Round 30 (Chest Pain)

EM Clerkship

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

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

4.9 • 816 Ratings

🗓️ 1 February 2022

⏱️ 22 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

You are working a shift at Clerkship General Hospital when you go see your next patient, a 70 year old male presenting with chest pain.

Initial Vitals

* Temp 98.7* HR 140* RR 20* BP 125/85* O2 99%

Critical Actions

* Obtain EKG* Treat AFib RVR via rate control (and not cardioversion)* Diagnose Acute Arterial Occlusion* Treat with Heparin* Consult Vascular Surgery for further management (possible thrombectomy, bypass, etc)

Further Reading:

EMDocs – Acute Limb Ischemia

EMDocs – Systematic Approach to the Peripheral Vascular Exam

Transcript

Click on a timestamp to play from that location

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.
0:10.1	This episode is sponsored by Pearson Rabbit's Insurance, my personal, independent life and disability insurance agent.
0:18.2	We will talk more about Pearson Rabbits later in this episode. Now let's get into it.
0:23.2	Today is round number 30 of the game. Mike will need to perform today's case in real ABEM
0:28.8	oral boards format. He has 15 minutes to complete the full case. He does not know what this case is
0:34.8	ahead of time. If Mike hits all the critical actions that I've listed out beforehand, he wins. If he doesn't, or if he performs a dangerous action, I win. These cases were created by me. They're not derived from actual ABM cases that I had, and they are not real patience. 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 are ready. I am ready, but dude, we're at episode 30. Isn't that crazy? I know. It's crazy, right? We've been doing a lot of these. But it doesn't feel like it's been that long. Like, time is just, I don't know, time goes by faster the longer you're alive, I think. Yeah, I think that's possibly true. The days go slow, the years go fast, as they say. All right, but yeah, I'm ready. Let's do it. All right. 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?
1:28.1	No questions, my friend.
1:30.1	All right, let's begin.
1:31.7	Dr. Esophon, you are working at Clerkship General Hospital when you are assigned your next patient chief complaint, chest pain.
1:38.9	Chest pain.
1:39.7	Okay.
1:40.9	I walk into the room.
1:42.7	What do I see?
1:55.5	You see a 70-year-old gentleman, and he is just sitting in the bed looking at you, being like, hey, Doc. All right. Can I get an opening set of vitals?
2:03.0	Sure. His heart rate is 140. His respiratory rate is 20. His blood pressure is 125 over 85.
2:05.4	His O2 saturation is 99%. And can I get a temperature on him?
2:07.9	98.7.
2:09.2	Great.
2:10.1	Hi, sir.
2:10.8	My name is Mike.
2:11.8	I'm one of the doctors that will be taking care of you.
2:14.1	What brought you into the emergency room today?
	...

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