DOWNEAST EMERGENCY MEDICINEBLOGPODCASTJOURNAL CLUBVIDEO LECTURESWELLNESSRESIDENT EDUCATION November 10, 2020. / Tania D. Strout, PhD, RN, MS. Vasopressors are used in Emergency Medicine to treat cardiac arrest, hypotension, and shock. Recent studies have sought to investigate questions around timing, medication choices, and administration of these medications in varying clinical scenarios. The emergency provider must be familiar

with

TWO STEMI MIMICS YOU'VE GOT TO KNOW! Two STEMI Mimics You've Got to Know! April 05, 2021. / Amal Mattu, 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. AIRWAY — DOWNEAST EMERGENCY MEDICINE Rapid Sequence Intubation, Airway Rescue Devices, Surgical Airway. Michael Gibbs, MD, FACEP. Chair, Department of Emergency Medicine. Carolinas Medical Center. Charlotte, North Carolina. Professor of Emergency Medicine. Carolinas HealthCare System. Use of the Fiberoptic Scope in the Emergency Department from Downeast Emergency Medicine on

Vimeo.

ULTRASOUND — DOWNEAST EMERGENCY MEDICINE Ocular Ultrasond. Recorded at the Maine Medical Center Winter Symposium in March 2017 in Sugarloaf, Maine. David Mackenzie, MD. Co-Director of Emergency Ultrasound. Maine Medical Center. The Softer Side of Ultrasound - Soft Tissue Ultrasound from Downeast Emergency Medicine on Vimeo. from Downeast Emergency Medicine. TRANSCUTANEOUS PACING Step 1: Apply the pacing electrodes and consider sedation (eg. versed) Avoid placing the pads over an AICD or transdermal drug patches. There is little data on optimal placement however, try to place the pads as close as possible to the PMI (point of maximal impulse) NERVE BLOCKS OF THE FOOT AND ANKLE The deep peroneal nerve lies in the groove between the extensor hallucis longus and the tibialis anterior tendon. The hallucis longus can be located by having the patient flex and extend the big toe. The tibialis interior can be located by having the patient dorsi flex the foot and invert the ankle. The injection site should be at the level

of

ED BOARDING

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. NERVE BLOCKS OF THE HAND AND WRIST ECHO EXTRAVAGANZA PART 4: THE SUPRASTERNAL NOTCH VIEW Echo Extravaganza Part 4: The Suprasternal Notch View. Here’s comes another heaping helping of ultrasound highlights from our winter symposium’s echo extravaganza! In this serving, Dr. Mindy Lipsitz, MD shares some pearls about the suprasternal notch view to assess for trauma, coarctation, aortic root regurgitation, and aortic aneurysm. BLOOD CAN BE VERY BAD! Blood can be very bad. Utilizing a systematic approach is one way that the clinician can ensure significant neuropathology will not be missed. Just as physicians are taught a uniform, consistent approach to reading an ECG (rate, rhythm, axis, etc.), the cranial CT can also be broken down into discreet entities, attention to which will help avoid the pitfall of a missed diagnosis. DOWNEAST EMERGENCY MEDICINEBLOGPODCASTJOURNAL CLUBVIDEO LECTURESWELLNESSRESIDENT EDUCATION November 10, 2020. / Tania D. Strout, PhD, RN, MS. Vasopressors are used in Emergency Medicine to treat cardiac arrest, hypotension, and shock. Recent studies have sought to investigate questions around timing, medication choices, and administration of these medications in varying clinical scenarios. The emergency provider must be familiar

with

TWO STEMI MIMICS YOU'VE GOT TO KNOW! Two STEMI Mimics You've Got to Know! April 05, 2021. / Amal Mattu, 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. AIRWAY — DOWNEAST EMERGENCY MEDICINE Rapid Sequence Intubation, Airway Rescue Devices, Surgical Airway. Michael Gibbs, MD, FACEP. Chair, Department of Emergency Medicine. Carolinas Medical Center. Charlotte, North Carolina. Professor of Emergency Medicine. Carolinas HealthCare System. Use of the Fiberoptic Scope in the Emergency Department from Downeast Emergency Medicine on

Vimeo.

ULTRASOUND — DOWNEAST EMERGENCY MEDICINE Ocular Ultrasond. Recorded at the Maine Medical Center Winter Symposium in March 2017 in Sugarloaf, Maine. David Mackenzie, MD. Co-Director of Emergency Ultrasound. Maine Medical Center. The Softer Side of Ultrasound - Soft Tissue Ultrasound from Downeast Emergency Medicine on Vimeo. from Downeast Emergency Medicine. TRANSCUTANEOUS PACING Step 1: Apply the pacing electrodes and consider sedation (eg. versed) Avoid placing the pads over an AICD or transdermal drug patches. There is little data on optimal placement however, try to place the pads as close as possible to the PMI (point of maximal impulse) NERVE BLOCKS OF THE FOOT AND ANKLE The deep peroneal nerve lies in the groove between the extensor hallucis longus and the tibialis anterior tendon. The hallucis longus can be located by having the patient flex and extend the big toe. The tibialis interior can be located by having the patient dorsi flex the foot and invert the ankle. The injection site should be at the level

