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EMplify Emergency Medicine Podcast

Get quick-hit summaries of hot topics in emergency medicine. EMplify summarizes evidence-based reviews in a monthly podcast. It highlights the latest research published in EB Medicine's peer-reviewed journals in order to educate and arm you for life in the ED.

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Most recent episodes

Episode 50

Management of Deep Vein Thrombosis in the Emergency Department October 1, 2020

In this episode of EMplify, Dr. Sam Ashoo reviews the evidence as presented in the October 2020 issue of Emergency Medicine Practice. Deep vein thrombosis (DVT) can present a diagnostic dilemma due to the overlapping of symptoms with other diseases, and ED management of patients with DVT has changed markedly over the last 10 years.

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Table 1. Likelihood Ratios of Clinical Features Ruling In Deep Vein Thrombosis

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Episode 49

Emergency Care for Transgender and Gender-Diverse Children and Adolescents (Ethics CME) September 2, 2020

In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Hannah Janeway and Dr. Clinton Coil, of the David Geffen School of Medicine at UCLA, the authors of the September 2020 issue of Pediatric Emergency Medicine Practice, "Emergency Care for Transgender and Gender-Diverse Children and Adolescents." In this in-depth conversation, they explore the topics covered in the issue, including barriers to care, potential medical complications associated with gender-affirming therapies and appearance-altering practices, and the risks faced by this patient population.

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Table 1. Terminology and Definitions Relating to Gender Identity and Expression

Episode 48

Infective Endocarditis September 1, 2020

Recognition of infective endocarditis in the ED can be a challenge, with varied and sometimes subtle complaints, and there is a lack of definitive testing available in the acute care setting. Learn when to suspect the disease, how recognize the risk factors for its development, and how to provide stabilization and treatment

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Table 1. Risk Factors for Infective Endocarditis

Episode 47

Racism In Medicine with Dr. Maurice Selby August 12, 2020

In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Maurice Selby, Assistant Professor of Emergency Medicine at the Emory University School of Medicine; Dr. Selby is also the host of the Health in Harlem radio show and podcast. Dr. Ashoo and Dr. Selby discuss racism in medicine, both historically and currently, and how it impacts patients and clinicians.

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Episode 46

Ventilator Management of Adult Patients in the ED: An Interview with Dr. Ryan Pedigo (Part 2) July 1, 2020

In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Ryan Pedigo of Harbor-UCLA Medical Center, the author of the July 2020 issue of Emergency Medicine Practice, "Ventilator Management of Adult Patients in the Emergency Department." In this finale of their two-part conversation, Dr. Pedigo and Dr. Ashoo discuss the nuances of ventilation management for patients with ARDS (especially in those with COVID-19), as well as metabolic derangements such as DKA.

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Table 3. Examples of Initial Ventilator Settings for Obstructive Physiology (Asthma/COPD), Volume Assist-Control Mode

Episode 45

Ventilator Management of Adult Patients in the ED: An Interview with Dr. Ryan Pedigo (Part 1) July 1, 2020

In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Ryan Pedigo of Harbor-UCLA Medical Center, the author of the July 2020 issue of Emergency Medicine Practice, "Ventilator Management of Adult Patients in the Emergency Department." In Part 1 of their two-part conversation, Dr. Pedigo and Dr. Ashoo discuss modes of ventilation, tidal volumes, and ventilator settings for patients with COPD and asthma.

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Table 3. Examples of Initial Ventilator Settings for Obstructive Physiology (Asthma/COPD), Volume Assist-Control Mode

Episode 44

Multi-system Inflammatory Syndrome in Children (MIS-C) with COVID-19: An Interview with Dr. Ilene Claudius and Dr. Mohsen Saidinejad June 15, 2020

In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Ilene Claudius and Dr. Mohsen Saidinejad about Multi-system Inflammatory Syndrome in Children (MIS-C) with COVID-19.

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Dr. Ilene Claudius and Dr. Mohsen Saidinejad

Episode 43

Rural Emergency Medicine and COVID-19: An Interview with Dr. Harry Wingate and Dr. Ken Gramyks June 13, 2020

In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Harry Wingate and Dr. Ken Gramyk about Rural Emergency Medicine during the COVID-19 pandemic.

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Episode 42

The New Orleans Experience and Palliative Care: An Interview with Dr. Ashley Shreves May 15, 2020

In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Ashley Shreves about her experience as an emergency clinician and palliative medicine clinician in New Orleans during the COVID-19 pandemic.

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Dr. Sam Ashoo interviews Dr. Ashley Shreves

Episode 41

Mt Sinai COVID-19 Protocols - Interview with Dr. Eric Legome May 1, 2020

In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Eric Legome about "Emergency Department COVID Management Protocols: One Institution’s Experience and Lessons Learned."

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Dr. Sam Ashoo interviews Dr. Eric Legome

Episode 40

COVID-19 Discussion with Colby Redfield, MD April 20, 2020

In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Colby Redfield, about Triage Tent Implementation, Telemedicine, PPE and EMS.

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Dr. Sam Ashoo interviews Dr. Colby Redfield

Episode 39

COVID-19: Discussion with MDCalc on COVID-19 risk scores & NYC April 2, 2020

In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Joe Habboush, MD, CEO of MDCalc about new COVID-19 tools and his New York City experience.

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Dr. Sam Ashoo interviews Dr. Joe Habboush

Episode 38

COVID-19 Update: An Interview with Andrea Duca, MD March 19, 2020

In this episode of EMplify, Dr. Sam Ashoo interviews Dr. Andrea Duca, an attending physician in the Emergency Department of Papa Giovanni XXIII Hospital in Bergamo, Italy.

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Table 2. Clinical Features and Epidemiological Risks of COVID-19

Episode 37

Novel Coronavirus COVID-19: An Overview for Emergency Clinicians February 20, 2020

This overview analyzes the best information from the early research and offers valuable links to the most reliable and trustworthy resources to stay up-to-date.

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Table 2. Clinical Features and Epidemiological Risks of COVID-19

Episode 36

Diagnosis and Management of Acute Gastroenteritis in the Emergency Department (Pharmacology CME) March 1, 2020

Acute gastroenteritis is a common complaint in the ED, and we know that in 79% of the cases, a causative organism is never found. Neither patients nor emergency clinicians want unnecessary testing or antibiotics

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Table 3. Exposure/Patient Factors Associated With Bacterial Causes Likely to be Found on Stool Culture and Shiga Toxin Testing

Episode 35

Diabetic Hyperglycemic Emergencies: A Systematic Approach (Pharmacology CME) February 1, 2020

Hyperglycemic emergencies – diabetic ketoacidosis (DKA) and the hyperosmolar hyperglycemic state (HHS) – are common presentations in the ED that require swift, specialized management strategies.

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Table 8. Recommended Potassium Replacement in the First Hours of Diabetic Ketoacidosis

Episode 34

Emergency Department Management of Non–ST-Segment Elevation Myocardial Infarction January 1, 2020

Chest pain is a common presentation to the emergency department, and survival outcomes depend on prompt, accurate risk assessment, diagnosis, and initiation of care. This issue reviews the current guidelines and latest evidence regarding the most effective strategies in emergency management of NSTEMI.

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Table 4. Sgarbossa Criteria

Episode 33

Acute Bronchiolitis: Assessment and Management in the Emergency Department (Pharmacology CME) October 2, 2019

Differentiating bronchiolitis from asthma and reactive airway disease in young children can be challenging, and a rapidly changing clinical presentation can confound accurate assessment of the severity of the illness.

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Table 1. Differential Diagnosis for Wheezing in Infancy

Episode 32

Assisting With Air Travel Medical Emergencies: Responsibilities and Pitfalls (Ethics CME) September 1, 2019

Next time you’re onboard an airplane and hear, “Is there a medical professional on board?” should you raise your hand? What are your risks, responsibilities, and protections as a medical volunteer? This podcast reviews what you need to know before you fly.

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Table 2. FAA-Mandated Supplies Contained in the Emergency Medical Kit

EXTRA Supplement Podcast

Concussion in the Emergency Department: A Review of Current Guidelines - Trauma EXTRA Supplement (Trauma CME) September 15, 2019

Dr. Susan Kirelik, a concussion specialist and emergency medicine physician, discusses the key points of concussion diagnosis and management from the perspective of the emergency medicine clinician.

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Table 7. Proper Sleep Hygiene Techniques

Episode 31

Emergency Department Management of Patients Taking Direct Oral Anticoagulant Agents (Pharmacology CME) August 1, 2019

The use of direct oral anticoagulants – the direct thrombin inhibitor and the anti-factor Xa inhibitors – has increased greatly since 2010, when the first agent was approved by the FDA. Though DOACs are popular with patients because they don’t require the lab monitoring and dietary changes of warfarin, these patients can present new challenges to emergency clinicians.

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Figure 1. Clotting Factor Cascade and Site of Action of Oral Anticoagulant Agents

Episode 30

Emergency Department Management of Patients With Complications of Bariatric Surgery July 1, 2019

Bariatric surgery has shown evidence of being a means of achieving sustainable weight loss, along with improvement in the comorbidities associated with obesity, such as hypertension, diabetes, and dyslipidemia. Though relatively safe, these patients do frequently present to the ED with complications, and proper management depends on emergency clinicians’ swift recognition and treatment.

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Figure 3. Roux-en-Y Gastric Bypass

Episode 29

Assessing Abdominal Pain in Adults: A Rational, Cost-Effective, and Evidence-Based Strategy June 1, 2019

Patients with abdominal pain are common in the ED, but you need a strategy for quickly identifying patients who are at high risk for life-threatening causes of pain, and you need to order testing and consultation that improves the accuracy of your clinical assessment.

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Table 6. Alvarado Score

Episode 28

Depressed and Suicidal Patients in the Emergency Department: An Evidence-Based Approach (Behavioral Health CME) May 1, 2019

Though there is growing evidence that shows that ED patients present with high rates of depression and suicidal ideation, there are some novel strategies that emergency clinicians can use to quickly identify patients most at risk: What are the DSM-5 symptoms for major depressive disorder (MDD)?

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Table 2. Risk Factors for Major Depression

Episode 27

Emergency Department Diagnosis and Treatment of Sexually Transmitted Diseases (Pharmacology CME and Infectious Disease CME) April 1, 2019

Sexually transmitted disease can cause severe outcomes for patients, their partners, and their unborn babies, and swift and accurate diagnosis and treatment is essential to reduce morbidity and minimize the potential public health risks.

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Table 1. Sexually Transmitted Diseases Differential

Episode 26

Blunt Cardiac Injury: Emergency Department Diagnosis and Management (Trauma CME) March 1, 2019

When a patient arrives in the ED following blunt force trauma to the anterior chest wall, how can you tell whether they have a life-threatening cardiac injury that requires urgent operative management or just some soreness and can be discharged?

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Table 1. Eastern Association for the Surgery of Trauma – Levels of Recommendation

Episode 25

Evaluation and Management of Life-Threatening Headaches in the Emergency Department February 1, 2019

Though patients often present to the ED seeking relief from headaches that cause significant pain and suffering, 90% of them can be considered “benign.” It is essential to identify the 10% of headache patients who are in danger of having a life-threatening disorder presenting with a sudden and severe headache to ensure that they are treated quickly and effectively.

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Table 2. Historical and Physical Examination Findings Associated with Subarachnoid Hemorrhage

Episode 24

First Trimester Pregnancy Emergencies: Recognition and Management January 1, 2019

When a first-trimester-pregnant patient presents to the ED, emergency clinicians must consider the life and health of both the mother and the fetus in diagnosis and management. Abdominal pain, bleeding, urinary tract infection, and nausea and vomiting are common conditions in the differential for pregnant patients – as well as for patients who don’t yet know they’re pregnant.

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Figure 1. Sites of Ectopic Pregnancy Implantation

Episode 23

Influenza: Diagnosis and Management in the Emergency Department (Pharmacology CME) December 1, 2018

Patients presenting to the ED with “influenza-like illness” (cough, sore throat, fever) are typical in the fall and winter. How can you tell whether a patient might have influenza and infect others with a potentially dangerous strain? Are the guidelines the same in the spring and summer?

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Table 4. Most Frequent Clinical Symptoms of Seasonal Influenza, by Age Group

Episode 22

Electrical Injuries in the Emergency Department: An Evidence-Based Review (Trauma CME) November 1, 2018

A patient presenting to the ED after an electric shock is a potential multisystem trauma patient. All body systems can be affected by electrical injury: musculoskeletal, cardiac, vascular, respiratory, and neurologic. History and physical examination will be the best indicators of the extent of injury.

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Table 1. Physical Effects at Selected Currents

Episode 21

Updates and Controversies in the Early Management of Sepsis and Septic Shock (Pharmacology CME) October 1, 2018

For patients in the ED who are suspected of having sepsis, swift, effective management is vital to improving outcomes. This issue reviews the latest evidence on the diagnosis and treatment of sepsis and septic shock: how do the definitions of sepsis affect treatment decisions – and CMS quality measurements?

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Table 5. Historical and Physical Examination Findings Concerning for Sepsis

Episode 20

Emergency Department Management of North American Snake Envenomations (Trauma CME and Pharmacology CME) September 1, 2018

Venomous native North American snake families include the pit vipers (copperheads, water moccasins/cottonmouths, and rattlesnakes) and coral snakes. Pit viper venom is coagulopathic, and coral snake venom is neurotoxic – so what are the differences in ED management between the 2 types of envenomations?

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Figure 3. Elapidae (Coral Snake) Distribution in North America

Episode 19

Cannabinoids: Emerging Evidence in Use and Abuse (Pharmacology CME) August 1, 2018

As the use of cannabinoids increases, so have ED presentations of patients with acute intoxication and cannabinoid hyperemesis syndrome. This issue reviews the latest evidence on recognizing and managing patients with emergent conditions related to cannabinoid use, including an overview of the pathophysiology of cannabinoids.

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Table 4. Differential Diagnosis for Suspected Cannabis Intoxication

Episode 18

Emergency Department Management of Dyspnea in the Dying Patient (Pharmacology CME) July 1, 2018

Up to three quarters of patients with terminal cancer experience dyspnea, and many patients near the end of life will present to the ED seeking help. For emergency clinicians, the goals of care for patients with terminal illness are very different. This issue reviews what emergency clinicians must know to safely, effectively, and sensitively manage the distressing symptoms of breathlessness.

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Table 3. Prognostic Signs in the Dyspneic Patient at the End of Life

Episode 17

Managing Shoulder Injuries in the Emergency Department: Fracture, Dislocation, and Overuse (Trauma CME) June 1, 2018

Fractures, dislocations, and overuse syndromes all produce shoulder pain, but a systematic approach to evaluation and treatment will ensure that your diagnosis and treatment plan locates the source of the pain and reduces the chances that the patient will have life-long disability or life-threatening sequelae.

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Figure 15. Traction-Countertraction Technique

Episode 16

Recognizing and Managing Emerging Infectious Diseases in the Emergency Department May 1, 2018

This issue reviews management of patients with suspected Middle East respiratory syndrome, chikungunya virus infection, and Zika virus infection. To safeguard the health of the public – and hospital staff – it is essential for emergency clinicians to know the current status of worldwide infectious disease outbreaks

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Table 2. Travel Risk Exposures and Associated Infections

Episode 15

Jaundice in the Emergency Department: Meeting the Challenges of Diagnosis and Treatment (Pharmacology CME) April 1, 2018

Jaundice is a manifestation of elevated serum bilirubin, and can have many causes, some of which can be life-threatening. This issue will help the emergency clinician narrow down the differential diagnosis to determine a cause and allow for swift disposition

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Table 11. Stages of Hepatic Encephalopathy

Episode 14

Emergency Department Management of Smoke Inhalation Injury in Adults (Trauma CME) March 1, 2018

When treating patients who have suffered injury in a fire, managing their airway is as critical as treating their burns. Following on the February 2018 issue on Thermal Burns, this issue reviews strategies for diagnosing and treating inhalation injuries in fire-exposed patients.

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Figure 1. Soot and Bronchial Casts From Smoke Inhalation

Episode 13

Emergency Department Management of Patients With Thermal Burns (Trauma CME and Pharmacology CME) February 1, 2018

Thermal burn injuries are a significant cause of morbidity and mortality worldwide. In addition to treatment of the burns, emergency clinicians must assess for inhalation injury, exposure to toxic gases, and related traumatic injuries. Priorities for emergency resuscitation include stabilization of airway and breathing, intravenous fluid administration, pain control, and local wound care.

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Figure 6. Accidental Versus Intentional Scald

Episode 12

Managing Patients with Oncologic Complications in the Emergency Department (Pharmacology CME) January 1, 2018

Whether a patient with cancer presents to the ED with cancer-treatment side effects or complications of the disease itself, timely diagnostic workup and evidence-based management strategies can make the difference in their quality of life. This issue reviews management recommendations for 3 ED presentations of oncologic patients: metastatic spinal cord compression, tumor lysis syndrome, and neutropenic fever.

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Table 1. Components of the Multinational Association of Supportive Care in Cancer (MASCC) Risk Index

Episode 11

Managing Dislocations of the Hip, Knee, and Ankle in the Emergency Department (Trauma CME) December 1, 2017

Dislocations of the hip, knee, or ankle are painful presentations in the trauma ED that must be managed quickly to avoid morbidity, disability, and even possible amputation. This issue presents an evidence-based approach to: Quickly assess the dislocation based on the mechanism of injury, manage fractures often associated with dislocations, quickly and safely diagnose and treat dangerous knee dislocations, and order diagnostic studies to determine the exact nature of the dislocation: x-rays or CT?

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Figure 2. Anatomy of the Knee

Episode 10

Management of Inflammatory Bowel Disease Flares in the Emergency Department (Pharmacology CME) November 1, 2017

Managing acute flares of chronic inflammatory bowel disease (IBD) in the ED can be challenging. This issue will help you: Differentiate the routine flare from a complication, learn the extraintestinal manifestations of undiagnosed IBD to help spot the disease early, determine whether the signs and symptoms indicate an infectious etiology, and communicate effectively with gastroenterologists and assist in long-term management

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Table 2. Differential Diagnosis of an Inflammatory Bowel Disease Flare

Episode 9

Diagnosis and Management of Acute Exacerbations of Chronic Obstructive Pulmonary Disease (Pharmacology CME) October 1, 2017

As more and more patients present to the ED with symptoms that suggest an acute exacerbation of COPD –worsening dyspnea, cough and sputum production – emergency clinicians can improve patient comfort and possibly mitigate morbidity and mortality with the right testing and treatment interventions

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Figure 4. End-Tidal Capnography Tracings

Episode 8

Recognizing and Managing Adrenal Disorders in the Emergency Department (Pharmacology CME) September 1, 2017

Adrenal disorders can be life-threatening if they are unrecognized. In this issue, you will learn to distinguish primary and secondary adrenal insufficiency from many similar presentations, order laboratory tests in the ED that will assist emergent management, administer the optimal corticosteroid in the correct dose to quickly manage the cortisol deficit, and recognize and treat adrenal insufficiency in patients with critical illnesses

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Figure 1. Hypothalamic-Pituitary-Adrenal Axis and Feedback Loops

Episode 7

Emergency Management of Renal and Genitourinary Trauma: Best Practices Update (Trauma CME) August 1, 2017

For trauma patients in the ED, life- and limb-threatening injuries take priority, but renal and genitourinary injury can have long-term consequences for patients, including chronic kidney disease, erectile dysfunction, incontinence, and other serious problems. This issue offers a review of the literature regarding treatment of renal and GU injuries, from diagnosis to management to disposition.

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Table 1. Potential Sequelae of Renal and Genitourinary Injuries

Episode 6

Identifying Emergency Department Patients With Chest Pain Who Are at Low Risk for Acute Coronary Syndromes July 1, 2017

A missed diagnosis of acute coronary syndromes can be life threatening, but what about patients who appear to be at low risk of ACS? What are the best ways to make sure those at risk are flagged without ordering unnecessary testing? In this issue, you will learn to Manage the special diagnostic challenges with women, the young, the old, and those with previously treated CAD

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Table 2. Electrocardiographic Classification and Likelihood of 30-day Major Adverse Cardiac Event

Episode 5

Dental Emergencies: Management Strategies That Improve Outcomes (Trauma CME and Pharmacology CME) June 1, 2017

This article makes management of most dental emergencies easier by providing recommendations for replanting avulsed teeth, the use of imaging to identify suspected deep neck infections (especially in high-risk immunocompromised or diabetic patients), appropriate use of antibiotics, and familiarity with orofacial nerve blocks to deliver safe and effective pain relief.

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Figure 4. Luxation of Teeth

Episode 4

Acute Decompensated Heart Failure: New Strategies for Improving Outcomes (Pharmacology CME) May 1, 2017

Acute decompensated heart failure is a common emergency department presentation with significant associated morbidity and mortality. This issue reviews recent literature regarding appropriate management of emergency department presentations of acute decompensated heart failure, with special attention to newer medication options.

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Figure 1. Diastolic and Systolic Heart Failure

Episode 3

Maxillofacial Trauma: Managing Potentially Dangerous And Disfiguring Complex Injuries (Trauma CME) April 1, 2017

Patients with maxillofacial trauma require a careful evaluation due to the anatomical proximity of the maxillofacial region to the head and neck. Facial injuries can range from soft-tissue lacerations and nondisplaced nasal fractures to severe, complex fractures, eye injuries, and possible brain injury.

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Figure 10. Fractures Of The Right Parasymphysis And The Left Mandibular Ramus

Episode 2

Sedative-Hypnotic Drug Withdrawal Syndrome: Recognition and Treatment (Critical Care Topic and Pharmacology CME) March 1, 2017

Sedative-hypnotic drugs include gamma-Aminobutyric acid (GABA)ergic agents such as benzodiazepines, barbiturates, gamma-Hydroxybutyric acid [GHB], gamma-Butyrolactone [GBL], baclofen, and ethanol. Benzodiazepines, phenobarbital, propofol, and other GABA agonists or analogues can effectively control symptoms of withdrawal from GABAergic agents.

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Table 2_ Differential Diagnosis For Sympathomimetic Toxidrome

Episode 1

Optimizing Survival Outcomes for Adult Patients with Nontraumatic Cardiac Arrest (Pharmacology CME) October 1, 2016

This systematic review analyzes the basic life support factors that improve survival outcome, including chest compression technique and rapid defibrillation of shockable rhythms. For patients who are successfully resuscitated, comprehensive postresuscitation care is essential. Management of cardiac arrest in circumstances such as pregnancy, pulmonary embolism, opioid overdose and other toxicologic causes, hypothermia, and coronary ischemia are also reviewed.

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Table 1. The Hs And Ts In Pulseless Electrical Activity

Meet the Host

Sam Ashoo, MD, FACEP

Dr. Ashoo is a practicing emergency physician, board-certified in emergency medicine and clinical informatics. Join him as he takes you through the October 2019 issue of Pediatric Emergency Medicine Practice: Acute Bronchiolitis: Assessment and Management in the Emergency Department (Pharmacology CME).

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Last Modified: 10/23/2020 © EB Medicine. All rights reserved.