EM Clerkship
Summary: 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.
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- Artist: Zack Olson, MD and Michael Estephan, MD
Podcasts:
This week we continue our discussion (started several years ago) on the most important procedural skill set in Emergency Medicine…. Airway!
How do you oxygenate a patient (while you are preparing for RSI) if suction, moving the tongue, and basic BVM ventilation are unsuccessful? Pharyngeal Airways * These tools bypass the posterior portion of the tongue to help with BVM ventilation* Nasopharyngeal Airway (NP)* Measure from earlobe to tip of nose* TEST QUESTION: Don’t use in a patient with possible skull fracture* Oropharyngeal Airway (OP)* Measure from earlobe to corner of mouth Laryngeal Mask Airway (LMA) * Essentially a modified BVM to place inside the mouth* It fits OVER the larynx (cords, epiglottis, etc) Retroglottic Airways * “King”* “Combitube” Additional Reading * Laryngeal Mask Airway (Wikipedia)* King Airway (Wikipedia)* Combitube (Wikipedia)
Super random. Except for mucormycosis. Remember mucormycosis!
Most Life Threatening Fungal Infection * Mucormycosis* Black facial discharge* Cranial nerve dysfunction* Facial swelling* Eschar formation When to Suspect a Fungal Infection * Immunocompromised (HIV, Diabetes, Organ Transplants, etc)* Not getting better on typical antibiotics Other Fungal Infections * Aspergillus* Aspergilloma* Bronchopulmonary Aspergillosis* Invasive Aspergillosis* Coccidiomycosis* Southwestern United States* Histoplasmosis* North Central United States* Blastomycosis* Southeast United States Additional Reading * Fungal infection archive and data sheets (CDC)
My personal strategy on how I keep life organized and get stuff done.
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Simple. Pragmatic. Palliative Care. Lunney JR, Lynn J, Foley DJ, Lipson S, Guralnik JM. Patterns of Functional Decline at the End of Life. JAMA. 2003;289(18):2387–2392. doi:10.1001/jama.289.18.2387
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Flying Reindeer, Ham Heart, and the Nativity
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Medical Clearance and Risk Assessment
The Two Objectives During Every Psychiatric-Type Complaint * Medical Clearance* Psychiatric Risk Assessment Medical Clearance * Required by EMTALA to perform a “screening exam” regardless of complaint* Most psychiatric facilities have poor diagnostic/treatment capabilities for non-psychiatric conditions and will want patient to be “medically cleared”* Sometimes they will require specific tests to be performed, blood pressure to be treated, etc* My “medical clearance” order set includes* Electrolytes* CBC* Serum Alcohol* Urine Drug Screen (UDS)* Pregnancy (if appropriate)* Tylenol/Salicylate Levels (especially if suicidal)* Psychiatric patients frequently have other non-psychiatric emergencies* Overdoses (salicylate, acetaminophen, etc)* Trauma (alcoholics with subdural hematoma from falls)* Encephalopathy (hypoglycemia, encephalitis) Psychiatric Risk Assessment * Will this patient truly put themself or others at risk if sent home due to mental health?* Do you need to involuntarily hold patient? * Are they having passive thoughts of being dead or true INTENT and PLAN to harm themself? * Did they name a specific person/group of people that they intend to harm? Additional Reading * State Laws on Involuntary Mental Health Holds (Psychiatry Online)
Real Talk
OBGYN
