Core EM - Emergency Medicine Podcast – Details, episodes & analysis

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Core EM - Emergency Medicine Podcast

Core EM

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Frequency: 1 episode/18d. Total Eps: 233

Core EM Emergency Medicine Podcast

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Data updated on 24/09/2026

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https://coreem.net/tag/toxicology/
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https://coreem.net/tag/infectious-diseases/
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https://coreem.net/tag/critical-care/
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http://www.ncbi.nlm.nih.gov/pubmed/23911102
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http://www.ncbi.nlm.nih.gov/pubmed/24360351
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https://www.ncbi.nlm.nih.gov/books/NBK507891/
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https://www.youtube.com/watch?v=toFiGSfesZk
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Episode 227: Diarrhea

Episode 227

Thursday, September 24, 2026 • Duration 14:58

https://coreem.net/podcast/episode-227-diarrhea/

Acute diarrhea in the ED: stool testing, treatment, and a spotlight on Cyclospora.

Hosts:
Neya Vishwanath, MD
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Diarrhea.mp3 Download Leave a Comment Tags: Gastrointestinal, Gastrointestinal Diseases Show Notes Core EM Modular CME Course

Maximize your commute with the new Core EM Modular CME Course, featuring the most essential content distilled from our top-rated podcast episodes. This course offers 12 audio-based modules packed with pearls! Information and link below. Course Highlights:

Credit: 12.5 AMA PRA Category 1 Credits™
Curriculum: Comprehensive coverage of Core Emergency Medicine, with 12 modules spanning from Critical Care to Pediatrics.
Cost:
- Free for NYU Learners
- $250 for Non-NYU Learners

Click Here to Register and Begin Module 1 Framing the Patient

Acute is <2 weeks, persistent is 2–4 weeks, chronic is >30 days. Most acute diarrhea is self-limited and needs only supportive care.
Stool cultures are positive in only 2–6% of unselected patients. Yield rises with >4 stools/day and longer duration.
The ED job is not to name the organism. It is to find volume depletion, rule out the dangerous mimic, and decide who needs testing, antibiotics, or admission.

Don’t-Miss Mimics

Diarrhea is a symptom, not a diagnosis. In anyone who looks sick, gastroenteritis is a diagnosis of exclusion.
Abdominal catastrophes: mesenteric ischemia (pain out of proportion, vascular risk factors), early appendicitis, partial obstruction with overflow stool, diverticulitis.
Systemic disease presenting through the gut: sepsis from another source, DKA, adrenal insufficiency.
Fulminant C. diff or toxic megacolon: distension, fever, tachycardia, peritonitis. The diarrhea may actually stop as the colon dilates.
GI bleeding masquerading as dark diarrhea, and in women of childbearing age, ectopic pregnancy.

History & Exam

Duration, frequency, and appearance. Watery and high-volume suggests small bowel. Small, painful, frequent stools suggest colon.
Volume status: urine output, dark concentrated urine, dry mucous membranes, orthostatic symptoms.
Exposures: recent foods, travel, sick contacts, occupation (animal or sewage contact), recent antibiotics or hospitalization.
Timing after ingestion: <6 hours suggests a preformed toxin (Staph aureus, Bacillus cereus), 8–16 hours suggests Clostridium perfringens, and >16 hours suggests viral or other bacterial causes.
High-risk hosts: pregnancy → Listeria, cirrhosis → Vibrio, hemochromatosis → Yersinia (both siderophilic).
Exam: volume status plus a real abdominal exam. A soft belly does not end the evaluation.

