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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

    • Medicin
    • 5.0, 3 betyg

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.

    Round 11 (Headache)

    Round 11 (Headache)

    CAUTION: THESE NOTES CONTAIN SPOILERS!!!







    Case Introduction







    You are having a busy day in the department when you are paged overhead to the resuscitation bay for an ill appearing patient with a headache…







    Initial Vitals







    * Temp 98.9* HR 99* RR 18* BP 180/110* O2 94%







    Critical Actions







    * Verbalize a Full Neurologic Examination* Obtain CT Scan Without Contrast* Consult Neurosurgery for Subarachnoid Hemorrhage* Reverse Warfarin Coagulopathy* Administer Antihypertensives







    Final Diagnosis







    Acute Subarachnoid Hemorrhage on Anticoagulation







    Tips and Tricks







    Always ask the patient if they have allergies prior to administering ANYTHING.







    Additional Reading







    * Basics of Subarachnoid Hemorrhage (EM Clerkship)* How to Reverse Warfarin (AHA)

    • 33 min
    Round 10 (Allergic Reaction)

    Round 10 (Allergic Reaction)

    CAUTION: THESE NOTES CONTAIN SPOILERS!!!







    Case Introduction







    A 45 year old female is exposed to peanut butter and shrimp pizza and begins to have an apparent allergic reaction…















    Initial Vitals







    * Temp 98.8* HR 130* RR 35* BP 70/40* O2 92%







    Critical Actions







    * Verbalize Airway Evaluation* Complete a FOCUSED History and Exam* Normal Saline Bolus* Epinephrine both IM and (subsequently) IV* Glucagon 1mg IV







    Final Diagnosis







    Refractory Anaphylaxis Due to Beta Blockers







    Tips and Tricks







    You still need to obtain a quick history and exam even if you know the diagnosis in the first few seconds of the case







    Additional Reading







    * Basic approach to anaphylaxis (EM Clerkship)* Tranexamic acid as first-line emergency treatment for episodes of bradykinin-mediated angioedema induced by ACE inhibitors. (PubMed)* Glucagon infusion in refractory anaphylactic shock in patients on beta-blockers. (PubMed)

    • 30 min
    Round 9 (Seizure)

    Round 9 (Seizure)

    CAUTION: THESE NOTES CONTAIN SPOILERS!!!







    Case Introduction







    The nurse brings back a young adult male from the lobby who is having a seizure…







    Initial Vitals







    * Temp 98.8* HR 90* RR 10* BP 120/80* O2 92%







    Critical Actions







    * Verbalize ABCs on a Critical Patient* Obtain Immediate Blood Glucose Level* Give Benzodiazepine* Initiate Workup of New-Onset Seizures* Give Pyridoxine (Vitamin B6)







    Final Diagnosis







    Isoniazid Toxicity







    Tips and Tricks







    When the patient is unable to provide history, attempt to obtain the information from external sources







    Additional Reading







    * Isoniazid toxicity overview (Life in the Fast Lane)* Basic approach to seizures (EM Clerkship)* Basic approach to status epilepticus (EM Clerkship)* Ketamine for refractory status epilepticus (PubMed)







    Corrections







    Ketamine not Keppra as potential induction agent for status epilepticus (32:40)

    • 38 min
    Round 8 (Fall)

    Round 8 (Fall)

    CAUTION: THESE NOTES CONTAIN SPOILERS!!!







    Case Introduction







    EMS brings in an elderly man who has fallen…







    Initial Vitals







    * Temp 98.6* HR 58* RR 16* BP 105/60* 99%







    Critical Actions







    * Treat the patient’s pain* Consult orthopedics for a hip fracture* Obtain an EKG* Treat Severe Hyperkalemia* Consult nephrology for dialysis







    Final Diagnosis







    Ground level fall resulting in hip fracture, missed dialysis, and severe hyperkalemia







    Tips and Tricks







    Patient’s will frequently have more than one final diagnosis. Do not prematurely close an the initial, obvious, diagnosis.







    A man can have as many diseases as he damn well pleases! Hickam’s dictum







    Additional Reading







    * Basic approach to hyperkalemia (EM Clerkship)* EKG manifestations of hyperkalaemia (LITFL)

    • 29 min
    Round 7 (Headache)

    Round 7 (Headache)

    CAUTION: THESE NOTES CONTAIN SPOILERS!!!







    Case Introduction







    Just a routine day at your hospital, your next patient has a chief complaint of headache…







    Initial Vitals







    * Temp 98.8* HR 88* RR 16* BP 130/80* O2 99%







    Critical Actions







    * Identify Acute Angle Closure Glaucoma* Initiate Appropriate Treatment for Acute Angle Closure Glaucoma* Emergent Consult to Ophthalmology* Recheck Intra-Ocular Pressure After Initiating Treatment







    Dangerous Actions







    * Giving NSAIDS (The Patient Had This on Allergy List)* Performing a Lateral Canthotomy







    Final Diagnosis







    Acute Angle Closure Glaucoma







    Tips and Tricks







    Do not be surprised or scared when an examiner has a monotone voice and flat affect







    Additional Reading







    * Management of acute angle closure glaucoma (PubMed)* Basic approach to eye complaints (EM Clerkship)

    • 30 min
    Round 6 (Back Pain)

    Round 6 (Back Pain)

    CAUTION: THESE NOTES CONTAIN SPOILERS!!!







    Case Introduction







    A notorious, disheveled frequent flyer presents to your emergency department for her back pain and is asking for more Dilaudid…







    Initial Vitals







    * Temp 99.0* HR 99* RR 18* BP 118/78* O2 99%







    Critical Actions







    * Ask about Red Flags for Spinal Infection* Perform a Thorough Spinal Exam* Obtain MRI Spine with Contrast* Initiate Broad Spectrum Antibiotics* Treat Pain when Pathology Identified







    Final Diagnosis







    Spinal Epidural Abscess







    Tips and Tricks







    Don’t let consultants or other members of your team talk you out of appropriate management of a patient







    Additional Reading







    * Basic approach to Back Pain (EM Clerkship)* Epidural Abscess Overview (AAFP Website)

    • 52 min

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