{"id":1235,"date":"2017-02-15T06:09:45","date_gmt":"2017-02-15T11:09:45","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=1235"},"modified":"2017-02-15T06:09:45","modified_gmt":"2017-02-15T11:09:45","slug":"ep-16-training-exam-review-part-1-3-abdominal-cardiovascular-cutaneous-endocrine-environmental-emergencies","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/ep-16-training-exam-review-part-1-3-abdominal-cardiovascular-cutaneous-endocrine-environmental-emergencies\/","title":{"rendered":"Podcast Ep 16: In-Training Exam Review, Abdominal, Cardiovascular &amp; More"},"content":{"rendered":"\n<figure class=\"wp-block-audio\"><audio controls src=\"https:\/\/media.blubrry.com\/thereveal\/s\/media.blubrry.com\/roshcast\/s\/content.blubrry.com\/roshcast\/Ep_16_Roshcast_Emergency_Board_Review.mp3\"><\/audio><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>What we think, we become<\/p><cite>-Buddha<\/cite><\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">Welcome back to Episode 16! With the In-training Exam next week, we are doing things a little different this week. Instead of covering new material before the exam, we are launching three episodes, back to back, reviewing the most high-yield points that we have&nbsp;covered so far, organized by topic. We think this extra layer of spaced repetition will help you gain a few extra points during your test. We have set it up in a quiz format, so you can pause the podcast as you go along.<\/h6>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\"><strong>Now onto this week\u2019s podcast<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline\"><strong>Abdominal Emergencies<\/strong><\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Small bowel obstructions<\/strong> are caused most commonly by <strong>postoperative adhesions<\/strong> followed by malignancy. &nbsp;<\/li><li><strong>Large bowel obstructions<\/strong> are caused most commonly by <strong>malignancy<\/strong> followed by volvulus.<\/li><li><strong>Reynolds\u2019 pentad<\/strong> for acute cholangitis consists of <strong>fever<\/strong>, <strong>right upper quadrant pain<\/strong>, <strong>jaundice<\/strong>, <strong>altered mental status, and hypotension<\/strong>.<\/li><li>The initial treatment for <strong>GERD<\/strong> should always begin with <strong>lifestyle and behavior modifications<\/strong> including weight loss, head of bed elevation, and avoiding eating prior to sleeping. If lifestyle modifications are not providing adequate relief, PPIs are the empiric treatment of choice for GERD.<\/li><li><strong>Untreated GERD<\/strong> can lead to<strong> Barrett Esophagus<\/strong>, which increases the risk for esophageal neoplasm.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline\"><strong>Cardiovascular Emergencies<\/strong><\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Nitrates<\/strong> reduce both the preload and the afterload by dilating vascular smooth muscles. <strong>Avoid nitrates<\/strong> in <strong>inferior MIs<\/strong> and in those on <strong>phosphodiesterase inhibitors<\/strong>.<\/li><li>The most common finding in an <strong>acute aortic dissection<\/strong> is <strong>hypertension<\/strong>.<\/li><li><strong>Capture beats<\/strong> are <strong>normal narrow supraventricular beats within a run of wide complex beats<\/strong>. <strong>Fusion beats<\/strong> occur when <strong>impulses from two different locations activate the ventricle<\/strong>. One impulse is typically ventricular and the other is supraventricular, resulting in a QRS complex with hybrid morphology of a sinus beat and an intraventricular beat.<\/li><li>For hemodynamically stable patients, <strong>AVNRT<\/strong> can be treated with <strong>beta-blockers<\/strong>, <strong>calcium channel blockers<\/strong>, or, less commonly, <strong>digoxin<\/strong>. Unstable or refractory cases require <strong>cardioversion<\/strong>.<\/li><li>The mnemonic <strong>FROM JANE<\/strong> (<strong>Fever, Roth\u2019s spots, Osler\u2019s nodes, Murmur, Janeway lesions, Anemia, Nail-bed hemorrhages, and Emboli<\/strong>), can be used to remember the findings associated with <strong>bacterial<\/strong> <strong>endocarditis<\/strong>.<\/li><li>In <strong>IV drug users with endocarditis<\/strong>, the <strong>tricuspid valve<\/strong> is most commonly affected and <strong><em>Staph aureus<\/em><\/strong> is the most common bacteria isolated.<\/li><li>In <strong>native valve endocarditis<\/strong>, the <strong>mitral valve<\/strong> is most commonly infected followed by the <strong>aortic valve<\/strong>.<\/li><li><strong><em>Strep bovis<\/em><\/strong><strong> endocarditis<\/strong> is associated with <strong>colon cancer<\/strong> (remember: cancer in the colon, bovis in the blood).<\/li><li>In <strong>cardiac arrest<\/strong>, <strong>AED use<\/strong>, <strong>early bystander CPR<\/strong>, <strong>amiodarone<\/strong> for shock-resistant ventricular tachycardia or ventricular fibrillation, <strong>therapeutic hypothermia<\/strong>, and <strong>cardiac catheterization<\/strong> for ventricular dysrhythmias, even in EKGs that do not meet STEMI criteria, have all been shown to improve outcomes.<\/li><li><strong>MAP = CO x SVR + CVP.<\/strong> Its\u2019 more easily estimated by the formula <strong>MAP = \u2153SBP + \u2154DBP.<\/strong><\/li><li>The <strong>right coronary artery<\/strong> occlusion supplies the <strong>AV node<\/strong> in the majority of patients. Acute occlusion can lead to heart black.<\/li><li>The six P\u2019s of <strong>acute arterial occlusion<\/strong> are <strong>paresthesias<\/strong>, <strong>paralysis<\/strong>, <strong>pallor<\/strong>, <strong>pulselessness<\/strong>, <strong>poikilothermia<\/strong>, and <strong>pain out of proportion to exam<\/strong>. <strong>P<\/strong><strong>aralysis<\/strong> and <strong>paresthesias<\/strong> require <strong>emergent surgical intervention<\/strong>.<\/li><li><strong>Acute arterial embolisms<\/strong> should be managed by<strong> embolectomy<\/strong>, whereas<strong> in situ thromboses<\/strong> may respond to<strong> anticoagulation<\/strong>.<\/li><li><strong>Left ventricular thrombus formation<\/strong> after an MI is the most common source of an arterial embolus.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline\"><strong>Cutaneous Emergencies<\/strong><\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Escharotomies<\/strong> are performed along the <strong>medial and lateral aspects of both the upper and lower extremities<\/strong>.<\/li><li>The <strong>Parkland formula = 4 x percentage burned x weight (in kg). <\/strong>Give the <strong>first half<\/strong> of the fluid over the <strong>first 8 hours<\/strong> and the <strong>second half<\/strong> of the fluid over the <strong>next 16 hours.<\/strong><\/li><li><strong>Staph scalded skin syndrome<\/strong> is caused by an <strong>exotoxin<\/strong>. These patients will have a <strong>positive Nikolsky\u2019s sign<\/strong>. Rupturing the bullae will not spread the toxin, as it is spread <strong>via the blood stream<\/strong>.<\/li><li><strong>Trousseau\u2019s syndrome<\/strong> is a <strong>migratory thrombophlebitis<\/strong> associated with <strong>pancreatic cancer<\/strong>.<\/li><li><strong>Erythema nodosum<\/strong> is an inflammatory condition characterized by <strong>tender red-violet nodules<\/strong> under the skin. The most common cause is an infection but drugs can also cause erythema nodosum, with <strong>OCPs<\/strong> being the most common culprit. The <strong>treatment is NSAIDs<\/strong> for mild to moderate cases. <strong>Potassium iodine<\/strong> can be used in severe cases.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><span style=\"text-decoration: underline\"><strong>Endocrine Emergencies<\/strong><\/span><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Sulfonylurea<\/strong><strong> anti-hyperglycemia <\/strong>can cause recurrent episodes of <strong>hypoglycemia<\/strong><span>.<\/span><\/li><li>In <strong>factitious hypoglycemia,<\/strong> <strong>C-peptide<\/strong> should be <strong>low<\/strong> and <strong>insulin levels<\/strong> should be <strong>high<\/strong> due to exogenous administration of insulin.