EMplify by EB Medicine

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/

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 Patients

• Welcome and brief overview of the episode
• Promotion of EB Medicine’s $1 for 7-day trial offer

• Seizures make up ~1% of ED visits and ~3% of EMS calls
• High-risk and high-stakes condition requiring rapid action
• Status epilepticus now defined as ≥5 minutes of seizure activity
• ILAE’s T1 and T2 timelines help define when to treat and when damage begins

• Top contributors:
• Fever/infection
• Structural CNS abnormalities
• Toxic ingestions
• Genetic/metabolic disorders
• Additional factors by age:
• Infants: febrile seizures, chromosomal issues, trauma
• School-age: autoimmune disorders
• Adolescents: eclampsia, hypertension, functional disorders
• Always consider non-accidental trauma

• IM midazolam is effective and recommended (RAMPART trial)
• Other options: intranasal, rectal, or IV benzodiazepines
• Early benzodiazepine administration improves outcomes
• Importance of airway support, glucose check, and EMS flexibility
• Parent-administered home meds (e.g. rectal diazepam) can be helpful

• Prioritize ABCs: Airway, Breathing, Circulation, Consciousness
• Use end-tidal CO₂ to monitor ventilation if available
• Point-of-care glucose is essential
• Labs: CMP, Mg, Phos, lactate, drug levels, pregnancy test (when indicated)
• Imaging: Head CT if concern for trauma, shunt malfunction, or focal signs
• Case examples highlight pitfalls and diagnostic delays

• Benzodiazepines remain the cornerstone
• Lorazepam preferred IV agent (0.1 mg/kg)
• Midazolam preferred if no IV access (IN, IM, or IO)
• Diazepam is also effective, especially rectally
• Be mindful of respiratory depression and the need for airway control

• Based on ESETT trial:
• Levetiracetam, fosphenytoin, and valproate have similar efficacy
• Levetiracetam favored for safety and ease of use
• Fosphenytoin may be avoided in trauma or toxicity
• Valproate not recommended in mitochondrial disease
• Phenobarbital reserved for refractory cases only

• Definition: persistent seizures despite first- and second-line agents
• Requires sedation and likely intubation
• Infusion 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 activity

• Neonates:
• Watch for subtle signs (lip smacking, bicycling, tongue thrusting)
• Broad differential includes asphyxia, infection, metabolic errors
• Febrile Status Epilepticus:
• Higher risk of CNS infections, especially if unvaccinated
• Consider lumbar puncture if indicated
• Electrolyte/Metabolic Triggers:
• Treat hypoglycemia, hyponatremia, and hypocalcemia directly
• Use 3% saline or dextrose as appropriate

• Many children will require ICU-level care
• Some known epilepsy patients may go home if back to baseline
• Ensure rescue medications are up to date (rectal/intranasal benzos)
• Consider “clonazepam bridge” for short-term seizure prevention
• Collaborate with neurology for medication adjustment and follow-up

• Keep treatment tables and dosing references accessible
• Early, aggressive treatment can prevent long-term harm
• Episode closes with gratitude to article authors and a reminder to visit EBMedicine.net

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

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 Emergencies
• Understanding Decompensated Hypothyroidism
• Thyroid Storm: The Other Extreme
• Differential Diagnosis and Complications
• Medication Triggers and Patient History
• Physical Examination Findings
• Laboratory Analysis
• Scoring Systems and Risk Assessment
• Introduction to Treatment Approaches
• Managing Decompensated Hypothyroidism
• Treating Thyroid Storm
• Special Considerations and Populations
• Risk Management Pitfalls

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

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the May 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Complications of Chronic Neurologic Disease: Parkinson Disease, Myasthenia Gravis, and Multiple Sclerosis

• Importance of maintaining medication schedule for Parkinson's patients
• Strategies for ensuring patients receive their medications promptly
• Overview of Carbidopa Levodopa's mechanism of action

• Description of the disease mechanism
• Importance of assessing respiratory function
• Diagnostic alternatives like the negative inspiratory force test and counting test
• Discussion on appropriate emergency department actions and treatments including steroids, plasmapheresis, and IVIG

• Description of the disease mechanism
• Description of the typical patient demographic
• Discussion on the varied presentation of MS
• Treatment strategies including high-dose steroids and Baclofen

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

In this episode, Sam Ashoo, MD interviews Rob Orman, MD about ways to manage the trauma inflicted by the ER.

• Discussing Trauma in Emergency Medicine
• Personal Experiences with Trauma
• The Impact of Suppression
• Defining Trauma and Its Effects
• Integration vs. Disintegration
• Debriefing and Coping Mechanisms
• The Driveway Debrief
• Nurse and Physician Dynamics
• Reflective Solitude vs. Isolation
• Creating Narratives During Trauma
• Dropping Anchor Technique
• Body-Oriented Resets
• Post-Incident Rituals
• Addressing Lowercase t Traumas
• Therapy and Trauma Pathways

For more about Rob Orman and physician coaching: https://roborman.com/

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the April 2025 Emergency Medicine Practice article, Sodium Disorders in the Emergency Department: A Review of Hypernatremia and Hyponatremia

Hypernatremia (High Sodium Levels)

• Definition: Sodium level greater than 145 mEq/L
• Breakdown into three categories based on total body water status
• Hypovolemic Hypernatremia
• Euvolemic Hypernatremia
• Hypervolemic Hypernatremia
• Common causes and conditions associated

Hyponatremia (Low Sodium Levels)

• Definitions: Mild (130-135 mEq/L), Moderate (125-129 mEq/L), Profound (< 125 mEq/L)
• Breakdown into three categories
• Pseudo Hyponatremia
• Hypovolemic Hyponatremia
• Euvolemic Hyponatremia
• Hypervolemic Hyponatremia
• Common causes and conditions associated

Treatment Guidelines and Strategies

• Emphasizing slow correction to avoid complications like cerebral edema and osmotic demyelination syndrome
• Suggested treatment rates for acute and chronic conditions

Special Considerations

• Addressing severe cases and the importance of proper diagnostics
• Pre-hospital care considerations and scenarios
• Pediatrics and consideration of child abuse in sodium disorders

Five Things That Will Change Your Practice

• Central lab sodium values over point-of-care for accuracy
• Rectal temperature checks in endurance athletes
• Loop diuretics for hypervolemic hyponatremia (e.g., CHF patients)
• Enteral treatment for hypernatremia, if possible
• Considering COVID-19 as a possible cause for new onset SIADH

In this episode, Sam Ashoo, MD interviews Patrick O'Malley MD about his career in emergency medicine, The Laceration Course, and the power of connection with our patients.

• Dr. Patrick O'Malley's Journey in Emergency Medicine
• The Laceration Course: Origins and Evolution
• The EM Docs Side Hustle Facebook Group
• The Patient That Changed My Life

• The Laceration Course, The Abscess Course, and more...
• EM Docs Side Hustle Facebook Group
• Patrick O'Malley, MD: LinkedIn

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the March 2025 Emergency Medicine Practice article, Emergency Department Management of Knee Pain

• Common Etiologies of Knee Pain
• Risk Factors and Statistics
• Infectious Causes of Knee Pain
• Pre-Hospital Care and EMS
• History and Physical Exam
• Imaging Guidelines
• Ottawa Knee Rule and X-Ray Necessity
• Imaging Modalities for Knee Effusion
• Ultrasound for Tendon Injury and Arthrocentesis
• CT and MRI in Knee Injury Diagnosis
• Lab Tests for Septic Knee Diagnosis
• Treatment Options for Knee Conditions
• Knee Immobilizers: When and How to Use Them
• Steroid Injections in the Emergency Department
• Managing Traumatic Knee Injuries

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

In this episode, Sam Ashoo, MD interviews Ashley Weisman, MD about her career in rural emergency medicine, and the February 2025 Emergency Medicine Practice article, Management of Traumatic Intracranial Hemorrhage in the Emergency Department 

Interview with Dr. Ashley Wiseman

• Introduction of Dr. Wiseman: Emergency physician specializing in rural ER.
• Dr. Wiseman’s Background: Overview of her work and responsibilities in rural hospitals and academia.
• Experience in Rural Medicine: 
• Contrast with urban and academic practice.
• Stories of practical challenges and learning experiences in remote areas like Kotzebue, Alaska.

Practicing Skills in Rural Medicine

• Discussion of skill retention: Importance of continuously applying and practicing critical skills.
• Resources and Training: Role of fellowship, networking, and practical experiences for skill enhancement.

Advocacy for Rural Emergency Medicine

• Work with ACEP: Dr. Wiseman’s efforts in advocating for rural EM at the national level.
• Collaboration Between Rural and Academic Centers: Importance of knowledge exchange and mutual support.

Focus on Traumatic Intracranial Hemorrhage (ICH)

• Introduction to the February Article: Traumatic ICH in rural settings.
• Key Points from the Article:
• Importance of basic neurocritical care practices.
• Practical adjustments and simplified approaches in care.
• Dr. Wiseman’s Contribution: How her experiences shaped the content and practical advice for rural medicine.

Conclusion

• Upcoming Contributions: Announcing more contributions and resources from Dr. Wiseman.
• Access the In Rural Life (IRrL*) content here.
• Emergency Medicine Residents, get your free subscription by writing [email protected]

If you practice in a rural environment, you know that managing a patient with traumatic ICH can present challenges with diagnostic and treatment resources, personnel, training, and transport. Dr. Weisman has created resources for emergency clinicians, IRrL* (In Rural Life*) that EB Medicine is proud to share with subscribers.   

Resources for emergency clinicians managing patients with traumatic ICH in rural settings include: 

• Checklist for Managing Traumatic Intracranial Hemorrhage in Rural Life (IRrL): 7 steps to providing neurocritical care in resource-limited settings.
• Simulation for Critical Access Neurocritical Care: Saving Brain Hours from Tertiary Care: A customizable simulation designed for you and your team to practice managing patients with brain injury.