The EM Clerkship Podcast

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction An ill appearing patient has been rushed back from the lobby, clutching his chest, you are needed immediately at the bedside… Initial Vitals Temp 99.1 HR 95 RR 20 BP 120/80 O2 98% Critical Actions Obtain Early EKG Notify Cardiology of Inferior STEMI Bring Crash Cart to Bedside […]

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction EMS brings in a postictal 34 year old female after she has a seizure. She is complaining of a headache… Initial Vitals Temp 98.9 HR 110 RR 10 BP 175/115 O2 95% Critical Actions Articulate Full Neurologic Exam Early Blood Glucose Identification of Pregnancy Administer Magnesium Treat the […]

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are called to the resuscitation bay for a poorly responsive patient that has been brought in by EMS. Initial Vitals Temp 98.8 HR 78 RR 4 BP 124/78 O2 98% Critical Actions Obtain Early Blood Glucose Administer Dextrose Obtain Salicylate and Acetaminophen Levels Admit for Further Observation […]

ABEM-style cases presented on EM Clerkship are not my actual ABEM exam cases, and they are not derived from my actual exam cases. I will never be discussing my specific exam details with anybody, including on this podcast. The cases were created independently, by me, for the purpose of medical education and improving patient care. […]

There are HUNDREDS of other non-GI/GU causes of abdominal pain… Acute coronary syndrome (ACS) Test with EKG and troponin Treat with aspirin and heparin Acidosis Diabetic Ketoacidosis (DKA) Respiratory Acidosis (COPD) Salicylate Toxicity (Remember MUDPILES) Abdominal Aortic Aneurysm (AAA) Older people with abdominal/flank/back pain or syncope Testing CT Scan Abdomen with contrast (Good) CTA Abdomen...

Testicular Torsion History Pain in the testicles Referred pain in the flank or lower abdomen Usually sudden and severe Usually WITHOUT urinary symptoms Exam Asymmetric testicular lie High riding testicle Tenderness and swelling of the testicle itself Cremasteric reflex Testing Testicular Ultrasound Treatment Immediate call to urology when suspected Manual detorsion (“Open the Book”) Prostatitis […...

Women have two additional diseases that must be added to the differential diagnosis of their abdominal pain. PID and ovarian torsion. Pelvic Inflammatory Disease (and Tube-Ovarian Abscess) Deep pelvic infections high in the reproductive tract frequently caused by sexually transmitted infection but can be caused by other infections (especially anaerobic infections) as well History Symptoms […]

How to Read a Urinalysis Signs of Inflammation Leukocyte Esterace WBCs Multiple conditions cause inflammation on a urinalysis. Anything that causes nearby inflammation (appendicitis, pelvic infections, diverticulitis) or slows urine output (dehydration, renal disease) can commonly elevate these markers. Signs of bacterial presence (not present in ~25% of proven urinary tract infections!!!) Nitrite...

All women of childbearing age who present with abdominal pain need a pregnancy test a core teaching of EMergency medicine Ectopic pregnancy is the leading cause of maternal death in the first trimester History Abdominal pain present in 90% of cases Amenorrhea present in 70% of cases Vaginal bleeding present in 50% of cases The […]

Bowel Perforations History Perforation takes time, frequently symptoms were either ignored or not noticed as can occurring in… Elderly, diabetic, or immunosuppressed patients (frequently have minimal symptoms) Pediatric patients (unable to or scared to mention symptoms) Exam Commonly have “peritoneal signs” Guarding Rebound Tenderness Rigidity Testing CT Scan X-Ray? (not your primary test, but a [...

Mesenteric Ischemia Celiac truck supplies blood to the stomach and duodenum SMA supplies blood to the rest of the small bowel and proximal colon IMA supplies blood to the distal colon and rectum Arterial flow can be blocked because of emboli (atrial fibrillation) Venous flow can be blocked because of thrombosis (hypercoagulable states) Effective flow […]

Biliary Diseases Biliary Colic- A gallstone DOES NOT GET STUCK, but it slowly rolls out of the gallbladder, through the cystic duct, then the common bile duct and pancreatic duct. This results in several hours of crampy “colicky” pain as the stone passes. Cholecystitis- A gallstone gets stuck IN THE NECK OF THE GALLBLADDER OR […]

Appendicitis History Vague nonspecific abdominal cramping and nausea (Nonspecific Phase) gradually progresses to localized pain (Localized Phase). The pain most commonly localizes in the RIGHT LOWER QUADRANT near McBurney’s Point. Exam Focal tenderness in the right lower quadrant McBurney’s Point: 1/3 the distance traveled from anterior superior iliac spine (ASIS) to the navel. Psoas Sign: […]

EM Clerkship’s 10 Step Patient Presentation Demographics (Age, Gender, Pertinent Medical/Surgical History, Chief Complaint) At Least 4 Descriptors (Location, Quality, Severity, Duration, Timing, Context, Modifying Factors) Red Flags/Pertinent Positives and Negatives Vital Signs Focused Physical Exam of the Complaint Suspected Diagnosis Can’t Miss Diagnosis Testing Plan Treatment Plan (If Asked) An...

