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Davos Technique Gains Traction for Shoulder Dislocations
Multiple methods are touted for reducing anterior shoulder dislocations, and every emergency physician seems to have gravitated to one or two methods that he uses routinely. Why someone prefers one technique over another is not clear, but the factors for technique selection seem to be training, ease of application, and prior successful experiences.Every reduction procedure will have some degree of applied rotation, torque, and traction, and pain is a common and unavoidable theme. Unfortunately, not all shoulder reductions are created equally. Variations in human anatomy, time duration of dislocation, and the actual locatio...
Source: M2E Too! Mellick's Multimedia EduBlog - June 27, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

A Kinder, Gentler Approach for Felons
I have serious issues with the current management recommendations for fingertip felons. I hate the thought of blindly "slicing and dicing" fingertips as treatment. I agree that fingertip abscesses should be drained, but I really question whether current approaches are the best. Thankfully, the really aggressive techniques of the past such as the through-and-through, hockey stick, or fish mouth incisions are no longer recommended. Currently, the unilateral longitudinal approach and the volar finger pad longitudinal approaches are recommended in textbooks. Unfortunately, even these recommendations are based purely ...
Source: M2E Too! Mellick's Multimedia EduBlog - June 2, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Treating Priapism in the Emergency Department
It's clear to me that emergency physicians have a number of mental blocks when it comes to managing priapism, which means this penile compartment syndrome is often allowed to languish while we wait for the urologists to come to our rescue.In this video blog, I remove some of the performance anxiety associated with this condition by teaching how to mix up the phenylephrine used for intracavernosal blocks. And, in the second video, I demonstrate how to set up an aspiration and irrigation system, which dramatically simplifies the entire process.Watch the first video here.Watch the second video here. Tags: priapism,...
Source: M2E Too! Mellick's Multimedia EduBlog - May 2, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

An Ophthalmic Photo and Video Tool for the iPhone
I purchased a neat little tool that allows me to use my iPhone 6s to take videos and photographs of the external surface of the eye. I am still learning how to maximize the photographs and videos, but the clinical and educational possibilities are really exciting. The Eidolon Photo Bluminator has the potential to take excellent still photographs and high-quality videos of the external surface of the eye.This tool allows photo filters that have blue LED light for fluorescein photos of the cornea or white LED illumination for photos of the anterior segment. Both are options for taking photos or shooting video. The lens provi...
Source: M2E Too! Mellick's Multimedia EduBlog - April 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Peritoneal Taps for Removing Ascites Fluids
Paracentesis, or a peritoneal tap, is a procedure emergency physicians often perform to obtain ascitic fluid for diagnostic or therapeutic purposes. Catheter aspiration of fluid is performed to determine the etiology in new onset ascites, to look for infection or presence of cancer, or simply to relieve pressure from a painful, distended abdomen that sometimes can interfere with breathing. Contraindications to the procedure might include an acute abdomen, severe thrombocytopenia, or a coagulopathy. Relative contraindications include pregnancy, a distended urinary bladder, abdominal wall cellulitis, adhesions, or distended ...
Source: M2E Too! Mellick's Multimedia EduBlog - March 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Ear Cartilage Laceration Repair
I find the repair of eyelid and ear lacerations sometimes daunting. In fact, I often allow the ophthalmology service to take the lead with eyelid injuries and plastic surgery to manage severely lacerated ears. Not only are the repair of these unique skin-over-cartilage structures at risk of serious complications, they are also potentially time-consuming.Ear cartilage is completely dependent on the overlying skin for survival and has unique risks for infection. Perichondritis is a feared complication that is sometimes resistant to treatment and can result in disfiguring complications.This video allows us to review the basic...
Source: M2E Too! Mellick's Multimedia EduBlog - February 1, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Like Pulling Teeth
“Like pulling teeth” is a commonly used idiom that refers to something difficult to accomplish. My video this month, however, would suggest that pulling teeth may actually not be all that tough. I recently spent a week in Jamaica as part of a medical and dental team providing care under relatively harsh conditions. The layout of our makeshift clinics allowed me to work alongside a dentist and two dental assistants. Besides getting the opportunity to pull my first permanent tooth, I was able to enlist the dental team’s collaboration on a teaching video, in which we demonstrate the elemental steps of pulling a too...
Source: M2E Too! Mellick's Multimedia EduBlog - January 4, 2016 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs

Triceps Surae Examination Pearls
Obviously, the patient who presents with calf pain requires careful consideration for a deep vein thrombosis. But when the history doesn’t fit, you may find yourself scratching your head trying to figure out the other sources of calf pain. Sure, you can just pick your favorite ICD-10 diagnosis for right or left calf strain, write a prescription for ibuprofen, give some crutches, and send the patient out the door. But that makes the practice of emergency medicine less exciting and fulfilling. Why not take the two additional minutes required to sort out exactly the source of the calf pain? This blog post provides several p...
Source: M2E Too! Mellick's Multimedia EduBlog - December 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs