months Months Months

Pediatric
Pediatric ER ,1 Pediatric ER, 1 Pediatric ER, 1
Emergency, 1
month Month Month
Month

Amb. & Amb. &

Anesthesia and Ophthalmology, 1
Leadership, 1 Leadership, 1
OR, 1 Month Month
Month Month

General
Obst. & Gyne., 1 Anesthesia & OR,
Medicine, 1 ENT, 1 Month
Month 1 Month
Month

General Surgery, Orthopedics, 1

Burns, 1 Month ICU, 1 Month
1 Month Month

Radiology, 1 Orthopedics, 1
ICU, 1 Month PICU, 1 Month
Month Month

Special Surgery Toxicology, 1 Psychiatry, 1

CCU, 1 Month
(CT), 1 Month Month Month

Special Surgery Neurology, 1 General Surgery, Pediatrics, 1

(N/U), 1 Month Month 1 Month Month

General
1 Month 1 Month
Chest, 1 Month Medicine, 1
Vacation Vacation
Month

1 Month 1 Month
Vacation Vacation

N.B.: Annual leave should be during emergency rotation.

20
FIRST PART
SYLLABUS
BASIC SCIENCE

21
 BASIC SCIENCE TOPICS
APPLIED ANATOMY

1. SURFACE ANATOMY of The human body

2. NERVOUS SYSTEM (Nerve supply of body wall and limbs, dermatomes, myotomes, nerve
supply of head and neck, autonomic nervous system, sympathetic nervous system,
parasympathetic nervous system, cranial autonomic ganglia
3. CENTRAL NERVOUS SYSTEM (Brain, Mid Brain, Brain Stem, Cerebellum and Spinal Cord)
4. HEAD AND NECK (Skull and Cranial Cavity, Face, Mouth, Pharynx, Larynx, Ear, Neck,
Vessels, Cranial Nerves, Vertebral Column , Spinal Canal and the Eye)
5. UPPER LIMB (Pectoral Girdle, Breast and Axilla, Scapular Region, Arm, Forearm, Hand,
Joints, Vessels and Nerves)
6. LOWER LIMB ( Front of the Thigh, Adductor Compartment, Gluteal Region, Hamstring
Compartment, Popliteal Fossa, Front of the leg, Dorsum of the foot, Peroneal Compartment,
Calf, Sole, Joints, Vessels and Nerves)
7. THORAX (chest wall and diaphragm, Mediastinum, Heart and Great Vessels, Airways and
Lungs)
8. ABDOMEN AND PELVIS (Abdominal Wall and Peritoneum, Gut, Liver, Spleen, Pancreas,
Kidneys, Ureters, Bladder and Urethra, Reproductive Organs, Joints of Pelvis, related Vessels and
related Nerves)

CLINICAL PATHOLOGY
1. Normalvalues:Normal values in emergency diseases
2. Abnormal values: Pathological values in emergency diseases

PATHOLOGY
1. TISSUE REPAIR AND INFLAMMATION
1.1. Inflammation
1.2. Repair by healing, scar formation, and fibrosis
1.3. Cutaneous wound healing
1.4. Fibrosis
2. HEMODYNAMIC DISTURBANCES
2.1. Edema
2.2. Hyperemia and congestion
2.3. Hemorrhage
2.4. Thrombosis
2.5. Hemostasis
2.6. Embolism
2.7. Infarction and atherosclerosis
2.8. Shock

PHYSIOLOGY/PHARMACOLOGY & MICROBIOLOGY

1. CARDIOLOGY
1.1. Physiological principles of cardiac cycle and cardiac conduction
1.2. Homeostasis of the circulation
1.3.Atherosclerosis
22
 1.4. The clinical pharmacology of emergency cardiac drugs (drugs used in arrest, inotropes and other
emergency cardiac medications)
1.5.Antiarrhythmic medications (sodium channel blockers, beta blockers, action potential prolonging
drugs and calcium channel blockers)
1.6. Antihypertensive medications (beta blockers, ACE inhibitors, vasodilators and sympatholytics)
2. RESPIRATORY SYSTEM
2.1. Physiology of gas exchange: ventilation, perfusion, ventilation and perfusion matching
2.2. Acid-base homeostasis
2.3. The clinical pharmacology of Sympathomimetics, Oxygen therapy and steroids in respiratory
problems
3. GASTROENTEROLOGY AND HEPATOLOGY
3.1. Principles of action of liver
3.2. The pharmacology of (antiemetics, antidiarrheals, antiulcer medications and antispasmodics)
4. HEMATOLOGY
4.1. Coagulation
4.2. The clinical pharmacology of drugs used in anticoagulation, thrombolysis and angiography
(streptokinase, tissue plasminogen activator, Abciximab, ticlopidine, aspirin warfarin&
heparin)
5. INFECTIOUS DISEASES
5.1. General features of microbial activity and modes of transmission
5.2. Viral and bacterial infections and mechanism of resistance to antimicrobial therapy
5.3. Features of other infectious diseases fungi, protozoa, helminths
5.4. Principles of sterilization and infection control… Physiology Microbiology
5.5. Antimicrobial therapy (Principles of action, Beta lactam agents, Aminoglycosides, Sulpho
amides, Quinolones, Antimycobacterial agents, Antifungal, Antiviral, Disinfectants, Anti-
protozoal, anti-helminthic and Macrolide agents)
5.6. Hospital acquired infection, prevention and control
6. NEUROLOGY AND PAIN
6.1. Neuroanatomy and cerebral blood flow
6.2. Pathophysiology of pain
6.3. The clinical pharmacology of analgesics and anti-inflammatory drugs(aspirin and other NSAD)
6.4. Pharmacology of local anesthestic
6.5. Hypnotics and sedatives (benzodiazepine, barbiturates, opiates and its antagonists, alcohol)
6.6. Anticonvulsants (phenytoin, carbamazepine, valproate)
7. RENAL MEDICINE
7.1. Homeostasis of fluid, electrolytes and acid base
7.2. Measurement of renal function
7.3. Metabolic basis of acute, chronic, and end-stage renal failure and associated treatments
8. ENDOCRINE SYSTEM
8.1. Drugs used in treatment of diabetes
8.2. The clinical pharmacology of steroids
9. ENVIRONMENTAL PATHOLOGY
9.1. Industrial exposure
9.2. Physical injury
10. TOXICOLOGY
10.1 Gastric decontaminants (emetics and adsorbents)
10.2. Overdose

23
 TOPICS AND CASES THAT IS SUBJECT FOR THE FIRST PART
TRAINING AND EVALUATION REQUIREMENTS

1. Cardiopulmonary resuscitation

2. Pain, anesthesia, analgesia and sedation

3. Diabetes

4. Acute coronary syndrome

5. Bronchial asthma

6. Initial assessment of polytraumatized & critically ill patients

7. Initial assessment of patients with isolated injury and fracture

8. Blood product transfusion and principles of fluid therapy

9. Unconsciousness and coma

10. Urine retention and renal colic

11. Burns

12. Acute osteomyelitis and septic arthritis

24
DETAILED CURRICULUM
OF
EMERGENCY MEDICINE

25
 RESUSCITATION

1. Airway (intended learning outcomes)

First emergency medicine rotation, according to the latest guidelines, trainees should be
able to:
1. IDENTIFY the conditions of the airway (patent, obstructed and at risk) and its causes.
2. DISCUSS methods of maintaining a patent airway i.e. head tilt, jaw thrust, and suction
and so on.
KNOWLEDGE

3. OUTLINE the principles of bag valve mask ventilation.

4. DEFINE different oxygen delivery systems.
5. DESCRIBE the indications for use of Laryngeal Mask Airway and methods of its
application.
6. LIST the indications and potential complications of tracheal intubation
7. DISCUSS the indications for use of pharmacological agents in induction and maintains
anesthesia, their potential complications and side effects.
8. OUTLINE the principles of simple ventilators.
9. DISCUSS the principles of various monitoring techniques and their Values.
10. DESCRIBE the management of failed airway drill, including needle oxygenation and
cricothyroidotomy.
11. LIST the indications for urgent tracheostomy.
12. EXPLAIN the outcomes of respiratory arrest in adults and children.

Upon completion of ALS course and First emergency medicine rotation, Trainees
should be able to:
1. ASSESS airway and optimize the patient position for airway Management.
2. RECOGNIZE difficult airway and be able to use different approaches to handle it.
3. MANAGE airway using different adjuncts (oropharyngeal and nasal)
SKILLS

4. START ventilation using bag valve and mask

5. IDENTIFY correct and incorrect placement of endotracheal tube.
6. PERFORM needle/surgical cricothyroidotomy and percutaneous transtracheal ventilation.
7. INTERPRET capnograph trace if available.
8. APPROPRIATELY use pocket mask during field resuscitation.
9. RECOGNIZE signs of choking and manage it competently in conscious and unconscious
patients according to age appropriate logarithm.
10. RECOGNIZE self-limits and ask appropriately for senior advice.

26
2. Peri-arrest Cardiac Care (Intended learning outcomes)

Upon completion of ALS course and First emergency medicine rotation, Trainees
should be able to:
KNOWLEDGE

1. SUMMARIZE the ALS and APLS treatment algorithms.

2. OUTLINE the principles of cardiac arrest management in special circumstances (e.g.
pregnancy, asthma, anaphylaxis, hypothermia or trauma).
3. IDENTIFY the outcomes of pre-hospital arrest.
4. DISCUSS the principles of post resuscitation care.
5. OUTLINE the causes of peri-arrest Arrhythmias and its management including the
knowhow of defibrillator operations.
6. DISCUSS the causes and prognostic features of cardiac arrest in children.
7. EXPLAIN the ethical and legal dilemmas surrounding resuscitation.

Upon completion of ALS course and First emergency medicine rotation, Trainees
should be able to:
1. PERFORM effective BLS and A.L.S in adults and children.
2. RECOGNIZE different rhythm problems and treat them.
SKILLS

3. PERFORM safe and effective defibrillation (safely refers to all concerned parties,
patient, resuscitation team and himself).
4. DECIDE appropriately when to discontinue resuscitation.
5. APPLY competently peripheral and central venous lines.
6. PERFORM external pacing.
7. ADMINISTER drugs endotracheally.
8. WORK effectively as a team member and team leader during resuscitation.
9. COMMUNICATE effectively with patient relatives in difficult situations.

3. Shock (intended learning outcomes)

Upon completion of ALS course and First emergency medicine rotation, Trainees
KNOWLEDGE

should be able to:

1. DEFINE shock and outline its pathophysiology
2. DISCUSS The differential diagnosis and clinical presentation of different types of
shock (distributive, hypovolemic, cardiogenic and obstructive)
3. OUTLINE The principles of hemodynamic monitoring
4. The INDICATIONS AND METHODS of action of vaso active drugs in the
management of shock
5. LIST the indications for imaging in shocked patients (echocardiography)

27
 Upon completion of ALS course and First emergency medicine rotation, Trainees
SKILLS should be able to:
1. GAIN peripheral and central venous access in shocked patients.
2. PERFORM arterial line insertion.
3. USE fluids appropriately in shocked and trauma patients.
4. USE competently and appropriately intraosseous and venous cut down Techniques.
5. RECOGNIZE the need for surgical referral timely and refer indicated cases
appropriately.

4. Coma (intended learning outcomes)

Upon completion of ALS course and First emergency medicine rotation, Trainees
should be able to:
KNOWLEDGE

1. DEFINE coma and list its causes.

2. DESCRIBE the pathophysiology of different types of coma.
3. DISCUSS the differential diagnosis of coma.
4. DISCUSS initial investigations and principles of management of different types of
coma

Upon completion of ALS course and First emergency medicine rotation, Trainees
should be able to:
1. APPLY The A, B, C, D, E management approach to manage and stabilize coma
Patients
SKILLS

2. PROTECT coma patients using appropriate measures (log rolling and urinary
catheter application).
3. CONSULT and refer to different specialties in different types of coma.

28
 ANESTHESIA, SEDATIONAND PAIN MANAGEMEN

1. Pain management and analgesia (intended learning outcomes)

Upon completion of emergency medicine rotations, Trainees should be able to:

1. RECALL methods of analgesia
 Drugs (narcotics, NSAID, others)
 Nerve blocks
KNOWLEDGE

 Cryotherapy
 Inhalation
 TENS
2. EXPLAIN different pain scores used for adults and children.
3. DISCUSS The rational for use of analgesics in The ER.
4. DESCRIBE The mode of action of different analgesics (paracetamol NSAIDs, Opioids,
Ketamine and Entonox), their route of administration, methods of monitoring their effect
and expected side effects and Interactions
5. RECOGNIZE local policies for controlled drugs.
6. OUTLINE the role of regional and local anesthesia in the management of pain (regional
include intravenous regional anesthesia).
7. IDENTIFY non pharmacological methods of pain management.

Upon completion of the emergency medicine rotations, trainees should be able to:
1. ASSESS children and adults for pain and recognize the pain severity.
2. SELECT and safely prescribe appropriate analgesics, using the correct dosage and route
of administration
3. DISCUSS options for pain relief with the patient.
SKILLS

4. TREAT the underlying cause of pain and seek senior and specialist advice when
needed
5. UNDERTAKE the following nerve blocks and know their contraindications:
5.1 Digital
5.2 Infiltration
5.3 Surface
6. CALCULATE maximum dose of local anesthesia for any given patient.
7. RECOGNIZE the emergency physician limitations in the use of local anesthesia and
ask for help appropriately

29
2. Conscious sedation (intended learning outcomes)
Upon completion of emergency medicine rotations, Trainees should be able to:
KNOWLEDGE

1. DESCRIBE the role of conscious sedation in the ER.

2. RECOGNIZE risk factors for sedation (airway, drugs, alcohol andco-morbidities
3. OUTLINE the pharmacology, dosage and root of administration of Sedatives
4. LIST different indications of sedation.
5. LIST the indications and types of antagonists.
6. DEFINE procedures, indications and levels of sedation and methods of monitoring
and indications for discharge (recovery score)

Upon completion of emergency medicine rotations, Trainees should be able to:

1. PROVIDE sedation and safely titrate the drug in a monitored environment.
SKILLS

2. RECOGNIZE types, procedures, levels of sedation.

3. EARLY recognize and manage over sedation.
4. ACCESS and manage airway and deal appropriately with complication.
5. SEEK consultations from anesthesiologists and seniors when indicated.

3. Anesthesia (intended learning outcomes)

Upon completion of emergency medicine rotations, Trainees should be able to:
1. DISCUSS The types and safety of anesthesia
KNOWLEDGE

2. DESCRIBE The levels of anesthesia, its complications and how to avoid and treat these
complications
3. RECOGNIZE equipment and medications of anesthesia
4. OUTLINE the role of regional and local anesthesia in the management of pain (regional
include intravenous regional anesthesia).
5. IDENTIFY non pharmacological methods of pain management.

Upon completion of the emergency medicine rotations, trainees should be able to:
1. PROVIDE I.V canulation (peripheral & central).
2. SELECT level of anesthesia
3. DISCUSS airway management & how to apply
 OP/NP airway.
 Supraglottic device
SKILLS

 ET intubation
4. TREAT the post-anesthetic complications
5.UNDERTAKE the following procedures:
5.1 Positioning
5.2 Monitoring
5.3 Postanethetic care
6. CALCULATE maximum dose of anesthesia for any given patient.
7. RECOGNIZE limitations of anesthesia and ask for help appropriately

30
ACID BASE, FLUID AND ELECTROLYTE DISORDERS

1. Acid base disorders (intended learning outcomes)

KNOWLEDGE

Upon completion of the First emergency rotation, Trainees should be able to:
1. DISCUSS the causes, physiological basis and clinical manifestations of acute and chronic
disorders of acid/base balance.
2. EXPLAIN the anion and osmolar gap.
3. DESCRIBE The principles of management of acid/base problems.

Trainees should be able to:

1. INTERPRET arterial blood gas results.
SKILLS

2. CALCULATE alveolar gas equation ad A‐a gradient.

3. TAKE arterial blood gas samples from the radial and femoral artery safely and
competently.
4. INSERT arterial blood line if indicated and take arterial blood samples.

2. Fluids and electrolytes (intended learning outcomes)

Upon completion of emergency rotations, Trainees should be able to:

KNOWLEDGE

1. DESCRIBE the volume and composition of diff body fluid compartments.

2. ENUMERATE constituents of common crystalloid and colloid solutions.
3. DISCUSS common or life threatening electrolyte disturbances, their clinical presentation
and methods of management.
4. IDENTIFY the etiology and pathophysiology and the clinical manifestations of
dehydration in adults and children.

Trainees should be able to:

1. USE appropriate fluid types and volumes in different clinical conditions presented to the
ER.
SKILLS

2. AVOID fluid overload and recognize its early manifestations.

3. TREAT safely and competently common or life threatening electrolyte disturbances.
4. IDENTIFY adults and children with dehydration and recognize any potential
Complications.
5. CALCULATE fluid losses and provide appropriate fluid replacement for treatment of
dehydration.

31
INFECTIOUS DISEASES AND SEPSIS (intended learning outcomes)

Upon completion of emergency medicine rotations, Trainees should be able to:

1. DESCRIBE the epidemiology, microbiology, pathology and clinical manifestations of
common and life threatening infections that presents to The ER in Egypt (both in adults and
KNOWLEDGE

children).
2. OUTLINE their potential complications, methods of diagnosis & principles of management.
3. DEFINE sepsis & describe the inflammatory response & clinical presentation of septic
shock.
4. SUMMARIZE the principles of management of sepsis and septic shock in the ER
5. RECALL the causes and manifestations of infections in immune-compromised hosts
6. UNDERSTAND the national policies & procedures followed in case of needle stick injury.

Upon completion of emergency medicine rotations, Trainees should be able to:

1. RECOGNIZE patients presenting with various infections to the emergency and initiate
appropriate investigations and treatment.
2. STABILIZE, initiate treatment and refer patients presenting with serious infections that
must be treated in specialized centers like fever hospital or CCU
SKILLS

3. IMMEDIATELY RECOGNIZE and rapidly resuscitate patients with septic shock

meningococcal meningitis and toxic shock syndrome.
4. USE appropriately vasopressin agents & initiate antibiotic therapy in case of septic SHOCK.
5. CONSULT infection disease specialists and refer for fever hospital or specialized infection
center when appropriate.
6. In case of needle stick injury, SELECT appropriate investigations and treatment according
to local/national policy.

TOPICS COVERED BY LECTURES

1. The general principles for identification and management of infections in the ER

2. Sepsis and septic shock
3. CNS infections
4. Needle stick injury
5. Fever without focus in children
6. Fever with rash

32
INFECTIONS IN THE ED (Clinical presentations)

1. Upper respiratory tract infect6ion

1.1 Tonsillitis
1.2 Sinusitis
1.3 Otitis media
1.4 Laryngotracheitis
2. Lower respiratory tract infection
2.1 Bronchitis
2.2 Pneumonia
3. Infectious diarrhea and gastroenteritis
4. Urinary tract infections
5. Fever without rash in children
6. CNS infections
6.1 Meningitis
6.2 Encephalitis
7. Infections in immune compromised host
7.1 Infection in nephrotic syndrome and renal transplant recipient
7.2 Febrile neutropenic cancer and non-cancer patients
7.3 Infection in adults and children with immunodeficiency Syndromes
8. Sepsis and septic shock
9. Fever without focus in children
10. Kawasaki syndrome

RHEUMATOLOGY (intended learning outcomes)

Upon completion of emergency medicine rotations, Trainees should be able to:

1. DESCRIBE the etiology, pathology, clinical presentation and differential diagnosis of
KNOWLEDGE

acute arthritis in The ER (both monarticular and polyarthritis).

2. EXPLAIN the causes and principles of management of acute lower back pain in the
emergency room.
3. RECALL the clinical presentation of other rheumatologic presentations to The ER
(tendinitis, bursitis and peripheral nerve syndromes).
4. LIST the complications of immunosuppressive therapy that can brought rheumatology
patients to The ER

33
 Upon completion of emergency medicine rotations, Trainees should be able to:

SKILLS 1. ASSESS, patients presenting to the ER with acute arthritis, initiate investigations and
refer appropriately to inpatient service, orthopedic consultation or others.
2. DIFFERENTIATE septic arthritis from other causes through clinical examination,
ultrasonography and plain radiography.
3. INITIATE pain management in case of acute lower back pain and refer patients
appropriately.
4. CONSULT when rheumatologists, neurosurgeons or orthopedic Surgery indicated.

RHEUMATOLOGIC CASES IN THE ED

1. Rheumatic arthritis
2. Rheumatoid arthritis
3. Septic arthritis
4. Mono or poly arthritis for D.D
5. Back pain for DD
6. Synovitis, tendinitis and bursitis
7. Rheumatoid arthritis

TOPICS IN RHEUMATOLOGIC EMERGENCIES

1. Arthritis in The Emergency room

2. Acute lower back Pain (guidelines for diagnosis and management )

34
 DIABETES & OTHER ENDOCRINOLOGIC DISEASES
(Intended learning outcomes)

Upon completion of emergency medicine rotations, Trainees should be able to:

1. OUTLINE the clinical presentation, methods of diagnosis & precipitating factors for The
following conditions
1.1 Diabetic ketoacidosis
KNOWLEDGE

1.2 Hyperosmolar non ketotic coma

1.3 Hypoglycemic coma
2. DISCUSS the principles of their management based on nationally approved Guidelines and
protocols
3. SUMMARIZE the emergency presentations of the following endocrine conditions and how
to suspect them
3.1 Thyroid storm and hypothyroid crises
3.2 Pheochromocytoma
3.3 Pituitary failure and diabetes insipidus
Upon completion of emergency medicine rotations, Trainees should be able to:

1. ANTICIPATE diabetes and its potential complications in The ER

2. DIAGNOSE through clinical and laboratory assessment the following conditions
2.1 Diabetic ketoacidosis
2.2 Hyperosmolar non ketotic coma
2.3 Hypoglycemic coma
3. MANAGE diabetic ketoacidosis and hyperosmolar non ketotic coma through the
SKILLS

appropriate prescription of fluids, electrolytes and other lines

4. MEASURE and Interpret blood sugar results at The patient bed side using glucose strips
and urine dipstick
5. RAPIDLY and appropriately administer glucose and glucagon in case of hypoglycemia
6. CALL for specialized help from endocrinologists and ICU specialists
7. INITIATE symptomatic and lifesaving management in the following conditions while
requesting specialized help
7.1 Thyroid storm and hypothyroid crises
7.2 Pheochromocytoma
7.3 Pituitary failure and diabetes insipidus

35
ENDOCRINOLOGIC CASES IN THE ED

1. Diabetic ketoacidosis in adults and children

2. Hyperosmolar non ketotic coma
3. Hypoglycemia
4. Thyroid storm
5. hypothyroid crises
6. Pheochromocytoma
7. Pituitary failure
8. Diabetes insipidus
9. Other complications of diabetes

TOPICS IN ENDOCRINOLOGIC EMERGENCIES:

