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  • 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  

  • 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 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 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 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 »

  • 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 15, 2011
  • 07:30 AM

Intraosseous Versus Intravenous Vascular Access During Out-of- Hospital Cardiac Arrest – A Randomized Controlled Trial

by Rogue Medic in Rogue Medic

For treatment of medical cardiac arrest patients, which is better – IO (IntraOsseous) or IV (IntraVenous) access for medication administration?

Since no medications have ever been demonstrated to improve survival from cardiac arrest (only chest compressions and defibrillation have), the most important consideration will be what method results in the least interruption of compressions and the least interference with defibrillation.... Read more »

  • December 14, 2011
  • 02:52 PM

Living Kidney Donors & Health Insurance

by in Living Donors Are People Too

The US, unlike other industrialized nations, has no national health care. Since post-WWII, health insurance has been provided and partially supplemented through one's employer. However, not every employers offers health insurance to their employees, and not every employee can afford their portion of the health insurance premium even if it is offered. Then there are the self-employed or unemployed. In short, far too many people in the US (40-50 million) have no health insurance. And there is no r........ Read more »

Gibney EM, Doshi MD, Hartmann EL, Parikh CR, & Garg AX. (2010) Health insurance status of US living kidney donors. Clinical journal of the American Society of Nephrology : CJASN, 5(5), 912-6. PMID: 20413444  

  • December 13, 2011
  • 03:54 PM

Living Donor Guidelines: Systematic, International Review

by in Living Donors Are People Too

Tong and Company looked at ten different living donor related guidelines published from 2006-2010 from Australia, New Zealand, Europe, Canada, United Kingdom, and two International contingencies (WHO & Amsterdam Forum), analyzing their scope, quality and consistency. Here's what they found. - The guidelines varied in scope and lacked methodological rigor. In layperson's terms, this means the documents were all over the place, and made up out of thin air. - Few specific guidelines on women of chi........ Read more »

  • December 12, 2011
  • 01:00 PM

Does Epinephrine Improve Survival from Cardiac Arrest

by Rogue Medic in Rogue Medic

Even though epinephrine (adrenaline) is used automatically in cardiac arrest, and there is evidence that epinephrine helps to produce a pulse (ROSC – Return Of Spontaneous Circulation), there is no evidence that epinephrine improves the only survival statistic that matters – discharge from the hospital with a brain that still works. There were so many deviations from assignment protocol in their 2009 study,[1] that the authors decided to examine the results based on what treatment pa........ Read more »

  • December 1, 2011
  • 11:30 AM

Droperidol, QT prolongation, and sudden death - what is the evidence - Part I

by Rogue Medic in Rogue Medic

The FDA relies on surrogate endpoints. Surrogate endpoints are great for making it seem that we know more than we actually do know. When there is not enough information, surrogate end points are a way of saying, "If this belief is true, and this other belief is also true, then Treatment Z is safe (or dangerous), or saves X number of lives per year (or kills X number of patients who otherwise would have been expected to live)."... Read more »

Kao LW, Kirk MA, Evers SJ, & Rosenfeld SH. (2003) Droperidol, QT prolongation, and sudden death: what is the evidence?. Annals of emergency medicine, 41(4), 546-58. PMID: 12658255  

  • November 30, 2011
  • 07:30 AM

How Dangerous is a Long QT Segment on the ECG

by Rogue Medic in Rogue Medic

There are many things that will lengthen the QT segment, but how much should we worry when the patient has a long QT segment, or when giving the patient a treatment that lengthens the QT segment? Are there some things that, even though they may lengthen the QT segment, may protect the heart from arrhythmia at the same time?... Read more »

  • November 18, 2011
  • 07:30 AM

Automated external defibrillators and survival after in-hospital cardiac arrest

by Rogue Medic in Rogue Medic

Yesterday I described the problems with the recent article claiming that corruption was the reason the AHA recommended AEDs be placed in non-acute care parts of hospitals. Today I will look at the study that seems to have inspired the article, even though it came out a year ago.

Does the research claim that there is any suspicion of corruption in the recommendation?

No. The corruption claims appear to be entirely due to the ideological bias of this conspiracy theory site.... Read more »

Chan PS, Krumholz HM, Spertus JA, Jones PG, Cram P, Berg RA, Peberdy MA, Nadkarni V, Mancini ME, Nallamothu BK.... (2010) Automated external defibrillators and survival after in-hospital cardiac arrest. JAMA : the journal of the American Medical Association, 304(19), 2129-36. PMID: 21078809  

  • November 16, 2011
  • 04:55 PM

Penile Cancer: Another Reason to Stop Banging Animals: (Insert Zoophilia Joke)

by Pranab Chatterjee in Scepticemia

First up, I cannot believe the numbers! This is awe-inspiring. I read the abstract three times in order to convince myself that I was not seeing things. More than the results of the study itself what intrigues me no ends is how the researchers got the participants to open up about screwing with Billy. Billy [...]... Read more »

Zequi SD, Guimarães GC, da Fonseca FP, Ferreira U, de Matheus WE, Reis LO, Aita GA, Glina S, Fanni VS, Perez MD.... (2011) Sex with Animals (SWA): Behavioral Characteristics and Possible Association with Penile Cancer. A Multicenter Study. The journal of sexual medicine. PMID: 22023719  

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