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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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CRACKCast & Physicians as Humans on CanadiEM
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Nov 20, 2017

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!

Nov 16, 2017

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.

Nov 13, 2017

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?

 

 

Nov 9, 2017

Core questions

  1. What are the five most common causes of hyperkalemia?
  2. Describe the ECG features seen with hyperkalemia. List at least 5.

  3. How is hyperkalemia managed? How does each intervention work, and how long do the effects typically last?

  4. What are the five most common causes of hypokalemia?

  5. Describe the ECG features seen with hypokalemia. List at least 4.

  6. How is hypokalemia managed?

  7. What are the three main types of hypernatremia? Give 3 examples of each.

  8. List four central and four nephrogenic causes of diabetes insipidus.

  9. What are the four broad categories of hyponatremia?

  10. Give an example of two clinical conditions for each: hypovolemic, euvolemic and hypervolemic hyponatremia.

  11. What are the three most common causes of SIADH?

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

    1. Actively seizing

    2. Euvolemic with acute hyponatremia

    3. Hypovolemic with chronic hyponatremia

    4. Hypovolemic with acute hyponatremia

  13. What are the five most common causes of hypercalcemia?

  14. What are the five most common symptomatic causes of hypocalcemia seen in the emergency department?

  15. What ECG features are seen in hypercalcemia vs. hypocalcemia? How is each managed?

  16. What are the five most common causes of hypermagnesemia?

  17. List five clinical manifestations of hypermagnesemia.

  18. List five common causes of hypomagnesemia.

  19. What are the five most common causes of hyperphosphatemia?

  20. What are the five most common causes of hypophosphatemia in the ED? How do they manifest clinically?

Wisecracks.

  1. What electrolytes abnormalities are often with hypomagnesemia?
  2. How do you estimate the total body water?
Nov 6, 2017

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.

Nov 2, 2017

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.

Oct 30, 2017

Episode Overview:

 

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

 

Wisecracks:

 

  • How do you differentiate coagulation disorders from platelet disorders?
  • What is thrombocytopathy?
  • What do INR and PTT test?
  • What is DIC?

 

 

Oct 26, 2017

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.

Oct 23, 2017

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

Episode Overview

  1. List five broad categories of rashes

  2. Describe the primary skin lesion types 

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

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

    • Generalized rash

    • Head and neck

    • Hands

    • Legs

    • Palms and Soles

  2. Describe the various presentations of tinea and their treatment

  3. List 8 RFs for candida infections

  4. Describe the stepwise management of diaper dermatitis

  5. Describe the distribution of Pityriasis rosea

  6. Describe the management of atopic dermatitis

  7. Describe the management of impetigo & folliculitis

  8. List 6 RFs of C.A.-MRSA and 4 oral Abx treatments

  9. Describe the presentation and management of Staph Scalded Skin andTSS

  1. List 10 causes of EM / SJS / TEN

  2. Describe presentation of EM + SJS/TEN. Differentiate between TEN and SJS

  3. List 6 broad categorical causes of urticaria

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

    • Measles

    • Rubella

    • Roseola Infantum

    • Erythema Infectiosum

    • Scarlet Fever

  5. Describe treatment of poison ivy

  6. Describe presentation and treatment of Pediculosis + Scabies

  7. List 10 causes of Erythema Nodosum

  8. List a 6 ddx for vesicular lesions

  9. List 4 lesions with a positive Nikolsky’s sign

  10. List 4 complications of HSV infection

  11. List 5 complications of Varicella + describe the management of an exposure during pregnancy

  12. List 5 complications of Zoster + differentiate between Ophthalmicus and Oticus

  13. What is the treatment of herpes zoster?

Wisecracks

  1. List 5 causes of desquamating lesions

  2. List 5 palm and sole rashes

  3. List 10 maculopapular rashes

  4. List 1 low, medium and high potency topical steroid

  5. Identify the following rashes: erythema migrans, erythema marginatum, erythema multiforme, erythema nodosum, meningococcemia

Oct 19, 2017

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!!!

