CRACKCast & Physicians as Humans on CanadiEM

This episode of CRACKCast covers Rosen's Chapter 124, Acid Base Disorders. This chapter covers a simple approach to acid base disorders and ABG interpretation, including the differential diagnosis for the identified disorders & treatment options.

This 123rd episode of CRACKCast covers Rosen's 9th edition, Chapter 115, Selected Oncologic Emergencies. With an ever aging population, cancer incidence continues to rise. Therapies continue to prolong life often with high risks of side effects, and emergency physicians need to be equipped to treat complications of this treatment and importantly cancer morbidity itself.

Episode Overview:

1. List 10 causes of Thrombocytopenia
2. List 6 causes of Thrombocytosis
3. Describe the presentation and treatment of HIT, ITP and TTP
4. Describe what causes an abnormal PT? What causes an abnormal PTT?
5. Describe the deficiency and management of Hemophilia A, Hemophilia B, and vWD
6. Describe the management of a major and minor bleed in hemophilia A
7. List 4 items in cryoprecipitate
8. List adjunctive therapies in DIC

Wisecracks:

• How do you differentiate coagulation disorders from platelet disorders?

• What is thrombocytopathy?

• What do INR and PTT test?

• What is DIC?

This 121st episode of CRACKCast covers Rosen's 9th edition, Chapter 112 and 113, Anemia, Polycythemia, and White Blood Cell Disorders. These blood disorders are numerous and this episode attempts to break their classification and approach down in a systematic manner.

This episode covers Chapter 110 of Rosen's Emergency Medicine (9th Ed.), Dermatologic Presentations.

Episode Overview

1. List five broad categories of rashes

2. Describe the primary skin lesion types

a. Bonus: What are the secondary skin lesions (show notes only)

1. List systemic diseases that present with cutaneous signs for each of the following locations:

   • Generalized rash

   • Head and neck

   • Hands

   • Legs

   • Palms and Soles

2. Describe the various presentations of tinea and their treatment

3. List 8 RFs for candida infections

4. Describe the stepwise management of diaper dermatitis

5. Describe the distribution of Pityriasis rosea

6. Describe the management of atopic dermatitis

7. Describe the management of impetigo & folliculitis

8. List 6 RFs of C.A.-MRSA and 4 oral Abx treatments

9. Describe the presentation and management of Staph Scalded Skin andTSS

1. List 10 causes of EM / SJS / TEN

2. Describe presentation of EM + SJS/TEN. Differentiate between TEN and SJS

3. List 6 broad categorical causes of urticaria

4. Describe the typical features for each of the following:

   • Measles

   • Rubella

   • Roseola Infantum

   • Erythema Infectiosum

   • Scarlet Fever

5. Describe treatment of poison ivy

6. Describe presentation and treatment of Pediculosis + Scabies

7. List 10 causes of Erythema Nodosum

8. List a 6 ddx for vesicular lesions

9. List 4 lesions with a positive Nikolsky's sign

10. List 4 complications of HSV infection

11. List 5 complications of Varicella + describe the management of an exposure during pregnancy

12. List 5 complications of Zoster + differentiate between Ophthalmicus and Oticus

13. What is the treatment of herpes zoster?

Wisecracks

1. List 5 causes of desquamating lesions

2. List 5 palm and sole rashes

3. List 10 maculopapular rashes

4. List 1 low, medium and high potency topical steroid

5. Identify the following rashes: erythema migrans, erythema marginatum, erythema multiforme, erythema nodosum, meningococcemia

Episode 119 of CRACKCast covers chapter 109 of Rosen's Emergency Medicine 9th edition.

Its hard to go a couple hours in the ED without seeing allergy or that life-threatening anaphylaxis, so you need to be tres familiar with this entity!!!

This episode covers Ch 108 of Rosens (9th Ed.), SLE and the Vasculitides. These conditions can lead to some pretty varied ED presentations, so we need to know when to suspect lupus or vasculitis, and how to manage it.

