The first episode serves as a trailer to both the conference and the series. Stay tuned for more amazing summaries from CAEP 2023!

Warning: Explicit language in this episode.

In this episode, Tiffany shares her transition from Resident to Med Staff during the COVID pandemic. She candidly shares her challenges balancing job uncertainty, family, kid zoom classes, finishing residency and a cross country move. Take a listen!

Host: Tiffany Proffitt DO, Staff Emergency Medicine Physician Honor Health

Short Bio: Dr. Tiffany Proffitt is an Emergency Medicine Physician in Scottsdale, Arizona, USA. I completed residency in Michigan, USA with Spectrum Health Lakeland. During my time I graduated from the Medical Education Track. I am honored to be one of the inaugural fellows of EMRACAST, the official resident run podcast of EMRA. In my Med Staff life I am the co-founder of the HonorHealth Women Physicians Leadership Council, advancing leadership opportunities for over 550 women physicians. In my spare time, I cart my twin eight-year-olds to various activities, laugh with my husband and podcast! I am a MedEd enthusiast and proud to be part of the CanadiEM team!

In this episode, Tiffany shares her transition from Resident to Med Staff during the COVID pandemic. She candidly shares her challenges balancing job uncertainty, family, kid zoom classes, finishing residency and a cross country move. Take a listen!

Host: Tiffany Proffitt DO, Staff Emergency Medicine Physician Honor Health

Short Bio: Dr. Tiffany Proffitt is an Emergency Medicine Physician in Scottsdale, Arizona, USA. I completed residency in Michigan, USA with Spectrum Health Lakeland. During my time I graduated from the Medical Education Track. I am honored to be one of the inaugural fellows of EMRACAST, the official resident run podcast of EMRA. In my Med Staff life I am the co-founder of the HonorHealth Women Physicians Leadership Council, advancing leadership opportunities for over 550 women physicians. In my spare time, I cart my twin eight-year-olds to various activities, laugh with my husband and podcast! I am a MedEd enthusiast and proud to be part of the CanadiEM team!

Yannopoulos D, Bartos J, Raveendran G, Walser E, Connett J, Murray TA, Collins G, Zhang L, Kalra R, Kosmopoulos M, John R, Shaffer A, Frascone RJ, Wesley K, Conterato M, Biros M, Tolar J, Aufderheide TP. Advanced reperfusion strategies for patients with out-of-hospital cardiac arrest and refractory ventricular fibrillation (ARREST): a phase 2, single centre, open-label, randomised controlled trial. Lancet. 2020 Dec 5;396(10265):1807-1816. doi: 10.1016/S0140-6736(20)32338-2. Epub 2020 Nov 13. PMID: 33197396; PMCID: PMC7856571. Lamhaut L, Hutin A, Puymirat E, Jouan J, Raphalen JH, Jouffroy R, Jaffry M, Dagron C, An K, Dumas F, Marijon E, Bougouin W, Tourtier JP, Baud F, Jouven X, Danchin N, Spaulding C, Carli P. A Pre-Hospital Extracorporeal Cardio Pulmonary Resuscitation (ECPR) strategy for treatment of refractory out hospital cardiac arrest: An observational study and propensity analysis. Resuscitation. 2017 Aug;117:109-117. doi: 10.1016/j.resuscitation.2017.04.014. Epub 2017 Apr 14. PMID: 28414164.

Matsuoka Y, Goto R, Atsumi T, Morimura N, Nagao K, Tahara Y, Asai Y, Yokota H, Ariyoshi K, Yamamoto Y, Sakamoto T; SAVE-J Study Group. Cost-effectiveness of extracorporeal cardiopulmonary resuscitation for out-of-hospital cardiac arrest: A multi-centre prospective cohort study. Resuscitation. 2020 Dec;157:32-38. doi: 10.1016/j.resuscitation.2020.10.009. Epub 2020 Oct 17. PMID: 33080369.

Grunau B, Shemie SD, Wilson LC, Dainty KN, Nagpal D, Hornby L, Lamarche Y, van Diepen S, Kanji HD, Gould J, Saczkowski R, Brooks SC. Current Use, Capacity, and Perceived Barriers to the Use of Extracorporeal Cardiopulmonary Resuscitation for Out-of-Hospital Cardiac Arrest in Canada. CJC Open. 2020 Nov 13;3(3):327-336. doi: 10.1016/j.cjco.2020.11.005. PMID: 33778449; PMCID: PMC7985000.

Sun T, Guy A, Sidhu A, Finlayson G, Grunau B, Ding L, Harle S, Dewar L, Cook R, Kanji HD. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) for emergency cardiac support. J Crit Care. 2018 Apr;44:31-38. doi: 10.1016/j.jcrc.2017.10.011. Epub 2017 Oct 12. PMID: 29040883.

Hsu CH, Meurer WJ, Domeier R, Fowler J, Whitmore SP, Bassin BS, Gunnerson KJ, Haft JW, Lynch WR, Nallamothu BK, Havey RA, Kidwell KM, Stacey WC, Silbergleit R, Bartlett RH, Neumar RW. Extracorporeal Cardiopulmonary Resuscitation for Refractory Out-of-Hospital Cardiac Arrest (EROCA): Results of a Randomized Feasibility Trial of Expedited Out-of-Hospital Transport. Ann Emerg Med. 2021 Jul;78(1):92-101. doi: 10.1016/j.annemergmed.2020.11.011. Epub 2021 Feb 1. PMID: 33541748; PMCID: PMC8238799.

Twitter: @kevinjdongMD

1. Outline the anatomic borders of the anterior and posterior triangles of the neck.
2. Detail the borders and associated contents of the three zones of the neck.(Box 37.1)
3. List 5 hard and 5 soft signs of penetrating neck trauma (Box 37.2)
4. List 5 hard and 5 soft signs of vascular injury 
5. Outline an approach to the management of a patient with a hemorrhaging penetrating neck wound.
6. Describe the management of a patient with a suspected venous air embolism.
7. Outline the steps in performing an awake intubation.
8. Outline the indications for imaging to screen for blunt cerebrovascular injury.(Table 37.2)
9. Detail the appropriate imaging studies to order in the patient at risk for or with suspected blunt cerebrovascular injury.

Wisecracks

1. What structure, if violated, should make you suspect injury to the deep tissues of the neck?
2. What study or studies is/are indicated to evaluate a patient for suspected esophageal injury.
3. List 4 mechanisms of morbidity and mortality that occur as the result of vascular injury in the neck.
4. What is the most common mechanism of injury causing blunt cerebrovascular injury?
5. List 3 mechanisms that cause pulmonary edema in a patient post-hanging.

1. Outline the Denis Classification system for determining the stability of spinal injuries
2. List 5 flexion, 2 flexion-rotation, 3 extension, and 2 vertical compression spinal injuries (Table 36.1)
   1. Wedge Fracture 
   2. Flexion Teardrop Fracture
   3. Clay Shoveler's Fracture
   4. Spinal Subluxation
   5. Bilateral Facet Dislocation
   6. Altlanto-occipital Dislocation
   7. Anterior Atlanto-axial Dislocation
   8. Unilateral Facet Dislocation
   9. Posterior Neural Arch Fracture
   10. Hangman's Fracture
   11. Extension Tear Drop Fracture
   12. Burst Fracture
   13. Jefferson Fracture
3. Outline the mechanisms and potential complications of the following injuries:
4. How are odontoid fractures classified and what causes them?
5. Organize the spinal motor, sensory, and reflex examinations based on spinal levels. (Tables 36.3, 36.4, 36.5)
   1. Central Cord
   2. Anterior Cord
   3. Brown-Sequard
6. Detail the following cord syndromes:
7.  List the components of the following imaging decision-making tools: Canadian C-Spine Rule, NEXUS C-Spine Rule.

Wisecracks

1. How do you calculate Power's Ratio and why is it important?
2. What injuries is the open-mouth odontoid radiograph best at visualizing?
3. How are whiplash-associated injuries classified?
4. At what spinal level would you expect an injury to potentially cause Horner's Syndrome?
5. What is spinal shock and what physical exam finding indicates its end?

Welcome back to Journal Club by CanadiEM! In this episode we go over an approach to systematic reviews and meta analyses based on Oxford centre of EBM, and learn about diagnosing pneumothorax with ultrasound vs X-ray

Using the Oxford centre of EBM tool, we will ask:

1. What question(s) did the systematic review address?
2. Is it likely that important, relevant studies were missed?
3. Were the criteria used to select articles for inclusion appropriate?
4. Were the included studies sufficiently valid for the type of question asked?
5. Were the results similar from study to study?
6. What were the results?
7. What is the clinical significance of the results?

and then a clinical pearl on pneumothorax!!

Hosts: 

• Dakoda Herman
• Jayneel Limbachia
• Jake Domm

Paper: "Chest ultrasonography versus supine chest radiography for diagnosis of pneumothorax in trauma patients in the emergency department" Cochrane Database of Systematic Reviews by Chan KK, Joo DA, McRae AD, Takwoingi Y, Premji ZA, Lang E, Wakai A

What question(s) did the systematic review address?

P: Trauma patients in the ER

I: chest ultrasonography by non rad physicians

C: Chest xray

O: diagnosis of pneumothorax, improved patient safety 

• Secondary: investigate potential sources of hetero such as type of CUS operator, type of trauma, type of US probe on test accuracy

T: inception to 10 April 2020

Is it unlikely that important, relevant studies were missed?

• This study included prospective, paired comparative  accuracy studies in which patients were suspected of having pneumothorax. Patients must have undergone both CUS by a frontline non-radiologist and CXR, as well as CT of the chest or tube thoracostomy as the reference standard.
• The authors carried out systematic searches in the following electronic databases: Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; MEDLINE; Embase; Cumulative Index to Nursing and Allied Health Literature (CINAHL) Plus; Database of Abstracts of Reviews of EIects; Web of Science core collection (which includes: Science Citation Index Expanded; Social Sciences Citation Index; Arts & Humanities Citation Index; Conference Proceedings Citation Index - Science; Conference Proceedings Citation Index - Social Sciences & Humanities; and Emerging Sources Citation Index; and Clinicaltrials.gov from database creation to April 2020.
• The authors also handsearched reference lists of included articles and reviews, retrieved via electronic searching, for potentially eligible studies. Additionally, they carried out forward citation searching of relevant articles in Google Scholar and looked at the "Related articles" on PubMed.
• They did not limit the search to Englsih language only and included articles published in all languages.
• Their search strategy in volved the use of MeSH terms such as Pneumothorax, Radiography, Ultrasonography, and focused assessment with ultrasonography for trauma. They also used many text words.
• Using this search strategy 3473 records were identified. 1180 duplicated records were removed, leaving 2293 records to be screened. These records were screened by two of the authors for their relevance, when there was a discrepancy a third author decided whether to include the record or not. 2268 records were excluded, leaving 25 full-text articles that were assessed for eligibility. 12 studies were excluded - 5 missing CUS/CXR/CT chest/chest tube, 4 CUS not performed by frontline non-radiologist physicians, 2 wrong patient population, 1 wrong study design. A total of 13 studies were included in qualitative and quantitative analysis. 9 studies using patients as units of analysis included in primary analysis. 4 studies using lung fields as units of analysis included in secondary analysis.
• Authors provide a nice figure depicting this.
• Authors did not contact experts for unpublished data but were very thorough and transparent in their search strategy. I think it is unlikely that important, relevant studies were missed.

Were the criteria used to select articles for inclusion appropriate?

• The authors of this study clearly outlined their study inclusion and exclusion criteria.
• They included prospective, comparative accuracy studies in which patients were suspected of having pneumothorax. 
• They included trauma patients in the emergency department setting. Patients must have undergone both CUS by frontline non-radiologist physicians and CXR as index tests, as well as CT of the chest or tube thoracostomy as the reference standard. The two main index tests were CUS completed by a frontline nonradiologist physician and CXR, both being performed in the supine position. If data on specific CUS findings (such as the absence of lung sliding, absence of B-lines or comet-tail artefact, presence of lung point, and absence of lung pulse) were available, they planned to assess the diagnostic accuracy of these individual CUS findings. The target condition was traumatic pneumothorax of any severity. They defined a pneumothorax identified on CT scan of the chest or via clinical findings of a rush of air or bubbling in a chest drain after tube thoracostomy as the reference standard.
• The authors excluded studies involving participants with already diagnosed pneumothorax (i.e. case-control studies); studies involving participants with nontraumatic pneumothorax; studies involving participants who had already been treated with tube thoracostomy; and studies in which a frontline non-radiologist physician did not perform CUS.
• These criteria were appropriate for inclusion. However, many studies did differ in their units of measurement - lung fields vs. patients, which could introduce significant bias into the results of individual studies.

Were the included studies sufficiently valid for the type of question asked?

• The authors used the QUADAS-2 tool to assess risk of bias and the applicability of each included study. 
• This tool assesses risk of bias in four domains: patient selection; index tests; reference standard; and flow and timing. In addition, they examined concerns about applicability in the first three domains. They tailored the tool to their review question - one of the signalling questions in the patient selection domain was not applicable because they excluded case-control studies; therefore they deleted this question from the tool. 
• Two review authors performed the assessments independently. They discussed and resolved any disagreements that arose through consultation with a third review author.
• They included a figure describing their assessments of study quality.
• Of the nine studies that we included in the primary analysis:
• • One had a low risk of bias, two had an unclear risk, and six had high risk of bias in the patient selection domain, mostly due to convenience sampling or inappropriate exclusion criteria, such as excluding haemodynamically unstable patients, lack of access to CUS, chest wall injuries precluding CUS, or if CT was not indicated. 
  • The risk of bias in the interpretation of CUS results was low in five studies, unclear in two studies, and high in two studies; this was related to unclear blinding methodology of outcome assessors interpreting CUS and CXR results. 
  • The risk of bias in the interpretation of CXR results was low in two studies, unclear in six studies, and high in one study; this was largely due to unclear blinding methodology of outcome assessors interpreting CXR and CT results, as in some studies it was not clear whether radiologists had access to both imaging results or not. 
  • The risk of bias introduced in interpretation of the reference standard results was low in three studies but unclear in the remainder for similar concerns regarding blinding methodology. 
  • The risk of bias in the flow and timing domain was low in two studies, unclear in four studies, and high in three studies; this was due to the exclusion of patients based on missing CT data or unclear/inappropriate time intervals between CUS, CXR, and CT.
  • They judged applicability concerns regarding patient selection as low for six studies but high for three studies; this was due to the exclusion of haemodynamically unstable patients or lack of access to CUS despite the study focusing on comparing CUS. 
  • They judged one included study to have unclear concern regarding applicability of the reference standard used as there was insuIicient reporting of the method of assessment. 
  • They deemed all other domains for applicability concerns as low risk for all studies.
• Studies that used lung fields as their unit of analysis had several limitations including missing CUS data for some lung fields and using two CUS tests (one for each lung field) compared to one CXR (for both lungs) on the same patient. Inherently, there would be an inability to blind the CUS operator during collection of CUS data while performing the two CUS tests (one on each side of the patient), as well as during the interpretation of the CXR and CT results between the two lung fields. By analysing lung fields separately, it is diIicult to ascertain whether patient characteristics, past medical history, or traumatic injury pattern could have affected one or both lungs and may have confounded the diagnostic accuracy. Out of the four studies included in the secondary analysis: 
• • The risk of bias in the patient selection domain was low in one study, unclear in two studies, and high in one study; this was due to inappropriate exclusion criteria, such as excluding haemodynamically unstable patients or chest wall injuries precluding CUS, or due to unclear sampling technique.
  • The risk of bias introduced in interpreting CUS results was low in two studies and unclear in two studies due to lack of clarity about blinding of the outcome assessors interpreting CUS and CXR results. 
  • The risk of bias introduced in interpreting CXR and CT results to be low in one study, unclear in two studies, and high in one study; this was again due to definite unblinded interpretation of test results or unclear blinding methodology of outcome assessors interpreting CXR and CT results.
  • The risk of bias in the flow and timing domain was low in two studies and high in two studies due to missing patient data.
  • They judged applicability concerns in the patient selection domain as low for two studies, unclear for one study, and high for one study, due to unclear patient selection methods and exclusion of haemodynamically unstable patients or chest wall injuries precluding CUS. 
  • They judged one study to have unclear concern regarding applicability of the reference standard, as blinding of the outcome assessor interpreting the results of CUS, CXR, and CT was unclear. We deemed all other domains as 'low concern' for all studies.
• The authors were thorough in their assessment of each study's quality and discussed how this may have impacted the results. The most common area of bias seemed to be in patient selection where 11/13 studies were judged to be at unclear or high risk of bias.

Were the results similar from study to study?

• Substantial heterogeneity in sensitivity analysis of supine CXR
• • Based on Figure 4, Forest plot: 
  • • Sensitivity ranged from 0.09 to 0.75
    • Wide and non overlapping confidence intervals are suggestive of high variability between studies 
    • Limits the evidence 
  • But they do not list the reasons for why such heterogeneity exists
  • • Some possibilities for the heterogeneity include the high or unclear risk of bias of included studies 
    • There is no I squared statistic shown - a statistical measure that confirms the presence of significant heterogeneity in a meta-analysis

Results of the study: 

• Included 13 studies, 1271 trauma patients with 410 who had a pneumothorax
• • 9 studies used patients as unit of analysis
  • 4 studies used lung field as unit of analysis
  • Most studies were high or unclear risk of bias - 11/13 
• CUS sensitivity and specificity: 0.91 (95% CI: 0.85 - 0.94) and 0.99 (95% CI: 0.97 - 1.00)
• CXR sensitivity and specificity: 0.47 (95% CI: 0.31 - 0.63) and 1.00 (95% CI: 0.97 - 1.00) 
• • Difference in sensitivity: 0.44 (95% CI: 0.27 - 0.61) 

Practise Changing?

This is an excellently executed Systematic Review that makes the most of the limited evidence available and presents such in a transparent way. The results of this study suggest that CUS has better sensitivity in detecting pneumothorax in the emergency department than CXR, and comparable specificity. This publication adds to the body of research that is building in support of US in the primary care setting, and promotes a change in culture as US adoption rates grow. 

Clinical pearl: 

Pneumothorax, or, air in the pleural space, is a fairly common complication of thoracic traumas, occurring 15-50% of the time.

• History: If you're able to get a history, and often you won't be able to, you'll hear about a Sudden, severe, chest pain, sometimes referred to shoulder and maybe associated pleuritic pain or SOB.
  
  
• On Exam: Exam findings range from nothing to respiratory distress and shock. May have decreased chest wall motion, subcutaneous emphysema, or poprock skin, hyperresonance, or decreased or absent breath sounds on the affected side.
  
  
• Imaging: traditionally via x-ray or US depending on physician.
• • On xray: Absence of lung markings beyond the edge of the lung. The edge of the scapula or upper ribs are often mistaken for a pneumothorax.
  • On US: Scan over the most upright part of the patient's chest. if supine go right over the top of their chest (third or fourth intercostal space in the midclavicular line and is repeated on both sides) and if upright scan the apices. Looking for lung sliding and the classic "seashore sign" in M-mode in normal lungs, or absence of lung sliding and "barcode sign" seen in pneumothorax. There are tons of good videos online to take a look at. 
  • CT is gold standard, but rarely necessary

- Rush of air on thoracostomy is also diagnostic.

- Treatment: varies based on severity, from no treatment if patient tolerating well, to drains and chest tubes, to needle or finger thoracostomy for immediate decompression if pneumothorax clinically indicated and hypotension.

Welcome to Carmscast, the podcast that aims to answer all the questions medical students have when creating a competitive CARMS application. In today's episode, our co-hosts, Kara and Dakoda, mix up the podcast format and reflect on their CaRMS experience over the last year.

Dr. Kara Tastad is now a graduate of the University of Saskatchewan College of Medicine. She will soon be starting her first year of emergency medicine residency at the University of Toronto. Dr. Dakoda Herman just graduated from the Temerty Faculty of Medicine at the University of Toronto. He will be trading places with Kara as he begins residency in Family Medicine at the University of Saskatchewan in Saskatoon.

For shownotes Click Here

1. Detail the nerve supply of the face.
2. What bones form the borders of the orbit?
3. Outline the LeFort fracture classification system.
4. What is the tongue blade test and how is it performed?
5. Outline the Ellis System for dental fracture classification.
6. Outline an approach to the management of ingested/aspirated teeth.
7. Describe three techniques for the reduction of anterior TMJ dislocations.
8. List four indications for Panorex X-rays.

Wisecracks

1. At what age do the following sinuses become aerated:
2. 1. Mastoid
   2. Ethmoid
   3. Facial
   4. Maxillary
   5. Sphenoid
3. What is the association between the presence of facial injuries and the presence of intracranial injuries/cervical spine injuries? 
4. What facial lacerations require prophylactic antibiotics?
5. List three solutions in which avulsed teeth can be placed to preserve them.

This is the third episode of our CanadiEM's podcast series in collaboration with CAEP 2021, with our guest host Ken Milne. You may recognize Ken Milne's voice from the popular podcast Skeptic's Guide to Emergency Medicine. In this series, Ken breaks down will tell you everything you need to know about the upcoming CAEP 2021 conference, CAEP at the Forks: Rising to the Challenge!

In today's episode, Ken Milne meets with Dr. Tamara McColl to discuss everything you need to know about the upcoming CAEP conference tracks and plenary speakers. Dr. Tamara McColl breaks down why you should attend the CAEP conference, and what exciting tracks to look out for!

This is the second episode of our CanadiEM's podcast series in collaboration with CAEP 2021, with our guest host Ken Milne. You may recognize Ken Milne's voice from the popular podcast Skeptic's Guide to Emergency Medicine. In this series, Ken breaks down will tell you everything you need to know about the upcoming CAEP 2021 conference, CAEP at the Forks: Rising to the Challenge!

In today's episode, Ken Milne meets with Dr. Tamara McColl to discuss everything you need to know about the upcoming CAEP pre-conference. Dr. Tamara McColl breaks down the meaning behind CAEP at the Forks, why you should attend the CAEP pre-conference!

This is the first episode of our CanadiEM's podcast series in collaboration with CAEP 2021, with our guest host Kevin Milne. You may recognize Kevin Milne's voice from the popular podcast Skeptic's Guide to Emergency Medicine. In this series, Kevin breaks down will tell you everything you need to know about the upcoming CAEP 2021 conference, CAEP at the Forks: Rising to the Challenge!

In today's episode, Kevin Milne meets with Dr. Tamara McColl to discuss everything you need to about the upcoming CAEP Conference. Dr. Tamara McColl breaks down the meaning behind CAEP at the Forks, why you should attend the CAEP conference and all the details you need to know before attending!

Track Chairs - Tracks:

Check out the podcast and register for the conference at CAEP Conference website at www.caepconference.ca

1. Define mild, moderate, and severe TBI (including Box 34.1). 
2. Explain the concepts of cerebral autoregulation and CPP. Why is this clinically relevant? 
   • Primary and secondary brain injury. 
   • direct and indirect brain injury. 
3. Differentiate between: 
4. Describe the 4 herniation syndromes 
5. List the extra-axial brain injuries 
6. List the intra-axial brain injuries 
7. Outline your approach to the clinical assessment of the brain injured patient (including GCS and brainstem reflexes). 
8. Describe key imaging findings in the main types of traumatic brain injury. 
   • Inititial resuscitation 
   • ICP management and hyperosmolar therapy
   • Indications for seizure and antibiotic prophylaxis 
   • Reversal of anticoagulation 
   • Decompressive therapies 
9. Outline your management priorities in TBI with respect to: 
10. List the complications of TBI. 

Wisecracks

1. What are the layers of the scalp? 
2. What is the Munro-Kellie doctrine? 
3. What is Cushing's reflex? 
4. List the clinical features of basal skull fracture (Box 34.2) 
5. Describe 3 clinical decision rules that apply to  neuroimaging in mild TBI. 
6. Describe a graduated return to play protocol as per Rosen's. 

1. What are the injuries for the following blunt trauma mechanisms:
2. 1. Head-on collision
   2. Rear end collision
   3. Lateral (T-bone) collision
   4. Rollover
   5. Ejected from vehicle
   6. Windshield damage
   7. Steering wheel damage
   8. Dashboard involvement or damage
   9. Restraint or seat belt use
   10. Air bag deployment
   11. Low-speed pedestrian versus automobile
   12. High-speed pedestrian versus automobile
   13. Bicycle versus automobile
   14. Non-automobile-related
   15. Vertical impact falls
   16. Horizontal impact falls
3. Outline an approach to the primary survey for the trauma patient.
4. Describe the elements of the eFAST exam.
5. Outline an approach to the secondary survey in the trauma patient.
6. Detail relevant ancillary laboratory tests to order in the trauma patient.
   1. Canadian CT Head Rule
   2. Canadian C-Spine Rule
   3. NEXUS C-Spine Rule
   4. NEXUS Chest Rule
7. List the components of the following imaging decision-making tool
8. What are the indications for a CT abdomen/pelvis in the trauma patient?

Wisecracks

1. What are the mechanisms of injury for the following weapons:
2. 1. Knives
   2. Handgun rounds
   3. Shotgun rounds
   4. Rifle rounds
3. What is the LD50 in feet for falls from a given height?
4. What is permissive hypotension and what evidence does it have? 

1. Learn the importance of treatment studies (RCTs) in EBM 
2. Understand and interpret methods and results of treatment based studies 
3. Become familiar with critically appraising treatment based studies

Hosts: 

1. Dylan Collins 
2. Levi Johnston
3. Dakoda Herman
4. Jayneel Limbachia
5. Jake Domm

Paper: 

1. Warren, Jaimee, et al. "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial." Academic Emergency Medicine 27.9 (2020): 905-909. https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14069 

EBM Checklist for therapy studies (University of Oxford:

• https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf 

Episode takeaway 

• RCTs are considered gold standard in terms of evidence since the randomization process controls for both known and unknown confounding variables 
• Understanding how to quickly and efficiently appraise studies by assessing its methods is an important skill that can help you assess its utility to your practice and whether the authors adequately answered the question
• Use a validated critical appraisal tool. We used the CEBM tool, but there are others. The GATE from by Rod Jackson is another great method to learn. Know that sometimes people use publishing guidelines as critical appraisal tools, like the CONSORT for RCTs, but these are just work arounds. 
• Be skeptical and curious. If there is a published protocol, check it. Look at who funded the study. Read the COI and method to mitigate bias.

CAEP and CanadiEM are collaborating to help promote the Virtual CAEP Conference 2021!

Did you know Canadian Association of Emergency Physicians (CAEP) is hosting a virtual CAEP Conference in 2021?

CAEP at the Forks: Rising to the Challenge
When is it? June 15-17, 2021
Where is it? It's virtual but its hosted by the organizers at University of Manitoba, Winnipeg in collaboration with educators from all over Canada.
How can I register? caepconference.ca #CAEP2021

The CAEP Conference 2021 Social Media and Promotions team consists of many members of the CanadiEM Leadership as well as some of the most well-known educators in the country. Our goal is to help CAEP promote their amazing annual conference and bring awareness to some of the highlights from the upcoming event.

Some of the promotional items coming at you:

1. Pre and In-Conference Podcasts and Videocasts - highlighting our key plenaries, speakers, and providing quick summaries of each day's events.
2. Social Media updates will come regularly, highlighting some of the best from the conference.
3. Infographic summaries and reviews of the day's events and clinical, med-ed, research concepts/pearls.
4. Newsletter updates using our various channels (CAEP Connects, CanadiEM Newsletter, etc.)
5. More to come! If you have ideas, feel free to let us know!

Introducing the CAEP Conference Social Media / Promotions Committee Members:

Dr. Daniel Ting
Dr. Kevin Junghwan Dong
Dr. Ken Milne
Dr. Hans Rosenberg
Dr. Shahbaz Sayed
Dr. Fareen Zaver
Dr. Alkarim Velji
Dr. Sonja Wakeling
Dr. Patrick Boreskie
Evan Formosa

Follow @caepconference on Twitter and stay tuned for more content!

1. Learn the importance of treatment studies (RCTs) in EBM
2. Understand and interpret methods and results of treatment based studies
3. Become familiar with critically appraising treatment based studies

Hosts:
Dylan Collins
Levi Johnston
Dakoda Herman
Jayneel Limbachia
Jake Domm

Paper:
Warren, Jaimee, et al. "Antacid Monotherapy Is More Effective in Relieving Epigastric Pain Than in Combination With Lidocaine: A Randomized Double‐blind Clinical Trial." Academic Emergency Medicine 27.9 (2020): 905-909.
https://onlinelibrary.wiley.com/doi/epdf/10.1111/acem.14069EBM

Checklist for therapy studies (University of Oxford:
https://www.cebm.net/wp-content/uploads/2018/11/RCT.pdf

Episode takeaway
1. RCTs are considered gold standard in terms of evidence since the randomization process controls for both known and unknown confounding variables
2. Understanding how to quickly and efficiently appraise studies by assessing its methods is an important skill that can help you assess its utility to your practice and whether the authors adequately answered the question
3. Use a validated critical appraisal tool. We used the CEBM tool, but there are others. The GATE from by Rod Jackson is another great method to learn. Know that sometimes people use publishing guidelines as critical appraisal tools, like the CONSORT for RCTs, but these are just work arounds.
4. Be skeptical and curious. If there is a published protocol, check it. Look at who funded the study. Read the COI and method to mitigate bias.

1. List key historical red flags in a patient presenting with back pain. (Box 32.1) 
2. List red flags on physical examination of a patient with back pain. (Box 32.1) 
3. List key critical differential diagnoses for a patient presenting with acute back pain (Box 32.2)
4. Describe an approach to the rapid assessment of a patient with acute lower back pain (Fig 32.1) 
5. Describe an approach to ancillary testing and imaging for critical causes of acute back pain (table 32.1) 
6. List the sensory, motor, and screening tests for the lumbar nerve roots L3-S1 (table 32.2) 
7. Describe an overview of the management of acute low back pain (Fig 32.2) 

Wisecracks

1. What are 4 variables associated with serious outcomes in patients with back pain (p. 276) 
2. Differentiate between conus medullaris syndrome and cauda equina syndrome. 
3. What physical exam/ancillary findings are most predictive of cauda equina? (CJEM 2020;22(5):652–654) 
4. How does Rosen's differentiate between disc herniation and radiculopathy?

Dr. Larissa Hattin is a 4th-year emergency medicine resident at UBC and co-chief resident of the Victoria site. She completed medical school at McMaster and quickly moved out to the island to escape the snow. This year she is completing her fellowship in Medical Education through Oxford University.

Dr. Dillan Radomske went to medical school in Calgary at the Cumming School of Medicine and is now in his third year of emergency medicine resident at the University of Saskatchewan. He is interested in medical education, and some of our listeners may recognize his voice from the CanadiEM CrackCast series. 

Dr. Ben Forestell is a graduate of McMaster medical school and he is now in his first year of emergency medicine residency, also at McMaster. He is passionate about medical education and has been lucky to be involved with projects like ClerkCast at CanadiEM.

Click Here for more information about today's episode. 

