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Hands On During Defibrillation: ‘I’m Not Clear!’
It’s a wonder that anyone survives — or survives neurologically intact — with all the interruptions that happen during the recognition, delivery, transfer, and treatment of a patient undergoing cardiopulmonary resuscitation.   The American Heart Association and the international resuscitation community have been constantly beating the drum in recent years about quality of chest compressions and the need to decrease interruptions that occur during cardiopulmonary resuscitation. (Circulation 2010;122[18 Suppl 3]:S706, 2010;122[18 Suppl 3]:S640, 2009;120[13]:1241; Resuscitation 2011;82[3]:263; Resuscitation 2010;81[10]...
Source: M2E Too! Mellick's Multimedia EduBlog - November 29, 2012 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Six Mistakes of Awake Intraosseous Infusion
I’ve been inserting and teaching how to insert an intraosseous (IO) needle for several decades. Like most of you, however, almost all of the IO needle insertions that I have performed were on obtunded or cardiac arrest patients (mostly pediatric and a few adult). Several years ago I did my first intraosseous needle insertion on an altered but awake adult. Much to my chagrin, I quickly learned that I really didn’t know what I was doing. I even documented my ineptness with a video so that others could learn from my mistakes. Most emergency physicians are comfortable with using IO needles during resuscitation, but their s...
Source: M2E Too! Mellick's Multimedia EduBlog - November 5, 2012 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Another Arrow for Your Headache Quiver: Cervical Injections
People don’t come to the emergency department for treatment of headaches unless their headache severity or duration is intolerable or the headache is frighteningly different. (Neurol Clin 1998 May;16[2]:285.) Usually, these headaches have failed to respond to their usual and standard therapies. In fact, those who market the migraine-specific triptan drugs recognize that headaches that have progressed to the state of central sensitization simply don’t respond well to their drugs. (Ann Neurol 2004;55[1]:27; Ann Neurol 2004;55[1]:19; Clin Ther 2000;22[9]:1035.) Central sensitization is an increased response to stimulation...
Source: M2E Too! Mellick's Multimedia EduBlog - October 2, 2012 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Priapism Emergency
Last month I focused on managing a common female genital problem, the Bartholin Gland abscess. In the spirit of equality, this month’s blog post looks at an important male genital problem, priapism. Unfortunately, the literature guiding treatment is not the most robust. Nevertheless, we do have recommendations and guidelines created by national and international experts who have digested the available literature. The guidelines created by the American Urological Association are the most frequently touted resource.(1)   I have written and delivered several lectures to our residents on this topic over the past several yea...
Source: M2E Too! Mellick's Multimedia EduBlog - September 5, 2012 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A Word about Word Catheters
Treating Bartholin’s gland abscesses by incision and drainage using a Word catheter seems pretty simple and straightforward. Buford Word, MD, a gynecologist, first described his invention in 1964. (1) The basic premise is to place a mini-Foley catheter balloon into the abscess, and the balloon foreign body prevents closure with the subsequent formation of an epithelial fistula. Ideally, it remains in place for four to six weeks. Patient satisfaction and the success rate is excellent in comparison with a simple incision and drainage or marsupialization. (2, 3) The apparent simplicity is a little deceiving, and some of the...
Source: M2E Too! Mellick's Multimedia EduBlog - August 1, 2012 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Tourniquets and Bleeding Varicose Veins
A large varicose vein ruptured on the back of this 37-year-old man’s lower leg. He had been afflicted with chronic lymphedema and large varicose veins for years. The bleeding was vigorous. A coworker created a makeshift tourniquet by wrapping his belt around the thigh. Unfortunately, the bleeding continued unabated for 20 minutes, and did not stop until the paramedics arrived and applied pressure dressings. Nevertheless, the prehospital providers applauded the coworker’s efforts and went so far as to give him credit for saving his colleague’s life. Was that a correct attribution? Is it possible that the proximal tour...
Source: M2E Too! Mellick's Multimedia EduBlog - May 30, 2012 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs