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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.
Podcast: Play in new window | Download
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.
Podcast: Play in new window | Download
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
Critical Actions:
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
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:
Don’t forget to add some personality to your application with the hobbies section!
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ERAS Pt 1: The 8 Parts of the Application
There are 8 parts to the application:
Further Reading:
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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
Critical Actions
Further Reading
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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
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Brainstorming ideas – how to make it personal
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
2. What am I looking for in a training program?
3. Where do I see myself in 5-10 years?
Further Reading:
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Welcome to EM Clerkship Maddie Watts!
The personal statement should be *personal* and should *make a statement*.
Further Reading:
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You are working at Clerkship General when you are called to the resuscitation bay for a 55yo M presenting in respiratory distress.
Initial Vitals
Critical Actions
Further Reading:
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Cardiac Glycoside containing plants : Foxglove, Lilly of the Valley, Oleander, Squill
Anticholinergic Alkaloid containing plants: Jimson Weed, Angels Trumpet, Deadly Nightshade
Toxic Mushrooms
Further Reading:
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You are working at Clerkship General when you see your next patient : a 3 year old male accompanied by his father with chief complaint of vomiting.
Initial Vitals
Critical Actions
Further Reading:
Podcast: Play in new window | Download
Further Reading:
Podcast: Play in new window | Download
Critical Actions:
Further Reading:
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AFib with Rapid Ventricular Rate (RVR) – Rate >110
Primary AFib – Patients symptoms or their hemodynamic instability is due to the AFib itself. Treatment is by rate or rhythm control.
Secondary AFib – Patients AFib rate or their hemodynamic instability is due to an underlying secondary process (eg thyrotoxicosis, PE, sepsis, drugs, etc). Treatment is by treating the underlying process.
Unstable Primary AFib – The presence of hypotension, altered mental status, or pulmonary edema. Treatment is immediate cardioversion, second line agents include digoxin or amiodarone.
Stable Primary AFib (<48 hours duration ) – Treatment is by cardioversion in the ED
Stable Primary AFib ( >48hours or unknown duration) – Treatment is by rate control by CCB (diltiazem or verapimil), or by BB (metoprolol or esmolol)
Anticoagulation – Calculate CHADS2VASC and HASBLED score. Weigh risk of stroke versus risk of major bleeding prior to starting anticoagulation
Further Reading:
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You are working a shift at Clerkship General Hospital when you go see your next patient, a 70 year old male presenting with chest pain.
Initial Vitals
Critical Actions
Further Reading:
EMDocs – Systematic Approach to the Peripheral Vascular Exam
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tPA usage is controversial. Listen to find out why. Read more to form your own opinions.
Episode Sources:
After Re-Analysis, No Trials Show Efficacy of tPA in Acute Ischemic Stroke
Why we can’t trust clinical guidelines – BMJ
Alteplase for Stroke: Money and Optimistic Claims Buttress the “Brain Attack” Campaign
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Initial Assessment:
Workup:
Treatment:
Post-tPA Complications: Angioedema (2-5%) and Hemorrhage (2-7%)
Further Reading:
MD Calc- tPA Contraindications
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ATLS – Advanced Traumatic Life Support
Primary Survey
Secondary Survey
Tertiary Survey
Further Reading:
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You are working a shift at ABEM General when you receive a call from EMS over the radio for a patient involved in a house fire.
Initial Vitals
Critical Actions
Further Reading:
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