Crackcast & Physicians As Humans On Canadiem

This episode of CRACKCast covers Rosen's chapter 183, approach to the geriatric patient. Our geriatric patients can often mask serious diagnoses with vague presentations and multiple co-morbidities.

This episode of CRACKCast covers Rosen’s Chapter 181, Labor and Delivery. This chapter covers the high risk realm of ED deliveries, including potential complications such as PROM, malpresentation and umbilical cord emergencies.

This episode of CRACKCast covers Rosen’s Chapter 179, Drug Therapy in Pregnancy. There is a lot of fear and anxiety often present within pharmacologic therapy in pregnancy, but having informed, shared decision making with patients can lead to safer outcomes and adherence when treating.

This episode of CRACKCast covers Rosen’s Chapter 178, Co-Morbid Medical Emergencies during Pregnancy. This chapter covers many complicated issues that arise during the care of pregnant patients already suffering from concomitant medical illness, and how to manage these conditions balancing risks to both mother and fetus.

This episode of CRACKCast covers Rosen’s Chapter 177, Acute Complications of Pregnancy. This chapter covers many acute issues that arise during the unique physiologic state that is pregnancy, from first trimester bleeding to diagnostic challenges and management of other conditions during pregnancy.

Core questions What are the indications for orthopedic surgery for clavicle fracture? List 5 Xray features of supracondylar fracture Describe the Gartland Classification for Extension-type supracondylar fractures List specific complications of a supracondylar fracture. Describe the sequence of ossification around the elbow. What is Baumann’s Angle? (shownotes) Monteggia fracture-dislocation Toddler’s fracture Nursemaid’s elbow. Describe the radiographic findings and management of: Describe the Ortolani and Barlow maneuvers. (shownotes) List 3 physical exam findings consistent with DDH. List 10 causes of hip pain in children Provide a differential diagnosis of limp in the toddler, school-aged child and adolescent. How would you differentiate between transient synovitis and septic arthritis in a child with hip pain? What is the most common location for septic arthritis in a child? What is the prognosis for transient synovitis? What is the most common cause of septic arthritis? Age < 2 months 2 months – 5 y

This episode of CRACKCast covers Chapter 174 in Rosen's 9th Edition. Today, we will go over common topics in paediatric neurology and emergency medicine that will help you on your next shift! Knowledge of neurologic disorders is essential for any practitioner of emergency medicine, so strap in for a high-yield post. Core Questions List ten causes of provoked (acutely symptomatic) seizures. List four episodic disorders that may mimic seizures in neonates and four in non-neonates. How does it differ if you are unable to obtain IV or IO access? Give an approach to acute seizure control in a 9-month-old and in a 5-year-old. What is the definition of status epilepticus? List 6 medical treatments for status epilepticus. What is the definition of a simple febrile seizure? Describe the management of febrile seizure. Which patients should have outpatient imaging and neurology follow-up? Which children with seizure should be admitted to hospital? List 5 reasons for CT Head after seizure and describe management a

This episode of CRACKCast covers Rosen's Chapter 173, Genitourinary and Renal Tract Disorders. Torsion, phimosis, UTIs, stones, and priapism are some of the high-yield topics covered here. Core questions: 1. List a DDx for priapism and describe treatment. 2. Describe the management of a paraphimosis. 3. Describe the management of a phimosis. 4. What is the pathophysiology of balanoposthitis? What is the most common bug in balanoposthitis? 5. How is balanoposthitis managed? 6. Describe the diagnosis and management of pediatric epididymitis and orchitis. 7. Describe the diagnosis and management of testicular torsion. 8. List common bacteria in peds UTI and describe treatment in patients

Core Questions: 1) What are three pathophysiologic types of diarrhea? Give an example of a cause for each. 2) List 6 common causes of childhood infectious diarrhea in developed countries. 3) List 5 important differential diagnoses of diarrhea in children. 4) List 5 important differential diagnoses of vomiting in children. 5) When should you initiate a medical evaluation of children with acute diarrhea? 6) Describe the typical presentation of: Rotavirus Norovirus Salmonella Shigella Yersinia E. Coli C. Difficile 7) List routine and high risk treatment recommendations for common bacteria causing acute infectious diarrhea in children: Salmonella non-typhi Salmonella typhi Shigella Campylobacter jejuni Yersinia enterocolitica C. Difficile Vibrio cholerae Vibrio parahaemolyticus E. Coli 8) List the presenting features and treatments for three common protozoa causing infectious diarrhea in children. 9) Define and describe your diagnosis and management approach to dehydration that is: Mild Moderate Severe Assoc

