EM Clerkship

By Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MDScience Medicine Health & Fitness Education Life Sciences

Favorites
337
Followers
Typical duration
29 min
per episode

Based on Podcast App listening data

EM Clerkship episodes

May 16, 2023 Deep Dive MW R9

Indications for LP: CNS infection, SAH, Guillian Barree, IIH

Contraindications for LP: Space occupying lesion with mass effect ; severe thrombocytopenia and coagulopathy; cellulitis over LP site or concern for epidural abscess ; traumatic injury to spine

Complications for LP: Post LP Headache, spinal hematoma, brainstem herniation

Technique for LP: Positioning is everything. Use US if necessary. Check for CSF early and often.

When to CT before LP?: AMS; focal neuro deficit; new onset seizures, known CNS lesions; immunosuppression; papilledema
15 min
May 01, 2023 Round 9 (MW) Altered Mental Status

You are working at Clerkship General when the charge nurse comes and grabs you… “Hey doc, we need you in room 2, this kid looks sick…”

Initial Vitals:

BP: 68/40

HR: 128

RR: 22

O2: 99% (Room Air)

Temp: 103.5F

Critical Actions:

* Diagnose Meningitis and Perform Lumbar Puncture

* Give Empiric Antibiotics

* Treat Septic Shock

* Give Steroids

* Give Prophylaxis to Close Contacts

Check Out:

Pearson Ravitz Webinar – “Disability Insurance 101 for Residents”

https://us06web.zoom.us/webinar/register/1416806357023/WN_ziYRNc0kT8yAyOOJZ-Xk2g
32 min
April 16, 2023 Deep Dive MW R8

* Two Types of Priapism

* Low Flow “Ischemic” (Most Common >95% of Cases)

* Urologic Emergency

* Results in Erectile Dysfunction

* Painful

* Common Etiologies

* Idiopathic

* Erectile Dysfunction Drugs (ex. sildenafil)

* Sickle Cell Disease

* Trazodone (“TrazoBONE”)

* Cocaine/Meth

* High Flow

* Caused by Trauma and AV Fistulas

* Management

* Analgesia

* Dorsal Penile Nerve Block

* Aspiration

* Can intermittently irrigate with normal saline to dilute the clot

* Injection

* Phenylepherine

* Recommend cardiac monitor

13 min
April 01, 2023 Round 8 (MW) Groin Pain

You are working at Clerkship General on an overnight shift when the next chart is handed to you. It’s a 35 year old male with a chief complaint of groin pain.

Initial Vitals:

BP: 150/90

HR: 107

RR: 20

O2: 99% (Room Air)

Temp: 98.0F

Critical Actions:

* Diagnose Ischemic/Low Flow Priapism

* Perform Penile Nerve Block

* Aspirate Blood and Irrigate with Saline

* Inject Intracavernous Phenylepherine

* Diagnose and Treat Ventricular Tachycardia

34 min
March 16, 2023 Deep Dive MW R7

Obtain IV Access – get two large bore IVs (18g or larger)

Resuscitate – un-crossmatched blood at first, don’t forget type and screen!

Medicate – Give Pantoprazole always, Octreotide and Ceftriaxone if hx liver disease, reverse anticoagulation if indicated

Imaging – Upright CXR to assess for perforation, CTA if concerned for lower GIB

Consult – GI if unstable / if variceal bleeding

Disposition – based on amount of bleeding and hemodynamic stability

11 min
March 01, 2023 Round 7 (MW) – Vomiting Blood

You are working at Clerkship General when the charge nurse grabs you – “hey we got a real sick one, a 57yo Male who I just put in the resuscitation bay, he is vomiting blood”.

Initial Vitals:BP: 77/34

HR: 135

RR: 24

O2%: 95%

Temp: 98.8F

Critical Actions:

* Place two large bore IVs

* Transfuse emergency uncross matched blood

* Administer IV Pantoprazole

* Administer IV Ceftriaxone and IV Octreotide

* Consult GI

Further Reading: EMDocs – GI Bleed
32 min
February 19, 2023 Flash Pulmonary Edema (aka SCAPE)

* “Sympathetic Crashing Acute Pulmonary Edema”

* Pathophysiology – Rapid onset of pulmonary edema caused by sudden hypertension

* Triggers- Missed Medication, Cocaine, Stress/Anxiety

* Increase in BP = Increase in afterload

* Increased afterload causes acute pulmonary edema (in patients with CHF)

* The worsening pulmonary edema causes shortness of breath which worsens blood pressure and further increases afterload

* Presentation- Sudden, severe respiratory distress AND hypertension

* Different than CHF exacerbation

* Not necessarily caused by hypervolemia

* More rapid in onset

* Typically crackles/rales on exam or diffuse B-Lines on POCUS

* Treatment

* BiPAP/CPAP

* High Dose Nitroglycerin

* Diuretics IF Hypervolemic

14 min
February 01, 2023 Opioid Use Disorder – What You Do Matters!

In this long-form episode we will discuss opioid use disorder, the leading cause of death in young adults in the United States. What you do matters!

* Why you should care about OUD

* What is OUD

* Buprenorphine Works

References

* National Safety Counsel Injury Facts

* DebunkingDenial – Purdue Pharma and America’s Opioid Epidemic

* Addiction Neuroscience 101 – Youtube

* Cochran Review – Buprenorphine for OUD

46 min
January 20, 2023 The Rank List

This episode will answer 3 big pre-Match Day questions:

1. How do I go about making my rank list?

2. What about post-interview communication both from and to programs?

3. How does this whole thing called the Match actually work?

Resources:

EM Match Advice: Post Interview Communications

https://www.emra.org/books/msadvisingguide/preparing-and-submitting-your-rank-list/

21 min
January 16, 2023 Deep Dive MW R6

Aortic Dissection – when there is a tear in the intima layer of the aorta and the blood dissects the intima away from the media creating a false lumen in the aorta

* Historical Features

* Be VERY suspicious with ABRUPT onset of chest/back pain that reaches MAXIMAL SEVERITY immediately after onset of pain.

* Chest pain or Back pain with a neurologic deficit

* Pain “above and below the diaphragm”

* Diagnosis

* CT Angiography of chest abdomen and pelvis is gold standard

* Can see widened mediastinum on CXR or dissection flap on POCUS

* Treatment

* Pain control first

* Heart rate control second (goal <60bpm, use esmolol)

* Blood pressure control third (goal 100-120SBP, use nicardipine/clevidipine)

* CT Surgery consult (should go directly to OR with a Type A dissection)

* Arterial Line placement

Further Reading:

Core EM – Aortic Dissection

LITFL – Aortic Dissection
22 min

About EM Clerkship

From the publisher's feed

The purpose of this podcast is to help medical students crush their emergency medicine clerkship and get top 1/3 on their SLOE. The content is organized in an approach to format and covers different…