Emergency medicine (EM) is the only medical specialty that has a scientifically derived and commonly accepted description of the domain of its clinical practice. That document, The Model of the Clinical Practice of Emergency Medicine (EM Model), was developed through the collaboration of six organizations: the American Board of Emergency Medicine (ABEM), the administrative organization for the project; the American College of Emergency Physicians (ACEP); the Council of Emergency Medicine Residency Directors (CORD); the Emergency Medicine Residents’ Association (EMRA); the Residency Review Committee for Emergency Medicine (RRC-EM); and the Society for Academic Emergency Medicine (SAEM). Development of the EM Model was based on an extensive practice analysis of the specialty. The practice analysis relied on both empiric data gathered from actual emergency department (ED) visits and several expert panels.1 The resulting product was first published in 20012,3 and has successfully served as the common source document for all EM organizations. One of its strengths is incorporating the reality that EM is a specialty driven by symptoms, not diagnoses, requiring simultaneous therapeutic and diagnostic interventions. The task force that developed the EM Model recommended that a new task force, composed of representatives from all six organizations, be formed every 2 years to assess the success of the document in accomplishing its objective of supporting the ongoing development of the specialty of EM, to consider alterations to the EM Model suggested by the collaborating organizations, and to recommend changes to the six sponsoring organizations. The initial 2-year review occurred in 2003, with representatives from each of the six organizations suggesting changes and reporting how their respective organizations had used the document. This initial 2-year update was published in Annals of Emergency Medicine and Academic Emergency Medicine in 2005.4,5 Subsequently, a task force met every 2 years, to review the EM Model and make suggested changes.6–9 This article provides a brief review of the original EM Model, a listing of the conditions and components that include the changes made before and during the 2007 review, a summary of the changes made to it as a result of the 2009 review conducted by the current task force, and an update on current uses of the EM Model by the six collaborating EM organizations. The EM Model is a three-dimensional description of EM clinical practice. The three dimensions are patient acuity, physician tasks, and the listing of conditions and components. All of these dimensions are interrelated and employed concurrently by a physician when providing patient care. The EM physician’s initial approach is determined by the acuity of the patient’s presentation. While assessing the patient, the physician completes a series of tasks collecting information. Through this process, the physician is able to select the most likely etiology of the patient’s problem from the listing of the conditions and components. Through simultaneous application of all three components, the physician is able to arrive at the most probable diagnosis and implement a treatment plan for the patient. Hence, the three dimensions of the EM Model are interrelated and applied concurrently in the practice of EM. The three dimensions, as revised in 2005, are included in Tables 1–4. The Accreditation Council for Graduate Medical Education (ACGME) is implementing the ACGME Outcome Project to assure that physicians are appropriately trained in the knowledge and skills of their specialties. The ACGME has identified six general (core) competencies thought to be essential for any practicing physician: patient care, medical knowledge, practice-based learning and improvement, interpersonal skills, professionalism, and systems-based practice. The six general competencies are an integral part of the practice of EM and are embedded in the EM Model.10,11 The EM Model is designed for use as the core document for the specialty. It will provide the foundation for developing medical school and residency curricula, certification examination specifications, continuing education objectives, research agendas, residency program review requirements, and other documents necessary for the definition, skills acquisition, assessment, and practice of the specialty. In conjunction with the EM Model, these six general competencies construct a framework for evaluation of physician performance and curriculum design to further refine and improve the education and training of competent emergency physicians. The six competencies and the Model also form the core of ABEM’s maintenance of certification program, Emergency