CRACKCast & Physicians as Humans on CanadiEM: Recent Episodes

View Details

In the final episode of the series, Sam Savard interviews Dr. Kevin Wasko on the power packed panel he hosted. Additionally, we highlight a member of the CanadiEM team who was featured in the conference.

View Details

The second day of CAEP truly embodied the essence of phrase "Work Hard, Play Hard." It was a jam-packed day filled with remarkable talks, enlightening presentations, and a thought-provoking plenary by Dr. Heather Patterson on using photography to cope with burnout.Tune in to our podcast, where our host, Sam Savard, provides a comprehensive summary of the day.

View Details

In this episode, our host, Sam Savard, conducts an insightful interview with Dr. Sunil Mangal to capture the essence of the remarkable first day at CAEP alongside a glimpse into the numerous other captivating sessions and discussions that took place throughout the day.

View Details

As the highly anticipated annual CAEP conference approaches, we are thrilled to announce our partnership with CanadiEM to bring you "The CAEP Capsule," a dynamic podcast series that will give you a brief overview of each conference day. Get ready for insightful interviews, succinct summaries, and thought-provoking discussions, all designed to capture the essence of this renowned conference.

The first episode serves as a trailer to both the conference and the series. Stay tuned for more amazing summaries from CAEP 2023!

View Details

In this episode, Amie speaks with Dr. Jill Roberge, a Métis physician about how she integrates Métis Worldview into her practice. We discuss her upbringing and background, why she chose emergency medicine and her experiences with racism in healthcare. We also discuss how the Métis worldview can be practiced every day through a compassionate lens. Dr. Roberge also provides some tangible tips on dealing with racism in healthcare for providers and how she addresses it in her everyday life and practice.

Warning: Explicit language in this episode.

View Details

Overview:

In this episode, Tiffany shares her transition from Resident to Med Staff during the COVID pandemic. She candidly shares her challenges balancing job uncertainty, family, kid zoom classes, finishing residency and a cross country move. Take a listen!

Host: Tiffany Proffitt DO, Staff Emergency Medicine Physician Honor Health

Short Bio: Dr. Tiffany Proffitt is an Emergency Medicine Physician in Scottsdale, Arizona, USA. I completed residency in Michigan, USA with Spectrum Health Lakeland. During my time I graduated from the Medical Education Track. I am honored to be one of the inaugural fellows of EMRACAST, the official resident run podcast of EMRA. In my Med Staff life I am the co-founder of the HonorHealth Women Physicians Leadership Council, advancing leadership opportunities for over 550 women physicians. In my spare time, I cart my twin eight-year-olds to various activities, laugh with my husband and podcast! I am a MedEd enthusiast and proud to be part of the CanadiEM team!

View Details

Overview:

In this episode, Tiffany shares her transition from Resident to Med Staff during the COVID pandemic. She candidly shares her challenges balancing job uncertainty, family, kid zoom classes, finishing residency and a cross country move. Take a listen!

Host: Tiffany Proffitt DO, Staff Emergency Medicine Physician Honor Health

Short Bio: Dr. Tiffany Proffitt is an Emergency Medicine Physician in Scottsdale, Arizona, USA. I completed residency in Michigan, USA with Spectrum Health Lakeland. During my time I graduated from the Medical Education Track. I am honored to be one of the inaugural fellows of EMRACAST, the official resident run podcast of EMRA. In my Med Staff life I am the co-founder of the HonorHealth Women Physicians Leadership Council, advancing leadership opportunities for over 550 women physicians. In my spare time, I cart my twin eight-year-olds to various activities, laugh with my husband and podcast! I am a MedEd enthusiast and proud to be part of the CanadiEM team!

View Details

This updated episode of CRACKCast reviews Chapter 40 - Genitourinary System in Rosen's 9th Edition.

View Details

In this episode, hosts Jayneel Limbachia, Dakoda Herman, and Jake Domm discuss ECMO and mature ECMO programs, appraise the ARREST trial and consider the future of cardiac arrest care with expert guest Dr. James Gould. References: Yannopoulos D, Bartos J, Raveendran G, Walser E, Connett J, Murray TA, Collins G, Zhang L, Kalra R, Kosmopoulos M, John R, Shaffer A, Frascone RJ, Wesley K, Conterato M, Biros M, Tolar J, Aufderheide TP. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. Lancet. 2020 Dec 5;396(10265):1807-1816. doi: 10.1016/S0140-6736(20)32338-2. Epub 2020 Nov 13. PMID: 33197396; PMCID: PMC7856571. Lamhaut L, Hutin A, Puymirat E, Jouan J, Raphalen JH, Jouffroy R, Jaffry M, Dagron C, An K, Dumas F, Marijon E, Bougouin W, Tourtier JP, Baud F, Jouven X, Danchin N, Spaulding C, Carli P. A Pre-Hospital Extracorporeal Cardio Pulmonary Resuscitation (ECPR) strategy for treatment of refractory out hospital cardiac arrest: An observational study and propensity analysis. Resuscitation. 2017 Aug;117:109-117. doi: 10.1016/j.resuscitation.2017.04.014. Epub 2017 Apr 14. PMID: 28414164.

Matsuoka Y, Goto R, Atsumi T, Morimura N, Nagao K, Tahara Y, Asai Y, Yokota H, Ariyoshi K, Yamamoto Y, Sakamoto T; SAVE-J Study Group. Cost-effectiveness of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A multi-centre prospective cohort study. Resuscitation. 2020 Dec;157:32-38. doi: 10.1016/j.resuscitation.2020.10.009. Epub 2020 Oct 17. PMID: 33080369.

Grunau B, Shemie SD, Wilson LC, Dainty KN, Nagpal D, Hornby L, Lamarche Y, van Diepen S, Kanji HD, Gould J, Saczkowski R, Brooks SC. Current Use, Capacity, and Perceived Barriers to the Use of Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest in Canada. CJC Open. 2020 Nov 13;3(3):327-336. doi: 10.1016/j.cjco.2020.11.005. PMID: 33778449; PMCID: PMC7985000.

Sun T, Guy A, Sidhu A, Finlayson G, Grunau B, Ding L, Harle S, Dewar L, Cook R, Kanji HD. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for emergency cardiac support. J Crit Care. 2018 Apr;44:31-38. doi: 10.1016/j.jcrc.2017.10.011. Epub 2017 Oct 12. PMID: 29040883.

Hsu CH, Meurer WJ, Domeier R, Fowler J, Whitmore SP, Bassin BS, Gunnerson KJ, Haft JW, Lynch WR, Nallamothu BK, Havey RA, Kidwell KM, Stacey WC, Silbergleit R, Bartlett RH, Neumar RW. Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest (EROCA): Results of a Randomized Feasibility Trial of Expedited Out-of-Hospital Transport. Ann Emerg Med. 2021 Jul;78(1):92-101. doi: 10.1016/j.annemergmed.2020.11.011. Epub 2021 Feb 1. PMID: 33541748; PMCID: PMC8238799.

View Details

In this episode, Tiffany talks with Dr. Kevin Dong from Hamilton, Canada, and CanadiEM podcast extraordinaire! We reflect on two years of practicing medicine during the COVID pandemic and share our own unique challenges, lessons learned and motivation to continue to work in the department as we enter our third year of the pandemic. Take a listen! Short Bio: Dr. Kevin Dong. Kevin is an Emergency Medicine physician at the Hamilton Health Sciences in Hamilton, Canada. He is an assistant clinical professor at McMaster University and he is currently the Director of Continuing Professional Development with the Tri-Divisions of Emergency Medicine. He is a FOAMed enthusiast and is heavily involved in the CanadiEM world. 

Twitter: @kevinjdongMD

View Details

In this episode, Amie Archibald-Varley talks to Dr. Chris Keefer, an Emergency Medicine physician is who is a pro-nuclear climate and clean air activist and the host of the Decouple Podcast and WeCANDUIt! podcast. We discuss Dr. Keefer’s trip to The UN Climate Change Conference (COP26) in Glasgow, on how the summit's outcomes will impact climate action and the Sustainable Development Goals (SDGs). We discuss the impact of waste in hospitals as well as tackle the conversation in relation to sustainable energy sources for healthcare.

View Details

View Details

Core Questions

1. Outline the anatomic borders of the anterior and posterior triangles of the neck.
2. Detail the borders and associated contents of the three zones of the neck.(Box 37.1)
3. List 5 hard and 5 soft signs of penetrating neck trauma (Box 37.2)
4. List 5 hard and 5 soft signs of vascular injury
5. Outline an approach to the management of a patient with a hemorrhaging penetrating neck wound.
6. Describe the management of a patient with a suspected venous air embolism.
7. Outline the steps in performing an awake intubation.
8. Outline the indications for imaging to screen for blunt cerebrovascular injury.(Table 37.2)
9. Detail the appropriate imaging studies to order in the patient at risk for or with suspected blunt cerebrovascular injury.

Wisecracks

1. What structure, if violated, should make you suspect injury to the deep tissues of the neck?
2. What study or studies is/are indicated to evaluate a patient for suspected esophageal injury.
3. List 4 mechanisms of morbidity and mortality that occur as the result of vascular injury in the neck.
4. What is the most common mechanism of injury causing blunt cerebrovascular injury?
5. List 3 mechanisms that cause pulmonary edema in a patient post-hanging.

View Details

Core Questions

1. Outline the Denis Classification system for determining the stability of spinal injuries
2. List 5 flexion, 2 flexion-rotation, 3 extension, and 2 vertical compression spinal injuries (Table 36.1)
   1. Wedge Fracture
   2. Flexion Teardrop Fracture
   3. Clay Shoveler’s Fracture
   4. Spinal Subluxation
   5. Bilateral Facet Dislocation
   6. Altlanto-occipital Dislocation
   7. Anterior Atlanto-axial Dislocation
   8. Unilateral Facet Dislocation
   9. Posterior Neural Arch Fracture
   10. Hangman’s Fracture
   11. Extension Tear Drop Fracture
   12. Burst Fracture
   13. Jefferson Fracture
3. Outline the mechanisms and potential complications of the following injuries:
4. How are odontoid fractures classified and what causes them?
5. Organize the spinal motor, sensory, and reflex examinations based on spinal levels. (Tables 36.3, 36.4, 36.5)
   1. Central Cord
   2. Anterior Cord
   3. Brown-Sequard
6. Detail the following cord syndromes:
7. List the components of the following imaging decision-making tools: Canadian C-Spine Rule, NEXUS C-Spine Rule.

Wisecracks

1. How do you calculate Power’s Ratio and why is it important?
2. What injuries is the open-mouth odontoid radiograph best at visualizing?
3. How are whiplash-associated injuries classified?
4. At what spinal level would you expect an injury to potentially cause Horner's Syndrome?
5. What is spinal shock and what physical exam finding indicates its end?

View Details

CanadiEM Journal Club E04 Systematic reviews and meta analyses show notes

Welcome back to Journal Club by CanadiEM! In this episode we go over an approach to systematic reviews and meta analyses based on Oxford centre of EBM, and learn about diagnosing pneumothorax with ultrasound vs X-ray

Using the Oxford centre of EBM tool, we will ask:

1. What question(s) did the systematic review address?
2. Is it likely that important, relevant studies were missed?
3. Were the criteria used to select articles for inclusion appropriate?
4. Were the included studies sufficiently valid for the type of question asked?
5. Were the results similar from study to study?
6. What were the results?
7. What is the clinical significance of the results?

and then a clinical pearl on pneumothorax!!

Hosts:

• Dakoda Herman
• Jayneel Limbachia
• Jake Domm

Paper: “Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department” Cochrane Database of Systematic Reviews by Chan KK, Joo DA, McRae AD, Takwoingi Y, Premji ZA, Lang E, Wakai A

What question(s) did the systematic review address?

P: Trauma patients in the ER

I: chest ultrasonography by non rad physicians

C: Chest xray

O: diagnosis of pneumothorax, improved patient safety

• Secondary: investigate potential sources of hetero such as type of CUS operator, type of trauma, type of US probe on test accuracy

T: inception to 10 April 2020

Is it unlikely that important, relevant studies were missed?

• This study included prospective, paired comparative accuracy studies in which patients were suspected of having pneumothorax. Patients must have undergone both CUS by a frontline non-radiologist and CXR, as well as CT of the chest or tube thoracostomy as the reference standard.
• The authors carried out systematic searches in the following electronic databases: Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; MEDLINE; Embase; Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus; Database of Abstracts of Reviews of EIects; Web of Science core collection (which includes: Science Citation Index Expanded; Social Sciences Citation Index; Arts & Humanities Citation Index; Conference Proceedings Citation Index - Science; Conference Proceedings Citation Index - Social Sciences & Humanities; and Emerging Sources Citation Index; and Clinicaltrials.gov from database creation to April 2020.
• The authors also handsearched reference lists of included articles and reviews, retrieved via electronic searching, for potentially eligible studies. Additionally, they carried out forward citation searching of relevant articles in Google Scholar and looked at the “Related articles” on PubMed.
• They did not limit the search to Englsih language only and included articles published in all languages.
• Their search strategy in volved the use of MeSH terms such as Pneumothorax, Radiography, Ultrasonography, and focused assessment with ultrasonography for trauma. They also used many text words.
• Using this search strategy 3473 records were identified. 1180 duplicated records were removed, leaving 2293 records to be screened. These records were screened by two of the authors for their relevance, when there was a discrepancy a third author decided whether to include the record or not. 2268 records were excluded, leaving 25 full-text articles that were assessed for eligibility. 12 studies were excluded - 5 missing CUS/CXR/CT chest/chest tube, 4 CUS not performed by frontline non-radiologist physicians, 2 wrong patient population, 1 wrong study design. A total of 13 studies were included in qualitative and quantitative analysis. 9 studies using patients as units of analysis included in primary analysis. 4 studies using lung fields as units of analysis included in secondary analysis.
• Authors provide a nice figure depicting this.
• Authors did not contact experts for unpublished data but were very thorough and transparent in their search strategy. I think it is unlikely that important, relevant studies were missed.

Were the criteria used to select articles for inclusion appropriate?

• The authors of this study clearly outlined their study inclusion and exclusion criteria.
• They included prospective, comparative accuracy studies in which patients were suspected of having pneumothorax.
• They included trauma patients in the emergency department setting. Patients must have undergone both CUS by frontline non-radiologist physicians and CXR as index tests, as well as CT of the chest or tube thoracostomy as the reference standard. The two main index tests were CUS completed by a frontline nonradiologist physician and CXR, both being performed in the supine position. If data on specific CUS findings (such as the absence of lung sliding, absence of B-lines or comet-tail artefact, presence of lung point, and absence of lung pulse) were available, they planned to assess the diagnostic accuracy of these individual CUS findings. The target condition was traumatic pneumothorax of any severity. They defined a pneumothorax identified on CT scan of the chest or via clinical findings of a rush of air or bubbling in a chest drain after tube thoracostomy as the reference standard.
• The authors excluded studies involving participants with already diagnosed pneumothorax (i.e. case-control studies); studies involving participants with nontraumatic pneumothorax; studies involving participants who had already been treated with tube thoracostomy; and studies in which a frontline non-radiologist physician did not perform CUS.
• These criteria were appropriate for inclusion. However, many studies did differ in their units of measurement - lung fields vs. patients, which could introduce significant bias into the results of individual studies.

Were the included studies sufficiently valid for the type of question asked?

• The authors used the QUADAS-2 tool to assess risk of bias and the applicability of each included study.
• This tool assesses risk of bias in four domains: patient selection; index tests; reference standard; and flow and timing. In addition, they examined concerns about applicability in the first three domains. They tailored the tool to their review question - one of the signalling questions in the patient selection domain was not applicable because they excluded case-control studies; therefore they deleted this question from the tool.
• Two review authors performed the assessments independently. They discussed and resolved any disagreements that arose through consultation with a third review author.
• They included a figure describing their assessments of study quality.
• Of the nine studies that we included in the primary analysis:
• • One had a low risk of bias, two had an unclear risk, and six had high risk of bias in the patient selection domain, mostly due to convenience sampling or inappropriate exclusion criteria, such as excluding haemodynamically unstable patients, lack of access to CUS, chest wall injuries precluding CUS, or if CT was not indicated.
  • The risk of bias in the interpretation of CUS results was low in five studies, unclear in two studies, and high in two studies; this was related to unclear blinding methodology of outcome assessors interpreting CUS and CXR results.
  • The risk of bias in the interpretation of CXR results was low in two studies, unclear in six studies, and high in one study; this was largely due to unclear blinding methodology of outcome assessors interpreting CXR and CT results, as in some studies it was not clear whether radiologists had access to both imaging results or not.
  • The risk of bias introduced in interpretation of the reference standard results was low in three studies but unclear in the remainder for similar concerns regarding blinding methodology.
  • The risk of bias in the flow and timing domain was low in two studies, unclear in four studies, and high in three studies; this was due to the exclusion of patients based on missing CT data or unclear/inappropriate time intervals between CUS, CXR, and CT.
  • They judged applicability concerns regarding patient selection as low for six studies but high for three studies; this was due to the exclusion of haemodynamically unstable patients or lack of access to CUS despite the study focusing on comparing CUS.
  • They judged one included study to have unclear concern regarding applicability of the reference standard used as there was insuIicient reporting of the method of assessment.
  • They deemed all other domains for applicability concerns as low risk for all studies.
• Studies that used lung fields as their unit of analysis had several limitations including missing CUS data for some lung fields and using two CUS tests (one for each lung field) compared to one CXR (for both lungs) on the same patient. Inherently, there would be an inability to blind the CUS operator during collection of CUS data while performing the two CUS tests (one on each side of the patient), as well as during the interpretation of the CXR and CT results between the two lung fields. By analysing lung fields separately, it is diIicult to ascertain whether patient characteristics, past medical history, or traumatic injury pattern could have affected one or both lungs and may have confounded the diagnostic accuracy. Out of the four studies included in the secondary analysis:
• • The risk of bias in the patient selection domain was low in one study, unclear in two studies, and high in one study; this was due to inappropriate exclusion criteria, such as excluding haemodynamically unstable patients or chest wall injuries precluding CUS, or due to unclear sampling technique.
  • The risk of bias introduced in interpreting CUS results was low in two studies and unclear in two studies due to lack of clarity about blinding of the outcome assessors interpreting CUS and CXR results.
  • The risk of bias introduced in interpreting CXR and CT results to be low in one study, unclear in two studies, and high in one study; this was again due to definite unblinded interpretation of test results or unclear blinding methodology of outcome assessors interpreting CXR and CT results.
  • The risk of bias in the flow and timing domain was low in two studies and high in two studies due to missing patient data.
  • They judged applicability concerns in the patient selection domain as low for two studies, unclear for one study, and high for one study, due to unclear patient selection methods and exclusion of haemodynamically unstable patients or chest wall injuries precluding CUS.
  • They judged one study to have unclear concern regarding applicability of the reference standard, as blinding of the outcome assessor interpreting the results of CUS, CXR, and CT was unclear. We deemed all other domains as 'low concern' for all studies.
• The authors were thorough in their assessment of each study's quality and discussed how this may have impacted the results. The most common area of bias seemed to be in patient selection where 11/13 studies were judged to be at unclear or high risk of bias.

Were the results similar from study to study?

• Substantial heterogeneity in sensitivity analysis of supine CXR
• • Based on Figure 4, Forest plot:
  • • Sensitivity ranged from 0.09 to 0.75
    • Wide and non overlapping confidence intervals are suggestive of high variability between studies
    • Limits the evidence
  • But they do not list the reasons for why such heterogeneity exists
  • • Some possibilities for the heterogeneity include the high or unclear risk of bias of included studies
    • There is no I squared statistic shown - a statistical measure that confirms the presence of significant heterogeneity in a meta-analysis

Results of the study:

• Included 13 studies, 1271 trauma patients with 410 who had a pneumothorax
• • 9 studies used patients as unit of analysis
  • 4 studies used lung field as unit of analysis
  • Most studies were high or unclear risk of bias - 11/13
• CUS sensitivity and specificity: 0.91 (95% CI: 0.85 - 0.94) and 0.99 (95% CI: 0.97 - 1.00)
• CXR sensitivity and specificity: 0.47 (95% CI: 0.31 - 0.63) and 1.00 (95% CI: 0.97 - 1.00)
• • Difference in sensitivity: 0.44 (95% CI: 0.27 - 0.61)

Practise Changing?

This is an excellently executed Systematic Review that makes the most of the limited evidence available and presents such in a transparent way. The results of this study suggest that CUS has better sensitivity in detecting pneumothorax in the emergency department than CXR, and comparable specificity. This publication adds to the body of research that is building in support of US in the primary care setting, and promotes a change in culture as US adoption rates grow.

Clinical pearl:

Pneumothorax, or, air in the pleural space, is a fairly common complication of thoracic traumas, occurring 15-50% of the time.

• History: If you’re able to get a history, and often you won’t be able to, you’ll hear about a Sudden, severe, chest pain, sometimes referred to shoulder and maybe associated pleuritic pain or SOB.
• On Exam: Exam findings range from nothing to respiratory distress and shock. May have decreased chest wall motion, subcutaneous emphysema, or poprock skin, hyperresonance, or decreased or absent breath sounds on the affected side.
• Imaging: traditionally via x-ray or US depending on physician.
• • On xray: Absence of lung markings beyond the edge of the lung. The edge of the scapula or upper ribs are often mistaken for a pneumothorax.
  • On US: Scan over the most upright part of the patient's chest. if supine go right over the top of their chest (third or fourth intercostal space in the midclavicular line and is repeated on both sides) and if upright scan the apices. Looking for lung sliding and the classic “seashore sign” in M-mode in normal lungs, or absence of lung sliding and “barcode sign” seen in pneumothorax. There are tons of good videos online to take a look at.
  • CT is gold standard, but rarely necessary

• Rush of air on thoracostomy is also diagnostic.

• Treatment: varies based on severity, from no treatment if patient tolerating well, to drains and chest tubes, to needle or finger thoracostomy for immediate decompression if pneumothorax clinically indicated and hypotension.

View Details

Welcome to Carmscast, the podcast that aims to answer all the questions medical students have when creating a competitive CARMS application. In today’s episode, our co-hosts, Kara and Dakoda, mix up the podcast format and reflect on their CaRMS experience over the last year.

Dr. Kara Tastad is now a graduate of the University of Saskatchewan College of Medicine. She will soon be starting her first year of emergency medicine residency at the University of Toronto. Dr. Dakoda Herman just graduated from the Temerty Faculty of Medicine at the University of Toronto. He will be trading places with Kara as he begins residency in Family Medicine at the University of Saskatchewan in Saskatoon.

For shownotes Click Here

View Details

View Details

This year, CanadiEM has partnered with the Canadian Association of Emergency Physicians, EMOttawa, and the Skeptic’s Guide to Emergency Medicine to help promote #CAEP21: CAEP at the Forks - Rising to the Challenge. From June 15-17, 2021 we will be publishing The CAEP Daily, a journalistic summary of highlights from the conference. Please join the discussion!

View Details

CanadiEM has partnered with the Canadian Association of Emergency Physicians, EMOttawa, and the Skeptic’s Guide to Emergency Medicine to help promote CAEP at the Forks - Rising to the Challenge. From June 15-17, 2021 we will be publishing The CAEP Daily, a journalistic summary of highlights from the conference. Please join the discussion!

View Details

Core Questions

1. Detail the nerve supply of the face.
2. What bones form the borders of the orbit?
3. Outline the LeFort fracture classification system.
4. What is the tongue blade test and how is it performed?
5. Outline the Ellis System for dental fracture classification.
6. Outline an approach to the management of ingested/aspirated teeth.
7. Describe three techniques for the reduction of anterior TMJ dislocations.
8. List four indications for Panorex X-rays.

Wisecracks

1. At what age do the following sinuses become aerated:
2. 1. Mastoid
   2. Ethmoid
   3. Facial
   4. Maxillary
   5. Sphenoid
3. What is the association between the presence of facial injuries and the presence of intracranial injuries/cervical spine injuries?
4. What facial lacerations require prophylactic antibiotics?
5. List three solutions in which avulsed teeth can be placed to preserve them.

View Details

This is the third episode of our CanadiEM’s podcast series in collaboration with CAEP 2021. In this episode, Dr. Hans Rosenberg is joined by two CAEP 2021 Track Chairs, who give a sneak peak about the great speakers lined up! First, we are joined by Dr. Ken Milne, who outlines the Recent Emergency Medicine Literature track. Afterwards, Dr. Caroline Kowal highlights the Global Emergency Medicine track. 

View Details

This is the third episode of our CanadiEM’s podcast series in collaboration with CAEP 2021, with our guest host Ken Milne. You may recognize Ken Milne’s voice from the popular podcast Skeptic’s Guide to Emergency Medicine. In this series, Ken breaks down will tell you everything you need to know about the upcoming CAEP 2021 conference, CAEP at the Forks: Rising to the Challenge!

In today’s episode, Ken Milne meets with Dr. Tamara McColl to discuss everything you need to know about the upcoming CAEP conference tracks and plenary speakers. Dr. Tamara McColl breaks down why you should attend the CAEP conference, and what exciting tracks to look out for!

View Details

This is the second episode of our CanadiEM’s podcast series in collaboration with CAEP 2021, with our guest host Ken Milne. You may recognize Ken Milne’s voice from the popular podcast Skeptic’s Guide to Emergency Medicine. In this series, Ken breaks down will tell you everything you need to know about the upcoming CAEP 2021 conference, CAEP at the Forks: Rising to the Challenge!

In today’s episode, Ken Milne meets with Dr. Tamara McColl to discuss everything you need to know about the upcoming CAEP pre-conference. Dr. Tamara McColl breaks down the meaning behind CAEP at the Forks, why you should attend the CAEP pre-conference!

View Details

This episode covers drowning in the wilderness/prehospital setting.

View Details

This is the first episode of our CanadiEM's podcast series in collaboration with CAEP 2021, with our guest host Kevin Milne. You may recognize Kevin Milne's voice from the popular podcast Skeptic's Guide to Emergency Medicine. In this series, Kevin breaks down will tell you everything you need to know about the upcoming CAEP 2021 conference, CAEP at the Forks: Rising to the Challenge!

In today's episode, Kevin Milne meets with Dr. Tamara McColl to discuss everything you need to about the upcoming CAEP Conference. Dr. Tamara McColl breaks down the meaning behind CAEP at the Forks, why you should attend the CAEP conference and all the details you need to know before attending!

View Details

In this collaboration CAEP Conference + CanadiEM promotions podcast episode - We introduce some of our amazing track chairs from the conference. They discuss their guest speakers and some of the awesome content they will be hosting at their respective tracks!

Track Chairs - Tracks:

Dr. Brandon Ritcey - Procedures Dr. Hasan Sheikh - Advocacy and Public Affairs: Leading System-Wide Change as an Emergency Physician Dr. Lisa Thurgur - CORE-EM Dr. Eddy Lang - Leadership and Admin (LeAd) and Flow Check out the podcast and register for the conference at CAEP Conference website at www.caepconference.ca

View Details

In this episode, Tiffany talks with Dr. Jazmyn Shaw, the current EMRA Medical Student Council Chair, about the unique challenges faced by medical students during the COVID pandemic. From being abruptly pulled from rotations, uncertainty over audition rotations, virtual interviews and match to the first doses of a COVID vaccine, we cover it all! As we enter year 2 of the COVID pandemic, Dr. Shaw gives us a reminder to love ourselves more and fully appreciate all we have overcome in this past year. Take a listen!

View Details

Core Questions

1. Define mild, moderate, and severe TBI (including Box 34.1).
2. Explain the concepts of cerebral autoregulation and CPP. Why is this clinically relevant?
   • Primary and secondary brain injury.
   • direct and indirect brain injury.
3. Differentiate between:
4. Describe the 4 herniation syndromes
5. List the extra-axial brain injuries
6. List the intra-axial brain injuries
7. Outline your approach to the clinical assessment of the brain injured patient (including GCS and brainstem reflexes).
8. Describe key imaging findings in the main types of traumatic brain injury.
   • Inititial resuscitation
   • ICP management and hyperosmolar therapy
   • Indications for seizure and antibiotic prophylaxis
   • Reversal of anticoagulation
   • Decompressive therapies
9. Outline your management priorities in TBI with respect to:
10. List the complications of TBI.

Wisecracks

1. What are the layers of the scalp?
2. What is the Munro-Kellie doctrine?
3. What is Cushing’s reflex?
4. List the clinical features of basal skull fracture (Box 34.2)
5. Describe 3 clinical decision rules that apply to neuroimaging in mild TBI.
6. Describe a graduated return to play protocol as per Rosen’s.

View Details

This episode covers a recent article published : "Pharmacokinetics of intramuscular tranexamic acid in bleeding trauma patients"

View Details

Core Questions

1. What are the injuries for the following blunt trauma mechanisms:
2. 1. Head-on collision
   2. Rear end collision
   3. Lateral (T-bone) collision
   4. Rollover
   5. Ejected from vehicle
   6. Windshield damage
   7. Steering wheel damage
   8. Dashboard involvement or damage
   9. Restraint or seat belt use
   10. Air bag deployment
   11. Low-speed pedestrian versus automobile
   12. High-speed pedestrian versus automobile
   13. Bicycle versus automobile
   14. Non-automobile-related
   15. Vertical impact falls
   16. Horizontal impact falls
3. Outline an approach to the primary survey for the trauma patient.
4. Describe the elements of the eFAST exam.
5. Outline an approach to the secondary survey in the trauma patient.
6. Detail relevant ancillary laboratory tests to order in the trauma patient.
   1. Canadian CT Head Rule
   2. Canadian C-Spine Rule
   3. NEXUS C-Spine Rule
   4. NEXUS Chest Rule
7. List the components of the following imaging decision-making tool
8. What are the indications for a CT abdomen/pelvis in the trauma patient?

Wisecracks

1. What are the mechanisms of injury for the following weapons:
2. 1. Knives
   2. Handgun rounds
   3. Shotgun rounds
   4. Rifle rounds
3. What is the LD50 in feet for falls from a given height?
4. What is permissive hypotension and what evidence does it have?

View Details

Purpose:

1. Learn the importance of treatment studies (RCTs) in EBM
2. Understand and interpret methods and results of treatment based studies
3. Become familiar with critically appraising treatment based studies

Hosts:

1. Dylan Collins
2. Levi Johnston
3. Dakoda Herman
4. Jayneel Limbachia
5. Jake Domm

Paper:

1. Warren, Jaimee, et al. "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial." Academic Emergency Medicine 27.9 (2020): 905-909. https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14069

EBM Checklist for therapy studies (University of Oxford:

• https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf

Episode takeaway

• RCTs are considered gold standard in terms of evidence since the randomization process controls for both known and unknown confounding variables
• Understanding how to quickly and efficiently appraise studies by assessing its methods is an important skill that can help you assess its utility to your practice and whether the authors adequately answered the question
• Use a validated critical appraisal tool. We used the CEBM tool, but there are others. The GATE from by Rod Jackson is another great method to learn. Know that sometimes people use publishing guidelines as critical appraisal tools, like the CONSORT for RCTs, but these are just work arounds.
• Be skeptical and curious. If there is a published protocol, check it. Look at who funded the study. Read the COI and method to mitigate bias.

View Details

CAEP and CanadiEM are collaborating to help promote the Virtual CAEP Conference 2021!

Did you know Canadian Association of Emergency Physicians (CAEP) is hosting a virtual CAEP Conference in 2021?

CAEP at the Forks: Rising to the Challenge
When is it? June 15-17, 2021
Where is it? It's virtual but its hosted by the organizers at University of Manitoba, Winnipeg in collaboration with educators from all over Canada.
How can I register? caepconference.ca #CAEP2021

The CAEP Conference 2021 Social Media and Promotions team consists of many members of the CanadiEM Leadership as well as some of the most well-known educators in the country. Our goal is to help CAEP promote their amazing annual conference and bring awareness to some of the highlights from the upcoming event.

Some of the promotional items coming at you:

1. Pre and In-Conference Podcasts and Videocasts - highlighting our key plenaries, speakers, and providing quick summaries of each day's events.
2. Social Media updates will come regularly, highlighting some of the best from the conference.
3. Infographic summaries and reviews of the day's events and clinical, med-ed, research concepts/pearls.
4. Newsletter updates using our various channels (CAEP Connects, CanadiEM Newsletter, etc.)
5. More to come! If you have ideas, feel free to let us know!

Introducing the CAEP Conference Social Media / Promotions Committee Members:

Dr. Daniel Ting
Dr. Kevin Junghwan Dong
Dr. Ken Milne
Dr. Hans Rosenberg
Dr. Shahbaz Sayed
Dr. Fareen Zaver
Dr. Alkarim Velji
Dr. Sonja Wakeling
Dr. Patrick Boreskie
Evan Formosa

Follow @caepconference on Twitter and stay tuned for more content!

View Details

Purpose:

1. Learn the importance of treatment studies (RCTs) in EBM
2. Understand and interpret methods and results of treatment based studies
3. Become familiar with critically appraising treatment based studies

Hosts:
Dylan Collins
Levi Johnston
Dakoda Herman
Jayneel Limbachia
Jake Domm

Paper:
Warren, Jaimee, et al. "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial." Academic Emergency Medicine 27.9 (2020): 905-909.
https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14069EBM

Checklist for therapy studies (University of Oxford:
https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf

Episode takeaway
1. RCTs are considered gold standard in terms of evidence since the randomization process controls for both known and unknown confounding variables
2. Understanding how to quickly and efficiently appraise studies by assessing its methods is an important skill that can help you assess its utility to your practice and whether the authors adequately answered the question
3. Use a validated critical appraisal tool. We used the CEBM tool, but there are others. The GATE from by Rod Jackson is another great method to learn. Know that sometimes people use publishing guidelines as critical appraisal tools, like the CONSORT for RCTs, but these are just work arounds.
4. Be skeptical and curious. If there is a published protocol, check it. Look at who funded the study. Read the COI and method to mitigate bias.

View Details

In this episode host Dr. Tiffany Proffitt talks with Dr. Mark Ramzy about finishing residency and starting his Critical Care fellowship in the hotspots of the COVID pandemic. They also discuss the unique challenges Dr. Ramzy faced when he became a father at the start of the pandemic.  Dr. Ramzy shares how he rediscovered artistic talents and reinforced old friendships and family bonds to help overcome the sense of isolation during quarantine. Take a listen, we will get through this together.

View Details

Core Questions

1. List key historical red flags in a patient presenting with back pain. (Box 32.1)
2. List red flags on physical examination of a patient with back pain. (Box 32.1)
3. List key critical differential diagnoses for a patient presenting with acute back pain (Box 32.2)
4. Describe an approach to the rapid assessment of a patient with acute lower back pain (Fig 32.1)
5. Describe an approach to ancillary testing and imaging for critical causes of acute back pain (table 32.1)
6. List the sensory, motor, and screening tests for the lumbar nerve roots L3-S1 (table 32.2)
7. Describe an overview of the management of acute low back pain (Fig 32.2)

Wisecracks

1. What are 4 variables associated with serious outcomes in patients with back pain (p. 276)
2. Differentiate between conus medullaris syndrome and cauda equina syndrome.
3. What physical exam/ancillary findings are most predictive of cauda equina? (CJEM 2020;22(5):652–654)
4. How does Rosen’s differentiate between disc herniation and radiculopathy?

View Details

Journal Club by CanadiEM is a podcast designed to help medical learners at all stages of training develop the skills necessary to properly appraise, interpret, and apply medical research to the practice of Emergency Medicine, all in the spirit of evidence based medicine. 

View Details

In this week’s episode, we are covering how to best prepare for your all-important interviews! From what questions to expect to how to leave a positive impression, we cover it all! Helping break this all down for us is a panel of resident guests from diverse programs across Canada: Dr. Larissa Hattin, Dr. Dillan Radomske, and Dr. Ben Forestell.

Dr. Larissa Hattin is a 4th-year emergency medicine resident at UBC and co-chief resident of the Victoria site. She completed medical school at McMaster and quickly moved out to the island to escape the snow. This year she is completing her fellowship in Medical Education through Oxford University.

Dr. Dillan Radomske went to medical school in Calgary at the Cumming School of Medicine and is now in his third year of emergency medicine resident at the University of Saskatchewan. He is interested in medical education, and some of our listeners may recognize his voice from the CanadiEM CrackCast series.

Dr. Ben Forestell is a graduate of McMaster medical school and he is now in his first year of emergency medicine residency, also at McMaster. He is passionate about medical education and has been lucky to be involved with projects like ClerkCast at CanadiEM.

Click Here for more information about today's episode.

View Details

This is the first episode of the KelownaKast podcast, hosted by Hasan Abdullah and Eric DeHaas, UBC Kelowna Family Medicine residents. We are residents who are interested in medical teaching, mentorship and minority issues in healthcare. We hope to share these interests with you, with a focus on tips/tools for clinical practice. In this first episode we are joined by Ashley Mikasko, a Master's of Social Work student, to share cases on challenging patient encounters due to cross-cultural communication as well as some tips to help in such situations.

View Details

Core Questions

1. Define the following terms:
2. 1. Menorrhagia
   2. Metrorrhagia
   3. Menometrorrhagia
   4. Oligomenorrhea
3. What points on history are important to elucidate in the patient with PV bleeding?
4. Outline an approach to the physical examination in the patient with PV bleeding.
5. Describe an approach to ancillary testing in the patient with PV bleeding.
6. Outline the DDx of PV bleeding in the non-pregnant patient.
7. Outline the DDx of PV bleeding in the pregnant patient.
8. Detail an approach to the management of PV bleeding in nonpregnant patients in the ED.

Wisecracks

1. What is the average volume of blood lost during typical menstruation?
2. What is the risk of spontaneous abortion in the patient who presents with vaginal bleeding in the first trimester?
3. List five risk factors for placental abruption.
4. List five risk factors for PPH.
5. List five risk factors for ectopic pregnancy.
6. List five absolute contraindications to the use of oral contraceptive pills.

View Details

This new CanadiEM series features Emergency Medicine figures from around Canada while they participate in some sort of ice-breaking activity. First up, how can Dr. Brent Thoma from the University of Saskatchewan manage increasingly spicy chicken wings while talking about his academic interests?

This podcast is the audio-only version of a video that you can watch on www.canadiem.org.

View Details

In this episode, Dr. Tiffany Proffitt talks with Dr. Andy Little about career and life transitions during the COVID pandemic. They discuss the unique challenges of moving his family across the US from Ohio to Florida in the pursuit of the career for which they had planned and sacrificed. Dr. Little shares with us how the pandemic forced him to refocus on the things that matter most and helped him discover new adventures with his family. 

View Details

Core Questions

1. Outline the anatomic contents of the female pelvis.
2. Describe an approach to the history in a patient with acute pelvic pain.
3. Describe an approach to the physical examination in the patient with acute pelvic pain.
4. List 10 differential diagnoses for the patient presenting with acute pelvic pain. (Box 30.1)
5. Outline an approach to ancillary testing for the patient presenting with acute pelvic pain.
6. What must be seen on bedside ultrasound to confirm a definitive intrauterine pregnancy (IUP)?

Wisecracks

1. What is the incidence of domestic violence in patients presenting with pelvic pain?
2. What is the incidence of heterotopic pregnancy in the general population and in those that have conceived using reproductive technology?
3. Under what circumstances can a pelvic examination be omitted in a patient presenting to the ED with acute pelvic pain?
4. What is the classic triad of pelvic inflammatory disease (PID)?

View Details

In this week’s episode, we are covering how to get to know more about programs and give you some quick pointers on how to create your personal letters! Here to help us tackle this topic is our guest: Dr. Pardhan!

Dr. Kaif Pardhan is an emergency medicine physician and Deputy Chief of the ED at Sunnybrook Health Sciences Centre in Toronto. He serves as the Assistant Program Director for the University of Toronto’s emergency medicine residency program. He also works as a pediatric emergency physician at McMaster Children’s Hospital in Hamilton.

Click Here for more information about today's episode.

View Details

In this episode of Clerkcast Lauren and Ben are teaming up with Dr. Kaif Pardhan to cover an approach to pediatric fever. 

View Details

This episode is the first of the Physician Passion Projects series, a podcast focused on highlighting Canadian EM physicians' work outside of clinical medicine. 

View Details

Core Questions

1. List risk factors for constipation .
2. List 10 causes of constipation (Box 29.1).
3. Describe an approach to the history and physical exam of the constipated patient.
4. What ancillary testing should and should not be ordered in constipation?
5. Describe an approach to management of constipation in the ED (figure 29.1) .
6. Describe 5 classes of laxative agents.
7. List the lifestyle changes that constipation patients should be counselled about.

Wisecracks

1. List 5 medications that can cause constipation.
2. What agents can be considered in refractory opioid-induced constipation?
3. Describe the mechanism of action of PEG 3350.
4. Describe the mechanism of overflow incontinence.

View Details

Core Questions

1. Define diarrhea.
2. Outline the pathophysiologic processes that result in diarrhea.
3. List 10 infectious causes of diarrhea. - Box 28.1
4. List 10 non-infectious causes of diarrhea. - Box 28.2
5. Outline 5 important aspects of a patient’s history to elucidate in cases of diarrhea.
6. Detail an approach to laboratory testing in the patient with diarrhea.
7. When are empiric antibiotics indicated for the treatment of diarrheal illnesses?

Wisecracks

1. What antibiotics are most commonly implicated with precipitating C.difficile diarrhea?
2. What factors increase the probability of non-benign diarrheal illness?
3. Outline the constituent ingredients contained within the World Health Organization’s rehydration formula.
4. What is the BRAT diet and why is it recommended in patients with acute diarrheal illnesses?

View Details

In today’s episode, we cover how to prepare for your upcoming emergency medicine elective and how best to ask for that coveted reference letter. Helping us navigate this subject is our expert guest Dr. Brent Thoma.

Dr. Thoma works clinically as a trauma and emergency medicine physician. Academically, he studies technology-enhanced medical education and works for the Royal College of Physicians and Surgeons of Canada as a Clinician Educator. He is also the CEO of CanadiEM.

Click here for resources mentioned in today's episode.

View Details

Core Questions

1. Define upper gastrointestinal versus lower gastrointestinal bleeding and differentiate between the two based on anatomic location
2. Outline an approach to the history and physical examination for the patient with complaints consistent with GIB.- Box 27.3
3. List 5 causes of UGI bleeding and 5 causes of LGI bleeding- Table 27.1
4. Outline six alternative diagnoses or mimics of GI bleeding - Box 27.1
5. List five characteristics of patients with high-risk GI bleeds - Box 27.2
6. Describe an approach to ancillary testing in the patient with GI bleeding.
7. List five substances that when ingested, can result in a falsely-positive stool guaiac study
8. Outline an approach to the management of the patient with GI bleeding - Fig 27.3
9. Detail the Blatchford and Clinical Rockall Risk Scores - Tables 27.3/27.4

Wisecracks

1. Outline the three most common causes of UGIB in pediatric and adult patients.
2. Outline the three most common causes of LGIB in pediatric and adult patients.
3. What percentage of patients presenting with hematochezia actually have an UGIB?
4. What volume of blood loss is needed to produce symptoms of anemia in the patient with an acute/subacute GI bleed?

View Details

Core Questions

1. Define the following terms:
2. 1. Nausea
   2. Retching
   3. Vomiting
3. Outline the neural pathway regulating nausea and vomiting.
4. List 6 potential sequelae of vomiting.
5. Outline an approach to the history in the patient complaining of nausea and vomiting.
6. Outline an approach to the physical exam in the nauseated and/or vomiting patient.
7. List 10 differential diagnoses for the vomiting patient.
8. What ancillary tests are indicated in the patient with nausea and/or vomiting?
9. List five antiemetics that can be used to treat the nauseous and vomiting patient.

Wisecracks

1. What are the three phases of vomiting?
2. What is Hamman’s Sign and what pathology does it point to?
3. What medication is indicated in the patient with intractable chemotherapy-induced nausea and vomiting.

View Details

In this episode of Danger Zone, our hosts examine a relatively rare procedure performed in the ED – the Surgical Airway! They discuss indications, procedural considerations, and important clinical pearls.

View Details

Core Questions

1. Explain broad causes of elevated bilirubin (obstructive, hepatocellular, and hemolysis) and the significance of direct vs. indirect hyperbilirubinemia (Fig 25.1)
2. Explain your approach to the history and physical exam in patients with jaundice (Fig 25.2)
3. List 10 causes of jaundice (Table 25.2)
4. Explain your approach to ancillary testing in patients with jaundice.

Wisecracks

1. What are the stages of hepatic encephalopathy?
2. What is the triad of acute hepatic failure?
3. What is Charcot’s triad and Reynold’s pentad?
4. What is the “1000s Club” and how do you become a member?

View Details

In this episode, Kevin Dong interviews Dr. Mohamed Hagahmed on his transition to practice and how to prepare for your board/licensing exams after you graduate from residency. Dr. Mohamed Hagahmed is an Assistant Clinical Professor in the Department of Emergency Medicine at UT Health San Antonio.

View Details

Core Questions

1. What are risk factors for serious underlying causes of abdominal pain? (Box 24.1)
2. Explain key symptoms and signs to look for in the evaluation of the patient with abdominal pain.
3. What diagnoses are associated with different patterns of abdominal pain? (Fig 24.1)
4. List 5 critical and 5 emergent causes of abdominal pain (Table 24.1, 24.2)
5. Explain an approach to ancillary testing in abdominal pain.
6. Outline a diagnostic algorithm for patients with abdominal pain (Fig 24.4)
7. Outline an empiric management algorithm for abdominal pain. (Fig 24.5)

Wisecracks

1. What are the structures included in the foregut, midgut, and hindgut? More importantly, why do you care?
2. List indications for bedside US in the ED patient with abdominal pain (Table 24.3)
3. Explain how referred pain works in the setting of abdominal pain (Fig 24.2)

View Details

In this episode of First Year Diaries, I am joined by Dr. Daniel Ting and Dr. Jared Baylis. Dr. Daniel Ting is a first-year staff at UBC, who is currently working from the Vancouver General Hospital and BC Children’s Hospital. Dr. Jared Baylis is also a first-year staff, working at the Kelowna General Hospital. I asked them what it is like to transition from residency to working as staff physicians. Later, we discussed the challenges they face as staff physicians and how residency prepared them for life as Emergency Physicians.

View Details

Core Questions

1. Describe an approach to key history and physical exam for chest pain patients presenting to the ED. (Table 23.2 and 23.3)
2. List 5 critical diagnoses, 5 emergent, and 5 nonemergent diagnoses to consider in the patient presenting with chest pain. (Table 23.1)
3. Describe an approach to the critically ill patient with undifferentiated chest pain. (Figure 23.1)
4. Describe an approach to ancillary testing in chest pain. (Table 23.4 and 23.5)
5. List the risk factors associated with each critical chest pain diagnosis (Box 23.1)
6. Explain the approach to risk stratification of ED chest pain patients.

Wisecracks

1. What are the X-ray findings of aortic dissection?
2. What are your HR and BP targets in Aortic dissection?
3. List the components of the HEART score.

View Details

Today we are sitting down with Dr Alim Pardhan. Dr Pardhan is the FRCP EM program director at McMaster University, Hamilton General Hospital ED side lead, and a passionate medical educator.

Your key takeaways from this episode are:

1. Understanding the mechanisms behind fever and hyperthermia
2. The causes of hyperthermia - think drugs, CNS infections, thyroid storm, and environmental exposure
3. Five big, bad, and deadly causes of fever in our patients in the ED - necrotizing fasciitis! Endocarditis! Meningitis! Ascending cholangitis! Sepsis!
4. Identification and management of the patient with sepsis

View Details

Core Questions

1. Define the following terms:
   1. Dyspnea
   2. Tachypnea
   3. Hyperpnea
   4. Hyperventilation
   5. Dyspnea on exertion
   6. Orthopnea
   7. Paroxysmal Nocturnal Dyspnea
2. What anatomical structures are responsible for controlling respiratory effort?
3. Outline an approach to the history for the dyspneic patient.
4. Detail the physical examination for the dyspneic patient and highlight pivotal exam findings that point to specific pathologies.
5. Outline the differential diagnosis for the patient presenting with dyspnea and highlight 5 critical, 5 emergent, and 5 non-emergent causes of shortness of breath.
6. What ancillary tests are indicated for the dyspneic patient?
7. Detail the utility of point-of-care ultrasound in the assessment of the dyspneic patient.
8. Outline a management algorithm for the acutely dyspneic patient.

Wisecracks

1. List three findings on chest radiograph suggestive of pulmonary embolism.
2. What is the utility of venous blood gas testing and how do its values correlate with that of an arterial blood gas?

View Details

Core Questions:

1. Define “massive hemoptysis”.
2. Which vessels, when injured, are typically associated with small and massive hemoptysis, and how do the vessel characteristics influence the degree of bleeding?
3. Outline an approach to the history and physical examination for a patient presenting with hemoptysis.
4. Outline the differential diagnosis for hemoptysis and highlight five critical and five emergent diagnoses that cause hemoptysis. (Box 21.1 and 21.2)
5. What ancillary tests are warranted in the patient with hemoptysis?
6. Detail the utility of imaging studies in patients with hemoptysis.
7. Detail the diagnostic approach to the patient with hemoptysis. (Figure 21.1)
8. Outline an approach to managing the patient with hemoptysis. (Figure 21.2)
9. What two maneuvers can be used to address massive hemoptysis from a suspected tracheo-innominate fistula (TIF)?
10. What strategies can be used to improve oxygenation in the patient with massive hemoptysis?

Wisecracks:

1. List one gynecologic cause of hemoptysis.
2. List five causes of massive hemoptysis.
3. What is the most lethal consequence of massive hemoptysis?

View Details

We are finally back with episode 3 of ClerkCast!

Today we will be talking about ABDOMINAL PAIN with McMaster FRCP EM resident Dr Rakesh Gupta

Key takeaways from this episode include:

1. Thinking outside the GI tract for patients with abdominal pain

2. The importance of a good physical exam

3. What type of imaging is best for your patient? Hint: it depends!

4. How to consult your inpatient colleagues! P-I-Q-U-E-D

Thanks for the listen!

View Details

Core Questions:

1. What are the three anatomically-distinct zones of the pharynx, and what structures outline their borders?
   1. Ultrasound of the Neck
   2. Lateral neck radiograph
   3. Nasopharyngoscopy
   4. CT Soft Tissues Neck
2. Describe the utility of the following imaging modalities in the patient with sore throat.
3. Outline five viral, five bacterial, and five other potential aetiologies of sore throat in the ED patient? (Table 20.1)
4. Outline the components of the Modified Centor Score and describe its application.
5. Describe the diagnostic algorithm for the patient with sore throat. (Figure 20.4)
6. Outline the approach to managing a patient with sore throat in the ED. (Figure 20.4)
7. What antibiotics can be used in the patient with suspected or confirmed streptococcal pharyngitis? (Box 20.2)

Wisecracks:

1. In what age groups is streptococcal pharyngitis rarely seen?
2. What is Waldeyer’s Tonsillar Ring?
3. What is the “thumb sign” and what pathology does it point to?

View Details

Core Questions:

1. Detail the pertinent points to review when taking the history of a patient presenting with a red and painful eye - Box 19.2
2. Outline an approach to the ocular physical examination - Box 19.3
3. Outline the components of the slit lamp examination - Box 19.4
4. What signs and symptoms, if present, likely indicate the presence of serious ocular pathologies - Box 19.1
5. What is a relative afferent pupillary defect and what conditions cause it?
6. List ten causes of increase intraocular pressure
7. List five causes for an absent red reflex - Box 19.5
8. Name three critical, emergent, urgent, and non-urgent causes of the red and painful eye? - Figure 19.8

Wisecracks:

1. What are the fundoscopic findings of a central retinal artery occlusion.
2. What is the pinhole test and what visual disturbances does it correct?
3. What are the three most common causes of an irregularly shaped pupil
4. What is Seidel’s Test and what condition does it identify?

View Details

Core Questions:

1. What is diplopia and how is it classified?
2. What four questions help clinicians delineate the potential cause of a patient’s diplopia?
3. What are the cardinal directions of gaze and how are they tested?
4. Outline the physical exam for the patient with monocular and binocular diplopia.
5. Outline the DDx for monocular diplopia?
6. Outline the DDx for binocular diplopia? [Table 18.1]
7. Detail the different oculomotor palsies. [Figure 18.3]
8. Detail the various lacunar stroke syndromes. [Box 18.1]
9. Define internuclear ophthalmoplegia.
10. What ancillary tests are required for the patient presenting with diplopia? [Figure 18.4]

Wisecracks:

1. What are the most common oculomotor palsies and what causes them?
2. What is orbital apex syndrome?
3. What is the “rule of the pupil” and how reliable is it?
4. Detail the physical exam maneuvers used to identify patients with myasthenia gravis.

View Details

Ruminations from two residents about handling and thriving in call shifts for medical students.

View Details

Welcome to ClerkCast! A podcast for medical students by medical students, focusing on cognitive approaches to common EM presentations.

This episode covers how to approach patients with chest pain in the Emergency Department as a medical student with our guest co-host Dr. Shawn Mondoux, staff EM doc at St Joseph's Hospital in Hamilton, and a Quality Improvement guru

We cover:

1. The SIX CAN'T MISS chest pain diagnoses

2. Acute coronary syndrome and the Terrible Triad

3. Aortic dissection history pearls

4. Investigations in patients with chest pain

Enjoy!

View Details

Core Questions:

1. List three primary headache disorders
2. Describe the pathophysiology of migraines and name three Emergency Department treatments for same
3. List five critical and five emergent causes of headache (Table 17.1)
4. Outline your approach to the history for the patient presenting with headache ( Box 17.1)
5. Outline your approach to the physical exam for the patient presenting with headache (Table 17.3)
6. Describe your diagnostic approach to the patient with a suspected SAH
7. Detail the findings on LP that would suggest your patient has bacterial meningitis

Wisecracks:

1. What percentage of patients presenting with headache to the ED have a SAH?
2. Outline the SNOOP MEETS Pregnancy mnemonic
3. Which diagnostic test is best to establish the diagnosis of cerebral venous sinus thrombosis?
4. Detail how to elicit Kernig’s and Brudzinski’s Sign

View Details

An intro to the latest CanadiEM podcast, ClerkCast!

Hosted by two McMaster medical students, Lauren Beals and Ben Forestell, ClerkCast is your one stop shop for approaches to common EM presentations... enjoy!

View Details

Welcome to ClerkCast! A podcast for medical students by medical students, focusing on cognitive approaches to common EM presentations.

This episode covers how to succeed in the Emergency Department as a medical student with our guest co-host Dr. Teresa Chan, staff EM doc at Hamilton Health Sciences, CanadiEM co-founder, and medical educator extraordinaire

We cover:

1. How to structure your differential diagnosis in the ED

2. Eye-balling a patient - edits have been made clarifying the ABCs

3. How to prioritize management in the ED using the RAPID mnemonic

4. How to present a case in the ED

5. Feedback at the end of a shift

Enjoy!

View Details

On this episode of First Year Diaries, I am joined by Dr. Mike Kirlew, a rural family and emergency medicine physician from Sioux Lookout in Northern Ontario. I asked him about how he ended up working in a rural area, and what it is like working with scarce medical resources. Later, we discussed how a resident physician can prepare themselves for working in a rural community, and how best to transition to living in a rural area.

View Details

Core Questions:

1. What is dizziness and what pathologies can cause it?
2. Define vertigo and acute vestibular syndrome
3. What three systems are involved in the maintenance of equilibrium and how many of these systems must be affected to cause vertigo?
4. Trace the neuronal impulse from the vestibular apparatus to the muscle endplate
5. Define nystagmus
6. List five peripheral causes of vertigo (see Table 16.2)
7. List five central causes of vertigo (see Table 16.2)
8. Differentiate between central and peripheral vertigo based on history and clinical exam findings
9. Describe the Dix Hallpike Test
10. Outline your approach to the HINTS exam
11. What is the Epley maneuver and what pathology does it treat?
12. Describe the Barbecue Roll Test and what pathology does it treat?
13. Outline your approach to managing the vertiginous patient

Wisecracks:

1. What diagnoses cause both vertigo and hearing loss?
2. What features of nystagmus suggest a central pathology?
3. What is truncal ataxia and what typically causes it?

View Details

Core Questions:

1. Define seizure and provide an explanation of the classification systems for seizure
2. Define recruitment as it relates to seizure development and progression
3. Differentiate between seizure and syncope
4. Differentiate between neurogenic and psychogenic seizures
5. List 5 diagnoses that can mimic seizures (see Box 15.2)
6. Define status epilepticus and differentiate between convulsive and non-convulsive status epilepticus
7. List 10 causes of status epilepticus in adults (see Box 15.1 and 15.3)
8. Outline management of status epilepticus.
9. List indications for head CT for first seizure.

Wisecracks:

1. List 5 properties of ictal events
   1. Isoniazid Toxicity
   2. TCA Toxicity
   3. Eclampsia
   4. Hypoglycemia
   5. Hyponatremia
2. What medications are needed to treat seizing patients with the following:
3. Name 3 key metabolic abnormalities that can cause seizures
4. Name 3 common seizure provokers that can worsen pre-existing seizure disorders
5. What percentage of patients with convulsive status epilepticus will develop non-convulsive status epilepticus?

View Details

The same 65-year-old man who was seen earlier with an ICH has now recovered. His past medical history is remarkable for hypertension, dyslipidemia, a mechanical aortic valve replacement, diabetes, and sleep apnea. His list of medications include ramipril, atorvastatin, aspirin, metformin, and warfarin. Should his anti-coagulation be resumed? If so, how long should the clinician wait prior to re-starting his medications? Objective 1: Summarize the most recent guidelines regarding when to re-start anti-coagulation after ICH (ASA, DVT-P, Xa inhibitors, warfarin) Objective 2: What factors need to be taken into consideration when making this decision? Objective 3: Interpret the evidence behind the guidelines Objective 4: Describe instances where one would consider re-starting anti-coagulation earlier/later Objective 5: Develop an approach to re-starting anti-coagulation after ICH including which agent to use and why Objective 6: How would you approach this scenario? Objective 7: What do guidelines suggest? Objective 8: Would scenario change depending on type of valve? What if the indication was AF, not mechanical valve? Objective 9: Does the type of bleeding matter? (lobar versus deep ICH)

View Details

Core Questions:

1. Define confusion.
2. What is your differential diagnosis for the confused patient?
3. Differentiate between organic and functional causes of confusion.
4. What is the Quick Confusion Scale (QCS) and how is it calculated?
5. What is the Brief Confusion Assessment Method (bCAM) and how is it used?
6. What is the Mini-Mental State Examination (MMSE) and how is it scored?
7. What ancillary tests are used when working up the confused patient?
8. What is the role of thiamine in the treatment of the acutely confused patient?

Wisecracks:

1. What simple tests can you use to assess concentration at the bedside?
2. What treatments should be used for the patient with acute hypoglycemia causing confusion?
3. List 5 emergent and 5 critical diagnoses that cause confusion.

View Details

Today on First Year Diaries I am joined by Dr. David Carr, a University Health Network emergency physician, renowned medical education speaker, and Toronto Blue Jays physician. In this episode, I asked him to impart his wisdom to new staff physicians like myself and share his approaches to a successful career in medicine. Later in the interview, we also discuss workflow strategies for the ED, common mistakes made by new physicians, and tips on how to maintain wellness/avoid burnout.

Questions:

1. 01:57 – 03:05 - Can you please introduce yourself? (name, training, where you work, interests, etc.).

2. 03:05 – 04:45 – Tell me about your philosophy, and what your career trajectory has been?

3. 04:55 – 08:07 – How can new physicians get to become an educator like you?

4. 08:07 – 12:43 – Do you have any tips for new physicians looking to reach their goals, and become a well-respected physician like yourself?

5. 12:43 – 27:56 – Can you tell us about how you manage department flow efficiently and safely, especially during busy times?

6. 20:41 – 23:56 – Tips to effectively manage flow

7. 23:56 – 27:56 – Tips to effectively manage learners

8. 27:56 – 32:45 – What are some mistakes that you’ve seen new physicians make? (Either clinical or non-clinical).

9. 32:45 – 36:38 – What can new staff do to keep their wellness intact and avoid burnout? What are some strategies you use?

10. 36:36 – 38:28 – Do you have any final comments you would like to share?

View Details

Core Questions:

1. Define coma and differentiate coma from lethargy and stupor.

2. Name five neuroanatomic structures involved in maintaining arousal.

3. List five critical and five emergent causes of depressed consciousness. (see Table 13.1)

4. Describe your approach to the history and physical examination for the patient with depressed consciousness.

5. Outline your exam to accurately assess the Glasgow Coma Scale (GCS). (see Table 13.2)

6. What is the FOUR score, and how is it calculated? (see Table 13.3)

7. What ancillary tests should be ordered in the patient with depressed consciousness?

8. Outline your plan of management for the patient with depressed consciousness. (see Figure 13.2)

Wisecracks:

1. What is the best noxious stimulus to apply to evaluate GCS?

2. What are the oculocephalic and oculovestibular reflexes, and what information do they provide?

3. Describe decorticate and decerebrate posturing.

4. What is the utility of serum ammonia testing?

View Details

Core Questions:

1. List 10 life-threatening causes of syncope
2. List 10 medications that can precipitate syncope
3. What are the red flags on history and physical exam in syncope?
4. What are markers of increased short-term risk in syncope patients? (box)
5. What are 5 ECG findings to look for in the syncopal patient?
6. List five indications for admission and inpatient evaluation for the patient with syncope?

Wisecracks:

1. What is the significance of a patient presenting with syncope vs. near syncope?
2. What is the utility of orthostatic vital signs?
3. What degree of cerebral hypoperfusion is needed to cause unconsciousness?

View Details

Core Questions:

1. Define cyanosis and explain what causes it?
2. What is central cyanosis and what typically causes it?
3. What is peripheral cyanosis and what typically causes it?
4. At what concentration of deoxyhemoglobin does cyanosis present?
5. List 10 differential diagnoses for cyanosis - Box 11.2?
6. Describe your initial workup for the patient with cyanosis.- Figure 11.3/11.4
7. What is the oxyhemoglobin dissociation curve and what information can be taken from it? - Figure 11.1
8. Name four factors that shift the oxyhemoglobin dissociation curve to the left and three factors that shift it to the right.
9. Differentiate between ferrous and ferric hemoglobin and describe how these forms of hemoglobin affect oxygen binding.
10. What is methemoglobinemia and how does it present?
11. What are the two biochemical pathways that are used to reduce methemoglobin?
12. List 10 causes of methemoglobinemia - See Box 11.1
13. What is sulfhemoglobinemia and when should you suspect it?
14. Differentiate between primary, secondary, and relative polycythemia and how does it cause cyanosis?

Wisecracks:

1. What is the colour of the blood in a patient with methemoglobinemia?
2. What is clubbing and what causes it?
3. What SpO2 is present on the monitor in the patient with a methemoglobinemia?
4. What is the hyperoxia test and how does it help you in your workup of the cyanotic patient?
5. What is the dose of methylene blue when prescribed to treat patients with methemoglobinemia?

View Details

From CAEP 2019

I always love the activities and experiences at CAEP, but year after year I’m drawn to the Simulation Olympiad. Every time I think it’s just incredible. This year, I decided to talk with some of the people who make the SIMOlympiad such a great experience for audiences and participants alike. In my first interview, I heard about what the average SIM team looks like, how the competition runs, and what the scope of the material covers. We also got the details on what the characteristics of a winning team look like and how SIM hopefuls can start the team that will win it all at CAEP 2020.

Here is my interview with Dr. Tamara McColl of the University of Manitoba and judge for the CAEP 2019 SIMOlympiad.

(If you like to follow along, the show questions are below)

1. Tell us about yourself, what you do, where you work, and what your involvement is in the CAEP Simulation Olympiad.

2. What is the Simulation Olympiad at CAEP for our listeners who have not attended the session or have never been to CAEP? What is the structure and what you do?

3. What kind of cases are simulated? Can you tell us an example of a good case and how the teams went through it?

4. Tell us what you look for when you see a good SIM team (both medical management and crisis resource management or CRM)?

5. How can residents and interdisciplinary teams get ready for SIM? What should they prepare to become successful at the Olympiad and at SIM in general?

6. If future teams/residents want to get involved, how do they make this happen?

7. Any last comments?

Contact Dr. Kevin Dong: junghwan.dong@medportal.ca Dr. Tamara McColl: tamaramccoll@gmail.com

View Details

View Details

Core Questions:

1. What structures are affected by UMJ, LMJ, and NMJ lesions, and what are causes of weakness associated with each?

2. What are common signs of UMN, LMN, and NMJ dysfunction?

3. What are (7) pathophysiologic causes of non-neurologic weakness (Box 10.1)?

4. What is the DDx of neuromuscular weakness? (Table 10.1)

5. Describe an approach to general weakness in the ED.

Wisecracks:

1. Differentiate between “plegia” and “paresis”.

2. List (5) DDx‘s for non-neurologic weakness (based on pathophysiologic processes).

3. List (5) non-emergent causes of peripheral neuropathy (Box 10.2)

4. Explain how you recognize an ED patient that may be approaching the end of life.

View Details

Today’s episode is to aid new physicians to traverse through the first few months of their independent practice safely and effectively. As a new physician myself, I had the luxury of having many mentors and colleagues who were gracious enough to help me find my way in providing safe patient care. Additionally, they assisted me on integral aspects that we don’t necessary learn or get exposed to as a resident, such as billing, department flow, and the politics of the ED. However, as a new staff, there are so many uncertainties that you must face alone, and I wanted to find a guide to help me transition more effectively. After not finding something that fit the bill of what I truly wanted, I decided to tackle the issue myself and find colleagues who would help me out with the task of navigating through the First Year of Practice.

Questions:

1. Can you please introduce yourself? (name, training, where you work {academic, community, etc}, any other work you are doing {tox, primary care, etc.}).
2. How is it being a new ED staff physician 6 months into practice?
3. What has been the biggest difference been so far being a staff vs. a resident?
4. Can you share an interesting story as a staff? (can be anything – having residents, billing experience, research you are working on etc.)
5. What is the best thing about being a staff physician?
6. What are some struggles/challenges of being a new staff physician?
7. Do you have any billing tips for new physicians? What kind of tips do you have for management of your financial assets? (investments, taxes, accountants, etc.)
8. Any tips on work-life balance? (wellness, coping with struggles, travel, etc.)

Take Home Points:

1. Ask questions to fellow colleagues about difficult cases, department flow, and billing. You will need help with the transition to practice so ask the people who have done it before you.
2. Don’t commit to too many things initially. Remember, it’s a marathon not a sprint. Plan ahead and make sure to find a good balance between work and life.
3. Find time to learn about billing during your residency. Make sure to have a good feel for it so that once you are staff, you don’t leave money on the table (you deserve it!).
4. Live like a “resident” and plan for the future. Planning for retirement and finding a good financial advisor and an accountant is pivotal for your future.
5. Be humble and continue to learn. You will not know everything at the end of your training. Keep reading around cases and develop yourself to become better every day.

View Details

Core Questions:

1. What structure controls body temperature and how does it go about controlling it?
2. What are pyrogens and how are they classified?
3. What is the difference between fever and hyperthermia?
4. What is the role of PGE2 in fever and what medications can you give to combat its effects?
5. List four factors that blunt the febrile response.
6. What are the benefits and pitfalls of the febrile response?
7. List five infectious and five non-infectious causes of fever. (see Box/Table 9.1)
8. Describe your approach to the febrile patient. (see Figure 9.1/9.2)

Wisecracks:

1. What is the most accurate temperature measurement site?
2. How are heart rate and body temperature related?
3. How are respiratory rate and body temperature related?
4. How high must a fever be to necessitate rapid cooling interventions?

View Details

Core Questions:

1. Describe your history and physical exam in the patient being actively resuscitated.
2. Discuss the process of deterioration to cardiac arrest with respiratory failure and cardiac obstruction.
3. List 6 aspects of optimal CPR.
4. What medications have been shown to improve outcomes in cardiac arrest?
5. List 8 differential diagnoses for PEA arrest (See Table 8.4)
6. What is electromechanical dissociation (EMD) and how does it differ from pseudo electromechanical dissociation (pseudo EMD)?
7. What is echo-guided life support (EGLS) and how is it used?
   1. Carotid or femoral pulse
   2. CPP
   3. Arterial relaxation (diastolic) pressure
   4. PETCO2
   5. SCVO2
8. What are your targets during CPR for the following metrics? (See Table 8.3)

Wisecracks:

1. What is cough CPR and when should it be used?
2. What is the only antidysrhythmic shown to improve rates of VF conversion to a perfusing rhythm?
3. What is the minimum coronary perfusion pressure (CPP) is needed to achieve return of spontaneous circulation (ROSC)?
4. What is the triad of cardiac arrest?

View Details

Core Questions:

1. What is cerebral autoregulation?
2. Describe your parameters for post-arrest care of a brain injured patient.
3. List 7 interventions for management of a patient with elevated ICP.
4. What are the equations for cerebral blood flow and cerebral perfusion pressure?
5. Describe a protocol for induced hypothermia after cardiac arrest.
6. In the patient with a traumatic brain injury, what is the optimal drug for and duration of seizure prophylaxis?

Wisecracks:

1. What are Lundberg A waves?
2. What is the relationship between PaCO2 and CBF?
3. What is the Monro-Kellie hypothesis?
   1. How do these values change in patients with severe coma?
4. What is the probability that a survivor of cardiac arrest has a full neurologic recovery?

View Details

This episode covers Chapter 6 in Rosen's 9th edition, shock. 

View Details

Are you a Family Medicine resident about to graduate and embark on an extra year of training in Emergency Medicine (EM)?

Are you worried you don’t know what it is really like to be an Emergency Medicine resident and you want to find a guide to help maximize your learning in a short and extremely fast year?

As a recent CCFP-EM graduate, I can strongly relate to your fears. The one year of extra training is an important one, and you will learn a plethora of information that will be pertinent to your success as a future Emergency physician. Thus, it is paramount that you maximize and optimize this year. In this blog post, I hope to act as a guide and provide insight into how to get the most out of your training.

For those individuals who do not know what the CCFP-EM program is, it is an Emergency Medicine residency fellowship (or added competency program) stemming from the tree of Family Medicine in Canada. Residents completing this program will have the ability to complete the Emergency Medicine Licensing Exam (administered by the Canadian College of Family Physicians) and practice EM across the country. It is a highly competitive program and as a one year program, the training is rigorous and substantive. Residents are expected to achieve a large volume of objectives, and experience various teaching requirements in different specialties to achieve competency for independent practice.

See the companion blog post: https://canadiem.org/steps-to-success-in-enhanced-training-in-emergency-medicine-ccfp-em-year

View Details

This updated episode of CRACKCast covers Rosen’s Chapter 005, Monitoring the Emergency Patient (9th Ed.).

Core Questions:

1. List modalities for measurement of BP and note which modalities are likely to over and underestimate blood pressure.
2. What is pulse pressure and how does it relate to stroke volume?
3. List 4 indications for an arterial line.
4. What is the Beer-Lambert Law and how does it allow us to measure pulse oximetry?
5. How do dyshemoglobinemias affect your measured SpO2?
6. What are the 4 phases of the ETCO2 waveform?
7. List 5 uses for ETCO2.

Wisecracks:

1. List the pitfalls of pulse oximetry.
   1. Purple
   2. Yellow
   3. Tan
2. Describe colorimetric ETCO2 monitoring and cite the ranges at which you would expect to see the following colours:
3. How are ETCO2 values related to PaCO2?
4. What are causes of elevated ETCO2?
5. What does MOVIE stand for (aka - how to rock your oral exam resus questions)?

View Details

This updated episode of CRACKCast cover’s Rosen’s Chapter 004, Procedural Sedation and Analgesia (9th Ed.).

View Details

This episode of CRACKCast covers Chapter 3 in Rosen’s Emergency Medicine (9th Ed.) – Pain Management. This podcast will give you a solid approach to the basics pain management to use on your next shift!

Core Questions:

1. Define the following terms (Box 3.1):

2. Allodynia

3. Amnesia/amnestic
4. Local anesthesia
5. Analgesia
6. Hypnotic
7. Narcotic
8. Nociceptor
9. Noxious stimulus
10. Opiate
11. Opioid
12. Pain
13. Procedural Sedation

14. Sedative

15. Describe a practical approach to stepwise management of pain in the ED.

16. Describe the adult parenteral and oral doses for:

17. Morphine

18. Hydromorphone

19. Fentanyl

20. Differentiate between opioid side effects and opioid toxicity.

21. How do you manage opioid toxicity?

22. Describe relative safety profiles for the NSAIDS.

23. List the classes of local anesthetics. How do they work?

24. List the toxic doses for each local anesthetic:

25. Lidocaine

26. Lidocaine with Epi

27. Bupivicaine

28. List 5 techniques to reduce pain of injection of local anesthetic.

29. List agents that can be used for topical anesthesia of:

30. Intact skin

31. Mucous membranes
32. Open skin/lacerations

Wisecracks:

1. What agent can be used as a substitute in cases of anaphylaxis to local anesthetic?

2. Why should you avoid use of the following agents:

3. Tramadol

4. Demerol

5. How does local anesthetic toxicity present?

View Details

The first episode of the Thrombophonia podcast addresses three objectives:

1. Summarize an approach to the acute management of patients with intracerebral hemorrhage while on anticoagulation for a mechanical heart valve 2. Describe the benefits and risks of anticoagulant reversal, including the risk of thromboembolism 3. Describe the principles of effective communication and collaboration of bleeding & clotting cases with consultants

View Details

This episode of CRACKCast covers Chapter 2 in Rosen’s Emergency Medicine (9th Ed.) – Mechanical Ventilation and Noninvasive Ventilatory Support. 

View Details

This Episode of CRACKCast covers Rosen's Chapter 1 - Airway. We are updating the first several episodes with 9th edition content. Enjoy!

There's a reason that the first chapter of Rosen's is devoted to airway. These are some of the most critical skills we need to know as emergency clinicians. This episode provides an overview of core airway knowledge and skills.

View Details

This episode of CRACKCast covers Chapter 193 in Rosen's Emergency Medicine (9th Ed.) – Weapons of Mass Destruction. Although attacks involving WMD's are relatively uncommon, being thoroughly prepared for these events will prove invaluable for the community affected. Sit tight and listen in to make sure you are ready if the unthinkable should happen.

Core Questions:

1) List 6 potential agents that may be used as weapons of mass destruction.

2) List 6 features of weapons of mass destruction threats that make them unique.

3) Describe 6 signs suggesting biologic weapon deployment.

4) What are recommendations for prevention of in-hospital transmission of contagious agents?

5) Describe the 2 typical presentations of Anthrax. What are typical CXR findings? How is each type of anthrax treated?

6) How is the plague transmitted? What are the 2 typical presentations of the plague? How is each treated?

Wisecracks:

1) Why are children at higher risk of death from Weapons of Mass Destruction (WMD)?

2) What are components of ED preparedness for chemical weapons of mass destruction?

3) Describe a basis ER protocol for handling radiation exposure / casualties (review).

4) Differentiate between chickenpox and smallpox.

5) How are nerve agents treated (3 drugs)?

6) Describe the clinical effects of mustard gas. How is this treated?

View Details

Core questions

• Define a disaster

• Describe PICE nomenclature

• List 6 potentially paralytic PICE

• List 6 critical substrates for hospital operations

• Describe START triage and SAVE

• List the 5 functional elements of an incident command system

• Describe the 4 stages comprehensive emergency management

• Describe the 5 elements of a hospital disaster response plan

• List the 8 basic components of a hospital comprehensive disaster response planning process

Wisecracks:

• Describe the SALT triage approach

• Describe TTDAD SAD approach (see EM Cases Episode 100 on disaster medicine)

• What is “surge capacity”?

View Details

Core Questions

• List 6 criteria for air medical transport.

  • When should/could helicopter EMS transport be beneficial?

• List advantages and disadvantages of rotor-wing aircraft and fixed-wing aircraft, relating to each other and land-transfer.

• What are 6 principles of landing zone safety?

Wisecracks:

• What are the most common in-flight emergencies on commercial flights?

• What are some practical implications of providing in-flight emergency care?

View Details

This episode of CRACKCast covers Chapter 190 of Rosen's Emergency Medicine(9th Ed.). After listening to this podcast, you will have a more comprehensive understanding of the intricacies of pre-hospital care and be better able to address issues in your community's out-of-hospital healthcare network.

View Details

This episode of CRACKCast covers Chapter 189 in Rosen's Emergency Medicine (9th Ed.) – The Combative and Difficult Patient. Next time a severely agitated patient rolls into the department, you won't even break a sweat!

View Details

This episode of CRACKCast covers Rosen’s Chapter 140 (9th Edition), Substance Abuse. This chapter gives a brief overview regarding the burden of substance abuse from adolescent to elderly patients. An important consideration in the emergency department is self-awareness and advocacy for these patients that often are challenging to interact with and can provoke countertransference.

View Details

This episode of CRACKCast covers Rosen’s Chapter 142 (9th Edition), Alcohol Related Disease. This chapter covers the spectrum of alcohol use, including effects of mild, moderate, and severe use disorders, including prevention, screening, diagnosis and management. We also examine the wide variety of complications associated with acute and chronic alcohol use.

View Details

This episode of CRACKCast covers Rosen's chapter 188, The Solid Organ Transplant Donor. Although short in duration, this chapter has straightforward and useful information for emergency physicians in regards to complications possible with transplant donors.

View Details

This episode of CRACKCast covers Rosen’s Chapter 187, The Immunocompromised Patient. This chapter covers the unique population of immunocompromised patients, including management of febrile neutropenia, as well as common infections seen in these patients and how to treat them.