Who Gets Testing

Ask first whether the result will change anything. If the patient is going home on supportive care, a stool study often just generates a callback.
Test when the patient is likely to be admitted or is higher risk: febrile, hypovolemic, elderly (roughly >70), known cardiac disease, immunocompromised, IBD, or pregnant.
Bloodwork is not routine. Send a BMP and CBC for significant hypovolemia, persistent vomiting, bloody stool, or the elderly and comorbid.
Routine cultures cover Salmonella, Campylobacter, Shigella. Ask the lab specifically for Vibrio, Yersinia, Aeromonas, or Listeria.
Know your multiplex GI PCR panel. At many shops it already includes C. diff, so ordering it separately is redundant. One call to your lab settles this.
Bloody stool → send Shiga toxin. Bloody but fecal WBC negative → consider amoebiasis.
Bloody diarrhea plus anemia, thrombocytopenia, or a rising creatinine → think HUS, especially in young children.
Antibiotics or hospitalization within 3 months → C. diff moves up the differential.
Neutropenic patient on active chemotherapy → consider typhlitis (enterocolitis of the cecum).
CT only for peritoneal signs or focal tenderness. It is not part of the routine workup.

Management

Oral rehydration solution is the mainstay for anyone tolerating PO — water, salt, sugar. Preferred over sports drinks and flavored electrolyte powders, which are not ORS-formulated. A commercial ORS packet is ideal, and the home recipe works when you do not have one. One liter of water, six level teaspoons of sugar, half a teaspoon of salt.
IV fluids for severe hypovolemia, intractable vomiting, or if labs are being drawn anyway.
Most non-bloody, non-traveler’s diarrhea does not need antibiotics.
Suspected Shiga toxin E. coli: no antibiotics. Lysing the organism releases toxin and raises HUS risk.
When empiric coverage is warranted: azithromycin for severe inflammatory diarrhea, fever, dysentery risk, or fluoroquinolone resistance. Otherwise cipro or levofloxacin, and IV ceftriaxone if PO is not tolerated.
Traveler’s diarrhea: most cases are self-limited. Reserve antibiotics for moderate to severe illness, and reach for azithromycin given widespread quinolone resistance in South and Southeast Asia.
Confirmed C. diff: oral vancomycin 125 mg four times daily for 10 days, or fidaxomicin. Stop the inciting antibiotic where you can.
Loperamide: generally avoid. If diarrhea is mild and the patient is afebrile, let it run.
Bismuth subsalicylate is an option — avoid in younger patients (Reye’s syndrome) and in salicylate allergy or intolerance.
Diet: eat what is tolerated. Early refeeding is fine and BRAT is not required. Dairy can transiently make things worse. Probiotics are unlikely to change the course.

Disposition

Set expectations: we often never identify the organism, and in a stable acute patient there is no routine test and no routine cure.
Food handlers and healthcare workers may need occupational clearance before returning to work.
Return precautions: bloody stools, fever, falling urine output, or an inability to keep fluids down.
No improvement past 1–2 weeks warrants re-evaluation for parasitic or non-infectious causes, including IBD.

Cyclospora

Protozoan with no person-to-person spread — transmission is poop to produce to person. Humans are the only natural host.
Oocysts need days to weeks to sporulate, so long-shelf-life produce is the culprit: berries, basil, cilantro, and leafy greens.
Incubation is about a week. Presents as watery, explosive diarrhea, typically non-bloody and afebrile.
Untreated, it drags on for weeks and tends to relapse, often with profound fatigue, anorexia, and weight loss.
Included on many multiplex GI PCR panels. Microscopy requires a special stain or it will be missed.
Treatment is Bactrim (TMP-SMX), one DS tablet twice daily for 7–10 days, which disrupts the parasite’s folate synthesis. Azithromycin does not cover Cyclospora — this is the exception to the usual workhorse. Ciprofloxacin is the fallback for sulfa allergy, and it is less effective.
Washing produce does not kill it. Only heat does.

Take Home Points

Most acute diarrhea is self-limited. If the patient tolerates PO, is afebrile, and the course is short, supportive care and discharge is the right answer.
Before you call it gastroenteritis, make sure it is not mesenteric ischemia, DKA, or a surgical abdomen.
Bloody diarrhea with concern for Shiga toxin gets no antibiotics.
For Cyclospora, wash and cook your produce — and remember it is Bactrim, not azithro.

