In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the February 2026 Emergency Medicine Practice article, Emergency Department Diagnosis and Management of Acute Coronary Occlusion

00:00 - Introduction & Welcome

01:21 - Episode Overview: Acute Coronary Occlusion

02:06 - Why This Topic Matters: Statistics & New Guidelines

03:35 - Nomenclature: ACO vs STEMI/NSTEMI

06:15 - Differential Diagnosis for STEMI

07:41 - Pre-Hospital Care & EMS Role

11:37 - Patient History & Presenting Symptoms

12:28 - Physical Examination Findings

14:54 - EKG: The Most Important Test

17:00 - STEMI Definition & Criteria

20:32 - STEMI Equivalents: Scarbosa Criteria

22:40 - Smith Modified Scarbosa Criteria

24:10 - Hyperacute T Waves

25:30 - Posterior STEMI

28:40 - De Winter Sign

29:38 - Non-STEMI EKG Findings

31:30 - AVR ST Elevation

32:47 - Wellens Syndrome

33:54 - Reciprocal ST Segment Changes

36:15 - Inferior MI Patterns

37:54 - Laboratory Testing

39:51 - Imaging: Chest X-Ray & Echocardiography

42:25 - Supplemental Oxygen: What the Evidence Shows

44:50 - Analgesia & Pain Management

46:35 - Pharmacotherapy: Aspirin & Antiplatelet Agents

49:18 - Reperfusion Therapies & Thrombolytics

53:05 - Cardiac Arrest in STEMI Patients

53:55 - Closing Remarks & CME Information

• 0:15 Introduction
• 0:51 Guest Introduction
• 1:20 Jeff's Background
• 2:00 Current Work
• 3:37 How He Got Started
• 6:57 Pre-Litigation vs. Expert Witness
• 8:01 Four Components of Malpractice Cases
• 13:55 Case Review Statistics
• 17:11 When Cases Get Filed
• 18:58 Common Patterns in Cases
• 19:55 Documentation Best Practices
• 22:06 Shift Handoff Problems
• 25:56 Bounce Backs
• 27:25 Medical Record Volume
• 30:00 Audit Trails
• 32:53 Communication with Consultants
• 41:35 Conflicting Documentation
• 43:46 Getting Started in This Work
• 47:37 Closing

Syphilis cases have surged 42% in the US, making it critical for emergency physicians to recognize and treat this "great masquerader." In this episode, hosts Sam Ashoo and Dr. T.R. Eckler break down the January 2026 Emergency Medicine Practice article on syphilis diagnosis and management. They cover the rising prevalence in high-risk populations, the four clinical stages (primary, secondary, latent, and tertiary), special presentations like neurosyphilis and congenital syphilis, and practical diagnostic approaches. With a national penicillin shortage, they discuss alternative treatment options including doxycycline and post-exposure prophylaxis. The conversation also addresses the dark history of the Tuskegee Study and its lasting impact on medical ethics. Whether you're seeing more cases in your ED or want to sharpen your diagnostic skills, this episode provides actionable insights for frontline providers.

[0:00] Opening/Introduction

[0:11] Host Welcome & Resources

[0:50] Episode Introduction

[1:30] Epidemiology & Rising Cases

[4:30] Risk Factors & Screening

[6:30] Pathophysiology & Transmission

[9:30] Primary Syphilis

[12:30] Secondary Syphilis

[15:30] Tertiary & Latent Syphilis

[18:30] Neurosyphilis

[22:30] Congenital Syphilis

[25:30] Ocular & Otic Syphilis

[28:30] Differential Diagnosis & Pre-hospital Care

[31:30] History & Physical Examination

[34:30] Diagnostic Testing Overview

[38:30] Testing Details & Titers

[41:30] Treatment: Penicillin & Alternatives

[43:30] Closing