M2E Too! Mellick's Multimedia EduBlog 
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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
Managing Sacroiliac Pain in the Emergency Department
I have been treating specifically localized sacroiliac pain with injections of bupivacaine and methylprednisolone for several years. It seems that every few months I have a patient who presents with localized pain and can benefit from this procedure. The only patients on whom I perform these injections are those who localize their pain to the back dimples, also known as the dimples of Venus or fossae lumbales laterales.
Anatomically, it is known that beneath these dimples are the superior aspects of the sacroiliac joints. These sacral sulci are anatomically just above the posterior superior iliac spine and also the ju...
Source: M2E Too! Mellick's Multimedia EduBlog - November 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Managing Sacroiliac Pain in the Emergency Department
I have been treating specifically localized sacroiliac pain with injections of bupivacaine and methylprednisolone for several years. It seems that every few months I have a patient who presents with localized pain and can benefit from this procedure. The only patients on whom I perform these injections are those who localize their pain to the back dimples, also known as the dimples of Venus or fossae lumbales laterales.
Anatomically, it is known that beneath these dimples are the superior aspects of the sacroiliac joints. These sacral sulci are anatomically just above the posterior superior iliac spine and also the junc...
Source: M2E Too! Mellick's Multimedia EduBlog - November 2, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Open Airway-Neutral Cervical Spine
We received three consecutive pediatric trauma patients on backboards and in cervical collars during a recent shift in the pediatric ED. What was obvious with all three of these patients was their lack of a neutral cervical spine. Their airways simultaneously appeared to be partially compromised as large occiputs caused cervical flexion, their chins were pushed upward, and their mouths were forced closed as the cervical collars’ chin stabilizers were scrunched against their chest walls.
The heads of children are disproportionately large compared with their bodies. The cartoonist, Charles Schulz, captured the essence...
Source: M2E Too! Mellick's Multimedia EduBlog - October 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Open Airway-Neutral Cervical Spine
We received three consecutive pediatric trauma patients on backboards and in cervical collars during a recent shift in the pediatric ED. What was obvious with all three of these patients was their lack of a neutral cervical spine. Their airways simultaneously appeared to be partially compromised as large occiputs caused cervical flexion, their chins were pushed upward, and their mouths were forced closed as the cervical collars’ chin stabilizers were scrunched against their chest walls.
The heads of children are disproportionately large compared with their bodies. The cartoonist, Charles Schulz, captured the essence o...
Source: M2E Too! Mellick's Multimedia EduBlog - October 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Appreciating My Surgical Colleagues
Emergency medicine was a section in the department of surgery at the Medical College of Georgia until we became a department in 1996. The designation as an academic department occurred as part of my job negotiations when I was being recruited as the first academic chairman of emergency medicine.
But sometimes hard feelings and animosity lingers. I would like to say that relations with our surgical services were amiable and characterized by mutual respect in the years that followed, but in fact, hostility, open and hidden, was common. Consequently, to this day I still have a slight surge of adrenaline (fight, not fligh...
Source: M2E Too! Mellick's Multimedia EduBlog - September 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Appreciating My Surgical Colleagues
Emergency medicine was a section in the department of surgery at the Medical College of Georgia until we became a department in 1996. The designation as an academic department occurred as part of my job negotiations when I was being recruited as the first academic chairman of emergency medicine.
But sometimes hard feelings and animosity lingers. I would like to say that relations with our surgical services were amiable and characterized by mutual respect in the years that followed, but in fact, hostility, open and hidden, was common. Consequently, to this day I still have a slight surge of adrenaline (fight, not flight)...
Source: M2E Too! Mellick's Multimedia EduBlog - September 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Solving the Problem of Delivering Oxygen during Needle Cricothyroidotomy
BY RICAURTE A. SOLIS, DO
When faced with a "can't intubate, can't oxygenate" crisis, the decision to move to a surgical airway must be made rapidly and deliberately. A surgical cricothyroidotomy is debatably the better approach in these situations, but a needle cricothyroidotomy may sometimes be indicated. It may be easier to perform in a very small child, for example, and although it is probably less than ideal in an adult, a rapid needle cricothyroidotomy may provide an oxygenation bridge that will prevent a critically hypoxic patient from arresting until a more definitive airway is secured.
Cricothyr...
