EM Clerkship
Episodes
Round 32 (Pediatric Vomiting)
01 Apr 2022
Contributed by Lukas
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. ...
Opioid Use Disorder (Deep Dive R31)
15 Mar 2022
Contributed by Lukas
Opioid overdose is the number one leading cause of death in adults under the age of 50. Many ED Physicians fail to recognize that offering MAT (medica...
Round 31 (Altered Mental Status)
01 Mar 2022
Contributed by Lukas
Critical Actions: Administer Naloxone Minimize Unnecessary Testing Discuss options for Rehab Offer opioid replacement therapy Provide Social Support F...
Atrial Fibrillation (Deep Dive R30)
15 Feb 2022
Contributed by Lukas
AFib with Rapid Ventricular Rate (RVR) – Rate 110 Primary AFib – Patients symptoms or their hemodynamic instability is due to the AFib itself. Tre...
Round 30 (Chest Pain)
01 Feb 2022
Contributed by Lukas
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...
tPA (Deep Dive R29)
15 Jan 2022
Contributed by Lukas
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 o...
Round 29 (Weakness)
01 Jan 2022
Contributed by Lukas
Initial Assessment: Obtain Vitals and blood glucose level Time of onset (important for tPA/TNK vs thrombectomy) Neurologic and Cardiac Examination / N...
Trauma (Deep Dive R28)
15 Dec 2021
Contributed by Lukas
ATLS – Advanced Traumatic Life Support Primary Survey Airway Breathing Circulation Disability Exposure Secondary Survey Head to Toe Examination Look...
Round 28 (Burn)
01 Dec 2021
Contributed by Lukas
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 Temp 99...
Pelvic Inflammatory Disease (Deep Dive R27)
15 Nov 2021
Contributed by Lukas
50% of cases of Pelvic Inflammatory Disease (PID) is caused by common STIs (Gonorrhea, Chlamydia ) but up to 50% is caused by native vaginal flora/oth...
Round 27 (Back Pain, Dysuria, Knee Pain)
05 Nov 2021
Contributed by Lukas
You are working a shift at ABEM General when three patients check in simultaneously at the start of your shift at 6AM. Initial Vitals#1 (Ms. Taylor, 6...
Cardiac Tamponade (Deep Dive R26)
15 Oct 2021
Contributed by Lukas
Cardiac Tamponade Cardiac Tamponade – A physiological state caused by a pericardial effusion in which the pressure in the pericardial sac is higher ...
Round 26 (Stridor, Vomiting, Shock)
01 Oct 2021
Contributed by Lukas
Case Introduction You are working a shift at your local free-standing emergency room when a family of three checks in to be seen (a father and his two...
Hyponatremia (Deep Dive R25)
15 Sep 2021
Contributed by Lukas
Hyponatremia in the ED Four questions to ask yourself: Is the patient symptomatic from their hyponatremia (confusion, nausea/vomiting, ams, seizures, ...
Round 25 (Seizure)
01 Sep 2021
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!! Case Introduction You are working a shift at EM Clerkship General when you are called to the waiting room by t...
Acetaminophen Overdose (Deep Dive R24)
16 Aug 2021
Contributed by Lukas
Acetaminophen Overdose & Toxicology Pearls History: Figure out how much was taken, what time the ingestion occurred, and if any other toxins were inge...
Round 24 (Altered Mental Status)
01 Aug 2021
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!! Case Introduction You are working a shift at EM Clerkship General when you receive a radio call from EMS who a...
Asymptomatic Hypertension (Deep Dive R23)
15 Jul 2021
Contributed by Lukas
Asymptomatic Hypertension Make SURE the patient isn’t having symptoms of end organ dysfunction, which could make this hypertensive emergency (confus...
Round 23 (High Blood Pressure)
01 Jul 2021
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!! Case Introduction You are working a shift at EM Clerkship General when you are handed the next chart, a 60 yea...
Neonatal Resuscitation (Deep Dive R22)
15 Jun 2021
Contributed by Lukas
Neonatal Resuscitation *THIS IS A BASIC FRAMEWORK AND IS NOT COMPREHENSIVE* EVALUATE Is the newborn crying/breathing spontaneously? Does the newborn h...
