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All posts; Tags Include "Medical Ethics"

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  • November 15, 2012
  • 05:30 PM
  • 853 views

Extreme Spinal Injury With Preservation of Neurologic Function

by Rogue Medic in Rogue Medic

How bad can spinal injuries be without causing paralysis?

The spine is supposed to be continuous.

The spine should not zig, zig, or take any other detours.

The red line over the spine should be drawn as a roughly straight line, with slight curvature, which can be extreme with kyphosis, scoliosis, or other diseases affecting the spine.... Read more »

  • November 14, 2012
  • 09:00 PM
  • 799 views

Is a clot-busting drug safe for 6 hours after stroke symptom onset – or only for an hour and a half? – Part II

by Rogue Medic in Rogue Medic

It has been a couple of months since I wrote Part I and I have not been that motivated to write this part, but Dr. Jerome R Hoffman and Dr. Richelle J Cooper have been busy with the topic. Their paper appears in the current Emergency Medicine Australasia.


"Just before the release of the results of the third inter-national stroke trial (IST-3),1 the largest trial of thrombolysis in acute ischaemic stroke (AIS), the journal Stroke published a remarkable pre-emptive strike – a comm........ Read more »

  • October 30, 2012
  • 01:00 AM
  • 1,025 views

Fluid Replacement in the vomiting child - IV, IO, or NG?

by Rogue Medic in Rogue Medic

Annals of Emergency Medicine has some Systematic Review Snapshots that are free and useful for getting a quick look at the evidence on various topics. In the current issue, there is a review of the evidence on fluid replacement for the child unable to take fluids orally, or unable to keep those fluids down.


Which is the best route to give fluids?

IV?

IO?

NG?
... Read more »

  • October 25, 2012
  • 06:30 PM
  • 1,027 views

Uneventful prolonged misdiagnosis of esophageal intubation

by Rogue Medic in Rogue Medic

The ability of the patient to remain alive, and even stable, in spite of medical mismanagement, does not mean that the endotracheal tube has been placed endotracheally.

We have an infinite capacity for self-deception. This case is just one example of what is probably the most common mistake in medicine.
... Read more »

  • October 17, 2012
  • 05:00 PM
  • 1,187 views

Nitroglycerin for Treatment of Acute, Hypertensive Heart Failure – Bolus, Drip or Both?

by Rogue Medic in Rogue Medic

If standard doses of nitrate – NTG, ISDN, or ISMN improve outcomes for CHF/ADHF patients, and larger IV doses are more effective than standard doses,[1],[2],[3],[4],[5],[6],[7],[8],[9],[10],[11],[12] what method(s) of drug delivery works best?

High dose IV drip?

High dose IV bolus?

A high dose IV bolus combined with a high dose IV drip?... Read more »

Kwiatkowski, G.M.; Saely, S.; Purakal, J.; Mahajan, A.; Levy, P.D. (2012) Nitroglycerin for Treatment of Acute, Hypertensive Heart Failure - Bolus, Drip or Both?. Annals of Emergency Medicine, 60(4), 59-59. info:/

  • October 11, 2012
  • 08:15 PM
  • 1,142 views

Is Epinephrine a Rat Poison AND a Human Poison?

by Rogue Medic in Rogue Medic

Dr. Minh LeCong has been a proponent of epinephrine in cardiac arrest, but he is now realizing that the evidence in favor of epinephrine is weak, old, and limited to animal studies. In humans, the evidence for epinephrine is based on an unreasonable infatuation with the temporary production of a pulse.
... Read more »

  • September 27, 2012
  • 07:00 PM
  • 1,144 views

Serious adverse events during procedural sedation with ketamine – Part I

by Rogue Medic in Rogue Medic

What contributes to adverse events with the use of ketamine for PSA (Procedural Sedation and Analgesia) in children?

"The pre-PSA use of fentanyl or morphine or concomitant use of midazolam and/or atropine was not associated with an increased in adverse event in either IM or IV ketamine (Table 1)."... Read more »

  • September 22, 2012
  • 09:00 AM
  • 1,051 views

New Caledonian crows reason about hidden causal agents

by Rogue Medic in Rogue Medic

We have generally believed that animals are not capable of very complex thought, even though many species use tools and engage in other complex behaviors.

Even a bird brain appears to be capable of understanding things that are not visible may be affecting their environment.

