Episodes
-
In this episode, Sam Ashoo, MD and Dr. T.R. Eckler, MD discuss the June 2026 Emergency Medicine Practice article, Diagnosis and Management of Heat Stroke and Other Heat-Related Illness in the Emergency Department
0:21 Intro & Promo0:56 Episode Introduction3:14 Spectrum of Heat-Related Illnesses7:37 Differential Diagnosis8:58 Pre-Hospital Management11:54 Exertional Heat Stroke13:50 Non-Exertional Heat Stroke15:40 ED Evaluation21:54 ED Treatment27:15 Managing Complications29:33 Special Populations30:58 Disposition & J-ERATO Score33:12 Risk Management Pearls36:56 Wrap-Up & PromoSubscribers, take the CME test here.
Emergency Medicine Residents, get your free subscription by writing [email protected]
-
In this episode, Sam Ashoo, MD and Dr. T.R. Eckler, MD discuss the May 2026 Emergency Medicine Practice article, Emergency Department Evaluation and Management of Serious and High-Risk Infections in the Febrile Returning Traveler.
0:16 — Podcast Introduction1:08 — Episode Introduction7:30 — Malaria13:55 — Dengue17:33 — Enteric Fever (Typhoid/Paratyphoid)20:53 — Leptospirosis22:43 — Clinical Presentations26:33 — Diagnostic Testing33:17 — Treatment38:59 — Special Populations & Risk Pitfalls43:05 — Closing Pearls & OutroSubscribers, take the CME test here.
Emergency Medicine Residents, get your free subscription by writing [email protected]
-
Missing episodes?
-
In this episode, Sam Ashoo, MD and Dr. T.R. Eckler, MD discuss the April 2026 Emergency Medicine Practice article, Wide Complex Tachycardia in the Emergency Department: An Updated Approach to Diagnosis and Management.
Introduction – 0:11Article Overview – 2:02Top 5 Bedside Steps – 7:54Sodium Channel Blockade – 9:26Hyperkalemia – 11:53SVT with Aberrancy – 12:47WPW & Accessory Pathway – 13:34AFib with Accessory Pathway – 14:09Monomorphic VT – 19:01Polymorphic VT / Torsades – 20:08Bidirectional VT – 21:29Pacemaker-Mediated Tachycardia – 22:30Pre-Hospital Considerations – 24:52Stable vs. Unstable Assessment – 27:58Diagnostic Studies – 29:42Treatment – 38:00Risk Management Pitfalls – 44:49Wrap-Up – 49:44Subscribers, take the CME test here.
Emergency Medicine Residents, get your free subscription by writing [email protected]
-
In this episode, Sam Ashoo, MD interviews Jack Teitel on the topic of AI in medicine. Introduction & Welcome — 0:17Jack's Background in Healthcare AI — 0:58Brief History of AI — 3:57The "Perfect Storm" That Created Modern AI — 5:48From General to Specialized: Fine-Tuning AI for Medicine — 7:04LLM Confidence & the Sycophancy Problem — 13:01The Benchmark Problem — 14:25Building Your Own Personal AI Benchmark — 17:44Can You "Turn Off" AI Sycophancy? — 20:00RAG Systems & How Specialty AI Tools Work — 22:09Choosing the Right AI Tool for Clinical Use — 26:18Why 95% of AI Pilots Fail in Deployment— 28:10How to Ask AI Questions Well (Prompt Quality) — 31:25Knowledge Base Currency & Sam's Drug Withdrawal Test — 35:06Closing & Contact Info — 37:12For more about Jack Teitel - Title-AI.com Emergency Medicine Residents, get your free subscription by writing [email protected]
-
In this episode, Sam Ashoo, MD and Dr. Dana Klavansky, MD discuss the March 2026 Emergency Medicine Practice article, Emergency Department Evaluation and Management of Severe Traumatic Brain Injury
Introduction & Welcome (0:15)Guest Introduction (0:55)Epidemiology of Severe TBI (2:37)Pathophysiology: Primary vs. Secondary TBI (4:24)Types of Hemorrhage and Hematomas (5:25)Classification (7:31)Mild vs. Moderate vs. Severe TBIImpact Loading vs. Inertial LoadingDifferential Diagnosis (9:22)Prehospital Care (9:42)Emergency Department History (13:33)Diagnostics (15:13)CT Scan and the A-B-B-B-C ApproachRepeat CT TimingBedside Ultrasound for Optic Nerve Sheath DiameterPupillometryBiomarkersTreatment (24:52)Airway ManagementVentilation and CO2 TargetsHyperosmolar Therapy: Hypertonic Saline and MannitolCerebral Perfusion PressureBlood Pressure GoalsTemperature ManagementCoagulopathy ManagementSeizure Prophylaxis and EEG MonitoringTiered ICP Management (35:29)Surgical Indications (38:40)Prognosis (40:33)Special Topics (41:30)Sports Injuries and CTETranexamic Acid (CRASH-3 Trial)Wrap-Up (43:46)Subscribers, take the CME test here.
