Rogue Medic

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Commentary on EMS (Emergency Medical Services), medicine, and science.

Rogue Medic
182 posts

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  • September 27, 2012
  • 07:00 PM
  • 1,140 views

Serious adverse events during procedural sedation with ketamine – Part I

by Rogue Medic in Rogue Medic

What contributes to adverse events with the use of ketamine for PSA (Procedural Sedation and Analgesia) in children?

"The pre-PSA use of fentanyl or morphine or concomitant use of midazolam and/or atropine was not associated with an increased in adverse event in either IM or IV ketamine (Table 1)."... Read more »

  • September 22, 2012
  • 09:00 AM
  • 1,047 views

New Caledonian crows reason about hidden causal agents

by Rogue Medic in Rogue Medic

We have generally believed that animals are not capable of very complex thought, even though many species use tools and engage in other complex behaviors.

Even a bird brain appears to be capable of understanding things that are not visible may be affecting their environment.

This study looks at whether New Caledonian crows, that were caught just for this experiment, are capable of attributing actions to a hidden cause, when they see that possible cause come and go.... Read more »

  • September 18, 2012
  • 04:00 PM
  • 1,078 views

Wide variability in drug use in out-of-hospital cardiac arrest: A report from the resuscitation outcomes consortium – Part II

by Rogue Medic in Rogue Medic

Only low dose epinephrine was shown to improve ROSC (Return Of Spontaneous Circulation) in this study, but even low dose epinephrine dramatically decreased survival. I looked at that in Part I. Here I look at some of what the authors have to say about this in the discussion.

What seems most surprising is how bad the results were for epinephrine.... Read more »

Glover BM, Brown SP, Morrison L, Davis D, Kudenchuk PJ, Van Ottingham L, Vaillancourt C, Cheskes S, Atkins DL, Dorian P.... (2012) Wide variability in drug use in out-of-hospital cardiac arrest: A report from the resuscitation outcomes consortium. Resuscitation. PMID: 22858552  

  • September 17, 2012
  • 09:00 AM
  • 901 views

Wide variability in drug use in out-of-hospital cardiac arrest: A report from the resuscitation outcomes consortium – Part I

by Rogue Medic in Rogue Medic

Here is some more research looking at the use of medications in cardiac arrest. In this part, I will look at the outcomes for patients treated with epinephrine. In Part II I will look at the authors’ discussion of their results.

Maybe this time epinephrine will produce a good outcome.... Read more »

Glover BM, Brown SP, Morrison L, Davis D, Kudenchuk PJ, Van Ottingham L, Vaillancourt C, Cheskes S, Atkins DL, Dorian P.... (2012) Wide variability in drug use in out-of-hospital cardiac arrest: A report from the resuscitation outcomes consortium. Resuscitation. PMID: 22858552  

Bigham BL, Koprowicz K, Aufderheide TP, Davis DP, Donn S, Powell J, Suffoletto B, Nafziger S, Stouffer J, Idris A.... (2010) Delayed prehospital implementation of the 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiac care. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 14(3), 355-60. PMID: 20388032  

  • September 13, 2012
  • 09:00 AM
  • 1,061 views

Is a clot-busting drug safe for 6 hours after stroke symptom onset – or only for an hour and a half? – Part I

by Rogue Medic in Rogue Medic

The clot-buster tPA (tissue Plasminogen Activator) is given to stroke patients within 3 hours of onset of symptoms (some use 4 1/2 hours), based on a poorly done study. Some doctors are claiming that the benefits from tPA for stroke can be extended even to 6 hours.

Are the authors exhibiting stroke-like symptoms from sipping too much of their own Kool-Aid?

My first experience with a patient being given tPA for stroke was over a decade ago with a patient I brought to the hospital within abo........ Read more »

Katzan IL, Furlan AJ, Lloyd LE, Frank JI, Harper DL, Hinchey JA, Hammel JP, Qu A, & Sila CA. (2000) Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience. JAMA : the journal of the American Medical Association, 283(9), 1151-8. PMID: 10703777  

  • September 11, 2012
  • 10:00 PM
  • 10,917 views

Prove it – Ventilation improves survival from cardiac arrest

by Rogue Medic in Rogue Medic

Is a dead person going to be resuscitated sooner if we decrease the return of blood to the heart?

Ventilations decrease the return of blood to the heart.

Is a dead person going to be resuscitated sooner if we decrease whatever blood pressure we are creating with continuous chest compressions?

Ventilations decrease blood pressure, too.

Is a dead person short of breath?

Not unless resuscitated.

Is a person in cardiac arrest from an arrhythmia going to be hypoxic?

Probably not,........ Read more »

Mosier J, Itty A, Sanders A, Mohler J, Wendel C, Poulsen J, Shellenberger J, Clark L, & Bobrow B. (2010) Cardiocerebral resuscitation is associated with improved survival and neurologic outcome from out-of-hospital cardiac arrest in elders. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 17(3), 269-75. PMID: 20370759  

  • September 9, 2012
  • 09:00 AM
  • 976 views

Should oxygen be given in myocardial infarction?

by Rogue Medic in Rogue Medic

In 2010, a Cochrane Review showed something that we already knew, but wanted to keep ignoring.

There is no evidence that supplemental oxygen improves outcomes for patients having an acute myocardial infarction, but there is evidence that oxygen is causing harm to these patients.

Should we continue to treat these patients with supplemental oxygen in the absence of either hypoxia or respiratory distress?

Dan Atar, professor and head of cardiology, wrote –... Read more »

  • September 7, 2012
  • 01:00 PM
  • 1,336 views

Supraventricular tachycardia induced by chocolate – is chocolate too sweet for the heart?

by Rogue Medic in Rogue Medic

Apparently chocolate, which is an adenosine antagonist, has the potential to cause arrhythmia.

Actually, the methylxanthines in chocolate are the adenosine antagonists (theobromine and caffeine), but it is the theobromine that appears to be what we (I) crave about chocolate. Should I give up chocolate or get an implanted defibrillator? While there is also caffeine in chocolate, only wimps get addicted to caffeine.That headache is just because people are more annoying without caffeine. The ca........ Read more »

  • September 6, 2012
  • 05:00 PM
  • 1,393 views

The cricoid cartilage and the esophagus are not aligned in close to half of adult patients

by Rogue Medic in Rogue Medic

Cricoid pressure has been used to keep the stomach contents in the stomach, and out of the airway, since Dr. Brian A. Sellick wrote about it in 1961.[1] The problem is that the evidence does not show that it works.

This study looked at cervical CT (Computed Tomography) scans to see what anatomic relationship exists between the cricoid ring and the esophagus in a group of patients with some sort of reason to have a neck CT.... Read more »

  • September 2, 2012
  • 09:00 AM
  • 861 views

Does experience matter – Part I

by Rogue Medic in Rogue Medic

In response to some of what I have recently written about the problems with too many medics, people have claimed that I don’t have any evidence to support my statements.[1],[2],[3]

This will cover just one of the many studies that demonstrate that less experience is bad for patients. For those who think that having all medic crews run all 911 calls, your problem will be burnout, since only a minority of patients are likely to benefit from any ALS (Advanced Life Support) providers. I wil........ Read more »

  • August 31, 2012
  • 09:00 AM
  • 808 views

Blue Moon 2012 – Except parts of Oceanea

by Rogue Medic in Rogue Medic

Tonight is a Blue Moon and a Friday the Dyslexic 13th Full Moon.

As conspiracy theorists say, "That can’t be a coincidence!"

Of course it can be a coincidence.... Read more »

Chapman S, & Morrell S. (2000) Barking mad? another lunatic hypothesis bites the dust. BMJ (Clinical research ed.), 321(7276), 1561-3. PMID: 11124174  

  • August 30, 2012
  • 06:00 PM
  • 885 views

EMS Zebra Hunting, Doing What’s Right or What’s Expected

by Rogue Medic in Rogue Medic

Is needle decompression of tension pneumothorax overused?

