Episodes
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...
Published 05/01/23
* Two Types of Priapism
* Low Flow “Ischemic” (Most Common >95% of Cases)
* Urologic Emergency
* Results in Erectile Dysfunction
* Painful
* Common Etiologies
* Idiopathic
* Erectile Dysfunction Drugs (ex. sildenafil)
* Sickle Cell Disease
* Trazodone (“TrazoBONE”)
* Cocaine/Meth
* High Flow
* Caused by Trauma and AV Fistulas
* Management
* Analgesia
* Dorsal Penile Nerve Block
*...
Published 04/16/23
You are working at Clerkship General on an overnight shift when the next chart is handed to you. It’s a 35 year old male with a chief complaint of groin pain.
Initial Vitals:
BP: 150/90
HR: 107
RR: 20
O2: 99% (Room Air)
Temp: 98.0F
Critical Actions:
* Diagnose Ischemic/Low Flow Priapism
* Perform Penile Nerve Block
* Aspirate Blood and Irrigate with Saline
* Inject Intracavernous Phenylepherine
* Diagnose...
Published 04/01/23
Obtain IV Access – get two large bore IVs (18g or larger)
Resuscitate – un-crossmatched blood at first, don’t forget type and screen!
Medicate – Give Pantoprazole always, Octreotide and Ceftriaxone if hx liver disease, reverse anticoagulation if indicated
Imaging – Upright CXR to assess for perforation, CTA if concerned for lower GIB
Consult – GI if unstable / if variceal bleeding
Disposition – based on amount of bleeding and hemodynamic stability
Published 03/16/23
You are working at Clerkship General when the charge nurse grabs you – “hey we got a real sick one, a 57yo Male who I just put in the resuscitation bay, he is vomiting blood”.
Initial Vitals:BP: 77/34
HR: 135
RR: 24
O2%: 95%
Temp: 98.8F
Critical Actions:
* Place two large bore IVs
* Transfuse emergency uncross matched blood
* Administer IV Pantoprazole
* Administer IV Ceftriaxone and IV Octreotide
* Consult...
Published 03/01/23
* “Sympathetic Crashing Acute Pulmonary Edema”
* Pathophysiology – Rapid onset of pulmonary edema caused by sudden hypertension
* Triggers- Missed Medication, Cocaine, Stress/Anxiety
* Increase in BP = Increase in afterload
* Increased afterload causes acute pulmonary edema (in patients with CHF)
* The worsening pulmonary edema causes shortness of breath which worsens blood pressure and further increases afterload
* Presentation- Sudden, severe...
Published 02/19/23
In this long-form episode we will discuss opioid use disorder, the leading cause of death in young adults in the United States. What you do matters!
* Why you should care about OUD
* What is OUD
* Buprenorphine Works
References
* National Safety Counsel Injury Facts
* DebunkingDenial – Purdue Pharma and America’s Opioid Epidemic
* Addiction Neuroscience 101 – Youtube
* Cochran Review – Buprenorphine for OUD
Published 02/01/23
This episode will answer 3 big pre-Match Day questions:
1. How do I go about making my rank list?
2. What about post-interview communication both from and to programs?
3. How does this whole thing called the Match actually work?
Resources:
EM Match Advice: Post Interview Communications
https://www.emra.org/books/msadvisingguide/preparing-and-submitting-your-rank-list/
Published 01/20/23
Aortic Dissection – when there is a tear in the intima layer of the aorta and the blood dissects the intima away from the media creating a false lumen in the aorta
* Historical Features
* Be VERY suspicious with ABRUPT onset of chest/back pain that reaches MAXIMAL SEVERITY immediately after onset of pain.
* Chest pain or Back pain with a neurologic deficit
* Pain “above and below the diaphragm”
* Diagnosis
* CT Angiography of chest abdomen and pelvis...
Published 01/16/23
You are working at Clerkship General when the base command phone rings –
“Hey doc just wanted to give you a heads up on this stroke alert we’re bringing you – we have a 70yo M with sudden onset left arm numbness and weakness, last known well 2 hours ago, we’ll be there in about 5 minutes”
Initial Vital Signs:
HR 120
BP 180/90
RR 22
O2 97%
Temp 97.7F
Critical Actions:
1. Check a blood glucose
2. Diagnose Aortic...
Published 01/02/23
Not your typical wellness episode – by Zack
Published 12/16/22
You are working at Clerkship General Hospital when EMS calls in a female with opioid overdose, but she won’t stop complaining of leg pain…
Initial Vitals:
Temp: 98
BP: 120/80
HR: 89
RR: 20
O2 Sat: 100%
Critical Actions:
* Treat patient’s pain without NSAIDs (history of solitary kidney)
* Assess patient’s leg pain beyond the point of just fracture vs. no fracture
* Recognize the signs and symptoms of compartment...
