EM Clerkship Zack Olson, MD and Michael Estephan, MD
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- 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.
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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 -
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 -
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 -
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 -
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
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