1. Define the following terms:
2. 1. Menorrhagia
   2. Metrorrhagia
   3. Menometrorrhagia 
   4. Oligomenorrhea 
3. What points on history are important to elucidate in the patient with PV bleeding?
4. Outline an approach to the physical examination in the patient with PV bleeding.
5. Describe an approach to ancillary testing in the patient with PV bleeding.
6. Outline the DDx of PV bleeding in the non-pregnant patient.
7. Outline the DDx of PV bleeding in the pregnant patient.
8. Detail an approach to the management of PV bleeding in nonpregnant patients in the ED.

Wisecracks

1. What is the average volume of blood lost during typical menstruation?
2. What is the risk of spontaneous abortion in the patient who presents with vaginal bleeding in the first trimester?
3.  List five risk factors for placental abruption.
4. List five risk factors for PPH.
5. List five risk factors for ectopic pregnancy.
6. List five absolute contraindications to the use of oral contraceptive pills.

This podcast is the audio-only version of a video that you can watch on www.canadiem.org. 

1. Outline the anatomic contents of the female pelvis.
2. Describe an approach to the history in a patient with acute pelvic pain.
3. Describe an approach to the physical examination in the patient with acute pelvic pain.
4. List 10 differential diagnoses for the patient presenting with acute pelvic pain. (Box 30.1)
5. Outline an approach to ancillary testing for the patient presenting with acute pelvic pain.
6. What must be seen on bedside ultrasound to confirm a definitive intrauterine pregnancy (IUP)?

Wisecracks

1. What is the incidence of domestic violence in patients presenting with pelvic pain? 
2. What is the incidence of heterotopic pregnancy in the general population and in those that have conceived using reproductive technology?
3. Under what circumstances can a pelvic examination be omitted in a patient presenting to the ED with acute pelvic pain?
4. What is the classic triad of pelvic inflammatory disease (PID)?

In this week's episode, we are covering how to get to know more about programs and give you some quick pointers on how to create your personal letters! Here to help us tackle this topic is our guest: Dr. Pardhan!

Dr. Kaif Pardhan is an emergency medicine physician and Deputy Chief of the ED at Sunnybrook Health Sciences Centre in Toronto. He serves as the Assistant Program Director for the University of Toronto's emergency medicine residency program. He also works as a pediatric emergency physician at McMaster Children's Hospital in Hamilton.

Click Here for more information about today's episode. 

1. List risk factors for constipation .
2. List 10 causes of constipation (Box 29.1).
3. Describe an approach to the history and physical exam of the constipated patient. 
4. What ancillary testing should and should not be ordered in constipation? 
5. Describe an approach to management of constipation in the ED (figure 29.1) .
6. Describe 5 classes of laxative agents.
7. List the lifestyle changes that constipation patients should be counselled about.  

Wisecracks

1. List 5 medications that can cause constipation. 
2. What agents can be considered in refractory opioid-induced constipation? 
3. Describe the mechanism of action of PEG 3350. 
4. Describe the mechanism of overflow incontinence.

1. Define diarrhea.
2. Outline the pathophysiologic processes that result in diarrhea.
3. List 10 infectious causes of diarrhea. - Box 28.1
4. List 10 non-infectious causes of diarrhea. - Box 28.2
5. Outline 5 important aspects of a patient's history to elucidate in cases of diarrhea.
6. Detail an approach to laboratory testing in the patient with diarrhea.
7. When are empiric antibiotics indicated for the treatment of diarrheal illnesses?

Wisecracks

1. What antibiotics are most commonly implicated with precipitating C.difficile diarrhea?
2. What factors increase the probability of non-benign diarrheal illness?
3. Outline the constituent ingredients contained within the World Health Organization's rehydration formula.
4. What is the BRAT diet and why is it recommended in patients with acute diarrheal illnesses?

In today's episode, we cover how to prepare for your upcoming emergency medicine elective and how best to ask for that coveted reference letter. Helping us navigate this subject is our expert guest Dr. Brent Thoma.

Dr. Thoma works clinically as a trauma and emergency medicine physician. Academically, he studies technology-enhanced medical education and works for the Royal College of Physicians and Surgeons of Canada as a Clinician Educator. He is also the CEO of CanadiEM.

Click here for resources mentioned in today's episode. 

1. Define upper gastrointestinal versus lower gastrointestinal bleeding and differentiate between the two based on anatomic location 
2. Outline an approach to the history and physical examination for the patient with complaints consistent with GIB.- Box 27.3
3. List 5 causes of UGI bleeding and 5 causes of LGI bleeding- Table 27.1
4. Outline six alternative diagnoses or mimics of GI bleeding - Box 27.1
5. List five characteristics of patients with high-risk GI bleeds - Box 27.2
6. Describe an approach to ancillary testing in the patient with GI bleeding.
7. List five substances that when ingested, can result in a falsely-positive stool guaiac study
8. Outline an approach to the management of the patient with GI bleeding - Fig 27.3
9. Detail the Blatchford and Clinical Rockall Risk Scores - Tables 27.3/27.4

Wisecracks

1. Outline the three most common causes of UGIB in pediatric and adult patients.
2. Outline the three most common causes of LGIB in pediatric and adult patients.
3. What percentage of patients presenting with hematochezia actually have an UGIB?
4. What volume of blood loss is needed to produce symptoms of anemia in the patient with an acute/subacute GI bleed?

1. Define the following terms:
2. 1. Nausea
   2. Retching
   3. Vomiting
3. Outline the neural pathway regulating nausea and vomiting.
4. List 6 potential sequelae of vomiting.
5. Outline an approach to the history in the patient complaining of nausea and vomiting.
6. Outline an approach to the physical exam in the nauseated and/or vomiting patient.
7. List 10 differential diagnoses for the vomiting patient.
8. What ancillary tests are indicated in the patient with nausea and/or vomiting?
9. List five antiemetics that can be used to treat the nauseous and vomiting patient.

Wisecracks

1. What are the three phases of vomiting? 
2. What is Hamman's Sign and what pathology does it point to?
3. What medication is indicated in the patient with intractable chemotherapy-induced nausea and vomiting.

1. Explain broad causes of elevated bilirubin (obstructive, hepatocellular, and hemolysis) and the significance of direct vs. indirect hyperbilirubinemia (Fig 25.1)
2. Explain your approach to the history and physical exam in patients with jaundice (Fig 25.2) 
3. List 10 causes of jaundice (Table 25.2) 
4. Explain your approach to ancillary testing in patients with jaundice. 

Wisecracks

1. What are the stages of hepatic encephalopathy?  
2. What is the triad of acute hepatic failure? 
3. What is Charcot's triad and Reynold's pentad? 
4. What is the "1000s Club" and how do you become a member? 

1. What are risk factors for serious underlying causes of abdominal pain? (Box 24.1) 
2. Explain key symptoms and signs to look for in the evaluation of the patient with abdominal pain. 
3. What diagnoses are associated with different patterns of abdominal pain? (Fig 24.1) 
4. List 5 critical and 5 emergent causes of abdominal pain (Table 24.1, 24.2) 
5. Explain an approach to ancillary testing in abdominal pain. 
6. Outline a diagnostic algorithm for patients with abdominal pain (Fig 24.4) 
7. Outline an empiric management algorithm for abdominal pain. (Fig 24.5) 

Wisecracks

1. What are the structures included in the foregut, midgut, and hindgut? More importantly, why do you care? 
2. List indications for bedside US in the ED patient with abdominal pain (Table 24.3) 
3. Explain how referred pain works in the setting of abdominal pain (Fig 24.2)

1. Describe an approach to key history and physical exam for chest pain patients presenting to the ED. (Table 23.2 and 23.3) 
2. List 5 critical diagnoses, 5 emergent, and 5 nonemergent diagnoses to consider in the patient presenting with chest pain. (Table 23.1)
3. Describe an approach to the critically ill patient with undifferentiated chest pain. (Figure 23.1)
4. Describe an approach to ancillary testing in chest pain. (Table 23.4 and 23.5)
5. List the risk factors associated with each critical chest pain diagnosis (Box 23.1) 
6. Explain the approach to risk stratification of ED chest pain patients. 

Wisecracks

1. What are the X-ray findings of aortic dissection? 
2. What are your HR and BP targets in Aortic dissection? 
3. List the components of the HEART score. 

Today we are sitting down with Dr Alim Pardhan. Dr Pardhan is the FRCP EM program director at McMaster University, Hamilton General Hospital ED side lead, and a passionate medical educator.

Your key takeaways from this episode are:

1. Understanding the mechanisms behind fever and hyperthermia
2. The causes of hyperthermia - think drugs, CNS infections, thyroid storm, and environmental exposure
3. Five big, bad, and deadly causes of fever in our patients in the ED - necrotizing fasciitis! Endocarditis! Meningitis! Ascending cholangitis! Sepsis!
4. Identification and management of the patient with sepsis

1. Define the following terms:
   1. Dyspnea
   2. Tachypnea
   3. Hyperpnea
   4. Hyperventilation
   5. Dyspnea on exertion
   6. Orthopnea
   7. Paroxysmal Nocturnal Dyspnea
2. What anatomical structures are responsible for controlling respiratory effort?
3. Outline an approach to the history for the dyspneic patient.
4. Detail the physical examination for the dyspneic patient and highlight pivotal exam findings that point to specific pathologies.
5. Outline the differential diagnosis for the patient presenting with dyspnea and highlight 5 critical, 5 emergent, and 5 non-emergent causes of shortness of breath.
6. What ancillary tests are indicated for the dyspneic patient?
7. Detail the utility of point-of-care ultrasound in the assessment of the dyspneic patient.
8. Outline a management algorithm for the acutely dyspneic patient.

Wisecracks

1. List three findings on chest radiograph suggestive of pulmonary embolism.
2. What is the utility of venous blood gas testing and how do its values correlate with that of an arterial blood gas?

1. Define "massive hemoptysis".
2. Which vessels, when injured, are typically associated with small and massive hemoptysis, and how do the vessel characteristics influence the degree of bleeding?
3. Outline an approach to the history and physical examination for a patient presenting with hemoptysis.
4. Outline the differential diagnosis for hemoptysis and highlight five critical and five emergent diagnoses that cause hemoptysis. (Box 21.1 and 21.2)
5. What ancillary tests are warranted in the patient with hemoptysis?
6. Detail the utility of imaging studies in patients with hemoptysis.
7. Detail the diagnostic approach to the patient with hemoptysis. (Figure 21.1)
8. Outline an approach to managing the patient with hemoptysis. (Figure 21.2)
9. What two maneuvers can be used to address massive hemoptysis from a suspected tracheo-innominate fistula (TIF)?
10. What strategies can be used to improve oxygenation in the patient with massive hemoptysis?

