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In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the October 2024 Pediatric Emergency Medicine Practice article, Elder Abuse and Neglect: Making the Diagnosis and Devising a Treatment Plan in the Emergency Department
00:00 Welcome and Introduction 00:13 Free Subscription for Emergency Medicine Residents 01:05 Introduction to Pediatric Emergency Medicine Practice 01:37 Discussion on Acute Scrotal Pain 02:35 Testicular Torsion: Key Insights 09:50 Differential Diagnosis for Acute Scrotal Pain 17:21 Diagnostic Indicators of IgA Vasculitis 17:44 Pre-Hospital Care for Severe Pain 18:13 The Twist Score for Torsion 18:44 Emergency Department Evaluation 20:04 Ultrasound in Diagnosing Torsion 29:44 Operative Management and Other Conditions 31:41 Manual Detorsion Techniques 32:37 Risk Management and Key Takeaways 34:19 Conclusion and Final ThoughtsEmergency Medicine Residents, get your free subscription by writing [email protected]
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In this special episode Sam Ashoo, MD interviews Ryan Johnson, Pharm. D. who shares strategies to address the recent IV fluid shortage caused by Hurricane Helene.
00:00 Introduction and Episode Overview
01:10 Meet Ryan Johnson: Clinical Pharmacist
02:06 Role of Clinical Pharmacists in Emergency Medicine
05:03 IV Fluid Shortage: Causes and Impact
05:56 Institutional Strategies to Mitigate IV Fluid Shortages
14:52 Provider-Level Solutions for Fluid Conservation
22:11 Pharmacy and Nursing Staff Roles in Fluid Management
26:34 Advanced Measures and Federal Guidelines
34:40 Conclusion and Final Thoughts
Resources mentioned in the podcast:
(Brigham and Women's Protocol) Patiño, A. M., Marsh, R. H., Nilles, E. J., Baugh, C. W., Rouhani, S. A., & Kayden, S. (2018). Facing the shortage of IV fluids — a Hospital-Based Oral Rehydration strategy. New England Journal of Medicine, 378(16), 1475–1477. https://doi.org/10.1056/nejmp1801772 Vizient shares conservation strategies for potential IV fluid supply disruption caused by Hurricane Helene https://newsroom.vizientinc.com/en-US/releases/releases-vizient-shares-conservation-strategies-for-potential-iv-fluid-supply-disruption-caused-by-hurricane-helene -
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In this episode, Dr. Julia Draper shares her firsthand account of managing a crisis during a hurricane in Asheville, North Carolina. As the area faced unprecedented flooding, Dr. Draper describes the challenges faced at Mission Hospital, including loss of power and water. She details the innovative solutions the hospital implemented and highlights the tireless efforts of staff during a natural disaster of this magnitude.
00:00 Introduction to Dr. Julia Draper
01:03 Experiencing the Hurricane
03:19 Immediate Aftermath and Hospital Challenges
11:22 Dealing with Water and Supply Shortages
20:48 Community and External Support
24:10 Ongoing Efforts and Future Plans
27:51 Conclusion and Final Thoughts
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In this special episode, Sam Ashoo MD and Rob Orman MD discuss the concept of Maladaptive Perfectionism and its application to emergency medicine.
Understanding Maladaptive PerfectionismCase Example and DiscussionAdaptive vs Maladaptive PerfectionismPersonal Experiences and Legal ChallengesDealing with Negative OutcomesStrategies for Managing Perfectionism in the EDHandling Overwhelming ShiftsManaging Expectations in the EDA Soul-Crushing Day in the EDFinding Meaning in Moments of CrisisThe Importance of Meaningful WorkOperationalizing Meaning in Your ShiftThe Driveway Debrief: Transitioning from Work to HomePreparing for the Next ShiftConclusion and Next Episode TeaserFor more from Rob Orman, MD check out Orman Physician Coaching
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In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the September 2024 Emergency Medicine Practice article, Elder Abuse and Neglect: Making the Diagnosis and Devising a Treatment Plan in the Emergency Department
Introduction and AnnouncementsElder Abuse and Neglect: An OverviewRisk Factors and ReportingPre-Hospital and Emergency Department ConsiderationsScreening Tools and Physical ExaminationDocumentation and DispositionCultural Considerations and Future DirectionsConclusion and ResourcesSuspected Elder Abuse should be reported to one of these organizations:
ADULT PROTECTIVE SERVICES - Living at homeLONG-TERM CARE OMBUDSMAN - Living in a long term care facility -
In this episode, Sam Ashoo, MD interviews social media marketing expert Adam Goodcoff, DO, Founder and CEO of MedFluencers.
