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EM Clerkship

NBME Shelf Review (Part 4) – Environmental

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9816 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

0:11.9

time with our patients and less time mindlessly writing notes? Freed AI is the product for you. It is a

0:20.4

secure, hippocompliant scribe that anybody can use.

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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