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Though Much Maligned, BVM is a Good Tool
​I’ve heard for years in emergency medicine circles that it was impossible to preoxygenate with a bag-valve mask (BVM) unless one is actually compressing the bag and forcing oxygen flow to the patient. I recently did an informal survey of my colleagues at work, and the responses varied from confident affirmation that the BVM was an inadequate tool for preoxygenation to quasi-warnings not to tread on this dogma without first consulting anesthesia or respiratory therapy. What started as a simple quest to clarify whether the dogma about BVMs and preoxygenation was true turned into a fascinating review and new personal ins...
Source: M2E Too! Mellick's Multimedia EduBlog - October 5, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A Role for Magnetism in the ED
​Children have this strange predilection for placing small objects in body cavities and orifices. Besides putting foreign bodies in their mouths, an act that often leads to ingestion or aspiration, the ear canals and nares are their favorite locations for depositing plastic beads, toy parts, paper materials, small vegetables, jewelry, screws, and nails, and that frequently brings them to the emergency department. Unsuccessful attempts to remove the foreign bodies in the ED lead to a consultation or referral to an ENT specialist. The timing, technique, and tools used to remove a foreign body will depend on the anatom...
Source: M2E Too! Mellick's Multimedia EduBlog - September 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Desperate Times Call for Desperate Measures: Double Simultaneous Defibrillation
​Double sequential defibrillation appears to work in the electrophysiology lab, and anecdotal evidence shows that lives can be saved in the prehospital setting and in the emergency department. With all the unanswered questions swirling around it, should we use this technique? Let’s consider the evidence.Using two sets of defibrillators fired simultaneously or in a sequential pattern to treat refractory ventricular fibrillation is a relatively new concept. A number of different names for the procedure exist, but double sequential external defibrillation (DSED) or double simultaneous defibrillation (DSD) are commonly use...
Source: M2E Too! Mellick's Multimedia EduBlog - August 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Survival of a Torsed Testicle
​The time for possible salvage and survival of a torsed testicle is commonly thought to be six to eight hours, a period that is expressed with confidence by the medical and legal professions. Survival of torsed testicles with and without subsequent atrophy is known to occur outside that critical window. My colleagues recently treated a 17-year-old boy approximately three days after the onset of right scrotal pain. He reported his pain constantly as 8/10 in severity. He didn't tell his mother for several days because he was scared, embarrassed, and hoping that the pain and swelling would resolve.​The patient was taken t...
Source: M2E Too! Mellick's Multimedia EduBlog - July 3, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

‘Out-the-Door’ v. ‘Kitchen-Sink’ Asthma Management
​Are you one of those clinicians who frequently finds himself frustrated with asthma patients who improve to a point but not enough to discharge home? Even though this has to be a common problem, no one seems to talk or write much about it. I was feeling deeply frustrated about these patients, and it led me to serious clinical introspection. Why does everyone write about the crashing asthma patient, but hardly anyone addresses the problematic patient with improving but recalcitrant bronchospasm?Most articles typically cover every available therapeutic option, including the proverbial “kitchen sink” for managing sever...
Source: M2E Too! Mellick's Multimedia EduBlog - June 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Appendagitis, a Rare Cause of Abdominal Pain
​The differential list of potential causes of abdominal pain is pretty long. Like most differentials, though, it usually boils down to a handful of more common etiologies benign and serious. Potentially life- or organ-threatening conditions such as appendicitis, diverticulitis, or ovarian or testicular torsion simply cannot be misdiagnosed and usually aren't missed.​We frequently find ourselves walking into the patient's room at the end of an extensive and exhaustive workup and announcing the good news that the cause of the pain isn't one of these more serious causes. As emergency physicians working in an uncontrolled ...
Source: M2E Too! Mellick's Multimedia EduBlog - May 3, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Mistakes that Kill during Cardiopulmonary Resuscitation
​Hanging out with cardiopulmonary researchers effectively imprinted on my psyche that we fail our patients during cardiopulmonary resuscitation in many ways. Unfortunately, too many patients who could have walked out of the hospital after experiencing death don't because of our mistakes in CPR. It's critical to find the resuscitation sweet spot for each patient and to never waver during a CPR event. These are the ways we can kill our patients during cardiopulmonary resuscitation:Too Slow or Too FastThe recommended heart rate for cardiopulmonary resuscitation was 60 compressions/minute in 1960. (JAMA 1960;173:1064...
Source: M2E Too! Mellick's Multimedia EduBlog - March 31, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Oldie but Goodie Pediatric Clinical Concepts
​A number of older clinical concepts may be unfamiliar to younger clinicians, but these clinical concepts are useful in pediatric medicine. Some of these concepts showed up in the medical literature for the first time nearly a century ago. Physicians should feel free to question the potential value and validity of older clinical concepts that aren't at the forefront of medical education, but my experience of more than 30 years practicing pediatrics and emergency medicine has repeatedly affirmed to me that these are valuable in emergency medicine.​Parenteral DiarrheaThe concept of parenteral diarrhea has been around for...
Source: M2E Too! Mellick's Multimedia EduBlog - March 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs