In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the December 2025 Emergency Medicine Practice article, Diagnosis and Management of Cannabis-Related Emergencies

Episode Outline:

• [0:00] Introduction
• Welcome and show overview by Sam Ashoo
• Mention of resources at ebmedicine.net
• [0:46] Episode Start
• Hosts introduce themselves: Sam Ashoo and Dr. T.R. Eckler
• Dr. Eckler’s background and experience with cannabis cases in Colorado
• [1:16] Topic Introduction
• Focus on diagnosis and management of cannabis-related emergencies
• Prevalence and importance in emergency medicine
• [1:34] Legal Landscape
• Overview of cannabis legality across states
• Medicinal vs. non-medicinal use
• [3:03] Increase in ED Visits
• Statistics: ~1 million cannabis-related ED visits annually
• Demographics: younger population most affected
• [3:52] Synthetics and Challenges
• Discussion of synthetic cannabinoids and their risks
• Issues with detection and legality
• [4:50] Clinical Spectrum
• Range of presentations: from nausea/vomiting to psychosis and seizures
• Impact on different age groups
• [6:34] FDA-Approved Uses
• Cannabis-derived products approved for specific medical conditions
• [7:20] Physiology and Pathophysiology
• Cannabinoid receptors (CB1 and CB2) and their effects
• Differences between plant-derived and synthetic cannabinoids
• [9:10] Chronic Use and Withdrawal
• Downregulation of receptors, withdrawal symptoms, and persistent nausea
• [10:20] Product Forms and Delivery Methods
• Smoking, edibles, oils, tinctures, suppositories, topicals, etc.
• Risks associated with concentrated forms (e.g., wax, oils)
• [12:00] Clinical Effects by System
• Psychiatric: anxiety, psychosis, paranoia
• Cardiovascular: tachycardia, MI risk, QT prolongation
• Pulmonary, renal, metabolic, dental, and ocular effects
• [13:50] Cannabinoid Hyperemesis Syndrome (CHS)
• Phases: prodrome, hyperemesis, recovery
• Hot showers as a diagnostic clue
• [16:00] Withdrawal Syndrome
• Symptoms and timeline
• Exacerbation with synthetic cannabinoids
• [18:15] Counseling and Management
• Importance of cessation and patient education
• Timeline for symptom improvement
• [18:42] Differential Diagnosis
• Broad differential for persistent nausea/vomiting and abdominal pain
• Importance of considering other causes
• [20:55] Diagnostics and Testing
• Limitations of drug screens (false positives/negatives)
• Importance of EKG, labs, and imaging as indicated
• [23:10] Treatment Approaches
• First-line: benzodiazepines, antiemetics (ondansetron, metoclopramide)
• Second-line: butyrophenones (haloperidol, droperidol), olanzapine
• Capsaicin as adjunct therapy
• [29:50] Complications and Special Considerations
• Risks of undertreatment (e.g., Boerhaave syndrome, aspiration)
• Pediatric and pregnant populations: unique risks and reporting requirements
• [36:00] Five Practice-Changing Takeaways
• Elicit cannabis use history
• Know testing limitations
• Consider ECG and appropriate labs
• Use butyrophenones when indicated
• Admit if symptoms are refractory
• [39:00] Conclusion

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In this episode, Sam Ashoo, MD and Tim Horeczko, MD discuss the November 2025 Pediatric Emergency Medicine Practice article, Emergency Department Management of Measles, Mumps, Rubella, and Varicella in Pediatric Patients

00:00 Introduction to Emergency Medicine

00:21 Welcome and Holiday Greetings

01:16 Special Guest Introduction

01:41 Discussion on Pediatric Emergency Medicine

04:55 Epidemiology of Measles

08:16 Challenges in Diagnosing Measles

14:27 Mumps: Symptoms and Complications

27:36 Rubella: Risks and Symptoms

29:28 Varicella: Symptoms and Precautions

33:12 Differential Diagnosis and Conclusion

35:14 Using Inductive Reasoning in Medical Diagnosis

35:40 Recognizing Purpuric Rash and Its Implications

36:22 Guidance for EMS Colleagues on Handling Fever and Rash

37:14 Importance of Communication and Relationships with EMS

39:12 Decontamination and PPE Protocols for EMS

42:34 Detailed Patient Assessment in the ED

46:06 Diagnostic Testing and Clinical Diagnosis

49:20 Reporting Responsibilities and Treatment Protocols

01:01:19 Addressing Vaccine Controversies and Public Trust

01:06:25 Conclusion and Additional Resources

Check out Dr Horeczko's podcast - Pediatric Emergency Playbook

Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the November 2025 Emergency Medicine Practice article, Diagnosis and Management of Emergency Department Patients With Alcohol Withdrawal Syndrome

1. Epidemiology & Background

• Rising ED visits related to alcohol use.
• Mortality rates and spectrum of patient presentations.
• Importance of high suspicion and complexity of cases.
• Pathophysiology & Mechanisms
• Alcohol metabolism and neurochemical changes.
• Differential diagnosis: Conditions that mimic alcohol withdrawal.
• Prehospital & EMS Considerations
• Role of EMS in triage and initial management.
• Use of sobering centers vs. ED transport.
• Prehospital administration of benzodiazepines (IM midazolam).
• History & Risk Assessment
• Key questions to assess risk for alcohol withdrawal syndrome.
• Importance of patient history, medication use, and comorbidities.
• Discussion on patient honesty and rapport.
• Physical Exam & Scoring Systems
• DSM-5 criteria for alcohol withdrawal.
• Use of CIWA-AR, BAWS, and PAWSS scoring systems.
• Importance of objective measurement for monitoring and disposition.
• Complications & Special Presentations
• Complicated alcohol withdrawal: Hallucinosis, seizures, delirium tremens.
• Diagnostic workup: Labs, imaging, and co-ingestions.
• Special populations: End-stage liver disease, pregnancy, intubated patients.
• Treatment Strategies
• Mainstay: Benzodiazepines (types, dosing, and protocols).
• Phenobarbital: Indications, dosing, and evidence.
• Adjunctive therapies: Thiamine, glucose, magnesium.
• Alternative/adjunct medications: Gabapentin, ketamine, dexmedetomidine, baclofen.
• Clinical Pearls & Practice Changes
• Early, aggressive therapy to prevent complications.
• Symptom-based vs. fixed-schedule treatment.
• Gabapentin as an alternative or adjunct.
• Anti-craving medications for relapse prevention.
• Disposition & Protocols
• Use of scoring systems for safe discharge, observation, or admission.
• Importance of protocolized approaches and community resources.
• Summary & Take-Home Points
• Five key practice-changing points.
• Clinical pathway.

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In this episode, Sam Ashoo, MD and Lara Zibners, MD discuss the August 2025 Pediatric Emergency Medicine Practice article, Diphtheria, Pertussis, and Tetanus: An Update of Evidence-Based Management of Pediatric Patients in the Emergency Department

• Introduction and guest background
• Host welcome, show context
• Dr. Lara Zibners’ credentials
• EB Medicine involvement
• Personal stories and clinical experience
• Memorable tetanus and pertussis cases
• Vaccine advocacy
• Rare disease encounters
• Diphtheria: overview, presentation, treatment
• Toxigenic vs. non-toxigenic, “bull neck”
• Cardiac, neurologic complications
• Antitoxin, antibiotics, public health
• Pertussis: symptoms, vaccine, treatment
• “100-day cough,” apnea in infants
• Waning immunity, boosters
• Azithromycin, treat contacts
• Tetanus: risk, presentation, management
• Clostridium ubiquity, no outbreaks
• Muscle spasms, autonomic instability
• Airway, sedation, antibiotics
• Key ED takeaways and pearls
• Early suspicion, isolation
• ICU admission for severe cases
• Vaccination, reporting
• Resources and article summary
• Appendix, clinical pathway
• ebmedicine.net reference
• CME, further reading
• Guest’s podcast plug and closing remarks
• “Unstable Vitals” podcast
• Where to listen
• Thank you, sign-off

Check out Dr Zibner's podcast Unstable Vitals

Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the October 2025 Emergency Medicine Practice article, Emergency Department Evaluation and Management of Patients With Adrenal Insufficiency

Introduction

• Welcome and host introductions
• Brief overview of the episode’s topic
• Resources and CME reminder

Article Overview

• Source: Emergency Medicine Practice, October 2025
• Authors: The Simcoes
• Importance of evidence-based review

Clinical Context & Epidemiology

• Frequency and rarity of adrenal insufficiency
• Diagnostic challenges and statistics
• Importance of recognizing adrenal crisis

Pathophysiology

• Primary, secondary, and tertiary adrenal insufficiency
• Causes and mechanisms
• Key anatomical and physiological concepts

Differential Diagnosis

• Overlap with other diseases (infections, autoimmune, endocrine, psychiatric, cardiac, GI, etc.)
• Importance of considering adrenal crisis in complex cases

Prehospital Care

• EMS recognition and limitations
• Importance of medication history and emergency kits
• Legal and logistical barriers to prehospital hydrocortisone

Emergency Department Evaluation

• Recognizing symptoms and prioritizing care
• Role of EMR and clinical decision support
• Key history and risk factors (medications, steroid use, opioid use, comorbidities)

Physical Examination

• Specific and nonspecific findings
• Cushingoid features vs. primary adrenal insufficiency signs

Diagnostic Workup

• Laboratory studies (cortisol, ACTH, renin, aldosterone, TSH, etc.)
• Imaging considerations
• Gold standard tests and their limitations in the ED

Treatment

• Immediate administration of hydrocortisone
• Dosing for adults and pediatrics
• Supportive care (fluids, glucose, treating underlying cause)
• Sick day dosing and home management

Special Populations

• Pregnancy considerations
• Septic shock and adrenal crisis

Common Pitfalls & Takeaways

• Delaying steroids for labs/diagnosis
• Importance of high suspicion and early treatment
• Key trivia and learning points

ClosingSummary and final thoughts

• Reminders for further reading and CME
• Farewell and next episode teaser

Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD interviews Evan Dvorin, MD about the dangers of short term steroid use.

Background & Regional Differences

• Dr. Dvorin’s clinical journey from New England to New Orleans.
• Noticing increased use of corticosteroids for common conditions in the Southeast.
• Discussion of how steroid prescribing practices vary by region and setting.

Inappropriate Steroid Use

• Common conditions where steroids are often inappropriately prescribed (sinus infections, bronchitis, sciatica, rashes, plantar fasciitis, etc.).
• Trends showing increased steroid prescribing over time.
• Similar patterns observed in emergency, urgent care, and primary care settings.

Risks and Side Effects of Short-Term Steroid Use

• Short-term steroids can cause significant side effects: infection, sepsis, bone fractures, thromboembolism, psychiatric effects, hyperglycemia.
• Dose-response relationship: higher doses and repeated use increase risks.
• Some side effects (e.g., bone loss) may persist beyond two months.

Patient Communication & Shared Decision-Making

• Importance of discussing risks with patients, tailored to individual risk factors (e.g., diabetes, psychiatric history, age).
• Strategies for educating patients and managing expectations.
• The role of patient education videos and resources.

Impact of Provider Education & Quality Metrics

• Ochsner Health’s initiatives to reduce inappropriate steroid use.
• Use of CME, quality dashboards, and feedback to clinicians.
• Evidence that education and reporting can reduce unnecessary prescriptions.

Special Populations & Scenarios

• Considerations for pediatric patients and repeated dosing.
• Challenges when specialists recommend steroids for certain conditions (e.g., sciatica, neurosurgery cases).
• The need for evidence-based practice and inter-provider communication.

Medical-Legal Considerations

• Lawsuits related to steroid side effects (e.g., fat atrophy, infection).
• Importance of documentation and informed consent.

Alternatives & Symptom Management

• Focusing on treating the patient’s most bothersome symptoms.
• Non-steroid options and the value of patient education about illness duration and expectations.

Resources

• Mention of Dr. Dvorin’s educational video on corticosteroid side effects (available on YouTube).
• Reminder of EB Medicine’s journals and resources for further learning.

Conclusion

• Key takeaway: “Do no harm” and practice evidence-based medicine.
• Encouragement for clinicians to review their prescribing habits and educate patients.

Ochsner "Side effects from corticosteroids" Video: https://www.youtube.com/watch?v=PdMJ9HYxkck

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the September 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Status Epilepticus

Topic Introduction

• Focus: Status Epilepticus in Adults
• Reference to recent pediatric episode
• Article authors: Dr. Marquez, Dr. Kaur, Dr. Lay

Why Status Epilepticus Matters

• Teaching value and clinical challenge
• Team-based care and multidisciplinary involvement

Guidelines and Evidence

• Review of major guidelines (International League Against Epilepsy, Neurocritical Care Society, American Epilepsy Society)
• Key trials: EcLiPSE, ConSEPT, ESETT
• Updated definition of status epilepticus

Classification and Diagnosis

• Convulsive vs. non-convulsive status
• Importance of repeated neurologic exams
• Diagnostic challenges and mimics (e.g., syncope, psychogenic seizures)

Etiology and Workup

• Acute vs. non-acute causes
• Common triggers: medication noncompliance, metabolic issues, infections, trauma
• Importance of sleep patterns and ammonia levels
• The NORSE acronym (new onset refractory status epilepticus)

Prehospital and ED Management

• Airway, breathing, circulation priorities
• Early pharmacologic intervention (IM midazolam preferred in prehospital)
• Gathering history and medication information
• Positioning and airway protection

Diagnostics

• Laboratory workup: glucose, CBC, metabolic panel, drug levels, pregnancy test
• Imaging: non-contrast CT, MRI, ultrasound, lumbar puncture
• EEG: spot vs. continuous monitoring

Treatment Approach

• First-line: Benzodiazepines (lorazepam, midazolam)
• Second-line: Levetiracetam, valproate, fosphenytoin, phenobarbital, lacosamide
• Third-line: Continuous infusions (midazolam, propofol, pentobarbital, thiopental, ketamine)
• Dosing pearls and importance of rapid escalation

Special Populations

• Pregnancy (eclampsia: magnesium as first-line)
• Substance-induced status epilepticus (e.g., isoniazid toxicity and pyridoxine)
• Brief mention of pediatric management and the PD stat app

Risk Management Pitfalls

• Non-convulsive status is common and easily missed
• Importance of weight-based dosing
• Need for formal EEG in ambiguous cases
• Don’t assume non-adherence is the only cause in known epileptics
• Always consider higher level of care for status patients

Clinical Pathway

• Stepwise approach to medication and escalation
• Emphasis on having a pathway/checklist for these high-stress cases

Conclusion

• Recap of key points
• Thanks to authors and listeners
• Reminder to visit ebmedicine.net for CME and resources

Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD interviews Ali Chaudhary, MD about the benefits of working Locum Tenens in Emergency Medicine.

• 00:00 Introduction and Welcome
• 00:54 Meet Dr. Ali Chaudhary
• 01:41 The State of Emergency Medicine
• 03:29 Understanding Locum Tenens
• 05:45 Financial Benefits of Locum Work
• 08:40 Balancing Family Life with Locum Work
• 12:54 Locum Work Logistics and Misconceptions
• 17:34 Maximizing Travel Perks as a Contractor
• 18:07 Adjusting to New Hospitals and EMRs
• 19:32 The Hassles of Credentialing
• 20:48 Navigating Locum Staffing Companies
• 22:27 Understanding Your Worth and Negotiation
• 25:14 The Importance of Organization
• 27:41 About Our Locum Staffing Company
• 29:59 Practical Tips for Malpractice Insurance
• 31:09 Final Thoughts and Contact Information

For more about Dr. Ali Chaudhary: https://thelocums.com/

In this episode, Sam Ashoo, MD interviews Lauren Black, MD about the August 2025 Emergency Medicine Practice article, Updates and Controversies in the Early Management of Sepsis and Septic Shock

00:00 Introduction and Welcome

01:09 Meet Dr. Lauren Page Black: Sepsis Expert

01:56 Sepsis Statistics and Impact

04:16 Understanding Sepsis Definitions

09:56 Screening Tools for Sepsis

13:57 Pre-Hospital Sepsis Recognition

19:33 Clinical Examination and Diagnostics

24:03 The Role of Lactate and Procalcitonin

27:40 Clinical Gestalt and Imaging in Diagnosis

29:21 CMS Bundle Requirements and Updates

34:02 Fluid Type Preferences in Sepsis

36:49 Antibiotic Timing and Selection

43:43 Vasopressors and Steroids in Sepsis Management

50:18 Special Populations and Future Directions

53:44 Conclusion and Resources

Emergency Medicine Residents, get your free subscription by writing [email protected] 

In this episode, Sam Ashoo, MD interviews Christina Shenvi, MD, PhD, MBA about ways to manage your day and keep distraction at bay.

• Introduction to Dr. Christina Shenvi
• Why Focus and Time Management Matter
• Experiences coaching medical students and professionals
• The importance of managing mind, time, and attention
• Applicability to both career and personal life
• Framework for Focus
• Three-step framework: Prioritize, Strategize, Focus
• Explanation of prioritization
• Mapping personal and professional activities to priorities
• Deep Work vs. Shallow Work
• Defining deep work and shallow work
• Strategies for categorizing and scheduling tasks
• Time-blocking and protecting focus time
• Overcoming Distraction
• The psychology of distraction and procrastination
• The impact of digital devices and social media on attention
• The variable reward system of social media and its addictive nature
• Strategies to Improve Focus
• Clearing mental, physical, and digital environments
• The importance of a distraction-free workspace
• Systems for capturing and organizing tasks
• The Pomodoro method and using time pressure
• Building a Personal System
• Experimenting with different task management tools
• Adapting systems to personal needs and preferences
• Daily Practice and Training Focus
• Reviewing and updating task lists daily
• Chunking email and shallow work to specific times
• Training the brain to focus like a muscle
• Special considerations for people with ADHD
• Resources and Contact
• Dr. Shenvi’s website and online course (timeforyourlife.org)
• Invitation to connect for coaching or further learning

For more about Christina Shenvi : https://timeforyourlife.org/