NEJM Resident360 > Rotation Prep > Emergency Medicine > Introduction

Introduction

<div class="onepub-jats-front" id="10.1056/r360.i000916-front"><div class="onepub-jats-metadata two-column table"><div class="onepub-jats-row"><div class="onepub-jats-cell"><div class="onepub-jats-metadata-group"></div></div></div></div><div class="onepub-jats-metadata centered"></div></div><div class="onepub-jats-body" id="10.1056/r360.i000916-body"><div class="onepub-jats-section-container"><div class="onepub-introduction"><div class="onepub-jats-main-title"><h6 class="onepub-jats-title body-sec">Introduction</h6></div><p><b>For information on Covid-19, please see the <a href="https://www.nejm.org/coronavirus" class="onepub-link-primary" target="_blank">NEJM Coronavirus (Covid-19) Topic Page</a>.</b></p><div class="onepub-jats-section-title"><h1 class="onepub-jats-title">Introduction</h1></div><p>Emergency medicine (EM) is a fast-paced practice caring for any patient with an emergency condition, including pediatric and trauma patients. Acuity ranges from patients with straightforward concerns to those with very complicated problems received in extremis by emergency medical systems, helicopter, or from another institution. In this guide, we cover key topics that you will encounter in the emergency department (ED).</p><p>The practice of medicine in the emergency department can feel quite different from the inpatient ward, and it is important to adapt your approach to the patients and situations that present to you. Whereas the evaluation of a patient is traditionally taught as a linear process of obtaining a history, performing a complete physical exam, ordering lab tests, and making the diagnosis, in the ED you may have to perform all these steps in parallel. A patient in extremis requires treatment before a final diagnosis, and a therapeutic intervention may even help clarify a diagnosis. Serial examination of a patient can be crucial as well. Ultimately, the ED is a place for ruling out emergencies, delivering urgent interventions, and ensuring a smooth transition of care.</p><p><b>Selected topics in the following areas are addressed in this rotation guide:</b></p><ul class="onepub-jats-list-unordered"><li><p><a href="https://resident360.nejm.org/rotation-prep/emergency-medicine/toxicologic-emergencies/fast-facts" class="onepub-link-primary" target="_blank">Toxicologic Emergencies</a></p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/emergency-medicine/cardiopulmonary-emergencies/fast-facts" class="onepub-link-primary" target="_blank">Cardiopulmonary Emergencies</a></p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/emergency-medicine/abdominopelvic-emergencies/fast-facts" class="onepub-link-primary" target="_blank">Abdominopelvic Emergencies</a></p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/emergency-medicine/trauma/fast-facts" class="onepub-link-primary" target="_blank">Trauma</a></p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/emergency-medicine/clinical-rules-and-guidance/fast-facts" class="onepub-link-primary" target="_blank">Clinical Rules and Guidance</a></p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/emergency-medicine/common-procedures/fast-facts" class="onepub-link-primary" target="_blank">Common Procedures</a><tt><br class="onepub-jats-br"></tt><tt><br class="onepub-jats-br"></tt></p></li></ul><p><b>In addition to the information covered in this rotation guide, overlapping topics related to EM are covered in other rotation guides:</b></p><ul class="onepub-jats-list-unordered"><li><p><a href="https://resident360.nejm.org/rotation-prep/infectious-diseases/pneumonia/fast-facts" class="onepub-link-primary" target="_blank">Pneumonia</a>, <a href="https://resident360.nejm.org/rotation-prep/infectious-diseases/sstis/fast-facts" class="onepub-link-primary" target="_blank">Skin and Soft Tissue Infections</a>, <a href="https://resident360.nejm.org/rotation-prep/infectious-diseases/diabetic-foot-infection/fast-facts" class="onepub-link-primary" target="_blank">Diabetic Foot Infection</a>&nbsp;(Infectious Diseases)</p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/neurology/acute-stroke/fast-facts" class="onepub-link-primary" target="_blank">Stroke</a>, <a href="https://resident360.nejm.org/rotation-prep/neurology/seizures-and-epilepsy/fast-facts" class="onepub-link-primary" target="_blank">Seizures and Epilepsy,&nbsp;</a><a href="https://resident360.nejm.org/rotation-prep/neurology/cns-infection/fast-facts" class="onepub-link-primary" target="_blank">Meningitis</a>&nbsp;(Neurology)</p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/critical-care/sepsis-shock/fast-facts" class="onepub-link-primary" target="_blank">Sepsis and Shock</a>, <a href="https://resident360.nejm.org/rotation-prep/critical-care/acid-base-status-electrolytes/fast-facts" class="onepub-link-primary" target="_blank">Acid-Base, Lactic Acidosis, and Electrolytes</a>, <a href="https://resident360.nejm.org/rotation-prep/critical-care/fluids-transfusion/fast-facts" class="onepub-link-primary" target="_blank">Resuscitation