EM Clerkship

Latest Episodes:

Round 7 (Headache) Jan 01, 2020

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
Just a routine day at your hospital, your next patient has a chief complaint of headache…
Initial Vitals
* Temp 98.8* HR 88* RR 16* BP 130/80* O2 99%
Critical Actions
* Identify Acute Angle Closure Glaucoma* Initiate Appropriate Treatment for Acute Angle Closure Glaucoma* Emergent Consult to Ophthalmology* Recheck Intra-Ocular Pressure After Initiating Treatment
Dangerous Actions
* Giving NSAIDS (The Patient Had This on Allergy List)* Performing a Lateral Canthotomy
Final Diagnosis
Acute Angle Closure Glaucoma
Tips and Tricks
Do not be surprised or scared when an examiner has a monotone voice and flat affect
Additional Reading
* Management of acute angle closure glaucoma (PubMed)* Basic approach to eye complaints (EM Clerkship)

Round 6 (Back Pain) Dec 01, 2019

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
A notorious, disheveled frequent flyer presents to your emergency department for her back pain and is asking for more Dilaudid…
Initial Vitals
* Temp 99.0* HR 99* RR 18* BP 118/78* O2 99%
Critical Actions
* Ask about Red Flags for Spinal Infection* Perform a Thorough Spinal Exam* Obtain MRI Spine with Contrast* Initiate Broad Spectrum Antibiotics* Treat Pain when Pathology Identified
Final Diagnosis
Spinal Epidural Abscess
Tips and Tricks
Don’t let consultants or other members of your team talk you out of appropriate management of a patient
Additional Reading
* Basic approach to Back Pain (EM Clerkship)* Epidural Abscess Overview (AAFP Website)

Round 5 (Geriatric Fall) Nov 01, 2019

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
The nurse is asking you to evaluate a 70 year old male who has been placed in a hall bed after hitting the back of his head. She wants to know if you would like to call a trauma alert…
Initial Vitals
* Temp 103.7 (Hidden by Examiner)* HR 115* RR 18* BP 110/75* O2 99%
Critical Actions
* Diagnose Fournier’s Gangrene on Secondary Survey* Obtain Full Vital Signs Including Temperature* Perform Sepsis “Core Measures”* Initiate Appropriate Treatment for Fournier Gangrene* Immediate Surgical Consultation
Final Diagnosis
Septic Shock due to Fournier Gangrene
Tips and Tricks
Always ask for the patient’s temperature if it is not given with initial vital signs
Additional Reading
* Fournier Gangrene Overview (PubMed)* Basic Approach to Sepsis (EM Clerkship)* Basic Approach to Trauma (EM Clerkship)

Round 4 (Flank Pain) Oct 01, 2019

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
The nurse tells you that you have a new patient and is requesting a verbal order for nausea medicine. She advises you that the patient is the CEO of your hospital…
Initial Vitals
* Temp 98.9* HR 99* RR 18* BP 120/80* O2 98%
Critical Actions
* Perform Genitourinary Exam* Rule Out Abdominal Aortic Aneurysm* Consult Urology* Treat the Patient’s Pain* Resist Delays on Consultant Pushback
Dangerous Actions
* Delaying Urology Consultation to Obtain an Ultrasound
Final Diagnosis
Testicular Torsion with Referred Pain
Tips and Tricks
Don’t forget to verbalize genitourinary exam when appropriate
Additional Reading
* Testicular torsion overview (EM Clerkship)
Corrections
It is rare for testicular torsion to occur at this age

Round 3 (Chest Pain) Sep 22, 2019

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
An ill appearing patient has been rushed back from the lobby, clutching his chest, you are needed immediately at the bedside…
Initial Vitals
* Temp 99.1* HR 95* RR 20* BP 120/80* O2 98%
Courtesy of LITFL Medical Blog https://creativecommons.org/licenses/by-nc-sa/4.0/
Critical Actions
* Obtain Early EKG* Notify Cardiology of Inferior STEMI* Bring Crash Cart to Bedside* Administration of Heparin* Counsel the Family
Dangerous Actions
* Giving Nitroglycerine to Patient with Inferior MI and on Sildenafil* Giving Aspirin to Patient with Allergy to Aspirin
Final Diagnosis
Cardiac Arrest due to Inferior STEMI
Tips and Tricks
Ask about allergies prior to administering medications
Additional Reading
* Approach to STEMI (EM Clerkship)* American Heart Association STEMI Guidelines (AHA)

