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Learn about Maddie’s experience in New Zealand as well as unique aspects of New Zealand medical practice. Disclaimer: This is based on personal experience. If you’d like to learn more, some resources are listed below.
https://www.mcnz.org.nz/about-us/glossary
https://pharmac.govt.nz/about/what-we-do/how-pharmac-works
https://www.luc.edu/media/lucedu/law/centers/healthlaw/pdfs/advancedirective/pdfs/8/robin.pdf
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You are working at Clerkship General on New Year’s Day when you see a nurse running from triage. He is carrying an unresponsive child to the resuscitation bay.
Initial Vitals:
HR: 43
BP: 47/20
Temp: 66F
RR: 4
O2: 95% (BVM)
Critical Actions:
- Obtain Core Temperature
- Use the Broslow Tape
- Follow PALS
- Begin Invasive Warming
- Transfer for ECMO
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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:
- Blood glucose
- Obtain core temperature
- Rapidly cool the patient
- 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:
- Grab the Broslow!
- Fingerstick Glucose
- Choose Endotracheal Tube Size
- Administer Atropine until bronchial secretions stop
- 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:
- Diagnose DKA
- Replete potassium
- Start insulin AFTER potassium repletion
- EITHER place central line for faster K repletion OR initiate bipap to allow time for potassium repletion via existing peripheral line
- Admit to ICU
Further Reading:
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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
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- Understand the timeline – research programs to find out when they extend invites and when they host interviews
- Prepare for invitations – set up email and text notifications, get a calendar
- Accept invitations – respond promptly and keep your calendar updated
- Optimize invitations – any interview date you get is a good one, but planning ahead can help you optimize timing
- 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:
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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)