Thema indeling VGT / REVISED EUROPEAN EMERGENCY MEDICINE CORE CURRICULUM – APRIL 2017

Cardiovascular                                                                                   16 (14/2)         

Dermatology, immunology, endocrinology, metabolic       16 (14/2)         

Ear nose throat, oral and maxillofacial, opthalmic               12 (10/2)         

Gastro-intestinal                                                                                10 (9/1)           

Urogenital                                                                                            7 (6/1)              

Haematology, oncology, infectious diseases                          8                         

Musculoskeletal, trauma, forensic issues                                16 (14/2)         

Neurology and psychiatry                                                              15 (13/2)         

Pulmonology                                                                                       10 (9/1)           

Procedural sedation and analgesia                                             10 (9/1)           

Prehospital care                                                                                 4                         

Legal issues                                                                                          3                         

Geriatrics                                                                                              3                         

Toxicology                                                                                            10                       

Ultrasound in emergency care                                                     5                         

 

Total                                                                                                       145 (14 paediatric)

 

Cardiovascular

16 questions, 14 adult/2 paediatric

5 signs and symptoms/epidemiology

5 diagnostic

5 therapeutic

3.2.1.Cardiovascular Emergencies in Adults and Children

3.3.6.Cardiac Arrest

3.3.7.Chest pain

3.3.16.Palpitations

3.3.18.Shock in Adults and Children

3.3.20.Syncope

3.5.2.cardiopulmonary resuscitation Skills

3.5.5.Circulatory Support and Cardiac Skills and Procedures

Dermatology, immunology, endocrinology, metabolic

16 questions 14 adult/2 paediatric

5 signs and symptoms/epidemiology

5 diagnostic

5 therapeutic

3.2.2.Dermatological Emergencies in Adults and Children

3.3.19.Skin Manifestations in Adults and Children

3.2.9.Immunological Emergencies in Adults and Children

3.2.3.Endocrine and Metabolic Emergencies in Adults and Children

3.2.4.Fluid and Electrolyte Disturbances

Ear nose throat, oral and maxillofacial, opthalmic

12 questions, 10 adult/2 paediatric

3 signs and symptoms/epidemiology

3 diagnostic

4 therapeutic

3.2.5.Ear, Nose, Throat, Oral and Neck Emergencies in Adults and Children

3.3.5.BLEEDING (NON TRAUMATIC) • Ear, Nose, Throat causes

3.5.7.ENT Skills and Procedures

3.5.19.oral and maxillofacial procedures

3.2.13.Ophthalmic Emergencies in Adults and Children

3.5.14.Ophthalmic Skills and Procedures

Gastro-intestinal

10 questions, 8 adult/2 paediatric

3 signs and symptoms/epidemiology

3 diagnostic

4 therapeutic

3.2.6.Gastrointestinal Emergencies in Adults and Children

3.3.1.Acute Abdominal Pain/ distension in adults and children

3.3.5.BLEEDING (NON TRAUMATIC)• Gastrointestinal causes

3.3.9.Diarrhoea

3.3.13.Jaundice

3.3.23.Vomiting

3.5.8.Gastrointestinal Procedures

Urogenital

7 questions, 6 adult/1 paediatric

2 signs and symptoms/epidemiology

3 diagnostic

2 therapeutic

3.2.7.Gynaecological and Obstetric Emergencies

3.2.16.Renal and genitoUrological Emergencies in Adults and Children

3.3.5.BLEEDING (NON TRAUMATIC)• Gynaecological and Obstetric causes • Renal and Genitourinary causes

3.3.21.Urinary Symptoms (Dysuria, Oligo/Anuria, Polyuria)

3.5.9.Genitourinary Procedures

3.5.13.Obstetric and Gynaecological Skills and Procedures

Haematology, oncology, infectious diseases

8 questions, paediatric optional

3 signs and symptoms/epidemiology

2 diagnostic

3 therapeutic

3.2.8.Haematology and Oncology Emergencies in Adults and Children

3.2.10.Infectious Diseases and Sepsis in Adults and Children

3.3.11.Fever and Endogenous Increase in Body Temperature

3.5.1.infection control

3.5.15.Temperature Control Procedures

Musculoskeletal, trauma, forensic issues

16 questions, 14 adult/2 paediatric

5 signs and symptoms/epidemiology

5 diagnostic

5 therapeutic

3.2.11.Musculo-Skeletal Emergencies

3.2.17.Trauma in Adults and Children (including hand injuries)

