1,042 episodes

Our near daily podcasts move quickly to reflect current events, are inspired by real patient care, and speak to the true nature of what it’s like to work in the Emergency Room or Pre-Hospital Setting. Each medical minute is recorded in a real emergency department, by the emergency physician or clinical pharmacist on duty – the ER is our studio and everything is live.

Emergency Medical Minute Emergency Medical Minute

    • Health & Fitness
    • 4.8 • 224 Ratings

Our near daily podcasts move quickly to reflect current events, are inspired by real patient care, and speak to the true nature of what it’s like to work in the Emergency Room or Pre-Hospital Setting. Each medical minute is recorded in a real emergency department, by the emergency physician or clinical pharmacist on duty – the ER is our studio and everything is live.

    Episode 900: Ketamine Dosing

    Episode 900: Ketamine Dosing

    Contributor: Travis Barlock MD
    Educational Pearls:
    Ketamine is an NMDA receptor antagonist with a wide variety of uses in the emergency department. To dose ketamine remember the numbers 0.3, 1, and 3.
    Pain dose
    For acute pain relief administer 0.3 mg/kg of ketamine IV over 10-20 minutes (max of 30 mg).
    Note: There is evidence that a lower dose of 0.1-0.15 mg/kg can be just as effective.
    Dissociative dose
    To use ketamine as an induction agent for intubation or for procedural sedation administer 1 mg/kg IV over 1-2 minutes.
    IM for acute agitation
    If a patient is out of control and a danger to themselves or others, administer 3 mg/kg intramuscularly (max 500 mg).
    If you are giving IM ketamine it has to be in the concentrated 100 mg/ml vial.
    Additional pearls
    Pushing ketamine too quickly can cause laryngospasm.
    Between .3 and 1 mg/kg is known as the recreational dose. You want to avoid this range because this is where ketamine starts to pick up its dissociative effects and can cause unpleasant and intense hallucinations. This is colloquially known as being in the “k-hole”.
    Gao, M., Rejaei, D., & Liu, H. (2016). Ketamine use in current clinical practice. Acta pharmacologica Sinica, 37(7), 865–872. https://doi.org/10.1038/aps.2016.5
    Lin, J., Figuerado, Y., Montgomery, A., Lee, J., Cannis, M., Norton, V. C., Calvo, R., & Sikand, H. (2021). Efficacy of ketamine for initial control of acute agitation in the emergency department: A randomized study. The American journal of emergency medicine, 44, 306–311. https://doi.org/10.1016/j.ajem.2020.04.013
    Stirling, J., & McCoy, L. (2010). Quantifying the psychological effects of ketamine: from euphoria to the k-Hole. Substance use & misuse, 45(14), 2428–2443. https://doi.org/10.3109/10826081003793912
    Summarized by Jeffrey Olson MS2 | Edited by Jorge Chalit, OMS II

    • 2 min
    Episode 899: Thrombolytic Contraindications

    Episode 899: Thrombolytic Contraindications

    Contributor: Travis Barlock MD
    Educational Pearls:
    Thrombolytic therapy (tPA or TNK) is often used in the ED for strokes
    Use of anticoagulants with INR > 1.7 or  PT >15
    Warfarin will reliably increase the INR
    Current use of Direct thrombin inhibitor or Factor Xa inhibitor 
    aPTT/PT/INR are insufficient to assess the degree of anticoagulant effect of Factor Xa inhibitors like apixaban (Eliquis) and rivaroxaban (Xarelto) 
    Intracranial or intraspinal surgery in the last 3 months
    Intracranial neoplasms or arteriovenous malformations also increase the risk of bleeding
    Current intracranial or subarachnoid hemorrhage
    History of intracranial hemorrhage from thrombolytic therapy also contraindicates tPA/TNK
    Recent (within 21 days) or active gastrointestinal bleed
    BP >185 systolic or >110 diastolic
    Administer labetalol before thrombolytics to lower blood pressure
    Timing of symptoms
    Onset > 4.5 hours contraindicates tPA
    Platelet count BGL Potential alternative explanation for stroke-like symptoms obviating need for thrombolytics
    1. Fugate JE, Rabinstein AA. Absolute and Relative Contraindications to IV rt-PA for Acute Ischemic Stroke. The Neurohospitalist. 2015;5(3):110-121. doi:10.1177/1941874415578532
    2. Powers WJ, Rabinstein AA, Ackerson T, et al. Guidelines for the Early Management of Patients with Acute Ischemic Stroke: 2019 Update to the 2018 Guidelines for the Early Management of Acute Ischemic Stroke a Guideline for Healthcare Professionals from the American Heart Association/American Stroke Association. Vol 50.; 2019. doi:10.1161/STR.0000000000000211
    Summarized by Jorge Chalit, OMSII | Edited by Jorge Chalit

    • 3 min
    Episode 898: Takotsubo Cardiomyopathy

    Episode 898: Takotsubo Cardiomyopathy

    Contributor: Ricky Dhaliwal, MD
    Educational Pearls:
    Takotsubo cardiomyopathy, also known as "broken heart syndrome,” is a temporary heart condition that can mimic the symptoms of a heart attack, including troponin elevations and mimic STEMI on ECG.
    The exact cause is not fully understood, but it is often triggered by severe emotional or physical stress. The stress can lead to a surge of catecholamines which affects the heart (multivessel spasm/paralysed myocardium).
    The name "Takotsubo" comes from the Japanese term for a type of octopus trap, as the left ventricle takes on a distinctive shape resembling this trap during systole. The LV is dilated and part of the wall becomes akenetic. These changes can be seen on ultrasound.
    The population most at risk for Takotsubo are post-menopausal women.
    Coronary angiography is one of the only ways to differentiate Takotsubo from other acute coronary syndromes.
    Most people with Takotsubo cardiomyopathy recover fully.
    Amin, H. Z., Amin, L. Z., & Pradipta, A. (2020). Takotsubo Cardiomyopathy: A Brief Review. Journal of medicine and life, 13(1), 3–7. https://doi.org/10.25122/jml-2018-0067
    Bossone, E., Savarese, G., Ferrara, F., Citro, R., Mosca, S., Musella, F., Limongelli, G., Manfredini, R., Cittadini, A., & Perrone Filardi, P. (2013). Takotsubo cardiomyopathy: overview. Heart failure clinics, 9(2), 249–x. https://doi.org/10.1016/j.hfc.2012.12.015
    Dawson D. K. (2018). Acute stress-induced (takotsubo) cardiomyopathy. Heart (British Cardiac Society), 104(2), 96–102. https://doi.org/10.1136/heartjnl-2017-311579
    Kida, K., Akashi, Y. J., Fazio, G., & Novo, S. (2010). Takotsubo cardiomyopathy. Current pharmaceutical design, 16(26), 2910–2917. https://doi.org/10.2174/138161210793176509
    Summarized by Jeffrey Olson MS2 | Edited by Jorge Chalit, OMSII

    • 3 min
    Episode 897: Adrenal Crisis

    Episode 897: Adrenal Crisis

    Contributor: Ricky Dhaliwal MD
    Educational Pearls:
    Primary adrenal insufficiency (most common risk factor for adrenal crises)
    An autoimmune condition commonly known as Addison's Disease
    Defects in the cells of the adrenal glomerulosa and fasciculata result in deficient glucocorticoids and mineralocorticoids
    Mineralocorticoid deficiency leads to hyponatremia and hypovolemia
    Lack of aldosterone downregulates Endothelial Sodium Channels (ENaCs) at the renal tubules
    Water follows sodium and generates a hypovolemic state
    Glucocorticoid deficiency contributes further to hypotension and hyponatremia
    Decreased vascular responsiveness to angiotensin II
    Increased secretion of vasopressin (ADH) from the posterior pituitary
    An adrenal crisis is defined as a sudden worsening of adrenal insufficiency
    Presents with non-specific symptoms including nausea, vomiting, fatigue, confusion, and fevers
    Fevers may be the result of underlying infection
    Work-up in the ED includes labs looking for infection and adding cortisol + ACTH levels
    Emergent treatment is required
    100 mg hydrocortisone bolus followed by 50 mg every 6 hours
    Immediate IV fluid repletion with 1L normal saline
    The most common cause of an adrenal crisis is an acute infection in patients with baseline adrenal insufficiency
    Often due to a gastrointestinal infection
    1. Bancos I, Hahner S, Tomlinson J, Arlt W. Diagnosis and management of adrenal insufficiency. Lancet Diabetes Endocrinol. 2015;3(3):216-226. doi:10.1016/S2213-8587(14)70142-1
    2. Bornstein SR, Allolio B, Arlt W, et al. Diagnosis and Treatment of Primary Adrenal Insufficiency: An Endocrine Society Clinical Practice Guideline. J Clin Endocrinol Metab. 2016;101(2):364-389. doi:10.1210/jc.2015-1710
    3. Cronin CC, Callaghan N, Kearney PJ, Murnaghan DJ, Shanahan F. Addison disease in patients treated with glucocorticoid therapy. Arch Intern Med. 1997;157(4):456-458.
    4. Feldman RD, Gros R. Vascular effects of aldosterone: sorting out the receptors and the ligands. Clin Exp Pharmacol Physiol. 2013;40(12):916-921. doi:10.1111/1440-1681.12157
    5. Hahner S, Loeffler M, Bleicken B, et al. Epidemiology of adrenal crisis in chronic adrenal insufficiency: the need for new prevention strategies. Eur J Endocrinol. 2010;162(3):597-602. doi:10.1530/EJE-09-0884 
    Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit

    • 4 min
    Podcast 896: Cancer-Related Emergencies

    Podcast 896: Cancer-Related Emergencies

    Contributor: Travis Barlock, MD
    Educational Pearls:
    Cancer-related emergencies can be sorted into a few buckets:
    Cancer itself and the treatments (chemotherapy/radiation) can be immunosuppressive. Look out for conditions such as sepsis and neutropenic fever.
    Cancer causes a hypercoagulable state. Look out for blood clots which can cause emergencies such as a pulmonary embolism, stroke, superior vena cava (SVC) syndrome, and cardiac tamponade.
    Cancer can affect the metabolic system in a variety of ways. For example, certain cancers like bone cancers can stimulate the bones to release large amounts of calcium leading to hypercalcemia. Tumor lysis syndrome is another consideration in which either spontaneously or due to treatment, tumor cells will release large amounts of electrolytes into the bloodstream causing hyperuricemia, hyperkalemia, hyperphosphatemia, and hypocalcemia.
    Medication side effect
    Immunomodulators can have strange side effects. A common one to know is Keytruda (pembrolizumab), which can cause inflammation in any organ. So if you have a cancer patient on immunomodulators with any inflammatory changes (cystitis, colitis, pneumonitis, etc), talk to oncology about whether steroids are indicated.
    Chemotherapy can cause tumor lysis syndrome (see above), and multiple chemotherapeutics are known to cause heart failure (doxorubicin, trastuzumab), kidney failure (cisplatin), and pulmonary toxicity (bleomycin).
    Campello, E., Ilich, A., Simioni, P., & Key, N. S. (2019). The relationship between pancreatic cancer and hypercoagulability: a comprehensive review on epidemiological and biological issues. British journal of cancer, 121(5), 359–371. https://doi.org/10.1038/s41416-019-0510-x
    Gyamfi, J., Kim, J., & Choi, J. (2022). Cancer as a Metabolic Disorder. International journal of molecular sciences, 23(3), 1155. https://doi.org/10.3390/ijms23031155
    Kwok, G., Yau, T. C., Chiu, J. W., Tse, E., & Kwong, Y. L. (2016). Pembrolizumab (Keytruda). Human vaccines & immunotherapeutics, 12(11), 2777–2789. https://doi.org/10.1080/21645515.2016.1199310
    Wang, S. J., Dougan, S. K., & Dougan, M. (2023). Immune mechanisms of toxicity from checkpoint inhibitors. Trends in cancer, 9(7), 543–553. https://doi.org/10.1016/j.trecan.2023.04.002
    Zimmer, A. J., & Freifeld, A. G. (2019). Optimal Management of Neutropenic Fever in Patients With Cancer. Journal of oncology practice, 15(1), 19–24. https://doi.org/10.1200/JOP.18.00269
    Summarized by Jeffrey Olson MS2 | Edited by Meg Joyce & Jorge Chalit, OMSII

    • 2 min
    Episode 895: Indications for Exogenous Albumin

    Episode 895: Indications for Exogenous Albumin

    Contributor: Travis Barlock MD
    Educational Pearls:
    There are three indications for IV albumin in the ED
    Spontaneous bacterial peritonitis (SBP)
    Patients with SBP develop renal failure from volume depletion
    Albumin repletes volume stores and reduces renal impairment
    Albumin binds inflammatory cytokines and expands plasma volume
    Reduced all-cause mortality if IV albumin is given with antibiotics
    Hepatorenal syndrome
    Cirrhosis of the liver causes the release of endogenous vasodilators
    The renin-angiotensin-aldosterone system (RAAS) fails systemically but maintains vasoconstriction at the kidneys, leading to decreased renal perfusion
    IV albumin expands plasma volume and prevents failure of the RAAS
    Large volume paracentesis
    Large-volume removal may lead to circulatory dysfunction
    IV albumin is associated with a reduced risk of paracentesis-associated circulatory dysfunction
    There are many other FDA-approved conditions for which to use exogenous albumin but the data are conflicted about the benefits on mortality
    1. Arroyo V, Fernandez J. Pathophysiological basis of albumin use in cirrhosis. Ann Hepatol. 2011;10(SUPPL. 1):S6-S14. doi:10.1016/s1665-2681(19)31600-x
    2. Bai Z, Wang L, Wang R, et al. Use of human albumin infusion in cirrhotic patients: a systematic review and meta-analysis of randomized controlled trials. Hepatol Int. 2022;16(6):1468-1483. doi:10.1007/s12072-022-10374-z
    3. Batool S, Waheed MD, Vuthaluru K, et al. Efficacy of Intravenous Albumin for Spontaneous Bacterial Peritonitis Infection Among Patients With Cirrhosis: A Meta-Analysis of Randomized Control Trials. Cureus. 2022;14(12). doi:10.7759/cureus.33124
    4. Kwok CS, Krupa L, Mahtani A, et al. Albumin reduces paracentesis-induced circulatory dysfunction and reduces death and renal impairment among patients with cirrhosis and infection: A systematic review and meta-analysis. Biomed Res Int. 2013;2013. doi:10.1155/2013/295153
    5. Sort P, Navasa M, Arroyo V, et al. Effect of Intravenous Albumin on Renal Impairment and Mortality in Patients with Cirrhosis and Spontaneous Bacterial Peritonitis. N Engl J Med. 1999;341(6):403-409.
    Summarized by Jorge Chalit, OMSII | Edited by Meg Joyce & Jorge Chalit

    • 2 min

Customer Reviews

4.8 out of 5
224 Ratings

224 Ratings

ggarcia.ur ,

Fantastic podcast

The information provided is fantastic for medical/emergency providers. I enjoy the briefness of each episode. Will continue listening!

hnhhk ,


As someone who is passionate about the topic, I was overjoyed to discover a podcast that not only offers insightful information, but also does so in an interesting and amusing manner.

Every episode demonstrates the host's passion for the topic and his expertise of it. They invite industry professionals as guests, who share their knowledge, insights, and opinions to offer a balanced and thorough examination of the issue.

Ryan Novoa ,

A bit dense

There is likely a lot of good vocabulary that would be useful in medicine, but these terms are not given much context. One would have to be a medical student or physician to get a considerable amount of value out of this. For pre-meds like myself, this would mostly give insight into what medical jargon and reasoning sounds like.

Top Podcasts In Health & Fitness

Huberman Lab
Scicomm Media
On Purpose with Jay Shetty
The Peter Attia Drive
Peter Attia, MD
Passion Struck with John R. Miles
John R. Miles
Ten Percent Happier with Dan Harris
Ten Percent Happier
The Doctor's Farmacy with Mark Hyman, M.D.
Dr. Mark Hyman

You Might Also Like

Core EM - Emergency Medicine Podcast
Core EM
Emergency Medicine Cases
Dr. Anton Helman
EM Clerkship
Zack Olson, MD and Michael Estephan, MD
EMCrit FOAM Feed
Scott D. Weingart, MD FCCM
Critical Care Scenarios
Brandon Oto, PA-C, FCCM and Bryan Boling, DNP, ACNP, FCCM
The Internet Book of Critical Care Podcast
Adam Thomas & Josh Farkas