Wisecracks: 

1. List one gynecologic cause of hemoptysis.
2. List five causes of massive hemoptysis.
3. What is the most lethal consequence of massive hemoptysis?

Today we will be talking about ABDOMINAL PAIN with McMaster FRCP EM resident Dr Rakesh Gupta

Key takeaways from this episode include:

1. Thinking outside the GI tract for patients with abdominal pain

2. The importance of a good physical exam

3. What type of imaging is best for your patient? Hint: it depends!

4. How to consult your inpatient colleagues! P-I-Q-U-E-D

Thanks for the listen!

1. What are the three anatomically-distinct zones of the pharynx, and what structures outline their borders?
   1. Ultrasound of the Neck
   2. Lateral neck radiograph
   3. Nasopharyngoscopy
   4. CT Soft Tissues Neck
2. Describe the utility of the following imaging modalities in the patient with sore throat.
3. Outline five viral, five bacterial, and five other potential aetiologies of sore throat in the ED patient? (Table 20.1)
4. Outline the components of the Modified Centor Score and describe its application.
5. Describe the diagnostic algorithm for the patient with sore throat. (Figure 20.4)
6. Outline the approach to managing a patient with sore throat in the ED. (Figure 20.4)
7. What antibiotics can be used in the  patient with suspected or confirmed streptococcal pharyngitis? (Box 20.2)

Wisecracks: 

1. In what age groups is streptococcal pharyngitis rarely seen?
2. What is Waldeyer's Tonsillar Ring?
3. What is the "thumb sign" and what pathology does it point to?

1. Detail the pertinent points to review when taking the history of a patient presenting with a red and painful eye - Box 19.2
2. Outline an approach to the ocular physical examination - Box 19.3
3. Outline the components of the slit lamp examination - Box 19.4 
4. What signs and symptoms, if present, likely indicate the presence of serious ocular pathologies - Box 19.1
5. What is a relative afferent pupillary defect and what conditions cause it?
6. List ten causes of increase intraocular pressure
7. List five causes for an absent red reflex - Box 19.5
8. Name three critical, emergent, urgent, and non-urgent causes of the red and painful eye? - Figure 19.8

Wisecracks: 

1. What are the fundoscopic findings of a central retinal artery occlusion.
2. What is the pinhole test and what visual disturbances does it correct?
3. What are the three most common causes of an irregularly shaped pupil
4. What is Seidel's Test and what condition does it identify?

1. What is diplopia and how is it classified?
2. What four questions help clinicians delineate the potential cause of a patient's diplopia?
3. What are the cardinal directions of gaze and how are they tested?
4. Outline the physical exam for the patient with monocular and binocular diplopia.
5. Outline the DDx for monocular diplopia?
6. Outline the DDx for binocular diplopia? [Table 18.1]
7. Detail the different oculomotor palsies. [Figure 18.3]
8. Detail the various lacunar stroke syndromes. [Box 18.1]
9. Define internuclear ophthalmoplegia.
10. What ancillary tests are required for the patient presenting with diplopia? [Figure 18.4]

Wisecracks: 

1. What are the most common oculomotor palsies and what causes them?
2. What is orbital apex syndrome?
3. What is the "rule of the pupil" and how reliable is it?
4. Detail the physical exam maneuvers used to identify patients with myasthenia gravis.

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!

1. List three primary headache disorders
2. Describe the pathophysiology of migraines and name three Emergency Department treatments for same
3. List five critical and five emergent causes of headache (Table 17.1)
4. Outline your approach to the history for the patient presenting with headache ( Box 17.1)
5. Outline your approach to the physical exam for the patient presenting with headache (Table 17.3)
6. Describe your diagnostic approach to the patient with a suspected SAH
7. Detail the findings on LP that would suggest your patient has bacterial meningitis

Wisecracks: 

1. What percentage of patients presenting with headache to the ED have a SAH?
2. Outline the SNOOP MEETS Pregnancy mnemonic
3. Which diagnostic test is best to establish the diagnosis of cerebral venous sinus thrombosis?
4. Detail how to elicit Kernig's and Brudzinski's Sign 

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!

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

1. What is dizziness and what pathologies can cause it?
2. Define vertigo and acute vestibular syndrome
3. What three systems are involved in the maintenance of equilibrium and how many of these systems must be affected to cause vertigo?
4. Trace the neuronal impulse from the vestibular apparatus to the muscle endplate
5. Define nystagmus
6. List five peripheral causes of vertigo (see Table 16.2)
7. List five central causes of vertigo (see Table 16.2)
8. Differentiate between central and peripheral vertigo based on history and clinical exam findings
9. Describe the Dix Hallpike Test
10. Outline your approach to the HINTS exam
11. What is the Epley maneuver and what pathology does it treat?
12. Describe the Barbecue Roll Test and what pathology does it treat?
13. Outline your approach to managing the vertiginous patient

Wisecracks: 

1. What diagnoses cause both vertigo and hearing loss?
2. What features of nystagmus suggest a central pathology?
3. What is truncal ataxia and what typically causes it?

1. Define seizure and provide an explanation of the classification systems for seizure
2. Define recruitment as it relates to seizure development and progression
3. Differentiate between seizure and syncope
4. Differentiate between neurogenic and psychogenic seizures
5. List 5 diagnoses that can mimic seizures (see Box 15.2)
6. Define status epilepticus and differentiate between convulsive and non-convulsive status epilepticus
7. List 10 causes of status epilepticus in adults (see Box 15.1 and 15.3) 
8. Outline management of status epilepticus. 
9. List indications for head CT for first seizure. 

Wisecracks: 

1. List 5 properties of ictal events 
   1. Isoniazid Toxicity
   2. TCA Toxicity
   3. Eclampsia
   4. Hypoglycemia
   5. Hyponatremia 
2. What medications are needed to treat seizing patients with the following:
3. Name 3 key metabolic abnormalities that can cause seizures
4. Name 3 common seizure provokers that can worsen pre-existing seizure disorders
5. What percentage of patients with convulsive status epilepticus will develop non-convulsive status epilepticus?

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?
Objective 8: Would scenario change depending on type of valve? What if the indication was AF, not mechanical valve?
Objective 9: Does the type of bleeding matter? (lobar versus deep ICH)

1. Define confusion.
2. What is your differential diagnosis for the confused patient?
3. Differentiate between organic and functional causes of confusion.
4. What is the Quick Confusion Scale (QCS) and how is it calculated?
5. What is the Brief Confusion Assessment Method (bCAM) and how is it used?
6. What is the Mini-Mental State Examination (MMSE) and how is it scored?
7. What ancillary tests are used when working up the confused patient?
8. What is the role of thiamine in the treatment of the acutely confused patient?

Wisecracks: 

1. What simple tests can you use to assess concentration at the bedside?
2. What treatments should be used for the patient with acute hypoglycemia causing confusion?
3. List 5 emergent and 5 critical diagnoses that cause confusion.

Questions:

1. 01:57 – 03:05 - Can you please introduce yourself? (name, training, where you work, interests, etc.).

2. 03:05 – 04:45 – Tell me about your philosophy, and what your career trajectory has been?

3. 04:55 – 08:07 – How can new physicians get to become an educator like you?

4. 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?

5. 12:43 – 27:56 – Can you tell us about how you manage department flow efficiently and safely, especially during busy times?

• 20:41 – 23:56 – Tips to effectively manage flow
• 23:56 – 27:56 – Tips to effectively manage learners

6. 27:56 – 32:45 – What are some mistakes that you've seen new physicians make? (Either clinical or non-clinical).

7. 32:45 – 36:38 – What can new staff do to keep their wellness intact and avoid burnout? What are some strategies you use?

8. 36:36 – 38:28 – Do you have any final comments you would like to share?

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?

1. List 10 life-threatening causes of syncope 
2. List 10 medications that can precipitate syncope 
3. What are the red flags on history and physical exam in syncope? 
4. What are markers of increased short-term risk in syncope patients? (box) 
5. What are 5 ECG findings to look for in the syncopal patient? 
6.  List five indications for admission and inpatient evaluation for the patient with syncope?

Wisecracks: 

1. What is the significance of a patient presenting with syncope vs. near syncope? 
2. What is the utility of orthostatic vital signs?
3.  What degree of cerebral hypoperfusion is needed to cause unconsciousness?

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

Wisecracks:

1. What is the colour of the blood in a patient with methemoglobinemia?
2. What is clubbing and what causes it?
3. What SpO2 is present on the monitor in the patient with a methemoglobinemia?
4. What is the hyperoxia test and how does it help you in your workup of the cyanotic patient?
5. What is the dose of methylene blue when prescribed to treat patients with methemoglobinemia?

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? What is the structure and what you do?

3. What kind of cases are simulated? Can you tell us an example of a good case and how the teams went through it?

4. Tell us what you look for when you see a good SIM team (both medical management and crisis resource management or CRM)?

5. How can residents and interdisciplinary teams get ready for SIM? What should they prepare to become successful at the Olympiad and at SIM in general?

6. If future teams/residents want to get involved, how do they make this happen? 

7. Any last comments?

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.

1. Can you please introduce yourself? (name, training, where you work {academic, community, etc}, any other work you are doing {tox, primary care, etc.}).
2. How is it being a new ED staff physician 6 months into practice?
3. What has been the biggest difference been so far being a staff vs. a resident?
4. Can you share an interesting story as a staff? (can be anything – having residents, billing experience, research you are working on etc.)
5. What is the best thing about being a staff physician?
6. What are some struggles/challenges of being a new staff physician?
7. Do you have any billing tips for new physicians? What kind of tips do you have for management of your financial assets? (investments, taxes, accountants, etc.)
8. Any tips on work-life balance? (wellness, coping with struggles, travel, etc.)

Take Home Points:

1. Ask questions to fellow colleagues about difficult cases, department flow, and billing. You will need help with the transition to practice so ask the people who have done it before you.
2. Don't commit to too many things initially. Remember, it's a marathon not a sprint. Plan ahead and make sure to find a good balance between work and life.
3. Find time to learn about billing during your residency. Make sure to have a good feel for it so that once you are staff, you don't leave money on the table (you deserve it!).
4. Live like a "resident" and plan for the future. Planning for retirement and finding a good financial advisor and an accountant is pivotal for your future.
5. Be humble and continue to learn. You will not know everything at the end of your training. Keep reading around cases and develop yourself to become better every day.

1. What structure controls body temperature and how does it go about controlling it?
2. What are pyrogens and how are they classified?
3. What is the difference between fever and hyperthermia?
4. What is the role of PGE2 in fever and what medications can you give to combat its effects?
5. List four factors that blunt the febrile response.
6. What are the benefits and pitfalls of the febrile response?
7. List five infectious and five non-infectious causes of fever. (see Box/Table 9.1)
8. Describe your approach to the febrile patient. (see Figure 9.1/9.2)

Wisecracks:

1. What is the most accurate temperature measurement site?
2. How are heart rate and body temperature related?
3. How are respiratory rate and body temperature related?
4. How high must a fever be to necessitate rapid cooling interventions?

1. Describe your history and physical exam in the patient being actively resuscitated.
2. Discuss the process of deterioration to cardiac arrest with respiratory failure and cardiac obstruction.
3. List 6 aspects of optimal CPR.
4. What medications have been shown to improve outcomes in cardiac arrest?
5. List 8 differential diagnoses for PEA arrest (See Table 8.4)
6. What is electromechanical dissociation (EMD) and how does it differ from pseudo electromechanical dissociation (pseudo EMD)?
7. What is echo-guided life support (EGLS) and how is it used?
   1. Carotid or femoral pulse
   2. CPP
   3. Arterial relaxation (diastolic) pressure
   4. PETCO2
   5. SCVO2
8. What are your targets during CPR for the following metrics? (See Table 8.3)

Wisecracks:

1. What is cough CPR and when should it be used?
2. What is the only antidysrhythmic shown to improve rates of VF conversion to a perfusing rhythm?
3. What is the minimum coronary perfusion pressure (CPP) is needed to achieve return of spontaneous circulation (ROSC)?
4. What is the triad of cardiac arrest?

1. What is cerebral autoregulation?
2. Describe your parameters for post-arrest care of a brain injured patient.
3. List 7 interventions for management of a patient with elevated ICP.
4. What are the equations for cerebral blood flow and cerebral perfusion pressure?
5. Describe a protocol for induced hypothermia after cardiac arrest.
6. In the patient with a traumatic brain injury, what is the optimal drug for and duration of seizure prophylaxis?

Wisecracks:

1. What are Lundberg A waves?
2. What is the relationship between PaCO2 and CBF?
3. What is the Monro-Kellie hypothesis?   
   1. How do these values change in patients with severe coma?
4. What is the probability that a survivor of cardiac arrest has a full neurologic recovery?

Are you worried you don't know what it is really like to be an Emergency Medicine resident and you want to find a guide to help maximize your learning in a short and extremely fast year?

As a recent CCFP-EM graduate, I can strongly relate to your fears. The one year of extra training is an important one, and you will learn a plethora of information that will be pertinent to your success as a future Emergency physician. Thus, it is paramount that you maximize and optimize this year. In this blog post, I hope to act as a guide and provide insight into how to get the most out of your training.

For those individuals who do not know what the CCFP-EM program is, it is an Emergency Medicine residency fellowship (or added competency program) stemming from the tree of Family Medicine in Canada. Residents completing this program will have the ability to complete the Emergency Medicine Licensing Exam (administered by the Canadian College of Family Physicians) and practice EM across the country. It is a highly competitive program and as a one year program, the training is rigorous and substantive. Residents are expected to achieve a large volume of objectives, and experience various teaching requirements in different specialties to achieve competency for independent practice.

See the companion blog post: https://canadiem.org/steps-to-success-in-enhanced-training-in-emergency-medicine-ccfp-em-year 

Core Questions:

1. List modalities for measurement of BP and note which modalities are likely to over and underestimate blood pressure.
2. What is pulse pressure and how does it relate to stroke volume?
3. List 4 indications for an arterial line.
4. What is the Beer-Lambert Law and how does it allow us to measure pulse oximetry?
5. How do dyshemoglobinemias affect your measured SpO2?
6. What are the 4 phases of the ETCO2 waveform?
7. List 5 uses for ETCO2.

Wisecracks:

1. List the pitfalls of pulse oximetry.
   1. Purple
   2. Yellow
   3. Tan  
2. Describe colorimetric ETCO2 monitoring and cite the ranges at which you would expect to see the following colours:
3. How are ETCO2 values related to PaCO2?
4. What are causes of elevated ETCO2?
5. What does MOVIE stand for (aka - how to rock your oral exam resus questions)?

Core Questions:

1. Define the following terms (Box 3.1):

• Allodynia
• Amnesia/amnestic
• Local anesthesia
• Analgesia
• Hypnotic
• Narcotic
• Nociceptor
• Noxious stimulus
• Opiate
• Opioid
• Pain
• Procedural Sedation
• Sedative

2. Describe a practical approach to stepwise management of pain in the ED.

3. Describe the adult parenteral and oral doses for:

• Morphine
• Hydromorphone
• Fentanyl 

4. Differentiate between opioid side effects and opioid toxicity.

5. How do you manage opioid toxicity?

6. Describe relative safety profiles for the NSAIDS.

7. List the classes of local anesthetics. How do they work?

8. List the toxic doses for each local anesthetic:

• Lidocaine
• Lidocaine with Epi
• Bupivicaine

9. List 5 techniques to reduce pain of injection of local anesthetic.

10. List agents that can be used for topical anesthesia of:

• Intact skin
• Mucous membranes
• Open skin/lacerations 

Wisecracks:

1. What agent can be used as a substitute in cases of anaphylaxis to local anesthetic?

2. Why should you avoid use of the following agents:

• Tramadol
• Demerol

3. How does local anesthetic toxicity present?

1. Summarize an approach to the acute management of patients with intracerebral hemorrhage while on anticoagulation for a mechanical heart valve

2. Describe the benefits and risks of anticoagulant reversal, including the risk of thromboembolism

3. Describe the principles of effective communication and collaboration of bleeding & clotting cases with consultants

There's a reason that the first chapter of Rosen's is devoted to airway. These are some of the most critical skills we need to know as emergency clinicians. This episode provides an overview of core airway knowledge and skills.

Core Questions:

1) List 6 potential agents that may be used as weapons of mass destruction.

2) List 6 features of weapons of mass destruction threats that make them unique.

3) Describe 6 signs suggesting biologic weapon deployment.

4) What are recommendations for prevention of in-hospital transmission of contagious agents?

5) Describe the 2 typical presentations of Anthrax. What are typical CXR findings? How is each type of anthrax treated?

6) How is the plague transmitted? What are the 2 typical presentations of the plague? How is each treated?

Wisecracks:

1) Why are children at higher risk of death from Weapons of Mass Destruction (WMD)?

2) What are components of ED preparedness for chemical weapons of mass destruction?

3) Describe a basis ER protocol for handling radiation exposure / casualties (review).

4) Differentiate between chickenpox and smallpox.

5) How are nerve agents treated (3 drugs)?

6) Describe the clinical effects of mustard gas. How is this treated?

• Define a disaster

• Describe PICE nomenclature

• List 6  potentially paralytic PICE

• List 6 critical substrates for hospital operations

• Describe START triage and SAVE

• List the 5 functional elements of an incident command system

• Describe the 4 stages comprehensive emergency management

• Describe the 5 elements of a hospital disaster response plan

• List the 8 basic components of a hospital comprehensive disaster response planning process

Wisecracks:

• Describe the SALT triage approach

• Describe TTDAD SAD approach (see EM Cases Episode 100 on disaster medicine)

• What is "surge capacity"?

• List 6 criteria for air medical transport. 
  • When should/could helicopter EMS transport be beneficial?

• List advantages and disadvantages of rotor-wing aircraft and fixed-wing aircraft,  relating to each other and land-transfer.

• What are 6 principles of landing zone safety?

Wisecracks:

• What are the most common in-flight emergencies on commercial flights?

• What are some practical implications of providing in-flight emergency care?

1. List 4 factors altering pharmacokinetics in the elderly (ADME)
2. List 6 factors contributing to adverse events from medications in the elderly
   1. Beers List
3. Which 8 meds are most responsible for adverse events in the elderly?
4. List 5 harmful drug interactions in the elderly
5. What are top 10 STOPP criteria?

1. What are the indications for orthopedic surgery for clavicle fracture?
2. List 5 Xray features of supracondylar fracture
3. Describe the Gartland Classification for Extension-type supracondylar fractures
4. List specific complications of a supracondylar fracture.
5. Describe the sequence of ossification around the elbow.
6. What is Baumann's Angle? (shownotes)
   1. Monteggia fracture-dislocation
   2. Toddler's fracture
   3. Nursemaid's elbow.
7. Describe the radiographic findings and management of:
8. Describe the Ortolani and Barlow maneuvers. (shownotes)
9. List 3 physical exam findings consistent with DDH.
10. List 10 causes of hip pain in children
11. Provide a differential diagnosis of limp in the toddler, school-aged child and adolescent.
12. How would you differentiate between transient synovitis and septic arthritis in a child with hip pain?
13. What is the most common location for septic arthritis in a child?
14. What is the prognosis for transient synovitis?
15. What is the most common cause of septic arthritis?
    1. Age < 2 months
    2. 2 months – 5 yrs
    3. 5 yrs – 12 yrs
    4. > 12 yrs
    5. Prosthetic joint
    6. Sickle cell disease
    7. Immunocompromised
16. What are the important pathogens of septic arthritis in the following groups:
17. Describe three mechanisms for the development of septic arthritis in children.
18. Regarding synovial fluid analysis, which tests should be ordered. How are the results interpreted?
19. Describe the management of a child with septic arthritis? What the indications for operative debridement?
20. What are the potential complications of septic arthritis?
21. Describe the pathophysiology of Legg-Perthes disease; how does slipped capital femoral epiphysis (SCFE) occur?
22. Describe the common clinical presentation of SCFE + LCPD
23. Describe 2 radiographic findings consistent with SCFE + LCPD
24. How is SCFE classified? How is this classification used to determine management? (shownotes)
25. What is the risk of bilateral SCFE? (shownotes)
26. What are the potential complications of SCFE? (shownotes)
27. What is a juvenile Tilleaux fracture? How does it occur?
28. What is a triplanar fracture?
29. List seven red flags for pediatric back pain.
30. What is spondylolysis? What is spondylolisthesis? How is it managed?
31. List 4 common apophyseal injuries in children.

Wisecracks:

1. List 6 specific xray findings / fractures consistent with non-accidental injury (shownotes)
2. What is a corner / bucket handle fracture?
3. What are the investigations in a complete skeletal survey (shownotes)
4. List 4 conditions with similar presentation to child abuse (shownotes)
5. List causes of pathologic fractures in children.
6. What is the utility of blood culture, ESR and CRP in a child with suspected septic arthritis of the hip?
7. What the mechanism of a lateral elbow condyle fracture and how are they managed? (shownotes)
8. What is the mechanism of a medial elbow condyle fracture and how are they managed? (shownotes)

What is the most common pediatric fracture?

