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EM Clerkship

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.

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NBME Shelf Review (Part 1) – General Concepts

General Approach to a Test Question Read the last sentence of the question Read the answer choices THEN read the vignette Common Scenarios with Quick Answers Hypotensive patients Give a fluid bolus Altered mental status Check a blood glucose Hypoglycemia Orange juice if can swallow safely D50 if patient cannot swallow and mildly altered IM […]

17mins

30 Sep 2018

Rank #1

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Abdominal Pain Presentations (History)

EM Clerkship’s 10 Step Patient Presentation Demographics (Age, Gender, Pertinent Medical/Surgical History, Chief Complaint) At Least 4 Descriptors (Location, Quality, Severity, Duration, Timing, Context, Modifying Factors) Red Flags/Pertinent Positives and Negatives Vital Signs Focused Physical Exam of the Complaint Suspected Diagnosis Can’t Miss Diagnosis Testing Plan Treatment Plan (If Asked) Anticipated Disposition Demographics (Age, Gender, […]

28mins

19 May 2019

Rank #2

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Chest Pain

There are six cardiopulmonary causes of chest pain that you need to know. The SIX Causes Cardiac Acute coronary syndrome (ACS) Pericarditis with tamponade Pulmonary Pneumonia Pneumothorax Vascular Pulmonary embolism Aortic dissection Step 1: Core Measures Aspirin EKG Step 2: Look for the “King” (Acute Coronary Syndrome) Four high yield symptoms Radiation to the RIGHT […]

9mins

27 Mar 2016

Rank #3

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Cardiac Arrest (ACLS)

Hard, fast, unrelenting chest compressions are the core of ACLS!!! Step 1: Check the Patient’s Pulse If the patient does not have a pulse, start CPR Hard, fast, unrelenting compressions Intubated patients Continuous Compressions Non-intubated adults 30 compressions then 2 breaths… Repeat Non-intubated pediatrics 15 compressions then 2 breaths… Repeat Step 2: Determine if the […]

8mins

20 Aug 2017

Rank #4

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Sepsis

Sepsis guidelines are constantly changing. Refer to your national guidelines or institutional protocol for most up to date treatment information. Introduction Sepsis is bad and needs to be treated aggressively Confusion around multiple conflicting guidelines and requirements Surviving Sepsis Campaign recommendations CMS requirements Sepsis-3 SOFA/SIRS/qSOFA Institutional protocols Sepsis-3 Proposed Recommendations Screen for sepsis by applying […]

8mins

1 Apr 2018

Rank #5

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NBME Shelf Review (Part 2) – Trauma

Penetrating Abdominal Trauma Anything below the 4th intercostal space (nipple) is potentially an abdominal injury Gunshot wounds to the abdomen Needs immediate exploratory laparotomy Stab wounds to the abdomen Needs immediate exploratory laparotomy IF… Hemodynamically unstable Peritonitis on exam (rebound, rigidity, guarding) Organs hanging out of abdomen Blunt Abdominal Trauma If the patient is unstable […]

11mins

7 Oct 2018

Rank #6

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Appendicitis and Diverticulitis

Appendicitis History Vague nonspecific abdominal cramping and nausea (Nonspecific Phase) gradually progresses to localized pain (Localized Phase). The pain most commonly localizes in the RIGHT LOWER QUADRANT near McBurney’s Point. Exam Focal tenderness in the right lower quadrant McBurney’s Point: 1/3 the distance traveled from anterior superior iliac spine (ASIS) to the navel. Psoas Sign: […]

25mins

2 Jun 2019

Rank #7

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Round 1 (Altered Mental Status)

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are called to the resuscitation bay for a poorly responsive patient that has been brought in by EMS. Initial Vitals Temp 98.8 HR 78 RR 4 BP 124/78 O2 98% Critical Actions Obtain Early Blood Glucose Administer Dextrose Obtain Salicylate and Acetaminophen Levels Admit for Further Observation […]

31mins

8 Sep 2019

Rank #8

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Subarachnoid Hemorrhage

History Sudden and maximal in onset Compared to previous headaches Family history of aneurysm Associated Symptoms Photophobia Visual Changes Neck Stiffness Exam Full neuro examination Cranial nerves Visual fields Speech Cerebellar (finger-nose) Motor Sensation Gait Testing Plan Non-contrast head CT Excellent sensitivity <6 hours from onset Lumbar puncture >100 RBCs in tube 4 Can be […]

8mins

20 May 2018

Rank #9

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How to Crush Your SLOE (Tips 1-5)

Tip #1 Introduce yourself. Attending? “Hello, my name is Zack, I’m one of the medical students” Resident? “Hello, my name is Zack, I’m one of the medical students” Nurse? “Hello, my name is Zack, I’m one of the medical students” Janitor? “Hello, my name is Zack, I’m one of the medical students” Tip #2 Be […]

24mins

3 Mar 2019

Rank #10

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How to Read an EKG

Always remember…1, 2, 3, get an old EKG!!! Step 1: Identify the Rate and Rhythm Is it sinus rhythm? P wave before every QRS Is it one of the tachycardias? (Refer to THIS episode) Is it one of the bradycardias? (Refer to THIS episode) Step 2: Look for Signs of Ischemia Most consistent way is […]

8mins

3 Dec 2017

Rank #11

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NBME Shelf Review (Part 3) – Pediatrics

Febrile Seizures Simple (All features must be present) Age 6 months – 5 years Febrile Lasts less than 15 minutes Only one seizure in 24 hour period No focal neuro deficits on exam Generalized seizure (must have LOC) Treat with acetaminophen and reassurance Complex Does not meet ALL of the criteria for a simple febrile […]

15mins

14 Oct 2018

Rank #12

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Nausea and Vomiting

The hardest part about this chief complaint is expanding your differential beyond gastritis!!! Step 1: Expand Your Differential Diagnosis Early appendicitis Bowel obstructions Myocardial infarction Elevated ICP Diabetic Ketoacidosis Step 2: Give a Testing Plan High yield tests to consider EKG – older adults Pregnancy test – women of child bearing age Electrolytes – most […]

7mins

4 Mar 2018

Rank #13

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Diabetic Ketoacidosis (DKA)

The blood sugar is NOT the emergency- Acidosis, Hypokalemia, and Dehydration are!!! Signs and Symptoms Vomiting Abdominal pain Polydipsia Polyuria Step 1: Test for DIABETIC-KETO-ACIDOSIS Diabetes Blood sugar Typically notably elevated (>250 mg/dL) Can be normal in certain circumstances Ketones Easiest test is a urinalysis Serum ketones also can be obtained Acidosis Blood gas (arterial […]

9mins

2 Apr 2017

Rank #14

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Hyperkalemia

Hyperkalemia = EKG… EKG changes = Calcium… Step 1: Recheck the Potassium Most common cause of hyperkalemia is PSEUDOhyperkalemia Caused by too aggressive/fast of a blood draw Causes RBCs to break open and falsely increase serum potassium Step 2: Get an EKG Earliest EKG change Peaked T waves Late EKG changes Flattened P wave Prolonged […]

9mins

1 Jan 2017

Rank #15

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Abdominal Pain Basics

Elderly people die from abdominal pain Step 1: Risk Stratify Certain patient groups have VERY high mortality when having abdominal pain Geriatrics Immunocompromised Diabetics Step 2: Consider Genitourinary Causes Be especially cautious with lower abdominal/flank pain Mention that you performed or considered performing GU exam during presentation! Common GU causes of abdominal pain Testicular/ovarian torsion […]

8mins

28 Aug 2016

Rank #16

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Syncope

6 EKG Findings. 6 Risk Factors. 6 Mimics. Step 1: Get an EKG This is the only “required” test for a patient with syncope Other common tests CBC Evaluate for anemia hCG If patient might be pregnant Step 2: Look For 6 High Risk EKG Patterns Mnemonic: QT-BRIDE QT prolongation Especially QTc >500 Brugada pattern […]

9mins

7 Aug 2016

Rank #17

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Altered Mental Status

Mnemonic: AEIOU-TIPS Step 1: Evaluate the Airway General principles “If they can’t speak, they can’t control their airway” “If GCS is <8, intubate” In the real world, it’s a clinical judgement call Postictal patients? Intoxicated patients? Step 2: Point of Care Labs Finger stick blood glucose EKG Dysrhythmia? Ischemia? Abnormal intervals? Pregnancy test Step 3: […]

9mins

11 Jul 2016

Rank #18

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ACS, Acidosis, AAA and Other Miscellaneous Causes of Abdominal Pain

There are HUNDREDS of other non-GI/GU causes of abdominal pain… Acute coronary syndrome (ACS) Test with EKG and troponin Treat with aspirin and heparin Acidosis Diabetic Ketoacidosis (DKA) Respiratory Acidosis (COPD) Salicylate Toxicity (Remember MUDPILES) Abdominal Aortic Aneurysm (AAA) Older people with abdominal/flank/back pain or syncope Testing CT Scan Abdomen with contrast (Good) CTA Abdomen […]

13mins

11 Aug 2019

Rank #19

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Trauma

Airway/C-spine. Breathing. Circulation. Disability. Exposure. Secondary Survey. Airway and C-Spine General airway principles “If they can’t speak, they can’t control their airway” “If GCS is <8, intubate” In the real world, it’s a clinical judgement call General c-spine principles Clear c-spine with NEXUS/Canadian rules Otherwise stabilize spine and place in cervical collar Breathing If patient […]

8mins

6 Jun 2016

Rank #20