EM Clerkship
This podcast is designed to help medical students excel in their emergency medicine clerkship and achieve top scores on their SLOE. The content is organized in an approachable format covering various chief complaints, critical diagnoses, and essential skills for the clerkship.
Episodes
Deep Dive R13 (SR)
To learn more on today’s topic:
https://www.emrap.org/corependium/chapter/recgSYYhIe7uv1r8x/Pediatric-DKA#h.mhab9ovl1fy9
https://www.chop.edu/clinical-pathway/diabetes-type1-with-dka-clinical-pathway
https://emergencymedicinecases.com/wp-content/uploads/filebase/pdf/Episode%20063%20Apr2015%20Pediatric%20DKA.pdf
https://www.ebmedicine.net/topics/endocrine/pediatric-emergency-medicine-diabetes
Round 13 (SR) – Vomiting Child
Gotta be gastroenteritis right? Tune in to find out!
Deep Dive R12 (IT)
Let’s talk teeth!
 
For more learning, check out these resources:
https://www.ncbi.nlm.nih.gov/books/NBK570590/
https://emergencymedicinecases.com/traumatic-dental-emergencies/
https://coreem.net/core/dental-trauma/
https://www.nuemblog.com/blog/oral-nerve-blocks
Round 12 (IT) – Dental Problem
Deep Dive R11 (SR)
Crotalinae, elapidae, hymenoptera and more!
Check out these additional resources for all things bites and stings!
EB Medicine North American Snake Envenomations
ALiEM Envenomations
EMRAP Corependium Snake Bites and Insect/Arthropod Stings
Links available on emclerkship.com
Round 11 (SR) – Bite
Snakes and scorpions and spiders, oh my! What bit our patient and how did Dr. Rumney handle it?
Deep Dive R10 (IT)
Hypertensive emergency? Urgency? Crisis? What’s the difference?
 
For further reading, check out:
https://www.ebmedicine.net/topics/cardiovascular/emergency-medicine-hypertensive-emergencies
Round 10 (IT) – Altered Mental Status
The altered hypertensive elderly patient – what’s the diagnosis? Stroke? Trauma? Sepsis? Dr. Tweedt gets put to the test in this latest case, following a new format designed to mirror new 2026 ABEM Certifying Exam.
Deep Dive R9 (SR)
Do you struggle with rashes? Learn about this life threatening rash on our deep dive.
If you haven’t listened to the case yet, first check out The Game Season 3 Round 9 with Maddie Watts and Sean Rumney.
 
Sources:
UptoDate – SJS/TEN Diagnosis and Management
https://www.dermacompass.net/en/diseases/stevens-johnson-syndrome-and-toxic-epidermal-necrolysis3
https://dermnetnz.org/topi
Round 9 (SR) – Rash
Everyone’s favorite chief complaint… rash. What could it be? Join Dr. Rumney in cracking this latest case
Disability Insurance for Physicians: Interview with Stephanie Pearson
Hear about the importance of own occupation disability insurance for physicians with none other than the expert herself – Stephanie Pearson from Pearson Ravitz!
Deep Dive R8 (IT)
Round 8 (IT) – Arm Pain
Deep Dive R7 (SR)
Round 7 (SR) Penis Problem
Upstairs Episode 1 – Psychiatry
Welcome to Isobel’s new series called “Upstairs”, where she gives us various pearls and teaching points from her experiences on off service rotations.
Deep Dive R6 (IT)
Round 6 (IT) – Diarrhea
Deep Dive R5 (SR)
Round 5 (SR) – Stridor
Deep Dive R4 (IT)
Round 4 (IT) – Abdominal Pain
Deep Dive R3 (SR)
Round 3 (SR) – Motor Vehicle Collision
Deep Dive R2 (IT)
Round 2 (IT) – Palpitations
Deep Dive R1 (SR)
Round 1 (SR) – Shortness of Breath
Deep Dive R32 MW
Round 32 (MW) – Altered Mental Status
Deep Dive R31 MW
Deep Dive – Decompensated Hypothyroidism
Round 31 (MW) – Confusion
Deep Dive R30 MW
Round 30 (MW) – Constipation
April 2025 Update
March 2025 Update
New Zealand
Learn about Maddie’s experience in New Zealand as well as unique aspects of New Zealand medical practice. Disclaimer: This is based on personal experience. If you’d like to learn more, some resources are listed below.
https://www.mcnz.org.nz/about-us/glossary
https://pharmac.govt.nz/about/what-we-do/how-pharmac-works
https://www.acc.co.nz
https://www.luc.edu/media/lucedu/law/centers/h
Deep Dive R29 MW
Round 29 (MW) Pediatric Respiratory Distress
You are working at Clerkship General when the triage nurse walks back and gets you. “Hey doc, we just put a hypoxic infant in bed 7”.
Initial Vitals:
HR: 168
RR: 44
BP: 81/40
O2: 81% (Room Air)
Critical Actions:
* Administer oxygen
* Obtain chest xray
* Correctly perform tube thoracostomy
* Initiate non-accidental trauma workup
* Complete mandated reporting
Deep Dive R28 MW
Round 28 (MW) – Hypothermia
You are working at Clerkship General on New Year’s Day when you see a nurse running from triage. He is carrying an unresponsive child to the resuscitation bay.
Initial Vitals:
HR: 43
BP: 47/20
Temp: 66F
RR: 4
O2: 95% (BVM)
Critical Actions:
* Obtain Core Temperature
* Use the Broslow Tape
* Follow PALS
* Begin Invasive Warming
* Transfer for ECMO
Deep Dive R27 MW
Round 27 (MW) Geriatric Fever
You are working at Clerkship General when you hear an EMS call on the base command radio. “Clerkship General. We are bringing you a minimally responsive 79 year-old female found lying on the floor inside her apartment. ETA 5 minutes”
Initial Vitals:
HR: 143
BP: 160/105
Temp: 106.3F
RR: 22
O2: 99% Room Air
Critical Actions:
* Blood glucose
* Obtain core temperature
*
Deep Dive R26 MW
Round 26 (MW) Dizziness and Fatigue
Introduction:
You are working at Clerkship General when the next chart is handed to you. It’s a 35-year-old female with a chief complaint of dizziness and fatigue. She is here accompanied by her husband.
Initial Vitals:
HR: 118
BP: 150/91
Temp: 100.4F
RR: 20
O2: 99% Room Air
Critical Actions:
* Check pregnancy test
* Check hemolysis labs
* Diagnose TTP
* Consu
Deep Dive R25 MW
Transcript/Summary coming soon!
Round 25 (MW) Laboring Mom in Triage
You are working at Clerkship General when you hear a woman screaming from triage… It’s baby time!
Initial Vitals:
HR: 120
RR: Shallow
O2: 58%
Critical Actions:
* Place neonate in warmer
* Administer positive pressure ventilation
* Obtain pre-ductal pulse ox
* Check blood glucose
* Place umbilical vein catheter
* Administer dextrose
Deep Dive MW R24
Transcript coming soon!
Round 24 (MW) Nursing Home Transfer
You are working at Clerkship General when the nurse comes up to you and says, “Hey doc, EMS dropped off this guy named Randy from the memory care unit at the nursing home down the street. He’s in the hall bed outside of room 7. EMS says he’s here for confusion, we will get him in a room once we can get one clean.
Initial Vitals:
HR: 118
BP: 109/55
Temp: 102.5 F
RR: 22
O2: 99%
Deep Dive MW R23
Episode summary coming soon!
Round 23 (MW) Pediatric Altered Mental Status
You are working at Clerkship General when you hear an EMS call on the radio. “Clerkship General, we are bringing you a 3 year old female with complaints of altered mental status. We are pulling in now.”
Initial Vitals:
HR: 129
BP: 98/66
Temp: 99.7F
RR: 35
O2: 99% Room Air
Critical Actions:
* Check blood glucose
* Check ingestion labs
* Start bicarbonate drip
* Ca
Deep Dive MW R22
Guillain-Barre Syndrome (GBS) – Autoimmune polyneuropathy that results in widespread demylination of peripheral nerves
Typically occur 1 week after a triggering infection
Paresthesias/Neuropathic Pain -> Ascending symmetric paralysis -> Respiratory Failure
Major Diagnostic Criteria
* Progressive limb weakness in multiple limbs that is relatively symmetric
* Diminished/Absent deep
Round 22 (MW) Fall with Weakness
Critical Actions:
* Treat the Patient’s Pain
* Perform a detailed neurologic exam (including reflexes)
* Perform LP
* Administer IVIG
* Check NIF or FVC and intubate prior to transfer
Deep Dive MW R21
Orbital Compartment Syndrome – needs to be diagnosed CLINICALLY
On exam, LOOK for: Proptosis, Ophthalmoplegia, Afferent Pupillary Defect, Vision Loss
On exam, FEEL for: Rock hard globe, tense eyelids, resistance to retropulsion
IOP > 40 means immediate canthotomy is indicated!