Core questions:     List 8 causes of neonatal jaundice and indicate whether they are conjugated or unconjugated List indications for work-up of a jaundiced infant What are RFs for hyperbilirubinemia? (8) What is the differential diagnosis for vomiting in a child? Describe the typical presentation of each of the following: Hypertrophic pyloric stenosis Malrotation with midgut volvulus NEC GERD Intussusception Hirschsprung's Disease Meckel’s Diverticulum HSP List Xray findings for each of the following: Malrotation with midgut volvulus (2) NEC (4) Intussusception (5) Hirschsprung's Disease (2) Describe the conservative management of a patient with GERD. What is the preferred diagnostic test for diagnosis for intussusception? List causes of lead points in pts with intussusception. Describe each of the following signs on physical exam: Sandifer’s syndrome Red-currant Jelly Stools Dance’s Sign Rovsing’s sign Psoas Sign Obturator Sign Describe the “Rule of 2”

This episode of CRACKCast reviews Rosen’s Chapter 170, Pediatric Cardiac Disorders. This podcast covers the common infectious complications leading to pediatric cardiac issues. Additionally, we will review Kawasaki's Disease, Acute Rheumatic Fever, HOCM, and much more.  Episode Overview: 1. Describe procedures and conditions for which prophylaxis for bacterial endocarditis is recommended. 2. Describe 2 potential prophylaxis regimens. 3. What is the differential diagnosis of myocarditis? What is the most common cause of myocarditis in children? 4. What is the differential diagnosis of pericarditis in children? Describe any differences b/n adults and children. 5. What are the clinical diagnostic criteria for Kawasaki’s disease? 6. If the clinical criteria are not met, but you are still suspicious, how else might Kawasaki’s disease be diagnosed? 7. What are some unusual clinical presentations of Kawasaki’s disease? 8. How is Kawasaki’s disease managed? What is treatment directed towards preventing? 9. List the J

This episode of CRACKCast covers Rosen’s Chapter 170, Pediatric Cardiac Disorders. This podcast covers cyanotic and acyanotic cardiac defects, the presentation and management of congestive heart failure in pediatric populations, and the management of common arrhythmias in children. A second podcast will release next week detailing other issues in pediatric cardiology. Episode Overview: 1. What is the most common form of congenital heart disease? 2. List 6 Acyanotic and 8 Cyanotic types of CHD. 3. What are the ductal dependent heart lesions? 4. Describe the emergent management of the hypoxic infant with a suspected ductal dependent cardiac lesion. 5. List types of CHD which are most likely to present outside of the neonatal period. 6. What are the anatomic anomalies seen in Tetralogy of Fallot? What is the pathophysiology of a Tet spell and how is it         managed? What is a ductal-dependent ToF? 7. Describe the management of CHF in the infant. 8. List 12 conditions associated with a high risk of developin

Core questions:   Name 8 non-infectious causes that may present as pneumonia Describe the workup for a child with suspected pneumonia? What are the typical causes of bacterial pneumonia and viral pneumonia in the following age groups: < 1 month 1 month – 3 months 3 months – 5 years ≥ 5 years What is the empiric treatment of bacterial pneumonia in these age groups for outpatients? For inpatients? List 8 complications of pneumonia List 6 criteria for admission with pneumonia What are three clinical complications of cystic fibrosis? What is the pathophysiology of CF? How is suspected pneumonia in a patient with CF treated?   Wisecracks:   What is the cause of whooping cough? What are the stages of whooping cough? How is whooping cough managed? How is the flu shot used in the pediatric population? Describe common pneumonia syndromes: Chlamydia trachomatis Mycoplasma pneumonia   What is the most common bacterial infection in CF?

Core questions:   Excluding asthma, list 8 causes of wheeze Outline the pathophysiology of asthma. What are the features of mild, moderate and severe asthma? Describe the PRAM score List 8 medications for asthma treatment with doses What is the typical ED management for a pts with an asthma exacerbation? Describe adjunctive therapies that might be used in a patient with refractory symptoms. How are PO corticosteroids used in the management of asthma? When should children be started on inhaled corticosteroids? Outline a plan for disposition of a pt presenting to the ED with an acute asthma exacerbation. What are risk factors for sudden death in a patient with asthma? List risk factors for bronchiolitis. What are the typical pathogens of bronchiolitis? What is the pathophysiology of bronchiolitis? How is bronchiolitis managed? Which children with bronchiolitis should be admitted to hospital? List potential complications of RSV.     Wisecracks:   What’s the natural history of i

Core questions:   What is the pathophysiology of inspiratory and expiratory stridor? Provide a differential diagnosis for stridor in children (based on location: supraglottic, glottic, subglottic) list at least three in each category. What is the typical presentation of a retropharyngeal abscess? Describe the management of a RPA. What are the typical pathogens? What the typical pathogens in epiglottis? How are these patients managed? Differentiate between croup and other conditions mimicking croup. Contrast mild, moderate, and severe croup. What is the management of croup? Which children with croup require admission to hospital? Management of upper airway FB: Describe the management of an airway obstruction (progresses from partial obstruction to full obstruction to unconscious) in a 6 month old. In a 6 year old?     Wisecracks:   Ddx of stridor (8) (review) List 5 Xray findings of epiglottitis Which infections are associated with croup? How do you handle the CICV scenario?    

Core questions:   List 10 non-infectious causes of fever in children List 3 bacterial pathogens responsible for infections in the following age groups 0-28 days 1-3 months 3-36 months > 3 yr List 5 tests to perform on CSF Describe the empiric management of fever in the neonate (0-28 days) Why is ceftriaxone not recommended for the neonate? Describe one of The Rochester criteria The Philadelphia criteria Define simple and complex febrile seizure. What are indications for LP? What is the likelihood of Recurrent febrile seizure after 1 st presentation Risk of epilepsy after first febrile seizure? List 6 causes of Fever and Petechiae Describe the criteria for the diagnosis of Toxic Shock Syndrome What sickle cell patients require prophylaxis and why? What Abx? List the Duke criteria for infective endocarditis.   Wisecracks:   Provide a differential diagnosis for fever (review question) Which patients are excluded from the Rochester Criteria? What are the low-risk Roche

Core questions:   1) List age specific vital signs (RR, HR): “1 odd yr - 60 count down aid” 2) What is the lower fifth percentile of systolic BP for the neonate, infant, and 1-10 yr old child? 2) Describe the 3 components of the Pediatric Assessment Triangle. 3) Describe the Canadian Pediatric Triage and Acuity Scale 4) List 5 historical indicators of child abuse 5) List 5 features suggestive of child abuse on physical examination and/or radiology?   Wisecracks:   What are developmental milestones (gross motor and otherwise) for 1-24 months? What are other considerations in the management of pediatric patients: consent, pediatric-readiness, pediatric-friendly ERs?    

This episode of CRACKCast covers Rosen's 9th Edition, Ch. 159. In the podcast, we will look at the sedative hypnotic toxidrome and the various agents that bring patients to your ED.   Core questions:    Describe the components of the GABA receptor complex and their physiologic effect Describe the sedative-hypnotic toxidrome, and list 8 drugs in the DDx How do barbiturates work? What are the clinical symptoms of barbiturate overdose? How are they managed? How do benzodiazepines work? List risk factors for benzodiazepine withdrawal and its management What are the indications for flumazenil? What are the contraindications? How does chloral hydrate toxicity present? What is the clinical presentation of GHB toxicity? How is GHB withdrawal managed?   Wisecracks:   List 2 drugs used for ‘date-rape’ and describe their toxicity What Benzos WILL NOT be detected on urine drug screen?    

This episode of CRACKCast covers Chapter 158 in Rosen's Emergency Medicine, 9th Edition. Core Questions: For each of the following, describe the expected toxicity: Jequirity pea, rosary Umbrella tree, Dieffenbachia, Dumb cane Capsicum annum Water Hemlock Jimson Weed, Deadly Nightshade Eucalyptus oil Poinsettia Oleander, Foxglove Tobacco Pokeweed Rhododendron Yew Castor Beans List 5 mushrooms with early onset toxicity and 3 with late onset – and describe the toxicity expected. List 4 mechanism of toxicity resulting from the use of herbal medicine. List 4 plants containing cardiac glycosides. What is Buckthorn?

This episode of CRACKCast covers Rosen’s 9th Edition Chapter 155, Antipsychotics. Continuing along the spectrum of toxicologic exposures, these agents account for a large number of presentations to emergency departments every year. Being equipped with the knowledge of how to deal with the side effects of these medications and their associated toxidromes is imperative and may help you save lives in the future.