Rogue Medic

182 posts · 423,858 views

Rogue Medic
182 posts

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  • November 26, 2010
  • 02:45 PM
  • 1,598 views

How Not to Respond to Negative Research – Addendum

by Rogue Medic in Rogue Medic

Does carboxyhemoglobin vary that much that a few seconds later, the HbCO is wildly different?

If that is the case, why buy a machine that will only give us a snap shot of a rapidly fluctuating and unreliable number?

Is there any reason to believe that carboxyhemoglobin changes that rapidly and unpredictably?... Read more »

  • November 26, 2010
  • 07:30 AM
  • 4,864 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 »

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  

  • November 17, 2010
  • 07:30 AM
  • 7,770 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 »

  • November 12, 2010
  • 10:24 AM
  • 1,650 views

The RAD-57 Pulse Co-Oximeter – Does It Work – Part I

by Rogue Medic in Rogue Medic

The RAD-57 "zero" readings are in the Pet Rock Area. I could run some wires and a fancy probe to a Pet Rock. I would obtain the same result as the RAD-57 for all of these patients. The laboratory readings indicate that they had readings of up to 35.2. ... Read more »

  • September 7, 2010
  • 06:22 PM
  • 3,006 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  

  • August 26, 2010
  • 09:18 PM
  • 2,212 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  

  • August 24, 2010
  • 06:58 PM
  • 1,890 views

Drug Shortages Affect Those Still in the Dark Ages – Lidocaine

by Rogue Medic in Rogue Medic

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 »

Komura S, Chinushi M, Furushima H, Hosaka Y, Izumi D, Iijima K, Watanabe H, Yagihara N, & Aizawa Y. (2010) Efficacy of procainamide and lidocaine in terminating sustained monomorphic ventricular tachycardia. Circulation journal : official journal of the Japanese Circulation Society, 74(5), 864-9. PMID: 20339190  

  • June 4, 2010
  • 05:49 AM
  • 979 views

A protocol to improve analgesia use in the accident and emergency department

by Rogue Medic in Rogue Medic

Also posted over at Paramedicine 101 and at Research Blogging. Go check out the rest of the excellent material at both sites.Last month I pointed out Prehospital use of analgesia for suspected extremity fractures. The study I am covering now looks at a similar group of patients in A&E (Accident & Emergency - the British version of ED - Emergency Department).We aimed to assess the use of analgesia within our department and identify shortcomings. Having done this we devised a protocol for interven........ Read more »

  • May 18, 2010
  • 03:38 AM
  • 977 views

Prehospital use of analgesia for suspected extremity fractures

by Rogue Medic in Rogue Medic

Also posted over at Paramedicine 101 and at Research Blogging. Go check out the rest of the excellent material at both sites.This is an older study that puts the prehospital pain management problem into a bit of perspective. While prehospital pain management has improved a lot in some places, other places may still be handling pain as described in this study. This is only ten years old. Attitudes are not changed so easily. The authors looked at what is probably the least controversial type of pa........ Read more »

White, L., Cooper, J., Chambers, R., & Gradisek, R. (2000) P REHOSPITAL U SE OF A NALGESIA FOR S USPECTED E XTREMITY F RACTURES. Prehospital Emergency Care, 4(3), 205-208. DOI: 10.1080/10903120090941209  

  • May 7, 2010
  • 09:59 AM
  • 968 views

Intravenous morphine at 0.1 mg/kg is not effective for controlling severe acute pain in the majority of patients

by Rogue Medic in Rogue Medic

Also posted over at Paramedicine 101 and at Research Blogging. Go check out the rest of the excellent material at both sites.The EMS Garage also covers pain management on the 5/07/10 podcast. EMS Garage - Episode 84. Go listen to that, as well. Chris Montera, Dr. Keith Wesley, Will Dunn, Kyle David Bates, Kelly Grayson, and I discussed several aspects of prehospital pain management.I have been meaning to cover the research on prehospital pain management for a long time. I did write about one exc........ Read more »

