M2E Too! Mellick's Multimedia EduBlog 
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This is an RSS file. You can use it to subscribe to this data in your favourite RSS reader or to display this data on your own website or blog.Sucking Chest Wound Management
A sucking chest wound or open pneumothorax is a fairly uncommon event off the battlefield, and civilian guidelines as a result are highly dependent on the experience of the military expert opinion concerning their management. Past recommendations were to place a three-sided occlusive dressing to allow air to egress to prevent a tension pneumothorax, but battlefield guidelines calling for an occlusive dressing closed on three of four sides have not proven to be effective or realistic. Covering the wound improves respiratory mechanics, but the three-sided occlusive dressing on bleeding chest wounds is no longer recommended. ...
Source: M2E Too! Mellick's Multimedia EduBlog - September 3, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Hypotension and Paradoxical Bradycardia
Relative or paradoxical bradycardia in the face of severe blood loss and hypotension fits squarely in the “it-just-ain’t-right” category. It isn’t right because it happens far more frequently than we recognize, and it contradicts what we have been taught about the body’s response to hemorrhage. A definite and significant subset of hypotensive patients will not mount a tachycardia response to hypotension, and a third or more of hypotensive trauma patients will present with bradycardia. (J Trauma 1998;45[3]:534 and 2009;67[5]:1051; J Am Coll Surg 2003;196[5]:679.)
But it just isn’t relative bradycardia in the fa...
Source: M2E Too! Mellick's Multimedia EduBlog - August 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Hypotension and Paradoxical Bradycardia
Relative or paradoxical bradycardia in the face of severe blood loss and hypotension fits squarely in the “it-just-ain’t-right” category. It isn’t right because it happens far more frequently than we recognize, and it contradicts what we have been taught about the body’s response to hemorrhage. A definite and significant subset of hypotensive patients will not mount a tachycardia response to hypotension, and a third or more of hypotensive trauma patients will present with bradycardia. (J Trauma 1998;45[3]:534 and 2009;67[5]:1051; J Am Coll Surg 2003;196[5]:679.)
But it just isn’t relative bradycardia in the fac...
Source: M2E Too! Mellick's Multimedia EduBlog - August 6, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
My Difficult Airway
Looks can be deceiving. I was not supposed to have a difficult airway, but we found out the hard way that wasn’t true. I was about to undergo an exploratory laparotomy for suspected appendicitis in 1989, and my wife was adamant that an attending anesthesiologist perform my intubation. The anesthesiology resident at a large Midwest teaching hospital made a claim that I suspect many of us did as we advanced through training and began to feel procedurally invincible. He claimed that the attending anesthesiologist rarely did intubations, and that the residents who performed them daily were more prepared. Unaware of any uniqu...
Source: M2E Too! Mellick's Multimedia EduBlog - July 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
My Difficult Airway
Looks can be deceiving. I was not supposed to have a difficult airway, but we found out the hard way that wasn’t true. I was about to undergo an exploratory laparotomy for suspected appendicitis in 1989, and my wife was adamant that an attending anesthesiologist perform my intubation. The anesthesiology resident at a large Midwest teaching hospital made a claim that I suspect many of us did as we advanced through training and began to feel procedurally invincible. He claimed that the attending anesthesiologist rarely did intubations, and that the residents who performed them daily were more prepared. Unaware of any uniqu...
Source: M2E Too! Mellick's Multimedia EduBlog - July 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Stopping Hemorrhage by Aortic Compression
Limb exsanguination is no longer the most common cause of preventable death on the battlefield because of emergency tourniquets. Hemorrhage control for wounds in the junction between the trunk and the limbs and in the neck are an obvious care gap, most commonly in the pelvic area, including the buttocks and groin proximal to the inguinal ligament. (US Army Med Dep J 2011 Apr-Jun:38.) Managing hemorrhagic shock also requires support of central aortic pressure to maximize perfusion of the brain and heart and to control bleeding effectively.
Noncompressible torso hemorrhage is recognized as the leading cause of death in ...
Source: M2E Too! Mellick's Multimedia EduBlog - June 4, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Stopping Hemorrhage by Aortic Compression
Limb exsanguination is no longer the most common cause of preventable death on the battlefield because of emergency tourniquets. Hemorrhage control for wounds in the junction between the trunk and the limbs and in the neck are an obvious care gap, most commonly in the pelvic area, including the buttocks and groin proximal to the inguinal ligament. (US Army Med Dep J 2011 Apr-Jun:38.) Managing hemorrhagic shock also requires support of central aortic pressure to maximize perfusion of the brain and heart and to control bleeding effectively.
Noncompressible torso hemorrhage is recognized as the leading cause of death in tr...
Source: M2E Too! Mellick's Multimedia EduBlog - June 4, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Can You Avoid Lumbar Puncture in Febrile Neonates?
I don’t have a problem with lumbar punctures in febrile neonates. In fact, my son ended up with three lumbar punctures before aging out of the febrile seizure protocols. I do have a problem, however, with doing unnecessary spinal taps. The emotional stress of a neonatal LP on parents is significant, and the physical stress of the procedure on the infant is also substantial.
The pain of the needle and the unique restraint required for the procedure are also potentially problematic. The pain of the needle can be minimized by EMLA cream (eutectic mixture of local anesthetics [lidocaine and prilocaine]) and local ...
Source: M2E Too! Mellick's Multimedia EduBlog - May 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Can You Avoid Lumbar Puncture in Febrile Neonates?
I don’t have a problem with lumbar punctures in febrile neonates. In fact, my son ended up with three lumbar punctures before aging out of the febrile seizure protocols. I do have a problem, however, with doing unnecessary spinal taps. The emotional stress of a neonatal LP on parents is significant, and the physical stress of the procedure on the infant is also substantial.
The pain of the needle and the unique restraint required for the procedure are also potentially problematic. The pain of the needle can be minimized by EMLA cream (eutectic mixture of local anesthetics [lidocaine and prilocaine]) and local anes...
Source: M2E Too! Mellick's Multimedia EduBlog - May 1, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Cockroach in the Ear
I took a surprisingly enjoyable course in medical entomology as an undergrad at Ohio State University. Admittedly, decades later, the only things I remember from that course are that only four of the 4500 species of cockroaches are classified as pests: the German, Asian, American, and Oriental cockroaches.
The majority of cockroach species live in their natural habitats in woods, tropical forests, or deserts, but these four have taken up residence with humans and have become serious pests. They may have distinctly cosmopolitan names, but it is believed that they all started in Africa. Their mouths can chomp through ca...
Source: M2E Too! Mellick's Multimedia EduBlog - April 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Cockroach in the Ear
I took a surprisingly enjoyable course in medical entomology as an undergrad at Ohio State University. Admittedly, decades later, the only things I remember from that course are that only four of the 4500 species of cockroaches are classified as pests: the German, Asian, American, and Oriental cockroaches.
The majority of cockroach species live in their natural habitats in woods, tropical forests, or deserts, but these four have taken up residence with humans and have become serious pests. They may have distinctly cosmopolitan names, but it is believed that they all started in Africa. Their mouths can chomp through card...
Source: M2E Too! Mellick's Multimedia EduBlog - April 2, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Laboratory Abnormalities and Pyloric Stenosis
The classic clinical presentation of infantile hypertrophic pyloric stenosis (IHPS) is an emaciated 3- to 6-week-old infant who has been experiencing immediate postprandial, nonbilious, projectile vomiting over a period of weeks. The infants remain hungry and demand to be re-fed after vomiting. Caucasian, full-term boys (4:1 to 6:1) tend to present with this condition most frequently, and these patients tend to be firstborns.
An olive-sized tumor can be felt to the right of the umbilicus, and this may best be palpable immediately after the infant has vomited. Visible peristaltic waves may also be noted. The infants are ty...
Source: M2E Too! Mellick's Multimedia EduBlog - February 28, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
Laboratory Abnormalities and Pyloric Stenosis
The classic clinical presentation of infantile hypertrophic pyloric stenosis (IHPS) is an emaciated 3- to 6-week-old infant who has been experiencing immediate postprandial, nonbilious, projectile vomiting over a period of weeks. The infants remain hungry and demand to be re-fed after vomiting. Caucasian, full-term boys (4:1 to 6:1) tend to present with this condition most frequently, and these patients tend to be firstborns.
An olive-sized tumor can be felt to the right of the umbilicus, and this may best be palpable immediately after the infant has vomited. Visible peristaltic waves may also be noted. The infants are typ...
Source: M2E Too! Mellick's Multimedia EduBlog - February 28, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
UPDATED Feb. 27: All You Ever Wanted to Know about Group A Streptococcal Pharyngitis But Were Afraid to Ask
Why I Disagree with the IDSA Guidelines for GAS in Children Under 3
IDSA Statement: Diagnostic studies for GAS pharyngitis are not indicated for children under age 3 because acute rheumatic fever is rare in children under 3 and the incidence of streptococcal pharyngitis and the classic presentation of streptococcal pharyngitis are uncommon in this age group [emphasis added]. Selected children under 3 who have other risk factors, such as an older sibling with GAS infection, may be considered for testing (strong, moderate).
The prevalence of GAS pharyngitis is significantly lower for children under 3; it ranges fro...
Source: M2E Too! Mellick's Multimedia EduBlog - January 31, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
UPDATED Feb. 27: All You Ever Wanted to Know about Group A Streptococcal Pharyngitis But Were Afraid to Ask
Why I Disagree with the IDSA Guidelines for GAS in Children Under 3
IDSA Statement: Diagnostic studies for GAS pharyngitis are not indicated for children under age 3 because acute rheumatic fever is rare in children under 3 and the incidence of streptococcal pharyngitis and the classic presentation of streptococcal pharyngitis are uncommon in this age group [emphasis added]. Selected children under 3 who have other risk factors, such as an older sibling with GAS infection, may be considered for testing (strong, moderate).
The prevalence of GAS pharyngitis is significantly lower for children under 3; it ranges from 10...
Source: M2E Too! Mellick's Multimedia EduBlog - January 31, 2014 Category: Emergency Medicine Tags: Blog Posts Source Type: blogs
