As knowledge increases, wonder deepens. -Charles Morgan Welcome back to Episode 20! We have a great episode lined up for you this week, again covering topics that run the gamut of Emergency Medicine. We are excited to say that we have covered over 100 questions in approximately five hours of Roshcast over six months! As always, send us any feedback or suggestions to [email protected]. Let’s get going with this week’s content! * TTP is treated with plasmapheresis. If plasmapheresis cannot be performed expediently, FFP can be used as a temporizing measure. * For any patient on warfarin with a life-threatening bleed, FFP, PCC, or Recombinant factor VIIa should be given. For a patient on aspirin with a life-threatening bleed, DDAVP should be given in addition to platelets. * For patients with intracranial hemorrhages, new evidence from the PATCH trial suggests that platelets may actually increase the risk of death and dependence, so such patients should only be given DDAVP. * Both Hemophilia A and B are X-linked recessive disorders. Now onto this week’s podcast Question 1 A 23-year-old man presents with chest tightness after intranasal cocaine use. Vital signs are HR 133, BP 155/95, and oxygen saturation 95%. ECG reveals sinus tachycardia with no ischemic changes. What medication should be administered? A. Benzodiazepine B. Beta blocker C. Calcium channel blocker D. Naloxone Teaching Image 1 Teaching Image 2 Question 2 Which of the following is the most common type of migraine headache? A. Basilar-type migraine B. Migraine with aura C. Migraine without aura D. Ophthalmoplegic migraine Teaching Image  Question 3 A 59-year-old man is found naked under a bridge. He is unresponsive and does not respond to painful stimulation. His rectal temperature is 32ºC. The patient is intubated for airway protection, warm blankets are placed, and active internal rewarming measures are initiated. The patient’s temperature slowly rises to 35ºC, but then begins to fall. Which of the following is most likely responsible for this phenomenon? A. Cooling of blood during cardiopulmonary circulation B. Equipment failure C. Paradoxical splanchnic vasoconstriction D. Return of cold blood to core from periphery Teaching Image  Question 4 Which of the following statements regarding drug exposure and overdose in pregnancy is true? A. Gastric decontamination with charcoal or whole-bowel irrigation should be avoided in pregnancy B. Iron crosses the placenta and causes direct fetal toxicity C. Most antidotes should not be given in pregnancy due to the risk of fetal harm D. Salicylate overdose is associated with poor fetal outcomes E. The threshold to treat carbon monoxide poisoning is the same in pregnant and nonpregnant women Teaching Image Question 5 A 32-year old woman with HIV presents for the evaluation of a headache. She denies fever and her neurologic examination is normal.