Oct 16, 2017

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

Episode Overview:

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

 

WiseCracks

  1. What is the differential for SLE patient and Chest pain?
  2. Name and identify 2 pathognomonic clinical features for lupus
  3. When should Rheum be involved in the ED with a SLE patient?
  4. Spot Diagnosis: A 36 year old female stock trader present with what appears to be necrosis of the nose and ears…
  5. Spot diagnosis: 13 year old presents with abdo pain, polyarticular arthritis, foaming urine and the following rash…
  6. Rounds Pimper: List 10 side effects of chronic steroid use
Oct 12, 2017

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

Episode Overview:

  • Mechanical overload and repetitive micro-trauma are the key underlying mechanisms of tendinopathy
  • Most patients present with progressively worsening pain after work or sports-related activities that are repetitive in nature
  • Tendinopathy can also be associated with non-mechanical causes such as:
    • Systemic manifestations of disease
    • Use of fluoroquinolones
    • Infectious etiologies 
  • Most patients with tendinopathies can be treated with conservative measures, such as:
    • Protection
    • Relative rest
    • Application of ice
    • Elevation
    • Medications
  • Overuse syndromes take at least 6-12 weeks to heal
    • Patients need optimal loading and referral for physiotherapy or sports medicine therapy
  • Urgent imaging of tendinopathy in the ED is rarely useful
    • Clinicians may elect to use bedside ultrasound to evaluate for other diagnoses
  • Operative treatment of tendinopathy is required in select cases
  • Consider infectious bursitis in all cases of acute bursitis
  • Aspirate bursa and evaluate the fluid
    • Infectious bursitis is typically caused by Staph aureus 
  • Non-septic bursitis differential diagnosis:
    • Traumatic
    • Rheumatologic
    • Idiopathic
  • Management of septic bursitis:
    • Antibiotics
    • NSAID's
    • Rest
    • Application of ice
    • Elevation
    • Prompt referral for follow-up +/- admission

Core questions:

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

Wisecracks:

  1. Differentiate septic and inflammatory bursitis based on clinical exam and fluid aspirate results
  2. List 4 physical exam findings of impingement syndrome
Oct 9, 2017

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.

Oct 5, 2017

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

Episode Overview:

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

 

Core questions:

  1. Name 10 risk factors for suicide
  2. Name an additional 5 risk factors for adolescent suicide
  3. Describe the SAD PERSONS Scale
  4. Describe 4 potential targeted investigations for patients presenting to the ED with suicide
  5. Name 3 protective factors for against suicide
Oct 4, 2017

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

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

Thanks for listening and please refer your colleagues!

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

  1. ambient by strange day. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
  2. NOWË - Burning (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/AWv6Cr-RJaM
  3. Jorm - Broken (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/sl-o3ywNTV4
  4. Skander Music - Back Home (Vlog No Copyright Music). Music promoted by Vlog No Copyright Music. Video Link: https://youtu.be/uwXmBL1kQT4
  5. Pressure - Riot https://youtu.be/ELksuZkgQsQ
  6. Joakim Karud - Waves. Song/Free Download - https://youtu.be/xG8AWZSnFgI. Support Joakim Karud - http://smarturl.it/joakimkarud
  7. LAKEY INSPIRED - In My Dreams (Vlog No Copyright Music). Music provided by Vlog No Copyright Music. Video Link: https://youtu.be/PiKks_6yC8Q
Oct 2, 2017

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
Sep 28, 2017

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.

Sep 25, 2017

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

Episode Overview

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



Core questions:

 

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

 

 

Sep 21, 2017

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

Episode Overview

  • Patients with apparent mood disorders should be evaluated for medical disorders, medication effects, substance abuse or withdrawal because these conditions can mimic both depression and mania.

  • Mood disorders should be suspected in patients with multiple, vague, nonspecific complaints and in patients who are frequent, heavy users of medical care.

  • The differentiation of depression and dementia in elders can be difficult, but is important because depression often responds dramatically to treatment.

  • Patients with mood disorders should be assessed for their suicide potential.

    Core questions:

  1. List the 3 neurotransmitters implicated in depression

  2. List the DSM V criteria for Major Depressive Episode (box)

  3. Define Seasonal Affective disorder, Dysthymic Disorder and Cyclothymic

    disorder

  4. Define Bipolar I and Bipolar II

  5. List the DSM V Criteria for a Manic Episode (box)

  6. List 8 general medical conditions and 8 medications that cause depression

  7. Describe first line medical therapy for depression and bipolar disorder

  8. List 4 criteria for hospitalization in an acute psychiatric episode

Wisecracks


    1. Mnemonics for symptoms of depression and mania

Sep 18, 2017

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!

Sep 14, 2017

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.

Sep 14, 2017

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.

Sep 7, 2017

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.

Sep 4, 2017

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!

 

 

Aug 31, 2017

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.

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