The DownEast Emergency Medicine Podcast

Interviewing and beginning your career in medicine comes with challenges! Dr. Sarah Bunting, MD is a PGY-1 emergency medicine resident at Maine Medical Center. Listen in to hear her advice on transitioning from medical school to residency, virtual interviewing, and what to look for in a residency! For the full show notes, click here.   Hallie Bates, MSIV and Alex Schin, MSIV Peer Reviewed by Lauren Wendell, MD and Jeffrey A. Holmes, MD

The 21st Century CURES act has mandated that starting on April 5th, 2021 patient notes (with a few very narrow exceptions) must be easily available to patients via their patient portal. How did this come about, and what does it mean for us? Click Here for full show notes   This lecture was presented at the 2021 Maine Medical Center Winter Symposium. For more information on the symposium click here. Sam Wood, MD

Ultrasound Jedi, Dr. Andrew Fried, takes us through a masterclass on placing ultrasound guided peripheral IV's.   For full show notes, check out our blog post on Down East EM.    Jeffrey A Holmes, MD  

This year we are very fortunate to have Dr. Amal Mattu, EKG Jedi, as teaching faculty for our 39th Maine Medical Center/Maine ACEP Winter Symposium. In this lecture, he helps us differentiate septal STEMIs from other potentially life threatening mimics. Click here for show notes To check out our virtual 39th Winter Symposium, check out the conference website at www.mmcwintersymposium.com     Jeff Holmes, MD

Kids poop. Most of the time it goes well- aside from the messes and the wipes and the cleaning and the change of clothes. But sometimes medically pediatric diarrhea is not alright. In this interview with pediatrician Dr. Jay Larmon we go over the spectrum of pediatric diarrhea, from the a-okay to the not-so-right and everything in between.   Check out our blog post for more.   Authors: Jason Hine MD and Jay Larmon MD Peer Review: Jeff Holmes MD and Mike Burla MD

In medicine we often draw a solid line between community and academic medicine, but this likely is a fallacy. In fact there is a huge amount of academia that can be found and thrive in a community hospital. In this interview we talk with Dr. Salim Rezaie of the REBEL EM blog and podcast, a man who has walked both sides of this imaginary line between community and academics. In our chat we discuss ways to get involved in academics in the community and the vast array of rewards that come with that including improved patient care, increased fervor for your work, decreased burnout, and increased career longevity.    Authors: Jason Hine MD, Salim Rezaie MD Peer Review: Jeff Holmes MD, Mike Burla MD

In this episode we dive into the nasty, gnarly infection that is Ludwig's Angina. It's a bad player- and with complications including mediastinitis, epiglottitis, and asphyxiation- it's one you need to know. In this vodcast we highlight a case of Ludwig's Angina, showing some important images and videos of the presentation, and dive into the finer points of the disease.    Check out our blog  for shownotes, references, and more   Author: Jason Hine MD Peer Review: Dr. Jeff Holmes and Dr. Mike Burla

This is Part 2 of our discussion of the COVID-19 vaccines. With frontline providers across the country (and world) asking themselves "Am I comfortable getting this vaccine?" we thought it important to review some of the basic science (Part 1) and data (Part 2) behind these mRNA vaccines.    In this podcast we ask What did the Pfizer phase 3 study show? What outcomes did they look at? Did they meet those outcome targets? Specifically- what the vaccine effective ... and was it safe?   Disclaimer: I am not an infectious disease physician, immunologist, or population health specialist. These perspectives are those of an Emergency Medicine physician. In order to expedite the delivery of this material to you, the frontline provider, this content did not undergo our typical peer review process.    References: Rabies vaccine phase 1 study [pubmed] Pfizer Phase 3 study results [NEJM] Check out the DownEast EM site for more.   Author: Jason Hine MD

This is Part 1 of our discussion of the COVID-19 vaccines. With frontline providers across the country (and world) asking themselves "Am I comfortable getting this vaccine?" we thought it important to review some of the basic science (Part 1) and data (Part 2) behind these mRNA vaccines.    In this podcast we ask What exactly is an RNA vaccine? How do they work? Is the COVID-19 vaccine the first of these types of vaccines? among many others   Disclaimer: I am not an infectious disease physician, immunologist, or population health specialist. These perspectives are those of an Emergency Medicine physician. In order to expedite the delivery of this material to you, the frontline provider, this content did not undergo our typical peer review process.    References: Rabies vaccine phase 1 study [pubmed] Pfizer Phase 3 study results [NEJM] Check out the DownEast EM site for show notes.   Author: Jason Hine MD  

