Crackcast & Physicians As Humans On Canadiem

Core Questions:    What is diplopia and how is it classified? What four questions help clinicians delineate the potential cause of a patient’s diplopia? What are the cardinal directions of gaze and how are they tested? Outline the physical exam for the patient with monocular and binocular diplopia. Outline the DDx for monocular diplopia? Outline the DDx for binocular diplopia? [Table 18.1] Detail the different oculomotor palsies. [Figure 18.3] Detail the various lacunar stroke syndromes. [Box 18.1] Define internuclear ophthalmoplegia. What ancillary tests are required for the patient presenting with diplopia? [Figure 18.4]   Wisecracks:    What are the most common oculomotor palsies and what causes them? What is orbital apex syndrome? What is the “rule of the pupil” and how reliable is it? Detail the physical exam maneuvers used to identify patients with myasthenia gravis.

Ruminations from two residents about handling and thriving in call shifts for medical students.

Welcome to ClerkCast! A podcast for medical students by medical students, focusing on cognitive approaches to common EM presentations. This episode covers how to approach patients with chest pain in the Emergency Department as a medical student with our guest co-host Dr. Shawn Mondoux, staff EM doc at St Joseph's Hospital in Hamilton, and a Quality Improvement guru We cover: 1. The SIX CAN'T MISS chest pain diagnoses 2. Acute coronary syndrome and the Terrible Triad 3. Aortic dissection history pearls 4. Investigations in patients with chest pain Enjoy!

Core Questions:    List three primary headache disorders Describe the pathophysiology of migraines and name three Emergency Department treatments for same List five critical and five emergent causes of headache (Table 17.1) Outline your approach to the history for the patient presenting with headache ( Box 17.1) Outline your approach to the physical exam for the patient presenting with headache (Table 17.3) Describe your diagnostic approach to the patient with a suspected SAH Detail the findings on LP that would suggest your patient has bacterial meningitis Wisecracks:    What percentage of patients presenting with headache to the ED have a SAH? Outline the SNOOP MEETS Pregnancy mnemonic Which diagnostic test is best to establish the diagnosis of cerebral venous sinus thrombosis? Detail how to elicit Kernig’s and Brudzinski’s Sign 

An intro to the latest CanadiEM podcast, ClerkCast!   Hosted by two McMaster medical students, Lauren Beals and Ben Forestell, ClerkCast is your one stop shop for approaches to common EM presentations... enjoy!

Welcome to ClerkCast! A podcast for medical students by medical students, focusing on cognitive approaches to common EM presentations. This episode covers how to succeed in the Emergency Department as a medical student with our guest co-host Dr. Teresa Chan, staff EM doc at Hamilton Health Sciences, CanadiEM co-founder, and medical educator extraordinaire We cover: 1. How to structure your differential diagnosis in the ED 2. Eye-balling a patient - edits have been made clarifying the ABCs 3. How to prioritize management in the ED using the RAPID mnemonic 4. How to present a case in the ED 5. Feedback at the end of a shift Enjoy!

On this episode of First Year Diaries, I am joined by Dr. Mike Kirlew, a rural family and emergency medicine physician from Sioux Lookout in Northern Ontario. I asked him about how he ended up working in a rural area, and what it is like working with scarce medical resources. Later, we discussed how a resident physician can prepare themselves for working in a rural community, and how best to transition to living in a rural area.

Core Questions:    What is dizziness and what pathologies can cause it? Define vertigo and acute vestibular syndrome What three systems are involved in the maintenance of equilibrium and how many of these systems must be affected to cause vertigo? Trace the neuronal impulse from the vestibular apparatus to the muscle endplate Define nystagmus List five peripheral causes of vertigo (see Table 16.2) List five central causes of vertigo (see Table 16.2) Differentiate between central and peripheral vertigo based on history and clinical exam findings Describe the Dix Hallpike Test Outline your approach to the HINTS exam What is the Epley maneuver and what pathology does it treat? Describe the Barbecue Roll Test and what pathology does it treat? Outline your approach to managing the vertiginous patient   Wisecracks:    What diagnoses cause both vertigo and hearing loss? What features of nystagmus suggest a central pathology? What is truncal ataxia and what typically causes it?