Core Questions

1. List ten causes of provoked (acutely symptomatic) seizures.
2. List four episodic disorders that may mimic seizures in neonates and four in non-neonates.
   • How does it differ if you are unable to obtain IV or IO access?
3. Give an approach to acute seizure control in a 9-month-old and in a 5-year-old.
4. What is the definition of status epilepticus?
5. List 6 medical treatments for status epilepticus.
6. What is the definition of a simple febrile seizure?
7. Describe the management of febrile seizure.
   • Which patients should have outpatient imaging and neurology follow-up?
   • Which children with seizure should be admitted to hospital?
8. List 5 reasons for CT Head after seizure and describe management after the 1st peds seizure.
9. List 10 differential diagnoses for headache in peds.
10. List 8 indications for radiologic imaging in patients with headache.
11. With regards to presentation and management, how are migraines different in children?
12. Describe the criteria which define migraine headache (review).
13. List 10 causes of pediatric ataxia.
14. Describe an approach to the pediatric patient with ataxia.
15. List 5 central and 5 peripheral causes of vertigo. Which is the more common cause of vertigo in children?
16. List 8 risk factors for pediatric stroke.

Wisecracks

1. Describe each of the following:
2. • Infantile Spasms
   • Absence Epilepsy
   • Benign Rolandic Epilepsy of Childhood
   • Lennox-Gastaut Syndrome
3. What is the most common cause of status epilepticus in children? In adults?
4. List five side effects of therapeutic dilantin use.
5. When is LP indicated in children with febrile seizures?
6. Give causes of acute, acute recurrent, chronic progressive and chronic non-progressive headaches.
7. Describe the presentation of infantile botulism.

Core questions:

1. List a DDx for priapism and describe treatment.

2. Describe the management of a paraphimosis.

3. Describe the management of a phimosis.

4. What is the pathophysiology of balanoposthitis? What is the most common bug in balanoposthitis?

5. How is balanoposthitis managed?

6. Describe the diagnosis and management of pediatric epididymitis and orchitis.

7. Describe the diagnosis and management of testicular torsion.

8. List common bacteria in peds UTI and describe treatment in patients <2 months, 2M-2Y, 2Y+.

9. List 6 ddx renal mass – how should these be imaged first?

10. Give a differential diagnosis of proteinuria in children.

11. What is the most common cause of proteinuria in children?

12. Provide a differential diagnosis of acute renal failure in children. What is the most common causes?

13. Describe the clinical presentation of glomerulonephritis in a child.

14. Define hypertension in a child.

15. List causes of hypertension in a child.

16. List 2 medical treatments for acute HTN crisis in children.

17. What are the two types of HUS? What are the typical presenting features?

18. Describe the management of HUS and HSP in kids.

Wisecracks:

1. List three complications of circumcision.

2. Describe approaches to penile entrapment and tourniquet states.

3. Which side is a varicocele concerning and why?

4. Other than cystitis and pyelonephritis, list 6 other causes of pediatric dysuria

5. List 10 ddx for hematuria in peds.

6. List 5 false indicators of hematuria.

7. List 6 causes of nephrotic syndrome in peds.

8. List 5 complications of acute renal failure in children.

9. How does E. coli cause HUS? Which strain of E. coli is the concerning one?

1) What are three pathophysiologic types of diarrhea? Give an example of a cause for each.

2) List 6 common causes of childhood infectious diarrhea in developed countries.

3) List 5 important differential diagnoses of diarrhea in children.

4) List 5 important differential diagnoses of vomiting in children.

5) When should you initiate a medical evaluation of children with acute diarrhea?

6) Describe the typical presentation of:

• Rotavirus
• Norovirus
• Salmonella
• Shigella
• Yersinia
• E. Coli
• C. Difficile

7) List routine and high risk treatment recommendations for common bacteria causing acute infectious diarrhea in children:

• Salmonella non-typhi
• Salmonella typhi
• Shigella
• Campylobacter jejuni
• Yersinia enterocolitica
• C. Difficile
• Vibrio cholerae
• Vibrio parahaemolyticus
• E. Coli

8) List the presenting features and treatments for three common protozoa causing infectious diarrhea in children.

9) Define and describe your diagnosis and management approach to dehydration that is:

• Mild
• Moderate
• Severe
• Associated with Hypo/Hypernatremia

Wisecracks:

1) Name 5 causes of bloody diarrhea.

2) Other than vomiting and diarrhea from infectious gastroenteritis, list 6 causes of volume depletion.

3) Name the components of the Gorelick scale.

4) What's the 4-2-1 rule?

• List 8 causes of neonatal jaundice and indicate whether they are conjugated or unconjugated

• List indications for work-up of a jaundiced infant

• What are RFs for hyperbilirubinemia? (8)

• What is the differential diagnosis for vomiting in a child?

• Describe the typical presentation of each of the following:

• Hypertrophic pyloric stenosis

• Malrotation with midgut volvulus

• NEC

• GERD

• Intussusception

• Hirschsprung's Disease

• Meckel's Diverticulum

• HSP

• List Xray findings for each of the following:

• Malrotation with midgut volvulus (2)

• NEC (4)

• Intussusception (5)

• Hirschsprung's Disease (2)

• Describe the conservative management of a patient with GERD.

• What is the preferred diagnostic test for diagnosis for intussusception?

• List causes of lead points in pts with intussusception.

• Describe each of the following signs on physical exam:

• Sandifer's syndrome

• Red-currant Jelly Stools

• Dance's Sign

• Rovsing's sign

• Psoas Sign

• Obturator Sign

• Describe the "Rule of 2" for Meckel's Diverticulum

• What are 3 common locations of lodging in the esophagus

• List 3 indications for FB removal from stomach.  Describe the management of button battery FBs

• What is HSP? How does it typically present?

• List three complications of HSP.

• Why is appendicitis different in very young children?

• List 10 causes of pancreatitis in children

• List 10 causes of biliary tract disease in children

• List conditions associated with the development of gallstones in children.

Wisecracks.

• What are the risk factors for necrotizing enterocolitis?

• Describe the proposed pathophysiology of necrotizing enterocolitis?

• List five pathologic causes of constipation in a child.

• What is the most concerning complication of hirschsprung's disease? How does it occur?

• What is gallbladder hydrops? What conditions is it associated with?

Episode Overview:

1. Describe procedures and conditions for which prophylaxis for bacterial endocarditis is recommended.

2. Describe 2 potential prophylaxis regimens.

3. What is the differential diagnosis of myocarditis? What is the most common cause of myocarditis in children?

4. What is the differential diagnosis of pericarditis in children? Describe any differences b/n adults and children.

5. What are the clinical diagnostic criteria for Kawasaki's disease?

6. If the clinical criteria are not met, but you are still suspicious, how else might Kawasaki's disease be diagnosed?

7. What are some unusual clinical presentations of Kawasaki's disease?

8. How is Kawasaki's disease managed? What is treatment directed towards preventing?

9. List the Jones Criteria for the diagnosis of Acute Rheumatic Fever.

10. Describe the management of Acute Rheumatic Fever.

11. List 10 causes of sudden death in young athletes.

12. What is a normal pediatric QT interval.

13. What are ECG findings of HCM?

Wisecracks:

1. What is the hyperoxia test? How is it clinically useful?

2. Describe common Xray findings in CHD: "boot-shaped heart", "egg-on-a-string", "snowman".

3. What is Eisenmenger's Syndrome?

4. Until what age is the thymus visible on CXR?

5. List 8 ductal dependent cardiac lesions in the neonate.

6. List features of pathologic heart murmur .

7. When does the ductus arteriosus close functionally? Physically?

Episode Overview:

1. What is the most common form of congenital heart disease?

2. List 6 Acyanotic and 8 Cyanotic types of CHD.

3. What are the ductal dependent heart lesions?

4. Describe the emergent management of the hypoxic infant with a suspected ductal dependent cardiac lesion.

5. List types of CHD which are most likely to present outside of the neonatal period.

6. What are the anatomic anomalies seen in Tetralogy of Fallot?

• What is the pathophysiology of a Tet spell and how is it         managed?
• What is a ductal-dependent ToF?

7. Describe the management of CHF in the infant.

8. List 12 conditions associated with a high risk of developing dysrhythmias.

9. Compare SVT and ST.

10. Describe the management of SVT in the infant/child.

• Name 8 non-infectious causes that may present as pneumonia

• Describe the workup for a child with suspected pneumonia?

• What are the typical causes of bacterial pneumonia and viral pneumonia in the following age groups:

• < 1 month

• 1 month – 3 months

• 3 months – 5 years

• ≥ 5 years

• What is the empiric treatment of bacterial pneumonia in these age groups for outpatients? For inpatients?

• List 8 complications of pneumonia

• List 6 criteria for admission with pneumonia

• What are three clinical complications of cystic fibrosis?

• What is the pathophysiology of CF?

• How is suspected pneumonia in a patient with CF treated?

Wisecracks:

• What is the cause of whooping cough?

• What are the stages of whooping cough?

• How is whooping cough managed?

• How is the flu shot used in the pediatric population?

• Describe common pneumonia syndromes:

• Chlamydia trachomatis

• Mycoplasma pneumonia

6. What is the most common bacterial infection in CF?

• Excluding asthma, list 8 causes of wheeze

• Outline the pathophysiology of asthma.

• What are the features of mild, moderate and severe asthma?

• Describe the PRAM score

• List 8 medications for asthma treatment with doses

• What is the typical ED management for a pts with an asthma exacerbation?

• Describe adjunctive therapies that might be used in a patient with refractory symptoms.

• How are PO corticosteroids used in the management of asthma?

• When should children be started on inhaled corticosteroids?

• Outline a plan for disposition of a pt presenting to the ED with an acute asthma exacerbation.

• What are risk factors for sudden death in a patient with asthma?

• List risk factors for bronchiolitis.

• What are the typical pathogens of bronchiolitis?

• What is the pathophysiology of bronchiolitis?

• How is bronchiolitis managed?

• Which children with bronchiolitis should be admitted to hospital?

• List potential complications of RSV.

Wisecracks:

• What's the natural history of infants/toddlers who wheeze?

• What is a peak flow? What is the FEV1? What are the advantages to measuring peak flow? What are the disadvantages?

• Risk factors for death in bronchiolitis

• What is the pathophysiology of inspiratory and expiratory stridor?

• Provide a differential diagnosis for stridor in children (based on location: supraglottic, glottic, subglottic) list at least three in each category.

• What is the typical presentation of a retropharyngeal abscess?

