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 R15
Dec 17, 2023
Show notes Shock – A state of deranged physiology characterized by systemic, widespread hypoperfusion * Hypovolemic Shock * Hemorrhage * Volume Loss (vomiting/diarrhea, dehydration) * Cardiogenic Shock * ACS, Myocarditis, CHF, Valve failure, Endocarditis, etc * Obstructive Shock * Massive PE, Tension Pneumothorax, Cardiac Tamponade * Distributive Shock * SIRS (Septic Shock, Pancreatitis, Severe Burns) * Anaphylactic Shock * Neurogenic Shock * Adrenal Crisis
Round 15 (MW) MVA
Dec 02, 2023
Show notes You are working at Clerkship General when you hear and EMS call on the radio. “Clerkship General, we are activating a trauma alert. We are bringing you a 33 year old male from a high-speed single vehicle collision” Initial Vitals: HR: 65 BP: 88/50 Temp: 97.0F RR: 20 O2: 96% Room Air Critical Actions: * Apply Cervical Collar * Treat the Patient’s Pain * Give Antibiotics for Open Fracture * Identify and Prioritize Etiologies of Shock in Trauma * Start Vasopressors for Neurogenic Shock
Round 14 (MW) Leg Pain
Nov 01, 2023
Show notes You are working a beautiful sunny day in Pennsylvania when the next chart gets put in your rack. It is a 2 year-old male with a leg injury. Initial Vitals: HR: 112 BP: 97/67 Temp: 99.2F RR: 20 O2: 97% Room Air Critical Actions: * Consider Non-Accidental Trauma * Evaluate for Septic Arthritis * Treat the Childs Pain * Diagnose Lyme Disease * Prescribe Antibiotics (Avoid Doxycycline)
Deep Dive MW R13
Oct 15, 2023
Show notes * Focused Physical Exam * Tachypnea and Hypoxemia * Able to speak in complete sentences * Accessory muscle use/retractions * Moving air or quiet on auscultation * Basic Treatment Algorithm * Albuterol Inhaler * Albuterol/Ipratropium Nebulized (Duoneb) * Steroids * IV Magnesium * Non Invasive Ventilation (CPAP or BiPAP) * Decreases Work of Breathing * Epinepherine * Less Common Treatments * Benzodiazepines * Ketamine * Heliox * Intubation (Last resort) * Use a large ETT (8.0) * Increase the Expiratory Time * “Permissive Hypercapnea” * Appropriate ventilator management of asthma frequently results in mild hypercapnia and respiratory acidosis. IT’S OK * Air Trapping * Results in decreased preload, obstructive shock and pneumothorax * Suspect with high airway pressures and when waveform doesn’t return to zero (see media) * Treat by briefly unhooking ventilator and gently pressing on the patient’s chest to get out the trapped air * Ventilator Settings * Decrease the respiratory rate (ex 10) * Increase the tidal volume (although some hypercapnia is permitted) * Increase I:E ratio (1:4 or greater)
Round 13 (MW) Respiratory Distress
Oct 01, 2023
Show notes You are working at Clerkship General when you hear an EMS call: “Clerkship General, we are bringing you a young female in respiratory distress. ETA 2 minutes” Initial Vitals: HR: 123 BP: 142/78 Temp: Unknown RR: 36 O2: 97% (NonRebreather) Critical Actions: * Give Albuterol, Steroids, and Magnesium * Give either Epinephrine or Terbutaline * Post Intubation Checklist: Sedation, Tubes, and Xray * Choosing Appropriate Vent Settings * Allow permissive hypercapnia
Deep Dive MW R12
Sep 16, 2023
Show notes Introduction * Used as pesticides * Used as weapons (nerve agents) * Sarin Gas, VX Gas, Novichok * Transdermal, Inhalation, Ingestion Clinical Presentation * Muscarinic Activation (Dumbels Mnemonic) * Defication * Urination * Myosis * Bradycardia, Bronchospasm, and Bronchorrhea * “The Killer B’s” * Emesis * Lacrimation * Salivation and Sweating * Nicotinic Activation * Muscle weakness and paralysis * CNS Activation * Respiratory Depression * Altered Mental Status * Seizures Treatment * Atropine * Reverses Dumbels * Keep giving and doubling the dose until brochorrhea and bradycardia resolve * Pralidoxime * Only works before ‘aging’ occurs * Diazepam * Stops the seizures
Round 12 (MW) Respiratory Distress
Sep 01, 2023
Show notes You are working at Clerkship General when you hear an EMS call on the radio. “Clerkship General. We are bringing you an unresponsive 6-year-old female found foaming at the mouth by her babysitter. ETA 2 minutes.” Initial Vitals: BP: 125/80 HR: 62 RR: 34 O2: 81% (Non Rebreather) Critical Actions: * Grab the Broslow! * Fingerstick Glucose * Choose Endotracheal Tube Size * Administer Atropine until bronchial secretions stop * Pralidoxime
OBGYN: The Vaginal Delivery (Pt 2)
Aug 15, 2023
Show notes Shoulder dystocia is an OB emergency. Remember McRobert’s maneuver and suprapubic pressure. For more information, take a look at the resources below. References ACOG- Shoulder Dystocia AAFP- Shoulder Dystocia
OBGYN: The Vaginal Delivery (Pt 1)
Aug 01, 2023
Show notes Maddie’s 7 Cardinal Movements of a Successful Delivery: 1. Head comes out 2. Head turns 3. Cord Assessment 4. Anterior shoulder delivered 5. Posterior shoulder delivered 6. Body delivered. 7. Baby on mom’s chest T’s of Postpartum Hemorrhage: 1. Tone 2. Trauma 3. Tissue 4. Thrombosis
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