They have something DOWN THERE... No surprises, it's herpes. But making the diagnosis is the just first of many issues and questions- how do you treat it? Will it come back? How do I stop from spreading it to other partners? Is there something I can do to decrease my number of outbreaks? All great questions we should be ready to answer. In this vodcast Dr. Leger reviews this disease and these important questions.   Check out our Down East EM blog for references and a whole lot more amazing content.     Author: Dr. Janessa Leger MD Peer Review: Dr. Jason Hine MD and Dr. Jeff Holmes MD

Intubation in the emergency department (ED) can be a stressful endeavor. We are often presented with patients who have complex anatomy and tenous physiology. Because of this, it can be hard to look past the critical step of securing the airway. Rapid sequence intubation (RSI) and positive pressure ventilation can dismantle patients' physiology and contribute to an almost 4% rate of post intubation cardiac arrest (PICA). Is there anything we can do to predict or prevent this? In this podcast, Sam Wood gives us an overview of the literature to help us answer these questions.   Check out our Down East EM blog for show notes, references and a whole lot more amazing content.   Author: Dr. Sam Wood MD Peer Review: Dr. Jason Hine MD and Dr. Jeff Holmes MD

The management of diabetic ketoacidosis (DKA) in children is full of difficult questions- how much insulin should I give? Who is at risk for cerebral edema? What treatments, if any, increase the risk for this dreaded complication? Which fluid is ideal? How much of this fluid should I give? We sat down with ED physician and endocrine aficionado Dr. George Willis to answer these questions.   Click here for show notes   Authors: Dr. Jason Hine and Dr. George Willis Peer Review: Dr. Mike Burla and Dr. Jeff Holmes

The diagnosis of Wernicker's encephalopathy is a elusive beast. The classic triad of altered mental status, ataxia, and ophthalmoplegia is, of course, anything but classic in terms of presentation. To make matters worse, the most at-risk population, the chronic alcohol misuser, often have these signs and symptoms for alternative reasons. In this podcast we discuss diagnosing Wernicke's in the alcoholic.   Check out our post on the Down East EM blog for shownotes, references, and more.   Author: Jason Hine MD Peer Review: Jeff Holmes MD

Boarding is a problem across most Emergency Departments in the United States, and likely the world. This adversely affects patients and staff. In this post we review the data on the detriments of boarding in the ED, how it impacts patients, and some ideas on how to fix it.   Check out our post on the Down East EM blog for shownotes, references, and more.   Authors: Pat Sanders MD and Jason Hine MD Peer Review: Jeff Holmes MD and Michael Burla MD    

In this vodcast we review the prolific use of FOAM (free open access medical education) by learners, the need to assess FOAM quality, and a structured way to do so.    Check out our post on the Down East EM blog for shownotes, references, and more.   Author: Jason Hine MD  

In this vodcast we review the logistics of running a CODE BLUE (cardiac arrest) in a COVID patient, or any other patient under isolation care. Please note PAPR use is throughout this video, but PAPR can be replaced with proper eye protection and N95s.   Check out our post on the Down East EM blog for shownotes, references, and more.   Author: Jeff Holmes MD

The personal protective equipment (PPE) for COVID-19 has been the center of attention in the medical world and laypress, in part because of the short supply and in part because of the importance of healthcare personnel safety. In this vodcast we review the different levels of PPE and what you need to know to safely protect yourself.   Check out our post on the Down East EM blog for shownotes, references, and more.     Author: Jason Hine MD Peer Review: Christina Dematteo, DO and Jeff Holmes MD

Uterine bleeding is a common presentation to the Emergency Department and rarely these patients are SICK. When they come in sick, it's not the time to be googling the ACOG recs on managing uterine bleeding. Here we review the proper management of the pregnant, post-partum, and non-pregnant patient with uterine bleeding.   Check out our post on the Down East EM blog for shownotes, references, and more.   When listening to this post, please consider the following questions (and follow us on twitter for spaced retrieval of this material @downeastem):   What tools do we have at our disposal to treat uterine bleeding in the non-pregnant patient? What is your overall approach to uterine bleeding in the hemodynamically unstable patient? What are your first two interventions? What is the number one cause of postpartum hemorrhage? What are the standard preventative interventions? What other agents do we have at our disposal? Are there any procedures?   Authors: Jason Hine MD Peer Review: Jeff Holmes MD Rebecca Bloch MD

Tranexamic acid (TXA) is a synthetic lysine derivative that binds with the lysine site on plasminogen, inhibits fibrinolysis and stabilizes clot. While it has been around since the 1960's, its popularity for major trauma has gained a lot of steam in recent years. This has also resulted in creative emergency providers finding novel uses for it at the bedside. In this podcast, Dr. Tim Fallon discusses some of the more novel bedside uses of TXA including epistaxis, hemoptysis, post tonsillectomy bleeding, and dental trauma. Click Here for the Show Notes on Downeastem.org References Zahad, R. A new and rapid method for espistaxis treatmetn using injectable form of tranexamic acid topically: a randomized controlled trial. AJEM. 31 (2013)1389-1392.[Pubmed] Wand, O. Inhaled Tranexamic Acid for Hemoptysis Treatment. Chest. 2018; 154(6):1379-1384.[Pubmed] Schwarz, W. Nebulized tranexamic Acid Use for Pediatric Secondary Post-Tonsillectomy Hemorrhage. Annals of Emerg Med. in Press. [Pdf] Dietrich, S. Trick of the Trade: Topical Tranexamic Acid Paste for Hemostasis. ALiEM. https://www.aliem.com/category/clinical/tricks-of-the-trade/ Mason, J. Epistaxis TXA Pack. EMRAP HD. May 2018 Rezaie, S. TXA for Everyone: Inhaled TXA for Hemoptysis. RebelEM. Rezaie, S. Topical Tranexamic Acid for Epistaxis or Oral Bleeds. RebelEM

Syncope is an incredibly common presentation to the Emergency Department with a broad differential diagnosis from the benign (vasovagal) to the lethal (arrhythmia). Because of this, the care and disposition of these patients can be challenging. In this podcast we sat down with Dr. Mike Burla to talk through the details of a new(er) decision aid- the Canadian Syncope Risk Score.   The paper we discuss can be found HERE Thiruganasambandamoorthy V et al. Duration of Electrocardiographic Monitoring of Emergency Department Patients With Syncope. Circulation. 2019 Mar 12;139(11):1396-1406.     Check out our post on the Down East EM blog for shownotes, references, and more.   When listening to this post, please consider the following questions (and follow us on twitter for spaced retrieval of this material @downeastem): 1. How long did the CSRS study investigators observe patients for major arrhythmic outcomes after presentation to the ED?  2. Approximately what percentage of the study cohort was classified as low risk by the CSRS? 3. What proportion of serious arrhythmic outcomes occurred within 6 hours of ED arrival, regardless of CSRS score?  4. According to the study authors, what is the recommended time for observation of a low risk patient by CSRS? How about for Medium and High Risk Patients?  5. Based on the study results, what risk stratification category are the recommendations most applicable to? What is the recommendation for electrocardiographic monitoring of this group?    Authors: Mike Burla MD and Jason Hine MD Peer Review: Lauren Wendell MD

FOAM [free open access medical education] is growing at an amazing rate (we are actually using FOAM now to talk about FOAM). Like most powerful tools, this resource has both its pro and cons. To review FOAM and its use in Graduate Medical Education, we sat down with Matt Delaney.   Check out our post on the Down East EM blog for shownotes, references, and more.   To hear more on FOAM, check out Dave Mackenzie's talk at the Sugarloaf Conference   Author: Jason Hine MD Peer Review: Jeff Holmes MD  

We have a lot of numbers to remember when it comes to the care of the brain injured patient. From subarachnoid hemorrhage to traumatic brain injury, it can be hard to keep all the numbers straight. We sat down with neuro-intensivist Dr. Evie Marcolini to discuss blood pressure targets for these different disease processes. Check out our post on the Down East EM blog for more    SUMMARY OF RECOMMENDATIONS AND ASSOCIATED LITERATURE Subarachnoid Hemorrhage (SAH) Systolic blood pressure (SBP) to

Coding cardiac arrest patients is tough. There's lots to do- from getting access, to doing ultrasounds, to analyzing rhythms, the tasks really add up! This is especially true in a low-staffing, low-resource setting. In this post we review how to code someone well with limited resources.   Check out our post on the Down East EM blog for shownotes, references, and more.   Author: Jason Hine MD Peer Reviewer: Jeff Holmes MD

