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Acute Coronary Occlusion

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 Occlusion00:00 - Introduction & Welcome01:21 - Episode Overview: Acute Coronary Occlusion02:06 - Why This Topic Matters: Statistics & New Guidelines03:35 - Nomenclature: ACO vs STEMI/NSTEMI06:15 - Differential Diagnosis for STEMI07:41 - Pre-Hospital Care & EMS Role11:37 - Patient History & Presenting Symptoms12:28 - Physical Examination Findings14:54 - EKG: The Most Important Test17:00 - STEMI Definition & Criteria20:32 - STEMI Equivalents: Scarbosa Criteria22:40 - Smith Modified Scarbosa Criteria24:10 - Hyperacute T Waves25:30 - Posterior STEMI28:40 - De Winter Sign29:38 - Non-STEMI EKG Findings31:30 - AVR ST Elevation32:47 - Wellens Syndrome33:54 - Reciprocal ST Segment Changes36:15 - Inferior MI Patterns37:54 - Laboratory Testing39:51 - Imaging: Chest X-Ray & Echocardiography42:25 - Supplemental Oxygen: What the Evidence Shows44:50 - Analgesia & Pain Management46:35 - Pharmacotherapy: Aspirin & Antiplatelet Agents49:18 - Reperfusion Therapies & Thrombolytics53:05 - Cardiac Arrest in STEMI Patients53:55 - Closing Remarks & CME InformationSubscribers, take the CME test here.Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

Being A Pre-Litigation Expert with Jeff Willis, MD

In this episode, Sam Ashoo, MD interviews Jeff Willis, MD on the topic of pre-litigation review, being a medical expert, and common pitfalls leading to medical malpractice cases. 0:15 Introduction0:51 Guest Introduction1:20 Jeff's Background2:00 Current Work3:37 How He Got Started6:57 Pre-Litigation vs. Expert Witness8:01 Four Components of Malpractice Cases13:55 Case Review Statistics17:11 When Cases Get Filed18:58 Common Patterns in Cases19:55 Documentation Best Practices22:06 Shift Handoff Problems25:56 Bounce Backs27:25 Medical Record Volume30:00 Audit Trails32:53 Communication with Consultants41:35 Conflicting Documentation43:46 Getting Started in This Work47:37 ClosingEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

Syphilis: The Great Masquerader

In this episode, Sam Ashoo, MD and T.R. Eckler, MD discuss the Januray 2026 Emergency Medicine Practice article, Emergency Department Diagnosis and Management of Patients With SyphilisSyphilis 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.Timestamps[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] ClosingSubscribers, take the CME test here.Emergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

Cannabis Related Emergencies

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 EmergenciesEpisode Outline: [0:00] IntroductionWelcome and show overview by Sam AshooMention of resources at ebmedicine.net[0:46] Episode StartHosts introduce themselves: Sam Ashoo and Dr. T.R. EcklerDr. Eckler’s background and experience with cannabis cases in Colorado[1:16] Topic IntroductionFocus on diagnosis and management of cannabis-related emergenciesPrevalence and importance in emergency medicine[1:34] Legal LandscapeOverview of cannabis legality across statesMedicinal vs. non-medicinal use[3:03] Increase in ED VisitsStatistics: ~1 million cannabis-related ED visits annuallyDemographics: younger population most affected[3:52] Synthetics and ChallengesDiscussion of synthetic cannabinoids and their risksIssues with detection and legality[4:50] Clinical SpectrumRange of presentations: from nausea/vomiting to psychosis and seizuresImpact on different age groups[6:34] FDA-Approved UsesCannabis-derived products approved for specific medical conditions[7:20] Physiology and PathophysiologyCannabinoid receptors (CB1 and CB2) and their effectsDifferences between plant-derived and synthetic cannabinoids[9:10] Chronic Use and WithdrawalDownregulation of receptors, withdrawal symptoms, and persistent nausea[10:20] Product Forms and Delivery MethodsSmoking, edibles, oils, tinctures, suppositories, topicals, etc.Risks associated with concentrated forms (e.g., wax, oils)[12:00] Clinical Effects by SystemPsychiatric: anxiety, psychosis, paranoiaCardiovascular: tachycardia, MI risk, QT prolongationPulmonary, renal, metabolic, dental, and ocular effects[13:50] Cannabinoid Hyperemesis Syndrome (CHS)Phases: prodrome, hyperemesis, recoveryHot showers as a diagnostic clue[16:00] Withdrawal SyndromeSymptoms and timelineExacerbation with synthetic cannabinoids[18:15] Counseling and ManagementImportance of cessation and patient educationTimeline for symptom improvement[18:42] Differential DiagnosisBroad differential for persistent nausea/vomiting and abdominal painImportance of considering other causes[20:55] Diagnostics and TestingLimitations of drug screens (false positives/negatives)Importance of EKG, labs, and imaging as indicated[23:10] Treatment ApproachesFirst-line: benzodiazepines, antiemetics (ondansetron, metoclopramide)Second-line: butyrophenones (haloperidol, droperidol), olanzapineCapsaicin as adjunct therapy[29:50] Complications and Special ConsiderationsRisks of undertreatment (e.g., Boerhaave syndrome, aspiration)Pediatric and pregnant populations: unique risks and reporting requirements[36:00] Five Practice-Changing TakeawaysElicit cannabis use historyKnow testing limitationsConsider ECG and appropriate labsUse butyrophenones when indicatedAdmit if symptoms are refractory[39:00] ConclusionEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net

Measles, Mumps, Rubella, and Varicella with Dr Tim Horeczko

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 Patients00:00 Introduction to Emergency Medicine00:21 Welcome and Holiday Greetings01:16 Special Guest Introduction01:41 Discussion on Pediatric Emergency Medicine04:55 Epidemiology of Measles08:16 Challenges in Diagnosing Measles14:27 Mumps: Symptoms and Complications27:36 Rubella: Risks and Symptoms29:28 Varicella: Symptoms and Precautions33:12 Differential Diagnosis and Conclusion35:14 Using Inductive Reasoning in Medical Diagnosis35:40 Recognizing Purpuric Rash and Its Implications36:22 Guidance for EMS Colleagues on Handling Fever and Rash37:14 Importance of Communication and Relationships with EMS39:12 Decontamination and PPE Protocols for EMS42:34 Detailed Patient Assessment in the ED46:06 Diagnostic Testing and Clinical Diagnosis49:20 Reporting Responsibilities and Treatment Protocols01:01:19 Addressing Vaccine Controversies and Public Trust01:06:25 Conclusion and Additional ResourcesCheck out Dr Horeczko's podcast - Pediatric Emergency PlaybookEmergency Medicine Residents, get your free subscription by writing resident@ebmedicine.net