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 involvement* Personal stories and clinical experienceMemorable tetanus and pertussis casesVaccine advocacyRare disease encounters* Diphtheria: overview, presentation, treatmentToxigenic vs. non-toxigenic, “bull neck”Cardiac, neurologic complicationsAntitoxin, antibiotics, public health* Pertussis: symptoms, vaccine, treatment“100-day cough,” apnea in infantsWaning immunity, boostersAzithromycin, treat contacts* Tetanus: risk, presentation, managementClostridium ubiquity, no outbreaksMuscle spasms, autonomic instabilityAirway, sedation, antibiotics* Key ED takeaways and pearlsEarly suspicion, isolationICU admission for severe casesVaccination, reporting* Resources and article summaryAppendix, clinical pathwayebmedicine.net referenceCME, further reading* Guest’s podcast plug and closing remarks“Unstable Vitals” podcastWhere to listenThank you, sign-offCheck out Dr Zibner's podcast Unstable VitalsEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

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 InsufficiencyIntroduction* Welcome and host introductions* Brief overview of the episode’s topic* Resources and CME reminderArticle Overview* Source: Emergency Medicine Practice, October 2025* Authors: The Simcoes* Importance of evidence-based reviewClinical Context & Epidemiology* Frequency and rarity of adrenal insufficiency* Diagnostic challenges and statistics* Importance of recognizing adrenal crisisPathophysiology* Primary, secondary, and tertiary adrenal insufficiency* Causes and mechanisms* Key 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 limitations* Importance of medication history and emergency kits* Legal and logistical barriers to prehospital hydrocortisoneEmergency Department Evaluation* Recognizing symptoms and prioritizing care* Role of EMR and clinical decision support* Key history and risk factors (medications, steroid use, opioid use, comorbidities)Physical Examination* Specific and nonspecific findings* Cushingoid features vs. primary adrenal insufficiency signsDiagnostic Workup* Laboratory studies (cortisol, ACTH, renin, aldosterone, TSH, etc.)* Imaging considerations* Gold standard tests and their limitations in the EDTreatment* Immediate administration of hydrocortisone* Dosing for adults and pediatrics* Supportive care (fluids, glucose, treating underlying cause)* Sick day dosing and home managementSpecial Populations* Pregnancy considerations* Septic shock and adrenal crisisCommon Pitfalls & Takeaways* Delaying steroids for labs/diagnosis* Importance of high suspicion and early treatment* Key trivia and learning pointsClosingSummary and final thoughts* Reminders for further reading and CME* Farewell and next episode teaserEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

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 (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 Adults* Reference to recent pediatric episode* Article authors: Dr. Marquez, Dr. Kaur, Dr. LayWhy Status Epilepticus Matters* Teaching value and clinical challenge* Team-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, ESETT* Updated definition of status epilepticusClassification and Diagnosis* Convulsive vs. non-convulsive status* Importance of repeated neurologic exams* Diagnostic challenges and mimics (e.g., syncope, psychogenic seizures)Etiology and Workup* Acute vs. non-acute causes* Common triggers: medication noncompliance, metabolic issues, infections, trauma* Importance of sleep patterns and ammonia levels* The NORSE acronym (new onset refractory status epilepticus)Prehospital and ED Management* Airway, breathing, circulation priorities* Early pharmacologic intervention (IM midazolam preferred in prehospital)* Gathering history and medication information* Positioning and airway protectionDiagnostics* Laboratory workup: glucose, CBC, metabolic panel, drug levels, pregnancy test* Imaging: non-contrast CT, MRI, ultrasound, lumbar puncture* EEG: spot vs. continuous monitoringTreatment Approach* First-line: Benzodiazepines (lorazepam, midazolam)* Second-line: Levetiracetam, valproate, fosphenytoin, phenobarbital, lacosamide* Third-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 missed* Importance of weight-based dosing* Need for formal EEG in ambiguous cases* Don’t assume non-adherence is the only cause in known epileptics* Always consider higher level of care for status patientsClinical Pathway* Stepwise approach to medication and escalation* Emphasis on having a pathway/checklist for these high-stress casesConclusion* Recap of key points* Thanks to authors and listeners* Reminder to visit ebmedicine.net for CME and resourcesEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

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/ (https://thelocumos.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 Shock00:00 Introduction and Welcome01:09 Meet Dr. Lauren Page Black: Sepsis Expert01:56 Sepsis Statistics and Impact04:16 Understanding Sepsis Definitions09:56 Screening Tools for Sepsis13:57 Pre-Hospital Sepsis Recognition19:33 Clinical Examination and Diagnostics24:03 The Role of Lactate and Procalcitonin27:40 Clinical Gestalt and Imaging in Diagnosis29:21 CMS Bundle Requirements and Updates34:02 Fluid Type Preferences in Sepsis36:49 Antibiotic Timing and Selection43:43 Vasopressors and Steroids in Sepsis Management50:18 Special Populations and Future Directions53:44 Conclusion and ResourcesEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net 

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 Shenvi* Why Focus and Time Management MatterExperiences coaching medical students and professionalsThe importance of managing mind, time, and attentionApplicability to both career and personal life* Framework for FocusThree-step framework: Prioritize, Strategize, FocusExplanation of prioritizationMapping personal and professional activities to priorities* Deep Work vs. Shallow WorkDefining deep work and shallow workStrategies for categorizing and scheduling tasksTime-blocking and protecting focus time* Overcoming DistractionThe psychology of distraction and procrastinationThe impact of digital devices and social media on attentionThe variable reward system of social media and its addictive nature* Strategies to Improve FocusClearing mental, physical, and digital environmentsThe importance of a distraction-free workspaceSystems for capturing and organizing tasksThe Pomodoro method and using time pressure* Building a Personal SystemExperimenting with different task management toolsAdapting systems to personal needs and preferences* Daily 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 ADHD* Resources 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/ (https://timeforyourlife.org/)

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the July 2025 Emergency Medicine Practice article, 

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 Emergencies* Understanding Decompensated Hypothyroidism* Thyroid Storm: The Other Extreme* Differential Diagnosis and Complications* Medication Triggers and Patient History* Physical Examination Findings* Laboratory Analysis * Scoring Systems and Risk Assessment* Introduction to Treatment Approaches* Managing Decompensated Hypothyroidism* Treating Thyroid Storm* Special Considerations and Populations* Risk Management PitfallsEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the May 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Complications of Chronic Neurologic Disease: Parkinson Disease, Myasthenia Gravis, and Multiple Sclerosis Parkinson's Disease* Importance of maintaining medication schedule for Parkinson's patients* Strategies for ensuring patients receive their medications promptly* Overview of Carbidopa Levodopa's mechanism of actionMyasthenia Gravis* Description of the disease mechanism* Importance of assessing respiratory function* Diagnostic alternatives like the negative inspiratory force test and counting test* Discussion on appropriate emergency department actions and treatments including steroids, plasmapheresis, and IVIGMultiple Sclerosis* Description of the disease mechanism* Description of the typical patient demographic* Discussion on the varied presentation of MS* Treatment strategies including high-dose steroids and BaclofenEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net 

In this episode, Sam Ashoo, MD interviews Rob Orman, MD about ways to manage the trauma inflicted by the ER.* Discussing Trauma in Emergency MedicinePersonal Experiences with Trauma* The Impact of Suppression* Defining Trauma and Its Effects* Integration vs. Disintegration* Debriefing and Coping MechanismsThe Driveway DebriefNurse and Physician DynamicsReflective Solitude vs. IsolationCreating Narratives During TraumaDropping Anchor TechniqueBody-Oriented ResetsPost-Incident Rituals* Addressing Lowercase t Traumas* Therapy and Trauma PathwaysFor more about Rob Orman and physician coaching: https://roborman.com/ (https://roborman.com/)

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the April 2025 Emergency Medicine Practice article, Sodium Disorders in the Emergency Department: A Review of Hypernatremia and HyponatremiaHypernatremia (High Sodium Levels)* Definition: Sodium level greater than 145 mEq/L* Breakdown into three categories based on total body water statusHypovolemic HypernatremiaEuvolemic HypernatremiaHypervolemic Hypernatremia* Common causes and conditions associatedHyponatremia (Low Sodium Levels)* Definitions: Mild (130-135 mEq/L), Moderate (125-129 mEq/L), Profound (< 125 mEq/L)* Breakdown into three categoriesPseudo HyponatremiaHypovolemic HyponatremiaEuvolemic HyponatremiaHypervolemic Hyponatremia* Common causes and conditions associatedTreatment Guidelines and Strategies* Emphasizing slow correction to avoid complications like cerebral edema and osmotic demyelination syndrome* Suggested treatment rates for acute and chronic conditionsSpecial Considerations* Addressing severe cases and the importance of proper diagnostics* Pre-hospital care considerations and scenarios* Pediatrics and consideration of child abuse in sodium disordersFive Things That Will Change Your Practice* Central lab sodium values over point-of-care for accuracy* Rectal temperature checks in endurance athletes* Loop diuretics for hypervolemic hyponatremia (e.g., CHF patients)* Enteral treatment for hypernatremia, if possible* Considering COVID-19 as a possible cause for new onset SIADH 

In this episode, Sam Ashoo, MD interviews Patrick O'Malley MD about his career in emergency medicine, The Laceration Course, and the power of connection with our patients.* Dr. Patrick O'Malley's Journey in Emergency Medicine* The Laceration Course: Origins and Evolution* The EM Docs Side Hustle Facebook Group* The Patient That Changed My LifeFor More Information:* The Laceration Course, The Abscess Course, and more... (https://www.ebmedicine.net/store/Courses-and-LLSAs)* EM Docs Side Hustle Facebook Group (https://www.facebook.com/share/g/1ATYdpbXJL/)* Patrick O'Malley, MD: LinkedIn (https://www.linkedin.com/in/drpatrickomalley/)

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the March 2025 Emergency Medicine Practice article, Emergency Department Management of Knee Pain* Common Etiologies of Knee Pain* Risk Factors and Statistics* Infectious Causes of Knee Pain* Pre-Hospital Care and EMS* History and Physical Exam* Imaging Guidelines* Ottawa Knee Rule and X-Ray Necessity* Imaging Modalities for Knee Effusion* Ultrasound for Tendon Injury and Arthrocentesis* CT and MRI in Knee Injury Diagnosis* Lab Tests for Septic Knee Diagnosis* Treatment Options for Knee Conditions* Knee Immobilizers: When and How to Use Them* Steroid Injections in the Emergency Department* Managing Traumatic Knee InjuriesEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

In this episode, Sam Ashoo, MD interviews Ashley Weisman, MD about her career in rural emergency medicine, and the February 2025 Emergency Medicine Practice article, Management of Traumatic Intracranial Hemorrhage in the Emergency Department Interview with Dr. Ashley Wiseman* Introduction of Dr. Wiseman: Emergency physician specializing in rural ER.* Dr. Wiseman’s Background: Overview of her work and responsibilities in rural hospitals and academia.* Experience in Rural Medicine: Contrast with urban and academic practice.Stories of practical challenges and learning experiences in remote areas like Kotzebue, Alaska.Practicing Skills in Rural Medicine* Discussion of skill retention: Importance of continuously applying and practicing critical skills.* Resources and Training: Role of fellowship, networking, and practical experiences for skill enhancement.Advocacy for Rural Emergency Medicine* Work with ACEP: Dr. Wiseman’s efforts in advocating for rural EM at the national level.* Collaboration Between Rural and Academic Centers: Importance of knowledge exchange and mutual support.Focus on Traumatic Intracranial Hemorrhage (ICH)* Introduction to the February Article: Traumatic ICH in rural settings.* Key Points from the Article:Importance of basic neurocritical care practices.Practical adjustments and simplified approaches in care.* Dr. Wiseman’s Contribution: How her experiences shaped the content and practical advice for rural medicine.Conclusion* Upcoming Contributions: Announcing more contributions and resources from Dr. Wiseman.* Access the In Rural Life (IRrL*) content here (https://www.ebmedicine.net/topics/neurologic/emergency-medicine-traumatic-intracranial-hemorrhage#IRrL).* Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.netManaging Traumatic Intracranial Hemorrhage in the Rural Setting: EMP: IRrL* If you practice in a rural environment, you know that managing a patient with traumatic ICH can present challenges with diagnostic and treatment resources, personnel, training, and transport. Dr. Weisman has created resources for emergency clinicians, IRrL* (In Rural Life*) that EB Medicine is proud to share with subscribers.   Resources for emergency clinicians managing patients with traumatic ICH in rural settings include: * Checklist for Managing Traumatic Intracranial Hemorrhage in Rural Life (IRrL): 7 steps to providing neurocritical care in resource-limited settings.* Simulation for Critical Access Neurocritical Care: Saving Brain Hours from Tertiary Care: A customizable simulation designed for you and your team to practice managing patients with brain injury.

