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In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the November 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Low Back Pain: A Review of Current EvidencePrevalence and Importance of Back Pain in the ED Differential Diagnosis and Serious Pathologies Patient Expectations and Management Strategies Missed Serious Pathologies and Their Implications Conflicting Evidence and Treatment Protocols Pathologies Causing Low Back Pain Mechanical and Infectious Causes Red Flags and Risk Factors Pre-Hospital Care and EMS Considerations History and Physical Examination Laboratory Testing and Inflammatory Markers Introduction to Imaging in Back Pain Common Findings in Imaging Choosing Wisely Campaign and Imaging Guidelines Patient Expectations and Imaging CT and MRI: When and Why Ultrasound in Back Pain Diagnosis Treatment Options for Back Pain NSAIDs and Other Pharmacologic Treatments Non-Pharmacologic Management Risk Management and PitfallsEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the October 2024 Pediatric Emergency Medicine Practice article, Elder Abuse and Neglect: Making the Diagnosis and Devising a Treatment Plan in the Emergency Department00:00 Welcome and Introduction 00:13 Free Subscription for Emergency Medicine Residents 01:05 Introduction to Pediatric Emergency Medicine Practice 01:37 Discussion on Acute Scrotal Pain 02:35 Testicular Torsion: Key Insights 09:50 Differential Diagnosis for Acute Scrotal Pain 17:21 Diagnostic Indicators of IgA Vasculitis 17:44 Pre-Hospital Care for Severe Pain 18:13 The Twist Score for Torsion 18:44 Emergency Department Evaluation 20:04 Ultrasound in Diagnosing Torsion 29:44 Operative Management and Other Conditions 31:41 Manual Detorsion Techniques 32:37 Risk Management and Key Takeaways 34:19 Conclusion and Final ThoughtsEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

In this special episode Sam Ashoo, MD interviews Ryan Johnson, Pharm. D. who shares strategies to address the recent IV fluid shortage caused by Hurricane Helene.00:00 Introduction and Episode Overview01:10 Meet Ryan Johnson: Clinical Pharmacist02:06 Role of Clinical Pharmacists in Emergency Medicine05:03 IV Fluid Shortage: Causes and Impact05:56 Institutional Strategies to Mitigate IV Fluid Shortages14:52 Provider-Level Solutions for Fluid Conservation22:11 Pharmacy and Nursing Staff Roles in Fluid Management26:34 Advanced Measures and Federal Guidelines34:40 Conclusion and Final ThoughtsResources mentioned in the podcast:(Brigham and Women's Protocol) Patiño, A. M., Marsh, R. H., Nilles, E. J., Baugh, C. W., Rouhani, S. A., & Kayden, S. (2018). Facing the shortage of IV fluids — a Hospital-Based Oral Rehydration strategy. New England Journal of Medicine, 378(16), 1475–1477. https://doi.org/10.1056/nejmp1801772 Vizient shares conservation strategies for potential IV fluid supply disruption caused by Hurricane Helene https://newsroom.vizientinc.com/en-US/releases/releases-vizient-shares-conservation-strategies-for-potential-iv-fluid-supply-disruption-caused-by-hurricane-helene

In this episode, Dr. Julia Draper shares her firsthand account of managing a crisis during a hurricane in Asheville, North Carolina. As the area faced unprecedented flooding, Dr. Draper describes the challenges faced at Mission Hospital, including loss of power and water. She details the innovative solutions the hospital implemented and highlights the tireless efforts of staff during a natural disaster of this magnitude.00:00 Introduction to Dr. Julia Draper01:03 Experiencing the Hurricane03:19 Immediate Aftermath and Hospital Challenges11:22 Dealing with Water and Supply Shortages20:48 Community and External Support24:10 Ongoing Efforts and Future Plans27:51 Conclusion and Final Thoughts

In this special episode, Sam Ashoo MD and Rob Orman MD discuss the concept of Maladaptive Perfectionism and its application to emergency medicine.Understanding Maladaptive PerfectionismCase Example and DiscussionAdaptive vs Maladaptive PerfectionismPersonal Experiences and Legal ChallengesDealing with Negative OutcomesStrategies for Managing Perfectionism in the EDHandling Overwhelming ShiftsManaging Expectations in the EDA Soul-Crushing Day in the EDFinding Meaning in Moments of CrisisThe Importance of Meaningful WorkOperationalizing Meaning in Your ShiftThe Driveway Debrief: Transitioning from Work to HomePreparing for the Next ShiftConclusion and Next Episode TeaserFor more from Rob Orman, MD check out Orman Physician Coaching

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the September 2024 Emergency Medicine Practice article, Elder Abuse and Neglect: Making the Diagnosis and Devising a Treatment Plan in the Emergency Department Introduction and AnnouncementsElder Abuse and Neglect: An OverviewRisk Factors and ReportingPre-Hospital and Emergency Department ConsiderationsScreening Tools and Physical ExaminationDocumentation and DispositionCultural Considerations and Future DirectionsConclusion and ResourcesSuspected Elder Abuse should be reported to one of these organizations:ADULT PROTECTIVE SERVICES - Living at homeLONG-TERM CARE OMBUDSMAN - Living in a long term care facility

In this episode, Sam Ashoo, MD interviews social media marketing expert Adam Goodcoff, DO, Founder and CEO of MedFluencers. Meet Dr. Adam Goodcoff The Role of Physicians on Social Media Legal Considerations for Physicians on Social Media Employer Policies and Social Media Creating Engaging Content Balancing Professionalism and Personal Life on Social Media Navigating Negative Comments and Trolls Handling Low Engagement and Negative Feedback Becoming a Medfluencer: Tips and Strategies Connecting with Adam and Final Thoughts

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the August 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Sickle Cell DiseaseEpidemiologyCommon Presentation of Sickle Cell Disease in the EDScreening and Diagnosis DifferencesEpidemiology: 200,000 ED Visits Annually, 85% for PainPathophysiologyLife Expectancy and ComplicationsVado-Occlusive Crises and PathophysiologySequestration Crisis in Sickle Cell PatientsAcute Chest Syndrome and PriapismClinical ManagementTreatment Advocacy and Pain ManagementPatient History and Examination ImportanceImaging RecommendationsLaboratory Studies and FindingsEmergency Department Care ProtocolsAdvanced Treatment OptionsIntravenous (IV) Fluids GuidelineManagement of PriapismRole of Exchange TransfusionAcute Chest Syndrome DetailsApproach in Rural and Critical Access HospitalsSpecial PopulationsPregnant Patients with Sickle Cell DiseaseIncreased Risks and Complication Management

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the July 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Complications of DialysisOverview of Dialysis ComplicationsKey Dialysis ComplicationsCardiovascular DiseaseCongestive Heart FailurePericarditis and Cardiac TamponadeNeurological SequelaeGastrointestinal ComplicationsHypotensionDialysis Disequilibrium SyndromeAir Embolism and Chloramine ToxicityDisaster PreparednessVascular Access ComplicationsHemorrhage risks and treatmentThrombosis, stenosis, and aneurysmsInfection risks and managementPre-Hospital CareED History Differential diagnosis Key questions to ask dialysis patientsExamination Physical Exam TipsTreatmentsRisk Management PitfallsCommon Pitfalls to AvoidConclusion

In this episode, Sam Ashoo, MD and T.R. Eckler, MD interview Corey Hazekamp, MD, MS, one of authors of the June 2024 Emergency Medicine Practice article, Managing Emergency Department Patients With Opioid Use DisorderCurrent State of Opioid EpidemicOverview of overdose deaths and trends.Data and statistics about opioid overdose mortality rates.Three Waves of Opioid Overdose Deaths in the U.S.Opioid Classifications and Urine Drug TestingTypes of opioids: synthetic, semi-synthetic, and natural.Urine drug testing limitations and false positives/negatives.Practical use and research on co-ingestionsEmergency Medical Services (EMS) and Pre-Hospital CareImportance of ABCs in acute opioid overdose cases.Naloxone usage trends and an empirical approach.Anecdotal insights on changing naloxone administration dosages.Clinical Management in the Emergency DepartmentBuprenorphine InitiationProtocols for initiating buprenorphine in ED settings.Assessment using the Clinical Opiate Withdrawal Scale (COWS).Safe dosing procedures for buprenorphine.Withdrawal and Overdose CareLaboratory testing recommendations.Capnography and VBG in overdose management.The role of end-tidal CO2 monitoring and respirations.Methadone vs. Buprenorphine ConsiderationsMethadone to buprenorphine transition protocols.Personal testimonials and clinical experiences in managing overdoses and withdrawal symptoms.Patient Discharge and Follow-upPreparation of discharge prescriptions.Referral to addiction medicine clinics and resources.Educating patients on continued treatment and harm reduction.

In this episode, Sam Ashoo, MD interviews Rob Orman, MD, founder of Orman Physician Coaching, about routine examination of our careers in emergency medicine.Understanding Career Cycles and Embracing ChangeThe Importance of Career Reflection and Making TradesNavigating Career Satisfaction and Preventing BurnoutProactive Career Management and Reflection StrategiesExploring Career Alternatives and Rediscovering Joy in MedicineBalancing Work, Love, Play, and Health for a Satisfying LifeWhen to Seek Coaching for Career GuidancePractical Tools for Self-Reflection and Taking ActionClosing Thoughts and Resources for Emergency Physicians

In this episode, Sam Ashoo, MD and T.R. Eckler, MD interview Reuben J. Strayer, MD, author of the May 2024 Emergency Medicine Practice article, Current Concepts in Ketamine Therapy in the Emergency DepartmentDiving Into Ketamine Use in Emergency MedicineUnderstanding Ketamine: From Origins to Emergency UseExploring the Ketamine Brain ContinuumKetamine Dosing and Administration TechniquesCombining Ketamine with Neuroleptic MedicationsPractical Approaches to Ketamine for Pain ManagementInnovative Pain Management and Ketamine UseProcedural Sedation with Ketamine: Techniques and ConsiderationsAddressing Agitation and Sedation in Emergency SituationsNavigating Intubation Strategies: DSI and Ketamine-Only ApproachesKetamine's Role in Treating Asthma, Status Epilepticus, and Alcohol WithdrawalExploring Ketamine for Treatment-Resistant DepressionConcluding Remarks on Ketamine's Versatility in Emergency Medicine

In this episode, Sam Ashoo, MD interviews Ashley A. Foster, MD, Bijan Ketabchi, MD, MPH and Jennifer A. Hoffmann, MD, MS on the March 2024 Pediatric Emergency Medicine Practice article, Evaluation and Management of Suicidal Ideation and Self-Harm in Children in the Emergency DepartmentIntroductionUnderstanding Suicidal Ideation and Self Harm in YouthsScreening Tools and ApproachesAsk Suicide-Screening Questions (ASQ) ToolkitColumbia Suicide Severity Rating Scale (C-SSRS)Prehospital CareManaging Patients in the EDDealing with Challenging PopulationsLethal Means CounselingEmerging Tools in Suicide Risk IdentificationSuicide Risk Screening PathwayDisposition and ReferralsNational 988 Suicide & Crisis Lifeline

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the April 2024 Pediatric Emergency Medicine Practice article, Brief Resolved Unexplained Events: Practical Evaluation and Management in the Emergency DepartmentIntroductionThe Evolution of BRUEUnderstanding BRUE GuidelinesThe Importance of Pre-Hospital Care in BRUE CasesInvestigating the Event: Questions to AskMedical and Family History: Key FactorsEnvironmental and Social ConsiderationsDefinitions and Risk AssessmentPhysical ExaminationRisk Stratification: Low Risk vs. High Risk PatientsManagement: What to Do and What Not to DoHigh Risk Population: Studies and RecommendationsThe Importance of Communication and Decision Making5 Things That Will Change Your Practice

