Consider removing the terminology “Agitated Delirium” from your vocabulary, as there is significant racial bias behind this term.

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