A patient came into my emergency room vomiting 10 times a day, two days after a semaglutide injection. They had just increased their dose. When I asked why, they did not know. It was what the app told them to do.

Ozempic, Wegovy, Mounjaro and the rest of the GLP-1 family are the biggest story in medicine right now, and the conversation around them has collapsed into two camps. Half the internet calls them a miracle. The other half calls them poison. Neither is being straight with you.

So this episode runs them through the same framework I use for every medication. We start with the physiology, because not all GLP-1s are created equal and the difference between a GLP-1 agonist and a dual GIP and GLP-1 agonist actually matters when you are reading about them online.

Then question one, what is the real benefit? Split by condition, because these are not just weight loss drugs. There is the head-to-head diabetes data on blood sugar control. There is a trial of 17,604 people with cardiovascular disease but no diabetes, where the rate of cardiovascular death, heart attack or stroke dropped meaningfully. And there is the tirzepatide weight data, which approaches surgical territory.

Then question two, what are the real risks? I give you the actual discontinuation number from a large trial rather than a vague warning about nausea, and we cover the rarer risks worth screening for.

And then the part I care about most, because it is my world and it is being badly undercommunicated. These drugs slow gastric emptying. That is the mechanism, not a side effect. Which means when you fast before a procedure, your stomach may not be empty. There is an ultrasound study on exactly this, and the number should change how you prepare for surgery.

We finish with muscle, fiber, what actually happens when you stop, and the specific hazard with compounded and app-directed prescribing.

I am Dr Adrian Cois, an Emergency Medicine physician and Assistant Professor. Companion guide and the full reference list at drcois.com.

Let's chase less bad days and more good decades together.

Key takeaways

●  The benefit is real and goes well beyond weight loss,with a demonstrated reduction in cardiovascular death, heart attack and strokein people without diabetes.

●  These drugs were built for type 2 diabetes. The weight loss was a happy side effect, and the diabetes evidence base is still the largest one.

●  The most common side effects are gastrointestinal, and in one large trial roughly one in six people stopped the drug permanently because of adverse effects.

●  Slowed gastric emptying is the mechanism, not a side effect, which is why it cannot simply be avoided.

●  Tell every clinician on your care team that you take a GLP-1, especially before any procedure. Do not assume it is in the chart.

●  Protein, resistance training and fiber matter more onthese drugs, not less.

●  Weight tends to return when you stop, which is also true after any diet. That makes this chronic disease management, not a short course.

●  Dosing errors from compounded and app-directed prescribing are what land people in the emergency department.

Cardiovascular disease is the number one killer in the US and in Australia, and cholesterol is the most misunderstood set of numbers in medicine. On one side you have people insisting it does not matter at all. On the other you have people selling you a supplement to fix it.

In this episode I take you through a standard lipid panel line by line. What each number actually measures, what the evidence really shows, and what your numbers mean for you rather than for a reference range on a page.

I am Dr Adrian Cois, an Emergency Medicine physician and Assistant Professor. I met the consequence of 20 years of unexplained cholesterol at 2 a.m. in my emergency department, and that case opens this episode.

In this episode:

●  How an LDL particle physically gets into your arterywall, and why ApoB is the part that causes the damage

●   Why LDL cholesterol is a surrogate for particle countrather than a direct measure of it

●   Why HDL got called the good cholesterol, and why thedrugs that raised it failed

●  What moderately high triglycerides are quietly tellingyou about your metabolic health

●  How to calculate your non-HDL cholesterol from numbersyou already have

●  When ApoB and lipoprotein(a) are worth asking yourdoctor about

●  Why oxidized LDL, LDL particle size, and thetriglyceride to HDL ratio do not get you off the hook

●   Whether you actually need to fast before a lipid panel

Resources and links

●   Companionguide and printable summary: https://drcois.com/blog

●   Listenon Spotify: https://open.spotify.com/show/5wKvs7CY1WKWJciPFq9H9U

●   Subscribeon YouTube: https://www.youtube.com/@dr_cois

●   Watchfirst, the Lab Results Explained framework episode: [link S2E2 (17)]

●   Book mentioned in the outro: Cholesterol Truths by Dr Mohammed Alo, written with Dr Thomas Dayspring. I have no financial relationship with the authors or publisher and receive nothing from this mention.

Key papers

●   Ference BA, et al. Low-density lipoproteins cause atherosclerotic cardiovasculardisease. Eur Heart J. 2017;38(32):2459-2472.https://doi.org/10.1093/eurheartj/ehx144

●   Blumenthal RS, et al. 2026 ACC/AHA/Multisociety Guideline on the Management ofDyslipidemia. Circulation. 2026;153(17):e1154-e1276.https://doi.org/10.1161/CIR.0000000000001423

●   Baigent C, et al. Efficacy and safety of cholesterol-lowering treatment: 90,056participants in 14 randomised trials of statins. Lancet.2005;366(9493):1267-1278. https://doi.org/10.1016/S0140-6736(05)67394-1

●   Voight BF, et al. Plasma HDL cholesterol and risk of myocardial infarction: amendelian randomisation study. Lancet. 2012;380(9841):572-580.https://doi.org/10.1016/S0140-6736(12)60312-2

Disclosures

I have no financial relationship with any product, company, laboratory, book, or author mentioned in this episode. No affiliate links are used anywhere on this channel or at drcois.com.

Disclaimer

This video is for educational purposes only. It does not provide medical advice or establish a physician-patient relationship. Always consult a qualified clinician about your own health.

A patient is writhing on the bed, unable to lie still, pale with the pain. It is the textbook picture of renal colic, and the classic reflex is an IV in the arm, intravenous pain medication, and a trip down the hall for a CT. But what if the typical patient does not need all of that?

This is Overheard Journal Club, where I take a paper I love, break it down, and tell you how it makes me think about the way I practice. This episode breaks the usual format and pairs twocomplementary trials, because together they sketch something more interesting than either does alone.

We cover both in full PICO, walk through the results, and then get honest about the limitations, including why one trial was allocated by calendar date rather than truly randomized, why a bedside scan that is only 72 percent sensitive cannot rule out a stone, and where the evidence stops and clinical extrapolation begins.

Key takeaways

•  Leading with bedside ultrasound cut emergencydepartment length of stay by 62 minutes and about 60 dollars per patient, withno increase in missed diagnoses or 30-day complications

•  The time was won by reaching CT faster rather than byavoiding it, since every patient in that trial was scanned

•  Intranasal ketorolac matched intravenous ketorolac for severe renal colic pain by 60 minutes, with the same safety profile and no needle

•  Both trials are small and single-center, so this is asignal worth acting on thoughtfully rather than a mandate

•  For the right patient, consider the scan-and-spray pathway, and reserve the CT for those who do not settle, look infected, or have a complicated history

Chapter markers

Build the YouTube chapter list first from the final edit, then mirror it here so the two platforms never drift apart. Spotify chapter markers should match the YouTube timestamps exactly.

Disclaimer

Educational purposes only. This podcast does not provide medical advice and does not establish a physician-patient relationship. Cases are deidentified and altered. Always discuss management decisions with a qualified clinician.

Links

Companion blog and full reference list: https://drcois.com/blog

A man in his fifties sat at his kitchen table one night, certain he had bad indigestion. He took an antacid and went to bed. By the time he came to the Emergency Department several hours later, his ECG told a very different story, and those hours had cost him heart muscle we could never get back.

Here is the uncomfortable truth at the center of that story. The person least able to tell whether chest pain is a heart attack is the person having it.

So in this episode, Dr Adrian Cois walks through the warning signs emergency physicians actually look for, including the quiet ones that show up in women, older adults, and people with diabetes. He covers why roughly one in three confirmed heart attacks in a registry of more than 400,000 patients arrived with no chest pain at all, and why those patients did so much worse. He explains why a heart attack and a panic attack cannot be reliably told apart by symptoms alone, and what actually raises the stakes enough to call for help. And he gives you the exact plan for the first 10 minutes, including where aspirin fits and the one thing you should never do.

This is Spoke 1 of the “ER or Wait?” cluster. If you have not heard the framework episode yet, start there.

Key takeaways

•  Chest discomfort with pressure, sweating,breathlessness, or pain spreading to the arm or jaw is an emergency, notsomething to sleep on.

•  A heart attack does not always bring dramatic pain,especially in women, older adults, and people with diabetes.

• You cannot reliably separate a heart attack from apanic attack at home, so when in doubt, you call.

• In the first minutes: stop, call, do not driveyourself, and take aspirin only if the dispatcher advises it.

• The Tier 1 version of this episode is a primary care physician who knows your blood pressure, cholesterol, blood sugar, and family history.

Links

• Companion blog post and full reference list:https://drcois.com/blog

• Watch on YouTube: https://www.youtube.com/@dr_cois

• More from Dr Cois: https://drcois.com

Disclaimer

Educational purposes only. This episode does not provide medical advice and does not establish a physician-patient relationship. If you think you may be having an emergency, call your local emergency number immediately. Always consult aqualified clinician for personal health questions. No financial relationship with any product, company, or service mentioned.

A patient of mine stopped taking his medication because of a 30-second video. An influencer with great lighting and zero medical training told him the pills were poison. A few months later, we met in my emergency department, dealing with the exact consequence we had been preventing all along.

This is the pillar episode for the whole medication series. It is not a defense of every drug, and it is not a hit piece. Good medicine welcomes hard questions. What I am giving you is a framework for asking the right ones.

First, the four tricks used to scare people off their medication, because once you can see the move it stops working on you. Then the four questions to ask about any drug, whether you are starting it or being tempted to stop it.

WHAT YOU WILL TAKE AWAY

Why natural tells you where something came from and nothing about whether it is safe

Why a single story cannot tell you what happens across millions of people

How to answer the scariest headline in health media with three words: double of what? Why stopping a medication is itself a decision, with its own risks. Why your pharmacist is the most underused expert in your life. Why supplement is a regulatory category and not a safety guarantee

Companion blog post, full references, and free resources at DrCois.com.

Educational content only. This episode does not provide medical advice and does not establish a physician-patient relationship. Never stop a prescribed medication without speaking to your prescriber.

No affiliate links. Cronometer is referenced across this show with no financial relationship of any kind.

Less bad days, more good decades.

A patient comes in for a laceration on her hand. Simple visit. Then the cuff cycles and the number thatcomes back is 182 over 112. She feels completely fine. No headache, no chest pain, nothing. And now there is a decision to make that is one of the more contested calls in emergency medicine.

This is Overheard Journal Club, where I take a single paper I find genuinely interesting, break it down, and tell you how it changed the way I practice. Today it is a 2024 observational cohort study of more than 93,000 discharged emergency department visits carrying a hypertension diagnosis, asking whether an antihypertensive prescription at discharge is associated with better 30-day outcomes.

We go through the full PICO, the results, and an honest critical appraisal, including why an adjusted odds ratio that looks dramatic still cannot prove cause and effect. I also explain where I sit relative to the ACEP clinical policy, which is deliberately cautious here, and what I actually do on shift instead of reflexively starting a drug.

Key takeaways

•  Asymptomatic hypertension is everywhere in theemergency department, and fewer than 1 in 20 of these patients leave with aprescription

•  Prescribing at discharge was associated with lower30-day odds of severe adverse events and ED revisits, with no difference inmortality

•  This is observational data, so it is a strong signal toengage rather than proof that a prescription is right for everyone

•  The ACEP policy warns against rapid pressure reductionin the department, and it is right to do so

•  The practical move is structured home monitoring,honest lifestyle counseling, and a values-based conversation about medication

Disclaimer

Educational purposes only. This podcast does not provide medical advice and does not establish a physician and patient relationship. Cases are deidentified and altered. Always discuss management decisions with a qualified clinician.

Links

Companion blog and full reference list: https://drcois.com/blog

For most acute musculoskeletal injuries, the patient asks for something strong and we reach for the opioid almost by reflex. But is the opioid actually stronger? In this episode of Overheard Journal Club, I unpack a randomized trial of 600 emergency department patients that compared 5 common oral analgesic combinations, including two with no opioid at all, for acute pain in the arms and legs.

