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All posts; Tags Include "Medical Ethics"

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  • August 28, 2012
  • 10:30 PM
  • 761 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
  • 914 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
  • 1,111 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
  • 1,456 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
  • 671 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
  • 727 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
  • 748 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 »

  • July 17, 2012
  • 09:00 AM
  • 1,066 views

What is the effect of clopidogrel on head injuries? Part IV

by Rogue Medic in Rogue Medic

All of these patients were ground-level falls, so from standing, or sitting, or lying on bed. All of these patients had a GCS (Glasgow Coma Score) of 15, which is normal. There does not appear to have been anything alarming about any of these patients, but two of them died - and the information does not provide any clues to identify them while they might have been treated successfully. ... Read more »

  • July 10, 2012
  • 09:00 PM
  • 877 views

What is the effect of clopidogrel on head injuries? Part III

by Rogue Medic in Rogue Medic

Continuing from Part I and Part II about the comparative effects of warfarin (Coumadin) and clopidogrel (Plavix) on tICH (traumatic IntraCranial Hemorrhage).

Total patients – 1,064.

Total seen at a trauma center – 364 (34.2%).

Total seen at a community hospital – 700 (65.8%).... Read more »

  • June 25, 2012
  • 09:00 AM
  • 1,572 views

Laryngospasm, hypoxia, excited delirium, and ketamine – Part II

by Rogue Medic in Rogue Medic

Continuing from Part I, where our excited delirium patient was sedated quickly with IM (IntraMuscular) ketamine, but developed laryngospasm and cyanosis later at the hospital.

Do we have a good drug to prevent muscular spasm of the smooth muscles?

Can we ventilate him again? Yes, but there is a bit of a pattern developing. It would not be good to ignore the possibility that this will not be the last episode of laryngospasm for this patient today.... Read more »

Burnett AM, Watters BJ, Barringer KW, Griffith KR, & Frascone RJ. (2012) Laryngospasm and hypoxia after intramuscular administration of ketamine to a patient in excited delirium. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 16(3), 412-4. PMID: 22250698  

  • June 21, 2012
  • 04:00 PM
  • 1,088 views

Laryngospasm, hypoxia, excited delirium, and ketamine - Part I

by Rogue Medic in Rogue Medic

One of the concerns with ketamine is the rare occurrence of laryngospasm.

Can EMS manage the airway without paralytics?

If we can find just one bad outcome,should we prohibit EMS ketamine use and thus prevent all of the good outcomes, just to be safe?

Let’s look at an actual example, rather than waxing philosophical.... Read more »

Burnett AM, Watters BJ, Barringer KW, Griffith KR, & Frascone RJ. (2012) Laryngospasm and hypoxia after intramuscular administration of ketamine to a patient in excited delirium. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 16(3), 412-4. PMID: 22250698  

  • June 21, 2012
  • 11:23 AM
  • 844 views

Genomic Medicine: The Road Ahead

by GDW in The Beast, the Bard and the Bot

DNA sequencing is becoming cheaper and faster. In fact, full genome sequencing is possible. It seems reasonable to assume that this increase in speed and decrease in cost will persist. As such, genomic medicine, where the patient’s genomic information is … Continue reading →... Read more »

Chen R, Mias GI, Li-Pook-Than J, Jiang L, Lam HY, Chen R, Miriami E, Karczewski KJ, Hariharan M, Dewey FE.... (2012) Personal omics profiling reveals dynamic molecular and medical phenotypes. Cell, 148(6), 1293-307. PMID: 22424236  

Green Eric D., Guyer Mark S. Guyer, & National Human Genome Research Institute. (2011) Charting a course for genomic medicine from base pairs to bedside. Nature. DOI: 10.1038/nature09764  

MacArthur, Daniel G., & Lek, Monkol. (2012) The uncertain road towards genomic medicine. Trends in Genetics. DOI: 10.1016/j.tig.2012.05.001  

  • June 19, 2012
  • 09:00 AM
  • 1,183 views

One hundred percent oxygen in the treatment of acute myocardial infarction and severe angina pectoris

by Rogue Medic in Rogue Medic

In the absence of hypoxia, is supplemental oxygen good for a patient with cardiac chest pain, but no hypoxia or shortness of breath?