1. Diabetic ketoacidosis in adults

2. Diabetic ketoacidosis in children
3. Other endocrinologic emergencies

36
 CARDIAC EMERGENCIES (intended learning outcomes)
Upon completion of emergency medicine rotations, Trainees should be able to:

1. DISCUSS The common & life threatening causes of chest pain & their associated clinical
presentations
2. EXPLAIN The clinical manifestations of different acute coronary syndromes (stable and
unstable angina and acute myocardial infarction)
3. OUTLINE The pathophysiology of ST elevation myocardial infarction and non ST elevation
myocardial infarction
KNOWLEDGE

4. DISCUSS The principles of investigation and management of acute coronary syndromes

5. OUTLINE The principle of management of heart failure as a complication of acute
myocardial infarction
6. DEFINE syncope, list its important causes and outline methods of diagnosis
7. DISCUSS The etiology, pathophysiology, clinical presentation & management of heart failure
8. LIST common and life threatening Arrhythmias that presents to The ER and discuss how to
diagnose them
9. DISCUSS The principles of management of Arrhythmias (based on recognized guidelines)
and mention The indications for pacing
10. LIST The causes, clinical manifestations, methods of management and prognosis of
cardiogenic shock
11. BE AWARE of other cardiac presentations to The ER (endocarditis, congenital heart diseases
in adults and hypertensive emergencies
Upon completion of emergency medicine rotations, Trainees should be able to:
1. Promptly ASSESS patients presenting with chest pain in The ER, risk stratify them and
differentiate between cardiac and non-cardiac causes
2. INITIATE emergency treatment for patients presenting with acute coronary syndromes
(including oxygen, proper analgesia, aspirin and nitroglycerine)
3. RECOGNIZE the indications for thrombolysis and immediately call for help from CCU and
cardiology specialists
4. PERFORM& interpret correctly the results of ECG & interpret the results of cardiac enzymes
5. EARLY recognize and treat complications of ACS (Arrhythmias, pulmonary edema,
hypotension and cardiogenic shock)
SKILLS

6. RISK stratifies patients with syncope and request appropriate investigations. In addition,
differentiate cases who requires admission from cases who could be discharged for follow up
with cardiology clinic
7. INVESTIGATE and treat patients with heart failure (whether left or right) and recognize
The indications for mechanical ventilation
8. DIAGNOSE and treat Arrhythmias according to resuscitation council guidelines.
9. PERFORM external pacing
10. Early RECOGNIZE patients with cardiogenic shock due to any cause, initiate investigations
and treatment, stabilize and refer appropriately for ICU
11. RECOGNIZE patients presenting with hypertensive emergencies to The ER and initiate
treatment them appropriately
12. HAVE a high index of suspicion for other possible cardiac presentation to the ER
(pericarditis, pericardial effusion, carditis and congenital heart disease

37
CARDIAC CASES IN THE ED

1. Chest pain (cardiac and non-cardiac)

2. Acute coronary syndromes
2.1 Angina
2.2 Acute myocardial infarction
3. Syncope
4. Heart failure in The ER
4.1 Rheumatic heart
4.2 Secondary to ACS
4.3Cardiomyopathies and other causes of heart failure
5. Arrhythmias
5.1 Atrial
5.2 Ventricular
5.3 Complex Arrhythmias
6. Cardiogenic shock
7. Pericarditis
8. Pericardial effusion
9. Hypertensive emergencies
9.1 Heart failure
9.2 Encephalopathies
10. Congenital heart diseases in adults and children

TOPICS & LECTURES IN CARDIAC EMERGENCIE S

1. Differential diagnosis of chest pain in The ER

2. Emergency management of acute coronary syndromes
3. Syncope
4. Congestive heart failure
5. Cardiac Arrhythmias and their ER presentation and management
6. Hemodynamic instability and cardiogenic shock
7. Other cardiac emergencies

38
 RESPIRATORY EMERGENCIES (intended learning outcomes)
(Respiratory distress and respiratory failure)
Upon completion of emergency medicine rotations, Trainees should be able to:
1. EXPLAIN the pathophysiology of bronchial asthma, its clinical manifestations and
principles of management in emergency situations
2. OUTLINE the indications and difficulties of mechanical ventilation in bronchial
asthma
3. DISCUSS the causes of pneumonia and methods of diagnosis and treatment
KNOWLEDGE

4. DESCRIBE the causes, presentation and management of spontaneous pneumothorax

5. DISCUSS the etiology, signs and symptoms, investigations and treatment of
pulmonary embolism
6. OUTLINE the differential diagnosis of pulmonary embolism and its prognosis
7. RECALL the causes and principles of management of chronic obstructive airway
disease
8. DEFINE respiratory failure, list its common and important causes and outline the
methods of investigations and principles of treatment
9. LIST the indications for mechanical ventilation in case of respiratory failure
10. OUTLINE the essential features of other important respiratory emergencies (e.g.
foreign body inhalation and irritants , pleural effusion, hemoptysis and acute lung
injury
Upon completion of emergency medicine rotations, Trainees should be able to:
1. RECOGNIZE bronchial asthma, differentiate patients according to asthma severity
and install appropriate therapy according to accepted guidelines
2. In case of bronchial asthma, EARLY IDENTIFY patients who might require
mechanical ventilation and ask for senior or specialist support
3. ADMIT bronchial asthma cases to hospital care, ICU or safely discharge according to
patient presentation and initial treatment outcomes
4. In case of spontaneous pneumothorax, he should be able to INSERT Intercostal drain
after consultation with pulmonology or cardiothoracic specialists
5. INITIATE investigations in case of suspected pulmonary embolism and ask for
SKILLS

specialist support
6. INITIATE appropriate treatment for COPD and prevent or treat precipitating factors
7. IDENTIFY COPD cases that require mechanical ventilation
8. RISK stratify patients with pneumonia and differentiate those who requires hospital,
ICU admission from those who can be referred for primary care
9. INVESTIGATE and treat patients with pneumonia and recognize cases with
associated sepsis
10. DIAGNOSE clinically and by lab respiratory failure
11. INITIATE treatment for respiratory failure cases in the form of oxygen and bag valve
mask ventilation
12. RECOGNIZE respiratory failure patients who need mechanical ventilation stabilize &
immediately arrange for referral to ICU care

39
R E S P I R AT O RY C A S E S I N T H E E D

1. Bronchial asthma
2.
2.1. Community acquired
2.2. Aspiration pneumonia
3. Upper respiratory tract infections
3.1. Croup and laryngitis
3.2 .Epiglottitis
4. Pneumothorax
5. Pulmonary embolism
6. Chronic obstructive airway disease
7. Hemoptysis
8. Foreign body inhalation
9. Respiratory emergencies of important infections (HIV, T.B)
10.Respiratory failure due to various causes

T O P I C S I N R E S P I R AT O RY E M E R G E N C I E S

1. Bronchial asthma (diagnosis and management)

2. Respiratory failure
3. Respiratory emergencies due to upper airway problems
4. Respiratory emergencies related to lower airway problems

40
 HEPATIC EMERGENCIES (intended learning outcomes)
Upon completion of emergency medicine rotations, Trainees should be able to:
1. DISCUSS The causes, clinical presentation and complications of acute hepatic failure
KNOWLEDGE

(both DE Novo and on top of chronic)

2. OUTLINE The methods for diagnosis and management of liver failure in the ER
3. DEFINE hematemesis and list its most important causes in Egypt. In addition outline
clinical presentation to The ER, methods of diagnosis and principles of management
4. The CAUSES OF JAUNDICE that presents to emergency, associated clinical signs &
symptoms & investigations required to establish diagnosis
5. RECALL the causes for emergency visits in case of liver transplant recipient
Upon completion of emergency medicine rotations, Trainees should be able to:
1. ASSESS patients with possibility of liver cell failure & initiate investigations to establish
diagnosis
2. STABILIZE liver cell failure patients, manage its complications and consult hepatology
SKILLS

specialists or refer for ICU care

3. CONTROL bleeding in case of variceal hematemesis, provide blood product transfusion if
indicated and refer timely to specialty care
4. INITIATE investigations in cases of acute jaundice and refer to appropriate specialty care
(fever hospital, surgery hepatology specialty or in patient service)
5. CAREFULLY choose drugs that don't exacerbate liver injury in case of hepatic
Emergencies

H E PAT I C P R E S E N TAT I O N S T O T H E E D

1. Acute liver cell failure

2. Hepatitis
3. Jaundice for D.D
4. Hematemesis due to portal hypertension
5. Hepato‐renal syndrome

T O P I C S A N D L E C T U R E S F O R H E PAT I C E M E R G E N C I E S

1. Liver failure
2. Management of gastrointestinal bleeding in The emergency
3. Other hepatic emergencies

41
 GASTROINTESTINAL EMERGENCIES (intended learning outcomes)
Upon completion of emergency medicine rotations, Trainees should be able to:
KNOWLEDGE
1. DISCUSS The causes of acute abdomen, associated clinical manifestations, differential
diagnosis and The principles of management in The ER
2. OUTLINE The causes of non-hepatic upper GIT bleeding, investigations and initial
management
3. LIST causes of anal pain and lower GIT bleeding and mention the role of emergency
physician in the diagnosis and treatment of these conditions
Upon completion of emergency medicine rotations, Trainees should be able to:
1. HAVE an A B C D E management approach for acute abdomen, through effective fluid
resuscitation, control of pain, appropriate antibiotic prescription and use of naso gastric
tube
2. IDENTIFY rapidly cases that need surgical intervention and differentiate cases that
require hospital admission from those managed in The ER and dis charged safely to
SKILLS

primary care
3. INTERPRET radiological imaging studies and requested labs in various acute abdomen
conditions
4. MANAGE shock effectively in patients presenting with bleeding and provide timely
blood transfusion
5. TREAT patients presenting with non variceal GIT bleeding according to nationally
accepted guidelines and consult appropriate specialties
6. MANAGE shock and control pain in case of lower GIT bleeding, provide blood
transfusion if indicated & refer to appropriate specialty or primary care.

42
GASTROINTESTINAL EMERGENCIES (CASES)
1. Acute abdomen due to GIT causes
1.1. Peptic ulcer
1.2. Pancreatitis
1.3. Cholecystitis and Cholangitis
1.4. Biliary colic's
1.5. Bowel obstruction
1.6. Acute appendicitis and Meckel's diverticulum
1.7. Intestinal perforation , volvulus and colitis
1.8. irreducible or strangulated Hernia
1.9. Inflammatory bowel diseases
2. Hematemesis in the ER
2.1. Variceal bleeding
2.2. Duodenal /gastric ulcer
2.3. Coagulation disorders
3. Lower GIT bleeding and anal pain
3.1. Anal fissure, anorectal abscess, fistula and pilonidal sinus
3.2. Rectal prolapse
3.3. Colitis /tumor
3.4 . Hemorrhoids ( thrombosed or bleeding)

TOPICS IN GASTROINTESTINAL EMERGENCIES

1. Diagnosis and management of acute abdominal conditions in the ER

2. Upper gastro intestinal bleeding
3. Lower gastrointestinal presentations to The ER

HEMATOLOGICAL EMERGENCIES (intended learning outcomes)

Upon completion of emergency medicine rotations, Trainees should be able to:

1. DISCUSS The causes of pallor, The reason for its presentation to The ER other
associated signs and symptoms and differential diagnosis
KNOWLEDGE

2. OUTLINE the most common coagulation disorders that present to emergency

physicians. These include both bleeding disorder and tendency for coagulation
3. DESCRIBE The causes and management of disseminated intravascular coagulopathy
(DIC)
4. SUMMARIZE The diverse clinical presentations of sickle cell anemia to the ER
5. DEFINE fever with neutropenia, list its causes and principles of management in ER
6. DISCUSS The indications for blood and blood product transfusion in the ER,
universal precautions and management of blood transfusion reactions

43
 Upon completion of emergency medicine rotations, Trainees should be able to:

1. ASSESS patients with various hematological presentations, initiate investigations and

apply emergency treatment
2. APPROPRIATLY request and interpret hematological investigations (CBC,PT, PTT,
SKILLS

etc.)
3. PROVIDE blood and blood products transfusions judiciously and when indicated
4. RECOGNIZE and promptly mange blood transfusion reactions
5. PRESCRIBE iv fluids and pain killers for sickle cell anemia and ask for hematologists
help
6. STABILIZE patients with DIC and transfer for intensive care
7. RISK STRATIFY febrile neutropenic patients and initiate treatment and refer for
inpatient admission

H E M AT O L O G I C A L C A S E S I N T H E E D
1. Anemias
1.1. Anemia for DD
1.2. Iron deficiency anemia
1.3. Glucose six phosphate dehydrogenase deficiency (favism)
1.4. Thalassemia and spherocytosis
1.5. Sickle cell anemia
2. Bleeding tendency
2.1. purpura and thrombocytopenia
2.2. Hemophilia
2.3. patients on anticoagulants
3. Disseminated intravascular coagulopathies
4. Thrombophilias
4.1. Spontaneous venous thrombosis
4.2. Gangrene
5. The fever with neutropenia
5.1. Aplastic anemia
5.2. Lymphoma and leukemia

H E M AT O L O C A L T O P I C S & L E C T U R E S

1. Anemia in The emergency room ( a guide for diagnosis & treatment )

2. Bleeding in the ER
3. Disseminated intravascular Coagulopathy
4. Congenital & acquired Thrombophilias
5. Fever with neutropenia
6. Blood transfusion

44
 ONCOLOGICAL EMERGENCIES (intended learning outcomes)
Upon completion of emergency medicine rotations, Trainees should be able to:
KNOWLEDGE
1. LIST emergencies related to local tumor progression, their clinical presentation and
methods of diagnosis
2. ENUMERATE metabolic complications of malignancy, their signs and symptoms and
initial management steps in The ER
3. DEFINE emergencies related to oncological treatment & how to suspect them in The ER
4. OUTLINE The role of emergency physician in The management of tumor related
emergencies
Upon completion of emergency medicine rotations, Trainees should be able to:

1. RECOGNIZE resuscitate and stabilize patients presenting with the following

complications secondary to tumor progression:
1.1. acute spinal cord compression
1.2. upper airway obstruction
1.3. malignant pleural or pericardial effusion
1.4. increased intracranial tension
1.5. superior vena cava syndrome
SKILLS

2. ENSURE early involvement of oncologists

3. DIAGNOSE and initiate treatment of metabolic complications of malignancy and timely
refer for oncology services
3.1. hypercalcemia
3.2. inappropriate secretion of The antidiuretic hormone
3.3. adrenocortical insufficiency
4. RECOGNIZE The complications of oncological treatment and initiate management or
timely refer
4.1. tumor lysis syndrome
4.2. fever with neutropenia
5. MANAGE pain related to malignant tumors when present to emergency

ONCOLOGICAL CASES IN THE E D

1. Patients presenting with tumor spread related emergencies

1.1.Increased intracranial tension (severe vomiting, sudden headache, or blurring of vision)
1.2. Respiratory distress secondary to pleural or pericardial effusion
1,3.Acute flaccid paralysis secondary to spinal cord compression
1.4. Upper airway obstruction
2. Metabolic oncological presentations

ONCOLOGICAL TOPICS & LECTURES

The topic will be covered in one lecture: Oncological Emergencies

45
 NEUROLOGICAL EMERGENCIES (intended learning outcomes)
1. HEADACHE
Upon completion of emergency medicine rotations, Trainees should be able to:
KNOWLEDGE

1. OUTLINE The common, important and life threatening causes of headache

presentation to The ER
2. DESCRIBE The different methods for investigating a case of headache,
including The role of imaging

Upon completion of emergency medicine rotations, Trainees should be able to:

1. DIFFERENTIATE between benign and serious headaches and initiate appropriate
SKILLS

investigations
2. MANAGE simple headache cases and discharge safely to primary care
3. CONSULT neurologists/neurosurgery for management and referral of serious
and unusual causes of headache

2 . S TAT U S E P I L E P T I C U S
KNOWLEDGE

Upon completion of emergency medicine rotations, Trainees should be able to:

1. DISCUSS the causes , manifestations and complications of status epilepticus
2. OUTLINE the difference between status epilepticus and pseudoseizures
3. DESCRIBE the management algorithm and indications for various
pharmacological agents

Upon completion of emergency medicine rotations, Trainees should be able to:

SKILLS

1. STABILIZE The patient using The ABCDE approach

2. ABORT the epileptic attack using appropriate medications
3. CONSULT neurologist for further care and referral

46
3. COMA
KNOWLEDGE

Upon completion of emergency medicine rotations, Trainees should be able to:

1. DESCRIBE the causes and differential diagnosis of various types of coma
2. OUTLINE the coma scoring system (GCS)
3. DEFINE the indications for mechanical ventilation in case of coma

Upon completion of emergency medicine rotations, Trainees should be able to:

SKILLS

1. STABILIZE comatose patients and initiate appropriate investigations

2. PERFORM complete neurological examination and classify coma severity
according to GCS

4. CNS (MENINGITIS & ENCEPHALITIS )

KNOWLEDGE

Upon completion of emergency medicine rotations, Trainees should be able to:

1. DESCRIBE the clinical features and diagnostic workup of CNS infection skills
2. DESCRIBE the differential diagnosis of CNS infections

Upon completion of emergency medicine rotations, Trainees should be able to:

SKILLS

1. ASSESS and diagnose cases with possibility of CNS infection using appropriate
investigations techniques (CT scan and lumbar puncture)
2. STABILIZE patients and initiate urgent treatment
3. REFER appropriately and early for concerned specialty

5 . C E R E B R O VA S C U L A R E M E R G E N C I E S
KNOWLEDGE

Upon completion of emergency medicine rotations, Trainees should be able to:

1. DISCUSS the causes, clinical presentation and differential diagnosis of common and
important cerebrovascular presentations to The emergency
2. OUTLINE important investigations that could aid in the diagnosis at the ER
SKILLS

Upon completion of emergency medicine rotations, Trainees should be able to:

1. RECOGNIZE early The manifestations of transient ischemic attacks and
2. REQUEST specialists advice

47
6. OTHER NEUROLOGICAL EMERGENCIES
Upon completion of emergency medicine rotations, Trainees should be able to:

1. Increased intracranial tension: Recognize patients with increased intracranial pressure &initiate
treatment after consultation with neurosurgery/neurology
2. Movement disorders: Differentiate vertigo from ataxia and recognize patients presenting with
dystonia
3. Hydrocephalus: Identify patients with possibility or obstructed or infected shunt and request
specialist care
4. Flaccid paralysis: Differentiate patients with Guillain-Barre syndrome from other causes of
acute flaccid paralysis
5. Others
5.1. Suspect The diagnosis of tetanus and timely refer
5.2. Be aware of The following neurological presentations
5.2.1. Emergency presentation of myasthenia gravis, multiple sclerosis & peripheral
neuropathie
5.2.2. Emergency presentation of brain tumors

RENAL EMERGENCIES ( I n t e n d e d learning o u t c o m e s )

1 . A C U T E R E N A L FA I L U R E (Intended learning outcomes)

Upon completion of emergency medicine rotations, Trainees should be able to:
KNOWLEDGE

1. DISCUSS the causes and strategies for management of pre-renal failure

2. THE ETIOLOGY AND CLINICAL PRESENTATIONS of patients with possible urinary
tract obstruction
3. OUTLINE The initial investigations needed to assess severity and cause of acute renal failure
4. EXPLAIN The indications for dialysis, its different types and possible complications
Upon completion of emergency medicine rotations, Trainees should be able to:
SKILLS

1. RECOGNIZE and initiate management for patients with acute pre-renal failure (through
proper clinical evaluation and interpretation of laboratory results
2. RECOGNIZE and Initiate investigations for patients with acute renal failure and consult
appropriately renal specialists

48
2 . U R I N A RY T R A C T I N F E C T I O N ( i n a d u l t s a n d c h i l d r e n )
KNOWLEDGE

Upon completion of emergency medicine rotations, Trainees should be able to:

1. DISCUSS the causes, microbiology, clinical manifestations, investigations and treatment of
urinary tract infection in adults and children
2. LIST indications for admission and reasons for referral for specialist care

Upon completion of emergency medicine rotations, Trainees should be able to:

1. DIAGNOSE cases with urinary tract infection including pyelonephritis
SKILLS

2. DIAGNOSE cases with urinary tract obstruction

3. INTERPRET the results of urine dipstick , urine microscopic analysis and urine culture
4. SELECT and initiate appropriate antimicrobial therapy
5. ORGANIZE patient further pathways according to diagnosis and risk factors ( hospital
admission, referral to nephrology or referral to primary care)

3 . E M E R G E N C I E S F O R PAT I E N T S W I T H R E N A L
REPLACEMENT THERAPY AND OTHER RENAL DISORDERS
Upon completion of emergency medicine rotations, Trainees should be able to:
KNOWLEDGE

1. OUTLINE The most important causes for emergency presentations to patients on dialysis or
renal transplant recipient
2. DESCRIBE briefly other emergency presentations of renal diseases ( rhabdomyolysis,
hemolytic uremic syndrome, hepato-renal syndrome, generalized edema, frank hematuria and
proteinuria )
Upon completion of emergency medicine rotations, Trainees should be able to:
SKILLS

1. RECOGNIZE and immediately treat life threatening complications like hyperkalemia

2. IDENTIFY those who need dialysis and liaise with nephrologists
3. INITIATE investigations for other renal emergencies and timely consult nephrologists

RENAL CASES IN THE ED

1 . Acute renal failure (DE Novo or on top of chronic)

2. Urinary tract infection (adults and children)
3. Life threatening electrolyte disturbances
4. Hemolytic uremic syndrome
5. Hematuria for DD
6. Proteinuria for DD

49
 U R O L O G I C A L E M E R G E N C I E S ( I n t e n d e d learning o u t c o m e s )

Upon completion of emergency medicine rotations, Trainees should be able to:

KNOWLEDGE

1. LIST The causes of acute urinary retention and how to manage

2. LIST The indications for suprapubic catheterization and know how to perform it
3. OUTLINE The etiology of acute scrotal pain, how to diagnose different disease that lead to it
4. EXPLAIN The clinical presentation of renal calculi that lead to emergency room visits
5. RECALL The causes of other important urological conditions that could be presented to
the emergency (all conditions will be listed in The cases table)
Upon completion of emergency medicine rotations, Trainees should be able to:
SKILLS

1. APPLY competently urethral catheter to release urine retention

2. RECOGNIZE patients presenting with conditions listed in The case table and ask for
immediate urological support or refer for specialist care

UROLOGICAL CONDITIONS IN THE ED

1 . Acute retention of urine

2. Acute scrotal pain
3. Renal colic
4. Emergency penile conditions
4.1. Priapism
4.2. Fracture of penis
5. Gangrene of the scrotum
6. Phimosis and paraphimosis
7. Prostatitis