The punchline is clean. Every combination dropped pain by about the same amount at 1 and 2 hours. The opioid arms delivered no additional relief and came with more nausea and vomiting, and that is before you count the dependence risk a short trial cannot measure. I walk through the PICO, the results, an honest critical appraisal, and the companion trial that speaks to the patient who is still hurting after first-line treatment. Then I lay out a practical, opioid-sparing default you can use on your next shift.

Key Takeaways

●   Five oral analgesic combinations produced essentially equal relief for acute musculoskeletal pain at 1 and 2 hours.

●   The opioid arms added nausea and vomiting without adding analgesia.

●   Ibuprofen plus acetaminophen works through two mechanisms, giving additive relief that competes with low-dose oxycodone.

●   Default to the non-opioid combination for acute musculoskeletal pain, and reserve opioids for specific, deliberate indications.

Disclaimer

Educational purposes only. This podcast does not provide medical advice and does not establish a physician–patient relationship. Always discuss management decisions with a qualified clinician.

One red number at 11 p.m. cansend an otherwise healthy person into a full worst-case spiral before their doctor has even seen the result. In this Season 2 episode, Dr Cois walks through the framework physicians actually use to read a lab report: why a “normal range” isn’t the line between healthy and sick, why 1 in 20 healthy people flag on any given test, why how far out of range a value is matters more than the color of the flag, and the one question that defuses almost any result. This is the home base for the whole Lab Results Explained series, and the episode that makes all the test-specific ones make sense. Companion guide and references at DrCois.com.

Two patients came through the emergency department on the same shift. One waited 9 hours at home with chest pressure. One arrived at 3 am for a splinter. Both made the same mistake: neither had a way to answer the question, do I need to be seen right now, or not?

In this episode, Dr. Cois shares the decision framework he uses to triage, simplified for home use. You will learn the one screening question that sorts almost every symptom into three lanes, the red-lane patterns that mean calling 911 immediately, when urgent care is the smarter choice, the tie-breaker rule for genuine uncertainty, and the modifiers that shift you between lanes, including blood thinners, age extremes, and your own gut instinct. It closes with the Tier 1 move that keeps more people out of the emergency department than any symptom list: a primary care doctor who actually knows you.

Printable framework and companion guide at DrCois.com. Educational purposes only; this episode does not provide medical advice or establish a physician-patient relationship. If you think you may be having an emergency, call your local emergency number.

Key takeaways

• Ask one question first: could this seriously harm me inthe next few hours if I do nothing?

•  Red lane means call 911, and calling beats drivingbecause the ambulance is the start of treatment

•  Amber lane means seen today, usually at urgent care;green lane belongs with your own doctor

•  When genuinely unsure, always treat it as the moreserious lane

•  A primary care physician who knows you is the singlebest tool for staying out of the ER

For ten years I treated the bougie as a backup — the break-glass tool, Plan B. Then a 2024 systematic review and meta-analysis in Annals of Emergency Medicine made me reconsider whether it should be my first move on every airway.

In this episode of Overheard Journal Club, I break down von Hellmann and colleagues’ pooled analysis of 18 studies and 9,151 patients: the headline 11% relative improvement in first-attempt success, the much larger benefit in difficult airways, and the honest caveats — high heterogeneity, low certainty, and a heavy dependence on operator skill. We also unpack the BEAM versus-BOUGIE plot twist that explains why the same tool can look transformative in one trial and useless in another, and I lay out a practical, four-step way to decide whether the bougie belongs in your hand on attempt number one.

Key takeaways

•  Across 18 studies and 9,151 patients, bougie use was associated with an 11% relative improvement in first-attempt success (RR 1.11).

•  The benefit is much larger in difficult airways — Cormack-Lehane grade 3–4 — where the relative risk hit 1.60.

•  Certainty is low and heterogeneity is high; the effectdepends heavily on who is holding the bougie.

•  The bougie is a standard-geometry tool — keep direct laryngoscopy plus bougie fluent even if your department defaults to hyper-angulated video laryngoscopy.

•  With a standard-geometry blade, consider moving the bougie from backup to first-line — then practice it.

Disclaimer

This podcast is for educational purposes only. It is not medical advice and does not establish a physician–patient relationship. Always discuss management decisions with a qualified clinician.