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EM Clerkship

Zack Olson, MD

28
Followers
176
Plays
EM Clerkship

EM Clerkship

Zack Olson, MD

28
Followers
176
Plays
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About Us

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 chief complaints, critical diagnoses, and skills important for your clerkship.

Latest Episodes

Announcement

EThe website it updated! Please check it out and email me with any technical issues or other comments/concerns. Enjoy your shift!

1 MIN2 w ago
Comments
Announcement

Round 12 (Difficulty Breathing)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction A young gentlemen runs out to triage yelling “I can’t breath!” and collapses to the floor in front of the nurse… Initial Vitals * Temp 98.8* HR 145* RR 45* BP 60/30* O2 85% Critical Actions * Give Supplemental Oxygen* Identify Pneumothorax Prior to Imaging* Correctly Perform Needle Thoracostomy* Correctly Perform Tube Thoracostomy Final Diagnosis Pneumothorax Secondary to Penetrating Chest Trauma Tips and Tricks Be careful, lack of visual cues during oral cases can mislead you! Additional Reading * Thoracic Trauma (EM Clerkship)* NBME Trauma Review (EM Clerkship)

34 MINJUL 1
Comments
Round 12 (Difficulty Breathing)

Round 11 (Headache)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are having a busy day in the department when you are paged overhead to the resuscitation bay for an ill appearing patient with a headache… Initial Vitals * Temp 98.9* HR 99* RR 18* BP 180/110* O2 94% Critical Actions * Verbalize a Full Neurologic Examination* Obtain CT Scan Without Contrast* Consult Neurosurgery for Subarachnoid Hemorrhage* Reverse Warfarin Coagulopathy* Administer Antihypertensives Final Diagnosis Acute Subarachnoid Hemorrhage on Anticoagulation Tips and Tricks Always ask the patient if they have allergies prior to administering ANYTHING. Additional Reading * Basics of Subarachnoid Hemorrhage (EM Clerkship)* How to Reverse Warfarin (AHA)

33 MINJUN 1
Comments
Round 11 (Headache)

Round 10 (Allergic Reaction)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction A 45 year old female is exposed to peanut butter and shrimp pizza and begins to have an apparent allergic reaction… Initial Vitals * Temp 98.8* HR 130* RR 35* BP 70/40* O2 92% Critical Actions * Verbalize Airway Evaluation* Complete a FOCUSED History and Exam* Normal Saline Bolus* Epinephrine both IM and (subsequently) IV* Glucagon 1mg IV Final Diagnosis Refractory Anaphylaxis Due to Beta Blockers Tips and Tricks You still need to obtain a quick history and exam even if you know the diagnosis in the first few seconds of the case Additional Reading * Basic approach to anaphylaxis (EM Clerkship)* Tranexamic acid as first-line emergency treatment for episodes of bradykinin-mediated angioedema induced by ACE inhibitors. (PubMed)* Glucagon infusion in refractory anaphylactic shock in patients on beta-blockers. (PubMed)

30 MINMAY 1
Comments
Round 10 (Allergic Reaction)

Round 9 (Seizure)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction The nurse brings back a young adult male from the lobby who is having a seizure… Initial Vitals * Temp 98.8* HR 90* RR 10* BP 120/80* O2 92% Critical Actions * Verbalize ABCs on a Critical Patient* Obtain Immediate Blood Glucose Level* Give Benzodiazepine* Initiate Workup of New-Onset Seizures* Give Pyridoxine (Vitamin B6) Final Diagnosis Isoniazid Toxicity Tips and Tricks When the patient is unable to provide history, attempt to obtain the information from external sources Additional Reading * Isoniazid toxicity overview (Life in the Fast Lane)* Basic approach to seizures (EM Clerkship)* Basic approach to status epilepticus (EM Clerkship)* Ketamine for refractory status epilepticus (PubMed) Corrections Ketamine not Keppra as potential induction agent for status epilepticus (32:40)

38 MINMAR 2
Comments
Round 9 (Seizure)

Round 8 (Fall)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction EMS brings in an elderly man who has fallen… Initial Vitals * Temp 98.6* HR 58* RR 16* BP 105/60* 99% Critical Actions * Treat the patient’s pain* Consult orthopedics for a hip fracture* Obtain an EKG* Treat Severe Hyperkalemia* Consult nephrology for dialysis Final Diagnosis Ground level fall resulting in hip fracture, missed dialysis, and severe hyperkalemia Tips and Tricks Patient’s will frequently have more than one final diagnosis. Do not prematurely close an the initial, obvious, diagnosis. A man can have as many diseases as he damn well pleases! Hickam’s dictum Additional Reading * Basic approach to hyperkalemia (EM Clerkship)* EKG manifestations of hyperkalaemia (LITFL)

29 MINFEB 1
Comments
Round 8 (Fall)

Round 7 (Headache)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction Just a routine day at your hospital, your next patient has a chief complaint of headache… Initial Vitals * Temp 98.8* HR 88* RR 16* BP 130/80* O2 99% Critical Actions * Identify Acute Angle Closure Glaucoma* Initiate Appropriate Treatment for Acute Angle Closure Glaucoma* Emergent Consult to Ophthalmology* Recheck Intra-Ocular Pressure After Initiating Treatment Dangerous Actions * Giving NSAIDS (The Patient Had This on Allergy List)* Performing a Lateral Canthotomy Final Diagnosis Acute Angle Closure Glaucoma Tips and Tricks Do not be surprised or scared when an examiner has a monotone voice and flat affect Additional Reading * Management of acute angle closure glaucoma (PubMed)* Basic approach to eye complaints (EM Clerkship)

30 MINJAN 1
Comments
Round 7 (Headache)

Round 6 (Back Pain)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction A notorious, disheveled frequent flyer presents to your emergency department for her back pain and is asking for more Dilaudid… Initial Vitals * Temp 99.0* HR 99* RR 18* BP 118/78* O2 99% Critical Actions * Ask about Red Flags for Spinal Infection* Perform a Thorough Spinal Exam* Obtain MRI Spine with Contrast* Initiate Broad Spectrum Antibiotics* Treat Pain when Pathology Identified Final Diagnosis Spinal Epidural Abscess Tips and Tricks Don’t let consultants or other members of your team talk you out of appropriate management of a patient Additional Reading * Basic approach to Back Pain (EM Clerkship)* Epidural Abscess Overview (AAFP Website)

52 MIN2019 DEC 1
Comments
Round 6 (Back Pain)

Round 5 (Geriatric Fall)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction The nurse is asking you to evaluate a 70 year old male who has been placed in a hall bed after hitting the back of his head. She wants to know if you would like to call a trauma alert… Initial Vitals * Temp 103.7 (Hidden by Examiner)* HR 115* RR 18* BP 110/75* O2 99% Critical Actions * Diagnose Fournier’s Gangrene on Secondary Survey* Obtain Full Vital Signs Including Temperature* Perform Sepsis “Core Measures”* Initiate Appropriate Treatment for Fournier Gangrene* Immediate Surgical Consultation Final Diagnosis Septic Shock due to Fournier Gangrene Tips and Tricks Always ask for the patient’s temperature if it is not given with initial vital signs Additional Reading * Fournier Gangrene Overview (PubMed)* Basic Approach to Sepsis (EM Clerkship)* Basic Approach to Trauma (EM Clerkship)

43 MIN2019 NOV 1
Comments
Round 5 (Geriatric Fall)

Round 4 (Flank Pain)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction The nurse tells you that you have a new patient and is requesting a verbal order for nausea medicine. She advises you that the patient is the CEO of your hospital… Initial Vitals * Temp 98.9* HR 99* RR 18* BP 120/80* O2 98% Critical Actions * Perform Genitourinary Exam* Rule Out Abdominal Aortic Aneurysm* Consult Urology* Treat the Patient’s Pain* Resist Delays on Consultant Pushback Dangerous Actions * Delaying Urology Consultation to Obtain an Ultrasound Final Diagnosis Testicular Torsion with Referred Pain Tips and Tricks Don’t forget to verbalize genitourinary exam when appropriate Additional Reading * Testicular torsion overview (EM Clerkship) Corrections It is rare for testicular torsion to occur at this age

31 MIN2019 OCT 1
Comments
Round 4 (Flank Pain)

Latest Episodes

Announcement

EThe website it updated! Please check it out and email me with any technical issues or other comments/concerns. Enjoy your shift!

