EM Clerkship

* Common during the first year of life as well as during puberty * Presents with nausea/vomiting, abdominal pain, and/or testicular pain * ALWAYS examine a child for signs of torsion who presents with abdominal pain (especially lower abdominal pain) * Look for tenderness, firmness, high riding testicle or testicle with unequal lie, swelling, and the absence of a cremaste

You are working at Clerkship General when the next patient is put into your rack. It is an 8 year-old male with vomiting Initial Vitals: HR: 119 BP: 104/63 Temp: 98.0F RR: 20 O2: 99% (Room Air) Critical Actions: * Finger Stick Blood Glucose * Treat Patient’s Pain * Diagnose Testicular Torsion * Immediate Urology Consult * Perform Manual D

Phase One: CNS * Ataxia, Slurred Speech, Confusion, N/V, Seizures Phase Two: Cardiopulmonary * CHF, Cardiogenic Shock/Hypotension, Pulmonary Edema, ARDS Phase Three: Renal * Flank pain, Hematuria, Oliguria, Renal Failure Diagnosis: * HIGH INDEX OF SUSPICION * Ethylene Glycol Serum Level * Elevated Osmolar Gap * Serial Anion Gap Measurements

You are working at Clerkship General when you hear an EMS call on the radio. Clerkship General, we are bringing you Arthur. He is intoxicated… Again Initial Vitals: HR: 116 BP: 150/70 Temp: 98.8 RR: 26 O2: 85% (Room Air) Critical Actions: * Recognize Hypoxemia * Diagnose Toxic Alcohol Ingestion * Consult Nephrology Emergent Dialysis * Admini

Hypertensive Emergencies of Pregnancy PreEclampsia, Eclampsia, HELLP syndrome Diagnosis: BP 140/90 plus end organ dysfunction * Acute Kidney Injury * Proteinuria * Thrombocytopenia * Transaminitis * Hemolysis * Pulmonary Edema * Cerebral Edema / Hemorrhage * Headache refractory to tylenol * Visual Changes * RUQ Pain not attributable to another

You are working at Clerkship General when the next chart is put in your rack. It’s a 41-year-old female with a chief complaint of headache. Initial Vitals: HR: 56 BP: 172/93 Temp: 98.8F RR: 18 O2: 97% Critical Actions: * Check a Blood Glucose * Diagnose Preecclampsia/Ecclampsia * Administer Magnesium * Treat the Hypertension * Discuss wi

Diagnosing PE: Step 1: Consciously consider the diagnosis Step 2: Risk Stratify into low, intermediate, and high risk Step 3: Choose appropriate testing based on pre-test probability Classification of PE * High Risk/Massive PE: Hemodynamic Instability * Intermediate Risk/Submassive PE: Right Heart Strain without instability ; or PESI Class 3+ * Low Risk/Non-M

You are working at Clerkship General when you overhear the base command radio. “Clerkship General. We have a 57 year-old female coming in for leg pain. She just had surgery at your hospital. Her blood pressure is 85/50. We’ll be there in 5 minutes.” Initial Vitals: HR: 122 BP: 75/40 Temp: 100.1 RR: 24 O2: 74% Critical Actions: * Obtain f

Shock – A state of deranged physiology characterized by systemic, widespread hypoperfusion * Hypovolemic Shock * Hemorrhage * Volume Loss (vomiting/diarrhea, dehydration) * Cardiogenic Shock * ACS, Myocarditis, CHF, Valve failure, Endocarditis, etc * Obstructive Shock * Massive PE, Tension Pneumothorax, Cardiac Tamponade * Distributive Shock * SIRS

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