Emergency Medicine End of Rotation ™ Exam Blueprint & Topic List

The Emergency Medicine End of Rotation™ (EOR) exam is one of the PA Education Association’s objective, standardized evaluations and is intended to serve as one measure of the medical knowledge PA students gain during their supervised clinical practice experience. This article outlines the updated PAEA Emergency Medicine EOR Exam Blueprint, including its content and task areas, and presents the Exam Topic List. The specifications presented here reflect the updated Emergency Medicine Blueprint and Topic List published by PAEA as of July 2026. Updated Emergency Medicine exam versions based on these specifications were published July 2026; legacy Emergency Medicine examinations remain available through July 2027, so students should confirm which version their program is administering. Questions on an examination represent only a sample of the content that may be assessed and may not reflect every topic identified in the Topic List. Exam candidates and clinical coordinators are encouraged to review the original Blueprint, Topic List, and Core Tasks and Objectives through PAEA’s End of Rotation™ Blueprints and Topic Lists resource page at https://paeaonline.org/assessment/end-of-rotation/blueprints-and-topic-lists. ^[1]

AMBOSS is an independent entity with no affiliation to or endorsement by the PA Education Association (PAEA) or the PAEA End of Rotation™ examinations. The PAEA-derived portions of this article are based on the PAEA Emergency Medicine End of Rotation™ Exam Blueprint, Topic List, and Core Tasks and Objectives, which are created and owned by PAEA®. The emergency medicine-specific "Knowledge of" and "Skill in" descriptions, general study guidance, and organization of certain Professional Practice concepts were developed by AMBOSS and are not taken verbatim from the PAEA Core Tasks and Learning Objectives or from another source. AMBOSS does not claim ownership of material originating from PAEA. This article is provided at no cost to the public as an informational resource for PA students, educators, clinicians, and other healthcare professionals. It is not an official PAEA publication and does not contain actual PAEA examination questions. Use or reproduction of PAEA materials is subject to PAEA’s applicable terms and any required permissions. ^[2]

Content Categories

Task Categories

Each End of Rotation™ exam contains 120 multiple-choice questions, including 100 scored questions and 20 unscored pretest questions. The Blueprint percentages apply to the 100 scored questions. The updated Emergency Medicine Blueprint is organized by both content area and task area, and Professional Practice is one of its eight task areas.

General study approach

• Use the Blueprint percentages to set relative study priorities rather than to exclude lower-percentage categories.
  • Cardiovascular, rheumatologic/musculoskeletal, gastrointestinal, and pulmonary together account for 50% of the scored questions; however, every listed category remains testable.
  • Diagnosis and Clinical Therapeutics together account for 43% of the scored questions, emphasizing the need to move beyond factual recall and practice selecting the most likely diagnosis and the most appropriate pharmacologic management.
• Emergency Medicine End of Rotation™ questions cover the full lifespan and may be set in the emergency department or urgent care. Preparation should therefore include pediatric, adolescent, adult, pregnant, geriatric, immunocompromised, and medically complex patients.
• End of Rotation™ questions use a one-best-answer clinical-vignette format intended to assess higher-order thinking. Study each condition through its presenting symptoms, immediately life-threatening alternatives, key distinguishing findings, appropriate diagnostic evaluation, stabilization priorities, definitive treatment, disposition, reassessment, and return precautions.

Content Categories

Arrhythmias/Conduction disorders

• Atrial
• Heart blocks
• Junctional
• Premature beats
• Ventricular

Cardiomyopathy

• Dilated
• Hypertrophic
• Restrictive

Coronary artery disease

• Acute coronary syndrome
• Vasospastic angina (Prinzmetal angina)

Heart failure

Hypertensive disorders

• Hypertensive emergencies
• Severe asymptomatic hypertension (hypertensive urgency)

Hypotension

• Orthostatic hypotension
• Vasovagal hypotension

Shock

• Cardiogenic
• Distributive
• Hypovolemic
• Obstructive

Traumatic, infectious, and inflammatory heart conditions

• Acute rheumatic carditis
• Cardiac tamponade
• Infective endocarditis
• Myocarditis
• Pericardial effusion
• Pericarditis

Valvular disorders

• Aortic
• Mitral
• Pulmonary
• Rheumatic heart disease
• Tricuspid

Vascular disorders

• Aortic aneurysm/dissection
• Arterial embolism/thrombosis
• Arteriovenous malformation
• Atherosclerosis
• Deep vein thrombosis
• Peripheral artery disease
• Phlebitis/thrombophlebitis
• Vasculitides

Avascular necrosis

Carpal tunnel syndrome

Infectious disorders

• Osteomyelitis
• Septic arthritis

Inflammatory conditions

• Bursitis
• Costochondritis
• Myositis
• Tendonitis
• Tenosynovitis

Osteoarthritis

Rheumatologic disorders

• Gout/pseudogout
• Polyarteritis nodosa
• Polymyalgia rheumatica
• Polymyositis
• Reactive arthritis

Spine disorders

• Ankylosing spondylitis
• Disc disease
• Spinal stenosis
• Spondylolisthesis
• Spondylolysis

Traumatic conditions

• Cauda equina syndrome
• Compartment syndrome
• Fractures/dislocations
• Ligamentous tears
• Meniscal injuries
• Sprains/strains

Acute pancreatitis

Biliary tract disorders

• Acute cholangitis
• Acute cholecystitis

Blunt and penetrating abdominal trauma

Bowel perforation

Esophageal disorders

• Boerhaave syndrome
• Esophageal varices
• Esophagitis
• Gastroesophageal reflux disease
• Mallory-Weiss tear

Foodborne illness

Foreign body

Gastric disorders

• Gastritis
• Peptic ulcer disease

Gastrointestinal bleeding

Hepatic disorders

• Acute hepatitis
• Cirrhosis

Intestinal/Colorectal disorders

• Abscess/fistula
• Acute appendicitis
• Acute infectious gastroenteritis (viral, bacterial)
• Anal fissure/fistula
• Diverticular disease
• Fecal impaction/incontinence
• Hemorrhoidal disorders
• Hernias (incarcerated/strangulated)
• Inflammatory bowel disease
• Ischemic bowel disease
• Obstruction (small bowel, large bowel, volvulus)
• Toxic megacolon

Neoplasms

• Benign
• Malignant

Toxidromes

• Acetaminophen poisoning
• Reye syndrome
• Substances

Acute respiratory distress syndrome

Acute respiratory failure

Airway obstruction

Anaphylaxis

Asthma exacerbation

Blunt and penetrating chest trauma

Bronchiectasis

Carbon monoxide poisoning

Chronic obstructive pulmonary disease exacerbation

Drowning

Foreign body aspiration

Hypercapnia

Hypoxia

Infectious disorders

• Acute bronchiolitis
• Acute bronchitis
• Acute epiglottitis
• Influenza
• Laryngotracheobronchitis
• Pertussis
• Pneumonias
  • Bacterial
  • Fungal
  • Human immunodeficiency virus-related
  • Viral
• Tuberculosis

Inhalation injury

Neoplasms

• Benign
• Malignant

Pleural effusion

Pneumothorax

Pulmonary circulation

• Pulmonary edema
• Pulmonary embolism

Altered mental status

Cerebellar dysfunction

Cerebral edema/herniation

Cranial nerve palsies

Degenerative/Neuromuscular disease

• Dementia/delirium

Headache

• Cluster
• Migraine
• Tension

Increased intracranial pressure

Loss of consciousness/Coma

Neurogenic syncope

Peripheral nerve disease

• Guillain-Barré syndrome
• Myelopathy
• Neuralgia/neuritis
• Neuropathy
• Radiculopathy

Seizure disorders

• Epilepsy
• Nonepileptic seizures
• Status epilepticus

Stroke

• Hemorrhagic
• Ischemic
• Transient ischemic attack

Subarachnoid hemorrhage/Cerebral aneurysm

Trauma

• Head trauma/traumatic brain injury
• Intracranial hemorrhage
• Spinal cord injury
• Spinal epidural abscess/hemorrhage

Ear disorders

• Barotrauma
• Dysfunction of the eustachian tube
• External ear trauma/hematoma
• Foreign body
• Mastoiditis
• Otitis externa
• Otitis media
• Tympanic membrane perforation
• Vertigo

Eye disorders

• Conjunctivitis
• Corneal disorders
  • Corneal abrasion/ulcer
  • Keratitis
• Glaucoma (acute angle closure)
• Inflammatory disorders
  • Scleritis
  • Uveitis
• Lid disorders
  • Blepharitis
• Ocular trauma
  • Blowout fracture
  • Foreign body
  • Globe rupture
  • Hyphema
• Optic neuritis
• Orbital/periorbital cellulitis
• Retinal disorders
  • Retinal detachment
  • Retinal vascular occlusion
• Vision abnormalities
  • Amaurosis fugax

Nose/sinus disorders

• Acute/chronic rhinosinusitis
• Epistaxis
• Nasal trauma

Oropharyngeal disorders

• Angioedema
• Dacryoadenitis
• Dental abscess
• Dental caries
• Epiglottitis
• Laryngitis
• Laryngotracheobronchitis (croup)
• Peritonsillar abscess/retropharyngeal abscess
• Pharyngitis