1 MIN2 w ago
Comments
Announcement

Round 12 (Difficulty Breathing)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction A young gentlemen runs out to triage yelling “I can’t breath!” and collapses to the floor in front of the nurse… Initial Vitals * Temp 98.8* HR 145* RR 45* BP 60/30* O2 85% Critical Actions * Give Supplemental Oxygen* Identify Pneumothorax Prior to Imaging* Correctly Perform Needle Thoracostomy* Correctly Perform Tube Thoracostomy Final Diagnosis Pneumothorax Secondary to Penetrating Chest Trauma Tips and Tricks Be careful, lack of visual cues during oral cases can mislead you! Additional Reading * Thoracic Trauma (EM Clerkship)* NBME Trauma Review (EM Clerkship)

34 MINJUL 1
Comments
Round 12 (Difficulty Breathing)

Round 11 (Headache)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are having a busy day in the department when you are paged overhead to the resuscitation bay for an ill appearing patient with a headache… Initial Vitals * Temp 98.9* HR 99* RR 18* BP 180/110* O2 94% Critical Actions * Verbalize a Full Neurologic Examination* Obtain CT Scan Without Contrast* Consult Neurosurgery for Subarachnoid Hemorrhage* Reverse Warfarin Coagulopathy* Administer Antihypertensives Final Diagnosis Acute Subarachnoid Hemorrhage on Anticoagulation Tips and Tricks Always ask the patient if they have allergies prior to administering ANYTHING. Additional Reading * Basics of Subarachnoid Hemorrhage (EM Clerkship)* How to Reverse Warfarin (AHA)

33 MINJUN 1
Comments
Round 11 (Headache)

Round 10 (Allergic Reaction)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction A 45 year old female is exposed to peanut butter and shrimp pizza and begins to have an apparent allergic reaction… Initial Vitals * Temp 98.8* HR 130* RR 35* BP 70/40* O2 92% Critical Actions * Verbalize Airway Evaluation* Complete a FOCUSED History and Exam* Normal Saline Bolus* Epinephrine both IM and (subsequently) IV* Glucagon 1mg IV Final Diagnosis Refractory Anaphylaxis Due to Beta Blockers Tips and Tricks You still need to obtain a quick history and exam even if you know the diagnosis in the first few seconds of the case Additional Reading * Basic approach to anaphylaxis (EM Clerkship)* Tranexamic acid as first-line emergency treatment for episodes of bradykinin-mediated angioedema induced by ACE inhibitors. (PubMed)* Glucagon infusion in refractory anaphylactic shock in patients on beta-blockers. (PubMed)

30 MINMAY 1
Comments
Round 10 (Allergic Reaction)

Round 9 (Seizure)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction The nurse brings back a young adult male from the lobby who is having a seizure… Initial Vitals * Temp 98.8* HR 90* RR 10* BP 120/80* O2 92% Critical Actions * Verbalize ABCs on a Critical Patient* Obtain Immediate Blood Glucose Level* Give Benzodiazepine* Initiate Workup of New-Onset Seizures* Give Pyridoxine (Vitamin B6) Final Diagnosis Isoniazid Toxicity Tips and Tricks When the patient is unable to provide history, attempt to obtain the information from external sources Additional Reading * Isoniazid toxicity overview (Life in the Fast Lane)* Basic approach to seizures (EM Clerkship)* Basic approach to status epilepticus (EM Clerkship)* Ketamine for refractory status epilepticus (PubMed) Corrections Ketamine not Keppra as potential induction agent for status epilepticus (32:40)

