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  • March 9, 2012
  • 09:00 AM

Intramuscular Midazolam for Seizures – Part IV

by Rogue Medic in Rogue Medic

If an IV is already in place, on average the IV lorazepam should stop the seizure about 1.6 minutes after the lorazepam is pushed into the IV line.

The IM midazolam should stop the seizure about 3.3 minutes after the midazolam is injected into the muscle, on average.

If an IV is already in place, IV lorazepam should be significantly faster.

An IV is usually not already in place when EMS shows up. so what should we do?... Read more »

Silbergleit, R., Durkalski, V., Lowenstein, D., Conwit, R., Pancioli, A., Palesch, Y., & Barsan, W. (2012) Intramuscular versus Intravenous Therapy for Prehospital Status Epilepticus. New England Journal of Medicine, 366(7), 591-600. DOI: 10.1056/NEJMoa1107494  

  • March 7, 2012
  • 09:00 AM

Nontraumatic out-of-hospital hypotension predicts inhospital mortality

by Rogue Medic in Rogue Medic

An interesting examination of something that we take for granted. Does any instance of hypotension increase the risk of death for patients with life-threatening or potentially life-threatening conditions? Hypotension is categorized as SBP (Systolic Blood Pressure) less than 100 mm Hg, rather than SBP less than 90.

They assessed patients with respiratory distress, syncope, chest pain, dizziness, altered mental status, anxiety, thirst, weakness, fatigue, or the sensation of impending doom.... Read more »

Jones, A., Stiell, I., Nesbitt, L., Spaite, D., Hasan, N., Watts, B., & Kline, J. (2004) Nontraumatic out-of-hospital hypotension predicts inhospital mortality☆. Annals of Emergency Medicine, 43(1), 106-113. DOI: 10.1016/j.annemergmed.2003.08.008  

  • March 4, 2012
  • 03:28 PM

4 reasons why all women should play Mass Effect

by TheCellularScale in The Cellular Scale

Another adventure outside of the 'cellular neuroscience' walls for The Cellular Scale.  Today we are traveling to the land of video games, video games and women.  Commander Shepard, the most badass woman in the galaxyMass Effect 3 is being released in a few days and I thought I would use this time (while my xbox is downloading the free demo) to write about why the world would be a better (or at least slightly more gender-neutral) place if all women played Mass Effec........ Read more »

Galinsky AD, Wang CS, & Ku G. (2008) Perspective-takers behave more stereotypically. Journal of personality and social psychology, 95(2), 404-19. PMID: 18665710  

  • February 29, 2012
  • 10:55 AM

Playing “Good Cop, Bad Cop” with Octopuses

by Miss Behavior in The Scorpion and the Frog

Have you ever seen an octopus in an aquarium, or maybe even in the ocean, and thought, “I know you!”? No? Well, they might think that when they see you!We’ve known for some time that many domestic animals, like dogs, can tell us people apart. It turns out that a lot of animal species can recognize individual people. But how do we humans know that? It’s not like you can walk right up to an animal and say “Hey! Remember me?” ...Well, I guess you could do that, but how would you interpr........ Read more »

Anderson RC, Mather JA, Monette MQ, & Zimsen SR. (2010) Octopuses (Enteroctopus dofleini) recognize individual humans. Journal of applied animal welfare science : JAAWS, 13(3), 261-72. PMID: 20563906  

  • February 27, 2012
  • 12:59 AM

Trauma Criteria – preventative medicine – Part I

by Rogue Medic in Rogue Medic

There are a lot of interesting things about this study, but Table 3 shows that there is some ability to improve the accuracy of triage criteria by combining criteria. This should be a no brainer, but here are some data to support this. 2.8% 4.7% 8.0% = 50%. That is a tremendous improvement over the 15.5% that they add up to individually.... Read more »

Sasser SM, Hunt RC, Sullivent EE, Wald MM, Mitchko J, Jurkovich GJ, Henry MC, Salomone JP, Wang SC, Galli RL.... (2009) Guidelines for field triage of injured patients. Recommendations of the National Expert Panel on Field Triage. MMWR. Recommendations and reports : Morbidity and mortality weekly report. Recommendations and reports / Centers for Disease Control, 58(RR-1), 1-35. PMID: 19165138  

  • February 22, 2012
  • 09:00 AM

Mass sociogenic illness initially reported as carbon monoxide poisoning

by Rogue Medic in Rogue Medic

Here is a report of a mass delusion that seems to have been compounded by the use of the Masimo RAD-57 non-invasive CO monitor. CO (Carbon monOxide) is a significant cause of poisoning in the US, but not relevant in this case. The RAD-57 incorrectly identified CO poisoning in half a dozen people who do not appear to have had any exposure to CO.... Read more »

Nordt, S., Minns, A., Carstairs, S., Kreshak, A., Campbell, C., Tomaszweski, C., Hayden, S., Clark, R., Joshua, A., & Ly, B. (2012) Mass Sociogenic Illness Initially Reported as Carbon Monoxide Poisoning. The Journal of Emergency Medicine, 42(2), 159-161. DOI: 10.1016/j.jemermed.2011.01.028  

  • February 21, 2012
  • 07:10 PM

Accuracy of Noninvasive Multiwave Pulse Oximetry Compared With Carboxyhemoglobin From Blood Gas Analysis in Unselected Emergency Department Patients

by Rogue Medic in Rogue Medic

The Masimo RAD-57 non-invasive CO monitor is promoted as an accurate way to identify patients at risk of life-threatening complications of CO poisoning. CO (Carbon monOxide) is a significant cause of poisoning in the US, with hundreds of fatalities each year.

Masimo claims that their RAD-57 is able to accurately measure blood levels of CO without any complicated lab equipment. If it works, the RAD-57 might save some lives. Unfortunately, the research that has not been funded by Masimo does no........ Read more »

  • February 20, 2012
  • 09:50 AM

Intramuscular Midazolam for Seizures – Part III

by Rogue Medic in Rogue Medic

This presents an interesting conundrum. Doses of benzodiazepines (midazolam, lorazepam, diazepam, . . .) are often limited, due to a fear of causing respiratory complications. When treating seizures, higher doses of benzodiazepines may protect patients from respiratory complications.... Read more »

Silbergleit, R., Durkalski, V., Lowenstein, D., Conwit, R., Pancioli, A., Palesch, Y., & Barsan, W. (2012) Intramuscular versus Intravenous Therapy for Prehospital Status Epilepticus. New England Journal of Medicine, 366(7), 591-600. DOI: 10.1056/NEJMoa1107494  

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. The New England journal of medicine, 345(9), 631-7. PMID: 11547716  

  • February 20, 2012
  • 09:03 AM

The Climate War

by Umberto in Up and Down in Moxos

Climate is changing. This is like an obvious conclusion if you areold enough to remember how it was only 20 or 30 years ago. “Non c'è più la mezza stagione” (“There are no more middle seasons” which is the Italian equivalent of “Things are not what they used to be”) is one of themost used expression when travelling on the train in Italy, like a mantra used to start any conversation.Less commonly accepted among the general public is that the causeof this change towards a w........ Read more »

  • February 19, 2012
  • 07:30 AM

Intramuscular Midazolam for Seizures – Part II

by Rogue Medic in Rogue Medic

While there have been studies comparing IM (IntraMuscular) midazolam (Versed) with IV (IntraVenous) anti-epileptic medications, this is a large study that compares IM midazolam with the best IV anti-epileptic medication in a double-blind, randomized, noninferiority trial.

For the study, there were two different doses for the auto-injector (the same as an EpiPen). The doses were not small.

Midazolam for seizures is an off-label use both when given IM and when given IV.[2]

The lorazepa........ Read more »

Silbergleit, R., Durkalski, V., Lowenstein, D., Conwit, R., Pancioli, A., Palesch, Y., & Barsan, W. (2012) Intramuscular versus Intravenous Therapy for Prehospital Status Epilepticus. New England Journal of Medicine, 366(7), 591-600. DOI: 10.1056/NEJMoa1107494  

  • February 7, 2012
  • 10:10 AM

Military Use of Neuroscience Should Be Regulated, Report Warns

by United Academics in United Academics

tDCS is a form of neurostimulation that, in the case of the research mentioned above, led to a better detection of concealed objects, based on the fact that the brain detects things before the subject is consciously aware of them. The results also showed that it may improve learning abilities, thus decreasing “the time required to attain expertise in a variety of settings,” according to the study.... Read more »

Clark, V., Coffman, B., Mayer, A., Weisend, M., Lane, T., Calhoun, V., Raybourn, E., Garcia, C., & Wassermann, E. (2012) TDCS guided using fMRI significantly accelerates learning to identify concealed objects. NeuroImage, 59(1), 117-128. DOI: 10.1016/j.neuroimage.2010.11.036  

