CanadiEM Podcasts: CRACKCast, ClerkCast, CarmsCast, First Year Diaries

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.

Core Questions Explain broad causes of elevated bilirubin (obstructive, hepatocellular, and hemolysis) and the significance of direct vs. indirect hyperbilirubinemia (Fig 25.1) Explain your approach to the history and physical exam in patients with jaundice (Fig 25.2) List 10 causes of jaundice (Table 25.2) Explain your approach to ancillary testing in patients with jaundice. Wisecracks What are the stages of hepatic encephalopathy? What is the triad of acute hepatic failure? What is Charcot's triad and Reynold's pentad? What is the "1000s Club" and how do you become a member?

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.

Core Questions What are risk factors for serious underlying causes of abdominal pain? (Box 24.1) Explain key symptoms and signs to look for in the evaluation of the patient with abdominal pain. What diagnoses are associated with different patterns of abdominal pain? (Fig 24.1) List 5 critical and 5 emergent causes of abdominal pain (Table 24.1, 24.2) Explain an approach to ancillary testing in abdominal pain. Outline a diagnostic algorithm for patients with abdominal pain (Fig 24.4) Outline an empiric management algorithm for abdominal pain. (Fig 24.5) Wisecracks What are the structures included in the foregut, midgut, and hindgut? More importantly, why do you care? List indications for bedside US in the ED patient with abdominal pain (Table 24.3) Explain how referred pain works in the setting of abdominal pain (Fig 24.2)

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.

Core Questions Describe an approach to key history and physical exam for chest pain patients presenting to the ED. (Table 23.2 and 23.3) List 5 critical diagnoses, 5 emergent, and 5 nonemergent diagnoses to consider in the patient presenting with chest pain. (Table 23.1) Describe an approach to the critically ill patient with undifferentiated chest pain. (Figure 23.1) Describe an approach to ancillary testing in chest pain. (Table 23.4 and 23.5) List the risk factors associated with each critical chest pain diagnosis (Box 23.1) Explain the approach to risk stratification of ED chest pain patients. Wisecracks What are the X-ray findings of aortic dissection? What are your HR and BP targets in Aortic dissection? List the components of the HEART score.

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

Core Questions Define the following terms: Dyspnea Tachypnea Hyperpnea Hyperventilation Dyspnea on exertion Orthopnea Paroxysmal Nocturnal Dyspnea What anatomical structures are responsible for controlling respiratory effort? Outline an approach to the history for the dyspneic patient. Detail the physical examination for the dyspneic patient and highlight pivotal exam findings that point to specific pathologies. 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. What ancillary tests are indicated for the dyspneic patient? Detail the utility of point-of-care ultrasound in the assessment of the dyspneic patient. Outline a management algorithm for the acutely dyspneic patient. Wisecracks List three findings on chest radiograph suggestive of pulmonary embolism. What is the utility of venous blood gas testing and how do its values correlate with that of an arterial blood gas?

Core Questions: Define "massive hemoptysis". Which vessels, when injured, are typically associated with small and massive hemoptysis, and how do the vessel characteristics influence the degree of bleeding? Outline an approach to the history and physical examination for a patient presenting with hemoptysis. Outline the differential diagnosis for hemoptysis and highlight five critical and five emergent diagnoses that cause hemoptysis. (Box 21.1 and 21.2) What ancillary tests are warranted in the patient with hemoptysis? Detail the utility of imaging studies in patients with hemoptysis. Detail the diagnostic approach to the patient with hemoptysis. (Figure 21.1) Outline an approach to managing the patient with hemoptysis. (Figure 21.2) What two maneuvers can be used to address massive hemoptysis from a suspected tracheo-innominate fistula (TIF)? What strategies can be used to improve oxygenation in the patient with massive hemoptysis? Wisecracks: List one gynecologic cause of hemoptysis. List five causes of massive hemoptysis. What is the most lethal consequence of massive hemoptysis?

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!

Core Questions: What are the three anatomically-distinct zones of the pharynx, and what structures outline their borders? Ultrasound of the Neck Lateral neck radiograph Nasopharyngoscopy CT Soft Tissues Neck Describe the utility of the following imaging modalities in the patient with sore throat. Outline five viral, five bacterial, and five other potential aetiologies of sore throat in the ED patient? (Table 20.1) Outline the components of the Modified Centor Score and describe its application. Describe the diagnostic algorithm for the patient with sore throat. (Figure 20.4) Outline the approach to managing a patient with sore throat in the ED. (Figure 20.4) What antibiotics can be used in the patient with suspected or confirmed streptococcal pharyngitis? (Box 20.2) Wisecracks: In what age groups is streptococcal pharyngitis rarely seen? What is Waldeyer's Tonsillar Ring? What is the "thumb sign" and what pathology does it point to?

Core Questions: Detail the pertinent points to review when taking the history of a patient presenting with a red and painful eye - Box 19.2 Outline an approach to the ocular physical examination - Box 19.3 Outline the components of the slit lamp examination - Box 19.4 What signs and symptoms, if present, likely indicate the presence of serious ocular pathologies - Box 19.1 What is a relative afferent pupillary defect and what conditions cause it? List ten causes of increase intraocular pressure List five causes for an absent red reflex - Box 19.5 Name three critical, emergent, urgent, and non-urgent causes of the red and painful eye? - Figure 19.8 Wisecracks: What are the fundoscopic findings of a central retinal artery occlusion. What is the pinhole test and what visual disturbances does it correct? What are the three most common causes of an irregularly shaped pupil What is Seidel's Test and what condition does it identify?

Core Questions: What is diplopia and how is it classified? What four questions help clinicians delineate the potential cause of a patient's diplopia? What are the cardinal directions of gaze and how are they tested? Outline the physical exam for the patient with monocular and binocular diplopia. Outline the DDx for monocular diplopia? Outline the DDx for binocular diplopia? [Table 18.1] Detail the different oculomotor palsies. [Figure 18.3] Detail the various lacunar stroke syndromes. [Box 18.1] Define internuclear ophthalmoplegia. What ancillary tests are required for the patient presenting with diplopia? [Figure 18.4] Wisecracks: What are the most common oculomotor palsies and what causes them? What is orbital apex syndrome? What is the "rule of the pupil" and how reliable is it? Detail the physical exam maneuvers used to identify patients with myasthenia gravis.

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

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!

Core Questions: List three primary headache disorders Describe the pathophysiology of migraines and name three Emergency Department treatments for same List five critical and five emergent causes of headache (Table 17.1) Outline your approach to the history for the patient presenting with headache ( Box 17.1) Outline your approach to the physical exam for the patient presenting with headache (Table 17.3) Describe your diagnostic approach to the patient with a suspected SAH Detail the findings on LP that would suggest your patient has bacterial meningitis Wisecracks: What percentage of patients presenting with headache to the ED have a SAH? Outline the SNOOP MEETS Pregnancy mnemonic Which diagnostic test is best to establish the diagnosis of cerebral venous sinus thrombosis? Detail how to elicit Kernig's and Brudzinski's Sign

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!

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!

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.

Core Questions: What is dizziness and what pathologies can cause it? Define vertigo and acute vestibular syndrome What three systems are involved in the maintenance of equilibrium and how many of these systems must be affected to cause vertigo? Trace the neuronal impulse from the vestibular apparatus to the muscle endplate Define nystagmus List five peripheral causes of vertigo (see Table 16.2) List five central causes of vertigo (see Table 16.2) Differentiate between central and peripheral vertigo based on history and clinical exam findings Describe the Dix Hallpike Test Outline your approach to the HINTS exam What is the Epley maneuver and what pathology does it treat? Describe the Barbecue Roll Test and what pathology does it treat? Outline your approach to managing the vertiginous patient Wisecracks: What diagnoses cause both vertigo and hearing loss? What features of nystagmus suggest a central pathology? What is truncal ataxia and what typically causes it?

