EM Clerkship

Latest Episodes:

Round 35 (Pediatric Trauma) Jul 01, 2022

Show notes

You are working at *rural* Clerkship General when you receive a radio call from EMS – 7yo male from a severe bus accident with a large scalp laceration, unable to control the hemorrhage.
Initial Vitals
* HR: 136* RR: 22* BP: 80/35* O2%: 100%* Temp: 98F
Critical Actions:
* Perform ATLS Algorithm* Control Hemorrhage* Transfuse pRBCs* Replete Factor VIII with correct dosing (100% replacement)* Diagnose supracondylar fracture on XR and splint appropriately
Further Reading:
emDOCs – Managing Hemophilia in the ED
CoreEM – Supracondylar fracture in the ED

Bradycardia (Deep Dive R34) Jun 15, 2022

Show notes

Asymptomatic Bradycardia – usually don’t treat
Symptomatic Stable Bradycardia – atropine, further workup
Symptomatic Unstable Bradycardia – SIMULTANEOUS treatment with medications and electricity
* Meds: Trial of atropine, then either epinephrine, dopeamine, or isoproterenol* Electricity: Transcutaneous Pace –> TVP
DDX of Bradycardia – BRADIE
Blocks (av blocks)
Reduced vital signs (hypoxemia, hypothermia, hypoglycemia)
Acs (acute coronary syndrome/ischemia)
Drugs (beta blocker, calcium channel blocker, digoxin, organophosphate)
Infection/Inc ICP (Lyme, myocarditis // cushings reflex)
Electrolyte/Endocrine (hyperkalemia, hypermagnesemia, hypocalcemia // myxedema coma)

ERAS 2 of 2 – How to fill out the CV section Jun 09, 2022

Show notes

What is most important to programs from ERAS? SLOEs, clinical grades on EM rotations and residency interviews.
How do you look good on interviews? Have a thorough ERAS application that gives interviewers lots to ask about!
On ERAS, there are four sections in the curriculum vitae portion:
* Education – honorary societies, medical school awards, other awards/accomplishments (e.g. college, volunteer, previous career awards)* Experiences –* Work (paid, unpaid clinical or teaching)* Volunteer (public service, leadership, clubs and organizations)* Research (labs, projects)* Licensure – only if previous medical career, legal history* Publications – papers, presentations, online publications
Don’t forget to add some personality to your application with the hobbies section!
Further Reading

ERAS 1 of 2 – The 8 parts of the application Jun 03, 2022

Show notes

ERAS Pt 1: The 8 Parts of the ApplicationThere are 8 parts to the application:
* Personal and Biographic Information – mostly self-explanatory* Curriculum Vitae (Resume) – keep an updated CV throughout medical school to makethis easy to fill out, be concise but specific* Personal Statement – start early* Letters of Recommendation – should ideally have two SLOEs from rotations in EMdepartments plus one extra letter* Test Scores – transfer reports from USMLE or COMLEX* MSPE or Dean’s Letter – submitted by your school* Medical School Transcript – submitted by your school* Photo – business professional headshot with neutral background
Further Reading:
CordEM – SLOE 1
CordEM – SLOE 2

Round 34 (Shortness of Breath / Bradycardia) Jun 01, 2022

Show notes

You are working at Clerkship General when you are called to see a 70 yo male who is presenting with shortness of breath.
Initial Vitals
* Temp 98.0* HR 36* RR 28* BP 80/35* O2 82%
Critical Actions
* Interpret ECG Correctly (3rd degree AV block)* Order a troponin* Perform and Describe transcutaneous pacing* Perform and Describe transvenous pacing* Treat NStemi (ASA, Heparin gtt, nitro if BP improved after pacing)
Further Reading
Complete Heart Block – EMDocs
Bradycardia – EMCrit

Ventilator Alarms (Deep Dive R33) May 15, 2022

Show notes

DOPES
D-Displacement – endotracheal tube dislodges from trachea, or falls into right mainstem bronchus
O-Obstruction – Mucous plugging, bronchospasm, patient biting tube
P –Pneumothorax – Look out for pneumothorax, it can be subtle
E – Equipment – Disconnected/unpowered equipment, ensure everything is powered on and connected appropriately
S – Stacking – common in asthma/COPD due to inadequate expiration resulting in air trapping between breaths
Further Reading
LITFL – Post-Intubation Hypoxia
CanadiEM – Approach to the Alarming Vent

Personal Statement Pt 2 – Brainstorming Ideas May 02, 2022

Show notes

Brainstorming ideas – how to make it personal
* What makes me unique?
2. What are some specific experiences I’ve had in my life that have either made me want to do EM or given me the skills that will prepare me well for training in EM?
3. If a family member or a friend were to describe me to a stranger, what would they talk about first?
Brainstorming ideas – how to make a statement
* What do I bring to the table?
2. What am I looking for in a training program?
3. Where do I see myself in 5-10 years?
Further Reading:
Personal Statement Library

Personal Statement Pt 1 – Dos and Donts May 02, 2022

Show notes

Welcome to EM Clerkship Maddie Watts!
The personal statement should be *personal* and should *make a statement*.
* Start early* Use solid organizational structure* Address the big three questions – who? what? why?* Check for grammar mistakes* Explain any red flags
Further Reading:
EMRA / CORD Advising Guide
NRMP Program Director Survey
ALiEM Match Advice Series

Round 33 (Respiratory Distress) May 01, 2022

Show notes

You are working at Clerkship General when you are called to the resuscitation bay for a 55yo M presenting in respiratory distress.
Initial Vitals
* Temp 99.9* HR 110* RR 22* BP 122/82* O2 82% on BiPAP 10/5 100%FiO2
Critical Actions
* Correctly interpret CXR #1 (multifocal PNA)* Correctly interpret CXR #2 (bilateral PNTX)* Treat with Oseltamivir* Troubleshoot vent alarm#1 (increase sedation)* Troubleshoot vent alarm#2 (place bilateral chest tubes)
Further Reading:
Acute Exacerbation of COPD – EMCrit
COPD – EM@3AM

Toxic Plants (Deep Dive R32) Apr 15, 2022

Show notes

Cardiac Glycoside containing plants : Foxglove, Lilly of the Valley, Oleander, Squill
* Contain cardiac glycosides, which act as a negative chronotrope as well as a positive inotrope.* Patients present with nausea, vomiting, visual changes, bradycardia/arrhythmia, and may develop hyperkalemia – a poor prognostic factor* Treatment is Digibind/DigiFAB – look out for the side effects of hypokalemia as well as anaphylaxis.
Anticholinergic Alkaloid containing plants: Jimson Weed, Angels Trumpet, Deadly Nightshade
* Contain alkaloids that act as anticholinergics ; often used recreationally* Patients present with delirium/hallucinations, pupillary dilation, anhydrosis, hyperthermia, skin flushing, urinary retention* Treatment is support care, with physostigmine for severe cases – remember to go low and slow!
Toxic Mushrooms
* Important to distinguish between acute onset symptoms (
Further Reading:
Stone Heart Syndrome – LITFL
Gyromitra – Indiana Poison Center
Anticholinergic Intoxication – EMCrit

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