Introduction

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).

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.

Selected topics in the following areas are addressed in this rotation guide:

In addition to the information covered in this rotation guide, overlapping topics related to EM are covered in other rotation guides:

Pneumonia, Skin and Soft Tissue Infections, Diabetic Foot Infection (Infectious Diseases)
Stroke, Seizures and Epilepsy, Meningitis (Neurology)
Sepsis and Shock, Acid-Base, Lactic Acidosis, and Electrolytes, Resuscitation Fluids and Transfusion, Ventilation (Critical Care)
Acute Coronary Syndrome (STEMI/NSTEMI), Arrhythmias, Congestive Heart Failure (CHF), Myocarditis and Pericarditis, Valvular Diseases (Cardiology)
Asthma, Chronic Obstructive Pulmonary Disease (COPD), Interstitial Lung Disease, Pulmonary Hypertension (Pulmonology)
Anaphylaxis (Allergy and Immunology)
Neutropenic Fever (Oncology)
Diverticulitis, Inflammatory Bowel Disease, Pancreatitis, Gastrointestinal Bleeding, Mesenteric Ischemia, Biliary Disease (Gastroenterology)
Acute Kidney Injury (Nephrology)
Hyperglycemic Emergencies (Endocrinology)
Pregnancy and Abortion, Sexually Transmitted Infections, Fibroids, Menstrual and Bleeding Disorders (Women’s Health)
Substance Use Disorder (Mental Health)

For a brief history of emergency medicine, click here.

Jon Adler, MD, is an emergency physician at Lahey Hospital and Medical Center. He served as a clinician and educator at Massachusetts General Hospital and Harvard Medical School for 23 years. He has been author or editor of 14 books and 4 medical journals. Jon is currently faculty at Tufts University School of Medicine.

This rotation guide was developed by a collaborative team of contributors including:
Writers: Ken Wu, MBBS MRCPCH; Michael Mi, MD (NEJM Fellows); Isabel Algaze Gonzalez, MD
Peer Reviewers: Patrick Tyler, MD; Jeremy Faust, MD
Section Expert: Jonathan Adler, MD
Senior Editor: Ole-Petter Hamnvik, MB BCh BAO, MMSc
Last updated: January 2023 by Colleen Laurence, MD; Andres Mallipudi, MD; and Zayir Malik, MD

Brief Case Presentations with Videos

Emergency Medicine Videos

Intranasal Naloxone Administration

Emergency Intubation in Covid-19

The video “Emergency Intubation in Covid-19” is intended for health care personnel involved in performing emergency endotracheal intubation in patients with suspected or proven infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes the respiratory illness coronavirus disease 2019 (Covid-19).

Examination of the Neck Veins

Examination of the neck veins is routinely performed to evaluate right atrial pressure and to estimate intravascular volume in patients with dyspnea, edema, or hypovolemia. In patients with dyspnea or edema, it is essential to estimate the venous pressure and to perform the abdominojugular reflux test at the bedside, as described in...

Percutaneous Tracheostomy

A tracheostomy is a surgically created airway that is kept open with a breathing tube, or tracheostomy tube. The tube is inserted directly into the trachea through an incision in the neck. A tracheostomy can be created with an open surgical or a percutaneous dilation technique and can take place in the operating room or at the patient’s...

Personal Protective Equipment and Covid-19

This video demonstrates a procedure for putting on and removing one type of PPE that has been recommended by the CDC for use in U.S. hospitals to minimize the risk of exposure to infectious material during the care of patients with 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

As is the case with medical procedures, family meetings require clinician training and a structured approach. The key functions of a family meeting are to build rapport with the family and to offer support, provide updates about the patient’s medical status, discuss...

How to Obtain a Nasopharyngeal Swab Specimen

Collecting specimens from the surface of the respiratory mucosa with nasopharyngeal swabs is a procedure used to diagnose Covid-19 as well as other respiratory viral infections and certain bacterial infections in adults and children. This video describes the collection of...

Closed Reduction of a Fractured and Dislocated Ankle

Prompt reduction of a displaced fracture of the ankle decreases the risk of trauma to the skin and soft tissues surrounding the joint. This video focuses on initial management and demonstrates techniques for reducing and splinting a displaced fracture of the ankle as well as the use of a hematoma block for anesthesia.

Peripheral Nerve Block for Hand Procedures

This video shows viewers how to administer a peripheral nerve block. Its primary use, demonstrated here, is to aid the treatment of hand lacerations. This procedure can also be used for other conditions, including dislocations, paronychia, and felon drainage.

Ultrasound-Guided Cannulation of the Subclavian Vein

Ultrasound Guidance for Pleural Catheter Placement

The indications for pleural drainage are diagnostic and therapeutic. This video demonstrates ultrasound-guided placement of a small-bore, pigtail catheter for drainage of a pleural effusion.