DNB Emergency Medicine: Admissions, Medical Colleges, Fees, Eligibility criteria details

DNB Emergency Medicine or Diplomate of National Board in Emergency Medicine also known as DNB in Emergency Medicine is a Postgraduate level course for doctors in India that is done by them after completion of their MBBS. The duration of this postgraduate course is 3 years, and it focuses on the study of injuries and diseases requiring immediate attention, initial investigations are performed to diagnose and treat the diseases in the acute phase.

The course is a full-time course pursued at various accredited institutes/hospitals across the country. Some of the top accredited institutes/hospitals offering this course are Aayush NRI LEPL Healthcare Private Limited- Andhra Pradesh, AIG Hospital- Telangana, Almadeena Institute of Medical Science- Kerala, and more.

Admission to this course is done through the NEET PG Entrance exam conducted by the National Board of Examinations, followed by counselling based on the scores of the exam that is conducted by DGHS/MCC/State Authorities.

The fee for pursuing DNB (Emergency Medicine) from accredited institutes/hospitals is Rs.1,25,000 to Rs. 3,15,000 per year.

After completion of their respective course, doctors can either join the job market or pursue a super-specialization course where DNB Emergency Medicine is a feeder qualification. Candidates can take reputed jobs at positions as Senior residents, Junior Consultants, Consultants etc. with an approximate salary range of Rs. 5,00,000 - Rs. 25,00,000 per year.

DNB is equivalent to MD/MS/DM/MCh degrees awarded respectively in medical and surgical super specialties. The list of recognized qualifications awarded by the Board in various broad and super specialties as approved by the Government of India are included in the first schedule of the Indian Medical Council Act, 1956.

The Diplomate of National Board in broad-specialty qualifications and super specialty qualifications when granted in a medical institution with the attached hospital or in a hospital with the strength of five hundred or more beds, by the National Board of Examinations, shall be equivalent in all respects to the corresponding postgraduate qualification and the super-specialty qualification granted under the Act, but in all other cases, senior residency in a medical college for an additional period of one year shall be required for such qualification to be equivalent for the purposes of teaching also.

What is DNB in Emergency Medicine?

Diplomate of National Board in Emergency Medicine, also known as DNB (Emergency Medicine) or DNB in Emergency Medicine is a three-year postgraduate programme that candidates can pursue after completing MBBS.

Emergency Medicine is the branch of medical science dealing with the study of injuries and diseases requiring immediate action, initial investigations are performed to diagnose and treat the diseases in the acute phase.

The National Board of Examinations (NBE) has released a curriculum for DNB in Emergency Medicine.

The curriculum governs the education and training of DNBs in Emergency Medicine.

PG education intends to create specialists who can contribute to high-quality health care and advances in science through research and training.

The required training done by a postgraduate specialist in the field of Emergency Medicine would help the specialist recognize the community's health needs. The student should be competent to handle medical problems effectively and should be aware of the recent advances in their speciality.

The candidate should be a highly competent specialist in Emergency Medicine possessing a broad range of skills that will enable her/him to practice Emergency Medicine independently. The PG candidate should also acquire the basic skills in teaching medical/para-medical students.

The candidate is also expected to know the principles of research methodology and modes of the consulting library. The candidate should regularly attend conferences, workshops, and CMEs to upgrade her/ his knowledge.

Course Highlights

Here are some of the course highlights of DNB in Emergency Medicine

Eligibility Criteria

The eligibility criteria for DNB in Emergency Medicine are defined as the set of rules or minimum prerequisites that aspirants must meet in order to be eligible for admission, which includes:

• Candidates must be in possession of an undergraduate MBBS degree from any college/university recognized by the Medical Council of India (MCI) now NMC.

• Candidates should have done a compulsory rotating internship of one year in a teaching institution or other institution which is recognized by the Medical Council of India (MCI) now NMC.

• The candidate must have obtained permanent registration of any State Medical Council to be eligible for admission.

• The medical college's recognition cut-off dates for the MBBS Degree courses and compulsory rotatory Internship shall be as prescribed by the Medical Council of India (now NMC).

• Candidates who have passed the final examination, leading to the award of a Post Graduate Degree (MD/MS) from an Indian University, which is duly recognized as per provisions of the National Medical Commission (NMC) Act, 2019 and the first schedule of the IMC Act can apply for the DNB Final examination in the same broad specialty.

Admission Process

The admission process contains a few steps to be followed in order by the candidates for admission to DNB in Emergency Medicine. Candidates can view the complete admission process for DNB in Emergency Medicine mentioned below:

• The NEET PG or National Eligibility Entrance Test for Post Graduate is a national-level master's level examination conducted by the NBE for admission to MD/MS/PG Diploma Courses.
• The requirement of eligibility criteria for participation in counselling towards PG seat allotment conducted by the concerned counselling authority shall be in lieu of the Post Graduate Medical Education Regulations (as per the latest amendment) notified by the MCI (now NMC) with prior approval of MoHFW.

Fees Structure

The fee structure for DNB in Emergency Medicine varies from accredited institute/hospital to hospital. The fee is generally less for Government Institutes and more for private institutes. The average fee structure for DNB in Emergency Medicine is Rs.1,25,000 to Rs. 3,15,000 per year.

Colleges offering DNB in Emergency Medicine

Various accredited institutes/hospitals across India offer courses for pursuing DNB (Emergency Medicine).

As per the National Board of Examinations website, the following accredited institutes/hospitals are offering DNB (Emergency Medicine) courses for the academic year 2022-23.

Syllabus

A DNB in Emergency Medicine is a three years specialization course that provides training in the stream of Emergency Medicine.

The course content for DNB in Emergency Medicine is given in the NBE Curriculum released by the National Board of Examinations, which can be assessed through the link mentioned below:

SYSTEM-BASED CORE KNOWLEDGE

This section of the curriculum gives an index of the system-based core knowledge appropriate to the management of patients presenting with undifferentiated symptoms and complaints. This list is mostly given in the following sequence: congenital disorders; inflammatory and infectious disorders; metabolic disorders; traumatic and related problems; tumors; vascular disorders, ischaemia and bleeding: other disorders. These lists cannot be exhaustive.

1. CARDIOVASCULAR EMERGENCIES IN ADULTS AND CHILDREN

• Arrhythmias

• Congenital heart disorders

• Contractility disorders, pump failure

• cardiomyopathies, congestive heart failure, acute pulmonary oedema,

• tamponade, valvular emergencies

• Inflammatory and infectious cardiac disorders

• endocarditis, myocarditis, pericarditis

• Ischaemic heart disease

• acute coronary syndromes, stable angina

• Traumatic injuries

• Vascular and thromboembolic disorders

• aortic dissection/aneurysm rupture, deep vein thrombosis, hypertensive

• emergencies, occlusive arterial disease, thrombophlebitis, pulmonary

• embolism, pulmonary hypertension

2. DERMATOLOGICAL EMERGENCIES IN ADULTS AND CHILDREN

• Inflammatory and Infectious disorders

• Skin manifestations of immunological disorders, systemic disorders, toxic disorders

3. ENDOCRINE AND METABOLIC EMERGENCIES IN ADULTS AND CHILDREN

 Acute presentation of inborn errors of metabolism

 Adrenal insufficiency and crisis

 Disorders of glucose metabolism hyperosmolar hyperglycaemic state, hypoglycaemia, ketoacidosis

 Thyroid disease emergencies hyperthyroidism, hypothyroidism, myxoedema coma, thyroid storm

4. FLUID AND ELECTROLYTE DISTURBANCES

• Acid-Base disorders

• Electrolyte disorders

• Volume status and fluid balance

5. EAR, NOSE, THROAT, ORAL AND NECK EMERGENCIES IN ADULTS AND CHILDREN

• Bleeding

• Complications of tumours, airway obstruction

• Foreign bodies

• Inflammatory and Infectious disorders angio-oedema, epiglottitis, laryngitis, paratonsillar abscess

• Traumatic problems

6. GASTROINTESTINAL EMERGENCIES IN ADULTS AND CHILDREN

• Congenital disorders Hirschsprung's disease, Meckel's diverticulum, pyloric stenosis

• Inflammatory and infectious disorders appendicitis, cholecystitis, cholangitis, diverticulitis, exacerbations and complications of inflammatory bowel diseases gastritis, gastroenteritis, gastro-oesophageal reflux disease, hepatitis, pancreatitis, peptic ulcer,peritonitis

• Metabolic disorders hepatic disorders, hepatic failure

• Traumatic and mechanical problems foreign bodies, hernia strangulation, intestinal obstruction and occlusion

• Tumours

• Vascular disorders/Ischaemia and bleeding: ischaemic colitis, upper and lower gastrointestinal bleeding, mesenteric ischaemia

• Other problems complications of gastrointestinal devices and surgical procedures

7. GYNAECOLOGICAL AND OBSTETRIC EMERGENCIES

• Inflammatory and Infectious disorders mastitis, pelvic inflammatory disease, vulvovaginitis

• Obstetric emergencies, abruptio placentae, eclampsia, ectopic pregnancy, emergency delivery,

• HELLP syndrome during pregnancy, hyperemesis gravidarum, placenta praevia, post-partum haemorrhage

• Traumatic and related problems ovarian torsion

• Tumours

• Vascular disorders/ Ischaemia and bleeding: vaginal bleeding

8. HAEMATOLOGY AND ONCOLOGY EMERGENCIES IN ADULTS AND CHILDREN

• Anaemias

• Complications of lymphomas and leukaemias

• Congenital disorders haemophilias and Von Willebrand's disease, hereditary haemolytic anaemias, sickle cell disease

• Inflammatory and Infectious disorders neutropenic fever, infections in immuno-compromised patients

• Vascular disorders/ Ischaemia and bleeding: acquired bleeding disorders (coagulation factor deficiency, disseminated intravascular coagulation), drug induced bleeding (anticoagulants,antiplatelet agents, fibrinolytics), idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura

• Transfusion reactions

9. IMMUNOLOGICAL EMERGENCIES IN ADULTS AND CHILDREN

• Allergies and anaphylactic reactions

• Inflammatory and Infectious disorders

• Acute complications of vasculitis

10. INFECTIOUS DISEASES AND SEPSIS IN ADULTS AND CHILDREN

Common viral and bacterial infections

• Food and water-born infectious diseases

• HIV infection and AIDS

• Common tropical diseases

• Parasitosis

• Rabies

• Sepsis and septic shock

• Sexually transmitted diseases

• Streptococcal toxic shock syndrome

• Tetanus

11. MUSCULO-SKELETAL EMERGENCIES

• Congenital disorders dislocated hip, osteogenesis imperfecta

• Inflammatory and Infectious disorders arthritis, bursitis, cellulitis, complications of systemic rheumatic diseases, necrotising fasciitis, osteomyelitis, polymyalgia rheumatica, soft tissue infections

• Metabolic disorders complications of osteoporosis and other systemic diseases

• Traumatic and degenerative disorders back disorders, common fractures and dislocations, compartment syndromes, crush syndrome, osteoarthrosis, rhabdomyolysis, soft tissue trauma

• Tumours: pathological fractures

12. NEUROLOGICAL EMERGENCIES IN ADULTS AND CHILDREN

• Inflammatory and Infectious disorders brain abscess, encephalitis, febrile seizures in children, Guillain-Barrè syndrome, meningitis, peripheral facial palsy (Bell's palsy), temporal arteritis

