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CRACKCast & Physicians as Humans on CanadiEM

CRACKCast (Core Rosen's and Clinical Knowledge) helps residents to "Turn on their learn on" through podcasts that assist with exam prep by covering essential core content. Physicians as Humans explores the struggles that physicians face and how they have overcome them. From addictions, mental health issues, and all manner of personal crises will be discussed to help let those who are currently struggling know that they are not alone. CanadiEM aims to improve emergency care in Canada by building an online community of practice for healthcare practitioners and providing them with high quality, freely available educational resources.
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May 23, 2017

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?
May 18, 2017

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?
May 16, 2017

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!!!

May 11, 2017

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?
May 8, 2017

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?

     

 

May 4, 2017

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?

May 1, 2017

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

 

Apr 27, 2017

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?
Apr 24, 2017

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? 
Apr 20, 2017

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
Apr 10, 2017

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
Apr 3, 2017

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?

Mar 20, 2017

 

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!

Mar 6, 2017

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?
Feb 27, 2017

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?

Feb 20, 2017

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
Feb 13, 2017

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?
Feb 6, 2017

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?
Jan 30, 2017

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
Jan 27, 2017

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
Jan 23, 2017

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?

Jan 16, 2017

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” 
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