This rotation was unique among my other clerkships because it was self-directed instead of involving in-person clinical experience. I decided to travel to visit family during the two weeks while completing modules and studying for the COMAT (shelf exam) at the same time. Despite not having the opportunity to learn under an emergency medicine physician in the emergency department, I still gained valuable insight into the role of emergency medicine physicians. I also reviewed emergent diagnoses less likely seen during my other rotations.
Here are some clinical pearls I learned from the rotation straight from my notes!
Loop diuretics like furosemide are the first-line treatments for cardiogenic pulmonary edema, which presents with bibasilar crackles and respiratory alkalosis.
In patients with panic attacks or pulmonary emboli, hyperventilation causes respiratory alkalosis.
Cardiac tamponade results from fluid accumulation in the pericardial sac, which increases intrapericardial pressure, compromises ventricular filling and decreases cardiac output.
Hyperkalemia shows peaked T waves. Hypokalemia shows flattened T waves, U waves, and QT prolongation.
Cannabinoid hyperemesis syndrome is a complication of chronic, weekly to daily marijuana use. Patients experience abdominal pain, nausea, and vomiting, which can lead to dehydration and electrolyte disturbances.
Meningococcal meningitis presents with a rapidly progressing fever, pharyngitis, myalgia, and skin mottling. Lumbar puncture and cerebrospinal fluid culture confirm the diagnosis. Prompt treatment with ceftriaxone decreases the risk of complications.
Blunt and penetrating chest trauma can cause pneumothorax, which presents with chest pain, shortness of breath, hypoxia, diminished breath sounds, and hyperresonance.
100% oxygen treats carbon monoxide toxicity. Nitrites and thiosulfate treat cyanide toxicity. Deferoxamine treats iron toxicity.
Risk factors for ectopic pregnancy include prior ectopic pregnancy, history of tubal ligation, smoking, and pelvic inflammatory disease.
Epidural hematomas almost always result from a direct injury to the head, which causes a skull fracture and the rupture of the middle meningeal artery.
Hear more about my 2-week rotation in Emergency Medicine (acute care medicine) in the First Line episode here.