3.3.4.Back Pain

3.4.1.Abuse and Assault in Adults and Children

3.4.5.Forensic Issues3.5.11.Musculoskeletal Techniques

3.5.17.Wound Management

Neurology and psychiatry

15 questions, 13 adult/2 paediatric

5 signs and symptoms/epidemiology

5 diagnostic

5 therapeutic

3.2.12.Neurological Emergencies in Adults and Children

3.2.15.Psychiatric and Behaviour Disorders

3.3.2.Altered Behaviour and Agitation

3.3.3.Altered Level of Consciousness in Adults and Children

3.3.12.Headache in Adults and Children

3.3.17.Seizures in Adults and Children

3.3.22.Vertigo and Dizziness

3.5.12.Neurological Skills and Procedures

Pulmonology

10 questions, 9 adult/1 paediatric

3 signs and symptoms/epidemiology

3 diagnostic

4 therapeutic

3.2.14.Pulmonary Emergencies in Adults and Children

3.3.5.BLEEDING (NON TRAUMATIC) • Respiratory causes

3.3.10.Dyspnoea in adults and children

3.5.4.Breathing and Ventilation Management Skills

Procedural sedation and analgesia

10 questions, 9 adult/1 paediatric

3 signs and symptoms/epidemiology

3 diagnostic

4 therapeutic

3.4.2.Analgesia and Sedation in Adults and Children

3.5.2.Airway Management Skills

3.5.3.Analgesia and Sedation Skills

Prehospital care

4 questions

3.4.3.Disaster Medicine

3.4.4.Environmental Accidents in Adult and Children

3.5.10.Hygiene Skills and Procedures

  1. 5.16.Transportation of the Patient

4.10.Pre-Hospital Care

Legal issues

2 questions

3.4.7.Patient Management Issues in Emergency Medicine

Geriatrics

2 questions

3.4.8.Problems in the Elderly

Toxicology

8 questions

3 signs and symptoms/epidemiology

2 diagnostic

3 therapeutic

3.4.9.Toxicology in Adults and Children

Ultrasound in emergency care

5 questions

4 diagnostic

1 therapeutic

3.5.20.point of care Ultrasound (POCUS)

REVISED EUROPEAN EMERGENCY MEDICINE CORE CURRICULUM – APRIL 2017

3.2.1.CARDIOVASCULAR EMERGENCIES IN ADULTS AND CHILDREN

  • Arrhythmias
  • Congenital heart disorders
  • Contractility disorders, pump failure

cardiomyopathies, congestive heart failure, acute pulmonary oedema,

tamponade, valvular emergencies

  • Inflammatory and infectious cardiac disorders

endocarditis, myocarditis, pericarditis

  • Ischaemic heart disease

acute coronary syndromes, stable angina

  • Traumatic injuries
  • Vascular and thromboembolic disorders

aortic dissection/aneurysm rupture, deep vein thrombosis, hypertensive

emergencies, occlusive arterial disease, thrombophlebitis, pulmonary

embolism, pulmonary hypertension

3.2.2.DERMATOLOGICAL EMERGENCIES IN ADULTS AND CHILDREN

  • Inflammatory and Infectious disorders
  • Skin manifestations of

immunological disorders, systemic disorders, toxic disorders

3.2.3.ENDOCRINE AND METABOLIC EMERGENCIES IN ADULTS AND CHILDREN

  • Adrenal insufficiency and crisis
  • Disorders of glucose metabolism

hyperosmolar hyperglycaemic state, hypoglycaemia, hyperglycaemia,

ketoacidosis

  • Thyroid disease emergencies

hyperthyroidism, hypothyroidism, myxoedema coma, thyroid storm

3.2.4.FLUID AND ELECTROLYTE DISTURBANCES

  • Acid-Base disorders
  • Electrolyte disorders
  • Volume status and fluid balance

3.2.5.EAR, NOSE, THROAT, ORAL AND NECK EMERGENCIES IN ADULTS AND CHILDREN

  • Bleeding
  • Complications of tumours

airway obstruction, bleeding

  • Foreign bodies
  • Inflammatory and Infectious disorders

angio-oedema, epiglottitis, laryngitis, peritonsillar abscess, mastoiditis

  • Traumatic problems

3.2.6.GASTROINTESTINAL EMERGENCIES IN ADULTS AND CHILDREN

  • Congenital disorders

Hirschsprung’s disease, Meckel’s diverticulum, pyloric stenosis

  • Inflammatory and Infectious disorders

appendicitis, cholecystitis, cholangitis, diverticulitis, exacerbations and

complications of inflammatory bowel diseases, gastritis, gastroenteritis,

gastro-oesophageal reflux disease, hepatitis, pancreatitis, peptic ulcer,

peritonitis, pilonidal abscess, perianal abscess

  • Metabolic disorders

hepatic disorders, hepatic failure

  • Traumatic and mechanical problems

foreign bodies, hernia strangulation, intestinal obstruction and occlusion

  • Tumours
  • Vascular disorders: Ischaemia and Bleeding

ischaemic colitis, upper and lower gastrointestinal bleeding, mesenteric

ischaemia, haemorrhoids, thromboses external haemorrhoids

  • Other problems

complications of gastrointestinal devices and surgical procedures

3.2.7.GYNAECOLOGICAL AND OBSTETRIC EMERGENCIES

  • Inflammatory and Infectious disorders

mastitis, metritis, pelvic inflammatory disease, vulvovaginitis, toxic shock

syndrome, sexual transmitted diseases, herpes simplex virus infection,

Bartholin gland abscess

  • Obstetric emergencies

spontaneous abortion in early pregnancy, abruptio placentae, preeclampsia,

eclampsia, ectopic pregnancy, emergency delivery (including

perimortem c-section), HELLP syndrome during pregnancy, hyperemesis

gravidarum, placenta praevia, postpartum haemorrhage,

  • Traumatic and related problems

ovarian torsion

  • Tumours
  • Vascular disorders: Ischaemia and Bleeding

vaginal bleeding

3.2.8.HAEMATOLOGY AND ONCOLOGY EMERGENCIES IN ADULTS AND CHILDREN

  • Anaemias
  • Complications of lymphomas and leukaemias
  • Congenital disorders