View Details

Core Questions

1. List 4 factors altering pharmacokinetics in the elderly (ADME)
2. List 6 factors contributing to adverse events from medications in the elderly
   1. Beers List
3. Which 8 meds are most responsible for adverse events in the elderly?
4. List 5 harmful drug interactions in the elderly
5. What are top 10 STOPP criteria?

View Details

This episode of CRACKCast covers Rosen's chapter 183, approach to the geriatric patient. Our geriatric patients can often mask serious diagnoses with vague presentations and multiple co-morbidities.

View Details

This episode of CRACKCast covers Rosen’s Chapter 181, Labor and Delivery. This chapter covers the high risk realm of ED deliveries, including potential complications such as PROM, malpresentation and umbilical cord emergencies.

View Details

This episode of CRACKCast covers Rosen’s Chapter 179, Drug Therapy in Pregnancy. There is a lot of fear and anxiety often present within pharmacologic therapy in pregnancy, but having informed, shared decision making with patients can lead to safer outcomes and adherence when treating.

View Details

This episode of CRACKCast covers Rosen’s Chapter 178, Co-Morbid Medical Emergencies during Pregnancy. This chapter covers many complicated issues that arise during the care of pregnant patients already suffering from concomitant medical illness, and how to manage these conditions balancing risks to both mother and fetus.

View Details

This episode of CRACKCast covers Rosen’s Chapter 177, Acute Complications of Pregnancy. This chapter covers many acute issues that arise during the unique physiologic state that is pregnancy, from first trimester bleeding to diagnostic challenges and management of other conditions during pregnancy.

View Details

Core questions

1. What are the indications for orthopedic surgery for clavicle fracture?
2. List 5 Xray features of supracondylar fracture
3. Describe the Gartland Classification for Extension-type supracondylar fractures
4. List specific complications of a supracondylar fracture.
5. Describe the sequence of ossification around the elbow.
6. What is Baumann’s Angle? (shownotes)
   1. Monteggia fracture-dislocation
   2. Toddler’s fracture
   3. Nursemaid’s elbow.
7. Describe the radiographic findings and management of:
8. Describe the Ortolani and Barlow maneuvers. (shownotes)
9. List 3 physical exam findings consistent with DDH.
10. List 10 causes of hip pain in children
11. Provide a differential diagnosis of limp in the toddler, school-aged child and adolescent.
12. How would you differentiate between transient synovitis and septic arthritis in a child with hip pain?
13. What is the most common location for septic arthritis in a child?
14. What is the prognosis for transient synovitis?
15. What is the most common cause of septic arthritis?
    1. Age < 2 months
    2. 2 months – 5 yrs
    3. 5 yrs – 12 yrs

    4. 12 yrs

    5. Prosthetic joint
    6. Sickle cell disease
    7. Immunocompromised
16. What are the important pathogens of septic arthritis in the following groups:
17. Describe three mechanisms for the development of septic arthritis in children.
18. Regarding synovial fluid analysis, which tests should be ordered. How are the results interpreted?
19. Describe the management of a child with septic arthritis? What the indications for operative debridement?
20. What are the potential complications of septic arthritis?
21. Describe the pathophysiology of Legg-Perthes disease; how does slipped capital femoral epiphysis (SCFE) occur?
22. Describe the common clinical presentation of SCFE + LCPD
23. Describe 2 radiographic findings consistent with SCFE + LCPD
24. How is SCFE classified? How is this classification used to determine management? (shownotes)
25. What is the risk of bilateral SCFE? (shownotes)
26. What are the potential complications of SCFE? (shownotes)
27. What is a juvenile Tilleaux fracture? How does it occur?
28. What is a triplanar fracture?
29. List seven red flags for pediatric back pain.
30. What is spondylolysis? What is spondylolisthesis? How is it managed?
31. List 4 common apophyseal injuries in children.

Wisecracks:

1. List 6 specific xray findings / fractures consistent with non-accidental injury (shownotes)
2. What is a corner / bucket handle fracture?
3. What are the investigations in a complete skeletal survey (shownotes)
4. List 4 conditions with similar presentation to child abuse (shownotes)
5. List causes of pathologic fractures in children.
6. What is the utility of blood culture, ESR and CRP in a child with suspected septic arthritis of the hip?
7. What the mechanism of a lateral elbow condyle fracture and how are they managed? (shownotes)
8. What is the mechanism of a medial elbow condyle fracture and how are they managed? (shownotes)

What is the most common pediatric fracture?

View Details

This episode of CRACKCast covers Chapter 174 in Rosen's 9th Edition. Today, we will go over common topics in paediatric neurology and emergency medicine that will help you on your next shift! Knowledge of neurologic disorders is essential for any practitioner of emergency medicine, so strap in for a high-yield post.

Core Questions

1. List ten causes of provoked (acutely symptomatic) seizures.
2. List four episodic disorders that may mimic seizures in neonates and four in non-neonates.
   • How does it differ if you are unable to obtain IV or IO access?
3. Give an approach to acute seizure control in a 9-month-old and in a 5-year-old.
4. What is the definition of status epilepticus?
5. List 6 medical treatments for status epilepticus.
6. What is the definition of a simple febrile seizure?
7. Describe the management of febrile seizure.
   • Which patients should have outpatient imaging and neurology follow-up?
   • Which children with seizure should be admitted to hospital?
8. List 5 reasons for CT Head after seizure and describe management after the 1st peds seizure.
9. List 10 differential diagnoses for headache in peds.
10. List 8 indications for radiologic imaging in patients with headache.
11. With regards to presentation and management, how are migraines different in children?
12. Describe the criteria which define migraine headache (review).
13. List 10 causes of pediatric ataxia.
14. Describe an approach to the pediatric patient with ataxia.
15. List 5 central and 5 peripheral causes of vertigo. Which is the more common cause of vertigo in children?
16. List 8 risk factors for pediatric stroke.

Wisecracks

1. Describe each of the following:
2. • Infantile Spasms
   • Absence Epilepsy
   • Benign Rolandic Epilepsy of Childhood
   • Lennox-Gastaut Syndrome
3. What is the most common cause of status epilepticus in children? In adults?
4. List five side effects of therapeutic dilantin use.
5. When is LP indicated in children with febrile seizures?
6. Give causes of acute, acute recurrent, chronic progressive and chronic non-progressive headaches.
7. Describe the presentation of infantile botulism.

View Details

This episode of CRACKCast covers Rosen's Chapter 173, Genitourinary and Renal Tract Disorders. Torsion, phimosis, UTIs, stones, and priapism are some of the high-yield topics covered here.

Core questions:

1. List a DDx for priapism and describe treatment.

2. Describe the management of a paraphimosis.

3. Describe the management of a phimosis.

4. What is the pathophysiology of balanoposthitis? What is the most common bug in balanoposthitis?

5. How is balanoposthitis managed?

6. Describe the diagnosis and management of pediatric epididymitis and orchitis.

7. Describe the diagnosis and management of testicular torsion.

8. List common bacteria in peds UTI and describe treatment in patients <2 months, 2M-2Y, 2Y+.

9. List 6 ddx renal mass – how should these be imaged first?

10. Give a differential diagnosis of proteinuria in children.

11. What is the most common cause of proteinuria in children?

12. Provide a differential diagnosis of acute renal failure in children. What is the most common causes?

13. Describe the clinical presentation of glomerulonephritis in a child.

14. Define hypertension in a child.

15. List causes of hypertension in a child.

16. List 2 medical treatments for acute HTN crisis in children.

17. What are the two types of HUS? What are the typical presenting features?

18. Describe the management of HUS and HSP in kids.

Wisecracks:

1. List three complications of circumcision.

2. Describe approaches to penile entrapment and tourniquet states.

3. Which side is a varicocele concerning and why?

4. Other than cystitis and pyelonephritis, list 6 other causes of pediatric dysuria

5. List 10 ddx for hematuria in peds.

6. List 5 false indicators of hematuria.

7. List 6 causes of nephrotic syndrome in peds.

8. List 5 complications of acute renal failure in children.

9. How does E. coli cause HUS? Which strain of E. coli is the concerning one?

View Details

Core Questions:

1) What are three pathophysiologic types of diarrhea? Give an example of a cause for each.

2) List 6 common causes of childhood infectious diarrhea in developed countries.

3) List 5 important differential diagnoses of diarrhea in children.

4) List 5 important differential diagnoses of vomiting in children.

5) When should you initiate a medical evaluation of children with acute diarrhea?

6) Describe the typical presentation of:

• Rotavirus
• Norovirus
• Salmonella
• Shigella
• Yersinia
• E. Coli
• C. Difficile

7) List routine and high risk treatment recommendations for common bacteria causing acute infectious diarrhea in children:

• Salmonella non-typhi
• Salmonella typhi
• Shigella
• Campylobacter jejuni
• Yersinia enterocolitica
• C. Difficile
• Vibrio cholerae
• Vibrio parahaemolyticus
• E. Coli

8) List the presenting features and treatments for three common protozoa causing infectious diarrhea in children.

9) Define and describe your diagnosis and management approach to dehydration that is:

• Mild
• Moderate
• Severe
• Associated with Hypo/Hypernatremia

Wisecracks:

1) Name 5 causes of bloody diarrhea.

2) Other than vomiting and diarrhea from infectious gastroenteritis, list 6 causes of volume depletion.

3) Name the components of the Gorelick scale.

4) What’s the 4-2-1 rule?

View Details

Core questions:

• List 8 causes of neonatal jaundice and indicate whether they are conjugated or unconjugated

• List indications for work-up of a jaundiced infant

• What are RFs for hyperbilirubinemia? (8)

• What is the differential diagnosis for vomiting in a child?

• Describe the typical presentation of each of the following:

• Hypertrophic pyloric stenosis

• Malrotation with midgut volvulus

• NEC

• GERD

• Intussusception

• Hirschsprung's Disease

• Meckel’s Diverticulum

• HSP

• List Xray findings for each of the following:

• Malrotation with midgut volvulus (2)

• NEC (4)

• Intussusception (5)

• Hirschsprung's Disease (2)

• Describe the conservative management of a patient with GERD.

• What is the preferred diagnostic test for diagnosis for intussusception?

• List causes of lead points in pts with intussusception.

• Describe each of the following signs on physical exam:

• Sandifer’s syndrome

• Red-currant Jelly Stools

• Dance’s Sign

• Rovsing’s sign

• Psoas Sign

• Obturator Sign

• Describe the “Rule of 2” for Meckel’s Diverticulum

• What are 3 common locations of lodging in the esophagus

• List 3 indications for FB removal from stomach. Describe the management of button battery FBs

• What is HSP? How does it typically present?

• List three complications of HSP.

• Why is appendicitis different in very young children?

• List 10 causes of pancreatitis in children

• List 10 causes of biliary tract disease in children

• List conditions associated with the development of gallstones in children.

Wisecracks.

• What are the risk factors for necrotizing enterocolitis?

• Describe the proposed pathophysiology of necrotizing enterocolitis?

• List five pathologic causes of constipation in a child.

• What is the most concerning complication of hirschsprung’s disease? How does it occur?

• What is gallbladder hydrops? What conditions is it associated with?

View Details

This episode of CRACKCast reviews Rosen’s Chapter 170, Pediatric Cardiac Disorders. This podcast covers the common infectious complications leading to pediatric cardiac issues. Additionally, we will review Kawasaki's Disease, Acute Rheumatic Fever, HOCM, and much more. 

Episode Overview:

1. Describe procedures and conditions for which prophylaxis for bacterial endocarditis is recommended.

2. Describe 2 potential prophylaxis regimens.

3. What is the differential diagnosis of myocarditis? What is the most common cause of myocarditis in children?

4. What is the differential diagnosis of pericarditis in children? Describe any differences b/n adults and children.

5. What are the clinical diagnostic criteria for Kawasaki’s disease?

6. If the clinical criteria are not met, but you are still suspicious, how else might Kawasaki’s disease be diagnosed?

7. What are some unusual clinical presentations of Kawasaki’s disease?

8. How is Kawasaki’s disease managed? What is treatment directed towards preventing?

9. List the Jones Criteria for the diagnosis of Acute Rheumatic Fever.

10. Describe the management of Acute Rheumatic Fever.

11. List 10 causes of sudden death in young athletes.

12. What is a normal pediatric QT interval.

13. What are ECG findings of HCM?

Wisecracks:

1. What is the hyperoxia test? How is it clinically useful?

2. Describe common Xray findings in CHD: “boot-shaped heart”, “egg-on-a-string”, “snowman”.

3. What is Eisenmenger’s Syndrome?

4. Until what age is the thymus visible on CXR?

5. List 8 ductal dependent cardiac lesions in the neonate.

6. List features of pathologic heart murmur .

7. When does the ductus arteriosus close functionally? Physically?

View Details

This episode of CRACKCast covers Rosen’s Chapter 170, Pediatric Cardiac Disorders. This podcast covers cyanotic and acyanotic cardiac defects, the presentation and management of congestive heart failure in pediatric populations, and the management of common arrhythmias in children. A second podcast will release next week detailing other issues in pediatric cardiology.

Episode Overview:

1. What is the most common form of congenital heart disease?

2. List 6 Acyanotic and 8 Cyanotic types of CHD.

3. What are the ductal dependent heart lesions?

4. Describe the emergent management of the hypoxic infant with a suspected ductal dependent cardiac lesion.

5. List types of CHD which are most likely to present outside of the neonatal period.

6. What are the anatomic anomalies seen in Tetralogy of Fallot?

7. What is the pathophysiology of a Tet spell and how is it         managed?

8. What is a ductal-dependent ToF?

9. Describe the management of CHF in the infant.

10. List 12 conditions associated with a high risk of developing dysrhythmias.

11. Compare SVT and ST.

12. Describe the management of SVT in the infant/child.

View Details

Core questions:

• Name 8 non-infectious causes that may present as pneumonia

• Describe the workup for a child with suspected pneumonia?

• What are the typical causes of bacterial pneumonia and viral pneumonia in the following age groups:

• < 1 month

• 1 month – 3 months

• 3 months – 5 years

• ≥ 5 years

• What is the empiric treatment of bacterial pneumonia in these age groups for outpatients? For inpatients?

• List 8 complications of pneumonia

• List 6 criteria for admission with pneumonia

• What are three clinical complications of cystic fibrosis?

• What is the pathophysiology of CF?

• How is suspected pneumonia in a patient with CF treated?

Wisecracks:

• What is the cause of whooping cough?

• What are the stages of whooping cough?

• How is whooping cough managed?

• How is the flu shot used in the pediatric population?

• Describe common pneumonia syndromes:

• Chlamydia trachomatis

• Mycoplasma pneumonia

• What is the most common bacterial infection in CF?

View Details

Core questions:

• Excluding asthma, list 8 causes of wheeze

• Outline the pathophysiology of asthma.

• What are the features of mild, moderate and severe asthma?

• Describe the PRAM score

• List 8 medications for asthma treatment with doses

• What is the typical ED management for a pts with an asthma exacerbation?

• Describe adjunctive therapies that might be used in a patient with refractory symptoms.

• How are PO corticosteroids used in the management of asthma?

• When should children be started on inhaled corticosteroids?

• Outline a plan for disposition of a pt presenting to the ED with an acute asthma exacerbation.

• What are risk factors for sudden death in a patient with asthma?

• List risk factors for bronchiolitis.

• What are the typical pathogens of bronchiolitis?

• What is the pathophysiology of bronchiolitis?

• How is bronchiolitis managed?

• Which children with bronchiolitis should be admitted to hospital?

• List potential complications of RSV.

Wisecracks:

• What’s the natural history of infants/toddlers who wheeze?

• What is a peak flow? What is the FEV1? What are the advantages to measuring peak flow? What are the disadvantages?

• Risk factors for death in bronchiolitis

View Details

Core questions:

• What is the pathophysiology of inspiratory and expiratory stridor?

• Provide a differential diagnosis for stridor in children (based on location: supraglottic, glottic, subglottic) list at least three in each category.

• What is the typical presentation of a retropharyngeal abscess?

• Describe the management of a RPA. What are the typical pathogens?

• What the typical pathogens in epiglottis? How are these patients managed?

• Differentiate between croup and other conditions mimicking croup.

• Contrast mild, moderate, and severe croup.

• What is the management of croup?

• Which children with croup require admission to hospital?

• Management of upper airway FB: Describe the management of an airway obstruction (progresses from partial obstruction to full obstruction to unconscious) in a 6 month old. In a 6 year old?

Wisecracks:

• Ddx of stridor (8) (review)

• List 5 Xray findings of epiglottitis

• Which infections are associated with croup?

• How do you handle the CICV scenario?

View Details

Core questions:

• List 10 non-infectious causes of fever in children

• List 3 bacterial pathogens responsible for infections in the following age groups

• 0-28 days

• 1-3 months

• 3-36 months

• 3 yr

• List 5 tests to perform on CSF

• Describe the empiric management of fever in the neonate (0-28 days)

• Why is ceftriaxone not recommended for the neonate?

• Describe one of

• The Rochester criteria

• The Philadelphia criteria

• Define simple and complex febrile seizure. What are indications for LP?

• What is the likelihood of

• Recurrent febrile seizure after 1 st presentation

• Risk of epilepsy after first febrile seizure?

• List 6 causes of Fever and Petechiae

• Describe the criteria for the diagnosis of Toxic Shock Syndrome

• What sickle cell patients require prophylaxis and why? What Abx?

• List the Duke criteria for infective endocarditis.

Wisecracks:

• Provide a differential diagnosis for fever (review question)

• Which patients are excluded from the Rochester Criteria?

• What are the low-risk Rochester Criteria, and how are these children managed?

• Which age groups should always have a urinalysis when presenting with fever without source?

• Which children should have a CXR to r/o pneumonia in the setting of fever without source?

View Details

Core questions:

• 1) List age specific vital signs (RR, HR): “1 odd yr - 60 count down aid”

• 2) What is the lower fifth percentile of systolic BP for the neonate, infant, and 1-10 yr old child?

• 2) Describe the 3 components of the Pediatric Assessment Triangle.

• 3) Describe the Canadian Pediatric Triage and Acuity Scale

• 4) List 5 historical indicators of child abuse

• 5) List 5 features suggestive of child abuse on physical examination and/or radiology?

Wisecracks:

• What are developmental milestones (gross motor and otherwise) for 1-24 months?

• What are other considerations in the management of pediatric patients: consent, pediatric-readiness, pediatric-friendly ERs?

View Details

This episode of CRACKCast covers Rosen's 9th Edition, Ch. 159. In the podcast, we will look at the sedative hypnotic toxidrome and the various agents that bring patients to your ED.

Core questions:

1. Describe the components of the GABA receptor complex and their physiologic effect
2. Describe the sedative-hypnotic toxidrome, and list 8 drugs in the DDx
3. How do barbiturates work?
4. What are the clinical symptoms of barbiturate overdose?
5. How are they managed?
6. How do benzodiazepines work?
7. List risk factors for benzodiazepine withdrawal and its management
8. What are the indications for flumazenil? What are the contraindications?
9. How does chloral hydrate toxicity present?
10. What is the clinical presentation of GHB toxicity?
11. How is GHB withdrawal managed?

Wisecracks:

1. List 2 drugs used for ‘date-rape’ and describe their toxicity
2. What Benzos WILL NOT be detected on urine drug screen?

View Details

This episode of CRACKCast covers Chapter 158 in Rosen's Emergency Medicine, 9th Edition.

Core Questions:

1. For each of the following, describe the expected toxicity:
2. • Jequirity pea, rosary
   • Umbrella tree, Dieffenbachia, Dumb cane
   • Capsicum annum
   • Water Hemlock
   • Jimson Weed, Deadly Nightshade
   • Eucalyptus oil
   • Poinsettia
   • Oleander, Foxglove
   • Tobacco
   • Pokeweed
   • Rhododendron
   • Yew
   • Castor Beans
3. List 5 mushrooms with early onset toxicity and 3 with late onset – and describe the toxicity expected.
4. List 4 mechanism of toxicity resulting from the use of herbal medicine.
5. List 4 plants containing cardiac glycosides.
6. What is Buckthorn?

View Details

This episode of CRACKCast covers Rosen’s 9th Edition Chapter 155, Antipsychotics. Continuing along the spectrum of toxicologic exposures, these agents account for a large number of presentations to emergency departments every year. Being equipped with the knowledge of how to deal with the side effects of these medications and their associated toxidromes is imperative and may help you save lives in the future.

View Details

This episode of CRACKCast covers Rosen's Chapter 154, Lithium. You will have a solid approach to lithium overdose after listening to this episode!

View Details

Core questions:

• Describe the cholinergic toxidrome from organophosphates

• Describe the clinical presentation of organophosphate toxicity.

• How is organophosphate toxicity managed?

• What are the complications of organophosphate toxicity?

• What is the difference between organophosphates and carbamates?

• What are the unique features of chlorinated hydrocarbon toxicity? What is an example of a chlorinated hydrocarbon? How are they managed?

• How do Substituted Phenols (Dinitrophenol) cause toxicity? How are they managed?

• How is toxicity from chlorophenoxy Compounds (Agent Orange) managed?

• What is expected in paraquat toxicity? and how is this managed?

• What are the toxic effects of pyrethrins and pyrethroids?

Wisecracks:

• What is aging - in relation to organophosphate toxicity?

• What is the maximum formulation of DEET in pediatrics? When should you not use DEET?

View Details

This episode of CRACKCast covers Rosen’s 9th Ed Chapter 151, Iron and Heavy Metals. While often not recognized in the acute care setting, chronic toxicity from heavy metals is common and has high morbidity, especially in pediatric populations and requires careful attention to risk factors and symptomatology.

View Details

Core questions:

1. List 6 commonly abused opioids (Table 156:1)
2. Describe the opioid toxidrome (list opioid effects on Neuro, Resp, Ophtho, CV, GI, Derm)

3. List opioid preparations associated with the following presentations:

4. Long QTc →

5. Prolonged QRS →
6. Seizures →
7. Hallucinations →)
8. Sensorineural hearing loss →

9. Serotonin syndrome →

10. i) What is the dose of narcan? ii) What is the duration of action? iii) How do you administer a narcan infusion?

11. What opioid overdoses/ingestions need longer than 6 hours of observation?
12. What is the clinical presentation of opioid withdrawal?
13. What are risk factors for opioid withdrawal?
14. List 3 medications effective for opioid withdrawal.
15. What is the number one killer of people under 50?
16. What is Suboxone?
17. How do you do a Suboxone induction?

WiseCracks:

1. List 5 ddx for opioid intoxication (CNS + resp depression, + miosis).
2. What opioids don’t cause miosis?
3. Risk factors for opioid overdose?
4. What is NAPE? Narcan induced pulmonary edema.
5. Difference between a “body packer” and “body stuffer”?

View Details

This episode of CRACKCast covers Rosen’s Chapter 141, Toxic Alcohols. This chapter covers exposure to your stereotypical toxic alcohols (i.e., ethylene glycol and methanol) as well as the consequences of ingesting ethanol and isopropyl alcohol. 

View Details

This episode of CRACKCast covers Rosen’s Chapter 153, Inhaled Toxins. This chapter covers exposure to various inhalation toxins including CO, hydrogen sulfide, etc. and includes their treatment and management for acute exposures.

View Details

This episode of CRACKCast covers Rosen’s 9th Ed Chapter 147, Cardiovascular Drugs. With increasingly common use of these medications for heart disease and an ever aging population, it is imperative to understand the prompt recognition and therapy for toxic exposures. Recognition of the more lethal agents and how to disposition these patients in the ED are the cornerstones of this chapter.

View Details

This episode of CRACKCast covers Rosen’s 9th Edition Chapter 154, Cocaine and Other Sympathomimetics. Continuing along the spectrum of toxicologic exposures, these agents account for a large number of presentations to emergency departments every year. Having an in-dept understanding of their mechanism of action and a solid approach to the assessment and treatment of these patients is critical.

View Details

This episode of CRACKCast covers Rosen’s 9th Ed Chapter 152, Hydrocarbons. Continuing the spectrum of toxicologic exposures, these agents account for relatively few presentations. Recognition of the more lethal agents and how to disposition these patients in the ED are the cornerstones of this chapter.

View Details

This episode of CRACKCast covers Rosen’s 9th Ed Chapter 150, Hallucinogens. This chapter covers exposure to several families of hallucinogenic toxins, their presentations, complications, and treatment.

View Details

This episode of CRACKCast covers Rosen’s Chapter 153, Caustics. This chapter covers oral exposure to caustic agents, including the ED management, complications and potential treatment.

View Details

This episode of CRACKCast covers Rosen’s 9th Edition Chapter 146, Antidepressants. Continuing the section on toxicology, antidepressants make up one of the most commonly prescribed medications in the general population. The use and misuse of antidepressants can have serious consequences and having a high suspicion of overdose in suicidal patients can lead to timely antidote therapy.

View Details

This episode of CRACKCast Covers Rosen's Chapter 145, Anticholinergics. You will learn everything you need to know for the next hot and bothered patient that rolls in to the ED!

View Details

This episode of CRACKCast covers Rosen's Chapter 149, Aspirin and Nonsteroidal agents. You will become well-versed in the presentation of Salicylism and how to manage it. The episode also touches on NSAID overdose, with rare severe complications.

View Details

This 148th episode of CRACKCast covers Rosen’s 9th edition, Chapter 143, acetaminophen. Also known as paracetamol and Tylenol, you need to know this overdose cold!

View Details

This episode of CRACKCast covers Rosen’s Chapter 147, A General Approach to the Poisoned Patient. This is probably one of the most cornerstone podcasts we have done, and you'll enjoy the pearls dropped by staff ED-Toxicologist, Dr Jesse Godwin.

View Details

In this 146th episode of CRACKCast, we cover Radiation injury. A very rare, but important topic to know cold. From alpha particles to triage systems, we've got you covered.

View Details

This episode of CRACKCast covers Rosen’s Chapter 144, High Altitude Medicine. The problems encountered can be mostly be prevented through slow ascent and generally treated with oxygen and descent. This summary of respiratory physiology will explain why people can find themselves quickly quite unwell at high altitudes.

