Hello, residents. My name is Zach Olson. I'm joined today by our newest hero, Maddie Watts,

and thank you for downloading this month's episode of the EM Clerkship podcast. This episode is

sponsored by Pearson Rabbit's Insurance, my personal, independent life and disability insurance agent.

We will talk more about Pearson Rabbits later in this episode, but let's get into it. Today is round number one of the game for Maddie. We are recording this

in June, actually, so Maddie hasn't even started her first rotation of residency yet. Maddie,

how is it going? How's residency so far? Nice to meet you. It's nice to have you on board.

Yeah, I'm so excited to be here. Residency's been great so far. Nice to meet you. It's nice to have you on board. Yeah, I'm so excited to be here.

Residency's been great so far because I've only had to do orientation. We've been going through all

of our pals, ACLS, BLS, ATLS, all that fun stuff, and getting to meet all my co-interns,

which has been a lot of fun. And lots and lots and lots of paperwork, I'm sure. Oh, yes. Lots of corporate compliance, HIPAA, all that fun stuff. It's a good time. But just to clarify, so you have not started your first rotation yet? No, I have not. I don't start till July. See, this is what's exciting because we're getting fresh. We're going to see where we're at.

For everyone that's listening, like, Maddie and I have never recorded. This is literally, this is the first. We're going to see how this goes. It's super exciting. We're all really excited. We're going to see how much I forgot during fourth year. And it's going to be fine. And just so everyone's listening, the same level of mercy, lack of mercy that I had from Mike, I'm going to just carry that right on to Maddie. She's got, she doesn't have a shot. Like, I'm just going to be terrible. I'm just kidding. It'll be, it'll be fine. Bring it on. Bring it on. I like, all right, there we go. Let's get into it. So, Maddie will need to perform today's case

in real ABEM oral boards format, even though she hasn't even started residency yet. She has 15

minutes to complete the full case. No mercy. She does not know what the case is ahead of time.

If Maddie hits all of the critical actions that I have listed out beforehand, she wins.

But if she doesn't, or if she performs a dangerous action, I win. These cases were created by me. They're not derived from actual ABM cases that I had. They're not real patience. Maddie take out a piece of paper and a pencil, place the paper sideways in front of you, outline a human body on the left side of it, and let me know when you are ready. I'm ready. All right, let me get the timer ready here. Dr. Watts, this will be a single patient encounter. You will have 15

minutes to complete the case before we begin. Do you have any questions? Nope, I'm ready to go.

All right, let's begin. I am starting the timer. Dr. Watts, you are working at Clerkship General. It's your first ever shift when the next patient gets put in your rack. It's a 60-year-old female with shortness of breath. Welcome to Emergency Medicine. You're up. Let's do this. All right. So I walk in her room. What do I see?

So you see a 60-year-old female. She's well-groomed, but she does look short of breath.

All right. Can I go ahead and get her on the monitor and get an opening set of vitals?

Sure. So the nurse is getting her on the monitor. Her initial vitals are a heart rate of 92, a respiratory rate of 28, a blood pressure of 120 over 80, and an O2 saturation of 89%.

All right. And do we have a temperature? 101.2. All right. And is she on any supplemental oxygen right now? She is not.

All right. Let's go ahead and put her on four liters, nasal cannula.

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