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  • April 3, 2014
  • 07:30 PM
  • 1,229 views

In Defense of No Improvement by Medic Madness – Part IV

by Rogue Medic in Rogue Medic

Continuing from Part I, Part II, and Part III in response to what I wrote about the failure of the LUCAS,[1] Sean continues with -

"Another issue I have with this data, is that it doesn’t address the following variables:
Down time
Whether or not bystander CPR was performed
Medications used
Whether or not an advanced airway was placed
Length of resuscitation"... Read more »

  • March 27, 2014
  • 11:15 AM
  • 1,566 views

In Defense of No Improvement by Medic Madness - Part III

by Rogue Medic in Rogue Medic

Sean continues to explain how the machine that does not improve outcomes allows him to provide other 'treatments' that do not improve outcomes.

I continue to point out the problems with his excuses.

.... Read more »

Larabee TM, Liu KY, Campbell JA, & Little CM. (2012) Vasopressors in cardiac arrest: a systematic review. Resuscitation, 83(8), 932-9. PMID: 22425731  

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), 1161-8. PMID: 22436956  

Hayashi Y, Iwami T, Kitamura T, Nishiuchi T, Kajino K, Sakai T, Nishiyama C, Nitta M, Hiraide A, & Kai T. (2012) Impact of early intravenous epinephrine administration on outcomes following out-of-hospital cardiac arrest. Circulation journal : official journal of the Japanese Circulation Society, 76(7), 1639-45. PMID: 22481099  

Allegra J, Lavery R, Cody R, Birnbaum G, Brennan J, Hartman A, Horowitz M, Nashed A, & Yablonski M. (2001) Magnesium sulfate in the treatment of refractory ventricular fibrillation in the prehospital setting. Resuscitation, 49(3), 245-9. PMID: 11719117  

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  

  • March 12, 2014
  • 12:55 AM
  • 1,255 views

Who Needs a 12 Lead ECG?

by Rogue Medic in Rogue Medic

Do we do too many 12 lead ECGs on patients who do not have chest pain?

This is something that some people worry about.

Save the electrodes!

Those poor little electrodes are being abused!

Are electrodes being abused?... Read more »

  • March 5, 2014
  • 04:00 PM
  • 1,344 views

The Failure of LUCAS to Improve Outcomes in the LINC Trial

by Rogue Medic in Rogue Medic

We love gadgets in EMS.

Dr. Bryan Bledsoe tells us that if we paint it orange and put a star of life on it, we can sell any product for a lot more money.

How much would you pay to not improve outcomes?

$10,000.00?

$20,000.00?

$30,000.00?

$40,000.00?

$50,000.00?... Read more »

  • February 22, 2014
  • 02:37 PM
  • 1,700 views

Pros and Cons of Online Doctor Consultations

by Imtiaz Ibne Alam in Medical-Reference - A Pioneer in Medical Blogging

In these days of Dr. Google, it's not surprising that scores of sites often invite you to ask unseen medical professionals a question, though little is known about what occurs on these sites.

I don't know whether you've used these services yet or not, but today many patients are seeking advice online from doctors they have never met. However, many are still out there who strongly believe these services are jam-packed with scam activities. So, the questions you may ask:
Are th........ Read more »

  • February 20, 2014
  • 11:17 PM
  • 1,077 views

Increasing Knowledge of HIV Transmission: An Important Ingredient in HIV Risk Reduction among Young African American Women Attending Community College

by JAID in JScholar Publishers

HIV/AIDS is currently the leading cause of death for African American women ages 25-34. As heterosexual behavior is the major mode of HIV transmission among this population, it is important to further understand the factors which may influence risky sexual behaviors and promote HIV testing behaviors. The target population for this study represents the convergence of two groups disproportionately at-risk for contracting HIV: African American women and college students. Specifically, the purpose o........ Read more »

Keisha Carr Paxton*, Brandilynn Villarreal, Oku OO, Naomi M Hall. (2013) Increasing Knowledge of HIV Transmission: An Important Ingredient in HIV Risk Reduction among Young African American Women Attending Community College. Journal of HIV/AIDS , 1(2), 1-7. info:/Vol 1: 201

  • December 10, 2013
  • 11:14 PM
  • 1,097 views

JUST PUBLISHED: Personal Qualities Assessment Across Cultures

by Mark Rubin in The University of Newcastle's School of Psychology Newsline

Myself (Miles Bore), Don Munro and David Powis have spent the last 15 years developing and testing personality questionnaires and ability tests for use in the selection of medical students. While much of the focus of our research has been the use of these tests in Australia and the UK, we have also had opportunities to trial the tests in countries where English is not the first language such as Sweden, Israel, Japan, Taiwan, Nepal and Fiji. Recently we were approached by Saharnaz Nedjat from Teh........ Read more »

  • November 26, 2013
  • 06:30 PM
  • 1,968 views

If We Are Not Competent With Direct Laryngoscopy, We Should Just Say So - Part II

by Rogue Medic in Rogue Medic

Continuing from Part I of a paper that could, at best, be described as a convenience sample, since a quarter of patients were excluded from randomization because of attending physician bias.

