NBME Shelf Review (Part 4) – Environmental
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 21 October 2018
⏱️ 16 minutes
🧾️ Download transcript
Summary
General Bite Wound Management
* Irrigate thoroughly* Update tetanus* LOW RISK bites get sutured* High risk bites to cosmetic areas (face) get sutured AND antibiotics* High risk bites to non-cosmetic areas are left open AND get antibiotics
Rabies
* Give vaccine if… * ANY suspicion for bat bite (bat in room, cave, etc)* Bite by wild animal that can’t be monitored* Bite by domestic animal that develops symptoms during observation
Black widow spider
* Painful bite* Symptoms* Abdominal pain* Diaphoresis* Myalgias* Muscle spasms/cramping* Supportive care
Pit Viper Bite
* Causes Coagulopathy/DIC* Swelling around bite site* Treat with CroFab antivenin
Brown Recluse Bite
* Painless bite* Ulceration/necrosis around bite site
Altitude Illnesses
* Acute Mountain Sickness (AMS)* Headache* Nausea and vomiting* Treat with acetazolamide or decent* High Altitude Pulmonary Edema (HAPE)* Shortness of breath* Treat with supplemental oxygen and immediate decent* Consider nifedipine or sildefenil* High Altitude Cerebral Edema* Ataxia* Confusion* Cushings reflex* Bradycardia* Hypertension* Cheyne-Stokes respirations* Treat with supplemental oxygen and immediate decent* Consider dexamethasone
Digit Amputation
* Wrap in saline soaked gauze* Put in plastic bag* Place on ice* Send to surgeon
Tooth avulsion
* Reimplant tooth in socket* Place in glass of milk
Frostbite
* Remove wet clothing* Rewarm at body temperature
Additional Reading
* Rabies Prophylaxis (EM Clerkship)
Transcript
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| 0:00.0 | Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of |
| 0:07.1 | endless charting once you become a doctor? Do you think that doctors should be spending more |
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| 0:24.7 | Focus your energy on what matters, providing good patient care. |
| 0:29.5 | Use coupon code EM50 to save 50% the first month you try it, |
| 0:34.1 | and you can cancel at any time if you decide it's not right for you. You can learn more |
| 0:38.9 | at www.gitfreed.a.i. Hey guys, what's going on? This is Mike Estefan from the University |
| 0:50.1 | of Rochester School of Medicine, bringing you episode four of the Emergency Medicine |
| 0:55.6 | Shelf Exam Review series. Today's episode is going to be covering a wide variety of topics. The one |
| 1:02.3 | thing that all these topics have in common is that they're specific to the field of emergency medicine. |
| 1:08.3 | You probably haven't seen most of these on your other shelf exams, |
| 1:12.1 | so this is very high-yield stuff. Before we dive into the content, I just have a couple of |
| 1:17.9 | thoughts that I want to share with you guys. If you're a fourth-year student, then you submit |
| 1:23.1 | your residency applications a while ago, and you're probably planning to go on your first couple of |
| 1:28.8 | interviews just like I am right now. This is a very stressful time for most of us. So I just wanted |
| 1:35.9 | to remind everyone of something that is easy to forget in times like this. If you're not getting |
| 1:41.8 | the interviews that you wanted or if match day doesn't go your way, |
| 1:46.5 | please, please remember that there is much more to life than medicine. Medicine does not have to |
| 1:54.2 | define you, and there is so much more life to live outside of medicine. If you're struggling in any way, please don't be scared to reach |
| 2:03.6 | out for help. I wish you all the best of luck with your interviews. Now, let's begin with the content. |
| 2:10.6 | So let's start this episode off by talking about the management of bite wounds on your exam. |
... |
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