• Traumatic and related problems complications of CNS devices, spinal cord syndromes, peripheral nerve trauma and entrapment, traumatic brain injury

• Tumours common presentations and acute complications of neurological and metastatic tumours

• Vascular disorders: carotid artery dissection, stroke, subarachnoid haemorrhage, subdural and extradural haematomata, transient ischaemic attack, venous sinus thrombosis

• Other problems acute complications of chronic neurological conditions (e.g. myasthenic crisis, multiple sclerosis), acute peripheral neuropathies, seizures and status epilepticus

13. OPHTHALMIC EMERGENCIES IN ADULTS AND CHILDREN

• Inflammatory and Infectious disorders conjunctivitis, dacrocystitis, endophthalmitis, iritis, keratitis, orbital and periorbital cellulitis, uveitis

• Traumatic and related problems foreign body in the eye, ocular injuries,

• Vascular disorders: retinal artery and vein occlusion, vitreous haemorrhage

• Others like acute glaucoma, retinal detachment

14. PULMONARY EMERGENCIES IN ADULTS AND CHILDREN

• Congenital cystic fibrosis

• Inflammatory and Infectious disorders asthma, bronchitis, bronchiolitis, pneumonia, empyema, COPD exacerbation, lung abscess, pleurisy and pleural effusion, pulmonary fibrosis, tuberculosis

• Traumatic and related problems foreign body inhalation, haemothorax, tension pneumothorax, pneumomediastinum

• Tumours common complications and acute complications of pulmonary and metastatic tumours,

• Vascular disorders pulmonary embolism

• Other disorders: acute lung injury, atelectasis, ARDS, spontaneous pneumothorax

15. PSYCHIATRIC AND BEHAVIOUR DISORDERS

• Behaviour disorders affective disorders, confusion and consciousness disturbances, intelligence disturbances, memory disorders, perception disorders, psycho-motor disturbances, thinking disturbances.

• Common psychiatric emergencies acute psychosis, anorexia and bulimia complications, anxiety and panic attacks, conversion disorders, deliberate self-harm and suicide attempt, depressive illness, personality disorders, substance, drug and alcohol abuse

16. RENAL AND UROLOGICAL EMERGENCIES IN ADULTS AND CHILDREN

• Inflammatory and Infectious disorders epididymo-orchitis, glomerulonephritis, pyelonephritis, prostatitis, sexually transmitted diseases, urinary tract infections

• Metabolic disorders acute renal failure, nephrotic syndrome, nephrolithiasis, uraemia

• Traumatic and related problemsurinary retention, testicular torsion

• Tumours

• Vascular disorders: Ischaemia and Bleeding

• Other disorders comorbidities in dialysis and renal transplanted patients, complications of urological procedures and devices, haemolytic uraemic syndrome

17. TRAUMA IN ADULTS AND CHILDREN

• Origin of trauma: burns, blunt trauma, penetrating trauma

• Anatomical location of trauma: head and neck, maxillo-facial, thorax, abdomen, pelvis, spine, extremities

• Polytrauma patient

• Trauma in specific populations: children, elderly, pregnant women.

Common Presenting Symptoms

This section of the Curriculum lists the more common presenting symptoms of patients in the emergency setting. The differential diagnoses are listed according to the systems involved and then in alphabetical order.

1. Acute Abdominal Pain

 Gastrointestinal causes

Appendicitis, cholecystitis, cholangitis, acute pancreatitis, complications of hernias, diverticulitis, hepatitis, hiatus hernia, inflammatory bowel disease, intestinal obstruction, ischaemic colitis, mesenteric ischaemia, peptic ulcer, peritonitis, viscus perforation

• Cardiac/vascular causes

Acute myocardial infarction, aortic dissection, aortic aneurysm rupture

 Dermatological causes

Herpes zoster

 Endocrine and metabolic causes

Addison's disease, diabetic ketoacidosis, other metabolic acidosis, porphyria

 Gynaecological and Obstetric causes

Complications of pregnancy, ectopic pregnancy, pelvic inflammatory disease, rupture of ovarian cyst, ovarian torsion

 Haematological causes

Acute porphyria crisis, familial mediterranean fever, sickle cell crisis

• Musculo-skeletal causes

Referred pain from thoraco-lumbar spine

• Renal and Genitourinary causes

Pyelonephritis, renal stones

• Respiratory causes

Pneumonia, pleurisy

• Toxicology

Poisoning

 Trauma

Abdominal

2. Altered Behaviour and Agitation

• Psychiatric causes

Acute psychosis, depression

• Cardiac/Vascular causes

Hypertension, vasculitis

• Endocrine and metabolic causes

Hypoglycaemia, hyperglycaemia, electrolyte imbalance, hyperthermia, hypoxaemia

• Neurological causes

Cerebral space-occupying lesions, dementia, hydrocephalus, intracranial hypertension, CNS infections

• Toxicology

Alcohol and drug abuse, poisoning

3. Altered Level of Consciousness in Adults and Children

• Neurological causes

Cerebral tumour, epilepsy and status epilepticus, meningitis, encephalitis, stroke, subarachnoid haemorrhage, subdural and extradural haematomata, traumatic brain injury

• Cardiovascular causes

Hypoperfusion states, shock

• Endocrine and metabolic causes

Electrolyte imbalances, hepatic coma, hypercapnia, hypothermia, hypoxia, hypoglycaemia/ hyperglycaemia, uraemia

• Gynaecological and Obstetric causes

Eclampsia

• Infectious causes

Septic shock

• Psychiatric causes

Conversion syndrome

• Respiratory causes

Respiratory failure

• Toxicology

Alcohol intoxication, carbon-monoxide poisoning, narcotic and sedative poisoning, other substances

