EM Clerkship

3 Steps to assessing your competitiveness for matching in an EM residency: 1.  Get a good advisor. 2.  Look at the data. 3.  Maximize your potential. Further Reading: EMRA – Apply smarter not harder EMRA Hangouts EMRA Student-Resident Mentorship Program NRMP Charting the Outcomes NRMP Residency Data ALiEM – Match Advice UTSW Texas STAR

The future of emergency medicine seems bleak. Listen to Zack’s perspective on the future of our beloved specialty in part TWO of this two-part series.

You are working your FIRST SHIFT EVER at Clerkship General hospital when a 60 year old female presents with shortness of breath. Initial Vitals: * HR: 92* RR: 28* BP: 120/80* O2%: 89%* Temp: 101.2F Critical Actions: * Obtain full set of vital signs* Diagnose PNA and COPD exacerbation* Administer appropriate antibiotics* Treat symptoms with steroids and nebulizers* Admit patient to the hospital

The future of emergency medicine seems bleak. Listen to Zack’s perspective on the future of our beloved specialty in part one of this two-part series.

You are working at *rural* Clerkship General when you receive a radio call from EMS – 7yo male from a severe bus accident with a large scalp laceration, unable to control the hemorrhage. Initial Vitals * HR: 136* RR: 22* BP: 80/35* O2%: 100%* Temp: 98F Critical Actions: * Perform ATLS Algorithm* Control Hemorrhage* Transfuse pRBCs* Replete Factor VIII with correct dosing (100% replacement)* Diagno...

Asymptomatic Bradycardia – usually don’t treat Symptomatic Stable Bradycardia – atropine, further workup Symptomatic Unstable Bradycardia – SIMULTANEOUS treatment with medications and electricity * Meds: Trial of atropine, then either epinephrine, dopeamine, or isoproterenol* Electricity: Transcutaneous Pace –> TVP DDX of Bradycardia – BRADIE Blocks (av blocks) Reduced vital signs (hypoxemia, hypo...

What is most important to programs from ERAS? SLOEs, clinical grades on EM rotations and residency interviews. How do you look good on interviews? Have a thorough ERAS application that gives interviewers lots to ask about! On ERAS, there are four sections in the curriculum vitae portion: * Education – honorary societies, medical school awards, other awards/accomplishments (e.g. college, volunteer,...

ERAS Pt 1: The 8 Parts of the ApplicationThere are 8 parts to the application: * Personal and Biographic Information – mostly self-explanatory* Curriculum Vitae (Resume) – keep an updated CV throughout medical school to makethis easy to fill out, be concise but specific* Personal Statement – start early* Letters of Recommendation – should ideally have two SLOEs from rotations in EMdepartments plus...

You are working at Clerkship General when you are called to see a 70 yo male who is presenting with shortness of breath. Initial Vitals * Temp 98.0* HR 36* RR 28* BP 80/35* O2 82% Critical Actions * Interpret ECG Correctly (3rd degree AV block)* Order a troponin* Perform and Describe transcutaneous pacing* Perform and Describe transvenous pacing* Treat NStemi (ASA, Heparin gtt, nitro if BP improve...

DOPES D-Displacement – endotracheal tube dislodges from trachea, or falls into right mainstem bronchus O-Obstruction – Mucous plugging, bronchospasm, patient biting tube P –Pneumothorax – Look out for pneumothorax, it can be subtle E – Equipment – Disconnected/unpowered equipment, ensure everything is powered on and connected appropriately S – Stacking – common in asthma/COPD due to inadequate exp...

Brainstorming ideas – how to make it personal * What makes me unique? 2. What are some specific experiences I’ve had in my life that have either made me want to do EM or given me the skills that will prepare me well for training in EM? 3. If a family member or a friend were to describe me to a stranger, what would they talk about first? Brainstorming ideas – how to make a statement * What do I bri...

Welcome to EM Clerkship Maddie Watts! The personal statement should be *personal* and should *make a statement*. * Start early* Use solid organizational structure* Address the big three questions – who? what? why?* Check for grammar mistakes* Explain any red flags Further Reading: EMRA / CORD Advising Guide NRMP Program Director Survey ALiEM Match Advice Series

You are working at Clerkship General when you are called to the resuscitation bay for a 55yo M presenting in respiratory distress. Initial Vitals * Temp 99.9* HR 110* RR 22* BP 122/82* O2 82% on BiPAP 10/5 100%FiO2 Critical Actions * Correctly interpret CXR #1 (multifocal PNA)* Correctly interpret CXR #2 (bilateral PNTX)* Treat with Oseltamivir* Troubleshoot vent alarm#1 (increase sedation)* Troub...

Cardiac Glycoside containing plants : Foxglove, Lilly of the Valley, Oleander, Squill * Contain cardiac glycosides, which act as a negative chronotrope as well as a positive inotrope.* Patients present with nausea, vomiting, visual changes, bradycardia/arrhythmia, and may develop hyperkalemia – a poor prognostic factor* Treatment is Digibind/DigiFAB – look out for the side effects of hypokalemia a...

You are working at Clerkship General when you see your next patient : a 3 year old male accompanied by his father with chief complaint of vomiting.  Initial Vitals * Temp 98.6* HR 50* RR 20* BP 95/55* O2 100% Critical Actions * Identify the history of ingestion* Check a blood glucose* Call Poison Control* Treat with DigiBind* Treat subsequent anaphylaxis Further Reading: EMCrit – Digoxin Toxicity...

* Opioid overdose is the number one leading cause of death in adults under the age of 50. * Many ED Physicians fail to recognize that offering MAT (medication assisted therapy) to victims of opiate overdose is one of the most effective interventions we can offer in medicine.* 1 in 2 using high-dose buprenorphine (≥ 16 mg) had retention in treatment – meaning NNT of 2! Further Reading: TheNNT – Opi...

Critical Actions: * Administer Naloxone* Minimize Unnecessary Testing* Discuss options for Rehab* Offer opioid replacement therapy* Provide Social Support Further Reading: Buprenorphine – EMDocs Naloxone – EMDocs Initiating Opioid Treatment in the ED – ACEP

AFib with Rapid Ventricular Rate (RVR) – Rate >110 Primary AFib – Patients symptoms or their hemodynamic instability is due to the AFib itself. Treatment is by rate or rhythm control. Secondary AFib – Patients AFib rate or their hemodynamic instability is due to an underlying secondary process (eg thyrotoxicosis, PE, sepsis, drugs, etc). Treatment is by treating the underlying process. Unstable Pr...

You are working a shift at Clerkship General Hospital when you go see your next patient, a 70 year old male presenting with chest pain. Initial Vitals * Temp 98.7* HR 140* RR 20* BP 125/85* O2 99% Critical Actions * Obtain EKG* Treat AFib RVR via rate control (and not cardioversion)* Diagnose Acute Arterial Occlusion* Treat with Heparin* Consult Vascular Surgery for further management (possible th...

tPA usage is controversial. Listen to find out why. Read more to form your own opinions. Episode Sources: After Re-Analysis, No Trials Show Efficacy of tPA in Acute Ischemic Stroke Clinical Policy: Use of Intravenous Tissue Plasminogen Activator for the Management of Acute Ischemic Stroke in the Emergency Department Why we can’t trust clinical guidelines – BMJ Alteplase for Stroke: Money and Optim...

Initial Assessment: * Obtain Vitals and blood glucose level* Time of onset (important for tPA/TNK vs thrombectomy)* Neurologic and Cardiac Examination / NIHSS* do not delay head CT to complete NIHSS, can always finish after CT* Assess contraindications for tPA Workup: * Labs: CBC, CMP, Troponin, Coags, EtOH, bedside accucheck* CXR and UA (infections can cause recrudescence of prior cva)* ECG looki...

ATLS – Advanced Traumatic Life Support Primary Survey * Airway* Breathing* Circulation* Disability* Exposure Secondary Survey * Head to Toe Examination* Look for injury patterns and important injuries, such as* Battle Sign (post auricular ecchymosis)* Raccoon Eyes (infraorbital ecchymosis)* Hemotympanum* Nasal Septal Hematoma* Urethral Injuries* Circumferential Burns* Obtain a basic medical histor...

You are working a shift at ABEM General when you receive a call from EMS over the radio for a patient involved in a house fire. Initial Vitals * Temp 99.0* HR 150* RR 40* BP 90/50* O2 95% Critical Actions * Administer 8L IVF in first 8 hours* Administer supplemental oxygen for CO poisoning* Administer TDAP* Give hydroxycobalamine for cyanide toxicity* Obtain head CT to diagnose SDH Further Reading...

* 50% of cases of Pelvic Inflammatory Disease (PID) is caused by common STIs (Gonorrhea, Chlamydia ) but up to 50% is caused by native vaginal flora/other organisms* No SINGLE historic, physical, or laboratory finding is both sensitive and specific for the diagnosis of acute PID* Women with PID may be asymptomatic!!* Presumptive treatment of PID should be initiated for sexually active women if the...

You are working a shift at ABEM General when three patients check in simultaneously at the start of your shift at 6AM. Initial Vitals#1 (Ms. Taylor, 65F with Back Pain) * Temp 98.8* HR 120* RR 22* BP 210/110* O2 97% Critical Actions#1 (Ms. Taylor, 65F withBack Pain) * Obtain Medication/Social Hx (Ciprofloxacin use, Cocaine use)* Diagnose Aortic Dissection (Type B)* Treat HR Appropriately (Esmolol...