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 Shock

00:00 Introduction and Welcome

01:09 Meet Dr. Lauren Page Black: Sepsis Expert

01:56 Sepsis Statistics and Impact

04:16 Understanding Sepsis Definitions

09:56 Screening Tools for Sepsis

13:57 Pre-Hospital Sepsis Recognition

19:33 Clinical Examination and Diagnostics

24:03 The Role of Lactate and Procalcitonin

27:40 Clinical Gestalt and Imaging in Diagnosis

29:21 CMS Bundle Requirements and Updates

34:02 Fluid Type Preferences in Sepsis

36:49 Antibiotic Timing and Selection

43:43 Vasopressors and Steroids in Sepsis Management

50:18 Special Populations and Future Directions

53:44 Conclusion and Resources

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

In this episode, Sam Ashoo, MD interviews Christina Shenvi, MD, PhD, MBA about ways to manage your day and keep distraction at bay.

• Introduction to Dr. Christina Shenvi
• Why Focus and Time Management Matter
• Experiences coaching medical students and professionals
• The importance of managing mind, time, and attention
• Applicability to both career and personal life
• Framework for Focus
• Three-step framework: Prioritize, Strategize, Focus
• Explanation of prioritization
• Mapping personal and professional activities to priorities
• Deep Work vs. Shallow Work
• Defining deep work and shallow work
• Strategies for categorizing and scheduling tasks
• Time-blocking and protecting focus time
• Overcoming Distraction
• The psychology of distraction and procrastination
• The impact of digital devices and social media on attention
• The variable reward system of social media and its addictive nature
• Strategies to Improve Focus
• Clearing mental, physical, and digital environments
• The importance of a distraction-free workspace
• Systems for capturing and organizing tasks
• The Pomodoro method and using time pressure
• Building a Personal System
• Experimenting with different task management tools
• Adapting systems to personal needs and preferences
• Daily Practice and Training Focus
• Reviewing and updating task lists daily
• Chunking email and shallow work to specific times
• Training the brain to focus like a muscle
• Special considerations for people with ADHD
• Resources and Contact
• Dr. Shenvi’s website and online course (timeforyourlife.org)
• Invitation to connect for coaching or further learning

For more about Christina Shenvi : https://timeforyourlife.org/

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 Patients

• Welcome and brief overview of the episode
• Promotion of EB Medicine’s $1 for 7-day trial offer

• Seizures make up ~1% of ED visits and ~3% of EMS calls
• High-risk and high-stakes condition requiring rapid action
• Status epilepticus now defined as ≥5 minutes of seizure activity
• ILAE’s T1 and T2 timelines help define when to treat and when damage begins

• Top contributors:
• Fever/infection
• Structural CNS abnormalities
• Toxic ingestions
• Genetic/metabolic disorders
• Additional factors by age:
• Infants: febrile seizures, chromosomal issues, trauma
• School-age: autoimmune disorders
• Adolescents: eclampsia, hypertension, functional disorders
• Always consider non-accidental trauma

• IM midazolam is effective and recommended (RAMPART trial)
• Other options: intranasal, rectal, or IV benzodiazepines
• Early benzodiazepine administration improves outcomes
• Importance of airway support, glucose check, and EMS flexibility
• Parent-administered home meds (e.g. rectal diazepam) can be helpful

• Prioritize ABCs: Airway, Breathing, Circulation, Consciousness
• Use end-tidal CO₂ to monitor ventilation if available
• Point-of-care glucose is essential
• Labs: CMP, Mg, Phos, lactate, drug levels, pregnancy test (when indicated)
• Imaging: Head CT if concern for trauma, shunt malfunction, or focal signs
• Case examples highlight pitfalls and diagnostic delays

• Benzodiazepines remain the cornerstone
• Lorazepam preferred IV agent (0.1 mg/kg)
• Midazolam preferred if no IV access (IN, IM, or IO)
• Diazepam is also effective, especially rectally
• Be mindful of respiratory depression and the need for airway control

• Based on ESETT trial:
• Levetiracetam, fosphenytoin, and valproate have similar efficacy
• Levetiracetam favored for safety and ease of use
• Fosphenytoin may be avoided in trauma or toxicity
• Valproate not recommended in mitochondrial disease
• Phenobarbital reserved for refractory cases only

• Definition: persistent seizures despite first- and second-line agents
• Requires sedation and likely intubation
• Infusion 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 activity

• Neonates:
• Watch for subtle signs (lip smacking, bicycling, tongue thrusting)
• Broad differential includes asphyxia, infection, metabolic errors
• Febrile Status Epilepticus:
• Higher risk of CNS infections, especially if unvaccinated
• Consider lumbar puncture if indicated
• Electrolyte/Metabolic Triggers:
• Treat hypoglycemia, hyponatremia, and hypocalcemia directly
• Use 3% saline or dextrose as appropriate

• Many children will require ICU-level care
• Some known epilepsy patients may go home if back to baseline
• Ensure rescue medications are up to date (rectal/intranasal benzos)
• Consider “clonazepam bridge” for short-term seizure prevention
• Collaborate with neurology for medication adjustment and follow-up

• Keep treatment tables and dosing references accessible
• Early, aggressive treatment can prevent long-term harm
• Episode closes with gratitude to article authors and a reminder to visit EBMedicine.net

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