{"id":888,"date":"2016-10-25T06:09:56","date_gmt":"2016-10-25T10:09:56","guid":{"rendered":"https:\/\/www.roshreview.com\/?p=888"},"modified":"2016-10-25T06:09:56","modified_gmt":"2016-10-25T10:09:56","slug":"ep-3-pulmonary-embolism-pneumothorax-axial-load-injury-amphetamine-abuse-escharotomy-thrombotic-thrombocytopenic-purpura-mumps-and-more","status":"publish","type":"post","link":"https:\/\/www.roshreview.com\/blog\/ep-3-pulmonary-embolism-pneumothorax-axial-load-injury-amphetamine-abuse-escharotomy-thrombotic-thrombocytopenic-purpura-mumps-and-more\/","title":{"rendered":"Podcast Ep 3: Pulmonary Embolism, Pneumothorax, Axial Load Injury, &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\/Roshcast_Emergency_Medicine_Board_Review_Ep3.mp3\"><\/audio><\/figure>\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\"><p>&#8220;The secret of getting ahead is getting started.&#8221; &nbsp; -Mark Twain<\/p><\/blockquote>\n\n\n\n<h6 class=\"wp-block-heading\">Hope you enjoyed ACEP as much as we did. Now it is time to get back to work. For current residents, the 2017 In-training Exam is scheduled for&nbsp;February 22nd. Do not forget to <a href=\"https:\/\/itunes.apple.com\/us\/podcast\/rosh-review\/id1156487141?mt=2\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">subscribe to RoshCast<\/a> on your favorite podcast player, so new episodes will automatically be downloaded after release. Regular review and spaced repetition are the keys to success.&nbsp;<\/h6>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\">You can find our <a href=\"https:\/\/itunes.apple.com\/us\/podcast\/rosh-review\/id1156487141?mt=2\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">previous episodes<\/a> here in case you missed them.&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Remember, we appreciate any feedback you can provide. Please send it to <a href=\"mailto:feedback@roshreview.com\">feedback@roshreview.com&nbsp;<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Lets get started&#8230;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Question 1<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 15-year-old boy presents to the ED after falling two stories down an elevator shaft. He complains of severe bilateral heel and back pain. On exam, he is alert with normal vital signs. His dorsalis pedis, popliteal, and femoral pulses are strong; no other deformity is recognized. Radiographs of the bilateral heels reveal calcaneal fractures. What additional test should be considered in this patient?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. &nbsp;Compartment pressures<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. &nbsp;Complete radiographs of the spine<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. &nbsp;CT angiography<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. &nbsp;Retrograde urethrogram<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Axial-Load.jpg\">Teaching card to supplement answer<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Bohler-Angle-Calcaneal-fracture-heel.png\">Teaching card to supplement answer<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\">Question 2<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">An 18-year-old man presents to the ED via the police because of altered mental status and violent behavior. The patient reportedly had been on a drug binge, using amphetamines and cocaine for the last two days. On arrival, he is afebrile, his heart rate is 140 beats per minute, blood pressure is 180\/110 mm Hg, and he is respiring at 22 breaths per minute. He is agitated and combative, but there is no evidence of traumatic injury. His pupils are dilated, and he is diaphoretic. Which of the following statements is true regarding the treatment of amphetamine and cocaine toxicity?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. &nbsp;Antipsychotics are the preferred initial therapy for agitation and psychosis<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. &nbsp;Beta-adrenergic blockers are safe for managing tachycardia and dysrhythmias<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. &nbsp;Body packers with leaking packets should receive whole-bowel irrigation<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. &nbsp;Vasodilators are first-line therapy for treating amphetamine-induced hypertension<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">E. &nbsp;Wide-complex tachydysrhythmias should be treated initially with sodium bicarbonate<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Sympathomimetic-toxidrome-cocaine.png\">Teaching card to supplement answer<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Body-packer-and-body-stuffer.png\">Teaching card to supplement answer<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\">Question 3<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 19-year-old man is brought in from a house fire. He has severe burns over a significant portion of his body. His right thigh has circumferential full-thickness burns and no palpable pulse in the foot. Where should an escharotomy be performed?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. &nbsp;Anterior midline thigh<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. &nbsp;Circumferentially in the mid-thigh<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. &nbsp;Medial and lateral thigh<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. &nbsp;Posterior midline thigh<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Locations-for-escharotomy-incisions.jpg\">Teaching card to supplement answer<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Parkland-Formula-Burn.png\">Teaching card to supplement answer<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\">Question 4<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following test results has the highest sensitivity for excluding pulmonary embolism?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. &nbsp;Normal chest radiograph<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. &nbsp;Normal duplex ultrasound of the lower extremities<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. &nbsp;Normal helical computed tomography scan<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. &nbsp;Normal ventilation-perfusion nuclear medicine scan<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Table-ECG-findings-in-pulmonary-embolism.png\">Teaching card to supplement answer<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\">Question 5&nbsp;<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A 20-year-old man presents to the ED with left-sided pleuritic chest pain. The onset was sudden and occurred while he was washing dishes. Vital signs are BP 125\/70 mm Hg, RR 16, HR 75, and pulse oximetry is 99% on room air. A chest radiograph is seen above. Which of the following is the most appropriate next step in management?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. &nbsp;Left side thoracostomy with a 32-French tube<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. &nbsp;Needle decompression of the left chest<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. &nbsp;Non-rebreather mask at 15 liters oxygen\/min<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. &nbsp;Repeat chest radiograph in 6 hours<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Pneumothorax-and-types.png\">Teaching card to supplement answer<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\">Question 6<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Which of the following is the hallmark characteristic of mumps?<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">A. &nbsp;Cough, coryza, and conjunctivitis<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">B. &nbsp;Epididymoorchitis<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">C. &nbsp;Maculopapular rash<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">D. &nbsp;Nonsuppurative parotid swelling<\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><a href=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/Image-Viral-parotitis-mumps.png\">Teaching card to supplement answer<\/a><\/p>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<div class=\"wp-block-image\"><figure class=\"aligncenter\"><img decoding=\"async\" src=\"https:\/\/www.roshreview.com\/wp-content\/uploads\/RapidReview-2-e1475624722961.png\" alt=\"rapidreview\" \/><\/figure><\/div>\n\n\n\n<ul class=\"wp-block-list\"><li>Over 80% of <strong>calcaneal fractures<\/strong> are associated with <strong>concomitant vertebral fractures<\/strong><\/li><li>In <strong>amphetamine overdoses<\/strong>, wide complex tachydysrhythmias are treated with<strong> sodium bicarbonate<\/strong>. Don\u2019t forget to address the underlying causes, and control the agitation with benzodiazepines and the hyperthermia with aggressive cooling measures.<\/li><li><strong>Body packers<\/strong> and <strong>stuffers<\/strong> who have ingested packets of drugs may undergo whole bowel irrigation only if the packets are intact. If they have ruptured, this becomes a surgical emergency.<\/li><li><strong>Escharotomies<\/strong> are performed along the <strong>medial and lateral aspects<\/strong> of both the upper and lower extremities in cases of circumferential burns<\/li><li><strong>Parkland formula<\/strong>: 4 x % total burned BSA x weight (in kg). Give the first half of the fluid over the first 8 hours and the second half of the fluid over the next 16 hours<\/li><li><strong>V\/Q scan<\/strong> has the highest sensitivity for excluding pulmonary embolism<\/li><li>The classic EKG finding with <strong>pulmonary embolism<\/strong>&nbsp;is S1Q3T3. <strong>Sinus tachycardia<\/strong> is the most common finding.<\/li><li>A <strong>simple pneumothorax<\/strong> is one involving &lt; 10% of the hemithorax and should be treated with a &#8220;non-rebreather&#8221; to increase the speed of resorption. With larger pneumothoraces, you may see a deep sulcus sign.<\/li><li><strong>Nonsuppurative parotid swelling<\/strong> is the hallmark characteristic of <strong>mumps<\/strong><\/li><\/ul>\n\n\n\n<hr class=\"wp-block-separator\" \/>\n\n\n\n<p class=\"wp-block-paragraph\">Please provide us feedback at <a href=\"mailto:feedback@roshreview.com\">feedback@roshreview.com<\/a> Hopefully you enjoyed listening to this week\u2019s episode and learned a thing or two as well. Don\u2019t forget to <a href=\"https:\/\/itunes.apple.com\/us\/podcast\/rosh-review\/id1156487141?mt=2\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">subscribe<\/a> to Roshcast on your favorite media player (iTunes, downcast, etc.) to ensure you will be the first to know about new episodes as they go up.<\/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. Please visit Rosh Review if you are looking for more high-quality <a href=\"https:\/\/www.roshreview.com\/specialties\/emergency-medicine\/\" target=\"_blank\" rel=\"noreferrer noopener\" aria-label=\" (opens in a new tab)\">emergency medicine board review<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>We are back with a quick dose of high quality, high yield emergency medicine board review. Episode 3 touches on Pulmonary Embolism, Pneumothorax, Axial Load Injury, Amphetamine Abuse, Escharotomy, Thrombotic Thrombocytopenic Purpura, Mumps&#8230;and more<\/p>\n","protected":false},"author":11,"featured_media":895,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"inline_featured_image":false,"footnotes":""},"categories":[2025,1999],"tags":[2140,2211,2618,3070,3330,3412,3650],"coauthors":[],"class_list":["post-888","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-emergency-medicine","category-podcast","tag-amphetamine-abuse","tag-axial-load-injury","tag-escharotomy","tag-mumps","tag-pneumothorax","tag-pulmonary-embolism","tag-thrombotic-thrombocytopenic-purpura"],"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 3: Lithium, Mastitis, Nitrates, Schistocytes &amp; More | RoshReview.com<\/title>\n<meta name=\"description\" content=\"Welcome to RoshCast (Ep. 3), 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-3-pulmonary-embolism-pneumothorax-axial-load-injury-amphetamine-abuse-escharotomy-thrombotic-thrombocytopenic-purpura-mumps-and-more\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"Podcast Ep 3: Pulmonary Embolism, Pneumothorax, Axial Load Injury, &amp; More\" \/>\n<meta property=\"og:description\" content=\"Welcome to RoshCast (Ep. 3), the first question and answer style emergency medicine podcast. 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