Anxiety disorders

• Generalized anxiety disorder
• Panic disorder

Bipolar and related disorders

Child/Elder neglect or violence

Delirium

Depressive disorders

Eating disorders

Functional neurological symptoms disorder

Homicidal ideation

Psychosis

Schizophrenia spectrum and other psychotic disorders

Sleep/wake disorders

Somatic symptom disorders

Substance-related disorders

Suicidal ideation

Toxidromes

Trauma/Stress-related disorders

• Posttraumatic stress disorder

Acid-base disturbances

Blunt and penetrating pelvic trauma

Electrolyte disturbances

Infectious disorders

• Cystitis
• Epididymitis
• Orchitis
• Prostatitis
• Pyelonephritis
• Urethritis

Obstructive disorders

• Uro/Nephrolithiasis

Renal disease

• Acute kidney injury
• Chronic kidney disease
• Rhabdomyolysis

Testicular torsion

Urinary retention

Allergic reactions

• Contact dermatitis
• Drug eruptions
• Urticaria

Diseases of hair, nails, or skin

• Bullous pemphigoid
• Erythema multiforme
• Pilonidal disease
• Toxic epidermal necrolysis

Infectious disorders

• Bacterial
  • Abscess
  • Cellulitis
  • Folliculitis
  • Impetigo
• Fungal
• Viral
  • Herpes zoster
  • Measles
  • Rubella/rubeola
  • Varicella
  • Viral exanthems

Skin infestations

• Pediculosis
• Scabies

Vector-borne illnesses

Wounds

• Abrasions/Lacerations
• Bites/Stings
• Burns
• Cold exposure injury
• Cutaneous foreign body
• Ulcers

Breast disorders

• Abscess
• Mastitis

Cervical disorders

• Cervicitis
• Pelvic inflammatory disease

Infectious disorders

• Chlamydia
• Gonorrhea
• Herpes simplex virus
• Syphilis
• Trichomoniasis

Menstrual disorders

Ovarian disorders

• Ovarian cyst
• Ovarian torsion
• Tubo-ovarian abscess

Pregnancy

• Abortion
• Bleeding in pregnancy
  • Abruptio placentae
  • Placenta previa
• Ectopic pregnancy
• Medical disorders of pregnancy
  • Fetal distress
  • Hyperemesis gravidarum
  • Hypertensive disorders of pregnancy
  • Prelabor rupture of membranes

Uterine disorders

• Endometriosis

Vaginal/Vulvar disorders

• Bartholin gland cysts
• Vaginitis

Adrenal disorders

• Acute adrenal insufficiency

Diabetes mellitus

Diabetic ketoacidosis

Hyperosmolar hyperglycemic syndrome

Hypoglycemia

Pituitary disorders

• Cushing disease
• Diabetes insipidus
• Syndrome of inappropriate antidiuretic hormone secretion

Thyroid and parathyroid disorders

• Hyper/Hypoparathyroidism
• Hyper/Hypothyroidism
• Thyroid storm
• Thyroiditis

Anemias

• Hemolytic

Coagulation disorders

• Disseminated intravascular coagulation
• Immune thrombocytopenic purpura
• Thrombotic thrombocytopenic purpura

Hemorrhagic shock

Leukemias

Lymphomas

Polycythemia

Sickle cell disease

Bacteremia

Bacterial infections

• Clostridioides difficile
• Clostridium tetani
• Necrotizing fasciitis
• Pertussis
• Tuberculosis

Encephalitis

Fever

• Fever of unknown origin
• Fever without a source

Fungal infections

Parasitic infections

• Toxoplasmosis

Sepsis

Sexually transmitted infections

Tuberculosis

Vector-borne infections

Viral infections

• Coronavirus disease 2019 (COVID-19)
• Herpes simplex virus
• Human immunodeficiency virus/Acquired immunodeficiency syndrome
• Influenza
• Rabies

Task Categories

*AMBOSS editorial study guidance: The following emergency medicine-specific "Knowledge of" and "Skill in" descriptions were developed by AMBOSS and are not taken verbatim from the PAEA Core Tasks and Learning Objectives or from another source.

• Knowledge of:
  • Components and techniques of comprehensive, focused, and problem-based emergency histories and physical examinations
  • Pertinent history, including symptom onset and progression, mechanism of injury, medications, allergies, comorbidities, pregnancy status, substance exposure, immunization status, and prior emergency presentations
  • Risk factors and historical features associated with life-threatening and time-sensitive emergency conditions
  • Significant vital-sign abnormalities and physical examination findings associated with clinical instability
  • Age-specific and population-specific differences in emergency presentations, including pediatric, pregnant, geriatric, immunocompromised, and cognitively impaired patients
  • Signs of nonaccidental trauma, abuse, neglect, intimate partner violence, trafficking, and other threats to patient safety
• Skill in:
  • Rapidly assessing general appearance, mental status, airway patency, respiratory effort, circulation, perfusion, and hemodynamic stability
  • Conducting comprehensive and/or problem-based emergency interviews and physical examinations with compassion and empathy
  • Obtaining pertinent information from patients, caregivers, emergency medical services personnel, witnesses, medical records, and other available sources
  • Performing primary and secondary trauma surveys and identifying immediately life-threatening injuries
  • Performing targeted cardiovascular, pulmonary, neurologic, abdominal, musculoskeletal, genitourinary, dermatologic, psychiatric, and EENOT examinations
  • Assessing pain, hydration, functional status, pregnancy possibility, substance exposure, and risk of self-harm or harm to others
  • Triaging and prioritizing patients based on abnormal vital signs, acuity, mechanism of injury, time-sensitive diagnoses, and risk of deterioration
  • Recognizing findings that require immediate stabilization, resuscitation, isolation, consultation, or escalation of care
  • Reassessing patients after treatment, procedures, medications, or changes in clinical status

• Knowledge of:
  • Patient- and family-centered education related to diagnostic and laboratory studies
  • Indications, limitations, risks, contraindications, techniques, and potential complications of common emergency diagnostic studies
  • Selection and sequencing of testing based on patient stability, presenting complaint, pretest probability, time sensitivity, cost, probable yield, invasiveness, and potential effect on management
  • Indications for laboratory testing, electrocardiography, radiography, ultrasonography, computed tomography, magnetic resonance imaging, and other emergency diagnostic modalities
  • Normal and abnormal findings associated with common and life-threatening emergency conditions
  • Age-specific and patient-specific considerations involving radiation, contrast, pregnancy, renal function, immunocompromise, and invasive testing
  • Uses and limitations of clinical decision rules and risk-stratification tools
• Skill in:
  • Selecting appropriate initial and subsequent diagnostic and laboratory studies
  • Collecting blood, urine, respiratory, wound, genital, tissue, and cerebrospinal fluid specimens using appropriate technique
  • Obtaining and interpreting electrocardiograms for ischemia, infarction, arrhythmias, conduction abnormalities, electrolyte disturbances, and toxicologic emergencies
  • Reviewing and interpreting laboratory studies, imaging, and point-of-care ultrasonography in the context of the patient’s history, physical examination findings, vital signs, and clinical course
  • Applying validated decision tools appropriately while recognizing their limitations
  • Monitoring serial laboratory, electrocardiographic, imaging, and physiologic findings when clinically indicated
  • Recognizing critical results that require immediate intervention, consultation, isolation, resuscitation, or escalation of care
  • Determining when additional diagnostic evaluation is required
  • Communicating indications, risks, benefits, preparation requirements, and results effectively to patients, caregivers, consultants, and members of the emergency care team

• Knowledge of:
  • Significance of the presenting complaint, history, risk factors, mechanism of injury, vital signs, and physical examination findings as they relate to the differential diagnosis
  • Significance of diagnostic and laboratory findings as they relate to acute and life-threatening conditions
  • Typical, atypical, and age-specific presentations of emergency medical conditions
  • Time-sensitive diagnoses in which stabilization or treatment should begin before diagnostic confirmation
  • Potential mimics of common emergency presentations, including chest pain, dyspnea, abdominal pain, altered mental status, syncope, weakness, fever, trauma, and psychiatric complaints
  • Effects of medications, substances, pregnancy, age, comorbidities, immunosuppression, and social factors on disease presentation
• Skill in:
  • Formulating a broad but appropriately prioritized differential diagnosis based on the presenting complaint and patient acuity
  • Identifying and prioritizing immediately life-threatening and time-sensitive diagnoses
  • Integrating history, physical examination findings, vital signs, diagnostic data, bedside assessment, and response to treatment into medical decision-making
  • Selecting the most likely diagnosis based on the totality of available clinical data
  • Revising the differential diagnosis as new information becomes available or the patient’s condition changes
  • Distinguishing medical, traumatic, toxicologic, psychiatric, infectious, and environmental causes of similar presentations
  • Recognizing atypical presentations in pediatric, pregnant, geriatric, immunocompromised, and medically complex patients
  • Recognizing when a definitive diagnosis cannot be established and determining the safest working diagnosis, disposition, and follow-up plan
  • Identifying patients who require immediate resuscitation, consultation, procedural intervention, observation, admission, transfer, or additional diagnostic evaluation

