You are working at Clerkship General when you hear an EMS call on the radio… “CLERKSHIP GENERAL – We are bringing you an agitated and combative 30 year old male, we’ll see you in 5 minutes.” Initial Vitals: BP: 192/105 HR: 134 RR: 22 O2: 99% (Room Air) Temp: 98.8 F Critical Actions: Dangerous Actions: […]

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 […]

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: Check Out: Pearson Ravitz Webinar – “Disability Insurance 101 for Residents” https://us06web.zoom.us/webinar/register/1416806357023/WN_ziYRNc0kT8yAyOOJZ-Xk2g

* 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

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:

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 – […]

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: Further Reading: EMDocs – GI Bleed

* “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

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! References

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