Round 19 (Bradycardia)
EM Clerkship
Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD
4.9 • 816 Ratings
🗓️ 1 March 2021
⏱️ 36 minutes
🧾️ Download transcript
Summary
CAUTION: THESE NOTES CONTAIN SPOILERS!!!
Case Introduction
You are working a shift at EM Clerkshift General when you are called to the resuscitation bay to see an elderly patient with unstable vitals brought in by EMS.
Initial Vitals
* Temp 98.0F* HR 43* RR 18* BP 60/40* O2 98%
Critical Actions
* Diagnose the etiology for the bradycardia (BB overdose)* Administer Atropine* Administer Glucagon* Administer Epinephrine drip* Attempt transcutaneous/transvenous pacing* Administer high-dose Insulin therapy
Final Diagnosis
Beta Blocker Overdose
Tips and Tricks
* Keep in mind the broad differential for severe bradycardia – ischemia, ingestion, electrolyte abnormalities, intrinsic arrhythmia/heart block, hypothyroidism, hypothermia, hypoglycemia, hypoxia, increased intracranial pressure, neurogenic shock.
Further Reading
High Dose Insulin Therapy (EMCRIT)
Low and Slow Poisoning (EMCASES)
Transcript
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| 0:00.0 | Hello, residents. My name is Zach Olson. I'm joined today by the one, the only, the illustrious, |
| 0:09.5 | my guest, Stefan, and thank you for downloading this month's episode of the EM Clerkship |
| 0:14.1 | Podcast. This episode is sponsored by Pearson Rabbit's Insurance, my personal disability and life |
| 0:20.2 | insurance agent. |
| 0:21.1 | We will talk more about them later in this episode. |
| 0:23.8 | Let's get into it. |
| 0:24.7 | Today is round number 19 of the game. |
| 0:28.6 | And Mike is going to need to perform today's case in real ABEM oral boards format. |
| 0:33.7 | He has a strict 15 minutes to complete the full case. |
| 0:37.1 | He does not know what the case is ahead of time. |
| 0:39.3 | And if he hits all the critical actions that I've listed out beforehand, he wins. |
| 0:42.5 | And if he doesn't, or if he does something dangerous, I win. |
| 0:45.6 | These cases were created by me. |
| 0:46.9 | They're not derived from actual ABM cases that I had. |
| 0:49.0 | They're not real patience. |
| 0:50.7 | Mike, you ready to go? |
| 0:52.3 | I am as ready as I'll ever be, Zach. |
| 0:55.1 | Let's do it. |
| 0:56.0 | All right. |
| 0:56.4 | Take out a piece of paper and a pencil. |
| 0:59.1 | Place the paper sideways in front of you, |
| 1:01.5 | outline a human body on the left side of it, and let me know when you're ready. |
... |
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