Episode Overview:

1. What the pathophysiology of lupus
2. List diagnostic criteria for SLE
3. List drugs that induce lupus
4. Describe the clinical manifestations w/ Classic triad & Symptoms and signs by system in lupus
5. List 3 drug regimens to treat SLE
6. How does neonatal lupus present?
7. What is antiphospholipid syndrome? What is the unusual laboratory feature seen with this condition?
8. What is the pathophysiology of vasculitis?
   1. Large vessel vasculitis
   2. Medium vessel vasculitis
   3. Small vessel vasculitis
   4. Hypersensitivity vasculitis
   5. Subcutaneous vasculitis
9. Give examples of:
10. Compare the findings for vasculitis
11. List 5 criteria for dx of temporal arteritis + 2 associated features
12. Describe the features of Behcet's Disease
13. List 10 causes of Erythema Nodosum
14. Compare Buerger's, Serum sickness and Hypersensitivity Vasculitis
15. List the diagnosis Criteria for HSP

WiseCracks

1. What is the differential for SLE patient and Chest pain?
2. Name and identify 2 pathognomonic clinical features for lupus
3. When should Rheum be involved in the ED with a SLE patient?
4. Spot Diagnosis: A 36 year old female stock trader present with what appears to be necrosis of the nose and ears…
5. Spot diagnosis: 13 year old presents with abdo pain, polyarticular arthritis, foaming urine and the following rash…
6. Rounds Pimper: List 10 side effects of chronic steroid use

This episode covers Chapter 107 of Rosen's Emergency Medicine (9th Ed.), Tendinopathy and Bursitis.

Episode Overview:

• Mechanical overload and repetitive micro-trauma are the key underlying mechanisms of tendinopathy
• Most patients present with progressively worsening pain after work or sports-related activities that are repetitive in nature
• Tendinopathy can also be associated with non-mechanical causes such as:
  • Systemic manifestations of disease
  • Use of fluoroquinolones
  • Infectious etiologies
• Most patients with tendinopathies can be treated with conservative measures, such as:
  • Protection
  • Relative rest
  • Application of ice
  • Elevation
  • Medications
• Overuse syndromes take at least 6-12 weeks to heal
  • Patients need optimal loading and referral for physiotherapy or sports medicine therapy
• Urgent imaging of tendinopathy in the ED is rarely useful
  • Clinicians may elect to use bedside ultrasound to evaluate for other diagnoses
• Operative treatment of tendinopathy is required in select cases
• Consider infectious bursitis in all cases of acute bursitis
• Aspirate bursa and evaluate the fluid
  • Infectious bursitis is typically caused by Staph aureus
• Non-septic bursitis differential diagnosis:
  • Traumatic
  • Rheumatologic
  • Idiopathic
• Management of septic bursitis:
  • Antibiotics
  • NSAID's
  • Rest
  • Application of ice
  • Elevation
  • Prompt referral for follow-up +/- admission

Core questions:

1. What is the differential diagnosis for tendinopathy?
2. What are common sites for tendinitis?
3. List 6 differential diagnoses for atraumatic non-septic bursitis
4. List common causes for infected bursitis

Wisecracks:

1. Differentiate septic and inflammatory bursitis based on clinical exam and fluid aspirate results
2. List 4 physical exam findings of impingement syndrome

This episode of CRACKCast covers Rosen's Ch 106, Arthritis. When a patient rolls in with an active joint, we need to know how to rule out those can't-miss diagnoses.

This episode covers Chapter 105 of Rosen's Emergency Medicine (9th Ed.), Suicide.

Episode Overview:

• Suicide is a common but preventable cause of death
• Suicide is usually triggered by treatable or reversible short-term crises
• Most attempted suicide survivors are grateful to be alive
• Suicide risk changes over time; estimations of imminent risk are NOT evidence-based
• Routine screening labs provide little value to most ED patients with self-harm behaviours
• Evaluations should be targeted to signs or symptoms of disease on presentation
• Any ED visit for suicidal thoughts or behaviours represents a crisis and a teachable moment
  • With your approach, it is important to be supportive, empathetic, and patient-centred
  • Have a collaborative plan that integrates the input from collateral sources
• When caring for suicidal patients, use precautions:
  • Sitters
  • Physical/chemical restraints
  • Involuntary admission forms
• Brief and focused risk assessment of patients in the ED can identify persons in need of further comprehensive evaluation and consultation with a mental health specialist
• Those patients who are deemed to be at low-risk of suicide may be discharged home to a safe and supportive environment, assuming they have no access to toxic medications or guns
  • They should receive education and safety planning in the ED
  • They should have early mental follow-up appointments

Core questions:

1. Name 10 risk factors for suicide
2. Name an additional 5 risk factors for adolescent suicide
3. Describe the SAD PERSONS Scale
4. Describe 4 potential targeted investigations for patients presenting to the ED with suicide
5. Name 3 protective factors for against suicide