Mark Corson

By W. Surus. Lehigh Univervsity.

Although the format stresses an approach useful in preparation for the emergency medicine oral boards generic elavil 75mg amex, the cases serve as a review (or introduction) to the practice of emergency medicine cheap 50 mg elavil otc. These pages contain heuristics on the general approach to patient management order 25 mg elavil otc, pearls on the care of children, tips on performing common bedside procedures, and a litany of cases. To mimic this process as closely as possible, you should review the cases in this book with a partner. Pairing with another emergency physician is ideal, as they will be familiar with the format of the boards and the medical decision making in the cases, and they will have more fun throwing curveballs at you to make the cases more interesting (or diffcult)! If you cannot fnd a colleague with a medical background to take you through the cases, a friend, family, or signifcant other will do. The “examiner instructions” for each case are written to help a nonphysician approach the case. It is quite likely that your fam- ily and friends already know a lot of the jargon in this book. Like most physicians, you have probably regaled them with enough stomach-turning stories over the dinner table to make them experts. If you are fortunate enough to have a partner (examiner), read through the introductory section and appendices and become familiar with the format for the boards, but do not look at the images or cases. You should read through 1 2 Emergency Medicine Oral Board review illustrated each case on your own after working through it with your examiner, and look up any areas you had diffculty with. References for standard emergency medicine texts; Emergency Medicine: A Comprehensive Study Guide, 6th ed. Please ask your partner to read the next section (Examiner Instructions) and the sample case before you tackle the cases in the rest of the book. Examiner instructions Thank you for helping your friend, family member, or colleague (the candidate) to review for the oral board exam. This is the fnal step in their quest to become a board- certifed emergency physician. It is probably not the frst (and certainly not the last) time you will ask yourself, “What have I gotten myself into? Your efforts will greatly exceed whatever reward you have been offered, especially if you were convinced by dinner in any restaurant they can afford on a resident’s salary. Your goal is to provide the candidate bits of information about the case and take the case in different direc- tions based on their actions (or inaction). You already understand enough about medical care to appreciate the daily struggles the candidate faces in taking care of patients. Keep in mind that none of the actors on today’s “doctor shows” ever attended medical school. Yet they can sound convincing, and you can appreciate the medical plot points, with a little coaching. Each case focuses on a patient presenting with some acute manifestation of ill- ness. Some will have subtle signs such as headache or nausea, and others will be quite obviously sick (vomiting blood, major motor vehicle accident, etc. Many patients will have straightforward problems such as broken bones, and others will have diagnoses that are diffcult to pin down (poisonings, drug reactions, or more rare illnesses). Start by reading the examiner instructions for each case; these will give you an overall picture of what the medical problem and major critical actions are. Within the description there will often be additional points on how to deal with situations that will arise in the course of the case – playing the part of a consultant, when to reveal certain key information, how to deal with common medical errors, and so on. Next, read the case from beginning to end to see the fow, starting with the “chief complaint” (reason for evaluation) to initial impressions (What do I see when I walk in the room? Patients, consultants, nurses, and other “characters” in oral board cases are typically portrayed in the frst person by examiners. Instead of saying, “the How to Use This Book 3 patient reports they are in pain,” try, “Doctor, my arm still hurts” or “Why isn’t my son getting anything for pain? Taking a friend through these cases can be similarly entertaining, even without the aid of alcohol. When you become fairly comfortable with the format (this is easier for medical professionals), you can deviate a bit from the cases to make them more interesting and challenging. Some of these curveballs will involve reluctant consultants, patients who aren’t forthcoming with the truth, or other factors which can make proper diagnosis and treatment diffcult. Many of these types of curveballs can appear on the real oral boards, because the candidate is being tested partially on their ability to work effec- tively in the emergency medicine practice system. Some are so important that they should be expected in every case, even when not explicitly stated in the instructions. For example, if the candidate orders a medication before checking the patient’s aller- gies, that patient should exhibit an allergic reaction to the medication. This is good practice for the boards (where points can be deducted for such mistakes) but more important in real life, where “points” are people. You can still use this book effectively to engage in “active learning,” which is much more effective for adult learners than fipping through pages and passively reading the text. You’ll have to use a bit of discipline in approaching the cases and force your- self to think about your management for each case. Read through the chief complaint and think about what you would do with that patient immediately. For example, if you saw an ashen, unresponsive patient, you will want to move immediately toward resuscitation.

