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This manuscript reports recommendations of the National Fourth Year Medical Student Emergency Medicine Curriculum Guide Task Force. This task force was convened by 6 major emergency medicine organizations to develop a standardized curriculum for fourth year medical students. The structure of the curriculum is based on clerkship curricula from other specialties such as internal medicine and pediatrics. The report contains a historical context, global and targeted needs assessment, goals and objectives, recommended educational strategies, implementation guidelines, and suggestions on feedback and evaluation.

Methotrexate is a chemotherapy antimetabolite, folic acid antagonist, that inhibits the enzyme dihydrofolate reductase resulting in decreased levels of tetrahydrofolate in the cells. This in turn blocks synthesis of thymidylate, a nucleotide necessary for DNA synthesis. It is readily absorbed from the gastrointestinal tract. Toxicity from overdose can affect multiple organ systems including bone marrow, liver, intestinal tract, kidneys, lungs, skin, and blood vessels, resulting in death in severe cases. Methotrexate is widely used to treat neoplastic disease, dermatologic disorders (psoriasis), and rheumatologic disorders (severe rheumatoid arthritis). As its indications for use increase, more accidental overdoses can be expected. We present the treatment and clinical course of one such case, that of a 2-year-old who accidentally took her grandmother's arthritis pills. Her initial serum level was 10 times greater than that needed to cause toxicity. She was treated with gastric lavage, activated charcoal, leucovorin rescue, and ICU admission. Her clinical course was unremarkable, and the only evidence of toxicity was a mild elevation in a liver-associated enzyme that resolved without any clinical sequela. Leucovorin at a dose equal to or greater than the possible ingestion should be given as soon as possible in methotrexate overdoses.

Study Objective: To determine the usefulness of ultrasound and radiography in detecting foreign bodies in soft-tissue models closely duplicating puncture-wound trauma and hand anatomy., Methods: In this randomized, blinded descriptive study, two radiologists independently evaluated 120 chicken thighs for foreign bodies with the use of standard two-view radiography and 7.5-MHz transducer ultrasonography. All chicken thighs were manipulated with hemostats to ensure uniform tissue damage. In 60 thighs, one foreign body had been inserted (10 each: gravel, metal, glass, cactus spine, wood, and plastic)., Results: The sensitivity of ultrasound in detecting gravel was 40%, that for metal was 45%, that for glass was 50%, that for cactus spine was 30%, that for wood was 50%, and that for plastic was 40%. The overall sensitivity, specificity, and false-negative and false-positive rates for ultrasound were 43%, 70%, 50%, and 30%, respectively. No individual foreign body had an ultrasound detection rate of 50%. Radiography detected foreign bodies generally considered radiopaque (gravel, glass, metal) 98% of the time, but it never detected bodies considered radiolucent (wood, plastic, cactus spine). The false-negative and false-positive rates for radiography were 50% and 1.6%, respectively., Conclusion: Ultrasound detection of foreign bodies by skilled operators in this animal model revealed poor sensitivity and specificity. Radiographic detection was highly sensitive for foreign bodies considered radiopaque. Our data suggest that ultrasound should not be relied on to rule out the possibility of a retained foreign body in the distal extremities.