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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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Now displaying: May, 2017
May 29, 2017

This episode covers Chapter 81 of Rosen’s Emergency Medicine. This one is mint! Heart failure is one of those must-know-about presentations, you WILL see this in the ED.

 

  1. Define
    1. Cardiac index
    2. Preload
    3. Afterload
  2. Describe:
    1. How compliance changes the relationship between end diastolic pressures and volume
    2. the Frank-Starling relationship
    3. Pousseils Law and LaPlaces Law
  3. List 3 CV and 4 Neurohormonal physiologic compensatory mechanisms in CHF
  4. List the 5 most common disease processes resulting in HF and briefly describe the contribution of each
  5. Describe the different classifications of heart failure:
    1. Acute vs. Chronic HF
    2. Systolic vs. Diastolic dysfunction
    3. Right vs. Left sided HF
    4. High-output vs. Low-output HF
  6. Describe the NYHA function HF Classes and the Killip Classification
  7. List 10 common precipitants of acute HF
  8. List 6 historical predictors of acute HF and 6 clinical features of acute HF
  9. List 5 CXR and 5 ECG findings of HF
  10. What is the role of BNP in HF?
  11. Describe the primary management goals in acute HF
  12. Describe the mechanism of action of NIPPV in HF. Who needs to be intubated? When is it contraindicated?
  13. Describe the pharmacologic treatment strategy for:
    1. Acute pulmonary edema + adequate perfusion
    2. Acute pulmonary edema + hypotension
  14. How do nitrates work in acute pulmonary edema? What is the dose?
  15. List 10 treatment options for chronic HF
May 25, 2017

This episode covers chapter 80 of Rosen's Emergency Medicine. All those juicy pearls about those funny little [black] boxes in your patients chest.

 

Chapter 80 – Implantable Cardiac Devices

 

  1. List 5 Indications for permanent pacing
    1. What are common Pacemaker types?
  2. Pacemaker nomenclature - what do the 5 letters mean
  3. List the causes of pacemaker malfunction (main categories with 2 examples each)
  4. List the complications of a pacemaker insertion
  5. What is pacemaker pseudo-malfunction?
  6. What is pacemaker syndrome, which type of pacer is most commonly involved, and what is the tx?
  7. What does magnet application do to a pacemaker? to an ICD?
  8. Indications for ICD
  9. Causes of shock delivery in patient with ICD
  10. Causes of syncope/presyncope in patient with ICD
  11. Fxns of an ICD

 

Wise Cracks

 

  1. What do you see on ECG when pacer battery dies (2)?
  2. What is twiddler’s syndrome?
  3. Describe your Approach to LVAD complications
  4. Approach to Pacemakers
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

 

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