Emergency Medicine Residents, get your free subscription by writing [email protected]
-
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the February 2026 Emergency Medicine Practice article, Emergency Department Diagnosis and Management of Acute Coronary Occlusion
00:00 - Introduction & Welcome
01:21 - Episode Overview: Acute Coronary Occlusion
02:06 - Why This Topic Matters: Statistics & New Guidelines
03:35 - Nomenclature: ACO vs STEMI/NSTEMI
06:15 - Differential Diagnosis for STEMI
07:41 - Pre-Hospital Care & EMS Role
11:37 - Patient History & Presenting Symptoms
12:28 - Physical Examination Findings
14:54 - EKG: The Most Important Test
17:00 - STEMI Definition & Criteria
20:32 - STEMI Equivalents: Scarbosa Criteria
22:40 - Smith Modified Scarbosa Criteria
24:10 - Hyperacute T Waves
25:30 - Posterior STEMI
28:40 - De Winter Sign
29:38 - Non-STEMI EKG Findings
31:30 - AVR ST Elevation
32:47 - Wellens Syndrome
33:54 - Reciprocal ST Segment Changes
36:15 - Inferior MI Patterns
37:54 - Laboratory Testing
39:51 - Imaging: Chest X-Ray & Echocardiography
42:25 - Supplemental Oxygen: What the Evidence Shows
44:50 - Analgesia & Pain Management
46:35 - Pharmacotherapy: Aspirin & Antiplatelet Agents
49:18 - Reperfusion Therapies & Thrombolytics
53:05 - Cardiac Arrest in STEMI Patients
53:55 - Closing Remarks & CME Information
Subscribers, take the CME test here.Emergency Medicine Residents, get your free subscription by writing [email protected] -
In this episode, Sam Ashoo, MD interviews Jeff Willis, MD on the topic of pre-litigation review, being a medical expert, and common pitfalls leading to medical malpractice cases. 0:15 Introduction0:51 Guest Introduction1:20 Jeff's Background2:00 Current Work3:37 How He Got Started6:57 Pre-Litigation vs. Expert Witness8:01 Four Components of Malpractice Cases13:55 Case Review Statistics17:11 When Cases Get Filed18:58 Common Patterns in Cases19:55 Documentation Best Practices22:06 Shift Handoff Problems25:56 Bounce Backs27:25 Medical Record Volume30:00 Audit Trails32:53 Communication with Consultants41:35 Conflicting Documentation43:46 Getting Started in This Work47:37 ClosingEmergency Medicine Residents, get your free subscription by writing [email protected]
-
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the Januray 2026 Emergency Medicine Practice article, Emergency Department Diagnosis and Management of Patients With Syphilis
Syphilis cases have surged 42% in the US, making it critical for emergency physicians to recognize and treat this "great masquerader." In this episode, hosts Sam Ashoo and Dr. T.R. Eckler break down the January 2026 Emergency Medicine Practice article on syphilis diagnosis and management. They cover the rising prevalence in high-risk populations, the four clinical stages (primary, secondary, latent, and tertiary), special presentations like neurosyphilis and congenital syphilis, and practical diagnostic approaches. With a national penicillin shortage, they discuss alternative treatment options including doxycycline and post-exposure prophylaxis. The conversation also addresses the dark history of the Tuskegee Study and its lasting impact on medical ethics. Whether you're seeing more cases in your ED or want to sharpen your diagnostic skills, this episode provides actionable insights for frontline providers.