The sides of the building were made of concrete block with holes to the outside placed at the desired height (bottom of the bird’s cage floor) and at numerous horizontal intervals (the num- ber would depend on the width of the interior and exterior enclosures) purchase elavil 25mg free shipping. A strip of florescent lighting was positioned down bowls and nest box dry can be used to breed birds in appropriate the center of the building order elavil 25mg without a prescription. The enclosure can be constructed over concrete pads with installed in the attic of the building with four evenly a drainage ditch to one side for ease of cleaning generic elavil 25 mg on line. The lighted indoor facility is made of concrete blocks on a concrete slab for ease of cleaning. The outdoor flights are connected to the indoor flights through a hole in the concrete block. Note the height of the enclosures, which provides extra physiological security for the birds, and the perimeter fence with a “kill zone” to discourage unwanted intruders (eg, raccoon, opossums, rats, snakes) (courtesy of Apalachee River Aviary). These enclosures should be placed so that lation was placed in the attic to reduce heat loss in the perches are above eye level of aviary personnel to the winter and keep the buildings cooler in the sum- contribute to the security and contentment of the mer. Enclosures should be spaced far enough apart to prevent any physical contact between birds in adja- The interior enclosures are suspended from beams in cent housing. Obese birds rarely placed on pipe racks attached to the concrete floor; breed, and larger enclosures provide for improved however, these are more difficult to clean. Suspended wire enclosures may not be ad- thermostat for the heating system is placed at a level visable for toucans or some aggressive species that even with the enclosure perches and maintained at need ample room to escape from attacking mates. By placing the thermostat at this position, a bird’s living space is heated to the desired Most enclosures for Psittaciformes are constructed temperature while the area below the outdoor en- from appropriate gauge welded wire (10 ga for larger trance hole (bottom of the enclosure floor) remains macaws, 14 to 16 ga for cockatoos and Amazon par- unheated. Wire that is galvanized after welding is supe- rior in strength to wire that is galvanized before Enclosures welding. The galvanized coating that is used on The two primary styles of enclosures used in breed- welded wire does contain heavy metals. This wire ing aviaries are suspended wire enclosures and should be thoroughly scrubbed with acetic acid using flights. A suspended enclosure is separated from the a wire brush and rinsed immediately to remove loose ground and is not entered by aviary personnel. Alcove servicing also prevents escapes because an enclosure door is not opened to gain access to the food and water containers. These alcoves can be de- signed to slide onto the floor or to fit under the floor of the enclosure. Some aviculturists flights in being easier to clean and less expensive to construct and in reducing the birds’ access to contaminated food or droppings. The perches in this bird’s enclosure are about seven feet birds in a dry climate that are incubating eggs must above ground level (courtesy of Apalachee River Aviary). Large Perches must be secure and non-movable in order to flights are aesthetically pleasing to people and pro- provide an optimal site for successful copulation. However, these enclosures are difficult to clean and to maintain pest- or parasite-free. Additionally, avi- ary personnel walking from one enclosure to the next can serve as mechanical vectors for the transmission of infectious agents. Enclosures should be designed with access locations that allow the capture of birds with minimal chasing. Escape proofing is suggested and may be accom- plished by safety aisles or suspended safety netting. In outdoor facilities without safety aisles or netting, a portable safety cage or drape can be suspended over the door, surrounding the handler in order to reduce the chance of escape. Food bowls should box, resulting in continuous excrement contamination of the food and water. Note also that these unproductive breeding birds were be positioned away from perches to reduce excrement on an all-seed diet. The incidence of recurrent enteritis in the contamination of the food and water containers (Fig- breeding adults and gram-negative bacterial septicemia in the neonates was high in this breeding facility. This type of feeding tray allows easy access to the food and water containers without opening a door to the enclosure that could allow an inhabitant to escape. Note that both of these alcove designs are lockable and have a flap that sufficiently covers the opening to the alcove. Wood perches that vary in diameter and surface tex- proofed or placed so they do not get wet during heavy ture provide the most natural standing surface. The nest boxes should also be shielded from larger psittacine birds, these perches should be made direct sunlight, which may cause overheating of the of manzanita, Australian pine or oak to prevent their occupants. Excessively large or flat perches species such as Amazon parrots require visual isola- may cause pressure lesions on the ventral surfaces of tion around the nest box, while other species such as the hocks. Having wooden perches in an enclosure provides psychological stimulation (chewing) and will help maintain beak health. Some foot and leg problems may be associ- ated with continuous perching on hard surfaces, es- pecially in cold climates where chilling of the feet or frostbite may occur. Nest Boxes Nest boxes should be placed in or on the enclosure in such a way as to allow easy and frequent examina- tion. Placing nest boxes on the same end as the feeding and watering station allows simultaneous feeding and nest box examination (Figure 2. Nest boxes must be water- bottle should be used during the transition phase to bottles. Changes in feeding or watering techniques are best performed after, not before or during the breeding season. The use of potting soil, corn cob bedding, eucalyptus leaves or hay may contribute to fungal growth.