Round 22 (Cardiac Arrest)
01 Jun 2021
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkship General when the triage nurse runs and grabs both y...
Torsades de Pointes (Deep Dive R21)
15 May 2021
Contributed by Lukas
Torsades de Pointes (TdP) A type of polymorphic ventricular tachycardia that is inherently unstable and often quickly degrades into ventricular fibril...
Round 21 (Drowning)
01 May 2021
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkship General when EMS calls you on the radio… “Hey d...
Kawasaki Disease (Deep Dive R20)
15 Apr 2021
Contributed by Lukas
Kawasaki Disease A small vessel vasculitis that affects children, usually
Round 20 (Dehydration)
01 Apr 2021
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkshift General when the next chart is handed to you – a...
Beta Blocker Overdose (Deep Dive R19)
15 Mar 2021
Contributed by Lukas
“The Brady Bunch” – Beta-Blockers, Calcium Channel Blockers, Digoxin, Clonidine Treatment of Beta Blocker OD Activated Charcoal – Only if inge...
Round 19 (Bradycardia)
01 Mar 2021
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkshift General when you are called to the resuscitation b...
Sepsis (Deep Dive R18)
16 Feb 2021
Contributed by Lukas
Four definitions you must know: SIRS – Must have at least 2 of 4 SIRS criteria (listed below): Fever (38C) or Hypothermia (12k or 10% Tachycardia 9...
Round 18 (Fatigue)
01 Feb 2021
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkshift General when a 20yo female accompanied by her moth...
Round 17 (Postpartum Fever)
01 Jan 2021
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkshift General when a sepsis alert is paged overhead for ...
Round 16 (Allergic Reaction)
01 Dec 2020
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are sitting at your computer on an otherwise beautiful Friday afternoon when a mother b...
Round 15 (Syncope)
01 Nov 2020
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at Clerkship General when a 51 year old female is brought in after ...
Round 14 (Shortness of Breath)
01 Oct 2020
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are sitting at your computer on an otherwise quiet night when a young male is brought i...
Round 13 (Dizziness)
01 Sep 2020
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working at your local hospital when the next chart gets put in your rack. You groan...
Announcement
01 Aug 2020
Contributed by Lukas
The website it updated! Please check it out and email me with any technical issues or other comments/concerns. Enjoy your shift!
Round 12 (Difficulty Breathing)
01 Jul 2020
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction A young gentlemen runs out to triage yelling “I can’t breath!” and collapses to the f...
Round 11 (Headache)
01 Jun 2020
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are having a busy day in the department when you are paged overhead to the resuscitatio...
Round 10 (Allergic Reaction)
01 May 2020
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction A 45 year old female is exposed to peanut butter and shrimp pizza and begins to have an app...
Round 9 (Seizure)
01 Mar 2020
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction The nurse brings back a young adult male from the lobby who is having a seizure… Initial ...
Round 8 (Fall)
01 Feb 2020
Contributed by Lukas
CAUTION: 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/...
Round 7 (Headache)
01 Jan 2020
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction Just a routine day at your hospital, your next patient has a chief complaint of headache…...
Round 6 (Back Pain)
01 Dec 2019
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction A notorious, disheveled frequent flyer presents to your emergency department for her back p...
Round 5 (Geriatric Fall)
01 Nov 2019
Contributed by Lukas
CAUTION: 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 af...
Round 4 (Flank Pain)
01 Oct 2019
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction The nurse tells you that you have a new patient and is requesting a verbal order for nausea...
Round 3 (Chest Pain)
22 Sep 2019
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction An ill appearing patient has been rushed back from the lobby, clutching his chest, you are ...
Round 2 (Seizure)
16 Sep 2019
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction EMS brings in a postictal 34 year old female after she has a seizure. She is complaining of...
Round 1 (Altered Mental Status)
08 Sep 2019
Contributed by Lukas
CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are called to the resuscitation bay for a poorly responsive patient that has been broug...