  • April 13, 2010
  • 04:50 AM
  • 1,061 views

The association between emergency medical services staffing patterns and out-of-hospital cardiac arrest survival

by Rogue Medic in Rogue Medic

Also posted over at Paramedicine 101 and at Research Blogging. Go check out the rest of the excellent material at both sites.A recent study looks at The association between emergency medical services staffing patterns (the number of paramedics dispatched on an ambulance) and out-of-hospital cardiac arrest survival. They make some interesting observations.We tested the hypothesis that two or more paramedics at the scene of OHCA would be correlated with a higher rate of survival to hospital discha........ Read more »

  • March 28, 2010
  • 03:55 PM
  • 926 views

Journal Club 3: Episode 53

by Rogue Medic in Rogue Medic

Also posted over at Paramedicine 101 and at Research Blogging. Go check out the rest of the excellent material at both sites.Of the two podcasts I had the opportunity to be on this week, this one is more to my liking, due to my desire to increase the use of research-based treatments. Having the lead author of one of the studies on the show was another positive. Greg Friese hosts Journal Club 3: Episode 53.There is a much more thorough discussion of these papers on the podcast.The papers covered ........ Read more »

  • March 7, 2010
  • 10:34 PM
  • 982 views

Correction on Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial.

by Rogue Medic in Rogue Medic

Also posted over at Paramedicine 101. Go check out the rest of what is there.In Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial,[1], [2] I missed some important information. I think I expected more detail to be in the text, than in the charts and figures, so I did not read Figure 2 carefully enough. Regardless of the reason, I did miss some important information.In response, Anonymous left this comment - RM: I was doing some reading on this article and c........ Read more »

Olasveengen TM, Sunde K, Brunborg C, Thowsen J, Steen PA, & 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), 2222-9. PMID: 19934423  

  • February 11, 2010
  • 01:55 AM
  • 998 views

Influence of Sex on the Out-of-hospital Management of Chest Pain - Part I

by Rogue Medic in Rogue Medic

Also posted at Research Blogging. Go read some of the other research there.Why Part I? Because there is a lot to write about in this study. While the authors mean well, they end up demonstrating two things. 1. How not to do a study. 2. How a medical director can endanger patients by lowering standards to meet the perceived abilities of the available medics in an EMS (Emergency Medical Services) system.Let's start at the beginning. In spite of the title, this has nothing to do with the Influence ........ 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  

  • January 21, 2010
  • 10:20 PM
  • 1,043 views

Spine Immobilization in Penetrating Trauma: More Harm Than Good?

by Rogue Medic in Rogue Medic

Also posted over at Paramedicine 101. Go check out the rest of what is there.A recent study points out some of the problems with EMS (Emergency Medical Services) treatment in some places. Each medical director, or state medical director, is permitted to ignore the evidence that some treatments are harmful. They can use ignorance as an excuse for continuing harmful practices. Rather than ignorance, those familiar with the research will claim that somebody might benefit. Their battle cry is What i........ 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  

  • January 1, 2010
  • 03:51 PM
  • 1,079 views

2009’s Top Threat To Science In Medicine

by Rogue Medic in Rogue Medic

Science-Based Medicine, has a post by Dr. Val Jones - 2009’s Top 5 Threats To Science In Medicine.I do not disagree with the list except, and what would one of my posts be without an except, the number one threat to science in medicine is much more of a problem. Our science education in grade school is where we fail our children. Before they even become adults, they are exposed to all sorts of magical thinking.Full moons, speaking about something bad increasing the chances it will occur (a jin........ Read more »

  • December 24, 2009
  • 07:59 PM
  • 1,153 views

Intravenous drug administration during out-of-hospital cardiac arrest: a randomized trial.

by Rogue Medic in Rogue Medic

Also posted over at Paramedicine 101. Go check out the rest of what is there.This study has received a lot of attention. I will interchangeably use the terms the IV (IntraVenous) group and the epinephrine group depending on the terminology I think is more relevant at the time. The distinction is not one that I believe is important. This is a study of IV medication in cardiac arrest. Epinephrine is the stated focus of the study.There has never been any evidence to suggest that medication leads im........ Read more »

Olasveengen TM, Sunde K, Brunborg C, Thowsen J, Steen PA, & 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), 2222-9. PMID: 19934423  

