EMER 4006: EMERGENCY MEDICINE ONCOLOGY                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                          2017-2018 
                                                                                                                                                                                                                                                                                                                                                                                                                      Contact Lyn Atkin (leatkin@mdanderson.org) 
                                                                                                      Faculty In Charge Of Course:                                                                                                                                                                                                                                                                                Kumar Alagappan, MD, FACEP, FAAEM, FIFEM 
                                                                                                      Participating Faculty:                                                                                                                                                                                                                                                                                      All Emergency Medicine faculty 
                                                                                                      Location:                                                                                                                                                                                                                                                                                                   M.D. Anderson Cancer Center  
                                                                                                      Offered:                                                                                                                                                                                                                                                                                                    August through April 
                                                                                                      Max. #  Students/Period:                                                                                                                                                                                                                                                                                    2 
                                                                                           
                                                                                                      Course Objective 
                                                                                           
                                                                                          The goal of the elective in oncologic emergencies is to provide in-person clinical and didactic instruction in oncologic emergency medicine, 
                                                                                          capitalizing on the knowledge and expertise of MD Anderson Cancer Center Department of Emergency Medicine faculty. An understanding of 
                                                                                          oncologic emergencies is critical for the effective care of cancer patients, as many cancer therapies, the sequelae of these treatments, and the 
                                                                                          natural history of many cancers are associated with urgent and emergent medical issues. 
                                                                                           
                                                                                          Material Covered: 
                                                                                           
                                                                                          This elective will provide a thorough introduction to the basic principles of oncologic emergency medicine including current treatment modalities 
                                                                                          for commonly treated cancers, side-effect profiles and toxicities of many commonly used oncologic agents and newer targeted-therapy 
                                                                                          medications, management of hematological problems encountered with acutely ill cancer patients, ability to identify causes of fever in 
                                                                                          immunocompromised patients and to understand the treatment of neutropenic fever, pain management in patients experiencing acute or chronic 
                                                                                          pain, addressing end-of-life issues and rendering appropriate palliative care, diagnostic and treatment strategies for cardiovascular emergencies 
                                                                                          (eg, heart failure, ischemic heart disease, arrhythmias, thromboembolism, cardiac tamponade, hypertension), identification and management of 
                                                                                          the most common radiological findings encountered on CXR, KUB, CT, MRI, and ultrasound, management of common complications of 
                                                                                          radiation therapy and to understand the treatment of such complications, and understand the use of ultrasound to diagnose common ailments and 
                                                                                          to aid in patient assessment and management. 
                                                                                           
                                                                                          Skills Acquired: 
                                                                                           
                                                                                          Emergency stabilization of patient, perform focused history and physical exam, recognize and interpret significant diagnostic studies, reevaluates 
                                                                                          patient’s response to therapeutic intervention, practices patient-centered communication, builds skills in team management communicating 
                                                                                          pertinent information to healthcare team. 
                                                                                           
                                                                                                      Activities Of Elective 
                                                                                           
                                                                                            Number Of New Patients/Student/Week:                                                                                                                                                                                                                                                                                                                                                                                                                                                           10 - will fluctuate based on number of patients 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           presenting to the Emergency Center per shift per week 
                                                                                            Responsibilities Of Student For Assigned Patients: 
                                                                                                                                                             Does history/physical:                                                                                                                                                                                                                                                                                                                                                                                                        Yes 
                                                                                                                                                             Who critiques:                                                                                                                                                                                                                                                                                                                                                                                                                Attending 
                                                                                                                                                             Follows patients, with appropriate notes as needed:                                                                                                                                                                                                                                                                                                                                                                           Yes 
                                                                                                                                                             Who supervises:                                                                                                                                                                                                                                                                                                                                                                                                               Attending 
                                                                                                                                                             Does student see ambulatory patients:                                                                                                                                                                                                                                                                                                                                                                                         Yes 
                                                                                             
                                                                                           
                                                                                                      Procedures                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                    Observe                                                                                                                                                                                                                                                                                                                    Perform 
                                                                                                      Endotracheal intubations, simple repair of superficial                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   X                                                                                                                                                                                                                                                                                                                                  
                                                                                                      wounds, ultrasound, arterial lines, nasogastric tube 
                                                                                                      placement, foley catheter placement, EKG, Paracentesis, 
                                                                                                      and lumbar puncture, among other oncologic emergent 
                                                                                                      procedures 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                  
                                                                                           
                                                                                                      Scheduled Duties of Student: 
                                                                                           
                                                                                                                                          Frequency of rounds on patients                                                                                                                                                                                                                                                                                                                                                                                                          Dependent on patient activity; Oncologic Emergency patients require constant 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   observation and evaluation.  Students work 11 shifts, 10 hours each, over the 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   month-long rotation. The Program Director assigns shifts for each student at 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   orientation. All students are required to attend an Emergency Medicine 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   orientation on the 1st weekday of the elective month. 
                                                                                                                                          Presents patients to preceptor or attending physician                                                                                                                                                                                                                                                                                                                                                                                    Yes 
                                                                                                                                          Weekly schedule of required teaching sessions                                                                                                                                                                                                                                                                                                                                                                                            Internal Medicine Morning Report (M, T 8-9am), Medical student lecture on 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   common oncologic emergencies (Wed 11-12:30), Emergency Medicine Didactic 
                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   Conference (Wed 1:30-3pm) 
                                                                                           
             EMER 4006: EMERGENCY MEDICINE ONCOLOGY                                                                                              2017-2018 
              Describe Optional Rounds And Activities, If Any: 
              
             Division of Internal Medicine Grand Rounds, Monday and Tuesday from 8-9am 
              
              Other Required Activities: 
              
                   Reading/review of current literature            No 
                   Writing or presenting a paper                   No 
              
              How Is Student Evaluated: 
             Observation of performance in patient care and development of skills and knowledge 
              
              Who Evaluates Students: 
             Program Director and Emergency Medicine faculty 
              
              Unique Features Of This Elective: 
             The Emergency Center at MDACC, one of the largest cancer repositories in the world, treats more than 26,000 patients annually with more than 
             95% having a cancer diagnosis. As such, the institution provides a rich environment for oncology education, and provides a gateway to a unique 
             perspective into the treatment of oncologic emergencies.