In this podcast we sit down the ED toxicologist Ryan Marino to talk about this phenomenon in the media of "fentanyl hysteria"- a trend of fear-mongering, exaggerated reporting, and misinformation.    Check out our post on the Down East EM blog for shownotes, references, and more.   Examples of Fentanyl Hysteria reporting: San Fran Chronicle Article on Police OD CNN Article on Deputy and EMT exposure   Author: Jason Hine MD Peer Review: Jeff Holmes MD

The world of emergency neuroimaging is evolving and increasingly influencing time-sensitive treatment decisions. A basic understanding of the imaging studies and sequences you may be asked to obtain in the ED may help you better manage your patients. In this post, Dr. Matthew Siket reviews the four major neuroimaging modalities (CT, CTA, Perfusion, and MRI). For the full show notes on our DownEast EM blog https://www.downeastem.org/downeastem/2018/6/29/neuroimaging   References: Smith AG and Hill CR. Imaging assessment of acute ischaemic stroke: a review of radiological methods. Br J Radiol. 2018;91:1083.[Pubmed] Albers GW et al. New Engl J Med 2018;378:708-18.[Pdf] Thomalla G et al. New Engl J Med 2018; 379(7):611-22.[Pdf] Author Matt Siket, MD and Jeff Holmes, MD Peer Reviewed by Andrew Perron, MD

Gender equity (or in truth, inequity) in medicine has come under the spotlight with an increasing focus on a culture of fairness, improving female practitioners' access to leadership roles, and moving away from the "good ol' boys club" medicine is prone to being.  In this guest lecture we have Dr. Kimon Ioannides talking on Mansplaining in the ED. Check out our post on the Down East EM blog for shownotes, references, and more.     Author: Jason Hine MD and Kimon Ioannides MD Peer Review: Jeff Holmes MD

Check out our post on the Down East EM blog for shownotes, references, and more.   The reality of America's opioid addiction and overdose problem has reached the lay press. As overdose deaths begin to outpace car accidents as the #1 cause of accidental deaths, the Opioid Crisis has people's attention. How we deal with this epidemic in the Emergency Department has been a topic of hot debate, both in publication and in the Free Open Access Medical Education (FOAM) world. To dive into these topics, we sat down with Dr. Ken Starr, an Emergency and Addiction medicine specialist, to review buprenorphine.    Author: Jason Hine MD and Ken Starr MD Peer Review: Jeff Holmes MD

Check out our post on the Down East EM blog for shownotes, references, and more. In this podcast we review the complexity of the oral foreign body (FB) in kids and why this disease process is so tough to handle.       Other helpful links! Down East Guideline on Pediatric sedation     Down East Pedi Med Dose Reference document   Amber Richards, Maine Medical Center PEM faculty, talk of foreign bodies     Author: Jason Hine MD Peer Reviewed: Jeff Holmes MD  

Check out our post on the Down East EM blog for shownotes, references, and more.   Metacognition is a person's ability to understand their thought patterns and how they come to their conclusions. It is a critically imporant skill for health care providers as it has the ability to both hinder and help their medical decsion making. In this podcast episode, Dr. Samantha Wood describes the dual process theory of thinking as well as seven metacognition hacks that you can use on your next shift.   Author: Samantha Wood MD Peer Reviewer:  Jeffrey A. Holmes, MD 

How should we handle the airway in out of hospital cardiac arrest? Just bag and go? Should we tube these guys? Maybe just toss in a supraglottic? In this podcast we review these three strategies and the recent research on the topic.   Article 1: Effect of Bag-Mask Ventilation vs Endotracheal Intubation During Cardiopulmonary Resuscitation on Neurological Outcome After Out-of-Hospital Cardiorespiratory Arrest A Randomized Clinical Trial [pubmed] Article 2: Effect of a Strategy of a Supraglottic Airway Device vs Tracheal Intubation During Out-of-Hospital Cardiac Arrest on Functional Outcome: The AIRWAYS-2 Randomized Clinical Trial. [pubmed] Article 3: Effect of a Strategy of Initial Laryngeal Tube Insertion vs Endotracheal Intubation on 72-Hour Survival in Adults With Out-of-Hospital Cardiac Arrest: A Randomized Clinical Trial. [pubmed]   The Glasgow-Pittsburgh Cerebral Performance Categories Modified Rankin Scale   Author: Jason Hine MD and Sam Potter MD Peer Reviewer: Jeff Holmes MD