Core Questions:    Define seizure and provide an explanation of the classification systems for seizure Define recruitment as it relates to seizure development and progression Differentiate between seizure and syncope Differentiate between neurogenic and psychogenic seizures List 5 diagnoses that can mimic seizures (see Box 15.2) Define status epilepticus and differentiate between convulsive and non-convulsive status epilepticus List 10 causes of status epilepticus in adults (see Box 15.1 and 15.3)  Outline management of status epilepticus.  List indications for head CT for first seizure.    Wisecracks:    List 5 properties of ictal events  Isoniazid Toxicity TCA Toxicity Eclampsia Hypoglycemia Hyponatremia  What medications are needed to treat seizing patients with the following: Name 3 key metabolic abnormalities that can cause seizures Name 3 common seizure provokers that can worsen pre-existing seizure disorders What percentage of patients with convulsive status epilepticus will develop non-convulsiv

The same 65-year-old man who was seen earlier with an ICH has now recovered. His past medical history is remarkable for hypertension, dyslipidemia, a mechanical aortic valve replacement, diabetes, and sleep apnea. His list of medications include ramipril, atorvastatin, aspirin, metformin, and warfarin. Should his anti-coagulation be resumed? If so, how long should the clinician wait prior to re-starting his medications? Objective 1: Summarize the most recent guidelines regarding when to re-start anti-coagulation after ICH (ASA, DVT-P, Xa inhibitors, warfarin) Objective 2: What factors need to be taken into consideration when making this decision? Objective 3: Interpret the evidence behind the guidelines Objective 4: Describe instances where one would consider re-starting anti-coagulation earlier/later Objective 5: Develop an approach to re-starting anti-coagulation after ICH including which agent to use and why Objective 6: How would you approach this scenario? Objective 7: What do guidelines suggest? Object

Core Questions:    Define confusion. What is your differential diagnosis for the confused patient? Differentiate between organic and functional causes of confusion. What is the Quick Confusion Scale (QCS) and how is it calculated? What is the Brief Confusion Assessment Method (bCAM) and how is it used? What is the Mini-Mental State Examination (MMSE) and how is it scored? What ancillary tests are used when working up the confused patient? What is the role of thiamine in the treatment of the acutely confused patient?   Wisecracks:    What simple tests can you use to assess concentration at the bedside? What treatments should be used for the patient with acute hypoglycemia causing confusion? List 5 emergent and 5 critical diagnoses that cause confusion.

Today on First Year Diaries I am joined by Dr. David Carr, a University Health Network emergency physician, renowned medical education speaker, and Toronto Blue Jays physician. In this episode, I asked him to impart his wisdom to new staff physicians like myself and share his approaches to a successful career in medicine. Later in the interview, we also discuss workflow strategies for the ED, common mistakes made by new physicians, and tips on how to maintain wellness/avoid burnout.   Questions: 01:57 – 03:05 - Can you please introduce yourself? (name, training, where you work, interests, etc.).   03:05 – 04:45 – Tell me about your philosophy, and what your career trajectory has been?   04:55 – 08:07 – How can new physicians get to become an educator like you?   08:07 – 12:43 – Do you have any tips for new physicians looking to reach their goals, and become a well-respected physician like yourself?   12:43 – 27:56 – Can you tell us about how you manage department flow efficiently and safely, especial

Core Questions: 1. Define coma and differentiate coma from lethargy and stupor. 2. Name five neuroanatomic structures involved in maintaining arousal. 3. List five critical and five emergent causes of depressed consciousness. (see Table 13.1) 4. Describe your approach to the history and physical examination for the patient with depressed consciousness. 5. Outline your exam to accurately assess the Glasgow Coma Scale (GCS). (see Table 13.2) 6. What is the FOUR score, and how is it calculated? (see Table 13.3) 7. What ancillary tests should be ordered in the patient with depressed consciousness? 8. Outline your plan of management for the patient with depressed consciousness. (see Figure 13.2) Wisecracks: 1. What is the best noxious stimulus to apply to evaluate GCS? 2. What are the oculocephalic and oculovestibular reflexes, and what information do they provide? 3. Describe decorticate and decerebrate posturing. 4. What is the utility of serum ammonia testing?

