EM Clerkship

You are working at Clerkship Rural when the nurse hands you your next chart to see. It’s a 59 year old farmer with chest pain. Initial Vitals: BP: 156/97 HR: 110 RR: 22 O2: 98% (Room Air) Temp: 98.8F Critical Actions: * Give Aspirin, Nitroglycerin, and Heparin * Identify Posterior STEMI * Assess for Thrombolytic Contraindications and Consent * Transfer for PCI * Diagnose Accelerated Idioventricula...

* The MILDLY agitated patient : verbal de-escalation or PO benzo/antipsychotic * The MODERATELY agitated patient : IM benzo/antipsychotic * The SEVERELY agitated patient : IM Ketamine 5mg/kg Consider removing the terminology “Agitated Delirium” from your vocabulary, as there is significant racial bias behind this term.

You are working at Clerkship General when you hear an EMS call on the radio… “CLERKSHIP GENERAL – We are bringing you an agitated and combative 30 year old male, we’ll see you in 5 minutes.” Initial Vitals: BP: 192/105 HR: 134 RR: 22 O2: 99% (Room Air) Temp: 98.8 F Critical Actions: * Administer Sedation for Patient/Staff Safety * Intubate the Patient and Obtain Chest Xray * Diagnose Intracranial...

Indications for LP: CNS infection, SAH, Guillian Barree, IIH Contraindications for LP: Space occupying lesion with mass effect ; severe thrombocytopenia and coagulopathy; cellulitis over LP site or concern for epidural abscess ; traumatic injury to spine Complications for LP: Post LP Headache, spinal hematoma, brainstem herniation Technique for LP: Positioning is everything.  Use US if necessary. ...

You are working at Clerkship General when the charge nurse comes and grabs you… “Hey doc, we need you in room 2, this kid looks sick…” Initial Vitals: BP: 68/40 HR: 128 RR: 22 O2: 99% (Room Air) Temp: 103.5F Critical Actions: * Diagnose Meningitis and Perform Lumbar Puncture * Give Empiric Antibiotics * Treat Septic Shock * Give Steroids * Give Prophylaxis to Close Contacts Check Out: Pearson Ravi...

* Two Types of Priapism * Low Flow “Ischemic” (Most Common >95% of Cases) * Urologic Emergency * Results in Erectile Dysfunction * Painful * Common Etiologies * Idiopathic * Erectile Dysfunction Drugs (ex. sildenafil) * Sickle Cell Disease * Trazodone (“TrazoBONE”) * Cocaine/Meth * High Flow * Caused by Trauma and AV Fistulas * Management * Analgesia * Dorsal Penile Nerve Block * Aspiration * Can...

You are working at Clerkship General on an overnight shift when the next chart is handed to you. It’s a 35 year old male with a chief complaint of groin pain. Initial Vitals: BP: 150/90 HR: 107 RR: 20 O2: 99% (Room Air) Temp: 98.0F Critical Actions: * Diagnose Ischemic/Low Flow Priapism * Perform Penile Nerve Block * Aspirate Blood and Irrigate with Saline * Inject Intracavernous Phenylepherine *...

Obtain IV Access – get two large bore IVs (18g or larger) Resuscitate – un-crossmatched blood at first, don’t forget type and screen! Medicate – Give Pantoprazole always, Octreotide and Ceftriaxone if hx liver disease, reverse anticoagulation if indicated Imaging – Upright CXR to assess for perforation, CTA if concerned for lower GIB Consult – GI if unstable / if variceal bleeding Disposition – ba...

You are working at Clerkship General when the charge nurse grabs you – “hey we got a real sick one, a 57yo Male who I just put in the resuscitation bay, he is vomiting blood”. Initial Vitals:BP: 77/34 HR: 135 RR: 24 O2%: 95% Temp: 98.8F Critical Actions: * Place two large bore IVs * Transfuse emergency uncross matched blood * Administer IV Pantoprazole * Administer IV Ceftriaxone and IV Octreotide...

* “Sympathetic Crashing Acute Pulmonary Edema” * Pathophysiology – Rapid onset of pulmonary edema caused by sudden hypertension * Triggers- Missed Medication, Cocaine, Stress/Anxiety * Increase in BP = Increase in afterload * Increased afterload causes acute pulmonary edema (in patients with CHF) * The worsening pulmonary edema causes shortness of breath which worsens blood pressure and further in...

