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  • May 15, 2012
  • 09:00 AM
  • 957 views

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

by Rogue Medic in Rogue Medic

Part I was written in 2010, so I am a bit late in continuing to ridicule this example of bad research.

How do we determine what is good care for our patients?

By having our treatment follow the category that dispatch dispatch assigned the call? I used to work in a county, where this did appear to be the case. The medics would become very upset with dispatch if they did not receive a lot of information about the patient prior to arriving on scene.

Dispatchers would express surprise when ........ 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  

  • May 14, 2012
  • 03:11 AM
  • 845 views

Why your heart attack may just be collateral damage in big pharma's turf wars.

by Lutz Kraushaar in Chronic Health

























When a pharmaceutical company tells you that its drug is
safer than it really is, it probably plays with your health. And possibly with
your life. That's not a very nice thing to do. But it's also very profitable. Which
is why it happens more often that you care to know. 


 These days Takeda Pharmaceuticals has gotten some bad press
from a whistle blower suit which claims that TP deliberately withheld trial
data for Actos, a drug which t........ Read more »

  • May 10, 2012
  • 04:00 PM
  • 787 views

Doesn’t that study prove Lasix works?

by Rogue Medic in Rogue Medic

You ask an excellent question.

The study does give the impression that furosemide improved outcomes, but it was never designed as a study of whether furosemide is helpful, or even just not harmful. Other than oxygen, morphine, and furosemide (apparently in that order) we do not know much about the treatment of this small group of patients. Even pulmonary suction is listed as a treatment, but there are no suggestions that treatments are even limited to those listed.... Read more »

  • May 8, 2012
  • 09:15 PM
  • 1,322 views

Blood volume prior to and following treatment of acute cardiogenic pulmonary edema

by Rogue Medic in Rogue Medic

One of the myths of treatment for CHF/ADHF (Congestive Heart Failure/Acute Decompensated Heart Failure) is that the patients are fluid overloaded. We MUST make the patient pee.

If you want to live, you have to pee!... Read more »

  • May 3, 2012
  • 08:00 PM
  • 894 views

Safety of prehospital intravenous fentanyl for adult trauma patients

by Rogue Medic in Rogue Medic

What prevents us from treating pain appropriately?

Actual adverse effects of pain medicine or unwarranted anxiety, due to exaggerated fears of potential adverse effects of pain medicine?

Pain management is important. Unfortunately, EMS and emergency medicine have been better at coming up with excuses for not treating pain, than we have been at coming up with good protocols that encourage treating pain.... Read more »

Soriya GC, McVaney KE, Liao MM, Haukoos JS, Byyny RL, Gravitz C, & Colwell CB. (2012) Safety of prehospital intravenous fentanyl for adult trauma patients. The journal of trauma and acute care surgery, 72(3), 755-759. PMID: 22491566  

  • April 26, 2012
  • 11:00 AM
  • 931 views

Lessons for management of anaphylaxis from a study of fatal reactions – Part I

by Rogue Medic in Rogue Medic

What can help us to learn more about what leads up to a bad outcome from anaphylaxis?

"it seemed that study of a large number of fatal reactions might give insight into why prevention and treatment had failed."... Read more »

Pumphrey RS. (2000) Lessons for management of anaphylaxis from a study of fatal reactions. Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology, 30(8), 1144-50. PMID: 10931122  

  • April 24, 2012
  • 07:30 PM
  • 1,050 views

Glucose before Thiamine for Wernicke Encephalopathy – A Literature Review

by Rogue Medic in Rogue Medic

Maybe that explains how the requirement for thiamine before glucose came about – confabulation.

Many of our traditional treatments are better explained by confabulation, based on a persuasive hypothesis, than by any evidence of benefit to the patient.... Read more »

  • April 19, 2012
  • 08:49 PM
  • 1,184 views

The fertile 'philosophy' of homeopathy

by Lee Turnpenny in The Mawk Moth Profligacies

On the marketing of homeopathy and its claimed effectiveness as treatment for infertility... Read more »

  • April 19, 2012
  • 01:30 PM
  • 881 views

Flawed Helicopter EMS vs Ground EMS Research - Part II

by Rogue Medic in Rogue Medic

Most of the data was incomplete? Is this a surprise?

No. The authors used the NTDB® (National Trauma Data Bank®) to number crunch to find associations and then declared that association is proof. The NTDB® is very flawed data.

The scientific method does not state that we should use weak data to data mine for associations and then claim that these weak associations are proof of anything. This is a failure to use the scientific method.

The NTDB® has been used before. I hav........ Read more »

Galvagno, S., Haut, E., Zafar, S., Millin, M., Efron, D., Koenig, G., Baker, S., Bowman, S., Pronovost, P., & Haider, A. (2012) Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma. JAMA: The Journal of the American Medical Association, 307(15), 1602-1610. DOI: 10.1001/jama.2012.467  

Hemmila, M., Jakubus, J., Wahl, W., Arbabi, S., Henderson, W., Khuri, S., Taheri, P., & Campbell, D. (2007) Detecting the blind spot: Complications in the trauma registry and trauma quality improvement. Surgery, 142(4), 439-449. DOI: 10.1016/j.surg.2007.07.002  

  • April 18, 2012
  • 04:30 PM
  • 638 views

Flawed Helicopter EMS vs Ground EMS Research - Part I

by Rogue Medic in Rogue Medic

The media are posting headlines that there is finally evidence that helicopters save lives.[1]

This is from JAMA, which generated a bunch of headlines with the misleading claim that a glucose-insulin-potassium cocktail saves lives just a few weeks ago. The press bought it. A lot of people accepted the news reports.