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><strong><span style=\"text-decoration: underline\">Environmental Emergencies<\/span><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\"><li><strong>Scorpion stings<\/strong> cause local <strong>redness and edema<\/strong> with a <strong>heightened sensitivity<\/strong> to touch in the area. You can also have <strong>numbness and weakness<\/strong> in the affected area. Systemic symptoms include <strong>fasciculations<\/strong>, <strong>disconjugate<\/strong> <strong>gaze<\/strong>, <strong>temperature reversal<\/strong>, and <strong>pancreatitis<\/strong>.<\/li><li><strong>Black widow spiders<\/strong> are found throughout the <strong>entire United States<\/strong>. They can be identified by the <strong>hourglass<\/strong> on their abdomen. In contrast, <strong>brown recluse spiders<\/strong> are found in the <strong>Midwest<\/strong>.<\/li><li><strong>Black widow spider<\/strong> <strong>bites<\/strong> cause a local <strong>papule with a halo<\/strong>. Severe systemic symptoms include a <strong>peritonitic<\/strong> <strong>abdomen<\/strong>, <strong>muscle fasciculations<\/strong>, and <strong>diaphoresis<\/strong>. <strong>Brown recluse spider bites<\/strong> cause a <strong>papule that later blisters<\/strong> and may <strong>necrose<\/strong>. Systemic symptoms include <strong>renal<\/strong> <strong>failure<\/strong>, <strong>pulmonary<\/strong> <strong>edema<\/strong>, and <strong>shock<\/strong><\/li><li><strong>Pit viper snakebites<\/strong> cause <strong>local swelling<\/strong> and oozing from the wound. Severe envenomation can lead to a <strong>DIC-like coagulopathy and hemorrhagic bullae<\/strong>.<\/li><li><strong>Frostbite<\/strong> should be treated with immersion in a <strong>warm water bath at 37 to 39 degrees Celsius<\/strong>. Water at a higher temperature will warm no faster and cause increased pain and potentially tissue damage.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">So, that&#8217;s it for part 1. Stay tuned for the remaining two parts. Was this review helpful? Do you want us to change anything? Send us your thoughts at <a href=\"mailto:roshcast@roshreview.com\">roshcast@roshreview.com<\/a>.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Until next time,<br>Jeff and Nachi<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">P.S. If you missed Episode 15, including arterial emboli, <a href=\"https:\/\/www.roshreview.com\/podcasts\/ep-15-erythema-multiforme-pneumothorax-heart-block-brain-natriuretic-peptide-angioedema-arterial-emboli-airway-obstructionand\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">listen here<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Welcome back to Episode 16! With the In-training exam next week, we are doing things a little different this week. Instead of covering new material before the exam, we are launching three episodes, back to back, reviewing the most high-yield points that we have covered so far, organized by topic. We think this extra layer of spaced repetition will help you gain a few extra points during your test. We have set it up in a quiz format, so you can pause the podcast as you go along.<\/p>\n","protected":false},"author":11,"featured_media":1238,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[2025,1999],"tags":[2037,2332,2470,2594,2604,2866,3465],"coauthors":[],"class_list":["post-1235","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-abdominal","tag-cardiovascular","tag-cutaneous","tag-endocrine","tag-environmental","tag-in-training-exam","tag-review"],"yoast_head":"<!-- This site is optimized with the Yoast SEO Premium plugin v21.7 (Yoast SEO v26.6) - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Podcast Ep 16: In-Training Exam Review, Abdominal &amp; Cardiovascular Em. | RoshReview.com<\/title>\n<meta name=\"description\" content=\"Welcome to RoshCast (Ep. 16), the first question and answer style emergency medicine podcast. Listen and learn more.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/www.roshreview.com\/blog\/ep-16-training-exam-review-part-1-3-abdominal-cardiovascular-cutaneous-endocrine-environmental-emergencies\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Podcast Ep 16: In-Training Exam Review, Abdominal, Cardiovascular &amp; More\" \/>\n<meta property=\"og:description\" content=\"Welcome to RoshCast (Ep. 16), the first question and answer style emergency medicine podcast. 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