Round 2 (Seizure) Sep 16, 2019

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
EMS brings in a postictal 34 year old female after she has a seizure. She is complaining of a headache…
Initial Vitals
* Temp 98.9* HR 110* RR 10* BP 175/115* O2 95%
Critical Actions
* Articulate Full Neurologic Exam* Early Blood Glucose* Identification of Pregnancy* Administer Magnesium* Treat the Patient’s Blood Pressure
Final Diagnosis
Eclampsia
Tips and Tricks
All women of childbearing age should receive a pregnancy test early in the case
Additional Reading
* Approach to Eclampsia (EM Clerkship)* American College of OB-GYN Eclampsia Guidelines (ACOG)

Round 1 (Altered Mental Status) Sep 08, 2019

Show notes

CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
You are called to the resuscitation bay for a poorly responsive patient that has been brought in by EMS.
Initial Vitals
* Temp 98.8* HR 78* RR 4* BP 124/78* O2 98%
Critical Actions
* Obtain Early Blood Glucose* Administer Dextrose* Obtain Salicylate and Acetaminophen Levels* Admit for Further Observation* Psychiatry Consult
Final Diagnosis
Intentional Sulfonylurea Overdose
Tips and Tricks
All unresponsive patients should receive a blood glucose level early in the case
Additional Reading
* Sulfonylurea Toxicity Overview (LITFL)* Approach to Altered Mental Status (EM Clerkship)

MUST LISTEN (re ABEM) Aug 25, 2019

Show notes

ABEM-style cases presented on EM Clerkship are not my actual ABEM exam cases, and they are not derived from my actual exam cases. I will never be discussing my specific exam details with anybody, including on this podcast. The cases were created independently, by me, for the purpose of medical education and improving patient care. Topics are chosen from the publicly available ABEM model of clinical practice and are built from scratch using a my own custom template. If you would like a copy of this template, please email me and I can send you a copy.
-Zack

ACS, Acidosis, AAA and Other Miscellaneous Causes of Abdominal Pain Aug 11, 2019

Show notes

There are HUNDREDS of other non-GI/GU causes of abdominal pain…
Acute coronary syndrome (ACS)
* Test with EKG and troponin
* Treat with aspirin and heparin
Acidosis
* Diabetic Ketoacidosis (DKA)* Respiratory Acidosis (COPD)* Salicylate Toxicity (Remember MUDPILES)
Abdominal Aortic Aneurysm (AAA)
* Older people with abdominal/flank/back pain or syncope* Testing* CT Scan Abdomen with contrast (Good)* CTA Abdomen (Better)* Bedside Ultrasound (Best)
Additional Reading
* Approach to STEMI (EM Clerkship)* Approach to Diabetic Ketoacidosis (EM Clerkship)* Approach to Salicylate Overdose (EM Clerkship)* Approach to Abdominal Aortic Aneurysm (EM Clerkship)

Testicular Torsion and Prostatitis Aug 04, 2019

Show notes

Testicular Torsion
History
* Pain in the testicles * Referred pain in the flank or lower abdomen* Usually sudden and severe* Usually WITHOUT urinary symptoms
Exam
* Asymmetric testicular lie* High riding testicle* Tenderness and swelling of the testicle itself* Cremasteric reflex
Testing
* Testicular Ultrasound
Treatment
* Immediate call to urology when suspected* Manual detorsion (“Open the Book”)
Prostatitis
History
* Pelvic pain* Pain with sex* Urinary symptoms* Fevers and chills
Exam
* Tenderness of the prostate/epididymis/testicle
Testing
* Urinalysis* Generally a clinical diagnosis
Treatment
* Commonly sexually transmitted in young men* Commonly E coli in older men* Bactrim or Fluoroquinolones
Additional Reading
* Testicular Torsion (EM Clerkship)* EMRA Antibiotic Guide (Amazon)

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