CRACKCast & Physicians as Humans on CanadiEM

This episode covers chapter 84 of Rosen's Emergency Medicine. All the little nuggets of medical goodness you wanted to know about hypertension related emergencies.

1. Define the three classes of hypertension relevant to emergency medicine practice
2. List 10 possible etiologies for hypertension.
3. What is the pathophysiology of target-organ damage?
4. How does hypertensive encephalopathy occur?
5. List 6 hypertensive emergencies; their management goals; the optimal agents for BP control and any relevant caveats
6. List five intravenous antihypertensive medications and their mechanism of action.
7. Describe the ER management of poorly controlled HTN

Wisecracks:

1. What are the management targets / indications for treatment in the following pts:
2. 1. 57 yo male with ICH and no signs of ↑ ICP.
   2. 39 yo female with SAH in the ED.
   3. 22 yo female with eclampsia.
   4. 66 yo female with ACS.
   5. 57 yo male with aortic dissection.
   6. 62 yo female with ICH, ↓ GCS, shift on CT scan.

This episode covers Chapter 83 of Rosen's Emergency Medicine.

1. List 6 RFs for bacterial endocarditis
2. List 5 common bacteria responsible for infective endocarditis
3. Give three examples of immunologic sequelae of IE.
4. Give three examples of vascular sequelae of IE.
5. What are the diagnostic criteria for endocarditis, and how are they used?
6. List 5 lab or investigative findings in bacterial endocarditis
7. Describe the treatment of infective endocarditis
8. List four complications of IE.
9. List the indications for infectious endocarditis prophylaxis. What are the empiric antibiotics used for pts with suspected infectious endocarditis?
10. Describe the Jones Criteria for Acute Rheumatic Fever
11. What is the treatment of rheumatic fever
12. Name three causes of acute mitral regurgitation.
13. How is acute MR managed?
14. What is the pathophysiology of mitral valve prolapse? How does it present?
15. List four causes of mitral stenosis.
16. List four causes of aortic valve insufficiency.
17. List 3 physical exam findings associated with AS
18. What is critical aortic stenosis?Outline the ED management for a pt with critical aortic stenosis with CHF and hypotension.
19. List 5 complications of prosthetic valves.

WiseCracks:

1. Describe
   1. Janeway lesions
   2. Osler nodes
   3. Splinter hemorrhages
   4. Roth Spots

1. What are the HACEK organisms, and what is their significance in pts with IE?

1. Brief run down of all valvular disease - in one or two lines.

This episode covers chapter 82 of Rosen's Emergency Medicine. Take a listen for all those juicy pericardial-pump-pearls!

1. List eight causes of pericarditis.
2. Describe typical pain of pericarditis, expected lab work abnormalities,
3. What is the typical sequence of ECG changes in pts with pericarditis? (the stages)
4. Describe the treatment of pericarditis associated with: Uremia, Neoplasm, and SLE
5. Outline the management of Dressler's syndrome.
6. What is the pathophysiology of cardiac tamponade? Describe the mechanism of hypotension in pericardial tamponade and list 4 expected findings on physical examination.
7. Describe the procedural steps in pericardiocentesis
8. List 4 causes of pneumopericardium and one specific PEX finding
9. List five causes of constrictive pericarditis.
10. What is the pathophysiology of purulent pericarditis? List 5 organisms responsible for infectious pericarditis? How is it managed?
11. Describe the pathophysiology of hypertrophic cardiomyopathy
12. Describe the clinical exam and ECG findings associated with HCM
13. List 5 RFs for sudden death in HCM
14. A pt with known hypertrophic cardiomyopathy presents to the ED with acute cardiogenic pulmonary edema causing mild hypoxia. What is the general approach to management in the ED? Explain your choices.
15. List four causes of dilated cardiomyopathy.
16. Describe ECG findings of dilated cardiomyopathy
17. List 5 RFs for developing a dilated cardiomyopathy
18. In what time frame would one expect peripartum DCM?
19. List 5 causes of restrictive cardiomyopathy
20. List 8 common pathogens responsible for myocarditis, and 3 non-infectious causes of myocarditis
21. Describe the stages of viral myocarditis and the management at each stage

Wisecracks:

1. What are some functions of the pericardium?
2. What are Chagas Disease and Trichinosis, list bizz-buzz features for each?
3. What are the expected cardiac findings in Lyme disease and how is it treated?
4. How does sarcoid affect the heart?
5. Amyloidosis?

This episode covers Chapter 81 of Rosen's Emergency Medicine. This one is mint! Heart failure is one of those must-know-about presentations, you WILL see this in the ED.

1. Define
   1. Cardiac index
   2. Preload
   3. Afterload
2. Describe:
   1. How compliance changes the relationship between end diastolic pressures and volume
   2. the Frank-Starling relationship
   3. Pousseils Law and LaPlaces Law
3. List 3 CV and 4 Neurohormonal physiologic compensatory mechanisms in CHF
4. List the 5 most common disease processes resulting in HF and briefly describe the contribution of each
5. Describe the different classifications of heart failure:
   1. Acute vs. Chronic HF
   2. Systolic vs. Diastolic dysfunction
   3. Right vs. Left sided HF
   4. High-output vs. Low-output HF
6. Describe the NYHA function HF Classes and the Killip Classification
7. List 10 common precipitants of acute HF
8. List 6 historical predictors of acute HF and 6 clinical features of acute HF
9. List 5 CXR and 5 ECG findings of HF
10. What is the role of BNP in HF?
11. Describe the primary management goals in acute HF
12. Describe the mechanism of action of NIPPV in HF. Who needs to be intubated? When is it contraindicated?
13. Describe the pharmacologic treatment strategy for:
    1. Acute pulmonary edema + adequate perfusion
    2. Acute pulmonary edema + hypotension
14. How do nitrates work in acute pulmonary edema? What is the dose?
15. List 10 treatment options for chronic HF

This episode covers chapter 80 of Rosen's Emergency Medicine. All those juicy pearls about those funny little [black] boxes in your patients chest.

Chapter 80 – Implantable Cardiac Devices

1. List 5 Indications for permanent pacing
   1. What are common Pacemaker types?
2. Pacemaker nomenclature - what do the 5 letters mean
3. List the causes of pacemaker malfunction (main categories with 2 examples each)
4. List the complications of a pacemaker insertion
5. What is pacemaker pseudo-malfunction?
6. What is pacemaker syndrome, which type of pacer is most commonly involved, and what is the tx?
7. What does magnet application do to a pacemaker? to an ICD?
8. Indications for ICD
9. Causes of shock delivery in patient with ICD
10. Causes of syncope/presyncope in patient with ICD
11. Fxns of an ICD

Wise Cracks

1. What do you see on ECG when pacer battery dies (2)?
2. What is twiddler's syndrome?
3. Describe your Approach to LVAD complications
4. Approach to Pacemakers

This episode covers Chapter 79 of Rosen's Emergency Medicine.

All those funny squigly marks on the ECG confusing you? Us too. Here is some knowledge to help you out.

1. What is the blood supply of the following parts of the conduction system: SA node, AV node
2. What are the three pathophysiologic mechanisms for dysrhythmias?
3. What causes & how does AV nodal reentry tachycardia occur?
4. List the classes of antidysrhythmics. Describe their mechanism of action and usual uses, as well as an example of each.
5. How does digoxin work as an antidysrhythmic? When is it used?
6. List underlying etiologies of sick sinus syndrome.
7. What are three ECG presentations of sick sinus syndrome?
8. Define 1° heart block. List three causes.
9. Differentiate between the two types of 2° heart block with respect to etiology, ECG appearance and management.
10. What is 'high grade' heart block? How is it managed?
11. Describe the difference between AV dissociation & 3° AV block.
12. Compare PAC's to PVC's.
13. Give a differential diagnosis of irregularly irregular tachycardia.
14. Define pre-excitation and list the 3 ECG features of classic WPW
15. Explain the concept of antidromic and orthodromic conduction with respect to WPW. Which pts with WPW should not receive AV node blockers? Why?
16. List 10 causes of PVC and VT
17. How do you differentiate b/n SVT with aberrant conduction & ventricular tachycardia?
18. List 10 causes of atrial fibrillation.
19. Describe the management of AFIB, including a discussion about the CHADS2 score and long term stroke risk.
20. What is Brugada syndrome? What is the management?

WiseCracks:

1. List 8 side effects of Amiodarone.
2. Describe features that favor VT over SVT.
3. Describe the Brugada approach to the Dx of VT
4. List Causes of acquired pause-dependent QT prolongation causing Torsades & List causes of adrenergic dependent TdP
5. Describe the treatment of pause dependent TdP
6. Define PSVT and describe management
7. What's Ashman's phenomenon?

Here is the follow-up to the mammoth ACS chapter. This one has some key factoids to put into your mind map / memory pallace / organic computer.

1. List Sgarbossa criteria for AMI in pre-existing LBBB
2. What is Takotsubo cardiomyopathy and how does it present?
3. Describe the kinetics of cardiac biomarkers (Troponins and CK)
4. List DDx for ↑ Troponin
5. What is the utility of CTA in the diagnosis of MI?
6. What is the role of ED-based chest pain centers?
7. List 3 phases of delay in the management of AMI; and describe the time-points in ED management of AMI.
8. What are door-to-needle and door-to-balloon timelines by AHA recommendations?
9. Describe the mechanism of action and indications/contraindications for
   1. Nitroglycerin
   2. Morphine
   3. BBlockers
   4. ACE-I
   5. Antiplatelet Therapies
   6. Anti-thrombins
10. Describe eligibility criteria for Fibrinolytics
11. List contraindications to Fibrinolytic therapy in MI
12. What is the utility of Rescue PCI and Facilitated PCI?
13. List 5 indications for Rescue PCI
14. Describe factors assisting with decision to utilize PCI or thrombolytics
15. In NSTEMI, who will benefit from an early invasive strategy of management?

Wise Cracks:

1. What is the HEART Score?
2. What is the management of ACS in the setting of recent cocaine use?
3. How is STEMI diagnosed in the setting of LBBB?
4. How is STEMI diagnosed in the setting of a ventricular pacemaker?
5. When should you be getting a 15 lead ECG?

This episode covers Chapter 78 of Rosen's Emergency Medicine. Acute Coronary Syndromes... its a gooder.

Acute Coronary Syndromes Part A (Monday)

1. Define Stable Angina, UA, AMI
2. Describe the pathophysiology of AMI
3. What are the components of prehospital management of AMI
4. List population RFs for CAD.
   1. Do they matter in the evaluation of a specific patient?
5. List RFs for atypical presentation of ACS. What are the risks of atypical presentations?
6. List 8 early complications of AMI and briefly describe the management of each one.
7. Describe the progression of ECG changes in STEMI
8. List expected ECG changes (ST↑ and reciprocal ST↓) and culprit vessel for the following:
   1. Anterior wall MI
   2. Lateral wall MI
   3. Inferior wall MI
   4. RV wall MI
   5. Posterior wall MI
9. Describe the ECG characteristics of Left Main Occlusion
10. What is Wellens' sign and what is it's significance
11. List 10 DDx for ST-elevation
12. Describe the ECG features of
    1. Benign early repolarization
    2. Pericarditis
    3. LBBB
    4. RBBB
    5. Ventricular-paced rhythm
    6. LVH / Strain-pattern
    7. LV aneurysm

Wise Cracks:

What are the STEMI equivalents? Know these patterns!!!

This episode covers Chapter 77 of Rosen's Emergency Medicine. The Pleural Space is not to be trifled with!

1. List 5 RFs for 1° spontaneous PTX.
2. What is the most common pathophysiologic cause of PTX?
3. List 8 causes of 2° spontaneous PTX
4. List 5 clinical findings suggestive of tension PTX
5. Describe how to estimate the size of a PTX
6. Describe the management of 1° and 2° spontaneous PTX
7. Describe the procedure needle aspiration of a PTX. List 3 benefits of this over TT
8. Describe the procedure of TT. List 6 complications of TT placement and contraindications.
9. List 10 causes of pleural effusion. What is the most common transudative and exudative?
10. What is starling's law and how does it apply to the development of pleural effusions
11. List 5 CXR findings of pleural effusion
12. Describe Light's Criteria for pleural effusion and list 5 other tests to perform on pleural fluid. What does a low pH indicate?
13. Describe the procedure of thoracentesis. List 2 contraindications and 9 complications

Wise Cracks

1. What is Catamenial pneumothorax? How is it tx?
2. How do you properly Secure a chest tube?
3. Describe the seldinger technique for chest tube insertion
4. What are the false positives for PTX on lung U/S?