There's a neat clinical tool that can help you here
The answer is not what you think
No really, the answer is not just an antibiotic Rx.
A quick summary breakdown of ways you'll be tested on rhabdomyolysis. More importantly, way to help you diagnose / manage your patients with rhabdo.
There is one lab finding that everyone seems to forget about when it comes to rhabdo
Let's hope you brought a fresh set of pants
The "ultimate test" of hemostasis
Vertebral osteomyelitis can be sneaky...
There is one key clinical finding that will help you easily distinguish between the two.
The key here is 'which organ is disproportionally affected?". This can have an insidious presentation unless you know what to look for.
Which ones are red flags?
Do you know what to do with a child who swallows this?
There's a disturbance in the phosphate (lol)
Do you know the key clinical presentations to look out for? More importantly, what's the next best step?
You're not going to be asked about acute treatment, but you certainly need to know the key epi and the chronic findings.
This is the perfect board question- listen twice to understand this pearl!
Do you know the 4 main end organ findings? You need to be able to rapidly diagnosis this syndrome.
Reduce 'em and discharge? Not so fast!
Can you guess this classic, rare illicit substance?
There's one nasty bug you can never miss!
Do you know how to interpret changing lab values and vital signs in your patients with pregnancy?
There are 3 main pathogens you need to know for tests and for life.
Do you know what causes this reaction? It's the most common adverse reaction to vancomycin.
How to manage this patient with bags of cocaine in their intestines
Body packing is a sad, but fascinating topic in the ED
Sadly, the answer is different in clinical practice vs boards. But you must know it!
You know it... but what happens first?
Which vasopressor is your go-to? You may be surprised.
This one pathology on EKG will change what you order next!
You certainly aren't going to be doing what you usually do....
This is one of the easiest questions to get right on a test. Do you know the 4 key lab values they will always ask you about?
Knowing the right order for treatment is critical for this pathology.
Its easier than you think, so let's just tweak your maneuvers!
Bring a fresh pair of undergarments and make sure you do this critical step right!
There is ONE thing you MUST do!
You need to react quickly with this child with an orbital fracture
So yes, the answer is get a MRI, but do you know the studies to do if MRI is not available? What about the study that has similar sensitivity?
Hint: it actually should not be that common...
No, the first line treatment for this is NOT your go to antiemetic for every other patient in your ER!
So you have a patient who was bitten by a monkey. Do you know the pathogen you should be worried about? Do you know how to treat?!
Who are you concerned the most about?
Pain and swelling to the orbit, what is your next move?
You got back pain and fever, what's your next move?
Multiple rib fractures, hypoxic, what's your move?
Do you know ALL the complications of pediatric VP shunts? Well then, we have a lot to talk about.
What's your next move?
Lateral view elbow, posterior fat pad seen - what's the diagnosis AND management?
Do you know the 4 kanaval signs? Sure, but do you know which one presents FIRST and which one presents LAST?
There are two specific things you need to do that can be life changing for not only the mother but the fetus. Do you know what they are?
Do you know which drugs are safe... or which ones do you avoid?
Want to kill your patient? Don't do this.
There is only one antidote, and its time to stop overthinking this
Do you know the clonidine "antidote" and how and when to dose?
Okay, so this might be a difficult question for you. Either way, we make sure you know how to treat Sulfonylureas toxicity.
This is a critical antibiotic to know. It doesn't take much of it to cause seizures. The antidote is critical to remember.
Can you recognize this tox case early enough?
Can you name the correct antibiotics for RPA tx?
Kenny Loggins knows it, but could you catch this scary infection?
Do you know WHEN to give it? Like, specifically when...
Asthma is the most common chronic respiratory condition in pregnancy - which means you need to know this for boards but more importantly for life.
No its not just constipation.
Labs, imaging and every "objective" measure can be normal, but after you listen to this, you'll know how to make this diagnosis.
The title alone should tell you what we're going to discuss. If you don't make the connection, you will after you're done listening to this episode!
There are some critical things you must know
Its not as common as Warfarin reversal, but you need to know it!
Which healthcare workers need post-exposure vaccination?
I'll give you a hint- tap it!
"Blood and thunder", cherry red spots, fluffy white perivascular lesions, out of focus retina -- do you know what each of these are associated with?
Let's rapidly review these classic envenomations for the boards!
Do you know the correct order? You should.
TL;DR- they aren't that accurate.
Sudden onset and painless vision loss. Do you know the "buzz words"? What about the first IMMEDIATE thing you should be doing to this patient to help restore their vision? Even before ophthalmology comes to see them??
The patient has injected conjunctiva, a fixed midpoint pupil, severe eye pain. You better know the medications that need to be administered as well as definitive management of this.
Key difference from NMS!
NMS treatment isn't just about dantrolene
What is the next BEST step? Imaging? IV labetalol? ocular eval? migraine cocktail? You should know the diagnosis simply from our title to this pod, but what's the next best step?
Let's quickly cover Neuroleptic Malignant Syndrome!
Let's knock out some easy board pearls!
Do you know how to treat elevated lithium levels. And what will make you decide on your treatment choices?
There are 3 key ways this question is asked on exams.
Plus let's talk how to diagnose it!
Objective measures are all reassuring, so what are you doing to do?
So based on this presentation we give you, are you going to A. order neuroimaging B. do a TIA workup? C. give tPA immediately or D. give steroids?
Review of pediatric pneumonia pathogens, but this particular one is a dreaded one...
Do you transfuse before tapping?
Sure it sounds easy, but can avoid this trap?
The presentation is classic, but do you really know the details?
Can you name the correct, go-to antibiotic?
Let's stop misinterpreting UA results
UTIs are common in pediatrics, let's stop being bad at diagnosing them...
Let's finally put an end to our talk on toxic alcohols.
Do you know what the CDC says about influenza and hospitalized patients?
Fomepizole vs Ethanol? Its not what you think...
CDC makes it clear when you need antivirals, do you know what they are? (and it's not just that 48 hour thing...)
Osmolal gap, anion gap, you getting the picture? If not, listen to this and we got you.
Do you know the right type of fluid / concentrations to give and when?
Neurogenic vs hemorrhagic and a host of other key pearls you need to know
Is it oliguria or diuresis? hypoglycemia or hyperglycemia? metabolic acidosis or alkalosis? and more...
Treatment: "nothing" or EGD or admit and observe? We tell you the key dispositions.
Tricky question, but so easy to get it right on the exam. Good to know for real life as we talk about the key temperature when deciding between External vs Internal rewarming.
Everyone loves asking about EKG changes for hypothermia patients. The great thing is there are only 3 main changes you need to know -- we review them quickly for you.
What are the key imaging modalities you can use, and what presentation should worry you?
Do you know them? Are you sure you won't confuse them with iron overdose?
Its not what you think...
...we're pretty sure you'll get this question wrong, but promise it'll be seared into your memory.
This might catch hemorrhage shock faster than HR or BP!
Never underestimate Mesenteric Ischemia
Pearls to avoid a AAA miss...
It stinks, but you really need to know the order of these!
Hint: ipecac is always the wrong answer (hehe)
Hint: A specific vaccination has dramatically reduced it's incidence....
Important to know for test questions, but "more importantly", life.
Are you certain you can treat priapism correctly?
Do you know the most common cause?
MG and it's most common presentation? Mainstays of treatment? And a sneaky presentation that could save a life....
Hold your breath when you see these patients crashing!
It's straightforward, but here are the key disposition pearls
Are you REALLY sure what to do first?
Swollen joints and their treatment. You need to know the causative agent here. It's not obvious and kinda sneaky. Did we just give this answer away?
No, the correct answer choice is not "migraine cocktail". Also, we equate using the phrase "migraine cocktail" with saying "double pneumonia". Come on now.
So you think you do, this seems pretty straight forward. But there is only one agent in this answer choice that is overwhelmingly the correct answer choice.
Yes, you know to give IV magnesium. But do you know what to do when there isn't proteinuria present? What is the diagnostic criteria then?
Do you know which agents to use?
Do you know how to keep these sick patients alive?
You might think this is obvious, just refer to "the nomogram". But -- when exactly should you refer to it? When should you NOT refer to it? When can you give NAC without referring to it?
Gotta remember Coagulative necrosis vs liquefactive necrosis. We review management of caustic agents. We also review things you should NOT do.
Part 2 of LVADS. We review the most common cause of failure, the most common cause of hypotension, sites of infection, immediate ED interventions, and more.
LVADS - yes, annoying, but a limited number of ways you can be tested on them. We rapidly go through some pearls in this part 1
Do you fall into this trap?
But if you have this drug at your disposal, it might change the game!
Would you restart NAC after anaphylaxis?? Get ready to be floored.
Would you send this patient to the operating room or CTA?
*sigh* yes, you just need to know these. Good news: easy to remember, easy to get right on the test, and great pearls to bring up during work!
They love asking about Ludwig, and there is a reason why. There are some critical aspects you need to identify quickly in order to save a life.
Also, do you know these critical adverse effects?
There are a lot of myths when it comes to pancreatitis, let's clear it up.
Everyone knows what to do with the atrial fibrillation patient who is unstable. However, what are you going to do with the stable yet symptomatic patient with A-fib? There are some key pearls and specific cutoffs you just need to know.
Forget the weird order of medications, let's simplify this!
This answer highlights how to not miss a bad fracture outcome!
Not only do you need to be able to rapidly recognize this condition, but you should know key things that can predispose your patients to it and how you can prevent it from happening in the first place.
Do you know the order of organ injuries from most to least likely? We get into this and then deliver some key pearls you'll love.
This classic rash can cause a headache if you forget its causes!
We're sure a lot of you will pick one answer, so that's why we're doing this podcast.
Post-obstructive diuresis is something you need to know because it can result in significant morbidity and mortality if not diagnosed appropriately. Do you know the numbers to make this diagnosis?
Its a weird word to describe the rash, but boards love to use it!
Seriously, you were probably taught wrong in medical school so let's clear it up.
This question will change the way you think about NPH (normal pressure hydrocephalus)!
A review of a commonly seen acute condition in the ED - urinary retention! You need to know the key causes!
You may have never ordered this test, but you better know it for trauma patients!
This answer choice might differ from what you've seen in practice, but its right!
You might be thinking this is obvious, I know this, I know the bacteria I'm treating. But do you? Do you?
Eye pain in trauma is something that get really bad, really fast. There are two treatment modalities you need to know. One of those we know you know, the other...maybe not?
You may have forgotten this from med school, but we promise you'll never forget it after this episode!
This may not be that obvious but in combination with one other symptom, you cannot miss anticholinergic toxicity!
One of our answer choices here might surprise you. We use it off label for every time of bleeding, but it's actually FDA approved for this.
Botulism is a scary little anaerobe, gram positive rod. It inhibits the release of Ach at motor junctions, leading to a flaccid motor paralysis...
There is one specific treatment that is considered first line for active vaginal bleeding in unstable patients.....(FDA approved)
Bells palsy = Unilateral facial nerve paralysis from lower motor neuron involvement of Cranial Nerve VII...
We talked earlier this week about defining acute liver failure. This question delivers a similar aspect of treating end stage liver disease...
Do you know about "dogmentin"? But what exactly are you treating and what about that dreaded Penicillin allergy?
Acute liver failure is some type of severe liver injury that leads to near-immediate failure of the synthetic function of the liver, with a high risk of permanent liver infarction and mortality...
It's all about the triad right? The pentad? nope.
Classically monoarticular, large joints are the most common sites, and the knee is involved >50% of cases....
So you're telling me the RUQ U/S might not be the best test? You need to know your tests and their limitations.
Hemolytic uremic syndrome (HUS) is a clinical syndrome characterized by an acute kidney injury with associated microangiopathic hemolytic anemia and thrombocytopenia...
Subungual hematoma is blood accumulating under the fingernail or toenail from trauma. Typically its from a blow to the distal phalanx...
Ascending paralysis is always terrifying, especially in the pediatric population. We go through the differential and ask a specific board type question that you might not get right.
Digoxin causes numerous changes to cardiac electrophysiology....
You need to know high risk vs low risk syncope. What gets admitted and what can be discharged? Do risk stratification tools even work?
A “brief resolved unexplained event” or BRUE, is not a specific diagnosis, but rather a diverse group of patients with various pathology...
Syncope is one of the most common presentations to the ED. We go through high yield tests that actually help, and talk about one in particular you should really avoid ordering in most patients.
