Episodes

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: * Apply Cervical Collar * Treat the Patient’s Pain * Give Antibiotics for Open Fracture * Identify and Prioritize Etiologies of Shock in Trauma * Start Vasopressors for Neurogenic Shock

* Differential * Traumatic causes: non-accidental trauma, fracture, dislocation, sprain, strain, tendonitis, osgood schlatter * Non-traumatic causes: septic arthritis, transient synovitis, osteomyelitis, SCFE, LCP disease, rheumatologic disease, bony tumors * Work-up * XRay * Labs to evaluate for septic arthritis – CBC BMP ESR CRP * Kocher Criteria * Non-weight bearing * Fever >38.5C * ESR >40 * WBC >12 * Kocher Criteria Statistics * 0 points: 0.2% (or 2% in prospective studies) * 1...

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: * Consider Non-Accidental Trauma * Evaluate for Septic Arthritis * Treat the Childs Pain * Diagnose Lyme Disease * Prescribe Antibiotics (Avoid Doxycycline)

* Focused Physical Exam * Tachypnea and Hypoxemia * Able to speak in complete sentences * Accessory muscle use/retractions * Moving air or quiet on auscultation * Basic Treatment Algorithm * Albuterol Inhaler * Albuterol/Ipratropium Nebulized (Duoneb) * Steroids * IV Magnesium * Non Invasive Ventilation (CPAP or BiPAP) * Decreases Work of Breathing * Epinepherine * Less Common Treatments * Benzodiazepines * Ketamine * Heliox * Intubation (Last resort) * Use a large ETT (8.0) *...

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: * Give Albuterol, Steroids, and Magnesium * Give either Epinephrine or Terbutaline * Post Intubation Checklist: Sedation, Tubes, and Xray * Choosing Appropriate Vent Settings * Allow permissive hypercapnia

Introduction * Used as pesticides * Used as weapons (nerve agents) * Sarin Gas, VX Gas, Novichok * Transdermal, Inhalation, Ingestion Clinical Presentation * Muscarinic Activation (Dumbels Mnemonic) * Defication * Urination * Myosis * Bradycardia, Bronchospasm, and Bronchorrhea * “The Killer B’s” * Emesis * Lacrimation * Salivation and Sweating * Nicotinic Activation * Muscle weakness and paralysis * CNS Activation * Respiratory Depression * Altered Mental Status * Seizures ...

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: * Grab the Broslow! * Fingerstick Glucose * Choose Endotracheal Tube Size * Administer Atropine until bronchial secretions stop * Pralidoxime

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

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 6 STEMI Equivalents: * Posterior MI * ST Depression V2/V3 (or STE in V7-V9) * Right Ventricular MI * STE V1 associated with inferior MI ; or STE V4R-V6R * Wellens Syndrome * Type A: Biphasic T-waves V2/3 * Type B: Deep Symmetric T-wave Inversion V2/V3 * De Winter’s T Wave * ST Depression with a large, symmetric, upright T wave * STE avR with diffuse ST-Depression * Usually a strain pattern due to underlying pathology, in correct clinical context can represent a left main or proxim...

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: * Give Aspirin, Nitroglycerin, and Heparin * Identify Posterior STEMI * Assess for Thrombolytic Contraindications and Consent * Transfer for PCI * Diagnose Accelerated Idioventricular Rhythm (AIVR)

* The MILDLY agitated patient : verbal de-escalation or PO benzo/antipsychotic * The MODERATELY agitated patient : IM benzo/antipsychotic * The SEVERELY agitated patient : IM Ketamine 5mg/kg Consider removing the terminology “Agitated Delirium” from your vocabulary, as there is significant racial bias behind this term.

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: * Administer Sedation for Patient/Staff Safety * Intubate the Patient and Obtain Chest Xray * Diagnose Intracranial Hemorrhage * Treat Patients Hypertension * Diagnose Rhabdomyolysis and Give Fluids Dan...

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 if necessary. Check for CSF early and often. When to CT before LP?: AMS; focal neuro deficit; new onset seizure...

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: * Diagnose Meningitis and Perform Lumbar Puncture * Give Empiric Antibiotics * Treat Septic Shock * Give Steroids * Give Prophylaxis to Close Contacts Check Out: Pearson Ravitz Webinar – “Disability Insurance 101 for Residents” https://us06web.zoom.us/webinar...

* Two Types of Priapism * Low Flow “Ischemic” (Most Common >95% of Cases) * Urologic Emergency * Results in Erectile Dysfunction * Painful * Common Etiologies * Idiopathic * Erectile Dysfunction Drugs (ex. sildenafil) * Sickle Cell Disease * Trazodone (“TrazoBONE”) * Cocaine/Meth * High Flow * Caused by Trauma and AV Fistulas * Management * Analgesia * Dorsal Penile Nerve Block * Aspiration * Can intermittently irrigate with normal saline to dilute the clot * Injection * Pheny...

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: * Diagnose Ischemic/Low Flow Priapism * Perform Penile Nerve Block * Aspirate Blood and Irrigate with Saline * Inject Intracavernous Phenylepherine * Diagnose and Treat Ventricular Tachycardia

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 – GI if unstable / if variceal bleeding Disposition – based on amount of bleeding and hemodynamic stability

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: * Place two large bore IVs * Transfuse emergency uncross matched blood * Administer IV Pantoprazole * Administer IV Ceftriaxone and IV Octreotide * Consult GI Further Reading: EMDocs – GI Bleed

* “Sympathetic Crashing Acute Pulmonary Edema” * Pathophysiology – Rapid onset of pulmonary edema caused by sudden hypertension * Triggers- Missed Medication, Cocaine, Stress/Anxiety * Increase in BP = Increase in afterload * Increased afterload causes acute pulmonary edema (in patients with CHF) * The worsening pulmonary edema causes shortness of breath which worsens blood pressure and further increases afterload * Presentation- Sudden, severe respiratory distress AND hypertension * Diff...

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! * Why you should care about OUD * What is OUD * Buprenorphine Works References * National Safety Counsel Injury Facts * DebunkingDenial – Purdue Pharma and America’s Opioid Epidemic * Addiction Neuroscience 101 – Youtube * Cochran Review – Buprenorphine for OUD

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: EM Match Advice: Post Interview Communications https://www.emra.org/books/msadvisingguide/preparing-and-submitting-your-rank-list/

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 * Historical Features * Be VERY suspicious with ABRUPT onset of chest/back pain that reaches MAXIMAL SEVERITY immediately after onset of pain. * Chest pain or Back pain with a neurologic deficit * Pain “above and below the diaphragm” * Diagnosis * CT Angiography of chest abdomen and pelvis is gold standard * Can see widened med...

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 5 minutes” Initial Vital Signs: HR 120 BP 180/90 RR 22 O2 97% Temp 97.7F Critical Actions: 1. Check a blood glucose 2. Diagnose Aortic Dissection 3. Give Esmolol first, titrate to HR<60 4. Give Nicardipine/Cle...