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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Orbital Compartment Syndrome (Deep Dive MW R21)
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12:35
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Orbital Compartment Syndrome – needs to be diagnosed CLINICALLY On exam, LOOK for: Proptosis, Ophthalmoplegia, Afferent Pupillary Defect, Vision Loss On exam, FEEL for: Rock hard globe, tense eyelids, resistance to retropulsion IOP > 40 means immediate canthotomy is indicated! Don’t perform if open globe is present Lateral Canthotomy Procedure: Ane…
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You are working at Clerkship General when the next chart is put into your rack. It’s a 76 year-old male who has fallen. Initial Vitals: HR: 101 BP: 138/85 Temp: 98.0F RR: 20 O2: 99% (Room Air) Critical Actions:By Zack Olson, MD and Michael Estephan, MD
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Symptoms of stroke – weakness, facial droop, slurred speech. vision loss, vertigo, ataxia, confusion or changes to mental status. The “typical” stroke workup – blood glucose level, CTH non-con, CTA head/neck, CT Perfusion, CBC BMP Troponin EKG CXR and Coags. Common stroke mimics – hypoglycemia, drug/alcohol intoxication, Bell’s palsy, aortic dissec…
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You are working at Clerkship General when one of the nurses comes and grabs you. “Hey doc, we need you in bed 10. I think this patient is having a stroke.” Initial Vitals: HR: 51 BP: 201/98 Temp: 98.0F RR: 18 O2: 99% (Room Air) Critical Actions:By Zack Olson, MD and Michael Estephan, MD
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* Common during the first year of life as well as during puberty * Presents with nausea/vomiting, abdominal pain, and/or testicular pain * ALWAYS examine a child for signs of torsion who presents with abdominal pain (especially lower abdominal pain) * Look for tenderness, firmness, high riding testicle or testicle with unequal lie, swelling, and th…
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Round 19 (MW) Tummy Ache in Child with Diabetes
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You are working at Clerkship General when the next patient is put into your rack. It is an 8 year-old male with vomiting Initial Vitals: HR: 119 BP: 104/63 Temp: 98.0F RR: 20 O2: 99% (Room Air) Critical Actions: References: Mellick LB, Sinex JE, Gibson RW, Mears K. A Systematic Review of Testicle Survival Time […]…
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Phase One: CNS Phase Two: Cardiopulmonary Phase Three: Renal Diagnosis: Treatment: Further Reading: EMCrit Toxic AlcoholsBy Zack Olson, MD and Michael Estephan, MD
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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:By Zack Olson, MD and Michael Estephan, MD
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Hypertensive Emergencies of Pregnancy PreEclampsia, Eclampsia, HELLP syndrome Diagnosis: BP >140/90 plus end organ dysfunction TreatmentBy Zack Olson, MD and Michael Estephan, MD
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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:By Zack Olson, MD and Michael Estephan, MD
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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 Treatment of PEBy Zack Olson, MD and Michael Estephan, MD
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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: […]…
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Shock – A state of deranged physiology characterized by systemic, widespread hypoperfusionBy Zack Olson, MD and Michael Estephan, MD
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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:…
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* 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…
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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:By Zack Olson, MD and Michael Estephan, MD
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* 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…
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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:By Zack Olson, MD and Michael Estephan, MD
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Organophosphate Poisoning (Deep Dive R12 MW)
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Introduction Clinical Presentation TreatmentBy Zack Olson, MD and Michael Estephan, MD
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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:By Zack Olson, MD and Michael Estephan, MD
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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 DystociaBy Zack Olson, MD and Michael Estephan, MD
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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. ThrombosisBy Zack Olson, MD and Michael Estephan, MD
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The 6 STEMI Equivalents: Other atypical ischemic EKG findings: Further Reading (see photos in the article): ECG Diagnosis of Life-Threatening STEMI Equivalent’s: Journal of the American College of CardiologyBy Zack Olson, MD and Michael Estephan, MD
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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:By Zack Olson, MD and Michael Estephan, MD
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Consider removing the terminology “Agitated Delirium” from your vocabulary, as there is significant racial bias behind this term.By Zack Olson, MD and Michael Estephan, MD
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