CRACKCast & Physicians as Humans on CanadiEM

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**CRACKCast & Physicians as Humans on CanadiEM**

CanadiEM aims to improve emergency care in Canada by building an online community of practice for healthcare practitioners and providing them with high quality, freely available educational resources. The CanadiEM Podcast brings you cutting edge clinical topics on the National Rounds Series and delves into the struggles that doctors face on the Physicians as Humans Series.

Latest Episodes:

CRACKCast E173 – Infectious Diarrheal Disease and Dehydration Apr 30, 2018

Show notes

Core Questions:

1) What are three pathophysiologic types of diarrhea? Give an example of a cause for each.

2) List 6 common causes of childhood infectious diarrhea in developed countries.

3) List 5 important differential diagnoses of diarrhea in children.

4) List 5 important differential diagnoses of vomiting in children.

5) When should you initiate a medical evaluation of children with acute diarrhea?

6) Describe the typical presentation of:

Rotavirus
Norovirus
Salmonella
Shigella
Yersinia
E. Coli
C. Difficile

7) List routine and high risk treatment recommendations for common bacteria causing acute infectious diarrhea in children:

Salmonella non-typhi
Salmonella typhi
Shigella
Campylobacter jejuni
Yersinia enterocolitica
C. Difficile
Vibrio cholerae
Vibrio parahaemolyticus
E. Coli

8) List the presenting features and treatments for three common protozoa causing infectious diarrhea in children.

9) Define and describe your diagnosis and management approach to dehydration that is:

Mild
Moderate
Severe
Associated with Hypo/Hypernatremia

Wisecracks:

1) Name 5 causes of bloody diarrhea.

2) Other than vomiting and diarrhea from infectious gastroenteritis, list 6 causes of volume depletion.

3) Name the components of the Gorelick scale.

4) What's the 4-2-1 rule?

CRACKCast E172 – Gastrointestinal Disorders Apr 26, 2018

Show notes

Core questions:

List 8 causes of neonatal jaundice and indicate whether they are conjugated or unconjugated

List indications for work-up of a jaundiced infant

What are RFs for hyperbilirubinemia? (8)

What is the differential diagnosis for vomiting in a child?

Describe the typical presentation of each of the following:

Hypertrophic pyloric stenosis

Malrotation with midgut volvulus

GERD

Intussusception

Hirschsprung's Disease

Meckel's Diverticulum

List Xray findings for each of the following:

Malrotation with midgut volvulus (2)

NEC (4)

Intussusception (5)

Hirschsprung's Disease (2)

Describe the conservative management of a patient with GERD.

What is the preferred diagnostic test for diagnosis for intussusception?

List causes of lead points in pts with intussusception.

Describe each of the following signs on physical exam:

Sandifer's syndrome

Red-currant Jelly Stools

Dance's Sign

Rovsing's sign

Psoas Sign

Obturator Sign

Describe the "Rule of 2" for Meckel's Diverticulum

What are 3 common locations of lodging in the esophagus

List 3 indications for FB removal from stomach. Describe the management of button battery FBs

What is HSP? How does it typically present?

List three complications of HSP.

Why is appendicitis different in very young children?

List 10 causes of pancreatitis in children

List 10 causes of biliary tract disease in children

List conditions associated with the development of gallstones in children.

Wisecracks.

What are the risk factors for necrotizing enterocolitis?

Describe the proposed pathophysiology of necrotizing enterocolitis?

List five pathologic causes of constipation in a child.

What is the most concerning complication of hirschsprung's disease? How does it occur?

What is gallbladder hydrops? What conditions is it associated with?

CRACKCast E171 – Pediatric Cardiac Disorders - PART B Apr 23, 2018

Show notes

This episode of CRACKCast reviews Rosen's Chapter 170, Pediatric Cardiac Disorders. This podcast covers the common infectious complications leading to pediatric cardiac issues. Additionally, we will review Kawasaki's Disease, Acute Rheumatic Fever, HOCM, and much more.

Episode Overview:

1. Describe procedures and conditions for which prophylaxis for bacterial endocarditis is recommended.

2. Describe 2 potential prophylaxis regimens.

3. What is the differential diagnosis of myocarditis? What is the most common cause of myocarditis in children?

4. What is the differential diagnosis of pericarditis in children? Describe any differences b/n adults and children.

5. What are the clinical diagnostic criteria for Kawasaki's disease?

6. If the clinical criteria are not met, but you are still suspicious, how else might Kawasaki's disease be diagnosed?

7. What are some unusual clinical presentations of Kawasaki's disease?

8. How is Kawasaki's disease managed? What is treatment directed towards preventing?

9. List the Jones Criteria for the diagnosis of Acute Rheumatic Fever.

10. Describe the management of Acute Rheumatic Fever.

11. List 10 causes of sudden death in young athletes.

12. What is a normal pediatric QT interval.

13. What are ECG findings of HCM?

Wisecracks:

1. What is the hyperoxia test? How is it clinically useful?

2. Describe common Xray findings in CHD: "boot-shaped heart", "egg-on-a-string", "snowman".

3. What is Eisenmenger's Syndrome?

4. Until what age is the thymus visible on CXR?

5. List 8 ductal dependent cardiac lesions in the neonate.

6. List features of pathologic heart murmur .

7. When does the ductus arteriosus close functionally? Physically?

CRACKCast E171 – Pediatric Cardiac Disorders - PART A Apr 19, 2018

Show notes

This episode of CRACKCast covers Rosen's Chapter 170, Pediatric Cardiac Disorders. This podcast covers cyanotic and acyanotic cardiac defects, the presentation and management of congestive heart failure in pediatric populations, and the management of common arrhythmias in children. A second podcast will release next week detailing other issues in pediatric cardiology.

Episode Overview:

1. What is the most common form of congenital heart disease?

2. List 6 Acyanotic and 8 Cyanotic types of CHD.

3. What are the ductal dependent heart lesions?

4. Describe the emergent management of the hypoxic infant with a suspected ductal dependent cardiac lesion.

5. List types of CHD which are most likely to present outside of the neonatal period.

6. What are the anatomic anomalies seen in Tetralogy of Fallot?

What is the pathophysiology of a Tet spell and how is it managed?
What is a ductal-dependent ToF?

7. Describe the management of CHF in the infant.

8. List 12 conditions associated with a high risk of developing dysrhythmias.

9. Compare SVT and ST.

10. Describe the management of SVT in the infant/child.

CRACKCast E170 – Pediatric Respiratory Emergencies: Disease of the Lungs Apr 16, 2018

Show notes

Core questions:

Name 8 non-infectious causes that may present as pneumonia

Describe the workup for a child with suspected pneumonia?

What are the typical causes of bacterial pneumonia and viral pneumonia in the following age groups:

1 month – 3 months

3 months – 5 years

≥ 5 years

What is the empiric treatment of bacterial pneumonia in these age groups for outpatients? For inpatients?

List 8 complications of pneumonia

List 6 criteria for admission with pneumonia

What are three clinical complications of cystic fibrosis?

What is the pathophysiology of CF?

How is suspected pneumonia in a patient with CF treated?

Wisecracks:

What is the cause of whooping cough?

What are the stages of whooping cough?

How is whooping cough managed?

How is the flu shot used in the pediatric population?

Describe common pneumonia syndromes:

Chlamydia trachomatis

Mycoplasma pneumonia

What is the most common bacterial infection in CF?

CRACKCast E169 – Pediatric Respiratory Emergencies: Lower Airway Obstruction Apr 12, 2018

Show notes

Core questions:

Excluding asthma, list 8 causes of wheeze

Outline the pathophysiology of asthma.

What are the features of mild, moderate and severe asthma?

Describe the PRAM score

List 8 medications for asthma treatment with doses

What is the typical ED management for a pts with an asthma exacerbation?

Describe adjunctive therapies that might be used in a patient with refractory symptoms.

How are PO corticosteroids used in the management of asthma?

When should children be started on inhaled corticosteroids?

Outline a plan for disposition of a pt presenting to the ED with an acute asthma exacerbation.

What are risk factors for sudden death in a patient with asthma?

List risk factors for bronchiolitis.

What are the typical pathogens of bronchiolitis?

What is the pathophysiology of bronchiolitis?

How is bronchiolitis managed?

Which children with bronchiolitis should be admitted to hospital?

List potential complications of RSV.

Wisecracks:

What's the natural history of infants/toddlers who wheeze?

What is a peak flow? What is the FEV1? What are the advantages to measuring peak flow? What are the disadvantages?

Risk factors for death in bronchiolitis

CRACKCast E168 – Pediatric Respiratory Emergencies: Upper Airway Obstruction and Infections Apr 09, 2018

Show notes

Core questions:

What is the pathophysiology of inspiratory and expiratory stridor?

Provide a differential diagnosis for stridor in children (based on location: supraglottic, glottic, subglottic) list at least three in each category.

What is the typical presentation of a retropharyngeal abscess?

Describe the management of a RPA. What are the typical pathogens?

What the typical pathogens in epiglottis? How are these patients managed?

Differentiate between croup and other conditions mimicking croup.

Contrast mild, moderate, and severe croup.

What is the management of croup?

Which children with croup require admission to hospital?

Management of upper airway FB: Describe the management of an airway obstruction (progresses from partial obstruction to full obstruction to unconscious) in a 6 month old. In a 6 year old?

Wisecracks:

Ddx of stridor (8) (review)

List 5 Xray findings of epiglottitis

Which infections are associated with croup?

How do you handle the CICV scenario?

CRACKCast E167 – Pediatric Fever Apr 05, 2018

Show notes

Core questions:

List 10 non-infectious causes of fever in children

List 3 bacterial pathogens responsible for infections in the following age groups

0-28 days

1-3 months

3-36 months

> 3 yr

List 5 tests to perform on CSF

Describe the empiric management of fever in the neonate (0-28 days)

Why is ceftriaxone not recommended for the neonate?

Describe one of

The Rochester criteria

The Philadelphia criteria

Define simple and complex febrile seizure. What are indications for LP?

What is the likelihood of

Recurrent febrile seizure after 1 st presentation

Risk of epilepsy after first febrile seizure?

List 6 causes of Fever and Petechiae

Describe the criteria for the diagnosis of Toxic Shock Syndrome

What sickle cell patients require prophylaxis and why? What Abx?

List the Duke criteria for infective endocarditis.

Wisecracks:

Provide a differential diagnosis for fever (review question)

Which patients are excluded from the Rochester Criteria?

What are the low-risk Rochester Criteria, and how are these children managed?

Which age groups should always have a urinalysis when presenting with fever without source?

Which children should have a CXR to r/o pneumonia in the setting of fever without source?

CRACKCast E166 – General Approach to the Pediatric Patient Apr 02, 2018

Show notes

Core questions:

1) List age specific vital signs (RR, HR): "1 odd yr - 60 count down aid"

2) What is the lower fifth percentile of systolic BP for the neonate, infant, and 1-10 yr old child?

2) Describe the 3 components of the Pediatric Assessment Triangle.

3) Describe the Canadian Pediatric Triage and Acuity Scale

4) List 5 historical indicators of child abuse

5) List 5 features suggestive of child abuse on physical examination and/or radiology?

Wisecracks:

What are developmental milestones (gross motor and otherwise) for 1-24 months?

What are other considerations in the management of pediatric patients: consent, pediatric-readiness, pediatric-friendly ERs?

CRACKCast E165 – Sedative Hypnotics Mar 29, 2018

Show notes

This episode of CRACKCast covers Rosen's 9th Edition, Ch. 159. In the podcast, we will look at the sedative hypnotic toxidrome and the various agents that bring patients to your ED.

Core questions:

Describe the components of the GABA receptor complex and their physiologic effect
Describe the sedative-hypnotic toxidrome, and list 8 drugs in the DDx
How do barbiturates work?
What are the clinical symptoms of barbiturate overdose?
How are they managed?
How do benzodiazepines work?
List risk factors for benzodiazepine withdrawal and its management
What are the indications for flumazenil? What are the contraindications?
How does chloral hydrate toxicity present?
What is the clinical presentation of GHB toxicity?
How is GHB withdrawal managed?

Wisecracks:

List 2 drugs used for 'date-rape' and describe their toxicity
What Benzos WILL NOT be detected on urine drug screen?

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