Unstable and no peritonitis, but fast scan is positive > laparatomy. Mainly for that, bec there is fluid leakage, no peritonitis, and there unstable, so surgical exploration is needed. Fast scan negative + unstable or fast scan positive + stable = CT bec it’s not urgent danger and have time to investigate further.

The below comment hit it on the head, great point! Imaging is always helpful for localizing a source of trauma but FAST is faster, and done at bedside without any potential delay meanwhile CT may take time to transfer, wait time, and then the process of completing the scan itself. So FAST is a more time-efficient way to confirm that there is significant intra-abdominal injury to warrant surgery. CT will give a more detailed survey but the downside is the time it takes could delay surgery by even a few minutes, so its only ideal when there is time (either the patient is stable, or FAST is negative and there's indeterminate location of an injury).

Case Files - Internal Medicine fourth edition by Toy and Patlan is what a lot of us are using. Maybe not specifically for emergency medicine but it has a lot of examples that you're describing. Maybe you can buy it but I know people just airdropped PDFs of it so it's probably around

Yes, that's exactly the thought! Unless you can see the measures of significance in detail or if they mention some internal flaws of the study, it's usually best to just interpret with those assumptions (unless they specifically mention otherwise).

Yes, that's right. Specifically for the diagnosis/next step/management style of questions the material has quite a bit of overlap!

That's a tough one. There are probably several that are decent but hard to fine one that is totally comprehensive. The Amboss library, U-World summary tables, Divine Intervention series, and even Up-to-Date articles can all be useful!

Great question! The main things to keep in mind are using whatever diagnostic criteria they are giving and using those when you can. Like for example with schizoaffective, they will almost always emphasize a 2-week period with psychotic symptoms and no features of the mood disorder. Otherwise sometimes it can be helpful to try and figure out what the primary symptom(s) are and which seems more "accessory" or "secondary". For example in bipolar disorder with psychotic features, the hallmark symptoms of mania will be the focal point of the question with some added notes about hallucinations. For sure though these can be difficult and it's a combo of using diagnostic criteria and using the "picture" they are trying to paint to find the underlying primary diagnosis.

Done!

For sure!

That's a reasonable thought, it is pretty early in the timeline for troponin to be significantly elevated. Because it is such a highly sensitive marker though, it can be useful early on in management to see what the "baseline" value is and see if that changes over time. So even if it was normal or only mildly elevated, being able to trend it over the next several hours will be very useful in management. Great point though!

That's great to hear! Definitely have a pulmonary review in the works, that's a great suggestion!!

I'm glad it was helpful for you! Best of luck!

Great question. Sarcoid could definitely be considered solely based on the lab findings alone including the restrictive pattern and even reduced DLCO. The way to differentiate it from ILD was the history and demographic information. The age-range and "fine" crackles fits more with ILD and helps deter from sarcoid. They could show you a similar question with a young female with no prior history and that shifting of the background and demographic would be more typical of a sarcoid question!

@@Doctor_Tim Thank you Dr. Tim, great video btw, I've watched every single one, now IM is my last rotation

@@Imonaboattt900 That's great to hear! Best of luck on your rotation!

That is a great suggestion, definitely some topics I can incorporate into a QI/QC type video!

@@Doctor_Tim Thank you doctor. I am in medical school and surprisingly (or surprising to me) This topic (plus biostats) is worth 11% of my total grade from year 1 and year 2 of medical school and a substantial part of my Step 1 Exam. Its become a huge topic in medical school.

That's a great question. What you are saying could be possible after an extended period of distributive shock. However, they tend to primarily test the initial insult and the direct cardiovascular manifestations of that dysfunction. And in the short term, the decreased SVR and relative pooling of blood in the extremities is how the extremities stay warm in contrast to the other types of shock.

Yes, this video was more focused on the clinical side but much of this is very applicable to Step 1 and the basic sciences as well!

Great suggestion, definitely one that is planned!