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Commentary on EMS (Emergency Medical Services), medicine, and science.
Rogue Medic
141 posts
DRCAICEDO
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- December 27, 2011
- 06:30 AM
- 504 views
Charging the Defibrillator While Continuing Chest Compressions – Part II
by Rogue Medic in Rogue Medic
ACLS (Advanced Cardiac Life Support) recommends charging the defibrillator during compressions. This is no less of a recommendation than giving epinephrine. How many people ignore ACLS guidelines for compressions during charging, but claim that it is evil to disobey anything ACLS recommends on epinephrine, amiodarone, or ventilations? ... Read more »
Edelson, D., Robertson-Dick, B., Yuen, T., Eilevstjønn, J., Walsh, D., Bareis, C., Vanden Hoek, T., & Abella, B. (2010) Safety and efficacy of defibrillator charging during ongoing chest compressions: A multi-center study. Resuscitation, 81(11), 1521-1526. DOI: 10.1016/j.resuscitation.2010.07.014
- December 15, 2011
- 06:30 AM
- 762 views
Intraosseous Versus Intravenous Vascular Access During Out-of- Hospital Cardiac Arrest – A Randomized Controlled Trial
by Rogue Medic in Rogue Medic
For treatment of medical cardiac arrest patients, which is better – IO (IntraOsseous) or IV (IntraVenous) access for medication administration?
Since no medications have ever been demonstrated to improve survival from cardiac arrest (only chest compressions and defibrillation have), the most important consideration will be what method results in the least interruption of compressions and the least interference with defibrillation.... Read more »
Reades R, Studnek JR, Vandeventer S, & Garrett J. (2011) Intraosseous Versus Intravenous Vascular Access During Out-of-Hospital Cardiac Arrest: A Randomized Controlled Trial. Annals of emergency medicine, 58(6), 509-16. PMID: 21856044
- December 12, 2011
- 12:00 PM
- 2,953 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
- December 1, 2011
- 10:30 AM
- 627 views
Droperidol, QT prolongation, and sudden death - what is the evidence - Part I
by Rogue Medic in Rogue Medic
The FDA relies on surrogate endpoints. Surrogate endpoints are great for making it seem that we know more than we actually do know. When there is not enough information, surrogate end points are a way of saying, "If this belief is true, and this other belief is also true, then Treatment Z is safe (or dangerous), or saves X number of lives per year (or kills X number of patients who otherwise would have been expected to live)."... Read more »
Kao LW, Kirk MA, Evers SJ, & Rosenfeld SH. (2003) Droperidol, QT prolongation, and sudden death: what is the evidence?. Annals of emergency medicine, 41(4), 546-58. PMID: 12658255
- November 30, 2011
- 06:30 AM
- 647 views
How Dangerous is a Long QT Segment on the ECG
by Rogue Medic in Rogue Medic
There are many things that will lengthen the QT segment, but how much should we worry when the patient has a long QT segment, or when giving the patient a treatment that lengthens the QT segment? Are there some things that, even though they may lengthen the QT segment, may protect the heart from arrhythmia at the same time?... Read more »
Storm C, Hasper D, Nee J, Joerres A, Schefold JC, Kaufmann J, & Roser M. (2011) Severe QTc prolongation under mild hypothermia treatment and incidence of arrhythmias after cardiac arrest--a prospective study in 34 survivors with continuous Holter ECG. Resuscitation, 82(7), 859-62. PMID: 21482009
- November 18, 2011
- 06:30 AM
- 686 views
Automated external defibrillators and survival after in-hospital cardiac arrest
by Rogue Medic in Rogue Medic
Yesterday I described the problems with the recent article claiming that corruption was the reason the AHA recommended AEDs be placed in non-acute care parts of hospitals. Today I will look at the study that seems to have inspired the article, even though it came out a year ago.
Does the research claim that there is any suspicion of corruption in the recommendation?
No. The corruption claims appear to be entirely due to the ideological bias of this conspiracy theory site.... Read more »
Chan PS, Krumholz HM, Spertus JA, Jones PG, Cram P, Berg RA, Peberdy MA, Nadkarni V, Mancini ME, Nallamothu BK.... (2010) Automated external defibrillators and survival after in-hospital cardiac arrest. JAMA : the journal of the American Medical Association, 304(19), 2129-36. PMID: 21078809
- November 9, 2011
- 06:30 AM
- 1,035 views
Is IV Bolus Nitro Dangerous – Part II
by Rogue Medic in Rogue Medic
Those high doses are enough to give a stroke to the doctors, nurses, and medics who think that CHF = Lasix (furosemide), but I am not writing this for people stuck in the 1980s. Most doctors, nurses, and medics appear to realize that nitrates are the most effective medication for CHF. The important question is "How aggressive is too aggressive?"... Read more »
Levy P, Compton S, Welch R, Delgado G, Jennett A, Penugonda N, Dunne R, & Zalenski R. (2007) Treatment of severe decompensated heart failure with high-dose intravenous nitroglycerin: a feasibility and outcome analysis. Annals of emergency medicine, 50(2), 144-52. PMID: 17509731
- October 20, 2011
- 06:15 PM
- 700 views
Sleep quality and fatigue among prehospital providers
by Rogue Medic in Rogue Medic
Even though many in EMS will tell you that EMS stands not for Emergency Medical Services, but for Earn Money Sleeping, sleep deprivation is a problem for many in EMS, many in medicine, and many in other fields. I am a night person, much more awake and alert at 2 AM, than at 8 AM. ... Read more »
Patterson PD, Suffoletto BP, Kupas DF, Weaver MD, & Hostler D. (2010) Sleep quality and fatigue among prehospital providers. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 14(2), 187-93. PMID: 20199233
- October 13, 2011
- 06:30 AM
- 482 views
Propofol and the Michael Jackson Effect
by Rogue Medic in Rogue Medic
Why do we allow one unusual, dramatically publicized case affect our expectations?
Because we don't stop and think for ourselves.... Read more »
Senula, G., Sacchetti, A., Moore, S., & Cortese, T. (2010) Impact of addition of propofol to ED formulary. The American Journal of Emergency Medicine, 28(8), 880-883. DOI: 10.1016/j.ajem.2009.04.035
- October 9, 2011
- 05:00 PM
- 973 views
Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy – Part 1
by Rogue Medic in Rogue Medic
Yesterday I wrote about the law being signed to allow teachers to give rectal diazepam (Valium) to student (for seizures, not to keep the class quiet).[1] Today I look at some of the reasons to question the use of RD (Rectal Diazepam) Diastat from Valeant Pharmaceuticals North America.... Read more »
Holsti M, Dudley N, Schunk J, Adelgais K, Greenberg R, Olsen C, Healy A, Firth S, & Filloux F. (2010) Intranasal midazolam vs rectal diazepam for the home treatment of acute seizures in pediatric patients with epilepsy. Archives of pediatrics , 164(8), 747-53. PMID: 20679166
- September 29, 2011
- 06:30 AM
- 1,038 views
Reducing Unnecessary Hospitalizations of Nursing Home Residents
by Rogue Medic in Rogue Medic
Today in the New England Journal of Medicine there is a perspective piece on something near, and dear, to all of our hearts - unnecessary hospital admissions from nursing homes.
A lot of nursing home patients could be treated on site, without calling an ambulance to take them to the ED (Emergency Department) to produce large bill, but maybe not any better care.... Read more »
Joseph G. Ouslander, M.D., and Robert A. Berenson, M.D. (2011) Reducing Unnecessary Hospitalizations of Nursing Home Residents. N Engl J Med , 365(September 29, 2011), 1165-1167. info:/
- September 12, 2011
- 01:20 PM
- 2,633 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 11, 2011
- 06:30 AM
- 3,408 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
- September 10, 2011
- 06:30 AM
- 1,158 views
Patient Perceptions of Computed Tomographic Imaging and Their Understanding of Radiation Risk and Exposure – Part II
by Rogue Medic in Rogue Medic
When presented as 50 out of 121 who did not answer the question, it seems to be a large percentage, but it is only 50 out of about a thousand patients who did answer the question. Not a large percentage.
The authors included a footnote to the study that produced the numbers they are relying on, but they never specifically cite the X-rays per CT number from that study.... 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
- September 9, 2011
- 06:30 AM
- 1,097 views
Patient Perceptions of Computed Tomographic Imaging and Their Understanding of Radiation Risk and Exposure - Part I
by Rogue Medic in Rogue Medic
What do patients with abdominal pain want?
