Preface

The purpose of this audio course is to prepare the osteopathic student for the clinical series of COMAT examinations, which are sponsored by and provided to students by the National Board of Osteopathic Medical Examiners. This is actually a series of shorter examinations on eight core clinical areas of practice by the doctor of osteopathy. The world of osteopathy is a large one, encompassing all the different areas of medicine plus specialized care given by the general osteopathist.

The area of study in this course is emergency medicine. You will take the COMAT examination in emergency medicine after your emergency medicine rotation. In the introduction to the course, we will talk about the COMAT examination itself as well as how you can prepare for it. Upon finishing the course, you should have a solid basis of understanding of the practice of osteopathy in emergency medicine and will have reviewed each of the topics represented in the COMAT exam.

The introduction to the course will teach you specifically about the examination itself. As you will see, each of the tests have a specific format and rules you will need to follow when you take the examination. The COMAT examinations are standardized to give everyone a reliable way to demonstrate their knowledge and skills on the different exams.

Chapter one in the course represents the abdominal and gastrointestinal complaints you will most likely encounter in an emergency medicine practice and reflects the content on the COMAT emergency medicine examination. Areas covered include abdominal pain, gastrointestinal bleeding, bowel obstruction, certain infectious processes, gallbladder disease, and hepatitis. As will be asked of you in all areas of the clinical COMAT examination, you will focus on patient presentation, differential diagnosis, and management of the patient in an emergency situation.

Chest pain is a common complaint in the emergency department; this is the main topic of discussion in chapter two. While each case must be treated as though it represents a serious process, most cases seen do not represent serious pathology but are secondary to

anxiety or chest wall pain. What follows in this chapter is a discussion of the emergency medicine approach to chest pain and information on some known causes of chest pain and related symptoms seen in the emergency setting.

Chapter three in the course covers environmental and travel disorders, including the different types of burns, snakebites, other envenomation’s, hypothermia, and heatrelated injuries, including heatstroke. These are problems that bring patients into the emergency department for treatment every day, although you will need to familiarize yourself with those things that are most likely to affect your patients in your community and in different weather situations.

The purpose of chapter four is to discuss the control of hemorrhaging, including gastrointestinal hemorrhaging. Hemorrhage itself takes on a relatively high priority, after airway and breathing. You need to recognize both internal and external bleeding and treat the patient accordingly. GI bleeding can come from many different sources in the GI tract. Depending on the severity of the bleeding, your treatment may be an urgent matter.

Chapter five in the course includes the different head, eye, ear, nose, and throat disorders seen in emergency medicine. There is a variety of infectious processes linked to the ear, nose, and throat that are covered in this chapter. In addition, headaches, eye diseases, and facial trauma fall in this category as part of what you will encounter in the emergency department.

Chapter six talks about issues related to the central nervous system and related phenomena. The patient with weakness or a mental status change can have a variety of different underlying etiologies, which range from metabolic diseases to actual central nervous system diseases. This chapter will focus on these types of conditions and how they are managed in the emergency department setting.

Chapter seven in the course refers to the different gynecological and obstetric conditions encountered in emergency medicine. The pregnant woman can present with a variety of emergency conditions, some of which are true obstetrical emergencies. Women who are not pregnant can still present with complaints that are seen and

evaluated in the emergency department; these kinds of things are discussed as part of this chapter.

Chapter eight talks about the different conditions you will be asked to manage in the emergency department that are related to the use of substances that lead to poisoning, overdose, or withdrawal symptoms. Some of these patients come with a clear history, while others present with symptoms suggestive of toxicity and a medical puzzle as to what might be the causative agent. The different toxic ingestions are covered in this chapter.

Chapter nine in the course discusses psychiatric emergencies in the emergency medical setting. There are a great number of emergency department visits related to psychiatric problems. For this reason, the emergency department physician should know how to handle these types of emergencies. Discussed in this chapter are the psychiatric examination, handling the agitated patient, the identification and management of psychosis, and the management of suicidal behavior.

Chapter ten deals with shock and the resuscitation of the patient. These are critical care issues that come up all the time in the emergency department. You will need to refresh yourself on airway management, cardiopulmonary resuscitation, identification and management of arrhythmias, and the treatment of shock in an emergency setting. Each of these is dealt with as part of this chapter.

The focus of chapter eleven in the course is the different manifestations of dyspnea or shortness of breath. The patient with a variety of diseases can have shortness of breath as their primary complaint in the emergency department. The evaluation of dyspnea is covered in this chapter because the approach to this can involve a great many differential diagnoses. Primary lung diseases leading to dyspnea include asthma and COPD. Infections like pneumonia can be causes of dyspnea. Heart failure and epiglottitis can also lead to shortness of breath in the emergency department.

Chapter twelve is about the management of traumatic injuries. Traumatic injuries generally present to the emergency department for evaluation and early management. These injuries can come from automobile accidents, falls, sporting injuries, and violent

acts. The different types of traumatic injuries you can encounter are discussed in this chapter.

The topics in chapter thirteen in the course are traumatic wounds, the management of lacerations, and tetanus prophylaxis in wound care. Not every wound need suturing, depending on the nature of the injury. Animal bites represent special wounds requiring advanced care measures. The management of lacerations is covered in this chapter as well as guidelines for how you can prevent the complication of tetanus after the patient has sustained a wound.