February 19, 2021

Journal Club - COVID-19 Therapeutics

February 19, 2021/ Jeffrey A. Holmes, MD

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.

July 08, 2020

Resuscitative Transesophageal Echocardiography in the Emergency Department

July 08, 2020/ Jeffrey A. Holmes, MD

We are extremely fortunate to have one of our fearless ultrasound leaders, Dr. Andrew Fried, lead us into the world of resuscitative transesophageal echocardiography at Maine Medical Center. In our recent grand rounds, he presented the latest cutting edge literature behind this technology and why its the right thing to do for our patients.

May 26, 2020

Feature Film - How to Design and Deliver a Powerful Presentation

May 26, 2020/ Jeffrey A. Holmes, MD

The need to effectively communicate your message during a presentation goes without saying (pun intended). Presentation mediums like Powerpoint and Keynote have the potential to help a speaker, but they too often serve as nothing more than containers for reams of text. “Death by Powerpoint!”, we joke to one another. So how do we improve? What are the core principles of preparation, design and delivery that make up a powerful presentation? In this post’s feature film, David Mackenzie, known for his engaging and powerful presentations, shares with us some of the ingredients in his secret sauce.

May 07, 2020

COVID19 and Point of Care Lung Ultrasound

May 07, 2020/ Jeffrey A. Holmes, MD

COVID19 has presented many difficult challenges in its diagnosis and managment. This is no truer than bedside lung evaluation. Personal protective equipment can be prohibitive of adequate lung ausculation and the use of a stethoscope is discouraged by some as it is considered a high risk fomite. Fortunately, point of care ultrasound (POCUS) continues to be an important tool in the emergency provider’s toolbox for decision support and risk stratification. It is quick to perform, easy to interpret, and may be done quickly at the bedside. To help us quickly understand the technique, findings and evidence behind lung POCUS for the COVID19 (+) or suspected patient, ultrasound fellow Dr. Christopher Allison has crafted us a high yield infographic.

April 06, 2020

Diagnostic Musculoskeletal Ultrasound - Joint effusion

April 06, 2020/ Jeffrey A. Holmes, MD

Musculoskeletal ultrasound can be a powerful tool for the emergency provider. It can help diagnose acute and chronic painful conditions, evaluate dynamic movement, and assist in bedside procedures like a hematoma block. It is cost effective, accessible, lacks radiation, and can visualize fine details of local anatomy that xrays cannot (i.e. ligaments, bursa, tendons, muscles and nerves). This year’s ultrasound workshop at our Winter Symposium included various uses of musculoskeletal ultrasound (shoulder evaluation, evaluation of a suspected joint effusion, hematoma blocks/reductions, and tendon injuries). In this week’s post we bring you Dr. Nick Ashenburg’s presentation on the use of ultrasound for the evaluation of joint effusions.

March 20, 2020

Diagnostic Musculoskeletal Ultrasound - Shoulder Dislocation

March 20, 2020/ Jeffrey A. Holmes, MD

Musculoskeletal ultrasound can be a powerful tool for the emergency provider. It can help diagnose acute and chronic painful conditions, evaluate dynamic movement, and assist in bedside procedures like a hematoma block. It is cost effective, accessible, lacks radiation, and can visualize fine details of local anatomy that xrays cannot (i.e. ligaments, bursa, tendons, muscles and nerves). This year’s ultrasound workshop at our Winter Symposium included various uses of musculoskeletal ultrasound (shoulder evaluation, evaluation of a suspected joint effusion, hematoma blocks/reductions, and tendon injuries). In this week’s post we bring you Dr. Gabriela Lopes presentation on the use of ultrasound for shoulder dislocation.

March 16, 2020

TXA Beyond Trauma

March 16, 2020/ Jeffrey A. Holmes, 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 led creative emergency providers to find novel uses for it at the bedside. In this podcast, Dr. Tim Fallon discusses some of the more novel bedside uses for TXA including epistaxis, hemoptysis, post tonsillectomy bleeding, and dental trauma.

March 10, 2020

Diagnostic Musculoskeletal Ultrasound - Tendon Injuries

March 10, 2020/ Jeffrey A. Holmes, MD

Musculoskeletal ultrasound can be a powerful tool for the emergency provider. It can help diagnose acute and chronic painful conditions, evaluate dynamic movement, and assist in bedside procedures like a hematoma block. It is cost effective, accessible, lacks radiation, and can visualize fine details of local anatomy that xrays cannot (i.e. ligaments, bursa, tendons, muscles and nerves). This year’s ultrasound workshop at our Winter Symposium included various uses of musculoskeletal ultrasound (shoulder evaluation, evaluation of a suspected joint effusion, hematoma blocks/reductions, and tendon injuries). We are excited to roll out this content to you in the coming weeks, starting with Dr. Fried’s presentation on the use of ultrasound for tendon injury.

January 31, 2020

Simulation Cases Cliff's Notes - Appendicitis in Pregnancy

January 31, 2020/ Jeffrey A. Holmes, MD

Every month we summarize our simulation cases. No deep dive here, just the top five take aways from this month's case on diagnosing appendicits in pregnancy.