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Commentary on EMS (Emergency Medical Services), medicine, and science.
Rogue Medic
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- February 22, 2011
- 06:30 AM
- 6,029 views
Prehospital Intravenous Fluid Administration is Associated With Higher Mortality in Trauma Patients – Part II
by Rogue Medic in Rogue Medic
Even the "no fluids group" in that study did have "two 14 gauge IVs started." If we evaluated that study according to the criteria of the current study, both groups received IV fluids, since both had IVs started.
We know that is not true.
In the Bickell study, we know which of the patients who had IVs started received fluids and we know how much fluid patients received.... Read more »
Haut ER, Kalish BT, Cotton BA, Efron DT, Haider AH, Stevens KA, Kieninger AN, Cornwell EE 3rd, & Chang DC. (2010) Prehospital Intravenous Fluid Administration is Associated With Higher Mortality in Trauma Patients: A National Trauma Data Bank Analysis. Annals of surgery. PMID: 21178760
Bickell, W., Wall, M., Pepe, P., Martin, R., Ginger, V., Allen, M., & Mattox, K. (1994) Immediate versus Delayed Fluid Resuscitation for Hypotensive Patients with Penetrating Torso Injuries. New England Journal of Medicine, 331(17), 1105-1109. DOI: 10.1056/NEJM199410273311701
- November 17, 2010
- 06:30 AM
- 3,754 views
The RAD-57 Pulse Co-Oximeter – Does It Work – Part II
by Rogue Medic in Rogue Medic
Should anyone ever use a low RAD-57 reading to justify returning a fire fighter to a fire?
No.
Sending a fire fighter, with a not-yet-detected elevated COHb, back into the fire is probably only sending that fire fighter back into the same environment that produced the not-yet-detected elevated COHb.
This is not the way to make good things happen.... Read more »
Touger, M., Birnbaum, A., Wang, J., Chou, K., Pearson, D., & Bijur, P. (2010) Performance of the RAD-57 Pulse Co-Oximeter Compared With Standard Laboratory Carboxyhemoglobin Measurement. Annals of Emergency Medicine, 56(4), 382-388. DOI: 10.1016/j.annemergmed.2010.03.041
- January 28, 2011
- 06:30 AM
- 3,686 views
Etomidate in procedural sedation
by Rogue Medic in Rogue Medic
"Some patients, even with significant doses of medication, still continued to verbalize significant amounts of pain."
Just giving more is not always an option. Maybe there are restrictions in the protocol. Maybe the patient's vital signs change in a way that suggests that more medication is not the best idea at that time.
... Read more »
Levins T. (2011) Etomidate in procedural sedation. Air medical journal, 30(1), 45-8. PMID: 21211712
- September 11, 2011
- 06:30 AM
- 3,425 views
Patient Perceptions of Computed Tomographic Imaging and Their Understanding of Radiation Risk and Exposure – Part III
by Rogue Medic in Rogue Medic
Bringing up the imagery of Hiroshima radiation exposure in a study is one way to get us to by-pass the purpose of an objective study, while retaining the appearance of objectivity. Was this the intent of the authors? Probably not, since they got this question from an earlier study. However, they may have appreciated the emotional appeal.... Read more »
Baumann BM, Chen EH, Mills AM, Glaspey L, Thompson NM, Jones MK, & Farner MC. (2011) Patient perceptions of computed tomographic imaging and their understanding of radiation risk and exposure. Annals of emergency medicine, 58(1), 1-700. PMID: 21146900
- December 31, 2010
- 06:30 AM
- 3,338 views
Asymptomatic Sustained Ventricular Fibrillation in a Patient With Left Ventricular Assist Device
by Rogue Medic in Rogue Medic
This patient is pulseless. Pulseless patients are not rare. A 911 call for a pulseless patient is usually because the pulseless patient is dead.
Contrariwise, a patient talking to me has a pulse. I have had several patients who were awake and talking, but without any palpable pulses. The absence of palpable pulses is different from the absence of pulses. All of these patients, with no palpable pulses, were significantly symptomatic.... Read more »
Busch MC, Haap M, Kristen A, & Haas CS. (2011) Asymptomatic sustained ventricular fibrillation in a patient with left ventricular assist device. Annals of emergency medicine, 57(1), 25-8. PMID: 20674087
Farrar DJ, Hill JD, Gray LA Jr, Galbraith TA, Chow E, & Hershon JJ. (1989) Successful biventricular circulatory support as a bridge to cardiac transplantation during prolonged ventricular fibrillation and asystole. Circulation, 80(5 Pt 2). PMID: 2680160
Fasseas P, Kutalek SP, Samuels FL, Holmes EC, & Samuels LE. (2002) Ventricular assist device support for management of sustained ventricular arrhythmias. Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 29(1), 33-6. PMID: 11995847
- November 26, 2010
- 06:30 AM
- 3,008 views
How Not to Respond to Negative Research
by Rogue Medic in Rogue Medic
That advice from Dr. O'Reilly may encourage us to return fire fighters to an environment that has already made them toxic, but with the mistaken belief that they have carboxyhemoglobin levels of zero, when their carboxyhemoglobin is really very high.
Dr. O'Reilly's advice is bad for Masimo investors.
Dr. O'Reilly's advice is bad for patients.
Dr. O'Reilly's advice misrepresents the research.... Read more »
O'Reilly M. (2010) Performance of the Rad-57 pulse co-oximeter compared with standard laboratory carboxyhemoglobin measurement. Annals of emergency medicine, 56(4), 442. PMID: 20868919
Touger, M., Birnbaum, A., Wang, J., Chou, K., Pearson, D., & Bijur, P. (2010) Performance of the RAD-57 Pulse Co-Oximeter Compared With Standard Laboratory Carboxyhemoglobin Measurement. Annals of Emergency Medicine, 56(4), 382-388. DOI: 10.1016/j.annemergmed.2010.03.041
Nilson D, Partridge R, Suner S, & Jay G. (2010) Non-invasive carboxyhemoglobin monitoring: screening emergency medical services patients for carbon monoxide exposure. Prehospital and disaster medicine : the official journal of the National Association of EMS Physicians and the World Association for Emergency and Disaster Medicine in association with the Acute Care Foundation, 25(3), 253-6. PMID: 20586019
- December 12, 2011
- 12:00 PM
- 2,979 views
Does Epinephrine Improve Survival from Cardiac Arrest
by Rogue Medic in Rogue Medic
Even though epinephrine (adrenaline) is used automatically in cardiac arrest, and there is evidence that epinephrine helps to produce a pulse (ROSC – Return Of Spontaneous Circulation), there is no evidence that epinephrine improves the only survival statistic that matters – discharge from the hospital with a brain that still works. There were so many deviations from assignment protocol in their 2009 study,[1] that the authors decided to examine the results based on what treatment pa........ Read more »
Olasveengen TM, Wik L, Sunde K, & Steen PA. (2011) Outcome when adrenaline (epinephrine) was actually given vs. not given - post hoc analysis of a randomized clinical trial. Resuscitation. PMID: 22115931
Olasveengen, T., Sunde, K., Brunborg, C., Thowsen, J., Steen, P., & Wik, L. (2009) Intravenous Drug Administration During Out-of-Hospital Cardiac Arrest: A Randomized Trial. JAMA: The Journal of the American Medical Association, 302(20), 2222-2229. DOI: 10.1001/jama.2009.1729
- January 12, 2011
- 06:30 AM
- 2,813 views
Injury-adjusted Mortality of Patients Transported by Police Following Penetrating Trauma
by Rogue Medic in Rogue Medic
What this study does examine is the policy of having police transport patients with penetrating injuries to the head, neck, torso, upper arm, or thigh, rather than wait for EMS. Since the staffing problems seem to have continued to deteriorate after the completion of the study, the policy probably leads to a significantly higher percentage of police transports now, than when the original study was done.... Read more »
Band RA, Pryor JP, Gaieski DF, Dickinson ET, Cummings D, & Carr BG. (2010) Injury-adjusted Mortality of Patients Transported by Police Following Penetrating Trauma. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. PMID: 21166730
- September 12, 2011
- 01:20 PM
- 2,659 views
Patient Perceptions of Computed Tomographic Imaging and Their Understanding of Radiation Risk and Exposure – Part IV
by Rogue Medic in Rogue Medic
We seem to most insist on stripping information of its meaning when we create multiple choice tests. Correct answers become a simple matter of memorization separated from understanding. This is one way to create the protocol monkey - the automaton, whom we claim is rendered harmless by being prevented from thinking. This desire to prevent the use of judgment may be the ultimate irrational decision.... Read more »
Baumann BM, Chen EH, Mills AM, Glaspey L, Thompson NM, Jones MK, & Farner MC. (2011) Patient perceptions of computed tomographic imaging and their understanding of radiation risk and exposure. Annals of emergency medicine, 58(1), 1-700. PMID: 21146900
Wears RL. (2011) Risk, radiation, and rationality. Annals of emergency medicine, 58(1), 9-11. PMID: 21459481
- September 7, 2010
- 05:22 PM
- 2,263 views
Inadequate needle thoracostomy rate in the prehospital setting for presumed pneumothorax: an ultrasound study – abstract
by Rogue Medic in Rogue Medic
This is only based on the limited information in an abstract, but it does raise some important questions about when and why we needle decompress someone with a suspected tension pneumotorax.... Read more »
Blaivas M. (2010) Inadequate needle thoracostomy rate in the prehospital setting for presumed pneumothorax: an ultrasound study. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 29(9), 1285-9. PMID: 20733183
- December 6, 2010
- 06:30 AM
- 1,940 views
Amiodarone for Cardiac Arrest in the 2010 ACLS – Part III
by Rogue Medic in Rogue Medic
The research only demonstrates improved survival to admission, as if that does anything more than provide false hope and huge hospital bills. Why do we base the standard of care on such limited research?
Since there is no new amiodarone research, let's look at the old surrogate endpoint research that compares amiodarone with placebo. Keep in mind that this surrogate endpoint study is the basis for over a decade of still unproven treatment.... Read more »
Kudenchuk PJ, Cobb LA, Copass MK, Cummins RO, Doherty AM, Fahrenbruch CE, Hallstrom AP, Murray WA, Olsufka M, & Walsh T. (1999) Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. The New England journal of medicine, 341(12), 871-8. PMID: 10486418
- June 14, 2011
- 06:30 AM
- 1,601 views
ED procedural sedation of elderly patients: is it safe
by Rogue Medic in Rogue Medic
Compared with the patients receiving propofol alone, patients receiving propofol with an opioid had a much more dramatic drop in the dose of propofol given as their age increased.
Were there differences between the rates of hypotension among those only receiving propofol and those receiving propofol with an opioid? Among all patients? More among elderly patients? Less among elderly patients?... Read more »
Weaver CS, Terrell KM, Bassett R, Swiler W, Sandford B, Avery S, & Perkins AJ. (2011) ED procedural sedation of elderly patients: is it safe?. The American journal of emergency medicine, 29(5), 541-4. PMID: 20825829
- February 14, 2011
- 01:30 PM
- 1,553 views
Inadequate needle thoracostomy rate in the prehospital setting for presumed pneumothorax: an ultrasound study – Full paper
by Rogue Medic in Rogue Medic
Should we assume that a tension pneumothorax is subtle?
I don't think so.
Why do we teach about tension pneumothorax as if it is the same as an easily missed simple pneumothorax?
I think it is because we don't realize just how unsubtle a tension pneumothorax is.
Absolutely.
... Read more »
Blaivas M. (2010) Inadequate needle thoracostomy rate in the prehospital setting for presumed pneumothorax: an ultrasound study. Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 29(9), 1285-9. PMID: 20733183
- April 5, 2011
- 06:30 AM
- 1,464 views
Motor Vehicle Intrusion – EMS Research Episode 7
by Rogue Medic in Rogue Medic
Why let reality get in the way of a protocol for trauma triage?
After all, we have never let reality interfere with trauma treatment before.
What about cardiology has led us to focus exclusively on specificity, but ignore sensitivity?
What about trauma has led us to focus exclusively on sensitivity, but ignore specificity?
... Read more »
Isenberg D, Cone DC, & Vaca FE. (2011) Motor vehicle intrusion alone does not predict trauma center admission or use of trauma center resources. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 15(2), 203-7. PMID: 21226551
- May 13, 2011
- 06:30 AM
- 1,452 views
Is Friday the 13th bad for your health
by Rogue Medic in Rogue Medic
This is reminiscent of some of the old medics' tales in EMS that are cited as the basis for otherwise baseless nonsense, such as - "If you don't give anti-nausea medication with morphine, then the patient will vomit." A small percentage of patients receiving morphine will develop nausea. Only some of that small percentage of patients will end up vomiting. ... Read more »
Scanlon TJ, Luben RN, Scanlon FL, & Singleton N. (1993) Is Friday the 13th bad for your health?. BMJ (Clinical research ed.), 307(6919), 1584-6. PMID: 8292946
- February 20, 2011
- 06:30 AM
- 1,417 views
Prehospital Intravenous Fluid Administration is Associated With Higher Mortality in Trauma Patients – Part I
by Rogue Medic in Rogue Medic
We expect the PubMed abstract to provide the important information.
In this case, we would be wrong.
This study does not look at Prehospital Intravenous Fluid Administration.... Read more »
Haut ER, Kalish BT, Cotton BA, Efron DT, Haider AH, Stevens KA, Kieninger AN, Cornwell EE 3rd, & Chang DC. (2010) Prehospital Intravenous Fluid Administration is Associated With Higher Mortality in Trauma Patients: A National Trauma Data Bank Analysis. Annals of surgery. PMID: 21178760
- March 15, 2011
- 06:30 AM
- 1,398 views
Correction to Spine Immobilization in Penetrating Trauma: More Harm Than Good
by Rogue Medic in Rogue Medic
I let my biases get the better of me when I wrote about this in "Spine Immobilization in Penetrating Trauma: More Harm Than Good?"
While I spent a significant portion of that review explaining why evidence of benefit was not present in this study, I ignored the problems with the data when the authors concluded that there was harm.
That was a mistake on my part. While I do believe that harm is likely, this study does not provide evidence to support that belief. ... Read more »
Haut, E., Kalish, B., Efron, D., Haider, A., Stevens, K., Kieninger, A., Cornwell, E., & Chang, D. (2010) Spine Immobilization in Penetrating Trauma: More Harm Than Good?. The Journal of Trauma: Injury, Infection, and Critical Care, 68(1), 115-121. DOI: 10.1097/TA.0b013e3181c9ee58
- July 5, 2011
- 06:30 AM
- 1,345 views
Dextrose 10% or 50%: EMS Research Episode 10
by Rogue Medic in Rogue Medic
1. Is 50% dextrose as safe as 10% dextrose?
2. Is 50% dextrose as efficacious as 10% dextrose?
3. Is 50% dextrose as affordable as 10% dextrose?... Read more »
Moore, C. (2005) Dextrose 10% or 50% in the treatment of hypoglycaemia out of hospital? A randomised controlled trial. Emergency Medicine Journal, 22(7), 512-515. DOI: 10.1136/emj.2004.020693
- August 26, 2010
- 08:18 PM
- 1,318 views
Drug Shortages Affect Those Still in the Dark Ages – Furosemide
by Rogue Medic in Rogue Medic
Part 2 - Furosemide.
This drug shortage could be a good thing.
EMS may be forced to do without drugs that cause more harm than benefit.
Maybe we will be smart enough to realize that we are not helping our patients with these drugs.
Maybe.... Read more »
Mosesso VN Jr, Dunford J, Blackwell T, & Griswell JK. (2003) Prehospital therapy for acute congestive heart failure: state of the art. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 7(1), 13-23. PMID: 12540139
Mattu A, Martinez JP, & Kelly BS. (2005) Modern management of cardiogenic pulmonary edema. Emergency medicine clinics of North America, 23(4), 1105-25. PMID: 16199340
- March 24, 2011
- 06:30 AM
- 1,278 views
Killing Poison Control Centers to Pretend to Save Money
by Rogue Medic in Rogue Medic
So, to celebrate "National Poison Prevention Week" (March 20 - March 26), politicians decided to kill the Poison Control Centers.
No, they're just cutting the funding a little bit.
From $29.3 million down to $2 million.
Assume that you make $29.3 thousand dollars per year. Now assume that your pay is cut to $2 thousand per year. How is that going to work?... Read more »
LoVecchio, F., Curry, S., Waszolek, K., Klemens, J., Hovseth, K., & Glogan, D. (2008) Poison control centers decrease emergency healthcare utilization costs. Journal of Medical Toxicology, 4(4), 221-224. DOI: 10.1007/BF03161204
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