SAMPLE IMAGES OF INTRACRANIAL HEMORRHAGES FROM PEARLS OF WISDOM TEXT ED 7 (PREPRESS RELEASE)

The image in the upper left is a classic generalized subarachnoid hemorrhage.

The image in the upper right is the classic appearance of an epidural hematoma on the right with some evidence for midline shift.

The image in the lower left is a spontaneous intracranial hemorrhage due to an AV malformation.  This cut shows blood bilaterally in the posterior horns of the lateral ventricles.

The image int ehe lower right is most correctly described as a large subdural hematoma with extension along the fall cerebrii.  It also shows significant compression of the right ventricle and substantial shift of the fall to the left.

The original 5th edition of Pearls of Wisdom in Emergency Medicine was the first version to include 80 grayscale and color plates with detailed descriptions.  This is an excellent text if you can find a copy.  All of the images were removed by the publisher in the sixth ed so it is not worth purchasing if you are preparing for boards.  I hope to have the 7th edition completed in 2017.  It is the most comprehensive and contains many more images and is looking like it may be as many as 1200 pages.  I have spent years on this edition to make it the one book that will remain a classic in the knowledge needed by every provider of emergency and ICU care.

Since I have written over 700 test items for one board and numerous others as well as simulated patient encounters, I have virtually all of the test items that I predicted by looking at the wording in the core content.  Everywhere you see, most common, most important (and such superlative) these I predicted to be test items and this proved to be correct.  That is why I emphasized Tintinalli’s text as a reference only and made it mandatory as material for the program.  You don’t need anything but Pearl’s, and the case studies I have written (72 cases) to pass any of the Emergency Medicine board examinations.  I can promise that.  ABEM has seen all of my case studies and they are more comprehensive and yet cover every topic tested.  In my opinion the most important thing you gain by fully understanding these cases is that it will make you a great clinician.  That is what really matters.  It wil give you great confidence.

I let ABEM’s chief examiner read every page of every case the first year I trained physicians at the Chicago Marriott.  He was very happy to see what I had done and his only request was that I not teach at “their hotel.”  I moved the program across the street to their sister hotel which is much less stressful for those of you taking exams.  You don’t see all the physicians who will likely make you more nervous and you have a place where you can better rest. I have been privately tutoring physicians in Chicago since 1990.  I only work with my attendees because such tutoring a day before your exam without any practice would likely cause more harm than good.  It takes 6 days to get through my program I usually conduct in Boca Raton or Atlanta.  So you can imagine the level of testing is very comprehensive once you have completed that program.  That is more training for an exam that the examiners receive to prepare to administer it.  I have to warn some candidates to be careful not to verbally overpower some examiners.  It is not polite, not necessary and they can only here one thing at a time.  So you need to relax and speak in a natural pace and tone.   For the majority this takes practice because most have a true fear of public speaking (often cited as the most common fear) and you really have no idea what you will say until you practice.

The goal when sitting for orals is to know and practice what you will say for the classic simulations I teach.  If you know those you will be confident and you will completely understand how to get the points to pass.  You will completely understand the scoring criteria.  This is much more important that most realize.   I publish a manual with this program (The Oral Board Tutorial) which I have sent to my attendees in advance since 1989.  It is over 300 pages and it is all of the pathophysiology questions you can expect, the explanation of the ABEM scoring criteria in detail.

I trained all of the examiners for one of the emergency  medicine boards for a decade.  I know exactly what they are trained to test.  My cases represent the knowledge they test and more.  You want to prepare this way so you have no surprises.  Even when you prepare in such detail you can still have one room that is a ‘surprise”.  That won’t cause anyone to fail.  I can assure you they don’t want to fail you, but they don’t want to pass a physician who demonstrates dangerous actions either.

I spend 330 pages describing the exam in detail in the preprogram manual so you are fully prepared to understand how to proceed in the simulations in the live program which takes an additional six days.  It will truly change you and I have had many physicians come back for this training because they feel it keeps them sharp.  Over 12,000 emergency physicians have completed this program.  I only teach the most serious conditions in this program but I go through a discussion of each case and we spend 10-12 hours a day for 5 of those days.   It is true there is no other program like this offered by anyone.  I have taught it for over a quarter century and remember I practice clinically  too.  I think it is important that you know that when I work I usually work 200 hours or more per month.  So I have my nose in both clinical emergency medicine, reading, illustrating, and then presenting it in two very long programs.  So please understand that I am here to help you.  I spend my life doing this so patients get better healthcare and so that you love your work more.  Boards are not really my motivation.  However,  I will do all I can to ensure you pass.  Yes my programs are twice as long as any other.  They are for a reason.  You can’t rush a great education or mentoring.  I explain everything.  I don’t require outlines or notes.  I have printed these programs hundreds of times.   I do a fair amount of drawing for you as well so you can recall detailed pathophysiology.  You should know they “why” for what you do.  The diagnosis is really only 1/64th of your score…surprise you?  That is because emergency medicine is a unique form of medical practice unlike any other.  You have to diagnose and treat in tandem or just treat when patients are in extremis.  Your goal is to manage them maximally in the least amount of time and to get them an ideal disposition.  It is highly unlikely you will send anyone home on the oral examination.  They expect you can manage such fast track patients.

They want to know you can care for the severely ill patients and exactly how you do it.  They are looking at your process once you understand the scoring criteria this becomes very obvious.  So you can leave a room pass a case and not feel like you had the diagnosis…but that is just like live clinical practice.  So it does not mean you failed a case.  By the way I have rewritten the entire manual for the oral board program 13 times.  So understand that this is my life’s work.  I view it as my missionary work.  I am not saying any of this to brag.  I am telling you I have spent more time dissecting emergency medicine than anyone I ever met.

Why?  I just love medicine.  I always did.  I knew as a young child I would be a doctor.  I told my parents I would as a child.  My greatest struggle has been all the time wasted on credentialling and missing work.  It has stressed me more than anything except for the loss of my parents.

They simply just don’t want to certify physicians who end up in court; so it is very important that everything from your tone to rate of speech, details, truly managing patients (there are eight performance ratings I will discuss in detail) and 4 or 5 critical actions per simulation.  Everyone will have two triple patient encounters in their live examination.  One single case on your entire examination is  a field test case which is not scored.  More to follow….DDC 🙂

Here is is for all to see my NPDB.  I had my MD at age 23.  So yeah I’m not the norm.  This document represents my clinical practice and life for 37 years.  Realize that people are sued in residencies and even when perfect care was given because of a bad outcome people get sued.  i have been fortunate.

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