EMplify by EB Medicine

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 DiseaseImportance of maintaining medication schedule for Parkinson's patients Strategies for ensuring patients receive their medications promptly Overview of Carbidopa Levodopa's mechanism of actionMyasthenia GravisDescription 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 SclerosisDescription 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 TraumaThe Impact of SuppressionDefining Trauma and Its EffectsIntegration vs. DisintegrationDebriefing and Coping MechanismsThe Driveway DebriefNurse and Physician DynamicsReflective Solitude vs. IsolationCreating Narratives During TraumaDropping Anchor TechniqueBody-Oriented ResetsPost-Incident RitualsAddressing Lowercase t TraumasTherapy and Trauma PathwaysFor more about Rob Orman and physician coaching: 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/LBreakdown into three categories based on total body water statusHypovolemic HypernatremiaEuvolemic HypernatremiaHypervolemic HypernatremiaCommon 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 HyponatremiaCommon causes and conditions associatedTreatment Guidelines and StrategiesEmphasizing slow correction to avoid complications like cerebral edema and osmotic demyelination syndromeSuggested treatment rates for acute and chronic conditionsSpecial ConsiderationsAddressing severe cases and the importance of proper diagnosticsPre-hospital care considerations and scenariosPediatrics and consideration of child abuse in sodium disordersFive Things That Will Change Your PracticeCentral lab sodium values over point-of-care for accuracyRectal temperature checks in endurance athletesLoop diuretics for hypervolemic hyponatremia (e.g., CHF patients)Enteral treatment for hypernatremia, if possibleConsidering 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 MedicineThe Laceration Course: Origins and EvolutionThe EM Docs Side Hustle Facebook GroupThe Patient That Changed My LifeFor More Information:The Laceration Course, The Abscess Course, and more... EM Docs Side Hustle Facebook Group Patrick O'Malley, MD: LinkedIn

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the March 2025 Emergency Medicine Practice article, Emergency Department Management of Knee PainCommon Etiologies of Knee PainRisk Factors and StatisticsInfectious Causes of Knee PainPre-Hospital Care and EMSHistory and Physical ExamImaging GuidelinesOttawa Knee Rule and X-Ray NecessityImaging Modalities for Knee EffusionUltrasound for Tendon Injury and ArthrocentesisCT and MRI in Knee Injury DiagnosisLab Tests for Septic Knee DiagnosisTreatment Options for Knee ConditionsKnee Immobilizers: When and How to Use ThemSteroid Injections in the Emergency DepartmentManaging 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 WisemanIntroduction 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 MedicineDiscussion 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 MedicineWork 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.ConclusionUpcoming Contributions: Announcing more contributions and resources from Dr. Wiseman.Access the In Rural Life (IRrL*) content here.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 PathophysiologyTypes of Traumatic Brain InjuriesPre-Hospital CareCritical History and Physical ExaminationNeurological Assessment and MonitoringLaboratory and Imaging StudiesEmergency Department TreatmentSurgical 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 TreatmentPatient 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 statisticsTypes and Effects of Exposure: Different types of exposure: ingestion, ocular, dermalEffects of ingestion, particularly in children and young adultsPre-hospital Care and First Response:Importance of decontaminationSafety measures for EMS personnelSteps to take in pre-hospital careHistory and Physical Examination: Key points to focus on during history takingImportant signs and symptoms to checkLaboratory and Diagnostic Testing: Overview of useful lab tests and imagingRole of EKG and chest x-rayImportance of early consultation with poison controlEndoscopy and CT Imaging: Use of endoscopy to classify injuries and guide treatment Role of CT imaging Complementary use of endoscopy and CTTreatment Approaches:Initial resuscitation and airway managementUse of steroids and other medications like antibiotics, H2 antagonists, and topical mitomycin CWhen and how to use NG tubesSpecial Populations and Long-term Considerations: Special considerations for childrenRisks associated with laundry detergent podsLong-term complications, including strictures and increased risk of esophageal cancerConclusion: 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 DepartmentIntroduction to Acute Mesenteric IschemiaStatistics on prevalence and mortalityPathophysiology and EtiologyMesenteric artery embolismMesenteric artery thrombosisMesenteric venous thrombosisNon-occlusive mesenteric ischemiaDiagnosisManagement and TreatmentSpecial 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 EvidencePrevalence 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

