The EM Clerkship Podcast

Four important injuries. Four different imaging studies to obtain. Step 1: Obtain Pelvic X-Ray Commonly performed at bedside as part of initial trauma evaluation A pelvic injury significantly increases risk of GU injury Step 2: Examine the Perineum Common signs of GU injury Blood at urethral meatus Bruising of the perineum Step 3: Obtain Urinalysis […]

Step 1: Does This Patient Need Surgery NOW? Obvious penetrating injury to abdomen Peritonitis Hypotensive Step 2: FAST Scan Performed with bedside ultrasound machine Blood/intra-peritoneal fluid is hypoechoic (black) in appearance Four views required Right upper quadrant Probe marker points towards patient’s head “Morrisons Pouch” Potential space between liver and right kidney Left upper quadrant...

Cardiac tamponade. Aortic Dissection. Blunt cardiac injury. Cardiac Tamponade Blood fills pericardial sac Increasing pressure on myocardium -> Decreased preload Decreased preload -> Hypotension -> Death Clinical exam shows Beck’s Triad Hypotension Muffled heart sounds Jugular venous distension (JVD) Diagnosed during FAST exam (subxiphoid view) Treat with pericardiocentesis Bedside thoraco...

Step 1: Perform ATLS Primary Survey (B- Breathing) Signs of respiratory distress/injury Shortness of breath Hypoxemia Tracheal deviation Diminished breath sounds Step 2: Consider Performing Bedside Tube Thoracostomy Insert at 5th intercostal space just anterior to mid-axillary line Step 3: Imaging Start with portable bedside chest x-ray Pneumothorax can also be diagnosed by thoracic ultrasound […]

The hardest question… Should you get a CTA? Blunt Trauma of Neck Obtain CTA if… Patient has neurologic deficit Numbness Weakness Visual changes Patient sustained forceful impact to the neck Patient has fracture Basilar skull Facial bones Cervical spine Penetrating Trauma of the Neck Go to OR if patient is unstable Go to OR if […]

Step 1: Protect the Spine Apply cervical collar Step 2: Apply NEXUS Criteria Use the “SPINE” mnemonic Spinal midline tenderness Painful distracting injury Intoxication Neurologic deficit Encephalopathy Step 3: If Patient Has None of the NEXUS Criteria… You Are Done! Step 4: If Patient Has Positive NEXUS Criteria… Obtain CT scan of the cervical scan […]

There are 6 major areas/injuries to the face. Basic Approach to Facial Injury Step 1: Airway Indications for intubation after trauma Burns to the airway Rapidly expanding hematoma GCS <8 Step 2: CT Maxillofacial Without Contrast Step 3: Supportive Care Stop bleeding Apply pressure Control epistaxis Caution advised with packing if patient has basilar skull […]

CT scan without contrast is your test of choice. Step 1: Consider Your Differential Diagnoses Five high-yield head trauma diagnoses Skull fracture External skull fracture Basilar skull fracture Epidural hematoma Subdural hematoma Traumatic subarachnoid hemorrhage (SAH) Concussion Step 2: Important Add-ons When Taking History Specific mechanism of injury Loss of consciousness Blood thinners/antipla...

Elderly people die from abdominal pain Step 1: Risk Stratify Certain patient groups have VERY high mortality when having abdominal pain Geriatrics Immunocompromised Diabetics Step 2: Consider Genitourinary Causes Be especially cautious with lower abdominal/flank pain Mention that you performed or considered performing GU exam during presentation! Common GU causes of abdominal pain Testicular/ovari...

Get your attending! Step 1: Obtain Last Known Well Stroke treatments including tPA and thrombectomy both require last known well <3-4.5 hours for tPA <24 hours mechanical thrombectomy Step 2: Finger Stick Blood Glucose Hypoglycemia is classic mimic of CVA Results can be obtained immediately Step 3: STAT Head CT Without Contrast Poor sensitivity for […]

You need an organized, anatomical approach. Step 1: Consider Differential Diagnosis Upper airway Angioedema Foreign body Abscess Lower airway COPD Asthma Alveoli Pneumonia Pulmonary edema Blood Anemia Acidosis DKA Sepsis (lactic acid) Toxins (salicylic acid) Blood vessels Pulmonary embolism Aortic dissection Heart Myocardial infarction Acute heart failure Cardiac tamponade Step 2: Examine Anatomic...

6 EKG Findings. 6 Risk Factors. 6 Mimics. Step 1: Get an EKG This is the only “required” test for a patient with syncope Other common tests CBC Evaluate for anemia hCG If patient might be pregnant Step 2: Look For 6 High Risk EKG Patterns Mnemonic: QT-BRIDE QT prolongation Especially QTc >500 Brugada pattern […]

Acetaminophen. Ibuprofen. Hydrocodone. Ketorolac. Morphine. Hydromorphone. Oral Acetaminophen (Tylenol) Give every 4-6 hours Regular strength – 325mg Extra strength – 500mg Maximum Daily Dose – 3000mg Oral Ibuprofen (Advil) NSAID Give every 4-6 hours Regular strength – 200mg Therapeutic Ceiling – 400mg Oral Hydrocodone-Acetaminophen (Vicodin, Norco) Give ever 4-6 hours Common doses – 5-325mg, 7.5-...

You have 90 minutes to restore blood flow. Step 1: Obtain EKG and Call STEMI Alert This activates ED resources as well as cath lab, interventional cardiology, etc Step 2: Stop the Platelets Dual anti-platelet therapy Aspirin 325mg chewed (or PR) Plavix 600mg (not usually given in ED) Complicates management if patient needs CABG Step […]

Mnemonic: AEIOU-TIPS Step 1: Evaluate the Airway General principles “If they can’t speak, they can’t control their airway” “If GCS is <8, intubate” In the real world, it’s a clinical judgement call Postictal patients? Intoxicated patients? Step 2: Point of Care Labs Finger stick blood glucose EKG Dysrhythmia? Ischemia? Abnormal intervals? Pregnancy test Step 3: […]

Poison Control Hotline: 1-800-222-1222 Step 1: Evaluate the Airway General principles “If they can’t speak, they can’t control their airway” “If GCS is <8, intubate” In the real world, it’s a clinical judgement call Step 2: Toxicology History What did they take? How much did they take? Why did they take it? When did they […]

3 Categories: High Risk BRUE. Low Risk BRUE. Not a BRUE. Step 1: Is This a BRUE? Brief <60 seconds Resolved Exam and vitals back to baseline in the ED Unexplained No symptoms other than event itself Event Concerning change in any of the following… Tone Color Breathing Mental status Step 2: Is This Low […]

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 <8, intubate” In the real world, it’s a clinical judgement call General c-spine principles Clear c-spine with NEXUS/Canadian rules Otherwise stabilize spine and place in cervical collar Breathing If patient...

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 […]

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 Headache Visual changes A...

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 […]

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 ketoacidosis Step 2: Do Pedi...

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 Diagnosis: Ultraso...

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 […]

“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 […]