Round 18 (Fatigue)

EM Clerkship

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

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

4.9 • 816 Ratings

🗓️ 1 February 2021

⏱️ 33 minutes

🔗️ Recording | iTunes | RSS

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Summary

CAUTION: THESE NOTES CONTAIN SPOILERS!!!

Case Introduction

You are working a shift at EM Clerkshift General when a 20yo female accompanied by her mother checks into the ER with chief complaint of fatigue.

Initial Vitals

* Temp 101.2F* HR 122* RR 22* BP 110/90* O2 98%

Critical Actions

* Obtain travel history in patient presenting with fever of unknown source* Perform sepsis workup and treatment in patient with at least 2 SIRS criteria* Order thick/thin peripheral blood smear* Consult ID* Admit patient

Final Diagnosis

Malaria

Tips and Tricks

* Always obtain detailed history in patient presenting with fever without obvious source (travel history for infectious agents, IV Drug history for endocarditis, etc)* Utilize CDC.org to determine which infections are endemic to each country that your patient traveled in

Further Reading

Malaria (EMDocs)

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.
0:09.8	This episode is sponsored by Pearson Rabbit's Insurance, my personal disability and life insurance agent. We will talk more about them later in this episode. Let's get into it.
0:19.6	Today, I think what are we? Round number 18 of the game.
0:23.4	Mike will need to perform today's case in real ABEM oral boards format. He has 15 minutes to
0:29.9	complete the full case. He doesn't know what the case is ahead of time. If Mike hits all of the
0:35.2	critical actions that I've listed out beforehand, he wins.
0:38.0	If he doesn't or if he performs anything extremely dangerous, like a lateral canthotomy
0:42.7	on a glaucoma or something, I win.
0:45.5	These cases were created by me.
0:47.3	They are not derived from actual ABM cases that I had.
0:50.3	They are not real patients.
0:51.5	How'd you like that flashback to history, Mike?
0:53.2	Oh, man.
0:55.2	Mike,
1:01.8	take out a piece of paper of pencil. Place the paper sideways in front of you. I can't talk.
1:06.9	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 hate you, Zach. I'm ready. Dr. Esdafan, this is going to be a single patient encounter.
1:15.6	You will have 15 minutes to complete the case.
1:17.6	Before we begin, do you have any questions?
1:19.6	No, my friend.
1:21.6	Let's go.
1:22.6	All right.
1:23.6	Let's begin.
	...

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