Medicine Continuous Certification (EMCC; for further information on the EMCC program see ABEM’s website, http://www.abem.org. The 2009 EM Model review task force met to consider changes based on feedback received from the six collaborating organizations. Each organization was asked to comment on how it was using the Model and to recommend changes in the document that would address any perceived deficiencies. Table 5 lists the changes recommended by the 2009 EM Model Review Task Force and accepted by the six organizations. The ABEM uses the EM Model to define its test and examination specifications. Each question or structured case used in any ABEM examination is referenced to the EM Model. Every test and examination that ABEM develops is based on a blueprint derived directly from the EM Model. It also uses the conditions and components section to structure the lifelong learning and self-assessment component of its EMCC program. The ACEP uses the EM Model primarily as the basis for its educational activities. In addition, the ACEP Academic Affairs Committee used the EM Model to survey EM residency program directors and recent residency graduates to identify curricula gaps and educational needs. This information has been used to develop a comprehensive list of Web-based educational resources that can be incorporated into residency curricula. The integration of the competencies in the EM Model meets the program requirements of the RRC-EM that the six core competencies are included in residency training. The EM Model is a major tool for CORD and EM program faculty to use when integrating the competencies into the training, residency curricula, and evaluation of residents. In summary, the EM Model is accomplishing the intended purposes for which it was developed. The 2009 review of the EM Model resulted in only minor changes and clarifications (see Table 5). Several EM organizations are using the EM Model to support the ongoing development of the specialty of EM. The complete updated 2009 EM Model can be found on the websites of each of the six collaborating organizations.

[Ann Emerg Med. 2011;57:e1-e15.]OverviewEmergency medicine is the only medical specialty that has a scientifically derived and commonly accepted description of the domain of its clinical practice. That document, The Model of the Clinical Practice of Emergency Medicine (EM Model), was developed through the collaboration of 6 organizations: the American Board of Emergency Medicine (ABEM), the administrative organization for the project, the American College of Emergency Physicians (ACEP), the Council of Emergency Medicine Residency Directors (CORD), the Emergency Medicine Residents' Association (EMRA), the Residency Review Committee for Emergency Medicine (RRC-EM), and the Society for Academic Emergency Medicine (SAEM). Development of the EM Model was based on an extensive practice analysis of the specialty. The practice analysis relied on both empiric data gathered from actual emergency department visits and several expert panels.1Hockberger R.S. LaDuca A. Orr N.A. et al.Creating the model of a clinical practice: the case of emergency medicine.Acad Emerg Med. 2003; 10: 161-168Crossref PubMed Google Scholar The resulting product was first published in 20012Core Content Task Force IIThe model of the clinical practice of emergency medicine.Ann Emerg Med. 2001; 37: 745-770Abstract Full Text Full Text PDF PubMed Scopus (161) Google Scholar, 3Core Content Task Force IIThe model of the clinical practice of emergency medicine.Acad Emerg Med. 2001; 8: 660-681Crossref PubMed Scopus (37) Google Scholar and has successfully served as the common source document for all emergency medicine organizations. One of its strengths is incorporating the reality that emergency medicine is a specialty driven by symptoms, not diagnoses, requiring simultaneous therapeutic and diagnostic interventions.The task force that developed the EM Model recommended that a new task force, composed of representatives from all 6 organizations, be formed every 2 years to assess the success of the document in accomplishing its objective of supporting the ongoing development of the specialty of emergency medicine, to consider alterations to the EM Model suggested by the collaborating organizations, and to recommend changes to the 6 sponsoring organizations.The initial 2-year review occurred in 2003, with representatives from each of the 6 organizations suggesting changes and reporting how their respective organizations had used the document. This initial 2-year update was published in Annals of Emergency Medicine and Academic Emergency Medicine in 2005.4Hockberger R.S. Binder L.S. Chisholm C.D. et al.The model of the clinical