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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

Varicella Virus, the Old and the New
I want to reawaken awareness of a disappearing but highly contagious infectious disease — varicella. Thanks to immunizations for the wild-type varicella virus and shingles, or herpes zoster, younger health care providers are less aware of the appearance and clinical presentations of this viral infection.Presentations of this viral disease have markedly declined and presentations are often atypical since the advent of immunizations for varicella in 1995. This DNA virus within the herpes virus family is generally a mild childhood disease but can wreak physical havoc in adults, especially pregnant women. Immunosuppressed...
Source: M2E Too! Mellick's Multimedia EduBlog - February 1, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Soto Saline Sign for Pseudoseizures
Conversion reactions are commonly seen conditions in health care and come in various forms and presentations. Two common conversion reactions seen in the emergency department are conversion coma and psychogenic nonepileptic seizures (PNES). Both mimic life-threatening conditions and require rapid differentiation. Premature anchoring and wrong diagnoses can result in potentially harmful outcomes or expensive and unnecessary procedures, workups, and evaluations.Conversion disorder, or functional neurological symptom disorder, is categorized under the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, (...
Source: M2E Too! Mellick's Multimedia EduBlog - January 4, 2017 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Hemiplegic Migraine and Paraspinous Cervical Injections with Bupivacaine
I recently treated a patient with hemiplegic migraines successfully with bupivacaine cervical injections, a novel therapeutic technique using paraspinous cervical injections. The technique employs deep intramuscular injections of 1.5 mL of 0.5% bupivacaine bilaterally into the paraspinous muscles of the lower neck. (Read more in my October 2012 blog and see it demonstrated in a video at http://bit.ly/2ewC5n1.)This headache and orofacial pain treatment was first described in 1996 by my twin brother, Gary Mellick, DO, a neurologist who did a pain fellowship. The exact mechanism is unknown, but the treatment appears to...
Source: M2E Too! Mellick's Multimedia EduBlog - December 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Post-Tonsillectomy and Adenoidectomy Bleeding Emergencies
I have immense respect for a few pediatric emergency conditions. Post-surgical bleeding following a tonsillectomy and adenoidectomy (T&A) has given me several memorable patient care experiences over the years. Honestly, the word "memorable" is actually a euphemism for terrifying.Part of the problem with post-T&A bleeding is the patient. Typically, it's a pediatric patient who for hours has been quietly bleeding into the posterior pharynx while quietly swallowing the evidence (e.g., blood). By the time the patient presents to the ED, a significant but unknown percentage of the child's total blood vol...
Source: M2E Too! Mellick's Multimedia EduBlog - November 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

The Importance of Reproducing the Injury
Ankle dislocations are usually the result of high-energy trauma that cause plantar flexion of the ankle combined with an inversion or eversion stress. These dislocations are typically described according to the direction of displacement of the talus and foot in relation to the tibia. Consequently, dislocation may be upward, posterior, medial, lateral, posteromedial, or anterior. Posterior dislocation of the talus is the most common form of ankle dislocation. Associated fractures are the rule rather than exception, and ligamentous disruption varies according to the type of dislocation. One of the most dramatic joint di...
Source: M2E Too! Mellick's Multimedia EduBlog - October 3, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Two Novel Conditions with an Intriguing Link
How could a Lyme disease lookalike rash and anaphylaxis to meat have anything in common? As I found out recently, they do. They both have a common vector, the Lone Star Tick, which is also known by its formal name, Amblyomma americanum, and is found predominately in the East, Southeast, and Southwest. It is an aggressive tick that loves humans.In fact, all three growth stages (adult, nymph, and larva) are known to feed on humans. Besides the common signs of irritation that often accompany a tick bite, a rash similar to the rash of Lyme disease has been commonly described. This "bull's-eye" rash is often accomp...
Source: M2E Too! Mellick's Multimedia EduBlog - September 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Fish Hook Removal Emergency
Geographic location and seasonal variations often dictate the frequency of specific emergencies. I have been impressed over the years how often my geographic location would determine the type of injuries and emergencies that would show up in my emergency department. My two years in Honolulu taught me a lot about illnesses and injuries associated with work and recreation in the Pacific Ocean. Seasonal variations also affect the types of emergencies we see. Fish hook removal injuries are a prime example. Already this spring and summer I have had a number of children present with fish hooks embedded in their flesh so ...
Source: M2E Too! Mellick's Multimedia EduBlog - August 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs