Replies to This Discussion

Permalink Reply by Paul Montpetit on July 11, 2008 at 4:30pm

Hmmmm 27 years ....? You might catch up to me......if I drop dead.....LOL Have a great day....stay safe....(Sorry about that, I just can't help mtself sometimes)

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Permalink Reply by Johnathan Turner on July 11, 2008 at 6:24pm

I thought the "e" in Pneumothroax was in the wrong place. Silly Southern Ohio edumacation. Lol. Anywho, I'll try better. Our department needs one anyways, as I am normally the one who spells out these words. Thanks for the heads up!

-John

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Permalink Reply by Johnathan Turner on July 11, 2008 at 6:39pm

Hey thanks everyone for all their help! I really do appreciate all the help I can get. This site has been the greatest resource so far for me. A lot of the things that are discussed here I tend to take with me and apply to my department. One being Tiger Schmittendorf, whose discussion of funeral procedure was posted at the right time. We had a retired assistant chief pass away at that same time, and I quickly adopted his ideas and used them for our own purposes. It had been our first full department funeral, and we wanted it done right. This site has been nothing but a blessing since I came across it. Again, Thanks everybody who contributed with this. And Siren, I'll work a little harder on my spelling.

Thanks Again.

-John
EMTB Ohio

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Permalink Reply by lutan1 on July 12, 2008 at 1:25am

Generally if they're dead, I tend to not worry about oxygen- seems like a bit of a waste of time.... :(

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Permalink Reply by Ben Waller on July 12, 2008 at 10:17am

Actually, medicine is a science. That's why medical students have to take all of that biology, chemistry, math, etc in pre-med just to get admitted to med school.

Another big EMS issue is that right now every state and national EMS certification agency bases most of their standards on 50 years of urban legends instead of science.
There's a huge case for evidence-based (read "scientific") medicine. A lot of those old EMS urban legends just don't stand up to scientific inquiry.

A couple of examples...there's a lot of scientific evidence that asystole is a confirmation of death, not a treatable rhythm. I've been involved in fire/EMS for over 33 years, and my asystole save rate is zero-for-hundreds. Ditto for every other paramedic I know.

Example 2 - Show me any scientific evidence that a KED or other short spine immobilizer is therapeutic or efficacious. You can't - there's not a single such study out there. Yet, every basic EMT class makes the students apply KEDs to seated accident victims as if it were a religious ritual. Why? Because the national standard curriculum and all 50 state EMS regulating agencies require us to do so. That practice is based on 35 years of urban legend, as far as I can tell.

Science-based medicine, not trial-and-error practice, antecdotes, or urban legend should be the core basis of what we do. And...if there isn't any scientific basis for it, then we should stop doing it and teaching it.

Paul, this really isn't directed at you - you just hit one of my pet peeve activation buttons without knowing it.

I'll put my soapbox away now.

Have a terrific weekend.
Ben

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Permalink Reply by Paul Montpetit on July 12, 2008 at 11:17am

That's ok Ben...its nice to disagree sometimes...as I must disagree with your assumptions....you take "science" classes to understand how the body acts and reacts to situations and conditions....How we treat them is the "practice"...Not so many years ago they felt that blood letting would release the cause of the condition....now, we hopefully know better...and who knows what the future may bring....As for asystole...if it is true asystole the patient is technically dead...BUT...Not all straight lines are asystole as fine fib can and sometimes does slip in there...and as you know fib IS a treatable rhythm. Well thats my bit for today.....hey maybe all that education has sunk in a bit....hate to think I got my masters for nothing....LOL...Have a great day...stay safe out there.........Paul

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Permalink Reply by Ben Waller on July 12, 2008 at 11:46am

Paul,

Actually, blood letting has been found to be beneficial in some medical conditions, including excessive clotting disorders and polycythemia vera.

http://www.emedicine.com/MED/topic1864.htm

There is even a branch of medicine related to using leeches as a bloodletting therapy. It is called "hirudotherapy".