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Episode 226: Superwarfarin Toxicity

Episode 226

Tuesday, August 11, 2026 • Duration 13:54

https://coreem.net/podcast/episode-226-superwarfarin-toxicity/

Superwarfarin toxicity: recognition, reversal, and prolonged vitamin K therapy.

Hosts:
Mac Josh Reandelar, DO
Avir Mitra, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Superwarfarin_Toxicity.mp3 Download Leave a Comment Tags: Toxicology Show Notes Toxicology & Pathophysiology

Long-acting vitamin K antagonists (LA-VKAs), developed as potent rodenticides
Examples: brodifacoum, bromadiolone, difenacoum, chlorophacinone
Much more potent + far longer acting than warfarin
MOA: inhibits VKORC1 → ↓ vitamin K recycling → impaired γ-carboxylation
↓ factors II, VII, IX, X + proteins C/S
Highly lipophilic → extensive tissue/fat sequestration + slow redistribution
Effect can persist weeks-months; occasionally much longer
Not dialyzable
Exposure: large acute ingestion OR repeated low-dose exposure

Presentation Labs & Diagnosis Elevated INR: Differential ED Management Major/Life-Threatening Bleeding No Major Bleeding, Critical INR Poison Control The Long Game Take Home Points

Episode 225: Group A Strep

Episode 225

Tuesday, July 14, 2026 • Duration

https://coreem.net/podcast/episode-225-group-a-strep/

Group A strep in the pediatric ED: from strep throat to invasive disease and toxic shock.

Host:
Ellen Duncan, MD, PhD
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Group_A_Strep.mp3 Download Leave a Comment Tags: Infectious Diseases, Pediatrics Show Notes

Background

Group A strep = Streptococcus pyogenes — gram-positive organism that colonizes the pharynx, but also the perianal and genital mucosa (worth remembering when the source isn’t the throat).
Extremely common. The episode cites an estimated ~289 million cases/yr of strep pharyngitis in children 5–14 (NIH). For a U.S.-specific, verifiable anchor: the CDC estimates strep throat drives in people <65.

Pathophysiology — the throughline Clinical Presentation Diagnosis / Workup Centor / Modified (McIsaac) Score Testing Who to test Management The Bounce-Back / Treatment Failure Complications Invasive Group A Strep (iGAS) Why it’s on the radar The spectrum The trap — nonspecific early presentation Workup Management The Kawasaki overlap Take-Home Points Links & References Calculators Guidelines CDC

Episode 224: Kidney Stones

Episode 224

Monday, June 8, 2026 • Duration

https://coreem.net/podcast/episode-224-kidney-stones/

A guide to diagnosing, imaging, and managing acute renal colic and nephrolithiasis in the ED.

Hosts:
Brian Gilberti, MD
Avir Mitra, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Nephrolithiasis.mp3 Download Leave a Comment Tags: Kidney Stones, Urology Show Notes 1. CLINICAL CORE & PHYSIOLOGIC FRAMEWORK

Epidemiologic Risk Profiles
- Lifetime incidence parameters hover around 1 in 11, presenting with a prominent male sex skew.
- Peak demographic manifestation concentrated within the 30–60 age band.
- High-yield temporal parameter: 50% recurrence vector within a 5-year post-initial-insult window.
Mineralogical Composition Vectors
- Calcium oxalate crystals represent the predominant structural matrix.

2. EXCLUSION DIAGNOSES & CRITICAL PATHWAY RED FLAGS 3. LABORATORY TESTING & PHYSIOLOGIC EVALUATION 4. IMAGING MODALITIES & ALGORITHMIC CLINICAL SELECTION 5. 6. IMAGING SELECTION MATRIX 7. EMERGENCY PHARMACOTHERAPY & COLIC MANAGEMENT 8. MEDICAL EXPULSIVE THERAPY (MET) CLINICAL PARAMETERS 9. SPONTANEOUS PASSAGE PROBABILITIES 10. ADMISSION ARCHITECTURE & UROLOGIC CONSULTATION CRITERIA Refractory Symptom Complexes 11. OUTPATIENT DISCHARGE MATRICES & SAFETY NETTING 12. CLINICAL PEARLS & QUICK-REFERENCE SUMMARY NOTES

Episode 223: Thyroid Storm

Episode 223

Friday, May 15, 2026 • Duration 09:16

https://coreem.net/podcast/episode-223-thyroid-storm/

Diagnosis, workup, and the four-step treatment protocol for thyroid storm.