RENAL AND UROLOGIC TOPICS AND LECTURES

1. Acute renal failure

2. Urinary tract infection (guidance for diagnosis and management in adults and children)
3. Urological emergencies

50
 DERMATOLOGICAL EMERGENCIES
KNOWLEDGE
( I n t e n d e d learning o u t c o m e s )
Upon completion of emergency medicine rotations, Trainees should be able to:
1. OUTLINE The causes, clinical manifestations and potential complications of common and
important dermatological emergencies presented to emergency physicians
2. DISCUSS initial management steps that must be done in The emergency room and list the
indications for referral to dermatology specialist care

Upon completion of emergency medicine rotations, Trainees should be able to:

1. CAREFULLY take a structured history and perform a focused clinical examination in

dermatological cases to identify The possible etiology
2. In case of possible drug reaction, he should be able to ANALYZE The drug history of the
patient and identify The causative drug
3. HAVE AHIGH INDEX of suspicion in order to diagnose life threatening dermatological
conditions like toxic epidermal necrolysis and Steven Johnsonn syndrome
SKILLS

4. INITIATE treatment rapidly and cooperate with dermatologists and other important
specialties
5. ASSESS The air way and manage upper airway obstruction in case of severe allergic
conditions
6. MANAGE cases of anaphylaxis
7. MANAGE different types of skin infections either independently or under senior or
dermatology supervision (according to level of training)
8. DIAGNOSE adults and children presenting with fever and rash. Specifically, he should
be able to recognize meningococcemic rash and initiate rapid management or refer

51
DERMATOLOGICAL CASES PRESENTED TO THE ED

1. Vesiculobulbous disorders
1.1. Toxic epidermal necrolysis
1.2. Steven Johnson syndrome
1.3. Pemphigus Vulgaris
2. Allergic skin problems
2.1. Urticaria
2.2. Angioedema
2.3. Anaphylaxis
3. Skin infections
3.1. Cellulitis
3.2. Erysipelas
3.3. Necrotizing fasciitis
3.4. Reversal reaction in leprosy
3.5. Neonatal herpes simplex
4. Fever with rash
4.1. Meningococcal meningitis
4.2. Childhood exanthemata
5. Autoimmune disorders

TOPICS AND LECTURES FOR DERMATOLOGY

Dermatologic emergencies (diagnosis and management)

52
 PSYCHIATRIC EMERGENCIES ( I n t e n d e d learning o u t c o m e s )

Upon completion of emergency medicine and psychiatry rotation, Trainees should have the following
knowledge and skills
1. LIST life threatening and important psychiatric conditions that could be presented to the
emergency service. Discuss their causes, clinical presentations, methods of diagnosis and initial
KNOWLEDGE

management plan that should be started in The ER

2. HIGHLIGHT medical life threatening conditions that could be presented by psychiatric
symptoms to The ER (delirium and acute psychosis)
3. EXPLAIN different passive and active techniques that should appropriately be used to protect
emergency staff in case of real anticipation of violence
4. OUTLINE medico legal issues surrounding The management of psychiatric emergencies

Upon completion of emergency medicine rotations, Trainees should be able to:

1. PERFORM a rapid focused psychiatric interview to obtain all necessary data

2. Beside physical examination, he should be able to . PERFORM a complete mental status
examination
3. RISK stratify psychiatric emergencies according to the risk of harm to self or others and
according to the life threatening nature of the condition and refer appropriately to inpatient or
outpatient care
4. RECOGNIZE suicidal patients, stabilize them and timely involve psychiatry specialist
SKILLS

5.Timely RECOGNIZE and initiate management for cases presented with delirium or psychosis
secondary to medical emergencies ( like renal or hepatic failure)
6. Early IDENTIFY emergency presentations of patients on psychiatric medications (neuroleptic
malignant syndrome and serotonin syndrome). stop The medication, adequately hydrate and
involve specialist
7. judiciously USE various types of restrains in case of real risk of violence(passive and active
restrain)
8. RECOGNIZE cases with psychiatric symptoms related to substance abuse or intoxication and
initiate management after psychiatric consultation
9. Be able to DIFFERENTIATE real from factitious illness in The ER
10. IDENTIFY cases of abuse and domestic violence and involve appropriate authorities
11. COMMUNICATE effectively with difficult patients and different age groups

53
PSYCHIATRIC EMERGENCIES THAT COULD BE PRESENTED TO THE ED

1. Major psychiatric presentations

1.1. Deliberate self-harm/suicidal patients
1.2. Agitated or violent patients
2. Medical emergencies in psychiatry
2.1. Delerium
2.2. Acute psychosis
2.3. Neuroleptic malignant syndrome
2.4. Serotonin syndrome
2.5. Subacute abuse/withdrawal
3. Non-life threatening psychiatric emergencies
3.1. Panic attacks
3.2. Disaster and grief reactions
3.3. Domestic violence
3.4. Rape
4. Malingering and factitious illnesses

PSYCHIATRIC LECTURES AND TOPICS

1. Assessment and emergency management of Suicidal patients

2. Assessment and emergency management of agitated and violent patients
3. The medical causes of psychiatric symptoms
4. Substance abuse and substance withdrawal
5. Anxiety and depression in the ER
6. Recognition and management of victims of domestic violence

54
 TRAUMA AND WOUNDS

TRAUMA
By the end of job training at Emergency, surgical and orthopedic rotations, trainees should have
the following knowledge and skills

1. Major trauma and disastrous management ( I n t e n d e d learning o u t c o m e s )

KNOWLEDGE

1. DISCUSS The epidemiology of trauma in Egypt, mechanisms of injury and different scoring
systems used for trauma assessment
2. OUTLINE The functions and responsibilities of trauma teams

1. ASSESS, resuscitate and stabilize trauma victims according to The ATLS principles & to The
APLS principles in pediatric injuries
2. LEAD ambulance services in emergency and disastrous situation
SKILLS

3. INTERPRET plain radiography and abdominal ultrasound for trauma patients

4. MANAGE pain adequately and recognize cases that need lifesaving or limb salvage surgery
5. CONSIDER cervical injury possibility during management of trauma patients until proved
otherwise
6. Frequently REASSESS trauma victims for ABCDE

2. Head Injuries ( I n t e n d e d learning o u t c o m e s )

KNOWLEDGE

1. OUTLINE the major anatomical landmarks of The head and The physiology of cerebral
perfusion and intracranial pressure
2. EXPLAIN the intracranial consequences of head injury
3. DESCRIBE radiological changes expected in head trauma

55
 1. RECOGNIZE and risk stratify patients presenting with head and injury and use different
methods for neurological status assessment (GCS, AVPU) in adults and children
2. APPLY the ABCDE approach in management, while taking care to prevent secondary
brain injury
3. INITIATE mechanical ventilation in indicated cases
SKILLS

4.Promptly CONSULT neurosurgery and other indicated disciplines and optimize team work
for the management of serious cases
5. MANAGE patients presenting with scalp laceration and minor head injury and discharge
them safely (both adults and children)
6. INTERPRET imaging studies performed in the ER for head injury patients
7. IDENTIFY cases with suspected child abuse as a cause for head injury and notify
appropriate authorities

3. Chest trauma( I n t e n d e d learning o u t c o m e s )

KNOWLEDGE

1. RECALL the anatomy of intrathoracic organs and The surface anatomy of The thorax
2. OUTLINE the pathophysiology and possible consequences of chest trauma
3. SUMMARIZE the clinical manifestations, investigations needed and initial management
and consultation plan in case of life threatening chest traumas

1.Timely RECOGNIZE patients presenting with the following chest injuries and initiate
resuscitation and stabilization according to The ATLS principles and to The APLS principles
in pediatric injuries.
1.1. Tension and open pneumothorax
1.2. Flail chest
1.3. Hemothorax
1.4. Rib and sternal fractures
SKILLS

1.5. Cardiac tamponade

1.6. Aortic injury
1.7. Diaphragmatic hernia
1.8. pulmonary or myocardial contusion
2. CONSULT cardiothoracic surgery or another involved disciplines in The appropriate time
and avoid delays
3. UNDERTAKE needle thoracentesis and assist cardiothoracic surgeons and senior colleagues
in insertion of intercostal tube drain and performance of pericardiocentesis
4. In case of minor chest injuries, EDUCATE patients before discharge

56
4. Abdominal trauma( I n t e n d e d learning o u t c o m e s )
KNOWLEDGE

1. RECALL The anatomy of intra-abdominal organs and The surface anatomy of The
abdomen
2. OUTLINE The mechanism of injury in blunt abdominal trauma and its clinical presentation
3. EXPLAIN The clinical presentation and causes of hollow viscus injury
4.LIST The indications for imaging studies in case of abdominal trauma

1. ASSESS and appropriately reassess trauma patients, resuscitate and stabilize according The
ATLS principles and timely involve appropriate specialties
SKILLS

2. RECOGNIZE The effect of other injuries on abdominal organs

3. PERFORM and interpret abdominopelvic ultrasound and interpret CT imaging data
4. PLACE nasogastric tube in indicated cases and assist in peritoneal lavage

5. Spinal injury( I n t e n d e d learning o u t c o m e s )

1. OUTLINE the basic anatomy and physiologic functions of The spinal cord and related
KNOWLEDGE

structures
2. DISCUSS the causes and mechanism of injury to The vertebral column and spinal cord
3. EXPLAIN the clinical presentation of spinal injury ( in adults and children) and methods of
diagnosis

1. STABILIZE, resuscitate and competently perform spinal immobilization for patients with
potential injury to The spinal cord
2. USE judiciously plain radiography, CT scan and MRI for diagnosis of spinal injury and be
able to interpret them
3. Always CONSIDER the possibility of spinal cord injury in trauma patients and consult
SKILLS

appropriate specialties
4. RECORD the neurological status of trauma patients using different scoring methods
5. RECOGNIZE patients presenting with neurogenic or spinal shock and initiate treatment
6. In case of children, he should be able to EXAMINE the spine and manage the irritable
immobilized child
7. APPLY the principles of being able to clinically "clear" the spine

57
 6. Maxillo-Facial trauma( I n t e n d e d learning o u t c o m e s )

1.DESCRIBE the basic anatomy of facial structures, mechanisms and complications of facial
injuries, including different facial fractures
KNOWLEDGE

2.OUTLINE the clinical presentation and method of diagnosis of tempromanidbular joint

dislocation
3.BRIEF on The features of injury for The following facial structures
3.1. Tongue
3.2. Facial nerve
3.3. Salivary glands
3.4. Lacrimal ducts

1. RECOGNIZE cases with facial injury and threat to The airway, insure proper oxygenation and
call for immediate consultations
SKILLS

2.CHARACTERIZE maxillofacial injuries and differentiate cases that need inpatient from
outpatients treatment
3.RECOGNIZE the implications of facial injury on hemodynamics
4.CONTROLbleeding from nasopharynx and from tongue lacerations
5.ENSURE cosmetic results after facial suturing

WOUND MANAGEMENT ( I n t e n d e d learning o u t c o m e s )

By The end of training at Emergency rotations, trainees should have the following knowledge and
skills

1.DISCUSS the classification and description of wounds

KNOWLEDGE

2.OUTLINE various wound closure techniques

3.DESCRIBE reasons and manifestations of wound infection and The role of antibiotics in
wound management
4.RECALL the features of special wounds ( e.g. punctures and bites)
5.LISTindications for tetanus immunization

1.ASSESS wounds and underlying structure, provide analgesia and ensure adequate exploration
SKILLS

, cleaning and debridement

2.DECIDE if wound should be closed or not and ask for senior help when indicated
3. In case of wound closure, USE local anesthesia, appropriate suturing material and document
The procedure before referring patient for further follow up

58
TRAUMA CASES EXPECTED DURING VARIOUS ROTATIONS

1. Major multiple trauma in adults.

2. Major multiple trauma in children.
3. Head injuries:
3.1. Post-concussion syndrome.
3.2. Brain contusion and diffuse axonal injury.
3.3. Extradural, subdural and intracerebral hematoma.
3.4. Scalp, acre and neck lacerations.
3.5. Skull fissure fracture.
3.6. Skull depressed fracture
3.7. Fracture base.
4. Chest trauma.
4.1. Tension and open pneumothorax.
4.2. Flail chest.
4.3. Hemothorax.
4.4. Rib and trmponade.
4.5. Cardiac tamponade.
4.6. Aortic injury.
4.7. Diaphagmatic hernia.
4.8. Pulmonary or myocardial contusion.
5. Abdominal trauma
5.1. With organ lacerationy /injury.
5.2. With hollow viscus injury.
6. Spinal injuries.
6.1. Vertebral fractures
6.2. Spinal cord transaction
7. Maxillofacial injuries
7.1. Nasal fractures
7.2. Mandibular fractures
7.3. Zygomatic fractures
7.4. Orbital fractures
7.5. Le fort fractures
7.6. Dental avulsion and fractures.
7.7. TMJ dislocation.
7.8 Tongue lacerations.
8. Different types of wounds

59
TOPICS AND LECTURES FOR TRAUMA IN THE EMERGENCY
DEPARTMENT

1. Advanced trauma life support (course).

2. Principle for management of head injures in emergency.
3. Presentation, diagnosis and management of spinal injures in The ER.
4. Chest injures in emergency.
5. Diagnosis and management of abdominal traumas.
6. Basic concept in maxillofacial injures.

