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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 InsufficiencyIntroductionWelcome and host introductionsBrief overview of the episode’s topicResources and CME reminderArticle OverviewSource: Emergency Medicine Practice, October 2025Authors: The SimcoesImportance of evidence-based reviewClinical Context & EpidemiologyFrequency and rarity of adrenal insufficiencyDiagnostic challenges and statisticsImportance of recognizing adrenal crisisPathophysiologyPrimary, secondary, and tertiary adrenal insufficiencyCauses and mechanismsKey anatomical and physiological conceptsDifferential DiagnosisOverlap with other diseases (infections, autoimmune, endocrine, psychiatric, cardiac, GI, etc.)Importance of considering adrenal crisis in complex casesPrehospital CareEMS recognition and limitationsImportance of medication history and emergency kitsLegal and logistical barriers to prehospital hydrocortisoneEmergency Department EvaluationRecognizing symptoms and prioritizing careRole of EMR and clinical decision supportKey history and risk factors (medications, steroid use, opioid use, comorbidities)Physical ExaminationSpecific and nonspecific findingsCushingoid features vs. primary adrenal insufficiency signsDiagnostic WorkupLaboratory studies (cortisol, ACTH, renin, aldosterone, TSH, etc.)Imaging considerationsGold standard tests and their limitations in the EDTreatmentImmediate administration of hydrocortisoneDosing for adults and pediatricsSupportive care (fluids, glucose, treating underlying cause)Sick day dosing and home managementSpecial PopulationsPregnancy considerationsSeptic shock and adrenal crisisCommon Pitfalls & TakeawaysDelaying steroids for labs/diagnosisImportance of high suspicion and early treatmentKey trivia and learning pointsClosingSummary and final thoughtsReminders for further reading and CMEFarewell and next episode teaserEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the September 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Status Epilepticus Topic IntroductionFocus: Status Epilepticus in AdultsReference to recent pediatric episodeArticle authors: Dr. Marquez, Dr. Kaur, Dr. LayWhy Status Epilepticus MattersTeaching value and clinical challengeTeam-based care and multidisciplinary involvementGuidelines and EvidenceReview of major guidelines (International League Against Epilepsy, Neurocritical Care Society, American Epilepsy Society)Key trials: EcLiPSE, ConSEPT, ESETTUpdated definition of status epilepticusClassification and DiagnosisConvulsive vs. non-convulsive statusImportance of repeated neurologic examsDiagnostic challenges and mimics (e.g., syncope, psychogenic seizures)Etiology and WorkupAcute vs. non-acute causesCommon triggers: medication noncompliance, metabolic issues, infections, traumaImportance of sleep patterns and ammonia levelsThe NORSE acronym (new onset refractory status epilepticus)Prehospital and ED ManagementAirway, breathing, circulation prioritiesEarly pharmacologic intervention (IM midazolam preferred in prehospital)Gathering history and medication informationPositioning and airway protectionDiagnosticsLaboratory workup: glucose, CBC, metabolic panel, drug levels, pregnancy testImaging: non-contrast CT, MRI, ultrasound, lumbar punctureEEG: spot vs. continuous monitoringTreatment ApproachFirst-line: Benzodiazepines (lorazepam, midazolam)Second-line: Levetiracetam, valproate, fosphenytoin, phenobarbital, lacosamideThird-line: Continuous infusions (midazolam, propofol, pentobarbital, thiopental, ketamine)Dosing pearls and importance of rapid escalationSpecial PopulationsPregnancy (eclampsia: magnesium as first-line)Substance-induced status epilepticus (e.g., isoniazid toxicity and pyridoxine)Brief mention of pediatric management and the PD stat appRisk Management PitfallsNon-convulsive status is common and easily missedImportance of weight-based dosingNeed for formal EEG in ambiguous casesDon’t assume non-adherence is the only cause in known epilepticsAlways consider higher level of care for status patientsClinical PathwayStepwise approach to medication and escalationEmphasis on having a pathway/checklist for these high-stress casesConclusionRecap of key pointsThanks to authors and listenersReminder to visit ebmedicine.net for CME and resourcesEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

In this episode, Sam Ashoo, MD interviews Lauren Black, MD about the August 2025 Emergency Medicine Practice article, Updates and Controversies in the Early Management of Sepsis and Septic Shock00:00 Introduction and Welcome01:09 Meet Dr. Lauren Page Black: Sepsis Expert01:56 Sepsis Statistics and Impact04:16 Understanding Sepsis Definitions09:56 Screening Tools for Sepsis13:57 Pre-Hospital Sepsis Recognition19:33 Clinical Examination and Diagnostics24:03 The Role of Lactate and Procalcitonin27:40 Clinical Gestalt and Imaging in Diagnosis29:21 CMS Bundle Requirements and Updates34:02 Fluid Type Preferences in Sepsis36:49 Antibiotic Timing and Selection43:43 Vasopressors and Steroids in Sepsis Management50:18 Special Populations and Future Directions53:44 Conclusion and ResourcesEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the July 2025 Emergency Medicine Practice article, Emergency Department Management of Status Epilepticus in Pediatric PatientsIntroductionWelcome and brief overview of the episodePromotion of EB Medicine’s $1 for 7-day trial offerWhy Pediatric Status Epilepticus MattersSeizures make up ~1% of ED visits and ~3% of EMS callsHigh-risk and high-stakes condition requiring rapid actionStatus epilepticus now defined as ≥5 minutes of seizure activityILAE’s T1 and T2 timelines help define when to treat and when damage beginsCommon CausesTop contributors:Fever/infectionStructural CNS abnormalitiesToxic ingestionsGenetic/metabolic disordersAdditional factors by age:Infants: febrile seizures, chromosomal issues, traumaSchool-age: autoimmune disordersAdolescents: eclampsia, hypertension, functional disordersAlways consider non-accidental traumaPrehospital CareIM midazolam is effective and recommended (RAMPART trial)Other options: intranasal, rectal, or IV benzodiazepinesEarly benzodiazepine administration improves outcomesImportance of airway support, glucose check, and EMS flexibilityParent-administered home meds (e.g. rectal diazepam) can be helpfulED Evaluation and Initial ManagementPrioritize ABCs: Airway, Breathing, Circulation, ConsciousnessUse end-tidal CO₂ to monitor ventilation if availablePoint-of-care glucose is essentialLabs: CMP, Mg, Phos, lactate, drug levels, pregnancy test (when indicated)Imaging: Head CT if concern for trauma, shunt malfunction, or focal signsCase examples highlight pitfalls and diagnostic delaysFirst-Line TreatmentBenzodiazepines remain the cornerstoneLorazepam preferred IV agent (0.1 mg/kg)Midazolam preferred if no IV access (IN, IM, or IO)Diazepam is also effective, especially rectallyBe mindful of respiratory depression and the need for airway controlSecond- and Third-Line TherapiesBased on ESETT trial:Levetiracetam, fosphenytoin, and valproate have similar efficacyLevetiracetam favored for safety and ease of useFosphenytoin may be avoided in trauma or toxicityValproate not recommended in mitochondrial diseasePhenobarbital reserved for refractory cases onlyRefractory Status EpilepticusDefinition: persistent seizures despite first- and second-line agentsRequires sedation and likely intubationInfusion options:Midazolam (preferred for flexibility)Propofol (short-term use only due to risk of infusion syndrome)Pentobarbital (rare, ICU-level care)Need for continuous EEG to assess seizure activitySpecial ScenariosNeonates:Watch for subtle signs (lip smacking, bicycling, tongue thrusting)Broad differential includes asphyxia, infection, metabolic errorsFebrile Status Epilepticus:Higher risk of CNS infections, especially if unvaccinatedConsider lumbar puncture if indicatedElectrolyte/Metabolic Triggers:Treat hypoglycemia, hyponatremia, and hypocalcemia directlyUse 3% saline or dextrose as appropriateDisposition and Discharge ConsiderationsMany children will require ICU-level careSome known epilepsy patients may go home if back to baselineEnsure rescue medications are up to date (rectal/intranasal benzos)Consider “clonazepam bridge” for short-term seizure preventionCollaborate with neurology for medication adjustment and follow-upFinal ThoughtsKeep treatment tables and dosing references accessibleEarly, aggressive treatment can prevent long-term harmEpisode closes with gratitude to article authors and a reminder to visit EBMedicine.netEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the May 2025 Emergency Medicine Practice article, Emergency Department Management of Patients With Complications of Chronic Neurologic Disease: Parkinson Disease, Myasthenia Gravis, and Multiple Sclerosis Parkinson's DiseaseImportance of maintaining medication schedule for Parkinson's patients Strategies for ensuring patients receive their medications promptly Overview of Carbidopa Levodopa's mechanism of actionMyasthenia GravisDescription of the disease mechanism Importance of assessing respiratory function Diagnostic alternatives like the negative inspiratory force test and counting test Discussion on appropriate emergency department actions and treatments including steroids, plasmapheresis, and IVIGMultiple SclerosisDescription of the disease mechanism Description of the typical patient demographic Discussion on the varied presentation of MS Treatment strategies including high-dose steroids and BaclofenEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the April 2025 Emergency Medicine Practice article, Sodium Disorders in the Emergency Department: A Review of Hypernatremia and HyponatremiaHypernatremia (High Sodium Levels)Definition: Sodium level greater than 145 mEq/LBreakdown into three categories based on total body water statusHypovolemic HypernatremiaEuvolemic HypernatremiaHypervolemic HypernatremiaCommon causes and conditions associatedHyponatremia (Low Sodium Levels)Definitions: Mild (130-135 mEq/L), Moderate (125-129 mEq/L), Profound (< 125 mEq/L)Breakdown into three categoriesPseudo HyponatremiaHypovolemic HyponatremiaEuvolemic HyponatremiaHypervolemic HyponatremiaCommon causes and conditions associatedTreatment Guidelines and StrategiesEmphasizing slow correction to avoid complications like cerebral edema and osmotic demyelination syndromeSuggested treatment rates for acute and chronic conditionsSpecial ConsiderationsAddressing severe cases and the importance of proper diagnosticsPre-hospital care considerations and scenariosPediatrics and consideration of child abuse in sodium disordersFive Things That Will Change Your PracticeCentral lab sodium values over point-of-care for accuracyRectal temperature checks in endurance athletesLoop diuretics for hypervolemic hyponatremia (e.g., CHF patients)Enteral treatment for hypernatremia, if possibleConsidering COVID-19 as a possible cause for new onset SIADH

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the March 2025 Emergency Medicine Practice article, Emergency Department Management of Knee PainCommon Etiologies of Knee PainRisk Factors and StatisticsInfectious Causes of Knee PainPre-Hospital Care and EMSHistory and Physical ExamImaging GuidelinesOttawa Knee Rule and X-Ray NecessityImaging Modalities for Knee EffusionUltrasound for Tendon Injury and ArthrocentesisCT and MRI in Knee Injury DiagnosisLab Tests for Septic Knee DiagnosisTreatment Options for Knee ConditionsKnee Immobilizers: When and How to Use ThemSteroid Injections in the Emergency DepartmentManaging Traumatic Knee InjuriesEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net