CRACKCast & Physicians as Humans on CanadiEM

This episode covers Chapter 67 of Rosen's Emergency Medicine. Its a heavy topic, but important to get right.

• What precautions should be taken prior to engaging in potential sexual abuse cases?

• What information can be useful in determining the location and likelihood of injury in sexual assault?

• What is the prevalence of mental illness in sexual assault patients? Which populations are found to have a higher proportion of mental illness? What effect does mental illness have on the severity of the attack?

• What factors make genital injury more likely to be observed? Less likely?

• What are the risks of STI's after sexual assault?

• What are appropriate treatments for STI prophylaxis in cases of suspected sexual abuse/assault?

• What resources exist to help medical providers and any victims of sexual abuse?

• What differences should be considered with male victims of sexual assault?

------------------------------

Thank-you to Dr. Sampsel for her assistance with this episode!

This episode covers Chapter 65 of Rosen's Emergency Medicine. Its a big intro into the next few chapters covering forensic medicine in the emergency department. Tighten up those boot straps, this stuff is heavy!

1. What are some pearls and pitfalls for ER physicians when dealing with Forensic Emergency Medicine?
2. What are proper terms used to describe wound injury patterns?
3. What's the anatomy of a cartridge (bullet)? What are the types and important aspects of wound ballistics?
4. What signs would you see for the various ranges of fire of a bullet?
5. What are common red flags to alert you to the possibility of domestic violence? What risk factors make domestic violence more common?
6. Describe the different types of blunt force pattern injuries and the pathophysiology of how they occur. Do the same for sharp force and thermal wounds.
7. What does the Health Insurance Portability and Accountability Act permit a physician to disclose to the investigating law enforcement officer?

This episode covers Chapter 64 of Rosen's Emergency Medicine. Worried about what to do with those patient's coming in with their skin melting off from a chemical exposure? We've got you covered.

1) Describe the difference between Alkali and Acid injuries

2) Describe a HAZMAT response on scene

3) Describe the decontamination of an individual

4) List PPE for first responders or caregivers

Wisecracks

-Name two acids that cause damage through liquefactive necrosis -List Chemical Agents used in Warfare / Terrorism -What chemicals should you NOT irrigate with water?

This episode of CRACKCast covers Rosen's Chapter 63, Thermal Burns. These patients are often the sickest in the department and many are on their way to the ICU. There are life-saving interventions that are begun in the emergency department with significant impacts on morbidity and mortality, and many are discussed in this episode.

Signposts:

1. List zones of burns
2. List 6 indications for intubation in the burn patient
3. List and describe 2 formulas for fluid resuscitation
4. Describe depth classification for burn injuries
5. List indicators of upper airway and lower airway burns
6. What is the Rule of 9's and how is it modified in pediatrics
7. List criteria for transfer to burn unit
8. Describe basic burn dressing management
9. List 5 burn prevention strategies

Wisecracks:

1. What are the indications for an escharotomy
2. What are the primary considerations in mechanical ventilation of burn patients

This episode covers Chapter 62 of Rosen's Emergency Medicine. Does leaving the comfort of your warm, safe bed scare you? After this chapter, it might...

Sign Post:

1. List the 4 families of venomous snakes.
2. Describe phenotypic characteristics of Pit-Vipers
3. Describe phenotypic characteristics of coral snakes?
4. List the grades of pit viper envenomation and indicate therapy?
5. Describe a black-widow spider and expected management goals?
6. Describe a brown recluse spider and expected management goals
7. List 3 classes of venomous marine injuries, and describe key principles of management for each?

WiseCrack:

• What does expert opinion suggest to avoid anaphylaxis in non-recombinant antivenin administration?
• What is the most toxic, per weight, venom?
• What are the general phenotypic features of poisonous snakes in North America?

This episode covers Chapter 61 of Rosen's Emergency Medicine. Know anything about mammalian bites...? Yeah, neither did we until we read this chapter. Lots of juicy clinical pearls.

1. List 5 pathogens responsible for infection from Dog bite
2. List 4 risk factors for overwhelming sepsis from dog bite
3. What first line antibiotic is a good choice for cat and dog bites?
4. What species are known to cause infection with Pasteurella multocida?
5. What are the risk factors for infection with animal bites?
6. Describe the treatment of Monkey Bites?
7. When is anti-viral prophylaxis NOT indicated for a monkey bite
   1. What is the duration of therapy of antiviral prophylaxis?
8. Describe the recommendations for wound closure and antibiotics in bite cases

Wisecracks:

1. What about seal bites?
2. What about rabies in BC?
3. Waterhouse-Friderichsen syndrome & capnocytophagia-related Gangrene sepsis - what are they?

This episode of CRACKCast covers Rosen's Chapter 60, Foreign Bodies. This episode covers an approach to foreign bodies, including location specific tips, complications and safe removal in the ED.

1. Describe your approach to Ocular FB
2. What is Seidel Sign?
3. List indirect signs of FB on Xray
4. List complications of ear FB
5. Describe the process of anesthesia of the ear and preparation for FB removal
6. Describe 5 techniques for removal of FB from ear
7. Describe the management of TM perforation secondary to FB
8. Describe 5 techniques for removal of FB from nose
9. Describe a step-wise approach to pediatric FB airway obstruction
10. List 7 symptoms of Esophageal FB
11. List 8 complications of esophageal FB
12. List 4 complications specific to button battery ingestions
13. List indications for removal of esophageal FBs
14. List 4 removal techniques of esophageal FB
15. List 5 techniques for management of food bolus and their mechanism of action
16. List the criteria for continued expectant management for intestinal FB
17. Describe the stepwise management of a Rectal FB

Wisecracks:

1. What is the safe dose of topical anesthetics?
2. How do you test the radiolucency of an object?
3. What is a Cafe Coronary? What is Penetration Syndrome?
4. Differentiate Body stuffing from Body Packing

In the third episode of the Physicians as Humans project, I corresponded with a Canadian emergency physician who sent me her personal account of depression. The result is this beautiful, thoughtful story that she has graciously allowed me to read for the podcast.

This is an ongoing project, so if you or anyone you know have a story about managing personal struggles while in medicine, please contact [email protected].

Music for Episode 02 (All songs have been modified for the project)

1. ambient by strange day. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
2. Cease by A Himitsu. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
3. I Dunno by Grapes. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
4. Lost Within by A Himitsu. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
5. Moon by LEMMiNO. Music provided by Music for Creators under a Creative Commons Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 license.
6. Tomorrow by Bensound
7. Laws of Movement by The Passion HiFi. www.thepassionhifi.com

This episode of CRACKCast covers Rosen's Chapter 59, Wound Management Principles. This episode covers the nitty-gritty details of wound management and what you need to know to get that perfect wound closure!

Questions:

1) List risk factors for wound infection2) List the 5 stages of wound healing3) List toxic doses of local anesthetics4) 3 types of wound closure?5) List advantages of and contraindications of tissue adhesives6) List indications for tetanus immune prophylaxis7) List 5 specific wound care instructions8) List 7 situations where antibiotic prophylaxis is indicated in wound management

WiseCracks:

Evidence guided tips for scar healing?

How to decrease pain of anaesthetic injection?

Where can I find a concise guide to Suture material use?