Rogue Medic

159 posts · 142,486 views

Rogue Medic
159 posts

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  • April 3, 2014
  • 06:30 PM
  • 92 views

In Defense of No Improvement by Medic Madness – Part IV

by Rogue Medic in Rogue Medic

Continuing from Part I, Part II, and Part III in response to what I wrote about the failure of the LUCAS,[1] Sean continues with -

"Another issue I have with this data, is that it doesn’t address the following variables:
Down time
Whether or not bystander CPR was performed
Medications used
Whether or not an advanced airway was placed
Length of resuscitation"... Read more »

  • March 27, 2014
  • 10:15 AM
  • 105 views

In Defense of No Improvement by Medic Madness - Part III

by Rogue Medic in Rogue Medic

Sean continues to explain how the machine that does not improve outcomes allows him to provide other 'treatments' that do not improve outcomes.

I continue to point out the problems with his excuses.

.... Read more »

Larabee TM, Liu KY, Campbell JA, & Little CM. (2012) Vasopressors in cardiac arrest: a systematic review. Resuscitation, 83(8), 932-9. PMID: 22425731  

Hagihara A, Hasegawa M, Abe T, Nagata T, Wakata Y, & Miyazaki S. (2012) Prehospital epinephrine use and survival among patients with out-of-hospital cardiac arrest. JAMA : the journal of the American Medical Association, 307(11), 1161-8. PMID: 22436956  

Hayashi Y, Iwami T, Kitamura T, Nishiuchi T, Kajino K, Sakai T, Nishiyama C, Nitta M, Hiraide A, & Kai T. (2012) Impact of early intravenous epinephrine administration on outcomes following out-of-hospital cardiac arrest. Circulation journal : official journal of the Japanese Circulation Society, 76(7), 1639-45. PMID: 22481099  

Allegra J, Lavery R, Cody R, Birnbaum G, Brennan J, Hartman A, Horowitz M, Nashed A, & Yablonski M. (2001) Magnesium sulfate in the treatment of refractory ventricular fibrillation in the prehospital setting. Resuscitation, 49(3), 245-9. PMID: 11719117  

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  

  • March 11, 2014
  • 11:55 PM
  • 92 views

Who Needs a 12 Lead ECG?

by Rogue Medic in Rogue Medic

Do we do too many 12 lead ECGs on patients who do not have chest pain?

This is something that some people worry about.

Save the electrodes!

Those poor little electrodes are being abused!

Are electrodes being abused?... Read more »

  • March 5, 2014
  • 03:00 PM
  • 126 views

The Failure of LUCAS to Improve Outcomes in the LINC Trial

by Rogue Medic in Rogue Medic

We love gadgets in EMS.

Dr. Bryan Bledsoe tells us that if we paint it orange and put a star of life on it, we can sell any product for a lot more money.

How much would you pay to not improve outcomes?

$10,000.00?

$20,000.00?

$30,000.00?

$40,000.00?

$50,000.00?... Read more »

  • November 26, 2013
  • 05:30 PM
  • 232 views

If We Are Not Competent With Direct Laryngoscopy, We Should Just Say So - Part II

by Rogue Medic in Rogue Medic

Continuing from Part I of a paper that could, at best, be described as a convenience sample, since a quarter of patients were excluded from randomization because of attending physician bias.

What were the authors assuming when comparing GVL (GlideScope Video Laryngoscope) with DL (Direct Laryngoscopy) for intubation?... Read more »

Yeatts DJ, Dutton RP, Hu PF, Chang YW, Brown CH, Chen H, Grissom TE, Kufera JA, & Scalea TM. (2013) Effect of video laryngoscopy on trauma patient survival: a randomized controlled trial. The journal of trauma and acute care surgery, 75(2), 212-9. PMID: 23823612  

Lundstrøm LH, Vester-Andersen M, Møller AM, Charuluxananan S, L'hermite J, Wetterslev J, & Danish Anaesthesia Database. (2011) Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177 088 patients. British journal of anaesthesia, 107(5), 659-67. PMID: 21948956  

  • November 20, 2013
  • 06:00 PM
  • 285 views

Is Earlier Better for Therapeutic Hypothermia? Part I

by Rogue Medic in Rogue Medic

When is the right time to begin TH (Therapeutic Hypothermia) to produce the best outcomes?

In the ICU (Intensive Care Unit)?

In the ED (Emergency Department)?

In the ambulance?

While the patient is still pulseless?

This question was asked in 2010.... Read more »

  • November 7, 2013
  • 12:00 PM
  • 253 views

If We Are Not Competent With Direct Laryngoscopy, We Should Just Say So - Part I

by Rogue Medic in Rogue Medic

This study starts out looking good, but there is a huge problem with the design.

If the person intubating felt that he needed to use the video laryngoscope to get the tube, then the patient was not randomized into the study.

How was this paper accepted for publication with such an obviously violation of research methodology?
... Read more »

Yeatts DJ, Dutton RP, Hu PF, Chang YW, Brown CH, Chen H, Grissom TE, Kufera JA, & Scalea TM. (2013) Effect of video laryngoscopy on trauma patient survival: a randomized controlled trial. The journal of trauma and acute care surgery, 75(2), 212-9. PMID: 23823612  

  • September 4, 2013
  • 10:00 PM
  • 274 views

Unreasonable Fear of Hypotension and High-Dose NTG - Part II

by Rogue Medic in Rogue Medic

Continuing from Part I to look at the results of the study of high-dose SL (SubLingual) NTG (NiTroGlycerin – GTN GlycerylTriNitrate in Commonwealth countries) by EMS for CHF (Congestive Heart Failure) that Peter Canning wrote about.[1]

For CHF, more NTG does not produce more of a drop in blood pressure.

If you disagree, provide evidence.... Read more »

Clemency BM, Thompson JJ, Tundo GN, & Lindstrom HA. (2013) Prehospital High-dose Sublingual Nitroglycerin Rarely Causes Hypotension. Prehospital and disaster medicine, 1-4. PMID: 23962769  

  • August 29, 2013
  • 05:20 PM
  • 278 views

Unreasonable Fear of Hypotension and High-Dose NTG - Part I

by Rogue Medic in Rogue Medic

Peter Canning writes about a study of high-dose sublingual nitroglycerin by EMS for congestive heart failure.[1]

I have some problems with the study.

The doses are not high doses.... Read more »

Clemency BM, Thompson JJ, Tundo GN, & Lindstrom HA. (2013) Prehospital High-dose Sublingual Nitroglycerin Rarely Causes Hypotension. Prehospital and disaster medicine, 1-4. PMID: 23962769  

Bertini G, Giglioli C, Biggeri A, Margheri M, Simonetti I, Sica ML, Russo L, & Gensini G. (1997) Intravenous nitrates in the prehospital management of acute pulmonary edema. Annals of emergency medicine, 30(4), 493-9. PMID: 9326864  

  • August 20, 2013
  • 04:30 PM
  • 229 views

Factors associated with failed intubation attempts in the ED - Difficult Airway

by Rogue Medic in Rogue Medic

As with any procedure, each attempt at intubation increases the chance of harm to the patient.

What can we do to minimize the possibility of making more than one attempt at intubation?... Read more »

Kim JH, Kim YM, Choi HJ, Je SM, Kim E, & on behalf of the Korean Emergency Airway Management Registry (KEAMR) Investigators. (2013) Factors associated with successful second and third intubation attempts in the ED. The American journal of emergency medicine. PMID: 23906622  

  • July 31, 2013
  • 09:45 PM
  • 313 views

Dilaudid – Start With 2 mg or Start With 1 mg?

by Rogue Medic in Rogue Medic

What is the proper interval before we should give another dose of opioid to patients who still have significant pain?

