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

Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

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

1. 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.

Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

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 resident@ebmedicine.net