Shows
Dirty White CoatNew CEO, The Pitt and the Future of EM EducationSend us a textWhat happens when a trusted EM education brand hands the day-to-day to a leader who grew up on County shifts, built startups, and still believes teaching should feel human? We open up about a big leadership change, why credibility beats polish, and how we’re rebuilding medical education to match the realities of modern emergency medicine.First, we trace Mizuho’s path from Santa Barbara to County, through early EM:RAP projects and entrepreneurial swings, to a CEO role focused on protecting the core—reliable, relatable, high-yield teaching—while pushing formats forward...
2026-01-0730 min
Invictus ReviewsSubmersion, Event! and End of the Pod (for now)Coming Soon: Invictus.ReviewsYouTube VersionWe reframe “drowning” as submersion incidents and lay out a simple path from shore to safe disposition. Hypoxia drives arrest, observation prevents misses, and ECMO has a clear role when ventilation fails or hypothermia persists.• replacing drowning with submersion incidents• hypoxia as the primary cause of arrest• selective C‑spine precautions based on mechanism• ECMO for refractory hypoxemia or hypothermia• normal chest X‑ray can mislead after aspiration• strict four to six hour observation window• discharge only if fully asymptomatic with normal vitals and exam...
2025-10-1615 min
EMRA*CastFrom the ED to The Pitt: Dr. Mel Herbert on Medicine, Storytelling, and the Power of HollywoodIn this EMRACast episode, hosts Lauren Rosenfeld and D'Monte Farley sit down with Dr. Mel Herbert, emergency physician, educator, and writer/medical consultant for The Pitt, the hit TV drama inspired by life in the emergency department.
2025-10-1520 minDirty White CoatAI Updates and RegressionsSend us a textWe examine how clinician-built AI can safely support emergency care, where consumer tools fall short, and why planning, context, and evaluation matter more than model hype. We also share a patient-facing approach to unify records and recordings for safer, clearer answers.• differences between consumer and medical‑grade AI, HIPAA and BAAs• model regressions, sycophancy, and hallucinations• context engineering and planned prompting for safety• ambient clinical decision support at the bedside• evaluations, benchmarks, and model selection• medico‑legal uncertainty and state regulations• education risks of over‑reliance on AI•...
2025-10-0343 min
The Ketamine StartUp PodcastEpisode 041 - Pioneers Who Challenged Medical Orthodoxy: Howard Kornfeld, Joe Tafur & Mel HerbertStarting a ketamine clinic can mean challenging the status quo - and that can feel isolating when colleagues question your vision or patients don't understand the treatment. But here's what's reassuring: every major breakthrough in medicine started with physicians who were willing to stand alone and persist through doubt.In this compilation episode, we're featuring three remarkable doctors who faced the exact same resistance you might be experiencing. Each was told their ideas wouldn't work. Each had colleagues who doubted them. And each proved that individual practitioners can create massive change when they refuse to take "no"...
2025-09-2931 min
ACEP Frontline - Emergency MedicineFrontline Headliners with Dr. Mel HerbertIn this first interview of the "Frontline Headliners" series, we talk with EM:RAP founder and education leader, Dr. Mel Herbert. We talk about his childhood, growing up, and the path that led him to be where he is today.
www.MelHerbert.com
2025-09-2350 minInvictus ReviewsAntidepressants ToxicityYouTube LinkDr. Sean Nordt delivers a comprehensive pharmacology lecture on antidepressants, their mechanisms, and the management of toxicity cases in emergency settings. The board-certified emergency physician, pharmacologist, and toxicologist walks through the complex pharmacology of psychiatric medications, focusing on their potentially deadly complications and how to recognize and treat them.• Cyclic antidepressants cause toxicity through fast sodium channel blockade, leading to QRS widening and ventricular dysrhythmias• Sodium bicarbonate is the cornerstone treatment for cyclic antidepressant toxicity, working by increasing pH and altering cardiac binding• SSRIs and SNRIs have distinct adverse effect profiles, with S...
2025-09-0219 minInvictus ReviewsHousehold Poison PearlsYouTube LinkUpdates on the Invictus medical review courses with "baby Invictus" for oral exams coming soon and a comprehensive border review course in development. Dr. Sean Nort shares vital insights on common household ingestions, challenging assumptions about what substances actually pose dangers to children.• Household bleach (3% sodium hypochlorite) ingestion typically requires only reassurance and discharge home• Industrial bleach is more concerning due to higher concentration• Most cosmetics, window cleaners, soaps and detergents have minimal toxicity• Laundry pods can cause more significant caustic burns and sometimes reduced consciousness• Silica gel...
2025-08-1903 minDirty White CoatVaccines in the ER: A Public Health FrontierSend us a textDr. Rob Rodriguez, MD Professor of MedicineAssociate Dean of Clinical & Population Health ResearchUniversity of California Riverside School of MedicineThe MMWR ArticleDiscusses his groundbreaking study examining vaccination screening in emergency departments across America. The research reveals a critical public health opportunity as 86% of ED patients aren't up-to-date on their vaccinations, yet nearly half would accept them if offered during their visit.• Vaccination has saved more lives than any other public health intervention• For 25-30% of Americans, emergency depar...
2025-08-1815 minDirty White CoatAugust Updates and Book Suggestion!Send us a textMel give some updates and his book selection for this summer!Everything is Tuberculosis by John GreenInvictus.Reviews landing Page is live.Support the show
2025-08-0404 minInvictus ReviewsNecrotizing Infections For ExamsYouTube LinkDr. Mel Herbert provides a crucial update on the Invictus Board Review program alongside critical pearls for identifying and managing deadly necrotizing infections. These rapidly progressing infections require immediate recognition, prompt treatment, and surgical intervention to prevent death from these tissue-destroying processes.• Necrotizing infections include necrotizing fasciitis, Fournier's gangrene, Ludwig's angina, and malignant otitis externa• Key warning signs include pain out of proportion to physical findings, rapidly progressive spread, dishwater discharge, and woody edema• "La belle indifference" describes patients who appear strangely calm despite severe infection• Polymicrobial infections often start as norma...
2025-07-3006 minDirty White CoatHealthcare's Frontline Heroes Need Help TooSend us a textThis is a reproduction of the Caring Greatly Podcast. The 100th episode and the interviewer Liz Boehm.Dr. Mel Herbert, emergency physician, educator and medical consultant for the hit TV drama "The Pit," shares how the show portrays the realities of emergency medicine and healthcare's biggest challenges. The conversation reveals how healthcare professionals are pushing for system-wide change, especially in addressing clinician mental health needs.• Emergency departments serve as society's 24/7 safety net but are facing unprecedented staffing and capacity challenges• Wait times at prestigious hosp...
2025-07-2129 min
Caring GreatlyThe Pitt and the truth about care team member safety and wellbeing – Mel Herbert, MD, FACEPSince 2019, Caring Greatly has beena destination where listeners can be inspired to innovate and help transform healthcarefor the better. All 100 episodes have been thoughtfully created to bring morevisibility to the importance of care team safety and wellbeing, which the Heartof Safety Coalition defines as psychological and emotional safety, dignity andinclusion, and physical safety. To commemorate this excitingmilestone and bring more awareness to the three pillars of care team safety, weinvited Mel Herbert, MD, to join podcast host Liz Boehm for a specialconversation. Dr. Herbert is an ED physician, medical educator and a consultantand writer for t...
2025-07-1729 minInvictus ReviewsTrach EmergenciesYouTube LinkTracheostomy and laryngectomy emergencies demand specific knowledge and immediate action to prevent devastating complications. Jess Mason delivers critical pearls on managing occluded, dislodged, and bleeding tracheostomies that are essential for both board exams and clinical practice.• Cuffed tracheostomies have a pilot balloon and are required for positive pressure ventilation• Uncuffed tracheostomies are more common in established patients but cannot be used with ventilators• Occluded tracheostomies should be managed with oxygen first, followed by suctioning and inner cannula cleaning• Dislodged tracheostomies require immediate replacement to prevent stomal narrowing• Bl...
2025-07-1417 minInvictus ReviewsPediatric Status Epilepticus: A PrimerYouTube LinkStatus epilepticus has been redefined from 30 minutes to just 5 minutes of continuous seizure activity, aligning better with current treatment approaches that emphasize early intervention. This includes recognizing non-convulsive status, which often presents as a prolonged postictal state with subtle eye movements or gaze deviation.• Systematic assessment includes history of seizures, medications, shunts, trauma, potential ingestions• Lab evaluation should include glucose, electrolytes, calcium, pregnancy testing when applicable• Initial treatment involves two doses of benzodiazepines via IV, rectal, buccal, or intranasal routes• Simplified dosing: midazolam/diazepam 0.2 mg/kg (max 10mg); lorazepam 0.1 mg/kg (max...
2025-07-0312 minInvictus ReviewsA kid with a rash, again :)YouTube LinkStaph Scalded Skin Syndrome presents with terrifying skin desquamation but typically heals without scarring within two weeks. This case demonstrates the classic presentation in a three-year-old child with recent URI, highlighting the typical appearance, clinical course, and management principles.• Staph Scalded Skin Syndrome results from staphylococcal toxins that cleave the epidermis• Most common in young children, often following upper respiratory infections• No mucosal involvement - key differentiating factor from Stevens-Johnson Syndrome• Treatment includes anti-staphylococcal antibiotics and supportive care• Colonization site may be difficult to identify, often in nares or umbilical...