In myocytes, the intracellular influx of calcium is necessary for muscle contraction. Cardiac glycosides reversibly inhibit the membrane Na-K ATPase...
Kidney stones are common causes of abdominal pain, with total prevalence in the US 5%, making it quite a routine ED diagnosis...
You have to know when this happens and how to manage it rapidly in the ER. The mortality is 90% but the temporizing measures work 85% of the time.
We get into the weeds about Lyme disease treatment when it comes to prophylaxis
This is everything you need to know on mesenteric ischemia in less than 4 minutes. Plus we tell you how they will set it up for you on tests!
We tell you 3 critical PE pearls you just need to know!
This patient has a concerning Lemierre Syndrome, otherwise known as septic thrombophlebitis of the internal jugular vein...
You think you know this, but this question will probably trip you up!
There's only one right answer here
Key pearls you will NEVER forget
What you learned in med school is wrong
First and most obvious -- evaluate the patient’s ABCs. Next -- supportive agents, such as fluids and vasopressors are indicated due to the patient’s hemodynamic instability...
If you don't feel good about SAHs, you better listen to this one
Steroids or antibiotics? How about neither
Let's hope you didn't forget the correct order of steps here
Cocaine is really bad for hearts, no joke.
No these patients aren't just flexing...
Don't make the same mistake so many others do with this!
The answer is really not what you would think
Everything you need to know in <3 minutes.
There's one right answer for the test, let's review.
TRALI and TACO revisited in detail.
One compartment to rule them all
We dare you to spell it correctly
It's the bloody eye again!
The answer is simple but often missed
TACOs and TRALIs- weird names, scary conditions.
A scary, rare condition you cannot miss.
Don't trip up when caring for these pregnant patients!
Changes in one electrolyte abnormality you cannot forget.
Not just Marfan's...
This is a "cannot-miss" question.
A short, but critical lesson.
Let's talk about the most common opportunistic infection in HIV.
Key pearls for an classic condition.
One more time on meningitis
Side effects are commonly tested with this drug, let's clear it up.
Another reminder of bugs and drugs for this disease.
A rare, but life-saving procedure in the right context.
There's only one right answer for the test!
Are you up for a challenge on this question?
Some great pearls and pitfalls for you
The most common cause of bleeding postpartum is??
Ticking timebombs you don't want to miss.
Open books can kill!
A quick one, but a solid reminder of these dumb drugs.
Let's fully cover this electrolyte abnormality!
You may be surprised at the answer to this.
Some key pearls on this strangely high yield pediatric disease!
Let's clear up some of the drama on this pathology.
When you see this, there's only 2 answers.
This is a high yield pathology you can never miss.
Let's talk everything IOs.
Finally an easy question... is it?
Hamman's Crunch is not reliable, just sayin'
The EKG finding you never want to miss.
Some major pearls on this testable pathology.
Bugs and Drugs for this infection
You might get fooled on this one.
Some quick pearls regarding a high yield question
Let's review this classic hand surgical emergency
There's one surprising element here that will reliably catch this injury.
Its the bloody eye!
A quick review of these important meds!
The annoying stats of drowning you must know
Don't fall for the trap on this question
Let's put this disease to rest- so you ace the test!
Only one thing matters the most in terms of "next best step."
"HUS- its what's for dinner". We hope you enjoy that joke.
Again, you have to know these stats for the test.
Some risk factors you must know for admission vs d/c.
Everything you need to know about the FAST exam on boards.
Its inexcusable if you miss this question on the test.
Iltifat is super proud of this question, and he should be.
This question will get you at least 2 questions right on the boards.
This is the first, but definitely not the last, question on dissections...
This dreaded question has haunted you since medical school.
There's a lot of myths with spider bites
This is an amazing question, let's make sure you don't miss this one on the test.
We set the record straight on all you need to know here.
There's definitely some ways you can miss this one!
Annoying Neuro question... but let us help you through it.
Never give nitrates to these patients!
The correct answer may surprise you here.
Antibiotics are controversial, let's set the record straight.
Let's quickly review this high yield pathology
This is a "gimme" question you must know!
Let's talk about what you need to know for Anti-coags.
Start here- Let's do this thing
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