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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] Introduction
Welcome and show overview by Sam Ashoo
Mention of resources at ebmedicine.net
[0:46] Episode Start
Hosts introduce themselves: Sam Ashoo and Dr. T.R. Eckler
Dr. Eckler’s background and experience with cannabis cases in Colorado
[1:16] Topic Introduction
Focus on diagnosis and management of cannabis-related emergencies
Prevalence and importance in emergency medicine
[1:34] Legal Landscape
Overview of cannabis legality across states
Medicinal vs. non-medicinal use
[3:03] Increase in ED Visits
Statistics: ~1 million cannabis-related ED visits annually
Demographics: younger population most affected
[3:52] Synthetics and Challenges
Discussion of synthetic cannabinoids and their risks
Issues with detection and legality
[4:50] Clinical Spectrum
Range of presentations: from nausea/vomiting to psychosis and seizures
Impact on different age groups
[6:34] FDA-Approved Uses
Cannabis-derived products approved for specific medical conditions
[7:20] Physiology and Pathophysiology
Cannabinoid receptors (CB1 and CB2) and their effects
Differences between plant-derived and synthetic cannabinoids
[9:10] Chronic Use and Withdrawal
Downregulation of receptors, withdrawal symptoms, and persistent nausea
[10:20] Product Forms and Delivery Methods
Smoking, edibles, oils, tinctures, suppositories, topicals, etc.
Risks associated with concentrated forms (e.g., wax, oils)
[12:00] Clinical Effects by System
Psychiatric: anxiety, psychosis, paranoia
Cardiovascular: tachycardia, MI risk, QT prolongation
Pulmonary, renal, metabolic, dental, and ocular effects
[13:50] Cannabinoid Hyperemesis Syndrome (CHS)
Phases: prodrome, hyperemesis, recovery
Hot showers as a diagnostic clue
[16:00] Withdrawal Syndrome
Symptoms and timeline
Exacerbation with synthetic cannabinoids
[18:15] Counseling and Management
Importance of cessation and patient education
Timeline for symptom improvement
[18:42] Differential Diagnosis
Broad differential for persistent nausea/vomiting and abdominal pain
Importance of considering other causes
[20:55] Diagnostics and Testing
Limitations of drug screens (false positives/negatives)
Importance of EKG, labs, and imaging as indicated
[23:10] Treatment Approaches
First-line: benzodiazepines, antiemetics (ondansetron, metoclopramide)
Second-line: butyrophenones (haloperidol, droperidol), olanzapine
Capsaicin as adjunct therapy
[29:50] Complications and Special Considerations
Risks of undertreatment (e.g., Boerhaave syndrome, aspiration)
Pediatric and pregnant populations: unique risks and reporting requirements
[36:00] Five Practice-Changing Takeaways
Elicit cannabis use history
Know testing limitations
Consider ECG and appropriate labs
Use butyrophenones when indicated
Admit if symptoms are refractory
[39:00] Conclusion

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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

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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 Presentations
Complicated 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.

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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 background
Host welcome, show context
Dr. Lara Zibners’ credentials
EB Medicine involvement
Personal stories and clinical experience
Memorable tetanus and pertussis cases
Vaccine advocacy
Rare disease encounters
Diphtheria: overview, presentation, treatment
Toxigenic vs. non-toxigenic, “bull neck”
Cardiac, neurologic complications
Antitoxin, antibiotics, public health
Pertussis: symptoms, vaccine, treatment
“100-day cough,” apnea in infants
Waning immunity, boosters
Azithromycin, treat contacts
Tetanus: risk, presentation, management
Clostridium ubiquity, no outbreaks
Muscle spasms, autonomic instability
Airway, sedation, antibiotics
Key ED takeaways and pearls
Early suspicion, isolation
ICU admission for severe cases
Vaccination, reporting
Resources and article summary
Appendix, clinical pathway
ebmedicine.net reference
CME, further reading
Guest’s podcast plug and closing remarks
“Unstable Vitals” podcast
Where to listen
Thank you, sign-off

Check out Dr Zibner's podcast Unstable Vitals

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

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the October 2025 Emergency Medicine Practice article, Emergency Department Evaluation and Management of Patients With Adrenal Insufficiency

Introduction
Welcome and host introductions
Brief overview of the episode’s topic
Resources and CME reminder
Article Overview
Source: Emergency Medicine Practice, October 2025
Authors: The Simcoes
Importance of evidence-based review
Clinical Context & Epidemiology
Frequency and rarity of adrenal insufficiency
Diagnostic challenges and statistics
Importance of recognizing adrenal crisis
Pathophysiology
Primary, secondary, and tertiary adrenal insufficiency
Causes and mechanisms
Key anatomical and physiological concepts
Differential Diagnosis
Overlap with other diseases (infections, autoimmune, endocrine, psychiatric, cardiac, GI, etc.)
Importance of considering adrenal crisis in complex cases
Prehospital Care
EMS recognition and limitations
Importance of medication history and emergency kits
Legal and logistical barriers to prehospital hydrocortisone
Emergency Department Evaluation
Recognizing symptoms and prioritizing care
Role of EMR and clinical decision support
Key history and risk factors (medications, steroid use, opioid use, comorbidities)
Physical Examination
Specific and nonspecific findings
Cushingoid features vs. primary adrenal insufficiency signs
Diagnostic Workup
Laboratory studies (cortisol, ACTH, renin, aldosterone, TSH, etc.)
Imaging considerations
Gold standard tests and their limitations in the ED
Treatment
Immediate administration of hydrocortisone
Dosing for adults and pediatrics
Supportive care (fluids, glucose, treating underlying cause)
Sick day dosing and home management
Special Populations
Pregnancy considerations
Septic shock and adrenal crisis
Common Pitfalls & Takeaways
Delaying steroids for labs/diagnosis
Importance of high suspicion and early treatment
Key trivia and learning points
ClosingSummary and final thoughts
Reminders for further reading and CME
Farewell and next episode teaser

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