Check out our post on the Down East EM blog for shownotes, references, and more.   We talk a fair bit in MedEd (that's medical education for cool people) about how to best teach medicine, but rarely sit down these trainees after they've been through to really get a sense of what they think.  So we sat down with two of our graduating chief residents to ask them their parting thoughts on GME.    Author: Jason Hine MD Peer Reviewed by: Jeff Holmes MD

Check out our post on the Down East EM blog for shownotes, references, and more.   When you're intubating a patient, twiddling your thumbs waiting for your induction and paralytic to work, do you ever ask yourself "hmm, should I be bagging this patient?" In this podcast we talk about that very question and the new data from the PREVENT trial. Full article [pubmed]     Author: Jason Hine MD and Sam Potter MD Peer Reviewer: Jeff Holmes MD

Hypertensive Emergency is an umbrella term for a wide range of disease processes seen in the ED. They all represent as sick-as-stink patients with critical care up to your eyeballs. In this podcast we review the involved organs in hypertensive emergencies, their presentation, and our targeted treatments.   At the end of this podcast learners will be able to: Articulate an understanding of at-risk organ systems in severe hypertension Differentiate the presentations of hypertensive emergency by involved organ Appraise different pharmacotherapies for the treatment hypertensive emergency and their ideal clinical setting References: The JNC7 [pubmed] The JNC8 [pubmed] The ACC/AHA Clinical Practice Guidelines [pubmed] The ESC/ESH Clinical Practice Guidelines [pubmed] for full list of references for this talk, please use the comments section or reach out to us on Twitter @Downeastem   Author: Jason Hine MD Peer Reviewer: Jeff Holmes MD

Check out our post on the Down East EM blog for shownotes, references, and more. In this podcast we sit down with Dr. Daria Thompson, a pediatric hospitalist at Tufts Medical Center and an old friend of mine to talk ear infections- a common disease commonly diagnosed... and possibly commonly done wrong. We'll talk definitions of disease, common alternative diagnoses, and treatment plans by age. I assure you- you'll learn something new.     Author: Jason Hine MD and Daria Thompson MD Peer Reviewer: Jeff Holmes MD

Check out our post on the Down East EM blog for shownotes, references, and more.   Which central venous catheter (CVC) is best for our patients? Is it the internal jugular (IJ), subclavian, or femoral? We all have our go-to, which I would argue for most, is the ultrasound (US) guided IJ. But is that what is best? Is it recommended by our medical societies? To answer this question we dive into the literature . . . I think you'll be surprised by what we find. (Hint: it's the Subclavian!!)     Author: Jason Hine MD  Peer Reviewer: Jeff Holmes MD

Check out our post on the Down East EM blog for shownotes, references, and more.   Prompt, safe, and effective pain management is a core competency of the emergency provider. Unfortunately, traditional strategies for administering analgesics in the emergency department have been shown to have poor success rates. In this podcast episode, Dr. Matthew Delaney shares a few evidence based pain pearls you can use on your next shift.    Author: Matt Delaney MD Peer Reviewer: Jason Hine MD and Jeff Holmes MD  

Check out our post on the Down East EM blog for shownotes, references, and more.   Author: Jason Hine MD and Sam Potter MD Peer Review: Jeff Holmes MD

Check out our post on the Down East EM blog for shownotes, references and more. Author: Jason Hine MD and Sam Potter MD Peer Reviewer: Jeff Holmes MD

Check out our post on the Down East EM blog for shownotes, references and more.   Author: Jason Hine MD and Salim Rezaie MD Peer Reviewer: Jeff Holmes MD  

Check out our post on the Down East EM blog for shownotes, references and more.   Author: Jason Hine MD and Sergey Motov MD Peer Review: Jeff Holmes MD

This is our introductory podcast to tell you a bit about who we are and what we do.   We are committed to providing high quality education to improve the care of the emergency patient in Maine, northern New England, and beyond.   The goal of this podcast is to bring you engaging, entertaining, and informative posts on the varying topics in Emergency Medicine. Content will range from bread and butter to cutting edge and will have something for everyone- from the resident trainee to the seasoned veteran.   To learn more about our contributors, visit our Down East EM Blog   Authors: Jason Hine MD and Jeff Holmes MD Peer Reviewer: Jeff Holmes MD