The EM Clerkship Podcast

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 […]

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 […]

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 […]

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 […]

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 history Obtain XRs, FA...

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 […]

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 […]

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 […]

Cardiac Tamponade Cardiac Tamponade – A physiological state caused by a pericardial effusion in which the pressure in the pericardial sac is higher than the pressure inside the right sided chambers of the heart, leading to impaired filling, decreased cardiac output, and hemodynamic collapse. Pericardial Effusions – Can be caused by infections, rheumatologic diseases, malignancy, […]

Case Introduction You are working a shift at your local free-standing emergency room when a family of three checks in to be seen (a father and his two sons). Initial Vitals#1 (Chris, 18mo with stridor) Temp 100.4F HR 120 RR 40 O2 93% Critical Actions#1 (Chris, 18mo with stridor) Check pulse oximetry (hidden) Administer PO […]

Hyponatremia in the ED Four questions to ask yourself: Is the patient symptomatic from their hyponatremia (confusion, nausea/vomiting, ams, seizures, etc)? If not, outpatient followup (unless super low) Is the patient having severe neurologic symptoms from their hyponatremia? (seizures, AMS) If yes, treat with hypertonic saline (3%) Is the patient going to be admitted from […]

CAUTION: THESE NOTES CONTAIN SPOILERS!! Case Introduction You are working a shift at EM Clerkship General when you receive a radio call from EMS who are bringing in a young female who was found unresponsive. Initial Vitals Temp 98.0F HR 97 RR 16 BP 120/80 O2 98% Critical Actions Obtain collateral history from EMS/friends Administer […]

Asymptomatic Hypertension Make SURE the patient isn’t having symptoms of end organ dysfunction, which could make this hypertensive emergency (confusion, severe headache, blurry vision, weakness, chest pain, shortness of breath, seizures during pregnancy, etc). ACEP clinical policy states, that in the patient with true asymptomatic hypertension who presents to the emergency department, no routine t...

CAUTION: THESE NOTES CONTAIN SPOILERS!! Case Introduction You are working a shift at EM Clerkship General when you are handed the next chart, a 60 year old male presenting with high blood pressure. Initial Vitals Temp 98.0F HR 90 RR 18 BP 220/120 O2 98% Critical Actions Perform thorough neurological exam (and find papilledema) Diagnose […]

Neonatal Resuscitation *THIS IS A BASIC FRAMEWORK AND IS NOT COMPREHENSIVE* EVALUATE Is the newborn crying/breathing spontaneously? Does the newborn have good tone? Is the newborn a term infant? If YES, hand baby to mom for direct skin-to-skin. If NO, proceed to step 2. INTERVENE STIMULATE – dry vigorously WARM – place cap on head, […]

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkship General when the triage nurse runs and grabs both you and your attending for a patient in triage who has active CPR in progress. Initial Vitals Temp 98.0F HR 0 RR 0 BP unmeasurable O2 70% Critical Actions Identify pregnancy […]

Torsades de Pointes (TdP) A type of polymorphic ventricular tachycardia that is inherently unstable and often quickly degrades into ventricular fibrillation. It usually occurs in the setting of a prolonged QT interval, which can either be genetic or acquired. Treatment Defibrillation – per ACLS, ventricular tachycardia with a pulse should receive synchronized cardioversion. But in […]

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkship General when EMS calls you on the radio… "Hey doc we're bringing a young female who drowned in a pool ETA 1 minute". Initial Vitals * Temp 95.0F* HR 55* RR 5-6* BP 110/82* O2 90% Critical Actions * Evaluate for traumatic injury (and/or place C-Collar)* Intubate the patient* Identify Long QT Syndrome...

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkship General when EMS calls you on the radio… “Hey doc we’re bringing a young female who drowned in a pool ETA 1 minute”. Initial Vitals Temp 95.0F HR 55 RR 5-6 BP 110/82 O2 90% Critical Actions Evaluate for traumatic […]

Kawasaki Disease A small vessel vasculitis that affects children, usually <5 years old. Symptoms – remember the CRASH AND BURN mnemonic! Conjunctivitis Rash – nonspecific morbilliform or maculopapular rash, usually on torso Adenopathy – usually unilateral cervical lymphadenopathy Strawberry Tongue – erythema, swelling, or cracking of lips/mucous membranes Hands – swelling, erythema, or desquama...

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkshift General when the next chart is handed to you – a four year old male named Tommy with chief complaint of dehydration. Initial Vitals Temp 100.4F HR 132 RR 22 BP 98/64 O2 98% Critical Actions Identify key historical findings […]

“The Brady Bunch” – Beta-Blockers, Calcium Channel Blockers, Digoxin, Clonidine Treatment of Beta Blocker OD Activated Charcoal – Only if ingestion time was <1 hour ago, and only if patient is protecting their airway (or intubated).   2. Glucagon – the best answer for the exam, unlikely to work in real life 3. Epinephrine Drip […]

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkshift General when you are called to the resuscitation bay to see an elderly patient with unstable vitals brought in by EMS. Initial Vitals * Temp 98.0F* HR 43* RR 18* BP 60/40* O2 98% Critical Actions * Diagnose the etiology for the bradycardia (BB overdose)* Administer Atropine* Administer Glucagon* Adm...

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkshift General when you are called to the resuscitation bay to see an elderly patient with unstable vitals brought in by EMS. Initial Vitals Temp 98.0F HR 43 RR 18 BP 60/40 O2 98% Critical Actions Diagnose the etiology for the […]