In this episode, Sam Ashoo, MD interviews Erin D'Agostino, MD about the February 2025 Emergency Medicine Practice article, Management of Traumatic Intracranial Hemorrhage in the Emergency Department * Pathophysiology* Types of Traumatic Brain Injuries* Pre-Hospital Care* Critical History and Physical Examination* Neurological Assessment and Monitoring* Laboratory and Imaging Studies* Emergency Department Treatment* Surgical Interventions and ConsiderationsPatient DemographicsSummary of major points discussedReminder for continued vigilance and the importance of early consultationEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net 

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the January 2025 Emergency Medicine Practice article, Alkali Exposure: An Evidence-Based Approach to Diagnosis and Treatment* Patient Demographics and Case Scenarios:Types of patients prone to alkali exposureCauses and scenarios leading to alkali exposure (e.g., accidental, intentional, social media challenges) Poison control reports and statistics* Types and Effects of Exposure: Different types of exposure: ingestion, ocular, dermalEffects of ingestion, particularly in children and young adults* Pre-hospital Care and First Response:Importance of decontaminationSafety measures for EMS personnelSteps to take in pre-hospital care* History and Physical Examination: Key points to focus on during history takingImportant signs and symptoms to check* Laboratory and Diagnostic Testing: Overview of useful lab tests and imagingRole of EKG and chest x-rayImportance of early consultation with poison control* Endoscopy and CT Imaging: Use of endoscopy to classify injuries and guide treatment Role of CT imaging Complementary use of endoscopy and CT* Treatment Approaches:Initial resuscitation and airway managementUse of steroids and other medications like antibiotics, H2 antagonists, and topical mitomycin CWhen and how to use NG tubes* Special Populations and Long-term Considerations: Special considerations for childrenRisks associated with laundry detergent podsLong-term complications, including strictures and increased risk of esophageal cancer* Conclusion: Summary of major points discussedReminder for continued vigilance and the importance of early consultationEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

In this episode, Sam Ashoo, MD interviews Nicholas Stark, MD, MBA & Zaid Altawil, MD about the Emergency Medicine Innovation Collaborative1. Discussion on EMIC  - Overview of the collaborative  - Background and formation during the pandemic in late 20212. Growth of EMIC  - Expansion from three members to over 500  - Focus areas: Education, mentorship, opportunity3. Achievements of EMIC  - Examples of innovations and initiatives born from EMIC  - Pitch event at ACEP annual conference and other engagements4. Importance of Physicians in Innovation  - Internal and external factors  - Benefits of physicians leading innovation efforts in healthcare5. Opportunities for Collaboration  - Engaging with healthcare startups and companies  - Expanding collaborations and growing the network6. EMIC Fellowship  - Ideal candidates  - Application process and benefits  - Success stories and projects undertaken7. Long-Term Vision for EMIC  - Goals for future growth and expansion  - Bridging gaps between industry and physicians for better patient care8. Membership Details  - How to join EMIC  - Benefits of membershipFor more about the EM Innovation Collaborative... https://www.eminnovationcollaborative.org/

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the December 2024 Emergency Medicine Practice article, Diagnosis and Management of Acute Mesenteric Ischemia in the Emergency Department* Introduction to Acute Mesenteric Ischemia* Statistics on prevalence and mortality* Pathophysiology and EtiologyMesenteric artery embolismMesenteric artery thrombosisMesenteric venous thrombosisNon-occlusive mesenteric ischemia* Diagnosis* Management and Treatment* Special PopulationsPediatric patientsPregnant patientsElderly patientsEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net 

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the November 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Low Back Pain: A Review of Current Evidence* Prevalence and Importance of Back Pain in the ED* Differential Diagnosis and Serious Pathologies* Patient Expectations and Management Strategies* Missed Serious Pathologies and Their Implications* Conflicting Evidence and Treatment Protocols* Pathologies Causing Low Back Pain* Mechanical and Infectious Causes* Red Flags and Risk Factors* Pre-Hospital Care and EMS Considerations* History and Physical Examination* Laboratory Testing and Inflammatory Markers* Introduction to Imaging in Back Pain* Common Findings in Imaging* Choosing Wisely Campaign and Imaging Guidelines* Patient Expectations and Imaging* CT and MRI: When and Why* Ultrasound in Back Pain Diagnosis* Treatment Options for Back Pain* NSAIDs and Other Pharmacologic Treatments* Non-Pharmacologic Management* Risk Management and PitfallsEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net