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the March 2024 Emergency Medicine Practice article, Emergency Department Evaluation and Management of ConstipationPrevalence and ImpactUnderstanding the CausesMedications That Can Cause ConstipationDealing with Fecal ImpactionUnderstanding Stercoral ColitisPre-Hospital CareED History and Physical ExamDiagnostic Studies and ImagingX-RayCT ScansAdvanced TestingTreatment Options for ConstipationEnemasOsmotic Laxatives and Stool SoftenersSpecial Considerations: Pregnant, Pediatric, and Hospice PatientsPrescription Medications for ConstipationClinical Pathway for Constipation Management

In this episode, Sam Ashoo, MD interviews Paul Aronson, MD, MHS, one of the authors of the February 2024 Pediatric Emergency Medicine Practice article, Febrile Infants Aged ≤60 Days: Evaluation and Management in the Emergency DepartmentGuideline ChangesPathophysiologyEtiology and DefinitionsPrehospital CareED History and Physical Diagnostic StudiesAge 0-21 Days Age 22-28 Days Age 29-60 DaysLumbar PunctureViral TestingUrinalysisShared Decision MakingDisposition

In this episode, Sam Ashoo, MD, and T.R. Eckler MD interview Nick Harrison, MD and Daniel Brenner, MD, two of the authors of the February 2024 Emergency Medicine Practice article, Emergency Department Management of Patients With Right Heart FailurePathophysiologyPresenting SymptomsDifferential DiagnosisSpecific Acute CausesPESepsisRVMIPPVARDSCOVID-19Specific Chronic CausesCTEPHLeft Heart FailureCongenital Heart DiseaseLVADLung Disease Group 3 Pulmonary HypertensionPulmonary Arterial HypertensionPrehospital CareED history and PhysicalBiomarkersECG (table 5)ImagingEchoCTMRITreatmentRevascularizationRespiratory SupportVasopressors and Inotropes

In this episode, Sam Ashoo, MD, interviews Vasisht Srinivasan, MD, FACEP one of the authors of the December 2023 Emergency Medicine Practice EXTRA article, Emergency Department Management of Stroke in Pregnant and Postpartum PatientsEpidemiologyEvidenceCausesRisk FactorsDifferential DiagnosisPrehospital CareED History and Physical ExamLabsImagingED BP ManagementSpecific Ischemic Stroke TherapiesSpecific Hemorrhagic Stroke Therapies

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the January 2024 Pediatric Emergency Medicine Practice article, Management of Pediatric Urinary Tract Infections in the Emergency Department, and the January 2024 Evidence Based Urgent Care article on Pediatric Community-Acquired Pneumonia: Diagnosis and Management in the Urgent Care Setting.UTIEpidemiology and NomenclaturePrehospital CareED History and Physical ExamInfants Age Children Age 2 Months to 2 Years Children >2 Years AdolescentsUrinalysisClean Catch Protocol Catheterization Suprapubic AspirationBlood Cultures and CSFBiomarkers (CRP and ESR)TreatmentCommunity Acquired PneumoniaDistinguishing Viral vs Bacterial PneumoniaImagingAntibiotic TreatmentVaccinationSteroidsAtypical PresentationsCheck out the clinical pathways at https://www.ebmedicine.net/pathways

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the December 2023 Pediatric Emergency Medicine Practice article, Management of Pediatric Toxic Ingestions in the Emergency Department.Need help now? Call the Poison Help Line at: 1‑800‑222‑1222EpidemiologyPrehospital CareED History and Physical ExamDiagnostic StudiesLabsEKGImagingUrine Toxicology TestingTreatmentHemodialysisActivated CharcoalWhole Bowel IrrigationGastric LavageIpecacDrug Specific TherapiesAcetaminophenAlcoholsAnticholinergicsBeta BlockersCalcium Channel BlockersCholinergic AgentsDigoxinIronOpioidsSalicylatesSedative HypnoticsSulfonylureasLaundry PodsCheck out the clinical pathways at https://www.ebmedicine.net/pathways