What were the authors assuming when comparing GVL (GlideScope Video Laryngoscope) with DL (Direct Laryngoscopy) for intubation?... Read more »

Yeatts DJ, Dutton RP, Hu PF, Chang YW, Brown CH, Chen H, Grissom TE, Kufera JA, & Scalea TM. (2013) Effect of video laryngoscopy on trauma patient survival: a randomized controlled trial. The journal of trauma and acute care surgery, 75(2), 212-9. PMID: 23823612  

Lundstrøm LH, Vester-Andersen M, Møller AM, Charuluxananan S, L'hermite J, Wetterslev J, & Danish Anaesthesia Database. (2011) Poor prognostic value of the modified Mallampati score: a meta-analysis involving 177 088 patients. British journal of anaesthesia, 107(5), 659-67. PMID: 21948956  

  • November 20, 2013
  • 07:00 PM
  • 1,384 views

Is Earlier Better for Therapeutic Hypothermia? Part I

by Rogue Medic in Rogue Medic

When is the right time to begin TH (Therapeutic Hypothermia) to produce the best outcomes?

In the ICU (Intensive Care Unit)?

In the ED (Emergency Department)?

In the ambulance?

While the patient is still pulseless?

This question was asked in 2010.... Read more »

  • November 7, 2013
  • 01:00 PM
  • 1,307 views

If We Are Not Competent With Direct Laryngoscopy, We Should Just Say So - Part I

by Rogue Medic in Rogue Medic

This study starts out looking good, but there is a huge problem with the design.

If the person intubating felt that he needed to use the video laryngoscope to get the tube, then the patient was not randomized into the study.

How was this paper accepted for publication with such an obviously violation of research methodology?
... Read more »

Yeatts DJ, Dutton RP, Hu PF, Chang YW, Brown CH, Chen H, Grissom TE, Kufera JA, & Scalea TM. (2013) Effect of video laryngoscopy on trauma patient survival: a randomized controlled trial. The journal of trauma and acute care surgery, 75(2), 212-9. PMID: 23823612  

  • October 29, 2013
  • 08:02 PM
  • 2,167 views

Bridging Study in Clinical Trials: Definition, History, and Importance

by Imtiaz Ibne Alam in Medical-Reference - A Pioneer in Medical Blogging

In today’s economic environment, globalization of pharmaceutical products has turned into the key to success for drug manufacturers. Investors in new drug development are therefore required to do more at less cost and faster rate now. However, sponsors are facing a new challenge due to ethnic factors, as the pharmacodynamic or clinical data in the original population could vary with the population in the new region. ... Read more »

Liu JP, & Chow SC. (2002) Bridging studies in clinical development. Journal of biopharmaceutical statistics, 12(3), 359-67. PMID: 12448577  

  • September 4, 2013
  • 11:00 PM
  • 1,091 views

Unreasonable Fear of Hypotension and High-Dose NTG - Part II

by Rogue Medic in Rogue Medic

Continuing from Part I to look at the results of the study of high-dose SL (SubLingual) NTG (NiTroGlycerin – GTN GlycerylTriNitrate in Commonwealth countries) by EMS for CHF (Congestive Heart Failure) that Peter Canning wrote about.[1]

For CHF, more NTG does not produce more of a drop in blood pressure.

If you disagree, provide evidence.... Read more »

Clemency BM, Thompson JJ, Tundo GN, & Lindstrom HA. (2013) Prehospital High-dose Sublingual Nitroglycerin Rarely Causes Hypotension. Prehospital and disaster medicine, 1-4. PMID: 23962769  

  • August 29, 2013
  • 06:20 PM
  • 1,336 views

Unreasonable Fear of Hypotension and High-Dose NTG - Part I

by Rogue Medic in Rogue Medic

Peter Canning writes about a study of high-dose sublingual nitroglycerin by EMS for congestive heart failure.[1]

I have some problems with the study.

The doses are not high doses.... Read more »

Clemency BM, Thompson JJ, Tundo GN, & Lindstrom HA. (2013) Prehospital High-dose Sublingual Nitroglycerin Rarely Causes Hypotension. Prehospital and disaster medicine, 1-4. PMID: 23962769  

Bertini G, Giglioli C, Biggeri A, Margheri M, Simonetti I, Sica ML, Russo L, & Gensini G. (1997) Intravenous nitrates in the prehospital management of acute pulmonary edema. Annals of emergency medicine, 30(4), 493-9. PMID: 9326864  

  • July 31, 2013
  • 10:45 PM
  • 1,227 views

Dilaudid – Start With 2 mg or Start With 1 mg?

by Rogue Medic in Rogue Medic

What is the proper interval before we should give another dose of opioid to patients who still have significant pain?

This study suggests that 3 to 5 minutes would be ideal, but that the ED (Emergency Department) is not a setting where that is practical. ... Read more »

  • July 8, 2013
  • 02:45 AM
  • 13,850 views

Do Paralytics Improve Outcomes Following Resuscitation?

by Rogue Medic in Rogue Medic

This study will get some people excited because of an impressive p value for an odds ratio of improved cardiac arrest outcomes - 7.23 (1.56–33.38) p = 0.01.

NMBs (NeuroMuscular Blockers/Blockade) are paralytic drugs that are used to prevent movement by the patient. Does this study truly show that immediate use of NMBs improves neurologically intact survival from cardiac arrest?... Read more »

Salciccioli JD, Cocchi MN, Rittenberger JC, Peberdy MA, Ornato JP, Abella BS, Gaieski DF, Clore J, Gautam S, Giberson T.... (2013) Continuous neuromuscular blockade is associated with decreased mortality in post-cardiac arrest patients. Resuscitation. PMID: 23796602  

  • June 29, 2013
  • 09:00 AM
  • 1,226 views

Lack of Association of Guillain-Barré Syndrome With Vaccinations

by Rogue Medic in Rogue Medic

Don’t expect the self-proclaimed vaccine safety organizations to write about this, unless they are claiming that it is a part of some sort of international conspiracy of governments, universities, private companies, and other research organizations.

They are not interested in safety.

They are interested in creating fear and making money off of the fear they create.... Read more »

Baxter R, Bakshi N, Fireman B, Lewis E, Ray P, Vellozzi C, & Klein NP. (2013) Lack of association of guillain-barre syndrome with vaccinations. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 57(2), 197-204. PMID: 23580737  

  • June 27, 2013
  • 03:45 PM
  • 1,045 views

Looks Like Anaphylaxis, But Isn't

by Rogue Medic in Rogue Medic

Half an hour after lunch, a 67 year old man passes out.

He regains consciousness, as often happens with syncope.

He is not quite back to normal, blood pressure is 80/60 mm Hg, heart rate is 110, respiratory rate is 25, oxygen saturation is 99% on room air, with a temperature of 96.8° Fahrenheit.

If we tilt him, we will probably get a worsening of his vital signs, but there is no need to actually obtain the numbers if the assessment is causing deterioration.... Read more »

Bourcier S, Mongardon N, Daviaud F, Moachon L, Arnould MA, Perruche F, Pène F, & Cariou A. (2013) Disulfiram ethanol reaction mimicking anaphylactic, cardiogenic, and septic shock. The American journal of emergency medicine, 31(1), 2700-3. PMID: 22809767  

Senthilkumaran S, Menezes RG, Ravindra G, Jena NN, & Thirumalaikolundusubramanian P. (2013) Antabuse reaction due to occupational exposure-an another road on the map?. The American journal of emergency medicine. PMID: 23791458  

Ehrlich RI, Woolf DC, Kibel DA. (2012) Disulfiram reaction in an artist exposed to solvents. Occup Med (Lond)., 62(1), 64-66. DOI: 10.1093/occmed/kqr172  

  • June 22, 2013
  • 02:43 PM
  • 3,413 views

[Warning: NSFW] Sex and the CT (MRI, Actually)

by Pranab Chatterjee in Scepticemia

Disclaimer: This post contains a lot of explicit images and one explicit video as well. The language is also not suited for the run of the mill blog, but in the spirit of writing unhindered, I have edited myself as little as possible. If there is a possibility that graphic references to (human) sexual activities offend […]... Read more »

  • June 12, 2013
  • 12:30 AM
  • 859 views

Publication Bias - The Lit Whisperers

by Rogue Medic in Rogue Medic

The Lit Whisperers raise an important point about publication bias and the validity of published studies that show benefit from a drug company study of a treatment that still has patent exclusivity.[1]

There are many problems with science. Science will never be perfect, but only people who do not understand science claim that it should be perfect.

One of the problems with science is publication bias. A paper that has a positive results about a brand name drug is twice as likely to be publi........ Read more »

Kudenchuk, P., Cobb, L., Copass, M., Cummins, R., Doherty, A., Fahrenbruch, C., Hallstrom, A., Murray, W., Olsufka, M., & Walsh, T. (1999) Amiodarone for Resuscitation after Out-of-Hospital Cardiac Arrest Due to Ventricular Fibrillation. New England Journal of Medicine, 341(12), 871-878. DOI: 10.1056/NEJM199909163411203  

  • May 8, 2013
  • 05:30 PM
  • 854 views

Does experience matter – Part II

by Rogue Medic in Rogue Medic

In spite of the evidence to the contrary and a lack of rationality in the claim, we continue to be told that increasing the number of people with a title, such as paramedic, will result in better care.

Here is more evidence that dividing the skills among more people leads to less skilled care.

The authors begin by referring to other studies that demonstrate the high failure rate of doctors performing procedures on children.

How is that relevant to EMS? We have a low frequency of use of ........ Read more »

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