haemophilias and Von Willebrand’s disease, hereditary haemolytic

anaemias, sickle cell disease

  • Inflammatory and Infectious disorders

neutropenic fever, infections in immunocompromised patients, severe

sepsis and septic shock

  • Vascular disorders: Ischaemia and Bleeding

acquired bleeding disorders (coagulation factor deficiency, disseminated

intravascular coagulation), drug induced bleeding (anticoagulants,

antiplatelet agents, fibrinolytics), idiopathic thrombocytopenic purpura,

thrombotic thrombocytopenic purpura

  • Transfusion reactions
  • Metabolic disorders

hypercalcaemia, tumour lysis syndrome, SIADH

  • Neurological disorders

spinal cord compression, brain metastases, raised intracranial pressure

  • Cardiovascular disorders

malignant pericardial effusion, superior vena cava syndrome

3.2.9.IMMUNOLOGICAL EMERGENCIES IN ADULTS AND CHILDREN

  • Allergies and anaphylactic reactions
  • Angioneurotic oedema
  • Inflammatory and Infectious disorders

acute complications of vasculitis

3.2.10.INFECTIOUS DISEASES AND SEPSIS IN ADULTS AND CHILDREN

  • Common viral and bacterial infections
  • Food and water-born infectious diseases
  • HIV infection and AIDS
  • Common tropical diseases
  • Parasitosis
  • Rabies
  • Sepsis and septic shock
  • Sexually transmitted diseases
  • Streptococcal toxic shock syndrome
  • Tetanus
  • Ebola, MERS, Tuberculosis, Measles, Influenza outbreak

3.2.11.MUSCULO-SKELETAL EMERGENCIES

  • Congenital disorders

dislocated hip, osteogenesis imperfecta

  • Inflammatory and Infectious disorders

arthritis, bursitis, cellulitis, complications of systemic rheumatic diseases,

necrotising fasciitis, osteomyelitis, polymyalgia rheumatica, soft tissue

infections

  • Metabolic disorders

complications of osteoporosis and other systemic diseases

  • Traumatic and degenerative disorders

back disorders, common fractures and dislocations, compartment

syndromes, crush syndrome, osteoarthrosis, rhabdomyolysis, soft tissue

trauma

  • Tumours:

pathological fractures

3.2.12.NEUROLOGICAL EMERGENCIES IN ADULTS AND CHILDREN

  • Inflammatory and Infectious disorders

brain abscess, encephalitis, febrile seizures in children, Guillain-Barrè

syndrome, meningitis, peripheral facial palsy (Bell’s palsy), temporal

arteritis

  • Traumatic and related problems

complications of CNS devices, spinal cord syndromes, peripheral nerve

trauma and entrapment, traumatic brain injury

  • Tumours

common presentations and acute complications of neurological and

metastatic tumours

  • Vascular disorders: Ischaemia and Bleeding

carotid artery dissection, stroke, subarachnoid haemorrhage, subdural and

extradural haematoma, transient ischaemic attack, venous sinus

thrombosis

  • Other problems

acute complications of chronic neurological conditions (e.g. myasthenic

crisis, multiple sclerosis), acute peripheral neuropathies, seizures and

status epilepticus

3.2.13.OPHTHALMIC EMERGENCIES IN ADULTS AND CHILDREN

  • Inflammatory and Infectious disorders

conjunctivitis, dacrocystitis, endophthalmitis, iritis, keratitis, orbital and

periorbital cellulitis, uveitis, scleritis, episcleritis

  • Traumatic and related problems

foreign body in the eye, ocular injuries, perforating injuries of the globe

  • Vascular disorders: Ischaemia and Bleeding

retinal artery and vein occlusion, vitreous haemorrhage

  • Others

acute glaucoma, retinal detachment

3.2.14.PULMONARY EMERGENCIES IN ADULTS AND CHILDREN

  • Congenital

cystic fibrosis

  • Inflammatory and Infectious disorders

asthma, bronchitis, bronchiolitis, pneumonia, empyema, COPD

exacerbation, lung abscess, pleurisy and pleural effusion, pulmonary

fibrosis, tuberculosis

  • Traumatic and related problems

foreign body inhalation, haemothorax, tension pneumothorax,

pneumomediastinum

  • Tumours

common complications and acute complications of pulmonary and

metastatic tumours,

  • Vascular disorders

pulmonary embolism

  • Other disorders

acute lung injury, atelectasis, ARDS, spontaneous pneumothorax

3.2.15.PSYCHIATRIC AND BEHAVIOUR DISORDERS

  • Behaviour disorders

affective disorders, confusion and consciousness disturbances, intelligence

disturbances, memory disorders, perception disorders, psycho-motor

disturbances, thinking disturbances, altered mood, delusion, situational

crisis, social crisis

  • Common psychiatric emergencies

acute psychosis, anorexia and bulimia complications, anxiety and panic

attacks, conversion disorders, deliberate self-harm and suicide attempt,

depressive illness, personality disorders, substance, drug and alcohol

abuse

3.2.16.RENAL AND GENITOUROLOGICAL EMERGENCIES IN ADULTS AND CHILDREN

  • Inflammatory and Infectious disorders

epididymitis, orchitis, glomerulonephritis, pyelonephritis, prostatitis,

sexually transmitted diseases, urinary tract infections, balanitis

  • Metabolic disorders

acute renal failure, nephrotic syndrome, nephrolithiasis, uraemia

  • Traumatic and related problems

urinary retention, testicular torsion, torsion of the appendix testis,

paraphimosis, phimosis, scrotal hydrocele, testicular haematoma

  • Tumours
  • Vascular disorders: Ischaemia and Bleeding
  • Other disorders

comorbidities in dialysis and renal transplanted patients, complications of

urological procedures and devices, haemolytic uraemic syndrome

3.2.17.TRAUMA IN ADULTS AND CHILDREN

  • Origin of trauma:

burns, blunt trauma, penetrating trauma

  • Anatomical location of trauma:

head and neck, maxillofacial, thorax, abdomen, pelvis, spine, extremities

  • Polytrauma patient
  • Trauma in specific populations:

children, elderly, pregnant women.

