xiiiHOW TO USE THIS BOOKAs we have done with other books in the First Aid series, we encourage you to
read this book early on and throughout your residency, and to supplement it
with margin notes. As with general medicine, mastering emergency medicine
does not result from a single reading of a textbook but from many readings
and multiple experiences treating patients. For common conditions, such as
blunt trauma, CHF, and pneumonia, we focus on the kinds of complicated
scenarios that you will find on the test. At this point in your career, you will
not be tested on your knowledge of basic information. You will not be asked
What is the most common cause of community acquired pneumonia? for exam-
ple. Instead, you are tested on your ability to apply that basic knowledge in
the far more challenging situations you are likely to encounter in the ED,
where the question is more likely to be What is the cause of pneumonia in this
patient who has just returned from a rat-infested cabin in New Mexico? For rare
conditions, such as an organophosphate overdose, ciguatera toxicity, or high-
altitude pulmonary edema, our goal has been to provide simple, clear, memo-
rable explanations. By the time you have read this book two or three times,
you should be well prepared to make the right decisions on the exam and in
real life.
Some young physicians say that practicing medicine is intuitive and experience
based, that once you have done a residency, studying and memorizing are
things of the past. For most of us, this is not true. When a patient comes into
the emergency department 15 minutes after eating dark-meat fish with flush-
ing and palpitations, you might know that you need to initiate treatment with
diphenhydramine for scombroid poisoning. But this knowledge is hardly
intuitive. And, unless you had trained in Florida, you would probably never
have seen this disease. For most examinees, study and memorization are a
necessary part of test preparation.
In preparing for the exam, take an expansive and a reductionist approach. Be
expansive by studying with your reference books and internet resources readily
at hand. Supplementing your clinical knowledge with pictures and detailed
descriptions of illnesses will help you remember how to identify and manage
complex and rare diseases. Be reductionist by preparing notes on the subjects
you have difficulty remembering. Linking key words together on paper, “den-
dritic ulcer →herpes keratitis,” for example, and reviewing them regularly is
often enough to help you “capture” an important piece of knowledge—and
ensure the right answer—on test day.
Most cases you see in an emergency department will require more complex
thinking than can be presented in a multiple choice question. We encourage
you to accept that the test simplifies complexities in order to provide an
objective measure of your knowledge. For evolving and complex situations,
such as evaluating the source of chest pain, we describe the current, generally
accepted approaches. Please be aware that medicine continually changes, and
there are many situations for which we still do not know the best approach.