  • February 2, 2012
  • 07:30 AM

This is the Way to Bad Medicine - II

by Rogue Medic in Rogue Medic

Their categorization of only 3 (out of 32) serious adverse events as "Probably related to treatment" and none as "Definitely related to treatment" suggests that they are not being objective. How do they explain this in the discussion? They don’t. Maybe they aren’t referring to the serious adverse events, but are referring to deaths. I don’t know and since they do not explain, I can only speculate.... Read more »

  • January 24, 2012
  • 05:30 PM

This is the Way to Bad Medicine

by Rogue Medic in Rogue Medic

Dr. Radecki at EM Literature of Note has a nice analysis of a study that promises to try to change medicine for the worse. Of course, that is not the intent of the study’s authors, but they have too much confidence in their results. The study is only looking at patients with minor head injury and minor symptoms, but taking warfarin (Coumadin).... Read more »

  • January 15, 2012
  • 09:09 PM

Avoiding Lasting Pain With Administration of High Dosage Spurts of Morphine

by DJ Busby in Astronasty

This discovery, in a nutshell, can be found in the last sentence of the abstract:
"Opioids thus not only temporarily dampen pain but may also erase a spinal memory trace of pain."... Read more »

  • January 9, 2012
  • 02:35 AM

Patient Safety in Medical Education

by Dr Shock in Dr Shock MD PhD

Buffer When searching in pubmed for the two mesh terms “patient safety” and “medical education” results in 8 hits. Some research articles and editorials. One quote with literature reference about the extend of the problem is: Our health care system today has an adverse event rate approximately equal to that of driving an automobile putting [...]
No related posts.... Read more »

Wagner, D., Noel, M., Barry, H., & Reznich, C. (2011) Safe Expectations. Academic Medicine, 86(11). DOI: 10.1097/ACM.0b013e3182327c81  

  • January 4, 2012
  • 10:39 PM

A Walkthrough To Find Credible Souces and Answers to the Controversies of Vaccines, Evolution, Holocaust, and Global Warming

by DJ Busby in Astronasty

Where do you get your facts?
Hopefully, a reliable source.
So what's an online reliable source, and how can a regular Joe get a hold of this information?

A very easy way to be confident is to make sure that you're reading from an .edu or .gov page. One of the easiest (and quickest) ways to find your topic is through the citations on Wikipedia. Some people doubt the validity of Wikipedia in fear of hecklers. The nature or self-maintaining issue of Wikipedia aside, the citation........ Read more »

Bonhoeffer J, & Heininger U. (2007) Adverse events following immunization: perception and evidence. Current opinion in infectious diseases, 20(3), 237-46. PMID: 17471032  

Demicheli V, Jefferson T, Rivetti A, & Price D. (2005) Vaccines for measles, mumps and rubella in children. Cochrane database of systematic reviews (Online). PMID: 16235361  

Committee on Revising Science and Creationism: A View from the National Academy of Sciences, National Academy of Sciences and Institute of Medicine of the National Academies. (2008) Science, Evolution, and Creationism. The National Academies Press. info:/9780309105866

  • January 4, 2012
  • 03:20 PM

Nifekalant versus lidocaine for in-hospital shock-resistant ventricular fibrillation or tachycardia

by Rogue Medic in Rogue Medic

Why compare nikefelant with lidocaine? Why not compare nikefelant with amiodarone? Why not compare nikefelant with an antiarrhythmic that is more effective than amiodarone – procainamide, sotalol, or ajmaline?

Lidocaine is probably used because the IRB (Institutional Review Board) would consider it unethical to have a placebo group. Lidocaine is the placebo, but with less safety than the placebo.... Read more »

  • January 2, 2012
  • 03:07 AM

Principles for Patient Safety

by Dr Shock in Dr Shock MD PhD

Buffer Teaching patient safety starts in medical school. Hospitals can be weired chaotic places. It’s often a wonder everything keeps working as it should although failures do occur. Medical professionals come to realize that mistakes happen and they adapt their working procedures to those of the so called high reliability organizations such as aircrafts, airline [...]
No related posts.... Read more »

Prasanna, P., & Nagy, P. (2011) Learning From High-Reliability Organizations. Journal of the American College of Radiology, 8(10), 725-726. DOI: 10.1016/j.jacr.2011.06.020  

  • December 27, 2011
  • 07:30 AM

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 18, 2011
  • 09:06 AM

NHS research ethics procedures: a modern-day Circumlocution Office

by Dorothy Bishop in bishopblog

A discussion of the impact of research ethics and governance procedures in the UK... Read more »

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