• Knowledge of:
  • Age-appropriate preventive care, screening, immunization, and risk-reduction recommendations relevant to emergency encounters
  • Indications, risks, and benefits of tetanus, rabies, hepatitis B, and other postexposure prophylaxis
  • Prevention of recurrent injury, falls, poisoning, overdose, sexually transmitted infections, and complications of chronic disease
  • Patient education regarding acute diagnoses, expected clinical course, treatment options, medication use, follow-up, and return precautions
  • Principles of harm reduction, including overdose prevention, naloxone access, safer substance-use practices, and referral for treatment
  • Emergency contraception, pregnancy prevention, sexually transmitted infection prevention, and relevant screening recommendations
  • Effects of health literacy, language, disability, culture, transportation, finances, housing, medication access, and other barriers to care
  • Signs and symptoms of abuse and neglect and indications for intervention, referral, and mandated reporting
  • Community and public-health resources relevant to primary care, mental health, substance use, violence, homelessness, food insecurity, and other patient needs
• Skill in:
  • Providing clear, patient-centered education regarding the diagnosis, treatment plan, medications, procedures, and expected recovery
  • Giving specific verbal and written return precautions based on the patient’s condition and risk of deterioration
  • Assessing patient and caregiver understanding through teach-back and addressing language, literacy, cognitive, or sensory barriers
  • Counseling patients regarding injury prevention, fall prevention, poison prevention, safe driving, firearm safety, and occupational or recreational risks
  • Providing smoking-cessation, substance-use, overdose-prevention, sexual-health, and other risk-reduction counseling
  • Administering or arranging indicated immunizations and postexposure prophylaxis
  • Identifying barriers to adherence, medication access, transportation, housing, nutrition, and follow-up care
  • Coordinating appropriate follow-up with primary care, specialty care, public-health services, and community resources
  • Educating patients about incidental findings and ensuring an appropriate plan for further evaluation

• Knowledge of:
  • Indications, contraindications, risks, benefits, complications, and techniques associated with emergency procedures and clinical interventions
  • Principles of stabilization and resuscitation using airway, breathing, circulation, disability, and exposure priorities
  • Management of airway obstruction, respiratory failure, shock, cardiac arrest, severe hemorrhage, anaphylaxis, sepsis, trauma, and other life-threatening emergencies
  • Indications for basic and advanced airway management, oxygen delivery, noninvasive ventilation, endotracheal intubation, and mechanical ventilation
  • Principles of basic life support, advanced cardiovascular life support, pediatric advanced life support, and postresuscitation care
  • Indications for vascular, intraosseous, urinary, gastric, thoracic, and other emergency access or drainage procedures
  • Principles of wound evaluation, irrigation, debridement, foreign-body removal, hemostasis, anesthesia, closure, dressing, and infection prevention
  • Indications for fracture and dislocation reduction, splinting, immobilization, and emergent orthopedic consultation
  • Indications for procedural sedation, local anesthesia, regional anesthesia, analgesia, and physiologic monitoring
  • Criteria for consultation, observation, admission, transfer, discharge, or escalation to a higher level of care
  • Sterile technique, Standard Precautions, isolation precautions, procedural safety, and prevention of occupational exposure
• Skill in:
  • Recognizing and immediately treating threats to airway, breathing, circulation, neurologic function, and environmental exposure
  • Initiating cardiopulmonary resuscitation, defibrillation, synchronized cardioversion, transcutaneous pacing, and postresuscitation care when indicated
  • Providing oxygenation and ventilation support, including airway positioning, suctioning, bag-mask ventilation, supraglottic airway placement, and assistance with endotracheal intubation
  • Establishing vascular or intraosseous access and initiating fluid, blood-product, or medication resuscitation
  • Controlling external hemorrhage through direct pressure, wound packing, tourniquets, hemostatic agents, and appropriate escalation
  • Performing or assisting with emergency procedures using sterile technique and within the PA’s training and assigned role
  • Providing local anesthesia, regional nerve blocks, analgesia, anxiolysis, and procedural sedation with appropriate monitoring and rescue preparedness
  • Reducing and immobilizing fractures or dislocations and reassessing distal neurovascular status
  • Managing wounds through irrigation, debridement, exploration, closure, dressing, and assessment for prophylaxis or antimicrobial treatment
  • Monitoring response to intervention through repeat examination, vital signs, cardiac monitoring, pulse oximetry, capnography, laboratory trends, and bedside reassessment
  • Recognizing failed treatment or deterioration and escalating resuscitation, consultation, transfer, or level of care
  • Determining appropriate disposition based on diagnosis, stability, response to treatment, social circumstances, follow-up capability, and risk of deterioration

• Knowledge of:
  • Indications for use
  • Contraindications and precautions
  • Mechanisms of action
  • Dosing and routes of administration
  • Pharmacokinetics and pharmacodynamics
  • Selection of empiric pharmacologic therapy when treatment must begin before definitive diagnostic confirmation
  • Pharmacologic management of cardiac arrest, acute coronary syndrome, arrhythmias, hypertensive emergencies, acute heart failure, and shock
  • Pharmacologic management of acute pulmonary, neurologic, endocrine, infectious, toxicologic, psychiatric, and pain-related emergencies
  • Selection and timing of empiric antimicrobial therapy and principles of antimicrobial stewardship
  • Use of analgesics, antiemetics, local anesthetics, anxiolytics, sedatives, paralytic medications, antidotes, vasopressors, anticoagulants, antiplatelet agents, thrombolytics, and reversal agents
  • Medication and dose modifications required for pediatric, pregnant, geriatric, obese, renally impaired, hepatically impaired, and medically complex patients
  • Drug interactions, including presentation and management
  • Presentation and management of adverse effects, allergic reactions, withdrawal syndromes, medication toxicity, and medication-induced emergencies
  • Safe prescribing and monitoring of opioids, benzodiazepines, stimulants, and other controlled substances
  • Medication reconciliation and management of chronic therapies during acute illness
  • Methods for preventing medication errors during resuscitation, verbal orders, weight-based dosing, transitions of care, and high-acuity treatment
• Skill in:
  • Selecting and administering appropriate emergency pharmacotherapy based on the suspected diagnosis, patient stability, comorbidities, allergies, organ function, pregnancy status, and prior treatment
  • Calculating accurate adult and weight-based pediatric medication doses, infusion rates, maximum doses, and dose adjustments
  • Initiating appropriate medications during cardiac arrest, acute coronary syndrome, arrhythmias, shock, anaphylaxis, respiratory failure, seizures, and other life-threatening emergencies
  • Selecting and administering empiric antimicrobial therapy promptly when serious infection is suspected
  • Providing multimodal analgesia while balancing pain relief, respiratory safety, sedation risk, and potential substance-use concerns
  • Selecting medications for procedural sedation, rapid-sequence intubation, agitation control, local anesthesia, and regional nerve blocks
  • Identifying suspected poisoning or overdose and initiating appropriate antidotal and pharmacologic therapy
  • Administering anticoagulants, antiplatelet agents, thrombolytics, vasopressors, or reversal agents when indicated
  • Monitoring therapeutic response through repeat examination, vital signs, cardiac monitoring, laboratory results, electrocardiography, and clinical reassessment
  • Recognizing treatment failure, adverse reactions, medication toxicity, and drug interactions and modifying pharmacologic regimens promptly
  • Reconciling outpatient medications and determining which medications should be continued, withheld, adjusted, reversed, or restarted
  • Drafting accurate prescriptions and discharge medication instructions
  • Counseling patients and caregivers regarding medication purpose, administration, expected effects, adverse effects, interactions, safe storage, and adherence
  • Preventing medication errors through allergy verification, weight confirmation, dose checks, clear communication, medication reconciliation, and appropriate monitoring

• Knowledge of:
  • Associations among disease conditions and complications identified through the application of scientific concepts
  • Genetics
  • Normal anatomy and physiology relevant to acute illness, trauma, resuscitation, and emergency procedures
  • Pathophysiology of shock, respiratory failure, cardiac arrest, sepsis, trauma, poisoning, neurologic emergencies, and other time-sensitive conditions
  • Ventilation, oxygenation, gas exchange, airway resistance, pulmonary compliance, and acid-base physiology
  • Cardiovascular physiology, including preload, afterload, contractility, cardiac output, vascular resistance, tissue perfusion, and compensatory responses to shock
  • Electrophysiology underlying normal cardiac conduction, arrhythmias, electrocardiographic abnormalities, and electrical therapies
  • Neurologic, renal, fluid, electrolyte, metabolic, coagulation, and inflammatory physiology relevant to emergency care
  • Microbiology, immunology, and mechanisms of transmission relevant to acute infection, sepsis, anaphylaxis, isolation, and postexposure prophylaxis
  • Pharmacologic and toxicologic principles relevant to emergency medications, antidotes, sedation, analgesia, antimicrobial therapy, and resuscitation
  • Biomechanics and mechanisms of injury associated with blunt trauma, penetrating trauma, burns, electrical injury, drowning, and environmental exposure
  • Age-related physiologic differences affecting pediatric, pregnant, and geriatric emergency patients
  • Behavioral, psychological, social, and public-health factors that influence emergency presentations, treatment decisions, adherence, and disposition
• Skill in:
  • Applying anatomy and physiology to rapid assessment, differential diagnosis, procedural planning, and recognition of clinical deterioration
  • Relating pathophysiologic mechanisms to the signs, symptoms, diagnostic findings, and management of emergency conditions
  • Interpreting hemodynamic, respiratory, neurologic, renal, metabolic, coagulation, and inflammatory abnormalities during acute illness
  • Applying ventilation, oxygenation, and acid-base physiology to airway and respiratory management
  • Applying cardiovascular and electrophysiologic principles to resuscitation, treatment of shock, electrocardiogram interpretation, defibrillation, cardioversion, and pacing
  • Applying microbiologic and immunologic principles to antimicrobial therapy, infection-control precautions, and management of sepsis or anaphylaxis
  • Applying pharmacologic and toxicologic principles to medication selection, dose adjustment, antidote use, and monitoring for adverse effects
  • Relating mechanism of injury and biomechanics to anticipated patterns and severity of traumatic injury
  • Applying evidence-based guidelines, clinical decision rules, and current medical literature to emergency evaluation and treatment
  • Evaluating emerging diagnostic technologies, procedures, medications, and emergency-care evidence critically as they relate to patient outcomes

Legal/medical ethics

• Knowledge of:
  • Informed consent and refusal for emergency procedures, medications, blood products, sedation, transfer, and other interventions
  • Exceptions to conventional informed consent when immediate treatment is required to prevent death or serious harm
  • Decision-making capacity and identification of an appropriate surrogate decision-maker
  • Advance directives, code status, including do-not-resuscitate and do-not-intubate orders, medical power of attorney, organ donation, and goals-of-care decisions
  • Legal and ethical requirements related to emergency evaluation and stabilization, patient transfer, refusal of care, and leaving against medical advice
  • Patient privacy, confidentiality, and appropriate disclosure of protected health information
  • Ethical considerations involving emergency triage, resource limitations, medical futility, medical errors, adverse events, and end-of-life care
  • Effective strategies for navigating legal and policy issues encountered by emergency patients and patient populations
• Skill in:
  • Assessing and documenting decision-making capacity in patients with intoxication, psychiatric illness, cognitive impairment, severe pain, or altered mental status
  • Obtaining informed consent or recognizing when emergency treatment may proceed without conventional consent
  • Respecting informed refusal while explaining risks, alternatives, warning signs, and reasonable harm-reduction measures
  • Managing patients who leave against medical advice through risk assessment, counseling, documentation, and follow-up planning
  • Recognizing and reporting suspected abuse, neglect, exploitation, trafficking, communicable diseases, and credible threats to patient or public safety
  • Escalating complex ethical or legal concerns to the supervising physician, ethics service, risk management, legal counsel, or other appropriate resource

Medical informatics

• Knowledge of:
  • Accurate and timely documentation of emergency history, examination, diagnostic reasoning, treatment, procedures, reassessment, consultation, and disposition
  • Documentation and coding requirements related to reimbursement, quality reporting, critical care, procedural sedation, restraints, refusal of care, and interfacility transfer
  • Electronic health records, clinical decision-support systems, prescription-monitoring programs, imaging systems, and evidence-based emergency medicine resources
  • Risks associated with copied documentation, incomplete medication reconciliation, alert fatigue, and electronic communication errors
• Skill in:
  • Documenting the differential diagnosis, medical decision-making, response to treatment, and rationale for disposition clearly and promptly
  • Recording critical communications, consultations, handoffs, transfer arrangements, informed refusal, and return precautions
  • Using clinical information systems to identify prior diagnoses, medications, allergies, recent testing, controlled-substance prescriptions, and relevant health trends
  • Protecting patient information when using electronic records, mobile devices, telemedicine, and other communication systems

Patient care and communication (individual patients)

• Knowledge of:
  • Affordable, effective, and patient-specific emergency care
  • Communication and care preferences of diverse patient populations
  • Effects of health literacy, language, disability, culture, finances, housing, transportation, medication access, and follow-up capability on emergency treatment and disposition
  • Communication strategies for patients experiencing pain, fear, agitation, intoxication, psychiatric crisis, cognitive impairment, diagnostic uncertainty, or serious illness
  • Communication needs of pediatric patients, older adults, pregnant patients, patients with disabilities, and individuals from diverse backgrounds
• Skill in:
  • Establishing rapport quickly while maintaining empathy, professionalism, and situational awareness
  • Communicating clearly during high-stress, time-sensitive, or emotionally difficult encounters
  • Demonstrating cultural humility and using qualified interpreters or accessible communication methods when appropriate
  • Explaining diagnostic uncertainty, treatment options, risks, benefits, disposition, follow-up, and return precautions in understandable language
  • Using de-escalation techniques with agitated, intoxicated, psychotic, or behaviorally dysregulated patients
  • Delivering serious news and discussing goals of care with patients, families, caregivers, and surrogates
  • Assessing barriers to adherence and coordinating realistic and safe follow-up plans

PA role in professional practice

• Knowledge of:
  • Professional and clinical limitations, scope of practice, credentialing, privileging, supervision, and collaboration requirements
  • Responsibilities of the PA during triage, resuscitation, procedural care, observation, consultation, admission, discharge, and interfacility transfer
  • Roles and responsibilities of physicians, nurses, emergency medical services personnel, pharmacists, consultants, social workers, and other members of the interprofessional emergency care team
  • Appropriate use of specialty consultation and escalation to the supervising physician or emergency physician
  • Professional boundaries, conflicts of interest, clinician impairment, workplace violence, ethical conduct, and effects of implicit bias on emergency care
• Skill in:
  • Recognizing personal limitations and seeking supervision or consultation without delaying necessary stabilization
  • Communicating effectively with physicians, nurses, emergency medical services personnel, pharmacists, consultants, social workers, and other team members
  • Participating effectively in resuscitations, trauma teams, bedside procedures, handoffs, consultations, and transitions of care
  • Using closed-loop communication and clearly assigning or confirming responsibilities during emergencies
  • Maintaining professional behavior in crowded, stressful, uncertain, and rapidly changing clinical environments

