The purpose of this podcast is to help medical students crush their emergency medicine clerkship and get top 1/3 on their SLOE. The content is organized in an approach to format and covers different chief complaints, critical diagnoses, and skills important for your clerkship.
Deep Dive MW R20
May 16, 2024
Show notes Symptoms of stroke – weakness, facial droop, slurred speech. vision loss, vertigo, ataxia, confusion or changes to mental status. The “typical” stroke workup – blood glucose level, CTH non-con, CTA head/neck, CT Perfusion, CBC BMP Troponin EKG CXR and Coags. Common stroke mimics – hypoglycemia, drug/alcohol intoxication, Bell’s palsy, aortic dissection, complex migraines, and seizure with Todd’s paralysis. Management/treatment – thrombolytics (within 4.5 hrs), thrombectomy (within 24 hrs) , and blood pressure control (
Remember that time is brain, so move fast! AAEM tPA Infographic AHA Stroke – “Getting the Gist Across Is Enough for Informed Consent for Acute Stroke Thrombolytics”
Round 20 (MW) – Weakness
May 01, 2024
Show notes You are working at Clerkship General when one of the nurses comes and grabs you. “Hey doc, we need you in bed 10. I think this patient is having a stroke.” Initial Vitals: HR: 51 BP: 201/98 Temp: 98.0F RR: 18 O2: 99% (Room Air) Critical Actions: * Check a Blood Glucose * Activate a Stroke Alert * Assess Contraindications to tPA * Consent for tPA * Transfer via Air for Thrombectomy
Deep Dive MW R19
Apr 16, 2024
Show notes * Common during the first year of life as well as during puberty * Presents with nausea/vomiting, abdominal pain, and/or testicular pain * ALWAYS examine a child for signs of torsion who presents with abdominal pain (especially lower abdominal pain) * Look for tenderness, firmness, high riding testicle or testicle with unequal lie, swelling, and the absence of a cremasteric reflex * Consult Urology IMMEDIATELY if you have high suspicion, otherwise proceed to ultrasound * Ultrasound is only 85% sensitive, so clinical gestalt can trump even a negative US * Attempt manual detorsion if there will be a significant delay to surgery
Round 19 (MW) – Pediatric Abdominal Pain
Apr 02, 2024
Show notes You are working at Clerkship General when the next patient is put into your rack. It is an 8 year-old male with vomiting Initial Vitals: HR: 119 BP: 104/63 Temp: 98.0F RR: 20 O2: 99% (Room Air) Critical Actions: * Finger Stick Blood Glucose * Treat Patient’s Pain * Diagnose Testicular Torsion * Immediate Urology Consult * Perform Manual Detorsion References: Mellick LB, Sinex JE, Gibson RW, Mears K. A Systematic Review of Testicle Survival Time After a Torsion Event. Pediatr Emerg Care. 2019 Dec;35(12):821-825. doi: 10.1097/PEC.0000000000001287. PMID: 28953100.
Deep Dive MW R18
Mar 16, 2024
Show notes Phase One: CNS * Ataxia, Slurred Speech, Confusion, N/V, Seizures Phase Two: Cardiopulmonary * CHF, Cardiogenic Shock/Hypotension, Pulmonary Edema, ARDS Phase Three: Renal * Flank pain, Hematuria, Oliguria, Renal Failure Diagnosis: * HIGH INDEX OF SUSPICION * Ethylene Glycol Serum Level * Elevated Osmolar Gap * Serial Anion Gap Measurements Treatment: * Fomepizole or Ethanol to prevent breakdown to toxic glycolic acid/oxalic acid * Hemodialysis * Consider Bicarb drip, pyridoxine, and thiamine Further Reading: EMCrit Toxic Alcohols
Round 18 (MW) – Intoxication
Mar 01, 2024
Show notes You are working at Clerkship General when you hear an EMS call on the radio. Clerkship General, we are bringing you Arthur. He is intoxicated… Again Initial Vitals: HR: 116 BP: 150/70 Temp: 98.8 RR: 26 O2: 85% (Room Air) Critical Actions: * Recognize Hypoxemia * Diagnose Toxic Alcohol Ingestion * Consult Nephrology Emergent Dialysis * Administer Fomepizole * Workup Anion Gap Metabolic Acidosis
Deep Dive MW R17
Feb 16, 2024
Show notes Hypertensive Emergencies of Pregnancy PreEclampsia, Eclampsia, HELLP syndrome Diagnosis: BP >140/90 plus end organ dysfunction * Acute Kidney Injury * Proteinuria * Thrombocytopenia * Transaminitis * Hemolysis * Pulmonary Edema * Cerebral Edema / Hemorrhage * Headache refractory to tylenol * Visual Changes * RUQ Pain not attributable to another diagnosis Treatment * Loading Dose: IV Magnesium 4-6g over 20-30 min OR 5g IM in each buttock * Maintenance Dose: 1g/hr IV * Antihypertensives (goal 20% reduction): Labetalol, Nicardipine, Hydralazine * Delivery of fetus and placenta
Round 17 (MW) Headache
Feb 01, 2024
Show notes You are working at Clerkship General when the next chart is put in your rack. It’s a 41-year-old female with a chief complaint of headache. Initial Vitals: HR: 56 BP: 172/93 Temp: 98.8F RR: 18 O2: 97% Critical Actions: * Check a Blood Glucose * Diagnose Preecclampsia/Ecclampsia * Administer Magnesium * Treat the Hypertension * Discuss with OBGYN and Admit
Deep Dive MW R16
Jan 17, 2024
Show notes Diagnosing PE: Step 1: Consciously consider the diagnosis Step 2: Risk Stratify into low, intermediate, and high risk Step 3: Choose appropriate testing based on pre-test probability Classification of PE * High Risk/Massive PE: Hemodynamic Instability * Intermediate Risk/Submassive PE: Right Heart Strain without instability ; or PESI Class 3+ * Low Risk/Non-Massive PE: Everything else (no instability, no heart strain, PESI Class 1-2) Treatment of PE * High Risk/Massive PE: Thrombolytics and often thrombectomy * Intermediate Risk/Submassive PE: Heparin and sometimes intervention * Low Risk/Non-Massive PE: Either discharge with DOAC or admit with heparin
Round 16 (MW) Leg Pain
Jan 01, 2024
Show notes You are working at Clerkship General when you overhear the base command radio. “Clerkship General. We have a 57 year-old female coming in for leg pain. She just had surgery at your hospital. Her blood pressure is 85/50. We’ll be there in 5 minutes.” Initial Vitals: HR: 122 BP: 75/40 Temp: 100.1 RR: 24 O2: 74% Critical Actions: * Obtain full set of vital signs * Treat the patient’s pain * Diagnose PE without imaging * Stabilize patient prior to imaging * Transfer the patient for thrombectomy
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