Category: Uncategorized (Page 1 of 3)

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You are working at Clerkship General when you hear an EMS call on the base command radio. “Clerkship General. We are bringing you a minimally responsive 79 year-old female found lying on the floor inside her apartment. ETA 5 minutes”

Initial Vitals:

HR: 143

BP: 160/105

Temp: 106.3F

RR: 22

O2: 99% Room Air

Critical Actions:

1. Blood glucose
2. Obtain core temperature
3. Rapidly cool the patient
4. Diagnose rhabdomyolysis

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Transcript/Summary coming soon!

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You are working at Clerkship General when you hear an EMS call on the radio. “Clerkship General. We are bringing you an unresponsive 6-year-old female found foaming at the mouth by her babysitter. ETA 2 minutes.”

Initial Vitals:

BP: 125/80

HR: 62

RR: 34

O2: 81% (Non Rebreather)

Critical Actions:

1. Grab the Broslow!
2. Fingerstick Glucose
3. Choose Endotracheal Tube Size
4. Administer Atropine until bronchial secretions stop
5. Pralidoxime

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Not your typical wellness episode – by Zack

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You are working a shift at Clerkship General when the charge nurse comes and grabs you to see a 24yo male who appears to be in respiratory distress.

Critical Actions:

1. Diagnose DKA
2. Replete potassium
3. Start insulin AFTER potassium repletion
4. EITHER place central line for faster K repletion OR initiate bipap to allow time for potassium repletion via existing peripheral line
5. Admit to ICU

Further Reading:

EMCrit – DKA

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Before interview day, do your research on programs and interviews and reflect on the way in which you want to portray yourself.

On interview day, have a cheat sheet with notes about your conversations, questions, and pro-cons. Remember to stay calm, take a pause if you need to, and above all be authentic to who you are.

After interview day, be sure to capture you gut impression and write down any follow-up questions or concerns remaining.

Here are some resources to use for interview day:

EMRA Residency Interview Guide

AliEM – Dos and Don’ts of residency interviewing

EMRA – Common Interview Questions

EMRA – Making the most out of interview day

ALiEM – EM Match Advice Podcast Episode

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1. Understand the timeline – research programs to find out when they extend invites and when they host interviews
2. Prepare for invitations – set up email and text notifications, get a calendar
3. Accept invitations – respond promptly and keep your calendar updated
4. Optimize invitations – any interview date you get is a good one, but planning ahead can help you optimize timing
5. Too many or too little interviews – drop early, keep tabs with whether programs have extended invites and stay in close contact with your advisors

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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 EM

Further Resources:

EMRA Residency Map
Doximity Navigator
SAEM Residency Fair
EMRA Residency Fair

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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 harder
EMRA Hangouts
EMRA Student-Resident Mentorship Program
NRMP Charting the Outcomes
NRMP Residency Data
ALiEM – Match Advice
UTSW Texas STAR

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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.

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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

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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.

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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

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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)

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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:

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

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

Further Reading

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

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

Further Reading:

CordEM – SLOE 1

CordEM – SLOE 2

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You are working at Clerkship General when you are called to see a 70 yo male who is presenting with shortness of breath.

Initial Vitals

• Temp 98.0
• HR 36
• RR 28
• BP 80/35
• O2 82%

Critical Actions

• Interpret ECG Correctly (3rd degree AV block)
• Order a troponin
• Perform and Describe transcutaneous pacing
• Perform and Describe transvenous pacing
• Treat NStemi (ASA, Heparin gtt, nitro if BP improved after pacing)

Further Reading

Complete Heart Block – EMDocs

Bradycardia – EMCrit

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DOPES

D-Displacement – endotracheal tube dislodges from trachea, or falls into right mainstem bronchus

O-Obstruction – Mucous plugging, bronchospasm, patient biting tube

P –Pneumothorax – Look out for pneumothorax, it can be subtle

E – Equipment – Disconnected/unpowered equipment, ensure everything is powered on and connected appropriately

S – Stacking – common in asthma/COPD due to inadequate expiration resulting in air trapping between breaths

Further Reading

LITFL – Post-Intubation Hypoxia

CanadiEM – Approach to the Alarming Vent

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Brainstorming ideas – how to make it personal

1. What makes me unique?

2. What are some specific experiences I’ve had in my life that have either made me want to do EM or given me the skills that will prepare me well for training in EM?

3. If a family member or a friend were to describe me to a stranger, what would they talk about first?

Brainstorming ideas – how to make a statement

1. What do I bring to the table?

2. What am I looking for in a training program?

3. Where do I see myself in 5-10 years?

Further Reading:

Personal Statement Library