We take it for granted that giving oxygen is good, and more oxygen is better, even if the patient is not hypoxic or short of breath, but what does the research show for cardiac patients?

This double-blinded study, released only 62 years ago – in 1950, strongly suggests that supplemental oxygen is not good for patients with chest pain and/or ECG changes......... Read more »

  • June 15, 2012
  • 09:00 AM
  • 949 views

Is this what an IRB is supposed to do?

by Rogue Medic in Rogue Medic

These researchers appear to have started off with an obstacle that they never could completely overcome. What do we do when the IRB (Institutional Review Board) is opposed to studying treatment in a way that will actually test the hypothesis in question?... Read more »

  • June 13, 2012
  • 09:00 AM
  • 958 views

What is the effect of clopidogrel on head injuries? Part II

by Rogue Medic in Rogue Medic

A part of this study that should received more attention is the rate of immediate tICH (traumatic IntraCranial Hemorrhage) among patients taking clopidogrel or warfarin.

5.1% of warfarin (Coumadin) patients had immediate traumatic intracranial hemorrhage.

12.0% of clopidogrel (Plavix) patients had immediate traumatic intracranial hemorrhage.

The sample was from all patients with any kind of head trauma who presented to the participating trauma centers or to the participating community h........ Read more »

  • June 7, 2012
  • 09:00 AM
  • 1,129 views

What is the effect of clopidogrel on head injuries? Part I

by Rogue Medic in Rogue Medic

This is the final paper on head trauma and anticoagulants from the current Annals of Emergency Medicine. I wrote about the pair of editorials and the other article earlier.[1],[2] There is a lot to write about in this paper, so I am glad that this is a very well done paper. It is a pleasure to read research on an important topic and not be disappointed.... Read more »

  • June 4, 2012
  • 09:00 AM
  • 1,089 views

Will spontaneous pneumothorax progress to tension pneumothorax?

by Rogue Medic in Rogue Medic

If the conventional teaching were true, then why do so few spontaneous pneumothoraces progress to tension pneumothoraces?

Why is tension pneumothorax is rare.

Treatment of presumed tension pneumothorax appears to be much more common than tension pneumothorax.[2]... Read more »

  • May 25, 2012
  • 09:00 AM
  • 1,133 views

Cochrane and a Significantly Biased Review of Steroids for acute spinal cord injury

by Rogue Medic in Rogue Medic

An interesting relic of trauma care is the use of steroids for the treatment of acute spinal cord injury. As with The Golden Hour, there are people still promoting this idea. In the words of Monty Python, it’s not quite dead, yet.

Who is promoting this idea? The Cochrane Collaboration.

Here is a list of the papers evaluated in this 2012 update of the 2009 Cochrane Review, which was an update of the 2002 Cochrane Review. There has been no change in the references, since the most recen........ Read more »

Bracken MB. (2012) Steroids for acute spinal cord injury. Cochrane database of systematic reviews (Online). PMID: 22258943  

  • May 24, 2012
  • 03:35 PM
  • 773 views

Validation of the Dime

by Rogue Medic in Rogue Medic

The current Annals of Emergency Medicine has a pair of editorials on the article I wrote about[1] in This is the Way to Bad Medicine back in January. Dr. Radecki also was critical of this paper.[2] There is another study that refers to the same question published in this issue, but I will write about that paper later.

"These data raise the real question, Do such findings matter? By admitting more patients and ordering more CTs, do we improve outcomes? Or do we simply find more things tha........ Read more »

  • May 22, 2012
  • 02:00 PM
  • 1,086 views

How Diagnostic is Narcan?

by Rogue Medic in Rogue Medic

At Resus.ME,[1] Dr. Reid suggests that one benefit of nebulized naloxone[2] is its diagnostic value. He asks –

"Do you ever use naloxone diagnostically, and if so, do you think it’s worth knowing that the nebulised route is an option?"

This has been studied.... Read more »

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