EM Clerkship’s 10 Step Patient Presentation Demographics (Age, Gender, Pertinent Medical/Surgical History, Chief Complaint) At Least 4 Descriptors (Location, Quality, Severity, Duration, Timing, Context, Modifying Factors) Red Flags/Pertinent Positives and Negatives Vital Signs Focused Physical Exam of the Complaint Suspected Diagnosis Can’t Miss Diagnosis Testing Plan Treatment Plan (If Asked) An...

Tip #26 Update your attending when the nurse is having difficulty with your patient’s IV or drawing blood. Tip #27 Get the urine sample from your patient (there is no greater delay in patient flow than waiting on urine) Tip #28 Round on your patients and repeat your initial scripting. “It’s Zack the medical student […]

Tip #21 Review and note if the patient has any IMPORTANT old records. Any ED visit within the last month for a similar complaint (aka “Bouncebacks” and frequent fliers) Any echocardiogram or catheterization reports for a patient with cardiac symptoms H&P and discharge summary for recent hospitalizations Any large imaging studies (CT, MRI, etc) that […]

Tip #16 Recheck the patient’s heart rate and respiratory rate (and put in your presentation that you did so) Heart rate frequently falsely elevated when being triaged Respiratory rate frequently falsely normal when being triaged Tip #17 Fully examine the specific complaint. Some common misses include… Neurologic complaints (headache, paresthesias, dizziness, asymptomatic hypertension, seizures, vi...

Tip #11 Give 4 descriptors/adjectives for each complaint Location Quality Duration Modifying Factors Severity Context Timing Associated Symptoms Tip #12 Get the ACTUAL story. Why did the patient come NOW? Did something change or worsen? Did family force them to come? Do they have a family history of something similar? Tip #13 Present the pertinent […]

Tip #6 Make your patient remember your name. Introduce yourself clearly Show the patient your badge Use a nickname if your name is difficult for people to remember/understand Repeat your name again and again Tip #7 Keep the patient informed about… Diagnosis Anticipated ED course/timeline Delays Tip #8 Keep your patient comfortable. Get them blankets […]

Tip #1 Introduce yourself. Attending? “Hello, my name is Zack, I’m one of the medical students” Resident? “Hello, my name is Zack, I’m one of the medical students” Nurse? “Hello, my name is Zack, I’m one of the medical students” Janitor? “Hello, my name is Zack, I’m one of the medical students” Tip #2 Be […]

Verbalize the out loud prior to performing rapid sequence intubation. The Bougie Ideal for situations when you’re view is suboptimal Advance it through the cords and into the trachea BEFORE the endotracheal tube. It will stay in place and guide the tube into position (this is called a Seldinger technique). Video Laryngoscopy (Glidescope) Laryngoscope with […]

The most important thing to do when preparing for RSI is to PREOXYGENATE the patient. Step 1: Choose Your Equipment Miller or Mac blade? Miller blade is straight (like the ‘L’ in miller) Frequently used in kids Mac blade is curved (like the ‘c’ in mac) (Generally, this is the best choice to use on […]

How do you oxygenate a patient (while you are preparing for RSI) if suction, moving the tongue, and basic BVM ventilation are unsuccessful? Pharyngeal Airways These tools bypass the posterior portion of the tongue to help with BVM ventilation Nasopharyngeal Airway (NP) Measure from earlobe to tip of nose TEST QUESTION: Don’t use in a […]

Most Life Threatening Fungal Infection Mucormycosis Black facial discharge Cranial nerve dysfunction Facial swelling Eschar formation When to Suspect a Fungal Infection Immunocompromised (HIV, Diabetes, Organ Transplants, etc) Not getting better on typical antibiotics Other Fungal Infections Aspergillus Aspergilloma Bronchopulmonary Aspergillosis Invasive Aspergillosis Coccidiomycosis Southwestern...