EM Clerkship

Airway/C-spine. Breathing. Circulation. Disability. Exposure. Secondary Survey. Airway and C-Spine * General airway principles* “If they can’t speak, they can’t control their airway”* “If GCS is

The nerve, artery, and vein are at 12 o’clock. The urethra is at 6 o’clock. Two Types of Priapism * High flow (non-ischemic)* Common causes* Trauma* AV malformations* Tumors* Priapism from too much blood coming IN* Not painful* Consult urology* Low flow (ischemic)* Common causes* Sickle cell disease* Drug side-effects* Priapism from blood being unable to flow OUT* Patient requires emergent detumes...

Never ignore a pregnant woman’s blood pressure. Introduction * Pre-Eclampsia* Pathophysiology unknown* Pregnancy induced multi-organ dysfunction* Definition* Pregnancy* PLUS* BP 135/85* PLUS* Proteinuria* Eclampsia* Preeclampsia* PLUS* Seizures* HELLP Syndrome* Preeclampsia* PLUS* Hemolysis* PLUS* Elevated liver enzymes* PLUS* Low platelets Step 1: Evaluate For Four Big Symptoms * Swelling/edema*...

With this complaint, it’s ALL about doing a good history and exam. Step 1: Write Out Your Differential Diagnosis * The KING* Subarachnoid hemorrhage* The QUEEN* Meningitis* 3 Killers in the BRAIN* Stroke* Hematomas* Elevated ICP/Tumors* 3 Killers in the VESSELS* Arterial dissection* Brain DVT (Dural Venous Sinus Thrombosis)* Giant cell/temporal arteritis* 3 MISCELLANEOUS killers* Preeclampsia* Car...

Don’t forget to do a thorough GU exam! Step 1: Write Out Your Differential Diagnosis * Remember 2-4-2-4* (2) In the upper abdomen* Pyloric stenosis* Pneumonia* (4) In the lower abdomen* Hirschsprung’s disease* Intussusception* Appendicitis* Hernia* (2) Genitourinary* UTI* Testicular/Ovarian torsion* (4) Generalized* Volvulus* Necrotizing enterocolitis* Henoch Schonlein Purpura* Diabetic ketoacidos...

Tank. Clogged Pipes. Broken Pipes. Pump. Introduction * “Tank”* Hypovolemic shock* Hemorrhagic shock* “Clogged Pipes”* Cardiac tamponade* Tension pneumothorax* Pulmonary embolism* “Broken Pipes”* Septic Shock* Neurogenic Shock* Anaphylactic Shock* “Pump”* Cardiogenic Shock Step 1: Fill the Tank * Establish an IV* IO line alternative in emergent situations Step 2: Consider Clogs * Cardiac tamponade...

Hypoxemia fixed by only TWO things: FiO2 and PEEP Step 1: Add FiO2 * If the patient is breathing…* Nasal cannula* Non-rebreather mask* If the patient is NOT breathing…* Bag-valve mask Step 2: Add PEEP * *Cannot be completed in 60 seconds, but equipment can be requested* If patient is breathing…* BiPAP* If the patient is NOT breathing…* Intubation Additional Reading * Ventilator Basics (EM Clerkshi...

“Airway” does not necessarily mean “Intubation” Introduction * In emergency medicine we are taught “A-B-Cs”* These are actions that can be accomplished in first 60 seconds of patient encounter* Intubation takes several minutes to accomplish* Intubating a crashing patient might even KILL them!* Resuscitate THEN intubate Step 1: Suction * Immediately suction if patient is…* Altered and vomiting* Gur...

Don’t forget to wear protective gear. Gown up! Initial Encounter * History* Anticoagulants* Easy bleeding/bruising* Lightheadedness* Exam* Pallor* Tachycardia/Hypotension Step 1: Put on Personal Protective Equipment * Gown* Gloves* Mask* Eye Protection Step 2: Clear Nose and Visualize Bleeding * Have patient blow out/remove any clot and look for source of bleed* Kiesselbachs plexus* “Anterior” epi...

There are six cardiopulmonary causes of chest pain that you need to know. The SIX Causes * Cardiac* Acute coronary syndrome (ACS)* Pericarditis with tamponade* Pulmonary* Pneumonia* Pneumothorax* Vascular* Pulmonary embolism* Aortic dissection Step 1: Core Measures * Aspirin* EKG Step 2: Look for the “King” (Acute Coronary Syndrome) * Four high yield symptoms* Radiation to the RIGHT shoulder* Vomi...

Patient presentations are the single most important skill to develop for your Emergency Medicine rotation. General Principles * Stay focused, thorough, and organized* Write out the basic 8-step presentation for reference The 8-Step Patient Presentation * Summary statement* Demographics* Risk factors/Past medical history* Chief complaint* History* OPQRST* Try to give at least 4 descriptors* This is...

To Do Well On WRITTEN Exam * Study the “Core 4” body systems* Neurology* Headache* Strokes* Meningitis* Cardiology* Chest pain* ACS* EKG interpretation* Pulmonary* Shortness of breath* PE* GI* Abdominal pain* Nausea/vomiting* Appendicitis To Do Well In the DEPARTMENT * Study the “other stuff”* Epistaxis* Foley catheter issues* Rectal bleeding* Laceration repair* Rashes* Geriatric falls* Suicidal i...