Only I can change my life. No one can do it for me. -Carol Burnett Welcome back to Episode 30! First, we must congratulate Sean for winning the trauma ring tone challenge by being the first to respond after the episode release. An honorable mention goes out to Nich and Dhinakar. Stay tuned for future contests and prizes!! Today’s episode also marks the launch of a new partnership with the EM Clerkship podcast. Going forward, we are going to occasionally focus episodes on a specific topic – a topic that was recently covered by EM Clerkship. We will cover a few questions on that specific area and fill in the rest of the episode with the usual random assortment.  You can listen to the podcasts in either order.  Either start with Roshcast to see where you stand and then head over to EM clerkship for more detail — or alternatively, start with EM clerkship to learn the nuts and bolts, and then head back here to test yourself. Any time we do these joint releases, we will plan to match our mid-week release with their release a few days earlier on Sunday. Hopefully you enjoy our new collaboration! Enough announcement. Let’s get going with the rapid review! * To diagnose Kawasaki disease, you must have a fever for five or more days and four of the following five criteria: bilateral bulbar conjunctival injection, oral mucous membrane changes, peripheral extremity changes, polymorphous rash, and cervical lymphadenopathy. * Kawasaki disease is treated with IVIG and aspirin. * Ocular findings associated with Wernicke’s encephalopathy include nystagmus, lateral rectus palsy, and conjugate gaze palsies. * When treating Wernicke’s encephalopathy, you should replace thiamine before repleting their glucose. Now onto this week’s podcast Question 1 You are caring for a 60-kg patient who has been seizing for 30 minutes. You have already administered 4 mg of IV lorazepam and 1200 mg of phenytoin without termination of seizure activity. Which of the following should most likely be your next step? A. Administer another bolus of IV phenytoin B. Administer IV fosphenytoin C. Administer IV pentobarbital D. Administer IV sodium bicarbonate Teaching Image Question 2 A 33-year-old man presents with a seizure lasting for 5 minutes. EMS administered 2 mg of lorazepam with cessation of seizure activity. On presentation, the patient is confused. The patient’s medication list includes metoprolol and isoniazid. During the evaluation, he has another seizure lasting for 10 minutes and then a third seizure lasting for another 10 minutes. What adjunctive therapy should be given? A. Folic acid B. Phenobarbital C. Pyridoxine D. Sodium bicarbonate Teaching Image Question 3 A 75-year-old nursing home patient presents with abdominal distension. Vital signs are normal and the patient is “non-toxic” appearing. An abdominal X-ray is obtained. What management is indicated? A. Endoscopic detorsion B. Intravenous antibiotics C. Observation and reassessment D. Surgical resection Question 4 A 26-year-old woman with a history of dysmenorrhea and depression presents to the ED after having a seizure witnessed by her husband. He reports finding her on the bedroom floor with an empty pill bottle. Which of the following non-steroidal anti-inflammatory (NSAIDs) medications did she most likely ingest? A. Celecoxib B.