Hosts:
Annaliese Elam, MD
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Thyroid_Storm.mp3 Download Leave a Comment Tags: Critica Care, Endocrine, Thyroid Storm Show Notes I. Pathophysiology & Diagnosis

Definition: Life-threatening hypermetabolic state resulting from decompensated thyrotoxicosis.

Hormonal Profile: Absolute levels of total T₄/T₃ often mirror uncomplicated thyrotoxicosis; storm is driven by rapid rate of rise, increased catecholamine sensitivity, or increased free T₄/T₃ concentrations.

Clinical Presentation:

II. Laboratory & Ancillary Findings III. Management: The Four-Step Blocking Strategy IV. Supportive Care & Avoidance Measures Take Home Points I. Diagnostic Essentials II. The Four-Step Blocking Strategy III. Critical Supportive Care

Episode 222: Local Anesthetic Systemic Toxicity (LAST)

Episode 222

Tuesday, April 7, 2026 • Duration

https://coreem.net/podcast/episode-222-local-anesthetic-systemic-toxicity-last/

We discuss this ominous complication of providing local anesthesia.

Hosts:
Elaine Jonas, MD
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/LAST.mp3 Download Leave a Comment Tags: Critical Care, Toxicology Show Notes I. Pathophysiology & Mechanisms

Definition: Systemic toxicity secondary to local anesthetic (LA) via accidental intravascular injection or excessive systemic absorption.
Threshold: Occurs when plasma concentration exceeds the safety threshold for cardiac and neural tissue.
Agent Profile: Bupivacaine (High Risk)
- Highly lipophilic with high protein binding.
- “Fast-on, Slow-off” Kinetics: Strong Na+ channel binding with extremely slow dissociation during diastole.

II. Risk Assessment & Prevention Patient-Specific Risk Factors Procedural Risk Factors Prevention Mandates III. Clinical Presentation Neurologic Phase (Early to Late) Cardiovascular Phase IV. Immediate Management Algorithm 1. Initial Actions 2. Seizure Control 3. Lipid Emulsion Therapy 20% 4. Modified ACLS V. Differential Diagnosis for the Peri-Procedural Patient VI. Post-Resuscitation & Complications VII. Clinical “Red Flags” for Toxicity

Episode 221: High-Output Heart Failure

Episode 221

Tuesday, March 24, 2026 • Duration

https://coreem.net/podcast/episode-221-high-output-heart-failure/

We discuss the diagnosis and treatment of one of EM's paradoxes: High-Output Heart Failure.

Hosts:
Nicolas Gonzalez, MD
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/HOHF.mp3 Download Leave a Comment Tags: Cardiology Show Notes Core EM Modular CME Course

Course Highlights:

Credit: 12.5 AMA PRA Category 1 Credits™
Curriculum: Comprehensive coverage of Core Emergency Medicine, with 12 modules spanning from Critical Care to Pediatrics.
Cost:
- Free for NYU Learners
- $250 for Non-NYU Learners

Click Here to Register and Begin Module 1 1. Core Definition & Hemodynamic Profile 2. Pathophysiology: The Hemodynamic Paradox 3. Differential Diagnosis: Etiological “Buckets” Category A: Increased Metabolic Demand (Systemic) Category B: Peripheral Vascular Effects (Shunting/Vasodilation) 4. Special Focus: Hemodialysis Access-Induced HOHF Physiologic Phases of AVF Creation: 5. Point-of-Care Physical Exam & Maneuvers 6. Diagnostic Workup (Technical Targets) POCUS / Echocardiography: Laboratory Evaluation: 7. Management Strategy: A Stepwise Approach Phase 1: Immediate Stabilization (Volume Offloading) Phase 2: Targeted Therapy (Etiology Specific) Phase 3: Surgical/Interventional Salvage (Refractory AVF Cases) 8. Key Clinical Takeaways

Episode 220: Post-ROSC Care

Episode 220

Tuesday, March 3, 2026 • Duration

https://coreem.net/podcast/episode-220-post-rosc-care/

We explore how to refine and optimize care in the vital minutes following ROSC.