View Details

This episode of CRACKCast covers Rosen’s Chapter 145, Drowning. Not only an important topic to know about in the resuscitation bay, but also out in the world!

View Details

This episode of CRACKCast covers Rosen's Chapter 143, Diving Injuries and Dysbarism. While infrequently encountered except for those centers frequented by SCUBA enthusiasts, we must know the hard facts on the potentially life-threatening diving related injuries that may occur suddenly and need urgent attention.

View Details

This episode of CRACKCast covers Chapter 134 of Rosen's Emergency Medicine (9th Ed.): Electrical and Lightning Injuries.

Core questions:

• What is the relationship between current, voltage and resistance? How does this relate to potential for injury from electrical and lightning injuries?

• What are the types of electrical injury? (based on type of current)

• Differentiate between AC and DC current injuries.

• List 4 types of electrical burns and 5 mechanisms of lightning injury

• List 5 expected injury patterns for high-voltage and lightning injuries

• List clinical findings (early and late) associated with electrical injuries.

• List clinical findings associated with lightning exposure.

• Describe the skin injuries associated with lightning and electricity.

• Describe the modifications in field triage of multiple victims following a lightning strike.

• Describe the prehospital management of electrical injuries

• List 6 admission criteria for electrical/lightning injuries

• List 6 complications of high-voltage injuries

• Tips to avoid getting hit by lightning

Wisecracks:

• List six mechanisms of lightning injury.

• ECG features of lightning strike.

• What is keraunoparalysis?

• Describe the management of a pregnant patient (1st trimester and 2nd /3rd trimester) in the setting of electrical injury.

• How are perioral electrical burns managed? List three early and three late complications.

View Details

This 141st episode of CRACKCast covers Rosen’s 9th edition, Chapter 133, heat illness. Want to mentally escape from the throes of our gripping winter? Let's go straight into heat illnesses.

View Details

Core Questions

1. List 5 mechanisms of heat loss and 5 physiological responses to cold
2. Describe 3 CV manifestations of hypothermia
3. What are the risk factors for hypothermia? List 6.
4. Define mild, moderate and severe hypothermia.
5. Describe the CNS, CVS, hematologic and GU presentations associated with hypothermia for each stage (mild, moderate, severe)
6. What are the changes made to BLS and ACLS in the setting of hypothermia?
7. What are the indications for CPR, defibrillation, and antidysrhythmics in the hypothermic patient?
8. Differentiate between active and passive rewarming. What are the two types of active rewarming?
9. What are five indications for active rewarming? Describe 6 techniques for active rewarming.
   1. Active External Rewarming
   2. Active Core Rewarming
10. What are examples of:
11. In what situations would you not initiate resuscitation of a hypothermic patient?

Wisecracks

1. What is core-temperature afterdrop?
2. List 5 DDx for an Osborne J-wave
3. List 5 laboratory abnormalities expected in hypothermia
4. What three mechanisms cause worsening bleeding in trauma in hypothermia?
5. Describe 5 management considerations other than rewarming in hypothermia
6. What are the prehospital management priorities for the hypothermic patient in each of these categories: mild, moderate and severe?

View Details

This episode of CRACKCast covers Rosen's Chapter 131, Frostbite. You will be a pro at managing the spectrum of cold injury that can present to the ED!

View Details

This episode of CRACKCast covers Rosen’s Chapter 138, Sepsis Syndromes. Sepsis is a topic that has undergone a lot of change in the last 15 years since the Rivers paper was published. This episode covers the original definitions of SIRS and sepsis, while also covering more recent evidence & the newest evidence-based treatment protocols.

View Details

This episode of CRACKCast covers Rosen’s Chapter 129, Skin Infections. These are common and rarely life threatening, but careful consideration should be given for those who may benefit from admission over outpatient treatment. This is a big episode covering the bugs, presentations, and useful tips when treating these infections in the ED.

View Details

Episode Overview:

1. List 6 risk factors for bone and joint infections
2. Describe the classification of osteomyelitis (based on pathophysiology)
3. List the 3 most common bacteria causing osteomyelitis/septic arthritis for each age group: neonate, child, adult; and the following circumstances:
   • Sexually active adolescent
   • Infected prosthesis
   • Sickle cell disease
   • IVDU
   • Human bite
   • Plantar puncture wound
   • Diabetic foot
4. Describe a diagnostic approach to osteomyelitis. What is the utility of bloodwork?
5. List 4 early findings of osteomyelitis on Xray
6. List 5 complications of osteomyelitis
7. List 6 differential diagnoses for osteomyelitis
8. Describe the empiric management of suspected osteomyelitis
9. What is the clinical triad of septic arthritis? Describe typical findings in joint aspiration + radiography.
10. List 5 complications of septic arthritis
11. What is the triad of disseminated Gonococcal disease?
12. List X-ray findings of septic arthritis in a joint with a prosthesis.
13. List 10 differential diagnoses for septic arthritis
14. Describe the empiric management of suspected septic arthritis

Wisecracks:

1. What is Kocher’s Criteria?
2. What is a Biofilm? What is its clinical significance?

View Details

Episode 135 of CRACKCast covers Rosen's 9th edition, Chapter 127, tuberculosis. TB, or not TB, that is the question. This episode will elucidate the early recognition, risk factors, therapy and precautions regarding this worldwide killer.

View Details

This 134th episode of CRACKCast covers Rosen’s 9th edition, Chapter 126, tick-borne illnesses. Can't get all those crazy rare diseases straight in your head? We've got you covered.

View Details

This episode of CRACKCast covers Rosen’s Chapter 125, Parasitic Infections. This episode will give you the tools to adequately investigate the peculiar parasitic infections that present in patients coming to the ED. In an age where physicians are increasingly exposed to international travelers and immigrant/refugee populations, knowing this content is absolutely essential.

View Details

Core Questions:

1. Define AIDS
2. List 5 risk factors for AIDS
3. List 10 AIDS-defining conditions
4. Describe 3 serum tests for HIV
5. List 6 Ddx for respiratory infections in HIV
6. Describe the presentation and treatment of PCP pneumonia
7. Describe an approach to diagnosis and management of CNS infections in AIDS
8. List 5 causes of odynophagia in HIV
9. List 6 causes of diarrhea in the HIV patient
10. Describe HAART therapy
11. Describe prophylaxis of opportunistic infections in HIV

WiseCracks:

1. Risk stratify exposure to HIV
2. What is Coccidiomycosis?
3. Name common ART agents and their adverse effects

View Details

Core questions:

1. What are the top 5 rabies-virus carrying animals in Canada? In the world?
2. Describe the pathogenesis of the rabies virus disease (see fig. 123.6)
3. List 5 stages of rabies. What are the clinical presentations of rabies?
4. How is rabies diagnosed?
5. What factors are involved in a rabies risk assessment. Which types of animal contact require PEP?
   1. Non-immunized
   2. Immunized
6. Describe important aspects of rabies post-exposure immunoprophylaxis for the following exposures:

Wisecracks:

1. List 4 reservoirs of rabies
2. What is the dose of HRIG?

View Details

This 130th episode of CRACKCast covers Rosen’s 9th edition, Chapter 122, Viruses. Viruses account for most infections and are typically self-limited illnesses. Recognition of specific viral illness patterns is important in the ED, where our intervention or withholding an ineffective treatment such as antibiotics can affect the health at a population level.

View Details

This 129th episode of CRACKCast covers Rosen’s 9th edition, Chapter 121, Bacteria. Bacterial infections represent a large proportion of presentations to the emergency department. Here we examine some of the most infrequently seen but extremely dangerous bacterial infections that you must be able to recognize. For more frequent infections, please see their individual chapters in Rosen’s.

View Details

This episode of CRACKCast covers Rosen's Chapter 120, Thyroid and Adrenal disorders. This episode is going to have a nice breakdown of how each of these major endocrine glands can go haywire and what to do when the storm approaches. The shownotes also have some additional material worth checking out!

View Details

This 127th episode of CRACKCast covers Rosen’s 9th edition, Chapter 119, Rhabdomyolysis. Although usually benign, rhabdomyolysis can have deadly complications. Acute kidney injury and hyperkalemia are accompanied by high mortality. At-risk patients (see the "MUSCLE Breakdown" mnemonic) may present with muscle pain or altered mentation.

View Details

Core questions:

• Define DKA.

• List 6 potential triggers of DKA.

• Describe the pathophysiology of DKA. (Fig 118.1)

• How is DKA managed in children? In adults?

• What are the epidemiologic risk factors for cerebral edema in DKA?

• What are signs and symptoms of cerebral edema? How do you manage a pt with DKA and suspected cerebral edema?

• List 5 complications of DKA management

• List five common serious infections in diabetics and how they are managed.

• How does hypoglycemia classically present?

• List 10 causes of hypoglycemia

• Describe the treatment of hypoglycemia

• What is the definition of hyperglycemic, hyperosmolar state?

• Contrast DKA and HHS (Table 118.2)

• What is the pathophysiology of HHS?

• How is HHS managed?

WiseCracks:

• Why are urine ketones less sensitive for DKA than serum ketones?

• When do you give NaHCO3 to a patient with DKA?

• What is euglycemic DKA?

• What is the differential diagnosis of hypoglycemia in a patient who does not have DM? What would you add to the differential diagnosis in a pt who has DM?

View Details

Core questions

1. What are the five most common causes of hyperkalemia?
2. Describe the ECG features seen with hyperkalemia. List at least 5.
3. How is hyperkalemia managed? How does each intervention work, and how long do the effects typically last?
4. What are the five most common causes of hypokalemia?
5. Describe the ECG features seen with hypokalemia. List at least 4.
6. How is hypokalemia managed?
7. What are the three main types of hypernatremia? Give 3 examples of each.
8. List four central and four nephrogenic causes of diabetes insipidus.
9. What are the four broad categories of hyponatremia?
10. Give an example of two clinical conditions for each: hypovolemic, euvolemic and hypervolemic hyponatremia.
11. What are the three most common causes of SIADH?

12. Describe the management of hyponatremia in the following patients:

    1. Actively seizing
    2. Euvolemic with acute hyponatremia
    3. Hypovolemic with chronic hyponatremia
    4. Hypovolemic with acute hyponatremia
    5. What are the five most common causes of hypercalcemia?
    6. What are the five most common symptomatic causes of hypocalcemia seen in the emergency department?
    7. What ECG features are seen in hypercalcemia vs. hypocalcemia? How is each managed?
    8. What are the five most common causes of hypermagnesemia?
    9. List five clinical manifestations of hypermagnesemia.
    10. List five common causes of hypomagnesemia.
    11. What are the five most common causes of hyperphosphatemia?
    12. What are the five most common causes of hypophosphatemia in the ED? How do they manifest clinically?

    Wisecracks.

13. What electrolytes abnormalities are often with hypomagnesemia?

14. How do you estimate the total body water?

View Details

This episode of CRACKCast covers Rosen’s Chapter 124, Acid Base Disorders. This chapter covers a simple approach to acid base disorders and ABG interpretation, including the differential diagnosis for the identified disorders & treatment options.

View Details

This 123rd episode of CRACKCast covers Rosen’s 9th edition, Chapter 115, Selected Oncologic Emergencies. With an ever aging population, cancer incidence continues to rise. Therapies continue to prolong life often with high risks of side effects, and emergency physicians need to be equipped to treat complications of this treatment and importantly cancer morbidity itself.

View Details

Episode Overview:

1. List 10 causes of Thrombocytopenia
2. List 6 causes of Thrombocytosis
3. Describe the presentation and treatment of HIT, ITP and TTP
4. Describe what causes an abnormal PT? What causes an abnormal PTT?
5. Describe the deficiency and management of Hemophilia A, Hemophilia B, and vWD
6. Describe the management of a major and minor bleed in hemophilia A
7. List 4 items in cryoprecipitate
8. List adjunctive therapies in DIC

Wisecracks:

• How do you differentiate coagulation disorders from platelet disorders?

• What is thrombocytopathy?

• What do INR and PTT test?

• What is DIC?

View Details

This 121st episode of CRACKCast covers Rosen’s 9th edition, Chapter 112 and 113, Anemia, Polycythemia, and White Blood Cell Disorders. These blood disorders are numerous and this episode attempts to break their classification and approach down in a systematic manner.

View Details

This episode covers Chapter 110 of Rosen’s Emergency Medicine (9th Ed.), Dermatologic Presentations.

Episode Overview

1. List five broad categories of rashes
2. Describe the primary skin lesion types

a. Bonus: What are the secondary skin lesions (show notes only)

1. List systemic diseases that present with cutaneous signs for each of the following locations:

   • Generalized rash
   • Head and neck
   • Hands
   • Legs
   • Palms and Soles
   • Describe the various presentations of tinea and their treatment
   • List 8 RFs for candida infections
   • Describe the stepwise management of diaper dermatitis
   • Describe the distribution of Pityriasis rosea
   • Describe the management of atopic dermatitis
   • Describe the management of impetigo & folliculitis
   • List 6 RFs of C.A.-MRSA and 4 oral Abx treatments
   • Describe the presentation and management of Staph Scalded Skin andTSS

2. List 10 causes of EM / SJS / TEN

3. Describe presentation of EM + SJS/TEN. Differentiate between TEN and SJS
4. List 6 broad categorical causes of urticaria

5. Describe the typical features for each of the following:

   • Measles
   • Rubella
   • Roseola Infantum
   • Erythema Infectiosum
   • Scarlet Fever
   • Describe treatment of poison ivy
   • Describe presentation and treatment of Pediculosis + Scabies
   • List 10 causes of Erythema Nodosum
   • List a 6 ddx for vesicular lesions
   • List 4 lesions with a positive Nikolsky’s sign
   • List 4 complications of HSV infection
   • List 5 complications of Varicella + describe the management of an exposure during pregnancy
   • List 5 complications of Zoster + differentiate between Ophthalmicus and Oticus
   • What is the treatment of herpes zoster?

   Wisecracks

6. List 5 causes of desquamating lesions

7. List 5 palm and sole rashes
8. List 10 maculopapular rashes
9. List 1 low, medium and high potency topical steroid
10. Identify the following rashes: erythema migrans, erythema marginatum, erythema multiforme, erythema nodosum, meningococcemia

View Details

Episode 119 of CRACKCast covers chapter 109 of Rosen's Emergency Medicine 9th edition.

Its hard to go a couple hours in the ED without seeing allergy or that life-threatening anaphylaxis, so you need to be tres familiar with this entity!!!

View Details

This episode covers Ch 108 of Rosens (9th Ed.), SLE and the Vasculitides. These conditions can lead to some pretty varied ED presentations, so we need to know when to suspect lupus or vasculitis, and how to manage it.

Episode Overview:

1. What the pathophysiology of lupus
2. List diagnostic criteria for SLE
3. List drugs that induce lupus
4. Describe the clinical manifestations w/ Classic triad & Symptoms and signs by system in lupus
5. List 3 drug regimens to treat SLE
6. How does neonatal lupus present?
7. What is antiphospholipid syndrome? What is the unusual laboratory feature seen with this condition?
8. What is the pathophysiology of vasculitis?
   1. Large vessel vasculitis
   2. Medium vessel vasculitis
   3. Small vessel vasculitis
   4. Hypersensitivity vasculitis
   5. Subcutaneous vasculitis
9. Give examples of:
10. Compare the findings for vasculitis
11. List 5 criteria for dx of temporal arteritis + 2 associated features
12. Describe the features of Behcet’s Disease
13. List 10 causes of Erythema Nodosum
14. Compare Buerger’s, Serum sickness and Hypersensitivity Vasculitis
15. List the diagnosis Criteria for HSP

WiseCracks

1. What is the differential for SLE patient and Chest pain?
2. Name and identify 2 pathognomonic clinical features for lupus
3. When should Rheum be involved in the ED with a SLE patient?
4. Spot Diagnosis: A 36 year old female stock trader present with what appears to be necrosis of the nose and ears…
5. Spot diagnosis: 13 year old presents with abdo pain, polyarticular arthritis, foaming urine and the following rash…
6. Rounds Pimper: List 10 side effects of chronic steroid use

View Details

This episode covers Chapter 107 of Rosen’s Emergency Medicine (9th Ed.), Tendinopathy and Bursitis.

Episode Overview:

• Mechanical overload and repetitive micro-trauma are the key underlying mechanisms of tendinopathy
• Most patients present with progressively worsening pain after work or sports-related activities that are repetitive in nature
• Tendinopathy can also be associated with non-mechanical causes such as:
  • Systemic manifestations of disease
  • Use of fluoroquinolones
  • Infectious etiologies

• Most patients with tendinopathies can be treated with conservative measures, such as:

  • Protection
  • Relative rest
  • Application of ice
  • Elevation
  • Medications
  • Overuse syndromes take at least 6-12 weeks to heal
  • Patients need optimal loading and referral for physiotherapy or sports medicine therapy
  • Urgent imaging of tendinopathy in the ED is rarely useful
  • Clinicians may elect to use bedside ultrasound to evaluate for other diagnoses
  • Operative treatment of tendinopathy is required in select cases
  • Consider infectious bursitis in all cases of acute bursitis
  • Aspirate bursa and evaluate the fluid
  • Infectious bursitis is typically caused by Staph aureus
  • Non-septic bursitis differential diagnosis:
  • Traumatic
  • Rheumatologic
  • Idiopathic
  • Management of septic bursitis:
  • Antibiotics
  • NSAID's
  • Rest
  • Application of ice
  • Elevation
  • Prompt referral for follow-up +/- admission

Core questions:

1. What is the differential diagnosis for tendinopathy?
2. What are common sites for tendinitis?
3. List 6 differential diagnoses for atraumatic non-septic bursitis
4. List common causes for infected bursitis

Wisecracks:

1. Differentiate septic and inflammatory bursitis based on clinical exam and fluid aspirate results
2. List 4 physical exam findings of impingement syndrome

View Details

This episode of CRACKCast covers Rosen’s Ch 106, Arthritis. When a patient rolls in with an active joint, we need to know how to rule out those can't-miss diagnoses.

View Details

This episode covers Chapter 105 of Rosen’s Emergency Medicine (9th Ed.), Suicide.

Episode Overview:

• Suicide is a common but preventable cause of death
• Suicide is usually triggered by treatable or reversible short-term crises
• Most attempted suicide survivors are grateful to be alive
• Suicide risk changes over time; estimations of imminent risk are NOT evidence-based
• Routine screening labs provide little value to most ED patients with self-harm behaviours
• Evaluations should be targeted to signs or symptoms of disease on presentation
• Any ED visit for suicidal thoughts or behaviours represents a crisis and a teachable moment
  • With your approach, it is important to be supportive, empathetic, and patient-centred
  • Have a collaborative plan that integrates the input from collateral sources
• When caring for suicidal patients, use precautions:
  • Sitters
  • Physical/chemical restraints
  • Involuntary admission forms
• Brief and focused risk assessment of patients in the ED can identify persons in need of further comprehensive evaluation and consultation with a mental health specialist
• Those patients who are deemed to be at low-risk of suicide may be discharged home to a safe and supportive environment, assuming they have no access to toxic medications or guns
  • They should receive education and safety planning in the ED
  • They should have early mental follow-up appointments

Core questions:

1. Name 10 risk factors for suicide
2. Name an additional 5 risk factors for adolescent suicide
3. Describe the SAD PERSONS Scale
4. Describe 4 potential targeted investigations for patients presenting to the ED with suicide
5. Name 3 protective factors for against suicide

View Details

In the fourth episode of the Physicians as Humans project, I speak with Dr. Kevin Dueck, a family medicine resident at McMaster, about his decision to take parental leave during residency. Also check out his blog https://abootmedicine.wordpress.com/!

This is an ongoing project, so if you or anyone you know have a story about managing personal struggles while in medicine, please contact velmurug@ualberta.ca. If you are unfamiliar with the project, please read this post for more information on the origin of this podcast series. The CanadiEM podcast can be added to your podcast application from the iTunes store or by entering the podcast RSS feed. If you would prefer to download it, click here. It can also be streamed above.

Thanks for listening and please refer your colleagues!

Music for Episode 04 (All songs have been modified for the project)

1. ambient by strange day. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
2. NOWË - Burning (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/AWv6Cr-RJaM
3. Jorm - Broken (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/sl-o3ywNTV4
4. Skander Music - Back Home (Vlog No Copyright Music). Music promoted by Vlog No Copyright Music. Video Link: https://youtu.be/uwXmBL1kQT4
5. Pressure - Riot https://youtu.be/ELksuZkgQsQ
6. Joakim Karud - Waves. Song/Free Download - https://youtu.be/xG8AWZSnFgI. Support Joakim Karud - http://smarturl.it/joakimkarud
7. LAKEY INSPIRED - In My Dreams (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/PiKks_6yC8Q

View Details

This episode of CRACKCast covers Rosen' 9th edition, Chapter 104, Factitious Disorders and Malingering.

Episode Overview

• Two categories of psychiatric illness are covered in this episode
  • Factitious Disorder
  • Malingering
• Individuals suffering from factitious disorders fabricate symptoms of illness to fulfill the sick role (primary gain)
• Individuals suffering from malingering fabricate symptoms of illness to obtain something (secondary gain)
• Despite the fact that we may suspect either factitious disorder or malingering, we must strive to objectively assess the patient for concrete evidence of disease
• If no objective evidence of disease exists in a patient, do not investigate with needless and/or harmful diagnostic modalities
  • Refer back to their primary care physician
• If you are suspecting factitious disorder by proxy, the safety of your patient should always be your first priority

Core Questions

• What is a factitious disorder and what is malingering?
• List the DSM-5 diagnostic criteria for factitious disorder imposed on self (FDIS)
• List the DSM-5 diagnostic criteria for factitious disorder imposed on another (FDIA)
• List four characteristics of malingering

View Details

This 113th episode of CRACKCast covers Rosen’s 9th edition, Chapter 103, Somatoform Disorders. The diagnosis of SSD is made when there are persistent and clinically significant physical complaints that are accompanied by excessive and disproportionate health-related thoughts, feelings, and behaviours regarding these symptoms. Recent publications refer to “medically unexplained physical or somatic symptoms,” rather than somatization.

View Details

This episode covers Chapter 102 of Rosen’s Emergency Medicine (9th Ed.), Anxiety Disorders.

Episode Overview

• Patients who present with predominant symptoms of anxiety may be suffering from medical disorders (think cardiac, resp, endocrine, neurologic), medication effects, or substance abuse or withdrawal.
• Anxiety may accompany the onset of serious medical disease, cause significant metabolic demands, and stress a marginally compensated organ system.
• Anxiety caused by physical illness is usually suggested by the patient’s physical findings but may require testing to further delineate the cause.
• Oral, intravenous, or intramuscular medication may be necessary for patients who are a significant threat to themselves or others and for anxious patients with significant medical illness.
• Limited benzodiazepine therapy may be helpful for select patients. SSRI’s are the go-to long term therapy.

Core questions:

1. List 5 predictors of anxiety caused by an underlying medical issue (box)
2. List 10 organic diseases that may present with anxiety
3. Name 10 characteristics of a panic attack (box)
4. List characteristics of post-traumatic stress disorder (box)
5. Define the following:
   1. Panic attack
   2. OCD
   3. GAD
6. List ED management goals for patients with anxiety
7. List 6 non-pharmacologic therapies for anxiety

View Details

This episode of CRACKCast covers Rosen’s Chapter 101 (9th Ed.), mood disorders. The podcast will focus on the diagnosis and management of common mood disturbances.

Episode Overview

• Patients with apparent mood disorders should be evaluated for medical disorders, medication effects, substance abuse or withdrawal because these conditions can mimic both depression and mania.
• Mood disorders should be suspected in patients with multiple, vague, nonspecific complaints and in patients who are frequent, heavy users of medical care.
• The differentiation of depression and dementia in elders can be difficult, but is important because depression often responds dramatically to treatment.
• Patients with mood disorders should be assessed for their suicide potential.

Core questions:

1. List the 3 neurotransmitters implicated in depression
2. List the DSM V criteria for Major Depressive Episode (box)
3. Define Seasonal Affective disorder, Dysthymic Disorder and Cyclothymic

disorder 4. Define Bipolar I and Bipolar II 5. List the DSM V Criteria for a Manic Episode (box) 6. List 8 general medical conditions and 8 medications that cause depression 7. Describe first line medical therapy for depression and bipolar disorder 8. List 4 criteria for hospitalization in an acute psychiatric episode

Wisecracks

1. Mnemonics for symptoms of depression and mania

View Details

This episode covers chapter 110 of Rosen's emergency medicine (100 in the 9th edition). Confused about thought disorders? We can set you thinking straight!

View Details

This episode of CRACKCast covers Rosen’s Chapter 109, CNS Infections. This chapter covers a differential diagnosis for CNS infections, including necessary workup and approaches to treatment.

View Details

Are you confused by the NMJ? Good.... because we were too. This episode of CRACKCast covers Rosen’s Chapter 108, Neuromuscular Disorders. These disorders have a wide range of presentations and etiologies.

View Details

This episode of CRACKCast covers Rosen’s Chapter 107, Peripheral Nerve Disorders. These disorders have a wide range of presentations and etiologies. This chapter includes a comprehensive classification system to help in the ED in recognizing the various disorders.

View Details

This episode covers chapter 106 of Rosen's Emergency Medicine. Check out chapter 96 in the pretty new 9th edition. If you don't have it yet... you should. Ever wondered about how to get the spinal syndrome's straight? We've got that covered, and more of course!

View Details

This episode of CRACKCast covers Rosen’s Chapter 105, Brain and Cranial Nerve Disorders. These can be the weird and wonderful in the ED, but subtle hints can clue us in that further investigation is needed for our patients. Having a high suspicion for these diagnoses can help you make an appropriate care plan and follow up for patients with neurological disease.

View Details

This episode covers Chapter 104 (or 94 in the 9th Edition) of Rosen's Emergency Medicine. If you can't get delirium versus dementia straight in your head, then this is the podcast for you!

Core questions:

1. List the four key diagnostic criteria for delirium
2. List six strong predisposing or precipitating factors for delirium
3. List 15 causes of delirium
4. Describe how to use a screening tool for delirium: MMSE
5. List 3 potential medications used for chemical restraint
6. List 2 potential side effects of Haldol administration
7. Compare delirium with dementia
8. List important diagnostic studies for the workup of delirium
9. List four diagnostic criteria for dementia
10. List 10 specific causes of reversible dementia
11. List 10 causes of non-reversible dementia

Wisecracks:

1. Explain how you differentiate between psychosis, delirium and dementia.
2. How does Aricept work?
3. Describe the pathophysiology of Alzheimer’s dz and list RFs for its development
4. What is the triad of normal pressure hydrocephalus?

View Details

This episode of CRACKCast covers Rosen’s Chapter 103, Headache Disorders. This chapter covers an approach to headaches, including the red flags and key history questions to clinch the diagnosis.

View Details

This episode of CRACKCast covers Rosen’s Chapter 102, Seizures. This can be a challenging complaint to diagnose without collateral, but recognition and treatment is critical for patient and public safety. This chapter covers the various etiologies of seizure and their management - both acutely and in the community.

View Details

This episode covers chapter 101 of Rosen's Emergency Medicine. Its a gooder... Stroke! All things brain badness, so come have a listen or take a gander at the shownotes.

View Details

This (centennial!) episode of CRACKCast covers Rosen’s Chapter 100, Gynecologic Disorders. This chapter covers the common presentation of pelvic pain and vaginal bleeding in the emergency department, including can't miss life or organ diagnoses.

View Details

This episode of CRACKCast covers Rosen’s Chapter 99, Urological Disorders. This episode will cover a selection of urological disorders commonly seen in the ED along with key steps in management.

Episode Overview

1. UTI’s in Adults
2. Prostatitis
3. Renal Calculi
4. Bladder (Vesical) Calculi
5. Acute Scrotal Pain
6. Acute Urinary Retention
7. Hematuria

View Details

This episode of CRACKCast covers Rosen’s Chapter 98, Sexually Transmitted Infections. This chapter covers an overview of the various sexually transmitted infections commonly seen in the ED, as well as their management.

View Details

This episode of CRACKCast covers Rosen’s Chapter 97, Renal Failure. This chapter covers an approach to acute and chronic kidney injuries, including causes, complications and treatments.

View Details

This episode of CRACKCast covers Rosen’s Chapter 96, Anorectal Disorders. These complaints are sensitive in nature and are not easily volunteered by patients. A sensitive and thorough history is necessary to help resolve these complaints that can be devastating to quality of life.

• What are risk factors for the develop of symptomatic haemorrhoids?

• Describe 4 degrees of internal hemorrhoids and indicated management options

• Describe the management of non-thrombosed external haemorrhoid & thrombosed external hemorrhoids

• List causes of fissures. Which type of fissure is suspicious for underlying disease?

• Describe the treatment of anal fissures – 5 options

• Which conditions are associated with the development of abscesses and fistulas?

• List 5 types/sites of anorectal abscess. Which can be drained in ER?

• What is a pilonidal cyst? How do you treat it?

• List 8 causes of fecal incontinence.

• List 8 causes of pruritus ani

• Describe 6 rectal STI’s and their management

• List conditions associated with rectal prolapse.

• Describe the ED management of rectal foreign bodies

Wisecracks:

Mixed bag of anorectal stuff - levator ani syndrome, proctalgia fugax, radiation proctitis, hidradenitis suppurativa, and more...

View Details

This episode of CRACKCast covers Rosen’s Chapter 95, Large Intestine. This chapter covers a number of pathologies affecting the large colon, including their associated risk factors & complications.

1. List features that are typical for IBS.

(Describe the Rome IV criteria and list 4 medications used to treat irritable bowel syndrome - show notes)

1. What is the pathophysiology of diverticular disease?

2. List clinical presentations of diverticular disease.

3. How is diverticular disease managed in the ED? Which patients should be admitted to hospital? List 3 complications.

4. List the types and potential causes of large bowel obstruction.

5. What are the four types of GI volvulus? What are the risk factors for developing each type?

6. List the extra-intestinal manifestations of IBD.

7. What are the pathologic and clinical differences between UC and Crohn’s?

8. List 4 categories of medical therapy for IBD and give one example for each.

9. Describe the radiologic features of toxic megacolon.

10. What the potential causes of toxic megacolon?

11. Which conditions are associated with the development of colonic ischemia? List 4 precipitants of ischemic colitis in the elderly and 3 in young patients

12. List 4 ddx for colitis

13. Differentiate between acute and chronic radiation proctocolitis in pathophys and clinical presentation

Wisecracks:

1) What is Ogilvie’s Syndrome? List 3 RFs

2) Compare AXR findings in SBO with LBO

3) What is the difference between each Cecal and Sigmoid volvulus on AXR? How is management different?

4) List 3 Perianal complications and 6 Extra-intestinal manifestations of Crohn’s disease.

5) How does adult intussusception differ from peds

View Details

This episode covers Chapter 94 of Rosen’s Emergency Medicine 8th edition (look at chapter 84 for the 9th edition). Have you ever seen gastroenteritis? If you haven't, its probably because you aren't in emergency medicine yet... but once you are... you will. Listen to this post to get ready for the brown winter.

1. Describe a general approach or investigation and management for suspected infectious diarrhea in the following groups:
   1. Non-bloody diarrhea
   2. Bloody Diarrhea
2. What are the 4 most common causes of infectious diarrhea? List 4 pathogens that a special test needs to be requested to diagnose in addition to stool C+S, O+P.
3. Describe common infectious patterns and risk factors for each of the following
   1. Campylobacter
   2. Salmonella
   3. Shigella
   4. Yersinia
   5. Vibrio parahaemolyticus
   6. Enterohemorrhagic E. coli
4. List 6 causes of bloody diarrhea and 5 features of illness that suggest invasive E.coli
5. List causes of toxin-induced bacterial enteritis: 4 performed toxins, 4 in-which toxins are produced after colonization. For each, describe typical source and pattern of illness
6. List 5 RFs for C. diff. What are 2 therapy options?
7. List the 2 most common causes of viral gastroenteritis. Differentiate the two based on patient population and course of illness
8. List 4 protozoal causes of gastroenteritis. For each, describe the clinical presentation
9. List 6 causes of diarrhea in AIDS. Describe an appropriate initial work-up. What additional steps may be required?
10. What is food poisoning?
11. Describe an approach to the management of travelers’ diarrhea. What are 5 common causes. Which if the most common?

View Details

This podcast covers Chapter 93 of Rosen's 8th Edition Emergency Medicine (or Chapter 83 if you've got the new-shiny 9th edition).

All hail to the appendix. The pluto of our organs.

1. List 8 ddx for appendicitis
2. List 5 causes of acute appendiceal obstruction and describe the pathophysiology of appendicitis including pain location
3. List 5 PEX findings in appendicitis. Describe how the presentation of appendicitis is different in peds, pregnant women, and elderly.
4. List 2 advantages and disadvantages each for CT and US in the diagnosis of appendicitis. What is the sensitivity/specificity of ↑WBC
5. Describe a clinical pathway for the diagnosis and management of appendicitis.
6. When are antibiotics indicated?

Wisecracks:

1) Which patient groups present atypically

2) Describe the Alvarado Score and the Ped for Appendicitis

3) What are U/S findings of appendicitis?

View Details

This episode of CRACKCast covers Rosen’s Chapter 92 for the 8th Edition (Chapter 82 9th Edition), Small Intestine. This chapter covers the various pathologies, diagnoses and treatments of the Small Intestine.

1. List types of mechanical bowel obstruction.
2. What are potential etiologies of mechanical bowel obstruction?
3. List causes of functional small bowel obstruction.
4. List 5 lab tests useful in the dx of SBO. What findings are expected on AXR? On CT?
5. Describe the acute management of SBO.
6. What are the potential complications of a small bowel obstruction?
7. List the 4 primary types of mesenteric ischemia. For each describe 4 associated factors/etiologies.
8. Describe the classic presentation of acute mesenteric ischemia?
9. How is mesenteric ischemia diagnosed? List 4 lab abnormalities expected in acute mesenteric ischemia. List 5 findings on AXR.
10. What is the management approach for the different types of mesenteric ischemia?

Wisecracks:

1.What is an adynamic ileus? List at least 5 causes.
2.Which patients with SBO should receive antibiotics?
3.What are the 3 arteries supplying the GI tract? Which most common culprit in acute 4.mesenteric ischemia?

View Details

This episode covers Chapter 91 of Rosen’s Emergency Medicine 8th edition (or Chapter 81 of the 9th edition).

1. List 10 ddx for pancreatitis
2. List 10 causes of pancreatitis. Which are most common in adults? Which one is most common in pediatrics?
3. Describe 6 management priorities in acute pancreatitis.
4. What are the early, late and chronic complications of pancreatitis?
5. Describe Ranson’s criteria and Atlanta criteria
6. List causes of chronic pancreatitis. What is the best diagnostic tool? What 4 findings can be seen?
7. Describe the management of chronic pancreatitis (6 priorities)?
8. What is the 5 year survival of pancreatic cancer? Describe typical clinical findings. How is it diagnosed? What is the management?

Wisecracks:

1. Specifically list 10 drug causes.
2. List 5 causes of false-positive amylase elevation.
3. List 4 peripancreatic/local complications of pancreatitis that may be visualized on CT

View Details

This episode covers Chapter 80 of Rosen's Emergency Medicine 9th edition. (Yes the new edition). Building on previous episodes (see fever, Jaundice and abdo pain), today we take a look at all things right upper quadrant badness.

1) List 8 ddx for hepatitis

2) Complete the following table for Hepatitis A, B & C: Transmission, Risk Factors, Carrier State, Acute Infection, Previous Infection, Chronic Infection, Prev Vaccine, Transmission Risk, Vaccine.

(show notes: What is hepatitis E? Where is it commonly found (geographically)? What is the significance of hepatitis D?)

3) Describe the post-exposure prophylaxis for exposure to HepA, HepB, HepC

4) Compare the expected lab work in acute viral hepatitis vs EtOH hepatitis

5) What liver diseases are associated with alcohol abuse? What non-hepatic conditions are associated with alcohol abuse? Describe the management of EtOH hepatitis

6) List 6 stigmata of chronic liver dz and list 3 complications

7) How is are chronic cirrhosis and ascites managed in the ER?

8) Describe a grading scale for hepatic encephalopathy and list 5 management considerations

9) Describe the ER diagnosis and management of SBP.

10) List 3 types of drug-induced liver disease.

11) What are two types of hepatic abscesses? How are they diagnosed and treated?

12) What is budd-chiari syndrome? How is it managed?

13) What is primary sclerosing cholangitis (PSC)? What is primary biliary cirrhosis? What is PSC associated with?

14) List 6 RFs for Cholelithiasis

15) Describe the clinical presentation of cholecystitis. List Lab, Xray (3) and US (4) findings

16) List 4 patients that get acalculous cholecystitis

17) List 4 considerations in the management of acute cholecystitis. When is surgery performed early?

18) What is the classic presentation of ascending cholangitis? What two clinical eponyms are described? How is ascending cholangitis managed?

Wisecracks:

1.. Which conditions are associated with transaminases in the 10000s?

1. How do you approach a patient with a needlestick injury? What is the risk of transmission following a needlestick?
2. What are underlying causes of hepatic encephalopathy in patients with known liver disease?
3. What are the typical investigations performed on ascites fluid? What is the SAAG and how is it interpreted?
4. What is the significance of a calcified gallbladder?

View Details

This episode covers Chapter 89 of Rosen’s Emergency 8th edition (or chapter 79 of 9th edition). Great review of some old concepts already presented, add a few spritzers of new stuff.

• List the the types of dysphagia. What is an ED approach to this condition?

• What are 4 areas of narrowing in the esophagus that FBs get stuck?

• List 8 causes of esophageal obstruction & List 3 therapies for a food bolus.

• What are the indications for removal of an esophageal foreign body?

• What are the indications for removal of a gastric foreign body?

• List 6 causes of esophageal perforation – where does the perforation usually happen?

• List 4 CXR findings of esophageal perforation and 3 other studies that can be performed.

• What is the ED management of a patient with esophageal perforation?

• List causes of esophagitis.

• List 10 agents or conditions associated with GERD and list 3 complications of GERD

• List 6 lifestyle modifications for someone with GERD and 3 medical therapies

• List 6 causes of gastritis and 6 ddx

• List the 2 main causes of PUD and describe the management of each.

• How are prostaglandins used the setting of GI disorders?

• What are the types of gastric volvulus? List risk factors for each. Describe the ED management.

Wisecracks:

• *Differentiate between chest pain from ACS and that of an esophageal origin.*

• What is the mechanism of NSAID toxicity in PUD? List 3 at risk populations and 2 methods of preventing PUD in these people.

• List 4 features of chest pain in PUD and 4 complications of PUD

• What is Borchardt’s triad?

• Describe the mechanism of action of H2 blockers and PPIs

• What are the potential complications of antacid use?

View Details

This Episode covers Chapter 88 (or 78 in 9th edition) of Rosen's Emergency Medicine.

PE and DVT. Jeff Kline wrote this chapter, so you knows its a gooder!

1. *List 8 DDx for DVT*
2. Describe management of superficial thrombophlebitis + isolated calf thrombosis
3. How is the d-dimer test used in the diagnosis of DVT?
4. List 8 causes of an elevated D-dimer
5. What are the Wells criteria for DVT? Describe how to use this score.
6. Describe diagnostic approach of suspected DVT
7. How is a proximal lower limb DVT managed?
8. What are the common causes of upper limb DVT?
9. How are upper limb DVTs managed?
10. List 10 classic risk factors for PE
11. What are the classifications of PE?
12. List 4 ECG + 2 CXR findings consistent with PE
13. What are the Wells criteria for PE? Describe how to use this score.
14. What is the PERC rule? How is it used?
15. Which imaging tests can be used to diagnose PE? List advantages and disadvantages of each.
16. List indications for thrombolysis in PE, what is the risk of ICH?
17. What are the absolute and relative contraindications for thrombolysis
18. List markers of poor prognosis in patients with PE.

Wisecracks:

• *What is phlegmasia cerulea dolens? How is it managed?*

• *Which patients should have an IVC filter?*

• *What about PE/DVT in pregnancy?*

• *What is the cause of hypoxia in patients with PE? What causes chest pain? What causes hypotension?*

• *What is Paget-Schroetter Syndrome?*

View Details

This episode covers Chapter 87 of Rosen’s Emergency Medicine

1. What is an atheroma and how is it formed?
2. What are the classic symptoms of arterial insufficiency?
3. Provide a differential diagnosis for chronic arterial insufficiency.
4. What is blue toe syndrome? What is its significance?
5. Differentiate between thrombotic and embolic limb ischemia based on clinical features
6. What is the management of an acutely ischemic limb?
7. List three disorders characterized by abnormal vasomotor response.
8. Describe Raynaud's disease and how it’s treated?
9. What is the most common site for arterial aneurysm in the leg?
10. List four potential sites for upper extremity aneurysms, and their associated underlying causes.
11. Name three types of visceral aneurysms and their associated conditions.
12. List 6 ddx of occluded indwelling catheter + describe the management of suspected line infection.
13. What are the two types of AV fistulas used for dialysis?
14. How do you access an AV fistula?
15. List 5 complications of dialysis fistulas + treatment
16. List the 3 types of thoracic outlet syndrome. What are the typical symptoms of thoracic outlet syndrome? What is a simple bedside test for this condition?
17. List 4 anatomic abnormalities associated with thoracic outlet syndrome.

Wisecracks:

Describe Buerger’s sign and ankle brachial index
List clinical criteria for Buerger’s Disease (5)
What is Leriche's syndrome?
List 4 types of infective aneurysms
Differentiate between arterial insufficiency ulcers and venous stasis ulcers

View Details

This episode covers Chapter 86 of Rosen’s Emergency Medicine. AAAs are our Great-White-Buffalo in emergency medicine. You need to know this!

1. List six presentations of an abdominal aortic aneurysm.
2. Compare Aneurysm and Pseudoaneurysm
3. List common misdiagnoses in patients with ruptured AAA
4. List three common early and delayed complications of AAA repair
5. List common delayed complications of Endovascular repair

Wisecracks:

• What to do about the intact, asymptomatic aneurysm?

View Details

View Details

This episode covers chapter 84 of Rosen's Emergency Medicine. All the little nuggets of medical goodness you wanted to know about hypertension related emergencies.

1. Define the three classes of hypertension relevant to emergency medicine practice
2. List 10 possible etiologies for hypertension.
3. What is the pathophysiology of target-organ damage?
4. How does hypertensive encephalopathy occur?
5. List 6 hypertensive emergencies; their management goals; the optimal agents for BP control and any relevant caveats
6. List five intravenous antihypertensive medications and their mechanism of action.
7. Describe the ER management of poorly controlled HTN

Wisecracks:

1. What are the management targets / indications for treatment in the following pts:
2. 1. 57 yo male with ICH and no signs of ↑ ICP.
   2. 39 yo female with SAH in the ED.
   3. 22 yo female with eclampsia.
   4. 66 yo female with ACS.
   5. 57 yo male with aortic dissection.
   6. 62 yo female with ICH, ↓ GCS, shift on CT scan.

View Details

This episode covers Chapter 83 of Rosen's Emergency Medicine.

1. List 6 RFs for bacterial endocarditis
2. List 5 common bacteria responsible for infective endocarditis
3. Give three examples of immunologic sequelae of IE.
4. Give three examples of vascular sequelae of IE.
5. What are the diagnostic criteria for endocarditis, and how are they used?
6. List 5 lab or investigative findings in bacterial endocarditis
7. Describe the treatment of infective endocarditis
8. List four complications of IE.
9. List the indications for infectious endocarditis prophylaxis. What are the empiric antibiotics used for pts with suspected infectious endocarditis?
10. Describe the Jones Criteria for Acute Rheumatic Fever
11. What is the treatment of rheumatic fever
12. Name three causes of acute mitral regurgitation.
13. How is acute MR managed?
14. What is the pathophysiology of mitral valve prolapse? How does it present?
15. List four causes of mitral stenosis.
16. List four causes of aortic valve insufficiency.
17. List 3 physical exam findings associated with AS
18. What is critical aortic stenosis?Outline the ED management for a pt with critical aortic stenosis with CHF and hypotension.
19. List 5 complications of prosthetic valves.

WiseCracks:

1. Describe

   1. Janeway lesions
   2. Osler nodes
   3. Splinter hemorrhages
   4. Roth Spots

2. What are the HACEK organisms, and what is their significance in pts with IE?

3. Brief run down of all valvular disease - in one or two lines.

View Details

This episode covers chapter 82 of Rosen's Emergency Medicine. Take a listen for all those juicy pericardial-pump-pearls!

1. List eight causes of pericarditis.
2. Describe typical pain of pericarditis, expected lab work abnormalities,
3. What is the typical sequence of ECG changes in pts with pericarditis? (the stages)
4. Describe the treatment of pericarditis associated with: Uremia, Neoplasm, and SLE
5. Outline the management of Dressler's syndrome.
6. What is the pathophysiology of cardiac tamponade? Describe the mechanism of hypotension in pericardial tamponade and list 4 expected findings on physical examination.
7. Describe the procedural steps in pericardiocentesis
8. List 4 causes of pneumopericardium and one specific PEX finding
9. List five causes of constrictive pericarditis.
10. What is the pathophysiology of purulent pericarditis? List 5 organisms responsible for infectious pericarditis? How is it managed?
11. Describe the pathophysiology of hypertrophic cardiomyopathy
12. Describe the clinical exam and ECG findings associated with HCM
13. List 5 RFs for sudden death in HCM
14. A pt with known hypertrophic cardiomyopathy presents to the ED with acute cardiogenic pulmonary edema causing mild hypoxia. What is the general approach to management in the ED? Explain your choices.
15. List four causes of dilated cardiomyopathy.
16. Describe ECG findings of dilated cardiomyopathy
17. List 5 RFs for developing a dilated cardiomyopathy
18. In what time frame would one expect peripartum DCM?
19. List 5 causes of restrictive cardiomyopathy
20. List 8 common pathogens responsible for myocarditis, and 3 non-infectious causes of myocarditis
21. Describe the stages of viral myocarditis and the management at each stage

Wisecracks:

1. What are some functions of the pericardium?
2. What are Chagas Disease and Trichinosis, list bizz-buzz features for each?
3. What are the expected cardiac findings in Lyme disease and how is it treated?
4. How does sarcoid affect the heart?
5. Amyloidosis?

View Details

This episode covers Chapter 81 of Rosen’s Emergency Medicine. This one is mint! Heart failure is one of those must-know-about presentations, you WILL see this in the ED.

1. Define
   1. Cardiac index
   2. Preload
   3. Afterload
2. Describe:
   1. How compliance changes the relationship between end diastolic pressures and volume
   2. the Frank-Starling relationship
   3. Pousseils Law and LaPlaces Law
3. List 3 CV and 4 Neurohormonal physiologic compensatory mechanisms in CHF
4. List the 5 most common disease processes resulting in HF and briefly describe the contribution of each
5. Describe the different classifications of heart failure:
   1. Acute vs. Chronic HF
   2. Systolic vs. Diastolic dysfunction
   3. Right vs. Left sided HF
   4. High-output vs. Low-output HF
6. Describe the NYHA function HF Classes and the Killip Classification
7. List 10 common precipitants of acute HF
8. List 6 historical predictors of acute HF and 6 clinical features of acute HF
9. List 5 CXR and 5 ECG findings of HF
10. What is the role of BNP in HF?
11. Describe the primary management goals in acute HF
12. Describe the mechanism of action of NIPPV in HF. Who needs to be intubated? When is it contraindicated?
13. Describe the pharmacologic treatment strategy for:
    1. Acute pulmonary edema + adequate perfusion
    2. Acute pulmonary edema + hypotension
14. How do nitrates work in acute pulmonary edema? What is the dose?
15. List 10 treatment options for chronic HF

View Details

This episode covers chapter 80 of Rosen's Emergency Medicine. All those juicy pearls about those funny little [black] boxes in your patients chest.

Chapter 80 – Implantable Cardiac Devices

1. List 5 Indications for permanent pacing
   1. What are common Pacemaker types?
2. Pacemaker nomenclature - what do the 5 letters mean
3. List the causes of pacemaker malfunction (main categories with 2 examples each)
4. List the complications of a pacemaker insertion
5. What is pacemaker pseudo-malfunction?
6. What is pacemaker syndrome, which type of pacer is most commonly involved, and what is the tx?
7. What does magnet application do to a pacemaker? to an ICD?
8. Indications for ICD
9. Causes of shock delivery in patient with ICD
10. Causes of syncope/presyncope in patient with ICD
11. Fxns of an ICD

Wise Cracks

1. What do you see on ECG when pacer battery dies (2)?
2. What is twiddler’s syndrome?
3. Describe your Approach to LVAD complications
4. Approach to Pacemakers

View Details

This episode covers Chapter 79 of Rosen’s Emergency Medicine.

All those funny squigly marks on the ECG confusing you? Us too. Here is some knowledge to help you out.

1. What is the blood supply of the following parts of the conduction system: SA node, AV node
2. What are the three pathophysiologic mechanisms for dysrhythmias?
3. What causes & how does AV nodal reentry tachycardia occur?
4. List the classes of antidysrhythmics. Describe their mechanism of action and usual uses, as well as an example of each.
5. How does digoxin work as an antidysrhythmic? When is it used?
6. List underlying etiologies of sick sinus syndrome.
7. What are three ECG presentations of sick sinus syndrome?
8. Define 1° heart block. List three causes.
9. Differentiate between the two types of 2° heart block with respect to etiology, ECG appearance and management.
10. What is ‘high grade’ heart block? How is it managed?
11. Describe the difference between AV dissociation & 3° AV block.
12. Compare PAC’s to PVC’s.
13. Give a differential diagnosis of irregularly irregular tachycardia.
14. Define pre-excitation and list the 3 ECG features of classic WPW
15. Explain the concept of antidromic and orthodromic conduction with respect to WPW. Which pts with WPW should not receive AV node blockers? Why?
16. List 10 causes of PVC and VT
17. How do you differentiate b/n SVT with aberrant conduction & ventricular tachycardia?
18. List 10 causes of atrial fibrillation.
19. Describe the management of AFIB, including a discussion about the CHADS2 score and long term stroke risk.
20. What is Brugada syndrome? What is the management?

WiseCracks:

1. List 8 side effects of Amiodarone.
2. Describe features that favor VT over SVT.
3. Describe the Brugada approach to the Dx of VT
4. List Causes of acquired pause-dependent QT prolongation causing Torsades & List causes of adrenergic dependent TdP
5. Describe the treatment of pause dependent TdP
6. Define PSVT and describe management
7. What’s Ashman’s phenomenon?

View Details

Here is the follow-up to the mammoth ACS chapter. This one has some key factoids to put into your mind map / memory pallace / organic computer.

1. List Sgarbossa criteria for AMI in pre-existing LBBB
2. What is Takotsubo cardiomyopathy and how does it present?
3. Describe the kinetics of cardiac biomarkers (Troponins and CK)
4. List DDx for ↑ Troponin
5. What is the utility of CTA in the diagnosis of MI?
6. What is the role of ED-based chest pain centers?
7. List 3 phases of delay in the management of AMI; and describe the time-points in ED management of AMI.
8. What are door-to-needle and door-to-balloon timelines by AHA recommendations?
9. Describe the mechanism of action and indications/contraindications for
   1. Nitroglycerin
   2. Morphine
   3. BBlockers
   4. ACE-I
   5. Antiplatelet Therapies
   6. Anti-thrombins
10. Describe eligibility criteria for Fibrinolytics
11. List contraindications to Fibrinolytic therapy in MI
12. What is the utility of Rescue PCI and Facilitated PCI?
13. List 5 indications for Rescue PCI
14. Describe factors assisting with decision to utilize PCI or thrombolytics
15. In NSTEMI, who will benefit from an early invasive strategy of management?

Wise Cracks:

1. What is the HEART Score?
2. What is the management of ACS in the setting of recent cocaine use?
3. How is STEMI diagnosed in the setting of LBBB?
4. How is STEMI diagnosed in the setting of a ventricular pacemaker?
5. When should you be getting a 15 lead ECG?

View Details

This episode covers Chapter 78 of Rosen's Emergency Medicine. Acute Coronary Syndromes... its a gooder.

Acute Coronary Syndromes Part A (Monday)

1. Define Stable Angina, UA, AMI
2. Describe the pathophysiology of AMI
3. What are the components of prehospital management of AMI
4. List population RFs for CAD.
   1. Do they matter in the evaluation of a specific patient?
5. List RFs for atypical presentation of ACS. What are the risks of atypical presentations?
6. List 8 early complications of AMI and briefly describe the management of each one.
7. Describe the progression of ECG changes in STEMI
8. List expected ECG changes (ST↑ and reciprocal ST↓) and culprit vessel for the following:
   1. Anterior wall MI
   2. Lateral wall MI
   3. Inferior wall MI
   4. RV wall MI
   5. Posterior wall MI
9. Describe the ECG characteristics of Left Main Occlusion
10. What is Wellens’ sign and what is it’s significance
11. List 10 DDx for ST-elevation
12. Describe the ECG features of
    1. Benign early repolarization
    2. Pericarditis
    3. LBBB
    4. RBBB
    5. Ventricular-paced rhythm
    6. LVH / Strain-pattern
    7. LV aneurysm

Wise Cracks:

What are the STEMI equivalents? Know these patterns!!!

View Details

This episode covers Chapter 77 of Rosen’s Emergency Medicine. The Pleural Space is not to be trifled with!

1. List 5 RFs for 1° spontaneous PTX.
2. What is the most common pathophysiologic cause of PTX?
3. List 8 causes of 2° spontaneous PTX
4. List 5 clinical findings suggestive of tension PTX
5. Describe how to estimate the size of a PTX
6. Describe the management of 1° and 2° spontaneous PTX
7. Describe the procedure needle aspiration of a PTX. List 3 benefits of this over TT
8. Describe the procedure of TT. List 6 complications of TT placement and contraindications.
9. List 10 causes of pleural effusion. What is the most common transudative and exudative?
10. What is starling’s law and how does it apply to the development of pleural effusions
11. List 5 CXR findings of pleural effusion
12. Describe Light’s Criteria for pleural effusion and list 5 other tests to perform on pleural fluid. What does a low pH indicate?
13. Describe the procedure of thoracentesis. List 2 contraindications and 9 complications

Wise Cracks

1. What is Catamenial pneumothorax? How is it tx?
2. How do you properly Secure a chest tube?
3. Describe the seldinger technique for chest tube insertion
4. What are the false positives for PTX on lung U/S?

View Details

This episode covers Chapter 76 of Rosen’s Emergency Medicine. Have you ever seen pneumonia? Yeah.... we thought so. Now here are all the nitty-gritty details.

1. What are the typical associative pathogens?
2. Describe the typical clinical presentation/RFs/Management for each of the following

-S. pneumonia
-H. influenzae
-Staph aureus
-Klebsiella
-Mycoplasma pneumoniae & Chlamydia pneumoniae
-Legionella
-Anaerobes
-Pseudomonas
-PJP & Other Fungal Pneumsonia
-Tuberculosis
-Tularemia
-Hantavirus 3. List the typical etiologies of viral pneumonia. 4. Which patient groups should receive pneumovax? 5. Which pneumonias can present with cavitating lesions (abscesses) on x-ray 6. What is the differential for possible pneumonia visible on CXR? 7. Describe the analysis of pleural fluid.
-Which effusions should be sampled?
-What are Light's criteria? 8. What is the CURB65 score?

View Details

This episode covers Chapter 75 of Rosen’s Emergency Medicine.

1. List potential causes of pharyngitis. (List 5 viral and 5 bacterial etiology of pharyngitis)

2. What are the indications for steroids in a patient with pharyngitis?

3. List causes of epiglottitis.

4. What are the deep spaces of the neck? List 4 deep space infections of the neck

5. What are the typical bacterial causes of deep space infections? What are the different syndromes called?

6. What are the potential complications of deep space neck/face infections? List 5.

7. When do the sinuses typically develop?

8. What the pathophysiology of sinusitis? What are the typical pathogens?

9. Describe the management of acute rhinosinusitis and list 6 predisposing factors

Wisecracks:

List 5 suppurative and 5 non-suppurative complications of GABHS
List 4 findings on lateral neck xray of epiglottitis
Describe an approach to airway management in deep space neck infections
What are lateral neck xray findings suspicious for RPA?

View Details

This episode covers Chapter 74 of Rosen’s Emergency Medicine. As Vanilla is to chocolate, COPD is to Asthma. Look for all things wheez-e-y here.

1. Define acute exacerbation
2. Describe GOLD classification for COPD
3. List factors of decompensation or triggers of an AECOPD
4. Name 4 mimics for AECOPD
5. What are the clinical features used to diagnose AECOPD?
6. Describe the ED management of AECOPD.
7. What does the end tidal tracing look like in COPD?
8. List indications and contraindications to NIPPV in COPD
9. Which patients with AECOPD should be treated with antibiotics?
10. Which patients with AECOPD require admission?
11. List indications for intubation for AECOPD

Wise Cracks

1. List 4 CXR and 3 ECG findings in COPD

View Details

This episode covers Chapter 73 of Rosen’s Emergency Medicine. The ancient Greeks knew about Asthma... so should you! We give you all the major points for diagnosis and treatment in the ED.

Sign post

1. 10 different causes of a wheeze.
2. List 8 risk factors for death from asthma
3. List 6 objective findings of severe asthma
4. 10 therapies for an acute severe asthma exacerbation
5. Discuss a ventilation strategy for the critically-ill asthmatic patient
6. Discuss disposition and discharge planning for an acute asthma exacerbation presenting to the ER

Wise Cracks

1. What is delayed sequence intubation? Can it be used for severe Asthma exacerbation?
2. What about pregnancy and Asthma is so important?

View Details

This episode covers Chapter 72 of Rosen’s Emergency Medicine. All those pearls you need for ears, masses, nose bleeds and weird stones in weird places.

1. Define Otitis Media
   1. Acute
   2. Chronic
   3. Recurrent
2. Describe the diagnosis treatment of Otitis Media
3. What are the complications of OM?
4. Describe the diagnosis and tx of Otitis Externa
5. Differentiate from malignant otitis externa
6. What is Ramsay Hunt Syndrome? How is it Tx?
7. Describe your approach to sudden hearing loss
   1. How is it treated?
8. Name 10 causes of epistaxis
9. Describe your approach to tx epistaxis
   1. Anterior bleeds
   2. Posterior bleeds
10. What is the differential diagnosis of neck masses?
11. What is SIALOLITHIASIS? How is it tx?

View Details

This episode covers Chapter 71 of Rosen’s Emergency Medicine. For such a small organ, the eye has A LOT of things to cover. Here we finish up in everything you need to know about that juicy ball of potential badness.

1. List 10 causes of ↓ vision post blunt eye trauma
2. What historical features are concerning for intra-ocular foreign body?
3. List 4 options for treatment of corneal abrasions
4. Describe the management of traumatic hyphema
5. What causes the finding of a ‘second pupil’ post-trauma?
6. Describe the physical findings of globe rupture and describe management
7. List 5 indications for ophtho consultation for eyelid lacerations
8. Describe diagnosis and treatment for orbital floor fractures:
9. List 2 findings on X-ray of orbital floor fracture
10. List indications for surgical repair of orbital floor fracture
11. Describe the clinical findings of retrobulbar hemorrhage and the steps in performing lateral canthotomy
12. List 3 complications of ocular trauma

View Details

View Details

This episode covers Chapter 70 of Rosen’s Emergency Medicine.

1. How are teeth traditionally numbered?
2. Describe the classification and management of tooth fractures
3. Describe the method for reducing a jaw dislocation? What is the usual direction of the dislocation?
4. Explain Ludwig’s Angina and its management
5. List 3 complications of maxillary (eg canine) tooth infection?
6. Describe management of Dental Caries vs Periapical abscess
7. Describe your approach to Acute Necrotising Ulcerative Gingivitis
   1. what is Vincent’s Angina?
   2. what is cancrum oris?
8. Rapid Fire treatment for the following:
   1. Post root canal pain
   2. Cracked Tooth or Split root syndromes
   3. Maxillary Sinusitis
   4. Atypical Odontalgia
   5. Post extraction pain
   6. Neuropathic pain
   7. Temporomandibular Myofascial Pain Dysfunction Syndrome
   8. Pericoronitis
   9. Apthous Stomatitis

WiseCracks

1. Spot diagnosis

View Details

This episode covers Chapter 69 of Rosen’s Emergency Medicine.

Sign Post:

1. List six types of elder abuse?
2. List ten risk factors for elder abuse?
3. List ten questions to screen for elder abuse?
4. What are some indicators on the medical history and physical exam that may suggest ongoing elder abuse?
5. Discuss ethical and legal implications of elder abuse. Who needs to be reported?

View Details

View Details

This episode covers Chapter 67 of Rosen’s Emergency Medicine. Its a heavy topic, but important to get right.

• What precautions should be taken prior to engaging in potential sexual abuse cases?

• What information can be useful in determining the location and likelihood of injury in sexual assault?

• What is the prevalence of mental illness in sexual assault patients? Which populations are found to have a higher proportion of mental illness? What effect does mental illness have on the severity of the attack?

• What factors make genital injury more likely to be observed? Less likely?

• What are the risks of STI's after sexual assault?

• What are appropriate treatments for STI prophylaxis in cases of suspected sexual abuse/assault?

• What resources exist to help medical providers and any victims of sexual abuse?

• What differences should be considered with male victims of sexual assault?

Thank-you to Dr. Sampsel for her assistance with this episode!

View Details

View Details

This episode covers Chapter 65 of Rosen’s Emergency Medicine. Its a big intro into the next few chapters covering forensic medicine in the emergency department. Tighten up those boot straps, this stuff is heavy!

1. What are some pearls and pitfalls for ER physicians when dealing with Forensic Emergency Medicine?
2. What are proper terms used to describe wound injury patterns?
3. What’s the anatomy of a cartridge (bullet)? What are the types and important aspects of wound ballistics?
4. What signs would you see for the various ranges of fire of a bullet?
5. What are common red flags to alert you to the possibility of domestic violence? What risk factors make domestic violence more common?
6. Describe the different types of blunt force pattern injuries and the pathophysiology of how they occur. Do the same for sharp force and thermal wounds.
7. What does the Health Insurance Portability and Accountability Act permit a physician to disclose to the investigating law enforcement officer?

View Details

This episode covers Chapter 64 of Rosen’s Emergency Medicine. Worried about what to do with those patient's coming in with their skin melting off from a chemical exposure? We've got you covered.

1) Describe the difference between Alkali and Acid injuries

2) Describe a HAZMAT response on scene

3) Describe the decontamination of an individual

4) List PPE for first responders or caregivers

Wisecracks

-Name two acids that cause damage through liquefactive necrosis
-List Chemical Agents used in Warfare / Terrorism
-What chemicals should you NOT irrigate with water?

View Details

This episode of CRACKCast covers Rosen’s Chapter 63, Thermal Burns. These patients are often the sickest in the department and many are on their way to the ICU. There are life-saving interventions that are begun in the emergency department with significant impacts on morbidity and mortality, and many are discussed in this episode.

Signposts:

1. List zones of burns
2. List 6 indications for intubation in the burn patient
3. List and describe 2 formulas for fluid resuscitation
4. Describe depth classification for burn injuries
5. List indicators of upper airway and lower airway burns
6. What is the Rule of 9’s and how is it modified in pediatrics
7. List criteria for transfer to burn unit
8. Describe basic burn dressing management
9. List 5 burn prevention strategies

Wisecracks:

1. What are the indications for an escharotomy
2. What are the primary considerations in mechanical ventilation of burn patients

View Details

This episode covers Chapter 62 of Rosen’s Emergency Medicine. Does leaving the comfort of your warm, safe bed scare you? After this chapter, it might...

Sign Post:

1. List the 4 families of venomous snakes.
2. Describe phenotypic characteristics of Pit-Vipers
3. Describe phenotypic characteristics of coral snakes?
4. List the grades of pit viper envenomation and indicate therapy?
5. Describe a black-widow spider and expected management goals?
6. Describe a brown recluse spider and expected management goals
7. List 3 classes of venomous marine injuries, and describe key principles of management for each?

WiseCrack:

• What does expert opinion suggest to avoid anaphylaxis in non-recombinant antivenin administration?
• What is the most toxic, per weight, venom?
• What are the general phenotypic features of poisonous snakes in North America?

View Details

This episode covers Chapter 61 of Rosen’s Emergency Medicine. Know anything about mammalian bites...? Yeah, neither did we until we read this chapter. Lots of juicy clinical pearls.

1. List 5 pathogens responsible for infection from Dog bite
2. List 4 risk factors for overwhelming sepsis from dog bite
3. What first line antibiotic is a good choice for cat and dog bites?
4. What species are known to cause infection with Pasteurella multocida?
5. What are the risk factors for infection with animal bites?
6. Describe the treatment of Monkey Bites?
7. When is anti-viral prophylaxis NOT indicated for a monkey bite
   1. What is the duration of therapy of antiviral prophylaxis?
8. Describe the recommendations for wound closure and antibiotics in bite cases

Wisecracks:

1. What about seal bites?
2. What about rabies in BC?
3. Waterhouse-Friderichsen syndrome & capnocytophagia-related Gangrene sepsis - what are they?

View Details

This episode of CRACKCast covers Rosen’s Chapter 60, Foreign Bodies. This episode covers an approach to foreign bodies, including location specific tips, complications and safe removal in the ED.

1. Describe your approach to Ocular FB
2. What is Seidel Sign?
3. List indirect signs of FB on Xray
4. List complications of ear FB
5. Describe the process of anesthesia of the ear and preparation for FB removal
6. Describe 5 techniques for removal of FB from ear
7. Describe the management of TM perforation secondary to FB
8. Describe 5 techniques for removal of FB from nose
9. Describe a step-wise approach to pediatric FB airway obstruction
10. List 7 symptoms of Esophageal FB
11. List 8 complications of esophageal FB
12. List 4 complications specific to button battery ingestions
13. List indications for removal of esophageal FBs
14. List 4 removal techniques of esophageal FB
15. List 5 techniques for management of food bolus and their mechanism of action
16. List the criteria for continued expectant management for intestinal FB
17. Describe the stepwise management of a Rectal FB

Wisecracks:

1. What is the safe dose of topical anesthetics?
2. How do you test the radiolucency of an object?
3. What is a Cafe Coronary? What is Penetration Syndrome?
4. Differentiate Body stuffing from Body Packing

View Details

In the third episode of the Physicians as Humans project, I corresponded with a Canadian emergency physician who sent me her personal account of depression. The result is this beautiful, thoughtful story that she has graciously allowed me to read for the podcast.

This is an ongoing project, so if you or anyone you know have a story about managing personal struggles while in medicine, please contact velmurug@ualberta.ca.

Music for Episode 02 (All songs have been modified for the project)

1. ambient by strange day. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
2. Cease by A Himitsu. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
3. I Dunno by Grapes. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
4. Lost Within by A Himitsu. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
5. Moon by LEMMiNO. Music provided by Music for Creators under a Creative Commons Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 license.
6. Tomorrow by Bensound
7. Laws of Movement by The Passion HiFi. www.thepassionhifi.com

View Details

This episode of CRACKCast covers Rosen’s Chapter 59, Wound Management Principles. This episode covers the nitty-gritty details of wound management and what you need to know to get that perfect wound closure!

Questions:

1) List risk factors for wound infection
2) List the 5 stages of wound healing
3) List toxic doses of local anesthetics
4) 3 types of wound closure?
5) List advantages of and contraindications of tissue adhesives
6) List indications for tetanus immune prophylaxis
7) List 5 specific wound care instructions
8) List 7 situations where antibiotic prophylaxis is indicated in wound management

WiseCracks:

Evidence guided tips for scar healing?

How to decrease pain of anaesthetic injection?

Where can I find a concise guide to Suture material use?

View Details

This episode covers Chapter 58 of Rosen’s Emergency Medicine: Orthopaedic Ankle and Foot injuries. Its a gooder for sure.

1. Describe the bones of the foot and important joints/ligaments
2. List Ankle stress tests
3. Describe an approach to ankle x rays (including the Ottawa ankle rules)
4. Describe the Weber classification
5. List indications for ortho referral in the ER
6. Describe the management of Achilles and Tibialis posterior tendon ruptures
7. Describe the Hawkin’s classification of talar neck fractures
8. Describe the diagnosis and management of calcaneal fractures and list 3 injuries associated with calcaneal fractures
9. Describe the anatomy and classification of lisfranc injuries
10. Describe the management of metatarsal shaft fractures.
11. List 6 predisposing conditions for stress fractures
12. List 4 causes each of hindfoot pain and forefoot pain
13. Differentiate between Jones and Dancer’s fracture
14. Describe 4 plain-film radiographic abnormalities for stress fracture
15. Describe the Tillaux fracture and pathophysiology

Wisecracks:

1. Discuss soft tissue injuries of the ankle
2. Name 6 other mimics of the “ it's just an ankle sprain”

View Details

This episode covers Chapter 57 of Rosen’s Emergency Medicine.

1) List contents of popliteal fossa

2) Describe Ottawa knee Rule

3) Describe Schatzker classification for tibial plateaus fractures

4) Describe the Insall-Salvati ratio

5) Describe the management of a knee dislocation

6) Describe the management and classification of patellar fracture and dislocation

7) List 6 overuse syndromes

8) Describe the sensory and motor function of nerves of the lower extremity

9) Describe the 4 compartments of the lower leg and their contents

10) Describe the management of Tibial tubercle fractures and Osgood-Schlatter Disease

11) List 4 complications of tibial shaft fractures

12) Describe the management of proximal fibula fractures

Wisecracks

• *What is a Baker’s cyst and how is it managed?*

• What are extensor mechanism injuries in the knee?

• DDx of acute onset calf pain?

View Details

This episode covers Chapter 56 of Rosen’s Emergency Medicine.

1) List 3 compartments of leg and contents

2) List 8 causes of AVN (traumatic and atraumatic)

3) List 5 most common primary cancers metastatic to bone

4) List 15 causes of hip pain without an obvious hip fracture

5) List 3 techniques for reduction of the hip

6) Describe 4 types of hip dislocation.

Wisecracks

1. Pediatric hip/femur pathology?
2. Hip dislocations
3. Classification of femur fractures
4. 6 causes of a child with a limp

View Details

This episode covers Chapter 55 of Rosen’s Emergency Medicine.

1) Describe common pelvic fractures and their classification

A)Young-Burgess classification

B)Tile classification

C)Denis classification

2) List 3 categories of complications of pelvic fractures

3) Describe the approach and management of hemodynamically unstable pelvic fracture.

4) List 5 radiographic cues to posterior arch fractures

5) What is the management of penetrating pelvic trauma

Wisecracks:

1) How are open pelvic fractures diagnosed and managed?

2) What is the classification of acetabular fractures?

3) How are coccygeal fractures managed?

View Details

This episode covers Chapter 54 of Rosen’s Emergency Medicine. 

1) Describe the myotomes and dermatomes L3-S1

2) List 4 Red Flag Diagnoses with associated RFs, Hx, PEX findings

3) Describe SLR, crossed-SLR, flip-test, reverse SLR and their implications

4) List 5 indications for Xray in low back pain

5) Discuss the discrimination of functional from organic back pain

6) Describe the management of:

a. Fracture

b. Cauda Equina Syndrome

c. Spinal Infection

d. Vertebral Malignancy

e. Simple Radiculopathy

7) List 8 DDx for Thoracic back pain

Wisecracks:
Backpain treatment cocktails?
When to order the CT scan?
How to estimate the amount of post-void residual volume with ultrasound?

View Details

View Details

This episode covers Chapter 52 of Rosen's Emergency Medicine.

1. Describe an approach to the pediatric elbow
2. Classify supracondylar fractures in children
3. List 3 complications of supracondylar fractures
4. Describe the management of supracondylar fractures
5. Describe the management of humeral shaft fractures – displaced and non-displaced
6. Describe 3 injuries common in Little-leaguer's elbow
7. Describe the management and classification of radial head fractures
8. Describe the expected neurovascular injuries and management of posterior elbow dislocations
9. List the indications for x-ray in radial head subluxation
10. Describe the management of olecranon bursitis

View Details

This episode covers Chapter 51 of Rosen’s Emergency Medicine.

1) Describe normal radiographic relationships:

1. Radial length measurement
2. Radial inclination
3. Volar Tilt
4. Scapholunate angle
5. Capitolunate angle
6. Wrist arcs

2) Describe xray findings and management of

1. Scaphoid fracture
2. Lunate fracture
3. Triquetral fracture

3) Describe Mayfield’s stages of carpal instability 4) Describe DISI and VISI

5) Describe xray findings and management of

1. Colles’
2. Smith’s
3. Barton’s
4. Hutchinson’s / Chauffer’s
5. DRUJ Disruption

6) Describe management of pediatric 1. Forearm fractures 2. Torus fractures 3. Greenstick fractures

7) List 8 RFs for Carpal Tunnel Syndrome + Describe 2 tests for CTS

8) Describe the Monteggia and Galeazzi’s fracture patterns

View Details

View Details

View Details

View Details

This episode covers Chapter 47 of Rosen’s Emergency Medicine.

1. List 6 general indicators of genitourinary trauma?

Lower urinary tract and external genitalia

• What are the four parts of the male urethra?

• What is the mechanism of an anterior urethral injury (at least 5 causes)? What is the mechanism of a posterior urethral injury?

• List 4 indications for retrograde urethrogram before foley placement?

• Describe the technique for a retrograde urethrogram?

• Classify bladder injuries and describe the mechanism of injury.

• Differentiate between extraperitoneal and Intraperitoneal bladder rupture

• Describe the indications and technique for retrograde cystogram?

• Outline the management of the different types of bladder injuries.

• List 3 clinical findings of a penile fracture

• Describe the management of penile

• Constricting devices

• Superficial hematoma

• Superficial lacerations

• Degloving injury

• Penile Fracture

• Penile amputation

• Blunt scrotal trauma

• Bites

Upper urinary tract

• What is the presentation of a ureteric injury?

• What are the indications for renal imaging in an adult trauma patient? In a pediatric trauma ?

• Describe the management of renal injuries:

• Blunt

• Penetrating

Wisecracks:

What is the most common site of urethral injuries?

View Details

This episode covers chapter 46 of Rosen's Emergency Medicine text book.

Episode Overview:

1) What are three mechanisms of injury in blunt trauma?

2) List expected seat-belt injuries

3) What are the most common intra-abdominal injuries in children?

4) Differentiate between the use of CT scan, diagnostic peritoneal lavage (DPL) and ultrasound – advantages & disadvantages.

5) List intra-abdominal injuries that may be missed on CT.

6) Describe the process of local wound exploration.

1. List 5 ways to determine if peritoneum has been violated

7) List clinical indications for laparotomy in blunt and penetrating abdominal trauma

8) Describe the management of unstable blunt abdominal trauma

1. Pelvic fracture
2. Head injury (closed head injury)
3. Wide mediastinum (aortic injury)

9) Provide an approach to anterior abdominal trauma with:

1. Evidence of peritoneal violation (penetrating injuries)
2. Evidence of intra-abdominal injury with blunt abdominal trauma

10) Provide an approach to flank injuries

11) Provide an approach to back injuries

Wisecracks:

1) Describe indications and technique of diagnostic peritoneal lavage (DPL). What is a positive DPL?

2) List 1 absolute contraindication and 4 relative contraindications to DPL

3) What is Waddel’s triad?

4) What are Gray-Turner and Cullen’s signs?

5) How much blood is detectable by bedside US?

View Details

This episode covers Chapter Chapter 45 of Rosen’s Emergency Medicine text book and is full of pearls for Thoracic Trauma. Sign Post: 1. Differentiate Chest wall injury, rib fracture, and flail chest 2. Describe the clinical presentation and management of a sternal fracture 3. Describe Injuries to lung parenchyma 4. What is Traumatic asphyxia? 5. List 6 indication for tube thoracostomy 6. Indications for OR Thoracotomy 7. What is the management of Diaphragmatic injury? 8. Differentiate between myocardial concussion, contusion and rupture 9. Review indications for ED Thoracotomy 10. Describe your approach to identification and management of pericardial tamponade 11. CXR findings for blunt aortic injury. 12. List the 6 most common causes of esophageal perforation 13. What is the Nexus CT Chest Rule?

WiseCracks:

1. Clinical conditions that mimic esophageal perforation
2. Describe the basic approach to ED thoracotomy
3. What is Electrical Alternans?

View Details

This episode of CRACKCast covers Rosen’s Chapter 044, Neck Trauma. Continuing in our trauma series, this episode tackles the challenging issue of neck trauma and injuries, and explores the anatomy and relevant considerations in the diagnosis and management of both blunt and penetrating neck injuries.

Episode Overview:

1) Describe the landmarks and structures using the Zones of the neck & the Triangles of neck

2) List 6 hard and 6 soft signs of penetrating neck trauma. What are the indications for immediate OR vs CTA in managing penetrating neck trauma

3) Describe an approach to managing acute neck trauma in the ER

4) Describe the management of venous air embolism

5) Describe techniques for airway management in penetrating neck trauma

6) Describe the management of suspected pharyngoesophageal trauma. What are signs of esophageal injury?

7) List 3 hard signs of laryngotracheal trauma and describe airway management dilemmas

Wisecracks:

1) Differentiate between choking, hanging and strangulation

2) Define judicial and non-judicial hanging and describe expected injury patterns

View Details

This episode covers Chapter 043 of Rosen’s Emergency Medicine, Spinal Injuries.

Episode Overview

• Describe the anatomical contents of the anterior and posterior spinal columns
• List cervical spinal injuries for the following mechanisms, and indicated whether they are stable or unstable
  1. Flexion x 6
  2. Shear / AP forces x 1
  3. Flexion-Rotation x 2
  4. Extension x 3
  5. Vertical Compression x 2
• List 8 unstable C-spine injuries
• Describe an approach to C-Spine X-rays, and define normal:
  1. Predental space
  2. Soft-tissue spaces
  3. Line of Swischuck
• Describe Canadian C-Spine Rule + Nexus Rule
• Describe incomplete cord lesions
• Describe:
  1. Wallenburgs Syndrome
  2. Dejeune Onion Skin Pattern of Analgesia
  3. Horners Syndrome
  4. Cauda Equina
• How does the bulbocavernosus reflex reflect the presence of spinal shock
• List features of sacral sparing
• List Dermatomes/ Myotomes / Spinal reflexes
• List 6 causes of Horner’s
• For what C-spine injuries is a CT-a indicated to R/O vascular injury
• Are Steroids indicated for C-spine injuries
• For whom is surgical intervention indicated immediately with a spinal cord injury
• Define neurogenic shock and describe its management
• Define spinal shock
• What is the risk of cervical injury in Down’s Syndrome? Rheumatoid Arthritis?
• What are the Denver criteria?

View Details

This episode covers Chapter 42 of Rosen’s Emergency Medicine, Facial Trauma.

1) Describe the anatomy of the bones, glands, and ducts of the face. At what ages do the sinuses appear?

2) List 5 types of facial fractures.

3) Describe the clinical presentation and associated radiographic findings of an orbital blowout fracture.

4) Describe an orbital tripod fracture and its management.

5) List the indications for antibiotics in a patient with facial trauma?

6) What is the importance of perioral electrical burns?

7) What are the indications for specialist repair of an eyelid laceration?

8) Describe the classification and management of dental fractures.

1. What is the management of an avulsed tooth?
2. What is a luxed tooth? How is it managed?
3. What is an alveolar ridge fracture?

9) Describe the method for reducing a jaw dislocation? What is the usual direction of the dislocation?

View Details

In the second episode of the Physicians as Humans project, I speak with Dr. Rob Rogers (@EM_Educator), a leading educator in emergency medicine and director of The Teaching Course. He shares his experiences of dealing with a devastating illness in his own family and the effect it had on his career as an emergency physician.

This is an ongoing project, so if you or anyone you know have a story about managing personal struggles while in medicine, please contact velmurug@ualberta.ca. If you are unfamiliar with the project, please read this post for more information on the origin of this podcast series. The CanadiEM podcast can be added to your podcast application from the iTunes store or by entering the podcast RSS feed. If you would prefer to download it, click here. It can also be streamed above.

Thanks for listening and please refer your colleagues!

Music for Episode 02 (All songs have been modified for the project)

1. ambient by strange day. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
2. Moon by LEMMiNO. Music provided by Music for Creators under a Creative Commons Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 license.
3. Icy Vindur by A Himitsu. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
4. Flourish, Wither, Bye by A Himitsu Music provided by Music for Creators under a Creative Commons — Attribution 3.0 Unported— CC BY 3.0 license.
5. Where Silence is Nonexistent by A Himitsu Music provided by Music for Creators under a Creative Commons — Attribution 3.0 Unported— CC BY 3.0 license.
6. Tomorrow by Bensound
7. Pressure by Riot

View Details

This episode covers Chapter 41 of Rosen’s Emergency Medicine.

1) list 7 causes of altered LOC in the trauma patient

2) List four herniation syndromes.

Describe the pathophysiology of uncal herniation and the typical presentation.

Describe the presentation of central herniation.

3) Describe how cerebral blood flow in relationship to the following parameters: PO2 , PCO2 , MAP and ICP. What are the indications for ICP monitoring?

4) What is the Canadian CT head rule? What are the inclusion criteria. What is the New Orleans CT head rule? What are the inclusion criteria? Which test is more sensitive? More specific?

5) What is a concussion? How is a concussion managed? What are potential complications? Define second impact syndrome & return to play

6) Outline the ED management goals of TBI.

• differentiated between direct and indirect TBI
• What are the indications for seizure prophylaxis following TBI?
• What are the indications for antibiotics in TBI?
• Complications of TBI?

7) 7 clinical features of basal skull #

Wisecracks

1. CT tips: 3 signs of cerebral edema on CT, 5 differences on CT between SDH And EDH, List 3 CT findings in DAI
2. What are: the Monroe-Kellie doctrine, the Cushing’s reflex, What is kernihan’s notch, and how does this syndrome present?

View Details

This episode of CRACKCast covers Rosen’s Chapter 040, Injury Prevention and Control.

1) What are the three key aspects to Injury Control?

2) What makes up the Injury Triangle?

3) List 6 of 10 potential strategies for preventing transfer of energy

Wisecracks:

1) What can you actually do, as a health practitioner, to help injury prevention?

View Details

This episode covers Chapter 39 of Rosen’s Emergency Medicine textbook.

Episode Overview

1) 5 Risk Factors for falls in the elderly?

2) What anatomic and physiologic changes in the elderly patient are important for the management of trauma in the elderly patient. (changes in the CVS, CNS, reap, MSK, skin) Explain why these are important?

3) What are the most common c-spine injury in the geriatric patient?

View Details

This episode covers Chapter 38 of Rosen's Emergency Medicine.

Episode Overview

1. List 5 relevant anatomic/physiologic differences between children and adults in relation to trauma management
2. List 8 airway differences between pediatrics and adults with their relevant implications
3. List potential fluid therapies for hemorrhagic shock and their doses
4. List 3 ideal IO sites in pediatrics and describe the procedure
5. Describe the pediatric GCS
6. List 6 indications for laparotomy
7. List 6 signs of elevated ICP in infants and children
8. What is an impact seizure?
9. List the 5 layers of the scalp and describe 3 types of extra cranial bleeding in pediatrics
10. What is the difference between a linear and a diastatic skull fracture
11. Describe the typical presentation and etiologic cause of an epidural hematoma and a subdural hematoma
12. Describe the management of elevated ICP
13. List 10 anatomical differences between the pediatric and adult cervical spine
14. How can you discern between true subluxation and pseudosubluxation at C2/C3
15. List 2 ways to choose the size of chest tube in pediatrics
16. What are indications for ER resuscitative thoracotomy in chest trauma?
17. List pediatric specific cardiovascular and abdominal injury patterns

View Details

This episode covers Chapter 37 of Rosen's Emergency Medicine.With trauma in pregnancy we need to think about blunt vs. penetrating trauma. Many women do not know they are pregnant.

Episode Overview:

• What is the threshold for fetal viability and how can this be estimated clinically?
• List the expected physiologic changes during pregnancy.
• List 8 unique considerations in the management of the pregnant trauma patient.
• How is fetal distress detected?
• Discuss placental abruption including the pathophysiology, clinical findings, diagnostic modalities, management, and complications.
• List 2 potential uterine injuries
• What is a safe radiation dose in pregnancy? What diagnostic tests have the potential to exceed this dose?
• Describe early, variable, and late decelerations. What is the implication of each? What is one other indicator of fetal distress related to the FHR?

Wisecracks:

• How is feto-maternal hemorrhage diagnosed and managed?
• Describe specific management in the following conditions:
• What are indications for peri-mortem c-sections. Describe the procedure.

View Details

This episode covers Chapter 36 of Rosen's Emergency Medicine.

Episode Overview: * List indications for activation of a trauma team * What is the general approach to a multi-trauma patient? * List commonly missed trauma injuries * ED thoracotomy indications and contraindication for blunt and penetrating trauma

Wisecracks: * Describe the term permissive hypotension and when you would not use it * What are 3 goals for out of hospital care of a trauma patient

View Details

This episode covers Chapter 35 of Rosen's Emergency Medicine.

Episode overview:

1) List 10 historical red flags for back pain
2) List 6 Emergent Diagnosis for back pain

Wisecracks:

1) Describe the most common sites of disc protrusion with their associated neurologic findings
2) Outline your approach to acute undifferentiated back pain
3) Describe your treatment approach for acute musculoskeletal low back pain

View Details

This episode covers Chapter 34 of Rosen's Emergency Medicine.

Episode Overview:

1) Indicate 12 causes of vaginal bleeding, indicating at which age group each is most common
2) List 6 causes of bleeding in early pregnancy
3) Describe the management of severe third trimester bleeding and postpartum hemorrhage

Wisecracks:
1) List options for managing vaginal bleeding in the non-pregnant patient
2) When would you avoid estrogen products in non-pregnant women with vaginal bleeding?

View Details

This episode covers Chapter 33 of Rosen's Emergency Medicine.

Episode overview:

1) List 8 diagnoses of pelvic pain in women that are of reproductive tract origin
2) List 3 causes of pelvic pain in the pregnant patient who is: Fewer than 20 weeks pregnant or Greater than 20 weeks pregnant

WiseCracks:

1) List 6 life threatening causes of acute pelvic pain in women
2) Outline a systematic approach to acute pelvic pain in women
3) List 6 risk factors for ectopic pregnancy

View Details

This episode covers Chapter 32 of Rosen's Emergency Medicine.

Chapter 32 – Constipation

Episode Overview:

1) List 6 treatment options for the management of constipation

Wisecracks:

1) What are 6 broad categories for the causes of constipation?

View Details

This episode covers Chapter 30 of Rosen's Emergency Medicine.

Episode overview:

1) List 5 causes of UGIB in adults and pediatrics
2) List 5 causes of LGIB in adults and pediatrics
3) Describe your management approach for severe UGIB
4) List 6 low-risk criteria D/C of GIB
5) List components of the Rockall and Glasgow-Blatchford score

Wisecracks:

1) Describe the insertion of a Blakemore tube
2) List 6 causes of false positive stool guaic

View Details

This episode covers Chapter 31 of Rosen's Emergency Medicine.

Episode Overview:

1) Define Acute, Persistent, Chronic Diarrhea
2) Describe the 4 mechanisms of diarrhea
3) List 15 historical factors that increase the risk of probability of non-benign diarrhea
4) What are the indications for empiric antibiotic treatment?
5) List 6 organisms that cause bloody diarrhea

WiseCracks

1) When is Loperamide indicated?
2) When should you use stool cultures / O&P
3) Best way to give children pedialyte?

View Details

This episode covers Chapter 29 of Rosen's Emergency Medicine.

Episode Overview:

1. Describe the mechanism of development of a Hypochloremic Metabolic Alkalosis in vomiting
2. List commonly used anti-emetics including their dose and their receptor site of action.
3. List causes of vomiting specific to age groups: infant, newborn, child, and teen.

Wisecracks:

1. What are the three main areas providing afferent inputs to the vomiting centre?
2. Name 6 critical causes and 6 complications of vomiting

View Details

This episode covers Chapter 28 of Rosen's Emergency Medicine.

Episode overview:

1) Describe heme metabolism
2) List common pre-hepatic/hepatic/post-hepatic causes of jaundice

Wisecracks:

1) What are clinical signs of liver disease?
2) What laboratory tests can be useful in a jaundiced patient?
3) List the triad of acute hepatic failure
4) List and describe 6 critical causes of jaundice
5) What are 3 causes of jaundice in pregnancy?

View Details

This episode covers Chapter 27 of Rosen's Emergency Medicine.

Episode overview:

1. List and explain 8 causes of life-threatening abdominal pain
2. List 15 causes of extra-abdominopelvic abdominal pain

Wisecracks:

1. Why is WBC of so little utility in abdominal pain?
2. When is an abdominal x-ray useful in investigating abdominal pain?

View Details

This episode covers Chapter 26 of Rosen's Emergency Medicine.

Episode overview:

1. List 6 critical causes of chest pain

Wisecracks:

1. Walk through a systems approach to chest pain including common and uncommon causes of chest pain
2. Outline your approach to the person with sudden onset severe chest pain

View Details

On behalf of the Physicians as Humans project, I’m thrilled to present the first episode of the series: “Addiction in a medical student.” If you are unfamiliar with the project, please read this post to learn about the podcast series' origins.

In this first episode I speak with a Canadian medical student about his personal battle with drug addiction during medical school. He candidly describes his experience and the powerful impact it has had on his future as a physician.

This is an ongoing project, so if you or anyone you know have a story about managing personal struggles while in medicine, please contact velmurug@ualberta.ca.

Thanks for listening!

Niresha, Physicians as Humans Project

Music for Physicians as Humans Episode 01

ambient by strange day https://soundcloud.com/strange-day
Creative Commons — Attribution 3.0 Unported— CC BY 3.0
http://creativecommons.org/licenses/by/3.0/
Music provided by Music for Creators https://youtu.be/_CxScpf_Dds

untitled by NICKV. https://soundcloud.com/nickvmusik
Creative Commons — Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0
http://creativecommons.org/licenses/by-sa/3.0/
Music provided by Music for Creators https://youtu.be/c9y0bwX2kSQ

Fireflies by Muciojad https://soundcloud.com/muciojad
Creative Commons — Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0
http://creativecommons.org/licenses/by-sa/3.0/
Music provided by Music for Creators https://youtu.be/nlFVU2SSBHA

I Am A Man That Will Fight For Your Honour by Chris Zabriskie
Indie Disco by Ben Fawkes https://soundcloud.com/benfawkes
Creative Commons — Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0
http://creativecommons.org/licenses/by-sa/3.0/
Music provided by Music for Creators https://youtu.be/9yN_wLfNA9g

Your Heart Beats Like Mine by Crimson Mourn https://soundcloud.com/crimson-mourn
Creative Commons — Attribution 3.0 Unported— CC BY 3.0
http://creativecommons.org/licenses/by/3.0/
Music provided by Music for Creators https://youtu.be/45BYLXYmLEI
All songs have been modified for the project

View Details

This episode covers Chapter 25 of Rosen's Emergency Medicine.

Episode overview:

1. List 10 critical causes of dyspnea

Wisecracks:

1. Outline your approach to the acutely dyspneic patient
2. Name 6 uncommon causes of dyspnea

View Details

This episode covers Chapter 24 of Rosen's Emergency Medicine.

Episode overview:

1. Describe the management of massive hemoptysis
2. List the 12 causes of hemoptysis

Wisecracks:

1. How do you tease out other hemoptysis mimics?

View Details

This episode covers Chapter 23 of Rosen's Emergency Medicine.

Episode overview:

1. List 8 Emergent Diagnoses for the chief complaint of sore throat
2. List the most common viral, bacterial, and non-infectious causes of sore throat
   • List at least 8
3. Describe the modified Centor Criteria and their use

Wisecracks:

1. Describe the pros and cons of antibiotics for suspected or confirmed acute GAS pharyngitis (see Rosen’s page 202)
2. Other than Group B Strep, name 6 agents causing exudative pharyngitis

View Details

This episode covers Chapter 22 of Rosen's Emergency Medicine.

Episode overview:

1. Describe the Relative Afferent Pupillary Defect, how it is diagnosed, and list a
   differential diagnoses for this finding
2. List 6 treatment options for Acute Angle Closure Glaucoma
3. Describe 5 history or physical exam findings that distinguish between periorbital
   cellulitis and orbital cellulitis

Wisecracks:

1. What are the causes of exophthalmos?
2. How can you differentiate between viral and bacterial conjunctivitis?
3. Causes of anisocoria?

View Details

This episode covers Chapter 21 of Rosen's Emergency Medicine.

Episode overview:

1. List the differential diagnosis (critical emergent, urgent) for Diplopia
   • Including at least 7 causes of binocular diplopia
2. Describe the mechanisms of normal extraocular movements
3. Describe the specific cranial nerve palsies causing diplopia

Wisecracks:

1. What are the 5 most important questions to ask yourself about diplopia?
2. Describe your approach to diplopia in the sick patient

View Details

This episode covers Chapter 20 of Rosen's Emergency Medicine.

Episode overview:

1. List 7 life threatening causes of headaches
2. List 5 red flags on history for headaches
3. When should you perform a CT before performing a LP?
4. Describe 8 clinical findings indicative of elevated ICP

Wisecracks:

1. Describe 5 CT findings suggestive of elevated ICP
2. List 7 non-life threatening causes of headache

View Details

This episode covers Chapter 19 of Rosen's Emergency Medicine.

Episode overview:

1. Compare characteristics of peripheral and central vertigo
2. What are risk factors for central causes of vertigo?
3. List 4 vestibulotoxic drugs.
4. Describe the Hallpike Maneuver and the Epley Maneuver
5. List 5 causes of Peripheral Vertigo and describe features of illness
6. List 5 causes of Central Vertigo and describe the features of illness

Wisecracks:

1. HINTS exam
2. Pathophysiology stumper:
   • Why does dizziness or vertigo lead to nausea, sweating, malaise?
3. What is the barbecue roll?

View Details

This episode covers Chapter 18 of Rosen's Emergency Medicine.

Episode Overview:

1. Define status epilepticus
2. List the doses of common medications used for status epilepticus
3. List 10 differential diagnoses for seizures
4. List 10 indications for head CT in new-onset seizure

Wisecracks:

1. How long does a driver in British Columbia require their driver’s license be suspended after a seizure?
2. What are the most common causes of status epilepticus?
3. What are the “cannot miss” causes of seizure?

View Details

This episode covers Chapter 17 of Rosen's Emergency Medicine.

Episode Overview:

1. List the Major Categories for the differential diagnosis of Confusion
2. Differentiate between organic and functional confusion.
3. List the Critical and Emergent causes of Confusion

Wise Cracks:

1. Describe a quick assessment tool for screening for confusion

View Details

This episode covers Chapter 16 of Rosen's Emergency Medicine.

Episode Overview:

1. List a broad differential diagnosis for coma
2. List GCS / Pediatric GCS
3. Describe the oculocephalic and oculovestibular reflex

Wise Cracks:

1. List the common age-related causes of altered mental status
2. What is the initial investigation management of an altered LOC patient?

View Details

This episode covers Chapter 15 of Rosen's Emergency Medicine.

Episode Overview:

1. What are 12 critical causes of syncope?
2. List common medications that can cause syncope
3. Describe the San Francisco Syncope Rule
4. What are red flags that require admission in syncope?

View Details

This episode coveers Chapter 14 of Rosen's Emergency Medicine.

Episode Overview:

1. What is the differential diagnosis for cyanosis?
2. List the common causes for methemoglobinemia
   • 10 medications
   • 6 toxins
3. Describe the mechanism for methemoglobin formation, treatment, and indications for methylene blue

Wisecracks

1. Explain the oxygen-hemoglobin dissociation curve
2. What is the hyperoxia test?

View Details

This episode covers Chapter 13 of Rosen's Emergency Medicine.

Episode Overview:

1. Compare upper motor neuron (UMN), lower motor neuron (LMN), and neuromuscular junction (NMJ) causes of weakness
2. List 10 neuromuscular causes of weakness and describe their basic pathophysiologic mechanism
3. What are warning signs of impending respiratory failure in a patient with neuromuscular weakness?

Wisecracks

1. List seven non-emergent causes of peripheral neuropathy
2. What are some causes of non-neuromuscular weakness?
3. Clinical pearls for the weak patient

View Details

This episode covers Chapter 12 of Rosen's Emergency Medicine.

Episode Overview:

1. Describe the physiologic mechanism of increasing the body’s temperature
2. What is the change in HR and RR with every increase of 1°C core body temperature?
3. What is the emergency medicine specific approach to defining the infectious differential?
4. List 15 causes of non-infectious hyperthermia

Wisecracks

1. Description of fever vs. hyperthermia
   • Approach to a patient with an elevated temperature
2. Points on fever in the elderly, chronically ill, or immunosuppressed
3. What is the most accurate way of measuring core body temperature?

View Details

This episode covers Chapter 11 of Rosen's Emergency Medicine.

Episode Overview:

1. List the equipment needed for neonatal resuscitation
2. List 5 questions to ask the mother during an imminent delivery
3. Describe the components of the initial assessment of the newborn (APGAR)
4. What is the management of meconium?
5. When should oxygen be used in the neonatal resuscitation period?
6. What is the indication for CPR in a neonate?
7. Describe how to perform CPR on a neonate
8. What are the indications for intubation of a neonate?
9. List 4 reasons not to resuscitate a newborn

Wisecracks

1. What are some special considerations for resuscitating a preterm infant?
2. Describe the Neonatal Resuscitation algorithm
3. A quick review of specific neonatal disorders:
   • Diaphragmatic hernia
   • Meningomyelocele
   • Omphalocele
   • Choanal atresia
   • Pierre-Robin sequence
4. Neonatal Resuscitation Case (shownotes only)

View Details

This episode covers Chapter 10 of Rosen's Emergency Medicine.

Episode Overview:

1. Describe the CPR technique for an infant
2. Describe the PALS cardiac arrest, bradycardia and tachycardia algorithms
3. Describe the PALS septic shock algorithm
4. List the dose and primary indication for core pediatric resuscitation medications
5. What are 8 risk factors for Sudden Infant Death Syndrome (SIDS)?
6. List 8 strategies for preventing SIDS
7. Describe the management of a SIDS death
8. Define Apparent Life Threatening Events (ALTE) and list 10 causes

Wisecracks

1. Epidemiology and pathophysiology of pediatric cardiac arrest
2. What does Rosen’s say about atropine and succinylcholine use in pediatric resuscitation?
3. What are the pertinent anatomic features of children as it relates to laryngoscopy and intubation?

View Details

This episode covers Chapter 9 of Rosen's Emergency Medicine

Episode Overview:

1. List 10 etiologies of non-traumatic cardiac arrest
2. List the two most important determinants of good outcomes in cardiac arrest
3. List the components of good quality CPR
4. List 6 ways to monitor CPR
5. What are 3 hard indicators of adequate perfusion during CPR?
6. What are your post-cardiac arrest goals?

Wisecracks:

1. List 4 contraindications to CPR
2. ACLS algorithms talk through – you must know!
   1. pulseless VT or VF
   2. PEA
      • list all the 5H’s and 5T’s
        1. asystole
        2. respiratory arrest
        3. brain arrest / cognitive arrest
3. Sleuthing out why the patient arrested? (our approach to the hx and physical)

View Details

This episode covers Chapter 8 of Rosen's Emergency Medicine.

Episode Overview:

1. Describe 6 therapeutic interventions for the post-arrest brain
2. List 5 techniques for initiating therapeutic hypothermia
3. List 4 mechanisms of therapeutic hypothermia in improving neurological outcome

Wisecracks:

1. What components make up cerebral blood flow and CPP?
2. (shownotes only) Essential Evidence: Target Temperature Management at 33 C vs 36 C after Cardiac Arrest (Nielsen et al., 2013)

View Details

This episode covers Chapter 7 of Rosen's Emergency Medicine.

Episode Overview:

1. Describe the 3 categories of blood antigens
2. Who is the universal donor and why?
3. Define massive transfusion
4. List 5 physiologic complications of massive transfusion
5. What are the indications for the administration of: pRBCs / FFP / Platelets** / Cryoprecipitate
6. List 6 complications of blood transfusions and their management

Wisecracks:

1. What are the components of octaplex? When is it indicated?
2. What is FEIBA?
3. List the three types of plasma that are available from the blood bank?
4. What are the absolute and off-label uses for recombinant factor VII?
5. Which products are most likely to result in sepsis?
6. What is a hyperhemolytic crisis?

View Details

This episode covers Chapter 6 of Rosen's Emergency Medicine.

Episode Overview:

1. List, define and explain the 5 causes of shock
2. What is the utility of lactate and base deficit in the management of shock?
3. Define: SIRS, Sepsis, Severe Sepsis, and Septic Shock
4. List 5 empirical criteria for the diagnosis of circulatory shock
5. Describe Early Goal Directed Therapy
6. Describe the management goals in cardiogenic shock

Wisecracks:

1. A stepwise approach to cardiogenic shock

View Details

This episode covers Chapter 5 of Rosen's Emergency Medicine.

Episode Overview

1. List 6 situations when pulse oximetry is not useful?
2. List 10 situations when capnography is useful?
3. Describe the ETCO2 curve?
4. List four indications for invasive blood pressure monitoring?

View Details

This episode covers Chapter 4 of Rosen's Emergency Medicine.

Episode Overview:

1. What are the depths of procedural sedation (PSA)?
2. Describe the continuum of procedural sedation?
3. Describe the recommended personnel and monitoring during PSA?
4. What are contraindications for PSA in the ED?
5. What agents can be used for procedural sedation and analgesia?
6. Describe ASA classification system?
7. Describe appropriate discharge instructions for patients post-procedural sedation?
8. List 8 complications / side effects of ketamine and how some can be treated?
9. List 4 situations when ketamine may be contraindicated?
10. List 4 side effects of propofol in procedural sedation?

View Details

This episode covers Chapter 3 of Rosen's Emergency Medicine.

Episode Overview:

1. Describe the steps in the afferent pain pathway?
2. Differentiate between acute and chronic pain?
3. List options for pain management at various steps in pain perception?
4. Describe the different methods of assessing pain for all ages
5. List 4 side effects of NSAIDS, what factors increase risk of GI bleeding?
6. What is the mechanism of action of local anesthetics? What are the two classes?
7. What is the toxic dose of lidocaine and bupivacaine? What are expected toxicities? How are they treated?
8. List 6 techniques for reducing pain of injection of local anesthetic.
9. List one topical anesthetic for intact skin, mucous membranes, and open skin
10. What is the dose of sucrose in a neonate for anesthesia?

View Details

This episode covers Chapter 2 of Rosen's Emergency Medicine.

Episode Overview:

1. What are Indications and contraindications to NIPPV?
2. Describe your initial BePAP or CPAP settings?
3. What are good initial vent settings?
4. How do you troubleshoot the crashing patient on the ventilator?

View Details

This episode covers Chapter 1 of Rosen's Emergency Medicine.

Episode Overview:

1. How do you make the decision to intubate a patient?
2. What are predictors of difficult bag valve mask ventilation?
3. What are the predictors of difficult intubation?
4. What are the predictors of difficult LMA insertion?
5. What are the predictors of a difficult surgical airway?
6. Differentiate non-depolarizing vs. depolarizing paralytic agents?
7. What are the contraindications to succinylcholine?

View Details

In this first and very special episode of CRACKCast we interview the legend himself, Dr. Peter Rosen.

A huge thank you Dr. Peter Rosen for making his time available for this. Portions of the interview will be showing up in later episodes.

Remember: "study from fear"