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

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.

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.

Core Questions: Define AIDS List 5 risk factors for AIDS List 10 AIDS-defining conditions Describe 3 serum tests for HIV List 6 Ddx for respiratory infections in HIV Describe the presentation and treatment of PCP pneumonia Describe an approach to diagnosis and management of CNS infections in AIDS List 5 causes of odynophagia in HIV List 6 causes of diarrhea in the HIV patient Describe HAART therapy Describe prophylaxis of opportunistic infections in HIV WiseCracks: Risk stratify exposure to HIV What is Coccidiomycosis? Name common ART agents and their adverse effects

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

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.

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.

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!

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.

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?

Core questions What are the five most common causes of hyperkalemia? Describe the ECG features seen with hyperkalemia. List at least 5. How is hyperkalemia managed? How does each intervention work, and how long do the effects typically last? What are the five most common causes of hypokalemia? Describe the ECG features seen with hypokalemia. List at least 4. How is hypokalemia managed? What are the three main types of hypernatremia? Give 3 examples of each. List four central and four nephrogenic causes of diabetes insipidus. What are the four broad categories of hyponatremia? Give an example of two clinical conditions for each: hypovolemic, euvolemic and hypervolemic hyponatremia. What are the three most common causes of SIADH? Describe the management of hyponatremia in the following patients: Actively seizing Euvolemic with acute hyponatremia Hypovolemic with chronic hyponatremia Hypovolemic with acute hyponatremia What are the five most common causes of hypercalcemia? What are the five most common symptomatic causes of hypocalcemia seen in the emergency department? What ECG features are seen in hypercalcemia vs. hypocalcemia? How is each managed? What are the five most common causes of hypermagnesemia? List five clinical manifestations of hypermagnesemia. List five common causes of hypomagnesemia. What are the five most common causes of hyperphosphatemia? What are the five most common causes of hypophosphatemia in the ED? How do they manifest clinically? Wisecracks. What electrolytes abnormalities are often with hypomagnesemia? How do you estimate the total body water?

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.

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.

Episode Overview: List 10 causes of Thrombocytopenia List 6 causes of Thrombocytosis Describe the presentation and treatment of HIT, ITP and TTP Describe what causes an abnormal PT? What causes an abnormal PTT? Describe the deficiency and management of Hemophilia A, Hemophilia B, and vWD Describe the management of a major and minor bleed in hemophilia A List 4 items in cryoprecipitate 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?

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.

This episode covers Chapter 110 of Rosen's Emergency Medicine (9th Ed.), Dermatologic Presentations. Episode Overview List five broad categories of rashes Describe the primary skin lesion types a. Bonus: What are the secondary skin lesions (show notes only) 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 List 10 causes of EM / SJS / TEN Describe presentation of EM + SJS/TEN. Differentiate between TEN and SJS List 6 broad categorical causes of urticaria 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 List 5 causes of desquamating lesions List 5 palm and sole rashes List 10 maculopapular rashes List 1 low, medium and high potency topical steroid Identify the following rashes: erythema migrans, erythema marginatum, erythema multiforme, erythema nodosum, meningococcemia

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!!!

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: What the pathophysiology of lupus List diagnostic criteria for SLE List drugs that induce lupus Describe the clinical manifestations w/ Classic triad & Symptoms and signs by system in lupus List 3 drug regimens to treat SLE How does neonatal lupus present? What is antiphospholipid syndrome? What is the unusual laboratory feature seen with this condition? What is the pathophysiology of vasculitis? Large vessel vasculitis Medium vessel vasculitis Small vessel vasculitis Hypersensitivity vasculitis Subcutaneous vasculitis Give examples of: Compare the findings for vasculitis List 5 criteria for dx of temporal arteritis + 2 associated features Describe the features of Behcet's Disease List 10 causes of Erythema Nodosum Compare Buerger's, Serum sickness and Hypersensitivity Vasculitis List the diagnosis Criteria for HSP WiseCracks What is the differential for SLE patient and Chest pain? Name and identify 2 pathognomonic clinical features for lupus When should Rheum be involved in the ED with a SLE patient? Spot Diagnosis: A 36 year old female stock trader present with what appears to be necrosis of the nose and ears… Spot diagnosis: 13 year old presents with abdo pain, polyarticular arthritis, foaming urine and the following rash… Rounds Pimper: List 10 side effects of chronic steroid use

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: What is the differential diagnosis for tendinopathy? What are common sites for tendinitis? List 6 differential diagnoses for atraumatic non-septic bursitis List common causes for infected bursitis Wisecracks: Differentiate septic and inflammatory bursitis based on clinical exam and fluid aspirate results List 4 physical exam findings of impingement syndrome

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.

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

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

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

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.