Fluids and Transfusion</a>,&nbsp;<a href="https://resident360.nejm.org/rotation-prep/critical-care/ventilation/fast-facts" class="onepub-link-primary" target="_blank">Ventilation</a> (Critical Care)</p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/cardiology/cad-acs/fast-facts" class="onepub-link-primary" target="_blank">Acute Coronary Syndrome (STEMI/NSTEMI)</a>, <a href="https://resident360.nejm.org/rotation-prep/cardiology/arrhythmias/fast-facts" class="onepub-link-primary" target="_blank">Arrhythmias</a>, <a href="https://resident360.nejm.org/rotation-prep/cardiology/chf/fast-facts" class="onepub-link-primary" target="_blank">Congestive Heart Failure (CHF)</a>, <a href="https://resident360.nejm.org/rotation-prep/cardiology/myocarditis-pericarditis/fast-facts" class="onepub-link-primary" target="_blank">Myocarditis and Pericarditis</a>,&nbsp;<a href="https://resident360.nejm.org/rotation-prep/cardiology/valvular-diseases/fast-facts" class="onepub-link-primary" target="_blank">Valvular Diseases</a> (Cardiology)</p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/pulmonology/asthma/fast-facts" class="onepub-link-primary" target="_blank">Asthma</a>, <a href="https://resident360.nejm.org/rotation-prep/pulmonology/copd/fast-facts" class="onepub-link-primary" target="_blank">Chronic Obstructive Pulmonary Disease (COPD)</a>, <a href="https://resident360.nejm.org/rotation-prep/pulmonology/interstitial-lung-disease/fast-facts" class="onepub-link-primary" target="_blank">Interstitial Lung Disease</a>, <a href="https://resident360.nejm.org/rotation-prep/pulmonology/pulmonary-hypertension/fast-facts" class="onepub-link-primary" target="_blank">Pulmonary Hypertension</a> (Pulmonology)</p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/allergy-immunology/anaphylaxis/fast-facts" class="onepub-link-primary" target="_blank">Anaphylaxis</a> (Allergy and Immunology)</p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/oncology/febrile-neutropenia/fast-facts" class="onepub-link-primary" target="_blank">Neutropenic Fever</a> (Oncology)</p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/gastroenterology/diverticulitis/fast-facts" class="onepub-link-primary" target="_blank">Diverticulitis</a>, <a href="https://resident360.nejm.org/rotation-prep/gastroenterology/ibd/fast-facts" class="onepub-link-primary" target="_blank">Inflammatory Bowel Disease</a>, <a href="https://resident360.nejm.org/rotation-prep/gastroenterology/pancreatitis/fast-facts" class="onepub-link-primary" target="_blank">Pancreatitis</a>, <a href="https://resident360.nejm.org/rotation-prep/gastroenterology/acute-gi-bleeding/fast-facts" class="onepub-link-primary" target="_blank">Gastrointestinal Bleeding</a>, <a href="https://resident360.nejm.org/rotation-prep/gastroenterology/intestinal-ischemia/fast-facts" class="onepub-link-primary" target="_blank">Mesenteric Ischemia</a>, <a href="https://resident360.nejm.org/rotation-prep/gastroenterology/biliary-disease/fast-facts" class="onepub-link-primary" target="_blank">Biliary Disease</a> (Gastroenterology)</p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/nephrology/aki/fast-facts" class="onepub-link-primary" target="_blank">Acute Kidney Injury</a> (Nephrology)</p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/endocrinology/glycemic-emergencies/fast-facts" class="onepub-link-primary" target="_blank">Hyperglycemic Emergencies</a> (Endocrinology)</p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/women-s-health/miscarriage-and-abortion/fast-facts" class="onepub-link-primary" target="_blank">Pregnancy and Abortion</a>, <a href="https://resident360.nejm.org/rotation-prep/women-s-health/vaginitis-stis-pid/fast-facts" class="onepub-link-primary" target="_blank">Sexually Transmitted Infections</a>, <a href="https://resident360.nejm.org/rotation-prep/women-s-health/fibroids/fast-facts" class="onepub-link-primary" target="_blank">Fibroids, Menstrual and Bleeding Disorders</a> (Women’s Health)</p></li><li><p><a href="https://resident360.nejm.org/rotation-prep/mental-health/substance-use-disorders/fast-facts" class="onepub-link-primary" target="_blank">Substance Use Disorder</a> (Mental Health)</p></li></ul><p><b>For a brief history of emergency medicine, click <a href="https://resident360.nejm.org/content-items/history-of-emergency-medicine" class="onepub-link-primary" target="_blank">here</a>.</b></p><div class="onepub-grayBox"><p>This rotation guide was developed by a collaborative team of contributors including:<tt><br class="onepub-jats-br"></tt><b>Writers:</b> Ken Wu, MBBS MRCPCH; Michael Mi, MD (NEJM Fellows); Isabel Algaze Gonzalez, MD<tt><br class="onepub-jats-br"></tt><b>Peer Reviewers:</b> Patrick Tyler, MD; Jeremy Faust, MD<tt><br class="onepub-jats-br"></tt><b>Section Expert:</b> Jonathan Adler, MD <tt><br class="onepub-jats-br"></tt><b>Senior Editor:</b> Ole-Petter Hamnvik, MB BCh BAO, MMSc<tt><br class="onepub-jats-br"></tt><b>Last updated:</b> January 2023 by Colleen Laurence, MD; Andres Mallipudi, MD; and Zayir Malik, MD</p></div></div></div></div>