Don’t perform if open globe is present
Lateral Canthotomy Procedure: Anesthetize, Devascularize, Canth
Round 21 (MW) Geriatric Fall
You are working at Clerkship General when the next chart is put into your rack. It’s a 76 year-old male who has fallen.
Initial Vitals:
HR: 101
BP: 138/85
Temp: 98.0F
RR: 20
O2: 99% (Room Air)
Critical Actions:
* Diagnose Retrobulbar Hematoma
* Diagnose Subdural Hematoma
* Reverse Anticoagulation
* Perform a Lateral Canthotomy Procedure
* Administer Tetanus S
Deep Dive MW R20
Symptoms of stroke – weakness, facial droop, slurred speech. vision loss, vertigo, ataxia, confusion or changes to mental status.
The “typical” stroke workup – blood glucose level, CTH non-con, CTA head/neck, CT Perfusion, CBC BMP Troponin EKG CXR and Coags.
Common stroke mimics – hypoglycemia, drug/alcohol intoxication, Bell’s palsy, aortic dissection, complex migraines, and seizure w
Round 20 (MW) – Weakness
You are working at Clerkship General when one of the nurses comes and grabs you. “Hey doc, we need you in bed 10. I think this patient is having a stroke.”
Initial Vitals:
HR: 51
BP: 201/98
Temp: 98.0F
RR: 18
O2: 99% (Room Air)
Critical Actions:
* Check a Blood Glucose
* Activate a Stroke Alert
* Assess Contraindications to tPA
* Consent for tPA
* Transfer vi
Deep Dive MW R19
* Common during the first year of life as well as during puberty
* Presents with nausea/vomiting, abdominal pain, and/or testicular pain
* ALWAYS examine a child for signs of torsion who presents with abdominal pain (especially lower abdominal pain)
* Look for tenderness, firmness, high riding testicle or testicle with unequal lie, swelling, and the absence of a cremasteric reflex
Round 19 (MW) – Pediatric Abdominal Pain
You are working at Clerkship General when the next patient is put into your rack. It is an 8 year-old male with vomiting
Initial Vitals:
HR: 119
BP: 104/63
Temp: 98.0F
RR: 20
O2: 99% (Room Air)
Critical Actions:
* Finger Stick Blood Glucose
* Treat Patient’s Pain
* Diagnose Testicular Torsion
* Immediate Urology Consult
* Perform Manual Detorsion
Reference
Deep Dive MW R18
Phase One: CNS
* Ataxia, Slurred Speech, Confusion, N/V, Seizures
Phase Two: Cardiopulmonary
* CHF, Cardiogenic Shock/Hypotension, Pulmonary Edema, ARDS
Phase Three: Renal
* Flank pain, Hematuria, Oliguria, Renal Failure
Diagnosis:
* HIGH INDEX OF SUSPICION
* Ethylene Glycol Serum Level
* Elevated Osmolar Gap
* Serial Anion Gap Measurements
Treatment:
Round 18 (MW) – Intoxication
You are working at Clerkship General when you hear an EMS call on the radio. Clerkship General, we are bringing you Arthur. He is intoxicated… Again
Initial Vitals:
HR: 116
BP: 150/70
Temp: 98.8
RR: 26
O2: 85% (Room Air)
Critical Actions:
* Recognize Hypoxemia
* Diagnose Toxic Alcohol Ingestion
* Consult Nephrology Emergent Dialysis
* Administer Fomepizole
* W
Deep Dive MW R17
Hypertensive Emergencies of Pregnancy
PreEclampsia, Eclampsia, HELLP syndrome
Diagnosis: BP >140/90 plus end organ dysfunction
* Acute Kidney Injury
* Proteinuria
* Thrombocytopenia
* Transaminitis
* Hemolysis
* Pulmonary Edema
* Cerebral Edema / Hemorrhage
* Headache refractory to tylenol
* Visual Changes
* RUQ Pain not attributable to another diagnosis
Round 17 (MW) Headache
You are working at Clerkship General when the next chart is put in your rack. It’s a 41-year-old female with a chief complaint of headache.
