ERcast: Clinical Perspectives Podcast Preview
The summary below is from an episode of ERcast: Clinical Perspectives
Acute dystonia is usually a medication-induced dopamine blockade syndrome with dramatic twisting postures, preserved alertness, and rapid reversal after anticholinergic treatment. Burnout in emergency medicine is also a career-risk problem, and diversifying into roles like sports medicine can improve longevity, scheduling control, and clinical range.
Medication-Induced Acute Dystonia
- Basal ganglia imbalance: Acute dystonia reflects a dopamine-acetylcholine imbalance in basal ganglia motor circuits, producing sustained contractions, abnormal postures, and repetitive twisting movements.
- Typical offending medications: Dopamine-blocking drugs are the usual trigger, especially haloperidol, prochlorperazine, and metoclopramide; SSRIs, antiepileptics, and stimulants are much less common culprits.
- Classic bedside syndromes: Oculogyric crisis, torticollis, trismus, and buccolingual movements are the recognizable patterns, while laryngeal dystonia is the rare dangerous form with stridor and airway risk.
- Clinical diagnosis clues: The diagnosis is clinical when symptoms follow a recent medication exposure and the patient remains alert and interactive; altered mental status or focal deficits should push you elsewhere.
- Rapid first-line reversal: Diphenhydramine 25 to 50 mg IV or IM and benztropine 1 to 2 mg IV or IM are first-line, with symptom relief often appearing within 5 to 15 minutes. We get into the airway caveat in the episode.
Emergency Medicine Career Diversification
- Burnout protection strategy: Diversifying professional identity with parallel clinical or non-clinical roles can reduce burnout by adding variety, schedule flexibility, and fewer nights or holidays over time.
- Sports medicine crossover: Sports medicine sharpens physical exam skills and comfort with subacute or chronic problems, which translates directly to stronger ED musculoskeletal and outpatient-minded decision-making.
- Persistence and networking: Career-defining opportunities can start with one unsolicited email; persistence, mentorship, and willingness to accept rejection are recurring themes in non-linear EM careers.
- Hybrid practice structure: A blended career can span ED shifts, clinic work, team coverage, teaching, and remote administrative roles, creating more control without leaving emergency medicine entirely.
- Early-career practical advice: Listening more than speaking, seeking mentors, and taking small proactive steps matter more than a perfect master plan. We walk through that mindset in the chapter.
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References:
- Tarsy D, Simon DK. Dystonia. N Engl J Med. 2006 Aug 24;355(8):818-29. doi: 10.1056/NEJMra055549. PMID: 16928997.
Faculty
- Brett Murray, MD
Dr. Murray is an Emergency Medicine physician practicing at a busy community trauma center. After attending Boston University School of Medicine, he completed his residency training at Brown University / Rhode Island Hospital, where he also served as Chief Resident from 2020 – 2021. His clinical interests center on medical education, performance science, and Emergency Medical Services.
- Anne Steckowych, APRN
Emergency medicine is in Anne’s blood; her father has been an Emergency Medicine physician for the last 30 years. After earning her nursing degree from the University of New Hampshire (UNH) in 2018, Anne worked as an EMT at her local fire department, gaining practical experience that prepared her for five years as a nurse in the emergency department. She eventually returned to UNH to become an NP and has spent the last 8 years in the same ED, building relationships with a clinical team dedicated to providing the best possible patient care. Outside of the hospital, she’s usually skiing, hiking, or running in the New Hampshire hills. ERcast is her first podcast, and she’s thrilled to be part of the Hippo team.
- Tiffany Proffitt, DO
Dr. Proffitt is a board-certified Emergency Medicine physician practicing in Scottsdale, Arizona. She completed her medical training at Midwestern University Chicago College of Osteopathic Medicine and found her passion for medical education during her residency at Spectrum Health Lakeland. Tiffany is the co-founder and co-chairwoman of the HonorHealth Women Physicians Leadership Council, where she works to enhance professional development for 550 women clinicians. When she isn’t in the ED or podcasting, she’s chasing twins, dancing with toddlers, and enthusiastically singing the wrong lyrics to every song.
- Matthew Hall, CRNP
Matthew started his career as an ER nurse and part-time flight nurse at the University of Alabama at Birmingham. After graduating from NP school, he continued in the Department of Emergency Medicine at UAB as an NP, eventually serving as the clinical educator for the APP team. Matthew joined Hippo as a medical editor for ERcast in 2023 and, in 2025, moved into the role of clinical manager and senior editor. He lives in a small town outside of Birmingham, Alabama, with his wife, two children, three dogs, and a small flock of chickens.
- Christopher Hogrefe, MD