BURNS ( I n t e n d e d learning o u t c o m e s )
By The end of training at Emergency, surgical and plastic surgery rotations, trainees should have
the following knowledge and skills
KNOWLEDGE

1. EXPLAIN the pathophysiology of burns and The principles of burn management (in adults &
children)
2. BRIEF on special types of burn ( chemical and electrical burn)

1. Immediately RECOGNIZE burn cases with threat to The airway and initiate management using
The ABCDE approach
2. ASSESS and define The size & depth of burn and accordingly calculate The estimated fluid loss
SKILLS

3.After initial management and stabilization, he should REFER to specialized burn centers
4. MANAGE minor burns and arrange for safe discharge and follow up
5. UNDERTAKE escharotomy
6. In case of suspecting child abuse, he should Notify authorities and arrange for psychiatric
consultation

TOPICS AND LECTURES FOR BURNS

1. Different degrees of burn
2.Management of burn

60
 ORTHOPEDIC EMERGENCIES ( I n t e n d e d learning o u t c o m e s )

Upon completion emergency medicine and orthopedic rotations, Trainees should have
KNOWLEDGE

adequate knowledge and deep understanding of:

1. The general principles for the diagnosis and management of fractures and joint injuries
2. The clinical presentation, diagnosis and management of common and important upper and
lower extremities musculoskeletal injuries
3. The clinical presentation, diagnosis and basics of management of pelvis and spinal injures

Upon completion emergency medicine and orthopedic rotations, Trainees should be able to
perform the procedures mentioned in the following table either as assistant or independently
according to their level of training and supervision provided:

Name of The procedural skills

1. Safe examination of the shoulder joint
2. Safe examination of the elbow joint
3. Safe examination of the Hip joint
4. Safe examination of the knee joint
5. Safe examination of the ankle joint
6. Safe reduction of shoulder dislocation
7. Application of above elbow POP
8. Safe reduction of distal radius fracture
9. Application of below elbow POP and short arm back slap
10. Safe reduction of dislocation of elbow and pulled elbow
SKILLS

11. Application of figure of 8 bandage, broad arm sling, Collar and Cuff or U shaped slab
12. Fasciotomy for forearm compartment syndrome
13. Safe reduction of phalangeal dislocation
14. Safe reduction of simple phalangeal fracture
15. Application of hand splint
16. Splinting for fracture femur
17. Skin and skeletal traction
18. Reduction of patellar dislocation
19. Reduction of knee dislocation in case of limb threatening vascular compromise
20. Application of knee immobilizer
21. Arthrocentesis
22. Reduction of ankle lesions that needs urgent reduction
23. Application of above and below knee POP
24. Fasciotomy for leg compartment syndrome
25. Application of pelvic splint "Hammock"
26. Immobilization of fracture spine "log roll"

61
Upper/Lower Extremities & Pelvis (Intended learning outcomes)

Upon completion emergency medicine and orthopedic rotations, Trainees should be able to:
1. Examine The shoulder , elbow , wrist, hip, knee, ankle joints and long bones to identify
KNOWLEDGE

injuries and associated neurovascular problems

2. Assess neurovascular functions and tendon function of The hand and foot
3. Assess cases of fracture pelvis
4. Differentiate pathological from traumatic fracture
5. Interpret plain radiography
6. Apply broad arm sling/collar and cuff/U slab

1. Apply broad arm sling/collar and cuff/ U slab

2. Apply splinting for fracture femur
3. Apply POP cast (above, below the elbow and knee)
SKILLS

4. Apply a pelvic splint

5. Immobilization of fracture spine (logroll, cervical collar)
6. Recognize possibly missed injuries (osteoporotic spine fracture, impacted fracture neck
femur, stress fracture, fracture scaphoid, dislocation of carpal bones, Lisfranc fracture)
7. Recognize The indications for urgent orthopedic referral

62
Orthopedic Topics and cases for emergency trainees

The following Cases and topics represent a theoretical and practical guide for trainees to direct
their self-studies and on Job training studies during emergency and orthopedic rotations. Some of
these topics will also be covered in lectures

Trunk
Upper extremity Lower extremity
General topics/ cases
Shoulder and arm Hip and thigh Pelvis
Principles for management 1. fracture clavicle, 1. dislocation of hip 1. fractures
of fractures and joint proximal humerus, 2. fracture upper femur 2. management
injuries scapula 3. fracture shaft femur of
Open fractures 2. ACJ and SCJ 4. fracture lower end bleeding
Compartment syndromes injuries femur related to
Nerve injuries 3. dislocated shoulder pelvic
Crush injuries 4. fracture humorous fractures
shaft
Pediatric trauma Elbow and forearm Knee and leg
1. Epiphyseal plate 1. fractures 1. meniscal injuries
injury 2. dislocation elbow 2. knee ligaments injury
2. Birth fractures and pulled elbow 3. patella fracture and
3. Limping child 3. fracture radius and dislocation
4. Differences between ulna 4. knee dislocation
fractures in adults and 4. forearm 5. tear & rupture of
children compartment quadriceps and
5. Painful hip syndrome ligamentous patellae
6. rupture Baker's cyst
7. tibial plateau fractures
8. fractures Tibia and
fibula
Skeletal infections Wrist and hand Ankle and foot Spine
1. Osteomyelitis 1. fractures 1. ankle fractures 1. fracture spine
2. Acute septic 2. nail bed injuries 2. ankle ligamentous 2. neurological
arthritis 3. hand compartment injuries and anatomy
3. Bursitis and syndrome dislocations (dermatomes
tenosynovitis 4. tendon injuries 3. tendoAchillis injuries & myotomes)
5. hand wounds and 4. fractures & crush 3. cord injury
crush injuries injuries of foot bones syndromes
4. low back pain

63
 ENT PROBLEMS IN THE EMERGENCY
( I n t e n d e d learning o u t c o m e s )
Upon completion of emergency medicine and ENT rotations, Trainees should be able to:
1. DESCRIBE the common and important causes of ear pain together with their clinical pictures
2. DEFINE epistaxis, mention its important causes and highlight The importance of excluding
hypertension as a cause of epistaxis
KNOWLEDGE

3. EXPLAIN the different presentations of pain in The throat and why some of them are
considered life threatening
4. RECALL the different locations of foreign bodies in The head and neck and explain their
expected complications and methods of removal
5. BE AWARE of different types of facial traumas (e.g. mandibular and nasal fractures) and
principles for their initial management. In addition he should list important dental emergencies
that presents to ER

Upon completion of emergency medicine rotations, Trainees should be able to:

1. ASSESS diagnose and manage common causes of ear pain (otitis media, otitisexterna,
cholesteatoma)
2. INITIATE treatment and refer to ENT specialist, the following conditions ( perforated
tympanic membrane and mastoiditis)
3. REMOVE accessible foreign bodies ( from the ear and nose) and refer in case of anticipated
difficulties
4. USE otoscope in the assessment of ear conditions
5. PERFORM anterior nasal packing and use nasal tampons. In addition he should assist ENT
specialist in performing posterior nasal packing
6. SUSPECT nasal and mandibular fractures and refer for specialist care
7. SUSPECT patients at risk of air way compromise and timely involve appropriate specialist in
the management of their conditions

8. OBSERVE and assist ENT specialists in " indirect laryngoscopy"

9. DIAGNOSE and initiate management of patients presenting with sinusitis & seventh nerve
palsy
10. DIAGNOSE vertigo & differentiate between vertigo & cerebellar symptoms
SKILLS

11.Properly MANAGE ear lacerations using appropriate suturing technique and avoid including
the cartilage
12. Immediately RECOGNIZE post-tonsillectomy bleeding, stabilize the patient and arrange for
immediate referral
13. PROVIDE analgesia and antibiotic treatment for patients presenting with dental abscess

64
ENT CASES PRESENTED TO THE ED

1. Ear pain
1.1. Otitis media and externa
1.2. Cholesteatoma
1.3. Perforated tympanic membrane
1.4. Mastoiditis
1.5. Foreign body
2. Epistaxis
3. Sore throat
3.1. Tonsillitis and tonsillar abscess
3.2. Retropharyngeal abscess fasciitis
3.4. Epiglottitis
4. Foreign bodies
4.1. Ear, nose
4.2. Throat, esophagus
4.3. Pharynx and larnx
4.4. Button batteries
5. Vertigo
6. Facial palsy
7. Sinusitis
8. Trauma to the head and neck
8.1.Mandibular fracture
8.2.Nasal fracture
8.3.Dental fracture and avulsed teeth
9. Ear lacerations
10.post-tonsillectomy bleeding

TOPICS AND LECTURES FOR ENT EMERGENCIES

1. Ear and throat emergencies

2. Management of epistaxis
3. Identification & management of head & neck trauma (basic guide for emergency doctors)

65
 EYE EMERGENCIES ( I n t e n d e d learning o u t c o m e s )
KNOWLEDGE
Upon completion of emergency medicine rotations, Trainees should be able to:
1. Discuss the causes and clinical presentation of common and serious eye emergencies (mentioned
in The case list)
2. Outline the causes and mechanisms of trauma to The eyes and explain its sequelae on various
intraorbital structures
Upon completion of emergency medicine rotations, Trainees should be able to:
1. Diagnose and manage completely or diagnose & initiate management or timely refer patients
SKILLS

presenting with eye emergency conditions (mentioned in the case list) according to case
complexity, the competency level of the trainee & the availability of ophthalmologist supervision
2. treat immediately patients presenting with ocular chemical burn

OPHTHALMIC EMERGENCY CASES PRESENTED TO THE ED

1. The red eye

1.1. Conjunctivitis
1.2. Corneal abrasions and ulcers
1.3. Keratitis
1.4. Foreign bodies
1.5. Occular burns
1.6. Scleral inflammation
2. Sudden visual loss
2.1. Retinal hemorrhage
2.2. Retinal vascular occlusion
2.3. Vitreous hemorrhage
2.4. Retinal detachment
2.5. Optic neuritis
2.6. CNS causes
3. Painful eye
3.1. Glaucoma
3.2. Uveitis and iritis
4. Eye trauma
4.1. Orbital fracture
4.2. Retinal detachment
4.3. Lens dislocation and hyphema
4.4. Penetrating eye injuries
5. Other eye problems
5.1.Orbital cellulitis
5.2.Cavernous sinus thrombosis
5.3.Eye lid problems
5.4.Dacrocystitis

66
TOPICS AND LECTURES FOR ENT EMERGENCIES
1. Common eye presentations to the ER, diagnosis &management
2. Intra occular trauma

VASCULAR EMERGENCIES ( I n t e n d e d learning o u t c o m e s )

Upon completion of vascular rotations, trainees should have acquired the following knowledge and
skills
KNOWLEDGE

1. DESCRIBE the causes, clinical presentation and principles of treatment of common and
important arterial problems that could be presented in The ER
2.The adverse SEQUELAE and presentation of iatrogenic intraarterial drug injection
3. The causes, differential diagnosis and principles of managing swollen calf in The ER

1. RESUSCITATE arterial injury and emergencies, initiate appropriate investigations and timely
SKILLS

consult or refer for specialty care

2. DIFFERENTIATE between DVT and other causes of swollen calf and request appropriate
investigations

VASCULAR EMERGENCY CASES

1 . Acute limb ischemia

2. Aortic aneurysm and aortic dissection
3. Acute abdomen secondary to mesenteric ischemia
4. Iatrogenic ischemia secondary to intra-arterial drug injection
5. Traumatic vascular injuries

TOPICS AND LECTURES FOR VASCULAR EMERGENCIES

1. Arterial emergencies
2. Deep venous thrombosis

67
 GYNECOLOGICAL AND OBSTETRIC EMERGENCIES
( I n t e n d e d learning o u t c o m e s )
Upon completion of obstetric and gynecology rotations, trainees should have acquired the following
knowledge and skills

Upon completion of obstetric and gynecology rotations, trainees should have acquired the
following knowledge and skills
1. DESCRIBE the gynecological causes of acute abdomen, their clinical presentations, differential
diagnosis and principles for their management in the emergency department
KNOWLEDGE

2. OUTLINE the causes of abnormal vaginal bleeding in different age groups and during
pregnancy and list The differential diagnosis, methods of investigations and principles of
management in emergency settings
3. DESCRIBE the emergency physician role in the management of sexual assaults
4. DEFINE preeclampsia and eclampsia, outline the clinical presentation and management
priorities
5. EXPLAIN the causes and consequences of trauma during pregnancy
6. BRIEF the stages of normal delivery, the features of complicated labor and the role of
emergency physicians in each

1. PERFORM pelvic examination competently and be able to use speculum

2. DIFFERENTIATE patients with acute abdomen due to gynecological causes, stabilize and
early involve gynecologist
3. USE ultrasound as an aid in The diagnosis of gynecological emergencies
4. RESUSCITATE and stabilize patients presenting with abnormal vaginal bleeding and call for
specialty care
5. MANAGE cases of eclampsia (eclamptic fits) in The emergency, stabilize patients and call for
SKILLS

obstetric help
6. IDENTIFY and refer cases with preeclampsia
7. RECOGNIZE the consequences of trauma in case of pregnancy and be able to resuscitate
trauma pregnant patients
8. IDENTIFY victims of sexual assaults and involve appropriate authorities. be able to provide
emergency contraception
9. MANAGE normal labor in emergency situations and resuscitate the newborn. in case of
abnormal labor during any stage, he should timely involve obstetricians

68
GYNECOLOGICAL AND OBSTETRIC CASES PRESENTED TO THE ED

1. Acute abdomen
1.1. Ectopic pregnancy
1.2. Endometriosis
1.3. Ovarian cyst and torsion
1.4. Pelvic inflammatory disease
1.5. Complications of fibroid
1.6. Severe dysmenorrhea
2. Abnormal vaginal bleeding
2.1. Premenopausal
2.2. Postmenopausal
2.3. During pregnancy (abortion, placenta brevia, & abruption placentae)
3. Rape and sexual assaults
4. Eclampsia and pre-eclampsia
5. Normal and abnormal labor

TOPICS AND LECTURES FOR GYNECOLOGICAL AND OBSTETRIC

EMERGENCIES
1. Gynecological emergencies
1.1. Bleeding
1.2. Acute abdominal pain
2. Obstetric emergencies
2.1. Bleeding in pregnancy
2.2. Trauma
2.3. Pre-eclampsia and eclampsia
2.4. Normal and abnormal delivery
2.5. Neonate resuscitation in delivery room
3. The medicolegal aspects of gynecological emergencies

69
 TOXICOLOGY AND ENVIRONMENTAL EMERGENCIES
( I n t e n d e d learning o u t c o m e s )

1. Toxicology
Upon completion of emergency medicine and toxicology rotations, Trainees should have acquired
the following knowledge and skills

Upon completion of emergency medicine and toxicology rotations, Trainees should have
acquired the following knowledge and skills

1. EXPLAIN the epidemiology of poisoning in Egypt and define The common types of
KNOWLEDGE

ingestions by age groups

2. DESCRIBE the clinical features of common poisons and The principle of their
management (e.g. salicylate poisoning, Paracetamol, antidepressants, etc.)
3. HIGHLIGHT the medico legal aspects of poisoning and what emergency physicians
should do to protect their patients
4. DESCRIBE The role of gastric lavage, activated charcoal, alkalinization and antidote in
The management of poisoning

1. RECOGNIZE the symptoms and signs suggestive of poisoning, stabilize The patients and
call for help through immediate contact with poisoning centers
SKILLS

2. Carefully OBTAIN drug history from patient and relatives to identify The causative agent
3. PERFORM gastric lavage only when indicated
4. RECOGNIZE cases suggestive of drug abuse stabilize and consult or refer to toxicology
center. in The meantime The ER physician should involve appropriate authorities

TOXICOLOGICAL CASES PRESENTED TO THE ED

1. Salicylate poisoning
2. Paracetamol poisoning
3. Antidepressants
4. Benzodiazipines
5. Opioids
6. Accidental kerosene ingestion
7. Ingestion of corrosives

70
TOPICS AND LECTURES FOR TOXICOLOGY EMERGENCY

1. Principles of toxicology
2. Toxins and toxicants
2.1. Drugs
2.2. Industrial, household & environmental toxicants
2.3. Natural products
3. Therapeutics

71
 2. Environmental emergencies
Upon completion of emergency medicine rotations, Trainees should have acquired the following
knowledge and skills

Upon completion of emergency medicine rotations, Trainees should have acquired the
KNOWLEDGE

following knowledge and skills

1. LIST the common types of environmental emergencies seen by emergency physicians

2. OUTLINE their clinical manifestations and methods of treatment

1. STABILIZE and resuscitate patients using The ABCDE approach

2. PROVIDE specific treatment if available or ensure safe referral
SKILLS

3. IDENTIFY associated complications if present

4. In case of scorpion or snake bite, he should be able to RECOGNIZE The bite and initiate
treatment through The immediate provision of passive immunization

ENVIRONMENTAL EMERGENCY CASES

1 . Hypothermia
2. Heat stroke and heat exhaustion
3. Hyperthermia related medications
4. Electric burn and electric shock
5. Drowning and near drowning
6. Industrial chemical exposure
7. Pesticide and insecticide exposure
8. Carbon monoxide poisoning
9. Bites and envenomation

TOPICS AND LECTURES FOR ENVIRONMENTAL EMERGENCIES

1. Temperature related emergencies

2. Electric burn and electric shock
3. Drowning and near drowning
4. Bites and envenomation

72
 PEDIATRIC EMERGENCIES
( I n t e n d e d learning o u t c o m e s )

By the end of the pediatric emergency rotations and APLS course, trainees should have the
following knowledge and skills

By the end of the pediatric emergency rotations and APLS course, trainees should
have the following knowledge and skills

1. SUMMARIZE the signs and symptoms that suggest life threatening or critical illnesses
in neonates, infants and children
2. DISCUSS the Management of cardiopulmonary arrest according to APLS
KNOWLEDGE

3. EXPLAIN the etiology and clinical presentation of shock in infants and children
4. DESCRIBE the etiology and clinical presentation of different types of coma in infants
and children
5. OUTLINE the Causes and clinical presentation of childhood poisoning
6. DESCRIBE the Initial management of burns, drowning and traumatized children
7. EXPLAIN the etiology, clinical presentation and management of acid base disturbances
and electrolyte imbalance in infants and children
8. RECALL the causes and basics of management of childhood pain
9. HIGHLIGHT the medico legal and Ethical issues related to pediatric emergency

1. RECOGNIZE neonates, infants and children with critical or life threatening presentation
related to any body organ/system
2. Timely INVOLVE pediatricians in the management of cases
3. ASSESS infants and children for fluid needs and manage different degrees of dehydration
4. DIFFERENTIATE between types of electrolyte disturbances and initiate management
appropriately
5. DIFFERENTIATE between various types of acid base disturbances and initiate
management appropriately
6. PERFORM cardiopulmonary resuscitation according to APLS
SKILLS

7. ASSESS and initiate management for different types of shock

8. ASSESS and manage different types of pain in infants and children
9. INITIATE management and refer appropriately infants and children presenting with
burns, multiple traumas and pediatric surgical emergencies
10. RECOGNIZE and initiate management for infants and children presenting with
uncommon emergencies like drowning, cold injury, and electric injury, psychiatric and
gynecological emergencies
11. COMMUNICATE effectively with parents and children in critical situations like
communicating bad news
12. ADVISE parents about prevention of childhood injuries

73
PEDIATRIC CASES PRESENTED TO THE ED
Case description Case description
Respiratory emergencies Metabolic emergencies
1. Stridor 1. Electrolyte disturbances with or without dehydration
2. Wheezy infants and bronchial asthma 2. Acid-base disturbances
3. Pneumonia , effusion and pneumothorax 3. Diabetic ketoacidosis
4. Foreign body inhalation 4. Addisonian crises
5. Respiratory failure due to various causes 5. Urea cycle defects
Cardiac emergencies 6. Aminoacidopathies
1. Arrhythmias 7. Hepatic coma
2. Cyanotic heart diseases Hematological emergencies
3. Heart failure 1. Acute hemolytic crises
4. Cardiogenic shock 2. Sickle cell anemia in crises
Neurological emergencies 3. Febrile neutropenia
1. Coma 4. Severe pallor for D.D
2. Convulsions 5. Hypercoagulable conditions
3. Stroke Other emergencies
4. Sudden weakness/ paralysis 1. Childhood injuries
5. Increased intracranial tension 2. Burns and surgical emergencies
6. Hypertensive encephalopathy 3. Shock, sepsis and DIC

PEDIATRIC PROCEDURAL SKILLS

The following pediatric procedures should be competently performed by Emergency medicine

trainees by the end of training
1. Cardiopulmonary resuscitation according to APLS
2. Intravenous line insertion
3. Nasal-gastric tube insertion and gastric lavage
4. Oro- pharyngeal suction
5. Urinary catheter application
6. Intravenous fluid therapy
7. Blood product transfusion
8. Arterial and capillary sampling for blood gas analysis
9. Wound dressing
10. Simple Suturing of wounds

74
TOPICS AND LECTURES FOR PEDIATRIC EMERGENCY

1. APLS
2. Emergency pediatrics as related to different organs/systems
3. Pediatric surgical emergencies ( principles of identification and stabilization)
4. Pediatric trauma
5. Pediatric toxicology and environmental emergencies

75
COMMUNIICATION, COLLABORATIION & INTERPERSONAL SKILLS

Upon completion emergency medicine rotations, Trainees should be able to demonstrate

communication and interpersonal skills that include the following:
1. Patients and relatives
2. Colleagues and other health care providers
3. Other care providers such as the police, the fire department and social services
4. Mass media and the general public

PROFESSIIONALISM AND OTHER ETHICAL AND LEGAL ISSUES

Upon completion emergency medicine rotations, Trainees should be able to be
1. Professional behavior and attributes
2. Working within a team as a leader or a member of the team
3. Delegation and referral
4. Patient confidentiality
5. Autonomy and informed consent
6. The competent/incompetent patient
7. Abuse and violence
8. Do not attempt to resuscitate (dnar) and limitations of therapeutic interventions
9. Medico-legal issues
10. Legislation and ethical issues in emergency medicine

76
Pre-hospital Care
“Newly qualified doctors are ill-equipped to deal with pre-hospital trauma emergencies despite a public
perception that medical education provides both experience and knowledge in this field. The diversity
of recreational sport is associated with a significant number of injuries, invariably some of which are
life-threatening. It is estimated that up to a third of pre-hospital deaths are preventable mainly from
airway and blood loss problems. There is a clear need for an appropriately structured trauma course in
pre-hospital care which include :
■ Self and scene safety
■ Control of massive life-threatening bleeding
■ Airway and cervical spine control
■ Breathing and ventilation
■ Circulation and arrest of external haemorrhage
■ Disability (neurological assessment)
■ Exposure and environment
Candidates will undertake skill stations on basic and advanced airway management, including oro-
and nasopharyngeal airways and surgical cricothyroidotomy. Control of external haemorrhage,
vascular access options, spinal immobilisation and limb splintage is also taught.
There are specific sessions dealing with pre-hospital analgesia, multiple casualty scenarios and major
incidents.

