EM Clerkship

CAUTION: THESE NOTES CONTAIN SPOILERS!! Case Introduction You are working a shift at EM Clerkship General when you are called to the waiting room by the charge nurse for a seizing patient. Initial Vitals Temp 99.0F HR 97 RR 16 BP 120/80 O2 90% Critical Actions Perform airway maneuvers to clear obstruction Administer IV Benzodiazepines […]

Acetaminophen Overdose & Toxicology Pearls History: Figure out how much was taken, what time the ingestion occurred, and if any other toxins were ingested Physical Exam: Perform a regular physical exam, and in addition, perform the toxicologic physical exam! Check pupil size Assess neuromuscular status for rigidity/clonus Perform the “toxicologist handshake” Listen to bowel sounds […]

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkship General when EMS calls you on the radio… “Hey doc we’re bringing a young female who drowned in a pool ETA 1 minute”. Initial Vitals Temp 95.0F HR 55 RR 5-6 BP 110/82 O2 90% Critical Actions Evaluate for traumatic […]

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkshift General when you are called to the resuscitation bay to see an elderly patient with unstable vitals brought in by EMS. Initial Vitals Temp 98.0F HR 43 RR 18 BP 60/40 O2 98% Critical Actions Diagnose the etiology for the […]

Four definitions you must know: SIRS – Must have at least 2 of 4 SIRS criteria (listed below): Fever (>38C) or Hypothermia (12k or 10% Tachycardia > 90 Tachypnea > 20 SEPSIS – Must have SIRS + have a suspected infectious source (eg pulmonary, urinary, intra-abdominal, etc) SEVERE SEPSIS […]

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkshift General when a 20yo female accompanied by her mother checks into the ER with chief complaint of fatigue. Initial Vitals Temp 101.2F HR 122 RR 22 BP 110/90 O2 98% Critical Actions Obtain travel history in patient presenting with fever […]

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at EM Clerkshift General when a sepsis alert is paged overhead for a young female  who appears diaphoretic and confused. Initial Vitals Temp 102.7F HR 145 RR 32 BP 141/85 O2 93% Critical Actions Workup and treat for sepsis upfront (Cultures, Lactate, IVF, […]

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are sitting at your computer on an otherwise beautiful Friday afternoon when a mother brings her 16 year old son to the ED with chief complaint of allergic reaction.   Initial Vitals Temp 98.7 HR 155 RR 28 BP 125/85 O2 99% Critical Actions Interpret ECG Interview […]

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working a shift at Clerkship General when a 51 year old female is brought in after a syncopal episode. Initial Vitals Temp 100.2 HR 132 RR 28 BP 105/69 O2 85% Critical Actions Give supplemental Oxygen Diagnose Pulmonary Embolism Administer Heparin Assess contraindications for tPA Administer […]

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are sitting at your computer on an otherwise quiet night when a young male is brought into your ED in obvious respiratory distress. Initial Vitals Temp 98.6 HR 99 RR 34 BP 105/69 O2 95% Critical Actions Give Albuterol + Ipratropium + Steroids Obtain Chest Xray Give […]

CAUTION: THESE NOTES CONTAIN SPOILERS!!! Case Introduction You are working at your local hospital when the next chart gets put in your rack. You groan. The chief complaint is dizziness.. Initial Vitals Temp 98.6 HR 109 RR 20 BP 105/69 O2 100% Critical Actions Diagnose Upper GI Bleed Initiate IV Proton Pump Inhibitor Obtain Type […]

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