Core Questions: Define seizure and provide an explanation of the classification systems for seizure Define recruitment as it relates to seizure development and progression Differentiate between seizure and syncope Differentiate between neurogenic and psychogenic seizures List 5 diagnoses that can mimic seizures (see Box 15.2) Define status epilepticus and differentiate between convulsive and non-convulsive status epilepticus List 10 causes of status epilepticus in adults (see Box 15.1 and 15.3) Outline management of status epilepticus. List indications for head CT for first seizure. Wisecracks: List 5 properties of ictal events Isoniazid Toxicity TCA Toxicity Eclampsia Hypoglycemia Hyponatremia What medications are needed to treat seizing patients with the following: Name 3 key metabolic abnormalities that can cause seizures Name 3 common seizure provokers that can worsen pre-existing seizure disorders What percentage of patients with convulsive status epilepticus will develop non-convulsive status epilepticus?

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)

Core Questions: Define confusion. What is your differential diagnosis for the confused patient? Differentiate between organic and functional causes of confusion. What is the Quick Confusion Scale (QCS) and how is it calculated? What is the Brief Confusion Assessment Method (bCAM) and how is it used? What is the Mini-Mental State Examination (MMSE) and how is it scored? What ancillary tests are used when working up the confused patient? What is the role of thiamine in the treatment of the acutely confused patient? Wisecracks: What simple tests can you use to assess concentration at the bedside? What treatments should be used for the patient with acute hypoglycemia causing confusion? List 5 emergent and 5 critical diagnoses that cause confusion.

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: 01:57 – 03:05 - Can you please introduce yourself? (name, training, where you work, interests, etc.). 03:05 – 04:45 – Tell me about your philosophy, and what your career trajectory has been? 04:55 – 08:07 – How can new physicians get to become an educator like you? 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? 12:43 – 27:56 – Can you tell us about how you manage department flow efficiently and safely, especially during busy times? 20:41 – 23:56 – Tips to effectively manage flow 23:56 – 27:56 – Tips to effectively manage learners 27:56 – 32:45 – What are some mistakes that you've seen new physicians make? (Either clinical or non-clinical). 32:45 – 36:38 – What can new staff do to keep their wellness intact and avoid burnout? What are some strategies you use? 36:36 – 38:28 – Do you have any final comments you would like to share?

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?

Core Questions: List 10 life-threatening causes of syncope List 10 medications that can precipitate syncope What are the red flags on history and physical exam in syncope? What are markers of increased short-term risk in syncope patients? (box) What are 5 ECG findings to look for in the syncopal patient? List five indications for admission and inpatient evaluation for the patient with syncope? Wisecracks: What is the significance of a patient presenting with syncope vs. near syncope? What is the utility of orthostatic vital signs? What degree of cerebral hypoperfusion is needed to cause unconsciousness?

Core Questions: Define cyanosis and explain what causes it? What is central cyanosis and what typically causes it? What is peripheral cyanosis and what typically causes it? At what concentration of deoxyhemoglobin does cyanosis present? List 10 differential diagnoses for cyanosis - Box 11.2? Describe your initial workup for the patient with cyanosis.- Figure 11.3/11.4 What is the oxyhemoglobin dissociation curve and what information can be taken from it? - Figure 11.1 Name four factors that shift the oxyhemoglobin dissociation curve to the left and three factors that shift it to the right. Differentiate between ferrous and ferric hemoglobin and describe how these forms of hemoglobin affect oxygen binding. What is methemoglobinemia and how does it present? What are the two biochemical pathways that are used to reduce methemoglobin? List 10 causes of methemoglobinemia - See Box 11.1 What is sulfhemoglobinemia and when should you suspect it? Differentiate between primary, secondary, and relative polycythemia and how does it cause cyanosis? Wisecracks: What is the colour of the blood in a patient with methemoglobinemia? What is clubbing and what causes it? What SpO2 is present on the monitor in the patient with a methemoglobinemia? What is the hyperoxia test and how does it help you in your workup of the cyanotic patient? What is the dose of methylene blue when prescribed to treat patients with methemoglobinemia?

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: [email protected] Dr. Tamara McColl: [email protected]

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.

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: Can you please introduce yourself? (name, training, where you work {academic, community, etc}, any other work you are doing {tox, primary care, etc.}). How is it being a new ED staff physician 6 months into practice? What has been the biggest difference been so far being a staff vs. a resident? Can you share an interesting story as a staff? (can be anything – having residents, billing experience, research you are working on etc.) What is the best thing about being a staff physician? What are some struggles/challenges of being a new staff physician? 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.) Any tips on work-life balance? (wellness, coping with struggles, travel, etc.) Take Home Points: 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. 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. 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!). 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. 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.