Published 12/02/22
Diabetic Ketoacidosis – hyperglycemia, ketosis, and anion gap metabolic acidosis
* Don’t forget about euglycemic DKA (especially in setting of SGLT2 inhibitor) or mimics such as alcoholic ketoacidosis
* Treatment of the ketoacidosis * Insulin (usually a drip or bolus + drip) – only once K>3.5* Volume Resuscitation (NS initially, change to LR)* Bicarb drip (poor evidence, only as last resort for critical patients)* Treatment of electrolyte abnormalities* Correct sodium for...
Published 11/15/22
You are working a shift at Clerkship General when the charge nurse comes and grabs you to see a 24yo male who appears to be in respiratory distress.
Critical Actions:
* Diagnose DKA* Replete potassium* Start insulin AFTER potassium repletion* EITHER place central line for faster K repletion OR initiate bipap to allow time for potassium repletion via existing peripheral line* Admit to ICU
Further Reading:
EMCrit – DKA
Published 11/01/22
Before interview day, do your research on programs and interviews and reflect on the way in which you want to portray yourself.
On interview day, have a cheat sheet with notes about your conversations, questions, and pro-cons. Remember to stay calm, take a pause if you need to, and above all be authentic to who you are.
After interview day, be sure to capture you gut impression and write down any follow-up questions or concerns remaining.
Here are some resources to use...
Published 10/24/22
show notes coming soon
Published 10/19/22
Show comments to be posted shortly
Published 10/03/22
* Understand the timeline – research programs to find out when they extend invites and when they host interviews* Prepare for invitations – set up email and text notifications, get a calendar* Accept invitations – respond promptly and keep your calendar updated* Optimize invitations – any interview date you get is a good one, but planning ahead can help you optimize timing* Too many or too little interviews – drop early, keep tabs with whether programs have extended invites and stay in close...
Published 09/29/22
Summary of Key Points
1. You should consider ectopic pregnancy in every patient who is capable of bearing children
2. If a patient of child bearing age presents with severe abdominal pain or vaginal bleeding and is either hemodynamically unstable or very ill appearing, this is a ruptured ectopic pregnancy until proven otherwise and I would recommend performing a bedside FAST exam immediately.
3. Remember that the discriminatory zone for TVUS is approximately 1500....
Published 09/18/22
You are working at Clerkship General when the next chart gets handed to you – a 31 year old female presenting with abdominal pain.
Initial Vitals:
BP: 109/65
HR: 96
RR: 21
O2: 99%
Temp: 99.1F
Critical Actions:
* Obtain pregnancy test* Confirm IUP * Administer Rhogam* Treat UTI* Counsel the patient and discharge them
Further Reading:
CoreEM – Utility of Anti-D Immunoglobulin(Rho Gam) During First Trimester...
Published 09/01/22
Things to consider when selecting residency programs to apply to: 1. What type of program (County, Community, Academic) 2. What length of program (3 year vs. 4 year) 3. Location 4. Culture and Lifestyle 5. Niches in EMFurther Resources:
EMRA Residency MapDoximity NavigatorSAEM Residency FairEMRA Residency Fair
Published 08/17/22
3 Steps to assessing your competitiveness for matching in an EM residency: 1. Get a good advisor. 2. Look at the data. 3. Maximize your potential.
Further Reading:
EMRA – Apply smarter not harderEMRA HangoutsEMRA Student-Resident Mentorship ProgramNRMP Charting the OutcomesNRMP Residency DataALiEM – Match AdviceUTSW Texas STAR
Published 08/17/22
The future of emergency medicine seems bleak. Listen to Zack’s perspective on the future of our beloved specialty in part TWO of this two-part series.
Published 08/15/22
You are working your FIRST SHIFT EVER at Clerkship General hospital when a 60 year old female presents with shortness of breath.
Initial Vitals:
* HR: 92* RR: 28* BP: 120/80* O2%: 89%* Temp: 101.2F
Critical Actions:
* Obtain full set of vital signs* Diagnose PNA and COPD exacerbation* Administer appropriate antibiotics* Treat symptoms with steroids and nebulizers* Admit patient to the hospital
Published 08/01/22
The future of emergency medicine seems bleak. Listen to Zack’s perspective on the future of our beloved specialty in part one of this two-part series.
Published 07/19/22