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

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: List the 3 neurotransmitters implicated in depression List the DSM V criteria for Major Depressive Episode (box) Define Seasonal Affective disorder, Dysthymic Disorder and Cyclothymic disorder Define Bipolar I and Bipolar II List the DSM V Criteria for a Manic Episode (box) List 8 general medical conditions and 8 medications that cause depression Describe first line medical therapy for depression and bipolar disorder List 4 criteria for hospitalization in an acute psychiatric episode Wisecracks 1. Mnemonics for symptoms of depression and mania

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!

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.

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.

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.

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!

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.

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: List the four key diagnostic criteria for delirium List six strong predisposing or precipitating factors for delirium List 15 causes of delirium Describe how to use a screening tool for delirium: MMSE List 3 potential medications used for chemical restraint List 2 potential side effects of Haldol administration Compare delirium with dementia List important diagnostic studies for the workup of delirium List four diagnostic criteria for dementia List 10 specific causes of reversible dementia List 10 causes of non-reversible dementia Wisecracks: Explain how you differentiate between psychosis, delirium and dementia. How does Aricept work? Describe the pathophysiology of Alzheimer's dz and list RFs for its development What is the triad of normal pressure hydrocephalus?

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.

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.

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.

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.

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 UTI's in Adults Prostatitis Renal Calculi Bladder (Vesical) Calculi Acute Scrotal Pain Acute Urinary Retention Hematuria

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.

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.

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...

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. List features that are typical for IBS. (Describe the Rome IV criteria and list 4 medications used to treat irritable bowel syndrome - show notes) What is the pathophysiology of diverticular disease? List clinical presentations of diverticular disease. How is diverticular disease managed in the ED? Which patients should be admitted to hospital? List 3 complications. List the types and potential causes of large bowel obstruction. What are the four types of GI volvulus? What are the risk factors for developing each type? List the extra-intestinal manifestations of IBD. What are the pathologic and clinical differences between UC and Crohn's? List 4 categories of medical therapy for IBD and give one example for each. Describe the radiologic features of toxic megacolon. What the potential causes of toxic megacolon? Which conditions are associated with the development of colonic ischemia? List 4 precipitants of ischemic colitis in the elderly and 3 in young patients List 4 ddx for colitis 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

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. Describe a general approach or investigation and management for suspected infectious diarrhea in the following groups: Non-bloody diarrhea Bloody Diarrhea 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. Describe common infectious patterns and risk factors for each of the following Campylobacter Salmonella Shigella Yersinia Vibrio parahaemolyticus Enterohemorrhagic E. coli List 6 causes of bloody diarrhea and 5 features of illness that suggest invasive E.coli 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 List 5 RFs for C. diff. What are 2 therapy options? List the 2 most common causes of viral gastroenteritis. Differentiate the two based on patient population and course of illness List 4 protozoal causes of gastroenteritis. For each, describe the clinical presentation List 6 causes of diarrhea in AIDS. Describe an appropriate initial work-up. What additional steps may be required? What is food poisoning? Describe an approach to the management of travelers' diarrhea. What are 5 common causes. Which if the most common?

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

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

This episode covers Chapter 91 of Rosen's Emergency Medicine 8th edition (or Chapter 81 of the 9th edition). List 10 ddx for pancreatitis List 10 causes of pancreatitis. Which are most common in adults? Which one is most common in pediatrics? Describe 6 management priorities in acute pancreatitis. What are the early, late and chronic complications of pancreatitis? Describe Ranson's criteria and Atlanta criteria List causes of chronic pancreatitis. What is the best diagnostic tool? What 4 findings can be seen? Describe the management of chronic pancreatitis (6 priorities)? What is the 5 year survival of pancreatic cancer? Describe typical clinical findings. How is it diagnosed? What is the management? Wisecracks: Specifically list 10 drug causes. List 5 causes of false-positive amylase elevation. List 4 peripancreatic/local complications of pancreatitis that may be visualized on CT

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

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?

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

This episode covers Chapter 87 of Rosen's Emergency Medicine What is an atheroma and how is it formed? What are the classic symptoms of arterial insufficiency? Provide a differential diagnosis for chronic arterial insufficiency. What is blue toe syndrome? What is its significance? Differentiate between thrombotic and embolic limb ischemia based on clinical features What is the management of an acutely ischemic limb? List three disorders characterized by abnormal vasomotor response. Describe Raynaud's disease and how it's treated? What is the most common site for arterial aneurysm in the leg? List four potential sites for upper extremity aneurysms, and their associated underlying causes. Name three types of visceral aneurysms and their associated conditions. List 6 ddx of occluded indwelling catheter + describe the management of suspected line infection. What are the two types of AV fistulas used for dialysis? How do you access an AV fistula? List 5 complications of dialysis fistulas + treatment 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? 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

This episode covers Chapter 86 of Rosen's Emergency Medicine. AAAs are our Great-White-Buffalo in emergency medicine. You need to know this! List six presentations of an abdominal aortic aneurysm. Compare Aneurysm and Pseudoaneurysm List common misdiagnoses in patients with ruptured AAA List three common early and delayed complications of AAA repair List common delayed complications of Endovascular repair Wisecracks: What to do about the intact, asymptomatic aneurysm?