141 posts · 109,707 views
Commentary on EMS (Emergency Medical Services), medicine, and science.
Rogue Medic
141 posts
DRCAICEDO
0 posts
Sort by: Latest Post, Most Popular
View by: Condensed, Full
- August 14, 2012
- 04:30 PM
- 203 views
These authors read far too much into their limited study – Part I
by Rogue Medic in Rogue Medic
There is a new study that looks at prehospital fentanyl. It starts out well, it is even randomized, blinded, and prospective, but it loses focus and draws conclusions that are not remotely justified by the study. Starting out well -... Read more »
Smith MD, Wang Y, Cudnik M, Smith DA, Pakiela J, & Emerman CL. (2012) The Effectiveness and Adverse Events of Morphine versus Fentanyl on a Physician-staffed Helicopter. The Journal of emergency medicine, 43(1), 69-75. PMID: 21689900
- August 8, 2012
- 08:00 AM
- 212 views
Why are we making the heart work harder in heart failure?
by Rogue Medic in Rogue Medic
Is the harm from furosemide (Lasix) anything new?
This study is looking at the effects of furosemide in patients with chronic CHF (Congestive Heart Failure), not acute exacerbations of CHF. This should have led to studies of the effects of furosemide on acute CHF. After all, in 1985 everyone seems to have been using furosemide for acute CHF.... Read more »
Francis GS, Siegel RM, Goldsmith SR, Olivari MT, Levine TB, & Cohn JN. (1985) Acute vasoconstrictor response to intravenous furosemide in patients with chronic congestive heart failure. Activation of the neurohumoral axis. Annals of internal medicine, 103(1), 1-6. PMID: 2860833
- July 17, 2012
- 08:00 AM
- 400 views
What is the effect of clopidogrel on head injuries? Part IV
by Rogue Medic in Rogue Medic
All of these patients were ground-level falls, so from standing, or sitting, or lying on bed. All of these patients had a GCS (Glasgow Coma Score) of 15, which is normal. There does not appear to have been anything alarming about any of these patients, but two of them died - and the information does not provide any clues to identify them while they might have been treated successfully. ... Read more »
Nishijima, D., Offerman, S., Ballard, D., Vinson, D., Chettipally, U., Rauchwerger, A., Reed, M., & Holmes, J. (2012) Immediate and Delayed Traumatic Intracranial Hemorrhage in Patients With Head Trauma and Preinjury Warfarin or Clopidogrel Use. Annals of Emergency Medicine, 59(6), 460-2147483647. DOI: 10.1016/j.annemergmed.2012.04.007
Menditto, V., Lucci, M., Polonara, S., Pomponio, G., & Gabrielli, A. (2012) Management of Minor Head Injury in Patients Receiving Oral Anticoagulant Therapy: A Prospective Study of a 24-Hour Observation Protocol. Annals of Emergency Medicine. DOI: 10.1016/j.annemergmed.2011.12.003
- July 10, 2012
- 08:00 PM
- 303 views
What is the effect of clopidogrel on head injuries? Part III
by Rogue Medic in Rogue Medic
Continuing from Part I and Part II about the comparative effects of warfarin (Coumadin) and clopidogrel (Plavix) on tICH (traumatic IntraCranial Hemorrhage).
Total patients – 1,064.
Total seen at a trauma center – 364 (34.2%).
Total seen at a community hospital – 700 (65.8%).... Read more »
Nishijima, D., Offerman, S., Ballard, D., Vinson, D., Chettipally, U., Rauchwerger, A., Reed, M., & Holmes, J. (2012) Immediate and Delayed Traumatic Intracranial Hemorrhage in Patients With Head Trauma and Preinjury Warfarin or Clopidogrel Use. Annals of Emergency Medicine, 59(6), 460-2147483647. DOI: 10.1016/j.annemergmed.2012.04.007
- June 25, 2012
- 08:00 AM
- 416 views
Laryngospasm, hypoxia, excited delirium, and ketamine – Part II
by Rogue Medic in Rogue Medic
Continuing from Part I, where our excited delirium patient was sedated quickly with IM (IntraMuscular) ketamine, but developed laryngospasm and cyanosis later at the hospital.
Do we have a good drug to prevent muscular spasm of the smooth muscles?
Can we ventilate him again? Yes, but there is a bit of a pattern developing. It would not be good to ignore the possibility that this will not be the last episode of laryngospasm for this patient today.... Read more »
Burnett AM, Watters BJ, Barringer KW, Griffith KR, & Frascone RJ. (2012) Laryngospasm and hypoxia after intramuscular administration of ketamine to a patient in excited delirium. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 16(3), 412-4. PMID: 22250698
- June 21, 2012
- 03:00 PM
- 264 views
Laryngospasm, hypoxia, excited delirium, and ketamine - Part I
by Rogue Medic in Rogue Medic
One of the concerns with ketamine is the rare occurrence of laryngospasm.
Can EMS manage the airway without paralytics?
If we can find just one bad outcome,should we prohibit EMS ketamine use and thus prevent all of the good outcomes, just to be safe?
Let’s look at an actual example, rather than waxing philosophical.... Read more »
Burnett AM, Watters BJ, Barringer KW, Griffith KR, & Frascone RJ. (2012) Laryngospasm and hypoxia after intramuscular administration of ketamine to a patient in excited delirium. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 16(3), 412-4. PMID: 22250698
- June 19, 2012
- 08:00 AM
- 310 views
One hundred percent oxygen in the treatment of acute myocardial infarction and severe angina pectoris
by Rogue Medic in Rogue Medic
In the absence of hypoxia, is supplemental oxygen good for a patient with cardiac chest pain, but no hypoxia or shortness of breath?
We take it for granted that giving oxygen is good, and more oxygen is better, even if the patient is not hypoxic or short of breath, but what does the research show for cardiac patients?
This double-blinded study, released only 62 years ago – in 1950, strongly suggests that supplemental oxygen is not good for patients with chest pain and/or ECG changes......... Read more »
RUSSEK HI, REGAN FD, & NAEGELE CF. (1950) One hundred percent oxygen in the treatment of acute myocardial infarction and severe angina pectoris. Journal of the American Medical Association, 144(5), 373-5. PMID: 14774103
- June 15, 2012
- 08:00 AM
- 376 views
Is this what an IRB is supposed to do?
by Rogue Medic in Rogue Medic
These researchers appear to have started off with an obstacle that they never could completely overcome. What do we do when the IRB (Institutional Review Board) is opposed to studying treatment in a way that will actually test the hypothesis in question?... Read more »
Wilcox SR, Bittner EA, Elmer J, Seigel TA, Nguyen NT, Dhillon A, Eikermann M, & Schmidt U. (2012) Neuromuscular blocking agent administration for emergent tracheal intubation is associated with decreased prevalence of procedure-related complications*. Critical care medicine, 40(6), 1808-1813. PMID: 22610185
- June 13, 2012
- 08:00 AM
- 334 views
What is the effect of clopidogrel on head injuries? Part II
by Rogue Medic in Rogue Medic
A part of this study that should received more attention is the rate of immediate tICH (traumatic IntraCranial Hemorrhage) among patients taking clopidogrel or warfarin.
5.1% of warfarin (Coumadin) patients had immediate traumatic intracranial hemorrhage.
12.0% of clopidogrel (Plavix) patients had immediate traumatic intracranial hemorrhage.
The sample was from all patients with any kind of head trauma who presented to the participating trauma centers or to the participating community h........ Read more »
Menditto, V., Lucci, M., Polonara, S., Pomponio, G., & Gabrielli, A. (2012) Management of Minor Head Injury in Patients Receiving Oral Anticoagulant Therapy: A Prospective Study of a 24-Hour Observation Protocol. Annals of Emergency Medicine. DOI: 10.1016/j.annemergmed.2011.12.003
Nishijima, D., Offerman, S., Ballard, D., Vinson, D., Chettipally, U., Rauchwerger, A., Reed, M., & Holmes, J. (2012) Immediate and Delayed Traumatic Intracranial Hemorrhage in Patients With Head Trauma and Preinjury Warfarin or Clopidogrel Use. Annals of Emergency Medicine, 59(6), 460-2147483647. DOI: 10.1016/j.annemergmed.2012.04.007
- June 7, 2012
- 08:00 AM
- 404 views
What is the effect of clopidogrel on head injuries? Part I
by Rogue Medic in Rogue Medic
This is the final paper on head trauma and anticoagulants from the current Annals of Emergency Medicine. I wrote about the pair of editorials and the other article earlier.[1],[2] There is a lot to write about in this paper, so I am glad that this is a very well done paper. It is a pleasure to read research on an important topic and not be disappointed.... Read more »
Nishijima, D., Offerman, S., Ballard, D., Vinson, D., Chettipally, U., Rauchwerger, A., Reed, M., & Holmes, J. (2012) Immediate and Delayed Traumatic Intracranial Hemorrhage in Patients With Head Trauma and Preinjury Warfarin or Clopidogrel Use. Annals of Emergency Medicine, 59(6), 460-2147483647. DOI: 10.1016/j.annemergmed.2012.04.007
- June 4, 2012
- 08:00 AM
- 393 views
Will spontaneous pneumothorax progress to tension pneumothorax?
by Rogue Medic in Rogue Medic
If the conventional teaching were true, then why do so few spontaneous pneumothoraces progress to tension pneumothoraces?
Why is tension pneumothorax is rare.
Treatment of presumed tension pneumothorax appears to be much more common than tension pneumothorax.[2]... Read more »
Simpson, G. (2010) Spontaneous pneumothorax: time for some fresh air. Internal Medicine Journal, 40(3), 231-234. DOI: 10.1111/j.1445-5994.2009.02155.x
- May 25, 2012
- 08:00 AM
- 399 views
Cochrane and a Significantly Biased Review of Steroids for acute spinal cord injury
by Rogue Medic in Rogue Medic
An interesting relic of trauma care is the use of steroids for the treatment of acute spinal cord injury. As with The Golden Hour, there are people still promoting this idea. In the words of Monty Python, it’s not quite dead, yet.
Who is promoting this idea? The Cochrane Collaboration.
Here is a list of the papers evaluated in this 2012 update of the 2009 Cochrane Review, which was an update of the 2002 Cochrane Review. There has been no change in the references, since the most recen........ Read more »
Bracken MB. (2012) Steroids for acute spinal cord injury. Cochrane database of systematic reviews (Online). PMID: 22258943
- May 24, 2012
- 02:35 PM
- 343 views
Validation of the Dime
by Rogue Medic in Rogue Medic
The current Annals of Emergency Medicine has a pair of editorials on the article I wrote about[1] in This is the Way to Bad Medicine back in January. Dr. Radecki also was critical of this paper.[2] There is another study that refers to the same question published in this issue, but I will write about that paper later.
"These data raise the real question, Do such findings matter? By admitting more patients and ordering more CTs, do we improve outcomes? Or do we simply find more things tha........ Read more »
Menditto, V., Lucci, M., Polonara, S., Pomponio, G., & Gabrielli, A. (2012) Management of Minor Head Injury in Patients Receiving Oral Anticoagulant Therapy: A Prospective Study of a 24-Hour Observation Protocol. Annals of Emergency Medicine. DOI: 10.1016/j.annemergmed.2011.12.003
- May 22, 2012
- 01:00 PM
- 455 views
How Diagnostic is Narcan?
by Rogue Medic in Rogue Medic
At Resus.ME,[1] Dr. Reid suggests that one benefit of nebulized naloxone[2] is its diagnostic value. He asks –
"Do you ever use naloxone diagnostically, and if so, do you think it’s worth knowing that the nebulised route is an option?"
This has been studied.... Read more »
Hoffman JR, Schriger DL, & Luo JS. (1991) The empiric use of naloxone in patients with altered mental status: a reappraisal. Annals of emergency medicine, 20(3), 246-52. PMID: 1996818
- May 15, 2012
- 08:00 AM
- 432 views
Influence of Sex on the Out-of-hospital Management of Chest Pain - Part II
by Rogue Medic in Rogue Medic
Part I was written in 2010, so I am a bit late in continuing to ridicule this example of bad research.
How do we determine what is good care for our patients?
By having our treatment follow the category that dispatch dispatch assigned the call? I used to work in a county, where this did appear to be the case. The medics would become very upset with dispatch if they did not receive a lot of information about the patient prior to arriving on scene.
Dispatchers would express surprise when ........ Read more »
Meisel, Z., Armstrong, K., Crawford Mechem, C., Shofer, F., Peacock, N., Facenda, K., & Pollack, C. (2010) Influence of Sex on the Out-of-hospital Management of Chest Pain. Academic Emergency Medicine, 17(1), 80-87. DOI: 10.1111/j.1553-2712.2009.00618.x
- May 10, 2012
- 03:00 PM
- 288 views
Doesn’t that study prove Lasix works?
by Rogue Medic in Rogue Medic
You ask an excellent question.
The study does give the impression that furosemide improved outcomes, but it was never designed as a study of whether furosemide is helpful, or even just not harmful. Other than oxygen, morphine, and furosemide (apparently in that order) we do not know much about the treatment of this small group of patients. Even pulmonary suction is listed as a treatment, but there are no suggestions that treatments are even limited to those listed.... Read more »
Figueras J, & Weil MH. (1978) Blood volume prior to and following treatment of acute cardiogenic pulmonary edema. Circulation, 57(2), 349-55. PMID: 618625
- May 8, 2012
- 08:15 PM
- 394 views
Blood volume prior to and following treatment of acute cardiogenic pulmonary edema
by Rogue Medic in Rogue Medic
One of the myths of treatment for CHF/ADHF (Congestive Heart Failure/Acute Decompensated Heart Failure) is that the patients are fluid overloaded. We MUST make the patient pee.
If you want to live, you have to pee!... Read more »
Figueras J, & Weil MH. (1978) Blood volume prior to and following treatment of acute cardiogenic pulmonary edema. Circulation, 57(2), 349-55. PMID: 618625
- May 3, 2012
- 07:00 PM
- 373 views
Safety of prehospital intravenous fentanyl for adult trauma patients
by Rogue Medic in Rogue Medic
What prevents us from treating pain appropriately?
Actual adverse effects of pain medicine or unwarranted anxiety, due to exaggerated fears of potential adverse effects of pain medicine?
Pain management is important. Unfortunately, EMS and emergency medicine have been better at coming up with excuses for not treating pain, than we have been at coming up with good protocols that encourage treating pain.... Read more »
Soriya GC, McVaney KE, Liao MM, Haukoos JS, Byyny RL, Gravitz C, & Colwell CB. (2012) Safety of prehospital intravenous fentanyl for adult trauma patients. The journal of trauma and acute care surgery, 72(3), 755-759. PMID: 22491566
- April 26, 2012
- 10:00 AM
- 341 views
Lessons for management of anaphylaxis from a study of fatal reactions – Part I
by Rogue Medic in Rogue Medic
What can help us to learn more about what leads up to a bad outcome from anaphylaxis?
"it seemed that study of a large number of fatal reactions might give insight into why prevention and treatment had failed."... Read more »
Pumphrey RS. (2000) Lessons for management of anaphylaxis from a study of fatal reactions. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, 30(8), 1144-50. PMID: 10931122
- April 24, 2012
- 06:30 PM
- 396 views
Glucose before Thiamine for Wernicke Encephalopathy – A Literature Review
by Rogue Medic in Rogue Medic
Maybe that explains how the requirement for thiamine before glucose came about – confabulation.
Many of our traditional treatments are better explained by confabulation, based on a persuasive hypothesis, than by any evidence of benefit to the patient.... Read more »
Schabelman, E., & Kuo, D. (2012) Glucose before Thiamine for Wernicke Encephalopathy: A Literature Review. The Journal of Emergency Medicine, 42(4), 488-494. DOI: 10.1016/j.jemermed.2011.05.076
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
topics
join us!
Do you write about peer-reviewed research in your blog? Use ResearchBlogging.org to make it easy for your readers — and others from around the world — to find your serious posts about academic research.
If you don't have a blog, you can still use our site to learn about fascinating developments in cutting-edge research from around the world.
