• 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.

00:00 - Introduction and welcome

02:15 - Epidemiology: Why syphilis cases are surging

06:30 - High-risk populations and screening recommendations

10:45 - Pathophysiology of Treponema pallidum

14:20 - Clinical stages: Primary syphilis and the chancre

18:40 - Secondary syphilis: The classic rash presentation

24:15 - Tertiary syphilis and cardiac complications

28:50 - Neurosyphilis: Meningitis, cranial nerve deficits, and stroke-like symptoms

34:10 - Congenital syphilis: Rising cases and screening importance

38:25 - Ocular and otosyphilis presentations

42:00 - Diagnostic approach: VDRL, RPR, and treponemal tests

47:30 - Interpreting titers and fourfold changes

51:15 - Dark field microscopy ("the coolest lab job")

54:40 - Treatment: Benzathine penicillin G and the national shortage

59:20 - Alternative treatments: Doxycycline and ceftriaxone

1:03:45 - Jarisch-Herxheimer reaction explained

1:07:30 - Partner management and contact tracing

1:11:00 - Post-exposure prophylaxis: The "Doxy-PEP" protocol

1:15:20 - Historical context: Tuskegee Study and Guatemala experiments

1:22:45 - Emerging therapies and future directions

1:26:10 - Five key practice-changing takeaways

1:29:00 - Closing remarks and CME information

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

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

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

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the October 2025 Emergency Medicine Practice article, Emergency Department Evaluation and Management of Patients With Adrenal Insufficiency

Introduction

• Welcome and host introductions
• Brief overview of the episode’s topic
• Resources and CME reminder

Article Overview

• Source: Emergency Medicine Practice, October 2025
• Authors: The Simcoes
• Importance of evidence-based review

Clinical Context & Epidemiology

• Frequency and rarity of adrenal insufficiency
• Diagnostic challenges and statistics
• Importance of recognizing adrenal crisis

Pathophysiology

• Primary, secondary, and tertiary adrenal insufficiency
• Causes and mechanisms
• Key anatomical and physiological concepts

Differential Diagnosis

• Overlap with other diseases (infections, autoimmune, endocrine, psychiatric, cardiac, GI, etc.)
• Importance of considering adrenal crisis in complex cases

Prehospital Care

• EMS recognition and limitations
• Importance of medication history and emergency kits
• Legal and logistical barriers to prehospital hydrocortisone

Emergency Department Evaluation

• Recognizing symptoms and prioritizing care
• Role of EMR and clinical decision support
• Key history and risk factors (medications, steroid use, opioid use, comorbidities)

Physical Examination

• Specific and nonspecific findings
• Cushingoid features vs. primary adrenal insufficiency signs

Diagnostic Workup

• Laboratory studies (cortisol, ACTH, renin, aldosterone, TSH, etc.)
• Imaging considerations
• Gold standard tests and their limitations in the ED

Treatment

• Immediate administration of hydrocortisone
• Dosing for adults and pediatrics
• Supportive care (fluids, glucose, treating underlying cause)
• Sick day dosing and home management

Special Populations

• Pregnancy considerations
• Septic shock and adrenal crisis

Common Pitfalls & Takeaways

• Delaying steroids for labs/diagnosis
• Importance of high suspicion and early treatment
• Key trivia and learning points

ClosingSummary and final thoughts

• Reminders for further reading and CME
• Farewell and next episode teaser

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

In this episode, Sam Ashoo, MD interviews Evan Dvorin, MD about the dangers of short term steroid use.

Background & Regional Differences

• Dr. Dvorin’s clinical journey from New England to New Orleans.
• Noticing increased use of corticosteroids for common conditions in the Southeast.
• Discussion of how steroid prescribing practices vary by region and setting.

Inappropriate Steroid Use

• Common conditions where steroids are often inappropriately prescribed (sinus infections, bronchitis, sciatica, rashes, plantar fasciitis, etc.).
• Trends showing increased steroid prescribing over time.
• Similar patterns observed in emergency, urgent care, and primary care settings.

Risks and Side Effects of Short-Term Steroid Use

• Short-term steroids can cause significant side effects: infection, sepsis, bone fractures, thromboembolism, psychiatric effects, hyperglycemia.
• Dose-response relationship: higher doses and repeated use increase risks.
• Some side effects (e.g., bone loss) may persist beyond two months.

Patient Communication & Shared Decision-Making

• Importance of discussing risks with patients, tailored to individual risk factors (e.g., diabetes, psychiatric history, age).
• Strategies for educating patients and managing expectations.
• The role of patient education videos and resources.

Impact of Provider Education & Quality Metrics

• Ochsner Health’s initiatives to reduce inappropriate steroid use.
• Use of CME, quality dashboards, and feedback to clinicians.
• Evidence that education and reporting can reduce unnecessary prescriptions.

Special Populations & Scenarios

• Considerations for pediatric patients and repeated dosing.
• Challenges when specialists recommend steroids for certain conditions (e.g., sciatica, neurosurgery cases).
• The need for evidence-based practice and inter-provider communication.

Medical-Legal Considerations

• Lawsuits related to steroid side effects (e.g., fat atrophy, infection).
• Importance of documentation and informed consent.

Alternatives & Symptom Management

• Focusing on treating the patient’s most bothersome symptoms.
• Non-steroid options and the value of patient education about illness duration and expectations.

Resources

• Mention of Dr. Dvorin’s educational video on corticosteroid side effects (available on YouTube).
• Reminder of EB Medicine’s journals and resources for further learning.

Conclusion

• Key takeaway: “Do no harm” and practice evidence-based medicine.
• Encouragement for clinicians to review their prescribing habits and educate patients.

Ochsner "Side effects from corticosteroids" Video: https://www.youtube.com/watch?v=PdMJ9HYxkck