This study suggests that 3 to 5 minutes would be ideal, but that the ED (Emergency Department) is not a setting where that is practical. ... Read more »

  • July 27, 2013
  • 12:30 AM
  • 275 views

Not all mechanisms are created equal

by Rogue Medic in Rogue Medic

How do we determine which patients go to a trauma center?

Too often by MOI (Mechanism Of Injury).

Physiologic criteria are not too bad and involve some assessment of the patient.... Read more »

Stuke, Lance E. MD, MPH; Duchesne, Juan C. MD; Greiffenstein, Patrick MD; Mooney, Jennifer L. MD; Marr, Alan B. MD; Meade, Peter C. MD; McSwain, Norman E. MD; Hunt, John P. MD, MPH. (2013) Not all mechanisms are created equal: A single-center experience with the national guidelines for field triage of injured patients. Journal of Trauma and Acute Care Surgery, 75(1), 140-145. DOI: 10.1097/TA.0b013e3182988ae2  

  • July 8, 2013
  • 01:45 AM
  • 398 views

Do Paralytics Improve Outcomes Following Resuscitation?

by Rogue Medic in Rogue Medic

This study will get some people excited because of an impressive p value for an odds ratio of improved cardiac arrest outcomes - 7.23 (1.56–33.38) p = 0.01.

NMBs (NeuroMuscular Blockers/Blockade) are paralytic drugs that are used to prevent movement by the patient. Does this study truly show that immediate use of NMBs improves neurologically intact survival from cardiac arrest?... Read more »

Salciccioli JD, Cocchi MN, Rittenberger JC, Peberdy MA, Ornato JP, Abella BS, Gaieski DF, Clore J, Gautam S, Giberson T.... (2013) Continuous neuromuscular blockade is associated with decreased mortality in post-cardiac arrest patients. Resuscitation. PMID: 23796602  

  • June 29, 2013
  • 08:00 AM
  • 370 views

Lack of Association of Guillain-Barré Syndrome With Vaccinations

by Rogue Medic in Rogue Medic

Don’t expect the self-proclaimed vaccine safety organizations to write about this, unless they are claiming that it is a part of some sort of international conspiracy of governments, universities, private companies, and other research organizations.

They are not interested in safety.

They are interested in creating fear and making money off of the fear they create.... Read more »

Baxter R, Bakshi N, Fireman B, Lewis E, Ray P, Vellozzi C, & Klein NP. (2013) Lack of association of guillain-barre syndrome with vaccinations. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 57(2), 197-204. PMID: 23580737  

  • June 27, 2013
  • 02:45 PM
  • 342 views

Looks Like Anaphylaxis, But Isn't

by Rogue Medic in Rogue Medic

Half an hour after lunch, a 67 year old man passes out.

He regains consciousness, as often happens with syncope.

He is not quite back to normal, blood pressure is 80/60 mm Hg, heart rate is 110, respiratory rate is 25, oxygen saturation is 99% on room air, with a temperature of 96.8° Fahrenheit.

If we tilt him, we will probably get a worsening of his vital signs, but there is no need to actually obtain the numbers if the assessment is causing deterioration.... Read more »

Bourcier S, Mongardon N, Daviaud F, Moachon L, Arnould MA, Perruche F, Pène F, & Cariou A. (2013) Disulfiram ethanol reaction mimicking anaphylactic, cardiogenic, and septic shock. The American journal of emergency medicine, 31(1), 2700-3. PMID: 22809767  

Senthilkumaran S, Menezes RG, Ravindra G, Jena NN, & Thirumalaikolundusubramanian P. (2013) Antabuse reaction due to occupational exposure-an another road on the map?. The American journal of emergency medicine. PMID: 23791458  

Ehrlich RI, Woolf DC, Kibel DA. (2012) Disulfiram reaction in an artist exposed to solvents. Occup Med (Lond)., 62(1), 64-66. DOI: 10.1093/occmed/kqr172  