MUST LISTEN (re ABEM)
25 Aug 2019
Contributed by Lukas
ABEM-style cases presented on EM Clerkship are not my actual ABEM exam cases, and they are not derived from my actual exam cases. I will never be disc...
ACS, Acidosis, AAA and Other Miscellaneous Causes of Abdominal Pain
11 Aug 2019
Contributed by Lukas
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 hepa...
Testicular Torsion and Prostatitis
04 Aug 2019
Contributed by Lukas
Testicular Torsion History Pain in the testicles Referred pain in the flank or lower abdomen Usually sudden and severe Usually WITHOUT urinary symptom...
PID and Ovarian Torsion
28 Jul 2019
Contributed by Lukas
Women have two additional diseases that must be added to the differential diagnosis of their abdominal pain. PID and ovarian torsion. Pelvic Inflammat...
Urinary Tract Infections
21 Jul 2019
Contributed by Lukas
How to Read a Urinalysis Signs of Inflammation Leukocyte Esterace WBCs Multiple conditions cause inflammation on a urinalysis. Anything that causes ne...
Ectopic Pregnancy
14 Jul 2019
Contributed by Lukas
All women of childbearing age who present with abdominal pain need a pregnancy test a core teaching of EMergency medicine Ectopic pregnancy is the lea...
Bowel Perforation and Volvulus
30 Jun 2019
Contributed by Lukas
Bowel Perforations History Perforation takes time, frequently symptoms were either ignored or not noticed as can occurring in… Elderly, diabetic, or...
Mesenteric Ischemia and Small Bowel Obstruction
23 Jun 2019
Contributed by Lukas
Mesenteric Ischemia Celiac truck supplies blood to the stomach and duodenum SMA supplies blood to the rest of the small bowel and proximal colon IMA s...
Biliary Diseases and Pancreatitis
09 Jun 2019
Contributed by Lukas
Biliary Diseases Biliary Colic- A gallstone DOES NOT GET STUCK, but it slowly rolls out of the gallbladder, through the cystic duct, then the common b...
Appendicitis and Diverticulitis
02 Jun 2019
Contributed by Lukas
Appendicitis History Vague nonspecific abdominal cramping and nausea (Nonspecific Phase) gradually progresses to localized pain (Localized Phase). The...
Abdominal Pain Presentations (Exam, Plan, and Disposition)
26 May 2019
Contributed by Lukas
EM Clerkship’s 10 Step Patient Presentation Demographics (Age, Gender, Pertinent Medical/Surgical History, Chief Complaint) At Least 4 Descriptors (...
Abdominal Pain Presentations (History)
19 May 2019
Contributed by Lukas
EM Clerkship’s 10 Step Patient Presentation Demographics (Age, Gender, Pertinent Medical/Surgical History, Chief Complaint) At Least 4 Descriptors (...
How to Crush Your SLOE (Tips 26-30)
14 Apr 2019
Contributed by Lukas
Tip #26 Update your attending when the nurse is having difficulty with your patient’s IV or drawing blood. Tip #27 Get the urine sample from your pa...
How to Crush Your SLOE (Tips 21-25)
07 Apr 2019
Contributed by Lukas
Tip #21 Review and note if the patient has any IMPORTANT old records. Any ED visit within the last month for a similar complaint (aka “Bouncebacks”...
How to Crush Your SLOE (Tips 16-20)
31 Mar 2019
Contributed by Lukas
Tip #16 Recheck the patient’s heart rate and respiratory rate (and put in your presentation that you did so) Heart rate frequently falsely elevated ...
How to Crush Your SLOE (Tips 11-15)
24 Mar 2019
Contributed by Lukas
Tip #11 Give 4 descriptors/adjectives for each complaint Location Quality Duration Modifying Factors Severity Context Timing Associated Symptoms Tip #...
How to Crush Your SLOE (Tips 6-10)
10 Mar 2019
Contributed by Lukas
Tip #6 Make your patient remember your name. Introduce yourself clearly Show the patient your badge Use a nickname if your name is difficult for peopl...
How to Crush Your SLOE (Tips 1-5)
03 Mar 2019
Contributed by Lukas
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 o...
Airway Part 4- What to Do If Intubation Fails
03 Feb 2019
Contributed by Lukas
Verbalize the out loud prior to performing rapid sequence intubation. The Bougie Ideal for situations when you’re view is suboptimal Advance it thro...
Airway Part 3- Rapid Sequence Intubation
27 Jan 2019
Contributed by Lukas
The most important thing to do when preparing for RSI is to PREOXYGENATE the patient. Step 1: Choose Your Equipment Miller or Mac blade? Miller blade ...
Airway Part 2- Bag Valve Mask Adjuncts
20 Jan 2019
Contributed by Lukas
How do you oxygenate a patient (while you are preparing for RSI) if suction, moving the tongue, and basic BVM ventilation are unsuccessful? Pharyngeal...
Common Fungal Infections
13 Jan 2019
Contributed by Lukas
Most Life Threatening Fungal Infection Mucormycosis Black facial discharge Cranial nerve dysfunction Facial swelling Eschar formation When to Suspect ...
Psychiatric Complaints
23 Dec 2018
Contributed by Lukas
The Two Objectives During Every Psychiatric-Type Complaint Medical Clearance Psychiatric Risk Assessment Medical Clearance Required by EMTALA to perfo...
NBME Shelf Review (Part 11) – OBGYN
09 Dec 2018
Contributed by Lukas
Think A-B-C-P (Airway, Breathing, Circulation, Pregnancy Test) in ALL Women of Child-Bearing Age! It changes the differential diagnosis It changes the...
NBME Shelf Review (Part 10) – Miscellaneous
02 Dec 2018
Contributed by Lukas
Stroke Most appropriate initial tests Blood Glucose Hypoglycemia is a common stroke mimic CT Head without contrast Rules out HEMORRHAGIC strokes Subar...
NBME Shelf Review (Part 9) – Cardiopulmonary
25 Nov 2018
Contributed by Lukas
Pulmonary Embolism Three types of pulmonary embolism “Massive” Hypotension or severe bradycardia Treat with tPA or thrombectomy “Submassive” N...
NBME Shelf Review (Part 8) – Abdominal Pain
18 Nov 2018
Contributed by Lukas
Acute Mesenteric Ischemia History of atrial fibrillation “Pain out of proportion to exam” Bowel Obstruction History Abdominal pain Bloating/Disten...
NBME Shelf Review (Part 7) – Abdominal Pain
11 Nov 2018
Contributed by Lukas
Hernia 3 classifications for hernia Reducible Able to be reduced (placed back into the abdomen) at bedside Incarcerated Cannot be reduced but not seve...
NBME Shelf Review (Part 6) – Common Arrhythmias
04 Nov 2018
Contributed by Lukas
“Unstable” Arrhythmias Arrhythmias that cause Hypotension Pulmonary Edema Chest Pain Altered Mental Status Supraventricular Tachycardia (SVT) Stab...
NBME Shelf Review (Part 5) – Ophthalmology and Toxicology
28 Oct 2018
Contributed by Lukas
Corneal Abrasion Stain the eye with fluorescein and use woods lamp Look for fixed staining (“uptake”) on the cornea Acute Angle Closure Glaucoma S...
NBME Shelf Review (Part 4) – Environmental
21 Oct 2018
Contributed by Lukas
General Bite Wound Management Irrigate thoroughly Update tetanus LOW RISK bites get sutured High risk bites to cosmetic areas (face) get sutured AND a...
NBME Shelf Review (Part 3) – Pediatrics
14 Oct 2018
Contributed by Lukas
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 ...
NBME Shelf Review (Part 2) – Trauma
07 Oct 2018
Contributed by Lukas
Penetrating Abdominal Trauma Anything below the 4th intercostal space (nipple) is potentially an abdominal injury Gunshot wounds to the abdomen Needs ...
NBME Shelf Review (Part 1) – General Concepts
30 Sep 2018
Contributed by Lukas
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 ...
When to Stop CPR
09 Sep 2018
Contributed by Lukas
Why is this Important? It is a poor stewardship of resources to continue a resuscitation when the prognosis is clearly dismal. Hospitals need to stewa...
Abdominal Aortic Aneurysm
02 Sep 2018
Contributed by Lukas
Kidney Stones are a Diagnosis of Exclusion!!! History Risk factors Age 60 Tobacco use Classic presentations Stable with sudden flank/back/abdominal pa...
Testicular Torsion
26 Aug 2018
Contributed by Lukas
Kidney Stones are a Diagnosis of Exclusion!!! Introduction Testicular torsion is a time sensitive diagnosis (risk of infertility, etc) Commonly mimics...
Flank Pain and Kidney Stones
19 Aug 2018
Contributed by Lukas
Kidney Stones are a Diagnosis of Exclusion!!! Step 1: Consider the Differential Diagnosis for Flank Pain Appendicitis Abdominal Aortic Aneurysm Ectopi...
Ventilator Basics
08 Jul 2018
Contributed by Lukas
Step 1: Start Patient on Volume Assist-Control Ventilation The most basic mode of ventilation Provides a FIXED VOLUME at a FIXED RATE If the patient o...
Rabies Prophylaxis
24 Jun 2018
Contributed by Lukas
Introduction What is rabies? A very rare and aggressive encephalitis Global impact with exception of UK/Australia Animals whose bites/scratches may re...
Occupational Exposures
17 Jun 2018
Contributed by Lukas
The only chief complaint that you are guaranteed to eventually have to manage in a colleague Respiratory Exposures Meningococcus (meningococcemia,...
Breast Complaints
10 Jun 2018
Contributed by Lukas
All breast complaints are cancer until proven otherwise!!! History Increased risk of breast cancer Family history of breast cancer (especially 1st deg...
Neonatal Conjunctivitis
03 Jun 2018
Contributed by Lukas
The 3 Worst Causes of Neonatal Conjunctivitis Gonorrhea Causes corneal ulcers and sepsis Red flags 1st week of life Copious purulent drainage Diagnose...
Subarachnoid Hemorrhage
20 May 2018
Contributed by Lukas
History Sudden and maximal in onset Compared to previous headaches Family history of aneurysm Associated Symptoms Photophobia Visual Changes Neck Stif...
Blood in the Diaper
13 May 2018
Contributed by Lukas
The 4 Most Common Causes of Blood in Diaper Urinary crystals Will be guaiac negative Common in first few weeks of life Vaginal bleeding Common in newb...
Nutritional Emergencies
06 May 2018
Contributed by Lukas
Consider In High Risk Patients Alcoholics GI disorders Eating disorders Starvation/poor diet Extremes of age Thiamine (B1) deficiency Causes damage to...
Complications of Myocardial Infarction
29 Apr 2018
Contributed by Lukas
Mnemonic: DARTH VADER Death Arrhythmia ACS patients need to be placed on cardiac monitor Frequently degenerate into non-perfusing rhythms Rupture of V...
tPA Basics
15 Apr 2018
Contributed by Lukas
My original source for this episode was the MDCalc tPA contraindication guidelines which are based off older recommendations (2015). Stroke guidelines...
Sepsis
01 Apr 2018
Contributed by Lukas
Sepsis guidelines are constantly changing. Refer to your national guidelines or institutional protocol for most up to date treatment information. Intr...
Neonatal Jaundice
25 Mar 2018
Contributed by Lukas
Physiology RBC hemoglobin breakdown - unconjugated (indirect) bilirubin Unconjugated (indirect) bilirubin - liver - conjugated (direct) bilirubin Conj...
Thrombocytopenia
11 Mar 2018
Contributed by Lukas
Clinical Presentation Incidental finding on routing CBC Petechiae/purpura Mucosal bleeding Epistaxis Gingival bleeding Hematuria Vaginal bleeding 5 Ma...
Nausea and Vomiting
04 Mar 2018
Contributed by Lukas
The hardest part about this chief complaint is expanding your differential beyond gastritis!!! Step 1: Expand Your Differential Diagnosis Early append...
Complications of Cirrhosis
25 Feb 2018
Contributed by Lukas
Organ Failure Complications Hepatorenal syndrome (renal failure) Decreased urine output Labs show elevated creatinine Admit to hospital (high mortalit...