EM Clerkship
Summary: The purpose of this podcast is to help medical students crush their emergency medicine clerkship and get top 1/3 on their SLOE. The content is organized in an approach to format and covers different chief complaints, critical diagnoses, and skills important for your clerkship.
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- Artist: Zack Olson, MD and Michael Estephan, MD
Podcasts:
C→ Episode Summary
Specific tips on how to take “ownership” of your patients.
Tip #6 Make your patient remember your name. * Introduce yourself clearly* Show the patient your badge* Use a nickname if your name is difficult for people to remember/understand* Repeat your name again and again Tip #7 Keep the patient informed about… * Diagnosis* Anticipated ED course/timeline* Delays Tip #8 Keep your patient comfortable. * Get them blankets* Show them how to use the remote/call light* Adjust the bed* Turn down the lights* Get them something to drink Tip #9 Move fast. * Spend no more than 10 minutes with the patient* Immediately grab your attending if the patient is ill appearing Tip #10 Use a translator. * Learn how to use a medical translator in your department (phone vs consult vs video consult)* INDEPENDENTLY use a translator to obtain your history when appropriate
No BS, No cliche, specific tips on how to do well on your EM rotation. The ideal attitude of an EM student.
Tip #1 Introduce yourself. * Attending? “Hello, my name is Zack, I’m one of the medical students” * Resident? “Hello, my name is Zack, I’m one of the medical students”* Nurse? “Hello, my name is Zack, I’m one of the medical students”* Janitor? “Hello, my name is Zack, I’m one of the medical students” Tip #2 Be humble but confident. * Humility- Students know very little about the practice of medicine, the smartest med students actually realize that.* Confidence- You have to be able to act confident, be decisive in your presentations, and make decisions. The best way to achieve this is to remember that you have (hopefully) been working hard and studying consistently. Tip #3 Stay focused. * Your humor, hobbies, activities, dress, and “cool” personality, don’t impress anybody in the emergency department. * The best students tend to be friendly, focused, hardworking, and generally quiet (yay introverts!)* Emergency medicine tends to be a very pragmatic, no b.s, specialty. Let your performance speak for itself. Tip #4 Do the majority of your learning BEFORE your rotation starts. Your audition rotation should not be when you are downloading podcasts, studying pretest, or going through practice questions. Your learning should be completed well in advance so you can focus your energy on clinical performance). Tip #5 HELP around the department. * Help patient change into gown* Get urine samples* Keep patients updated* Go back and ask missing information
What is the knowledge set, lifestyle, and personality of an EM doctor?
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State of the Podcast
State of the Podcast
Thank you to our EMS. There will be no episode this weekend. I plan on postponing the 2019 kickoff episode until next week out of respect for recent events. The pre-recorded 2019 kickoff episode will post at that time and we will be back on a normal schedule and with normal content. Thanks, Zack https://www.nbc4i.com/news/local-news/memorial-held-for-crew-members-killed-in-survival-flight-crash/1759423171 Pilot: Jennifer Topper Flight Paramedic: Bradley Haynes Flight Nurse: Rachel Cunningham
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Plan B. What to do when you CAN’T intubate a patient.
Verbalize the out loud prior to performing rapid sequence intubation. The Bougie * Ideal for situations when you’re view is suboptimal* Advance it through the cords and into the trachea BEFORE the endotracheal tube. It will stay in place and guide the tube into position (this is called a Seldinger technique). Video Laryngoscopy (Glidescope) * Laryngoscope with a camera at the tip which displays on a screen at bedside* Ideal for situations when both view and direct access to the cords is suboptimal (c-collar, poor mallampati). Some physicians use this as their primary technique. * Use it like a camera that you advance into position so you can see the cords. Maneuver the endotracheal tube by watching indirectly on the screen. Flexible Endoscopy * It is a flexible stylet that you can control and has a camera at the tip.* Advances through the cords like a bougie and the (preloaded) endotracheal tube advances over it. * Can intubate through both the nose or mouth with this LMA (laryngeal mask airway) * Placed blindly and sits above the cords, forming a seal. * Not a “definitive” airway, but can oxygenate and ventilate the patient when in a difficult situation. Cricothyrotomy * Immediately perform this step in “can’t intubate can’t oxygenate” situations* The 3-step EMCrit method is best in my opinion (see link below)* “Scalpel, Finger, Bougie” Additional Reading * Overview of the bougie with videos (LITFL)* The 3-step cricothyrotomy (EMCrit)
How to intubate a patient…
The most important thing to do when preparing for RSI is to PREOXYGENATE the patient. Step 1: Choose Your Equipment * Miller or Mac blade? * Miller blade is straight (like the ‘L’ in miller)* Frequently used in kids* Mac blade is curved (like the ‘c’ in mac)* (Generally, this is the best choice to use on your clerkship and most common in the ED)* Tube Size?* 7.5 cuffed tube for a small adult* 8.0 cuffed tube for a big adult Step 2: Choose your Meds * You need both a sedative and a paralytic to perform RSI* Paralytic options are succinylcholine or rocuronium* Succinylcholine is best if you need something short acting* For example, when frequent neurologic checks are required* Rocuronium is best because it’s easy to remember (1mg/kg)* “Rocuronium Rocks”* Sedative options include ketamine, propofol, and midazolam. * My favorite is ETOMIDATE. * It is hemodynamically neutral.* Dosing is 0.3mg/kg Step 3: Prepare Your Equipment * Suction* Bag Valve Mask* Backup airway (ex. LMA)* Cardiac monitor* Capnography for tube placement Step 4: DO IT * Push the sedative* Push the paralytic* Put the blade in your LEFT hand* Open mouth with right hand* Slowly advance (holding top of blade against tongue) until you see cords* The cords will be hiding under the white, cartilaginous, tongue-like epiglottis NOTE: It’s OK if you don’t get it. It happens and it won’t make you look bad if your form was otherwise great. Step 5: Advance the Tube and then CLOSING STATEMENT * Generally, you want depth to equal 3x the size of the tube* Closing statement* “Please attach capnography to confirm tube placement”* “We will need to get an X-ray, foley, OG tube and start the patient on propofol (or versed)” CONGRATULATIONS!! THEY ARE INTUBATED!!
