229 episodes

The purpose of this podcast is to help medical students crush their emergency medicine clerkship and get top 1/3 on their SLOE. The content is organized in an approach to format and covers different chief complaints, critical diagnoses, and skills important for your clerkship.

EM Clerkship Zack Olson, MD and Michael Estephan, MD

    • Health & Fitness

The purpose of this podcast is to help medical students crush their emergency medicine clerkship and get top 1/3 on their SLOE. The content is organized in an approach to format and covers different chief complaints, critical diagnoses, and skills important for your clerkship.

    Ethylene Glycol (Deep Dive MW R18)

    Ethylene Glycol (Deep Dive MW R18)

    Phase One: CNS









    * Ataxia, Slurred Speech, Confusion, N/V, Seizures









    Phase Two: Cardiopulmonary









    * CHF, Cardiogenic Shock/Hypotension, Pulmonary Edema, ARDS









    Phase Three: Renal









    * Flank pain, Hematuria, Oliguria, Renal Failure









    Diagnosis:









    * HIGH INDEX OF SUSPICION







    * Ethylene Glycol Serum Level







    * Elevated Osmolar Gap







    * Serial Anion Gap Measurements









    Treatment:









    * Fomepizole or Ethanol to prevent breakdown to toxic glycolic acid/oxalic acid







    * Hemodialysis







    * Consider Bicarb drip, pyridoxine, and thiamine

















    Further Reading:







    EMCrit Toxic Alcohols

    • 18 min
    Round 18 (MW) Drunk Man Wants Pizza

    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:









    * Recognize Hypoxemia







    * Diagnose Toxic Alcohol Ingestion







    * Consult Nephrology Emergent Dialysis







    * Administer Fomepizole







    * Workup Anion Gap Metabolic Acidosis

    • 36 min
    Pre-Eclampsia (Deep Dive MW R17)

    Pre-Eclampsia (Deep Dive MW R17)

    Hypertensive Emergencies of Pregnancy







    PreEclampsia, Eclampsia, HELLP syndrome







    Diagnosis: BP >140/90 plus end organ dysfunction









    * Acute Kidney Injury







    * Proteinuria







    * Thrombocytopenia







    * Transaminitis







    * Hemolysis







    * Pulmonary Edema







    * Cerebral Edema / Hemorrhage







    * Headache refractory to tylenol







    * Visual Changes







    * RUQ Pain not attributable to another diagnosis









    Treatment









    * Loading Dose: IV Magnesium 4-6g over 20-30 min OR 5g IM in each buttock







    * Maintenance Dose: 1g/hr IV







    * Antihypertensives (goal 20% reduction): Labetalol, Nicardipine, Hydralazine







    * Delivery of fetus and placenta

    • 16 min
    Round 17 (MW) Headache

    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:









    * Check a Blood Glucose







    * Diagnose Preecclampsia/Ecclampsia







    * Administer Magnesium







    * Treat the Hypertension







    * Discuss with OBGYN and Admit

    • 30 min
    Pulmonary Embolism (Deep Dive MW R16)

    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









    * High Risk/Massive PE: Hemodynamic Instability







    * Intermediate Risk/Submassive PE: Right Heart Strain without instability ; or PESI Class 3+







    * Low Risk/Non-Massive PE: Everything else (no instability, no heart strain, PESI Class 1-2)









    Treatment of PE









    * High Risk/Massive PE: Thrombolytics and often thrombectomy







    * Intermediate Risk/Submassive PE: Heparin and sometimes intervention







    * Low Risk/Non-Massive PE: Either discharge with DOAC or admit with heparin

    Round 16 (MW) Leg Pain

    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: 74%







    Critical Actions:









    * Obtain full set of vital signs







    * Treat the patient’s pain







    * Diagnose PE without imaging







    * Stabilize patient prior to imaging







    * Transfer the patient for thrombectomy

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