Initial Vitals:
HR: 56
BP: 172/93
Temp: 98.8F
RR: 18
O2: 97%
Critical Actions:
* Check a Blood Glucose
* Diagnose Preecclampsia/Ecclampsia
* Administer Magnesium
* Treat the Hypertension
* Discuss with OBGYN and Admit
Deep Dive MW R16
Diagnosing PE:
Step 1: Consciously consider the diagnosis
Step 2: Risk Stratify into low, intermediate, and high risk
Step 3: Choose appropriate testing based on pre-test probability
Classification of PE
* High Risk/Massive PE: Hemodynamic Instability
* Intermediate Risk/Submassive PE: Right Heart Strain without instability ; or PESI Class 3+
* Low Risk/Non-Massive PE: Every
Round 16 (MW) Leg Pain
You are working at Clerkship General when you overhear the base command radio. “Clerkship General. We have a 57 year-old female coming in for leg pain. She just had surgery at your hospital. Her blood pressure is 85/50. We’ll be there in 5 minutes.”
Initial Vitals:
HR: 122
BP: 75/40
Temp: 100.1
RR: 24
O2: 74%
Critical Actions:
* Obtain full set of vital signs
* Treat
Deep Dive MW R15
Shock – A state of deranged physiology characterized by systemic, widespread hypoperfusion
* Hypovolemic Shock
* Hemorrhage
* Volume Loss (vomiting/diarrhea, dehydration)
* Cardiogenic Shock
* ACS, Myocarditis, CHF, Valve failure, Endocarditis, etc
* Obstructive Shock
* Massive PE, Tension Pneumothorax, Cardiac Tamponade
* Distributive Shock
* SIRS (Septic Shock, Pancrea
Round 15 (MW) MVA
You are working at Clerkship General when you hear and EMS call on the radio. “Clerkship General, we are activating a trauma alert. We are bringing you a 33 year old male from a high-speed single vehicle collision”
Initial Vitals:
HR: 65
BP: 88/50
Temp: 97.0F
RR: 20
O2: 96% Room Air
Critical Actions:
* Apply Cervical Collar
* Treat the Patient’s Pain
* Give Antibiot
Deep Dive MW R14
* Differential
* Traumatic causes: non-accidental trauma, fracture, dislocation, sprain, strain, tendonitis, osgood schlatter
* Non-traumatic causes: septic arthritis, transient synovitis, osteomyelitis, SCFE, LCP disease, rheumatologic disease, bony tumors
* Work-up
* XRay
* Labs to evaluate for septic arthritis – CBC BMP ESR CRP
* Kocher Criteria
* Non-weight bearing
* Fe
Round 14 (MW) Leg Pain
You are working a beautiful sunny day in Pennsylvania when the next chart gets put in your rack. It is a 2 year-old male with a leg injury.
Initial Vitals:
HR: 112
BP: 97/67
Temp: 99.2F
RR: 20
O2: 97% Room Air
Critical Actions:
* Consider Non-Accidental Trauma
* Evaluate for Septic Arthritis
* Treat the Childs Pain
* Diagnose Lyme Disease
* Prescribe Antibio
Deep Dive MW R13
* Focused Physical Exam
* Tachypnea and Hypoxemia
* Able to speak in complete sentences
* Accessory muscle use/retractions
* Moving air or quiet on auscultation
* Basic Treatment Algorithm
* Albuterol Inhaler
* Albuterol/Ipratropium Nebulized (Duoneb)
* Steroids
* IV Magnesium
* Non Invasive Ventilation (CPAP or BiPAP)
* Decreases Work of Breathing
* Epinepherin
Round 13 (MW) Respiratory Distress
You are working at Clerkship General when you hear an EMS call: “Clerkship General, we are bringing you a young female in respiratory distress. ETA 2 minutes”
Initial Vitals:
HR: 123
BP: 142/78
Temp: Unknown
RR: 36
O2: 97% (NonRebreather)
Critical Actions:
* Give Albuterol, Steroids, and Magnesium
* Give either Epinephrine or Terbutaline
* Post Intubation Checkli
Deep Dive MW R12
Introduction
* Used as pesticides
* Used as weapons (nerve agents)
* Sarin Gas, VX Gas, Novichok
* Transdermal, Inhalation, Ingestion
Clinical Presentation
* Muscarinic Activation (Dumbels Mnemonic)
* Defication
* Urination
* Myosis
* Bradycardia, Bronchospasm, and Bronchorrhea
* “The Killer B’s”
* Emesis
* Lacrimation
* Salivation and Sweating
*
Round 12 (MW) Respiratory Distress
You are working at Clerkship General when you hear an EMS call on the radio. “Clerkship General. We are bringing you an unresponsive 6-year-old female found foaming at the mouth by her babysitter. ETA 2 minutes.”
Initial Vitals:
BP: 125/80
HR: 62
RR: 34
O2: 81% (Non Rebreather)
Critical Actions:
* Grab the Broslow!
* Fingerstick Glucose
* Choose Endotracheal Tube Size
OBGYN: The Vaginal Delivery (Pt 2)
Shoulder dystocia is an OB emergency. Remember McRobert’s maneuver and suprapubic pressure. For more information, take a look at the resources below.
References
ACOG- Shoulder Dystocia
AAFP- Shoulder Dystocia
OBGYN: The Vaginal Delivery (Pt 1)
Maddie’s 7 Cardinal Movements of a Successful Delivery:
1. Head comes out
2. Head turns
3. Cord Assessment
4. Anterior shoulder delivered
5. Posterior shoulder delivered
6. Body delivered.
7. Baby on mom’s chest
T’s of Postpartum Hemorrhage:
1. Tone
2. Trauma
3. Tissue
4. Thrombosis
Deep Dive MW R11
The 6 STEMI Equivalents:
* Posterior MI
* ST Depression V2/V3 (or STE in V7-V9)
* Right Ventricular MI
* STE V1 associated with inferior MI ; or STE V4R-V6R
* Wellens Syndrome
* Type A: Biphasic T-waves V2/3
* Type B: Deep Symmetric T-wave Inversion V2/V3
* De Winter’s T Wave
* ST Depression with a large, symmetric, upright T wave
* STE avR with diffuse ST
Round 11 (MW) Chest Pain
You are working at Clerkship Rural when the nurse hands you your next chart to see. It’s a 59 year old farmer with chest pain.
Initial Vitals:
BP: 156/97
HR: 110
RR: 22
O2: 98% (Room Air)
Temp: 98.8F
Critical Actions:
* Give Aspirin, Nitroglycerin, and Heparin
* Identify Posterior STEMI
* Assess for Thrombolytic Contraindications and Consent
* Transfer for PCI
Deep Dive MW R10
* The MILDLY agitated patient : verbal de-escalation or PO benzo/antipsychotic
* The MODERATELY agitated patient : IM benzo/antipsychotic
* The SEVERELY agitated patient : IM Ketamine 5mg/kg
Consider removing the terminology “Agitated Delirium” from your vocabulary, as there is significant racial bias behind this term.
Round 10 (MW) Agitation
You are working at Clerkship General when you hear an EMS call on the radio…
“CLERKSHIP GENERAL – We are bringing you an agitated and combative 30 year old male, we’ll see you in 5 minutes.”
Initial Vitals:
BP: 192/105
HR: 134
RR: 22
O2: 99% (Room Air)
Temp: 98.8 F
Critical Actions:
* Administer Sedation for Patient/Staff Safety
* Intubate the Patient and Obtain
Deep Dive MW R9
Indications for LP: CNS infection, SAH, Guillian Barree, IIH
Contraindications for LP: Space occupying lesion with mass effect ; severe thrombocytopenia and coagulopathy; cellulitis over LP site or concern for epidural abscess ; traumatic injury to spine
Complications for LP: Post LP Headache, spinal hematoma, brainstem herniation
Technique for LP: Positioning is everything. Use US if n
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