This study looks at whether New Caledonian crows, that were caught just for this experiment, are capable of attributing actions to a hidden cause, when they see that possible cause come and go.... Read more »

  • September 18, 2012
  • 04:00 PM
  • 1,080 views

Wide variability in drug use in out-of-hospital cardiac arrest: A report from the resuscitation outcomes consortium – Part II

by Rogue Medic in Rogue Medic

Only low dose epinephrine was shown to improve ROSC (Return Of Spontaneous Circulation) in this study, but even low dose epinephrine dramatically decreased survival. I looked at that in Part I. Here I look at some of what the authors have to say about this in the discussion.

What seems most surprising is how bad the results were for epinephrine.... Read more »

Glover BM, Brown SP, Morrison L, Davis D, Kudenchuk PJ, Van Ottingham L, Vaillancourt C, Cheskes S, Atkins DL, Dorian P.... (2012) Wide variability in drug use in out-of-hospital cardiac arrest: A report from the resuscitation outcomes consortium. Resuscitation. PMID: 22858552  

  • September 17, 2012
  • 09:00 AM
  • 903 views

Wide variability in drug use in out-of-hospital cardiac arrest: A report from the resuscitation outcomes consortium – Part I

by Rogue Medic in Rogue Medic

Here is some more research looking at the use of medications in cardiac arrest. In this part, I will look at the outcomes for patients treated with epinephrine. In Part II I will look at the authors’ discussion of their results.

Maybe this time epinephrine will produce a good outcome.... Read more »

Glover BM, Brown SP, Morrison L, Davis D, Kudenchuk PJ, Van Ottingham L, Vaillancourt C, Cheskes S, Atkins DL, Dorian P.... (2012) Wide variability in drug use in out-of-hospital cardiac arrest: A report from the resuscitation outcomes consortium. Resuscitation. PMID: 22858552  

Bigham BL, Koprowicz K, Aufderheide TP, Davis DP, Donn S, Powell J, Suffoletto B, Nafziger S, Stouffer J, Idris A.... (2010) Delayed prehospital implementation of the 2005 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiac care. Prehospital emergency care : official journal of the National Association of EMS Physicians and the National Association of State EMS Directors, 14(3), 355-60. PMID: 20388032  

  • September 13, 2012
  • 09:00 AM
  • 1,063 views

Is a clot-busting drug safe for 6 hours after stroke symptom onset – or only for an hour and a half? – Part I

by Rogue Medic in Rogue Medic

The clot-buster tPA (tissue Plasminogen Activator) is given to stroke patients within 3 hours of onset of symptoms (some use 4 1/2 hours), based on a poorly done study. Some doctors are claiming that the benefits from tPA for stroke can be extended even to 6 hours.

Are the authors exhibiting stroke-like symptoms from sipping too much of their own Kool-Aid?

My first experience with a patient being given tPA for stroke was over a decade ago with a patient I brought to the hospital within abo........ Read more »

Katzan IL, Furlan AJ, Lloyd LE, Frank JI, Harper DL, Hinchey JA, Hammel JP, Qu A, & Sila CA. (2000) Use of tissue-type plasminogen activator for acute ischemic stroke: the Cleveland area experience. JAMA : the journal of the American Medical Association, 283(9), 1151-8. PMID: 10703777  

  • September 11, 2012
  • 10:00 PM
  • 10,919 views

Prove it – Ventilation improves survival from cardiac arrest

by Rogue Medic in Rogue Medic

Is a dead person going to be resuscitated sooner if we decrease the return of blood to the heart?

Ventilations decrease the return of blood to the heart.

Is a dead person going to be resuscitated sooner if we decrease whatever blood pressure we are creating with continuous chest compressions?

Ventilations decrease blood pressure, too.

Is a dead person short of breath?

Not unless resuscitated.

Is a person in cardiac arrest from an arrhythmia going to be hypoxic?

Probably not,........ Read more »

Mosier J, Itty A, Sanders A, Mohler J, Wendel C, Poulsen J, Shellenberger J, Clark L, & Bobrow B. (2010) Cardiocerebral resuscitation is associated with improved survival and neurologic outcome from out-of-hospital cardiac arrest in elders. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine, 17(3), 269-75. PMID: 20370759  

  • September 9, 2012
  • 09:00 AM
  • 978 views

Should oxygen be given in myocardial infarction?

by Rogue Medic in Rogue Medic

In 2010, a Cochrane Review showed something that we already knew, but wanted to keep ignoring.