2025-06-2304 minDirty White CoatUnfunded Mandates: How ER Docs Bear the Cost of America's Healthcare CrisisSend us a textDr Gillian Schmitz former ACEP president and current vice chair of education at Naval Medical Center San Diego, examines emergency medicine's financial crisis and its consequences. She identifies the fundamental contradiction in how America treats emergency care as a universal right while funding it as a privilege, creating an unsustainable system where nearly 70% of ED patients don't cover their care costs.• Former ACEP president with extensive experience in civilian and military emergency medicine• Healthcare in America faces a fundamental conflict between right vs privilege approaches• Nearly 70% of emergency department patien...
2025-06-2319 minInvictus ReviewsA fever and a RashYouTube LinkTry and guess before reading the summary.Stevens-Johnson Syndrome presents a critical dermatological emergency characterized by mucosal lesions and diffuse rash with high mortality if untreated. Recognizing this condition requires understanding its presentation, pathophysiology, and immediate management strategies to improve patient outcomes.• Case presentation of 20-year-old female with fever, mucosal lesions, and diffuse rash• Mucosal involvement is the key diagnostic feature of Stevens-Johnson syndrome• Common triggers include sulfa drugs, anti-epileptics, NSAIDs, and infections like mycoplasma• Positive Nikolsky sign where skin cleaves and sloughs off when pressed• SJS affects le...
2025-06-1605 minInvictus ReviewsNavigating Pregnancy Complications: A Sneak PeekYouTube LinkBritt Guest's lecture on pregnancy complications with expert emphasis from Matt Delaney. This preview focuses on differentiating normal pregnancy nausea from hyperemesis gravidarum while demonstrating effective board exam question strategies.• Normal pregnancy nausea can be managed with pyridoxine (B6), doxalamine, ondansetron, ginger, and eating smaller frequent meals• Hyperemesis gravidarum causes severe dehydration, weight loss, vitamin deficiencies, and potential complications including Wernicke's encephalopathy• Severe vomiting can lead to mechanical complications like Mallory-Weiss tears, pneumomediastinum, and pneumothorax• Treatment escalation includes IV/IM medications and possibly steroids (with caution in first trimester)• Board-styl...
2025-06-0209 minDirty White CoatThe Real Crisis in the ER: Systemic Dysfunction vs Financial ConcernsSend us a textThe ACEP and RAND StudyInterview with David Schriger, Peter Viccellio, and Al Sacchetti, MD'sFour decades of emergency medicine experience reveals how the specialty continues to normalize dysfunction while failing to articulate what emergency care should look like. Veterans explore solutions to the systemic problems that have kept emergency departments "at the breaking point" for over 30 years.• Emergency physician compensation ranks around 16th among medical specialties—not the financial crisis some portray• Working conditions, not compensation, represent the true crisis in emergency medicine today• Emergenc...
2025-06-0238 minInvictus ReviewsRubella In Question FormLink to CXR Fundamentals Series on EM:RAPWe explore Rubella (German measles or three-day measles), a disease that remains clinically relevant despite being considered nearly eradicated in the US due to vaccination.• Congenital rubella syndrome can cause severe complications including cataracts, cardiac abnormalities, growth restriction, and hearing loss• Rubella typically presents with cephalocaudal rash, low-grade fever, and arthralgia • The disease is less severe than measles but still concerning for pregnant women• Written documentation of at least one MMR dose is sufficient evidence of immunity• PCR testing provides the most accurate diagnosis d...
2025-05-2210 min
ACEP Frontline - Emergency MedicineLife in The PITT at ACEP25 with Dr. Mel Herbert and Dr. Joe SachsAre you a fan of The PITT or medical shows? Then you will love this episode of the podcast in preparation for ACEP25 in Salt Lake City. With talk with co-executive producer, Dr. Joe Sachs, and medical expert and writer, Dr. Mel Herbert, about The PITT. We discuss what it got right, the 3(+1) things it got wrong, and some behind the camera discussion on making the show happen.
2025-05-1929 minInvictus ReviewsUnderstanding Pneumomediastinum: When Air Escapes into Potential SpacesYouTube LinkThe Invictus curriculum continues to expand with new lectures, emphasized content, transcripts, and multiple-choice questions, with Matt Delaney now helping with development. We explore pneumomediastinum and pneumopericardium through a simple balloon analogy: two lungs squishing around the heart where air can leak into potential spaces, sometimes tracking into the neck or even dissecting into the pericardium.• Invictus curriculum growing with new features and comprehensive content for residents• Continuous board review is valuable throughout a medical career• Pneumomediastinum occurs when air leaks into the mediastinum from lungs, esophagus, or trachea• Air can trac...
2025-05-1206 minDirty White CoatPhysician, Heal Thyself (Without Losing Your License)Send us a textThe Dr. Lorna Breen Heroes Foundation works to eliminate barriers to mental health access and improve work environments for healthcare workers, following the tragic suicide of Dr. Lorna Breen during the first COVID wave.A interview with CEO Stephanie SimmonsLinks:ALL IN for Mental Health: https://drlornabreen.org/allinformentalhealth/Specifically the ALL IN for Mental Health resource page: https://drlornabreen.org/allinformentalhealth/six-actions/accessible-affordable-mental-health-care/ACEP wellbeing resource page: https://www.acep.org/life-as-a-physician/wellnessDr. Lorna...
2025-05-0522 minInvictus ReviewsHow to Never Miss an Elbow Fracture Again: A Radiographic RoadmapLink to YouTube VideoWe explore the essential techniques for accurately interpreting elbow X-rays, focusing on key lines, fat pad signs, and common fracture patterns that help reveal hidden injuries.• Standard elbow series includes AP, lateral, and oblique views, with the lateral being the most critical "money shot"• Two essential lines to draw: anterior humeral line (should pass through middle third of capitellum) and radiocapitellar line (should bisect the capitellum)• Fat pad signs are crucial indicators – posterior fat pads are NEVER normal and always indicate pathology• Pediatric injuries typically involve supracondylar fractures (60% of all ped...
2025-04-2315 min
Dirty White CoatThe Nocturnists Present: Inside 'The Pit': Medicine's Most Authentic TV DramaSend us a textThe Nocturnists Podcast with Emily Silverman, MDThe HBO Max series "The Pit" has struck a chord with healthcare professionals unlike any medical drama before it. What makes this show so different? Why are doctors and nurses messaging each other saying, "You have to watch this—they finally got it right"?In this special bonus episode, I sit down with the brilliant creative team behind the show that's capturing the true essence of emergency medicine: R. Scott Gemmel (creator and showrunner), Joe Sachs (emergency physician and writer), and Mel He...
2025-04-2153 min
The NocturnistsBONUS: Behind the Scenes of The Pitt with Gemmill, Sachs, and HerbertOn this episode of Conversations, Emily sits down with the creative team behind The Pitt—a gripping new medical drama on HBO Max that’s making waves in the healthcare world and beyond. Joining her are showrunner R. Scott Gemmill (ER, NCIS: LA), physician-writer Dr. Joe Sachs (ER), and emergency medicine educator and EM:RAP founder Dr. Mel Herbert. Together, they go behind the scenes of the show, discussing characters, medical cases, set design, and the creative team’s relentless pursuit of medical authenticity. Find show notes, transcript, and more at thenocturnists.org. The Nocturnists is made...
2025-04-1553 minInvictus ReviewsSpecial non-board review content on burnoutLink to Scott Course: https://guidewirecoaching.com/unburnable/Scott Weingart discusses his journey into physician executive coaching, focusing on helping emergency medicine physicians overcome burnout through mindset shifts and practical skills development. • Burnout often stems from inner voice negativity that physicians mistake as their core identity• Cognitive distancing teaches docs to separate unhelpful thoughts from themselves• Stoic philosophy helps physicians accept unchangeable situations while finding meaningful challenges• Communication techniques like nonviolent communication transform difficult consultant interactions• "Fundies" (fundamentals) include maintaining basic physical needs during shifts• Optimal pace is sustainable rather than superhuma...
2025-04-1435 minDirty White CoatBurnout and Coaching with Scott WeingartSend us a textLink to scott course: https://guidewirecoaching.com/unburnable/Scott Weingart shares his experiences developing physician executive coaching to help emergency physicians find meaning and purpose despite a broken healthcare system.• Burnout often stems from negative inner voice rather than external circumstances• Cognitive distancing helps physicians separate themselves from unhelpful thoughts• Stoic acceptance allows doctors to focus energy on what they can control• Nonviolent communication techniques transform interactions with difficult consultants• Maintaining fundamentals during shifts (eating, drinking, bathroom breaks) is essential• Optimal performance pace prioritizes patient safet...
2025-04-1435 minInvictus ReviewsThe Poopy Pants EpisodeYouTube LinkWe explore the clinical management of foodborne and waterborne illnesses, focusing on key differences between viral and bacterial causes that determine treatment approaches. Understanding when to use supportive care versus antimicrobial therapy helps clinicians provide appropriate management for this common presentation.• The vast majority of diarrheal illnesses are viral, self-limited, and need no testing or treatment beyond oral rehydration• Oral rehydration solutions are preferred over sports drinks, which can worsen diarrhea unless diluted• Homemade solution can be made with half teaspoon salt, six teaspoons sugar, and one liter of water• Anti-mot...
2025-04-0805 min