practice of emergency medicine: a 2-year update.Ann Emerg Med. 2005; 45: 659-674Abstract Full Text Full Text PDF PubMed Scopus (38) Google Scholar, 5Hockberger R.S. Binder L.S. Chisholm C.D. et al.The model of the clinical practice of emergency medicine: a 2-year update.Acad Emerg Med. 2005; 12: 543-558Crossref Google Scholar Subsequently, a task force met every 2 years to review the EM Model and make suggested changes.6Thomas H.A. Binder L.S. Chapman D.M. et al.The 2003 model of the clinical practice of emergency medicine: the 2005 update.Ann Emerg Med. 2006; 48: e1-e17Abstract Full Text Full Text PDF PubMed Scopus (17) Google Scholar, 7Thomas H.A. Binder L.S. Chapman D.M. et al.The 2003 model of the clinical practice of emergency medicine: the 2005 update.Acad Emerg Med. 2006; 13: 1070-1073Crossref PubMed Scopus (22) Google Scholar, 8Thomas H.A. Beeson M.S. Binder L.S. et al.The 2005 model of the clinical practice of emergency medicine: the 2007 update.Acad Emerg Med. 2008; 16: 776-779Crossref Scopus (28) Google Scholar, 9Thomas H.A. Beeson M.S. Binder L.S. et al.The 2005 model of the clinical practice of emergency medicine: the 2007 update.Ann Emerg Med. 2008; 52: e1-e17Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar This article provides a brief review of the original EM Model, a listing of the conditions and components that include the changes made before and during the 2007 review, a summary of the changes made to it as a result of the 2009 review conducted by the current task force, and an update on current uses of the EM Model by the 6 collaborating EM organizations.The EM ModelThe EM Model is a 3-dimensional description of emergency medicine clinical practice. The 3 dimensions are patient acuity, physician tasks, and the listing of conditions and components. All of these dimensions are interrelated and used concurrently by a physician when providing patient care. The emergency physician's initial approach is determined by the acuity of the patient's presentation. While assessing the patient, the physician completes a series of tasks, collecting information. Through this process, the physician is able to select the most likely cause of the patient's problem from the listing of the conditions and components. Through simultaneous application of all 3 components, the physician is able to arrive at the most probable diagnosis and implement a treatment plan for the patient. Hence, the 3 dimensions of the EM Model are interrelated and applied concurrently in the practice of emergency medicine. The 3 dimensions, as revised in 2007, are included in Table 1, Table 2, Table 3, Table 4.Table 1Matrix of physician tasks by patient acuity.Physician TasksPatient AcuityCriticalEmergentLower AcuityPre-hospital careEmergency stabilizationPerformance of focused history and physical examinationModifying factorsProfessional issuesDiagnostic studiesDiagnosisTherapeutic interventionsPharmacotherapyObservation and reassessmentConsultation and dispositionPrevention and educationDocumentationMultitasking and team management Open table in a new tab Table 2Patient acuity definitions.CriticalEmergentLower AcuityPatient presents with symptoms of a life-threatening illness or injury with a high probability of mortality if immediate intervention is not begun to prevent further airway, respiratory, hemodynamic, and/or neurologic instability.Patient presents with symptoms of an illness or injury that may progress in severity or result in complications with a high probability for morbidity if treatment is not begun quickly.Patient presents with symptoms of an illness or injury that have a low probability of progression to more serious disease or development of complications. Open table in a new tab Table 3Physician task definitions.Pre-hospital careParticipate actively in pre-hospital care; provide direct patient care or online or offline medical direction or interact with pre-hospital medical providers; assimilate information from pre-hospital care into the assessment and management of the patient.Emergency stabilizationConduct primary assessment and take appropriate steps to stabilize and treat patients.Performance of focused history and physical examinationCommunicate effectively to interpret and evaluate the patient's symptoms and history; identify pertinent risk factors in the patient's history; provide a focused evaluation; interpret the patient's appearance, vital signs and condition; recognize pertinent physical findings; perform techniques required for conducting the examination.Modifying factorsRecognize age, sex, ethnicity, barriers to communication, socioeconomic status, underlying disease, and other factors that may affect patient management.Professional and