EMplify by EB Medicine

• Adrenal Insufficiency

  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]

  --------  

  25:55

  --------

  25:55
• Steroid Use – An Interview with Dr. Evan Dvorin

  In this episode, Sam Ashoo, MD interviews Evan Dvorin, MD about the dangers of short term steroid use.Background & Regional DifferencesDr. Dvorin’s clinical journey from New England to New Orleans. Noticing increased use of corticosteroids for common conditions in the Southeast. Discussion of how steroid prescribing practices vary by region and setting.Inappropriate Steroid UseCommon conditions where steroids are often inappropriately prescribed (sinus infections, bronchitis, sciatica, rashes, plantar fasciitis, etc.). Trends showing increased steroid prescribing over time. Similar patterns observed in emergency, urgent care, and primary care settings.Risks and Side Effects of Short-Term Steroid UseShort-term steroids can cause significant side effects: infection, sepsis, bone fractures, thromboembolism, psychiatric effects, hyperglycemia. Dose-response relationship: higher doses and repeated use increase risks. Some side effects (e.g., bone loss) may persist beyond two months.Patient Communication & Shared Decision-MakingImportance of discussing risks with patients, tailored to individual risk factors (e.g., diabetes, psychiatric history, age). Strategies for educating patients and managing expectations. The role of patient education videos and resources.Impact of Provider Education & Quality MetricsOchsner Health’s initiatives to reduce inappropriate steroid use. Use of CME, quality dashboards, and feedback to clinicians. Evidence that education and reporting can reduce unnecessary prescriptions.Special Populations & ScenariosConsiderations for pediatric patients and repeated dosing. Challenges when specialists recommend steroids for certain conditions (e.g., sciatica, neurosurgery cases). The need for evidence-based practice and inter-provider communication.Medical-Legal ConsiderationsLawsuits related to steroid side effects (e.g., fat atrophy, infection). Importance of documentation and informed consent.Alternatives & Symptom ManagementFocusing on treating the patient’s most bothersome symptoms. Non-steroid options and the value of patient education about illness duration and expectations.ResourcesMention of Dr. Dvorin’s educational video on corticosteroid side effects (available on YouTube). Reminder of EB Medicine’s journals and resources for further learning.ConclusionKey takeaway: “Do no harm” and practice evidence-based medicine. Encouragement for clinicians to review their prescribing habits and educate patients.Ochsner "Side effects from corticosteroids" Video: https://www.youtube.com/watch?v=PdMJ9HYxkck

  --------  

  18:57

  --------

  18:57
• Adult Status Epilepticus

  In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the September 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Status Epilepticus Topic IntroductionFocus: Status Epilepticus in AdultsReference to recent pediatric episodeArticle authors: Dr. Marquez, Dr. Kaur, Dr. LayWhy Status Epilepticus MattersTeaching value and clinical challengeTeam-based care and multidisciplinary involvementGuidelines and EvidenceReview of major guidelines (International League Against Epilepsy, Neurocritical Care Society, American Epilepsy Society)Key trials: EcLiPSE, ConSEPT, ESETTUpdated definition of status epilepticusClassification and DiagnosisConvulsive vs. non-convulsive statusImportance of repeated neurologic examsDiagnostic challenges and mimics (e.g., syncope, psychogenic seizures)Etiology and WorkupAcute vs. non-acute causesCommon triggers: medication noncompliance, metabolic issues, infections, traumaImportance of sleep patterns and ammonia levelsThe NORSE acronym (new onset refractory status epilepticus)Prehospital and ED ManagementAirway, breathing, circulation prioritiesEarly pharmacologic intervention (IM midazolam preferred in prehospital)Gathering history and medication informationPositioning and airway protectionDiagnosticsLaboratory workup: glucose, CBC, metabolic panel, drug levels, pregnancy testImaging: non-contrast CT, MRI, ultrasound, lumbar punctureEEG: spot vs. continuous monitoringTreatment ApproachFirst-line: Benzodiazepines (lorazepam, midazolam)Second-line: Levetiracetam, valproate, fosphenytoin, phenobarbital, lacosamideThird-line: Continuous infusions (midazolam, propofol, pentobarbital, thiopental, ketamine)Dosing pearls and importance of rapid escalationSpecial PopulationsPregnancy (eclampsia: magnesium as first-line)Substance-induced status epilepticus (e.g., isoniazid toxicity and pyridoxine)Brief mention of pediatric management and the PD stat appRisk Management PitfallsNon-convulsive status is common and easily missedImportance of weight-based dosingNeed for formal EEG in ambiguous casesDon’t assume non-adherence is the only cause in known epilepticsAlways consider higher level of care for status patientsClinical PathwayStepwise approach to medication and escalationEmphasis on having a pathway/checklist for these high-stress casesConclusionRecap of key pointsThanks to authors and listenersReminder to visit ebmedicine.net for CME and resourcesEmergency Medicine Residents, get your free subscription by writing [email protected]

  --------  

  25:35

  --------

  25:35
• The Locums Life with Ali Chaudhary, MD

  In this episode, Sam Ashoo, MD interviews Ali Chaudhary, MD about the benefits of working Locum Tenens in Emergency Medicine.00:00 Introduction and Welcome 00:54 Meet Dr. Ali Chaudhary 01:41 The State of Emergency Medicine 03:29 Understanding Locum Tenens 05:45 Financial Benefits of Locum Work 08:40 Balancing Family Life with Locum Work 12:54 Locum Work Logistics and Misconceptions 17:34 Maximizing Travel Perks as a Contractor 18:07 Adjusting to New Hospitals and EMRs 19:32 The Hassles of Credentialing 20:48 Navigating Locum Staffing Companies 22:27 Understanding Your Worth and Negotiation 25:14 The Importance of Organization 27:41 About Our Locum Staffing Company 29:59 Practical Tips for Malpractice Insurance 31:09 Final Thoughts and Contact InformationFor more about Dr. Ali Chaudhary: https://thelocums.com/

  --------  

  16:40

  --------

  16:40
• Sepsis & Septic Shock- An Interview with Dr Lauren Black

  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 Shock00:00 Introduction and Welcome01:09 Meet Dr. Lauren Page Black: Sepsis Expert01:56 Sepsis Statistics and Impact04:16 Understanding Sepsis Definitions09:56 Screening Tools for Sepsis13:57 Pre-Hospital Sepsis Recognition19:33 Clinical Examination and Diagnostics24:03 The Role of Lactate and Procalcitonin27:40 Clinical Gestalt and Imaging in Diagnosis29:21 CMS Bundle Requirements and Updates34:02 Fluid Type Preferences in Sepsis36:49 Antibiotic Timing and Selection43:43 Vasopressors and Steroids in Sepsis Management50:18 Special Populations and Future Directions53:44 Conclusion and ResourcesEmergency Medicine Residents, get your free subscription by writing [email protected] 

  --------  

  27:19

  --------

  27:19

More Education podcasts

Trending Education podcasts

About EMplify by EB Medicine

EMplify by EB Medicine: Podcasts in Family