of

ED BOARDING

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. NERVE BLOCKS OF THE HAND AND WRIST ECHO EXTRAVAGANZA PART 4: THE SUPRASTERNAL NOTCH VIEW Echo Extravaganza Part 4: The Suprasternal Notch View. Here’s comes another heaping helping of ultrasound highlights from our winter symposium’s echo extravaganza! In this serving, Dr. Mindy Lipsitz, MD shares some pearls about the suprasternal notch view to assess for trauma, coarctation, aortic root regurgitation, and aortic aneurysm. BLOOD CAN BE VERY BAD! Blood can be very bad. Utilizing a systematic approach is one way that the clinician can ensure significant neuropathology will not be missed. Just as physicians are taught a uniform, consistent approach to reading an ECG (rate, rhythm, axis, etc.), the cranial CT can also be broken down into discreet entities, attention to which will help avoid the pitfall of a missed diagnosis. ULTRASOUND — DOWNEAST EMERGENCY MEDICINE Ocular Ultrasond. Recorded at the Maine Medical Center Winter Symposium in March 2017 in Sugarloaf, Maine. David Mackenzie, MD. Co-Director of Emergency Ultrasound. Maine Medical Center. The Softer Side of Ultrasound - Soft Tissue Ultrasound from Downeast Emergency Medicine on Vimeo. from Downeast Emergency Medicine. NERVE BLOCKS OF THE FACE AND MOUTH Facial Nerve BLOCKS . The supraorbital, infraorbital and mental nerves all line along an imaginary vertical line drawn through the pupil.When injecting in the mouth, provide topical anesthetic, retract mucosa to enhance vision & minimize needle insertion trauma, dry the injection site, and penetrate mucosa using distracting pain to minimize the pain

of injection.

TXA BEYOND TRAUMA

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 DOWNEAST EMERGENCY MEDICINE Journal Club - Gender Bias and Discrimination in emergency medicine training. May 04, 2021. / Christine Hein, MD. 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

ECHO EXTRAVAGANZA PART 4: THE SUPRASTERNAL NOTCH VIEW Echo Extravaganza Part 4: The Suprasternal Notch View. Here’s comes another heaping helping of ultrasound highlights from our winter symposium’s echo extravaganza! In this serving, Dr. Mindy Lipsitz, MD shares some pearls about the suprasternal notch view to assess for trauma, coarctation, aortic root regurgitation, and aortic aneurysm. UTERINE BLEEDING IN THE EMERGENCY DEPARTMENT 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

BEDSIDE PROCEDURES

Intra-nasal Foreign Body Removal. Recorded at the Maine Medical Center emergency medicine residency grand rounds. George L. Higgins III, MD, FACEP. Professor of Emergency Medicine. Maine Medical Center. Tufts University School of Medicine. Avulsed Fingernail Repair from Downeast Emergency Medicine on Vimeo. Avulsed Fingernail Repair. ARE YOU POSITIVE . . . OR FALSE POSITIVE? IMPROVING YOUR The EFAST exam is an integral component of an emergency provider’s trauma evaluation. In the right hands, it has a specificity > 90% for intra-abdominal free fluid. There are some pitfalls, however, that can trick the provider into thinking a false positive represents free

fluid. In this p

VELOCITY TIME INTEGRAL (VTI) AND THE PASSIVE LEG RAISE Hypotensive patients requiring volume resuscitation are a regular occurrence for emergency physicians. Clinicians are often faced with determining whether patients will respond favorably to IV fluids both before and during vasopressor administration. The ability for point of care ultrasound (includ WHAT THE HECK IS GOING ON WITH THIS PACEMAKER?! The magnet turns the sensing function of a pacemaker off and sets the pacer to a preprogrammed asynchronous mode (usually 70-90 bpm) Application of the magnet allows for: DOWNEAST EMERGENCY MEDICINEBLOGPODCASTJOURNAL CLUBVIDEO LECTURESWELLNESSRESIDENT EDUCATION November 10, 2020. / Tania D. Strout, PhD, RN, MS. Vasopressors are used in Emergency Medicine to treat cardiac arrest, hypotension, and shock. Recent studies have sought to investigate questions around timing, medication choices, and administration of these medications in varying clinical scenarios. The emergency provider must be familiar

with

TWO STEMI MIMICS YOU'VE GOT TO KNOW! Two STEMI Mimics You've Got to Know! April 05, 2021. / Amal Mattu, 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.

ED BOARDING

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. AIRWAY — DOWNEAST EMERGENCY MEDICINE Rapid Sequence Intubation, Airway Rescue Devices, Surgical Airway. Michael Gibbs, MD, FACEP. Chair, Department of Emergency Medicine. Carolinas Medical Center. Charlotte, North Carolina. Professor of Emergency Medicine. Carolinas HealthCare System. Use of the Fiberoptic Scope in the Emergency Department from Downeast Emergency Medicine on

Vimeo.

