EM Clerkship

You are working at Clerkship General when the next chart gets handed to you – a 31 year old female presenting with abdominal pain.

Initial Vitals:

BP: 109/65

HR: 96

RR: 21

O2: 99%

Temp: 99.1F

Critical Actions:

* Obtain pregnancy test* Confirm IUP * Administer Rhogam* Treat UTI* Counsel the patient and discharge them

Further Reading:

CoreEM – Utility of Anti-D Immunoglobulin(Rho Gam) During First Trimester Pregnancy

EMDocs – Bleeding in Early Pregnancy

Things to consider when selecting residency programs to apply to: 1.  What type of program (County, Community, Academic) 2.  What length of program (3 year vs. 4 year) 3.  Location 4.  Culture and Lifestyle 5.  Niches in EMFurther Resources:

EMRA Residency MapDoximity NavigatorSAEM Residency FairEMRA Residency Fair

3 Steps to assessing your competitiveness for matching in an EM residency: 1.  Get a good advisor. 2.  Look at the data. 3.  Maximize your potential.

Further Reading:

EMRA – Apply smarter not harderEMRA HangoutsEMRA Student-Resident Mentorship ProgramNRMP Charting the OutcomesNRMP Residency DataALiEM – Match AdviceUTSW Texas STAR

The future of emergency medicine seems bleak. Listen to Zack’s perspective on the future of our beloved specialty in part TWO of this two-part series.

You are working your FIRST SHIFT EVER at Clerkship General hospital when a 60 year old female presents with shortness of breath.

Initial Vitals:

* HR: 92* RR: 28* BP: 120/80* O2%: 89%* Temp: 101.2F

Critical Actions:

* Obtain full set of vital signs* Diagnose PNA and COPD exacerbation* Administer appropriate antibiotics* Treat symptoms with steroids and nebulizers* Admit patient to the hospital

The future of emergency medicine seems bleak. Listen to Zack’s perspective on the future of our beloved specialty in part one of this two-part series.

You are working at *rural* Clerkship General when you receive a radio call from EMS – 7yo male from a severe bus accident with a large scalp laceration, unable to control the hemorrhage.

Initial Vitals

* HR: 136* RR: 22* BP: 80/35* O2%: 100%* Temp: 98F

Critical Actions:

* Perform ATLS Algorithm* Control Hemorrhage* Transfuse pRBCs* Replete Factor VIII with correct dosing (100% replacement)* Diagnose supracondylar fracture on XR and splint appropriately

Further Reading:

emDOCs – Managing Hemophilia in the ED

CoreEM – Supracondylar fracture in the ED

Asymptomatic Bradycardia – usually don’t treat

Symptomatic Stable Bradycardia – atropine, further workup

Symptomatic Unstable Bradycardia – SIMULTANEOUS treatment with medications and electricity

* Meds: Trial of atropine, then either epinephrine, dopeamine, or isoproterenol* Electricity: Transcutaneous Pace –> TVP

DDX of Bradycardia – BRADIE

Blocks (av blocks)

Reduced vital signs (hypoxemia, hypothermia, hypoglycemia)

Acs (acute coronary syndrome/ischemia)

Drugs (beta blocker, calcium channel blocker, digoxin, organophosphate)

Infection/Inc ICP (Lyme, myocarditis // cushings reflex)

Electrolyte/Endocrine (hyperkalemia, hypermagnesemia, hypocalcemia // myxedema coma)

What is most important to programs from ERAS? SLOEs, clinical grades on EM rotations and residency interviews.

How do you look good on interviews? Have a thorough ERAS application that gives interviewers lots to ask about!

On ERAS, there are four sections in the curriculum vitae portion:

* Education – honorary societies, medical school awards, other awards/accomplishments (e.g. college, volunteer, previous career awards)* Experiences –* Work (paid, unpaid clinical or teaching)* Volunteer (public service, leadership, clubs and organizations)* Research (labs, projects)* Licensure – only if previous medical career, legal history* Publications – papers, presentations, online publications

Don’t forget to add some personality to your application with the hobbies section!

Further Reading

ERAS Pt 1: The 8 Parts of the ApplicationThere are 8 parts to the application:

* Personal and Biographic Information – mostly self-explanatory* Curriculum Vitae (Resume) – keep an updated CV throughout medical school to makethis easy to fill out, be concise but specific* Personal Statement – start early* Letters of Recommendation – should ideally have two SLOEs from rotations in EMdepartments plus one extra letter* Test Scores – transfer reports from USMLE or COMLEX* MSPE or Dean’s Letter – submitted by your school* Medical School Transcript – submitted by your school* Photo – business professional headshot with neutral background

Further Reading:

CordEM – SLOE 1

CordEM – SLOE 2