legal issuesUnderstand and apply principles of professionalism, ethics, and legal concepts pertinent to patient management.Diagnostic studiesSelect and perform the most appropriate diagnostic studies and interpret the results, eg, ECG, emergency ultrasonography, and laboratory tests.DiagnosisDevelop a differential diagnosis and establish the most likely diagnoses in light of the history, physical, interventions, and test results.Therapeutic interventionsPerform procedures and nonpharmacologic therapies, and counsel.PharmacotherapySelect appropriate pharmacotherapy, recognize pharmacokinetic properties, and anticipate drug interactions and adverse effects.Observation and reassessmentEvaluate and reevaluate the effectiveness of a patient's treatment or therapy, including addressing complications and potential errors; monitor, observe, manage, and maintain the stability of one or more patients who are at different stages in their evaluations.Consultation and dispositionCollaborate with physicians and other professionals to evaluate and treat patients, arrange appropriate placement and transfer if necessary, formulate a follow-up plan, and communicate effectively with patients, family, and involved health care members.Prevention and educationApply epidemiologic information to patients at risk; conduct patient education; select appropriate disease and injury prevention techniques.DocumentationCommunicate patient care information in a concise manner that facilitates quality care and coding.Multitasking and team managementPrioritize multiple patients in the emergency department to provide optimal patient care; interact, coordinate, educate, and supervise all members of the patient management team; utilize appropriate hospital resources; have familiarity with disaster management. Open table in a new tab Table 4Listing of conditions and components.1.0 Signs, Symptoms, and PresentationsCriticalEmergentLower Acuity1.1 General Altered mental statusXX AnxietyX ApneaX AtaxiaXX Back painXXX BleedingXXX ComaX ConfusionX Crying/fussinessXX CyanosisX Decreased level of consciousnessXX DehydrationXX DizzinessXX EdemaXX Failure to thriveXX FatigueXX Feeding problemsX FeverXXX HypotensionXX JaundiceX Joint pain/swellingXX LimpXX LymphadenopathyX MalaiseXX Multiple traumaXX Needle stickXX PainXXX ParalysisXX Paresthesia/dysesthesiaXX PoisoningXXX PruritusXX RashXXX ShockX SIDS (See 3.1)X Sleeping problemsX SyncopeXXX TremorXX WeaknessXX Weight lossXX1.2 Abdominal Abnormal vaginal bleedingXXX AnuriaX AscitesXX ColicXX ConstipationX CrampsXX DiarrheaXX DysmenorrheaX DysuriaX HematemesisXX HematocheziaXXX HematuriaXX Nausea/vomitingXX PainXXX Pelvic painXXX PeritonitisXX Rectal bleedingXXX Rectal painXX Urinary incontinenceX Urinary retentionX1.3 Chest Chest painXXX CoughXX DyspneaXX HemoptysisXX HiccupX PalpitationsXXX Shortness of breathXX TachycardiaXX WheezingXX1.4 Head and Neck CongestionX DiplopiaX DysphagiaXX Eye painXX Headache (See 12.3)XXX Loss of hearingX Loss of visionX RhinorrheaX Sore throatXX StridorXX TinnitusX VertigoXX2.0 Abdominal and Gastrointestinal DisordersCriticalEmergentLower Acuity2.1 Abdominal Wall HerniasXX2.2 Esophagus Infectious disorders Candida (See 4.4, 7.5)XX Inflammatory disorders EsophagitisXX Gastroesophageal reflux (GERD)X Toxic effects of caustic (See 17.1) AcidXX AlkaliXX Motor abnormalities SpasmsX Structural disorders Boerhaave's syndromeXX DiverticulaXX Foreign bodyX HerniasXX Mallory-Weiss syndromeXX Stricture and stenosisXX Tracheoesophageal fistulaXX VaricesXX TumorsXX2.3 Liver CirrhosisXX AlcoholicXX Biliary obstructiveX Drug-inducedXX Hepatorenal failureXX Infectious disordersXX AbscessX Hepatitis AcuteXX ChronicX TumorsXX2.4 Gall Bladder and Biliary Tract CholangitisXX CholecystitisX Cholelithiasis/choledocholithiasisXX TumorsXX2.5 Pancreas PancreatitisXX TumorsXX2.6 Peritoneum Spontaneous bacterial peritonitisXX2.7 Stomach Infectious disordersX Inflammatory disorders GastritisXX Peptic ulcer diseaseXX HemorrhageXX PerforationXX Structural disorders Congenital hypertrophic pyloric stenosisX Foreign bodyXX TumorsXX2.8 Small Bowel Infectious disordersXX Inflammatory disorders Regional enteritis/Crohn's diseaseXX Motor abnormalities ObstructionX Paralytic ileusX Structural disorders Aortoenteric fistulaX Congenital anomaliesXX Intestinal malabsorptionXX Meckel's diverticulumXX TumorsXX Vascular insufficiencyXX2.9 Large Bowel Infectious disorders Antibiotic associatedX BacterialXX ParasiticXX ViralXX Inflammatory disorders Acute appendicitisX Necrotizing enterocolitis (NEC)XX Radiation colitisX Ulcerative colitisXX Motor abnormalities Hirschsprung's diseaseXX Irritable bowelX ObstructionX Structural disorders Congenital anomaliesXX