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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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Now displaying: Page 3
Dec 19, 2016

This episode covers Chapter 54 of Rosen’s Emergency Medicine. 

1) Describe the myotomes and dermatomes L3-S1

2) List 4 Red Flag Diagnoses with associated RFs, Hx, PEX findings

3) Describe SLR, crossed-SLR, flip-test, reverse SLR and their implications

4) List 5 indications for Xray in low back pain

5) Discuss the discrimination of functional from organic back pain

6) Describe the management of:

a. Fracture

b. Cauda Equina Syndrome

c. Spinal Infection

d. Vertebral Malignancy

e. Simple Radiculopathy

7) List 8 DDx for Thoracic back pain


Wisecracks:
Backpain treatment cocktails?
When to order the CT scan?
How to estimate the amount of post-void residual volume with ultrasound?

 

Dec 5, 2016

This episode covers Chapter 52 of Rosen's Emergency Medicine. 

  1. Describe an approach to the pediatric elbow
  2. Classify supracondylar fractures in children
  3. List 3 complications of supracondylar fractures
  4. Describe the management of supracondylar fractures
  5. Describe the management of humeral shaft fractures – displaced and non-displaced
  6. Describe 3 injuries common in Little-leaguer's elbow
  7. Describe the management and classification of radial head fractures
  8. Describe the expected neurovascular injuries and management of posterior elbow dislocations
  9. List the indications for x-ray in radial head subluxation
  10. Describe the management of olecranon bursitis

 

Nov 28, 2016

This episode covers Chapter 51 of Rosen’s Emergency Medicine. 

1) Describe normal radiographic relationships:

  1. Radial length measurement
  2. Radial inclination
  3. Volar Tilt
  4. Scapholunate angle
  5. Capitolunate angle
  6. Wrist arcs

2) Describe xray findings and management of

  1. Scaphoid fracture
  2. Lunate fracture
  3. Triquetral fracture
3) Describe Mayfield’s stages of carpal instability

4) Describe DISI and VISI

5) Describe xray findings and management of

  1. Colles’
  2. Smith’s
  3. Barton’s
  4. Hutchinson’s / Chauffer’s
  5. DRUJ Disruption
6) Describe management of pediatric
  1. Forearm fractures
  2. Torus fractures
  3. Greenstick fractures

7) List 8 RFs for Carpal Tunnel Syndrome + Describe 2 tests for CTS

8) Describe the Monteggia and Galeazzi’s fracture patterns

Oct 31, 2016

This episode covers Chapter 47 of Rosen’s Emergency Medicine.

1. List 6 general indicators of genitourinary trauma?

Lower urinary tract and external genitalia

 

  • What are the four parts of the male urethra?
  • What is the mechanism of an anterior urethral injury (at least 5 causes)? What is the mechanism of a posterior urethral injury?
  • List 4 indications for retrograde urethrogram before foley placement?
  • Describe the technique for a retrograde urethrogram?
  • Classify bladder injuries and describe the mechanism of injury.
  • Differentiate between extraperitoneal and Intraperitoneal bladder rupture
  • Describe the indications and technique for retrograde cystogram?
  • Outline the management of the different types of bladder injuries.
  • List 3 clinical findings of a penile fracture
  • Describe the management of penile
  • Constricting devices
  • Superficial hematoma
  • Superficial lacerations
  • Degloving injury
  • Penile Fracture
  • Penile amputation
  • Blunt scrotal trauma
  • Bites

 

 

Upper urinary tract

 

  • What is the presentation of a ureteric injury?
  • What are the indications for renal imaging in an adult trauma patient? In a pediatric trauma ?
  • Describe the management of renal injuries:
  • Blunt
  • Penetrating

 

 

Wisecracks:

 

What is the most common site of urethral injuries?

Oct 24, 2016

This episode covers chapter 46 of Rosen's Emergency Medicine text book.

 

Episode Overview:

1) What are three mechanisms of injury in blunt trauma?

2) List expected seat-belt injuries

3) What are the most common intra-abdominal injuries in children?

4) Differentiate between the use of CT scan, diagnostic peritoneal lavage (DPL) and ultrasound – advantages & disadvantages.

5) List intra-abdominal injuries that may be missed on CT.

6) Describe the process of local wound exploration.

  1. List 5 ways to determine if peritoneum has been violated

7) List clinical indications for laparotomy in blunt and penetrating abdominal trauma

8) Describe the management of unstable blunt abdominal trauma

  1. Pelvic fracture
  2. Head injury (closed head injury)
  3. Wide mediastinum (aortic injury)

9) Provide an approach to anterior abdominal trauma with:

  1. Evidence of peritoneal violation (penetrating injuries)
  2. Evidence of intra-abdominal injury with blunt abdominal trauma

10) Provide an approach to flank injuries

11) Provide an approach to back injuries

 

Wisecracks:

 

1) Describe indications and technique of diagnostic peritoneal lavage (DPL). What is a positive DPL?

2) List 1 absolute contraindication and 4 relative contraindications to DPL

3) What is Waddel’s triad?

4) What are Gray-Turner and Cullen’s signs?

5) How much blood is detectable by bedside US?

Oct 17, 2016

This episode covers Chapter Chapter 45 of Rosen’s Emergency Medicine text book and is full of pearls for Thoracic Trauma.

Sign Post:

  1. Differentiate Chest wall injury, rib fracture, and flail chest

  2. Describe the clinical presentation and management of a sternal fracture

  3. Describe Injuries to lung parenchyma

  4. What is Traumatic asphyxia?

  5. List 6 indication for tube thoracostomy 

  6. Indications for OR Thoracotomy 

  7. What is the management of Diaphragmatic injury?

  8. Differentiate between myocardial concussion, contusion and rupture

  9. Review indications for ED Thoracotomy

  10. Describe your approach to identification and management of pericardial tamponade

  11. CXR findings for blunt aortic injury.
  12. List the 6 most common causes of esophageal perforation

  13. What is the Nexus CT Chest Rule?

 

WiseCracks:

  1. Clinical conditions that mimic esophageal perforation
  2. Describe the basic approach to ED thoracotomy
  3. What is Electrical Alternans?
Oct 10, 2016

This episode of CRACKCast covers Rosen’s Chapter 044, Neck Trauma. Continuing in our trauma series, this episode tackles the challenging issue of neck trauma and injuries, and explores the anatomy and relevant considerations in the diagnosis and management of both blunt and penetrating neck injuries.

Episode Overview:

1) Describe the landmarks and structures using the Zones of the neck & the Triangles of neck

2) List 6 hard and 6 soft signs of penetrating neck trauma. What are the indications for immediate OR vs CTA in managing penetrating neck trauma

3) Describe an approach to managing acute neck trauma in the ER

4) Describe the management of venous air embolism

5) Describe techniques for airway management in penetrating neck trauma

6) Describe the management of suspected pharyngoesophageal trauma. What are signs of esophageal injury?

7) List 3 hard signs of laryngotracheal trauma and describe airway management dilemmas

Wisecracks:

1) Differentiate between choking, hanging and strangulation

2) Define judicial and non-judicial hanging and describe expected injury patterns

Oct 3, 2016

This episode covers Chapter 043 of Rosen’s Emergency Medicine, Spinal Injuries.

Episode Overview

  • Describe the anatomical contents of the anterior and posterior spinal columns
  • List cervical spinal injuries for the following mechanisms, and indicated whether they are stable or unstable
    1. Flexion x 6
    2. Shear / AP forces x 1
    3. Flexion-Rotation x 2
    4. Extension x 3
    5. Vertical Compression x 2
  • List 8 unstable C-spine injuries
  • Describe an approach to C-Spine X-rays, and define normal:
    1. Predental space
    2. Soft-tissue spaces
    3. Line of Swischuck
  • Describe Canadian C-Spine Rule + Nexus Rule
  • Describe incomplete cord lesions
  • Describe:
    1. Wallenburgs Syndrome
    2. Dejeune Onion Skin Pattern of Analgesia
    3. Horners Syndrome
    4. Cauda Equina
  • How does the bulbocavernosus reflex reflect the presence of spinal shock
  • List features of sacral sparing
  • List Dermatomes/ Myotomes / Spinal reflexes
  • List 6 causes of Horner’s
  • For what C-spine injuries is a CT-a indicated to R/O vascular injury
  • Are Steroids indicated for C-spine injuries
  • For whom is surgical intervention indicated immediately with a spinal cord injury
  • Define neurogenic shock and describe its management
  • Define spinal shock
  • What is the risk of cervical injury in Down’s Syndrome? Rheumatoid Arthritis?
  • What are the Denver criteria?
Sep 26, 2016

This episode covers Chapter 42 of Rosen’s Emergency Medicine, Facial Trauma.

1) Describe the anatomy of the bones, glands, and ducts of the face. At what ages do the sinuses appear?

2) List 5 types of facial fractures.

3) Describe the clinical presentation and associated radiographic findings of an orbital blowout fracture.

4) Describe an orbital tripod fracture and its management.

5) List the indications for antibiotics in a patient with facial trauma?

6) What is the importance of perioral electrical burns?

7) What are the indications for specialist repair of an eyelid laceration?

8) Describe the classification and management of dental fractures.

  1. What is the management of an avulsed tooth?
  2. What is a luxed tooth? How is it managed?
  3. What is an alveolar ridge fracture?

9) Describe the method for reducing a jaw dislocation? What is the usual direction of the dislocation?

Sep 21, 2016

In the second episode of the Physicians as Humans project, I speak with Dr. Rob Rogers (@EM_Educator), a leading educator in emergency medicine and director of The Teaching Course. He shares his experiences of dealing with a devastating illness in his own family and the effect it had on his career as an emergency physician.

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 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. Moon by LEMMiNO. Music provided by Music for Creators under a Creative Commons Attribution-ShareAlike 3.0 Unported— CC BY-SA 3.0 license.
  3. Icy Vindur by A Himitsu. Music provided by Music for Creators under a Creative Commons Attribution 3.0 Unported— CC BY 3.0 license.
  4. Flourish, Wither, Bye by A Himitsu Music provided by Music for Creators under a Creative Commons — Attribution 3.0 Unported— CC BY 3.0 license.
  5. Where Silence is Nonexistent by A Himitsu Music provided by Music for Creators under a Creative Commons — Attribution 3.0 Unported— CC BY 3.0 license.
  6. Tomorrow by Bensound
  7. Pressure by Riot
Sep 19, 2016

This episode covers Chapter 41 of Rosen’s Emergency Medicine.

1) list 7 causes of altered LOC in the trauma patient

2)  List four herniation syndromes.

Describe the pathophysiology of uncal herniation and the typical presentation.

Describe the presentation of central herniation.

3)  Describe how cerebral blood flow in relationship to the following parameters: PO2 , PCO2 , MAP and ICP. What are the indications for ICP monitoring?

 

4) What is the Canadian CT head rule? What are the inclusion criteria. What is the New Orleans CT head rule? What are the inclusion criteria? Which test is more sensitive? More specific?

5)  What is a concussion? How is a concussion managed? What are potential complications? Define second impact syndrome & return to play

6) Outline the ED management goals of TBI.  

  • differentiated between direct and indirect TBI
  • What are the indications for seizure prophylaxis following TBI?
  • What are the indications for antibiotics in TBI?
  • Complications of TBI?

7)  7 clinical features of basal skull #

 

Wisecracks

  1. CT tips: 3 signs of cerebral edema on CT,  5 differences on CT between SDH And EDH, List 3 CT findings in DAI
  2. What are: the Monroe-Kellie doctrine, the Cushing’s reflex, What is kernihan’s notch, and how does this syndrome present?
Sep 12, 2016

This episode of CRACKCast covers Rosen’s Chapter 040, Injury Prevention and Control.

1) What are the three key aspects to Injury Control?

2) What makes up the Injury Triangle?

3) List 6 of 10 potential strategies for preventing transfer of energy

Wisecracks:

1) What can you actually do, as a health practitioner, to help injury prevention?

Sep 5, 2016

This episode covers Chapter 39 of Rosen’s Emergency Medicine textbook. 

Episode Overview

1) 5 Risk Factors for falls in the elderly?

2) What anatomic and physiologic changes in the elderly patient are important for the management of trauma in the elderly patient. (changes in the CVS, CNS, reap, MSK, skin) Explain why these are important?

3) What are the most common c-spine injury in the geriatric patient?

Aug 29, 2016

 

This episode covers Chapter 38 of Rosen's Emergency Medicine.

Episode Overview

  1. List 5 relevant anatomic/physiologic differences between children and adults in relation to trauma management
  2. List 8 airway differences between pediatrics and adults with their relevant implications
  3. List potential fluid therapies for hemorrhagic shock and their doses
  4. List 3 ideal IO sites in pediatrics and describe the procedure
  5. Describe the pediatric GCS
  6. List 6 indications for laparotomy
  7. List 6 signs of elevated ICP in infants and children
  8. What is an impact seizure?
  9. List the 5 layers of the scalp and describe 3 types of extra cranial bleeding in pediatrics
  10. What is the difference between a linear and a diastatic skull fracture
  11. Describe the typical presentation and etiologic cause of an epidural hematoma and a subdural hematoma
  12. Describe the management of elevated ICP
  13. List 10 anatomical differences between the pediatric and adult cervical spine
  14. How can you discern between true subluxation and pseudosubluxation at C2/C3
  15. List 2 ways to choose the size of chest tube in pediatrics
  16. What are indications for ER resuscitative thoracotomy in chest trauma?
  17. List pediatric specific cardiovascular and abdominal injury patterns
Aug 22, 2016

This episode covers Chapter 37 of Rosen's Emergency Medicine.With trauma in pregnancy we need to think about blunt vs. penetrating trauma. Many women do not know they are pregnant.

Episode Overview:

  • What is the threshold for fetal viability and how can this be estimated clinically?
  • List the expected physiologic changes during pregnancy.
  • List 8 unique considerations in the management of the pregnant trauma patient.
  • How is fetal distress detected?
  • Discuss placental abruption including the pathophysiology, clinical findings, diagnostic modalities, management, and complications.
  • List 2 potential uterine injuries
  • What is a safe radiation dose in pregnancy? What diagnostic tests have the potential to exceed this dose?
  • Describe early, variable, and late decelerations. What is the implication of each? What is one other indicator of fetal distress related to the FHR?

Wisecracks:

  • How is feto-maternal hemorrhage diagnosed and managed?
  • Describe specific management in the following conditions:
  • What are indications for peri-mortem c-sections. Describe the procedure.
Aug 15, 2016

This episode covers Chapter 36 of Rosen's Emergency Medicine.

Episode Overview:

  • List indications for activation of a trauma team
  • What is the general approach to a multi-trauma patient?
  • List commonly missed trauma injuries
  • ED thoracotomy indications and contraindication for blunt and penetrating trauma

Wisecracks:

  • Describe the term permissive hypotension and when you would not use it
  • What are 3 goals for out of hospital care of a trauma patient

 

Jul 25, 2016

This episode covers Chapter 35 of Rosen's Emergency Medicine.

Episode overview:

1)  List 10 historical red flags for back pain
2)  List 6 Emergent Diagnosis for back pain

Wisecracks:

1)  Describe the most common sites of disc protrusion with their associated neurologic findings
2)  Outline your approach to acute undifferentiated back pain
3)  Describe your treatment approach for acute musculoskeletal low back pain

Jul 20, 2016

This episode covers Chapter 34 of Rosen's Emergency Medicine.

Episode Overview:

1) Indicate 12 causes of vaginal bleeding, indicating at which age group each is most common
2) List 6 causes of bleeding in early pregnancy
3) Describe the management of severe third trimester bleeding and postpartum hemorrhage

Wisecracks:
1) List options for managing vaginal bleeding in the non-pregnant patient
2) When would you avoid estrogen products in non-pregnant women with vaginal bleeding?

Jul 19, 2016

This episode covers Chapter 33 of Rosen's Emergency Medicine.

Episode overview:

1)  List 8 diagnoses of pelvic pain in women that are of reproductive tract origin
2)  List 3 causes of pelvic pain in the pregnant patient who is: Fewer than 20 weeks pregnant or Greater than 20 weeks pregnant

WiseCracks:

1)  List 6 life threatening causes of acute pelvic pain in women
2)  Outline a systematic approach to acute pelvic pain in women
3)  List 6 risk factors for ectopic pregnancy

Jul 12, 2016

This episode covers Chapter 32 of Rosen's Emergency Medicine.

Chapter 32 – Constipation

Episode Overview:

1) List 6 treatment options for the management of constipation

Wisecracks:

1) What are 6 broad categories for the causes of constipation?

Jul 5, 2016

This episode covers Chapter 30 of Rosen's Emergency Medicine.

Episode overview:

1) List 5 causes of UGIB in adults and pediatrics
2) List 5 causes of LGIB in adults and pediatrics
3) Describe your management approach for severe UGIB
4) List 6 low-risk criteria D/C of GIB
5) List components of the Rockall and Glasgow-Blatchford score

Wisecracks:

1) Describe the insertion of a Blakemore tube
2) List 6 causes of false positive stool guaic

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