TRANSCUTANEOUS PACING Step 1: Apply the pacing electrodes and consider sedation (eg. versed) Avoid placing the pads over an AICD or transdermal drug patches. There is little data on optimal placement however, try to place the pads as close as possible to the PMI (point of maximal impulse) NERVE BLOCKS OF THE FOOT AND ANKLE The deep peroneal nerve lies in the groove between the extensor hallucis longus and the tibialis anterior tendon. The hallucis longus can be located by having the patient flex and extend the big toe. The tibialis interior can be located by having the patient dorsi flex the foot and invert the ankle. The injection site should be at the level

of

NERVE BLOCKS OF THE HAND AND WRIST NERVE BLOCKS OF THE FACE AND MOUTH Facial Nerve BLOCKS . The supraorbital, infraorbital and mental nerves all line along an imaginary vertical line drawn through the pupil.When injecting in the mouth, provide topical anesthetic, retract mucosa to enhance vision & minimize needle insertion trauma, dry the injection site, and penetrate mucosa using distracting pain to minimize the pain

of injection.

ECHO EXTRAVAGANZA PART 4: THE SUPRASTERNAL NOTCH VIEW Echo Extravaganza Part 4: The Suprasternal Notch View. Here’s comes another heaping helping of ultrasound highlights from our winter symposium’s echo extravaganza! In this serving, Dr. Mindy Lipsitz, MD shares some pearls about the suprasternal notch view to assess for trauma, coarctation, aortic root regurgitation, and aortic aneurysm. BLOOD CAN BE VERY BAD! Blood can be very bad. Utilizing a systematic approach is one way that the clinician can ensure significant neuropathology will not be missed. Just as physicians are taught a uniform, consistent approach to reading an ECG (rate, rhythm, axis, etc.), the cranial CT can also be broken down into discreet entities, attention to which will help avoid the pitfall of a missed diagnosis. DOWNEAST EMERGENCY MEDICINEBLOGPODCASTJOURNAL CLUBVIDEO LECTURESWELLNESSRESIDENT EDUCATION November 10, 2020. / Tania D. Strout, PhD, RN, MS. Vasopressors are used in Emergency Medicine to treat cardiac arrest, hypotension, and shock. Recent studies have sought to investigate questions around timing, medication choices, and administration of these medications in varying clinical scenarios. The emergency provider must be familiar

with

TWO STEMI MIMICS YOU'VE GOT TO KNOW! Two STEMI Mimics You've Got to Know! April 05, 2021. / Amal Mattu, 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.

ED BOARDING

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. AIRWAY — DOWNEAST EMERGENCY MEDICINE Rapid Sequence Intubation, Airway Rescue Devices, Surgical Airway. Michael Gibbs, MD, FACEP. Chair, Department of Emergency Medicine. Carolinas Medical Center. Charlotte, North Carolina. Professor of Emergency Medicine. Carolinas HealthCare System. Use of the Fiberoptic Scope in the Emergency Department from Downeast Emergency Medicine on

Vimeo.

TRANSCUTANEOUS PACING Step 1: Apply the pacing electrodes and consider sedation (eg. versed) Avoid placing the pads over an AICD or transdermal drug patches. There is little data on optimal placement however, try to place the pads as close as possible to the PMI (point of maximal impulse) NERVE BLOCKS OF THE FOOT AND ANKLE The deep peroneal nerve lies in the groove between the extensor hallucis longus and the tibialis anterior tendon. The hallucis longus can be located by having the patient flex and extend the big toe. The tibialis interior can be located by having the patient dorsi flex the foot and invert the ankle. The injection site should be at the level

of

NERVE BLOCKS OF THE HAND AND WRIST NERVE BLOCKS OF THE FACE AND MOUTH Facial Nerve BLOCKS . The supraorbital, infraorbital and mental nerves all line along an imaginary vertical line drawn through the pupil.When injecting in the mouth, provide topical anesthetic, retract mucosa to enhance vision & minimize needle insertion trauma, dry the injection site, and penetrate mucosa using distracting pain to minimize the pain

of injection.

ECHO EXTRAVAGANZA PART 4: THE SUPRASTERNAL NOTCH VIEW Echo Extravaganza Part 4: The Suprasternal Notch View. Here’s comes another heaping helping of ultrasound highlights from our winter symposium’s echo extravaganza! In this serving, Dr. Mindy Lipsitz, MD shares some pearls about the suprasternal notch view to assess for trauma, coarctation, aortic root regurgitation, and aortic aneurysm. BLOOD CAN BE VERY BAD! Blood can be very bad. Utilizing a systematic approach is one way that the clinician can ensure significant neuropathology will not be missed. Just as physicians are taught a uniform, consistent approach to reading an ECG (rate, rhythm, axis, etc.), the cranial CT can also be broken down into discreet entities, attention to which will help avoid the pitfall of a missed diagnosis. ULTRASOUND — DOWNEAST EMERGENCY MEDICINE Ocular Ultrasond. Recorded at the Maine Medical Center Winter Symposium in March 2017 in Sugarloaf, Maine. David Mackenzie, MD. Co-Director of Emergency Ultrasound. Maine Medical Center. The Softer Side of Ultrasound - Soft Tissue Ultrasound from Downeast Emergency Medicine on Vimeo. from Downeast Emergency Medicine. AIRWAY — DOWNEAST EMERGENCY MEDICINE Rapid Sequence Intubation, Airway Rescue Devices, Surgical Airway. Michael Gibbs, MD, FACEP. Chair, Department of Emergency Medicine. Carolinas Medical Center. Charlotte, North Carolina. Professor of Emergency Medicine. Carolinas HealthCare System. Use of the Fiberoptic Scope in the Emergency Department from Downeast Emergency Medicine on

Vimeo.

