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 Emergencies

Episode Outline:

• [0:00] Introduction
• Welcome and show overview by Sam Ashoo
• Mention of resources at ebmedicine.net
• [0:46] Episode Start
• Hosts introduce themselves: Sam Ashoo and Dr. T.R. Eckler
• Dr. Eckler’s background and experience with cannabis cases in Colorado
• [1:16] Topic Introduction
• Focus on diagnosis and management of cannabis-related emergencies
• Prevalence and importance in emergency medicine
• [1:34] Legal Landscape
• Overview of cannabis legality across states
• Medicinal vs. non-medicinal use
• [3:03] Increase in ED Visits
• Statistics: ~1 million cannabis-related ED visits annually
• Demographics: younger population most affected
• [3:52] Synthetics and Challenges
• Discussion of synthetic cannabinoids and their risks
• Issues with detection and legality
• [4:50] Clinical Spectrum
• Range of presentations: from nausea/vomiting to psychosis and seizures
• Impact on different age groups
• [6:34] FDA-Approved Uses
• Cannabis-derived products approved for specific medical conditions
• [7:20] Physiology and Pathophysiology
• Cannabinoid receptors (CB1 and CB2) and their effects
• Differences between plant-derived and synthetic cannabinoids
• [9:10] Chronic Use and Withdrawal
• Downregulation of receptors, withdrawal symptoms, and persistent nausea
• [10:20] Product Forms and Delivery Methods
• Smoking, edibles, oils, tinctures, suppositories, topicals, etc.
• Risks associated with concentrated forms (e.g., wax, oils)
• [12:00] Clinical Effects by System
• Psychiatric: anxiety, psychosis, paranoia
• Cardiovascular: tachycardia, MI risk, QT prolongation
• Pulmonary, renal, metabolic, dental, and ocular effects
• [13:50] Cannabinoid Hyperemesis Syndrome (CHS)
• Phases: prodrome, hyperemesis, recovery
• Hot showers as a diagnostic clue
• [16:00] Withdrawal Syndrome
• Symptoms and timeline
• Exacerbation with synthetic cannabinoids
• [18:15] Counseling and Management
• Importance of cessation and patient education
• Timeline for symptom improvement
• [18:42] Differential Diagnosis
• Broad differential for persistent nausea/vomiting and abdominal pain
• Importance of considering other causes
• [20:55] Diagnostics and Testing
• Limitations of drug screens (false positives/negatives)
• Importance of EKG, labs, and imaging as indicated
• [23:10] Treatment Approaches
• First-line: benzodiazepines, antiemetics (ondansetron, metoclopramide)
• Second-line: butyrophenones (haloperidol, droperidol), olanzapine
• Capsaicin as adjunct therapy
• [29:50] Complications and Special Considerations
• Risks of undertreatment (e.g., Boerhaave syndrome, aspiration)
• Pediatric and pregnant populations: unique risks and reporting requirements
• [36:00] Five Practice-Changing Takeaways
• Elicit cannabis use history
• Know testing limitations
• Consider ECG and appropriate labs
• Use butyrophenones when indicated
• Admit if symptoms are refractory
• [39:00] Conclusion

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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

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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