38 MINMAR 2
Comments
Round 9 (Seizure)

Round 8 (Fall)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction EMS brings in an elderly man who has fallen… Initial Vitals * Temp 98.6* HR 58* RR 16* BP 105/60* 99% Critical Actions * Treat the patient’s pain* Consult orthopedics for a hip fracture* Obtain an EKG* Treat Severe Hyperkalemia* Consult nephrology for dialysis Final Diagnosis Ground level fall resulting in hip fracture, missed dialysis, and severe hyperkalemia Tips and Tricks Patient’s will frequently have more than one final diagnosis. Do not prematurely close an the initial, obvious, diagnosis. A man can have as many diseases as he damn well pleases! Hickam’s dictum Additional Reading * Basic approach to hyperkalemia (EM Clerkship)* EKG manifestations of hyperkalaemia (LITFL)

29 MINFEB 1
Comments
Round 8 (Fall)

Round 7 (Headache)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction Just a routine day at your hospital, your next patient has a chief complaint of headache… Initial Vitals * Temp 98.8* HR 88* RR 16* BP 130/80* O2 99% Critical Actions * Identify Acute Angle Closure Glaucoma* Initiate Appropriate Treatment for Acute Angle Closure Glaucoma* Emergent Consult to Ophthalmology* Recheck Intra-Ocular Pressure After Initiating Treatment Dangerous Actions * Giving NSAIDS (The Patient Had This on Allergy List)* Performing a Lateral Canthotomy Final Diagnosis Acute Angle Closure Glaucoma Tips and Tricks Do not be surprised or scared when an examiner has a monotone voice and flat affect Additional Reading * Management of acute angle closure glaucoma (PubMed)* Basic approach to eye complaints (EM Clerkship)

30 MINJAN 1
Comments
Round 7 (Headache)

Round 6 (Back Pain)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction A notorious, disheveled frequent flyer presents to your emergency department for her back pain and is asking for more Dilaudid… Initial Vitals * Temp 99.0* HR 99* RR 18* BP 118/78* O2 99% Critical Actions * Ask about Red Flags for Spinal Infection* Perform a Thorough Spinal Exam* Obtain MRI Spine with Contrast* Initiate Broad Spectrum Antibiotics* Treat Pain when Pathology Identified Final Diagnosis Spinal Epidural Abscess Tips and Tricks Don’t let consultants or other members of your team talk you out of appropriate management of a patient Additional Reading * Basic approach to Back Pain (EM Clerkship)* Epidural Abscess Overview (AAFP Website)

52 MIN2019 DEC 1
Comments
Round 6 (Back Pain)

Round 5 (Geriatric Fall)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction The nurse is asking you to evaluate a 70 year old male who has been placed in a hall bed after hitting the back of his head. She wants to know if you would like to call a trauma alert… Initial Vitals * Temp 103.7 (Hidden by Examiner)* HR 115* RR 18* BP 110/75* O2 99% Critical Actions * Diagnose Fournier’s Gangrene on Secondary Survey* Obtain Full Vital Signs Including Temperature* Perform Sepsis “Core Measures”* Initiate Appropriate Treatment for Fournier Gangrene* Immediate Surgical Consultation Final Diagnosis Septic Shock due to Fournier Gangrene Tips and Tricks Always ask for the patient’s temperature if it is not given with initial vital signs Additional Reading * Fournier Gangrene Overview (PubMed)* Basic Approach to Sepsis (EM Clerkship)* Basic Approach to Trauma (EM Clerkship)

43 MIN2019 NOV 1
Comments
Round 5 (Geriatric Fall)

Round 4 (Flank Pain)

ECAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction The nurse tells you that you have a new patient and is requesting a verbal order for nausea medicine. She advises you that the patient is the CEO of your hospital… Initial Vitals * Temp 98.9* HR 99* RR 18* BP 120/80* O2 98% Critical Actions * Perform Genitourinary Exam* Rule Out Abdominal Aortic Aneurysm* Consult Urology* Treat the Patient’s Pain* Resist Delays on Consultant Pushback Dangerous Actions * Delaying Urology Consultation to Obtain an Ultrasound Final Diagnosis Testicular Torsion with Referred Pain Tips and Tricks Don’t forget to verbalize genitourinary exam when appropriate Additional Reading * Testicular torsion overview (EM Clerkship) Corrections It is rare for testicular torsion to occur at this age

31 MIN2019 OCT 1
Comments
Round 4 (Flank Pain)
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