Keep your eyes on the stars and your feet on the ground. – Theodore Roosevelt Welcome back to Roshcast Episode 34! This week we continue our collaboration with the EM Clerkship podcast, focusing on appendicitis. Don’t forget that we launched another trauma ring tone contest last week, so listen up through episode 38 to win the prize. For this week’s rapid review, we reviewed dysbarism in honor of the Rosh Review Core Content Winner’s presentation. If you haven’t seen Dr. Sanders and Dr. Levin’s fantastic presentation, it’s definitely worth checking out. Let’s get started! * A diver with an arterial gas embolism would classically presents within 10 minutes with neurologic symptoms that resolve and then recur. * Typical symptoms of an arterial gas embolism include unconsciousness, respiratory or cardiac arrest, coma, stupor, confusion, unilateral neurologic changes, visual disturbances, dizziness, or convulsions. * Decompression sickness presents in a variety of ways. 68% of patients will present with joint pains, 63% will present with numb patches and paresthesias, and 41% will have constitutional symptoms and fatigue. Other less common symptoms include dizziness, weakness, itching, hearing loss, and tinnitus. * On scene, a diver with either an arterial gas embolism or decompression sickness should be treated with the standard IV fluids, supplemental oxygen, and then be placed on a monitor. Definitive treatment is with hyperbaric oxygen. Now onto this week’s podcast Question 1 Which of the following is the average duration of a typical generalized tonic-clonic seizure? A. 1-2 minutes B. 10-15 seconds C. 30-40 seconds D. 4-5 minutes Question 2 A 23-year-old man presents with abdominal pain, vomiting and two loose, nonbloody stools. Physical examination reveals right lower quadrant tenderness to palpation. A CT is performed showing a normal appendix and some inflammation at the ileocecal junction. What pathogen is commonly implicated in this disorder? A. Aeromonas species B. Salmonella enterica C. Vibrio parahaemolyticus D. Yersinia enterocolitica Teaching Image Question 3 A 9-month-old girl presents to the ED with signs of progressive dyspnea. The patient’s mother reports URI symptoms that have been present for two weeks. Over the previous 24 hours, the patient has been increasingly fussy, noted to be sweaty with feeds, and has become increasingly dyspneic. Her vital signs are T 38.3°C, HR 180, RR 38, POx 93%, and BP 60/40. On examination, you note rales at the lung bases. Her heart rhythm is irregular with an S3 gallop, and the liver is palpable 3 cm below the costal margin. Which of the following is the most appropriate therapeutic intervention? A. Dobutamine B. Immediate endotracheal intubation C. Normal saline 20 ml/kg bolus D. Propranolol E. Transcutaneous pacing Teaching Image Question 4 Which of the following statements is true regarding appendicitis? A. An appendicolith is identified in the majority of cases of appendicitis B. Leukocytosis is seen in the majority of cases C. Perforation is rare in patients younger than 2 years D. The presence of an appetite makes the diagnosis unlikely Teaching Image Question 5 Which of the following is most characteristic of ph...