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All posts; Tags Include "Medical Ethics"

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  • February 20, 2011
  • 07:30 AM

Prehospital Intravenous Fluid Administration is Associated With Higher Mortality in Trauma Patients – Part I

by Rogue Medic in Rogue Medic

We expect the PubMed abstract to provide the important information.

In this case, we would be wrong.

This study does not look at Prehospital Intravenous Fluid Administration.... Read more »

  • February 14, 2011
  • 02:30 PM

Inadequate needle thoracostomy rate in the prehospital setting for presumed pneumothorax: an ultrasound study – Full paper

by Rogue Medic in Rogue Medic

Should we assume that a tension pneumothorax is subtle?

I don't think so.

Why do we teach about tension pneumothorax as if it is the same as an easily missed simple pneumothorax?

I think it is because we don't realize just how unsubtle a tension pneumothorax is.
... 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  

  • February 8, 2011
  • 09:00 AM

The Science Behind Health At Every Size (HAES)

by Arya M. Sharma in Dr. Sharma's Obesity Notes

Regular readers of these pages will recall my past criticism of the use of BMI in individual counseling, my introduction of the Edmonton Obesity Staging System (which classifies obese patients not by how “big” they are but rather by how “sick” they are), and the many previous posts that recommend avoidance of weight gain rather [...]... Read more »

  • February 6, 2011
  • 10:00 PM

Misrepresentation of ADHD in scientific journals and in the mass media

by Hadas Shema in Information Culture

The scientific community often discusses the misrepresentation of health news by the media. A less discussed subject is misrepresentation of data in the scientific literature. Gonon, Bezard and Boraud used their knowledge about ADHD to find misrepresentations of data in scientific literature and mass media, and found that the misrepresentation problem often begins in the scientific literature. 1. Internal inconsistenciesThe good news is that only 2 out of about 360 papers (Barbaresi et al and V........ Read more »

  • January 28, 2011
  • 07:30 AM

Etomidate in procedural sedation

by Rogue Medic in Rogue Medic

"Some patients, even with significant doses of medication, still continued to verbalize significant amounts of pain."

Just giving more is not always an option. Maybe there are restrictions in the protocol. Maybe the patient's vital signs change in a way that suggests that more medication is not the best idea at that time.
... Read more »

Levins T. (2011) Etomidate in procedural sedation. Air medical journal, 30(1), 45-8. PMID: 21211712  

  • January 27, 2011
  • 01:57 PM

Measuring Discrimination…with 9/11

by Rob Mitchum in ScienceLife

It is widely acknowledged that racial or ethnic discrimination can negatively affect a person’s health. But how can a scientist measure this impact? The treatment that a person encounters due to the color of their skin, their language, or their country of origin is likely a chronic stimulus, encountered over their entire life rather than [...]... Read more »

  • January 25, 2011
  • 12:12 AM

The DDT Dilemna

by Ashartus in exposure/effect

The insecticide DDT (dichlorodiphenytrichloroethane) has been in the public mind ever since Rachel Carson’s Silent Spring was published in 1962. Growing awareness of its environmental effects, persistence, biomagnification in food chains, and presence in humans (including in breast milk) led to severe restrictions being placed on its use, particularly in the developed world. However, its [...]... Read more »

Bouwman, H., van den Berg, H., & Kylin, H. (2011) DDT and Malaria Prevention: Addressing the Paradox. Environmental Health Perspectives. DOI: 10.1289/ehp.1002127  

  • January 13, 2011
  • 02:39 PM

The Myth of the Happy Living Donor

by in Living Donors Are People Too

I was recently reading the AMA's Council on Ethical and Judicial Affair's statement on nonsimultaneous living kidney donation (aka kidney pairs, swaps and chains, especially those that occur over a period of time). At one point, it said:Benefits may include rewarding feelings of helping another, of empowerment, or of increased self-esteemThe thing about documents like this and statements like that is that the authors are required to back it up. So I consult the reference and it is - shock - anot........ Read more »

Johnson EM, Anderson JK, Jacobs C, Suh G, Humar A, Suhr BD, Kerr SR, & Matas AJ. (1999) Long-term follow-up of living kidney donors: quality of life after donation. Transplantation, 67(5), 717-21. PMID: 10096528  

  • January 12, 2011
  • 12:49 PM

Live Kidney Donation and the Ethic of Care

by in Living Donors Are People Too

Yep, I stole the title from the article itself. Much of this article could be confusing to those who don't know the vocabulary of ethics, medical ethics and the like. I'll spare my wandering readers the authors' process and skip right to their conclusions and recommendations. The focus in organ transplants needs to shift perspective from solving the orgsn scarity problem to caring for both donor and recipient. "The societal problem of how to get more organs needs to be clearly separated from the........ Read more »

Kane F, Clement G, & Kane M. (2008) Live kidney donations and the ethic of care. The Journal of medical humanities, 29(3), 173-88. PMID: 18642067  

  • January 12, 2011
  • 07:30 AM

Injury-adjusted Mortality of Patients Transported by Police Following Penetrating Trauma

by Rogue Medic in Rogue Medic

What this study does examine is the policy of having police transport patients with penetrating injuries to the head, neck, torso, upper arm, or thigh, rather than wait for EMS. Since the staffing problems seem to have continued to deteriorate after the completion of the study, the policy probably leads to a significantly higher percentage of police transports now, than when the original study was done.... Read more »

Band RA, Pryor JP, Gaieski DF, Dickinson ET, Cummings D, & Carr BG. (2010) Injury-adjusted Mortality of Patients Transported by Police Following Penetrating Trauma. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. PMID: 21166730  

  • December 31, 2010
  • 07:30 AM

Asymptomatic Sustained Ventricular Fibrillation in a Patient With Left Ventricular Assist Device

by Rogue Medic in Rogue Medic

This patient is pulseless. Pulseless patients are not rare. A 911 call for a pulseless patient is usually because the pulseless patient is dead.

Contrariwise, a patient talking to me has a pulse. I have had several patients who were awake and talking, but without any palpable pulses. The absence of palpable pulses is different from the absence of pulses. All of these patients, with no palpable pulses, were significantly symptomatic.... Read more »

  • December 29, 2010
  • 06:48 PM

Fluoride and IQ

by Ashartus in exposure/effect

One effect that has been claimed for fluoridation of drinking water that I didn’t really examine in my previous examination of fluoride toxicity is reduced IQ. The major regulatory reviews have previously concluded there is no evidence for any such link at relevant concentrations, but a new study published ahead of print in Environmental Health [...]... Read more »

  • December 17, 2010
  • 10:06 AM

Doctors happier to prescribe sex drugs than smart drugs

by Caspar Addyman in Your Brain on Drugs

A new survey of family doctors in North America has found that they are more comfortable prescribing viagra than modafinil or ritalin. The new study in PLoS ONE was conducted by Opeyemi Banjo, Roland Nadler and Peter Reiner, three neuroethicists at the University of British Columbia in Vancouver. They were interested in doctor’s attitudes to pharmacological cognitive enhancers (or smart drugs as we stupid people call them)... Read more »

  • December 13, 2010
  • 01:43 AM

Study: Dialysis Death Risk Is Higher in For-Profit Clinics

by David Berreby in Mind Matters

A majority of Americans who've suffered kidney failure go to Medicare-certified treatment centers three times weekly for dialysis. Many of these are part of large chains, that are for-profit businesses. According to this study, that's unfortunate: It found that patients at for-profit centers had a ...Read More
... Read more »

  • December 6, 2010
  • 09:00 AM

non-Traditional family structures and genomics

by Trey in OpenHelix

As I and my family await our 23andme kit to scan our genomes, family history has come back to the forefront of my thoughts. I used to be very fascinated by my own genealogy, and with adopted children, the concepts of descent, biology and culture have taken adjusted meanings for me. It’s why we have a ‘family map’ instead of a ‘family tree’. The difference between our cultural genealogy and our genetic genealogy has been become quite clear to me. Obtaining our family........ Read more »

  • December 6, 2010
  • 07:30 AM

Amiodarone for Cardiac Arrest in the 2010 ACLS – Part III

by Rogue Medic in Rogue Medic

The research only demonstrates improved survival to admission, as if that does anything more than provide false hope and huge hospital bills. Why do we base the standard of care on such limited research?

Since there is no new amiodarone research, let's look at the old surrogate endpoint research that compares amiodarone with placebo. Keep in mind that this surrogate endpoint study is the basis for over a decade of still unproven treatment.... Read more »

Kudenchuk PJ, Cobb LA, Copass MK, Cummins RO, Doherty AM, Fahrenbruch CE, Hallstrom AP, Murray WA, Olsufka M, & Walsh T. (1999) Amiodarone for resuscitation after out-of-hospital cardiac arrest due to ventricular fibrillation. The New England journal of medicine, 341(12), 871-8. PMID: 10486418  

  • November 26, 2010
  • 02:45 PM

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

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

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?


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 16, 2010
  • 10:39 PM

A Brush with Madness

by Kristopher Hite in Tom Paine's Ghost

I'm giving myself ten minutes to do this. To write whatever storms into my mind then hit post.

I think the archaic revival might run into some barriers. Like starvation, no communication, and other electrical difficulties if it embraces the Abbey-esque Luddite philosophy entirely.

As much as I want to get onto that other boat I think I will just slip between the hulls and end up swimming by myself among the sea-monsters, bullets whizzing past my head with bubbles trailing behind in dark ........ Read more »

Sedel F, Baumann N, Turpin JC, Lyon-Caen O, Saudubray JM, & Cohen D. (2007) Psychiatric manifestations revealing inborn errors of metabolism in adolescents and adults. Journal of inherited metabolic disease, 30(5), 631-41. PMID: 17694356  

Rose FC. (2006) Van Gogh's madness. International review of neurobiology, 253-69. PMID: 16730519  

Altintoprak AE, Ersel M, & Bayrakci A. (2009) An unusual suicide attempt: a case with psychosis during an acute porphyric attack. European journal of emergency medicine : official journal of the European Society for Emergency Medicine, 16(2), 106-8. PMID: 19262206  

Mandoki MW, & Sumner GS. (1994) Psychiatric manifestations of hereditary coproporphyria in a child. The Journal of nervous and mental disease, 182(2), 117-8. PMID: 8308532  

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