Meet Dr. Adam Goodcoff The Role of Physicians on Social Media Legal Considerations for Physicians on Social Media Employer Policies and Social Media Creating Engaging Content Balancing Professionalism and Personal Life on Social Media Navigating Negative Comments and Trolls Handling Low Engagement and Negative Feedback Becoming a Medfluencer: Tips and Strategies Connecting with Adam and Final Thoughts -
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the August 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Sickle Cell Disease
Epidemiology
Common Presentation of Sickle Cell Disease in the EDScreening and Diagnosis DifferencesEpidemiology: 200,000 ED Visits Annually, 85% for PainPathophysiology
Life Expectancy and ComplicationsVado-Occlusive Crises and PathophysiologySequestration Crisis in Sickle Cell PatientsAcute Chest Syndrome and PriapismClinical Management
Treatment Advocacy and Pain ManagementPatient History and Examination ImportanceImaging RecommendationsLaboratory Studies and FindingsEmergency Department Care ProtocolsAdvanced Treatment Options
Intravenous (IV) Fluids GuidelineManagement of PriapismRole of Exchange TransfusionAcute Chest Syndrome DetailsApproach in Rural and Critical Access HospitalsSpecial Populations
Pregnant Patients with Sickle Cell DiseaseIncreased Risks and Complication Management -
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the July 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Complications of Dialysis
Overview of Dialysis Complications
Key Dialysis ComplicationsCardiovascular DiseaseCongestive Heart FailurePericarditis and Cardiac TamponadeNeurological SequelaeGastrointestinal ComplicationsHypotensionDialysis Disequilibrium SyndromeAir Embolism and Chloramine ToxicityDisaster Preparedness
Vascular Access ComplicationsHemorrhage risks and treatmentThrombosis, stenosis, and aneurysmsInfection risks and managementPre-Hospital Care
ED History Differential diagnosis Key questions to ask dialysis patientsExamination Physical Exam TipsTreatments
Risk Management PitfallsCommon Pitfalls to AvoidConclusion
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In this episode, Sam Ashoo, MD and T.R. Eckler, MD interview Corey Hazekamp, MD, MS, one of authors of the June 2024 Emergency Medicine Practice article, Managing Emergency Department Patients With Opioid Use Disorder
Current State of Opioid Epidemic
Overview of overdose deaths and trends.Data and statistics about opioid overdose mortality rates.Three Waves of Opioid Overdose Deaths in the U.S.Opioid Classifications and Urine Drug Testing
Types of opioids: synthetic, semi-synthetic, and natural.Urine drug testing limitations and false positives/negatives.Practical use and research on co-ingestionsEmergency Medical Services (EMS) and Pre-Hospital Care
Importance of ABCs in acute opioid overdose cases.Naloxone usage trends and an empirical approach.Anecdotal insights on changing naloxone administration dosages.Clinical Management in the Emergency Department
Buprenorphine Initiation
Protocols for initiating buprenorphine in ED settings.Assessment using the Clinical Opiate Withdrawal Scale (COWS).Safe dosing procedures for buprenorphine.Withdrawal and Overdose Care
Laboratory testing recommendations.Capnography and VBG in overdose management.The role of end-tidal CO2 monitoring and respirations.Methadone vs. Buprenorphine Considerations
Methadone to buprenorphine transition protocols.Personal testimonials and clinical experiences in managing overdoses and withdrawal symptoms.Patient Discharge and Follow-upPreparation of discharge prescriptions.