Hosts:
Jonathan Elmer, MD, MS
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Post-ROSC_care.mp3 Download Leave a Comment Show Notes Core EM Modular CME Course

Course Highlights:

Credit: 12.5 AMA PRA Category 1 Credits™
Curriculum: Comprehensive coverage of Core Emergency Medicine, with 12 modules spanning from Critical Care to Pediatrics.
Cost:
- Free for NYU Learners
- $250 for Non-NYU Learners

Click Here to Register and Begin Module 1 I. Phase 1: Stabilization (Minutes 0–10) The “Rearrest” Window & Pathophysiology Immediate Resuscitative Actions II. Phase 2: Diagnostic Workup (Minutes 10–40) Etiology Epidemiology The “Broad Net” Strategy III. Hemodynamic & Respiratory Targets Mean Arterial Pressure (MAP) Ventilation and Oxygenation IV. Neurological Prognostication & Communication The “Stunned” Brain Family Engagement

Episode 219: Meningitis 2.0

Episode 219

Tuesday, February 3, 2026 • Duration

https://coreem.net/podcast/episode-219-meningitis-2-0/

We review diagnosing and managing bacterial meningitis in the ED.

Hosts:
Sarah Fetterolf, MD
Avir Mitra, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/Meningitis_2_0.mp3 Download Leave a Comment Tags: CNS Infections, Infectious Diseases, Neurology Show Notes Core EM Modular CME Course

Course Highlights:

Credit: 12.5 AMA PRA Category 1 Credits™
Curriculum: Comprehensive coverage of Core Emergency Medicine, with 12 modules spanning from Critical Care to Pediatrics.

Patient Presentation & Workup CSF Analysis & Microbiology Management Protocol Stats & Clinical Pearls: Austrian Syndrome

Episode 218: Sympathetic Crashing Acute Pulmonary Edema (SCAPE)

Episode 218

Saturday, January 17, 2026 • Duration 12:45

https://coreem.net/podcast/episode-218-sympathetic-crashing-acute-pulmonary-edema-scape/

We discuss the diagnosis and management of SCAPE in the ED.

Hosts:
Naz Sarpoulaki, MD, MPH
Brian Gilberti, MD

https://media.blubrry.com/coreem/content.blubrry.com/coreem/SCAPEv2.mp3 Download Leave a Comment Tags: Acute Pulmonary Edema, Critical Care Show Notes Core EM Modular CME Course

Course Highlights:

Credit: 12.5 AMA PRA Category 1 Credits™
Curriculum: Comprehensive coverage of Core Emergency Medicine, with 12 modules spanning from Critical Care to Pediatrics.

The Clinical Case Differential Diagnosis for the Hypoxic/Tachypneic Patient What is SCAPE? Bedside Diagnosis: POCUS vs. CXR Management Strategy 1. NIPPV (CPAP or BiPAP) 2. High-Dose Nitroglycerin 3. Refractory Hypertension Troubleshooting & Pitfalls The “Mask Intolerant” Patient The Role of Diuretics Disposition Take-Home Points

Core EM - Emergency Medicine Podcast – Details, episodes & analysis

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Core EM - Emergency Medicine Podcast – Details, episodes & analysis

Podcast details

Recent rankings

Apple Podcasts

Spotify

Shared links between episodes and podcasts

Other99+

U.S. National Library of Medicine99+

YouTube21

RSS feed quality and score

Publication history

Latest published episodes

Similar podcasts and content

Related Shows Based on Content Similarities

Related Shows Based on Content Similarities

Other99+

U.S. National Library of Medicine99+

YouTube21

Apple Podcasts

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