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Ultrasound of the Month: Can you use Pocus for pneumonia? — Downeast Emergency Medicine
In the emergency room, shortness of breath and cough are common complaints, and chest x-rays are frequently ordered to evaluate for pneumonia. However, what is the sensitivity and specificity of chest x-ray for pneumonia? Is it a "rule out" test? Is there a ro
Two STEMI Mimics You've Got to Know! — Downeast 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.
OMG, TMI! What does open notes mean for you and your patients? — Downeast Emergency Medicine
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?
Pediatric Diarrhea with Dr. Jay Larmon — Downeast Emergency Medicine
Kids poop. Most of the time it is benign (aside from the blowouts, the wiping, cleaning and changing of clothes). Occassionaly, pediatric diarrhea has a more serious etiology. 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.
Advice from a Resident: Virtual Interviewing and Transitioning to Residency — Downeast Emergency Medicine
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!
Journal Club - Racism is a Public Health Problem — Downeast Emergency Medicine
In the United States, racism is a critical public health problem, permeating everyday systems including educational and health care systems; criminal justice and legal systems; financial, housing, and economic systems; environmental issues and beyond to create differential health outcomes that adversely affect Black, Indigenous, and other people of color. This pervasive system of power is based on the socio-politically constructed notion that non-Hispanic white people are inherently superior to people of color (Black, African American, Indigenous, Native American, Alaska Native, Native Hawaiian, Pacific Islander, Asian, Latine, Hispanic) and this ideology operates across multiple levels (individual, interpersonal, institutional) to unjustly advantage non-Hispanic white people, unjustly disadvantaging people of color. We recognize that racism is an important cause of health disparities and that, as health care providers, we have a responsibility to educate ourselves about racism so that we will be prepared to acknowledge the impact of racism on our patients’ health and work towards more equitable systems in support of health equity. One important component of that education is learning how to engage in productive conversations about race and racism. In service of that goal, we chose Ijeoma Oluo’s book, So you want to talk about race, as our common read for this special Journal Club session.
Journal Club - COVID-19 Therapeutics — Downeast Emergency Medicine
COVID vaccines have dominated the media and our recent efforts to combat the SARS-CoV-2 virus. It will likely take some time, however, until we reach herd immunity. To help curb the severity of disease, the medical community continues to investigate other therapeutics. By examining the virus life cycle and our immune system’s response to it (both protective and destructive), we may be able to develop anti-viral and immune therapy that counteracts the cytokine storm and leads to acute respiratory distress syndrome, respiratory failure, shock, organ failure and potentially death. In this journal club, we reviewed the use of steroids and convalescent plasma for the treatment of patients with SARS-CoV-2.
Journal Club - Physician Depression and Suicide — Downeast Emergency Medicine
Suicide is disturbingly prevalent among patients we care for in the Emergency Department. It is unfortunately also common among physicians. Most estimates suggest that approximately 400 physicians die by suicide annually. Physicians also have a higher rate of suicide than the general population. Male physicians have a 40% increased risk of suicide compared to their age-matched peers and female physicians have a 130% increased risk. We chose this topic for Journal Club with the goals to raise awareness around these shocking statistics, discuss etiologies behind these high rates of suicide and to normalize the discussion around physician mental health.
Ultrasound of the Month - Is your probe marker switched? — Downeast Emergency Medicine
This is the inagural installment of our monthly series recognizing some great point of care ultrasound images performed in our department. This case will highlight some beautiful echocardiogram images obtained by the one and only Dr. Nicholas Fling, one of our chief resident physicians. Echo is a basic ultrasound skill that all EM docs need to have, and making sure your probe marker is set up appropriately on the screen is a great first step. The apical four-chamber view of Dr. Fling's would make anyone double check that!
Journal Club - Tranexamic Acid in Trauma — Downeast Emergency Medicine
The use of TXA in the care of the trauma patient has become prevalent since the publication of the MATTERs and CRASH-2 studies which demonstrated significant mortality benefits in trauma patients who received early TXA after admission. Since these publications, there continues to be several additional questions regarding its TXA: 1) If earlier treatment with TXA for the trauma patient is better, would there be benefit in its administration in the prehospital setting? 2) Is there benefit to the use of TXA in patients with TBI to prevent the progression and subsequent morbidity and mortality? 3) Lastly, does TXA carry a significant risk for side effects, including venous thromboembolic events? This journal club reviewed four articles that aim to answer these questions.