Timestamps[0:00] Opening/Introduction
[0:11] Host Welcome & Resources
[0:50] Episode Introduction
[1:30] Epidemiology & Rising Cases
[4:30] Risk Factors & Screening
[6:30] Pathophysiology & Transmission
[9:30] Primary Syphilis
[12:30] Secondary Syphilis
[15:30] Tertiary & Latent Syphilis
[18:30] Neurosyphilis
[22:30] Congenital Syphilis
[25:30] Ocular & Otic Syphilis
[28:30] Differential Diagnosis & Pre-hospital Care
[31:30] History & Physical Examination
[34:30] Diagnostic Testing Overview
[38:30] Testing Details & Titers
[41:30] Treatment: Penicillin & Alternatives
[43:30] Closing
Subscribers, take the CME test here.Emergency Medicine Residents, get your free subscription by writing [email protected] -
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the December 2025 Emergency Medicine Practice article, Diagnosis and Management of Cannabis-Related Emergencies
Episode Outline:
[0:00] IntroductionWelcome and show overview by Sam AshooMention of resources at ebmedicine.net[0:46] Episode StartHosts introduce themselves: Sam Ashoo and Dr. T.R. EcklerDr. Eckler’s background and experience with cannabis cases in Colorado[1:16] Topic IntroductionFocus on diagnosis and management of cannabis-related emergenciesPrevalence and importance in emergency medicine[1:34] Legal LandscapeOverview of cannabis legality across statesMedicinal vs. non-medicinal use[3:03] Increase in ED VisitsStatistics: ~1 million cannabis-related ED visits annuallyDemographics: younger population most affected[3:52] Synthetics and ChallengesDiscussion of synthetic cannabinoids and their risksIssues with detection and legality[4:50] Clinical SpectrumRange of presentations: from nausea/vomiting to psychosis and seizuresImpact on different age groups[6:34] FDA-Approved UsesCannabis-derived products approved for specific medical conditions[7:20] Physiology and PathophysiologyCannabinoid receptors (CB1 and CB2) and their effectsDifferences between plant-derived and synthetic cannabinoids[9:10] Chronic Use and WithdrawalDownregulation of receptors, withdrawal symptoms, and persistent nausea[10:20] Product Forms and Delivery MethodsSmoking, edibles, oils, tinctures, suppositories, topicals, etc.Risks associated with concentrated forms (e.g., wax, oils)[12:00] Clinical Effects by SystemPsychiatric: anxiety, psychosis, paranoiaCardiovascular: tachycardia, MI risk, QT prolongationPulmonary, renal, metabolic, dental, and ocular effects[13:50] Cannabinoid Hyperemesis Syndrome (CHS)Phases: prodrome, hyperemesis, recoveryHot showers as a diagnostic clue[16:00] Withdrawal SyndromeSymptoms and timelineExacerbation with synthetic cannabinoids[18:15] Counseling and ManagementImportance of cessation and patient educationTimeline for symptom improvement[18:42] Differential DiagnosisBroad differential for persistent nausea/vomiting and abdominal painImportance of considering other causes[20:55] Diagnostics and TestingLimitations of drug screens (false positives/negatives)Importance of EKG, labs, and imaging as indicated[23:10] Treatment ApproachesFirst-line: benzodiazepines, antiemetics (ondansetron, metoclopramide)Second-line: butyrophenones (haloperidol, droperidol), olanzapineCapsaicin as adjunct therapy[29:50] Complications and Special ConsiderationsRisks of undertreatment (e.g., Boerhaave syndrome, aspiration)Pediatric and pregnant populations: unique risks and reporting requirements[36:00] Five Practice-Changing TakeawaysElicit cannabis use historyKnow testing limitationsConsider ECG and appropriate labsUse butyrophenones when indicatedAdmit if symptoms are refractory[39:00] ConclusionEmergency Medicine Residents, get your free subscription by writing [email protected]
-
In this episode, Sam Ashoo, MD and Tim Horeczko, MD discuss the November 2025 Pediatric Emergency Medicine Practice article, Emergency Department Management of Measles, Mumps, Rubella, and Varicella in Pediatric Patients
00:00 Introduction to Emergency Medicine
00:21 Welcome and Holiday Greetings
01:16 Special Guest Introduction
01:41 Discussion on Pediatric Emergency Medicine
04:55 Epidemiology of Measles
08:16 Challenges in Diagnosing Measles
14:27 Mumps: Symptoms and Complications
27:36 Rubella: Risks and Symptoms
29:28 Varicella: Symptoms and Precautions
33:12 Differential Diagnosis and Conclusion
35:14 Using Inductive Reasoning in Medical Diagnosis
35:40 Recognizing Purpuric Rash and Its Implications
36:22 Guidance for EMS Colleagues on Handling Fever and Rash
37:14 Importance of Communication and Relationships with EMS
39:12 Decontamination and PPE Protocols for EMS
42:34 Detailed Patient Assessment in the ED
46:06 Diagnostic Testing and Clinical Diagnosis
49:20 Reporting Responsibilities and Treatment Protocols
01:01:19 Addressing Vaccine Controversies and Public Trust
01:06:25 Conclusion and Additional Resources
Check out Dr Horeczko's podcast - Pediatric Emergency Playbook
Emergency Medicine Residents, get your free subscription by writing [email protected]
-
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the November 2025 Emergency Medicine Practice article, Diagnosis and Management of Emergency Department Patients With Alcohol Withdrawal Syndrome
Epidemiology & Background Rising ED visits related to alcohol use. Mortality rates and spectrum of patient presentations. Importance of high suspicion and complexity of cases.Pathophysiology & Mechanisms Alcohol metabolism and neurochemical changes. Differential diagnosis: Conditions that mimic alcohol withdrawal.Prehospital & EMS Considerations Role of EMS in triage and initial management. Use of sobering centers vs. ED transport. Prehospital administration of benzodiazepines (IM midazolam).History & Risk Assessment Key questions to assess risk for alcohol withdrawal syndrome. Importance of patient history, medication use, and comorbidities. Discussion on patient honesty and rapport.Physical Exam & Scoring Systems DSM-5 criteria for alcohol withdrawal. Use of CIWA-AR, BAWS, and PAWSS scoring systems. Importance of objective measurement for monitoring and disposition.Complications & Special PresentationsComplicated alcohol withdrawal: Hallucinosis, seizures, delirium tremens. Diagnostic workup: Labs, imaging, and co-ingestions. Special populations: End-stage liver disease, pregnancy, intubated patients.Treatment Strategies Mainstay: Benzodiazepines (types, dosing, and protocols). Phenobarbital: Indications, dosing, and evidence. Adjunctive therapies: Thiamine, glucose, magnesium. Alternative/adjunct medications: Gabapentin, ketamine, dexmedetomidine, baclofen.Clinical Pearls & Practice Changes Early, aggressive therapy to prevent complications. Symptom-based vs. fixed-schedule treatment. Gabapentin as an alternative or adjunct. Anti-craving medications for relapse prevention.Disposition & Protocols Use of scoring systems for safe discharge, observation, or admission. Importance of protocolized approaches and community resources.Summary & Take-Home Points Five key practice-changing points. Clinical pathway.Emergency Medicine Residents, get your free subscription by writing [email protected]