Referral to addiction medicine clinics and resources.Educating patients on continued treatment and harm reduction. -
In this episode, Sam Ashoo, MD interviews Rob Orman, MD, founder of Orman Physician Coaching, about routine examination of our careers in emergency medicine.
Understanding Career Cycles and Embracing ChangeThe Importance of Career Reflection and Making TradesNavigating Career Satisfaction and Preventing BurnoutProactive Career Management and Reflection StrategiesExploring Career Alternatives and Rediscovering Joy in MedicineBalancing Work, Love, Play, and Health for a Satisfying LifeWhen to Seek Coaching for Career GuidancePractical Tools for Self-Reflection and Taking ActionClosing Thoughts and Resources for Emergency Physicians -
In this episode, Sam Ashoo, MD and T.R. Eckler, MD interview Reuben J. Strayer, MD, author of the May 2024 Emergency Medicine Practice article, Current Concepts in Ketamine Therapy in the Emergency Department
Diving Into Ketamine Use in Emergency MedicineUnderstanding Ketamine: From Origins to Emergency UseExploring the Ketamine Brain ContinuumKetamine Dosing and Administration TechniquesCombining Ketamine with Neuroleptic MedicationsPractical Approaches to Ketamine for Pain ManagementInnovative Pain Management and Ketamine UseProcedural Sedation with Ketamine: Techniques and ConsiderationsAddressing Agitation and Sedation in Emergency SituationsNavigating Intubation Strategies: DSI and Ketamine-Only ApproachesKetamine's Role in Treating Asthma, Status Epilepticus, and Alcohol WithdrawalExploring Ketamine for Treatment-Resistant DepressionConcluding Remarks on Ketamine's Versatility in Emergency Medicine -
In this episode, Sam Ashoo, MD interviews Ashley A. Foster, MD, Bijan Ketabchi, MD, MPH and Jennifer A. Hoffmann, MD, MS on the March 2024 Pediatric Emergency Medicine Practice article, Evaluation and Management of Suicidal Ideation and Self-Harm in Children in the Emergency Department
IntroductionUnderstanding Suicidal Ideation and Self Harm in YouthsScreening Tools and ApproachesAsk Suicide-Screening Questions (ASQ) ToolkitColumbia Suicide Severity Rating Scale (C-SSRS)Prehospital CareManaging Patients in the EDDealing with Challenging PopulationsLethal Means CounselingEmerging Tools in Suicide Risk IdentificationSuicide Risk Screening PathwayDisposition and ReferralsNational 988 Suicide & Crisis Lifeline -
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the April 2024 Pediatric Emergency Medicine Practice article, Brief Resolved Unexplained Events: Practical Evaluation and Management in the Emergency Department
IntroductionThe Evolution of BRUEUnderstanding BRUE GuidelinesThe Importance of Pre-Hospital Care in BRUE CasesInvestigating the Event: Questions to AskMedical and Family History: Key FactorsEnvironmental and Social ConsiderationsDefinitions and Risk AssessmentPhysical ExaminationRisk Stratification: Low Risk vs. High Risk PatientsManagement: What to Do and What Not to DoHigh Risk Population: Studies and RecommendationsThe Importance of Communication and Decision Making5 Things That Will Change Your Practice -
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the March 2024 Emergency Medicine Practice article, Emergency Department Evaluation and Management of Constipation
Prevalence and Impact
Understanding the Causes
Medications That Can Cause Constipation
Dealing with Fecal Impaction
Understanding Stercoral Colitis
Pre-Hospital Care
ED History and Physical Exam
Diagnostic Studies and Imaging
X-RayCT ScansAdvanced TestingTreatment Options for Constipation
EnemasOsmotic Laxatives and Stool SoftenersSpecial Considerations: Pregnant, Pediatric, and Hospice Patients
Prescription Medications for Constipation
Clinical Pathway for Constipation Management
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In this episode, Sam Ashoo, MD interviews Paul Aronson, MD, MHS, one of the authors of the February 2024 Pediatric Emergency Medicine Practice article, Febrile Infants Aged ≤60 Days: Evaluation and Management in the Emergency Department