3.3.1.ACUTE ABDOMINAL PAIN/ DISTENSION IN ADULTS AND CHILDREN

  • Gastrointestinal causes

appendicitis, cholecystitis, cholangitis, acute pancreatitis, complications of

hernias, diverticulitis, hepatitis, hiatus hernia, inflammatory bowel disease,

intestinal obstruction, ischaemic colitis, mesenteric ischaemia, peptic ulcer,

peritonitis, viscus perforation, intussusception

  • Cardiac/vascular causes

acute myocardial infarction, aortic dissection, aortic aneurysm rupture

  • Dermatological causes

herpes zoster

  • Endocrine and metabolic causes

Addison’s disease, diabetic ketoacidosis, other metabolic acidosis,

porphyria

  • Gynaecological and Obstetric causes

complications of pregnancy, ectopic pregnancy, pelvic inflammatory

disease, rupture of ovarian cyst, ovarian torsion

  • Haematological causes

acute porphyria crisis, familial mediterranean fever, sickle cell crisis

  • Musculo-skeletal causes

referred pain from thoraco-lumbar spine

  • Renal and Genitourinary causes

pyelonephritis, renal stones

  • Respiratory causes

pneumonia, pleurisy

  • Toxicology

poisoning

  • Trauma

abdominal

3.3.2.ALTERED BEHAVIOUR AND AGITATION

  • Psychiatric causes

acute psychosis, depression, hallucination, anxiety, panic attack

  • Cardiac/Vascular causes

hypertension, vasculitis, ischaemic or hemorrhagic stroke

  • Endocrine and metabolic causes

hypoglycaemia, hyperglycaemia, electrolyte imbalance, hyperthermia,

hypoxaemia, myxoedema coma or crisis, thyrotoxicosis

  • Neurological causes

cerebral space-occupying lesions, dementia, hydrocephalus, intracranial

hypertension, CNS infections, extradural, subdural, subarachnoid or

intracranial haemorrhage

  • Toxicology

alcohol and drug abuse, poisoning

  • Iatrogenic causes and non-compliance

missed essential therapy, e.g. dialysis, faulty medication doses

3.3.3.ALTERED LEVEL OF CONSCIOUSNESS IN ADULTS AND CHILDREN

  • Neurological causes

cerebral tumour, epilepsy and status epilepticus, meningitis, encephalitis,

stroke, subarachnoid haemorrhage, subdural and extradural haematoma,

traumatic brain injury

  • Cardiovascular causes

hypoperfusion states, shock

  • Endocrine and metabolic causes

electrolyte imbalances, hepatic coma, hypercapnia, hypothermia, hypoxia,

hypoglycaemia/ hyperglycaemia, uraemia, Addison crisis, myxoedema

coma or crisis, thyrotoxicosis

  • Gynaecological and Obstetric causes

eclampsia

  • Infectious causes

septic shock

  • Psychiatric causes

conversion syndrome

  • Respiratory causes

respiratory failure

  • Toxicology

alcohol intoxication, carbon-monoxide poisoning, narcotic and sedative

poisoning, other substances

  • Iatrogenic causes and non-compliance

missed essential therapy, e.g. dialysis, medications

3.3.4.BACK PAIN

  • Musculo-Skeletal causes

fractures, intervertebral disc strain and degeneration, strain of muscles,

ligaments and tendons, spinal stenosis, arthritis, arthrosis

  • Cardiovascular causes

aortic aneurysm, aortic dissection

  • Infectious causes

osteomyelitis, discitis, pyelonephritis, prostatitis

  • Endocrine and metabolic causes

Paget’s disease

  • Gastrointestinal causes

pancreatitis, cholecystitis

  • Dermatological causes

herpes zoster

  • Gynaecological causes

endometriosis, pelvic inflammatory disease

  • Haematological and Oncological causes

abdominal or vertebral tumours, pathological fractures

  • Neurological cause:

subarachnoid haemorrhage

  • Renal and Genitourinary causes

renal abscess, renal calculi

  • Trauma

3.3.5.BLEEDING (NON TRAUMATIC)

  • Ear, Nose, Throat causes

ear bleeding (otitis, trauma, tumours), epistaxis

  • Gastrointestinal causes

haematemesis and melaena (acute gastritis, gastro-duodenal ulcer,

Mallory Weiss syndrome, oesophageal varices) rectal bleeding (acute

diverticulitis, haemorrhoids, inflammatory bowel disease, tumours)

  • Gynaecological and Obstetric causes

menorrhagia/metrorrhagia (abortion, abruptio placentae, tumours)

  • Renal and Genitourinary causes

haematuria (pyelitis, tumours, urolithiasis)

  • Respiratory causes

haemoptysis (bronchiectasis, pneumonia, tumours, tuberculosis)

3.3.6.CARDIAC ARREST

  • Cardiac arrest treatable with defibrillation

ventricular fibrillation, pulseless ventricular tachycardia

  • Pulseless electric activity

Acidosis, hypoxia, hypothermia, hypo/hyperkalaemia, hypocalcaemia,

hypo/hyperglycaemia, hypovolaemia, tension pneumothorax, cardiac

tamponade, myocardial infarction, pulmonary embolism, poisoning

  • Asystole

3.3.7.CHEST PAIN

  • Cardiac/vascular causes

acute coronary syndrome, aortic dissection, arrhythmias, pericarditis,

myocarditis, pulmonary embolism, pericardial effusion

  • Respiratory causes

pneumonia, pneumomediastinum, pneumothorax (especially tension

pneumothorax), pleurisy

  • Gastrointestinal causes

Gastro-oesophageal reflux, oesophageal rupture, oesophageal spasm

  • Musculo-Skeletal causes

costosternal injury, costochondritis, intercostal muscle pain, pain referred

from thoracic spine

  • Psychiatric causes

anxiety, panic attack

  • Dermatological causes

herpes zoster

3.3.9.DIARRHOEA

  • Infectious causes

AIDS, bacterial enteritis, viral, parasites, food-borne, toxins

  • Toxicological causes

drugs related, poisoning (including heavy metals, mushrooms,

organophosphates, rat poison, seafood)

  • Endocrine and metabolic causes

carcinoids, diabetic neuropathy

  • Gastrointestinal causes

diverticulitis, dumping syndrome, ischaemic colitis, inflammatory bowel

disease, enteritis due to radiation or chemotherapy

  • Haematological and Oncological causes

toxicity due to cytostatic therapies

  • Immunology

food allergy

  • Psychiatric disorders

diarrhoea “factitia”

3.3.10.DYSPNOEA IN ADULTS AND CHILDREN

  • Respiratory Causes

airway obstruction, broncho-alveolar obstruction, parenchymal diseases,

pulmonary shunt, pleural effusion, atelectasis, pneumothorax,

haemoptysis, bronchiolitis

  • Cardiac/vascular causes

cardiac decompensation, cardiac tamponade, pulmonary embolism

  • Ear, Nose, Throat causes

epiglottitis, croup and pseudocroup

  • Fluid & Electrolyte disorders

hypovolaemia, shock, anaemia

  • Gastrointestinal causes

hiatus hernia

  • Immunological causes

vasculitis

  • Metabolic causes

metabolic acidosis, uraemia

  • Neurological causes

myasthenia gravis, Guillain Barrè syndrome, amyotrophic lateral sclerosis

  • Psychiatric disorders

conversion syndrome

  • Toxicology

CO intoxication, cyanide intoxication

  • Trauma

flail chest, lung contusion, traumatic pneumothorax, haemothorax

3.3.11.FEVER AND ENDOGENOUS INCREASE IN BODY TEMPERATURE

  • Systemic infectious causes

sepsis, severe sepsis and septic shock, multiple organ dysfunction

syndrome, parasitosis, flu-like syndrome, common viral and bacterial

infections

  • Organ-specific infectious causes

endocarditis, myocarditis, pharyngitis, tonsillitis, abscesses, otitis,

cholecystitis and cholangitis, meningitis, encephalitis

  • Non-infectious causes

Lyell syndrome, Stephen-Johnson syndrome, thyroid storm, pancreatitis,

inflammatory bowel disease, pelvic inflammatory disease, toxic shock,

  • Haematological and Oncological causes

leukaemia and lymphomas, solid tumours, neutropenic fever

  • Immunological causes

arteritis, arthritis, lupus, sarcoidosis

  • Musculo-Skeletal causes

osteomyelitis, fasciitis and cellulitis, erysipelas, necrotising fascitis

  • Neurological causes

cerebral haemorrhage

  • Psychiatric causes

factitious fever

  • Renal and Genitourinary causes

pyelonephritis, prostatitis, sexual transmitted diseases

  • Toxicology
  • pyrexia of unknown origin

3.3.12.HEADACHE IN ADULTS AND CHILDREN

  • Vascular causes

migraine, cluster headache, tension headache, cerebral haemorrhage,

hypertensive encephalopathy, ischaemic stroke

  • Haematological and Oncological causes

brain tumours

  • Immunological causes

temporal arteritis, vasculitis

  • Infectious causes

abscesses, dental infections, encephalitis, mastoiditis, meningitis, sinusitis

  • Musculo-Skeletal causes

cervical spine diseases, temporomandibular joint syndrome

  • Neurological causes

trigeminal neuralgia

  • Ophthalmological causes

optic neuritis, acute glaucoma

  • Toxicology

alcohol, analgesic abuse, calcium channel blockers, glutamate, nitrates,

opioids and caffeine withdrawal

  • Trauma:

head trauma

3.3.13.JAUNDICE

  • Gastrointestinal causes

cholangitis, hepatic failure, pancreatic head tumour, pancreatitis,

obstructive cholestasis

  • Cardiac/Vascular causes

chronic cardiac decompensation

  • Haematological and Oncological causes

haemolytic anaemias, thrombotic thrombocytopenic purpura, haemolytic

uraemic syndrome, disseminated intravascular coagulation

  • Infectious causes

malaria, leptospirosis

  • Gynaecological causes

HELLP syndrome

  • Toxicology

drug induced haemolytic anaemias, snake venom

3.3.16.PALPITATIONS

  • Cardiac/Vascular causes

bradyarrhythmias (including sinus bradycardia and AV blocks),

extrasystoles, tachyarrhythmias (including atrial fibrillation, sinus

tachycardia, supraventricular tachycardia, ventricular tachycardia)

  • Endocrine and metabolic causes

thyrotoxicosis

  • Toxicology

drugs

3.3.17.SEIZURES IN ADULTS AND CHILDREN

  • Neurological causes

generalised epilepsy, partial complex or focal epilepsy, status epilepticus

  • Cardiac/Vascular causes

hypertensive encephalopathy, syncope, dysrhythmias, migraines

  • Endocrine and metabolic causes

metabolic seizures

  • Gynaecological causes

eclampsia

  • Infectious causes

febrile seizures in children

  • Psychiatric causes

narcolepsy, pseudo-seizures

  • Respiratory causes

respiratory arrest

  • Toxicology

drugs/toxins

3.3.18.SHOCK IN ADULTS AND CHILDREN

  • Cardiogenic
  • Hypovolaemic
  • Obstructive
  • Distributive (anaphylactic, septic, neurogenic, Addison crisis)
  • Cardiac/Vascular causes

cardiogenic shock, arrhythmias

  • Endocrine and metabolic causes

Addison’s crisis

  • Fluid and Electrolyte disorders

hypovolaemic shock

  • Gastrointestinal causes

vomiting, diarrhoea

  • Gynaecological causes

toxic shock

  • Immunological causes

anaphylactic shock

  • Infectious causes

septic shock

  • Neurological causes

neurogenic shock

  • Trauma

hypovolaemic shock, neurogenic shock.

  • Others

Methaemoglobinaemia, carbon monoxide poisoning

3.3.19.SKIN MANIFESTATIONS IN ADULTS AND CHILDREN

  • Dermatological causes

eczema, psoriasis, skin tumours

  • Immunological causes

vasculitides, urticaria, Stevens-Johnson syndrome, Lyell syndrome (toxic

epidermal necrolysis)

  • Infectious causes

viral exanthemata, meningococcaemia, herpes zoster/simplex, abscesses

of the skin, cellulitis, lymphangitis

  • Psychiatric causes

Self-inflicted skin lesions or from abuse

  • Toxicology
  • Haematological and Oncological causes

idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura

3.3.20.SYNCOPE

  • Cardiac/vascular causes

aortic dissection,

cardiac arrhythmias (including bradytachycardia syndrome, Brugada

syndrome, drug overdose, long QT syndrome, sick sinus syndrome,

torsades de pointes, ventricular tachycardia, 2nd and 3rd degree AV-block,

junctional rhythm).

other causes of hypoperfusion (including ischaemia, valvular,

haemorrhage, obstruction: e.g. aortic stenosis, pulmonary embolism,

tamponade)

orthostatic hypotension

  • Endocrine and metabolic causes

Addison’s disease

  • Fluid and Electrolyte disorders

hypovolaemia

  • Gastrointestinal causes

vomiting, diarrhoea, gastrointestinal bleeding

  • Neurological causes

autonomic nervous system disorder, epilepsy, vasovagal reflex

  • Toxicology

alcoholic or drug consumption

3.3.21.URINARY SYMPTOMS (DYSURIA, OLIGO/ANURIA, POLYURIA)

  • Renal and Genitourinary causes

acute renal failure, acute urinary retention, cystitis and pyelonephritis,

prostatitis

  • Cardiac/Vascular causes

cardiac decompensation

  • Endocrine and metabolic causes

diabetes mellitus, diabetes insipidus

  • Fluid and Electrolyte disorders

hypovolaemia

3.3.22.VERTIGO AND DIZZINESS

  • Ear and Labyrinth causes

benign postural vertigo, Meniere’s disease, otitis, vestibular neuritis, viral

labyrinthitis

  • Cardiac/Vascular causes

arrhythmias, hypotension

  • Endocrine and metabolic causes

hypoglycaemia

  • Haematological and Oncological causes

anaemias

  • Nervous system causes

acoustic neuroma, bulbar or cerebellar lesions, multiple sclerosis, temporal

epilepsy

  • Psychiatric causes

anxiety

  • Respiratory causes

hypoxia

  • Toxicology

alcohol abuse, drugs and substances

3.3.23.VOMITING

  • Gastrointestinal causes

appendicitis, cholecystitis, gastroparesis, gastric obstruction and retention,

gastroenteritis, hepatitis, pancreatitis, pyloric stenosis, small bowel

obstructions

  • Cardiac/Vascular causes

myocardial ischaemia

  • Ear, Nose, Throat causes

vestibular disorders

  • Endocrine and metabolic causes

diabetic ketoacidosis, hypercalcaemia

  • Fluid and Electrolyte disorders

hypovolaemia

  • Gynaecological and Obstetric causes

pregnancy

  • Infectious causes

sepsis, meningitis

  • Neurological causes

cerebral oedema or haemorrhage, hydrocephalus, intracranial spaceoccupying

lesions

  • Ophthalmological causes

acute glaucoma

  • Psychiatric causes

eating disorders

  • Renal and Genitourinary causes

renal calculi, uraemia

  • Toxicology

3.4.SPECIFIC ASPECTS OF EMERGENCY MEDICINE

3.4.1.ABUSE AND ASSAULT IN ADULTS AND CHILDREN

  • Abuse in the elderly and impaired
  • Child abuse and neglect
  • Intimate partner violence and abuse
  • Sexual assault
  • Patient safety in Emergency Medicine
  • Violence management and prevention in the Emergency Department

3.4.2.ANALGESIA AND SEDATION IN ADULTS AND CHILDREN

  • Pain transmission (anatomy, physiology, pharmacology)
  • Pain assessment
  • Pharmacology of sedative and pain relieving drugs
  • Psychological and social aspects of pain in paediatric, adult and elderly patients

3.4.3.DISASTER MEDICINE

  • Disaster preparedness
  • Major/mass casualty incident planning/procedures/practice
  • Disaster response
  • Mass gatherings
  • Specific medical topics (triage, bioterrorism, blast and crush injuries, chemical agents,

radiation injuries)

  • Debriefing and mitigation

3.4.4.ENVIRONMENTAL ACCIDENTS IN ADULT AND CHILDREN

  • Electricity (electrical and lightening injuries)
  • Flora and Fauna (injuries from exposure, bites and stings)
  • High-altitude (medical problems)
  • NBCR (nuclear, biological, chemical and radiological:, decontamination, specific

aspects)

  • Temperature (heat and cold related emergencies)
  • Travel medicine
  • Water (near-drowning, dysbarism and complications of diving, marine fauna)
  • Major/minor burns
  • Toxic ingestion or exposure

3.4.5.FORENSIC ISSUES

  • Basics of relevant legislation in the country of practice
  • Recognise and preserve evidence
  • Provide appropriate medical documentation (including forensic and clinical

photography, collection of biological samples, ballistics)

  • Appropriate reporting and referrals (e.g. child abuse or neglect, gunshot and other

forms of penetrating wounds, elder abuse, sexual assault allegations)

  • Medico-legal documentation

3.4.7.PATIENT MANAGEMENT ISSUES IN EMERGENCY MEDICINE

  • Emergency Department organisation (administration, structure, staffing, resources)
  • Management of specific populations:

children in special circumstances including child protection

elderly patients

homeless patients

mentally incompetent adults

psychiatric patients

overweight/underweight patients

3.4.8.PROBLEMS IN THE ELDERLY

  • Atypical presentations (e.g. abdominal pain, infections, myocardial infarction)
  • Delirium
  • Dementia
  • Falls (causes & investigations)
  • Immobility
  • Multiple pathology and multiple therapies
  • Self-dependency
  • Trauma & co-morbidity
  • Polypharmacy

3.4.9.TOXICOLOGY IN ADULTS AND CHILDREN

  • General principles of toxicology and management of poisoned patients
  • Principles of drug interactions
  • Toxidromes
  • Specific aspects of poisoning

drugs (including paracetamol, amphetamine, anticholinergics,

anticonvulsants, antidepressants, antihypertensives, benzodiazepines,

digitalis, monoamine oxidase inhibitors, neuroleptics)

industrial, chemicals

plants & mushrooms

alcohol abuse and alcohols poisoning, alcohol withdrawal

drugs of abuse

  • Organisation and information (e.g. poison centres, databases)

3.4.10.PRE-HOSPITAL CARE

  • Emergency Medical Services organisation (administration, structure, staffing,

resources)

  • Medical transport (including neonates and children, air transport)
  • Paramedic training and function
  • Safety at the scene
  • Collaboration with other emergency services (e.g. police, fire department)
  • Disaster preparedness and management inclusive triage

3.5.CORE CLINICAL PROCEDURES AND SKILLS IN ADULTS AND CHILDREN

3.5.1.INFECTION CONTROL

  • Aseptic and sterile techniques

3.5.2.CARDIOPULMONARY RESUSCITATION SKILLS

  • Cardio-pulmonary resuscitation procedures in a timely and effective manner

according to the current European Resuscitation Council guidelines for adults and

children

  • Advanced CPR skills (e.g. cardiac ultrasound – identification of cardiac activity during

CPR, targeted temperature management, open chest CPR, resuscitative

thoracotomy, peri-mortem c-section)

3.5.2.AIRWAY MANAGEMENT SKILLS

  • Open (simple airway manoeuvres, e.g. chin lift, jaw thrust, head tilt, positioning of the

patient and maintain the airway in the emergency setting (insertion of oropharyngeal

or nasopharyngeal airway)

  • Insertion of oral endotracheal tube
  • Alternative airway techniques in the emergency setting (e.g. laryngeal mask insertion,

surgical airway, insertion of cricothyroid needle and jet insufflation of oxygen)

  • Difficult airway management algorithm
  • Use of rapid sequence intubation in the emergency setting (including knowledge of

relevant drugs, use of stylet or bougie)

  • Securing and caring for ETT (including during transport), plan for extubation
  • Replacement of blocked or dislodged tracheostomy

3.5.3.ANALGESIA AND SEDATION SKILLS

  • Assessment of the level of pain and sedation
  • Monitor vital signs and potential side effects during pain management
  • Provide procedural sedation and analgesia including conscious sedation (including

testing of life support equipment)

  • Use of appropriate local, topical and regional anaesthesia techniques – preferable

ultrasound guided

3.5.4.BREATHING AND VENTILATION MANAGEMENT SKILLS

  • Assessment of breathing and ventilation
  • Oxygen therapy
  • Interpretation of blood gas analysis, pulse oximetry and capnography, spirometry,

peak flow measurement

  • Bag-mask-valve ventilation
  • Thoracocentesis
  • Decompression needle/ finger thoracostomy
  • Chest tube insertion, connection to under-water drainage and assessment of

functioning

  • Non-invasive ventilation techniques
  • Invasive ventilation techniques
  • Setting up a transport ventilator

3.5.5.CIRCULATORY SUPPORT AND CARDIAC SKILLS AND PROCEDURES

  • Administration of fluids including blood and substitutes
  • Monitoring of ECG and the circulation
  • Defibrillation and pacing (e.g. cardioversion, transcutaneous pacing)
  • Emergency pericardiocentesis
  • Vascular access (peripheral venous, arterial, and central venous catheterisation,

intraosseous access, ultrasound guided peripheral/central vascular access)

  • Arterial puncture for blood sampling

3.5.7.ENT SKILLS AND PROCEDURES

  • Anterior rhinoscopy (nasal speculum insertion)
  • Nasal cautery
  • Insertion of nasal pack (anterior and posterior packing)
  • Inspection of oropharynx and larynx
  • Otoscopy
  • Dix-Hallpike and Epley’s Manoeuvre
  • Head impulse test and test of skew
  • Removal of nasal, aural and laryngeal foreign body if airway is compromised
  • Insertion and replacement of tracheostomy tube
  • Aspiration or incision/drainage of peritonsillar abscess

3.5.8.GASTROINTESTINAL PROCEDURES

  • Insertion of nasogastric or orogastric tube
  • Gastric lavage
  • Abdominal hernia reduction
  • Abdominal paracentesis or insertion of drain
  • Measurement of abdominal pressure
  • Proctoscopy
  • Emergency replacement of dislodged or non-functioning (blocked) gastrostomy tube

3.5.9.GENITOURINARY PROCEDURES

  • Insertion of indwelling urethral catheter
  • Suprapubic cystostomy
  • Testicular torsion reduction
  • Evaluation of patency of urethral catheter

3.5.10.HYGIENE SKILLS AND PROCEDURES

  • Decontamination of patient and the environment
  • Patient isolation and staff protection

3.5.11.MUSCULOSKELETAL TECHNIQUES

  • Aseptic joint aspiration
  • Fracture immobilisation and reduction
  • Reduction of joint dislocation
  • Log roll, transfer and spine immobilisation
  • Splinting (plasters, braces, slings, tapes and other bandages)
  • Management of compartment syndrome, insertion of a fascial intra-compartment

monitor

  • Fasciotomy, escharotomy

3.5.12.NEUROLOGICAL SKILLS AND PROCEDURES

  • Evaluation of consciousness including the Glasgow Coma Scale
  • Fundoscopy
  • Lumbar puncture
  • Interpretation of neuro-imaging

3.5.13.OBSTETRIC AND GYNAECOLOGICAL SKILLS AND PROCEDURES

  • Emergency delivery (spontaneous vaginal delivery, shoulder dystocia, breech)
  • Vaginal examination using speculum
  • Assessment of the sexual assault victim (regardless of gender)
  • Removal of products of conception from cervical os
  • Check for presence/absence of foetal heart beat, eg foetal doppler, ultrasound
  • Perimortem c-section

3.5.14.OPHTHALMIC SKILLS AND PROCEDURES

  • Removal of foreign body from the eye
  • Direct and indirect ophthalmoscopy
  • Lateral canthotomy
  • Tonometry
  • Eye irrigation
  • Application of eye pad or shield

3.5.15.TEMPERATURE CONTROL PROCEDURES

  • Measuring and monitoring of body temperature
  • Cooling techniques (evaporative cooling, ice water or slush immersion)
  • Internal cooling methods
  • Warming techniques
  • Monitoring heat stroke patients
  • Treatment and prevention of hyper- and hypothermia

3.5.16.TRANSPORTATION OF THE PATIENT

  • Telecommunication and telemedicine procedures
  • Preparation of the EMS vehicle
  • Specific aspects of monitoring and treatment during transportation

3.5.17.WOUND MANAGEMENT

    • Incision and drainage (simple, superficial abscess, paronychia, subungal haematoma)
    • Nail bed repair
    • Aseptic techniques

 

  • Treatment of lacerations and soft tissue injuries (basic and advanced skin suturing

techniques, alternative skin closure, e.g. tissue adhesives, staples)

  • Wound exploration, cleaning, irrigation, debridement and wound closure
  • Superficial open wound dressing
  • Burn first aid and debridement of burns, primary burn dressings
  • Soft tissue ultrasound (presence/ absence of foreign bodies)

3.5.19.ORAL AND MAXILLOFACIAL PROCEDURES

  • Joint reduction: temporomandibular joint (TMJ) reduction
  • Enlocation of avulsed/extruded/intruded/laterally injured tooth
  • Temporary stabilisation of injured tooth
  • Haemostatis following dental extraction

3.5.20.POINT OF CARE ULTRASOUND (POCUS)

EPs should be able to obtain the following views and identify the following conditions:

  • Cardiac views – focused cardiac ultrasound (subxiphoid, parasternal long axis,

parasternal short axis, apical four chamber): identification of pericardial fluid,

tamponade, dilated right ventricle, decreased contractility/left ventricular function,

asystole

  • Inferior vena cava: measurement of size and collapse upon inspiration
  • Perihepatic and perisplenic views: identification of intraabdominal fluid,

hydronephrosis, pleural fluid, pulmonary consolidation

  • Suprapubic views (sagittal and transverse): identification of intraabdominal fluid,

distended urinary bladder, intrauterine pregnancy

  • Abdominal aorta: identification of abdominal aortic aneurysm, possible dissection flap
  • Lung: identification of pneumothorax, interstitial syndromes, consolidations, correct

endotracheal tube placement

  • Hepatobiliary: identification of gallstones, cholecystitis, dilated common bile duct,

pericholic fluid

  • Proximal femoral vein and popliteal vein – two-point limited compression ultrasound:

identification of deep venous thrombosis

  • Ocular: identification of globe rupture, intraocular foreign body, retinal detachment,

elevated ICP, eye movement, vitreous hemorrhage, pupillary reflex

  • Soft-tissue: identification of foreign body, fluid collection/abscess, cellulitis

In addition, the EP physician should be able perform the following ultrasound-guided

procedures:

  • Nerve blocks
  • Peripheral/central vascular access
  • Pericardiocentesis in the setting of pericardial tamponade