Professional development

• Knowledge of:
  • Continuing medical education resources relevant to emergency medicine, resuscitation, trauma, toxicology, and procedural care
  • Evidence-based guidelines, clinical decision rules, quality standards, and evolving emergency diagnostic and therapeutic practices
  • Effects of fatigue, stress, burnout, moral injury, and repeated exposure to trauma on clinician performance and well-being
• Skill in:
  • Critically evaluating emergency medicine literature and applying evidence-based recommendations appropriately
  • Identifying and interpreting information from reliable emergency medicine sources
  • Recognizing personal knowledge or skill gaps and pursuing education, simulation, feedback, supervision, or additional procedural training
  • Participating in morbidity and mortality review, peer feedback, quality improvement, and patient-safety activities
  • Using strategies that support clinician well-being, resilience, and safe performance during high-stress clinical work

Public health (population/society)

• Knowledge of:
  • Emergency department responsibilities in disaster preparedness, mass-casualty incidents, outbreak response, and public-health surveillance
  • Principles of disaster triage, decontamination, isolation, quarantine, and allocation of limited resources
  • Occupational and environmental hazards, including needlestick injuries, bloodborne pathogens, chemical exposures, radiation, and hazardous materials
  • Population-level prevention of overdose, suicide, violence, firearm injury, motor-vehicle injury, drowning, burns, falls, and infectious disease
  • Mandated-reporting requirements for communicable diseases, abuse, neglect, poisonings, occupational exposures, and other public-health threats
• Skill in:
  • Applying appropriate infection-control, isolation, and personal protective equipment precautions
  • Participating in disaster response, mass-casualty triage, decontamination, and allocation of emergency resources
  • Identifying emerging infectious diseases, clusters of illness, environmental exposures, and other public-health concerns
  • Providing harm-reduction counseling and connecting patients with overdose prevention, violence prevention, mental health, and community resources
  • Identifying vulnerable populations and addressing inequities in access to emergency and follow-up care

Risk management

• Knowledge of:
  • Standards of care and accountability in emergency medicine
  • Common causes of diagnostic error, treatment delay, medication error, communication failure, and unsafe discharge
  • Risks associated with overcrowding, boarding, interruptions, handoffs, high-risk medications, procedural sedation, restraints, and patient elopement
  • Appropriate resource utilization involving laboratory testing, imaging, consultation, medication use, observation, admission, and transfer
  • Patient-safety measures, including patient identification, allergy verification, medication reconciliation, procedural time-outs, checklists, and closed-loop communication
  • Requirements for reporting adverse events, near misses, equipment failures, occupational exposures, and safety concerns
• Skill in:
  • Using patient identification, allergy verification, medication reconciliation, procedural time-outs, checklists, and closed-loop communication
  • Recognizing and addressing diagnostic uncertainty, high-risk presentations, abnormal vital signs, pending tests, and incidental findings before disposition
  • Performing and documenting appropriate reassessment before discharge, admission, transfer, or release from observation
  • Providing safe handoffs that communicate acuity, working diagnosis, completed and pending studies, treatments, response, and contingency plans
  • Recognizing, documenting, reporting, and responding appropriately to adverse events and near misses
  • Escalating concerns when patient safety, clinician impairment, staffing, equipment function, or standards of care are compromised

AMBOSS is an independent entity with no affiliation to or endorsement by the PA Education Association (PAEA) or the PAEA End of Rotation™ examinations. The PAEA-derived portions of this article are based on the publicly available PAEA Emergency Medicine End of Rotation™ Exam Blueprint, Topic List, and Core Tasks and Objectives, which are solely created and owned by PAEA®. The emergency medicine-specific "Knowledge of" and "Skill in" descriptions were developed by AMBOSS and are not taken verbatim from the PAEA Core Tasks and Learning Objectives or from another source. AMBOSS does not claim ownership of material originating from PAEA. This article is provided at no cost to the public as an informational resource for PA students, educators, clinicians, and other healthcare professionals. It is not an official PAEA publication and does not contain actual PAEA examination questions. Questions on an examination represent only a sample of the content that may be assessed, and the Topic List is not a comprehensive list of all possible examination topics. Use or reproduction of PAEA materials is subject to PAEA’s applicable terms and any required permission. ^[2]