In this episode, Sam Ashoo, MD and Dr. T.R. Eckler, MD discuss the September 2026 Emergency Medicine Practice article, <a href="https://www.ebmedicine.net/topics/toxicologic-environmental/emergency-medicine-acetaminophen-salicylate-toxicity">Emergency Department Diagnosis and Management of Acetaminophen or Salicylate Toxicity</a>1:13 — Welcome and topic introduction3:50 — Key rules: check levels, call Poison Control5:13 — Acetaminophen pathophysiology8:16 — Salicylate pathophysiology10:51 — Coingestions11:11 — Differential diagnosis12:19 — History & pre-hospital care15:28 — Product confusion17:08 — Toxic dose thresholds18:26 — Physical exam & vital signs20:16 — Acetaminophen toxicity stages (1-4)22:35 — Salicylate exam findings23:43 — Lab workup & testing24:45 — Acetaminophen nomogram & levels30:39 — Activated charcoal — when to give it34:11 — NAC therapy — dosing & timing37:22 — Hemodialysis for acetaminophen38:40 — King's College Criteria41:00 — Salicylate treatment44:42 — Potassium management during alkalinization47:28 — Hemodialysis for salicylate48:05 — Intubation50:00 — Pregnancy considerations51:20 — Pediatric considerations52:06 — Emerging: fomepizole as adjunct therapy52:45 — Summary & wrap-upSubscribers, take the CME test <a href="https://www.ebmedicine.net/cme/toxicologic-environmental/emergency-medicine-acetaminophen-salicylate-toxicity">here</a>.Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

In this episode, Sam Ashoo, MD and Dr. T.R. Eckler, MD discuss the September 2026 Emergency Medicine Practice article, Emergency Department Diagnosis and Management of Acetaminophen or Salicylate Toxicity 1:13 — Welcome and topic introduction 3:50 — Key rules: check levels, call Poison Control 5:13 — Acetaminophen pathophysiology 8:16 — Salicylate pathophysiology 10:51 — Coingestions 11:11 — Differential diagnosis 12:19 — History & pre-hospital care 15:28 — Product confusion 17:08 — Toxic dose thresholds 18:26 — Physical exam & vital signs 20:16 — Acetaminophen toxicity stages (1-4) 22:35 — Salicylate exam findings 23:43 — Lab workup & testing 24:45 — Acetaminophen nomogram & levels 30:39 — Activated charcoal — when to give it 34:11 — NAC therapy — dosing & timing 37:22 — Hemodialysis for acetaminophen 38:40 — King's College Criteria 41:00 — Salicylate treatment 44:42 — Potassium management during alkalinization 47:28 — Hemodialysis for salicylate 48:05 — Intubation 50:00 — Pregnancy considerations 51:20 — Pediatric considerations 52:06 — Emerging: fomepizole as adjunct therapy 52:45 — Summary & wrap-up Subscribers, take the CME test here. Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

In this episode, Sam Ashoo, MD and Dr. T.R. Eckler, MD discuss the September 2026 Emergency Medicine Practice article, <a href="https://www.ebmedicine.net/topics/toxicologic-environmental/emergency-medicine-acetaminophen-salicylate-toxicity" rel="noopener noreferrer">Emergency Department Diagnosis and Management of Acetaminophen or Salicylate Toxicity</a>1:13 — Welcome and topic introduction3:50 — Key rules: check levels, call Poison Control5:13 — Acetaminophen pathophysiology8:16 — Salicylate pathophysiology10:51 — Coingestions11:11 — Differential diagnosis12:19 — History &amp; pre-hospital care15:28 — Product confusion17:08 — Toxic dose thresholds18:26 — Physical exam &amp; vital signs20:16 — Acetaminophen toxicity stages (1-4)22:35 — Salicylate exam findings23:43 — Lab workup &amp; testing24:45 — Acetaminophen nomogram &amp; levels30:39 — Activated charcoal — when to give it34:11 — NAC therapy — dosing &amp; timing37:22 — Hemodialysis for acetaminophen38:40 — King's College Criteria41:00 — Salicylate treatment44:42 — Potassium management during alkalinization47:28 — Hemodialysis for salicylate48:05 — Intubation50:00 — Pregnancy considerations51:20 — Pediatric considerations52:06 — Emerging: fomepizole as adjunct therapy52:45 — Summary &amp; wrap-upSubscribers, take the CME test <a href="https://www.ebmedicine.net/cme/toxicologic-environmental/emergency-medicine-acetaminophen-salicylate-toxicity" rel="noopener noreferrer">here</a>.Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

Acetaminophen and Salicylate Toxicity

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the July 2025 Emergency Medicine Practice article, <a href="https://www.ebmedicine.net/topics/neurologic/pediatric-emergency-medicine-status-epilepticus" style="color:rgb(0,80,165);">Emergency Department Management of Status Epilepticus in Pediatric Patients</a>Introduction<ul><li>Welcome and brief overview of the episode</li><li><a href="https://www.ebmedicine.net/" style="color:rgb(0,80,165);">Promotion of EB Medicine’s $1 for 7-day trial offer</a></li></ul>Why Pediatric Status Epilepticus Matters<ul><li>Seizures make up ~1% of ED visits and ~3% of EMS calls</li><li>High-risk and high-stakes condition requiring rapid action</li><li>Status epilepticus now defined as ≥5 minutes of seizure activity</li><li>ILAE’s T1 and T2 timelines help define when to treat and when damage begins</li></ul>Common Causes<ul><li>Top contributors:</li><li>Fever/infection</li><li>Structural CNS abnormalities</li><li>Toxic ingestions</li><li>Genetic/metabolic disorders</li><li>Additional factors by age:</li><li>Infants: febrile seizures, chromosomal issues, trauma</li><li>School-age: autoimmune disorders</li><li>Adolescents: eclampsia, hypertension, functional disorders</li><li>Always consider non-accidental trauma</li></ul>Prehospital Care<ul><li>IM midazolam is effective and recommended (RAMPART trial)</li><li>Other options: intranasal, rectal, or IV benzodiazepines</li><li>Early benzodiazepine administration improves outcomes</li><li>Importance of airway support, glucose check, and EMS flexibility</li><li>Parent-administered home meds (e.g. rectal diazepam) can be helpful</li></ul>ED Evaluation and Initial Management<ul><li>Prioritize ABCs: Airway, Breathing, Circulation, Consciousness</li><li>Use end-tidal CO₂ to monitor ventilation if available</li><li>Point-of-care glucose is essential</li><li>Labs: CMP, Mg, Phos, lactate, drug levels, pregnancy test (when indicated)</li><li>Imaging: Head CT if concern for trauma, shunt malfunction, or focal signs</li><li>Case examples highlight pitfalls and diagnostic delays</li></ul>First-Line Treatment<ul><li>Benzodiazepines remain the cornerstone</li><li>Lorazepam preferred IV agent (0.1 mg/kg)</li><li>Midazolam preferred if no IV access (IN, IM, or IO)</li><li>Diazepam is also effective, especially rectally</li><li>Be mindful of respiratory depression and the need for airway control</li></ul>Second- and Third-Line Therapies<ul><li>Based on ESETT trial:</li><li>Levetiracetam, fosphenytoin, and valproate have similar efficacy</li><li>Levetiracetam favored for safety and ease of use</li><li>Fosphenytoin may be avoided in trauma or toxicity</li><li>Valproate not recommended in mitochondrial disease</li><li>Phenobarbital reserved for refractory cases only</li></ul>Refractory Status Epilepticus<ul><li>Definition: persistent seizures despite first- and second-line agents</li><li>Requires sedation and likely intubation</li><li>Infusion options:</li><li>Midazolam (preferred for flexibility)</li><li>Propofol (short-term use only due to risk of infusion syndrome)</li><li>Pentobarbital (rare, ICU-level care)</li><li>Need for continuous EEG to assess seizure activity</li></ul>Special Scenarios<ul><li>Neonates:</li><li class="ql-indent-1">Watch for subtle signs (lip smacking, bicycling, tongue thrusting)</li><li class="ql-indent-1">Broad differential includes asphyxia, infection, metabolic errors</li><li>Febrile Status Epilepticus:</li><li class="ql-indent-1">Higher risk of CNS infections, especially if unvaccinated</li><li class="ql-indent-1">Consider lumbar puncture if indicated</li><li>Electrolyte/Metabolic Triggers:</li><li class="ql-indent-1">Treat hypoglycemia, hyponatremia, and hypocalcemia directly</li><li class="ql-indent-1">Use 3% saline or dextrose as appropriate</li></ul>Disposition and Discharge Considerations<ul><li>Many children will require ICU-level care</li><li>Some known epilepsy patients may go home if back to baseline</li><li>Ensure rescue medications are up to date (rectal/intranasal benzos)</li><li>Consider “clonazepam bridge” for short-term seizure prevention</li><li>Collaborate with neurology for medication adjustment and follow-up</li></ul>Final Thoughts<ul><li>Keep treatment tables and dosing references accessible</li><li>Early, aggressive treatment can prevent long-term harm</li><li>Episode closes with gratitude to article authors and a reminder to visit EBMedicine.net</li></ul>Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the July 2025 Emergency Medicine Practice article, Emergency Department Management of Status Epilepticus in Pediatric PatientsIntroductionWelcome and brief overview of the episodePromotion of EB Medicine’s $1 for 7-day trial offerWhy Pediatric Status Epilepticus MattersSeizures make up ~1% of ED visits and ~3% of EMS callsHigh-risk and high-stakes condition requiring rapid actionStatus epilepticus now defined as ≥5 minutes of seizure activityILAE’s T1 and T2 timelines help define when to treat and when damage beginsCommon CausesTop contributors:Fever/infectionStructural CNS abnormalitiesToxic ingestionsGenetic/metabolic disordersAdditional factors by age:Infants: febrile seizures, chromosomal issues, traumaSchool-age: autoimmune disordersAdolescents: eclampsia, hypertension, functional disordersAlways consider non-accidental traumaPrehospital CareIM midazolam is effective and recommended (RAMPART trial)Other options: intranasal, rectal, or IV benzodiazepinesEarly benzodiazepine administration improves outcomesImportance of airway support, glucose check, and EMS flexibilityParent-administered home meds (e.g. rectal diazepam) can be helpfulED Evaluation and Initial ManagementPrioritize ABCs: Airway, Breathing, Circulation, ConsciousnessUse end-tidal CO₂ to monitor ventilation if availablePoint-of-care glucose is essentialLabs: CMP, Mg, Phos, lactate, drug levels, pregnancy test (when indicated)Imaging: Head CT if concern for trauma, shunt malfunction, or focal signsCase examples highlight pitfalls and diagnostic delaysFirst-Line TreatmentBenzodiazepines remain the cornerstoneLorazepam preferred IV agent (0.1 mg/kg)Midazolam preferred if no IV access (IN, IM, or IO)Diazepam is also effective, especially rectallyBe mindful of respiratory depression and the need for airway controlSecond- and Third-Line TherapiesBased on ESETT trial:Levetiracetam, fosphenytoin, and valproate have similar efficacyLevetiracetam favored for safety and ease of useFosphenytoin may be avoided in trauma or toxicityValproate not recommended in mitochondrial diseasePhenobarbital reserved for refractory cases onlyRefractory Status EpilepticusDefinition: persistent seizures despite first- and second-line agentsRequires sedation and likely intubationInfusion options:Midazolam (preferred for flexibility)Propofol (short-term use only due to risk of infusion syndrome)Pentobarbital (rare, ICU-level care)Need for continuous EEG to assess seizure activitySpecial ScenariosNeonates:Watch for subtle signs (lip smacking, bicycling, tongue thrusting)Broad differential includes asphyxia, infection, metabolic errorsFebrile Status Epilepticus:Higher risk of CNS infections, especially if unvaccinatedConsider lumbar puncture if indicatedElectrolyte/Metabolic Triggers:Treat hypoglycemia, hyponatremia, and hypocalcemia directlyUse 3% saline or dextrose as appropriateDisposition and Discharge ConsiderationsMany children will require ICU-level careSome known epilepsy patients may go home if back to baselineEnsure rescue medications are up to date (rectal/intranasal benzos)Consider “clonazepam bridge” for short-term seizure preventionCollaborate with neurology for medication adjustment and follow-upFinal ThoughtsKeep treatment tables and dosing references accessibleEarly, aggressive treatment can prevent long-term harmEpisode closes with gratitude to article authors and a reminder to visit EBMedicine.netEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the July 2025&nbsp;Emergency Medicine Practice&nbsp;article,&nbsp;<a href="https://www.ebmedicine.net/topics/neurologic/pediatric-emergency-medicine-status-epilepticus" rel="noopener noreferrer">Emergency Department Management of Status Epilepticus in Pediatric Patients</a>Introduction<ul><li>Welcome and brief overview of the episode</li><li><a href="https://www.ebmedicine.net/" rel="noopener noreferrer">Promotion of EB Medicine’s $1 for 7-day trial offer</a></li></ul>Why Pediatric Status Epilepticus Matters<ul><li>Seizures make up ~1% of ED visits and ~3% of EMS calls</li><li>High-risk and high-stakes condition requiring rapid action</li><li>Status epilepticus now defined as ≥5 minutes of seizure activity</li><li>ILAE’s T1 and T2 timelines help define when to treat and when damage begins</li></ul>Common Causes<ul><li>Top contributors:</li><li>Fever/infection</li><li>Structural CNS abnormalities</li><li>Toxic ingestions</li><li>Genetic/metabolic disorders</li><li>Additional factors by age:</li><li>Infants: febrile seizures, chromosomal issues, trauma</li><li>School-age: autoimmune disorders</li><li>Adolescents: eclampsia, hypertension, functional disorders</li><li>Always consider non-accidental trauma</li></ul>Prehospital Care<ul><li>IM midazolam is effective and recommended (RAMPART trial)</li><li>Other options: intranasal, rectal, or IV benzodiazepines</li><li>Early benzodiazepine administration improves outcomes</li><li>Importance of airway support, glucose check, and EMS flexibility</li><li>Parent-administered home meds (e.g. rectal diazepam) can be helpful</li></ul>ED Evaluation and Initial Management<ul><li>Prioritize ABCs: Airway, Breathing, Circulation, Consciousness</li><li>Use end-tidal CO₂ to monitor ventilation if available</li><li>Point-of-care glucose is essential</li><li>Labs: CMP, Mg, Phos, lactate, drug levels, pregnancy test (when indicated)</li><li>Imaging: Head CT if concern for trauma, shunt malfunction, or focal signs</li><li>Case examples highlight pitfalls and diagnostic delays</li></ul>First-Line Treatment<ul><li>Benzodiazepines remain the cornerstone</li><li>Lorazepam preferred IV agent (0.1 mg/kg)</li><li>Midazolam preferred if no IV access (IN, IM, or IO)</li><li>Diazepam is also effective, especially rectally</li><li>Be mindful of respiratory depression and the need for airway control</li></ul>Second- and Third-Line Therapies<ul><li>Based on ESETT trial:</li><li>Levetiracetam, fosphenytoin, and valproate have similar efficacy</li><li>Levetiracetam favored for safety and ease of use</li><li>Fosphenytoin may be avoided in trauma or toxicity</li><li>Valproate not recommended in mitochondrial disease</li><li>Phenobarbital reserved for refractory cases only</li></ul>Refractory Status Epilepticus<ul><li>Definition: persistent seizures despite first- and second-line agents</li><li>Requires sedation and likely intubation</li><li>Infusion options:</li><li>Midazolam (preferred for flexibility)</li><li>Propofol (short-term use only due to risk of infusion syndrome)</li><li>Pentobarbital (rare, ICU-level care)</li><li>Need for continuous EEG to assess seizure activity</li></ul>Special Scenarios<ul><li>Neonates:</li><li>Watch for subtle signs (lip smacking, bicycling, tongue thrusting)</li><li>Broad differential includes asphyxia, infection, metabolic errors</li><li>Febrile Status Epilepticus:</li><li>Higher risk of CNS infections, especially if unvaccinated</li><li>Consider lumbar puncture if indicated</li><li>Electrolyte/Metabolic Triggers:</li><li>Treat hypoglycemia, hyponatremia, and hypocalcemia directly</li><li>Use 3% saline or dextrose as appropriate</li></ul>Disposition and Discharge Considerations<ul><li>Many children will require ICU-level care</li><li>Some known epilepsy patients may go home if back to baseline</li><li>Ensure rescue medications are up to date (rectal/intranasal benzos)</li><li>Consider “clonazepam bridge” for short-term seizure prevention</li><li>Collaborate with neurology for medication adjustment and follow-up</li></ul>Final Thoughts<ul><li>Keep treatment tables and dosing references accessible</li><li>Early, aggressive treatment can prevent long-term harm</li><li>Episode closes with gratitude to article authors and a reminder to visit EBMedicine.net</li></ul>Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

Pediatric Status Epilepticus

Special Offer - EB Medicine is 26 years old! Get 26% off all purchases at ebmedicine.net!In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the June 2025 Emergency Medicine Practice article, <a href="https://www.ebmedicine.net/topics/endocrine/emergency-medicine-thyroid-emergencies">Emergency Department Management of Patients With Thyroid Emergencies</a><ul><li>Introduction to Thyroid Emergencies</li><li>Understanding Decompensated Hypothyroidism</li><li>Thyroid Storm: The Other Extreme</li><li>Differential Diagnosis and Complications</li><li>Medication Triggers and Patient History</li><li>Physical Examination Findings</li><li>Laboratory Analysis </li><li>Scoring Systems and Risk Assessment</li><li>Introduction to Treatment Approaches</li><li>Managing Decompensated Hypothyroidism</li><li>Treating Thyroid Storm</li><li>Special Considerations and Populations</li><li>Risk Management Pitfalls</li></ul>Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

Special Offer - EB Medicine is 26 years old! Get 26% off all purchases at ebmedicine.net! In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the June 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Thyroid Emergencies Introduction to Thyroid EmergenciesUnderstanding Decompensated HypothyroidismThyroid Storm: The Other ExtremeDifferential Diagnosis and ComplicationsMedication Triggers and Patient HistoryPhysical Examination FindingsLaboratory Analysis Scoring Systems and Risk AssessmentIntroduction to Treatment ApproachesManaging Decompensated HypothyroidismTreating Thyroid StormSpecial Considerations and PopulationsRisk Management Pitfalls Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

Special Offer - EB Medicine is 26 years old! Get 26% off all purchases at ebmedicine.net!In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the June 2025&nbsp;Emergency Medicine Practice article, <a href="https://www.ebmedicine.net/topics/endocrine/emergency-medicine-thyroid-emergencies" rel="noopener noreferrer">Emergency Department Management of Patients With Thyroid Emergencies</a><ul><li>Introduction to Thyroid Emergencies</li><li>Understanding Decompensated Hypothyroidism</li><li>Thyroid Storm: The Other Extreme</li><li>Differential Diagnosis and Complications</li><li>Medication Triggers and Patient History</li><li>Physical Examination Findings</li><li>Laboratory Analysis </li><li>Scoring Systems and Risk Assessment</li><li>Introduction to Treatment Approaches</li><li>Managing Decompensated Hypothyroidism</li><li>Treating Thyroid Storm</li><li>Special Considerations and Populations</li><li>Risk Management Pitfalls</li></ul>Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

Thyroid Emergencies

Brought to you by EB Medicine, this new emergency medicine podcast will refresh your knowledge on each monthly topic from Emergency Medicine Practice while you're on the go.

Pilot Episode - Transient Global Amnesia

Take a deeper dive into our peer-reviewed emergency medicine content with the EMplify podcast. Join hosts Sam Ashoo, MD and T.R. Eckler, MD for educational, conversational reviews of current evidence guaranteed to help you make your best clinical decisions. Each high-yield episode gives you practical, time-tested guidance from practicing emergency medicine clinicians and subject-matter experts. Listen and learn!

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