Round 26 (Stridor, Vomiting, Shock)

EM Clerkship

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

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

4.9 • 816 Ratings

🗓️ 1 October 2021

⏱️ 48 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

Case Introduction

You are working a shift at your local free-standing emergency room when a family of three checks in to be seen (a father and his two sons).

Initial Vitals#1 (Chris, 18mo with stridor)

* Temp 100.4F* HR 120* RR 40* O2 93%

Critical Actions#1 (Chris, 18mo with stridor)

* Check pulse oximetry (hidden)* Administer PO Steroids* Administer Racemic Epinephrine* Reassess patient after therapy* Discharge patient

Initial Vitals#2 (Ronnie, 3yo with vomiting)

* Temp 98.0F* HR 140* RR 38* O2 98%

Critical Actions #2 (Ronnie, 3yo with vomiting)

* Identify Iron overdose* Obtain abdominal XR * Obtain Iron level* Administer IVF bolus* Administer deferoxamine

Initial Vitals#3 (Carson, 55yo with shock)

* Temp 98.0F* HR 130* RR 28* BP 82/68* O2 92%

Critical Actions#3 (Carson, 55yo with shock)

* Obtain ECG* Identify pericardial tamponade* Administer IVF Bolus (tamponade is preload dependent)* Perform pericardiocentesis* Consult CT Surgery/CVICU

Further Reading

Life in the Fast Lane – Iron Toxicity

EMDocs – Croup

EMDocs – Pericardial Tamponade

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. This episode is sponsored by Pearson Rabbit's Insurance, and today is round number 26 of the game.
0:16.9	Mike will need to perform today's case in real ABM oral boards format. He has, drum roll, please, 30 minutes to complete the case.
0:25.5	He has no idea what the case is ahead of time, but it's a triple.
0:29.4	It's a triple, Mike.
0:30.6	Oh, yeah, here we go.
0:34.1	These cases were created by me.
0:36.1	They are not derived from actual ABM cases that I had. They are not real patients. Mike, take out a piece of paper and a pencil. Place the paper sideways in front of you. You can outline. So the way this would work is you would actually have three human bodies on it that you want to outline. So I'll give you actually some time to prepare that. Yeah.
0:57.3	Zach, Zach, Zach.
0:57.6	Okay.
0:58.9	Yeah, give me a minute.
1:03.6	I just got to say, my palms started instantly sweating as soon as you said that.
1:05.2	I can't even hold on to my pen.
1:07.1	You know it was coming.
1:09.0	All right.
1:10.4	Give me a minute.
1:14.5	This is why when you're like, my computer has 7%, I was like, yeah, you're going to need to reskage.
1:19.9	Isn't it fun just knowing these things?
1:22.7	Like carrying on casual conversation as I know I'm about to crush you.
1:24.4	It's like my favorite part about this whole deal.
1:25.6	Oh, my God.
1:26.8	I'm ready.
1:35.8	Let's do it. All right. So we got the, we did some modifications of Mike's piece of paper here. Mike, this is Dr. Estefan. This will be a single,
	...

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