Core Questions:    List 10 life-threatening causes of syncope  List 10 medications that can precipitate syncope  What are the red flags on history and physical exam in syncope?  What are markers of increased short-term risk in syncope patients? (box)  What are 5 ECG findings to look for in the syncopal patient?   List five indications for admission and inpatient evaluation for the patient with syncope?   Wisecracks:    What is the significance of a patient presenting with syncope vs. near syncope?  What is the utility of orthostatic vital signs?  What degree of cerebral hypoperfusion is needed to cause unconsciousness?

Core Questions:   Define cyanosis and explain what causes it? What is central cyanosis and what typically causes it? What is peripheral cyanosis and what typically causes it? At what concentration of deoxyhemoglobin does cyanosis present? List 10 differential diagnoses for cyanosis - Box 11.2? Describe your initial workup for the patient with cyanosis.- Figure 11.3/11.4 What is the oxyhemoglobin dissociation curve and what information can be taken from it? - Figure 11.1 Name four factors that shift the oxyhemoglobin dissociation curve to the left and three factors that shift it to the right. Differentiate between ferrous and ferric hemoglobin and describe how these forms of hemoglobin affect oxygen binding. What is methemoglobinemia and how does it present? What are the two biochemical pathways that are used to reduce methemoglobin? List 10 causes of methemoglobinemia - See Box 11.1 What is sulfhemoglobinemia and when should you suspect it? Differentiate between primary, secondary, and relative polycythemia

From CAEP 2019 I always love the activities and experiences at CAEP, but year after year I’m drawn to the Simulation Olympiad. Every time I think it’s just incredible. This year, I decided to talk with some of the people who make the SIMOlympiad such a great experience for audiences and participants alike. In my first interview, I heard about what the average SIM team looks like, how the competition runs, and what the scope of the material covers. We also got the details on what the characteristics of a winning team look like and how SIM hopefuls can start the team that will win it all at CAEP 2020. Here is my interview with Dr. Tamara McColl of the University of Manitoba and judge for the CAEP 2019 SIMOlympiad.   (If you like to follow along, the show questions are below) 1. Tell us about yourself, what you do, where you work, and what your involvement is in the CAEP Simulation Olympiad.  2. What is the Simulation Olympiad at CAEP for our listeners who have not attended the session or have never been to CAEP

Core Questions: 1. What structures are affected by UMJ, LMJ, and NMJ lesions, and what are causes of weakness associated with each? 2. What are common signs of UMN, LMN, and NMJ dysfunction? 3. What are (7) pathophysiologic causes of non-neurologic weakness (Box 10.1)? 4. What is the DDx of neuromuscular weakness? (Table 10.1) 5. Describe an approach to general weakness in the ED. Wisecracks: 1. Differentiate between “plegia” and “paresis”. 2. List (5) DDx‘s for non-neurologic weakness (based on pathophysiologic processes). 3. List (5) non-emergent causes of peripheral neuropathy (Box 10.2) 4. Explain how you recognize an ED patient that may be approaching the end of life.

Today’s episode is to aid new physicians to traverse through the first few months of their independent practice safely and effectively. As a new physician myself, I had the luxury of having many mentors and colleagues who were gracious enough to help me find my way in providing safe patient care. Additionally, they assisted me on integral aspects that we don’t necessary learn or get exposed to as a resident, such as billing, department flow, and the politics of the ED. However, as a new staff, there are so many uncertainties that you must face alone, and I wanted to find a guide to help me transition more effectively. After not finding something that fit the bill of what I truly wanted, I decided to tackle the issue myself and find colleagues who would help me out with the task of navigating through the First Year of Practice. Questions: Can you please introduce yourself? (name, training, where you work {academic, community, etc}, any other work you are doing {tox, primary care, etc.}). How is it being a ne

Core Questions: What structure controls body temperature and how does it go about controlling it? What are pyrogens and how are they classified? What is the difference between fever and hyperthermia? What is the role of PGE2 in fever and what medications can you give to combat its effects? List four factors that blunt the febrile response. What are the benefits and pitfalls of the febrile response? List five infectious and five non-infectious causes of fever. (see Box/Table 9.1) Describe your approach to the febrile patient. (see Figure 9.1/9.2) Wisecracks: What is the most accurate temperature measurement site? How are heart rate and body temperature related? How are respiratory rate and body temperature related? How high must a fever be to necessitate rapid cooling interventions?