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 Department00:00 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 resident@ebmedicine.net 

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 Overview01:10 Meet Ryan Johnson: Clinical Pharmacist02:06 Role of Clinical Pharmacists in Emergency Medicine05:03 IV Fluid Shortage: Causes and Impact05:56 Institutional Strategies to Mitigate IV Fluid Shortages14:52 Provider-Level Solutions for Fluid Conservation22:11 Pharmacy and Nursing Staff Roles in Fluid Management26:34 Advanced Measures and Federal Guidelines34:40 Conclusion and Final ThoughtsResources 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

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 Draper01:03 Experiencing the Hurricane03:19 Immediate Aftermath and Hospital Challenges11:22 Dealing with Water and Supply Shortages20:48 Community and External Support24:10 Ongoing Efforts and Future Plans27:51 Conclusion and Final Thoughts

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

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 DiseaseEpidemiologyCommon Presentation of Sickle Cell Disease in the EDScreening and Diagnosis DifferencesEpidemiology: 200,000 ED Visits Annually, 85% for PainPathophysiologyLife Expectancy and ComplicationsVado-Occlusive Crises and PathophysiologySequestration Crisis in Sickle Cell PatientsAcute Chest Syndrome and PriapismClinical ManagementTreatment Advocacy and Pain ManagementPatient History and Examination ImportanceImaging RecommendationsLaboratory Studies and FindingsEmergency Department Care ProtocolsAdvanced Treatment OptionsIntravenous (IV) Fluids GuidelineManagement of PriapismRole of Exchange TransfusionAcute Chest Syndrome DetailsApproach in Rural and Critical Access HospitalsSpecial PopulationsPregnant 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 DialysisOverview of Dialysis ComplicationsKey Dialysis ComplicationsCardiovascular DiseaseCongestive Heart FailurePericarditis and Cardiac TamponadeNeurological SequelaeGastrointestinal ComplicationsHypotensionDialysis Disequilibrium SyndromeAir Embolism and Chloramine ToxicityDisaster PreparednessVascular Access ComplicationsHemorrhage risks and treatmentThrombosis, stenosis, and aneurysmsInfection risks and managementPre-Hospital CareED History Differential diagnosis Key questions to ask dialysis patientsExamination Physical Exam TipsTreatmentsRisk Management PitfallsCommon Pitfalls to AvoidConclusion

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 DisorderCurrent State of Opioid EpidemicOverview 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 TestingTypes 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 CareImportance 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 DepartmentBuprenorphine InitiationProtocols for initiating buprenorphine in ED settings.Assessment using the Clinical Opiate Withdrawal Scale (COWS).Safe dosing procedures for buprenorphine.Withdrawal and Overdose CareLaboratory testing recommendations.Capnography and VBG in overdose management.The role of end-tidal CO2 monitoring and respirations.Methadone vs. Buprenorphine ConsiderationsMethadone 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 Change The Importance of Career Reflection and Making Trades Navigating Career Satisfaction and Preventing Burnout Proactive Career Management and Reflection Strategies Exploring Career Alternatives and Rediscovering Joy in Medicine Balancing Work, Love, Play, and Health for a Satisfying Life When to Seek Coaching for Career Guidance Practical Tools for Self-Reflection and Taking Action Closing 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 DepartmentDiving 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 DepartmentIntroductionUnderstanding 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 DepartmentIntroductionThe 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 ConstipationPrevalence and ImpactUnderstanding the CausesMedications That Can Cause ConstipationDealing with Fecal ImpactionUnderstanding Stercoral ColitisPre-Hospital CareED History and Physical ExamDiagnostic Studies and ImagingX-RayCT ScansAdvanced TestingTreatment Options for ConstipationEnemasOsmotic Laxatives and Stool SoftenersSpecial Considerations: Pregnant, Pediatric, and Hospice PatientsPrescription Medications for ConstipationClinical Pathway for Constipation Management

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 DepartmentGuideline ChangesPathophysiologyEtiology and DefinitionsPrehospital CareED History and Physical Diagnostic StudiesAge 0-21 Days Age 22-28 Days Age 29-60 DaysLumbar PunctureViral TestingUrinalysisShared Decision MakingDisposition