There is no evidence that supplemental oxygen improves outcomes for patients having an acute myocardial infarction, but there is evidence that oxygen is causing harm to these patients.

Should we continue to treat these patients with supplemental oxygen in the absence of either hypoxia or respiratory distress?

Dan Atar, professor and head of cardiology, wrote –... Read more »

  • September 7, 2012
  • 06:58 PM
  • 1,961 views

The messy science behind The Autism Enigma

by Jon Brock in Cracking the Enigma

Last Monday, the Australian current affairs program Four Corners featured a Canadian documentary entitled The Autism Enigma (it’s still currently available on iView in Australia). The main thrust of the program was that autism is caused by harmful bacteria in the gut. Not surprisingly, the program caused quite a stir, prompting responses from various members of the Australian autism research community. Critics argued that it over-simplified the problem of autism, ignored alternative expla........ Read more »

Finegold SM, Downes J, & Summanen PH. (2012) Microbiology of regressive autism. Anaerobe, 18(2), 260-2. PMID: 22202440  

  • September 7, 2012
  • 01:00 PM
  • 1,339 views

Supraventricular tachycardia induced by chocolate – is chocolate too sweet for the heart?

by Rogue Medic in Rogue Medic

Apparently chocolate, which is an adenosine antagonist, has the potential to cause arrhythmia.

Actually, the methylxanthines in chocolate are the adenosine antagonists (theobromine and caffeine), but it is the theobromine that appears to be what we (I) crave about chocolate. Should I give up chocolate or get an implanted defibrillator? While there is also caffeine in chocolate, only wimps get addicted to caffeine.That headache is just because people are more annoying without caffeine. The ca........ Read more »

  • September 6, 2012
  • 05:00 PM
  • 1,396 views

The cricoid cartilage and the esophagus are not aligned in close to half of adult patients

by Rogue Medic in Rogue Medic

Cricoid pressure has been used to keep the stomach contents in the stomach, and out of the airway, since Dr. Brian A. Sellick wrote about it in 1961.[1] The problem is that the evidence does not show that it works.

This study looked at cervical CT (Computed Tomography) scans to see what anatomic relationship exists between the cricoid ring and the esophagus in a group of patients with some sort of reason to have a neck CT.... Read more »

  • September 2, 2012
  • 09:00 AM
  • 863 views

Does experience matter – Part I

by Rogue Medic in Rogue Medic

In response to some of what I have recently written about the problems with too many medics, people have claimed that I don’t have any evidence to support my statements.[1],[2],[3]

This will cover just one of the many studies that demonstrate that less experience is bad for patients. For those who think that having all medic crews run all 911 calls, your problem will be burnout, since only a minority of patients are likely to benefit from any ALS (Advanced Life Support) providers. I wil........ Read more »

  • August 31, 2012
  • 09:00 AM
  • 811 views

Blue Moon 2012 – Except parts of Oceanea

by Rogue Medic in Rogue Medic

Tonight is a Blue Moon and a Friday the Dyslexic 13th Full Moon.

As conspiracy theorists say, "That can’t be a coincidence!"

Of course it can be a coincidence.... Read more »

Chapman S, & Morrell S. (2000) Barking mad? another lunatic hypothesis bites the dust. BMJ (Clinical research ed.), 321(7276), 1561-3. PMID: 11124174  

  • August 30, 2012
  • 06:00 PM
  • 887 views

EMS Zebra Hunting, Doing What’s Right or What’s Expected

by Rogue Medic in Rogue Medic

Is needle decompression of tension pneumothorax overused?

Are we too aggressive with the harpoon?

Didn’t this get Ahab into trouble?
... Read more »

Tien HC, Jung V, Rizoli SB, Acharya SV, & MacDonald JC. (2009) An evaluation of tactical combat casualty care interventions in a combat environment. Journal of special operations medicine : a peer reviewed journal for SOF medical professionals, 9(1), 65-8. PMID: 19813350  

  • August 29, 2012
  • 03:30 PM
  • 1,019 views

How Accurate are We at Rapid Sequence Intubation for Pediatric Emergency Patients - Part II

by Rogue Medic in Rogue Medic

Do we accurately report errors and success with pediatric RSI (Rapid Sequence Intubation/Induction)?

Should we trust our memories?... Read more »

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