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The Curse of Delusional Parasitosis
​Delusional parasitosis is a rare condition, but it is more common where methamphetamine and cocaine abuse is high. It is a fascinating condition to witness; patients are convinced that their skin is infested with foreign organisms or materials despite incontrovertible evidence to the contrary.This condition is known by numerous names—Ekbom syndrome, delusory parasitosis, psychogenic parasitosis, delusional parasitosis, delusional ectoparasitosis, formication, chronic tactile hallucinosis, dermatophobia, parasitophobia, and cocaine bugs—but delusional parasitosis and more recently delusional infestation are considere...
Source: M2E Too! Mellick's Multimedia EduBlog - September 29, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

My Foley Balloon Won’t Deflate!
​Sometimes when it's time to remove a Foley catheter, the balloon won't deflate. This problem occurs more commonly in patients with long-term Foley catheters. Even though we have all seen nursing home patients present with penile bleeding after pulling out their Foley catheter with the balloon still inflated, that is obviously not an option for emergency physicians. The problem is that the recalcitrant balloon is sitting out of reach, deep in the urinary bladder.The cause of the balloon malfunction can be anywhere along the catheter, but it's usually found in the balloon inflation port, the balloon drainage channel, or t...
Source: M2E Too! Mellick's Multimedia EduBlog - August 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Managing All Manner of Bursitis Cases
​A bursa, a fluid-filled synovial sack, serves in the body as either a pulley or a cushion, and bursitis, of course, is an inflammatory response that can occur to a bursa. The causes of the inflammatory response can be trauma (direct or overuse), infection, or rheumatologic or crystal-induced disease.​Whether a bursa is deep or superficial ultimately determines the most likely pathophysiology and dictates the most appropriate treatment. Superficial bursae are those closest to the skin, and they are most vulnerable to direct trauma and infection—the prepatellar, infrapatellar, and olecranon bursae. Deep bursae include...
Source: M2E Too! Mellick's Multimedia EduBlog - August 6, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Compartment Syndrome Like You Haven’t Seen Before
​The fascial planes in the upper and lower extremities play an important role in function and form, but they also make the extremities vulnerable to compartment syndrome. Emergency physicians are quite comfortable evaluating and diagnosing compartment syndrome: severe unrelenting pain, pain with passive motion of the muscle groups involved, and possibly paresthesias and pallor. The first patient I saw with this condition was at the Tripler Army Medical Center in Hawaii. A sailor dangling his legs over the dock presented after his leg was crushed between the dock and a battleship that suddenly shifted its position. I ...
Source: M2E Too! Mellick's Multimedia EduBlog - July 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Severe Disulfiram or Antabuse Reactions
​Alcoholism has been treated with disulfiram (Antabuse) ever since the drug received FDA approval in 1951. Disulfiram is one of a number of medications that produces unwanted side effects caused by the accumulation of acetaldehyde when taken with alcohol.​The story behind the discovery of disulfiram is typical of serendipitous observations. A physician noted in 1937 that workers in the rubber industry exposed to disulfiram developed a reaction after drinking alcohol. Several decades later, two Danish researchers evaluating disulfiram as an antihelminthic developed symptoms after attending a cocktail party. (Medscape, J...
Source: M2E Too! Mellick's Multimedia EduBlog - June 1, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Small Hairs Make Big Cuts (and Consequences)
​The hair or thread tourniquet syndrome is a relatively rare condition that has evaded me in the emergency department for several decades, until past year when three cases showed up over six months. This condition has been around for as long as there has been hair or thread and body appendages. In fact, this condition may have first been described in the 1600s. (J Pediatr Adolesc Gynecol 2005;18[3]:155.)The etiology of this condition seems almost unbelievable. How in the world does a hair get wrapped repeatedly and tightly around an appendage of the body? Some authors expressed the need to consider nonaccidental etio...
