In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the September 2023 Emergency Medicine Practice article, Emergency Department Management of Patients With Rectal BleedingEtiology/pathophysiologyRisk factorsDifferential diagnosisPrehospital careED history and physical examDiagnostic studiesLaboratory testingImaging studiesTreatmentTransfusionCoagulation reversalEmbolizationSpecial PopulationsPediatricsPregnant patientsElderly patientsScoring systemsDispositionCheck out the clinical pathway at https://clinicalpathways.ebmedicine.net

In this episode, Sam Ashoo, MD, and TR Eckler, MD, interview Al Sacchetti, MD, about the August 2023 Emergency Medicine Practice article, Evidence-Based Management of Pulmonary Embolism in the Emergency DepartmentEtiology/pathophysiologyRisk factorsDifferential diagnosisPrehospital careED history and physical examDiagnostic scoring systemsPregnant patients Diagnostic studiesECGD-DimerTroponin & BNPChest x-rayCT V/Q scansMRIUSTreatmentIV fluidsAnticoagulationVasopressorsThrombolyticsThrombectomyECMODispositionCheck out the clinical pathway at https://clinicalpathways.ebmedicine.net

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the July 2023 Emergency Medicine Practice article, Diagnosing and Treating Pericarditis and Myocarditis in the Emergency DepartmentEpidemiologyNomenclatureEtiologyDifferential diagnosisPrehospital careED history and physicalDiagnosticsECGLabsImaging (X-ray, CT, US, MRI)Treatment Special populationsCOVID-19AthletesMIS-C

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the June 2023 Emergency Medicine Practice article, Hypertensive Emergencies: Guidelines and Best Practice RecommendationsEpidemiologyEtiologyDifferential diagnosisPrehospital careHistory and physical DiagnosticsTreatmentAcute decompensated heart failureAcute ischemic strokeAcute coronary syndromeIntracerebral hemorrhageSubarachnoid hemorrhageAortic dissectionHypertensive encephalopathySevere pre-eclampsia and eclampsiaControversiesArterial line placementBeta blockers and cocaineRisk management caveatsSummary

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the May 2023 Emergency Medicine Practice article on Emergency Department Management of Gastrointestinal Foreign Body IngestionEpidemiologyEtiology - types of ingestionsAnatomy - common locations by ageFood impactionSharp objectsButton batteriesMagnetsColorectal foreign bodiesPrehospital careHistory and PhysicalImagingExpectant managementEndoscopic removalNon-endoscopic techniquesBody PackingGlucagonGastric button batteriesSummary

In this episode, Sam Ashoo, MD, talks with Rob Orman, MD, founder of Orman Physician Coaching, about longevity in emergency medicine.Personal foundation Regular check-insBecoming an expert in… Job stressLiving beneath your meansRecharging and shift workBad outcomesPhysician loungeLearning to say noSet a reminderMore at Orman Physician Coaching

Announcements: The interactive Clinical Pathways have launched and they are available for free! In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the March 2023 Emergency Medicine Practice article on Emergency Department Management of Infective Endocarditis-Associated StrokeEpidemiologyPathophysiologyPopulations at RiskComplicationsIntracranial hemorrhageAneurysmsHeart blockPrehospital CareED History and ExaminationImagingAntibiotic TherapySurgical TreatmentSpecial PopulationsSummary

Announcements:  The interactive Clinical Pathways have launched and they are available for free!  — In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the February 2023 Pediatric Emergency Medicine Practice article on Pediatric Electrolyte Emergencies: Recognition and Management in the Emergency Department — History Point-of-care testing I/O lines Presentation, differential, and treatment of:HyponatremiaHypernatremiaHypokalemiaHyperkalemiaHypocalcemiaHypercalcemiaHypomagnesemiaHypophosphatemia

Announcements: The interactive Clinical Pathways have launched and they are available for free! ___In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the January 2023 Pediatric Emergency Medicine Practice article on the Responsible and Safe Use of Opioids in Children and Adolescents in the Emergency DepartmentDEA-X Waiver Repeal:The Mainstreaming Addiction ActThe Medication Access and Training Expansion Act (MATE)FOAMed postOpioids in Children and Adolescents: IntroductionEpidemiology and Statistics Medication safety at homeEscalation of pain meds at homeNaloxone prescriptionsMedications in childrenCodeineTramadolNSAIDsLocal anesthetics and nerve blocksIntranasal meds: Ketamine and fentanylOpioids and sedationRegional anesthesiaChronic pain

Announcements: The interactive Clinical Pathways have launched and they are available for free! — In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the July 2022 Emergency Medicine Practice article on the Management of Allergic Reactions and Anaphylaxis in the Emergency Department.  IntroThe number of ED visits and hospitalizationsStudies show up to 57% of anaphylactic reactions are not recognized, and epinephrine is not administered in up to 80% of cases. Criteria2006 Second National Institute of Allergy and Infectious Disease/Food Allergy and Anaphylaxis Network (NIAID/FAAN)WAO revised the criteria in 2020 Delphi group and Brown et alPathophysiology EpidemiologyMost common causes in children and adultsMore than half of deaths from anaphylaxis occur within the first hour of symptom onsetPrehospital CareGive epi, H1 blockersMainstay = recognitionED CareAirwayEpinephrineDecontaminationH1 and H2 blockersCorticosteroidsBiphasic reactionsGlucagonSpecial CasesAlpha-galScombroidKounis syndrome

Announcements: 1) The interactive Clinical Pathways have launched and they are available for free! 2) 2023 E/M coding guidelines are in effect. See the summary here. ___ In this episode, Sam Ashoo, MD, interviews Ara Festekjian, MD, one of the authors of the November 2022 Pediatric Emergency Medicine Practice article on Pediatric Septic Shock in the Emergency Department Introduction: How common is sepsis in kids and what is the mortality rate in the US? DefinitionsSeptic shockSepsis associated organ dysfunctionSepsis-3Compensated vs uncompensated shock EtiologyNeonateCentral line and VP shuntsAspleniaImmunocompromised children Differential Diagnosis Prehospital Care ED EvaluationHistoryExaminationSeptic shock + cardiogenic shockWarm vs cold shockEvolution of physical exam findingsDiagnosticsLabsImagingTreatmentIV/IO placementFluid bolusesAntibiotics Pressors Airway management Special PopulationsFebrile neutropeniaNewborns with septic shockControversiesFluid volumeFluid typeAntibiotic timingCorticosteroids

In this episode, Sam Ashoo, MD, and TR Eckler, MD, discuss the December 2022 Evidence-Based Urgent Care article on Influenza in Urgent Care.EpidemiologyHistorical dataSince COVID, tracking "influenza-like illness" has been complicatedInfluenza deaths and ageAnnual mortality OutbreaksTransmissionClassificationInfluenza A, B, and CHemagglutinin and neuraminidase subgroupsAntigenic drift and shiftPathophysiologyTransmissionIncubation Secondary infectionH3N2VaccinesEgg-based, cell-based, and recombinant influenza vaccinesCDC recommendationsPatients aged >65 yearsDifferential DiagnosisComplications TestingWhen is it indicated? What types of tests are available? Testing in periods of low and high prevalence TreatmentHigh-risk conditions that suggest treatment Antiviral medications Oseltamivir: NNT and NNHResistance patternsBilling and Coding

In this episode, Sam Ashoo, MD, interviews Prayag Mehta, MD, and Nikola Milanko, MD, two of the authors of the October 2022 Emergency Medicine Practice article on Angioedema in the Emergency Department Pathophysiology: Non-pitting edema of respiratory or GI tractHistamine meditated, bradykinin mediated, or idiopathicAcquired, inherited, or idiopathicDo they present differently? (Urticaria, speed of onset)Histamine MediatedMost common form: 40%-70%Can be triggered by NSAIDsCan be induced by physical mechanism like cold, vibrationIs rash a reliable method of distinguishing the types?Bradykinin MediatedMay progress slowlyCan be inherited or acquiredCommon triggers include ACE inhibitors and TPATable 1 Differential Diagnosis Prehospital CareProtect airwayEpi, steroids, antihistaminesAvoid CPAPED HistoryFigure 2: Distinguishing characteristics of histamine vs bradykinin mediatedED ExamImportance of repetitive examsAirway examinationLaryngoscopy?DiagnosticsFigure 6: Flow diagram of ED workupLabsImagingTreatmentAirway: IntubationMedicationSpecial PopulationsPediatricPregnant/lactating patientsControversiesTXADisposition

In this episode, Sam Ashoo, MD, interviews Ami Shah, MD, MPH, and Don Walker, MD, about eye injuries in the pediatric population.  Why ocular injuries? Why did you pick this topic? What kind of injuries are included and at what age are they most common? Injury zones and terminology Differential DiagnosisWhat should we keep in mind when we are confronted with an ocular injury? (Table 3)Prehospital CareWhat do our EMS colleagues need to keep in mind when transporting a child with an ocular injury?How can they help us in the ED?ED EvaluationHistory: What's important to know?Physical: Visual acuity and eye examDiagnostics: Slit lamp, ocular pressure, US, CT, MRITreatmentLid lacerations: Who repairs and when?Orbital fractures: What should we be looking for? Why is it different in children? When does repair typically occur?Corneal abrasionsCorneal foreign bodyChemical injuries: Irrigate with what and for how long?Traumatic hyphema: Treatment, dispositionTraumatic iritis: Treatment, outcomeOpen globe injuriesRetrobulbar hematoma - First 10 EMSpecial PopulationsHemophilia, Von Willebrand diseaseSickle cell and traitNeonates and infantsContact lensesControversies and Cutting EdgeKetamineTetanusNSAIDs, topical?Topical anestheticsVisual acuity apps

In this episode of EMplify: Conversation, Sam Ashoo, MD talks with Rob Orman, MD, founder of Orman Physician Coaching, about career disillusionment.Career Disillusionment: What is it? How do we combat it? Should we combat it? A frog in boiling water... BurnoutTwo questions to ask yourselfHow coaching can helpThe advice trapA framework to explore your career and life goalsMore at Orman Physician Coaching.

In this episode, Sam Ashoo, MD interviews Rawad Rayes, MD and Eva Tovar Hirashima, MD, MPH – two of the authors of the August 2022 PEMP article on Pediatric Firearm Injuries to the Extremity: Management in the Emergency Department.Episode Outline:How common are pediatric firearm injuries? What is the most common location of these injuries? Is there much literature published on this topic? Epidemiology What’s been the trend in pediatric firearm injuries over the past 10 years? Do we have any idea how/why these are occurring (ie, accidental, intentional, etc)Terminology: For those unfamiliar with firearms (table 1)Ballistics: Mechanisms of damage. Pre-hospital careTrauma center transportPrehospital hemorrhage control -- Combat application tourniquet, anything else? ED EvaluationSIPA -- What is it and why use it? Primary survey -- Tachycardia -> delayed cap refill -> hypotension in children? Secondary SurveyDiagnostic Studies: Damage Control ResuscitationWound Care -- Do we remove projectiles? Can they stay in? Antibiotics Joint InvolvementCompartment Syndrome -- 3 As vs 6 PsRhabdomyolysisControversiesCTA for all injuries? Hemostatic devices -- Any role for these in the ED?

In this episode of EMplify: Conversation, Sam Ashoo, MD talks with Andrew Phillips, MD, MEd, founder of EM Coach, about artificial intelligence and emergency medicine education.EM/Critical care practice - what’s that like? EM Coach - what is it? Artificial Intelligence -What is it and how does EM Coach use it? The algorithmHow did you create it? What does it do? The evidence behind itHow and where to access EM Coach

In this episode, Sam Ashoo, MD interviews Lela Bachrach, MD, MS, Larissa Truschel, MD, MPH, and Makini Chisolm-Straker, MD, MPH - the authors of the July 2022 PEMP article on Human Trafficking of Children and Adolescents: Recognition and Response in the Emergency Department. Listen to the discussion to hear more about the emergency medicine approach to human trafficking. Human Trafficking of Children and Adolescents: Recognition and Response in the Emergency Department EMplify - Sept 2022Episode Outline:Differential DiagnosisWhat is the differential diagnosis for this scenario in the ED?Are these diagnoses mutually exclusive ?EMS/Prehospital CareWhat role do EMS providers play in the recognition of trafficking?ED EvaluationWhat are common presentations/complaints that may represent trafficking?Examination: Privacy, use of a separate room, how do we accomplish this with minors?Ground rules: What does this mean? How do you state this in your practice? Do you find this dissuades patients form reporting?Technology: What if they are on the phone?History - HEADS-EDPhysical examination - Findings that lead to suspicion, documentation best practices.Diagnostic StudiesImaging: Any role for this?Lab testing: STI, anything else?Screening tools: Trauma-informed care, PEARR toolLocal laws differ by state. How do we handle this with patients? Does it dissuade reporting?"Rescuing mentality" and what that means in the EDTreatment MedicalBeyond medicines: Local services, national hotlineSpecial PopulationsDiagnosis: What to chart? National Human Trafficking Hotline 1-888-373-7888https://humantraffickinghotline.org/

In this episode of EMplify: Conversation – Sam Ashoo, MD, and TR Eckler, MD, speak with John Roberts, MD, MPH, about his work with the International Medical Corps and his efforts in Ukraine.Topics include:What is the International Medical Corps (IMC) and what does it do?What has IMC been doing in the U.S.?What is involved in disaster response?What has IMC been doing in Ukraine?What are the conditions like in Ukraine now?How does bombing of civilian areas affect Ukraine and the IMC projects?How can we support IMC efforts?How can we volunteer with the IMC?How does IMC balance long-term efforts and short-term relief to prevent harm to communities?How has the war in Ukraine effected surrounding areas?What has been most frustrating and most rewarding for you in your work with IMC?How did you start your career in disaster medicine and how would someone interested in it follow your footsteps?LinksIMC WebsiteIMC JobsRoster PositionsRoster position - MDRoster position - Nurse Roster position - Nurse Practitioner Roster position - Midwife Disaster MedicineThe Nuts & Bolts of Global EM, free e-book

In this episode, Sam Ashoo, MD interviews Adam Sigal, MD and Stephanie Costa, MD - the authors of the August 2022 EMP article on Managing Acute Cardiac Valvular Emergencies in the Emergency Department. Listen to the discussion to hear more about the emergency medicine approach to valvular emergencies. Managing Acute Cardiac Valvular Emergencies in the Emergency DepartmentEMplify - August 2022Episode Outline:Why Valvular disease? How common is it? How often do we see it in the ED? Which valves are we talking about? Aortic Valve DiseaseTypes and causesMitral Valve DiseaseTypes and causesTricuspid and Pulmonic DiseaseDifferential Diagnosisacute coronary syndromes (ACS)pulmonary embolismtamponadechronic obstructive pulmonary disease (COPD)pneumoniapneumothoraxPrehospital CareEvaluation of chest painHistoryShock ED EvaluationHistoryAortic StenosisAortic RegurgitationMitral StenosisMitral RegurgitationPhysical exam findings Diagnostic Testing LabsECGCXRBedside USFormal ECHOTreatmentSpecial PopulationsProsthetic valvesPregnant patientsSee Episode Page