Sunday, October 26, 2014

Deep Neck Space Infections

Author: Alexandra Murray, OMSIV
Ohio University Heritage College of Osteopathic Medicine

Since the advent of modern antibiotic use, deep neck space infections have decreased in occurrence; however, when these infections take place, the complications can be life threatening.[1-4] Because of the unique compartments of the cervical fascia, deep neck space infections can range in severity and have the potential to extend into the mediastinum. Based on how the infection propagates, these infections have the potential to cause upper airway edema, airway obstruction, mediastinitis, internal jugular vein septic thrombophlebitis, sepsis and septic embolization.[1,2]

Common Sources
Deep neck space infections can develop from infections of the teeth, salivary glands, nasal cavity, paranasal sinuses, pharynx and adenotonsillar tissues.[1,2] In children, adenoids and tonsillar infections are the most common source as they create a drainage pathway through the retropharyngeal lymph nodes resulting in retropharyngeal, parapharyngeal and peritonisllar space infections.1 In adults, dentoalveolar infections are the most common source of infection. In particular, infections of the lower second and third molars are dangerous because their roots spread directly into the submandibular space.[1] Other causes of deep neck space infections in adults include: pharyngitis, tonsillitis, sialoadenitis, trauma, foreing body ingestion, sinusitis, cervical lymphadenitis, middle ear infections, mastoid infections, and IV drug use.[2]

Sunday, October 19, 2014

The Adult Learner: Has Medicine Missed the Mark?

Originally published in
Jul/Aug 2014 Common Sense
Author: Andrew W Phillips, MD MEd
AAEM/RSA Publications Committee Chair

On a recent whim I searched Google for “emergency medicine education fellowship” and “learning theory.” During this entirely non-rigorous search I found that most of the first forty hits were programs specifically mentioning their emphasis on teaching Adult Learning Theory. In fact, even most non-educators reading this have probably heard of ALT. I would wager, however, that you have not heard of Situated Cognition, Cognitive Apprenticeship, Social Learning Theory, or Sociocultural Theory.

Who cares? Why does this matter to the everyday practitioner? Why does this matter to emergency medicine (EM)? The answer lies in the often gross misinterpretation of Adult Learning Theory and the strong case that it does not qualify as legitimate theory, thus leaving learners and teachers selling each other short of the most effective education. Additionally, the medical education community is beginning to move away from emphasizing Adult Learning Theory, and it is important that EM practices education with the most accurate information possible.

This is a two-part series that will first explore the criticisms of ALT, and later offer a breadth of alternatives that together inform us well about how we (adults and children) learn. 

Sunday, October 12, 2014

Ocular Ultrasound: Unavoidably Essential

Author: Peter Malamet OMS- IV
Philadelphia College of Osteopathic Medicine

This post was peer reviewed. Click to learn more.

Recently, I heard a quote that has summarized a large part of the emergency medicine practice I have experienced thus far. My attending said, “In a few years, ultrasound will be the new stethoscope.” What he was referring to is not only how popular ultrasound is becoming, but the necessity for physicians to be able to use ultrasound correctly. Ultrasound can help keep certain patients right where we want them, not in a CT scanner, but in our emergency room where we can adequately diagnose and treat them. Ask any physician in the hospital, the last place they want an unstable (or potentially unstable) patient is in the radiology suite. From the Focused Assessment with Sonography in Trauma (FAST) exam to a simple post void residual, ultrasound is a fantastic tool. In this article I will present a relatively newer type of ultrasound technique as an example showing how important this tool can be.