EMplify by EB Medicine

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the November 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Low Back Pain: A Review of Current Evidence

• Prevalence and Importance of Back Pain in the ED
• Differential Diagnosis and Serious Pathologies
• Patient Expectations and Management Strategies
• Missed Serious Pathologies and Their Implications
• Conflicting Evidence and Treatment Protocols
• Pathologies Causing Low Back Pain
• Mechanical and Infectious Causes
• Red Flags and Risk Factors
• Pre-Hospital Care and EMS Considerations
• History and Physical Examination
• Laboratory Testing and Inflammatory Markers
• Introduction to Imaging in Back Pain
• Common Findings in Imaging
• Choosing Wisely Campaign and Imaging Guidelines
• Patient Expectations and Imaging
• CT and MRI: When and Why
• Ultrasound in Back Pain Diagnosis
• Treatment Options for Back Pain
• NSAIDs and Other Pharmacologic Treatments
• Non-Pharmacologic Management
• Risk Management and Pitfalls

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In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the October 2024 Pediatric Emergency Medicine Practice article, Elder Abuse and Neglect: Making the Diagnosis and Devising a Treatment Plan in the Emergency Department

• 00:00 Welcome and Introduction
• 00:13 Free Subscription for Emergency Medicine Residents
• 01:05 Introduction to Pediatric Emergency Medicine Practice
• 01:37 Discussion on Acute Scrotal Pain
• 02:35 Testicular Torsion: Key Insights
• 09:50 Differential Diagnosis for Acute Scrotal Pain
• 17:21 Diagnostic Indicators of IgA Vasculitis
• 17:44 Pre-Hospital Care for Severe Pain
• 18:13 The Twist Score for Torsion
• 18:44 Emergency Department Evaluation
• 20:04 Ultrasound in Diagnosing Torsion
• 29:44 Operative Management and Other Conditions
• 31:41 Manual Detorsion Techniques
• 32:37 Risk Management and Key Takeaways
• 34:19 Conclusion and Final Thoughts
• 
  

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

In this special episode Sam Ashoo, MD interviews Ryan Johnson, Pharm. D. who shares strategies to address the recent IV fluid shortage caused by Hurricane Helene.

00:00 Introduction and Episode Overview

01:10 Meet Ryan Johnson: Clinical Pharmacist

02:06 Role of Clinical Pharmacists in Emergency Medicine

05:03 IV Fluid Shortage: Causes and Impact

05:56 Institutional Strategies to Mitigate IV Fluid Shortages

14:52 Provider-Level Solutions for Fluid Conservation

22:11 Pharmacy and Nursing Staff Roles in Fluid Management

26:34 Advanced Measures and Federal Guidelines

34:40 Conclusion and Final Thoughts

Resources mentioned in the podcast:

• (Brigham and Women's Protocol) Patiño, A. M., Marsh, R. H., Nilles, E. J., Baugh, C. W., Rouhani, S. A., & Kayden, S. (2018). Facing the shortage of IV fluids — a Hospital-Based Oral Rehydration strategy. New England Journal of Medicine, 378(16), 1475–1477. https://doi.org/10.1056/nejmp1801772
• Vizient shares conservation strategies for potential IV fluid supply disruption caused by Hurricane Helene https://newsroom.vizientinc.com/en-US/releases/releases-vizient-shares-conservation-strategies-for-potential-iv-fluid-supply-disruption-caused-by-hurricane-helene

In this episode, Dr. Julia Draper shares her firsthand account of managing a crisis during a hurricane in Asheville, North Carolina. As the area faced unprecedented flooding, Dr. Draper describes the challenges faced at Mission Hospital, including loss of power and water. She details the innovative solutions the hospital implemented and highlights the tireless efforts of staff during a natural disaster of this magnitude.

00:00 Introduction to Dr. Julia Draper

01:03 Experiencing the Hurricane

03:19 Immediate Aftermath and Hospital Challenges

11:22 Dealing with Water and Supply Shortages

20:48 Community and External Support

24:10 Ongoing Efforts and Future Plans

27:51 Conclusion and Final Thoughts

In this special episode, Sam Ashoo MD and Rob Orman MD discuss the concept of Maladaptive Perfectionism and its application to emergency medicine.

• Understanding Maladaptive Perfectionism
• Case Example and Discussion
• Adaptive vs Maladaptive Perfectionism
• Personal Experiences and Legal Challenges
• Dealing with Negative Outcomes
• Strategies for Managing Perfectionism in the ED
• Handling Overwhelming Shifts
• Managing Expectations in the ED
• A Soul-Crushing Day in the ED
• Finding Meaning in Moments of Crisis
• The Importance of Meaningful Work
• Operationalizing Meaning in Your Shift
• The Driveway Debrief: Transitioning from Work to Home
• Preparing for the Next Shift
• Conclusion and Next Episode Teaser

For more from Rob Orman, MD check out Orman Physician Coaching

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the September 2024 Emergency Medicine Practice article, Elder Abuse and Neglect: Making the Diagnosis and Devising a Treatment Plan in the Emergency Department

•  Introduction and Announcements
• Elder Abuse and Neglect: An Overview
• Risk Factors and Reporting
• Pre-Hospital and Emergency Department Considerations
• Screening Tools and Physical Examination
• Documentation and Disposition
• Cultural Considerations and Future Directions
• Conclusion and Resources

Suspected Elder Abuse should be reported to one of these organizations:

• ADULT PROTECTIVE SERVICES - Living at home
• LONG-TERM CARE OMBUDSMAN - Living in a long term care facility

In this episode, Sam Ashoo, MD interviews social media marketing expert Adam Goodcoff, DO, Founder and CEO of MedFluencers.

• Meet Dr. Adam Goodcoff
• The Role of Physicians on Social Media
• Legal Considerations for Physicians on Social Media
• Employer Policies and Social Media
• Creating Engaging Content
• Balancing Professionalism and Personal Life on Social Media
• Navigating Negative Comments and Trolls
• Handling Low Engagement and Negative Feedback
• Becoming a Medfluencer: Tips and Strategies
• Connecting with Adam and Final Thoughts

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the August 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Sickle Cell Disease

Epidemiology

• Common Presentation of Sickle Cell Disease in the ED
• Screening and Diagnosis Differences
• Epidemiology: 200,000 ED Visits Annually, 85% for Pain

Pathophysiology

• Life Expectancy and Complications
• Vado-Occlusive Crises and Pathophysiology
• Sequestration Crisis in Sickle Cell Patients
• Acute Chest Syndrome and Priapism

Clinical Management

• Treatment Advocacy and Pain Management
• Patient History and Examination Importance
• Imaging Recommendations
• Laboratory Studies and Findings
• Emergency Department Care Protocols

Advanced Treatment Options

• Intravenous (IV) Fluids Guideline
• Management of Priapism
• Role of Exchange Transfusion
• Acute Chest Syndrome Details
• Approach in Rural and Critical Access Hospitals

Special Populations

• Pregnant Patients with Sickle Cell Disease
• Increased Risks and Complication Management

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the July 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Complications of Dialysis

Overview of Dialysis Complications

• Key Dialysis ComplicationsCardiovascular Disease
• Congestive Heart Failure
• Pericarditis and Cardiac Tamponade
• Neurological Sequelae
• Gastrointestinal Complications
• Hypotension
• Dialysis Disequilibrium Syndrome
• Air Embolism and Chloramine Toxicity

Disaster Preparedness

• Vascular Access ComplicationsHemorrhage risks and treatment
• Thrombosis, stenosis, and aneurysms
• Infection risks and management

Pre-Hospital Care

• ED History Differential diagnosis
•  Key questions to ask dialysis patients
• Examination Physical Exam Tips

Treatments

• Risk Management PitfallsCommon Pitfalls to Avoid

Conclusion

In this episode, Sam Ashoo, MD and T.R. Eckler, MD interview Corey Hazekamp, MD, MS, one of authors of the June 2024 Emergency Medicine Practice article, Managing Emergency Department Patients With Opioid Use Disorder

Current State of Opioid Epidemic

• Overview of overdose deaths and trends.
• Data and statistics about opioid overdose mortality rates.
• Three Waves of Opioid Overdose Deaths in the U.S.

Opioid Classifications and Urine Drug Testing

• Types of opioids: synthetic, semi-synthetic, and natural.
• Urine drug testing limitations and false positives/negatives.
• Practical use and research on co-ingestions

Emergency Medical Services (EMS) and Pre-Hospital Care

• Importance of ABCs in acute opioid overdose cases.
• Naloxone usage trends and an empirical approach.
• Anecdotal insights on changing naloxone administration dosages.

Clinical Management in the Emergency Department

Buprenorphine Initiation

• Protocols for initiating buprenorphine in ED settings.
• Assessment using the Clinical Opiate Withdrawal Scale (COWS).
• Safe dosing procedures for buprenorphine.

Withdrawal and Overdose Care

• Laboratory testing recommendations.
• Capnography and VBG in overdose management.
• The role of end-tidal CO2 monitoring and respirations.

Methadone vs. Buprenorphine Considerations

• Methadone to buprenorphine transition protocols.
• Personal testimonials and clinical experiences in managing overdoses and withdrawal symptoms.

Patient Discharge and Follow-upPreparation of discharge prescriptions.

• Referral to addiction medicine clinics and resources.
• Educating patients on continued treatment and harm reduction.