In this episode of Danger Zone, our hosts examine a relatively rare procedure performed in the ED – the Surgical Airway! They discuss indications, procedural considerations, and important clinical pearls.

Core Questions

1. Explain broad causes of elevated bilirubin (obstructive, hepatocellular, and hemolysis) and the significance of direct vs. indirect hyperbilirubinemia (Fig 25.1)
2. Explain your approach to the history and physical exam in patients with jaundice (Fig 25.2) 
3. List 10 causes of jaundice (Table 25.2) 
4. Explain your approach to ancillary testing in patients with jaundice. 

Wisecracks

1. What are the stages of hepatic encephalopathy?  
2. What is the triad of acute hepatic failure? 
3. What is Charcot’s triad and Reynold’s pentad? 
4. What is the “1000s Club” and how do you become a member? 

In this episode, Kevin Dong interviews Dr. Mohamed Hagahmed on his transition to practice and how to prepare for your board/licensing exams after you graduate from residency. Dr. Mohamed Hagahmed is an Assistant Clinical Professor in the Department of Emergency Medicine at UT Health San Antonio.

Core Questions

1. What are risk factors for serious underlying causes of abdominal pain? (Box 24.1) 
2. Explain key symptoms and signs to look for in the evaluation of the patient with abdominal pain. 
3. What diagnoses are associated with different patterns of abdominal pain? (Fig 24.1) 
4. List 5 critical and 5 emergent causes of abdominal pain (Table 24.1, 24.2) 
5. Explain an approach to ancillary testing in abdominal pain. 
6. Outline a diagnostic algorithm for patients with abdominal pain (Fig 24.4) 
7. Outline an empiric management algorithm for abdominal pain. (Fig 24.5) 

Wisecracks

1. What are the structures included in the foregut, midgut, and hindgut? More importantly, why do you care? 
2. List indications for bedside US in the ED patient with abdominal pain (Table 24.3) 
3. Explain how referred pain works in the setting of abdominal pain (Fig 24.2)

In this episode of First Year Diaries, I am joined by Dr. Daniel Ting and Dr. Jared Baylis. Dr. Daniel Ting is a first-year staff at UBC, who is currently working from the Vancouver General Hospital and BC Children’s Hospital. Dr. Jared Baylis is also a first-year staff, working at the Kelowna General Hospital. I asked them what it is like to transition from residency to working as staff physicians. Later, we discussed the challenges they face as staff physicians and how residency prepared them for life as Emergency Physicians. 

Core Questions

1. Describe an approach to key history and physical exam for chest pain patients presenting to the ED. (Table 23.2 and 23.3) 
2. List 5 critical diagnoses, 5 emergent, and 5 nonemergent diagnoses to consider in the patient presenting with chest pain. (Table 23.1)
3. Describe an approach to the critically ill patient with undifferentiated chest pain. (Figure 23.1)
4. Describe an approach to ancillary testing in chest pain. (Table 23.4 and 23.5)
5. List the risk factors associated with each critical chest pain diagnosis (Box 23.1) 
6. Explain the approach to risk stratification of ED chest pain patients. 

Wisecracks

1. What are the X-ray findings of aortic dissection? 
2. What are your HR and BP targets in Aortic dissection? 
3. List the components of the HEART score. 

Today we are sitting down with Dr Alim Pardhan. Dr Pardhan is the FRCP EM program director at McMaster University, Hamilton General Hospital ED side lead, and a passionate medical educator.

Your key takeaways from this episode are:

1. Understanding the mechanisms behind fever and hyperthermia
2. The causes of hyperthermia - think drugs, CNS infections, thyroid storm, and environmental exposure
3. Five big, bad, and deadly causes of fever in our patients in the ED - necrotizing fasciitis! Endocarditis! Meningitis! Ascending cholangitis! Sepsis!
4. Identification and management of the patient with sepsis

Core Questions

1. Define the following terms:
   1. Dyspnea
   2. Tachypnea
   3. Hyperpnea
   4. Hyperventilation
   5. Dyspnea on exertion
   6. Orthopnea
   7. Paroxysmal Nocturnal Dyspnea
2. What anatomical structures are responsible for controlling respiratory effort?
3. Outline an approach to the history for the dyspneic patient.
4. Detail the physical examination for the dyspneic patient and highlight pivotal exam findings that point to specific pathologies.
5. Outline the differential diagnosis for the patient presenting with dyspnea and highlight 5 critical, 5 emergent, and 5 non-emergent causes of shortness of breath.
6. What ancillary tests are indicated for the dyspneic patient?
7. Detail the utility of point-of-care ultrasound in the assessment of the dyspneic patient.
8. Outline a management algorithm for the acutely dyspneic patient.

Wisecracks

1. List three findings on chest radiograph suggestive of pulmonary embolism.
2. What is the utility of venous blood gas testing and how do its values correlate with that of an arterial blood gas?

Core Questions: 

1. Define “massive hemoptysis”.
2. Which vessels, when injured, are typically associated with small and massive hemoptysis, and how do the vessel characteristics influence the degree of bleeding?
3. Outline an approach to the history and physical examination for a patient presenting with hemoptysis.
4. Outline the differential diagnosis for hemoptysis and highlight five critical and five emergent diagnoses that cause hemoptysis. (Box 21.1 and 21.2)
5. What ancillary tests are warranted in the patient with hemoptysis?
6. Detail the utility of imaging studies in patients with hemoptysis.
7. Detail the diagnostic approach to the patient with hemoptysis. (Figure 21.1)
8. Outline an approach to managing the patient with hemoptysis. (Figure 21.2)
9. What two maneuvers can be used to address massive hemoptysis from a suspected tracheo-innominate fistula (TIF)?
10. What strategies can be used to improve oxygenation in the patient with massive hemoptysis?

Wisecracks: 

1. List one gynecologic cause of hemoptysis.
2. List five causes of massive hemoptysis.
3. What is the most lethal consequence of massive hemoptysis?

We are finally back with episode 3 of ClerkCast!

Today we will be talking about ABDOMINAL PAIN with McMaster FRCP EM resident Dr Rakesh Gupta

Key takeaways from this episode include:

1. Thinking outside the GI tract for patients with abdominal pain

2. The importance of a good physical exam

3. What type of imaging is best for your patient? Hint: it depends!

4. How to consult your inpatient colleagues! P-I-Q-U-E-D

Thanks for the listen!