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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 EmergenciesEpisode 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] ConclusionEmergency 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 Patients00:00 Introduction to Emergency Medicine00:21 Welcome and Holiday Greetings01:16 Special Guest Introduction01:41 Discussion on Pediatric Emergency Medicine04:55 Epidemiology of Measles08:16 Challenges in Diagnosing Measles14:27 Mumps: Symptoms and Complications27:36 Rubella: Risks and Symptoms29:28 Varicella: Symptoms and Precautions33:12 Differential Diagnosis and Conclusion35:14 Using Inductive Reasoning in Medical Diagnosis35:40 Recognizing Purpuric Rash and Its Implications36:22 Guidance for EMS Colleagues on Handling Fever and Rash37:14 Importance of Communication and Relationships with EMS39:12 Decontamination and PPE Protocols for EMS42:34 Detailed Patient Assessment in the ED46:06 Diagnostic Testing and Clinical Diagnosis49:20 Reporting Responsibilities and Treatment Protocols01:01:19 Addressing Vaccine Controversies and Public Trust01:06:25 Conclusion and Additional ResourcesCheck out Dr Horeczko's podcast - Pediatric Emergency PlaybookEmergency 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 SyndromeEpidemiology & 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-offCheck out Dr Zibner's podcast Unstable VitalsEmergency 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 InsufficiencyIntroductionWelcome and host introductionsBrief overview of the episode’s topicResources and CME reminderArticle OverviewSource: Emergency Medicine Practice, October 2025Authors: The SimcoesImportance of evidence-based reviewClinical Context & EpidemiologyFrequency and rarity of adrenal insufficiencyDiagnostic challenges and statisticsImportance of recognizing adrenal crisisPathophysiologyPrimary, secondary, and tertiary adrenal insufficiencyCauses and mechanismsKey anatomical and physiological conceptsDifferential DiagnosisOverlap with other diseases (infections, autoimmune, endocrine, psychiatric, cardiac, GI, etc.)Importance of considering adrenal crisis in complex casesPrehospital CareEMS recognition and limitationsImportance of medication history and emergency kitsLegal and logistical barriers to prehospital hydrocortisoneEmergency Department EvaluationRecognizing symptoms and prioritizing careRole of EMR and clinical decision supportKey history and risk factors (medications, steroid use, opioid use, comorbidities)Physical ExaminationSpecific and nonspecific findingsCushingoid features vs. primary adrenal insufficiency signsDiagnostic WorkupLaboratory studies (cortisol, ACTH, renin, aldosterone, TSH, etc.)Imaging considerationsGold standard tests and their limitations in the EDTreatmentImmediate administration of hydrocortisoneDosing for adults and pediatricsSupportive care (fluids, glucose, treating underlying cause)Sick day dosing and home managementSpecial PopulationsPregnancy considerationsSeptic shock and adrenal crisisCommon Pitfalls & TakeawaysDelaying steroids for labs/diagnosisImportance of high suspicion and early treatmentKey trivia and learning pointsClosingSummary and final thoughtsReminders for further reading and CMEFarewell and next episode teaserEmergency Medicine Residents, get your free subscription by writing [email protected]