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, …

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. …

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, MDBy Down East Emergency Medicine

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 conferen…

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 ou…

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 betwee…

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 …

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…

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 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 vod…

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 …

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. …

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 po…

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 m…

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 MDBy Down East Emergency Medicine

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 Holm…

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 p…

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 Do…

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 th…

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- th…

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…

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…

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, ref…

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 P…

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,…

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. C…

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 D…

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 Ce…

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 epis…

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 Neurolog…

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…

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 ar…

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 …

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 alt…

Check out the post on SimKit 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 answe…

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 D…

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 MDBy Down East Emergency Medicine

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 MDBy Down East Emergency Medicine

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 MDBy Down East Emergency Medicine

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 MDBy Down East Emergency Medicine

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 Me…