Are we too aggressive with the harpoon?

Didn’t this get Ahab into trouble?
... Read more »

Tien HC, Jung V, Rizoli SB, Acharya SV, & MacDonald JC. (2009) An evaluation of tactical combat casualty care interventions in a combat environment. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 9(1), 65-8. PMID: 19813350  

  • August 29, 2012
  • 03:30 PM
  • 1,016 views

How Accurate are We at Rapid Sequence Intubation for Pediatric Emergency Patients - Part II

by Rogue Medic in Rogue Medic

Do we accurately report errors and success with pediatric RSI (Rapid Sequence Intubation/Induction)?

Should we trust our memories?... Read more »

  • August 28, 2012
  • 10:30 PM
  • 804 views

How Accurate are We at Rapid Sequence Intubation for Pediatric Emergency Patients

by Rogue Medic in Rogue Medic

Which patients cause most of us the most anxiety?

Kids.

Which patients do most of us least want to injure?

Kids.

What skill do we tend to brag about as if we are much better than our actual success rates?

IVs, 12 lead ECG interpretation, and even driving are up there for EMS, but the biggest exaggeration is probably for intubation.

Combine all of these and move to the ED (Emergency Department) and the skill most inaccurately represented as positive may be pediatric intubation. ........ Read more »

  • August 26, 2012
  • 04:00 PM
  • 961 views

Geriatric patients may not experience increased risk of oligoanalgesia in the emergency department

by Rogue Medic in Rogue Medic

The current Annals of Emergency Medicine has an editorial and two studies of pain management in older adults.

One study is a 10-year prospective, observational study of a convenience sample of patients who had pain on presentation to the ED. Over 10 years any Hawthorne effect can be expected to wear off. Over a decade a lot can change, especially with the ways that pain management has progressed.... Read more »

Cinar O, Ernst R, Fosnocht D, Carey J, Rogers L, Carey A, Horne B, & Madsen T. (2012) Geriatric patients may not experience increased risk of oligoanalgesia in the emergency department. Annals of emergency medicine, 60(2), 207-11. PMID: 22818367  

  • August 23, 2012
  • 03:00 PM
  • 1,159 views

Adenosine for wide-complex tachycardia - diagnostic?

by Rogue Medic in Rogue Medic

This study looks at the "efficacy and safety" of adenosine as a diagnostic tool for WCT (Wide Complex Tachycardia) WCT is a fast rhythm with prolonged ventricular conduction that has not had its cause diagnosed, yet. The W in WCT is its Width on an ECG (ElectroCardioGram), which is a measure of time.

The authors claim that a lack of response to adenosine will identify VT (V Tach - Ventricular Tachycardia). At least, that is what they claim that their study demonstrates.... Read more »

Marill KA, Wolfram S, Desouza IS, Nishijima DK, Kay D, Setnik GS, Stair TO, & Ellinor PT. (2009) Adenosine for wide-complex tachycardia: efficacy and safety. Critical care medicine, 37(9), 2512-8. PMID: 19623049  

  • August 22, 2012
  • 09:00 AM
  • 1,505 views

Does the parachute study prove that research doesn't matter? Part I

by Rogue Medic in Rogue Medic

Every now and then, somebody who doesn't like science claims that research is not important and uses the reference of the parachute study.

The parachute study authors make it clear that their paper is a satire. It appears in the Christmas issue, which is the most comedic of the BMJ (British Medical Journal) issues.... Read more »

  • August 15, 2012
  • 09:00 AM
  • 720 views

These authors read far too much into their limited study – Part II

by Rogue Medic in Rogue Medic

The authors do not find dramatic differences between fentanyl and morphine in their ability to relieve pain in patients who are not hypotensive. In the discussion, they begin to give their reasons for not wanting to use fentanyl.

Why?

I don’t know why they are not fond of fentanyl, but this is what they write in their discussion.... Read more »

  • August 14, 2012
  • 05:30 PM
  • 776 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 »

  • August 8, 2012
  • 09:00 AM
  • 800 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 »

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