American Academy of Emergency Medicine



Topics covered in the course include:

Abdominal & Gastrointestinal Disorders
Cardiovascular Disorders
Cutaneous Disorders
Endocrine & Metabolic
Environmental Emergencies
Hematology, Oncology & Immunology
Neurology & Neurotrauma
Obstetrics & Gynecologic Emergencies

Prehospital Emergency Medical Services
Psychobehavioral Disorders
Renal & Urogenital Disorders
Systemic Infectious Disease
Thoracic & Respiratory Disorders
Traumatic Disorders
Visual Stimulus Pictorial Session

Example of Pearls from the Course - #aaemWB17

Below is just a sample of the many pearls you will have access to electronically when you register for the Written Board Review Course. Be sure to follow AAEM on Twitter, @AAEMinfo, for more pearls and Written Board info!

Traumatic Disorders

  • Trauma is the number one cause of death in ages between 1 and 44 years old.
  • Orotracheal intubation (with in-line immobilization) is the procedure of choice (even with suspected C-spine injury)
  • Most reliable method of assuring endotracheal intubation is visualizing the tube pass through the cords.
  • Elderly patients, athletes, and those on rate controlling medications may not develop tachycardia.
  • A narrowed pulse pressure suggests significant blood loss and use of compensatory mechanisms.
  • Class III shock is the first class in which there is a drop in the systolic blood pressure below 90mmHg.
  • The hallmark of neurogenic shock is hypotension with normal heart rate or bradycardia, and lack of vasoconstriction on exam.
  • Normal urine output in adults is 0.5cc/kg/hour.

Systemic Infectious Disease

  • Lyme disease
    • The most common vector-borne illness in the US
    • Central clearing is not always present with erythema migrans
    • CN VII most common nerve involved in early disseminated Lyme disease
  • Antrax
    • Toxic patient with mediastinal widening and hilar LAD = anthrax
  • Smallpox
    • Similar to chickpox but the lesions of smallpox are all of same age and stage
  • Mucormycosis = Diabetic patient with thick black nasal discharge
  • Aspergilloma  = Sarcoidosis patient with hemoptysis
  • Malaria
    • Patients with parasitemia >5% should be admitted to the ICU
    • Rapid infusion of quinine may result in hypoglycemia
  • Giardia
    • Most common parasite infection in the US
  • Necator americanus major cause of iron-deficiency anemia worldwide
  • Back pain + IVDU = spinal epidural abscess until proven otherwise

Renal & Urogenital Disorders

  • Indications for dialysis in acute renal failure: Acidosis, Electrolytes (hyperkalemia), Ingestions—toxin (litrium), Overload-volume, Uremia (pericardial effusion)
  • Hypotension due to excessive ultrafiltration is the most common HD complication
  • Most common HD vascular access complication: graft stenosis or thrombosis
  • Vascular grafts get infected more than fistulas; most common organism Staphylococcus aureus
  • Drug of choice for vascular access infection: vancomycin
  • Most common complication of PD: acute peritonitis from Staphylococcus epidermidis.  Give abx intraperitoneally.
  • Knee pain in an adolescent or obese patient may be referred from the hip, consider the diagnosis of SCFE, slipped capital femoral epiphysis

Pediatric Disorders

  • Initial defibrillation voltage in children is 2J/kg followed by 4J/kg for subsequent shocks
  • Patients with a high fever, stridor, and symptoms that are minimally responsive to croup therapy may have bacterial tracheitis
  • Most cases of bronchiolitis are due to RSV.  Supportive treatment is basic standard.
  • Hypoglycemia is defined as less than 30gm/dl in newborns and less than 40gm/dl in older children.  Newborns should be replaced with 2-4ml/kg of D10 solution, older children may be replaced with 2-4ml/kg of D25 solution
  • Projectile vomiting may not be initially present in patients with pyloric stenosis.  Consider this diagnosis in patients with persistent non-bilious emesis, who look healthy and have a voracious appetite

Cutaneous Disorders

  •  Stevens-Johnson Syndrome: drug reaction; target lesions, bullous lesions, <10%BSA, +Nikolsky, + mucous membrane involvement; Rx: supportive care, sick patient
  • Toxic Epidermal Necrolysis: drug reaction, target lesions, +Nikolsky, + mucous membrane involvement, >30%BSA,  sick patient; Rx: steroids
  • Staph Scalded Skin Syndrome: flaccid bullae, +Nikolsky, No mucous membrane involvement, No target lesions; Staph infection, children, Rx: anti-staph abx
  • Toxic Shock Syndrome: diffuse blanching erythema; +palms and soles, +Nikolsky, +mucous membrane involvement, Staph etiology, look for retained foreign body, sick patient, Rx: anti-staph abx
  • Necrotizing fasciitis: POOP, hemorrhagic bullae, rapidly progressive, polymicrobial or GAS; Rx: Clinda and Vanc plus early debridement, sick patient
  • Menningococcemia: diffuse petechia, hemorrhagic bullae, close living quarters, Rx: as for meningitis, treat close contacts as well; sick patient

Endocrine and Metabolic

  • Treatment for alcoholic ketoacidosis: glucose and normal saline
  • Wernicke’s encephalopathy — confusion, ataxia, ophthalmoplegia, and nystagmus
  • Ketosis without acidosis and normal glucose — think isopropyl alcohol
  • Lactic acidosis
    • Most common anion-gap metabolic acidosis
    • Multiple causes: common ones include sepsis, seizures, Metformin
  • Methanol — visual changes, abdominal pain
  • Ethylene glycol (antifreeze) — calcium oxalate crystals in urine

New pearls added frequently - join the course for full access to all pearls & review materials!