EM Clerkship

Latest Episodes:

Flash Pulmonary Edema (aka SCAPE) Feb 19, 2023

Show notes

* “Sympathetic Crashing Acute Pulmonary Edema”
* Pathophysiology – Rapid onset of pulmonary edema caused by sudden hypertension
* Triggers- Missed Medication, Cocaine, Stress/Anxiety
* Increase in BP = Increase in afterload
* Increased afterload causes acute pulmonary edema (in patients with CHF)
* The worsening pulmonary edema causes shortness of breath which worsens blood pressure and further increases afterload
* Presentation- Sudden, severe respiratory distress AND hypertension
* Different than CHF exacerbation
* Not necessarily caused by hypervolemia
* More rapid in onset
* Typically crackles/rales on exam or diffuse B-Lines on POCUS
* Treatment
* BiPAP/CPAP
* High Dose Nitroglycerin
* Diuretics IF Hypervolemic

Opioid Use Disorder – What You Do Matters! Feb 01, 2023

Show notes

In this long-form episode we will discuss opioid use disorder, the leading cause of death in young adults in the United States. What you do matters!
* Why you should care about OUD
* What is OUD
* Buprenorphine Works
References
* National Safety Counsel Injury Facts
* DebunkingDenial – Purdue Pharma and America’s Opioid Epidemic
* Addiction Neuroscience 101 – Youtube
* Cochran Review – Buprenorphine for OUD

The Rank List Jan 20, 2023

Show notes

This episode will answer 3 big pre-Match Day questions:
1. How do I go about making my rank list?
2. What about post-interview communication both from and to programs?
3. How does this whole thing called the Match actually work?
Resources:
EM Match Advice: Post Interview Communications
https://www.emra.org/books/msadvisingguide/preparing-and-submitting-your-rank-list/

Deep Dive MW R6 Jan 16, 2023

Show notes

Aortic Dissection – when there is a tear in the intima layer of the aorta and the blood dissects the intima away from the media creating a false lumen in the aorta
* Historical Features
* Be VERY suspicious with ABRUPT onset of chest/back pain that reaches MAXIMAL SEVERITY immediately after onset of pain.
* Chest pain or Back pain with a neurologic deficit
* Pain “above and below the diaphragm”
* Diagnosis
* CT Angiography of chest abdomen and pelvis is gold standard
* Can see widened mediastinum on CXR or dissection flap on POCUS
* Treatment
* Pain control first
* Heart rate control second (goal
* Blood pressure control third (goal 100-120SBP, use nicardipine/clevidipine)
* CT Surgery consult (should go directly to OR with a Type A dissection)
* Arterial Line placement
Further Reading:
Core EM – Aortic Dissection
LITFL – Aortic Dissection

Round 6 (MW) – Weakness Jan 02, 2023

Show notes

You are working at Clerkship General when the base command phone rings –
“Hey doc just wanted to give you a heads up on this stroke alert we’re bringing you – we have a 70yo M with sudden onset left arm numbness and weakness, last known well 2 hours ago, we’ll be there in about 5 minutes”
Initial Vital Signs:
HR 120
BP 180/90
RR 22
O2 97%
Temp 97.7F
Critical Actions:
1. Check a blood glucose
2. Diagnose Aortic Dissection
3. Give Esmolol first, titrate to HR
4. Give Nicardipine/Clevidipine second, titrate for SBP 100-120
5. Consult cardiothoracic surgery for type A dissection
Further Reading:
EMCrit – Aortic Dissection

New Years Resolutions Dec 16, 2022

Show notes

Not your typical wellness episode – by Zack

Round 5 (MW) – Leg Pain Dec 02, 2022

Show notes

You are working at Clerkship General Hospital when EMS calls in a female with opioid overdose, but she won’t stop complaining of leg pain…
Initial Vitals:
Temp: 98
BP: 120/80
HR: 89
RR: 20
O2 Sat: 100%
Critical Actions:
* Treat patient’s pain without NSAIDs (history of solitary kidney)
* Assess patient’s leg pain beyond the point of just fracture vs. no fracture
* Recognize the signs and symptoms of compartment syndrome
* Get orthopedic surgery to bedside emergently for fasciotomy
* Recognize and treat rhabdomyolysis

Deep Dive MW R4 Nov 15, 2022

Show notes

Diabetic Ketoacidosis – hyperglycemia, ketosis, and anion gap metabolic acidosis
* Don’t forget about euglycemic DKA (especially in setting of SGLT2 inhibitor) or mimics such as alcoholic ketoacidosis
* Treatment of the ketoacidosis * Insulin (usually a drip or bolus + drip) – only once K>3.5* Volume Resuscitation (NS initially, change to LR)* Bicarb drip (poor evidence, only as last resort for critical patients)* Treatment of electrolyte abnormalities* Correct sodium for hyperglycemia* Replete potassium if K
Further Reading:
EMCRIT – DKA

Round 4 (MW) – Shortness of Breath Nov 01, 2022

Show notes

You are working a shift at Clerkship General when the charge nurse comes and grabs you to see a 24yo male who appears to be in respiratory distress.
Critical Actions:
* Diagnose DKA* Replete potassium* Start insulin AFTER potassium repletion* EITHER place central line for faster K repletion OR initiate bipap to allow time for potassium repletion via existing peripheral line* Admit to ICU
Further Reading:
EMCrit – DKA

Interviews Part 2 – Acing your interview Oct 24, 2022

Show notes

Before interview day, do your research on programs and interviews and reflect on the way in which you want to portray yourself.
On interview day, have a cheat sheet with notes about your conversations, questions, and pro-cons. Remember to stay calm, take a pause if you need to, and above all be authentic to who you are.
After interview day, be sure to capture you gut impression and write down any follow-up questions or concerns remaining.
Here are some resources to use for interview day:
EMRA Residency Interview Guide
AliEM – Dos and Don’ts of residency interviewing
EMRA – Common Interview Questions
EMRA – Making the most out of interview day
ALiEM – EM Match Advice Podcast Episode

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