  • June 19, 2013
  • 08:45 PM
  • 421 views

Epinephrine for V Tach - Instant Death or Effective Treatment?

by Rogue Medic in Rogue Medic

The patient has V Tach (Ventricular Tachycardia) with a pulse. After amiodarone is given the patient's blood pressure drops and the patient becomes unstable. The patient is still awake, so cardioversion would be very painful and these physicians would need to get anesthesia to sedate the patient. I know - that anesthesia requirement is a bad policy and completely unnecessary for the safety of the patient, but it is politics in that facility. However, sedation for emergency cardioversion is ........ Read more »

  • June 11, 2013
  • 11:30 PM
  • 310 views

Publication Bias - The Lit Whisperers

by Rogue Medic in Rogue Medic

The Lit Whisperers raise an important point about publication bias and the validity of published studies that show benefit from a drug company study of a treatment that still has patent exclusivity.[1]

There are many problems with science. Science will never be perfect, but only people who do not understand science claim that it should be perfect.

One of the problems with science is publication bias. A paper that has a positive results about a brand name drug is twice as likely to be publi........ Read more »

Kudenchuk, P., Cobb, L., Copass, M., Cummins, R., Doherty, A., Fahrenbruch, C., Hallstrom, A., Murray, W., Olsufka, M., & Walsh, T. (1999) Amiodarone for Resuscitation after Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation. New England Journal of Medicine, 341(12), 871-878. DOI: 10.1056/NEJM199909163411203  

  • May 28, 2013
  • 09:30 AM
  • 333 views

Examples of Ventricular Tachycardia Caused by Amiodarone - Part I

by Rogue Medic in Rogue Medic

How much worse could the patient get if we give amiodarone?

But amiodarone doesn’t cause V Tach (Ventricular Tachycardia). Amiodarone stops V Tach.

Right?

If amiodarone can cause V Tach, shouldn’t someone have told us?... Read more »

Marill, K., deSouza, I., Nishijima, D., Stair, T., Setnik, G., & Ruskin, J. (2006) Amiodarone Is Poorly Effective for the Acute Termination of Ventricular Tachycardia. Annals of Emergency Medicine, 47(3), 217-224. DOI: 10.1016/j.annemergmed.2005.08.022  

Helmy, I., Herre, J., Gee, G., Sharkey, H., Malone, P., Sauve, M., Griffin, J., & Scheinman, M. (1988) Use of intravenous amiodarone for emergency treatment of life-threatening ventricular arrhythmias. Journal of the American College of Cardiology, 12(4), 1015-1022. DOI: 10.1016/0735-1097(88)90470-6  

  • May 8, 2013
  • 04:30 PM
  • 331 views

Does experience matter – Part II

by Rogue Medic in Rogue Medic

In spite of the evidence to the contrary and a lack of rationality in the claim, we continue to be told that increasing the number of people with a title, such as paramedic, will result in better care.

Here is more evidence that dividing the skills among more people leads to less skilled care.

The authors begin by referring to other studies that demonstrate the high failure rate of doctors performing procedures on children.

How is that relevant to EMS? We have a low frequency of use of ........ Read more »

  • May 2, 2013
  • 04:30 PM
  • 355 views

Will IV Oxygen Save Lives?

by Rogue Medic in Rogue Medic

Intravenous oxygen delivery that works?

Maybe temporary oxygenation, but not yet.

Will this change the approach to CICV (Can’t Intubate, Can’t Ventilate) patients?

No, but it may change the approach to CICO (Can’t Intubate, Can’t Oxygenate) patients.

The distinction is important. ... Read more »

Kheir, J., Scharp, L., Borden, M., Swanson, E., Loxley, A., Reese, J., Black, K., Velazquez, L., Thomson, L., Walsh, B.... (2012) Oxygen Gas-Filled Microparticles Provide Intravenous Oxygen Delivery. Science Translational Medicine, 4(140), 140-140. DOI: 10.1126/scitranslmed.3003679  

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