Core Questions: What structure controls body temperature and how does it go about controlling it? What are pyrogens and how are they classified? What is the difference between fever and hyperthermia? What is the role of PGE2 in fever and what medications can you give to combat its effects? List four factors that blunt the febrile response. What are the benefits and pitfalls of the febrile response? List five infectious and five non-infectious causes of fever. (see Box/Table 9.1) Describe your approach to the febrile patient. (see Figure 9.1/9.2) Wisecracks: What is the most accurate temperature measurement site? How are heart rate and body temperature related? How are respiratory rate and body temperature related? How high must a fever be to necessitate rapid cooling interventions?

Core Questions: Describe your history and physical exam in the patient being actively resuscitated. Discuss the process of deterioration to cardiac arrest with respiratory failure and cardiac obstruction. List 6 aspects of optimal CPR. What medications have been shown to improve outcomes in cardiac arrest? List 8 differential diagnoses for PEA arrest (See Table 8.4) What is electromechanical dissociation (EMD) and how does it differ from pseudo electromechanical dissociation (pseudo EMD)? What is echo-guided life support (EGLS) and how is it used? Carotid or femoral pulse CPP Arterial relaxation (diastolic) pressure PETCO2 SCVO2 What are your targets during CPR for the following metrics? (See Table 8.3) Wisecracks: What is cough CPR and when should it be used? What is the only antidysrhythmic shown to improve rates of VF conversion to a perfusing rhythm? What is the minimum coronary perfusion pressure (CPP) is needed to achieve return of spontaneous circulation (ROSC)? What is the triad of cardiac arrest?

Core Questions: What is cerebral autoregulation? Describe your parameters for post-arrest care of a brain injured patient. List 7 interventions for management of a patient with elevated ICP. What are the equations for cerebral blood flow and cerebral perfusion pressure? Describe a protocol for induced hypothermia after cardiac arrest. In the patient with a traumatic brain injury, what is the optimal drug for and duration of seizure prophylaxis? Wisecracks: What are Lundberg A waves? What is the relationship between PaCO2 and CBF? What is the Monro-Kellie hypothesis? How do these values change in patients with severe coma? What is the probability that a survivor of cardiac arrest has a full neurologic recovery?

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

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

This updated episode of CRACKCast covers Rosen's Chapter 005, Monitoring the Emergency Patient (9th Ed.). Core Questions: List modalities for measurement of BP and note which modalities are likely to over and underestimate blood pressure. What is pulse pressure and how does it relate to stroke volume? List 4 indications for an arterial line. What is the Beer-Lambert Law and how does it allow us to measure pulse oximetry? How do dyshemoglobinemias affect your measured SpO2? What are the 4 phases of the ETCO2 waveform? List 5 uses for ETCO2. Wisecracks: List the pitfalls of pulse oximetry. Purple Yellow Tan Describe colorimetric ETCO2 monitoring and cite the ranges at which you would expect to see the following colours: How are ETCO2 values related to PaCO2? What are causes of elevated ETCO2? What does MOVIE stand for (aka - how to rock your oral exam resus questions)?

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

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): Allodynia Amnesia/amnestic Local anesthesia Analgesia Hypnotic Narcotic Nociceptor Noxious stimulus Opiate Opioid Pain Procedural Sedation Sedative 2. Describe a practical approach to stepwise management of pain in the ED. 3. Describe the adult parenteral and oral doses for: Morphine Hydromorphone Fentanyl 4. Differentiate between opioid side effects and opioid toxicity. 5. How do you manage opioid toxicity? 6. Describe relative safety profiles for the NSAIDS. 7. List the classes of local anesthetics. How do they work? 8. List the toxic doses for each local anesthetic: Lidocaine Lidocaine with Epi Bupivicaine 9. List 5 techniques to reduce pain of injection of local anesthetic. 10. List agents that can be used for topical anesthesia of: Intact skin Mucous membranes 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: Tramadol Demerol 3. How does local anesthetic toxicity present?

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

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

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.

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?

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"?

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?

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.

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!

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.

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.

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.