Is this research similarly exaggerated far beyond what the evidence justifies?

Is this research valid?... Read more »

Galvagno, S., Haut, E., Zafar, S., Millin, M., Efron, D., Koenig, G., Baker, S., Bowman, S., Pronovost, P., & Haider, A. (2012) Association Between Helicopter vs Ground Emergency Medical Services and Survival for Adults With Major Trauma. JAMA: The Journal of the American Medical Association, 307(15), 1602-1610. DOI: 10.1001/jama.2012.467  

  • April 12, 2012
  • 11:45 PM
  • 1,121 views

Most Common Cause of Death in Anaphylaxis is Failure to Give Epinephrine

by Rogue Medic in Rogue Medic

The most common cause of death in anaphylaxis is failure to give epinephrine.

That is according to Dr. Corey Slovis, presenting at the 2012 Gathering of Eagles Conference.[1]

This is shocking news. Where do we have any evidence of that?... Read more »

  • April 5, 2012
  • 10:30 PM
  • 1,440 views

Naloxone in cardiac arrest with suspected opioid overdoses

by Rogue Medic in Rogue Medic

Can naloxone improve survival from cardiac arrest?

This is an interesting study that looks at some old charts to try to figure out if naloxone made any difference when it was given to cardiac arrest patients suspected of having an opioid overdose. Here is the interesting part of their hypothesis –... Read more »

Saybolt, M., Alter, S., Dos Santos, F., Calello, D., Rynn, K., Nelson, D., & Merlin, M. (2010) Naloxone in cardiac arrest with suspected opioid overdoses. Resuscitation, 81(1), 42-46. DOI: 10.1016/j.resuscitation.2009.09.016  

  • April 4, 2012
  • 03:40 PM
  • 1,119 views

Should We Start Using a Glucose-Insulin-Potassium Cocktail

by Rogue Medic in Rogue Medic

Those unfamiliar with research have been making the usual exaggerated claims that come from wishful thinking and not considering the possible harm from rushing to adopt a treatment based on weak evidence.

Should we rush to make this a standard treatment, that will become a Standard Of Care through inertia and tradition?... Read more »

  • March 23, 2012
  • 09:00 AM
  • 964 views

Dr. Ken Grauer on Killing Patients Just to Get a Temporary Pulse With Epinephrine – Part II

by Rogue Medic in Rogue Medic

Dr. Ken Grauer wrote a couple of extended comments in response to "Killing Patients Just to Get a Temporary Pulse With Epinephrine."

Dr. Grauer has provided some commentary on this on his web site – KG-EKG Press.

"ISSUE #10: Should We Still Use Epinephrine for Cardiac Arrest?"

So, how bad was epinephrine in this study?... Read more »

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), 1161-1168. DOI: 10.1001/jama.2012.294  

Callaway, C. (2012) Questioning the Use of Epinephrine to Treat Cardiac Arrest. JAMA: The Journal of the American Medical Association, 307(11), 1198-1200. DOI: 10.1001/jama.2012.313  

  • March 17, 2012
  • 01:30 PM
  • 932 views

Two Experiments Confirm the Importance of the Scientific Method

by Rogue Medic in Rogue Medic

I could try to make this suspenseful, but it is not a surprise. Attempts to confirm the experiment did not confirm faster than light neutrinos.

The other experiment is even less surprising. There was a paper that claimed that psychic powers are real and that there is proof. Several attempts have been made to reproduce the results. The psychics predicted success, but those predictions were not correct and nobody should be surprised.... Read more »

  • March 15, 2012
  • 10:31 PM
  • 2,597 views

Caramel Color Carcinogens -- Bring Back Crystal Pepsi Part 2

by DJ Busby in Astronasty

Recently in the news, 4-MEI in cola's caramel coloring includes a carcinogen. I explain the severity, and follow it up with my proposal for the resurrection of Crystal Pepsi.... Read more »

National Toxicology Program (NTP, 2007). (2007) Chemical Meeting The Criteria For Listing As Causing Cancer Via The Authoritative Bodies Mechanism: 4-Methylimidazole. NTP Technical Report Series. info:other/NIH: 07-4471

  • March 15, 2012
  • 05:45 PM
  • 1,090 views

Does RSI Protect Against Aspiration of Stomach Contents

by Rogue Medic in Rogue Medic

One of the reasons we use RSI (Rapid Sequence Induction/Intubation) is to protect the airway from aspiration of stomach contents, blood, debris, and other things that might make their way into the lungs and make the patient’s already very bad day, very much worse.

Does RSI protect against aspiration?

We are presented with a patient who appears to need airway management.... Read more »

  • March 14, 2012
  • 09:00 AM
  • 1,228 views

Intramuscular Midazolam for Seizures – Part VI

by Rogue Medic in Rogue Medic

Which seizure patients should be treated with benzodiazepines?

Most patients stop seizing without any treatment and benzodiazepines can cause respiratory depression, so we need to be careful.

You can’t be too careful!

Right?... 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 13, 2012
  • 01:15 PM
  • 1,064 views

Intramuscular Midazolam for Seizures – Part V

by Rogue Medic in Rogue Medic

How should this large double-blind, randomized, noninferiority trial comparing IM (IntraMuscular) midazolam (Versed) with IV (IntraVenous) lorazepam (Ativan) affect the way we treat patients with seizures?

21.3% of patients had their seizures stop before they could be given IV lorazepam, while none of the IM midazolam patients had seizures stop before being given medication.

Does that provide a bias toward improved outcomes with IM midazolam?... 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  

  • March 9, 2012
  • 09:00 AM
  • 1,129 views

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  

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