NEUROLOGY — DOWNEAST EMERGENCY MEDICINE Neuroimaging Update: The Studies and Sequences You Should Know. Recorded at the 2018 Maine Medical Center Winter Symposium in Sugarloaf, Maine. www.mmcwintersymposium.com. Matthew S. Siket, MD, MS. Attacking TIAs: The Data to Drive Diagnostic Decision-Making and Management from Downeast Emergency Medicine on Vimeo. Attacking TIAs:

The Data to

DOWNEAST EMERGENCY MEDICINE We are committed to providing high quality education to improve the care of the emergency patient in Maine, northern New England and beyond. We are a non-commercial website and have no financial conflicts of interest.

ADMINISTRATION

This lecture was recorded at the 2016 Maine Medical Center Winter Symposium in Sugarloaf, Maine. mmcwintersymposium.com. Mattew Delaney, MD Assistant Director, Emergency Medicine Residency at the University of Alabama. ICD-10 and the Emergency Physician from Downeast Emergency Medicine on Vimeo. ICD-10 and the Emergency Physician. UTERINE BLEEDING IN THE EMERGENCY DEPARTMENT 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

TXA BEYOND TRAUMA

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 ECHO EXTRAVAGANZA PART 4: THE SUPRASTERNAL NOTCH VIEW Echo Extravaganza Part 4: The Suprasternal Notch View. Here’s comes another heaping helping of ultrasound highlights from our winter symposium’s echo extravaganza! In this serving, Dr. Mindy Lipsitz, MD shares some pearls about the suprasternal notch view to assess for trauma, coarctation, aortic root regurgitation, and aortic aneurysm. RESUS OF THE HYPOTENSIVE PATIENT PART 1 Take away Points. 1. Unnecessary IV fluid increases mortality and kidney injury in the critically ill. 2. Most patients with septic shock do not have profound volume depletion but an increase in unstressed venous volume. 3. Cardiac output can be increased with vasopressor infusions without exposing patients to the harms of IV

fluid.

ARE YOU POSITIVE . . . OR FALSE POSITIVE? IMPROVING YOUR The EFAST exam is an integral component of an emergency provider’s trauma evaluation. In the right hands, it has a specificity > 90% for intra-abdominal free fluid. There are some pitfalls, however, that can trick the provider into thinking a false positive represents free

fluid. In this p

DOWNEAST EMERGENCY MEDICINEBLOGPODCASTJOURNAL CLUBVIDEO LECTURESWELLNESSRESIDENT EDUCATION November 10, 2020. / Tania D. Strout, PhD, RN, MS. Vasopressors are used in Emergency Medicine to treat cardiac arrest, hypotension, and shock. Recent studies have sought to investigate questions around timing, medication choices, and administration of these medications in varying clinical scenarios. The emergency provider must be familiar

with

TWO STEMI MIMICS YOU'VE GOT TO KNOW! Two STEMI Mimics You've Got to Know! April 05, 2021. / Amal Mattu, 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. AIRWAY — DOWNEAST EMERGENCY MEDICINE Rapid Sequence Intubation, Airway Rescue Devices, Surgical Airway. Michael Gibbs, MD, FACEP. Chair, Department of Emergency Medicine. Carolinas Medical Center. Charlotte, North Carolina. Professor of Emergency Medicine. Carolinas HealthCare System. Use of the Fiberoptic Scope in the Emergency Department from Downeast Emergency Medicine on

Vimeo.

ED BOARDING

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. TRANSCUTANEOUS PACING Step 1: Apply the pacing electrodes and consider sedation (eg. versed) Avoid placing the pads over an AICD or transdermal drug patches. There is little data on optimal placement however, try to place the pads as close as possible to the PMI (point of maximal impulse) NERVE BLOCKS OF THE FOOT AND ANKLE The deep peroneal nerve lies in the groove between the extensor hallucis longus and the tibialis anterior tendon. The hallucis longus can be located by having the patient flex and extend the big toe. The tibialis interior can be located by having the patient dorsi flex the foot and invert the ankle. The injection site should be at the level

of

NERVE BLOCKS OF THE HAND AND WRIST

TXA BEYOND TRAUMA

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 RESUS OF THE HYPOTENSIVE PATIENT PART 1 Take away Points. 1. Unnecessary IV fluid increases mortality and kidney injury in the critically ill. 2. Most patients with septic shock do not have profound volume depletion but an increase in unstressed venous volume. 3. Cardiac output can be increased with vasopressor infusions without exposing patients to the harms of IV

fluid.