DiverticulaXX IntussusceptionXX VolvulusXX TumorsXX2.10 Rectum and Anus Infectious disorders Perianal/anal abscessXX Perirectal abscessX Pilonidal cyst and abscessXX Inflammatory disorders ProctitisX Structural disorders Anal fissureX Anal fistulaXX Congenital anomaliesX Foreign bodyXX HemorrhoidsX Rectal prolapseX TumorsXX2.11 SpleenXXX3.0 Cardiovascular DisordersCriticalEmergentLower Acuity3.1 Cardiopulmonary ArrestX SIDS (See 1.1)X3.2 Congenital Abnormalities of the Cardiovascular System Disorders due to anatomic anomaliesXXX Genetically transmitted disordersXXX3.3 Disorders of Circulation Arterial AneurysmXXX Aortic dissectionX ThromboembolismXX Venous Thromboembolism (See 16.6)XX3.4 Disturbances of Cardiac Rhythm Cardiac dysrhythmiasXXX VentricularXX SupraventricularXXX Conduction disordersXXX3.5 Diseases of the Myocardium, Acquired Cardiac failureXX Cor pulmonaleXX High outputXX Low outputXX CardiomyopathyXXX HypertrophicXXX Congestive heart failureXX Coronary syndromesXX Ischemic heart diseaseXX Myocardial infarctionXX MyocarditisXXX Ventricular aneurysmXXX3.6 Diseases of the Pericardium Pericardial tamponade (See 18.1)XX PericarditisXX3.7 EndocarditisXX3.8 HypertensionXXX3.9 TumorsXX3.10 Valvular DisordersXXX4.0 Cutaneous DisordersCriticalEmergentLower Acuity4.1 Cancers of the Skin Basal cellX Kaposi's sarcomaX MelanomaX Squamous cellX4.2 Decubitus UlcerXX4.3 Dermatitis AtopicX ContactX EczemaX PsoriasisX Sebaceous cystX SeborrheaX4.4 Infections Bacterial AbscessXX CellulitisXX ErysipelasX ImpetigoX Necrotizing infectionXX Fungal Candida (See 2.2, 7.5)X TineaX Parasitic Pediculosis infestationX ScabiesX Viral Aphthous ulcersX Erythema infectiosumX Herpes simplex (See 10.6, 13.1)X Herpes zoster (See 10.6)XX Human papillomavirus (HPV) (See 13.1)X Molluscum contagiosumX WartsX4.5 Maculopapular Lesions Erythema multiformeXX Erythema nodosumX Henoch-Schönlein purpura (HSP)X Pityriasis roseaX PurpuraXX UrticariaXX4.6 Papular/Nodular Lesions Hemangioma/lymphangiomaX LipomaX4.7 Vesicular/Bullous Lesions PemphigusX Staphylococcal scalded skin syndromeXX Stevens-Johnson syndromeXX Toxic epidermal necrolysisXX5.0 Endocrine, Metabolic, and Nutritional DisordersCriticalEmergentLower Acuity5.1 Acid-Base Disturbances Metabolic or respiratory AcidosisXX AlkalosisXXX Mixed acid-base balance disorderXX5.2 Adrenal Disease Corticoadrenal insufficiencyXX Cushing's syndromeXX5.3 Fluid and Electrolyte Disturbances Calcium metabolismXXX Fluid overload/volume depletionXX Hyperkalemia/hypokalemiaXXX Hypernatremia/hyponatremiaXXX Magnesium metabolismXX Phosphorus metabolismXX5.4 Glucose Metabolism Diabetes mellitus Type IXXX Type IIXX Complications in glucose metabolism Diabetic ketoacidosis (DKA)XX HyperglycemiaXX Hyperosmolar comaXX HypoglycemiaXX SystemicXX5.5 Nutritional Disorders Vitamin deficienciesX Vitamin excessX Wernicke-Korsakoff syndromeX5.6 Parathyroid DiseaseXX5.7 Pituitary DisordersXX PanhypopituitarismX5.8 Thyroid Disorders HyperthyroidismXXX HypothyroidismXXX ThyroiditisXX5.9 Tumors of Endocrine Glands AdrenalXX PituitaryXX ThyroidXX6.0 Environmental DisordersCriticalEmergentLower Acuity6.1 Bites and Envenomation (See 18.1) ArthropodsXX InsectsX SpidersXX MammalsXX Marine organisms (See 17.1)XXX SnakesXXX6.2 Dysbarism Air embolismXX BarotraumaXXX Decompression syndromeXX6.3 Electrical Injury (See 18.1)XXX LightningXX6.4 High-Altitude Illness Acute mountain sicknessXX Barotrauma of ascentXX High-altitude cerebral edemaXX High-altitude pulmonary edemaXX6.5 Submersion Incidents Cold water immersionXX Near drowningXX6.6 Temperature-Related Illness Heat Heat exhaustionXX Heat strokeX Cold FrostbiteXX HypothermiaXX6.7 Radiation EmergenciesXXX7.0 Head, Ear, Eye, Nose, Throat DisordersCriticalEmergentLower Acuity7.1 Ear Foreign bodyXX Impacted cerumenX LabyrinthitisX MastoiditisX Meniere's diseaseX Otitis externaX InfectiveX MalignantX Otitis mediaXX Perforated tympanic membrane (See 18.1)X7.2 Eye External eye BlepharitisX Burn confined to eye and adnexa (See 18.1)X ConjunctivitisX Corneal abrasions (See 18.1)XX DacryocystitisXX Disorders of lacrimal systemX Foreign bodyXX Inflammation of the eyelidsX ChalazionX HordeolumX KeratitisXX Anterior pole GlaucomaXX Hyphema (See 18.1)XX Iritis (See 18.1)XX Posterior pole Choroiditis/chorioretinitisX Optic neuritisX PapilledemaXX Retinal detachments and defects (See 18.1)X Retinal vascular occlusionX Orbit Cellulitis PreseptalX PostseptalX Purulent endophthalmitisX7.3 Cavernous Sinus ThrombosisXX7.4 Nose EpistaxisXXX Foreign bodyXX RhinitisX SinusitisX7.5 Oropharynx/Throat DentalgiaX Diseases of the oral soft tissue Ludwig's anginaXX StomatitisX Diseases of the salivary glands SialolithiasisXX Suppurative parotitisX Foreign bodyXX Gingival and periodontal disorders GingivostomatitisX Larynx/trachea Epiglottitis (See 16.1)XX LaryngitisX TracheitisXX Oral candidiasis (See 2.2, 4.4)X Periapical abscessXX Peritonsillar abscessX Pharyngitis/tonsillitisX Retropharyngeal abscessXX Temporomandibular joint disordersX7.6 TumorsXX8.0 Hematologic DisordersCriticalEmergentLower Acuity8.1 Blood Transfusion ComplicationsXX8.2 Hemostatic Disorders Coagulation defectsXXX AcquiredXXX HemophiliasXXX Disseminated intravascular coagulationX Platelet disordersXXX ThrombocytopeniaXX8.3 LymphomasXX8.4 PancytopeniaXX8.5 Red Blood Cell Disorders Anemias AplasticXX HemoglobinopathiesXX Sickle cell diseaseXX HemolyticX Hypochromic Iron deficiencyXX MegaloblasticXX PolycythemiaXX Methemoglobinemia (See 17.1)XX8.6 White Blood Cell Disorders LeukemiaXX Multiple myelomaXX LeukopeniaXX9.0 Immune System DisordersCriticalEmergentLower Acuity9.1 Collagen Vascular Disease Raynaud's diseaseX Reiter's syndromeXX Rheumatoid arthritis (See 11.3)XX SclerodermaXX Systemic lupus erythematosusXX VasculitisXX9.2 HIV and Manifestations (See 10.6)XXX9.3 Hypersensitivity Allergic reactionXX AnaphylaxisX AngioedemaXX Drug allergiesXXX9.4 Kawasaki SyndromeX9.5 SarcoidosisXX9.6 Transplant-related ProblemsXXX ImmunosuppressionXX RejectionXX9.7 Rheumatic FeverXX10.0 Systemic Infectious DisordersCriticalEmergentLower Acuity10.1 Bacterial Bacterial food poisoningXX BotulismXX ChlamydiaXX Gonococcal infectionsXX MeningococcemiaXX Mycobacterial infections Atypical mycobacteriaXX TuberculosisXX Other bacterial diseasesXX Gas gangrene (See 11.6)XX Sepsis/bacteremiaXX ShockX Systemic inflammatory response syndrome (SIRS)XX Toxic shock syndromeXX Spirochetes SyphilisXX TetanusXX10.2 Biologic WeaponsXX10.3 Fungal InfectionsXX10.4 Protozoan/Parasites MalariaX ToxoplasmosisXX10.5 Tick-borne EhrlichiosisX Lyme diseaseX Rocky Mountain spotted feverX10.6 ViralXX Infectious mononucleosisXX Influenza/parainfluenzaXX HantavirusXX Herpes simplex (See 4.4, 13.1)XX Herpes zoster/varicella (See 4.4)XX HIV (See 9.2)XXX RabiesX RoseolaX RubellaX10.7 Emerging Infections/PandemicsXX11.0 Musculoskeletal Disorders (Nontraumatic)CriticalEmergentLower Acuity11.1 Bony Abnormalities Aseptic necrosis of hipXX OsteomyelitisX TumorsXX11.2 Disorders of the Spine Disc disordersXX Inflammatory spondylopathiesXX Low back pain Cauda equina syndrome (See 18.1)XX SacroiliitisX Sprains/strainsX11.3 Joint Abnormalities Arthritis SepticX GoutXX Rheumatoid (See 9.1)X JuvenileX OsteoarthrosisX Congenital dislocation of the hipXX Slipped capital femoral epiphysisX11.4 Muscle Abnormalities Myalgia/MyositisX RhabdomyolysisXX11.5 Overuse Syndromes BursitisX Muscle strainsX Peripheral nerve syndromeX Carpal tunnel syndromeX TendonitisX11.6 Soft Tissue Infections FasciitisX FelonX Gangrene (See 10.1)XX ParonychiaXX Synovitis/tenosynovitisXX12.0 Nervous System DisordersCriticalEmergentLower Acuity12.1 Cranial Nerve DisordersX Idiopathic facial nerve paralysis (Bell's palsy)X Trigeminal neuralgiaX12.2 Demyelinating DisordersXX Multiple sclerosisXX12.3 Headache (See 1.4)XXX Muscle contractionX VascularXX12.4 HydrocephalusXX Normal pressureXX VP shuntX12.5 Infections/Inflammatory Disorders EncephalitisXX Intracranial and intraspinal abscessXX Meningitis BacterialXX ViralXX MyelitisX Neuralgia/neuritisX12.6 Movement DisordersXX Dystonic reactionXX12.7 Neuromuscular Disorders Guillain-Barré syndromeXX Myasthenia gravisXXX Peripheral neuropathyX12.8 Other Conditions of the Brain Dementia (See 14.5)X Parkinson's diseaseX Pseudotumor cerebriXX12.9 Seizure DisordersXXX FebrileXX NeonatalX Status epilepticusX12.10 Spinal Cord CompressionXX12.11 Stroke Hemorrhagic IntracerebralXX SubarachnoidXX Ischemic EmbolicXX ThromboticXX12.12 Transient Cerebral IschemiaXX12.13 TumorsXX13.0 Obstetrics and GynecologyCriticalEmergentLower Acuity13.1 Female Genital Tract Cervix Cervicitis and endocervicitisXX TumorsX Infectious disorders Pelvic inflammatory diseaseX Fitz-Hugh-Curtis syndromeX Tubo-ovarian abscessX Lesions Herpes simplex (See 4.4, 10.6)X Human papillomavirus (HPV) (See 4.4)X Ovary CystX TorsionX TumorsXX Uterus Dysfunctional bleedingXX EndometriosisX ProlapseX TumorsXX Gestational trophoblastic diseaseX LeiomyomaX Vagina and vulva Bartholin's abscessX Foreign bodyXX Vaginitis/vulvovaginitisX13.2 Normal PregnancyX13.3 Complications of Pregnancy AbortionX Ectopic pregnancyXX Hemolysis, elevated liver enzymes, low platelets (HELLP) syndromeXX Hemorrhage, antepartum Abruptio placentae (See 18.2)XX Placenta previaXX Hyperemesis gravidarumXX Hypertension complicating pregnancyXX EclampsiaXX PreeclampsiaX InfectionsX Rh isoimmunizationX13.4 High-risk PregnancyXX13.5 Normal Labor and DeliveryXX13.6 