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 FailurePathophysiologyPresenting 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 PatientsEpidemiologyEvidenceCausesRisk 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 NomenclaturePrehospital CareED History and Physical ExamInfants Age 2 Years AdolescentsUrinalysisClean Catch Protocol Catheterization Suprapubic AspirationBlood Cultures and CSFBiomarkers (CRP and ESR)TreatmentCommunity Acquired PneumoniaDistinguishing Viral vs Bacterial PneumoniaImagingAntibiotic TreatmentVaccinationSteroidsAtypical PresentationsCheck out the clinical pathways at https://www.ebmedicine.net/pathways

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: 1‑800‑222‑1222EpidemiologyPrehospital CareED History and Physical ExamDiagnostic StudiesLabsEKGImagingUrine Toxicology TestingTreatmentHemodialysisActivated CharcoalWhole Bowel IrrigationGastric LavageIpecacDrug Specific TherapiesAcetaminophenAlcoholsAnticholinergicsBeta BlockersCalcium Channel BlockersCholinergic AgentsDigoxinIronOpioidsSalicylatesSedative HypnoticsSulfonylureasLaundry PodsCheck out the clinical pathways at https://www.ebmedicine.net/pathways

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.EpidemiologyDifferential diagnosisPrehospital careED history and physical examDiagnostic studiesPoint of care testing Labs ImagingTreatmentIV fluids, the 2-bag system Mild DKA Moderate to severe DKA Potassium and phosphate supplementation Magnesium and calcium Sodium bicarbonate Hypoglycemia HHS MonitoringComplicationsCerebral edema IntubationInsulin pumpsDispositionSummaryHighlightsEBUC - 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

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the October 2023 Pediatric Emergency Medicine Practice article, Substance Use in Adolescents: Recognition and Management in the Emergency Department and the October 2023 Emergency Medicine Practice article, Evidence-Based Emergency Department Management of Migraine and Other Primary HeadachesSubstance Use In Adolescents EpidemiologyRisk FactorsDifferential DiagnosisPrehospital CareED History and Physical ExamUrine Drug ScreenTreatmentMarijuana Alcohol Methaphetamines MDMA Cocaine OpioidsDispositionMigraine and Other Primary HeadachesEpidemiologyCluster HeadachesMedication Overuse HeadacheNerve BlocksGreater Occipital Sphenopalatine GanglionPregnant PatientsDispositionCheck out the clinical pathway at https://clinicalpathways.ebmedicine.net

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the September 2023 Emergency Medicine Practice article, Emergency Department Management of Patients With Rectal BleedingEtiology/pathophysiologyRisk factorsDifferential diagnosisPrehospital careED history and physical examDiagnostic studiesLaboratory testingImaging studiesTreatmentTransfusionCoagulation reversalEmbolizationSpecial PopulationsPediatricsPregnant patientsElderly patientsScoring systemsDispositionCheck out the clinical pathway at https://clinicalpathways.ebmedicine.net

In this episode, Sam Ashoo, MD, and TR Eckler, MD, interview Al Sacchetti, MD, about the August 2023 Emergency Medicine Practice article, Evidence-Based Management of Pulmonary Embolism in the Emergency DepartmentEtiology/pathophysiologyRisk factorsDifferential diagnosisPrehospital careED history and physical examDiagnostic scoring systemsPregnant patients Diagnostic studiesECGD-DimerTroponin & BNPChest x-rayCT V/Q scansMRIUSTreatmentIV fluidsAnticoagulationVasopressorsThrombolyticsThrombectomyECMODispositionCheck out the clinical pathway at https://clinicalpathways.ebmedicine.net

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the July 2023 Emergency Medicine Practice article, Diagnosing and Treating Pericarditis and Myocarditis in the Emergency DepartmentEpidemiologyNomenclatureEtiologyDifferential diagnosisPrehospital careED history and physicalDiagnosticsECGLabsImaging (X-ray, CT, US, MRI)Treatment Special populationsCOVID-19AthletesMIS-C

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the June 2023 Emergency Medicine Practice article, Hypertensive Emergencies: Guidelines and Best Practice RecommendationsEpidemiologyEtiologyDifferential diagnosisPrehospital careHistory and physical DiagnosticsTreatmentAcute decompensated heart failureAcute ischemic strokeAcute coronary syndromeIntracerebral hemorrhageSubarachnoid hemorrhageAortic dissectionHypertensive encephalopathySevere pre-eclampsia and eclampsiaControversiesArterial line placementBeta blockers and cocaineRisk management caveatsSummary

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the May 2023 Emergency Medicine Practice article on Emergency Department Management of Gastrointestinal Foreign Body IngestionEpidemiologyEtiology - types of ingestionsAnatomy - common locations by ageFood impactionSharp objectsButton batteriesMagnetsColorectal foreign bodiesPrehospital careHistory and PhysicalImagingExpectant managementEndoscopic removalNon-endoscopic techniquesBody PackingGlucagonGastric button batteriesSummary

In this episode, Sam Ashoo, MD, talks with Rob Orman, MD, founder of Orman Physician Coaching, about longevity in emergency medicine.Personal foundation Regular check-insBecoming an expert in… Job stressLiving beneath your meansRecharging and shift workBad outcomesPhysician loungeLearning to say noSet a reminderMore at Orman Physician Coaching 

Announcements: The interactive Clinical Pathways have launched and they are available for free! In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the March 2023 Emergency Medicine Practice article on Emergency Department Management of Infective Endocarditis-Associated StrokeEpidemiologyPathophysiologyPopulations at RiskComplicationsIntracranial hemorrhageAneurysmsHeart blockPrehospital CareED History and ExaminationImagingAntibiotic TherapySurgical TreatmentSpecial PopulationsSummary

Announcements:  The interactive Clinical Pathways have launched and they are available for free!  — In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the February 2023 Pediatric Emergency Medicine Practice article on Pediatric Electrolyte Emergencies: Recognition and Management in the Emergency Department — History Point-of-care testing I/O lines Presentation, differential, and treatment of:HyponatremiaHypernatremiaHypokalemiaHyperkalemiaHypocalcemiaHypercalcemiaHypomagnesemiaHypophosphatemia

Announcements: The interactive Clinical Pathways have launched and they are available for free! ___In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the January 2023 Pediatric Emergency Medicine Practice article on the Responsible and Safe Use of Opioids in Children and Adolescents in the Emergency DepartmentDEA-X Waiver Repeal:The Mainstreaming Addiction ActThe Medication Access and Training Expansion Act (MATE)FOAMed postOpioids in Children and Adolescents: IntroductionEpidemiology and Statistics Medication safety at homeEscalation of pain meds at homeNaloxone prescriptionsMedications in childrenCodeineTramadolNSAIDsLocal anesthetics and nerve blocksIntranasal meds: Ketamine and fentanylOpioids and sedationRegional anesthesiaChronic pain

Announcements: The interactive Clinical Pathways have launched and they are available for free! — In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the July 2022 Emergency Medicine Practice article on the Management of Allergic Reactions and Anaphylaxis in the Emergency Department.  IntroThe number of ED visits and hospitalizationsStudies show up to 57% of anaphylactic reactions are not recognized, and epinephrine is not administered in up to 80% of cases. Criteria2006 Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network (NIAID/FAAN)WAO revised the criteria in 2020 Delphi group and Brown et alPathophysiology EpidemiologyMost common causes in children and adultsMore than half of deaths from anaphylaxis occur within the first hour of symptom onsetPrehospital CareGive epi, H1 blockersMainstay = recognitionED CareAirwayEpinephrineDecontaminationH1 and H2 blockersCorticosteroidsBiphasic reactionsGlucagonSpecial CasesAlpha-galScombroidKounis syndrome

