EM Clerkship

Testicular Torsion (Deep Dive MW R19)

Round 19 (MW) Tummy Ache in Child with Diabetes

You are working at Clerkship General when the next patient is put into your rack. It is an 8 year-old male with vomiting Initial Vitals: HR: 119 BP: 104/63 Temp: 98.0F RR: 20 O2: 99% (Room Air) Critical Actions: References: Mellick LB, Sinex JE, Gibson RW, Mears K. A Systematic Review of Testicle Survival Time […]

Ethylene Glycol (Deep Dive MW R18)

Phase One: CNS Phase Two: Cardiopulmonary Phase Three: Renal Diagnosis: Treatment: Further Reading: EMCrit Toxic Alcohols

Round 18 (MW) Drunk Man Wants Pizza

You are working at Clerkship General when you hear an EMS call on the radio. Clerkship General, we are bringing you Arthur. He is intoxicated… Again Initial Vitals: HR: 116 BP: 150/70 Temp: 98.8 RR: 26 O2: 85% (Room Air) Critical Actions:

Pre-Eclampsia (Deep Dive MW R17)

Hypertensive Emergencies of Pregnancy PreEclampsia, Eclampsia, HELLP syndrome Diagnosis: BP >140/90 plus end organ dysfunction Treatment

Round 17 (MW) Headache

You are working at Clerkship General when the next chart is put in your rack. It’s a 41-year-old female with a chief complaint of headache. Initial Vitals: HR: 56 BP: 172/93 Temp: 98.8F RR: 18 O2: 97% Critical Actions:

Pulmonary Embolism (Deep Dive MW R16)

Diagnosing PE: Step 1: Consciously consider the diagnosis Step 2: Risk Stratify into low, intermediate, and high risk Step 3: Choose appropriate testing based on pre-test probability Classification of PE Treatment of PE

Round 16 (MW) Leg Pain

You are working at Clerkship General when you overhear the base command radio. “Clerkship General. We have a 57 year-old female coming in for leg pain. She just had surgery at your hospital. Her blood pressure is 85/50. We’ll be there in 5 minutes.” Initial Vitals: HR: 122 BP: 75/40 Temp: 100.1 RR: 24 O2: […]

Shock (Deep Dive R15 MW)

Shock – A state of deranged physiology characterized by systemic, widespread hypoperfusion

Round 15 (MW) MVA

You are working at Clerkship General when you hear and EMS call on the radio. “Clerkship General, we are activating a trauma alert. We are bringing you a 33 year old male from a high-speed single vehicle collision” Initial Vitals: HR: 65 BP: 88/50 Temp: 97.0F RR: 20 O2: 96% Room Air Critical Actions:

Pediatric Septic Arthritis (Deep Dive R14 MW)

Round 14 (MW) Leg Pain

You are working a beautiful sunny day in Pennsylvania when the next chart gets put in your rack. It is a 2 year-old male with a leg injury. Initial Vitals: HR: 112 BP: 97/67 Temp: 99.2F RR: 20 O2: 97% Room Air Critical Actions:

Asthma (Deep Dive R13 MW)

Round 13 (MW) Respiratory Distress

You are working at Clerkship General when you hear an EMS call: “Clerkship General, we are bringing you a young female in respiratory distress. ETA 2 minutes” Initial Vitals: HR: 123 BP: 142/78 Temp: Unknown RR: 36 O2: 97% (NonRebreather) Critical Actions:

Organophosphate Poisoning (Deep Dive R12 MW)

Introduction Clinical Presentation Treatment

Round 12 (MW) Respiratory Distress

You are working at Clerkship General when you hear an EMS call on the radio. “Clerkship General. We are bringing you an unresponsive 6-year-old female found foaming at the mouth by her babysitter. ETA 2 minutes.” Initial Vitals: BP: 125/80 HR: 62 RR: 34 O2: 81% (Non Rebreather) Critical Actions:

OBGYN: The Vaginal Delivery (Pt 2)

Shoulder dystocia is an OB emergency. Remember McRobert’s maneuver and suprapubic pressure. For more information, take a look at the resources below. References ACOG- Shoulder Dystocia AAFP- Shoulder Dystocia

OBGYN: The Vaginal Delivery (Pt 1)

Maddie’s 7 Cardinal Movements of a Successful Delivery: 1. Head comes out 2. Head turns 3. Cord Assessment 4. Anterior shoulder delivered 5. Posterior shoulder delivered 6. Body delivered. 7. Baby on mom’s chest T’s of Postpartum Hemorrhage: 1. Tone 2. Trauma 3. Tissue 4. Thrombosis

The Ischemic EKG (Deep Dive R11 MW)

The 6 STEMI Equivalents: Other atypical ischemic EKG findings: Further Reading (see photos in the article): ECG Diagnosis of Life-Threatening STEMI Equivalent’s: Journal of the American College of Cardiology

Round 11 (MW) Chest Pain

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:

Agitation (Deep Dive R10 MW)

Consider removing the terminology “Agitated Delirium” from your vocabulary, as there is significant racial bias behind this term.

Round 10 (MW) Agitation

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: Dangerous Actions: […]

Lumbar Punctures (Deep Dive R9 MW)

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 […]

Round 9 (MW) Altered Mental Status

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: Check Out: Pearson Ravitz Webinar – “Disability Insurance 101 for Residents” https://us06web.zoom.us/webinar/register/1416806357023/WN_ziYRNc0kT8yAyOOJZ-Xk2g

Priapism (Deep Dive R8 MW)

Round 8 (MW) Groin Pain

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:

Upper GI Bleed (Deep Dive R7 MW)

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 – […]

Round 7 (MW) – Vomiting Blood

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: Further Reading: EMDocs – GI Bleed

Flash Pulmonary Edema (aka SCAPE)

Opioid Use Disorder – What You Do Matters!

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! References

The Rank List

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: https://www.emra.org/books/msadvisingguide/preparing-and-submitting-your-rank-list/

Aortic Dissection (Deep Dive R6 MW)

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 Further Reading: Core EM – Aortic Dissection LITFL – Aortic Dissection

Round 6 (MW) – Weakness

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 […]

New Years Resolutions

Not your typical wellness episode – by Zack

Round 5 (MW) – Leg Pain

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:

DKA (Deep Dive R4 MW)

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 […]

Round 4 (MW) – Shortness of Breath

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 […]

Interviews Part 2 – Acing your interview

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 […]

Black Box Warnings (Deep Dive R3 MW)

show notes coming soon

Round 3 (MW) – MVC

Show comments to be posted shortly

Interviews Part 1 – Crafting your schedule

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 […]

Ectopic Pregnancy (Deep Dive R2 MW)

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 […]

Round 2 (MW) – Abdominal Pain

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: […]

Selecting Programs

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 EM Further Resources: EMRA Residency MapDoximity NavigatorSAEM Residency FairEMRA Residency Fair

Competitiveness

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 harderEMRA HangoutsEMRA Student-Resident Mentorship ProgramNRMP Charting the OutcomesNRMP Residency DataALiEM – Match AdviceUTSW Texas STAR

Should I go into EM? Pt 2

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.

Round 1 (MW) – Shortness of Breath

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 […]

Should I go into EM? – Part 1

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.

Round 35 (Pediatric Trauma)

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 […]

Bradycardia (Deep Dive R34)

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, hypothermia, hypoglycemia) Acs (acute coronary […]