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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 [email protected]

In this episode, Sam Ashoo, MD and Dr. Syeda Maria Muzammil, MD discuss the August 2026 Emergency Medicine Practice article, Emergency Department Management of Postthrombolysis Intracranial Hemorrhage. 0:25 – Intro & sponsor message1:18 – Guest introduction: Dr. Maria Muzammil2:24 – Timeframe for post-thrombolysis hemorrhage & ED/ICU boarding considerations4:46 – Thrombolysis eligibility criteria & contraindications5:46 – Incidence rates & symptomatic vs. asymptomatic hemorrhage7:09 – Pathophysiology & risk factors for post-thrombolytic ICH10:18 – Combining IV thrombolysis with endovascular thrombectomy12:33 – Post-treatment monitoring protocols & neurological exam frequency15:02 – Differentiating hemorrhage from other causes of neurological decline18:34 – Initial ED steps20:35 – Heidelberg classification of hemorrhage types21:60 – Follow-up imaging25:27 – Treatment of confirmed hemorrhage30:10 – Platelet transfusion guidance32:39 – Delayed hemorrhage & treatment timing considerations34:21 – Blood pressure management goals post-hemorrhage37:20 – Special populations38:48 – Summary of ED management algorithm40:48 – Closing remarksSubscribers, take the CME test here. Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and Dr. T.R. Eckler, MD discuss the July 2026 Emergency Medicine Practice article, Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis: Diagnosis and Management in the Emergency Department. 0:17 – Intro & sponsor promo1:09 – Episode introduction4:03 – Definitions: SJS vs. TEN vs. "overlap" by body surface area6:12 – Pathophysiology9:52 – Incidence and rarity of the disease10:53 – Differential diagnosis & clinical presentation clues12:08 – Prehospital care & fluid resuscitation considerations13:47 – ED history-taking: medications, infections, rash progression14:47 – Physical exam findings16:46 – Diagnostic studies18:12 – Scoring systems: SCORTEN and ABCD-1020:50 – Treatment goals23:57 – Wound care principles24:43 – Mechanical ventilation risk factors26:02 – Other possible therapies27:50 – Specialty consults & special populations29:06 – Ophthalmologic treatment31:17 – HIV patients and elevated risk31:55 – Emerging therapies & AI-based diagnostic tools32:57 – Five key clinical takeaways34:37 – Closing remarks & sponsor sign-offSubscribers, take the CME test here.  Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and Dr. T.R. Eckler, MD discuss the June 2026 Emergency Medicine Practice article, Diagnosis and Management of Heat Stroke and Other Heat-Related Illness in the Emergency Department 0:21 Intro & Promo0:56 Episode Introduction3:14 Spectrum of Heat-Related Illnesses7:37 Differential Diagnosis8:58 Pre-Hospital Management11:54 Exertional Heat Stroke13:50 Non-Exertional Heat Stroke15:40 ED Evaluation21:54 ED Treatment27:15 Managing Complications29:33 Special Populations30:58 Disposition & J-ERATO Score33:12 Risk Management Pearls36:56 Wrap-Up & Promo Subscribers, take the CME test here. Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and Dr. T.R. Eckler, MD discuss the May 2026 Emergency Medicine Practice article, Emergency Department Evaluation and Management of Serious and High-Risk Infections in the Febrile Returning Traveler. 0:16 — Podcast Introduction1:08 — Episode Introduction7:30 — Malaria13:55 — Dengue17:33 — Enteric Fever (Typhoid/Paratyphoid)20:53 — Leptospirosis22:43 — Clinical Presentations26:33 — Diagnostic Testing33:17 — Treatment38:59 — Special Populations & Risk Pitfalls43:05 — Closing Pearls & Outro Subscribers, take the CME test here.  Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and Dr. T.R. Eckler, MD discuss the April 2026 Emergency Medicine Practice article, Wide Complex Tachycardia in the Emergency Department: An Updated Approach to Diagnosis and Management.  Introduction – 0:11Article Overview – 2:02Top 5 Bedside Steps – 7:54Sodium Channel Blockade – 9:26Hyperkalemia – 11:53SVT with Aberrancy – 12:47WPW & Accessory Pathway – 13:34AFib with Accessory Pathway – 14:09Monomorphic VT – 19:01Polymorphic VT / Torsades – 20:08Bidirectional VT – 21:29Pacemaker-Mediated Tachycardia – 22:30Pre-Hospital Considerations – 24:52Stable vs. Unstable Assessment – 27:58Diagnostic Studies – 29:42Treatment – 38:00Risk Management Pitfalls – 44:49Wrap-Up – 49:44 Subscribers, take the CME test here. Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD interviews Jack Teitel on the topic of AI in medicine. Introduction & Welcome — 0:17Jack's Background in Healthcare AI — 0:58Brief History of AI — 3:57The "Perfect Storm" That Created Modern AI — 5:48From General to Specialized: Fine-Tuning AI for Medicine — 7:04LLM Confidence & the Sycophancy Problem — 13:01The Benchmark Problem — 14:25Building Your Own Personal AI Benchmark — 17:44Can You "Turn Off" AI Sycophancy? — 20:00RAG Systems & How Specialty AI Tools Work — 22:09Choosing the Right AI Tool for Clinical Use — 26:18Why 95% of AI Pilots Fail in Deployment— 28:10How to Ask AI Questions Well (Prompt Quality) — 31:25Knowledge Base Currency & Sam's Drug Withdrawal Test — 35:06Closing & Contact Info — 37:12 For more about Jack Teitel - Title-AI.com Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and Dr. Dana Klavansky, MD discuss the March 2026 Emergency Medicine Practice article, Emergency Department Evaluation and Management of Severe Traumatic Brain Injury Introduction & Welcome (0:15)Guest Introduction (0:55)Epidemiology of Severe TBI (2:37)Pathophysiology: Primary vs. Secondary TBI (4:24)Types of Hemorrhage and Hematomas (5:25)Classification (7:31)Mild vs. Moderate vs. Severe TBIImpact Loading vs. Inertial LoadingDifferential Diagnosis (9:22)Prehospital Care (9:42)Emergency Department History (13:33)Diagnostics (15:13)CT Scan and the A-B-B-B-C ApproachRepeat CT TimingBedside Ultrasound for Optic Nerve Sheath DiameterPupillometryBiomarkersTreatment (24:52)Airway ManagementVentilation and CO2 TargetsHyperosmolar Therapy: Hypertonic Saline and MannitolCerebral Perfusion PressureBlood Pressure GoalsTemperature ManagementCoagulopathy ManagementSeizure Prophylaxis and EEG MonitoringTiered ICP Management (35:29)Surgical Indications (38:40)Prognosis (40:33)Special Topics (41:30)Sports Injuries and CTETranexamic Acid (CRASH-3 Trial)Wrap-Up (43:46) Subscribers, take the CME test here. Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the February 2026 Emergency Medicine Practice article, Emergency Department Diagnosis and Management of Acute Coronary Occlusion 00:00 - Introduction & Welcome 01:21 - Episode Overview: Acute Coronary Occlusion 02:06 - Why This Topic Matters: Statistics & New Guidelines 03:35 - Nomenclature: ACO vs STEMI/NSTEMI 06:15 - Differential Diagnosis for STEMI 07:41 - Pre-Hospital Care & EMS Role 11:37 - Patient History & Presenting Symptoms 12:28 - Physical Examination Findings 14:54 - EKG: The Most Important Test 17:00 - STEMI Definition & Criteria 20:32 - STEMI Equivalents: Scarbosa Criteria 22:40 - Smith Modified Scarbosa Criteria 24:10 - Hyperacute T Waves 25:30 - Posterior STEMI 28:40 - De Winter Sign 29:38 - Non-STEMI EKG Findings 31:30 - AVR ST Elevation 32:47 - Wellens Syndrome 33:54 - Reciprocal ST Segment Changes 36:15 - Inferior MI Patterns 37:54 - Laboratory Testing 39:51 - Imaging: Chest X-Ray & Echocardiography 42:25 - Supplemental Oxygen: What the Evidence Shows 44:50 - Analgesia & Pain Management 46:35 - Pharmacotherapy: Aspirin & Antiplatelet Agents 49:18 - Reperfusion Therapies & Thrombolytics 53:05 - Cardiac Arrest in STEMI Patients 53:55 - Closing Remarks & CME Information Subscribers, take the CME test here.Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD interviews Jeff Willis, MD on the topic of pre-litigation review, being a medical expert, and common pitfalls leading to medical malpractice cases. 0:15 Introduction0:51 Guest Introduction1:20 Jeff's Background2:00 Current Work3:37 How He Got Started6:57 Pre-Litigation vs. Expert Witness8:01 Four Components of Malpractice Cases13:55 Case Review Statistics17:11 When Cases Get Filed18:58 Common Patterns in Cases19:55 Documentation Best Practices22:06 Shift Handoff Problems25:56 Bounce Backs27:25 Medical Record Volume30:00 Audit Trails32:53 Communication with Consultants41:35 Conflicting Documentation43:46 Getting Started in This Work47:37 Closing Emergency Medicine Residents, get your free subscription by writing [email protected]

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the Januray 2026 Emergency Medicine Practice article, Emergency Department Diagnosis and Management of Patients With Syphilis Syphilis cases have surged 42% in the US, making it critical for emergency physicians to recognize and treat this "great masquerader." In this episode, hosts Sam Ashoo and Dr. T.R. Eckler break down the January 2026 Emergency Medicine Practice article on syphilis diagnosis and management. They cover the rising prevalence in high-risk populations, the four clinical stages (primary, secondary, latent, and tertiary), special presentations like neurosyphilis and congenital syphilis, and practical diagnostic approaches. With a national penicillin shortage, they discuss alternative treatment options including doxycycline and post-exposure prophylaxis. The conversation also addresses the dark history of the Tuskegee Study and its lasting impact on medical ethics. Whether you're seeing more cases in your ED or want to sharpen your diagnostic skills, this episode provides actionable insights for frontline providers. Timestamps[0:00] Opening/Introduction [0:11] Host Welcome & Resources [0:50] Episode Introduction [1:30] Epidemiology & Rising Cases [4:30] Risk Factors & Screening [6:30] Pathophysiology & Transmission [9:30] Primary Syphilis [12:30] Secondary Syphilis [15:30] Tertiary & Latent Syphilis [18:30] Neurosyphilis [22:30] Congenital Syphilis [25:30] Ocular & Otic Syphilis [28:30] Differential Diagnosis & Pre-hospital Care [31:30] History & Physical Examination [34:30] Diagnostic Testing Overview [38:30] Testing Details & Titers [41:30] Treatment: Penicillin & Alternatives [43:30] Closing Subscribers, take the CME test here.Emergency Medicine Residents, get your free subscription by writing [email protected]

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] IntroductionWelcome and show overview by Sam AshooMention of resources at ebmedicine.net[0:46] Episode StartHosts introduce themselves: Sam Ashoo and Dr. T.R. EcklerDr. Eckler’s background and experience with cannabis cases in Colorado[1:16] Topic IntroductionFocus on diagnosis and management of cannabis-related emergenciesPrevalence and importance in emergency medicine[1:34] Legal LandscapeOverview of cannabis legality across statesMedicinal vs. non-medicinal use[3:03] Increase in ED VisitsStatistics: ~1 million cannabis-related ED visits annuallyDemographics: younger population most affected[3:52] Synthetics and ChallengesDiscussion of synthetic cannabinoids and their risksIssues with detection and legality[4:50] Clinical SpectrumRange of presentations: from nausea/vomiting to psychosis and seizuresImpact on different age groups[6:34] FDA-Approved UsesCannabis-derived products approved for specific medical conditions[7:20] Physiology and PathophysiologyCannabinoid receptors (CB1 and CB2) and their effectsDifferences between plant-derived and synthetic cannabinoids[9:10] Chronic Use and WithdrawalDownregulation of receptors, withdrawal symptoms, and persistent nausea[10:20] Product Forms and Delivery MethodsSmoking, edibles, oils, tinctures, suppositories, topicals, etc.Risks associated with concentrated forms (e.g., wax, oils)[12:00] Clinical Effects by SystemPsychiatric: anxiety, psychosis, paranoiaCardiovascular: tachycardia, MI risk, QT prolongationPulmonary, renal, metabolic, dental, and ocular effects[13:50] Cannabinoid Hyperemesis Syndrome (CHS)Phases: prodrome, hyperemesis, recoveryHot showers as a diagnostic clue[16:00] Withdrawal SyndromeSymptoms and timelineExacerbation with synthetic cannabinoids[18:15] Counseling and ManagementImportance of cessation and patient educationTimeline for symptom improvement[18:42] Differential DiagnosisBroad differential for persistent nausea/vomiting and abdominal painImportance of considering other causes[20:55] Diagnostics and TestingLimitations of drug screens (false positives/negatives)Importance of EKG, labs, and imaging as indicated[23:10] Treatment ApproachesFirst-line: benzodiazepines, antiemetics (ondansetron, metoclopramide)Second-line: butyrophenones (haloperidol, droperidol), olanzapineCapsaicin as adjunct therapy[29:50] Complications and Special ConsiderationsRisks of undertreatment (e.g., Boerhaave syndrome, aspiration)Pediatric and pregnant populations: unique risks and reporting requirements[36:00] Five Practice-Changing TakeawaysElicit cannabis use historyKnow testing limitationsConsider ECG and appropriate labsUse butyrophenones when indicatedAdmit if symptoms are refractory[39:00] Conclusion Emergency Medicine Residents, get your free subscription by writing [email protected]

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

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 backgroundHost welcome, show contextDr. Lara Zibners’ credentialsEB Medicine involvementPersonal stories and clinical experienceMemorable tetanus and pertussis casesVaccine advocacyRare disease encountersDiphtheria: overview, presentation, treatmentToxigenic vs. non-toxigenic, “bull neck”Cardiac, neurologic complicationsAntitoxin, antibiotics, public healthPertussis: symptoms, vaccine, treatment“100-day cough,” apnea in infantsWaning immunity, boostersAzithromycin, treat contactsTetanus: risk, presentation, managementClostridium ubiquity, no outbreaksMuscle spasms, autonomic instabilityAirway, sedation, antibioticsKey ED takeaways and pearlsEarly suspicion, isolationICU admission for severe casesVaccination, reportingResources and article summaryAppendix, clinical pathwayebmedicine.net referenceCME, further readingGuest’s podcast plug and closing remarks“Unstable Vitals” podcastWhere to listenThank you, sign-off Check out Dr Zibner's podcast Unstable Vitals Emergency Medicine Residents, get your free subscription by writing [email protected]