Announcements: 1) The interactive Clinical Pathways have launched and they are available for free! 2) 2023 E/M coding guidelines are in effect. See the summary here. ___ In this episode, Sam Ashoo, MD, interviews Ara Festekjian, MD, one of the authors of the November 2022 Pediatric Emergency Medicine Practice article on Pediatric Septic Shock in the Emergency Department Introduction: How common is sepsis in kids and what is the mortality rate in the US? DefinitionsSeptic shockSepsis associated organ dysfunctionSepsis-3Compensated vs uncompensated shock EtiologyNeonateCentral line and VP shuntsAspleniaImmunocompromised children Differential Diagnosis Prehospital Care ED EvaluationHistoryExaminationSeptic shock + cardiogenic shockWarm vs cold shockEvolution of physical exam findingsDiagnosticsLabsImagingTreatmentIV/IO placementFluid bolusesAntibiotics Pressors Airway management Special PopulationsFebrile neutropeniaNewborns with septic shockControversiesFluid volumeFluid typeAntibiotic timingCorticosteroids

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the December 2022 Evidence-Based Urgent Care article on Influenza in Urgent Care.EpidemiologyHistorical dataSince COVID, tracking "influenza-like illness" has been complicatedInfluenza deaths and ageAnnual mortality OutbreaksTransmissionClassificationInfluenza A, B, and CHemagglutinin and neuraminidase subgroupsAntigenic drift and shiftPathophysiologyTransmissionIncubation Secondary infectionH3N2VaccinesEgg-based, cell-based, and recombinant influenza vaccinesCDC recommendationsPatients aged >65 yearsDifferential DiagnosisComplications TestingWhen is it indicated? What types of tests are available? Testing in periods of low and high prevalence TreatmentHigh-risk conditions that suggest treatment Antiviral medications Oseltamivir: NNT and NNHResistance patternsBilling and Coding

In this episode, Sam Ashoo, MD, interviews Prayag Mehta, MD, and Nikola Milanko, MD, two of the authors of the October 2022 Emergency Medicine Practice article on Angioedema in the Emergency Department Pathophysiology: Non-pitting edema of respiratory or GI tractHistamine meditated, bradykinin mediated, or idiopathicAcquired, inherited, or idiopathicDo they present differently? (Urticaria, speed of onset)Histamine MediatedMost common form: 40%-70%Can be triggered by NSAIDsCan be induced by physical mechanism like cold, vibrationIs rash a reliable method of distinguishing the types?Bradykinin MediatedMay progress slowlyCan be inherited or acquiredCommon triggers include ACE inhibitors and TPATable 1 Differential Diagnosis Prehospital CareProtect airwayEpi, steroids, antihistaminesAvoid CPAPED HistoryFigure 2: Distinguishing characteristics of histamine vs bradykinin mediatedED ExamImportance of repetitive examsAirway examinationLaryngoscopy?DiagnosticsFigure 6: Flow diagram of ED workupLabsImagingTreatmentAirway: IntubationMedicationSpecial PopulationsPediatricPregnant/lactating patientsControversiesTXADisposition

In this episode, Sam Ashoo, MD, interviews Ami Shah, MD, MPH, and Don Walker, MD, about eye injuries in the pediatric population.  Why ocular injuries? Why did you pick this topic? What kind of injuries are included and at what age are they most common? Injury zones and terminology Differential DiagnosisWhat should we keep in mind when we are confronted with an ocular injury? (Table 3)Prehospital CareWhat do our EMS colleagues need to keep in mind when transporting a child with an ocular injury?How can they help us in the ED?ED EvaluationHistory: What's important to know?Physical: Visual acuity and eye examDiagnostics: Slit lamp, ocular pressure, US, CT, MRITreatmentLid lacerations: Who repairs and when?Orbital fractures: What should we be looking for? Why is it different in children? When does repair typically occur?Corneal abrasionsCorneal foreign bodyChemical injuries: Irrigate with what and for how long?Traumatic hyphema: Treatment, dispositionTraumatic iritis: Treatment, outcomeOpen globe injuriesRetrobulbar hematoma - First 10 EMSpecial PopulationsHemophilia, Von Willebrand diseaseSickle cell and traitNeonates and infantsContact lensesControversies and Cutting EdgeKetamineTetanusNSAIDs, topical?Topical anestheticsVisual acuity apps

In this episode of EMplify: Conversation, Sam Ashoo, MD talks with Rob Orman, MD, founder of Orman Physician Coaching, about career disillusionment.Career Disillusionment: What is it? How do we combat it? Should we combat it? A frog in boiling water... BurnoutTwo questions to ask yourselfHow coaching can helpThe advice trapA framework to explore your career and life goalsMore at Orman Physician Coaching. 

In this episode, Sam Ashoo, MD interviews Rawad Rayes, MD and Eva Tovar Hirashima, MD, MPH – two of the authors of the August 2022 PEMP article on Pediatric Firearm Injuries to the Extremity: Management in the Emergency Department.Episode Outline:How common are pediatric firearm injuries? What is the most common location of these injuries? Is there much literature published on this topic? Epidemiology What's been the trend in pediatric firearm injuries over the past 10 years? Do we have any idea how/why these are occurring (ie, accidental, intentional, etc)Terminology: For those unfamiliar with firearms (table 1)Ballistics: Mechanisms of damage. Pre-hospital careTrauma center transportPrehospital hemorrhage control -- Combat application tourniquet, anything else? ED EvaluationSIPA -- What is it and why use it? Primary survey -- Tachycardia -> delayed cap refill -> hypotension in children? Secondary SurveyDiagnostic Studies: Damage Control ResuscitationWound Care -- Do we remove projectiles? Can they stay in? Antibiotics Joint InvolvementCompartment Syndrome -- 3 As vs 6 PsRhabdomyolysisControversiesCTA for all injuries? Hemostatic devices -- Any role for these in the ED? 

In this episode of EMplify: Conversation, Sam Ashoo, MD talks with Andrew Phillips, MD, MEd, founder of EM Coach, about artificial intelligence and emergency medicine education.EM/Critical care practice - what's that like? EM Coach - what is it? Artificial Intelligence -What is it and how does EM Coach use it? The algorithmHow did you create it? What does it do? The evidence behind itHow and where to access EM Coach

In this episode, Sam Ashoo, MD interviews Lela Bachrach, MD, MS, Larissa Truschel, MD, MPH, and Makini Chisolm-Straker, MD, MPH - the authors of the July 2022 PEMP article on Human Trafficking of Children and Adolescents: Recognition and Response in the Emergency Department. Listen to the discussion to hear more about the emergency medicine approach to human trafficking. Human Trafficking of Children and Adolescents: Recognition and Response in the Emergency Department EMplify - Sept 2022Episode Outline:Differential DiagnosisWhat is the differential diagnosis for this scenario in the ED?Are these diagnoses mutually exclusive ?EMS/Prehospital CareWhat role do EMS providers play in the recognition of trafficking?ED EvaluationWhat are common presentations/complaints that may represent trafficking?Examination: Privacy, use of a separate room, how do we accomplish this with minors?Ground rules: What does this mean? How do you state this in your practice? Do you find this dissuades patients form reporting?Technology: What if they are on the phone?History - HEADS-EDPhysical examination - Findings that lead to suspicion, documentation best practices.Diagnostic StudiesImaging: Any role for this?Lab testing: STI, anything else?Screening tools: Trauma-informed care, PEARR toolLocal laws differ by state. How do we handle this with patients? Does it dissuade reporting?"Rescuing mentality" and what that means in the EDTreatment MedicalBeyond medicines: Local services, national hotlineSpecial PopulationsDiagnosis: What to chart? National Human Trafficking Hotline 1-888-373-7888https://humantraffickinghotline.org/

In this episode of EMplify: Conversation – Sam Ashoo, MD, and TR Eckler, MD, speak with John Roberts, MD, MPH, about his work with the International Medical Corps and his efforts in Ukraine.Topics include:What is the International Medical Corps (IMC) and what does it do?What has IMC been doing in the U.S.?What is involved in disaster response?What has IMC been doing in Ukraine?What are the conditions like in Ukraine now?How does bombing of civilian areas affect Ukraine and the IMC projects?How can we support IMC efforts?How can we volunteer with the IMC?How does IMC balance long-term efforts and short-term relief to prevent harm to communities?How has the war in Ukraine effected surrounding areas?What has been most frustrating and most rewarding for you in your work with IMC?How did you start your career in disaster medicine and how would someone interested in it follow your footsteps?LinksIMC WebsiteIMC JobsRoster PositionsRoster position - MDRoster position - Nurse Roster position - Nurse Practitioner Roster position - Midwife Disaster MedicineThe Nuts & Bolts of Global EM, free e-book