Maybe even more than pain medicine, patients seem to want a CT. If that doesn't provide answers, they want another one. As if radiation will work differently or the body will change or . . . .... 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
- September 8, 2011
- 02:10 PM
- 922 views
Can We Simplify Triage by Using Just GCS
by Rogue Medic in Rogue Medic
Imagine a system where we intentionally ignore the usual horribly inaccurate trauma triage criteria, such as MOI (Mechanism Of Injury). And these are not even the usual criteria, because this is in a system with criteria already modifieded to avoid a lot of overtriage. :-)... Read more »
Norwood SH, McAuley CE, Berne JD, Vallina VL, Creath RG, & McLarty J. (2002) A prehospital glasgow coma scale score . The Journal of trauma, 53(3), 503-7. PMID: 12352488
- September 1, 2011
- 06:30 AM
- 1,036 views
Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury – Summary
by Rogue Medic in Rogue Medic
All EMS RSI patients had waveform capnography, which may explain why the results are so different from the results of the study by Davis on EMS RSI for TBI. This study raised a bunch of questions about those results, which showed worse outcomes for EMS RSI. One hypothesis was that the much higher incidence of hypocapnea contributed to the bad outcomes even though the EMS intubation success rates more than doubled for TBI patients. ... Read more »
Bernard SA, Nguyen V, Cameron P, Masci K, Fitzgerald M, Cooper DJ, Walker T, Std BP, Myles P, Murray L.... (2010) Prehospital rapid sequence intubation improves functional outcome for patients with severe traumatic brain injury: a randomized controlled trial. Annals of surgery, 252(6), 959-65. PMID: 21107105
- August 2, 2011
- 06:30 AM
- 1,114 views
Management of prehospital seizure patients by paramedics
by Rogue Medic in Rogue Medic
Does that mean that we should make every medical EMS call ALS, just to check BGL?
This could be the Mechanism Of Injury that could help minor medical calls leapfrog past trauma in ALS over-triage.
"If it saves just one life (even though maybe a dozen who would otherwise have lived will now die), it's worth it! Go ALS!"... Read more »
Martin-Gill, C., Hostler, D., Callaway, C., Prunty, H., & Roth, R. (2009) Management of Prehospital Seizure Patients by Paramedics. Prehospital Emergency Care, 13(2), 179-184. DOI: 10.1080/10903120802706229
- July 24, 2011
- 06:30 AM
- 809 views
Is There a Placebo Effect – Part II
by Rogue Medic in Rogue Medic
If Daniel Moerman, PhD is correct and the subjective improvement is what is important, then we should pay attention to the following chart of subjective improvement. Subjective improvement is what the patient thinks is real, even if reality does not agree.
When we go to a magic show and see a woman being cut in half, we are experiencing subjective reality. The objective reality is that the woman was never really cut in half, even though our subjective experience is that she has been cut in ha........ Read more »
Wechsler, M., Kelley, J., Boyd, I., Dutile, S., Marigowda, G., Kirsch, I., Israel, E., & Kaptchuk, T. (2011) Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma. New England Journal of Medicine, 365(2), 119-126. DOI: 10.1056/NEJMoa1103319
Moerman, D. (2011) Meaningful Placebos — Controlling the Uncontrollable. New England Journal of Medicine, 365(2), 171-172. DOI: 10.1056/NEJMe1104010
- July 24, 2011
- 06:30 AM
- 938 views
Is There a Placebo Effect – Part II
by Rogue Medic in Rogue Medic
If Daniel Moerman, PhD is correct and the subjective improvement is what is important, then we should pay attention to the following chart of subjective improvement. Subjective improvement is what the patient thinks is real, even if reality does not agree.
When we go to a magic show and see a woman being cut in half, we are experiencing subjective reality. The objective reality is that the woman was never really cut in half, even though our subjective experience is that she has been cut in ha........ Read more »
Wechsler, M., Kelley, J., Boyd, I., Dutile, S., Marigowda, G., Kirsch, I., Israel, E., & Kaptchuk, T. (2011) Active Albuterol or Placebo, Sham Acupuncture, or No Intervention in Asthma. New England Journal of Medicine, 365(2), 119-126. DOI: 10.1056/NEJMoa1103319
Moerman, D. (2011) Meaningful Placebos — Controlling the Uncontrollable. New England Journal of Medicine, 365(2), 171-172. DOI: 10.1056/NEJMe1104010
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