PRINCIPLES OF PRE-HOSPITAL CARE

■ Personal rescuer safety
■ Scene safety
■ Patient safety
■ Primary survey with resuscitation
■ Stabilisation
■ Packaging and transfer
Pre-hospital care is about getting...
The RIGHT patient
To the RIGHT hospital
At the RIGHT time
By the RIGHT transport
It is important to inform the hospital as soon as possible, preferably BEFORE leaving the scene.
Pre-alert messages should include the following information (using the MIST format):
■ Mechanism of injury
■ Injuries sustained and suspected
■ Signs and symptoms
■ Treatments given and required

77
THE ASSESSMENT OF THE PROBLEMS FACED IN
PRE-HOSPITAL EMERGENCY CARE
AIMS
■ To understand the need for rapid and accurate patient and scene assessment.
■ Understand the framework for patient assessment.
■ To recognise the need for effective time management whilst resuscitating and stabilising a patient.
■ To recognise if further skills and/or treatments are needed.
■ To know how to stabilise and transfer a patient providing safe care in transit in a timely fashion
and to the
right hospital

THE TRAUMA CHAIN OF SURVIVAL.

Good pre-hospital care
Rapid transport
Emergency medicine
Specialist intervention
Recovery

PRE-HOSPITAL APPROACH TO BURNS PATIENT

MANAGEMENT
AIMS
To understand the importance and size of the problem for this group of patients
To have a classification system for the burn
To have a consideration of the relevant aspects of the patient’s history
To have a priority based package of care, which is evidence based

PAIN RELIEF IN PRE-HOSPITAL CARE

AIMS
1. To understand the need to relieve pain
2. To understand the principles and practice of pain relief
3. To understand the priority pain relief has within pre-hospital care

SHOCK RELATED TO PRE-HOSPITAL CARE

AIMS
To understand the definition of shock.
To know the types of shock which are commonly encountered.
To recognize the pre-shocked clinical state and be able to treat shock when present.

BREATHING AND VENTILATION IN PRE-HOSPITAL

EMERGENCY CARE
AIMS
1. To understand the importance of breathing.
2. To understand the problems which may cause inadequate ventilation.
78
3. To know how to deal with problems of breathing
LIST OF FIRST PART REQUIRED LECTURES

Subject Number
Applied basic science and core emergency topics
1. Regional and applied anatomy 10
1.1 Head and neck 2
1.2 Neuroanatomy 1
1.3 Upper limb 2
1.4 Lower limb 2
1.5 Abdomen 1
1.6 Pelvis 1
1.7 Chest and heart 1
2. Pathology 4
2.1 Tissue repair and inflammation 1
2.2 General approach to trauma patient 1
2.3 Burn 1
2.4 Urine retention and renal colic 1
3. General outline of fractures 1
4. Triage 1
5. Ambulance 1
Total 17

LIST OF EMERGENCY MEDICINE LECTURES (2nd part)

Subject Number
Emergency general topics
General approach to patients in ED 1
The unconscious patient 1
Shock 2
Anesthesia and pain management 2
Fluid and electrolyte disturbances 1
Total 7

Cardiac emergencies
Types of cardiac arrest 1
Infective endocarditis 1
Dysrethmias 1
Acute coronary syndromes 2
ECG interpretation 1
Congestive heart failure and acute pulmonary edema 1
Total 3

79
Neurological emergencies
Meningitis and encephalitis 1
Stroke and transient ischemic attack 1
Epilepsy and statue epilepticus 1
Total 3

Subject Number
Hepatic and GIT emergencies
GIT bleeding 1
Liver cell failure 1
Total 2

Hematological emergencies
Blood product transfusion 1
Deep venous thrombosis 1
Hematological emergencies 1
Total 3

Infectious emergencies
General approach for identification and management 1
Of infections in the ER 1
The febrile child in the ER 1
Principles of infection control in the ER 1
Total 4

Oncology
Oncological emergencies
Total 1

Chest emergencies
Pulmonary embolism 1
Upper airway emergencies 1
Massive hemoptysis 1
Cyanosed patient 1
Total 4

Endocrinologic emergencies
Hypoglycemia 1
Diabetic ketoacidosis and hyperglycemia 2
Other endocrinologic emergencies 1
Total 4

Renal emergencies
Oncological emergencies
Total 1
80
Chest emergencies
Acute renal failure 1
Urinary tract infections 1
Total 2

Urological emergencies
Hematuria 1
Testicular torsion and epidydimitis 1
Total 2
Subject Number
Pediatric emergencies
Advanced pediatric life support 1
Pediatric medical emergencies 1
Pediatric surgical emergencies 1
Dermatological emergencies 1
Assessment and stabilization of behavior in the ER 1
Total 5

Gynecological emergencies
Medical emergencies of pregnancy 2
Vaginal bleeding 1
Eclampsia and preeclampsia 1
Total 4

Toxicology
General management of poison patient 1
Carbonmonoxide poisoning 1
Common poisons 1
Total 3

Autoimmune emergencies
Autoimmune emergencies 1

Surgical emergencies
Soft tissue infections 1
Acute abdominal pain 1
Emergency wound management 1
Acute limb ischemia 1
Head injury 1
Chest trauma 1
Chest injury (rupture A.A & FB inhalation) 1
Abdominal injury 1
Upper and lower GI bleeding 1
DVT and pulmonary embolism 1
Intestinal obstruction 1
Pediatric surgical emergencies 1
81
Oncological emergencies 1
Testicular pain, torsion 1
Ophthalmic emergencies 1
ENT emergencies 1
X rays for surgery 1
Total 17

Orthopedic emergencies
Upper limb injuries 1
Lower limb injuries 1
Fracture pelvis and hand injuries 1
Spinal fractures 1
Low back pain 1
X rays of fractures 2
Total 7

Common presenting symptoms

Chest pain 1
Headache 1
Altered level of consciousness 1
Seizures, Vertigo, & dizziness 1
Crying baby 1
Diarrhea, Vomiting 1
Dyspnea 1
Fever 1
Jaundice 1
Palpitation 1
Skin manifestations 1
Urinary symptoms 1
Total 12

82
 METHODS OF ASSESSMENTS
The general rules and regulations of assessment approved by the Egyptian fellowship board and published
at the training handbook and also at the board web site applies for emergency medicine specialty. In
addition to the successful completion of the training program, all candidates must successfully pass three
exams in order to get the fellowship certificate.

FIRST PART EXAM

The first part exam is a written exam. Trainees are allowed to sit for the first part exam after at least six
months of training. Each candidate has three chances to pass the exam and one more additional chance
may be granted in some special circumstances approved by the secretary general of the higher committee
of medical specialties. It is to be noted that after one year of training each time the candidate choose not
to enter the exam will be calculated as one of his three attempts.

PRE–REQUISITES FOR ENTERING FIRST PART EXAM:

Trainees should pass the following courses in order to be eligible for the first part exam.
1. Local TOEFFL with a score of at least 500.
2. Computer courses in word processing, power point and internet.

SECOND PART EXAM

The second part exam is a written exam. Trainees are allowed to sit for the second part exam after passing
successfully the first part and after completion of the training period (three years). In addition, each
candidate must submit his log book for final assessment. The log book requirements must all be
completed and signed by the trainer and educational supervisor.
Each candidate has three chances to pass the exam and one more additional chance may be grated in
special approved circumstances.

Audit or research project must be submitted, discussed and accepted by the scientific council before the
second part exam.

CLINICAL EXAM (THIRD PART)

The third part exam is a clinical and oral exam. Candidates who pass successfully the second part are
allowed to sit for the third part. Again each candidate has three chances to pass the clinical exam and an
additional fourth chance may be granted in epical approved circumstances.

THE STRUCTURE OF THE EXAMINATION:

The first part exam aims to test trainee's knowledge in basic science as it applies to the practice of
emergency medicine. It also aims to test their knowledge in the basics of emergency medicine practice.
The scientific council has make it very clear in the curriculum, which parts of the emergency curriculum
must be studied in the first year and these parts will be the subject of assessment in the first part exam.

The structure of the first part exam.

Part I examination consists of two parts:
1. Paper 1 (2 hours): Multiple choice questions with a single best answer format. This paper will
cover applied basic sciences mentioned in the curriculum.
2. Paper II (2 hours): short answer and/or problem solving questions and this paper test trainees'
83
 knowledge in the basis of emergency medicine that must be covered during the first year of
training.

The structure of the second part exam.

The second part exam aims to test trainee's knowledge and skills in emergency medicine. In this
exam all the curriculum will be covered.

Part II examination consists of four papers:

1. Two MCQ papers each two hours in duration. They are covering all emergency medicine
topics. In both papers, facts, problem solving and management skills are going to be
assessed. You will choose one best answer in each question.
2. One short answer question (SAQ) paper two hours in duration. It covers all emergency
subspecialties. Questions will assess Trainees' knowledge about various diseases and their
management.
3. In addition, one paper will be composed of problem solving questions (MCQ, short
answer or extended matching questions). It will test Trainees' problem solving skills.

The structure of the third part exam.

Part III exam is a clinical and oral exam and is composed of the following components:

OSPE: The objective structured practical exam is a multiple station examination (10-12 stations)
including ECG/ X-ray / CT scans/ laboratory data reports/ simulated patients and stations for procedural
skills on mannequins. The candidate rotates from station to station where he/ she are tested on specific
elements that measure his procedural, clinical and data interpretation skills.

VIVA: The oral exam which tests the candidates' ability to manage patients and explores his/her
knowledge of making an accurate diagnosis and whether he/her understands the essentials of therapeutics.
It also assesses his attitudes and interpersonal communication skills. It is based on a set of topics with
opening and supplementary questions. The questions cards are prepared in advance together with the
expected ideal answer and allocated marks. This allows a good objective basis for marking. The candidate
usually rotate through four oral committees, each committee is composed of two examiner and cover two
emergency medicine domains. The duration of each examination is 10 minutes with a total of 80 minutes
for the whole oral exam.

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