-
In this episode, Sam Ashoo, MD and Lara Zibners, MD discuss the August 2025 Pediatric Emergency Medicine Practice article, Diphtheria, Pertussis, and Tetanus: An Update of Evidence-Based Management of Pediatric Patients in the Emergency Department
Introduction and guest backgroundHost welcome, show contextDr. Lara Zibners’ credentialsEB Medicine involvementPersonal stories and clinical experienceMemorable tetanus and pertussis casesVaccine advocacyRare disease encountersDiphtheria: overview, presentation, treatmentToxigenic vs. non-toxigenic, “bull neck”Cardiac, neurologic complicationsAntitoxin, antibiotics, public healthPertussis: symptoms, vaccine, treatment“100-day cough,” apnea in infantsWaning immunity, boostersAzithromycin, treat contactsTetanus: risk, presentation, managementClostridium ubiquity, no outbreaksMuscle spasms, autonomic instabilityAirway, sedation, antibioticsKey ED takeaways and pearlsEarly suspicion, isolationICU admission for severe casesVaccination, reportingResources and article summaryAppendix, clinical pathwayebmedicine.net referenceCME, further readingGuest’s podcast plug and closing remarks“Unstable Vitals” podcastWhere to listenThank you, sign-offCheck out Dr Zibner's podcast Unstable Vitals
Emergency Medicine Residents, get your free subscription by writing [email protected]
-
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the October 2025 Emergency Medicine Practice article, Emergency Department Evaluation and Management of Patients With Adrenal Insufficiency
Introduction
Welcome and host introductionsBrief overview of the episode’s topicResources and CME reminderArticle Overview
Source: Emergency Medicine Practice, October 2025Authors: The SimcoesImportance of evidence-based reviewClinical Context & Epidemiology
Frequency and rarity of adrenal insufficiencyDiagnostic challenges and statisticsImportance of recognizing adrenal crisisPathophysiology
Primary, secondary, and tertiary adrenal insufficiencyCauses and mechanismsKey anatomical and physiological conceptsDifferential Diagnosis
Overlap with other diseases (infections, autoimmune, endocrine, psychiatric, cardiac, GI, etc.)Importance of considering adrenal crisis in complex casesPrehospital Care
EMS recognition and limitationsImportance of medication history and emergency kitsLegal and logistical barriers to prehospital hydrocortisoneEmergency Department Evaluation
Recognizing symptoms and prioritizing careRole of EMR and clinical decision supportKey history and risk factors (medications, steroid use, opioid use, comorbidities)Physical Examination
Specific and nonspecific findingsCushingoid features vs. primary adrenal insufficiency signsDiagnostic Workup
Laboratory studies (cortisol, ACTH, renin, aldosterone, TSH, etc.)Imaging considerationsGold standard tests and their limitations in the EDTreatment
Immediate administration of hydrocortisoneDosing for adults and pediatricsSupportive care (fluids, glucose, treating underlying cause)Sick day dosing and home managementSpecial Populations
Pregnancy considerationsSeptic shock and adrenal crisisCommon Pitfalls & Takeaways
Delaying steroids for labs/diagnosisImportance of high suspicion and early treatmentKey trivia and learning pointsClosingSummary and final thoughts
Reminders for further reading and CMEFarewell and next episode teaserEmergency Medicine Residents, get your free subscription by writing [email protected]
-
In this episode, Sam Ashoo, MD interviews Evan Dvorin, MD about the dangers of short term steroid use.
Background & Regional Differences
Dr. Dvorin’s clinical journey from New England to New Orleans. Noticing increased use of corticosteroids for common conditions in the Southeast. Discussion of how steroid prescribing practices vary by region and setting.Inappropriate Steroid Use
Common conditions where steroids are often inappropriately prescribed (sinus infections, bronchitis, sciatica, rashes, plantar fasciitis, etc.). Trends showing increased steroid prescribing over time. Similar patterns observed in emergency, urgent care, and primary care settings.Risks and Side Effects of Short-Term Steroid Use
Short-term steroids can cause significant side effects: infection, sepsis, bone fractures, thromboembolism, psychiatric effects, hyperglycemia. Dose-response relationship: higher doses and repeated use increase risks. Some side effects (e.g., bone loss) may persist beyond two months.Patient Communication & Shared Decision-Making
Importance of discussing risks with patients, tailored to individual risk factors (e.g., diabetes, psychiatric history, age). Strategies for educating patients and managing expectations. The role of patient education videos and resources.Impact of Provider Education & Quality Metrics
Ochsner Health’s initiatives to reduce inappropriate steroid use. Use of CME, quality dashboards, and feedback to clinicians. Evidence that education and reporting can reduce unnecessary prescriptions.Special Populations & Scenarios
Considerations for pediatric patients and repeated dosing. Challenges when specialists recommend steroids for certain conditions (e.g., sciatica, neurosurgery cases). The need for evidence-based practice and inter-provider communication.Medical-Legal Considerations
Lawsuits related to steroid side effects (e.g., fat atrophy, infection). Importance of documentation and informed consent.Alternatives & Symptom Management
Focusing on treating the patient’s most bothersome symptoms. Non-steroid options and the value of patient education about illness duration and expectations.Resources
Mention of Dr. Dvorin’s educational video on corticosteroid side effects (available on YouTube). Reminder of EB Medicine’s journals and resources for further learning.Conclusion
Key takeaway: “Do no harm” and practice evidence-based medicine. Encouragement for clinicians to review their prescribing habits and educate patients.Ochsner "Side effects from corticosteroids" Video: https://www.youtube.com/watch?v=PdMJ9HYxkck
-
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the September 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Status Epilepticus
Topic Introduction
Focus: Status Epilepticus in AdultsReference to recent pediatric episodeArticle authors: Dr. Marquez, Dr. Kaur, Dr. LayWhy Status Epilepticus Matters
Teaching value and clinical challengeTeam-based care and multidisciplinary involvementGuidelines and Evidence
Review of major guidelines (International League Against Epilepsy, Neurocritical Care Society, American Epilepsy Society)Key trials: EcLiPSE, ConSEPT, ESETTUpdated definition of status epilepticusClassification and Diagnosis
Convulsive vs. non-convulsive statusImportance of repeated neurologic examsDiagnostic challenges and mimics (e.g., syncope, psychogenic seizures)Etiology and Workup
Acute vs. non-acute causesCommon triggers: medication noncompliance, metabolic issues, infections, traumaImportance of sleep patterns and ammonia levelsThe NORSE acronym (new onset refractory status epilepticus)Prehospital and ED Management
Airway, breathing, circulation prioritiesEarly pharmacologic intervention (IM midazolam preferred in prehospital)Gathering history and medication informationPositioning and airway protectionDiagnostics
Laboratory workup: glucose, CBC, metabolic panel, drug levels, pregnancy testImaging: non-contrast CT, MRI, ultrasound, lumbar punctureEEG: spot vs. continuous monitoringTreatment Approach
First-line: Benzodiazepines (lorazepam, midazolam)Second-line: Levetiracetam, valproate, fosphenytoin, phenobarbital, lacosamideThird-line: Continuous infusions (midazolam, propofol, pentobarbital, thiopental, ketamine)Dosing pearls and importance of rapid escalationSpecial Populations
Pregnancy (eclampsia: magnesium as first-line)Substance-induced status epilepticus (e.g., isoniazid toxicity and pyridoxine)Brief mention of pediatric management and the PD stat appRisk Management Pitfalls
Non-convulsive status is common and easily missedImportance of weight-based dosingNeed for formal EEG in ambiguous casesDon’t assume non-adherence is the only cause in known epilepticsAlways consider higher level of care for status patientsClinical Pathway
Stepwise approach to medication and escalationEmphasis on having a pathway/checklist for these high-stress casesConclusion
Recap of key pointsThanks to authors and listenersReminder to visit ebmedicine.net for CME and resourcesEmergency Medicine Residents, get your free subscription by writing [email protected]
-
In this episode, Sam Ashoo, MD interviews Ali Chaudhary, MD about the benefits of working Locum Tenens in Emergency Medicine.
00:00 Introduction and Welcome 00:54 Meet Dr. Ali Chaudhary 01:41 The State of Emergency Medicine 03:29 Understanding Locum Tenens 05:45 Financial Benefits of Locum Work 08:40 Balancing Family Life with Locum Work 12:54 Locum Work Logistics and Misconceptions 17:34 Maximizing Travel Perks as a Contractor 18:07 Adjusting to New Hospitals and EMRs 19:32 The Hassles of Credentialing 20:48 Navigating Locum Staffing Companies 22:27 Understanding Your Worth and Negotiation 25:14 The Importance of Organization 27:41 About Our Locum Staffing Company 29:59 Practical Tips for Malpractice Insurance 31:09 Final Thoughts and Contact InformationFor more about Dr. Ali Chaudhary: https://thelocums.com/
-
In this episode, Sam Ashoo, MD interviews Lauren Black, MD about the August 2025 Emergency Medicine Practice article, Updates and Controversies in the Early Management of Sepsis and Septic Shock
00:00 Introduction and Welcome
01:09 Meet Dr. Lauren Page Black: Sepsis Expert
01:56 Sepsis Statistics and Impact
04:16 Understanding Sepsis Definitions
09:56 Screening Tools for Sepsis
13:57 Pre-Hospital Sepsis Recognition
19:33 Clinical Examination and Diagnostics
24:03 The Role of Lactate and Procalcitonin
27:40 Clinical Gestalt and Imaging in Diagnosis
29:21 CMS Bundle Requirements and Updates
34:02 Fluid Type Preferences in Sepsis
36:49 Antibiotic Timing and Selection
43:43 Vasopressors and Steroids in Sepsis Management
50:18 Special Populations and Future Directions
53:44 Conclusion and Resources
Emergency Medicine Residents, get your free subscription by writing [email protected]
-
In this episode, Sam Ashoo, MD interviews Christina Shenvi, MD, PhD, MBA about ways to manage your day and keep distraction at bay.
Introduction to Dr. Christina ShenviWhy Focus and Time Management MatterExperiences coaching medical students and professionalsThe importance of managing mind, time, and attentionApplicability to both career and personal lifeFramework for FocusThree-step framework: Prioritize, Strategize, FocusExplanation of prioritizationMapping personal and professional activities to prioritiesDeep Work vs. Shallow WorkDefining deep work and shallow workStrategies for categorizing and scheduling tasksTime-blocking and protecting focus timeOvercoming DistractionThe psychology of distraction and procrastinationThe impact of digital devices and social media on attentionThe variable reward system of social media and its addictive natureStrategies to Improve FocusClearing mental, physical, and digital environmentsThe importance of a distraction-free workspaceSystems for capturing and organizing tasksThe Pomodoro method and using time pressureBuilding a Personal SystemExperimenting with different task management toolsAdapting systems to personal needs and preferencesDaily Practice and Training FocusReviewing and updating task lists dailyChunking email and shallow work to specific timesTraining the brain to focus like a muscleSpecial considerations for people with ADHDResources and ContactDr. Shenvi’s website and online course (timeforyourlife.org)Invitation to connect for coaching or further learningFor more about Christina Shenvi : https://timeforyourlife.org/
-
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the July 2025 Emergency Medicine Practice article, Emergency Department Management of Status Epilepticus in Pediatric Patients
