EM Clerkship

Latest Episodes:

Round 16 (Allergic Reaction) Dec 01, 2020

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
You are sitting at your computer on an otherwise beautiful Friday afternoon when a mother brings her 16 year old son to the ED with chief complaint of allergic reaction.
Initial Vitals
* Temp 98.7* HR 155* RR 28* BP 125/85* O2 99%
Critical Actions
* Interpret ECG * Interview patient alone (and identify trigger)* Perform vagal maneuver* Administer Adenosine* Discharge patient
Final Diagnosis
Supraventricular Tachycardia
Tips and Tricks
* Interview pediatric patients without family members in the patient’s room* Escort family out of patient room during invasive procedures* Ask about / rule out potential triggers (caffeine use, drugs, ischemia, electrolyte abnormalities, etc)
Further Reading
The REVERT Trial (RebelEM)

Round 15 (Syncope) Nov 01, 2020

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
You are working a shift at Clerkship General when a 51 year old female is brought in after a syncopal episode.
Initial Vitals
* Temp 100.2* HR 132* RR 28* BP 105/69* O2 85%
Critical Actions
* Give supplemental Oxygen* Diagnose Pulmonary Embolism* Administer Heparin* Assess contraindications for tPA* Administer tPA
Final Diagnosis
Massive Pulmonary Embolism
Tips and Tricks
* Reassess vital signs after interventions* Obtain collateral history from EMS and family* Make sure your diagnosis fits the patient’s symptoms! (EG don’t diagnose pneumonia based on a consolidation on CXR if the patient doesn’t clinically have pneumonia)
Further Reading
Submassive and Massive PE (EMCrit)

Round 14 (Shortness of Breath) Oct 01, 2020

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
You are sitting at your computer on an otherwise quiet night when a young male is brought into your ED in obvious respiratory distress.
Initial Vitals
* Temp 98.6* HR 99* RR 34* BP 105/69* O2 95%
Critical Actions
* Give Albuterol + Ipratropium + Steroids* Obtain Chest Xray* Give Magnesium* Place patient on BiPAP* Give IV Beta Agonist (Epinephrine)
Final Diagnosis
Status Asthmaticus
Tips and Tricks
Frequently perform verbal reassessments on patients with the examiner (vitals, patient appearance, pain, etc)
Additional Reading
* The Crashing Asthmatic (REBEL EM)

Round 13 (Dizziness) Sep 01, 2020

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
You are working at your local hospital when the next chart gets put in your rack. You groan. The chief complaint is dizziness..
Initial Vitals
* Temp 98.6* HR 109* RR 20* BP 105/69* O2 100%
Critical Actions
* Diagnose Upper GI Bleed* Initiate IV Proton Pump Inhibitor* Obtain Type and Screen* Admit Patient to the Hospital* Identify Medications That Increase Risk of Ulcer (If Prompted)
Final Diagnosis
Upper GI Bleed due to Peptic Ulcer
Tips and Tricks
If you get stuck in a case and don’t know what to do next. Identify all abnormal findings that you have been provided
Additional Reading
* Why You Should Never Ask “What Do You Mean By Dizzy?” (PubMed)

Announcement Aug 01, 2020

Show notes

The website it updated! Please check it out and email me with any technical issues or other comments/concerns. Enjoy your shift!

Round 12 (Difficulty Breathing) Jul 01, 2020

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
A young gentlemen runs out to triage yelling “I can’t breath!” and collapses to the floor in front of the nurse…
Initial Vitals
* Temp 98.8* HR 145* RR 45* BP 60/30* O2 85%
Critical Actions
* Give Supplemental Oxygen* Identify Pneumothorax Prior to Imaging* Correctly Perform Needle Thoracostomy* Correctly Perform Tube Thoracostomy
Final Diagnosis
Pneumothorax Secondary to Penetrating Chest Trauma
Tips and Tricks
Be careful, lack of visual cues during oral cases can mislead you!
Additional Reading
* Thoracic Trauma (EM Clerkship)* NBME Trauma Review (EM Clerkship)

Round 11 (Headache) Jun 01, 2020

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
You are having a busy day in the department when you are paged overhead to the resuscitation bay for an ill appearing patient with a headache…
Initial Vitals
* Temp 98.9* HR 99* RR 18* BP 180/110* O2 94%
Critical Actions
* Verbalize a Full Neurologic Examination* Obtain CT Scan Without Contrast* Consult Neurosurgery for Subarachnoid Hemorrhage* Reverse Warfarin Coagulopathy* Administer Antihypertensives
Final Diagnosis
Acute Subarachnoid Hemorrhage on Anticoagulation
Tips and Tricks
Always ask the patient if they have allergies prior to administering ANYTHING.
Additional Reading
* Basics of Subarachnoid Hemorrhage (EM Clerkship)* How to Reverse Warfarin (AHA)

Round 10 (Allergic Reaction) May 01, 2020

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
A 45 year old female is exposed to peanut butter and shrimp pizza and begins to have an apparent allergic reaction…
Initial Vitals
* Temp 98.8* HR 130* RR 35* BP 70/40* O2 92%
Critical Actions
* Verbalize Airway Evaluation* Complete a FOCUSED History and Exam* Normal Saline Bolus* Epinephrine both IM and (subsequently) IV* Glucagon 1mg IV
Final Diagnosis
Refractory Anaphylaxis Due to Beta Blockers
Tips and Tricks
You still need to obtain a quick history and exam even if you know the diagnosis in the first few seconds of the case
Additional Reading
* Basic approach to anaphylaxis (EM Clerkship)* Tranexamic acid as first-line emergency treatment for episodes of bradykinin-mediated angioedema induced by ACE inhibitors. (PubMed)* Glucagon infusion in refractory anaphylactic shock in patients on beta-blockers. (PubMed)

Round 9 (Seizure) Mar 01, 2020

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
The nurse brings back a young adult male from the lobby who is having a seizure…
Initial Vitals
* Temp 98.8* HR 90* RR 10* BP 120/80* O2 92%
Critical Actions
* Verbalize ABCs on a Critical Patient* Obtain Immediate Blood Glucose Level* Give Benzodiazepine* Initiate Workup of New-Onset Seizures* Give Pyridoxine (Vitamin B6)
Final Diagnosis
Isoniazid Toxicity
Tips and Tricks
When the patient is unable to provide history, attempt to obtain the information from external sources
Additional Reading
* Isoniazid toxicity overview (Life in the Fast Lane)* Basic approach to seizures (EM Clerkship)* Basic approach to status epilepticus (EM Clerkship)* Ketamine for refractory status epilepticus (PubMed)
Corrections
Ketamine not Keppra as potential induction agent for status epilepticus (32:40)

Round 8 (Fall) Feb 01, 2020

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
EMS brings in an elderly man who has fallen…
Initial Vitals
* Temp 98.6* HR 58* RR 16* BP 105/60* 99%
Critical Actions
* Treat the patient’s pain* Consult orthopedics for a hip fracture* Obtain an EKG* Treat Severe Hyperkalemia* Consult nephrology for dialysis
Final Diagnosis
Ground level fall resulting in hip fracture, missed dialysis, and severe hyperkalemia
Tips and Tricks
Patient’s will frequently have more than one final diagnosis. Do not prematurely close an the initial, obvious, diagnosis.
A man can have as many diseases as he damn well pleases! Hickam’s dictum
Additional Reading
* Basic approach to hyperkalemia (EM Clerkship)* EKG manifestations of hyperkalaemia (LITFL)

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