Complications of Labor Fetal distressX Premature labor (See 18.2)X Premature rupture of membranesX Rupture of uterus (See 18.2)X13.7 Complications of Delivery Malposition of fetusXX Nuchal cordX Prolapse of cordX13.8 Postpartum Complications EndometritisX HemorrhageXX MastitisXX14.0 Psychobehavioral DisordersCriticalEmergentLower Acuity14.1 Addictive Behavior Alcohol dependenceX Drug dependenceX Eating disordersXX Substance abuseX14.2 Mood Disorders and Thought Disorders Acute PsychosisXX Bipolar disorderXX DepressionXX Suicidal riskXX Grief reactionX SchizophreniaXX14.3 Factitious Disorders Drug-seeking behaviorX Munchausen syndrome/Munchausen by proxyXX14.4 Neurotic Disorders Anxiety/panicX Obsessive compulsiveX PhobicX Posttraumatic stressX14.5 Organic Psychoses Chronic organic psychotic conditionsX Alcoholic psychosesXX Drug psychosesXX DeliriumX Dementia (See 12.8)X Intoxication or withdrawal (See 17.1) AlcoholXXX HallucinogensXX OpioidsXXX PhencyclidineX Sedatives/hypnotics/anxiolyticsXXX Sympathomimetics and cocaineXXX14.6 Patterns of Violence/Abuse/Neglect Interpersonal violence Child, intimate partner, elderX Homicidal riskXX Sexual assaultX Staff/patient safetyX14.7 Personality DisordersX14.8 Psychosomatic Disorders HypochondriasisX Hysteria/conversionX15.0 Renal and Urogenital DisordersCriticalEmergentLower Acuity15.1 Acute and Chronic Renal FailureXXX15.2 Complications of Renal DialysisXX15.3 Glomerular Disorders GlomerulonephritisXX Nephrotic syndromeXX15.4 Infection CystitisX PyelonephritisX Urinary tract infection (UTI)X15.5 Male Genital Tract Genital lesionsX HerniasXX Inflammation/infection Balanitis/balanoposthitisXX Epididymitis/orchitisXX Gangrene of the scrotum (Fournier's gangrene)XX ProstatitisXX UrethritisX Structural Paraphimosis/phimosisX PriapismX Prostatic hypertrophy (BPH)X Torsion of testisX Testicular massesX Tumors ProstateX TestisX15.6 NephritisXX Hemolytic uremic syndromeX15.7 Structural Disorders Calculus of urinary tractXX Obstructive uropathyX Polycystic kidney diseaseX15.8 TumorsX16.0 Thoracic-Respiratory DisordersCriticalEmergentLower Acuity16.1 Acute Upper Airway Disorders Infections CroupX Epiglottitis (See 7.5)XX Pertussis/whooping coughXX Upper respiratory infectionX ObstructionX Tracheostomy/complicationsXX16.2 Disorders of Pleura, Mediastinum, and Chest Wall CostochondritisX MediastinitisXX Pleural effusionXX PleuritisX PneumomediastinumX Pneumothorax (See 18.1) SimpleX TensionX16.3 Noncardiogenic Pulmonary EdemaXX16.4 Obstructive/Restrictive Lung Disease Asthma/reactive airway diseaseXX Bronchitis and bronchiolitisXX Bronchopulmonary dysplasiaXX Chronic obstructive pulmonary diseaseXXX Cystic fibrosisXXX Environmental/industrial exposureXXX Foreign bodyXX16.5 Physical and Chemical Irritants/Insults PneumoconiosisXX Toxic effects of gases, fumes, vapors (See 18.1)XXX16.6 Pulmonary Embolism/Infarct Septic emboliXX Venous thromboembolism (See 3.3)XX16.7 Pulmonary Infections Lung abscessX Pneumonia AspirationXX AtypicalX BacterialXX ChlamydiaX FungalXX MycoplasmalXX ViralXXX Pulmonary tuberculosisX16.8 Tumors BreastX Chest wallX PulmonaryXX17.0 Toxicologic DisordersCriticalEmergentLower Acuity17.1 Drug and Chemical Classes Analgesics AcetaminophenX Nonsteroidal anti-inflammatories (NSAIDS)XX Opiates and related narcoticsXX SalicylatesXX Alcohol EthanolXXX GlycolXX IsopropylXXX MethanolXX AnestheticsXX Anticholinergics/cholinergicsXX AnticoagulantsXX AnticonvulsantsXX AntidepressantsXX Antiparkinsonism drugsX Antihistamines and antiemeticsX AntipsychoticsXX BronchodilatorsX Carbon monoxideXX Cardiovascular drugs AntiarrhythmicsXX DigitalisXX AntihypertensivesXX Beta-BlockersXX Calcium-channel blockersXX Caustic agents AcidXX AlkaliXX CocaineXXX Cyanides, hydrogen sulfideXX HallucinogensXX Hazardous materialsXX Heavy metalsXX Herbicides, insecticides, and rodenticidesXX Household/industrial chemicalsXXX Hormones/steroidsXX HydrocarbonsXX Hypoglycemics/insulinXX Inhaled toxinsXX IronXX IsoniazidXX Marine toxins (See 6.1)XXX Methemoglobinemia (See 8.5)XX Mushrooms/poisonous plantsXX NeurolepticsXX Nonprescription drugsXX OrganophosphatesXX Recreational drugsXXX Sedatives/hypnoticsXX Stimulants/sympathomimeticsXX StrychnineXX LithiumXXX18.0 Traumatic DisordersCriticalEmergentLower Acuity18.1 Trauma Abdominal trauma DiaphragmXX Hollow viscusXX PenetratingXX RetroperitoneumXX Solid organXX VascularXX Chest trauma Aortic dissection/disruptionX Contusion CardiacXXX PulmonaryXX Fracture ClavicleXX Ribs/flail chestXXX SternumXX HemothoraxXX Penetrating chest traumaXX Pericardial tamponade (See 3.6)X Pneumothorax (See 16.2) SimpleX TensionX Cutaneous injuries AvulsionsXX Bite wounds (See 6.1)XX Burns Electrical (See 