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Core Requirements
Peripheral Vascular Disease
October
1. If you are assigned to the Emergency Department in October, Peripheral Vascular
Disease is assigned as your topic to read about and study. There will be conference time
given to Peripheral Vascular Disease, and the online tests for the month will be
Peripheral Vascular Disease. Dr. XXXX is in charge of conference educational content.
2. Read the assigned readings- all are from the 6th ed. of Tintinalli: Emergency Medicine a
Comprehensive Study Guide, 6th ed, ch. 56, 57, 58, and 59. See goals and objectives for
complete references. The Peripheral Vascular Disease readings comprise a little over 30
pages of readings. This can be accomplished in one month!
a. Hypertension. pp394-404.
b. Aortic Dissection and Aneurysms. pp404-409.
c. Thrombophlebitis and Occlusive Arterial Disease. pp409-418.
d. Pulmonary Embolism. pp386-394.
3. There are no evaluation forms to have completed for the month.
4. Take the practice Peripheral Vascular Disease online test (www.cordtests.org) during the
month, and the Peripheral Vascular Disease online test by the end of the month.
5. Your ED work shifts have been input into New Innovations software. Please log all other
Duty Hours- conference time, EMS time, etc.
6. To successfully complete this rotation, you must pass (70% or better) the Scored
Peripheral Vascular Disease online test.
7. Document all procedures
PERIPHERAL VASCULAR DISEASE
October ED Rotation
GOAL: To develop the ability to evaluate, stabilize, and initiate treatment in patients who
present with symptoms consistent with peripheral vascular disease.
METHODS:
These objectives will be achieved during October of every year for those EM residents on rotation
in the Emergency Department YOUR HOSPITAL HERE participating in the management of
Emergency Department patients. During October, conference time is devoted to Peripheral
Vascular Disease. It is expected that the resident’s readings will be focused on Peripheral Vascular
Disease. The Emergency Medicine Program Director will review and monitor the progress of this
rotation. Duty Hours rules must be followed. It is the responsibility of the emergency medicine
resident to notify the Emergency Medicine Program Director of potential Duty Hours violations in
order to avoid possible disciplinary action.
A practice online test consisting of 25 questions is to be completed during the rotation.
Feedback and rationale for correct answers is given as the resident answers each question. The
test may be found at www.cordtests.org. At the completion of the Peripheral Vascular Disease
rotation the Scored Peripheral Vascular Disease Test is to be taken online. The test results may
be obtained from the residency office.
Lectures: Residents attend Emergency Medicine conferences in which the Peripheral Vascular
Disease curriculum is incorporated.
Reading Assignments:
Tintinalli: Emergency Medicine a Comprehensive Study Guide, 6th ed, ch. 56, 57, 58, and 59.
1. Wu MM, Chanmugam A. Hypertension. In: Tintinalli JE, Kelen GD, Stapczynski JS
(Editors): Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill, 6th ed.,
2004:pp394-404.
2. Prince LA, Johnson GA. Aortic Dissection and Aneurysms. In: Tintinalli JE, Kelen GD,
Stapczynski JS (Editors): Emergency Medicine: A Comprehensive Study Guide.
McGraw-Hill, 6th ed., 2004:pp404-409.
3. Chopra A. Thrombophlebitis and Occlusive Arterial Disease. In: Tintinalli JE, Kelen
GD, Stapczynski JS (Editors): Emergency Medicine: A Comprehensive Study Guide.
McGraw-Hill, 6th ed., 2004:pp409-418.
4. Kline JA. Pulmonary Embolism. In: Tintinalli JE, Kelen GD, Stapczynski JS (Editors):
Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill, 6th ed.,
2004:pp386-394.
Clinical Activities: Residents are assigned to work with an attending EM physician who oversees
their work. They are responsible for performing an appropriate history and physical exam
assessment and treatment of patients. At all times the care that the Emergency Medicine resident
provides will be under the direct supervision of the Emergency Department Attending. The
evaluation and management of patients who present with Peripheral Vascular Disease is
incorporated into this clinical time.
Duty Hours Requirements: The resident is required to monitor his/her own weekly hours, to
ensure that 80 hours per week averaged over a four week period is not exceeded. Additionally, on
days that call is taken, care must be taken that no new patients are evaluated after the initial 24 hours
of service, and that in no situation may the resident stay past 30 hours of total call time. The
resident should not be on call more often than every third day, averaged over a four week period. It
is the responsibility of the resident to notify the Emergency Medicine Program Director if any of
these rules are violated. The Duty Hours for any off service rotations must be entered online, using
New Innovations residency management software, www.new-innov.com/suite.
Evaluations: Residents receive written evaluations from attending staff.. Specifically, patient
assessment and management skills are evaluated in terms of the ACGME-defined Core
Competencies. All evaluations are reviewed by the program director and the Core Faculty
Committee. Residents sign their ED evaluations and these are kept in their file. Oral testing occurs
during simulated patient encounters during scheduled conferences. Additionally, oral testing may
occur during the months' rotation to assess knowledge learned of Peripheral Vascular Disease.
Feedback: The Program Director will notify the resident of any problems noted. Satisfactory
completion of the Peripheral Vascular Disease rotation consists of attendance of conference lectures
on Peripheral Vascular Disease as well as satisfactory completion (70% or better score) of the
Peripheral Vascular Disease Scored online Test. Failure to attain 70% or better on the Scored
online Peripheral Vascular Disease test will result in the resident having to retake the test and
possible remedial work directed by the Attending physicians in charge of educational content.
Residents may review their ED evaluations online. Formal six month evaluations are available for
review during normal working hours. They are developed formally with the program director and
by the Core Faculty Committee on a semiannual basis.
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GOALS AND OBJECTIVES FOR
PERIPHERAL VASCULAR DISEASE ROTATION
Attending Physician in charge of educational content:
GOAL: To develop the ability to evaluate, stabilize, and initiate treatment in patients who present
with symptoms consistent with peripheral vascular disease.
CORE COMPETENCIES:
PATIENT CARE CORE COMPETENCY OBJECTIVES
1. To develop thorough patient interactions, combined with compassion and respect
2. To develop interviewing skills that will facilitate patient interaction, leading to developing
the medical history necessary for individualized and respectful patient care
3. To develop skills at providing informed decision-making by patients and their families. To
learn of specific situations in which informed decision-making may not be possible due to a
patient’s medical condition or advance directive.
4. To develop and carry out neurotrauma patient management plans under the supervision of
more senior residents and attending staff.
5. To develop skills at counseling and educating patients and their families of their medical
conditions.
6. To develop skills at the use of information technology in order to promote patient care.
Examples of this include the use of Plato for retrieving laboratory and radiology reports, the
use of the internet to facilitate patient care, etc.
7. To develop competency in the performance of procedures required of emergency
physicians, as well as performance of physical examination related to a patient’s chief
complaint.
8. To develop knowledge of preventive health aspects of patient care that may be incorporated
into the practice of emergency medicine. Examples could include routine influenza and
pneumococcal vaccine screenings, breast exam instruction, smoking cessation
encouragement, etc.
9. To develop awareness and facilitate the provision of health care within a team of health care
providers.
PRACTICE-BASED LEARNING AND IMPROVEMENT CORE
COMPETENCY OBJECTIVES
1. To develop a personal program of learning related to the requirements of the emergency
medicine residency.
2. To develop methods of analyzing the resident’s own practice to improve quality of health
care provided.
3. To develop skills in the use of evidence from scientific studies to alter the resident’s practice
of medicine, with the goal of improving the health care provided.
4. To develop skills in the use of information technology, and in particular online Medline
reference searching.
5. To recognize personal weaknesses in the Peripheral Vascular Disease rotation Goals and
Objectives, and to develop strategies to address those identified areas of weakness.
INTERPERSONAL AND COMMUNICATION SKILLS CORE
COMPETENCY OBJECTIVES
1. To develop a physician-patient relationship model that creates a therapeutic relationship
with patients.
2. To develop listening skills that will facilitate communication with patients, their families,
and other members of the health care.
3. To further develop skills at working within a health care team with the goal of providing
excellent patient care in the setting of the Emergency Department.
PROFESSIONALISM CORE COMPETENCY OBJECTIVES
1. To develop respectful and altruistic attitudes towards patients, their families, and other
members of the health care team.
2. To incorporate principles of ethics into the practice of medicine.
3. To develop sensitivity to cultural, age, gender, and disability issues that may impede patient
care through disruption of the physician-patient interaction.
4. To maintain these Professionalism Core Competency objectives throughout all Emergency
Department rotations.
SYSTEMS-BASED PRACTICE CORE COMPETENCY OBJECTIVES
1. To develop an understanding of the interaction of the practice of emergency medicine with
that of the larger health care system as a whole.
2. To develop knowledge of the practice and delivery of health care in different systems and
environments
3. To develop cost-effective strategies in the practice of emergency medicine.
4. To develop an attitude of being an advocate for the patient within the health care system.
5. To develop a willingness to become involved in a partnership to improve health care and
system performance within the emergency department and hospital health care system.
6. To learn of the need for an integrated health care delivery system to patients who present to
the Emergency Department.
MEDICAL KNOWLEDGE CORE COMPETENCY OBJECTIVES
Hypertension: Tintinalli 6th ed., ch. 57.
Wu MM, Chanmugam A. Hypertension. In: Tintinalli JE, Kelen GD, Stapczynski JS (Editors):
Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill, 6th ed., 2004:pp394-404.
Objectives:
1. Differentiate between acute hypertensive emergency, hypertensive urgency, and
uncomplicated hypertension.
2. Discuss the indications for treatment of hypertension in the emergency department.
3. Describe the syndrome of hypertensive encephalopathy.
4. Outline the treatment for acute hypertensive emergency and differentiate treatment in the
setting of thoracic aortic dissection.
5. Differentiate between primary agents for hypertensive emergency to include their
advantages and disadvantages.
6. Demonstrate knowledge of clinical findings in a patient with chronic hypertension.
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7. Demonstrate knowledge of physical findings that may be present during an acute
hypertensive emergency.
8. List three CNS disorders and three cardiovascular problems that may cause a
hypertensive emergency in a critically ill patient.
Peripheral Arteriovascular Disease: Tintinalli 6th ed., ch. 59.
Chopra A. Thrombophlebitis and Occlusive Arterial Disease. In: Tintinalli JE, Kelen GD,
Stapczynski JS (Editors): Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill,
6th ed., 2004:pp409-418.
Objectives:
1. Demonstrate knowledge of the pathophysiology of peripheral vascular disease.
a. demonstrate knowledge of the etiology and clinical presentation of patients who have
arterial embolism, including thromboembolism, and arterial thrombosis
b. discuss the risk factors that predispose an individual to peripheral vascular disease,
including thromboembolism.
2. Demonstrate knowledge of important historical and physical exam findings in the evaluation
of the patient with peripheral vascular disease.
3. Discuss the bedside tests that may be done to support the presumptive diagnosis of
peripheral vascular disease.
4. Demonstrate knowledge of differentiating factors between embolus and thrombosis.
5. Demonstrate knowledge of ancillary tests that help to diagnose peripheral vascular disease
and its end effects, including Doppler ultrasonography, duplex scanning, arteriography,
computed tomography, and magnetic residence imaging.
6. Demonstrate knowledge of the treatment of peripheral vascular disease and its end effects,
including thrombectomy, angioplasty, surgical intervention, sympathectomy,
anticoagulation, as well as thrombolytic therapy.
7. Demonstrate knowledge of the clinical effects of chronic arterial insufficiency, including
Buerger's disease, arterial embolism, atheroembolism, and arterial thrombosis.
8. Demonstrate knowledge of the pathophysiology, as well as risk factors that preclude the
development of peripheral arterial aneurysms.
9. Demonstrate knowledge of the various vasospastic disorders, including Raynaud's disease.
10. Demonstrate knowledge of the various vasculitides, including large arteries, medium
arteries, and small arteries.
11. Discuss clinical characteristics of thoracic outlet syndrome, including its' pathophysiology
and etiology.
12. Discuss the clinical findings of patients of who have thoracic outlet syndrome.
13. Demonstrate knowledge of the complications from catheters and vascular access catheters
for hemodialysis, including the differential diagnosis of occluded chronic indwelling
catheters.
a. Discuss measures that may be pursued for short-term vascular access in the
hemodialysis patient.
14. Demonstrate knowledge of the epidemiology of venous disease of the extremities.
15. Demonstrate knowledge of normal venous anatomy as well as pathophysiology of venous
disease of the extremitates.
16. Delineate risk factors for the development for venous thromboembolism.
17. Discuss the typical presentations of the patient with deep venous thrombosis, including
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historical and physical exam findings.
18. Discuss the ancillary evaluation for deep venous thrombosis, including venography,
impedance plethysmography, Doppler ultrasound, Duplex ultrasonography, fibrinogen
scanning.
19. Demonstrate knowledge of the approach to the diagnosis of acute DVT, including
indications for testing and which tests as well as the emergency department treatment of
patients who have DVT.
20. Discuss the differential diagnosis of DVT.
Aortic Dissection and Aneurysms: Tintinalli 6th ed., ch. 58.
Prince LA, Johnson GA. Aortic Dissection and Aneurysms. In: Tintinalli JE, Kelen GD,
Stapczynski JS (Editors): Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill,
6th ed., 2004:pp404-409.
Objectives:
1. Demonstrate knowledge of the medical history of abdominal aortic aneurysms, including
early attempts at surgery.
2. Discuss the pathophysiology of acute abdominal aortic aneurysms, including differentiation
of the various types of aortic aneurysms.
3. Discuss risk factors for the development of AAA.
4. Demonstrate knowledge of the clinical findings of a patient with AAA.
5. Discuss the diagnosis of AAA, including measures that may be undertaken in the
emergency department for the rapid detection and disposition.
a. Discuss the indications for tests such as CAT scan and angiography for the diagnosis
of AAA through the emergency department.Discuss the emergency department
management of the patient with AAA, including measures to control hypotension or
hypertension.
6. Demonstrate knowledge of potential complications following surgical repair of AAAs.
7. Demonstrate knowledge of the epidemiology for aortic dissection.
8. Demonstrate knowledge of the pathophysiology for aortic dissection, including anatomic
location.
9. Demonstrate knowledge of the classification for aortic dissection.
10. Discuss clinical findings that may be found during the history and physical examination of
the patient suspected of having aortic dissection.
11. Discuss the indications and clinical value of ancillary testing, including radiography,
computed tomography, magnetic resonance imaging, as well as contrast angiography.
12. List other clinical entities that should be considered in the differential diagnosis of the
patient suspected of having aortic dissection.
13. Discuss the emergency department treatment for a patient suspected of having aortic
dissection.
Pulmonary Embolism: Tintinalli 6th ed., ch. 56.
Kline JA. Pulmonary Embolism. In: Tintinalli JE, Kelen GD, Stapczynski JS (Editors):
Emergency Medicine: A Comprehensive Study Guide. McGraw-Hill, 6th ed., 2004:pp386-394.
Objectives:
1. Demonstrate knowledge of the historical perspective of pulmonary embolism.
2. Discuss the pathophysiology of pulmonary embolism.
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3. Discuss risk factors for pulmonary embolism, including the multiple causes of
hypercoagulable state.
4. Discuss the clinical presentation of the patient with pulmonary embolus.
5. List the most common symptoms, including percentages in patients with angiographically
proven pulmonary embolism.
6. List the signs found in patients with angiographically proven pulmonary embolism,
including the percentages.
7. Identify "classic" findings in a patient with pulmonary embolus with regards to:
a. EKG
b. chest x-ray
c. ABGs
d. (A-a) O2 gradient
8. State the diagnostic findings of pulmonary embolism on ventilation-profusion scan and
pulmonary angiography.
9. Discuss the indication for investigation of DVT when ventilation-perfusion scanning is
negative.
10. Demonstrate knowledge of the management of the patient with demonstrated pulmonary
embolus, including measures to anticoagulate.
11. Discuss the indications and contraindications for thrombolysis in the patient with
documented pulmonary embolus.
12. Demonstrate knowledge of preventive measures against the development of pulmonary
embolism.
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