4. Back Pain

• Musculo-Skeletal causes

Fractures, intervertebral disc strain and degeneration, strain of muscles, ligaments and tendons, spinal stenosis, arthritides, arthrosis

• Cardiovascular causes

Aortic aneurysm, aortic dissection

• Infectious causes

Osteomyelitis, discitis, pyelonephritis, prostatitis

• Endocrine and metabolic causes

Paget's disease

• Gastrointestinal causes

Pancreatitis, cholecystitis

• Dermatological causes

Herpes zoster

• Gynaecological causes

Endometriosis, pelvic inflammatory disease

• Haematological and Oncological causes

Abdominal or vertebral tumours

•Neurological cause

Subarachnoid haemorrhage

• Renal and Genitourinary causes

Renal abscess, renal calculi

• Trauma

5. Bleeding (Non Traumatic)

• Ear, Nose, Throat causes

Ear bleeding (otitis, trauma, tumours), epistaxis

• Gastrontestinal causes

Haematemesis and melaena (acute gastritis, gastro-duodenal ulcer, Mallory Weiss syndrome, oesophageal varices) rectal bleeding (acute diverticulitis, haemorrhoids, inflammatory bowel disease, tumours)

• Gynaecological and Obstetric causes

Menorrhagia/metrorrhagia (abortion, abruptio placentae, tumours)

• Renal and Genitourinary causes

Haematuria (pyelitis, tumours, urolithiasis)

• Respiratory causes

Haemoptysis (bronchiectasia, pneumonia, tumours, tuberculosis)

6. Cardiac Arrest

• Cardiac arrest treatable with defibrillation

Ventricular fibrillation, pulseless ventricular tachycardia

• Pulseless electric activity

Acidosis, hypoxia, hypothermia, hypo/hyperkalaemia, hypocalcaemia, hypo/ hyperglycaemia, hypovolaemia, tension pneumothorax, cardiac tamponade, myocardial infarction, pulmonary embolism, poisoning

• Asystole

7. Chest Pain

• Cardiac/vascular causes

Acute coronary syndrome, aortic dissection, arrhythmias, pericarditis, pulmonary embolism

• Respiratory causes

• Pneumonia, pneumomediastinum, pneumothorax (especially tension pneumothorax), pleurisy

• Gastrointestinal causes

Gastro-oesophageal reflux, oesophageal rupture, oesophageal spasm

• Musculo-Skeletal causes

Costosternal injury, costochondritis, intercostal muscle pain, pain referred from thoracic spine

• Psychiatric causes

Anxiety, panic attack

• Dermatological causes

Herpes zoster

8. Crying Baby

I - Infections: herpes stomatitis, meningitis, osteomyelitis, urinary tract infection T -Testicular torsion, trauma, teeth problems,

C - Cardiac: arrhythmias, congestive heart failure R -Reaction to milk, reaction to medications, reflux I - Immunisation and allergic reactions, insect bites

E - Eye: corneal abrasions, glaucoma, ocular foreign bodies

S - Some gastrointestinal causes: hernia, intussusception, volvulus

9. Diarrhea

• Infectious causes

AIDS, bacterial enteritis, viral, parasites, food-borne, toxins

• Toxicological causes

Drugs related, poisoning (including heavy metals, mushrooms, organophosphates, rat poison, and seafood)

• Endocrine and metabolic causes

Carcinoids, diabetic neuropathy

• Gastrointestinal causes

Diverticulitis, dumping syndrome, ischaemic colitis, inflammatory bowel disease, enteritis due to radiation or chemotherapy

• Haematological and Oncological causes

Toxicity due to cytostatic therapies

• Immunology

Food allergy

• Psychiatric disorders

Diarrhea "factitia"

10. Dyspnoea

• Respiratory Causes

Airway obstruction, broncho-alveolar obstruction, parenchymal diseases, pulmonary shunt, pleural effusion, atelectasis, pneumothorax

• Cardiac/vascular causes

Cardiac decompensation, cardiac tamponade, pulmonary embolism

• Ear, Nose, Throat causes

Epiglottitis, croup and pseudocroup

• Fluid & Electrolyte disorders

Hypovolaemia, shock, anaemia

• Gastrointestinal causes

Hiatus hernia

• Immunological causes

Vasculitis

• Metabolic causes

Metabolic acidosis, uraemia

• Neurological causes

Myasthenia gravis, Guillain Barrè syndrome, amyotrophic lateral sclerosis

• Psychiatric disorders

Conversion syndrome

• Toxicology

CO intoxication, cyanide intoxication

• Trauma

Flail chest, lung contusion, traumatic pneumothorax, haemothorax

11. Fever and Endogenous Increase in Body Temperature

• Systemic infectious causes

Sepsis and septic shock, parasitosis, flu-like syndrome

• Organ-specific infectious causes

Endocarditis, myocarditis, pharyngitis, tonsillitis, abscesses, otitis, cholecystitis and cholangitis, meningitis, encephalitis

• Non-infectious causes

Lyell syndrome, Stephen-Johnson syndrome, thyroid storm, pancreatitis, inflammatory bowel disease, pelvic inflammatory disease, toxic shock

• Haematological and Oncological causes

Leukaemia and lymphomas, solid tumours

• Immunological causes

Arteritis, arthritis, lupus, sarcoidosis

• Musculo-Skeletal causes

Osteomyelitis, fasciitis and cellulitis

• Neurological causes

Cerebral haemorrhage

• Psychiatric causes

Factitious fever

• Renal and Genitourinary causes Pyelonephritis, prostatitis

• Toxicology

12. Headache in Adults and Children

• Vascular causes

Migraine, cluster headache, tension headache, cerebral haemorrhage, hypertensive encephalopathy, ischaemic stroke