Source: M2E Too! Mellick's Multimedia EduBlog - April 30, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Understanding Headache Classifications
​Many types and etiologies of headache and facial pain afflict our patients, and sorting through them can be a challenge. Craniofacial experts themselves, in fact, do not attempt to remember the subtle differences between the various conditions causing craniofacial pain, but instead refer to the third edition of the International Classification of Headache Disorders (ICHD-3). (https://www.ichd-3.org/.)The ICHD-3 can help the clinician manage patients presenting with headache as their chief complaint. An international panel of headache experts oversee the classification, which is currently published in a beta format s...
Source: M2E Too! Mellick's Multimedia EduBlog - April 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

That Darned Foreskin
​I was a practicing pediatrician before I did a residency in emergency medicine. One of the most common and sometimes most stressful decisions parents had to make in the neonatal nursery was whether to circumcise their newborn son. I have to admit that the hullabaloo about the foreskin has always intrigued me. The American Academy of Pediatrics has gone back and forth over the years on the topic of circumcision and its benefits, but the current evidence clearly establishes a benefit from this procedure (Pediatrics 2012;130[3]:e756) that is performed approximately 1.4 million times each year in the United States. (May...
Source: M2E Too! Mellick's Multimedia EduBlog - February 28, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Babies, Puppies, and Therapy Pets
​Recently, I acquired a little Yorkshire terrier puppy for my 15-year-old daughter who had been requesting a puppy for many months. On the way home, she silently wept with joy over the puppy sleeping in her lap. The two girls immediately fell in love, and it has been fascinating watching my daughter's maternal instincts unfold. She now gushes over babies in strollers, every dog or puppy she sees, and every other small animal that runs across the road. It has also brought out the mama bear protective instincts in her. I mean, if I turn in front of a car a quarter mile away, she admonishes me for putting the "the baby...
Source: M2E Too! Mellick's Multimedia EduBlog - January 31, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Tactical Tourniquets to Stop Traumatic Bleeding
​Four different tourniquets can be used to manage uncontrolled extremity hemorrhage—the SWAT-Tourniquet, the Combat Application Tourniquet (C-A-T), the SOF Tactical Tourniquet, and the Rapid Application Tourniquet System (R.A.T.S.). All four include a tightening strap that wraps around an extremity.​R.A.T.S. uses a thick bungee-like elastic cord. Both the C-A-T and SOF use an adjusting strap, but only the C-A-T uses Velcro to secure the strap and prevent loosening. The SOF has a tightening buckle that can be unsnapped to open the tourniquet and allow the strap to be wrapped around the limb rather than pulling it over...
Source: M2E Too! Mellick's Multimedia EduBlog - January 2, 2018 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The AAJT: Simplicity in the Face of Adversity
​There is a saying, "Complexity in the face of adversity breeds chaos." I'm not sure where this maxim originated, but it is definitely true in resuscitation settings. That's the crux of this post: Is the abdominal tourniquet simplicity in the face of adversity compared with the resuscitative endovascular balloon occlusion of the aorta (REBOA)?​We all know how futile it feels to do CPR on a traumatic cardiac arrest patient with suspected massive blood loss. Just what are we pumping, and if there is any remaining intravascular blood, where are we pumping it?I will never forget the pain of trying to resuscit...
Source: M2E Too! Mellick's Multimedia EduBlog - December 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Cardioverting the First Emergency Medicine Residency Graduate
​The labor pains leading to the birth of the specialty of emergency medicine began in the mid-1960s. The public demand for emergency care was growing around the country, and physicians were leaving their private practices in greater numbers and working full-time in urban emergency departments. Nevertheless, the quality of care was at times problematic, and the need for training in emergency medicine was widely recognized.The American College of Emergency Physicians was founded in 1968, and it became a driving force for the creation of the specialty. The first training institution was the University of Cincinnati, and thi...
Source: M2E Too! Mellick's Multimedia EduBlog - November 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs