Round 15 (Syncope)

EM Clerkship

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

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

4.9 • 816 Ratings

🗓️ 1 November 2020

⏱️ 33 minutes

🔗️ Recording | iTunes | RSS

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Summary

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 a syncopal episode.

Initial Vitals

* Temp 100.2* HR 132* RR 28* BP 105/69* O2 85%

Critical Actions

* Give supplemental Oxygen* Diagnose Pulmonary Embolism* Administer Heparin* Assess contraindications for tPA* Administer tPA

Final Diagnosis

Massive Pulmonary Embolism

Tips and Tricks

* Reassess vital signs after interventions* Obtain collateral history from EMS and family* Make sure your diagnosis fits the patient’s symptoms! (EG don’t diagnose pneumonia based on a consolidation on CXR if the patient doesn’t clinically have pneumonia)

Further Reading

Submassive and Massive PE (EMCrit)

Transcript

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0:00.0	Hello, residents. My name is Zach Olson. I'm joined today by Mike Estefan, and thank you for downloading this month's episode of the EM Clerkship podcast.
0:09.7	This episode is sponsored by Pearson Rabbit's Insurance, my personal independent life and disability insurance agent.
0:14.8	We will talk more about Pearson Rabbits later in this episode. Let's get into it. Today is round number 15 of the game. And Mike is going to need
0:24.7	to perform today's case in real ABEM oral boards format. He has 15 minutes to complete the full
0:30.4	case. He does not know what the case is ahead of time. If Mike hits all of the critical actions
0:35.6	that I have listed out beforehand, he wins. And if he doesn't or if he performs a dangerous action, I will win. These cases were created by me. They are not derived from actual ABM cases that I had and they are not real patience. Mike, you ready to go? Yeah, let's do it, Zach. All right. Mike, 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're ready. I am ready, my friend. Dr. Estefan, this will be a single patient encounter. You will have 15 minutes to complete the case. Before we begin, do you have any questions? I do not.
1:13.2	All right, Dr. Estefan, you are working at Clerkship General Hospital. When EMS brings in your
1:18.5	next patient, it's a 51-year-old female, Ms. Emerson, and she has had an episode of syncope. She
1:24.6	passed out. Okay. I walk into the room. What do I see?
1:29.5	You see a 51-year-old female. Her name's Ms. Emerson. She appears anxious.
1:36.7	Okay. Can we get her hooked up on the monitor and get an opening set of vitals?
1:41.8	Nursing is placed her on the monitor. Her heart rate is 132.
1:45.4	Her respiratory rate is 28.
1:47.7	Her blood pressure is 105 over 69.
1:50.7	Her O2 saturation is 85%.
1:53.1	And a temperature?
1:55.9	100.2.
1:58.0	100.2.
2:07.0	All right. Let's get two large more IVs and her start her on two liters nasal cannula and i would like to talk to her is she awake alert talking uh yes hi there
2:14.6	dr estherfan my name is Ms. Emerson.
2:22.1	Okay. And also, before we begin, uh, could I get a acci check on her?
2:27.7	Sure. Uh, the tech gets an acu check, uh, 100.
	...

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