IntroductionWelcome and brief overview of the episodePromotion of EB Medicine’s $1 for 7-day trial offerWhy Pediatric Status Epilepticus MattersSeizures make up ~1% of ED visits and ~3% of EMS callsHigh-risk and high-stakes condition requiring rapid actionStatus epilepticus now defined as ≥5 minutes of seizure activityILAE’s T1 and T2 timelines help define when to treat and when damage beginsCommon CausesTop contributors:Fever/infectionStructural CNS abnormalitiesToxic ingestionsGenetic/metabolic disordersAdditional factors by age:Infants: febrile seizures, chromosomal issues, traumaSchool-age: autoimmune disordersAdolescents: eclampsia, hypertension, functional disordersAlways consider non-accidental traumaPrehospital CareIM midazolam is effective and recommended (RAMPART trial)Other options: intranasal, rectal, or IV benzodiazepinesEarly benzodiazepine administration improves outcomesImportance of airway support, glucose check, and EMS flexibilityParent-administered home meds (e.g. rectal diazepam) can be helpfulED Evaluation and Initial ManagementPrioritize ABCs: Airway, Breathing, Circulation, ConsciousnessUse end-tidal CO₂ to monitor ventilation if availablePoint-of-care glucose is essentialLabs: CMP, Mg, Phos, lactate, drug levels, pregnancy test (when indicated)Imaging: Head CT if concern for trauma, shunt malfunction, or focal signsCase examples highlight pitfalls and diagnostic delaysFirst-Line TreatmentBenzodiazepines remain the cornerstoneLorazepam preferred IV agent (0.1 mg/kg)Midazolam preferred if no IV access (IN, IM, or IO)Diazepam is also effective, especially rectallyBe mindful of respiratory depression and the need for airway controlSecond- and Third-Line TherapiesBased on ESETT trial:Levetiracetam, fosphenytoin, and valproate have similar efficacyLevetiracetam favored for safety and ease of useFosphenytoin may be avoided in trauma or toxicityValproate not recommended in mitochondrial diseasePhenobarbital reserved for refractory cases onlyRefractory Status EpilepticusDefinition: persistent seizures despite first- and second-line agentsRequires sedation and likely intubationInfusion options:Midazolam (preferred for flexibility)Propofol (short-term use only due to risk of infusion syndrome)Pentobarbital (rare, ICU-level care)Need for continuous EEG to assess seizure activitySpecial ScenariosNeonates:Watch for subtle signs (lip smacking, bicycling, tongue thrusting)Broad differential includes asphyxia, infection, metabolic errorsFebrile Status Epilepticus:Higher risk of CNS infections, especially if unvaccinatedConsider lumbar puncture if indicatedElectrolyte/Metabolic Triggers:Treat hypoglycemia, hyponatremia, and hypocalcemia directlyUse 3% saline or dextrose as appropriateDisposition and Discharge ConsiderationsMany children will require ICU-level careSome known epilepsy patients may go home if back to baselineEnsure rescue medications are up to date (rectal/intranasal benzos)Consider “clonazepam bridge” for short-term seizure preventionCollaborate with neurology for medication adjustment and follow-upFinal ThoughtsKeep treatment tables and dosing references accessibleEarly, aggressive treatment can prevent long-term harmEpisode closes with gratitude to article authors and a reminder to visit EBMedicine.netEmergency Medicine Residents, get your free subscription by writing [email protected]
-
Special Offer - EB Medicine is 26 years old! Get 26% off all purchases at ebmedicine.net!
In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the June 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Thyroid Emergencies
Introduction to Thyroid EmergenciesUnderstanding Decompensated HypothyroidismThyroid Storm: The Other ExtremeDifferential Diagnosis and ComplicationsMedication Triggers and Patient HistoryPhysical Examination FindingsLaboratory Analysis Scoring Systems and Risk AssessmentIntroduction to Treatment ApproachesManaging Decompensated HypothyroidismTreating Thyroid StormSpecial Considerations and PopulationsRisk Management PitfallsEmergency Medicine Residents, get your free subscription by writing [email protected]
- Show more