In this long-form episode we will discuss opioid use disorder, the leading cause of death in young adults in the United States. What you do matters! * Why you should care about OUD * What is OUD * Buprenorphine Works References * National Safety Counsel Injury Facts * DebunkingDenial – Purdue Pharma and America’s Opioid Epidemic * Addiction Neuroscience 101 – Youtube * Cochran Review – Buprenorphi...

This episode will answer 3 big pre-Match Day questions: 1. How do I go about making my rank list? 2. What about post-interview communication both from and to programs? 3. How does this whole thing called the Match actually work? Resources: EM Match Advice: Post Interview Communications https://www.emra.org/books/msadvisingguide/preparing-and-submitting-your-rank-list/

Aortic Dissection – when there is a tear in the intima layer of the aorta and the blood dissects the intima away from the media creating a false lumen in the aorta * Historical Features * Be VERY suspicious with ABRUPT onset of chest/back pain that reaches MAXIMAL SEVERITY immediately after onset of pain. * Chest pain or Back pain with a neurologic deficit * Pain “above and below the diaphragm” *...

You are working at Clerkship General when the base command phone rings – “Hey doc just wanted to give you a heads up on this stroke alert we’re bringing you – we have a 70yo M with sudden onset left arm numbness and weakness, last known well 2 hours ago, we’ll be there in about 5 minutes” Initial Vital Signs: HR 120 BP 180/90 RR 22 O2 97% Temp 97.7F Critical Actions: 1. Check a blood glucose 2. Di...

Not your typical wellness episode – by Zack

You are working at Clerkship General Hospital when EMS calls in a female with opioid overdose, but she won’t stop complaining of leg pain… Initial Vitals: Temp: 98 BP: 120/80 HR: 89 RR: 20 O2 Sat: 100% Critical Actions: * Treat patient’s pain without NSAIDs (history of solitary kidney) * Assess patient’s leg pain beyond the point of just fracture vs. no fracture * Recognize the signs and symptoms...

Diabetic Ketoacidosis – hyperglycemia, ketosis, and anion gap metabolic acidosis * Don’t forget about euglycemic DKA (especially in setting of SGLT2 inhibitor) or mimics such as alcoholic ketoacidosis * Treatment of the ketoacidosis * Insulin (usually a drip or bolus + drip) – only once K>3.5* Volume Resuscitation (NS initially, change to LR)* Bicarb drip (poor evidence, only as last resort for cr...

You are working a shift at Clerkship General when the charge nurse comes and grabs you to see a 24yo male who appears to be in respiratory distress. Critical Actions: * Diagnose DKA* Replete potassium* Start insulin AFTER potassium repletion* EITHER place central line for faster K repletion OR initiate bipap to allow time for potassium repletion via existing peripheral line* Admit to ICU Further R...

Before interview day, do your research on programs and interviews and reflect on the way in which you want to portray yourself. On interview day, have a cheat sheet with notes about your conversations, questions, and pro-cons. Remember to stay calm, take a pause if you need to, and above all be authentic to who you are. After interview day, be sure to capture you gut impression and write down any...

show notes coming soon

Show comments to be posted shortly

* Understand the timeline – research programs to find out when they extend invites and when they host interviews* Prepare for invitations – set up email and text notifications, get a calendar* Accept invitations – respond promptly and keep your calendar updated* Optimize invitations – any interview date you get is a good one, but planning ahead can help you optimize timing* Too many or too little...

Summary of Key Points 1. You should consider ectopic pregnancy in every patient who is capable of bearing children 2. If a patient of child bearing age presents with severe abdominal pain or vaginal bleeding and is either hemodynamically unstable or very ill appearing, this is a ruptured  ectopic pregnancy until proven otherwise and I would recommend performing a bedside FAST exam immediately. 3....

You are working at Clerkship General when the next chart gets handed to you – a 31 year old female presenting with abdominal pain. Initial Vitals: BP: 109/65 HR: 96 RR: 21 O2: 99% Temp: 99.1F Critical Actions: * Obtain pregnancy test* Confirm IUP * Administer Rhogam* Treat UTI* Counsel the patient and discharge them Further Reading: CoreEM – Utility of Anti-D Immunoglobulin(Rho Gam) During First T...

Things to consider when selecting residency programs to apply to: 1.  What type of program (County, Community, Academic) 2.  What length of program (3 year vs. 4 year) 3.  Location 4.  Culture and Lifestyle 5.  Niches in EMFurther Resources: EMRA Residency Map Doximity Navigator SAEM Residency Fair EMRA Residency Fair