BLOOD CAN BE VERY BAD! Blood can be very bad. Utilizing a systematic approach is one way that the clinician can ensure significant neuropathology will not be missed. Just as physicians are taught a uniform, consistent approach to reading an ECG (rate, rhythm, axis, etc.), the cranial CT can also be broken down into discreet entities, attention to which will help avoid the pitfall of a missed diagnosis. DOWNEAST EMERGENCY MEDICINEBLOGPODCASTJOURNAL CLUBVIDEO LECTURESWELLNESSRESIDENT EDUCATION November 10, 2020. / Tania D. Strout, PhD, RN, MS. Vasopressors are used in Emergency Medicine to treat cardiac arrest, hypotension, and shock. Recent studies have sought to investigate questions around timing, medication choices, and administration of these medications in varying clinical scenarios. The emergency provider must be familiar

with

TWO STEMI MIMICS YOU'VE GOT TO KNOW! Two STEMI Mimics You've Got to Know! April 05, 2021. / Amal Mattu, 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. AIRWAY — DOWNEAST EMERGENCY MEDICINE Rapid Sequence Intubation, Airway Rescue Devices, Surgical Airway. Michael Gibbs, MD, FACEP. Chair, Department of Emergency Medicine. Carolinas Medical Center. Charlotte, North Carolina. Professor of Emergency Medicine. Carolinas HealthCare System. Use of the Fiberoptic Scope in the Emergency Department from Downeast Emergency Medicine on

Vimeo.

ED BOARDING

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. TRANSCUTANEOUS PACING Step 1: Apply the pacing electrodes and consider sedation (eg. versed) Avoid placing the pads over an AICD or transdermal drug patches. There is little data on optimal placement however, try to place the pads as close as possible to the PMI (point of maximal impulse) NERVE BLOCKS OF THE FOOT AND ANKLE The deep peroneal nerve lies in the groove between the extensor hallucis longus and the tibialis anterior tendon. The hallucis longus can be located by having the patient flex and extend the big toe. The tibialis interior can be located by having the patient dorsi flex the foot and invert the ankle. The injection site should be at the level

of

NERVE BLOCKS OF THE HAND AND WRIST

TXA BEYOND TRAUMA

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 RESUS OF THE HYPOTENSIVE PATIENT PART 1 Take away Points. 1. Unnecessary IV fluid increases mortality and kidney injury in the critically ill. 2. Most patients with septic shock do not have profound volume depletion but an increase in unstressed venous volume. 3. Cardiac output can be increased with vasopressor infusions without exposing patients to the harms of IV

fluid.

BLOOD CAN BE VERY BAD! Blood can be very bad. Utilizing a systematic approach is one way that the clinician can ensure significant neuropathology will not be missed. Just as physicians are taught a uniform, consistent approach to reading an ECG (rate, rhythm, axis, etc.), the cranial CT can also be broken down into discreet entities, attention to which will help avoid the pitfall of a missed diagnosis. ULTRASOUND — DOWNEAST EMERGENCY MEDICINE Ocular Ultrasond. Recorded at the Maine Medical Center Winter Symposium in March 2017 in Sugarloaf, Maine. David Mackenzie, MD. Co-Director of Emergency Ultrasound. Maine Medical Center. The Softer Side of Ultrasound - Soft Tissue Ultrasound from Downeast Emergency Medicine on Vimeo. from Downeast Emergency Medicine.

ADMINISTRATION

This lecture was recorded at the 2016 Maine Medical Center Winter Symposium in Sugarloaf, Maine. mmcwintersymposium.com. Mattew Delaney, MD Assistant Director, Emergency Medicine Residency at the University of Alabama. ICD-10 and the Emergency Physician from Downeast Emergency Medicine on Vimeo. ICD-10 and the Emergency Physician. NERVE BLOCKS OF THE FACE AND MOUTH Facial Nerve BLOCKS . The supraorbital, infraorbital and mental nerves all line along an imaginary vertical line drawn through the pupil.When injecting in the mouth, provide topical anesthetic, retract mucosa to enhance vision & minimize needle insertion trauma, dry the injection site, and penetrate mucosa using distracting pain to minimize the pain

of injection.

REGIONAL ANESTHESIA

1. Altman RS, Smith-Coggins R, Ampel LL. Local Anesthetics. Ann Emerg Med. 1985 Dec. 14 (12):1209-17. 2. Bartfield JM, Jandreau SW, Raccio-Robak N. Randomized Trial of Diphenhydramine versus Benzyl Alcohol with Epinephrine as an Alternative to Lidocaine Local Anesthesia. Ann Emerg Med. 1998;32 (6):650–654. 3. Becker DE, Reed

KL.

UTERINE BLEEDING IN THE EMERGENCY DEPARTMENT 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 AIRWAY DAY — DOWNEAST EMERGENCY MEDICINE Recorded at the Maine Medical Center emergency medicine residency grand rounds. Michael Gibbs, MD, FACEP Professor and Chief of Emergency Medicine Carolinas Medical Center. Airway Day Part 2 - Assessing Patient's Physiology for Intubation from Downeast Emergency Medicine on Vimeo. Airway Day Part 2 - Assessing Patient's Physiology

for Intubation.

ECHO EXTRAVAGANZA PART 4: THE SUPRASTERNAL NOTCH VIEW Echo Extravaganza Part 4: The Suprasternal Notch View. Here’s comes another heaping helping of ultrasound highlights from our winter symposium’s echo extravaganza! In this serving, Dr. Mindy Lipsitz, MD shares some pearls about the suprasternal notch view to assess for trauma, coarctation, aortic root regurgitation, and aortic aneurysm. VELOCITY TIME INTEGRAL (VTI) AND THE PASSIVE LEG RAISE Hypotensive patients requiring volume resuscitation are a regular occurrence for emergency physicians. Clinicians are often faced with determining whether patients will respond favorably to IV fluids both before and during vasopressor administration. The ability for point of care ultrasound (includ BLOOD CAN BE VERY BAD! Blood can be very bad. Utilizing a systematic approach is one way that the clinician can ensure significant neuropathology will not be missed. Just as physicians are taught a uniform, consistent approach to reading an ECG (rate, rhythm, axis, etc.), the cranial CT can also be broken down into discreet entities, attention to which will help avoid the pitfall of a missed diagnosis. GET DOWN THAT K-HOLE! KETAMINE FOR CONTROL OF THE AGITATED Background. Agitation in the Emergency Department is a reality and there are ramifications for the staff and of course the patient. There are multiple causes for agitation ranging from psychiatric illness to drug intoxication and it can be difficult to know the etiology early

in the ED course.

DOWNEAST EMERGENCY MEDICINEBLOGPODCASTJOURNAL CLUBVIDEO LECTURESWELLNESSRESIDENT EDUCATION November 10, 2020. / Tania D. Strout, PhD, RN, MS. Vasopressors are used in Emergency Medicine to treat cardiac arrest, hypotension, and shock. Recent studies have sought to investigate questions around timing, medication choices, and administration of these medications in varying clinical scenarios. The emergency provider must be familiar

with

TWO STEMI MIMICS YOU'VE GOT TO KNOW! Two STEMI Mimics You've Got to Know! April 05, 2021. / Amal Mattu, 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. ULTRASOUND — DOWNEAST EMERGENCY MEDICINE Ocular Ultrasond. Recorded at the Maine Medical Center Winter Symposium in March 2017 in Sugarloaf, Maine. David Mackenzie, MD. Co-Director of Emergency Ultrasound. Maine Medical Center. The Softer Side of Ultrasound - Soft Tissue Ultrasound from Downeast Emergency Medicine on Vimeo. from Downeast Emergency Medicine. AIRWAY — DOWNEAST EMERGENCY MEDICINE Rapid Sequence Intubation, Airway Rescue Devices, Surgical Airway. Michael Gibbs, MD, FACEP. Chair, Department of Emergency Medicine. Carolinas Medical Center. Charlotte, North Carolina. Professor of Emergency Medicine. Carolinas HealthCare System. Use of the Fiberoptic Scope in the Emergency Department from Downeast Emergency Medicine on

Vimeo.

NERVE BLOCKS OF THE FOOT AND ANKLE The deep peroneal nerve lies in the groove between the extensor hallucis longus and the tibialis anterior tendon. The hallucis longus can be located by having the patient flex and extend the big toe. The tibialis interior can be located by having the patient dorsi flex the foot and invert the ankle. The injection site should be at the level

of

TRANSCUTANEOUS PACING Step 1: Apply the pacing electrodes and consider sedation (eg. versed) Avoid placing the pads over an AICD or transdermal drug patches. There is little data on optimal placement however, try to place the pads as close as possible to the PMI (point of maximal impulse) NERVE BLOCKS OF THE HAND AND WRIST

ED BOARDING

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.

TXA BEYOND TRAUMA

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 BLOOD CAN BE VERY BAD! Blood can be very bad. Utilizing a systematic approach is one way that the clinician can ensure significant neuropathology will not be missed. Just as physicians are taught a uniform, consistent approach to reading an ECG (rate, rhythm, axis, etc.), the cranial CT can also be broken down into discreet entities, attention to which will help avoid the pitfall of a missed diagnosis. DOWNEAST EMERGENCY MEDICINEBLOGPODCASTJOURNAL CLUBVIDEO LECTURESWELLNESSRESIDENT EDUCATION November 10, 2020. / Tania D. Strout, PhD, RN, MS. Vasopressors are used in Emergency Medicine to treat cardiac arrest, hypotension, and shock. Recent studies have sought to investigate questions around timing, medication choices, and administration of these medications in varying clinical scenarios. The emergency provider must be familiar

with

TWO STEMI MIMICS YOU'VE GOT TO KNOW! Two STEMI Mimics You've Got to Know! April 05, 2021. / Amal Mattu, 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. ULTRASOUND — DOWNEAST EMERGENCY MEDICINE Ocular Ultrasond. Recorded at the Maine Medical Center Winter Symposium in March 2017 in Sugarloaf, Maine. David Mackenzie, MD. Co-Director of Emergency Ultrasound. Maine Medical Center. The Softer Side of Ultrasound - Soft Tissue Ultrasound from Downeast Emergency Medicine on Vimeo. from Downeast Emergency Medicine. AIRWAY — DOWNEAST EMERGENCY MEDICINE Rapid Sequence Intubation, Airway Rescue Devices, Surgical Airway. Michael Gibbs, MD, FACEP. Chair, Department of Emergency Medicine. Carolinas Medical Center. Charlotte, North Carolina. Professor of Emergency Medicine. Carolinas HealthCare System. Use of the Fiberoptic Scope in the Emergency Department from Downeast Emergency Medicine on

Vimeo.

NERVE BLOCKS OF THE FOOT AND ANKLE The deep peroneal nerve lies in the groove between the extensor hallucis longus and the tibialis anterior tendon. The hallucis longus can be located by having the patient flex and extend the big toe. The tibialis interior can be located by having the patient dorsi flex the foot and invert the ankle. The injection site should be at the level

of

TRANSCUTANEOUS PACING Step 1: Apply the pacing electrodes and consider sedation (eg. versed) Avoid placing the pads over an AICD or transdermal drug patches. There is little data on optimal placement however, try to place the pads as close as possible to the PMI (point of maximal impulse) NERVE BLOCKS OF THE HAND AND WRIST

ED BOARDING

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.

TXA BEYOND TRAUMA

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 BLOOD CAN BE VERY BAD! Blood can be very bad. Utilizing a systematic approach is one way that the clinician can ensure significant neuropathology will not be missed. Just as physicians are taught a uniform, consistent approach to reading an ECG (rate, rhythm, axis, etc.), the cranial CT can also be broken down into discreet entities, attention to which will help avoid the pitfall of a missed diagnosis.

ED BOARDING

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.

ADMINISTRATION

This lecture was recorded at the 2016 Maine Medical Center Winter Symposium in Sugarloaf, Maine. mmcwintersymposium.com. Mattew Delaney, MD Assistant Director, Emergency Medicine Residency at the University of Alabama. ICD-10 and the Emergency Physician from Downeast Emergency Medicine on Vimeo. ICD-10 and the Emergency Physician. NEUROLOGY — DOWNEAST EMERGENCY MEDICINE Neuroimaging Update: The Studies and Sequences You Should Know. Recorded at the 2018 Maine Medical Center Winter Symposium in Sugarloaf, Maine. www.mmcwintersymposium.com. Matthew S. Siket, MD, MS. Attacking TIAs: The Data to Drive Diagnostic Decision-Making and Management from Downeast Emergency Medicine on Vimeo. Attacking TIAs:

The Data to

REGIONAL ANESTHESIA

1. Altman RS, Smith-Coggins R, Ampel LL. Local Anesthetics. Ann Emerg Med. 1985 Dec. 14 (12):1209-17. 2. Bartfield JM, Jandreau SW, Raccio-Robak N. Randomized Trial of Diphenhydramine versus Benzyl Alcohol with Epinephrine as an Alternative to Lidocaine Local Anesthesia. Ann Emerg Med. 1998;32 (6):650–654. 3. Becker DE, Reed

KL.

UTERINE BLEEDING IN THE EMERGENCY DEPARTMENT 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

TXA BEYOND TRAUMA

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 PEDIATRICS — DOWNEAST EMERGENCY MEDICINE Recorded at the Maine Medical Center Emergency Medicine grand rounds in August 2017. Nathan W. Mick, MD, FACEP. Associate Chief, Emergency Medicine. Maine Medical Center. Associate Professor, Tufts University School of Medicine. Pediatric Fever in the Child 3-36 Months Old from Downeast Emergency Medicine on Vimeo. AIRWAY DAY — DOWNEAST EMERGENCY MEDICINE Recorded at the Maine Medical Center emergency medicine residency grand rounds. Michael Gibbs, MD, FACEP Professor and Chief of Emergency Medicine Carolinas Medical Center. Airway Day Part 2 - Assessing Patient's Physiology for Intubation from Downeast Emergency Medicine on Vimeo. Airway Day Part 2 - Assessing Patient's Physiology

for Intubation.

ARE YOU POSITIVE . . . OR FALSE POSITIVE? IMPROVING YOUR The EFAST exam is an integral component of an emergency provider’s trauma evaluation. In the right hands, it has a specificity > 90% for intra-abdominal free fluid. There are some pitfalls, however, that can trick the provider into thinking a false positive represents free

fluid. In this p

VELOCITY TIME INTEGRAL (VTI) AND THE PASSIVE LEG RAISE Hypotensive patients requiring volume resuscitation are a regular occurrence for emergency physicians. Clinicians are often faced with determining whether patients will respond favorably to IV fluids both before and during vasopressor administration. The ability for point of care ultrasound (includ _WELCOME TO OUR NEW EDUCATIONAL WEBSITE!  PLEASE SIGN UP IN THE SIDE BAR ON THE RIGHT TO RECEIVE UPDATES AND NEW POSTS BY EMAIL._

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July 08, 2019

ECHO EXTRAVAGANZA PART 4: THE SUPRASTERNAL NOTCH VIEW July 08, 2019 / Mindy Lipsitz, MD Here’s comes another heaping helping of ultrasound highlights from our winter symposium’s echo extravaganza! In this serving, Dr. Mindy Lipsitz, MD shares some pearls about the suprasternal notch view to assess for trauma, coarctation, aortic root regurgitation, and aortic

aneurysm.

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__July 08, 2019 / __Mindy Lipsitz,

MD / __Comment

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__ULTRASOUND , ECHO

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July 02, 2019

THE PREVENT TRIAL - WHEN TO USE BAG MASK VENTILATION IN YOUR

INTUBATIONS→

July 02, 2019

/

Sam Potter, MD and Jason Hine, MD When you're intubating your patient, twiddling your thumbs and waiting for your induction and paralytic to work, do you ever ask yourself "hmm, should I be bagging this patient?" In this podcast episode we talk about that very question and the new data from the PREVENT trial.

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__July 02, 2019

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May 20, 2019

ECHO EXTRAVAGANZA PART 3: THE 5 E’S OF ECHOCARDIOGRAPHY

May 20, 2019

/

Heidi Kimberly, MD

Here’s comes another heaping helping of ultrasound highlights from our winter symposium’s echo extravaganza! In this serving, Dr. Heidi Kimberly teaches us how to identify and characterize the 5 E’s of echocardiography: effusion, ejection fraction, equality of the right and left ventricle, exit (aortic root) and entrance (IVC).

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__May 20, 2019

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__Heidi Kimberly, MD / __Comment

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May 11, 2019

ACUTE OTITIS MEDIA- DO YOU REALLY KNOW WHAT YOU'RE DOING?

May 11, 2019

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Jason Hine, MD

In this blog post we talk ear infections, or Acute Otitis Media (AOM)- a common disease commonly diagnosed... and probably 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.

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__May 11, 2019

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__Jason Hine, MD / __Comment

__BLOG , PODCAST

__ACUTE OTITIS MEDIA

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April 16, 2019

THE SUBCLAVIAN LINE: THE RESUSCITATION LINE OF CHAMPIONS

April 16, 2019

/

Jason Hine, MD

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!!)

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__April 16, 2019

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__Jason Hine, MD / __Comment

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, PODCAST

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April 13, 2019

ECHO EXTRAVAGANZA PART 2: UNLOCKING THE APICAL FOUR CHAMBER VIEW

April 13, 2019

/

Christina Wilson, MD The apical four chamber view is a key window in obtaining the bedside echo as it helps assess both the size and function of the atria, and ventricles. Window shopping for this view can be tricky, however, as there are specific requirements for probe orientation. In this blog post and video, Dr. Christina Wilson helps us understand the subtleties of this window and how to troubleshoot for the perfect four

chamber view.

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__April 13, 2019

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__Christina Wilson, MD / __Comment

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, FOUR CHAMBER

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March 27, 2019

FEATURE FILM - WINDOW TO THE HEART- POINT OF CARE ECHOCARDIOGRAPHY

March 27, 2019

/ Randy

Kring, MD

We apologize that it has been so long since our last blog post . . . we were busy preparing for our annual Winter Symposium. What a fantastic year it was! It included an amazing point of care echocardiography extravaganza by the course’s ultrasound faculty. We covered core content, the 5 E’s of echocardiography, mastering the suprasternal notch, unlocking the apical four chamber view and tricuspid annular plane systolic excursion … phew! We are excited to roll out this content to you over the coming weeks, starting with Dr. Kring’s core content on point of care echocardiography.

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February 11, 2019

ARE YOU POSITIVE . . . OR FALSE POSITIVE? IMPROVING YOUR INTERPRETATION OF THE EFAST EXAM

February 11, 2019

/

Evan Gill, MD and Randy Kring, MD The EFAST exam is an integral component of an emergency provider’s trauma evaluation. In the right hands, it has a specificity > 90% for intra-abdominal free fluid. There are some pitfalls, however, that can trick the provider into thinking a false positive represents free fluid. In this post, Dr. Gill and Dr. Kring help us improve our EFAST interpretation and recognize these “fake-outs.”

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__February 11, 2019

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__Evan Gill, MD and Randy Kring, MD

/ __Comment

__ULTRASOUND , BLOG

__EFAST

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February 04, 2019

ANALGESICS IN THE ED: WHAT WORKS, WHAT DOESN’T

February 04, 2019

/

Matthew Delaney, MD, FACEP Prompt, safe, and effective pain management is a core competency of the emergency provider. Unfortunately, traditional strategies for administering analgesics for acute pain have shown poor success rates. In this podcast episode, Dr. Matthew Delaney shares a few evidence based pain management pearls you can use on your next shift.

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__Matthew Delaney, MD, FACEP /

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, IBUPROFEN

, DILAUDID ,

MORPHINE , NSAIDS

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January 08, 2019

EPINEPHRINE IN OUT OF HOSPITAL CARDIAC ARREST - THE PARAMEDIC-2 TRIAL

January 08, 2019

/

Samuel Potter, MD

In this blog post and podcast we take a look at the PARAMEDIC-2 trial and discuss the implications this study has on the use of epinephrine in out of hospital cardiac arrest.

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__January 08, 2019

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__CARDIAC ARREST , Epinephrine

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Resuscitation

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