CRACKCast & Physicians as Humans on CanadiEM

This episode covers Chapter 47 of Rosen's Emergency Medicine.

1. List 6 general indicators of genitourinary trauma?

Lower urinary tract and external genitalia

• What are the four parts of the male urethra?

• What is the mechanism of an anterior urethral injury (at least 5 causes)? What is the mechanism of a posterior urethral injury?

• List 4 indications for retrograde urethrogram before foley placement?

• Describe the technique for a retrograde urethrogram?

• Classify bladder injuries and describe the mechanism of injury.

• Differentiate between extraperitoneal and Intraperitoneal bladder rupture

• Describe the indications and technique for retrograde cystogram?

• Outline the management of the different types of bladder injuries.

• List 3 clinical findings of a penile fracture

• Describe the management of penile

• Constricting devices

• Superficial hematoma

• Superficial lacerations

• Degloving injury

• Penile Fracture

• Penile amputation

• Blunt scrotal trauma

• Bites

Upper urinary tract

• What is the presentation of a ureteric injury?

• What are the indications for renal imaging in an adult trauma patient? In a pediatric trauma ?

• Describe the management of renal injuries:

• Blunt

• Penetrating

Wisecracks:

What is the most common site of urethral injuries?

This episode covers chapter 46 of Rosen's Emergency Medicine text book.

Episode Overview:

1) What are three mechanisms of injury in blunt trauma?

2) List expected seat-belt injuries

3) What are the most common intra-abdominal injuries in children?

4) Differentiate between the use of CT scan, diagnostic peritoneal lavage (DPL) and ultrasound – advantages & disadvantages.

5) List intra-abdominal injuries that may be missed on CT.

6) Describe the process of local wound exploration.

1. List 5 ways to determine if peritoneum has been violated

7) List clinical indications for laparotomy in blunt and penetrating abdominal trauma

8) Describe the management of unstable blunt abdominal trauma

1. Pelvic fracture
2. Head injury (closed head injury)
3. Wide mediastinum (aortic injury)

9) Provide an approach to anterior abdominal trauma with:

1. Evidence of peritoneal violation (penetrating injuries)
2. Evidence of intra-abdominal injury with blunt abdominal trauma

10) Provide an approach to flank injuries

11) Provide an approach to back injuries

Wisecracks:

1) Describe indications and technique of diagnostic peritoneal lavage (DPL). What is a positive DPL?

2) List 1 absolute contraindication and 4 relative contraindications to DPL

3) What is Waddel's triad?

4) What are Gray-Turner and Cullen's signs?

5) How much blood is detectable by bedside US?

1. Differentiate Chest wall injury, rib fracture, and flail chest
2. Describe the clinical presentation and management of a sternal fracture
3. Describe Injuries to lung parenchyma
4. What is Traumatic asphyxia?
5. List 6 indication for tube thoracostomy
6. Indications for OR Thoracotomy
7. What is the management of Diaphragmatic injury?
8. Differentiate between myocardial concussion, contusion and rupture
9. Review indications for ED Thoracotomy
10. Describe your approach to identification and management of pericardial tamponade
11. CXR findings for blunt aortic injury.
12. List the 6 most common causes of esophageal perforation
13. What is the Nexus CT Chest Rule?

WiseCracks:

1. Clinical conditions that mimic esophageal perforation
2. Describe the basic approach to ED thoracotomy
3. What is Electrical Alternans?

This episode of CRACKCast covers Rosen's Chapter 044, Neck Trauma. Continuing in our trauma series, this episode tackles the challenging issue of neck trauma and injuries, and explores the anatomy and relevant considerations in the diagnosis and management of both blunt and penetrating neck injuries.

Episode Overview:

1) Describe the landmarks and structures using the Zones of the neck & the Triangles of neck

2) List 6 hard and 6 soft signs of penetrating neck trauma. What are the indications for immediate OR vs CTA in managing penetrating neck trauma

3) Describe an approach to managing acute neck trauma in the ER

4) Describe the management of venous air embolism

5) Describe techniques for airway management in penetrating neck trauma

6) Describe the management of suspected pharyngoesophageal trauma. What are signs of esophageal injury?

7) List 3 hard signs of laryngotracheal trauma and describe airway management dilemmas

Wisecracks:

1) Differentiate between choking, hanging and strangulation

2) Define judicial and non-judicial hanging and describe expected injury patterns

This episode covers Chapter 043 of Rosen's Emergency Medicine, Spinal Injuries.