Health and the built environment: the efects of where we live order 75 mg elavil visa, work and play [videocassette] quality elavil 25 mg. April and Renee: the supermodel discount elavil 25mg fast delivery, the tennis player, and the discourses of trans/sexual diference [videocassette]. Audiovisuals with organization as author with subsidiary part of organization named Kaiser Permanente, Southern California Permanente Medical Group. Udalenie doli legkogo pri tuberkuleze [Lung lobe resection in tuberculosis] [motion picture]. Audiovisuals with more than one organization as author American Association of Oral and Maxillofacial Surgeons; American Academy of Oral Pathology. Audiovisuals with no authors found Collaborative research with communities: value added & challenges faced [videocassette]. New York: Society for French American Cultural Services and Educational Aid; 1991. New York: Society for French American Cultural Services and Educational Aid; 1991. Udalenie doli legkogo pri tuberkuleze [Lung lobe resection in tuberculosis] [motion picture]. Audiovisuals published with parallel text in two languages Choropampa: the price of gold = Choropampa: el precio del oro [videocassette]. Paranormale heilmethoden auf den Philippinen = Paranormal healing in the Philippines [videocassette]. Audiovisuals published with text in multiple languages A plastic story: a history of plastic surgery [videocassette]. Audiovisuals with Greek letters in titles β-arrestins: trafc cops of cell signaling [videocassette]. Audiovisuals with more than one type of medium Microhemagglutination assay methods in the diagnosis of syphilis [audiocassette + slide]. Case studies in human growth and development: a fexible instructional module [audiocassette + videocassette]. Following Antigone: forensic anthropology and human rights investigations [videocassette]. Optimizing the mammographic study: positioning and technical considerations [videodisc]. Audiovisuals with authors and producer(s), editor(s), or other secondary authors Hable M. Washington State University College of Nursing, Learning Resources Center, producer. Surgical techniques in orthopaedics: anterior cruciate ligament reconstruction [videodisc]. Kontrastdarstellung des Herzens und der grossen Gefasse im Rontgen-Kinoflm [Demonstration of the heart and large vessels in cine-radiographic flm] [motion picture]. Audiovisuals with place of publication inferred Fluoride: the magnifcent mineral [motion picture]. Health and the built environment: the efects of where we live, work and play [videocassette]. Audiovisuals with government agency as publisher Epidemiology and prevention of viral hepatitis A, B, C, D, E: an overview [slide]. Aspirin in the secondary and primary prevention of cardiovascular disease [audiocassette]. Audiovisuals with no publisher found Kontrastdarstellung des Herzens und der grossen Gefasse im Rontgen-Kinoflm [Demonstration of the heart and large vessels in cine-radiographic flm] [motion picture]. Books and Other Individual Titles in Audiovisual Formats 951 Bonn (Germany): [publisher unknown]; 1959. Audiovisuals with no place of publication or publisher found Onepauur ydarehur dephmpudhou kucmbi cpedocmehur [Ablation of a cyst in the mediastinum] [motion picture]. Dosing antipsychotic medications: insights from data and practice [videocassette]. Audiovisuals with date of copyright instead of date of publication Assessment & diagnosis [videocassette]. Audiovisuals with date of publication and date of copyright MacIntyre R, Preston I. Audiovisuals with date range of publication Paranormale heilmethoden auf den Philippinen = Paranormal healing in the Philippines [videocassette]. Udalenie doli legkogo pri tuberkuleze [Lung lobe resection in tuberculosis] [motion picture]. Confronting racial and gender diference: 3 approaches to multicultural counseling and therapy [videocassette]. Audiovisuals with no place, publisher, or date of publication found Technique of laparoscopy [motion picture]. Audiovisuals with sponsorship note included Advances in diagnosis and treatment of sleep apnea and snoring [videocassette]. Audiovisuals with supplemental note included A family perspective: type 2 diabetes in young people [videocassette]. Health and the built environment: the efects of where we live, work and play [videocassette]. Microhemagglutination assay methods in the diagnosis of syphilis [audiocassette + slide].