• Describe the management of a RPA. What are the typical pathogens?

• What the typical pathogens in epiglottis? How are these patients managed?

• Differentiate between croup and other conditions mimicking croup.

• Contrast mild, moderate, and severe croup.

• What is the management of croup?

• Which children with croup require admission to hospital?

• Management of upper airway FB: Describe the management of an airway obstruction (progresses from partial obstruction to full obstruction to unconscious) in a 6 month old. In a 6 year old?

Wisecracks:

• Ddx of stridor (8) (review)

• List 5 Xray findings of epiglottitis

• Which infections are associated with croup?

• How do you handle the CICV scenario?

• List 10 non-infectious causes of fever in children

• List 3 bacterial pathogens responsible for infections in the following age groups

• 0-28 days

• 1-3 months

• 3-36 months

• > 3 yr

• List 5 tests to perform on CSF

• Describe the empiric management of fever in the neonate (0-28 days)

• Why is ceftriaxone not recommended for the neonate?

• Describe one of

• The Rochester criteria

• The Philadelphia criteria

• Define simple and complex febrile seizure. What are indications for LP?

• What is the likelihood of

• Recurrent febrile seizure after 1 st presentation

• Risk of epilepsy after first febrile seizure?

• List 6 causes of Fever and Petechiae

• Describe the criteria for the diagnosis of Toxic Shock Syndrome

• What sickle cell patients require prophylaxis and why? What Abx?

• List the Duke criteria for infective endocarditis.

Wisecracks:

• Provide a differential diagnosis for fever (review question)

• Which patients are excluded from the Rochester Criteria?

• What are the low-risk Rochester Criteria, and how are these children managed?

• Which age groups should always have a urinalysis when presenting with fever without source?

• Which children should have a CXR to r/o pneumonia in the setting of fever without source?

• 1) List age specific vital signs (RR, HR): "1 odd yr - 60 count down aid"

• 2) What is the lower fifth percentile of systolic BP for the neonate, infant, and 1-10 yr old child?

• 2) Describe the 3 components of the Pediatric Assessment Triangle.

• 3) Describe the Canadian Pediatric Triage and Acuity Scale

• 4) List 5 historical indicators of child abuse

• 5) List 5 features suggestive of child abuse on physical examination and/or radiology?

Wisecracks:

• What are developmental milestones (gross motor and otherwise) for 1-24 months?

• What are other considerations in the management of pediatric patients: consent, pediatric-readiness, pediatric-friendly ERs?

Core questions: 

1. Describe the components of the GABA receptor complex and their physiologic effect
2. Describe the sedative-hypnotic toxidrome, and list 8 drugs in the DDx
3. How do barbiturates work?
4. What are the clinical symptoms of barbiturate overdose?
5. How are they managed?
6. How do benzodiazepines work?
7. List risk factors for benzodiazepine withdrawal and its management
8. What are the indications for flumazenil? What are the contraindications?
9. How does chloral hydrate toxicity present?
10. What is the clinical presentation of GHB toxicity?
11. How is GHB withdrawal managed?

Wisecracks:

1. List 2 drugs used for 'date-rape' and describe their toxicity
2. What Benzos WILL NOT be detected on urine drug screen?

Core Questions:

1. For each of the following, describe the expected toxicity:
2. • Jequirity pea, rosary
   • Umbrella tree, Dieffenbachia, Dumb cane
   • Capsicum annum
   • Water Hemlock
   • Jimson Weed, Deadly Nightshade
   • Eucalyptus oil
   • Poinsettia
   • Oleander, Foxglove
   • Tobacco
   • Pokeweed
   • Rhododendron
   • Yew
   • Castor Beans
3. List 5 mushrooms with early onset toxicity and 3 with late onset – and describe the toxicity expected.
4. List 4 mechanism of toxicity resulting from the use of herbal medicine.
5. List 4 plants containing cardiac glycosides.
6. What is Buckthorn?

• Describe the cholinergic toxidrome from organophosphates

• Describe the clinical presentation of organophosphate toxicity.

• How is organophosphate toxicity managed?

• What are the complications of organophosphate toxicity?

• What is the difference between organophosphates and carbamates?

• What are the unique features of chlorinated hydrocarbon toxicity? What is an example of a chlorinated hydrocarbon? How are they managed?

• How do Substituted Phenols (Dinitrophenol) cause toxicity? How are they managed?

• How is toxicity from chlorophenoxy Compounds (Agent Orange) managed?

• What is expected in paraquat toxicity? and how is this managed?

• What are the toxic effects of pyrethrins and pyrethroids?

Wisecracks:

• What is aging - in relation to organophosphate toxicity?

• What is the maximum formulation of DEET in pediatrics? When should you not use DEET?

1. List 6 commonly abused opioids (Table 156:1)
2. Describe the opioid toxidrome (list opioid effects on Neuro, Resp, Ophtho, CV, GI, Derm)
3. List opioid preparations associated with the following presentations:

4. i) What is the dose of narcan? ii) What is the duration of action? iii) How do you administer a narcan infusion?
5. What opioid overdoses/ingestions need longer than 6 hours of observation?
6. What is the clinical presentation of opioid withdrawal?
7. What are risk factors for opioid withdrawal?
8. List 3 medications effective for opioid withdrawal.
9. What is the number one killer of people under 50?
10. What is Suboxone?
11. How do you do a Suboxone induction?

WiseCracks:

1. List 5 ddx for opioid intoxication (CNS + resp depression, + miosis).
2. What opioids don't cause miosis?
3. Risk factors for opioid overdose?
4. What is NAPE? Narcan induced pulmonary edema.
5. Difference between a "body packer" and "body stuffer"?

Core questions:

• What is the relationship between current, voltage and resistance?  How does this relate to potential for injury from electrical and lightning injuries?

• What are the types of electrical injury? (based on type of current)

• Differentiate between AC and DC current injuries.

• List 4 types of electrical burns and 5 mechanisms of lightning injury

• List 5 expected injury patterns for high-voltage and lightning injuries

• List clinical findings (early and late) associated with electrical injuries.

• List clinical findings associated with lightning exposure.

• Describe the skin injuries associated with lightning and electricity.

• Describe the modifications in field triage of multiple victims following a lightning strike.

• Describe the prehospital management of electrical injuries

• List 6 admission criteria for electrical/lightning injuries

• List 6 complications of high-voltage injuries

• Tips to avoid getting hit by lightning

Wisecracks:

• List six mechanisms of lightning injury.

• ECG features of lightning strike. 

• What is keraunoparalysis?

• Describe the management of a pregnant patient (1st trimester and 2nd /3rd trimester) in the setting of electrical injury.

• How are perioral electrical burns managed? List three early and three late complications.

1. List 5 mechanisms of heat loss and 5 physiological responses to cold
2. Describe 3 CV manifestations of hypothermia
3. What are the risk factors for hypothermia? List 6.
4. Define mild, moderate and severe hypothermia.
5. Describe the CNS, CVS, hematologic and GU presentations associated with hypothermia for each stage (mild, moderate, severe)
6. What are the changes made to BLS and ACLS in the setting of hypothermia?
7. What are the indications for CPR, defibrillation, and antidysrhythmics in the hypothermic patient?
8. Differentiate between active and passive rewarming. What are the two types of active rewarming?
9. What are five indications for active rewarming?  Describe 6 techniques for active rewarming.
   1. Active External Rewarming
   2. Active Core Rewarming
10. What are examples of:
11. In what situations would you not initiate resuscitation of a hypothermic patient?

Wisecracks

1. What is core-temperature afterdrop?
2. List 5 DDx for an Osborne J-wave
3. List 5 laboratory abnormalities expected in hypothermia
4. What three mechanisms cause worsening bleeding in trauma in hypothermia?
5. Describe 5 management considerations other than rewarming in hypothermia
6. What are the prehospital management priorities for the hypothermic patient in each of these categories: mild, moderate and severe?

1. List 6 risk factors for bone and joint infections
2. Describe the classification of osteomyelitis (based on pathophysiology)
3. List the 3 most common bacteria causing osteomyelitis/septic arthritis for each age group: neonate, child, adult; and the following circumstances:
   • Sexually active adolescent
   • Infected prosthesis
   • Sickle cell disease
   • IVDU
   • Human bite
   • Plantar puncture wound
   • Diabetic foot
4. Describe a diagnostic approach to osteomyelitis. What is the utility of bloodwork?
5. List 4 early findings of osteomyelitis on Xray
6. List 5 complications of osteomyelitis
7. List 6 differential diagnoses for osteomyelitis
8. Describe the empiric management of suspected osteomyelitis
9. What is the clinical triad of septic arthritis? Describe typical findings in joint aspiration + radiography.
10. List 5 complications of septic arthritis
11. What is the triad of disseminated Gonococcal disease?
12. List X-ray findings of septic arthritis in a joint with a prosthesis.
13. List 10 differential diagnoses for septic arthritis
14. Describe the empiric management of suspected septic arthritis

Wisecracks:

1. What is Kocher's Criteria?
2. What is a Biofilm? What is its clinical significance?

1. What are the top 5 rabies-virus carrying animals in Canada? In the world?
2. Describe the pathogenesis of the rabies virus disease (see fig. 123.6)
3. List 5 stages of rabies. What are the clinical presentations of rabies?
4. How is rabies diagnosed?
5. What factors are involved in a rabies risk assessment. Which types of animal contact require PEP?
   1. Non-immunized
   2. Immunized
6. Describe important aspects of rabies post-exposure immunoprophylaxis for the following exposures:

Wisecracks:

1. List 4 reservoirs of rabies
2. What is the dose of HRIG?

• Define DKA.

• List 6 potential triggers of DKA.

• Describe the pathophysiology of DKA. (Fig 118.1)

• How is DKA managed in children? In adults?

• What are the epidemiologic risk factors for cerebral edema in DKA?

• What are signs and symptoms of cerebral edema? How do you manage a pt with DKA and suspected cerebral edema?

• List 5 complications of DKA management

• List five common serious infections in diabetics and how they are managed.

• How does hypoglycemia classically present?

• List 10 causes of hypoglycemia

• Describe the treatment of hypoglycemia

• What is the definition of hyperglycemic, hyperosmolar state?

• Contrast DKA and HHS (Table 118.2)

• What is the pathophysiology of HHS?

• How is HHS managed?

WiseCracks:

• Why are urine ketones less sensitive for DKA than serum ketones?

• When do you give NaHCO3 to a patient with DKA?

• What is euglycemic DKA?

• What is the differential diagnosis of hypoglycemia in a patient who does not have DM? What would you add to the differential diagnosis in a pt who has DM?