* 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 the absence of a cremasteric reflex * Consult Urology IMMEDIATELY if you have high suspicion, otherwise proceed to...

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: * Finger Stick Blood Glucose * Treat Patient’s Pain * Diagnose Testicular Torsion * Immediate Urology Consult * Perform Manual Detorsion References: Mellick LB, Sinex JE, Gibson RW,...

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...

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

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...

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

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...

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...

Shock – A state of deranged physiology characterized by systemic, widespread hypoperfusion * Hypovolemic Shock * Hemorrhage * Volume Loss (vomiting/diarrhea, dehydration) * Cardiogenic Shock * ACS, Myocarditis, CHF, Valve failure, Endocarditis, etc * Obstructive Shock * Massive PE, Tension Pneumothorax, Cardiac Tamponade * Distributive Shock * SIRS (Septic Shock, Pancreatitis, Severe Burns) * Anaphylactic Shock *...

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: * Apply Cervical Collar * Treat the Patient’s Pain * Give Antibiotics for Open Fracture * Identify and Prioritize...

* 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 * Non-weight bearing * Fever >38.5C * ESR >40 * WBC >12 *...

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: * Consider Non-Accidental Trauma * Evaluate for Septic Arthritis * Treat the Childs Pain * Diagnose Lyme Disease * Prescribe Antibiotics (Avoid Doxycycline)

* 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 * Epinepherine * Less Common Treatments *...

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: * Give Albuterol, Steroids, and Magnesium * Give either Epinephrine or Terbutaline * Post Intubation Checklist: Sedation, Tubes, and Xray * Choosing...

Introduction * Used as pesticides * Used as weapons (nerve agents) * Sarin Gas, VX Gas, Novichok * Transdermal, Inhalation, Ingestion Clinical Presentation * Muscarinic Activation (Dumbels Mnemonic) * Defication * Urination * Myosis * Bradycardia, Bronchospasm, and Bronchorrhea * “The Killer B’s” * Emesis * Lacrimation * Salivation and Sweating * Nicotinic Activation * Muscle...

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: * Grab the Broslow! * Fingerstick Glucose * Choose Endotracheal Tube Size * Administer Atropine until bronchial secretions...

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 Dystocia

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. Thrombosis

The 6 STEMI Equivalents: * Posterior MI * ST Depression V2/V3 (or STE in V7-V9) * Right Ventricular MI * STE V1 associated with inferior MI ; or STE V4R-V6R * Wellens Syndrome * Type A: Biphasic T-waves V2/3 * Type B: Deep Symmetric T-wave Inversion V2/V3 * De Winter’s T Wave * ST Depression with a large, symmetric, upright T wave * STE avR with diffuse ST-Depression * Usually a strain pattern due to...

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: * Give Aspirin, Nitroglycerin, and Heparin * Identify Posterior STEMI * Assess for Thrombolytic Contraindications and Consent * Transfer for PCI * Diagnose Accelerated Idioventricular...

* The MILDLY agitated patient : verbal de-escalation or PO benzo/antipsychotic * The MODERATELY agitated patient : IM benzo/antipsychotic * The SEVERELY agitated patient : IM Ketamine 5mg/kg Consider removing the terminology “Agitated Delirium” from your vocabulary, as there is significant racial bias behind this term.

You are working at Clerkship General when you hear an EMS call on the radio… “CLERKSHIP GENERAL – We are bringing you an agitated and combative 30 year old male, we’ll see you in 5 minutes.” Initial Vitals: BP: 192/105 HR: 134 RR: 22 O2: 99% (Room Air) Temp: 98.8 F Critical Actions: * Administer Sedation for Patient/Staff Safety * Intubate the Patient and Obtain Chest Xray * Diagnose Intracranial...

Indications for LP: CNS infection, SAH, Guillian Barree, IIH Contraindications for LP: Space occupying lesion with mass effect ; severe thrombocytopenia and coagulopathy; cellulitis over LP site or concern for epidural abscess ; traumatic injury to spine Complications for LP: Post LP Headache, spinal hematoma, brainstem herniation Technique for LP: Positioning is everything.  Use US if necessary.  Check for CSF early and often.   When to CT before LP?: AMS; focal...

You are working at Clerkship General when the charge nurse comes and grabs you… “Hey doc, we need you in room 2, this kid looks sick…” Initial Vitals: BP: 68/40 HR: 128 RR: 22 O2: 99% (Room Air) Temp: 103.5F Critical Actions: * Diagnose Meningitis and Perform Lumbar Puncture * Give Empiric Antibiotics * Treat Septic Shock * Give Steroids * Give Prophylaxis to Close Contacts Check...