• Haematological and Oncological causes

Brain tumours

• Immunological causes

Temporal arteritis, vasculitis

• Infectious causes

Abscesses, dental infections, encephalitis, mastoiditis, meningitis, sinusitis

• Musculo-Skeletal causes

Cervical spine diseases, temporomandibular joint syndrome

• Neurological causes

Trigeminal neuralgia

• Ophthalmological causes

Optic neuritis, acute glaucoma

• Toxicology

Alcohol, analgesic abuse, calcium channel blockers, glutamate, nitrates, opioids and caffeine withdrawal

• Trauma

Head trauma

13. Jaundice

• Gastrointestinal causes

Cholangitis, hepatic failure, pancreatic head tumour, pancreatitis, obstructive cholestasis

• Cardiac/Vascular causes

Chronic cardiac decompensation

• Haematological and Oncological causes

Haemolytic anaemias, thrombotic thrombocytopenic purpura, haemolytic uraemic syndrome, disseminated intravascular coagulation

• Infectious causes

Malaria, leptospirosis

• Gynaecological causes

HELLP syndrome

• Toxicology

Drug induced haemolytic anaemias, snake venom

14. Pain in Arms

• Cardiac/Vascular causes

Aortic dissection, deep venous thromboembolism, ischaemic heart disease

• Musculo-skeletal causes

Periarthritis, cervical spine arthrosis

• Trauma

15. Pain in Legs

• Cardiac/Vascular causes

Acute ischaemia, arteritis, deep venous thrombosis, superficial thrombophlebitis

• Immunological causes

Polymyositis

• Infectious causes

Arthritis, cellulites, necrotising fasciitis, osteomyelitis

• Musculo-Skeletal causes

Sciatalgia

• Neurological causes

Sciatica

• Nervous system causes

Peripheral nerve compression

• Trauma

16. Palpitations

• Cardiac/Vascular causes

Brady-arrythmias (including sinus bradycardia and AV blocks), extrasystoles, tachyarrythmias (including atrial fibrillation, sinus tachycardia, supraventricular tachycardia,ventricular tachycardia)

• Endocrine and metabolic causes

Thyrotoxicosis

• Toxicology

Drugs

17. Seizures in Adults and Children

• Neurological causes

Generalised epilepsy, partial complex or focal epilepsy, status epilepticus

• Cardiac/Vascular causes

Hypertensive encephalopathy, syncope, dysrhythmias, migraines

• Endocrine and metabolic causes

Metabolic seizures

• Gynaecological causes

Eclampsia

• Infectious causes

Febrile seizures in children

• Psychiatric causes

Narcolepsy, pseudo-seizures

• Respiratory causes

Respiratory arrest

• Toxicology

Drugs/toxins

18. Shock in Adults and Children

• Anaphylactic

• Cardiogenic

• Hypovolaemic

• Obstructive

• Septic

• Neurogenic

• Cardiac/Vascular causes

• Cardiogenic shock, arrhythmias

• Endocrine and metabolic causes

Addison's crisis

• Fluid and Electrolyte disorders

Hypovolaemic shock

• Gastrontestinal causes

Vomiting, diarrhoea

• Gynaecological causes

Toxic shock

• Immunological causes

Anaphylactic shock

• Infectious causes

Septic shock

• Neurological causes

Neurogenic shock

• Trauma

Hypovolaemic shock, neurogenic shock.

19. Skin Manifestations in Adults and Children

• Dermatological causes

Eczema, psoriasis, skin tumours

• Immunological causes

Vasculitides, urticaria, Stevens-Johnson syndrome, Lyell syndrome

• Infectious causes

Viral exanthemata, meningococcaemia, herpes zoster/simplex, abscesses of the skin

• Psychiatric causes

Self-inflicted skin lesions or from abuse

• Toxicology

• Haematological and Oncological causes

Idiopathic thrombocytopenic purpura, thrombotic thrombocytopenic purpura

20. Syncope

• Cardiac/vascular causes

Aortic dissection, cardiac arrhythmias (including brady-tachy syndrome, Brugada syndrome, drug overdose, long QT syndrome, sick sinus syndrome, torsade depointes,ventricular tachycardia), other causes of hypoperfusion (including ischaemia, valvular, haemorrhage, obstruction: e.g. aortic stenosis, pulmonary embolism, tamponade), orthostatic hypotension

• Endocrine and metabolic causes

Addison's disease

• Fluid and Electrolyte disorders

Hypovolaemia

• Gastrointestinal causes

Vomiting, diarrhoea

• Neurological causes

Autonomic nervous system disorder, epilepsy, vasovagal reflex,

• Toxicology

Alcoholic or drug consumption

21. Urinary Symptoms (Dysuria, Oligo/Anuria, Polyuria)

• Renal and Genitourinary causes

Acute renal failure, acute urinary retention, cystitis and pyelonephritis, prostatitis

• Cardiac/Vascular causes

Cardiac decompensation

• Endocrine and metabolic causes

Diabetes mellitus, diabetes insipidus

• Fluid and Electrolyte disorders

Hypovolaemia

22. Vertigo and Dizziness

• Ear and Labyrinth causes

Benign postural vertigo, Meniere's disease, otitis, vestibular neuritis, viral labyrinthitis

• Cardiac/Vascular causes

Arrhythmias, hypotension

• Endocrine and metabolic causes

Hypoglycaemia

• Haematological and Oncological causes

Anaemias

• Nervous system causes

Acoustic neuroma, bulbar or cerebellar lesions, multiple sclerosis, temporal epilepsy

• Psychiatric causes

Anxiety

• Respiratory causes

Hypoxia

• Toxicology

Alcohol abuse, drugs and substances

23. Vomiting

• Gastrointestinal causes

Appendicitis, cholecystitis, gastroparesis, gastric obstruction and retention, gastroenteritis, hepatitis, pancreatitis, pyloric stenosis, small bowel obstructions

• Cardiac/Vascular causes

Myocardial ischaemia

• Ear, Nose, Throat causes

Vestibular disorders

• Endocrine and metabolic causes

Diabetic ketoacidosis, hypercalcaemia

• Fluid and Electrolyte disorders

Hypovolaemia

• Gynaecological and Obstetric causes

Pregnancy

• Infectious causes

Sepsis, meningitis

• Neurological causes

Cerebral oedema or haemorrhage, hydrocephalus, intracranial space occupying lesions

• Ophthalmological causes

Acute glaucoma

• Psychiatric causes

Eating disorders

• Renal and Genitourinary causes

Renal calculi, uraemia

• Toxicology

SPECIFIC ASPECTS OF EMERGENCY MEDICINE

1. ABUSE AND ASSAULT IN ADULTS AND CHILDREN

• Abuse in the elderly and impaired

• Child abuse and neglect

• Intimate partner violence and abuse

• Sexual assault

• Patient safety in Emergency Medicine

• Violence management and prevention in the Emergency Department

2. ANALGESIA AND SEDATION IN ADULTS AND CHILDREN

• Pain transmission (anatomy, physiology, pharmacology)

• Pain assessment

• Pharmacology of sedative and pain relieving drugs

• Psychological and social aspects of pain in paediatric, adult and elderly patients

3. DISASTER MEDICINE

• Disaster preparedness

• Major incident planning/procedures/practice

• Disaster response

• Mass gatherings

• Specific medical topics (triage, bioterrorism, blast and crush injuries, chemical agents, radiation injuries)

• Debriefing and mitigation

4. ENVIRONMENTAL ACCIDENTS IN ADULT AND CHILDREN

• Electricity (electrical and lightening injuries)

• Flora and Fauna (injuries from exposure, bites and stings)

• High-altitude (medical problems)

• NBCR (nuclear, biological, chemical and radiological:, decontamination, specific aspects)

• Temperature (heat and cold related emergencies)

• Travel medicine

• Water (near-drowning, dysbarism and complications of diving, marine fauna)

5. FORENSIC ISSUES

• Basics of relevant legislation in the country of practice

• Recognise and preserve evidence

• Provide appropriate medical documentation (including forensic and clinical photography, collection of biological samples, ballistics)

• Appropriate reporting and referrals (e.g. child abuse or neglect, gunshot and other forms of penetrating wounds, elder abuse, sexual assault allegations)

• Medico-legal documentation

6. INJURY PREVENTION AND HEALTH PROMOTION

• Collection and interpretation of data related to prevention and health promotion

• Epidemiology of Accidents and Emergencies

• Formulation of recommendations

7. PATIENT MANAGEMENT ISSUES IN EMERGENCY MEDICINE

• Emergency Department organization (administration, structure, staffing, resources)

• Management of specific populations: Children in special circumstances including child protection Elderly patients Homeless patients Mentally incompetent adults Psychiatric patients

8. PROBLEMS IN THE ELDERLY

• Atypical presentations (e.g. abdominal pain, infections, myocardial infarction)

• Delirium

• Dementia

• Falls (causes & investigations)

• Immobility

• Multiple pathology and multiple therapies

• Self-dependency

• Trauma & co-morbidity

9. TOXICOLOGY IN ADULTS AND CHILDREN

• General principles of toxicology and management of poisoned patients

• Principles of drug interactions

• Specific aspects of poisoning

• drugs (including paracetamol, amphetamine, anticholinergics, anticonvulsants, antidepressants, antihypertensives, benzodiazepines, digitalis, monoamine oxidase inhibitors,neuroleptics) industrial, chemicals plants & mushrooms alcohol abuse and alcohols poisoning drugs of abuse

• Local poisonings such as OPC, aluminium phosphide, yellow phosphorous, heavy metal poisoning, plant poisonings, paraquat poisoning, cyber methrine poisoning, corrosives petroleum products, methanol and ethanol, dyes and nitrobenzene.

• Organization and information (e.g. poison centres, databases)

10. PRE-HOSPITAL CARE

• Emergency Medical Services organisation (administration, structure, staffing, resources)

• Medical transport (including neonates and children, air transport)

• Paramedic training and function

• Safety at the scene

• Collaboration with other emergency services (e.g. police, fire department)

11. PSYCHO-SOCIAL PROBLEMS

• Social wellbeing of specific populations

• Patients with social issues

• Frequent visitors

• Social care following discharge

B. CORE CLINICAL PROCEDURES AND SKILLS

1. CPR SKILLS

• Cardio-pulmonary resuscitation procedures in a timely and effective manner according to the current ILCOR guidelines for adults and children

• Advanced CPR skills (e.g. therapeutic hypothermia, open chest CPR)

2. AIRWAY MANAGEMENT SKILLS

• Open and maintain the airway in the emergency setting (insertion of oropharyngeal or nasopharyngeal airway)

• Endotracheal intubation

• Alternative airway techniques in the emergency setting (e.g. laryngeal mask insertion, surgical airway)

• Difficult airway management algorithm

• Use of rapid sequence intubation in the emergency setting

3. ANALGESIA AND SEDATION SKILLS

• Assessment of the level of pain and sedation

• Monitor vital signs and potential side effects during pain management

• Provide procedural sedation and analgesia including conscious sedation (including

• testing of life support equipment)

• Use of appropriate local, topical and regional anaesthesia techniques

4. BREATHING AND VENTILATION MANAGEMENT SKILLS

• Assessment of breathing and ventilation

• Oxygen therapy

• Interpretation of blood gas analysis, pulse oximetry and capnography

• Bag-mask-valve ventilation

• Thoracocentesis

• Chest tube insertion, connection to under-water drainage and assessment of

• functioning

• Non-invasive ventilation techniques

• Invasive ventilation techniques

5. CIRCULATORY SUPPORT AND CARDIAC SKILLS AND PROCEDURES

• Administration of fluids including blood and substitutes

• Monitoring of ECG and the circulation

• Defibrillation and pacing (e.g. cardioversion, transcutaneous pacing)

• Emergency pericardiocentesis

• Vascular access (peripheral venous, arterial, and central venous catheterisation, intraosseous access)

6. DIAGNOSTIC PROCEDURES AND SKILLS

• Interpretation of ECG

• Appropriate request and interpretation of laboratory investigations (blood chemistry, blood gases, respiratory function testing and biological markers)

• Appropriate request and interpretation of imaging (e.g. x-rays, ultrasound, CT/MRI)

• Focused Assessment of Sonography in Trauma (FAST).

• Emergency Ultrasound and Echocardiology

• Gastrointestinal Procedures: Shangstaken tube insertion, endoscopic banding, scelerotherapy in UGI bleed

7. ENT SKILLS AND PROCEDURES

• Anterior rhinoscopy

• Insertion of nasal pack

• Inspection of oropharynx and larynx

• Otoscopy

• Removal of foreign body if airway is compromised

• Insertion and replacement of tracheostomy tube

8. GASTROINTESTINAL PROCEDURES

• Insertion of nasogastric tube

• Gastric lavage

• Peritoneal lavage

• Abdominal hernia reduction

• Abdominal paracentesis

• Measurement of abdominal pressure

• Proctoscopy

9. GENITOURINARY PROCEDURES

• Insertion of indwelling urethral catheter

• Suprapubic cystostomy

• Testicular torsion reduction

• Evaluation of patency of urethral catheter

10. HYGIENE SKILLS AND PROCEDURES

• Decontamination of patient and the environment

• Patient isolation and staff protection

11. MUSCULOSKELETAL TECHNIQUES

• Aseptic joint aspiration

• Fracture immobilisation

• Reduction of joint dislocation

• Log roll and spine immobilisation

• Splinting (plasters, braces, slings, tapes and other bandages)

• Management of compartment syndrome

• Fasciotomy, escharotomy

12. NEUROLOGICAL SKILLS AND PROCEDURES

• Evaluation of consciousness including the Glascow Coma Scale

• Fundoscopy

• Lumbar puncture

• Interpretation of neuro-imaging

13. OBSTETRIC AND GYNAECOLOGICAL SKILLS AND PROCEDURES

• Emergency delivery

• Vaginal examination using speculum

• Assessment of the sexual assault victim

14. OPHTHALMIC SKILLS AND PROCEDURES

• Removal of foreign body from the eye

• Slit lamp use

• Lateral canthotomy

15. TEMPERATURE CONTROL PROCEDURES

• Measuring and monitoring of body temperature

• Cooling techniques (evaporative cooling, ice water or slush immersion)

• Internal cooling methods

• Warming techniques

• Monitoring heat stroke patients

• Treatment and prevention of hyper- and hypothermia

16. TRANSPORTATION OF THE CRITICALLY ILL PATIENT

• Telecommunication and telemedicine procedures

• Preparation of the EMS vehicle

• Specific aspects of monitoring and treatment during transportation

17. WOUND MANAGEMENT

• Abscess incision and drainage

• Aseptic techniques

• Treatment of lacerations and soft tissue injuries

• Wound irrigation and wound closure

Competencies to be attained by the end of 3 years

By the end of their first year, emergency medicine residents will:

1. Demonstrate the ability to provide appropriate care to patients with non-emergent problems:

Obtain an accurate and complete clinical and psychosocial history and perform a comprehensive physical examination

• Develop appropriate differential diagnoses

• Know the available investigative and therapeutic options

• After review, implement an appropriate investigative and therapeutic plan

• Develop and, after review, implement an appropriate written and verbal discharge plan

• Demonstrate an awareness of the available information systems to support patient care and discharge planning

• Demonstrate competency (including an understanding of the indications, contraindications, and techniques) in the core procedures used on non- emergent patients (eg, laceration repair, reduction in or immobilization of extremity

• injury, pelvic examination, slit-lamp examination)

• Demonstrate an understanding of the concepts of disease prevention as it applies to emergency medicine

• Properly document all historical, physical examination, and diagnostic test findings

2. Demonstrate a level-appropriate knowledge of the biochemical, clinical, epidemiologic, and social-behavioural basis of diseases seen in the emergency department:

• Demonstrate a basic understanding of the principles of evidence-based medicine

• Demonstrate mastery of minor acute and nonemergent conditions

• Demonstrate mastery of the principles of ACLS and ATLS

• PALS and NALS (paediatric advanced life support and neonate advanced life support)

• Demonstrate a level-appropriate understanding of the core curriculum

3. Demonstrate the ability to appraise and assimilate scientific evidence and analyze and improve their own practice:

• Demonstrate the ability to critically assess their competency in managing minor acute and on emergent cases

• Demonstrate the ability to apply published studies to their own practice

• Demonstrate the ability to use available information technology appropriate to the care of their patients

4. Demonstrate effective interpersonal and communication skills with:

• Patients and their families

• Other physicians

• Other health care providers

5. Demonstrate the professionalism required of a physician:

• Accept responsibility for continuity of patient care

• Demonstrate respect for patients' privacy and autonomy

• Demonstrate sensitivity and responsiveness to patients' culture, age, gender, and disabilities

• Demonstrate a commitment to sound ethical principles regarding the care of patients

• Demonstrate respect for the dignity of patients and colleagues as persons

6. Demonstrate a basic understanding of the role of the emergency department in the larger context of health care delivery:

• Demonstrate an understanding of the principles of a cost-benefit analysis

• Know the relative costs of the various tests and treatment contemplated

• Serve as an advocate for the patient in their dealing with the complexities of the health care system, specifically with regard to appropriate referral and followup

By the end of their second year, residents will, in addition to the objectives achieved during the first year:

1. Demonstrate the ability to provide appropriate care to patients with emergent and life threatening conditions:

• Obtain an appropriately focused history and perform an appropriately focused physical examination

• Develop comprehensive differential diagnoses

• Develop an investigative and therapeutic plan

• Develop and, after review, implement an appropriate written and verbal discharge plan

• Demonstrate competency (including an understanding of the indications, contraindications, and techniques) in the core procedures used on patients with emergent and life-threatening conditions (eg, endotracheal intubation, tube thoracostomy, defibrillation/cardioversion, etc.)

2. Demonstrate a level-appropriate knowledge of the biochemical, clinical, epidemiologic, and social-behavioural basis of diseases seen in the emergenc

department:

• Apply the principles of evidence-based medicine

• Demonstrate mastery of the emergent and life-threatening conditions that present to the emergency department

• Demonstrate a level-appropriate understanding of the core

3. Demonstrate the ability to appraise and assimilate scientific evidence and analyze and improve their own practice:

• Demonstrate the ability to critically assess their competency in managing the emergent and life-threatening conditions that present to the emergency department

• Use published studies to improve their own practice

• Use available information technology appropriate to the care of their patients

4. Demonstrate a level-appropriate understanding of the role of the emergency department in the larger context of health care delivery:

• Demonstrate the ability to divide his or her time and energies appropriately to provide optimal care for several patients concurrently

• Develop plans for evaluation and treatment that, without compromising patient care, acknowledge the patient's particular health care system

By the end of their third year, residents will, in addition to the objectives achieved during the first 2 years:

1. Demonstrate the ability to provide appropriate care to patients

• Listen to a history and physical examination presentation from a junior resident and provide appropriate feedback and guidance

• Perform an appropriately focused history and physical examination, taking into consideration the previous evaluation of the junior resident

• Implement an appropriate investigative and therapeutic plan

• Implement an appropriate written and verbal discharge plan

• Demonstrate understanding of the indications, contraindications, and techniques in uncommonly performed but lifesaving procedures (eg, cricothyroidotomy, burr craniotomy) and mastery of all other core procedures

• Demonstrate an understanding of documentation as it applies to billing and reimbursement requirements

2. Demonstrate a level-appropriate knowledge of the biochemical, clinical, epidemiologic, and social-behavioural basis of diseases seen in the emergency

department:

• Demonstrate mastery of all conditions that commonly present to the emergency department

• Teach courses such as ACLS as a certified instructor

• Demonstrate an understanding of the core curriculum

3. Facilitate the learning of others

• Teach and appropriately supervise medical students and junior residents

4. Demonstrate an understanding of the role of the emergency department in the larger context of health care delivery

• Triage patients and direct the attention of junior-level residents so as to provide optimal care for all patients in the emergency department. Plan and participate in a mass-casualty disaster drill.

Career Options

After completing a DNB in Emergency Medicine, candidates will get employment opportunities in Government as well as in the Private sector.

In the Government sector, candidates have various options to choose from, including Registrar, Senior Resident, Demonstrator, Tutor, etc.

While in the Private sector the options include Resident Doctor, Consultant, Visiting Consultant (Emergency Medicine), Junior Consultant, Senior Consultant (Emergency Medicine), Consultant Emergency Medicine Specialist, etc.

Courses After DNB in Emergency Medicine Course

DNB in Emergency Medicine is a specialization course that can be pursued after finishing MBBS. After pursuing a specialization in DNB (Emergency Medicine), a candidate could also pursue super specialization courses recognized by NMC, where DNB (Emergency Medicine) is a feeder qualification.

DM Critical care medicine is the course that requires DNB (Emergency Medicine) as a feeder qualification

Frequently Asked Questions (FAQs) – DNB in Emergency Medicine Course

Question: What is a DNB in Emergency Medicine?

Answer: DNB Emergency Medicine or Diplomate of National Board in Emergency Medicine also known as DNB in Emergency Medicine is a Postgraduate level course for doctors in India that is done by them after completion of their MBBS.

Question: Is DNB in Emergency Medicine equivalent to MD in Emergency Medicine?

Answer: DNB in Emergency Medicine is equivalent to MD in Emergency Medicine, the list of recognized qualifications awarded by NBE in various broad and super specialties as approved by the Government of India are included in the first schedule of the Indian Medical Council Act, 1956.

Question: What is the duration of a DNB in Emergency Medicine?

Answer: DNB in Emergency Medicine is a postgraduate programme of three years.

Question: What is the eligibility of a DNB in Emergency Medicine?

Answer: Candidates must be in possession of an undergraduate MBBS degree from any college/university recognized by the Medical Council of India (now NMC).

Question: What is the scope of a DNB in Emergency Medicine?

Answer: DNB in Emergency Medicine offers candidates various employment opportunities and career prospects.

Question: What is the average salary for a DNB in Emergency Medicine postgraduate candidate?

Answer: The DNB in Emergency Medicine candidate's average salary is between Rs. 5,00,000 - Rs. 25,00,000 per year depending on the experience.

Question: Are DNB Emergency Medicine and MD Emergency Medicine equivalent for pursuing teaching jobs?

Answer: The Diplomate of National Board in broad-speciality qualifications and super speciality qualifications when granted in a medical institution with attached hospital or in a hospital with the strength of five hundred or more beds, by the National Board of Examinations, shall be equivalent in all respects to the corresponding postgraduate qualification and the super-speciality qualification granted under the Act, but in all other cases, senior residency in a medical college for an additional period of one year shall be required for such qualification to be equivalent for the purposes of teaching also.