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



All Episodes
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Jul 31, 2017

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




Mixed bag of anorectal stuff - levator ani syndrome, proctalgia fugax, radiation proctitis, hidradenitis suppurativa, and more...

Jul 27, 2017

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.



  1. List features that are typical for IBS.

(Describe the Rome IV criteria and list 4 medications used to treat irritable bowel syndrome - show notes)

  1. What is the pathophysiology of diverticular disease?
  1. List clinical presentations of diverticular disease.
  1. How is diverticular disease managed in the ED? Which patients should be admitted to hospital? List 3 complications.
  1. List the types and potential causes of large bowel obstruction.
  1. What are the four types of GI volvulus? What are the risk factors for developing each type?
  1. List the extra-intestinal manifestations of IBD.
  1. What are the pathologic and clinical differences between UC and Crohn’s? 
  1. List 4 categories of medical therapy for IBD and give one example for each.
  1. Describe the radiologic features of toxic megacolon.
  1. What the potential causes of toxic megacolon?
  1. Which conditions are associated with the development of colonic ischemia? List 4 precipitants of ischemic colitis in the elderly and 3 in young patients
  1. List 4 ddx for colitis
  1. Differentiate between acute and chronic radiation proctocolitis in pathophys and clinical presentation




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

Jul 24, 2017

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.



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


Jul 20, 2017

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.

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




1) Which patient groups present atypically

2) Describe the Alvarado Score and the Ped for Appendicitis

3) What are U/S findings of appendicitis?




Jul 17, 2017

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.


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


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?

Jul 17, 2017

This episode covers Chapter 91 of Rosen’s Emergency Medicine 8th edition (or Chapter 81 of the 9th edition).


  1. List 10 ddx for pancreatitis
  2. List 10 causes of pancreatitis. Which are most common in adults? Which one is most common in pediatrics?
  3. Describe 6 management priorities in acute pancreatitis.
  4. What are the early, late and chronic complications of pancreatitis?
  5. Describe Ranson’s criteria and Atlanta criteria
  6. List causes of chronic pancreatitis. What is the best diagnostic tool? What 4 findings can be seen?
  7. Describe the management of chronic pancreatitis (6 priorities)?
  8. What is the 5 year survival of pancreatic cancer? Describe typical clinical findings. How is it diagnosed? What is the management?



  1. Specifically list 10 drug causes.
  2. List 5 causes of false-positive amylase elevation.
  3. List 4 peripancreatic/local complications of pancreatitis that may be visualized on CT
Jul 6, 2017

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?



1.. Which conditions are associated with transaminases in the 10000s?

  1. How do you approach a patient with a needlestick injury? What is the risk of transmission following a needlestick?
  2. What are underlying causes of hepatic encephalopathy in patients with known liver disease?
  3. What are the typical investigations performed on ascites fluid? What is the SAAG and how is it interpreted?
  4.  What is the significance of a calcified gallbladder?
Jul 3, 2017

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.





  • 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?



Jun 29, 2017

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! 


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




  • 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?




Jun 26, 2017

This episode covers Chapter 87 of Rosen’s Emergency Medicine


  1. What is an atheroma and how is it formed?
  2. What are the classic symptoms of arterial insufficiency?
  3. Provide a differential diagnosis for chronic arterial insufficiency.
  4. What is blue toe syndrome? What is its significance?
  5. Differentiate between thrombotic and embolic limb ischemia based on clinical features
  6. What is the management of an acutely ischemic limb?
  7. List three disorders characterized by abnormal vasomotor response.
  8. Describe Raynaud's disease and how it’s treated?
  9. What is the most common site for arterial aneurysm in the leg?
  10. List four potential sites for upper extremity aneurysms, and their associated underlying causes.
  11. Name three types of visceral aneurysms and their associated conditions.
  12. List 6 ddx of occluded indwelling catheter + describe the management of suspected line infection.
  13. What are the two types of AV fistulas used for dialysis?
  14. How do you access an AV fistula?
  15. List 5 complications of dialysis fistulas + treatment
  16. 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?
  17. List 4 anatomic abnormalities associated with thoracic outlet syndrome.


    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
Jun 15, 2017

This episode covers Chapter 86 of Rosen’s Emergency Medicine. AAAs are our Great-White-Buffalo in emergency medicine. You need to know this!


  1.  List six presentations of an abdominal aortic aneurysm.
  2. Compare Aneurysm and Pseudoaneurysm
  3. List common misdiagnoses in patients with ruptured AAA
  4. List three common early and delayed complications of AAA repair
  5. List common delayed complications of Endovascular repair





  • What to do about the intact, asymptomatic aneurysm?



Jun 8, 2017

This episode covers chapter 84 of Rosen's Emergency Medicine. All the little nuggets of medical goodness you wanted to know about hypertension related emergencies.

  1. Define the three classes of hypertension relevant to emergency medicine practice
  2. List 10 possible etiologies for hypertension.
  3. What is the pathophysiology of target-organ damage?
  4. How does hypertensive encephalopathy occur?
  5. List 6 hypertensive emergencies; their management goals; the optimal agents for BP control and any relevant caveats
  6. List five intravenous antihypertensive medications and their mechanism of action.
  7. Describe the ER management of poorly controlled HTN


  1. What are the management targets / indications for treatment in the following pts:
    1. 57 yo male with ICH and no signs of ↑ ICP.
    2. 39 yo female with SAH in the ED.
    3. 22 yo female with eclampsia.
    4. 66 yo female with ACS.
    5. 57 yo male with aortic dissection.
    6. 62 yo female with ICH, ↓ GCS, shift on CT scan.


Jun 5, 2017

This episode covers Chapter 83 of Rosen's Emergency Medicine.


  1. List 6 RFs for bacterial endocarditis
  2. List 5 common bacteria responsible for infective endocarditis
  3. Give three examples of immunologic sequelae of IE.
  4. Give three examples of vascular sequelae of IE.
  5. What are the diagnostic criteria for endocarditis, and how are they used?
  6. List 5 lab or investigative findings in bacterial endocarditis
  7. Describe the treatment of infective endocarditis
  8. List four complications of IE.
  9. List the indications for infectious endocarditis prophylaxis. What are the empiric antibiotics used for pts with suspected infectious endocarditis?
  10. Describe the Jones Criteria for Acute Rheumatic Fever
  11. What is the treatment of rheumatic fever
  12. Name three causes of acute mitral regurgitation.
  13. How is acute MR managed?
  14. What is the pathophysiology of mitral valve prolapse?  How does it present?
  15. List four causes of mitral stenosis.
  16. List four causes of aortic valve insufficiency.
  17. List 3 physical exam findings associated with AS
  18. What is critical aortic stenosis?Outline the ED management for a pt with critical aortic stenosis with CHF and hypotension.
  19. List 5 complications of prosthetic valves. 


  1. Describe
    1. Janeway lesions
    2. Osler nodes
    3. Splinter hemorrhages
    4. Roth Spots
  1. What are the HACEK organisms, and what is their significance in pts with IE?
  1. Brief run down of all valvular disease - in one or two lines.
Jun 1, 2017

This episode covers chapter 82 of Rosen's Emergency Medicine. Take a listen for all those juicy pericardial-pump-pearls!


  1. List eight causes of pericarditis.
  2. Describe typical pain of pericarditis, expected lab work abnormalities,
  3. What is the typical sequence of ECG changes in pts with pericarditis? (the stages)
  4. Describe the treatment of pericarditis associated with: Uremia, Neoplasm, and SLE
  5. Outline the management of Dressler's syndrome.
  6. What is the pathophysiology of cardiac tamponade? Describe the mechanism of hypotension in pericardial tamponade and list 4 expected findings on physical examination.
  7. Describe the procedural steps in pericardiocentesis
  8. List 4 causes of pneumopericardium and one specific PEX finding
  9. List five causes of constrictive pericarditis.
  10. What is the pathophysiology of purulent pericarditis?  List 5 organisms responsible for infectious pericarditis? How is it managed?
  11. Describe the pathophysiology of hypertrophic cardiomyopathy
  12. Describe the clinical exam and ECG findings associated with HCM
  13. List 5 RFs for sudden death in HCM
  14. A pt with known hypertrophic cardiomyopathy presents to the ED with acute cardiogenic pulmonary edema causing mild hypoxia.  What is the general approach to management in the ED?  Explain your choices.
  15. List four causes of dilated cardiomyopathy.
  16. Describe ECG findings of dilated cardiomyopathy
  17. List 5 RFs for developing a dilated cardiomyopathy
  18. In what time frame would one expect peripartum DCM?
  19. List 5 causes of restrictive cardiomyopathy
  20. List 8 common pathogens responsible for myocarditis, and 3 non-infectious causes of myocarditis
  21. Describe the stages of viral myocarditis and the management at each stage





  1. What are some functions of the pericardium?
  2. What are Chagas Disease and Trichinosis, list bizz-buzz features for each?
  3. What are the expected cardiac findings in Lyme disease and how is it treated?
  4. How does sarcoid affect the heart?
  5. Amyloidosis?


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?



  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
    -Mycoplasma pneumoniae & Chlamydia pneumoniae
    -PJP & Other Fungal Pneumsonia

  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


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?
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