Here's a link to an overview...
http://www.leeches.biz/hirudotherapy.htm

Medicine as a trial-and-error "practice" is an outmoded concept.
Scientific study, while not perfect and not error-free, is doing a good job of carving delicious steaks out of the formerly sacred cows of "practice".

As for fine v-fib, it is rarely a treatable rhythm. There is a lot of good scientific evidence that if you can't defibrillate v-fib successfully while it is coarse and with the first shock, your chances of a patient save are almost nil. Show me a fine v-fib, and I'll show you a patient that's getting ready to go into asystole as soon as you stun the myocardium with 200 joules a time or two. The AHA 2005 ECC standards (science-based, BTW) still allow for defibrillation of rhythms that may be fine v-fib and may also be asystole.
Shock them all you want. Scientifically speaking, that will be a waste of time, virtually every time.

AHA includes defib for fine v-fib as an insurance policy for the rare cases when clinicians can't determine the rhytm. I've found that turning up the gain on the monitor typically does the trick, as does examining the rhythm in multiple leads.

And...I didn't get my masters for nothing, either, but that's not really germaine to this discussion.

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Permalink Reply by Ben Waller on July 12, 2008 at 1:50pm

Jonathan,

Some re-thinking about your original post stimulated some additional research on my part.
In one circumstance, pneumothorax is a contraindication for oxygen.

That circumstance is when using hyperbaric oxygen. In that case, the contraindication is actually due to the oxygen pressure, not the oxygen percentage.

http://www.hbotoday.com/treatment/contra-indications.shtml

So...your guestimate about pneumothorax being an oxygen contraindication wasn't actually a bad guess, it was just a little out of context.

It's easy to assume that everything we do will be in routine, normal ambient conditions. However, that's not always the case. If you have an abnormal atmospheric pressure or an chemical that poses a reaction problem with the oxygen, then oxygen very likely is contraindicated.

There is also a controversy about whether high-flow oxygen is the single causative agent, or merely a contributor to blindness in premature neonates from ROP - Retinopathy of Prematurity. ROP is a disease that is thought to be linked to high-flow oxygen causing vasoconstriction in the intraocular blood vessels in preemies.

http://www.emedicine.com/oph/byname/Retinopathy-of-Prematurity.htm
http://www.emedicine.com/oph/TOPIC413.HTM

The research, dating back to the 1950's indicates that premature neonates resuscitated with ambient air had lesser rates of morbidity and mortality than did equivalent preemies resuscitated with oxygen.

I can't find anything that states that oxygen is an absolute contraindication in premature neonates, but it is definately a relative contraindication.

Don't worry about mispellings and how your questions will be percieved. You want to be a good clinician, and you're asking questions. Those two things go hand-in-hand. Remember, there are no such things as dumb questions - but there are plenty of dumb mistakes.

Good luck with your continued research and have a long, productive, happy, and safe career.

Ben

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Permalink Reply by Ben Waller on July 12, 2008 at 2:46pm

Think globally, act locally. :-)

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Permalink Reply by Ben Waller on July 13, 2008 at 10:25am

Siren,

Re: the ROP discussion, you're entirely correct about a few minutes of oxygen from a scene call being unlikely to contribute to ROP.

On the other hand, for EMS systems that do interfacility NICU transports, the oxygen concentration might be pertinent, especially where those transports are prolonged, and where the preemie is in a high-oxygen concentration in an isolette. As my earlier links describe, the role of oxygen in ROP isn't well understood. I just threw it out to see if it is one of the answers John's instructor was fishing for.

I'm interested in seeing the instructor's viewpoint on this one as well.

Ben

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Permalink Reply by Johnathan Turner on July 15, 2008 at 5:31pm

Thanks Ben.

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Permalink Reply by Walter Messer on July 15, 2008 at 6:04pm

so did everyone read to deep into this... with our luck it was a simple answer

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