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EM Clerkship

EM Clerkship

Zack Olson, MD and Michael Estephan, MD

Education, Courses, Health & Fitness, Medicine

5 • 795 Ratings

Overview

The purpose of this podcast is to help medical students crush their emergency medicine clerkship and get top 1/3 on their SLOE. The content is organized in an approach to format and covers different chief complaints, critical diagnoses, and skills important for your clerkship.

250 Episodes

Round 29 (MW) Pediatric Respiratory Distress

You are working at Clerkship General when the triage nurse walks back and gets you. “Hey doc, we just put a hypoxic infant in bed 7”. Initial Vitals: HR: 168 RR: 44 BP: 81/40 O2: 81% (Room Air) Critical Actions:

Transcribed - Published: 1 February 2025

Deep Dive R28 MW

Transcribed - Published: 16 January 2025

Round 28 (MW) Child Found in the Woods

You are working at Clerkship General on New Year’s Day when you see a nurse running from triage. He is carrying an unresponsive child to the resuscitation bay. Initial Vitals: HR: 43 BP: 47/20 Temp: 66F RR: 4 O2: 95% (BVM) Critical Actions:

Transcribed - Published: 2 January 2025

Deep Dive R27 MW

Transcribed - Published: 16 December 2024

Round 27 (MW) Geriatric Fever

You are working at Clerkship General when you hear an EMS call on the base command radio. “Clerkship General. We are bringing you a minimally responsive 79 year-old female found lying on the floor inside her apartment. ETA 5 minutes” Initial Vitals: HR: 143 BP: 160/105 Temp: 106.3F RR: 22 O2: 99% Room Air Critical […]

Transcribed - Published: 6 December 2024

Deep Dive R26 MW

Transcribed - Published: 15 November 2024

Round 26 (MW) Dizziness and Fatigue

Introduction: You are working at Clerkship General when the next chart is handed to you. It’s a 35-year-old female with a chief complaint of dizziness and fatigue. She is here accompanied by her husband. Initial Vitals: HR: 118 BP: 150/91 Temp: 100.4F RR: 20 O2: 99% Room Air Critical Actions:

Transcribed - Published: 1 November 2024

Deep Dive R25 MW

Transcript/Summary coming soon!

Transcribed - Published: 17 October 2024

Round 25 (MW) Laboring Mom in Triage

You are working at Clerkship General when you hear a woman screaming from triage… It’s baby time! Initial Vitals: HR: 120 RR: Shallow O2: 58% Critical Actions:

Transcribed - Published: 1 October 2024

Deep Dive MW R24

Transcript coming soon!

Transcribed - Published: 16 September 2024

Round 24 (MW) Nursing Home Transfer

You are working at Clerkship General when the nurse comes up to you and says, “Hey doc, EMS dropped off this guy named Randy from the memory care unit at the nursing home down the street. He’s in the hall bed outside of room 7. EMS says he’s here for confusion, we will get him […]

Transcribed - Published: 2 September 2024

Deep Dive MW R23

Episode summary coming soon!

Transcribed - Published: 17 August 2024

Round 23 (MW) Pediatric Altered Mental Status

You are working at Clerkship General when you hear an EMS call on the radio. “Clerkship General, we are bringing you a 3 year old female with complaints of altered mental status. We are pulling in now.” Initial Vitals: HR: 129 BP: 98/66 Temp: 99.7F RR: 35 O2: 99% Room Air Critical Actions:

Transcribed - Published: 1 August 2024

Deep Dive MW R22

Guillain-Barre Syndrome (GBS) – Autoimmune polyneuropathy that results in widespread demylination of peripheral nerves Typically occur 1 week after a triggering infection Paresthesias/Neuropathic Pain -> Ascending symmetric paralysis -> Respiratory Failure Major Diagnostic Criteria Treatment – IVIG and monitor respiratory status

Transcribed - Published: 16 July 2024

Round 22 (MW) Fall with Weakness

Critical Actions:

Transcribed - Published: 3 July 2024

Deep Dive MW R21

Orbital Compartment Syndrome – needs to be diagnosed CLINICALLY On exam, LOOK for: Proptosis, Ophthalmoplegia, Afferent Pupillary Defect, Vision Loss On exam, FEEL for: Rock hard globe, tense eyelids, resistance to retropulsion IOP > 40 means immediate canthotomy is indicated! Don’t perform if open globe is present Lateral Canthotomy Procedure: Anesthetize, Devascularize, Canthotomy, Cantholysis (inferior […]

Transcribed - Published: 16 June 2024

Round 21 (MW) Geriatric Fall

You are working at Clerkship General when the next chart is put into your rack. It’s a 76 year-old male who has fallen. Initial Vitals: HR: 101 BP: 138/85 Temp: 98.0F RR: 20 O2: 99% (Room Air) Critical Actions:

Transcribed - Published: 1 June 2024

Deep Dive MW R20

Symptoms of stroke – weakness, facial droop, slurred speech. vision loss, vertigo, ataxia, confusion or changes to mental status.   The “typical” stroke workup – blood glucose level, CTH non-con, CTA head/neck, CT Perfusion, CBC BMP Troponin EKG CXR and Coags.  Common stroke mimics – hypoglycemia, drug/alcohol intoxication, Bell’s palsy, aortic dissection, complex migraines, and […]

Transcribed - Published: 16 May 2024

Round 20 (MW) Stroke Symptoms

You are working at Clerkship General when one of the nurses comes and grabs you. “Hey doc, we need you in bed 10. I think this patient is having a stroke.” Initial Vitals: HR: 51 BP: 201/98 Temp: 98.0F RR: 18 O2: 99% (Room Air) Critical Actions:

Transcribed - Published: 1 May 2024

Deep Dive MW R19

Transcribed - Published: 16 April 2024

Round 19 (MW) Tummy Ache in Child with Diabetes

You are working at Clerkship General when the next patient is put into your rack. It is an 8 year-old male with vomiting Initial Vitals: HR: 119 BP: 104/63 Temp: 98.0F RR: 20 O2: 99% (Room Air) Critical Actions: References: Mellick LB, Sinex JE, Gibson RW, Mears K. A Systematic Review of Testicle Survival Time […]

Transcribed - Published: 2 April 2024

Deep Dive MW R18

Phase One: CNS Phase Two: Cardiopulmonary Phase Three: Renal Diagnosis: Treatment: Further Reading: EMCrit Toxic Alcohols

Transcribed - Published: 16 March 2024

Round 18 (MW) Drunk Man Wants Pizza

You are working at Clerkship General when you hear an EMS call on the radio. Clerkship General, we are bringing you Arthur. He is intoxicated… Again Initial Vitals: HR: 116 BP: 150/70 Temp: 98.8 RR: 26 O2: 85% (Room Air) Critical Actions:

Transcribed - Published: 1 March 2024

Deep Dive MW R17

Hypertensive Emergencies of Pregnancy PreEclampsia, Eclampsia, HELLP syndrome Diagnosis: BP >140/90 plus end organ dysfunction Treatment

Transcribed - Published: 16 February 2024

Round 17 (MW) Headache

You are working at Clerkship General when the next chart is put in your rack. It’s a 41-year-old female with a chief complaint of headache. Initial Vitals: HR: 56 BP: 172/93 Temp: 98.8F RR: 18 O2: 97% Critical Actions:

Transcribed - Published: 1 February 2024

Deep Dive MW R16

Diagnosing PE: Step 1: Consciously consider the diagnosis Step 2: Risk Stratify into low, intermediate, and high risk Step 3: Choose appropriate testing based on pre-test probability Classification of PE Treatment of PE

Transcribed - Published: 17 January 2024

Round 16 (MW) Leg Pain

You are working at Clerkship General when you overhear the base command radio. “Clerkship General. We have a 57 year-old female coming in for leg pain. She just had surgery at your hospital. Her blood pressure is 85/50. We’ll be there in 5 minutes.” Initial Vitals: HR: 122 BP: 75/40 Temp: 100.1 RR: 24 O2: […]

Transcribed - Published: 1 January 2024

Deep Dive MW R15

Shock – A state of deranged physiology characterized by systemic, widespread hypoperfusion

Transcribed - Published: 17 December 2023

Round 15 (MW) MVA

You are working at Clerkship General when you hear and EMS call on the radio. “Clerkship General, we are activating a trauma alert. We are bringing you a 33 year old male from a high-speed single vehicle collision” Initial Vitals: HR: 65 BP: 88/50 Temp: 97.0F RR: 20 O2: 96% Room Air Critical Actions:

Transcribed - Published: 2 December 2023

Deep Dive MW R14

Transcribed - Published: 15 November 2023

Round 14 (MW) Leg Pain

You are working a beautiful sunny day in Pennsylvania when the next chart gets put in your rack. It is a 2 year-old male with a leg injury. Initial Vitals: HR: 112 BP: 97/67 Temp: 99.2F RR: 20 O2: 97% Room Air Critical Actions:

Transcribed - Published: 1 November 2023

Deep Dive MW R13

Transcribed - Published: 15 October 2023

Round 13 (MW) Respiratory Distress

You are working at Clerkship General when you hear an EMS call: “Clerkship General, we are bringing you a young female in respiratory distress. ETA 2 minutes” Initial Vitals: HR: 123 BP: 142/78 Temp: Unknown RR: 36 O2: 97% (NonRebreather) Critical Actions:

Transcribed - Published: 1 October 2023

Deep Dive MW R12

Introduction Clinical Presentation Treatment

Transcribed - Published: 16 September 2023

Round 12 (MW) Respiratory Distress

You are working at Clerkship General when you hear an EMS call on the radio. “Clerkship General. We are bringing you an unresponsive 6-year-old female found foaming at the mouth by her babysitter. ETA 2 minutes.” Initial Vitals: BP: 125/80 HR: 62 RR: 34 O2: 81% (Non Rebreather) Critical Actions:

Transcribed - Published: 1 September 2023

OBGYN: The Vaginal Delivery (Pt 2)

Shoulder dystocia is an OB emergency. Remember McRobert’s maneuver and suprapubic pressure. For more information, take a look at the resources below. References ACOG- Shoulder Dystocia AAFP- Shoulder Dystocia

Transcribed - Published: 15 August 2023

OBGYN: The Vaginal Delivery (Pt 1)

Maddie’s 7 Cardinal Movements of a Successful Delivery: 1. Head comes out 2. Head turns 3. Cord Assessment 4. Anterior shoulder delivered 5. Posterior shoulder delivered 6. Body delivered. 7. Baby on mom’s chest T’s of Postpartum Hemorrhage: 1. Tone 2. Trauma 3. Tissue 4. Thrombosis

Transcribed - Published: 1 August 2023

Deep Dive MW R11

The 6 STEMI Equivalents: Other atypical ischemic EKG findings: Further Reading (see photos in the article): ECG Diagnosis of Life-Threatening STEMI Equivalent’s: Journal of the American College of Cardiology

Transcribed - Published: 15 July 2023

Round 11 (MW) Chest Pain

You are working at Clerkship Rural when the nurse hands you your next chart to see. It’s a 59 year old farmer with chest pain. Initial Vitals: BP: 156/97 HR: 110 RR: 22 O2: 98% (Room Air) Temp: 98.8F Critical Actions:

Transcribed - Published: 2 July 2023

Deep Dive MW R10

Consider removing the terminology “Agitated Delirium” from your vocabulary, as there is significant racial bias behind this term.

Transcribed - Published: 17 June 2023

Round 10 (MW) Agitation

You are working at Clerkship General when you hear an EMS call on the radio… “CLERKSHIP GENERAL – We are bringing you an agitated and combative 30 year old male, we’ll see you in 5 minutes.” Initial Vitals: BP: 192/105 HR: 134 RR: 22 O2: 99% (Room Air) Temp: 98.8 F Critical Actions: Dangerous Actions: […]

Transcribed - Published: 1 June 2023

Deep Dive MW R9

Indications for LP: CNS infection, SAH, Guillian Barree, IIH Contraindications for LP: Space occupying lesion with mass effect ; severe thrombocytopenia and coagulopathy; cellulitis over LP site or concern for epidural abscess ; traumatic injury to spine Complications for LP: Post LP Headache, spinal hematoma, brainstem herniation Technique for LP: Positioning is everything.  Use US […]

Transcribed - Published: 16 May 2023

Round 9 (MW) Altered Mental Status

You are working at Clerkship General when the charge nurse comes and grabs you… “Hey doc, we need you in room 2, this kid looks sick…” Initial Vitals: BP: 68/40 HR: 128 RR: 22 O2: 99% (Room Air) Temp: 103.5F Critical Actions: Check Out: Pearson Ravitz Webinar – “Disability Insurance 101 for Residents” https://us06web.zoom.us/webinar/register/1416806357023/WN_ziYRNc0kT8yAyOOJZ-Xk2g

Transcribed - Published: 1 May 2023

Deep Dive MW R8

Transcribed - Published: 16 April 2023

Round 8 (MW) Groin Pain

You are working at Clerkship General on an overnight shift when the next chart is handed to you. It’s a 35 year old male with a chief complaint of groin pain. Initial Vitals: BP: 150/90 HR: 107 RR: 20 O2: 99% (Room Air) Temp: 98.0F Critical Actions:

Transcribed - Published: 1 April 2023

Deep Dive MW R7

Obtain IV Access – get two large bore IVs (18g or larger) Resuscitate – un-crossmatched blood at first, don’t forget type and screen! Medicate – Give Pantoprazole always, Octreotide and Ceftriaxone if hx liver disease, reverse anticoagulation if indicated Imaging – Upright CXR to assess for perforation, CTA if concerned for lower GIB Consult – […]

Transcribed - Published: 16 March 2023

Round 7 (MW) – Vomiting Blood

You are working at Clerkship General when the charge nurse grabs you – “hey we got a real sick one, a 57yo Male who I just put in the resuscitation bay, he is vomiting blood”. Initial Vitals:BP: 77/34 HR: 135 RR: 24 O2%: 95% Temp: 98.8F Critical Actions: Further Reading: EMDocs – GI Bleed

Transcribed - Published: 1 March 2023

Flash Pulmonary Edema (aka SCAPE)

Transcribed - Published: 19 February 2023

Opioid Use Disorder – What You Do Matters!

In this long-form episode we will discuss opioid use disorder, the leading cause of death in young adults in the United States. What you do matters! References

Transcribed - Published: 1 February 2023

The Rank List

This episode will answer 3 big pre-Match Day questions: 1. How do I go about making my rank list? 2. What about post-interview communication both from and to programs? 3. How does this whole thing called the Match actually work? Resources: https://www.emra.org/books/msadvisingguide/preparing-and-submitting-your-rank-list/

Transcribed - Published: 20 January 2023

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