6.3)XXX Chemical (See 16.5)XXX ThermalXXX LacerationsXX Puncture woundsXX Facial fracturesX DentalXX Le FortXXX MandibularXX OrbitalXX Genitourinary trauma BladderX External genitaliaX RenalXX UreteralX Head trauma Intracranial injuryXX Scalp lacerations/avulsionsXX Skull fracturesXX Injuries of the spine Dislocations/subluxationsXX FracturesXXX Sprains/strainsX Lower extremity bony trauma Dislocations/subluxationsX Fractures (open and closed)XX Neck trauma Laryngotracheal injuriesXX Penetrating neck traumaXX Vascular injuries Carotid arteryXX Jugular veinXX Ophthalmologic trauma Corneal abrasions/lacerations (See 7.2)XX Corneal burns AcidX AlkaliX UltravioletXX Eyelid lacerationsX Foreign bodyX Hyphema (See 7.2)X Lacrimal duct injuriesX Penetrating globe injuriesX Retinal detachments (See 7.2)X Traumatic iritis (See 7.2)XX Retrobulbar hematomaX Otologic trauma HematomaXX Perforated tympanic membrane (See 7.1)X Pediatric fractures EpiphysealXX GreenstickX TorusX Pelvic fractureXX Soft-tissue extremity injuries Amputations/replantationX Compartment syndromesX High-pressure injectionX Injuries to jointsXX KneeXX PenetratingX Penetrating soft-tissueXX PeriarticularX Sprains and strainsX Tendon injuries Lacerations/transectionsX RupturesX Achilles tendonX Patellar tendonX Vascular injuriesXX Spinal cord and nervous system trauma Cauda equina syndrome (See 11.2)XX Injury to nerve rootsXX Peripheral nerve injuryXX Spinal cord injuryXX Spinal cord injury without radiologic abnormality (SCIWORA)X Upper extremity bony trauma Dislocations/subluxationsX Fractures (open and closed)XX18.2 Trauma in PregnancyAbruptio placentae (See 13.3)XX Perimortem C-sectionX Premature labor (See 13.6)X Rupture of uterus (See 13.6)X18.3 Multisystem TraumaXX Blast injuryXX Open table in a new tab The Accreditation Council for Graduate Medical Education (ACGME) is implementing the ACGME Outcome Project to ensure that physicians are appropriately trained in the knowledge and skills of their specialties. The ACGME has identified 6 general (core) competencies thought to be essential for any practicing physician: patient care, medical knowledge, practice-based learning and improvement, interpersonal skills, professionalism, and systems-based practice. The 6 general competencies are an integral part of the practice of emergency medicine and are embedded in the EM Model.10Chapman D.M. Hayden S. Sanders A.B. et al.Integrating the Accreditation Council for Graduate Medical Education core competencies into the model of the clinical practice of emergency medicine.Ann Emerg Med. 2004; 43: 756-759Abstract Full Text Full Text PDF PubMed Scopus (65) Google Scholar, 11Chapman D.M. Hayden S. Sanders A.B. et al.Integrating the Accreditation Council for Graduate Medical Education core competencies into the model of the clinical practice of emergency medicine.Acad Emerg Med. 2004; 11: 674-685 PubMed Google ScholarThe EM Model is designed for use as the core document for the specialty. It will provide the foundation for developing medical school and resi

Study objective: In 2005, the Food and Drug Administration approved deferasirox as an oral iron chelating agent for chronic iron overload. To determine usefulness in management of acute iron ingestion, we study the effect of orally administered deferasirox in healthy human adults.Methods: A double-blinded, placebo-controlled, randomized, crossover study of 8 healthy human volunteers was conducted. Subjects ingested 5 mg/kg of elemental iron in the form of ferrous sulfate. One hour after iron ingestion, subjects were randomized to receive 20 mg/kg of deferasirox or placebo. Serial iron levels were then obtained. A 2-week washout was used between study arms. The paired t test was used to compare area under time-concentration curves from baseline to both 12- and 24-hour iron levels between groups.Results: Baseline serum iron levels were similar in the 2 groups. Deferasirox significantly reduced serum iron area under concentration-time curves compared with placebo during both 1 to 12 hours and 1 to 24 hours (12 hour=577 mu mol-hour/L and 392 mu mol-hour/L, 95% confidence interval for the difference 15.8 to 353.0 mu mol-hour/L; 24 hour=808 mu mol-hour/L and 598 mu mol-hour/L, 95% confidence interval for difference 54.4 to 366.7 mu mol-hour/L).Conclusion: Orally administered deferasirox significantly reduced serum iron levels when administered 1 hour after iron ingestion during the 12- and 24-hour periods after acute ingestion of 5 mg/kg of elemental iron in healthy human volunteers. Further study is required to determine optimal dosing, but deferasirox may be an important addition to current therapy for acute iron poisoning. [Ann Emerg Med. 2011;58:69-73.]