• 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.

[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] Closing

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

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