  • November 20, 2009
  • 10:52 AM
  • 1,075 views

Emergency Medical Services Intervals and Survival in Trauma - Assessment of the “Golden Hour”

by Rogue Medic in Rogue Medic

There is a very important paper due to be published in the Annals of Emergency Medicine.[1] I expect that there will be a lot of criticism of this paper. There will be many reasons for being cautious in implementing the suggestions of the authors, but bad research is not one of them. One of the difficult things about this paper is that the authors are very good about identifying potential confounding influences. They explain that there are many factors that may have affected the results. They ar........ Read more »

  • November 30, -1
  • 12:00 AM
  • 1,495 views

The Fatal Flaw in Trial of Continuous or Interrupted Chest Compressions during CPR

by Rogue Medic in Rogue Medic

This is not a study that has a valid control group to determine if there is any benefit from ventilation. There is no group that does not receive ventilations, so it is like a study of one type of blood-letting vs. another type of blood-letting with the researchers taking for granted that blood-letting does improve outcomes. That is not a problem if blood-letting actually improves outcomes.

Should we take it for granted that blood-letting improves outcomes and that the only hypothesis worth s........ Read more »

Nichol, G., Leroux, B., Wang, H., Callaway, C., Sopko, G., Weisfeldt, M., Stiell, I., Morrison, L., Aufderheide, T., Cheskes, S.... (2015) Trial of Continuous or Interrupted Chest Compressions during CPR. New England Journal of Medicine, 2147483647. DOI: 10.1056/NEJMoa1509139  

Alldredge BK,, Gelb AM,, Isaacs SM,, Corry MD,, Allen F,, Ulrich S,, Gottwald MD,, O’Neil N,, Neuhaus JM,, Segal MR,.... (2001) A Comparison of Lorazepam, Diazepam, and Placebo for the Treatment of Out-of-Hospital Status Epilepticus. New England Journal of Medicine, 345(25), 1860-1860. DOI: 10.1056/NEJM200112203452521  

  • November 30, -1
  • 12:00 AM
  • 1,318 views

The PROCAMIO Trial – IV Procainamide vs IV Amiodarone for the Acute Treatment of Stable Wide Complex Tachycardia

by Rogue Medic in Rogue Medic

This is a very interesting trial that may surprise the many outspoken amiodarone advocates, but it should not surprise anyone who pays attention to research.

ALPS showed that we should stop giving amiodarone for unwitnessed shockable cardiac arrest. The lead researcher is still trying to spin amiodarone for witnessed shockable cardiac arrest, even though the results do not show improvement in the one outcome that matters – leaving the hospital with a brain that still works.[1],[2],[3]... Read more »

Kudenchuk PJ, Brown SP, Daya M, Rea T, Nichol G, Morrison LJ, Leroux B, Vaillancourt C, Wittwer L, Callaway CW.... (2016) Amiodarone, Lidocaine, or Placebo in Out-of-Hospital Cardiac Arrest. The New England journal of medicine, 374(18), 1711-22. PMID: 27043165  

Marill KA, deSouza IS, Nishijima DK, Senecal EL, Setnik GS, Stair TO, Ruskin JN, & Ellinor PT. (2010) Amiodarone or procainamide for the termination of sustained stable ventricular tachycardia: an historical multicenter comparison. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 17(3), 297-306. PMID: 20370763  

Marill KA, deSouza IS, Nishijima DK, Stair TO, Setnik GS, & Ruskin JN. (2006) Amiodarone is poorly effective for the acute termination of ventricular tachycardia. Annals of emergency medicine, 47(3), 217-24. PMID: 16492484  

Kułakowski P, Karczmarewicz S, Karpiński G, Soszyńska M, & Ceremuzyński L. (2000) Effects of intravenous amiodarone on ventricular refractoriness, intraventricular conduction, and ventricular tachycardia induction. Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology, 2(3), 207-15. PMID: 11227590  

Bonny A, De Sisti A, Márquez MF, Megbemado R, Hidden-Lucet F, & Fontaine G. (2012) Low doses of intravenous epinephrine for refractory sustained monomorphic ventricular tachycardia. World journal of cardiology, 4(10), 296-301. PMID: 23110246  

Kowey PR. (1988) The calamity of cardioversion of conscious patients. The American journal of cardiology, 61(13), 1106-7. PMID: 3364364  

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