Ultrasound of the Month: A Case of Unilateral Knee Swelling — Downeast Emergency Medicine
Welcome back to the first installment of the Ultrasound of the Month in the new year! After reviewing our cases from January we have selected a case of unilateral knee swelling to highlight the use of ultrasound in this extremely common ED chief complaint. The amazing images with obtained by Dr. Hadley Gunnell, anouther one of our stellar interns!
Journal Club - Emergency Department Initiated Buprenorphine for Opioid Use Disorder — Downeast Emergency Medicine
Recent data from the National Center for Health Statistics reveal that in the 12-month period ending in April 2021, more than 100,000 Americans died of an overdose, a staggering increase of nearly 30% the prior year. While the ongoing COVID-19 pandemic has contributed to overdose deaths and taxed constrained ED resources, it has also clarified the important role that emergency physicians have in expanding access to life-saving medications to treat opioid use disorder. In this journal club, we review the evidence on ED-initiated buprenorphine, including barriers to implementing ED-buprenorphine here in rural Maine.
Journal Club - Pain management of Renal Colic — Downeast Emergency Medicine
Renal colic is a commonly encountered diagnosis in the emergency department that is known to cause significant pain. In clinical practice, the initial goal is prompt pain management while simultaneously working to confirm the suspected diagnosis. Because of the severity and acuity of the pain associated with renal colic, opioid pain management has often been used. Given the overall goal of reducing the use of opioid pain medications, emergency physicians have been working to identify alternative pain management strategies with agents such ketorolac and lidocaine. In this journal club, we examine the evidence in support of these treatment strategies.
Journal Club - Gender Bias and Discrimination in emergency medicine training — Downeast Emergency Medicine
On January 23rd, 1849 Elizabeth Blackwell became the first female graduate of a US medical school, graduating from Geneva College in New York as the Valedictorian of her class. Despite the passage of 172 years from that remarkable moment, female physicians continue to face both implicit and explicit gender bias within the medical profession and culture. This journal club examined the impact of gender bias on female emergency medicine trainees.
Ultrasound of the Month - Not all veggies are good for your health — Downeast Emergency Medicine
We're back with some more exciting and beautiful echocardiogram images this month! This case and images are courtesy of Dr. Sarah Bunting, a rising ultrasound star within our program. Here she has obtained some uncommon images of an unfortunately more and more prevalent disease process. So grab your warm holiday drink of choice and enjoy our ultrasound of the month.
Journal Club - Optimal Pharmacology for Alcohol Withdrawal — Downeast Emergency Medicine
Alcohol abuse is common in the United States with 14.1 million adults estimated to have some degree of alcohol use disorder. Emergency physicians will encounter this quite often, either as the primary presenting problem or as a complicating factor in a patient’s care. Unfortunately, alcohol consumption appears to be increasing, with the World Health Organization projecting ongoing increases through at least 2025. As a result, it is becoming increasingly important that we understand the serious and potentially life-threatening consequences of alcohol withdrawal syndrome (AWS) and the treatment options that exist in order to best manage these patients. The following three journal club articles sought to investigate potential clinical benefits for the use of phenobarbital in the emergency department (ED) for the treatment of AWS.
Academics for the Community Provider- Bringing quality and longevity to your career — Downeast Emergency Medicine
In medicine we often draw a solid line between community and academic medicine, but this is likely 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.
Bread and Butter Abdominal Ailments for Medical Students in the ED — Downeast Emergency Medicine
Abdominal pain is the most common chief complaint for adult patients in the ED. It’s one of the presenting symptoms that can run the gamut between largely benign to imminently lethal, making it imperative for medical students to be able to triage and assess it appropriately.
Pathways to Emergency Medicine: What to Know Early in the Career Exploration Process — Downeast Emergency Medicine
How and when do medical students become interested in emergency medicine? In this post we review how Tufts University School of Medicine’s 2021 class of EM-bound students reflect on the circumstances behind how they first became interested in the field and what experiences were most important in their decision to pursue EM.