Podcasts about emergency departments

“If you read this book on a Friday, we promise you will be better at your job on Monday.” In the high-stakes environment of the Emergency Department, we often focus on the “big saves,” but what if the secret to a thriving career lies in the tiny details? In part one of this special two-part series, we sit down with Dr. Resa Lewiss, an emergency and lifestyle medicine physician, TEDMED speaker, and co-author of the hit book Micro Skills: Small Actions, Big Impact. We dive into why the “workplace playbook” isn’t always handed to us and how breaking down overwhelming professional goals into small, actionable behaviors can transform your trajectory. What Exactly Are “Micro Skills”? Dr. Lewiss defines Micro Skills as the small, actionable behaviors and steps that serve as the building blocks for achieving massive goals. Whether it's tackling an overwhelming project or building a habit you thought was “just for other people,” almost everything can be broken down into these manageable units. For Dr. Lewiss and her co-author, Dr. Adaira Landry, these skills are the “missing playbook” they wish they'd had earlier in their careers. Early Career: The Micro Skills of Self-Care For those just entering the workforce—from residents to new attendings—the focus must be on sustainability. Become an “Award-Winning Sleeper”: Stop wearing exhaustion as a badge of honor. Dr. Lewiss highlights why sleep is a professional necessity, not a luxury. The Personal Board of Directors: Create a “round table” of go-to people—mentors, peers, and sponsors—who can help you navigate professional and personal hurdles. Mid-Career: Navigating Conflict & Team Dynamics As physicians gain competence and move into leadership, the challenges become more interpersonal. The “Paper Tiger” Colleague: Learn how to identify coworkers who project authority they don't actually have by trusting your “Spidey sense”, checking organizational charts, asking established leadership. Inquiring Carefully: When navigating workplace tension, focus on avoiding gossip and seeking clarity from trusted supervisors. Late Career: Modeling Culture & Professionalism Seasoned physicians have the greatest power to shift the culture of a department. The Scheduled Send: Protect your team's “deliberate rest” by scheduling emails to arrive during standard business hours. From Bystander to Upstander: Use your seniority to shut down unprofessional behavior with simple scripts like, “I don't understand the joke, can you explain it to me?” Coming Up in Part 2… The conversation continues! In the next episode, we explore the “Power of the Pause,” why Dr. Lewiss advocates for the “Joy of Missing Out” (JOMO), and a simple three-question framework (Start, Stop, Continue) to get the meaningful feedback you actually need to grow. We want to hear from you! Which of these micro skills resonated with you? Have you been able to apply these to your daily life and medical practice? Connect with us on social media @empulsepodcast or on our website ucdavisem.com. Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guest: Dr. Resa E. Lewiss, Emergency Medicine and Lifestyle Medicine Physician, Adjunct Professor of Emergency Medicine at the Warren Alpert Medical School of Brown University, TEDMED speaker, educator and mentor. Resources: Micro Skills: Small Actions, Big Impact, by Adaira Landry, MD and Resa E. Lewiss, MD The Visible Voices Podcast, hosted by Dr. Resa Lewiss Lewiss on Lifestyle Medicine, column on Healio by Dr. Resa Lewiss *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.

Contributor: Aaron Lessen, MD Educational Pearls: How long do we need to watch patients with a presumed overdose who were treated with naloxone in the field? A 2025 study in the Annals of Emergency Medicine took a look at this question Methods Prospective, multi-institutional cohort study Included ED patients with suspected acute opioid overdose with biologic testing to confirm substances. This paper performed a secondary analysis evaluating the risk of "delayed intubation," defined as intubation occurring >4 hours after ED arrival. Results 1,591 patients with presumed opioid overdose were included. Delayed intubation occurred in only 9 patients (0.6%). 8 of the 9 cases had non-respiratory causes contributing to intubation. Only 1 patient had respiratory-related deterioration, presenting with respiratory acidosis after receiving 6.4 mg naloxone prior to intubation. Key Takeaway Delayed respiratory deterioration requiring intubation after 4 hours of ED monitoring is extremely rare, suggesting prolonged monitoring may not be necessary for most stabilized overdose patients. How else can we mitigate risk? Give patients take-home naloxone at discharge and educate them on how to use it (See Episode 673: Leaving the ED with Naloxone). When are naloxone drips necessary? If a patient requires repeated naloxone boluses, consider a drip To get the dose, take the total naloxone dose that restored adequate breathing and give two-thirds of that dose per hour Typically these patients are admitted to the ICU References McCabe DJ, Gibbs H, Pratt AA, Culbreth R, Sutphin AM, Abston S, Li S, Wax P, Brent J, Campleman S, Aldy K, Falise A, Manini AF; ToxIC Fentalog Study Group. Risk of Delayed Intubation After Presumed Opioid Overdose in the Emergency Department. Ann Emerg Med. 2025 Jun;85(6):498-504. doi: 10.1016/j.annemergmed.2025.01.022. Epub 2025 Mar 4. PMID: 40047773; PMCID: PMC12955731. Summarized and edited by Jeffrey Olson MS4 Donate: https://emergencymedicalminute.org/donate/ Join our mailing list: http://eepurl.com/c9ouHf

In part one of this series, Dr. Tesha Monteith and Dr. Jennifer Robblee discuss an international consensus definition for refractory migraine and why clearer criteria are needed.  Show citations: Robblee J, Minen MT, Friedman BW, Cortel-LeBlanc MA, Cortel-LeBlanc A, Orr SL. 2025 Guideline Update to Acute Treatment of Migraine for Adults in the Emergency Department: The American Headache Society Evidence Assessment of Parenteral Pharmacotherapies. Headache. 2026;66(1):53-76. doi:10.1111/head.70016 Robblee J, Khan FA, Marmura MJ, et al. Reaching International Consensus on the Definition of Refractory Migraine Using the Delphi Method. Cephalalgia. 2025;45(9):3331024251367767. doi:10.1177/03331024251367767 Show transcript:  Dr. Tesha Monteith: Hi, this is Tesha Monteith with the Neurology Minute. I've just been speaking with Jennifer Robblee about her exciting work defining refractory migraine with an international consensus, as well as her work with the American Headache Society on a guideline update for parental pharmacotherapies for migraine in the emergency department. Hi, Jennifer. Thanks again for coming on our Neurology Minute. Dr. Jennifer Robblee: Thank you so much for having me. I'm delighted to be here. Dr. Tesha Monteith: You've done a lot of work in the area of refractory migraine. Why don't you tell us why you felt there need to be clarification on the definition? Dr. Jennifer Robblee: Well, this is a patient population that I'm really passionate about. There's not enough research out there. We don't really know who these patients are, why they're not responding to treatment, and we don't know how to help them because we have no guidelines, obviously, since they're refractory to what we use for treating. So I thought it was really good to get an international group to standardize our definition and hopefully help move the research forward. Dr. Tesha Monteith: Why don't you tell us a little bit about the consensus definition Dr. Jennifer Robblee: So we came up with an international consensus definition for refractory migraine that was laid out the same way that migraine is, say, laid out in the ICHD-3 diagnostic manual, if you want to call it that. So we have different criteria on. So criterion A basically allowed for it to be episodic or chronic migraine. Criterion B had three subcriteria, so you needed to have at least two out of three of severe to very severe disability and/or a constant background headache and/or at least eight monthly migraine days. Criterion C was about the lack of response to treatment. And basically it says that you needed to have failure of all medication categories, and there is an extra one for an other in case any new treatments emerge before the diagnostic criteria get updated. And what we considered a, quote, unquote, failure was that you did not have a 50% improvement in monthly migraine days, or you had intolerable side effects, or you had an absolute contraindication. There is a caveat that you need to have at least four true lack of efficacies. And then the CGRP monoclonal antibody or gepant category and the onabotulinumtoxin toxin category both had to be a true lack of response. And of course, there's a criterion B to say that this should not be from another diagnosis. Dr. Tesha Monteith: Thanks so much, Jennifer.

The Health Minister has pledged to enhance services at Ennis Hospital but has given no commitment to emergency care in Clare. Minister Jennifer Carroll MacNeill has described a new “strategic site” acquired in Limerick to solve hospital overcrowding in the MidWest as “HIQA's Option B and C Plus.” The Minister has described the €14 million, 43.8 acre site in Raheen as a strategic site for the MidWest Health system for the next thirty years, located a 28 minute drive away from Ennis and Nenagh. Over 40% of Clare's population lives more than an hour's drive from their nearest Emergency Department and the Minister said her vision for Ennis's progression is similar to that of Bantry General Hospital in Cork, which doesn't have an ED or proposals for one. Despite this, Minister Carroll MacNeill insists Clare “was at the centre of their plans” in the MidWest. However, health campaigners here have expressed "anger and deep frustration" following the announcement that a site has been identified for a new hospital campus for the Midwest. The Friends of Ennis Hospital claims 130,000 people in Clare along with a further 80,000 in Tipperary will see limited benefit from the hospital being located in the city. Alan spoke with Fianna Fáil TD Cathal Crowe and Fine Gael TD Joe Cooney about the announcement Image © Alan Place

The Health Minister has pledged to enhance services at Ennis Hospital, but has given no commitment to emergency care in Clare. During her official announcement today, Minister Jennifer Carroll MacNeill has described a new "strategic site" acquired in Limerick to solve hospital overcrowding in the MidWest as "HIQA's Option B and C Plus." Health Minister Jennifer Carrol MacNeill visited Limerick this morning, where she confirmed details of the Midwest's new hospital. The Minister has described the €14 million, 43.8 acre site in Raheen as a strategic site for the MidWest Health system for the next thirty years, located a 28 minute drive away from Ennis and Nenagh. Her next step will be to appoint a project development board, which will develop healthcare services for the overall region and a report is due to be published later this year that will recommend additional services are provided in Clare. Last September, the Department of Health pledged to progress all three of HIQA's recommendations to solve hospital overcrowding in the region. The options included expanding the University Hospital Limerick Campus, extending the campus to another nearby site and delivering a new Model 3 hospital with a new ED in the MidWest. Jennifer Carroll MacNeill believes Option B and C can be delivered in Raheen. During her announcement today, which Clare media were not invited to attend, the Minister said emergency care in the region had to be expanded and that having two model 4 hospitals within 10 minutes of each other was a possibility. She also hasn't ruled out moving the maternity hospital to the Raheen site. Over 40% of Clare's population lives more than an hour's drive from their nearest Emergency Department and the Minister said her vision for Ennis's progression is similar to that of Bantry General Hospital in Cork, which doesn't have an ED or proposals for one. Despite this, Minister Carroll MacNeill insists Clare "was at the centre of their plans" in the MidWest.

Dr. Tesha Monteith talks with Dr. Jennifer Robblee about the latest consensus on refractory migraine, its definition, and management strategies, including new guidelines for emergency treatment.  Read the related article in Cephalalgia.  Read the related article in Headache. Disclosures can be found at Neurology.org. 

Emergency departments are under more pressure than ever as they are facing overcrowding, extended wait times, workforce strain, and rising patient demand fueled in part by primary care shortages. In this episode of Value-Based Care Insights, host Daniel Marino examines how these mounting challenges are reshaping the hospital's front door and what they mean for patient care, operational performance, and long-term sustainability. Daniel is joined by Dr. Richard Wolfe, Chief of Emergency Medicine at Beth Israel Deaconess Medical Center and a nationally recognized leader in emergency medicine operations. Together, they explore why emergency departments have become a critical pressure point for hospitals, how overcrowding affects quality, safety, and clinician burnout, and what forward-thinking health systems can do to better support their emergency medicine teams while continuing to serve their communities effectively.

Emergency departments are under more pressure than ever as they are facing overcrowding, extended wait times, workforce strain, and rising patient demand fueled in part by primary care shortages. On this episode Dan examines how these mounting challenges are reshaping the hospital's front door and what they mean for patient care, operational performance, and long-term sustainability. Dan is joined by Dr. Richard Wolfe, Chief of Emergency Medicine at Beth Israel Deaconess Medical Center and a nationally recognized leader in emergency medicine operations. Together, they explore why emergency departments have become a critical pressure point for hospitals, how overcrowding affects quality, safety, and clinician burnout, and what forward-thinking health systems can do to better support their emergency medicine teams while continuing to serve their communities effectively. To stream our Station live 24/7 visit www.HealthcareNOWRadio.com or ask your Smart Device to “….Play Healthcare NOW Radio”. Find all of our network podcasts on your favorite podcast platforms and be sure to subscribe and like us. Learn more at www.healthcarenowradio.com/listen

As overfilled hospitals everywhere are struggling to cope with a busy winter of respiratory disease and influenza, many in healthcare are calling for a more “upstream” approach to preventing Emergency Department visits and hospital admissions. But intervening upstream is more difficult than it sounds. Today's guests have done just this. Talking us through their award-winning, quality improvement work in reducing ED visits and hospital admissions for patients with Chronic Obstructive Pulmonary Disease are Donna Jouantapp, Lina Alsakran and Dr. Zoe Pullan from Cowichan on Vancouver Island. In this interview, we learn how a well-designed project with a dedicated, inclusive and nimble team can overcome obstacles on the path to sustainable, cost effective and patient-centered care. Links: The INSPIRED COPD Outreach Program and COPD Care and Education Nova Scotia

PeaceHealth Oregon has decided to use the Atlanta-based company ApolloMD to staff its emergency departments in Lane County, ending a decadeslong contract with Eugene Emergency Physicians. The decision led the group to hold a no-confidence vote in PeaceHealth leadership, which the hospitals’ medical staff supported overwhelmingly. In a statement, PeaceHealth said it selected ApolloMD based on “Lane County’s future emergency medicine needs and the type of resource required to meet increasingly high patient volumes and medical complexity.” Margaret Pattison is the emergency department medical director at PeaceHealth RiverBend in Springfield and a member of Eugene Emergency Physicians. She joins us to talk about the decision and how the group is responding.

🧭 REBEL Rundown 🔑Key Points Try the coffee nap! Where you combine caffeine and a 30-minute nap to then have that boost energy and alertness by the time it kicks in.💤 Sleep isn’t optional—it’s crucial for memory, mood regulation, and physical recovery. It is fundamentally different from rest❌ Replacing sleep with caffeine isn’t effective and can have negative health impacts. Make getting enough sleep a priority🌞 Sunlight exposure is important for maintaining circadian rhythms and sleep quality. This applies even if you work as a nocturnist💡 Creating a personalized sleep system enhances quality and consistency. It gives you back control of a schedule that you may feel like is out of your hands.🧩 If you’ve tried these strategies and you’re still struggling, consider true sleep pathology (insomnia, shift work disorder, sleep apnea) and get help—this is not a “be tougher” problem.🩺 Better sleep isn’t just about feeling good; it’s directly tied to error reduction, patient safety, and longevity in EM/ICU careers. Click here for Direct Download of the Podcast. 👀Previously Covered and Related Content: REBEL Core Cast: Sleep HygieneREBEL MIND: Rest Is Not Sleep: The Seven Dimensions of True RecoveryRebellion in EM: Care For Yourself – Sleep HygieneFirst10EM: Some Evidence For Working Night ShiftsREBEL MIND: Dunning Kruger Effect 📝 Introduction Welcome to this episode of REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. Today we are exploring the imperative topic of rest and why it’s not just about sleeping. The second of a two part series, hosted by Dr. Mark Ramzy with guests Dr. Maureen Aiad and Dr. Amil Badoolah, continue our discussion but this time on the multifaceted nature of sleep, how it serves as medicine and how we can use our tools deliberately to get more of it! Cognitive Question How would your clinical performance, patience with families, and long-term career sustainability change if you treated sleep as a non-negotiable clinical intervention rather than a flexible “nice-to-have”? 💤How is Sleep Different From Rest? 1. Rest reduces load; sleep repairs systemsWe previously talked about the 7 types of rest and you can check that out hereExamples of physical rest include: pausing tasks, stepping away from the monitor, taking a walk, stretching, breathing, journaling, connecting with a colleague. This lightens your cognitive/emotional burden.Sleep is fundamentally different in that it’s an active biologic process that helps:Consolidates memory and learning (yes, including the tough cases from last night).Regulates mood, impulse control, and emotional reactivity.Supports immunity, metabolic health, and cardiovascular function.Repairs tissue, replenishes neurotransmitters, and fine-tunes neural networks.You can have “rested but underslept” days (you took breaks but got 4 hours in bed), and “slept but unrested” days (you got hours, but all junk sleep). Both matter, but they are not interchangeable.2. Sleep architecture vs. “knocking out”True restorative sleep cycles through NREM and REM in predictable patterns.Alcohol, late caffeine, and fragmented nights may help you fall asleep faster but:Suppress REM.Shorten deep sleep.Increase awakenings and light sleep.The result: you technically slept, but your brain didn’t get the “software updates” it needed.Biology isn’t built for your scheduleCircadian rhythms were designed for light-day / dark-night cycles, not:10 pm–7 am ED shifts.24-hour calls.6 nights in a row followed by days.Your body can adapt partially, but not instantly and not perfectly. That’s why:You can feel “jet-lagged” even when you haven’t traveled.Sleep before and after nights feels odd and fragile.Recognizing that “this is biologically unnatural” is key: you’re not weak; you’re fighting physiology. 🏥How This Applies to the Emergency Department or ICU? Performance & safetySleep deprivation:Slows reaction time and increases error rate.Impairs risk assessment and complex decision-making.Drops your frustration tolerance with consultants, families, and staff.In both emergency medicine and critical care, that translates into:Anchoring on the wrong diagnosis.Missing subtle clinical changes.Snapping at a tech, nurse or resident and damaging team culture. Chronic health for chronic shift workLong-term sleep disruption is associated with:Hypertension, diabetes, obesity.Depression, anxiety, burnout.Arrhythmias (e.g., AFib) and increased stroke risk.Possibly increased all-cause mortality.You’re already in a high-stress, high-exposure specialty. Chronically poor sleep amplifies that risk profile and can end a career early—or make you miserable while you’re still in it.Culture of “heroics” vs. healthSkipping sleep to pick up extra shifts, late meetings, or “just one more note” is often praised.We rarely celebrate:The attending who says “no” to a 2 pm meeting post-nights.The resident who defends their blackout-curtains-and-earplugs routine. 🛏️Different Ways to Improve Your Sleep Clarify your “sleep non-negotiables”Decide how many hours you realistically need to function (e.g., 7–9 on off days, realistic blocks on nights).Treat those hours as you would a procedure time—blocked, protected, and respected.Use caffeine like a drug, not a reflexAim for ≤ 2 cups equivalent on most days.Avoid caffeine within 4–6 hours of your planned sleep time (remember: it can hang around up to 12 hours).Consider scheduling caffeine for:Early in the shift for alertness.Strategic “coffee naps” (see below), not late-night chugging.Respect alcohol’s impact on sleepRecognize that even small to moderate doses degrade sleep architecture.Avoid using alcohol as a “sleep aid”—you’ll fall asleep faster but sleep worse.If you do drink, separate it from bedtime and keep it modest.Optimize food and fluid timingHydrate consistently on shift, but taper fluids ~4 hours before bed to reduce nocturnal bathroom trips.Avoid heavy, spicy, or large meals within 2–3 hours of sleep to decrease reflux and discomfort.Plan a light, balanced “pre-sleep” snack if going to bed hungry keeps you awake.Move your body (but not right before bed)Regular exercise improves sleep depth and latency.Try to avoid intense workouts within 2 hours of bedtime.On shift: micro-movement (stairs, brisk walks between pods, quick stretch sessions) can help alertness without wrecking sleep later.Control light exposureMaximize sunlight or bright light after waking (even if that’s 3–4 pm after a night).Minimize bright light and screens before sleep:Dim lights.Use night mode/blue-light filters if you must scroll.For daytime sleep:Use blackout curtains, tinfoil, cardboard, or sleep masks.Yes seriously use tinfoil if you have to, we talk about it on the podcast episode!Aim for “I might be blind” darkness—so dark you can’t see your hand in front of your face.Dial in your sleep environmentCool room temperature (fan or AC if possible).White noise or sound machine to mask household/traffic noise.Earplugs and eye masks as needed.Bed used primarily for sleep (and sex)—not for charting, doom scrolling, or email.Strategic power napsKeep naps ≤ 20–30 minutes to avoid sleep inertia.Prefer early-afternoon or pre-night-shift naps.Coffee nap strategy:Drink a small coffee.Immediately lie down for a 20–30 min nap.Wake up as the caffeine kicks in, combining nap benefit + stimulant.Thoughtful melatonin useRemember melatonin is a hormone, not a vitamin gummy.Lower doses often work as well as (or better than) large OTC doses.Use it intentionally and intermittently, not as a crutch every night.Over-reliance may reduce your own natural production and its effectiveness over time.Build pre-sleep ritualsRepeated, calming habits signal your body it’s time to downshift:Warm shower, gentle stretching, or yoga.Guided breathing or body scan.Brief journaling or “brain dump” of tasks to get them out of your head and onto paper.Protect from pathologic patternsIf despite consistent effort you:Snore heavily, stop breathing, or gasp in sleep.Feel excessively sleepy driving home or at work.Cannot fall asleep or stay asleep for weeks to months.Consider evaluation for sleep apnea, insomnia, or shift-work sleep disorder with your physician or sleep specialist. ⏩Immediate Action Steps for Before/During/After Your Next Shift 1. **Before the Shift**: Plan a 20–90 minute nap before your first night shift (many clinicians find 3–5 hours earlier in the day is ideal).I treat ED and ICU shifts very differently. I always sleep 3-5 hours before my night shifts aiming for the full 5 (sometimes 6 or more) hours for my ED shifts because you always have to be “on”. Depending on the ICU I’m working in, I may have a bit more downtime so 3 to 5 hours is plenty.Set a caffeine plan: decide in advance when your last dose will be (e.g., none after 2–3 am if sleeping at 8–9 am).Tell your household, “This is my sleep block” and agree on a plan for kids, pets, deliveries, etc.On my calendar, I completely block off time called “Pre-call sleep” so no meetings can be scheduled and then put my phone in airplane mode2. **During the Shift** Hydrate early; taper fluids in the last 3–4 hours of your shift Eat something light but adequate; avoid “last-minute” heavy meals right before sign-out.Build in micro-breaks and movement: one or two short walks, a few stretches, even a quick stair run if safe.Get outside or near a window for a few minutes of light exposure if possible.3. **After the Shift**On the way home:Use sunglasses to reduce bright morning light if you’re aiming for sleep soon.Avoid “just checking” email or messages; shift into wind-down mode.At home:Do a brief, calming decompression (shower, light snack, 10–15 minutes of low-stimulation TV or reading).Make your room cold, quiet, and dark (blackout curtains, tinfoil/cardboard, white noise, fan).Put your phone on Do Not Disturb and physically place it away from the bed.On my calendar, I completely block off time called “Post-call sleep” so again no meetings can be scheduled and then I personally don’t just put my phone on Do Not Disturb but rather in airplane mode and WIFI OFF If you can’t sleep after ~20–30 minutes:Get out of bed, do something calming in dim light (breathing, gentle stretching, journaling).Return to bed when sleepy—this trains your brain to associate bed with sleep, not frustration. Conclusion Rest and sleep are both critical—but they’re not interchangeable. Rest helps you step out of the constant “on” of our jobs, while sleep is the biological intervention that restores your ability to show up safely and sustainably. Rest ≠ sleep. Rest reduces load; sleep repairs your brain and body. You need both, on purpose.As EM and ICU clinicians, we’re trying to perform formula-one-level medicine with engines that often only see half their maintenance. You won’t fix shift work. You can build a sleep system that respects your biology, your schedule, and your life at home.That system starts with valuing sleep, then prioritizing it, personalizing it, trusting the process when it’s imperfect, and actively protecting both your routine and your mindset. 🚨 Clinical Bottom Line Sleep is medicine. Shift work is biologically unnatural. Struggling does not mean you’re weak; it means you’re human fighting physiology. Use your tools deliberately. Caffeine, naps, light, food, movement, melatonin, and environment can be leveraged—or can quietly sabotage you. Build and defend a personalized sleep routine. Communicate it, normalize it, and protect it from casual encroachment. You can’t control every trauma, code, or admission—but you can control how seriously you take your own recovery. Your patients, your team, and your future self all benefit when you do. Further Reading Espie CA. The ‘5 principles’ of good sleep health. J Sleep Res. 2022 Jun; PMID: 34676592Solodar, J“Sleep hygiene: Simple practices for better rest.” Harvard Health, 31 January 2025 Link is HereSuni, E.“Mastering Sleep Hygiene: Your Path to Quality Sleep.” Sleep Foundation, 7 July 2025, Link is Here Meet the Authors Mark Ramzy, DO Co-Editor-in-Chief Cardiothoracic Intensivist and EM Attending RWJBH / Rutgers Health, Newark, NJ Maureen Aiad, DO Assistant Professor of Emergency Medicine NYU Grossman Long Island School of Medicine, New York Amil Badoolah, DO Assistant Professor of Emergency Medicine NYU Grossman Long Island School of Medicine, New York REBEL Core Cast 119.0 – Sleep Hygiene REBEL Core Cast 119.0 – Sleep Hygiene Click here for Direct Download of ... Read More The post REBEL MIND – How to Sleep When the World Says You Can't appeared first on REBEL EM - Emergency Medicine Blog.

Today, we're speaking to Dr Mike Holmes, a GP in Yorkshire and Chair of Nimbuscare, a local GP-led multi-neighbourhood provider.Title of paper: Neighbourhood delivery of urgent care in North Yorkshire, UKAvailable at: https://bjgp.org/content/76/764/133Neighbourhood-based urgent care, led by GP Multineighbourhood providers, can reduce reliance on hospitals and NHS 111. Delivering urgent care in community settings is more cost effective than Urgent Treatment Centre and Emergency Departments attendances. Digital integration and shared clinical systems improve safety, responsiveness, and patient experience. Co-locating operational and clinical teams streamlines service delivery and enables operational and quality oversight. Sustained impact requires recurrent funding and performance measures that reflect system-wide improvement rather than single-provider metrics.

In this episode of PEM Currents: The Pediatric Emergency Medicine Podcast, we take a structured, evidence-based approach to the acute treatment of migraine in children and adolescents. From confirming the diagnosis and screening for concerning features to optimizing outpatient therapy and executing a protocolized emergency department strategy, this episode walks through what works. We review the role of NSAIDs and triptans, clarify how IV fluids and ketorolac fit into care, and provide a stepwise framework for dopamine antagonists, valproate bridge therapy, DHE protocols, steroids, discharge planning, and admission decisions. Practical dosing, reassessment timing, and family-centered communication strategies are emphasized throughout. Learning Objectives Recognize the clinical features of pediatric migraine and distinguish it from secondary causes of headache. Implement a stepwise, evidence-based emergency department approach to acute pediatric migraine, including appropriate medication selection and timing of reassessment. Develop safe discharge and follow-up plans by defining treatment endpoints, minimizing medication overuse, and identifying patients who require referral or inpatient management. References 1. Oskoui M, Pringsheim T, Holler-Managan Y, et al. Practice Guideline Update Summary: Acute Treatment of Migraine in Children and Adolescents: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology and the American Headache Society. Neurology. 2019;93(11):487-499. doi:10.1212/WNL.0000000000008095. 2. Patterson-Gentile C, Szperka CL. The Changing Landscape of Pediatric Migraine Therapy: A Review. JAMA Neurology. 2018;75(7):881-887. doi:10.1001/jamaneurol.2018.0046. 3. Bachur RG, Monuteaux MC, Neuman MI. A Comparison of Acute Treatment Regimens for Migraine in the Emergency Department. Pediatrics. 2015;135(2):232-238. doi:10.1542/peds.2014-2432. 4. Ashina M. Migraine. The New England Journal of Medicine. 2020;383(19):1866-1876. doi:10.1056/NEJMra1915327. 5. Richer L, Billinghurst L, Linsdell MA, et al. Drugs for the Acute Treatment of Migraine in Children and Adolescents. The Cochrane Database of Systematic Reviews. 2016;4:CD005220. doi:10.1002/14651858.CD005220.pub2. Transcript This transcript was generated using Descript automated transcription software and has been reviewed and edited for accuracy by the episode's author. Edits were limited to correcting names, titles, medical terminology, and transcription errors. The content reflects the original spoken audio and was not substantively altered. And today we're gonna talk about the acute treatment of migraine headache in children and adolescents. This is bread and butter for the PED, requires precise diagnosis and evidence-based treatment. We're gonna talk about making that diagnosis, red flags, outpatient and ED treatment, as well as some second-line agents, admission decisions, and a whole lot more. So migraine in children is defined by three criteria, and at least five attacks lasting two to 72 hours. So you gotta have at least two of the following: pulsating or throbbing quality, moderate to severe intensity, aggravation by routine activity, and a unilateral location. Although in children, it's often bilateral, plus at least one of nausea or vomiting and photophobia and/or phonophobia. In children headaches are frequently bilateral, bifrontal, bitemporal. The duration might be shorter than adults, especially in kids under second or third grade. And you may have to infer whether or not they have photophobia from their behavior. Like does the child close their eyes or wanna go into a dark room? In the emergency department, we're often diagnosing based on pattern recognition plus exclusion of dangerous secondary causes. Or even more often than that, the patient comes in and says, I've got a migraine. Before I move on to treatments, let's talk about some red flags where you might wanna pause and not just jump to migraine therapy. And the mnemonic SNOOP can be helpful here. And it stands for S for systemic symptoms such as fevers, myalgia, weight loss, or another S, secondary risk factors such as an immune deficiency, cancer, pregnancy, N for neurologic signs, papilledema, focal deficit, confusion, seizures. O onset sudden, or thunderclap. Migraines are often a little more gradual than that. The other O is older age, or technically younger age too, younger than five years or older than 50. Hopefully those patients are not coming into the pediatric emergency department. And then pattern changes, these new symptoms in a previously stable pattern. Don't ignore that. And precipitants, you know, is it worse with Valsalva, position change, or under significant exertion? If these signs are present, you'll probably wanna take a pause and just not throw migraine treatment at the patient. If they're stable, MRI is the preferred imaging modality, but a very sick patient, it'd be okay to get a head CT. If you've got a normal neurologic exam, there's no red flags. Again, you don't need routine imaging for migraine headaches. So let's talk about treatment. So hopefully patients have actually started to treat their headache before they arrive in the emergency department. If they haven't, it's a good idea to have some triage protocols in place. So ibuprofen, 7.5 to 10 milligrams per kilogram, 10 milligrams per kilogram is superior to placebo and it's superior to acetaminophen at two hours. So that's what we would use. Early treatment's critical. So ideally within the first hour of onset. So that's why triage protocols help. We'll give kids 10 mg per kg of ibuprofen and like 30 ounces of Gatorade. Blue is often the first Gatorade choice, though that's not an evidence-based statement. You can also use naproxen, but most of the studies are on ibuprofen. If NSAIDs fail, many adolescents and some older children will be prescribed triptans. The best evidence currently supports sumatriptan plus naproxen or zolmitriptan nasal spray. Rizatriptan is FDA approved down to age six. Adolescents respond to these agents better than younger children, and the route matters. The nasal formulations help when nausea is prominent. Families should be counseled to treat early, use weight-appropriate dosing, and avoid using acute medications more than 10 days per month. Often patients will have already taken an NSAID and a triptan before they get to the ED, and that's where we get into the treatment of refractory migraine. Now this is most of the patients that I will see, and before we push medications, let's briefly review ED treatment goals. You either want the patient headache free. Back to their baseline or mild descending pain. So a pain score of one to three. If you don't reach one of those endpoints and it's not agreed upon with the patient and their family, you've not completed treatments. You should do a reassessment within one hour after each intervention. And let's face it, if you're not reassessing within an hour and defining treatment goals, you're not practicing protocolized migraine care. So in the emergency department, many of you may be familiar with the migraine cocktail. So what is that? In general, it's a dopaminergic agent such as prochlorperazine or metoclopramide plus ketorolac, plus IV fluids. Let's take a look at all three of those components and see if you can guess which one is actually the one that can abort the migraine. So fluids are commonly given in pediatric migraine, but they alone do not treat it. They're helpful. Many patients have been throwing up or a bit dehydrated, but there are small randomized trials that show essentially no meaningful pain reduction in patients that get IV fluids alone. Well, what about ketorolac? Toradol, like that's the first thing you give to a kid with a kidney stone, right? It does help, but it's really adjunctive. So the main first-line agents for refractory or status migrainosus in the emergency department are the dopamine antagonists, and the first-line treatment for most patients is prochlorperazine or Compazine. The dose is 0.15 milligram per kilogram IV. The max is 10 milligrams. This is the backbone of ED migraine care. And why do they work? Well, migraines aren't just some random vascular headache. This is an inherited disorder with central pain pathways gone awry. Dopamine plays a large role in that pain, nausea, hypersensitivity, amplification of symptoms and more that, frankly, I won't get into this podcast because molecules hurt my head. The dopamine antagonists treat the headache, they reduce the nausea, and they just tamp down this process. Overall, the response rates approach 85%. Some studies have suggested that the response rate is about 77% at an hour and 90% at three hours. If you add the ketorolac and IV fluids, you get your response rate up to about 93 to 94%. These agents really do work well together. There have been randomized trials comparing IV prochlorperazine versus ketorolac. 85% of prochlorperazine patients achieved headache relief versus only 55% of ketorolac patients. So ketorolac helps, but really it's the prochlorperazine. Metoclopramide, or Reglan, is used in a lot of centers as well. There are some smaller studies in children and adolescents that show that prochlorperazine is more effective, but if kids have an adverse reaction, more on that in a moment, or they prefer metoclopramide because they've responded to it in the past, it's okay to go with it as well. Right. So what does it actually look like when you give the migraine cocktail to a patient? I think it's important to explain to patients and families what to expect, and if this is a teenager, I'm talking to them directly. I mean, they're getting the medication first and foremost. I tell them that the most effective way to treat their headache is with an IV. This often causes lots of angst, even in older teenagers. The medication just does not get to the brain as effectively and fast enough if you take it by mouth. Many patients who get the dopaminergic agents, so prochlorperazine, will invariably feel jittery or anxious or like they gotta move or like they got ants in their pants. I tell them to expect this so they're not surprised and worried when it happens. I tell them that once they start feeling that way, it means the medicine is probably working. They need to hit the nurse button and we're gonna get them up and have them take a walk. This fixes it for the majority of patients just getting up and moving. In adult centers, even with the initial administration of the prochlorperazine or as sort of a reflexive response to any of those symptoms, they just give a slug of IV Benadryl. There's some studies in adolescents especially that this may decrease the effectiveness of the IV agents you're giving in the first place, and it may also increase return rates to the ED. So I will use IV diphenhydramine if getting up and moving around isn't working, or if the distress is significant, or if the patient clearly indicates they've needed it in the past. So if after the migraine cocktail, the patient has met their pain goals and the reassessment is favorable, they can go home to outpatient follow-up. How about if the headache got better, but not all the way? It's usually when the initial migraine cocktail didn't achieve the pain endpoints fully, like it helped partially. If the dopamine blockade didn't do anything, valproate is unlikely to rescue the case. And so valproate works on GABA and it stabilizes some of these pain processes, but the dopaminergic agent needs to have done something first for valproate to work. Per the most common protocol, you give an initial dose of IV valproate, then you discharge the patient home on Depakote ER. So oral valproic acid under 10 years old or under 50 kilograms, 250 milligrams PO twice a day for two weeks, or older than 10 or greater than 50 kilos, 500 milligrams twice a day for two weeks. This is the extended release and it's most helpful if you give the first oral dose in the emergency department. So that's why it's very important to build this protocol in advance. If you don't have IV valproate, then don't just give the patient oral valproate, and definitely don't prescribe an oral course for discharge. All right, well, what about DHE? Dihydroergotamine for refractory or status migrainosus? Generally, this is only given at pediatric centers where you have neurology coverage. It's contraindicated if you've had another dose of DHE within 14 days, or you've had any triptan of any sort within 24 hours, and you must obtain a pregnancy test in adolescent females before giving it. The dosing for less than 30 kilograms is 0.5 milligram. At least 30 kilograms is one milligram. You give 50% of the dose over three minutes, then the remaining 50% over 30 minutes. If this is gonna work, the patients are gonna start feeling wretched at first. They're gonna get very nauseous and they're gonna vomit. They're gonna have flushing, and you'll see transient hypertension. Most of that resolves within the hour in most centers. If you're committing to DHE, you're kind of bringing the patient into the hospital anyway, though some facilities will have DHE done in the emergency department with close outpatient follow-up. Either way, it's really best practice to involve child neurology if you're giving DHE. Alright, well what about steroids? They give those in grownups too, right? Steroids really only have a role for recurrence prevention in children. So for kids that have a history of returning within 72 hours for rebound headache, you can give dexamethasone 0.6 milligram per kilogram IV dose, the max of 10 milligrams. You do not discharge them home on a steroid prescription or a Medrol dose pack or something else, and this can cut the recurrence risk down a bit. There's other therapies out there like magnesium and ketamine. There's just not enough evidence there. And the purpose of this episode is to discuss the therapies that have good evidence behind them and should be part of protocols across the country. Some patients are unfortunately not responsive to emergency department therapy and need admission. The main inpatient therapy is the DHE protocol. If they're not DHE eligible, they haven't tolerated it well or it's unavailable, admission's unlikely to help them unless they just need some IV fluids to help them get back up on their feet. You should consult neurology if the headache goals are not met after maximizing ED therapy for advice. And we should definitely avoid opioids. They don't treat patients with migraines. They increase recurrence risk. They increase revisit rates. Again, the dopamine antagonist prochlorperazine, it's superior for sustained relief when families ask about them, and fortunately they're asking about opioids far less. We use medications that treat the migraine pain pathways and signaling. We don't just wanna mask the pain. All right, so that's all I've got on the acute management of migraine headaches, especially in the emergency department. Remember that migraine care in the ED should be protocolized and evidence-based. IV fluids are supportive. Prochlorperazine is the first line, or you can use metoclopramide as well. Ketorolac is an adjunctive therapy. Valproate is next line. If you've gotta escalate, and DHE is specialized therapy, you can start in the ED, but most of these patients are getting admitted. Dexamethasone or steroids in children can reduce recurrence risk, but they're not really part of the acute management. You should definitely define the endpoints and structurally and systematically reassess patients at an hour. The goal is to get them feeling better to a defined endpoint and to restore function. There is evidence-based pediatric emergency migraine care. You should understand that, plus how to explain why these agents are being given and some of the side effects to patients and families. I find that that approach increases your likelihood of buy-in and success. Alright, so that's it for this episode on the Acute Management of Migraine Headaches in Children and Adolescents. I hope you found it helpful and I can pretty much guarantee that you're gonna see a patient with a migraine on your next shift. If you've got any feedback or comments, send them my way. If you like this episode, leave a review on your favorite podcast site. It helps more people find the show. Or recommend it to a colleague. If there's other topics that you'd like to hear, send them my way for the Pediatric Emergency Medicine podcast. This has been Brad Sobolewski. See you next time.    

Tonight on NJ Spotlight News, New Jersey is responding after President Trump, together with Israeli leaders, carried out major combat operations in Iran this weekend.   Also, the state's facing a $3 billion dollar deficit, we talk with the Republican Budget Officer who's been warning of this for years.   Plus, the Emergency Department at Heights Hospital is set to close in Jersey City. Local leaders says it's a critical service for the community.    And, is your school district using proven methods to teach reading? Many aren't. We'll discuss why.

What if the most powerful clinical tool in healthcare wasn't a drug, a device, or a data platform — but a word? In this episode of Experiencing Healthcare, Jamie and Matt have a conversation that starts with Disney World germs and ends with something that will change the way you lead your team tomorrow. They unpack the idea of Intentional Positive Reinforcement — not the hollow "great job" you throw over your shoulder in the hallway, but the kind of deliberate, meaningful recognition that creates a ripple effect all the way to the patient's bedside. Matt shares what a dental hygienist taught him about doing things right, why a pair of clicking heels in a nursing home hallway was actually a leadership strategy, and what happens to a healthcare team that only ever hears what they're doing wrong. This is a conversation for the bedside nurse and the C-suite executive. For the credentialing specialist who never sees a patient and the clinical coordinator who sees dozens. Because in healthcare, everyone plays a role in the patient experience — and the way we lead people determines the care those people deliver. If you've ever wondered whether your words are adding to your team or subtracting from them, this episode is your answer.

In this episode of The Gritty Nurse Podcast with host Amie Archibald-Varley, she interviews fellow nurse, Danielle Gibbs Koenitzer. Danielle recounts her experience presenting to the Emergency Department at St. Thomas Elgin General Hospital—the very institution where she served as a nurse. Despite her clinical background as an emergency room nurse and professional ties to the facility, Danielle's care was marked by significant gaps, dangerous dismissal of her symptoms and pain. and questions concerning racial bias and health equity.  Her experience is not an anomaly, but a reflection of a documented public health crisis. In Canada, studies show that Black patients are 22% less likely to receive any pain medication compared to white patients, and many healthcare providers still hold the dangerous, non-evidence-based belief that Black people have a higher pain threshold. These biases often lead to misdiagnosis and medical neglect, where symptoms are ignored until they reach a point of no return. The conversation moves beyond the clinical errors to address the institutional silence that followed. Danielle discusses her ongoing efforts to seek accountability from the hospital's leadership team, who have yet to provide substantive answers or engage in a meaningful quality improvement process. This is a factual look at the systemic barriers Black women face in healthcare and the breakdown of institutional responsibility when patients demand transparency. Black women do not seek justice and accountability only during the month of February, but every day they navigate a system that fails them. Episdoe EDIT: @10:37 Danielle says 180 cm, she meant to say 180cc of fluid. Takeaways Danielle's journey into nursing was influenced by her mother's advice. She has worked in various nursing roles, including critical care and education. Danielle experienced severe pain after a medical procedure but faced challenges in receiving adequate care. Her experience highlights systemic failures in healthcare, particularly for Black women. Racial bias plays a significant role in how pain is perceived and treated in healthcare settings. Danielle's colleague had a vastly different experience at the same hospital, raising concerns about racial disparities. The healthcare system often dismisses the pain of women, especially women of color. Education on racial bias in healthcare is crucial for future providers. Advocacy for patients is essential, but can be difficult for those within the system. There is a need for co-conspirators to address and change systemic issues in healthcare. Keywords: nursing, healthcare, racial bias, pain management, advocacy, systemic issues, black women, healthcare disparities, patient experience, interventional radiology Chapters 00:00 Introduction to Danielle's Journey 02:25 The Painful Experience: A Personal Story 05:04 Systemic Issues in Healthcare for Black Women 07:46 Racial Bias in Pain Management 10:42 The Aftermath: Seeking Accountability 13:03 Reflections on Healthcare Inequities 21:38 Addressing Racial Bias in Healthcare 25:21 The Challenges of Self-Advocacy in Medicine 27:15 The Need for Systemic Change in Healthcare 32:00 Empowering Patients and Advocates 35:34 The Call for Co-Conspirators in Healthcare Reform * Listen on Apple Podcasts – : The Gritty Nurse Podcast on Apple Apple Podcasts  https://podcasts.apple.com/ca/podcast/the-gritty-nurse/id1493290782 * Watch on YouTube –  https://www.youtube.com/@thegrittynursepodcast Stay Connected: Website: grittynurse.com Instagram: @grittynursepod TikTok: @thegrittynursepodcast Facebook: https://www.facebook.com/profile.php?id=100064212216482 X (Twitter): @GrittyNurse Collaborations & Inquiries: For sponsorship opportunities or to book Amie for speaking engagements, visit: grittynurse.com/contact Thank you to Hospital News for being a collaborative partner with the Gritty Nurse! www.hospitalnews.com 

In this episode, Jacqueline Hong and Kuljeet Chohan interview Dr. Bilal Akil, an Emergency Physician, Trauma Team Leader, Medical Director, and Assistant Professor at the Schulich School of Medicine & Dentistry. Dr. Akil is also a co-founder of a CFMS partner, MCCQBank. Dr. Akil shares a day in his life, reflects on the current state of emergency medicine, and discusses his perspective on the future of AI in the emergency department.He also offers practical advice for medical students on making the most of their ED rotations, what defines a great emergency physician, and how to effectively prepare for the Medical Council of Canada Qualifying Examination, a required step for all Canadian physicians.----Produced by Ahad Daudi, Jacqueline Hong, Sarah Almasaad, and Kuljeet Chohan.Music provided by https://freebeats.io (produced by White Hot).

Emergency Department–Initiated Buprenorphine for Opioid Use Disorder JAMA Network This multicenter randomized study examined if 7-day extended-release injectable buprenorphine compared with sublingual buprenorphine to improve treatment engagement at 7 days.  It included 1,994 adult patients presenting to the emergency department with untreated opioid use disorder and a Clinical Opiate Withdrawal Scale (COWS) score of 4 or higher.  In treatment at 7 days, 40.5% were in the extended-release group and 38.5% were in the sublingual buprenorphine group, demonstrating no significant difference between groups. The study concluded that a 7-day extended-release injectable preparation of buprenorphine does not improve treatment engagement.   Read this issue of the ASAM Weekly Subscribe to the ASAM Weekly Visit ASAM

In this episode, Dr Grace Xu discusses the critical role of peripheral intravenous catheters (PIVCs) in emergency departments, highlighting the challenges and current practices in insertion techniques. With over 20 years of experience, Dr Xu emphasizes the need for improved training, patient involvement, and evidence-based practices to enhance patient care and reduce complications associated with PIVC insertions. The conversation covers the importance of understanding the unique challenges faced by patients with difficult venous access and the need for a systematic approach to improve outcomes in emergency care.

Not sure whether to visit the Emergency Department or Physicians Care Express? You're not alone.In this episode, Rachel Martin, BSN, RN, explains the differences and helps you understand where to go for the care you need. Learn when it's an emergency and when a quick visit to Physicians Care Express is the right fit.When in doubt, it's always okay to seek care.

A first impression is usually formed within the first 7 secondsof an interaction (Harvard Study of Communication); it takes as little as 56 seconds to make a meaningful connection (Christina Dempsey, the former Chief Nursing Officer of Press Ganey); providers usually interrupt a patient within11-30 seconds of when they start speaking (2018 study published in the Journalof General Internal Medicine).In this episode, Dr. Stephanie McDonald meets with Michelle Lundy, a nurse practitioner at Atrium Health Wake Forest Brenner Children's Emergency Department, about her sit and hear project.

🧭 REBEL Rundown 📌 Key Points 🔍 Understanding the Why: The significance of understanding underlying causes, beyond initial diagnoses, in both sports and emergency medicine is explored. ⏱️ Recovery Focus: Emphasizing the importance of recovery time and small daily choices in optimizing performance for both athletes and emergency physicians. 📊 Data-Driven Insights: The Arena Labs approach uses personalized data, leveraging wearable technology and expert coaching to tackle burnout and enhance well-being. 🤝 Personalization and Partnership: Arena Labs’ collaboration with emergency clinicians sheds light on personalized performance solutions rooted in scientific evidence. Click here for Direct Download of the Podcast. 📝 Introduction Welcome back to REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. In this episode, we’re excited to continue collaboration with Arena Labs, where host Dr. Mark Ramzy interviews Allyn Abadie, Arena Labs’ Principal Scientist on how we can apply performance science in and out of the emergency department. Arena Labs is helping us measure healthcare performance through innovative programs designed to combat burnout and enhance personal wellness using data-driven strategies. 🔙Previously Covered on REBEL MIND: Performance Under Pressure – What Medicine Can Learn from Elite TeamsThe Power of Performance Coaching in MedicineRest Is Not Sleep: The Seven Dimensions of True Recovery 🤔Cognitive Question How can emergency department clinicians utilize techniques inspired by athletic performance to better manage stress, prevent burnout, and optimize recovery? 💭 Why This is Important Burnout among healthcare workers is a growing concern, especially in such high-pressure environments as emergency and intensive care units. The collaboration with Arena Labs brings forth a vital focus on using data and coaching to build resilience among medical professionals. 🏥How This Applies to the Emergency Department or ICU? Emergency medicine, akin to high-performance sports, demands intense energy and quick decision-making under pressure, often leading to stress and burnout. By applying principles from athletic recovery and personalized data tracking, clinicians can moderate their performance intensity, enhance their recovery even in short breaks, and prevent long-term burnout. This approach allows emergency physicians to maintain endurance and clarity, improving patient care and team dynamics. ⏩ Things You Can Do on Your Next Shift Measure and Reflect: Start tracking your vital health metrics like heart rate with wearable sensors. Reflect on how daily activities impact these measurements to identify stress patterns.Implement Quick Recovery Techniques: Use short, actionable exercises such as deep breathing or the de-stress breath method between patient encounters to moderate stress levels.Invest in Self-Care: Dedicate brief time slots for essential self-care activities like hydration or quick reflection journaling, aiming to enhance mental resilience throughout your shift.Utilize Coaching Tools: Engage with personalized coaching apps or resources that offer science-backed recovery strategies tailored to your personal and professional needs. 👀 Where to Learn More Intrigued by the possibilities this partnership offers? You can explore more by visiting Arena Labs’ website here. Also, check out the comprehensive coaching program available, designed specifically for healthcare providers looking to enhance their well-being and performance. 🚨 Clinical Bottom Line In an era where burnout is pervasive, our collaboration with Arena Labs offers a beacon of hope for healthcare workers. By leveraging cutting-edge data insights and practical coaching, this partnership aims to redefine healthcare wellness, fostering a sustainable, resilient workforce that’s equipped to navigate the pressures of modern medicine. Join us in this journey towards enhanced well-being and workforce empowerment, ensuring that those who care for us are also cared for. Meet the Authors Mark Ramzy, DO Co-Editor-in-Chief RWJBH / Rutgers Health, Newark NJ Allyn Abadie Principal Scientist Arena Labs REBEL MIND: Applying Performance Science In and Out of the Emergency Department In this episode, we're excited to continue collaboration with Arena Labs, where host ... Human Behavior Read More REBEL Core Cast 150.0: Emergency Medicine Consults: How to Call a Consult + Handle Pushback (With Scripts) Consults aren’t a formality—they’re a patient-care intervention. In this post, Swami breaks down ... Read More REBEL MIND – Rest Is Not Sleep: The Seven Dimensions of True Recovery Today we are exploring the imperative topic of rest and why it’s not ... Human Behavior Read More REBEL MIND: The Power of Performance Coaching in Medicine In this episode, we're excited to continue collaboration with Arena Labs, where host ... Human Behavior Read More REBEL MIND: Performance Under Pressure – What Medicine Can Learn from Elite Teams Welcome back to Rebel MIND, the podcast where we sharpen the person behind ... Human Behavior Read More REBEL MIND – The Dunning Kruger Effect: Why Looking Inward Improves Patient Care In this episode and blog post, hosts Mark Ramzy and Kim Bambach (Assistant ... Human Behavior Read More The post REBEL MIND: Applying Performance Science In and Out of the Emergency Department appeared first on REBEL EM - Emergency Medicine Blog.

A new survey has shown overwhelming support for the Government to urgently progress with plans for a new Emergency Department in the MidWest. The assessment carried out by the MidWest Hospital Campaign received 2,567 public responses between December and January alone. Over 93% of respondents said they wanted to see HIQA's option C progressed at the same time as Options A and B which involve increasing capacity on the University Hospital Limerick campus and developing another site nearby. MidWest Hospital Campaign Spokesperson Marie McMahon says the will of the people needs to be respected.

We've all seen it: the patient whose chart is “flagged” with a penicillin allergy, but when you dig into the history, the story doesn’t quite add up. Maybe it was a stomach ache in the 90s, or maybe they're just carrying a “inherited” allergy from a parent. In this episode of EM Pulse, we sit down with ED Clinical Pharmacist Haley Burhans to discuss why these labels are more than just a nuisance—they're a clinical liability—and how a simple tool can empower you to fix them on the fly. The Hidden Danger of the “Safe” Choice Choosing a non-beta-lactam antibiotic because of a questionable allergy label feels like the path of least resistance, but the data tells a different story. We explore how “playing it safe” can actually lead to: Worse Outcomes: Why second line antibiotics often mean higher treatment failure rates. The “Superbug” Factor: The surprising link between penicillin allergy labels and the rise of MRSA and VRE in our communities. The C. diff Connection: Why alternative choices might be setting your patient up for a much more difficult recovery. The Solution: The PEN-FAST Score How do you move from “I think this might not be a true allergy” to “I am confident this antibiotic is safe”? Haley introduces the PEN-FAST score, a validated scoring tool designed to risk-stratify patients based on a few key historical questions. The Mnemonic: We break down the PEN-FAST acronym so you know exactly which three questions to ask to risk-stratify your patient in seconds. IgE vs. The Rest: Learn to distinguish between the “true” dangerous hypersensitivity and the delayed reactions that shouldn’t stop you from using the best drug for the job. The “Amoxicillin Rash”: We dive into this common pediatric “gotcha.”, why many kids end up with a lifelong allergy label after a routine ear infection, and why it often has nothing to do with the drug itself. The Bottom Line: Patients with low PEN-FAST scores are considered low risk, making an oral challenge under observation in the ED a reasonable option. Higher scores may require shared decision-making or referral. Why the ED is the Perfect Place for a “Challenge” Delabeling isn’t just for the allergist’s office. We argue that the Emergency Department is actually the ideal setting to challenge these allergies. The “Oral Challenge”: Learn the practical steps for performing a trial dose in the department. Safety First: Why your environment and expertise make you uniquely qualified to handle the “what-ifs” better than anyone else. Key Takeaways Question the Label: The vast majority of reported penicillin allergies are inaccurate due to patients outgrowing the allergy or misinterpreting common side effects as allergic reactions. History is Everything: Dig deeper than just “rash.” Ask about the timing relative to the dose, specific appearance (hives vs. flat rash), and what treatment was required (epinephrine vs. antihistamines). Use PEN-FAST: Utilize this tool to objectify the risk. Document Tolerance: Even if you don’t fully delete the allergy label, if you successfully treat the patient with another beta-lactam (like ceftriaxone), document that tolerance clearly to aid future clinicians. Cephalosporins are likely safe: Later-generation cephalosporins generally have very low cross-reactivity and are usually safe options even in truly allergic patients How do you handle documented penicillin allergies? Do you use the PEN-FAST tool? Share your experience with us on social media @empulsepodcast or at ucdavisem.com Hosts: Dr. Julia Magaña, Professor of Pediatric Emergency Medicine at UC Davis Dr. Sarah Medeiros, Professor of Emergency Medicine at UC Davis Guests: Haley Burhans, PharmD, Emergency Medicine Clinical Pharmacist at UC Davis Resources: PEN-FAST Score on MDCalc Penicillin Allergy Evaluation Should Be Performed Proactively in Patients with a Penicillin Allergy Label – A Position Statement of the American Academy of Allergy, Asthma & Immunology Staicu ML, Vyles D, Shenoy ES, Stone CA, Banks T, Alvarez KS, Blumenthal KG. Penicillin Allergy Delabeling: A Multidisciplinary Opportunity. J Allergy Clin Immunol Pract. 2020 Oct;8(9):2858-2868.e16. doi: 10.1016/j.jaip.2020.04.059. PMID: 33039010; PMCID: PMC8019188. Yang C, Graham JK, Vyles D, Leonard J, Agbim C, Mistry RD. Parental perspective on penicillin allergy delabeling in a pediatric emergency department. Ann Allergy Asthma Immunol. 2023 Jul;131(1):82-88. doi: 10.1016/j.anai.2023.03.023. Epub 2023 Mar 27. PMID: 36990206. *** Thank you to the UC Davis Department of Emergency Medicine for supporting this podcast and to Orlando Magaña at OM Productions for audio production services.  

In this episode, Dr. Lisa Fort, Assistant Chief Medical Information Officer at Ochsner Health, discusses how her team is using virtual care to reduce emergency department overcrowding and streamline patient care. She shares insights on integrating technology, improving care transitions, and creating a patient-centric approach across the health system.

This episode is an absolute cracker! And we can say that as we've got outsider help... We've all been involved with patients where securing the airway with a prehospital anaesthetic feels intuitively right; the patient with a severe head injury after a fall from height, the unrestrained driver in a high-speed collision with devastating chest injuries, or the patient with significant maxillofacial trauma following assault. In these situations, advanced airway management appears clearly beneficial. What remains a bit ambiguous is the effect of that intervention. Does it play out into a mortality benefit and if so how should we redesign systems to meet a 24 hour need for this (with many prehospital critical care services not being available fully around the clock), bearing in mind competing financial priorities for optimum health care. Maybe it's okay that for some patients the anaesthetic is delayed to the Emergency Department? Worldwide, trauma accounts for an estimated 4.4 million deaths annually and carries a substantial economic burden. Despite decades of improvements in trauma systems, medications such as tranexamic acid, and the development of prehospital critical care teams, some key aspects of trauma care remain really difficult to study well. Prehospital emergency anaesthesia is a prime example. It is time-critical, ethically complex, highly operator dependent and almost impossible to study using conventional randomised trial designs. As a result, clinicians have largely been forced to rely on observational studies, despite the well-recognised problems of bias and confounding that accompany them. In this episode, we explore the existing evidence base and then focus on a landmark new study published in The Lancet Respiratory Medicine. This paper applies machine-learning techniques to a large UK trauma dataset to address the question; does prehospital intubation improve survival in patients who are predicted to need early airway intervention? We walk through how the authors developed a predictive model to identify high-risk patients, how doubly robust estimation was used to move beyond simple association, and how survival and health-economic outcomes were assessed. The results suggest a clinically meaningful reduction in 30-day mortality for selected high-risk trauma patients who receive prehospital intubation. And we're then joined by two of the study's authors, Amy Nelson and Julian Thompson. Together, we explore what these findings may mean for the future of prehospital emergency anaesthesia, how we should think about evidence in complex emergency care environments, and whether this type of analytical approach could reshape trauma research more broadly. Once again we'd love to hear any thoughts or feedback either on the website or via X @TheResusRoom! Simon & Rob

In this episode, Dr. Lisa Fort, Assistant Chief Medical Information Officer at Ochsner Health, discusses how her team is using virtual care to reduce emergency department overcrowding and streamline patient care. She shares insights on integrating technology, improving care transitions, and creating a patient-centric approach across the health system.

Dr. Codi Peterson is a pediatric pharmacist with over a decade of experience specializing in acute care and pediatric emergency medicine. He currently serves as a clinical pharmacist at Rady’s Children’s Health of Orange County, where he works night shifts in the Emergency Department and applies his expertise to optimize medication safety and therapeutic outcomes in children. Beyond the hospital, Codi is deeply committed to education and mentorship. He is an Associate Clinical Professor at the University of California, Irvine, where he teaches cannabis pharmacology and therapeutics, and a guest lecturer at OCEMT, instructing paramedics and firefighters in applied pharmacology. He is also an active researcher on Cannabinoid Hyperemesis Syndrome (CHS), having led one of the largest patient surveys on the condition to date. At CannMed 26, Codi will share the results of that study in a presentation titled, “Through the Eyes of a Patient: Integrating Story and Science to Demystify CHS”.  During our conversation, we discuss:  Defining CHS and explaining why it is difficult to research  Cannabis use patterns among CHS sufferers  Whether contaminants and pesticides play a role in developing CHS  The prodromal phase and early warning signs of CHS  Sex-based differences in CHS patients  Understanding the biological mechanisms behind the development of CHS  and more Thanks to This Episode’s Sponsor: The Cannigma  The Cannigma takes an evidence-based approach to cannabis content – from safety to cooking to medical research – and makes all the information digestible and useful. They are committed to making sure scientific information is accessible to anyone who needs it – be it to relieve their own suffering or that of a loved one, to learn a bit more, or even just for fun.  Learn more at cannigma.com  Additional Resources Surveying Cannabinoid Hyperemesis Syndrome Patients with Megan Mbengue and Codi Peterson [Video] Cannabinoid Hyperemesis Syndrome What You Need to Know [Video] what-is-chs.com Connect with Codi (Instagram, LinkedIn) The Cannigma Register for CannMed 26 – Early Bird Ends February 20th!

The Midwest Hospital Campaign has slammed comments from a government TD suggesting that a new hospital for the region will be built in Limerick. It follows a social media video by Fianna Fáil's Willie O'Dea, which indicates the Health Minister is pressing ahead with plans to deliver a new hospital on a greenfield site near University Hospital Limerick. Last September, HIQA issued three recommendations to solve hospital overcrowding in the Midwest, including a proposal to build a new Emergency Department. Midwest Hospital Campaign Founder Hilary Tonge says Clare's TDs need to clarify if a location has been decided.

🧭 REBEL Rundown 🔑Key Points 🛌 Rest isn’t a luxury; it’s a necessity and differs significantly from sleep in terms of mental and physical recovery needs.🧠 Uncovering the seven types of rest can highlight diverse needs: physical, mental, sensory, creative, emotional, social, and spiritual.🏃‍️ Rest from high-stress environments such as the ED is crucial for reducing exhaustion, enhancing decision-making, and maintaining empathy.🔄 The necessity for intentional rest: tailor your rest strategies to meet personal recharge needs effectively.🧐 Rest should be deserved, not earned—it’s a vital component of overall health and wellness, on par with nutrition and hydration. Click here for Direct Download of the Podcast. 👀Previously Covered and Related Content: REBEL Core Cast: Sleep HygieneRebellion in EM: Care For Yourself – Sleep HygieneFirst10EM: Some Evidence For Working Night ShiftsREBEL MIND: Dunning Kruger Effect 📝 Introduction Welcome to this episode of REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. Today we are exploring the imperative topic of rest and why it’s not just about sleeping. The first of a two part series, hosted by Dr. Mark Ramzy with guests Dr. Maureen Aiad and Dr. Amil Badoolah, our discussion sheds light on the multifaceted nature of rest, especially in the demanding field of emergency medicine. If you’re a clinician striving to perform at your best under pressure, this episode offers valuable insights into achieving the rest you deserve. Cognitive Question How do healthcare professionals in high-stress environments distinguish between rest and sleep, and how can they effectively incorporate various types of rest into their routines to manage stress and improve performance? 💤How is Rest Different From Sleep? Sleep is biological. It’s essential—but it’s only one form of recovery.Rest, on the other hand, is intentional, multifaceted, and active. You can sleep for 8 hours and still feel depleted—because what you needed wasn’t sleep, it was rest—in a different dimension. 🏥How This Applies to the Emergency Department or ICU? In the fast-paced, high-pressure world of the ED or ICU, medical professionals often overlook the importance of rest, perceiving it as unproductive. Yet, rest is crucial for maintaining cognitive function and emotional resilience. The unique concept of rest outlined in the ‘seven types of rest’ can be particularly beneficial. Understanding and implementing these can help practitioners handle the rigors of patient care and decision-making more effectively. 7️⃣The Seven Types of Rest 1️⃣Physical Rest: Passive (like sleep) and active (like stretching, massage, gentle movement).2️⃣Mental Rest: Reducing decision fatigue. Tools like brain dumping, meditation, or taking real breaks during work.3️⃣Sensory Rest: This involves reducing the input from your senses, such as limiting screen time, turning off the lights, or enjoying quiet time.4️⃣Creative Rest: Reconnecting with awe. Nature, art, music—things that refill your inspiration tank5️⃣Emotional Rest: Being around people you don’t have to perform for. Saying “I’m not okay.” spaces and people where you can be your authentic self and be at peace6️⃣Social Rest: Taking space from draining interactions; spending time with life-giving people. 7️⃣Spiritual Rest: Connection to a greater purpose—faith, community, reflection, meditation ⏩Immediate Action Steps for Your Next Shift **Identify Your Rest Needs**: Reflect on what kind of fatigue you’re experiencing and tailor rest activities accordingly, whether it’s sensory detox or emotional unwinding.**Practice Sensory Rest**: Take brief moments to close your eyes, or step outside for fresh air to manage overstimulation during shifts.**Plan Intentional Breaks**: Schedule specific times for rest that focus on particular dimensions you identify as lacking.**Engage in Active Rest**: Incorporate activities like stretching or meditation during your breaks to enhance mental clarity and reduce physical exhaustion.**Connect with Supportive Colleagues**: Seek interactions with peers who offer emotional and social support, promoting a healthy work-life balance. 🛌🏽The Many Aspects of What Makes Up Rest Rest is multifaceted – it comes in more than one formRest is productive – it improves performance, decision-making, empathyRest is intentional – it requires thoughtful engagement, not autopilot. Make a real planRest is layered – especially sensory, which uses all 5 sensesRest is about input and detox – what you consume, and what you remove. Social rest is a good exampleRest is personal – one person’s recharge is another’s stressorRest is deserved, not earned – full stop. Conclusion Rest is a pivotal, multi-dimensional tool that extends beyond mere sleep. For healthcare professionals navigating the strenuous environment of an emergency setting, recognizing and implementing varied forms of rest can enhance overall well-being, decision-making, and patient care. Make rest a deliberate part of your routine, understand its different forms, and remember that it’s a necessity you deserve. 🚨 Clinical Bottom Line Incorporating rest into your lifestyle aligns with the demands of your professional roles and personal health needs. By understanding and employing various types of rest, you not only support your individual wellness but also enhance your ability to care for patients effectively. Rest is vital; it is not a privilege earned but an essential right you deserve every day. Further Reading Dalton-Smith, S. Sacred Rest: Recover Your Life, Renew Your Energy, Restore Your Sanity. Hachette Nashville, 2017.Dalton-Smith, S.The 7 Types of Rest: Seven Ways to Live a More Energized Life. Hachette Book Group, 2022Abramson, A“Seven types of rest to help restore your body’s energy.” American Psychological Association, 6 May 2025, Link is Here Meet the Authors Mark Ramzy, DO Co-Editor-in-Chief Cardiothoracic Intensivist and EM Attending RWJBH / Rutgers Health, Newark, NJ Maureen Aiad, DO Assistant Professor of Emergency Medicine NYU Grossman Long Island School of Medicine, New York Amil Badoolah, DO Assistant Professor of Emergency Medicine NYU Grossman Long Island School of Medicine, New York REBEL Core Cast 119.0 – Sleep Hygiene REBEL Core Cast 119.0 – Sleep Hygiene Click here for Direct Download of ... Read More The post REBEL MIND – Rest Is Not Sleep: The Seven Dimensions of True Recovery appeared first on REBEL EM - Emergency Medicine Blog.

In his weekly clinical update, Dr. Griffin and Vincent Racaniello discuss with disgust the decline and fall of American public health and the rise of "only me" when highlighting completion of the US withdrawal from the WHO and possibility of making IPV and MMR optional vaccines, before Dr. Griffin then deep dives into recent statistics RSV, influenza and SARS-CoV-2 infections, the Wasterwater Scan dashboard, Johns Hopkins measles tracker, Europe losing its measles elimination status, first measles death in Mexico, almost 1000 measles cases in South Carolina, where to find PEMGARDA, how to access and pay for Paxlovid, long COVID treatment center, the effectiveness of this season's influenza vaccine, where to go for answers to your long COVID questions and contacting your federal government representative to stop the assault on science and biomedical research. Subscribe (free): Apple Podcasts, RSS, email Become a patron of TWiV! Links for this episode US completes withdrawal from World Health Organization (AP News) Rejecting Decades of Science, Vaccine Panel Chair Says Polio and Other Shots Should Be Optional (NY Times) A Frightening Interview (Beyond the Noise) Unexplained Pauses in Centers for Disease Control and Prevention Surveillance: Erosion of the Public Evidence Base for Health Policy (Annals of Internal Medicine) Wastewater for measles (WasterWater Scan) UK among 6 European countries losing measles elimination status (Dougall MD: DG Alerts) European Regional Verification Commission for Measles and Rubella Elimination (RVC) (WHO: Europe) Measles Outbreak Associated with an Infectious Traveler — Colorado, May–June 2025 (CDC: MMWR) South Carolina measles cases hit 789, surpassing Texas' 2025 outbreak total (Reuters) Measles cases and outbreaks (CDC Rubeola) Tracking Measles Cases in the U.S. (Johns Hopkins) Measles vaccine recommendations from NYP (jpg) Weekly measles and rubella monitoring (Government of Canada) Measles (WHO) Get the FACTS about measles (NY State Department of Health) Measles (CDC Measles (Rubeola)) Measles vaccine (CDC Measles (Rubeola)) Presumptive evidence of measles immunity (CDC) Contraindications and precautions to measles vaccination (CDC) Adverse events associated with childhood vaccines: evidence bearing on causality (NLM) Measles Vaccination: Know the Facts(ISDA: Infectious Diseases Society of America) Deaths following vaccination: what does the evidence show (Vaccine) States across the country report first measles cases of year(CIDRAP) First measles death confirmed in Mexico in 2026 (Mexico News) Influenza: Waste water scan for 11  pathogens (WastewaterSCan) US respiratory virus activity (CDC Respiratory Illnesses) Respiratory virus activity levels (CDC Respiratory Illnesses) Weekly surveillance report: cliff notes (CDC FluView) Influenza Vaccine Effectiveness Among Children With and Without Underlying Conditions(Pediatrics) OPTION 2: XOFLUZA $50 Cash Pay Option(xofluza) RSV: Waste water scan for 11 pathogens (WastewaterSCan) Respiratory Diseases (Yale School of Public Health) US respiratory virus activity (CDC Respiratory Illnesses) RSV-Network (CDC Respiratory Syncytial virus Infection) Vaccines for Adults (CDC: Respiratory Syncytial Virus Infection (RSV)) Economic Analysis of Protein Subunit and mRNA RSV Vaccination in Adults aged 50-59 Years (CDC: ACIP) Waste water scan for 11 pathogens (WastewaterSCan) COVID-19 deaths (CDC) Respiratory Illnesses Data Channel (CDC: Respiratory Illnesses) COVID-19 national and regional trends (CDC) COVID-19 variant tracker (CDC) SARS-CoV-2 genomes galore (Nextstrain) Effectiveness and Durability of the BNT162b2 KP.2 vaccine against COVID-19 Hospitalization and Emergency Department or Urgent Care Encounters in US Adults (OFID) Where to get pemgarda (Pemgarda) EUAfor the pre-exposure prophylaxis of COVID-19 (INVIYD) Infusion center (Prime Fusions) CDC Quarantine guidelines (CDC) NIH COVID-19 treatment guidelines (NIH) Drug interaction checker (University of Liverpool) Help your eligible patients access PAXLOVID with the PAXCESS Patient Support Program (Pfizer Pro) Understanding Coverage Options (PAXCESS) Infectious Disease Society guidelines for treatment and management (ID Society) Association of Nirmatrelvir-ritonavir with intubation or mortality risks in severe COVID-19 patients (BMC Infectious Diseases) Molnupiravir safety and efficacy (JMV) Convalescent plasma recommendation for immunocompromised (ID Society) What to do when sick with a respiratory virus (CDC) Managing healthcare staffing shortages (CDC) Anticoagulationguidelines (hematology.org) Daniel Griffin's evidence based medical practices for long COVID (OFID) Long COVID hotline (Columbia : Columbia University Irving Medical Center) The answers: Long COVID Reaching out to US house representative Letters read on TWiV 1292 Dr. Griffin's COVID treatment summary (pdf) Timestamps by Jolene Ramsey. Thanks! Intro music is by Ronald Jenkees Send your questions for Dr. Griffin to daniel@microbe.tv Content in this podcast should not be construed as medical advice.

Psychogenic nonepileptic seizures (PNES) are common, often misunderstood, and increasingly encountered in pediatric emergency care. These events closely resemble epileptic seizures but arise from abnormal brain network functioning rather than epileptiform activity. In this episode of PEM Currents, we review the epidemiology, pathophysiology, and clinical features of PNES in children and adolescents, with a practical focus on Emergency Department recognition, diagnostic strategy, and management. Particular emphasis is placed on seizure semiology, avoiding iatrogenic harm, communicating the diagnosis compassionately, and understanding how early identification and referral to cognitive behavioral therapy can dramatically improve long-term outcomes. Learning Objectives Identify key epidemiologic trends, risk factors, and semiological features that help differentiate psychogenic nonepileptic seizures from epileptic seizures in pediatric patients presenting to the Emergency Department. Apply an evidence-based Emergency Department approach to the evaluation and initial management of suspected PNES, including strategies to avoid unnecessary escalation of care and medication exposure. Demonstrate effective, patient- and family-centered communication techniques for explaining the diagnosis of PNES and facilitating timely referral to appropriate outpatient therapy. References Sawchuk T, Buchhalter J, Senft B. Psychogenic Nonepileptic Seizures in Children-Prospective Validation of a Clinical Care Pathway & Risk Factors for Treatment Outcome. Epilepsy & Behavior. 2020;105:106971. (PMID: 32126506) Fredwall M, Terry D, Enciso L, et al. Outcomes of Children and Adolescents 1 Year After Being Seen in a Multidisciplinary Psychogenic Nonepileptic Seizures Clinic. Epilepsia. 2021;62(10):2528-2538. (PMID: 34339046) Sawchuk T, Buchhalter J. Psychogenic Nonepileptic Seizures in Children - Psychological Presentation, Treatment, and Short-Term Outcomes. Epilepsy & Behavior. 2015;52(Pt A):49-56. (PMID: 26409129) Labudda K, Frauenheim M, Miller I, et al. Outcome of CBT-based Multimodal Psychotherapy in Patients With Psychogenic Nonepileptic Seizures: A Prospective Naturalistic Study. Epilepsy & Behavior. 2020;106:107029. (PMID: 32213454) Transcript This transcript was generated using Descript automated transcription software and has been reviewed and edited for accuracy by the episode's author. Edits were limited to correcting names, titles, medical terminology, and transcription errors. The content reflects the original spoken audio and was not substantively altered. Welcome to PEM Currents: The Pediatric Emergency Medicine Podcast. As always, I'm your host, Brad Sobolewski, and today we are talking about psychogenic non-epileptic seizures, or PNES. Now, this is a diagnosis that often creates a lot of uncertainty in the Emergency Department. These episodes can be very scary for families and caregivers and schools. And if we mishandle the diagnosis, it can lead to unnecessary testing, medication exposure, ICU admissions, and long-term harm. This episode's gonna focus on how to recognize PNES in pediatric patients, how we make the diagnosis, what the evidence says about management and outcomes, and how what we do and what we say in the Emergency Department directly affects patients, families, and prognosis. Psychogenic non-epileptic seizures are paroxysmal events that resemble epileptic seizures but occur without epileptiform EEG activity. They're now best understood as a subtype of functional neurological symptom disorder, specifically functional or dissociative seizures. Historically, these events were commonly referred to as pseudo-seizures, and that term still comes up frequently in the ED, in documentation, and sometimes from families themselves. The problem is that pseudo implies false, fake, or voluntary, and that implication is incorrect and harmful. These episodes are real, involuntary, and distressing, even though they're not epileptic. Preferred terminology includes psychogenic non-epileptic seizures, or PNES, functional seizures, or dissociative seizures. And PNES is not a diagnosis of exclusion, and it does not require identification of psychological trauma or psychiatric disease. The diagnosis is based on positive clinical features, ideally supported by video-EEG, and management begins with clear, compassionate communication. The overall incidence of PNES shows a clear increase over time, particularly from the late 1990s through the mid-2010s. This probably reflects improved recognition and access to diagnostic services, though a true increase in occurrence can't be excluded. Comorbidity with epilepsy is really common and clinically important. Fourteen to forty-six percent of pediatric patients with PNES also have epilepsy, which frequently complicates diagnosis and contributes to diagnostic delay. Teenagers account for the highest proportion of patients with PNES, especially 15- to 19-year-olds. Surprisingly, kids under six are about one fourth of all cases, so it's not just teenagers. We often make the diagnosis of PNES in epilepsy monitoring units. So among children undergoing video-EEG, about 15 to 19 percent may ultimately be diagnosed with PNES. And paroxysmal non-epileptic events in tertiary epilepsy monitoring units account for about 15 percent of all monitored patients. Okay, but what is PNES? Well, it's best understood as a disorder of abnormal brain network functioning. It's not structural disease. The core mechanisms at play include altered attention and expectation, impaired integration of motor control and awareness, and dissociation during events. So the patients are not necessarily aware that this is happening. Psychological and psychosocial features are common but not required for diagnosis and may be less prevalent in pediatric populations as compared with adults. So PNES is a brain-based disorder. It's not conscious behavior, it's not malingering, and it's not under voluntary control. Children and adolescents with PNES have much higher rates of psychiatric comorbidities and psychosocial stressors compared to both healthy controls and children with epilepsy alone. Psychiatric disorders are present in about 40 percent of pediatric PNES patients, both before and after the diagnosis. Anxiety is seen in 58 percent, depression in 31 percent, and ADHD in 35 percent. Compared to kids with epilepsy, the risk of psychiatric disorders in PNES is nearly double. Compared to healthy controls, it is up to eight times higher. And there's a distinct somatopsychiatric profile that strongly predicts diagnosis of PNES. This includes multiple medical complaints, psychiatric symptoms, high anxiety sensitivity, and solitary emotional coping. This profile, if you've got all four of them, carries an odds ratio of 15 for PNES. Comorbid epilepsy occurs in 14 to 23 percent of pediatric PNES cases, and it's associated with intellectual disability and prolonged diagnostic delay. And finally, across all demographic strata, anxiety is the most consistent predictor of PNES. Making the diagnosis is really hard. It really depends on a careful history and detailed analysis of the events. There's no single feature that helps us make the diagnosis. So some of the features of the spells or events that have high specificity for PNES include long duration, so typically greater than three minutes, fluctuating or asynchronous limb movements, pelvic thrusting or side-to-side head movements, ictal eye closure, often with resisted eyelid opening, ictal crying or vocalization, recall of ictal events, and rare association with injury. Younger children often present with unresponsiveness. Adolescents more commonly demonstrate prominent motor symptoms. In pediatric cohorts, we most frequently see rhythmic motor activity in about 27 percent, and complex motor movements and dialeptic events in approximately 18 percent each. Features that argue against PNES include sustained cyanosis with hypoxia, true lateral tongue biting, stereotyped events that are identical each time, clear postictal confusion or lethargy, and obviously epileptic EEG changes during the events themselves. Now there are some additional historical and contextual clues that can help us make the diagnosis as well. If the events occur in the presence of others, if they occur during stressful situations, if there are psychosocial stressors or trauma history, a lack of response to antiepileptic drugs, or the absence of postictal confusion, this may suggest PNES. Lower socioeconomic status, Medicaid insurance, homelessness, and substance use are also associated with PNES risk. While some of these features increase suspicion, again, video-EEG remains the diagnostic gold standard. We do not have video-EEG in the ED. But during monitoring, typical events are ideally captured and epileptiform activity is not seen on the EEG recording. Video-EEG is not feasible for every single diagnosis. You can make a probable PNES diagnosis with a very accurate clinical history, a vivid description of the signs and appearance of the events, and reassuring interictal EEG findings. Normal labs and normal imaging do not make the diagnosis. Psychiatric comorbidities are not required. The diagnosis, again, rests on positive clinical features. If the patient can't be placed on video-EEG in a monitoring unit, and if they have an EEG in between events and it's normal, that can be supportive as well. So what if you have a patient with PNES in the Emergency Department? Step one, stabilize airway, breathing, circulation. Take care of the patient in front of you and keep them safe. Use seizure pads and precautions and keep them from falling off the bed or accidentally injuring themselves. A family member or another team member can help with this. Avoid reflexively escalating. If you are witnessing a PNES event in front of you, and if they're protecting their airway, oxygenating, and hemodynamically stable, avoid repeated benzodiazepines. Avoid intubating them unless clearly indicated, and avoid reflexively loading them with antiseizure medications such as levetiracetam or valproic acid. Take a focused history. You've gotta find out if they have a prior epilepsy diagnosis. Have they had EEGs before? What triggered today's event? Do they have a psychiatric history? Does the patient have school stressors or family conflict? And then is there any recent illness or injury? Only order labs and imaging when clinically indicated. EEG is not widely available in the Emergency Department. We definitely shouldn't say things like, “this isn't a real seizure,” or use outdated terms like pseudo-seizure. Don't say it's all psychological, and please do not imply that the patient is faking. If you see a patient and you think it's PNES, you're smart, you're probably right, but don't promise diagnostic certainty at first presentation. Remember, a sizable proportion of these patients actually do have epilepsy, and referring them to neurology and getting definitive testing can really help clarify the diagnosis. Communication errors, especially early on, worsen outcomes. One of the most difficult things is actually explaining what's going on to families and caregivers. So here's a suggestion. You could say something like: “What your child is experiencing looks like a seizure, but it's not caused by abnormal electrical activity in the brain. Instead, it's what we call a functional seizure, where the brain temporarily loses control of movement and awareness. These episodes are real and involuntary. The good news is that this condition is treatable, especially when we address it early.” The core treatment of PNES is CBT-based psychotherapy, or cognitive behavioral therapy. That's the standard of care. Typical treatment involves 12 to 14 sessions focused on identifying triggers, modifying maladaptive cognitions, and building coping strategies. Almost two thirds of patients achieve full remission with treatment. About a quarter achieve partial remission. Combined improvement rates reach up to 90 percent at 12 months. Additional issues that neurologists, psychologists, and psychiatrists often face include safe tapering of antiseizure medications when epilepsy has been excluded, treatment of comorbid anxiety or depression, coordinating care between neurology and mental health professionals, and providing education for schools on event management. Schools often witness these events and call prehospital professionals who want to keep patients safe. Benzodiazepines are sometimes given, exposing patients to additional risk. This requires health system-level and outpatient collaboration. Overall, early diagnosis and treatment of PNES is critical. Connection to counseling within one month of diagnosis is the strongest predictor of remission. PNES duration longer than 12 months before treatment significantly reduces the likelihood of remission. Video-EEG confirmation alone does not predict positive outcomes. Not every patient needs admission to a video-EEG unit. Quality of communication and speed of treatment, especially CBT-based therapy, matter the most. Overall, the prognosis for most patients with PNES is actually quite favorable. There are sustained reductions in events along with improvements in mental health comorbidities. Quality of life and psychosocial functioning improve, and patients use healthcare services less frequently. So here are some take-home points about psychogenic non-epileptic seizures, or PNES. Pseudo-seizure and similar terms are outdated and misleading. Do not use them. PNES are real, involuntary, brain-based events. Diagnosis relies on positive clinical features, what the events look like and when they happen, not normal lab tests or CT scans. Early recognition and diagnosis, and rapid referral to cognitive behavioral therapy, change patients' lives. If you suspect PNES, get neurology and mental health professionals involved as soon as possible. Alright, that's all I've got for this episode. I hope you found it educational. Having seen these events many times over the years, I recognize how scary they can be for families, schools, and our prehospital colleagues. It's up to us to think in advance about how we're going to talk to patients and families and develop strategies to help children who are suffering from PNES events. If you've got feedback about this episode, send it my way. Likewise, like, rate, and review, as my teenagers would say, and share this episode with a colleague if you think it would be beneficial. For PEM Currents: The Pediatric Emergency Medicine Podcast, this has been Brad Sobolewski. See you next time.

Staff cuts are to blame for a massive IT outage at hospitals in Auckland and Northland according to a union. The Public Service Association says its members had to resort to paper systems and white boards overnight Wednesday after it says an outage took down Emergency Department, laboratory and in patient systems. Health New Zealand says hospitals and emergency departments remained open and patient care continued safely during the incident. The PSA says the latest failure is a direct result of cuts to Health New Zealand's digital team. PSA national Secretary Fleur Fitzsimons spoke to Lisa Owen.

A Clare TD has told the Dáil that her nephew was forced to wait for treatment for hours on a chair at University Hospital Limerick's Emergency Department after a failed suicide attempt. Shannon Deputy Donna McGettigan has made the contribution during a debate on a Sinn Féin motion calling for the Dáil to note a Mental Health Commission report which reveals "international best practice" isn't available in EDs in Ireland. Data recently released to the party by the HSE shows the Midwest doesn't currently have a mental health clinical nurse specialist. Deputy McGettigan says families like hers have felt let down by inadequate mental health services.

🧭 REBEL Rundown 📌 Key Points 💪 Building Resilience: Rebel MIND, in partnership with Arena Labs, introduces a science-based performance coaching platform specifically tailored for healthcare professionals, focusing on stress management and burnout prevention.🤝 Personal Insights: Jackie Penn shares her journey from exercise science to digital coaching, highlighting the importance of tailored coaching in high-pressure environments like healthcare.🎯 Clinician-Centric Approach: Understanding unique challenges faced by ER doctors, the program provides practical tools for stress and transition management, improving both professional and personal life balance.💻 Revolutionary Wearables: Utilizing wearables, the program offers objective feedback on recovery and health metrics, allowing personalization of strategies to enhance clinician well-being. Click here for Direct Download of the Podcast. 📝 Introduction Welcome back to REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. In this episode, we’re excited to continue collaboration with Arena Labs, where host Dr. Marco Propersi interviews Jackie Pen, Heading of Performance Coaching at Arena Labs. Arena Labs is helping us measure healthcare performance through innovative programs designed to combat burnout and enhance personal wellness using data-driven strategies.  🔙Previously Covered on REBEL MIND: Performance Under Pressure – What Medicine Can Learn from Elite Teams 🤔Cognitive Question How do specific performance coaching strategies and tools assist healthcare professionals, particularly those in emergency medicine, in managing stress and preventing burnout effectively? 💭 Why This is Important Burnout among healthcare workers is a growing concern, especially in such high-pressure environments as emergency and intensive care units. The collaboration with Arena Labs brings forth a vital focus on using data and coaching to build resilience among medical professionals. 🏥How This Applies to the Emergency Department or ICU? In the chaotic and high-stakes environment of the ED/ICU, healthcare professionals are often required to make split-second decisions under pressure while managing emotional stress. This necessitates not just clinical acumen but also strong emotional resilience and stress management skills. Performance coaching provides the tools and frameworks to enhance these skills, offering strategies like the de-stress breath and transition protocols to help clinicians navigate between high-pressure situations efficiently. These tools are designed to not only improve their professional performance but also ensure they are emotionally present for their personal lives, ensuring a healthier work-life balance. ⏩ Things You Can Do on Your Next Shift Practice the De-stress Breath: Before moving from one critical case to another, take a moment to take two inhales through the nose followed by an extended exhale, helping to reset your nervous system by activating your parasympathetic nervous system.Implement a Transition Protocol: Choose a point in your journey home to mentally switch from clinician to family member, helping you to be more present outside of work.Optimize Your Nutrition and Rest: Even small changes during your shift, like meals that promote easy digestion or quick physical activities, can make a significant difference in your energy levels.Engage with Wearables: If possible, use wearables to monitor your physiological responses, helping tailor personalized strategies for your shifts 👀 Where to Learn More Intrigued by the possibilities this partnership offers? You can explore more by visiting Arena Labs’ website here. Also, check out the comprehensive coaching program available, designed specifically for healthcare providers looking to enhance their well-being and performance. 🚨 Clinical Bottom Line In an era where burnout is pervasive, our collaboration with Arena Labs offers a beacon of hope for healthcare workers. By leveraging cutting-edge data insights and practical coaching, this partnership aims to redefine healthcare wellness, fostering a sustainable, resilient workforce that’s equipped to navigate the pressures of modern medicine. Join us in this journey towards enhanced well-being and workforce empowerment, ensuring that those who care for us are also cared for. Meet the Authors Marco Propersi Co-Editor-in-Chief Vassar Brothers Medical Center, Poughkeepsie, NY Jackie Pen Head of Performance Coaching Arena Labs The post REBEL MIND: The Power of Performance Coaching in Medicine appeared first on REBEL EM - Emergency Medicine Blog.

Cardiology and emergency medicine teams are coming together to transform cardiovascular care. In this MedAxiom HeartTalk, host Melanie Lawson, MS, is joined by David Wohns, MD, FACC, FACP, FSCAI, division chief of cardiology at Corewell Health, and Meredith Busman, MD, emergency physician at Corewell Health, to discuss how shared pathways, trust, and streamlined communication are improving patient outcomes and hospital efficiency. They share real-world examples of protocol-driven care that enable faster decision-making and support smoother patient flow.

The number of patients treated at Ennis' Local Injury Unit increased by more than 15% last year. New figures show 18,573 people presented to the county town's LIU over the past twelve months. According to HSE MidWest, there have been an average of 280 daily attendances to University Hospital Limerick's Emergency Department this month. Mayor of Ennis, Fine Gael Councillor Mary Howard has been telling Clare FM's Daragh Dolan that the Ennis injury unit is a vital resource for reducing waiting times.

We were all taught succinylcholine is contraindicated in hyperkalemia because it can cause potassium release, exacerbating the problem. But does it? Does it really?Dr. Jarvis discusses a recent paper that seems to compare mortality within 24 hours of RSI in hyperkalemic patients between those intubated with succ or rocuronium. And then we discuss methods.. including the Table 1 Fallacy. Citations:1.     Simmer PE, Perza M, Cho YD, et al.: Hyperkalemic emergency department patients intubated with rocuronium or succinylcholine: Retrospective study of clinical outcomes. The American Journal of Emergency Medicine. 2026; February;100:154–64.2.     Cole JB, Knack SKS, Driver BE: The value of P-values in “Table 1.” The American Journal of Emergency Medicine. 2026; February;100:182–6.3.     Pappal RD, Roberts BW, Mohr NM, et al.: The ED-AWARENESS Study: A Prospective, Observational Cohort Study of Awareness With Paralysis in Mechanically Ventilated Patients Admitted From the Emergency Department. Ann Emerg Med. 2021;77(5):532–44.4.     ‘Rick & Jerry' Pass the Baton | Emergency Physicians Monthly. Available at https://epmonthly.com/article/rick-jerry-pass-the-baton/. Accessed January 25, 2026.

In this episode of Communicable, Josh Davis (Newcastle, Australia) and Emily McDonald (Montreal, Canada), plus invited guest, Steven Tong (Melbourne, Australia)—all practicing physicians and clinical trialists—assemble to discuss some of their ‘top infectious diseases papers published in 2025'. Bassam Ghanem (Jeddah Lol, Saudi Arabia), whom one might know better as Antibiotic Steward on social media, was also invited to share his favourite publications of 2025.Six papers that were most consistently picked by the panel are presented, explaining why they were picked and how they have shifted paradigms or changed their practice. This episode complements the previous episode, which presented ‘top clinical microbiology papers in 2025', and was peer reviewed by Akshatha Ravindra of Kasturba Medical College, Manipal, India.   ResourcesCLARITY initiative websitePapers presented (in order of presentation) Turner NA, et al. Dalbavancin for Treatment of Staphylococcus aureus Bacteremia. JAMAMeya DB, et al. Trial of High-Dose Oral Rifampin in Adults with Tuberculous Meningitis. NEJMVodstrcil LA, et al. Male-Partner Treatment to Prevent Recurrence of Bacterial Vaginosis. NEJMKreimer A, et al. Noninferiority of One HPV Vaccine Dose to Two Doses. NEJMGuglielmetti L, et al. Oral Regimens for Rifampin-Resistant, Fluoroquinolone-Susceptible Tuberculosis. NEJMRoss JDC et al, Oral gepotidacin for the treatment of uncomplicated urogenital gonorrhoea (EAGLE-1). Lancet  ‘One liners' (in order of presentation)Burdet C et al. Cloxacillin versus cefazolin for meticillin-susceptible Staphylococcus aureus bacteraemia (CloCeBa). LancetLemiale V et al, Adjunctive corticosteroids in non-AIDS patients with severe Pneumocystis jirovecii pneumonia (PIC). Lancet Respir MedLuetkemeyer AF et al, Doxycycline to prevent bacterial sexually transmitted infections in the USA. Lancet Inf DisEyting M, et al. A natural experiment on the effect of herpes zoster vaccination on dementia. NatureXie M, et al. The effect of shingles vaccination at different stages of the dementia disease course. CellPomirchy M, et al. Herpes Zoster Vaccination and Dementia Occurrence. JAMADurbin AP et al, Daily Mosnodenvir as Dengue Prophylaxis in a Controlled Human Infection Model. NEJMHook EW et al, One Dose versus Three Doses of Benzathine Penicillin G in Early Syphilis. NEJMOpdam MAA et al, Continuation versus temporary interruption of immunomodulatory agents during infections in patients with inflammatory rheumatic diseases. Clin Infect DisArundel C et al, Negative pressure wound therapy versus usual care in patients with surgical wound healing by secondary intention in the UK (SWHSI-2). LancetHonourable mentionsChaccour C, et al. Ivermectin to Control Malaria. NEJMLucinde RK, et al. A Pragmatic Trial of Glucocorticoids for Community-Acquired Pneumonia. NEJMMorel J, et al. Effect of a 1-month methotrexate delay on pneumococcal vaccine immunogenicity and disease control in patients with early rheumatoid arthritis (VACIMRA). Lancet RheumatolHaukoos J, et al. Hepatitis C Screening in Emergency Departments. JAMAMajor Extremity Trauma Research Consortium (METRC). Oral vs Intravenous Antibiotics for Fracture-Related Infections: The POvIV Randomized Clinical Trial, JAMA SurgAnderson CS, et al. Influenza vaccination to improve outcomes for patients with acute heart failure (PANDA II). LancetSt Peter SD, et al. Appendicectomy versus antibiotics for acute uncomplicated appendicitis in children. LancetPan CQ, et al. Tenofovir and Hepatitis B Virus Transmission During Pregnancy. JAMAGohil SK, et al. Improving Empiric Antibiotic Selection for Patients Hospitalized With Abdominal Infection. JAMA SurgRelated podcast episodesCommunicable E44: Top clinical microbiology papers in 2025 https://share.transistor.fm/s/6e5c26aeCommunicable E29: Bacterial vaginosis & male partners, https://share.transistor.fm/s/3de4f5c3 Communicable E28: Late-breaker trials at ESCMID Global: Should they change your practice? - part 2, https://share.transistor.fm/s/4f044e8c Communicable E20: Tuberculosis today https://share.transistor.fm/s/9858900e 

🧭 REBEL Rundown 📌 Key Points 🎯Partnership Focus: New collaboration with Arena Labs aimed at enhancing healthcare worker wellness.🏃🏽‍️‍➡️Personalized Coaching: Tools and coaching programs designed for stress management and performance improvement.📊Data-Driven Insights: Utilizing wearable sensor data to tackle burnout effectively.🌄Broad Impact: Offers a unique opportunity to contribute to large-scale healthcare improvements. Click here for Direct Download of the Podcast. 📝 Introduction Welcome back to REBEL MIND, where MIND stands for Mastering Internal Negativity during Difficulty. Here we sharpen the person behind the practitioner by focusing on things that improve our performance, optimizing team dynamics and the human behavior that embodies the hidden curriculum of medicine. In this episode, hosted by Drs. Mark Ramzy and Marco Propersi, we’re excited to introduce a collaboration with Arena Labs. Arena Labs is helping us measure healthcare performance through innovative programs designed to combat burnout and enhance personal wellness using data-driven strategies.  Cognitive Question What would it look like in emergency medicine and critical care to be set up with the same tools as elite teams and professional athletes when it comes to measuring performance and recovery? How would our patients benefit? 💭 Why This is Important Burnout among healthcare workers is a growing concern, especially in such high-pressure environments as emergency and intensive care units. The collaboration with Arena Labs brings forth a vital focus on using data and coaching to build resilience among medical professionals. 🌟Be Brilliant at the Basics Ask yourself — “What is it on your time off that gives you a deep sense of fulfillment?”On your time off are you doing things that fill your bucket and add to your recovery? What is Allostasis and Allostatic Load Allostasis: Our body’s ability to adapt over time to stress. It’s relevant to the phase you are in during this particular season in your life. Ex. You are a first year medical student freaking out about your very first exam. Over time as you do more exams, they are still stressful, but by now you have developed modified study habits to succeed and get used to the frequent examsIn the context of emergency medicine, you may be nervous or stressed about your first shift at a new hospital but overtime you learn the staff, the location of equipment, the acuity of that particular site, the patient population so over time you get used to the stress of a shift at that new hospitalAllostatic Load: The wear and tear on the body from chronic stress due to maladaptation or poor recovery methods.This refers to the cumulative burden of chronic stress and life events. It involves the interaction of different physiological systems at varying degrees of activity.Ex. You are an emergency medicine physician at a very busy, high acuity center and have never prioritized taking care of yourself on/during a shift. As a result, external factors add to not being able to fully recover when you get home or are off shift (ie. Admin work, teaching obligations, family/friends) and so you never fully recover before you have to go back on shift to the same stressors you just exposed yourself to. So the cycle continuesFigure 1: Long term effects of Chronic Stress (Source: Andrew Hogue from NeuroFit) 🏥How This Applies to the Emergency Department or ICU? Healthcare workers in emergency departments (ED) and intensive care units (ICU) are often under enormous stress due to the nature of their work. Arena Labs’ program offers tailored solutions, helping ED and ICU staff manage their unique challenges through effective recovery techniques and performance tools. This approach caters specifically to the demanding schedules and the unpredictability inherent in these environments. 👀 Where to Learn More Intrigued by the possibilities this partnership offers? You can explore more by visiting Arena Labs’ website here. Also, check out the comprehensive coaching program available, designed specifically for healthcare providers looking to enhance their well-being and performance. 🚨 Clinical Bottom Line In an era where burnout is pervasive, our collaboration with Arena Labs offers a beacon of hope for healthcare workers. By leveraging cutting-edge data insights and practical coaching, this partnership aims to redefine healthcare wellness, fostering a sustainable, resilient workforce that’s equipped to navigate the pressures of modern medicine. Join us in this journey towards enhanced well-being and workforce empowerment, ensuring that those who care for us are also cared for. 📚References Guidi J, et al.Allostatic Load and Its Impact on Health: A Systematic Review. Psychother Psychosom. 2021; Epub 2020 Aug 14. PMID: 32799204Frueh BC, et al.“Operator syndrome”: A unique constellation of medical and behavioral health-care needs of military special operation forces. Int J Psychiatry Med. Epub 2020 Feb 13. PMID: 32052666 Meet the Authors Mark Ramzy, DO Co-Editor-in-Chief Cardiothoracic Intensivist and EM Attending RWJBH / Rutgers Health, Newark, NJ Marco Propersi Co-Editor-in-Chief Chair of Emergency Medicine at Vassar Brothers Medical Center, Poughkeepsie, NY Brain Ferguson Founder and CEO Arena Labs The post REBEL MIND: Performance Under Pressure – What Medicine Can Learn from Elite Teams appeared first on REBEL EM - Emergency Medicine Blog.

We're back at Pittsburgh Trauma Medical Center for Season 2, Episode 2, “8:00 AM,” of The Pitt. Jodie and Andrea track the Gut vs AI debate, Santos wins the Funniest Person in the Emergency Department award, and Whitaker stars in a very bleak 50 First Dates reboot. We finally learn one single fact about Dr. Robby's personal life, Andrea's birthday wish comes true, and we deliver a very important PSA about personal space.Join us every Monday as The Watchers break down each episode of Season 2 of The Pitt, the HBO Max medical drama from Noah Wyle and the team behind ER, which, by the way, is just a coincidence.If you're reading this, that means you've probably got your podcatcher of choice open right now. It would be SO helpful if you gave our little show a follow. If you like what you hear, you could even leave us a review.Follow:The Watchers on Instagram (@WatchersPodNJ)Andrea on Instagram (@AQAndreaQ)Jodie on Instagram (@jodie_mim)Thanks to Kitzy (@heykitzy) for the use of our theme song, "No Book Club."

Dr. Jeff Bohmer, Medical Director of the Emergency Department at Northwestern Medicine Central DuPage Hospital, joins Jon Hansen ( in for Bob Sirott) to talk about flu season and hospitalizations. Plus, the GLP-1 shot in pill form and how it can be a game changer for pricing and accessibility.

Christine L H Snozek, Matthew D Krasowski, Jennifer M Colby, Kamisha L Johnson-Davis, Rebecca E Bruccoleri, Stacy E Melanson. ADLM Guidance Document on Laboratory Testing for Drugs of Misuse to Support the Emergency Department. The Journal of Applied Laboratory Medicine, Volume 11, Issue 1, January 2026, Pages 155–180.  https://doi.org/10.1093/jalm/jfaf172

University Hospital Limerick's Emergency Department is expected to remain under intense pressure into next week amid a spike in presentations. HSE Mid West is once again urging the public to consider all options before attending the facility, following a 27% year-on-year increase in presentations between January 2nd and 11th. A total of 127 patients were waiting for a bed at the hospital this morning, which was up from 125 yesterday. Consultant in Emergency Medicine and Clinical Director in Urgent and Emergency Care at HSE Mid West, Dr Damien Ryan, has been telling Clare FM's Seán Lyons continued high numbers are expected to come through the doors in the coming days.

About this episode:   Emmy-award winning drama "The Pitt" returns for a second, thrilling season that follows 15 hours in an emergency department for doctors, nurses, residents, and administrators. In this episode: Dr. Emily Boss discusses what the show gets right about real-life hospitals, from the medicine to the stress to the systemic barriers that can make delivering quality health care difficult. You don't have to watch the show to enjoy this conversation!  Guests:  Dr. Emily Boss, MPH, is a pediatric otolaryngologist and a professor of Health Policy & Management at the Johns Hopkins Bloomberg School of Public Health.   Host:  Dr. Josh Sharfstein is distinguished professor of the practice in Health Policy and Management, a pediatrician, and former secretary of Maryland's Health Department.  Show links and related content:  I'm a Surgeon. This Is the Messy Truth 'The Pitt' Exposes—Newsweek  Transcript information: Looking for episode transcripts? Open our podcast on the Apple Podcasts app (desktop or mobile) or the Spotify mobile app to access an auto-generated transcript of any episode. Closed captioning is also available for every episode on our YouTube channel. Contact us: Have a question about something you heard? Looking for a transcript? Want to suggest a topic or guest? Contact us via email or visit our website. Follow us: @‌PublicHealthPod on Bluesky @‌PublicHealthPod on Instagram @‌JohnsHopkinsSPH on Facebook @‌PublicHealthOnCall on YouTube Here's our RSS feed Note: These podcasts are a conversation between the participants, and do not represent the position of Johns Hopkins University.

This content has been developed for healthcare professionals only. Patients who seek health information should consult with their physician or relevant patient advocacy groups.For the full presentation, downloadable Practice Aids, slides, and complete CME/AAPA information, and to apply for credit, please visit us at PeerView.com/SCE865. CME/AAPA credit will be available until December 18, 2026.First Move Matters: Playing to Win in EoE – From Emergency Department Recognition to Continued Care Strategies In support of improving patient care, PVI, PeerView Institute for Medical Education, is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.SupportThis activity is supported by an independent educational grant from Regeneron Pharmaceuticals, Inc and Sanofi.Disclosure information is available at the beginning of the video presentation.

Emergency departments across the U.S. are under unprecedented strain, with overcrowding, staffing shortages, and inpatient bed constraints converging into a throughput crisis. The American Hospital Association reports that hospital capacity and workforce growth have lagged, intensifying delays from arrival to disposition. At the same time, advances in artificial intelligence are moving from experimental to operational—raising the stakes for how technology can meaningfully improve patient flow rather than add complexity.So, how can emergency departments reduce bottlenecks and move patients more efficiently through care without compromising clinical judgment or trust?Welcome to I Don't Care. In the latest episode, host Dr. Kevin Stevenson sits down with Mitch Quinn, Director of AI/ML at ChoreoED, to explore how AI-driven insights can help hospitals anticipate admissions and discharges earlier, coordinate downstream services, and ultimately improve ED throughput. Their conversation spans the real-world operational challenges ED leaders face, the practical application of machine learning in high-acuity settings, and what it takes to deploy AI tools that clinicians actually trust and use.What you'll learn…How AI models trained on a hospital's own historical data can accurately anticipate admissions up to hours earlier, enabling parallel workflows.Why focusing on “high-certainty” admissions and discharges—rather than rare edge cases—creates immediate operational value in the ED.How adaptive, continuously retrained models can support both experienced clinicians and newer providers in high-turnover environments.Mitch Quinn is a Director of AI and Machine Learning and a computer scientist with 20+ years of experience building production-grade AI systems across healthcare and cybersecurity. He specializes in deep learning, large-scale model architecture, and end-to-end ML pipelines, with leadership roles spanning applied research at Blue Cross NC, enterprise AI consulting, and real-time cyber threat detection. His career highlights include designing high-performance deep neural networks, anomaly detection systems operating at enterprise scale, and foundational software frameworks used by large engineering organizations.

Rebekah Griffith joins the podcast to talk about what it means to be a newly minted AAOMPT Fellow working in one of the most unlikely settings — the Emergency Department.She shares why OMPT-level manual therapy skills are not only relevant in the ED, but essential for rapid assessment, safe decision-making, and efficient patient care. Rebekah explains how fellowship training sharpened her clinical reasoning, helped her manage acute MSK presentations, and expanded her impact within emergency medicine teams.In this episode: • The PT's role in the ED • How manual therapy speeds clarity and improves outcomes • Examples of OMPT reasoning in acute, high-stakes scenarios • Why fellowship training matters outside outpatient ortho • Reducing unnecessary imaging, opioids, and admissions • Rebekah's journey through AAOMPT Fellowship and into ED practiceWhether you're a clinician, student, or educator, Rebekah's perspective will reshape how you think about where — and how — manual therapy skills should be used.

Text Dr. Lenz any feedback or questions In this episode of the Conquering Your Fibromyalgia podcast, host Mike introduces the podcast's first medical doctor guest, Dr. Maureen Allen. Dr. Allen shares her extensive journey from being a nurse to becoming a family medicine physician and an emergency medicine expert in Nova Scotia, Canada. The episode dives deep into the complexities of managing chronic pain, explaining how palliative care intersects with chronic pain treatment and the challenges patients face in finding the right care. They discuss the distinctions between acute and chronic pain, the role of emergency departments, and the need for a bottom-up approach to pain management. Dr. Allen also highlights the importance of patient education and shares insights from her own practice to help listeners understand and manage chronic pain more effectively.Watch on YouTube HERE00:00 Welcome to the Conquering Your Fibromyalgia Podcast00:10 Introducing Dr. Maureen Allen00:55 Dr. Allen's Medical Journey01:54 Chronic Pain and Palliative Care02:36 Addressing Misconceptions About Substance Use04:00 Challenges in Diagnosing Fibromyalgia05:39 Pain Education and Management in Canada09:08 Emergency Departments and Pain Management13:09 Understanding Chronic Pain Flare-ups20:13 Patient Concerns and Misdiagnoses23:29 Understanding Chronic Pain24:22 Acute Pain vs. Chronic Pain25:30 Pain Protective Behaviors27:33 The Role of Exercise in Pain Management32:27 The Intersection of Anxiety and Pain36:05 The Importance of Education and Support40:29 Real Stories and Hope Click here for the YouTube channel International Conference on ADHD in November 2025 where Dr. Lenz will be one of the speakers. Support the showWhen I started this podcast and YouTube Channel—and the book that came before it—I had my patients in mind. Office visits are short, but understanding complex, often misunderstood conditions like fibromyalgia takes time. That's why I created this space: to offer education, validation, and hope. If you've been told fibromyalgia “isn't real” or that it's “all in your head,” know this—I see you. I believe you. This podcast aims to affirm your experience and explain the science behind it. Whether you live with fibromyalgia, care for someone who does, or are a healthcare professional looking to better support patients, you'll find trusted, evidence-based insights here, drawn from my 29+ years as an MD. Please remember to talk with your doctor about your symptoms and care. This content doesn't replace per...