Round 27 (Back Pain, Dysuria, Knee Pain)

EM Clerkship

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

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

4.9 • 816 Ratings

🗓️ 5 November 2021

⏱️ 49 minutes

🔗️ Recording | iTunes | RSS

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Summary

You are working a shift at ABEM General when three patients check in simultaneously at the start of your shift at 6AM.

Initial Vitals#1 (Ms. Taylor, 65F with Back Pain)

* Temp 98.8* HR 120* RR 22* BP 210/110* O2 97%

Critical Actions#1 (Ms. Taylor, 65F withBack Pain)

* Obtain Medication/Social Hx (Ciprofloxacin use, Cocaine use)* Diagnose Aortic Dissection (Type B)* Treat HR Appropriately (Esmolol drip)* Treat BP Appropriately (Cardene drip)* Treat Pain

Initial Vitals#2 (Ms. Thomas, 50F with Dysuria)

* Temp 101.0F* HR 120* RR 22* BP 106/65* O2 98%

Critical Actions #2 (Ms. Thomas, 50F with Dysuria)

* Obtain pregnancy test* Perform chaperoned pelvic exam* Diagnose PID /w Fitz Hugh Curtis & Treat /w abx* Treat pain* Council patient appropriately on +STD (treatment of partner, no intercourse until treated)

Initial Vitals#3 (Ms. Wells, 40F with Knee Pain)

* Temp 99.9F* HR 90* RR 18* BP 120/80* O2 98%

Critical Actions#3 (Ms. Wells, 40F with Knee Pain)

* Obtain appropriate workup (ESR, CRP, XRay, Cultures)* Treat pain* Perform Arthrocentesis* Gonococcal Arthritis* Treat with appropriate Antibiotics

Further Reading

Aortic Dissection – CoreEM

Pelvic Inflammatory Disease – EMDocs

Septic Arthritis – 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. This episode is sponsored by our amazing sponsor, Pearson Rabbit's Insurance, and today is round number, I believe, 27 of the game, Mike. If I'm counting correctly, Mike will need to perform today's
0:23.6	case in real ABEM oral boards format. He has 30 minutes to complete the case and has no
0:29.4	idea what the case is ahead of time. These cases were created by me. They are not dry from
0:33.6	actual ABAM cases and they are not real patients. Mike take out a piece of paper and a pencil
0:38.4	place the paper sideways in front of you outline your three human bodies kind of divide it into three
0:44.9	parts three human bodies and let me know when you are ready. All right my friend I am ready.
0:50.8	All right here we go. Dr. Estefan, this will be a triple patient encounter.
0:56.2	You will have 30 minutes to complete this case.
0:58.6	Before we begin, do you have any questions?
1:00.9	Nope, let's do it.
1:02.8	All right, your timer starts now.
1:05.5	Dr. Estefan, you are working at Clerkship General.
1:08.1	It's 6 a.m. on a beautiful Sunday morning and the nurse comes up to
1:12.1	you and says, sorry, Doc, they're all checking in and puts three patients in your rack at the
1:15.7	same time. It's choose your own adventure, Mike. I have three patients. I have Ms. Taylor,
1:21.0	Miss Thomas, and Ms. Wells. Um, so Taylor, Thomas, and Wells.
1:30.0	What are their chief complaints?
1:32.7	Well, Ms. Taylor has back pain.
1:35.8	Ms. Thomas has dysuria, and Ms. Wells has knee pain.
1:40.1	Can I get a set of vitals on all three of them before I decide who I want to see first?
1:45.6	No, that's too complicated. Just pick one. Just pick one. All right. Let's do Miss Taylor, back pain.
1:51.2	All right. So, Miss Taylor is a 65-year-old female here with back pain, and she is in room one.
	...

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