Episodes

Not your typical wellness episode – by Zack

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: * Treat patient’s pain without NSAIDs (history of solitary kidney) * Assess patient’s leg pain beyond the point of just fracture vs. no fracture * Recognize the signs and symptoms of compartment syndrome * Get orthopedic surgery to bedside emergently for fasciotomy * ...

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 as last resort for critical patients)* Treatment of electrolyte abnormalities* Correct sodium for hyperglycemia* Replet...

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 repletion via existing peripheral line* Admit to ICU Further Reading: EMCrit – DKA

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 you are. After interview day, be sure to capture you gut impression and write down any follow-up questions or concerns remaining. Here are some resources to use for interview day: EMR...

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* 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 ahead can help you optimize timing* Too many or too little interviews – drop early, keep tabs with whether programs have extended invites and stay in close con...

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 would recommend performing a bedside FAST exam immediately. 3. Remember that the discriminatory zone for TVUS is approximately 1500. 4. Don’t forget your three ...

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: CoreEM – Utility of Anti-D Immunoglobulin(Rho Gam) During First Trimester Pregnancy EMDocs – Bleeding in Early Pregnancy

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 EMFurther Resources: EMRA Residency MapDoximity NavigatorSAEM Residency FairEMRA Residency Fair

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

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.

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 nebulizers* Admit patient to the hospital

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.

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 Factor VIII with correct dosing (100% replacement)* Diagnose supracondylar fracture on XR and splint appropriately Further Reading: emDOCs – Managing He...

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 syndrome/ischemia) Drugs (beta blocker, calcium c...

What is most important to programs from ERAS? SLOEs, clinical grades on EM rotations and residency interviews. How do you look good on interviews? Have a thorough ERAS application that gives interviewers lots to ask about! On ERAS, there are four sections in the curriculum vitae portion: * Education – honorary societies, medical school awards, other awards/accomplishments (e.g. college, volunteer, previous career awards)* Experiences –* Work (paid, unpaid clinical or teaching)* Volunteer (pub...

ERAS Pt 1: The 8 Parts of the ApplicationThere are 8 parts to the application: * Personal and Biographic Information – mostly self-explanatory* Curriculum Vitae (Resume) – keep an updated CV throughout medical school to makethis easy to fill out, be concise but specific* Personal Statement – start early* Letters of Recommendation – should ideally have two SLOEs from rotations in EMdepartments plus one extra letter* Test Scores – transfer reports from USMLE or COMLEX* MSPE or Dean’s Letter – sub...

You are working at Clerkship General when you are called to see a 70 yo male who is presenting with shortness of breath. Initial Vitals * Temp 98.0* HR 36* RR 28* BP 80/35* O2 82% Critical Actions * Interpret ECG Correctly (3rd degree AV block)* Order a troponin* Perform and Describe transcutaneous pacing* Perform and Describe transvenous pacing* Treat NStemi (ASA, Heparin gtt, nitro if BP improved after pacing) Further Reading Complete Heart Block – EMDocs Bradycardia – EMCrit

DOPES D-Displacement – endotracheal tube dislodges from trachea, or falls into right mainstem bronchus O-Obstruction – Mucous plugging, bronchospasm, patient biting tube P –Pneumothorax – Look out for pneumothorax, it can be subtle E – Equipment – Disconnected/unpowered equipment, ensure everything is powered on and connected appropriately S – Stacking – common in asthma/COPD due to inadequate expiration resulting in air trapping between breaths Further Reading LITFL – Post-Intubation Hyp...

Brainstorming ideas – how to make it personal * What makes me unique? 2. What are some specific experiences I’ve had in my life that have either made me want to do EM or given me the skills that will prepare me well for training in EM? 3. If a family member or a friend were to describe me to a stranger, what would they talk about first? Brainstorming ideas – how to make a statement * What do I bring to the table? 2. What am I looking for in a training program? 3. Where do I see myself in ...

Welcome to EM Clerkship Maddie Watts! The personal statement should be *personal* and should *make a statement*. * Start early* Use solid organizational structure* Address the big three questions – who? what? why?* Check for grammar mistakes* Explain any red flags Further Reading: EMRA / CORD Advising Guide NRMP Program Director Survey ALiEM Match Advice Series

You are working at Clerkship General when you are called to the resuscitation bay for a 55yo M presenting in respiratory distress. Initial Vitals * Temp 99.9* HR 110* RR 22* BP 122/82* O2 82% on BiPAP 10/5 100%FiO2 Critical Actions * Correctly interpret CXR #1 (multifocal PNA)* Correctly interpret CXR #2 (bilateral PNTX)* Treat with Oseltamivir* Troubleshoot vent alarm#1 (increase sedation)* Troubleshoot vent alarm#2 (place bilateral chest tubes) Further Reading: Acute Exacerbation of COPD...