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EM Clerkship

Round 5 (Geriatric Fall)

EM Clerkship

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

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

4.9816 Ratings

🗓️ 1 November 2019

⏱️ 44 minutes

🧾️ Download transcript

Summary


CAUTION: THESE NOTES CONTAIN SPOILERS!!!



Case Introduction



The nurse is asking you to evaluate a 70 year old male who has been placed in a hall bed after hitting the back of his head. She wants to know if you would like to call a trauma alert…



Initial Vitals



* Temp 103.7 (Hidden by Examiner)* HR 115* RR 18* BP 110/75* O2 99%



Critical Actions



* Diagnose Fournier’s Gangrene on Secondary Survey* Obtain Full Vital Signs Including Temperature* Perform Sepsis “Core Measures”* Initiate Appropriate Treatment for Fournier Gangrene* Immediate Surgical Consultation



Final Diagnosis



Septic Shock due to Fournier Gangrene



Tips and Tricks



Always ask for the patient’s temperature if it is not given with initial vital signs



Additional Reading



* Fournier Gangrene Overview (PubMed)* Basic Approach to Sepsis (EM Clerkship)* Basic Approach to Trauma (EM Clerkship)




Transcript

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0:00.0

Hello, med students. This episode has been sponsored by Freed AI. Do you dread the thought of

0:07.1

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0:11.9

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0:20.4

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0:24.7

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0:29.5

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0:34.1

and you can cancel at any time if you decide it's not right for you.

0:37.7

You can learn more at www.gitfreed.a.i.

0:44.8

All right. Hello, residents. My name is Zach Olson. I'm joined today by Mike Estefan.

0:50.7

And thank you for downloading this month's episode of the EM Clerkship podcast. I'm currently

0:55.2

holding a small child. So if you hear noises, that would be my baby breathing. Anyways, this is

1:01.8

EM Clerkship's secret residency curriculum, advanced content designed to test graduates of EM

1:08.3

clerkship. And today is round number five of the game.

1:14.3

Mike will need to perform today's case in real ABEM oral boards format. 15 minutes to complete

1:19.5

the full case. He does not know what the case is ahead of time. I'm going to text him

1:24.6

EKG images and x-ray images during the recording and ask him to interpret.

1:29.8

And if it turns out to be a super interesting image or EKG, I'll post it online.

1:34.2

If Mike hits all of the critical actions that I've already listed out beforehand, he wins.

1:39.4

And if he doesn't, or if he performs a dangerous action, I win.

2:22.4

These cases were created by me. They are not actual ABEM cases that I've had. They are certainly not real patients. We're going to get right into it this month. That way, if you're just tuning in for the case, you don't have to wait very long. And if you want to stick around for some discussion about EM at the end, that kind of stuff, you'll have that option as well. So let's get going. Shh, quiet. Quiet, baby. Okay, this is going to be good. All right. I want to move the mic a little closer to my face here. All right. Mike, I'm believing in you this week. Are you ready, though? Because I'm going to need you. This is a totally passable case, but you need to have perfect technique.

2:24.3

So are you focused and ready to go?

2:26.8

I am ready to go.

...

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