Emergency Medicine

Toxicologic Emergencies

Fast Facts

Research

Reviews

Guidelines

Additional Resources

Cardiopulmonary Emergencies

Abdominopelvic Emergencies

Trauma

Clinical Rules and Guidance

Common Procedures

Evolving Infarction in the Anterior Circulation

Chvostek's and Trousseau's Signs

Bilateral Hilar and Mediastinal Lymphadenopathy

Angioedema

Ocular Flutter in the Serotonin Syndrome

Battle's Sign

Pronator Drift

Bilateral Corneal Abrasions from Airbag Deployment

Cholesterol Emboli after Coronary Bypass Surgery

Left Main Coronary Artery Thrombosis

Roth Spots in Infective Endocarditis

Superior Vena Cava Syndrome

Electrical Alternans with Pericardial Tamponade

Hyperkalemia after Missed Hemodialysis

Cocaine-Induced Coronary-Artery Vasospasm

Emphysematous Pyelonephritis

Fournier’s Gangrene

Sugar to Reduce a Prolapsed Ileostomy

Bilateral Anterior Shoulder Dislocation

Acromioclavicular Joint Separation

Pneumothorax — An Uncommon Complication of a Common Procedure

Flail Chest

Deep Sulcus Sign

Westermark Sign in Pulmonary Embolism

Skin Mottling

Epiglottitis in an Adult

Intranasal Naloxone Administration

Emergency Intubation in Covid-19

Examination of the Neck Veins

Percutaneous Tracheostomy

Personal Protective Equipment and Covid-19

Focused Cardiac Ultrasonography for Left Ventricular Systolic Function

How to Perform an Elliptical Excision of the Skin

Family Meetings on Behalf of Patients with Serious Illness

How to Obtain a Nasopharyngeal Swab Specimen

Closed Reduction of a Fractured and Dislocated Ankle

Peripheral Nerve Block for Hand Procedures

Ultrasound-Guided Cannulation of the Subclavian Vein

Ultrasound Guidance for Pleural Catheter Placement

Peripheral Intravenous Cannulation

Pulmonary Embolus and Syncope

Bystander Efforts in Out-of-Hospital Cardiac Arrest

Reduction of Paraphimosis in Boys

Pelvic Examination

Chest-Tube Insertion

Clinical Evaluation of the Knee

Clinical Examination of the Shoulder

Managing Procedural Anxiety in Children

Cricothyroidotomy

Nasogastric Intubation

Orotracheal Intubation

Procedural Sedation and Analgesia in Children

Point of Care Ultrasonography

Intraosseous Catheter Placement in Children

Central Venous Catheterization

Noninvasive Positive-Pressure Ventilation

Abscess Incision and Drainage

Carotid Sinus Massage 

Treatment of Hematoma of the Nasal Septum

Technique for Temporary Pelvic Stabilization after Trauma

Repositioning Dislocated Temporomandibular Joints

Conscious Sedation for Minor Procedures in Adults

Basic Splinting Techniques

Basic Laceration Repair

Thoracentesis

Lumbar Puncture

Needle Aspiration of Primary Spontaneous Pneumothorax

Reduction of Pulled Elbow