Episode Overview

• Describe the anatomical contents of the anterior and posterior spinal columns
• List cervical spinal injuries for the following mechanisms, and indicated whether they are stable or unstable
  1. Flexion x 6
  2. Shear / AP forces x 1
  3. Flexion-Rotation x 2
  4. Extension x 3
  5. Vertical Compression x 2
• List 8 unstable C-spine injuries
• Describe an approach to C-Spine X-rays, and define normal:
  1. Predental space
  2. Soft-tissue spaces
  3. Line of Swischuck
• Describe Canadian C-Spine Rule + Nexus Rule
• Describe incomplete cord lesions
• Describe:
  1. Wallenburgs Syndrome
  2. Dejeune Onion Skin Pattern of Analgesia
  3. Horners Syndrome
  4. Cauda Equina
• How does the bulbocavernosus reflex reflect the presence of spinal shock
• List features of sacral sparing
• List Dermatomes/ Myotomes / Spinal reflexes
• List 6 causes of Horner's
• For what C-spine injuries is a CT-a indicated to R/O vascular injury
• Are Steroids indicated for C-spine injuries
• For whom is surgical intervention indicated immediately with a spinal cord injury
• Define neurogenic shock and describe its management
• Define spinal shock
• What is the risk of cervical injury in Down's Syndrome? Rheumatoid Arthritis?
• What are the Denver criteria?

This episode covers Chapter 42 of Rosen's Emergency Medicine, Facial Trauma.

1) Describe the anatomy of the bones, glands, and ducts of the face. At what ages do the sinuses appear?

2) List 5 types of facial fractures.

3) Describe the clinical presentation and associated radiographic findings of an orbital blowout fracture.

4) Describe an orbital tripod fracture and its management.

5) List the indications for antibiotics in a patient with facial trauma?

6) What is the importance of perioral electrical burns?

7) What are the indications for specialist repair of an eyelid laceration?

8) Describe the classification and management of dental fractures.

1. What is the management of an avulsed tooth?
2. What is a luxed tooth? How is it managed?
3. What is an alveolar ridge fracture?

9) Describe the method for reducing a jaw dislocation? What is the usual direction of the dislocation?

In the second episode of the Physicians as Humans project, I speak with Dr. Rob Rogers (@EM_Educator), a leading educator in emergency medicine and director of The Teaching Course. He shares his experiences of dealing with a devastating illness in his own family and the effect it had on his career as an emergency physician.

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]. If you are unfamiliar with the project, please read this post for more information on the origin of this podcast series. The CanadiEM podcast can be added to your podcast application from the iTunes store or by entering the podcast RSS feed. If you would prefer to download it, click here. It can also be streamed above.

Thanks for listening and please refer your colleagues!

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. Moon by LEMMiNO. Music provided by Music for Creators under a Creative Commons Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 license.
3. Icy Vindur by A Himitsu. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
4. Flourish, Wither, Bye by A Himitsu Music provided by Music for Creators under a Creative Commons — Attribution 3.0 Unported— CC BY 3.0 license.
5. Where Silence is Nonexistent by A Himitsu Music provided by Music for Creators under a Creative Commons — Attribution 3.0 Unported— CC BY 3.0 license.
6. Tomorrow by Bensound
7. Pressure by Riot

This episode covers Chapter 41 of Rosen's Emergency Medicine.

1) list 7 causes of altered LOC in the trauma patient

2) List four herniation syndromes.

Describe the pathophysiology of uncal herniation and the typical presentation.

Describe the presentation of central herniation.

3) Describe how cerebral blood flow in relationship to the following parameters: PO2 , PCO2 , MAP and ICP. What are the indications for ICP monitoring?

4) What is the Canadian CT head rule? What are the inclusion criteria. What is the New Orleans CT head rule? What are the inclusion criteria? Which test is more sensitive? More specific?

5) What is a concussion? How is a concussion managed? What are potential complications? Define second impact syndrome & return to play

6) Outline the ED management goals of TBI.

• differentiated between direct and indirect TBI
• What are the indications for seizure prophylaxis following TBI?
• What are the indications for antibiotics in TBI?
• Complications of TBI?

7) 7 clinical features of basal skull #

Wisecracks

1. CT tips: 3 signs of cerebral edema on CT, 5 differences on CT between SDH And EDH, List 3 CT findings in DAI
2. What are: the Monroe-Kellie doctrine, the Cushing's reflex, What is kernihan's notch, and how does this syndrome present?

This episode of CRACKCast covers Rosen's Chapter 040, Injury Prevention and Control.

1) What are the three key aspects to Injury Control?

2) What makes up the Injury Triangle?

3) List 6 of 10 potential strategies for preventing transfer of energy

Wisecracks:

1) What can you actually do, as a health practitioner, to help injury prevention?