Source: M2E Too! Mellick's Multimedia EduBlog - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Solving the Problem of Delivering Oxygen during Needle Cricothyroidotomy
BY RICAURTE A. SOLIS, DO
When faced with a "can't intubate, can't oxygenate" crisis, the decision to move to a surgical airway must be made rapidly and deliberately. A surgical cricothyroidotomy is debatably the better approach in these situations, but a needle cricothyroidotomy may sometimes be indicated. It may be easier to perform in a very small child, for example, and although it is probably less than ideal in an adult, a rapid needle cricothyroidotomy may provide an oxygenation bridge that will prevent a critically hypoxic patient from arresting until a more definitive airway is secured.
Cricothyroido...
Source: M2E Too! Mellick's Multimedia EduBlog - August 3, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Pain Management with Low-Dose Ketamine Infusions
Ketamine is a fascinating drug with multiple potential applications in the emergency department, but emergency physicians should consider this phencyclidine-like dissociative agent for pain management.
Pain, as we know, has complex mechanisms and pathways. Peripheral and central sensitization of pain pathways are recognized as part of the process of chronic and subacute pain syndromes. The NMDA receptor is central to the sensation of pain, and ketamine’s ability to centrally block the NMDA receptor is widely recognized and accepted as the mechanism for pain relief.
Ketamine is rapidly distributed into the brain...
Source: M2E Too! Mellick's Multimedia EduBlog - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Pain Management with Low-Dose Ketamine Infusions
Ketamine is a fascinating drug with multiple potential applications in the emergency department, but emergency physicians should consider this phencyclidine-like dissociative agent for pain management.
Pain, as we know, has complex mechanisms and pathways. Peripheral and central sensitization of pain pathways are recognized as part of the process of chronic and subacute pain syndromes. The NMDA receptor is central to the sensation of pain, and ketamine’s ability to centrally block the NMDA receptor is widely recognized and accepted as the mechanism for pain relief.
Ketamine is rapidly distributed into the brain and...
Source: M2E Too! Mellick's Multimedia EduBlog - July 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Teasing Out the Characteristics of Targetoid Rashes
Targeted or targetoid rashes are one specific rash presentation that is commonly seen and occurs with at least three conditions. Other conditions have target-like lesions, but by far the most common are acute annular urticaria or urticaria multiforme, erythema multiforme, and serum sickness-like rashes (SSLR).
Unlike true serum sickness, SSLR is not a type III reaction, and frank arthritis, hypocomplementemia, vasculitis, and nephropathy are not typically seen. These rashes have significant overlap in presentation and appearance, and they are frequently confused for each other. Nevertheless, it is possible to tease ou...
Source: M2E Too! Mellick's Multimedia EduBlog - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Teasing Out the Characteristics of Targetoid Rashes
Targeted or targetoid rashes are one specific rash presentation that is commonly seen and occurs with at least three conditions. Other conditions have target-like lesions, but by far the most common are acute annular urticaria or urticaria multiforme, erythema multiforme, and serum sickness-like rashes (SSLR).
Unlike true serum sickness, SSLR is not a type III reaction, and frank arthritis, hypocomplementemia, vasculitis, and nephropathy are not typically seen. These rashes have significant overlap in presentation and appearance, and they are frequently confused for each other. Nevertheless, it is possible to tease out ...
Source: M2E Too! Mellick's Multimedia EduBlog - June 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Flesh-Eating Vasculitis from Cocaine Adulterant
My father was a small-town preacher. I heard the Bible verse that begins with the phrase “For the wages of sin is death” many, many times. Admittedly, it comes to mind at least once every shift I work in the ED. The cyanotic and apneic heroin overdose patient dropped off by “friends,” the drunk driver who just killed someone, or the pack-a-day cigarette smoker receiving news of lung cancer are all examples of self-destructive scenarios that might stimulate this memory.
I had read about levamisole-adulterated cocaine causing a flesh-destructive vasculitis, but had not seen a patient with this condition until re...
Source: M2E Too! Mellick's Multimedia EduBlog - May 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Flesh-Eating Vasculitis from Cocaine Adulterant
My father was a small-town preacher. I heard the Bible verse that begins with the phrase “For the wages of sin is death” many, many times. Admittedly, it comes to mind at least once every shift I work in the ED. The cyanotic and apneic heroin overdose patient dropped off by “friends,” the drunk driver who just killed someone, or the pack-a-day cigarette smoker receiving news of lung cancer are all examples of self-destructive scenarios that might stimulate this memory.
I had read about levamisole-adulterated cocaine causing a flesh-destructive vasculitis, but had not seen a patient with this condition until rece...
Source: M2E Too! Mellick's Multimedia EduBlog - May 1, 2015 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
