CRACKCast & Physicians as Humans on CanadiEM

Latest Episodes:

CRACKCast E124 - Acid Base Disorderw Nov 06, 2017

Show notes

This episode of CRACKCast covers Rosen's Chapter 124, Acid Base Disorders. This chapter covers a simple approach to acid base disorders and ABG interpretation, including the differential diagnosis for the identified disorders & treatment options.

CRACKCAST E123 - Selected Oncologic Emergencies Nov 02, 2017

Show notes

This 123rd episode of CRACKCast covers Rosen's 9th edition, Chapter 115, Selected Oncologic Emergencies. With an ever aging population, cancer incidence continues to rise. Therapies continue to prolong life often with high risks of side effects, and emergency physicians need to be equipped to treat complications of this treatment and importantly cancer morbidity itself.

CRACKCast E122 – Disorders of Hemostasis Oct 30, 2017

Show notes

Episode Overview:

List 10 causes of Thrombocytopenia
List 6 causes of Thrombocytosis
Describe the presentation and treatment of HIT, ITP and TTP
Describe what causes an abnormal PT? What causes an abnormal PTT?
Describe the deficiency and management of Hemophilia A, Hemophilia B, and vWD
Describe the management of a major and minor bleed in hemophilia A
List 4 items in cryoprecipitate
List adjunctive therapies in DIC

Wisecracks:

How do you differentiate coagulation disorders from platelet disorders?

What is thrombocytopathy?

What do INR and PTT test?

What is DIC?

CRACKCast E121 - Anemia, Polycythemia and WBC disorders Oct 26, 2017

Show notes

This 121st episode of CRACKCast covers Rosen's 9th edition, Chapter 112 and 113, Anemia, Polycythemia, and White Blood Cell Disorders. These blood disorders are numerous and this episode attempts to break their classification and approach down in a systematic manner.

CRACKCast E120 – Dermatologic Presentations Oct 23, 2017

Show notes

This episode covers Chapter 110 of Rosen's Emergency Medicine (9th Ed.), Dermatologic Presentations.

Episode Overview

List five broad categories of rashes
Describe the primary skin lesion types

a. Bonus: What are the secondary skin lesions (show notes only)

List systemic diseases that present with cutaneous signs for each of the following locations:
- Generalized rash
- Head and neck
- Hands
- Legs
- Palms and Soles
Describe the various presentations of tinea and their treatment
List 8 RFs for candida infections
Describe the stepwise management of diaper dermatitis
Describe the distribution of Pityriasis rosea
Describe the management of atopic dermatitis
Describe the management of impetigo & folliculitis
List 6 RFs of C.A.-MRSA and 4 oral Abx treatments
Describe the presentation and management of Staph Scalded Skin andTSS

List 10 causes of EM / SJS / TEN
Describe presentation of EM + SJS/TEN. Differentiate between TEN and SJS
List 6 broad categorical causes of urticaria
Describe the typical features for each of the following:
- Measles
- Rubella
- Roseola Infantum
- Erythema Infectiosum
- Scarlet Fever
Describe treatment of poison ivy
Describe presentation and treatment of Pediculosis + Scabies
List 10 causes of Erythema Nodosum
List a 6 ddx for vesicular lesions
List 4 lesions with a positive Nikolsky's sign
List 4 complications of HSV infection
List 5 complications of Varicella + describe the management of an exposure during pregnancy
List 5 complications of Zoster + differentiate between Ophthalmicus and Oticus
What is the treatment of herpes zoster?

Wisecracks

List 5 causes of desquamating lesions
List 5 palm and sole rashes
List 10 maculopapular rashes
List 1 low, medium and high potency topical steroid
Identify the following rashes: erythema migrans, erythema marginatum, erythema multiforme, erythema nodosum, meningococcemia

CRACKCast E119 - Allergy & Anaphylaxis Oct 19, 2017

Show notes

Episode 119 of CRACKCast covers chapter 109 of Rosen's Emergency Medicine 9th edition.

Its hard to go a couple hours in the ED without seeing allergy or that life-threatening anaphylaxis, so you need to be tres familiar with this entity!!!

CRACKCast E118 – Vasculitis Oct 16, 2017

Show notes

This episode covers Ch 108 of Rosens (9th Ed.), SLE and the Vasculitides. These conditions can lead to some pretty varied ED presentations, so we need to know when to suspect lupus or vasculitis, and how to manage it.

Episode Overview:

What the pathophysiology of lupus
List diagnostic criteria for SLE
List drugs that induce lupus
Describe the clinical manifestations w/ Classic triad & Symptoms and signs by system in lupus
List 3 drug regimens to treat SLE
How does neonatal lupus present?
What is antiphospholipid syndrome? What is the unusual laboratory feature seen with this condition?
What is the pathophysiology of vasculitis?
1. Large vessel vasculitis
2. Medium vessel vasculitis
3. Small vessel vasculitis
4. Hypersensitivity vasculitis
5. Subcutaneous vasculitis
Give examples of:
Compare the findings for vasculitis
List 5 criteria for dx of temporal arteritis + 2 associated features
Describe the features of Behcet's Disease
List 10 causes of Erythema Nodosum
Compare Buerger's, Serum sickness and Hypersensitivity Vasculitis
List the diagnosis Criteria for HSP

WiseCracks

What is the differential for SLE patient and Chest pain?
Name and identify 2 pathognomonic clinical features for lupus
When should Rheum be involved in the ED with a SLE patient?
Spot Diagnosis: A 36 year old female stock trader present with what appears to be necrosis of the nose and ears…
Spot diagnosis: 13 year old presents with abdo pain, polyarticular arthritis, foaming urine and the following rash…
Rounds Pimper: List 10 side effects of chronic steroid use

CRACKCast E117 - Tendinopathy and Bursitis Oct 12, 2017

Show notes

This episode covers Chapter 107 of Rosen's Emergency Medicine (9th Ed.), Tendinopathy and Bursitis.

Episode Overview:

Mechanical overload and repetitive micro-trauma are the key underlying mechanisms of tendinopathy
Most patients present with progressively worsening pain after work or sports-related activities that are repetitive in nature
Tendinopathy can also be associated with non-mechanical causes such as:
- Systemic manifestations of disease
- Use of fluoroquinolones
- Infectious etiologies
Most patients with tendinopathies can be treated with conservative measures, such as:
- Protection
- Relative rest
- Application of ice
- Elevation
- Medications
Overuse syndromes take at least 6-12 weeks to heal
- Patients need optimal loading and referral for physiotherapy or sports medicine therapy
Urgent imaging of tendinopathy in the ED is rarely useful
- Clinicians may elect to use bedside ultrasound to evaluate for other diagnoses
Operative treatment of tendinopathy is required in select cases
Consider infectious bursitis in all cases of acute bursitis
Aspirate bursa and evaluate the fluid
- Infectious bursitis is typically caused by Staph aureus
Non-septic bursitis differential diagnosis:
- Traumatic
- Rheumatologic
- Idiopathic
Management of septic bursitis:
- Antibiotics
- NSAID's
- Rest
- Application of ice
- Elevation
- Prompt referral for follow-up +/- admission

Core questions:

What is the differential diagnosis for tendinopathy?
What are common sites for tendinitis?
List 6 differential diagnoses for atraumatic non-septic bursitis
List common causes for infected bursitis

Wisecracks:

Differentiate septic and inflammatory bursitis based on clinical exam and fluid aspirate results
List 4 physical exam findings of impingement syndrome

CRACKCast E116 - Arthritis Oct 09, 2017

Show notes

This episode of CRACKCast covers Rosen's Ch 106, Arthritis. When a patient rolls in with an active joint, we need to know how to rule out those can't-miss diagnoses.

CRACKCast E115 - Suicide Oct 05, 2017

Show notes

This episode covers Chapter 105 of Rosen's Emergency Medicine (9th Ed.), Suicide.

Episode Overview:

Suicide is a common but preventable cause of death
Suicide is usually triggered by treatable or reversible short-term crises
Most attempted suicide survivors are grateful to be alive
Suicide risk changes over time; estimations of imminent risk are NOT evidence-based
Routine screening labs provide little value to most ED patients with self-harm behaviours
Evaluations should be targeted to signs or symptoms of disease on presentation
Any ED visit for suicidal thoughts or behaviours represents a crisis and a teachable moment
- With your approach, it is important to be supportive, empathetic, and patient-centred
- Have a collaborative plan that integrates the input from collateral sources
When caring for suicidal patients, use precautions:
- Sitters
- Physical/chemical restraints
- Involuntary admission forms
Brief and focused risk assessment of patients in the ED can identify persons in need of further comprehensive evaluation and consultation with a mental health specialist
Those patients who are deemed to be at low-risk of suicide may be discharged home to a safe and supportive environment, assuming they have no access to toxic medications or guns
- They should receive education and safety planning in the ED
- They should have early mental follow-up appointments

Core questions:

Name 10 risk factors for suicide
Name an additional 5 risk factors for adolescent suicide
Describe the SAD PERSONS Scale
Describe 4 potential targeted investigations for patients presenting to the ED with suicide
Name 3 protective factors for against suicide

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