Guideline Changes
Pathophysiology
Etiology and Definitions
Prehospital Care
ED History and Physical
Diagnostic StudiesAge 0-21 Days Age 22-28 Days Age 29-60 DaysLumbar Puncture
Viral Testing
Urinalysis
Shared Decision Making
Disposition
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In this episode, Sam Ashoo, MD, and T.R. Eckler MD interview Nick Harrison, MD and Daniel Brenner, MD, two of the authors of the February 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Right Heart Failure
PathophysiologyPresenting SymptomsDifferential DiagnosisSpecific Acute CausesPESepsisRVMIPPVARDSCOVID-19Specific Chronic CausesCTEPHLeft Heart FailureCongenital Heart DiseaseLVADLung Disease Group 3 Pulmonary HypertensionPulmonary Arterial HypertensionPrehospital CareED history and PhysicalBiomarkersECG (table 5)ImagingEchoCTMRITreatmentRevascularizationRespiratory SupportVasopressors and Inotropes -
In this episode, Sam Ashoo, MD, interviews Vasisht Srinivasan, MD, FACEP one of the authors of the December 2023 Emergency Medicine Practice EXTRA article, Emergency Department Management of Stroke in Pregnant and Postpartum Patients
EpidemiologyEvidenceCausesRisk FactorsDifferential DiagnosisPrehospital CareED History and Physical ExamLabsImagingED BP ManagementSpecific Ischemic Stroke TherapiesSpecific Hemorrhagic Stroke Therapies -
In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the January 2024 Pediatric Emergency Medicine Practice article, Management of Pediatric Urinary Tract Infections in the Emergency Department, and the January 2024 Evidence Based Urgent Care article on Pediatric Community-Acquired Pneumonia: Diagnosis and Management in the Urgent Care Setting.
UTIEpidemiology and Nomenclature
Prehospital Care
ED History and Physical Exam
Infants Age <2 Months Children Age 2 Months to 2 Years Children >2 Years AdolescentsUrinalysis
Clean Catch Protocol Catheterization Suprapubic AspirationBlood Cultures and CSF
Biomarkers (CRP and ESR)
Treatment
Community Acquired PneumoniaDistinguishing Viral vs Bacterial Pneumonia
Imaging
Antibiotic Treatment
Vaccination
Steroids
Atypical Presentations
Check out the clinical pathways at https://www.ebmedicine.net/pathways
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In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the December 2023 Pediatric Emergency Medicine Practice article, Management of Pediatric Toxic Ingestions in the Emergency Department.
Need help now? Call the Poison Help Line at: 1‑800‑222‑1222Epidemiology
Prehospital Care
ED History and Physical Exam
Diagnostic Studies
LabsEKGImagingUrine Toxicology TestingTreatment
HemodialysisActivated CharcoalWhole Bowel IrrigationGastric LavageIpecacDrug Specific Therapies
AcetaminophenAlcoholsAnticholinergicsBeta BlockersCalcium Channel BlockersCholinergic AgentsDigoxinIronOpioidsSalicylatesSedative HypnoticsSulfonylureasLaundry PodsCheck out the clinical pathways at https://www.ebmedicine.net/pathways
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In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the November 2023 Pediatric Emergency Medicine Practice article, Pediatric Diabetes: Management of Acute Complications in the Emergency Department and some of the highlights from the other EB Medicine articles published in November.
Epidemiology
Differential diagnosis
Prehospital care
ED history and physical exam
Diagnostic studies
Point of care testing Labs ImagingTreatment
IV fluids, the 2-bag system Mild DKA Moderate to severe DKA Potassium and phosphate supplementation Magnesium and calcium Sodium bicarbonate Hypoglycemia HHS MonitoringComplications
Cerebral edema IntubationInsulin pumps
Disposition
Summary
Highlights
EBUC - Management of Acute Asthma Exacerbations in Urgent CareEMP - Evidence-Based Emergency Department Management of Methamphetamine ToxicityPEMP - Trauma Extra - Blunt Thoracic Injuries (coming Nov. 15th)Check out the clinical pathways at https://www.ebmedicine.net/pathways
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